CHE 44 *Note: Preface of Abridged Report. For information only. PREFACE. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Chelsea. Madam Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report on the health and sanitary conditions of the Borough for 1940. In accordance with instructions from the Ministry of Health, the report has been prepared in an abridged form. Complete records of each year's work are, however, being retained so that a comprehensive report covering the war period may in due course be available. The Registrar-General's estimate of the resident population is 38,700, as against 55,400 in 1939. This marked decrease arises mainly from conditions of war. The death rate of 22.0 per 1000 of estimated civilian population - as compared with 14.6 in 1939 - is due to deaths from enemy action. The health of the population has been good. The incidence of infectious disease is low, although the risk of such outbreaks was serious owing to abnormal conditions associated with air-raid shelters. Every effort has, however been made for the prevention of disease, including infestation by vermin. The number of cases of tuberculosis in the Borough w&s lower than last year. Sanitary administration of the Borough was satisfactorily maintained throughout the year, despite the many extra duties thrown upon the Department as a result of sustained enemy action. These duties included inspections by the Sanitary Inspectors of first-aid repairs to property, salvaged household effects, billets for homeless persons and problems arising out of removal and storage of food stuffs from bombed premises. Normal house-to-house inspection is necessarily in abeyance for the duration of hostilities, but all complaints were investigated and the necessary action taken. As in former years, close attention was devoted to the supervision of food supplies. The Chelsea Health Society continues to render valuable assistance in connection with Maternity and Child Welfare work, also in cooperating with the responsible authorities in dealing with the evacuation of expectant and nursing mothers and young children. In addition, the health Visitors undertake the issue and fitting of respirators to babies and toddlers I should like to thank the members of the Council for the support and sympathetic consideration which have been extended to me and for their attention to the problems which it has been my duty to lay before them. To the staff of the Public Health Department I have also to express my appreciation of their devotion to duty in maintaining the service of the department at a high standard. I am, Madam Mayor, Ladies and Gentlemen, Your obedient servant, W.H.L. McCarthy Medical Officer of Health. 16th September, 1941. Metropolitan Borough of Chelsea. Annual Report OF THE Medical Officer of Health FOR CHELSEA 1940 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, farrjngdon road london, E.C.I. 1940. 2 PREFACE To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Chelsea. Madam Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report on the health of the Metropolitan Borough of Chelsea for 1940. The chief vital statistics relating to the year are as follows:- The Civilian population of the Borough is estimated by the Registrar-General at 38,700 a figure which is lower than that for last year. The birth rate (11.0) is higher than that for last year (9.7). The marriage rate (2.1.6) is higher than that for last year (19.2). The death rate (22.0) higher than that for London generally (17.8) and compares with 14.6 last year. It is, perhaps, not generally realised that over 10 per cent, of the Chelsea population is made up of persons over 65 years of age—a much higher proportion than that obtaining in any other Metropolitan Borough—and that over one-half of all deaths in Chelsea occur in persons over 65 years of age. The infant mortality rate is 40 per 1,000 live births, as compared with 33 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, was 343, as compared with 372 last year. At the end of the year there were 177 cases of pulmonary tuberculosis and 35 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 4650 and 4,700 visits to homes of patients were recorded. I continue to receive most valuable assistance from the Chelsea Health Society, and cannot speak too highly of the efficiency of the Society's work. Section III. of the report deals with Sanitary Administration. The statistics indicate that constant attention is devoted to the improvement of housing accommodation in the Borough. As in former years, much attention has been devoted to the supervision of food supplies. 3 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, Madam 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, 1940. HER,Worship the Mayor (Councillor lady clare Hartnellj.P.) The Deputy Mayor (Councillor R,.Q. Wharam) Alderman Miss C. Fulford, J.P., L.C.C. (Chairman). Alderman Lt.Col.S. Boyle, C.B.E.,M.C.D.L,J.P. Alderman Lady Phipps. Alderman G. M. Stevenson. Councillors: W. G. .Arrowsmith, m.a. g.m. Colli s. Mrs. J. T. Cockburjt R.A. Lygon, B .A, G. A. Beaton. Mrs. C. Williams. Hon. Eveleen Campbell-Gray. Housing Committee. HER Worship the Mayor (Councillor Lady Clare Hartnell.J.P.) The Deputy Mayor (Councillor R.G. WHARAM..) Alderman Lady Phipps (Chairman). Councillor Mis, J.T. Cockburn( Vice-Chairman). Alderman Basil Marsden-Smedley, L.C.C. Councillors: w.g.Arrowsmith M.A R. A. Lygon. J. M. Buckley. G. A. Thesiger. a. s benton. 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 Lady Clare Hartnell. J.P.) The Deputy Mayor (.Councillor R.G.Wharaw.) Alderman Lady Phipps (Chairman). Alderman Miss C. Fulford, J.P., L.C.C. Councillors: Hon. Eveleen Campbell-Gray. 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, 1940, are tabulated below in the form required by the Ministry of Health. (a) Medical. Year appointed. Name. Qualifications. Appointment. 1924 McCarthy, W. H. L. M.D.,M.R.C.P., D.P.H. Medical Officer of Health, Administrative Tuberculosis Officer and Executive Officer under the Council's Maternity and Child Welfare Scheme (Part time). 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, Mz.ternity and Child Welfare (Part time). 1930 Salmond, Margaret M.D., F.R.C.S., M.C.O.G. Medical Officer of AnteNatal Clinic (Part time). 1929 McCulllagh, W.Mck M.B., F.R.C.S. Consultant for Puerperal Fever an a Puerperal Pyrexia (Part 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). 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 (b) Other Officers 6 I.—Statistics and Social Conditions of the Borough. General Statistics 11 Physical Features and General Character of the Area 12 Social Conditions, including Chief Occupations of Inhabitants 12 Vital Statistics 12 Births 13 Registered Number of 13 Notifications 15 Illegitimate 16 Stillbirths 16 Marriages 16 Deaths 16 Registered Number of 16 In Public Institutions 17 Causes (Table) 20 Children 1-5 years 21 Infants 22 Illegitimate 23 Maternal Mortality 23 Apparent Excessive Mortality in the Borough 24 Causes of Sickness in the Borough 24 II.—Provision of Health Services in the Borough. Professional Nursing in the Home 25 (a) 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 Welfare 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 III.—Sanitary Circumstances and Administration. PAGE Complaints 42 Closet Accommodation 42 Removal and Disposal of Refuse 42 Sanitary Inspection of the Borough 42 Magisterial Proceedings 45 Shops 45 Smoke Abatement 45 Fouling of Footways by Dogs 45 Rats and Mice (Destruction) Act 45 Pigeons, Nuisance caused by 45 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 IV.—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 (e.) Unhealthy Areas 50 (f.) Byelaws relating to Houses and Houses Let in Lodgings 56 (g.) Housing Inspections 56 V.—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 VI.—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 69 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 Annual Report on the Health of the Metropolitan Borough of Chelsea. Year ending 31st December, 1940. SECTION I.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. GENERAL STATISTICS. TABLE No. 1. Area (acres) 660 Civilian population - Registrar - Generate estimate 38,700. Number of Inhabited Houses (end of 1940) according to Rate Books 12,492 Rateable value, October, 1940 £1,322,428 Sum represented by a penny rate, October, 1940 £4,257. POPULATION IN WARDS. (Census 1931.) Males. Females. Total. Cheyne 3,349 5,436 8,785 Church 4,390 5,929 10,319 Hans Town 2,961 5,839 8,800 Royal Hospital 2,550 4,833 7,383 Stanley 10,696 13,048 23,744 23,946 35,085 59,031 12 Physical Features and General Character of the Area.—The Metropolitan Borough of Chelsea, situated near the centre of the Metropolis, is bounded on the north by the Royal Borough of Kensington, on the west by the Borough of Fulham, on the east by the City of Westminster, and on the south by the River Thames. It is a small compact borough, less than two miles in length, by about three-quarters of a mile in width. Over nearly the whole area the soil consists of gravel and sand, highly permeable to water. In a small portion of the western side of the Borough there is a thin loamy deposit of brick earth resting upon the gravel. There is a narrow strip of alluvial deposit extending along the Embankment from Battersea Bridge westwards. The northern portion of the area is largely built over. The central zone comprises a number of pleasant squares occupied by people in affluent circumstances. The grounds of the Royal Hospital, with the River Thames and Battersea Park beyond, render the southern zone unusually open. Social Conditions.—The density of population (number of persons per acre) as shown by the 1931 Census, is 89.4, the corresponding figure for London, as a whole, being 58.7. The density of population of each of the five Wards in the Borough is as follows:—Church Ward, 111.0; Stanley Ward, 123.7; Hans Town Ward, 78.6; Cheyne Ward, 76.4; Royal Hospital Ward, 49.9. Analysis of the 1931 Census figures shows that there is a greater proportion of unoccupied and retired persons in Chelsea than in any other Metropolitan borough. There is, however, a considerable "working class" population. Thus, of a total of 19,600 adult males, about 16,750 are occupied. The chief occupations are transport work (2,704), personal service (2,224), metal work (1,036), and clerical work (1,260). Over one half of the 30,800 adult females are occupied. Of these, domestic servants account for 8,746, dressmakers number 1,243, shop assistants 1,090, and clerks 1,471. There are no dangerous or offensive trades carried on in the Borough. There is no evidence that any of the occupations of the inhabitants exerts a deleterious influence on the public health. VITAL STATISTICS. In accordance with the requirements of the Ministry of Health, the following extracts from the Vital Statistics of the year are shown below :— TABLE No. 2. Total M. F. Live Births :— Legitimate 389 166 209 Birth rate per 1,000 of the estimated civiljan population,11.0 Illegitimate 39 16 23 • 13  Total M. F. Still Births 10 5 5 Rate per 1,000 total (live and still) births 22.8 Deaths 851 402 449 Death rate per 1,000 of the estimated civilian population , 22.0 Deaths. Rate per 1,000 total (live and still) births. Deaths from Puerperal Causes :— Puerperal Sepsis 2 5. 2 Other Puerperal Causes 1 2.6 Total 3 7 8 Death rate of Infants under one year of age :— All infants, per 1,000 live births 40 Legitimate infants per 1,000 legitimate live births 41 Illegitimate infants per 1,000 illegitimate live births 26 Deaths from Cancer (all ages) 106 Deaths from Measles (all ages) - Deaths from Whooping Cough (all ages) - Deaths from Diarrhoea (under 2 years of age) 1 BIRTHS. The total number of births of Chelsea residents during the year was 428 , equivalent to a birth rate of 11.0 per 1,000 of estimated civilian population. The birth-rate for England and Wales in 1940 was 14.6 while that for London as a whole was 13.7. The following Tables are self-explanatory:— TABLE No. 3. Registered Births. Legitimate and Illegitimate Births. Total. Births Registered in the Borough 169 Births of Non-Parishioners 35 134 Births of Chelsea Mothers in Lyingin Hospitals and elsewhere outside of the Borough 294 Nett Chelsea Births 428 14 TABLE No. 4. Births, Birth-Rates, Births in Wards and Inward Transfer Births. Year. Leg. Births. Total. BirthRate Per 1,000 of Population. Births in Wards. Inward Transfer Births. Leg. Hans Town. Royal Hospital. Church. Cheyne. Stanley. Hospitals. Nursing Homes. Private Addresses. Total. 1939 490 49 539 9.7 51 57 85 71 27 5 275 55 18 348 1940 389 39 428 11.0 48 34 66 61 219 19 4 73 27 29 4 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 Countv Council \— . St. Luke's Hospital St. Mary Abbots 129 St. Stephen's Hospital St. Janes', Battersea 2 Lambeth 2 Hammersmith 1 Voluntary :— Chelsea Hospital for Women1 Voluntary:- Royal Cancer Hospital l Westminster 5 Nursing Homes :— Queen Charlotte's 3 Wilbraham 4 City of London 2 Royal Avenue 1 Royal Free 1 Miscellaneous 49 Nursing Homes:— Miscellaneous 73 Total 7 Total 267 From Table No. 4 it will be observed that the number of births of Chelsea Infants in Hospitals and elsewhere outside Chelsea accounted for 69 per cent, of the total births. In the preceding year the percentage was 64. 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 143 births, including stillbirths, were notified as occurring in Chelsea. Of this number, in 22 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 197 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 318. The following table indicates the source of notification of the 143 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 26 - 26 22 — 22 Midwives 93 2 95 - - Poor Law Institutions - - - _ — — Parents — — — - - - 119 2 121 22 - 22 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. 1939 23 26 4.9 9.09 1940 16 23 39 9.11 Stillbirths.—The corrected number of stillbirths during the year was 10 which represents a rate for the Borough of 0.25 per 1,000 of the population, as compared with 0.44 for London as a whole. MARRIAGES. There were 839 marriages registered in the Borough during the year (1065 in 1939). The marriage rate (number of marriages per 1,000 of population) was 21.6 In the preceding year the marriage rate was 19.2.. DEATHS. The total number of deaths of Chelsea residents during the year was 851 equivalent to a death rate of 22.0 per 1,000 of estimated estimated civilian population. The death rate for England and Wales for 1940 was 14.3, and for London 17.8. Adjusted Death Rate.—If the populations of all areas were similarly constituted as regards the proportions of their sex and age group components, their crude death rates (deaths per 1,000 population) could be accepted as valid comparative measures of the mortalities experienced by the several populations. In practice, however, populations are not thus similarly constituted, and the Registrar-General has accordingly calculated a factor (called the Areal Comparability Factor) for each district. This is, in effect, an adjustment of the age and sex composition of the district to that of England and Wales as a whole, so that all may be compared on the same basis. To obtain the adjusted death rate, the crude death rate is multiplied by the Comparative Factor which has the effect of making a corrected death rate comparable with the death rate of any other district which has been similarly adjusted. The Areal Comparative Factor for Chelsea is 0.81. and the death rate for 1940 when set adjusted is 17.8. 17 The following tables are self-explanatory :— TABLE No. 8. Registered Deaths. Total. Deaths registered in the Borough 1883 Non-parishioners 1216 667 Deaths of Chelsea residents in hospitals and elsewhere outside the Borough 184 Nett Chelsea deaths 851 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 667 Chelsea deaths registered in the Borough, 359 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 107 St. Luke's Hospital and Institution 251 Mental Hospitals 13 Infectious Disease Hospitals St. Stephen's Hospital and Institution 54 (L.C.C.) 5 Tuberculosis Sanatoria, etc.4 St. George's Home for Tuberculosis _ Nursing Homes 22 Poor Law Institutions (L.C.C.)8 Voluntary :— Miscellaneous 25 Chelsea Hospital for Women 1 Cheyne Hospital for Children — Brompton Hospital 6 Royal Hospital for Pensioners 40 Royal Cancer Hospital 5 Victoria Hospital for Children 2 359 184 Of the 1,216 deaths of non-residents registered in Chelsea 1,158 occurred in hospitals or Institutions within the Borough. 18 TABLE No. 10. Deaths, Death Rates, Deaths in Wards and Seasonal Mortality. Year. Deaths. DeathRate per 1,000 of Population. Deaths in Wards. Seasonal Mortality Rate. Hans Town. Royal Hospital. Church. Cheyne. Stanley. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. 1939 743 14.6 69 109 180 i 24 311 19 .8 14.3 12.7 11.7 1940 851 22.0 67 93 I59 169 369 23.3 16.4 19.3 28.9 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 Towns and 148 Smaller Towns. (Provisional figures based on Weekly and Quarterly Returns.) England and Wales. 126 County Boro's and Great Towns including London. 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census). London Administrative County. Rates per 1,000 Population. Births :— Live 14 .6 16.0 15.7 13.7 Still 0.65 0.64 0.56 0.44 Deaths :— All Causes 44.3 16.8 12.8 17.8 Typhoid and Paratyphoid fevers 0.00 0.00 0.00 0.00 Smallpox 0.00 0.00 0.00 0.00 Measles 0.02. 0.02 0.02 0.01 Scarlet fever 0.00 0.00 0 .00 0.00 Whooping Cough 0.02 0.02 0.02 0. 00 Diphtheria. 0.06 0.07 0.05 0 .01 Influenza 0.3£ 0.29 0.30 0.18 Noticication:- Cerebro- Spinal Fever 0.32 0.33 0.29 0.28 Whooping Cough 1.34 1.29 1.35 0.22 Smallpox ... 0.00 0.00 0. 00 0.00 Scarlet fever 1.63 1.53 1 .57 0.82 Diphtheria 1.16 1.29 1.21 0.61 Enteric fever 6.07 0 06 0.10 0.06 Erysipelas 0.33 0.36 0.30 0.35 Pneumonia 1.20 1.37 1.00 0. 87 Measles 10.24 9.23 9.99 1.78 Rates per 1000 live birth. Deaths under 1 year of age 55 5.9 54 56 Deaths from Diarrhoea and Enteritis under 2 years of age 4.6 5. 3 4.4 5.8 Rates per 1000 total births. Maternal Mortality:- (excluding abortion) Puerperal Sepsis 0.52 Not availble Others 1.64 Total 2. 16 Notifications:— Puerperal fever Puerperal pyrexia 11.96 13 .30 9.73 3.94 13.30 20 TABLE No. 12. Deaths of Chelsea Residents Registered during the Year 1938, 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 5 years. 5and under 15 years. 15 and. under 45 years. 45 and under 65 years. 66 years and upwards. All Causes 851 15 4 9 154 226 443 1. Typhoid and Paratyphoid Fevers — — — — — — — 2.' Cerebro-spinal Fever 1 — — — — 1 — 3. Scarlet i'ever — — — — — — — 4. Whooping Cough — — — — — — 5. Diphtheria — — — — — — — 6. Tuberculosis of Resp. System. 37 — 1 — 49 10 7 7. Other forms of Tuberculosis 6 — — 1 3 1 1 8. Syphilitic diseases 5 — — — — 4 1 9. Influenza 12 1 — — 4 5 2 10. Measles — — — — — —- — 11. Ac.Polio-myelitis. Ac.Polio-enceph. — — — — — — — 12. Acute Inf. Encephalitis 2 — — — 1 — 1 13. Caneer of Buccal Cavity fund 0esophagus(M), Uterus(F) 15 — — — 1 6 8 14. Caneer Stomach, Duodenum 13 — — — — 8 11 15. Cancer of Breast 10 — — — — 6 4 16. Cancer of ail other sites 62. — — - 2 26 34 17. Diabetes 5 — — — 1 4 — 18. Intra-cranial vascular lesions 42 — — — — 8 34 19. Heart Disease 204 — — — 4 33 167 20. Other diseases of the circ.System. 26 —- — — — 7 19 21. Bronchitis 31 1 — - - 10 20 22. Pnemonia 46 3 1 — 2 11 28 23. Other respiratory diseases 8 — — — 2 2. 4 ( 24. Ulcer of stomach or duodenun 11 — — — 2 3 6 25. Diarrhoea under 2 years 1 '— '— — — — — | 26. Appendicitis 3 — 1 — — 2 — i 27. Other digestive disease 9 — 1 1 2 5 28. Acute ana chromic Nephritis 7 — —| — 1 5 1 29. Puerperal Sepsis (and.post aboyttne) 2. _ — 2 — — . 30. Other maternal Causes 1 — — — 1 — — 31. Prematura birth 3 3 — — — — — 32 Congenital malformation, birth injury, infantile diseases 4 4 — — — — — 33. Suicide 13 — — — 5 5 3 34. Road traffic accidents 11 — — — 4 4 3 35. Other violent causes 205 2 — 6 90 56 55 36. All other causes .47 — — 2 9 7 29 851 15 4 3 154 126 443 21 CAUSES OF DEATH. Table No. 12 shows that 204 deaths were due to Organic Heart Disease, 106 to Cancer, 31 to Bronchitis, 45 to Pneumonia, 37 to Pulmonary Tuberculosis, 26 to Circulatory Diseases, twelve to Influenza and 4 to Congenital Debility and Malformation. Fifty- Two per cent, of all deaths occurred in persons over 65 years of age. RESPIRATORY DISEASES. Table No. 13 shows the number of deaths from respiratory diseases during the past two years. The annual death rate, the number of deaths under 5 years, and the percentage of deaths occurring in children under 5 years of age is also shown:— TABLE No. 13. Year. Bronchitis. Pneumonia. Other Respiratory Diseases. Total. Deathrate. No. of deaths under 5 years. Percentage under 5 years. 1939 20 39 6 65 1.3 8 7 7 1940 31 4.5 8 84 2.2 5 6.o DEATHS OF CHILDREN 1-5 YEARS OF AGE. The causes ot death are given during the past two years. TABLE No. 14. Child Mortality (1-5 Years). Year. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrhoeal Diseases. All other causes. Total Deaths. 1939 1 1 - — 3 5 1940 - 1 1 — 2 4 22 INFANT MORTALITY. There were 15 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 40 as compared with 33 in the. previous year. In London as a whole the rate of infant mortality was 50 per 1,000 live births. The causes of death in the various age groups are set out in Table No. 15 TABLE No. 15. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 4 weeks and under 3 months 3-6 months. 6-9 months. 9-12 months. Total deaths under 1 year. Small pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever — Whooping Cough - - - - - — - - - Diphtheria - - - - - - - - - - Cerebro-Spinal Fever - - - — - — - - - - Influenza - - - — - — 1 - - 1 Erysipelas - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis Convulsions - - — — - —— - —— - - Laryngitis - - - - - - - - - - Bronchitis - - - — - l - - - 1 Pneumonia - - - 1 1 — 1 1 - 3 Diarrhoea and Enteritis - - 1 - 1 — - - - 1 Gastritis - - - - - - - - - - Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Suffocation - - - - - - - - - - Injury at Birth - - - — - — - - - — Atelectasis - - - - - - - - - - Congenital Malformations - - - - - - - - - - Premature Birth. 3 - - - 3 - - - - 3 Atrophy,Debility and Marasmus 1 1 - — 2 1 1 — — 4 Other causes 1 - - — 1 — 1 - - 2 6 1 1 l 8 2 4 1 — 15 Nett Births registered during the calendar year Legitimate 399 Illegitimate 39 Nett Deaths (under 1) registered during the calendar year Legitimate 14 Illegitimate 1 23 The following Table gives the Infant Mortality Rate in Chelsea under various headings, for the past two years :— TABLE No.16 1939 1940 Infectious Diseases 3.9 - Diarrhoeal Diseases 1.9 2.8 Developmental Defects and Wasting 15.8 18.6 Other causes 11.8 18.6 Total Rate 33.0 40.0 TABLE No. 17. Infantile Mortality Rates per 1,000 Births in Wards. 1939 1940 Hans Town - - Royal Hospital 18 - Church 47 24 Cheyne - 56 Stanley 49 41 Chelsea Borough 33 40 Illegitimate Deaths.—The following Table No. 18 shows the number of deaths among illegitimate infants during the past two years. TABLE No. 18. 1939 1940 Total number of illegitimate deaths under 1 year 2 1 Illegitimate death rate 41 26 MATERNAL MORTALITY. During the year three 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. Puerperal Sepsis. Other complications of Pregnancy and Childbirth. Total Death-rate. 1939 1.9 1.9 1940 5.2 2.6 7.8 APPARENT EXCESSIVE MORTALITY IN THE BOROUGH. • The Census Returns have consistently shown that there is a considerably higher percentage of persons of advanced age living in Chelsea than in any other Metropolitan Borough. The 1931 Census Returns showed that in London generally 7 3 per cent. of the total population were included in the age-group 65 and upwards. In Chelsea, however, no less than 10.2 per cent. of the total population constituted the agegroup 65 and upwards. These facts must be borne in mind in any analysis of the Chelsea mortality rate, as they are naturally reflected in the death returns. In 19:40 deaths of pensioners in the Royal Hospital, Chelsea, accounted for 47 deaths, inward transfers included (equivalent to 1.2 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. Deaths from "other violent causes", mainly from enemy auction numbered 209, equivalent to 5.1 of the death rate. 25 SECTION II.—PROVISION OF HEALTH SERVICES IN THE BOROUGH. PUBLIC HEALTH OFFICERS OF THE BOROUGH COUNCIL. The names and qualifications of members of the staff of the Public Health Department at 31st December, 1940 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 1940:— TABLE No. 20. Year. Visits. Cases. 1939 1,498 158 1940 1,404 135 26 TABLE No.21. Nursed by District Nurses During 1038. Visits. Cases. Bronchitis 67 8 Burns - - Chicken Pox 18 1 Circumcision 58 7 Diarrhoea 1 1 Eye Trouble 202 14 Ear Trouble 13 1 Expectant and Nursing Mothers 122 12 Influenza,Pneumonia(under 5) 93 4 Influenza,Pneumonia(over 5) 77 3 Impetigo 119 4 Meningitis and Peritonitis - - Measles (under 5) 2 1 Measles(over 5) 10 3 Ophthalmia Neonatorum 82 2 Pemphigus Neonatorum - - Pemphigus 88 4 Poliomyelitis - - Post-Vaccination 149 31 Puerperal Fever - - Puerperal Pyrexia 24 2 Rickets — — Septic sores 47 4 Tonsils and Adenoids - - Whooping Cough - - Worms 65 12 Miscellaneous 167 21 1,404 135 (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 infections 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. 27 The London Countv Council is the Authority responsible for the supervision of midwives and domiciliary midwifery in the Borough. HOME HELP IN MATERNITY CASES. Home Helps are employed by the Borough Council for service in the homes of necessitous women during confinement. A panel scheme is in operation under which selected women are placed upon a roster and their services utilised in rotation. This system is found to be very successful in its working. The following Table No. 23 shows, for the past two years, the number of applications received for Home Help service, the number of cases attended, the amount of assessment on cases attended and the nett expenditure by the Council for this service:- 28 TABLE No. 23. Year. No. of applications for services of Home Help, including extension over the usual period of 2 weeks. Total number of cases attended by the Home Helps. Amount of Assessment on cases attended. Nett Cost to Council. £ s. d. £ s. d. 1939 16 4 5. 7. 0 15. 13. 0 1940 2 1 15. 0 4. 10. 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.1. Arrangements have also been made with the Clinical Research Association for the bacteriological examination of samples of milk under the Milk (Special Designations) Order. Seven specimens were submitted during the year. In cases of suspected bacterial food poisoning, samples of the supposed peccant food, samples of blood, etc., from sufferers, and post-mortem materials from fatal cases are transmitted to the laboratory of the Ministry of Health for examination and report. The number of bacteriological, bacterioscopic and other examinations carried out during the year was 85. Of these, 59 were for the bacillus associated with Diphtheria. 13 for the bacillus associated with Tuberculosis, 2 for the bacillus associated with Enteric Fever and 2 investigations of milk on delivery. 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 £19. 2s. 10d The total number of bacteriological examinations during the preceding year was 278 Anti-toxin.—Diphtheria anti-toxin is available at the Town Hall daily during office hours. It may also be obtained at the premises of Messrs. Timmis and Richards, 432, King's Road, S.W., at any hour, day or night. It is supplied free of charge, both in prophylactic and in curative doses, to medical practitioners for use in connection with patients resident in Chelsea. The amount supplied during the year was nil. 29 The total cost to the Council for anti-toxin supplied during the year was nil. 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 DQGS. (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 Yes Royal National Orthopaedic Hospital Great Portland Street, W.1 Deformities and Malformations 170 Yes St. George's Hospital Hyde Park Corner, S.W.1 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.10 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 table are fully equipped for operative surgery on modern lines. Each of them .also provides special departments for X-ray investigation, dental, ophthalmic, massage and pathological work. MATERNITY AND NURSING HOMES. 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. 1539 1940 (1) Work of the Health Visitors. First visits to Infants under one year of age 319 279 Return „ „ „ „ „ 1,252 1110 First visits to Children between the ages of 1 and 5 years 245 184 Return visits to Children between the ages of 1 and 5 years 2,196 1770 Ante-natal visits to Expectant Mothers :— Primi-para cases 103 103 Multi-para „ 164 142 Return visits 590 440 Visits to Enteritis cases amongst children 1 - Return visits „ „ „ „ - - Visits to Ophthalmia Neonatorum cases 5 3 Return visits „ „ „ 5 7 Visits to Whooping Cough cases (under 5 years of age) 110 3 Return visits „ „ „ 103 - Visits to Measles cases (under 5 years of age) 11 21 Return visits „ „ „ - 3 Visits to Measles cases (over 5 years of age) 6 42 Return visits „ „ „ - 4 General additional visits 648 589 Total visits 5,758 4,700 Half-day attendances at Infant Welfare Centres Half-day attendances at Play Centre 624 135 487 (2) Infant Welfare Centres. Total number of attendances :— (a) By children under one year of age 3,673 2,391 (b) By children between the ages.of 1 and 5 years 2,917 1,535 (c) By Ante-Natal mothers 898 703 (d) By Post-Natal mothers 26 21 Total attendances 7,514 4,650 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, 193c. whereby milk is provided in necessitous cases, free or at less than cost price. From July the National Milk Scheme mas introduced by the Ministry of Food and provided, for fresh milk, to be available for mothers and children either free or at half price if the income scale, exceeded a certain standard. As this scheme ran on similar lines to the Councils own Maternity and Child Welfare. Scheme the administration. was transferred to the Food Control Department. The following table shows for the past two years, the extent of this service under the Borough Council Scheme :— TABLE No.27. Year. • Milk Orders issued and taken up. Approx. Cost. March quarter. June quarter. Sept. quarter. Dec. quarter. *Total. 1939 892 845 637 577 2951 £ 945 1940 678 700 176 1 1555 435 * These totals do not include orders subsequently cancelled or withdrawn, which average 80 or more during each year. It will be observed that in 193 9 there was a large decrease in the cost of milk. Cows' milk was supplied to 84 per cent. of the applicants, dried milk being supplied to the remaining 16 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 2559 gallons Cows Milk at reduced cost 1342 „ 3901 „ Dried Milk, free of cost 552 lbs. Dried Milk at reduced cost 253 ,, Total 805 „ 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. 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. , r * Under the Borough Council scheme. 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. 36 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 1940-1941. 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 four infant clinics were held weekly at Flood Walk. At Flood Walk one ante-natal clinic was held weekly. 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. Throughout the year the Nursery was functioning at an address in Suseex. The attendances at the Nursery during the past two years were as follows :— TABLE No.28. *1939  Total number of attendances during the year 7,386 12,822 Average daily attendance (5 days a week) 40 41 Total number of individual children who attended 101 (not available) The Nursery was closed for two weeks during the year owing to infectious disease. *The Nursery was evacuated on the 1st. Sept., 1939,and, figures shown, are up to that date. + Nursery in receiving area, throughout the year. 37 The health of the children has been satisfactory. (3) Chelsea Mothercraft Home.—Chelsea Manor Street, S.W.3. The Mothercrafi Home was closed throughout the year. 38 2(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, SAV.3. The Association provides, for children referred to it, treatment in Hospitals, Sanatoria and Nursing Homes, according to need; convalescence in the country or at the seaside; orthopaedic appliances and surgical boots; massage, remedial exercises, surgical dressings and medical comforts; help in training for suitable work: additional clothing, etc. Two members of the Public Health Committee of the Borough Council and the Medical Officer of Health are members of the local Committee of the Association. The Borough Council made a financial grant of £100 to the Association for the year commencing 1st April, 1940. TABLE No. 29. 1939 1940 Actual cases- children under 5 years of age 110 76 Children sent out of London, for convalescence 46 14 Children admitted to L .C.C Boarding-out Home under Tuberculosis Contast Scheme 2 - Sanatorium treatment arranged 2 2 Children supplied with surgical appliances 14 4 Children treated at I.C.A.A Orthopaedic Clinic 4 - Medical aid granted 30 21 Children maintained in permanent home - 1 Referred to L.C.C. special convalenscent Hospitals 10 - Extensions of convalescence & Sanatorium treatment 3 Referred to other agencies for help 1 - Referrred from hospitals for special reports &c. 4 6 Children granted outfits of clothing etc 20 34 Children evacuated cases followed up with reports 8 7 Applicant tons withdrawn-own arrangements made 8 5 Applications for Assistance, Total:— 149 97 39 (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 one case was sent to a Home free of charge. The period of convalescence granted is two weeks. TABLE No. 30. Year. No. of Applications. Nursing Mothers and Infants sent away under Council Scheme. Contributions by Mothers. Nett Cost to Borough. £ s d. £ s. d. 1939 24 9 1 15 6 23 5 4 1940 3 1 - 3 2 6 40 DENTAL TREATMENT. Children under Five Years of Age.— A 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. Sixty-six cases attended during 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 Society and the Chelsea Health Society, the Borough Council has formulated a scheme whereby dental treatment is provided for expectant and nursing mothers. During the year six mothers received dental treatment (including four cases for dentures), the Borough Council making a contribution of £18. Is. 6d. 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 1940-41. WIDOWS', ORPHANS' AND OLD AGE CONTRIBUTORY PENSIONS ACTS, 1925 AND 1929. The powers and duties under these Acts, in respect of deserted, abandoned or neglected children in the Borough, are undertaken by the Council, and a scheme for the administration of the Acts has been arranged. The Health Visitors investigate and exercise supervision over children under school age, while the Woman Sanitary Inspector carries out these duties in the case of older children, except where a Health Visitor is already in attendance on the family concerned. No case for enquiry under the Act occurred during the year. CHILD LIFE PROTECTION. The Borough Council is responsible for all duties under Part 13 of the Public Health (London) Act, 1936. The following table shows the number of Foster Mothers and Children resident in the Borough during the year and the number of visits in connection with this work. TABLE No.31. Child Life Protection Return. (Year 1938). Foster Mothers. Foster Children. Number on register at beginning of year 6 7 Removed from register 7 10 Added to register 3 6 Remaining on register 2 3 Medical attendance arranged - 2 Attended Maternity and Child Welfare Clinic - 4 Visits to foster mothers 49 Miscellaneous visits 23 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 five years of age to be carried out by the Health Visitors. Reports are furnished to the County Council as occasion arises, when the home conditions are found to be unsuitable for blind children or where it is considered necessary that the child should be admitted into a suitable institution. No case came to the knowledge of the department during the year. SUMMARY OF ARRANGEMENTS REGARDING MATERNITY AND CHILD WELFARE. The Borough Council's scheme for Maternity and Child Welfare includes the following activities :— (a.)The issue of pamphlets giving advice on various matters concerning the welfare of mothers and infants. (b.)The co-ordination of the work of the voluntary Maternity and Child Welfare agencies in the Borough. (c.)The home visitation of expectant and nursing mothers and infants by a staff of Health Visitors who work (a.) from the Town Hall, and (b.) from the Centres of the Chelsea Health Society. (d.)The subsidisation of the Chelsea Health Society's Maternity and Child Welfare Centres and Clinics for mothers, infants and young children. (e.)The subsidisation of the local branch of the Invalid Children's Aid Association. (f.)The subsidisation of the voluntary Day Nursery in the Borough. (g.)The subsidisation of the Chelsea District Nursing Association for the home nursing of expectant and nursing mothers and young children. (h.) The provision of Home Helps. (i.)The provision of midwifery attendance, free or at reduced rates, for necessitous Chelsea women. (j)The provision of Convalescent Home accommodation for nursing mothers and infants. (k.)The provision of dental treatment for expectant and nursing mothers. (l)The supply of milk, free or at reduced rates, to necessitous nursing and expectant mothers, infants, and young children. (m.) The provision of sterile maternity outfits at cost price. (n.) The administration of the Widows', Orphans' and Old Age Contributory Pensions Acts, 1925 and 1929, in respect of deserted, abandoned or neglected children. 42 SECTION III.—SANITARY CIRCUMSTANCES AND ADMINISTRATION. Complaints.—The number of complaints received during the year was 892, compared with 648 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. 193(5. 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 442, The number of statutory notices was 156. These compared with 273 and 97 in 1939. Summary of Work carried out by Sanitary Inspectors during the Year. Inspections. On complaint of nuisance 892, On notification of infectious disease (including non-notifiable diseases) 146 House to House - Re-inspection calls made 3309 Inspection of:— Bakehouses 76 Slaughterhouses - Milkshops 95 Ice Cream Premises 20 Overcrowding 48 Houses Let in Lodgings 3 Stables 9 Restaurant Kitchens 68 Marine Stores 7 Food Premises other than above 766 Premises under Meat Regulations 179 Factories and Workshops 133 Outworkers' Premises 18 Common Lodging Houses - Other visits 2139 Verminous Premises 235 Rat enquiries 141 Smoke observations 40 Total 8,344 43 Premises: Walls and Ceilings cleansed :— (a)Premises throughout - (b)Premises partially 193 (c)Verminous rooms cleansed 63 (d)Total number of rooms cleansed 300 Wash-house walls and ceilings cleansed 3 Walls and ceilings of water closets cleansed and repaired 67 Wash-house roofs repaired 1 Dirty tenants' rooms cleansed 5 Yard and area walls clcansed 4 Defective roofs repaired 73 Defective gutters repaired 39 Defective rain water pipes repaired 19 Dampness abated 113 Miscellaneous repairs 257 Wash-house floors repaired 2 Yard surfaces repaired, paved, etc 13 Ashpits demolished - New and proper dustbins provided 20 Workrooms provided with light and ventilation or light and ventilation improved 1 Drainage : Reconstructed 8 Repaired 8 Cleansed 1 Inspection chambers and traps provided 8 Fresh air inlets provided or repaired 17 New soil pipes provided 12 New ventilation pipes provided 10 • Soil and ventilation pipes repaired 1 Anti-syphonage pipes provided 1 Drains sealed off - Drains cleared (obstruction removed) 14 New covers provided to inspection chambers 11 Rainwater pipes disconnected and caused to discharge over properly trapped gullies 2 Sink wastes provided with traps 65 Sink waste pipes cleansed 8 New sink wastes provided 56 New sinks provided 40 New bath and lavatory basin wastes provided 13 Water Closets. Improvements in sanitary conveniences (factories, workshops, etc.) - New water closet pans provided 32 Water closet pans (foul) cleansed 8 Choked water closet pans unstppped and cleansed 13 Water waste preventers renewed 21 Water waste preventers repaired 18 Water closet roofs repaired 4 Ventilation and light provided or improved 1 W.C. floors repaired - Water supply. Water supply to premises reinstated 27 Water supply provided to upper storeys of tenement houses 10 New drinking water cisterns provided 2 Drinking water cisterns cleansed 10 Drinking water cisterns provided with new covers or covers repaired 8 Smoke Nuisance. Number of observations 40 Number of nuisances and complaints 17 Number of notices - Number of summonses - 44 Nuisances abated arising from :— Keeping animals in an improper manner or place 1 Defective manure cages - Accumulation of manure or refuse 17 Overcrowding 8 Rat nuisance 141 Underground rooms - Food Condemned and Destroyed 1556 Eggs, 172½lbs . Mutton and Lamb 53 Ihs. Beaf, 2049 lbs. Pork, 11O lbs. Kidneys, 74lbs. Bacon, 51 lbs. Ham(cooked),267 Rabbits, 367lbs. Fish 84 loaves, 400lbs. Flour 27lbs. Butter, 36lbs. Grams Disinfection. Rooms disinfected after infectious discases (Scarlet Fever, Diphtheria, etc.) 169 Rooms disinfected after Tuberculous disease 48 Rooms fumigated for verminous and filthy conditions 315 Miscellaneous disinfection 101 Certificates of disinfection given 5 School notices after disinfection 5 Notices sent to Public Library of Premises where infectious diseases have occurred 40 Proceedings taken. Intimation Notices served 442 Statutory Notices under Public Health (London) Act, 1936 155 Statutory Notices under Section 9 of Housing Act, - Statutory Notices under byelaws for provision of dustbins 8 Total number of samples purchased for analysis under the Food and Drugs (Adulteration) Act 210 Samples (informal) purchased 190 Legal proceedings instituted in respect of defective sanitary conditions and nuisances 21 Legal proceedings under Milk and Dairies (Amendment) Act, 1922 - Legal proceedings in respect of unsound food - Certificates issued in accordance with " Kent Restrictions Act " 5 Entries in Inhabitants' Complaint Book 892 Cleansing and Disinfection. Number of adults cleansed 17 Number of children cleansed 498 Number of persons treated for Scabies 58 Number of articles (bedding, ctc.) disinfected 11724* Number of articles (various) destroyed 3,397 Disinfection Station Shelter. Persons accommodated :— Adults - Children - Mortuary. Number of bodies received 1 Number of infectious bodies receivtd - Number of bodies removed to Public Mortuary on Sanitary grounds - Number of bodies detained in Mortuary Chapel Diunfection. Civil Defence, including Rehousing,Billets,Rooms disinfected 442 (Precautionary measure: Town Hall sprayed, twice daily by Disinfectors from beginning of year to May Subsequently, work carried out by Town Hall Staff). *Military 1,596; Public Health 4,843; Civil defence 1,574; Rehousing&c.3 TABLE NO.32. MAGISTERIAL PROCEEDINGS DURING THE YEAH. Situation of Premises. Nature of Nuisance or Complaint Pebby Sessions. Date of Heaving. Result. 120 Lots Road Failing to comply With. Statutory Notice re condition of promises. « Kensington 19.3.40 Order, 28 days. 120 Lots Road. Failing to comply with, Statutory Notice recondition of yard paving Kensington. 19.3.40\ Fined £l.0.0. 120 Lots Road. Failing to comply with Statutory Notice re provision of dust-bin Kensington. 19.3.40 Fined 10s.0d. 124 Lots Road. Failing to comply With. statutory Notice recondition of premises Kensington. 19.8.40 Order, 28 days. 124 Lots Road. Failing to comply with, Statutory Notice reprovision of dust-bin Kensington. 19.3.40 Fined 10s. Od. Situation of Premises. Nature of Nuisance or Complaint Petty Sessions. Date of Hearing. Result. 37 Edith. Grove Failing to comply with Statutory No tice recondition of premises. Kensington. 19.3.40. Works carried out. Summons withdrawn. 45 Lamont Road. Failing to comply with Statutory Notice recondition of premises. Kensington. 19.3.40. Order 28 days. 31 Cremoyrie Road. Failing to comply with Statutory Notice recondition of premises. Kensington. 21.5.40. Works carried out Summons withdrawn. Albert House, Tetcott Road. Failing comply with Statutory Notice recondition of premises. Kensington. 21.5.40. Works in progress. Summons withdrawn. 16 Gillray Square. Failing to comply with Statutory Notice recondition of premises. Kensington. 21.5.40. Order; 14 days. Situation of Premises Nature of Nuisance or Complaint Petty Sessions. Date of Hearing. Result. 120 Lots Road Failing to comply with Court Order requiring necessary works to be carried, out within 28days. Kensington. 2.5.40. Fined £6.10.0. 124 Lots Road Failing to comply with, Court Order requiring necessary works to be. carried, out withim, 28 days. Kensington. 21.5.40 Fined, 16.10.0. 41 Lamont Road Failing to comply with, Statutory Notice re condition, of premises Kensington. 18.6.40 Order; 14 days. 21Dartrey Road Carrying out Drainage work not in accordance with L.C.C (Drainage) byelaws. Kensington. 23.7.40 Fined £l.10.0. 7 Langton Street Failing to comply with Statutory Notice to abate overcrowding Kensington 23.7. 40 Nuisance abated Summons withdrawn. 46 Fernshaw Road Failing to ccmply with Statutory Notice recondition of premises, Kensington 25.7.40 Order; 14 days. 24 Lamont Road Failing to comply with statutory Notice recondition of premises. Kensington. 23. 7. 40 Order; 28 days. Situation of Premises. Nature of Nuisance or Complaint. pett's Sessions Date of Hearing. Result. 6 Upcerne Road. Failing to comply with Statutory Notice re condition of premises. Kensington 23. 7. 40. Order; 28 days. 30 Smith Street. » Failing to comply with Statutory Notice re condition of premises. Kensington. 23. 7 40. Order; 7 days. 31/3 Milman's Street Failing to comply with Statutory Notice re condition of premises. Kensington. 13 8. 40. Adjourned sine die. 23 Ashburnham Road. Failing to comply with Statutory Notice re condition of premises Kensington. 13 8. 40. Order; 14-da.ys. 45 TABLE No. 32. Magisterial Proceedings during the Year. Table attached. 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 40 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. Seven 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. 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, 193G, 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 pigeons were captured and humanely destroyed. 40 TABLE No. 33. Number of Premises. Number of inspections during 1940 Number of notices served during 1940 Number of prosecutions during 1940 On register at end of 1939 Added in 1940 Removed in 1940 On register at end of 1940 Premises used for Business Purposes :— Milk Premises 81 1 - 82 95 1 - Cowsheds - - - - - - - Ice Cream Premises 42' - 2 40 20 - - Butter and Margarine 10 - - 10 10 - - Manufacturers and Dealers:- Fried Fish Premises 14 - - 14 20 - - Fish Curers 5 - - 5 5 - - Bakehouses 26 - - 26 76 1 - Slaughterhouses - - - - - - Food Stalls 30 - - 30 under daily observation - - Offensive Trade Premises - - - - - - - 2. Premises used for Human Habitation :— Houses let in lodgings ? - - ? - - - Common Lodging Houses ... 1 - 1 - - - - Canal Boats - - - - - - - 47 Premises and Occupations Controlled by Byelaws and Regulations.—The preceding Table No. 33 summarises the number and character of premises and occupations in the borough which are controlled by byelaws and regulations. Underground rooms and underground sleeping rooms, although controlled, the former under the Public Health (London) Act, 1936, and the latter under the Housing Act, 1936, are 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." Eradication of bed bugs.— Two hundred and nine premises were found to be infested with bed bugs, 12 being owned by the Borough Council and 174 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. Prior to 1940. the furniture of each tenant removing to a Council flat was subjected to treatment in a specially constructed Cyanide Van before entry into the new flat. Cyanide fumigation was carried out by the Westminster City Council, under an agreement with the Borough Council. Owing to war conditions this treatment was suspended, throughout 1940. 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 50. The number of inspections of these premises was 133, which compares with 62 in 1933. Defects were found in 21 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). Premises (1) Number of Inspections. (2) Written Notices. (3) Occupiers prosecuted. (4) Factories (with mechanical power) 37 - - Workshops (without mechanical power) 68 - - Other Premises under the Act (including works of building and engineering construction but not including Outworkers' premises) 8 - - Total 133 - - *Also 35 in connection with Civil Defence. 48 2.—Defects found in Factories and Other Premises. Particulars. Number of Defects. Number of offences in respect to which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts :—* Want of cleanliness 1 1 - - Want of ventilation 1 1 - - Overcrowding - - - - Want of drainage of floors - - - - Other nuisances 18 18 - - Sanitary accommodation :— Insufficient - - - - Unsuitable or defective 1 1 - - 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 21 21 - - * Including those specified in Sections 2, 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 III. 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 1939 14 21 24 165 - 18 - - - - - - 1940 14 20 18 160 - 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 1940 1 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, fifty-three 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. NOTE: Action under the Housing Act was suspended throughout the year. 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) 1,038 (b) Number of inspections made for the purpose 4,347 (2) («) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1032 nil (ib) Number of inspections made for the purpose nil (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 2. Remedy of Defects during the Year without Service of Formal notices :— Number of defective dwelling houses tendered fit in consequence of informal action by the Local Authority or their officers 417 3. Action under Statutory Powers' during the Year :— («) 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 441 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 155 (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 - (2) Number of dwelling houses demolished in ance of Demolition Orders - (d) 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 fit 4. Housing Act, 1936.—Part IV.— Overcrowding. (a) (i) Number of dwellings overcrowded at end of year (ii) Number of families dwelling therein (iii) Number of persons dwelling therein (b) Number of new cases of overcrowding reported during the year (due to increase of children's age) (c) (i) Number of cases of overcrowding relieved during the year (ii) Number of persons concerned in such cases Suspended. No Figures available. (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. (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report. Although overcrowding conditions in Chelsea have been much less prevalent than in many other metropolitan boroughs, definite alleviation has taken place since the Housing Act of 1935 became operative. Sixtyone cases of overcrowding in houses owned by the Local Authority have been abated. None 52 HOUSING CONDITIONS IN THE BOROUGH. General Observations.— It is difficult to discuss the subject of housing in Chelsea without some understanding of the peculiar conditions which appertain to the district. Probably in few London boroughs have there been so many alterations, consequent on demolitions and reconstructions, during the past 40 years, as in Chelsea. The process of reconstruction is still in progress, though largely suspended by the operation of the Rent 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 operations of this nature, to make any provision for rehousing the working classes displaced. Despite the difficulties of the problem, in Chelsea a considerable amount of accommodation had been provided for the working classes during the years preceding the outbreak of War. This had been effected by municipal undertakings, by private enterprise and by the operation of benevolent agencies and trusts. Sufficiency of Supply of Houses.—Municipal undertakings for the housing of the working classes carried out by the Borough Council prior to 1914 are shown in Table No. 36:— 53 TABLE No. 36. Pre-War Housing. Properties Owned and Managed by the Chelsea Borough Council. Property. No. of Flats Population (approx.) Rents. Sir Thomas More Buildings, Beaufort Street 262 725 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 arc 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, declinc to consider the proposition, on the ground that the distance of the County Council's Estates from their work is too great. Others have become attached to the district and will not contemplate forsaking existing 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 cases of overcrowding during the year. Whenever possible, arrangements are made with the London County Council for the provision of a house for the overcrowded family. 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 farther 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 arc old, worn out and below the modern standards of sanitation and convenience. It is probable that only a minority of the tenants would be able to pay economic rents for alternative accommodation, having regard to the rents that require to be fixed for new dwellings, owing to the greatly increased cost of land and construction during recent years. Another problem is caused by certain old people, usually women. Many of these live alone in a single room with no one to look after them. Frequently they rely almost entirely on the Old Age Pension for sustenance. Gradually growing feebler with the passage of time, they eventually become unable properly to care for themselves or their homes. Although every means of persuasion is tried, these cases usually decline to enter a Poor Law Institution and the condition often persists for a lengthened period. Fortunately, this problem has now been met by legislation. Under the 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 1,038, the number found not to be in all respects reasonably fit for human habitation being 442.. The number rendered fit in consequence of informal action by the Sanitary Inspectors was 417 and the number in respect of which statutory notices were served requiring defects to be remedied wast 155. 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. Five applications under the Increase of Rent and Mortgage Interest (Restrictions) Act "were made by occupiers of dwelling houses that the houses occupied by them-were 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 suspended throughout the year. 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 the 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 or default of such person in relation to the quality, storage or distribution of milk. The premises at which registered purveyors of milk carry on their business have been subject to frequent inspection. During the year one application was made for registration as purveyors of milk, which, after appropriate investigation, was approved by the Council. In Table No. 33 (page 46) is shown the alterations which took place in the Register of Milk Purveyors during the year. During the year there were 95 inspections of dairies and milkshops made in the Borough. Notice was served requiring remedy of defects found on one of the premises visited. There are no cowsheds in the district. 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 28 applications from 12 retailers under the Milk (Special Designations) Order for licences to sell special grades of milk. All these licences were granted. In each case the licence was granted for the purpose of authorising the dealer to sell specially designated milk from shops within the Borough. No application has been made for a licence giving authority to set up bottling or pasteurising establishments in the Borough. TABLE. No. 39. Licences Granted under Milk (Special Designations) Order. 1940 To sell "Accredited" Milk - To sell " Tuberculin Tested " Milk 9 To sell " Pasteurised " Milk 15 Supplementary Licenccs 4 28 59 Further reference to milk is made in the Public Analyst's Report fur 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 than tuberculosis. - - - - - Tuberculosis only. Whole carcases condemned - - - - - Carcases of which some part or organ was condemned. - - - - - Percentage of the number inspected affected with tuberculosis - - - - - Slaughterhouses.— There is no slaughterhouse in the Borough Bakehouses.— There are 26 bakehouses in the Borough, and 76 inspections of these premises were made during the year. One notice was served for the cleansing of walls and ceilings. 60 Ice Cream Vendors.— At the end of the year, 40 premises were shown in the Register as places where ice-cream is prepared or sold. There were 2.0 inspections of these premises This trade is mainly regulated under the Public Health (London) Act, 1936. It is an offence to store ice-cream in a sleeping room or in any shed or room in which there is an inlet to a drain. Vendors of ice-cream must notify the occurrence of infectious disease among their employees or persons living on their premises. The Act also provides that every itinerant vendor shall exhibit on his barrow the name and address of the person from whom the ice-cream has been obtained. Fried Fish Vendors.—At the end of the year there were 14 premises in which the frying of fish was carried on and 20 inspections of these premises were made. It is found that a reasonable standard of cleanliness is now being maintained, but it is necessary for the Inspectors to maintain a constant vigilance to impress upon the vendors the necessity for the systematic observance of cleanliness. 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. During the year, During the year, unsound food was surrendered and destroyed, including 1,566 eggs; 172½ lbs. mutton and lamb; 53 lbs. beef; 2,049 lbs. Pork; 110 lbs. kidneys; 74lbs bacon 51 lbs. harm (cooked); 267 rabbits; 367 lbs. fish; 84 loaves; 400 lbs. flour, 27 lbs. butter; and 36 lbs. greens. * No carcases were destroyed on account of Tuberculosis. Food Poisoning.— No case of food poisoning occurred during the year. Food and Drugs Act, 1938.—Four hundred samples, including 95 samples of milk 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 Act Under their direction, the taking of samples is effected by individuals temporarily employed for the purpose, the services of persons outside the Borough being frequently utilised. The samples procured are of two kinds—formal and informal. Formal samples are those taken strictly in conformity with the Act. Informal samples are those taken without these strict formalities and afford useful indication of the conditions without disclosing to the vendor that the object of purchase is analysis. * Numerous visits were made by the Sanitary inspectors at premises damaged by enemy action with a view to the vage of foods at such premises. 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. Seven 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, of 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 SECTION VI— INFECTIOUS DISEASES. (a) Infectious Diseases Generally. DISEASES COMPULSORILY NOTIFIABLE IN THE BOROUGH. Acute Poliomyelitis. Diphtheria. Acute Polio-encephalitis. Membranous Croup. Acute Encephalitis Lethargica. Dysentery. Acute Primary Pneumonia. Erysipelas. Acute Influenzal Pneumonia. Malaria. Cerebro-spinal Fever. Puerperal Fever and Puerperal 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. NOTIFICATIONS DURING THE YEAR. The total number of notifications, excluding duplicates, was 343. Of this figure, 49 were notifications of Pulmonary Tuberculosis and 5 of Non-pulmonary Tuberculosis. As compared with the previous year, there was a decrease of 50 in the number of notifications of Diphtheria. The number of notifications of Scarlet Fever (13) represents a decrease ol36, as compared with that for 1933. The number of notifications of Tuberculosis was 54, a decrease of 26 as compared with that for 1939 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 TABLENo. 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. Cheyne. Church. Hans Town. Royal Hospital. Small-pox - - — - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - Diphtheria 15 - 1 5 1 - 3 - 4 - - - 11 - 2 - 2 15 Erysipelas 9 - - - - - - - - 1 4 2 5 1 2 1 5 Scarlet Fever 13 1 1 - 1 - 3 1 - 5 1 - - 6 2 - 2 1 12 Typhus Fever - - - - - - - - - - - - - - - - - - Enteric Fever 1 - - - - - - - 1 - - - - - - - 1 - Puerperal Fever 2 - - - - - - - 2 - - - l - - 1 - 2 Puerperal pyrexia 6 - - - - - - - 6 - - - 4 1 - 1 - 3 Cerebro-spinal Fever 7 - - - - - - 2 3 1 - - 1 - 2 2 - 6 Ophthalmia Neonatorum 3 3 - - - - - - - - - - 2 - 1 - - - Poliomyelitis - - - - - - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - - - - - - Polio-encephalitis - - - - - - - - - - - - - - - - - - Malaria - - - - - - - - - - - - - - - - - - Dysentery 6 - - 1 - 1 - - - 1 2 1 2 - 4 - - 6 Acute Primary Pneumonia 59 8 6 1 2 2 - 1 - 7 9 12 11 24 9 19 2 5 53 Acute Influenzal Pneumonia 9 1 - - - - - - - 3 4 1 3 3 2 1 - 8 Food Poisoning 5 - - - - - - - 2 - 2 1 - - 7 3 - 1 Measles 150 9 to 28 21 9 22 4 9 23 4 1 - 110 11 12 9 8 108 Whooping Cough 4 1 1 1 - - - - - - - 1 - 2 - 2 - - i Total 289 23 30 31 30 12 26 9 12 53 20 27 16 171 27 SO 22 19 221 Tuberculosis :— Pulmonary 49 - - - 1 1 1 - 6 2.1 6 8 4 25 5 11 5 3 Non-Pulmonary 5 - - — - - - - 1 2 1 - 1 4 - 1 - - Totals (Tuberculosis) 54 - - 1 1 1 - 7 24 7 8 5 29 5 13 5 3 Totals 343 23 30 31 31 13 27 9 19 77 27 35 21 200 32. 62 27 22 Note - notifications have not been corrected, for any subsequent revision of diagnosis. 64 Poliomyelitis No cases of Small-pox, Cholera, Typhus Fever,Encephalitis Lethargica, Polio-Encephalitis, Malaria, Continued Fever, Relapsing Fever, Plague, Anthrax, Glanders or Hydrophobia were notified during the year. DIPHTHERIA. Notifications.— During the year 15 cases of diphtheria were notified as compared with 65 in the previous year. Information was received from the London County Council that 5 of the cases sent to Hospital proved not to be suffering from Diphtheria. The actual number of cases was therefore 10 . Deaths.- No deaths from the disease occurred during the year, 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. 1919 60 100 3 5.0 51 Feb. 236 24 10.0 2..12. 90.0 1940 10 100 0 0.0 53 Jans, 59 - 0.0 59 100.0 It will be observed that there was a decrease in the number of cases notified in 1940. The percentage of removals to the L.C.C. Hospitals was high, and the case mortality rate was lower than that for 1939 DIPHTHERIA IMMUNISATION CLINIC. In April, 1934, the Borough Council approved an annual grant of £50 for immunisation against diphtheria and Schick testing to be carried out at the Violet Melchett Infant Welfare Centre for children under 5 years of age on the register of the Centre. Early in 1935, the Borough Council arranged to extend these facilities to children of school age, the Borough Council contributing towards the cost of this service. A weekly clinic has been held during the year. In co-operation with the London County Council, leaflets have been prepared and distributed at the various schools in the Borough. Attendances of elementary school children for immunisation against diphtheria at the clinic are allowed to count as attendances at school. 65 The following table gives details of the work of the clinic during the past two years. TABLE 41A. Year No. of newcases. Preliminary Schick Tested. Commenced treatment without Schick Test. Naturally Immune Immunised. Discontinued treatment and removed from register. No. under treatment at end of year. Preschool Age. School Age. Preschool Age. School Age. 1939 241 3 36 202 16 164 22 10 125 1940 191 4 22 165 12 160 19 3 118 Diphtheria Anti-toxin.— Anti-toxin is supplied, in prophylactic and in curative doses, free of charge to any medical practitioner requiring it for Chelsea patients. An anti-toxin syringe, needles and steriliser are also available. Further details will-be found on page 28. SCARLET FEVER. Notifications.— During the year, 13 cases of Scarlet Fever were notified, the figure for 1939 being 49 Information was received from the L.C.C. Hospitals that all of the cases proved to be Scarlet Fever. The actual number of cases was therefore 13. No " 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. 1939 48 88 - - 57 FEB 1940 13 92. - - 31 jan No application of the Dick test or of artificial immunization against Scarlet Fever has yet been made in the Borough. MEASLES AND WHOOPING COUGH. 66 Information as to cases occurring in the Borough was derived by notification., and from the School Authorities., 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 unndtified cases coming 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 5 years Under 5 years Over S years Total Under 5 years Over 5 years Total[/### 1939 6 - 5 11 22 - 11 6 17 - - - 1940 - 6 87 63 156 - 24 46 70 2 10 12 WHOOPING COUGH. The incidence of the disease during the past two years is shown in Table No. 44 :— TABLE No. 44. Year. cases coming 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. 1939 36 74 110 - 213 137 1940 - 4 4 - 3 - Removal to Hospital.— Cases of Measles and Whooping Cough are received in the hospitals of the London County Council. 67 ENTERIC FEVER. Notifications.— During the year one case under the Enteric Fever Group notified in Chelsea, and treated at home The history of the case was thoroughly explored. Two specimens of blood were examined during the year for the Widal reaction. Deaths.— There was no death from this disease during the year. PNEUMONIA, MALARIA AND DYSENTERY. These diseases are compulsorily notifiable under the Public Health (Infectious Diseases) Regulations, 1927. The following table shows the number of notified cases during the past two years:— TABLE No. 45. Year PNEUMONIA. MALARIA. DYSENTERY. Total Number of Cases Notified. Treatment in Hospital. Total Number of Cases Notified. Treatment in Hospital. Total Number of Cases Notified. Treatment in Hospital 1939 47 39 1 1 4 4 1940 59 53 - - 6 6 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 visits were made during the year. Deaths.— There were 45 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. No case of Malaria was notified during the year. Dysentery.— The six 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 six 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 2 0 0 - Puerperal Pyrexia 6 3 2 1 1 The notifications of puerperal fever and puerperal pyrexia during the past two years were as follows:— Puerperal Fever. Puerperal Pyrexia 1939 2 10 1940 2 6 With the sanction of the Ministry of Health the Borough Council has made arrangements for the services of a skilled obstetric consultant in puerperal cases and in cases of difficult labour, when desired by the medical practitioner in attendance. One 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. Three 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. 3 3 - 3 - - - - cases of the disease wer£ 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. Eighty-two visits were made during the year. In addition to notified cases of Ophthalmia Neonatorum, three cases of inflammation of the eyes were reported by the Medical Officer of Health of the London County Council. These cases were visited by the Health Visitors and action taken where necessary. POLIOMYELITIS AND POLIO-ENCEPHALITIS. or polio -encephalitis, No cases of Poliomyelitis were notified during the year. ENCEPHALITIS LETHARGICA. No case of Encephalitis Lethargica was notified during the year, four visits to old cases of Encephalitis Lethargica were made by the Woman Sanitary Inspector. Encephalitis Lethargica is undoubtedly infectious, but the infectivity is of very low nature. The 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 were two deaths _ from this disease during the year. CEREBRO-SPINAL FEVER. Seuen cases (incbuding two military cases) of cerebro -spinal fever were notifed during the. year. Six castswere treated in hospitaL. Deaths.— there was one death. (a femals,aqed 50 years) from, this disease during the year. 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 1939 The figures for the year 1940 are not yet available. 70 TABLE No. 48. Vaccinations. f Number Percentage of births regisbered Births registered in 1939 310 100 Successfully vaccinated 176 56.8 Insusceptible of vaccination 2 0.6 Had Small Pox - - Statutory Declaration of conscientious objection 55 17.7 Died unvaccinated 7 2.3 Postponed by medical certificate - - Removed to other districts 31 10.0 Removed to unknown addresses 37 12.0 Not accounted for in previous columns 2 0.6 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 1940 was 213. 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 Disin- • fecting Station. Disinfection in connection with the notifiable infectious diseases is carried out free of charge. Applications tor special disinfection, not associated with the notifiable infectious diseases, are considered, and, if the work of the Department permits it, are carried out at the expense of the applicant. Fourteen such •disinfections were carried out during the year, the total charges amounting to £34, 13s. 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 86 occasions. The following Table No. 49 shows the number of attendances in each quarter:— TABLE No. 49. Quarter. Minor Ailments Attendances. Verminous. Impetigo. March 9 110 - June — 234 - September 88 107 - December — 47 - 91 498 - The amount recoverable from the London County Council, as the School Authority, for the cleansing for the year is £ 54. 7s. Seventy-fivr adults (induding 17military eases) were cleansed at the Station. (b) TUBERCULOSIS. This part of the report deals with the work of the Department under the Public Health (Tuberculosis) Regulations, 1930, and under the Dispensary scheme approved by the Ministry of Health and the London County Council. The latter contribute 25 per cent, of the nett expenditure of that scheme. Staff.—The staff of the Dispensary is set out on pages 5-6. Notifications.—The total number of notifications received was 57 but 3 of these related to cases which had been previously notified, so that the total number of new notifications was 6ft. In the previous year, the corresponding number was 80 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 36 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 1938. New Cases. Deaths. Age Periods. Respiratory. Nonrespiratory. Respiratory. Nonrespiratory. M. F. M. F. M. F. M. F. 0—1 - - - - - - - - 1- 5 2 1 - - 1 - - - 5—10 1 - - - - - - - 10—15 1 1 - - - - - 1 15—20 4 3 1 - - 2 1 - 20—25 6 9 1 - - 3 2 - 25—35 11 7 - 2 4 - - - 35—45 8 7 1 - 4 6 - - 45—55 4 1 - - 2 1 1 - 65—65 It 1 6 1 - 65 and upwards 6 - — 1 6 1 - 1 Totals 54 30 3 3 23 14 4 2 The death rate from all forms of Tuberculosis in Chelsea was 1-1 per 1,000. Of the total number of deaths (43) from all forms of Tuberculosis, 15 died non-notified or to notification* The ratio of nonnotified tuberculosis deaths to total tuberculosis deaths was therefore as 1 is to 3. The corresponding ratio for 1939 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 whichshave 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 *Of the 16 non-robified deaths, 8 occurred in Hospitals (no fixed home address), 1 in hospital (patient from Switzerland), and 3 posthumous notifuations — after P.M. in Hospitals. 73 (f.) The number of cases remaining on the Register at the end of the Quarter. The returns made in accordanae 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 105 72 177 Non-pulmonary 20 15 35 12.5 87 212. (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 106 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 cases dealt with at the Chelsea Tuberculosis Dispensary, Brompton Hospital, and (b.) Special Cases which were accepted for institutional treatment by the London County Council, but which were not dealt with by the Chelsea Tuberculosis Dispensary. Prior to 1929 this Table comprised cases dealt with at the Chelsea Tuberculosis Dispensary only. 74 TABLE No. 52. Treatment of Tuberculosis, Year 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 21 13 1 - 1| 1 - - 22 14 1 - 161 (6) Diagnosis not completed - - - - - - - - - - 1 - (c) Non-tuberculous - - - - - - - - 38 56 18 11 B.—Contacts examined during the year:— (a) Definitely tuberculous - - 1 - - - - - - - 1 - 83 (6) Diagnosis not completed - - - - - - - - - - - - (c) Non-tuberculous — — — - - — — — 12 35 18 17 C.—Cases written off the Dispensary Register as:— (a) Recovered 8 1 1 - 1 1 - - 3 2 1 - 215 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 58 92 36 28 D.—Number of Cases on Dispensary Register on December 31st:- (a) Definitely tuberculous 83 64 10 1 7 10 3 2 90 74 13 9 l81 (6) Diagnosis not completed - - 1 - - - - - - - - - 1. Number of cases on Dispensary Register on January 1st 214 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 32 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 63 4. Cases written off during the year as Dead (all causes) 31 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 2 6. Number of attendances at the Dispensary (including Contacts) 1,046 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 18 7. Number of consultations with medical practitioners:— (а) Personal (б) Other 51 10. Number of:— (а) Specimens of sputum, etc., examined (б) X-ray examinations made in connection with Dispensary work 84 303 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 2,124 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above 1 12. Number of " T.B. plus " cases on Dispensary Register on December 31st 94 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. 77 Chelsea Tuberculosis Dispensary.—This Dispensary, located at Brompton Hospital, provides highly efficient treatment for all cases resident in the Borough. By agreement with the Borough Council, adequate Medical, Nursing and other necessary services are provided. The Tuberculosis Officer's 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, 1940. 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. 1930 208 10 percent. 1,563 1940 140 12 ,, ,, 1,046 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, 47 per cent, died in St. Luke's Hospital and 39 per cent, in other public institutions, that is to say 86 per cent, died away from their homes, the corresponding figure for 1939 being 90 per cent. Co-operation with Hospitals and Invalid Children's Aid Association.—Existing arrangements with general and special hospitals in the neighbourhood continue to give satisfaction. Cases under treatment at St. Luke's Hospital are visited by the Tuberculosis Visitor. Arrangements are made with Brompton Hospital for the X-ray examination of difficult cases, and for the provision of artificial pneumothorax refills. Many patients, both adults and children, who attend the Dispensary for examination, either as contacts or on their own initiative, are found to be suffering from conditions other than 78 Tuberculosis, which require treatment. These cases are advised as to obtaining such treatment, either from private practitioners or at general hospitals. Many children are found to be suffering from anaemia, malnutrition and similar diseases and are referred to the Chelsea branch of the Invalid Children's Aid Association with a view to provision of convalescent home treatment. Co-operation with the School Medical Service.—The relationship with the School Medical Service continues to be satisfactory. The School Medical Authorities frequently afford valuable help in deciding what supervision is desirable in connection with children. Many children are referred direct to the School Clinic for the treatment of minor ailments and dental caries. Co-operation with Medical Practitioners.—During the year the Tuberculosis Officer visited 18 cases (including personal consultations) at the homes of the patients, and 51 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 83 a decrease of 67, compared with the previous year. Special arrangements are made for following up patients in cases where the diagnosis is doubtful. Such cases are again examined at intervals, and, when necessary, X-ray or other special investigation is made. The Social Worker at the Dispensary maintains regular observation in connection with these patients. Artificial Pneumo-thorax Treatment.—On the recommendation of the Tuberculosis Officer, patients are supplied with refills in connection with artificial pneumo-thorax treatment. During the year twenty-eight patients received treatment. The total cost(£242. 8s) was borne by the Borough Council. Home Nursing.—The Dispensary organization includes home nursing, which is much appreciated by such patients as are confined to bed. The Dispensary Nurse also visits the home for observation purposes. During the year, the number of visits paid by Nurses to the homes of patients was 2,124 a de crease of 748 over the number for the previous year. The Council lent a bedstead and bedding to one case during the year. Extra Nourishment.-Twenty-five cases of Tuberculosis were certified by the Tuberculosis Officer during the year to require extra nourishment as part of their treatment. These cases were supplied with foods such as milk, eggs and butter. The total cost of extra nourishment (£58.14s.5d.) was borne by the Borough Council. Non-Tuberculous Cases.—All cases examined at the Dispensary in which special treatment is indicated, other than for Tuberculosis, are assisted in obtaining such treatment at an appropriate hospital. Others are sent to country or seaside convalescent homes through the agency of the Invalid Children's Aid Association or other organisation. 79 Special Examinations.- Three hundred and three X-ray examinations 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 been made with the British Dental Hospital, 235, Hammersmith Road, W., for the provision of adequate dental treatment, including dentures, if necessary, for patients attending the Chelsea Tuberculosis Dispensary. In each case the certificate of the Tuberculosis Officer is required and dental treatment must be shown as necessary to render other treatment more completely efficacious. During the year 4 patients received dental treatment (including two cases for dentures), the Borough Council making a contribution of £8. 17s. 6d. towards the cost. Bacteriological Examinations.—During the year, 84 specimens of sputum were examined in connection with the work of the Dispensary. In addition, 13 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 (Sanitary 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 6 Cases considered 127 Cases reported admitted to L.C.C. Institutions 81 Dental treatment given through Borough Council Scheme 4 Extra nourishment given through Borough Council Scheme 25 Extra nourishment given through other agencies 16 Other assistance given 67 Children boarded out through the L.C.C. Contact Scheme - Convalescence arranged 2 Patients' voluntary contributions towards the cost of Institutional treatment collected on behalf of the L.C.C. £23. 5s. Metropolitan Borough of Chelsea. Annual Report OF THE PUBLIC ANALYST For the Year ended 31st December, 1938. BY THOMAS McLACLAN, A.C.G.F.C., F.I.C. 82 TO THE MAYOR, ALDERMEN & COUNCILLORS OF The Metropolitan Borough of Chelsea. Madam Mayor, Ladies and Gentlemen, During the year 1940, 400 samples were submitted for analysis by the Sampling Officers appointed under the Food and Drugs Act, 1938, Of these, 101 were samples of milk or milk products, 14 of spirits, 258 of other foods, and 27 of Drugs. The accompanying table shows the wide range of foods and drugs covered. The total percentage of samples returned as adulterated is exactly twice that reported against in the year 1939 and is attributable almost entirely to the various changes connected with the rationing of butter and attempts to mix it with margarine or to substitute margarine entirely, in restaurants or eating houses. Eleven samples of bread and butter out of twenty samples taken were adulterated. Three samples of mint sauce, stated to have been prepared with' malt vinegar, contained not more than 30 per cent of malt vinegar and about 70 per cent of spirit or artificial vinegar. Four samples of milk were adulterated, two containing added water and two having had a portion of the cream abstracted. Since it has been made illegal to sell cream there is less inducement* for the abstraction of cream, and the practice has almost entirely disappeared. All other samples were found to be satisfactory and this indicates that, on the whole, there has been no widespread tendency for foods sold in the Borough to be of lower quality than those sold in peacetime. This is a different state of affairs from that which existed in the last war and it indicates that the present method of Food Control has certainly been effective in this respect. Occasionally it has been necessary to introduce fresh standards, as with sausages, but here it has almost invariably been found that manufacturors have complied with the standards laid down as a result of the war. I have the honour to be, Madam Mayor, Ladies and Gentlemen, Your obedient Servant, THOMAS McLACHLAN. Article Taken Formally. Adulterated- Taken Informally. Adulterated. Total Samples Analysed Total Samples Adulterated. Milk 91 3 4 1 9S 4 "condensed 0 0 2 0 2 0 n maA/ted 0 0 4 0 4 0 Ba.com 0 c £ z 0 taking lewder 8 0 0 0 3 0 Stscmts 1 0 3 0 4 o Bread, and Butter 6 3 14 8 20 11 Butter 2 0 3 0 5 0 cakes & Pudding 1 0 2 0 3 o C&P Mixbure 7 0 2 0 9 0 Cereal Toed 2 0 6 0 8 0 Cereals 10 0 3 0 13 0 Cheese 1 0 2 0 3 0 Cocoa. 1 0 5 0 6 0 Coffee 1 0 2 0 3 0 Caffes and chicery 2 0 0 0 2 0 Coffes Extract 0 0 7 0 7 0 Confectionery 2 0 2 0 4 0 Cooking fat 0 0 2 0 2 0 Oream/(artifoial) 0 0 1 0 1 0 Fteh 'Paste 1 0 1 0 0 0 Fish (Pressrved) 8 0 10 0 13 0 FLour 2 0 4 0 6 0 Fruit (dried) 4 o o Q 4 Q "(presrved) 0 0 1 o 1 0 Fruit Juise 4 0 2 0 6 0 fruit (trvrmed) 2 o 12 o 14- 0 Grary & soup powder 5 V 0 2 o 1 0 Honey Jem Narmalods 2 0 14 0 16 o Jelly & Jally Crystals 6 0 1 0 7 o Lord 1 0 0 o 1 o Margarine 3 0 2 0 6 o Meat (Preserved) 0 0 2 0 2 0 " (tinned.) 2 0 6 0 2 0 Ous, salad 0 0 1 0 1 0 Plektes Sauces 4 1 8 2 12 3 peanut Butter 0 0 1 0 1 0 84 Arttol* Taken Formall*. Adulterated Taken Informally. Multer»ttd Total Sample Analysed Total S»ir.jies /4ulterahiri Sausages 0 0 2JL 0 22 o SemcliyuL 0 0 1 o 1 Salt 0 0 4 c 4 U 0 BpiCMS n 0 4 c IZ c su/tb, sh/ndd&cL 3 0 0 c 3 0 Tea. 0 0 4- 0 4- c Vegetables, dried, 1 0 / o i. /I " tVrvned Z 0 6 0 8 u c Vinegar 3 0 1 0 4- 0 SPIRITS etc. Beer S 0 0 0 £ c Bra/ndy 3 c 0 o 3 o flt-n, S 0 0 0 8 o ffhiskey i 0 0 0 3 c DRUBS. Aipi/n/n, 1 0 0 o 1 o oj Soda. 0 0 2. 0 i 9, o Borax 0 0 2 0 ** % o Beric Acid 0 0 Z 0 x 0 Castor OH 0 0 a o I Q Chtecleuki laptative 0 0 n 1 A Ztsom, SaXts 0 0 i 1/ c 4 w A nriart Balsam 0 ' 0 z 0 I w o 9lye.Lemon fefoeeao. 0 0 1 0 / o Health Salt 3 0 f A A A Liver PH2s 1 0 0 V 0 T" i u 0 * tVnetnrt of Iodine 1 0 0 0 i o SeitUitz Po&dtr 0 0 z 0 I 0 Suiphu/r Thbltts o o o /) 0 Syrup of Figj 1 ' 0 m 0 w 0 f o 0 Th.-rt4.rie Acid. o 0 z 0 z 0 TOTALS 210 7 190 11 400 IS Percentages of total 6Z-S 173 47s 2'7* 100 4-5 CfC (44. METROPOLITAN BOROUGH OF CHELSEA. ANNUAL (ABRIDGED) REPORT of the MEDICAL OFFICER OF HEALTH, V7.II. LESLIE MCCARTHY, D.S.O., M.C., M.D., M.R.C.P., D»P.H., Barrister-at-law. for the year 1940 To the Mayor, Aldermen & Councillors P.H.3. of the Metropolitan Borough of Chelsea. Madam Mayor, Ladies & Gentlemen, I have the honour to submit my Annual Report on the health and sanitary conditions of the Borough for 1940. In accordance with instructions from the Ministry of Health, the report has been prepared in an abridged form. Complete records of each year's work are, however, being retained so that a comprehensive report covering the war period may in due course be available. The Registrar-General's estimate of the resident population is 38,700, as against 55,400 in 1939. This marked decrease arises mainly from conditions of war. The death rate of 22.0 per 1,000 of estimated civilian population - as compared with 14.6 in 1939 - is due to deaths from enemy action. The health of the population has been good. The incidence of infectious disease is low, although the risk of such outbreaks was serious owing to abnormal conditions associated with airraid shelters. Every effort has? however, been made for the prevention of disease, including infestation by vermin. The number of cases of tuberculosis in the Borough was lower than last year. Sanitary administration of the Borough was satisfactorily maintained throughout the year, despite the many extra duties thrown upon the Department as a result of sustained enemy action. These duties included inspections by the Sanitary Inspectors of f irst-aid repairs to property, salvaged household effects, billets for homeless persons and problems arising out of removal and storage of foodstuffs from bombed premises. Normal house-to-house inspection is necessarily in abeyance for the duration of hostilities, but all complaints were investigated and the necessary action taken. As in former years, close attention was devoted to the supervision of food supplies. The Chelsea Health Society continues to render valuable assistance in connection with Maternity and Child Welfare work, also in co-operating with the responsible authorities in dealing with the evacuation of expectant and nursing mothers and young children. In addition, the Health Visitors undertake the issue and fitting of respirators to babies and toddlers. I should like to thank the members of the Council for the support and sympathetic consideration which have been extended to me and for their attention to the problems which it has been my duty to lay before them. To the staff of the Public Health Department I have also to express my appreciation of their devotion to duty in maintaining the service of the department at a high standard. I am, Madam Mayor, Ladies and Gentlemen, Your obedient Servant, w.h.l. McCarthy, Medical Officer of Health. 16th September, 1941. P . T. 0. - 1 - METROPOLITAN BOROUGH OF CHELSEA. ANNUAL (ABRIDGED) REPORT OF THE MEDICAL OFFICER OF HEALTH. for the year 1940. POPULATION. Registrar-General's estimate of 38,700 Total. M. F. LIVE BIRTHS. Legitimate 389 186 203 Birth rate per 1,000 11.0 Illegitimate , 39 16 23 estimated civilian 428 202 226 population STILL BIRTHS. 10 5 5 Rate per 1,000 Total (live and still births) DEATHS. 851 402 449 Death Rate per 1,000 estimated civilian DEATHS FROM PUERPERAL CAUSES Deaths. Rate per 1,000 total (live and still) births. Puerperal Sepsis 2 5.2 Other puerperal causes 1 2.6 3 7.8 DEATH RATE OF INFANTS UNDER ONE YEAR OF AGE;- All infants per 1,000 live births 40 Legitimate infants per 1,000 legitimate live births 41 Illegitimate infants per 1,000 illegitimate live births 26 NOTIFICATION OF BIRTHS. The total number of notified Chelsea births, including stillbirths, from all sources was 318. Of this number, 95 were notified by midwives. CLASSIFICATION OF DEATHS. The causes of deaths (851) were as follows:- Typhoid and Paratyphoid Fevers o, Cerebro-spinal fever 1, Scarlet fever 0, Whooping Cough o, Diphtheria 0, Tuberculosis of respiratory system 37, other forms of Tuberculosis 6, Syphilitic Diseases 5? Influenza 12, Measles 0, Ac. Poliomyelitis and Ac. PolioEncephalitis 0, Ac. Inf. Encephalitis 2, Cancer of Buc. Cav. and Oesoph. (M) Uterus (F) 15, Cancer Stomach and Duodenum 19, Cancer of Breast 10, Cancer of all other sites 62, Diabetes 5, Intracranial Vascular Lesions 42, Heart disease 204, other dis. circ. system 26, Bronchitis 31, Pneumonia 45, other respiratory diseases 8, Ulcer of Stomach or Duodenum 11, Diarrhoea under 2 years 1, Appendicitis 3, other digestive diseases 9, Nephritis 7, Puerperal and post-abortive sepsis 2, other maternal causes 1, Premature birth 3, Con. mal. birth, Injury, Infant diseases 4, Suicide 13, Road traffic, Accidents 11, other violent causes 209, all other causes 47. INFANT MORTALITY. There were 15 deaths of infants under one year of age. The causes of death were as follows:- Influenza 1, Bronchitis 1, Pneumonia 3, Diarrhoea 1, Premature births 3? Congenital Malformations etc. 4, and other violent causes 2. - 2 - provision of he:lth services in the borough. B ACT5RIOLOGICAL EXAMINATIONS . The total number of bacteriological examinations carried out was 85. Included in this number were 59 for the bacillus associated with Diphtheria and 13 for tuberculosis. NURSING IN THE HOME. The arrangements with the Chelsea District Nursing Association to undertake the nursing of cases of illness occurring in expectant and nursing mothers and the nursing of children under 5 years of age suffering from any illness was continued throughout the year, the total number of visits being 1404 (135 cases). CLINICS AND TREATMENT CENTRES. The Violet Melchett Infant Welfare Centre maintains the maternity and child welfare services in the Borough. Four infant clinics and one ante-natal clinic were held weekly throughout the year. The total number of attendances at the clinics by infants under one year of age was 2391, ancL 1535 children attended between the ages of 1 and 5 years. There were 703 attendances by mothers at the ante-natal clinic and 21 mothers attended the post-natal clinic. The Chelsea Day Nursery functioned at an address in Sussex throughout the year, the average number of children being 41. The Chelsea Mothercraft Home was closed throughout the year. INVALID CHILDREN'S AID ASSOCIATION. The arrangement with the Association was continued during the year. The number of applications referred to them for assistance of children under 5 years of age was 97 (actual cases 76), HEALTH VISITORS. The total number of visits made by the Health Visitors was 4700. The number of half-day attendances at Clinics was 487. CHILD LIFE PROTECTION. 72 visits (including 23 miscellaneous visits) were made to foster mothers. DENTAL TREATMENT. 66 cases attended the Dental Clinic at the Violet Melchett Infant Welfare Centre for the provision of preventive denta.l treatment for children under 5 years of age. Arrangements were also made for 6 expectant or nursing mothers to receive dental treatment, the Borough Council making a contribution of £18. 1. 6. towards the cost. HOME NET .PS. One case was attended by a Home Help - the nett co st to the Council being £4. 10). 0. SUPPLY OF MILK TO MOTHERS AND YOUNG CHILDREN. The total quantity of milk supplied was as follows:- Cows'milk (free of cost) 2559 gallons5 at reduced cost - 1342 gallons. Dried mi 11c (free of cost) 552 lbs; at reduced cost - 253 lbs. The approximate cost to the Borough Council was £435. CONVALESCENCE. One nursing mother and infant were sent away to a home free of charge. The nett cost to the Borough Council was £3. 2. 6. P.T.O. - 3 - SANITARY CIRCUMSTANCES & ADMINISTRATION. During the year 8,344 inspections (including rc-inspections) were carried out by the Sanitary Inspectors. Included in this total number were 892 inspections on complaint of nuisance and 146 with reference to infectious disease. Legal proceedings under the Public Health (London) Act, 1936, in respect of sanitary conditions were undertaken in 21 instances. The number of inspections of Factories, Workshops and Workplaces was 133. Defects were found end remedied in 21 instances. 442 Intimation notices, 155 Statutory notices under the Public Health (London) Act, 1936, and 8 Statutory notices under byelaws for provision of dustbins were served during the year. DISINFECTION. During the year 217 rooms were disinfected after cases of infectious or other disease. Of these, 48 were rooms which had been occupied by tuberculous persons. In addition, 315 rooms were disinfected for the presence of vermin and 101 rooms for miscellaneous disinfection. At the Disinfecting Station, 11,724 articles of bedding, etc., were disinfected and 3)397 articles destroyed in the incinerator, 442 rooms in connection with Civil Defence were also disinfected. As a precautionary measure the Town Hall was sprayed throughout the year. CLFANSING STATION. The number of adults cleansec cr treated for scabies was 75 (including 17 military cases). Under the scheme arranged with the London County Council, 498 children attending elementary schools, were cleansed at the Station. In addition, facilities were ma.de ave.ilable for the use of the station by theLondon County Council for the treatment of 91 children suffering from minor ailments. HOUSING. The total number of dwelling houses inspected for housing defects was 1,038, the number found not to be in a.ll respects reasonably fit for human habitation being 442. The number rendered fit in consequence of informal action by the Sanitary Inspectors was 417, and the number in respect of which statutory notices were served requiring defects to be remedied was 155• - 4 - INSPECTION AND SUPERVISION OF FOOD. MILK. The number of milk premises on the Register is 82, and 95 inspections were made. Notice was served on one of these requiring rectification of defects. MILK (SPECIAL DESIGNATIONS) ORDER. Nine licences to sell "Tuberculin Tested" milk, 15 to sell "Pasteurised" milk a.nd 4 Supplementary licences v/ere granted during the year. PUBLIC HEALTH (MEAT) REGULATIONS, 1924. 179 inspections were made during the year. INSPECTION OF OTHER PREMISES WHERE FOOD IS PREPARED OR OFFERED FOR SALE. The Inspectors keep under frequent observation all such premises. Included in this category are Bakehouses (26), Food Stalls (30), and Ice Cream premises (40). 76 inspections of bakehouses were ma.de and 1 notice was served requiring remedy of defects. UNSOUND FOOD. During the year approximately 2 tons of unsound food was surrendered and destroyed. FOOD AND DRUGS APT. 400 samples were submitted to the Public Analyst for analysis during the year. Of these, 210 were taken as "formal" and 190 as "informal". 18 samples were returned a.s adulterated. In each of these ca.ses a warning letter was sent to the vendor concerned. All other samples were returned as genuine. No legal proceedings were taken. INFECTIOUS DISEASE AND OTHER DISEASES. NOTIFICATIONS . The total number of notifications was 343 • These were as follows:- Diphtheria 15, Erysipelas 9? Scarlet fever 13, Enteric fever 1, Puerpera.l fever 2, Puerperal pyrexia 6, Cerebro-spinal fever 7, Food poisoning 5, Ophthalmia. Neonatorum 3, Dysentery 6, Acute Primary Pneumonia. 59, Acute Influenzal Pneumonia. 9, Measles 150, Whooping Cough 4, Pulmonary Tuberculosis 49, and Non-pulmonary Tuberculosis 5. DIPHTHERIA. 15 cases were notified, of which 5 proved not to be suffering from this disea.se. There were no deaths. DIPHTHERIA IMMUNISATION CLINIC, 191 new cases attended the Clinic during the year. SCARLET FEVER. 13 cases were notified. There were no deaths. MEASLES. 156 cases were reported. 150 of these were notified. There were no deaths. 70 visits were made by the Health Visitors. WHOOPING COUGH. 4 cases were reported, all of which were notified. 3 visits were made by the Health Visitors. PUERPERAL FEVER AND PUERPERAL PYREXIA. Two cases of puerperal fever and 6 cases of puerperal pyrexia were notified. One case required the services of the Borough Council's Obstetric Consultant. P.T.O. - 5 - OPHTHALITLA. NEONATORUM. 3 cases wore notified and treated at home. All cases made a complete recovery. SMALLPOX & VACCINATION. No case of smallpox was notified. Of the 310 tirths registered in Chelsea during 1939, 176 were successfully vaccinated - a percentage of 56.8. (Figures for 1940 are not yet available). TUBERCULOSIS. 49 new cases of pulmonary and 5 of non-pulmonary tuberculosis were notified. In addition 36 new cases came to the knowledge of the Medical Officer of Health through other sources. The total number was therefore 90 (PulmonaryMales 54, Females 3O; Non-pulmonary - Males 3, Females 3). The total number of deaths from all forms of Tuberculosis was 43, the death rate being 1.1 per 1,000 of the civilian population. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. The total number of cases "of tuberculosis in the Borough on 31st December, 1940 was 212. (Pulmonary Males 105, Females 72; Non-pulmonary - Males 20, Females 15). The Tuberculosis Visitor paid 106 visits to non-dispensary cases. DISPENSARY & SPECIAL CASES. The number of new cases examined was 161. 37 of these were definitely tuberculous. 83 contacts were also examined, of which 1 was definitely tuberculous. The number of attendances (including contacts) was 1,046, and 2,124 visits were made by nurses to homes of patients. The Tuberculosis Officer visited 18 patients at their homes, and 51 were referred to him at the Dispensary by Medical Practitioners in the Borough. 84 specimens of sputum were examined and 303 X-ray examinations were made in connection with the work. The total number of cases on the register on the 31st December, 1940, was l8l. ARTIFICIAL PNEUMO-THORAX TREATMENT. 28 patients received treatment. The total cost (£242. 8. 0.) was borne by the Council. EXTRA NOURISHMENT. 25 cases received extra nourishment as part of their treatment. The total cost (£58. 14. 5.) was borne by the Council. DENTAL TREATMENT. 4 patients received dental treatment, the Borough Council making a contribution of £8. 17. 6. towards the cost. CHELSEA TUBERCULOSIS CARE COMMITTEE. The Committee met tines during the year and 127 cases were considered. Social services in co-operation with voluntary societies were continued throughout the year. - 6 -