CHE 33 Metropolitan Borough of Chelsea. Annual Report of the Medical Officer of Health for CHELSEA. 1929 BY w. h. leslie McCarthy, D.S.O., M.C. ; M.A. ; M.D., M.R.C.P., D.P.H. Barrister-at-Law. MEDICAL OFFICER OF HEALTH. London : shield and spring, printers, 26-28, lancelot place, bromfion" road, s.vv. 1. 1930. 2 Public Health, Maternity and Child Welfare Committee, At 31st December, 1929. Her Worship the Mayor (Councillor Lady Phipps, J.P.). Councillor F. G. Chambers [Chairman). Alderman C. B. Clapcott, O.B.E. Alderman F. J. Synge. Councillors : A. Bayf.s. E. Milnes Gaskell, J .P. The Right Hon. The Earl Miss C. L. Paterson. of Cranbrook. q m. Stevenson. E. W. Hall. „ „ c- ,, T TT Mrs. C. Stewart-Moore. Mrs. M. I. Hewitt. A. F. Loveridge. Mrs. F. L. C. Walter. Sir E. L. Meinertzhagen, J .P. Mrs. P. C. M. Worsthorne. (one vacancy). Housing Committee. Her Worship the Mayor (Councillor Lady Phipps, J .P.). Councillor E. B. Baggallay [Chairman). Alderman C. B. Clapcott, O.B.E. Alderman F. W. Proctor, J.P. Alderman A. C. Seton Christopher. Alderman F. J. Synge. Councillors : The Right Hon. The Earl Mrs. F. M. Snowden, O.B.E. of Cranbrook. Mrs. C. Stewart-Moore. E. W. Hall. Mrs. F. L. C. Walter. B. F. Marsden-Smedley. Mrs. P. C. M. Worsthorne. Miss C. L. Paterson. Milk and Welfare Sub-Committee. Her Worship the Mayor (Councillor Lady Phipps, J.P.). Councillor Miss C. L. Paterson [Chairman). Alderman C. B. Clapcott, O.B.E. Councillor F. G. Chambers. 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 (c.) Deaths 11 (d.) Deaths of Children, 1-5 years of age 16 (e.) Infant Mortality 16 (/.) Illegitimate Deaths 18 Poor Law Relief in the Borough 18 Utilization of Hospital and other forms of Gratuitous Medical Relief 18 Causes of Sickness in the Borough 19 II.—Provision of Health Services in the Borough. Hospitals 20 Institutional Provision for Unmarried Mothers 20 Ambulance Facilities 20 Clinics and Treatment Centres 20 (a.) Chelsea Health Society and School for Mothers 20 (b.) Chelsea Day Nursery 21 (c.) Chelsea Tuberculosis Dispensary 21 (d.) Invalid Children's Aid Association 22 (e.) The Babies'Club 22 (/.) Charity Organisation Society .22 Public Health Officers of the Borough Council 23 Nursing Arrangements 25 (a.) Professional Nursing in the Home 25 (6.) 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 Magisterial Proceedings under Public Health (London) Act, 1891 31 Smoke Abatement 32 Fouling of Foot-paths by Dogs 32 Rats and Mice (Destruction) Act 32 Pigeons, Nuisance caused by 33 Factories, Workshops and Workplaces 33 Public Mortuary 35 Rag Flock Act 36 Offensive Trades 36 IV.—Housing. Housing Statistics 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 Fried Fish Vendors 47 Bakehouses 47 4 PAGE Slaughter-houses 47 Other Premises where Food is Prepared or Offered for Sale 47 Public Health (Meat) Regulations, 1024 48 Unsound Food 48 Food Poisoning 48 Food and Drugs (Adulteration) Act, 1928 48 The Public Health (Preservatives, etc., in Food) Regulations 40 Margarine 49 Magisterial Proceedings under Food and Drugs (Adulteration)Act, 1928 49 VI.—Infectious Disease. (a.) Infectious Diseases Generally 50 Diseases notifiable in the Borough 50 Notifications 50 Diphtheria 51 Scarlet Fever 53 Measles 54 Enteric Fever 54 Pneumonia, Malaria and Dysentery 55 Puerperal Fever and Puerperal Pyrexia 55 Ophthalmia Neonatorum 56 Influenza 56 Poliomyelitis and Polio-encephalitis 56 Encephalitis Lethargica 56 Chicken Pox 57 Smallpox and Vaccination 57 Venereal Disease 58 Disinfection 58 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 61 Chelsea Tuberculosis Scheme 61 Dispensary and Institutional Facilities for Treatment 63 Co-operation with Hospitals and I.C.A.A. 63 Co-operation with School Medical Service 64 Co-operation with Medical Practitioners 64 Home Contacts 64 Artificial Pneumothorax Treatment 64 Home Nursing 64 Extra Nourishment 64 Non-pulmonary Cases 64 Orthopaedic Treatment 64 Dental Treatment 65 Bacteriological Examinations 65 Care and After-care Work 65 VII.—Maternity and Child Welfare. General Arrangements in the Borough 67 Health Visitors 67 Maternity Nurses'and Mid wives 68 Home Help 69 Home Nursing 70 Clinics and Treatment Centres 71 Ormond Maternity Home 71 Convalescent Home Treatment for Nursing Mothers and Infants 71 Chelsea Branch of the Invalid Children's Aid Association 72 Chelsea Day Nursery 72 Puerperal Fever and Puerperal Pyrexia 73 Other Diseases and Complications of Childbirth 73 Maternal Mortality 73 Ante-natal Work 74 Supply of Milk to Mothers and Young Children 74 Widows', Orphans' and Old Age Contributory Pensions Acts, 1925 and 1929 75 Appendix. Report of the Public Analyst for 1929 78 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Chelsea. Madam Mayor, Ladies and Gentlemen, I have the honour to submit the Annual Report on the health ' the Metropolitan Borough of Chelsea for 1929. 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 expected to deal with the sanitary circumstances, the sanitary administration, 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 62,680 a figure which is below that for last year. The birth rate (11*7) is lower than that for last year (12-6). The marriage rate (11'01) is higher than that for last year (10-5). The death rate (15-7) is higher than that for London generally (13-8) and compares with 13-5 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 Boroughand that one-half of all deaths in Chelsea occur in persons over 65 year of age. The infant mortality rate was 70 as compared with 48 last year. In London generally, the infant mortality rate was also high In Chelsea, as elsewhere, the increased mortality was due in part to greater incidence of whooping cough, enteritis and pneumonia and also to the reduced number of births. The total incidence of notifiable infectious disease was increase last year, mainly owing to an incre'ased number, of cases of pneumonia and scarlet-fever. The number of cases of diphtheria and'erysipelas remained about the same. At the end of the year there were 283 cases of pulmonary tuberculosis and 59 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 centres were 6,609, and 7,560 visits to homes of patients were re-corded I continue to receive must valuable assistance from the Chelsea Health Society, and cannot speak too highly of the efficiency of the Society's work. " 6 Section III. of the report deals with Sanitary Administration. The statistics indicate that constant attention is devoted to the improvement of housing accommodation in the Borough. Although to less extent than in other Metropolitan Boroughs, this side of the work of the department is frequently hampered by the inadequate number of houses available. 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 at the close of the year the new buildings in King's Road, erected by the Borough Council, in conjunction with the Guinness Trust, were completed. In addition, further progress was made in connection with the Council's Improvement Scheme for 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. Progress was also made in connection with the Manor Street Housing Scheme. 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. With deep regret I have to record the death from meningitis following empyema, on February 4th, 1930, of Mr. J. C. Goodwin, Sanitary Inspector. Mr. Goodwin joined the staff in 1926 and had discharged his duties faithfully and well. He was invariably courteous and obliging, and whole-heartedly devoted to his work. I should like 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, Madam 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, 1929. SECTION I.—NATURAL AND SOCIAL CONDITIONS OF THE BOROUGH. GENERAL STATISTICS. TABLE No. 1. Area (acres) 660 Population:— (Census, 1921) 63,700 (Estimated, 1929) 62,680 Number of Inhabited Houses, 1921 10,355 Number of families or separate occupiers, 1921 16,555 Rateable value, October, 1929 £1,090,014 Sum represented by a penny rate, October, 1929 £4,397 Physical Features and General Character of the Area.—The Metropolitan Borough of Chelsea, situated near the centre of the Metropolis, is bounded on the north by the Royal Borough of Kensington, on the west by the Borough of Fulham, on the east by the City of Westminister, and on the south by the river Thames. It is a small compact borough, less than two miles in length by about three-quarters of a mile in width. Over nearly the whole area the soil consists of gravel and sand, highly permeable to water. In a small portion of the western side of the Borough there is a thin loamy deposit of brick earth resting upon the gravel. There is a narrow strip of alluvial deposit extending along the Embankment from Battersea Bridge westwards. The northern portion of the area is largely built over. The central zone comprises a number of pleasant squares occupied by people in affluent circumstances. The grounds of the Royal Hospital, with the river Thames and Battersea Park beyond, render the southern zone unusually open. Social Conditions.—The density of population (number of persons per acre), as shown by the 1921 Census, is 97, the corresponding figure for London, as 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 664 Births—Illegitimate 72 736 Birth Rate 11.7 Still-births 26 (a.) Legitimate 22 (b.) Illegitimate 4 Deaths 983 Death Rate 15.7 Number of women dying in, or in consequence of childbirth 7 (a.) From sepsis 8 (b.) From other causes 4 Deaths of infants under one year 52 (a.) Legitimate 43 (b.) Illegitimate 9 Infantile Mortality Rate 70 Deaths from Measles (all ages) 2 Deaths from Whooping Cough (all ages) 12 Deaths from Diarrhæa (under 2 years) 8 Zymotic Death Rate 0.4 Deaths from the Zymotic Diseases 28 Tuberculosis Death Rate 0.86 BIRTHS. During the year 902 births were registered in Chelsea, 447 being boys and 455 girls. Of these, births of non-parishioners account for 352, (175 boys and 177 girls), and must be deducted. In addition, there were 186 births amongst Chelsea mothers in Lying-in Hospitals and elsewhere outside the Borough, 99 boys and 87 girls. The total number of Chelsea births for the year was 736 of which 371 were males and 365 females. The following Tables are self-explanatory 9 TABLE No. 3. Births and Birth-rate. Year. Births. Birth-rate per 1,000. Birth-rate London. 1928 805 12.6 15.9 1929 736 11.7 15.7 TABLE No.4. Births in Wards. Year. Hans Town. Royal Hospital. Church. Cheyne. Stanley. Total. 1928 103 79 125 130 368 805 1929 96 71 134 97 338 736 TABLE No.5. Notification of Births Act, 1907. Notification of Chelsea Births (Live and Stillborn) Received During the Years 1928 and 1929. 1928. 1929. Living Children 583 510 Still-born Children 15 15 598 525 Notified by Medical Practitioners 144 128 „ St. George's Hospital, Extern. Department 19 7 „ Midwives 284 244 „ Chelsea Institution 129 131 „ Parents, etc. 22 15 598 525 Percentage of notified births of Chelsea residents registered in the Borough 95 95 10 TABLE No. 6. Inward Transfers (1929). Confinements in Hospitals outside the Borough 133 Confinements in Nursing Homes outside the Borough 37 Confinements in private residences outside the Borough 16 186 From Table No. 3 it will he observed that the number of births of Chelsea Infants in Hospitals and elsewhere outside Chelsea accounted for 25-3 per cent, of the total births. In the preceding year the percentage was 22.0. Chelsea births in Hospitals outside the Borough were distributed during the year as follows:—St. George's Hospital, 63; Oueen Charlotte's Hospital, 26; General Lying-in Hospital, 10; Royal Free Hospital, 4; Clapham Maternity Hospital, 4; Charing Cross Hospital, 4; Westminster Hospital, 3; City of London Institution, 3 ; Middlesex Hospital, 2 ; Royal Northern Hospital, 2 ; St. Thomas's Hospital, 2 ; Miscellaneous Hospitals, 10. Chelsea births in Hospitals and Homes within the Borough during the year numbered 174. These were distributed as follows :—St. Luke's Hospital, 134 ; Ormond Maternity Home, 21 ; St. Stephen's Hospital, 4 ; Wilbraham Nursing Home, 9 ; Chelsea Hospital for Women, 3 ; Illegitimate Births.—The following Table shows the number of illegitimate births and the illegitimate birth rate per 1,000 births. In 1929, 155 such births were registered in Chelsea, and 28 inward transfers and 111 outward transfers were made by the Registrar General. The nett figure for the Borough is therefore 72, of which 41 were under observation by the Health Visitors at the end of the year. TABLE No. 7. Year. Number of Illegitimate births. Illegitimate birth rate per 1,000 births. 1928 73 90.7 1929 72 97.8 Stillbirths.—During the year 25 stillbirths were registered in Chelsea, 18 being males and 12 females. Of these, still-births of non-parishioners account for 6 (3 males and 3 females) and must be deducted. In addition, there were 7 still-births amongst Chelsea mothers outside the Borough (6 males and 1 female). The total number of still-births for the year Was 26, of which 16 were males and 10 females. Four of the total number were illegitimate. MARRIAGES. There were 692 marriages registered in the Borough during the year (671 in 1928). The marriage rate (number of mairiages per 1,000 of 11 population) was 11.04. In the preceding year the marriage rate was 10.5. DEATHS. The total deaths registered in the Borough during the year were 1,964. Transferable deaths of non-residents registered in the Borough numbered 1,163, and are to be deducted. In addition, there were 182 deaths of Chelsea residents in Institutions and elsewhere outside the Borough. The nett Chelsea deaths were therefore 983 and the death rate was 15.7 per 1,000. The death rate for England and Wales was 13.4, for London 13.8, and the mean death rate for the 107 Great Towns was 13.7. 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. 1928 861 13.5 1929 983 15.7 The seasonal mortality in the four quarters of 1929 was as follows:— First quarter, 26.4; second quarter, 13.6; third quarter, 11.2; fourth quarter, 11.6. The 1921 Census Returns show that there is a considerably higher percentage of persons of advanced age living in Chelsea than in any other Metropolitan borough. In London generally 7.7 per cent, of the total population are included in the age-group 55-65, and 5.8 per cent, in the age-group 65 and upwards. In Chelsea 9-2 per cent, of the total population come within the age group 55-65, while no less than 8-8 per cent, constitute the age-group 65 and upwards. These facts must be borne in mind in any analysis of the Chelsea mortality rate, as they are naturally reflected in the death returns. Thus, in 1929, deaths of pensioners in the Royal Hospital, Chelsea, accounted for 76 deaths, inward transfers included (equivalent to 1.2 of the death rate). DEATHS IN PUBLIC INSTITUTIONS. In tabular form is shown below the number of deaths of Chelsea residents which took place in various Institutions during the year. Of the 801 Chelsea deaths registered in the Borough 461 occurred in Institutions within the Borough. 12 TABLE No. 9. Hospitals or Institutions within the Borough. Number of Deaths St. Luke's Hospital and Chelsea Institution 355 Royal Hospital for Pensioners 69 Cancer Hospital 18 Victoria Hospital for Children, Tite Street 8 St. Stephen's Hospital (Westminster Infirmary) 7 Brompton Hospital 1 Chelsea Hospital for Women 2 Cheyne Hospital for Children — Freemasons Hospital — St. George's Home for Tuberculosis 1 461 Of the 1,163 deaths of non-residents registered in Chelsea, 1,138 occurred in the foregoing Institutions. The deaths (182) of Chelsea residents in Institutions and elsewhere outside the Borough were distributed as under:— General Hospitals 58 Mental Hospitals 17 Special Hospitals 22 Infectious Disease Hospitals 5 Tuberculosis Sanatoria, etc. 9 Nursing Homes 39 Poor Law Institutions 11 Private Addresses, etc. 21 The following Tables are self-explanatory:— TABLE No. 10. Birth Rate, Death Rate, and Analysis of Mortality During the Year 1920. (Provisional figures. The rates for England and Wales have been calculated on a population estimated to the middle of 1929, but those for the towns have been calculated on populations estimated to the middle of 1928. 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. ) - Rate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Live Births. Percentage of Total Deaths. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhæa and Enteritis (under Two years). Total Deaths under One year. Certified by Registered Medical Practitioners. Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death Live Births. Still Births. England and Wales 16.3 0.68 13.4 0.01 0.00 0.08 0.02 0.15 0.08 0.74 0.55 8.1 74 91.5 6.1 1.5 0.9 107 County Boroughs and Great Towns, including London 16.6 0.69 13.7 0.01 0.00 0.12 0.02 0.19 0.09 0.76 0.50 10.9 79 91.8 5.8 1.9 0.5 157* Smaller Towns (1921 Adjusted Populations 20,000-50,000) 16.0 0.71 12.3 0.01 0.00 0.06 0.02 0.15 0.07 0.71 0.45 5.9 69 92.6 5.4 1.0 1.0 London 15.7 0.53 13.8 0.01 0.00 0. 04 0.02 0.26 0.08 0.69 0.56 10.7 70 89.5 6.8 3.7 0.0 Chelsea 11.7 0.41 15.7 0.01 0.00 0.03 0.00 0.19 0.05 1.18 0.64 10.9 70 89.0 5.9 5.1 0. 0 * By the extension of Uxbridge U.D. on the 1st April, 1929, the number of Smaller Towns was increased to 157. 14 TABLE No. 11. Deaths of Chelsea Residents Registered during the Year 1929, classified by Age and Cause. (In accordance with Registrar General's Return). Causes of Death. Nett Deaths, whether occurring within or without the borough. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and under 75 years. 75 and upwards. All Causes 983 52 14 12 14 22 93 244 255 277 1. Enteric Fever 1 - - - - - - - 1 - 2. Small-pox - - - - - - - - - - 3. Measles 2 — 1 — 1 — — — — — 4. Scarlet Fever - - - - - - - - - - 5. Whooping Cough 12 4 4 2 2 - - - - - 6. Diphtheria 3 — — 2 - — — 1 — — 7. Influenza 74 — 1 1 1 1 7 15 23 25 8. Encephalitis Lethargica - - - - - - - - - - 9. Meningococcal Meningitis - - - - - - - - - - 10. Tuberculosis of Respiratory System 45 - 9 15 17 4 - 11. Other Tuberculous Diseases 9 1 — 2 1 — 2 2 1 - 12. Cancer, malignant disease 134 — — — — 1 11 49 43 30 13. Rheumatic Fever — — — — — — — — -— — 14. Diabetes 3 - - - - - - 1 2 — 15. Cerebral Hæmorrhage, etc. 43 - - - - - - 7 21 15 16. Heart Disease 227 — — — 1 2 3 46 71 104 17. Arterio-sclerosis - - - - - - — 6 12 15 18. Bronchitis 43 1 — — — — 5 9 11 17 19. Pneumonia (all forms) 86 10 4 3 - 1 9 29 15 15 20. Other Respiratory Diseases 1 1 — 1 — — — 1 2 6 1 21. Ulcer of Stomach or Duodenum 8 - - - - - 2 6 - - 22. Diarrhæa, etc. 10 8 — — — — 1 1 — — 23. Appendicitis and Typhlitis 4 — — — 1 1 1 — 1 - 24. Cirrhosis of Liver 6 - - - - - 1 4 1 - 25. Acute and Chronic Nephritis 24 - - - - - 1 9 8 6 26. Puerperal Sepsis 3 - - - - - 3 - - - 27. Other accidents and diseases of Pregnancy and Parturition 4 - - - - 1 3 - - - 28. Congenital Debility and Malformation, Premature Birth 20 19 1 - - - - - - - 29. Suicide 13 — — — — 1 3 6 2 1 30. Other Deaths from Violence 27 1 1 — 3 3 6 7 3 3 31. Other Defined Diseases 137 8 1 2 4 2 19 27 30 44 32. Causes ill-defined or unknown 1 - - - -- - - - - 1 983 52 14 12 14 22 93 244 255 277 15 CAUSES OF DEATH. Tabic No. 11 shows that 227 deaths were due to Organic Heart Disease, 134 to Cancer, 43 to Bronchitis, 86 to Pneumonia, 45 to Pulmonary Tuberculosis, 33 to Arterio-sclerosis, 43 to Cerebral Hemorrhage, 74 to Influenza and 20 to Congenital Debility and Malformation. Fiftyfour per cent, of all deaths occurred in persons over 65 years of age. Organic Heart Disease.—Of the 227 deaths from cardiac diseases, 175 were in persons over the age of 65 years. In 1928, there were 199 deaths from Heart Disease, 148 being persons over the age of 65 years. Cancer and Malignant Disease.—There were 134 deaths from Cancer during the year, as against 128 in 1928. Eleven of the deaths were between the ages of 25 and 45 ; 49 between the ages of 45 and 65; and 73 above the age of 65 years. There were 6,690 deaths from Cancer in London during the year, as compared with 6,615 in 1928. On request, rooms are disinfected after a death from Cancer, and arrangements made for the removal, fumigation or destruction of bedding. Twenty-one such applications were made during the year and disinfection was carried out in each case. Tuberculosis and the Infectious Fevers.—These are reviewed in the section dealing with the notifiable infectious diseases. Diarrhoea and Enteritis.—There were ten deaths from these diseases as against one in 1928. Eight of the deaths were under the age of twelve months ; one between the ages of 25 and 45 ; and one between the ages of 45 and 65. , During the September quarter the mean temperature was 62.9°, as against 61.7° in 1928. The rainfall of this quarter in 1929 was 3.9 inches, as against 5.6 in 1928. Violence and Suicide.—Twenty-seven deaths occurred from violence apart from suicide. Suicide was responsible for 13 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. Year. Bronchitis. Pneumonia. Other Respiratory Diseases. Total. Death. rate. No. of deaths under 5 years. Percentage under 5 years. 1928 28 50 6 84 1.3 1.2 14.3 1920 43 86 11 140 2.2 19 13.6 DEATHS OF CHILDREN 1-5 YEARS OF AGE. The number of deaths of children between 1-2 years of age was 14 and between 2-5 years, 12. In the previous year these figures were 10 and 12 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. Diarrhæal Diseases. All other causes. Total Deaths. 1928 5 5 3 — 9 22 1929 11 2 8 — 5 26 INFANT MORTALITY. There were 52 deaths of infants under one year of age in Chelsea during the year. The corrected death rate is TO per 1,000 births, as compared with 48 in the previous year. This increased mortality was due in part to greater incidence of whooping cough, enteritis and pneumonia and also to the reduced number of births. In London as a whole the rate of infant mortality was 70 per 1,000 births. The causes of death in the various age groups are set out in Table No. 14 17 TABLE No. 14. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3-6 months. 6-9 months. 9-12 months. Total deaths under 1 year. Small-pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - Whooping Cough - - - - - 2 1 - 1 4 Diphtheria - - - - - - - - - - Influenza - - - - - - - - - - Erysipelas - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - 1 1 Meningitis - - - - - - - - - - Convulsions - - - - - - - - - - Laryngitis - - - - - - - - - - Bronchitis - - - 1 - - 1 Pneumonia - - - 1 1 3 5 10 Diarrhæa and Enteritis - - - - - 2 2 3 1 8 Gastritis - - - - - - - - - - Syphilis - - - 1 - - - 1 *Rickets - - - - - - - - - - Suffocation - - - - - - - - - - Injury at Birth - - - - - - - - - - Atelectasis 2 - - 1 3 1 - - - 4 Congenital Malformations 1 1 - 2 - - - - 2 Premature Birth 9 - 1 10 2 - - - 12 Atrophy, Debility and Marasmus - - - - - 3 2 - - 5 Other causes 1 - 1 - 2 1 - - 1 4 13 - 3 1 17 13 7 6 9 52 Nett Births registered during Legitimate 664 the calendar year Illegitimate 72 Nett Deaths (under I) registered Legitimate 43 during the calendar year Illegitimate 9 The following Table gives the Infant Mortality Rate in Chelsea under various headings, for the past two years:— TABLE No. 15. 1928. 1929. Infectious Diseases 2.5 5.4 Diarrhæal Diseases 1.2 10.7 Developmental Defects and Wasting 21.1 31.2 Other causes 23.6 23.2 Total Rate 48.4 70.5 18 TABLE No. 16. Infantile Mortality Rates per 1,000 Births in Wards. 1928. 1929. Hans Town 19 31 Royal Hospital 38 56 Church 88 67 Cheyne 38 62 Stanley 49 89 Chelsea Borough 48 70 Illegitimate Deaths.—The following Table No. 17 shows the number of deaths among illegitimate infants during the past two years. TABLE No. 17. 1928. 1929. Total number of illegitimate deaths under 1 year 5 9 Illegitimate death rate 68 125 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 past two years. TABLE No. 18. 1928. 1929. Average daily number of persons who received medical relief only 76 81 Average daily number of persons who received relief (indoor and outdoor) 1,390 1,386 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. Over 80 per cent. of the inhabitants suffering from serious illness or disease seek and obtain in-patient hospital accommodation. 19 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 very cold, particularly in the early months. As a consequence, there was an abnormal amount of respiratory and rheumatic affections, and the deaths from diseases of this character were higher than in previous years. The number of deaths is, of course, no measure of the amount of sickness and can only be regarded as an index. Influenza, more severe in type than that which has been experienced in preceding years, occurred in January, February and March, its distribution being general throughout the Borough. Judged by the notifications received, there was an increase in the amount of pneumonia, 196 notifications being received, compared with 109 in the previous year. This number probably under-estimates the incidence of the disease, as many cases still escape notification. During the year every medical practitioner in the Borough was supplied with a list of the notifiable diseases, and efforts were made to ensure prompt notification in every case. There was an increase in the number of cases of infectious disease. 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 12. 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, provides accommodation for 15 unmarried mothers and their infants. Cases are not received until after birth of the child. Daily work is provided by 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 noninfectious cases to hospitals or homes. 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. 21 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 further progress was made in connection with the proposed new Melchett Infant Welfare Centre. Plans have been approved by the Borough Council and the Ministry of Health, and it is anticipated that building operations will be commenced at an early date. During the year four infant clinics were held weekly—three at Manor Street and one at King's Road. An extra monthly clinic for toddlers was started during the year. One ante-natal clinic was held weekly at Manor Street. Details of the work carried out will be found on page 68 (Table No. 42). 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 commencing 1st April, 1929. (b.) Chelsea Day Nursery.—65 Sydney Street, S.W. 3. Chairman Eric W. Hall, Esq. Hon. Sec. : The Hon. Diana 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, 1929. (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 ot 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 62, 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, 1929. 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 : Alderman 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 72. 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, 1929. (e.) The Babies' Club.—35, Danvers Street, S.W. 3. Chairman: Mrs. William Piercy. Hon. Sec. : Mrs. Stanley Robinson. • Medical Officers : Dr. Harold Waller and Dr. Neville Lloyd. 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 Executive 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 81st December, 1929, are tabulated below in the form required by the Ministry of Health. All appointments are whole time except where otherwise indicated. Year appointed. Name. Qualifications. Appointment. *1924 McCarthy, "W. H. L. M.D., M.R.C.P., D.P.H. Medical Officer °f Health, Administrative Tuberculosis Of" ficer and Executive Officer under the Council's Maternity and Child Welfafe Scheme (Part time). 1925 Gerrans, B. H. F.I.C. Public Analyst (Part time). *1920 Crandell, W. Cert. San. Insp. Exam. Senior Sanitary Inspector Board, Cert. Royal San.Inst., Cert.Meat and other Foods *1926 Goodwin, J. C. Cert. San. Insp. Exam. Sanitary Inspector. Board, Cert. Meat and other Foods *1926 Shelley, A. P. T. Cert. San. Insp. Exam. Sanitary Inspector. Board. . *1927 Castley, J. .. Cert. San. Insp. Exam. Sanitary Inspector, wit Board, Cert. Meat special reference * and Other Foods Duties under Housiw Act, 1925. , *1909 Tettenborn, Miss F. Cert. San. Insp. Exam. Sanitary Inspector an Board, Cert. Royal Tuberculosis Heal' San. Inst., Cert. Visitor. L.C.C. Adv. Home Nursing, C.M.B., Nat. Health Diploma, Health Visitors' Diploma, approved by Bd. of Education, Special Cert, for Tuberculosis. fl916 Brown, Miss M. Cert. San, Insp. Exam. Health Visitor. Board, Cert. Royal , San. Inst., Health Visitors' Diploma, approved by Bd. of Education. Cert. C.M.B * Salary contributions made under Public Health Acts, f Salary contributions made by Exchequer Grants. Clerical Staff : A. B. J. Hayden, Senior Clerk. E. Bosley. J. C. Bryant. Mrs. H. M. Kennedy f (Maternity and Child Welfare). 24 Other Staff: Mortuary Keeper and Messenger C. Leonard. Chief Disinfector E. Hancock. Disinfectors G. Cowper R. J. Weston. Shelter Attendant Mrs. A. Hatch. Cleansing Attendant Mrs. E. Smith. Home Helps Mrs. Lowe. Home Helps 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. Grace Nelson. Dr. Margaret Rorke. Health Visitors (Whole Time). Name. Qualifications. Appointment. 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. 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) Secretary and Social Worker in connection with Tuberculosis. Puttick, Miss C. K. Cert. General Hospital Training and Tuberculosis Tuberculosis Nurse to Dispensary. 25 NURSING ARRANGEMENTS. (a.) Professional Nursing in the Home.—This is carried out by the Chelsea, Pimlico and Belgravia 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. 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 70. 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, 1929. The total fees paid by the Council for nurses' visits during the year amounted to £93 0s. 6d. (b.) Midwives.—Provision has been made by the Borough Council whereby necessitous women may obtain the services of a Maternity Nurse or Midwife at a reduced rate, the balance of the fee being paid by the Council. The fees charged vary from £2 to £2 5s. Od. for Primipara cases, and from £1 5s. 0d. to £1 10s. Od. 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. Contributions by patients towards the cost of midwifery assistance are collected by the Maternity Nurse or Midwife who undertakes the case. The cases dealt with by the Sub-committee during the past two years are summarized in Table No. 43 (page 69). 26 The London County Council is the Authority responsible for the supervision of midwives in the Borough. Through the courtesy of Dr. F. N. Kay Menzies, the County Medical Officer of Health, I have been able to ascertain that 11 midwives gave notice during the year of their intention to practise as midwives in Chelsea. LABORATORY WORK. Analysis of Food and Drugs.—The Public Analyst is Mr. B. H. Gerrans, F.I.C., and the investigations in connection with food and drugs sold in the Borough are carried out in his laboratories. The detailed results of analyses made during 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 436. Of these, 370 were for the bacillus association with Diphtheria and 64 for the bacillus associated with Tuberculosis. One specimen of urine was examined for B.Coli. In addition a specimen of the water at the public Baths was submitted for examination. The total cost of these services to the Borough Council was £69 3s. 9d. The total number of bacteriological examinations during the preceding year was 435. 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 136,000 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 18s. 6d. 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. 27 In addition, the Council, on 18th February, 1925, in pursuance of the provisions of Section 23 of the Municipal Corporations Act, 1882, Section 16 of the Local Government Act, 1888, and Section 5 of the London Government Act, 1899, made the following 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 several of the metropolitan boroughs. 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 621 compared with 423 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 724. The number of statutory notices was 198. These compare with 753 and 166 respectively in 1928. In eight 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 621 On notification of infectious disease (including Non-notifiable diseases) 396 House to House 251 Re-inspection Calls made 4,455 Inspection of Bakehouses 34 Slaughterhouses 35 Milkshops 100 Ice Cream Premises 37 Overcrowding 30 *Houses let in Lodgings 73 Stables 24 Restaurant Kitchens 95 Marine Stores 20 * This figure is included in House to House Inspections. 29 Inspection of :— Food Premises other than above 100 Premises under Meat Regulations 45 Factory and Workshops 630 Outworkers' Premises 94 Other visits 849 Verminous Premises and Children 75 Rat enquiries 54 Smoke observations 10 Total 8,028 Premises. Walls and Ceilings cleansed :— (a.) Premises throughout 43 (b.) Premises partially 348 (c.) Verminous rooms cleansed 32 (d.) Total number of rooms cleansed 851 Wash-house walls and ceilings cleansed 119 Wash-house roofs repaired 28 Dirty tenants' rooms cleansed 23 Yard and area walls cleansed 29 Defective roofs repaired 131 Defective gutters repaired 30 Defective rain water pipes repaired 43 Dampness abated 132 Miscellaneous repairs 223 Wash-house floors repaired 21 Yard surfaces repaired, paved, etc. 23 Ashpits demolished and sites made good - Ashpits cleansed - New and proper dustbins provided 84 Workrooms provided with light and ventilation or light and ventilation improved 2 Yards cleansed 4 Drainage. Reconstructed 52 Repaired 19 Cleansed 18 Inspection Chambers and traps provided 97 Fresh air inlets provided or repaired 70 Gully traps provided 102 Drains ventilated 48 New soil pipes provided 48 New ventilation pipes provided 48 Soil and ventilation pipes repaired 15 Anti-syphonage pipes provided 15 Drains sealed off - Drains cleared (obstruction removed) 25 New covers provided to inspection chambers 52 Rainwater pipes disconnected and caused to discharge over properly trapped gullies 17 Sink wastes provided with traps 28 Sink waste pipes ventilated 2 Sink waste pipes cleansed 10 New sinks provided 31 Bath and lavatory wastes repaired or renewed 7 New lavatory basins fixed 10 New baths fixed 6 New bidets fixed - Water Closets. Improvements in sanitary conveniences (factories, workshops, etc.) 12 New water closet pans provided 47 30 Water Closets. New water closet pans and traps provided 98 Water closet pans (foul) cleansed 9 Choked water closet pans unstopped and cleansed 14 Water waste preventers renewed 21 Water waste preventers repaired 50 Overflows to water waste preventers provided 10 Walls and ceilings of water closets cleansed and repaired 152 Water closet roofs repaired 24 Ventilation and light provided or improved 2 W.C. Floors repaired 11 Water Supply. Water supply to premises re-instated 54 Water supply provided to upper storeys of tenement houses 3 Water closets provided with water supply to flushing apparatus 28 New drinking water cisterns provided 1 Drinking water cisterns cleansed 27 Drinking water cisterns repaired 6 Drinking water cisterns provided with new covers or covers repaired 11 Smoke Nuisances. Number of observations 10 Number of nuisances and complaints 2 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 11 Dead animals 6 Overcrowding 6 Rat nuisance 15 Underground rooms 2 Food Condemned and Destroyed. Walnuts 200 lbs. Bacon 20 lbs. Fish 24 stone Greens 4 baskets Disinfection. Premises disinfected after Zymotic diseases (Scarlet Fever, Diphtheria, etc.) 343 Rooms disinfected after Tuberculous disease 64 Rooms fumigated for verminous and filthy conditions 198 Miscellaneous disinfection 55 Certificates of disinfection given 236 School notices after disinfection 226 Notices sent to Public Library of Premises where infectious diseases have occurred 120 Proceedings taken. Intimation Notices served 724 Statutory Notices under Public Health (London) Act, 1891 174 Statutory Notices under Section 3 of Housing Act, 1925 - Statutory Notices under by-laws for provision of dustbins 24 Total number of samples purchased for analysis under the Food and Drugs (Adulteration) Act 369 Samples of cream taken 7 Samples of Drugs taken - Samples (informal) purchased 31 Legal proceedings instituted in respect of defective sanitary conditions and nuisances 8 Legal proceedings under Food and Drugs (Adulteration) Act 2 Legal proceedings in respect of unsound food - Certificates issued in accordance with " Rent Restrictions Acts " — Entries in Inhabitants' Complaint Book 621 31 Cleansing and Disinfection. Number of adults cleansed 15 Number of children cleansed 893 Number of rooms or premises cleansed or disinfected 660 Number of persons treated for Scabies 9 Number of articles (bedding, etc.) disinfected 2,939 Number of articles (various) destroyed 495 Disinfection Station Shelter. Persons accommodated :— Adults - ChildrenMortuary. Number of bodies received 144 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. 104, Beaufort Street. Dampness in back addition rooms on ground floor and rooms on second and top floors. Kensington 5-2-29 Withdrawn. 20, Christchurch street Want of proper and sufficient water supply to premises. Kensington 9-4-29 Adjourned for fourteen days. 20, Christchurch street. Want of proper and sufficient water supply to premises. Kensington 23-4-29 Work done, Case withdrawn. 13, Gertrude Street. Failing to comply with Statutory Notice re condition of premises Kensington 7-5-29 Order, 4 weeks. 13, Gertrude Street. Failing to remove ashpit. Kensington 7-5-29 Order, 4 weeks. 14, Gertrude Street. Non - compliance with Statutory Notice re dirty condition of premises. Kensington 7-5-29 Order, 4 weeks. 20, Blantyre Street. Non - compliance with Statutory Notice served to abate over-crowding. Kensington 5-11-29 Order, 28 days. 13, Gertrude Street. Failing to carry out repairs to roof as set out in Statutory Notice. Kensington 1-10-29 Order, 14 days. 21, Riley Street. Failing to comply with Council's Notice to carry out repairs and cleansing. Kensington 17-12-29 Order, 21 days. 32 Situation of premises. Nature of Nuisance or Complaint. Petty Sessions. Date of Hearing. Result. Nuisances By Dogs. Failing to comply with Council's By-law re fouling of footway by dogs in Knightsbridge. Kensington 5-2-29 Fined 5s. Failing to comply with Council's By-law re fouling of footway by dogs in King's Road. Kensington 5-2-29 Fined 5s. Failing to comply with Council's By-law re fouling of footway by dogs in King's Road. Kensington 7-5-29 Fined 10s. Failing to comply with Council's By-law re Fouling of footway by dogs in Sloane Square. Kensington 17-12-29 Fined 10s. Smoke Abatement.—It is part of the work of a Sanitary Inspector to observe any nuisance arising from smoke. There were 10 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. Two complaints of smoke nuisance were received during the year and cautionary letters were sent to the offenders. 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 1928 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 four prosecutions were taken for infringement of the by-law, a conviction being obtained in each case. Rats and Mice (Destruction) Act, 1919.—A Sanitary Inspector is authorised under this Act to act as Rat Officer in his district. The Act places the reponsibility for rat preventive measures upon the occupiers 33 of premises. During the year the Council provided rat catching varnish to applicants for the destruction of rats and 100 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 £3 18s. Od. 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 arrangements for the capture and humane destruction of a proportion of these birds. About 80 birds have 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 132 of the Factory and Workshops Act, 1901, to include in his annual report details of the administration of this Act in his district. The total number of factories, workshops, and workplaces on the register at the end of the year was 283. The number of inspections of these premises was 630, which compares with 677 in. 1928. Sanitary defects were found in 38 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 :— 34 TABLE No. 20. Factories, Workshops, Workplaces, and Homeworkers' Premises. I.—Inspection of Factories, Workshops and Workplaces. (Including Inspections made by Sanitary Inspectors). Premises. Number of Inspections. Written Notices. Occupiers prosecuted. (1) (2) (3) (4) Factories (including Factory Laundries) 34 2 — Workshops (including Workshop Laundries) 581 22 — Workplaces (other than Outworkers' premises) 15 2 — Total 630 26 — 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of offences in respect to which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts :—* Want of cleanliness 11 11 — - Want of ventilation 1 1 — - Overcrowding 2 2 - - Want of drainage of floors — — — - Other nuisances 12 12 - - * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 35 2.—Defects found in Factories, Workshops and Workplaces.—continued. Particulars. Number of Defects. Number of offences in respect to which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Sanitary accommodation :— Insufficient 2 2 - — Unsuitable or defective 7 7 - — Not separate for sexes 3 3 - — 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 38 38 — — 3.—Home Work. Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises. Secs. 109,110 Lists received from Employers. Number of Addresses of outworkers received from other Councils Number of Addresses of outworkers forwarded to other Councils Prosecutions. No. of Inspections of Outworkers Premises. Instances. Notices served. Prosecutions. Instances. Orders made (Sec. 109). Prosecutiotion (Sec. 109,110 Lists. Chelsea Outworkers. 1928 21 37 37 200 - 82 2 2 - - — - 1929 17 16 9 193 — 84 - - - - - - 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. 36 The Chelsea Mortuary is situated in Arthur Street. Number of Bodies received in Mortuary during 1929 144 1. To await Inquests :— (a.) Infectious - (b.) Non-infectious 86 2. To await burial 9 3. Sanitary grounds - Number of Post-Mortem examinations 66 Rag Flock Act.—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. 37 SECTION IV.—HOUSING. In accordance with the instructions of the Ministry of Health, following tabular statement has been prepared :— TABLE No. 21. Housing Statistics for the Year 1929. Number of New houses erected during the year :— (a.) .Total (including numbers given separately under (b.) ) 181 (b.) With State assistance under Housing Acts :— (i.) By the Local Authority 0 (ii.) By other bodies or persons 0 1. Inspection of dwelling-houses during the year :— (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 933 (2) Number of dwelling houses which were inspected and recorded (House-to-house inspections) 112 (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 724 2. Remedy of Defects without Service of formal Notices. Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers (intimation only) 526 3. 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 repairs 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 tions by owners of intention to close 0 B. Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 724 88 (2) Number of dwelling houses in which defects were remedied after service of formal notices— (a.) by owners 198 (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 0 (2) Number of dwelling houses in respect of which Closing Orders were made 0 (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 of four Sanitary Inspectors, each carrying out all the duties of a Sanitary Inspector in the district allocated to him. One of these was mainly engaged 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 many alterations, consequent on demolitions and reconstructions, during the past SO years, as in Chelsea. The process of reconstruction is still in progress, though largely suspended by the operation of the Rent Restriction Acts. The developments which have taken place have arisen from the fact that a very considerable proportion of Chelsea is comprised within the areas of two large estates—the Cadogan Estate and the Sloane Stanley Estate. Many of the building leases on these estates were granted early in the 19th century and a large number have already expired. A certain proportion of demolition of small property has been due to the acquisition of land by large trading corporations, but up to the present this has not been a factor of any great magnitude. Owing to the proximity of the eastern boundary of the Borough to Hyde Park and Belgravia, and to the attractiveness of the Embankment forming the southern boundary, residential values in these neighbourhoods have greatly appreciated in recent years, the price of land has been correspondingly increased, and the old type of small house, accommodating the small trader and the artizan or labourer, has been replaced by modern houses and mansions let in flats commanding high rents. 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, 39 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 inhabitant, chiefly of the working and small trader class, have been displaced and compelled to migrate into surrounding districts. Despite the difficulties of the problem, in Chelsea a considerable amount of accommodation had been provided for the working classes during the years preceding the outbreak of War. This had been effected 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, Ixworth 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. 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. 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 40 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 working classes. Two schemes—those of Hortensia Road and King's Road—were completed in 1925 and 1929 respectively, and the buildings are now fully occupied. The remain'ng scheme is 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 °n 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) Guinness Trust Buildings, King's Road. This group of buildings comprises an area of 1 acre, 3 roods and 28½ Poles, situated 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 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 erected working-class dwellings thereon, Preference as to tenancies being given (a.) to persons residing in Chelsea a.nd (b.) to persons employed in Chelsea. These buildings comprise 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 has, in addition a scullery, bathroom and lavatory. Perambulator sheds are provided in the grounds, also a drying room for clothes, and a constant hot water supply at the boiler house. These additional housing facilities are 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 41 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. Reviewing the history of the past 30 years, it would appear tnat 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 former Mayor (Mr. Alderman C. B. Clapcott, O.B.E.), and the recent 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 some little improvement in its prevalence during the year. Many of the cases when approached as to the desirability of having their names submitted to the County Council, with a view to provision of housing on one of the Council's Estates, decline to consider the proposition, on the ground that the distance of the County Council's Estates from their work is too great. Others have become attached to the district and will not contemplate forsaking existing interests and associations. Owing to the extreme difficulty of finding alternative accommodation it has not been found possible to deal with more than a 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. Seven 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 42 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 abutting 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 are 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 5contain 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 at 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 on this site has now been completed. It has 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. Owing to the very high commercial value of this site, these houses are rapidly being demolished and being replaced by modern houses and mansions let in flats commanding high rents. 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 43 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 accommdation, 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, this problem has now been met by legislation. Under the London County Council (General Powers) Act. 1928, it is 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 the owners regarding the difficulties they experience in keeping their property in a reasonable state of repair because of the dirty and destructive habits of a number of their tenants. It is alleged that, through carelessness or wilful damage by tenants, repairs and cleansing have to be carried out with unreasonable frequency and that, as a consequence, it is impossible to maintain even the minimum requirements of the Local Authority without incurring financial loss. Investigation has shown that these statements are often well-founded especially in the poorer class tenement lo'dging 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 inspecte for housing defects was 933, the number found not to be in all respects reasonably fit for human habitation being 724. The number rendered fit in consequence of informal action by the Sanitary Inspectors was 526 and the number in respect of which statutory notices were served requiring defects to be remedied was 198. Two cases came to the knows 44 ledge of the Department in the course of the year of underground rooms being illegally used for sleeping purposes. Appropriate action was taken in each case. There were no applications under the Inciease of Rent and Mortgage Interest (Restrictions) Acts made by occupiers of dwellings 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 10 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, 112 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 Puveyors 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 one application was made for registration as a purveyor of milk which after appropriate investigation, was approved by the Council. tabular form below is shown the alterations which took place in Register of Milk Purveyors during the year. TABLE No. 22. Retail. Wholesale. Total. On Register, 31st December, 1928 75 — 75 Vacated during the year 5 — 5 Added during the year 1 — 1 On Register, 31st December, 1929 71 — 71 During the year there were 100 inspections of dairies and milkshoPs made in the Borough. Notices were served requiring remedy of defecdts found on three of the premises visited. There are no cowsheds in the district. Milk (Special Designations) Order.—There were 29 applications from 11 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 to sell specially designated milk from shops within the Borough. application has been made for a licence giving authority to set up bottling 46 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. TABLE No. 23. Licences Granted under Milk (Special Designations) Order. Licences granted under Milk (Special Designations) Order. 1928. 1929. To sell " Certified " Milk 7 7 To sell " Grade A " Milk — — To sell " Grade a" (Tuberculin Tested) " Milk 11 11 To sell " Pasteurised " Milk 10 11 28 29 No samples of graded or other milk were submitted for bacteriological examination during the year. Further reference to milk is made in the Public Analyst's Report for the year and details of magisterial proceedings taken in cases of adulterated milk will be found in the sub-section dealing with the Food and Drugs (Adulteration) Act. Ice-Cream Vendors.—At the end of the year, 27 premises were shown in the Register as places where ice-cream is prepared or sold. There were 37 inspections of these premises as compared with 30 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 of ice-cream must notify the occurrence of infectious disease among their employees or persons living on their premises. The Act also provides that every itinerant vendor shall exhibit on his barrow the name and address of the person from whom the ice-cream has been obtained. 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 apparent 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 47 similar commodity shall be registered by the owner or occupier there of 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 35 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 34 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 35 inspections of these premises were made during 1929 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 Health, the number of private slaughter-houses in use in the Boroug on the dates indicated :— TABLE No. 24. In January, 1929. In December, 1929 Registered — — Licensed 2 2 Total 2 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. 2n. Inspection of Premises where Food was Prepared or Sold. Nature of Premises. 1928. 1929. No. on Register No. of Inspections. No. on Register No. of Inspections. Cowsheds Slaughter Houses 2 55 2 35 Milk Shops 85 96 71 100 Ice Cream Premises 26 30 27 37 Bakehouses 26 39 26 34 Restaurant Kitchens 32 60 32 35 Food Premises (other than above) 90 100 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 271 (41 pigs and 230 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 :— 24 stone of fish, 20 lbs. of bacon, 4 baskets of greens and 200 lbs. of walnuts. No carcases were destroyed on account of tuberculosis. Food Poisoning.—No case of food poisoning occurred during the year. Food and Drugs (Adulteration) Act, 1928.—Four hundred samples, including 173 samples of milk and 7 samples of cream, were taken and submitted for analysis during the year. These samples were investigated by 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 Act,. Informal samples are those taken without these strict formalities and afford 49 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 two samples of milk were found adulterated to such a degree as to justify legal proceedings. Certain other food samples were found to be inferior, but not to such an extent as to justify legal action. In each of these cases a warning letter was sent to the Vendor concerned. The proceedings in respect to the adulterated Milk samples were dismissed under the First Offenders' Act on payment of costs. Details of these proceedings are given in Table 26. The work carried out under the Food and Drugs (Adulteration) Act, during the year is summarized in the Public Analyst's Report in the appendix. Margarine.—One application for transfer of registration was received during the year from a firm of wholesale dealers in margarineAfter inspection of the premises, the necessary certificate was issued and the Ministry of Agriculture and Fisheries were so informed. 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. TABLE No. 26. Magisterial Proceedings under Food and Drugs (Adulteration) Act, 1928. Street where Purchased. Offence. Petty Sessions. Date of Hearing. Result. King's Road. Selling milk from which 8 % of fat had been abstracted. Kensington 9-4-29 Dismissed, £2 2s. costs. Cale Street. Selling milk from which 22 % of fat had been abstracted. Kensington 30-7-29 Dismissed, £3 3s. costs. 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. Dyserftery. Acute Primary Pneumonia. Erysipelas. Acute Influenzal Pneumonia. Malaria. Cerebrospinal Fever. Puerperal Fever and Puerperal Chicken Pox. Pyrexia. Plague. Relapsing Fever. Anthrax. Small-pox. Clanders. Typhus Fever. Hydrophobia. Tuberculosis. Cholera. Scarlatina or Scarlet Fever. Continued Fever. Typhoid or Enteric Fever. Ophthalmia Neonatorum. NOTIFICATIONS DURING THE YEAR. The total number of notifications, excluding duplicates, was 673. of this figure, 95 were notifications of Pulmonary Tuberculosis and 11of Non-pulmonary Tuberculosis. In addition, 223 cases of Measles (including German Measles), came to the knowledge of the Department, Mainly through the School Authority. Compared with the previous year, there was a decrease of 7 in the number of notifications of Diphtheria. The number of notifications of scarlet Fever (149) represents an increase of 31 as compared with that for 1928. The notifications of Tuberculosis show a slight increase. in 1929, there were 6 deaths from non-notified Tuberculosis, while in 1928 there were 9 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. 15-25 Years. 25-45 Years. 45-65 Years. 65 and upwards. Small-pox - - - - - - - - - Chicken-pox 15 — 9 4 2 — — — 5 Cholera — — — — — — — — — Diphtheria 148 4 49 63 20 9 3 — 146 Erysipelas 36 1 1 2 3 8 14 7 24 Scarlet Fever 149 3 31 78 29 7 1 — 140 Typhus Fever — — — — — — — — — Enteric Fever 3 — — — 1 2 — — 2 Puerperal Fever 2 — — — — 2 — — 2 Puerperal pyrexia 5 — — — 3 2 — — 4 Cerebro-spinal Fever 1 — — 1 — — — — 1 Ophthalmia Neonatorum 5 5 — — — — — — 2 Poliomvelitis 2 — 1 1 — — — — 2 Encephalitis Lethargica — — — — — — — — — Polio-encephalitis — — — — — — — — — Malaria 4 — — — 1 3 — — — Dysentery 1 — — —. — 1 — — 1 Acute Primary Pneumonia 149 11 29 12 12 33 33 19 118 Acute Influenzal Pneumonia 47 1 — 1 5 23 10 7 38 Total 567 25 120 162 76 90 61 33 485 Tuberculosis :— Pulmonary . . 95 — — 1 27 40 25 2 Non -Pulmonary 11 — 4 5 — 2 — — Totals (Tuberculosis) 106 — 4 6 27 42 25 2 Totals 673 25 124 168 103 « 132 86 35 No cases of Small-pox, Cholera, Typhus Fever, Encephalitis Lethargica, Polio-encephalitis, Continued Fever, Relapsing Fever, Plague, Anthrax, Glanders or Hydrophobia were notified during the year. DIPHTHERIA. Notifications.—During the year 148 cases of diphtheria were notified, as compared with 155 in the previous year. The incidence of the disease during the past two years is shown in Table No. 28. Deaths.—Three deaths from the disease occurred, 2 in the M.A.B. Hospitals and one in St. Luke's Hospital. Two of the cases were under five years of age. 52 Return Cases.—One "return" case occurred during the year and necessary action was taken. TABLE No. 28. Cases of Diphtheria during the Years, 1928 and 1929. Year. Cases Notified. Percent age of Remov als. Deaths Case Mortality Rate. Percent age of cases of School age (3-13 years) Month of greatest prevalence. Bacterioscopic Diagnosis, Lister Institute. No. of Specimens submitted Positive Percent age Positive. Negative. Percent age Negative. 1928 155 99 4 2-6 54 Mar. 360 39 10.8 321 89.2 1920 148 99 3 2-3 53 Apr. 370 39 10.5 331 89.5 It will be observed that there was a slight decrease in the number of cases notified in 1929. The percentage of removals to the M.A.B. Hospitals was high, while the case mortality rate was somewhat lower than that for 1928. Information was received from the M.A.B. that 16 of the cases sent to Hospital in the course of the year proved not to be suffering from diphtheria. Of the 148 cases notified, 53 occurred in Stanley Ward, 40 in Church Ward, 29 in Cheyne Ward, 11 in Hans Town Ward, and 15 in Royal Hospital Ward. 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. Quinquennial Periods. Average Annual case-rate per 1,000 population. Average Annual case-mortality rate. Average Annual percentage of cases removed to hospital. 1911-15 1.24 5.8 89 1916-20 1.35 8.9 92 1921-25 1.81 7.2 93 Diphtheria Anti-toxin.—Anti-toxin is supplied, in prophylactic and curative doses, free of charge to any medical practitioner requiring for Chelsea patients. An anti-toxin syringe, needles and steriliser are 53 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, 17 bulbs of serum were supplied to medical practitioners, the cost to the Council being £8 18s. 6d. As 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, 149 cases of Scarlet Fever were notified, the figure for 1928 being 118. Information was received from the M.A.B. Hospitals that 9 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 covers the quinquennial periods since 1911. Deaths.—There was no death from Scarlet Fever during the year, TABLE No. 30. Year. Cases Notified. Percentage of Removals. Deaths. Case Mortality. Rate. Percentage of cases of School-age 3-13 years. Month of greatest prevalence. 1928 118 92 — — 62 May 1929 149 94 — — 64 March TABLE No.. 31. Quinquennial Periods. Average Annual case-rate per 1,000 population. Average Annual Case-Mortality rate. Average Annual percentage of cases removed to hospital. 1911-15 2.69 1.8 91 1910-20 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. (Including German 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. 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. On request by the School Medical Officer of Health of the London County Council, advice leaflets are supplied to the Head Teacher of schools in the area affected with an outbreak of Measles. These leaflets are distributed to the parents and guardians of the children attending such schools. Co-operation between the school nurses and the Borough Health Visitors is being arranged. The number of cases coming to the knowledge of the Department during the year was 223, as compared with 493 in 1928. Deaths.—The number of deaths was 2. One of the cases was under two years of age. Visiting and Nursing.—During the year, 136 visits and re-visits Were made by the Health Visitors. Cases are also visited by the District Nurses whenever circumstances render this necessary. Forty-one nurses' visits were required in 1929. 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 44 cases were removed. In addition a 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 3. (One of these, a non-resident, was notified from a Chelsea Hospital). All three cases were males, the ages being 21, 26 and 37 respectively. One case was nursed at home. None of the cases proved fatal. 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 (a male, aged 66 years) from Enteric fever in a London Hospital. A summary of Enteric and Para-Typhoid B. cases for the past two years is given in the following Table :— 55 TABLE No. 32. Year. Enteric. Para Typhoid B. Cases. Recovered. Fatal. Cases. Recovered. Fatal. 1928 4 3 1 9 9 — 1929 3 3 *1 — — — * Inward Transferable death. No specimens of blood were examined during the year for the Widal reaction. PNEUMONIA, MALARIA AND DYSENTERY. These diseases are compulsorily notifiable under the Public Health (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1919. During the year the fol'owing numbers of cases were notified :— Pneumonia 196 Malaria 4 Dysentery 1 Pneumonia.—All primary pneumonias, lobar or lobular, are notifi" able. 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. 1928 109 50 1929 196 86 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 Health shall take all practical steps to ensure that persons suffering from malaria are supplied with sufficient mosquito netting ; receive adequate quinine treatment during the attack and subsequently ; and receive appropriate advice as to precautions necessary to prevent the spread of the disease. Four cases of Malaria were notified during the 'year. PUERPERAL FEVER AND PUERPERAL PYREXIA. Two cases of Puerperal Fever and 5 cases of Puerperal Pyrexia were notified during the year. Of these, 6 were treated in hospital. Further details of these cases are given on page 73. 56 OPHTHALMIA NEONATORUM. Five cases of ophthalmia neonatorum were notified during the year. Two 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. Deaths. No. Notified. Treated. At Home. In Hospital. 5 3 2 4 — — 1* * Female, 7 weeks old, cause of death—Marasmus, Ophthalmia Neonatorum, Prematurity. Eleven 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 74 deaths in 1929, as against 17 in the previous year. There was considerable epidemic prevalence of the disease but no special action was called for in the Borough in regard to it. Nursing Provision.—By arrangement with the Chelsea District Cursing Association all severe cases of influenza receive skilled nursing attention, where circumstances render this necessary. POLIOMYELITIS AND POLIO-ENCEPHALITIS. Two cases of Poliomyelitis were notified during the year. Both cases were treated in hospital. None of these proved fatal. No case of Polio-Encephalitis was notified. ENCEPHALITIS LETHARGICA. No case of Encephalitis Lethargica was notified during the year, thirteen 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 sequelae 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 1n London and in Chelsea during the years 1928 and 1929. 57 TABLE No. 34. Year. Cases Notified, in Chelsea. Removed to Hospital. Deaths notified during year in Chelsea. Cases notified in London. Deaths notified in London. 1928 1† 1 1* 108 54 1929 — — — 98 58 * Case notified in 1924. f Died in hospital. Death Certificate : (a) Cerebellar tumour. (b) Coma. CHICKEN POX. With the approval of the Ministry of Health, the Borough Council under Section 55 of the Public Health (London) Act, 1891, made the disease known as chicken pox notifiable in the Borough on, and from, the 12th August, 1929. Up to the close of the year fifteen notifications were received and appropriate steps were taken. SMALLPOX. No case of small pox was notified in Chelsea during the year. Appropriate action was taken as regards contacts of notified cases from other boroughs. Vaccination.—No vaccinations have been performed by the Medical Officer of Health under the. Publie 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 1929 are not yet available. TABLE No. 35. 1927. 1928. No. of primary vaccinations performed 630 627 No. of infants died unvaccinated 62 46 No. removed to other districts 46 60 No. removed to unknown addresses 57 56 No. postponed by medical certificate 12 14 No. of certificates of exemption issued 156 125 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). 58 venereal disease. The London County Council is the Authority responsible for the provision of facilities for the diagnosis and treatment of venereal disease and special clinics are held in various hospitals. The hospital for Chelsea residents is St. George's Hospital. arrangements for disinfection and tion and the extent of their use. The Borough Council maintains a Disinfecting and Cleansing Station situated at 9a, Lots Road, Chelsea, adjoining the river. Disinfection.—The disinfecting staff numbers three. A steam disinfector is provided. An appropriate motor vehicle is utilised for the conveyance of infected and disinfected articles to and from the Disinfecting Station. Disinfection in connection with the notifiable infectious diseases is carried out free of charge. Applications for special disinfection, not associated with the notifiable infectious diseases, are considered, and, if the work of the Department permits it, are carried out at the expense, of the applicant. Seventy such disinfections were carried out during the year, the total charges amounting to £42 lis. Od. 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 660 Number of Articles (bedding, etc.), disinfected 2939 Number of articles (various) destroyed 495 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. No family was accommodated at the shelter during the year. 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 59 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 88 occasions. The following Table No. 37 shows the number of attendances in each quarter :— TABLE No. 37. Quarter. No. of days on which the Station was opened Attendances. Verminous. Impetigo. March 22 187 — June 23 246 — September 15 212 2 December 28 246 — 88 891 2 The amount recoverable from the London County Council, as the School Authority, for the cleansing for the year is £89 4s. 0d. Fifteen adults were cleansed at the Station during the year. (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 155 but 49 of these related to cases which had been previously notified' that the total number of new notification was 108. In the previous year, the corresponding number was 101. The notifications received on forms C and D, i.e., notifications from institutions regarding admission and discharge, are not included in the foregoing figures. In Table 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 13 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. 60 TABLE No. 38. Tuberculosis. New Cases and Mortality during 1929. Age Periods. New Cases. Deaths. Pulmonary. Nonpulmonary. Pulmonary. Nonpulmonary. m. f. m. f. m. f. m. f. 0— 1 — 1 —. _ — — — 1 1-5 3 1 2 5—10 — 1 3 2 — — 1 — 10—15 — — 1 1 -—. — — 15-20 7 7 — 1 3 20-25 10 5 — — 2 3 — — 25—35 13 10 1 2 4 4 1 1 35—45 15 6 — — 5 2 — 45—55 13 5 1 10 2 1 55—65 6 2 __ 3 2 — 1 65 and upwards 1 2 — — 3 1 1 — Totals 65 39 8 7 28 17 5 4 The death rate from all forms of Tuberculosis in Chelsea was 0.86 Per 1,000. Of the total number of deaths (54) from all forms of Tuberculosis, six died non-notified or prior to notification. The ratio of nonnotified tuberculosis deaths to total tuberculosis deaths was therefore as one is to nine. The corresponding ratio for 1928 was 1 : 8. 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 compiled from the register of notifications showing :— (a.) The number of cases of Tuberculosis on the register at the com mencement of the quarter ; (b.) The number of cases notified under the Regulations, 1912, for the first time during the quarter ; (c.) The number of cases removed from the register during the quarter, giving the name and address of each such case and the reason for such removal ; and (d.) The number of cases remaining on the register at the end of the quarter. 61 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 163 120 283 Non-pulmonary 29 30 59 192 150 342 (The Register of Notifications contains particulars of all persons who have been notified to the Medical Officer of Health as suffering from Tuberculosis. It should be distinguished from the Dispensary Register referred to in Table 40 which contains the names of all persons attending at, or seen in connection with, the Dispensary for diagnosis and treat ment). Home Visiting.—The Municipal Tuberculosis Visitor in the course of the year visited 38 new cases of Pulmonary and Non-Pulmonary Tuberculosis. Other visits made by this Officer were as follows : Revisits, 360; visits for purpose of disinfection, 52; visits in connection with extra nourishment, 15; miscellaneous visits, 173. Total number, 638. Visits made by the Dispensary Staff are recorded in Table 40. 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. Chelsea Tuberculosis Scheme.—fable No 40, subjoined, has been amended for the year 1929 in order to conform with the requirements of the Ministry of Health. As now compiled, the Table includes :— {a.) Summary of cases dealt with at the Chelsea Tuberculosis Dispensary, Brompton Hospital, and (b.) Special Cases which were accepted for institutional ment by the London County Council, but which were not dealt with by the Chelsea Tuberculosis Dispensary. Prior to 1929 this Table comprised cases dealt with at the Chelsea Tuberculosis Dispensary only. 62 TABLE No. 40. Diagnosis. Pulmonary. Non-Pulmonary. Total. Adults. Children. Adults. Children Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A. new cases examined during the year (excluding contacts)- (a) Definitely tuberculous (b) doubtfully tuberculous (c) non-tuberculous 40 13 2 2 3 40 13 o 5 r 519 /J ^oubtfully tuberculous 6 2 1 -^on-tuberculous — — 72 140 149 89 J B.- contacts examined during the year:- (a) l 138 (c) Poubtfully tuberculous — — — — — — — — —- 2 — — I ^\^jNon-tuberculous 8 48 42 38 J Pen«Ses written off the Dis(au7 Register as (6 5,"red 1 1 1 X 1 2 1 1 1 | Ulagnosis not confirmed 0r non-tuberculous (inluding cancellation of notified in error) .. 80 194 191 127 I 397 Peng ^ber of Persons on Dis3lst. ry Register on December (S ^|agnosis completed .. 107 76 1 3 4 7 7 110 80 7 8 210 - -Diagnosis not completed 4 1 • \ R • persons on Dispensary j^^S^ster on January 1st 204 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 13 j^ber 0f patients transferred v sj®?1 other areas and of " lost of " cases returned »• _ 22 10. Number of consultations with medical practitioners :—■ (a) At Homes of Applicants (b) Otherwise .. . 3 70 otJ?er °f patients transferred to 1 v. areas and cases " lost ^^HShtof" 44 11. Number of other visits by Tuberculosis Officers to Homes 47 during the year — 32 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 3,20.-» A ifT observation cases under Per ant^ B (6) above in which v <> 'od of observation exceeded Months 2 13. Number of :— (a) Specimens of sputum, etc., ined (b) X-ray examinations made in nection with Dispensary work 294 137 x pener °f attendances at the Dis(including Contacts) .. 3,369 124 Pu?er attendances of non0,tm°nary cases at Orthopaedic V Si],, stations for treatment or j\Pei>ision ' A'd — pensary Register on the 31 December st er 15. Number of Insured Persons unc 5 er^^of attendances, at Gentj0 Hospitals or other Institui of r.^ approved for the purpose, ? " T ^tients for Oth^ " treatment r sPecial forms of treatment — 31st December 16. Number of reports received during the year in respect of Insured Persons :— (a) Form G.P. 17 — (Signed) W. H. L. McCARTHY, Administrative Tuberculosis Officer. 63 Chelsea Tuberculosis Dispenary.—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. 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. Year. Number of Persons examined for the first time. Definite Tuberculosis. Total attendances at Dispensary. 1928 447 7 per cent. 2,834 1929 507 10 „ 3,369 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 BoroughThe 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 pul" monary 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, 56 per cent, died in St. Luke's Hospital and 31 per cent, in other public institutions, that is to say 87 per cent. died away from their homes, the corresponding figure for 1928 being 66 per cent. Co-operation with Hospitals and Invalid Childrens' 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, 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 antenna, ma¬l nutrition 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. 64 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 50 new cases at the homes of the patients, and 70 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 138, an increase °f 42 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 °f 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 3,265, a decrease of 214 over the number for the previous year. The Council lent a bedstead and bedding to one case during the year. Extra Nourishment.—Twenty cases of Tuberculosis were certified by the Tuberculosis Officer during the year to require extra nourishment as part of their treatment. These cases were supplied with foods such as milk, eggs, and butter. The total cost of extra nourishment (£27 0s 3d.) Was borne by the Borough Council. Non-pulmonary Cases.—All cases in which special treatment is indicated are assisted in obtaining admission to hospital. Others are sent to country or seaside convalescent homes through the agency of the Invalid Children's Aid Association. Orthopaedic Treatment.—In appropriate cases surgical boots and appliances, splints, crutches, spinal carriages, and wheeled chairs are supplied through the Invalid Children's Aid Association. 65 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 thirteen patients thus received dental treatment. Bacteriological Examinations.—During the year, 294 specimens of sputum were examined in connection with the work of the DispensaryIn addition, 64 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 Councillor Lady Phipps. London County Council Dr. A. W. Sikes (Divisional Medical Officer). Miss Paddon (District Organiser of School Care Committees). Miss Barff (After-care Committee). Chelsea Invalid Children's Aid Mrs. Rathbone and Association Miss Barcroft (Vice-Chairman). Chelsea Board of Guardians Dr. E. T. Holland. Chelsea Charity Organisation Miss Larken. Society Chelsea District Nursing Miss Page Association Chelsea Health Society Mrs. Melville Miller. Brompton Hospital Miss Marx. ' Local Panel Committee Dr. A. M. Gibson, and Dr. E. F. Thomas. . London Insurance Committee (Vacancy). Local War Pensions Committee Miss Forbes, and United Services Fund St. George's Hospital Lady Almoner. British Red Cross Society Miss Trench and Miss M. Woods 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. 66 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 91 Reported admitted to L.C.C. Institutions 73 Temporary assistance arranged 18 Extra nourishment granted 20 Work found 2 Housing conditions improved 4 Children boarded out through L.C.C. Contact Scheme and otherwise 4 Convalescence 84 The total cost of extra nourishment to appropriate cases was £27 0s. 3d. 67 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 73. General Arrangements—The Borough Council's scheme for Maternity and Child Welfare includes the following activities :— (a.) The issue of pamphlets giving advice on various matters Concerning the welfare of mothers and infants. (b.) The co-ordination of the work of the voluntary Maternity and Child Welfare agencies in the Borough. (c.) The home visitation of expectant and nursing mothers and infants by a staff of Health Visitors who work (a.) from the Town Hall, and (b.) from the Centres of the Chelsea Health Society. (d.) The subsidisation of the Chelsea Health Society's Maternity and Child Welfare Centres and Clinics for mothers, infants and young children. (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 rates, for necessitous Chelsea women. (j) The provision of Convalescent Home accommodation for nursing mothers and infants. (k.) The supply of milk free or at reduced rates, for necessitous nursing and expectant mothers, infants and young' children. (l.) The administration of the Widows', Orphans' and Old Age Contributory Pensions Acts, 1925 and 1929, in respect of deserted, abandoned or neglected children. HEALTH VISITORS. Duties.—The duties alloted to the Health Visitor 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. 68 8. 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 Acts 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. 1928. 1929. Number of homes visited (first visits), Infants 568 538 Number of revisits, Infants 2,452 2,106 Number of Infants' attendances at Infant Consultations 3,733 3,755 Number of visits to Children of one year to school age 390 392 Number of revisits to Children of one year to school age 2,987 2,638 Number of children of one year to school age, attendances at Medical Inspections 1,933 2,428 Number of ante-natal visits to Expectant Mothers :— Primi-para 95 84 Multi-para 201 184 Revisits 489 493 Total 785 761 Number of ante-natal case-attendances at ante-natal clinic 318 406 Number of visits to Diarrhoea cases amongst children 25 2 Number of visits to cases of Ophthalmia Neonatorum 36 9 General additional visits in connection with the work 759 939 Number of visits re Whooping Cough 60 175 Health Visitors attendances at Welfare Centres (half-days) 435 468 MATERNITY NURSES AND MIDWIVES. The arrangements made by the Borough Council for the provision of midwifery attendance have already been outlined in Sec. II. of this 69 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. Year. (1) No. of applications for services of (2) Total number provided with a Amount of Assessment on cases attended. (3) Nett Cost to Council. Maternity Nurse. Midwife. Maternity Nurse. Midwife. Maternity Nurse. Midwife. Maternity Nurse. Midwife £ s. d. £ s. d. £ s. d. £ s. d. 1928 6 42 6 30 3 5 0 15 5 6 6 7 0 28 10 6 1929 3 35 2 28 1 13 6 17 18 6 1 6 6 25 5 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 the homes of necessitous women during confin ment. A panel scheme is in operation under which selected women are placed upon a roster and their services utilised in rotation. This system is found to be very successful in its working. The following Table No. 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. Year. No. of applications for services of Home Help, including extension over the usual period of 2 weeks. Total number of cases attended by the Home Helps. Amount of Assessment on cases attended. *Nett Cost to Council. 1928 22 9 plus 1 extension £ s. d. 12 15 0 £ s. d. 27 5 0 1929 28 17 plus 1 extension 23 16 0 42 4 0 * Half the nett cost to Council is recovered as grant from the Ministry of Health. 70 HOME NURSING. The arrangement whereby the trained nurses of the Chelsea, Pimlico and Belgravia 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 nurs'ng mothers and children under five years of age, while Table No. 46 shows the conditions which necessitated attendance during the year 1929 :— TABLE No. 45. Year. Visits. Cases. 1928 2,026 148 1929 1,326 110 TABLE No. 46. Nursed by District Nurses during 1929. Visits. Cases. Bronchitis 78 6 Burns 23 3 Circumcision 10 2 *Diarrhcea 28 2 Eye trouble 23 3 Ear trouble 83 6 Influenza and Pneumonia (under 5) .. 221 13 Influenza and Pneumonia (over 5) 189 16 Impetigo 3 1 Meningitis and Peritonitis — — *Measles 41 2 *Ophthalmia Neonatorum 160 4 Pemphigus Neonatorum 7 1 *Poliomyelitis — — *Puerperal State 175 13 Rickets — — Septic sores 65 6 Tonsils and Adenoids 33 8 ""Whooping Cough 29 3 Worms 60 8 Miscellaneous 98 13 1,326 113 * Ranks for grant from the Ministry of Health. 71 CLINICS AND TREATMENT CENTRES. The Maternity and Child Welfare work carried on in the Borough by the Chelsea Health Society and School for Mothers has already been outlined in Section II. of this report and an account of the Society's activities during the past two years has been included in Table No. 42. The Society is controlled by a Voluntary Committee and is supported by (1) voluntary contributions, (2) financial grants from the Ministry of Health and from the Borough Council. During the year four infant clinics were held weekly and one ante-natal clinic weekly. One infant clinic was held weekly at 484, King's Road, the remaining three infant clinics and the ante-natal clinic being held at 1, Manor Street. An extra monthly clinic for toddlers was started during the year. 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 58 in 1928 to 75 in 1929. 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 213 Cases admitted and attended in the Home 75 Cases attended in the district 138 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 seven 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. 72 TABLE No. 47. Year. No. of Applications. Nursing Mothers and Infants sent away under Council Scheme. Contributions by Mothers. *Nett Cost to Borough. £ s. d. £ s. d. 1928 27 16 4 7 0 30 18 0 1929 23 13 4 19 0 24 11 0 * Half the nett cost to Council is recovered as a grant from the Ministry of Health. CHELSEA BRANCH OF THE INVALID CHILDREN' S AID ASSOCIATION. During the year the branch had 119 children under school age referred to them for assistance. These children were suffering from marasmus and malnutrition, congenital deformities, rickets, and anaemia and debility following acute illness such as bronchitis, pneumonia, measles, diphtheria and scarlet fever. Forty-seven children were sent out of London for convalescence, for periods varying from six weeks to six months. Five children had hospital treatment arranged for them. All children were given medical aids as 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. Eleven 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 £284 3s. 9d., towards which sum parents contributed £82 0s. Id., leaving a balance of £202 3s. 8d., to be raised by the Chelsea Branch. CHELSEA DAY NURSERY. The attendances at the Nursery during the past two years were as follows:- 73 TABLE No. 48. 1928. 1929. Total number of children attending during the year 4,868 3,322 Average daily attendance (5 days a week) 19 17 Total number of individual children who attended 107 58 The Nursery was closed from the beginning of the year until March owing to reconstruction and renovation. In accordance with the structions of the Ministry of Health, the daily number of children now received is limited to 20. The health of the Nursery has been remarkably good, and no case of infectious illness occurred during the year. Dr. Winifred Gray is Medical Officer to the Nursery and makes a fortnightly inspection of the children. PUERPERAL FEVER AND PUERPERAL PYREXIA. Two cases of Puerperal Fever and five cases of Puerperal Pyrexia were notified during the year. Of these six were treated in hospital There were three deaths. PREGNANCY AND CHILDBIRTH. Four deaths associated with complications in childbirth occurred during the year. Of these, one death followed operation for ectopic gestation. Two deaths were due to pulmonary embolus during labour. The fourth case died from severe eclampsia. MATERNAL MORTALITY. The following table shows the Maternal mortality in Chelsea during the past two years. TABLE No. 49. Year. Death-rate per 1,000 Births. Total Death-rate Puerperal Fever. Other complica tions of Pregnancy and Childbirth. 1928 — 3.73 3.73 1929 4.07 5.14 9.51 74 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. In the case of every maternal death during the year the circumstances Were fully investigated by the Medical Officer of Health, the findings being reported to the Ministry of Health. 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 of 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 has made arrangements 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 Ante-natal Clinic. Every effort is being made to ensure that mothers will take full advantage of the excellent arrangements made by the Chelsea Health Society so that as far as possible all risk of disease and accident incidental to 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. 75 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 incomes 5s. to 6s. at the rate of Id. per pint. ,, ,,6s. to 7s. „ „ 1½ ,, „ ,, 7s. to 8s. ,, „ 2 ,, „ ,, 8s. to 9s. ,, ,, 2½d. ,, The following table shows for the past two years, the extent of this service :— TABLE No. 50. Year. Milk Orders issued and taken up. † Apprcx. Cost. March quarter. June quarter. Sept. quarter. Dec. quarter. *Total. 1928 448 395 332 427 1.602 £ 344 1929 428 374 297 352 1,451 349 * 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 mother and children. WIDOWS', ORPHANS' AND OLD AGE CONTRIBUTORY PENSIONS ACTS, 1925 AND 1929. The powers and duties under these Acts, in respect of deserted, abandoned or neglected children in the Borough, have been taken over by the Council, and a scheme for the administration of the Acts 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 Acts has yet occurred in the Borough. 77 Metropolitan Borough of Chelsea. Annual Report of the PUBLIC ANALYST For the Year ended 31st December, 1929. by B. HENRY GERRANS, F.I.C., Public Analyst. 78 Town Hall, Chelsea, S.W. 3. To the Mayor, Aldermen and Councillors, of the Metropolitan Borough of Chelsea. Madam Mayor, Ladies and Gentlemen, 1. During the year ended on the 31st December, 1929, four hundred samples of Food and Drugs were submitted to me for analysis by the Sampling Officers appointed under the Act. Thirty-one of these samples were submitted as " Informal samples." 2. The nature of the samples submitted and the general procedure in taking samples are not within the control of the Public Analyst. 3. Table I. shows the number and the names of the Genuine, Adulterated, and Inferior samples, both " Formal " and " Informal," reported upon during the year. The term " Genuine Composition " is to be understood to mean that the composition of the samples so described Was in accordance with the scientific definitions which can at present be given to the various articles dealt with, and that adulteration could not be certified in regard to them. The term " Inferior " means that the samples so described were of low quality or of doubtful character and that actual adulteration could not be certified in regard to them. TABLE I. Name of Sample. Genuine Composition or Not Adulterated. Adulterated. Inferior. Total. " Formal." " Informal." " Formal." " Informal." " Formal." 44 Informal." Milk 167 2 4 — — — 173 Butter 29 — 1 30 Margarine Tea 14 — — — 1 — 15 Cocoa 11 13 — — — — 11 13 Coffee and Chicory 10 — — — — 10 Quaker Oats 2 ' 2 Sgar 5 5 Coffee 10 10 Cream 7 — 7 Mustard 1 1 Mustard Mixture 13 13 Baking Powder 4 4 Cornflour 6 6 Custard Powder Lard 9 — — — — — 9 8 — — — — — 8 79 Name of Sample. Genuine Composition or Not Adulterated. Adulterated. Inferior. Total " Formal." " Informal." " Formal." " Inmal." " Formal." "In- formal." Pepper 9 1 — — — — 10 Dried Peas 3 — — 3 " Indian " Toffee 1 — — 2 Jam — 1 1 1 Pepper Mixture 1 — 9 Rice 7 2 4 Flour 4 — — — — 1 Cake 1 — — — 1 Salt 1 — — 2 Haricot Beans 2 — — 3 Self-rising Flour 3 — — 1 Currants 1 — — — 6 Tapioca 6 1 Sultanas 1 — 9 Pork Sausage — 9 — 1 Cheese — 1 — 1 Tomato Ketchup 1 — — 1 Dessicated Soup 1 — — 3 Ground Almonds 3 — — 3 Sponge-Cake 2 1 — — 1 Sauce — 1 — — 1 Salad Cream — 1 — — 1 Fish Paste — 2 — — 2 Olive Oil — 1 — — 1 Coffee and Chicory — — — 1 Essence — 1 1 Ground Rice 3 — — 3 Suet Mixture 1 — — — 1 Cakeoma 1 — — — 1 Mayonnaise 1 — 1 Whisky — 2 — 2 Pork Pie —_ 1 — — 1 Chicken and Ham — — — — — 1 Rissole 1 — — 1 Custard Tart 1 — — 2 Epsom Salts — 2 1 Mulligatawny Soup — 1 — — — 400 Totals 361 30 6 — 2 1 4. The percentages given by the data in Table I. are as follows:- Genuine Composition 97.75 per cent. Adulterated 1.5 per cent. Inferior 0.75 per cent. MILK. 5. The particulars relating to the four samples of Milk reported as adulterated are given in Table II. 80 TABLE II. No. Percentage of Extraneous Water. Percentage of required Fat deficient. " Preservatives." Remarks. 1 22 2 — 8 — — 3 3.5 — — — 3 — 3 — — 6. The remaining 169 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," 31 being of " Good " quality, 108 of " Fair " quality and 30 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. „ 3.35 to 3.8 „ ,, Fair Quality. „ 3.8 and over ,, „ Good Quality. CUSTARD POWDER. 8. 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." MARGARINE. 9. The sample of Margarine reported as Inferior was certified to contain 14.93 per cent, of water, an amount below the limit of 16 per cent, laid down by the Act. In view, however, of the high percentage of water the sample was reported as Inferior. The samples were free from preservatives except salt, and in all the samples the percentage of Butter Fat was under 10 per cent. as required. by the Act. 81 JAM. 10. With respect to the Informal sample of Jam, actual adulteration could not be certified, although it was of very Inferior quality. MUSTARD MIXTURE. 11. These samples all consisted of Mustard mixed with a small Percentage of Wheat Flour, and in view of the declarations at the time of purchase, they must.be regarded as having been properly described RICE. 12. The two samples reported as adulterated contained the following percentages of Extraneous Mineral matter, consisting of a Silicate of Magnesia, and having the characters of powdered Talc :— (1) 0.25 per cent. equivalent to 17.5 grains per pound. (2) 0.20 per cent, equivalent to 14.0 grains per pound. COFFEE AND CHICORY MIXTURE. 13. These samples were found to contain the following percentages of Chicory:— 40, 38 (2), 37, 35 (2), 32, 30 (2), and 25. and therefore the composition of these mixtures was correctly described SAUSAGES. 14. Six 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. In other respects the samples were of normal composition. 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. PEPPER MIXTURE. 16. This sample contained Rice Starch together with Pepper and other condiments, but in view of the disclosure upon the packet, the sample was reported as a sample of genuine Pepper Mixture. 82 CREAM. 17. The fat of these samples had the composition of fat derived from milk, they were free from preservatives, and had the composition of genuine samples of Cream. WHISKY. 18. The samples had the composition of genuine Whisky, or of samples Which must be regarded as unadulterated. They were above the limit of strength laid down by the Food and Drugs (Adulteration) Act, 1928, which limit is 35 degrees under proof for all spirits. 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. PUBLIC HEALTH (PRESERVATIVES, ETC., IN FOOD) AMENDMENT REGULATIONS, 1926. 20. There were no cases of infringement of the above Regulations during the year. I have the honour to be, Madam Mayor, Ladies and Gentlemen, Your obedient Servant, B. HENRY GERRANS, F.I.C. Public Analyst.