CHE 22 Library Metropolitan Borough of Chelsea. Annual (Abridged) Reports OF THE MEDICAL OFFICER OF HEALTH. LOUIS C. PARKES, M.D, D.P.H., FOR THE YEARS 1917 and 1918. LONDON. Shield and Spring, Printers, 26.28, Lancelot Place, Brompton Road, S.W. 7. 1919. Metropolitan Borough of Chelsea. ANNUAL (ABRIDGED) REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1917. POPULATION OF CHELSEA. There appears to have been no marked change in the population of the Borough so the population for the middle of the year 1917 may be assumed to be the same as in 1916, namely, 63,130. The same deduction of 5,370 males of military age serving with the forces has been made as in 1915 and 1916. Births and Birth-Rate. In 1917, 979 births were registered in the Borough. Excluding 105 births of non-parishioners, and including 82 births taking place amongst Chelsea mothers in Lying-in Hospitals and Homes outside the Borough, the total number of births for the year was 936, the corresponding figure for 1916 being 1,096. The birth-rate for the year was 14.8 per 1,000, which is 2.6 per 1,000 below the rate of 1916. Notification of Births. Number. Living Children 782 Still-born children 18 800 Notified by Medical Practitioners 260 „ St. George's Hospital 87 „ Midwives 341 „ Chelsea Workhouse 56 „ Parents and other persons 74 818 Dual notifications—deduct 18 800 2 Total number of Chelsea births registered in the Borough, 862. The notifications, therefore, formed 93 per cent. of the total births of Chelsea residents registered in the Borough, as compared with 91 per cent. in each of the years 1915, 1916. The number of births notified by midwives was 43 per cent. of the total, as compared with 42 per cent. in 1916. Deaths, Death-Rates and Disease Prevalence. There were 896 deaths of Chelsea residents in 1917, the death-rate being 14.2 per 1,000, as against 15.1 in 1916, and 17.5 in 1915. There were 77 deaths of infants under one year of age, equivalent to an infant mortality rate of 82 per 1,000 births. In 1916, the rate was 91, in 1915, 100, and in 1914, 67. At the end of 1916 a whole-time Health Visitor was appointed by the Borough Council, and during the year the maternity and child welfare work of the Borough has been carried on conjointly by the two women officials of the Borough Council, and by the Chelsea Health Society, the periodical reports of the paid officer of that Society being laid before the Public Health Committee with the reports of the Council's officers. The two weekly Infant Consultations and clinics and the weekly ante-natal clinic are held at 49, Sydney-street—the premises of the Chelsea Health Society—and are attended by the Council's Health Visitors. The coordination of the work of the Chelsea Health Society with that of the Borough Council in Maternity and Child Welfare directions has been attended with success, and has been of undoubted advantage to the Borough. The following Tabular statement gives an outline of the work carried on in Chelsea during 1917, the visits being those paid by the trained and paid workers of the Borough Council and Chelsea Health Society, and does not include visits by voluntary workers attached to the Society:— Summary of Reports of Health Visitors for 1917. Number of homes visited (first visits), Infants 599 Number of re-visits, Infants 1637 Number of infants' attendances at Infant Consultations 1164 Number of visits to children of 1 year to school age 806 Number of re-visits 1280 Number of children of 1 year to school age attendances at medical inspection centre 541 Number of Ante-natal visits to expectant mothers 449 Number of Ante-natal cases attendances at Antenatal clinic 209 Number of visits to Diarrhoea cases amongst Infants 126 Number of visits to cases of Ophthalmia Neonatorum 71 General additional visits in connection with the work 1147 3 Report of Public Health Committee to Borough Council, 31st October, 1917. Scheme for rendering medical assistance to Midwives in urgent cases of labour of necessitous women residing in the Borough. In consequence of a letter from the London County Council of the 8th June, 1917, enquiring if this Council would be prepared to consider the adoption of a scheme in the Borough for rendering medical assistance to midwives in urgent cases of labour, we have had the matter under consideration and decided that such a scheme would be valuable as an adjunct to the work of maternity and child welfare already operating in the Borough. We have been in communication with the practising midwives in the Borough, and with certain medical practitioners, who are engaged in midwifery practice, and have undertaken in the past to render assistance to midwives. The scheme is limited to the cases in which, under Rule 2 (3) of the Central Midwives' Board, midwives are required to summon medical assistance, viz.: "In the case of a woman in labour at or near term, where there is any abnormality or complication." The scheme is intended to cover the case of such emergencies, and does not provide medical attendance for illnesses arising out of a confinement, but in certain instances the fees paid cover any subsequent attendance after the first or emergency visit, which may be needed to complete the case as a case of confinement. The scheme and the suggested scale of fees have been approved (under Section 77 of the Public Health (London] Act) by the Local Government Board under the date 11th October, 1917, such fees ranging from 5s. for attendance on the slighter cases to £2 2s. for the more serious cases. In normal times some 400 cases of labour amongst Chelsea women are attended annually by midwives; and it is estimated that in about 15 per cent. of these labours medical assistance is summoned by midwives in accordance with the rules of the Central Midwives' Board. We estimate that the annual cost of the scheme will be about £90, of which half will be returned by a grant from the Local Government Board. The estimated cost of the scheme to the Boroguh for the remainder of the current financial year will be £19. In certain of the cases in which medical assistance is rendered, the patient may be in a position to repay and be desirous of repaying to the Council a certain proportion of the doctor's fee. As the amount so recovered will probably be small, and as the amount can hardly be estimated at the present time, we have not considered it necessary to allow for such rebate in our estimation of the cost of the scheme. Recommending that the scheme above outlined for rendering skilled medical assistance to midwives in urgent cases of labour amongst 4 necessitous women residing in the Borough, under Rule 2 (3) of the Central Midwives' Board, be approved, and that the Finance Committee be asked to bring forward the necessary financial estimate for the remainder of the current financial year. [Adopted.] Maternity Nurse. On the 18th July, 1917, the Borough Council resolved to make provision for the attendance of a nurse in maternity cases where the assistance is needed, and where the woman cannot afford to pay for it (L.G.B. circular letter, 23rd September, 1916), at an expense not exceeding £120 per annum. An arrangement was accordingly entered into for the supply of a properly qualified maternity nurse by the Ormond Home Association, for such cases as the above, payment being made at a fixed rate for each case attended. The arrangement terminated on the 81st March, 1918, and the scheme for supplying a nurse was not renewed by the Council. Measles caused 6 deaths in 1917, as compared with 5 in 1916, and 39 in 1915. The deaths were 1 under 1 year, 8 between 1 and 2 years, and 2 between 2 and 5 vears. The number of cases of measles and German measles (Rubella) notified in the 4 quarters have been as follows:— Measles. Rubella. 1st Quarter 172 147 2nd „ 319 203 3rd „ 133 24 4th „ 87 18 Year 661 387 Of the total measles cases notified 76 per cent. were children under 15 years of age, and of the Rubella cases 41 per cent. were under 15 years. The case mortality of measles for the year (0.9 per cent. of the attacks proving fatal, as against 1.2 in 1916), was again a low one, and shows that the disease continues mild in type. The woman sanitary inspector in the course of the year made 480 visits in connection with measles and German measles inquiries. In accordance with the arrangement made with the Chelsea Nursing Association 238 visits were made by the Association's nurses to 17 families who had children ill with measles. The average number of visits per family was 14, as against 13 in the previous year. Twenty-nine cases of measles were removed from their homes to M.A.B. hospitals, and 20 cases to the London Fever Hospital. Twenty-six cases of German measles were removed to the London Fever Hospital. During the year 99 cases of Scarlet Fever were notified in Chelsea, as against 109 in 1916. There were no deaths from the disease; 85 per cent. of the cases were removed to hospital. The disease was most prevalent in the three autumn months—September, October, and November—59 per cent. of the total cases occurring in those three months. There was no special incidence on any particular school in the Borough. The percentage of cases of school age (3 to 13 years) was 77, as against 75 in 1916. 5 In 1917, 56 cases of diphtheria were notified in Chelsea, as compared with 109 in 1916. This disease caused 8 deaths in 1917, the case mortality being 5.3 per cent., as compared with 14 per cent, in 1916; 86 per cent. of the cases were removed to hospital. The percentage of cases of school age (3 to 13 years) was 66, as against 71 in 1916. There was no special incidence on any particular school, and practically no increased prevalence in the autumn months. During the year medical practitioners sent 70 throat swabbings to the Lister Institute for bacterioscopic diagnosis, as compared with 108 in 1916. Of the 70 specimens, 40 or 57 per cent. were sent by the Victoria Hospital in respect of Chelsea children. Of the total 70 specimens, 17, or 24 per cent., afforded positive evidence of the diphtheria bacillus, and 53, or 76 per cent., were negative. In 1916 the positives were 20 per cent. and the negatives 80 per cent. The number of cases of enteric fever notified amongst the civil population was 10, as against 8 in 1916. Of the 10 cases in one the diagnosis was not confirmed at the M.A.B. hospital to which the patient was removed. In 3 other cases the infection was due to the Paratyphoid (B.) organism and not to the Bacillus Typhosus. In two other cases the patients were infected prior to their arrival in Chelsea—1 at Reigate, and 1 in another Metropolitan Borough. There were, therefore, only 4 cases of enteric fever, out of the 10 notified, in which it seems probable that the infection was contracted in the Borough. There were no deaths amongst these 4 cases. Five specimens of blood from suspected cases were sent to the Lister Institute for the Widal reaction. One was positive, and 4 were negative. The deaths in Chelsea from diarrhoea and enteritis in 1917 were 35 in number, as against 26 in 1916. Nineteen of the deaths were of infants under 1 year, and 6 were between 1 and 2 years of age. Twenty deaths occurred in the summer quarter of the year. The Health visitors paid 126 visits to homes in connection with cases of summer diarrhoea. Outbreak of Dysentery. From early in August, 1917, until mid-October, some 31 cases of this disease occurred in Stanley Ward, and there were 9 deaths, the case mortality being 29 per cent. The two earliest cases occurred in a house in Davis-place, World's End-passage, and in a house at the South end of Riley-street, close to Davis-place, in the first week of August. After the lapse of a week there were 3 more cases in the same house in Riley-street, followed after an interval of 5 or 6 days by other cases in two houses in Blantyre-street. Until the end of September all the cases occurred in the vicinity of the World's End, but later, 5 cases occurred in a house in the western portion of Lots-road, and 2 cases in a house in Meek-street, which are some distance from the World's End. In eight houses only one person in a single family was attacked. In one house 2 families were attacked— 8 persons in one family and 2 in another. In four other houses single families were attacked, the number of persons in each family affected being 5, 4, 2 and 2. Of the 31 cases the ages were ascertained in 26, and were as follows:—under 1 year, 2; 1-5 years, 9; 5-10 years, 4; 10-15 years, 4; 6 15-20 years, 6; over 20 years, 1. The ages of the fatal cases were:— l9/l2, 2, 3, 3, 3, 4, 6, 6 and 10 years. Fourteen cases occurred in August, 12 in September and 5 in October, the onset of the last case being about the 9th October. In one family living in a house in Blantyre-street, where 4 children were attacked, 3 died, and inquests were held on two of these fatal cases. At the inquests it was stated that there was superficial ulceration of the mucous membrane of the colon (lower bowel) from the ileo-cœcal valve to the rectum in these cases, and that a streptococcus had been isolated, which was regarded as the causative organism. Subsequent research, however, carried out on behalf of the Local Government Board, showed that the bacillus of dysentery (Shiga's bacillus) was present in a number of the cases, and there can be but little doubt that the outbreak was one of Dysentery. The distribution of the cases occurring in August and September in a very circumscribed locality in a poor neighbourhood is suggestive of infection by contact, the children meeting and playing together in the streets, and also possibly of fly infection by food. There was no evidence pointing to an infection of any special food, such as milk, meat, fish, bread, sugar, or ice-cream; and a sample of water taken at the Blantyre-street house, where the fatal cases occurred on which inquests were held, was found on analysis to be quite pure both bacteriologically and chemically. Having regard to the number of soldiers who have been discharged from the Army, who have had dysentery on foreign service, inquiries were made as to any possible connection of this outbreak with the military forces. One of the cases was a discharged soldier, but he was not attacked until the 3rd week of August. It seems likely that the house in Davisplace, World's End passage, which gave the first case in the outbreak was visited by soldiers, but no actual evidence was obtainable. Influenza caused 23 deaths in 1917, as against 24 in 1916. The number of deaths from respiratory diseases was 172 in 1917, as against 195 in 1916. The deaths from pulmonary tuberculosis in 1917 numbered 79 (48 males and 31 females). Other tubercular diseases caused 24 deaths, as against 12 in 1916, 17 being from tuberculous meningitis. Of the pulmonary tuberculosis cases ending fatally, 28 per cent. died in the Chelsea Infirmary, and 40.5 per cent. in other public institutions; that is to say, 68.5 per cent, died away from their homes. In 1916 the corresponding figure was 61.5 per cent. During the year, 161 new cases of pulmonary tuberculosis were notified, as against 167 in 1916, 92 being males and 69 females. Fiftyfive specimens of sputum were sent by medical practitioners to the Lister Institute for examination as against 61 in 1916. Of the 55 specimens 33 per cent. were positive for Tubercle Bacillus and 67 per cent. were negative; the figures for 1916 being 26 per cent. positive and 74 per cent. negative. In 1917, 21 cases of pulmonary tuberculosis were discharged from open-air sanatoria, in which they had received institutional treatment as 7 "insured persons" under the sanatorium benefit provided by the London Insurance Committee. In 1916, 17 cases of "insured persons" were discharged from sanatoria. The average duration of the stay of the 21 cases in sanatoria was 2¼ months, as against 3 months in 1916, 8·3 months in 1915, 3·2 months in 1914, and 2·5 in 1913. In addition to the above 21, 4 insured persons had hospital treatment, the average duration of stay in hospital being 3·3 months. Nine of the insured persons were discharged soldiers or sailors. Thirteen uninsured persons were discharged after receiving open air sanatorium institutional treatment under the London County Council scheme for the uninsured, as against 6 in 1916, and 7 in 1915. The average duration of stay in a sanatorium of these cases was 4·4 months, as compared with 3·7 months in 1916. In addition 4 cases had hospital treatment; average stay 3 months. The number of new cases of pulmonary tuberculosis visited in the course of the year was 121, and of non-pulmonary cases 25. The total number of visits paid in respect of all cases of tuberculosis was 562. Four patients were lent beds and bedding by the Borough Council, and 7 pocket spittoons were given to patients in need of them. Forty-one new cases of non-pulmonary tuberculosis were notified in 1917, 31 being children under 15 years of age. and 10 adults. Several cases were helped to obtain proper surgical treatment in hospitals, and others were sent to country or seaside homes. As in previous years, a great deal of this work was carried out by the Chelsea branch of the Invalid Children's Aid Association. Chelsea Tuberculosis Dispensary, Brompton Hospital. Record of work for 9 months—April to December, 1917. Number of persons examined for the first time:— Insured 84 Uninsured 188 272 Number of persons suffering from:— Tuberculosis 84, or 31 per cent. Doubtful diagnosis 45, or 17 „ Not Tuberculosis 139, or 52 „ 268 Total attendances at Dispensary:— Insured 272 Uninsured 518 790 Visits at homos of patients byMedical Officer:— Insured 1 Uninsured 3 4 8 Visits to homes of patients by Dispensary and District Nurses:— Insured 220 Uninsured 535 755 Consultations with Medical adviser of Insurance Committee 28 Consultations with Practitioners at homes of patients 1 Number of written reports concerning individual patients made to Public Authorities 32 Number of written reports made to Practitioners 3 Number of X-ray examinations of patients 18 Number of examinations of sputum:— Insured 70 Uninsured 108 178 In addition to the above work of the Dispensary, all the secretarial work of the Tuberculosis Care Committee is undertaken by paid officers of the Brompton Hospital. The Dispensary commenced working under an agreement made between the Borough Council and the Brompton Hospital on the 1st April, 1917, for a period of one year. The agreement is to be renewed at its termination for another period of one year. Four cases of cerebro-spinal meningitis were notified in Chelsea in 1917 as against 5 cases in 1916, and 10 in 1915. One of the cases was found however, after death to be a case of septic meningitis. Of the 8 undoubted cases, 2 ended fatally. Two were infants under one year of age, and one was a girl of 17 years. All the cases were removed to hospital. Only one case of poliomyelitis (infantile paralysis) was notified in Chelsea in 1917, a boy of 7 years who was treated at Victoria Hospital. Four cases of puerperal fever were notified in Chelsea in 1917. There were no deaths. Two cases were attended in their confinements by doctors, and two by midwives. Fourteen cases of ophthalmia neonatorum were notified in Chelsea in 1917, and an additional 10 cases of eye trouble in infants, which were not notified, were visited by the woman sanitary inspector. Of these 24 cases, 14 made complete recoveries, and the remainder were left with some eye weakness. Steps were taken in all cases to ensure that the affected eyes received appropriate treatment. Sale of Food and Drugs Acts. Of the 400 samples taken for analysis in 1917; 185 were milk, 124 being genuine, and 11 adulterated, equivalent to 8·1 per cent. of the total milks examined, as against 6 per cent. in 1916. Of the 11 adulterated samples, proceedings were taken and convictions obtained in 5 cases. In the other 6 cases no proceedings were taken, as the amounts of adulteration 9 were small. Of butter 107 samples were taken, 103 being genuine and 4 adulterated. No proceedings were taken, as two samples were not taken under the Acts, and the adulterations (excess of water) in the other two were slight. All other samples of food taken were found to be genuine with the exception of one sample of coffee and one of mustard, which were not taken under the Acts. Work of the Public Health Department. During the year 1917, 703 separate premises were reported on by the staff, 230 of this number being with reference to cases of notifiable infectious disease, and 163 in the course of house-to-house inspections made in certain of the poorer streets of the Borough. Legal proceedings were taken in one case to enforce compliance with notices under the Public Health (London) Act, the owner being fined 20s. with 21s. costs, and an order made for the execution of the work. During the year 261 inspections were made of factories, workshops and laundries. Verminous School children.—In 1917, 62 children attending elementary schools in the Borough were reported 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 in 1916 was 72, in 1915, 65, and in 1914, 266. All the homes of the verminous children reported were visited by the Woman Sanitary Inspector; altogether 50 visits were paid in connection with this work, several cases occurring in one family. Scabies.—The number of cases of school children reported as being affected with scabies in 1917 was 66, and 103 visits were paid to the homes in connection with these cases. Eight cases attended at the Shelter in Lots-road for courses of disinfectant baths, and 87 such baths were given. Disinfection.—During the year 430 premises were disinfected after cases of infectious or other disease, and an additional 185 rooms were disinfected for bugs and other vermin. At the disinfecting station, 993 separate articles of bedding and clothing were disinfected, and 77 articles were destroyed in the Incinerator. Staff.—During the year the work of the Department was carried on by the 2 male sanitary inspectors, 1 woman sanitary inspector, who is also part time Tuberculosis Visitor and Health Visitor, one woman Health Visitor, 2 disinfectors (one of whom acts as office assistant), and the part time services of the mortuary-keeper as disinfector. 10 ANNUAL (ABRIDGED) REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1918. POPULATION OF CHELSEA. The population of the Borough may be assumed to be the same as in 1916 and 1917, namely, 63,130, the same deduction of 5,370 males of military age serving with the forces being made as in the three preceding years. Births and Birth-Rate. In 1918, 843 births were registered in the Borough. Excluding 139 births of non-parishioners, and including 86 births taking place amongst Chelsea mothers in Lying-in Hospitals and Homes outside the Borough, the total number of births for the year was 790, the corresponding figure for 1917 being 936. The notifications, therefore, formed 89 per cent. of the total births of Chelsea residents registered in the Borough, as compared with 93 per cent. in 1917, and 91 per cent. in each of the years, 1915, 1916. The birth-rate for the year was 12·5 per 1,000, which is 2·3 per 1,000 below the rate of 1917, and 6·7 per 1,000 below the rate of 1914. Notification of Births. Number. Living children 606 Still-born children 21 627 Notified by Medical Practitioners 202 „ St. George's Hospital 78 „ Midwives 272 „ Chelsea Workhouse 38 „ Parents and other Persons 50 640 Dual notifications—deduct 13 627 Total number of Chelsea Births registered in the Borough 704 11 The number of births notified in 1918 by midwives was 43 per cent. of the total, the same as in 1917. Deaths, Death-Rates and Disease Prevalence. There were 1,111 deaths of Chelsea residents in 1918, the death-rate being 17.6 per 1,000, as against 14.2 in 1917,15.1 in 1916, and 17.5 in 1915. The higher death-rate of 1918 is due to 234 deaths from Influenza in that year. If the number of deaths from Influenza had been only 22, which is the average for the 3 years 1915, 1916 and 1917, the death-rate for the year 1918 would have been only 14.3 per 1,000, or practically the same as in 1917. There were 72 deaths of infants under one year of age, equivalent to an infant mortality rate, of 91 per 1,000 births. The rates in recent years have been as follows:—1917, 82; 1916, 91; 1915, 100; and 1914, 67. The following tabular statement gives an outline of the work carried on in Chelsea during 1918, the visits being those paid by the trained and paid workers of the Borough Council (2) and the Chelsea Health Society and School for Mothers (1), and does not include visits by voluntary workers attached to the Society. Summary of Reports of Health Visitors for 1918. Number of homes visited (first visits), Infants 566 Number of re-visits, Infants 1809 Number of infants' attendances at Infant Consultations 1343 Number of visits to children of 1 year to school age 242 Number of re-visits 1932 Number of children of 1 year to school age attendances at medical inspection centre 715 Number of Ante-natal visits to expectant mothers 460 Number of Ante-natal cases attendances at Ante-natal clinic 293 Number of visits to Diarrhoea cases amongst Infants 55 Number of visits to cases of ophthalmia neonatorum 48 General additional Visits in connection with the Work 1008 On the 9th November, 1918, the Borough Council agreed to extend the scheme for rendering medical assistance to midwives in urgent cases of labour of necessitous women residing in the Borough, so as to allow midwives to seek medical aid in cases of pregnancy, during the lying-in period, and for the child (Rule 21 of the Central Midwives' Board), the scale of fees for doctors to be that adopted by the British Medical Association and approved by the Local Government Board. The consent of the Local Government Board was obtained to the enlarged scheme, but the scheme came to an end on the 31st December, 1918, as under Section 14 of the Midwives' Act, 1918, which came into operation on 1st January, 1919, the duty is placed upon the London County Council as the local 12 supervising authority under the Midwives' Acts, 1902, and 1918, of paying fees to medical practitioners called to the assistance of midwives. The London County Council in consequence is preparing a scheme for the County of London, and the Borough Council scheme has no longer any raison d'etre. During the 13 months the Borough Council's scheme was in operation, 24 cases were attended by doctors at the request of midwives at a total cost of £38 6s. 6d. (£1 10s. 11d. per case); and contributions to the amount of £9 13s., or 25 per cent., were received from patients. On the 9th November, 1918, the Borough Council approved of a scheme for the provision of a maternity nurse for necessitus women in Chelsea. Under this scheme, which relates to women who will be attended in their confinements by medical practitioners or by the extern maternity department of St. George's Hospital, a maternity nurse can be chosen by the patient from amongst the midwives residing and practising in the Borough, whose names are on the Midwives' Roll of the Central Midwives' Board, the Borough Council paying the fee of the maternity nurse up to a sum not exceeding £1 5s. A condition precedent to the granting of an application for the services of a maternity nurse is to be the undertaking by the patient to pay such sum as a contribution towards the cost of the maternity nurse as a Sub committee of the Maternity and Child Welfare Committee may determine. This scheme has received the approval of the Local Government Board. In the autumn of 1918, a scheme for the Supply of Milk at less than current selling price was brought into operation under the powers conferred by the Milk (Mothers and Children) Order, 1918. It applies to necessitous women with families of children, except those who are in receipt of Separation Allowances under Military or Naval Regulations, who can obtain milk orders from the War Pensions Committee. Applications for milk, when received, are submitted to a sub-committee of the Maternity and Child Welfare Committee to determine in each case the reduction in current price suitable to the circumstances of the applicant. Applications have to be made on special forms and require to be endorsed by a Health Visitor or by some Institution which has knowledge of the applicants needs and circumstances. Measles caused 14 deaths in 1918, as compared with 6 in 1917, 5 in 1916, and 39 in 1915. There were 5 deaths under 1 year of age, 4 between 1 and 2 vears, 4 between 2 and 5 years, and 1 over 5 year. The number of cases of measles and German measles (Rubella) notified in the 4 quarters have been as follows:— Measles. Rubella. 1st Quarter 84 33 2nd „ 275 34 3rd „ 42 14 4th ,, 46 5 Year 447 86 13 Of the total measles cases notified 89 per cent. were children under 15 years of age, as compared with 76 per cent. in 1917; and of the Rubella cases, 70 per cent. were under 15 years, as compared with 41 per cent. in 1917. The case mortality of measles for 1918 was 3.1, as against 0.9 in 1917, and 1.2 in 1916, which shows that the disease was more severe in type than in the two preceding years. The woman sanitary inspector and the Health Visitor in the course of the year made 474 visits to homes in connection with measles and Rubella cases. In accordance with the arrangement made with the Chelsea Nursing Association, 561 visits were made by the Association's nurses to 47 families who had a child or children ill with measles. The average number of visits per family was 12, as against 14 in 1917, and 13 in 1916. In 1917 only 288 visits were made by nurses to measles cases. Fifty-seven cases of measles were removed from their homes or from Institutions in the Borough to M.A.B. hospitals, and 7 cases to the London Fever Hospital. Seven cases of Rubella were removed to the London Fever Hospital. During the year 67 cases of Scarlet Fever were notified in Chelsea, as against 99 in 1917. These were no deaths from the disease: 88 per cent. of the cases were removed to hospital. January and February were the months of greatest prevalence, but throughout the rest of the year the number of cases was very small. The percentage of cases of school age (3 to 13 years) was 78, as against 77 in 1917. In 1918, 47 cases of diphtheria were notified in Chelsea, as compared with 56 in 1917. This disease caused 5 deaths in 1918, the case mortality being 10.6 per cent., as compared with 5.3 per cent. in 1917; 80 per cent. of the cases were removed to hospital. The percentage of cases of school age (3 to 13 years) was 53, as against 66 in 1917. During the year medical practitioners sent 101 throat swabbings to the Lister Institute for bacterioscopic diagnosis, as compared with 70 in 1917. Of the 101 specimens, 10 afforded positive evidence of the diphtheria bacillus, and 91 were negative. Of the total 101 specimens, 65 were sent by the Victoria Hospital in respect of Chelsea children. The number of cases of enteric fever notified amongst the civil population was 4, as against 10 in 1917. Of the four cases, in one the diagnosis was not confirmed at the M.A.B. Hospital to which the patient was removed. There were no deaths amongst these 4 cases. No specimens of blood were examined for the Widal reaction. The deaths in Chelsea from diarrhœa and enteritis in 1918 were only 11 in number, as against 35 in 1917. Six of the deaths were of infants under 1 year. The amount of summer diarrhœa was exceedingly small. Influenza caused 284 deaths in 1918, as against 23 deaths in 1917. Of these 234 deaths, 11 occurred in the 5 weeks ended the 27th July constituting the summer outbreak, and 208 occurred in the 12 weeks ended the 28th December, constituting the autumn outbreak. The ages of these fatal cases in the two outbreaks were as follows:— under 15. 15—45. over 45. Summer outbreak 2 or 18% 3 or 27% 6 or 55% Autumn „ 42 or 20% 112 or 54% 54 or 26% 14 The notable features of the autumn outbreak was the large percentage of deaths of people in the prime of life (15 to 45 years). In this outbreak the deaths of males were 91, and of females, 117. In London generally there were 12,927 deaths from Influenza in 1918, namely, 1st quarter, 154; 2nd quarter, 172; 3rd quarter, 938; 4th quarter, 11,663. Chelsea's proportion of the total London Influenza deaths in London in 1918, according to its population, is 184 deaths, whereas the actual number of Chelsea deaths was 234, so that it would appear that the epidemic in Chelsea was more fatal, and probably more prevalent, than in London generally. During the autumn, owing to the large number of deaths, and the inability of undertakers and grave diggers to carry out the burials, the Public Mortuary became highly congested, and many bodies had to remain unburied for considerable periods in private houses. The number of deaths from respiratory diseases was 205 in 1918, as compared with 172 in 1917, and 195 in 1916. Of the 205 deaths 82 were from pneumonia, as compared with 53 in 1917, and 32 in 1916. The deaths from pulmonary tuberculosis in 1918 numbered 77 (53 males and 24 females), as against 79 in 1917. Other tubercular diseases caused 23 deaths, as against 24 in 1917, and 12 in 1916. Of the pulmonary tuberculosis cases ending fatally, 30 per cent. died in the Chelsea Infirmary, and 46 per cent. in other public institutions; that is to say 76 per cent. died away from their homes. In 1917, 68.5 per cent died away from home. During the year 1918, 145 new cases of pulmonary tuberculosis were notified, as against 161 in 1917, 76 being males and 69 females. Sixtyeight specimens of sputum were sent by medical practitioners to the Lister Institute for examination as against 55 in 1917. Of the 68 specimens, 20 per cent. were positive for tubercle bacilli, and 80 per cent. were negative. In 1918, 29 cases of pulmonary tuberculosis were discharged from open air sanatoria, in which they had received institutional treatment, as "insured persons" under the sanatorium benefit provided by the London Insurance Committee, as against 21 cases in 1917. The average duration of the stay of the 29 cases in sanatoria was 2½ months, as against 2¼ months in 1917. In addition to the above, 8 insured persons had hospital treatment, the average duration of stay in hospital being 2 months. Seven uninsured persons were discharged after receiving open-air sanatorium treatment under the L.C.C. scheme for the uninsured. The average duration of stay in sanatorium of these cases was 6¼ months. In addition 10 cases had hospital treatment; average stay being 2 months. The number of new cases of pulmonary tuberculosis visited in the course of the year was 145, and of non-pulmonary cases, 17. The total number of visits paid in respect of all cases of tuberculosis and suspected tuberculosis was 1,136. Four patients were lent beds and bedding by the Borough Council. Seventeen new cases of non-pulmonary tuberculosis were notified in 1918, 13 being children under 15 years of age, and 4 adults. Twelve were males, and 5 females. Several cases were helped to obtain proper surgical treatment in hospitals, and others wero sent to country or sea-side convalescent homes. As in previous years, a great deal of this work was carried out by the Chelsea branch of the Invajid Children's Aid Association. 15 Chelsea Tuberculosis Dispensary, Brompton Hospital. Work done during 1918. Number of Persons examined for the first time:— Insured 99 Uninsured 191 290 Number of Persons suffering from:— Tuberculosis 61 or 21 % Doubtful diagnosis 158 „ 53 % Not tuberculous 74 „ 26 % Total attendances at Dispensary:— Insured 720 Uninsured 979 1699 Visits at homes of patients by Medical Officer:— Insured 5 Uninsured 5 10 Visits to homes of patients by Dispensary and District Nurses:— Insured 516 Uninsured 855 1371 Consultations with Medical Adviser of Insurance Committee 51 Consultations with Practitioners at homes of patients - Number of written reports concerning individual patients made to:— Public Authorities 62 Practitioners 6 Number of X-ray examinations of patients 9 Number of examinations of sputum:— Insured 136 Uninsured 125 261 Only one case of cerebro-spinal meningitis was notified amongst the civil population of Chelsea in 1918, namely a female, aged 29, a bank clerk. The case ended fatally after 8 days illness. There were no cases notified in Chelsea of poliomyelitis. A case of encephalitis letharqica was believed to be present at the Chelsea Infirmary in May, 1918, in the person of a female, aged 43, but the symptoms were not very definite, and the case may have been one of hystero-epilepsy. The patient recovered. Another case with wellmarked symptoms occurred in the person of a coal porter, aged 56, living in Dartrey-road. This patient was treated in the Chelsea Infirmary in May, and recovered. 16 Six cases of puerperal fever were notified in Chelsea in 1918. There were 4 deaths from this disease. Nineteen cases of ophthalmia neonatorum were notified in Chelsea in 1918, and an additional eleven cases of eye trouble in infants, which were not notified, were visited. Of these 30 cases, 23 made complete recoveries, and the remainder were left with some eye weakness. Sale of Food and Drugs Acts. Of the 400 samples taken for analysis in 1918, 94 were milk, 81 being genuine, and 18 adulterated, equivalent to 13·8 per cent. of the total milks examined, as against 8·1 per cent. in 1917, and 6·0 per cent. in 1916. Of the 18 adulterated samples, proceedings were taken in 6 cases, and convictions obtained in 4 cases. In the other 7 cases, no proceedings were taken in five, as the vendors were protected by warranties. In one case the milk vendor's business had been sold before proceedings could be taken, and the person liable could not be traced. In one case the amount of adulteration was insufficient to warrant proceedings. The other samples taken included coffee, mustard, confectionery, non-wheaten flours, jam, tea, bread, baking powder, cocoa, wheaten flour and beer. Work of the Public Health Department. During the year 1918, 699 separate premises were reported on by the staff, 237 of this number being with reference to cases of notifiable infectiousdisease, and 157 in the course of house-to-house inspections made in certain of the poorer streets of the Borough. Legal proceedings were taken in one case to enforce compliance with notices under the Public Health (London) Act, and an order was made for the execution of the necessary works. During the year 487 inspections were made of factories, workshops, laundries, etc. Disinfection.—In 1918, 272 premises were disinfected after cases of infectious and other disease, and an additional 182 rooms were disinfected for bugs and other vermin. At the disinfecting station, 545 separate articles of bedding and clothing were disinfected, and 473 consignments of meat, fish, rabbits, butter, eggs, cheese, condensed milk, tomatoes and jam, bedding and carcases of animals were destroyed in the incinerator. Verminous school children.—In 1918, 36 children attending elementary schools in the Borough were reported as being found by the school nurses to be in a verminous condition. The corresponding number in 1917 was 62, in 1916, 72, in 1915, 65, and in 1914, 266. Altogether 47 home visits were paid in connection with this work. Scabics.—The number of cases of school children reported as being affected with scabies in 1918 was 104, as against 66 in 1917. Altogether 141 visits to homes were paid in connection with these cases. Staff.—The staff has been the same as in 1917.