AC4343 CHE 28 Metropolitan Borough of Chelsea. Annual Report for 1924 of The Medical Officer of Health, W.H. LESLIE McCarthy. D.S.O., M.C: MA.; M.D.; M.R.C.P. (Lond.); D.P.H. (Oxford). D.P.H. (Oxford). TOWN HALL, KING'S CHELSEA, S.W.3. Metropolitan Borough of Chelsea. Annual Report for 1924 of The Medical Officer of Health, W.H. LESLIE McCarthy, D.S.O., M.C.; M.A.; M.D.; M.R.C.P. (Lond.); D.P.H. (Oxford). TOWN HALL, KING'S ROAD, CHELSEA, S.W.3. LONDON : SHIELD AND SPRING PRINTERS, 26 AND 28, LANCELOT-PLACE BROMPTON-ROAD, S.W.7. 1925 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 Chelsea Day Nursery 5 Maternity Nurse and Midwife 6 Home-help 6—7 Convalescent Homes 7 Supply of Milk at less than cost price 7 Chelsea Branch of I.C.A.A 8 Deaths and Death-rate 8 Birth and Death-rates of Special Classes 8—9 Infant Mortality Rates and Deaths, 1-5 years 9—10 Infectious and other Diseases 10—13 Influenza and Pneumonia 13 Tuberculosis 14 Chelsea Tuberculosis Dispensary 14—15 Tuberculosis Care Committee 16 Cancer 16 Encephalitis Lethargica and Cerebro-spinal Meningitis 17—20 Puerperal Fever and Ophthalmia Neonatorum 20—21 Malaria and Smallpox 21 Nurses' Visits 21 Venereal Disease Diagnosis 22 Sale of Food and Drugs Acts 22 Housing of the Working Classes 22—23 Factories, Workshops and Workplaces 23—24 Rats and Mice Destruction Act 24 Cleansing Station for Verminous Children 24 Work of the Public Health Department 25 Summary of Work in 1924 26—28 Magisterial Proceedings p. 3 of cover Annual Report of the Medical Officer of Health for the Year 1924. POPULATION OF CHELSEA. The Registrar-General's estimated population for the middle of 11)24 is 64,580. 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 10,855. The rateable value of the Borough in 1924 was £959,514, and the sum represented by a penny rate was £3,816. Births and Birth-rate. In 1924, 873 births were registered in the Borough. Excluding 166 births of non-parishioners, and including 221 births taking place amongst Chelsea mothers in Lying-in Hospitals and homes outside the Borough, the total number of births for the year was 928, the corresponding figure for 1923 being 971; for 1922, 1,032; for 1921, 1,057; and for 1920, 1,392. The birth-rate for the year was 14.4 per 1,000, as compared with 15-1 per 1,000 in 1923, and 16-1 per 1,000 in 1922. The birth-rate of London for 1924 was 18.7 per 1,000, as compared with 20-2 in 1923, and 21-0 per 1,000 in 1922. Notification oj Births. Number. Living Children 685 Still-born Children 12 697 Notified by Medical Practitioners 204 „ St. George's Hospital, Extern Department 34 „ Midwives 355 „ Chelsea Institution 68 „ Parents, etc. 36 697 Total number of Chelsea births registered in the Borough 707 4 The notifications, therefore, formed 98 per cent, of the total births of Chelsea residents registered in the Borough, as against 96 per cent, in 1923, and 97 per cent, in 1922. The number of births notified by midwives in 1924 was 50 per cent, of the total, as against 53 per cent, in 1923, and 51 per cent, in 1922. Illegitimate Births. Total number of illegitimate births 41 Alive at end of year 32 Dead at end of year 4 Unaccounted for 5 Maternity and Child Welfare. There were 59 deaths of infants under one year of age in 1924, which includes 4 deaths registered in the Borough, although the home address or parents are not known. Causes of deaths were as follows:— Measles, 7; Tuberculous Disease, 1; Bronchitis, 5; Pneumonia, 8; Diarrhoea and Enteritis, 12; Suffocation, 1; Atelectasis, 2; Premature Birth, 15; Marasmus, 2; and other causes, 6. The Infant Mortality Bate was 63.5 per 1,000 births, as compared with 58 per 1,000 in 1923. In London in 1924 the rate of Infant Mortality was 69 per 1,000 births. The number of births of Chelsea Infants in Outlying Institutions in 1924 was 221, or 23-8 per cent, of the total births. The number of births occurring in outlying Institutions is still increasing. Of the total number of outside births, 74 occurred in the Maternity Ward of the St. George's Hospital, 35 at the Queen Charlotte's Hospital, 20 at the General Lying-in Hospital, the remainder being at various institutions in and out of the Metropolis. Fourteen Chelsea women were confined at the Ormond Home, 155, King's-road, during the year. There were 68 births of Chelsea residents in the Maternity Ward of St. Luke's Hospital in 1924, or 7-3 per cent, of the total births. The following tabular statement gives an outline of the work carried on in Chelsea during 1924 in Maternity and Child Welfare, and also the figures for 1923, 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). It does not include work done by voluntary workers attached to the Society. Summary of Reports of Health Visitors. 1924 1923 Number of homes visited (first visits), Infants 6210 636 „ revisits. Infants 1681 1828 „ Infants attendances at Infant Consultations 8391 3115 „ visits to Children of one year to school age 299 304 5  1924 1923 „ revisits to Children of one year to school age 2662 2664 „ Children of one year to school age, attendances at Medical Inpections 2067 2634 „ ante-natal visits to Expectant Mothers:— Primi-para 06 Multi-para 222 Revisits 368 696 555 „ ante-natal case attendances at ante-natal clinic 300 306 „ visits to Diarrhœa cases amongst Children 6 - „ cases of Diarrhoea found 5 - „ visits to cases of Ophthalmia Neonatorum 10 - General additional visits in connection with the work 977 772 During the year 1924 the clinics hold at 1, Manor-street were:— Tuesday afternoons, 2 clinics; Wednesday afternoons, ante-natal clinic; Thursday afternoons, 2 clinics; at 484, King's-road, one clinic on Monday afternoons. Total number of infaCnt 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, 1924, as under:— £ s. d. Chelsea Health Society and School for Mothers 700 0 0 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 £950 0 0 Half this amount, namely, £475, 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, with the exception of one week, when it was closed for Mumps, also for one week at Easter and one week at Christmas. The total number of children attending during the year was 5,441, as against 5,679 in 1923, 5,355 in 1922, and 4,649 in 1921. The average daily attendance (5 days a week) was 22, as against 23 in 1923, 23 in 1922, and 18 in 1921. The total number of individual children who attended during the year was 99. Dr. Alice Benham, Medical Officer, makes a fortnightly medical inspection of the children, 6 Fees for Maternity Nurse and Midwife. The Borough Council scheme has worked very satisfactorily during the year. The fees charged by The Ormond House for Mid wives, also by Midwife Andrews and by Midwife Cooke, are £2 for Primipara, and 30s. for Multipara cases. The fees charged by The St. Mary's Nursing Home, Fulham, are £2 2s. for Primipara, £1 10s. for second and 3rd cases, and 25s. for fourth and subsequent cases. Maternity Nurse. Ten applications were received during the year 1924 from necessitous women for provision of a Maternity Nurse at their approaching confinements at less than cost price. Nine of the applications were granted; one case was refused on account of being over standard. Of the 9 cases granted, 7 were provided with a Maternity Nurse, one case reconsidered and reassessed as a Midwife case, and one case was 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 1924 was 10, as against 11 in 1923. Five of the cases were attended by The Ormond Home for Midwives, 3 cases by Midwife Andrews, and 2 cases by The St. Mary's Nursing Home. The amount paid by the Council to the Maternity Nurse for these 10 cases was £8 8s. 6d., £6 Is. 6d. being the amount of assessment paid, or to be paid by the applicants as contributions to the Maternity Nurse. The net cost to the Borough was £8 8s. 6d., half of which is recovered as a grant from the Ministry of Health. Midwife. Forty-six applications were received during the year 1924 from necessitous women for the services of a midwife at less than cost price; 43 were granted, 2 refused, as being over standard, and one refused as not suitable under the scheme. Of the 43 applications granted, 30 were supplied with a midwife, one application was withdrawn and 12 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 1924 was 37, of which number 13 were attended by The Ormond Home for Midwives, 18 by Midwife Andrews, one by Midwife Cooke, and 5 by St. Mary's Nursing Home. The amount paid by the Council to the Midwives was £32 14s., £21 16s. 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 £32 14s., half of which is recovered as a grant from the Ministry of Health. Honie Help. Nineteen applications were received in 1924 from necessitous women for the service of a home-help during their confinements and of this number 18 were granted, and one refused as not a suitable case under the scheme. 7 Of the 18 applications granted, 7 were supplied with the services of the Home Help, 7 were withdrawn by the applicants, and 4 cases were still awaiting confinement at the end of the year. Four applications were also received for an extension of the services of home-help over the usual period of two weeks and these were granted and the home-help attended. The total number of cases receiving the services of the home-help under the Council's scheme in 1924 was 8. The total amount paid by the Council to home-helps for their services was £36 (this sum includes the four extensions already mentioned), and the amount of contributions assessed to patients was £8 15s., leaving a balance of £27 5s., as the net cost to the Borough, half of which is recovered as a grant from the Ministry of Health. Convalescent Homes. Thirty-five applications were received for convalescence of mothers with their infants under the Council's scheme in 1924. Thirty-four of the applications were granted and one refused as being over standard. Of the applications granted 20 of the mothers were sent away and 14 were withdrawn. The payments to Homes made by the Council amounted to £51 5s. and the contributions of patients amounted to £9 6s. 6d. Nine mothers were sent to Homes apart from the Council's scheme. The average duration of stay in the Homes is two weeks. With the approval of the Ministry of Health an estimated sum of £60 was granted by the Borough Council to provide mothers and children with convalescence at Convalescent Homes. Supply of Milk at less than Cost Price. There has been no alteration in the scheme approved by the Minister of Health since 1921. During 1924 73.8 per cent, of the milk granted at less than cost price was Dried Milk, and 26.2 per cent, was Cow's Milk from retail dairies. During 1924 the number of applications for milk, including renewals, granted by the Sub-Committee were as follows:—1st Quarter, 540; 2nd Quarter, 443; 3rd Quarter 379; 4th Quarter, 417; total for the year, 1,779, as against 2 210 in 1923, 1,880 in 1922, 2,530 in 1921, and 2,340 in 1920. The approximate total cost for the year was £335, namely:— 1st Quarter, £108; 2nd Quarter, £76; 3rd Quarter, £64; and 4th Quarter, £87. In 1923 the approximate total sum expended was £421. in 1922, £429, in 1921, £990, in 1920, £1,515, and in 1919, £342. The Borough Council receives a grant from the Ministry of Health of hi If the cost incurred. Note.—All figures given for number of applications and cost are approximate and are made up for the year ending December 31st. 8 Chelsea Branch of the Invalid Children's Aid Association. Report of Work done in 1924 in respect of Children under 5 years. During 1924 the Branch have had under their care 140 children up to the age of 5 years. These children were suffering from Marasmus and Malnutrition, Rickets, Anaemia, enlarged Glands, Debility after acute illness, injuries or congenital deformities. Fifty-five children were sent to Convalescent Homes in the country or to the seaside. Four children were placed in special hospitals for prolonged treatment. One child went to a Sana torium. Two children were referred to the Guardians to be passed on to Queen Mary's Hospital, Carshalton. The length of convalescence varied from six weeks to six months and in some cases longer. In a few instances treatment has been prolonged over two years. Four children were provided with surgical boots and appliances. Thirty-four children (infants) whose fathers were out of employment, were given medical aids, such as tonic medicines, phosphates, vitoleum cream, malt and cod-liver oil, during periods varying from one to three months. Warm clothing, hospital letters, the loan of perambulators, escorts, railway fares, etc., were provided when necessary. All children referred to the Association were kept under supervision by friendly visiting and advice to mothers. The total amount disbursed by the Association on these cases during 1924 was £371 lis. 9d., towards which sum the parents contributed £90 10s., leaving a balance of £281 Is. 9d. to be raised by the Chelsea Branch. Deaths and Death-rate. There were 856 deaths of Chelsea residents in 1924, as compared with 788 in 1923, and 853 in 1922. The death-rate for the year was 13.2 per 1,000, as against 12-2 in 1923, and 13-3 in 1922. In London the death-rate for 1924 was 12.1, and in England and Wales 12.2. Birth and Death-rates of Special Classes. Chelsea Borouqli. Year. Birthrate. Deathrate. Zymotic Deathrate. Tubercular Deathrate. Deaths under one year to 1,000 Births. 1905-8 22.0 16.2 1.8 2.0 122 1909-12 19.6 15.2 1.2 1.8 99 1913-16 18.0 14.8 1.0 1.5 87 1917-20 15.7 14.6 0.7 1.5 75 1921-24 155 130 0.6 1.0 66 1924 14.4 13.2 0.8 1.3 63 9 Industrial Dwellings. Year. Birthrate. Deathrate. Zymotic Deathrate. Tubercular Deathrate. Deaths under one year to 1,000 Births 1905-8 29.5 14.8 2.2 2.2 95 1909-12 27.7 13.0 1.4 1.4 92 1913-16 27.4 13.3 1.3 2.1 75 1917-20 18.5 12.1 0.7 1.8 60 1921-24 15.5 10.8 0.7 1.2 76 1924 13.3 9.9 0.8 1.6 66 Poor.Class Streets.* 1905-8 38.0 24.4 4.2 3.4 183 1909-12 36.8 24.1 3.0 3.8 137 1913-16 32.9 20.3 3.2 2.1 124 1917-20 22.0 14.4 1.6 1.4 88 1921-24 23.2 12.6 1.1 1.2 84 1924 20.1 9.2 1.1 0.8 100 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 1912-1924 „ „ 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. Infant Mortality Eates and Deaths, One to Five Years. The following table shows the average Infantile Mortality Rates in four-yearly periods in Chelsea since 1901, and the average number of annual deaths in these periods of children one to five years of age; also similar figures for the year 1924:— 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 1920-24 66 36 1924 63 55 10 The following table gives the Infantile Mortality Rates in Chelsea under various headings, for six four-yearly periods, and for 1924:— 190104. 190508. 190912. 191316. 191720. 192124. 1924. Infectious Diseases 10.0 11.5 8.0 6.2 5.0 5.8 7.5 Diarrhœal Diseases 23.5 26.0 18.0 16.4 12.2 9.8 13.0 Developmental Defects and Wasting 48.0 37.0 34.5 28.2 31.9 25.5 20.4 Other Causes 58.0 44.0 36.0 36.6 28.9 25.2 22.6 Total Rate 139.5 118.5 96.5 87.4 78.0 66.3 63.5 Infantile Mortality Rates in Wards. Wards. Average of 12 years, 1912.23. 1924. Hans Town 69 112 Royal Hospital 65 19 Church 88 48 Cheyne 60 71 Stanley 85 65 Chelsea Borough 78 63 Five.yearly Average Number of Annual Deaths, 1-5 years. Infectious Diseases. Diarrhœa and Enteritis. Tuberculosis. Bronchitis and Pneumonia. Other Causes. Total. 1901-5 36 7 15 27 18 103 1906-10 38 7 12 19 11 87 1911-15 26 3 8 13 12 62 1916-20 13 3 6 12 14 47 1921 3 2 4 5 4 18 1922 30 1 3 10 5 51 1923 5 — 1 11 4 21 1924 29 2 6 9 9 55 Infectious and Other Diseases. Measles. There were 30 deaths from Measles in Chelsea in 1924. All these deaths occurred within the first six months of the year. Seven of the deaths being under 1 year of age, and the remainder between the ages of 1-5 years. No deaths were registered for Chelsea in 1923, or in 1921, but 11 deaths occurred in 1922. During the year 1,104 visits, including revisits, were made by the Sanitary Inspector (Miss Tettenborn) and the Health Visitor (Miss Brown), as against 157 visits in 1923, and 439 in 1922. The Nurses of the District Nursing Association paid 311 visits to 14 cases. Seventy-eight cases were removed to hospital. 11 Erysimelas. Thirty-six cases of Erysipelas were notified during the year. Three deaths were registered of Chelsea residents during 1924. Scarlet Fever. During the year, 87 cases of Scarlet Fever were notified in Chelsea, as against 111 in 1928, and 197 in 1922. Two military cases also occurred at the Duke of York's Headquarters and were removed to Hospital. No death occurred during the year from this disease in Chelsea. Of the total cases notified, 77 were removed to hospital, or 88 per cent., as against 95 per cent, in 1928, and 91 per cent, in 1922. The month of greatest prevalence was October (15 cases) and of least prevalence April (3 cases). Information was received from the Metropolitan Asylums Board that 7 of the cases sent to hospital proved not to be suffering from Scarlet Fever. The percentage of cases of school age (3 to 13 years), was 62, as compared with 74 in 1923, and 69 in 1922. Diphtheria. During the year 81 cases of Diphtheria were notified in Chelsea, as against 97 in 1923, and 120 in 1922. The disease caused two deaths in the same family, a boy of 8 years, and a younger brother of 8 years. A death was also reported from the Western Hospital of a Chelsea boy, aged 4 years, who was taken away from a temporary address in Westminster. This case was not notified in Chelsea. The total deaths of Chelsea residents was 3 during the year. The case fatality rate was 3.7, as against 11.3 in 1923, 11.7 in 1922, and 5.4 in 1921. Of the total 81 cases, 75 were removed to hospital, or 92 per cent., as against 90 per cent, in 1923, and 93 per cent, in 1922. The month of greatest prevalence was November (19 cases) and the month of least prevalence September (1 case). Information was received from the Metropolitan Asylums Board that 11 of the cases sent to hospital proved not to be Diphtheria. The percentage of cases of school age (3 to 13 years) was 65, as against 62 in 1923, and 56 in 1922. During the year, medical practitioners sent 95 throat or nose swabbings to the Lister Institute for bacterioscopic diagnosis, as compared with 94 in 1923, and 73 in 1922. Of the 95 specimens, 9, or 9.5 per cent., afforded positive evidence of the diphtheria bacillus, and 86, or 90.5 per cent., were negative, the corresponding figures for 1923 being 9.6 positive, and 90.4 per cent, negative. Diphtheria anti-toxin both in prophylatic and curative doses is supplied, and issued, on request, free of charge, to any medical prac 12 titioner in the Borough who desires it for Chelsea patients. An antitoxin syringe with needles and steriliser is also available if required. Enteric Fever. The number of cases of Enteric Fever notified in Chelsea in 1924 was 6. In addition three cases of Paratyphoid Fever (B.) were notified. A summary of the cases is as follows:— Sex. Age. Notification. Removed. Nursed at home. Remarks. F. 14 Para Typhoid (B.) Bart's. Hospital - No cause suspected. M. 3½ Para Typhoid (B.) - Yes No cause suspected. M. 43 Typhoid - Yes No cause suspected. F. 12½ Para Typhoid (B.) Nursing Home American family on a visit. Patient taken ill in Hotel. No cause suspected. M. 12 Enteric - Yes Taken ill whilst on holiday in Cornwall. No shell fish or sea bathing. No cause suspected. M. 3 Typhoid M.A.B. No cause susected. M. 55 Enteric - Yes Visitor from Paris. Taken ill in Hotel. No cause suspected. Nursed in isolated suite of rooms at Hotel. F. 22 Typhoid - Yes Possible clue of having had an oyster supper about the time, allowing for incubation. Fatal. F. 55 Typhoid - Yes Probably contracted from previous case. Same family. 13 From the foregoing Table it will be seen that one death occurred during the year 1924, and this probably due to shell fish. Two of the cases were visitors to London from abroad and must be accepted as Chelsea notifications. Since making up this report another death has been registered of the last case in table, and this will be included in the statistics for 1925. Six specimens of blood were examined for the Widal reaction, one proving positive and 5 negative. Diarrhœa and Enteritis. There were 14 deaths from these diseases in 1924 as against 8 in 1923 and 7 in 1922. Of this total, 12 were under one year of age. Six of the total deaths occurred in the first quarter, one in the second quarter, 3 in the third quarter, and 4 in December quarter. During the September quarter, the mean temperature was 61.1°, as against 60.8° in 1923, and 57.3° in 1922. The rainfall of the quarter in 1924 was 8.5, as against 5£ inches in 1923 and 8.1 inches in 1922. Nine of the deaths took place in St. Luke's Hospital and one in the Victoria Hospital. Five cases of Diarrhoea were found by the Health Visitors and 6 visits made. Influenza. Influenza caused 36 deaths in 1924, as compared with 15 in 1923 and 48 in 1922. In London there were 1,663 deaths from Influenza in 1924, as against 752 in 1923 and 2,572 in 1922. Ten cases of Influenzal Pneumonia were notified in Chelsea in the course of the year. Pneumonia. Pneumonia and Broncho-Pneumonia caused 64 deaths in Chelsea in 1924, as against 59 in 1923. During the year 94 cases of Acute Primary Pneumonia were notified, 28 in the first quarter, and 39 in the last quarter. Fifty-nine cases were notified by St. Luke's Hospital, 18 cases by other public institutions, and 17 cases by private doctors. The District Nurses paid 399 visits to 33 patients suffering from Pneumonia or Influenza. The Woman Sanitary Inspector made 35 visits to ascertain if nursing assistance was required. In London there were 5,320 deaths from Pneumonia in 1924, as against 4,218 in 1923, and 6,522 in 1922, 14 Tuberculosis. The deaths from Pulmonary Tuberculosis in 1924 numbered 77 (48 males and 29 females), as against 52 in 1923, and 57 in 1922. Other Tuberculous diseases caused 11 deaths (10 males and 1 female), as against 5 in 1923, and 9 in 1922. Of the total number of deaths from all forms of Tuberculosis, 24 died un-notified or notified at death; 5 notified within one month of death; 6 notified within three months of death; and 3 notified within 6 months of death. Of the Pulmonary Tuberculosis cases ending fatally, 40 per cent. died in St. Luke's Hospital, and 26 per cent. in other public institutions, that is to say 66 per cent. died away from their homes, the corresponding figure for 1923 being 71, and for 1920, 66 per cent. Fifty-nine specimens of sputum were sent by medical practitioners to the Lister Institute for examination, this being the same number as in 1923. Of the 59 specimens, 19 per cent. were positive for tubercle bacillus and 81 per cent. were negative, as compared with 22 per cent. positive and 78 per cent. negative for 1923. The death-rate from all forms of Tuberculosis for Chelsea in 1924 was 1.3 per 1,000. Chelsea Tuberculosis Dispensary, Brompton Hospital. Work done during 1924. 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 diagnosis. Pulmonary. NonPulmon ary. (a) All persons (including contacts). Adults 113 223 336 54 - 238 37 7 Under 15 157 206 363 4 11 302 46 - Total 270 429 699 58 11 540 83 7 (b) Contacts (included in (a) ) Adults 15 43 58 4 - 53 1 - Under 15 33 72 105 1 2 99 3 - Total 48 115 163 5 2 152 4 - (c) Insured persons (included in (a)) Total 57 116 173 37 - 119 17 - Number of patients under treatment or supervision on the 31st December 1924:- 308 Total number of attendances at the Dispensary during 1924:— Insured 1387 Uninsured 2029 3416 15 Number of persons placed under observation for diagnosis 347 Number of observation cases where observation exceeded 2 months 56 Number of visits paid by Tuberculosis Officer to homes of patients 70 Number of visits paid by Nurses to homes of patients 2792 Number of specimens of sputum examined 555 Number of X-ray examinations 59 Number of complement Fixation Tests 10 Number of Wassermann Tests 13 Work done at the Dispensary, 1917-1924. Year. 1917 (April to Dec.) Number of person examined for the first time. Definite Tuberculosis. Total attendances at Dispensary. 272 84 equals 31 per cent. 790 1918 290 61 „ 21 „ 1699 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 1924 429 69 „ 16 „ 3416 Total for 8 years 3529 532 „ 15 „ 21861 Annual average 441 66 „ 15 „ 2733 A large number of insured and uninsured patients received hospital and sanatorium treatment under the London County Council scheme. One hundred and four new cases of Pulmonary Tuberculosis were notified in Chelsea in 1924 (57 males and 47 females). The nonpulmonary cases were 33 (19 males and 14 females). The number of new cases of Tuberculosis visited by the Municipal Tuberculosis Visitor in the course of the year was 67. The total number of visits paid in respect of all cases (Pulmonary and non-Pulmonary) was 508. The Borough Council lent beds and bedding to 4 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 Branch of the Invalid Children's Aid Association. Sixteen 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 (£25 10s. 7d.) with extra foods, such as milk, eggs, butter and Bovril. 16 Tuberculosis Care Committee. During the year the Chelsea Tuberculosis Care Committee met on 19 occasions, and dealt with cases as under:— Sanatorium Cases 64 Treated in Brompton Hospital 22 Referred to I.C.A.A 77 Extra Nourishment, including renewals 16 Referred to Charity Organisation Society 8 Referred to British Red Cross 5 Referred to Guardians 7 Referred to United Services Fund 3 Children sent to Open Air School 2 Recommended and received Artificial Pneumothorax treatment 7 Cancer. There were 114 deaths from Cancer during the year, as against 117 in 1923. Twenty-five of these deaths took place in St. Luke's Hospital and 12 at the Cancer Hospital. Five of the deaths were between the ages of 25 and 45; 47 between the ages of 45 and 65; and 62 from 65 years and upwards. There were 6,427 deaths from Cancer in London for 1924 as against 6,162 for 1928. On request, fumigation of room is carried out after a death from Cancer, and arrangements made by the Tuberculosis Visitor to have the bedding taken away and fumigated or destroyed. During 1924, 10 rooms were fumigated after deaths from Cancer. Deaths in Mental Hospitals. The number of deaths of Chelsea residents in Mental Hospitals and Asylums in 1924 was 23, as compared with 20 in 1923, and 31 in 1922. 17 Encephalitis Lethargica. Fourteen cases of this disease were notified during 1924. A short summary of the cases is given below:— Sex. Age. Date notified. Whether fatal, if so, date of death. Subsequent progress, i.e., whether recovery complete or partial. If regarded as a genuine case of E. L. Later report at end of March, 1925. F. 50 21 Jan. 2/2/24 - Death return. Acute Enceph. Leth.,19days. No p.m. - M. 10 18 Mar. No Lethargy still marked at times; speech slow and indistinct. Pt. bites tongue which causes ulcers. Sensible to talk to; no paralysis; awaiting admission to Convalescent Home. Yes. Received treatment in St. Luke's Hospital. No improvement. At present at Darenth. M. 22 17 April No In good health, and works full time. Occasional headaches and eyes easily over-strained. Yes. - M. 54 20 April No Quite well; works as usual as Commissionaire. Noises may set up headaches. Yes. - 18 Encephalitis Lethargica—continued. Sex. Age. Date notified. Whether fatal, if so, date of death. Subsequent progress, i.e., whether recovery complete or partial. If regarded as a genuine case of E. L. Later report at end of March, 1925. M. 7¾ 30 April No Now at home. Health poor; very drowsy and lethargic. Easily startled and very nervous; ocular twitching. Yes. Back at school after three weeks' convalescence at Broadstairs. F. 12 1 May No Movements of body very stiff; dribbles saliva; one side of mouth drawn down; nervous at night, groans in sleep. Altered habits. Yes. Received treatment at St. Luke's Hospital. Now at Broadstairs. M. 23 8 May No Returned to St. George's Hospital Medical School, 1st Oct., 1924. Sleeps very badly and cannot read at night. Very slight strabismus still. Cannot concentrate his attention for long. Yes, Now at Home in North of England. M. 10 26 May No Movements stiff; eyes protruding. Headaches and restlessness. Sleep disturbed and groans in sleep. Now attends school, but does very little there. Makes no progress. Yes. Condition much the same. 19 Encephalitis Lethargica—continued. Sex. Age. Date notified. Whether fatal, if so, date of dea th. Subsequent progress, i.e., whether recovery complete or partial. If regarded as a genuine case of E. L. Later report at end of March, 1925. F. 20 13 June No Twitching of facial muscles, right arm and right leg with spasticity. Answers questions sensibly. Has had 6 attacks since admission to St. Luke's Hospital. Attacks less severe recently. Yes. Attending as out-patient at Maida Vale Hospital. Improving. M. 52 21 May 19/5/24 - Yes. - F. 55 10 July 22/7/24 —- Yes. - F. 9 9 Sept No Headaches and nervous twitchings of the muscles. Very drowsy. Yes. Received treatment at M.A.B. Hospital. Sent by I.C.A.A. to Broadstairs. Much improved and returned to school. M. 29 3 Oct. 21/9/24 - Yes. - F. 59 31 Oct. - In St. Luke's Hospital and in M.A.B. Headache; divergent squint; marked lethargy; incontinence of urine, etc. Yes. Died at Home, 13/4/25. 20 From the foregoing summary it will be seen that 4 deaths occurred from this disease during the year in Chelsea, and one case has since been reported as having died in April of 1925, which will be included in the returns for 1925. Thirty-six visits ware made by the Woman Sanitary Inspector during the year. There were 140 deaths registered from this disease for London during 1924. The prevalence of Encephalitis Lethargica in England and Wales has greatly increased as shown by the following table:— Cases Notified. England and Wales. 1919 1920 1921 1922 1923 1924 Quarter:— First 283 268 952 140 448 760 Second 70 233 244 132 279 2870 Third 64 168 144 89 144 821 Fourth 121 245 130 93 154 615 Total for Year 538 914 1470 454 1025 5066 Encephalitis Lethargica was made compulsorily notifiable from 1st January, 1919. Cerebro-Spinal Meningitis. No case of this disease was notified in Chelsea in 1924. In London there were 73 deaths in 1924 as compared with 58 deaths in 1923. Polio-Myelitis and Polio-Encephalitis. Three cases of Polio-Myelitis were notified in Chelsea in 1924. One case was notified by St. George's Hospital in July and remained in hospital until October and was then transferred to Queen Mary's Hospital; now making slow progress. One case was notified in September and removed to St. George's Hospital and died there; cause of death certified as (1.) Polio-Encephalitis; (2.) Broncho-pneumonia. One case was notified in November and removed to St. Luke's Hospital and died in January, 1925. From the above it will be seen that one death occurred in 1924, and one in 1925, this latter will be included in the returns for 1925. No case of Polio-Encephalitis was notified during the year. In London, 21 deaths from these diseases were registered during the year. Puerperal Fever. One case of Puerperal Fever was notified in Chelsea in 1924 and removed to hospital. This case proved fatal. Pregnancy and Parturition. Three deaths occurred in Chelsea in 1924, one being from obstructed labour, one from Eclampsia, and one from Heart disease. Two cases attended the Ante-natal Clinic on two occasions. Ophthalmia Neonatorum. Five cases of this disease were notified in Chelsea in 1924 and all were visited. In 1923, 5 cases were notified, and in 1922, 4 cases. 21 Nine cases were visited by the District Nurses and 159 visits paid to the homes, which gives an average of 17 visits per case as against 18 in 1923, and 10 in 1922. In London 729 cases of Ophthalmia Neonatorum were notified in 1924, as against 764 in 1923. Malaria. Two deaths from Malaria were registered in Chelsea. One case being a male adult who came from India 1½ years ago, and had had severe Malaria in India. The other case was a male adult who worked at the Post Office as Telephone Linesman. Smallpox. A case of Smallpox was notified in Chelsea during the year. Patient went to Brighton for a holiday from an address in Fulham, and on her return, not feeling well, came to stay with a niece at an address in Chelsea. Patient was removed to the M.A.B. Hospital and recovered. All precautions were taken to prevent the spreading of the disease. The case appeared to be an isolated one and although notified in Chelsea was not a Chelsea resident. Nurses' Visits. The District Nurses paid 2,226 visits to the homes of expectant and nursing mothers and children under 5 years of age, during 1924, to attend to conditions as under:— Visits. Cases. Bronchitis 92 12 Burns 15 2 Circumcision 30 2 *Diarrhœa 14 2 Eye trouble 22 2 Ear trouble 96 6 Influenza and Pneumonia (under 5) 276 23 Influenza and Pneumonia (above 5) 123 10 Impetigo 142 4 Meningitis and Peritonitis 17 2 *Measles 311 14 *Ophthalmia Neonatorum 159 9 *Polio-myelitis - - *Puerperal State, including Breasts, Miscarriage, and Rise of Temperature 310 21 Rickets 77 1 Septic sores 227 13 Tonsils and Adenoids 74 18 *Whooping Cough 1 1 Worms 166 17 Miscellaneous 74 7 2226 166 * Grant received from the Ministry of Health. The corresponding figures for 1923 were 1,567 visits to 132 cases. 22 Venereal Disease. Thirteen specimens of blood were sent to the Lister Institute in 1924 by the Medical Officer of the Ante-natal Clinic for the Wassermann (Syphilis) reaction. All these specimens proved negative. Thirteen specimens of vaginal discharge were examined for gonococci, and all were negative. Eleven of these specimens were sent from the Ante-natal Clinic, and two by medical practitioners. Sale of Food and Drugs Act. Four hundred samples were taken for analysis in 1924. Milk. One hundred and forty-five samples of milk were taken, and of this number 141 were genuine and 4 adulterated. Three of these samples were not sufficiently adulterated to warrant legal proceedings being taken. The other sample was adulterated to the extent of 10.5 per cent. of added water. Proceedings were instituted in this instance and the summons dismissed on the defendants proving a warranty. Drugs. Four samples of drugs were submitted to the Analyst, and all four were returned as genuine. Other Foods. The samples of other foods taken were all found to be genuine on analysis, viz.: Butl er, 45; Coffee, 43; Cocoa, 52; Margarine, 16; Sugar, 1; Cheese, 10; Baking Powder, 9; Pepper, 12; Vinegar, 10; Ground Ginger, 2; Flour, 9; Mustard, 11; Chocolate, 2; Condensed Milk, 11; Cream, 6; Tea, 9; Ground Almonds, 3. Milk and Dairies (Amendment) Act, 1922. Milk (Special Designations) Order, 1923. During the year 27 licences under the above order were granted to 10 Milk Retailers in the Borough, as follows :— To sell Certified Milk 17 To sell Grade A. Milk - To sell Grade A. Milk, Tuberculin tested 10 To sell Pasteurised Milk - Housing of the Working Classes. New Housing Scheme. The 56 flats for the working classes in Hortensia-road are still in the course of erection and will probably be completed and ready for occupation in May of 1925. 23 Housing. Number of new houses and flats erected during the year:— (a.) Total 44 (b.) By the Local Authority - 1. Unfit Dwelling-houses:— Inspection:— (1.) Total number of Dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 905 (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 740 2. Action under Statutory Powers:— A.—Proceedings under Section 28 of the Housing, Town Planning, etc., Act, 1919 - B.—Proceedings under Public Health Acts:— (1.) Number of Dwelling-houses in respect of which notices were served requiring defects to be remedied 731 (2.) Number of Dwelling-houses in which defects were remedied:— (a.) By owners 740 (b.) By Local Authority in default of owners - C.—Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909 - The Staff engaged on housing work in 1924 consisted of 3 Sanitary Inspectors, each carrying out all the duties of a Sanitary Inspector in the district allocated to him. Factories, Workshops and Workplaces. 1. Inspection:— Infections. Written Notices. Prosecutions. Factories (including Factory Laundries) 38 38 - Workshops (including Workshop Laundries) 561 10 - Workplaces (other than Outworkers' Premises) 61 18 - Total 660 66 - 24 2. Defects:— Number of Defects. Particulars. Found. Remedied. Referred to H.M. Inspector. Number of Prosecutions. Nuisances under the Public Health Acts:— Want of cleanliness 37 37 - - Want of ventilation 4 4 - - Overcrowding 3 3 - - Want of drainage of floors - - - Other nuisances 14 14 - - Sanitary accommodation:— Insufficient - - - - Unsuitable or defective 3 3 - - Not separate for sexes 3 3 - - 64 64 - - During the year, the Woman Sanitary Inspector made the following number of visits: Work Factories, 38; Workrooms, 543; Workplaces, 12; Laundries, 36; Outworkers, 119. Eats and Mice Destruction Act, 1919. During the year the Council has provided rat catching varnish to applicants for the destruction of rats and 178 bait traps were prepared and given out. These traps are prepared on cardboard and found to be very effective. Station for Cleansing Verminous Children. During 1924 this station was opened for the entire day on 43 occasions. The following table shows the number of attendances for each Quarter:— Quarter. No. of days on which the station was opened. Attendances. Verminous. Impetigo. March 12 143 2 June 11 162 1 September 8 100 1 December 12 198 2 43 603 6 The amount recoverable from the London County Council as the School Authority, for the cleansing for the year 1924 is £60 12s. 25 Work of the Public Health Department. The staff of the Department consists of three male sanitary inspectors, one woman sanitary inspector, one health visitor, two male clerks, and one woman clerk (Maternity and Child Welfare); the staff of the Chelsea Health Society and School for Mothers consisting of two whole-time health visitors. A tabular statement of the work carried out by the sanitary inspectors is included in this report. Considerable nuisance was caused during the early part of the summer by an offensive trade being established in Lots-road. The nature of the business was the conversion of waste food into cattle meal. This involved the extraction of fat, thereby bringing it, in the opinion of the Public Health Committee, within the bye-laws relating to offensive trades. It required exceptional vigilance and numerous visits on the part of the Sanitary Inspector in charge of the district to minimise the nuisance which arose, and he formed the opinion that the premises were entirely unsuitable for the purpose for which they were being used, and also that the trade was an offensive one. After numerous interviews and communications on the matter and visits to the premises by the County Council's Inspector dealing with offensive trades, the Company eventually agreed to apply to the County Council for a Licence to carry on their business, and the Borough Council, on the advice of the Public Health Committee, decided to oppose the granting of the Licence on the ground that the business was a nuisance and detrimental to the health of residents in the vicinity. The County Council, after hearing the application, and the objections, decided not to grant the Licence and the premises in Lots-road were subsequently closed down, the business being transferred to a district outside the area of the London County Council. During the year inspections were made by the Sanitary Inspectors of all urinals attached to licensed premises, which were approached directly from the public footway. In 14 instances, steps were taken by the Department with a view to having these urinals modernised by being provided with proper channels, sloped floors, automatic flushing, etc., and also to ensure that the interior of the urinals should be properly screened off from the view of passers-by when the doors are open. In the majority of cases, the above requirements have been met, and work is in progress in regard to the remainder with a view to having these alterations carried out. Five hundred and seventy-six school children were reported by the school nurses to be in a verminous condition, and 299 visits to homes were paid in connection with these cases. Seventeen cases of Scabies were reported during the year, and 19 visits to homes were paid in connection with these cases. The Woman Sanitary Inspector paid 98 visits to homes in consequence of complaints received as to old age pensioners and others living under neglected and insanitary conditions. 26 SUMMARY OF WORK CARRIED OUT BY SANITARY INSPECTORS DURING THE YEAR 1924. Houses and Premises. Inspections:— *Total number of inspections 905 House-to-house inspections 213 Complaints 350 Infectious disease 743 Drainage. Drains constructed or reconstructed 29 Drains cleansed and repaired 125 Gully traps provided 24 Drain and soil pipes ventilated and new soil pipes or ventilation pipes provided 38 Ventilating pipes repaired 33 Antisyphonage pipes provided to water closet 13 New water closet pans and traps provided 57 Additional water closet accommodation provided 8 Rain water pipes disconnected and caused to discharge over properly trapped gullies 44 Sink, bath and lavatory waste pipes repaired, or new provided 66 New sinks and lavatory basins fixed 29 New baths fixed 9 Premises. Houses and premises or parts thereof cleansed and repaired 402 Defective roofs, gutters and rain water pipes repaired 287 Damp walls remedied 58 Water closets, walls and ceilings cleansed and repaired 105 Water closets provided with light and ventilation, or light and ventilation improved 1 Workrooms provided with light and ventilation or light and ventilation improved 5 Wash-houses, forecourts and areas cleansed, repaired and paving repaired 126 Yards cleansed and paving repaired 55 New and proper dust bins provided 143 Ashpits demolished and sites made good 8 Miscellaneous repairs 376 Number of premises where special investigations were carried out in connection with Rat infestation 25 * This number does not include revisits or inspections of premises where no defects were found. 27 Disinfection. Premises disinfected after Zymotic diseases (Scarlet Fever, Diphtheria, etc.) 228 Rooms disinfected after Tuberculous disease 99 Miscellaneous disinfection 20 Water Supply. Water supply to premises reinstated 30 Water supply provided to upper storeys of tenement houses 2 Water closets provided with water supply or flushing apparatus repaired 120 Drinking water cisterns cleansed and repaired 28 Drinking water cisterns provided with new covers or covers repaired 18 Inspections of Special Premises. No. on Register at end of 1924. No. of Inspections. No. of Prosecutions. Cowsheds - - - Slaughter Houses 3 40 - Milkshops 75 145 - Ice Cream Premises 60 72 - Bakehouses 26 56 - Houses let in lodgings - - - Offensive Trades:— Special visits and Servations on mises used for sive trade a Licence - 150 Premises. No. of Inspections. Restaurant kitchens 35 Food premises other than above 200 Marine store dealers' premises 24 Smoke Nuisances. Number of observations 16 Number of nuisances and complaints 6 Number of notices - Number of Summonses — Nuisances Abated arising from. Keeping animals in an improper manner or place 10 Accumulations of manure or refuse 42 Dead animals 3 Overcrowding 5 Food Condemned and Destroyed. Chicken 1 Apples 8 boxes Cherries 40 lbs. 28 Proceedings Taken. Intimation Notices served 731 Statutory Notices under Public Health (London) Act, 1891 180 Statutory Notices under Section 28 of Housing, Town Planning, Act, 1919 - Statutory Notices under Bye-laws for paving yards and open spaces 19 Statutory Notices under Bye-laws for provision of dust bins 33 Total number of samples purchased for analysis under Sale of Food and Drugs Act 391 Samples (Informal) purchased 9 Samples of cream taken (Milk and Cream Regulations) 6 Samples of Drugs purchased 4 Legal Proceedings instituted in respect to defective sanitary conditions and nuisances - Legal proceedings under Sale of Food and Drugs Act 1 Legal proceedings in respect of unsound food - Certificates issued in accordance with "Bents Restriction Act" 1 Correspondence. Number of letters written in connection with sanitary matters 405 Entries in Inspectors' Beport Books 740 Entries in Inhabitants' Complaints Book 47 Notifications of infectious cases sent to School Authorities 199 Notifications of infectious cases sent to Metropolitan Asylums Board 352 Certificates of disinfection given 309 Certificates of infectious disease for removal cases 54 Notices sent to Public Library of premises where infectious diseases have occurred 36 Post cards sent re samples under sale of food drugs Act 387 Cleansing and Disinfection. Number of Adults cleansed 4 Number of Children cleansed 609 Number of rooms or premises cleansed and disinfected 428 Number of persons bathed for Scabies 14 Number of articles (bedding, etc.) disinfected 735 Number of articles (various) destroyed 148 Disinfecting Station Shelter. Persons accommodated 9 Mortuary. Number of bodies received 91 Number of infectious bodies received - Number of bodies removed to Mortuary for Sanitary reasons 1