CHE 26 Metropolitan Borough of Chelsea. Annual Report for 1921 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 1922. 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 4 Ante-Natal and Infant Clinics 5 Maternity Nurse and Midwife 6 Home-Help 6 Chelsea Day Nursery 7 Chelsea Red Cross Nursing Home for Infants 7 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 8 Infectious Diseases 9 Influenza and Pneumonia 12 Tuberculosis 12 Chelsea Tuberculosis Dispensary 13 Cancer and deaths in Asylums 14 Encephalitis Lethargica and Cerebro-spinal Meningitis 14 Puerperal Fever and Ophthalmia Neonatorum 15 Venereal Disease Diagnosis 16 Sale of Food and Drugs Acts 16 Housing of the Working Classes 17 Work of the Public Health Department 19 Summary of Work in 1921 20 Magisterial Proceedings 23-24 Annual Report of the Medical Officer of Health for the year 1921. POPULATION OF CHELSEA. The following Table shows the census populations of the Borough of Chelsea in 1911 and 1921 :— 1911 1921 Decrease Males 28470 25809 2661 Females 37915 37891 24 Person 66385 63700 2685 Whilst the female population is practically the same in 1921 as in 1911 there has been a decrease in the male population of 2,661, which is presumably the result of the wastage of the great war. The number of males of military age who served with the military and naval forces was 5,370, so that the wastage has been 50 per cent. The estimated population for the middle of 1921 is 64,290 (Registrar-General's estimate). Births and Birth-Rate. In 1921, 1,072 births were registered in the Borough. Excluding 143 births of non-parishioners, and including 128 births taking place amongst Chelsea mothers in Lying-in Hospitals and Homes outside the Borough, the total number of births for the year was 1,057, the corresponding figure for 1920 being 1,392. The birth-rate for the year was 16.6 per 1,000, which is 3.7 per 1,000 below the rate for 1920. The birth-rate of London for 1921 was 22.3 per 1,000, as compared with 26.5 per 1,000 in 1920. Notification of Births. Number. Living Children 864 Still-born Children 26 890 4 Notified by Medical Practitioners 231 „ St. George's Hospital 22 „ Midwives 504 „ Chelsea Workhouse 69 „ Parents, etc. 65 891 Deduct dual notification 1 890 Total number of Chelsea births registered in the Borough 929 The notifications, therefore, formed 93 per cent. of the total births of Chelsea residents registered in the Borough, as compared with 87 per cent. in 1920. The number of births notified by midwives in 1921 was 57 per cent. of the total, as compared with 42 per cent. in 1920. Illegitimate Births. Total number of illegitimate births 49 Alive at end of year 39 Dead at end of year 6 Unaccounted for 4 Maternity and Child Welfare. There were 83 deaths of infants under one year of age in Chelsea in 1921, equivalent to an Infant Mortality Rate of 78.5 per 1,000 Births, as compared with 52 per 1,000 in 1920, which was the lowest rate ever recorded in the Borough. In London, in 1921, the rate of infant mortality was 80, and in England and Wales 83. The number of births of Chelsea infants in outlying institutions in 1921 was 128, or 12.1 per cent. of the total births. This is the largest percentage yet recorded, the previous highest percentage being 11.2 in 1919. The increased resort to Lying-in Hospitals and Homes has been apparent since the first year of the War, 1914. The average percentage for the 6 years preceding the war was only 5.5 per cent.The births in the Chelsea Workhouse in 1921 were 46, or 4.4 per cent. of the total, the average for the preceding 13 years being 4 per cent. The following tabular statement gives an outline of the work carried on in Chelsea during 1921, the visits being those paid by the trained officers of the Borough Council (one whole-time Health Visitor, one parttime), and of the Chelsea Health Society and School for Mothers (one whole-time Health Visitor, one part-time), and does not include work done by voluntary workers attached to the Society. Summary oj Reports of Health Visitors for 1921. Number of homes visited (first visits), Infants 714 „ revisits, Infants 1517 „ Infants attendances at Infant Consultations 3279 5 Number of visits to Children of one year to school age 117 „ revisits ditto 2459 „ Children of one year to school age, attendances at medical inspections 1406 „ ante-natal visits to Expectant Mothers 684 „ ante-natal case attendances at ante-natal clinic 363 „ visits to Diarrhoea cases amongst Children 62 „ cases of Diarrhoea found 35 „ visits to cases of Ophthalmia Neonatorum 24 General additional visits in connection with the work 1188 As compared with 1920, there were nearly the same number of infants' attendances at the consultations, but the home visits to infants were 863 less in number in 1921 than in 1920, the reduction being due probably to the lesser number of births in 1921, namely 335. The number of attendances of children of one year to school age at medical inspections was 459 in excess of 1920, and the visits to the homes of these children were 52 in excess of the 1920 figure. The ante-natal visits to expectant mothers diminished by 136, and the case attendances at the clinic by 42, as the result of the diminished births. Although the birth-rate has diminished, the work of the clinics continues to grow, especially in the attendances of children over one year of age. The premises at 49, Sydneystreet are now too small for the proper performance of the work; and it is hoped in the current year that the Health Society will be able to move into a larger building in a central position better adapted for its work than the present premises. During the year 1921, the clinics held at 49, Sydney-street were: Tuesday afternoons, 2 clinics; Wednesday afternoons, ante-natal clinic; Thursday afternoons, 1 clinic: at 484, King's-road, 2 clinics are held on Monday afternoons. Total number of infant clinics 5 weekly; one ante-natal clinic weekly. All the medical officers now engaged are ladies. With the approval of the Ministry of Health, the Borough Council made financial grants for the year commencing 1st April, 1921, as follows:- £ Chelsea Health Society and School for Mothers 550 Red Cross Babies' Nursing Home, Edithterrace 400 Chelsea Day Nursery, 65, Sydney-street 100 Chelsea Branch of Invalid Children's Aid Association 80 Chelsea District Nursing Association 50 Convalescent Homes for Nursing Mothers and Infants 32 1212 6 Half this amount, namely £606, is 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 during 1921 was 22, as against 44 in 1920, and 60 in 1919. Fifteen of the cases were attended by the Ormond Home for Midwives, 5 by Nurse Andrews, and 2 by Nurse McAuliffe. The amount paid to the Maternity Nurse was £28 5s., and £7 11s. was received as contributions from the patients, leaving a balance of £20 14s., half of which is recovered as a grant from the Ministry of Health. Midwife. The number of necessitous women provided with a midwife under the Council's scheme during 1921 was 57, as against 25 in 1920. Thirtythree of the cases were attended by the Ormond Home for Midwives, 17 by Midwife Andrews, and 7 by Midwife McAuliffe. The amount paid to Midwives was £58 15s., and £16 11s. was received as contributions from the patients, leaving a balance of £42 4s., half of which is recovered as a grant from the Ministry of Health. The net cost to the Borough in 1921 for Maternity Nurse and Midwife was £31 9s., as against a net cost in 1920 of £21 9s. In 1921 there were 22 fewer Maternity Nurse cases, but there were 32 more Midwifery cases than in 1920. During 1921, 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. During 1921, Home-helps under the Council's scheme were provided for 23 necessitous cases. The total amount paid to Home-helps for their services during the year was £112 15s. 11d., and the contributions received from the assisted families amounted to £28, leaving a balance of £84 15s. 11d., half of which is recovered as a grant from the Ministry of Health. The net cost to the Borough of Maternity Nurses, Midwives, and Home-helps for 1921 was £73 17s. In July, 1921, the appointment of a whole-time Home-help was terminated, and a panel scheme was adopted by which suitable women willing to give their services, were placed upon a list, each woman being called upon in rotation as found convenient. The remuneration adopted was 30s. per week for full-time cases, and 20s. per week for half-time cases, but this was altered on the 9th November to 40s. per week for full-time cases, the part-time cases remaining at 20s. Convalescent Homes. Twenty-five nursing mothers, with their infants, were sent away to country convalescent homes in the course of the year. The payments made by the Borough Council amounted to £38 9s. 8d., and the amount received as contributions from patients was £4 6s. 7 Chelsea Day Nursery, 65, Sydney-street. The Chelsea Day Nursery was open throughout the year, except for a period of one week at Easter. The total number of attendances of children for the year was 4,649, as against 5,304 in 1920. The average daily attendance was 18, as against 21 in 1920. Dr. Benham is now acting as Medical Officer of the Nursery, and medical attendant of the staff. A fortnightly medical inspection is made of the children. Chelsea Red Cross Nursing Home for Babies, Edith-terrace. Fifty-five cases were admitted during 1920, as against 65 in 1920. Thirty-three of the children were infants under one year, and 22 were slightly older children. Of the total 55 cases, 21, or 38 per cent., were Chelsea residents, and 34, or 62 per cent., were residents of other districts. The conditions for which the children were admitted were:— Marasmus or Wasting, 36; after-effects of Bronchitis and Bronchopneumonia, 5; Diarrhoea, 5; Rickets, 3; other illnesses, 6. As the result of treatment of these 55 cases, 14 were discharged "cured"; 12 as "improved" or "satisfactory"; 5 were transferred to other institutions; 10 were only a few days in the Home; 5 died; and 10 remained in the Home at the end of the year. Two of the fatal cases were only in the Home for short periods—under 3 weeks. Chelsea Branch of the Invalid Children's Aid Association. During 1921 the Tuberculosis Care Committee referred to the Chelsea Branch of the I.C.A.A. 122 cases needing convalescence or care. Of these 74 were new cases, and 48 were already known to the Branch. Of the 122 children referred to, 99 received convalescent treatment in the country or at the sea-side, 14 of these being cases carried over from 1920. The average stay of the children in the homes was 2½ months. At the request of the Tuberculosis Care Committee the Chelsea Branch visited 22 cases of children treated under the London County Council Tuberculosis scheme, to collect and forward to the Council the parents' contributions. Of these cases 7 were carried over from 1920. The Milk (Mothers' and Childrens') Orders. During the year 1921, the number of applications for milk, including renewals, granted by the Sub-Committee were as follows :—1st quarter, 698; 2nd quarter, 692; 3rd quarter, 589; 4th quarter, 551; total for year, 2,530, as against 2,340 in 1920. The approximate total cost for the year was £990, namely, 1st quarter, £433; 2nd quarter, £245; 3rd quarter, £160; 4th quarter, £152. In 1920, the total sum expended was £1,515, and in 1919 £342. The Borough Council receives a grant from the Ministry of Health of half the cost incurred. From January until July the grants were for cow's milk supplied by retail dairymen; for the rest of the year dried milk was granted instead of dairy milk, except in special cases. During the last three quarters of the year, the standard of income entitling an applicant to receive milk at less than current price was reduced from 11s. to 10s. per head per week, owing to the reduction in the cost of living. On the 14th March, the Milk (Mothers' and Childrens') Order, 1919, was revoked by the Ministry of Health, and the sanction of the Minister became 8 necessary to the scheme for the supply of milk. This scheme provided that milk at less than cost price may be supplied in necessitous cases only to (a.) nursing mothers who are actually suckling their children; (6.) expectant mothers in the last 3 months of pregnancy; and (c.) children up to 3 years of age only, instead of up to 5 years. Children between 3 and 5 might be supplied on medical certificates. The quantity of milk supplied was reduced to one pint per day per person, but infants between 3 and 18 months might receive 1½ pints daily on production of medical certificates. Deaths and Death-Rate. There were 862 deaths of Chelsea residents in 1921, as compared with 773 in 1920. The death-rate for the year was 13.5 per 1,000, as against 12.1 in 1920. In London the death-rate for 1921 was 12.4. Birth and Death-Rates of Special Classes. Chelsea Borough. Year. Birthrate. Deathrate. Zymotic Deathrate. Tubercular Deathrate. Deaths under one year to 1000 Births. 1921 16.6 13.5 0.5 1.1 78 Industrial Dwellings. 1921 16.4 11.1 0.9 1.2 81 Poor-Class Streets. 1921 23.3 15.8 0.6 1.2 99 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, Peabody 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, Francisstreet, Gilray-square, Ives-street, Riley-street, Slaidburn-street, World's End-passage and courts adjacent, with a total population of 3,480. Infantile Mortality Rates 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 1921 :— Years. Infantile Mortality Rate. Deaths, 1-5 years. 1901-4 140 112 1905-8 119 88 1909-12 97 71 1913-16 87 56 1917-20 78 47 1921 78 18 9 The following table gives the Infantile Mortality Rates in Chelsea under various headings, for five 4-yearly periods, and for 1921:— 1901-4 1905-8 1909-12 1913-16 1917-20 1921 Infectious Diseases 10.0 11.5 8.0 6.2 5.0 0.9 Diarrhœal Diseases 23.5 26.0 18.0 16.4 12.2 14.2 Developmental Defects and Wasting 48.0 37.0 34.5 28.2 31.9 36.0 Other Causes 58.0 44.0 36.0 36.6 28.9 27.4 Total Rate 139.5 118.5 96.5 87.4 78.0 78.5 Infantile Mortality Rates in Wards. Wards. Average of 9 years, 1912-20. 1921. Hans Town 68 116 Royal Hospital 64 73 Church 92 82 Cheyne 64 56 Stanley 91 74 Chelsea Borough 81 78 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 1921 3 2 4 5 4 18 Although the Infantile Mortality rate in 1921 (78.5) was considerably higher than in 1920 (52), the number of deaths of children between one and five years was only 18 as against 24 in 1920. The mortality in 1921 (18 deaths), is the lowest ever recorded in Chelsea. Infectious and other Diseases. Measles. There were no deaths from Measles in Chelsea in 1921. In 1920 there were 8 deaths. The last considerable epidemic in Chelsea was in 1915, when there were 39 deaths. The Health Visitors in the course of the year made 12 visits to homes in connection with Measles cases, as against 271 visits in 1920. There was no occasion for the District Nurses' Association nurses to visit any cases in 1921. 10 Scarlet Fever. During the year, 233 cases of Scarlet Fever were notified in Chelsea, as against 191 in 1920, 148 in 1919, and 67 in 1918. There was only one death from this disease. Of the total cases, 208, or 90 per cent., were removed to hospital, as against 97 per cent. in 1920. The months of greatest prevalence were May (34 cases), October (26 cases), and November (33 cases). January and February were the months of least prevalence, 13 cases and 10 cases respectively; but in the latter month 8 cases occurred in the Cheyne Hospital for Children, followed by two additional cases in March. All these children resided when at home in outside Boroughs, and are not counted as Chelsea notifications. The percentage of cases of school-age (3 to 13 years), was 75, as against 69 in 1920. The followmg table shows the average annual case rate, case fatality rate, and percentage of cases removed to hospital in each of six quinquennial periods since 1891 in Chelsea Home District (1891-1900) and Chelsea Borough (1901-20).:— Quinquennial Periods. Average Annual Case-rate per 1,000 pop. Average Annual case fatality rate. Average Annual percentage of cases removed to Hospital. 1891-5 4.54 4.7 55 1896-1900 3.91 3.8 70 1901-5 2.60 3.2 88 1906-10 3.20 2.3 93 1911-15 2.69 1.8 91 1916-20 1.95 1.0 92 The decline in the case-rate has, no doubt, been largely influenced by the fall in the birth-rate, which has taken place during the past 25 years, the number of children between the ages of 2 and 10—the susceptible age for Scarlet Fever—being now considerably less in proportion to population than 30 years ago. In 1891-5 the average birth-rate in Chelsea was 27.7 per 1,000, and in 1916-20 only 16.1 per 1,000. The decline in the case fatality rate is due chiefly to change of type of Scarlet Fever. There has been no such change in medical treatment of the disease, similar to that occurring in Diphtheria after the introduction of Diphtheria Antitoxin in the early nineties, as would account for the progressive decline from 4.7 in 1891-5 to 1.0 in 1916-20. Scarlet Fever is now such a mild disease that only one per cent. of the cases prove fatal; and it has become a question whether the great expenditure incurred in London in isolating over 90 per cent. of the notified cases—the great majority of which are mild cases—could not be expended in other ways with better advantage to the public health. Diphtheria. During the year, 112 cases of Diphtheria were notified in Chelsea, as against 148 in 1920, 71 in 1919, and 47 in 1918. The disease caused 6 deaths in 1921, the case fatality rate being 5.4 per cent., as compared with 4.7 per cent. in 1920, 9.9 per cent. in 1919, and 10.6 per cent. in 1918; of the total 112 cases, 103, or 92 per cent., were removed to 11 hospital. The percentage of cases of school age (3 to 13 years), was 76, as against 65 in 1920. The months of greatest prevalence were January (13 cases), September (24 cases), and October (13 cases). During the year medical practitioners sent 80 throat or nose swabbings to the Lister Institute for bacterioscopic diagnosis, as compared with 90 in 1920. Of the 80 specimens, 25, or 31 per cent., afforded positive evidence of the diphtheria bacillus, and 55, or 69 per cent., were negative, the corresponding figures for 1920 being 21 per cent. positive and 79 per cent. negative. The following Table shows the average annual case rate, case fatality rate, and percentage of cases removed to hospital in each of six quinquennial periods since 1891 in Chelsea Home District (1891-1900), and Chelsea Borough (1901-20) :— Quinquennial Periods. Average Annual case-rate per 1,000 pop. Average Annual case-fatality rate. Average Annual percentage of cases removed to hospital. 1891-5 2.69 18.7 43 1896-1900 3.00 17.1 64 1901-5 1.25 8.0 80 1906-10 1.86 8.8 89 1911-15 1.24 5.8 89 1916-20 1.35 8.9 92 The diminution in the Diphtheria case-rate has not been quite so great as in the case of the Scarlet Fever case-rate. The great decline in the case fatality-rate commenced in the nineties of last century following upon the introduction of Diphtheria antitoxin. Enteric Fever. The number of cases of Enteric Fever notified in Chelsea in 1921 was 7, as against 5 in 1920. There were no deaths. Four of the cases were removed to hospital. In 3 of the cases the infection was contracted in Kensington. One case was that of a seaman, who landed from his ship on the 9th April, and was taken ill on the 29th April. In three other cases—a mother and two young daughters—the infection appears to have been contracted in the parish of Nutfield, Surrey, in September. In none of the 7 cases, then, was the infection contracted in Chelsea. Six specimens of blood were examined for the Widal reaction, two proving positive and four negative. A sample of faeces and of urine from a supposed carrier were examined for the presence of Typhoid Bacilli with negative results. This woman, who lived in Chelsea, was thought likely as a chronic carrier, to have initiated an outbreak in Kensington, but the evidence negatived this assumption. Paratyphoid Fever. Two cases of Paratyphoid Fever were notified in 1921, as against 3 in 1920. One of the cases was removed to hospital. Nothing was ascertained as to any source of infection in these cases. One blood examined showed the presence of paratyphoid B. organism. 12 Diarrhoea and Enteritis. There were 19 deaths from these diseases in Chelsea in 1921, as against 12 deaths in 1920. Of the 19 deaths, 14 were infants under one year of age; 2 were between 1 and 5 years; one was a child of 7 years, and 2 were old people. Twelve of the deaths occurred in the third or summer quarter of the year, the mean temperature of this quarter being 64.2° F., as compared with 59.1° F. of the summer quarter of 1920. The rainfall in the third quarter of 1921 was only 2.6 inches, as against 8.3 inches in 1920. In connection with these diseases, 62 visits were made to homes, and 35 cases were, as a result, discovered. Malaria. One case of Malaria only was notified in 1921, the patient being an ex-soldier, and the disease contracted in Africa. The blood of this man was found to contain malarial organisms. Influenza. Influenza caused 23 deaths in Chelsea in 1921, as against 10 in 1920, 104 in 1919, and 234 in 1918. Two of the deaths were of persons between 20 and 40 years, 7 between 40 and 60, and 14 over 60. In London there were 1,006 deaths in 1921, as against 1,364 in 1920, 4,222 in 1919, and 12,927 in 1918. Three cases of influenzal pneumonia were notified in the first quarter of the year, and three cases in the fourth quarter. No nurses visits were made to influenzal pneumonia cases in 1921. Pneumonia. Pneumonia and broncho-pneumonia caused 43 deaths in Chelsea in 1921, as against 49 in 1920, 53 in 1919, and 82 in 1918. Ten cases of acute primary pneumonia were notified in the first quarter of the year, none in the second, 8 in the third, and 4 in the fourth quarter. The nurses paid 156 visits to 10 patients suffering from pneumonia, the average number of visits per patient being 16. In London there were 4,799 deaths from pneumonia in 1921, as against 5,338 in 1920, 4,597 in 1919, and 7,485 in 1918. Tuberculosis. The deaths from Pulmonary Tuberculosis in 1921 numbered 58 (33 males and 25 females), as against 73 in 1920. Other tuberculous diseases caused 12 deaths (3 males and 9 females), as against 11 in 1920. Of the Pulmonary Tuberculosis cases ending fatally, 30 per cent. died in the Chelsea Infirmary, and 31 per cent. in other public institutions, that is to say, 61 per cent. died away from their homes, the corresponding figure for 1920 being 71 per cent. During the year 1921, 103 new cases of Pulmonary Tuberculosis were notified, as against 119 in 1920. Sixty-three specimens of sputum were sent by medical practitioners to the Lister Institute for examination, as against 48 in 1920. Of the 63 specimens, 16 per cent. were positive for tubercle bacilli, and 84 per cent. were negative, as compared with 19 per cent. positive and 81 per cent. negative in 1920. A large number of patients received hospital and sanatorium treatment under the London County Council scheme, which now embraces both insured and uninsured patients. 13 The number of new cases of Pulmonary and non-Pulmonary Tuberculosis visited by the Municipal Tuberculosis Visitor in the course of the year was 97. The total number of visits paid in respect of all cases of Tuberculosis and suspected Tuberculosis was 393. The Borough Council lent beds and bedding to five cases in the course of the year. Twenty-five new cases of non-Pulmonary Tuberculosis were notified in 1921. Several cases were helped to obtain proper surgical treatment in hospitals, and others were sent to country or sea-side convalescent homes through the agency of the Chelsea Branch of the Invalid Children's Aid Association. Four cases of Tuberculosis were certified during the year by the Tuberculosis Officer as requiring extra nourishment, as part of the medical treatment, and these cases were supplied at the cost of the Borough Council (£5 3s. 8d.), with extra foods such as milk, eggs and butter. Chelsea Tuberculosis Dispensary, Brompton Hospital. Work done during 1921. Number of persons examined for the first time :— Insured 140 Uninsured 432 - 572 Number of persons suffering from :— Tuberculosis 55, or 10 per cent. Doubtful diagnosis 51, or 9 per cent. Not Tuberculosis 466, or 81 per cent. 572 Total attendance at Dispensary :— Insured 897 Uninsured 2313 - 3210 Visits to homes of patients by Medical Officer:— Insured 18 Uninsured 17 - 35 Visits to homes of patients by Dispensary Nurses:— Insured 657 Uninsured 2624 3281 Number of written reports concerning individual patients made to:— Public Authorities 248 Practitioners 168 416 14 Number of examinations of sputum :— Insured 427 Uninsured 397 824 Number of X-ray examinations of patients 20 Cancer. The number of deaths from Cancer in Chelsea in 1921 was 112, which is the largest number on record. The following Table gives the average annual number of deaths from all causes, Tuberculosis and Cancer, in six quinquennial periods :— Period. All causes. Pulmonary. Tuberculosis. NonPulmonary. Total. Cancer. 1891-5 1550 151 59 210 65 1896-1900 1407 144 40 184 73 1901-5 .. 1207 120 30 150 78 1906-10.. 1086 105 28 133 79 1911-15.. 975 86 21 107 94 1916-20.. 935 75 18 93 85 1921 .... 862 58 12 70 112 In 1891-5, the deaths from Tuberculosis formed 13-5 per cent, of the total deaths, and the deaths from Cancer 4-2 per cent. In 1916-20 the deaths from Tuberculosis formed 10 per cent, of the total deaths, and the deaths from Cancer 9-1 per cent. Deaths in Lunatic Asylums. The average annual number of deaths of Chelsea residents in Mental Hospitals and Lunatic Asylums in the 20 years, 1891-1910, was 34. In the next 4 years, 1911-1914, the average annual number was 44. In the 4 years of the war, 1915-1918, the average annual number rose to 63, fell to 42 in 1919, 23 in 1920, and 24 in 1921. It would appear from these figures as if the higher mortality amongst lunacy patients in asylums in the 4 years of the War was due, not so much to an increase in lunacy, as to unfavourable conditions as regards food, care and supervision in the asylums, which reacted unfavourably upon the health and vitality of the patients. Encephalitis Lethargica. Four cases of this disease were notified in Chelsea in 1921, namely: female, 14 years—this case proved subsequently not to be one of Encephalitis Lethargica; female, 20 years—this case ended fatally; female, 31 years ; male, 39 years. All the cases were removed to hospital. In London in 1921, 240 cases of this disease were notified, as against 134 in 1920, and 63 in 1919. There were cases in every Metropolitan 15 Borough, except Stoke Newington, Holborn, City and Deptford. The largest number of cases occurred in Lambeth and Wandsworth—18 cases each. Ninety-one of the cases of which records came to hand were males, and 99 females. The ages were: under 15, 44 cases; 15-45, 93 cases; over 45, 53 cases. There were 40 deaths: males, 19; females, 21; which gives a case fatality rate of 21 per cent., but it is probable that other deaths occurred after the notifications were received, as the usual mortality of undoubted cases is about 50 per cent. Cerebrospinal Meningitis. Two cases of this disease were notified in Chelsea in 1921, namely: male, 11 months, and male, 47 years. Both cases were removed to hospital; both ended fatally. In London 106 cases of Cerebro-spinal Meningitis were notified in 1921, as against 160 in 1920, 205 in 1919, 231 in 1918, 415 in 1917, 438 in 1916, 712 in 1915, and 75 in 1914. Polio-Myelitis and Polio-Encephalitis. Only one case of Polio-Myelitis was notified in Chelsea in 1921, namely, female, 24 years. The patient was removed to hospital. In London 57 cases of Polio-Myelitis and 3 cases of Polio-Encephalitis were notified in 1921. Puerperal Fever. Three cases of Puerperal Fever were notified in Chelsea in 1921, as against 8 in 1920. One case was removed to hospital and one case to the Infirmary. One case ended fatally at home. Ophthalmia Neonatorum. Fifteen cases of this disease were notified in Chelsea in 1921, as against 17 in 1920. An additional six cases of eye trouble in infants, which were not notified, were visited, 24 visits in all being made by the Health Visitors. Eleven cases were attended by District Nurses, 214 visits being paid to the homes, which gives an average of 19 visits per case, as against 31 visits per case in 1920. Of the total 21 cases, 20 made complete recoveries, and one made a partial recovery. In London, 1,080 cases of Ophthalmia Neonatorum were notified in 1921, as against 1,228 in 1920, 833 in 1919, 614 in 1918, 641 in 1917, 783 in 1916, 775 in 1915, and 905 in 1914. The figures seem to indicate an increase of the disease, and possibly also of gonorrhœal infection of parents since the war. Non-notifiable Illnesses. The District Nurses paid 1,192 visits to the homes of expectant and nursing mothers and children under 5 years of age, during 1921, to attend to conditions as under :— 16  Visits. Cases. Abscesses and Septic Sores 361 14 Illness after childbirth 279 17 Bronchitis 98 9 Thread and other worms 98 12 Inflammation of eyes 93 8 Burns 39 2 Nose and Ear troubles 32 3 Tuberculosis 43 3 Diarrhœa 20 3 Other conditions 129 13 1192 84 —i — Venereal Diseases. Fourteen specimens of blood were sent to the Lister Institute in 1921 by medical practitioners for the Wassermann (Syphilis) reaction. Of these 14 specimens 2 proved positive, and 12 negative. Eleven of the specimens were sent by the Medical Officer of the Ante-Natal Clinic, 49, Sydney-street; and the remaining 3 were sent by one other doctor. One specimen of pus was sent from the Ante-Natal Clinic to be examined for the gonococcus—the result being negative. The facilities afforded for the diagnosis of Venereal Disease are being better utilised than formerly; but, so far, the Ante-Natal Clinic is the only institution that has made effective use of the Borough Council's scheme. Sale of Food and Drugs Acts. Of the 400 samples taken for analysis in 1921, 151 were milk, 148 being genuine and 8 adulterated, equivalent to 2.0 per cent. of the total milks examined, as against 4.1 per cent. in 1920, 3.7 in 1919, 13.8 in 1918, 8.1 in 1917, and 6.0 in 1916. Of the three adulterated samples, proceedings were taken in 2 cases, namely: 18.3 per cent. of fat abstracted, vendor fined £2 2s. as costs; 13.3 per cent. of fat abstracted, summons dismissed on production of Warranty. In the other case the amount of adulteration, 3.8 per cent. of added water, was considered insufficient for legal proceedings. The samples of other foods taken were all found to be genuine on analysis: namely, condensed milk, one sample; butter, 81 samples; margarine, 36 samples; lard, 27 samples; flour, 18 samples; coffee, 25 samples; coffee-mixtures, 2 samples; cocoa, 9 samples; baking powder, 9 samples; cornflour, 9 samples; pepper, 13 samples; oatmeal, 5 samples ; sago, 5 samples; and vinegar, 9 samples. Housing of the Working Classes. Housing, Town Planning, etc., Act, 1919, Section 28. During the year 1921 notices under this Section were served upon the owners of six houses to execute such works as may be necessary to make the houses in all respects reasonably fit for human habitation, as follows :— 17 Biley-street; two houses; notices for the whole of the premises; work completed by the owner. Britten-street; one house; notice for part of the house; work completed by the owner. Slaidburn-street; one house; notice for part of the house; work completed by the owner. Cale-street; one house; notice for part of the house; work partially done by owner; rooms then vacated and closed. Langton-street; one house ; notice for part of the house; work completed by owner. New Housing Scheme. On the 25th January, 1922, the Housing Committee reported that the Minister of Health was prepared to approve the erection of not more than 50 flats, provided the Council are able to acquire a site at a price which he would be justified in approving, and that tenders can be obtained at prices which compare favourably with those obtaining elsewhere. With regard to the acquisition of land for the purpose of the scheme, the Minister would be prepared to arrange for the District Valuer at once to open negotiations for the purchase of a site in Hortensia-road, which the Borough Council considers could probably be obtained at a reasonable figure. The Borough Council resolved that the Minister of Health be asked to arrange for the District Valuer to open negotiations for the purchase of a site in Hortensia-road, suitable for the erection thereon of 50 flats for housing the working classes. Metropolitan Borough of Chelsea. Housing Conditions. Statistics. For the year ended 31st December, 1921. 1.—General. (1.) Estimated population 63,700 (census) (2.) General death-rate 13.5 (8.) Death-rate from Tuberculosis 1.1 (4.) Infantile Mortality Rate 78.5 (5.) Number of dwelling-houses of all classes 11,433 (6.) Number of working-class dwelling-houses 2,455 (7.) Number of new working-class houses erected - 2.—Unfit Dwelling-houses. I.—Inspection. (1.) Total number of dwellinghouses inspected for housing defects, under Public Health or Housing Acts (2.) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910. 2634 Nil. These inspections, as far as regards separate records and entries in the books, were discontinued in 1914, and have not been resumed. 18 (3.) Number of dwelling houses found to be in a state so dangerous or injurious to health, as to be unfit for human habitation. Premises were not reported officially as unfit for human habitation, as Magistrates decline to make Closing Orders, there being no possibility of tenants dispossessed finding any accommodation elsewhere. (4.) Number of dwelling houses (exclusive of those referred to under the preceding subheading (3.)] found not to be in all respects reasonably fit for human habitation 2087 II.—Remedy of defects without service of Formal Notices. Number of defective dwellinghouses rendered fit in consequence of informal action by the Local Authority or their Officers. There is no informal action by the Officers of the Local Authority. Wherever sanitary defects are found, the appropriate notice, as required by Statutory Enactments, Regulations or Bye-laws, is served upon the owner or other person liable for the remedy. III.—Action under Statutory Powers. (a) Proceedings under Section 28 of the Housing, Town Planning, etc., Act, 1919. (1.) Number of dwelling-houses in respect of which notices were served requiring repairs 6 (2.) Number of dwelling-houses which were rendered fit :— (a.) By owners 6 (b.) By Local Authority in default of owners - (3.) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — (b.) Proceedings under Public Health Acts. (1.) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1015 (2.) Number of dwelling-houses in which defects were remedied :— (a.) By owners 1015 (b.) By Local Authority in default of owners — (c.) Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909. No proceedings taken under these Sections. 19 3.—Unhealthy Areas. Areas represented to the Local Authority with a view to Improvement Schemes under Part I. or Part II. of the Act of 1890. No areas represented. Staff engaged on housing work, and duties of each Officer. Four Sanitary Inspectors, each carrying out all the duties of a Sanitary Inspector in the district allocated to him. Work of the Public Health Department. The tabular statements prepared by the Sanitary Inspectors show that 3,119 separate premises were reported on by them during 1921, 485 of this number being with reference to cases of notifiable infectious disease, and 547 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 7 instances. During the year 427 premises were disinfected after cases of infectious or other disease, including 87 rooms which had been in occupation by persons suffering from tuberculosis. In addition 376 rooms were disinfected for the presence of bugs and other vermin, and were subsequently stripped and cleansed by the owners. Two hundred school children were reported by school-nurses to be in a verminous condition, and 306 visits to homes were paid in connection with these cases. Thirty-three cases of scabies were reported during the year, and 54 visits to homes were paid in connection with these cases. Workrooms (Women Employees). Number of workrooms inspected 426 „ workrooms measured 85 „ workroom cards given 48 „ outworkers premises inspected 126 „ laundries inspected 42 „ factories inspected 27 The Woman Sanitary Inspector also paid 74 visits to homes in consequence of complaints received as to old age pensioners living under neglected and insanitary conditions. She also undertook the supervision of the Women's Sanitary Convenience at the World's End, which was opened in February, 1921. 20 SUMMARY OF NUISANCES AND OTHER MATTERS REPORTED ON AND WORK DONE DURING 1921. Houses and Premises :— House-to-house inspections 547 *Reported on respecting nuisances complained of 2087 Reported on with reference to infectious cases 455 Reported on with reference to pneumonia, influenza, malaria, dysentery, trench fever 30 Cleansed, whitewashed and repaired 714 Defective roofs repaired 261 Disinfected after communicable diseases 340 Rooms disinfected for tubercular and other diseases 87 Rooms disinfected for verminous conditions 376 Cases of overcrowding abated 2 Dustbins provided 329 Ashpits demolished 26 Underground rooms occupied contrary to Act — Inspection of restaurant kitchens 58 „ slaughter houses 26 „ ice cream premises 30 „ milk shops 95 Drainage:— Drains opened, cleansed and made sound 67 Drains trapped with stoneware gullies 18 Water closets cleansed and repaired 251 Water closets, new pans and traps provided 77 Spout drains cleansed, repaired or renewed 154 Sink, bath and lavatory waste pipes provided and repaired 145 Drains and soil pipes ventilated or repaired 68 Soil pipes, new, provided 18 Additional W.C. accommodation provided 7 Anti-Syphonage pipes provided to W.C 11 Water Supply:— To tenement houses (upper storeys) — For domestic purposes, provided where cut off by Water Board 18 For water-closets or check cisterns provided and repaired 97 Main cisterns cleansed or repaired 81 „ new covers provided 10 „ new provided 2 Water certificates, issued in respect of newly erected dwelling houses 1 Nuisances Abated Arising from:— Keeping of animals 17 Accumulations of manure and other filth 60 Yard, areas and wash-houses paved or drained 100 Smoke 1 21 Miscellaneous :— Dead bodies removed to public mortuary for sanitary reasons 2 Goods disinfected after infectious cases at station 769 Goods destroyed after infectious cases 91 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 — Animals destroyed in Incinerator 22 Proceedings Taken :— Statutory notices issued 292 Intimations issued for sanitary works, etc. 1015 Water supply to tenement houses — Legal proceedings taken in respect of defective sanitary arrangements, nuisances, etc. 7 Legal proceedings taken in respect of food adulteration 2 Correspondence:— Number of letters written in connection with sanitary matters 896 Daily applications for removal of infectious cases sent to Metropolitan Asylums Board 35 Notifications of infectious cases sent to Metropolitan Asylums Board 145 Notifications of infectious cases sent to school authorities 371 Entries in Inspectors' Report Books 1029 Entries in Inhabitants' Complaint Book 56 Certificates of disinfection given 629 Certificates of infectious diseases for removal cases 170 Notices sent to Public Library of premises where infectious diseases have occurred 146 Post Cards sent re samples under Sale of Food and Drugs Act. 398 Food Destroyed :— Bacon 28 lbs. Babbits 5 lbs. Tomatoes 4 cases Plums 1 basket Beef 8 lbs. Chestnuts 3 bags Fish 13 stone, 2 boxes, 2 sacks Food Condemned:— Kippers 6 boxes Fish 12 st., 8 lbs. 22 Premises :— No. on Register at end of 1921. No. of Inspections. No. of prosecutions. Cowsheds — — — Milkshops . 67 95 — Houses let in lodgings — — — Ice Cream premises 17 30 — Slaughter-houses 3 26 — Offensive trades — — — Smoke Nuisances.:— Number of observations 6 Number of nuisances and complaints — Number of notices — Number of Summonses — Cleansing :— Number of adults cleansed 56 Number of children cleansed 40 Number of rooms or premises cleansed and disinfectec 1497 Sale of Food:— Number of premises used other than ice cream premises milk shops 73 Number of inspections 80 Disinfection Shelter :— Persons accommodated:— Adults 10 Children 17 Mortuary:— Number of bodies received 99 Number of infectious bodies received 2 23 MAGISTERIAL PROCEEDINGS DURING 1921 UNDER THE PUBLIC HEALTH (LONDON) ACT, 1921. Situation of Premises. Nature of Nuisance or Complaint. Petty Sessions. Date of Hearing. Result. 36, Ives-street Failing to comply with the Borough Council's Notices to repair and cleanse the interior of the premises, wash-house and water closet. To repair yard paving and provide dust bin. Kensington 3-5-21 Work to be done in 14 days 15, Caroline-place Failing to repair and cleanse top rooms, staircase, ground floor rooms, washhouse and water closet and yard paving and provide dust bin. Kensington 17-3-21 7-6-21 19-7-21 Adjourned till 19th July, and Order obtained for works to be done in 7 weeks. 6, Bramerton-street Failing to repair defective gutters and stack pipes, roof and skylight. Kensington 7-6-21 Withdrawn — works done. 65, Rawlings-street Failing to repair and cleanse top rooms, first floor back room, wash-house, staircase walls, front area walls and larder, and remedy dampness. Kensington 7-6-21 21-6-21 Adjourned till 216-21, and withdrawn — Works completed. 24 43, Langton-street .. Failing to repair roof, strip, repair and cleanse interior of premises and water closet. To provide dust bin, clear sink, waste and rain water pipes. Repair yard paving and water closet, and remedy dampness. Kensington 6-12-21 Order for works to be carried out in 14 days. 69, Blantyre-street .. Failing to repair roof, repair and cleanse top back room, firs* floor back room, and ground floor water closet. Cleanse cistern and provide cover to same. Kensington 6-12-21 Order for works to be carried out . in 14 days. 71, Blantyre-street .. Failing to repair the ground floor closet walls. Kensington 6-12-21 Order for works to be carried out in 14 days. MAGISTERIAL PROCEEDINGS DURING 1921 UNDER THE SALE OF FOOD AND DRUGS ACT. Street where purchased. Articles Purchased. Extent of Adulteration or Abstraction. Date of Hearing Result. Lots-road Milk 18.3 % Fat abstracted 17-5-21 No fine, £2 2s. costs. Radnor-street Milk 13.3% Fat abstracted 5-7-21 Dismissed on production of Warranty.