AC4345 M CHE 40 Metropolitan Borough of Chelsea. REPORT OF THE MEDICAL OFFICES OF HEALTH FOR THE YEAR 1936 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 & CO. LTD., Printers, 170, FARRINGDON ROAD, LONDON, E.C.4. Metropolitan Borough of Chelsea. Annual Report of the Medical Officer of Health for CHELSEA 1936 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. 1937, 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 1936. 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 56,500, a figure which is below that for last year. The birth rate (11.3) is higher than that for last year (10.2). The marriage rate (14.8) is also higher than that for last year (13.0). The death rate (13.7) is higher than that for London generally (12.5) and compares with 12.6 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 is 53 per 1,000 live births, as compared with 59.6 last year. The general improvement in the public health of the Borough continues to be maintained. There was an increase In the total incidence of notifiable infectious disease during the year. The total number of notifications, excluding duplicates, was 648, as compared with 483 last year. A considerable increase was recorded in the number of cases of measles. At the end of the year there were 259 cases of pulmonary tuberculosis and 51 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 7,192, and 7,223 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 Further progress was made in connection with the Survey of Working Class dwelling houses in the Borough, in accordance with the requirements of Part 1, section 1, of the Housing Act, 1935. The problem of abating overcrowding is receiving close consideration by a Special Committee of the Council. I have again to express my appreciation of the work of the staff of the Public Health Department. With regret I have to record the death on 12th August, after a short illness, of Mr. B. H. Gerrans, F.I.C. Mr. Gerrans joined the staff as Public Analyst in 1925, and throughout his period of service discharged his duties conscientiously and well. I should like to thank the members of the Public Health, Maternity, Child Welfare, and other Committees for the support and sympathetic consideration which they have extended to me, and for their keen attention to the problems which it has been my duty to lay before them. Copies of this report have been transmitted to the Ministry of Health, the Home Office and the London County Council, in accordance with statutory requirements. I am, 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 31 st December, 1936. His Worship the Mayor (Alderman Lt.-Col. S. Boyle, M.C., J.P.) Councillor H. Courtney Browne (Chairman). Alderman Miss C. Fulford. Lt.-Col. D. G. Adams. L. R. Andrews. E. B. Baggallay. G. A. Beaton. F. G. Chambers. Mrs. M. S. M. Elliott. Mrs. M. I. Hewitt. Councillors: J. Lilly. Miss C. L. Paterson. Lady Phipps. G. M. Stevenson. Mrs. C. M. Vaughan-Morgan. Mrs. C. Williams. Housing Committee. His Worship the Mayor (Alderman Lt.-Col. S. Boyle, M.C., J.P.) Councillor E. B. Baggallay (Chairman). Alderman F. J. Synge. Councillors: L. R. Andrews. Lady Meinertzhagen. D. H. Boggis-Rolfe. Miss C. L. Paterson. Mrs. M. S. M. Elliott. Lady Phipps. H. G. Evans. Mrs. C. M. Vaughan-Morgan. B. Marsden-Smedley. Mrs. C. Williams. Milk and Welfare Sub-Committee. His Worship the Mayor (Alderman 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, 1936, 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 M.R.C.S., L.R.C.P., Medical Officer, F. D.P.H. ternity and Child Welfare (Part time). 1928 Nelson, Grace M. M.R.C.S., L.RC.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., F.R.C.S., Medical Officer, L.R.C.P. nity and Child Welfare (Part time). 1935 Hamilton, C. K. J. M.B., F.R.C.P. Hon. Medical Director, Mothercraft Training Home, and Medical Officer, Chelsea Day Nursery (Part time). 1935 Chiesman, W. E. M.D., M.R.C.P. Asst. Medical Officer Mothercraft Training Home and Chelsea Day Nursery (Part (time). 1929 McCullagh, W. McK. M.B., F.R.C.S. Consultant for peral Fever and Puerperal Pyrexia (Part time). 1930 Holland, E. T. M.R.C.S., L.R.C.P. Public Vaccinator, St. Luke's Hospital (Part time). 1930 Sandiland, D. S. M.R.C.S., L.R.C.P. Public Vaccinator, St. Stephen's Hospital (Part time). 1933 Thomas, E. F. M.D., D.P.H. Public Vaccinator, Chelsea District (Part time). 6 (b.) Other Staff. Year Appointed. Name. Qualifications. Appointment. 1936 McLachlan, T. A.C.G.F.C., 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 SheUey, A. P. T. Cert. San. Insp. Exam. Board. Sanitary Inspector (Whole time). 1930 Hoy land, 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). t 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. S.R.N.,Cert.Gen.Hosp. Training, C.M.B.,and Cert. Mothercraft Training Society. Health Visitor, Chelsea Health Society (Half time). 1936 Hatt, Miss J. K. M. S.R.N., Cert. Gen. Hosp. Training, C.M.B., Royal San. Inst. Health Visitors' Cert. Health Visitor, Chelsea Health Society (Half time), Supt. of Play Centre (Half time). 1929 Broad, Mrs. E. M. S.R.N.,Gen. Hosp. Cert. Ashton - under - Lyne Hosp., Cert. C.M.B. Matron, Chelsea Day Nursery(Wholetime). 1936 Walker, Miss L. S.R.N., C.M.B., Cert. M.T.S. Matron, Mothercraft TrainingHome(Whole time). 1928 Squire, Miss H. M. L. Cert. Inst, of Hospital Almoners.Cert. Social Science (London School of Economics). Cert. San. Insp. Exam. Board. DiplomaNat. Health Society. Secretary of Chelsea Tuberculosis Dispensary, Tuberculosis Visitor and Social Worker in connection with Tuberculosis (Whole time). 1936 Mann, Miss Cert. General Hospital Training and Tuberculosis. Tuberculosis Nurse to Dispensary (Whole time). 1 Year Appointed. Name. Appointment. 1914 Hayden, A. B. J. Chief Clerk and Vaccination Officer, 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). 1936 Pittman, Miss R. General Secretary, The Violet Melchett Infant Welfare Centre (Whole time). 1035 Bennett, Miss H. M. Assistant Secretary, The Violet Melchett Infant Welfare Centre, (Part time). 1923 Godfrey, Miss Clerk, Chelsea Health Society (Part time). 1935 Gilliatt, Miss E. A. Matron's Secretary, Mothercraft Training Home (Full 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). 1931 Evans, Mrs. Home Help (Part time). 1936 Clark, 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 5 (0) 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 17 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 (а) General 25 (б) Infectious Diseases 26 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 31 Health Visitors 31 Ante-Natal Work 33 Compensation to Midwives 33 Supply of Milk to Mothers and Young Children 33 Institutional Provision for Unmarried Mothers, Illegitimate Infants and Homeless Children 34 Ambulance Facilities 35 Clinics and Treatment Centres 35 (a.) The Violet Melchett Infant Welfare Centre 35 (i.) Chelsea Health Society 36 (ii.) Chelsea Day Nursery 36 (iii.) Chelsea Mothercraft Training Home 37 (6.) Invalid Children's Aid Association 38 (c.) The Babies' Club 39 (d.) Charity Organisation Society 39 (e.) Chelsea Tuberculosis Dispensary 39 Convalescent Home Treatment for Nursing Mothers and Infants 40 Dental Treatment 40 Widows', Orphans' and Old Age Contributory Pensions Acts, 1925 and 1929 40 Child Life Protection 41 Blind Persons Act, 1920 41 Summary of Arrangements regarding Maternity and Child Welfare 41 9 III.—Sanitary Circumstances and Administration. PAGE Complaints 42 Closet Accommodation 42 Removal and Disposal of Refuse 42 Sanitary Inspection of the Borough 42 Magisterial Proceedings 45 Shops 45 Smoke Abatement 45 Fouling of Footways by Dogs 45 Rats and Mice (Destruction) Act 45 Pigeons, Nuisance caused by 45 Fremises and Occupations Controlled by Byelaws or Regulations 47 Bed Bugs, Eradication of 47 Factories, Workshops and Workplaces 47 Public Mortuary 40 Rag Flock 49 Offensive Trades 49 Swimming Baths and Pools 49 IV.—Housing. Housing Statistics 60 Housing Conditions in the Borough 62 (a.) General Observations 62 (£>.) Sufficiency of Supply of Houses 52 (c.) Overcrowding 64 (d.) Fitness of Houses 65 («.) Unhealthy Areas 56 (/.) Byelaws relating to Houses and Houses Let in Lodgings 56 (g.) Housing Inspections 56 V.—Inspection and Supervision of Food. Milk Supply 58 Public Health (Meat) Regulations, 1924 . 59 Slaughter-houses 59 Bakehouses 59 Ice-cream Vendors 59 Fried Fish Vendors 59 Other Premises where Food is Prepared or Offered for Sale 60 Unsound Food 60 Food Poisoning 60 Food and Drugs (Adulteration) Act, 1928 60 The Public Health (Preservatives, etc., in Food) Regulations 60 Margarine Chemical and Bacteriological Examination of Food 61 Nutrition, Dissemination of Knowledge as to 61 Shell Fish 61 Magisterial Proceedings 61 VI.—Infectious and Other Diseases. (a.) Infectious Diseases Generally 62 Diseases Notifiable in the Borough 62 Notifications 62 Diphtheria 64 Scarlct Fever 65 Measles 65 Enteric Fever 66 Pneumonia, Malaria and Dysentery 66 Puerperal Fever and Puerperal Pyrexia 67 10 page Ophthalmia Neonatorum 67 Poliomyelitis and Polio-Encephalitis 68 Encephalitis Lethargica 68 Chicken Pox 68 Smallpox and Vaccination 68 Venereal Disease 69 Disinfection 69 Infectious Diseases Shelter 70 Disinfestation 70 (6.) Tuberculosis 71 Notifications and Mortality 71 Cases of Tuberculosis in the Borough 72 Public Health (Prevention of Tuberculosis) Regulations, 1925 73 Chelsea Tuberculosis Scheme 73 Dispensary and Institutional Facilities for Treatment 77 Co-operation with Hospitals and I.C.A.A. 77 Co-operation with School Medical Service 78 Co-operation with Medical Practitioners 78 Home Contacts 78 Artificial Pneumo-thorax Treatment 78 Home Nursing 78 Extra Nourishment 78 Non-Tuberculous Cases 78 Orthopaedic Treatment 79 Dental Treatment 79 Bacteriological Examinations 79 Care and After-Care Work 79 Appendix. Report of the Public Analyst for 1936 82 Annual Report on the Health of the Metropolitan Borough of Chelsea. Year ending 3 1st December, 1936. SECTION I—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH GENERAL STATISTICS. TABLE No. 1. Area (acres) 660 Resident Population :—Registrar-General's estimate, 1936 56,500 Number of Inhabited Houses (end of 1P36) according to Rate Books 12,636 Rateable value, October, 1936 £1,246,575 Sum represented by a penny rate, October, 1936 £4,865 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 1936, viz., 56,500). 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 :— Legitimate 578 279 299 Birth rate per 1,000 of Illegitimate 60 39 21 the estimated resident population 11.3 13  Total M. F. Still Births 20 10 10 Rate per 1,000 total (live and still) births 30.4 Deaths 776 410 366 r Death rate per 1,000 of the estimated resile dent population 13 7 Deaths from Puerperal Causes :— Deaths. Rate per 1,000 total (live and still) births. Puerperal Sepsis — Other Puerperal Causes 2 30 Total 2 30 Death rate of Infants under one year of age :— All infants, per 1,000 Live Births 53 Legitimate infants per 1,000 legitimate live births 52 Illegitimate infants per i,000 illegitimate live births 67 Deaths from Cancer (all ages) 111 Deaths from Measles (all ages) 4 Deaths from Whooping Cough (all ages) 3 Deaths from Diarrhoea (under 2 years of age) 14 BIRTHS. The total number of births of Chelsea residents during the year was 638, equivalent to a birth rate of 113 per 1,000 of population. The birth.rate for England and Wales in 1936 was 14.8, while that for London as a whole was 13.6. The following Tables are self.explanatory:— TABLE No. 3. Registered Births. Legitimate. Illegitimate. Total. Male. Female. Male. Female. Births Registered in the Borough 445 462 78 48 1,023 Births of Non-Parishioners 303 288 58 43 692 Births of Chelsea Mothers in Lying. in Hospitals and elsewhere outside of the Borough 142 137 164 135 20 19 6 16 331 307 279 299 39 21 638 Nett Chelsea Births 678 60 638 14 TABLE No. 4. Births, Birth.Rates, Births in Wards and Inward Transfer Births. Year. Births. Birth. Rate 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. 1936 532 56 687 10.2 51 62 68 101 315 213 54 13 280 1936 578 60 638 11.3 70 67 96 96 319 232 68 7 307 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 St. Mary Abbots Hospital 138 tion — St. George's Hospital 27 St. Stephen's Hospital and Queen Charlotte's Hospital 8 tution 42 Princess Beatrice Hospital 18 Ormond Maternity Home 28 Westminster Hospital 7 Wilbraham Nursing Home 12 Miscellaneous Hospitals 34 Chelsea Hospital for Women — Nursing Homes 68 Royal Avenue Nursing Home 4 Total 86 Total 300 From Table No. 4 it will be observed that the number of births of Chelsea Infants in Hospitals and elsewhere outside Chelsea accounted for 48.0 per cent, of the total births. In the preceding year the percentage was 47.7. NOTIFICATION OF BIRTHS. Under the Act, all live and stillbirths occurring after the 28th week of pregnancy must be reported within 36 hours to the Medical Officer of Health of the district in which the birth takes place. This information is extremely valuable, as it enables the Health Visitor to exercise supervision of the mother and child shortly after confinement. During the year 991 births, including stillbirths, were notified as occurring in Chelsea. Of this number, in 678 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 302 births amongst Chelsea mothers in Lying.in hospitals and elsewhere outside the Borough. The total number of notified Chelsea births from all sources was 615. The following table indicates the source of notification of the 991 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 98 5 103 67 67 Midwives 157 3 160 47 — 47 Poor Law Institutions 40 2 42 553 11 564 Parents 7 1 8 — — — 302 11 313 667 11 678 16 Illegitimate Births.—The following table shows the number of illegitimate births and the percentage of the total births. In 1936, 126 such births were registered in Chelsea, and 35 inward transfers and 101 outward transfers were made by the Registrar-General. The nett figure for the Borough is, therefore, 60. TABLE No. 7. Year. Number of illegitimate births. ntage of total births. 1935 55 9.37 1936 60 9.40 Stillbirths.—During the year 26 stillbirths were registered in Chelsea, and 8 inward transfers and 14 outward transfers were made by the Registrar-General. The corrected number of stillbirths is therefore 20, which represents a rate for the Borough of 0-35 per 1,000 of the population, as compared with 0-53 for London as a whole. MARRIAGES. There were 837 marriages registered in the Borough during the year (748 in 1935). The marriage rate (number of marriages per 1,000 of population) was 14-8. In the preceding year the marriage rate was 130. DEATHS. The total number of deaths of Chelsea residents during the year was 776, equivalent to a death rate of 13.7 per 1,000 of population. The death rate for England and Wales for 1936 was 12.1, and for London 12.5. Adjusted Death Rate.—If the populations of all areas were similarly constituted as regards the proportions of their sex and age group components, their crude death rates (deaths per 1,000 population) could be accepted as valid comparative measures of the mortalities experienced by the several populations. In practice, however, populations are not thus similarly constituted, and the Registrar-General has accordingly calculated a factor (called the Areal Comparability Factor) for each district. This is, in effect, an adjustment of the age and sex composition of the district to that of England and Wales as a whole, so that all may be compared on the same basis. To obtain the adjusted death rate, the crude death rate is multiplied by the Comparative Factor which has the effect of making a corrected death rate comparable with the death rate of any other district which has been similarly adjusted. The Areal Comparative Factor for Chelsea is 0.85, and the death rate for 1936 when so adjusted is 11.6. 17 The following tables are self-explanatory :— TABLE No. 8. Registered Deaths. Total. Deaths registered in the Borough Non-parishioners 1,925 1,333 Deaths of Chelsea residents in hospitals and elsewhere outside the 592 Borough 184 Nett Chelsea deaths 776 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 592 Chelsea deaths registered in the Borough, 357 occurred in Institutions within the Borough. TABLE No. 9. Chelsea Deaths in Hospitals and Institutions within the Borough. Chelsea Deaths in Hospitals and Elsewhere Outside the Borough. St. Luke's Hospital and Chelsea General Hospitals 70 Institution ... 227 Mental Hospitals 23 Royal Hospital for Pensioners 36 Infectious Disease Hospitals 6 Cancer Hospital 12 Tuberculosis Sanatoria, etc. 1 Victoria Hospital for Children Nursing Homes 28 (Tite Street) 2 Poor Law Institutions 43 St. Stephen's Hospital Miscellaneous 13 (Westminster Infirmary) 76 Brompton Hospital 4 Chelsea Hospital for Women Cheyne Hospital for Children — St. George's Home for culosis — 357 184 Of the 1,333 deaths of non-residents registered in Chelsea 1,321 occurred in hospitals or Institutions within the Borough. 18 TABLE No. 10. 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. th Quarter. 1935 722 12.6 73 106 124 117 302 13.7 13.7 10.5 12 .8 1936 776 13.7 75 110 138 130 323 17.2 13.1 10.7 13.9 19 TABLE No. 11. Birth-rates, Death-rates, Analysis of Mortality. Maternal Death-rates and Case-rates for certain Infectious Diseases in the year 1936. England and Wales, London, 122 Great Towns and 143 Smaller Towns. (Provisional figures based on Weekly and Quarterly Returns.) England and Wales. 122 143 County Boro's and Great Towns ' including London. Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census). London Administrative County. Rates per 1,000 Population. Births :— Live 14.8 14.9 15.0 13.6 Still 0.61 0.67 0.64 0.53 Deaths:— AU Causes 12.1 12.3 11.5 12.5 Typhoid and Paratyphoid fevers 0.01 0.01 000 0.01 Smallpox — — — — Measles 0.07 0.09 0.04 0.14 Scarlet fever 0.01 0.01 0.01 0.01 Whooping Cough 0.05 0.06 0.04 0.06 Diphtheria 0.07 0.08 0.05 0.05 Influenza 0.14 0.14 0.15 0.14 Violence 0.52 0.45 0.39 0.52 Notifications :— Smallpox 0.00 0.00 — — Scarlet fever 2..53 2.18 2.48 2.57 Diphtheria 1..39 1.31 1.26 1.69 Enteric fever 0.06 0.05 0.06 0.06 Erysipelas 0.40 0.38 0.35 0.44 Pneumonia 1.11 1.10 0.96 0.99 Rates per 1,000 Live Births. Deaths under 1 year age 59 63 55 66 Deaths from Diarrhoea and Enteritis under 2 years of age 5.9 8.2 3.4 14.4 Maternal Mortality ; Puerperal Sepsis 1.40 Not avail able. Others 2.41 Total 3.81 Rates per 1,000 Total Births [i.e., Live and Still). Maternal Mortality :— Puerperal Sepsis 1..34 Not avail able. Others 2.31 Total 3.65 Notifications :— Puerperal fever 3.27 3.46 2.80 3.03 Puerperal pyrexia 9.64 9.52 7.57 11.15 20 TABLE No. 12. Deaths of Chelsea Residents Registered during the Year 1936, 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 776 34 7 1 3 17 28 37 71 148 216 214 1. Typhoid and Paratyphoid Fevers 1 — — — — — 1 — — — — — 2. Measles 4 — 3 — — 1 — — — — — — 3. Scarlet Fever — — — — — — — — — — — — 4. Whooping Cough 3 I 2 — — — — — — — — — 5. Diphtheria ] — — — — — — — — — — — 6. Influenza 11 — — — — 1 — — 2 1 4 3 7. Encephalitis Lethargica 8. Cerebro-Spinal Fever 1 1 — — — — — — — — — — 9. Tuberculosis of Respiratory Svstem 53 — — — 1 7 11 7 11 12 3 1 10. Other Tuberculous Diseases 1 11. Syphilis 2 — — — — — — — 1 1 — — 12. General Paralysis of the Insane, Tabes Dorsalis 2 — — — — — — — — 2 — — 13. Cancer, malignant disease 111 — — — — — 3 4 14 42 29 19 14. Diabetes 5 — — — — — — — 1 3 1 — 15. Cerebral Haemorrhage, etc. 32 — — — — — — — 1 6 12 13 16. Heart Disease 230 — — — — 1 — 3 10 32 90 94 17. Aneurysm 5 — — — — — — 2 — 1 2 — 18. Other Circulatory Diseases 29 — — — — — — 1 — 2 13 13 19. Bronchitis 26 — — — — — — — 1 6 10 9 20. Pneumonia (all forms) 51 4 1 1 — — 2 6 6 10 15 6 21. Other Respiratory Diseases 9 — — — — — — — 3 4 1 1 22. Peptic Ulcer 3 — — — — — — — — — 2 1 23. Diarrhoea, etc. 16 13 1 — — — 1 — 1 — — — 24. Appendicitis 4 — — — — — — 1 1 1 1 — 25. Cirrhosis of Liver 2 — — — — — — 1 — 1 — — 26. Other Diseases of Liver, etc. 6 — — — — — 1 — 1 1 1 2 27. Other Digestive Diseases 14 — — — — — — 1 2 2 5 4 28. Acute and Chronic Nephritis 21 — — — — — — 1 1 3 3 13 29. Puerperal Sepsis — — — — — — — — — 30. Other Puerperal Causes 2 — — — — — 1 1 — — — — 31. Congenital Debility, Premature Birth, Malformations, etc. 10 10 — — — — — — — — — — 32. Senility 17 — — — — — — — 17 33. Suicide 7 — — — — — —3 1 2 1 — — 34. Other Violence 36 2 — — 1 2 1 3 2 7 10 8 35. Other Defined Diseases 61 3 — — — 4 4 5 11 10 14 10 36. Causes ill-defined or unknown — — — — — — — — — — — — 776 34 7 1 3 17 28 37 71 148 216 214 § 21 CAUSES OF DEATH. Table No. 12 shows that 230 deaths were due to Organic Heart Disease, 111 to Cancer, 26 to Bronchitis, 51 to Pneumonia, 53 to Pulmonary Tuberculosis, 29 to Circulatory Diseases, 32 to Cerebral Haemorrhage, 11 to Influenza and 10 to Congenital Debility and Malformation. Fifty-five per cent. of all deaths occurred in persons over 65 years of age. RESPIRATORY DISEASES. Table No. 13 shows the number of deaths from respiratory diseases during the past two years. The annual death rate, the number of deaths under 5 years, and the percentage of deaths occurring in children under 5 years of age is also shown :— TABLE No. 13. Year. Bronchitis. Pneumonia. Other Respiratory Diseases. Total. Deathrate. No. of deaths under 5 years. ntage under 5 years. 1935 16 28 5 49 0.8 5 10.2 1936 26 51 9 86 1.5 6 7.0 DEATHS OF CHILDREN 1-5 YEARS OF AGE. The number of deaths of children between 1-2 years of age was 7 and between 2-5 years, 1. In the previous year these figures were 1 and 5 respectively. The causes of death are given during the past two years. TABLE No. 14. Child Mortality (1-5 Years). Year. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrhoeal Diseases. All other causes. Total Deaths. 1935 2 1 — 1 2 6 1936 5 — 2 1 — 8 22 INFANT MORTALITY. There were 34 deaths of infants under one year of age in Chelsea during the year. The infant mortality rate (deaths under 1 year per 1,000 live births) was 53, as compared with 59 6 in the previous year. In London as a whole the rate of infant mortality was 66 per 1,000 live births. The causes of death in the various age groups are set out in Table No. 15 :— TABLE No. 15. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks and under 3 months 3-6 months. 6-9 months. 9-12 months. Total deaths under 1 year. Small-pox – – – – – – – – – – Chicken-pox – – – – – – – – – – Measles – – – – – – – – – – Scarlet Fever – – – – – – – – – – Whooping Cough – – – – – 1 – – – 1 Diphtheria – – – – – – – – – – Influenza – – – – – – – – – – Erysipelas – – – – – – – – – – Tuberculous Meningitis – – – – – – – – – – Abdominal Tuberculosis – – – – – – – – – – Other Tuberculous Diseases – – – – – – – – – – Meningitis – – – – – – – – – – Convulsions – – – – – – – 1 – 1 Laryngitis – – – – – – – – – – Bronchitis – – – – – – – – – – Pneumonia – – – – – i 1 1 2 4 Diarrhoea and Enteritis – – – – i 7 5 — 13 Gastritis – – – – – – – – – – Syphilis – – – – – – – – – – Rickets – – – – – – – – – – Suffocation – – – – – – – – – 1 Injury at Birth – – – – – – – – – – Atelectasis – – – – – – – – – – Congenital Malformations 2 – – 2 4 — — — — 4 Premature Birth 3 1 – — 4 — — — — 4 Atrophy, Debility and Marasmus 2 – – — 2 — — — — 2 Other causes – – – – – – 1 2 1 4 7 1 – 2 10 4 9 8 3 34 Nett Births registered during /Legitimate 578 the calendar year \ Illegitimate 60 Nett Deaths (under 1) registered /Legitimate 30 during the calendar year \ Illegitimate 4 23 The following Table gives the Infant Mortality Rate in Chelsea under various headings, for the past two years :— TABLE No. 16. [####] 1935. 1936. Infectious Diseases 3.4 3.1 Diarrhoeal Diseases 11.95 20.4 Developmental Defects and Wasting 25.55 15.6 Other causes 18.7 14.1 Total Rate 59.6 53.2 TABLE No. 17. Infantile Mortality Rates per 1,000 Births in Wards. 1935. 1936. Hans Town 39 14 Royal Hospital 96 88 Church 103 83 Cheyne 40 21 Stanley 54 56 Chelsea Borough 59.6 53 Illegitimate Deaths.—The following Table No. 18 shows the number of deaths among illegitimate infants during the past two years. TABLE No. 18. 1935. 1936. Total number of illegitimate deaths under 1 year 9 4 Illegitimate death rate 164 67 MATERNAL MORTALITY. During the year two deaths were primarily classified as due directly to complications of pregnancy or childbirth. 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. 24 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) Biiths. Puerperal Fever. Other complications of Pregnancy and Childbirth. Total Death-rate. 1935 3.3 3.3 6.6 1936 — 3.0 3.0 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 1936, deaths of pensioners in the Royal Hospital, Chelsea, accounted for 40 deaths, inward transfers included (equivalent to 0.7 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, 1936, are tabulated on pages 5-7, in the form required by the Ministry of Health. NURSING ARRANGEMENTS. (a.) General Nursing in the Home.—This is carried out by the Chelsea, Pimlico and Belgravia District Nursing Association, located at 10, Sydney Street, Chelsea. The Borough Council makes an annual grant to the Association, in addition to a payment of Is. 6d. per visit. For this remuneration the Association has undertaken the nursing of all cases of illness occurring in expectant and nursing mothers and also, on the requisition of the Medical Officer of Health, the nursing of all children in the Borough under five years of age suffering from any illness. 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. 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, 1936. The total fees paid by the Council for nurses' visits during the year amounted to £212 7s. 6d. Details of the work undertaken by the Association on behalf of the Borough Council are shown in Table No. 20 by the number of home visits for the past two years and by Table No. 21 the conditions which necessitated attendance during the year 1936 :— TABLE No. 20. Year. Visits. Cases. 1935 1,554 138 1936 2,878 182 26 TABLE No. 21. Nursed by District Nurses During 1936. Bronchitis Visits. Cases. 438 24 Burns — — Chicken Pox 26 1 Circumcision 91 11 Diarrhœa 5 2 Eye Trouble 351 14 Ear Trouble 323 16 Expectant and Nursing Mothers 326 19 Pneumonia (under 5) 136 5 Pneumonia (over 5) 131 6 Impetigo — — Meningitis and Peritonitis — — Measles (under 5) 210 12 Measles (over 5) 48 4 Ophthalmia Neonatorum 57 2 Pemphigus Neonatorum — — Pemphigus 28 1 Poliomyelitis — — Post-Vaccination 297 25 Puerperal Fever — — Puerperal Pyrexia — — Rickets — — Septic sores 198 13 Tonsils and Adenoids 65 9 Whooping Cough 24 2 Worms 71 7 Miscellaneous 53 9 2,878 182 (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. 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 78. 27 MATERNITY NURSES AND MIDWIVES. Provision has been made by the Borough Council whereby necessitous women may obtain the services of a Maternity Nurse or Midwife at a reduced rate, the balance of the fee being paid by the Council. The fees charged vary from £2 to £2 2s. for Primipara cases, and £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. 1935 — 53 — 47 £ s. d. £ s. d. £ s. d. £ s. d. — 27 3 0 — 40 15 0 1936 — 33 — 32 — 18 18 9 — 29 11 3 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 10 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 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 :— 28 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. 1935 12 6 £ 7 s. 2 d. 0 . £ 16 s. 18 d. 0 1936 4 3 5 18 0 6 2 0 NATIONAL HEALTH INSURANCE. The work of a Sanitary Authority has no direct relation to this service, but wherever co-operation is possible such assistance is freely rendered by the Public Health Department. It is mainly in cases of tuberculosis, 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 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. Five 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. The number of bacteriological, bacterioscopic and other examinations carried out during the year was 287. Of these, 247 were for the bacillus associated with Diphtheria, 30 for the bacillus associated with Tuberculosis, 4 for the bacillus associated with Enteric Fever and 1 investigation for Hemolytic Streptococci. The total cost of these services to the Borough Council was £39 18s. Od. 29 The total number of bacteriological examinations during the preceding year was 298. 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 120,000 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 £7 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. 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. The Royal 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. 30 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 The Royal 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 104 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.l Deformities and Malformations 170 Yes By Voluntary Committee St. George's Hospital Hyde Park Corner, S.W.I General Medical, Surgical and Maternity 437 Yes By Voluntary Committee St. Luke's Hospital Cale Street, S.W.3 Medical and Surgical 390 Yes By Central Public Health Committee of L.C.C. St. Mary Abbots Hospital Marloes Road, W.8 Medical, Surgical and Maternity 555 Yes By Central Public Health Committee of L.C.C. St. Stephen's Hospital Fulham Road, S.W.10 Medical, Surgical and Maternity 718 Yes By Central Public Health Committee of L.C.C. Victoria Hospital for Children Tite Street, S.W.3 Children's Diseases 138 Yes By Voluntary Committee West London Hospital Hammersmith Road, W.6 General Medical and Surgical 234 Yes By Voluntary Committee St. George's Home Milman's Street, S.W.10 Tuberculosis 50 Yes By Central Public Health Committee of L.C.C. 31 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 81 Cases attended in the district 106 Total 187 Cases attended by Medical Practitioners 55 Cases attended by Midwives 132 Ante-natal attendances 931 Visits to cases in the district 2,120 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. 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. 32 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 (two whole-time and two part-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. 1935. 1936. (1) Work of the Health Visitors. First visits to Infants under one year of age 468 446 Return „ „ ,, ,, ,, 1,688 1,534 First visits to Children between the ages of 1 and 5 years 393 294 Return visits to Children between the ages of 1 and 5 years 2,657 2,614 Ante-natal visits to Expectant Mothers :— Primi-para cases 133 109 Multi-para „ 174 186 Return visits 473 491 Visits to Enteritis cases amongst children — 1 Return visits „ „ „ „ — — Visits to 0phthalmia Neonatorum cases 2 6 Return visits „ „ „ 7 5 Visits to Whooping Cough cases 109 60 Return visits „ „ „ 73 33 Visits to Measles cases (under 5 years of age) 7 283 Return visits „ „ „ 1 148 Visits to Measles cases (over 5 years of age) 4 219 Return visits „ „ „ 1 53 General additional visits 859 741 Total visits 7,049 7,223 Half-day attendances at Infant Welfare Centres 526 534 Half-day attendances at Play Centre — 160 (2) Infant Welfare Centres. Total number of attendances :— (a) By children under one year of age 3,861 4,009 (6) By children between the ages of 1 and 6 years 2,774 2,450 (c) By Ante-Natal mothe 667 690 (d) By Post-Natal mothers 37 43 Total attendances 7,339 7,192 33 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. Compensation to Midwives.—If the Medical Officer at the Antenatal Clinic finds it necessary to recommend hospital treatment for an expectant mother referred to him by a midwife, and the mother accepts such advice, the Council make a payment of 10/- to the midwife as compensation for loss of the case. No case occurred during the year in which such compensation was necessary. SUPPLY OF MILK TO MOTHERS AND YOUNG CHILDREN. Provision is made under the Public Health (London) Act, 1936, 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. Milk is supplied on the following basis :— Number of persons in family. Weekly income per head (after deduction of rent and insurance). Assessment. 3-4 Up to 8/- Free 8/- Id. per pint 9/- 2d. per pint 10/- 3d. per pint 5-6 Up to 7/- Free 7/- Id. per pint 8/- 2d. per pint 9/- 3d. per pint 7-8 Up to 6/- Free 6/- Id. per pint 7/- 2d. per pint 8/- 3d. per pint 9-10 Up to 5/- Free 5/- Id. per pint 6/- 2d. per pint 7/- 3d. per pint 34 The following table shows for the past two years, the extent of this service :— TABLE No. 27. Year. Milk Orders issued and taken up. Approx. Cost. March quarter. June quarter. Sept. quarter. Dec. quarter. *Total. 1935 564 418 385 519 1886 £ 453 1936 553 501 388 389 1831 420 * These totals do not include orders subsequently cancelled or withdrawn, which average 80 or more during each year. It will be observed that in 1936 there was a decrease in the cost of milk. Cows' milk was supplied to 82 per cent, of the applicants, dried milk being supplied to the remaining 18 per cent. The total quantity of milk supplied during the year to expectant and nursing mothers and young children was as follows:— Cows Milk, free of cost 2016 gallons Cows Milk at reduced cost 2207 „ 4223 „ Dried Milk, free of cost 498 lbs. Dried Milk at reduced cost 539 „ Total 1037 „ 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^ 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 35 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. (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, Wellington Street, S.W.3.—Chairman of Council : Violet, Lady Melchett, D.B.E. Hon. Treasurer : Col. Sir Courtauld Thomson, K.B.E., C.B. Hon. Secretary : Miss M. Bowden-Smith. This Centre, controlled by a Voluntary Council with headquarters in Wellington Street, adjoining the Town Hall, was completed in February, 1931, and formally opened by Her Majesty Queen Mary 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. Three members of the Public Health Committee of the Borough Council and the Medical Officer of Health are members of the Executive Committee. 36 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 Borough Council. A further source of income arises from the fees paid by pupils and parents. Under section 101 (6) of the Local Government Act, 1929, the Borough Council made an annual contribution of £3,535 to the Violet Melchett Infant Welfare Centre for services in respect of Maternity and Child Welfare work for the financial year 1938-1937. 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. 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 484, King's Road. At Wellington Street one ante-natal clinic was held weekly. 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. Two whole-time and two half-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. Details of the work carried out by the Society will be found on page 32 (Table No. 26). (2) Chelsea Day Nursery, Flood Street, S.W.3. The Chelsea Day Nursery provides accommodation for fifty children. In addition to two large nurseries for infants and toddlers, there are bathrooms, a kitchen and an enclosed garden for the children to play in. The staff consists of an Hon. Medical Director, an Assistant Medical Officer, a Matron, a Sister, a Staff Nurse, eight probationers, six London County Council Scholarship Students, and two non-resident students. The Nursery is ably administered and is much appreciated in the Borough. 37 The attendances at the Nursery during the past two years were as follows :— TABLE No. 28. Total number of attendances during the year 1935. 1936. 12,342 12,440 Average daily attendance (5 J days a week) 41 48 Total number of individual children who attended 104 114 The health of the children has been satisfactory. Dr. C. K. Hamilton is Medical Officer to the Nursery and makes a weekly inspection of the children. (3) Chelsea Mothercraft Training Home.—Manor Street, S.W.3. The Mothercraft Training Home 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, an Hon. Medical Director, an Assistant Medical Officer, a Matron, two Sisters, three Staff Nurses, Secretary (whole 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. The following Table No. 29 shows the work carried out in the Home during the past year :— TABLE No. 29. The Mothercraft Training Home, 1936. Admissions. Babies Mothers and Babies Obs. Malnutrition. Nat. Feeding difficulties. Normal Nat. Feeding. Total Mothers. Total Babies. 63 60 3 53 106 Average Stay. Obs. Malnutrition. Nat. Feeding difficulties. Normal N. Feeding cases. 48 days 26.2 days 284.6 days 38 Analysis of Natural Feeding Difficulties. Established Nat. Feeding. Re-established Nat. Feeding. Supply increased. Supply regulated. No change. 4 13 12 16 4 Deaths. 3. Mothers Attending with Babies for Test-Feeds. Number of Mothers attending : 1 Visit 2 Visits 3 Visits 4 Visits 5 Visits 6 Visits 7 Visits 8 Visits 11 Visits 95 6 7 3 1 3 2 2 1 Total number of Mothers : 120. Total number of Test Feeds: 205. Students. Completed one year Started one year Short courses 1 to 3 months 11 7 27 Started 6 months Started 4 months Started 9 months. 1 — 2 (b) Invalid Children's Aid Association.—Chairman : Alderman F. J. Synge. Hon. Secretary : Mrs. Rathbone. The Chelsea branch of the Invalid Children's Aid Association is located at 2, Glebe Place, King's Road, S.W.3. The Association provides, for children referred to 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. 39 The Borough Council made a financial grant of £100 to the Association for the year commencing 1st April, 1936. During the year the branch had 200 children under school age referred to them for assistance. These children were suffering from marasmus and malnutrition, congenital deformities, rickets, anaemia, debility and enlarged glands following acute illness such as bronchitis, pneumonia, measles, diphtheria and scarlet fever. Fifty-two children were sent out of London for convalescence, for periods varying from six weeks to six months. Three children had sanatorium treatment arranged. 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-three 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. Sixteen children were treated at the I.C.A.A. Orthopaedic Clinic and twelve 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 M. Solomons. Medical Officers : Dr. Langdon Lloyd, Dr. J. H. Gibbens, Dr. Grosvenor Millis and Dr. G. Ormiston. This Infant Welfare Clinic is controlled by a voluntary Committee. It is intended for the use of annual subscribers only. Four Infant consultations are held weekly at the premises of the Club. (d.) Charity Organisation Society.—Chairman: E. F. Dent, Esq., Hon. Secretaries : Miss Larken and Miss Fairtlough. The Chelsea branch of the Charity Organisation Society is located at 2, Glebe Place, King's Road, S.W.3. This Society arranges for convalescent treatment when necessary; for the supply of dentures and surgical appliances and for various forms of temporary assistance during disablement, etc. In connection with the Society there is a Women's Holiday Fund and a large number of Chelsea women are thus enabled to obtain holidays in the country or at the seaside during the summer months. (e.) Chelsea Tuberculosis Dispensary.—This Dispensary, located at Brompton Hospital, affords skilled diagnosis and efficient treatment for all cases of Tuberculosis within the Borough. Details of the work done by the Dispensary will be found on page 74. 40 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 seven 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. 1935 23 15 £ 3 s. 18 d. 6 £ 25 s. 15 d. 0 1936 29 19 8 14 0 32 14 6 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 thirteen mothers received dental treatment (including nine cases for dentures), the Borough Council making a contribution of £26 19s. 6d. towards the cost. 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. CHILD LIFE PROTECTION. The Borough Council is responsible for all duties under Part 13 of the Public Health (London) Act, 1936. 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. 41 TABLE No. 31. Foster Mothers. Foster Children. Child Life Protection Return. (Year 1936). Number on Register at beginning of year 16 19 Removed from register 8 16 Added to register 6 12 Remaining on register 14 15 Medical attendance arranged — 7 Attended Maternity and Child Welfare Clinic — 7 Visits to foster mothers 70 Miscellaneous visits 26 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. (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 (6.) 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. (/.) 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. (».) 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. (A.) The provision of dental treatment for expectant and nursing mothers. (I) The supply of milk, free or at reduced rates, to necessitous nursing and expectant mothers, infants, and young children. (m.) The provision of sterile maternity outfits at cost price, (n.) The administration of the Widows', Orphans' and Old Age Contributory Pensions Acts, 1925 and 1929, in respect of deserted, abandoned or neglected children. 42 SECTION III.—SANITARY CIRCUMSTANCES AND ADMINISTRATION. Complaints.—The number of complaints received during the year was 322, compared with 546 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 92 of the Public Health (London) Act, 1936. 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 402. The number of statutory notices was 56. These compared with 465 and 66 in 1935. In one case an owner neglected to comply with a statutory notice and it was found necessary to issue a summons. Details of this prosecution is set out in tabular form in Table No. 32. Summary of Work carried out by Sanitary Inspectors during the Year. Inspections. On complaint of nuisance 385 On notification of infectious disease (including non-notifiable diseases) 369 House to House 126 Re-inspection calls made 3,715 Inspection of:— Bakehouses 30 Slaughterhouses 12 Milkshops 172 Ice Cream Premises 35 Overcrowding 45 Houses Let in Lodgings 10 Stables 23 Restaurant Kitchens 50 Marine Stores 11 Food Premises other than above 66 Premises under Meat Regulations 30 Factories and Workshops 289 Outworkers' Premises 28 Common Lodging Houses 20 Other visits 435 Verminous Premises 170 Rat enquiries 102 Smoke observations 10 Total 6,133 43 Premises: Walls and Ceilings cleansed :— (a) Premises throughout — (6) Premises partially 119 (c) Verminous rooms cleansed 40 (d) Total number of rooms cleansed 168 Wash-house walls and ceilings cleansed 10 Walls and ceilings of water closets cleansed and repaired 25 Wash-house roofs repaired 4 Dirty tenants' rooms cleansed 3 Yard and area walls cleansed — Defective roofs repaired 55 Defective gutters repaired 5 Defective rain water pipes repaired 10 Dampness abated 28 Miscellaneous repairs 77 Wash-house floors repaired 6 Yard surfaces repaired, paved, etc 8 Ashpits demolished — New and proper dustbins provided 33 Workrooms provided with light and ventilation or light and ventilation improved 5 Drainage: Reconstructed 5 Repaired 7 Cleansed 1 Inspection Chambers and traps provided 15 Fresh air inlets provided or repaired 10 New soil pipes provided 6 New ventilation pipes provided 5 Soil and ventilation pipes repaired — Anti-syphonage pipes provided 2 Drains sealed off — Drains cleared (obstruction removed) 7 New covers provided to inspection chambers 12 Rainwater pipes disconnected and caused to discharge over properly trapped gullies Sink wastes provided with traps 109 Sink waste pipes cleansed 6 New sink wastes provided 135 New sinks provided 30 New bath and lavatory basin wastes provided 226 Water Closets. Improvements in sanitary conveniences (factories, workshops, etc.) 4 New water closet pans provided 22 Water closet pans (foul) cleansed 2 Choked water closet pans unstopped and cleansed 4 Water waste preventers renewed 4 Water waste preventers repaired 4 Water closet roofs repaired 7 Ventilation and light provided or improved 3 W.C. floors repaired 2 Water supply. Water supply to premises reinstated 2 Water supply provided to upper storeys of tenement houses 3 New drinking water cisterns provided 2 Drinking water cisterns cleansed 1 Drinking water cisterns provided with new covers or covers repaired 2 Smoke Nuisance. Number of observations 10 Number of nuisances and complaints 3 Number of notices — Number of Summonses — 44 Nuisances abated arising from :— Keeping animals in an improper manner or place — Defective manure cages — Accumulation of manure or refuse 6 Overcrowding 14 Rat nuisance 102 Underground rooms — Food Condemned and Destroyed 2 3 sacks of Brussel Sprouts. 2 lbs. of Blackcurrants. Disinfection. Rooms disinfected after Zymotic diseases (Scarlet Fever, Diphtheria, etc.) 278 Rooms disinfected after Tuberculous disease 73 Rooms fumigated for verminous and filthy conditions 376 Miscellaneous disinfection 73 Certificates of disinfection given 158 School notices after disinfection 148 Notices sent to Public Library of Premises where infectious diseases have occurred 105 Proceedings taken. Intimation Notices served 402 Statutory Notices under Public Health (London) Act, 1891 56 Statutory Notices under Section 17 of Housing Act, 1930 — Statutory Notices under byelaws for provision of dustbins 4 Total number of samples purchased for analysis under the Food and Drugs (Adulteration) Act 301 Samples of cream taken 12 Samples of drugs taken 20 Samples (informal) purchased 99 Legal proceedings instituted in respect of defective sanitary conditions and nuisances 1 Legal proceedings under Milk and Dairies Amendment Act, 1922 — Legal proceedings in respect of unsound food — Certificates issued in accordance with " Rent Restrictions Act " — Entries in Inhabitants' Complaint Book 322 Cleansing and Disinfection. Number of adults cleansed 7 Number of children cleansed 513 Number of rooms or premises cleansed or disinfected 800 Number of persons treated for Scabies 24 Number of articles (bedding, etc.) disinfected 4,908 Number of articles (various) destroyed 462 Disinfection Station Shelter. Persons accommodated :— Adults Children — Mortuary. Number of bodies received 7 Number of infectious bodies received Number of bodies removed to Public Mortuary on Sanitary grounds — Number of bodies detained in Mortuary Chapel 6 45 TABLE No. 32. Magisterial Proceedings during the Year under Public Health (London) Act, 1891. Situation of premises. Nature of Nuisance or Complaint. Petty Sessions. Date of Hearing. Result. 7a, Pavilion Road. Failing to comply with Statutory Notice re condition of premises. Kensington 17.3.36 Order 21 days. £5 5s. Od. nuisance by dogs. Failing to comply with Council's byelaw refouling of footway by dogs in King's Road. Kensington 16.6.36 Fined 10s. Shops.—No case requiring special action under the Shops Act, 1934, came to notice during the year. Smoke Abatement.—It is part of the work of a Sanitary Inspector to observe any nuisance arising from smoke. There were 10 actual recorded instances of observations during the year but the chimneys in the Borough have in fact been subject to daily observation by the Inspectors. Three 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 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 100 bait traps were prepared and issued. In conjunction with the Works Department, investigation was made of a number of old sewers likely to be infested with rats and a large number of baits were laid. During the year many persons were advised as to the best means of dealing with the rat nuisance so far as it affected their respective premises. Nuisance caused by Pigeons.—The Public Health (London) Act, 1936, 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 1936, 10 pigeons were captured and humanely destroyed. 46 TABLE Mo. 33. Number of Premises. Number of inspections during 1936. Number of notices served during 1936. Number of prosecutions during 1936. On register at end of 1935. Added in 1936. Removed in 1936. On register at end of 1936. 1. Premises used for Business Purposes :— Milk Premises 71 2 — 73 172 5 — Cowsheds — — — — — — — Ice Cream Premises 35 — — 35 35 — — Butter and Margarine 10 — — 10 10 — — Manufacturers and Dealers :— Fried Fish Premises 14 — — 14 20 3 — Fish Curers 5 — — 5 15 — — Bakehouses 26 — — 26 30 4 — Slaughterhouses 1 — — 1 12 — Food Stalls 34 32 under daily observation Offensive Trade Premises — — — — — — 2. Premises used for Human Habitation :— Houses let in lodgings 595 10 — 605 10 — — Common Lodging Houses 2 — — 2 20 1 — Canal Boats — — — — — — — 47 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, 1936, and the latter under the Housing Act, 1936, are net 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." Eradication of bed bugs.—Two hundred and forty-one houses were found to be infested with bed bugs, 43 flats being owned by the Borough Council and 198 owned privately. In each case disinfestation was carried out. The work of disinfestation is carried out by the staff of the Borough Council. The methods employed for freeing infested houses from bed bugs consist of fumigation with Sulphur dioxide and the employment of contact spraying with an insecticide. Where necessary, owners are called upon to remove or loosen wooden fittings and strip walls in order to assist fumigation. The furniture of each tenant removing to a Council Flat is subjected to treatment in a specially Constructed Cyanide Van before entry into the new Flat. Cyanide fumigation is carried out by the Westminster City Council, under an agreement with the Borough Council. 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 227. The number of inspections of these premises was 289, which compares with 314 in 1935. Sanitary defects were found in 19 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) 24 2 — Workshops (including Workshop Laundries) 250 10 — Workplaces (other than Outworkers' premises} 15 — — Total 289 12 — 48 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of offences in respect to which Prosecutions instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (6) Nuisances under the Public Health Acts :—* Want of cleanliness 10 10 - - Want of ventilation 2 2 - - Overcrpwding — — - - Want of drainage of floors — — - - Other nuisances 3 3 - - Sanitary accommodation :— Insufficient Unsuitable or defective 4 4 - - Not separate for sexes — — - - 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 19 19 — * 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. 1935 14 12 38 164 - 31 - - - - - - 1936 16 9 22 148 - 36 - - - - - - 49 Public Mortuary.—Under the Public Health (London) Act, 1936, section 234, 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 1936 ... 7 1. To await Inquests:— (a.) Infectious — (b.) Non-infectious 4 2. Sanitary grounds — Number of Post Mortem examinations ... 4 Number of bodies detained in Mortuary Chapel ... 6 Rag Flock.—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. Swimming Baths and Pools.—There is one Swimming Bath owned by the Borough Council, located in Manor Street, open to the public. No privately owned Swimming Baths are known to the Department. A chlorination filter system is in operation. A sample of the Baths water was submitted for examination and the Bacterial content was found to be in all respects satisfactory. Pharmacy and Poisons Act, 1933.—During the year, fifty-six applications were received from traders for entry in the Council's list of authorised sellers of poisons. In each case the application was approved. 50 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) 754 (6.) Number of inspections made for the purpose 3715 (2) (a.) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 126 (b.) Number of inspections made for the purpose 1161 (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 126 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 290 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 — 51 (B) Proceedings under Public Health Acts:— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 290 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a.) By owners 56 (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. Proceedings under section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 4. Housing Act, 1935. Overcrowding. (a) (i) Number of dwellings overcrowded at end of year 524 (ii) Number of families dwelling therein 547 (iii) Number of persons dwelling therein 3063 (b) Number of new cases of overcrowding reported during the year None (c) (i) Number of cases of overcrowding relieved during the year 36 (ii) Number of persons concerned in such cases (In addition, 169 families have removed, consisting of 920 persons) 174 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding None (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report. Although overcrowding conditions in Chelsea have been much less prevalent than in many other metropolitan boroughs, definite alleviation has taken place since the Housing Act of 1935 become operative. Thirtysix cases of overcrowding in houses owned by the Local Authority have been abated. 62 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 40 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. 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 housing of the working classes carried out by the Borough Council prior to 1914 are shown in Table No. 36:— 53 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 262 762 4/10 to 13/8 per week. Pond House, Pond Place 32 128 10/6 to 14/6 per week. Onslow Dwellings, Pond Place 108 305 6/5 to 8/5 per week. Grove Buildings, Manor Street 120 270 4/2 to 7/7 per week. 522 1,465 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. 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 2,037 3/5 to 10/10 per week. Lewis Trust Dwellings, Ixworth Place 398 1,299 3/1 to 10/3 per week. Marlborough Buildings, Walton Street 162 391 9/0 to 20/0 per week. Guinness Buildings, Draycott Avenue 303 711 2/3 to 7/5 per week. Peabody Buildings, Lawrence Street 68 163 3/8 to 8/4 per week. Chelsea Park Dwellings, King's Road 54 114 3/5 to 12/6 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. 54 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 57). Reviewing the history of the past 40 years, it would appear that the housing policy of the Borough Council has been firstly to preserve, where possible, in areas threatened with demolition, such working class accommodation as was of reasonably good type; and secondly, to provide accommodation by means of new buildings in an accessible situation within the Borough for those persons of the working class who are average representatives of their class, and for whom the necessities of their trade or calling render residence within the Borough desirable or necessary. It cannot be disputed that at the present time in Chelsea, as in other Metropolitan Boroughs, there is considerable dearth of accommodation both for the working classes, and for the classes in receipt of small salaries or earnings, and that, as elsewhere, this situation is primarily due to the restrictions imposed upon the building trades during the war and the economic disturbances which have succeeded it. It will, however, be evident from the details already given that the existing shortage of housing accommodation in Chelsea is being most adequately dealt with and that the extremely difficult problems which confronted the Borough Council subsequent to the war are gradually being overcome. In this connection the invaluable services rendered by the former Mayor (Mr. Councillor C. B. Clapcott, O.B.E.), and the Chairman of the Housing Committee (Mr. Councillor E. B. Baggallay) will always be remembered with appreciation in the municipality. Overcrowding.—During the period 1st November—4th December, 1935, a Survey of Working Class dwelling houses in the Borough was carried out in accordance with the requirements of Part 1, section 1, of the Housing Act, 1935. The total number of houses dealt with and recorded was 5,112. The total number of families comprised in the enumeration was 8,496, and judged by the standard laid down in the Housing Act, 1935,749 of these families were found to be living in overcrowded conditions—a percentage of 8.78 for the Borough as a whole. The problem of abating overcrowding is receiving close consideration by a Special Committee of the Council. Many cases when approached as to the desirability of having their names submitted to the County Council,with a view to provision of housing on one of the Council's Estates, decline to consider the proposition, on the ground that the distance of the County Council's Estates from their work is too great. Others have become attached to the district and will not contemplate forsaking existing 55 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. Twenty-eight 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 modern standards of sanitation and convenience. It is probable that only a minority of the tenants would be able to pay economic rents for alternative accommodation, having regard to the rents that require to be fixed for new dwellings, owing to the greatly increased cost of land and construction during recent years. Another problem is caused by certain old people, usually women. Many of these live alone in a single room with no one to look after them. Frequently they rely almost entirely on the Old Age Pension for sustenance. Gradually growing feebler with the passage of time, they eventually become unable properly to care for themselves or their homes. Although every means of persuasion is tried, these cases usually decline to enter a Poor Law Institution and the condition often persists for a lengthened period. Fortunately, 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. 56 Investigation has shown that these statements are often well-founded, especially in the poorer class tenement lodging houses where no responsible caretaker or landlord is resident. To lighten the difficulties of the owner in these cases, effort is made, as far as possible, to keep in view such powers as a Local Authority has of holding the tenant responsible for defects resulting from his neglect or default. Action was necessary during the year in respect of 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 754, the number found not to be in all respects reasonably fit for human habitation being 290. The number rendered fit in consequence of informal action by the Sanitary Inspectors was 234, and the number in respect of which statutory notices were served requiring defects to be remedied was 56. No case came to the knowledge of the Department in the course of the year of an underground room being illegally used for sleeping purposes. No application under the Increase of Rent and Mortgage Interest (Restrictions) Acts was made by an occupier of a dwelling house, that the house occupied by him was not in a reasonable state of repair. Unhealthy Areas.—One representation was made under the Housing Act during the year. No complaints that areas were unhealthy have been received. 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, 126 houses being inspected and recorded by the Inspector. 57 TABLE No. 38. Post-War Housing. Name of Undertaking. Area of Site. Total Cost. Date of Completion. Number of Flats. Population. Dec. 1936. Rents. Remarks. Hortensia House, Hortensia Road. 1 acre, 12 poles. £49,000 1925 56 223 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 160 747 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 112 510 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. 2 acre, 17 poles. £7,300 (approximate cost of site). 1935 64 327 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 1,807 58 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 46) is shown the alterations which took place in the Register of Milk Purveyors during the year. During the year there were 172 inspections of dairies and milkshops made in the Borough. Notices were served requiring remedy of defects found on two of the premises visited. There are no cowsheds in the district. Milk (Special Designations) Order.—There were 38 applications from 16 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. 1935. 1936. To sell "Certified." Milk 9 6 To sell "Grade A" Milk 2 2 To sell "Grade A Pasteurised" Milk 1 1 To sell "Grade A (Tuberculin Tested)" Milk 13 10 To sell "Pasteurised" Milk 19 15 Supplementary Licences 4 4 48 38 59 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 5 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. Inspection of Meat. Description of Animals Slaughtered. No. Number of Condemnations. Entire Carcases. Parts of Carcases. Organs. Tuberculosis. Other Diseases. Tuberculosis. Other Diseases. Tuberculosis. Other Diseases. Sheep and Lambs 5 — — — — — — Slaughterhouses.—There is now only one private slaughterhouse in the Borough and 12 inspections of these premises were made during 1936. 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 46) 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 30 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, 35 premises were shown in the Register as places where ice-cream is prepared or sold. There were 35 inspections of these premises as compared with 36 in the previous year. This trade is mainly regulated under the Public Health (London) Act, 1936. 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 20 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. 60 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. Table No. 33 (page 46) shows, for the past two years, the number of inspections of premises where food was prepared for or exposed for sale. Unsound Food.—On two occasions during the year, unsound food was surrendered and destroyed. Included in the unsound food surrendered and destroyed during the year was:— 3 sacks of Brussels Sprouts. 2 lb. of Black Currants. 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 115 samples of milk and 12 samples of cream, were taken and submitted for analysis during the year. These samples were investigated by the Public Analyst to the Borough, 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. Dining the year one sample of milk was found to be adulterated to such a degree as to justify legal proceedings. In this case proceedings were instituted but were withdrawn on technical grounds. 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. 61 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) Orders. Five 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. Shell-fish (Molluscan).—There are no shell-fish beds or layings in the Borough. No markets for the sale of shell-fish by wholesale exist in the district. Magisterial Proceedings under Food and Drugs (Adulteration) Act, 1928. Street where Purchased Offence. Petty Sessions. Date of Hearing Result. King's Road. Selling milk deficient in fat to the extent of 6%. Kensington 3-3-36 Withdrawn on technical grounds. Public Health (London) Act, 1891. King's Road. Exposing and depositing for sale Walnuts unfit for the food of man. Kensington 21-1-36 Dismissed £2 2s. 0d. costs. 62 SECTION VI—INFECTIOUS DISEASES. (a) Infectious Diseases Generally. DISEASES COMPULSORILY NOTIFIABLE IN THE BOROUGH. Acute Poliomyelitis. Acute Polio-encephalitis. Acute Encephalitis Lethargica. Acute Primary Pneumonia. Acute Influenzal Pneumonia. Cerebro-spinal Fever. Chicken Pox. Plague. Anthrax. Glanders. Hydrophobia. Cholera. Continued Fever. Ophthalmia Neonatorum. Diphtheria. Membranous Croup. Dysentery. Erysipelas. Malaria. Puerperal Fever and Puerperal Pyrexia. Relapsing Fever. Small-pox. Typhus Fever. Tuberculosis. Scarlatina or Scarlet Fever. Typhoid or Enteric Fever. Food Poisoning. NOTIFICATIONS DURING THE YEAR. The total number of notifications, excluding duplicates, was 648. Of this figure, 88 were notifications of Pulmonary Tuberculosis and 12 of Non-pulmonary Tuberculosis. In addition, 502 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 a decrease of 39 in the number of notifications of Diphtheria. The number of notifications of Scarlet Fever (154) represents an increase of 8, as compared with that for 1935. The number of notifications of Tuberculosis was 100, an increase of 12, as compared with that for 1935. 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:— 63 TABLE No. 40 Cases of Infectious Disease Notified during the Year. notified in Chelsea. Cases notified in each Ward. Removed to various Hospitals[/### At all Ages. Under 1 Year. 1—2 Years. 2—3 Years. 3—4 Years. 4—5 Years. 5—10 Years. 10—15 Years. 15—20 Years. 20—35 Years. 35—45 Years. 45—65 Years. 65 and Upwards. Stanley. Cheyne. Church. Hans Town. Royal Hospital. — — — — — — — — — — — — — — — — — — Chicken-pox 165 3 7 11 11 13 76 34 5 5 — — — 66 24 62 6 7 12 Cholera — — — — — — — — — — — — — — — — — — Diphtheria 72 3 3 2 6 3 33 6 6 7 2 1 — 30 13 19 5 5 67 40 — 1 — 1 1 4 6 19 8 16 4 18 — 2 28 Scarlet Fever 154 3 1 12 11 19 66 8 11 12 9 2 — 100 15 22 4 13 149 Typhus Fever — — — — — — — — — — — — — — — — — Enteric Fever 6 — — — — — 1 3 — 2 — 1 1 4 — — 5 Puerperal Fever 2 — — — — — 2 — — — 1 1 — — — 2 Puerperal pyrexia 6 — — — — — — — 1 4 1 — — 1 — 5 — — 6 Cerebro-spinal Fever 2 1 — — 1 — — — — — — — — — — — — 2 Ophthalmia Neonatorum 7 7 — — — — — — — — — — — — — — 1 4 Poliomyelitis 2 — — — — — 2 — — — — — — 1 1 — — — 2 Encephalitis Lethargica — — — — — — — — — — — — — — — — — — Polio-encephalitis — — — — — — — — — — — — — — — — — — Malaria 1 — — — — — — — — 1 — — — — — 1 — — 1 Dysentery 4 — — 1 — — 1 — 1 — — 1 — 1 — — 2 1 3 AcutePrimary Pneumonia 82 2 4 4 3 2 13 5 4 14 7 15 9 41 5 28 3 5 69 Acute Influenzal Pneumonia 5 — — — — — 1 — — 1 — 1 2 3 — — 1 1 2 Total 548 19 16 30 32 37 193 53 30 53 25 41 19 266 64 162 21 35 352 Tuberculosis:— 88 — 1 — 1 1 1 3 41 12 26 2 35 12 33 4 4 Non-Pulmonary 12 — — — — — 1 1 2 3 2 3 — 4 2 3 2 1 Totals (Tuberculosis) 100 — 1 — — 1 2 2 5 44 14 29 2 39 14 36 6 5 Totals 648 19 17 30 32 38 195 55 35 97 39 70 21 305 78 198 27 40 64 No cases of Small-pox, Cholera, Typhus Fever, Encephalitis Lethargica, Polio-Encephalitis, Continued Fever, Relapsing Fever, Plague, Anthrax, Glanders or Hydrophobia were notified during the year. DIPHTHERIA. Notifications.—During the year 72 cases of diphtheria were notified, as compared with 111 in the previous year. The incidence of the disease during the past two years is shown in Table No. 41. Deaths.—One death from the disease occurred during the year, a child, aged six years. 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. 1935 111 95 1 1.0 61 Nov. 263 25 9.5 238 90.5 1936 72 93 1 1.5 68 Jan. 247 23 9.0 224 91.0 It will be observed that there was a decrease in the number of cases notified in 1936. The percentage of removals to the L.C.C. Hospitals was high, and the case mortality rate was higher than that for 1935. Information was received from the L.C.C. that 5 of the cases sent to Hospital in the course of the year proved not to be suffering from diphtheria. DIPHTHERIA IMMUNISATION CLINIC. In April, 1934, the Borough Council approved an annual grant of £50 for immunisation against diphtheria and Schick testing to be carried out at the Violet Melchett Infant Welfare Centre for children under 5 years of age on the register of the Centre. Early in 1935, the Borough Council arranged to extend these facilities to children of school age, the Borough Council contributing towards the cost of this service. A weekly clinic has been held during the year. In co-operation with the London County Council, leaflets have been prepared and distributed at the various schools in the Borough. Attendances of elementary school children for immunisation against diphtheria at the clinic are allowed to count as attendances at school. 65 The following table gives details of the work of the clinic during the past two years. TABLE 41a. Year No. of new cases. Preliminary Schick Tested. Commenced treatment without Schick Test. Naturally Immune Immunised. Discontinued treatment and removed from register. No. under treatment at end of year. Preschool Age. School Age. Preschool Age. School Age. 1935 230 3 52 175 20 147 40 7 93 1936 221 3 49 135 20 115 55 7 80 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, 154 cases of Scarlet Fever were notified, the figure for 1935 being 146. Information was received from the L.C.C. Hospitals that 5 of the cases proved not to be Scarlet Fever. Two "return" cases of the disease occurred during the year. Deaths.—There were no deaths from Scarlet Fever during the year. 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. 1935 146 95 2 1.4 68 Jan. 1936 154 96 — — 65 June 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 66 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 502, as compared with 14 in the preceding year. Of the total number (502) 283 were under five years of age. Deaths.—There were four deaths from measles during the year. Visiting and Nursing.—During the year, 703 visits and re-visits were made by the Health Visitors. Cases are also visited by the District Nurses whenever circumstances render this necessary. Two hundred and fifty-eight visits were made in 1936. Removal to Hospital.—Cases of Measles are received in the Hospitals of the London County Council. ENTERIC FEVER. Notifications.—During the year six cases under the Enteric Fever Group were notified in Chelsea. Five 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. Four specimens of blood were examined during the year for the Widal reaction. Deaths.—There was one death from this disease during the year, an adult aged 25 years. 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 87 Malaria 1 Dysentery 4 Pneumonia.—All primary pneumonias, lobar or lobular, are notifiable The only secondary pneumonia which is notifiable is influenzal pneumonia. The notifications and deaths from pneumonia during the past two years were as follows:— Notifications. Deaths. (All Forms) 1935 55 28 1936 87 51 67 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. Two cases of Puerperal Fever and six 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 2 2 0 0 0 Puerperal Pyrexia 6 6 0 0 0 The notifications of puerperal fever and puerperal pyrexia during the past two years were as follows:— Puerperal Fever. Puerperal Pyrexia. 1935 6 7 1936 2 6 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. Under the Public Health (Ophthalmia Neonatorum) Regulations, 1926, the duty of notifying a case of Ophthalmia Neonatorum is placed solely upon the medical practitioner in attendance. This disease is defined as a purulent discharge from the eyes of an infant, commencing within twenty-one days from the date of its birth. Seven cases of ophthalmia neonatorum were notified during the year. As required by the Ministry of Health, particulars of the notified cases are set out in the following table:— 68 TABLE No. 44. Ophthalmia Neonatorum. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. No. Notified. Treated. At Home. In Hospital. 7 3 4 5* — — 1 *One case removed from Borough, information not available. Two 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. In addition to notified cases of Ophthalmia Neonatorum, four cases of inflammation of the eyes were reported by the Medical Officer of Health of the London County Council. These cases were visited by the Health Visitors and action taken where necessary. POLIOMYELITIS AND POLIO-ENCEPHALITIS. Two cases of Poliomyelitis were notified during the year. One of these, a non-resident, was notified from a Chelsea Hospital. The remaining case, a girl aged 9 years, was still receiving treatment at end of the year. No case of polio-encephalitis was notified. ENCEPHALITIS LETHARGICA. No case of Encephalitis Lethargica was notified during the year. Fifteen 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 sequelæ may be serious, as in most cases some permanent damage to the brain tissue occurs. The disease was made compulsorily notifiable from 1st January, 1919. Deaths.—There was no death from this disease during the year. CHICKEN POX. With the approval of the Ministry of Health, the Borough Council under Section 55 of the Public Health (London) Act, 1891, made the disease known as chicken pox notifiable in the Borough on, and from, the 12th August, 1929. One hundred and sixty-five notifications were received during the year. Of these, 12 were treated in hospital. SMALL POX. 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. 69 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 1935. The figures for the year 1936 are not yet available. TABLE No. 45. Vaccinations. Number. Percentage of births registered. Births registered in 1935 767 100 Successfully vaccinated 440 57.4 Insusceptible of vaccination 3 0.4 Had Small Pox — — Statutory Declaration of conscientious objection 133 17.3 Died unvaccinated 43 5.6 Postponed by medical certificate 2 0.3 Removed to other districts 66 8.6 Removed to unknown addresses 77 10.0 Not accounted for in previous columns 3 0.4 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 1936 was 763. 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. Disinfection.—The disinfecting staff numbers three. A steam disinfector is provided. An appropriate motor vehicle is utilised for the 70 conveyance of infected and disinfected articles to and from the Disinfecting Station. Disinfection in connection with the notifiable infectious diseases is carried out free of charge. Applications for special disinfection, not associated with the notifiable infectious diseases, are considered, and, if the work of the Department permits it, are carried out at the expense of the applicant. Thirty-one such disinfections were carried out during the year, the total charges amounting to £14 18s. 6d. On page 44 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, 1936, Section 195 (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. No family 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 89 occasions. The following Table No. 46 shows the number of attendances in each quarter:— TABLE No. 46. Quarter. No. of days on which the Station was opened. Attendances. Verminous. Impetigo. March 23 131 — June 24 132 — September 19 113 — December 23 137 — 89 613 — 71 The amount recoverable from the London County Council, as the School Authority, for the cleansing for the year is £51 6s. Seven 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 134, but 34 of these related to cases which had been previously notified, so that the total number of new notifications was 100. In the previous year, the corresponding number was 88. 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 34 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 1936. Age Periods. New Cases. Deaths. Pulmonary. Nonpulmonary. Pulmonary. Nonpulmonary. m. f. m. f. m. f. m. f. 0—1 — — — — — — — — 1—5 1 — — — — — — — 5—10 1 1 1 — — — — — 10—15 1 1 — — — 1 — — 15—20 2 2 — 2 . — 1 — 1 20—25 8 10 3 — 3 3 — — 26—35 10 24 1 3 3 8 — — 35—45 11 7 2 — 6 1 — — 45—55 17 1 — — 9 2 — — 55—65 12 6 2 1 9 3 — — 65 and upwards 4 — — — 4 — — — Totals 67 52 9 6 34 19 — 1 The death rate from all forms of Tuberculosis in Chelsea was 0.9 per 1,000. Of the total number of deaths (54) from all forms of Tuberculosis, eleven died non-notified or prior to notification. The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was therefore 72 as one is to 5. The corresponding ratio for 1935 was 1:10. 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 131 128 259 Non-pulmonary 34 17 51 165 145 310 (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 130 visits to nondispensary cases of Tuberculosis. Visits made to Dispensary cases of Tuberculosis are recorded in Table No. 49. 73 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 75), 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 1936, 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. 74 TABLE No. 49. Treatment of Tuberculosis Year, 1936. 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 42 32 2 — 7 5 — — 49 37 2 — 414 (b) Diagnosis not completed — — — — — — — — — 4 1 — (c) Non-tuberculous — — — — — — — — 100 125 48 48 B.—Contacts examined during the year:— (a) Definitely tuberculous — 2 1 1 — — — — — 2 1 1 133 {b) Diagnosis not completed — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 20 34 37 38 C.—Cases written off the Dispensary Register as:— (a) Recovered 6 12 1 — 1 5 3 1 7 17 4 1 485 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 121 163 86 86 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 118 104 5 6 15 13 9 9 133 117 14 15 283 (b) Diagnosis not completed — — — — — — — — — 4 — — 1. Number of cases on Dispensary Register on January 1st 310 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 31 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of" 73 4. Cases written off during the year as Dead (all causes) 47 5. Number of attendances at the Dispensary (including Contacts) ... 1,856 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 1 7. Number of consultations with medical practitioners:— (a) Personal 2 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 53 (b) Other 116 9. Number of visits by Nurses or Health Visitors to homes for 10. Number of:— (a) Specimens of sputum, etc., examined 407 Dispensary purposes 3,329 (b) X-ray examinations made in connection with Dispensary work 581 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above 5 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 130 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. 1935. 1936. Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B. plus Class T.B. minus. Class T.B, plus Class T.B. minus. Class T.B. plus Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1 Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus) Group 1. Group 2. Group 3. Total (Class T.B. plus) Group 1. Group 2. Group 3. Total (Class T.B. plus) Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). Group 1. Group 2. Group 3. Total (Class T.B. plus). (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults m. 1 1 1 — 2 — 2 — — 2 1 — — — — — — — — — 2 — — — — 1 1 — — 1 1 — 2 — 2 5 — 1 — 1 1 1 2 — 3 1 — — — — — — — — — — — — — — f 1 2 — — 2 1 — — — — — — — — — — — — — — 2 — — — — 1 — 3 — 3 3 — — — — 4 — 1 — 1 3 — — — — 2 1 — — 1 — — — — — — — — — — Children — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 3 — — — — — — — — — 4 — — — — — — — — — — — — — — Disease not Arrested Ad'lts m. 1 4 4 — 8 — 1 1 1 3 — — — — — — — 2 — 2 — 1 1 — 2 2 — — — — 2 1 2 — 3 — 1 — — 1 4 1 4 — 5 4 2 5 2 9 7 2 5 1 8 7 4 12 3 19 f. 2 1 2 — 3 — 1 1 — 2 1 2 1 — 3 2 — 1 — 1 — — — — — 1 1 — — 1 1 2 2 — 4 2 1 3 — 4 1 1 2 1 4 2 1 4 2 7 5 3 5 1 9 8 1 8 1 10 Children 1 — — — — — — — — — — — — — — — — — — — — — — — — 2 — 1 — 1 — — — — — — — — — — 1 — — — — 1 — 2 — 2 2 — — — — 2 — — — — Condition not ascertained during the year — 1 — — 1 — — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — 1 — — — — 1 — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 6 9 7 — 16 2 4 2 1 7 2 1 — 3 2 — 3 — 3 4 1 1 — 2 8 2 4 — 6 7 3 6 — 9 15 2 5 — 7 11 3 8 1 12 14 4 11 4 19 15 5 10 2 17 17 5 20 4 29 (b) Not now on Dispensary Register! and reasons for removal therefrom. Dischargee as Recovered Adults m. 17 8 5 — 13 1 — 1 — 1 2 — — — — — — 1 — 1 4 1 1 — 2 4 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — f. 13 7 2 — 9 4 — — — — 6 1 — — 1 2 — — — — 1 — — — — 6 1 — — 1 3 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Children 10 1 — — 1 1 — — — — — — — — — 1 — — — — — — — — — 1 — 1 — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 79 38 43 6 87 6 3 7 1 11 5 2 11 1 14 8 5 6 — 11 13 12 7 2 21 11 8 6 2 16 15 9 9 2 20 18 7 13 1 21 21 7 13 1 21 9 — 15 1 18 9 4 8 — 12 9 1 6 — 6 Dead Ad'lts m. 26 26 88 36 150 2 4 8 5 17 3 1 9 3 13 — 3 5 5 13 4 1 10 2 13 4 4 10 4 18 1 1 7 1 9 — — 16 5 21 6 1 9 3 13 4 — 2 5 7 2 — 4 4 8 — — 3 7 10 f. 10 11 38 30 79 1 1 4 5 10 4 — 7 4 11 — 1 5 5 11 — 1 2 5 8 1 2 3 2 7 1 — 5 2 7 — — 4 3 7 3 — 2 1 3 1 1 3 3 7 — — 4 4 8 — — 1 4 5 Children 4 — 5 — 5 — — — — — — — 1 — 1 — — 1 1 2 — 1 — — 1 — 1 1 — 2 — — — — — 2 — — — — — — — — — — — — — — 1 — — 1 1 — — — — — Total written off Dispensary Register 168 91 181 72 344 15 8 20 11 39 20 4 28 8 40 11 9 18 11 38 22 16 20 9 45 27 16 21 8 45 20 10 21 5 36 20 7 33 9 49 30 8 24 5 37 14 3 20 9 32 11 4 16 9 29 9 1 9 11 21 Grand Totals 174 100 188 72 360 17 12 22 12 46 22 6 29 8 43 13 9 21 11 41 26 17 21 9 47 35 18 25 8 51 27 13 27 5 45 35 9 38 9 56 41 11 32 6 49 28 7 31 13 5l| 26 9 26 11 46 26 6 29 15 50 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 1928. 1929. 1930. 1931. 1932. 1933. 1934. 1935. 1936. 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 Organ?. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. | Total Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Boces and Joints. Abdominal Other Otgans. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. (a) Remaining on Dispensary Register on 31st December. Disease Arrested Ad'lts M. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 1 — — — — — — — — — — — 1 1 — 2 — — 1 — 1 f. — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 1 — — — — — 1 — — 2 3 1 — — — 1 — — — — — — — — — — — — — — — Children — — — — — — — — — — — — — — — — — — — — — 1 — — 1 — — — — — — — — 1 1 1 — — 1 2 — — — 3 3 — — — 9 9 — — — 2 2 — — — — — Disease not Arrested. Ad'lts M. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 1 1 — — — 1 1 — — — 1 2 — 2 1 5 f. — — — — — — — — — — 1 — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — — 1 — 1 — — 1 2 — — 2 4 Children 1 — — — 1 — — — — — 1 — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — 1 — — 1 1 — — — 1 — — — — — — — — — — Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 1 — — — 1 — — — — — 2 — — — 2 — — — — — — 1 — — 1 1 — — — 1 — — — 1 1 3 — — 3 6 2 1 — 3 6 3 — — 9 12 1 2 1 2 6 4 — 3 3 10 (b) Not now on Dispensary Register « and reasons for removal therefrom. Transferred to Pulmonary — — — — — — — — — — — — — — — — — — — — — — — — — — — — 1 1 — — — — — 1 — — — 1 — — 1 — 1 — — — — — — — — — — — — — — — Discharged as Recovered Ad'lts M. 1 — — — 1 1 — — — 1 — — — — — — — — — — — — — — — — — — — — — — — 1 1 1 — — — 1 — — — 1 1 — — — — — — — — — — — — — — — f. — — — 1 1 1 — — — 1 2 — — — 2 — — — — — — — — — — — 1 — 2 3 — — — 1 1 — — — — — 1 — — — 1 — — — — — — — — — — — — — — — Children 4 — — 12 16 — 1 — 6 6 — — — — — — — — — — — 1 — 3 4 — 1 — 5 6 — 1 — 3 4 — — — — — — 1 — — 1 — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 5 1 1 10 17 3 — — 2 5 4 1 1 i 7 4 — 1 1 6 1 — — — 1 4 — 4 2 10 1 2 2 — 5 5 3 2 6 16 — 1 — 4 5 4 1 — 4 9 2 1 2 1 6 — 1 — — 1 Dead Ad'lts M. — — — — — — — 1 — 1 — — — — — — — — — — — — — — — 1 — — — 1 — — — — — — — — — — — — 1 — 1 — — — — — — — — — — — — — — — F. — — — 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Children 1 — — — 1 — — 1 1 2 — — — — — — — — — — — — — — — — — — — — 1 — — 1 2 — 1 — — 1 — — — — — — — — — — — — — — — — — — — — Total written off Dispensary Register 11 1 1 24 37 5 1 2 8 16 6 1 1 i 9 4 — 1 1 6 1 1 — 3 5 5 2 4 9 20 2 3 2 6 13 6 4 2 6 18 1 2 1 5 9 4 1 — 4 9 2 1 2 1 6 — 1 — — 1 Grand Totals of (a) and (b) (excluding those transferred to 12 1 1 24 38 5 1 2 8 16 8 1 1 1 11 4 — 1 1 6 1 2 — 3 6 6 2 4 9 21 2 3 2 7 14 9 4 2 9 24 3 3 1 8 15 7 1 — 13 21 3 3 3 3 12 4 1 3 3 11 (Signed) W. H. L. McCarthy, Chief Tuberculosis Officer. 77 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, 1936. 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. New cases examined during the year. Definite Tuberculosis. Total attendances at Dispensary. 1935 361 13 per cent. 2,204 1936 371 13 ,, 1,856 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, 54 per cent. died in St. Luke's Hospital and 24 per cent. in other public institutions, that is to say 78 per cent. died away from their homes, the corresponding figure for 1935 being 76 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. 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 pneumothorax refills. Many patients, both adults and children, who attend the Dispensary for examination, either as contacts or on their own initiative, are found to be suffering from conditions, other than 78 Tuberculosis, which require treatment. These cases are advised as to obtaining such treatment, either from private practitioners or at general hospitals. Many children are found to be suffering from anaemia, malnutrition and similar diseases and are referred to the Chelsea branch of the Invalid Children's Aid Association with a view to provision of convalescent home treatment. Co-operation with the School Medical Service.—The relationship with the School Medical Service continues to be satisfactory. The School Medical Authorities frequently afford valuable help in deciding 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 53 cases (including personal consultations) at the homes of the patients, and 118 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 133, an increase of 10 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 thirteen patients received treatment. The total cost (£108 3s.), 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 3,329, a decrease of 91 over the number for the previous year. The Council lent a bedstead and bedding to one case during the year. Extra Nourishment.—Twenty-three 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 (£23 2s. 6d.) 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 1 he agency of the Invalid Children's Aid Association or other organisation. 79 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 three patients thus received dental treatment. Bacteriological Examinations.—During the year, 407 specimens of sputum were examined in connection with the work of the Dispensary. In addition, 30 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 St. Luke's Hospital British Red Cross Society Victoria Hospital Councillor Lady Phipps. Dr. R. H. Simpson (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. Coote. Mrs. L. Fraser. Miss Larken. Miss Page. Mrs. Melville Miller. Miss Marx. Dr. A. M. Gibson and Dr. M. Cutner. Mr. R. A. Hanson. Miss Forbes. Lady Almoner. Miss Ellis. Miss M. Woods. Miss White. 80 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; pocket money; 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 voluntary 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. Meetings of Committee 9 Cases considered 342 Cases reported admitted to L.C.C. Institutions 142 Dental treatment given through Borough Council Scheme 3 Extra nourishment given through Borough Council Scheme 23 Extra nourishment given through other agencies 8 Other assistance given 39 Children boarded out through the L.C.C. Contact Scheme 12 Children otherwise "arranged for" 4 Convalescence arranged 24 Patients' voluntary contributions towards the cost of Institutional treatment collected on behalf of the L.C.C. £31 9s. 6d. Metropolitan Borough of Chelsea. Annual Report OF THE PUBLIC ANALYST For the Year ended 31st December, 1936. BY THOMAS McLACHLAN, A.C.G.F.C., F.I.C. 82 February, 1937. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Chelsea, Mr. Mayor, Ladies and Gentlemen, During the year ended 31st December, 1936, four hundred samples were submitted to Mr. Gerrans or to me for analysis by the Sampling Officers appointed under the Act. Of these, 301 samples were taken as "Formal Samples" and 99 were submitted as "Informal Samples." In the Metropolitan Borough of Chelsea the nature of the samples submitted is not discussed with the Public Analyst, and the wide range of substances chosen reflects considerable credit on your inspectors. In the Table are shown the names and numbers of samples examined, whether submitted formally or informally, and the number of each type reported as "Adulterated" or "Inferior"—the letter (A) being used to signify adulterated and the letter (I) to signify inferior. All other samples were reported as genuine. Samples reported as inferior are of low quality, though no actual adulteration would be ascribed to them. Article. Taken Formally. Adulterated . Taken Informally. Adulterated. Total Samples Analysed Total Sample s Adulterated. Milk 113 — 2 — 115 — Milk Condensed — — 3 — 3 — Almonds, Ground 2 — 1 — 3 — Baking Powder 4 — — — 4 — Barley 1 — — — 1 — Breakfast Food 1 — — — 1 — Butter 8 — 4 — 12 — Cake — — 4 1 (A) 4 1 Cheese — — 2 — 2 — Cocoa 19 — 1 — 20 — Coffee 4 — 2 — 6 — Coffee and Chicory 10 — 2 — 12 — Confectionery — — 3 — 3 — Cornflour 2 — — — 2 — Cream 9 — 3 — 12 — Dripping — — 3 1 (A) 3 1 Essences, Flavouring — — 4 — 4 — Fish, Canned 2 — 7 — 9 — Fish, Potted 1 — 1 — 2 — Flour 6 — — — 6 — Flour, Self-Raising 6 — — — 6 — Fruits, Bottled and Canned 6 — — — 6 — Fruit Powders 2 2 (A) 1 — 3 2 Fruits, Dried 7 — — — 7 — Honey — — 1 — 1 — Jam 1 — 1 — 2 — Lard 4 — — — 4 — Lard Substitute — — 1 — 1 — Margarine 8 — 2 — 10 — 83 TABLE—continued. Article. Taken Formally. Adulterated. Taken Informally. Adulterated. Total Samples Analysed Total Samples Adulterated. Mustard 9 — — — 9 — Olive Oil — — 2 — 2 — Pepper 7 — 2 — 9 — Powder Blancmange 3 — — — 3 — Powder Custard 6 — 1 — 7 — Powder Cake and Pudding 8 — 2 — 10 — Rice 7 — 1 — 8 — Sago 1 — — — 1 — Sausages, Polonies, etc. — — 13 1 (A) 13 1 Spices and Salts 6 1(1) — — 6 1 Soup Powders 1 — 1 — 2 — Suet 1 — — — 1 — Sugar 6 — 1 — 7 — Tapioca 3 — — — 3 — Tea 20 — 5 — 25 — Vegetables, Preserved 1 — — — 1 — Vegetables, Dried 1 1 — — 1 1 Vegetable Paste — — 1 — 1 — Vinegar — — 1 — 1 — Spirits:— Gin — — 1 — 1 — Whisky — — 5 5 5 5 Drugs:— Aspirin — — 2 — 2 — Bile Ovals — — 1 — 1 — Bismuthated Magnesia — — 1 — 1 — Boric Acid 1 — — — 1 — Cascara Tablets 1 — 1 — 2 — Epsom Salts — — 2 — 2 — Glauber Salts — — 2 — 2 — Glycerine — — 1 — 1 — Iodine and Blackcurrant Pastilles — — 1 — 1 — Kidney Pills 1 — — — 1 — Lemon, Honey and Glycerine Pastilles — — 1 — 1 — Linseed, Liquorice and Chlorodyne Lozenges — — 1 — 1 — Stomach Powder 1 — — — 1 — Stomach Tablets 1 — — — 1 — Tincture of Iodine — — 1 — 1 — Yeast Tablets — — 1 — 1 — Totals 301 4 99 8 400 12 Percentages of Total 75.25 1.0 24.75 2.0 100 3.0 The actual percentages given by the data in the Table are as follows:— General Composition 97% Adulterated 1.5% Inferior 1.5% 84 MILK. All samples of milk were reported to be of genuine composition in accordance with the requirements of the Sale of Milk Regulations, 1901, and the Milk & Dairies (Amendment) Act, 1922. It has to be remembered that the 1922 Act requires that— "No person shall add any colouring matter or water or any dried or condensed milk or any fluid reconstituted therefrom, or any skimmed milk or separated milk to milk intended for sale." The Regulations of 1901 state that a milk containing less than 3.0% of fat or 8.5% of solids-not-fat shall be presumed to be adulterated until the contrary is proved. It is thus seen that the 1922 Act places a much greater responsibility on Local Authorities than was formerly the case, and this point is frequently not appreciated. Owing to the difficulty of detecting adulteration by a simple abstraction of fat, it is now sufficient to be able to prove that certain processes are carried out in a factory. The application of the terms "Good," "Fair" and "Poor" are applied to milk according to the percentage of fat. They are:— Good quality Over 3.8% of fat. Fair „ Between 3.35 and 3.8% of fat. Poor „ „ 3.0 and 3.35% of fat. Of the samples examined during the year, 48 were returned as of of "Good" quality, 56 as "Fair" and 11 as "Poor." At the beginning of next year, the 1st January, 1937, those parts of the Milk (Special Designations) Order, 1936, will commence to operate which deal with the method of examination of Tuberculin-tested milk and Accredited Milk by the methylene-blue test instead of the bacteriological plate-count method. GROUND ALMONDS. Owing to the Spanish Civil War there was a shortage of almonds at the commencement of the Christmas season, and various substitutes were sold for ground almonds. One sample submitted as a "Ground Almond Mixture" proved to consist of ground apricot kernels. Another sample was obviously stale, but no exception could be taken to it; the third sample was quite satisfactory. CAMEMBERT CHEESE. A sample of Camembert cheese was submitted for examination, as it was thought to have been the cause of poisoning. Although it was examined very carefully, no deleterious matter of a chemical or bacteriological nature could be detected. In cases of this type a careful examination will usually indicate whether a foodstuff has been tampered with or not. The probability is that if any substance were present which would poison a human being, and if this substance had gained access during the preparation of the cheese, the micro-organisms which are responsible for the proper ripening of the cheese would have been affected. In the same manner, if any pathogenic bacteria had been present, they would 85 have died soon after the ripening process had commenced; otherwise the ripening would have proceeded in such a manner that the cheese would have been obviously faulty. If anything had been added to the cheese after it had been properly ripened, it would either show itself by careful examination, or, more probably, the victim would have eaten the part affected and left no trace to help the analyst. CITRUS FRUIT POWDERS. A sample of Orangeade powder and Lemon Barley powder were both reported as adulterated, as they contained tartaric acid instead of citric acid, the acid natural to citrus fruits. It does not appear to be fully appreciated that there is a distinct difference in the physiological action of citric and tartaric acids, and that it is largely on account of this difference that lemons have been used so largely in illness. CLOVES. A sample of cloves was returned as being of inferior quality. The buds were small and shrivelled, having been picked before they were properly developed. COFFEE AND COFFEE AND CHICORY. All samples examined were correctly described. CREAM. It is unfortunate that the only legal definition of cream is that it is that portion of milk rich in fat which has been separated by skimming or separating. Most of the samples examined contained from 45-51% of milk fat; whereas the tinned cream merely contained from 23-26% of fat. As tinned cream is homogenized to thicken it before it is sterilized, the public is unaware that it is really obtaining an inferior product when it is tinned. CREAM PASTRIES. A sample of Devon Splits was returned as adulterated because the fat employed in making the cream mixture was margarine fat and not milk fat. Whilst there is no objection to the use of fillings made with fats other than butter fat, the public should be made aware of the substitution by means of some description. The use of words such as "Cream," "Devon" and so on implies that the filling contains genuine cream. DRIPPING. An informal sample of dripping contained 4% of free fatty acids, and the vendor's attention was drawn to the fact. Dripping of this nature possesses a very distinct taste, so that there is little necessity on the part of the Authorities to take action. It is one of those cases where the vendor will find it necessary in his own interests to mend his ways. 86 FLAVOURING ESSENCES. All the four samples of flavouring essences had been prepared with isopropyl alcohol. In the quantities in which these essences are used this alcohol is not harmful; but it is regrettable that in order to avoid the payment of Excise duties, manufacturers should be able to employ as a solvent something of which very little is known about its pharmacological action. PRESERVATIVE REGULATIONS. All the samples of milk, cream, sausages, dried fruits, jam and jelly were examined for preservatives. The use of preservatives in milk and cream is prohibited, and they were not detected in any sample. A small amount of preservative may be added to sausages if notification is given by the exhibition of a notice in the shop or by a label placed on the sausages. One sample was found to contain 90 parts of sulphur dioxide per million parts of sausage without such notification having been given. Dried fruits, jams and jellies are allowed to contain small quantities of preservatives without any declaration; but the amount which is permitted was never found to be exceeded in any of the samples examined. SPLIT PEAS. A sample of split peas was returned as adulterated, because over 10% of the peas had been attacked very badly by maggots and the remainder were shrivelled. Examples such as this show the necessity for keeping a watch at mills where products of this type are ground, because inferior products, which cannot be sold otherwise, are commonly used for grinding. TINNED FOODS. In no case was any excessive amount of tin found in any of the samples of canned foods submitted. WHISKY. Five samples of whisky were all returned as inferior. The Food & Drugs (Adulteration) Act states that all spirits should be not less than 35% under proof; whereas all these samples were about 35.7% under proof. They were not reported as adulterated because it is customary to allow a slight margin of error in dilution ; but there is a tendency on the part of vendors to make the error on the wrong side in order to obtain the maximum profit. DRUGS. Several samples of drugs were obtained from chain store shops. It is not the province of the Public Analyst to attend to the enforcement of the Medicine Stamp Act, but it is remarkable to note the number of medicines which are sold in this type of shop without any disclosure of the composition of the medicine. Various mixtures may be sold as Kidney Pills or Bile Ovals. The kidney pills appeared to contain powdered buchu, liquorice and aloes; whilst the bile ovals appeared to 87 contain aloes, jalap and ginger. A sample of Iodine and Blackcurrant Pastilles contained .0465% of iodine. A sample of linseed, liquorice and chlorodyne tablets contained neither morphine nor prussic acid, which would render the seller liable under the Dangerous Drugs Act and the Pharmacy & Poisons Act; but the sale of these sweetmeats indiscriminately to children is dangerous. Sometimes they eat too many of these medicated sweets because they like the strong flavour, and may develop headaches; or there is the other risk, which is perhaps greater —that ignorant people take so-called medicated sweets or wines with impunity and think that they can do the same with the properly medicated preparation which they obtain from a chemist's shop. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, THOMAS McLACHLAN, A.C.G.F.C., F.I.C. Public Analyst.