' \ '--v / ■' ><*• W : CHE 43 Metropolitan Borough of Chelsea. Annual Report of the Medical Officer of Health > for CHELSEA 1 939 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., (t.u.), printers, 170, farr1ngdon road london; E.c.l. 1939. 74556 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 1939. The chief vital statistics relating to the year are as follows:—The resident population of the Borough is estimated by the Registrar-General at, a figure which is lower than that for last year. The birth rate ( ) is lower than that for last year (10.2). The marriage rate ( ) is higher than that for last year (15.6). The death rate ( ) is higher than that for London generally ( ) and compares with 13.5 last year. It is, perhaps, not generally realised that over 10 percent. of the Chelsea population is made up of persons over 05 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 per 1,000 live births, as compared with 80 last year. The general improvement in the public health of the Borough continues to be maintained. There was a decrease in the total incidence of notifiable infectious disease during the year. The total number of notifications, excluding duplicates, war 372 as compared with 591 last year. A considerable decrease was recorded in the number of cases of measles. At the end of the year there were 200 cases of pulmonary tuberculosis and 38 cases of non-pulmonary tuberculosis known to be living in the Borough—a total much 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 7,514 and 5,758 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 C. 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 The problem of abating overcrowding is receiving constant consideration by the Housing Committee of the Council. I have again to express my appreciation of the work of the staff of the Public Health Department. 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 31st December, 1939 Her Worship the Mayor (Councillor Mrs. C. I. Hartnell J.P) The Deputy Mayor ((Councillor E. F. Williams L.L.B.) Alderman Miss C. Fulford, J.P., L.C.C. [Chairman). Councillor J. Lilly (Vice-Chairman). Alderman Lady Phipps. Alderman G. M. Stevenson. Councillors: G. M. collis L. R. Andrews. I. T. Henderson. G. A. Beaton. Mrs. C. Williams. Hon. Eveleen Campbell-Gray. Mrs J. J. Cockburn. Housing Committee. Her Worship the Mayor (Councillor Mrs. C. I. Hartnell J.P.) The Deputy Mayor (Councillor E. F. L.L.B. Councillor H. G. Evans [Chairman). Alderman Lady Phipps [Vice-Chairman). Alderman Basil Marsden-Smedley, L.C.C. Councillors: L. R. Andrews. R. A. Lygon. J. M. Buckley. G. A. Thesiger. Mrs. J. T. Cockburn. Mrs. C. Williams. Capt. R. L. Edwards. P. A. Williams. Mrs. M. S. M. Elliott. Milk and Welfare Sub-Committee. Her Worship the Mayor (Councillor Mrs. C. I. Hartnell.) The Deputy Mayor ((Councillor E.F Williams L. L. C. Alderman Lady Phipps [Chairman). j*^) Alderman Miss C. Fulford, J.P., L.C.C. Councillors: Hon. Eveleen Campbell-Gray. Mrs. C. I. Hartnell. J. Lilly. Mrs. C. Williams. 5 PUBLIC HEALTH OFFICERS OF THE AUTHORITY. The names and qualifications of members of the staff of the Public Health Department, at 31st December, 1939, are tabulated below in the form required by the Ministry of Health. (a) Medical. Year appointed. Name. 0 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). 1939 , Lee-Lander, F.p. M.D., F.R.C.P. Tuberculosis Officer (Part time). 1926 Matthews, Kathleen F. M.R.C.S., L.R.C.P., D.P.H. Medical Officer, Maternity and Child Welfare (Part time). 1928 Nelson, Grace M. M.R.C.S., L.R.C.P. Medical Officer, Maternity and Child Welfare (Part time). 1921 Radford, Muriel A. M.B., B.S., D.P.H. Medical Officer, Maternity and Child Welfare (Part time). 1939 Gourlay, Elizabeth M.D. B.s., Medical Officer of AnteNatal Clinic (Part time). 1935 Hamilton. C. K. J. MB., F.R.C.P. Hon. Medical Director, Mothercraft Home, and Medical Officer, Chelsea Day Nursery (Part time). 1929 McCullagh, W. McK. M.B., F.R.C.S. Consultant for Puerperal Fever and Puerperal Pyrexia (Part time). 1930 Holland, E. T. M.R.C.S., L.R.C.P., Public Vaccinator, St. Luke's Hospital (Part time). 1930 Sandiland, D. S. M.R.C.S., L.R.C.P. Public Vaccinator, St. Stephen's Hospital (Part time). 1933 Thomas, E. F. M.D., D.P.H. Public Vaccinator, Chelsea District (Part time). 6 (b) Other Staff. Year Appointed. Name. Qualifications. Appointment. 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 Shelley, A. P. T. Cert. San. Insp. Exam. Board. Sanitary Inspector (Whole time). 1930 Hoyland, H. Cert. Royal San. Inst, and San. Insp. Exam. Joint Board, Cert. Meat and other Foods. Sanitary Inspector, (whole time) 1916 Brown, Miss M. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Health Visitors' Diploma, approved by Board of Education. Cert. C.M.B. Sanitary inspector and Health Visitor (Whole time). 1911 Hobart, Miss F. G. Cert. San. Insp. Exam. Board, Diploma of Nat. Health Soc., Royal San. Inst. Health Visitors' Cert. C.M.B. Health Visitor and Superintendent to Chelsea Health Society (Whole time). 1923 Shaw, Miss A. Cert. Gen. Hosp. Training, C.M.B. and Cert. Mothercraft Training Soc., Health Visitors' Cert, approved by Ministry, of Health. Health Visitor, Chelsea Health Society(Whole time)j 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 (Hali time). 1937 Shute, Miss P. E. M. S.R.N.,Cert.Gen.Hosp. Training, S.C.M., Royal San. Inst. Health Visitor; 'Cert. Matron caelsea day nvrsery (whole time)(temporary) 1938 Streatfieild, Miss M. B. Cert. Inst, of Hospital Almoners. Secretary of Chelsea Tuberculosis Dispensary, Tuberculosis Visitor and Social Worker in connection with Tuberculosis (Whole time). 1937 Dolan, Miss A. P. Cert. General Hospital Training and Tuberculosis, Cert. C.M.B. Tuberculosis Nurse to Dispensary (Whole time). 1939 Leacock, H. F. cert. royal san. inst. and san. inst. exam. joint board, cert. meat and other foods. sanitary inspector with special reference to duties under the housing acts. (Whole time) 7 Year Appointed. Name. Appointment. 1914 Hayden, A. B. J. Chief Clerk and Vaccination Officer, Public Health Department (Whole time). 1920 Boslcy, 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 K. General Secretary, The Violet Melchett Infant Welfare Centre (Whole time). 1935 Bennett, Miss H. M. Assistant Secretary, The Violet Melchett Infant Welfare Centre, (Whole time). 1906 Leonard, C. Mortuary Keeper and Messenger (Whole time). 1938 Berry, L. H. Chief Disinfector (Whole time). 1929 Weston, R. J. Disinfector (Whole time). 1931 Bosley, E., Jr. Disinfector (Whole time). 1937 Brady, Mrs. R Shelter and Cleansing Attendant (Whole time). 1936 Clark, Mrs. M Home Help (Part time). staff D. W J.Fenton9(Tuberculosis officer)Resigned D. FP. Lee-Lander appointed. MRW. Crandell second civil defence M R W. A. F Leacock appoointed sanitary induspector MR. AP . Shelley Miliary duties MR. J. Casley MC. CH. Berry 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 Section A.—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 2 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 Section B.—Provision of Health Services in the Borough. Professional Nursing in the Home 25 (а) General 25 (b ) 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 32 Compensation to Midwives 32 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 Welf are Centre 35 (i.) Chelsea Health Society 36 (ii.) Chelsea Day Nursery 36 (iii.) Chelsea Mothercraft Home 37 (b.) 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 39 Dental Treatment 40 Widows', Orphans and Old Age Contributory Pensions Acts, 1925 and 1929 40 Child Life Protection 40 Blind Persons Act, 1920 41 Summary of Arrangements regarding Maternity and Child Welfare 41 9 section C.—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 Premises and Occupations Controlled by Byelaws or Regulations 47 Bed Bugs, Eradication of 47 Factories, Workshops and Workplaces 47 Public Mortuary 49 Rag Flock 49 Offensive Trades 49 Swimming Baths and Pools 49 Pharmacy and Poisons Act, 1933 49 section D..—Housing. Housing Statistics 50 Housing Conditions in the Borough 52 (a.) General Observations 52 (b.) Sufficiency of Supply of Houses 52 (c.) Overcrowding 54 (d.) Fitness of Houses 55 («.) Unhealthy Areas 56 (/.) Byelaws relating to Houses and Houses Let in Lodgings 56 (g.) Housing Inspections 56 section E.—Inspection and Supervision of Food. Milk Supply 58 Milk (Special Designations) Order 58 Public Health (Meat) Regulations, 1924 59 Slaughter-houses 59 Bakehouses 59 Ice-cream Vendors 60 Fried Fish Vendors 60 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 61 Margarine 61 Chemical and Bacteriological Examination of Food 61 Nutrition, Dissemination of Knowledge as to 61 Shell Fish 61 section F.—Infectious and Other Diseases. (a.) Infectious Diseases Generally 62 Diseases Notifiable in the Borough 62 Notifications 62 Diphtheria 64 Diphtheria Immunisation Clinic 64 Scarlet Fever 65 Measles and Whooping Cough 65 Enteric Fever 67 Pneumonia, Malaria and Dysentery 67 Puerperal Fever and Puerperal Pyrexia 68 10 PAGE Ophthalmia Neonatorum 68 Poliomyelitis and Polio-Encephalitis 69 Encephalitis Lethargica 69 Chicken Pox 09 Smallpox and Vaccination 69 Venereal Disease 70 Disinfection 70 Infectious Diseases Shelter 70 Disinfestation 71 (b.) 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 82 Population Exposed to Risk. For the calculation of birth and death rates, comparable numbers of exposed, to risk have been furnished as follows:- For Birth Rates: the estimated resident population including non-civilians as at the middle of the year. For General Death Rates: a population estimate, constructed so as to allow for the exclusion of noncivilians during the last quarter and for the different areal assignment of deaths adopted for the first three and the last Quarters, respectively. For Infant and Maternal Mortality Rates: the number of births according To the system of areal assignment adopted for the deaths. Annual Report on the Health of the Metropolitan Borough of Chelsea. Year ending 3 1st December, I939 SECTION A—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. GENERAL STATISTICS. 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 7,3S3 Stanley 10,696 13,048 23,744 23,946 35,085 59,031 TABLE No. 1. Area registrar-generals estimate of (a) Resident population 1939 (b) average population appro priate to the calculation of death rates Number of Inhabited Houses (end of 1939) according to Rate Books Rateable value, October, 1939 £1,332,360 Sum represented by a penny rate, October, 1939 £4.850 12 Physical Features and General Character of the Area.—The Metropolitan Borough of Chelsea, situated near the centre of the Metropolis, is bounded on the north by the Royal Borough of Kensington, on the west by the Borough of Fulham, on the cast by the City of Westminster, and on the south by the River Thames. It is a small compact borough, less than two miles in length, by about three-quarters of a mile in width. Over nearly the whole area the soil consists of gravel and sand, highly permeable to water. In a small portion of the western side of the Borough there is a thin loamy deposit of brick earth resting upon the gravel. There is a narrow strip of alluvial deposit extending along the Embankment from Battersea Bridge westwards. The northern portion of the area is largely built over. The central zone comprises a number of pleasant squares occupied by people in affluent circumstances. The grounds of the Royal Hospital, with the River Thames and Battersea Park beyond, render the southern zone unusually open. Social Conditions.—The density of population (number of persons per acre) as shown by the 1931 Census, is 89.4, the corresponding figure for London, as a whole, being 58.7. The density of population of each of the five Wards in the Borough is as follows:—Church Ward, 111.0; Stanley Ward, 123.7; Hans Town Ward, 78.6; Cheyne Ward, 76.4; Royal Hospital Ward, 49.9. Analysis of the 1931 Census figures shows that there is a greater proportion of unoccupied and retired persons in Chelsea than in any other Metropolitan borough. There is, however, a considerable " working class " population. Thus, of a total of 19,600 adult males, about 16,750 are occupied. The chief occupations are transport work (2,704), personal service (2,224), metal work (1,036), and clerical work (1,260). Over one half of the 30,800 adult females are occupied. Of these, domestic servants account for 8,746, dressmakers number 1,243, shop assistants 1,090, and clerks 1,471. There are no dangerous or offensive trades carried on in the Borough. There is no evidence that any of the occupations of the inhabitants exerts a deleterious influence on the public health. VITAL STATISTICS. In accordance with the requirements of the Ministry of Health, the following extracts from the Vital Statistics of the year are shown below :— TABLE No. 2. Total M. F. Live Births Birth rate per 1,000 of the estimated resident population. Legitimate Illegitimate 13 Total M. F. Still Births Rate per 1,000 total (live and still) births Deaths Death rate per 1,000 of the estimated average population Deaths from Puerperal Causes :— Deaths. Rate per 1,000 total (live and still) births. Puerperal Sepsis ... Other Puerperal Causes ... Total ... Death rate of Infants under one year of age :— All infants, per 1,000 live births Legitimate infants per 1,000 legitimate live births Illegitimate infants per 1,000 illegitimate live births Deaths from Cancer (all ages) Deaths from Measles (all ages) Deaths from Whooping Cough (all ages) Deaths from Diarrhoea (under 2 years of age) BIRTHS. The total number of births of Chelsea residents during the year was , equivalent to a birth rate of per 1,000 of population. The birth-rate for England and Wales in 193 was , while that for London as a whole was The following Tables are self-explanatory:— TABLE No. 3. Registered Births. Legitimate and Illegitimate Births. Total. Births Registered in the Borough ... Births of Non-Parishioners ... Births of Chelsea Mothers in Lyingin Hospitals and elsewhere outside of the Borough ... Next Chelsea Births ... 14 TABLE No. 4. Births, Birth-Rates, Births in Wards and Inward Transfer Births. Year. Births. Total. BirthRate Per 1,000 of Population. Hans Town. Births in Wards. Stanley. Inward Transfer Births. Leg. IUeg. Royal Hospital. Church. Cheyne. Hospitals. Nursing Homes. Private Addresses. Total. 1938 519 55 574 10 2 59 64 85 91 275 £52 5(5 15 323 1939 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. London County Council:— London County Council:— St. Luke's Hospital 1 St. Mary Abbots Hospital St. Stephen's Hospital 4 Fulham Hospital St. Pancras Hospital i oluntarv :— St. Olave's Hospital Chelsea Hospital for Women - Voluntary:— Princess Beatrice Hospital Nursing Homes :— St. George's Hospital Wilbraham 4 Queen Charlotte's Hospital Royal Avenue ... 1 Clapham Maternity Hospital Miscellaneous Hospitals Nursing Homes:— Miscellaneous Total 10 Total km. From Table No. 4 it will be observed that the number of births of Chelsea Infants in Hospitals and elsewhere outside Chelsea accounted for 56 percent, of the total births. In the preceding year the percentage was 57. 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 278 births, including stillbirths, were notified as occurring in Chelsea. Of this number, in 109 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 3lS births, including stillbirths, amongst Chelsea mothers in Lying-in hospitals and elsewhere outside the Borough. The total number of notified Chelsea births from all sources was The following table indicates the source of notification of the 278 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 60 – 60 40 2 42 Midwives 97 4 101 – – – Poor Law Institutions 4 – 4 63 2 65 Parents 4 – 4 3 – 2 165 4 169 105 4 149 16 Illegitimate Births.—The following table shows the number of illegitimate births and the percentage of the total births. TABLE No. 7. Year. Number of Illegitimate Births. Percentage of Total Births. Male. Female. Total. 1938 34 21 55 9.58 1939 Stillbirths.—The corrected number of stillbirths during the year was which represents a rate for the Borough of per 1,000 of the population, as compared with for London as a whole. MARRIAGES. There were 1065 marriages registered in the Borough during the year 878 in 1938). The marriage rate (number of marriages per 1,000 of population) was In the preceding year the marriage rate was 15.6. DEATHS. The total number of deaths of Chelsea residents during the year was equivalent to a death rate of per 1,000 of population. The death rate for England and Wales for 1939 was and for London 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 Faitor 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 193 when so adjusted is The following tables are self-explanatory:— TABLE No. 8. Registered Deaths. Total. Deaths registered in the Borough Non-parishioners # Deaths of Chelsea residents in hospitals and elsewhere outside the Borough Nett Chelsea deaths 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 Chelsea deaths registered in the Borough, 365 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. London County Council:— General Hospitals St. Luke's Hospital and Institution 223 Mental Hospitals Infectious Disease Hospitals St. Stephen's Hospital and Institution 81 (L.C.C.) Tuberculosis Sanatoria, etc. St. George's Home for Tuberculosis - Nursing Homes Poor Law Institutions (L.C.C.) Voluntary:— Miscellaneous Chelsea Hospital for Women - Cheyne Hospital for Children - Brompton Hospital 2 Royal Hospital for Pensioners 52 Royal Cancer Hospital 5 Victoria Hospital for Children 2 365 Of the deaths of non-residents registered in Chelsea, occurred in hospitals or Institutions within the Borough. 17 18 TABLE No. 10. Deaths, Death Rates, Deaths in Wards and Seasonal Mortality. Seasonal Mortality Rate. - Fourth Quarter. 12.9 Third Quarter. 12.0 Second Quarter. 14.3 First Quarter. 14.8 Deaths in Wards. ; Stanley. 291 Cheyne. 104 ' Church. 144 Royal Hospital. 128 Hans Town. 90 DeathRate per 1,000 of Population. 13.5 Deaths. 757 Year. 1938 1939 19 TABLE No. 11. Birth-rates, Death-rates, Analysis of Mortality, England and Wales, Maternal Death-rates and Case-rates for certain London, 126 Great Infectious Diseases in the year 1938. Towns and 148 Smaller Towns. (Provisional figures based on Weekly and Quarterly Returns.) England and Wales. 126 County Boro's and Great Towns including Loudon. 148 Smaller Towns (Resident Populations 25.000 to 50,000 at 1931 Census). London Administrative County. Rates per 1,000 Population. Births:— Live 15.1 15.0 15.4 13.4 Still 0.60 0.65 0.60 0.48 Deaths:— All Causes ... 11.6 11.7 11.0 11.4 Typhoid and Paratyphoid fevers 0.00 0.00 0.00 0.00 Smallpox 0.00 — 0.00 Measles 0.04 0.05 0.03 0.06 Scarlet fever 0.01 0.01 0.01 0.01 Whooping Cough 0.03 0.03 0.02 0.03 Diphtheria 0.07 0.07 0.06 0.05 Influenza 0.11 0.10 0.11 0.06 Notifications:— Smallpox 0.00 0.00 0.00 Scarlet fever 2.41 2.60 2.58 2.05 Diphtheria 1.58 1.85 1.53 1.90 Enteric fever 0.03 0.03 0.04 0.05 Erysipelas 0.40 0.46 0.39 0.46 Pneumonia 1.10 1.28 0.98 0.98 Rates per 1,000 Live Births. Deaths under 1 year of age 53 57 51 57 Deaths from Diarrhoea and Enteritis under 2 years of age 5.5 7.8 3.6 13.1 Maternal Mortality :- Puerperal Sepsis 0.89 Others 2.19 Not avail able. Total 3.08 Rates per 1,000 Total Births (i.e., Live and Still). Maternal Mortality :— Puerperal Sepsis 0.86 Others 2.11 Not avail able. Total 2.97 Notifications:— Puerperal fever 14.42 18.08 12.51 3.53 Puerperal pyrexia 15.46 20 TABLE No. 12. Deaths of Chelsea Residents Registered during the Year 1939. 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 1. Typhoid and Paratyphoid Fevers 2. Measles 3. Scarlet Fever 4. Whooping Cough 6. Diphtheria 6. Influenza 7. Encephalitis Lethargica 8. Cerebro-Spinal Fever 9. Tuberculosis of Respiratory System 10. Other Tuberculous Diseases 11. Syphilis 12. General Paralysis of the Insane, Tabes Dorsalis 13. Cancer, malignant disease 14. Diabetes 15. Cerebral Hæmorrhage, etc 16. Heart Disease 17. Aneurysm 18. Other Circulatory Diseases 19. Bronchitis 20. Pneumonia (all forms) 21. Other Respiratory Diseases 22. Peptic Ulcer 23. Diarrhœa, etc. 24. Appendicitis 25. Cirrhosis of Liver 26. Other Diseases of Liver, etc. 27. Other Digestive Diseases 28. Acute and Chronic Nephritis 29. Puerperal Sepsis 30. Other Puerperal Causes 31. Congenital Debility, Premature Birth, Malformations, etc. 32. Senility 33. Suicide 34. Other Violence 35. Other Defined Diseases 36. Causes ill-defined or unknown 21 CAUSES OF DEATH. Table No. 12 shows that deaths were due to Organic. Heart Disease, to Cancer, Bronchitis, to Pneumonia, to Pulmonarv Tuberculosis, to Circulatory Diseases. to Cerebral Hæmorrhage, to Influenza and to Congenital Debility and Malformation. per cent. of all deaths occurred in persons over 65 years of age. RESPIRATORY DISEASES. Table No. 13 shows the number of deaths from respiratory diseases during the past two years. The annual death rate, the number of deaths under 5 years, and the percentage of deaths occurring in children under 5 years of age is also shown:— TABLE No. 13. Year. Bronchitis. Pneumonia. Other Respiratory Diseases. Total. Deathrate. No. of deaths under 5 years. Percentage under 5 years. 1937 35 44 2 82 1.4 1.2 14.6 1938 22 37 7 66 1.2 8 12.1 1939 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, 2. In the previous year these figures were 7 and 3 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. Diarrhœal Diseases. All other causes. Total Deaths. 1937 2 2 3 2 1 10 1938 4 2 3 9 1939 22 INFANT MORTALITY. There were 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 as compared with 80 in the previous year. In London as a whole the rate of infant mortality was per 1,000 live births. Nett Births registered during Legitimate the calendar year Illegitimate Nett Deaths (under 1) registered (Legitimate during the calendar year Illegitimate 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 Diphtheria Cerebro-Spinal Fever Influenza Erysipelas Tuberculous Meningitis Abdominal Tuberculosis Other Tuberculous Diseases Meningitis Convulsions Laryngitis Bronchitis Pneumonia Diarrhoea and Enteritis Gastritis Syphilis Rickets Suffocation Injury at Birth Atelectasis Congenital Malformations Premature Birth Atrophy Debility and Marasmus Other causes 23 The following Table gives the Infant Mortality Rate in Chelsea under various headings, for the past two years:— TABLE No. 16. 1938 1939 Infectious Diseases 5.2 Diarrhœal Diseases 19.1 Developmental Defects and Wasting 40.0 Other causes 15.4 Total Rate 80.0 TABLE No. 17. Infantile Mortality Rates per 1,000 Births In Wards. 1938 1939 Hans Town 51 Royal Hospital 44 Church 114 Cheyne 55 Stanley 91 Chelsea Borough 80 Illegitimate Deaths.— The following Table No. 18 shows the number of deaths among illegitimate infants during the past two years. TABLE No. 18. 1938 1939 Total number of illegitimate deaths under 1 year 13 Illegitimate death rate 236 MATERNAL MORTALITY. During the year 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) Births. Total Death-rate. Puerperal Sepsis. Other complications of Pregnancy and Childbirth. 1937 - - - 1938 3.4 1.7 5.1 1939 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 age-group 65 and upwards. These facts must be borne in mind in any analysis of the Chelsea mortality rate, as they are naturally reflected in the death returns. In 193, deaths of pensioners in the Royal Hospital. Chelsea, accounted for deaths, inward transfers included (equivalent to 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 3lst December. 1939, 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 a grant at the rate of £250 per annum to the Association for nursing services undertaken on behalf of the Council; the position being subject to review in the event of the number of nurses' visits exceeding 3,000 in any year. 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. 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 1939:— TABLE No. 20. Year. Visits. Cases. 1937 2,013 118 1938 2,362 227 1939 1,498 158 26 TABLE No. 21. Nursed by District Nurses During 1938. Visits. Cases. Bronchitis 159 18 Bums ... Chicken Pox 11 1 Circumcision 104 13 Diarrhœ a 4 1 Eye Trouble 106 4 Ear Trouble 98 6 Expectant and Nursing Mothers 144 11 Pneumonia (under 5) 40 3 Pneumonia (over 5) 131 2 Impetigo ... - Meningitis and Peritonitis ... - Measles (under 5) ... - Measles (over 5) ... - Ophthalmia Neonatorum 61 3 Pemphigus Neonatorum ... — Pemphigus ... - Poliomyelitis • • • - Post-Vaccination 303 54 Puerperal Fever .... - Puerperal Pyrexia .... - Rickets ... _ Septic sores 33 4 Tonsils and Adenoids 23 4 Whooping Cough 134 4 Worms 44 8 Miscellaneous 97 13 1498 158 (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. MATERNITY NURSES AND MIDWIVES. (From 1st January, 1938, the provisions of the Midwives' Act, 1936, came into operation). With the establishment of the london county council salaried midwifes service, the 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 was discontinved after the first six months of the year. 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. Three of the cases were provided with a Midwife free of charge, the remainder contributed according to their resources. 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. 1937 25 24 £ s. d. £ s. d. £ s. d. £ s. d. 22 22 1 14 6 20 15 6 The London county council is the Authority 3.6 responsible for the supervision of midwives in the borough. Eight midwives gave notice during the year of their intention to practise as midwives in Chelsea. Of these, one was engaged in private practice, one was employed as a resident municipal midwife by the L. C. C., four were employed by the Chelsea,Pimlico and Belgravia District Nursing Association under the L. C. C. scheme and two were resident midwives at a L. c. c hospital within the borough. 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. 1937 10 3 £ S. d. £ s. d. 3 8 0 8 12 0 1038 9 7 10 11 0 22 9 0 1939 16 4 5 4 0 15 3 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.l. Arrangements have also been made with the Clinical Research Association for the bacteriological examination of samples of milk under the Milk (Special Designations) Order. 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 248 Of these, 236 were for the bacillus associated with Diphtheria, 3l for the bacillus associated with Tuberculosis, for the bacillus associated with Enteric Fever for the bacillus associated and investigations for Hæmolytic Streptococci. In addition, 2 specimens of the water at the Public Baths were submitted for examination. The total cost of these services to the Borough Council was £52 115 The total number of bacteriological examinations during the preceding year was 645 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. Timmi 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 40,500 units. An anti-toxin syringe, needles and steriliser are also available on loan. 29 The total cost to the Council for anti-toxin supplied during the year was £2l1s. 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 Bye-laws under the Public Health Acts. In addition the Council on the 28th April, 1937, made the following bye-law for the good rule and government of Chelsea:— NUISANCES BY DOGS. (1) No person being in charge of a dog shall allow the dog to foul the footway of any street or public place by depositing its excrement thereon. Provided that a person shall not be liable to be convicted of an offence against this bye-law, if he satisfies the Court that the fouling of the footway by the dog was not due to culpable neglect or default on his part. (2) For the purposes of this bye-law the owner of the dog shall be deemed to be in charge thereof, unless the Court is satisfied that at the time when the dog fouled the footway it had been placed in or taken into the charge of some other person. (3) Any person offending against this bye-law shall be liable on summary conviction to a fine not exceeding forty shillings. (4) This bye-law shall cease to be in force on 1st June, 1939, unless a bye-law re-enacting its provisions has come into operation before that date. (5) As from the date on which this bye-law comes into operation, the bye-law made by the Council on 2nd February, 1927, under Section 23 of the Municipal Corporations Act, 1882, as to nuisances by dogs upon the public footways shall be and is hereby repealed. This bye-law 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. 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 Chelsea Hospital for Women Arthur Street, S.W.3 Obstetric and Gynaecological 104 Yes Cheyne Hospital for Children Cheyne Walk, S.W.3 Children's Diseases 71 Yes Princess Beatrice Hospital Richmond Road, S.W.5 General Medical, Surgical and Maternity 78 Y es Royal National Orthopaedic Hospital Great Portland Street, W.1 Deformities and Malformations 170 Yes St. George's Hospital Hyde Park Corner, S.W.l General Medical, Surgical and Maternity 437 Yes St. Luke's Hospital Cale Street, S.W.3 Medical and Surgical 390 Yes By Hospitals and Medical Services Committee of L.C.C. St. Mary Abbots Hospital Marloes Road, W.8 Medical, Surgical and Maternity 555 Yes St. Stephen's Hospital Fulham Road, S.W.10 Medical, Surgical and Maternity 718 Yes St. George's Home Milman's Street,S.W.I0 Tuberculosis 50 Yes 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 . 30 31 All the hospitals included in the foregoing tablr arc fully equipped for operative surgery on modem lines. Each of them also provides special departments for X-ray investigation, dental, ophthalmic, massage and pathological work. MATERNITY AND NURSING HOMES. There is no Municipal Maternity or Nursing Home in the Borough. 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 and puerperal pyrexia. 5. To investigate, when required, homes in which overcrowding is alleged to exist. 6. To investigate, when required, applications for the supply of milk free or below cost price. 7. To co-ordinate their efforts with those of the voluntary workers attached to the Maternity and Child Welfare organizations in the Borough. . 8. To investigate cases under the Widows', Orphans' and Old Age Contributory Pensions Acts where the children are under school age. Work of the Health Visitors.—The following tabular statement (Table No. 26) gives an outline of the work of the Health Visitors and of the Chelsea Health Society and School for Mothers during the past two years. The visits enumerated are those paid by the trained officer of the Borough Council (one part-time Health Visitor) and the trained officers of the Chelsea Health Society and School for Mothers (two whole-time and two part-time Health Visitors). It does not include work done by voluntary workers attached to the Society. 32 TABLE No. 26. Summary of Reports of Health: Visitors. 1938 1939 (1) Work of the Health Visitors. First visits to Infants under one year of age 382 319 Return 1,545 1252 First visits to Children between the ages of 1 and 5 years 268 245 Return visits to Children between the ages of 1 and 5 years 2,600 2,196 Ante-natal visits to Expectant Mothers:— Primi-para cases 139 103 Multi-para 160 164 Return visits 570 590 Visits to Enteritis cases amongst children - 1 Return visits - - Visits to Ophthalmia Neonatorum cases 1 5 Return visits 3 5 Visits to Whooping Cough cases (under 5 years of age) 22 110 Return visits 21 103 Visits to Measles cases (under 5 years of age) 275 11 Return visits 269 — Visits to Measles cases (over 5 years of age) 167 6 Return visits 121 - General additional visits 842 648 Total visits 7,385 5,458 Half-day attendances at Infant Welfare Centres 586 624 Half-day attendances at Play Centre 209 135 (2) Infant Welfare Centres. Total number of attendances:— (a) By children under one year of age 4,034 3,643 (b) By children between the ages of 1 and 5 years 3,167 2,914 (c) By Ante-Natal mothers 850 898 (d) By Post-Natal mothers 20 26 Total attendances 8,071 4.514 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. 33 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, fares and insurance). Assessment. 3-4 Up to 8/- Free 8/- 1d. per pint 9/- 2d. per pint 10/- 3d. per pint 5-6 Up to 7/- Free 7/- 1d. per pint 8/- 2d. per pint 9/- 3d. per pint 7-8 Up to 6/- Free 6/- 1d. per pint 7/- 2d. per pint 8/- 3d. per pint 0-10 Up to 5/- Free 5/- 1d. per pint 6/- 2d. per pint 7/- 3d. per pint 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. £ 1938 598 664 650 830 2742 884 1939 892 845 634 544 2951 945 * These totals do not include orders subsequently cancelled or withdrawn, which average 80 or more during each year. It will be observed that in 1939 there was a large increase in the cost of milk. Cows' milk was supplied to 85 per cent. of the applicants, dried milk being supplied to the remaining 15 per cent. 34 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 6,424 gallons Cows Milk at reduced cost 1,862„ 8,299„ Dried Milk, free of cost 1,084lbs. Dried Milk at reduced cost 441„ Total 1528„ The arrangements for the supply of milk in the Borough are working satisfactorily. Families in receipt of out-relief do not come under the Council's scheme for the supply of milk to necessitous mothers and children. These cases are dealt with entirely by the Public Assistance Committee, who grant the necessary extra milk on a certificate signed by a Doctor at the Welfare Centre. This scheme obviates the undesirable practice of an individual being granted a somewhat similar form of relief by two different authorities. The supply of milk under the Borough Council Scheme has undoubtedly effected very marked improvement in the general health of both mothers and children. INSTITUTIONAL PROVISION FOR UNMARRIED MOTHERS, ILLEGITIMATE INFANTS AND HOMELESS CHILDREN. (a) The Day Servants Hostel, 29-33, Danvers Street, Chelsea, provides accommodation for 15 unmarried mothers and their infants. Cases are not received until after birth of the child. Daily work is provided by the Hostel and the mothers reside with their babies at night. (b) The Fanny Hobson Hostel, 497, King's Road, Chelsea, provides accommodation for 20 women on discharge from prison or if found homeless. Unmarried mothers, but not illegitimate infants, are received. An expectant mother is retained until the confinement approaches. Arrangements are then made for her admission to Hospital. If she is subsequently re-admitted to the Hostel, the infant is settled with a foster mother. (c) St. Theresa's Shelter, 43, Smith Street, Chelsea, is a Rescue Home which provides accommodation for nine girls. Cases are detained for some weeks until some suitable employment can be found. In the case of an expectant mother, arrangements are made for her transfer to an appropriate Home or Institution elsewhere in the Metropolis. Homeless children in general are cared for by the Public Assistance Committee. 35 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, Flood Walk, S.W.3.—Patroness: Her Majesty Queen Mary. 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 Flood Walk, 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 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. ' 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. The Medical and other staff, appointed by the Voluntary Committee, are as follows:— (a) Chelsea Health Society. Four part-time Medical Officers, one part-time Dental Surgeon, two whole-time and two half-time trained Health Visitors, together with clerical and domestic assistance. (b) Chelsea Day Nursery and Mothercraft Home. Two Honorary Consultants, an Honorary Medical Director, an Assistant Medical Officer, Matron, four Sisters, four Staff Nurses, twenty-six resident Student 30 Nurses and six non-resident London County Council Scholarship students. There is also a whole-time Secretary, and a Nursery School teacher for the older children in the Day Nursery. In addition, much valuable work is done by voluntary workers attached to the Society. 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 1939-1940 Reference will now be made to the activities of the three organisations included in the Violet Melchett Infant Welfare Centre. (1) Chelsea Health Society.—Flood Walk, 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 Flood Walk and one at 484, King's Road. At Flood Walk one ante-natal clinic was held weekly. In addition, Play Mornings are held daily from 9.0 to 12.0 under the supervision of a Health Visitor, for children referred by the Medical Staff for observation, as being reported difficult, or needing companionship, fresh air or space. 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 with verandahs for toddlers and children also nursery for infants, there are bathrooms, a kitchen and an enclosed courtyard for the children to play in. The Nursery is ably administered and is much appreciated in the Borough. The attendances at the Nursery during the past two years were as follows:— TABLE No. 28. 1938. 1939 Total number of attendances during the year 11,319 4,386 Average daily attendance (5 days a week) 45 40 Total number of individual children who attended 98 101 The day nursery was evacuated on the 1st September and the figures shown are up to that date since evacuation, the average weeky number of children residing in the chezs day nursery at petworth house, susex, was 49. (3) Chelsea Mothercraft Home.—Chelsea Manor Street, S.W.3. The Mothercraft Training Home provides accommodation for six nursing mothers, with their babies, for the treatment of lactation difficulties, and for three normal breast-fed infants whose mothers arc employed as maids in the home. There is also accommodation for seven or more premature and other babies, requiring special care and dieting. In addition, there is an observation nursery to which four nursing mothers may come during the day, with their babies, for test feeds and instruction. The wards open on to a balcony and roof garden. 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 To the 1st September, 1939 Since this date the home has been TABLE No. 29. THE MOTHERCRAFT HOME. Mothers. Babies. Beds available 6 16 Admitted during year 45 84 Discharged during year 49 98 Average length of stay 26 days 40 days Daily average number of in-patients 4.2 16.5 Test-Feed attendances 94 94 Number of individual mothers who attended for Test Feeds (of whom 68 attended for 1 clay only) 80 - Number of mothers who brought their babies for advice re feeding 31 —- 37 (b) Invalid Children's Aid Association.—Chairman: Lady Edward Gleichen. Hon. Secretary: Miss Aileen Woodroffe. 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; orthopædic appliances and surgical boots; massage, remedial exercises, surgical dressings and medical comforts; help in training for suitable work; additional clothing, etc. Two members of the Public Health Committee of the Borough Council and the Medical Officer of Health are members of the local Committee of the Association. The Borough Council made a financial grant of £100 to the Association for the year commencing 1st April, 193 During the year the branch had 110 children under school age referred to them for assistance. These children were suffering from marasmus and malnutrition, congenital deformities, rickets, anaemia, debility and enlarged glands following acute illness such as bronchitis, pneumonia, measles, diphtheria and scarlet fever. Forty-six children were sent out of London for convalescence, for periods varying from one to three months. Two 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. Fourteen 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. Four children were treated at the I.C.A.A. Orthopaedic Clinic and Two 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. 38 39 (c) The Babies' Club.-35, Danvers Street, S.W.3. Chairman: Mrs. William Piercy, O.B.E. Secretary: Miss M. Burnaby. Medical Officers: Dr. Langdon Lloyd, Dr. J. H. Gibbens, Dr. Grosvenor Millis and Dr. J. Chisholm. This Infant Welfare Clinic is controlled by a voluntary Committee. It is intended for the use of 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. 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 of the 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. 1938 18 17 £ s. d. £ s. d. 2 16 6 36 6 0 1939 24 9 1 15 6 23 5 4 40 DENTAL TREATMENT. Children under Five Years of Age.-Commencing in May 1938 dental clinic was held monthly at the Violet Melchett Infant Welfare Centre for the provision of preventive dental treatment for children under five years of age. One hundred and fifty nine cases attended the year. Children requiring extractions were referred to the London County Council School Clinic in Bramerton Street, Chelsea. Expectant and Nursing Mothers.—In conjunction with the Chelsea Branch of the Charity Organisation Socicty 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 nine mothers received dental treatment (including six cases for dentures), the Borough Council making a contribution of £24.2 Od. towards the cost. The Borough Council also made a grant at the rate of £20 per annum to the Violet Melchett Infant Welfare Centre for the provision of preventive dental treatment for necessitous mothers for the financial year 1939-40 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, 1933. The following table shows the number of Foster Mothers and Children resident in the Borough during the year and the number of visits in connection with this work. TABLE No. 31. Child, Lijc Protection Return. (Year 1939). Foster Mothers. Foster Children. Number on register at beginning of year 5 5 Removed from register 9 24 Added to register 10 29 Remaining on register 4 Medical attendance arranged — 6 Attended Maternity and Child Welfaro Clinic — 9 Visits to foster mothers 65 Miscellaneous visits 46 41 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 live 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 RKGARDING MATERNITY AND CHILD WELFARE. The Borough Council's scheme for Maternity and Child Welfare includes the following activities:— (a.) The issue of pamphlets giving advice on various matters concerning the welfare of mothers and infants. (b.) The co-ordination of the work of the voluntary Maternity and Child Welfare agencies in the Borough. (c.) The home visitation of expectant and nursing mothers and infants by a staff of Health Visitors who work (a.) from the Town Hall, and (b.) from the Centres of the Chelsea Health Society. (d.) The subsidisation of the Chelsea Health Society's Maternity and Child Welfare Centres and Clinics for mothers, infants and young children. (e.) The subsidisation of the local branch of the Invalid Children's Aid Association. (f.) The subsidisation of the voluntary Day Nursery in the Borough. (g.) The subsidisation of the Chelsea District Nursing Association for the home nursing of expectant and nursing mothers and young children. (A.) The provision of Home Helps. (j.) The provision of midwifery attendance, free or at reduced rates, for necessitous Chelsea women. (j) The provision of Convalescent Home accommodation for nursing mothers and infants. (,k.) The provision of dental treatment for expectant and nursing mothers. (/) 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 648, compared with .358 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 The number of statutory notices was 97 These compared with 243 and 41 in 1938 Summary of Work carried out by Sanitary Inspectors during the Year. Inspections. _ On complaint of nuisance 648 On notification of infectious disease (including non-notifiable diseases) 243 House to House 99 Re-inspection calls made 3,468 Inspection of:— Bakehouses 121 Slaughterhouses 42 Milk shops 46 Ice Cream Premises 28 Overcrowding " 24 Houses Let in Lodgings 29 Stables 4 Restaurant Kitchens 55 Marine Stores 4 Food Premises other than above 120 Premises under Meat Regulations 141 Factories and Workshops 62 Outworkers' Premises 15 Common Lodging Houses 21 Other visits 554 Verminous Premises 165 Rat enquiries 114 Smoke observations 55 Total. 6,084 43 Premises: Walls and Ceilings cleansed :— (a) Premises throughout — - (b) Premises partially 209 (e) Verminous rooms cleansed 45 (d) Total number of rooms cleansed 254 Wash-house walls and ceilings cleansed 5 Walls and ceilings of water closets cleansed and repaired 51 Wash-house roofs repaired 13 Dirty tenants' rooms cleansed 8 Yard and area walls cleansed 4 Defective roofs repaired 80 Defective gutters repaired — — Defective rain water pipes repaired 2 0 Dampness abated 45 Miscellaneous repairs 214 Wash-house floors repaired - Yard surfaces repaired, paved, etc. 16 Ashpits demolished — - New and proper dustbins provided 23 Workrooms provided with light and ventilation or light and ventilation improved 8 Drainage : Reconstructed 10 Repaired 1 Cleansed 2 Inspection chambers and traps provided 13 Fresh air inlets provided or repaired 14 New soil pipes provided 10 New ventilation pipes provided 7 Soil and ventilation pipes repaired 1 Anti-syphonage pipes provided 5 Drains sealed off 2 Drains cleared (obstruction removed) 4 New covers provided to inspection chambers 13 Rainwater pipes disconnected and caused to discharge over properly trapped gullies Sink wastes provided with traps 24 Sink waste pipes cleansed New sink wastes provided 24 New sinks provided 16 New bath and lavatory basin wastes provided 3 Water Closets. Improvements in sanitary conveniences (factories, workshops, etc.) — New water closet pans provided 24 Water closet pans (foul) cleansed 6 Choked water closet pans unstopped and cleansed 3 Water waste preventers renewed 1 Water waste preventers repaired 11 Water closet roofs repaired 13 Ventilation and light provided or improved 2 W.C. floors repaired 1 Water supply. Water supply to premises reinstated 4 Water supply provided to upper storeys of tenement houses 6 New drinking water cisterns provided 2 Drinking water cisterns cleansed 4 Drinking water cisterns provided with new covers or covers repaired 5 Smoke Nuisance Number of observations 55 Number of nuisances and complaints 12 Number of notices Number of summonses 44 Nuisances abated arising from :— Keeping animals in ail improper manner or place Defective manure cages — / Accumulation of manure or refuse 4 6 Overcrowding 17 24 Rat nuisance 100 114 Underground rooms — Food Condemned and Destroyed. 508 LBS BEF: 199 LBS MUTTON; 42 LBS FISH 142 i LBS RICE.: 28 LBS FLOWT. 35 EGGS Disinfection. Rooms disinfected after Zymotic diseases (Scarlet Fever, Diphtheria, /» etc). 184 Rooms disinfected after Tuberculous disease 46 Rooms fumigated for verminous and filthy conditions 1434 Miscellaneous disinfection 56 Certificates of disinfection given 44 School notices after disinfection 44 Notices sent to Public Library of Premises where infectious diseases have occurred ... 95 Proceedings taken. 243 Intimation Notices served 180 Statutory Notices under Public Health (London) Act, 1930 41 94 1 Statutory Notices under Section 9 of Housing Act, 1936 — Statutorv Notices under byelaws for provision of dustbins 4 10 Total number of samples purchased for analysis under the Food and Drugs (Adulteration) Act 261 252 Samples (informal) purchased 139 148 Legal proceedings instituted in respect of defective sanitary conditions and nuisances - 3 Legal proceedings under Milk and Dairies (Amendment) Act, 1922 — - , Legal proceedings in respect of unsound food — 3 Certificates issued in accordance with " Rent Restrictions Act " — 3 Entries in Inhabitants' Complaint Book 358 648 Number of adults cleansed 29 Number of children cleansed 558 Number of persons treated for Scabies 82 Number of articles (bedding, etc.) disinfected 9828 Number of articles (various) destroyed 814 Disinfection Station Shelter. Persons accommodated :— Adults - Children - — Mortuary Number of bodies received nil Disinfection Civil Defence Rooms Disnfected for verminous conditions etc 518 (precaution ary measures town hall spramed daily since october) 45 TABLE No. 32. Magisterial Proceedings during the Year. Situation of Premises. Nature of Nuisance of Complaint. Petty Sessions. Date of Hearing. Result. 71, Blantyrc Street. Failing to comply with court - order re condition of premises Kensington 17.1.39 FINEO f2.140 COSTS f1.10 Blantyrc Street 1 Failing to comply with Courtorder re condition of premises. Kensington 17.1.39 FINEO f2.140 COSTS f1.10 58 Tetiott Road Failing to company with statutory notice Re condition of premises Ton 7.11.39 Order 28 Days. 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 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. Twezve complaints of smoke nuisance were received during the year and cautionary letters were sent to the offenders. Fouling of Footways by Dogs. — The Borough Council has obtained sanction for a byelaw to deal with this nuisance. This has already been found useful, the condition of footways having improved considerably since the measure came into operation. During the year NO prosecutions were taken for infringement of the byelaw, and a conviction obtained in each case. Rats and Mice (Destruction) Act, 1919.—A Sanitary Inspector is authorised under this Act to act as Rat Officer in his district. The Act places the responsibility for rat preventive measures upon the occupiers of premises. During the year the Council provided rat-catching varnish to applicants for the destruction' of rats and 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 1939,236 pigeons were captured and humanely destroyed. a TABLE No. 33. Number of Premises. On register at end of 1938 Added in 1939 Removed in 1939 On register at end of 1939 Number of inspections during 1939 Number of notices served during 1939 Number of prosecutions during 1939 1. Premises used for Business Purposes :— Milk Premises 77 4 81 46 1 - Ice Cream Premises 45 - 3 42 28 — - Butter and Margarine 10 - - 10 10 — / Manufacturers and Dealers :— Fried Fish Premises 14 - - 14 — Fish Curers 5 - - 5 5 Bakehouses 26 - - 26 121 12 - Slaughterhouses 1 - - 2 - — Food Stalls 32 - 2 30 under daily observation — — 2. Premises used for Human Habitation :— Houses let in lodgings 605 - - 6 05 29 - - Common Lodging Houses — — 1 1 21 — — 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 not registered. Further reference to these premises and occupations will be found in the Sections of this report dealing with " Inspection and Supervision of Food and Housing." l85 Eradication of bed bugs.—185 were found to be infested with bed bugs,'26 being owned by the Borough Council and 159 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. During the year the furniture of fifty-seven tenants was treated in this way. 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 128 of the Factories Act, 1937, 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 98. The number of inspections of these premises was which compares with 169 in1938 169 defects were found in 10 instances. The following Table No. 34 is in the form requested by the Home Office in order to ensure uniformity in the presentation of returns :— TABLE No. 34. Factories, Workshops, Workplaces, and Homeworkers' Premises. I.—Inspection of Factories and Other Premises. (Including Inspections made by Sanitary Inspectors). Number of Premises. (1) Inspections. (2) Written Notices. (3) Occupiers prosecuted. (4) Factories (with mechanical power) 10 - — Workshops (without mechanical power) 48 - — Other Premises under the Act (including works of building and engineering construction but not including Outworkers' premises) 4 - - Total 62 48 2. Deffects found in Factories and Other Premises. Particulars. (1) Number of Defects. N umber of offences in respect to which Prosecutions were instituted. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health Arts. Want of cleanliness 6 6 — — Want of ventilation 2 2 — — Overcrowding - — — — Want of drainage of doors — — — — Other nuisances / / — — Sanitary accommodation :— Insufficient - - — — Unsuitable or defective / / — — Not separate for sexes - - — — Offences under the Factory and Workshop Acts :— Illegal occupation of underground bakehouse (s. 54) — — — — 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 10 10 — — Including those specified in Sections 2, 3, 7 and 8 of the Factories Act, 1937, as remediable under the Public Health Acts. 3.—Home Work. Outworkers' Lists, Section 110. Outwork in Unwholesome Premises, Section 111. 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 1938 9 20 160 - 33 - - - - - - 1939 15 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 1939 NIL 1. To await Inquests :— (a.) Infectious — (b.) Non-infectious — 2. Sanitary grounds — Number of Post Mortem examinations - Number of bodies detained in Mortuary Chapel - 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 Chelsea Manor Street, open to the public. No privately owned Swimming Baths are known to the Department. A chlorination filter system is in operation. Two samples of the Baths water were submitted for examination and the bacterial content was found to be in all respects satisfactory. Pharmacy and Poisons Act, 1933.—During the, year, 56. applications were received from traders for entry in the Council's list of authorised sellers of poisons. In each case the application was approved, after investigation. 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) 694 (b) Number of inspections made for the purpose 3067 (2) (a) Number of dwelling houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 140 (b) Number of inspections made for the purpose 1120 (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 net to be in all respects reasonably fit for human habitation 140 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 195 3. Action under Statutory Powers during the Year :— (a) Proceedings under sections 9, 10 and 16 of the Housing Act, 1936 (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 236 (2) Number of dwelling houses in which defects were remedied after service of formal notices :— . (a) By owners 41 (b) By Local Authority in default of owners — (c) Proceedings under sections 11 and 13 of the Housing Act, 1936 :— (1) Number of dwelling houses in respect of which Demolition Orders were made 3 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 3 (it) Proceedings under section 12 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 4. Housing Act, 1936.—Part IV.—Overcrowding. (a) (i) Number of dwellings overcrowded at end of year 450 (ii) Number of families dwelling therein 490 (iii) Number of persons dwelling therein 2950 (b) Number of new cases of overcrowding reported during the year (due to increase of children's age) 9 (c) (i) Number of cases of overcrowding relieved during the year 81 (ii) Number of persons concerned in such cases 397 (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 (c) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health mav 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 became operative. Sixtyone cases of overcrowding in houses owned by the Local Authority have been abated. 52 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 ot the Rent Restrictions 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 operafions 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 262 725 4/11 to 13/10 per week Pond House, Pond Place 32 125 10/8 to 14/9 per week. Onslow Dwellings, Pond Place ... 108 312 6/6 to 8/7 per week. Grove Buildings, Chelsea Manor Street 120 220 4/2 to 7/8 per week. 522 1,382 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, five 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 arc gradually being overcome. 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 8,490, 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, or. the ground that the distance of the County Council's Estates from their work is too great. Others have become attached to the district and will not contemplate forsaking existing interests and associations. Owing to the extreme difficulty of finding alternative accommodation it has not been found practicable to deal 55 with more than a proportion of the eases 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. 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. During the period 7th January to 25th March, 1937, a further survey of working-class dwelling-houses in the Borough was carried out in accordance with the Housing Act, 1936. The purpose of the survey was to ascertain the permitted number of persons entitled under the Act to occupy a working-class dwelling. This necessitated the measurement of each room in 5,112 houses. Under Section 62 of the Housing Act, a Landlord or Occupier of a dwelling-house may apply to a Local Authority, and it is the duty of the Local Authority to inform the applicant, in writing, of the number of persons constituting the permitted number in relation to the house. 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 ten 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, leaving 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 Public Health (London) Act, 1936, it is possible to arrange for the removal of such cases to a suitable institution. 56 While in the majority of instances the defects found to exist in unfit houses are due to the lack of proper management and supervision by owners, from time to time complaints are made by the owners regarding the difficulties they experience in keeping their property in a reasonable state of repair because of the dirty and destructive habits of a number of their tenants. It is alleged that, through carelessness or wilful damage by tenants, repairs and cleansing have to be carried out with unreasonable frequency and that, as a consequence, it is impossible to maintain even the minimum requirements of the Local Authority without incurring financial loss. Investigation has shown that these statements are often well-founded, especially in the poorer class tenement lodging houses where no responsible caretaker or landlord is resident. To lighten the difficulties of the owner in these cases, effort is made, as far as possible, to keep in view such powers as a Local Authority has of holding the tenant responsible for defects resulting from his neglect or default. The total number of dwelling houses inspected for housing defects was 1020, the number found not to be in all respects reasonably fit for human habitation being 243 The number rendered fit in consequence of informal action by the Sanitary Inspectors was 218 and the number in respect of which statutory notices were served requiring defects to be remedied was 94. 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.—No representations were 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 Inspections.—House-to-house inspection was carried out during the year, as provided by statute, 99 houses being inspected and recorded by the Inspectors. 57 TABLE No. 38. Post-War Housing. Name of Undertaking. Area of Site. Total Cost. Date of Completion. Number of Flats. Population. Rents. Remarks. Hortensia House, Hortensia Road. 1 acre, 12 poles. £49,000 1925 56 202 persons. 22/10 to 31/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, 28J 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, Chelsea 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 tha Borough Council to the Peabody Trust. World's End Passage Improvement Scheme. 2 acres, 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. Chelsea Manor Buildings, Chelsea Manor Street. 2 acres, 35 poles. £61,862 — 94 214 persons 6/6 to 18/per week. Site purchased and buildings being erected by Borough Council. 486 2,000 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 01 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 foan applications were made for registration as purveyors 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 ycar. During the year there were 46 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. one Milk (Special Designations) Order, 1936 and 1938.—The following Table, No. 39, shows the number of licences granted for the sale of milk under the special designations'prescribed by the Order. There were 29 applications from 13 retailers under the Milk (Spccial 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. TABLE' No! 39. Licences Granted under Milk (Special Designations) Order. 1939 To sell "Accredited" Milk 1 To sell " Tuberculin Tested " Milk 9 To sell " Fasteurised" Milk 15 Supplementary Licences 4 29 59 Further rcfcrencc 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. 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. Carcases Inspected and Condemned. Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed (if known) — — — — Number inspected — — — — — All diseases except Tuberculosis. Whole carcases condemned — — - — — Carcases of which some part or organ was condemned. — — - — — percentage of the number inspected affected with disease other tlian tuberculosis. . . __ Tuberculosis only. Whole carcases condemned Carcases of which some part or organ was condemned. - — - — Percentage of the number inspected affected with tuberculosis - — — — - 60 42 Ice Cream Vendors.—At the end of the year, 45 premises were shown in the Register as places where ice-cream is prepared or sold. There were 28 inspections of these premises as compared with 54 in the Sty. 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 14 inspections of these premises were made. It is found that a reasonable standard of cleanliness is now being maintained, but it is necessary for the Inspectors to maintain a constant vigilance to impress upon the vendors the necessity for the systematic observance of cleanliness. Inspection of Other Premises where Food is Prepared or Offered for Sale.—The Inspectors keep under frequent observation all other premises where food is prepared for or exposed for sale. Included in this category are restaurants and premises used by provision dealers, butchers, fishmongers and greengrocers for the purposes of their trades. 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 Eleven occasion during the year, unsound food was surrendered and destroyed. Included in the unsound food surrendered and destroyed during the year was:— 508i lbs. Beef. 199.LAS MUTTON;42 LBS. FISH. 142i LBS RICE. 28 LAS FRUIT. 35 EGGS. No carcases were destoyed on accout of Tuberculosis. Food Poisoning.—No case of food poisoning occurred during the year. Food and Drugs (Adulteration) Act, 1928.—Four hundred sample 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 thesep strict formay.ties and afford useful indication of the conditions without disclosing to the vendor that the object of purchase is analysis. 61 No legal proceedings are possible in respect of an informal sample, but, when adulteration is discovered, formal samples are obtained immediately and necessary action is taken on receipt of the analytical report regarding them. During the year no sample of milk was found to be adulterated to such a degree as to justify legal proceedings. Certain other food samples were found to be inferior, but not to such an extent as to justify legal action. In each of these cases a warning letter was sent to the Vendor concerned. The work carried out under the Food and Drugs (Adulteration) Act, during the year is summarized in the Public Analyst's Report in the appendix. The Public Health (Preservatives, etc., in Food) Regulations.— All samples of milk and cream taken during the year were submitted to examination for preservatives. No evidence of the presence of preservatives was obtained sufficient to warrant legal proceedings. Margarine.—No application for transfer of registration was received during the year from wholesale dealers in margarine. 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. - Nine 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. 62 (a) Infectious Diseases Generally. DISEASES COMPULSORILY NOTIFIABLE IN THE BOROUGH. Acute Poliomyelitis. Diphtheria. Acute Polio-encephalitis. Membranous Croup. Acute Encephalitis Lethargica. Dysentery. Acute Primary Pneumonia. Erysipelas. Acute Influenzal Pneumonia. Malaria. Cerebro-spinal Fever. Puerperal Fever and Puerperal S Chicken Pox. Pyrexia. Plague. Relapsing Fever. Anthrax. Small-pox. Glanders. Typhus Fever. Hydrophobia. Tuberculosis. Cholera. Scarlatina or Scarlet Fever. Continued Fever. Typhoid or Enteric Fever. Ophthalmia Neonatorum. Measles. Food Poisoning. Whooping Cough. X Not notifiable from 4.1.1939 NOTIFICATIONS DURING THE YEAR. The total number of notifications, excluding duplicates, was 342. Of this figure, 45 were notifications of Pulmonary Tuberculosis and 5 of Non-pulmonary Tuberculosis. In addition, 22 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 103 in the number of notifications of Diphtheria. The number of notifications of Scarlet Fever (49) represents a decrease of 32 as compared with that for 1935. The number of notifications of Tuberculosis was 80, a decrease of as coinpajed with that for 1938 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. The notifications have not been corrected for any subsequent revision of diagnosis :— 63 TABLE No. 40 Cases of Infectious Disease Notified during the Year. Cases notified in Chelsea. Cases notified in each Ward. Removed to various Hospitals At all Ages. Under 1 Year. 1—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. Clieyne. Church. Hans Town. Royal Hospital. Small-pox .- - - - - - - - - - - - - - - - - - - Chicken-pox 1 - 1 • - - - - - - - - - - 1 — — 1 Relapsing fever 1 - - - * - - - - - - 1 - - - 1 _ - 1 Diphtheria 65 3 4 3 5 5 21 6 9 7 - - - - 13 6 2 3 65 Erysipelas 15 - - - - - - - - - 3 8 4 8 2 1 1 3 10 Scarlet Fever 49 1 4 4 4 4 4 7 1 7 1 1 1 20 8 12 5 4 43 Typhus Fever - - - - - - - - -- - - - - - - - - - - Enteric Fever 1 - • - - - - - - - 1 - - - 1 - - 1 Puerperal Fever 2 - - - - - - - - 2 - - - 1 - 1 - - 1 Puerperal pyrexia 10 - - - - - - - 2 8 - - - 4 3 2 1 - 8 Cerebro-spinal Fever 1 - 1 - - - - - -•- - - - - 1 - • - - - Ophthalmia Neonatorum 5 5 - * - - - - - -- - - - 2 - 3 - - 2 Poliomyeliti - - • * - - - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - - - - — - - Polio-encephalitis - - • - - - - - - - - - - - - - - - - Malaria 1 - - - - - - - - - - 1 - - - - 1 - 1 Dysentery 4 - 1 2 - - - - - 1 - - - - - 4 - - 4 Acute Primary Pneumonia 43 4 6 2 3 - 1 - 3 4 6 1 4 21 7 10 - 57 37 Acute Influenzal Pneumonia 4 * - • - - 1 - - - - 2 1 1 2 z / 2 Food Poisoning - - - - - - - - - - - - - - - - - Measles /6 1 3 - - / 6 / - 4 - - - 7 3 4 / / 5 Whooping Cough 74 7 // // 12 15 /4 2 / / - • 41 /3 19 - / 22 Total 292 21 3/ 22 24 25 67 16 /6 34 10 26 10 147 51 65 12 17 203 Tuberculosis :— Pulmonary 75 1 - - - - 2 / 7 14 15 25 10 39 11 17 5 3 Non-Pulmonary 5 - - - - - - 2 - / - / / - - - 2 Totals (Tuberculosis) 80 1 - - . 2 3 7 15 15 26 // 42 // 17 5 5 Totals 342 22 31 22 24 25 59 19 23 49 25 52 21 189 62 82 17 22 NOTE:- Notification Have Not Been Corrected For any Subsequent Revision of Diagnosis 64 No cases of Small-pox, Cholera, Typhus Fever, Encephalitis Lethargica, Polio-Encephalitis,Continued Fever, Polionvelitis Plague, Anthrax, Glanders or Hydrophobia were notified during the year. DIPHTHERIA. Notifications.—During the year 65 cases of diphtheria were notified as compared with l68 in the previous year. Information was received from the London County Council that & of the cases sent to Hospital proved not to be suffering from Diphtheria. The actual number of cases was therefore 60 . Deaths.- deaths from the disease occurred during the year, giving a case mortality rate of per cent. Return Cases.— No return " cases of the disease occurred during the year. The incidence of the disease during the past two years is shown in Table No. 41. TABLE No. 41. Year Cases (Corrected) 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. 1938 159 99 4 2.5 58 Oct. 573 57 10 0 516 90.0 1939 60 100 51 feb 236 24 10.0 2.2. 90.0 It will be observed that there was a de crease in the number of cases notified in 1939. The percentage of removals to the L.C.C. Hospitals was high, and the case mortality rate was lower than that for 1S37. 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 ifnmunisation^gainst 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. Immunised. Discontinued treatment and removed from register. ... . _ No. under treatment at end of year. Pre- 1 School Age. School Age. Naturally Immune Preschool Age. School Age. 1937 209 - 49 162 14 135 60 10 76 1938 302 - 53 249 17 218 36 5 138 1939 241 3 202 16 164 22 10 125 Diphtheria Anti-toxin.—Anti-toxin is supplied, in prophylactic ana 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 28. SCARLET FEVER. Notifications.—During the year 49 cases of Scarlet Fever were notified, the figure for 1928 being 87. Information was received from the L.C.C. Hospitals that Qugof the cases proved not to be Scarlet Fever. The actual number of cases was thereforeNo " return " case of the disease occurred during the year. Deaths.—There was No death from Scarlet Fever during the year. Table 42 shows the incidence of the disease during the past two years. TABLE No. 42. Year. Cases (Corrected). Percentage of Removals. Deaths. % Case Mortality Rate. Percentage of cases of School-age 3-13 years. Month of greatest prevalence. 1937 92 99 _ 55 Jan. 1938 80 95 1 1*2 51 Feb 1939 48 88 - - 57 Feb No application of the Dick test or of artificial immunization against Scarlet Fever has yet been made in the Borough. MEASLES AND WHOOPING COUGH. From lot Ootcibor) lt)ii8i thooo tliooitroo woro mado notiftablo in resppct tu tlic firot oaoo noourring in the houcm.—feubucriuont cauej occurring within a porioil of two muntliu of primary oaou arc not roquirod to be notified by the Doctor in attendance. 66 Information as to cases occurring in the Borough was derived from the School Authorities, Hospital and Medical By Notification,—In addition, many cases an1 discovered and 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. MEASLES. Table No. 43 shows the incidence of the disease during the past two years :— TABLE No. 43. Year. Number of casesAcoming to the knowledge of the P.H. Dept. Cases notified Total cases. Deaths. Number of Visits and Re-Visits by Health Visitors. Number of Visits by District Nurses. Under 5 years. Over 5 years Under 5 years Over 6 years Under 5 years Over 5 years Total Under 5 years Over 5 years Total 1938 321 187 1 - 509 3 544 288 832 341 96 437 1939 6 - 6 4 22 11 6 17 — - - WHOOPING COUGH. The incidence of the disease during the past two years is shown in Table No. 44 :— TABLE No. 44. Year. Number of casesoming to the knowledge of the P.H. Dept. Cases notified from 1/10/38. Total cases. Deaths. Number of Visits and Re-Visits by Health Visitors. Number of Visits by District Nurses. 1938 7 24 31 1 46 - 1939 36 74 110 - 213 134 Removal to Hospital.—Cases of Measles and Whooping Cough are received in the hospitals of the London County Cofincil. 67 ENTERIC FEVER. Notifications.-During the year one case under the Enteric Fever Group was notified in Chelsea, and treated in hospital. The history of each case was thoroughly explored, but it was found impossible to trace an unvarying causative factor between the various cases. One specimen of blood was examined during the year for the Widal reaction. Deaths.-There was no death from this disease during the year. PNEUMONIA, MALARIA AND DYSENTERY. These diseases are compulsorily notifiable under the Public Health (Infectious Diseases) Regulations, 1927. The following table shows the number of notified cases during the past two years:- TABLE No 45. PNEUMONIA. MALARIA. DYSENTERY. Year Total Number of Cases Notified. Treatment in Hospital. Total Number of Cases Notified. Treatment in Hospital. Total Number of Cases Notified. Treatment in Hospital 1937 68 68 - - 5 4 1938 64 57 - - 43 43 1939 44 39 1 1 4 4 Pneumonia.-All primary pneumonias, lobar or lobular, are notifiable. The only secondary pneumonia which is notifiable is influenzal pneumonia. Nursing Provision.-By arrangement with the Chelsea District Nursing Association, all cases of Pneumonia receive adequate nursing attention where the circumstances render this necessary. One hundred and Seventy one visits were made during the year. Deaths.-There were deaths from Pneumonia (all forms) during the year. 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. Dysentery.-The four cases notified during the year were due to infection from the Sonne bacillus. 68 PUERPERAL FEVER AND PUERPERAL PYREXIA. Two cases of Puerperal Fever and ten cases of Puerperal Pyrexia were notified during the year. Details of these cases are set out in the following table:- TABLE No. 46. Total number of cases notified. Treatment in Hospital. District Nurses in attendance Council's Obstetrician called in. Deaths. Puerperal Fever 2 1 0 0 0 Puerperal Pyrexia 10 8 0 0 1 * Non-parishioner died in a Chelsea Hospital The notifications of puerperal fever and puerperal pyrexia during the past two years were as follows:- Puerperal Fever. Puerperal Pyrexia 1937 1 7 1938 1 7 1939 2 10 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 case required consultation during the year Arrangements have also been made for the utilization of the emergency obstetrical service of the London County Council. 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. Five 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:- TABLE No. 47. Ophthalmia Neonatorum. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Left District. Deaths. No. Notified. Treated. At Home. In Hospital. 5 3 2 5 - - - - Three cases of the disease were notified in the previous year. 69 Nursing-By arrangement with the Chelsea District Nursing Association home nursing is provided for infants suffering from this disease, sixty-one visits were made during the year. In addition to notified cases of Ophthalmia Neonatorum six 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. RELAPSING FEVER One case of relapsing fever was notified during the year and treated in hospital ENCEPHALITIS LETHARGICA. No case of Encephalitis Lethargica was notified during the year. Seven visits to old cases of Encephalitis Lethargica were made by the Woman Sanitary Inspector. Encephalitis Lethargica is undoubtedly infectious, but the infectivity is of very low nature. The 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 made the disease known as chicken pox notifiable in the Borough on, and from, the 12th August, 1929. One notification was received during the year treated in hospital. (Note:-By resolution of the Borough Council and approved by the Ministry of Health this disease and ceased to be notifiable as an Infectious disease from 4th January, 1939). 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. Vaccination.-No vaccinations have been performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917. The following Table gives particulars as regards vaccination in respect of children whose births were registered in the Borough for the year 1938 The figures for the year 1939 are not yet available. 70 TABLE No. 48. Vaccinations. Number. Percentage of births registered. Births registered in 1938 811 100 Successfully vaccinated 463 54.1 Insusceptible of vaccination 2 0.2 Had Small Pox - - Statutory Declaration of conscientious objection 153 18.9 Died unvaccinated 29 3.6 Postponed by medical certificate 2 0.2 Removed to other districts 44 9.5 Removed to unknown addresses 48 9.6 Not accounted for in previous columns 4 0.9 The above table is based on total births occurring in Chelsea and is not confined to parishioners. The total number of successful primary vaccination certificates (children under 14 years of age) received during the year 1939 was 441. 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 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. Ten such disinfections were carried out during the year, the total charges amounting to £52 0d. 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 families were accommodated at the shelter during the year. 71 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 84 occasions. The following Table No. 49 shows the number of attendances in each quarter:- TABLE No. 49. Quarter. Attendances. Minor Ailments Verminous. Impetigo. March - 194 1 June - 216 - September - 80 - December 394 64 - 394 554 1 The amount recoverable from the London County Council, as the School Authority, for the cleansing for the year is £75, 9.0 One hundred and eleven adults were cleansed at the Station during the year(includes 63 military cases). (6) 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 88, but 8 of these related to cases which had been previously notified, so that the total number of new notifications was 80. In the previous year, the corresponding number was 81. The notifications received on forms I. and II., i.e., notifications from institutions regarding admission and discharge, are not included in the foregoing figures. In Table No. 50 are shown, in the form required by the Ministry of Health, the detailed figures relating to new cases and mortality during the year. Included in this Table are 43 new cases which came to the knowledge of the Medical 72 Officer of Health during the year, otherwise than by notification on Form A or Form B under the Public Health (Tuberculosis) Regulations. TABLE No. 50. Tuberculosis. New Cases and Mortality during 1939. Age Periods. New Cases. Deaths. Respiratory. Nonrespiratory. Respiratory. Nonrespiratory. m. f. m. f. m. f. m. f. 0-1 - 1 1 - 1-5 - - - - 5-10 1 1 2 - 10-15 - 1 1 1 15-20 4 5 - 1 20-25 3 4 2 - 25-35 8 8 - 1 35-45 15 9 - - 45-65 15 6 1 - 65-65 13 1 - 1 65 and upwards 11 2 1 - Totals 40 41 8 4 The death rate from all forms of Tuberculosis in Chelsea was 0.78 per 1,000. Of the total number of deaths (44) from all forms of Tuberculosis, died non-notified or prior to notification. The ratio of nonnotified tuberculosis deaths to total tuberculosis deaths was therefore as 1 is to 4. The corresponding ratio for 1937 was 1 : 3. 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 73 (f.) The number of cases remaining on the Register at the end of the Quarter. The returns made in accordance with these Regulations show that the numbers of cases of Tuberculosis in the Borough on 31st December last were as follows:- TABLE No. 51. Males. Females. Total. Pulmonary 116 84 200 Non-pulmonary 23 15 38 139 99 238 (The register of Notifications contains particulars of all persons who have been notified to the Medical Officer of Health as suffering from Tuberculosis. It should be distinguished from the Dispensary Register referred to in Table 52 which contains the names of all persons attending at, or seen in connection with, the Dispensary for diagnosis and treatment). Home Visiting.-The 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 92 visits to nondispensary cases of Tuberculosis. Visits made to Dispensary cases of Tuberculosis are recorded in Table No. 52. 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. 52, subjoined, is prepared in accordance with the requirements of the Ministry of Health. The Table includes:- (a.) Summary of case's dealt with at the Chelsea Tuberculosis Dispensary, Brompton Hospital, and (b.) Special Cases which were accepted for institutional treatment by the London County Council, but which were not dealt with by the Chelsea Tuberculosis Dispensary. Prior to 1929 this Table comprised cases dealt with at the Chelsea Tuberculosis Dispensary only. In addition, a further Table, No. 53 (page 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 1938, 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. 52. Treatment of Tuberculosis, Year 193 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 36 14 1 1 1 2 1 1 34 19 2 2 244 (c) Non-tuberculous - - - - - - - - 44 84 33 23 B.-Contacts examined during the year:- (a) Definitely tuberculous 2 1 - 2 - - 1 - 2 1 1 2 150 (b) Diagnosis not completed - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 30 40 32 42 C.-Cases written off the Dispensary Register as:- (a) Recovered 3 3 - 3 - - 1 - 3 3 1 3 349 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 82 124 65 65 D.-Number of Cases on Dispensary Register on December 31st:- (a) Definitely tuberculous ... 102 46 8 2 10 10 3 3 112 86 11 5 214 (b) Diagnosis not completed - - - - - - - - - - - - 1. Number of cases on Dispensary 2. Number of cases transferred from Register on January 1st other areas and cases returned 235 after discharge under Head 3 in previous years 35 3. Number of cases transferred to other areas, cases not desiring 4. Cases written off during the year further assistance under the as Dead (all causes) 42 scheme, and cases "lost sight of" 62 6. Number of Insured Persons under 5. Number of attendances at the DisDomiciliary Treatment on the pensary (including Contacts) 1,563 31st December - 8. Number of visits by Tuberculosis 7. Number of consultations with Officers to homes (including medical practitioners:- personal consultations) (а) Personal - (b) Other 75 10. Number of :- (a) Specimens of sputum, etc., 9. Number of visits by Nurses or examined 194 sputa Health Visitors to homes for (b) X-ray examinations made Dispensary purposes 2,972 in connection with Dispensary work 538 X-ray 11. Number of "Recovered" cases 12. Number of " T.B. plus" cases on restored to Dispensary Register, Dispensary Register on and included in A (a) and A(b) ber 31st 118 above 1 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. 53. Pulmonary Tuberculosis. Condition at the time of the last record made during the year to which the return relates. Previous to 1928 1928 1929. 1930. 1931. 1932. 1933. 1934. 1935. 1936. 1937. 1938. Class T.B. minus. Class T.B. plus 1 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. miuus. 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 Hus). 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 ou 31st December. Disease Arrested Adults M. - 1 2 - 3 - - 1 - 1 - - - - - 1 - - - - - - 1 - 1 - - 1 - 1 1 3 1 - 4 4 - - - - 4 - - - 1 - - - - - - - - - - - - - - - F 2 - - - - 1 - - - - - - - - - - - 1 - 1 - 1 - - 1 - - - - 2 2 - 1 - 1 3 1 - - 1 - - - - - 2 - - - - - - - - - - - - - - Children - - - - - - - - - - - - - - - 1 - - - - - - - - - 1 - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - Disease not Arrested Ad'lts M. - 3 3 1 7 - - - - - - 1 1 1 - - - - 1 1 1 - 2 - - - - - 1 1 4 - 5 - 1 4 1 6 3 3 5 1 2 2 - 5 1 6 7 3 5 3 11 8 6 6 2 14 F. 1 2 2 - 4 - - 1 - 1 - - - - - - - 1 - 1 - 1 1 - 2 - 1 1 - 2 - - 1 - 1 1 1 1 - 2 4 3 4 - 7 2 1 2 - 3 6 1 3 - 4 14 4 7 1 12 Children - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - 1 - - 2 - 2 1 - - - - - - - - - 2 - - - - - - - - - Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 3 3 6 7 1 14 1 - 2 - 2 - - 1 - 1 3 - 2 - 2 1 3 3 - 6 1 1 4 - 5 4 4 8 - 12 12 3 7 1 11 13 7 9 1 17 7 1 7 1 9 16 4 8 3 15 22 10 13 3 26 --(b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 19 10 8 - 18 - - 1 - 1 5 1 1 - 2 4 1 - - - - - 2 - 2 3 - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. 29 12 2 - 14 2 - - - - 4 - - - . 7 1 1 - 2 7 - - - - 2 - 1 - 1 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Children 12 - - - - 1 - - - - - - - - - 1 - 1 - 1 - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 91 46 61 8 115 8 5 6 - 11 13 13 7 2 22 12 8 9 2 19 14 10 9 2 21 25 7 13 21 23 6 14 2 22 11 3 17 1 21 10 6 10 16 22 6 13 1 20 13 6 9 3 18 6 1 3 1 5 Dead Ad'lts M. 31 31 106 44 181 - 3 6 5 14 4 1 10 2 13 4 4 10 4 18 2 1 • 1 9 - 1 16 5 22 7 2 10 3 15 4 - 2 6 8 2 - 6 4 10 - 1 9 9 19 1 - 5 3 8 2 1 2 2 5 F. 24 12 51 35 98 - 2 5 5 12 - 1 2 5 8 2 3 3 2 8 2 1 6 2 9 1 - 4 3 7 3 1 2 1 4 1 1 7 5 13 - - 6 5 11 1 - 5 5 10 2 1 - 5 6 - - 1 2 3 Children 4 - 6 3 9 - - 1 2 - 1 - - 1 - 1 1 - 2 - - - - - 2 - - - - - - - - - - - - - - 2 - - 1 1 - - - - - 2 - - - - - - - - - Total written off Dispensary Register 210 111 234 9o 135 11 10 19 11 40 26 17 20 9 46 30 18 25 8 51 25 12 24 5 41 34 8 34 9 51 35 9 26 6 41 16 4 26 12 42 14 6 22 10 38 23 7 27 16 49 18 7 14 11 32 8 2 6 5 13 Grand Totals 213 117 241 91 149 12 10 21 11 42 26 17 21 9 47 33 18 27 53 26 15 27 5 47 35 9 38 9 56 39 13 34 6 53 28 7 33 13 53 27 13 31 11 55 30 8 34 16 58 34 11 22 14 47 30 12 19 8 39 77 Chelsea Tuberculosis Dispensary.-Thi.- 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 Dean of the Medical School and Honorary Consulting Physician 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, 1938. 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. 54, summarises, for the past two years, the number of persons examined at the Dispensary for the first time, the percentage of these cases in which definite tuberculosis was found and the total attendances at the Dispensary. TABLE No. 54. Work done at the Dispensary. Year. Newcases examined during the year. Definite Tuberculosis. Total attendances at Dispensary. 1937 303 12 per cent. 1,733 1938 327 10 " 1818 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, per cent. died in St. Luke's Hospital and ' per cent. in other public institutions, that is to say ' per cent. died away from their homes, the corresponding figure for 1938 being 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 anæmia, malnutrition and similar diseases and are referred to the Chelsea branch of the Invalid Children's Aid Association with a view to provision of convalescent home treatment. Co-operation with the School Medical Service.-The relationship with the School Medical Service continues to be satisfactory. The 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 20 cases ''including personal consultations) at the homes of the patients, and ys. 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 150 an increase of 24 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 year Thirty received treatment. The total cost (222.124)was borne Dy the Borough Council. Home Nursing.-The Dispensary prganization 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 2,942 Decrease of 80 over the number for the previous year. The Council lent a bedstead and bedding to one case during the year. Extra Nourishment.NINETEEn cases 0f Tuberculosis were certified by the Tuberculosis Offiecr 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 (42.12.0 ) was borne by the Borough Council. Non-Tuberciflous Cases.-All cases examined at the Dispensary in which special treatment is indicated, other than for Tuberculosis, are assisted in obtaining such treatment at an appropriate hospital.'' Others are sent to country or seaside convalescent homes through the agency of the Invalid Children's Aid Association or other organisation. 79 Thirty-eight Special Examinations.-Five hundred and ninety X-ray examinations wMU*»^JiI,niLuuA li.jtj were made at the dispensary during the year. 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 I een 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 four patients received dental treatment (including Two cases for dentures), the Borough Council making a contribution of £10.12.6 towards the cost. Bacteriological Examinations.-During the year, specimens of sputum were examined in connection with the work of the Dispensary. In addition, 31 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 Alderman Lady Phipps. London County Council ... Dr. R. H. Simpson (Divisional Medical Officer). Miss Paddon (District Organiser of School Care Committees). Mrs. E. E. Potton (After-care Committee). Chelsea Invalid Children's Miss B. M. S. Caudwell and Aid Association ... Miss A. Woodroffe. Public Assistance Mrs. E. Coote. Committee Mrs. L. Fraser. Chelsea Charity Organisation Miss Larken. Society. Chelsea District Nursing Miss N. D. Dixon. Association. Chelsea Health Society ... Mrs. Melville Miller. Brompton Hospital ... Miss Marx. Local Panel Committee ... Dr. M. Cutner. London Insurance Committee Mr. W. E. Fish. Local War Pensions Com- Miss Forbes. mittee and United Services Fund. 80 St. George's Hospital Lady Almoner. St. Luke's Hospital ... Miss Ellis. British Red Cross Society Miss M. A. Battye. Victoria Hospital Miss White. Ex-officio Members Dr. Leslie McCarthy (Medical Officer of Health). Dr. W. J. Fenton (Tuberculosis Officer). Miss M. Brown (Sanilary Inspector). Hon. Secretary Miss M. B. Streatfeild, 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. 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 239 Cases reported admitted to L.C.C. Institutions119 Dental treatment given through Borough Council Scheme 4 Extra nourishment given through Borough Council Scheme 19 Extra nourishment given through other agencies 28 Other assistance given 44 Children boarded out through the L.C.C. Contact Scheme 2 Convalescence arranged 25 Patients' voluntary contributions towards the cost of Institutional treatment collected on behalf of the L.C.C.£13.165 Metropolitan Borough of Chelsea. Annual Report OF THE PUBLIC ANALYST For the Year ended 31st December, 1938. BY THOMAS McLACHLAN, A.C.G.F.C., F.I.C. 82 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Chelsea. Mr. Mayor, Ladies and Gentlemen, During the year ended 31st December, 1938, four hundred samples were submitted to me for analysis by the Sampling Officers appointed under the Act. Of these 261 samples were taken as "Formal," and 139 were purchased informally. It has not been the custom for your Sampling Officers to discuss the nature of samples submitted with the Public Analyst, and the wide range of substances chosen reflects credit on them. In the tables 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." Only two samples were returned as adultered, and the Borough is to be congratulated that the percentage of adulteration is only 0.5 per cent. Two other samples were reported to be inferior because they did not comply with the standard, which your Analyst expects, although they could not be described as adulterated. All samples not reported as adulterated or inferior were returned as " Genuine." Article. Taken Formally Adulterated. Taken Informally. Adulterated. Total Samples Analysed Total Samples Adulterated. Milk 88 0 9 0 97 0 Milk, Condensed 0 0 2 0 2 0 Milk, Malted 0 0 1 0 1 0 Milk, Soured 0 0 1 0 1 0 Almonds, Ground or Salted 1 0 1 0 0 0 Baking Powder 2 0 0 0 2 0 Barley 1 0 1 0 2 0 Blanc-Mange and Custard Powders 7 0 0 0 7 0 Butter 11 0 15 0 26 0 Cake and Pudding Mixtures 10 0 2 0 12 0 Cereal Food 1 0 0 0 1 0 Cheese 0 0 1 1 (1) 1 1 (1) Cherries, Glaæ 1 0 0 0 1 0 Cocoa 9 0 2 0 11 0 Cocoa, Malted 0 0 1 0 1 0 Coffee 5 0 0 0 5 0 Cofiee and Chicory 6 0 0 0 6 0 Cream, Fresh 0 0 4 0 4 0 Cream, Tinned 0 0 1 0 1 0 Fish, Preserved 6 0 6 0 12 0 Fish Paste 0 0 2 0 2 0 Flour 8 0 0 0 8 0 83 TABLE-continued. Article. Taken Formally. Adulterated. Taken Informally. Adulterated. Total Samples Analysed Total Samples Adulterated. Flour, Self-raising 4 0 0 0 4 0 Fruit, Canned 16 0 2 0 18 0 Fruit Pies 0 0 3 0 3 0 Ginger, Ground 1 0 1 0 2 0 Gravy Powder 1 0 4 0 5 0 Honey 1 0 1 0 2 0 Jam 0 0 1 0 1 0 Jelly Crystals 2 0 0 0 2 0 Junket, Fruit 0 0 1 0 1 0 Lard 0 0 15 0 15 0 Lard Substitute 1 0 0 0 1 0 Lemon Barley Crystals 2 0 0 0 2 0 Macaroni 2 0 0 0 2 0 Margarine 7 0 10 0 17 0 Mayonnaise 0 0 1 0 1 0 Meat, Cooked 4 0 8 0 12 0 Meat Extract 0 0 1 0 1 0 Meat Paste 0 0 3 1(A) 3 1(A) Mint Sauce 0 0 1 0 1 0 Mustard 8 0 0 0 8 0 Oats 0 0 2 0 2 0 Pastry, Puff 4 0 2 1 6 0 Pepper 0 0 1 0 1 0 Pickles 0 0 2 0 2 0 Raisins 2 0 0 0 2 0 Rice 8 0 0 0 8 0 Sago 2 0 0 0 2 0 Salt 1 0 0 0 1 0 Sauce, Tomato 0 0 1 0 1 0 Sausages 1 0 12 0 13 0 Semolina 3 0 0 0 3 0 Soup, Canned 0 0 4 0 4 0 Soup, Powder 2 0 0 0 2 0 Spaghetti 0 0 1 0 1 0 Spices 3 0 0 0 3 0 Suet, Shredded 1 0 0 0 1 0 Sugar 3 0 0 0 3 0 Syrup 0 0 1 0 1 0 Tapioca 6 0 0 0 5 0 Tea 12 0 1 0 13 0 Vegetables, Canned 6 0 6 0 12 0 Vegetables, Dried 2 0 1 1 (1) 3 1 (1) Spirits- 0 Whisky 1 0 0 0 1 0 Drugs- 0 Aspirin 0 0 1 0 1 0 Soft Paraffin 0 0 1 0 1 0 Syrup of Figs 0 0 1 0 1 1 Tincture of Iodine 0 0 1 1(A) 1 1(A) Totals 261 0 139 4 400 4(2A, 21) Percentages of Total 65.25 .0 34.75 .0 100 1.0 The actual percentages given by the data in the Table are as follows :- Genuine Composition 99 per cent. Adulterated 0.5 per cent. Inferior 0.5 per cent. 84 MILK. Of the 97 samples of milk examined, 88 were submitted formally and 9 informally, and all were found to be in genuine accordance with the requirements of the Sale of Milk Regulations, 1901, and the Milk and Dairies Act, 1922. In the Borough of Chelsea, milks are described as "Good," "Fair," and "Poor," according to the following percentages of fat:- Good Quality Over 3.8 per cent. of fat. Fair „ Between 3.35 and 3.8 per cent. of fat. Poor „ Between 3.0 and 3.35 per cent. of fat. Fourteen of the samples examined were described as of" Good " quality, 61 as "Fair," and 22 as " Poor." This is fairly satisfactory, but it is doubtful whether there is any real necessity for milks of " Poor " quality to come on to the market. The probability is that most milk as it comes from the cow is at least of " Fair " quality. SOURED MILK. One sample of specially fermented milk was submitted for analysis, and was found to contain only 2.44 per cent. of fat, as compared with 3.0 per cent., the minimum amount required to be present in milk. As this product is only stated to be prepared with pure milk constituents, no exception could be taken. ALMONDS. It is satisfactory to note that in spite of the Spanish Civil War, and the consequent tendency to pass off mixtures containing nuts other than almonds in the ground condition, or ground almonds mixed with various starches, all samples examined for Chelsea have been found to be genuine. The sample of salted almonds was quite satisfactory. BUTTER AND MARGARINE. In the report last year, mention was made of the fact that the water content of butter and margarine had increased, and it has been noticed that this larger amount of water has been present again this year in almost every sample examined. CAKE AND PUDDING MIXTURES. Twelve samples of cake and pudding mixtures and seven samples of custard and blanc-mange powders were examined, and all were found to be satisfactory. CEREALS AND LEGUMES. It is generally found that dried cereals are free from attack by maggots, but samples of dried legumes frequently show signs of their presence, and your Analyst makes it a practice to report as adultered any samples of which 10 per cent. have been so attacked. A sample of split peas was reported as inferior because over 7 por cent. of thepeas were maggotty. 85 CHEESE. A sample of Kraft cheese was returned as inferior, because it contained only 23.8 per cent. of butter fat, calculated on the dry cheese. Kraft cheese was originally a re-worked cheese made from cheese prepared from whole milk, but, there being no standards for this country, it is difficult to insist that because it was so prepared originally, it must always be so prepared. This would appear to be a good example of the advisability of having certain standards for recognised food names, the sample under discussion having been prepared from a partially skimmed milk. COCOA. It has been noticed during the year that the amount of arsenic in cocoa is increasing, and four samples were found to contain one two-hundredth of a grain per pound. Some years ago, it was found that cocoa was becoming contaminated with arsenic as a result of the sodium carbonate added to render it more soluble. COFFEE AND COFFEE AND CHICORY. Six samples of coffee and four samples of coffee and chicory were examined, and all were found to be satisfactory. CREAM. Four samples of fresh cream and one of tinned cream were examined. The average milk fat present in the fresh cream was 48 per cent., whereas that in the tinned sample was only 23 per cent., rather less than half that in the fresh cream. The thickness of tinned cream is obtained by homogenisation, and is increased during sterilisation. FRUIT JUNKET. A sample of fruit junket was found to consist of a coloured and orange flavoured solution of rennet. GROUND GINGER. A sample of ground ginger was examined during the year, and found to be quite satisfactory. During the last few years there has been an appreciable amount of Nigerian ginger on the market, which has had a large amount of water-soluble extract removed during its preparation. ( linger is grown in Nigeria by very primitive races, and in their endeavours to prepare an article which they imagined to be suitable for the British market, they have been far too drastic in its treatment for sale. The result is that the British spice merchants are nervous of handling Nigerian finger, and the Nigerian agricultural authorities are finding it difficult to explain to the naitives that the market has been ruined by good intention, and that ginger must be placed on the market without making it look quite so white. 86 LARD SUBSTITUTES. A sample of lard substitute was examined and found to be quite satisfactory. All samples of lard substitute examined by your Analyst have been satisfactory, but certain products have been placed on the market which contain water, and which cannot therefore be held to be lard substitutes. LEMON BARLEY CRYSTALS. Two samples of Lemon Barley Crystals were examined, and both were found to have been prepared with normal ingredients, containing powdered barley or barley flour, citric acid and lemon flavouring. MEAT PASTE. Of three samples of Meat Paste, one (Wild Duck Paste) was returned as adulterated on the ground that it appeared to contain a small quantity of sulphur dioxide. Certain samples of meat and fish pastes are found to give reactions for the presence of sulphur dioxide. Whilst the packers claim that no sulphur dioxide is present, and your Analyst agrees that no sulphur dioxide had been added originally, he is of the opinion that it is formed during processing; it is usually found that after attention had been drawn to the matter, future samples do not respond to the tests. SARDINES. Two tins of sardines were received as the result of a complaint made at the Town Hall. They were found to be sterile and to contain only the merest traces of lead, so that no complaint could be made with regard to the samples examined. PRESERVATIVES. Nearly all samples received, including cream, milk, butter, cereals, cheese, pastes and sausages, were examined for added preservatives, and no sample, apart from that of Wild Duck Paste mentioned above, was found to be contrary to the Preservatives Regulations. TINNED FOODS. No sample of tinned food was found to contain an excess of tin. • WHISKY. The sample of whisky submitted was found to have been diluted to the absolute lowest limit permitted by the Food and Drugs (Adulteration) Act. 87 DRUGS. Four samples of Drugs were submitted for examination, and one of these, a sample of Tincture of Iodine, was found to be adulterated. In the case of this sample, the tincture was placed in a very small bottle, and it has been noticed that the amount of liquid held by these bottles varies considerably, some bottles holding twice as much as others. They may be in stock in grocers' and similar shops for long periods, and lose much of their strength before being sold. In the case of the sample under review, it was 9.6 per cent. deficient in iodine according to the requirements of the British Pharmacopoeia, and it is suggested that it would be wiser if preparations of this type were definitely labelled as being of " approximately of British Pharmacopoeia Strength " only. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, THOMAS McLAGHLAN, A.C.G.F.G., F.I.G. Public Analyst. TABLE No. 53 (continued). Non-Pulmonary Tuberculosis. Condition at the time of the last record made during the year to which the return relates. Previous to 1928. 1928. 1929. 1930. 1931 1932. 1933. 1934. 1935. 1936. 1937. 1938. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints.) Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripher il Glands. Total Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal Other Organs. Peripheral Glands Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. Bones and Joints. Abdominal. Other Organs. Peripheral Glands. Total. (a) Remaining on Dispensary Register on 31st December. Disease Arrested Ad'lts m. 1 - - - 1 - - - - - - - - - - - - - - - - - 1 - - - - 1 - - - - - - 1 - - - 1 - - - - - - - 2 1 33 - 1 - i - - - - - f. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 - - - 1 1 1 - - 2 3 - - - 1 1 - - - - - Children - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - 1 1 - - - - - - - - - - - - - - - - 1 - - 1 Disease not Arrested. Ad'lts - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 - - - - - 1 - - - 1 - - - - - 1 - - - 1 1 - - - 1 f. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 - - - - - 2 - - - 2 1 - - - 1 1 - - 1 2 Children - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 - - - - - - - - - - - - - - - - - 1 - 1 Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - 1 1 - - 2 4 - - 1 2 1 - - 1 2 3 - 2 3 8 2 1 - 1 4 2 1 1 1 5 (b) Not now on Dispensary Register and reasons for removal therefrom. Transferred to Pulmonic - - - - - - - - - - - - - - - - - - - - - - - - - 2 - - - 2 - 1 - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - Discharged as Recovered Ad'lts m. 2 - - - 2 - - - - - - - - - - - - - - - - - - - 1 2 - - - 2 - - - 1 1 - - - - - - - - - - - - - - - - - - - - - - - - - f. 3 - 1 4 - - - - - - - - - - 1 1 - 2 4 - - - - 1 1 - - 2 3 2 - - - 2 - - - - - - - - - - - - - - - - - - - - - - - - - Children 6 1 - 17 24 - - - - - 2 - 3 5 - 1 - 6 7 - 1 - 4 5 1 - - 2 3 - 1 - - 1 - - - 7 7 - - - 2 2 - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 12 2 2 13 29 4 - 1 1 6 1 - - - 1 4 - 4 2 10 1 2 2 - 5 5 3 2 6 10 - - - 8 9 5 1 - 5 11 2 2 3 1 8 1 1 - 1 3 1 - 1 4 6 - 4 - - 4 Dead Ad'lts M. - - 1 - 1 - - - - - - - - - - 1 - - - 1 - - - - - - - - - - - - 1 - 1 - - - - - - - - - - 2 - 2 - 4 1 - 1 i 1 3 - - - - - f. 1 - 1 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 - - - - - Children 1 - 1 1 3 - - - - - - - - - - 3 - 3 1 7 l - - 1 2 - 1 - 1 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total written off Dispensary Register 25 3 4 33 65 4 - 1 1 6 1 2 - 3 6 9 2 7 11 29 2 3 2 7 14 9 4 2 11 26 2 2 1 9 14 5 1 - 12 18 2 2 2 3 3 10 3 3 1 1 7 3 - 2 5 10 - 4 - - 4 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 26 8 4 33 66 4 1 1 6 1 2 - 3 6 9 2 7 11 29 2 3 2 7 14 9 4 2 11 20 3 3 1 1 11 9 1 - 13 23 3 2 3 12 6 1 4 4 15 5 1 2 6 14 2 5 1 1 9 (Signed) w. H. l. McCarthy, Chief Tuberculosis Officer.