AC 4345 CHE 29 Metropolitan Borough of Chelsea. Annual Report of the Medical Officer of Health for CHELSEA. 1925. TOWN HALL, KING'S ROAD, CHELSEA, S.W. 3. Metropolitan Borough of Chelsea. Annual Report of the Medical Officer of Health for CHELSEA. 1925. by w. h. leslie McCarthy, D.S.O., M.C.; M.A.; M.D., M.R.C.P., D.P.H., Barrister-at-Law. Medical Officer of Health. LONDON : WIGHTMAN & CO., LTD., PRINTERS, REGENCY STREET, WESTMINSTER, S.W 1. 1926. 2 Public Health, Maternity and Child Welfare Committe . At 31st December, 1925. His Worship the Mayor (Mr. Alderman A. C. Seton Christopher, J.P.). Councillor Lady Phipps (Chairman). Councillors— A. Bayes. E. L. Meinertzhagen. F. G. Chambers. E. Milnes Gaskell. H. A. Dunmore. Sir T. W. Parkinson, M.D. E. W. Hall. Miss C. L. Paterson. Mrs. M. I. Hewitt. Miss E. E. Place. H. Kent. G. M. Stevenson. A. F. Loveridge. Mrs. F. L. C. Walter. Housing Committee. His Worship the Mayor (Mr. Alderman A. C. Seton Christopher, J.P.). Alderman C. B. Clapcott, O.B.E. [Chairman). Alderman Sir A. Gray, K.C.B., K.C. Councillors— J. Adam. Lady Phipps. E. B. Baggallay. Mrs. F. M. Snowden. A. Blomfield. Miss V. J. M. Stephenson. E. W. Hall. F. J. Synge. Miss C. L. Paterson. Mrs. F. L. C. Walter. Milk and Welfare Sub-Committee. His Worship the Mayor (Mr. Alderman A. C. Seton Christopher, J.P.). Councillor Miss C. L. Paterson (Chairman). Councillor Lady Phipps. Councillor Miss E. E. Place. Councillor Mrs. F. L. C. Walter. 3 TABLE OF CONTENTS. PAGE Public Health, Maternity and Child Welfare Committee 2 Housing Committee 2 Milk and Welfare Sub-Committee 2 Preface 5 I.—Natural and Social Conditions of the Borough. General Statistics 7 Physical Features and General Character of the Borough 7 Social Conditions, including Chief Occupations of the Inhabitants 7 Vital Statistics 8 (а) Births 8 (b) Marriages 10 (c) Deaths 10 (d) Deaths of Children, 1-5 years of age 16 (e) Infant Mortality 6 Poor Law Relief in the Borough 18 Utilization of Hospital and other forms of Gratuitous Medical Relief 18 Causes of Sickness in the Borough 19 II.—Provision of Health Services in the Borough. Hospitals 20 Institutional Provision for Unmarried Mothers 20 Ambulance Facilities 20 Clinics and Treatment Centres 20 (a)Maternity and Child Welfare Centres 20 (b) Chelsea Day Nursery 21 (c) Chelsea Tuberculosis Dispensary 21 (d) Invalid Children's Aid Association 21 Public Health Officers of the Borough Council 22 Nursing Arrangements 24 (а) Professional Nursing in the Home 24 (b) Midwives 25 Laboratory Work 25 Public Health Legislation in Force in the Borough 26 III.—Sanitary Circumstances and Administration. Complaints 27 Closet Accommodation 27 Removal and Disposal of Refuse 27 Sanitary Inspection of the Borough 27 Smoke Abatement 31 Fouling of Foot-paths by Dogs 31 Rats 31 Pigeons 31 Factories, Workshops and Workplaces 32 Public Mortuary 34 Rag Flock Act 34 Offensive Trades 34 IV.—Housing. Housing Statistics for the Year 1925 35 Housing Staff 36 General Housing Conditions in the Borough 36 Overcrowding 38 Fitness of Houses 39 Unhealthy Areas 40 Bye-laws relating to Houses and Houses Let in Lodgings 40 Housing Survey 41 4 V.—Inspection and Supervision of Food. PAGE Milk Supply 42 Ice-cream Vendors 43 Fried Fish Vendors 43 Bakehouses44 Slaughter-houses44 Other Premises where Food is Prepared or Sold 44 Public Health (Meat) Regulations, 1924 45 Unsound Food 45 Food Poisoning 45 Sale of Food and Drugs Acts 45 Milk and Cream Regulations, 1912-1917 46 VI.—Infectious Diseases. (а) Infectious Diseases Generally 48 Diseases notifiable in the Borough 48 Notifications during the Year 1925 48 Diphtheria 49 Scarlet Fever 51 Measles 52 Enteric Fever 52 Pneumonia, Malaria, Dysentery and Trjnch Fever 53 Puerperal Fever 54 Ophthalmia Neonatorum 54 Influenza 55 Encephalitis Lethargica 55 Smallpox and Vaccination 56 Disinfection 56 Infectious Diseases Shelter 57 Disinfestation 57 (b) Tuberculosis 58 Notifications and Mortality 58 Cases of Tuberculosis in the Borough 59 Public Health (Prevention of Tuberculosis) Regulations, 1925 59 Dispensary and Institutional Facilities for Treatment 60 Co-operation with Hospitals and I.C.A.A. 61 Co-operation with School Medical Service 62 Co-operation with Medical Practitioners 62 Home Contacts 62 Artificial Pneumothorax Treatment 62 Home Nursing 62 Extra Nourishment 62 Non-pulmonary Cases 63 Orthopaedic Treatment 63 Bacteriological Examinations 63 Care and After-care Work 63 VII.—Maternity and Child Welfare. General Arrangements in the Borough 65 Health Visitors 65 Midwives 66 Home Help 67 Home Nursing 68 Clinics and Treatment Centres 69 Ormond Maternity Home 69 Convalescent Home Treatment for Nursing Mothers and Infants 69 Chelsea Branch of the Invalid Children's Aid Association 70 Chelsea Day Nursery 71 Puerperal Fever 71 Other Diseases and Complications of Childbirth 71 Maternal Mortality 72 Infant Mortality 73 Ante-natal Work 73 Supply of Milk to Mothers and Young Children 73 Widows', Orphans' and Old Age Pensions Contributory Act, 1924 74 5 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Chelsea. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the Annual Report on the health of the Metropolitan Borough of Chelsea for 1925. The report is a "Survey" report as defined in the appropriate circular of the Ministry of Health. The Ministry's programme stipulates that for each series of five years from 1925 onwards there shall be published one Survey and four Ordinary reports. Survey reports are expected to deal with the measure of progress made in the area during the preceding five years in the improvement of the public health. Any further action of importance in the organization or development of public health services contemplated by the Local Authority or considered desirable by the Medical Officer of Health must also be dealt with. The chief vital statistics relating to the year are as follows : The civil population is estimated by the Registrar-General at 64,820, a figure which shows an increase of 240 compared with last year. The birth rate (14.4) is the same as that for last year. The marriage rate (8.9) is somewhat higher than that for last year (8.7). The death rate (13.6) is higher than that for London generally (11.7) and compares with 13.2 last year. It is, perhaps, not generally realised that nearly 9 per cent. of the Chelsea population is made up of persons over 65 years of age—a much higher proportion than that obtaining in any other Metropolitan borough. The infant mortality rate was 68, as compared with 63.5 last year. These figures indicate that the general improvement in the public health of the Borough continues to be maintained. The incidence of notifiable infectious diseases was somewhat higher last year owing to an outbreak of diphtheria in the early months of the year. The numbers of cases of scarlet fever and pneumonia remain, approximately, the same. A considerable decrease is recorded in the number of cases of measles. At the end of the year there were 280 cases of pulmonary tuberculosis and 52 cases of non-pulmonary tuberculosis known to be living in the Borough. These figures represent a decrease as compared with those 6 of 1924. The Public Health (Tuberculosis) Regulations, 1924, came into operation during the year. The removal of cured cases from the Tuberculosis register is thus provided for and more reliable statistics regarding the disease become available. Maternity and Child Welfare work has continued to grow in extent and usefulness during the year. The attendances at the welfare centres have increased from 5,046 in 1921 to 6,782 in 1925. I continue to receive most valuable assistance from the Chelsea Health Society, and cannot speak too highly of the efficiency of the Society's work. Section III. of the report deals with Sanitary Administration. The statistics indicate that constant attention is devoted to the improvement of housing accommodation in the Borough. Although to less extent than in other Metropolitan boroughs, this side of the work of the department is frequently hampered by the inadequate number of houses available. Your Housing Committee has been engaged for several months in examining possible sites which might be utilised for a Housing Scheme, but thus far their search has not led to the acquisition of a suitable site. The task is rendered difficult by the fact that Chelsea is already largely built up. There are few pieces of building land available, and the prices demanded for these are extremely high—at least twice as high as the Central Authorities are prepared to sanction for the purchase of land to be utilised for the erection of buildings to house the working classes. As in former years, much attention has been given to the supervision of food supplies. I have again to express my appreciation of the work of the staff of the Public Health Department, and to thank the members of the Public Health, Maternity, Child Welfare, and other Committees for the support and sympathetic consideration which they have extended to me, and for their keen attention to the problems which it has been my duty to lay before them. Copies of this report are being transmitted to the Ministry of Health, the Home Office and the London County Council, in accordance with statutory requirements, I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, w. h. l. McCarthy. Annual Report on the Health of the Metropolitan Borough of Chelsea, Year ending 31st December, 1925. SECTION 1.—NATURAL AND SOCIAL CONDITIONS OF THE BOROUGH. GENERAL STATISTICS. TABLE No. 1. Area (acres) 660 Population :— (Census, 1921) 63,700 (Estimated, 1925) 64,820 Number of Inhabited Houses, 1921 10,355 Number of families or separate occupiers, 1921 16,555 Rateable value, October, 1925 £965,525 Sum represented by a penny rate, October, 1925 £3,865 Physical Features and General Character of the Area.—The Metropolitan Borough of Chelsea, situated near the centre of the Metropolis, is bounded on the north by the Royal Borough of Kensington, on the west by the Borough of Fulham, on the east by the City of Westminster, and on the south by the river Thames. It is a small compact borough, less than two miles in length by about three-quarters of a mile in width. Over nearly the whole area the soil consists of gravel and sand, highly permeable to water. In a small portion of the western side of the Borough there is a thin loamy deposit of brick earth resting upon the gravel. There is a narrow strip of alluvial deposit extending along the Embankment from Battersea Bridge westwards. The northern portion of the area is largely built over. The central zone comprises a number of pleasant squares occupied by people in affluent circumstances. The grounds of the Royal Hospital, with the river Thames and Battersea Park beyond, render the southern zone unusually open. Social Conditions. The density of population (number of persons per acre), as shown by the 1921 Census, is 97, the corresponding figure for London, as a whole, being 60. The density of population of each 8 of the five Wards in the Borough is as follows:—Church Ward, 124; Stanley Ward, 122; Hans Town Ward, 93; Cheyne Ward, 83; Royal Hospital Ward, 59. Analysis of the 1921 Census figures shows that there is a greater proportion of unoccupied and retired persons in Chelsea than in any other Metropolitan borough. There is, however, a considerable " working class" population. Thus, of a total of 21,000 adult males, about 17,000 are occupied. The chief occupations are transport work (2,990), personal service (1,971), metal work (1,144), and clerical work (1,017). Nearly one-half of the 32,000 adult females are occupied. Of these, domestic servants account for 9,900, dressmakers number 1,355, shop assistants 1,900, and clerks 1,200. There are no dangerous or offensive trades carried on in the Borough. There is no evidence that any of the occupations of the inhabitants exerts a deleterious influence on the public health. VITAL STATISTICS. In accordance with the requirements of the Ministry of Health, the following extracts from the Vital Statistics of the year are shown below:— TABLE No. 2. Births—Legitimate 870 „ Illegitimate 65 935 Birth Rate 14.4 Deaths 883 Death Rate 13.6 Number of women dying in, or in consequence of child birth... 8 (a) From sepsis 2 (b) From other causes 6 Deaths of infants under one year 64 (a) Legitimate 58 (b) Illegitimate 6 Infantile Mortality Rate 68 Deaths from Measles (all ages) 2 „ „ Whooping Cough (all ages) 7 „ Diarrhoea (under 2 years) 12 Zymotic Death Rate 0.4 Deaths from the Zymotic Diseases 29 Tuberculosis Death Rate 0.9 BIRTHS. During the year 895 births were registered in Chelsea, 461 being boys and 434 girls. Of these, births of non-parishioners account for 192, and must be deducted. In addition, there were 232 births amongst Chelsea mothers in Lying-in Hospitals and elsewhere outside the Borough, 120 boys and 112 girls. Thus the total number of Chelsea births for the year was 935, of which 483 were males and 452 females. The following Tables are self-explanatory:— 9 TABLE No. 4. Births and Birth-Rates (1921-1925). Year. Births. Birth-rate per 1,000. Birth-rate London. 1921 1,057 16.6 22.3 1922 1,032 16.1 21.0 1923 971 15.1 20.2 1924 928 14.4 18.7 1925 935 14.4 18.0 TABLE No. 5. Births in Wards (1921-1925). Year. Hans Town. Royal Hospital. Church. Cheyne. Stanley. Total. 1921 138 137 194 144 444 1,057 1922 131 118 188 149 446 1,032 1923 140 101 142 137 451 971 1924 118 107 168 128 407 928 1925 131 108 163 126 407 935 TABLE No. 6. Notification of Births (1921-1925). 1921. 1922. 1923. 1924. 1925. Living Children 864 818 748 685 645 Still-born Children 26 20 31 12 12 890 838 779 697 657 Notified by Medical Practitioners 231 213 215 204 132 „ St. George's Hospital, Extern Department 22 48 42 34 20 „ Midwives 504 429 410 355 378 „ Chelsea Institution 69 81 65 68 99 „ Parents, etc. 65 80 47 36 28 891 851 779 697 657 Less dual notifications 1 13 — — — 890 838 779 697 657 Percentage of notified births of Chelsea residents registered in the Borough ... 96 93 96 98 93 10 TABLE No. 7. Inward Transfers (1925). Confinements in Hospitals outside the Borough 163 „ Nursing Homes outside the Borough 26 „ private residences outside the Borough 43 232 It will be observed that the number of births of Chelsea Infants in Hospitals and elsewhere outside Chelsea accounted for 24.8 per cent. of the total births in 1925 (23.8 in 1924). Chelsea births in Hospitals outside the Borough were distributed during 1925 as follows:—St. George's Hospital, 83; Queen Charlotte's Hospital, 34; Clapham Maternity Hospital, 11; General Lying-in Hospital, Lambeth, 11; Charing Cross Hospital, 8; Royal Free Hospital, 5; St. Thomas' Hospital, 4 ; Miscellaneous Hospitals, 7. Chelsea births in Hospitals and Maternity Homes within the Borough during 1925 numbered 108. These were distributed as follows :—St. Luke's Hospital, 82; Ormond Maternity Home, 22; St. Stephen's Hospital, 3; Chelsea Hospital for Women, 1. Illegitimate Births. The following Table shows the number of illegitimate births each year since 1921 and the illegitimate birth rate per 1,000 births. In 1925, 101 were registered in Chelsea, and 23 inward transfers and 59 outward transfers were made by the Registrar General. The nett figure for the Borough is therefore 65. TABLE No. 8. Year. Number of Illegitimate births. Illegitimate birth rate per 1,000 births. 1921 49 46 1922 57 55 1923 44 45 1924 41 44 1925 65 69 MARRIAGES. There were 578 marriages registered in the Borough in 1925 (563 in 1924). The marriage rate (number of marriages per 1,000 of population) was 8.9. For the years 1921-1924, the marriage rates were 10.3, 9.7, 8.7 and 8.7 respectively. DEATHS. The total deaths registered in the Borough in 1925 were 1,669. Transferable deaths of non-residents registered in the Borough numbered 971 and are to be deducted. In addition, there were 185 deaths of Chelsea residents in Institutions and elsewhere outside the Borough. The nett Chelsea deaths were therefore 883 and the death rate was 13.6 per 1,000. In 1925 the death rate for England and Wales was 12.2, for London 11.7, and the mean death rate for the 105 Great Towns was 12.2. 11 During the quinquennial period (1921-1925) the number of nett deaths in the Borough and the corresponding death rates were as shown in the following table:— TABLE No. 9. Year. Nett Deaths. Death Rate. 1921 862 13.5 1922 853 13.3 1923 788 12.2 1924 856 13.2 1925 883 13.6 The seasonal mortality in the four quarters of 1925 was as follows:— First quarter, 17.4; second quarter, 12.1; third quarter, 9.1; fourth quarter, 16.0. The 1921 Census Returns show that there is a considerably higher percentage of persons of advanced age living in Chelsea than in any other Metropolitan borough. In London generally 7.7 per cent. of the total population are included in the age-group 55-65, and 5-8 per cent. in the age-group 65 and upwards. In Chelsea 9.2 per cent, of the total population come within the age-group 55-65, while no less than 8.8 per cent. constitute the age-group 65 and upwards. These facts must be borne in mind in any analysis of the Chelsea mortality rate, as they are naturally reflected in the death returns. Thus, in 1925 deaths of pensioners in the Royal Hospital, Chelsea, accounted for 59 deaths (equivalent to 0.91 of the death rate). DEATHS IN PUBLIC INSTITUTIONS. In tabular form is shown below the number of deaths of Chelsea residents which took place in various Institutions during the year. Of the 698 Chelsea deaths registered in the Borough, 359 occurred in Institutions within the Borough. TABLE No. 10. Hospitals or Institutions within the Borough. Number of Deaths. St. Luke's Hospital and Chelsea Institution 270 Royal Hospital for Pensioners 59 Cancer Hospital 11 Victoria Hospital for Children, Tite Street 6 St. Stephen's Hospital (Westminster Infirmary) 5 Brompton Hospital 4 Chelsea Hospital for Women 3 Cheyne Hospital for Children 1 Freemasons Hospital — St. George's Home for Tuberculosis — 359 12 Of the 971 deaths of non-residents registered in Chelsea, 951 occurred in the foregoing Institutions. The deaths (185) of Chelsea residents in Institutions and elsewhere outside the Borough were distributed as under:— General Hospitals 78 Mental Hospitals 26 Special Hospitals 12 Infectious Disease Hospitals 10 Tuberculosis Sanatoria, etc 10 Nursing Homes 5 Poor Law Institutions 3 Private Addresses 41 The following Tables are self-explanatory:— 13 TABLE No. 11. Birth Rate, Death Rate and Analysis of Mortality During the Year 1925. (Provisional figures. The rates for England and Wales have been calculated on a population estimated to the middle of 1925, while those for the towns have been calculated on populations estimated to the middle of 1924. The mortality rates refer to the whole population as regards England and Wales, but only to civilians as regards London and the groups of towns.) Birthrate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Births. Percentage of Total Deaths. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza Violence. Diarrhoea and Enteritis (under Two years). Total Deaths under One year. Causes of Death certified by Registered Medical Practitioners. Inquest Cases. Uncertified Causes of Death. England and Wales 18.3 12.2 0.01 0.00 0.13 0. 03 0.15 0.07 0.32 0.47 8.4 75 92.1 6.9 1.0 105 County Boroughs and Great Towns, including London 18.8 12.2 0.01 0.00 0.17 0.03 0.18 0.09 0.30 0.43 10.8 79 92.1 7.3 0.6 157 Smaller Towns (1921 Adjusted Populations 20,000-50,000) 18.3 11.2 0.01 0.00 0.15 0. 02 0.14 0.06 0.31 0.38 7.6 74 93.0 5.9 1.1 London 18.0 11.7 0.01 0.00 0.08 0 .02 0.19 0.11 0.23 0.46 10.6 67 91.1 8.9 0.0 Chelsea 14.4 13.6 0.01 0.00 0.03 0.00 0.11 0.11 0.46 0.51 12.8 68 92.3 7.6 0.1 14 TABLE No. 12. Deaths of Chelsea Residents Registered During the Year 1925, Classified by Age and Cause. Causes of Death. Nett Deaths whether occurring within or without the Borough. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. All Causes 883 64 8 13 12 27 84 242 433 1. Enteric Fever 1 - - - - - - 1 - 2. Small-pox - - - - - - - - 3. Measles 2 - - 2 - - - - - 4. Scarlet Fever - - - - - - - - - 5. Whooping Cough 7 2 3 2 - - - - - 6. Diphtheria 7 - 1 3 - 1 - - - 6a. Encephalitis Lethargica 1 - - - - - - - - 7. Influenza 30 - - - - - - 12 18 8. Erysipelas 2 - - - - - 1 1 - 9. Pulmonary Tuberculosis 53 - - - - 6 28 17 - 10. Tuberculous Meningitis 5 2 - 1 1 - - 1 2 11. Other Tuberculous Diseases 4 1 - - - 2 - - 1 12. Cancer, Malignant Disease 123 - - - - - 8 55 60 13. Rheumatic Fever 7 - - - 2 1 - 2 2 13a. Diabetes 8 - - - 1 - - 3 4 14. Meningitis 3 - - - 1 - 2 - - 14a. Arterio Sclerosis 53 - - - - - - 7 46 15. Organic Heart Disease 135 - - - 1 3 8 23 100 15a. Cerebral Haemorrhage 41 - - - - 1 3 13 OA 16. Bronchitis 84 2 1 - - 1 - 15 65 17. Pneumonia (All Forms) 74 13 - 4 2 3 4 19 29 18. Other Diseases of Respiratory Organs 3 - - - - - - 1 2 19. Diarrhoea and Enteritis 12 12 - - - - - - - 20. Appendicitis and Typhlitis 2 - - - - 1 - - 1 21. Cirrhosis of Liver 6 - - - - - - 4 2 22. Nephritis and Bright's Disease 24 - - - - 1 2 11 10 23. Puerperal Sepsis 2 - - - - - 2 - - 24. Other Accidents and Diseases of Pregnancy and Parturition 6 - - - - - 5 1 - 25. Congenital Debility and Malformation, including Premature Birth 21 21 - - - - - - 26. Violent Deaths (excluding Suicide) 33 1 - - 2 2 9 12 7 27. Suicide 6 - - - - - 1 5 - 28. Other Defined Diseases 127 10 2 1 1 - 10 38 60 29. Diseases Ill-defined or Unknown 1 - 1 - - - - - - 15 CAUSES OF DEATH. Table No. 12 shows that 135 deaths were due to Organic Heart Disease, 123 to Cancer, 84 to Bronchitis, 74 to Pneumonia, 53 to Pulmonary Tuberculosis, 53 to Arterio.sclerosis, 41 to Cerebral Haemorrhage, 30 to Influenza and 21 to Congenital Debility and Malformation. These figures show an increase which is particularly marked in the case of Heart Disease and Cancer. 49 per cent. of all deaths occurred in persons over 65 years of age. Organic Heart Disease. Of the 135 deaths from cardiac diseases in 1925, 100 were in persons over the age of 65 years. In 1924, there were 101 deaths from Heart Disease, 71 being persons over the age of 65 years. Cancer and Malignant Disease. There were 123 deaths from Cancer during the year, as against 114 in 1924, 117 in 1923, 105 in 1922 and 112 in 1921. Eight of the deaths in 1925 were between the ages of 25 and 45; 55 between the ages of 45 and 65: and 60 above the age of 65 years. There were 6,488 deaths from Cancer in London during 1925, as compared with 6,427 in 1924. On request, rooms are disinfected after a death from Cancer, and arrangements made for the removal, fumigation or destruction of bedding. During 1925, 20 rooms were disinfected after deaths from Cancer. Tuberculosis and the Infectious Fevers. These are reviewed in the section dealing with the notifiable infectious diseases. Diarrhoea and Enteritis. There were 12 deaths from these diseases in 1925, as against 14 in 1924. All the deaths occurred in infants under the age of twelve months. During the years 1921.1923 the numbers of deaths from these causes were 19, 7 and 8, respectively. During the September quarter the mean temperature was 60.8°, as against 61.1° in 1924, and 60.8° in 1923. The rainfall of the quarter in 1925 was 7.9 inches, as against 8.5 in 1924 and 5.5 in 1923. Eight of the deaths took place in St. Luke's Hospital and one in the Infants Hospital, Vincent Square, Westminster. Violence and Suicide. 33 deaths occurred from violence apart from suicide. Suicide was responsible for 6 deaths. Puerperal Deaths. Deaths from puerperal fever and from other causes associated with childbirth are reviewed in the section dealing with Maternity and Child Welfare. Respiratory Diseases. Table No. 13 shows the number of deaths from respiratory diseases during the years 1924 and 1925. The annual death 16 rate, the number of deaths under 5 years, and the percentage of deaths occurring in children under 5 years of age is also shown:— TABLE No. 13. Year. Bronchitis. Pneumonia. Other Respiratory Diseases. Total. Death rate. No. of deaths under 5 years. Percentage under 5 years. 1924 63 64 12 139 2.1 23 16.5 1925 84 74 3 161 2.5 20 12.4 DEATHS OF CHILDREN 1.5 YEARS OF AGE. The number of deaths of children between 1.2 years of age was 8, and between 2.5 years, 13. In 1924 these figures were 38 and 17, respectively. The causes of death are given in detail in Table No. 12. Table No. 14 shows the causes of death during the five quinquennial periods from 1901. TABLE No. 14. Child Mortality (1-5 Years). Period or Year. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrhoea! Diseases. All other causes. Total Deaths. 1901-05 36 15 27 7 18 103 1906-10 38 12 19 7 11 87 1911-15 26 8 13 3 12 62 1916-20 13 6 12 3 14 48 1921 25 16 3 8 1 5 33 1921 3 4 5 2 4 18 1922 30 3 10 1 5 49 1923 5 1 11 — 4 21 1924 29 6 9 2 9 55 1925 11 1 5 4 21 INFANT MORTALITY. There were 64 deaths of infants under one year of age in Chelsea during 1925. The corrected death rate is 68 per 1,000 births, as compared with 63 in 1924, 58 in 1923, 66 in 1922, and 78 in 1921. In London, in 1925, the rate of infant mortality was 67 per 1,000 births. The causes of death in the various age groups are set out in Table No. 15:— 17 TABLE No. 15. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3-6 months. 6-9 months. 9-12 months. Total deaths under 1 year. Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... 1 1 2 Diphtheria ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... 2 2 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... 1 Meningitis ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... 1 ... ... ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 ... 1 ... 2 Pneumonia 1 ... ... ... 1 2 5 3 2 13 Diarrhoea and Enteritis ... 1 ... ... 1 1 5 4 1 12 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... 1 ... ... 2 1 ... ... ... 3 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation ... ... ... ... ... ... ... ... ... ... Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations 2 ... ... ... 2 1 ... ... ... 3 Premature Birth 12 l ... ... 13 ... ... ... ... 15 Marasmus 1 ... ... ... 1 1 1 ... ... 3 Other causes 1 ... ... ... 1 1 ... 1 2 5 19 3 ... 1 23 10 11 10 10 64 Nett Births registered during the calendar year Legitimate 870 Illegitimate 65 Nett Deaths registered during the calendar year Legitimate 58 Illegitimate 6 The following Table gives the Infant Mortality Rate in Chelsea under various headings, for the six four-yearly periods, and for the years 1924 and 1925:— TABLE No. 16. 19011904. 19051908. 19091912. 19131916. 19171920. 19211924. 1924. 1925. Infectious Diseases 10.0 11.5 8.0 6.2 5.0 5.8 7.5 2.1 Diarrhoeal Diseases 23.5 26.0 18.0 16.4 12.2 9.8 13.0 12.8 Developmental Defects and Wasting 48.0 37.0 34.5 28.2 31.9 25.5 20.4 22.4 Other causes 58.0 44. 0 36.0 36.6 28.9 25.2 22.6 31.0 Total Rate 139.5 118.5 96.5 87.4 78.0 66.3 63.5 68.3 18 TABLE No. 17. Infantile Mortality Rates in Wards. Average of 13 Years, 1912-1924. 1925. Hans Town 72 46 Royal Hospital 61 28 Church 85 104 Cheyne 61 56 Stanley 84 76 Chelsea Borough 77 68 Illegitimate Deaths. The following Table No. 18 shows the number of deaths among illegitimate infants during the years 1921-1925. TABLE No. 18. 1921. 1922. 1923. 1924. 1925. Total number of illegitimate births 49 57 44 41 65 Alive at end of year 39 40 37 32 48 Dead at end of year 6 4 1 4 4 Unaccounted for 4 13 6 5 13 Poor Law Relief. Through the courtesy of Mr. Shepherd, Clerk to the Chelsea Guardians, I am able to give below the figures as to the amount of relief dispensed by the Guardians during the years 1921.1925. It will be observed that there has been an increase in the number of persons in receipt of outdoor medical relief only. Similarly, in 1925, there has been an increase in the number of persons receiving indoor and outdoor relief compared with the 1924 total. TABLE No. 19. 1921. 1922. 1923. 1924. 1925. Numbers of persons who received medical relief only 106 86 72 106 118 Numbers of persons who received relief (indoor and outdoor) 1,932 2,020 1,919 1,665 1,934 Utilization of Hospital and Other Forms of Gratuitous Medical Relief. The Borough is singularly well provided with facilities for hospital treatment, both general and special. In addition, several important general and special hospitals are situated in the immediate neighbourhood. 19 Over 80 per cent. of the inhabitants suffering from serious illness or disease seek and obtain in.patient hospital accommodation. In the case of all patients suffering from notifiable infectious disease, it is the practice of the Department to advocate admission to an appropriate hospital for isolation and treatment. Reference has already been made to the increased numbers of persons in the Borough who utilised the arrangements for outdoor medical relief made by the Board of Guardians. CAUSES OF SICKNESS IN THE BOROUGH. The Ministry of Health directs that and causes of sickness and invalidity which have been specially noteworthy in the area during the year should be specified. It is difficult to write definitely on this section of the Annual Report, as the Medical Officer of Health has no access to sickness returns such as those which are available to the officers of approved societies under the National Insurance Act. The information that can be given is therefore mainly based on impressions gleaned from local general practitioners, from deductions on the incidence of certain diseases in the death returns and from details as to persons who received medical relief from the Board of Guardians. The year, generally, was an unfavourable one from a meteorological point of view. The weather was cold and damp, particularly in the early months. As a consequence, there was an abnormal amount of respiratory and rheumatic affections, the deaths from diseases of this character being higher than in previous years. The number of deaths is, of course, no measure of the amount of sickness and can only be regarded as an index. Influenza, milder in type than that which has been experienced in preceding years, occurred in epidemic form in January, February and March, its distribution being general throughout the Borough. Judged by the notifications received, there was an increase in the amount of pneumonia, 102 notifications being received, compared with 94 in the previous year. This number probably under.estimates the incidence of the disease, as many cases still escape notification. During the year every medical practitioner in the Borough was supplied with a list of the notifiable diseases, and efforts were made to ensure prompt notification in every case. There was an increase in the number of cases of infectious disease, especially in the case of diphtheria. Fortunately, this diphtheria epidemic was accompanied by a lower death rate than usual. The incidence of gastro.intestinal diseases was comparatively low. 20 SECTION II.—PROVISION OF HEALTH SERVICES IN THE BOROUGH. HOSPITALS. The Hospitals available for and situated within the Borough are enumerated on page 11. None of these Hospitals are supported wholly or in part by the Borough Council. INSTITUTIONAL PROVISION FOR UNMARRIED MOTHERS, ILLEGITIMATE INFANTS AND HOMELESS CHILDREN. The Day Servants Hostel, 29.33, Danvers Street, Chelsea, provides accommodation for 15 unmarried mothers and their infants. At the Hostel for Discharged Women Prisoners and Police Court Cases, 497, King's Road, Chelsea, unmarried mothers, but not illegitimate children, are received. There is accommodation for 15 cases in this Hostel. Homeless children are cared for in the Guardians' Institution. AMBULANCE FACILITIES. (a) Infectious Cases. Under the Public Health (London) Act, persons in London suffering from certain notifiable diseases may be conveyed without payment to a hospital of the Metropolitan Asylums Board. The Board's ambulances are also available, on payment, for the conveyance of persons suffering from infectious disease to places elsewhere in the metropolitan area. (b) Non.infectious and Accident Cases. The efficient ambulance service of the London County Council is available for cases of accident, sudden illness and also for maternity cases. The ambulances of the M.A.B. may also be utilized, on payment, for the removal of non.infectious cases to hospitals or homes. CLINICS AND TREATMENT CENTRES. (a) Chelsea Health Society and School for Mothers. Chairman of Executive Committee: The Lady Maud Hoare. Hon. Sec. : Miss M. Bowden.Smith. This voluntary Society, with headquarters at 1, Manor Street, adjoining the Town Hall, maintains the Maternity and Child Welfare Centres in the Borough. Clinics are held at the Society's premises (1, Manor Street and 484, King's Road, S.W.). During the year 1925, five infant clinics were held weekly—four at Manor Street and one at King's Road. One ante.natal clinic was also held weekly at Manor Street. Details of the work carried out will be found on page 66. 21 Four parttime Medical Officers are employed by the Society—Dr. Doris Howard, Dr. Nora Pinkerton, Dr. Muriel Radford and Dr. Margaret Rorke. Two whole.time trained Health Visitors are also employed, together with necessary clerical and domestic assistance. Proposals (which I cordially approve) for the appointment of an additional whole. time Health Visitor and for the adequate treatment of lactation cases are at present under consideration. Much valuable work is done by voluntary workers attached to the Society. Three members of the Public Health Committee of the Borough Council and the Medical Officer of Health are members of the Executive Committee. With the approval of the Ministry of Health, the Borough Council made a financial errant of £700 to the Society for the year commencing 1st April, 1925. (b) Chelsea Day Nursery, 65, Sydney Street, S.W. 3. Chairman: The Hon. Mrs. Eustace Hills. Hon. Sec. : Mrs. Sandwith. The Chelsea Day Nursery is conducted by a voluntary Association. The Nursery is ably administered and is much appreciated in the Borough. Details of work done by the Nursery during the years 1921.1925 will be found on page 71. Three members of the Public Health Committee and the Medical Officer of Health are members of the Day Nursery Committee. With the approval of the Ministry of Health, the Borough Council made a financial grant of £100 to the Day Nursery for the year commencing 1st April, 1925. (c) Chelsea Tuberculosis Dispensary. This Dispensary, located at Brompton Hospital, affords skilled diagnosis and efficient treatment for all cases of Tuberculosis within the Borough. By agreement with the Borough Council, adequate medical, nursing and other necessary services are provided. The Tuberculosis Officer (Dr. W. J. Fenton) is one of the Honorary Physicians to the Hospital and his services are available when required by any medical practitioner in the Borough. Social work in connection with the Dispensary cases is carried out systematically and well by a trained Social Worker. Details of the work done by the Dispensary will be found on page 60. With the approval of the Ministry of Health, the Borough Council made a financial grant of £1,000 to Brompton Hospital for the year commencing 1st April, 1925. An additional sum of £160 for Nurses' visits to homes of patients was also granted by the Council to the Hospital and approved by the Ministry of Health. (d) Invalid Children's Aid Association. Chairman: Councillor F. J. Synge. Hon. Sec. : Mrs. Rathbone. The Chelsea branch of the Invalid Children's Aid Association is located at 2, Glebe Place, King's Road, S.W. 3. The Association provides, for 22 children referred to them, treatment in Hospitals, Sanatoria and Nursing Homes, according to need; convalescence in the country or at the seaside; orthopaedic appliances and surgical boots; massage, remedial exercises, surgical dressings and medical comforts; help in training for suitable work ; additional clothing, etc. Details of work done by the Association during the year 1925 will be found on page 70. Three members of the Public Health Committee of the Borough Council and the Medical Officer of Health are members of the local Committee of the Association. With the approval of the Ministry of Health, the Borough Council made a financial grant of £100 to the Association for the year commencing 1st April, 1925. PUBLIC HEALTH OFFICERS OF THE BOROUGH COUNCIL. The names and qualifications of members of the staff of the Public Health Department at 31st December, 1925, are tabulated below in the form required by the Ministry of Health. In December, 1925, the Senior Sanitary Inspector, Mr. G. R. Metzler, was certified to be unable to follow his employment by reason of permanent infirmity of body, and the Council resolved to superannuate him. At the end of the year the appointment had not been filled. Another Sanitary Inspector, Mr. H. J. Heeley, obtained an appointment elsewhere towards the end of the year and his name does not appear in this list. Mr. A. P. T. Shelley was appointed temporarily to fill the vacancy thus created. In this case also at the end of the year a permanent appointment had not been made. All appointments are whole-time except where otherwise indicated. Year appointed. Name. Qualifications. Appointment. *1924 McCarthy, W. H. L. M.D., M.R.C.P., D.P.H. Medical Officer of Health, Administrative Tuberculosis Officer and Executive Officer under the Council's Maternity and Child Welfare Scheme (Part time) 1925 Gerrans, B. H. F.T.C. Public Analyst (Part time) *1898 ! Metzler, G. R. Cert. Royal San. Inst. Senior Sanitary Inspector *1920 Crandell, W. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Cert. Meat and other Foods Sanitary Inspector *1925 i Shelley, A. P. T. Cert. San. Insp. Exam. Board Sanitary Inspector (temp.) * Salary contributions made under Public Health Acts. 23 Year appointed. Name. Qualifications. Appointment. *1909 Tettenborn, Miss F. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Cert. L.C.C. Adv. Home Nursing, C.M.B., Health Visitors and Nat. Health Diplomas, Cert. approved by Bd. of Education, Special Cert. for Tuberculosis Sanitary Inspector and Tuberculosis Health Visitor 1916 Brown, Miss M. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Health Visitors Diploma Cert. approved by Bd. of Education Health Visitor * Salary contributions made under Public Health Acts, of Salary contributions made by Exchequer Grants. Clerical Staff : A. B. J. Hayden, Senior Clerk. E. Bosley. Mrs. H. M. Kennedy† (Maternity and Child Welfare). Other Staff : Mortuary Keeper and Messenger C. Leonard. Chief Disinfector E. Hancock. Disinfector G. Cowper. Shelter Attendant Mrs. J. Humphreys. Cleansing Attendant Mrs E. Smith. Home Helps Mrs. White. Mrs. Bonny. Mrs. Dawson. For convenience of reference, the names and qualifications of members of the staffs of the Chelsea Health Society and of the Chelsea Tuberculosis Dispensary are tabulated below. None of these officers are appointed by the Borough Council. CHELSEA HEALTH SOCIETY. Maternity and Child Welfare Centres. Medical Officers (Part Time). Dr. Doris Howard. Dr. Nora Pinkerton. Dr. Muriel Radford. Dr. Margaret Rorke. 24 Health Visitors (Whole Time). Name. Qualifications. Appointment. Hobart, Miss F. G. Cert. San. Insp. Exam. Board, Health Visitors and National Health Diplomas, Cert. approved by Bd. of Education. C.M.B. Health Visitor and Secretary Shaw, Miss A. ... Cert. General Hospital Training, C.M.B. and Cert. Mothercraft Training Society Health Visitor Clerk Miss Godfrey. CHELSEA TUBERCULOSIS DISPENSARY. Name. Qualifications. Appointment. Fenton, W. J. M.D., F.R.C.P. Borough Tuberculosis Officer Hordern, Miss M. A. Cert. Inst. of Hospital Almoners, Cert. Social Science (London School of Economics) Secretary and Social Worker in connection with Tuberculosis Workman, Miss V. Cert. General Hospital Training and Tuberculosis Tuberculosis Nurse to Dispensary NURSING ARRANGEMENTS. (a) Professional Nursing in the Home. This is carried out by the Chelsea District Nursing Association, located at 10, Sydney Street, Chelsea. The Borough Council makes an annual grant to the Association, in addition to a payment of 1s. 6d. per visit. For this remuneration the Association has undertaken the nursing of all cases of illness occurring in expectant and nursing mothers and, also on the requisition of the Medical Officer of Health, the nursing of all children in the Borough under five years of age suffering from any illness. Cases of ophthalmia neonatorum, measles, bronchitis, pneumonia and other diseases thus receive skilled attention. Acute cases are seen two or three times a day if necessary and are also visited on Sundays. Chronic bedridden patients receive a weekly blanket bath. When required, the nurses assist at minor operations in the patients' own homes. Adult patients are expected to make payment to the Association according to their means, but no patient, on account of inability to do so, is refused the services of a nurse. The only stipulations are that the patient must be under medical supervision, require nursing and be unable to pay the fees of a private Nursing Institution. 25 Details of the work done by the Association during 1925 on behalf of the Borough Council will be found on page 68. Three members of the Public Health Committee of the Borough Council are members of the Council of the Association. With the approval of the Ministry of Health, the Borough Council made a financial grant of £50 to the Association for the year commencing 1st April, 1925. The total fees paid by the Council for nurses' visits during the year 1925 amounted to £122 16s. 6d. (b) Midwives. Provision has been made by the Borough Council whereby necessitous women may obtain the services of a Maternity Nurse or Midwife at a reduced rate, the balance of the fee being paid by the Council. The fees charged vary from £2 to £2 2s. 0d. for Primipara cases, and from £1 5s. Od. to £1 10s. Od. for Multipara cases. Arrangements on this basis have been made with the Ormond Home for Midwives (Blantyre Street, Chelsea), St. Mary's Nursing Home (Fulham), and with Midwives Andrews and Cooke, who are practising midwives in the Borough. All cases must in the first instance be approved by the Milk and Welfare Sub-committee. The Sub-committee meets weekly to consider applications and assess cases according to the income of the family. Contributions by patients towards the cost of midwifery assistance are collected by the Maternity Nurse or Midwife who undertakes the case. The cases dealt with by the Sub-committee during the past five years are summarized in Table No. 45 (page 67). The London County Council is the Authority responsible for the supervision of midwives in the Borough. Through the courtesy of Dr. F. N. Kay Menzies, the County Medical Officer of Health, I have been able to ascertain that 11 midwives gave notice during the year of their intention to practise as midwives in Chelsea. LABORATORY WORK. Analysis of Food and Drugs. The Public Analyst is Mr. B. H. Gerrans, F.I.C., and the investigations in connection with food and drugs sold in the Borough are carried out in his laboratories. The detailed results of analyses made during 1925 will be found appended to this report. Bacteriological Examinations. Routine bacteriological examinations are carried out at the Lister Institute of Preventive Medicine. Special investigations for the Ante-natal Clinic are carried out at the London Hospital and the Hospital for Diseases of the Skin (Blackfriars Road, S.E.). Arrangements have also been made with the Clinical Research Association for the bacteriological examination of samples of milk under the Milk (Special Designations) Order, 1923. No occasion has yet arisen for such investigation. 26 The number of bacteriological, bacterioscopic and other examinations made during the year was 439. Of these, 338 were for the bacillus associated with Diphtheria, 78 for the bacillus associated with Tuberculosis and 23 for suspected organisms in Ante-natal cases. Twelve specimens of blood were examined for the Wassermann reaction and one for the Widal reaction. The total cost of these services to the Borough Council in 1925 was £79 9s. 6d. The number of bacteriological examinations in 1924 was 186. Anti-toxin. Diphtheria anti-toxin is available at the Town Hall daily during office hours. It may also be obtained at the premises of Messrs. Timmis and Richards, 432, King's Road, S.W., at any hour, day or night. It is supplied free of charge, both in prophylactic and in curative doses, to medical practitioners on application. The amount supplied during the year was 57,500 units. An anti-toxin syringe, needles and steriliser are also available on loan. The total cost to the Council for anti-toxin supplied in 1925 was £3 16s. l0d. PUBLIC HEALTH LEGISLATION IN FORCE IN THE BOROUGH. The powers under which the Council work are those contained in the Public General Acts, the London County Council (General Powers) Acts, and the Byelaws under the Public Health Acts. In addition, the Council, on 18th February, 1925, in pursuance of the provisions of Section 23 of the Municipal Corporations Act, 1882, Section 16 of the Local Government Act, 1888, and Section 5 of the London Government Act, 1899, made the following byelaw for the good rule and government of Chelsea, such byelaw being sealed and forwarded to the Secretary of State for the Home Department, and a copy being fixed to the Town Hall as required by Statute:— Nuisances by Dogs. "No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement on the public footway. Any person offending against this byelaw shall be liable to a penalty not exceeding forty shillings." A similar byelaw has been adopted by the metropolitan boroughs of Kensington, Hammersmith and Fulham. In all cases the byelaw was allowed by the Home Office as an experimental measure for a period of two years, unless a byelaw is made confirming and continuing its provisions before the expiration of that period. 27 SECTION III.—SANITARY CIRCUMSTANCES AND ADMINISTRATION. Complaints. The number of complaints received during the year was 385, compared with 350 last year. The complaints are, in the majority of cases, from the occupiers of houses and deal with alleged nuisances. These complaints are investigated by the Sanitary Inspectors, who, when the circumstances justify, serve the necessary notices required for the abatement of the nuisances. Closet Accommodation. The water-carriage system is general throughout the Borough. Removal and Disposal of Refuse. House refuse is removed by the Works Department of the Council. A weekly collection is made. The refuse is conveyed to the Council's Wharf on the River Thames, whence it is barged away. Inoffensive trade refuse is removed by the Council on payment of a fee in accordance with the provisions of Section 33 of the Public Health (London) Act, 1891. Fish offal and other offensive trade products, which could be removed on application as trade refuse, are invariably removed and sold by the persons to whom this class of refuse belongs. Sanitary Inspection of the Borough. Set out on the following pages is a summary of the work carried out by the Sanitary Inspectors during the years 1921-1925. During the year 1925, the number of intimation notices served was 765. The number of statutory notices was 244. These compare with 731 and 213, respectively, in 1924. In five cases the owners neglected to comply with the statutory notices and in these it was found necessary to issue summonses. Details of these prosecutions are set out in tabular form in Table No. 20. Summary of Work carried out by Sanitary Inspectors during the Years 1921-1925. 1921. 1922. 1923. 1924. 1925. Houses and Premises. Inspections. *Total number of inspections 2,087 1,014 1,033 905 1,332 House-to-house inspections 547 291 233 213 284 Complaints — — 234 350 385 Infectious disease 485 423 402 743 702 Drainage. Drains constructed or reconstructed — 15 41 29 23 Drains cleansed and repaired 67 87 123 125 110 Gully traps provided 13 3 29 24 14 *These figures do not include revisits or inspections of premises where no defects were found. Including these, the total number of inspections during 1925 was approximately 6,650. 28  1921. 1922. 1923. 1924. 1925. Drainage. Drain and soil pipes ventilated and new soil pipes or ventilation pipes provided 88 19 60 38 24 Ventilating pipes repaired — 37 45 33 37 Antisyphonage pipes provided to W.C.'s 11 3 13 13 8 New water closet pans and traps provided 77 62 121 57 65 Additional water closet accommodation provided 7 3 15 8 9 Rain water pipes disconnected and caused to discharge over properly trapped gullies 3 9 44 4 New covers provided to inspection chambers - - - - 10 Sink, bath and lavatory waste pipes repaired, or new provided 145 68 81 66 39 New sinks and lavatory basins fixed — — 75 29 22 New baths fixed — — 36 9 33 Premises. Houses and premises or parts thereof cleansed and repaired 714 512 454 402 335 Defective roofs, gutters and rain water pipes repaired 415 405 417 287 202 Damp walls remedied — 54 67 58 63 Water closet walls and ceilings cleansed and repaired 251 253 124 105 48 Water closets provided with light and ventilation, or light and ventilation improved 6 7 1 3 Work rooms provided with light and ventilation, or light and ventilation improved 4 5 6 Washhouses, forecourts and areas cleansed, repaired and paving repaired - 36 173 126 70 Yards cleansed and paving repaired — 76 98 55 81 New and proper dust bins provided 329 324 302 143 138 Ashpits demolished and sites made good 26 16 21 8 12 Miscellaneous repairs — 916 469 376 440 Number of premises where special investigations were carried out in connection with Rat infestation 25 8 Disinfection. Premises disinfected after Zymotic diseases (Scarlet Fever, Diphtheria, etc.) 340 294 191 228 278 Rooms disinfected after Tuberculous disease 87 120 110 99 112 Rooms fumigated for verminous and filthy conditions 376 207 52 70 72 Miscellaneous disinfection 26 27 25 20 38 Water Supply. Water supply to premises reinstated ... 13 21 18 30 26 Water supply provided to upper storeys of tenement houses 1 1 3 2 1 Water closets provided with water supply or flushing apparatus repaired 97 136 146 120 92 Drinking water cisterns cleansed and repaired ... 81 39 38 28 19 New drinking water cisterns provided ... 2 — — — 4 Drinking water cisterns provided with new covers or covers repaired 10 39 32 18 12 29  1921. 1922. 1923. 1924. 1925. No. in Inspections of Special Premises. Register. Houses let in lodgings — - - - - - Offensive trades (special visits to premises used for offensive trade without a licence) - - - 150 - Stables — — 38 — 20 Marine store dealers premises — — — 24 23 Smoke Nuisances. Number of observations 6 8 11 16 12 Number of complaints — - 3 6 5 Number of notices - - - - - Number of summonses - - - - - Nuisances Abated arising from— Keeping animals in improper place or manner 17 18 64 10 6 Accumulations of manure or refuse 60 54 60 42 40 Overcrowding — 4 7 5 3 Underground rooms illegally occupied — — 1 — 7 Cases of overcrowding and underground rooms illegally occupied not yet abated owing to difficulty in securing other accommodation - - 7 - - Proceedings Taken. Intimation Notices served 1,015 986 928 731 765 Statutory Notices under Public Health (London) Act, 1891 292 253 261 180 222 Statutory Notices under Section 28 of Housing Town Planning Act, 1919... - 38 4 - - Statutory Notices under by-laws for provision of dustbins - - 53 33 22 Total number of samples purchased for analysis under Sale of Food & Drugs Acts 400 400 394 391 391 Samples of Cream taken (Milk and Cream Regulations) - 6 18 6 6 Samples of drugs taken — — 34 4 — Samples (informal) purchased — — 6 9 9 Legal proceedings instituted in respect to defective sanitary conditions and nuisances 7 12 22 - 5 Legal proceedings under Sale of Food & Drugs Acts 2 1 8 1 2 Legal proceedings in respect to unsound food - 1 - - - Certificates issued in accordance with "Rents Restriction Act" - 3 - 1 - Correspondence. Number of letters written in connection with sanitary matters 896 899 780 405 758 Entries in Inspectors Report Books 1,029 994 981 740 799 Entries in Inhabitants Complaint Book 56 51 57 47 48 Notifications of infectious disease sent to School authorities 371 339 223 199 219 Notifications of infectious disease sent to Metropolitan Asylums Board 145 144 157 352 225 Certificates of disinfection given Certificates of infectious disease for 629 546 376 309 382 removal cases ... Notices sent to Public Library of premises 170 137 87 54 75 where infectious diseases have occurred Post Cards sent re Samples taken under 146 149 82 36 68 Sale of Food & Drugs Acts 398 400 386 387 389  1921 1922. 1923. 1924 1925. Cleansing and Disinfection. Number of adults cleansed 56 7 4 10 Number of children cleansed 40 99 599 609 966 Number of rooms or premises cleansed and disinfected 1,497 621 378 428 407 Number of persons bathed for Scabies — 16 2 14 — Number of articles (bedding, etc.) disinfected 769 242 826 735 663 Number of articles (various) destroyed 91 74 118 148 299 Disinfection Station Shelter. Persons accommodated:— Adults 10 10 14 7 16 Children 17 13 14 2 6 Mortuary. Number of bodies received 99 80 80 91 102 Number of infectious bodies received 2 — — — — Number of bodies removed to Public Mortuary for sanitary reasons - - 11 1 1 TABLE No. 20. Magisterial Proceedings during 1925 under Public Health (London) Act, 1891. Situation of Premises. Nature of Nuisance or Complaint. Petty Sessions. Date of Hearing. Result. 45, Elvstan Street Part of front and flank walls missing. Kensington 19/5/25 Closing Order in each case. £2 2s. Od. Costs. Order suspended for two months. 49, Elvstan Street Main roof defective. Part of front wall missing. Roof defective. Kensington 19/5/25 51, Elystan Street Part of front and flank walls missing. Roof defective. Kensington 19/5/25 21a, Caroline Place Very defective main roof. Dirty and dilapidated interior of premises. Kensington 19/5/25 Work completed before date of hearing. Costs 10s. 6d. Fined £3 0s. 0d. Costs £2 2s. 0d. 162, Kings Road Letting or knowingly suffering the occupation of an underground room. Kensington 7/7/25 162, Kings Road Non-payment of Costs and Penalties. Kensington Distress Warrant issued. Costs and Penalties paid Dec., 1925 Fined £2 0s. 0d. Costs £2 2s. 0d. Withdrawn. 10, Markham Street Defective ventilating pipe to drain. Kensington 21/7/25 59, Slaidburn Street Dirty and dilapidated walls of top floor rooms. Kensington 17/11/25 31 Smoke Abatement. It is part of the work of a Sanitary Inspector to observe any nuisance arising from smoke and while there were only 12 recorded instances of observations during 1925 the chimneys in the Borough can be regarded as being subject to daily observation by the Inspectors. There were five complaints of smoke nuisances during the year and cautionary letters were sent to the offenders. Fouling of Footpaths by Dogs. The Borough Council obtained sanction for a bye-law to deal with this nuisance during the year. It has already been found useful, the condition of footpaths having improved considerably since the measure came into operation. Rats and Mice (Destruction) Act. During the year the Council has provided rat catching varnish to applicants for the destruction of rats and 350 bait traps were prepared and issued. In conjunction with the Works Department, investigation was made of a number of old sewers likely to be infested with rats and a large number of baits were laid. During the year many persons were advised as to the best means of dealing with the rat nuisance so far as it affected their respective premises. The cost to the Council of rat catching varnish during 1925 was £24 7s. 6d. Nuisance caused by Pigeons. During the year a number of complaints were received from residents in the neighbourhood of Chelsea Embankment and Elm Park Gardens regarding nuisance arising from the large number of pigeons in the area. On investigation, it was found that very serious nuisance is being caused by these birds. In addition to accumulation of excreta in rain pipes and gullies, pipes are blocked by the nests of the birds, and the areas and walls of houses concerned are in an insanitary state generally. Further, the birds pick out portions of mortar and cement from the structures, tending to cause dampness within the houses. The removal, cleansing and replacement of rain pipes; the cleansing of areas and walls; and other repair work involves the owners of such property in considerable and recurring expense. At present a Sanitary Authority has no powers to deal with nuisance caused by pigeons, in fact there are restraining enactments which prevent steps being taken to reduce the nuisance, e.g., under the Larceny Act, 1861, section 23, there is a penalty of £2 if pigeons are shot or trapped, and this may be claimed by a common informer. With the object of arranging concerted action, the Medical Officer of Health for the City of London was communicated with and it was ascertained that the question has been under consideration by the City Corporation for some time with a view to obtaining special parliamentary sanction to deal with the nuisance. Subsequently, the Borough Council resolved that the London County Council be requested to include a clause dealing with the matter in their next General Powers Bill. 32 Factories, Workshops and Workplaces. The Medical Officer of Health is required under Section 132 of the Factory and Workshops Act, 1901, to include in his annual report details of the administration of this Act in his district. The total number of factories, workshops and workplaces on the register at the end of the year was 256. The number of inspections of these premises was 857, which compares with 660 in 1924. Sanitary defects were found in 13 instances. The following Table No. 21 is in the form requested by the Home Office in order to ensure uniformity in the presentation of returns:— TABLE No. 21. Factories, Workshops, Workplaces and Homeworkers' Premises. 1.—Inspection of Factories, Workshops and Workplaces. (Including Inspections made by Sanitary Inspectors.) Premises. Number of Inspections. Written Notices. Occupiers prosecuted. (1) (2) (3) (4) Factories (including Factory Laundries) 49 4 - Workshops (including Workshop Laundries) 755 33 - Workplaces (other than Outworkers' premises) 53 6 - Total 857 43 - 33 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of offences in respect to which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness - - - - Want of ventilation — - - - Overcrowding 2 2 - - Want of drainage of floors — - - - Other nuisances — - - - Sanitary accommodation— Insufficient - - - - Unsuitable or defective 4 4 - - Not separate for sexes 7 7 - - Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) - - - - Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921.) - - - - Total 13 13 - - *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 3.—Home Work. Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Secs. 109, 110 Lists received from Employers. Number of Addresses of outworkers received from other Councils. Number of Addresses of outworkers forwarded to other Councils. Prosecutions. No. of Inspections of Outworkers Premises. Instances. Notices served. Prosecutions. Instances. Orders made (Sec. 109). Prosecutions (Secs. 109, 110) Lists. Chelsea Outworkers. 1921 24 29 49 538' - 126 - - - - - - 1922 25 23 87 526 - 85 - - - - - - 1923 26 27 87 704 - 123 - - - - - - 1924 29 26 91 440 - 119 - - - - - - 1925 27 23 75 432 - 115 1 1 - - - - 34 PUBLIC MORTUARY. Under the Public Health (London) Act, 1891, section 88, every sanitary authority must provide and fit up a proper place for the reception of dead bodies before interment. The Chelsea Mortuary is situated in Arthur Street. During the year the drainage of the premises has been renewed and provision made for lavatory accommodation. Improvement in the existing lighting arrangements is under consideration. Number of Bodies received in Mortuary during 1925 102 1. To await Inquests— (a) Infectious— (b) Non-infectious 86 2. To await burial 15 3. Sanitary grounds 1 Number of Post-Mortem examinations 52 Rag Flock Act. No samples of rag flock have been taken during the year. Offensive Trades. At the present time there are no offensive trades in the Borough, but considerable nuisance was caused in the summer of 1924 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 byelaws 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. The Borough Council, on the advice of the Public Health Committee, decided to oppose the grant of a 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. The premises in Lots Road were subsequently closed down, the business being transferred to a district outside the area of the London County Council. 35 SECTION IV.—HOUSING. In accordance with the instructions of the Ministry of Health, the following tabular statement has been prepared:— TABLE No. 22. Housing Statistics for the Year 1925. 1. General. Number of New houses erected during the year:— (a) Total (including numbers given separately under (b)) 91 (b) With State assistance under Housing Acts:— (i.) By the Local Authority 56 (ii.) By other bodies or persons 35 2. Unfit Dwelling Houses. I.—Inspection. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 1,332 (2) Number of dwelling houses which were inspected and recorded (House-to-house inspections) 284 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (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 799 II.—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 34 III.—Action under Statutory Powers. A. Proceedings under section 28 of the Housing, Town Planning, &c., Act, 1919 (or section 3 of the Housing Act, 1925). (1) Number of dwelling houses in respect of which notices were served requiring; repair - (2) Number of dwelling houses which were rendered fit— (a) by owners - (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 - 36 B. Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied ... 765 (2) Number of dwelling houses in which defects were remedied after service of formal notices— (a) by owners 222 (b) by Local Authority in default of owners - C. Proceedings under sections 11, 14 and 15 of the Housing Act, 1925. (1) Number of representations made with a view to the making of Closing Orders - (2) Number of dwelling-houses in respect of which Closing Orders were made - (3) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit - (4) Number of dwelling houses in respect of which Demolition Orders were made - (5) Number of dwelling houses demolished in pursuance of Demolition Orders - Staff. The staff engaged on housing work in 1925 consisted of three Sanitary Inspectors, each carrying out all the duties of a Sanitary Inspector in the district allocated to him. General Housing Conditions. It is difficult to discuss the subject of housing in Chelsea without some understanding of the peculiar conditions which appertain to the district. Probably in few London boroughs have there been so many alterations, consequent on demolitions and reconstructions, during the past 30 years, as in Chelsea. The process of reconstruction is still in progress, though largely suspended by the operation of the Rent Restriction Acts. The developments which have taken place have arisen from the fact that a very considerable proportion of Chelsea is comprised within the areas of two large estates—the Cadogan Estate and the Sloane Stanley Estate. Many of the building leases on these estates were granted early in the 19th century and a large number have already expired. A certain proportion of demolition of small property has been due to the acquisition of land by large trading corporations, but up to the present this has not been a factor of any great magnitude. Owing to the proximity of the eastern boundary of the Borough to Hyde Park and Belgravia, and to the attractiveness of the Embankment forming the southern boundary, residential values in these neighbourhoods have greatly appreciated in recent years, the price of land has been correspondingly increased, and the old type of small house, accommodating the small trader and the artizan or labourer, has been replaced by modern houses and mansions let in flats commanding high rents. 37 The process of development has been largely in the hands of Estate Companies, who have purchased the reversionary interests of the ground landlords, and proceeded to carry out the demolitions and reconstructions, as soon as the property came into their possession. Until subsequent to the War, no restriction operated, nor did any liability attach to Estate Companies, conducting operations of this nature, to make any provision for rehousing the working classes displaced. In this way, during the past 30 years, some 18,000 Chelsea inhabitants, chiefly of the working and small trader class, have been displaced and compelled to migrate into surrounding districts. Despite the difficulties of the problem, in Chelsea a considerable amount of accommodation had been provided for the working classes during the years preceding the outbreak of War. This had been effected by municipal undertakings, by private enterprise and by the operation of benevolent agencies and trusts. Municipal undertakings for the housing of the working classes carried out by the Borough Council prior to 1914 were as follows Population Sir Thomas More Buildings, Beaufort Street 770 Pond House, Pond Place 130 Onslow Dwellings, Pond Place 380 Grove Buildings, Manor Street 300 1,580 Private enterprise, benevolent agencies and trusts had also made very important contributions to housing in Chelsea prior to 1914. These were as follows:— Population Sutton Model Dwellings, Cale Street 2,200 Lewis Trust Dwellings, Pond Place 1,390 Marlborough Buildings, Walton Street 500 Guinness Buildings, Draycott Avenue 940 Peabody Buildings, Lawrence Street 200 Chelsea Park Dwellings, King's Road 170 5,400 It will be seen that in Chelsea at the outbreak of war there was available accommodation for 6,980 persons of the wage-earning class—an amount which, in proportion to population, was considerably higher than that obtaining in any other metropolitan borough. Since the war, the economic situation and other factors, particularly the shortage of and greatly increased cost of building land in Chelsea have rendered an already difficult situation still more difficult. No new dwellings have been erected by private enterprise, benevolent agencies or trusts. Various schemes for making further provision for the housing of the working classes have been prepared by the Borough Council and 38 submitted to the Ministry of Health for approval. One such scheme —that of Hortensia Road site—has fortunately materialised, approval of the others not being obtained on the ground that the cost of the land was much higher than the price the Ministry could sanction for the purchase of land to be used for the erection of buildings to house the working classes. Hortensia House, Hortensia Road, completed in May, 1925, and now fully occupied, provides accommodation for 250 persons in 56 flats, namely 35 three-room flats and 21 four-room flats. The total cost of site and buildings was £53,800, including Exchequer subsidies amounting to about £4,350. The total weekly rents, including hot water supply and electricity, vary from 25s. to £1 14s. 3d. This scale of rents was drawn up on an economic basis, on the instructions of the Ministry of Health, the Ministry's decision being based upon the high cost of the site and construction. The rents are obviously much higher than the working classes proper can afford to pay and indeed most of the tenants are classes in receipt of small salaries or earnings—a group not usually classed as "working classes." Reviewing the history of the past twenty-five years, it would appear that the housing policy of the Borough Council has been firstly to preserve, where possible, in areas threatened with demolition, such working class accommodation as was of reasonably good type ; and secondly, to provide accommodation by means of new buildings in an accessible position within the Borough for those persons of the working class who are average representatives of their class, and for whom the necessities of their trade or calling render residence within the Borough desirable or necessary. It cannot be disputed that at the present time in Chelsea, as in other metropolitan boroughs, there is considerable dearth of accommodation both for the working classes and for the classes in receipt of small salaries or earnings and that, as elsewhere, this situation is primarily due to the restrictions imposed upon the building trades during the War and the economic disturbances which have succeeded it. As to whether, in the special circumstances of Chelsea, it is necessary or desirable to make further provision for the very lowest and least provident classes of the population, I am at present unable to express a definite opinion. A majority of these people are unable or unwilling to pay more than 9s. per week in rent, and it seems undesirable that they should be compelled to do so. The provision of the Hortensia Road dwellings during the year has been most valuable, but additional housing facilities are required to meet the needs of a large section unable to pay the rents at Hortensia Road. The Housing Committee is now actively engaged in investigating possible sites in connection with a further Housing Scheme. Overcrowding. Overcrowding, where it exists, is mainly confined to the western district of the Borough. There has been comparatively little improvement in its prevalence during the year. Many of the cases when approached as to the desirability of having their names submitted to the County Council, with a view to provision of housing on 39 one of the Council's Estates, decline to consider the proposition, on the ground that the distance of the County Council's Estates from their work is too great. Others have become attached to the district and will not contemplate forsaking existing interests and associations. Owing to the extreme difficulty of finding alternative accommodation it has not been found possible to deal with more than a few cases of overcrowding during the year. Whenever possible, arrangements are made with the London County Council for the provision of a house for the overcrowded family. Three such families obtained accommodation on the Council's Estates during the year. Further, when vacant tenements become available in the Borough Council's Dwellings, preferential treatment is as far as possible given to cases of overcrowding. With a view to preventing a recurrence of overcrowding in premises which are being vacated because of their overcrowded condition, a cautionary letter is always sent to the landlord concerned, warning him that action will be taken against him in the event of a recurrence of overcrowded conditions in the premises. Fitness of Houses. The general standard of housing in the borough is satisfactory. In a small portion of the western district the houses are old, worn out and require constant repairs and renovations. The area, however, is not such as could be readily adapted to any housing reconstruction proposal. A larger area in the north-western district contains many houses of similar character. This area is already scheduled for reconstruction, but nothing has yet been done, owing to conditions prevailing in the building trade and the operation of the Rent Restriction Acts. One of the most unsatisfactory features in this, as in other boroughs, is the presence of a large number of houses let in lodgings. These houses were not constructed for the purpose to which they are now put. The use of staircases, washhouses, yards, waterclosets, ashbins, etc., in common leads to misuse and neglect, and the general environment is not prone to the cultivation of habits of self-respect, morality or health. Many such houses are without adequate provision for the cooking or storage of food, and housework is carried on at great inconvenience. While the great majority of these houses are structurally sound, a number of them are old, worn out and below the modern standards of sanitation and convenience. It is probable that only a minority of the tenants would be able to pay economic rents for alternative accommodation, having regard to the rents that require to be fixed for new dwellings owing to the greatly increased cost of land and construction during recent years. Another problem is caused by certain old people, usually women. Many of these live alone in a single room with no one to look after them. Frequently they rely almost entirely on the Old Age Pension for sustenance. Gradually growing feebler with the passage of time, they eventually become unable properly to care for themselves or their homes. Although every means of persuasion is tried, these cases usually decline to enter a Poor Law Institution and the condition often persists for a lengthened period. No solution of the problem presented by these 40 people seems possible, apart from the granting of compulsory powers for their removal to a suitable institution. While in the majority of cases the defects found to exist in unfit houses are due to the lack of proper management and supervision by owners, from time to time complaints are made by owners regarding the difficulties they experience in keeping their property in a reasonable state of repair because of the dirty and destructive habits of a number of their tenants. It is alleged that, through carelessness or wilful damage by tenants, repairs and cleansing have to be carried out with unreasonable frequency and that, as a consequence, it is impossible to maintain even the minimum requirements of the Local Authority without incurring financial loss. Investigation has shown that these statements are often well-founded, especially in the poorer class tenement lodging houses where no responsible caretaker or landlord is resident. To lighten the difficulties of the owner in these cases, effort is made, as far as possible, to keep in view such powers as a Local Authority has of holding the tenant responsible for defects resulting from his neglect or default. Action was taken during the year in respect of three dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation. Closing Orders were made in each of these cases and the houses have since been demolished by the owner. The total number of dwelling houses inspected for housing defects during the year was 1,332, the number found not to be in all respects reasonably fit for human habitation being 799. The number rendered fit in consequence of informal action by the Sanitary Inspectors was 34 and the number in respect of which notices were served requiring defects to be remedied was 765. It came to the knowledge of the Department in the course of the year that seven underground rooms were being illegally used for sleeping purposes. Appropriate action was taken and the rooms were vacated in all cases. There were three applications under the Increase of Rent and Mortgage Interest (Restriction) Acts made by the occupiers of three dwelling houses that the houses occupied by them were not in a reasonable state of repair. In all cases the applications were withdrawn before they were considered by the Council as all the work necessary to put the houses in a reasonable state of repair had been carried out expeditiously. It is the usual practice when such an application is received to inspect the house and serve notices for the defects which exist. If these are amended promptly it is found unnecessary to take further action. Unhealthy Areas. No representations have been made under the Housing Acts during the year and no complaints that areas were unhealthy have been received. Byelaws relating to Houses and Houses Let in Lodgings. Existing byelaws relating to houses are, on the whole, found to be fairly satisfactory in their working, but there is undoubted need for new byelaws in respect of houses let in lodgings in order to deal adequately with present- day housing conditions. The proposed byelaws under Section 26 of the 1919 Housing, Town Planning, etc., Act, have not yet been issued by the London County Council. It is understood that draft byelaws have been prepared and submitted to the Ministry of Health for approval. It is hoped that they will shortly materialise in legal form as the existing byelaws are practically useless. Housing Survey. House-to-house inspection was continued on the same lines as in previous years. In the course of the year, 284 houses were inspected and recorded by the Inspectors, compared with 213 in 1924. During the year statements have appeared in the Press making allegations as to the widespread existence of insanitary conditions and slum areas in the borough. It is of great assistance to a Local Authority to have an intelligent interest in sanitary matters taken by the inhabitants, but the object is defeated when exaggerated statements are made. Some of the statements appeared to be due to a misunderstanding of the facts upon which the statements were based; others to conscious and deliberate exaggeration. 42 SECTION V.—INSPECTION AND SUPERVISION OF FOOD. Milk Supply. In accordance with statutory enactments, the Council keeps a Register of persons from time to time carrying on the trade of dairymen or purveyors of milk and no person is permitted to carry on the trade in the Borough unless he is registered. The Council is empowered to remove the name from or refuse to enter upon the Register the name of any person selling or proposing to sell milk on premises which are for any reason unsuitable for the purpose. The Milk and Dairies (Amendment) Act, 1922, further empowers the Council to refuse to enter the name of any person in the Register, or to remove the name of any person from that Register, if it is shown to the Council's satisfaction that the public health is or is likely to be endangered by any act or default of such person in relation to the quality, storage or distribution of milk. The premises at which registered purveyors of milk carry on their business have been subject to frequent inspection. During the year three applications were made for registration as purveyors of milk, all of which, after appropriate investigation, were approved by the Council. In tabular form below is shown the alterations which took place in the Register of Milk Purveyors during the year. TABLE No. 23. Retail Wholesale. Total. On Register 31st December, 1924 75 — 75 Vacated during the year 3 — 3 Added during the year 3 — 3 On Register 31st December, 1925 75 - 75 There were 40 applications from 12 retailers under the Milk (Special Designations) Order for licences to sell special grades of milk. All these licences were granted. In each case the licence was granted for the purpose of authorising the dealer to sell specially designated milk from shops within the Borough. No application has been made for a licence giving authority to set up bottling or pasteurising establishments in the Borough. The following Table No. 24 shows the numbers of licences granted for the sale of milk under special designations during the years 1923-1925. 43 TABLE No. 24. Licences granted under Milk (Special Designations) Order. Licences granted under Milk (Special) Designations) Order. 1923. 1924. 1925. To sell "Certified" Milk 16 17 19 To sell "Grade A" Milk 3 - — To sell "Grade A (Tuberculin Tested) Milk 1 10 13 To sell "Pasteurised" Milk 1 — 8 21 27 40 No samples of graded or other milk were submitted for bacteriological examination during the year. There were 122 inspections of dairies and milkshops made in the Borough. Notices were served requiring remedy of defects found on three of the premises visited. There are no cowsheds in the district. Further reference to milk is made in the Public Analyst's Report for the year and details of magisterial proceedings taken in cases of adulterated milk will be found in the sub-section dealing with the Food and Drugs Acts. Ice-Cream Vendors. At the end of the year, 40 premises were shown in the Register as places where ice-cream is prepared or sold. There were 42 inspections of these premises as compared with 72 in 1924. This trade is mainly regulated under the L.C.C. (General Powers) Act, 1902. It is an offence to store ice-cream in a sleeping room or in any shed or room in which there is an inlet to a drain. Vendors of ice-cream must notify the occurrence of infectious disease among their employees or persons living on their premises. The Act also provides that every itinerant vendor shall exhibit on his barrow the name and address of the person from whom the ice-cream has been obtained. Existing legislation enables a Sanitary Authority to exercise adequate control where the vendors and premises are known, but, inasmuch as ice-cream may be made under unsatisfactory conditions on premises other than those where it is stored, some system of compulsory registration should be provided, applicable to all premises where the commodity is manufactured or stored or sold, and also to the itinerant vendors. Fried Fish Vendors. At the end of the year there were 14 premises in which the frying of fish was carried on and 42 inspections of these premises were made. It is found that a reasonable standard of cleanliness is now being maintained, but it is necessary for the Inspectors to maintain a constant vigilance to impress upon the vendors the necessity for the systematic observance of cleanliness. 44 Bakehouses. There are 26 bakehouses in the Borough and 48 inspections of these premises were made during the year. Two notices were served for the cleansing of walls and ceilings. Slaughter-houses. There are three private slaughter-houses in the Borough and 71 inspections of these premises were made during 1925. In compliance with the byelaws prescribing humane slaughtering, approved methods of slaughter are employed in each of the premises. There is no public abattoir in the Borough. The following table shows, in the form required by the Ministry of Health, the number of private slaughter-houses in use in the Borough on the dates indicated:— TABLE No. 25. In 1920 In January. 1925. In December, 1925 Registered — — — Licensed 3 3 3 Total 3 3 3 Inspection of Other Premises where Food is Prepared or Offered for Sale. The Inspectors keep under frequent observation all other premises where food is prepared for or exposed for sale. Included in this category are restaurants and premises used by provision dealers, butchers, fishmongers and greengrocers for the purposes of their trades. The following Table No. 26 shows, for the years 1921-1925, the number of inspections of premises where food was prepared for or exposed for sale. TABLE No. 26. Inspection of Premises where Food was Prepared or Sold (1921-1925). 1921. 1922. 1923. 1924. 1925. Nature of Premises. No. on Register. No. of Inspections. No. on Register. No. of Inspections. No. on Register. No. of Inspections. No. on Register. No. of Inspections. No. on Register. No. of Inspections. Cowsheds — — — — — — — — — — Slaughter Houses 3 26 3 75 3 79 3 40 3 71 Milk Shops 67 95 68 146 72 168 75 145 75 122 Ice Cream Premises 17 30 17 47 59 81 60 72 40 42 Bakehouses — — 26 22 26 54 26 56 26 48 Restaurant Kitchens 30 58 30 42 32 40 32 35 32 34 Food Premises (other than above) 80 80 80 100 84 63 90 200 90 155 45 Public Health (Meat) Regulations, 1924. Meat inspection is carried out by the Sanitary Inspectors. Arrangements have been made whereby adequate notice of the time of slaughter is obtained. In 1925, the number of animals inspected at the time of slaughter was 270 (268 pigs and two calves). No application for the marking of meat under the Regulations has been received. Instructions under the Regulations have been formulated to deal with stalls, shops, stores and vehicles. These have been approved by the Council and circulated amongst traders concerned. No meat stalls exist in the Borough at the present time. A deputation of the local Butchers Association has also been received and improvement has already taken place in the conditions under which meat is stored, exposed for sale and transported. Unsound Food. On four occasions during the year unsound food was surrendered and destroyed. Included in the food surrendered was:— 40 stone of Pork, 5 stone of Fish and 2 cwts. of Mussels. The number of carcases destroyed on account of Tuberculosis was one—a pig. Food Poisoning. No cases of food poisoning were brought to the notice of the Department during the year. Sale of Food and Drugs Acts. Four hundred samples, including 100 samples of milk and six samples of cream, were taken and submitted for analysis during 1925. Six of these samples (all of which proved genuine) were investigated by the former Public Analyst to the Borough and 394 by the present holder of the appointment, Mr. B. H. Gerrans, F.I.C., whose Report is set out in the appendix. Each of the three male Sanitary Inspectors is appointed an Inspector under the Acts. Under their direction, the taking of samples is effected by individuals temporarily employed for the purpose, the services of persons outside the borough being frequently utilised. The samples procured are of two kinds—formal and informal. Formal samples are those taken strictly in conformity with the Sale of Food and Drugs Act, 1875. Informal samples are those taken without these strict formalities and afford useful indication of the conditions without disclosing to the vendor that the object of purchase is analysis. No legal proceedings are possible in respect of an informal sample, but, when adulteration is discovered, formal samples are obtained immediately and necessary action taken on receipt of the analytical report regarding them. In 1925, two samples of milk were found adulterated to such a degree as to justify legal proceedings. These proceedings were instituted but the summonses were dismissed on the defendants proving a warranty in each case. Details of these prosecutions are given in Table No. 27. 46 Table No. 28 shows the work carried out under the Food and Drugs Acts during the years 1921-1924. The figures for the year 1925 are given in the Public Analyst's Report in the appendix. Milk and Cream Regulations, 1912-1917. All samples of milk and cream taken during the year were submitted to examination for preservatives. No evidence of the presence of preservatives was obtained. TABLE No. 27. Magisterial Proceedings under Sale of Food and Drugs Acts during 1925. Street where Purchased. Offence. Petty Sessions. Date of Hearing. Result. 13, Kings Road For selling Milk from which 8 per cent. of milk fat had been abstracted. Kensington 21/4/25 Case dismissed. Warranty proved. 45, Radnor Street For selling Milk which contained 3 per cent. of extraneous water. Kensington 29/9/25 Case dismissed. Warranty proved. 47 TABLE No. 28. Nature of Samples taken under Food and Drugs Acts (1921-1924). Nature of Sample. 1921. 1922. 1923. 1924. Genuine Composition. Adulterated. Inferior. Total. Genuine Composition. Adulterated. Inferior. Total. Genuine Composition. Adulterated. Inferior. Total. Genuine Composition. Adulterated. Inferior. Total. Milk 148 3 — 151 123 1 — — 154 2 — 156 141 4 — 145 Butter 81 — — 81 60 — — 60 59 — — 59 45 — — 45 Margarine 36 — — 36 24 — — 24 6 — — 6 16 — — 16 Cocoa 9 — — 9 42 — — 42 23 — — 23 52 — — 52 Coffee 25 — — 25 39 — — 39 36 — — 36 43 — — 43 Coffee and Chicory 2 — — 2 7 — — 7 1 — — 1 — — — — Pepper 13 '— — 13 10 — — 10 9 — — 9 12 — — 12 Lard 27 — — 27 9 — — 9 — — — — — — — — Cornflour 9 — — 9 18 — — 18 — — — — — — — — Tea — — — — — — — — — — — — 9 — — 9 Baking Powder 9 — — 9 18 — — 18 — — — — 9 — — 9 Flour 18 — — 18 9 — — 9 1 — — 1 9 — — 9 Rice — — — — — — — — 13 — — 13 — — — — Cream — — — — 6 — — 6 18 — — 18 6 — — 6 Mustard Mixture — — — — — — — — — — — — — — — — Cheese — — — — — — — — 10 — — 10 10 — — 10 Sponge Cakes — — — — — — — — — — — 2 — — — — Sausages — — — — — — — — — — — — — — — — Ground Almonds — — — — — — — — 7 — — 7 3 — — 3 Ginger — — — — 9 — — 9 — — — — 2 — — 2 Mustard — — — — — — — — — — — — 11 — — 11 Condensed Milk 1 — — — — — — — — — — — 11 — — 11 Oatmeal 5 — — 5 — — — — — — — — — — — — Vinegar 9 — — 9 18 — — 18 15 — — 15 10 — — 10 Sago 5 — — 5 — — — — — — — — — — — — Sugar — — — — 3 — — 3 — — — — 1 — — 1 Drugs — — — — 2 — — 2 25 9 — 34 4 — — 4 Separated Milk — — — — 2 — — 2 — — — — — — — — Chocolate — — — — — — — — — — — — 2 — — 2 Confectionery — — — — — — — — — — — 1 — — — — Flour, Self Raising — — — — — — — — 9 — — 9 — — — — 397 3 — 400 397 1 — 400 389 11 — 400 396 4 — 400 48 SECTION VI.—INFECTIOUS DISEASES. (a) INFECTIOUS DISEASES GENERALLY. DISEASES COMPULSORILY NOTIFIABLE IN THE BOROUGH. Acute Poliomyelitis. Acute Polio-encephalitis. Acute Encephalitis Lethargica. Acute Primary Pneumonia. Acute Influenzal Pneumonia. Cerebro-spinal Fever Plague. Anthrax. Glanders. Hydrophobia. Cholera. Continued Fever. Ophthalmia Neonatorum. Diphtheria. Membranous Croup. Dysentery. Erysipelas. Malaria. Puerperal Fever. Relapsing Fever. Small-pox. Typhus Fever. Trench Fever. Tuberculosis. Scarlatina or Scarlet Fever. Typhoid or Enteric Fever. NOTIFICATIONS DURING THE YEAR 1925. The total number of notifications, excluding duplicates, was 558. Of this figure, 111 were notifications of Pulmonary Tuberculosis and 24 of Non-pulmonary Tuberculosis. In addition, 110 cases of Measles came to the knowledge of the Department, mainly through the School Authority. Compared with 1924, there is an increase of 91 in the number of cases of Diphtheria. The number of cases of Scarlet Fever (87) is the same as that in 1924. The notifications of Pneumonia and of Tuberculosis also remain approximately the same as in the previous year. In 1924, there were 24 deaths from non-notified Tuberculosis, while in 1925 there were 8 such deaths. Table No. 29 shows the total number of cases of infectious disease notified during the year, the distribution by age-groups and the number of cases treated in hospitals:— 49 TABLE No. 29. Cases of Infectious Disease Notified during the Year 1925. Cases notified in Chelsea. Removed to various Hospitals. At all Ages. Under 1 Year. 1-5 Years. 5-15 Years. 15-25 Years. 25-45 Years. 45-65 Years. 65 and upwards. Small-pox - - - - - - - - - Cholera - - - - - - - - - Diphtheria 172 7 43 77 22 17 5 1 168 Erysipelas 33 — — 2 2 9 14 6 21 Scarlet Fever 87 1 24 41 13 8 — — 78 Typhus Fever — — — — — — — — — Enteric Fever 4 — — 1 1 1 1 — 3 Puerperal Fever 3 — — — — 3 — — 3 Cerebro-Spinal Fever - - - - - - - - - Ophthalmia Neonatorum 11 11 - - - - - - 5 Poliomyelitis - - - - - - - - - Encephalitis Lethargica 4 1 1 1 1 3 Polio-encephalitis - - - - - - - - - Malaria 1 — — — 1 — — — — Dysentery 1 — — — — 1 — — — Trench Fever - — — — — — — — — Acute Primary Pneumonia 102 18 26 10 8 18 12 10 78 Acute Influenzal Pneumonia 5 1 — 1 — — 3 — 1 Total 423 38 93 132 48 58 36 18 360 Tuberculosis:— Pulmonary 111 — — 3 20 51 33 4 Non-Pulmonary 24 2 3 10 7 2 — - Totals (Tuberculosis) 135 2 3 13 27 53 33 4 Totals 558 40 96 145 75 111 69 22 No cases of Smallpox, Cholera, Typhus Fever, Cerebro-spinal Fever, Poliomyelitis, Polio-encephalitis, Trench Fever, Continued Fever, Relapsing Fever, Plague, Anthrax, Glanders or Hydrophobia were notified during the year. DIPHTHERIA. Notifications. During the year, 172 cases of diphtheria were notified, as compared with 81 in 1924. The incidence of the disease during the years 1921-1925 is shown in Table No. 30. Deaths. Seven deaths from the disease occurred in 1925, all in the M.A.B. Hospitals. Four of the cases were under five years of age. 50 Return Cases. Three return cases occurred during the year. In each case the primary case on discharge from hospital suffered from slight nasal discharge. TABLE No. 30. Year. Cases Notified. Percent age of Removals Deaths Case Fatality Rate. Percent age of cases of School age (3-13 years). Month of greatest prevalence. Bacterioscopic Diagnosis, Lister Institute. No. of Specimens submitted Positive Percent age Positive. Negative. Percent age Negative. 1921 112 92 6 5.4 76 Sept. 80 25 31 55 69 1922 120 93 14 11.7 56 Oct. 73 12 16 61 84 1923 97 90 11 11.3 62 Feb. 94 9 9.6 85 90.4 1924 81 92 3 3.7 65 Nov. 95 9 9.5 86 90.5 1925 172 98 7 4.1 50 Jan. 338 58 17.2 280 82.8 It will be observed that the number of cases notified in 1925 was abnormally high and that the percentage of removals to the M.A.B. Hospitals was also high. On the other hand, the case fatality rate was low as compared with former years. Information was received from the M.A.B. that 25 of the cases sent to Hospital in the course of the year proved not to be suffering from diphtheria. The incidence of the disease in London generally in 1925 was considerably higher than in previous years. Of the 172 cases notified, 83 occurred in Stanley Ward, 55 in Church Ward, 21 in Cheyne Ward, 8 in Hans Town Ward, and 5 in Royal Hospital Ward. Early in the year several cases were notified from the Infants' Ward of a Hospital in the Borough. A thorough examination of the drainage system of the Hospital was thereupon carried out and such defects as were found to exist were rectified by the Board of Management. Investigation for "carrier" cases was also made. It was also observed that a large proportion of the cases occurred in children who had been attending the Ashburnham Schools in West Chelsea. Accordingly, by arrangement with the Education Department of the London County Council, the drainage and sanitary arrangements of the Schools were investigated. No defects, however, were found. The following table shows the average annual case rate, case fatality rate, and percentage of cases removed to hospital in each of the seven quinquennial periods since 1891. 51 TABLE No. 31. Quinquennial Periods. Average Annual case-rate per 1,000 population. Average Annual case-fatality rate. Average Annual percentage of cases removed to hospital. 1891-5 2.69 18.7 43 1896-1900 3.00 17.1 64 1901-5 1.25 8.0 80 1906-10 1.86 8.8 89 1911-15 1.24 5.8 89 1916-20 1.35 8.9 92 1921-25 1.81 7.2 93 Diphtheria Anti-toxin. Anti-toxin is supplied, in prophylactic and in curative doses, free of charge to any medical practitioner requiring it for Chelsea patients. An anti-toxin syringe, needles and steriliser are also available. Anti-toxin can be obtained at the Public Health Department, daily during office hours, or at any hour, day or night, at the premises of Messrs. Timmis and Richards, Chemists, 432, King's Road, S.W. 10. During 1925, ten bulbs of serum were supplied to medical practitioners, the cost to the Council being £3 16s. lOd. As yet no application of the Schick test or of artificial immunization against the disease has been made in the Borough. SCARLET FEVER. Notifications. During the year, 87 cases of Scarlet Fever were notified, the figure for 1924 being identical. Information was received from the M.A.B. Hospitals that five of the cases proved not to be Scarlet Fever. One "return" case of the disease was discovered during the year and necessary action taken. Table No. 32 shows the incidence of the disease during the years 19211925, while Table No. 33 covers the seven quinquennial periods since 1891. Deaths. There were no deaths from Scarlet Fever in 1925. TABLE No. 32. Year. Cases Notified. Percentage of Removals. Deaths. Case Fatality Rate. Percentage of cases of School-age 3-13 years. Month of greatest prevalence. 1921 233 90 1 0.4 75 May 1922 197 91 6 3.0 69 Feb. 1923 111 95 1 0.9 74 Jan. 1924 87 88 – – 62 Oct. 1925 87 90 – – 59 Feb. 52 TABLE No. 33. Quinquennial Periods. Average Annual case-rate per 1,000 population. Average Annual case-fatality rate. Average Annual percentage of cases removed to hospital. 1891-5 4.54 4.7 55 1896-1900 3.91 3.8 70 1901-5 2.60 3.2 88 1906-10 3.20 2.3 93 1911-15 2.69 1.8 91 1916-20 1.95 1.0 92 1921-25 2.23 0.9 91 No application of the Dick test or of artificial immunization against Scarlet Fever has yet been made in the Borough. MEASLES. Notification Statistics. This disease is not notifiable. Information as to cases occurring in the Borough is derived from the School Authorities, Hospitals and medical practitioners. In addition, many cases are discovered by the Health Visitors in the course of their duties. All children suffering from the disease are visited by the Health Visitors at frequent intervals and advice is given as to the steps necessary to avoid complications. The number of cases coming to the knowledge of the Department during the year was 110, as compared with 450 in 1924, 148 in 1923, 557 in 1922, and 12 in 1921. Deaths. The number of deaths was 2, both of which were in children under five years of age. Visiting and Nursing. During 1925, 144 visits and re-visits were made by the Health Visitors. Cases are also visited by the District Nurses whenever circumstances render this necessary. No nurses visits were required in 1925. Removal to Hospital. Cases of Measles are received in the Hospitals of the Metropolitan Asylums Board on the certificate of the Medical Officer of Health. During the year 5 cases were removed. ENTERIC FEVER. Notifications. During the year the number of cases of Enteric fever notified in Chelsea was 4. A summary of the cases is given in Table No. 34. 53 TABLE No. 34. Sex. Age. Notification. Removed. Nursed at Home. Remarks. F. 24 Typhoid M.A.B. – Housemaid. No cause suspected. M. 12 Typhoid St. George's Hospital – Schoolboy. Bathed a good deal on the river side, close to Barges. F. 58 Typhoid – Yes Widow. May have eaten fish (soles). Nurse in attendance. F. 33 Enteric M.A.B. – Maid. May have eaten fresh herrings. Deaths. There were no deaths in the above cases, but one case notified in December, 1924, proved fatal in February, 1925. A summary of Enteric and Para Typhoid B cases for the years 19211925 is given below:— TABLE No. 35. Year. Enteric. Para Typhoid B. Cases. Recovered. Fatal. Cases. Recovered. Fatal. 1921 7 7 – 2 2 – 1922 4 4 – – – – 1923 4 4 – 2 2 – 1924 6 4 2* 3 3 – 1925 4 4 – – – – * One in 1924, and one in 1925. One specimen of blood was examined during the year for the Widal reaction and proved negative. PNEUMONIA, MALARIA, DYSENTERY AND TRENCH FEVER. These diseases are compulsorily notifiable under the Public Health (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1919. During the year the following numbers of cases were notified:— Pneumonia 107 Malaria 1 Dysentery 1 Trench Fever 0 54 Pneumonia. All primary pneumonias, lobar or lobular, are notifiable. The only secondary pneumonia which is notifiable is influenzal pneumonia. The notifications and deaths from pneumonia during the past five years have been as follows:— Notifications. Deaths. 1921 28 43 1922 70 49 1923 42 59 1924 104 64 1925 107 74 Nursing Provision. By arrangement with the Chelsea District Nursing Association, all cases of Pneumonia receive adequate nursing attention where the circumstances render this necessary. Malaria. The Regulations provide that the Medical Officer of Health shall take all practical steps to ensure that persons suffering from malaria are supplied with sufficient mosquito netting; receive adequate quinine treatment during the attack and subsequently; and receive appropriate advice as to precautions necessary to prevent the spread of the disease. In the one case of malaria notified in 1925, it was not necessary to take the action contemplated under the Regulations of 1919. PUERPERAL FEVER. Three cases of Puerperal fever were notified during the year. One of these was a patient already under treatment in a Maternity Hospital where she subsequently died. The other two cases were removed to M.A.B. Hospitals as soon as the disease was diagnosed. One of these cases recovered. OPHTHALMIA NEONATORUM. Eleven cases of ophthalmia neonatorum were notified during the year. Seven of these cases were treated in hospital, including two cases born in hospital. In tabular form is shown below, as required by the Ministry of Health, the result of each case:— TABLE No. 36. Ophthalmia Neonatorum. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. No. Notified. Treated. At Home. In Hospital. 11 4 7 10 1 – – Fifteen cases of the disease were notified in 1921, four in 1922, and five in each of the years 1923 and 1924. 55 Nursing. By arrangement with the Chelsea District Nursing Association, home nursing is provided for infants suffering from this disease. INFLUENZA. Influenza caused 30 deaths in 1925, as against 36 in 1924, 15 in 1923, 48 in 1922 and 23 in 1921. There was no serious epidemic prevalence of the disease in 1925 and no special action was called for in the Borough in regard to it. Nursing Provision. By arrangement with the Chelsea District Nursing Association all severe cases of influenza receive skilled nursing attention. During the first quarter of 1922, when the disease was epidemic, an additional nurse was engaged on the staff of the Nursing Association to deal with cases for the Borough Council, the average number of visits per case being 10. ENCEPHALITIS LETHARGICA. Four cases of encephalitis lethargica were notified during the year. As a result of subsequent observation and investigation, two of these cases were definitely regarded as not cases of encephalitis lethargica. One death occurred, the case having been notified in 1924. Of the four cases notified during 1925, three were treated in hospital—two in St. George's Hospital and one in a hospital of the Metropolitan Asylums Board. The remaining case was nursed at home. Twenty-six visits to cases of encephalitis lethargica were made by the Woman Sanitary Inspector during the year. The origin of each case was thoroughly investigated but it was impossible to trace any connection between any two cases. Encephalitis Lethargica is undoubtedly infectious but the infectivity is of very low nature. The sequelæ may be serious, as in most cases some permanent damage to the brain tissue occurs. The disease was made compulsorily notifiable from 1st January, 1919. In the following Table No. 37, is shown the numbers of cases notified in London and in Chelsea during the years 1921-1925. TABLE No. 37. Year. Cases Notified in Chelsea. Removed to Hospital. Deaths notified during year in Chelsea. Cases notified in London. Deaths notified in London. 1921 4 4 1 240 40 1922 – – – 71 50 1923 – – – 105 49 1924 14 11 4 614 140 1925 4 3 1* 302 117 * Case notified in 1924. 56 SMALLPOX. No cases of smallpox were notified in Chelsea during the year. One case was notified in 1924. The patient was removed to the M.A.B. Hospital and recovered. All precautions were taken to prevent the spread of the disease. The case appeared to be an isolated one and, although notified in Chelsea, was not a Chelsea resident. No other cases of the disease have been notified during the quinquennial period 1921-1925. Vaccination. No vaccinations have been performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917. I am indebted to Mr. A. W. Horsnell, Vaccination Officer for Chelsea, for particulars of primary vaccinations which have been performed in the Parish during the years 1921-1924. These are shown in Table No. 38. The complete figures for 1925 are not yet available. TABLE No. 38. Year. No. of Births in Chelsea. No. of Primary Vaccinations performed. 1921 1,057 671 1922 1,032 670 1923 971 720 1924 928 608 In 1924, 34 infants died (unvaccinated), 18 removed to other Districts, 35 removed to unknown addresses, 20 vaccinations were postponed and 151 Certificates of Exemption were issued. Small numbers of cases were insusceptible and outstanding. ARRANGEMENTS FOR DISINFECTION AND DISINFESTATION AND THE EXTENT OF THEIR USE. The Borough Council maintains a Disinfecting and Cleansing Station situated at 9a, Lots Road, Chelsea, adjoining the river. Disinfection. The disinfecting staff numbers two. A steam disinfector is provided. Disinfection in connection with the notifiable infectious diseases is carried out free of charge. Applications for special disinfection, not associated with the notifiable infectious diseases, are considered, and, if the work of the Department permits it, are carried out at the expense of the applicant. Eighteen such disinfections were carried out in 1925, the total charges amounting to £10 8s. 6d. 57 During the year the drainage system at the Disinfecting Station was overhauled and new sanitary fittings of approved type installed where necessary. The following Table No. 39 shows the work done by the disinfecting staff during the year. TABLE No. 39. Description. Number. Number of rooms or premises cleansed and disinfected 407 Number of Articles (bedding, etc.), disinfected 663 Number of articles (various) destroyed 299 Infectious Disease Shelter. Under the Public Health (London) Act, 1891, Section 60 (4), temporary house accommodation with necessary attendance is provided by the Borough Council free of charge at 9a, Lots Road, for families in which cases of dangerous infectious disease have appeared, and who have been compelled to leave their dwellings for the purposes of enabling such dwellings to be disinfected. During the year, six families were accommodated at the shelter. Disinfestation. A female cleansing attendant is employed by the Borough Council in connection with the work of the Cleansing Station. In 1922, the London County Council entered into an arrangement with the Borough Council for the use of the Station on specified days during the school year for the purpose of cleansing the heads of verminous school children. Under the L.C.C. Scheme, the work of cleansing is supervised by the school nurses, who also make all arrangements for the attendances of the children. The children cleansed are those attending schools situated west of a line running down the centre of Sydney Street and Oakley Street. The Borough Council receives payment from the London County Council at the rate of 2s. per child attendance. During 1925, the Station was opened for the entire day on 66 occasions. The following Table No. 40 shows the number of attendances in each quarter:— TABLE No. 40. Quarter. No. of days on which the Station was opened. Attendances. Verminous. Impetigo. March 12 215 – June 14 218 1 September 16 253 – December 24 278 1 66 964 2 58 The amount recoverable from the London County Council, as the School Authority, for the cleansing for the year 1925 is £96 10s. 0d. In addition to the above, 10 adults were cleansed at the Station during the year. These cases were verminous. There were no adult attendances as a consequence of infection by Scabies or Impetigo in 1925. (b) TUBERCULOSIS. This part of the report deals with the work of the Department under the Public Health (Tuberculosis) Regulations, 1912, and under the Dispensary scheme approved by the Ministry of Health and the London County Council who contribute 50 per cent. and 25 per cent. respectively of the nett expenditure of that scheme. Staff. The staff of the Dispensary is set out in Section II. Miss V. Kemble (Secretary of the Dispensary and Social Worker in connection with Tuberculosis) resigned her appointment during the year and Miss M. A. Hordern was appointed in her stead. Otherwise no change has taken place in the staff. Notifications. The total number of notifications received was 197, but 62 of these related to cases which had been previously notified, so that the total number of new notifications was 135. In 1924, the corresponding number was 137. The notifications received on forms C and D, i.e., notifications from institutions regarding admission and discharge, are not included in the foregoing figures. In Table No. 41 are shown, in the form required by the Ministry of Health, the detailed figures relating to new cases and mortality during 1925. Included in this Table are eight new cases which came to the knowledge of the Medical Officer of Health during the year, otherwise than by notification on Form A or Form B under the Public Health (Tuberculosis) Regulations. TABLE No. 41. Tuberculosis. New Cases and Mortality during 1925. Age Periods. New Cases. Deaths. Pulmonary. Nonpulmonary. Pulmonary. Nonpulmonary. M. F. M. F. M. F. M. F. 0 – – – – – – 2 1 1 – – 1 1 – – – 1 5 – – 2 1 – – – – 10 1 1 2 3 – – – 1 15 1 – 4 2 2 1 1 – 20 1 5 2 1 1 2 – 1 25 6 8 – 5 12 5 – – 35 14 12 – 2 7 4 – – 45 20 10 – – 9 2 1 – 55 21 6 – – 4 2 – – 65 and upwards 7 4 – – 1 1 1 – Totals 71 46 11 15 36 17 5 4 59 The death rate in 1925 from all forms of Tuberculosis in Chelsea was 0.9 per 1,000. Of the total number of deaths (62) from ail forms of Tuberculosis, eight died non-notified or prior to notification. The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was therefore as one is to eight. The corresponding ratio for 1924 was 1:4. Making allowance for difficult and doubtful cases in which a diagnosis cannot be established until after death, the notification of tuberculosis is carried out fairly efficiently in the Borough. During the year, however, a communication was addressed to every medical practitioner in the area with a view to securing still more systematic and prompt notification, not only of tuberculosis but of the notifiable infectious diseases generally. In Chelsea, the total number of new notifications received each year since 1921, has been very similar. Thus, 128 cases were notified in 1921, 135 in 1922, 131 in 1923, 137 in 1924, and 135 in 1925. The number of deaths certified as being due to Pulmonary Tuberculosis during each of these years were 58, 51, 52, 77 and 62, respectively. Cases of Tuberculosis in the Borough. The Public Health (Tuberculosis) Regulations, 1924, provide that the Medical Officer of Health shall furnish to the County Medical Officer, as soon as practicable after the end of each quarter, a statement showing:— (a) The number of cases of Tuberculosis on the register at the mencement of the quarter; (b) The number of cases notified under the Regulations, 1912, for the first time during the quarter; (c) The number of cases removed from the register during the quarter, giving the name and address of each such case and the reason for such removal; and (d) The number of cases remaining on the register at the end of the quarter. The returns made in accordance with these Regulations show that the number of cases of Tuberculosis in the Borough on 31st December last was as follows:— Males. Females. Total. Pulmonary 165 115 280 N on-pulmonary 19 33 52 184 148 332 Public Health (Prevention of Tuberculosis) Regulations, 1925. The Regulations provide, inter alia, that no person suffering from respiratory tuberculosis who is in an infectious condition shall be engaged in any form of dairy work involving the milking of cows, the treatment of milk, or the handling of milk containers. Investigations in connection with these Regulations have been made in the Borough but no case calling for action has thus far been discovered. 60 TABLE No. 42. Chelsea Tuberculosis Dispensary, Brompton Hospital. Work done during 1925. Number of Under observation at the Dispensary on Jan. 1st pending diagnosis. Examined for the first time during the year. Total. Found to be Under observation at the Dispensary on Dec. 31st pending diagnosis. Ceased attendance before completion of diagnosis. Suffering from Tuberculosis. Not suffering from Tuberculosis. Pulmonary. NonPulmonary (a) All persons (including "Contacts.") Adults M. 13 83 96 33 1 50 6 6 F. 24 125 149 25 – 107 7 10 Children under 15. M. 22 71 93 – – 89 – 4 F. 24 78 102 – – 93 4 5 Total 83 357 440 58 1 339 17 25 (b) "Contacts" (included in (a) ) Adults. M. – 11 11 1 – 10 – – F. 1 40 41 2 – 38 – 1 Children under 15. M. 1 17 18 – – 18 – – F. 2 22 24 – – 24 – – (c) Insured persons (included in (a) ). { m. 10 64 74 23 1 42 4 4 F. 7 52 59 14 – 42 2 1 1. Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st December* 424 7. Number of persons referred to affiliated hospital for consultation – 8. Number of consultations with medical practitioners at the homes of patients:— Insured – 2. Total number of attendances of patients at the Dispensary during the year:— Insured 1,182 Uninsured – Uninsured 1,820 9. Number of other visits paid by Tuberculosis Officers to the homes of patients... 54 3. Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 148 10. Number of visits paid by Nurses to the homes of patients for dispensary purposes 2,818 4. Number of cases in which the period of observation at the Dispensary exceeded two months 27 11. Number of specimens of sputum examined in connection with the work of the Dispensary 520 5. Number of insured patients under domiciliary treatment on December 3 lst † 19 Wassermann Tests 16 6. Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment durine the year – Complement Fixation Tests 10 X-ray examinations 67 * Insured persons under domiciliary treatment by Insurance practitioners are excluded, even though they may have attended the dispensary at intervals for examination or consultation. Such cases are included under Head 5. † All insured persons in the dispensary area who have actually received domiciliary treatment from Insurance practitioners are included, irrespective of the date upon which they were placed under domiciliary treatment and of any attendance at the dispensary. w. j. fenton, Tuberculosis Officer. 61 Chelsea Tuberculosis Dispensary. This Dispensary, located at Brompton Hospital, provides highly efficient treatment for all cases resident in the Borough. An annual grant is paid to the Hospital by the Borough Council to provide for all necessary medical, nursing and other services. Table No. 42 shows the work done by the Dispensary during 1925, while Table No. 43 summarises, for the years 1921-1925, the number of persons examined at the Dispensary for the first time, the percentage of these cases in which definite tuberculosis was found, and the total attendances at the Dispensary. TABLE No. 43. Work done at the Dispensary, 1921-1925. Year. Number of Persons examined for the first time. Definite Tuberculosis. Total attendances at Dispensary. 1921 572 10 per cent. 3,210 1922 507 11 3,268 1923 442 17 2,932 1924 429 16 3,416 1925 357 13 3,002 In addition to the visits to homes of patients made by the Dispensary staff and recorded in Table No. 42, 60 new cases of Pulmonary and Non-Pulmonary Tuberculosis were visited by the Municipal Tuberculosis Visitor in the course of the year. The total number of visits paid by her in respect of all cases of Tuberculosis and suspected Tuberculosis was 492. This official also paid 892 visits in connection with the Public Health (Tuberculosis) Regulations, 1924. Institutional Treatment. The London County Council is mainly responsible for the institutional treatment of Tuberculosis in London. No institution is maintained by the County Council in the Borough. The Metropolitan Asylums Board maintains St. George's Home, in Milmans Street, Chelsea, as a hospital for advanced pulmonary disease in women. There is accommodation for 50 cases, which are drawn from all parts of the metropolis. The majority of advanced cases of pulmonary tuberculosis in Chelsea are isolated and treated in St. Luke's Hospital under the Board of Guardians, while a smaller proportion receive treatment in other public institutions. Of the pulmonary cases which terminated fatally in 1925, 40 per cent. died in St. Luke's Hospital and 30 per cent. in other public institutions, that is to say 70 per cent. died away from their homes, the corresponding figure for 1924 being 66, and for 1923, 71 per cent. Co-operation with Hospitals and Invalid Children's Aid Association. Existing arrangements with general and special hospitals in the neighbourhood continue to give satisfaction. Cases under treatment at 62 St. George's Hospital and St. Luke's Hospital are visited by the Municipal Tuberculosis Visitor. Arrangements are made with Brompton Hospital for the X-ray examination of difficult cases and for the provision of artificial pneumo-thorax refills. Many patients, both adults and children, who attend the Dispensary for examination, either as contacts or on their own initiative, are found to be suffering from conditions, other than Tuberculosis, which require treatment. These cases are advised as to obtaining such treatment, either from private practitioners or at general hospitals. Many children are found to be suffering from anaemia, malnutrition and similar diseases and are referred to the Chelsea branch of the Invalid Children's Aid Association with a view to provision of convalescent home treatment. Co-operation with the School Medical Service. The relationship with the School Medical Service continues to be satisfactory. The School Medical Authorities frequently afford valuable help in deciding what supervision is desirable in connection with children. Many children are referred direct to the School Clinic for the treatment of minor ailments and dental caries. Co-operation with Medical Practitioners. During the year the Tuberculosis Officer examined 54 new cases at the homes of the patients, and 143 cases were referred to him at the Dispensary by medical practitioners in the Borough. Insured persons under the care of local medical practitioners are visited by the Municipal Tuberculosis Visitor. Home Contacts. The number of home contacts of tuberculous patients examined at the Dispensary during the year was 94, a decrease of 69 compared with 1924. Special arrangements are made for following up patients in cases where the diagnosis is doubtful. Such cases are again examined at intervals and, when necessary, X-ray or other special investigation is made. The Social Worker at the Dispensary maintains regular observation in connection with these patients. Artificial Pneumo-thorax Treatment. On the recommendation of the Tuberculosis Officer, three patients were supplied with 31 refills in connection with artificial pneumo-thorax treatment. Payments amounting to £16 5s. 6d. were made by the Borough Council for these refills. Home Nursing. The Dispensary organization includes home nursing, which is much appreciated by such patients as are confined to bed. During 1925, the number of visits paid by Nurses to the homes of patients was 2,818, an increase of 26 over the number for the previous year. Seventeen cases of Tuberculosis were certified by the Tuberculosis Officer during the year to require extra nourishment as part of their treatment. These cases were supplied with foods such as milk, eggs, butter and Bovril. The total cost of extra nourishment (£34 6s. Od.) was borne by the Borough Council. The Council lent bedsteads and bedding to two cases during the year. 63 Non-pulmonary Cases. All cases in which special treatment is indicated are assisted in obtaining admission to hospital. Others are sent to country or seaside convalescent homes through the agency of the Invalid Children's Aid Association. Orthopaedic Treatment. In appropriate cases surgical boots and appliances, splints, crutches, spinal carriages and wheeled chairs are supplied through the Invalid Children's Aid Association. Bacteriological Examinations. During the year, 520 specimens of sputum were examined in connection with the work of the Dispensary. In addition, 78 specimens were sent by medical practitioners to the Lister Institute for examination. The corresponding number in 1924 was 59. Care Work. The Chelsea Tuberculosis Care Committee constituted on the basis advised by the Ministry of Health in 1922 took over in that year the work of the former Interim Care Committee which had been formed by the Borough Council in 1917. The Committee now includes the following representation and membership:— Chelsea Borough Council Councillor Lady Phipps. London County Council Dr. A. W. Sikes (Divisional Medical Officer). Miss Paddon (District Organiser of School Care Committees). Miss Barff (After-Care Committee). Chelsea Invalid Children's Aid Mrs. Rathbone and Association Miss Barcroft (Vice-Chairman). Chelsea Board of Guardians Dr. E. T. Holland. Chelsea Charity Organisation Miss Larken. Society Chelsea District Nursing Miss Page. Association Chelsea Health Society Mrs. Melville Miller. Brompton Hospital Miss Marx. Local Panel Committee Dr. A. M. Gibson, and Dr. E. F. Thomas. London Insurance Committee W. E. Poole, Esq. Local War Pensions Committee, Miss Forbes. and United Services Fund St. George's Hospital Miss Seddon. British Red Cross Society Miss Trench and Colonel Irving. Fx-officio Members Dr. Leslie McCarthy (Chairman). Dr. W. J. Fenton (Tuberculosis Officer). Miss Tettenborn (Sanitary Inspector and Tuberculosis Visitor). Hon. Secretary Miss Hordern, Chelsea Tuberculosis Dispensary, Brompton Hospital, S.W. 64 The duties of the Committee include enquiries into the economic position of the family of a patient suffering from tuberculosis as soon as the patient comes within the purview of the Tuberculosis Scheme. The Committee endeavours to ensure that as far as possible there shall be no difficulties to prevent the patient from carrying out the recommendations made by the Dispensary. Such advice and assistance is given as the circumstances of the case dictate, e.g., assistance in the provision, where necessary, of clothing required by the institution to which the patient is sent; arrangements for the welfare of the family during absence of the father or mother; the securing of auxiliaries for domiciliary treatment which cannot be provided without charitable assistance, provision of extra nourishment and advising the Borough Council as to the extent to which assistance in this respect should be given; the rectification of unsatisfactory home conditions; recommendations to the London County Council as to the amount of payment, if any, by the patient towards the cost of institutional treatment and the collection of agreed amounts. The Committee also endeavours on the cessation of treatment to obtain suitable employment for the patient. The Care Committee meetings are held monthly at the Town Hall. In addition, a Sub-Committee meets every alternate fortnight to deal with new cases and other urgent business. During 1925, one hundred and ninety cases were considered. These were disposed of as under:— Sent to Sanatorium 55 Sent to Hospitals for Treatment 15 Sent to Dispensary for Treatment 59 Referred to I.C.A.A. 45 Referred to Charity Organisation Society 10 Referred to Guardians 6 The issue of extra nourishment was also approved in appropriate cases, at a total cost of £34 6s. 0d. 65 SECTION VII- MATERNITY AND CHILD WELFARE. The statistics regarding births and deaths of infants will be found on pages 8 and 16 of this report. The maternal death rate is dealt with on page 72. General Arrangements. The Borough Council's scheme for Maternity and Child Welfare includes the following activities: — (a) The issue of pamphlets giving advice on various matters concerning the welfare of mothers and infants. (b) The co-ordination of the work of the voluntary Maternity and Child Welfare agencies in the Borough. (c) The home visitation of expectant and nursing mothers and infants by a staff of Health Visitors who work (a) from the Town Hall, and (b) from the Centres of the Chelsea Health Society. (d) The subsidisation of the Chelsea Health Society's Maternity and Child Welfare Centres and Clinics for ailing mothers, infants and young children. (e) The subsidisation of the local branch of the Invalid Children's Aid Association. (J) The subsidisation of the voluntary Day Nursery in the Borough. (g) The subsidisation of the Chelsea District Nursing Association for the home nursing of expectant and nursing mothers and young children. (h) The provision of Home Helps. (i) The provision of midwifery attendance, free or at reduced rates, for necessitous Chelsea women. (j) The provision of Convalescent Home accommodation for nursing mothers and infants. (k) The supply of milk, free or at reduced rates, for necessitous nursing and expectant mothers, infants and young children. (I) The administration of the Widows', Orphans' and Old Age Contributory Pensions Act, 1925, in respect of deserted, abandoned or neglected children. HEALTH VISITORS. Duties. The duties allotted to the Health Visitors are as follows: 1. To visit the homes of all newly-born children amongst the working classes within 21 days after birth, and subsequently as circumstances dictate. 2. To visit the homes and make investigations in regard to stillbirths and infant deaths. 3. To visit and give advice to parents in cases of ophthalmia, zymotic enteritis and other diseases causing deaths amongst infants. 4. To visit and report upon all cases of puerperal fever. 5. To investigate, when required, homes in which overcrowding is alleged to exist. 66 6. To investigate, when required, applications for the supply of milk free or below cost price. 7. To co-ordinate their efforts with those of the voluntary workers attached to the Maternity and Child Welfare organizations in the Borough. 8. To investigate cases under the Widows', Orphans' and Old Age Contributory Pensions Act where the children are under school age. Work of the Health Visitors. The following tabular statement (Table No. 44) gives an outline of the work of the Health Visitors and of the Chelsea Health Society and School for Mothers during the years 1921-1925. The visits enumerated are those paid by the trained officer of the Borough Council (one whole-time Health Visitor) and the trained officers 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. TABLE No. 44. Summary of Reports of Health Visitors. 1921. 1922. 1923. 1924. 1925. Number of homes visited (first visits), Infants 714 702 636 621 627 Number of revisits, Infants 1,517 1,459 1,828 1,681 2,227 Number of Infants' attendances at Infant Consultations 3,279 3,004 3,115 3,391 3,878 Number of visits to Children of one year to school age 117 91 304 299 330 Number of revisits to Children of one year to school age 2,459 2,536 2,664 2,662 3,026 Number of children of one year to school age, attendances at Medical Inspections 1,406 1,535 2,634 2,067 2,102 Number of ante-natal visits to Expectant Mothers:— Primi-para 106 78 Multi-para 222 240 Revisits 368 484 Total 684 664 555 696 802 Number of ante-natal case-attendances at ante-natal clinic 363 381 306 300 395 Number of visits to Diarrhoea cases amongst children 62 27 – 6 2 Number of cases of Diarrhoea found 35 * 27 – 5 – Number of visits to cases of Ophthalmia Neonatorum ... 24 6 – 10 11 General additional visits in connection with the work 1,188 973 772 977 992 MATERNITY NURSES AND MIDWIVES. The arrangements made by the Borough Council for the provision of midwifery attendance have already been outlined in Section II. of this report. In the following Table No. 45 is shown, for the years 1921-1925, the number of applications for midwifery attendance, the number provided 67 with such attendance, the amount of assessment on cases attended and the nett expenditure by the Council for this service:— TABLE No. 45. Year. (1) No. of applications for services of (2) Total number provided with a Amount of Assessment on cases attended. (3) Nett Cost to Council. Maternity Nurse. Midwife. Maternity Nurse. Midwife. Maternity Nurse. Midwife. Maternity Nurse. Midwife. 1921 21 62 22 57 £ s. d. £ s. d. £ s. d. £ s d. 7 11 0 16 11 0 20 14 0 42 4 0 1922 18 49 15 45 8 10 6 27 1 6 10 4 6 29 8 6 1923 13 43 11 34 6 18 4 18 13 0 7 16 8 31 12 0 1924 10 46 10 37 6 1 6 21 16 0 8 8 6 32 14 0 1925 10 51 10 38 5 15 6 25 18 6 9 14 6 32 6 6 Note.—(1) Includes applications refused and cases subsequently withdrawn. (2) Includes cases assessed during former year. (3) Half the nett cost to Council is recovered as a grant from the Ministry of Health. HOME HELP. Prior to July, 1921, a whole-time Home Help was employed by the Borough Council for service in the homes of necessitous women during confinement. Since then a panel scheme has been in operation under which selected women are placed upon a roster and their services utilised in rotation. This system is found to be very successful in its working. The following Table No. 46 shows, for the years 1921-1925, the number of applications received for Home Help service, the number of cases attended, the amount of assessment on cases attended and the nett expenditure by the Council for this service:— TABLE No. 46. Year. No. of applications for services of Home Help, including extension over the usual period of 2 weeks. Total number of cases attended by the Home Helps. Amount of Assessment on cases attended. *Nett Cost to Council. 1921 39 23 £ s. d. £ s. d. 28 0 0 84 15 0 1922 1923 36 9 27 8 22 9 12 2 0 6 62 20 18 17 0 6 1924 23 8 plus 4 extensions 8 15 0 27 5 0 1925 40 19 plus 13 extensions 28 12 0 62 8 0 * Grant by the Ministry of Health. 68 HOME NURSING. The arrangement whereby the trained nurses of the Chelsea District Nursing Association undertake, when requested by the Medical Officer of Health, the home nursing of measles, german measles, whooping cough, ophthalmia, enteritis and any other disease for which nursing assistance is required, continues to give satisfaction. Medical practitioners in the Borough greatly appreciate the assistance they thus receive. No occasion has arisen where a request for nursing assistance has not been met promptly, even in times of pressure. The following Table No. 47 shows, for the years 1921-1925, the number of visits paid by the District Nurses to the homes of expectant and nursing mothers and children under five years of age, while Table No. 48 shows the conditions which necessitated attendance during the year 1925:— TABLE No. 47. Year. Visits. Cases. 1921 1,192 84 1922 1,865 157 1923 1,567 132 1924 2,226 166 1925 1,673 169 TABLE No. 48. Diseases Nursed by District Nurses during 1925. Visits. Cases. Bronchitis 154 27 Burns 11 1 Circumcision 33 3 *Diarrhœa 73 10 Eye trouble 77 3 Ear trouble 60 4 Influenza and Pneumonia (under 5) 220 15 Influenza and Pneumonia (above 5) 46 5 Impetigo 45 2 Meningitis and Peritonitis 19 1 *Measles – – *Ophthalmia Neonatorum 207 12 *Poliomyelitis – – *Puerperal State, including Breasts, Miscarriage, and Rise of Temperature 228 13 Rickets – – Septic sores 112 10 Tonsils and Adenoids 142 34 *Whooping Cough 13 1 Worms 122 15 Miscellaneous 111 13 1,673 169 * Grant received from the Ministry of Health. 69 CLINICS AND TREATMENT CENTRES. The Maternity and Child Welfare work carried on in the Borough by the Chelsea Health Society and School for Mothers has already been outlined in Section II. of this report and an account of the Society's activities during the years 1921-1925 has been included in Table No. 44. The Society is controlled by a Voluntary Committee and is supported by (1) voluntary contributions, (2) financial grants from the Ministry of Health and from the Borough Council. During the year 1925 five infant clinics were held weekly and one ante-natal clinic weekly. One infant clinic was held weekly at 484, King's Road, the remaining four infant clinics and the ante-natal clinic being held at 1, Manor Street. The medical and other staff are appointed by the Voluntary Committee. All the medical officers are ladies. ORMOND MATERNITY HOME. The Ormond Maternity Home, situated at 29, Blantyre Street, Chelsea, is the only institution of its kind in the Borough. It provides accommodation for six cases, a seventh bed being available in emergency. The Home is controlled by a Voluntary Committee and is supported by (1) voluntary subscriptions, (2) financial grant from the Board of Education, (3) payments by patients. The Institution does excellent work in the neighbourhood, providing an intern and extern midwifery service, and, in addition, is a recognised school for the training of midwives. The Medical Officer of Health is a member of the Advisory Committee of the Home. There is an ever-increasing demand for the Maternity beds, the number of in-patients dealt with having risen from 33 in 1924 to 44 in 1925. I am indebted to Miss Child, the Superintendent of the Home, for the following information regarding the work done during 1925 :—- Total cases attended during the year 267 Cases admitted and attended in the Home 44 Cases attended in the district 223 Maternal Deaths None CONVALESCENT HOME TREATMENT FOR NURSING MOTHERS AND INFANTS. The amount of convalescent home treatment provided for nursing mothers and infants, during the years 1921-1925, is shown in Table No. 49. During 1925, twelve of the cases were sent to Homes free of charge. The remainder contributed according to their resources. Of applications made for convalescent treatment, it is found that nearly 40 per cent. are subsequently withdrawn, owing to domestic circumstances rendering it impossible for the mother to leave her home. The period of convalescence granted is two weeks. 70 TABLE No. 49. Year. No. of Applications. Nursing Mothers and Infants sent away under Council Scheme. Contributions by Mothers. *Nett Cost to Borough. 1921 38 25 £ s. d. £ s. d. 4 6 0 38 9 8 1922 27 14 5 7 6 21 5 3 1923 12 7 1 17 0 11 1 0 1924 35 20 9 6 6 42 8 6 1925 45 27 11 18 6 44 7 0 * Grant from the Ministry of Health. CHELSEA BRANCH OF THE INVALID CHILDREN'S AID ASSOCIATION. During the year 1925, the branch had 93 children under school age referred to them for assistance. These children were suffering from marasmus and malnutrition, congenital deformities, rickets, and anæmia and debility following acute illness such as bronchitis, pneumonia, measles, diphtheria and scarlet fever. Thirty-seven children were sent out of London for convalescence, for periods varying from six weeks to six months. Eight children had special treatment arranged for them. Fifteen infants were given medical aids ordered by a doctor, such as vitoleum, cream, phosphates, malt and cod liver oil, etc., which their parents, owing to unemployment, were unable to provide. Eight children requiring surgical appliances, such as surgical boots, calliper splints, umbilical belts, etc., were provided with what was necessary. Fifteen children were given warm clothing, boots, etc., and fares for children and escorts were paid whenever necessary. Twenty-four children were specially visited and friendly supervision and advice given. Perambulators and push-carts were loaned to enable children to be taken regularly to hospital. The amount expended by the Association on these cases during the year 1925 was £273 2s. 10d., towards which sum parents contributed £59 18s. 10d., leaving a balance of £203 4s. Od. to be raised by the Chelsea Branch. 71 CHELSEA DAY NURSERY. The attendances at the Nursery during the years 1921-1925, were as shewn below:— TABLE No. 50. 1921. 1922. 1923. 1924. 1925. Total number of children attending during the year 4,649 5,355 5,679 5,441 4,366 Average daily attendance (5 days a week) 18 23 23 22 20 Total number of individual children who attended 78 87 89 99 79 It will be noted that the total attendances during 1925 have decreased. This is largely attributable to the fact that the Nursery was closed for nine weeks early in the year owing to an outbreak of diphtheria. In March, the staff nurse was notified as suffering from Diphtheria, removed to the M.A.B. Hospital, where she subsequently recovered. Measures were taken to prevent the spread of the disease, 32 swab throats being taken by the Medical Officer. One proved positive, a child of 18 months. This case was also removed to hospital and recovered. In addition, the mother of this patient contracted the disease. She, unfortunately, died in hospital. The Nursery was closed for a period of nine weeks during which time it was adequately disinfected, the drainage thoroughly overhauled and made good. Apart from these cases of Diphtheria, the health of the Nursery has been remarkably good. Dr. Alice Benham is the Medical Officer to the Nursery and makes a fortnightly inspection of the children. PUERPERAL FEVER. Three cases of puerperal fever were notified in 1925. One of these was a patient who had already been admitted to a Lying-in-Hospital, where she subsequently died. The other two cases were removed to hospital from their homes as soon as the disease was diagnosed. One of these recovered. PREGNANCY AND CHILDBIRTH. Six deaths from other complications of pregnancy and childbirth occurred in 1925. Of these, two resulted from abortion consequent upon illegally performed operations. Of the remaining four deaths, two were due to extra-uterine gestation and two to heart disease. 72 MATERNAL MORTALITY. The following table shows the Maternal mortality in Chelsea during the years 1921-1925. TABLE No. 51. Year. Death-rate per 1,000 Births. Total Death-rate. Puerperal Fever. Other complications of Pregnancy and Child-birth. 1921 0.94 3.78 4.72 1922 1.93 9.69 11.62 1923 1.02 2.05 3.07 1924 1.07 3.23 4.30 1925 2.13 6.42 8.54 A review of the causes of maternal deaths during the years 1921-1925, has convinced me that in one-third of the cases death could have been avoided had the woman at an early stage of pregnancy attended the Ante-natal Clinic regularly for examination and supervision, also that in a further considerable proportion—probably one-third—admission, or admission at an earlier stage, to a maternity bed in a hospital might have saved the mother's life. During the year further efforts were made to insure that in Chelsea still better results will accrue from the measures already in operation to diminish the risk involved in childbirth. The valuable report by Dame Janet Campbell issued by the Ministry of Health in 1924, has clearly shown the necessity for such increased effort. Neglect in the past of provision for the early diagnosis of conditions inimical to the health of mothers has resulted not only in a high mortality rate but also in a considerable, and largely avoidable amount of suffering and invalidity amongst the survivors. Puerperal fever, in particular, is a disease requiring early, active and efficient treatment. The type of treatment and the highly-skilled nursing involved are quite out of reach of the poorer sections of the community in their own homes. These invariably consist of small flats and tenements entirely lacking in facilities for confinement. Wherever possible in such cases arrangements are made for the woman to be confined in a maternity hospital or home, and there can be no doubt as to the desirability of women entering an institution when the home conditions are not satisfactory. Many object to making use of the accommodation and efficient treatment provided by the Board of Guardians, and with a view to providing for the safe confinement of such cases, most of the Metropolitan Borough Councils have made special arrangements. The Ministry of Health has also provided for the 73 admission of cases to certain of the M.A.B. Hospitals. Many patients, however, are unwilling to enter an institution situated at any considerable distance from their homes. During the year the Public Health Committee recommended that an annual grant be made by the Borough Council to the Ormond Maternity Home in Blantyre Street, whereby two beds would be available for necessitous cases in the Borough, wherever the home circumstances rendered safe confinement improbable or where for any medical reason confinement in an efficient maternity home was desirable. The Borough Council did not accept this recommendation, deeming that existing facilities for institutional treatment were adequate. INFANT MORTALITY. Infant mortality is reviewed in Section I of this report and the incidence of ophthalmia neonatorum is set out in Section VI. Appended to this report is a diagram showing the decline in infant mortality in the Borough since 1901. ANTE-NATAL WORK. The work of ante-natal consultations is growing as it becomes better known amongst mothers in the Borough. Sound advice, based on the most recent scientific investigation, is provided by the medical officer of the Ante-natal Clinic. Every effort is being made to ensure that mothers will take full advantage of the excellent arrangements made by the Chelsea Health Society so that as far as possible all risk of disease and accident incidental to child-birth may be removed. SUPPLY OF MILK AT LESS THAN COST PRICE. Provision is made under the Maternity and Child Welfare Act, 1918, whereby milk is provided in necessitous cases free or at less than cost price. The Milk and Welfare Sub-Committee meets weekly at the Town Hall to consider applications. Free milk is supplied when the total income of the family, after deducting rent and insurance, does not exceed 5s. per head per week. Milk is supplied to other cases on the following basis:— Nett available income 5s. to 6s. at the rate of 1d. per pint. .» 6s. to 7s. „ ,, 1½d. „ ,, ,, 7s. to 8s. ,, ,, 2d. ,, .. ,, 8s. to 9s. ,, ,, 2½d. ,, The following table shows, for the years 1921-1925, the extent of this service:— 74 TABLE No. 52. Year. Milk Orders issued and taken up. ‡ Approx. Cost. March quarter. June quarter. Sept. quarter. Dec. quarter. * Total. 1921 698 692 589 551 2,530 £ 990 1922 448 464 439 529 1,880 429 1923 607 589 463 551 2,210 421 1924 540 443 379 417 1,779 335 1925 365 425 339 476 1,605 326 * These totals do not include orders subsequently cancelled or withdrawn, which average 150 or more during each year. ‡ The Borough Council receives a grant from the Ministry of Health of one-half the cost incurred. It will be observed that the annual expenditure on milk has considerably decreased since 1921, although the number of orders issued has not diminished proportionately. This decreased expenditure is incidental to the operation of the following causes:—(a) In March, 1921, amended Regulations issued by the Ministry of Health in connection with the supply of milk by local authorities came into force. These regulations have limited not only the classes of case eligible for a supply of milk, but also the quantity of milk allowed to be supplied. (b) Various forms of dried milk are issued, on the recommendation of the Medical Officers of the Clinics. In a large number of cases such milk is tolerated better than cows' milk. It is also less liable to contamination. The use of dried milk, especially during the winter months, has effected further diminution in the total expenditure. (c) The retail cost price of milk has declined since 1920. The existing arrangements for the supply of milk in the Borough are working satisfactorily. In conjunction with the Board of Guardians, the Council's Milk Sub-Committee has formulated a scheme whereby milk is supplied to appropriate cases even when such cases are already in receipt of Poor Law relief. This scheme obviates the undesirable practice of an individual being granted a somewhat similar form of relief by two different authorities. The supply of milk under the Borough Council Scheme has undoubtedly effected very marked improvement in the general health of both mothers and children. WIDOWS', ORPHANS' AND OLD AGE CONTRIBUTORY PENSIONS ACT, 1925. The powers and duties under this Act, in respect of deserted, abandoned or neglected children in the Borough, have been taken over by the Council, and a provisional scheme for the administration of the Act has been arranged. The Health Visitors investigate and exercise supervision over children under school age, while the Woman Sanitary Inspector carries out these duties in the case of older children, except where a Health Visitor is already in attendance on the family concerned. No case for enquiry under the Act has yet occurred in the Borough. Infant Mortality Rates from 1901 to 1925. 75 Metropolitan Borough of Chelsea. Annual Report OF THE PUBLIC ANALYST For the Year ended 31st December, 1925. (7th February, 1925, to 31st December, 1925.) by B. HENRY GERRANS, F.I.C., Public Analyst. 76 Town Hall, Chelsea, S.W. 3. 9th March, 1920. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Chelsea. Mr. Mayor, Ladies and Gentlemen, 1. During the year ended on the 31st December, 1925, three hundred and ninety-four samples of Food were submitted to me for analysis by the Inspectors appointed under the Acts. Nine of these samples were submitted as " Informal samples." 2. The nature of the samples submitted and the general procedure in taking samples are not within the control of the Public Analyst. 3. Table I. shows the number and the names of the Genuine, Adulterated, and Inferior samples, both "Formal" and "Informal," reported upon during the year. The term "Genuine Composition" is to be understood to mean that the composition of the samples so described was in accordance with the scientific definitions which can at present be given to the various articles dealt with, and that adulteration could not be certified in regard to them. The term "Inferior" means that the samples so described were of low quality or of doubtful character and that actual adulteration could not be certified in regard to them. TABLE I. Name of Sample. Genuine Composition or Not Adulterated. Adulterated. Inferior. Total. " Formal." " Informal." " Formal." " Informal." " Formal." "Informal." Milk 89 5 6 — 100 Butter 45 2 — — 10 — 57 Margarine 30 1 — — 3 — 34 Cocoa 32 — — — — — . 32 Coffee 29 — — — — —- 29 Pepper 25 — — — — — 25 Lard 21 — — — — — 21 Cornflour 17 — — — — — 17 Tea 17 — — — — — 17 Baking Powder 14 — — — — — 14 Flour 7 — — — 2 — 9 Rice 6 — 1 — — — 7 Cream 6 — — — — — 6 Mustard Mixture 5 — — — — — 5 Cheese 3 — — — — — 3 Mustard 3 — — — — — 3 Sponge Cakes 3 — — — — — 3 Whisky 2 — — — — — 2 Sausages 1 1 — — — — 2 Ground Almonds 2 — — — 2 Ginger 1 — — — — — 1 Coffee and Chicory 1 1 Beef Dripping 1 — — — - — — 1 Cream Cheese — — 1 — — — 1 Shredded Beef Suet — — 1 — — — 1 Custard Powder — — — — 1 — 1 Totals 360 9 9 — 16 — 394 77 4. The percentages given by the data in Table I. are as follows:— Genuine Composition 93.65 per cent. Adulterated 2.29 Inferior 4.06 MILK. 5. The particulars relating to the six samples of Milk reported as adulterated are given in Table II.:— TABLE II. No. Percentage of Extraneous Water. Percentage of required Fat deficient. " Preservatives." Remarks. 1 — 10.0 — — 2 — 8.0 — — 3 6-9 — — — 4 4-0 — — — 5 4-0 — — — 6 3-0 — — — 6. The remaining 94 samples submitted, of which five were "Informal samples," were found to have the normal composition of unadulterated milks, or of milks which must be regarded as unadulterated, and to be in accordance with the requirements of the "Sale of Milk Regulations, 1901," 23 "Formal" and two "Informal" being of "Good" quality, 55 "Formal" and two "Informal" of "Fair" quality, and 11 "Formal" and 1 " Informal " of " Poor " quality. 7. The application of the terms "Good," "Fair," and "Poor" to samples of Milk is based on the following analytical data:— Non-fatty solids 8.5 per cent. or over:— With from 3.0 to 3.35 per cent. of fat, Poor Qualitv. 3.35 to 3.8 Fair „ „ 3.8 and over „ „ Good „ THE MILK AND DAIRIES (CONSOLIDATION) ACT, 1915. [5 & 6 Geo. 5, Ch. 66.] 8. This Act, dated the 29th July, 1915, came fully into force on the 1st September 1925, by the provisions of the Commencement of Operation Order, 1925, in respect of the said Act, dated 28th July, 1925. 9. The Sections thereof which more especially apply to the administration of the Sale of Food and Drugs Acts are Nos. 8 and 9. For the 78 sake of convenience the main provisions of these Sections are inserted in this Report, as under:— 10. Section 8 (s.s. 3).—Any Officer authorised for the purpose of taking samples under the Sale of Food and Drugs Acts may give a notice in writing requiring the Authorised Officer of a Local Authority outside his own area to take samples of Milk at a Dairy supplying Milk to the area of the former Authority, within 60 hours of the reception of such notice. This sample is supposed to be one of a corresponding milking to that which was taken by the Authority giving the notice, and is intended for the purposes of comparison. 11. Section 9.—In conjunction with the Third Schedule of the Act, provides that where a Warranty Defence is pleaded by a purveyor of Milk, a sample from a corresponding milking must be taken in the course of transit or delivery to the purveyor, and if the owner of the cows so requests, a further sample must be taken at the dairy at which the cows are kept. The Warranty Defence will not, however, be available when the sample in respect of which proceedings are taken is a mixture of Milk obtained from more than one seller or consignor. Power is also given to take proceedings against the seller or consignor, instead of, or in addition to, taking proceedings against the actual vendor. BUTTER. 12. Actual adulteration could not be certified with respect to the 10 samples of Butter reported as inferior. (See paragraph 3.) 13. The remaining 45 "Formal" and 2 "Informal" samples submitted were found to have the normal composition of unadulterated Butters, or of Butter which must at present be regarded as unadulterated, and they were therefore certified to be genuine. 14. Thirty-nine of the "Formal" and one of the "Informal" samples contained Boric Acid, the amount being under 0-5 per cent, in each case. Samples of Butter containing Boric Acid preparations and not adulterated in other respects, are at present reported as "genuine" or "inferior" as the case may require, and not as "adulterated." (Recommendation D, Para. 136—Report of the Departmental Committee on the Preservation and Colouring of Food, 1899.) MARGARINE. 15. Actual adulteration could not be certified with respect to the three samples (two containing Boric acid) of Margarine reported as inferior. (See paragraph 3.) 16. Twenty-seven of the remaining 31 samples (one "Informal" sample) of Margarine, reported as genuine, were found to contain Boric Acid, the amount in each case being under 0.5 per cent. In no case did the amount of Butter Fat in these samples exceed 10 per cent. (Section 8 of the Sale of Food and Drugs Act, 1899.) 79 FLOUR. 17. Actual adulteration could not be certified with respect to the two samples of Flour reported as inferior. (See paragraph 3.) These samples contained slight traces of Nitrites, the amount in each case being under 1 part per million, which is the limit suggested for Nitrites in Flour in the Report of the Local Government Board, No. 49. These samples had probably been treated with Nitrous compounds for the purpose of producing a bleached effect upon the Flour. In view of the presence of Nitrites they were reported as inferior. 18. The remaining seven samples submitted were found to have the composition of unadulterated samples of Wheaten Flour, and they were therefore certified to be genuine. RICE. 19. The sample of Rice reported as adulterated contained extraneous mineral matter, consisting of a Silicate of Magnesia, having the character of powdered Talc. The particulars are as understated:— 0.28 per cent. extraneous mineral matter equivalent to 19.6 grains per pound. 20. The mineral substance referred to is used in the preparation of Rice for the alleged purpose of improving the appearance of the Rice grains, the process being known as " facing." It is insoluble and its presence must be regarded as objectionable on account of the facts that its continued ingestion might cause injury to health and that it is a foreign ingredient which adds to the weight of the Rice. 21. The remaining 6 samples had the composition of genuine Rice. CREAM CHEESE. 22. The sample of Cream Cheese reported as adulterated contained Boric Acid, the particulars being as understated:— Boron Trioxide Equivalent to Equivalent to Boric Acid Boric Acid. 0.0768 per cent. 0.1360 per cent. 9.520 grains per lb. SHREDDED BEEF SUET. 23. The sample of Shredded Beef Suet, reported as adulterated, was found to contain 15 per cent. of Starchy matter, having the characters of Rice starch. CUSTARD POWDER. 24. Under existing circumstances adulteration cannot be certified with respect to the sample of "Custard Powder," reported as inferior. 80 It consisted of starch containing a slight amount of colouring matter, and was practically devoid of egg or other proteid material. 25. At present there is no official or generally recognised definition respecting the composition of articles sold as "Custard Powder," and the sale of such preparations appears to have become established as a Trade Custom; the absence of egg material makes it necessary, however, to regard such samples as inferior. COCOA, COFFEE, PEPPER, LARD, CORNFLOUR, TEA, BAKING POWDER, CREAM, MUSTARD MIXTURE, CHEESE, MUSTARD, SPONGE CAKES, WHISKY, GROUND ALMONDS, GINGER, COFFEE AND CHICORY, BEEF DRIPPING, SAUSAGES. 26. These samples were found to have the composition of unadulterated samples of the articles named, or of samples which must be regarded as unadulterated, and they were therefore certified to be genuine. One was submitted as an "Informal" sample. (See Table I.) I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, B. HENRY GERRANS, F.I.C., Public Analyst.