CHE 27 Metropolitan Borough of Chelsea. Annual Report for 1922 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. 1923 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 5-6 Home-help 6 Chelsea Day Nursery 6 Chelsea Red Cross Nursing Home for Infants 7 Chelsea Branch of I.C.A.A. 7 Supply of Milk at less than cost price 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 11 Tuberculosis 11 Chelsea Tuberculosis Dispensary 12 Cancer and deaths in Asylums 13 Encephalitis Lethargica and Cerebro-spinal Meningitis 13 Puerperal Fever and Ophthalmia Neonatorum 13 Venereal Disease Diagnosis 14 Sale of Food and Drugs Acts 15 Housing of the Working Classes 15 Rats and Mice Destruction Act 16 Cleansing Station for Verminous Children 17 Work of the Public Health Department 17 Summary of Work in 1922 19 Magisterial Proceedings 22-23 Annual Report of the Medical Officer of Health for the year 1922. POPULATION OF CHELSEA. The Registrar-General's estimated population for the middle of 1922 is 68,920. The actual census population in 1921 was 63,700. Births and Birth-Rate. In 1922, 1,038 births were registered in the Borough. Excluding 143 births of non-parishioners, and including 137 births taking place amongst Chelsea mothers in Lying-in Hospitals and Homes outside the Borough, the total number of births for the year was 1,032, the corresponding figure for 1921 being 1,057, and for 1920, 1,392. The birth-rate for the year was 16.1 per 1,000, as compared with 16.6 per 1,000 in 1921. The birth-rate of London for 1922 was 21.0 per 1,000, as compared with 22.8 per 1,000 in 1921. Notification of Births. Number. Living Children 818 Still-born Children 20 888 Notified by Medical Practitioners 218 „ St. George's Hospital 48 „ Midwives 429 „ Chelsea Workhouse 81 „ Parents, etc. 80 851 Deduct dual notifications 13 838 Total number of Chelsea births registered in the Borough 895 The notifications, therefore, formed 97 per cent. of the total births of Chelsea residents registered in the Borough, as compared with 93 per 4 cent. in 1921. The number of births notified by mid wives in 1922 was 51 per cent. of the total, as compared with 57 per cent. in 1921, and 42 per cent. in 1920. Illegitimate Births. Total number of illegitimate births 57 Alive at end of year 40 Dead at end of year 4 Unaccounted for 18 Maternity and Child Welfare. There were 68 deaths of infants under one year of age in Chelsea in 1922, equivalent to an Infant Mortality Rate of 66 per 1,000 Births, as compared with 78.5 per 1,000 in 1921, and 52 per 1,000 in 1920, which was the lowest rate ever recorded in the Borough. In London, in 1922, the rate of infantile mortality was 74, and in England and Wales, 77. The number of births of Chelsea infants in outlying institutions in 1922 was 134, or 13 per cent. of the total births, as compared with 12.1 per cent. in 1921. There were 64 births in the Chelsea Workhouse in 1922, or 6.2 per cent. of the total births, the average of the preceding 14 years being only 4 per cent. The following tabular statement gives an outline of the work carried on in Chelsea during 1922 in Maternity and Child Welfare, the visits being those paid by the trained officers of the Borough Council (one wholetime Health Visitor, and one part-time), and of the Chelsea Health Society and School for Mothers (one whole-time Health Visitor, and one part-time), and does not include work done by voluntary workers attached to the Society. Summary of Reports of Health Visitors for 1922. Number of homes visited (first visits), Infants 702 „ revisits, Infants 1459 „ Infants attendances at Infant Consultations 3004 „ visits to Children of one year to school age 91 „ revisits ditto 2536 „ Children of one year to school age, attendances at Medical Inspections 1535 „ ante-natal visits to Expectant Mothers 664 „ ante-natal case attendances at ante-natal clinic 381 „ visits to Diarrhoea cases amongst children 27 „ cases of Diarrhoea found 27 „ visits to cases of Ophthalmia Neonatorum 6 General additional visits in connection with the work 973 5 As compared with 1921, there were 275 fewer infant attendances at the consultations, and 70 fewer home visits to infants. The number of attendances of children of one year to school age at medical inspections was 129 in excess of 1921, and the visits to the homes of these children were 51 in excess of the 1921 figure. The ante-natal visits to expectant mothers diminished by 20, but the case attendances at the clinic increased by 18. Early in the present year, the Health Society's premises will be moved from 49, Sydney-street, to 1a, Manor-street, which is a larger building, and much better adapted for the clinics, and other work of the Society than those in Sydney-street. During the year 1921 the clinics held at 49, Sydney-street were: Tuesday afternoons, 2 clinics; Wednesday afternoons, ante-Datal clinic; Thursday afternoons, 1 clinic; at 484, King's-road, 2 clinics on Monday afternoons. Total number of infant clinics, 5 weekly; one ante-natal clinic weekly. All the medical officers are ladies. With the approval of the Ministry of Health, the Borough Council made financial grants for the year commencing 1st April, 1922, as under:— £ s. d. Chelsea Health Society and School for Mothers 550 0 0 Red Cross Babies' Nursing Home, Edith-terrace (closed 31st July, 1922) 133 6 8 Chelsea Day Nursery, 65, Sydney-street 100 0 0 Chelsea Branch of Invalid Children's Aid Association 100 0 0 Chelsea District Nursing Association 50 0 0 Convalescent Homes for Nursing Mothers and Infants 32 0 0 £965 6 8 Halt this amount, namely, £482 13s. 4d., is recovered as a grant from the Ministry of Health. Maternity Nurse. Eighteen applications were received during 1922 from necessitous women to be provided with a Maternity Nurse at their approaching confinements at less than cost price. All the applications were granted. Of the 18 cases, 9 were provided with a Maternity Nurse; in 3 cases the mother was sent into hospital for confinement; 2 cases were cancelled; and 4 cases were still awaiting confinement at the end of the year. The total number of necessitous women provided with a Maternity Nurse under the Council's scheme in 1922 was 15. Ten of the cases were attended by the Ormond Home for Midwives, 4 cases by Nurse Andrews, and one by Nurse Cooke. The amount paid by the Council to the Maternity Nurses was £10 4s. 6d., and £8 10s. 6d. is the amount of assessment paid or to be paid by the applicants as contributions to the Maternity Nurse. The net cost to the Borough is £10 4s. 6d., half of which is recovered as a grant from the Ministry of Health. 6 Midwife. Forty-nine applications were received during the year 1922 from necessitous women for the services of a midwife at less than cost price: 46 were granted, 2 were referred to the Guardians, and one was refused as being over the standard for a necessitous case. Of the 46 applications granted, 36 were supplied with a midwife, one application was withdrawn, and 9 cases were still awaiting confinement at the end of the year. The total number of necessitous women provided with a midwife under the Council's scheme during 1922 was 45, of which number 29 were attended by the Ormond Home for Midwives, 15 by Midwife Andrews, and one by Midwife Cooke. The amount paid by the Council to the Midwives was £29 8s. 6d., and £27 1s. 6d. is the amount of assessment paid, or to be paid by the applicants as contributions to the midwife. The net cost to the Borough is £29 8s. 6d., half of which is recovered as a grant from the Ministry of Health During 1922, 7 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. Thirty-six applications were received in 1922 from necessitous women for the services of a Home-help during their confinements, and 31 were granted. Of this number 21 were supplied with the services of a Home-help, 7 were withdrawn by the applicants, and 3 cases were still awaiting confinement at the end of the year. The total number of cases receiving the services of a Home-help under the Council's scheme in 1922 was 27. The total amount paid by the Council to Home-helps for their services was £85 9s. 11d., and the amount of contributions assessed to patients was £22 12s. 2d., leaving a balance of £62 17s. 9d., as the net cost to the Borough, half of which is recovered as a grant from the Ministry of Health. Convalescent Homes. Twenty-seven applications were received for convalescence of mothers with their infants under the Council's scheme in 1922. All the applications were granted, but only 14 of the mothers were sent away. The payments to Homes made by the Council amounted to £26 12s. 9d., and the contributions of patients amounted to £5 7s. 6d. Eight mothers were sent to Homes, apart from the Council's scheme. The average duration of stay in the Homes is 2 weeks. Chelsea Day Nursery, 65, Sydney-street. The Chelsea Day Nursery was open throughout the year, except for a period of a week at Easter, a week at Christmas, and three weeks in May owing to the prevalence of Measles. The total number of attendances of children was 5,355, as against 4,649 in 1921. The average daily attendance (5 days a week), was 23, as against 18 in 1921, and 21 in 1920. Dr. Alice Benham is the Medical Officer of the Nursery, and medical attendant of the Staff. A fortnightly medical inspection is made of the children. 7 Chelsea Red Cross Nursing Home for Babies, Edith-terrace. This Home was closed on the 31st July, 1922, in consequence of the complaints of a neighbouring resident, as to the noise of crying infants. It has not been found possible to acquire any other premises suitable for the carrying on of the Home. Chelsea Branch of the Invalid Children's Aid Association. During the year 1922, 188 new cases were referred to the Branch, of which number 79 were received from the Tuberculosis Care Committee. In addition 201 applications were made by old cases, making a total for the year of 389 cases. The number of cases already in Homes carried over from 1921 was 37. During the year the Branch sent away for convalescent treatment and assisted in various ways 66 children of 5 years and under. Thirtythree of these children were sent to convalescent homes in the country or at the sea-side for periods varying from one to six months, at a cost of from 10s. to 15s. weekly. The total cost was £164 9s. 6d., to which the parents contributed £61 14s. 6d., leaving a balance of £102 15s., to be raised by the Branch. The Branch also arranged free convalescence through the United Services Fund for two children. In six cases the parents refused to send the children at the last moment, although all arrangements had been made. Most of the children were visited regularly, and kept under observation. In many cases the children were sent free of railway fare. In other cases help was given by in- and out-patient letters, presents of warm clothing, books, etc. The Branch is now also giving medical comforts (cod-liver oil, malt, phosphates, cream, cough mixtures, etc.) to infants and young children recommended by the Chelsea Health Society, whose parents, owing to unemployment, are unable to pay for such medical comforts. The Branch undertakes to supply these comforts to each child for 3 months, and in exceptional circumstances for a longer period. Supply of Milk at less than Cost Price. There has been no alteration in the scheme approved by the Minister of Health since 1921. Necessitous cases only may be supplied, namely (a.) nursing mothers who are actually suckling their children; (b.) expectant mothers in the last 3 months of pregnancy; and (c.) children up to 8 years of age. Children between 3 and 5 may be supplied on the production of medical certificates. The amount of milk permitted under the scheme is one pint per day per person, but infants between 3 and 18 months may receive 1½ pints on production of medical certificates. About three-quarters of the total milk supplied is Ambrosia (dried milk), the remainder being the milk retailed by dairies. During 1922, the number of applications for milk, including renewals, granted by the Sub-Committee were as follows:—1st quarter, 448; 2nd quarter, 464; 3rd quarter, 439; 4th quarter, 529; total for the year, 1880, as against 2530 in 1921. The approximate total cost for the year was £429, namely, 1st quarter, £119; 2nd quarter, £94; 3rd 8 quarter, £86; and 4th quarter, £130. In 1921, the total sum expended was £990, in 1920, £1,515, and in 1919 £342. The Borough Council receives a grant from the Ministry of Health of half the cost incurred. Deaths and Death-Rate. There were 853 deaths of Chelsea residents in 1922, as compared with 862 in 1921. The death-rate for the year was 13.3 per 1,000, as against 13.5 in 1921. In London the death-rate for 1922 was 13.4, and in England and Wales, 12.9. 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 18.5 0.5 1.1 78 1922 16.1 13.3 0.8 0.9 66 Industrial Dwellings. 1921 16.4 11.1 0.9 1.2 81 1922 17.1 11.7 0.7 0.9 78 Poor-Class Streets. 1921 28.3 15.8 0.6 1.2 99 1922 25.0 14.9 2.0 2.3 126 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, Francis-street, Gilray-square, Ives-street, Riley-street, Slaidburn-street World's End-passage and courts adjacent, with a total population of 3,480. Infant 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 years 1921 and 1922:— 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 1922 66 51 9 The following table gives the Infantile Mortality Rates in Chelsea under various headings, for five four-yearly periods, and for 1921 and 1922:— 1901-4 1905-8 1909-12 1913-16 1917-20 1921 1922 Infectious Diseases 10.0 11.5 8.0 6.2 5.0 0.9 9.7 Diarrhœal Diseases 23.5 26.0 18.0 16.4 12.2 14.2 3.9 Developmental Defects and Wasting 48.0 37.0 34.5 28.2 31.9 36.0 26.1 Other Causes 58.0 44.0 36.0 36.6 28.9 27.4 26.1 Total Rate 139.5 118.5 96.5 87.4 78.0 78.5 65.8 Infantile Mortality Rates in Wards. Wards. Average of 10 years,1912-21. 1921. 1922. Hans Town 73 116 23 Royal Hospital 65 73 76 Church 91 82 85 Cheyne 63 56 20 Stanley 89 74 83 Chelsea Borough 81 78 66 Five-yearly Average Number of Annual Deaths, 1-5 years. Infectious Diseases. Diarrhœa and Enteritis. Tuberculosis Bronchitis a nd 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 1922 30 1 3 10 5 51 The increased number of deaths in 1922 is due to a much heavier mortality amongst children, 1 to 5 years of age, from Scarlet Fever, Diphtheria, Measles and Whooping Cough. Infectious and Other Diseases. Measles. There were 11 deaths from Measles in Chelsea in 1922, namely: 5 under 1 year of age, 4 between 1 and 3 years of age, one of 5 and one of 6 years. In 1921 there were no deaths from Measles. The last considerable epidemic in Chelsea was in 1915 (39 deaths). The Health Visitors in the course of the year made 439 visits to homes in connection with Measles cases, as against 12 in 1921. The 10 Nurses of the Chelsea District Nurses' Association paid 401 visits to 30 cases—an average of 13 visits per case. Fifty-eight cases were removed to Hospital, the total number brought to the notice of the Department in 1922 being 557 cases. Scarlet Fever. During the year, 197 cases of Scarlet Fever were notified in Chelsea' as against 233 in 1921. There were 6 deaths from this disease, namely: 5 between 1 and 5 years of age, and one child of 6 years. The case fatality rate for the year was 3.0 per cent., as compared with an average of only 1.0 per cent. for the 5 years 1916-20. The type of Scarlet Fever prevailing has been more severe than has characterised the disease for the last 12 years. Of the total cases notified, 91 per cent. were removed to hospital, as against 90 per cent. in 1921. The months of greatest prevalence were February (27 cases), August (21 cases), and October (24 cases). The months of least prevalence were December (7 cases), April (10 cases), and March (11 cases). The percentage of cases of school age (3 to 13 years) was 69 as compared with 75 in 1921. Diphtheria. During the year, 120 cases of Diphtheria were notified in Chelsea, as against 112 in 1921. The disease caused 14 deaths, namely: 12 of children between 1 and 5 years of age, a child of 8 and a child of 10. The case fatality rate was a high one, namely 11.7 per cent., as compared with 5.4 per cent. in 1921, and, as in the case of Scarlet Fever, the type of Diphtheria prevailing has been more severe than usual of recent years. Of the total 120 cases notified 93 per cent. were removed to hospital, as against 92 per cent. in 1921. The percentage of cases of school age (3 to 13 years), was 56, as against 76 in 1921. The month of greatest prevalance was October (25 cases). In no other month were there more than 12 cases. During the year medical practitioners sent 73 throat or nose swabbings to the Lister Institute for bacterioscopic diagnosis, as compared with 80 in 1921. Of the 73 specimens, 12, or 16 per cent., afforded positive evidence of the diphtheria bacillus, and 61, or 84 per cent., were negative, the corresponding figures for 1921 being 31 per cent. positive and 69 per cent. negative. In two cases the virulence of the bacillus isolated was tested by animal inoculation, one proving virulent and the other a virulent. Enteric Fever. The number of cases of Enteric Fever notified in Chelsea in 1922 was 4, as against 7 in 1921. There were no deaths. Three of the cases were removed to hospital. In two of the cases the infection of the disease was contracted outside the Borough. Two specimens of blood were examined for the Widal reaction, both proving negative. Diarrhœa and Enteritis. There were 7 deaths from these diseases in Chelsea in 1922, and one death from Dysentery in an asylum patient. Of the 7 deaths, 4 were of infants under one year, one a child between 1 and 2 years, and two were of old people. In 1921 there were 19 deaths from Diarrhoea. There were no Diarrhoea deaths in the 3rd or summer quarter of 1922. The 11 mean temperature of this quarter was low, namely 57.3°, as against 64.2° in 1921, when there were 12 deaths. The rainfall of the summer quarter in 1922 was 8.1 inches, as against 2.6 inches in 1921. In connection with these diseases, 27 visits were made to homes, and 27 cases were, as a result, discovered. Malaria. Two cases of Malaria were notified in 1922, both being persons (civilians) who had resided in India, the disease having been contracted there. Malarial parasites were found in the blood in each of these cases. Another specimen of blood was submitted for investigation from another supposed case, but no malarial parasites were found. Influenza. Influenza caused 48 deaths in 1922, 40 of which occurred in the first quarter of the year when the disease was epidemic. Of the 48 deaths, 3 were of infants under one year, 2 were between 1 and 5 years, 8 between 20 and 40, 18 between 40 and 60, and 17 over 60 years. In London there were 2,572 deaths from Influenza in 1922, as compared with 1,006 in 1921. In Chelsea no cases of Influenzal Pneumonia were notified in the first, second and third quarters, and only 3 cases in the fourth quarter. On behalf of the Borough Council an extra nurse was engaged on the staff of the Chelsea District Nursing Association for the 4 weeks ended the 8th February, so that all severe cases of Influenza and Pneumonia might receive adequate nursing attention, where required. Subsequent to the epidemic period, four cases of Influenza were attended by District Nurses, the average number of visits per case being 10. Pneumonia. Pneumonia and Broncho-Pneumonia caused 49 deaths in Chelsea in 1922, as against 43 in 1921. In the first quarter of the year 53 cases of acute primary Pneumonia were notified, in the second quarter, 5, in the third, 1, and in the fourth, 8. The District Nurses paid 183 visits to 15 patients suffering from Pneumonia, the average number of visits per case being 12. In London there were 6,522 deaths from Pneumonia in 1922, as against 1,799 in 1921. Tuberculosis. The deaths from Pulmonary Tuberculosis in 1922 numbered 51 (28 males and 23 females), as against 58 in 1921. Other Tuberculous diseases caused 9 deaths (7 males and 2 females), as against 12 in 1921. Of the 60 deaths from all forms of Tuberculosis, 11 had not been notified at any time prior to death occurring. Of the Pulmonary Tuberculosis cases ending fatally, 27 per cent. died in the Chelsea Infirmary, and 33 per cent. in other public institutions, that is to say, 60 per cent. died away from their homes, the corresponding figure for 1921 being 61 per cent. During 1922,113 new cases of Pulmonary Tuberculosis were notified, as against 103 in 1921. Forty-seven specimens of sputum were sent by medical practitioners to the Lister Institute for examination, as against 63 in 1921. Of the 47 specimens, 19 per cent. were positive for tubercle bacilli, and 81 per cent. were negative, as compared with 16 per cent. positive, and 84 per cent. negative in 1921. 12 A large number of insured and uninsured patients received hospital and sanatorium treatment under the London County Council scheme. The number of new cases of Pulmonary and Non-Pulmonary Tuberculosis visited by the Municipal Tuberculosis Visitor in the course of the year was 72. The total number of visits paid in respect of all cases of Tuberculosis and suspected Tuberculosis was 375. The Borough Council lent beds and bedding to 8 cases in the course of the year. Twenty-two new cases of Non-Pulmonary Tuberculosis were notified in 1922. 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. Twenty-five 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 (£57 17s.) with extra foods such as milk, eggs and butter. During the year the Tuberculosis Care Committee met fortnightly, except during the vacations, and dealt with cases as under:— Sanatorium cases 215 Referred to I.C.A.A. 79 Open-air school cases 14 Extra nourishment, including renewals 52 Referred to Poor Law Authorities 8 Referred to Medical Officer of Health 4 Miscellaneous cases 17 Under observation at Dispensary 235 624 Chelsea Tuberculosis Dispensary, Brompton Hospital. Work done during 1922. Under observation on Jan. 1st pending diagnosis. Examined for the first time. Total. Suffering from Tuberculosis. Not suffering from Tuberculosis. Under observation Dec. 31st Ceased attendance before diognosis. Pulmonary. Non. Pulmonary. (a) All persons (including contacts. Adults 110 275 385 46 4 285 38 12 Under 15 115 232 347 4 4 311 24 4 Total 225 507 732 50 8 596 62 16 (b) Contacts (included in (a) ) Adults 5 31 36 2 — 31 3 — Under 15 15 57 72 1 — 63 8 — Total 20 88 108 3 — 94 11 — (c) Insured persons (in-' eluded in (a)) 56 120 176 28 3 118 20 7 13 Number of patients under treatment or supervision on the 31st December, 1922 193 Total number of attendances at the Dispensary during 1922:— Insured 1211 Uninsured 2057 3268 Number of persons placed under observation for diagnosis 187 Number of observation cases where observation exceeded two months 58 Number of visits paid by Tuberculosis Officers to homes of patients 36 Number of visits paid by Nurses to homes of patients 3378 Number of specimens of sputum examined 957 Number of X-ray examinations 35 Number of Complement Fixation Tests 11 Cancer. The number of deaths from Cancer in Chelsea in 1922 was 106, as against 112 in 1921. The average annual number of deaths in the 5 years 1916-20, was only 85, so that the Cancer mortality appears to be increasing somewhat rapidly. In London generally the average annual number of deaths from Cancer in the 5 years, 1916-20, was 5,276, and the average for the 2 years 1921-2 was 5,889. The Chelsea increase for the past two years over the preceding 5 years average has been 28 per cent., and the London increase has been 11.6 per cent. Deaths in Lunatic Asylums. The number of deaths of Chelsea residents in Mental Hospitals and Asylums in 1922 was 31, as compared with 24 in 1921. Emephalitis Lethargica. There were no cases of this disease notified in Chelsea in 1922. In London 71 cases were notified during the year, and there were 50 deaths, the case fatality being 70 per cent. Cerebro-Spinal Meningitis. Four cases of this disease were notified in Chelsea in 1922, namely: male, 39, ended fatally, but was really Influenza; female, 1 year, 9 months, died in Victoria Hospital; male, 2 years, 2 months, died in St. George's Hospital; female, 22, died in St. George's Hospital, cause of death was Staphylococcal Pycemia, not Cerebro-spinal Meningitis. In London generally 88 cases of Cerebro-spinal Meningitis were notified in 1922, as against 106 in 1921, and 67 deaths were registered from this disease, the case fatality being 76 per cent. Polio-Myelitis and Polio-Encephalitis. No cases of these diseases were notified in Chelsea in 1922. In London 36 cases of Polio-Myelitis and 5 of Polio-Encephalitis were notified in 1922, there being 11 deaths from the two diseases. Puerperal Fever. Three cases of Puerperal Fever were notified in Chelsea in 1922, the same number as in 1921. There were 2 deaths. Two of the cases were admitted to the Chelsea Infirmary. 14 Pregnancy and Parturition. Ten deaths from the diseases and accidents of pregnancy and parturition occurred in 1922 in Chelsea, as compared with 4 in 1921, and 2 in 1920. Of the 10 deaths, 4 resulted from miscarriage in the early months of pregnancy, one being due to an illegally performed operation. Of the remaining 6 deaths, 3 were due to Puerperal Eclampsia, one to rupture of uterus at child-birth, one to contracted pelvis at childbirth, and one to Nephritis of pregnancy. Five of the deaths occurred in the Chelsea Infirmary, one in Queen Charlotte's Hospital, one in a Nursing Home in Chelsea, and 3 in the patients' own homes. In none of these cases had the woman attended at the Ante-natal Clinic of the Chelsea Health Society. Ophthalmia Neonatorum. Four cast s of this disease were notified in Chelsea in 1922, as against 15 in 1921. An additional two cases of eye trouble in infants, which were not notified, were visited, six visits in all being made by the Health Visitors. Five cases were attended by District Nurses, 51 visits being paid to the homes, which gives an average of 10 visits per case, as against 19 in 1921, and 31 in 1920, so that the cases in 1922 appear to have been less severe than those in 1920 and 1921. Of the total 6 cases, all made a complete recovery. In London, 875 cases of Ophthalmia Neonatorum were notified in 1922, as against 1,080 in 1921. Non-Notifiable Illnesses. The District Nurses paid 1,631 visits to the Homes of Expectant and Nursing Mothers and children under 5 years of age, during 1922, to attend to conditions as under:— Visits. Cases. Measles 401 30 Miscarriages and after confinements 227 15 Inflammation of Breasts 225 10 To take Temperatures for Clinics 171 6 Bronchitis 150 22 Septic Sores 79 8 Injuries 61 4 Ear troubles 49 6 Whooping Cough 37 3 Tonsils and Adenoids 32 6 Worms 30 7 Other conditions 169 20 1631 137 The corresponding figures for 1921 were 1,192 visits to 84 cases. Venereal Diseases. Ten specimens of blood were sent to the Lister Institute in 1922 by medical practitioners for the Wassermann (Syphilis) reaction. All these specimens proved negative. Nine of the specimens were sent by the 15 Medical Officer of the Ante-natal clinic. Seven specimens of pus were sent to be examined for the gonococcus, one being positive and 6 negative. Five of these specimens were sent from the Ante-natal clinic. Sale of Food and Drugs Acts. Of the 400 samples taken for analysis in 1922, 124 were milk, 123 being genuine, and one adulterated. This sample contained 4.7 per cent. of added water. As the vendor was protected by a warranty from the wholesale dealer, no proceedings were taken. Two samples of separated milk were taken, both being genuine. In May, 1922, six samples of cream were taken under the Public Health (Milk and Cream) Regulations, 1912 and 1917. Two samples were found on analysis to contain no boric acid, and were not labelled. Three samples were labelled "Preserved Cream containing Boric Acid not exceeding 0.5 per cent." These samples were found to contain the following amounts of Boric Acid:—0.32 per cent., 0.22 per cent., 0.25 per cent. The samples were consequently within the statutory limit of 0.4 per cent., prescribed by the Amending Order of 1917, but the labels were out of date. One sample was found to contain 0.18 per cent. of Boric Acid, but was not labelled in any way. All these samples of cream were obtained by the vendors from the same wholesale factory. The explanation obtained from the vendor of the sample containing 0.18 per cent. of Boric Acid, which was not labelled, was that she was out of labels at the time of sale. A cautionary letter was sent to the Vendors of the samples incorrectly labelled, and a printed Notice was sent to every shop in the Borough considered likely to sell by retail cream or preserved cream, drawing the attention of vendors of cream to the requirements of the Regulations. The samples of other foods taken were all found to be genuine on analysis; namely: Butter, 60 samples; Margarine, 24 samples; Coffee, 39 samples; Coffee-mixtures, 7 samples; Cocoa, 42 samples; Vinegar, 18 samples; Flour, 9 samples; Ground Ginger, 9 samples; Bakingpowder, 18 samples; Sugar, 3 samples; Lard, 9 samples; Pepper 10 samples; Cornflour, 18 samples; and Drugs, 2 samples. Housing of the Working Classes. New Housing Scheme. During the year the Borough Council agreed to purchase for the sum of £9,200 about 60,000 square feet of vacant land on the east side of Hortensia-road for the purpose of providing dwellings consisting of 3 and 4 roomed flats. The site has a frontage of 318 feet and a depth of 101 feet, but the Ministry of Health required that the northern portion of the land fronting Fulham-road to a depth of 100 feet should be offered for sale, and not included in the housing scheme. Housing. Number of new houses erected during the year:— (a.) Total 10 (b.) As part of a municipal housing scheme — 16 1. Unfit Dwelling-houses:— Inspection—(1.) Total number of Dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1014 (2.) Number of Dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 — (3.) Number of Dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4.) Number of Dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 986 2. Remedy of Defects without Service of Formal Notices:— Number of defective Dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers — 3. 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 38 (2.) Number of Dwelling-houses which were rendered fit:— (a.) By owners 38 (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 986 (2.) Number of Dwelling-houses in which defects were remedied :— (a.) By owners 986 (b.) By Local Authority in default of owners — C.—Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909 None The Staff engaged on housing work in 1922 consisted of 4 Sanitary Inspectors, each carrying out all the duties of a Sanitary Inspector in the district allocated to him. Rats and Mice Destruction Act, 1919. In July, 1922, complaint was received from a house forming one of a considerable block of buildings in the Northern portion of the Borough, that there was a serious rat infestation in this house and on adjoining premises. An inspection of the premises was made, and in reporting to the Public Health Committee, it was considered advisable to secure the services of Mr. C. L. Claremont, B.Sc., F.I.C., a Rat expert, to investigate and report. Mr. Claremont's report showed that there was a serious infestation of some of the premises comprised in this Block, the species of rat concerned being the black and grey rat, which are varieties of the Indian Black 17 Rat. This rat is much more difficult to exterminate than the common English Brown Rat, as it is a great climber, and nests in roofs and other inaccessible places, whereas the Brown Rat dwells in sewers, drains, and underground burrows, and does not usually invade floors higher than basement level. Preliminary notices of liability under the Act were served upon the occupiers of infested premises in September, 1922, and in November, 1922, notices were served upon the occupiers to take such steps as may from time to time be necessary and reasonably practicable for the destruction of rats on their premises, and for preventing such premises from becoming infested with rats. A further inspection by Mr. Claremont in February, 1923, showed that the infestation at that date was much less general than in the summer of 1922, although it was evident that complete extermination had not been effected. The matter is still under the consideration of the Public Health Committee. Cleansing Sta tion for Verminous Children. There being no proper cleansing station in Chelsea for cleansing the heads of verminous school children, the London County Council had made arrangements for children attending schools in the Eastern portion of the Borough to have their heads cleansed at the Westminster Cleansing Station, Chelsea Bridge, whilst those attending schools in the Western portion of the Borough were provided for at the L.C.C. Station in Seddlescombe-road, Fulham. The Public Health Committee considered that the rooms at the Shelter, Disinfecting Station, Lots-road, could be adapted and used for the purposes of a Cleansing Station, and that such a station would be more convenient for children in the Western portion of the Borough than the L.C.C. Station in Fulham. An arrangement was accordingly arrived at with the London County Council, by which a cleansing station should be formed at Lots-road, which should be used by children attending schools situated West of a line running down the centre of Sydney-street and Oakley-street. The station was to be adapted and fitted up by the Borough Council, who should also provide a cleansing attendant. The L.C.C. were to make all arrangements for the attendances of the children, and to supervise the work of cleansing by their school nurses. The cleansing station was fitted up with the necessary appliances at a cost of £26, and a woman was engaged as cleansing attendant at wages of 8s. per day for an 8-hour day once a week, and 1s. an hour for overtime for washing up, when necessary. The station was opened on the 27th October, 1922, and 8 sessions were held weekly between that date and the Christinas school holidays, when the station was closed for the vacation. Altogether 98 children attended at the 8 sessions, or an average of 12 per session. The Borough Council receive payment from the London County Council at the rate of 2s. per child attendance—the total sum received for the 98 children being £9 16s. Work of the Public Health Department. The tabular statements prepared by the Sanitary Inspectors show that 1,014 separate premises were reported on by them during 1922, 423 of this number being with reference to cases of notifiable infectious disease, and 291 in the course of house to house inspections made in 18 certain of the poorer streets of the Borough. Legal proceedings for breach of the Public Health (London) Act, were taken in 11 instances. During the year 414 premises were disinfected after cases of infectious or other disease, including 120 rooms which had been in occupation by persons suffering from Tuberculosis. In addition 207 rooms were disinfected for the presence of bugs and other vermin, and were subsequently stripped and cleansed by the owners. Three hundred and twenty-six school children were reported by the school-nurses to be in a verminous condition, and 318 visits to homes were paid in connection with these cases. Fifteen cases of Scabies were reported during the year, and 17 visits to homes were paid in connection with these cases. Workrooms (Women Employees). Number of workrooms inspected 875 „ workrooms measured 43 „ workroom cards given 31 „ outworkers premises inspected 85 „ laundries inspected 21 „ factories inspected 11 The woman Sanitary Inspector also paid 45 visits to homes in consequence of complaints received as to old age pensioners living under neglected and insanitary conditions. She also undertakes the supervision of the Women's Sanitary Convenience at the World's End. 19 SUMMARY OF WORKS CARRIED OUT BY SANITARY INSPECTORS DURING THE YEAR 1922. Houses and Premises:— *Total number of inspections 1014 House to House inspections 291 Inspections on Complaints 269 Inspections after infectious disease (Zymotic, pneumonia, etc.) 428 Miscellaneous inspections 31 Houses and premises or parts thereof cleansed and repaired 512 Defective roofs, gutters, and rain water pipes repaired 405 Damp walls remedied 54 New and proper dust-bins provided 324 Ashpits demolished 16 Water closet walls and ceilings cleansed and repaired 253 Water closets provided with light and ventilation 6 Washhouses, forecourts, areas, etc., cleansed, repaired, or paving repaired 36 Yards cleansed, repaired, or paving repaired 76 Sink, bath and lavatory waste pipes provided or repaired 68 Miscellaneous repairs 916 Premises disinfected after Zymotic diseases 294 Rooms disinfected after Tubercular and other diseases 120 Rooms disinfected for verminous conditions 207 Drainage:— Drains constructed or reconstructed 15 Drains cleansed and repaired 87 Drains trapped 8 Water closets, new pans and traps provided 62 Additional water closet accommodation provided 3 Ante-syphonage pipes provided to water closets 8 Ventilating pipes repaired 87 Drains and soil pipes ventilated and new soil ventilating pipes provided 19 Rain water pipes disconnected and caused to discharge over properly trapped gullies 3 Water Supply:— Water supply to premises reinstated 21 To tenement houses (upper stories) 1 Water closets provided with a water supply, or flushing apparatus repaired 136 Drinking water cisterns cleansed, repaired and covered 39 * This number does not include revisits or inspections of premises where no defects were found. 20 Nuisance Abated Arising From:— Keeping of animals 18 Accummulations of manure and refuse 54 Overcrowding 4 Stable abolished 1 Proceedings Taken:— Intimation Notices served 986 Statutory Notices under Public Health (London) Act served 253 Statutory Notices under Section 28 of Housing, Town Planning Act, 1919 38 Number of Samples taken for analysis (Food and Drugs Acts) 400 LEGAL PROCEEDINGS taken in respect of defective sanitary conditions and nuisances 12 Special sample of Cream taken (Milk and Cream Regulations) 6 LEGAL PROCEEDINGS in respect of unsound food 1 LEGAL PROCEEDINGS in respect of milk 1 Certificates issued in accordance with "Rents Restriction Act" 8 Correspondence:— Number of letters written in connection with sanitary matters 899 Entries in Inspectors Report Books 994 Entries in Inhabitants' Complaints Book 51 Notifications of infectious cases sent to Metropolitan Asylums Board 144 Notifications of infectious cases sent to School authorities 339 Certificates of disinfection given 546 Certificates of infectious diseases for removal cases 137 Notices sent to Public Library of premises where infectious diseases have occurred 149 Post Cards sent re samples under Sale of Food and Drugs Act 400 Inspections of Special Premises:— Restaurant Kitchens 42 Slaughter Houses 75 Ice Cream Premises 47 Milk Shops 146 Bakehouses 22 Food premises other than those above 100 Workshops (male employees) 42 Smoke Nuisances:— Number of observations 8 Number of nuisances and complaints — Number of Notices — Number of Summonses — 21 Premises:— No. on Register at end of 1922. No. of Inspections. No. of prosecutions Cowsheds — — — Milkshops 68 146 1 Houses let in lodginsg — — — Ice cream premises 17 47 — Slaughter houses 3 75 — Offensive trades — — — Cleansing:— Number of adults cleansed - Number of children cleansed 99 Number of rooms or premises cleansed and disinfected 621 Number of persons bathed for scabies 16 Disinfection Shelter:— Persons accommodated:— Adults 10 Children 18 28 Mortuary:— Number of Bodies received 80 Number of infectious Bodies received — Food Condemned and Destroyed:— Bacon 150 lbs. Beef 42 lbs. Cooked Ham 58 lbs. Fish 5 stone Kippers 1 box Apples 8 barrels Food Seized, Condemned and Destroyed:— Pickles 7 lbs. Miscellaneous:— Dead bodies removed to Public Mortuary for sanitary reasons 4 Goods disinfected after infectious cases at stations 242 articles Goods destroyed after infectious cases 74 articles Library books destroyed at Librarian's request 20 Animals destroyed in Incinerator 4 22 23 MAGISTERIAL PROCEEDINGS DURING 1922 UNDER THE PUBLIC HEALTH (LONDON) ACT, 1921. Situation of Premises. Nature of Nuisance or Complaint. Petty Sessions. Date of Hearing. Result. 71, Blantyre-street Failing to comply with an Abatement Order to repair and cleanse interior of premises. Kensington 17-1-22 Fined £3 5s.; Costs, £1 1s. 69, Blantyre-street Failing to comply with an Abatement Order to repair and cleanse interior of premises. Kensington 17-1-22 Fined £3 3s.; Costs, £1 1s. 8, Edith-grove Failing to provide a proper and sufficient supply of water to the premises. Kensington 2-5-22 Closing Order. 8, Edith-grove Failing to comply with Closing Order of 2-5-22. Kensington 16-5-22 Fined £5 or in default 14 days. 26, Church-street Failing to repair and cleanse interior of No. 5 Flat. Kensington 16-5-22 21s. costs; work to be done within 7 days. 32, Limerston-street Failing to provide proper dust-bin— repair and cleanse interior of premises. Kensington 18-7-22 21s. costs; work to be done within 21 days 46, Markham-street Failing to repair and cleanse interior of premises. Kensington 18-7-22 21s. costs; work to be done within 28 days. 8, Britten-street Failing to remove accumulation of filth and cleanse floor of room. Kensington 3-10-22 Fined £5; work to be done within 48 hours. 112, Lots-road Failing to cleanse first floor rooms and exterminate vermin. Kensington 17-10-22 Adjourned for three weeks. Situation of Premises. Nature of Nuisance or Complaint. Petty Sessions. Date of Hearing. Result. 22, Church-street Failing to cleanse floor and woodwork of ground floor room. Kensington 17-10-22 Costs, £2 2s., and an Order made to cleanse room forthwith. 36, Blantyre-street Failure to discontinue use of premises as a stable. Kensington 21-11-22 Adjourned for one month. Kensington 19-12-22 Abatement Order to discontinue use as stable, within 21 days. 58, Radnor-street Failing to cease to occupy top back room to abate overcrowding. Kensington 19-12-22 Closing Order (suspended for 21 days), and to, cleanse room. UNSOUND FOOD. 55, Arthur-street Exposing pickles for sale, for food, being unsound. Kensington 17-10-22 Fined £5. MAGISTERIAL PROCEEDINGS DURING 1922 UNDER THE COWSHEDS, MILKSHOPS AND DAIRIES ORDERS, 1885. 55, Arthur-street Carrying on Trade as Purveyor of Milk without being registered. Kensington 17-10-22 Fined £1 1s.