CHE 24 CU345 Metropolitan Borough of chelsea. Annual Report for 1923 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. Metropolitan Borough of Chelsea. Annual Report for 1923 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, 26 AND 28, LANCELOT-PLACE, BROMPTON-ROAD, S.W. 7. 1924 TABLE OF CONTENTS. Page Population of Chelsea 3 Births and Birth-rate 4 Notification of Births 4 Maternity and Child Welfare 5 Infant Mortality 5 Work of Health Visitors 5 Ante-Natal and Infant Clinics 6 Chelsea Day Nursery 6 Maternity Nurse and Midwife 6-7 Home-help 7 Supply of Milk at less than cost price 8 Chelsea Branch of I.C.A.A. 8 Deaths and Death-Rate 8 Birth and Death-rates of Special Classes 9 Infant Mortality Rates and Deaths, 1-5 years 10 Infectious Diseases 11 Influenza and Pneumonia 12 Tuberculosis 12 Chelsea Tuberculosis Dispensary 13-14 Cancer 14-16 Encephalitis Lethargica and Cerebro-spinal Meningitis 16 Puerperal Fever and Ophthalmia Neonatorum 16-17 Venereal Disease Diagnosis 17 Sale of Food and Drugs Acts 18 Housing of the Working Classes 18-19 Rats and Mice Destruction Act 19 Cleansing Station for Verminous Children 20 Work of the Public Health Department 20 Summary of Work in 1923 21-24 Magisterial Proceedings 25-28 Annual Report of the Medical Officer of Health for the Year 1923. POPULATION OF CHELSEA. The Registrar-General's estimated population for the middle of 1923 is 64,480. The actual census population in 1921 was 63,700. The area of the Borough is 660 acres. The number of inhabited houses in 1921 was 10,355. The rateable value of the Borough in 1923 was £939,188, and the sum represented by a penny rate was £3,750. Table showing percentages of Males and Females. Males. Females. Chelsea 40.5 59.5 London 46.2 53.8 Table showing percentages in sex-age groups. 0-5 5-15 15-25 25-35 35-45 45-55 55-65 65 and upwards Males: Chelsea 8.0 15.9 15.3 14.8 14.2 13.1 9.3 9.8 London 9.2 19.5 17.2 15.2 14.0 12.1 7.7 5.1 —1.2 —3.6 -1.9 —0.4 +0.2 +1.0 +1.6 +4.7 Females: Chelsea 5.4 11.6 18.2 18.4 15.9 13.3 9.6 8.1 London 7.7 16.8 18.3 16.9 14.7 11.7 7.6 6.4 -2.3 —5.2 -0.1 +1.5 +1.2 +1.6 +2.0 +1.7 Table showing proportion of males and females over 12 per 10,000 of each sex, unoccupied and employed as domestic servants. Unoccupied. Domestic Servants. Males: Chelsea 1820 452 London 1340 122 Females: Chelsea 4959 2491 London 5988 452 Table showing percentage of total population housed in Tenements of one and more rooms. Chelsea. London. Tenements of 1 room 6.5 5.8 „ 2 rooms 17.7 16.6 „ 3 rooms 20.8 22.5 „ 4 rooms 11.3 20.1 33.7 29.6 Over 4 rooms Living otherwise than in Private Dwellings 10.0 5.4 Table showing density of population—Persons per Acre. London 60 persons per acre. Chelsea 97 „ Wards: Hans Town 93 „ Royal Hospital 59 „ Church 124 „ Cheyne 83 „ Stanley 122 „ Births and Birth-Rate. In 1923, 965 births were registered in the Borough. Excluding 152 births of non-parishioners, and including 158 births taking place amongst Chelsea mothers in Lying-in Hospitals and Homes outside the Borough, the total number of births for the year was 971, the corresponding figure for 1922 being 1,032, for 1921, 1,057, and for 1920, 1,392. The birth-rate for the year was 15.1 per 1,000, as compared with 16.1 per 1,000 in 1922. The birth-rate of London for 1923 was 20.2 per 1,000, as compared with 21.0 in 1922. Notification of Births. Number. Living Children 748 Still-born Children 31 779 Notified by Medical Practitioners 215 „ St. George's Hospital, Extern Department 42 „ Midwives 410 „ Chelsea Institution 65 „ Parents, etc. 47 779 Total number of Chelsea births registered in the Borough 813 The notifications, therefore, formed 96 per cent, of the total births of Chelsea residents registered in the Borough, as against 97 per cent. in 1922. The number of births notified by midwives in 1923 was 53 per cent, of the total, as against 51 per cent. in 1922. Illegitimate Births. Total number of illegitimate births 44 Alive at end of year 37 Dead at end of year 1 Unaccounted for 6 Maternity and Child Welfare. There were 56 deaths of infants under one year of age in Chelsea in 1923, equivalent to an Infant Mortality Rate of 58 per 1,000 Births, as compared with 66 per 1,000 in 1922, 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 1923, the rate of Infant Mortality was 61, and in England and Wales, 69. The number of births of Chelsea infants in outlying institutions in 1923 was 156, or 16.1 per cent. of the total births, as compared with 13 per cent, in 1922. The number of births occurring in outlying institutions is steadily increasing, and is now about three-fold what it was before the war. St. George's Hospital opened a very well equipped Maternity Ward in May, 1923, and 45 Chelsea women were admitted for confinement between the date of opening and the end of the year. Ten Chelsea women were confined at the Ormond Home, 155, King'sroad, during the year. There were 57 births in the Maternity Ward of St. Luke's Hospital in 1923, or 5.9 per cent. of the total births. The following tabular statement gives an outline of the work carried on in Chelsea during 1923 in Maternity and Child Welfare, the visits being those paid by the trained officer of the Borough Council (one whole-time Health Visitor), and of the Chelsea Health Society and School for Mothers (two whole-time Health Visitors), and does not include work done by voluntary workers attached to the Society. Summary of Reports of Health Visitors for 1923. Number of homes visited (first visits), Infants 636 „ revisits, Infants 1828 „ Infants attendances at Infant Consultations 3115 „ visits to Children of one year to school age 304 „ revisits ditto 2664 „ Children of one year to school age, attendances at Medical Inspections 2634 „ ante-natal visits to Expectant Mothers 555 „ ante-natal case attendances at ante-natal clinic 306 „ visits to Diarrhœa cases amongst children „ cases of Diarrhœa found „ visits to cases of Ophthalmia Neonatorum General additional visits in connection with the work 772 As compared with 1922, there were 111 more infant attendances at the consultations, and 66 fewer home visits to infants. The number of attendances of children of one year to school age at medical inspections was 1,099 in excess of 1922, and the visits to the homes of these children were 213 in excess of the 1922 figure. The ante-natal visits to expectant mothers diminished by 109, and the case attendances at the clinic diminished by 75. During the year 1923, the clinics held at 1. Manor-street were:— Tuesday afternoons, 2 clinics; Wednesday afternoons, ante-natal clinic; Thursday afternoons, 1 clinic to mid-April, subsequently 2; at 484, King's-road, 2 clinics on Monday afternoons to mid-April, subsequently one clinic. Total number of infant clinics, 6 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 conmencing 1st April, 1923, as under:— £ s. d. Chelsea Health Society and School for Mothers 700 0 0 Chelsea Day Nursery, 65, Sydney-street Chelsea Branch of Invalid Children's Aid Association 100 0 0 100 0 0 Chelsea District Nursing Association 50 0 0 Convalescent Homes for Nursing Mothers and Infants 40 0 0 £990 0 0 Half this amount, namely, £495, is recovered as a grant from the Ministry of Health. Chelsea Day Nursery, 65, Sydney-street. The Chelsea Day Nursery was open throughout the year except for a week at Easter and a week at Christmas. The total number of attendances of children was 5,679. as against 5,355 in 1922, and 4,649 in 1921. The average daily attendance (5 days a week) was 23, as against 23 in 1922, 18 in 1921, and 21 in 1920; The total number of individual children who attended during 1923 was 89, Dr. Alice Benham, Medical Officer, makes a fortnightly medical inspection of the children. Fees of Maternity Nurse and Midwife. In February, 1923, the Council were informed by the Ormond Home for Midwives, and Nurse Andrews that the fee (in connection with the Borough Council Scheme) for a Maternity Nurse or Midwife, would be increased from 30s. to £2 for Primipara, and 255. to 30s. for Multipara Cases. This increase of fees was approved by the Milk and Welfare Sub-Committee after thorough consideration. In October, 1923, the Council included The St. Man's Nursing Home, Fulham, in their scheme. The fees in this instance being £2 2s. for Primipara, £1 10s. for 2nd and 3rd cases, and 25s. for 4th and subsequent cases. Maternity Nurse. Thirteen applications were received during the year 1923 from necessitous women to be provided with a Maternity Nurse at their approaching confinements at less than cost price. Ten of the applications were granted, and three cases were refused on account of unsuitable conditions for confinement at home. Of the 10 cases granted. 6 were provided with a Maternity Nurse; in one case the mother was sent into hospital for confinement, and 3 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 1923 was 11. Eight of the cases were attended by The Ormond Home for Midwives, and 3 cases by Nurse Andrews. The amount paid by the Council to the Maternity Nurses for these 11 cases was £7 16ds. 8d., £6 18s. 4d. being the amount of assessment paid, or to he paid by the applicants as contributions to the Maternity Nurse. The net cost to the Borough was £7 16s. 8d., half of which is recovered as a grant from the Ministry of Health. Midwife. Forty-three applications were received during the year 1923 from necessitous women for the services of a midwife at less than cost price: 36 were granted, 5 were referred to the Guardians, one refused (application too late), and one refused as not suitable under the scheme. Of the 30 applications granted, 26 were supplied with a midwife, 3 applications were withdrawn, and 7 cases were awaiting confinement at the end of the year. The total number of necessitous women provided with a midwife under the Council's scheme during 1928 was 34, of which number 16 were attended by the Ormond Home for Midwives, 16 by Nurse Andrews, one by Midwife Cooke, and one by St. Mary's Nursing Home. The amount paid by the Council to the Midwives was £31 12s., £18 13s. being the amount of assessment paid, or to be paid by the applicants as contributions to the midwife. The net cost to the Borough was £81 125., half of which is recovered as a grant from the Ministry of Health. Home Help. Nine applications were received in 1923 from necessitous women for the services of a Home-help during their confinements, and all were granted. Of this number 6 were supplied with the services of a Homehelp, 2 were withdrawn by the applicants, and 1 case was 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 8. The total amount paid by the Council to Home-helps for their services was £30, and the amount of contributions assessed to patients was £9 2s. 6d., leaving a balance of £20 17s. 6d. as the net cost to the Borough, half of which is recovered as a grant from the Ministry of Health. Convalescent Homes. Twelve applications were received for convalescence of mothers with their infants under the Council's scheme in 1923. All the applications were granted, but only 7 of the mothers were sent away, 4 were withdrawn, and one still remains on the books. The payments to Homes made by the Council amounted to £12 18s., and the contributions of patients amounted to £1 17s. Six mothers were sent to Homes, apart from the Council's scheme. The average duration of stay in the Homes is 2 weeks. 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 nursing their children; (b.) expectant mothers in the last 3 months of pregnancy; and (c.) children up to 3 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. During 1923, 72.5 per cent. of the milk granted at less than cost price was Dried Milk, and 27.5 per cent. was Cows' Milk from retail dairies. During 1923, the number of applications for milk, including renewals, granted by the Sub-Committee were as follows: — 1st quarter, 607; 2nd quarter, 589; 3rd quarter, 463; 4th quarter, 551; total for the year, 2,210, as against 1,880 in 1922. The approximate total cost for the year was £421, namely, 1st quarter, £130; 2nd quarter, £96; 3rd quarter, £82; and 4th quarter, £113. In 1922, the total sum expended was £429, in 1921, £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. Chelsea Branch of the Invalid Children's Aid Association. Report of work done in 1923 in respect of children under 5 years. During 1923, 113 children under 5 years of age were referred to the Branch for assistance or friendly visiting and advice. Of this number 56 children were sent by the Branch for periods varying from 6 weeks to 6 months or longer, to Convalescent Homes in the country or at the sea-side, or were placed with good foster-mothers under careful supervision in healthy country surroundings. Twenty-four children, whose parents were out of work, were given at the request of the Chelsea Health Society medical comforts, e.g., tonic medicines, cod-liver oil and malt, vitoleum cream, etc. Eight children were provided with surgical boots and other surgical appliances. Hospital letters were given and treatment arranged for many of the children. Railway fares and escorts were provided, and warm clothing given to many children going into the country. The total amount directly spent on these children under 5 years by the Branch during the year, 1923, was £354 18s. 11d., towards which the parents of the children contributed £98 19s., leaving a balance to be raised by the Branch of £255 19s. 11d. Deaths and Death-Rate. There were 788 deaths of Chelsea residents in 1923, as compared with 853 in 1922. The death-rate for the year was 12.2 per 1,000, as against 13.3 in 1922. In London the death-rate for 1923 was 11.2, and in England and Wales 11.6. Birth and Death-Rates of Special Classes. Chelsea Borough. Zymotic Deathrate. Tubercular Deathrate. Deaths under one year to 1000 Births. Birthrate. Deathrate. Year. 1905-8 22.0 16.2 1.8 2.0 122 1909-12 19.6 15.2 1.2 1.8 99 1913-16 18.0 14.8 1.0 1.5 87 1917-20 15.7 14.6 0.7 1.5 75 0.5 1921-23 16.0 13.1 1.0 68 Industrial Dwellings. 2.2 1905-8 29.5 14.8 2.2 95 1909-12 27.7 13.0 1.4 1.4 92 1913-16 27.4 13.3 1.3 2.1 75 1917-20 18.5 12.1 0.7 1.8 60 1921-23 16.3 11.1 0.7 1.1 79 Poor-Class Streets.* 1905-8 38.0 24.4 4.2 3.4 183 1909-12 36.8 24.1 3.0 3.8 137 1913-16 32.9 20.3 3.2 2.1 124 1.6 88 1917-20 22.0 14.4 1.4 1921-23 24.2 13.8 1.1 1.4 79 1893-6 - 34.6 7.5 4.3 - 1897-1900 - 33.7 7.0 4.6 - 1901-4 - 26.3 3.7 4.1 - *1893-1908 statistics based on populations of 11 streets 1909-1911 „ „ 10 streets 1912-1923 „ „ 7 streets The industrial dwellings includes the Borough Council dwellings with a population of 1,467, and other industrial dwellings with a population of 5,300. The poor-class streets are Dartrey-road, Francis-street, Gilray-square, Ives-street, Riley-street, Slaidburn-street, World's Endpassage and courts adjacent, with a population of 3,480. The tables show the great reduction of both birth and death-rates of recent years, both in the Industrial dwellings and in the poor-class streets. The birth-rate in the industrial dwellings has fallen from 29.5 in 1905-8 to 16.3 in 1921-3. The death-rate has similarly declined from 14.8 to 11·1. In the poor-class streets the birth-rate has fallen from 38·0 to 24·2, and the death-rate from 24·4 to 13·8, the infant mortality rate falling from 183 to 79. Within a period of 30 years the poor-class streets death-rate has declined 60 per cent. (34·6 to 13·8); the deathrate from infectious diseases has declined 85 per cent. (7·5 to 1·1); and the death-rate from tubercular diseases has declined 68 per cent. (4·3 to 1·4). These figures are astonishing when we consider that these streets have not been rebuilt; the houses are very much the same as they were 80 years ago, and are occupied by a similar class of people. The great improvement is attributable, I think, to the better education of the people, the better standard of living, greater temperance, and the work of the Health Visitors and Sanitary Inspectors. Infant 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, 1922 and 1923: — 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 1923 58 21 The following table gives the Infantile Mortality Rates in Chelsea under various headings, for five four-yearly periods, and for 1921, 1922 and 1923:— 1901-4 1905-8 1909-12 1913-16 1917-20 1921 1922 1923 Infectious Diseases 10·0 11·5 8·0 6·2 5·0 0·9 9·7 5·2 3·9 Diarrhœal Diseases Developmental Defects and Wasting 23·5 26·0 18·0 16·4 12·2 14·2 8·3 48·0 37· 0 34·5 28·2 31·9 36·0 26·1 19·5 58·0 44·0 36·0 36·6 28·9 27·4 26·1 24·7 Other Causes 139·5 118·5 96·5 87·4 78·0 78·5 65·8 57·7 Total Rate During the past 10 years, 1914-23, of the total deaths of infants under one year of age, 25 per cent. died in the first week of life, and 37.5 per cent. in the first 4 weeks of life. The majority of these deaths in the first 4 weeks of life are due to premature birth and defective vitality of the infant, to congenital defects, and to wasting attributable to inability to take nourishment, the result of weakness of the infant at birth. A development of the system of ante-natal care of the mothers, and the provision of milk for expectant mothers during the latter 6 months of pregnancy, should exert some influence in reducing the infantile mortality during the first weeks of life. Infantile Mortality Rates in Wards. 1922. Average of 10 years, 1912-21. Wards. 1923. Hans Town 73 23 71 Royal Hospital 65 76 50 Church 91 85 63 63 20 66 Cheyne Stanley 89 83 51 81 66 58 Chelsea Borough Five-yearly Average Number of Annual Deaths, 1-5 years. Diarrhoea and Enteritis. Bronchitis and Pneumonia. Infectious Diseases. Tuberculosis. 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 1923 5 1 11 4 21 Infectious and Other Diseases. Measles. There were no deaths from Measles in Chelsea in 1923. In 1922 there were 11 deaths, and in 1921 no deaths. The last considerable epidemic in Chelsea was in 1915 (39 deaths). The disease began to assume greater prevalence in the last six weeks of 1928, which is being maintained in the present year (1924): up to the end of the first week of March nine deaths have occurred. The Health Visitors in the course of the year made 157 visits to homes in connection with Measles cases, as against 439 in 1922. The Nurses of the District Nursing Association paid 48 visits to 5 cases. Eleven cases were removed to hospital, the total number of cases brought to the notice of the Department in 1923 being 148. Scarlet Fever. During the year, 111 cases of Scarlet Fever were notified in Chelsea, as against 197 in 1922. [There was only one death from this disease — a child of 5 years. The case fatality rate was 0.9 per cent., as compared with 3 per cent. in 1922. The average of the 5 years. 1916-20 was 1.0 per cent. Of the total cases notified, 95 per cent, were removed to hospital, as against 91 per cent. in 1922. The month of greatest prevalence was January (19 cases), and of least prevalence August (3 cases). The percentage of cases of school age (3 to 13 years) was 71, as compared with 69 in 1922. Diphtheria. During the year, 97 cases of Diphtheria were notified in chelsea, as against 120 in 1922. The disease caused 11 deaths, at the following ages, five months, and 2, 3, 4, 5, 6, 7, 7, 9,11, 11 years. The case fatality rate was 11.3, as compared with 11.7 in 1922, and 5.4 per cent. in 1921. Of the total 97 cases. 90 per cent. were removed to hospital, as against 93 per cent. in 1922. The percentage of cases of school age (3 to 13 years) was 62, as against 56 in 1922. The month of greatest, prevalence was February (20 cases), and the month of least prevalence November (2 cases). During the year medical practitioners sent 94 throat or nose swabbings to the Lister Institute for bacterioscopic diagnosis, as compared with 73 in 1922. Of the 94 specimens, 9, or 9.6 per cent., afforded positive evidence of the diphtheria bacillus, and 85, or 90.4 per cent., were negative, - the corresponding figures for 1922 being 16 per cent. positive, and 84 per cent. negative. Enteric Fever. The number of cases of Enteric Fever notified in Chelsea in 1923 was 4. In addition two cases of Paratyphoid Fever (B.) were notified. There were no deaths. Two of the Enteric Fever cases were removed to hospital. In one case the infection of the disease was contracted in Holland. In one case, the patient, who was in hospital for over three months, was the wife of an oysterman, employed at a West End hotel in opening oysters. This man was quarantined for a period, whilst his fœces and urine were examined for bacillus typhosus. The result was negative. He was compensated for loss of wages by the Borough Council. Two specimens of blood were examined for the Widal reaction—one proving positive, and the other negative. Diarrhœa and Enteritis. There were 8 deaths from these diseases in 1923, the number in 1922 being 7. All the 8 deaths were of infants under one year of age. There was only one death from diarrhœa in the 3rd or summer quarter of the year. The mean temperature of this quartet was 60·8 ° F., as against 57·3° in 1922, when no deaths occurred. The rainfall of the quarter in 1923 was 5½ inches, as against 8.1 inches in 1922. In connection with these diseases, 5 visits were made to homes, and 5 cases were, as a result, discovered. Influenza. Influenza caused 15 deaths in 1923, as against 48 in 1922. There was no epidemic prevalence in 1923. Of the 15 deaths one was an infant of 8 months, two were between 20 and 40 years, and 12 were over 60. In London there were only 752 deaths from Influenza in 1923. as compared with 2,572 in 1922. Five cases of Influenzal Pneumonia were notified in Chelsea in the course of the year. Pneumonia. Pneumonia and Broncho-Pneumonia caused 59 deaths in Chelsea in 1923, as against 49 in 1922. During the year 37 cases of Acute Primary Pneumonia were notified, 12 in the first quarter, and 16 in the last quarter of the year. Nineteen cases were notified by St. Luke's Hospital, 11 cases by other public, institutions, and 7 cases by private doctors. The District Nurses paid 261 visits to 15 patients suffering from Pneumonia, the average number of visits per case being 17. The Woman Sanitary Inspector also visited 11 cases to ascertain if nursing assistance was required. In London, there were 4,248 deaths from Pneumonia in 1923, as against 6,522 in 1922. Tuberculosis. The deaths from Pulmonary Tuberculosis in 1923 numbered 52 (28 males and 21 females), as against 51 in 1922. Other tuberculous diseases caused 5 deaths (2 males and 3 females), as against 9 in 1922. Of the 57 deaths from all forms of Tuberculosis, 5 had not been notified at any time prior to death occurring. Of the Pulmonary Tuberculosis cases ending fatally, 42 per cent. died in St. Luke's Hospital, and 29 per cent. in other public institutions, that is to say, 71 per cent. died away from their homes, the corresponding figure for 1922 being 60 per cent. Fifty-nine specimens of sputum were sent by medical practitioners to the Lister Institute for examination, as against 47 in 1922. Of the 59 specimens, 22 per cent. were positive for tubercle bacilli, and 78 per cent. were negative, as compared with 19 per cent. positive and 81 per cent. negative in 1922. The death-rate from all forms of Tuberculosis in Chelsea in 1923 was 0.9 per 1,000. Chelsea Tuberculosis Dispensary, Brompton Hospital. Work done during 1923. Under observation on Jan. 1st pending diagnosis. Examined for the first time. Suffering from Tuberculosis. Pulmonary. Non- Pulmonary. Not suffering from Tuber- culosis. Ceased attendance before diagnosis. Under observation Dec. 31st. Total. Adults 109 248 357 61 1 252 30 13 (a) All persons (including contacts). Under 15 128 194 322 15 273 33 1 237 442 679 61 16 525 63 14 Total 4 - Adults Under 15 10 57 67 2 61 (b) Contacts (included in (a) ) 30 53 83 - 1 76 6 - - 40 Total 110 150 2 1 137 10 - (c) Insured persons (included in (a)) Total 57 124 181 40 1 115 25 Number of patients under treatment or supervision on the 31st December, 1923 238 Total number of attendances at the Dispensary during 1923:— Insured 1157 Uninsured 1775 - 2932 Number of persons placed under observation for diagnosis Number of observation cases where observation exceeded 2 months 320 54 Number of visits paid by Tuberculosis Officer to homes of patients 98 Number of visits paid by Nurses to homes of patients 2995 Number of specimens of sputum examined 730 Number of X-ray examinations 92 Number of complement Fixation Tests 2 Number of Wassermann Tests - - 3 13 Work done at the Dispensary, 1917-1923. Number of persons examined for the first time. Total attendances at Dispensary. Definite Tuberculosis. Year. 1917 (April to Dec.) 84 equals 31 per cent. 790 272 1699 1918 290 61 „ 21 „ 1919 426 58 „ 14 „ 2705 1920 591 70 „ 12 „ 3841 1921 572 55 „ 10 „ 3210 1922 507 58 „ 11 „ 3268 1923 442 77 „ 17 „ 2932 3100 463 „ 15 18445 Total for 7 years Annual Average 443 66 „ 15 „ 2635 A large number 70 of insured and uninsured patients received hospital and sanatorium treatment under the London County Council scheme. One hundred and sixteen new cases of Pulmonary Tuberculosis were notified in Chelsea in 1923 (58 males and 58 females). The nonpulmonary cases were 15 (4 males and 11 females). The number of new cases of Tuberculosis visited by the Municipal Tuberculosis Visitor in the course of the year was 90. The total number of visits paid in respect of all cases (Pulmonary and non-Pulmonary) was 608. The Borough Council lent beds and bedding to 3 cases in the course of the year. Several cases of non-pulmonary tuberculosis 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 Brach of the Invalid Chilldren's Aid Association. Twenty cases of Tuberculosis were certified during the year by the Tuberculosis Officer as requiring extra nourishment, as part of their medical treatment, and these cases were supplied at the cost of the Borough Council (£37 5s. 2d.) with extra foods, such as milk, eggs, and butter. During the year the Tuberculosis Cre Committee met fortnightly except during the vacations, and dealt with cases as under:— Sanatorium Cases 70 Treated in Brompton Hospital 31 Referred to I.C.A.A. 116 Extra nourishment, including renewals 20 Referred to Poor Law Authorities 17 Referred to Charity Organisation Society 16 Cancer. The following Table shows the annual average of deaths from all causes, tuberculosis, and cancer in Chelsea in 6 quinquennial periods from 1891, and also in 1921, 1922 and 1923: — All Causes. Tuberculosis. Non- Pulmonary. Cancer. Period. Pulmonary. Total. 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 24 1916-20 935 75 18 93 85 1921 862 58 12 70 112 1922 853 51 9 60 105 1923 788 52 5 57 117 The deaths from cancer have increased cosiderably during the past 3 years, the total numbers for this period being 334.The following Table shows the different classes affected:- Professional and Independent. 63 Trading and Clerical. 51 Domestic Servants. 22 Other Working Class. 169 Royal Hospital Pensioners. 29 Total. 334 The following Table shows the ages at death amongst males and females:— 20-30 30-40 40-50 50-60 60-70 70-80 80-90 Total. Males 27 53 42 10 141 334 1 3 5 193 Females 2 3 23 39 51 51 24 The average annual Cancer death-rate for the 3 years, 1921-3, is Males, 1·8 per 1000; females, 1·7 per 1000. Amongst males 94 per cent. of the deaths occurred at ages at ages over 50,whilst in females 86 per cent. of the deaths were of women over 50 years. The following Table shows the chief organs affected in the fatal cases occurring in males and females in the 3 years. 1921-2-3: — Males. Females. Persons. Œsophagus 16 16 Stomach 13 31 44 Liver 16 14 30 Pancreas 6 1 7 Intestines 11 23 34 Rectum 19 20 39 Kidney 2 2 4 Bladder. 11 5 16 Tongue 9 9 Larynx 9 2 11 Breast 42 42 Uterus 27 27 Other organs 29 26 55 141 193 334 The Table shows that of the Cancer deaths in males in the past 3 years, 57 per cent. were due to cancerous affections of the digestive organs, the corresponding figure for females being 46 per cent. Cancer of the - - - - bread and uterus accounted for 36 per cent. of the female deaths. The Table also shows that all the deaths from cancer of the Œsophagus, all the deaths from cancer of the tongue, and 9 out of 11 deaths from cancer of the larynx occurred amongst males. An inquiry made as to the home addresses of the Chelsea residents dying of Cancer in the past 3 years shows that the vast majority of deaths occurred singly in a house. In 11 instances, however, there were two deaths from Cancer in one house. but two of these houses were of the nature of institutions, and not private houses. In the remaining 9 cases, in 5 houses there was no apparent connection between the cases of Cancer occurring in the house, but in 4 houses there was a family relationship between the cases, which is given below: — (1.) A man of 59 died of Cancer of the Larynx in May, 1922. His widow, aged 62, died of Sarcoma of the Armpit in January, 1923. (2.) A woman of 60 died of Cancer of the Intestines in February, 1921. Her sister, aged 68, died of Cancer of the Breast in November, 1923. (3.) A woman, still living, had her uterus removed for Cancer some years ago, and now has cancerous glands. Her husband died of Cancer of the Jaw in 1922. (4.) A man of 67 died of Cancer of the Rectum in September. 1923. His widow, aged 51, died of Cancer of the Ovary in December, 1923. These 4 instances of what might be considered infection may be mere coincidences. In the vast majority of cases there is no evidence of Cancer spreading in a house from one person to another. Deaths in Mental Hospitals. The number of deaths of Chelsea residents in Mental Hospitals and Asylums in 1928 was 20, as compared with 31 in 1922. Encephalitis. Lethargica. As in 1922, there were no cases of this disease notified in Chelsea in 1923. In London. 105 cases were notified in 1923, and there were 19 deaths, the case fatality being 47 per cent., as compared with 71 cases and 50 deaths (case fatality 70 per cent.) in 1922. Cerebrospinal Meningitis. No cases disease notified in chelsea in 1922. London, 71 cases were notified in 1923. and there were 58 deaths, the case fatality being 82 per cent., as compared with 88 cases and 67 deaths (case fatality 76 per cent.) in 1922. Polio-Myelitis and Polio-Encephalitis. One case of Polio-myelitis was notified in Chelsea in 1923 —a girl of 4 years, who was treated in St. George's Hospital, In London, 120 cases of Polio-myelitis and 11 cases of Polio-encephalitis were notified in 1923, there being 13 deaths from the two diseases. Puerperal Fever. Two cases of Puerperal Fever were notified in Chelsea in 1923. Both cases were removed to hospital. One proved fatal. Pregnancy and Parturition. Only 2 deaths occurred in Chelsea in 1923 —one from heart disease, and one from tubal abortion. In 1922, there were 10 deaths from the diseases and accidents of pregnancy and parturition. Ophthalmia Neonatorum. Five cases of this disease were notified in Chelsea in 1923, as against 4 in 1922. Three cases were attended by District Nurses, 58 visits being paid to the homes, which gives an average of 18 visits per case, as against 10 in 1922. Of the total five cases, all made a good recovery. In London, 764 cases of Ophthalmia Neonatorum were notified in 1923, as against 875 in 1922, and 1,080 in 1921. Nurses' Visits. The District Nurses paid 1,567 visits to the homes of expectant and nursing mothers and children under 5 years of age, during 1923, to attend to conditions as under:— Visits. Cases. Measles 48 5 Miscarriages, etc. 252 12 Breasts 115 4 Bronchitis 30 8 Pneumonia 261 15 Ophthalmia Neonatorum 53 3 Tonsils and Adenoids 47 13 Eye troubles 160 8 78 4 Ear troubles Worms 109 14 Septic sores 221 18 Burns 68 6 Circumcision 48 7 Other conditions 77 15 1567 132 The corresponding figures for 1922 were 1,865 visits to 157 cases. Venereal Diseases. Eleven specimens of blood were sent to the Lister Institute in 1928 by medical practitioners for the Wassermann (Syphilis) reaction. All these specimens proved negative. Six of the specimens were sent by the Medical Officer of the Ante-natal Clinic, and 5 specimens by two private practitioners. Three specimens of vaginal discharge were examined for gonococci, one being positive and two negative. All three were sent from the Ante-natal Clinic. Accommodation is now provided by the Metropolitan Asylums Board for the treatment of parturient women suffering from Venereal Diseases by arrangement with the Guardians of the City of London at the Thavies Inn Infirmary, Robin Hood Court, High Holborn, E.C. 1. There are 20 beds for mothers and infants, and there is an outdoor clinic for patients after discharge. Patients are admitted not earlier than the seventh month of pregnancy. Sale of Food and Drugs Act. Of the 400 samples taken for analysis in 1923, 156 were milk, 154 being genuine, and 2 adulterated. One of these samples was deficient in fat to the extent of 16·7 per cent., but in the absence of the Public Analyst no proceedings were taken. The other sample, which was deficient in fat to the extent of 11 per cent., was an informal sample not taken under the Act. Under the Public Health (Milk and Cream) Regulations, seven samples of Cream were submitted to analysis, all being genuine. Of three samples of "Preserved Cream" one was returned as genuine (no Boric Acid); one contained 0.16 per cent. of Boric Acid, but was properly labelled; and one contained 0.15 per cent. of Boric Acid, but was properly labelled. Eight samples of "Tinned Cream" were submitted to analysis all being genuine. Thirty-four samples of Drags were submitted to analysis, 25 being returned as genuine. Proceedings were initiated in respect of 9 samples. The summons in one case (the sample being deficient in Tincture of Iodine to the extent of 34.6 per cent.) was part heard on the 1st January, 1924, and adjourned in order that a report might be obtained from the Government Analyst on the 3rd portion. Of the other 8 samples, the summonses were withdrawn on hearing in 7 instances with the consent of the Magistrates owing to informalities in the certificates of the Public Analyst, and one case was dismissed with 10 guineas costs for the same reason. The samples of other foods taken were all found to be genuine on analysis, namely: Butter, 59 samples: Margarine, 0 samples: Coffee 86 samples: Coffee Mixture, 1 sample; Rice, 13 samples; Flour, 1 sample; Self-raising Flour, 9 sample's; Cocoa. 23 samples: pepper, 9 samples; Vinegar, 15 samples; Ground Almonds, 7 samples; Cheese, 10 samples; Confectionery, 1 sample; Sponge-cake, 2 samples. Milk and Dairies (Amendment) Act, 1922. Milk (Special Designations) Order, 1923. During the year 21 Licenses under the above order were granted to 10 Milk Retailers in the Borough as follows: — To sell Certified Milk 16 To sell Grade A. Milk 3 To sell Grade A. Milk-Tuberculin tested 1 1 To sell Pasteurised Milk 21 Housing of the Working Classes. New Housing Scheme In April, 1923, the Borough Council accepted the tender of Messrs. William Moss and Sons for the erection of Dwellings containing 56 Flats for the working classes, namely 35 3-room flats, and 21 4-room flats. The cost of the site is £6,400, and the estimated cost for the erection of the buildings is £42,228. A loan has been obtained from the London County Council for £6,400 for the cost of the site, repayable in 80 years, and for £43,023 for the buildings, repayable in 60 years. Housing. Number of new houses erected during the year:- (a.) Total 39 (b.) By the Local Authority 1. Unfit Dwelling-houses:— Inspection— (1.) Total number of Dwelling-houses inspected for housing delects (under Public Health or Housing Acts) 1902 (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 tit for human habitation 981 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 53 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 4 (2.) Number of Dwelling-houses which were rendered fit:— (a.) By owners 4 (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 928 (2.) Number of Dwelling-houses in which defects were remedied:— (a.) By owners 981 (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 3 Sanitary Inspectors, each carrying out all the duties of a Sanitary Inspector in the district allocated to him. Rats and Mice Destruction Act, 1919, The small area, including many business premises, mentioned in the Annual Report for 1922, as haying been much infested with black and grey rats, is now reported as nearly free from these vermin. There is some indication that the methods employed to exterminate the rats and prevent infestation of the buildings, had the effect of driving some of the rats into adjacent buildings in the Royal Borough of Kensington. Black and grey rats have also been found recently towards the West end of the Borough; and there is some reason to believe that these species of rat, which come from Eastern countries, and are much more difficult to exterminate than the common English Brown or Sewer Bat, are spreading over London at a fairly rapid rate. During the year about £16 was spent by the Borough Council on Paste Varnish, and about £4 on poisons for the destruction of rats, these substances being supplied gratuitously, where found to be required. Cleansing Station for Verminous Children, 9a, Lot's-road. During 1923, this station was open for the entire day on 43 occasions, and 602 children were cleansed, the average attendance per session being 14 children. The amount recoverable from the London County Council, as the School Authority, for the cleansing for the year is £60 4s. Work of the Public Health Department. The tabular statements prepared by the Sanitary Inspectors show that 1,033 separate premises were reported on by them during 1923, 402 of this number being with reference to cases of notifiable infectious disease, and 233 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 22 instances. During the year 191 premises were disinfected after cases of infectious disease, and 110 rooms were disinfected which had been in occupation by persons suffering from Tuberculosis. In addition 77 rooms were disinfected for verminous or filthy conditions. Five hundred and ninety-five school children were reported by the school nurses to be in a verminous condition, and 504 visits to homes were paid in connection with these cases. Twenty-three cases of Scabies were reported during the year, and 28 visits to homes were paid in connection with these cases. Workrooms (Women Employees). Number of workrooms inspected 557 „ workrooms measured 87 „ workroom cards given 64 „ outworkers premises inspected 123 „ laundries inspected 36 „ factories inspected 17 The woman Sanitary Inspector also paid 75 visits to homes in consequence of complaints received as to old age pensioners and others living under neglected and insanitary conditions. She also undertakes the supervision of the Women's Sanitary Conveniences at the World's End and in Sydney-street. SUMMARY OF WORKS CARRIED OUT BY SANITARY INSPECTORS DURING THE YEAR 1923. Houses and Premises: — Inspections:— *Total number of inspections 1033 House-to-house inspections 233 Complaints 234 Infectious disease 402 Miscellaneous inspections 48 Drainage:— Drains constructed or reconstructed 41 Drains cleansed and repaired 123 Gully traps provided 29 Drains and soil pipes ventilated and new soil or ventilating pipes provided 60 Ventilating pipes repaired 45 Antisyphonage pipes provided to water closets 13 New water closet pans and traps provided 121 Additional water closet accommodation provided 15 Rain water pipes disconnected and caused to discharge over properly trapped gullies 9 Sink, bath and lavatory waste pipes repaired or new provided 81 New sinks and lavatory basins fixed 75 New baths fixed 36 Premises:— Houses and premises or parts thereof cleansed and repaired 454 Defective roofs, gutters and rain water pipes repaired 417 Damp walls remedied 67 Water closets, walls and ceilings cleansed and repaired 124 Water closets provided with and ventilation, or light and ventilation improved 7 Work rooms provided with light and ventilation or light and ventilation improved 4 Wash-houses, forecourts and areas cleansed, repaired and paving repaired 173 Yards cleansed and paving repaired 98 New and proper dust bins provided 302 Ashpits demolished and sites made good 21 Miscellaneous repairs 469 *This number does not include revisits or inspections of premises where no defects were found. Number of premises where special investigations were carried out in connection with rat infestation 23 Number of basements in Borough used as dwelling places 4874 Number of basements with ceilings at or below street level 604 equals 12.4 per cent. Number of basements with areas not exceeding 3 feet in width 592 „ 12·1 „ Number of basements with areas over 3 feet but not exceeding 4 feel in width 1254 „ 25·7 „ Areas over 4 feet in width 3029 „ 62·2 „ Premises disinfected after Zymotic diseases (Scarlet Fever, Diphtheria, etc.) 191 Rooms disinfected after Tubercular diseases 110 Rooms disinfected for verminous and filthy conditions 52 Miscellaneous disinfection 25 Water Supply.:— Water supply to premises reinstated 18 Water supply provided to upper storeys of tenement houses 3 Water closets provided with water supply or flushing apparatus repaired 146 Drinking water cisterns cleansed and repaired 38 Drinking water cisterns provided with new covers or covers repaired 32 Inspections of Special Premises:- No. on Register at end of 1923. No. of Inspections No. of Prosecutions. Cowsheds - - - Slaughter Houses 3 79 - 72 168 - Milkshops Ice Cream Premises 59 81 - Bakehouses 26 54 - Houses let in lodgings - - - Offensive trades - - - No. of Inspections 40 Restaurant kitchens Food premises other than above 63 Stables 38 Marine store dealers' premises 22 Workshops and Factories 704 Smoke Nuisances. Number of observations 11 Number of complaints 3 Number of Notices - Number of Summonses - Nuisances abated arising from: — Keeping animals in an improper manner or place 64 Accumulations of manure or refuse 60 Overcrowding 7 Underground Rooms: — Illegal occupation discontinued 1 Cases of overcrowding and underground rooms illegally occupied not yet abated owing to difficulty in securing other accommodation:— Overcrowding 6 Underground rooms 1 Food Condemned and Destroyed:— Fish 54 stone Beef 1 whole carcase (about 17 cwts.) Proceedings taken: — Intimation Notices served 928 Statutory Notices under Public Health (London) Act, 1891 261 Statutory Notices under Section 28 of Housing, Town Planning Act, 1919 4 Statutory Notices under Bye-laws for paving yards and open spaces 30 Statutory Notices under Bye-laws for provision of dust bins 53 Total number of Samples purchased for analysis under Sale of Food and Drugs Acts 400 Samples of cream taken (Milk and Cream Regulations) 18 Samples of Drugs purchased 34 Informal samples purchased 6 Legal Proceedings instituted in respect to defective sanitary conditions and nuisances under Public Health (London) Act 22 Legal Proceedings under Sale of Food and Drugs Acts 8 Legal Proceedings in respect of unsound food - Certificates issued in accordance with "Rents Restriction Act" - Correspondence:— Number of letters written in connection with sanitary matters 780 Entries in Inspectors' Report Books 981 Entries in Inhabitants' Complaints Book 57 Notification of Infectious cases sent to School Authorities 223 Notification of infectious cases sent to Metropolitan Asylums Board 157 Certificates of disinfection given 376 Certificates of infectious diseases for removal cases 87 23 Notices sent to Public Library of premises where infectious diseases have occurred 82 Post cards sent re samples under Sale of Food and Drugs Acts 386 Cleansing and Disinfection: — Number of adults cleansed 7 Number of children cleansed 599 Number of rooms or premises cleansed and disinfected 378 Number of parsons bathed for Scabies 2 Number of articles (bedding, etc.) disinfected 826 Number of articles (various) destroyed and 1½ tons of paper and books 118 Disinfecting Station Shelter:— Persons accommodated: — Adults 14 Children 14 Mortuary:— Number of bodies received 80 Number of infectious bodies received - Dead bodies removed to Public Mortuary for sanitary reasons 11 24 Failing to repair and cleanse interior of premises. Kensington 16-1-23 23, Gillray-square Abatement Order to complete work in 21 days. 8, Slaidburn-street Failing to repair roof Kensington 16-1-23 Adjourned to February 6th, then withdrawn. Work completed. 3, Bywater-street Failing to reinstate water supply after being cut off by Metropolitan Water Board. Kensington 20-3-23 Closing Order within 7 days. 15-5-23 Summons withdrawn. Work completed. 23, Sydney-street Failing to repair water closet Kensington 15-5-23 30, Flood-street Room so overcrowded as to be a nuisance, or injurious or dangerous to health. Kensington Abatement Order to cease overcrowding within 21 days. 22, Church-street Kensington Basement front and back rooms, being underground rooms occupied separately, in contravention of Section 96 of the Act. 2-10-23 Adjourned from 19-6-23 6-11-23 Premises vacated. Summons withdrawn. 399, Fulham-road Kensington Failing to repair main and scullery roofs and to cleanse interior of premises. Order for roofs to be repaired within 21 days. Remainder of Summons adjourned sine die pending High Court Proceedings. 20-11-23 21 A, Caroline-place Kensington Failing to repair roof and water closet Abatement Order for work to be done in 14 days. Failing to repair main, wash-house and water closet roofs, to remove accumulation of refuse and repair the defective yard paving. 20-11-23 22, Caroline-place Kensington Abatement Order for work to be done in 14 days. 15, Gillray-square Failing to cleanse and repair interior of premises. Kensington 4-12-23 Abatement Order to be complied with within 14 days. Kensington 16, Gillray-square Failing to cleanse and repair interior of premises. 4-12-23 Abatement Order to be complied with within 14 days. 4-12-23 Kensington 22, Gillray-square Failing to cleanse and repair interior of premises and to repair roof. Abatement Order to be complied with within 14 days. Kensington 423, King's-road Failing to cleanse and repair interior of premises and to repair roof. 4-12-23 Abatement Order for work to be done within 21 days. Kensington 4-12-23 27, Tadema-road Failing to repair and cleanse interior of premises. Work done. Summons withdrawn. 8, Cale-street Ditto ditto Kensington 6-3-23 92-96, King's-road Ditto ditto Kensington 6-3-23 6-3-23 82, King's-road Ditto ditto Kensington 6-3-23 317, Fulham-road Ditto ditto Kensington Ditto ditto Kensington 183B, King's-road 6-3-23 77, Royal Hospital-road Kensington 6-3-23 Ditto ditto 6-3-23 133, King's-road Ditto ditto Kensington