Metropolitan Borough of Chelsea. Annual Report of the Medical Officer of Health CHELSEA 1941 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, farringdon road. london; e.c.i. 1939. Che 45 2 PREFACE To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Chelsea. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report on the health of the Metropolitan Borough of Chelsea for 1941. The chief vital statistics relating to the year are as follows:—The civilian population of the Borough is estimated by the Registrar-General at 26,470 a figure which is lower than thai tor last year. The birth rate (116) is higher fhan that for last year (11.0). The marriage rate a) l1 than that for last year 21-fal. The death rate 22.7. compares with 21.0 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 38 per 1,000 live births, as compared with 40 last year. The general improvement in the public health of the Borough continues to be maintained. There was an iricrease in the total incidence of notifiable infectious disease during the year. The total number of notifications, excluding duplicates, was 394 as compared with 343 last year. A considerable increase was recorded in the number of cases of dysentery. (Theae cases were notified from institutions in the Barcm^h). At the end of the year there were 156 cases of pulmonary tuberculosis and 31 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 2,375 and 2,945 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 accordancc with statutory requirements. i am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, w. h. l. McCarthy, Medical Officer of Health. 4 Public Health, Maternity and Child Welfare Committee. At 31st December, 1941. His Worship the Mayor (Councillor R. G. Wharam, J.P.) The Deputy Mayor (Councillor LADY clare Hartnell.) Alderman Miss C. Fulford, J.P., L.C.C. Alderman Lady Phipps. Alderman G. M. Stevenson. Councillors: Mrs. J.T. Cockburn R.A.Lyqon. G. M. Collis. fcev. W.G.AR/ROYVSMITH.M.A. G. A. Beaton. Mrs. C. Williams. Hon. Eveleen Campbell-Gray. Housing Committee. His Worship the Mayor (Councillor R. a. Wharam, J.P.) The Deputy Mayor (. Councillor Lady Clare Hartnell.) Alderman Lady Phipps Alderman Basil Marsden-Smedley, L.C.C. Councillors: H.G. E.vans. R. A. Lygon. J. M. Buckley. G. A. Thesiger. Mrs. J. T. Cockburn. Mrs. C. Williams. Capt. R. L. Edwards. P. A. Williams. Mrs. M. S. M. Elliott. A S. Benton. Hon. Eveleen CampbexvGray. Rev. W. GArrowsmith, M.A. Miss C. Welfare Subcommittee. His Worship the Mayor (Councillor R . G. Wharam, J.P.) The Deputy Mayor (Councillor Lady Clare Rartmell) Alderman Lady Phipps) 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, 1941 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). 1941 Davidson, Maurice M.D., F.R.C.P. Tuberculosis Officer (Part time). 1926 Matthews, Kathleen F. M.R.C.S., L.R.C.P., D.P.H. Medical Officer, Maternity and Child Welfare (Part time). 1928 Nelson, Grace M. M.R.C.S., L.R.C.P. Medical Officer, Maternity and Child Welfare (Part time). 1921 Radford, Muriel A. M.B., B.S., D.P.H. Medical Officer, Maternity and Child Welfare (Part time). 1932 Qourlay, Elizabeth M.D. B.S., Medical Officer of AnteNatal Clinic (Part time). 1929 McCullagh, W. McK. M.B., F.R.C.S. Consultant for Puerperal Fever and Puerperal Pyrexia (Part time) 1941 Taylor.R.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 timu). 1933 Thomas, E. F. M.D., D.P.H. Public Vaccinator, Chelsea District (Part time). 6 (b) Other Staff. Year Appointed. Name. Qualifications. Appointment. 1936 McLachlan, T. A.C.G.F.C., F.I.C. Public Analyst (Part time). 1920 Crandell, W. Cert. San. Insp. Exam. Board, Cert, Royal San. Inst., Cert. Meat and other Foods. Senior Sanitary Inspector (Whole time). 1927 Castley, J. Cert. San. Insp. Exam. Board, Cert. Meat and other Foods. Sanitary Inspector (Whole time). 1930 Hoyland, H. Cert. Royal San. Inst, and San. Insp. Exam. Joint Board, Cert. Meat and other Foods. Sanitary Inspector, (Whole time). 1916 Brown, Miss M. Cert. San. Insp. Exam. Board, Cert. Royal San. Inst., Health Visitors' Diploma, approved by Board of Education. Cert. C.M.B. Sanitary Inspector and Health Visitor (Whole time). 1939 Leacock.HT. Cert.ftoysd San.Inst and Sail. insp. Exam. Joint Board, Cert. Meat and other Foods. Sanitary Inspector (Whole time). 1923 Shaw, Miss A. Cert. Gen. Hosp. Training, C.M.B. and Cert. Mothercraft Training Soc., Health Visitors' Cert, approved by Ministry of Health. Health Visitor* Chelsea Health Society(Whole time). 1926 Harcourt, Miss G. E. S.R.N.,Cert Gen.Hosp. Training, C.M.B.,and Cert. Mothercraft Training Society. Health Visitor, Chelsea Health Society (Half time). 1941 Whitehouse, Mrs. S.R.N. .Cert.Gen. Hosp. Training, S.C.M., Royal San. Inst. Health Visitors' Cert. Health Visitor, Chelsea Health Society (Half time), Supt. of Play Mornings (Half time). 1941 Wiseman, Miss G. S.R N.,Gefl. HospjCcrt. Charing Cross Hosp. Matron, Chelsea Day Nursery (at Petworth House.) 1938 Streatfeild, Miss M. B. Cert. Inst, of Hospital Almoners. Secretary of Chelsea Tuberculosis Dispensary, Tuberculosis Visitor and Social Worker in connection with Tuberculosis (Whole time). 1937 Dolan, Miss A. P. Cert. General Hospital Training and Tuberculosis, Cert. C.M.B. Tuberculosis Nurse to Dispensary (Whole time). *And superintendent 1940 Drake, E. Sanitary lnspector (Whole time, tamporary) 1941 White, A.J. Sanitary lnspector (Whole time) 7 Year Appointed. Name. Appointment. 1914 . Hayden, A. B. J. Chief Clerk and Vaccination Officer, Public Health Department (Whole time). 1920 Bosley, E. Clerk, Public Health Department (Whole time). 1930 Bryant, J. C. Clerk, Public Health Department (Whole time). 1922 Kennedy, Mrs. H. M. ... £lerk (Maternity and Child Welfare) Public Health Department (Whole time). J 941 6r«en, Miss Nora. General Secretary, The Violet Melchett Infant Welfare Centre (Whole time). 1935 Bennett, Miss H. M. ... . .. - - - . ' Assistant Secretary, The Violet Melchett Infant Welfare Centre, (Whole time). 1940 Freeman, KC. Mortuary Keeper and Messenger (Whole time). Tem/po>Wy. 1938 Berry, L. H. Chief Disinfector (Whole time). 1929 Weston, R. J. ... Disinfector (Whole time). 1931 Bosley, E., Jr Disinfector (Whole time). 1941 Cooke, J. F. Dlsttifeotor ^Wiils time). Tem'p&funj. 1937 Brady, Mrs. R. ... Shelter and Cleansing Attendant (Whole time). 1936 Clark, Mrs. M Home Help (Part time). HOTE. Dr. let-lander ("tuberculous Officer) "resigned, and Dr. Mwrice DawUxrn. •wai crppolnttd iti hit stead- Mr. W- OtomMsU, Senior Saeiihary Inspector3etonded for Civil Defm<a taties. Meters J. Castiey, L.H. terry and Z. BosXe^jJr. 1vert ebsent m. mfUtarj *ruf«c throuj>i»ut th« year. 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 (а) 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 (а) General 25 (б) Infectious Diseases 26 Midwives and Maternity Nurses 27 Home Help in Maternity Cases 27 National Health Insurance 28 Laboratory Facilities 28 Public Health Legislation in force in the Borough 29 Hospital Services available in the Borough 29 Maternity and Nursing Homes 31 Health Visitors 31 Ante-Natal Work 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 (6) Invalid Children's Aid Association 38 \c) The Babies' Club 39 (d) Charity Organisation Society 39 (e) Chelsea Tuberculosis Dispensary 39 Convalescent Home Treatment for Nursing Mothers and Infants 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 56 (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 pace Ophthalmia Neonatorum 68 Poliomyelitis and Polio-Encephalitis 69 Encephalitis Lethargica 60 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, 19:io 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 3 1st December, 1941. SECTION I.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. GENERAL STATISTICS. TABLE No. 1. Area (acres) 660 Resident Population:—Registrar-General's estimate, 1941 26,470 Number of Inhabited Houses (end of 1941) according to Rate Books 11,767 Rateable value, October, 1941 £1,225,438 Sum represented by a penny rate, October, 1941 £3,492 POPULATION IN WARDS. (Census 1931.) Males. , Females. Total. Cheyne 3,349 5,430 8,785 Church 4,390 5,929 10,319 Hans Town 2,901 5,839 8,S00 Royal Hospital 2,550 4,833 7,383 Stanley 10,690 13,048 23,744 23,946 35,085 59,031 (Note.—All vital Statistics given in this Report are calculated on the Resident Population of the Borough as Estimated by the RegistrarGeneral for 1941, viz., 16,410) 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 WTard, 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 272 129 143 Birth rate per 1,000 of the estimated civillan" population. 11.6 Illegitimate 34 22 12 13  Total M. F. Still Births 4 2 2 Rate per 1,000 total (live and still) births 12.9 Deaths 600 328 272 Death rate per 1,000 of the estimated civillan population 22.7 Deaths from Puerperal Causes:— Deaths. Rate per 1,000 total (live and still) births. Puerperal Sepsis 0 0 Other Puerperal Causes 0 0 Total 0 0 Death rate of Infants under one year of age:— All infants, per 1,000 live births 38 Legitimate infants per 1,000 legitimate live births 40 Illegitimate infants per 1,000 illegitimate live births 29 Deaths from Cancer (all ages) 76 Deaths from Measles (all ages) none Deaths from Whooping Cough (all ages) none Deaths from Diarrhoea (under 2 years of age) none BIRTHS. The total number of births of Chelsea residents during the year was 3o6 equivalent to a birth rate of 11-6 per 1,000 of population. The birth-rate for England and Wales in 1941 was 14.2 while that for London as a whole was 8.9 The following Tables are self-explanatory:— TABLE No. 3. Registered Births. Legitimate and Illegitimate Births. 1939 1940 1941 Births Registered in the Borough 310 169 78 Births of Non-Parishioners 119 35 31 191 134 47 Births of Chelsea Mothers in Lyingin Hospitals and elsewhere outside of the Borough 348 294 259 Next Chelsea Births 539 428 306 14 TABLE No. 4. Births, Birth-Rates, Births in Wards and Inward Transfer Births. year. Births. BirthRate Per 1,000 of Population. Births in Wards. Inward Transfer Births. Leg. Illeg. Total. Hans Town. Royal Hospital. Church. Cheyne. Stanley. Hospitals. Nursing Homes. Private Addresses. Total. 1939 490 49 539 9.7 51 57 85 71 275 275 55 18 348 1940 389 39 428 11.0 40 34 66 61 219 194 73 17 294 1941 272 34 306 11.6 28 25 57 48 148 169 70 20 259 15 TABLE No. 5. Births in Hospitals and Nursing Homes. Chelsea Births in Hospitals and Nursing Homes Within the Borough. Chelsea Births in Hospitals and Nursing Homes Outside the Borough. London County Council:— London County Council:— St. Luke's Hospital 2 St. Mary Abbots Hospital 51 St. Stephen's Hospital 1 Hammersmith Hospital 14 Paddingfcon Hospital 12 Voluntary:— Miscellaneous Hospital 4 Chelsea Hospital for Women 1 Voluntary:— Nursing Homes:— Quean Charlotte's Hospital 16 Wilbraham - Miscellaneou Hospitals (London) 7 Royal Avenue - „ „ (outside London) 65 Nursing Homes:— Miscellaneous 70 Total 4 Total 239 From Table No. 4 it will be observed that the number of births of Chelsea Infants in Hospitals and elsewhere outside Chelsea accounted for 84 per cent, of the total births. In the preceding year the percentage was 69. 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 7o births, including stillbirths, were notified as occurring in Chelsea. Of this number, in 31 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 121 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 160. The following table indicates the source of notification of the 70 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 4 - 4 30 1 31 Midwives 34 -1 34 - - — Poor Law Institutions 1 - 1 — - - Parents - - - - - — 39 - 39 30 1 31 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 49 9.09 1940 16 23 39 9.11 1941 22 12 34 11.11 Stillbirths.—The corrected number of stillbirths during the year was 4, which represents a rate for the Borough of o-is per 1,000 of the civilian population, as compared with o 33 for London as a whole. MARRIAGES. There were 491 marriages registered in the Borough during the year ( 839 in l940). The marriage rate (number of marriages per 1,000 of population) was 18.5. In the preceding year the marriage rate was 21.6 DEATHS. The total number of deaths of Chelsea residents during the year was 600, equivalent to a death rate of 22.7 per 1,000 of population. The death rate for England and Wales for 1941 was 12-9, and for London 16.3. 17 The following tables are self-explanatory:— TABLE No. 8. Registered Deaths. 1939 1940 1941 Deaths registered in the Borough 1,662 1,883 1,157 Non-parishioners 1,085 1,216 746 577 667 411 Deaths of Chelsea residents in hospitals and elsewhere outside the Borough 166 184 189 Nett Chelsea deaths 743 851 600 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 4ll Chelsea-deaths registered in the Borough, 2.69 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 118 St. Luke's Hospital and Institution 92 Mental Hospitals 20 Infectious Disease Hospitals 6 St. Stephen's Hospital and Institution 115 Tuberculosis Sanatoria, etc. 4 St. George's Home for Tuberculosis Nursing Homes 21 Voluntary:— Miscellaneous 20 Chelsea Hospital for Women 3 Cheyne Hospital for Children — Brompton Hospital 7 \ Royal Hospital for Pensioners 44 Royal Cancer Hospital 8 Victoria Hospital for Children - 269 189 Of the 746 deaths of non-residents registered in Chelsea, 716 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 69 109 130 124 311 19.8 14.3 12.7 11.7 1940 851 22.0 67 93 159 163 369 23.3 16.4 19.3 28.9 1941 600 22.7 60 110 124 84 222 31.7 13.6 29.0 16.3 19 TABLE No. 11. Birth-rates, Death-rates, Analysis of Mortality, Maternal Death-rates and Case-rates for certain Infectious Diseases in the year 1941. England and Wales, London, 126 Great 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. Civilian. Rates per 1,000 Population. Births:— Live 14.2* 14.7 16.4 8.9 Still 0.51* 0.58 0.60 0.33 Deaths:— All Causes 12.9* 14.9 13.0 16.3 Typhoid and Paratyphoid fevers 0.00 0.00 0.00 0.01 Smallpox - - - - Measles 0.03 0.03 0.03 0.02 Scarlet fever 0.00 0.00 0.01 0.00 Whooping Cough 0.06 0.07 0.06 0.04 Diphtheria 0.07 0.08 0.06 0.03 Influenza 0.19 0.17 0.20 0.15 N0T1TI CATIONS:— Typhoid Fever 0.03 0.02. 0.03 0.04 Paratyphoid Fever 0.09 0.12 0.03 0.05 Smallpox - - - - Scarlet fever 1.47 1.49 1.51 1.01 Diphtheria 1.25 1.53 1.19 0.93 Cerebro-Spinal Fever 0.25 0.31 0.20 0.30 Erysipelas 0.30 0.36 0.27 0.50 Pneumonia Whooping Cough 4.39 4.37 4.50 3.50 Measles 10.33 8.27 10.47 4.77 Rates per 1,000 Live Births. Deaths under 1 year of age 59 71 56 68 Deaths from Diarrhoea and Enteritis under 2 years of age 5.1 7.5 4.6 6.8 Rates per 1,000 Total Births (i.e., Live and Still). Maternal Mortality:- (exciuding abortion) Puerperal Sepsis 0.48 not available Others 1.75 Total 2.23 Notifications:— Puerperal fever 11.91 15.64 943 2.29 Puerperal pyrexia 19.3† * These rates are those published in the Quarterly Reform - Signifies that there were no dearths. † Including puerperal fever. 20 TABLE No. 12. Deaths of Chelsea Residents Registered during the Year 1941 Classified by Age and Cause. (In accordance with Registrar-General's Return.) Year 1941. Nett deaths. whether occuring within or without the Borough. Year 1939 Year 1940 All. ages Under 1 year. 1 and under 5 years 5 and wnder 15 yea.rs 15 and under 45 year. 45 and under 65 year 65 years and upwards All causes 600 9 2 3 54 170 362 743 851 1. Typhoid and Paratyphoid Fs. - - - - - - - - - 2. Cerebro-spinal Fever - - - - - - - 2 1 3. Scarlet fever. - - - - - - - - - 4. Whooping Cough. - - - - - - - - - 5. Diphtheria - - - - - - - 3 - 6. Tuberculosis ef Respiratory System 31 - - - 12 12 7 46 37 7.Other forms of tuherculosis. 2 - - 1 1 - - 5 6 8. Syphilitic Diseases. 6 - - - - 2 4 1 5 S. Influenza 5 - 1 - 1 2 1 20 12 10. Measles. - - - - - - - - - 11. Acute Poliomyelitis & A. Pencephalitis - - - - - - - - - - 12. Acute Inf. Encephalitis - - - - - - - 1 2 13. Cancer pf Buccal Cavity and Occephagus (M) and Uterus (F). 11 - - - - 3 8 103 15 14. Center - Stomach & duodenum 13 - - - 1 3 9 19 15. Cancer of Breast. 11 - - - 1 6 4 10 16. Cancer of other sites. 41 - - - 3 20 18 62 17 Diabetes. 3 - - - - 2 1 13 5 18. Intracranial vasacular lesions 31 - - - - 6 25 38 42 19. Heart IHiease. 171 - - - 3 30 138 246 204 20. Otter diseases of the circulatory system 20 - - - 1 3 16 55 26 21. Bronchitis. 38 - - - 1 13 24 20 31 20. Pneumonia. 40 1 - - 5 10 24. 39 45 23. Other "Respiratory diseases. 5 - - - - 3 2 6 8 24. Ulcer cf stomach or duodenum 10 - - - - 3 7 9 11 25. Diarrhoea, under 2 years - - - - - - - 1 1 26. Appendicitis 3 - - - - 3 - 8 3 27. Ofttr digestive diseases. 10 - - 1 - 4 5 16 9 28. Nephritis. 13 - - - 1 5 7 8 7 29. Puerperal ani postabortive sepsis. - - - - - - - - 2 30. Other maternal causes. - - - - - - - 1 1 31. Premature birth. 4 4 - - - - - 5 3 33. Congemital malformations; birth injuries infant disease. 5 3 - l - - 1 3 4 53 Suicide. 3 — - - 1 2 - 8 13 34. Road traffic accidents. 1 - - - - - 1 26 11 35 Other violent causes. 91 1 1 - 22 30 37 209 36. All other causes. 32 - — — 1 8 23 60 47 600 9 2 3 54 170 362 743 851 21 CAUSES OF DEATH. Table No. 12 shows that 171 deaths were due to Organic Heart Disease, 76 to Cancer, 38 to Bronchitis, 40 to Pneumonia, 31 to Pulmonary Tuberculosis, 20 to Circulatory Diseases, 31 to Cerebral Hæmorrhage, 5 to Influenza and 5 to Congenital Debility and Malformation. Sixty 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 three 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 10 39 6 65 1.3 8 7.7 1940 31 45 8 84 2.2 5 6.0 1941 38 40 5 83 3.1 1 1.2 DEATHS OF CHILDREN 1-5 YEARS OF AGE. The causes of death are given during the past three years. TABLE No. 14. Child Mortality (1-5 Years). Year. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrhœal Diseases. All other causes. Total Deaths. 1939 1 1 — — 3 5 1940 - 1 1 - 2 4 1341 - - - - 2 2 22 INFANT MORTALITY. There were 9 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 38 as compared with 4.0 in the previous year. In London as a whole the rate of infant mortality was faS 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 - - - - - - - - - - Erysipelas - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis - - - - - - - Convulsions - - - - - - - - - - Laryngitis - - - - - - — - - - Bronchitis - - - - - - - - - - Pneumonia - - - - - - 1 - - 1 Diarrhœa and Enteritis - - - - - - - - - - Gastritis - - - - - - - - - - Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Suffocation - - - - - - - - - - Injury at Birth - - - - - - - - - - Atelectasis - - - - - - - - - - Congenital Malformations 2 1 - - 3 - - - - 3 Premature Birth 3 - - 1 4 - - - - 4 Atrophy. Debility and Marasmus - - - - - - - - - - Other causes 1 - - - 1 - - - - 1 6 1 - 1 8 - 1 - - 9 Nett Births registered during Legitimate 272 the calendar year Illegitimate 34 Nett Deaths (under 1) registered Legitimate 8 during the calendar year Illegitimate 1 23 The following Table gives the Infant Mortality Rate in Chelsea under various headings, for the past three years:— TABLE No. 16. 1935 1940 1941 Infectious Diseases 3.9 - - Diarrhœal Diseases 1.9 2.8 - Developmental Defects and Wasting 15.8 18.6 29.9 Other causes 11.8 18.6 8.5 Total Rate 33.0 40.0 38.4 Illegitimate Deaths.—The following Table No. 18 shows the number of deaths among illegitimate infants during the past three years. TABLE No. 18. 1939 1940 1941 Total number of illegitimate deaths under 1 year 2 1 1 Illegitimate death rate 41 26 2.9 MATERNAL MORTALITY. During the year no deaths were primarily classilied 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. TABLE No. 17. Infantile Mortality Rates per 1,000 Births in Wards. 1939. 1940. 1841. Hans Town — - 71 Royal Hospital 18 - - Church 47 24 35 Cheyne - 56 21 Stanley 43 41 27 Chelsea Borough 33 40 38 24 The following table shows the Maternal Mortality in Chelsea during the past threeyears:— TABLE No. 19. Year. Death-rate per 1,000 Total (Live and Still) Births. Total Death-rate. Puerperal Sepsis. Other complications of Pregnancy and Childbirth. 1939 — 1.9 1.9 1940 5.2 2.6 7.8 1941 — — — 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 73 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 1941, deaths of pensioners in the Royal Hospital, Chelsea, accounted for 62 deaths, inward transfers included (equivalent to 2.9 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 m This report. No special effects of any particular occupation, prejudically affecting the health of workers therein, have been reported. 25 SECTION II.—PROVISION OF HEALTH SERVICES IN THE BOROUGH. PUBLIC HEALTH OFFICERS OF THE BOROUGH COUNCIL. The names and qualifications of members of the staff of the Public Health Department at 3lst December, 1941. 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 £400 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 three years and by Table No. 21 the conditions which necessitated attendance during the year 1941:— TABLE No. 20. Year. Visits. Cases. 1939 1,430 158 1940 1,404 135 1941 1,483 135 26 TABLE No. 21. Nursed by District Nurses; 1939 1940 1941 Visits Cases Visits cases Visits Cases Bronchitis 159 18 67 8 153 15 Burns - - - - - - Chicken Pox 11 1 18 1 - - Circumcision 104 13 58 7 29 4 Diarrhœa 4 1 1 1 10 1 Eye Trouble 406 7 202 14 234 10 Ear Trouble 98 6 13 1 11 2 Expectant and Nursing Mothers 147 11 122 12 242 22 Influenza and Pneumonia (under 5) 40 3 93 4 78 5 Influenza and Pneumonia (over 5) 131 2 77 3 109 4 Impetigo - - 113 4 38 5 Meningitis and Peritonitis - - - - - - Measles (under 5) - - 2 1 29 3 Measles (over 5) - - 10 3 - - Ophthalmia Neonatorum 61 3 82 2 26 2 Pemphigus Neonatorum - - - - - - Pemphigus - - 88 4 16 1 Poliomyelitis - - - - - - Post-Vaccination 303 54 149 31 143 2o Puerperal Fever - - - - - - Puerperal Pyrexia - - 24 2 - - Rickets - - - - - - Septic sores 33 7 47 4 164 8 Tonsils and Adenoids 23 4 — - 3 1 Whooping Cough 137 7 - - 53 3 Worms 44 9 65 12 - - Miscellaneous 97 13 167 21 163 29 1,498 158 1.404 135 1,483 135 (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 County Council is the Authority responsible for the supervision of midwives and Domiciliary Midwifery Service 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 3 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. 22. Year. No. of applications for services of Home Help, including extension over the usual period of 2 weeks. Total number of cases attended by the Home Helps. Amount of Assessment on cases attended. Nett Cost to Council. £ s. d. £ s. d. 1938 16 4 5 7 0 15 13 0 1940 2 1 15 0 4 10 0 1941 1 1 - - - 5 5 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. TABLE No. 23 Bacteriological and ether examinations. Nature of Specimen 1939 1940 1941 Swabs for diphtheria bacilli 236 59 142 „ „ hemolytic streptococci 7 - 1 Sputum „ tubercle bacilli 31 13 11 Stools or blood for typhoid I 2. 5 Stools for dysentery l - - Water at public baths 2 2 2 Milk under Milk(Special Designations) Order - 7 6 Milk on delivery — 2 - 278 85 167 Total cost bo Borough Council £52.ll.0 £19.2.10 £33.3.2 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 8.200 units. An anti-toxin syringe, needles and steriliser are also available on loan. from April 1944, the examinations were carried out by the Clinical Reasearch' Association. 29 The total cost to the Council for anti-toxin supplied during the year was £.0.12.0- PUBLIC HEALTH LEGISLATION IN FORCE IN THE BOROUGH. The powers under which the Council work are those contained in the Public General Acts, the London County Council (General Powers) Acts, and the Bye-laws under the Public Health Acts. In addition the Council on the 28th April, 1937, made the following bye-law for the good rule and government of Chelsea: — NUISANCES BY DOGS. (1) No person being in charge of a dog shall allow the dog to foul the footway of any street or public place by depositing its excrement thereon. Provided that a person shall not be liable to be convicted of an offence against this bye-law, if he satisfies the Court that the fouling of the footway by the dog was not due to culpable neglect or default on his part. (2) For the purposes of this bye-law the owner of the dog shall be deemed to be in charge thereof, unless the Court is satisfied that at the time when the dog fouled the footway it had been placed in or taken into the charge of some other person. (3) Any person offending against this bye-law shall be liable on summary conviction to a fine not exceeding forty shillings. (4) This bye-law shall cease to be in force on 1st June, 1939, unless a bye-law re-enacting its provisions has come into operation before that date. (5) As from the date on which this bye-law comes into operation, the bye-law made by the Council on 2nd February, 1927, under Section 23 of the Municipal Corporations Act, 1882, as to nuisances by dogs upon the public footways shall be and is hereby repealed. This bye-law has proved of considerable assistance in preventing serious nuisance. HOSPITAL SERVICES. The Borough is singularly well provided with facilities for hospital treatment, both general and special. In addition, several important general and special hospitals are situated in the immediate neighbourhood. Over 80 per cent. of the inhabitants suffering from serious illness or disease seek and obtain in-patient hospital accommodation. The following Hospitals and Institutions are located within the Borough. None of these are controlled or supported wholly or in part by the Borough Council. Brompton Hospital for Consumption. The Royal Cancer Hospital. Chelsea Hospital for Women. Cheyne Hospital for Children. (Evacuated.) Royal Hospital for Pensioners. St. George's Home for Tuberculosis. St. Luke's Hospital and Institution. St. Stephen's Hospital and Institution. Victoria Hospital for Children. The following table No. 24 shows, in the form required by the Ministry of Health, particulars of the hospitals, public and voluntary, within and without the Borough, which are utilised by inhabitants of the Borough. 30 TABLE No. 24. Name. Situation. Nature of Cases'Treated. Available Beds. If used by persons resident outside the Borough. Management. Brompton Hospital for Consumption Fulham Road, S.W.3 Pulmonary Tuberculosis 339 Yes The Reyal 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 By Voluntary Committee Princess Beatrice Hospital Richmond Road, S.W.5 General Medical, Surgical and Maternity 78 Yes Royal National Orthopaedic Hospital Great Portland Street, W.l 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 St. Mary Abbots Hospital Marloes Road, W.8 Medical, Surgical and Maternity 555 Yes By Hospitals and Medical Services Committee of L.C.C. 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 Evacuated throzughoivt the year. 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 three years. The visits enumerated are those Daid bv 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. 1939 1940 1941 (1) Work of the Health Visitors. First visits to Infants under one year of age 319 279 188 Return „ „ „ „ 1,252 1,110 727 First visits to Children between the ages of 1 and 5 years 245 184 145 Return visits to Children between the ages of I and 5 years 2,196 1,770 979 Ante-natal visits to Expectant Mothers :— Primi-para cases 103 103 78 Multi-para „ 164 142 73 Return visits 590 440 259 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 110 3 25 Return visits „ „ „ 103 - 37 Visits to Measles cases (under 5 years of age) 11 21 3 Return visits „ „ - 3 14 Visits to Measles cases (over 5 years of age) 6 41 - Return visits - - - General additional visits 648 989 417 Total visits 5,759 4,700 2,945 Half-day attendances at Infant Welfare Centres 624 487 617 Half-day attendances at Play Centre 135 - - (2) Infant Welfare Centres. Total number of attendances:— (a) By children under one year of age 3,673 2,391 1,381 (b) By children between the ages of 1 and 5 years 2,917 1,535 557 (c) By Ante-Natal mothers 898 703 420 \d) By Post-Natal mothers 26 21 17 Total attendances 7,514 4,650 2,375 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. The following table shows for the past three years, the extent of this service : TABLE No. 27. Year. Milk Orders issued and taken up. Approx. Cost. March quarter. June quarter. Sept. quarter. Dec. quarter. Total. 1939 892 845 637 577 2951 £ 945 I 940 678 7O0 176 1 1555 £1435 1941 — - — - — - SUPPLY OF MILK TO MOTHERS AND YOUNG CHILDREN. From July, 1940, the National Milk scheme was '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 van on similar lines to the councils own maternity and, child welfare scheme the administration was Iransferred to the Food Control Department. * These totals do not include orders subsequently cancelled or withdrawn, which average 80 or more during each year. 33 34 past three The total quantity of milk supplied during the yearsto expectant and nursing mothers and young children was as follows:— 1939 1940 1941 Cows Milk, free of cost 6,4-3792 2559 - Cows Milk at reduced cost 1,862 1,342 „ — 8,299 „ 3,901 „ — Dried Milk, free of cost 1,087 552lbs _ Dried Milk at reduced cost 441„ 253„ — Total. 1,528 805" 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. 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 1941-4-2. 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, and one ante-natal clinic. 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. Throughout the. year the Nursery functioned, cub an address in Sussex The attendances at the Nursery during the past two years were as follows:— TABLE No. 28. 1939 1940† 1941† Total number of attendances during the year 7,386 - - Average daily attendance (5-daye-a week) 4.0 41 42 Total number of individual children who attended 101 (not available) * Nursery evacuated 1. 9. 39, and figures shown are up to that date Nursery in Roceiiving Area. 37 The health of the children has been satisfactory. (3) Chelsea Mothercraft Home.—Chelsea Manor Street, S.W.3. The Mothercraft Home was dosed throughout the year. 38 (b) Invalid Children's Aid Association.—Chairman: Lady Edward Gleichen. Hon. Secretary: Miss Aileen Woodroffc. The Chelsea branch of the Invalid Children's Aid Association is located at 2, Glebe Place, King's Road, S.W.3. The Association provides, for children referred to it, treatment in Hospitals, Sanatoria and Nursing Homes, according to need; convalescence in the country or at the seaside; orthopaedic appliances and surgical boots; massage, remedial exercises, surgical dressings and medical comforts; help in training for suitable work; additional clothing, etc. Two members of the Public Health Committee of the Borough Council and the Medical Officer of Health are members of the local Committee of the Association. The Borough Council made a financial grant of £100 to the Association for the year commencing 1st April., 1941. TABLE No. 29. 1939 1940 1941 Actual cases- children under 5 years of age 110 76 48 Children sent out of London for convalescence 46 14 17 Children admitted toL.C.C. Boarding-out Home under Tuberculosis Contact Scheme 2 - 5 Sanatorium treatment arranged 2 2 2 Children supplied with surgical appliances 14 4 6 Children treated at I.C A A. Orthopedic Clinic 4 - - Extensions granted - 3 4 Medical aid granted 30 21 - Maintained in permanent Home — 1 1 Children referred to L. C.C. special convalescent hospitals 10 - - Children referred to other Agencies for help 1 - - Children referred from hospitals for special reports &c. 4 6 8 Children granted outfits of clothing Ac. before going away 10 34 6 Children evacuated, cases followed up with reports 8 7 1 Applications withdrawn - own arrangements made 8 5 4 Applications for Assistance - TOTAL: 149 97 54 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 3 years is shown in Table No. 30. During the year ONE of the cases were sent to Homes free of charge. The remainder contributed according to their resources. The period of convalescence granted is two weeks. TABLE No. 30. Year. No. of Applications. Nursing Mothers and Infants sent away under Council Scheme. Contributions by Mothers. Nett Cost to Borough. £. s. d. £ s. d. 1939 24 9 1. 15. 6. 23. 5. 4. 1940 3 1 - 3. 2. 6. 1941 1 1 1. 10. 0. 2. 0. 0. 1942 2 2. 1. 10. 0. 19. 9. 9. 40 DENTAL TREATMENT. Children under Five Years of Age. A dental clinic was held monthly at the Violet Melchctt Infant Welfare Centre for the provision of preventive dental treatment for children under five years of age. Thirty 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.—Inconjunction 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, arrangements were made with, the london Courtly council for dental treatmert to be given at it. 8tephen’s hospital, Two mothers recived treatments. 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 194l). Foster Mothers. Foster Children. Number on register at beginning of year 2 3 Removed from register 5 10 Added to register 8 14 Remaining on register 5 7 Medical attendance arranged 11 Attended Maternity and Child Welfare Clinic 8 Visits to foster mothers 70 Miscellaneous visits 37 41 BLIND PERSONS ACT, 1920. At the request of the London County Council, the Borough Council has arranged for the home visiting of blind children under live years of age to be carried out by the Health Visitors. Reports are furnished to the County Council as occasion arises, when the home conditions are found to be unsuitable for blind children or where it is considered necessary that the child should be admitted into a suitable institution. No case came to the knowledge of the department during the year. SUMMARY OF ARRANGEMENTS 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 mdwifery attendance, free or at reduced rates, for necessitous Chelsea women. (j) The provision of Convalescent Home accommodation for nursing mothers and infants. (k.) The provision of dental treatment for expectant and nursing mothers. (I) The supply of milk, free or at reduced rates, to necessitous nursing and expectant mothers, infants, and young children. (m.) The provision of sterile maternity outfits at cost price. (n.) The administration of the Widows', Orphans' and Old Age Contributory Pensions Acts, 1925 and 1929, in respect of deserted, abandoned or neglected children. 42 SECTION III.—SANITARY CIRCUMSTANCES AND ADMINISTRATION. Complaints.—The number of complaints received during the year was 818 compared with 892 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. carriage system is general Closet Accommodation.—The water 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. 193G. 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 £29. The number of and IK in 1940- nuisance notices was 71. These compared with 442 Summary of Work carried out by Sanitary Inspectors during the Year. inspections. 1939 1940 1941 On complaint of nuisance 648 892 818 On notification of infectious disease (including non-notifiable diseases) 273 146 242 House to House 99 - - Re-inspection calls made 3,468 3.309 3,205 Inspection of:— Bakehouses 121 76 26 Slaughterhouses 2 - - Milkshops 46 95 86 Ice Cream Premises 28 20 5 Overcrowding 24 48 - Unucoc T of in T /%/)»•••» 20 3 - 12 Other visits for 1941 made up as follows. 4 2508 40 50 Public Health department 2,013 78 5 7 civil Defence: 74 Heat Centre3 48 85 83 94 Shelters 700 547 4 Homeless Persons 223 68 - Refugees 26 20 339 Food Decontamination 103 92 — Furniture Salvage 346 587 Food Salvage 197 661 First-Aid Repairs 956 388 Miiscellaneous 627 13 3221 2,461 Public Health: 2013 Civil Defence: 2461 Grand Total:- 4,474. 43 Premises: 1939 1940 1941 Walls and Ceilings cleansed:— (a) Premises throughout - - - (b) Premises partially 209 193 147 (c) Verminous rooms cleansed 45 63 77 (d) Total number of rooms cleansed 2£4 300 161 Wash-house walls and ceilings cleansed 5 3 4 Walls and ceilings of water closcts cleansed and repaired 51 67 30 Wash-house roofs repaired 13 1 4 Dirty tenants' rooms cleansed 8 5 - Yard and area walls cleansed 7 4 1 Defective roofs repaired 80 73 57 Defective gutters repaired - 99 44 Defective rain water pipes repaired 20 19 20 Dampness abated 75 113 56 Miscellaneous repairs 214 257 104 Wash-house floors repaired - 2 1 Yard surfaces repaired, paved, etc. 16 13 3 Ashpits demolished - - - New and proper dustbins provided 23 20 16 Workrooms provided with light and ventilation or light and ventilation improved 8 1 - Drainage: Reconstructed 10 8 2 Repaired l 1 5 Cleansed 2 1 2 Inspection chambers and traps provided 13 8 1 Fresh air inlets provided or repaired 14 17 — New soil pipes provided 6 12 1 New ventilation pipes provided 7 10 1 Soil and ventilation pipes repaired 1 1 1 Anti-syphonage pipes provided 5 1 - Drains sealed oft 2 - - Drains cleared (obstruction removed) 7 14 18 New covers provided to inspection chambers 13 11 3 Rainwater pipes disconnected and caused to discharge over properly trapped gullies _ 2 - Sink wastes provided with traps 24 65 11 Sink waste pipes cleansed - 8 1 New sink wastes provided 24 56 13 New sinks provided 16 40 6 New bath and lavatory basin wastes provided 3 13 1 Water Closets. Improvements in sanitary conveniences (factories, workshops, etc.) - - - New water closet pans provided 27 32 10 Water closet pans (foul) cleansed 6 8 1 Choked water closet pans unstopped and cleansed 1 13 2 Water waste preventers renewed , 13 21 10 Water waste preventers repaired 11 18 8 Water closet roofs repaired 13 4 5 Ventilation and light provided or improved 2 1 1 W.C. floors repaired 1 - - Water supply. Water supply to premises reinstated 7 27 24 Water supply provided to upper storeys of tenement houses 6 10 1 New drinking water cisterns provided 2 2 1 Drinking water cisterns cleansed 4 10 1 Drinking water cisterns provided with new covers or covers repaired 5 8 3 Smoke Nuisance. Number of observations 55 40 4 Number of nuisances and complaints 12 17 1 Number of notices - - 1 Number of summonses - - - 44 Nuisances abated arising from:— 1939 1940 1941 Keeping animals in an improper manner or place - 1 - Defective manure cages 1 - - Accumulation of manure or refuse Overcrowding 6 17 21 Rat nuisance 24 2 - 114 141 94 Underground rooms - - - Food Condemned and Destroyed. Disinfection. _ Rooms disinfected after Zymotic diseases (Scarlet Fever, Diphtheria, etc.) 184 169 142 Rooms disinfected after Tuberculous disease 46 48 30 Rooms fumigated for verminous and filthy conditions 434 315 481 Miscellaneous disinfection 56 101 38 Certificates of disinfection given 77 5 14 School notices after disinfection 74 8 26 Notices sent to Public Library of Premises where infectious diseases have occurred 95 40 43 looms disinfected (Civil Defene) Proceedings taken. 518 451 622 Intimation Notices served 273 442. 229 Statutory Notices under Public Health (London) Act, 1936 97 155 71 Statutory Notices under Section 9 of Housing Act, 1930 - - - Statutory Notices under byelaws for provision of dustbins 10 8 3 Total number of samples purchased for analysis under the Food and Drugs (Adulteration) Act 252 210 211 Samples (informal) purchased 148 190 189 Legal proceedings instituted in respect of defective sanitary conditions and nuisances 3 21 6 Legal proceedings under Milk and Dairies (Amendment) Act, 1922 - - - Legal proceedings in respect of unsound food - - 1 Certificates issued in accordance with "Rent Restrictions Act" 3 5 - Entries in Inhabitants' Complaint Book 648 892 600 Cleansing and Disinfection. Number of adults cleansed 29 17 18 Number of children cleansed 558 498 249 Number of adults treated for Scabies 90 Number of children treated for scabics 82 58 90 Number of articles (bedding, etc.) disinfected 9,828 11,724 18,785 Number of articles (various) destroyed 817 3,997 2,236 Disinfection Station Shelter. Persons accommodated:— Adults nil nil nil Children nil nil nil. Mortuary. Number of bodies received - 1 - Number of infectious bodies received - - - Number of bodies removed to Public Mortuaery on Sanitary grounds - - - Number of bodies detained in Mortuary Chapel - - - 1941 ARTICLES DISINFECTED: PUBLIC MEALTH SERVICES y101 CIVIL DEFENCE 8918 FIRE WARCNERS 976 MILITARY 1790 18.480 1941. ROOMS DISINFECTED: CIVIL DEFENCE 541 FIRE WATERS 73 MILITARY 38 622 TABLE No. 32. MAGISTERIAL PROCEEDINGS DURING THE YEAR. SITUATION OF PREMISES NATURE OF NUISANCE OR COMPLAINT PETTY SESSIONS DATE OF HEARING RESULT Flat 1, 22 Gunter Grove. Failing to comply with Statutory Notice re condition of premiaea. Kenaington. 21.1.41 Order, 28 days. 4, Bedford House, Bifron Street. ditto. Kensington. 21.1.41 Order, 28 days. 425, King ’s Road. ditto. Kensington. 8.4.41 Order, 14 days. 1, Hobury Street. ditto. Kenaington. 8.4.41 Order, 14 days. 4, Luna Street. ditto. Kensington. 26.4.41 Order, 14 days. 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 4 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. one complaint of smoke nuisance was received during the year 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, 1936, enables a Sanitary Authority to take necessary steps to reduce the number of pigeons within its area. Much difficulty has been experienced in carrying out pigeon destruction, owing to the opposition of a large section of the public. During the year 1941, pigeons were captured and humanely destroyed. For 1939 the number was , and for 1940 40 \ TABLE No. 33. Number of Premises. Number of inspections during 1941. Number of notices served during 1941. Number of prosecutions during 1941 On register at end of 1940. Added in 1941. Removed in 1941 On register at end of 1941. 1. Premises used for Business Purposes :— Milk Premises 82 — 35 47 86 — — Cowsheds — — — — — — — Ice Cream Premises ... 40 — 11 29 5 — — Butter and Margarine 10 — — 10 5 — — Manufacturers and Dealers :— Fried Fish Premises , 14 — 8 6 14 — — Fish Curers 5 — 3 2 — — — Bakehouses 2.6 — — 26 26 — — Slaughterhouses — — — — — — — Food Stalls 30 l — — 30 under daily observation — — Offensive Trade Premises — — — — — — — 2. Premises used for Human , Habitation :— Houses let in lodgings — — — — Common Lodging Houses — — — — — — — Canal Boats — — — — — > — — 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 two premises were found to be infested with bed bugs, 44 being owned by the Borough Council and 154 owned privately. In each case disinfestation was carried out. The work of disinfestation is carried out by the staff of the Borough Council. The methods employed for freeing infested houses from bed bugs consist of fumigation with Sulphur dioxide and the employment of contact spraying with an insecticide. Where necessary, owners are called upon to remove or loosen wooden fittings and strip walls in order to assist fumigation. The furniture of each tenant removing to a Council flat is subjected to treatment in a specially constructed Cyanide Van before entry into the new flat. During the year the furniture of tenants was treated in this way. Cyanide fumigation is carried out by the Westminster City Council, under an agreement with the Borough Council. Factories. Workshops and Workplaces.— The total number of factories, workshops and workplaces on the register at the end of the vear was 63. The number of inspections of these premises was 78 which compares with 133 in 1940. Sanitary defects were found in 10 instances. The following Table No. 34 is in the form requested by the Home Office in order to ensure uniformity in the presentation of returns:— TABLE No. 34 Factories, Workshops, Workplaces, and Homeworkers' Premises. I.—Inspection of Factories and Other Premises. (Including Inspections.made by Sanitary Inspectors). Number of Premises. (1) Inspections. (2) Written Notices. (3) Occupiers prosecuted. (4) Factories (with mechanical power) 10 — — Workshops (without mechanical power) 66 — — Other Premises under the Act (including works of building and engineering construction but not including Outworkers' premises) 2 — — Total 48 — — 47 48 2.—Defects found in Factories and Other Premises. Particulars. Number of Defects. IS umber of offences in respect to which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (6) Nuisances under the Public Health Acts :—* Want of cleanliness 8 8 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 2 2 — — Sanitary accommodation :— Insufficient — — Unsuitable or defective. — — — — Not separate for sexes — — — — Offences under the Factory and Workshop Acts :— Illegal occupation of underground bakehouse (s. 54) — — — — Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921). — — — — Total 10 10 — — * Including those specified in Sections 2, 3, 7 and 8 of the Factories Act, 1937, as remediable under the Public Health Acts. 3. Home Work. Outworkers' Lists, Section 110. Outwork in Unwholesome Premises, Section 111. Outwork in Infected Premises, Secs. 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 Inspec tions of Out workers Pre mises. Lists. Chelsea Outworkers Instances. Notioces served. utions Instances. Orders made (Sec. 109). Prosecutions. (Sec. 109, 110). 1939 14 21 24 165 — 18 — — — — — — 1940 14 20 18 160 — 15 — — — — — — 1941 16 12 10 140 — 5 — — — — — — 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 1941 Nil 1. To await Inquests:— (a.) Infectious (6.) Non-infectious 2. Sanitary grounds Number of Post Mortem examinations Nil Number of bodies detained in Mortuary Chapel Nil 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, fourty- four 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. * From 1939 (commencement of hostilities) the Public Mortuary has been reserved for Air Raid Casualties. Deaths from, other causes are Sent bo the HammerSmith Mortuasry. ' 50 SECTION IV—HOUSING. In accordance with the instructions of the Ministry of Health, the following tabular statement has been prepared :— TABLE No. 35. HOUSING STATISTICS FOR THE YEAR. 1. Inspection of Dwelling-houses During the Year :— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 694 (b) Number of inspections made for the purpose 3067 (2) (a) Number of dwelling houses (included under sub- head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 140 (b) Number of inspections made for the purpose 1120 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 140 2. Remedy of Defects during the Year without Service of Formal notices :— Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 195 3. Action under Statutory Powers during the Year :— * (a) Proceedings under sections 9, 10 and 16 of the Housing Act, 1936 (1) Number of dwelling houses in respect of which notices were served requiring repairs (2) Number of dwelling houses which were rendered fit after service of formal notices (a) By owners (b) By Local Authority in default of owners 51 (b) Proceedings under Public Health Acts :— (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 236 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 41 (b) By Local Authority in default of owners ... - (c) Proceedings under sections 11 and 13 of the Housing Act, 1 936:— (1) Number of dwelling houses in respect of which Demolition Orders were made 3 (2) Number of dwelling houses demolished in pursu- ance of Demolition Orders 3 (d) Proceedings under scction 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 Housing Act, 1936.—Part IV.—Overcrowding. It is not possibles to live dependable statistics under this heading. as a resort of various factors arising out of the war, over crowding was recovered. 52 Staff.—The staff engaged on housing work during the year consisted of four Sanitary Inspectors, each carrying out all the duties of a Sanitary Inspector in the district allocated to him. One of these was mainly engaged in duties connected with the Housing Regulations, 1925. HOUSING CONDITIONS IN THE BOROUGH. General Observations.—It is difficult to discuss the subject of housing in Chelsea without some understanding of the peculiar conditions which appertain to the district. Probably in few London boroughs have there been so many alterations, consequent on demolitions and reconstructions, during the past 40 years, as in Chelsea. The process of reconstruction is still in progress, though largely suspended by the operation 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 rhe shortage of and greatly increased cost of building land in Chelsea have rendered an already difficult situation still more difficult. The Housing Committee of the Borough Council has been actively engaged in investigating possible sites in connection with further housing schemes and from time to time various schemes have been formulated by the Council and submitted to the Ministry of Health for approval. Of the schemes prepared and submitted to the Ministry, 'five have fortunately materialised, approval of the others not being obtained on the ground that the cost of the land was much higher than the price the Ministry could sanction for the purchase of land to be used for the erection of buildings to house the working classes. These buildings are now fully occupied. Details of each approved scheme are shown in table No. 38 (Page 57). Reviewing the history of the past 40 years, it would appear that the housing policy of the Borough Council has been firstly to preserve, where possible, in areas threatened with demolition, such working class accommodation as was of reasonably good type ; and secondly, to provide accommodation by means of new buildings in an accessible situation within the Borough for those persons of the working class who are average representatives of their class, and for whom the necessities of their trade or calling render residence within the Borough desirable or necessary. It cannot be disputed that at the present time in Chelsea, as in other Metropolitan Boroughs, there is considerable dearth of accommodation both for the working classes, and for the classes in receipt of small salaries or earnings, and that, as elsewhere, this situation is primarily due to the restrictions imposed upon the building trades during the war and the economic disturbances which have succeeded it. It will, however, be evident from the details already given that the existing shortage of housing accommodation in Chelsea is being most adequately dealt with and that the extremely difficult problems which confronted the Borough Council subsequent to the war arc gradually being overcome. Overcrowding.—During the period 1st November—4th December, 1935, a Survey of Working Class dwelling houses in the Borough was carried out in accordance with the requirements of Part 1, section 1, of the Housing Act, 1935. The total number of houses dealt with and recorded was 5,112. The total number of families comprised in the enumeration was 8,490, and judged by, the standard laid down in the Housing Act, 1935,749 of these families were found to be living in overcrowded conditions—a percentage of 8-78 for the Borough as a whole. The problem of abating overcrowding is receiving close consideration by a Special Committee of the Council. Many cases when approached as to the desirability of having their names submitted to the County Council,with a view to provision of housing on one of the Council's Estates, decline to consider the proposition, 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 further survey of working-class dwelling-houses in the Borough was carried out in accordance with the Housing Act, 1930. The purpose of the survey was to ascertain the permitted number of persons entitled under the Act to occupy a working-class dwelling. This necessitated the measurement of each room in 5,112 houses. Under Section 62 of the Housing Act, a Landlord or Occupier of a dwelling-house may apply to a Local Authority, and it is the duty of the Local Authority to inform the applicant, in writing, of the number of persons constituting the permitted number in relation to the house. Fitness of Houses.—The general standard of housing in the Borough is satisfactory. There has been a very definite improvement in housing conditions during the past ten years. The vast majority of houses have an adequate internal water supply and adequate sanitary accommodation within their own curtilage. The constant vigilance of the Sanitary Inspectors has impressed upon both owners and tenants their determination that every dwelling house shall be maintained in a reasonable state of repair and that there shall be systematic observance of cleanliness. While the great majority of these houses are structurally sound, a number of them are old, worn out and below the modern standards of sanitation and convenience. It is probable that only a minority of the tenants would be able to pay economic rents for alternative accommodation, 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 694, the number found not to be in all respects reasonably fit for human habitation being 236. The number rendered fit in consequence of informal action by the Sanitary Inspectors was 195, and the number in respect of which statutory notices were served requiring defects to be remedied was 41. No case came to the knowledge of the Department in the course of the year of an underground room being illegally used for sleeping purposes. No application under the Increase of Rent and Mortgage Interest (Restrictions) Acts was made by an occupier of a dwelling house, that the house occupied by him was not in a reasonable state of repair. Unhealthy Areas.—No representations were made under the Housing Act during the year. No complaints that areas were unhealthy have been received. Byelaws relating to Houses and Houses Let in Lodgings.— Existing byelaws relating to houses are,-on the whole, found to be fairly satisfactory in their working. Housing Inspections.—House-to-house inspection was carried out during the year, as provided by statute, 140 houses being inspected and recorded by the Inspectors. 57 TABLE No. 38. Post-War Housing. Name of Undertaking. Area of Site. Total Cost. Date of Completion. Number of Flats. Population. Rents. Remarks. Hortensia House, Hortensia Road. 1 acre, 12 poles. £40,000 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, 28 poles. £21,200 (cost of site). 1920 160 747 persons. 41- to 13/- per week, exclusive of rales 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. Sito 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 of 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 freauent inspection. 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 86 inspections of dairies and milkshops made in the Borough. . 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 29 applications from 13 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. 1941 To sell "Accredited" Milk - To sell " Tuberculin Tested " Milk 6 To sell " Pasteurised" Milk i 11 Supplementary Licences 4 21 59 Further reference to milk is made in the Public Analyst's Report for the year. Public Health (Meat) Regulations, 1924.—Meat inspection is carried out by the Sanitary Inspectors. Arrangements have been made whereby adequate notice of the time of slaughter is obtained. 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 private slaughterhouse in the Borough. Bakehouses.—There arc 26 bakehouses in the Borough, and 26 inspections of these premises were made during the year. 60 Ice Cream Vendors.—At the end of the year, 29 premises were shown in the Register as places where ice-cream is prepared or sold. There were 5 inspections of these premises as compared with 50 in the previous year. This trade is mainly regulated under the Public Health (London) Act, 1936. It is an offence to store ice-cream in a sleeping room or in any shed or room in which there is an inlet to a drain. Vendors of ice-cream must notify the occurrence of infectious disease among their employees or persons living on their premises. The Act also provides that every itinerant vendor shall exhibit on his barrow the name and address of the person from whom the ice-cream has been obtained. Fried Fish Vendors.—At the end of the year there were 6 premises in which the frying of fish was carried on and 14 inspections of these premises were made. It is found that a reasonable standard of cleanliness is now being maintained, but it is necessary for the Inspectors to maintain a constant vigilance to impress upon the vendors the necessity for the systematic observance of cleanliness. Inspection of Other Premises where Food is Prepared or Offered for Sale.—The Inspectors keep under frequent observation all other premises where food is prepared for or exposed for sale. Included in this category are restaurants and premises used by provision dealers, butchers, fishmongers and greengrocers for the purposes of their trades. Table No. 33 (page 46) shows, for the past two years, the number of inspections of premises where food was prepared for or exposed for sale. UNSOUND FOOD. The amount of food seized or voluntarily surrendered as Unfit for human consumption showed a consider able Increase on quantities condemned as compared with pre- war years. 32 consignments of foodstuffs of Various kinds were exam wed. A certificate was given The owners after the articles were destroyed or Rendered un saleable . Inspection of food swaged from war-damaged premises Food Poisoning.—No case of food poisoning occurred during the year. Food and Drugs Act, 1938, Four hundred samples, were taken and submitted for analysis during the year. These samples were investigated by the Public Analyst to the Borough, whose Report is set out in the appendix. Each of the four male Sanitary Inspectors is appointed an Inspector under the Acts. Under their direction, the taking of samples is effected by individuals temporarily employed for the purpose, the services of persons outside the Borough being frequently utilised. The samples procured are of two kinds—formal and informal. Formal samples are those taken strictly in conformity with the Act. Informal samples are those taken without these strict formalities and afford useful indication of the conditions without disclosing to the vendor that the object of purchase is analysis. 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 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. six samples were submitted for investigation during the year, each of which was found to be satisfactory in character. DISSEMINATION OF KNOWLEDGE AS TO NUTRITION. Advice as to the necessity for a high standard of purity and quality in relation to food is given by the staff of the Public Health Department. In addition, lectures and film demonstrations on Health topics, including Diet, are given from time to time at the premises of the Chelsea Health Society. Leaflets are also issued to expectant and nursing mothers which are of great assistance in focussing attention on this important subject. The desire of the public to consume a natural product, or at least that they should be made aware if offered an artificial substitute, has found expression in the Artificial Cream Act, 1929. 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 394. Of this figure, 57 were notifications of Pulmonary Tuberculosis and 5 of Non-pulmonary Tuberculosis. As compared with the previous year, there was an increase of 16 in the number of notifications of Diphtheria. The number of notifications of Scarlet Fever (23) represents an increase of 10, as compared with that for 1940. The number of notifications of Tuberculosis was 6E,aniacrease of 6 as compared with that for 1940. 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 :— TABLE No. 40 Cases of Infectious Disease Notified during the Year. 1941 Cases notified in Chelsea. Cases notified in each Ward. Removed to various Hospitals cases notified in Chelses 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. C hurch. Hans Town. Royal Hospital. 1939 1940 Small-pox — — — — — — — — — — — — — — — — —- — — — — Chicken-pox — — — — — — — — — — — — — — — — — — — 1 — Relapsing Fever — — — — — — —- — — — — — — — — — — — — 1 — Diphtheria 31 4 '7 1 1 2 — 1 1 8 2 3 1 7 5 17 1 1 31 65 15 Erysipelas 16 — — — — — — — — 1 1 9 5 7 1 6 1 1 13 15 9 Scarlet Fever 23 2 2 1 3 3 4 1 3 2 2 — — 7 4 11 — 1 22. 49 13 Typhus Fever — — — — — — — — — — — - — — — — — — — — — Enteric Fever 6 — — — — — — 1 1 2 2 — — 6 — — — — 6 1 1 Puerperal Fever — — — — — — — 2 2 Puerperal pyrexia 3 — — — — —J —_ 2 1 — — 2 — — 1 — 3 10 6 Cerebro-spinal Fever ... 4 — — — — — 2 1 — 1 — — — 2 — — — — 4 1 7 Ophthalmia Neonatorum 4 4 — — — — — — — — — — — 2 — 2 — 2 5 3 Poliomyelitis — — — — — — — — — — — — — — — — — — — Encephalitis Lethargica — — — — — — — — — — — — — —• — — — — — — Polio-encephalitis — — — — — — — — — — — — — — — — — —_ — — — Malaria — — — — — — — — — — — — — — — — — — — 1 — Dysentery 95 5 2 2 — — — — — 3 1 18 64 86 — 9 — — 95 4 6 Acute Primary Pneumonia Acute Influenzal 64 9 3 2 2 — 2 — 1 4 5 22 14 19 2 31 7 5 46 43 59 Pneumonia 2 — — — — — — — — 1 1 — — 2 — — — — 1 4 9 Food Poisoning — — — — — — — — — — — — — — — — — — — — 5 Measles 40 5 8 3 9 2 5 2 2 10 — — — 15 — 14 10 1 16 16 150 "Whooping Cough 44 6 12 9 6 2 8 — — 1 — — — 27 3 18 1 — 15 74 4 Total Tuberculosis :— 332 35 34 18 15 9 21 6 8 35 15 52 84 182 15 103 21 11 254 292 289 Pulmonary 57 — — 1 — — 1 5 16 13 17 4 2.7 5 18 1 6 75 49 Non-Pulmonary 5 — — — — — — — — 3 — 2 — 3 — 2 — — 5 5 Totals (Tuberculosis)... 62 — — — 1 — — 1 5 19 13 19 4 30 5 20 1 6 80 54 Totals 394 35 34 18 16 9 21 7 13 54 28 71 88 212 20 123 22 17 372 343 NOTE:- Notifications have not been corrected for any subsequent revision of diagnosis. 64 No cases of Small-pox, Cholera, Typhus Fever, Encephalitis Lethargica, Polio-Encephalitis, Malaria, Continued Fever. Relapsing Fever. Plague. Anthrax, Glanders, Hydrophobia, Puerperal Fever, Poliomyelitiss, or Food Poisoning were notified during the year. DIPHTHERIA. Notifications.—During the year 31 cases of diphtheria were notified as compared with 15 in the previous vear. Information was received from the London County Council that 10 of the cases sent to Hospital proved not to be suffering from Diphtheria. The actual number of cases was therefore 21. Deaths.— Mo deaths from the disease occurred during the year. Return Cases.— One "return" case of the disease occurred during the year. The incidence" of the disease during the past three 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. Per cent age Nega tive. 1939 60 100 3 5.0 51 Feb. 236 24 10.0 212 90.0 1940 10 100 — 0.0 53 June 59 — 0.0 59 100.0 1941 21 100 — 0.0 14 May 142. 7 5.0 135 95.0 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. * In addition, clinics were held at the L.C.C. Schools in the Borough by the Medical Officer of the Borough Council Clinic. 65 The following table gives details of the work of the clinic during the past three years. TABLE 41A. Year No. of new cases. Preliminary Schick Tested. Commenced treatment without Schick Test. Immunised. Discontinued treatment and removed from register. No. under treatment at end of year. Preschool Age. School Age. Naturally Immune Preschool Age. School Age. 1939 241 3 36 202 16 164 22 10 125 1940 191 4 22 165 12 160 19 3 118 1941 754 5 396 353 149 151 420 29 29 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, 2,3 cases of Scarlet Fever were notified, the figure for 1940 being 18. Information was received from the L.C.C. Hospitals that 5 of the cases proved not to be Scarlet Fever. The actual number of cases was therefore 18. 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 three 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. 1941 18 96 — — 55 Feb. No application of the Dick test or of artificial immunization against Scarlet Fever has yet been made in the Borough. MEASLES AND WHOOPING COUGH. 66 Information as to cases occurring in the Borough was derived by notification; 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 three years :— TABLE No. 43. Year. Numbr of unnotified to the knowledge of the P.H. Dept. Cases notified Total cases. Deaths. Number of Visits and Re-Visits by Health Visitors. and Womain Sanitary inspector.. Number of Visits by District Nurses. Under 5 Over 5 Under 5 Over 5 Under 5 Over 5 Total Under 5 Over 5 Total years. years years years years years years years 1939 6 — 5 11 22 — 11 6 17 — — — 1940 — 6 87 63 156 — 24 46 70 2 10 12 1941 — — 21 19 40 — 33 24 57 29 — 29 WHOOPING COUGH. The incidence of the disease during the past three years is shown in Table No. 44 :— TABLE No. 44. Year. Numbr of unnotified cases coming to the knowledge of the P.H. Dept. Cases notified Total cases. Deaths. Number of Visits and Re-Visits by Health Visitors, and woman S.L. Number of Visits by District Nurses. 1939 36 74 110 — 213 137 1940 — 4 4 3 — 1941 — 44 44 — 103 53 Removal to Hospital.—Cases of Measles and Whooping Cough are received in the hospitals of the London County Council. 67 ENTERIC FEVER. Year Notifications. Treated in Hospital. Deaths. 1939 1 1 - 1940 1 - — 1941 6 6 - The history of each case was thoroughly explored, but it was found impossible to trace an unvarying causative factor between the various cases. Five specimens of blood were examined during the year 1941 for the Widal reaction. Deaths.—There was no death from this disease during the years 1939-41. 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 three years:— TABLE No 45. Year PNEUMONIA. MALARIA. DYSENTERY. Total Number of Cases Notified. T reatment in Hospital. Total Number of Cases Notified. Treatment in Hospital. Total Number of Cases Notified. Treatment in Hospital 1939 47 39 1 1 1 4 1940 59 53 — — 4 6 1941 66 47 — — 95 95 Pneumonia.—All primary pneumonias, lobar or lobular, are notifiable. The only secondary pneumonia which is notifiable is influenzal pneumonia. Nursing Provision.—By arrangement with the Chelsea District Nursing Association, all cases of Pneumonia receive adequate nursing attention where the circumstances render this necessary. One hundred and seventy-one visits were made during the year. Deaths.—There were 40 deaths from Pneumonia (all forms) during the year. The number in 1939 was 39, and in 1940- 45. 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 ninety-five cases notified during the year were due to infection from the Sonne bacillus. 68 PUERPERAL FEVER AND PUERPERAL PYREXIA. 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 1939 2 1 0 0 0 1940 2 2 0 0 — 19 41 — — — — — Puerperal pyrexia 1939 10 8 0 0 1* 1940 6 3 2 1 1 1941 2 3 — — — * Non-parishioner; died In a Chelsea, hospital. 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 Dractitioner in attendance. 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. As required by the Ministry of Health, particulars of the notified eases are set out in the following table :— TABLE No. 47. Ophthalmia Neonatorum. Cases. Vision Un impaired. Vision Impaired. Total Blindness. Left District. Deaths. Year No. Notified. Treated. At Home. In Hospital. 1939 5 3 2 5 — — — 1940 3 3 — 3 — — — — 11941 4 2 2 4 — — — — 69 Nursing -By arrangement with the Chelsea District Nursing Association, home nursing is provided for infants suffering from this disease. Twenty-six visits were made during the year. In 1939, 61 visits; 1940, 82. 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. No cases of Poliomyelitis were notified during the years 1939-41. ENCEPHALITIS LETHARGICA. No case of Encephalitis Lethargica was notified during the years l9391941. Visits to old cases of Encephalitis Lethargica were made by the Woman Sanitary Inspector. Encephalitis Lethargica is undoubtedly infectious, but the infectivity is of very low nature. The sequelæ may be serious, as in most cases some permanent damage to the brain tissue occurs. The disease was made compulsorily notifiable from 1st January, 1919. Deaths.—There was No death from this disease during the year. cerebro-spinal fever. Year Notification. Treatment in Hospital. Deaths. 1939 1 1 2 1940 7 6 1 1941 4 4 - 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 years 1938-40. The figures for the year 1941, are not yet available. 70 TABLE No. 48. Vaccinations. 1938 1939 1940 Number % Number % Number % Births registered 811 100 310 100 169 100 Successfully vaccinated 463 671 176 66.8 82 48.5 Insusceptible of vaccination 2 0.2 2 0.6 1 6 Had Small Pox - - - - - - Statutory Declaration of conscientious objection 153 18.9 55 17. 7 15 8.9 Died unvaccinated 29 3.6 7 1.3 7 4.1 Postponed by medical certificate 2 0.2 - - - Removed to other districts 77 9.9 31 10.0 32 18.3 Removed to unknown addresses 78 9.6 37 12.0 31 19.0 Not accounted for in previous columns 7 0.9 . 2 0.6 1 0.6 The above table is based on total births occurring in Chelsea and is not confined to parishioneis. The total number of successful primary vaccination certificates (children under 14 years of age) received during the year 1941 was 130. The number for 1930, 441 and 1940, 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 DISINFESTA- TION AND THE EXTENT OF THEIR USE. The Borough Council maintains a Disinfecting and Cleansing Station situated at 9a, Lots Road, Chelsea, adjoining the river. Disinfection.—The disinfecting staff, numbers three. A steam disinfector is provided. An appropriate motor vehicle is utilised for the conveyance of infected and disinfected articles to and from the Disinfecting Station. Disinfection in connection with the notifiable infectious diseases is carried out free of charge. Applications for special disinfection, not associated with the notifiable infectious diseases, are considered, and, if the work of the Department permits it, are carried out at the expense of the applicant. Seven such disinfections were carried out during the year, the total charges amounting to £2 8s. Od. 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. Two 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. TABLE No. 49. L.C.C. Scheme. Cleansing of Verminous Children etc. Attendances. 1 9 39 1940 1941 Verminous 557 298 233 Scabies - - 54 Impetigo 1 - - Minor ailments 394 91 - Amount recoverable from, L.C C. £75.9.0 £54.7.0 £26. 108 adults were cleansed at the Station during the year, of these, 90 were suffering from scabie, (6) TUBERCULOSIS. This part of the report deals with the work of the Department under the Public Health (Tuberculosis) Regulations, 1930, and under the Dispensary scheme approved by the Ministry of Health and the London County Council. The latter contribute 25 percent. 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 64 but 5 of these related to cases which had been previously notified, so that the total number of new notifications was 62 In the previous year, the corresponding number was 54, 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 13 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 1941. Age Periods. New Cases. Deaths. Respiratory. Nonrespiratory. Respiratory. Nonrespiratory. M. F. M. F. M. F. M. F. 0— 1 - - - - - - - - 1— 5 - 1 - - - - - - 5—10 - - - 1 - - - - 10—15 1 - - - - - 1 - 15—20 1 4 - - 2 2 - - 20—25 1 5 1 - - 2 - - 25—35 5 9 1 2 2 1 1 - 35—45 /o 4 - 2 1 - - 45—55 9 4 - 1 4 4 - - 55—65 6 1 - 1 4 - - - 65 and upwards 3 4 - - 4 3 - - Totals 36 32 2 5 18 13 2 - The death rate from all forms of Tuberculosis in Chelsea was 1.2 per 1,000. Of the total number of deaths (33) from all forms of Tuberculosis, 6 died non-notified or prior to notification. The ratio of nonnotified tuberculosis deaths to total tuberculosis deaths was therefore as 1 is to 5 The corresponding ratio for l940 was 1 : 3. Making allowance for difficult and doubtful cases in which a diagnosis cannot be established unt il after death, the notification of tuberculosis is carried out fairly efficiently in the Borough. Cases of Tuberculosis in the Borough.—The Public Health (Tuberculosis) Regulations, 1930, provide that the Medical Officer of Health shall furnish to the County Medical Officer, as soon as practicable after the end of each quarter, a statement compiled from the register of notifications showing :— (a.) The number of cases of Tuberculosis on the Register at the commencement of the Quarter ; (b.) The number of cases notified under the Regulations for the first time during the Quarter ; • (c.) The number of cases removed from the Register during a preceding Quarter which have been restored to the Register during the Quarter, giving the name and address of each such case and the reasons for the restoration; (d.) The number of cases added to the Register during the Quarter which have been brought to notice otherwise than by notification under the Regulations; (e.) The number of cases removed from the Register during the Quarter giving the name and address of each such case and the reason for such removal; and 73 (f.) The number of cases remaining on the Register at the end of the Quarter. The returns made in accordance with these Regulations show that the numbers of eases of Tuberculosis in the Borough on 31st December last were as follows :— TABLE No. 51. Males. Females. Total. Pulmonary 93 63 156 Non-pulmonary 16 15 31 109 78 187 (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 65 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. In addition, a further Table, No. 53 (page 75), has been compiled showing in summary form the condition of all patients whose case records were in possession of the Tuberculosis Dispensary at the end of 1938, arranged according to the years in which the patients first came under Public Medical Treatment of pulmonary and non-pulmonary tuberculosis. The special cases which were accepted for institutional treatment by the London County Council, but which were not dealt with by the Chelsea Tuberculosis Dispensary, are also included in this table. 74 TABLE No. 52. Treatment of Tuberculosis, Year 1941. 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 22 18 1 - 1 2 -__ - 23 20 1 - 145 (b) Diagnosis not completed - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 58 35 5 3 3.—Contacts examined during the year :— i . (a) Definitely tuberculous 1 1 - - - - - - 1 I - - 91 (b) Diagnosis not completed - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 12 39 20 18 2.—Cases written off the Dispensary Register as :— (a) Recovered 1 2 - - 3 l 1 - 4 3 1 - 202 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 72 75 25 22 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 73 57 8 - 3 10 2 2 76 67 10 2 155 (b) Diagnosis not completed - - - - - - - - - - - - 1. Number of cases on Dispensary 2. Number of cases transferred from Register on January 1st 180 other areas and cases returned after discharge under Head 3 in previous years 11 3. Number of cases transferred to [ other areas, cases not desiring 4. Cases written off during the year further assistance under the | as Dead (all causes) scheme, and cases " lost sight of"46 6. Number of Insured Persons under 5. Number of attendances at the Dis- Domiciliary Treatment on the pensary (including Contacts) 904 31st December 8. Number of visits by Tuberculosis 7. Number of consultations with Officers to homes (including medical practitioners :— personal consultations) 9 (a) Personal (b)Other 48 10. Number jf :— • (a) Specimens of sputum, etc., 9. Number of visits by Nurses or examined 59 Health Visitors to homes for (b) X-ray examinations made Dispensary purposes 1,650 in connection with Dispensary work 395 11. Number of " Recovered " cases 12. Number of " T.B. plus" cases on restored to Dispensary Register, Dispensary Register on Decern- and included in A (a) and A (b) . ber 31st 81 above 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 -(Dr. W. J. Fenton) is Dean of the Medical shool and Honorary Consulting Physician to the Hospital and his services are available when required by any medical practitioner in the Borough. Social work in connection with the Dispensary cases is carried out systematically and well by a trained Social Worker. With the approval of the Ministry of Health, the Borough Council made a financial grant of £1,000 to Brompton Hospital for the year commencing 1st April, 1938. An additional sum of £160 for Nurses visits to homes of patients was also granted by the Council to the Hospital and approved by the Ministry of Health. Table No. 54, summarises, for the past 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. 1939 208 10 percent. 1,563 1940 140 12 ,, ,, 1,046 1941 122 17 ,, ,, 904 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, 41 per cent. died in St. Luke's Hospital and 34 per cent. in other public institutions, that is to say 75 percent died away from their homes, the corresponding figure for 1937 being 94 percent. 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 9 case (including personal consultations) at the homes of the patients, and 48 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 91, an increase of 48 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-two patients received treatment. The total cost £193.14.6.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 1658, an increase of 466 over the number for the previous year. The Council lent a bedstead and bedding to one case during the year. Extra Nourishment.— Twenty six 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 (£63. 18s Id) 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 ninety five X-ray tions and 55 Mantoux tests 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 1 een made with the British Dental Hospital, 235, Hammersmith Road, W., for the provi-ion 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, 5 patients received dental treatment (including five cases for dentures), the Borough Council making a contribution of £14.5s. 0d. towards the cost. Bacteriological Examinations.—During the year, 323 specimens of sputum were examined in connection with the work of the Dispensary. In addition, 11 specimens were sent by medical practitioners to the Lifter Institute*for examination. *and Clinical Research Association 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 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 8 Cases considered 494 Cases reported admitted to L.C.C. Institutions 112 Dental treatment given through Borough Council Scheme 10 Extra nourishment given through Borough Council Scheme 16 Extra nourishment given through other agencies 25 Other assistance given 37 Children boarded out through the L.C.C. Contact Scheme 3 Convalescence arranged 29 Patients' voluntary contributions towards the cost of Institutional treatment collected on behalf of the L.C.C. £35 5s. Metropolitan Borough of Chelsea. Annual Report OF THE PUBLIC ANALYST For the Year ended 31st December, 1941 BY THOMAS McLACHLAN, A.C.G.F.C., F.I.C. To the MAYOR, ALDERMEN and COUNCILLORS of The Metropolitan Borough of Chesea. Mr. Mayor, Ladies and Gentlemen, During the year 1941 the most important factor resulting from the war was the introduction of numerous food substitutes, which made it necessary for the Minister of Food to issue the Food Substitutes (Control) Order, 1941. This Order has helped to improve matters considerably, but there is reason to believe that full information is not necessarily disclosed to the Minister by applicants for Licences whilst the Minister is unable to see his way to disclose the terms of the Licence to Local Authorities for the purposes of making analyses. In view of the fact that the Order states that holders have to comply with the provisions of the Food and Drugs Act, Public Analysts are often placed in a very difficult position owing to the action of the Minister. It is to be hoped that administration on these lines will disappear with the end of hostilities. ( Cent. on page 84 It is to be hoped that administration on these lines will disappear with the end of hostilities. Article. Taken Formally Adulterated. Taken Informally. Adulterated. Total Samples Analysed Total Samples Adulterated. Milk 20 0 0 0 20 0 Milk Substitute 1 1 0 0 1 1 Baking Powder 1 0 1 0 2 0 Bwowits, Cakes, Puddims 2 0 6 0 8 0 Bread 1 0 2 0 3 0 Butter 0 0 1 0 1 0 Cake and Pudding Mixtures 10 0 10 4 20 4 Cereal Tbods 3 0 6 0 9 0 Cereals 5 0 9 1 14 1 Cheese 1 0 1 0 2 0 Cocoa, 8 0 5 0 13 0 Cctfee 3 0 2 0 5 0 Coffee Extract. 4 0 1 0 5 0 Coffee with Chicor 1 0 1 0 3 0 Confectionary (sweets) 2 1 0 0 2 1 Cordials 10 0 7 0 17 0 Custard- Pewdars 11 0 5 2 16 2 'Eggs, dfied. 0 0 1 0 1 0 Egg Substitute. 1 0 3 0 4 0 Essences colouring and flovouring sotu fions 8 1 16 1 24 2 Fish, bottled and tinned 0 0 8 0 8 0 Fish pasta 0 0 4 0 4 0 Flour 14 0 1 0 15 0 Fruit, trinned 0 7 0 7 0 Gelatin 1 0 0 0 1 0 83 TABLE—continued. Article. Taken Formally. Adulterated. Taken Informally. Adulterated . Total Samples Analysed Samples Adulterated . Grawy & Soup Powders 11 1 5 2 16 3 Jelly. 1 0 0 0 1 0 Junket Powders 1 0 0 0 1 0 lemon Subtbibute 2 0 1 1 3 / Malted/ Milk Powder. 1 0 2 0 3 0 Meat, ceeked,. 2 0 0 0 2 0 Meat extract. 4 0 3 0 7 0 Meat paste. 2 0 5 0 7 0 Meat Pie 0 0 2 0 2 0 Meat, tinned. 2 0 2 0 4 0 Oilo, salad & culimary 1 0 1 0 2 0 Onions Substitute. 1 0 0 0 1 0 Orange Substitute 1 0 1 1 2 1 Peanut, Butter. 0 0 1 0 1 0 Pickles and Sauces. 19 0 19 1 38 1 Saccharin &, Sugar Suos. 4 2 8 2 12 4 Sausages. 0 0 0 0 6 0 Soups & Vegetables, tanned. 9 0 17 0 l6 0 Spices and Condiments. 9 1 8 1 17 2 Vegetables, Jried,. 1 0 0 0 7 0 Veqttable Extract 0 0 1 0 1 0 Vinegar, Malt & Nonbre 4 0 4 1 8 1 Yeast Extract. 0 0 2 0 2 0 WINE & SPIRITS. Ale and Bear 1 0 0 0 1 0 Wine. 0 0 2 0 2 0 DRUBS. Aspirin Tablets. 1 0 0 0 1 0 Bicarbonate of Ioda. 2 0 0 0 2 0 Castor Oil. 0 0 1 0 I 0 Cod. Liver Oil 2 0 1 0 3 3 friat's Balsam. 0 0 1 1 1 1 Glycerine. 1 0 0 0 1 0 Chemical food. 1 0 0 0 1 0 Headache Mixture. 1 0 0 0 1 0 Laxatives. 5 0 0 0 5 0 Lung Syrup. 1 0 0 0 1 0 Orange Tanic Wine. 1 1 0 0 1 1 Peppermint Essence. 1 1 1 1 2 2 syrup of Tigs. 0 0 2 0 2 0 Tincture of lodine. 0 0 1 0 1 0 Totals 211 9 189 19 400 28 Percentages of Total 52.1 2.23 47.25 4.75 1oo 7.00 The actual percentages given by the data in the Table are as follows :— Genuine Composition 93 per cent. Adulterated 7 per cent. Another feature, which does not appear to have been appreciated is that, owing to Excess Profits Tax, manufacturers are able to engage the most expensive legal and technical assistance obtainable for their defence at the cost of the tax payer, but without consulting him, where as the Local Authority, bringing the action, has seriously to consider the pockets of the local rate payers. In Chelsea recourse is seldon made to the Courts and on the whole manufacturers respond well to suggestions made to them. During the year 400 samples were submitted for examination Of these 20 were milks, one was a milk substitute, 3 were beers or vines, 353 other foods and 23 were drugs. It will be seen from the accompanying Table that the percentage of adulterated samples has risen to seven as compared with 4.5 in the previous year, 2.25 per cent in 1939, and 1.0 per cent in 1938. The Milk Substitute powder was composed of a mixture of wheat and rice flour with a small quantity of soya flour and possessed none of the properties of milk; it acted merely as a thickening agent in cooking. Four samples of cake and pudding mixtures were reported against. Of these one was swarming with acaries, two were sold as sweetened cake mixtures and were almost devoid of sweetening properties, whilst the fourth,sold as a Yorkshire Pudding Powder, was merely a coloured baking powder about oO per cent deficient in raising properties. In this case the Minister of Food refused to disclose the terms of the Licence, but with some trouble they were obtained from the manufacturer and it is needless to remark that they did not conform to requirements. A soup mixture sold as a Cereal Mixture contained only 11.2 per cent of cereals, the remainder being a mixture of legumes. .A sample of cachous were reported as Genuine, but inferior,.because they were dark violet in colour, indicating that they were cough cachous, but consisted of sugar with a rose flavour. Two samples described as Vitamin Custard Powder were devoid of vitamins. The manufacturers stated that the powder formerly contained vitamins and that when these-ceased to be available owing to the war they continued to use old cartons. Objection was taken to two samples of cochineal on the ground that they were 75 per cent deficient in colouring properties. Standards are laid down for cochineal solutions sold for pharamceutical purposes, but manufacturers claim that there is no necessity to conform to any standard provided that the preparation is sold only for culinary purposes, Since the housewife seldom buys a bottle of colouring solution she is not likely to remember what particular make is the best and I am, therefore, of the opinion that all preparations should conform to one standard, so that people know what they are obtaining for their money. Three samples of Gravy Powder made claims to contain vitamins and to be of high nutritive value, although they were devoid of the former and possessed practically no nutritive value, when used according to directions. A sample sold as a Lemon Substitute, containing about a third of an ounce of tartaric acid with the merest trace, if any, of vitamin C, was sold at ninepence, whilst an Orange Substitute consisted of a 4 per cent solution of tartaric acid and contained no Vitamin C. A bottle of Tomato Sauce contained sulphur dioxide preservative without a declaration to this effect on the label. Two samples of saccharin tablets and two of sweetening solution were found to be 50 per cent deficient in sweetening capacity, according to the claims made for them. A sample of cloves contained 20 per cent of stalk and powder, which could have been removed without much trouble and one of Parsley, Thyme and Lemon Stuffing was devoid of any lemon flavouring. This type of preparation is only seasonal and is dependent on catch sales. A sample of vinegar, sold from the bottom of a cask, was swarming with vinegar eels. Five bottles of Friars Balsam were found to contain from three-quarters to one and a half times the Pharmacopeoial dose, but without any guide to the purchaser as to dosage or quantity contained in the bottle. Orange Tonic Wine was found to contain no quinine or Vitamin C. and was devoid of any tonic properties, whilst two samples of Peppermint Essence, recommended for medicinal purposes, were prepared with isopropyl alcohol as a solvent. I have the honour to be, M.r. Mayor, Ladies and Gentlemen, Your obedient servant, THOMAS McLACHLAN, CHE45 METROPOLITAN BOROUGH OF CHELSEA.. ANNUAL (ABRIDGED) REPORT of the MEDICAL OFFICER OF HEALTH for the year 1941. To the Mayor, Alderman & Councillors of the Metropolitan Borough of Chelsea. Mr. Mayor, Ladies & Gentlemen, I have tho honour to submit my Annual Report on the health and sanitary conditions of the Borough for 1941, The health of the population was good. The incidence of infectious disease was low. Every effort was made for the prevention of disease, including infestation by vermin. Sanitary administration of the Borough was satisfactorily maintained throughout the year, despite the many extra duties thrown upon the Department. All complaints were investigated and necessary action taken. Close attention was devoted to the supervision of food supplies. The Chelsea Health Society continued to render valuable assistance in connection with Maternity and Child T"elfare work. The Society arranged for Protective Inoculation of a very high percentage of children against Diphtheria, I should like to thank 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. I am, Mr, Mayor, Ladies and Gentlemen, Your obedient Servant, W.h.l. McCarthy, m.d., d.p.h. Medical Officer of Health. Public Health Department, 43, Chelsea Manor Street, S. W. 3. l6th JULY. 1942. Total M. F. LIVE BIRTHS. Birth rate per 1,000 Legitimate 272 129 143 estimated civilian Illegitimate) 34 22 12 population 11.6 306 151 155 Rate per 1,000 total STILL BIRTHS. 4 2 2 (live and still) births 12.9 DEATHS. 600 328 272 Death rate per 1,000 estimated civilian population 22.7 deaths FROM PUERPERAL CAUSES: NONE. DEATH RATE OF INFANTS UNDER ONE YEAR OF AGE; ALL infants per 1,000 Live bir ths 38 Legitimato infants per 1,000 legitimate live births 40 Illegitimate infants per 1,000 illegitimate live births 31 CLASSIFICATION OF DEATHS. The causes of death (600) were as follows; Tuberculosis respiratory system 31; other forms of Tuberculosis 2; Syphilitic Diseases 6; Influenza 5; Cancer (various sites) 76; Diabetes 3; Intra-cranial Vascular Lesions 31; Heart Disease 171; other diseases of circulatory system 20; Bronchitis 38; Pneumonia 40; other respiratory diseases 5; Ulceration of Stomach or Duodenum 10; Appendicitis 35 other digestive diseases 10; Nephritis 13; Premature birth 4; Congenital malformations, Birth injury, Infantile disease 5; Suicide 3; Road traffic accidents 1; other violent causes 91; all other causes 32. INFANT MORTALITY. There were 9 deaths of infants under one year of ago. The causes of death were as follows :- pneumonia 1; Premature birth 4; Congenital Malformations 3; and other violent causes 1, PROVISION OF HEALTH SERVICES.THE ,THE BOROUGH. BACTEHRIOLOGICAL EXAMINATIONS. The total number was 167, including 142 for "the "bacillus associated with Diphtheria. NURSlNG IN THE HOME. The arrangement with the Chelsea District Nursing Association was s continued throughout the year, The total number of visits paid wore 1,483 (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 throu^iout the year. The total number of attendances at the clinics by infants under one year of ago was 1,381 and 557 children attended between the ages of 1 and 5 years. There were 420 attendances by mothers at the ante-natal clinic and 17 mothers attended the postnatal clinic. The Chelsea Day Nursery functioned at an address in Sussex. INVALID CHILDREN'S AID ASSOCIATION. The arrangement with the Association was continued throughout the year. The number of applications referred to them for assistance of children undor 5 years of age was 54 (actual cases 48). HEALTH VISITORS. The total number of visits made was 2,945, The number of half-day attendances at Clinics was 6l7. CHILD LIFE PROTECTION. 107 visits (including 37 miscellaneous visits were made to foster mothers, 2 DENTAL TREATMENT. 30 Cases attended the Dental Clinic at the Violet Melchett Infant welfare Centre for the provision of preventive treatment for children under 5 years of age. Arrangements were also made for 2 expectant mothers to receive dental treatment. HOME HELPS. One case was attended by a Home Help. CONVALESCENCE. One nursing mother and infant were sent away to a Convalescent home. SANITARY CIRCUMSTANCES AND ADMINISTRATION. 10,339 Inspections (including re-inspections) were carried out by the Sanitary Inspectors. Included in this total number were 8l8 inspections on complaint of nuisance, 242 with reference to infectious disease and 78 as to Factories. Legal proceedings in respect of sanitary conditions were undertaken in 5 instances. 229 Intimation Notices. 71 Nuisance Notices under the Public Health (London) Act, 1936, and 3 Statutory Notices under byelaws for provision of dustbins were served during the year. DISINFECTION. During the year 172 rooms were disinfected after dases of infectious or other disease. In addition, 481 rooms were disinfested owing to the presence of vermin and 38 rooms were disinfected for various reasons. At the Disinfecting Station 18,785 articles of bedding, etc., were disinfected and 2,236 articles destroyed in the incinerator. 622 rooms used in connection with Civil Defence were also disinfected. CLEANSING STATION. 90 Adults and 30 children were treated for Scabies. 18 Adults and 249 children (including 233 children attending elementary schools) were cleansed. INSPECTION AND SUPERVISION OF FOOD. The Inspectors made 969 inspections of premises where food is prepared, stored or sold. Unsound food was surrendered and destroyed, as necessary, FOOD AND DRUGS ACT. 400 Samples were submitted to the Public Analyst for analysis during the year. Of these 211 were taken as "formal'' and 189 as "informal''. 28 samples were returned as adulterated. In each of these cases a warning letter was sent to the Vendor concerned. All other samples were returned as genuine. INFECTIOUS DISEASE AND OTHER DISEASES. NOTIFICATIONS. The total number of notifications was 394 These were as follows:- Diphtheria 31; Erysipelas 16; Scarlet Fever 23; Enteric Fever 6; Puerperal Pyrexia 3;Cerebro-spinal Fever 4; Ophthalmia Neonatorum 4; Dysentery 95; Acute Primary Pneumonia 64; Acute Influenzal Pneumonia 2; Measles 403; Whooping Cough 44; Pulmonary Tuberculosis 57; and Non-pulmonary Tuberculosis 5. DIPHTHERIA. 31 Cases were notified, of which 10 proved not to be suffering from this disease. There were no deaths. DIPHTHERIA IMMUNISATION CLINIC. 754 New cases attended the Clinic and at Clinics held at the schools in the Borough, as compared with 191 in 1940. SCARLET FEVER. 23 Cases were notified, of which 5 proved not to be Scarlet Fever. There were no deaths, 3 PUERPERAL PYREXIA. 3 Cases were notified and removed to hospital for treatment. OPHTHALMIA NEONATORUM. 4 Cases were notified. Of these, 2 were treated at home. All cases made a complete recovery. SMALLPOX AND VACCINATION. No case of smallpox was notified. Of the 169 births registered in Chelsea during 1940, 82 were successfully vaccinated a percentage of 48.5. (Figures for 1941 are not yet available). TUBERCULOSIS. 57 New cases of pulmonary and 5 of non-pulmonary Tuberculosis were notified. In addition, 13 new cases came to the knowledge of the Medical Officer of Health through other sources. The total number was, therefore, 75 (Pulmonary-Males 36, Females 32; Non-pulmonary-Males 2, Females 5). The total number of deaths from all forms of Tuberculosis was 33, the death rate being 1.2 per 1,000 of the civilian population, PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1930. The total number of cases of Tuberculosis in the Borough on the 31st December, 1941, was 187. (Pulmonary-Males 93, Females 63; Non-pulmonaryMales 16, Females 15). The Tuberculosis Visitor paid 65 visits to non-dispensary cases. DISPENSARY AND SPECIAL CASES. The number of new cases examined was 145. 44 of these were definitely Tuberculous. 91 Contacts were also examined, of which 2 were definitely Tuberculous. The number of attendances (including contacts) was 904, and 1,658 visits were made by nurses to homes of patients. The Tuberculosis Officer visited 9 patients at their homes, and 48 were referred to him at the Dispensary by Medical Practitioners in the Borough. 59 Specimens of sputum were examined and 395 X-ray examinations were made in connection with the work. The total number of cases on the register on the 31st December, 1941 was 155. ARTIFICIAL PNEUMO-THORAX TREATMENT. 22 Patients received treatment, file total cost(£193. 14. 6) was borne by the Council. EXTRA NOURISHMENT. 26 Cases received extra nourishment as part of their treatment. The total cost (£63. 18. 1) was borne by the Council. DENTAL TREATMENT. 5 Patients received dental treatment, the Borough Council making a contribution of £14. 5. 0. towards the cost, CHELSEA TUBERCULOSIS CARE COMMITTEE. The Committee met 5 times during the year and 125 cases were considered. Social services in co-operation with voluntary societies were continued.