AC 4345 CHE 37 Metropolitan Borough of Chelsea. 65889 Metropolitan Borough of Chelsea. Annual Report of the Medical Officer of Health for CHELSEA 1933 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: vail and co., printers, 170, farringdon road, london, e.c.i. 1934. 2 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 1933. 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 58,850, a figure which is below that for last year. The birth rate (10.6) is lower than that for last year (11.9). The marriage rate (11.5) is higher than that for last year (9.9). The death rate (13.6) is higher than that for London generally (12.2) and compares with (12.9) last year. It is, perhaps, not generally realised that over 10 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 over one-half of all deaths in Chelsea occur in persons over 65 years of age. The infant mortality rate was 78, as compared with 52 last year. The general improvement in the public health of the Borough continues to be maintained. There was a large increase in the total incidence of notifiable infectious disease during the year, mainly owing to an increased number of cases of chicken pox and scarlet fever. The number of cases of diphtheria, erysipelas, enteric fever and tuberculosis were less, while those from pneumonia remained approximately the same. A considerable decrease was recorded in the number of cases of measles. At the end of the year there were 309 cases of pulmonary tuberculosis and 74 cases of non-pulmonary tuberculosis known to be living in the Borough—a total somewhat lower than that for last year. Maternity and Child Welfare work has continued to grow in extent and usefulness. The attendances at the welfare centres were 8,078, and 7,206 visits to homes of patients were recorded. I continue to 3 receive most valuable assistance from the Chelsea Health Society, and cannot speak too highly of the efficiency of the Society's work. Many desirable extensions and improvements in Maternity and Child Welfare services have been rendered possible by the provision of the " Violet Melchett Infant Welfare Centre "—the generous gift of the late Lord Melchett. 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 I submitted a formal representation in regard to an area in Manor Street where the existing houses are for the most part old and worn out. It is gratifying to record that your Council has decided to deal with the site as one to be cleared and to erect new houses for the working-classes thereon. 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. 4 Public Health, Maternity and Child Welfare Committee. At 31st December, 1933. His Worship the Mayor (Councillor Lt.-Col. S. Boyle, M.C., J.P.) Councillor F. G. Chambers (Chairman). Councillors: L. R. Andrews. Lady Meinertzhagen. 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. M. R. Martineau. 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. 5 PUBLIC HEALTH OFFICERS OF THE AUTHORITY. The names and qualifications of members of the staff of the Public Health Department, at 31st December, 1933, are tabulated below in the form required by the Ministry of Health. (a.) Medical. Year ap- Name. Qualifications. Appointment, pointed. 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). 1917 Fenton, W. J. M.D., F.R.C.P. Tuberculosis Officer (Part time). 1926 Matthews, Kathleen M.R.C.S., L.R.C.P., Medical Officer, MaF. D.P.H. ternity and Child Welfare (Part time). 1928 Nelson, Grace M. M.R.C.S., L.R.C.P. Medical Officer, Mater¬- nity 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., Medical Officer, Mater L.R.C.P. nity and Child fare (Part time). 1932 Gibbens, J. H. M.B., B.Ch., M.R.C.P. Medical Director, Mothercraft Training Home, and Medical Officer, Chelsea Day Nursery (Part time) 1929 McCullagh, W. McK M.B., F.R.C.S. Consultant for Puer¬- peral Fever and Puerperal Pyrexia (Part time). 1930 Holland, E. T. M.R.C.S., L.R.C.P. Public Vaccinator, St. Luke's Hospital (Part time). 1930 Sandiland, D. S. ... M.R.C.S., L.R.C.P. ... Public Vaccinator, St. Stephen's Hospital (Part time). 1933 Thomas, E. F. ... M.D., D.P.H. Public Vaccinator, sea District (Part , time). 6 (b.) Other Staff. Year Ap- ! Name. Qualifications. Appointment, pointed. 1925 Gerrans, B. H. ... F.I.C. Public Analyst (Part time). 1920 Crandell, W. Cert. San. Insp. Exam. Senior Sanitary Inspec- Board, Cert. Royal tor (Whole time). San. Inst_, Cert. Meat and other Foods. 1927 Castley, J. Cert. San. Insp. Exam. Sanitary Inspector Board, Cert. Meat (Whole time), and other Foods. 1926 Shelley, A. P. T. Cert. San. Insp. Exam. Sanitary Inspector Board. (Whole time). 1930 Hoyland, H. Cert. Royal San. Inst. Sanitary Inspector, with and San. Insp. Exam. special reference to Joint Board, Cert. Duties under Housing Meat and other Act, 1925 (Whole Foods. time). 1916 Brown, Miss M. Cert. San. Insp. Exam. Sanitary Inspector and Board, Cert. Royal Health Visitor (WholeSan. Inst., Health time). Visitors' Diploma, approved by Board of Education. Cert. C.M.B. 1911 Hobart, Miss F. G. Cert. San. Insp. Exam. Health Visitor and Su- Board, Diploma of perintendent to ChelNat. Health Soc., sea Health Society Royal San. Inst. (Whole time). Health Visitors' Cert. C.M.B. 1923 Shaw, Miss A. ... Cert. Gen. Hosp. Train- Health Visitor, Chelsea ing, C.M.B. and Cert. Health Society(Whole Mothercraft Training time). Soc., Health Visitors' Cert, approved by Ministry of Health. 1926 Haicourt, Miss G. E. Cert. Gen. Hosp. Train- Health Visitor, Chelsea. ing, C.M.B., and Cert. Health Society (Whole Mothercraft Training time). Society. 1929 Broad, Mrs. E. M. S.R N.,Gen. Hosp. Cert. Matron, Chelsea Day Ashton - under - Lyne Nursery. Hosp., Cert. C.M.B. 1926 Corke, Miss I. M. S.R.N.,Gen. Hosp. Cert. Matron, Mothercraft St. Thomas' Hosp., Training Home. Cert. C.M.B., Cert. M.T.S. 1928 Squire, Miss H. M. L. Cert. Inst, of Hospital Secretary of Chelseai Almoners, Cert Social Tuberculosis DispenScience (London sary, Tuberculosis School of Economics). Visitor and Social Cert. San. Insp. Exam. Worker in connection Board. Diploma Nat. with TuberculosisHealth Society. (Whole time). 1927 Puttick, Miss C. K. Cert. General Hospital Tuberculosis Nurse to Training and Tuber- Dispensary (Whole culosis. time). 7 Year Name. Appointment. Appointed. 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 Department (Whole time). 1931 Hayden, A. B. J. Vaccination Officer (Part time). 1930 Strange, Miss K. H. General Secretary, The Violet Melchett Infant Welfare Centre (Whole time). 1933 Phillips, Miss H. E. Assistant Secretary, The Violet Melchett Infant Welfare Centre, (Part 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 Smith, Mrs. E. Shelter and Cleansing Attendant (Whole time). 1929 Lowe, Mrs. I Home Help (Part time). 1931 Evans, Mrs. Home Help (Part time). 8 Table of Contents. page Preface2 Public Health, Maternity and Child Welfare Committee 4 Housing Committee 4 Milk and Welfare Sub-Committee 4 I.—Statistics and Social Conditions of the Borough. General Statistics 11 Physical Features and General Character of the Area 12 Social Conditions, including Chief Occupations of Inhabitants 12 Vital Statistics 12 Births 13 Registered Number of 13 Notifications 15 Illegitimate l6 Stillbirths 16 Marriages l6 Deaths l6 Registered Number of l6 In Public Institutions 18 Causes (Table) 20 Children 1-5 years 21 Infants 22 Illegitimate 23 Apparent Excessive Mortality in the Borough 23 Causes of Sickness in the Borough 24 II.—Provision of Health Services in the Borough. Public Health Officers of the Borough Council 5-7 (а) Medical 5-7 (б) Other Officers 5-7 Professional Nursing in the Home 25 (а) General 25 (б) Infectious Diseases 25 Midwives and Maternity Nurses 27 Home Help in Maternity Cases 27 National Health Insurance 28 Laboratory Facilities 28 Public Health Legislation in Force in the Borough 29 Hospital Services available in the Borough 29 Maternity and Nursing Homes 32 Puerperal Fever and Puerperal Pyrexia 32 Other Diseases and Complications of Childbirth 32 Maternal Mortality 32 Health Visitors 33 Ante-Natal Work 35 Supply of Milk to Mothers and Young Children 35 Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children 36 Ambulance Facilities 36 Clinics and Treatment Centres 37 (a.) The Violet Melchett Infant Welfare Centre 37 (i.) Chelsea Health Society 38 (ii.) Chelsea Day Nursery 38 (iii.) Chelsea Mothercraft Training Home 39 (b.) Invalid Children's Aid Association 41 (d.) Charity Organisation Society 41 (e.) Chelsea Tuberculosis Dispensary 41 Convalescent Home Treatment for Nursing Mothers and Infants 42 Dental Treatment 42 Widows', Orphans' and Old Age Contributory Pensions Acts, 1925 and 1929 43 Blind Persons Act, 1920 43 Children Act, 1908 43 Summary of Arrangements regarding Maternity and Child Welfare 43. 9 III.—Sanitary Circumstances and Administration. PAGE Complaints 45 Closet Accommodation 45 Removal and Disposal of Refuse 45 Sanitary Inspection of the Borough 45 Magisterial Proceedings 48 Smoke Abatement 49 Fouling of Footways by Dogs 49 Rats and Mice (Destruction) Act 49 Pigeons, Nuisance caused by 49 Premises and Occupations Controlled by Byelaws or Regulations 51 Factories, Workshops and Workplaces 51 Public Mortuary 53 Rag Flock Acts 53 Offensive Trades 53 IV.—Housing. Housing Statistics 54 Housing Conditions in the Borough 55 (a.) General Observations 55 (b.) Sufficiency of Supply of Houses 56 (c.) Overcrowding 58 (d.) Fitness of Houses 58 (e.) Unhealthy Areas 59 (/.) Byelaws relating to Houses and Houses Let in Lodgings 60 (,g.) Housing Survey 60 V.—Inspection and Supervision of Food. Milk Supply 62 Public Health (Meat) Regulations, 1924 63 Slaughter-houses 63 Bakehouses 63 Ice-cream Vendors 63 Fried Fish Vendors 63 Other Premises where Food is Prepared or Offered for Sale 63 Unsound Food 64 Food Poisoning 64 Food and Drugs (Adulteration) Act, 1928 64 The Public Health (Preservatives, etc., in Food) Regulations 64 Margarine 64 Chemical and Bacteriological Examination of Food 64 Nutrition, Dissemination of Knowledge as to 65 VI.—Infectious and Other Diseases. (a.) Infectious Diseases Generally 66 Diseases Notifiable in the Borough 66 Notifications 66 Diphtheria 67 Scarlet Fever 68 Measles 69 Enteric Fever 69 Pneumonia, Malaria and Dysentery 69 Puerperal Fever and Puerperal Pyrexia 70 10 PAGE Ophthalmia Neonatorum 70 Poliomyelitis and Polio-Encephalitis 71 Encephalitis Lethargica 71 Chicken Pox 71 Smallpox and Vaccination 71 Venereal Disease 72 Disinfection 72 Infectious Diseases Shelter 72 Disinfestation 73 (6.) Tuberculosis 73 Notifications and Mortality 74 Cases of Tuberculosis in the Borough 74 Public Health (Prevention of Tuberculosis) Regulations, 1925 75 Chelsea Tuberculosis Scheme 75 Dispensary and Institutional Facilities for Treatment 80 Co-operation with Hospitals and I.C.A.A. 80 Co-operation with School Medical Service 80 Co-operation with Medical Practitioners 81 Home Contacts 81 Artificial Pneumo-thorax Treatment 81 Home Nursing 81 Extra Nourishment 81 Non-Pulmonary Cases 81 Orthopaedic Treatment 81 Dental Treatment 81 Bacteriological Examinations 82 Care and After-Care Work 82 Appendix. Report of the Public Analyst for 1933 86 Annual Report on the Health of the Metropolitan Borough of Chelsea. Year ending 31st December, 1933. SECTION I.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. GENERAL STATISTICS. TABLE No. 1. Area (acres) 660 Resident Population :—Registrar-General's estimate, 1933 58,850 Number of Inhabited Houses (end of 1933) according to Rate Books 12,094 Rateable value, October, 1933 £1,240,804 Sum represented by a penny rate, October, 1933 £4,797 POPULATION IN WARDS. (Census 1931.) Males. Females. Total. Cheyne 3,349 5,436 8,785 Church 4,390 5,929 10,319 Hans Town 2,961 5,839 8,800 Royal Hospital 2,550 4,833 7,383 Stanley 10,696 13,048 23,744 23,946 35,085 59,031 (Note.—All vital Statistics given in this Report are calculated on the Resident Population of the Borough as Estimated by the RegistrarGeneral for 1933, viz., 58,850). 12 ✓ Physical Features and General Character of the Area.—The Metropolitan Borough of Chelsea, situated near the centre of the Metropolis, is bounded on the north by the Royal Borough of Kensington, on the west by the Borough of Fulham, on the east by the City of Westminster, and on the south by the river Thames. It is a small compact borough, less than two miles in length, by about three-quarters of a mile in width. Over nearly the whole area the soil consists of gravel and sand, highly permeable to water. In a small portion of the western side of the Borough there is a thin loamy deposit of brick earth, resting upon the gravel. There is a narrow strip of alluvial deposit, extending along the Embankment from Battersea Bridge westwards. The northern portion of the area is largely built over. The central zone comprises a number of pleasant squares occupied by people in affluent circumstances. The grounds of the Royal Hospital, with the River Thames and Battersea Park beyond, render the southern zone unusually open. Social Conditions.—The density of population (number of persons per acre) as shown by the 1931 Census, is 89.4, the corresponding figure for London, as a whole, being 58.7. The density of population of each of the five Wards in the Borough is as follows:—Church Ward, 111.0; Stanley Ward, 123.7 ; Hans Town Ward, 78.6 ; Cheyne Ward, 76.4; Royal Hospital Ward, 49.9. 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. The analysis for the 1931 Census figures relating to occupations and industries is not yet available. 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 :— Legitimate 577 291 286 Birth rate per 1,000 of the estimated resident population 10.6 Illegitimate 48 24 24 13  Total M. F. Still Births 17 12 5 Rate per 1,000 total (live and still) births 26.4 Death rate per 1,000 of the estimated resident population 13.6 Deaths 801 402 399 Deaths. Rate per 1,000 total (live and still births). Deaths from Puerperal Causes :— Puerperal Sepsis 0 0 Other Puerperal Causes 1 1.5 Total 1 1.5 Death rate of Infants under one year of age :— All infants, per 1,000 Live Births 78 Legitimate infants per 1,000 legitimate live births 62 Illegitimate infants per 1,000 illegitimate live births 270 Deaths from Measles (all ages) 2 Deaths from Whooping Cough (all ages) 4 Deaths from Diarrhoea (under 2 years of age) 15 BIRTHS. During the year 941 births were registered in Chelsea. Of these, births of non-parishioners account for 542. In addition, there were 226 births amongst Chelsea mothers in Lying-in Hospitals and elsewhere outside the Borough. The total number of Chelsea Births for the year was therefore 625, equivalent to an annual birth-rate of 10.6 per 1,000 of population. The birth-rate for England and Wales in 1933 was 14.4, while that for London as a whole was 13.2. The following Tables are self-explanatory:— TABLE No. 3. Registered Births. Legitimate. Illegitimate. Total. Male. Female. Male. Female. Births Registered in the Borough 390 402 78 71 941 Births of Non-Parishioners 205 210 66 61 542 Births of Chelsea Mothers in Lyingin Hospitals and elsewhere 185 192 12 10 399 side of the Borough 106 94 12 14 226 291 286 24 24 625 Next Chelsea Births 577 48 625 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. 1932 645 64 709 11.9 86 68 108 107 340 105 40 12 157 1933 577 48 625 10.6 67 54 86 97 321 183 34 9 226 14 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 60 St. Mary Abbots Hospital 96 St. George's Hospital 33 St. Stephen's Hospital and Institution 25 Queen Charlotte's Hospital 11 Princess Beatrice Hospital 8 Ormond Maternity Home 17 General Lying-in Hospital 4 Wilbraham Nursing Home 6 Royal Free Hospital 8 Chelsea Hospital for Women — Miscellaneous Hospitals 23 Royal Avenue Nursing Home 2 Nursing Homes 34 Total 110 Total 217 From Table No. 4 it will be observed that the number of births of Chelsea Infants in Hospitals and elsewhere outside Chelsea accounted for 36.1 per cent. of the total births. In the preceding year the percentage was 22.1. NOTIFICATION OF BIRTHS ACT, 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 887 births, including stillbirths, were notified as occurring in Chelsea. Of this number, in 497 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 226 births amongst Chelsea mothers in Lying-in hospitals and elsewhere outside the Borough. The total number of notified Chelsea births from all sources was 616. The following table indicates the source of notification of the 88 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 103 3 106 47 47 Midwives 179 2 181 40 40 Poor Law Institutions 84 2 86 387 22 409 Parents, etc. 16 1 17 1 — 1 382 8 390 475 22 497 TABLE No. 8. Registered Deaths. Total. Deaths registered in the Borough 2,002 Non-parishioners 1,392 Deaths of Chelsea residents in hospitals and elsewhere outside the 610 Borough 191 Nett Chelsea deaths 801 16 Illegitimate Births.—The following table shows the number of illegitimate births and the percentage of the total births. In 1933, 149 such births were registered in Chelsea, and 26 inward transfers and 127 outward transfers were made by the Registrar-General. The nett figure for the Borough is, therefore, 48, of which 15 were under observation by the Health Visitors at the end of the year. TABLE No. 7. Year. Number of illegitimate births. Percentage of total births. 1932 64 9.03 1933 48 7.68 Stillbirths.—During the year 32 stillbirths were registered in Chelsea, 20 being males and 12 females. Of these, stillbirths of non-parishioners account for 23 (14 males and 9 females) and must be deducted. In addition, there were 8 stillbirths amongst Chelsea mothers outside the Borough (6 males and 2 females). The corrected number of stillbirths is, therefore, 17, which represents a rate for the Borough of 0.29 per 1,000 of the population, as compared with 0.45 for London as a whole. MARRIAGES. There were 678 marriages registered in the Borough during the year (592 in 1932). The marriage rate (number of marriages per 1,000 of population) was 11.5. In the preceding year the marriage rate was 9.9. DEATHS. During the year 2,002 deaths were registered in Chelsea. Of these, deaths of non-residents accounted for 1,394. In addition, there were 193 deaths of Chelsea residents in Institutions and elsewhere outside the Borough. The total number of Chelsea deaths for the year was therefore 801, equivalent to an annual death-rate of 13.6 per 1,000 of population. The death rate for England and Wales for 1933 was 12.3, and for London 12.2. The following tables are self-explanatory :— 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. 1932 768 12.9 11l 122 141 137 257 16.8 12.5 10.0 12.2 1933 801 13.6 108 134 138 119 302 19.3 12.3 9.6 13.2 17 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 620 Chelsea deaths registered in the Borough, 366 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 233 General Hospitals 77 Mental Hospitals 25 Royal Hospital for Pensioners 55 Infectious Disease Hospitals 9 Cancer Hospital 21 Tuberculosis Sanatoria, etc. 2 Victoria Hospital for Children (Tite Street) 4 Nursing Homes 34 Poor Law Institutions 24 St. Stephen's Hospital (Westminster Infirmary) 48 Miscellaneous 20 191 Brompton Hospital 2 Chelsea Hospital for Women 2 Cheyne Hospital for Children 1 Freemasons' Hospital — St. George's Home for Tuberculosis — 366 Of the 1,392 deaths of non-residents registered in Chelsea 1,371 occurred, in hospitals or Institutions within the Borough. TABLE No. 11. Birth Rate, Death Rate and Analysis of Mortality During the Year 1933. (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. | Stillbirths. England and Wales 14.4 0.62 12.3 0.01 0. 00 0.05 0. 02 0. 05 0.06 0.57 0.54 7.1 64 90.9 6.3 1.9 0.9 118 County Boroughs and Great Towns, including London 14.4 0.67 12.2 0 .00 0.00 0. 06 0 .02 0.06 0.08 0.55 0.49 9.4 67 91.0 6.0 2.5 0.5 132 Smaller Towns (1931 Adjusted Populations 25,000-50,000) 14.5 0.63 11.0 0.00 0.00 0 .04 0.02 0.04 0. 04 0.53 0.44 4.9 56 91.7 5.8 1.5 1.0 London 13.2 0.45 12.2 0.00 0 .00 0. 02 0.02 0. 08 0.08 0.51 0.58 11.6 59 88.3 6.3 5.4 0.0 Chelsea 10.6 0.29 13.6 0 .00 0. 00 0. 03 0 .00 0. 07 0.12 0.43 0.85 24 .0 78 87.4 8.0 4.6 0.0 ; Puerperal Sepsis. Others. Total. The maternal mortality rates for England and Wales are as follows :— per 1,000 live births 1.79 2.63 4.42 per 1,000 total births 1.71 2.52 4.23 61 20 TABLE No. 12. Deaths of Chelsea Residents Registered during the Year 1933, 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. 1 65 and under 75 years. 75 years and upwards. All Causes 801 49 5 10 16 13 33 37 76 125 208 229 1. Typhoid and Paratyphoid Fevers — — — — — — — — — — — — 2. Measles 2 1 — — — — — — — — — — 3. Scarlet Fever — — — — — — — — — — — — 4. Whooping Cough 4 3 1 — 2 — — — — — — — 5. Diphtheria 7 1 — 4 — — — — — — 10 6. Influenza 25 — — 1 I — — — 3 7 3 7. Encephalitis Lethargica — — — — — — — — — — — — 8. Cerebro-Spinal Fever 1 — — — — — — — — 1 — — 9. Tuberculosis of Respiratory System 36 — — —_ 1 3 11 8 5 4 4 — 10. Other Tuberculous Diseases 3 1 — 1 — 1 — — — — — — 11. Syphilis 2 — — — — — — — 1 — 1 — 12. General Paralysis of the Insane, Tabes Dorsalis 6 — _ __ __ __ 1 — 4 1 13. Cancer, malignant disease 115 — — 1 — 1 1 6 19 30 39 18 14. Diabetes 4 — — — — — — — — I 1 2 15. Cerebral Haemorrhage, etc. 35 — — — — — — — 3 4 13 l5 16. Heart Disease 209 — — — — 2 2 6 13 29 61 96 17. Aneurysm 4 1 — 2 1 18. Other Circulatory Diseases 36 1 — — — 1 2 — 11 10 11 19. Bronchitis 24 — 1 — — — — 1 1 — 8 13 20. Pneumonia (all forms) 44 5 1 — 2 — 4 — 4 7 11 10 21. Other Respiratory Diseases 10 — — 1 — — — — — 3 3 3 22. Peptic Ulcer 11 — — — — — 2 — 4 — 4 1 23. Diarrhoea, etc. 18 14 1 — — — 1 — — — 2 — 24. Appendicitis 8 — — — 1 — 2 1 1 3 — — 25. Cirrhosis of Liver 3 — — — — — 1 — 1 1 — 26. Other Diseases of Liver, etc. 4 — — — — — — — — — 3 1 27. Other Digestive Diseases 21 1 — — 2 — — — 3 4 5 6 28. Acute and Chronic Nephritis 17 — — — — — — 2 — 3 7 5 29. Puerperal Sepsis — — — — — — — — — — — — 30. Other Puerperal Causes — — — — — — — — — — — — 31. Congenital Debility, Premature Birth, Malformations, etc. 20 20 — — — — — — — — — — 32. Senility 21 — — — — — — — — — 2 19 33. Suicide 10 — — — — — 1 2 2 4 1 — 34. Other Violence 40 2 — i 5 1 2 4 4 1 9 11 35. Other Defined Diseases 60 1 — i 1 5 3 5 7 12 18 7 36. Causes ill-defined or unknown 1 — — — — 1 — — — — — 801 49 5 10 16 13 33 37 76 125 208 229 21 CAUSES OF DEATH. Table No. 12 shows that 209 deaths were due to Organic Heart Disease, 115 to Cancer, 24 to Bronchitis, 44 to Pneumonia, 36 to PulmonaryTuberculosis, 36 to Circulatory Diseases, 35 to Cerebral Haemorrhage, 25 to Influenza and 20 to Congenital Debility and Malformation. Fifty-four per cent. of all deaths occurred in persons over 65 years of age. 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 :— TABLE No. 13. Year. Bronchitis. Pneumonia. Other Respiratory Diseases. Total. Deathrate. No. of deaths under 5 years. Percentage under 5 years. 1932 18 49 4 71 1.2 13 18.3 1933 24 44 10 78 1.3 8 10.2 DEATHS OF CHILDREN 1-5 YEARS OF AGE. The number of deaths of children between 1-2 years of age was 5 and between 2-5 years, 10. In the previous year these figures were 16 and 11 respectively. The causes of death are given 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. 1932 14 1 6 1 5 27 1933 6 1 3 1 4 15 22 INFANT MORTALITY. There were 49 deaths of infants under one year of age in Chelsea during the year. The correct death rate is 78 per 1,000 births, as compared with 52 in 1932. In London as a whole the rate of infant mortality was 59 per 1,000 births. The causes of death in the various age groups are set out in Table No. 15 :— 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 — — — — — — — 1 — 1 Scarlet Fever — — — — — — — Whooping Cough — — — — 2 1 3 Diphtheria — — — — — — 1 — 1 Influenza — — — — — — — — — — Erysipelas — — — — — Tuberculous Meningitis — — — — 1 1 Abdominal Tuberculosis — — — — — Other Tuberculous Diseases — Meningitis — — — — — — — — — — Convulsions Laryngitis — — — — — — — — — — Bronchitis — — Pneumonia — 1 1 1 — 1 2 5 Diarrhœa and Enteritis — — — — — 3 2 4 5 14 Gastritis — . — — __ Syphilis — — — — — — — — Rickets — — — — — — — — — — suffocation — — — — 1 1 2 Injury at Birth — — — — — — — — Atelectasis — — — — — — — — — — Congenital Malformations 3 1 — — 4 1 1 — — 6 Premature Birth 11 — — 1 12 — — — 12 Atrophy, Debility and Marasmus — — — — — — — — — 2 Other causes — — — — — 1 — 1 — 2 14 2 — 1 17 9 5 10 8 49 Nett Births registered during Legitimate 577 the calendar year Illegitimate 48 Nett Deaths (under 1) registered Legitimate 36 during the calendar year Illegitimate 13 The following Table gives the Infant Mortality Rate in Chelsea under various headings, for the past two years :— 23 TABLE No. 16. 1932. 1933. Infectious Diseases 4.2 8.0 Diarrhœal Diseases 15.5 22.4 Developmental Defects and Wasting 18.3 32.0 Other causes 14.0 16.0 Total Rate 52.0 78.4 TABLE No. 17. Infantile Mortality Rates per 1,000 Births in Wards. 1932. 1933. Hans Town 46 60 Royal Hospital 73 37 Church 64 151 Cheyne 46 51 Stanley 47 78 Chelsea Borough 52 78 Illegitimate Deaths.—The following Table No. 18 shows the number of deaths among illegitimate infants during the past two years. TABLE No. 18. 1932. 1933. Total number of illegitimate deaths under 1 year 8 13 Illegitimate death rate 125 270 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 showed that in London generally 7.3 per cent, of the total population were included in the age-group 65 and upwards. In Chelsea, however, no less than 10.2 per cent. of the total population 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 1933, deaths of pensioners in the Royal Hospital, Chelsea, accounted for 61 deaths, inward transfers included (equivalent to 1.03 of the death rate). For many years past more than half the deaths in Chelsea have occurred in persons over 65 years of age. 24 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. It is difficult to write definitely on the incidence of sickness 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. Noteworthy features were the excess of sunshine, deficiency of rainfall, the higher summer temperatures, the low day and night temperatures during the cold spells in January and December, the blizzard in February, and the abnormal sequence of thunderstorms in June. As a consequence, there was a considerable amount of respiratory and rheumatic affections during the early part of the year and the deaths from diseases of this character somewhat higher than in previous years. The number of deaths is, of course, no measure of the amount of sickness and can only be regarded as an index. Influenza was less prevalent than the average incidence of the disease during the preceding five years. Judged by the notifications received, there was a slight decrease in the amount of pneumonia, 117 notifications being received, as compared with 121 in the previous year. There was a large increase in the number of cases of notifiable infectious disease. No special effects of any particular occupation, prejudically affecting the health of workers therein, have been reported. 25 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 the Public Health Department at 31st December, 1933, are tabulated on pages 5-7, 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 Is. 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 26. 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, 1933. The total fees paid by the Council for nurses' visits during the year amounted to £90 l1s. l0d. (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. 26 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 82. The foregoing arrangement whereby the trained nurses of the Chelsea, Pimlico and Belgravia District Nursing Association undertake, when requested by the Medical Officer of Health, the home nursing of measles, German measles, whooping cough, ophthalmia, enteritis and any other disease for which nursing assistance is required, continues to give satisfaction. Medical practitioners in the Borough greatly appreciate the assistance they thus receive. No occasion has arisen where a request for nursing assistance has not been met promptly, even in times of pressure. The following Table No. 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 1933:- TABLE No. 19. Year. Visits. Cases. 1932 1,803 171 1933 1,300 116 TABLE No. 20. Nursed by District Nurses During 1933. Visits. Cases. Bronchitis 77 6 Burns — — Chicken Pox — — Circumcision 96 16 Diarrhœa — — Eye Trouble 119 7 Ear Trouble 237 16 Expectant and Nursing Mothers 101 9 Influenza and Pneumonia (under 5) 58 5 Influenza and Pneumonia (over 5) 140 10 Impetigo — — Meningitis and Peritonitis 2 1 Measles (under 5) 15 1 Measles (over 5) — — Ophthalmia Neonatorum 6 1 Pemphigus Neonatorum 59 2 Pemphigus 89 2 Poliomyelitis — — Puerperal Fever 12 1 Puerperal Pyrexia 4 1 Rickets — — Septic sores 60 5 Tonsils and Adenoids 33 8 Whooping Cough 9 1 Worms 81 11 Miscellaneous 102 13 1,300 116 27 MATERNITY NURSES AND MIDWIVES. Provision has been made by the Borough Council whereby necessitous, women may obtain the services of a Maternity Nurse or Midwife at a reduced rate, the balance of the fee being paid by the Council. The fees charged vary from £2 to £2 2s. 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 10 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. 1932 1 49 1 43 £ s. d. 0 10 0 £ s. d. 19 14 0 £ s. d. 1 12 0 £ s. d. 47 4 0 1933 2 43 1 39 0 17 6 19 18 9 0 12 6 39 1 3 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 28 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. 1932 15 5 plus 5 extensions 1 s. d. 6 18 6 £ s. d. 24 6 10 1933 16 9 11 1 0 24 19 0 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 Tuberculosis Dispensary, in conjunction with the appropriate officials of the Health Insurance Service. 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 drugs sold in the Borough are carried out in his laboratories. The detailed results of analyses made during the year will be found appended to this report. Bacteriological Examinations.—Routine bacteriological examinations are carried out at the Lister Institute of Preventive Medicine. Special investigations for the Ante-natal Clinic are carried out at St. George's Hospital, S.W.I. 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. Four specimens were sent during the year. 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. 29 No case of food poisoning was notified during the year. The number of bacteriological, bacterioscopic and other examinations carried out during the year was 330. Of these, 289 were for the bacillus associated with Diphtheria, 35 for the bacillus associated with Tuberculosis, and 1 for the bacillus associated with Enteric 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 l1s. 0d. The total number of bacteriological examinations during the preceding year was 383. 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 81,000 units. An anti-toxin syringe, needles and steriliser are also available on loan. The total cost to the Council for anti-toxin supplied during the year -was £5 2s. 3d. 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, has made the following byelaw for the good rule and government of Chelsea :— 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." This byelaw has proved of considerable assistance in preventing serious nuisance. 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. 30 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. 23 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. TABLE No. 23. 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 339 Yes By Voluntary commitee Cancer Hospital Fulham Road, S;W.3 Malignant Disease 128 Yes By Voluntary Committee Chelsea Hospital for Women Arthur Street, S.W.3 Obstetric and Gynaecological 100 Yes By Voluntary Committee Cheyne Hospital for Children Cheyne Walk, S.W.3 Children's Diseases 71 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 Orthopaedic Hospital Great Portland Street, W.l Deformities and Malformations 170 Yes By Voluntary Committee St. George's Hospital Hyde Park Corner, S.W.I General Medical, Surgical and Maternity 437 Yes By Voluntary Committee St. Luke's Hospital Cale Street, S.W.3 Medical and Surgical 411 Yes By Central Public Health Committee of L.C.C. St. Mary Abbots Marloes Road, W.8 Medical, Surgical and Maternity 621 Yes By Central Public Health Committee of L.C.C. St. Stephen's Hospital Fulham Road, S.W.10 Medical, Surgical and Maternity 750 Yes By Central Public Health Committee of L.C.C. Victoria Hospital for Children Tite Street, S.W.3 Children's Diseases 138 Yes By Voluntary Committee West London Hospital Hammersmith Road, W.6 General Medical and Surgical 234 Yes By Voluntary Committee St. George's Home Milman's Street, S.W. 10 Tuberculosis 50 Yes By Central Public Health Committee of L.C.C. 31 32 All the hospitals included in the foregoing table are fully equipped for operative surgery on modern lines. Each of them also provides. 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. It provides accommodation for six cases, a seventh bed being available in emergency. The Home is controlled by a Voluntary Committee and is supported by (1) voluntary subscriptions (2) payments by patients and by pupils. The Institution does excellent work in the neighbourhood, providing an intern and extern midwifery service, and, in addition, is a recognised school for the training of midwives. The Medical Officer of Health is a member of the Executive Committee of the Home. I am indebted to Miss A. Aldridge, the Matron of the Home, for the following information regarding the work done during the year :— Cases admitted and attended in the Home 67 Cases attended in the district 147 Total 214 Ante-natal attendances 736 Visits to cases in the district 2,746 Maternal deaths None PUERPERAL FEVER AND PUERPERAL PYREXIA. Three cases of Puerperal Fever and nine cases of Puerperal Pyrexia were notified during the year. Details of these cases are set out in the following table :— TABLE No. 24. Total number of cases notified. Treatment in Hospital. District Nurses in attendance Council's Obstetrician called in. Deaths. Puerperal Fever 3 3 1 0 0 Puerperal Pyrexia. 9 7 1 0 0 DISEASES AND COMPLICATIONS OF CHILDBIRTH. One death occurred during the year. The cause was syncope during instrumental delivery in Hospital. The Mother had for a considerable period suffered from serious heart disease. Every precaution appeared to have been taken to ensure a safe confinement. MATERNAL MORTALITY. The following table shows the Maternal Mortality in Chelsea during the past two years. 33 TABLE No. 25. Year. Total death-rate per 1,000. (Live and Still Births). Total Death-rate. Puerperal Fever. Other complications of Pregnancy and Childbirth. 1932 ___ __ 1933 — 1.5 1.5 In the case of every maternal death the circumstances are 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 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. No 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. 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. 34 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. 26) gives an outline of the work of the Health Visitors and of the Chelsea Health Society and School for Mothers during the past two years. The visits enumerated are those paid by the trained officer of the Borough Council (one part-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. 26. Summary of Reports of Health Visitors. 1932. 1933. (1) Work of the Health Visitors. First visits to Infants under one year of age 570 489 Return „ „ „ „ „ 1,765 1,794 First visits to Children between the ages of 1 and 5 years 356 378 Return visits to Children between the ages of 1 and 5 years 2,488 2,703 Ante-natal visits to Expectant Mothers :— Primi-para cases 86 90 Multi-para „ 148 176 Return visits 616 479 Visits to Enteritis cases amongst children — 9 Return visits „ „ „ „ — 12 Visits to Ophthalmia Neonatorum cases 5 4 Return visits „ „ „ — 6 Visits to Whooping Cough cases 56 141 Return visits „ „ ,, 27 79 Visits to Measles cases (under 5 years of age) 331 31 Return visits „ „ „ 246 10 Visits to Measles cases (over 5 years of age) 219 22 Return visits „ „ „ 54 5 General additional visits 838 778 Total visits 7,705 7,206 Half-day attendances at Infant Welfare Centres 519 454 35 Summary of Reports of Health Visitors—continued. (2) Infant Welfare Centres. , Total number of attendances :— 1932. 1933. (a) By children under one year of age 4,712 4,280 (b) By children between the ages of 1 and 5 years 3,023 3,181 (c) By Ante-Natal mothers 712 554 (d.) By Post-Natal mothers 49 03 Total attendances 8,496 8,078 ANTE-NATAL WORK. Close attention is devoted to the work of ante-natal consultations as the figures in Table No. 26 demonstrate. Sound advice, based on the most recent scientific investigation, is provided by the medical officer of the Ante-natal Clinic. Every effort is being made to ensure that mothers will take full advantage of the excellent arrangements made by the Chelsea Health Society so that as far as possible all risk of disease and accident incidental to childbirth may be removed. SUPPLY OF MILK 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. Od. per head per week. Milk is supplied to other cases on the following basis :— Nett available incomes 4s. to 5s. at the rate of Id. per pint. „ „ 5s. to 6s. „ „ l½d. „ „ „ 6s. to 7s. „ „ 2d. „ „ „ 7s. to 8s. „ „ 2½d. „ The following table shows for the past two years, the extent of this service :— TABLE No. 27. Year. Milk Orders issued and taken up. Approx. Cost. March quarter. June quarter. Sept. quarter. Dec. quarter. *Total. 1932 776 911 761 959 3407 £ 704 1933 908 871 700 790 3269 682 * These totals do not include orders subsequently cancelled or withdrawn, which average 150 or more during each year. 36 It will be observed that in 1933 there was a decrease in the cost of milk. Cows' milk was supplied to 72 per cent, of the applicants, dried milk being supplied to the remaining 28 per cent. 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 Fanny Hobson Hostel, 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. 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. 37 (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 TREATMENT CENTRES. (a.) The Violet Melchett Infant Welfare Centre.—Chairman of Council: Violet, Lady Melchett, D.B.E. Hon. Treasurer : Mrs. Hartnell; Hon. Secretary : Miss M. Bowden-Smith. 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, 1931. 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 magnificent 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. 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 ami 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. 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 are 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. 38 The Borough Council made a financial grant of £1,250 to the Violet Melchett Infant Welfare Centre for the financial year 1933-1934. 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 484, King's Road. During the year five infant clinics were held weekly—four at Wellington Street and one at King's Road. At Wellington Street one ante-natal clinic was held weekly. Details of the work carried out by the Society will be found on page 34 (Table No. 26). 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 (0) 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 the financial year 1933-1934. (2) Chelsea Day Nursery, Flood Street, S.W.3.—Chairman of Executive Committee : Alderman Eric Hall, L.C.C. Hon. Secretary : Miss E. G. Antrobus. The Chelsea Day Nursery is controlled by a Voluntary Committee. The staff consists of a Medical Officer, an honorary Medical Adviser, a Matron, a Sister, a Staff Nurse, eight probationers, and three London County Council Scholarship Students. 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. 39 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 1933-34. The attendances at the Nursery during the past two years were as follows :— TABLE No. 28. 1932. 1933. Total number of attendances during the year 8,970 11,397 Average daily attendance (5 days a week) 32 38 Total number of individual children who attended 116 152 The health of the children has been satisfactory. Dr. J. H. Gibbens is Medical Officer to the Nursery and makes a weekly inspection of the children. (3)Chelsea Mothercraft Training Home.—Manor Street, S.W.3. Chairman of Executive Committee : Mrs. C. M. Vaug~han-Morgan. Hon. Secretary : Miss Violet Trench. The Mothercraft Training Home is controlled by a Voluntary Committee. The staff consists of three honorary Consultants, a Medical Director, a Matron, two Sisters, three 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. The following Table No. 29 shows the work carried out in the Home during the past year :— TABLE No. 29. The Mothercraft Training Home, 1933. Admissions. Obs. Malnutrition. For Breast- Feeding. Resident B.F. Babies Total Mothers. Total Babies. 32 71 3 74 106 40 Average Stay. Artificially-fed Babies Breast-fed Babies. Normal B.F. Babies. 62 days 23 days 1 year Breast Feeding Analysis. Established. Ke-established. Supply increased. Supply regulated. No change. 6 0 45 7 3 Attendances for Test Feeds. Number of Mothers attending : 1 Visit 2 Visits 3 Visits" 4 Visits 5 Visits 6 Visits 7 Visits 8 Visits 116 23 5 2 1 1 1 2 Total number of Mothers : 151 Total number of Test Feeds : l'Jti Students. Started one year Completed one year Completed 4 months Completed 3 months 14 11 1 2 The Borough Council made an annual contribution to the Chelsea Mothercraft Training Home for the financial year 1933-1934. 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; orthopedic appliances and surgical boots ; massage, remedial exercises, surgical dressings and medical comforts ; help in training for suitable work; additional clothing, etc. 41 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, 1933. During the year the branch had 254 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. Forty-one children were sent out of London for convalescence, for periods varying from six weeks to six months. Five children had hospital and sanatorium treatment arranged for them. All children were given medical aids as ordered by a doctor, such as vitoleuin cream, phosphates, malt and cod liver oil, etc., which their parents, owing to unemployment, were unable to provide. Twenty 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. Secretary: Mrs. Pickering. Medical Officers: Dr. Langdon Lloyd, Dr. J. H. Gibbens and Dr. Grosvenor Millis. This Infant Welfare Clinic is controlled by a voluntary Committee. It is intended for the use of annual subscribers only. Infant consultations are held thrice 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 42 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 77. 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, 1933. 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. 30. During the year five 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. 30. Year. No. of Applications. Nursing Mothers and Infants sent away under Council Scheme. Contributions by Mothers. Nett Cost to Borough. 1932 14 10 £ s. d. 1 s. d. 9 0 0 17 16 0 1933 23 12 5 0 0 16 2 0 DENTAL TREATMENT. Children under Five Years of Age.—For many years dental treatment for children under five years of age has been carried out at the London County Council School Clinic in Bramerton Street, Chelsea. This arrangement has proved very satisfactory in its working. Expectant and Nursing Mothers.—In conjunction with the Chelsea Branch of the Charity Organisation Society and the Chelsea Health Society, the Borough Council has formulated a scheme whereby dental treatment is provided for expectant and nursing mothers. During the year dentures were supplied to three mothers, the Borough Council making a contribution of £7 18s. Od. towards the cost. 43 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 Act has yet occurred in the Borough. CHILDREN ACT, 1908. Since 1st April, 1933, the Borough Council has been responsible for the functions formerly discharged by the London County Council under Part 1 of the Children Act, 1908, as amended by Part V of the Children and Young Persons Act, 1932. The following table shows the number of Foster Mothers and Children resident in the Borough during this period and the number of visits in connection with this work. TABLE No. 31. lpfant Lije Protection Return. (Is/ April to 31s/ December, 1933). Foster Mothers. Foster Children. Number on Register at beginning of period 22 25 Removed from register 5 13 Added to register 9 17 Remaining on register 26 29 Medical attendance arranged — 11 Attended Maternity and Child Welfare Clinic — 8 Visits to foster mothers 96 Miscellaneous visits 62 BLIND PERSONS ACT, 1920. At the request of the London County Council, the Borough Council 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. 44 (c.) The home visitation of expectant and nursing mothers and infants by a staff of Health Visitors who work (a.) from the Town Hall, and (b.) from the Centres of the Chelsea Health Society. (d.) The subsidisation of the Chelsea Health Society's Maternity and Child Welfare Centres and Clinics for mothers, infants and young children. (e.) The subsidisation of the local branch of the Invalid Children's Aid Association. (f.) The subsidisation of the voluntary Day Nursery in the Borough. (g.) The subsidisation of the Chelsea District Nursing Association for the home nursing of expectant and nursing mothers and young children. (h.) The provision of Home Helps. (i.) The provision of midwifery attendance, free or at reduced rates, for necessitous Chelsea women. (j) The provision of Convalescent Home accommodation for nursing mothers and infants. (k.) The provision of dental treatment for expectant and nursing mothers. (I) The supply of milk, free or at reduced rates, to necessitous nursing and expectant mothers, infants, and young children. (m.) The provision of sterile maternity outfits at cost price. (n.) The administration of the Widows', Orphans' and Old Age Contributory Pensions Acts, 1925 and 1929, in respect of deserted, abandoned or neglected children. 45 SECTION III.—SANITARY CIRCUMSTANCES AND ADMINISTRATION. Complaints.—The number of complaints received during the year was 340, compared with 350 last year. The complaints are, in the majority of cases, from the occupiers of houses and deal with alleged nuisances. These complaints are investigated by the Sanitary Inspectors, who, when the circumstances justify, serve the necessary notices required for the abatement of the nuisances. Closet Accommodation.—The water carriage system is general throughout the Borough. Removal and Disposal of Refuse.—House refuse is removed by the Works Department of the Council. A 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 530. The number of statutory notices was 62. These compared with 575 and 99 in 1932. In three cases the owners neglected to comply with the statutory notices and in these it was found necessary to issue summonses. Details of these prosecutions are set out in tabular form in Table No. 32. Summary of Work carried out by Sanitary Inspectors during the Year. Inspections. On complaint of nuisance 340 On notification of infectious disease (including non-notifiable diseases) 261 House to House 173 Re-inspection calls made 5,630 Inspection of:— Bakehouses 29 Slaughterhouses 14 Milkshops 77 Ice Cream Premises 30 Overcrowding 26 Houses Let in Lodgings 69 Stables 44 Restaurant Kitchens 46 Marine Stores 13 Food Premises other than above 119 Premises under Meat Regulations 34 Factories and Workshops 256 Outworkers' Premises 23 Common Lodging Houses 18 Other visits 578 Verminous Premises 236 Rat enquiries 76 Smoke observations 25 Total 8,008 46 Premises: Walls and Ceilings cleansed :— (а) Premises throughout 1 (б) Premises partially 276 (c) Verminous rooms cleansed 50 (d) Total number of rooms cleansed 426 Wash-house walls and ceilings cleansed 11 Walls and ceilings of water closets cleansed and repaired 33 Wash-house roofs repaired 1 Dirty tenants' rooms cleansed 7 Yard and area walls cleansed 4 Defective roofs repaired 61 Defective gutters repaired 2 Defective rain water pipes repaired 30 Dampness abated 66 Miscellaneous repairs 106 Wash-house floors repaired 30 Yard surfaces repaired, paved, etc. 16 Ashpits demolished 1 New and proper dustbins provided 36 Workrooms provided with light and ventilation or light and ventilation improved 17 Drainage : Reconstructed 91 Repaired 13 Cleansed 2 Inspection Chambers and traps provided 181 Fresh air inlets provided or repaired 105 New soil pipes provided 67 New ventilation pipes provided 81 Soil and ventilation pipes repaired 3 Anti-syphonage pipes provided 1 Drains sealed off 4 Drains cleared (obstruction removed) 10 New covers provided to inspection chambers 178 Rainwater pipes disconnected and caused to discharge over properly trapped gullies 5 Sink wastes provided with traps 105 Sink waste pipes cleansed 5 New sink wastes provided 76 New sinks provided 81 New bath wastes provided 17 Water Closets. Improvements in sanitary conveniences (factories, workshops, etc.) 4 New water closet pans provided 160 Water closet pans (foul) cleansed 8 Choked water closet pans unstopped and cleansed 7 Water waste preventers renewed 34 Water waste preventers repaired 6 Water closet roofs repaired 6 Ventilation and light provided or improved 5 W.C. floors repaired 160 Water supply. Water supply to premises reinstated 5 Water supply provided to upper storeys of tenement houses 1 New drinking water cisterns provided 8 Drinking water cisterns cleansed 7 Drinking water cisterns provided with new covers or covers repaired 2 Smoke Nuisance. Number of observations 25 Number of nuisances and complaints 15 Number of notices — Number of Summonses — 47 Nuisances abated arising from :— Keeping animals in an improper manner or place 1 Defective manure cages 2 Accumulation of manure or refuse 12 Overcrowding 26 Rat nuisance 76 Underground rooms — Food Condemned and Destroyed. Mushrooms 13 lbs. Rabbits 3 Disinfection. Premises disinfected after Zymotic diseases (Scarlet Fever, Diphtheria, etc.) 379 Rooms disinfected after Tuberculous disease . 57 Rooms fumigated for verminous and filthy conditions 316 Miscellaneous disinfection 77 Certificates of disinfection given 154 School notices after disinfection 216 Notices sent to Public Library of Premises where infectious diseases have occurred 175 Proceedings taken. Intimation Notices served 530 Statutory Notices under Public Health (London) Act, 1891 62 Statutory Notices under Section 17 of Housing Act, 1930 — Statutory Notices under byelaws for provision of dustbins 9 Total number of samples purchased for analysis under the Food and Drugs (Adulteration) Act 353 Samples of cream taken 10 Samples of drugs taken 2 Samples (informal) purchased 47 Legal proceedings instituted in respect of defective sanitary conditions and nuisances 6 Legal proceedings under Milk and Dairies Amendment Act, 1922 3 Legal proceedings in respect of unsound food — Certificates issued in accoidance with " Rent Restrictions Act " Entries in Inhabitants' Complaint Book 340 Cleansing and Disinfection. Number of adults cleansed 22 Number of children cleansed 546 Number of rooms or premises cleansed or disinfected 829 Number of persons treated for Scabies 14 Number of articles (bedding, etc.) disinfected 5,493 Number of articles (various) destroyed 319 Disinfection Station Shelter. Persons accommodated :— Adults 2 Children — Mortuary. Number of bodies received 25 Number of infectious bodies received — Number of bodies removed to Public Mortuary on Sanitary grounds — Number of bodies detained in Mortuary Chapel 25 48 TABLE No. 32. Magisterial Proceedings during the Year. Public Health (London) Act, 1891. Situation of premises. Nature of Nuisance or Complaint. Petty Sessions. Date of Hearing. Result. Cranley Hse., Vicat Street. Failing to comply with Council's notice to reconstruct drainage. Kensington 18.4.33 Order, 14 days. 6, Craigside Hse., Vicat Street. Failing to comply with Council's notice to carry out cleansing. Kensington 18.4.33 Order, 14 days. Burlington Hse., Vicat Street. Failing to comply with Council's notice to reconstruct drainage. Kensington 18.4.33 Order, 14 days. LONDON COUNTY COUNCIL (DRAINAGE) BYE LAWS. 32, Pont Street. Failing to submit plans of proposed drainage work. Kensington 21.3.33 Fined £2 Failing to give 24 hours' notice of intention to commence work. Kensington 21.3 33 Fined £2 Fixing a new bath, the waste pipe of which discharged into a hopper head. Kensington 21.3.33 Fined £2 1, Lawrence Mansions. Failing to submit plans of proposed drainage work. Kensington 21.3.33 Fined £1. Failing to give 24 hours' notice of intention to commence work. Kensington 21.3.33 Fined £1 Fixing a new lavatory basin, the waste pipe of which discharged into a hopper head. Kensington 21.3.33 Fined £1 506, King's Road. Failing to submit plans of proposed drainage work. Kensington 21.3.33 Fined £1 Failing to give 24 hours' notice of intention to commence work. Kensington 21.3.33 Fined £1 Fixing a new lavatory basin the waste pipe of which discharged into a hopper head. Kensington 21.3.33 Fined £1 49 Smoke Abatement.—It is part of the work of a Sanitary Inspector to observe any nuisance arising from smoke. There were 25 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. Fifteen complaints of smoke nuisance were received during the year and cautionary letters were sent to the offenders. 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 no prosecution was taken for infringement of the byelaw. 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 occupiers of premises. During the year the Council provided rat catching varnish to applicants for the destruction of rats and 176 bait traps were prepared and issued. In conjunction with the Works Department, investigation was made of a number of old sewers likely to be infested with rats and a large number of baits were laid. During the year many persons were advised as to the best means of dealing with the rat nuisance so far as it affected their respective premises. The cost to the Council of rat catching varnish during the year was £7 16s. Od. Nuisance caused by Pigeons.—Until recently a Sanitary Authority had no powers to deal with nuisance caused by pigeons. 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. Much difficulty has been experienced in carrying out pigeon destruction, owing to the opposition of a large section of the public. During the year 1933, 30 pigeons were captured and humanely destroyed. 50 TABLE No. 33. Number of Premises. Number of inspections during 1933. Number of notices served during 1933. Number of prosecutions during 1933. On register at end of 1932. Added in 1933. Removed in 1933. On register at end of 1933. 1. Premises used for Business Purposes :— Milk Premises 73 1 2 72 77 2 — Cowsheds — — — — —i — — Ice Cream Premises 30 — — 30 30 — — Butter and Margarine 10 — — 10 10 — — Manufacturers and Dealers :— Fried Fish Premises 14 — — 14 25 1 — Fish Curers 5 — — 5 5 1 — Bakehouses 26 — — 26 26 2 — Slaughterhouses 2 — 1 1 14 — — Food Stalls 45 — — 46 under daily — — observation Offensive Trade Premises — — — — — — — 2. Premises used for Human Habitation :— Houses let in lodgings 460 69 — 529 69 — - — Common Lodging Houses 4 — — 4 18 — — Canal Boats - - - - - - - 51 PREMISES AND OCCUPATIONS CONTROLLED BY BYELAWS AND REGULATIONS. The preceding Table No. 33 summarises the number and character of premises 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 132 of the Factory and Workshops Act, 1901, to include in his annual report details of the administration of this Act in his district. The total number of factories, workshops and workplaces on the register at the end of the year was 240. The number of inspections of these premises was 256, which compares with 285 in 1932. Sanitary defects were found in 10 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. Number of Inspections. Written Notices. Occupiers prosecuted. (1) (2) (3) (4) Factories (including Factory Laundries) 18 — — Workshops (including Workshop Laundries) 231 9 — Workplaces (other than Outworkers' premises) 7 — — Total 256 9 — 52 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 2 2 Want of ventilation 1 1 Overcrowding — — - Want of drainage of floors — — - Other nuisances 4 4 Sanitary accommodation :— Insufficient 2 2 Unsuitable or defective 1 1 Not separate for sexes 1 1 - — Offences under the Factory and Workshop Acts :— Illegal occupation of ground bakehouse (s. 101) — — - — Other offences — (Excluding offences relating to outwork and offences under the Sections tioned in the Schedule to the Ministry of Health tories and Workshops fer of Powers) Order, 1921). Total 11 11 — — * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 3.—Home Work, Outworkers' Lists, Section 107. Outwork in Unwholesome Premises, Section 108. Outwork in Infected Premises, 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. 1932 17 12 34 159 — 56 1933 15 10 39 159 — 40 53 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 1933 25 1. To await Inquests :— (a.) Infectious — (b.) Non-infectious 3 2. Sanitary grounds — Number of Post Mortem examinations 19 Number of bodies detained in Mortuary Chapel 25 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. 54 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-mouses During the Year :— (1) (a.) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 774 (b.) Number of inspections made for the purpose 5530 (2) (a.) Number of dwelling houses (included under sub- head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 173 (b.) Number of inspections made for the purpose 2454 (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 173 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 490 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 after service of formal notices :— (a.) By owners — (b.) By local authority in default of owners — 55 (B) Proceedings under Public Health Acts :— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 530 (2) Number of dwelling houses in which defects were remedied after service of formal notices :— (a.) By owners 60 (6.) By local authority in default of owners ... — (C) Proceedings under sections 19 and 21 of the Housing Act, 1930 :— (1) Number of dwelling houses in respect of which Demolition Orders were made 6 (2) Number of dwelling houses demolished in pursu— ance of Demolition Orders 6 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 — Staff.—The staff engaged on housing work during the year consisted of four Sanitary Inspectors, each carrying out all the duties of a Sanitary Inspector in the district allocated to him. One of these was mainly engaged in duties connected with the Housing Regulations, 1925. HOUSING CONDITIONS IN THE BOROUGH. General Observations.—It is difficult to discuss the subject of housing in Chelsea without some understanding of the peculiar con— ditions which appertain to the district. Probably in few London boroughs have there been so many altera— tions, 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. 56 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 neighbour— hoods 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 has 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 are shown in Table No. 36:— TABLE No. 36.—Pre.War Housing. Properties Owned and Managed by the Chelsea Borough Council. Property. No. of Flats Population (approx.) Rents. Sir Thomas More Buildings, Beaufort Street 262 827 4/10 to 13/8 per week. Pond House, Pond Place 32 121 10/6 to 14/6 per week. Onslow Dwellings, Pond Place 108 326 6/5 to 8/5 per week. Grove Buildings, Manor Street 120 290 4/2 to 7/7 per week. 522 1,563 Private enterprise, benevolent agencies and trusts had also made very important contributions to housing in Chelsea prior to 1914. These are shown in Table No. 37. 57 TABLE No. 37. Properties erected by Private Enterprise, Benevolent Agencies, Trusts, etc. Property. No. of Flats. Population (approx.) Rents. Sutton Model Dwellings, Cale Street 660 2,200 3/4 to 8/11 per week. Lewis Trust Dwellings, Ixworth Place 398 1,390 3/1 to 10/3 per week. Marlborough Buildings, Walton Street 162 500 9/0 to 20/0 per week. Guinness Buildings, Draycott Avenue 303 940 2/3 to 7/5 per week. Peabody Buildings, Lawrence Street 68 200 3/8 to 8/4 per week. Chelsea Park Dwellings, King's Road 54 170 3/5 to 12/0 per week. It will be seen that in Chelsea at the outbreak of war there was available accommodation for about 7,000 persons of wage.earning class—an amount which, in proportion to population, was considerably higher than that obtaining in any other metropolitan borough. Since the war, the economic situation and other factors, particularly the shortage of and greatly increased cost of building land in Chelsea have rendered an already difficult situation still more difficult. The Housing Committee of the Borough Council has been actively engaged in investigating possible sites in connection with further Housing Schemes and from time to time various schemes have been formulated by the Council and submitted to the Ministry of Health for approval. Of the schemes prepared and submitted to the Ministry, four have fortunately material— ised, 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. These buildings are now fully occupied. Details of each approved scheme are shown in table No. 38. (Page 61). 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. 58 It cannot be disputed that at the present time in Chelsea, as in other Metropolitan Boroughs, there is considerable dearth of accommodation both for the working classes, and for the classes in receipt of small salaries or earnings, and that, as elsewhere, this situation is primarily due to the restrictions imposed upon the building trades during the war and the economic disturbances which have succeeded it. It will, however, be evident from the details already given that the existing shortage of housing accommodation in Chelsea is being most adequately dealt with and that the extremely difficult problems which confronted the Borough Council subsequent to the war are gradually being overcome. In this connection the invaluable services rendered by the former Mayor (Mr. Alderman C. B. Clapcott, O.B.E.), and the late Chairman of the Housing Committee (Mr. Councillor E. B. Baggallay) will always be remembered with appreciation in the municipality. Overcrowding.—Overcrowding, where it exists, is mainly confined to the western district of the Borough. 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 little improvement in its prevalence during the year. Many of the cases when approached as to the desirability of having their names submitted to the County Council, with a view to provision of housing on one of the Council's Estates, decline to consider the proposition, on the ground that the distance of the Comity Council's Estates from their work is too great. Others have become attached to the district and will not contemplate forsaking existing interests and associations. Owing to the extreme difficulty of finding alternative accommodation it has not been found practicable to deal with more than a proportion of the cases of over— crowding during the year. Whenever possible, arrangements are made with the London County Council for the provision of a house for the overcrowded family. Forty.two such families obtained accommodation on the Council's Estates during the year. Further, when vacant tenements become available in the Borough Council's dwellings preferential treat— ment is as far as possible given to cases of overcrowding. With a view to preventing a recurrence of overcrowding in premises which are being vacated because of their overcrowded condition, a cautionary letter is always sent to the landlord concerned, warning him that action will be taken against him in the event of a recurrence of overcrowded conditions in the premises. Fitness of Houses.—The general standard of housing in the Borough is satisfactory. There has been a very definite improvement in housing conditions during the past five years. The vast majority of houses have an adequate internal water supply and adequate sanitary accommodation within their own curtilage. The constant vigilance of the Sanitary Inspectors has impressed upon both owners and tenants their determina— tion that every dwelling house shall be maintained in a reasonable state of repair and that there shall be systematic observance of cleanliness. 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 accommo— dation, having regard to the rents that required to be fixed for new 59 dwellings owing to the greatly increased cost of land and construction during recent years. Another problem is caused by certain old people, usually women. Many of these live alone in a single room with no one to look after them. Frequently they rely almost entirely on the Old Age Pension for susten— ance. Gradually growing feebler with the passage of time, they eventually become unable properly to care for themselves or their homes. Although every means of persuasion is tried, these cases usually decline to enter a Poor Law Institution and the condition often persists for a lengthened period. Fortunately, this problem has now been met by legislation. Under the London County Council (General Powers) Act, 1928, it is possible to arrange for the removal of such cases to a suitable institution. While in the majority of instances the defects found to exist in unfit houses are due to the lack of proper management and supervision by owners, from time to time complaints are made by the owners regarding the difficulties they experience in keeping their property in a reasonable state of repair because of the dirty and destructive habits of a number of their tenants. It is alleged that, through carelessness or wilful damage by tenants, repairs and cleansing have to be carried out with unreasonable frequency and that, as a consequence, it is impossible to maintain even the minimum requirements of the Local Authority without incurring financial loss. Investigation has shown that these statements are often well.founded especially in the poorer class tenement lodging houses where no responsible caretaker or landlord is resident. To lighten the difficulties of the owner in these cases, effort is made, as far as possible, to keep in view such powers as a Local Authority has of holding the tenant responsible for defects resulting from his neglect or default. Action was necessary during the year in respect of six 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 774, the number found not to be in all respects reasonably fit for human habitation being 530. The number rendered fit in consequence of informal action by the Sanitary Inspectors was 490, and the number in respect of which statutory notices were served requiring defects to be remedied was 62. No case came to the knowledge of the Department in the course of the year of an underground room being illegally used for sleeping purposes. There were no applications under the Increase of Rent and Mortgage Interest (Restrictions) Acts made by occupiers of dwelling houses, that houses occupied by them were not in a reasonable state of repair. Unhealthy Areas.—One representation was made under the Housing Act during the year. No complaints that areas were unhealthy have been received. 60 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. Housing Survey.—House.to.house inspection was carried out during the year, as provided by statute, 173 houses being inspected and recorded by the Inspector. TABLE No. 38. Post-War Housing. Name of Undertaking. Area of Site. Total Cost. Date of Completion. Number of Flats. Population. Rents. Remarks. Hortensia House, Hortensia Road 1 acre, 12 poles. £49,000 1925 56 235* persons. 23/6 to 31/7 per week. Rents drawn up on an economic basis on instructions of Ministry of Health. Guinness Trust Buildings, King's Road. 1 acre, 3 roods, 28$ poles. £21,200 (cost of site). 1929 160 765* persons. 4/- to 13/per week exclusive of rates. Site leased for a term of 99 years at a nominal rent by the Borough Council to the Guinness Trust . Peabody Trust Buildings, Manor Street. 1 acre, 16 poles. £19,000 (cost of site). 1931 112 550 persons. 5/- to 13/6 per week, exclusive of rates. Site leased for a term of 99 years at a nominal rent by the Borough Council to the Peabody Trust. World's End Passage Improvement Scheme. 1 acre, 37 poles. £7,300 (approximate cost of site). 1932 64 316 persons. 5/- to 16/6 per week. Site leased for a term of 99 years at a nominal rent by the Borough Council to the Chelsea Housing Improvement Society. The Estate is managed by a representative of The Women House Property Managers. 392 1,866 * 1930 Population. 19 62 SECTION V.—INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—In accordance with statutory enactments, the Council keeps a Register of persons carrying on the trade of dairymen or purveyors of milk and no person is permitted to carry on the trade in the Borough unless he is registered. The Council is empowered to remove the name from or refuse to enter upon the Register the name of any person selling or proposing to sell milk on premises which are for any reason unsuitable for the purpose. The Milk and Dairies (Amendment) Act, 1922, further empowers the Council to refuse to enter the name of any person in the Register, or to remove the name of any person from that Register, if it is shown to the Council's satisfaction that the public health is or is likely to be endangered by any act or default of such person in relation to the quality, storage or distribution of milk. The premises at which registered purveyors of milk, carry on their business have been subject to frequent inspection. During the year one application was made for registration as purveyor of milk, which, after appropriate investigation, was approved by the Council. In Table No. 33 (page 50) is shown the alterations which took place in the Register of Milk Purveyors during the year. During the year there were 77 inspections of dairies and milkshops made in the Borough. Notices were served requiring remedy of defects found on two of the premises visited. There are ho cowsheds in the district. Milk (Special Designations) Order.—There were 45 applications from 14 retailers under the Milk (Special Designations) Order for licences to sell special grades of milk. All these licences were granted. In each case the licence was granted for the purpose of authorising the dealer to sell specially designated milk from shops within the Borough. No application has been made for a licence giving authority to set up bottling or pasteurising establishments in the Borough. The following Table No. 39 shows the numbers of licences granted for the sale of milk under special designations during the past two years. TABLE No. 39. Licences Granted under Milk (Special Designations) Order. Licences granted under Milk (Special Designations) Order. 1932. 1933. To sell " Certified " Milk 8 8 To sell " Grade A " Milk — 1 To sell "Grade A Pasteurised" Milk — 1 To sell " Grade A (Tuberculin Tested) " Milk 8 11 To sell " Pasteurised " Milk 12 13 Supplementary Licences 4 11 32 45 63 Four samples of graded milk were submitted for bacteriological examination during the year. Further reference to milk is made in the Public Analyst's Report for the year. 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 15 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 is now only one private slaughterhouse in the Borough and 14 inspections of these premises were made during 1933. In compliance with the byelaws prescribing humane slaughtering, approved methods of slaughter are employed at these premises. There is no public abattoir in the Borough. Table No. 33 (page 50) shows, in the form required by the Ministry of Health, the number of private slaughterhouses in use in the Borough on the dates indicated. Bakehouses.—There are 26 bakehouses in the Borough, and 29 inspections of these premises were made during the year. Two notices were served for the cleansing of walls and ceilings. Ice Cream Vendors.—At the end of the year, 30 premises were shown in the Register as places where ice.cream is prepared or sold. There were 30 inspections of these premises as compared with 37 in the previous year. This trade is mainly regulated under the L.C.C. (General Powers) Acts, 1902 and 1928. 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. Fried Fish Vendors.—At the end of the year there were 14 premises in which the frying of fish was carried on and 25 inspections of these premises were made. It is found that a reasonable standard of cleanliness is now being maintained, but it is necessary for the Inspectors to maintain a constant vigilance to impress upon the vendors the necessity for the systematic observance of cleanliness. 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. 64 Table No. 33 (page 50) shows, for the past two years, the number of inspections of premises where food was prepared for or exposed for sale. Unsound Food.—On two occasions during the year unsound food was surrendered and destroyed. Included in the food surrendered was :—Mushrooms, 13 lbs. ; Rabbits, 3. No carcases were destroyed on account of tuberculosis. Food Poisoning.—No case of food poisoning occurred during the year. Food and Drugs (Adulteration) Act, 1928.—Four hundred samples, including 82 samples of milk and 10 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 no 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. 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 preservatives 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 results of analyses made during the year will be found appended to this report. 65 Bacteriological Examinations.—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. Four samples were submitted for investigation during the year, each of which was found to be satisfactory in character. 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 are 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. TABLE No. 40. Magisterial Proceedings under Milk & Dairies Amendment Act, 1922. Street where purchased. Ofience. Petty Sessions. Date of Hearing. Result. Milner Street Failing to comply with the terms of a licence granted in relation to the sale of Grade "A" T.T. Milk on March 2nd, 1933. Kensington 18.4.33 Fined £5 Os. Od. £3 3s. Od. costs. Park Walk Failing to comply with the terms of a licence granted in relation to the sale of Grade "A" T.T. Milk on March 8th, 1933. Kensington 18.4.33 . Fined £5 Us. Od. £3 3s. Od. costs. Failing to comply with the terms of a licence granted in relation to the sale of Grade "A" T.T. milk in that an advertisement was issued contrary to such licence. Kensington 18.4.33 Fined £1 0s. Od. £3 3s. Od. costs. 66 SECTION VI.—INFECTIOUS DISEASES. (a) Infectious Diseases Generally. DISEASES COMPULSORILY NOTIFIABLE IN THE BOROUGH. Acute Poliomyelitis. Diphtheria. Acute Polio.encephalitis. Membranous Croup. Acute Encephalitis Lethargica. Dysentery. Acute Primary Pneumonia. Erysipelas. Acute Influenzal Pneumonia. Malaria. Cerebro.spinal Fever. Puerperal Fever and Puerperal Chicken Pox. Pyrexia. Plague. Relapsing Fever. Anthrax. Small.pox. Glanders. Typhus Fever. Hydrophobia. Tuberculosis. Cholera. Scarlatina or Scarlet Fever. Continued Fever. Typhoid or Enteric Fever. Ophthalmia Neonatorum. Food Poisoning. NOTIFICATIONS DURING THE YEAR. The total number of notifications, excluding duplicates, was 723. Of this figure, 83 were notifications of Pulmonary Tuberculosis and 17 of Non.pulmonary Tuberculosis. In addition, 53 cases of Measles (including German Measles), came to the knowledge of the Department, mainly through the School Authority. As compared with the previous year, there was an decrease of 19 in the number of notifications of Diphtheria. The number of notifications of Scarlet Fever (229) represents an increase of 53, as compared with that for 1932. The number of notifications of Tuberculosis was 100, a decrease of 15, as compared with that for 1932. 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 :— 67 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 134 9 42 73 9 1 — — 20 Cholera — — — — — — — — — Diphtheria 91 3 24 50 10 4 — — 91 Gi ysipelas 31 1 1 1 — 5 10 13 22 Scailet Fever 229 1 76 108 27 16 1 — 224 Typhus Fever — — — — — — — — — Enteric Fever . 1 — — — — 1 — — — Puerperal Fever 3 — — — 1 2 — — 3 Puerperal pyrexia 9 — — — 3 6 — — 7 Cerebro.spinal Fever 1 — — — — — 1 — 1 Ophthalmia Neonatorum 4 4 — — — — — — 3 Poliomyelitis 2 — — — 1 1 — — — Encephalitis Lethargica — — — — — — — — — Polio.encephalitis — — — — — — — — — Malaria — — — — — — — — — Dysentery 1 — — — — 1 — — 1 Acute Primary Pneumonia . 90 9 19 4 8 25 23 2 66 Acute Influenzal Pneumonia 27 — 5 — 1 5 12 4 18 Total 623 27 167 236 60 67 47 19 456 Tuberculosis :— Pulmonary 83 — — 1 19 41 20 2 Non.Pulmonary 17 1 1 6 6 — 3 — Totals (Tubercu— losis) 100 1 1 7 25 41 23 2 Totals 723 28 168 243 85 108 70 21 No cases of Small.pox, Cholera, Typhus Fever, Encephalitis Lethargica, Polio.encephalitis, Malaria, Continued Fever, Relapsing Fever, Plague, Anthrax, Glanders or Hydrophobia were notified during the year. DIPHTHERIA. Notifications.—During the year 91 cases of diphtheria were notified, as compared with 110 in the previous year. The incidence of the disease during the past two years is shown in Table No. 42. Deaths.—Seven deaths from the disease occurred during the year. 68 Return Cases.—No "return" case of the disease occurred during the year. TABLE No. 42. Year Cases Noti— fied. Per— cent— age of Re— mov— als. Deaths Case Mo— tality Rate. Per— cent— age of cases of School age (3.13 years) Month of great— est preva— lence. Bacterioscopic Diagnosis, Lister Institute. No. of Speci— mens sub— mitted Posi— tive. Per— cent— age Posi— tive. Nega— tive. Per— cent— age Nega— tive. 1932 110 99 2 1.9 55 Mar. 317 25 7.8 292 92.2 193:} 91 100 7 8.4 66 June 289 21 7.0 268 93.0 It will be observed that there was a decrease in the number of cases notified in 1933. The percentage of removals to the L.C.C. Hospitals was high, and the case mortality rate was higher than that for 1832. Information was received from the L.C.C. that 8 of the cases sent to Hospital in the course of the year proved not to be suffering from diphtheria. Of the 91 cases notified, 58 occurred in Stanley Ward, 16 in Church Ward, 3 in Cheyne Ward, 4 in Hans Town Ward, and 10 in Royal Hospital Ward. 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 artificial immunization against the disease has been made in the Borough. Further details will be found on page 29. SCARLET FEVER. Notifications.—During the year, 229 cases of Scarlet Fever were notified, the figure for 1932 being 176. Information was received from the L.C.C. Hospitals that 16 of the cases proved not to be Scarlet Fever. Two " return " cases of the disease occurred during the year. Deaths.—There was no death from Scarlet Fever during the year. Table 43 shows the incidence of the disease during the past two years TABLE No. 43. Year. Cases Notified. Percentage of Removals. Deaths. Case Mortality Rate. Percentage of cases of School.age 3.13 years. Month of greatest pre— valence. 1932 176 92 1 0.6 76 Oct. 1933 229 97 — — 68 June 69 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 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 53, as compared with 550 in the preceding year. Of the total number (53) 31 were under five years of age. Deaths.—The number of deaths was two, of which one was under two years of age. Visiting and Nursing.—During the year, 68 visits and re.visits were made by the Health Visitors. Cases are also visited by the District Nurses whenever circumstances render this necessary. Fifteen visits were required in 1933. Removal to Hospital.—Cases of Measles are received in the Hospitals of the London County Council. ENTERIC FEVER. Notifications.—During the year one case under the Enteric Fever Group was notified in Chelsea. The disease was probably contracted abroad. One specimen of blood was examined during the year for the Widal reaction. Deaths.—There were no deaths 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 117 Malaria None Dysentery 1 70 Pneumonia.—All primary pneumonias, lobar or lobular, are notifiable. The only secondary pneumonia which is notifiable is influenzal pneumonia. The notifications and deaths from pneumonia during the past two years were as follows :— Notifications. Deaths. (All Forms) 1932 121 49 1933 117 44 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. Three cases of Puerperal Fever and nine cases of Puerperal Pyrexia were notified during the year. Ten of these cases were treated in hospital. The notifications of puerperal fever and puerperal pyrexia during the past two years were as follows:— Puerperal Puerperal Fever. Pyrexia. 1932 1 10 1933 3 9 Further details of the cases notified in 1933 are given on page 32. OPHTHALMIA NEONATORUM. Four cases of ophthalmia neonatorum were notified during the year. Three 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. 44. Ophthalmia Neonatorum. No. Notified. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Treated. At Home. In Hospital. 4 1 3 3 — — 1 71 Six cases of the disease were notified in the previous year. Nursing—By arrangement with the Chelsea District Nursing Associa— tion, home nursing is provided for infants suffering from this disease. POLIOMYELITIS AND POLIO.ENCEPHALITIS. Two cases of Poliomyelitis were notified during the year. One of these proved fatal. No case of Polio.Encephalitis was notified. ENCEPHALITIS LETHARGICA. No case of Encephalitis Lethargica was notified during the year. Four 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 some permanent damage to the brain tissue occurs. The disease was made compulsorily notifiable from 1st January, 1919. Deaths.—There was no 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 12th August, 1929. One hundred and thirty.four notifications were received during the year. Of these, 20 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 the following Table which gives particulars as regards vaccination in respect of children whose births were registered in the Borough for the year 1932. The figures for the year 1933 are not yet available, 72 TABLE No. 45. Vaccinations. Number Percentage of births registered. Births registered in 1932 1,082 100 Successfully vaccinated 633 58.5 Insusceptible of vaccination 14 1.3 Had Small Pox — — Statutoiy Declaration of conscientious objection ... 164 15.2 Died unvaccinated 63 6.8 Postponed by medical certificate 6 0.5 Removed to other districts 103 9.6 Removed to unknown addresses 89 8.2 Not accounted for in previous columns 10 0.9 The above table is based on total births occurring in Chelsea and is not confined to parishioners. The total number of successful primary vaccination certificates (children under 14 years of age) received during the year 1933 was 731. 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 DISINFESTA. TION AND THE EXTENT OF THEIR USE. The Borough Council maintains a Disinfecting and Cleansing Station situated at 9a, Lots Road, Chelsea, adjoining the river. Disinfection.—The disinfecting staff numbers three. A steam disinfector is provided. An appropriate motor vehicle is utilised for the conveyance of infected and disinfected articles to and from the Disinfecting Station. Disinfection in connection with the notifiable infectious diseases is carried out free of charge. Applications for special disinfection, not associated with the notifiable infectious diseases, are considered, and, if the work of the Department permits it, are carried out at the expense of the applicant. Forty.six such disinfections were carried out during the year, the total charges amounting to £23 17s. 6d. On page 47 will be found a summary of the work done by the disinfecting staff during the year. 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, 73 Lots Road, for families in which cases of dangerous infectious disease have appeared, and who have been compelled to leave their dwellings for purposes of enabling such dwellings to be disinfected. Two adults were 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 1922, the London County Council entered into an arrangement with the Borough Council for the use of the Station on specified days during the school year for the purpose of cleansing the heads of verminous school children. Under the L.C.C. Scheme, the work of cleansing is supervised by the school nurses, who also make all arrangements for the attendances of the children. The children cleansed are those attending schools situated west of a line running down the centre of Sydney Street and Oakley Street. The Borough Council receives payment from the London County Council at the rate of 2s. per child attendance. During the year, the Station was opened for the entire day on 89 occasions. The following Table No. 46 shows the number of attendances in each quarter :— TABLE No. 46. Quarter. No. of days on which the Station was opened. Attendances. Verminous. Impetigo. March 29 141 — June 19 146 — September 18 124 — December 23 136 — 89 546 — The amount recoverable from the London County Council, as the School Authority, for the cleansing for the year is £55 12s. Twenty.two 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 pages 5.6, 74 Notifications.—The total number of notifications received was 127, but 27 of these related to cases which had been previously notified, so that the total number of new notifications was 100. In the previous year, the corresponding number was 115. 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. 47 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 36 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. 47. Tuberculosis. New Cases and Mortality during 1933. Age Periods. New Cases. Deaths. Pulmonary. Non. pulmonary. Pulmonary. Non. pulmonary. m. f. m. f. m. f. m. f. 0— 1 — — — 1 — — — 1 1—0 — — 1 — — — 1 — 5—10 — — 4 2 — — — — 10—15 1 — 2 — 1 — — — 15—20 6 3 1 1 — —. — — 20—25 8 12 2 4 3 _ 1 25—35 9 19 — — 7 4 — — 35—45 13 16 — — 7 1 — — 46—55 12 2 2 1 2 3 55—65 9 1 — — 4 — — — 65 and upwaids 4 — — — 4 — — — Totals 62 53 12 9 25 11 1 2 The death rate from all forms of Tuberculosis in Chelsea was 0.60 per 1,000. Of the total number of deaths (39) from all forms of Tuber— culosis, seven died non.notified or prior to notification. The ratio of non.notified tuberculosis deaths to total tuberculosis deaths was there— fore as one is to six. The corresponding ratio for 1932 was 1 : 27. 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 (Tuber— culosis) 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 notifi— cations showing :— (a.) The number of cases of Tuberculosis on the Register at the commencement of the quarter; 75 (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 reasons 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 (/.) 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. 48. Pulmonary Males. Females. Total. 161 148 309 Non-pulmonary 40 34 74 201 182 383 (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 49 which contains the names of all persons attending at, or seen in connection with, the Dispensary for diagnosis and treatment). Home Visiting.—The Tuberculosis Visitor in the course of the year paid 130 visits to non-dispensary cases of Tuberculosis. Visits made to Dispensary cases of Tuberculosis are recorded in Table 49. Public Health (Prevention of Tuberculosis) Regulations, 1925.— The Regulations provide, inter alia, that no person suffering from respiratory tuberculosis who is in an infectious condition, shall be engaged in any form of dairy work involving the milking of cows, the treatment of milk or the handling of milk containers. Investigations in connection with these Regulations have been made in the Borough but no case calling for action has thus far been discovered. Chelsea Tuberculosis Scheme.—Table No. 49, subjoined, is prepared in accordance with the requirements of the Ministry of Health. 76 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. 50 (page 79), 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 1933, 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. 77 TABLE No. 49. 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 41 32 2 — 5 4 2 3 46 36 4 3 433 (6) Diagnosis not completed — — — — — — — — 9 3 (c) Non-tuberculous _ _ _ _ _ _ _ _ 78 136 79 46 B.—Contacts examined during the year :— _ _ _ _ _ _ _ _ _ _ _ _ _ (a) Definitely tuberculous 1 — — — — — 1 — 1 — 1 131 (b) Diagnosis not completed _ _ _ _ _ _ _ _ _ _ _ _ (c) Non-tuberculous — — — — — — — — 19 32 37 41 C.—Cases written off the Dispensary Register as :— _ _ _ _ _ _ _ _ _ _ _ _ _ (a) Recovered 3 11 — 1 4 1 2 3 15 1 3 497 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) _ _ _ _ _ _ _ _ !)8 174 117 86 D.—Number of Cases on Dispensary Register on December 31st :— (a) Definitely tuberculous 142 116 5 2 15 15 18 12 157 131 23 14 328 (b) Diagnosis not completed _ _ _ _ _ _ _ _ — 1 — 2 1. Number of cases on Dispensary Register on January 1st 321 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 35 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of" 64 4. Cases written off during the year as Dead (all causes) 31 5. Number of attendances at the Dispensary (including Contacts) ... 2,197 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 6 7. Number of consultations with medical practitioners :— 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 56 (a) Personal 5 (6) Other 95 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 10. Number of :— (a) Specimens of sputum, etc., examined 289 3,433 (6) X-ray examinations made in connection with Dispensary work 361 11. Number of " Recovered " cases restored to Dispensary Register, and included in A (a) and A (b) above 12. Number of " T.B. plus " cases on Dispensary Register on December 31st 127 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 No. 50. 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. 1932. 1933. 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 Class T.B. minus. Class T.B. plus Class T.B. minus. 1 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). 1 Group 1. Group 2. Group 3. Total (Class T.B. plus) 1 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 6 3 _ 9 1 1 _ — 1 1 _ — _ — — 1 — 1 6 1 — _ 1 5 1 _ — 1 — — 1 — 1 — _ — — — — — _ — — p. 2 5 2 — 7 3 — _ _ _ 1 — — _ — 6 — _ — 2 _ — — 4 1 — 1 3 _ _ — — _ _ _ — — _ - _ _ Children _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ — _ _ _ _ _ 1 1 — 1 _' _ _ _ _ _ _ _ _ _ _ _ Disease not Arrested Ad'lts m. 2 4 4 8 — 2 2 2 6 2 - — - 2 2 2 2 2 4 4 1 3 4 3 2 5 — 7 9 2 11 1 14 16 3| 11 14 F. 2 3 2 5 1 1 2 — 3 1 1 — _ 1 1 — - — 4 1 1 — 2 8 1 3 — 4 6 2 3 — 5 12 2 6 2 10 13 2| 7 10 Children — _ _ 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 _ _ _ _ 6 _ _ _ _ 1 _ — Condition not ascertained during the year 1 _ _ _ 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 — _ 1 1 — 1 — 1 _ _ _ — — _ _ — — — — — — Total on Dispensary Register at 31st December 14 18 12 1 31 6 4 4 2 10 5 1 — — 1 7 _ 3 - 3 14 5 3 — 8 23 4 9 — 13 12 4 9 — 13 27 4 17 3 24 30 5 18 1 24 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Ad'lts m. 11 3 4 _ 7 1 — 1 _ 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ F. 12 4 1 _ 5 1 _ — _ — 6 _ — — — _ _ _ — — — — — — 11 — — —1 — — — — Children 1C 1 5 2 Lost sight of, or otherwise removed from Dispensary Register 7fl | 38 39 . : 82 2 ' 7 1 10 6 2 12 i 15 5 6 11 7 8 4 2 14 7 0 13 7 1 15 7 3 7 10 10 4 5 1 10 Dead Ad'lts M. 24 | 25 86 36 147 4 7 4 15 2 1 8 3 12 — 3 5 5 13 4 1 9 2 12 o 4 8 16 1 1 5 1 7 — — 8 4 12 2 — — 2 2 F. ie 11 38 30 79 1 3 5 9 4 — 7 1 4 11 1 5 11 1 1 5i 7 — 2 1 2 5 — 4 2 6 — — 2 2 4 1 • — — — — Children 4 5 6 - — : — — — 1 | — 1 — 1 2 — 1 —1 1 — 1 1 — 2 - ~1 — Total written off Dispensary Register 158 82 173 71 326 1C 1 18 10 35 1ft 3 28 1 8 39 6 9 17 11 37 11 " 11 14 9 34 9 13 15 8 36 8 16 4 28 9 3 17 6 26 13 4 5 3 12 Grand Totals 175 10C • 185 72 1357 16 11 22 12 45 23 4 ' 28 ; 8 40 13 9 !» 11 40 25 16 17 9 42 32 17 24 8) 49 24 12 20 4 41 36 7 34 9 50 43 9 23 4 36 TABLE No. 50 (continued). Non-Pulmonary Tuberculosis. Condition at the time of the last record made during tbe year to which the return relates. Previous to 1926. 1926. 1927. 192S. 1929. 1930. 1931 932 1933 Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bonts and Joints. Abdominal. (>ther Organs. Peripheral Glands. Total. Hones 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. 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 1 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Ad'lts M. F. _ — — — — — - — — - — — — i 1 — — 2 - 1 1 4 — Cliildi en 2 1 1 2 1 — i) — i — 3 — — 1 1 — — — Disease not Arrested. M. ; 1 1 2 — i — 3 1 i ' Li 5 b < F. - - 1 1 1 — 1 2 2 i J a Childi ren 1 1 — 2 — - 2 — - — 1 1 2 — — 1 — — 1 2 — 3 5 — 2 > 7 Condition not during the scertair -ear led Total on Dispensary Register at 31st December 3 — - — 3 - — 1 1 2 - - - 2 | — - — — — 2 2 4 1 1 7 13 1 1 1 5 8 7 — 2 7 16 3 4 2 15 (b) Not on Dispensary Register 1 and reasons for removal therefrom. T ransferred to Pulmonary 1 Ad'lts M. 1 1 1 1 _ — — Discharged as Recovered F. 1 - - Children 3 12 15 1 5 6 — - - 1 — 2 3 — - — — — — — — — — — - — I.ost sight of, or otherwise removed from Dispensary Register 5 1 1 10 17 3 • 4 7 4 1 1 1 7 4 1 1 6 1 1 1 • « 4 o - 2 1 3 3 3 2 8 1 1 Dead Ad'lts M. F. Children 1 Total written off Dispensary Register 11 1 24 37 4 1 2 9 16 4 1 1 1 7 4 — 1 1 6 1 1 — •j 4 3 — 3 10 1 2 1 1 5 3 4 — 2 9 — 1 1 Grand Totals of (a) and (6) excluding those transferred to ^ulmonarv). 14 1 1 24 40 4 i: 2 10 17 6 1 1 1 9 4 1 1 6 1 1 4 fl 7 v f»i 10 2 3 2 6 13 10 4 5> 9 J J J 2 7 1« (Signed) W. h. L. McCarthy, Chief Tuberculosis Offictr. 80 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. 51, 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. 51. Work done at the Dispensary. Year. Newcases examined during the year. Definite Tuberculosis. Total attendances at Dispensary. 1932 491 13 per cent. 2,795 1933 396 13 2.197 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). Of the cases which terminated fatally during the year, 46 per cent, died in St. Luke's Hospital and 31 per cent, in other public institutions, that is to say 77 per cent, died away from their homes, the corresponding figure for 1932 being 79 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 Tuberculosis Visitor. Arrangements are made with Brompton Hospital for the X-ray examination of difficult cases, and for the provision of artificial pneumo-thorax refills. Many patients, both adults and children, who attend the Dispensary for examination, either as contacts or on their own initiative, are found to be suffering from conditions, other than Tuberculosis, which require treatment. These cases are advised as to obtaining such treatment, either from private practitioners or at general hospitals. Many children are found to be suffering from anaemia, malnutrition and similar diseases and are referred to the Chelsea branch of the Invalid Children's Aid Association with a view to provision of convalescent home treatment. Co-operation with the School Medical Service.—The relationship with the School Medical Service continues to be satisfactory. The School Medical Authorities frequently afford valuable help in deciding 81 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 visited 61 cases (including personal consultations) at the homes of the patients, and 95 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 Tuberculosis Visitor. Home Contacts.—The number of home contacts of tuberculous patients examined at the Dispensary during the year was 131, a decrease of 42 compared with the previous year. Special arrangements are made for following up patients in cases where the diagnosis is doubtful. Such cases are again examined at intervals, and, when necessary, X-ray or other special investigation is made. The Social Worker at the Dispensary maintains regular observation in connection with these patients. Artificial Pneumo-thorax Treatment.—On the recommendation 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. The Dispensary Nurse also visits the home for observation purposes. During the year, the number of visits paid by Nurses to the homes of patients was 3,433, a decrease of 247 over the number for the previous year. The Council lent a bedstead and bedding to one case during the year. Extra Nourishment.—Twenty-one cases of Tuberculosis were certified by the Tuberculosis Officer during the year to require extra nourishment as part of their treatment. These cases were supplied with foods such as milk, eggs and butter. The total cost of extra nourishment (£27 18s.) was borne by the Borough Council. Non-Tuberculous Cases.—All casese xamined at the Dispensary in which special treatment is indicated, other than for Tuberculosis, are assisted in obtaining such treatment at an appropriate hospital. Others are sent to country or seaside convalescent homes through the agency of the Invalid Children's Aid Association. Orthopaedic Treatment.—In appropriate cases surgical boots and appliances, splints, crutches, spinal carriages and wheeled chairs are supplied through the Invalid Children's Aid Association. Dental Treatment.—With the approval of the Ministry of Health, arrangements have been made with the British Dental Hospital, 235, Hammersmith Road, W., for the provision of adequate dental treatment, including dentures, if necessary, for patients attending the Chelsea Tuberculosis Dispensary. In each case the certificate of the Tuberculosis 82 Officer is required and dental treatment must be shown as necessary to render other treatment more completely efficacious. During the year fourteen patients thus received dental treatment. Bacteriological Examinations.—During the year, 289 specimens of sputum were examined in connection with the work of the Dispensary. In addition, 35 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 Miss B. M. S. Caudwell and Aid Association Miss G. M. Burton. Public Assistance Mrs. E. Howard. Committee Mr. A. F. Coomber. 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 Mr. R. A. Hanson. Local War Pensions Com- Miss Forbes, mittee and United Services Fund. St. George's Hospital Lady Almoner. British Red Cross Society Miss M. Woods. Victoria Hospital Miss White. Ex-officio Members Dr. Leslie McCarthy (Chairman). Dr. W. J. Fenton (Tuberculosis Officer). Miss Brown (Sanitary Inspector). 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. 83 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 173 Cases reported admitted to L.C.C. Institutions 118 Dental treatment given through Borough Council Scheme 14 Extra nourishment given through Borough Council Scheme 21 Extra nourishment given through other agencies 4 Temporary assistance arranged 37 Children boarded out through the L.C.C. Contact Scheme 7 Children otherwise "arranged for" 6 Convalescence arranged 27 Patients' contributions towards the cost of Institutional treatment collected on behalf of the L.C.C. £94 12s. lOd. (Excluding payments for children collected by the I.C.A.A.) I Metropolitan Borough of Chelsea. Annual Report % OF THE PUBLIC ANALYST For the Year ended 31st December, 1933. BY B. HENRY GERRANS, F.I.C., Public Analyst. 86 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, 1933, four hundred samples of Food and Drugs were submitted to me for analysis by the Sampling Officers appointed under the Act. Forty-seven 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. Totals. " Formal." " Informal.' " Formal." " Informal." " Formal." " Informal." Milk 77 5 82 Tea 44 3 — 1 — 48 Cocoa 35 — — — — 35 Butter 27 3 1 — — 31 Coffee and Chicory 16 — — — — — 16 Margarine 13 2 — — —- — 15 Sugar 16 — — — — — 15 Lard 11 3 — — 14 Coffee 10 2 — — — 12 Cream 8 2 — — — 10 Mustard Mixture 9 — — — — 9 Flour 9 — — — 9 Custard Powder 8 — — 8 Ground Rice 8 — — — . 8 Ground Almonds 7 1 — — 8 Rice 5 1 1 — 7 Cornflour 7 — — — — 7 Pepper 6 — — — — 6 Pork Sausages - 3 — 1 — — 4 Baking Powder 4 — — — — 4 Self-raising Flour 3 — — — — — 3 Gin — 3 — — — 3 Whisky 3 — 3 87 TABLE I—continued. Name of Sample. Genuine Composition or Not Adulterated. Adulterated. Inferior. Total. *' " " " " For " mal." formal." mal." formal." mal." formal." Blanc Mange Powder 2 __ 2 Split Peas 2 2 Semolina o 2 Sultanas 2 __ 2 Mince Pie 1 1 2 Condensed FullCream Milk ... 1 1 Sponge Mixture... 1 1 Orangeade Powder 1 1 Je»y 1 1 Macaroni 1 1 Mustard ... 1 _ 1 Raisins ... 1 1 Spice 1 1 Ox Tongue Patb 1 1 Prawns ... 1 1 Fruit Salad 1 _ * 1 Soup 1 1 Sardines ... 1 __ 1 Beans in Tomato Sauce ... 1 1 Mincemeat 1 1 Currants 1 1 Coconut 1 1 Cheese 1 1 Cake 1 1 Strawberry Swiss Roll 1 1 Tinned Gooseberries ... 1 1 Tinned Blackberries ... — 1 1 Extract of Coffee and Chicory ... — 1 1 Essence of Ginger Wine ... 1 1 Sauce 1 . 1 Malt Vinegar — 1 1 Lemon Cheese ... — 1 1 Chicken in Jelly — 1 1 Breakfast Sausage — 1 1 Corned Beef — 1 i 1 Tinned Salmon ... — 1 _ 1 Iodine Ointment 1 1 Aspirin ... — 1 — — 1 351 45 2 2 0 0 Totals 396 4 0 400 The percentages given by the data in Table I are as follows Genuine Composition 99-0 per ccnt. Adulterated 1-0 per cent. Inferior — per cent. 88 MIL, IV. 4. The 82 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, 55 of "Fair" quality and 2 of " Poor " quality. 5. 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. COFFEE AND CHICORY MIXTURE. 6. These samples were found to contain the following percentages of Chicory :— 48, 41, 38, 37, (2), 36, (3), 35, (2), 34, 33, 30, (2), 29 and 23. and therefore the composition of these mixtures had been correctly described. PORK SAUSAGES. 7. The Informal sample of Pork Sausages which was reported as adulterated was certified to contain 0 03H45 per cent, of Sulphur di-oxide which was equivalent to 384 5 parts per million of the sausages. This was below the limit of 450 parts per million, of Sulphur di-oxide laid down in the Regulations, but the presence of preservative was not declared at the time of purchase as required, so the sample was reported as adulterated. TEA. 8. The Informal sample of Tea reported as adulterated was found to be free from Lead, as was supposed, but to contain 11 per cent, of matters having the characters of powdered Talc. How this adulterant got into the Tea sample is not clear. BUTTER. 9- The sample of Butter reported as adulterated was certified to contain the following percentages of Boric Acid :— 0 0366 per cent, of Boron Trioxide (B2Oj) equivalent to 0 0648 per cent, of Boric Acid, (H3BOj) this is equal to 4.53 grains per lb. The admixture of Boric Acid with Butter is absolutely prohibited by the Regulations. RICE. 10. The sample of Rice reported as Adulterated was certified to contain 0-13 per cent, equal to 91 grains per" pound of Extraneous Mineral Matter, 89 The IVJincral Matter consisted of a Silicate of Magnesia known as Talc. This substance is quite insoluble in water, aild in the gastric-Juice, and is used for the purpose of "Facing" the Rice to give it a better appearance, and is likely to cause indigestion. CREAM. 11. The fat of all the sanities had the composition of fat derived from milk, they were free from preservatives, and had the composition of samples of genuine Cream. GIN AND WHISKY. 12. The samples had the composition of genuine spirits. 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, and were free from Methyl Alcohol, and othef adulterations. CUSTARD POWDER. 13. The samples all consisted of starchy matter coloured with an aniline dye, and were practically devoid of Proteid matters, but in the absence of any official definition of the article, the samples were reported as genuine. CORNFLOUR. 14. All the samples consisted of maize starch, and they were reported as genuine. MARGARINE. 15. All samples were of genuine composition, and they contained less than 10 per cent, of Butter Fat as required by the Act. LARD. 16. All these samples consisted of the fat of the pig, and they were free from adulteration by the addition of foreign fats, and oils, and they were reported as genuine. DRIED FRUITS. 17. All of the samples-Currants, Raisins and Sultanas-were free from slight amounts of sulphur di-oxide, and other preservatives, and were reported as genuine. DRUGS. (Aspirin and Iodine Ointment). 18. These articles were all in accordance with the requirements of the British Pharmacopoeia respecting composition and purity. 90 BLACKBERRIES AND GOOSEBERRIES (TINNED). 19. These samples were free from metallic contamination from the containers, and were otherwise genuine. 20. The remaining samples submitted (see Table I.) do not call for comment, as they were all of the nature, substance and quality required by the Act. PUBLIC HEALTH (PRESERVATIVES, ETC., IN FOOD) AMENDMENT REGULATIONS, 1926. 21. There was one case of infringement of the above Regulations (Sausages) 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.