C.I. AC4345 M. CHE 38 Metropolitan Borough of Chelsea. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1934 w.h. leslie McCarthy, d.s.o., m.c., M.D., m.r.C.p., d.p.h., BARRISTER-AT-LAW. Medical Officer of Health and Administrative Tuberculosis Officer. Printed by Order of the Council. london: VAIL and Co., Ltd., PRINTERS, FARRINGDON ROAD, E.C.I Metropolitan Borough of Chelsea. Annual Report of the Medical Officer of Health for CHELSEA 1934 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. ltd., printers, 170, farringdon road, london E.c.I. 1935. 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 my Annual Report on the health of the Metropolitan Borough of Chelsea for 1934. The report is an "Ordinary" report as defined in the appropriate circular of the Ministry of Health. The chief vital statistics relating to the year are as follows:—The resident population of the borough is estimated by the Registrar-General at 58,160, a figure which is below that for last year. The birth rate (10.8) is higher than that for last year (10.6). The marriage rate (12.7) is also higher than that for last year (11.5). The death rate (13.4) is higher than that for London generally (11.9) and compares with 13.6 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 65 per 1,000 births, as compared with 78 last year. The general improvement in the public health of the Borough continues to be maintained. There was a decrease in the total incidence of notifiable infectious disease during the year. The number of cases of chicken pox, scarlet fever and pneumonia were less, while cases of diphtheria, erysipelas, and tuberculosis showed an increase. A considerable increase was recorded in the number of cases of measles. At the end of the year there were 305 cases of pulmonary tuberculosis and 65 cases of non-pulmonary tuberculosis known to be living in the Borough—a total 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 7,487, and 6,996 visits to homes of patients were recorded. I continue to receive most valuable assistance from the Chelsea Health Society, and cannot speak too highly of the efficiency of the Society's work. Section III. of the report deals with Sanitary Administration. The statistics indicate that constant attention is devoted to the improvement of housing accommodation in the Borough. As in former years, much attention has been devoted to the supervision of food supplies. 3 In May, 1934, a Survey of the Public Health services of the Council was made by the Medical Inspectors of the Ministry of Health, and in November, 1934, the Ministry's official report was made to the Council. The report stated that the Minister was satisfied that a reasonable standard of efficiency and progress is being maintained by the Council in the discharge of their functions relating to Public Health. Special appreciation was expressed in regard to the excellent provision for Maternity and Child Welfare resulting from the co-operation of municipal and voluntary effort in the Borough, and, in particular, the outstanding contribution to the service made by the work done at the Violet Melchett Infant Welfare Centre. The report concluded with a statement that the Council should take into early consideration the following points in connection with particular services, viz.: (1) the desirability of more frequent inspection of dairy premises and of houses let in lodgings, (2) the desirability of making arrangements for investigation of samples of pasteurised milk as to the presence of tubercle bacilli, etc., (3) the desirability of making arrangements for examination and treatment of cases of ear disease occurring in children under the age of 5 years. Each of these items has now received the attention of the Council and the necessary arrangements have been duly made. 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, Medical Officer of Health. 4 Public Health, Maternity and Child Welfare Committee. At 31st December, 1934. His Worship the Mayor (Councillor Lt.-Col. S. Boyle, M.C., J. P.) Councillor H. Courtney Browne (Chairman). Alderman Miss C. Fulford. Councillors: Lt.-Col. D. G. Adams. E.B. Baggallay. F.G. Chambers. Mrs. M.S.M. Elliott. Mrs. M.I. Hewitt. J.Lilly. Miss C.L. Paterson. Lady Phipps. G.M. Stevenson. Mrs. C.M. VaugHan-Morgan. Mrs. C. Williams. (Two vacancies.) Housing Committee. His Worship the Mayor (Councillor Lt.-Col. S. Boyle, M.C., J.P.) Councillor E. B. Baggallay (Chairman). Alderman F. J. Synge. Councillors: L.R. Andrews. D.H. Boggis-Rolfe. Mrs. M.S. M. Elliott. H.G. Evans. B.Marsden-Smedley. Lady Meinertzhagen. Miss C.L. Paterson. Lady Phipps. Mrs. C.M. Vaughan-Morgan. 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 H. Courtney Browne. 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, 1934, are tabulated below in the form required by the Ministry of Health. (a.) Medical. Year appointed. Name. Qualifications. Appointment. 1924 McCarthy, W.H.L. M.D., M.R.C.P., D.P.H. Medical Officer of Health, Administrative Tuberculosis Officer and Executive Officer under the Council's Maternity and Child Welfare Scheme (Part time). 1917 Fenton, W.J. M.D., F.R.C.P. Tuberculosis Officer (Part time). 1926 Matthews, Kathleen F. M.R.C.S., L.R.C.P., D.P.H. Medical Officer, Maternity and Child Welfare (Part time). 1928 Nelson, Grace M. M.R.C.S., L.R.C.P. Medical Officer, Maternity and Child Welfare (Part time). 1921 Radford, Muriel A. M.B., B.S., D.P.H. Medical Officer, Maternity and Child Welfare (Part time). 1930 Salmond, Margaret M.D., M.R.C.S., L.R.C.P. Medical Officer, Maternity and Child Welfare (Part time). 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 Puerperal 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, Chelsea District (Part time). 6 (b.) Other Staff. Year Appointed. Name. Qualifications. Appointment. 1925 Gerrans, B.H. F.I.C. Public Analyst (Part time). 1920 Crandell, W. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Cert. Meat and other Foods. Senior Sanitary Inspector (Whole time). 1927 Castley, J. Cert. San. Insp. Exam. Board, Cert. Meat and other Foods. Sanitary Inspector (Whole time). 1926 Shelley, A.P.T. Cert. San. Insp. Exam. Board. Sanitary Inspector (Whole time). 1930 Hoyland, H. Cert. Royal San. Inst. and San. Insp. Exam. Joint Board, Cert. Meat and other Foods. Sanitary Inspector, with special reference to Duties under Housing Act, 1925 (Whole time). 1916 Brown, Miss M. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Health Visitors' Diploma, approved by Board of Education. Cert. C.M.B. Sanitary Inspector and Health Visitor (Whole time). 1911 Hobart, Miss F.G. Cert. San. Insp. Exam. Board, Diploma of Nat. Health Soc., Royal San. Inst. Health Visitors' Cert. C.M.B. Health Visitor and Superintendent to Chelsea Health Society (Whole time). 1923 Shaw, Miss A. Cert. Gen. Hosp. Training, C.M.B. and Cert. Mothercraft Training Soc., Health Visitors' Cert. approved by Ministry of Health. Health Visitor, Chelsea Health Society(Whole time). 1926 Harcourt, Miss G.E. Cert. Gen. Hosp. Training, C.M.B., and Cert. Mothercraft Training Society. Health Visitor, Chelsea Health Society(Whole time). 1929 Broad, Mrs. E.M. S.R.N., Gen. Hosp. Cert. Ashton-under-Lyne Hosp., Cert. C.M.B. Matron, Chelsea Day Nursery. 1926 Corke, Miss I.M. S.R.N., Gen. Hosp. Cert. St. Thomas' Hosp., Cert. C.M.B., Cert. M.T.S. Matron, Mothercraft Training Home. 1928 Squire, Miss H.M.L. Cert. Inst. of Hospital Almoners, Cert. Social Science (London School of Economics) Cert. San. Insp. Exam. Board. Diploma Nat. Health Society. Secretary of Chelsea Tuberculosis Dispensary, Tuberculosis Visitor and Social Worker in connection with Tuberculosis (Whole time). 1927 Puttick, Miss C.K. Cert. General Hospital Training and Tuberculosis. Tuberculosis Nurse to Dispensary (Whole time). 7 Year Appointed. Name. Appointment. 1914 Hayden, A.B.J. Chief 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 Preface 2 Public Health, Maternity and Child Welfare Committee 4 Housing Committee 4 Milk and Welfare Sub-Committee 4 Public Health Officers of the Borough Council 5 (a) Medical 6 (b) Other Officers 6 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 16 Stillbirths 16 Marriages 16 Deaths 16 Registered Number of 16 In Public Institutions 18 Causes (Table) 20 Children 1-5 years 21 Infants 22 Illegitimate 23 Maternal Mortality 23 Apparent Excessive Mortality in the Borough 24 Causes of Sickness in the Borough 24 II.—Provision of Health Services in the Borough. Professional Nursing in the Home 25 (a) General 25 (b) 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 Health Visitors 32 Ante-Natal Work 34 Supply of Milk to Mothers and Young Children 34 Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children 35 Ambulance Facilities 35 Clinics and Treatment Centres 36 (a.) The Violet Melchett Infant Welfare Centre 36 (i.) Chelsea Health Society 36 (ii.) Chelsea Day Nursery 37 (iii.) Chelsea Mothercraft Training Home 38 (b.) Invalid Children's Aid Association 39 (c.) The Babies' Club 40 (d.) Charity Organisation Society 40 (e.) Chelsea Tuberculosis Dispensary 41 Convalescent Home Treatment for Nursing Mothers and Infants 41 Dental Treatment 41 Widows' Orphans' and Old Age Contributory Pensions Acts, 1925 and 1929 42 Blind Persons Act, 1920 42 Children Act, 1908 42 Summary of Arrangements regarding Maternity and Child Welfare 42 9 III.—Sanitary Circumstances and Administration. PAGE Complaints 44 Closet Accommodation 44 Removal and Disposal of Refuse 44 Sanitary Inspection of the Borough 44 Magisterial Proceedings 47 Smoke Abatement 48 Fouling of Footways by Dogs 48 Rats and Mice (Destruction) Act 48 Pigeons, Nuisance caused by 48 Premises and Occupations Controlled by Byelaws or Regulations 50 Factories, Workshops and Workplaces 50 Public Mortuary 52 Rag Flock Acts 52 Offensive Trades 52 IV.—Housing. Housing Statistics 53 Housing Conditions in the Borough 54 (a.) General Observations 54 (b.) Sufficiency of Supply of Houses 55 (c.) Overcrowding 57 (d.) Fitness of Houses 57 (e.) Unhealthy Areas 58 (f.) Byelaws relating to Houses and Houses Let in Lodgings 59 (g.) Housing Survey 59 V.—Inspection and Supervision of Food. Milk Supply 61 Public Health (Meat) Regulations, 1924 62 Slaughter-houses 62 Bakehouses 62 Ice-cream Vendors 62 Fried Fish Vendors 62 Other Premises where Food is Prepared or Offered for Sale 62 Unsound Food 63 Food Poisoning 63 Food and Drugs (Adulteration) Act, 1928 63 The Public Health (Preservatives, etc., in Food) Regulations 63 Margarine 63 Chemical and Bacteriological Examination of Food 64 Nutrition, Dissemination of Knowledge as to 64 VI.—Infectious and Other Diseases. (a.) Infectious Diseases Generally 65 Diseases Notifiable in the Borough 65 Notifications 65 Diphtheria 66 Scarlet Fever 67 Measles 68 Enteric Fever 68 Pneumonia, Malaria and Dysentery 69 Puerperal Fever and Puerperal Pyrexia 69 10 PAGE Ophthalmia Neonatorum 70 Poliomyelitis and Polio-Encephalitis 70 Encephalitis Lethargica 70 Chicken Pox 70 Smallpox and Vaccination 71 Venereal Disease 71 Disinfection 71 Infectious Diseases Shelter 72 Disinfestation 72 (b.) Tuberculosis 73 Notifications and Mortality 73 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 79 Co-operation with Hospitals and I.C.A.A. 79 Co-operation with School Medical Service 80 Co-operation with Medical Practitioners 80 Home Contacts 80 Artificial Pneumo-thorax Treatment 80 Home Nursing 80 Extra Nourishment 80 Non-Pulmonary Cases 80 Orthopaedic Treatment 81 Dental Treatment 81 Bacteriological Examinations 81 Care and After-Care Work 81 Appendix. Report of the Public Analyst for 1934 84 Annual Report on the Health of the Metropolitan Borough of Chelsea. Year ending 31st December, 1934. SECTION I.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. GENERAL STATISTICS. TABLE No. 1. Area (acres) 660 Resident Population:—Registrar-General's estimate, 1934 58,160 Number of Inhabited Houses (end of 1934) according to Rate Books 12,413 Rateable value, October, 1934 £1,256,453 Sum represented by a penny rate, October, 1934 £4,879 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 1934, viz., 58,160). 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 1931 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 19,600 adult males, about 16,750 are occupied. The chief occupations are transport work (2,704), personal service (2,224), metal work (1,036), and clerical work (1,260). Over one half of the 30,800 adult females are occupied. Of these, domestic servants account for 8,746, dressmakers number 1,243, shop assistants 1,090, and clerks 1,471. There are no dangerous or offensive trades carried on in the Borough. There is no evidence that any of the occupations of the inhabitants exerts a deleterious influence on the public health. VITAL STATISTICS. In accordance with the requirements of the Ministry of Health, the following extracts from the Vital Statistics of the year are shown below:— TABLE No. 2. Total M. F. Live Births:— Birth rate per 1,000 of the estimated resident population 10.8 Legitimate 575 305 270 Illegitimate 55 22 33 13  Total M. F. Still Births 26 12 14 Rate per 1,000 total (live and still) births 39.6 Deaths 779 419 360 Death rate per 1,000 of the estimated resident population 13.4 Deaths from Puerperal Causes:— Deaths. Rate per 1,000 total (live and still) births. Puerperal Sepsis — — Other Puerperal Causes 3 4.5 Total 3 4.5 Death rate of Infants under one year of age:— All infants, per 1,000 Live Births 65 Legitimate infants per 1,000 legitimate live births 56 Illegitimate infants per 1,000 illegitimate live births 164 Deaths from Measles (all ages) 8 Deaths from Whooping Cough (all ages) 4 Deaths from Diarrhœa (under 2 years of age) 7 BIRTHS. During the year 884 births were registered in Chelsea. Of these, births of non-parishioners account for 544. In addition, there were 290 births amongst Chelsea mothers in Lying-in Hospitals and elsewhere outside the Borough. The total number of Chelsea Births for the year was therefore 630, equivalent to an annual birth-rate of 10.8 per 1,000 of population. The birth-rate for England and Wales in 1934 was 14.8, 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 413 351 51 69 884 Births of Non-Parishioners 235 204 47 58 644 178 147 4 11 340 Births of Chelsea Mothers in Lyingin Hospitals and elsewhere outside of the Borough 127 123 18 22 290 305 270 22 33 630 Nett Chelsea Births 575 55 630 14 TABLE No. 4. Births, Birth-Rates, Births in Wards and Inward Transfer Births. Year. Births. BirthRate Per 1,000 of Population. Births in Wards. Inward Transfer Births. Leg. Illeg. Total. Hans Town. Royal Hospital. Church. Cheyne. Stanley. Hospitals. Nursing Homes. Private Addresses. Total. 1933 577 48 625 10.6 67 54 86 97 321 183 34 9 226 1934 575 55 630 10.8 93 61 82 101 293 232 41 17 290 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 2 St. Mary Abbots Hospital 136 St. George's Hospital 35 St. Stephen's Hospital and Institution 12 Queen Charlotte's Hospital 12 Princess Beatrice Hospital 26 Ormond Maternity Home 31 Royal Free Hospital 6 Wilbraham Nursing Home 9 Miscellaneous Hospitals 17 Chelsea Hospital for Women - Nursing Homes 41 Royal Avenue Nursing Home - Total 54 Total 273 From Table No. 4 it will be observed that the number of births of Chelsea Infants in Hospitals and elsewhere outside Chelsea accounted for 46.0 per cent. of the total births. In the preceding year the percentage was 36.1. NOTIFICATION OF BIRTHS ACT, 1907. Under the above Act, all live and still births 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 875 births, including stillbirths, were notified as occurring in Chelsea. Of this number, in 561 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 290 births amongst Chelsea mothers in Lying-in hospitals and elsewhere outside the Borough. The total number of notified Chelsea births from all sources was 604. The following table indicates the source of notification of the 875 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 115 - 115 61 - 61 Midwives 173 5 178 42 - 42 Poor Law Institutions 12 — 12 439 19 458 Parents, etc. 9 - 9 - — — 309 5 314 542 19 561 16 Illegitimate Births.—The following table shows the number of illegitimate births and the percentage of the total births. In 1934, 120 such births were registered in Chelsea, and 40 inward transfers and 105 outward transfers were made by the Registrar-General. The nett figure for the Borough is, therefore, 55, of which 19 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. 1933 48 7.68 1934 55 8.73 Stillbirths.—During the year 34 stillbirths were registered in Chelsea, 15 being males and 19 females. Of these, stillbirths of non-parishioners account for 20 (9 males and 11 females) and must be deducted. In addition, there were 12 stillbirths amongst Chelsea mothers outside the Borough (6 males and 6 females). The corrected number of stillbirths is, therefore, 26, which represents a rate for the Borough of 0.44 per 1,000 of the population, as compared with 0.50 for London as a whole. MARRIAGES. There were 739 marriages registered in the Borough during the year (678 in 1933). The marriage rate (number of marriages per 1,000 of population) was 12.7. In the preceding year the marriage rate was 11.5. DEATHS. During the year 1,820 deaths were registered in Chelsea. Of these, deaths of non-residents accounted for 1,215. In addition, there were 174 deaths of Chelsea residents in Institutions and elsewhere outside the Borough. The total number of Chelsea deaths for the year was therefore 779, equivalent to an annual death-rate of 13.4 per 1,000 of population. The death rate for England and Wales for 1934 was 11.8, and for London 11.9. The following tables are self-explanatory:— TABLE No. 8. Registered Deaths. Total. Deaths registered in the Borough 1,820 Non-parishioners 1,215 605 Deaths of Chelsea residents in hospitals and elsewhere outside the Borough 174 Nett Chelsea deaths 779 17 TABLE No. 9. Deaths, Death Rates, Deaths in Wards and Seasonal Mortality. Year. Deaths. DeathRate per 1,000 of Population. Deaths in Wards. Seasonal Mortality Rate. Hans Town. Royal Hospital. Church. Cheyne. Stanley. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. 1933 801 13.6 108 134 138 119 302 19.3 12.3 9.6 13.2 1934 779 13.4 84 125 121 134 315 18.0 13.4 9.9 12.2 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 605 Chelsea deaths registered in the Borough, 371 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 258 General Hospitals 66 Mental Hospitals 17 Royal Hospital for Pensioners 56 Infectious Disease Hospitals 15 Cancer Hospital 14 Tuberculosis Sanatoria, etc. — Victoria Hospital for Children (Tite Street) 3 Nursing Homes 29 Poor Law Institutions 29 St. Stephen's Hospital (Westminster Infirmary) 38 Miscellaneous 18 Brompton Hospital 2 Chelsea Hospital for Women - Cheyne Hospital for Children - St. George's Home for Tuberculosis - 371 174 Of the 1,215 deaths of non-residents registered in Chelsea 1,194 occurred in hospitals or Institutions within the Borough. 19 TABLE No. 11. Birth-rates, Death-rates and Analysis of Mortality in the year, 1934. England and Wales, 121 County Boroughs and Great Towns, ans 135 Smaller Towns. (Provisional figures. The rates for England and Wales have been calculated on a population estimated to the middle of 1934, but those for London and the Towns have been calculated on populations estimated to the middle of 1933. - 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. Typhoid and Paratyphoid Fevers. 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 14.8 0.62 11.8 0.00 0.00 0.09 0. 02 0. 05 0.10 0.14 0.54 5.5 59 90.4 6.5 2.1 1.0 121 County Boroughs and Great Towns, including London 14.7 0.66 11.8 0.00 0.00 0.12 0.02 0.06 0.11 0.12 0.47 7.4 63 90.5 6.1 2.9 0.5 135 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census 1931). 15.0 0.67 11.3 0.00 0.00 0.07 0.02 0.04 0.09 0.14 0.42 3.6 53 91.2 6.1 1.6 1.1 London 13.2 0.50 11.9 0.00 0.00 0.20 0.02 0.07 0.11 0.12 0.56 12.6 67 87.7 6.3 6.0 0.0 Chelsea 10.8 0.44 13.4 0.00 0.00 0.14 0.00 0.07 0.17 0.29 0.86 11.1 65 88.5 8.2 3.3 0.0 The maternal mortality rates for England and Wales are as follows:- Puerperal Sepsis. Others. Total. Per 1,000 live births 2.03 2.57 4. 60 Per 1,000 total births 1.95 2.46 4.41 20 TABLE No. 12. Deaths of Chelsea Residents Registered during the Year 1934, Classified by Age and Cause. (In accordance with Registrar-General's Return.) Causes of Death. Nett Deaths, whether occurring within or without the Borough. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards. All Causes 779 41 9 10 15 23 30 34 81 132 188 216 1. Typhoid and Paratyphoid Fevers - - - - - - - - - - - - 2. Measles 8 3 1 4 — — — — - — — — 3. Scarlet Fever - - - - - - - - - - - - 4. Whooping Cough 4 1 — 1 1 — — 1 - — — — 5. Diphtheria 10 — 1 3 5 — — 1 — — — — 6. Influenza 17 — — — — — 1 — 1 — 6 9 7. Encephalitis Lethargica - - - - - - - - - - - - 8. Cerebro-Spinal Fever - - - - - - - - - - - - 9. Tuberculosis of Respiratory System 33 - - - - 2 10 5 10 5 1 - 10. Other Tuberculous Diseases 10 - 1 — — 5 2 — 2 — — — 11. Syphilis 6 — — — — 1 1 — 3 1 - — 12. General Paralysis of the Insane, Tabes Dorsalis 2 - - - - - - - - 2 - - 13. Cancer, malignant disease 104 - - - - - 1 5 11 34 30 23 14. Diabetes 6 - - - - - - - - 2 2 2 15. Cerebral Hœmorrhage, etc 34 - - - - - - 2 4 8 3 17 16. Heart Disease 213 — — — 1 3 2 3 9 31 71 93 17. Aneurysm — — — — — — — — — — — — 18. Other Circulatory Diseases 40 - - - - - - - 3 5 17 15 19. Bronchitis 19 3 - - - - - 1 2 2 6 5 20. Pneumonia (all forms) 50 5 3 — — 1 1 3 7 5 9 16 21. Other Respiratory Diseases 4 - - - - - - - - 2 2 — 22. Peptic Ulcer 8 — — — — — — — 6 2 — — 23. Diarrhœa, etc. 10 6 1 - - — 1 — - 2 — - 24. Appendicitis 6 — — — 1 — 1 - 1 2 1 — 25. Cirrhosis of Liver 1 — — — — — — — 1 — — — 26. Other Diseases of Liver, etc. 6 - - - — 1 - — - 2 1 2 27. Other Digestive Diseases 19 - 1 1 2 1 2 3 1 3 3 2 28. Acute and Chronic Nephritis 15 - - - - - 1 1 1 5 4 3 29. Puerperal Sepsis — — — — — — — — — — — — 30. Other Puerperal Causes 3 — — — — — 3 — — — — — 31. Congenital Debility, Premature Birth, Malformations, etc. 22 22 - - - - - - - - - - 32. Senility 18 - - - — — - — - — 6 12 33. Suicide 17 - - - - 1 1 3 4 5 1 2 34. Other Violence 32 - - - 2 4 2 2 6 - 7 9 35. Other Defined Diseases 62 1 1 1 3 4 1 4 9 14 18 6 36. Causes ill-defined or unknown - - - - - - - - - - - - 779 41 9 10 15 23 30 34 81 132 188 216 21 CAUSES OF DEATH. Table No. 12 shows that 213 deaths were due to Organic Heart Disease, 104 to Cancer, 19 to Bronchitis, 50 to Pneumonia, 33 to Pulmonary Tuberculosis, 40 to Circulatory Diseases, 34 to Cerebral Haemorrhage, 17 to Influenza and 22 to Congenital Debility and Malformation. Fifty-two 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. chitis. Pneumonia. Other Respiratory Diseases. Total. Deathrate. No. of deaths under 5 years. Percentage under 5 years. 1933 24 44 10 78 1.3 8 10.2 1934 19 50 4 73 1.2 11 15.0 DEATHS OF CHILDREN 1-5 YEARS OF AGE. The number of deaths of children between 1-2 years of age was 9 and between 2-5 years, 10. In the previous year these figures were 5 and 10 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. 1933 6 1 3 1 4 15 1934 10 1 3 1 4 19 22 INFANT MORTALITY. There were 41 deaths of infants under one year of age in Chelsea during the year. The correct death rate is 65 per 1,000 births, as compared with 78 in 1933. In London as a whole the rate of infant mortality was 67 per 1,000 births. The causes of death in the various age group 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 2 3 Scarlet Fever - - - - — — - — - - Whooping Cough - - - - — 1 - — - 1 Diphtheria - - - - — — - - _ - Influenza - - - - — — - - — - Erysipelas - - - - — - - - — - Tuberculous Meningitis - - - - — - - - — - Abdominal Tuberculosis - - - - — - - - — — Other Tuberculous Diseases - - - - - - - - - - Meningitis. 1 - - - 1 - 1 Convulsions - - - - — - - - - - Laryngitis - - - - — — - - - - Bronchitis - 3 3 Pneumonia - - - - - 3 1 - 1 5 Diarrhœa and Enteritis - - - - — — 5 1 6 Gastritis - - - - - — — - — — Syphilis - - - - Rickets - - - - — — — - — — Suffocation - - - - — — — Injury at Birth 3 - - - 3 — — - — 3 Atelectasis 2 - - - 2 — — - — 2 Congenital Malformations 1 1 - - 2 — 1 - - 3 Premature Birth 9 1 - - 10 1 — - — 11 Atrophy, Debility and Marasmus 1 - — — 1 — 1 — — 2 Other causes — - - - - - - 1 — 1 17 2 — - 19 8 8 2 4 41 Nett Births registered during Legitimate 575 the calendar year Illegitimate 55 Nett Deaths (under 1) registered Legitimate 32 during the calendar year Illegitimate 9 The following Table gives the Infant Mortality Rate in Chelsea under various headings, for the past two years :— 23 TABLE No. 16. 1933. 1934. Infectious Diseases 8.0 6.3 Diarrhœal Diseases 22.4 9.5 Developmental Defects and Wasting 32.0 35.0 Other causes 16.0 14.2 Total Rate 78.4 65.0 TABLE No. 17. Infantile Mortality Rates per 1,000 Births in Wards. 1933. 1934 Hans Town 60 54 Royal Hospital 37 66 Church 151 61 Cheyne 51 10 Stanley 78 89 Chelsea Borough 78 65 Illegitimate Deaths.—The following Table No. 18 shows the number of deaths among illegitimate infants during the past two years. TABLE No. 18. 1933. 1934. Total number of illegitimate deaths under 1 year 13 9 Illegitimate death rate 270 164 MATERNAL MORTALITY. During the year three deaths occurred which were attributed directly to complications of pregnancy or childbirth. All cases died in hospital. 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. The following table shows the Maternal Mortality in Chelsea during the past two years :— TABLE No. 19. Year. Death-rate per 1,000 Total (Live and Still) Births. Puerperal Fever. Other complications of Pregnancy and Childbirth. Total Death-rate. 1933 — 1.5 1.5 1934 — 4.5 4.5 24 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 1934, deaths of pensioners in the Royal Hospital, Chelsea, accounted for 61 deaths, inward transfers included (equivalent to 1.04 of the death rate). For many years past more than half the deaths in Chelsea have occurred in persons over 65 years of age. CAUSES OF SICKNESS IN THE BOROUGH. The Ministry of Health directs that any causes of sickness and invalidity which have been specially noteworthy in the area during the year should be specified. There was no unusual or excessive mortality during the year, nor was the amount of sickness and invalidity, as far as could be ascertained, such as to call for any special comment in this report. 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, 1934, 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 1s. 6d. per visit. For this remuneration the Association has undertaken the nursing of all cases of illness occurring in expectant and nursing mothers and also, on the requisition of the Medical Officer of Health, the nursing of all children in the Borough under five years of age suffering from any illness. Cases of bronchitis, pneumonia and other diseases thus receive skilled attention. Acute cases are seen two or three times a day if necessary and are also visited on Sundays. Chronic bedridden patients receive a weekly blanket bath. When required, the nurses assist at minor operations in the patients' own homes. Patients are expected to make payment to the Association according to their means, but no patient, on account of inability to do so, is refused the services of a nurse. The only stipulations are that the patient must be under medical supervision, require nursing and be unable to pay the fees of a private Nursing Institution. Details of the work done by the Association during the year on behalf of the Borough Council will be found on page 26. Two 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, 1934. The total fees paid by the Council for nurses' visits during the year amounted to £168 8s. 8d. (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 80. 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. 20 shows, for the past two years, the number of home visits paid by the District Nurses, while Table No. 21 shows the conditions which necessitated attendance during the year 1934 :- TABLE No. 20. Year. Visits. Cases. 1933 1,300 116 1934 2,379 222 TABLE No. 21. Nursed by District Nurses During 1934. Visits. Cases. Bronchitis 146 13 Burns 28 2 Chicken Pox — — Circumcision 243 32 Diarrhœa — — Eye Trouble 53 5 Ear Trouble 427 28 Expectant and Nursing Mothers 166 13 Influenza and Pneumonia (under 5) 158 11 Influenza and Pneumonia (over 5) 257 16 Impetigo 38 3 Meningitis and Peritonitis — — Measles (under 5) 239 22 Measles (over 5) 147 12 Ophthalmia Neonatorum 38 1 Pemphigus Neonatorum — — Pemphigus — — Poliomyelitis — — Post-Vaccination 59 7 Puerperal Fever — — Puerperal Pyrexia 3 1 Rickets — — Septic sores 29 4 Tonsils and Adenoids 69 13 Whooping Cough 10 1 Worms 102 17 Miscellaneous 167 21 2,379 222 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. tor 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. In the following Table No. 22 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. 22. 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. £. s. d. £. s. d. £. s. d. £. s. d. 1933 2 43 1 39 0 17 6 19 18 9 0 12 6 39 1 3 1934 — 40 1 33 0 17 6 17 11 6 0 12 6 32 10 6 Note.—(1) Includes applications refused and cases subsequently withdrawn. (2) Includes cases assessed during previous year. 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 7 midwives gave notice during the year of their intention to practise as midwives in Chelsea. Of these, two are engaged in private practice, the remainder being employed on the staff of various hospitals, institutions and maternity homes within the Borough. 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. 23 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. 23. 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. £. s. d. £. s. d. 1933 16 9 11 1 0 24 19 0 1934 8 5 plus 1 extension 5 7 0 14 12 6 NATIONAL HEALTH INSURANCE. The work of a Sanitary Authority has no direct relation to this service, but wherever co-operation is possible such assistance is freely rendered by the Public Health Department. It is mainly in cases of advanced tuberculosis, without relatives and under treatment in hospitals and institutions, that arrangements are necessary in connection with payment of benefits under the Health Insurance Acts. These arrangements are made by the Tuberculosis Care Committee and the staff of the 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. Six specimens were submitted 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 examina- tions carried out during the year was 362. Of these, 319 were for the bacillus associated with Diphtheria, 34 for the bacillus associated with Tuberculosis, 1 for the bacillus associated with Enteric Fever and 1 for the bacillus associated with indolent ulcer of finger. 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 £49 18s. 6d. The total number of bacteriological examinations during the preceding year was 330. 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 72,000 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 £4 10s. Od. 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. Royal Hospital for Pensioners. St. George's Home for Tuberculosis. St. Luke's Hospital and Institution. St. Stephen's Hospital and Institution. Victoria Hospital for Children. The following table No. 24 shows, in the form required by the Ministry of Health, particulars of the hospitals, public and voluntary, within and without the Borough, which are utilised by inhabitants of the Borough. 31 TABLE No. 24. Name. Situation. Nature of Cases Treated. Available Beds. If used by persons resident outside the Borough. Management. Brompton Hospital for Consumption Fulham Road, S.W.3 Pulmonary Tuberculosis 339 Yes By Voluntary Committee 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 Princess Beatrice Hospital Richmond Road, S.W.5 General Medical, Surgical and Maternity 78 Yes By Voluntary Committee Royal National Orthopaedic Hospital Great Portland Street, W.1 Deformities and Malformations 170 Yes By Voluntary Committee St. George's Hospital Hyde Park Corner, S.W.1 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. 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:- TABLE No. 25. Cases admitted and attended in the Home 77 Cases attended in the district 107 Total 184 Ante-natal attendances 970 Visits to cases in the district 2,350 Maternal deaths None 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. 33 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. 1933. 1934. (1) Work of the Health Visitors. First visits to Infants under one year of age 489 454 Return „ „ „ „ „ 1,794 1,453 First visits to Children between the ages of 1 and 5 years 378 325 Return visits to Children between the ages of 1 and 5 years 2,703 2,320 Ante-natal visits to Expectant Mothers :— Primi-para cases 90 112 Multi-para „ 176 173 Return visits 479 451 Visits to Enteritis cases amongst children 9 1 Return visits „ „ „ „ 12 — Visits to Ophthalmia Neonatorum cases 4 1 Return visits „ „ „ 6 — Visits to Whooping Cough cases 141 34 Return visits „ „ „ 79 26 Visits to Measles cases (under 5 years of age) 31 368 Return visits „ „ „ 10 248 Visits to Measles cases (over 5 years of age) 22 228 Return visits „ „ „ 5 92 General additional visits 778 710 Total visits 7,206 6,996 Half-day attendances at Infant Welfare Centres 454 472 34 Summary of Reports of Health Visitors—continued. (2) Infant Welfare Centres. Total number of attendances :- 1933. 1934. (a) By children under one year of age 4,280 3,540 (b) By children between the ages of 1 and 5 years 3,181 3,067 (c) By Ante-Natal mothers 554 840 (d) By Post-Natal mothers 63 40 Total attendances 8,078 7,487 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. 0d. per head per week. Milk is supplied to other cases on the following basis :— Nett available incomes 4s. to 5s. at the rate of 1d. per pint, „ „ 5s. to 6s. „ l½d. „ „ „ 6s. to 7s. „ „ 2d. „ „ „ 7s. to 8s. „ „ 2½d. „ The following table show 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. £ 1933 908 871 700 790 3269 682 1934 759 651 461 464 2335 472 * These totals do not include orders subsequently cancelled or withdrawn, which average 150 or more during each year. 35 It will be observed that in 1934 there was a decrease in the cost of milk. Cows' milk was supplied to 75 per cent, of the applicants, dried milk being supplied to the remaining 25 per cent. The arrangements for the supply of milk in the Borough are working satisfactorily. Families in receipt of out-relief do not come under the Council's scheme for the supply of milk to necessitous mothers and children. These cases are dealt with entirely by the Public Assistance Committee, who grant the necessary extra milk on a certificate signed by a Doctor at the Welfare Centre. 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. 36 (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 Violet Melchett Infant Welfare Centre is supported by (1) voluntary contributions (2) an endowment of £500 per annum generously provided by Lady Melchett herself (3) financial grants from the Ministry of Health and the Borough Council. A further source of income arises from the fees paid by pupils and parents. The Borough Council made a financial grant of £1,250 to the Violet Melchett Infant Welfare Centre for the financial year 1934-1935. 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. Sec-' retary : 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. The accommodation provided includes a large central hall, with surrounding consulting-rooms and dressing rooms. There is also a perambulator store, an open-air court with a garden where children may play while awaiting medical inspection, and ample office accommodation. 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 33 (Table No. 26). 37 The Medical and other staff are appointed by the Voluntary Committee. Four part-time Medical Officers are employed—Dr. Mary Nelson, Dr. Muriel Radford, Dr. Kathleen Matthews and Dr. Margaret Salmond. Three whole-time trained Health Visitors are also employed, together with necessary clerical and domestic assistance. Much valuable work is done by voluntary workers attached to the Society. Three members of the Public Health Committee of the Borough Council and the Medical Officer of Health are members of the Executive Committee. The Society is supported by (1) voluntary contributions (2) financial grants from the Ministry of Health and from the Borough Council. Under section 101 (6) of the Local Government Act, 1829, 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 1934-1935. (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. It 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 staff consists of a Medical Officer, an honorary Medical Adviser, a Matron, a Sister, a Staff Nurse, eight probationers, and six 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. 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 1934-35. The attendances at the Nursery during the past two years were as follows:- TABLE No. 28. 1933. 1934. Total number of attendances during the year 11,397 12,689 Average daily attendance (5½ days a week) 38 45 Total number of individual children who attended 152 149 38 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. Vaughan-Morgan. Hon. Secretary : Miss Violet Trench. The Mothercraft Training Home is controlled by a voluntary Committee. It provides accommodation for six nursing mothers, with their babies, on the occurrence of lactation difficulties, also for 12 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 staff consists of three honorary Consultants, a Medical Director, a Matron, two Sisters, three Staff Nurses, Secretary (part time) 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, 1934. Admissions. Babies Mothers and Babies Obs. Malnutrition. Nat. Feeding difficulties. Normal Nat. Feeding. Total Mothers. Total Babies. 37 60 3 63 100 Average Stay. Obs. Malnutrition. Nat. Feeding difficulties. Normal N. Feeding cases. 60 days 23'2 days 1 year 39 Analysis of Natural Feeding Difficulties. Established Nat. Feeding. Re-established Nat. Feeding. Supply increased. Supply regulated. No change. 3 8 30 11 5 Deaths. 3* (1) Congenital heart. (2) Dying on admission. (3) Inherited Specific Disease. * These are the first deaths that have occurred of naturally fed babies during the nine years that such cases have been admitted. Mother Attending with Babies for Test-Feeds. Number of Mother attending: 1 Visit 2 Visits 3 Visits 4 Visits 5 Visits 6 Visits 7 Visits 9 Visits 10 Visits 95 7 4 2 3 2 2 1 1 Total number of Mothers : 117 Total number of Test Feeds: 181 Students. Completed one year Started one year Short courses 1 to 3 months 13 11 10 Started 6 months Started 4 months 2 2 The Borough Council made an annual contribution to the Chelsea Mothercraft Training Home for the financial year 1934-1935. This is included in the amount (£1,250) granted to the Violet Melchett Infant Welfare Centre. (B) Invalid Children's Aid Association.—Chairman: Alderman F. J. Synge. Hon. Secretary : Mrs. Rathbone. 40 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 it, treatment in Hospitals, Sanatoria and Nursing Homes, according to need; convalescence in the country or at the seaside; orthopaedic appliances and surgical boots; massage, remedial exercises, surgical dressings and medical comforts; help in training for suitable work; additional clothing, etc. Two 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, 1934. During the year the branch had 227 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-three children were sent out of London for convalescence, for periods varying from six weeks to six months. Nine children had hospital and sanatorium treatment arranged for them. Children were given medical aids as ordered by a doctor, such as vitoleum cream, phosphates, malt and cod liver oil, etc., which their parents, owing to unemployment, were unable to provide. Twenty-seven 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. Twenty-one children were treated at the I.C.A.A. Orthopaedic Clinic and eight children were placed under the L.C.C. contact scheme, as contact cases of tuberculous parents, in carefully chosen homes or with foster mothers. 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.O.B.E. Secretary: Miss E. Luttrell. 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. 41 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. Details of the work done by the Dispensary will be found on page 76. 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 eight 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. £ s. d. £ s. d. 1933 23 12 5 0 0 16 2 0 1934 16 12 1 12 6 22 14 2 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 twenty mot hers, the Borough Council making a contribution of £52 13s. 0d. towards the cost. 42 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, are undertaken 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 occurred during the year. 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 the year and the number of visits in connection with this work. TABLE No. 31. Infant Life Protection Return. (Year 1934). Foster Mothers. Foster Children. Number on Register at beginning of year 26 29 Removed from register 20 32 Added to register 13 24 Remaining on register 19 21 Medical attendance arranged — 9 Attended Maternity and Child Welfare Clinic — 17 Visits to foster mothers 106 Miscellaneous visits 51 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. 43 (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. (l) 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. 44 SECTION III.—SANITARY CIRCUMSTANCES AND ADMINISTRATION. Complaints.—The number of complaints received during the year was 483, compared with 340 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 468. The number of statutory notices was 72. These compared with 530 and 62 in 1933. 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 (page 47). Summary of Work carried out by Sanitary Inspectors during the Year. Inspections. On complaint of nuisance 483 On notification of infectious disease (including non-notifiable diseases) 350 House to House 290 Re-inspection calls made 5,851 Inspection of:— Bakehouses 36 Slaughterhouses 21 Milkshops 130 Ice Cream Premises 41 Overcrowding 20 Houses Let in Lodgings 40 Stables 48 Restaurant Kitchens 68 Marine Stores 8 Food Premises other than above 131 Premises under Meat Regulations 48 Factories and Workshops 329 Outworkers' Premises 32 Common Lodging Houses 24 Other visits 431 Verminous Premises 231 Rat enquiries 70 Smoke observations 30 Total 8,712 45 Premises: Walls and Ceilings cleansed:— (a) Premises throughout 2 (b) Premises partially 240 (e) Verminous rooms cleansed 47 (d) Total number of rooms cleansed 367 Wash-house walls and ceilings cleansed 28 Walls and ceilings of water closets cleansed and repaired 52 Wash-house roofs repaired 4 Dirty tenants' rooms cleansed 4 Yard and area walls cleansed 4 Defective roofs repaired 49 Defective gutters repaired 9 Defective rain water pipes repaired 32 Dampness abated 67 Miscellaneous repairs 180 Wash-house floors repaired 27 Yard surfaces repaired, paved, etc. 43 Ashpits demolished 4 New and proper dustbins provided 88 Workrooms provided with light and ventilation or light and ventilation improved 10 Drainage: Reconstructed 71 Repaired 19 Cleansed 9 Inspection Chambers and traps provided 106 Fresh air inlets provided or repaired 43 New soil pipes provided 30 New ventilation pipes provided 53 Soil and ventilation pipes repaired 5 Anti-syphonage pipes provided 1 Drains sealed off 10 Drains cleared (obstruction removed) 12 New covers provided to inspection chambers 108 Rainwater pipes disconnected and caused to discharge over properly trapped gullies 2 Sink wastes provided with traps 100 Sink waste pipes cleansed 3 New sink wastes provided 110 New sinks provided 90 New bath wastes provided 52 Water Closets. Improvements in sanitary conveniences (factories, workshops, etc.) 6 New water closet pans provided 91 Water closet pans (foul) cleansed 4 Choked water closet pans unstopped and cleansed 2 Water waste preventers renewed 15 Water waste preventers repaired 5 Water closet roofs repaired 6 Ventilation and light provided or improved 4 W.C. floors repaired 91 Water supply Water supply to premises reinstated 1 Water supply provided to upper storeys of tenement houses — New drinking water cisterns provided 4 Drinking water cisterns cleansed 12 Drinking water cisterns provided with new covers or covers repaired 9 Smoke Nuisance. Number of observations 30 Number of nuisances and complaints 10 Number of notices — Number of Summonses — 46 Nuisances abated arising from:— Keeping animals in an improper manner or place 2 Defective manure cages 1 Accumulation of manure or refuse 6 Overcrowding 20 Rat nuisance 70 Underground rooms 1 Food Condemned and Destroyed 7 18 lbs. Ox Liver. 16 stone of Meat. 4 Mackerel. 7 stone of Fish. 2 boxes Tomatoes. 2 boxes of Oranges. 14 lbs. of Kippers. Disinfection. Rooms disinfected after Zymotic diseases (Scarlet Fever, Diphtheria, etc.) 432 Rooms disinfected after Tuberculous disease 84 Rooms fumigated for verminous and filthy conditions 412 Miscellaneous disinfection 109 Certificates of disinfection given 269 School notices after disinfection 282 Notices sent to Public Library of Premises where infectious diseases have occurred 150 Proceedings taken. Intimation Notices served 468 Statutory Notices under Public Health (London) Act, 1891 72 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 371 Samples of cream taken 10 Samples of drugs taken 6 Samples (informal) purchased 29 Legal proceedings instituted in respect of defective sanitary conditions and nuisances 8 Legal proceedings under Milk and Dairies Amendment Act, 1922 — Legal proceedings in respect of unsound food 1 Certificates issued in accordance with "Rent Restrictions Act" — Entries in Inhabitants' Complaint Book 483 Cleansing and Disinfection. Number of adults cleansed 31 Number of children cleansed 640 Number of rooms or premises cleansed or disinfected 1,037 Number of persons treated for Scabies 10 Number of articles (bedding, etc.) disinfected 6,810 Number of articles (various) destroyed 406 Disinfection Station Shelter. Persons accommodated:— Adults 1 Children — Mortuary. Number of bodies received 24 Number of infectious bodies received 1 Number of bodies removed to Public Mortuary on Sanitary grounds 3 Number of bodies detained in Mortuary Chapel 20 47 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. 50, Upper Cheyne Row. Failing to comply with Council's notice to reconstruct drainage. Kensington 13.2.34 Withdrawn. Costs £3 3s. Od. Work completed. Falstaff House, Dartrey Rd. Failing to comply with Council's notice to carry out repairs and cleansing. Kensington 20.3.34 Order, 14 days. Failing to comply with Council's notice to carry out repairs and cleansing. Kensington 20.3.34 Order, 14 days. Failing to comply with Council's notice to carry out repairs and cleansing. Kensington 20.3.34 Order, 14 days. Failing to comply with Council's notice reprovision of dustbin. Kensington 20.3.34 Fined £1. 43, Ives Street. Failing to comply with Council's notice to provide efficient roof covering. Kensington 18.12.34 Order 14 days. 437a, King's Road Exposing for sale articles of food unfit for the food of man. Kensington 2.10.34 Fined 10s. Unlawful obstruction of Sanitary Inspector in execution of above Act. Kensington 2.10.34 Fined £2. LONDON COUNTY COUNCIL (DRAINAGE) BYELAWS. 38, Lowndes Square. Failing to submit plans of proposed drainage work. Kensington 15.5.34 Fined £2. Costs £1 1s. Od. Failing to give 24 hours' notice of intention to commence work. Kensington 15.5.34 Fined £2 Costs £1 Is. Od. nuisance BY dogs. Failing to comply with Council's bye-law refouling of footway in Manor Street. Kensington 13.2.34 Fined 10s. 48 Smoke Abatement.—It is part of the work of a Sanitary Inspector to observe any nuisance arising from smoke. There were 30 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. Ten 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 one prosecution was taken for infringement of the byelaw, and a conviction was obtained. 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 130 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 £2 12s. 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 1934, 25 pigeons were captured and humanely destroyed. 49 TABLE No. 33. Number of Premises. Number of inspections during 1934. Number of notices served during 1934. Number of prosecutions during 1934. On register at end of 1933. Added in 1934. Removed in 1934. On register at end of 1934. 1. Premises used for Business Purposes:— Milk Premises 72 2 4 70 130 4 — Cowsheds - - - - — Ice Cream Premises 30 30 41 — — Butter and Margarine 10 10 10 — — Manufacturers and Dealers:— Fried Fish Premises 14 14 31 3 — Fish Curers 5 5 8 — — Bakehouses 26 26 36 4 — Slaughterhouses 1 1 21 — — Food Stalls 46 - — 38 under daily observation — — Offensive Trade Premises — — — — — — — 2. Premises used for Human Habitation Houses let in lodgings 529 40 569 40 — — Common Lodging Houses 2 2 24 2 — Canal Boats — — — - 50 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 242. The number of inspections of these premises was 329, which compares with 256 in 1933. Sanitary defects were found in 25 instances. The following Table No. 34 is in the form requested by the Home Office in order to ensure uniformity in the presentation of returns:— TABLE No. 34. Factories, Workshops, Workplaces, and Homeworkers' Premises. I.—Inspection of Factories, Workshops and Workplaces. (Including Inspections made by Sanitary Inspectors). Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers prosecuted. (4) Factories (including Factory Laundries) 17 4 — Workshops (including Workshop Laundries) 306 16 — (Workplaces (other than Outworkers' premises) 6 — — Total 329 20 — 51 2.—Defects found in Factories, Workshops and Workplaces. Particulars. (1) Number of Defects. Number of offences in respect to which Prosecutions were instituted. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Acts:—* Want of cleanliness 10 10 - — Want of ventilation 3 3 - — Overcrowding — — - — Want of drainage of floors — — - — Other nuisances 6 6 - — Sanitary accommodation:— Insufficient 2 2 - — Unsuitable or defective — — - — Not separate for sexes 4 4 - — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) Other offences - — - — (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921). Total 25 25 — — * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshops 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. 1933 16 10 39 169 — 40 - - - - - - 1934 14 11 34 160 — 32 - - - - - - 52 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 1934 24 1. To await Inquests:— (a.) Infectious — (b.) Non-infectious 4 2. Sanitary grounds 4 Number of Post Mortem examinations 20 Number of bodies detained in Mortuary Chapel 20 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. 53 SECTION IV.—HOUSING. In accordance with the instructions of the Ministry of Health, the following tabular statement has been prepared:— TABLE No. 35. HOUSING STATISTICS FOR THE YEAR. 1. Inspection of Dwelling-houses During the Year:— (1) (a.) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 833 (b.) Number of inspections made for the purpose 5435 (2) (a.) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 173 (6.) Number of inspections made for the purpose 2344 (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 373 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 — 54 (B) Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 468 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a.) By owners 72 (b.) 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 (2) Number of dwelling houses demolished in pursuance of Demolition Orders — D. roceedings 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 conditions which appertain to the district. Probably in few London boroughs have there been so many alterations, consequent on demolitions and reconstructions, during the past 35 years, as in Chelsea. The process of reconstruction is still in progress, though largely suspended by the operation of the Rent Restriction Acts. The developments which have taken place have arisen from the fact that a very considerable proportion of Chelsea is comprised within the areas of two large estates—the Cadogan Estate and the Sloane Stanley Estate. Many of the building leases on these estates were granted early in the 19th century and a large number have already expired. A certain proportion of demolition of small property has been due to the acquisition of land by large trading corporations. 55 Owing to the proximity of the eastern boundary of the Borough to Hyde Park and Belgravia, and to the attractiveness of the Embankment forming the southern boundary, residential values in these neighbourhoods have greatly appreciated in recent years, the price of land has been correspondingly increased, and the old type of small house, accommodating the small trader and the artizan or labourer, has been replaced by modern houses and mansions let in flats commanding high rents. The process of development has been largely in the hands of Estate Companies, who have purchased the reversionary interests of the ground landlords, and proceeded to carry out the demolitions and reconstructions, as soon as the property came into their possession. Until subsequent to the War, no restriction operated, nor did any liability attach to Estate Companies, conducting operations of this nature, to make any provision for rehousing the working classes displaced. Despite the difficulties of the problem, in Chelsea a considerable amount of accommodation had been provided for the working classes during the years preceding the outbreak of War. This had been effected by municipal undertakings, by private enterprise and by the operation of benevolent agencies and trusts. Sufficiency of Supply of Houses.—Municipal undertakings for the housmg 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 108 325 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 (page 56). 56 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 materialised, approval of the others not being obtained on the ground that the cost of the land was much higher than the price the Ministry could sanction for the purchase of land to be used for the erection of buildings to house the working classes. These buildings are now fully occupied. Details of each approved scheme are shown in table No. 38 (Page 60). 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. 57 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. Councillor 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 County Council's Estates from their work is too great. Others have become attached to the district and will not coltemplate 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 overcrowding during the year. Whenever possible, arrangements are made with the London County Council for the provision of a house for the overcrowded family. Fifty-one such families obtained accommodation on the Council's Estates during the year. Further, when vacant tenements become available in the Borough Council's dwellings preferential treatment is as far as possible given to cases of overcrowding. With a view to preventing a recurrence of overcrowding in premises which are being vacated because of their overcrowded condition, a cautionary letter is always sent to the landlord concerned, warning him that action will be taken against him in the event of a recurrence of overcrowded conditions in the premises. Fitness of Houses.—The general standard of housing in the Borough is satisfactory. There has been a very definite improvement in housing conditions during the past nine 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 determination 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 modem standards of sanitation and convenience. It is probable that only a minority of the tenants would be able to pay economic rents for alternative accommodation, having regard to the rents that require to be fixed for new 58 dwellings, owing to the greatly increased cost of land and construction during recent years. Another problem is caused by certain old people, usually women. Many of these live alone in a single room with no one to look after them. Frequently they rely almost entirely on the Old Age Pension for sustenance. Gradually growing feebler with the passage of time, they eventually become unable properly to care for themselves or their homes. Although every means of persuasion is tried, these cases usually decline to enter a Poor Law Institution and the condition often persists for a lengthened period. Fortunately, this problem has now been met by legislation. Under the London County Council (General Powers) Act, 1928, it is possible to arrange for the removal of such cases to a suitable institution. While in the majority of instances the defects found to exist in unfit houses are due to the lack of proper management and supervision by owners, from time to time complaints are made by the owners regarding the difficulties they experience in keeping their property in a reasonable state of repair because of the dirty and destructive habits of a number of their tenants. It is alleged that, through carelessness or wilful damage by tenants, repairs and cleansing have to be carried out with unreasonable frequency and that, as a consequence, it is impossible to maintain even the minimum requirements of the Local Authority without incurring financial loss. Investigation has shown that these statements are often well-founded, especially in the poorer class tenement lodging houses where no responsible caretaker or landlord is resident. To lighten the difficulties of the owner in these cases, effort is made, as fax 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 two dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation. The total number of dwelling houses inspected for housing defects was 833, the number found not to be in all respects reasonably fit for human habitation being 468. The number rendered fit in consequence of informal action by the Sanitary Inspectors was 373, and the number in respect of which statutory notices were served requiring defects to be remedied was 72. One case came to the knowledge of the Department in the course of the year of an underground room being illegally used for sleeping purposes. The room was subsequently vacated, and is not now 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.—No representation was made under the Housing Act during the year. No complaints that areas were unhealthy have been received. 59 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. 60 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, 28½ 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 . 61 SECTION V.—INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—In accordance with statutory enactments, the Council keeps a Register of persons carrying on the trade of dairymen or purveyors of milk and no person is permitted to carry on the trade in the Borough unless he is registered. The Council is empowered to remove the name from or refuse to enter upon the Register the name of any person selling or proposing to sell milk on premises which are for any reason unsuitable for the purpose. The Milk and Dairies (Amendment) Act, 1922, further empowers the Council to refuse to enter the name of any person in the Register, or to remove the name of any person from that Register, if it is shown to the Council's satisfaction that the public health is or is likely to be endangered by any act or default of such person in relation to the quality, storage or distribution of milk. The premises at which registered purveyors of milk carry on their business have been subject to frequent inspection. During the year four applications were made for registration as purveyor of milk, which, after appropriate investigation, were approved by the Council. In Table No. 33 (page 49) is shown the alterations which took place in the Register of Milk Purveyors during the year. During the year there were 130 inspections of dairies and milkshops made in the Borough. Notices were served requiring remedy of defects found on four of the premises visited. There are no cowsheds in the district. Milk (Special Designations) Order.—There were 43 applications from 20 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. 1933. 1934. To sell "Certified" Milk 8 7 To sell "Grade A" Milk 1 1 To sell "Grade A Pasteurised" Milk 1 1 To sell "Grade A (Tuberculin Tested)" Milk 11 14 To sell "Pasteurised" Milk 13 16 Supplementary Licences 11 4 45 43 62 Six 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 16 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 21 inspections of these premises were made during 1934. 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 49) 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 36 inspections of these premises were made during the year. Four 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 41 inspections of these premises as compared with 30 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 31 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. 63 Table No. 33 (page 49) shows, for the past two years, the number of inspections of premises where food was prepared for or exposed for sale. Unsound Food.—On one occasion during the year, unsound food was seized by a district Sanitary Inspector, condemned and ordered to be destroyed by a Magistrate. The food concerned (four mackerel) was the subject of a successful prosecution, a conviction being obtained. Included in the unsound food surrendered and destroyed during the year was:— 18 lbs. Ox Liver. 16 stone of Meat. 4 Mackerel. 7 stone of Fish. 2 boxes of Tomatoes. 2 boxes of Oranges. 14 lbs. of Kippers. 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 121 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. 64 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. 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. Six 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. 65 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 705. Of this figure, 85 were notifications of Pulmonary Tuberculosis and 19 of Non-pulmonary Tuberculosis. In addition, 596 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 increase of 56 in the number of notifications of Diphtheria. The number of notifications of Scarlet Fever (193) represents a decrease of 36, as compared with that for 1933. The number of notifications of Tuberculosis was 104, an increase of 4, as compared with that for 1933. Table No. 40 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 66 TABLE No. 40 Cases of Infectious Disease Notified during the Year. Cases notified in Chelsea. Cases notified in each Ward. 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. Stanley Cheyne Church Hans Town Royal Hospital Small-pox — — — — — — — — — — — __ — Chicken-pox 98 12 38 36 10 1 1 44 8 38 7 i 37 Cholera _ — — — — —- Diphtheria 147 1 48 57 29 9 2 1 56 23 44 16 9 140 Erysipelas 39 1 3 4 9 15 7 22 — 8 3 6 29 Scarlet Fever 193 2 45 107 19 17 3 112 35 26 11 9 186 Typhus Fever — — — — — — — — — — — — — Enteric Fever 3 — 1 2 2 — — 1 — 2 Puerperal Fever 3 — — — 2 1 — 2 1 — — — 3 Puerperal pyrexia 9 — — — 2 7 — — 5 1 2 1 — 8 Cerebro-spinal Fever 1 — — — — 1 — — 1 — — — 1 Ophthalmia Neonatorum 1 1 — — — — — — — 1 — — — 1 Poliomyelitis — — — — — — — — — — — — — — Encephalitis Lethargica — — — — — — — — — — — — — — Polio-encephalitis 1 — 1 — 1 — —. — — 1 Malaria 1 — 1 — — — —• 1 1 Dysentery — — — — — — — — — Acute Primary Pneumonia 97 14 26 8 7 18 18 6 50 16 18 8 5 86 Acute Influenzal Pneumonia 8 — 2 — — 2 2 2 2 1 1 2 2 4 Total 601 31 162 209 74 65 44 16 297 86 137 48 33 499 Tuberculosis:— Pulmonary 85 — 1 7 12 32 26 7 31 18 14 12 10 Non-Pulmonary 19 — 1 12 1 5 — — 10 1 3 2 3 Totals (Tuberculosis) 104 — 2 19 13 37 26 7 41 19 17 14 13 Totals 705 31 164 228 87 102 70 23 338 105 154 62 46 No cases of Small-pox, Cholera, Typhus Fever, Encephalitis Lethargica, Poliomyelitis, Continued Fever, Relapsing Fever, Plague, Dysentery, Anthrax, Glanders or Hydrophobia were notified during the year. DIPHTHERIA. Notifications.—During the year 147 cases of diphtheria were notified, as compared with 91 in the previous year. The incidence of the disease during the past two years is shown in Table No. 41. Deaths.—Ten deaths from the disease occurred during the year. Of this number, four were under the age of 5 years, five between the ages of 5-10 years, and one was an adult, aged 35 years. 67 Return Cases.—No "return" case of the disease occurred during the year. TABLE No. 41. Year Cases Notified. Percent age of Remov als. Deaths Case Mortality Rate. Percent age of cases of School age (3-13 years) Month of greatest prevalence. Bacterioscopic Diagnosis, Lister Institute. No. of Specimens submitted Positive. Percent age Positive. Negative. Percent age Negative. 1933 91 100 7 8.4 66 June 289 21 7.0 268 93.0 1934 147 95 10 6.9 55 May 319 40 12.5 279 87.5 It will be observed that there was an increase in the number of cases notified in 1934. The percentage of removals to the L.C.C. Hospitals was high, but the case mortality rate was lower than that for 1933. Information was received from the L.C.C. that 3 of the cases sent to Hospital in the course of the year proved not to be suffering from diphtheria. DIPHTHERIA IMMUNISATION. In April, 1934, the Borough Council approved a grant of £50 for immunisation against diphtheria and Schick testing to be carried out at the Violet Melchett Infant Welfare Centre for children on the register of the Centre. The first Clinic was held on November 20th, with an attendance of 15. Five sessions were held altogether during 1934, 18 children being immunised and two having the Schick test only. The response to the small amount of propaganda already effected has been such that it seems likely that a weekly Clinic may be required. It is found that at least 26 children can be dealt with in the two hours, except in those sessions in which Schick tests have to be included, as the tests require more time than need be spent on cases for immunisation. 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. Further details will be found on page 29. SCARLET FEVER. Notifications.—During the year, 193 cases of Scarlet Fever were notified, the figure for 1933 being 229. Information was received from the L.C.C. Hospitals that 9 of the cases proved not to be Scarlet Fever. Five " return " cases of the disease occurred during the year. Deaths.—There was no death from Scarlet Fever during the year. 68 Table 42 shows the incidence of the disease during the past two years. TABLE No. 42. Year. Cases Notified. Percentage of Removals. Deaths. Case Mortality Rate. Percentage of cases of School-age 3-13 years. Month of greatest prevalence. 1933 229 97 — — 68 June 1934 193 96 — — 67 Mar. 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 596, as compared with 53 in the preceding year. Of the total number (596) 368 were under five years of age. Deaths.—The number of deaths was eight, of which four were under two years of age. Visiting and Nursing.—During the year, 936 visits and re-visits were made by the Health Visitors. Cases are also visited by the District Nurses whenever circumstances render this necessary. Three hundred and eighty six visits were required in 1934. Removal to Hospital.—Cases of Measles are received in the Hospitals of the London County Council. ENTERIC FEVER. Notifications.—During the year three cases under the Enteric Fever Group were notified in Chelsea. Two of these cases were treated in hospital. The history of each case was thoroughly explored, but it was found impossible to trace an unvarying causative factor between the various cases. One specimen of blood was examined during the year for the Widal reaction. Deaths.—There were no deaths from this disease during the year. 69 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 105 Malaria 1 Dysentery None Pneumonia.—All primary pneumonias, lobar or lobular, are notifiable The only secondary pneumonia which is notifiable is influenza pneumonia. The notifications and deaths from pneumonia during the past two years were as follows :— Notifications. Deaths. (All Forms) 1933 117 44 1934 105 50 Nursing Provision.—By arrangement with the Chelsea District Nursing Association, all cases of Pneumonia receive adequate nursing attention where the circumstances render this necessary. Malaria.—The Regulations provide that the Medical Officer of Health shall take all practical steps to ensure that persons suffering from 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. One 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. Details of these cases are set out in the following table :— TABLE No. 43. Total number of cases notified. Treatment in Hospital. District Nurses in attendance Council's Obstetrician called in. Deaths. Puerperal Fever 3 3 1 0 1 Puerperal Pyrexia 0 8 0 0 0 The notifications of puerperal fever and puerperal pyrexia during the past two years were as follows:— Puerperal Fever. Puerperal Pyrexia. 1933 3 9 1934 3 9 70 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. OPHTHALMIA NEONATORUM. One case of ophthalmia neonatorum was notified during the year. As required by the Ministry of Health, particulars of the notified cases are set out in the following table :— TABLE No. 44. Ophthalmia Neonatorum. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. No. Notified. Treated. At Home. In Hospital. 1 — 1 1 — — _ Four cases of the disease were notified in the previous year. Nursing—By arrangement with the Chelsea District Nursing Association, home nursing is provided for infants suffering from this disease. POLIOMYELITIS AND POLIO-ENCEPHALITIS. No case of Poliomyelitis was notified during the year. One case of polio-encephalitis was notified and treated in hospital. ENCEPHALITIS LETHARGICA. No case of Encephalitis Lethargica was notified during the year. Six 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. Ninety-eight notifications were received during the year. Of these, 37 were treated in hospital. 71 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 1933. The figures for the year 1934 are not yet available. TABLE No. 45. Vaccinations. Number. Percentage of births registered. Births registered in 1933 938 100 Successfully vaccinated 543 57.9 Insusceptible of vaccination 7 0.7 Had Small Pox — — Statutory Declaration of conscientious objection 151 16.1 Died unvaccinated 56 6.0 Postponed by medical certificate 4 0.4 Removed to other districts 88 9.4 Removed to unknown addresses 84 9.0 Not accounted for in previous columns 5 0.5 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 1934 was 715. 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 nearest hospital for Chelsea residents is St. George's Hospital. ARRANGEMENTS FOR DISINFECTION AND DISINFESTATION AND THE EXTENT OF THEIR USE. The Borough Council maintains a Disinfecting and Cleansing Station situated at 9a, Lots Road, Chelsea, adjoining the river. 72 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 tor 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-seven such disinfections were carried out during the year, the total charges amounting to £22 13s. (3d. On page 40 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, Lots Road, for families in which cases of dangerous infectious disease have occurred, and who have been compelled to leave their dwellings for purposes of enabling such dwellings to be disinfected. One adult was accommodated at the shelter during the year. Disinfestation.—The female shelter attendant is also employed in connection with the work of the Cleansing Station. In 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 85 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 23 127 — June 23 169 — September 17 138 — December 22 106 — 85 640 — 73 The amount recoverable from the London County Council, as the School Authority, for the cleansing for the year is £54. Thirty-one 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. Notifications.—The total number of notifications received was 132, but 28 of these related to cases which had been previously notified, so that the total number of new notifications was 104. In the previous year, the corresponding number was 100. 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 22 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 1934. Age Periods. New Cases. Deaths. Pulmonary. Nonpulmonary. Pulmonary. Nonpulmonary. M. F. M. F. M. F. M. F. 0— 1 — — _ 1— 5 — 1 — 2 — — — 1 5—10 2 2 5 4 — — — — 10—15 1 2 2 2 — — — — 15—20 2 4 — 1 — 1 — — 20—25 5 5 2 1 1 — 3 2 25—35 4 11 1 2 5 5 1 1 35—45 13 8 2 1 3 2 — — 45—55 11 11 — — 9 l 2 — 55—65 9 2 — — 4 l — — 65 and upwards 7 1 — — 1 — — — Totals 54 47 12 13 23 10 6 4 The death rate from all forms of Tuberculosis in Chelsea was 0.73 per 1,000. Of the total number of deaths (43) from all forms of Tuberculosis, nine died non-notified or prior to notification. The ratio of 74 non-notified tuberculosis deaths to total tuberculosis deaths was therefore as one is to five. The corresponding ratio for 1933 was 1:6. Making allowance for difficult and doubtful cases in which a diagnosis cannot be established until after death, the notification of tuberculosis is carried out fairly efficiently in the Borough. Cases of Tuberculosis in the Borough.—The Public Health (Tuberculosis) Regulations, 1930, provide that the Medical Officer of Health shall furnish to the County Medical Officer, as soon as practicable after the end of each quarter, a statement compiled from the register of notifications showing :— {a.) The number of cases of Tuberculosis on the Register at the commencement of the quarter; (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 (f.) The number of cases remaining on the register at the end of the Quarter. The returns made in accordance with these Regulations show that the numbers of cases of Tuberculosis in the Borough on 31st December last were as follows:— TABLE No. 48. Males. Females. Total. Pulmonary 162 143 305 Non-pulmonary 37 28 65 199 171 370 (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 duties of Tuberculosis Visitor in the Borough are undertaken by the staff of Brompton Hospital. A grant of £50 per annum is paid by the Borough Council for this service. The Tuberculosis Visitor in the course of the year paid 113 visits to nondispensary cases of Tuberculosis. Visits made to Dispensary cases of Tuberculosis are recorded in Table No. 49. 75 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. 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 77), has been compiled showing in summary form the condition of all patients whose case records were in possession of the Tuberculosis Dispensary at the end of 1934, 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. 76 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 32 28 2 1 1 0 4 3 33 34 6 4 419 (b) Diagnosis not completed — — — — — — — — 1 — — — (c) Non-tuberculous — — — — — — — — 91 141 64 45 B.—Contacts examined during the year:- (a) Definitely tuberculous 1 — —- 4 — — 3 — 1 — 3 4 170 (b) Diagnosis not completed — — — — — — — — — 2 1 — (c) Non-tuberculous — — — — — — — — 22 36 40 61 C.—Cases written off the Dispensary Register as:— (a) Recovered 8 5 — — — 2 3 5 8 7 3 5 526 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 113 178 105 107 D.—Number of Cases on Dispensary Register on December 31st (a) Definitely tuberculous 132 112 6 5 10 16 19 13 142 128 25 18 315 (b) Diagnosis not completed — — — — — — — — 1 1 — — 1. Number of cases on Dispensary 2. Number of cases transferred from Register on January 1st 328 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 4. Cases written off during the year further assistance under the as Dead (all causes) 30 scheme, and cases " lost sight of" 76 5. Number of attendances at the Dis- 6. Number of Insured Persons under pensary (including Contacts) 2,387 Domiciliary Treatment on the 31st December 6 7. Number of consultations with 8. Number of visits by Tuberculosis medical practitioners:— Officers to homes (including (а) Personal — personal consultations) 59 (б) Other 100 10. Number of:— 9. Number of visits by Nurses or (o) Specimens of sputum, etc., Health Visitors to homes for examined 283 Dispensary purposes 3,375 (6) X-ray examinations made in connection with Dispensary work 509 11. Number of "Recovered" cases 12. Number of "T.B. plus" cases on restored to Dispensary Register, Dispensary Register on Decemand included in A (a) and A (6) ber 31st 129 above 2 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 1934- | 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 Class T.B. minus. Class t.b. plus Class T.B. minus. Class T.B. plus riagg 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. minns. Class T.B. plus- Group 1. Group 2. Group 3. Total (Class T.B. plus) Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1 Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. phis) 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. 2 4 2 — 6 — — — — — — — — — — — — 1 — 1 6 1 1 — 2 6 — — — — 1 — 1 — 1 3 — — — — — — — — — — — _ — — F. 1 5 — — 5 2 — — — — 1 — — — — 3 — — — — 3 1 — — 1 8 1 — — 1 5 — — — — 2 — — — — — — — — — — — — — — Children — — — — — 1 — — — — — — — — — — — — — — — — — — — 1 — 1 — 1 — — — — — — — — — — — — — — — — — — — Disease not Arrested Adults m. 3 4 6 — 10 — 1 3 2 6 2 — 1 — 1 — — 2 — 2 — 2 1 — 3 1 1 1 — 2 3 2 4 — 6 6 2 3 1 6 9 2 10 — 12 8 3 10 4 17 F. 2 — 2 — 2 1 1 1 — 2 1 1 — — 1 — — — — — 3 1 1 — 2 3 — 2 — 2 2 2 2 — 4 8 2 6 2 10 6 1 6 — 7 8 1 10 2 13 Children — — — 1 1 — — — — — — — — — — — — — — — — — — — — 1 — 1 — 1 — — — — — 4 — — — — 1 — — — 7 — — — — Condition not ascertained during the year 1 — 1 — 1 — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 9 13 11 1 25 4 2 4 2 8 4 1 1 2 3 — 3 — 3 12 5 3 — 8 21 2 5 — 7 11 4 7 — 11 23 4 9 3 16 16 3 16 — 19 23 4 20 0 30 (b) Not now on Dispensary Register | and reasons for removal therefrom. Discharged as Recovered Ad'lts m. 14 5 4 — 9 1 — 1 — 1 1 — — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — F. 13 6 2 — 8 2 — — — — 6 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Children 10 1 — — 1 — — — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 80 39 40 5 84 6 4 6 1 11 6 2 11 1 14 9 5 6 — 11 8 9 4 2 15 9 8 6 2 16 13 7 8 2 17 10 4 10 — 14 20 6 8 1 15 5 — 3 — 3 Dead Ad'lts M. 24 25 87 36 148 2 4 7 4 16 2 1 8 3 12 — 3 5 5 13 4 1 10 2 13 4 4 9 4 17 1 1 5 1 7 — — 14 4 18 4 1 5 2 8 2 — — 3 3 F. 18 11 38 30 79 1 1 4 5 10 4 — 7 4 11 — 1 5 5 11 — 1 1 5 7 — 2 2 2 6 1 — 5 2 7 — — 3 2 5 1 — 1 1 2 — 1 1 1 3 Children 4 — 5 — 5 — — — — — — — 1 — 1 — — 1 1 2 — 1 — — 1 — 1 1 — 2 — — — — — 2 — — — — — — — — — — — — — — Total written off Dispensary Register 163 87 176 71 334 12 9 18 10 37 19 3 27 8 38 10 9 17 11 37 13 12 15 9 36 13 15 18 8 41 15 8 18 6 31 12 4 27 6 37 26 7 14 4 25 7 1 4 4 9 Grand Totals 172 100 187 72 359 16 11 22 12 45 23 4 28 8 40 13 9 2C 11 40 2£ 17 18 9 44 34 17 23 8 48 26 12 25 6 42 35 8 36 9 53 41 10 30 4 44 30 5 24 10 39 TABLE No. 50 (continued). Non-Pulmonary Tuberculosis. Condition at the time of the last record made during the year to which the return relates. Previous to 1926. 1926. 1927. 1923. 1929. 1930. 1931. 1932. 1933. 1934. 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. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. | (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults m. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 1 2 2 — — — 2 — — —1 1 1 — — — — — f. — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — 1 2 — — — — — 2 — 1 — 3 1 1 — — 2 — — — — — Children 2 — — _ 2 — — _ — - 2 — — — 2 - — — — — — — — — — — — — 2 2 — — — 3 3 1 — — 2 3 — 1 — 2 3 — — — 6 6 Disease not Arrested. Adults m. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 — 2 — — — 1 1 f. 1 — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 2 2 1 — — — 1 3 — — 1 4 Children — — — — — — — — 1 1 — — — — — — — — — — — 1 — 1 2 1 — — — 1 — — — — — 1 — — 1 2 — 1 2 3 1 1 — 3 5 Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 3 — — — 3 — — — 1 1 2 — — — 2 — — — — — — 1 — 1 2 2 — — 3 5 — — 1 4 5 6 — 1 5 12 3 3 1 5 12 4 1 — 11 16 (b) Not now on Dispensary Register | and reasons for removal therefrom. Transferred to Pulmonary 1 — — — 1 — — — — — — — — — — — — — — — — — — — — 1 — 1 — 2 — — — — — — — — — — — — — — — — — — — Discharged as Recovered Adults M. 1 — — — 1 — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — f. — — — 1 1 — — — — — 1 — — — 1 — — — — — — — — — — — — — 1 1 — — — 1 1 — — — — — — _ — — — — — — — — Children 4 — — 12 16 — 1 — 5 6 — — — — — — — — — — — 1 — 2 3 — — — 4 5 — 1 — 1 2 — — — — — — — — — — — — — — Lost 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 3 — 4 2 9 1 2 1 4 4 3 1 4 12 — 2 2 — — 2 2 Dead Adults m. — — — — — — — 1 — 1 — — — — — — — — — — — — — — — 1 — — — 1 — — — — — — — — — — — — 1 — 1 — — — — — f. — — — 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Children 1 — — — 1 — — 1 — 1 — — — — — — — — — — — — — — — — — — — — 1 — — 1 2 — 1 — — 1 — — — — — — — — — — Total written off Dispensary Register 11 1 1 24 37 4 1 2 9 16 5 1 1 1 8 4 — 1 1 6 1 1 — 2 4 4 1 4 7 16 2 3 1 3 9 4 4 1 4 13 — — 1 2 1 — — — 2 2 Grand Totals or (a) and (b) (excluding those transferred to Pulmonary). 14 1 1 24 40 4 1 2 10 17 7 1 1 1 10 4 - 1 1 6 1 2 — 3 6 6 1 4 10 21 2 3 2 7 14 10 4 2 9 25 3 3 2 7 15 4 1 — 13 18 (Signed) w. h. L. McCarthy, Chief Tuberculosis Officer. 79 Chelsea Tuberculosis Dispensary.—This Dispensary, located at Brompton Hospital, provides highly efficient treatment for all cases resident in the Borough. By agreement with the Borough Council, adequate Medical, Nursing and other necessary services are provided. The Tuberculosis Officer (Dr. W. J. Fenton) is one of the Honorary Physicians to the Hospital and his services are available when required by any medical practitioner in the Borough. Social work in connection with the Dispensary cases is carried out systematically and well by a trained Social Worker. 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, 1934. 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. 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. 1933 396 13 per cent. 2,197 1934 384 11 2,387 Institutional Treatment.—The London County Council, the authority mainly responsible for the institutional treatment of Tuberculosis in London, maintains St. George's Home, in Milman's Street, Chelsea, as a receiving hospital for cases of pulmonary tuberculosis (females). Of the cases which terminated fatally during the year, 58 per cent, died in St. Luke's Hospital and 26 per cent, in other public institutions, that is to say 84 per cent, died away from their homes, the corresponding figure for 1933 being 77 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 80 ditions, 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 affoid valuable help in deciding what supervision is desirable in connection with children. Many children are referred direct to the School Clinic for the treatment of minor ailments and dental caries. Co-operation with Medical Practitioners.—During the year the Tuberculosis Officer visited 59 cases (including personal consultations) at the homes of the patients, and 100 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 170, an increase of 39 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. During the year six patients received treatment. The total cost (£04 1s. 0d.), was borne by the Borough Council. 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 3,375, a decrease of 58 over the number for the previous year. The Council lent a bedstead and bedding to one case during the year. Extra Nourishment.—Sixteen 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 (£17 6s.) was borne by the Borough Council. Non-Tuberculous Cases.—All cases examined 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. 81 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 Officer is required and dental treatment must be shown as necessary to render other treatment more completely efficacious. During the year seven patients thus received dental treatment. Batceriological Examinations.—During the year, 283 specimens of sputum were examined in connection with the work of the Dispensary. In addition, 34 specimens were sent by medical practitioners to the Lister Institute for examination. Care Work.—The Chelsea Tuberculosis Care Committee, constituted on the basis advised by the Ministry of Health in 1922, took over in that year the work of the former Interim Care Committee which had been formed by the Borough Council in 1917. The Committee now includes the following representation and membership :— Chelsea Borough Council London County Council Chelsea Invalid Children's Aid Association Public Assistance Committee Chelsea Charity Organisation Society. Chelsea District Nursing Association. Chelsea Health Society Brompton Hospital Local Panel Committee London Insurance Committee Local War Pensions Committee and United Services Fund. St. George's Hospital British Red Cross Society Victoria Hospital Local General Practitioner Councillor Lady Phipps. Dr. A. W. Sikes (Divisional Medical Officer). Miss Paddon (District Organiser of School Care Committees). Mrs. E. E. Potton (After-care Committee). Miss B. M. S. Caudwell and Miss G. M. Burton. Mrs. E. Howard. Mrs. L. Fraser. Miss Larken. Miss Page. Mrs. Melville Miller. Miss Marx. Dr. A. M. Gibson and Dr. E. F. Thomas. Mr. R. A. Hanson. Miss Forbes. Lady Almoner. Miss M. Woods. Miss White. Dr. W. F. Hannay, 82 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. 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 23 Cases Assessed 120 Cases reported admitted to L.C.C. Institutions 132 Dental treatment given through Borough Council Scheme 7 Extra npurishment given through Borough Council Scheme 16 Extra nourishment given through other agencies 4 Temporary assistance arranged 18 Children boarded out through the L.C.C. Contact Scheme 5 Children otherwise " arranged for " 1 Convalescence arranged 45 Patients' contributions towards the cost of Institutional treatment collected on behalf of the L.C.C. £90 3s. 3d. (Excluding payments for children collected by the I.C.A.A.) Metropolitan Borough of Chelsea. Annual Report OF THE PUBLIC ANALYST For the Year ended 31st December, 1934. BY B. HENRY GERRANS, F.I.C., Public Analyst. 84 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, 1934, four hundred samples of Food and Drugs were submitted to me for analysis by the Sampling Officers appointed under the Act. Twenty-six 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 118 5 — 1 — — 124 Butter 34 — — — 2 — 36 Tea 25 — — — — — 25 Margarine 24 — — — — — 24 Cocoa 22 — — — — — 22 Mustard Mixture 11 — — — — — 11 Cream 7 2 — — — — 0 Rice 9 — — — — — 9 Lard 8 — — — — — 8 Flour 8 — — — — — 8 Coffee and Chicory 7 — — — — — 7 Coffee 6 1 — — — — 7 Sugar 7. — — — — — 7 Custard Powder 7 — — — — — 7 Self-raising Flour 6 — — — — — 6 Pepper 4 1 — — — — 5 Cornflour 4 — — — — — 4 Currants 4 — — — — — 4 Sausages — 1 — 3 — — 4 Blanc Mange Powder 3 _ — 3 Ground Rice 3 — — — — — 3 Sultanas 3 — — — — — 3 Dried Peas 2 — — — — — 2 Cordials 3 — — — — — 3 Sauce 3 — — — — — 3 Baking Powder 2 — — — — — 2 85 TABLE I—continued. Name of Sample. Genuine Composition or Not Adulterated. Adulterated. Inferior. Total. " Formal." "Informal." *' Formal." " Informal." " Formal." " Informal." Beans 2 — — 2 Raisins 2 — — — — — 2 Cake 2 — — — — — 2 Extract of Coffee and Chicory 2 — — — — — 2 Sardines in Olive Oil 1 1 — — — — 2 Fish Paste 2 — — — — — 2 Cheese 2 — — — — — 2 Split Peas 1 — — — — — 1 "Cakeoma" 1 — — — — — 1 Lemonade Crystals 1 — — — — — 1 Pearl Barley 1 — — — — — 1 Flaked Tapioca 1 — — — — — 1 Gravy Thickening 1 — — — — — 1 Shredded Suet 1 — — — — — 1 Macaroni 1 — — — — — 1 Olive Oil 1 — — — — — 1 Malt Vinegar 1 — — — — — 1 Golden Plums 1 — — — — — 1 Kipper Snacks 1 — — — — — 1 Small Herrings 1 — — — — — 1 Beef Extract 1 — — — — — 1 Tinned Salmon 1 — — — — — 1 Asparagus 1 — — — — — 1 Prepared Mustard 1 — — — — — 1 Iodine Ointment —— — — — 1 — 1 Small Sild 1 — — — — — 1 Vaseline 1 — — — — — 1 Aspirin 1 — — — — — 1 Bismuthated Magnesia 1 — — 1 Puffed Rice 1 — — — — — l Gelatine 1 — — — — — 1 Dried Mint 1 — — — — 1 Muscatels 1 — — — — — 1 Almonds 1 — — — — — 1 Dessicated Coconut 1 — — — — — 1 Sponge Cakes — 1 — — — — 1 Mince Tart — 1 — — — — 1 Potato Salad — 1 — — — — 1 Brawn Paste — 1 — — — — 1 Cream Cheese — 1 — — — — i Tinned Cream — 1 — — — — 1 Mint Sauce — 1 — — — — 2 Honey — 1 — — — — 1 Chocolates — 1 — — — — 1 Cold Cream — 1 — — — — 1 Cream Bun — — — 1 — — 1 Peas, Tinned 1 — — — — — 1 371 21 0 5 3 0 400 Totals 392 5 3 The percentages given by the data in Table I are as follows :— Genuine Composition 98.0 per cent. Adulterated 1.25 per cent. Inferior 0.75 per cent. 86 MILK. The informal sample reported as adulterated was certified to contain 2 per cent, of added water. 4. Of the 124 samples supplied 123 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," 51 being of "Good" quality, 62 of " Fair " quality and 10 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 :— 42, 41, 40, 38, 36 (2) and 35, and therefore the composition of these mixtures had been correctly described. SAUSAGES. 7. The 3 Informal samples of Sausages were certified to contain 68.66, 109.8 and 178.5 parts per million of sulphur di-oxide respectively. These amounts were below the limit of 450 parts per million, laid down in the Regulations. CREAM. 8. The fat of all the samples had the composition of fat derived from milk, they were free from preservatives, and had the composition of samples of genuine Cream. CUSTARD POWDER. 9. 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. BUTTER. 10. The 2 samples reported as inferior contained the following percentages of water : viz., 15.13 and 15.23. These amounts are below the extreme limit of 16 per cent, of water laid down by the Act, but in view of the high percentages, the samples were reported as inferior. CREAM BUN (INFORMAL). 11. This sample, reported as adulterated, contained 30 per cent, of fat and of this amount 24 per cent. (80 per cent, of the Cream portion) consisted of fat other than Butter fat. 87 CORDIALS. 12. Two of these samples, Ginger and Peppermint, contained traces of Benzoic Acid, well under the limit allowed. IODINE OINTMENT. 13. The sample was reported as Inferior in view of the fact that there appeared to be some deficiency of Iodine, but there was not sufficient evidence obtained. DRIED MINT AND MINT SAUCE. 14. No Ailanthus Leaves, or Tree of Haven Leaves were detected in these samples, and they were reported as genuine. PEAS (TINNED). 15. These Peas were dyed with an organic colouring matter, but in the absence of any official definition of the article the sample was reported as genuine. CURRANTS AND RAISINS. 16. These samples consisted of the dried varieties of the articles, they were free from preservatives, and were reported as genuine. SULTANAS (DRIED). 17. One of the samples contained 260.9 parts of Sulphur di-oxide per million, an amount well below the limit for this preservative allowed by the Regulations. MARGARINE. 18. All the samples were of genuine composition, and contained less than 10 per cent, of Butter Fat, as required by the Act. DRUGS. (Aspirin, Bismuthated Magnesia, Vaseline and Cold Cream.) 19. These substances had the normal composition of the various articles, and they were reported as genuine. MUSTARD MIXTURE. 20. All the samples consisted of mixtures of Mustard with small percentages of Wheat Flour, but as admixture was duly notified at the time of the sale they were reported as genuine. 88 FLOUR. 21. One of the samples contained a slight trace of Nitrites, well below the limit allowed, but it was otherwise genuine. 22. 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. 23. There were 3 cases 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.