CHE 35 Metropolitan Borough of Chelsea. Annual Report OF THE Medical Officer of Health FOR CHELSEA. 1931 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, BROMPTON ROAD, S.W 7. 1932. 2 Public Health, Maternity and Child Welfare Committee. At 31st December, 1931. His Worship the Mayor (Councillor Lt.-Col. S. Boyle, M.C., J.P.) Councillor F. G. Chambers (Chairman). Councillors : L. R. Andrews. M. R. Martineau. E. B. Baggallay. Miss C. L. Paterson. H. C. Browne. Lady Phipps. Mrs. M. S. M. Elliott. G. M. Stevenson. Mrs. M. I. Hewitt. Mrs. C. M. Vaughan-Morgan. D. E. Howells. G. White. A. F. Loveridge. Mrs. C. Williams. Housing Committee. His Worship the Mayor (Councillor Lt.-Col. S. Boyle, M.C., J.P.) Councillor Miss C. L. Paterson (Chairman). Alderman C. B. Clapcott, O.B.E. Alderman A. C. Seton Christopher, J.P. Alderman F. J. Synge. Councillors : L. R. Andrews. B. F. Marsden-Smedley. E. B. Baggallay. Lady Phipps. F. S. Cameron-Head. Mrs. C. M. Vaughan-Morgan. Mrs. M. S. M. Elliott. Mrs. C. Williams. Milk and Welfare Sub-Committee. His Worship the Mayor (Councillor Lt.-Col. S. Boyle, M.C., J.P.) Councillor Miss C. L. Paterson (Chairman) Councillor F. G. Chambers. Councillor Mrs. M. S. M. Elliott. Councillor Lady Phipps. Councillor Mrs. C. M. Vaughan-Morgan. 3 PUBLIC HEALTH OFFICERS OF THE AUTHORITY. The names and qualifications of members of the staff of the Public Health Department, at 31st December, 1931, are tabulated below in the form required by the Ministry of Health. (a) Medical. Year appointed. Name. Qualifications. Appointment. 1924 McCarthy, W. H. L. M.D., M.R.C.P., D.P.H. Medical Officer of Health, Administrative Tuberculosis Officer and Executive Officer under the Council's Maternity and Child Welfare Scheme (Part time). 1017 Fenton, W. J. M.D., F.R.C.P. Tuberculosis Officer (Part time). 1926 Matthews, Kathleen F. M.R.C.S., L.R.C.P., D.P.H. Medical Officer, Maternity and Child Welfare (Part time)- 1928 Nelson, Grace M. M.R.C.S., L.R.C.P. Medical Officer, Maternity and Child Welfare (Part time). 1921 Radford, Muriel A. M.B., B.S., D.P.H. Medical Officer, Maternity and Child Welfare (Part time). 1930 Salmond, Margaret M.D., M.R.C.S., L.R.C.P. Medical Officer, Maternity and Child Welfare (Part time). 1928 Gray, Winifred M. M.D., M.B., B.S. .. Medical Officer, Chelsea Day Nursery (Part time). l93l McLean, W. W. M.D., M.R.C.S., L.R.C.P. Medical Director, Mothercraft Training Home. 1929 'McCullagh, W. McK. M.B., F.R.C.S. Consultant for Puerperal Fever and Puerperal Pyrexia (Part time). 1930 Holland, E. T. M.R.C.S., L.R.C.P. Public Vaccinator, StLuke's Hospital (Part time). 1930 Robinson, J. M.D., D.P.H. Public Vaccinator, Chelsea District (Part time). 1930 Sandiland, D. S. M.R.C.S., L.R.C.P. Public Vaccinator, StStephen's Hospital (Part time). 4 (b.) Other Staff. Year Appointed. Name. Qualifications. Appointment. 1925 Gerrans, B. H. F.I.C. Public Analyst. (Part time). 1920 Crandell, W. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Cert. Meat and other Foods. Senior Sanitary Inspector (Whole time). 1927 Castley, J. Cert. San. Insp. Exam. Board, Cert. Meat and other Foods. Sanitary Inspector (Whole time). 1926 Shelley, A. P. T. Cert. San. Insp. Exam. Board. Sanitary Inspector (Whole time). 1930 Hoyland, H. Cert. Royal San. Inst, and San. Insp. Exam. Joint Board., Cert. Meat and other Foods. Sanitary Inspector, with special reference to Duties under Housing Act, 1925 (Whole time). 1909 Tettenborn, Miss F. Cert. San. Insp. Exam. Board, Cert. Royal San.Inst., Cert.L.C.C. Adv. Home Nursing, C.M.B., Nat. Health Diploma, Health Visitors' Diploma, approved by Board of Education, Special Cert. for Tuberculosis Sanitary Inspector and Tuberculosis Health Visitor (Whole time). 1916 Brown, Miss M. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Health Visitors' Diploma, approved by Board of Education. Cert. C.M.B. Health Visitor (Whole time). 1911 Hobart, Miss F. G. Cert. San. Insp. Exam. Board, Diploma of Nat. Health Soc., Royal San. Inst. Health Visitors' Cert. C.M.B. Health Visitor and Superintendent to Chelsea Health Society (Whole time). 1923 Shaw, Miss A. Cert. Gen. Hosp. Training, C.M.B. and Cert. Mothercraft Training Soc., Health Visitors' Cert, approved by Ministry of Health. Health Visitor, Chelsea Health Society (Whole time). 1926 Harcourt, Miss G. E. Cert. Gen. Hosp. Training, C.M.B., and Cert. Mothercraft Training Society. Health Visitor, Chelsea Health Society (Whole time). 1928 Squire, Miss H. L. M. Cert. San. Insp. Exam. Board, Dipl. Nat. Health Soc., Cert. Instit. of Hospital Almoners, Cert. Social Science (London School of Economics) Secretary of Chelsea Tuberculosis Dispensary and Social Worker in connection with Tuberculosis (Whole time). 1927 Puttick, Miss C. K. Cert. General Hospital Traning and Tuberculosis. Tuberculosis Nurse to Dispensary (Whole time). 5 Year appointed. Name. Appointment. 1914 Hayden, A. B. J. Senior Clerk, Public Health Department (Whole time) 1920 Bosley, E. Clerk, Public Health Department (Whole time). 1930 Bryant, J. C Clerk, Public Health Department (Whole time). 1922 Kennedy, Mrs. H. M. Clerk, (Maternity and Child Welfare) Public Health Pepartment (Whole time). 1931 Hayden, A. B. J. Vaccination Officer (Part time). 1930 Strange, Miss K. H. General Secretary, Chelsea Health Society, Chelsea Nursery and Mothers' Home (Whole time). 1923 Godfrey, Miss Clerk, Chelsea Health Society (Part time). 1906 Leonard, C. Mortuary Keeper and Messenger (Whole time). 1914 Hancock, E. Chief Disinfector (Whole time). 1929 Weston, R. J. Disinfector (Whole time). 1931 Bosley, E., Jr. Disinfector (Whole time). 1923 1929 Smith, Mrs. E. Lowe, Mrs. I. Shelter and Cleansing Attendant (Whole time). Home Help (Part time). 1931 Evans, Mrs. Home Help (Part time). 6 Table of Contents. PAGE Public Health, Maternity and Child Welfare Committee 2 Housing Committee 2 Milk and Welfare Sub-Committee 2 Preface 9 I.—Statistics and Social Conditions of the Borough. General Statistics 11 Physical Features and General Character of the Area 11 Social Conditions, including Chief Occupations of Inhabitants 12 Vital Statistics 12 (a.) Births 13 (b) Marriages 16 (c.) Deaths 16 (d.) Deaths of Children, 1-5 years of age 22 (e.) Infant Mortality 22 (f.) Illegitimate Deaths 24 Apparent Excessive Mortality in the Borough 24 Causes of Sickness in the Borough 24 II.—Provision of Health Services in the Borough. Public Health Officers of the Borough Council 3-5 (a.) Medical 3-5 (b.) Other Officers 3-5 Professional Nursing in the Home 26 (a.) General 26 (b.) Infectious Diseases 26 Mid wives and Maternity Nurses 28 Home Help in Maternity Cases 28 National Health Insurance 29 Poor Law Relief 29 Laboratory Facilities 29 Public Health Legislation in Force in the Borough 30 Hospital Services available in the Borough 31 Maternity and Nursing Homes 33 Puerperal Fever and Puerperal Pyrexia 33 Other Diseases and Complications of Childbirth 33 Maternal Mortality 33 Health Visitors 34 Ante-Natal Work 36 Supply of Milk to Mothers and Young Children 36 Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children 37 Institutional Provision for Mental Defectives 37 Ambulance Facilities 37 Clinics and Treatment Centres 38 (a.) The Violet Melchett Infant Welfare Centre 38 (I.) Chelsea Health Society 39 (II.) Chelsea Day Nursery 39 (III.) Chelsea Mothercraft Training Home 40 (b.) Invalid Children's Aid Association 41 (c.) The Babies' Club 42 (d.) Charity Organisation Society 42 (e.) Chelsea Tuberculosis Dispensary 42 Convalescent Home Treatment for Nursing Mothers and Infants 43 Local Government Act, 1020 43 Widows', Orphans' and Old Age Contributory Pensions Acts, 1025 and 1029 44 Blind Persons Act, 1020 44 Summary of Arrangements regarding Maternity and Child Welfare 44 7 III.—Sanitary Circumstances and Administration. page Complaints 46 Closet Accommodation 46 Removal and Disposal of Refuse 46 Sanitary Inspection of the Borough 46 Magisterial Proceedings 49 Smoke Abatement 49 Fouling of Footways by Dogs 50 Rats and Mice (Destruction) Act 50 Pigeons, Nuisance caused by 51 Premises and Occupations Controlled by Byelaws or Regulations 53 Factories, Workshops and Workplaces 53 Public Mortuary 55 Rag Flock Acts 55 Offensive Trades 55 IV.—Housing. Housing Statistics 56 Housing Conditions in the Borough 58 (a.) General Observations 58 (b.) Sufficiency of Supply of Houses 58 (c.) Overcrowding 61 (d.) Fitness of Houses 61 (e.) Unhealthy Areas 63 ( f.) Byelaws relating to Houses and Houses Let in Lodgings 64 (g.) Housing Survey 64 V.—Inspection and Supervision of Food. Milk Supply 65 Public Health (Meat) Regulations, 1924 66 Slaughter-houses 66 Bakehouses 67 Ice-cream Vendors 67 Fried Fish Vendors 67 Other Premises where Food is Prepared or Offered for Sale 67 Unsound Food 68 Food Poisoning 68 Food and Drugs (Adulteration) Act, 1928 68 The Public Health (Preservatives, etc., in Food) Regulations 69 Margarine 69 Chemical and Bacteriological Examination of Food 69 Magisterial Proceedings under Food and Drugs (Adulteration) Act, 1928 69 Nutrition, Dissemination of Knowledge as to 70 VI.—Infectious and Other Diseases. (a.) Infectious Diseases Generally 71 Diseases Notifiable in the Borough 71 Notifications 71 Diphtheria 72 Scarlet Fever 74 Measles 74 Enteric Fever 75 Pneumonia, Malaria and Dysentery 75 Puerperal Fever and Puerperal Pyrexia 76 Ophthalmia Neonatorum 76 Poliomyelitis and Polio-Encephalitis 77 Encephalitis Lethargica 77 Chicken Pox 77 Smallpox and Vaccination 77 Venereal Disease 78 Disinfection 78 Infectious Diseases Shelter 78 Disinfestation 79 8 page (b.) Tuberculosis 79 Notifications and Mortality 80 Cases of Tuberculosis in the Borough 80 Public Health (Prevention of Tuberculosis) Regulations, 1925 81 Chelsea Tuberculosis Scheme 81 Dispensary and Institutional Facilities for Treatment 86 Co-operation with Hospitals and I.C.A.A. 86 Co-operation with School Medical Service 86 Co-operation with Medical Practitioners 87 Home Contacts 87 Artificial Pneumo-thorax Treatment 87 Home Nursing 87 Extra Nourishment 87 Non-Pulmonary Cases 87 Orthopaedic Treatment 87 Dental Treatment 87 Bacteriological Examinations 88 Care and After-Care Work 88 Appendix. Report of the Public Analyst for 1931 91 9 PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Chelsea. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit the Annual Report on the health of the (Metropolitan Borough of Chelsea for 1931. 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 resident population of the borough is estimated by the Registrar-General at .57,220, a figure which is below that for last year. The birth rate (12.8) is higher than that for last year (12.7). The marriage rate (10.7) is also higher than that for last year (10.2). The death rate (14.1) is higher than that for London generally (12.4) and compares with (12.5) 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 Borough—and that one-half of all deaths in Chelsea occur in persons over 65 years of age. The infant mortality rate was 42, as compared with 40 last year. This represents the lowest infant mortality rate in the metropolitan area. These figures indicate that the general improvement in the public health of the Borough continues to be maintained. There was a considerable decrease in the total incidence of notifiable infectious disease last year. The numbers of cases of diphtheria, scarlet fever, chicken pox, erysipelas and tuberculosis were much less, while those of pneumonia showed a definite increase. A considerable reduction was recorded in the number of cases of measles. At the end of the year there were 300 cases of pulmonary tuberculosis and 76 cases of non-pulmonary tuberculosis known to be living in the Borough—a total approximately the same as that for last year. Maternity and Child Welfare work has continued to grow in extent and usefulness. The attendances at the welfare centres were 8,834, and 7,206 visits to homes of patients were recorded. I continue to receive most valuable assistance from the Chelsea Health Society, and 10 cannot speak too highly of the efficiency of the Society's work. The "Violet Melchett Infant Welfare Centre," now fully completed, has rendered possible many desirable extensions and improvements in Maternity and Child Welfare services. The striking generosity of the late Lord Melchett in providing this admirable health centre will always be remembered with appreciation in the Borough. 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 largely 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. During the year further progress was made in connection with the Council's Improvement Scheme for the World's Endpassage 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. The construction of the new working-class dwellings in connection with the Manor-street Housing Scheme was completed, in conjunction with the Peabody Trust. As in former years, much attention has been devoted to the supervision of food supplies. I have again to express my appreciation of the work of the staff of the Public Health Department. I should also 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, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, w.h.l. McCarthy. Annual Report on the Health of the Metropolitan Borough of Chelsea. Year ending 31st December, 1931. SECTION I.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. GENERAL STATISTICS. TABLE No. 1. Area (acres) 660 Resident Population :—Registrar-General's estimate, 1931 57,220 Number of Inhabited Houses (end of 1931) according to Rate Books 11,919 Rateable value, October, 1931 £1,217,381 Sum represented by a penny rate, October, 1931 £4,815 Physical Features and General Character of the Area.—The Metropolitan Borough of Chelsea, situated near the centre of the Metropolis, is bounded on the north by the Royal Borough of Kensington on the west by the Borough of Fulham, on the east by the City of Westminster, and on the south by the river Thames. It is a small compact borough, less than two miles in length, by about three-quarters of a mile in width. Over nearly the whole area the soil consists of gravel and sand, highly permeable to water. In a small portion of the western side of the Borough there is a thin loamy deposit of brick earth resting upon the gravelThere 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. 12 Social Conditions.—The density of population (number of persons per acre) as shown by the 1921 Census, is 97, the corresponding figure for London, as a whole, being 60. The density of population of each of the five Wards in the Borough is as follows:— Church Ward, 124; Stanley Ward, 122; Hans Town Ward, 98; Cheyne Ward, 83; Royal Hospital Ward, 59. Analysis of the 1921 Census figures shows that there is a greater proportion of unoccupied and retired persons in Chelsea than in any other Metropolitan borough. There is, however, a considerable "working class" population. Thus, of a total of 21,000 adult males, about 17,000 are occupied. The chief occupations are transport work (2,990), personal service (1,971), metal work (1,144), and clerical work (1,017). Nearly one half of the 32,000 adult females are occupied. Of these, domestic servants account for 9,900, dressmakers number 1,355, shop assistants 1,900, and clerks 1,200. There are no dangerous or offensive trades carried on in the Borough. There is no evidence that any of the occupations of the inhabitants exerts a deleterious influence on the public health. VITAL STATISTICS. In accordance with the requirements of the Ministry of Health, the following extracts from the Vital Statistics of the year are shown below :— TABLE No. 2. Total M. F. Live Births:— Birth rate per 1,000 of the estimated resident population 12.8 Legitimate 658 332 326 Illegitimate 77 34 43 Still Births 26 17 9 Rate per 1,000 total (live and still births) births 34.2 Deaths 805 423 382 Death rate per 1,000 of the estimated resident population 14.1 Deaths from diseases and accidents of pregnancy and childbirth:— From sepsis 3 From other causes 1 Death rate of Infants under one year of age :— All infants, per 1,000 Live Births 42 Legitimate infants per 1,000 legitimate live births 35 Illegitimate infants per 1,000 illegitimate live births 104 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) 3 Deaths from Diarrhœa (under 2 years of age) 4 13 BIRTHS. During the year 1,000 births were registered in Chelsea. Of these, births of non-parishioners account for 441. In addition, there were 176 births amongst Chelsea mothers in Lying-in Hospitals and elsewhere outside the Borough. The total number of Chelsea Births for the was therefore 735, equivalent to an annual birth-rate of 12.8 per 1,000 of population. The birth-rate for England and Wales in 1931 was 15.8, while that for London as a whole was 15.0. The following Tables are self-explanatory:— TABLE No. 3. Registered Births. Legitimate. Illegitimate. Total. Male. Female. Male. Female. Births Registered in the Borough 405 383 100 112 1000 Births of Non-Parishioners 154 133 76 78 441 251 250 24 34 559 Births of Chelsea Mothers in Lyingin Hospitals and elsewhere outside of the Borough 81 76 10 9 176 332 326 34 43 735 Nett Chelsea Births 658 77 735 14 TABLE No. 4. Births, Birth-Rates, Births in Wards and Inward Transfer Births. Year. Births. BirthRate Per 1,000 of Population. Births in Wards. Inward Transfer Births. Leg. Illeg. Total. Hans Town. Royal Hospital. Church Cheyne. Stanley. Hospitals. Nursing Homes. Private Addresses. Total. 1930 729 70 799 12.7 110 76 109 137 367 107 29 17 153 1931 658 77 735 12.8 94 78 108 86 369 115 48 13 176 15 TABLE No. 5. Births in Hospitals and Nursing Homes. Chelsea Births in Hospitals and Nursing Homes Within the Borough. Chelsea Births in Hospitals and Nursing Homes Outside the Borough. St. Luke's Hospital and Institution 159 St. George's Hospital 43 St. Stephen's Hospital and Institution 6 Queen Charlotte's Hospital 23 Clapham Maternity Hospital 3 Ormond Maternity Home 27 General Lying-in Hospital 4 Wilbraham Nursing Home 9 Royal Free Hospital 15 Chelsea Hospital for Women - Miscellaneous Hospitals 27 Royal Avenue Nursing Home 1 Nursing Homes 48 Total 202 Total 163 From Table No. 4 it will be observed that the number of births of Chelsea Infants in Hospitals and elsewhere outside Chelsea accounted for 23.9 per cent. of the total births. In the preceding year the percentage was 19.1. NOTIFICATION OF BIRTHS ACTS, 1907. Under the above Act, all live and stillbirths occurring after the 28th week of pregnancy must be reported within 36 hours to the Medical Officer of Health of the district in which the birth takes place. This information is extremely valuable, as it enables the Health Visitor to exercise supervision of the mother and child shortly after confinement. During the year, 997 births, including stillbirths, were notified as occurring in Chelsea. Of this number, in 440 instances the parents were resident in other Boroughs, and information of such births was transmitted to the Medical Officer of Health concerned. Information was received of 176 births amongst Chelsea mothers in Lying-in hospitals and elsewhere outside the Borough. The total number of notified Chelsea births from all,sources was 733. The following table indicates the source of notification of the 997 births notified in the Borough :— TABLE No. 6. Notification received from Chelsea Residents. Non-Residents. Live Births. Still Births. Total. Live Births. Still Births. Total. Medical Practitioners 129 4 133 62 - 62 Midwives 237 1 238 52 - 52 Poor Law Institutions 165 3 168 313 13 326 Parents 18 — 18 — — — 549 8 557 327 13 440 16. Illegitimate Births.—The following table shows the number of illegitimate births and the percentage of the total births. In 1931, 212 such births were registered in Chelsea, and 19 inward transfers and 154 outward transfers were made by the Registrar-General. The nett figure for the Borough is therefore 77, of which 23 were under observation by the Health Visitors at the end of the year. TABLE No. 7. Number of Percentage of Year. illegitimate births. total Births. 1930 70 8.8 1931 77 10.5 Stillbirths.—During the year 32 stillbirths were registered in Chelsea, 20 being males and 12 females. Of these, stillbirths of non-parishioners account for 16 (11 males and 5 females) and must be deducted. In addition, there were 10 stillbirths amongst Chelsea mothers outside the Borough (8 males and 2 females). The corrected number of stillbirths is, therefore, 26, which represents a rate for the Borough of 0.45 per 1,000 of the population, as compared with 0.50 for London as a whole. MARRIAGES. There were 614 marriages registered in the Borough during the year (642 in 1930). The marriage rate (number of marriages per 1,000 of population) was 10.7. In the preceding year the marriage rate was 10.2. DEATHS. During the year 1,855 deaths were registered in Chelsea. Of these, deaths of non-residents accounted for 1,203. In addition, there were 153 deaths of Chelsea residents in Institutions and elsewhere outside the Borough. The total number of Chelsea deaths for the year was therefore 805, equivalent to an annual death-rate of 14.1 per 1,000 of population. The death rate for England and Wales for 1931 was 12.3, and for London, 12.4. The following tables are self-explanatory:— TABLE No. 8. Registered Deaths. Total. Deaths registered in the Borough 1855 Non-parishioners 1203 Deaths of Chelsea residents in hospitals and elsewhere outside the 652 Borough 153 Nett Chelsea deaths 805 17 TABLE No. 9. Deaths, Death Rates, Deaths in Wards and Seasonal Mortality. Year. Deaths. DeathRate per 1,000 of Population. Deaths in Wards. Seasonal Mortality Rate. Hans Town. Royal Hospital. Church. Cheyne. Stanley. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. 1930 783 12.5 106 126 132 125 294 14.2 11.1 11.4 13.2 1031 805 14.1 103 154 135 117 296 18.3 13.0 11.4 13.5 18 deaths in public institutions and elsewhere. In tabular form is shown below the number of deaths of Chelsea residents which took place in various Institutions during the year. Of the 652 Chelsea deaths registered in the Borough, 388 occurred in Institutions within the Borough. TABLE No. 10. Chelsea Deaths in Hospitals and Institutions Within the Borough. Chelsea Deaths in Hospitals and Elsewhere Outside the Borough. St. Luke's Hospital and Chelsea Institution 295 General Hospitals 47 Mental Hospitals 13 Royal Hospital for Pensioners 52 Special Hospitals 17 Cancer Hospital 14 Infectious Disease Hospitals 6 Victoria Hospital for Children (Tite Street) 3 Tuberculosis Sanatoria, etc. 7 Nursing Homes 30 St. Stephen's Hospital (Westminster Infirmary) 13 Poor Law Institutions 12 Private Addresses 21 Brompton Hospital 5 Chelsea Hospital for Women — Cheyne Hospital for Children — Freemasons' Hospital 1 St. George's Home for Tuberculosis — 383 153 Of the 1,203 deaths of non-residents registered in Chelsea 1,187 occurred in hospitals or Institutions within the Borough. TABLE No. 11. Birth Rate, Death Rate, and Analysis of Mortality During the Year 1931. (Provisional figures. The mortality rates for England and Wales refer to the whole population, but for London and the towns to civilians only.) - 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. Diarrhœa 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 15.8 0.67 12.3 0.01 0.00 0.08 0.01 0.06 0.07 0.36 0.54 6.0 66 91.18 6.17 1.70 0.95 107 County Boroughs and Great Towns, including London 16.0 0.67 12.3 0.00 0.00 0.10 001 0.07 0.08 0.33 0.48 8.4 71 91.43 5.84 2.24 0.49 159 Smaller Towns (1921 Adjusted Populations 20,000-50,000) 15.6 0.73 11.3 0.00 0.00 0.07 0.01 0.05 0.05 0.36 0.43 4.0 62 92.17 5.49 1.25 1.09 London 15.0 0.50 12.4 0.01 0.00 0.03 0.02 0.07 0.06 0.26 0.57 9.7 65 89.52 6.23 4.24 0.01 Chelsea 12.8 0.45 14.1 0.00 0.00 0.02 0.00 0.05 0.03 0.33 0.80 4.9 42 88.69 6.96 4.85 0.00 The maternal mortality rates for England and Wales are as follows:— Puerperal Sepsis. Others. Total. Per 1,000 live births 1.66 2.45 4.11 Per 1,000 total births 1.59 2.35 3.95 20 TABLE No. 12. Deaths of Chelsea Residents Registered during the Year 1931, 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 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards. All causes 805 31 6 10 7 23 29 37 85 133 208 236 Typhoid and Paratyphoid Fevers — — — — — — — — — — — — 2 Measles 1 — — 1 — — — — — — — — 3. Scarlet Fever — — — — — — — — — — — — 4. Whooping Cough 3 1 1 1 — — — — — — — —- 5. Diphtheria 2 — — 1 — — — 1 — — — — 6. Influenza 19 — — 1 — 1 — — 2 5 4 6 7. Encephalitis Lethargica .. 1 — — — — — 1 — — — — — 8. Cerebro-Spinal Fever 1 — — — — — 1 — — — — — 9. Tuberculosis of Respiratory System 51 — 1 1 — 11 10 10 6 5 4 3 10 Other Tuberculous Diseases 1 1 — — — — — — — — — — 11. Syphilis 3 — — — — — — — 1 1 1 — 12. General Paralysis of the Insane, Tabes Dorsalis 2 — — — — — — — — 1 1 — 13. Cancer malignant disease 131 — — 1 — 2 1 7 23 29 41 27 14 Diabetes 12 — — — — — — 1 1 2 6 2 15.Cerebral Hæmorrhage, etc. 50 — — — — — — 1 4 .5 22 18 16. Heart Disease 204 — — — — 1 3 1 10 37 08 84 17. Aneurysm 2 — — — — — — — — — 2 — 18. Other Circulatory Diseases 39 — — — — — — — 2 9 7 21 19 bronchitis 23 1 — — — — — — — 5 7 10 20.Pneumonia (all forms) 47 6 2 1 1 2 4 5 7 3 7 9 21.Other Respiratory Diseases 8 — — — — — 1 2 1 2 — 2 22. Peptic Ulcer 7 — — — — 1 — 2 3 — 1 — 23. Diarrhœa, etc. 6 2 2 — — — — — 1 — — 1 24. Appendicitis 8 — — 1 — — — 2 1 2 1 1 25. Cirrhosis of Liver 3 — — — — — — — — 2 — 1 26 Other Diseases of Liver, etc. — — — — — — — — — — — — 27.Other Digestive Diseases 17 2 — — — — 1 — 6 2 2 4 28. Acute and Chronic Nephritis 15 — — — . — 1 — 1 1 4 5 3 29 Puerperal Sepsis 3 — — — — — 3 — — — — — 30. Other Puerperal Causes 1 — — — — — 1 — — — — — 31 Congenital Debility, Premature Birth, Malformations, etc. 13 13 — — — — — — — — — — 32. Senility 20 — — — — — — — — — 3 17 33 Suicide 1 1 — '— — — 2 1 1 3 4 — — 24. Other Violence 35 — — 1 3 — 1 1 3 8 4 14 35 Other Defined Diseases 65 4 — 1 3 2 1 2 10 7 22 13 36. Causes ill-defined or unknown 1 1 — — — — — — — — — — 805 31 6 10 7 23 29 37 85 133 208 236 21 CAUSES OF DEATH. Table No. 12 shows that 201 deaths were due to Organic Heart Disease, 131 to Cancer, 23 to Bronchitis, 47 to Pneumonia, 51 to Pulmonary Tuberculosis, 39 to Circulatory Diseases, 50 to Cerebral Haemorrhage, 19 to Influenza and 13 to Congenital Debility and Malformation. Fifty-five per cent. of all deaths occurred in persons over 65 years of age. Organic Heart Disease.—Of the 204 deaths from cardiac diseases, 152 were in persons over the age of 65 years. In 1930, there were 167 deaths from Heart Disease, 120 being persons over the age of 65 years. Cancer and Malignant Disease.—There were 131 deaths from Cancer during the year a figure identical with that for 1930. Three of the deaths were under 25 years of age ; 8 between the ages of 25 and 45 ; 52 between the ages of 45 and 65 ; and 68 above the age of 65 years. There were 6,984 deaths from Cancer in London during the year, as compared with 6,863 in 1930. On request, rooms are disinfected after a death from Cancer, and arrangements made for the removal, fumigation or destruction of bedding. Twenty 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. Diarrhœa and Enteritis.—There were six deaths from these diseases, a figure identical with that for 1930. Two of the deaths were under the age of twelve months ; two between the ages of one and two ; one between the ages of 45 and 65 ; and one above the age of 65 years. During the September quarter the mean temperature was 59.4°, as against 62.0° in 1930. The rainfall of this quarter in 1931 was 10.3 inches, as against 7.2 in 1930. Violence and Suicide.—-Thirty-five deaths occured from violence apart from suicide. Suicide was responsible for 11 deaths. Puerperal Deaths.—Deaths from puerperal fever and from other causes associated with childbirth are reviewed in Section II., page 33. Respiratory Diseases.—Table No. 13 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 :—- 22 TABLE No. 13. Year. Bronchitis. Pneumonia. Other Respiratory Diseases. Total. Death. rate. No. of deaths under 5 years. Percentage under 5 years. 1930 28 44 8 80 1.3 10 12.5 1931 23 47 8 78 1.3 10 12.8 DEATHS OF CHILDREN 1-5 YEARS OF AGE. The number of deaths of children between 1-2 years of age was 6 and between 2-5 years, 10. In the previous year these figures were 10 and 5 respectively. The causes of death are given in detail in Table No 12. Table No. 14 shows the causes of death during the past two years. TABLE No. 14. Child Mortality (1-5 Years). Period or Year. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrhœal Diseases. All other causes. Total Deaths. 1930 7 1 4 3 15 1931 5 2 3 2 4 16 INFANT MORTALITY. There were 31 deaths of infants under one year of age in Chelsea during the year. The corrected death rate is 42 per 1,000 births, as compared with 40 in 1930. In London as a whole the rate of infant mortality was 65 per 1,000 births. The causes of death in the various age groups are set out in Table No. 15 :- 23 TABLE No. 15. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3-6 months. 6-9 months. 9-12 months. Total deaths under 1 year. Small-pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - \\ hooping Cough - - - - - - 1 - - 1 Diphtheria - - - - - - - - - - Influenza - - - - - - - - - - Erysipelas - - - - - - 1 - - 1 Tuberculous Meningitis - - - - - - - - I 1 Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis - - - - - - - - - - Convulsions - - - - - - - - - - Laryngitis - - - - - - - - - - Bronchitis - - - - - - - - 1 1 Pneumonia - 1 - - 1 - 2 1 2 6 Diarrhœa and Enteritis - - - - - - 1 1 - 2 Gastritis - - - - - 1 - - - 1 Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Suffocation - - - - - - - - - - Injury at Birth - - - - - - - - - - Atelectasis 1 - - - 1 - - - - 1 Congenital Malformations 1 - - - 1 2 - - - 3 Premature Birth 7 - - 1 8 - - - - 8 Atrophy, Debility and Marasmus 1 - - - 1 - 1 - - 2 Other causes - - - - - 1 2 - 1 4 10 1 - 1 12 4 8 2 5 31 Nett Births registered during Legitimate 658 the calendar year Illegitimate 77 Nett Deaths (under 1) registered Legitimate 23 during the calendar year Illegitimate 8 The following Table gives the Infant Mortality Rate in Chelsea under various headings, for the past two years : — TABLE No. 16. 1930. 1931. Infectious Diseases 3.7 2.7 Diarrhœal Diseases 6.3 2.7 Developmental Defects and Wasting 12.5 19.0 Other causes 17.5 17.6 Total Rate 40.0 42.0 24 TABLE No. 17. Infantile Mortality Rates per 1,000 Births in Wards. 1930. 1931. Hans Town 27 43 Royal Hospital 13 26 Church 72 70 Cheyne 15 23 Stanley 49 41 Chelsea Borough 40 42 Illegitimate Deaths.—The following Table No. 18 shows the number of deaths among illegitimate infants during the past two years. TABLE No. 18. 1930. 1931. Total number of illegitimate deaths under 1 year 4 8 Illegitimate death rate 57 104 APPARENT EXCESSIVE MORTALITY IN THE BOROUGH. The Census Returns have consistently shown that there is a considerably higher percentage of persons of advanced age living in Chelsea than in any other Metropolitan Borough. The 1931 Census Returns are not yet available. The 1921 Returns showed that in London generally 7.7 per cent. of the total population were included in the agegroup 55-65, and 5.8 per cent. in the age-group 65 and upwards. In Chelsea, however, 9.2 per cent. of the total population came within the age-group 55-65, while no less than 8.8 per cent. constituted the agegroup 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. In 1931, deaths of pensioners in the Royal Hospital, Chelsea, accounted for 62 deaths, inward transfers included (equivalent to 1.08 of the death rate). For many years past more than half the deaths in Chelsea have occurred in persons over 65 years of age. 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. The incidence of the infectious diseases is dealt with in Section VI. of this report. 25 It is difficult to write definitely on the incidence of sickncss generally, as the. Medical Officer of Health has no access to sickness returns which would render a complete and accurate survey possible. 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 receive medical relief from the Public Assistance Committee. 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 a considerable amount of respiratory and rheumatic affections, but the deaths from diseases of this character were lower than in previous years. The number of deaths is, of course, no measure of the amount of sickness and can only be regarded as an index. Influenza was much less prevalent and less severe in type than the average incidence of the disease during the preceding five years. Judged by the notifications received, there was an increase in the amount of pneumonia, 127 notifications being received, as compared with 94 in the previous year. There was a definite decrease in the number of cases of infectious disease. The incidence of gastro-intestinal diseases was comparatively low. No special effects of any particular occupation, prejudically affecting the health of workers therein, have been reported. 26 SECTION II.—PROVISION OF HEALTH SERVICES IN THE BOROUGH. PUBLIC HEALTH OFFICERS OF THE BOROUGH COUNCIL, The names and qualifications of members of the staff of t he Public Health Department at 31 st December, 1931, are tabulated on pages 3-5, in the form required by the Ministry of Health. NURSING ARRANGEMENTS. (a.) General 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 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 27. Three members of the Public Health Committee of the Borough Council are members of the Council of the Association. The Borough Council made a financial grant of £50 to the Association for the year commencing 1st April, 1931. The total fees paid by the Council for nurses' visits during the year amounted to £106 2s. 9d. (b) Nursing of Infectious Disease Cases.—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. Under the Borough Council's Maternity and Child Welfare Scheme, arrangements have been made with the Chelsea District Nursing Association for the nursing of selected cases of infectious disease. In this category are included ophthalmia neonatorum, pneumonia, measles and German measles, whooping cough, epidemic diarrhoea, poliomyelitis, puerperal fever and puerperal pyrexia. 27 Arrangements are also in operation for the home nursing of cases of tuberculosis. This is carried out by the Tuberculosis Nurse to the Dispensary. Further details will be found on page 87. The foregoing arrangement whereby the trained nurses of the Chelsea, pimlieo 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 the}' 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. 19 shows, for the past two years, the number of home visits paid by the District Nurses, while Table No. 20 shows the conditions which necessitated attendance during the year 1981 TABLE No. 19. Year. Visits. Cases. 1980 1,838 157 1931 1,521 145 TABLE No. 20. Nursed by District Nurses During 1931. Visits. Cases. Bronchitis 143 20 Burns — — Chicken Pox 10 1 Circumcision 113 17 Diarrhœa — — Eye Trouble 143 13 Ear Trouble 199 11 Influenza and Pneumonia (under 5) 359 16 Influenza and Pneumonia (over 5) 68 5 Impetigo 62 6 Meningitis and Peritonitis — — Measles — — Ophthalmia Neonatorum 21 2 Pemphigus Neonatorum 21 1 Poliomyelitis — .... — Puerperal State 78 9 Rickets 5 1 Septic sores 29 4 Tonsils and Adenoids 58 13 Whooping Cough 26 5 Worms 78 8 Miscellaneous 108 13 1,521 145 28 MATERNITY NURSES AND MIDWIVES. Provision has been made by the Borough Council whereby necessitious women may obtain the services of a Maternity Nurse or Midwife at a reduced rate, the balance of the fee being paid by the Council. The fees charged vary from £2 to £2 2s. for Primipara cases, and from £1 5s. to £1 10s. for Multipara cases. Arrangements on this basis have been made with the Ormond Home for Midwives (Blantyre-street, Chelsea), and with Midwives Andrews and Briggs, who are practising midwives in the Borough. All cases must in the first instance be approved by the Milk and Welfare Sub-committee. The Sub-Committee meets weekly to consider applications and assess cases according to the income of the family. Contributions by patients towards the cost of midwifery assistance are collected by the Maternity Nurse or Midwife who undertakes the case. The London County Council is the Authority responsible for the supervision of midwives in the Borough. Through the courtesy of Sir Frederick Menzies, the County Medical Officer of Health, I have been able to ascertain that 13 midwives gave notice during the year of their intention to practise as midwives in Chelsea. Of these, three are engaged in Private practice, the remainder being employed on the staff of various hospitals, institutions and maternity homes within the Borough. In the following Table No. 21 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. 21. Year. (1) No. of applications for services of (2) Total number provided with a Amount of Assessment on cases attended. Nett Cost to Council. Maternity Nurse. Midwife. Maternity Nurse. Midwife. Maternity Nurse. Midwife. Maternity Nurse. Midwife. 1930 £ s. d. £ s. d. £ s. d. £ s. d. 4 45 3 33 2 0 0 20 6 6 2 10 0 29 3 6 1931 — 30 1 25 1 0 0 15 12 3 0 10 0 21 17 9 Note.—(1) Includes applications refused and cases subsequently withdrawn. (2) Includes cases assessed during previous year. HOME HELP IN MATERNITY CASES. Home Helps are employed by the Borough Council for service in the homes of necessitous women during confinement. 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. 22 shows, for the past 29 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. 22. 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. 1930 20 15 £ s. d. 23 13 0 £ s. d. 36 7 0 1 931 19 14 18 10 6 36 9 6 NATIONAL HEALTH INSURANCE. The work of a Sanitary Authority has no direct relation to this service but wherever co-operation is possible such assistance is freely rendered by the public Health Department. It is mainly in cases of advanced tuberculosis, without relatives and under treatment in hospitals and institutions, that arrangements are necessary in connection with payment of benefits under the Health Insurance Acts. These arrangements are made by the Tuberculosis Care Committee and the staff of the Tubercules is Dispensary, in conjunction with the appropriate officials of the Health Insurance Service. POOR LAW RELIEF IN THE BOROUGH. Through the courtesy of Sir Allen Powell, Chief Officer of Public Assistance, I am able to give below the figures as to the average daily number of persons chargeable to the London County Council during the past two year TABLE No. 23. 1930 1931 Average daily number of persons who received medical relief only 43 53 Average daily number of persons who received relief (indoor and outdoor) 1238 1239 LABORATORY FACILITIES. Analysis of Food and Drugs.—The Public Analyst is Mr. B. H. Gerrans F.I.C., and the investigations in connection with food and drags 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. 30 . 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. In cases of suspected bacterial food poisoning, samples of the supposed Peccant food, samples of blood, etc., from sufferers, and post-mortem Materials from fatal cases are transmitted to the laboratory of the Ministry of Health for examination and report. No cases of suspected food poisoning occurred during the year. The number of bacteriological, bacterioscopic and other examinations carried out during the year was 274. Of these, 226 were for the bacillus associated with Diphtheria, 43 for the bacillus associated with Tuberculosis, 3 for the bacillus associated with Enteric Fever, and one for Meningococcus associated with Cerebro-Spinal Fever. 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 £45 3s. The total number of bacteriological examinations during the preceding year was 419. 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 for use in connection with patients resident in Chelsea. The amount supplied during the year was 152,500 units. An anti-toxin syringe, needles and steriliser are also available on loan. The total cost to the Council for anti-toxin supplied during the year was £10 0s. 1d. PUBLIC HEALTH LEGISLATION IN FORCE IN THE BOROUGH. The powers under which the Council work are those contained in the public General Acts, the London County Council (General Powers) Acts, and the Byelaws under the Public Health Acts. In addition, the Council, on 18th February, 1925, in pursuance of the Provisions of Section 23 of the Municipal Corporations Act, 1882, Section 16 of the Local Government Act, 1888, and Section 5 of the London Government Act, 1899, made the following byelaw for the good rule and government of Chelsea, such byelaw being sealed and forwarded to the Secretary of State for the Home Department, and a copy being fixed to the Town Hall as required by Statute :— 31 NUISANCE BY DOGS. "No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement on the public footway. Any person offending against this byelaw shall be liable to a penalty not exceeding forty shillings." A similar byelaw has been adopted by several of the metropolitan boroughs. In all cases the byelaw was allowed by the Home Office as an experimental measure for a period of two years, unless a byelaw is made confirming and continuing its provisions before the expiration of that period. This byelaw has proved of considerable assistance in preventing serious nuisance and a confirming byelaw (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 byelaw has been authorised. HOSPITAL SERVICES. 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. 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. The following Hospitals and Institutions are located within the Borough. None of these are controlled or supported wholly or in part by the Borough Council. Brompton Hospital for Consumption. Cancer Hospital. Chelsea Hospital for Women. Cheyne Hospital for Children. Freemasons' Hospital. Royal Hospital for Pensioners. St. George's Home for Tuberculosis. St. Luke's Hospital and Institution. St. Stephen's Hospital and Institution. Victoria Hospital for Children. The following table No. 24 shows, in the form required by the Ministry of Health, particulars of the hospitals, public and voluntary, within and without the Borough, which are utilised by inhabitants of the Borough. 32 TABLE No. 24. Name. Situation. Nature of Cases Treated. Available Beds. If used by persons resident outside the Borough Management. Brompton Hospital for Consumption Fulham Road, S.W. 3 Pulmonary Tuberculosis 333 Yes By Voluntary Committee Cancer Hospital Fulham Road, S.W. 3. Malignant Disease 120 Yes By Voluntary Committee Chelsea Hospital for Women Arthur Street, S.W. 3. Obstetric and Gynæcological 97 Yes By Voluntary Committee Cheyne Hospital for Children Cheyne Walk, S.W. 3. Children's Diseases 70 Yes By Voluntary Committee. Freemasons' Hospital 237, Fulham Road, S.W. 3. General Medical and Surgical 46 Yes By Voluntary Committee Princess Beatrice Hospital Richmond Road, S.W. 5. General Medical and Surgical 78 Yes By Voluntary Committee Royal National Orthopædic Hospital Great Portland Street, W. 1. Deformities and Malformations 200 Yes By Voluntary Committee St. George's Hospital Hyde Park Corner, S.W. 1. General Medical, Surgical and Maternity 436 Yes By Voluntary Committee St. Luke's Hospital Cale Street, S.W. 3. Medical, Surgical and Maternity 420 Yes By Public Assistance Committee of L.C.C. St. Stephen's Hospital Fulham Road, S.W. 10 Medical, Surgical and Maternity 720 Yes By Public Assistance Committee of L.C.C. Victoria Hospital for Children Tite Street, S.W. 3. Children's Diseases 130 Yes By Voluntary Committee. West London Hospital Hammersmith Road, W. 6. General Medical and Surgical 220 Yes By Voluntary Committee 33 All the hospitals included in the foregoing table are fully equipped for operative surgery on modern lines. Each of them also provide special departments for X-ray investigation, dental, ophthalmic, massage and pathological work. MATERNITY AND NURSING HOMES. The Ormond Maternity Home, situated at 29, Blantyre Street, Chelsea, is the only institution of its kind in the Borough. Its 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. 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 247 Cases admitted and attended in the Home 80 Cases attended in the district 167 Maternal Deaths None PUERPERAL FEVER AND PUERPERAL PYREXIA. There were no cases of Puerperal Fever. Seven cases of puerperal Pyrexia were notified. Details of these cases are set out in the following table :— TABLE No. 25. Total number of cases notified. Treatment in Hospital. District Nurses in attendance Council's Obstetrician called in. Deaths. Puerperal Fever 0 0 0 0 0 Puerperal Pyrexia 7 7 1 1 3 DISEASES AND COMPLICATIONS OF CHILDBIRTH. Three deaths (already referred to under the heading of Puerperal Pyrexia, see Table No. 25), occurred during the year. A further death arose as a consequence of abortion, apparently self-induced. MATERNAL MORTALITY. The following table shows the Maternal Mortality in Chelsea during the past two years. 34 TABLE No. 26. Death-rate per 1,000 Births. Year. Puerperal Fever. Other complications of Pregnancy and Childbirth. Total Dea;th-rate. 1930 2.50 — 2.50 1931 4.08 1.36 5.44 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. Wherever possible in such cases arrangements are made for the women 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. Efficient treatment is provided by the Public Assistance Committee, and also, with a view to providing for the safe confinement of such cases, most of the Metropolitan Borough Councils have made special arrangements. In addition, the Ministry of Health has provided for the admission of cases to certain of the London County Council 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 and in cases of difficult labour, when desired by the medical practitioner in attendance. Two such cases required consultation during the year. HEALTH VISITORS. Duties.- The duties allotted to the Health Visitors are as follows:— 1. To visit the homes of all newly-born children amongst the working classes within 21 days after birth, and subsequently as circumstances dictate. 35 2, To visit the homes and make investigations in regard to stillbirths and infant deaths. 3. To visit and give advice to parents in cases of ophthalmia, zymotic enteritis and other diseases causing deaths amongst infants. 4. To visit and report upon all cases of puerperal fever. 5. To investigate, when required, homes in which overcrowding is alleged to exist. 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. 27) gives an outline of the work of the Health Visitors and of the Chelsea Health Society and School for Mothers during the past two year. 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. 27. Summary of Reports of Health Visitors. 1930 1931 Number of homes visited (first visits), Infants 563 557 Number of re-visits, Infants 1,957 1,747 Number of Infants attendances at Infant Consultations 4,184 4,044 Number of visits to Children of one year to school age. 363 314 Number of re-visits to Children of one year to school age 2,668 2,806 Number of children of one year to school age, attendances at Medical Inspections 3,102 3,310 Number of ante-natal visits to Expectant Mothers :— Primi-para 86 109 Multi-para 200 186 Re-visits 520 571 Total 806 866 Number of ante-natal case-attendances at ante-natal clinic 722 817 Number of post-natal case-attendances at post natal clinic 40 63 Number of visits to Diarrhœa cases amongst children — — Number of visits to cases of Ophthalmia Neonatorum 10 8 General additional visits in connection with the work 965 835 Number of visits re Whooping Cough 22 73 Health visitors attendances at Welfare Centres (half-days) 583 623 36 ANTE-NATAL WORK. The work of ante-natal consultations is increasing as the figures in Table No. 27 demonstrate. Sound advice, based on the most recent scientific investigation, is provided by the medical officer of the Antenatal Clinic. Every effort is being made to ensure that mothers will take full advantage of the excellent arrangements made by the Chelsea Health Society so that as far as possible all risk of disease and accident incidental to childbirth may be removed. SUPPLY OF MILK TO MOTHERS AND YOUNG CHILDREN. Provision is made under the Maternity and Child Welfare Act, 1918, whereby milk is provided in necessitous cases, free or at less than cost price. The Milk and Welfare Sub-committee meets weekly at the Town Hall to consider applications. Free milk is supplied when the total income of the family, after deducting rent and insurance, does not exceed 4s. 0d. per head per week. Milk is supplied to other cases on the following basis :— Nett available incomes 4s. to 5s. at the rate of 1d. per pint. „ ,, 5s. to 6s. „ ,, 1½d. ,, ,, ,, 6s. to 7s. ,, ,, 2d. „ „ ,, 7s. to 8s. ,, „ 1½d. „ The following table shows for the past two years, the extent of this service. :— TABLE No. 28. Year. Milk Orders issued and taken up. Approx. Cost. March quarter. June quarter. Sept. quarter. Dec. quarter. *Total. 1930 451 420 365 469 1705 £ £439 1931 562 516 510 606 2194 £527 * These totals do not include orders subsequently cancelled or withdrawn, which average 150 or more during each year. It will be observed that in 1931 there was a considerable increase in the cost of milk. This arose in part as a result of the great increase in unemployment, necessitating the supply of milk to a large number of applicants free of cost. It also arose by reason of the fact that cows' milk was supplied to 73 per cent. of the applicants, dried milk being supplied to the remaining 27 per cent. In 1926 only 30 per cent. of the milk supplied was cows' milk. 37 The existing arrangements for the supply of milk in the Borough are working satisfactorily. In conjunction with the Public Assistance Committee, the Council's Milk Sub-Committee has formulated a scheme whereby milk is supplied to appropriate cases even when such cases are already in receipt of Poor Law Relief. This scheme obviates the undesirable practice of an individual being granted a somewhat similar form of relief by two different authorities. The supply of milk under the Borough Council Scheme has undoubtedly effected very marked improvement in the general health of both mothers and children. 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 the 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 by the Public Assistance Committee. INSTITUTIONAL PROVISION FOR MENTAL DEFECTIVES. * The London County Council maintains for mentally defective children a number of schools, some of which are residential. The County Council also maintains institutions for the care and treatment of certified cases of mental deficiency occurring in adults and children. The supervising authority for cases of this nature, in England and Wales, is the Board of Control, Carlton House, Tothill Street, S.W. 1. from whom a complete list of approved institutions may be obtained. 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 London County Council. The London County Council ambulances are also available, on payment, for the conveyance of persons suffering from infectious disease to places elsewhere in the metropolitan area. 38 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 London County Council may also be utilized, on payment, for the removal of non-infectious cases to hospitals or homes. CLINICS AND TREAMENT CENTRES. (a.) The Violet Melchett Infant Welfare Centre.—Chairman of Council: Violet, Lady Melchett, D.B.E. Hon. Treasurers : Sir Algernon Peyton, Bart, and Mrs. Hartnell ; Hon. Secretaries : Miss M. BowdenSmith and the Hon. Diana Darling. This Institution, controlled by a Voluntary Council with headquarters in Wellington Street, adjoining the Town Hall, was completed in February, 1931, and formally opened by H.M. The Queen on '26th March. It signalises an entirely new development in the Infant Welfare movement in this country, in that it combines under one roof the work of a Welfare Centre, of a Day Nursery and of a Mothercraft Training Home. Each unit has its own appropriate accommodation, with separate entrance, and is worked independently, but there is easy communication between all three. The Violet Melchett Infant Welfare Centre maintains the Maternity and Child Welfare services in the Borough and embodies the activities of the Chelsea Health Society, the Chelsea Day Nursery and the Chelsea Mothercraft Training Home. The magnificient building, with the land on which it stands and a considerable portion of its equipment, was a gift of the late Lord Melchett as a memorial to Lady Melchett's life-long work for Infant Welfare. Erected on a site bounded on three sides by Manor Street, Flood Street and Wellington Street, it is planned to obtain the maximum of air and sunshine. The total cost of the site and buildings was £57,000—a figure representing the largest benefaction to Maternity and Child Welfare work ever made in this country. The building comprises two rectangular two-storey blocks, fronting Manor and Flood Streets, respectively, linked together by a one-storey administrative block in Wellington Street. In the latter the routine work of an Infant Welfare Centre is carried on. The accommodation provided in this unit includes a large central hall, with surrounding consulting-rooms and dressing rooms. There is also a perambulator store, an open-air court with a garden where children may play while awaiting medical inspection, ample office accommodation and, in rear, a threestorey block to accommodate the staff. The Chelsea Day Nursery is housed in the Flood Street block, the Manor Street block being utilised as the Chelsea Mothercraft Training Home. The Day Nursery provides accommodation for fifty children. In addition to two large nurseries for infants and toddlers, there are bathrooms, a kitchen and an enclosed garden for the children to play in. 39 The Mothercraft Training Home provides accommodation for six nursing mothers with their babies, on the occurrence of lactation difficulties, also for twelve babies suffering from digestive disorders and for three fatherless breast-fed babies whose mothers arc employed as maids in the Home. In addition, a nursery is available to which nursing mothers may come during the day for test feeds or observation. The wards open on to a balcony and roof garden. The Violet Melchett Infant Welfare Centre is supported by (1) voluntary contributions (2) an endowment of £500 per annum generously provided by Lady Melchett herself (3) financial grants from the Ministry of Health and the Borough Council. A further source of income arises from the fees paid by pupils and parents. The Borough Council made a financial grant of £l,250 to the Violet Melchett Infant Welfare Centre for the financial year 1931-1932. Reference will now be made to the activities of the three organisations included in the Violet Melchett Infant Welfare Centre. (1) Chelsea Health Society.—Wellington Street, S.W. 3. Chairman of Executive Committee : Violet, Lady Melchett, D.B.E. Hon. Secretary : Miss M. Bowden-Smith. This Society, controlled by a Voluntary Committee, with headquarters in Wellington Street, carries out the Maternity and Child Welfare services in the Borough. Clinics are held in Wellington Street and at 481, King's Road. During the year four infant clinics were held weekly—three at Wellington Street and one at King's Road. At Wellington Street one ante-natal clinic was held weekly and a post-natal clinic was held twice monthly. Details of the work carried out by the Society will be found on page 35 (Table No. 27). The Medical and other staff are appointed by the Voluntary Committee, Four part-time Medical Officers are employed—Dr. Mary Nelson, Dr. Muriel Radford, Dr. Kathleen Matthews and Dr. Margaret Salmond. Three whole-time trained Health Visitors are also employed, together with necessary clerical and domestic assistance. 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. The Society is supported by (1) voluntary contributions (2) financial grants from the Ministry of Health and from the Borough Council. Under section 101 (6) of the Local Government Act, 1929, the Borough Council made an annual contribution of £1,427 to the Chelsea Health Society for services in respect of Maternity and Child Welfare work for financial year 1931-1932. (2) Chelsea Day Nursery, Flood Street, S.W. 3.—Chairman of Executive Committee : Alderman Eric Hall, L.C.C. Hon Secretaries : Miss Antrobus and The Hon. Diana Darling. 40 The Chelsea Day Nursery is controlled by a Voluntary Committee. The staff consists of a Medical Officer, an honorary Medical Adviser, Matron, a Sister, a Staff Nurse and eight probationers. The Nursery is ably administered and is much appreciated in the Borough. Three members of the Public Health Committee and the Medical Officer of Health are members of the Day Nursery Committee. The Nursery is supported by (1) voluntary contributions (2) children's fees (3) a financial grant from the Borough Council. Under section 101 (6) of the Local Government Act, 1929, the Borough Council made an annual contribution of £358 to the Chelsea Day Nursery for the financial year 1931-32. The attendances at the Nursery during the past two years were as follows :— TABLE No. 29. 1930 1931 Total number of attendances during the year 4,364 8,103 Average daily attendance (5 days a week) 18 30 Total number of individual children who attended 44 153 The Nursery was closed for one week in March during removal to its new home in Flood Street. The health of the children has been excellent. Dr. Winifred Gray is Medical Officer to the Nursery and makes a fortnightly inspection of the children. (3) Chelsea Mothercraft Training Home.—Manor Street, S.W. 3. Chairman of Executive Committee : Miss Violet Trench. Hon. Secretary: Mrs. Methold. The Mothercraft Training Home is controlled by a Voluntary Committee. The staff consists of three honorary Consultants, a Medical Director, a Matron, two Sisters, two Staff Nurses and seventeen pupil nurses. These latter are trained in accordance with the principles evolved by the Mothercraft Training Society, Cromwell House, Highgate. The Home is efficiently administered and the arrangements instituted for the treatment of lactation cases have proved eminently satisfactory. Three members of the Borough Council and the Medical Officer of Health are members of the Executive Committee. 41 The following Table No. 30 shows the work carried out in the Home during the past year TABLE No. 30. Mothercraft Training Home. Analysis of Cases Admitted During the Year. Admissions. Babies. Mothers. Average stay. Malnutrition. For Breastfeeding. Artificially fed Breast-fed. 20 62 57 65 days 23 days Resident babies. Average stay. 4 9 months Breast Feeding Analysis. Established Re-established Supply increased. Supply regulated. No change. 4 4 32 13 4 Attendances for Test-Feeds. Mothers attending 1 day. 2 days. 3 days. 4 days. 5 days. 6 days. 14 days. Total No. of Mothers. Total No. of test feeds. 127 20 7 4 1 3 1 163 241 The Borough Council made an annual contribution to the Chelsea Mothercraft Training Home for the financial year 1931-1932. This is included in the amount (£1,250) to the Violet Melchett Infant Welfare Centre. (b) Invalid Children's Aid Association.—Chairman: Alderman F. J. Synge. Hon. Secretary: 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. 42 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. The Borough Council made a financial grant of £100 to the Association for the year commencing 1st April, 1931. During the year the branch had 150 children under school age referred to them for assistance. These children were suffering from marasmus and malnutrition, congenital deformities, rickets, anaemia, debility and enlarged glands following acute illness such as bronchitis, pneumonia, measles, diphtheria and scarlet fever. Fifty-three children were sent out of London for convalescence, for periods varying from six weeks to six months. Eight 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. Twenty-one 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. (c.) The Babies' Club.—35, Danvers Street, S.W. 3. Chairman: Mrs. William Piercy. Hon. Secretary : Miss Hilda Morris. 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. Infant consultations are held twice weekly at the premises of the Club. (d.) 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. (e.) 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 43 services are provided. The Tuberculosis Officer (Dr. W. J. Fenton) is one of the Honorary Physicians to the Hospital and his services are available when required by any medical practitioner in the Borough, Social work in connection with the Dispensary cases is carried out systematically and well by a trained Social Worker. Details of the work done by the Dispensary will be found on page 83. 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, 1931. 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. 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. 31. During the year four of the cases were sent to Homes free of charge. The remainder contributed according to their resources. The period of convalescence granted is two weeks. TABLE No. 31. Year. No. of Applications. Nursing Mothers and Infants sent away under Council Scheme. Contributions by Mothers. Nett Cost to Borough. £ s, d. £ s. d. 1930 31 12 4 10 6 20 0 2 1931 19 13 6 12 0 22 18 6 1 LOCAL GOVERNMENT ACT, 1929. This Act, which came into operation on 1st April, 1960, is intended to give greater freedom to local authorities in the administration of Health Services. Under the Act, block grants for these services are substituted for the former percentage grants. Power is given to local authorities to extend their existing services without sanction of the Ministry of Health. Additional expenditure thus incurred must, however, be borne by the local authority concerned. Since 1st April, 1980, the functions hitherto performed by Boards of Guardians and, in the Metropolitan area, by the Metropolitan Asylums Board, have been, with minor exceptions, transferred to the County Councils. Responsibility for the control of all London Hospitals and Institutions directly supported by the rates is thus now vested in the London County Council. A special provision as to London is made in 44 the Act, whereby the Minister of Health may make an order transferring or delegating any of the County Councils functions to the Metropolitan Boroughs. Thus far, the only duties transferred are those relating to the Registration of Births and Deaths and to Vaccination. 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. BLIND PERSONS ACT, 1920. At the request of the London County Council, the Borough Cbuncil has arranged for the home visiting of blind children under five years of age to be carried out by the Health Visitors. Reports are furnished to the County Council as occasion arises, when the home conditions are found to be unsuitable for blind children or where it is considered necessary that the child should be admitted into a suitable institution. No case came to the knowledge of the department during the year. SUMMARY OF ARRANGEMENTS REGARDING MATERNITY AND CHILD WELFARE. 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. 45 (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, to 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. 46 SECTION III.—SANITARY CIRCUMSTANCES AND ADMINISTRATION. Complaints.—The number of complaints received during the year was 526 compared with 491 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 bi-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 709. The number of statutory notices was 212. These compared with 630 and 219 respectively in 1930. In six 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. 32. Summary of Work Carried out by Sanitary Inspectors during the Year. Inspections. On complaint of nuisance 526 On notification of infectious disease (including Non-notifiable diseases) 147 House to House 177 Re-inspection calls made 7,320 Inspection of : — Bakehouses 56 Slaughterhouses 15 Milkshops 105 Ice Cream Premises 31 Overcrowding 93 Houses Let in Lodgings 30 Stables 80 Restaurant Kitchens 61 Marine Stores 34 Food Premises other than above 117 Premises under Meat Regulations 37 47 Inspection of—(continued):— Factory and Workshops 621 Outworkers' Premises 65 Other visits 900 Verminous Premises Ill Rat enquiries Ill Smoke observations 21 Total 10,664 Premises :— Walls and Ceilings cleansed : -- (a.) Premises throughout 11 (b.) Premises partially 429 (c.) Verminous rooms cleansed 40 (d.) Total number of rooms cleansed 747 Wash-house walls and ceilings cleansed 14 Walls and ceilings of water closets cleansed and repaired 118 Wash-house roofs repaired 4 Dirty tenants' rooms cleansed 5 Yard and area walls cleansed 5 Defective roofs repaired 111 Defective gutters repaired 12 Defective rain water pipes repaired 48 Dampness abated 108 Miscellaneous repairs 105 Wash-house floors repaired 9 Yard surfaces repaired, paved, etc 37 Ashpits demolished 1 New and proper dustbins provided 86 Workrooms provided with light and ventilation or light and ventilation improved 1 Drainage :— Reconstructed 112 Repaired 24 Cleansed 20 Inspection Chambers and traps provided 161 Fresh air inlets provided or repaired 79 New soil pipes provided 73 New ventilation pipes provided 100 Soil and ventilation pipes repaired 5 Anti-syphonage pipes provided 13 Drains sealed off 70 Drains cleared (obstruction removed) 11 New covers provided to inspection chambers 92 Rainwater pipes disconnected and caused to discharge over properly trapped gullies 4 Sink wastes provided with traps 11 Sink waste pipes cleansed 10 New sink wastes provided 113 New sinks provided 86 Water Closets. Improvements in sanitary conveniences (factories, workshops, etc.) 2 New water closet pans provided 202 Water closet pans (foul) cleansed 13 Choked water closet pans unstopped and cleansed 19 Water waste preventers renewed 60 Water waste preventers repaired 29 Water closet roofs repaired 38 Ventilation and light provided or improved 17 W.C. floors repaired 51 48 Water Supply. Water supply to premises reinstated 5 Water supply provided to upper storeys of tenement houses 2 New drinking water cisterns provided 2 Drinking water cisterns cleansed 13 Drinking water cisterns provided with new covers or covers repaired 6 Smoke Nuisance. Number of observations 8 Number of nuisances and complaints 0 Number of notices 2 Number of Summonses — Nuisances abated arising from Keeping animals in an improper manner or places 3 Defective manure cages — Accumulation of manure or refuse 8 Overcrowding 40 Rat nuisance Ill Underground rooms 1 Food Condemned and Destroyed. Fish—Cod 28 lbs. Disinfection. Premises disinfected after Zymotic diseases (Scarlet Fever, Diphtheria, etc.) 204 Rooms disinfected after Tuberculous disease 73 Rooms fumigated for verminous and filthy conditions 257 Miscellaneous disinfection 81 Certificates of disinfection given 109 School notices after disinfection 115 Notices sent to Public Library of Premises where infectious diseases have occurred 110 Proceedings taken. Intimation Notices served 709 Statutory Notices under Public Health (London) Act, 1891 205 Statutory Notices under Section 3 of Housing Act, 1925 — Statutory Notices under byelaws for provision of dustbins 7 Total number of samples purchased for analysis under the Food and Drugs (Adulteration) Act 367 Samples of cream taken 8 Samples of Drugs taken 8 Samples (informal) purchased 30 Legal proceedings instituted in respect of defective sanitary conditions and nuisances 6 Legal proceedings under Food and Drugs (Adulteration) Act 1 Legal proceedings in respect of unsound food — Certificates issued in accordance with " Rent Restrictions Act " — Entries in Inhabitants' Complaint Book 521 Cleansing and Disinfection. Number of adults cleansed 20 Number of children cleansed 656 Number of rooms or premises cleansed or disinfected 615 Number of persons treated for Scabies 21 Number of articles (bedding, etc.) disinfected 4,051 Number of articles (various) destroyed 450 Disinfection Station Shelter. Persons accommodated :— Adults 1 Children — Mortuary. Number of bodies received 78 Number of infectious bodies received — Number of bodies removed to Public Mortuary on Sanitary grounds. — 49 TABLE No. 32. Magisterial Proceedings during the Year under Public Health (London) Act, 1891. Situation premises Nature of Nuisance or Complaint. Petty Sessions. Date of Hearing. Result. 69 tyre Street. Failing to comply with Statutory Notice re condition of premises. Kensington 6-1-31 Work completed. Withdrawn. 73 tyre Street. Failing to comply with Statutory Notice re condition of premises. Kensington 6-1-31 Work completed. Withdrawn. 30B, morne Road. Failing to comply with Statutory Notice re condition of premises. Kensington 19-5-31 Order, 14 days. 33 Tadema Road Failing to comply with Statutory Notice re condition of premises. Kensington 19-5-31 Order, 14 days. 109, Lots Road. Failing to comply with Statutory Notice re condition of premises. Kensington 19-5-31 Order. 14 days. kingston House B From Street. Failing to comply with Statutory Notice re condition of premises Nuisance by Dogs. Kensington 19-5-31 Order, 28 days. Failing to comply with Council's byelaw re fouling of footway in Pont Street. Kensington 29 9-31 Fined £1 0s 0d. Failing to comply with Council's byelaw re fouling of footway in Sloane Street. Kensington 29-9-31 Fined 10s. Smoke Abatement.—It is part of the work of a Sanitary Inspector to, observe any nuisance arising from smoke. There were 21 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. Six complaints of smoke nuisance were received during the fear and cautionary letters were sent to the offenders. At intervals very serious nuisance has arisen owing to the emission or smoke and grit from the Generating Station of the London Electric Railways, situated in Lots Road. During 1,928 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 werre fully discussed. These include the provision of new boiler plant 50 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. The menace to health and property as a result of the emission of large Quantities of smoke, grit and sulphur gases from large Power Stations has given rise to widespread public anxiety during the past two years. Serious apprehension arose in Chelsea owing to the fact that the construction of a new large Power station, adjoining Chelsea Bridge, on the Battersea side of the river, had been approved in connection with the South-East England Electricity Scheme. Plans were also announced for a vast extension of the existing Fulham Power Station, adjoining the western boundary of the Borough. The adjacent boroughs of Westminster and Kensington, together with the London County Council also appreciated the gravity of the situation. As a consequence, these several Councils, in conjunction with the Chelsea Borough Council decided to oppose the proposed extension of the Fulham. i ower Station. A public enquiry was held before the Electricity Commissioners on 15th December, 1980, and following days, at which the Councils were legally represented and the objections to the extension °f the Fulham Station were put forward by experts. Subsequently, the Electricity Commissioners announced their consent to the proposed extension, subject to the provision of certain measures to prevent injury to health and property. The Fulham Borough Council "as been placed under statutory obligation not to work the generating station when extended so as to occasion a nuisance. To that end it is stipulated that the Fulham Borough Council shall employ continuously the most efficient methods which may for the time being be reasonably Practicable (a.) to eliminate smoke and grit; (b.) to prevent the discharge of sulphur and its compounds into the atmosphere; and (c.) to avoid noise or vibration arising from the working of the station. Fouling of Footways by Dogs.—The Borough Council has obtained sanction for a byelaw to deal with this nuisance. This has already been found useful, the condition of footways having improved considerably since the measure came into operation. During the year two prosecutions were taken for infringement of the byelaw, 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 responsibility for rat preventive measures upon the °ccupiers of premises. During the year the Council provided rat catching varnish to applicants for the destruction of rats and 150 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 s° far as it affected their respective premises. 51 The cost to the Council of rat catching varnish during the year was £5 17s. 0d. Nuisance caused by Pigeons.—During the year further complaints were received from residents in the neighbourhood of Chelsea Embankment, Elm Park Gardens, and Draycott Place regarding nuisance arising from the large number of pigeons in the area. On investigation, it is invariably found that very serious nuisance is 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. Section 52 of this Act provides that, for the purpose of abating or mitigating nuisance, annoyance or damage caused by the congregation at any place in the Borough of house doves or pigeons having, or believed by the Borough Council to have no owner, or of preventing or minimising any such nuisance, annoyance or damage which might, in the opinion of the Council, be so caused, the Council may seize and destroy or sell any such house doves or pigeons in excess of such number as the Council may consider reasonable, and take such steps as they may deem necessary for such purpose. It is however, necessary for the Council to obtain consent to the measures adopted by them from the person or corporation in whom the building or land upon which the birds congregate is vested. The Borough Council has from time to time employed various contractors for the destruction of a number of pigeons, at a cost to the Council of is. for each pigeon. Much difficulty has been experienced in carrying out pigeon destruction, owing to the opposition of a large section of the public. In particular, it has been found practically impossible to catch pigeons on a public highway owing to interference from adjoining residents and other persons. The best results have been obtained at churches and other institutions where there are enclosed spaces in which the contractor can operate and to which the public cannot gain admission. During the year 1931, 155 pigeons were captured and humanely destroyed. 52 TABLE No. 33. Number of Premises. Number of inspections during 1931 Number of notices served during 1931 Number of prosecutions during 1931 On register at end of 1930 Added in 1931 Removed in 1931 On register at end of 1931 1. Premises used for Business Purposes :— Milk Premises 70 7 4 73 105 Cowsheds — — —. — — Ice Cream Premises 25 — — 25 31 Butter and Margarine 10 — 10 10 — Manufacturers and Dealers :— Fried Fish Premises 14 — 14 18 Fish Curers 5 — 5 5 Bakehouses 20 — 20 56 4 Slaughterhouses 2 — — 2 15 Food Stalls 4 — — 49 under daily observation — — Offensive Trade Premises — — — — — — — 2. Premises used for Human Habitation :— Houses let in lodgings 390 30 — 426 30 Common Lodging Houses 4 — — 4 3 Canal Boats — — — — — — — 53 PREMISES AND OCCUPATIONS CONTROLLED BY BYELAWS AND REGULATIONS. The preceding Table No. 33 summarises the number and character of promises and occupations in the borough which are controlled by byelaws and regulations. Underground rooms and underground sleeping rooms, although controlled, the former under the Public Health (London) Act. 1891. and the latter under the Housing Acts,'1925 and 1930, are not registered. Further reference to these premises and occupations will be found in the Sections of this report dealing with " Inspection and Supervision of Food and Housing." Factories, Workshops and Workplaces.—The Medical Officer of Health is required under Section 182 of the Factory and Workshops Act, 1901, to include in his annual report details of the administration of this Act in his district. The total number of factories, workshops, and workplaces on the register at the end of the year was 279. The number of inspections of these premises was 621, which compares with 622 in 1930 Sanitary defects were found in 25 instances. The following Table No. 34 is in the form requested by the Home Office in order to ensure uniformity in the presentation of returns :— TABLE No. 34. Factories, Workshops, Workplaces, and Homeworkers' Premises. I.— Inspection of Factories, Workshops and Workplaces. (Including Inspections made by Sanitary Inspectors). Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers prosecuted. (4) Factories (including Factory Laundries) 20 2 — Workshops (including Workshop Laundries) 591 19 — Workplaces (other than Outworkers' premises) 10 I — Total 621 22 — 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 17 17 — Want of ventilation 1 1 — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 5 5 — — Sanitary accommodation :— Insufficient 1 1 — — Unsuitable or defective — — — Not separate for sexes 1 1 — — Offences under the Factory and Workshop Acts :— Illegal occupation of under- ground bakehouse (s. 101) — — — — Other offences — — — — (Excluding offences relating to outwork and offences under the Sections men- tioned in the Schedule to the Ministry of Health (Fac- tories and Workshops Trans- fer of Powers) Order, 1921). Total 25 25 — — . * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 54 3.—Home Work. Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, Sees. 109, 110 Lists received from Employers. Number of Addresses of outworkers received from other Councils Number of Addresses of outworkers forwarded to other Councils Prosecutions. No. of Inspections of Outworkers Premises. Instances. Notices served. Prosecutions. Instances. Orders made (Sec. 109). Prosecutions (Sec. 109, 110) Lists. Chelsea Outworkers. 1930 17 18 25 167 127 1 1 — — — — 1931 15 12 26 155 — 65 — — — — — 55 PUBLIC MORTUARY. Under the Public Health (London) Act, 1891, section 88, every sanitary authority must provide and fit up a proper place for the reception of dead bodies before interment. The Chelsea Mortuary is situated in Arthur Street. Number of Bodies received in Mortuary during 1931 78 1. To await Inquests:— (a) Infectious (b.)Non-infectious 41 2. To await burial 8 3. Sanitary grounds — Number of Post-Mortem examinations 64 Rag Flock Acts, 1911 and 1928.—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. 56 SECTION IV.—HOUSING. In accordance with the instructions of the Ministry of Health, the following tabular statement has been prepared :— TABLE No. 35. HOUSING STATISTICS FOR THE YEAR. 1. Inspection of Dwelling-houses During the Year :— (1) (a.) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts; 850 (b) Number of inspections made for the purpose 7326 (2) (a) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 159 (b) Number of inspections made for the purpose 3950 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation - (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 159 2. Remedy of Defects during the Year without Service of Formal notices :— Number of defective dwelling houses rendered Fit in consequence of informal action by the Local Authority or their officers 479 3. Action Under Statutory Powers during the Year:- (A) Proceedings under sections 17, 18 and 23 of the Housing Act, 1930:- (1) Number of dwelling houses in respect of which notices Were served requiring repairs (2) Number of dwelling houses which were rendered fit were service of formal notices :— (a.) By owners — (b.) By local authority in default of owners — (B) Proceedings under Public Health Acts :— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 659 57 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a.) By owners 180 (b.) By local authority in default of owners — (C) Proceedings under sections 19 and 21 of the Housing Art 1930:— (1) Number of dwelling houses in respect of which Demolition Orders were made _ (2) Number of dwelling houses demolished in pursuance of Demolition Orders — D. Proceedings under section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing orders were made - (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Proceedings under section 3 of the Housing Act, 1925:— (1) Number of dwelling houses in respect of which notices were served requiring repairs - (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a.) By Owners - (b.) By local authority in default of owners - (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close - F. Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925:— (1) Number of dwelling houses in respect of which Closing Orders were made (2) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit - (3) Number of dwelling houses demolished in pursuance of Demolition Orders 1 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 in duties connected with the Housing Regulations, 1925. 58 HOUSING CONDITIONS IN THE BOROUGH. General Observations. —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 35 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, 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 35 years, some 20,000 Chelsea inhabitants, chiefly of the working and small trader class, have been displaced and compelled to migrate into surrounding districts. Despite the difficulties of the problem, in Chelsea a considerable amount of accommodation had been provided for the working classes during the years preceding the outbreak of War. This had been effected by municipal undertakings, by private enterprise and by the operation of benevolent agencies and trusts. Sufficiency of Supply of Houses.—Municipal undertakings for the housing of the working classes carried out by the Borough Council prior to 1914 were as follows :— Population. No. of Flats. Sir Thomas More Buildings, Beaufort Street 770 262 Pond House, Pond Place 130 32 Onslow Dwellings, Pond Place 380 108 Grove Buildings, Manor-street 300 120 1,580 522 59 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 ??? Park Dwellings, King's Road 170 5,400 It will be seen that in Chelsea at the outbreak of war there was available accommodation for about 7,000 persons of wage-earning classan 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 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 1025 and 1929 respectively. The remaining scheme—that of Manor-street—was completed in October, 1931. These buildings are now fully occupied. 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 threeroom and 21 four-room flats. The total cost of the site and buildings was £48,970 . The total weekly rents, including hot water supply and electricity, vary from 25s. to £1 14s. 3d. This scale of rents was drawn up on. an economic basis, on the instructions of the Ministry of Health. the. Ministry's decision being based upon the high cost of the site and Construction. Such rents are obviously much higher than the working classes proper can afford to pay and indeed most of the tenants are classes in receipt of small salaries or earnings—a group not usually included under the term " working classes." (2) 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 60 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 northwest corner of the site and necessary for the purposes of the Scheme, was subsequently purchased by the Borough Council at a cost of £4,000, of which the Guinness Trust contributed £2,000. With the consent of the Minister of Health, the Borough Council has leased the site to the Guinness Trust for a term of 99 years at a nominal rent and the Trust has erected working-class dwellings thereon, preference as to tenancies being given (a.) to persons residing in Chelsea and (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. The total weekly rents vary from 5s. 6d. to 16s. l1d. 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) Peabody Trust Buildings, Manor Street. This site comprises an area of 1 acre, 16 poles, situated centrally in the Borough, in close proximity to the Town Hall. The frontage is on the western side of Manor Street, its northern and southern boundaries being Wellington Street and Grove Buildings respectively. It was purchased by the Borough Council towards the end of 1928 at a cost of £19,000. With the consent of the Minister of Health, the Borough Council has leased the site to the Peabody Trust for a term of 99 years at a nominal rent and the Trust has erected working-class dwellings thereon, in accordance with plans approved by the Borough Council, the London County Council, and the Ministry of Health. The buildings consist of eight blocks of flats' four stories high, comprising a total of 112 flats, of which 24 contain four rooms, 46 three rooms, 32 two rooms and 9 one room. In addition, each flat includes scullery, bathroom and lavatory. A combined flat and office is occupied by the Superintendent. The total weekly rents vary from 6s. 2d. to 16s. 9d. These additional housing facilities have also been of material assistance in meeting the needs of a large section who cannot pay a high rent. Reviewing the history of the past 35 years, it would appear that the housing policy of the Borough Council has been firstly to preserve, where possible, in areas threatened with demolition, such working class accommodation as was of reasonably good type ; and secondly, to provide accommodation by means of new buildings in an accessible situation within the Borough for those persons of the working class who are average representatives of their class, and for whom the necessities of their trade or calling render residence within the Borough desirable or necessary. It cannot be disputed that at the present time in Chelsea, as in other Metropolitan Boroughs, there is considerable dearth of accommodation 61 both for the working classes, and for the classes in receipt of small salaries or earning and that, as elsewhere, this situation is primarily due to the restriction 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 contronbed tea 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 late Chairman of the Housing Committee (Mr. Councillor E. B. Baggallay) will always be remembered with appreciation in the cipality Overcrowding.—Overcrowding, where it exists, is mainly confined to the western district of the Borough. This conclusion is based partly on house-to-house inspections of the area and partly on applications submitted for alternate housing accommodation. There has been some tittle improvement in its prevalence during the year. Many of the cases when approached as to the desirability of having their names submitted to the Coununtv Council, with a view to provision of housing on one of the Council Instates, decline to consider the proposition, on the ground that the distance of the County Council's Estates from their work is too greatother have become attached to the district and will not contemplate for saking existing interests and associations. Owing to the extreme difficulty of finding alternative accommodation it has not been found practicable to deal with more than a proportion of the cases of overcrowdiring the year. Whenever possible, arrangements are made with the London County Council for the provision of a house for the overcrowded family. Forty-three such families obtained accommodation the Council s during the year. Further, when vacant tenements become availiable in the Borough Council's dwellings preferential treatment is as for as possible given to cases of overcrowding. . With a view to preventing a recurrence of overcrowding in premises which are being vacated because of their overcrowded condition, a cautionary letter is always sent to the landlord concerned, warning him that action will be taken against him in the event of a recurrence of overcrowded conditions in the-premises. Fitness of Houses.—The general standard of housing in the Borough is satisfactory. There has been a very definite improvement in housing condition during the past five years. The vast majority of houses have adequate internal water supply and adequate sanitary accommodation with in their own curtilage. The constant vigilance of the Sanitary Inspector 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 systematic observance of cleanliness- For some years past it was apparent that in a portion of the western district the house were old, worn out and required constant repairs and renovations. This area, comprising World's End Passage and court abutting thereon, about 1 acre, 37 poles in extent, was during 62 1926, the subject of an official representation under the Housing Act, 1925. After full enquiry, the Minister of Health's ord,er 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 tota( of 62 flats, of which 5 contain four rooms, 37 contain three rooms, and 20 contain 2 rooms. A provisional estimate of £50,000, to include cost of acquisition, clearance of the area and the erection of buildings thereon, has been approved by the Borough Council. Necessary work in connection with clearance of the area and construction of new buildings is still in progress. 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 eastern section of the area was cleared first and the construction of two blocks of buildings on this site has been completed. This was followed by clearance of the central section on which the erection of a third block of buildings was completed last year. All these are now fully occupied. The total weekly rents vary from 5s. to 16s! 6d. The construction of the fourth block is being proceeded with. 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. A large area in the north-western district of the Borough contains many houses which are old, worn out and require constant repairs and renovations. During the year this area was the subject of an official representation made by me under the Housing Act. The matter is still receiving the close consideration of the Housing Committee. One of the most unsatisfactory features in this, as in other boroughs, is the presence of a large number of houses let in lodgings. These houses were not constructed for the purposes to which they are now put. The use of staircases, washhouses, yards, waterclosets, ashbins, etc., in common leads to misuse and neglect, and the general environment is not prone to the cultivation of habits of self-respect, morality or health. Many such houses are without adequate provision for the cooking or storage of food, and housework is carried on at great inconvenience. While the great majority of these houses are structurally sound, a number of them are old, worn out and below the modern standards of sanitation and convenience. It is probable that only a. minority of the tenants would be able to pay economic rents for alternative accommodation, having regard to the rents that required to be fixed for new dwellings owing to the greatly increased cost of land and construction during recent years. 63 Another problem is caused by certain old people, usually women. Many af 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, 19228. 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 ire 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 reasonabb State of repair because of the dirty and destructive habits of a number of their tenants. It is alleged that, through carelessness or Wilfuild image by tenants, repairs and cleansing have to be carried out With, unreasonable frequency and that, a,s 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 esecially ill the poorer class tenement lodging houses where no responSible caretaker or landlord is resident. To lighten the difficulties of the owner these cases, effort is made, as far as possible, to keep in vievv Such power as a Local Authority has of holding the tenant responsible for defects resulting from his neglect or default. Action was necessary during the year in respect of two dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation. The total number of dwelling houses inspected for housing defects was 850, the number found not to be in all respects reasonably fit for human habitation being 709. The number Hendered lit in consequence of informal action by the Sanitary Inspectors was 497, and the number in respect of which statutory notices were Served requiring defects to be remedied was 212. One case came to the knowledge of the Department in the course of the year of an undergronded being illegally used for sleeping purposes. Appropriate action was taken. There were no applications under the Increase of Rent and Mortgage Interest Restrictions) Acts made by occupiers of dwellings houses, that houses oupied by them were not in a reasonable state of repair. It is the usual practice when such an application is received to inspect the and serve notices for the defects which exist. If these are amended promptly it is found unnecessary to take further action. .Unhealthy Areas.—One representation, already referred to, was made under the Housing Act during the year. No complaints that areas were unhealthy have been received 64 Byelaws relating to Houses and Houses Let in Lodgings.— Existing byelaws relating to houses are, on the whole, found to be fairly satisfactory in their working. The new byelaws 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, 159 houses being inspected and recorded by the Inspector. From time to time statements have appeared in the Press making allegations as to the widespread existence of insanitary conditions and slum areas in the Borough. It is of great assistance to a Local Authority to have an intelligent interest in sanitary matters taken by the inhabitants, but the object is defeated when exaggerated statements are made. Some of the statements appeared to be due to a misunderstanding of the facts upon which the statements were based; others to conscious and deliberate exaggeration. 65 SECTION V.—INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—In accordance with statutory enactments, the Council keep a Register of persons carrying on the trade of dairymen or purVeyors of milk and no person is permitted to carry on the trade in the Borough unless he is registered. The Council is empowered to remove the name from or refuse to enter upon the Register the name of any person selling or proposing to sell milk on premises which are for any rtasco. 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 Seven applications were made for registration as purveyors of milk, all of after appropriate investigation, were approved by the Council. In tabular form below is shown the alterations which took place in the Roister of Milk Purveyors during the year. TABLE No. 36. Retail. Wholesale. Total. On Register, 31st December, 1930 70 70 Vacated during the year 4 — 4 Added during the year 7 — 7 On Register, 31st December, 1931 73 — 73 * During- the year there were 105 inspections of dairies and milkshops made in the Borough. Notices were served requiring remedy of defects found on four of the premises visited. There are no cowsheds in the Milk (Special Designations) Order.—There were 33 applications from retailers under the Milk (Special Designations) Order for licences to spell special grades of milk. All these licences were granted. In each case licence was granted for the purpose of authorising the dealer to sell specially designated milk from shops within the Borough. No application has been made for a licence giving authority to set up bottling or pasteurising establishments in the Borough. The following Table No. 37 shows the numbers of licences granted for the sale of milk under special designations during the past two years. 66 TABLE No. 37. Licences Granted under Milk (Special Designations) Order. Licences granted under Milk (Special Designations) Order. 1930. 1931. To sell " Certified " Milk 8 8 To sell " Grade A " Milk — — To sell " Grade A" (Tuberculin Tested) " Milk .. 11 10 To sell " Pasteurised " Milk 11 13 Supplementary Licences — 2 30 33 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. 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 6l sheep were inspected at the time of slaughter. 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. Slaughterhouses.—There are now two private slaughterhouses in the Borough and 15 inspections of these premises were made during 1931. In compliance with the byelaws prescribing humane slaughtering, approved methods of slaughter are employed in each of the premises. There is no public abattoir in the Borough. The following table shows, in the form required by the Ministry of Health, the number of private slaughterhouses in use in the Borough on the dates indicated :— TABLE No. 38. In January, 1931. In December, 1931. Registered — — Licensed 2 2 Total 2 2 67 Bakehouses.—There are 20 bakehouses in the Borough, and 56 Inspections of these premises were made during the year. Five notices were served for the cleansing of walls and ceilings. Ice-Cream Vendors.—At the end of the year, 25 premises were shown in the Register as places where ice-cream is prepared or sold There were 31 inspections of these premises as compared with 45 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 condition on premises other than those where it is stored, it had Jong become apparent that some system of compulsory registration was essential applicable to all premises where the commodity is manufactured stored or sold, and also to the itinerant vendors. Fortunately, difficulty has now been largely met by the London County Council. (General Powers) Act, 1928. Section ;29 of this Act provides that premises used for the manufacture, sale or storage of ice cream or other similar commodity shall be registered by the owner or occupier there of with the local sanitary authority. Appropriate penalties are provided for any offence against these provisions. Premises used as a hotel restaurant or club are specifically exempted from the operation of 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 18 inspections of the 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. 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. 39 shows, for the past two years, the number of inspections of premises where food was prepared for or exposed for sale. 68 TABLE No. 39. Inspection of Premises where Food was Prepared or Sold. Nature of Premises. 1930. 1931. No. on Register No. of Inspections. No. on Register No. of Inspections. Cowsheds Slaughter houses 2 30 2 15 Milk shops 70 120 73 105 Ice Cream premises 27 45 25 31 Bakehouses 26 41 2g 56 Restaurant kitchens 32 47 32 42 Food premises (other than above) 90 95 90 115 Unsound Food.—On one occasion during the year unsound food was surrendered and destroyed. Included in the food surrendered was :— 28 lbs. Cod. 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 and three samples, including 184 samples of milk and 8 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 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 is taken on receipt of the analytical report regarding them. During the year one sample of milk was found to be 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. 69 The. proceedings in respect to the adulterated Milk sample resulted in a conviction being obtained. Details of these proceedings are given in Table 10. 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. 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 presarvatives was obtained sufficient to warrant legal proceedings. Margarine.—No application for transfer of registration was received during the year from wholesale dealers in margarine. CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD. 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, liled results of analyses made during the year will be found appended to this report. Bacteriological Examinations.—Arrangements have also been made with the Clinical Research Association for the bacteriological examination at samples of milk under the Milk (Special Designations) Order, 1923, No occasion has yet arisen for such investigation. TABLE No. 40. Magisterial Proceedings under Food and Drugs (Adulteration) Act, 1928. Street where I 'urchased. Offence. Petty Sessions. Date of Hearing. Result. Meek Street. 15-12-31 Selling milk to which 15% of water had been added. Kensington 19-1-32 Fined £10 £2 2s. costs. Milk and Dairies Ordejr, 1926. Meek Street. 15-12-31 Carrying on trade of Purveyor of Milk without being registered as such. Kensington 19-1-32 Fined £3. 70 DISSEMINATION OF KNOWLEDGE AS TO NUTRITION. Advice as to the necessity for a high standard of purity and quality in relation to food is given by the staff of the Public Health Department. In addition, lectures and film demonstrations on Health topics, including Diet, are given from time to time at the premises of the Chelsea Health Society. Leaflets arc also issued to expectant and nursing mothers which are of great assistance in focussing attention on this important subject. The desire of the public to consume a natural product, or at least that they should be made aware if offered an artificial substitute, has found expression in the Artificial Cream Act, 1929. 71 SECTION VI.—INFECTIOUS DISEASES. (a) Infectious Diseases Generally. DISEASES COMPULSORILY NOTIFIABLE IN THE BOROUGH. Acute Poliomyelitis. Acute Polio-encephalitis. Acute Encephalitis Lethargica. Acute Primary Pneumonia. Acute Influenzal Pneumonia. Ceivbro-spinal Fever. Cnieken Pox. Plague. Anthrax. Glanders. Hylrophobia. Cholera. Continued Fever. Ophthalmia Neonatorum.. Diphtheria. Membranous Croup. Dysentery. Erysipelas. Malaria. Puerperal Fever and Puerperal Pyrexia. Relapsing Fever. Small-pox. Typhus Fever. Tuberculosis. Scarlatina or Scarlet Fever. Typhoid or Enteric Fever. NOTIFICATIONS DURING THE YEAR. The total number of notifications, excluding duplicates, was 533 this figure, 97 were notifications of Pulmonary Tuberculosis and 18 of Nn-pulmonary Tuberculosis. In addition, 12 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 39 in the number of notifications of Diphtheria. The number of notifications of Scarlet Fever (94) represents a decrease of 42, as compared with that for 1930. The notifications of Tuberculosis show a decrease of 43 as 'Compared with that for 1930. Table No. 41 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 72 TABLE No. 41. 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 79 2 42 29 6 — — — 28 Cholera — — —— — — — — — Diphtheria 7!) 2 22 35 12 7 1 _ 77 Erysipelas 22 2 1 1 2 8 3 13 Scarlet Fever 94 4 29 35 17 7 2 92 Typhus Fever — — — — — —— — — — Enteric Fever 2 i 1 2 puerperal Fever Puerperal pyrexia 7 — — — 7 — — 7 Cerebrospinal Fever 1 1 — 1 Ophthalmia Neonatorum 6 6 — — — — — — 4 Poliomyelitis 1 — 1 — — — — — 1 Enceplatics Lethargica — — — — — — — — — polio-encephalitis — — — — — — — — — Malaria — — — — — — — — — Dysentery — — — — — — — — — Acute Primary Pneumonia 106 7 43 9 10 16 15 6 79 Acute Influenzal Pneumonia 21 — 3 3 — 4 9 2 9 Total 418 23 142 113 47 47 35 11 313 Tuberculosis :— Pulmonary 97 — 1 2 28 39 20 7 — Non-Pulmonary 18 — 3 3 10 1 1 — — Totals (Tuberculosis) 115 — 4 5 38 40 21 7 — Totals 533 23 146 118 85 87 56 18 — No cases of Small-pox, Cholera, Typhus Fever, Puerperal Fever, Encephalitis Lethargica, Polio-encephalitis, Continued Fever, Malaria, Dysentery, Relapsing Fever, Plague, Anthrax, Glanders or Hydrophobia Were notified during the year. diphtheria: Notifications.—During the year 79 cases of diphtheria were notified, 3-s compared with 118 in the previous year. The incidence of the disease during the past two years is shown in Table No. 4'2. Deaths.—Two deaths from the disease occurred, 1 in an L.C.C. Hospital and one in St. George's Hospital. One of the cases was under five years of age. 73 Return Cases.—No " return " case of the disease occurred during the year. TABLE No. 42. Year. Cases Notified. Pecent 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. 1930 118 99 5 4.6 53 Jan. 364 36 10.0 328 90.0 1031 79 99 2 2-8 59 June 226 17 7-5 209 92.5 It will be observed that there was a considerable decrease in the number of cases notified in 1931. The percentage of removals to the L.C.C. Hospitals was high, and the case mortality rate was lower than that for 1930. Information was received from the L.C.C. that 7 of the cases sent to Hospital in the course of the year proved not to be suffering from diphtheria. Of the 79 cases notified, 27 occurred in Stanley Ward, 7 in Church Ward, 29 in Cheyne Ward, 12 in Hans Town Ward, and 4 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. 43. Quinquennial Periods. Average Annual case-rate per 1,000 population. Average Annual ca'se-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 1926-30 2.46 3.1 98 Diphtheria Anti-toxin.—Anti-toxin is supplied, in prophylactic and in curative doses, free of charge to any medical practitioner requiring it for Chelsea patients. An anti-toxin syringe, needles and steriliser are also available. As yet no application of the Schick test or of artifical 74 immunization against the disease has been made in the Borough. Further details will be found on page 30 SCARLET FEVER. Notifications.—During the year, 94 cases of Scarlet Fever were notified, the figure for 1930 being 136. Information was received from the L.C.C. Hospitals that 2 of the cases proved not to be Scarlet Fever, Two " return " cases of the disease occurred during the year and necessary action was taken. Deaths.—There was no death from Scarlet Fever during the year. Table 44 shows the incidence of the disease during the past two years, while Table No. 4.5 covers the quinquennial periods since 1911. TABLE No. 44. Year. Cases Notified. Percentage of Removals. Deaths. Case Mortality Rate. Percentage of cases of School-age 3-13 years. Month of greatest prevalence. 1930 136 90 1 0.8 6 July 1931 94 93 — — 53 Feb. TABLE No. 45. 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 1916-20 1.95 1.0 92 1921-25 2.23 0.9 91 1926-30 2.06 0.3 93 No application of the Dick test or of artificial immunization against Scarlet Fever has yet been made in the Borough. 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 75 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 Teachers 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 has been arranged. The number of cases coming to the knowledge of the Department during the year was 12, as compared with 748 in the preceding year. Deaths.—The number of deaths was one, a female, aged two years. Visiting and Nursing.—During the year, 12 visits and re-visits were made by the Health Visitors. Cases are also visited by the District Nurses whenever circumstances render this necessary. No visits were required in 1931. Removal to Hospital.—Cases of Measles are received in the Hospitals of the London County Council. ENTERIC FEVER. Notifications.-—During the year the number of cases under the Enteric Fever Group notified in Chelsea was 2 (Para-typhoid). The cases were females, their ages being 4 and 12 respectively. Each of them was removed to hospital and subsequently recovered. The history of each case was thoroughly explored but it was found impossible to trace an unvarying causative factor between the various cases. Three specimens of blood were examined during the year for the Widal reaction. Deaths.—There was no death from this disease during the year. PNEUMONIA, MALARIA AND DYSENTERY. These diseases are compulsorily notifiable under the Public Health (Infectious Diseases) Regulations, 1927. During the year the following numbers of cases were notified Pneumonia 127 Malaria . None Dysentery None Pneumonia.All primary pneumonias, lobar or lobular, are notifiable. The only secondary pneumonia which is notifiable is influenzal pneumonia. 76 The notifications and deaths from pneumonia during the past two years were as follows :— Notifications. Deaths 1930 94 44 1931 127 47 Nursing Provision.—By arrangement with the Chelsea District Nursing Association, all cases of Pneumonia receive adequate nursing attention where the circumstances render this necessary. Malaria.—The Regulations provide that the Medical Officer of Health shall take all practical steps to ensure that persons suffering from malaria are supplied with sufficient mosquito netting; receive adequate quinine treatment during the attack and subsequently; and receive appropriate advice as to precautions necessary to prevent the spread of the disease. No case of Malaria was notified during the year. PUERPERAL FEVER AND PUERPERAL PYREXIA. Seven cases of Puerperal Pyrexia were notified during the year. All these were treated in hospital. There were no notifications of Puerperal Fever during 1931. The notifications of puerperal fever and puerperal pyrexia during the past two years were as follows :— Puerperal Puerperal Fever. Pyrexia. 1930 7 9 1931 0 7 Further details of the cases notified in 1931 are given on page 33. OPHTHALMIA NEONATORUM. Six cases of ophthalmia neonatorum were notified during the year. Four of these cases were treated in hospital. As required by the Ministry of Health, particulars of the notified cases are set out in the following table TABLE No. 46. Ophthalmia Neonatorum. Cases. Vision "Unimpaired. Vision Impaired. Total Blindness. Deaths. No. Notified. Treated. At Home. In Hospital. 6 2 4 5 — — 1* * Male, 1 month old, cause of death—Gastro enteritis, malnutrition at birth, Gonorrhoeal ophthalmia. 77 Sx cases of the disease were notified in the previous year. Nursing.—By arrangement with the Chelsea District Nursing Association, home nursing is provided for infants suffering from this disease. poliomyelitis and polio-encephalitis. One case of Poliomyelitis was notified during the year. The case was a bov aged 4 years and was still receiving hospital treatment at the enci of the year. No case of Polio-Encephalitis was notified. ENCEPHALITIS LETHARGICA. No case of Encephalitis Lethargica was notified during the year. Seven visits to old cases of Encephalitis Lethargica were made by the Woman Sanitary Inspector. Encephalitis Lethargica is undoubtedly infectious, but the infectivity is of very low nature. The sequelae may be serious, as in most cases so me permanent damage to the brain tissue occurs. The disease was made compulsorily notifiable from 1st January, 1919. Deaths.—There was one death from this disease during the year. 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 1:2th August, 1929. Seventy-nine notifications were received during the year. Of these, 22 were treated in hospital. smallpox: No case of small pox was notified in Chelsea during the year. Appropriate action was taken as regards contacts of cases notified in other boroughs. Vaccination.—No vaccinations have been performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917. I am indebted to Mr. A. B. j. Hayden, Vaccination Officer for Chelsea, for particulars of primary vaccinations which have been performed in the Borough during the past two years. These are shown in Table No, 47. The complete figures for 1931 are not yet available. 78 TABLE No. 47. 1929. 1930. No. of primary vaccinations performed 510 710 No. of infants died unvaccinated 59 53 No. removed to other districts 86 77 No. removed to unknown addresses 70 92 No. postponed by medical certificate 10 9 No. of certificates of exemption issued 140 118 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). 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 DISINFESTATION AND THE EXTENT OF THEIR USE. The Borough Council maintains a Disinfecting and Cleansing Station situated at 9a Lots Road, Chelsea, adjoining the river. Disinfection.—The disinfecting staff numbers three. A steam disinfector is provided. An appropriate motor vehicle is utilised for the conveyance of infected and disinfected articles to and from the infecting 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. Fifty-eight such disinfections were carried out during the year, the total charges amounting to £86 6s. Od. The following Table No. 48 shows the work done by the disinfecting staff during the year. TABLE No. 48. Description. Number. Number of rooms or premises cleansed and disinfected 615 Number of Articles (bedding, etc.) disinfected 4051 Number of articles (various) destroyed 450 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 79 have appeared, and who have been compelled to leave their dwellings for purposes of enabling such dwellings to be disinfected. One adult was accommodated at the shelter during the year. Disinfestation.—The female shelter attendant is also employed in connection with the work of the Cleansing Station. In 19-22, the London County Council entered into an arrangement with the Borough Council for the use of the Station on specified days during the school year for the purpose of cleansing the heads of verminous School children. Under the L.C.C. Scheme, the work of cleansing is Supervised by the school nurses, who also make all arrangements for the Attendances of the children. The children cleansed are those attending schools situated west of a line running down the centre of Sydney Street and Oakley Street. The Borough Council receives payment from the London County Council at the rate of 2s. per child attendance. During the year, the Station was opened for the entire day on 86 occasions. The following Table No. 49 shows the number of attendances in each quarter :— TABLE No. 49. Quarter. No. of days on which the Station was opened Attendances. Verminous. Impetigo. March 25 189 — J une 21 177 — September 17 118 — December 23 172 — 86 656 — The amount recoverable from the London County Council, as the School Authority, for the cleansing for the year is £65 12s. Twenty-six 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, 1930, and under the Dispensary scheme approved by the Ministry of Health and the London County Council. The latter contribute 25 per cent, of the nett expenditure of that scheme. Staff.—The staff of the Dispensary is set out on page 3. 80 Notifications.—The total number of notifications received was 169, but 54 of these related to cases which had been previously notified, so that the total number of new notifications was 115. In the previous year, the corresponding number was 158. The notifications received on forms I. and II., i.e., notifications from institutions regarding admission and discharge, are not included in the foregoing figures. In Table No. 50 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 17 new cases which came to the knowledge of the Medical Officer of Health during the year, otherwise than by notification on Form A or Form B under the Public Health (Tuberculosis) Regulations. TABLE No. 50. Tuberculosis. New Cases and Mortality during 1931. Age Periods. New Cases. Deaths. Pulmonary. Nonpulmonary. Pulmonary. Nonpulmonary. m. f. m. f. m. f. m. f. 0—1 – – – 1 – – – 1 1— 5 1 – 2 3 – 2 – – 5—10 – – 1 2 – – – – 10—15 1 1 – 2 – – – – 15—20 2 7 2 5 1 3 – – 20—25 9 13 1 3 5 2 – – 25—35 6 16 2 – 6 4 – – 35—45 16 7 – – 7 3 – – 45—55 8 7 – 1 4 2 – – 55—65 5 1 – – 4 1 – – 65 and upwards 5 2 – – 4 3 – – Totals 53 54 8 17 31 20 – 1 The death rate from all forms of Tuberculosis in Chelsea was 0-91 per 1,000. Of the total number of deaths (52) from all forms of Tuberculosis, six died non-notified or prior to notification. The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was therefore as one is to nine. The corresponding ratio for 1930 was 1: 12. 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. Cases of Tuberculosis in the Borough.—The Public Health (Tuberculosis) Regulations, 1930, 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 commencement of the quarter; 81 (b.) The number of cases notified under the Regulations for the first time during the Quarter ; (c.) The number of cases removed from the Register during a preceding Quarter which have been restored to the Register during the Quarter, giving the name and address of each such case and the reason for the restoration; (d.) The number of cases added to the Register during the Quarter which have been brought to notice otherwise than by notification under the Regulations; (e.) 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 (f.) The number of cases remaining on the register at the end of the Quarter. The returns made in accordance with these Regulations show that the numbers of cases of Tuberculosis in the Borough on 31st December last were as follows:— TABLE No. 51. Males. Females. Total. Pulmonary 164 136 300 Non-pulmonary 36 40 76 200 176 376 (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 52 which contains the names of all persons attending at, or seen in connection with, the Dispensary for diagnosis and treatment). Home Visiting.—The Municipal Tuberculosis Visitor in the course of the year visited 42 new cases of Pulmonary and Non-Pulmonary Tuberculosis. Other visits made by this Officer were as follows: Revisits, 235 ; visits for purpose of disinfection, 36 ; visits in connection with extra nourishment, 12 ; miscellaneous visits, 66. Total number, 391. Visits made by the Dispensary Staff are recorded in Table 52. Public Health (Prevention of Tuberculosis) Regulations, 1925.— The Regulations provide, inter alia, that no person suffering frorn 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 connection with these Regulations have been made in the Borough but no case calling for action has thus far been discovered. Chelsea Tuberculosis Scheme.—Table No. 52, subjoined, is prepared in accordance with the requirements of the Ministry of Health. 82 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 treatment 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. In addition, a further Table, No. 53 (page 84), has been compiled showing in summary form the condition of all patients whose case records are in possession of the Tuberculosis Dispensary at the end of 1931, arranged according to the years in which the patients first came under Public Medical Treatment of pulmonary and non-pulmonary tuberculosis. The special cases which were accepted for institutional treatment by the London County Council, but which were not dealt with by the Chelsea Tuberculosis Dispensary, are also included in this table. 83 TABLE No. 52. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand 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 29 27 — 3 2 4 3 5 31 31 3 8 540 (b) Diagnosis not completed — — — — — — — — 3 5 1 — (e) Hon-tuberculous — — — — — — — — 7 9 100 141 87 B. —Contacts examined during the year:— (a) Definitely tuberculous 2 1 — — — — — — 2 1 — — 121 (b) Diagnosis not completed — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 22 43 20 27 C.— Cases written off the Dispensary Register as:— (a) Recovered 1 1 — — 1 — — — 2 1 — — 595 (b) Hon-tuberculous (including .any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 102 206 108 116 D. —Number of Cases on Dispensary Register on December 31st- (a) Definitely tuberculous 115 95 3 6 5 8 12 13 120 103 15 19 226 (b) Diagnosis not completed — — — — — — — — 3 5 1 — 1. N umber of cases on Dispensary 2. Number of cases transferred from Register on January 1st 250 other areas and cases returned after discharge under Head 3 in previous years 19 3. Number of cases transferred to other areas, cases not desiring 4. Cases written off during the year further assistance under the as Dead (all causes) 31 scheme, and cases " lost sight of '' 47 5. Number of attendances at the Dis6. Number of Insured Persons under pensary (including Contacts) 2,999 Domiciliary Treatment on the 31st December 5 ~t Number of consultations with 8. Number of visits by Tuberculosis medical practitioners :— Officers to homes (including (a.) Personal 2 personal consultations) 53 (6.) Other 98 10. Number of : — 9-. Number of visits by Nurses or (a.) Specimens of sputum, etc., Health Visitors to homes for examined 305 Dispensary purposes 3,859 (b.) X-ray examinations made 297 in connection with Dispensary work. 11. Mumber of " Recovered " cases 12. Number of " T.B. plus " cases on restored to Dispensary Register, Dispensary Register on and included in A(a) and A(b) ber 31st 117 above — B—Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment) :— Provided by the Council — Provided by Voluntary Bodies One (Signed) W. H. L. MCCARTHY, Chief Tuberculosis Officer. TABLE 53. (a.) PULMONARY TUBERCULOSIS. Condition at the time of the last record made during the year to which the Return relates. Previous to 1926. 1926. 1927. 1928. 1929. 1930. 1931. Class T.B. minus. Class T.B. plus. Class T.B. minus. Class T.B. plus. Class T.B. minus.' Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus. Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus.) Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class) T.B. plus). (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 7 3 1 — 4 1 1 1 — 2 1 — — — — — — — — — — — — — — — — — — — — — — — — F. 1 2 1 — 3 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Children — 1 1 — 2 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Disease not Arrested Adults M. 5 10 10 — 20 — 4 1 2 7 2 — 1 — 1 1 — — — — 6 7 2 — 9 14 3 5 1 9 4 2 12 1 15 F. 6 9 2 — 11 4 1 2 — 3 2 — 1 — 1 3 — — — — 6 1 1 — 2 13 2 2 — 4 10 4 7 3 14 Children — — 1 — 1 1 — — — — — — — — — — — 1 — 1 — — — — — 1 1 3 — 4 2 1 — — 1 Condition not ascertained during the year — — — — — 1 — — — — — — — — — 2 1 — — 1 2 — — — — — — 1 — 1 — — — — — Total on Dispensary Register at 31st December 19 25 16 — 41 8 6 4 2 12 10 — 2 — 2 7 1 2 — 3 14 8 3 — 11 28 6 11 1 18 16 7 19 4 30 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered Adults M. 10 2 4 — 6 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — F. 8 3 1 — 4 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Children 8 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 79 37 38 5 80 6 1 7 1 9 7 3 11 1 15 6 5 6 — 11 7 5 5 2 12 6 6 6 2 14 9 4 3 — 7 Dead Adults M. 24 24 83 36 143 2 3 7 4 14 2 1 8 3 12 — 3 5 5 13 4 1 8 2 11 1 2 4 3 9 1 — 1 — 1 F. 17 8 38 30 76 1 1 3 5 9 4 — 6 4 10 — — 5 5 10 — 1 — 5 6 — 1 1 2 4 — — — — — Children 4 — 5 — 5 — — — — — — — 1 — 1 — — — 1 1 — 1 — — 1 — — — — — — — — — — Total written off Dispensary Register 150 74 169 71 314 9 5 17 10 32 13 4 24 8 38 6 8 16 11 35 11 8 13 9 30 7 9 11 7 27 10 4 4 — 8 Grand Totals 169 99 185 71 355 17 11 21 12 44 23 4 28 8 40 13 9 18 11 38 25 16 16 9 41 35 15 22 8 45 26 11 23 4 38 TABLE 53 (continued). (b.) NON-PULMONARY TUBERCULOSIS. Condition at the time of the last record made during the year to which the Return relates. Previous to 1926. 1926. 1927 1928 1929. 1930. 1931 Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. j Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands, Total. (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — F. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Children 1 — — — 1 — — — 2 2 — — — — — — — — — — — — — 2 2 — — — — — — — — — — Disease not Arrested Adults M. — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 — — 1 1 2 F. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 1 1 3 Children 1 — — 1 2 — — — 1 1 2 — — — 2 — — — — — — — — — — 4 1 — 5 10 2 — — 5 7 Condition not ascertained during the year 1 — — — 1 — — — 2 2 — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 3 — — 2 5 — — — 5 5 2 — — — 2 — — — — — — — — 2 2 5 1 1 5 12 2 1 2 7 12 Transferred to Pulmonary — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as recovered Adults M. 1 — — — 1 — — — — — — — — 1 1 — — — — — — — — — — — — — — — — — — — — F. — — — 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Children 2 — — 10 12 — 1 — 2 3 — — — — — — — — — — — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary register 8 1 1 10 20 4 — — 3 7 4 1 1 — 6 4 — 1 1 6 1 1 — 2 4 1 — 4 6 11 — — — 1 2 Dead Adults M. — — — — — — — 1 — 1 — — — — — — — 1 — 1 — — — — — 1 — 1 — 2 — — — — — F. — — — 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Children 1 — — — 1 — — 1 — 1 — — — — — — — — — — — — — — — — — — — — — — — — — Total written off Dispensary register 12 1 1 22 36 4 1 2 5 12 4 1 1 1 7 4 — 2 1 7 1 1 — 2 4 2 — 5 6 13 — 1 — 1 2 Grand Totals of (a) and (b) (excluding 86 Chelsea Tuberculosis Dispensary. -This Dispensary, located at Brompton Hospital, provides highly efficient treatment for all cases resident in the Borough. An annual grant is paid to the Hospital by the Borough Council to provide for all necessary medical, nursing and other services. Table No. 54, 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. 54. Work done at the Dispensary. Year. Number of Persons examined for the first time. Definite Tuberculosis. Total attendances at Dispensary. 1930 501 13 per cent. 3,089 1931 520 9 „ 2,999 Institutional Treatment.—The London County Council is mainly responsible for the institutional treatment of Tuberculosis in London. The London County Council maintains St. George's Home, in Milman's Street, Chelsea, as a receiving hospital for pulmonary cases of tuberculosis (females). The majority of advanced cases of pulmonary tuberculosis in Chelsea are isolated and treated in St. Luke's Hospital under the Public Assistance Committee, while a smaller proportion receive treatment in other public institutions. Of the cases which terminated fatally during the year, 42 per cent, died in St. Luke's Hospital and 29 per cent, in other public institutions, that is to say 71 per cent, died away from their homes, the corresponding figure for 1930 being 74 per cent. Co-operation with Hospitals and Invalid Children's Aid Association.—Existing arrangements with general and special hospitals in the neighbourhood continue to give satisfaction. Cases under treatment at St. George's Hospital and St. Luke's Hospital are visited by the Municipal Tuberculosis Visitor. Arrangements are made with Brompton Hospital for the X-ray examination of difficult cases, and for the provision of artificial pneumo-thorax refills. Many patients, both adults and children, who attend the Dispensary for examination, either as contacts or on their own initiative, are found to be suffering from conditions, other than Tuberculosis, which require treatment. These cases are advised as to obtaining such treatment, either from private practitioners or at general hospitals. Many children are found to be suffering from anæmia, malnutrition and similar diseases and are referred to the Chelsea branch of the Invalid Children's Aid Association with a view to provision of convalescent home treatment. Co-operation with the School Medical Service.—The relationship with the School Medical Service continues to be satisfactory. The 87 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 55 new cases at the homes of the patients, and 98 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 tuberculoid patients examined at the Dispensary during the year was 121, a decrease of 45 compared with the previous year. Special arrangements are made for following up patients in cases where the diagnosis is doubtful. Such cases are again examined at intervals, and, when necessary, X-ray or other special investigation is made. The Social Worker at the Dispensary maintains regular observation in connection with these patients. Artificial Pneumo-thorax Treatment.—On the recommendation of the Tuberculosis Officer, patients are supplied with refills in connection with artificial pneumo-thorax treatment. Payment is made by the Borough Council for these refills. Home Nursing.—The Dispensary organization includes home nursing, which is much appreciated by such patients as are confined to bed. During the year, the number of visits paid by Nurses to the homes of patients was 3,859, an increase of 621 over the number for the previous year. The Council lent a bedstead and bedding to one case during the year. Extra Nourishment.—Twenty-nine 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 (£36 3s. 0d.) was borne by the Borough Council. Non-pulmonary Cases.—All cases in which Special treatment 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 supplied through the Invalid Children's Aid Association. Dental Treatment.—With the approval of the Ministry of Health arrangements have been made with the British Dental Hospital, 235, Hammersmith Road, W., for the provision of adequate dental treatment, including dentures, if necessary, for patients attending Chelsea Tuberculosis Dispensary. In each case the certificate of the 88 Tuberculosis Officer is required and dental treatment must be shown as necessary to render other treatment more completely efficacious. During the year three patients thus received dental treatment. Bacteriological Examinations.—During the year, 305 specimens of sputum were examined in connection with the work of the Dispensary. In addition, 43 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). Mrs. E. E. Potton (After-care Committee). Chelsea Invalid Children's Aid Miss B. M. S. Caudwell and Association Miss G. M. Burton. Public Assistance Committee Mrs. Philip Maud. 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 (Vacant). 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. Victoria Hospital Miss White. Ex-officio Members Dr. Leslie McCarthy (Chairman). Dr. W. J. Fenton (Tuberculosis Officer). Miss Tettenborn (Sanitary Inspector and Tuberculosis Visitor). Hon. Secretary Miss Squire, Chelsea Tuberculosis Dispensary, Brompton Hospital, S.W. The duties of the Committee include enquiries into the economic position of the family of a patient suffering from tuberculosis as soon as the patient comes within the purview of the Tuberculosis Scheme. 89 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. Meetings of Committee 26 Cases Assessed 143 Reported admitted L.C.C. Institutions 109 Dental treatment given through Borough Council Scheme 3 Extra nourishment given through Borough Council Scheme 29 Extra nourishment given through other agencies 4 Temporary assistance arranged 28 Children boarded out through the L.C.C. Contact Scheme 6 Children otherwise "arranged for" 5 Convalescence arranged 65 Patients' contributions towards the cost of Institutional treatment collected on behalf of the L.C.C. £210 9s. 0d. (Excluding payments for children collected by the I.C.A.A.) Metropolitan Borough of Chelsea. Annual Report of the PUBLIC ANALYST For the Year ended 31st December, 1931. by B. HENRY GERRANS. F.I.C., Public Analyst. 92 Town Hall, Chelsea, S.W. 3. To the Mayor, Aldermen and Councillors, of the Metropolitan Borough of Chelsea. Mr. Mayor, Ladies and Gentlemen, 1. During the year ended on the 31st December, 1931, four hundred and three samples of Food and Drugs were submitted to me for analysis by the Sampling Officers appointed under the Act. Thirty-nine of these samples were submitted as " Informal samples." 2. The nature of the samples submitted and the general procedure in taking samples are not within the control of the Public Analyst. 3. Table I. shows the number and the names of the Genuine, Adulterated, and Inferior samples, both "Formal" and Informal," reported upon during the year. The term "Genuine Composition" is to be understood to mean that the composition of the samples so described was in accordance with the scientific definitions which can at present be given to the various articles dealt with, and that adulteration could not be certified in regard to them. The term "Inferior" means that the samples so described were of low quality or of doubtful character and that actual adulteration could be certified in regard to them. TABLE I. Name of Sample. Genuine Composition or Not Adulterated. Adulterated. Inferior. Total. "Formal." "Informal." "Formal." "Informal." "Formal." "Informal." Milk 130 3 1 134 Butter 29 2 — 1 —: — 32 Margarine 11 1 — — 1 — 13 Prescription — 1 — — — — 1 Mincemeat 4 — — — — — 4 Tea 32 2 — — — — 34 Mustard Mixture 10 1 — — — — 11 Cocoa 21 1 — — — — 22 Coffee and Chicory 10 — — — — — 10 Coffee 9 — — — — — 9 Almonds 3 — — — — — 3 Pea Flour 1 — — — — 1 Sweets 1 — — — — 1 Cond. F.C. Milk 1 — — — — 1 Tomato Ketchup 1 — — — — — 1 Lemon Curd 1 — — — — — 1 Honey 1 — — — — — 1 Honey Mixture 1 — — — — — 1 Essence of Ginger Wine 1 — — — — — 1 Aspirin 1 — — — — — 1 Tincture of Iodine 1 — — — — — 1 Sausages — — — 2 — — 2 Pearl Barley 1 — — — — — 1 Pepper 7 1 — — — — 8 93 Name of Sample. Genuine Composition or Not Adulterated. Adulterated. Inferior. Total. "Formal." "Informal." "Formal." "Informal." "Formal." "Informal." Sponge Cakes 1 — — — — — 1 Curry 1 1 — — — — 2 Ground Ginger 1 1 2 Lard 10 10 Cream 7 1 8 Rice 4 1 — — 5 Sugar 4 — — 4 Dripping 1 — — 1 Self Raising Flour 2 — — 2 Flour 5 5 Cheese 1 — — — 1 Baking Powder 5 — 5 Custard Powder 5 — — — 5 Blanc-Manage Powder 2 — — — — — 2 Marmalade 1 — — — 1 Quaker Oats 1 — — — 1 Veal Stuffing 1 — — — 1 Sponge Mixture 1 — — 1 Shredded Suet 2 — — — 2 Dessicated Cocoanut 1 — — — — — 1 Cornflour 1 — — — 1 Chocolate Mould 1 — — — 1 Tinned Salmon — 2 — — — 2 Meat Pie 2 — — — 2 Sausage Roll 1 — — 1 Grilled Pilchards — 1 — — — 1 Tinned Fruit 3 1 — — — 4 Tinned Baked Beans 1 1 — — — — 2 Split Lentils — — — 1 Dried Peas 1 — — — 1 Tinned Peas 1 1 — — — 2 Spice 1 — — — 1 Dried Fruits 13 2 — — — 15 Meat Paste 1 — — — 1 Herrings in Tomato Sauce 1 — — — — — 1 Silds in Olive Oil 1 — — — 1 "Camp" Coffee — 1 — — — 1 Tinned Pork and Beans 1 — — — — — 1 Tinned Cream 1 — — — 1 Whisky — 2 — — — 2 Camphorated Oil 1 — — — 1 Boracic Ointment 2 — — — 2 Precipiated Sulphur — 1 — — — — 1 Mercury Ointments — 1 — — 1 Self- Raising Powder 1 — — — — — 1 Semolina — 1 — — — — 1 361 30 2 3 1 — 403 94 4. The percentages given by the data in Table I. are as follows Genuine Composition 98.51 per cent. Adulterated 1.24 per cent. Inferior 0.25 per cent. MILK. 5. The particulars relating to the sample or Milk reported as adulterated are given in Table II. TABLE II. No. Percentage of Water. Remarks. 1 15 — 6. The remaining 133 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," 25 being of " Good " quality, 97 of " Fair " quality and 11 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. MARGARINE. 8. The sample which was certified as Inferior contained 15.46 percent, of water. This amount was below the limit of 16 per cent, laid down by the Food and Drugs (Adulteration) Act, 1928, but in view of the high percentage of water the sample was reported as inferior. COFFEE AND CHICORY MIXTURE. 9. These samples were found to contain the following percentages of Chicory:— 44, 38 (2), 37 (2), 35 (5). and therefore the composition of these mixtures had been correctly described. 95 MUSTARD MIXTURE. 10. These samples all consisted of Mustard mixed with small percentages of Wheat Flour, and in view of the declarations at the time of purchase, they must be regarded as having been properly described. CREAM. 11. The fat of all the samples had the composition of fat derived from milk, they were free from preservatives, and had the composition of samples of genuine Cream. PORK SAUSAGES. 12. The two Informal samples of sausages reported as adulterated contained the following amounts of Sulphur di-oxide:— i. 0.02746 per cent, equivalent to 274.6 parts per million. ii. 0.0206 „ „ 206.0 PRESCRIPTION. 13. The sample of Prescription was of a composition in accordance with that ordered, and was therefore certified to be genuine. WHISKY. 14. The samples had the composition of genuine spirits 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. RICE. 15. The sample reported as Adulterated contained 0.19 per cent, of Fxtraneous Mineral matter, equivalent to 43.3 grains per pound of rice. This mineral matter consisted of a silicate of Magnesia .which is quite insoluble in water, and is used for the purpose of " Facing " the Rice, causing it to be indigestible. DRIED FRUITS. 16. Four of the samples contained slight amounts of sulphur dioxide, which had been used as a preservative, but the amounts were in all cases below the limits allowed. GREEN PEAS (TINNED). 17. The sample had been coloured with an organic dye to produce a green colour, it was free from metals such as copper. Whether the 96 addition of this dye can be held to constitute adulteration has not at present been decided, and the sample was therefore reported as genuine. HONEY MIXTURE. 18. This article consisted of a mixture of honey and invert sugar, sometimes called " Fruit Sugar," and as the fact of admixture was stated at the time of purchase, the sample was reported as genuine. TINNED FISH, TINNED FRUIT, AND TINNED MEAT. 19. These samples were all free from metallic contamination and from preservatives, and were reported as genuine. DRUGS. (Tincture of Iodine, Mercury Ointment, Boracic Acid Ointment, Camphorated Oil and Aspirin.) 20. These articles were all in accordance with the requirements of the British Pharmacopseia respecting composition and purity. PUBLIC HEALTH (PRESERVATIVES, ETC., IN FOOD) AMENDMENT REGULATIONS, 1926. 21. There were no cases of infringement of the above Regulations during the year. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, B. HENRY GERRANS, F.I.C., Public Analyst.