Metropolitan Borough of Chelsea. ANNUAL REPORT For 1920 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 ROAD, CHELSEA, S.W.3. Metropoiitan Borough of Chelsea. ANNUAL REPORT I For 1920 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 ROAD, CHELSEA, S.W.3. LONDON: SHIELD AND SPRING, PRINTERS, LANCELOT PLACE, BROMPTON ROAD, S.W. 7 1921. TABLE OF CONTENTS. Page Population of Chelsea 3 Births and Birth-Rate 3 Notification of Births 3 Maternity and Child Welfare 4 Infant Mortality 4 Work of Health Visitors 5 Ante-Natal and Infant Clinics 5 Maternity Nurse and Midwife 6 Home-Help 6 Chelsea Day Nursery 6 Chelsea Red Cross Nursing Home for Infants 6 Chelsea Branch of I.C.A.A. 7 The Milk (Mothers and Childrens) Orders 7 Deaths and Death-Rate 8 Birth and Death-Rates of Special Classes 8 Infant Mortality Rates and Deaths, 1-5 years 9 Infectious Diseases 10 Influenza and Pneumonia 11 Tuberculosis 12 Chelsea Tuberculosis Dispensary 12 Encephalitis Lethargica and Cerebro-spinal Meningitis 13 Puerperal Fever and Ophthalmia Neonatorum 14 Venereal Disease diagnosis 14 Housing of the Working Classes 14 Sale of Food and Drugs Acts 15 Work of the Public Health Department 16 Summary of Work in 1920 17-19 Magisterial Proceedings 20-22 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1920. POPULATION OP CHELSEA. The population of the Borough may be estimated in 1920 as 68,500, allowing for the return of all demobilised men to their homes after the war. Births and Birth-Rate. In 1920, 1,468 births were registered in the Borough. Excluding 209 births of non-parishioners, and including 133 births taking place amongst Chelsea mothers in Lying-in Hospitals and Homes outside the Borough, the total number of births for the year was 1,392, the corresponding figure for 1919 being 874. The birth-rate for the year was 203 per 1,000, which is 7-0 per 1,000 above the rate for 1919, and 1-1 per 1,000 above the rate of 1914. The number of births in Chelsea in 1920 exceeded that of any year since 1909. The number of births in the four quarters of the year were as follows :—1st quarter, 348 ; 2nd quarter, 352 ; 3rd quarter, 289 ; 4th quarter, 270. It would appear, therefore, that the high birth-rate of 1920 is not likely to be maintained. The birth-rate of London for 1920 was 26-5 per 1,000. Notification of Births. Number. Living Children 1068 Still-born Children 28 1096 Notified by Medical Practitioners 394 „ St. George's Hospital 72 „ Midwives 463 „ Chelsea Workhouse 94 „ Parents, etc 85 1108 Deduct dual notification 12 1096 Total number of Chelsea births registered in the Borough 259 4 The notifications, therefore, formed 87 per cent, of the total live births of Chelsea residents registered in the Borough, as compared with 100 per cent, in 1919, 89 per cent, in 1918, 98 per cent, in 1917, and 91 per cent, in each of the years 1915 and 1916. The number of births notified by midwives in 1920 was 42 per cent, of the total, as against 46 per cent, in 1919. Illegitimate Births. Total number of illegitimate births 84 Alive at end of year 59 Dead at end of year 8 Unaccounted for 17 Maternity and Child Welfare. There were 73 deaths of infants under one year of age in Chelsea in 1920, equivalent to an Infant Mortality Rate of 52 per 1,000 Births. This is the lowest rate ever recorded in the Borough. The rates in recent years have been as follows :—1919, 87; 1918, 91; 1917, 82 ; 1916, 91 ; 1915, 100 ; 1914, 67. The rate of 52 is only about one-third of the rate prevailing in Chelsea prior to 1905, when the first attempt was made to control infantile mortality by the appointment of a woman health officer. In London, in 1920, the rate of Infant Mortality was 75, and in England and Wales the rate was 80. The low rates of Infant Mortality in 1920 are in part due to the absence of extreme temperatures in that year, both in summer and winter, and to the very slight prevalences of such diseases as measles, whooping cough, infantile diarrhoea, influenza, bronchitis, and pneumonia, which always have, when prevalent, such serious results for infants. The following tabular statement gives an outline of the work carried on in Chelsea during 1920 (53 weeks), the visits being those paid by the trained 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 1920. Number of homes visited (first visits) Infants 974 „ revisits, Infants 2120 „ Infants' attendances at Infant sultations 3281 „ visits to Children of one year to School age 127 „ revisits, ditto 2897 „ Children of one year to School age, attendances at medical spections 947 „ Ante-natal visits to expectant mothers 820 „ Ante-natal case attendances at ante-natal clinic 405 5 Number of Visits to Diarrhcea cases amongst children 79 „ Cases of Diarrhcea found 31 „ Visits to cases of Ophthalmia natorum 37 General additional visits in connection with the work 968 As compared with 1919, there were 1,391 more infant attendances at infant consultations ; 38 more attendances of children of one year to School age at medical inspections ; 8 fewer attendances of ante-natal cases at the ante-natal clinic, whilst the ante-natal home visits were increased by 11. The number of home visits to infants and children of one year to School age exceeded by 1,156 the numbers in 1919. The work of the clinics continues to grow, especially in the attendances of infants at the consultations, due very largely to the greatly increased number of births in 1920. This has necessitated an increase in the number of medical officers for the clinics, there being now four lady doctors engaged in this work, who are especially skilled in the work of maternity and child welfare. The working of the clinics in 1920 is set out below :— 49, Sydney-street :— Dr. Dearnley Tuesday afternoon. Dr. Howard Tuesday afternoon—from November. Dr. Pinkerton Thursday afternoon. Dr. Rorke Wednesday afternoon—ante-natal. 484, King's-road :— Dr. Dearnley Monday afternoon. Dr. Pinkerton Monday afternoon. With the approval of the Ministry of Health, the Borough Council made financial grants for the year commencing 1st April, 1920, as follows :— Chelsea Health Society and School for Mothers £ 450 Bed Cross Nursing Home for Babies, Edithterrace 400 Chelsea Branch of Invalid Children's Aid Association 80 Chelsea Day Nursery, 65, Sydney-street 100 Convalescent Homes for Nursing Mothers and Infants 32 £1062 Half this amount, namely £531, is recovered as a grant from the Ministry of Health. The Borough Council also decided, with the approval of the Ministry of Health, to make an annual grant of £50 to the Chelsea District Nursing Association. 6 Maternity Nurse.—The number of necessitous women provided with a maternity nurse under the Council's scheme for confinements during 1920, was 44, as against 60 in 1919. Thirty-five of the cases were attended by the Ormond Home for 51 id wives, and 9 by Midwife Andrews. Midwife.—The number of necessitous women provided with a midwife under the Council's scheme during 1920 was 25,10 being attended by the Ormond Home for Midwives, 14 by Midwife Andrews, and one by Midwife McAuliffe. The total amount paid to Maternity Nurses and Midwives during the year was £82 Is. 6d., and the amount received as contributions from patients was £39 0s. 6d., leaving a balance of £43 Is., half of which will be recovered as a grant from the Ministry of Health. During 1920, 5 notifications were received from midwives under the Midwives Acts, 1902 and 1918, of the substitution of artificial feeding for breast feeding for various reasons. Home-Help.—On the 13th October, 1920, the Council appointed a Home-Help to attend maternity cases amongst necessitous women in the Borough, the functions of the Home-Help being to attend to the domestic duties of the household during the lying-in period, but not to act as a midwife or maternity nurse. The wages were fixed at £2 a week for a week of 44 hours, with suitable out-door uniform and overalls, but without food or food allowance. The engagement to be terminated at one month's notice, and not to be subject to the provisions of the Chelsea Borough Council (Superannuation and Pensions) Act, 1914. From the time of appointment until the end of the year, 1920, the Home-Help attended 3 cases. The contributions received from the patients amounted to £3, these being the amounts assessed by the Maternity and Child Welfare Sub-Committee. Chelsea Day Nuriery, 65, Sydney-street. The Chelsea Day Nursery was open throughout the year, except for a period of 2 weeks in the spring. The total number of attendances of children for the year was 5,304, which gives an average daily attendance of 21. Dr. C. J. Harrison acted as Honorary Medical Officer of the Day Nursery throughout the year, but resigned in December. Dr. Norah Pinkerton was appointed as Medical Officer on Dr. Harrison's resignation. Convalescent Homes. Seventeen nursing mothers, with their infants, were sent away to convalescent homes in the course of the year. Chelsea Bed Cross Nursing Home for Babies, Edith-terrace. The Home was opened for the reception of patients on the 19th January, 1920. Dr. A. C. D. Firth, Physician to the Victoria Hospital for Children, is the consulting physician. The visiting physicians are Dr. C. M. Anderson, Dr. E. V. Dunkley (resigned October, 1920), and Dr. Folliott Yaughan (appointed October, 1920). The nursing staff consists of a 7 sister-in-charge, two staff nurses, four resident V.A.D. probationers, and daily V.A.D. assistants. Mrs. Wilson Fitzgerald is the V.A.D. Commandant. There are fourteen cots in four wards. The Home is intended for cases of malnutrition, wasting, and other enfeebling diseases in infants and young children, who are in need of institutional treatment, but are not accepted by children's hospitals, or in ordinary children's wards. Moribund cases, infectious cases, cases of acute illness, or of acute diarrhoea and vomiting are not admitted to the Home. Sixty-five cases in all were admitted during the first year. Fifty of the children were infants under one year, and 15 slightly older children. Of the total 65 cases, 36, or 55 per centl were Chelsea residents, and 29, or 45 per cent., were residents of other districts. The conditions for which the children were admitted may be summarised as follows :—Marasmus or Wasting, 39; Bickets, 7; Aftereffects of Bronchitis and Broncho-pneumonia, 5; other illnesses, 14. As the result of treatment of these 65 cases, 16 were discharged "improved" or "satisfactory"; 16 were transferred on discharge to convalescent homes or other institutions; 10 were only a few days in the Home; 11 died; and 12 remained in the Home. Six of the fatal cases were only in the Home for a short period—three weeks or under. Chelsea Branch of the Invalid Children's Aid Association. During 1920 the Tuberculosis Care Committee referred to the Chelsea Branch of I.C.A.A. 102 cases needing convalescence or care. Of this number 70 received convalescent treatment in the country or at the sea-side, the length of treatment varying from one to six months. At the request of the Tuberculosis Care Committee the Chelsea Branch visited 21 cases of children, treated under the London County Council Tuberculosis scheme, to collect and forward to the Council the parents' contributions. The Milk (Mothers' and Children's) Orders, 1918, 1919. During the year 1920 the number of applications for milk, including renewals, granted by the Sub-Committee, were as follows:—1st quarter, 546; 2nd quarter, 626; 3rd quarter, 497; 4th quarter, 671; total for year, 2,340. The approximate total cost for the year was £1,515, namely, 1st quarter, £372; 2nd, £359; 3rd, £299; 4th, £485. In 1919 the total sum expended was £342. The Borough Council will receive a grant from the Ministry of Health of half the cost incurred. The grants were usually made for cows' milk to be supplied by dairymen at less than current retail price, but in some cases the grants were made for milk free of cost to the applicants. Milk is not supplied free of charge or under cost price to families when the income exceeds (after deducting, from the total income, rent and insurance payments), the following standard, viz. :— lis. per head per week for families of five or less ; 10s. 6d. per head per week for every additional member over five. 8 Free milk is supplied when the total income of the family does not exceed 5s. per head per week. When the total income of the family exceeds 5s. per head per week, but does not reach the maximum limit as stated above, a reduction in price is made of from 4d. per pint to Id. per pint. In every case the head of the family is required to sign a statement as to the wages earned weekly, before a grant of milk is made, and this statement is, as far as possible, verified. The amount of milk allowed in 1920, to be supplied under the orders was as follows :— For children under 18 months .. .. 1£ pints daily. For children between 18 months and 5 years 1 pint daily. For nursing and expectant mothers—the quantity prescribed by the person certifying. The current retail prices of milk in London in 1920 were as follows : Per quart: January, 1s.; February and March, lid.; April, 10d.; May to September, inclusive, 8d.; October and November, 10d.; December, lid. Deaths and Death-Rate. There were 778 deaths of Chelsea residents in 1920, as compared with 925 in 1919. The death-rate for the year was 11*3 per 1,000, as against 14-1 in 1919, 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 1920, as compared with 1919 and 1918, is due to a much lessened mortality from influenza, the deaths in 1920 from this disease being only 10, as against 104 in 1919, and 284 in 1918. The deaths from pneumonia were practically the same (49), as in 1919 (50), but considerably less than in 1918, when they numbered 82. In London the death-rate for 1920 was 12-4 per 1,000. Birth and Death-Kates of Special Classes. Chelsea Borough. Year Birthrate Deathrate Zynwtic Deathrate Tubereula Deathrate r Deaths under one year to 1000 Births. 1920 20.3 11.8 0.4 1.2 52 1917-19, .. average. 13.5 15.3 0.7 1.5 86 Industrial Dwellings. 1920 26.2 9.6 0.7 1.2 40 1917-19, .. average. 16.0 12.9 0.7 2.1 74 Poor-class Streets. 1920 35.9 10.1 0.9 1.4 56 1917-19, .. average. 17.5 15.8 2.0 1.4 115 9 From the above table it will be seen how greatly the birth.rate increased and the death.rate diminished in 1920, as compared with the averages of the three previous years. The Borough Council 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 Peabodv Buildings, Chelsea Park Dwellings, Sutton Trust Dwellings, and Lewis Trust Dwellings, with a total population of 5,300. The seven poor.class streets are Dartrey.road, Francis. street, Gilray.square, Ives.street, Biley.street, Slaidburn.street, World's End.passage and Courts adjacent, with a total population of 3,480. Infantile Mortality Bates and Deaths, One to'Five Years. The following table shows the average Infantile Mortality Rates in 4-yearly periods in Chelsea since 1901, and the average number of annual deaths in these periods of children one to five years of age; also similar figures for the year 1920:— Infantile Mortality Deaths. Years. Rate 1-5 Years 1901-4 140 112 1905-8 119 88 1909-12 ... 97 71 1913-16 ... 87 56 1917-20 ... 78 47 1920 52 24 The following table gives the Infantile Mortality Bates in Chelsea under various headings, for five 4.yearly periods :— Infantile Mortality Rates. 1901-4 1905-8 1909-12 1913-16 1917-20 1920 Infectious Diseases 10.0 11.5 8.0 6.2 5.0 1.4 Diarrhoeal Diseases 23.5 26.0 18.0 16.4 12.2 5.0 Developmental Defects and Wasting 48.0 37.0 34.5 28.2 31.9 27.3 Other Causes 58.0 44.0 36.0 36.6 28.9 18.7 Total Rate 140.0 119.0 97.0 87.0 78.0 52.0 Infantile Mortality Bates in Wards. Wards Average of 9 years, 1912-20 1920 Hans Town 68 49 Boyal Hospital 64 36 Church 92 56 Chevne 64 38 Stanley 91 60 Chelsea Borough 81 52 10 Five-yearly Average Number of Annual Deaths, 1-5 years. Infectious 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 1916-20 13 3 6 12 14 47 1920 9 2 4 5 4 24 Infectious Diseases. Measles. Measles caused 8 deaths in 1920, as compared with 7 in 1919, 14 in 1918, 6 in 1917, 5 in 1916, and 39 in 1915. All the 8 deaths in 1920 were of children under five years of age. The compulsory notification of measles and German measles ceased on the 31st January, 1920. The Woman Sanitary Inspector and the Health Visitor in the course of the year made 271 visits to homes in connection with Measles cases. In accordance with the arrangement made with the Chelsea District Nursing Association, 93 visits were made by the Association's Nurses to ten families who had a child or children ill with measles. The average number of visits per family was 9, as against 12 in 1919 and in 1918. In 1919, when measles was notifiable, 594 visits were made by nurses to measles cases. In the course of the year 1920, 38 cases of measles were removed to hospital. Scarlet Fever. During the year, 191 cases of scarlet fever were notified in Chelsea, as against 148 in 1919, and 67 in 1918. There were two deaths from this disease, the case mortality being 1-0 per cent.; 97 per cent, of the cases were removed to hospital. The disease maintained a rather high prevalence throughout the year, except in July (8 cases) and August (4 cases). The percentage of cases of school-age (3 to 13 years), was 69, as against 77 in 1919. Diphtherui. During the year, 148 cases of diphtheria were notified in Chelsea, as against 71 in 3 919, and 47 in 1918. The disease caused 7 deaths in 1920, the case mortality being 4-7 per cent., as compared with 9-9 per cent, in 1919, and 10-6 per cent, in 1918 ; 90 per cent, of the cases were removed to hospital. The percentage of cases of school age (3 to 13 years) was 65, as against 70 in 1919, and 53 in 1918. The months of greatest prevalence were October, 21 case3, November, 21 cases, and December, 18 cases. During the year medical practitioners sent 90 throat or nose swabbings to the Lister Institute for bacterioscopic diagnosis, as compared with 68 in 1919. Of the 90 specimens 32, or 36 per cent., afforded positive evidence of the diphtheria bacillus, and 58, or 64 per cent., were negative, the corresponding figures for 1919 being 21 per cent, and 79 per cent. 11 Enteric Fever. The number of cases of enteric fever notified in Chelsea in 1920 was 5, as against 2 in 1919. There was one death. Three of the cases were removed to hospital. One of the cases arrived in Chelsea, ill of the disease, from East Africa. In one case the cause of the illness was attributed to water-cress. Four specimens of blood were examined for the Widal reaction, and all proved negative. Paratyphoid Fever. Three cases of paratyphoid fever were notified in 1920, as against 5 in 1919. All three cases were removed to hospital. There were no deaths. In one case the disease was probably contracted in Sussex. In another case—a boy of 13 years—the father was stated to have had paratyphoid when in Salonica. One blood examined showed the presence of paratyphoid B. organism. Diarrhoea and Enteritis. The deaths in Chelsea from diarrhoea and enteritis in 1920 were 12, 7 being infants under one year of age, 3 being children of one to five years, and two being adults. None of the deaths occurred in the third or summer quarter of the year. In 1919 there were 17 deaths from these diseases, and in 191B 11 deaths. In connection with these diseases, 79 visits were made to homes, and 31 cases were as a result, discovered. There was one death from dysentery of a Chelsea resident, which occurred outside the Borough. Malaria. Two cases of malaria in ex-soldiers were notified in 1920. In one case the first attack was in India six years ago ; in the other the first attack was in Mesopotamia in 1916. This latter patient returned home in October, 1919, and remained almost continually under military treatment until May, 1920. He was notified in that month. Small-pox. In January a sergeant in the B.A.M.C., who lived in Chelsea, was notified as suffering from small-pox, and was removed to hospital. In May a student at Whiteland's College was notified. She was removed to the M.A.B. South Wharf on the 10th May, but was sent to the London Fever Hospital on the 12th May as a case of measles. As a precautionary measure all the contacts of the case at the college, and a considerable proportion of the students and staff were re-vaccinated. Influenza. Influenza caused only 10 deaths in Chelsea in 1920, as against 104 in 1919, and 234 in 1918. In London there were 1,364 deaths in 1920, of which number all but 219 occurred in the first six months of the year. In 1919 there were 4,222 deaths from this disease in London, and in 1918 there were 12,927 deaths. Only three cases of influenzal pneumonia were notified in Chelsea in the year. The Nurses paid 138 visits to eight patients suffering from influenzal pneumonia, the average number of visits per patient being 17.- 12 Pneumonia. Pneumonia and broncho-pneumonia caused 49 deaths in Chelsea in 1920, as against 58 in 1919, and 82 in 1918. Five cases of acute primary pneumonia in males, and 14 cases in females were notified in Chelsea during the year. The Nurses paid 171 visits to 13 patients suffering from pneumonia, the average number of visits per patient, being 13. In London there were 5,338 deaths from pneumonia in 1920, as against 4,597 in 1919, and 7,485 in 1918. The deaths from pulmonary tuberculosis in 1920 numbered 73 (41 males and 32 females), as against 67 in 1919. Other tuberculous diseases caused 11 deaths (2 males and 9 females), as against 22 in 1919. Of the pulmonary tuberculosis cases ending fatally, 41 per cent, died in the Chelsea Infirmary, and 30 per cent, in other public institutions, that is to say, 71 per cent, died away from their homes, the corresponding figure for 1919 being 64 per cent. During the year 1920, 119 new cases of pulmonary tuberculosis were notified, as against 113 in 1919. Fortyeight specimens of sputum were sent by medical practitioners to the Lister Institute for examination, as against 75 in 1919. Of the 48 specimens, 19 per cent. were positive for tubercle bacilli, and 81 per cent, were negative, practically the same proportions as in 1919. A considerable number of patients received hospital and 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 114. The total number of visits paid in respect of all cases of tuberculosis and suspected tuberculosis was 1,052. The Borough Council lent beds and bedding to three cases in the course of the year. Twenty-two new cases of non-pulmonary tuberculosis were notified in 1920. Several cases were helped to obtain proper surgical treatment in hospitals, and others were 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 Invalid Children's Aid Association. Tuberculosis. Chelsea Tuberculosis Dispensary, Brompton Hospital. Work done during 1920. Number of persons examined for the first time :— Insured 135 Uninsured 456 591 Number of persons suffering from :— Tuberculosis 70, or 12 per cent. Doubtful diagnosis 174, or 30 per cent. Not Tuberculosis 347, or 58 per cent. 13 Total attendances at Dispensary:— Insured 1452 Uninsured 2389 3841 Visits to homes of patients by Medical Officer :— Insured 6 Uninsured 11 17 Visits to homes of patients by Dispensary Nurses :— Insured 834 Uninsured 2199 3033 Number of written reports concerning individual patients made to :— Public Authorities 317 Practitioners 34 351 Number of examinations of sputum :— Insured 301 Uninsured 260 561 Number of X-ray examinations of patients 41 Encephalitis Letliargica. Three cases of this disease were notified in Chelsea in 1920, namely : male, 34 years ; male, 36 years ; female, 50 years. Two of the cases were removed to hospital. The female made a complete recovery. One of the males made a fairly good recovery ; but the other, after the lapse of a year, is still suffering from some paresis of the lower limbs and tremors of one hand. In London in 1920, 113 cases of this disease were notified, as against 63 in 1919. There were cases in every metropolitan Borough, except Finsbury and the City. The largest number of cases occurred in Wandsworth (13), Stepney (11), and Battersea (9). Fifty-five of the cases were males, and 58 females. The ages were :—under 15, 28 cases; 15-45, 73 cases; over 45, 12 cases. The deaths were 29: males, 14; females, 15; which gives a mortality rate of 26 per cent.; but it is probable that other deaths occurred after the notifications were received. The latest return from the Ministry of Health shows that about half, 54 per cent., of the undoubted cases of encephalitis lethargica have a fatal ending, and the illness may be very prolonged before death occurs. Cerebro-Spinal Meningitis. Only one case of this disease was notified in Chelsea in 1920. The patient, a girl of 17 years, was removed to hospital, and died there ten days after admission, but the P.M. examination showed that the disease 14 was tuberculous meningitis. Six examinations for meningococci were made at the Lister Institute in 1920, all proving negative. In London 160 cases of cerebro-spinal meningitis were notified in 1920, as against 205 in 1919, and 231 in 1918. Polio-Myelitis and Polio-Encephalitis. No cases of either of these diseases were notified in Chelsea in 1920. In London 48 cases of polio-myelitis were notified, against 101 in 1919, and 50 in 1918; 6 cases of polio-encephalitis were notified in London in 1920. Puerperal Fever. Eight cases of puerperal fever were notified in Chelsea in 1920, as against 3 in 1919. All the cases occurred in the first half of the year. There were 2 deaths. All but one of the cases were removed to hospital or to the Infirmary. Ophthalmia Neonatorum. Seventeen cases of this disease were notified in Chelsea in 1920, as against 13 in 1919. An additional three cases of eye trouble in infants, which were not notified, were visited, 35 visits in all being made by the Health Visitors. Ten cases were attended by District Nurses, 314 visits being paid to the homes, which gives an average of 31 visits per case. Of the total 20 cases, 18 made complete recoveries, 1 made incomplete recovery, and 1 infant remained blind of one eye. Non-notifiable Illnesses. The District Nurses paid 743 visits to the homes of expectant and nursing mothers and children under 5 years of age, during the year 1920, to attend to cases of bronchitis, worms, ear and nose discharges, septic wounds, mammary abscess, and other minor illnesses. Work of the Lister Institute : Venereal Disease. Five specimens of pus were examined for the gonococcus in 1920, two being positive and three negative, and 3 samples of blood for the Wassermann (syphilis) reaction, all being negative. The facilities afforded by the Borough Council, free of cost, in this connection, have so far been but little utilised by medical practitioners. Housing of the Working Classes. Housing, Town Planning, etc., Act, 1919, Section 28. During the year 1920, notices under this Section were served upon the owners of 24 houses to execute such works as may be necessary to make the houses in all respects reasonably fit for human habitation. In the case of 22 of the houses, the required works were carried out by the owners in accordance with the specifications prepared for each house. In the case of two houses belonging to one owner, the notices were not 15 complied with, and the work was done in respect of these two houses by a contractor on behalf of the Borough Council at a cost of £67. At the end of the year a re-inspection of houses on the estate of the Cadogan and Hans-place Estate Company was made, the houses being in the following streets Little Orford-street, Orford-street, Woodstreet, Leverett-street, Denyer-street, Green-street (s. side), Francisstreet, and Oakham-street. Most of these houses were inspected in June, 1919 (see Annual Eeport for 1919, p. 15). As a result of this inspection in 1920 of 159 houses, 180, or 82 per cent, were found to have defects as to sanitary conditions or want of repair, and in 19, or 12 per cent., there were minor defects of a less serious character. The owners of the Estate Company were communicated with, a complete list of the houses and defects being forwarded. As the result of an interview on the 17th February, 1921, between the representatives of the Company and the Town Clerk and Medical Officer of Health, the latter were informed that the defects ascertained to exist were being proceeded with as fast as possible, and that practically the whole revenue of the Estate, with the exception of establishment charges, was, and for some time past, had been devoted to necessary repairs to the houses on the Estate. By resolution of the Borough Council of the 17th December, 1919, the administration of the provisions of the Housing of the Working Classes Acts, and Housing and Town Planning Acts, 1890 to 1919, and any amendments thereof, were transferred from the Public Health Committee to a newly appointed Housing Committee, the executive functions being placed in the hands of the Surveyor's Department. New housing schemes have been under the consideration of the Housing Committee since the end of the year 1919. Sale of Food and Dbugs Acts. Of the 398 samples taken for analysis in 1920, 126 were milk, 121 being genuine, and 5 adulterated, equivalent to 4-1 per cent, of the total milks examined, as against 3-7 per cent, in 1919, 13-8 per cent, in 1918, 8-1 per cent, in 1917, and 6-0 per cent, in 1916. Of the 5 adulterated samples, proceedings were taken in two cases, namely, 13-7 per cent. of added water, vendor fined £5 and £1 lis. 6d. costs; 7 per cent. of fat abstracted, vendor fined £1 and 10s. 6d. costs. In the three other cases, the amounts of adulteration were considered insufficient for legal proceedings, namely, 5.3 per cent. of fat abstracted; 2.3 per cent. of fat abstracted, and 2.6 per cent. of added water; and 4.7 per cent. of fat abstracted. The vendors of these samples were cautioned. The other samples were, butter, 19 samples, all genuine; margarine, 27 samples, all genuine; oatmeal, 18 samples, all genuine; coffee, 34 samples, all genuine; coffee mixtures, 11 samples, all genuine; sago, 9 samples, all genuine; rice, 19 samples, all genuine; lard, 36 samples, all genuine; cornflour, 9 samples, all genuine: rice cornflour, 1 sample, genuine; mustard, 6 samples, all genuine; mustard mixtures, 3 samples, all genuine ; sugar, 17 samples, all genuine, and 9 samples, genuine, but containing traces of iron salts, so as to be unsuitable for use in tea; cocoa, 27 samples, all genuine; baking powder, 9 samples, all genuine; tea, 9 samples, all genuine; and pepper, 9 samples, all genuine. 16 Work of the Public Health Department. The tabular statements prepared by the Sanitary Inspectors show that 2,419 separate premises were reported on by them during 1920, 407 of this number being with reference to cases of notifiable infectious disease, and 344 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 9 instances, involving 22 separate premises. During the year 443 premises were disinfected after cases of infectious or other disease, including 141 rooms which had been in occupation by persons suffering from tuberculosis. In addition 387 rooms were disinfected for the presence of bugs and other vermin, and were subsequently stripped and cleansed by the owners. Eleven school children were reported by school-nurses to be in a verminous condition, and 12 visits to homes were paid in connection with these cases. Seventy-eight cases of scabies were reported during the year, and 85 visits to homes were paid in connection with these cases. Eighty-five baths were given to scabies cases at the Disinfecting Station. Workrooms (Women Employees). Number of workrooms inspected 424 „ workrooms measured 53 „ workroom cards given 86 „ outworkers premises inspected 68 „ laundries inspected 65 „ factories inspected 43 The Woman Sanitary Inspector also paid 58 visits to homes in consequence of complaints received as to old age pensioners living under neglected and insanitary conditions. 17 SUMMARY OF NUISANCES AND OTHER MATTERS REPORTED ON AND WORK DONE DURING 1920. Houses and Premises :— House-to-house inspections 344 *Reported on respecting nuisances complained of 1638 Reported on with reference to infectious cases 407 Reported on with reference to pneumonia, influenza, malaria, dysentery, trench fever 30 Cleansed, whitewashed and repaired 533 Defective roofs repaired 180 Disinfected after communicable diseases 302 Rooms disinfected for tubercular and other diseases 141 Rooms disinfected for verminous conditions 387 Cases of overcrowding abated 3 Dustbins provided 199 Ashpits demolished — Underground rooms occupied contrary to Act — Inspection of restaurant kitchens 61 „ slaughterhouses 36 „ ice cream premises 46 „ milk shops 150 Drainage :— Drains opened, cleansed and made sound 48 Drains trapped with stoneware gullies 8 Water closets cleansed and repaired 121 Water closets, new pans and traps provided 38 Spout drains cleansed, repaired or renewed 96 Sink, bath, and lavatory waste pipes provided and repaired 76 Drains and soil pipes ventilated or repaired 32 Soil pipes, new, provided 6 Additional W.C. accommodation provided 5 Anti-Syphonage pipes provided to W.C 2 Water Supply :— To tenement houses (upper storeys) 13 For domestic purposes, provided where cut off by Water Board 4 For water-closets, or check cisterns provided and repaired 65 Main cisterns cleansed or repaired 50 „ new covers provided 15 „ new provided 1 Water certificates, issued in respect of newly erected dwelling houses — Nuisances Abated Arising prom :— Keeping of animals 7 Accumulations of manure and other filth 22 Yard, areas, and wash-houses paved or drained 16 Smoke 1 18 Miscellaneous :— Dead bodies removed to public mortuary for sanitary reasons 9 Goods disinfected after infectious cases at station 1575 Goods destroyed after infectious cases 21 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 24 Animals destroyed in Incinerator 2 Proceedings Taken :— Statutory notices issued 387 Intimations issued for sanitary works, etc. 887 Water supply to tenement houses 13 Legal proceedings taken in respect of defective sanitary 24 arrangements, nuisances, etc. Legal proceedings taken in respect of food adulteration 2 Correspondence :— Number of letters written in connection with sanitary matters 699 Daily applications for removal of infectious cases sent to Metropolitan Asylums Board 22 Notifications of infectious cases sent to Metropolitan Asylums Board 142 Notifications of infectious cases sent to school authorities 308 Entries in Inspectors Report Books 834 Entries in Inhabitants Complaint Book 53 Certificates of disinfection given 528 Certificates of infectious diseases for removal cases 180 Notices sent to Public Library of premises where infectious diseases have occurred 146 Post Cards sent re samples under Sale of Foods and Drugs Act 398 Food Destroyed. Dates 1 box Rabbits 226 lbs. Milk 4 tins Cheese 80 lbs. Beef 64 St. 2 lbs. Mutton 96 lbs. Fish 2 trunks Food Condemned. Butter 116 lbs. Corned Beef 18 lbs. Potatoes 1 barrel 19 No. on Register No. of No. of Premises. at end of 1920. Inspections. prosecutions. Cowsheds — — — Milkshops 66 150 2 Houses let in lodgings — — — Ice Cream premises 17 17 — Slaughter-houses 3 40 — Offensive trades — — — Smoke nuisances :— Number of observations 2 Number of nuisances and complaints 2 Number of notices 2 Number of Summonses — Cleansing :— Number of adults cleansed 52 Number of children cleansed 30 Number of rooms or premises cleansed and disinfected 1061 Sale of Food :— Number of premises used other than ice cream premises, milk shops 70 Number of Inspections 70 Disinfection shelter :— Persons accommodated Adults 21 Children 16 Mortuary :— Number of bodies received 95 Number of infectious bodies received 2 20 21 MAGISTERIAL PROCEEDINGS UNDER PUBLIC HEALTH (LONDON) ACT, 1891. Situation of Premises. Nature of Nuisance or Complaint. Petty Sessions. Date of Hearing. Result. 182, Sloane-street Failing to comply with the provisions of an abatement and prohibition order made 18th November, 1919 Kensington 20 Jan. £10 fine and £2 2s. costs 43, Lamont-road Failing to comply with the Borough Council's notices to provide gutters and stack pipes and repair roof, and repair and cleanse basement rooms Kensington 16 March Order for works to be completed within 21 days Ditto Summons for non-compliance with above Order Kensington 20 April Penalty, 10s. per day for 9 days, viz., £4 10s. 18,20, 21,22,24,26, Gillray-square Failing to comply with the Borough Council's notices to execute sanitary repairs Kensington 15 June (No. 18), order for works in 10 days, the remainder within 8 weeks 9,11,13,15,17,19, Milman's-street Ditto ditto Kensington 15 June Adjourned sine die Marlborough House, Vicat-street Want of refuse accommodation Kensington 15 June Withdrawn, bin provided 30, Denyer-street Failure to comply with notices to strip and cleanse interior of premises, repair roof, yard Kensington 19 Oct. Adjourned to next meeting 15, Green-street face and floor To strip, cleanse and repair the premises and exterminate vermin Kensington 19 Oct. Order for works in 14 days 21, Green-street To provide dust bin, repair roof and seat to W.C., and cleanse, etc., first floor back room, passages and staircase, and exterminate vermin Kensington 19 Oct. Order for works in 21 days 28, Green-street Failing to comply with the Borough Council's notices to provide W.C. pan, repair roof, gutters and stack pipes to main and wash-house roofs Kensington 19 Oct. Order for works in 14 days 164, Sloane-street To repair roof Kensington 19 Oct. Order for works in 21 80, Denyer-street Adjourned hearing re sanitary repairs Kensington 2 Nov. LldJ O Order to prohibit the use for human habitation within one month 21, Henniker-mews Failing to strip and cleanse walls and ceiling of bedroom and ceilings of landing and living room Kensington 2 Nov. Order to execute work within 14 days 71, Edith-grove Failing to strip and cleanse interior of premises and repair roof Kensington 2 Nov. Order for works within a month 22 MAGISTERIAL PROCEEDINGS DURING 1920 UNDER THE SALE OF FOOD AND DRUGS ACT. Street where purchased. Articles Purchased. Extent of Adulteration or Abstraction. Date of Hearing. Result. Langton-street Milk Contained 13.7 per cent, added water 20th July £5 fine, £1 lis. 6d. costs. Green-street Milk 7 per cent, fat abstracted 19th Oct. £1 fine, 10s. 6d. costs.