CHE 25 Metropolitan Borough of Chelsea. ANNUAL REPORT For 1919 of the Medical Officer of Health, LOUIS C. PARKES, M.D. ; D.P.H. Lond. Univ.; M.R.C.S. Eng. TOWN HALL, KING'S BOAD, CHELSEA, S.W. 3. LONDON SHIELD AND SPRING, PRINTERS, LANCELOT PLACE, BROMPTON ROAD, S.W. 7. 1920. TABLE OF CONTENTS. PARE Population of Chelsea 3 Births and Birth-rate 3 Notification of Births 3 Maternity and Child Welfare 4 The Milk (Mothers and Children's) Orders 6 Deaths and Death-rates 6 Infectious Diseases 7 Dysentery and Malaria 8 Influenza and Pneumonia 8 Tuberculosis 10 Chelsea Tuberculosis Dispensary 10 Tuberculosis Care Committee 11 Encephalitis Lethargica 12 Cerebro spinal Meningitis and Polio-Myelitis 12 Puerperal Fever and Ophthalmia Neonatorum 12 Birth and Death-rates of Special Classes 13 Births in Wards of Borough 14 Infantile Mortality Rates 14 Housing of the Working Classes 15 World's End passage area 10 By-Laws for Houses let in Lodgings 10 Housing schemes 17 Industrial Dwellings in Chelsea 17 Housing, Town Planning, etc., Act, 1919 18 Sale of Food and Drugs Acts 10 Work of the Public Health Department 10 Summary of Work done in 1919 20 Food Condemned and Destroyed 21 Magisterial Proceedings 23-24 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1919. POPULATION OF CHELSEA. The population of the Borough may be assumed to be the same as in 1918, namely, 63,130, with the addition of 2,685 demobilised males of military age, this being half the total number of men who served in the military forces. The total population, therefore, was 65,815. Births and Birth-Bate. In 1919, 924 births were registered in the Borough. Excluding 148 births of non-parishioners, and including 98 births taking place amongst Chelsea mothers in Lying-in Hospitals and Homes outside the Borough, the total number of births for the year was 874, the corresponding figure for 1918 being 790. The birth-rate for the year was 13·3 per 1,000, which is 0.8 per 1,000 above the rate of 1918, but 5.9 per 1,000 below the rate of 1914. There was a considerable increase in the number of births in the latter half of 1919, the births in the 4 quarters being as follows:—1st quarter, 173; 2nd quarter, 154; 3rd quarter, 193; 4th quarter, 256. Notification of Births. Number.  Living Children 773 Still-born Children 13 786 Notified by Medical Practitioners 237 „ St. George's Hospital 51 „ Midwives 355 „ Chelsea Workhouse 74 „ Parents and other Persons 69 • 786 Total number of live Chelsea Births registered in the Borough 776 4 The notifications, therefore, formed 100 per cent. of the total live births of Chelsea residents registered in the Borough, as compared with 89 per cent. in 1918, 93 per cent. in 1917, and 91 per cent. in each of the years 1915, 1916. The number of births notified by midwives in 1919 was 46 per cent. of the total, as against 43 per cent, in 1918. Illegitimate Births. Total number of illegitimate births 66 Alive at end of year 47 Dead at end of year 6 Unaccounted for 18 Maternity and Child Welfare. There were 76 deaths of infants under one year of age in 1919, equivalent to an Infant Mortality Rate of 87 per 1,000 Births. The rates in recent years have been as follows:—1918, 91; 1917, 82; 1916, 91; 1915, 100; 1914, 67. The following tabular statement gives an outline of the work carried on in Chelsea during 1919, the visits being those paid by the trained and paid officers of the Borough Council (one whole-time Health Visitor, one part time), and the Chelsea Health Society and School for Mothers (one whole time officer), and does not include work done by voluntary workers attached to the Society. Summary of Reports of Health Visitors for 1919. Number of homes visited (first visits), Infants 583 „ revisits, Infants 1680 „ Infants attendances at Infant Consultations 1890 „ Visits to children of 1 year to school age 169 „ re-visits, ditto 2080 „ children of 1 year to school age attendances at medical inspection centre 909 „ Ante-natal visits to expectant mothers 809 „ Ante-natal case attendances at ante-natal clinic 413 „ Visits to Diarrhœa cases amongst children 105 „ Cases of Diarrhœa found 54 „ Visits to cases of Ophthalmia Neonatorum 21 General additional visits in connection with the work 1141 As compared with 1918, there were 547 more infant attendances at Infant Consultations in 1919; 194 more attendances of children of 1 year to school age at medical inspections; 120 more ante-natal case attendances at the ante-natal clinic, whilst the ante-natal home visits were increased 5 by 349. The work of the clinics was largely increased in 1919. The working of the clinics during 1919 was, as set out below:— Sydney-street:- Dr. Jewsbury Tuesday afternoon Resigned end of July. Dr. Dearnley Tuesday afternoon From August. Dr. Parkes Monday afternoon January to November (11 months). Dr. Pinkerton Monday afternoon December. Dr. Rorke Wednesday afternoon Ante-natal clinic. 484, King's-road:— Dr. Green Thursday afternoon From February. Dr. Pinkertoon Thursday afternoon From December, as 2nd Doctor. Dr. Dearnley acted as locum tenens for Dr. Green for 7 months. Subject to the approval of the Ministry of Health, the Borough Council has resolved to make financial grants for the year commencing 1st April, 1920, as follows:— £ Chelsea Health Society and School for Mothers 450 Nursing Home for Ailing Babies, Edith-terrace 400 Chelsea Branch of Invalid Children's Aid Association 80 Chelsea Day Nursery, 65, Sydney-street 100 Victoria Hospital for Children 50 Convalescent Homes for Nursing Mothers and Infants 32 Dinners for Chelsea Expectant and Nursing Mothers 20 £1,132 Half this amount, namely £566, will be recovered as a grant from the Ministry of Health. Maternity Nurse.—The number of necessitous women provided with a maternity nurse under the Council's scheme for confinements during 1919, was 60, 35 of the cases being attended by the Ormond Home for Midwives, and 25 by Midwife Andrews. The amount paid in fees to the Maternity Nurses was £34 10s. 6d., and the amount received as contributions from patients was £24 16s., leaving a balance of £9 14s. 6d., half of which will be recovered as a grant from the Ministry of Health. The circumstances of every applicant for a maternity nurse are considered by a Sub-Committee of the Maternity and Child Welfare Committee, which assesses the amount of the contribution to be paid by the patient. Midwife for Necessitous Women.—On the 17th December, 1919, the Borough Council approved a scheme for the provision of a midwife for necessitous women, who are unable to pay the midwife's ordinary fee, the Borough Council undertaking to pay the midwife's ordinary fee in 6 the cases that are approved by the Maternity and Child Welfare Committee, the applicant to agree to pay such portion of the fee as the Committee may determine. Convalescent Homes.—Twenty nursing mothers, with their infants, were sent away to convalescent homes in the course of the year. The Milk (Mothers' and Children's) Orders, 1918, 1919. During the year, 1919,520 applications for milk were granted by a Subcommittee of the Maternity and Child Welfare Committee, this number including renewals after the expiry of a month, for which period the applications are usually granted in the first instance. The mothers to whom grants were made were all necessitous, in the sense that it was ascertained that the family income in each case was insufficient for the purchase of milk in quantity sufficient for the bodily and health needs of the expectant or nursing mother, or children of the family under 5 years of age. The grants were usually made for cow's milk to be supplied by dairymen at less than current retail price, but in some few cases the grants were made for milk free of cost to the applicants. The current retail prices of milk in London in 1919 were as follows:— Per quart:—January, l0d.; February, 10d.; March, 10d.; April, 10d.; May, 7d.; June, 7d.; July, 9d.; August, 8d.; September, 9d.; October, l1.; November, 12d.; December, 12d. In the opinion of those competent to judge, the supply of milk under these conditions to necessitous mothers and children has been beneficial to the maintenance of a good standard of health, as evidenced by the satisfactory condition of mothers and children attending the clinics in the Borough. The cost to the Borough Council of the supply of milk was as follows:—1st quarter, £48; 2nd quarter, £57; 3rd quarter, £61; 4th quarter, £176. Total for year, £342. The large increase in the 4th quarter was due to a largely increased number of applications, and the higher price of milk in the three winter months. The Borough Council will receive a grant from the Ministry of Health for half the cost incurred. Deaths and Death-Rate. There were 925 deaths of Chelsea residents in 1919, of which number 199, or 21.5 per cent., occurred in the Chelsea Infirmary, and 310, or 35.5 per cent., in other public institutions. The death-rate for the year was 14.1 per 1,000. as against 17.6 in 1918, 14.2 in 1917, 15.1 in 1916, 17.5 in 1915, and 13.3 in 1914. The lower death-rate in 1919, as compared with 1918, is due to a lessened mortality from influenza, the deaths in 1919 from influenza being 104 as against 234 in 1918. There were also fewer deaths from pneumonia, namely, 50 in 1919, as against 82 in 1918. Measles. Measles caused 7 deaths in 1919, as compared with 14 in 1918, 6 in 1917, 5 in 1916, and 39 in 1915. Six of the deaths were of children between 1 and 5 years of age. 7 The number of cases of measles and German measles, notified in the four quarters of the year, were as follows:— Measles. German Measles.  1st Quarter 100 25 2nd „ 58 29 3rd „ 123 18 4th „ 243 33 Year 524 105 The case mortality of measles for 1919 was 1.3, as against 3.1 in 1918, so that the type of disease appears to have been of a milder character than in 1918. The Woman Sanitary Inspector and the Health Visitor in the course of the year made 552 visits to homes in connection with measles cases. In accordance with the arrangement made with the Chelsea District Nursing Association, 594 visits were made by the Association's nurses to 48 families who had a child or children ill with measles. The average number of visits per family was 12, the same as in 1918. In 1918, 561 visits were made by nurses to measles cases. Eighty-eight cases of measles and German measles were removed to hospitals. In accordance with the Rescission Order of the Ministry of Health of the 31st December, 1919, the compulsory notification of measles and German measles ceased on the 31st January, 1920. Scarlet Fever. During the year 148 cases of scarlet fever were notified in Chelsea, as against 67 in 1918. There were 4 deaths from this disease, the case mortality being 2.7 per cent; 92 per cent. of the cases were removed to hospital. The disease was very little prevalent until the autumn, 85 out of the 148 cases being notified in the last 3 months of the year, i.e., 60 per cent. of the total for the year. In December, 36 cases were notified, and during this month there was considerable delay in certain cases in getting the patients removed to the M.A.B. hospitals. The percentage of cases of school age (3 to 13 years) was 77, as against 78 in 1918. Diphtheria. During the year 71 cases of diphtheria were notified in Chelsea, as compared with 47 in 1918. The disease caused 7 deaths in 1919, the case mortality being 9.9 per cent., as compared with 10.6 per cent. in 1918; 92 per cent. of the cases were removed to hospital. The percentage of cases of school age (3 to 13 years) was 70, as against 53 in 1918. The months of greatest prevalence were June, 16 cases, and December, 12 cases. During the year medical practitioners sent 68 throat or nose swabbings to the Lister Institute for bacterioscopic diagnosis, as compared with 101 in 1918. Of the 68 specimens, 14, or 21 per cent., afforded positive evidence of the diphtheria bacillus, and 54, or 79 per cent., were negative. Of the total 68 specimens, 32 were sent by the Victoria Hospital in respect of Chelsea Children. 8 Enteric Fever. The number of cases of enteric fever notified in Chelsea in 1919 was 2, as against 4 in 1918. All the cases were removed to hospital. There were no deaths from this disease. Paratyphoid Fever. Five cases of paratyphoid fever were notified in 1919. One case only was removed to hospital. There were no deaths. Of 2 specimens of blood sent for examination, one was positive for paratyphoid A., and the other was negative for paratyphoid, A. and B. No history of infection could be obtained in any of these cases. Diarrhoea and Enteritis. The deaths in Chelsea from diarrhoea and enteritis in 1919 were 17 in number, 13 being of infants under 1 year of age. Eight of the deaths occurred in the third or summer quarter of the year. In 1918, there were 11 deaths from these diseases. In connection with this disease, 105 visits were made to homes, and 54 cases were as a result discovered. Dysentery. Only one case of dysentery was notified in 1919 (July). The patient, a man of 31 years, was working in a shop in the Borough as a butter salesman. He had had dysentery whilst in the Army in Flanders in November, 1915, and was in hospital for 5 months. He had had occasional attacks since 1915, during hot weather. At my suggestion he left his work, and went into hospital. The excreta were examined for bacilli, entamœbœ and cysts, but with negative results. There were 2 deaths from dysentery (colitis) of Chelsea parishioners in lunatic asylums, and one from dysentery contracted in Egypt of a Chelsea parishioner at Aberdovey. Malaria. Ten cases of malaria were notified in 1919. They were all cases of men who had been first attacked whilst serving abroad in the expeditionary forces—5 in Salonica, 1 in Egypt, 1 in Palestine, and 1 in Mesopotamia. In two cases no information was obtained as to residence at the time of first attack. Influenza. Influenza caused 104 deaths in 1919, as against 234 in 1918. Of these 104 deaths, 88 occurred in the first quarter of the year, 10 in the second quarter, 2 in the third quarter, and 4 in the fourth quarter. The ages and sex of the 104 fatal cases were as follows:— under 15 15—45 over 45 Total. Males 6 13 35 54 Females 4 27 19 50 Both sexes 10 40 54 104 9 The epidemic period in the first quarter of the year was from the middle of February to the end of March (about 6 weeks). In this period there were 13 deaths from influenza of aged pensioners of the Royal Hospital. In London generally there were 4,222 deaths from influenza in 1919, as compared with 12,927 in 1918. In the 1st quarter there were 3,488 deaths, in the 2nd quarter, 453, in the 3rd quarter, 56, and in the 4th quarter, 225. To cope with the epidemic in Chelsea in February and March, the following arrangements were made and carried out:—1. A trained nurse, who was about to leave the District Nurses' Association, was re-engaged at a salary of £3 a week for 5 weeks at the cost of the Council. She made an average attendance on influenza cases of 14 visits daily. In addition 190 visits to 16 patients suffering from influenzal pneumonia were made by the District Nurses under the Council's ordinary arrangement with the Association. 2. Leaflets of precautions against inflenza and posters were printed, the posters being displayed in public places, and the leaflets circulated amongst the public. The Public Health Committee also communicated with the Local Government Board as to the advisability of closing all places of public entertainment for a period, in order to limit the spread of infection, but the Board did not see its way to take such action. The epidemic of February and March, 1919, was of a much less serious nature than that of the preceding autumn, and the steps taken to prevent infection and to aid the sufferers by providing nurses were very much more efficacious in consequence. Pneumonia. Pneumonia caused 53 deaths in Chelsea in 1919, as against 82 in 1918. The ages and sex of the 53 fatal cases were as follows:— under 15 15—45 over 45 Total Males 9 0 13 22 Females 8 5 18 31 Both sexes 17 5 31 53 Only 5 notifications of pneumonia were received from medical practitioners during the year, but 52 notifications of influenzal pneumonia were received. In London generally there were 4,597 deaths from pneumonia in 1919, as compared with 7,485 in 1918. Tuberculosis. The deaths from pulmonary tuberculosis in 1919 numbered 67 (44 males and 23 females), as against 77 in 1918. Other tubercular diseases caused 22 deaths, as against 23 in 1918. Of the pulmonary tuberculosis cases ending fatally, 34 per cent. died in the Chelsea Infirmary, and 30 per cent. in other public institutions, that is to say, 64 per cent. died away from their homes, the corresponding number for 1918 being 76 per cent. During the year 1919, 113 new cases of pulmonary tuberculosis were notified as against 145 in 1918, 57 being males and 56 females. Seventyfive specimens of sputum were sent by medical practitioners to the Lister 10 Institute for examination, as against 68 in 1918. Of the 75 specimens, 17 per cent. were positive for tubercle bacilli, and 83 per cent. were negative. A considerable number of patients received open air sanatorium treatment either as insured persons under the London Insurance Committee scheme, or as uninsured persons under the London County Council scheme. The number of new cases of pulmonary and non-pulmonary tuberculosis visited in the course of the year was 106. The total number of visits paid in respect of all cases of tuberculosis and suspected tuberculosis was 912. Four patients were lent beds and bedding by the Borough Council. Thirty-one new cases of non-pulmonary tuberculosis were notified in 1919, 20 being children under 15 years of age, and 11 adults. Fourteen were males, and 17 females. Several cases were helped to obtain proper surgical treatment in hospitals, and others were sent to country or seaside convalescent 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. Work done during 1919. Number of persons examined for the first time :— Insured 168 Uninsured 258 426 Number of persons suffering from:— Tuberculosis 58, or 14 per cent. Doubtful diagnosis 160, or 37 „ Not Tuberculosis 208, or 49 „ Total attendances at Dispensary:— Insured 1218 Uninsured 1487 2705 Visits at homes of patients by Medical Officer:— Insured 9 Uninsured 6 15 Visits to homes of patients by Dispensary Nurses:— Insured 1471 Uninsured 1557 3028 Number of written reports concerning individual patients, made to:— Public Authorities 139 Practitioners 38 177 11 Number of examinations of sputum:— Insured 855 Uninsured 159 514 Number of X-ray examinations of patients 23 Tuberculosis Care Committee. The Tuberculosis Care Committee was formed by the Chelsea Borough Council in April, 1917, in connection with the institution of the Tuberculosis Dispensary in Chelsea. Whereas the Tuberculosis Dispensary deals entirely with the Medical side of the problem, the Care Committee is responsible for the social side. Its duty is to see that as far as possible there are no difficulties in the way of the patients carrying out the orders given at the Dispensary; to see that the patients have the necessary clothes, bedding, etc.; that patients and their families, who may be in need, owing to the disability of the breadwinner to work, are supplied with what is necessary before and during treatment. It also endeavours on the return of the patients to get them suitable work. The Committee is also responsible for seeing that, where the conditions of the rooms in which the patients live are unsatisfactory, these should be remedied; that where a change of residence is needed this should be effected. (Owing to the present housing conditions, it is almost impossible for anyone to move, so that at present these residences are only noted for future action.) The Committee is also responsible for making assessments in those cases where they consider that the patients are in a position to pay towards the cost of institutional treatment; and it decides, when the patient is an uninsured person, whether these cases are best dealt with under the L.C.C. or the Poor Laws. In all this work, both at the Dispensary and in their own sphere, the Committee feels strongly the necessity for getting into friendly relations with the patient and his family. By this means much education as to fresh air and inprovement in home conditions may be effected; also the family realises that there is someone to whom they can turn in case of difficulties arising during the patients absence, and one also whom they can consult as to future employment on his return. Members of Committee. Dr. Louis Parkes, Medical Officer of Health (Chairman). The Rev. R. H. Hudson, late Mayor, present Chairman of Health Committee (Vice-Chairman). Miss Loring, Charity Organisation Society, Hon. Sec. for Tuberculosis Care Committee. Miss Tetternborn, Tuberculosis Visitor. Miss Paddon, District Organiser of Care Committee. Mrs. Rathbone, I.C.A.A. Miss Barcroft, I.C.A.A. Lady Ogilvie, Chelsea Health Society and Mothers' Welcome. Miss Page, District Nurses. The Committee Officer, War Pensions Committee. Miss Seddon, St. George's Hospital, 12 Miss Marx, Brompton Hospital. Dr. Fenton, Tuberculosis Officer (Dispensary). Miss Moses, Tuberculosis Dispensary (Social worker in connection with Dispensary). Dr. A. W. Sikes, L.C.C. Dr. Hamer, L.C.C. Thomas Batey, Esq., L.I. Committee. F. Handel Booth, Esq., Representative of L.I. Committee. The representative of the Guardians has resigned. It is hoped that another may be appointed shortly. Encephalitis Lethargica. Two cases of this disease were notified in Chelsea in 1919. On inquiry one of the cases was found not to be a case of this disease. The other case was a nurse of the Brompton Hospital living in the Hospital Nursing Home, who eventually made a complete recovery. Cerebro-Spinal Meningitis. Three cases of Cerebro-spinal meningitis were notified in Chelsea in 1918, namely, male, 15, male, 4, and female, 8. All the cases were removed to hospital, and all recovered. In London generally, 205 cases of this disease were notified, in 1919, as against 231 in 1918. Polio-Myelitis. Three cases were notified in 1919 in Chelsea, namely, male, 10, male, 2, and female, 1. All the cases were removed to hospital, but recoveries have not as yet been complete, all three children having one or more limbs partially paralysed. In London 101 cases of polio-myelitis were notified, as against 50 in 1918. No cases of polio-encephilitis were notified in Chelsea in 1919. Puerperal Fever. Three cases of puerperal fever were notified in Chelsea in 1919, one of the cases proving fatal. In addition, an unmarried woman of 40 died of this disease, her case not being notified, and a woman of 21 died of puerperal eclampsia (convulsions). Ophthalmia Neonatorum. Thirteen cases of this disease were notified in Chelsea in 1919, and an additional five cases of eye trouble in infants, which were not notified, were visited, 21 visits in all being made by the Health Visitors. Eight cases were attended by District Nurses, 263 visits being paid to the homes, which gives an average of 33 visits per case. Of the 18 cases, 11 made complete recoveries, 4 made incomplete recoveries, one was left blind in one eye, and two died of other diseases. Non-Notifiable Illnesses. The District Nurses paid 475 visits to homes for whooping cough, bronchitis, worms, ear and nose discharges, circumcision, septic wounds, etc., during the course of 1919. 13 Birth and Death-Rates of Special Classes. The following Table gives the average birth-rates, death-rates, zymotic disease death-rates, tubercular disease death-rates, and deaths under 1 year to 1,000 births for 4-yearly periods from 1905 onwards, in respect of the Borough, the Borough Council Dwellings and other Industrial Dwellings, and seven of the streets inhabited by the lower wage-earning classes:— Chelsea Borough. Birth-rate Death-rate Zymotic Death-rate Tubercular Death-rate Deaths under 1 to 1,000 Births.  1905- 8 22.0 16.2 1.8 2.0 122 1909-12 19.6 15.2 1.2 1.8 99 1913-16 18.0 14.8 1.0 1.5 87 1917-19 13.5 15.3 0.7 1.5 86 Industrial Dwellings. 1905-8 29.5 14.8 2.2 2.2 95 1909-12 27.7 13.0 1.4 1.4 92 1913-16 27.4 13.3 1.3 2.1 75 1917-19 16.0 12.9 0.7 2.1 74 Poor-Class Streets.* 1905- 8 38.0 24.4 4.2 3.4 183 1909-12 36.8 24.1 3.0 3.8 137 1913-16 32.9 20.3 3.2 2.1 124 1917-19 17.5 15.8 2.0 1.4 115 1893- 6 34.6 7.5 4.3 1897-1900 33.7 7.0 4.6 1901-4 26.3 3.7 4.1 *1893-1908 statistics based on populations of 11 streets. 1909-1911 ,, ,, ,, ,, 10 ,, 1912-1919 „ ,, ,, ,, 7 ,, From this table it will be seen how greatly the birth-rate fell in the 3 years, 1917-19, as compared with the earlier periods, both in the Borough as a whole, in the Industrial Dwellings, and in the poor class streets. The death-rate of the poor class streets has now fallen to less than half of what it was in the 8 years 1893-1900, and the death-rates from infectious and tubercular diseases, and the infantile mortality rates in these streets also show very satisfactory declines. It is a somewhat remarkable fact that the death-rate from tubercular diseases in the Industrial Dwellings shows of late years no decline, and was during the period 1917-19 considerably higher than the death-rate for the poor class streets. The Borough Council's Dwellings are Sir Thomas More Buildings, Pond House, Onslow Dwellings, and Grove Buildings, with a total population of 1,467. The other Industrial Dwellings are the Marlborough Buildings, Guinness Buildings, Peabody Buildings, Chelsea Park Dwellings, 14 Sutton Trust Dwellings, and Lewis Trust Dwellings, with a total population of 5,300. The seven poor class streets are Dartrey-road, Francisstreet, Gilray-square, Ives-street, Riley-street, Slaidburn-street, World's End-passage and Courts adjacent, with a total population of 3,480. The following table gives the births in the 5 wards of the Borough in the year 1912 and the year 1918 (when the numbers were smallest), and the decrease per cent. in this period. The births for 1919 show that an increase took place last year, especially in Stanley and Royal Hospital wards. Births. 1912 1918 Decrease per cent. 1919  Hans Town 149 103 31 112 Royal Hospital 119 74 38 108 Church 188 173 8 168 Cheyne 167 122 27 119 Stanley 587 318 46 367 Chelsea Borough 1210 790 35 874 In Church Ward the decrease per cent. in births between 1912 and 1918 was only 8, as compared with 46 in Stanley Ward, but this is accounted for by the opening of Sutton Dwellings in 1914, and of Lewis Dwellings, in 1916. It is curious how, after the first year of occupancy in both these dwellings, the births began steadily to decline. In 1919, the births commenced to rise again. Births in Church Ward, Sutton Dwellings, and Lewis Dwellings. Year Church Ward. Sutton Dwlgs. Lewis Dwlgs.  1912 188 .. .. 1913 192 .. .. 1914 244 97 .. 1915 197 63 .. 1916 233 53 42 1917 197 43 25 1918 173 38 23 1919 168 43 29 The average Infantile Mortality Rate (deaths of Infants under one year per 1,000 births) for the five wards for the past 8 years, 1912-19, is as follows :— Wards. Infantile Mortality Rate.  Hans Town 71 Royal Hospital 67 Church 97 Cheyne 67 Stanley 95 Chelsea Borough 85 15 The following table shows the average Infantile Mortality Rates in 4-yearly periods for the Borough since 1901, also the average number of annual deaths in these periods of children one to five years of age:— Years. Chelsea Infantile Mortality Rate. Deaths 1 -5 years.  1901-4 140 112 1905-8 119 88 1909-12 97 71 1913-16 87 56 1917-19 87 54 In the year 1915 there were 29 deaths of children between 1 and 5 years from measles, and in 1918, 24 deaths from influenza. Having regard to these facts, the large reduction both in infantile and child mortality in Chelsea of recent years is very noteworthy, and may justly be attributed very largely to the efforts made by the Borough Council and the Voluntary Societies on behalf of infant and child welfare in the Borough. The following table gives the Infantile Mortality Bates in Chelsea under various headings, for five 4-yearly periods:- Chelsea Infantile Mortality Rates. 1901-4. 1905-8. 1909-12. 1013-16. 1917-19.  Infectious Diseases 10.0 11.5 8.0 6.2 6.2 Diarrhœal Diseases 23.5 26.0 18.0 16.4 14.6 Developmental Defects and Wasting 48.0 37.0 34.5 28.2 33.5 Other causes 58.0 44.0 36.0 36.6 32.3 Total Rate 139.5 118.5 96.5 87.4 86.5 Chelsea. Fire-Yearly Average number of Annual Deaths, 1-5 years. Infections Diseases. Diarrhoea and Enteritis. Tuberculosis. Bronchitis and Pneumonia Other . Causes. Total. 1901-5 36 7 15 27 18 103 1906-10 38 7 12 19 11 87 1911-15 26 3 8 13 12 62 1916-19 14 3 6 14 16 53 Housing of the Working Classes. In June, 1919, I made an inspection with Chief Inspector Grant of about 160 houses in the following streets:—Little Orford-street, Rawlingsstreet, W. side, Orford-street, Wood-street, Leverett-street, Denyerstreet, Green-street, S. side, Feltham-mews, Draycott-avenue, Francisstreet and Oakham-street. Of the 160 houses, between 40 and 50 were in fairly clean and tenantable condition, and required little doing to them. Some 60 were dirty and dilapidated, and more or less worn out by long usage and neglect, Thirty, in addition to the 60 mentioned, had one or more dirty rooms. 16 passages, and staircases. Twenty-seven had damp walls, arising from driving rain through unpointed walls, defective gutters, and rain-water pipes, or dampness rising from the ground. Seventy-five had defects in the roofs allowing rain to pass into the upper rooms. Thirty had dilapidated washhouses, many being unusable in wet weather. In 34 of the houses there were defects of one sort or another connected with the W.C.'s. In a majority of the houses the roof gutters and rain-water pipes were worn out or defective. In 32 of the houses the tenants stated that there were bugs in one or more rooms, continual warfare against them being necessary to keep them in abeyance. I communicated with the owners of these houses early in July, 1919, and since that time a great deal has been done to carry out the necessary repairs and cleansing. A re-inspection of the houses will be made shortly to ascertain how far the insanitary conditions have been rectified. There can be no question that for the past 5 years owners of property of this class have been much hampered by difficulties in connection with labour and repairing materials, and these difficulties are not yet at an end. World's End Passage Area. This area comprises World's End Passage (43 houses, 6 unoccupied), Davis-place (4 houses), Lacland-cottages (8 houses), Lacland-place (2 houses), Jackson's-buildings (5 houses, 2 unoccupied), and Foundryplace (15 houses). The population at present is about 450. In my opinion this area will have eventually to be dealt with by means of an "Improvement Scheme" under the Housing of the Working Classes Act, 1890, Part I., Section 4, owing to the narrowness, closeness, bad arrangement, and bad condition of the streets and houses, or groups of houses within such area, the want of light, air, ventilation and proper conveniences, and other sanitary defects, the evils connected with this area being incapable of effectual remedy otherwise than by an Improvement Scheme under the Housing Act of 1890. As required by the Ministry of Health, I have reported to the Ministry that this area will eventually have to be dealt with under an Improvement scheme; but there is no object in making an official representation at the present time, as it is impossible to re-house the 450 inhabitants who would be displaced by the clearance. By-Laws for Houses let in Lodgings. Under Section 26 of the Housing and Town Planning Act, 1919, the London County Council is required to make By-laws for houses occupied by the working classes, which are let in lodgings or occupied by members of more than one family. These By-laws will be enforced by the Borough Councils. The By-laws will require provision adequate for the use of, and readily accessible to each family of:—1. closet accommodation; 2. water supply and washing accommodation; 3. accommodation for the storage, preparation and cooking of food. Where necessary separate accommodation for every part of the house, which is occupied as a separate dwelling, must be provided. The new By-laws have not yet been made by the London County Council, 17 Housing Schemes. In Vol. '25 of the London County Council Statistics for 1914-15, there is a table giving particulars as to the Working Class Tenements erected or acquired by Metropolitan Borough Councils, up to the end of the year, 1913. Presumably, owing to the war, nothing further has been done in London up to date in the way of erecting or acquiring working class tenements. This table shows that, in proportion to its population, Chelsea had done more than twice as much as any other Borough (excluding the City) in the way of the erection or acquisition of working class tenements. Borough. Number Rooms. Number of Rooms per 10,000 of population. 1. Chelsea 1150 200 2. Battersea 1248 88 8. Camberwell 1722 72 4. Westminster 848 69 5. Bermondsey 490 46 6. Shoreditch 290 82 7. St. Pancras 558 30 8. Hampstead 124 16 9. Kensington 245 16 10. Marylebone 94 10 11. Deptford 96 9 12. Woolwich 100 8 18. Stepney 158 7 14. Hammersmith 84 7 The remaining 14 Metropolitan Boroughs had not erected or acquired any Working Class Tenements up to the end of 1913. The following table gives particulars of interest about the Industrial Dwellings in Chelsea. Total number of Rooms. Average number of occupants per room. Total Population. Associated. Selfcontained. Associated. Selfcontained. Associated. Selfcontained. Borough Council Dwellings 479 667 1.11 1.30 532 867 Trust or Company Dwellings 783 3001 1.36 1.39 1066 4172 Total 1262 3668 1.27 1.88 1598 5039 4930 1.35 6637 Associated Tenements are those which have a W.C. and washhouse common to more than one tenement, and self-contained tenements have each their own W.C. and scullery. The total population dwelling in Block Industrial Dwellings in Chelsea is 6.637, equal to 10.1 per cent. of the population of the Borough, and possibly to '25 per cent. of the working class population. 18 Housing, Town Planning, etc., Act, 1919. A survey made of the Borough in 1919 showed that approximately there were about 12 acres of vacant, unoccupied land in 12 plots, which might be utilised for purposes of housing. On the 23rd July, 1919, the Borough Council provisionally approved a scheme for housing 1,000 persons of the working classes, and for 500 other persons in houses not exceeding a rental of £80 per annum. The Public Health Committee asked the Government District Valuer to supply valuations of the land on the Cadogan Estate south of the Town Hall, south of Wellington-street, and east of Manor-street, also of the land south of King's-road, formerly occupied by Wimsett's Nursery garden. Mr. Charles Joseph, architect, was also asked to report on these sites, with a view to their suitability for the purpose of housing schemes. On the 17th December, 1919, the Borough Council appointed a Housing Committee, separate and distinct from the Public Health Committee, which had also for the past 20 years been a Housing Committee, the new Housing Committee to act as a Committee for the purpose of carrying out the provisions of the Housing of the Working Classes Acts, 1890 to 1919, and any amendments thereof, reporting, however, to the Council before taking action. The Council's resolution of the 16th July, 1919, appointing the Public Health Committee, a Committee for the initiation, consideration and negotiation of a scheme, or schemes, under the provisions of the Housing, Town Planning, etc., Act, 1919, was rescinded. In 1904, Sir Thomas More Buildings, Beaufort-street, was erected at a cost of £12,700 for land and conveyance, and £54,700 for buildings. The cost of erecting the buildings was £88 13s. 6d., per room. A loan was obtained from the London County Council for the £12,700 for the land at 3½ per cent., repayable in 60 years; and a loan was obtained from the Prudential Assurance Company, for the £54,700 for buildings, at £3 12s. 6d. per cent., also repayable in 60 years. At the present time the cost of erecting Industrial Block Dwellings in self-contained tenements is about £280 per room, as compared with £89 per room in 1904. The cost of erecting blocks of self-contained flats to be let at from £40 to £80 per annum is over £300 a room. A loan negotiated by the Borough Council for the erection of houses under a housing scheme at the present time would probably have to bear interest at 7 per cent. The costs of housing schemes in the County of London will be defrayed from the county rate, and any excess above 1d. in the £ on the county rate will be met by a government grant. In fixing the rentals of houses under the scheme, no account need be taken of one-third of the actual cost of construction, but the rentals should be calculated on two-thirds of the present costs, these being regarded under the circumstances as economic rents. These economic rents must necessarily be very much higher than anything now being paid for accommodation of a similar character under the restrictive regulations in force as to rents for houses under a rental value of £70 per annum. It can only be when the restrictions cease, and the rentals of houses are again fixed by the ordinary methods of supply and demand, that any light will be thrown on the question of whether the economic rents for the new houses can be obtained or not. 19 There can be no question that at the present time new houses for tho wage-earning and salaried classes are very much required as the congestion of population all over London is most serious, but the financial outlook for the new housing schemes is at present obscure. Sale of Food and Drugs Acts. Of the 400 samples taken for analysis in 1919, 108 were milk, 104 being genuine, and 4 adulterated, equivalent to 3.7 per cent. of the total milks examined, as against 13.8 per cent. in 1918, 8.1 per cent. in 1917, and 6.0 per cent. in 1916. Of the 4 adulterated samples, proceedings were taken in one case (4.1 per cent. of added water, and 16 per cent. of fat abstracted), and a fine of £2 was inflicted with 10s. 6d. costs. In two other cases (23.3 per cent. of fat abstracted, and 6.6 per cent. of fat abstracted) the vendors were protected by warranties, and no proceedings were taken, whilst in the other ease (3.8 per cent. of fat abstracted) the amount was insufficient for legal proceedings. The other samples were, coffee, 32 samples, 2 adulterated, namely 21 per cent. of chicory, fine, £1 and 10s. 6d. costs, and 16 per cent. of chicory, not taken under the Act; baking-powder, 36 samples, all genuine; rice, 33 samples, all genuine; oatmeal. 9 samples, all genuine; cocoa, 18 samples, all genuine; tapioca, 15 samples, all genuine; coffee mixtures, 4 samples (92, 82, 80 and 76 per cent. of coffee respectively); mustard, 9 samples, 5 samples being sold as mixtures, containing 30 to 15 per cent. of foreign starches; lard, 45 samples, all genuine; margarine, 45 samples, all genuine, but one, which contained 1.1 per cent. excess of water; beer, 18 samples, all genuine; and flour, 9 samples, all genuine. Work of the Public Health Department. The tabular statements prepared by the sanitary inspectors show that 1,256 separate premises were reported on by them during 1919, 346 of this number being with reference to cases of notifiable infectious disease, and 184 in the course of house-to-house inspections made in certain of the poorer streets of the Borough. Legal proceedings for breach of the Public Health (London) Act were taken in respect of nine premises. During the year, 345 premises were disinfected after cases of infections or other disease, including rooms which had been in occupation by persons suffering from tuberculosis. In addition 161 rooms were disinfected for the presence of bugs and other vermin, and were subsequently stripped and cleansed by the owners. Fourteen school children were reported by school-nurses to be in a verminous condition, and 28 visits to homes were paid in connection with these cases. Sixty visits to homes were paid in connection with scabies cases, 52 cases being in all reported. Workrooms. Number of workrooms inspected 282 „ „ measured 35 „ workroom cards given 51 ,, outworkers premises inspected 52 „ laundries inspected 35 „ factories inspected 23 20 SUMMARY OF NUISANCES AND OTHER MATTERS REPORTED ON AND WORK DONE DURING 1919. Houses and Premises:— House-to-house inspections 134 *Reported on respecting nuisances complained of 776 Reported on with reference to infectious cases 284 Reported on with reference to pneumonia, influenza, malaria, dysentery, trench fever 62 Cleansed, whitewashed and repaired 131 Defective roofs repaired 74 Disinfected after communicable diseases 209 Rooms disinfected for tubercular and other diseases 136 Rooms disinfected for verminous conditions 161 Cases of overcrowding abated 1 Dustbins provided 45 Ashpits demolished — Underground rooms occupied contrary to Act — Inspection of restaurant kitchens 96 „ slaughter houses 36 „ ice cream premises 50 „ milk shops 75 Drainage:— Drains opened, cleansed and made sound 30 Drains trapped with stoneware gullies 20 Water closets cleansed and repaired 64 Water closets, new pans and traps provided 27 Spout drains cleansed, repaired or renewed 14 Sink, bath, and lavatory waste pipes provided and repaired 11 Drains and soil pipes ventilated or repaired 6 Soil pipes, new, provided 15 Additional W.C. accommodation provided 3 Anti-Syphonage pipes provided to W.C 15 Water Supply:— To tenement houses (upper storeys) — For domestic purposes, provided where cut off by Water Board 7 For water-closets, or check cisterns provided and repaired 19 Main cisterns cleansed or repaired 7 „ new covers provided 11 „ new provided — Water certificates, issued in respect of newly erected dwelling houses — Nuisances Abated Arising from:— Keeping of animals 14 Accumulations of manure and other filth 24 Yard, areas, and wash-houses paved or drained 21 Smoke 3 21 Miscellaneous:— Dead bodies removed to public mortuary for sanitary reasons 1 Goods disinfected after infectious cases at station 445 Goods destroyed after infectious cases 593 Number of samples taken for analysis (Food and Drugs Act) 400 Special Cream samples (Milk and Cream Regulations — Unsound food, number of boxes of fruit, fish, rabbits condemned and destroyed see below Library books destroyed at Librarian's request 20 Animals destroyed in Incinerator 28 Proceedings Taken:— Statuary notices issued 113 Intimations issued for sanitary works, etc. 458 Water supply to tenement houses — Legal proceedings taken in respect of defective sanitary arrangements, nuisances, etc. 9 Legal proceedings taken in respect of food adulteration 2 Correspondence:— Number of letters written in connection with sanitary matters 635 Daily returns of infectious cases sent to Metropolitan Asylums Board 53 Notifications of infectious cases sent to Metropolitan Asylums Board 105 Notifications of infectious cases sent to school authorities 242 Entries in Inspectors Report Books 332 Entries in Inhabitants Complaint Book 26 Certificates of disinfection given 399 Certificates of infectious diseases for removal cases 131 Notices sent to Public Library of premises where infectious diseases has occurred 112 Post Cards sent re samples under Sale of Foods and Drugs Act 398 Food Condemned and Destroyed. Dates 1 box. Cheese 324 lbs. Kippers 10 boxes. Bacon 374 lbs. Herrings ½ barrel. Ducks 3. Haddock 1 trunk. Beef 7st. 4 lbs. Other Fish 2 boxes. Jam 511 lbs. Rabbits 141 and 61 lbs. Food Condemned. Milk (condensed) 19 tins. Butter 100 lbs. Eggs 952. Oatmeal 2 tons 10 cwts. 22 Premises. No. on Register at end of 1919. No. of Inspections. No. of prosecutions. Cowsheds — — — Milkshops 75 156 1 Houses let in lodgings — — — Ice Cream premises 21 30 — Slaughter-houses 3 36 — Offensive trades — — Smoke nuisances Number of observations 4 Number of nuisances and complaints 3 Number of notices 3 Number of Summonses — Cleansing:— Number of adults cleansed Number of children cleansed - Number of rooms or premises cleansed and disinfected 506 Sale of Food:— Number of premises used other than ice cream premises, milk shops 73 Number of Inspections 98 Disinfection shelter:— Persons accommodated:— Adults 26 Children 10 Mortuary:— Number of bodies received 74 No. of infectious bodies received — 23 MAGISTERIAL PROCEEDINGS DURING 1919 UNDER THE SALE OF FOOD AND DRUGS ACT. Street where purchased. Articles Purchased. Extent of Adulteration or Abstraction. Date of Hearing. Result. Coulson-street Coffee Contained 21% of chicory 16th March £1 fine, 10s. 6d. costs. Walton-street Milk 16% fat abstracted and 4.1% added water 16th March £2 fine, 10s. 6d. costs. 24 MAGISTERIAL PROCEEDINGS UNDER THE PUBLIC HEALTH (LONDON) ACT, 1891. Situation of Premises. Nature of Nuisance or Complaint. Petty Sessions. Date of Hearing. Result. 22, Christchurch-street Failing to comply with the Borough Council's notices to repair the defective roof Kensington 21 Jan. Work ordered to be done within 14 days. 55, ditto ditto ,, ditto ditto. Ashburnham Institute Animals (cats) kept so as to be a nuisance or injurious or dangerous to health ,, 15th April Prohibition order to cease keeping cats. 14, Limerston-street Foul and defective water closet ,, 15th April Fine £5; order to do work within 24 hours. 87, Caversham-street Defective roof, drains, gutters, etc., and verminous premises ,, 17th June Work to be done within a month. 22, Riley-street Dirty top rooms and dampness ,, 17th June Order within 14 days. 28, Netherton-grove Keeping fowls so as to be a nuisance or injurious or dangerous to health ,, 17 th June Adjourned for 1 month. 13, Sloane-street Failing to repair soilpipe and defective roofs ,, 18th Nov. £2 2s. costs; work to be done within 14 days. 18, Milmans-street Failing to exterminate vermin and cleanse and repair interior of premises ,, 18th Nov. Order for work to be done within 7 days.