CHE 32 Metropolitan Borough of Chelsea. Annual Report OF THE Medical Officer of Health FOR CHELSEA. 1928 BY w. H. LESLIE McCARTHY D.S.0., M.C. ; M.A. ; M.D., M.R.C.P., D.P.H. Barrister-at-Law. MEDICAL OFFICER OF HEALTH. London: SHIELD AND SPRING, PRINTERS, 26-28, LANCELOT PLACE, BROMPTON ROAD, S.W. 7 1929. 2 Public Health, Maternity and Child Welfare Committee. At 31st December, 1928. His Worship THE Mayor (Mr. Alderman C. B. Clapcott, O.B.E., J.P.). Councillor Lady Phipps (Chairman). Councillors: A. Bayes. E. Milnes Gaskell. F. G. Chambers. Miss C. L. Paterson. The Right Hon. The Earl OF Cranbrook. G. M. Stevenson. Mrs. C. Stewart-Moore. E. W. Hall. F. J. Synge. Mrs. M. I. Hewitt. Mrs. F. L. C. Walter. A. F. Loveridge. Mrs. P. C. M. Worsthorne. Sir E. L. Meinertzhagen. Housing Committee. His Worship the Mayor (Mr. Alderman C. B. Clapcott, O.B.E., J.P.). Councillor E. B. Baggallay Chairman). Alderman F. W. Proctor. Alderman A. C. Seton Christopher, J.P. Councillors : The Right Hon. The Earl Mrs. F. M. Snowden. OF Cranbrook. Mrs. C. Stewart-Moore. E. W. Hall. F. J. Synge. B. F. MARSDEN-SMEDLEY. Mrs. F. L. C. Walter. Miss C. L. Paterson. Mrs. P. C. M. Worsthorne. Milk And Welfare Sub-Committee. His Worship the Mayor (Mr. Alderman C. B. Clapcott, O.B.E., J.P.). Councillor Miss C. L. Paterson (Chairman). Councillor Lady Phipps. Councillor Mrs. C. Stewart-Moore. Councillor Mrs. F. L. C. Walter. Councillor Mrs. P. C. M. Worsthorne. 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 Area 7 Social Conditions, including Chief Occupations of the Inhabitants 7 Vital Statistics 8 (a) Births 8 (b) Marriages 10 10(c) Deaths 10 (d) Deaths of Children, 1-5 years of age 16 (e) Infant Mortality 16 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 21 (a) Chelsea Health Society and School for Mothers 21 (b) Chelsea Day Nursery 21 (c) Chelsea Tuberculosis Dispensary 21 (d) Invalid Children's Aid Association 16 (e) The Babies' Club 22 (f) Charity Organisation Society 22 Public Health Officers of the Borough Council 18 Nursing Arrangements 25 (a) Professional Nursing in the Home 25 (b) Midwives 25 Laboratory Work 26 Public Health Legislation in Force in the Borough 26 III. —Sanitary Circumstances and Administration. Complaints 28 Closet Accommodation 28 Removal and Disposal of Refuse 28 Sanitary Inspection of the Borough 28 Smoke Abatement 31 Fouling of Foot-paths by Dogs 32 Rats 32 Pigeons 32 Factories, Workshops and Workplaces 33 Public Mortuary 34 Rag Flock Act 35 Offensive Trades 35 Thames Flooding 35 IV. —Housing. Housing Statistics for the Year 1928 37 Housing Staff 38 General Housing Conditions in the Borough 38 Overcrowding 41 Fitness of Houses 42 Unhealthy Areas 44 By-laws relating to Houses and Houses Let in Lodgings 44 Housing Survey 44 V.—Inspection and Supervision of Food. Milk Supply 45 Ice-cream Vendors 46 4 PAGE Fried Fish Vendors 47 Bakehouses 47 Slaughter-houses 47 Other Premises where Food is Prepared or Sold 47 Public Health (Meat) Regulations, 1924 48 Unsound Food 48 Food Poisoning 48 Sale of Food and Drugs Acts 48 The Public Health (Preservatives, etc., in Food) Regulations 49 VI. —Infectious Diseases. (a) Infectious Diseases Generally 50 Diseases notifiable in the Borough 50 Notifications during the Year 1928 50 Diphtheria 51 Scarlet Fever 53 Measles 54 Enteric Fever 54 Pneumonia, Malaria, Dysentery and Trench Fever 55 Puerperal Fever and Puerperal Pyrexia 55 Ophthalmia Neonatorum 56 Influenza 56 Poliomyelitis and Polio-encephalitis 56 Encephalitis Lethargica 56 Smallpox and Vaccination 57 Disinfection 57 Infectious Diseases Shelter 58 Disinfestation 58 (b) Tuberculosis 59 Notifications and Mortality 59 Cases of Tuberculosis in the Borough 60 Public Health (Prevention of Tuberculosis) Regulations, 1925 60 Dispensary and Institutional Facilities for Treatment 62 Co-operation with Hospitals and I.C.A.A. 62 Co-operation with School Medical Service 63 Co-operation with Medical Practitioners 63 Home Contacts 63 Artificial Pneumothorax Treatment 63 Home Nursing 63 Extra Nourishment 63 Non-pulmonary Cases 64 Orthopædic Treatment 64 Dental Treatment 64 Bacteriological Examinations 64 Care and After-care Work 64 VII. —Maternity and Child Welfare. General Arrangements in the Borough 66 Health Visitors 66 Maternity Nurses and Midwives 67 Home Help 68 Home Nursing 69 Clinics and Treatment Centres 70 Ormond Maternity Home 70 Convalescent Home Treatment for Nursing Mothers and Infants 70 Chelsea Branch of the Invalid Children's Aid Association 71 Chelsea Day Nursery 71 Puerperal Fever and Puerperal Pyrexia 72 Other Diseases and Complications of Childbirth 72 Maternal Mortality 72 Ante-natal Work 73 Supply of Milk to Mothers and Young Children 73 Widows', Orphans' and Old Age Contributory Pensions Act, 1925 74 Appendix. Report of the Public Analyst for 1928 76 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 1928. The report is an " Ordinary " 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. Ordinary reports are exp ected to deal with the sanitary circumstances, the sanitary administion, and the vital statistics relating to the District for the year under review 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 63,630 a figure which is below that for last year. The birth rate (12-6) is lower than that for last year (13-4). The marriage rate (10-5) is approximately the same as that for last year (10-8). The death rate (13-5) is higher than that for London generally (11-6) and compares with 14-1 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 and that one-half of all deaths in Chelsea occur in persons over 65 years of age. The infant mortality rate was 48 as compared with (76) last year —-the lowest infant mortality rate ever recorded in the Borough The total incidence of notifiable infectious disease was diminishev last year. The numbers of cases of pneumonia and scarlet fe ver were much less, while those of diphtheria and erysipelas showed a slight increase. At the end of the year there were 293 cases of pulmonary tuberculosis and 68 cases of non-pulmonary tuberculosis known to be living in the Borough —a total lower than that for last year. These figures indicate that the general improvement in the public health of the Borough continues to be maintained. Maternity and Child Welfare work has continued to grow in extent and in usefulness during the year. The attendances at the welfare centre were 5,984 in 1928 and 8,062 visits to homes of patients were recorded I continued to receive most valuable assistance from the Chelsea Health Society, and cannot speak too highly of the efficiency of the Society work. 6 At the close of the year information was received that Lord and Lady Melchett had purchased a large site adjoining the Society's present premises and intended to erect thereon appropriate buildings with the object of co-ordinating Maternity and Child Welfare activities in the Borough. Such co-ordination will undoubtedly lead to still greater efficiency and the munificent gift of the donors is greatly appreciated. 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 Borough, this side of the work of the department is frequently hampered by the inadequate number of houses available. Since the War your Housing Committee has been engaged in examining possible sites which might be utilised for Housing Schemes — a task rendered difficult by the fact that Chelsea is already largely built up. It is gratifying to record that during the year the efforts of the Committee have led to the acquisition by the Borough Council of two very suitable sites. The combined area of these is over three acres and each site is admirably adapted for the erection of additional buildings to house the working classes. In addition, early in the year sanction of the Ministry of Health was obtained for the Borough Council's Improvement Scheme in connection with the World's End-passage area. The task of clearing this site and the construction of new buildings thereon is being actively proceeded with by the Chelsea Housing Improvement Society, Limited, in conjunction with the Borough Council. 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 have been 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, 1928. SECTION I.—NATURAL AND SOCIAL CONDITIONS OF THE BOROUGH. GENERAL STATISTICS. TABLE No. 1. 660 Area (acres) 660 Populations :— 63,700 (Census, 1921) 63,630 (Estimated, 1928) 10,355 Number of Inhabited Houses, 1921 16,555 Number of families or separate occupiers, 1921 £1,094,651 Rateable value, October, 1928 £4, 384 Sum represented by a penny rate, October, 1928 Physical Features and General Character of the Area.-Time Metropolitan Borough of Chelsea, situated near the centre of the Metropolis, is bounded on the north by the Royal Borough of Kensington. om the west by the Borough of Fulham, on the east by the City of west minster, 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,nighty 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 whole, being 60. The density of population of each 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. 8 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 .. 732 Births—Illegitimate .. 73 805 Birth Rate .. 12.6 Deaths .. 861 Death Rate .. 13.5 Number of women dying in, or in consequence of childbirth 3 (a.) From sepsis .. Nil (b.) From other causes .. 3 Deaths of infants under one year .. 39 (a.) Legitimate .. 34 (b.) Illegitimate .. 5 Infantile Mortality Rate .. 48 Deaths from Measles (all ages) .. 3 Deaths from Whooping Cough (all ages) .. 2 Deaths from Diarrhœa (under 2 years) 1 Zymotic Death Rate .. 0.2 Deaths from the Zymotic Diseases .. 11 Tuberculosis Death Rate .. 1.2 BIRTHS. During the year 944 births were registered in Chelsea, 480 being boys and 464 girls. Of these, births of non-parishioners account for 316, and must be deducted. In addition, there were 177 births amongst Chelsea mothers in Lying-in Hospitals and elsewhere outside the Borough, 91 boys and 86 girls. The total number of Chelsea births for the year was 805, of which 406 were males and 399 females. The following Tables are self-explanatory : — 9 TABLE No. 3. Births and Birth-Rates. Year. Births. Birth-rate per 1,000. Birth-rate London. 1927 856 13.4 16.1 1928 805 12.6 15.9 TABLE No. 4. Births in Wards. Year. Hans Town. Royal Hospital. Church. Cheyne. Stanley. Total. 110 94 146 114 392 856 1927 1928 103 79 125 130 368 805 TABLE No. 5. Notification of Births. 1927. 1928. Living Children 618 583 Still-born Children .. 16 15 634 598 Notified by Medical Practitioners 142 144 „ St. George's Hospital, Extern. Department 12 19 „ Midwives 339 284 „ Chelsea Institution 117 129 „ Parents, etc. 24 22 634 598 Percentage of notified births of Chelsea residents registered in the Borough .. 95 94 10 TABLE No. 6. Inward Transfers (1928). Confinements in Hospitals outside the Borough .. 119 Confinements in Nursing Homes outside the Borough .. 30 Confinements in private residences outside the Borough .. 28 177 It will be observed that the number of births of Chelsea Infants in Hospitals and elsewhere outside Chelsea accounted for 22.0 per cent. of the total births. In the preceding year the percentage was 21.2. Chelsea births in Hospitals outside the Borough were distributed during the year as follows : —St. George's Hospital, 52 ; Queen Charlotte's Hospital, 21 ; Clapham Maternity Hospital, 9; General Lying-in Hospital, Lambeth, 9 ; Charing Cross Hospital, 4 ; Royal Free Hospital, 5 ; St. Thomas' Hospital, 2 ; Westminster Hospital, 3 ; City of London Maternity Hospital, 6 ; Miscellaneous Hospitals, 8. Chelsea births in Hospitals and Homes within the Borough during the year numbered 151. These were distributed as follows:—St. Luke's Hospital, 122 ; Ormond Maternity Home, 23 ; St. Stephen's Hospital, 1 ; Wilbraham Nursing Home, 3 ; Chelsea Hospital for Women, 1 ; 39, Royal Avenue, 1. Illegitimate Births. —The following Table shows the number of illegitimate births and the illegitimate birth rate per 1,000 births. In 1928, 121 such births were registered in Chelsea, and 16 inward transfers and 64 outward transfers were made by the Registrar General. The nett figure for the Borough is therefore 73. TABLE No. 7. Number of Illegitimate birth Illegitimate births. rate per 1,000 births. Year. 1927 86 100.4 1928 73 90.7 MARRIAGES. There were 671 marriages registered in the Borough during the year (690 in 1927). The marriage rate (number of marriages per 1,000 of population) was 10.5. In the preceding year the marriage rate was 10.8. DEATHS. The total deaths registered in the Borough during the year were 1,658. Transferable deaths of non-residents registered in the Borough numbered 947, and are to be deducted. In addition, there were 150 deaths of Chelsea residents in Institutions and elsewhere outside the Borough. The nett Chelsea deaths were therefore 861 and the death rate was 13.5 per 1,000. The death rate for England and Wales was 11.7, for London 11.6, and the mean death rate for the 107 Great Towns was 11.6. 11 The number of nett deaths in the Borough and the corresponding death rates were as shown in the following table : — TABLE NO. 8. Year. Nett Deaths. Death Rate. 1927 901 14.1 1928 861 13.5 The seasonal mortality in the four quarters of 1928 was as follows:- First quarter, 152; second quarter, 13.9 ; third quarter, 11.2 ; fourth quarter, 13.8. 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 Cheldea mortality rate, as they are naturally reflected in the death returns Thus, in 1928, deaths of pensioners in the Royal Hospital, Chelsea, accounted for 60 deaths, inward transfers included (equivalent to 0.9 of the death rate). DEATHS IN PUBLIC INSTITUTIONS. In tabular form is shown below the number of deaths of Chelsea resi- dents which took place in various Institutions during the year. Of the 711 Chelsea deaths registered in the Borough 431 occurred in Institutions within the Borough. TABLE No. 9. Number of Deaths Hospitals or Institutions within the Borough. 338 St. Luke's Hospital and Chelsea Institution 57 Royal Hospital for Pensioners 13 Cancer Hospital 9 Victoria Hospital for Children, Tite Street 8 St. Stephen's Hospital (Westminster Infirmary) 2 Brompton Hospital 3 Chelsea Hospital for Women Cheyne Hospital for Children - _ Freemasons Hospital 1 St. George's Home for Tuberculosis 431 12 Of the 947 deaths of non-residents registered in Chelsea, 922 occurred in the foregoing Institutions. The deaths (150) of Chelsea residents in Institutions and elsewhere outside the Borough were distributed as under :— General Hospitals .. 43 Mental Hospitals 7 Special Hospitals .. 16 Infectious Disease Hospitals 6 Tuberculosis Sanatoria, etc. 7 Nursing Homes 36 Poor Law Institutions 9 Private Addresses, etc. .. 26 The following Tables are self-explanatory : — TABLE No. 10. Birth Rate, Death Rate, and Analysis of Mortality During the Year 1928. (Provisional figures. The rates for England and Wales have been calculated on a population estimated to the middle of 1928, but those for the towns have been calculated on populations estimated to the middle of 1927. 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). England and Wales 107 County Boroughs and Great Towns, including London 156* Smaller Towns (1921 Adjusted Populations 20,000-50,000) .. London Chelsea - Rate per 1,000 Total Population. Still Births. Live Births. 0.70 16.7 16.9 0.70 16.6 15.9 12.6 All Causes. 11.7 11.6 10.6 11.6 13.5 0.73 0.53 0.39 Annual Death-rate per 1,000 Population. Whooping Cough. Scarlet Fever. Diphtheria. Smallpox. Measles. Enteric Fever. 0.01 0.11 0.01 0.07 0.06 0.00 0.01 0.01 0.01 0.01 Influenza. 0.19 0.17 0.21 0.13 0.26 Violence. 0.53 0.48 0.41 0.55 0.83 Diarrhœa and Enteritis (under Two years). 7.0 9.6 4.8 10.2 1.2 Rate per 1,000 Births. Total Deaths under One year. 65 70 60 67 48 Certified by Registered Medical Practitioners. 90.9 6.5 91.0 5.7 7.6 8.2 92.6 88.7 88.0 Percentage of Total Deaths. Uncertified Causes of Death Inquest Cases. Certified by Coroner after P.M. No Inquest. 1.0 1.4 6.7 0.6 1.2 0.0 0.0 0.00 0.15 0.02 0.09 0.09 1.9 0.08 0.30 0.04 0.01 0.02 0.00 0.06 0.09 0.03 0.08 0.09 0.06 0.00 0.00 0.00 0.5 3.7 3.8 * BY the union of Moreeambe M.B. and Heysham U.D. on the 1st October, 1928, the number of the smaller Towns is increased to 156. 14 TABLE No. 11. Deaths of Chelsea Residents Registered during the Year 1928, classified by Age and Cause. (In accordance with Registrar General's Return). Nett Deaths, whether occurring WITHIN OR WITHOUT THE Borough. All Ages. Under 1 year. 1 and under 2 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 65 and under 75 years. 75 and upwards. 45 and under 65 years. 2 and under 5 years. Causes of Death. 861 39 12 16 32 79 241 184 248 All Causes 10 1. Enteric Fever 1 1 - - - - - - - - 2. Small-pox - - - - - - - - - - 3. Measles 3 1 1 1 - - - - - - 4. Scarlet Fever - - - 5. Whooping Cough - - - - - - - 2 - 1 1 - - - 6. Diphtheria - - - 4 1 1 2 - - - - - - 7. Influenza 17 - - 1 1 2 6 3 4 1 - 8. Encephalitis Lethargica 1 - 1 9. Meningococcal Meningitis - - - - - - 1 1 - - - - - 10. Tuberculosis of Respiratory System - - - - 62 1 1 1 12 23 16 6 2 11. Other Tuberculous Diseases 1 14 1 2 3 2 3 1 1 12. Cancer, malignant disease - 128 - - 11 40 25 - - 52 13. Rheumatic Fever - - 2 - 2 - - - - - - 14. Diabetes 12 - 7 3 2 - - - - - 15. Cerebral Hæmorrhage 41 12 16 13 - 16. Heart Disease - - - 1 - - 4 199 45 57 - - 1 91 17. Arterio-sclerosis 42 - - 1 13 19 - - - 9 - 18. Bronchitis 28 2 - 5 3 18 7 - - - - 19. Pneumonia (all forms) 17 50 2 1 1 6 7 9 - 20. Other Respiratory Diseases 3 6 1 2 - - - - - - 21. Ulcer of Stomach or Duodenum 11 - 1 2 8 - - - 22. Diarrhœa, etc. - - 1 1 - - - - - - - - 23. Appendicitis and Typhlitis 13 1 1 2 2 4 3 - - - 24. Cirrhosis of Liver 3 1 - - 2 - - - - - 25. Acute and Chronic Nephritis 21 1 - - - - 9 5 6 - - 26. Puerperal Sepsis - - - - - - - - - 27. Other accidents and diseases or Pregnancy and Parturition 3 - 1 2 - - - 28. Congenital Debility and Malformation, Premature Birth - - - 15 15 - - - - - - - - 29. Suicide - - 1 9 3 3 2 - - 3 - 30. Other Deaths from Violence 44 1 3 5 2 8 - 7 15 4 16 32 41 31. Other Defined Diseases 128 7 4 1 3 20 32. Causes ill-defined or unknown - - - - - - - - - - 861 10 16 12 32 79 241 184 248 39 15 CAUSES OF DEATH. Table No. 11 shows that 199 deaths were due to Organic Heart Disease, 128 to Cancer, 28 to Bronchitis, 50 to Pneumonia, 62 to Pulmonary Tuberculosis, 42 to Arterio-sclerosis, 41 to Cerebral Haemorrhage, 17 to Influenza and 15 to Congenital Debility and Malformation. Fifty per cent. of all deaths occurred in persons over 65 years of age. Organic Heart Disease. —Of the 199 deaths from cardiac diseases, 148 were in persons over the age of 65 years. In 1927, there were 176 deaths from Heart Disease, 129 being persons over the age of 65 years. Cancer and Malignant Disease. —There were 128 deaths from Cancer during the year, as against 141 in 1927. Eleven of the deaths were between the ages of 25 and 45 ; 52 between the ages of 45 and 65 ; a nd 65 above the age of 65 years. There were 6,615 deaths from Cancer in London during the year, as compared with 6,591 in 1927. On request, rooms are disinfected after a death from Cancer, and arrangements made for the removal, fumigation or destruction of bedding. During the year 14 rooms were disinfected after deaths from Cance r. Tuberculosis and the Infectious Fevers. —These are reviewed in the section dealing with the notifiable infectious diseases. Diarrhæa and Enteritis. —There was one death from these diseases as against 16 in 1927. The case was an infant under the age of twel ve months. During the September quarter the mean temperature was 61.7°, as against 59-5° in 1927. The rainfall of this quarter in 1928 was 5.6 inches, as against 9-8 in 1927. Violence and Suicide. —Forty-four deaths occurred from violence apart from suicide. Suicide was responsible for 9 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. 16 Respiratory Diseases.—Table No. 12 shows the number of deaths from respiratory diseases during the past two years. The annual death 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. 12. No. of deaths under 5 years. Other Respiratory Diseases. Death. rate. Year. Bronchitis. Pneumonia. Total. Percentage under 5 years. 1927 32 74 14 120 1.9 20 16.6 1928 28 50 6 84 1.3 12 14.3 DEATHS OF CHILDREN 1-5 YEARS OF AGE. The number of deaths of children between 1-2 years of age was 10 and between 2-5 years, 12. In the previous year these figures were 7 and 13 respectively. The causes of death are given in detail in Table No. 11. Table No. 13 shows the causes of death during the past two years. TABLE No. 13. Child Mortality (1-5 Years). Period or Year. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrhœal Diseases. All other causes. Total Deaths. 1927 6 2 7 5 20 - - 1928 5 5 3 9 22 INFANT MORTALITY. There were 39 deaths of infants under one year of age in Chelsea during the year. The corrected death rate is 48 per 1,000 births, as compared with 76 in the previous year. This represents the lowest infant mortality rate ever recorded in the Borough. In London as a whole 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. 14 :— 17 TABLE No. 14. 4 weeks and under 3 months. 3-6 months. 9-12 months. Total deaths under 1 year. Under 1 week. Total under 4 weeks. 6-9 months. 1-2 weeks. 2-3 weeks. 3-4 weeks. Measles 1 1 - - - - - - - - Scarlet Fever - - - - - - - - - - Whooping Cough - - - - - - - - - - Diphtheria 1 1 - - - - - - - - Influenza - - - - - - - - - - Erysipelas - - - - - - - - - - - 1 Tuberculous Meningitis 1 - - - - - - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases 1 1 - - - - - - - - 1 Meningitis - 1 - - - - - - - - Convulsions - - - - - - - - - Laryngitis - - - - - - - - - - Bronchitis 2 2 - - - - - - - - 7 Pneumonia - 1 1 1 1 2 2 - - 1 Diarrhœa and Enteritis 1 - - - - - - - - Gastritis - - - - - - - - - - Syphilis - - - - - - - - - - 1 Rickets 1 - - - - - - - - 1 Suffocation 1 - - - - - - - - Injury at Birth - - - - - - - - - - Atelectasis 1 2 1 1 - - - - - - Congenital Malformations - - - - - Premature Birth - - - - - 12 11 11 1 - - - - - - 3 Atrophy, Debility and Marasmus Other causes 1 1 1 - - - - - - 5 1 3 1 - - - - - - 13 39 .. 12 1 6 7 4 - - 9 Nett Births registered during the calendar year Nett Deaths registered during the calendar year Legitimate .. 732 Illegitimate .. 73 Legitimate .. 34 Illegitimate .. 5 The following Table gives the Infant Mortality Rate in Chelsea under various headings, for the past two years :— TABLE No. 15. 1927. 1928. Infectious Diseases 2.9 2.5 Diarrhœal Diseases 16.3 1.2 Developmental Defects and Wasting 30.4 21.1 Other causes 23.4 23.6 76.0 48.4 Total Rate 18 TABLE No. 16. Infantile Mortality Rates per 1,000 Births in Wards. 1927. 1928. Hans Town 45 19 Royal Hospital 53 38 Church 68 88 Cheyne 105 38 Stanley 84 49 48 Chelsea Borough 76 Illegitimate Deaths.—The following Table No. 17 shows the number of deaths among illegitimate infants during the past two years. TABLE No. 17. 1927. 1928. Total number of illegitimate births 86 73 Alive at end of year 52 50 Dead at end of year 8 5 Removed from Borough 26 18 Poor Law Relief. —Through the courtesy of Mr. Apted, Clerk to the Chelsea Guardians, I am able to give below the figures as to the average daily number of persons chargeable to the Guardians during the year. TABLE No. 18. 1928. Average daily number of persons who received medical relief only 76 Average daily number of persons who received relief (indoor and outdoor) 1,390 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 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 any 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, but the deaths from diseases of this character were lower 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 mild form in January, February and March, its distribution being general throughout the Borough. Judged by the notifications received, there was a decrease in the amount of pneumonia, 109 notifications being received, compared with 157 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 a decrease in the number of cases of infectious disease. 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. (a.) The Day Servants Hostel, 29-33, Danvers Street, Chelsea, pro- Vl des accommodation for 15 unmarried mothers and their infants. Cases ar e not received until after birth of the child. Daily work is provided b y the Hostel and the mothers reside with their babies at night. (b.) The Hostel for Discharged Woman Prisoners and Police Court Cases, 497, King's Road, Chelsea, provides accommodation for 20 women on discharge from prison or if found homeless. Unmarried mothers, but not illegitimate infants, are received. An expectant mother is retained Until confinement approaches. Arrangements are then made for her admission to Hospital. If she is subsequently re-admitted to the Hostel, the infant is settled with a foster mother. ( c .) St. Theresa's Shelter, 43, Smith Street, Chelsea, is a Rescue Home which provides accommodation for nine girls. Cases are detained for some weeks until some suitable employment can be found. In the case of an expectant mother, arrangements are made for her transfer to an appropriate Home or Institution elsewhere in the Metropolis. Homeless children in general 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. 21 CLINICS AND TREATMENT CENTRES. (a.) Chelsea Health Society and School for Mothers. —Chairman of Executive Committee: The Lady Melchett, D.B.E. 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 four infant clinics were held weekly —three 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 70. Four part-time Medical Officers are employed by the Society—Dr. Grace Nelson, Dr. Muriel Radford, Dr. Kathleen Matthews and Dr. Margaret Rorke. Three whole-time trained Health Visitors are also employed, together with necessary clerical and domestic assistance. With the approval of the Ministry of Health, arrangements for the adequate treatment of lactation cases have been instituted. These have proved most satisfactory in their working and in the results achieved. 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 grant of £750 to the Society for the year commencng 1st April, 1928. (b.) Chelsea Day Nursery.—65, Sydney Street, S.W. 3. Chairman : Eric W. Hall, Esq. Hon. Sec.: The Hon. D. Darling. 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 year will be found on page 72. 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, 1928. (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 22 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 61. 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, 1928. 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 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 will be found on page 71. 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, 1928. (e.) The Babies' Club. —35, Danvers Street, S.W. 3. Chairman Mrs. William Piercy. Hon. Sec.: Mrs. Stanley Robinson. Medical Officer: Dr. Harold Waller. This Infant Welfare Clinic is controlled by a voluntary Committee. It is intended for the use of annual subscribers only. The Medical Officer of Health is a member of the Committee of the Home. (f.) Charity Organisation Society. —Chairman: E. F. Dent Esq. Hon. Secretaries: Miss Larken and Miss Fairtlough. The Chelsea branch of the Charity Organisation Society is located at 2, Glebe Place, King's Road, S.W. 3. This Society arranges for convalescent treatment when necessary ; for the supply of dentures and surgical appliances and for various forms of temporary assistance during disablement, etc. In connection with the Society there is a Women's Holiday Fund and a large number of Chelsea women are thus enabled to obtain holidays in the country or at the seaside during the summer months. 23 PUBLIC HEALTH OFFICERS OF THE BOROUGH COUNCIL. The names and qualifications of members of the staff of the Public Health Department at 31st December, 1928, are tabulated below in the form required by the Ministry of Health. All appointments are wholetime 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). Public Analyst (Part time). Senior Sanitary Inspector. F.I.C. 1925 Gerrans, B. H. *1920 Crandell, W. Cert. San. Insp. Exam. Board, Cert. Royal San.Ist., Cert.Meat and other Foods *1926 Goodwin, J. C. Cert. San. Insp. Exam. Board. Cert. Meat and other Foods Sanitary Inspector. *1926 Shelley, A. P. T. Cert. San. Insp. Exam. Board Sanitary Inspector. *1927 Castley, J. Cert. San. Insp. Exam. Board. Cert. Meat and Other Foods Sanitary Inspector, with special reference to Duties under Housing Act, 1925. *1909 Tettenborn, Miss F. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Cert. L.C.C. Adv. Home Nursing, C.M.B., Nat. Health Diploma, Health Visitors' approved by Bd. of Education, Special Cert, for Tuberculosis. Sanitary Inspector and Tuberculosis Health Visitor. Brown, Miss M. †1916 Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Health Visitors' Diploma, approved by Bd. of Education. Cert. C.M.B. Health Visitor. * Salary contributions made under Public Health Acts. † Salary contributions made by Exchequer Grants. Clerical Staff: A. B. J. Hayden, Senior Clerk. E. Bosley. Mrs. H. M. Kennedy† (Maternity and Child Welfare). 24 Other Staff: Mortuary Keeper and Messenger .. C. Leonard. Chief Disinfector .. E. Hancock. Disinfector .. G. Cowper. Shelter Attendant .. Mrs. A. Hatch. Cleansing Attendant .. Mrs. E. Smith. Home He l ps {Mrs. Elliott. Mrs. White. 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. Muriel Radford. Dr. Kathleen Matthews. Dr. Margaret Rorke. Dr. Grace Nelson. Health Visitors (Whole Time). Qualifications. Appointment. Name. Hobart, Miss F. G. Cert. San. Insp. Exam. Board, Diploma, Nat. Health Soc., Royal San. Inst. Health Visitors' Cert., C.M.B. Health Visitor and Secretary. Shaw, Miss A. Cert. General Hospital Training, C.M.B. and Certificate Mothercraft Training Soc., Health Visitors' Certificate approved by Ministry of Health Health Visitor. Harcourt, Miss G. E. Cert. General Hospital Training, C.M.B. and Certificate 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. Secretary and Social Worker in connection with Tuberculosis. Squire, Miss H. M. L. .. Cert. San. Insp. Exam. Board, Diploma, Nat. Health Soc., Cert. Inst, of Hospital Almoners, Cert. Social Science (London School of Economics) Cert. General Hospital Training and Tuberculosis Puttick, Miss C. K. Tuberculosis Nurse to Dispensary. 25 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. Details of the work done by the Association during the year on behalf of the Borough Council will be found on page 69. 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, 1928. The total fees paid by the Council for nurses' visits during the year amounted to £141 8s. (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. 0d. to £1 10s. 0d. for Multipara cases. Arrangements on this basis have been made with the Ormond Home for Midwives (Blantyre Street, Chelsea), 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 Subcommittee. The Sub-committee meets weekly to consider applications and assess cases according to the income of the family. Contribution 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 two years are summarized in Table No. 43 (page 68). The London County Council is the Authority responsible for the supervision of midwives in the Borough. Through the courtesy of 26 Dr. F. N. Kay Menzies, the County Medical Officer of Health, I have been able to ascertain that 13 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.1.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 the year 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 St. George's Hospital, S.W. 1. 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. The number of bacteriological, bacterioscopic and other examinations made during the year was 435. Of these, 360 were for the bacillus associated with Diphtheria and 70 for the bacillus associated with Tuberculosis. One specimen of blood was examined for the Wassermann reaction, and four for the Widal reaction. The total cost of these services to the Borough Council was £66 16s. 6d. The total number of bacteriological examinations during the preceding year was 527. 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 136,500 units. An anti-toxin syringe, needles and steriliser are also available on loan. The total cost to the Council for anti-toxin supplied during the year was £8 19s. 7d. 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 By-laws 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 27 Government Act, 1899, made the following by-law for the good rule and government of Chelsea, such by-law 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 by-law shall be liable to a penalty not exceeding forty shillings." A similar by-law has been adopted by the metropolitan boroughs of Kensington, Hammersmith and Fulham. In all cases the by-law was allowed by the Home Office as an experimental measure for a period of two years, unless a by-law is made confirming and continuing its provisions before the expiration of that period. This by-law has proved of considerable assistance in preventing serious nuisance and a confirming by-law (approved by the Home Office) has now been made to continue and enforce its provisions. In addition, the assistance of the Metropolitan Police in reporting cases of breach of the by-law has been authorised. 28 SECTION III.—SANITARY CIRCUMSTANCES AND ADMINISTRATION. Complaints.—The number of complaints received during the year was 423 compared with 482 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.—Prepared by the Senior Sanitary Inspector and set out on the following pages is a summary of the work carried out by the Sanitary Inspectors. During the year, the number of intimation notices served was 753. The number of statutory notices was 166. These compare with 886 and 216 respectively, in 1927. In three 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. 19. Summary of Work carried out by Sanitary Inspectors during the Year. Inspections. On Complaint of Nuisance 599 On notification of infectious disease 213 House to House 286 Re-Inspection Calls made 6,082 Inspection of :— Bakehouses 39 Slaughterhouses 55 Milkshops 96 Ice Cream Premises 30 Overcrowding 8 *Houses Let in Lodgings 99 Stables 16 Restaurant Kitchens 60 Marine Stores 23 Food Premises other than above 100 Premises under Meat Regulations 47 Factory and Workshops 677 Outworkers' Premises 90 Other Visits 1,129 Verminous Premises 40 * This figure is included in House to House Inspections. 29 Inspection of:— Rat Enquiries 59 Smoke observations 52 Visits in relation to work due to the Flood 1,345 Total 11,046 Premises. Walls and Ceilings cleansed:— (a) Premises throughout 68 (b) Premises partially 338 (c) Verminous rooms cleansed 62 (d) Total number of rooms cleansed 1,109 Wash-house walls and ceilings cleansed 144 Wash-house roofs repaired 38 Dirty tenants' rooms cleansed 23 Yard and area walls cleansed 104 Defective roofs repaired 158 Defective gutters repaired 49 Defective rain water pipes repaired 42 Dampness abated 146 Miscellaneous repairs 240 Wash-house floors repaired 27 Yard surfaces repaired, paved, etc. 89 Ashpits demolished and sites made good 5 Ashpits cleansed - New and proper dustbins provided 90 Workrooms provided with light and ventilation or light and ventilation improved - Yards cleansed 4 Drainage. Reconstructed 70 Repaired 43 Cleansed 31 Inspection Chambers and traps provided 160 Fresh air inlets provided 64 Fresh air inlets repaired 11 Gully traps provided 158 Drains ventilated 60 New soil pipes provided 72 New ventilation pipes provided 20 Soil and ventilation pipes repaired 10 Anti-syphonage pipes provided 19 Drains sealed off 10 Drains cleared (obstruction removed) 27 New covers provided to inspection chambers 6 Rainwater pipes disconnected and caused to discharge'over properly trapped gullies 21 Sink wastes provided with traps 78 Sink waste pipes ventilated - Sink waste pipes cleansed 6 New sinks provided 26 Bath and lavatory wastes repaired or renewed 11 New lavatory basins fixed 6 New baths fixed 4 New bidets fixed - Water Closets. Improvements in sanitary conveniences (factories, workshops, etc.) 8 New water closet pans provided 2 New water closet pans and traps provided 187 Water closet pans (foul) cleansed 10 Choked water closet pans unstopped and cleansed 9 30 Water Closets. Water waste preventers renewed 35 Water waste preventers repaired 38 Overflows to water waste preventers provided - Walls and ceilings of water closets cleansed and repaired 140 Water closet roofs repaired 33 Ventilation and light provided or improved 4 W.C. Floors repaired 7 Water Supply. Water supply to premises reinstated 10 Water supply provided to upper storeys of tenement houses 1 Water closets provided with water supply to flushing apparatus 13 New drinking water cisterns provided 1 Drinking water cisterns cleansed 36 Drinking water cisterns repaired 1 Drinking water cisterns provided with new covers or covers repaired 27 Smoke Nuisance. Number of observations 52 Number of nuisances and complaints 3 Number of Notices — Number of Summonses — Nuisances Abated arising from:— Keeping animals in an improper manner or place 2 Defective manure cages - Accumulation of manure or refuse 25 Dead animals — Overcrowding 8 Rats 12 Food Condemned and Destroyed. Fish 17 stones Dog Fish 1 box Rabbits 5 Disinfection. Premises disinfected after Zymotic diseases (Scarlet Fever, Diphtheria, etc.) 345 Rooms disinfected after Tuberculous disease 117 Rooms fumigated for verminous and filthy condition 153 Miscellaneous disinfection 143 Certificates of disinfection given 210 School notices after disinfection 203 Notices sent to Public Library of Premises where infectious diseases have occurred 200 Proceedings Taken. Intimation Notices served 753 Statutory Notices under Public Health (London) Act, 1891 166 Statutory Notices under Section 3 of Housing Act, 1925 — Statutory Notices under by-laws for provision of dustbins 4 Total number of samples purchased for analysis under Sale of Food and Drugs Acts 366 Samples of cream taken (Milk and Cream Regulations) 5 Samples of Drugs taken - Samples (informal) purchased 34 Legal proceedings instituted in respect of defective sanitary conditions and nuisances 3 Legal proceedings under Sale of Food and Drugs Acts 1 Legal proceedings in respect to unsound food — Certificates issued in accordance with " Rent Restrictions Acts " — Entries in Inhabitants' Complaint Book 423 31 Cleansing and Disinfection. Number of adults cleansed 7 Number of children cleansed 995 Number of rooms or premises cleansed or disinfected 746 Number of persons treated for Scabies 7 Number of articles (bedding, etc.) disinfected 1,337 Number of articles (various) destroyed 425 Disinfection Station Shelter. Persons accommodated:— Adults 11 Children 14 Mortuary. Number of bodies received 131 Number of infectious bodies received — Number of bodies removed to Public Mortuary on Sanitary grounds — TABLE No. 19. Magisterial Proceedings during the Year under Public Health (London) Act, 1891. Situation of premises. Nature of Nuisance or Complaint. Petty Sessions. Date of Hearing. Result. 29, College Place. Rooms dirty. Defective flushing apparatus to W.C. Kensington 17-7-28 Order 14 days. 29, College Place. Premises without sufficient ashpits (dustbins). Kensington 17-7-28 Fined 20s. 14, Gertrude Street. Rooms dirty. Defective roof. Kensington 17-7-28 Order, £2 2s. (agreed costs). Nuisances by Dogs. - Failing to comply with Council's By-law re fouling of footway by dogs in Carlyle Square. Kensington 6-3-28 Fined 40s. 10s. 6d. costs. - Failing to comply with Council's By-law re fouling of footway by dogs in Draycott Terrace. Kensington 18-12-28 Fined 5s. Smoke Abatement. —It is part of the work of a Sanitary Inspector to observe any nuisance arising from smoke. There were 52 actual recorded instances of observations during the year but the chimneys in the Borough have in fact been subject to daily observation by the Inspectors. Three complaints of smoke nuisance were received during the year and cautionary letters were sent to the offenders. 32 At intervals very serious nuisance has arisen owing to the emission of smoke and grit from the Generating Station of the London Electric Railways, situated in Lots Road. During the year a conference was held in conjunction with the Public Control Committee of the London County Council. Representatives of the Electric Railways Company attended and the measures being adopted by the Company to deal with the nuisance were fully discussed. These include the provision of new boiler plant and suitable grit arrestors. The company gave an assurance that the work in connection with the installation of these would be carried out with all possible speed. It was arranged to hold a further Conference on the matter if necessity should arise. Fouling of Footways by Dogs.—The Borough Council have obtained sanction for a by-law to deal with this nuisance. It has already been found useful, the condition of footways having improved considerably since the measure came into operation. During the year two prosecutions were taken for infringement of the by-law, a conviction being obtained in each case. Rats and Mice (Destruction) Act. —During the year the Council has provided rat catching varnish to applicants for the destruction of r ats and 110 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 the year was £7 16s. 0d. Nuisance caused by Pigeons.—During the year further complaints were received from residents in the neighbourhood of Chelsea Embankment, Elm Park Gardens, and Draycott Place regarding nuisance arising from the large number of pigeons in the area. On investigation, it is invariably 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. Until recently a Sanitary Authority had no powers to deal with nuisance caused by pigeons ; in fact, there were restraining enactments which Prevented steps being taken to reduce the nuisance, e.g., under the Larcency 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. The London County Council (General Powers) Act, 1927, now enables a Sanitary Authority to take necessary steps to reduce the number of pigeons within its area. The Borough Council has made arrange- 33 ments for the capture and humane destruction of a proportion of these birds. At the end of the year about 80 birds had been destroyed, but it is hoped that this figure will be considerably augmented in the near future. Factories, Workshops and Workplaces.—The Medical Officer of Health is required under Section 182 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 288. The number of inspections of these premises was 677, which compares with 898 in in 1927. Sanitary defects were found in 12 instances. The following Table No. 20 is in the form requested by the Home Office in order to ensure uniformity in the presentation of returns : — TABLE No. 20. Factories, Workshops, Workplaces and Homeworkers' Premises. 1. —Inspection of Factories, Workshops and Workplaces. (Including Inspections made by Sanitary Inspectors). Number of Premises. (1) Inspections. (2) Written Notices. (3) Occupiers prosecuted. (4) - Factories (including Factory Laundries) 40 - Workshops (including Workshop Laundries) 605 10 - Workplaces (other than Outworkers' premises) 32 - - Total 677 10 - 2. —Defects found in Factories, Workshops and Workplaces. Number of offences in respect to which Prosecutions were instituted. (5) Number of Defects. Particulars. (1) Referred to H.M. Inspector. (4) Remedied, (3) Found. (2) Nuisances under the Public Health Acts:- * Want of cleanliness 5 5 - - Want of ventilation 1 1 - - Overcrowding - - - - Want of drainage of floors - - - - Other nuisances 4 4 - - * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 34 2 —Defects found in Factories, Workshops and Workplaces.—continued. Number of Defects. Number of offences in respect to which Prosecutions were instituted. (5) Particulars. (1) Referred to H.M. Inspector. (4) Remedied. (3) Found. (2) Sanitary accommodation: — Insufficient - - - - Unsuitable or defective 1 1 - - Not separate for sexes 1 1 - - 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 12 12 - - 3. —Home Work. Outwork in Unwholesome Premises, Section 108. Outworkers' Lists, Section 107. 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 No. of Inspections of Outworkers Premises. Notices served. Prosecutions. Orders made (Sec. 109). Prosecutions (Sec. 109, 110) Prosecutions. Instances. Instances. Chelsea Outworkers. Lists. 1927 192 8 22 26 36 185 72 - - - - - - - 21 37 37 200 82 2 2 - - - - - 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. 35 The Chelsea Mortuary is situated in Arthur Street. Number of Bodies received in Mortuary during 1928 131 1. To await Inquests :— (a.) Infectious - (b.) Non-infectious 125 2. To await burial 6 3. Sanitary grounds — Number of Post-Mortem examinations 53 1911 and 1928 Rag Flock Acts,—No premises for the manufacture of rag flock are maintained in the Borough and 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. THAMES FLOODING. During the night of 6th and early morning of 7th January, 1928, serious flooding occurred in consequence of the overflow of an abnormally high tide in the Thames. At the time there was a large volume of flood water in the river following an unusually heavy snowfall during the preceding fortnight. In addition, very full tides existed, these being aggravated by strong easterly winds from estuarial regions. The combined operation of these factors brought about a condition whereby the abnormally swollen river overflowed and, in some places, burst through the embankment walls. All riparian Metropolitan Boroughs were effected, serious loss of life occurring in some districts. Fortunately, no loss of life occurred in Chelsea, but great hardship and distress was occasioned in portions of the Borough adjoining the river. Thirty-three basements and ground floors of inhabited premises were flooded, a large amount of furniture, clothing and household equipment being irretrievably ruined. Immediate steps were taken by the Public Health Department to render all possible assistance. Disinfection was carried out in all cases and, where necessary, temporary accommodation was arranged. A supply of coal for the drying out of rooms was also provided. The 36 Mayor of the Borough personally visited the affected area and spared no effort to mitigate the plight of the unfortunate victims. In response to an urgent appeal by him, financial and other material assistance was rapidly forthcoming. All necessary household equipment was thus replaced. Traders in the Borough most generously assisted by supplying goods at reduced prices. Permission of the Ministry of Health was also obtained to make arrangements for the adequate drying and cleansing of premises, the replastering of walls and the renewing of floors where necessary, the cost being borne by the rates. An emergency relief depot was opened at the Town Hall. The issue of financial assistance and the distribution of household equipment was thereby efficiently organised. The Borough Council further assisted by sending into the country for convalescence eleven children of affected families. The development of the relief services and the wonderful voluntary effort exerted during the period of stress were beyond praise. The insanitary conditions resulting involved much extra work for the Public Health Staff. The inspection of flood damage in the submerged premises, the examination of household effects removed either for cleansing or destruction, the taking of inventories for the purpose of grants from the Mayor's Fund, the disinfection of premises after the offensive effluvium from the Thames silt and the drying out and renovation of walls and floorings continued for several weeks without remission. Over 1,400 visits were made by the Sanitary Inspectors and Health Visitors to houses and families affected by the flood. A great amount of their work was entirely voluntary and although often involving very long hours was cheerfully carried out. It is gratifying to record that there was no outbreak of infectious disease in consequence of the flood. 37 SECTION IV.—HOUSING. In accordance with the instructions of the Ministry of Health, the following tabular statement has been prepared : — TABLE No. 21. Housing Statistics for the Year 1928. 1. General. Number of New houses erected during the year: — (a.) Total (including numbers given separately under (b.) ) 28 (b.) With State assistance under Housing Acts :— (i.) By the Local Authority 0 (ii.) By other bodies or persons 0 2. Unfit Dwelling Houses. I.—Inspection. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 928 (2) Number of dwelling houses which were inspected and recorded (House-to-house inspections) 116 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 0 (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 753 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 (intimation only) 587 III. —Action under Statutory Powers. A. Proceedings under section 3 of the Housing Act, 1925. (1) Number of dwelling houses in respect of which notices were served requiring repair 0 (2) Number of dwelling houses which were rendered fit — (a.) by owners 0 (b.) by Local Authority in default of owners 0 (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close 0 38 B. Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 753 (2) Number of dwelling houses in which defects were remedied after service of formal notices — (a.) by owners 166 (b.) by Local Authority in default of owners 0 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 4 (2) Number of dwelling houses in respect of which Closing Orders were made 10 (3) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit 0 (4) Number of dwelling houses in respect of which Demolition Orders were made 0 (5) Number of dwelling houses demolished in pursuance of Demolition Orders 0 Staff.—The staff engaged on housing work during the year consisted four Sanitary Inspectors, each carrying out all the duties of a Sanitary Inspector in the district allocated to him. One of these was mainly en gaged in duties connected with the Housing Regulations, 1925. 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 may alterations, c onsequent 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 P r oportion of demolition of small property has been due to the acquisition of land by large trading corporations, but up to the present this has n ot 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 39 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. 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 amout 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 Beauclere Buildings, College Place 45 5,445 It will be seen that in Chelsea at the outbreak of war there was available accommodation for over 7,000 persons of the wage-earning class—an amount which, in proportion to population, was considerably higher than that obtaining in any other metropolitan borough. 40 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. The Housing Committee of the Borough Council has been Actively engaged in investigating possible sites in connection with further Housing Schemes and from time to time various schemes have been formulated by the Council and submitted to the Ministry of Health for Approval. The World's End Passage Improvement Scheme, 1927, is referred to elsewhere. Of the remaining schemes prepared and submitted to the Ministry, three have 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 forking classes. One scheme—that of Hortensia Road —was completed in May, 1925, and the buildings are now fully occupied. The remaining two schemes are in course of development. Details of each scheme are as follows :— (1) Hortensia House, Hortensia Road. This group of buildings, comprising an area of 1 acre, 12 poles, provides accommodation for 250 persons in 56 flats, namely 35 three-room and 21 four-room flats. The total cost of the site and buildings was £48,970. 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. Such 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 included under the term " working classes." (2) Wimsett Nursery Site Scheme. This site comprises an area of 1 acre. 3 roods and 28½ poles, situted towards the western extremity of the Borough and bounded by King's Road, Edith Grove and Tadema Road. It was purchased by the Borough Council in 1928 at a cost of £19,000. An additional small plot of land, 29¾ poles in extent, situated at the north-west corner of the site and necessary for the purposes of the Scheme, was subsequently purchased by the Borough Council at a cost of £4,000, of which the Guinness Trust contributed £2.000. With the consent of the Minister of Health, the Borough Council has leased the site to the Guinness Trust for a term of 99 years at a nominal rent and the Trust has agreed to erect working-class dwellings thereon, Preference as to tenancies to be given (a.) to persons residing in Chelsea and (b.) to persons employed in Chelsea. Plans for the buildings have been approved by the Borough Council, the London County Council and the Ministry of Health. They provide for the erection of four blocks of flats of five stories high, comprising a total of 160 flats, of which 41 contain four rooms, 78 three rooms, 40 two rooms, and one is a one-room flat. Each flat will have, in addition a scullery, bathroom and lavatory. 41 Perambulator sheds will be provided in the grounds, also a drying room for clothes, and a constant hot water supply at the boiler house. The area is admirably adapted for the erection of working class dwellings. The construction of these is being proceeded with rapidly and it is hoped that the additional housing facilities thus soon to become available will be of material assistance in meeting the needs of a large section unable to pay the rents at Hortensia Road. (3) Manor Street Site Scheme. This site comprises an area of 1 acre, 16 poles, situated centrally in the Borough, in close proximity to the Town Hall. The frontage is on the western side of Manor Street, its northern and southern boundaries being Wellington Street and Grove Buildings respectively. It was purchased by the Borough Council towards the end of 1928 at a cost of £19,000. With the consent of the Minister of Health, the Borough Council has leased the site to the Peabody Trust for a term of 99 years at a nominal rent and the Trust has agreed to erect working-class dwellings thereon, in accordance with plans to be approved by the Borough Council, the London County Council and the Ministry of Health. Details of this Scheme were under discussion at the close of the year and further reference to them will be made in this report next year. Reviewing the history of the past 30 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 situation 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. It will, however, be evident from the details already given that the existing shortage of housing accommodation in Chelsea is being most adequately dealt with and that the extremely difficult problems which confronted the Borough Council subsequent to the war are gradually being overcome. In this connection the invaluable services rendered by the present Mayor. (Mr. Alderman C. B. Clapcott, O.B.E., J.P.), and the present Chairman of the Housing Committee (Mr. Councillor E. B. Baggallay) will always be remembered with appreciation in the municipality. 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 42 cases when approached as to the desirability of having their names submitted to the County Council, with a view to provision of housing on 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 n ot 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 proportion of the 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. Thirty-nine 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. There has been a very definite improvement in housing conditions during the past three years. The constant vigilance of the Sanitary Inspectors has impressed upon both owners and tenants their determination that every dwelling house shall be maintained in a reasonable state of repair and that there shall be systematic observance of cleanliness. For some years past it was apparent that in a portion of the western district the houses were old, worn out and required constant repairs and renovations. This area, comprising World's End Passage and courts a butting thereon, about 1 acre 37 poles in extent, was during 1926, the subject of an official representation under the Housing Act, 1925. After full enquiry, the Minister of Health's order confirming the Scheme Was received by the Borough Council in March, 1928. Under the Scheme, as modified by the Minister of Health, the Council ar e to provide upon the site dwellings for the accommodation of 379 Persons of the working classes (approximately the number resident on the area). Arrangements have been made for the erection (on the cleared site) of four blocks of buildings comprising a total of 62 flats, of which 5 contain four rooms, 37 contain three rooms, and 20 contain 2 rooms. A provisional estimate of £50,000. to include cost of acquisition, clearance of the area and the erection of buildings thereon, has been approved by the Borough Council. All necessary work in connection with clearance of the area and construction of new buildings is now in operation. With the consent of the Minister of Health, the Borough Council has leased, for 99 years a nominal rent, to the Chelsea Housing Improvement Society, Limited—a public-spirited and practical body—a portion of the area. The site at the eastern end (that adjacent to the Embankment) was cleared first and the construction of the first block of buildings 43 on this site is now approaching completion. The Society has undertaken to construct working class dwellings in accordance with the lay-out plan and with building plans approved by the Borough Council, the London County Council, and the Ministry of Health. It has also been agreed that the Society shall have the management of the buildings on completion. During the process of reconstruction, the Borough Council have made arrangements for the management of the remaining properties on the area and the collection of rents, to be undertaken by the Association of Women House Property Managers, as agents of the Council. Another area in the north-western district of the Borough contains many houses which are old, worn out and require constant repairs and renovations. This area is already scheduled for reconstruction, but nothing has yet been done, owing to the operation of the Rent Restriction Acts and the very high commercial value of the site. 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 purposes 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. Fortunately, during the year this problem has been met by legislation. Under the London County Council (General Powers) Act, 1928, it is now possible to arrange for the removal of such cases to a suitable institution. While in the majority of instances 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 44 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. No action was necessary during the year in respect of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation. The total number of dwelling houses inspected for housing defects was 928, the number found not to be in all respects reasonably fit for human habitation being 753. The number rendered fit in consequence of informal action by the Sanitary Inspectors was 587 and the number in respect of which statutory notices were served requiring defects to be remedied was 166. No case came to the knowledge of the Department in the course of the year of underground rooms being illegally used for sleeping purposes. Appropriate action is taken in any such case. There were no applications under the Increase of Rent and Mortgage Interest (Restriction) Acts made by occupiers of dwelling houses, that houses occupied by them were not in a reasonable state of repair. 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 representation was made under the Housing Act during the year. No complaints that areas were unhealthy have been received. By-laws relating to Houses and Houses Let in Lodgings.— Existing by-laws relating to houses are, on the whole, found to be fairly satisfactory in their working. The new by-laws under Section 6 of the 1925 Housing Act, issued by the London County Council, will be of immense assistance in dealing adequately with present-day housing conditions when they become fully operative. Housing Survey.—House-to-house inspection was carried out during the year, as provided by statute, 116 houses being inspected and recorded by the Inspector. Statements have continued to appear 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. 45 SECTION V.—INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—In accordance with statutory enactments, the Council keeps a Register of persons 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 four 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. 22. Retail. Wholesale. Total. On Register, 31st December, 1927 85 85 - Vacated during the year 4 4 - Added during the year 4 4 - On Register, 31st December, 1928 - 85 85 There were 28 applications from 10 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. 23 shows the numbers of licences granted for the sale of milk under special designations during the past two years. 46 TABLE No. 23. Licences Granted under Milk (Special Designations) Order. 1927. 1928. Licences granted under Milk (Special Designations) Order. To sell "Certified" Milk 10 7 To sell "Grade A" Milk 1 - To sell "Grade A" (Tuberculin Tested)" Milk 6 11 To sell "Pasteurised" Milk 8 10 25 28 No samples of graded or other milk were submitted for bacteriological examination during the year. There were 96 inspections of dairies and milkshops made in the Borough. Notices were served requiring remedy of defects found on one 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 a dulterated milk will be found in the sub-section dealing with the Food a nd Drugs Acts. Ice-Cream Vendors. —At the end of the year, 26 premises were shown in the Register as places where ice-cream is prepared or sold. There were 30 inspections of these premises as compared with 31 in the Previous year. 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 ice-cream must notify the occurrence of infectious disease among their employees or persons living on their premises. The Act also pro- V ides that every itinerant vendor shall exhibit on his barrow the name an d address of the person from whom the ice-cream has been obtained. The foregoing legislative provisions enable a Sanitary Authority to exercise adequate control where the vendors and premises are known, but, inasmuch as ice-cream may be made under insanitary conditions on premises other than those where it is stored, it had long become a pparent that some system of compulsory registration was essential, applicable to all premises where the commodity is manufactured or stored or sold, and also to the itinerant vendors. Fortunately, this difficulty has now been largely met by the London County Council (General Powers) Act, 1928. Section 29 of this Act provides that Premises used for the manufacture, sale or storage of ice cream or other similar commodity shall be registered by the owner or occupier thereof 47 with the local sanitary authority. Appropriate penalties are provided for any offence against these provisions. Premises used as an hotel, restaurant or club are specifically exempted from the operation of this section, which is unsatisfactory in that complete control is thus not yet possible. 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. Bakehouses.—There are 26 bakehouses in the Borough and 39 inspections of these premises were made during the year. Four notices were served for the cleansing of walls and ceilings. Slaughter-houses.—There are now two private slaughter-houses in the Borough and 55 inspections of these premises were made during 1928. In compliance with the by-laws 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. 24. In January, 1928. In December, 1928. Registered - - Licensed 2 2 2 Total 2 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. 25 shows, for the past two years, the number of inspections of premises where food was prepared for or exposed for sale. 48 TABLE No. 25. Inspection of Premises where Food was Prepared or Sold. 1927. 1928. Nature of Premises. No. on Register No. of Inspections. No. on Register No. of Inspections. Cowsheds - - - - Slaughter Houses 2 76 28 26 32 90 62 2 55 Milk Shops 88 85 96 Ice Cream Premises 31 26 30 Bakehouses 27 39 26 Restaurant Kitchens 36 32 60 Food Premises (other than above) 102 90 100 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. During the year the number of animals inspected at the time of slaughter was 279 (59 pigs and 220 sheep). 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. Unsound Food. —On four occasions during the year unsound food was surrendered and destroyed. Included in the food surrendered was: — 17 stone of fish and five rabbits. No carcases were destroyed on account of Tuberculosis. Food Poisoning.—One case of food poisoning occurred during the year. Deceased was a boy aged eight years who died within an hour after admission to hospital, after having been taken ill on the previous day. At the post-mortem examination food poisoning was suspected by the pathologist and the matter was brought to the notice of the- Public Health Department. The intestinal organs were forthwith submitted to the Ministry of Health Laboratory and in due course a report was received stating that the bacillus of hog cholera (B. Aertrycke) —an established cause of food poisoning—was present in large numbers. A verdict was returned in accordance with this and other medical evidence, that the deceased had died from food poisoning. Despite searching enquiry, however, the source of the infection could not be traced. Sale of Food and Drugs Acts. —Four hundred samples, including 129 samples of milk and 5 samples of cream, were taken and submitted for analysis during the year. These samples were investigated by 49 the Public Analyst to the Borough Mr. B. H. Gerrans, F.I.C., whose Report is set out in the appendix. Each of the four 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. During the year one sample of milk was found adulterated to such a degree as to justify legal proceedings. These proceedings were dismissed on payment of costs, a warranty having been pleaded. Details of these proceedings are given in Table 26. The work carried out under the Food and Drugs Acts during the year is summarized in the Public Analyst's Report in the appendix. The Public Health (Preservatives, etc., in Food) Regulations. — 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 sufficient to warrant legal proceedings. Margarine Acts. —One application for registration was received during the year from a firm of wholesale dealers in margarine. After inspection of the premises, the necessary certificate was issued and the Ministry of Agriculture and Fisheries were so informed. TABLE No. 26. Magisterial Proceedings under Sale of Food and Drugs Acts DURING 1928. Street where Purchased. Offence. Result. Petty Sessions. Date of Hearing. Dismissed. (Warranty). £3 3s. costs. Beaufort Street 17-3-28 Selling milk from which 12% of Fat had been abstracted. Kensington 50 SECTION VI.—INFECTIOUS DISEASES. (a) Infectious Diseases Generally. DISEASES COMPULSORILY NOTIFIABLE IN THE BOROUGH. Acute Poliomyelitis. Diphtheria. Acute Polio-encephalitis Membranous Croup. Acute Encephalitis Lethargica. Dysentery. Acute Primary Pneumonia. Erysipelas. Acute Influenzal Pneumonia. Malaria. Cerebro-spinal Fever. Puerperal Fever and Puerperal Plague. Pyrexia. Anthrax. Relapsign Fever. Glanders. Small-pox. Hydrophobia. Typhus Fever. Cholera. Tuberculosis. Continued Fever. Scarlatina or Scarlet Fever. Ophthalmia Neonatorum. Typhoid or Enteric Fever. NOTIFICATIONS DURING THE YEAR. The total number of notifications, excluding duplicates, was 568. Of this figure, 81 were notifications of Pulmonary Tuberculosis and 20 of Non-pulmonary Tuberculosis. In addition, 493 cases of Measles c ame to the knowledge of the Department, mainly through the School Authority. Compared with the previous year, there was an increase of 28 in the number of notifications of Diphtheria. The number of notifications of Scarlet Fever (118), represents a decrease of 17 as compared with that for 1927, The notifications of Tuberculosis also show a decrease. In 1928. there were 9 deaths from non-notified Tuberculosis, while in 1927 there w ere 7 such deaths. Table No. 27 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: — 51 TABLE No. 27. Cases of Infectious Disease Notified during the Year. Cases notified in Chelsea. Removed to various Hospitals. At all Ages. Under 1 Year. 1-5 Years. 5-15 Years. 25-45 Years. 45-65 Years 65 and upwards. 15-25 Years. Small-pox 1 1 1 - - - - - - Cholera - - - - - - - - - 6 63 26 11 154 Diphtheria 155 49 - - 34 1 2 1 10 13 7 24 Erysipelas - 27 Scarlet Fever 118 20 60 10 1 109 - - Typhus Fever - - - - - - - - - 13 3 7 2 1 10 Enteric Fever - - - 3 3 Puerperal Fever Puerperal pyrexia - - - - - - 3 11 2 9 7 - - - - - Cerebro-spinal Fever - - - - - - - - - Ophthalmia Neonatorum Poliomyelitis 11 11 6 - - - - - - 2 3 3 - - - - - - Encephalitis Lethargica 1 1 1 - - - - - - Polio-encephalitis Malaria - - - - - - - - - 7 2 2 3 - - - - - - 1 Dysentery 1 1 - - - - - Acute Primary Pneumonia 103 12 27 14 7 16 22 5 75 Acute Influenzal Pneumonia 6 5 1 - - - - - - 43 14 393 467 30 101 137 69 73 Total Tuberculosis:- Pulmonary Non-Pulmonary 81 1 2 4 15 33 23 3 - 20 4 4 5 4 3 - - - Totals (Tuberculosis) 101 1 6 8 37 26 20 3 - Totals 568 145 89 69 - 31 107 110 17 No cases of Cholera. Typhus Fever, Cerebro-Spinal Fever, Polio-encephalitis, Continued Fever, Relapsing Fever, Plague, Anthrax, Glanders or Hydrophobia were notified during the year. DIPHTHERIA. Notifications.—During the year 155 cases of diphtheria were notified, as compared with 127 in the previous year. The incidence of the disease during the past two years is shown in Table No. 28. Deaths.—Four deaths from the disease occurred, all in the M.A.B. Hospitals. Two of the cases were under five years of age. 52 Return Cases. —Two "return" cases occurred during the year and necessary action was taken. TABLE No. 28. Cases of Diphtheria during the Years, 1927 and 1928. Percentage age of cases of School age (3-13 years) Month of greatest prevalence. Bacterioscopic Diagnosis, Lister Institute. Percentage age of Removals. als. Deaths Cases Notified. Case Mortality Rate. year. No. of Specimens submitted Positive Percentage age Positive. Negative. Percentage age Negative. 1927 127 96 4 3.1 56 Nov. 418 39 9.3 379 90.7 1928 155 99 4 2.6 54 Mar. 360 39 10.8 321 89.2 It will be observed that there was a slight increase in the number of cases notified in 1923. The percentage of removals to the M.A.B. Hospitals was high, while the case mortality rate was somewhat lower than that for 1927. Information was received from the M.A.B. that 18 of the cases sent to Hospital in the course of the year proved not to be suffering from diphtheria. Of the 155 cases notified, 35 occurred in Stanley Ward, 60 in Church Ward, 35 in Cheyne Ward, 15 in Hans Town Ward, and 10 in Royal Hospital Ward. During the year several cases were notified from the Infants' Ward of two Hospitals in the Borough. Thorough examinations of the drainage system of the Hospitals were 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. The following table shows the average annual case rate, case mortality rate, and percentage of cases removed to hospital in each of the quinquennial periods since 1911. TABLE No. 29. Average Annual case-rate per 1,000 population. Average Annual case-mortality rate. Average Annual percentage of cases removed to hospital. Quinquennial Periods. 1911-15 1.24 5.8 89 1916-20 92 1.35 8.9 1921-25 1.81 7.2 93 53 Diphtheria Anti-toxin.—Anti-toxin is supplied, in prophylactic and in curative doses, free of chaige 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 the year, eighteen bulbs of serum were supplied to medical practitioners, the cost to the Council being £8 19s. 7d. A s yet no application of the Schick test or of artifical immunization against the disease has been made in the Borough. SCARLET FEVER. Notifications. —During the year, 118 cases of Scarlet Fever were notified, the figure for 1927 being 135. Information was received from the M.A.B. Hospitals that 5 of the cases proved not to be Scarlet Fever- No "return" case of the disease occurred during the year. Table No. 30 shows the incidence of the disease during the past two years, while Table No. 31 cover the quinquennial periods since 1911. Deaths. —There was no death from Scarlet Fever during the year. TABLE No. 30. Percentage of Removals. Percentage of cases of School-age 3-13 years. Month of greatest prevalence. Case Mortality. Rate. Year. Cases Notified. Deaths. 1927 135 - 67 Oct. 93 - 1928 118 92 - - 62 May TABLE No. 31. Average Annual case-rate per 1,000 population. Average Annual Case-Mortality rate. Average Annual percentage of cases removed to hospital. Quinquennial Periods. 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. 54 MEASLES. 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 493, as compared with 318 in 1927. Deaths. —The number of deaths was 3. Two of the cases were under two years of age. Visiting and Nursing.—During the year, 623 visits and re-visits were made by the Health Visitors. Cases are also visited by the District Nurses whenever circumstances render this necessary. Three hundred and four nurses' visits were required in 1928. 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 97 cases were removed. In addition a large number were admitted to St. Luke's Hospital for treatment. ENTERIC FEVER. Notifications. —During the year the number of cases of Enteric fever notified in Chelsea was 13. Ten of these cases were treated in Hospital, the remainder being nursed at home. Nine were confirmed by bacteriological investigation to be suffering from Paratyphoid B while three were found to be suffering from true Typhoid Fever. In the remaining case bacteriological investigation did not confirm the clinical diagnosis. The single fatal case occurred in a male aged 18 years, the others being females between the ages of 22 and 55. The history of each case was thoroughly explored but it was found impossible to trace an unvarying causative factor between the various cases. Deaths.—There was one death from Enteric Fever during the year. A summary of Enteric and Para-Typhoid B. cases for the past two years is given below: — 55 TABLE No. 32. Enteric. Para Typhoid B. Year. Cases. Recovered. Fatal. Cases. Recovered. Fatal. 3 3 3 2 1 1927 - 1928 4 3 1 9 9 - Four specimens of blood were examined during the year for the Widal reaction, one specimen proved positive, and the remaining three negative. PNEUMONIA, MALARIA AND DYSENTERY. 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 109 Malaria 7 Dysentery 1 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 two years were as follows: — Notifications. Deaths. 1927 157 74 1928 109 50 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 malari a are supplied with sufficient mosquito netting; receive adequate quinin e treatment during the attack and subsequently; and receive appropriate advice as to precautions necessary to prevent the spread of the disease. Seven cases of Malaria were notified during the year. PUERPERAL FEVER AND PUERPERAL PYREXIA. Three cases of Puerperal Fever and 11 cases of Puerperal Pyrexia were notified during the year. Of these, 10 were treated in hospital. Further details of these cases are given on page 72. 56 OPHTHALMIA NEONATORUM. Eleven cases of ophthalmia neonatorum were notified during the year. Six of these cases were treated in hospital. In tabular form is shown below, as required by the Ministry of Health, the result of each case: — TABLE No. 33. Ophthalmia Neonatorum. Cases. Vision. Unimpaired. Vision Impaired. Total Blindness. Treated. Deaths. No. Notified. At Home. In Hospital. 5 6 10 1 - - 11 Eighteen cases of the disease were notified the previous year. Nursing.—By arrangement with the Chelsea District Nursing Association, home nursing is provided for infants suffering from this disease. INFLUENZA. Influenza caused 17 deaths in 1928, as against 41 in the previous year. There was no serious epidemic prevalence of the disease 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, where circumstances render this necessary. POLIOMYELITIS AND POLIO-ENCEPHALITIS. Three cases of Poliomyelitis were notified during the year. Two of these cases were treated in hospital. None of these proved fatal. No case of Polio-Encephalitis was notified. ENCEPHALITIS LETHARGICA. One case of Encephalitis Lethargica was notified during the year. Six visits to old cases of Encephalitis Lethargica were made by the Woman Sanitary Inspector during the year. 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. 34 is shown the numbers of cases notified in London and in Chelsea during the years 1927 and 1928. 57. TABLE No. 34. Cases Notified, in Chelsea. Removed to Hospital. Deaths notified during year in Chelsea. Cases notified in London. Deaths notified in London. Year. 149 1927 - 77 - - 1928 1† 1 1* 108 54 * Case notified in 1924. † Died in hospital. Death Certificate: (a) Cerebellar tumour. (b) Coma. SMALLPOX. One case of small pox was notified in Chelsea during the year, and appropriate action was taken. 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 past two years. These are shown in Table No. 35. The complete figures for 1928 are not yet available. TABLE No. 35. 1926. 1927. No. of primary vaccinations performed 766 766 No. of infants died unvaccinated 52 62 No. removed to other districts 34 46 No. removed to unknown addresses 36 57 No. postponed by medical certificate 17 12 No. of certificates of exemption issued 151 156 Small number of cases were insusceptible and outstanding in each year. (The above table is based on total births occurring in Chelsea and is not confined to parishioners). ARRANGEMENTS FOR DISINFECTION AND DISINFESTATION AND THE EXTENT OF THEIR USE. The Borough Council maintains a Disinfection 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, 58 if the work of the Department permits it, are carried out at the expense of the applicant. Fifty-five such disinfections were carried out during the year, the total charges amounting to £34 10s. 6d. The following Table No. 36 shows the work done by the disinfecting staff during the year. TABLE No. 36. Description. Number. Number of rooms or premises cleansed and disinfected 746 Number of Articles (bedding, etc.), disinfected 1337 Number of articles (various) destroyed 425 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 purposes of enabling such dwellings to be disinfected. During the year, three 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 the year, the Station was opened for the entire day on 87 occasions. The following Table No. 37 shows the number of attendances in each quarter:— TABLE No. 37. Quarter. March June September December No. of days on which the Station was opened Attendances. Verminous. Impetigo. 2 25 248 23 268 - 16 227 - 2 23 248 4 87 991 59 The amount recoverable from the London County Council, as th e School Authority, for the cleansing for the year is £99 6s. 0d. Seven adults were cleansed at the Station during the year. In addition there were seven adult attendances as a consequence of infection by Scabies or Impetigo. (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. Notifications. —The total number of notifications received was 156 but 55 of these related to cases which had been previously notified, so that the total number of new notifications was 101. In the previous year, the corresponding number was 129. The notifications received on forms C and D, i.e , notifications from institutions regarding admisson and discharge, are not included in the foregoing figures. In Table No-38 are shown, in the form required by the Ministry of Health, the detailed figures relating to new cases and mortality during the year. Included in this Table are 18 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. 38. Tuberculosis. New Cases and Mortality during 1928. New Cases. Deaths. Age Periods. Nonpulmonary. Nonpulmonary. Pulmonary. Pulmonary. M. F. M. F. M. F. M. F. 0-1 1 - 1 - 1 - 1 - 1-5 - 2 2 2 1 2 2 1 5-10 1 2 1 2 1 - - - 10—15 - 1 2 1 - - 1 3 - 2 3 4 1 1 - 15—20 5 20—25 2 8 2 2 - 5 - 1 25—35 12 15 2 3 9 9 2 - 35—45 7 6 - - 3 2 - - 45—55 11 4 1 - 6 3 - - 55—65 8 2 2 - 5 2 - - 65 and upwards 3 1 - - 8 - - 2 50 44 36 26 7 7 Totals 13 12 60 The death rate from all forms of Tuberculosis in Chelsea was 1.2 per 1,000. Of the total number of deaths (76) from all forms of Tuberculosis, nine died non-notified or prior to notification. The ratio of nonnotified tuberculosis deaths to total tuberculosis deaths was therefore as one is to eight. The corresponding ratio for 1927 was 1: 9. 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. 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 commencement 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 numbers of cases of Tuberculosis in the Borough on 31st December last was as follows:— TABLE No. 39. Males. Females. Total. Pulmonary 169 124 293 Non-pulmonary 33 35 68 202 159 361 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. 61 TABLE No. 40. Chelsea Tuberculosis Dispensary, Brompton Hospital. Work done during 1928. Pulmonary. Non-Pulmonary. Total. Adults. Children. Adults. Children. Diagnosis. Adults. Children. M. F. M. F. M. F. M. M. F. F. M. F. 15 - - A.-New cases examined during the year (excluding contacts) — I (a) Definitely tuberculous (b) Doubtfully tuberculous (c) Non-tuberculous 15 - 1 447 17 1 17 - - - 2 8 8 1 2 1 - - - - - - 74 127 126 76 - - - - 74 127 126 76 (B).-Contacts examined during the year:— 1 (a) Definitely tuberculous (b) Doubtfully tuberculous (c) Non-tuberculous 2 - - 2 2 2 - - - - - - 1 1 - - - - - - - - - - 10 12 39 30 12 39 30 - - - - 10 C. —Cases written off the Dispensary Register as: — (a) Cured (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) 2 - - - - - 1 2 - 1 - - 508 - 86 147 166 86 147 166 106 106 - - - (D).—Number of Persons on Dispensary Register on December 31st:- 1 (a) Diagnosis completed (b) Diagnosis not completed 75 7 7 204 6 102 74 1 1 2 1 6 104 1 2 8 1 - 2 8 - - - - - 1. Number of persons on Dispensary Register on January 1st 215 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 16 2. Number of patients transferred from other areas and of "lost sight of" cases returned 5 10. Number of consultations with medical practitioners : — (a) At Homes of Applicants 7 (b) Otherwise 49 3. Number of patients transferred to other areas and cases "lost sight of" 24 11. Number of other visits by Tuber- culosis Officers to Homes 33 4. Died during the year 27 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 3,479 5. Number of observation cases under A (6) and B (6) above in which period of observation exceeded 2 months 7 13. Number of:— (а) Specimens of sputum, etc., exam- ined 318 (б) X-ray examinations made in con- nection with Dispensary work 75 6. Number of attendances at the Dispensary (including Contacts) 2,834 14. Number of Insured Persons on Dispensary Register on the 31st December 127 7. Number of attendances of nonpulmonary cases at Orthopædic Out-stations for treatment or supervision - 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 11 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for (a) "Light" treatment — (b) Other special forms of treatment — 16. Number of reports received during the year in respect of Insured Persons:— (a) Form G.P. 17 8 (b) Form G.P. 36 1 (Signed) W. H. L. McCARTHY, Administrative Tuberculosis Officer. 62 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. 40 shows the work done by the Dispensary during the year, while Table No. 41 summarises, for the past two years, 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. 41. Work done at the Dispensary. Number of Persons examined for the first time. Definite Tuberculosis. Total attendances at Dispensary. Year. 1927 545 9 per cent. 3,307 1928 447 7 „ 2,834 In addition to the visits to homes of patients made by the Dispensary staff and recorded in Table No. 40, 52 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 604. 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 cases which terminated fatally during the year, 41 per cent. died in St. Luke's Hospital and 25 per cent. in other public institutions, that is to say 66 per cent, died away from their homes, the corresponding figure for 1927 being 75 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 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, 63 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 anæmia, 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 40 new cases at the homes of the patients, and 49 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 96, a decrease of 24 compared with the previous year. 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, patients are supplied with refills in connection with artificial pneumo-thorax treatment. Payment is 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 the year, the number of visits paid by Nurses to the homes of patients was 3,479, an increase of 348 over the number for the previous year. Fifteen 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, egg s, and butter. The total cost of extra nourishment (£24 15s. 6d.) w as borne by the Borough Council. The Council lent a bedstead and bedding to one case during the year. 64 Non-pulmonary Cases.—All cases in which special treament 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. Orthopædic Treatment. —In appropriate cases surgical boots and appliances, splints, crutches, spinal carriages, and wheeled chairs are supplied through the Invalid Children's Aid Association. Dental Treatment. —With the approval of the Ministry of Health arrangements have been made with the British Dental Hospital, 235, Hammersmith Road, W., for the provision of adequate dental treatment, including dentures, if necessary, for patients attending the Chelsea Tuberculosis Dispensary. In each case the certificate of the Tuberculosis Officer is required and dental treatment must be shown as necessary to render other treatment more completely efficacious. During the year sixteen patients thus received dental treatment. Bacteriological Examinations. —During the year, 318 specimens of sputum were examined in connection with the work of the Dispensary. In addition, 70 specimens were sent by medical practitioners to the Lister Institute for examination. 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 London County Council Chelsea Invalid Children's Aid Association Chelsea Board of Guardians Chelsea Charity Organisation Society Chelsea District Nursing Association Chelsea Health Society Brompton Hospital Local Panel Committee London Insurance Committee Local War Pensions Committee and United Services Fund Councillor Lady Phipps. Dr. A. W. Sikes (Divisional Medical Officer). Miss Paddon (District Organiser of School Care Committees). Miss Barff (After-Care Committee). Mrs. Rathbone and Miss Barcroft (Vice-Chairman). Dr. E. T. Holland. Miss Larken. Miss Page Mrs. Melville Miller. Miss Marx. Dr. A. M. Gibson and Dr. E. F. Thomas. W. E. Poole, Esq. Miss Forbes. 65 St. George's Hospital Lady Almoner. British Red Cross Society Miss Trench and Brig.-Gen. D. S. Dodgson, C.B., C.M.G. Ex-officio Members Dr. Leslie McCarthy (Chairman). Dr. W. J. Fenton (Tuberculosis Officer). Miss Tettenborn (Sanitary Inspector and Tuberculosis Visitor.) Hon. Secretary Miss Squire, Chelsea Tuberculosis Dispensary, Brompton Hospital, S.W. 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 the year the Care Committee met 11 times. Cases assessed 87 Reported admitted to L.C.C. Institutions 69 Temporary assistance arranged 22 Extra nourishment granted 15 Work found 6 Housing conditions improved 2 Children boarded out through L.C.C. Contact Scheme and otherwise 5 Convalescence 69 The total cost of extra nourishment to appropriate cases was £24 15s. 6d. 66 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 c oncerning the welfare of mothers and infants. (b.) The co-ordination of the work of the voluntary Maternity a nd 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 a nd Child Welfare Centres and Clinics for mothers, infants and young c hildren. (e.) The subsidisation of the local branch of the Invalid Children's Aid Association. (f.) 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 r ates, for necessitous Chelsea women. (j.) The provision of Convalescent Home accommodation for nu rsing mothers and infants. (k.) The supply of milk free or at reduced rates, for necessitous nursing and expectant mothers, infants and young children. (l.) 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. 67 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. 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. 42) gives an outline of the work of the Health Visitors and of the Chelsea Health Society and School for Mothers during the past two years. 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 (three whole-time Health Visitors). It does not include work done by voluntary workers attached to the Society. TABLE No. 42. Summary of Reports of Health Visitors. 1927. 1928. Number of homes visited (first visits), Infants 624 568 Number of revisits, Infants 2,427 2,452 3,470 Number of Infants' attendances at Infant Consultations 3,733 379 Number of visits to Children of one year to school age 390 Number of revisits to Children of one year to school age 3,296 2,987 Number of children of one year to school age, attendances at Medical Inspections 1,906 1,933 Number of ante-natal visits to Expectant Mothers: — Primi-para 82 95 206 Multi-para 201 489 488 Revisits Total 776 785 Number of ante-natal case-attendances at ante-natal clinic 428 318 Number of visits to Diarrhœa cases amongst children 5 25 Number of visits to cases of Ophthalmia Neonatorum 27 36 General additional visits in connection with the work 813 759 83 Number of visits re Whooping Cough 60 MATERNITY NURSES AND MIDWIVES. The arrangement made by the Borough Council for the provision of midwifery attendance have already been outlined in Sec. II of this 68 report. In the following Table No. 43 is shown, for the past two years the number of applications for midwifery attendance, the number Provided with such attendance, the amount of assessment on cases attended and the nett expenditure by the Council for this service:— TABLE No. 43. (1) No. of applications for services of (2) Total number provided with a Amount of Assessment on cases attended. (3) Nett Cost to Council. Year. Maternity Nurse. Midwife. Maternity Nurse. Midwife. Maternity Nurse. Maternity Nurse. Midwife. Midwife. £ d. £ d. £ d. £ d. s. s. s. s. 1927 2 49 1 42 9 39 0 10 0 24 5 1 0 0 6 3 1928 6 42 6 30 3 15 6 28 5 0 5 6 7 0 10 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. Home Helps are employed by the Borough Council for service in homes of necessitous women during confinement. A panel scheme is in operation under which selected women are placed upon a roster an d their services utilised in rotation. This system is found to be very successful in its working. The following Table No. 44 shows, for the past two years, 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. 44. 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. Year. d. £ s. d. £ s. 18 plus 5 extensions 9 plus 1 extension 1927 27 25 14 0 61 5 10 1928 22 12 15 0 27 5 0 *Grant from the Ministry of Health. 69 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. 45 shows, for the past two years, 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. 46 shows the conditions which necessitated attendance during the year 1928: — TABLE No. 45. Year. Visits. Cases. 1927 1,573 161 1928 2,026 148 TABLE No. 46. Nursed by District Nurses during 1928. Visits. Cases. Bronchitis 1 1 Burns 14 1 Circumcision 38 5 *Diarrhœa - — Eye trouble 241 10 Ear trouble 172 8 Influenza and Pneumonia (under 5) 87 8 Influenza and Pneumonia (over 5) 240 15 Impetigo 18 2 Meningitis and Peritonitis - - *Measles 304 23 *Ophthalmia Neonatorum 370 9 Pemphigus Neonatorum 75 4 *Poliomyelitis 11 1 *Puerperal State 160 11 Rickets 1 1 Septic sores 111 11 Tonsils and Adenoids 45 12 *Whooping Cough - - Worms 64 10 Miscellaneous 74 16 2,026 148 *Grant received from the Ministry of Health. 70 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 ac tivities during the past two years has been included in Table No. 42. The Society is controlled by a Voluntary Committee and is supported b y (1) voluntary contributions, (2) financial grants from the Ministry of Health and from the Borough Council. During the year four infant clinics were held weekly and one ante-natal clinic weekly. One infant c linic was held weekly at 484, King's Road, the remaining three 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) payments by patients and by pupils. 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 Executive Committee of the Home. There is an increasing demand for the Maternity beds, the number of in-patients dealt with having risen from 48 in 1926 to 58 in 1928. I am indebted to Miss A. Aldridge, the Matron of the Home, for the following information regarding the work done during the year: — Total cases attended during the year 217 Cases admitted and attended in the Home 58 Cases attended in the district 159 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 past two years is shown in Table No. 47. During the year ten 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 over 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. 71 TABLE No. 47. Nursing Mothers and Infants sent away under Council Scheme. Contributions by Mothers. *Nett Cost to Borough. Year. No. of Applications. £ s. d. £ s. d. 1927 32 7 12 6 24 12 0 13 1928 27 16 4 7 0 30 18 0 *Grant from the Ministry of Health. CHELSEA BRANCH OF THE INVALID CHILDREN'S AID ASSOCIATION. During the year the branch had 158 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. Fifty-four children were sent out of London for convalescence, for periods varying from six weeks to six months. Seven children had hospital treatment arranged for them. Fifty-five children 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. Twelve children requiring surgical appliances, such as surgical boots, calliper splints, umbilical belts, etc., were provided with what was necessary. Several children were given warm clothing, boots, etc., and fares for children and escorts were paid whenever necessary. All children were specially visited after convalescence and friendly supervision and advice was 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 was £329 18s. 10d., towards which sum parents contributed £97 19s. 5d. leaving a balance of £231 19s. 5d. to be raised by the Chelsea Branch. CHELSEA DAY NURSERY. The attendances at the Nursery during the past two years were as follows:— 72 TABLE No. 48. 1027. 1928. Total number of children attending during the year 6,268 4,868 Average daily attendance (5 days a week) 24 19 Total number of individual children who attended 107 98 The health of the Nursery has been remarkably good. Dr. Margaret Emslie is Medical Officer to the Nursery and makes a fortnightly inspection of the children. PUERPERAL FEVER AND PUERPERAL PYREXIA. Three cases of Puerperal Fever and eleven cases of Puerperal Pyrexia were notified during the year. Of these ten were treated in hospital. None of these proved fatal. PREGNANCY AND CHILDBIRTH. Three deaths associated with complications in childbirth occurred during the year. Two of the deaths followed Caesarian section operation in Hospital. The third case had refused midwifery assistance but was removed to Hospital one hour after delivery of a still-born child, owing to the development of severe eclampsia. Death supervened within 24 hours. MATERNAL MORTALITY. The following table shows the Maternal mortality in Chelsea during the past two years. TABLE No. 49. Death-rate per 1,000 Births. Year. Other complications of Pregnancy and Childbirth. Total Death-rate. Puerperal Fever. 2.32 1.16 3.48 1927 1928 - 3.73 3.73 (The slight apparent increase in the total death-rate in 1928 is due to a decrease in the number of births in the Borough.) 73 During the year further efforts were made to ensure that in Chelsea still better results will accrue from the measures already in operation to diminish the risk involved in childbirth. The valuable reports by Dame Janet Campbell issued by the Ministry of Health. have 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. Whereever 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 the Metropolitan Borough Councils have made special arrangements. The Ministry of Health has also provided for the admission of cases to certain of the M.A.B. Hospitals. Some patients, however, are unwilling to enter an institution situated at any considerable distance from their homes. With the sanction of the Ministry of Health, the Borough Council made arrangements during the year for the services of a skilled obstetric consultant in puerperal cases when desired by the medical practitioner in attendance. 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 Antenatal 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 childbirth 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. 74 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 the past two years, the extent of this service:— TABLE No. 50. Milk Orders issued and taken up. Year. *Approx. Cost. March quarter. June quarter. Sept. quarter. Dec. quarter. *Total. £ 1927 450 398 305 393 1,546 310 1928 448 395 332 427 1,602 344 *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. 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. 75 Metropolitan Borough of Chelsea. Annual Report OF THE PUBLIC ANALYST For the Year ended 31st December, 1928. BY B. HENRY GERRANS, F.I.C., Public Analyst. 76 Town Hall, Chelsea, S.W. 3. To the Mayor, Aldermen and Councillors, of the Metropoltian Borough of Chelsea. Mr. Mayor, Ladies and Gentlemen, 1. During the year ended on the 31st December, 1928, four hundred samples of Food and Drugs were submitted to me for analysis by the Inspectors appointed under the Acts. Forty 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 Genuine Composition or Not Adulterated. Adulterated. Inferior. Name of Sample. Total. " Formal." "Informal." "Formal." "Informal." "Formal." "Informal." - Milk 124 3 1 1 - 129 Cocoa 23 - - - 23 - - Butter 22 - - - - 22 - Margarine 18 1 19 - - - - Mustard Mixture Baking Powder Lard 12 - - 12 - - - 11 - - 11 - - - 10 - - - 10 - - Coffee 10 10 - - - - - Tea 12 1 13 - - - - Sugar 7 - - 7 - - - Pepper 7 - - - 7 - - Custard Powder - 7 - - - - 7 - Coffee and Chicory Mixture 6 - - 6 - - Sausages 6 - - - - 6 - Spice 6 1 5 - - - 6 - Whisky 6 - 4 - - 1 - - Wood Vinegar - 5 - - - 77 Genuine Composition or Not Adulterated. Adulterated. Inferior. Total. Name of Sample. "Formal." "Informal." "Formal." "Informal." "Formal." "Informal." - Dried Green Peas Self-raising Flour Cream 5 - - - - 5 4 - 5 1 - - - 5 - 5 - - - - Fish Paste - 5 - 5 - - - - Ground Almonds Flour 5 - - - 5 4 - 4 - - - - - Bi-carbonate of Soda - 4 - 4 - - - - Cornflour 4 - 4 - - - Sponge Cakes - 3 1 - - 4 - Ground Rice 4 4 - - - - - Rice 3 - - 3 - - - Shredded Suet Machine-skimmed Condensed Milk 3 - - 3 - - - - - 3 2 1 - - Tinned Fruit 3 - - - 3 - - Raisins 2 1 - 3 - - - Lemonade Powder Tapioca 1 1 - - - 2 - - 2 2 - - - - Sponge Mixture Salad Cream 2 - 2 - - - - 2 - - 2 - - - Tinned Salmon Blancmange Powder - 2 - - - 2 - 2 - - - 2 - - - "Quaker Oats" 2 - - - 2 - 1 Malt Vinegar 1 - - - - - Epsom Salts 1 1 - - - - - Mustard 2 2 - - - - - Dripping 1 - - - - - 1 Groats 1 - - - 1 - - Honey 1 - 1 - - - - Meat Paste 1 - 1 - - - - Corned Beef 1 1 - - - - - - Sardines - 1 - - 1 - Flaked Rice 1 1 - - - - 1 - "Cakeoma" - - - - - 1 Tomato Ketchup 1 - 1 - - - - Chocolate - 1 - 1 - - - Sultanas 1 - 1 - - - - Semolina 1 1 - - - - - ”ltine” 1 - - 1 - - - Jam 1 - - 1 - - - Mincemeat 1 - - - - 1 - - 1 ”Gravy Thick” Tapioca Flakes ”Bisto” 1 - - - - 1 - 1 - - - - 1 - - - 1 - - - Ground Ginger 1 - - - - 1 - Pea Flour 1 - - - - 1 - Curry Powder 1 - - 1 - - - 1 Brandy - 1 - - - 1 Port 1 - - - - - - 400 Totals 357 40 1 2 - 78 4. The percentages given by the data in Table I. are as follows:— Genuine Composition 99.25 per cent. Adulterated 0.75 per cent. MILK. 5. The particulars relating to the two samples of Milk reported as adulterated are given in Table II. TABLE II. No. Percentage of Extraneous Water. Percentage of required Fat deficient. ”reservatives. Remarks. - - 1 12 - - - 2 5 ”formal.” 6. The remaining 127 samples submitted 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," 33 being of "Good" quality, 81 of "Fair" quality, and 13 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 Quality. 3.85 to 3.8 „ „ Fair Quality. „ 3.8 and over „ „ Good Quality. TINNED FRUIT. 8. Two of the samples contained slight traces of tin, insufficient in amount to cause injury to health. 9. The presence of Salts of Tin in canned Foods is due to the solvent action of the natural acid of the fruit or vegetable upon the tinned surface of the containing vessel. These Salts are not added directly to the food material as is the case with Copper Salts, when the latter are used for the purpose of imparting a bright green colour to peas and other vegetables. Salts of Tin have an irritant action on the gastro-intestinal tract and their presence in a food would therefore tend to render such food injurious to health. 79 BUTTER. 10. The 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. Boric Acid was not present in any case. The use of Boric Acid in Butter is forbidden by the Preservatives Regulations. MARGARINE. 11. All the samples of Margarine were reported as genuine, and Boric Acid was not detected in them. 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). CUSTARD POWDER. 12. Under existing circumstances adulteration could not be certified with respect to the samples of "Custard Powder." They consisted of starch containing a slight amount of colouring matter, and were practically devoid of egg or other proteid material. At present there is no official or generally recognised definition respecting the composition of articles sold as "Custard Powder." COFFEE AND CHICORY MIXTURE. 13. The six samples submitted were all certified to be genuine. They contained the following percentages of Chicory respectively:- 40, 37, 35 (three samples), and 34; the descriptions applied to the articles were therefore justified. SAUSAGES. 14. Three of the samples of Sausages were found to contain very slight traces of sulphur di-oxide. The, amounts present in each case being well below the limit of the Regulations. DRIED GREEN PEAS. 15. These samples consisted of green peas dried, and they retained, to some extent the natural colour of the fresh peas; they were free from addition of copper salts. LEMONADE POWDER. 16. The sample was found to consist chiefly of sugar, acidified with citric acid, and flavoured with lemon, the mixture being coloured with an aniline dye. 80 DRIED FRUIT. 17. One of the samples of Raisins contained a slight trace of Sulphur di-oxide, but the amount was well under the limit allowed in the Regulations for this preservative. FLOUR. 18. One of the samples contained a slight trace of persulphate, but the amount was too small to cause the sample to be regarded as injurious to health. Persulphates are added to flour as their presence are stated to "Improve "it, and thus to enable an inferior flour to pass as of higher grade. 19. The remaining samples mentioned in Table I. 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. THE FOOD AND DRUGS ACT, 1928. 21. This Act repeals and consolidates the various provisions of the Sale of Food and Drugs Acts from 1875 to 1927, and it also contains a number of amending provisions which were present in the Milk and Dairies Act, 1915. Authorities who administer the Act are now referred to as "Food and Drugs Authorities," and Officers who procure samples under the Act are described as "Sampling Officers." The Act came into force on the 1st January, 1929. PUBLIC HEALTH (PRESERVATIVES, ETC., IN FOOD) AMENDMENT REGULATIONS, 1926. 21. There were no cases of infringement of the above Regulations during the year. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, B. HENRY GERRANS, F.I.C. Public Analyst.