Metropolitan Borough of Chelsea (Preface to the Annual (Abridged) Report 0f the medical Officer of Health for the year 1942). To the Mayor, Aldermen and Councilors of the Metropolitan Borough of Chelsea. Mr. Hay or, Ladies & Gentlemen, 1 have the honour to submit my Annual Report on the health and sanitary condition of the Borough for 1942. "The Health of the population was satisfactory. "The incidence of infectious disease was again low. A large increase in the number of new cases attending the diphtheria Immunisation Clinic is again reported At the end of 1942 it was estimated, that 81 par cent of children under 5, and 71 per cent of children between the ages of 5 and under 15 have been immunised. Sanitary administration of the Borough was adequately maintained throughout the year. Close attention was devoted to the supervision of food supplies. The Chelsea health "Society rendered valuable assistance in connection with the Maternity and Child Welfare work. The attendances at the Antenatal Clinic Were much higher than in. pre-war years. In (November,the Ministry of Health sanctioned the proposal for a War-time Day Nursery at the formed Chelsea Da y Nursery premises. Adaptations were in progress at the end of the year. (The nursery Was opened in March,1943 with, accommodation for 47 children). 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 arn,Mr.Hayor,Ladies t Gentlemen, Your obedient servant, W.H.L. McCarthy, M.D.,D.P.H., Medical Officer of Health. Public Health department, 43 Chelsea Wan or Street, S .W.3. 24 th. July, 1943 One 46 Metropolitan Borough of Chelsea. Annual Report of the Medical Officer of Health for CHELSEA 1942 BY w. h. leslie McCarthy, D.S.O., M.C., M.A., M.D., M.R.C.P., D.P.H., Barrister-at-Law, MEDICAL OFFICER OF HEALTH. London: vail and co. ltd., (t.u.), printers, 170, farr1ngdon road london, e.c.I. 1939. 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 1942 The chief vital statistics relating to the year are as follows The resident population of the Borough is estimated by the Registrar-General figure which is HIGHER than that for last year. The birth rate(12.5)is HIGHER than that for last year (11.6). The . marriage rate (' ) is higher than that for last year (. :). The death rate is higher than that for London generally(13.9) and compares with(22.9) 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 50 per 1,000 live births, as compared with 38 last year. The general improvement in the public health of the Borough continues to be maintained. There was a decrease in the total incidence of notifiable infectious disease during the year. The total number of notifications, excluding duplicates, was as compared with 394 last year. A considerable increase was recorded in the number of cases of measles. At the end of the year there were 212 cases of pulmonary tuberculosis and 40 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 5,012 and 4,582 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 I have again to express my appreciation of the work of the staff of the Public Health Department. I should like to thank the members of the Public Health, Maternity, Child Welfare and other Committees for the support and sympathetic consideration which they have extended to me, and for their keen attention to the problems which it has been my duty to lay before them. Copies of this report have been transmitted to the Ministry of Health, the Home Office and the London County Council, in accordance with statutory requirements. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, w. h. l. McCarthy, Medical Officer of Health. CONTROL OF VERMIN. During the year a scheme was submitted and approved by the council as to the provision of temporary accommodation for Chelsea residents whilst their flats were being treated for the extermination of vermin.This temporary accommodation embodied the Use of the ground floor flat at one of the Council's properties,the furnishin, of the flat for a family of at least seven persons,also the provision of bed linen, crockery and cooking utensils. The flat was opened in August andv/Vf persons v/ere accommodated up to the end of the year. WAR-TIME NURSERY. During the year the Ministry of Health and the Ministry of Labour and National Service v/ere approached as to the necessity for a War-time nursery to be opened in uhelsea. In November,the hinistry sanctioned the proposal for a War-time Nursery at the former Chelsea Day Nursery premises. The accommodation to provide for 45 children. Adaptions v/ere in progress at the end of the year and equipment has been requisitioned on the Ministry of Health's Central Stores. It is expected that the Nursery will be opened in March,1943. 4 Public Health, Maternity and Child Welfare Committee. At 31s/ December, 1942. His Worship the Mayor (Councillor R.G WHARAM J.P.,) The Deputy Mayor (Councillor G.A THESIGER m a) ALDERMAN S.BOYLE ,ALDERMAN MISS .C.FULFORD, ALDERMAN LAOY PHIPPS; ALDERMAN 6.M. STEVENSON VICE CHAIRMAN:-COUNCILOR REV W.G ARROW SMITH Councillors: Councillors D.G ADAMS R.A LYGON G.A BEATON MISS E. MURRAY MRS J.T COCKBURN MRS C.WILLIAMS G.M COLLIS Housing Committee. His Worship the Mayor (COUNCILLOR R.G. WHARAM,JP) The Deputy Mayor (COUNCILLIOR G.A THESIGNER MA) CHAIRMAN:-ALDERMAN LADY PHIPPS VICE CHAIRMAN:-COUNCILOR MRS J.T. COCKBUWN ALDERMAN BANSAL MARSDEN SMEDLEY Councillors: REV. W.G ARROW SMITH MRS C. RENNEDY J.M BUCKLEY R.A. LYGON MRS. M.S ELLIOTT MISS.E MURRAY Milk and Welfare Sub-Committee MRS.C.WILLIANS H.G EVANS P.A. WILLIAMS(SUB.L.T) His Worship the Mayor (COUNCILLOR R.G. WHARAM .J.P) The Deputy Mayor (COUNCILLIOR G.A THESIGER M.A) CHAIRMAN:-ALDERMAN LADY PHIPPS ALDERMAN MISS C.FULFORD Councillors: RJV. W.J. ARROWSMITH LADY CLARE HARTNELL 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, 1942 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). 1914 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, Ma ternity and Chid Welfare (Part time). 1928 Nelson, Grace M. M.R.C.S., L.R.C.P. Medical Officer, Mater nity and Child We] fare (Part time). 1921 Radford, Muriel A. M.B., B.S., D.P.H. Medical Officer, Mater nity and Child WeL fare (Part time). 1939 GOULARY, ELIZABETEN M,D,B.S Medical Officer of Ante Natal Clinic (Par time). 1929 McCullagh, W. McK. M.B., F.R.C.S. Consultant for Puer peral Fever and Puer peral Pyrexia (Par time). 3 FORD R. K. Public Vaccinator, St Luke's Hospital (Par time). Public Vaccinator, St Stephen's HospitaL (Part time). 1933 Thomas, E. F. M.D., D.P.H. Public Vaccinator, Chel sea District (Par time). FIRST MONDAY MONTHLY PLAY CORNER 3RD FEATHERS CLUB MEDICAL PLSPECTION DIPTHERIA CLINIC TUESDAY WEDNESDAY WEEKLY - 6 (b) Other Staff. Year Appointed. Name. Qualifications. Appointment. 1936 McLachlan, T. A.C.G.F.C., F.I.C. Public Analyst (Part time). 1930 HOYLAND, H 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). 1939 LEACOCK,H F 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. CMB Sanitary Inspector (WHOLE TIM E) WHITE HOUSE,MRS S.R.N.,GEN HOSP CERT S.C.M., R.S.I HEALTH VISIT TO RS CERT HEALTH VISITOR C.H.S (WHOLE TIME ) COCKBURN ,MRS HEALTH VISITOR CMS (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. SUPERIN TEN BENT HEALTH VISITOR C.W.S (WHOLE TIME ) 1926 Harcourt, Miss G. E. S.R.N.,Cert.Gen.Hosp. Training, C.M.B.,and Cert. Mothercraft Training Society. Health Society (Half time). 1938 Streatfeild, Miss M. B. 1 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). 1940 DRARE, E SANITARY INSPECTOR (WHOLE TIME )TEMPORARY 1941 WHITE,AJ SANITARY INSPECTOR (WHOLE TIME) 7 Year Appointed. Name. Appointment. 1914 1920 1930 1922 1935 Hayden, A. B. J. Bosley, E. Bryant, J. C. Kennedy, Mrs. H. M GREEN MISS N | Bennett, Miss H. M. Clerk and Vaccination Officer, Public Health Department (Whole time). Clerk, Public Health Department (Whole time). Clerk, Public Health Department (Whole time). Clerk (Maternity and Child Welfare) Public Health Department (Whole time). General Secretary, The Violet Melchett Infant Welfare Centre (Whole time). Assistant Secretary, The Violet Melchett Infant Welfare Centre, (Whole time) 1929 1938 FREEMAN FC Berry, L. H. Mortuary Keeper and Messenger (Whole time).TEMPORARY1 Chief Disinfector (Whole time). 1929 Weston, R. J Disinfector (Whole time). 1931 Bosley, E., Jr. Disinfector (Whole time). 1942 LABBON MRS Shelter and Cleansing Attendant (Whole time). TEMPORARY AT PRESENT SERIVING IN H.M FORCCES TEMPORARY STAFF 1941 COOKE, J.F DISINFECTOR (WHOLE TIME) 1942 BARER W.F DISINFECTOR (WHOLE TIME) CIVIL DEFENCE 1942 SMITH MRS CLERK-PUBLIC HEALTH DEPT (WHOLE TIME) 1942 BOOKER MRS CLEANER, DISINFECTING STATION (WHOLE TIME) Dec 1942 in Red Con appointed sanitary projector Command fan 1943 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 Stillbirth 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 5 (a) General 25 (b) Infectious Diseases 26 Midwives and Maternity Nurses 27 Home Help in Maternity Cases 27 National Health Insurance 28 Laboratory Facilities 28 Public Health Legislation in force in the Borough 29 Hospital Services available in the Borough 29 Maternity and Nursing Homes 31 Health Visitors 31 Ante-Natal Work 32 Compensation to Midwives 32 Supply of Milk to Mothers and Young Children 33 Institutional Provision for Unmarried Mothers, Illegitimate Infants' and Homeless Children 34 Ambulance Facilities 35 Clinics and Treatment Centres 35 (a.) The Violet Melchett Infant Welfare Centre 35 (i.) Chelsea Health Society 36 (ii.) Chelsea Day Nursery 36 (iii.) Chelsea Mothercraft Home 37 (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 Closet Accommodation 42 Removal and Disposal of Refuse 42 Sanitary Inspection of the Borough Magisterial Proceedings Shops 45 Smoke Abatement Fouling of Footways by Dogs 45 Rats and Mice (Destruction) Act 45 Pigeons, Nuisance caused by Premises and Occupations Controlled by Byelaws or Regulations Bed Bugs, Eradication of 47 Factories, Workshops and Workplaces 47 Public Mortuary Rag Flock 49 Offensive Trades Swimming Baths and Pools 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 56 (e.) Unhealthy Areas 56 (/.) Byelaws relating to Houses and Houses Let in Lodgings 56 (g.) Housing Inspections 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 Scarlet Fever 65 Measles and Whooping Cough 65 Enteric Fever 67 Pneumonia, Malaria and Dysentery 67 Puerperal Fever and Puerperal Pyrexia. 68 10 PAGE Ophthalmia Neonatorum 68 Poliomyelitis and Polio-Encephalitis 69 Encephalitis Lethargica 69 Chi cken Pox 69 Smallpox and Vaccination 69 Venereal Disease 70 Disinfection 70 Infectious Diseases Shelter 0 Disinfestation 71 (5.) Tuberculosis .71 Notifications and Mortality 71 Cases of Tuberculosis in the Borough 72 Public Health (Prevention of Tuberculosis) Regulations, 1925 73 Chelsea Tuberculosis Scheme . 73 Dispensary and Institutional Facilities for Treatment 77 Co-operation with Hospitals and I.C.A.A. 77 Co-operation with School Medical Service 78 Co-operation with Medical Practitioners 78 78 Artificial Pneumo-thorax Treatment 78 Home Nursing 78 Extra Nourishment 78 Non-Tuberculous Cases 78 Orthopaedic Treatment 79 Dental Treatment . 79 Bacteriological Examinations 79 Care and After-Care Work 79 Appendix. Report of the Public Analyst 82 Annual Report on the Health of the Metropolitan Borough of Chelsea. Year ending 31st December, 1942. SECTION I.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. GENERAL STATISTICS. TABLE No. 1. Area Resident Population :—Registrar-General's estimate. Number of Inhabited Houses (end of according Rate Books Rateable value, October, 1942 Sum represented by a penny rate, October, 1942 POPULATION IN WARDS. (Census 1931.) Males. Females. Total. Cheyne 3,349 .5,436 8,785 Church 4,390 5,929 10,319 Hans Town 2,961 5,839 8,800 Royal Hospital 2,550 4,833 7,383 Stanley 10,696 13,048 23,744 23,946 35,085 59,031 (Note.—All vital Statistics given in this Report arc calculated on the Resident Population of the Borough as Estimated by the RegistrarGeneral for 12 Physical Features and General Character of the Area.—The Metropolitan Borough of Chelsea, situated near the centre of the Metropolis, is bounded on the north by the Royal Borough of Kensington, on the west by the Borough of Fulham, on the east by the City of Westminster, and on the south by the River Thames. It is a small compact borough, less than two miles in length, by about three-quarters of a mile in width. Over nearly the whole area the soil consists of gravel and sand, highly permeable to water. In a small portion of the western side of the Borough there is a thin loamy deposit of brick earth resting upon the gravel. There is a narrow strip of alluvial deposit extending along the Embankment from Battersea Bridge westwards. The northern portion of the area is largely built over. The central zone comprises a number of pleasant squares occupied by people in affluent circumstances. The grounds of the Royal Hospital, with the River Thames and Battersea Park beyond, render the southern zone unusually open. Social Conditions.—The density of population (number of persons per acre) as shown by the 1931 Census, is 89.4, the corresponding figure for London, as a whole, being 58.7. The density of population of each of the five Wards in the Borough is as follows:—Church Ward, 111.0; Stanley Ward, 123*7 ; Hans Town Ward, 78.6 ; Cheyne Ward, 76.4; Royal Hospital Ward, 49.9. Analysis of the 1931 Census figures shows that there is a greater proportion of unoccupied and retired persons in Chelsea than in any other Metropolitan borough. There is, however, a considerable " working class " population. Thus, of a total of 19,600 adult males, about 16,750 are occupied. The chief occupations are transport work (2,704), personal service (2,224), metal work (1,036), and clerical work (1,260). Over one half of the 30,800 adult females are occupied. Of these, domestic servants account for 8,746, dressmakers number 1,243, shop assistants 1,090, and clerks 1,471. There are no dangerous or offensive trades carried on in the Borough. There is no evidence that any of the occupations of the inhabitants exerts a deleterious influence on the public health. VITAL STATISTICS. In accordance with the requirements of the Ministry of Health, the following extracts from the Vital Statistics of the year are shown below :— TABLE No. 2. Total M. F. Birth rate per 1,000 of 1 the estimated resi( dent population. 12.5 Live Births :— Legitimate 295 148 147 Illegitimate 47 29 18 342 177 165 13 Total M. F. Still Births 11 9 2 Rate per 1,000 total (live and still) births Deaths 502 247 255 Death rate per 1,000 of the estimated resident population 18. 3 Deaths from Puerperal Causes :— Deaths. Rate per 1,000 total (live and still) births. Puerperal Sepsis 1 2.8 Other Puerperal Causes 0 0.0 Total 1 2.8 Death rate of Infants under one year of age :— 1939. 1940. 1941 1942 All infants, per 1,000 live births 33 40 3 8 50 Legitimate infants per 1,000 legitimate live births 33 41 4O 41 Illegitimate infants per 1,000 illegitimate live birt 41 26 29 106 Deaths from Cancer (all ages) 103 106 7 6 79 Deaths from Measles (all ages) - - - 1 Deaths from Whooping Cough (all ages) — """ Deaths from Diarrhcea (under 2 years of age) 1 1 " 2 BIRTHS. THE TOTAL NUMBER OF BIRTHS OF CHELSEN RESIDENTS The following Tables are self-explanatory:— TABLE No. 3. Registered Births. [##]Legitimate and Illegitimate Births. * 1939 1940 141 1942 Births Registered in the Borough 310 169 98 181 951 Births of Non-Parishioners 119 35 31 94 531 191 134 44 84 420 Births of Chelsea Mothers in Lyingin Hospitals and elsewhere outside of the Borough 348 294 259 255 244 Next Chelsea Births 539 128 306 342 664 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. hoflfl L& (r>Lu 1 Sevang)j Leg. Illeg. Total. Hans Town. Royal Hospital. Church. Cheyne. Stanley. Hospitals. Nursing Homes. Private Addresses. Total. /9ie 49o 49 $39 9y f! ^> SS V/ lys 2^ 55 >6 4 -4 ■ ' 339 39 428 no 43 34 219 I9i, Y* 294 3/g 1941 34 3ob n 6 28 ss *y 43 IbO yo 20 2i>9 /to *y 342 iZS S(p 25 /s>c> 64 132. /9Z *8 /b" 265 314 /) Vcrt/Kic /O Yc»45 & //3 V9 % /o/ 3>2<, /$3 4fS /3 / 7,"> J:. 15 TABLE No. 5. Births in Hospitals and Nursing Homes. Chelsea Births in Hospitals and Chelsea Births in Hospitals and Nursing Homes Within the Nursing Homes Outside the Borough. Borough. LONDON COUNTY COUNCIL 1939 1940 1941 1942 1939 1940 1941 1942 LONDOM COUNTY COUNVIL ST- lokes 1 - 2 - ST.MARY ABBOTS 165 129 51 99 ST. STEPAENS 4 - / -" OTHER HOSPITAL 1Y 5 30 35 VOLUNTAEY HOSPITAL Misellaneous hospital (inceliding ) 58 , CHELSEA HOSP:FOR WOMEN - / / / Ineliding products 93 60 80 ROYAL CCANCER - / - - NURCING HOME Nursing Hommemaa 55 43 40 48 WILBAWAM PLACE 4 4 - 5 ROYAL ADECENCE 1 1 - — PRIVATE ADOROSSES 2y 2c IS 10 Y 4 6 248 294 259 255 Percentage of Chelsea Births in Hospitals of J and elsewhere outside Chelsea. ' 193964 nor cent. 194 0 69 "" 194 1 34 " " 1942*7784 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 141rths, including stillbirths, were notified as occurring in Chelsea. Of this number, in 89 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 232irths, 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 3/4 The following table indicates the source of notification of the 141 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 13 1 14 88 / 89 Midwives 6y - 6y - - - Poor Law Institutions - - - - - - Parents 7 - / - - - 81 / 82 88 / 89 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. l9 39 23 36 49 9 .09 1940 16 23 39 9 .11 1941 22 13 34 11.11 1942 29 18 44 13.44 Stillbirths 107,9 1940 1041 1942 Number 14 10 4 11 Rate par 1,000 of civilan population 0.25 0.25 0ol5 0.40 MARRIAGES. 1939 . 1940 .1941 .1942. Hunter registered in Borough 10S5 859 491 490 Rate per 1,000 of civilan population 19.2 21.6 18.5 14.8 DEATHS. The total number of deaths of Chelsea residents during the year was 502 equivalent to a death rate of 18.3per 1,000 of population. 17 The following tables are self-explanatory:— TABLE No. 8. Registered Deaths. 1939 1940 1041, 1942 Deaths registered in the Borough 1002 10313 1157 997 Non-parishioners 1085 1210 740 672 577 007 411 525 Deaths of Chelsea residents in hospitals and elsewhere . TWO Borough 160 104 189 177 Nett Chelsea deaths 743 851 600 502 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 569 Chelsea deaths registered in the Borough, 353 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 Countv Council :— General Hospitals 98 St. Luke's Hospital and Institution 3 Mental Hospitals 8 Infectious Disease Hospitals 4 St. Stephen's Hospital and Institution 154 Tuberculosis Sanatoria, etc. 5 St. George's Home for Tuberculosis - Nursing Homes 26 Poor Law Institutions 2 Voluntary :— - Miscellaneous 14 Chelsea Hospital for Women Cheyne Hospital for Children - Brompton Hospital - Royal Hospital for Pensioners 5 Royal Cancer Hospital 3 154 Victoria Hospital for Children - 168 55 Of the 1,287 deaths of non-residents registered in Chelsea, 1,277 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 19.6 14.3 12.4 11.4 1940 851 22.0 64 93 159 163 368 23.3 16.4 19.3 28.9 1941 600 22.4 60 110 124 84 222 31.4 13.6 29.0 16.3 1942 602 18.3 62 60 81 48 221 23.0 18.1 14.1 18.0 Average 10 Years 1929-1938 494 13.6 96 131 135 131 304 14.4 12.9 10.8 13.0 10 TABLE No. 11. Birth-rates, Death-rates, Analysis of Mortality, England and Wales, Maternal Death-rates and Case-rates for certain London, 126 Great Infectious Diseases in the year 1942 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 15.8 14.3 18.4 14.0 Still 0.54 0.66 0.62 0.48 Deaths:— All Causes 11.6 13.3 12.1 13.0 Typhoid and Paratyphoid fevers 0.00 0.00 0.00 0.00 SmallpoX - - - - Measles 0.01 0.02 0.01 0.01 Scarlet fever 0.00 0.00 0.00 0.00 Whooping Cough ... 0.02 0.03 0.02 0.04 Diphtheria 0.05 0.06 0.04 0.02 Influenza 0.09 0.09 0.10 0.04 NOTIFICATIONS - TYPHOID FEVER 0.01 0.01 0.01 0.02 PARA-TYPHOID 0.01 0.01 0.01 0.01 C.S.F 0.14 0.14 0.12 0.15 SCARLET FEVER 2. 19 2.49 2.34 1.86 WHOOPING COUGH 1.43 1.94 1.58 2.42 0.46 DIPHTHERIA 1.05 1.35 0.91 ERYSIPELAS 0.30 0.36 0.26 0.43 SMALLPOX 0.00 0.00 - 0.00 MEASLES 4.46 9.24 4.39 8.62 PNEUMONIA 1.04 1.30 0.94 0.94 Rates per 1,000 Live Births. Deaths under 1 year of age 49 59 46 60 Deaths from Diarrhoea and Enteritis under 2 years of age 52 4.5 4.8 8.6 Rates per 1,000 Total Births (i.e., Live and Still). Maternal Mortality:— Not avail able. Puerperal Sepsis 0.42 Others 1.59 Total 2.01 Notifications :— Puerperal fever Puerperal pyrexia 12.61 15.94 10.80 3.10 14.69 INCLUDING PUERPERAL FEVER 20 TABLE No. 12. Deaths of Chelsea Residents Registered during the Year 1938, Classified by Age and Cause. (In accordance with Registrar-General's Return.) YEAR NETT DEATHS, WHETHER OCCURRING WITHIN OR WITHOUT THE BOROUGH. YEAR YEAR YEAR AIL AGES UNDER 1 YEARS 1 AND UNDER 5 YEARS 5 AND UNDER 15 YEARS 15 AND UNDER 45 YEARS 45 AND UNDER 65 YEARS 65 YEARS AND UPWARDS 1942 1939 1940 1941 ALL CAUSES 502 14 3 - 42 126 314 443 851 600 1. TYPHOID AND PARATYPHOID FS - - - - - - - - - - 2. CEREBRO - SPINAL FEVER - - - - - - - 2 1 - 3. SCARLET FEVER - - - - - - - - - - 4. WHOOPING COUGH - - - - - - - - - - 5. DIPHTHERIA - - - - - - - 3 - - 6. TUBERCULOSIS RESP. SYSTEM 19 - - - 9 6 4 46 34 31 7. OTHER FORMS OF TUBERCULOSIS 5 - 1 - 1 2 1 5 6 2 8. SYPHILITIC DISEASES 8 1 - - 1 4 2 1 5 6 9. INFLUENZA 3 - - - 2 - 1 20 12 8 10. MEASLES 1 - 1 - - - - - - - 11. AC POLIOMMELITIS ETC - - - - - - - - - - 12. AC. INF.ENCIPHALITIS 2 - - - 1 1 - 1 2 - 13. CANCER.BUCCAL CAVITY AND ŒSOPN (M) UTERUS (F) 4 - - - 1 4 2 103 15 11 14. CANCER.STOMACH OF DUDOENUM 15 - - 1 3 11 19 13 15. CANCER OF BREAST 8 - - - 2 2 4 10 11 16. CANCER OF OTHER SITES 49 - - - 1 20 28 62 41 17. DIABETES 1 - - - 1 - - 13 5 3 18. INTRACRUNIAL VASCULAR LIBIONS 33 - - - 1 10 22 38 42 31 19. HEART DISEASE 129 - - - 1 14 111 246 204 141 20. OTHER DIS. CIRC. SYSTEM 19 - - - - 4 15 55 26 20 21. BRONCHITIS 26 2 - - 1 6 14 20 31 38 22. PNEUMONIA 38 4 - - 2 6 26 39 45 40 23. OTHER RESPIDISEASES 10 - - - - 4 6 6 8 6 24. ULCER - STOMACH - DUODENUM 5 - - - - 3 2 9 11 10 25. DIARRHŒA, UNDER 2 YEARS 2 2 - - - - - 1 1 - 26. APPENDICITIS 1 - - - - 1 - 8 3 3 27. OTHER DIGESTIVE DIS. 15 - 1 - 1 2 11 16 9 10 28. NEPHRITIS 19 - - - 2 9 8 8 4 13 29. PUERPERAL SEPSIS 1 - - - 1 - - - 2 - 30. OTHER MATERNAL CAUSES - - - - - - - 1 1 - 31. PREMATURE BIRTH 8 8 - - - - - 5 3 4 32. CONG. MALE BIRTH INJURES INFANT DISEASES 3 - - - 1 2 - 3 4 5 33. SUICIDE 6 - - - 1 4 1 8 13 3 34. ROAD TRAFFIC ACCIDENTS 2 - - - 1 1 26 11 1 35. OTHER VIOLENT CAUSES 23 6 4 13 209 91 36. ALL OTHER CAUSES 44 4 11 29 60 44 32 502 14 3 - 42 126 314 443 851 600 21 1939. 1940. 1941. 1942. 1943 Chelsea, deaths of persons over 65 years of age. 480 443 362 314 314 percentage of all deaths. 65 52 60 62 54 RESPIRATORY DISEASES. Table No. 13 shows the number of deaths from respiratory diseases during the past four 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 1 5 years. 1939 20 39 6 65 1.3 5 4.4 1940 31 45 8 84 2.2 5 6.0 1941 38 40 5 83 3.1 1 1.2 1942 26 38 10 44 2.4 6 8.0 AVERAGE 10 YRS 1929 - 1938 25 48 4 80 1.3 1O 12.5 DEATHS OF CHILDREN 1-5 YEARS OF AGE. 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 1941 - - - - 2 2 1942 1 1 - - 1 3 1943 1 2 - 3 22 INFANT MORTALITY. 1939. 194-0 1941 194 . Deaths of Infants under 1 year of age 17 15 9 17 infant Mortality rate (under 1 year per 1,000 live births) 35 40 58 50 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 1942 Total Deaths 1939 Total Deaths 1940 Total Deaths 1941 Smallpox - - - - - - - - - - - - - Chicken-pox - - - - - - - - - - - - - Measles - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - Diphtheria - - - - - - - - - - 1 - - Cerebro-Spinal Fever - - - - - - - - - - 1 - - Influenza - - - - - - - - - - - 1 - Erysipelas - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - 1 - - Abdominal Tuberculosis - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - Meningitis - - - - - - - - - - - - - Convulsions - - - - - - - - - - - - - Laryngitis - - - - - - - - - - - - - Bronchitis - - - - - 1 1 - - 2 1 1 - Pneumonia - - - - - 4 - - - 4 4 3 1 Diarrhœa and Enteritis - - - - - - 1 - 1 2 1 1 - Gastritis - - - - - - - - - - - - - Syphilis - - - 1 1 - - - - 1 - - - Rickets - - - - - - - - - - - - - Suffocation - - - - - - - - - - - - - Injury at Birth - - - - - - - - - - - - - Atelectasis - - - - - - - - - - - - - Congenital Malformations - - - - - - - - - - 2 - 3 Premature Birth 8 - - - 8 - - - - 8 5 3 4 Atrophy Debility and Marasmus - - - - - - - - - - 1 4 - Other causes - - - - - - - - - - - 2 1 8 - - 1 9 5 2 - 1 14 14 15 9 Nett Births registered during the calendar year 1939. 1940. 1941. 1942. Legitimate 490 589 272 295 Illegitimate 49 39 54 47 Nett Deaths (under 1) registered during the calendar year Legitimate 15 14 8 12 Illegitimate 3 1 1 5 23 The following Table gives the Infant Mortality Rate in Chelsea under various headings, for the past FouiZ years :— TABLE No. 16. 1939. 1940. 1941. 1942. Infectious Diseases 3.9 - - - Diarrhoeal Diseases 1.9 2.8 - 5.8 Developmental Defects and Wasting 15.8 18.6 29.9 23.4 Other causes 11.8 16.6 8. 5 20.5 Total Kate ... 33.0 40.0 38.4 49.7 TABLE No. 17. Infantile Mortality Rates per 1,000 Births in Wards. 1939. 1940 . 1941. 1942. 1943. Hans Town _ _ 71 36 40 Royal Hospital 18 _ - 80 81 Church 47 24 35 31 44 Cheyne - 56 21 31 48 Stanley 43 41 27 68 46 Chelsea Borough 33 40 38 50 70 Illegitimate Deaths.—The following Table No. 18 shows the number of deaths among illegitimate infants during the past Famiyears. TABLE No. 18. 1939. 1940. 1941. 1942. 1943. Total number of illegitimate deaths under 1 year 2 1 1 5 8 Illegitimate death rate 41 26 29 106 114 MATERNAL MORTALITY. During the year onte deaths was primarily classified as due directly to complications of pregnancy or childbirth. In the case of every maternal death the circumstances are fully investigated by the Medical Officer of Health, the findings beingrteported to the Ministry of Health. 24 The following table shows the Maternal Mortality in Chelsea during the past four years :— TABLE No. 19. Year. Death-rate per 1,000 Total (Live and Still) Births. Total Death-rate. Puerperal Sepsis. Other complications of Pregnancy and Childbirth. 1939. _ 1.9 1.9 1940. 5.2 2.6 7.8 1941. _ _ _ 1942 2.8 _ 2.8 APPARENT EXCESSIVE MORTALITY IN THE BOROUGH. The Census Returns have consistently shown that there is a considerably higher percentage of persons of advanced age living in Chelsea than in any other Metropolitan Borough. The 1931 Census Returns showed that in London generally 7'3 per cent, of the total population were included in the age-group 65 and upwards. In Chelsea, however, no less than 10*2 per cent, of the total population constituted the agegroup 65 and upwards. These facts must be bome in mind in any analysis of the Chelsea mortality rate, as thev are naturallv reflected in the death returns. 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 «.s could be ascertained, such as to call for any special comment in this report. No special effects of any particular occupation, prejudically affecting the health of workers therein, have been reported. 25 SECTION II.—PROVISION OF HEALTH SERVICES IN THE BOROUGH. PUBLIC HEALTH OFFICERS OF THE BOROUGH COUNCIL The names and qualifications of members of the staff of the Public Health Department at 31st December, [9^X, 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/££o<?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. TABLE. N o • • • • v isits. Cases. 1939 • • • • • • 1498 158 1940 • • • • • • 1404 135 1941 • • • • • • 1483 135 1942 • • • • • • 1319 167 26 TABLE No. 21. Nursed by District Nurses 1939. 1940. 1941. VISITS CASES VISITS CASES VISITS Bronchitis 169 18 64 8 133 Burns _ _ _ _ _ Chicken Pox 11 1 18 1 _ Circumcision 104 18 58 4 29 Diarrhcea 4 1 1 1 10 Eye Trouble 106 4 202 14 234 Ear Trouble 98 6 13 1 11 Expectant and Nursing Mothers 144 11 122 12 242 Pneumonia (under 5) 40 3 93 4 48 Pneumonia (over 5) 131 2 44 3 109 Impetigo _ _ 119 4 38 Meningitis and Peritonitis _ _ _ _ _ Measles (under 5) _ _ 2 1 29 Measles (over 5) _ _ 10 3 _ Ophthalmia Neonatorum 61 3 82 2 26 Pemphigus Neonatorum _ _ _ _ _ Pemphigus _ _ 88 4 16 Poliomyelitis _ _ _ _ _ Post-Vaccination 303 54 149 31 143 Puerperal Fever _ _ _ __ _ Puerperal Pyrexia _ _ 24 2 _ Rickets _ _ _ _ _ Septic sores 33 4 44 4 166 Tonsils and Adenoids 23 4 _ _ 3 Whooping Cough 134 4 _ _ 53 Worms 44 8 65 12 _ Miscellaneous 94 13 164 21 163 1498 158 1404 135 1483 INFLUENZA INFLUENZA (b) Nursing of Infectious Disease Cases.—In the case of all patients suffering from notifiable infectious disease, it is the practice of the Department to advocate admission to an appropriate hospital for isolation and treatment. Under the Borough Council's Maternity and Child Welfare Scheme, arrangements have been made with the Chelsea District Nursing Association for the nursing of selected cases of infectious disease. In this categoryare 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. The London 'Jounty uou^icil is the Authority responsible for the supervision of iaidv/ifes and Domiciliary Midwifery Service in the .borough. 27 1942 CASES VISITS CASES 15 138 16 _ _ _ _ _ _ 4 36 4 1 3 1 10 131 9 2 28 5 22 300 30 4 22 2 5 33 3 3 _ _ _ 21 4 2 3 1 1 _ _ _ _ _ 20 _ 48 _ 240 _ _ _ _ _ _ _ 8 46 12 1 2 1 3 28 2 _ 39 8 29 189 21 135 1319 164 With the establishment of the London County Council salaried Lidwives service the provision made by the liorough Council whereby necessitious women may obtain the services of a -aternity nurse or Lidwife at a reduced rate, the balance of the fee bein^ paid by the uouncil, was discontinued at the end of oune 1959. TABLE No. 22. ear. No. of applications for services of (2) Total number provided with a Amount of Assessment on cases attended. Nett Cost to Council. Maternity Nurse. Midwife. Maternity Nurse. Midwife. Maternity Nurse. Midwife. Maternity Nurse. Midwife. 39 _ 3 _ 4 _ 1.66 _ 10.30 NOTE: (2) INCLUDES CASES ASSESSED PREVIOUS YEAR SIX MONTH ONLY. 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. 2'i shows, for th£ past FouR. years, the number of applications received for Home Help scrvice, the number of cases attended, the amount of assessment on cases attended and the nett expenditure by the Council for this service :— 28 TABLE No. 23. Year. No. of applications for services of Home Help, including extension over the usual period of 2 weeks. Total number of cases attended by the Home Helps. Amount of Assessment on cases attended. Nett Cost to Council. 1939 16 4 5. 7. 0 15.15.0 1940 2 1 15. 0 4.10. 0 1941 1 1 - - - 5 . 5. 0 1942 — — --- - - - 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.-' TABLE NO BACTERIOLOGICAL AND OTHER EXAMINATION 5. NATURE OF SPECIMEN 1939 1940 1941 1942 SWARS FOR DIPTHERIA BACILLI 236 69 142 66 HÆMOLYTIC STREPTOCOCCI 4 _ 1 _ SPUTUM TUBERCLE BACILLI 31 13 11 5 STOOLS OR BLOOD FOR TYHOID 1 2 5 _ STOOLS FOR DYSENTERY 1 _ _ _ WATER AT PUBLIC BATHS 2 2 2 2 MILK UNDER MILK (SPECIAL DESIGNATION) ORDER _ 4 6 4 MILK ON DELIVERY _ 2 — 2 FOOD AND INVESTIGATION CANNED HEAT _ _ _ 4 248 85 164 83 TOTAL COST TO BOROUGH COUNCIL 52.110 19,210 35.32 19153 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 xeer. No.of Units supplied. Cost 1939. 40,500 2.11. 0 1940. - — 1941. 8,200 12. 0 1942. 8,000 10. 0 29 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, 1037, 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 neglector 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 ar(j 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. CCMCi/ATECy 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. Broir.pton Hospital for Consumption Fulham Road, S.W.3 Pulmonary Tuberculosis 339 Yes By Voluntary Committee The Royal Cancer Hospital Fulhani Road, S.W.3 Malignant Disease 128 Yes Chelsea Hospital for Women Arthur Street, S.W.3 Obstetric and Gynaecological 104 Yes Cheyne Hospital for Children Cheyne Walk, S.W.3 Children's Diseases ... 71 Yes Princess Beatrice Hospital Richmond Road, S.W.O 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.I General Medical. Surgical and Maternity 437 Yes St. Luke's Hospital Cale Street, S.W.3 Medical and Surgical 390 Yes By Hospitals and Medical Services Committee of L.C.C. St. Mary Abbots Hospital Marloes Road, W.8 Medical. Surgical and Maternity 555 Yes St. Stephen's Hospital Fulhani 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 load, W.6 General Medical and Surgical 234 Yes 31 All the hospitals included in the foregoing table are fully equipped for operative surgery ou modern lines. Each of them also provide s 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 FOUR years. The visits enumerated are those paid by the trained officer of the Borough Council (one part-time Health Visitor) and the trained officers of the Chelsea Health Society and School for Mothers (two whole-time and two part-time Health Visitors). It does not include work done by voluntary workers attached to the Society. 32 TABLE No. 26. Summary of Reports of Health Visitors. 1939 * 1940 1941 (1) Work of the Health Visitors. First visits to Infants under one year of age 319 279 188 Return „ „ „ „ 1252 1110 424 First visits to Children between the ages of 1 and 5 years 2456 184 145 Return visits to Children between the ages of 1 and 5 years 2196 1440 949 Ante-natal visits to Expectant Mothers :— Primi-para cases 103 103 48 Multi-para „ 164 142 43 Return visits 690 440 259 Visits to Enteritis cases amongst children 1 _ _ Return visits „ „ „ „ _ _ _ Visits to Ophthalmia Neonatorum cases 6 3 _ Return visits „ „ 5 4 _ Visits to Whooping Cough cases (under 5 years of age) 110 3 25 Return visits „ „ „ 103 _ 34 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 42 _ Return visits „ „ „ - 4 _ General additional visits 648 689 414 Total visits 6458 4400 2945 Half-day attendances at Infant Welfare Centres 624 484 614 Half-dav attendances at Plav Centre 135 _ _ MYGILINE INSPECTIONS-PLAY CORNER _ — — (2) Infant Welfare Centres. Total number of attendances :— (a) By children under one year of age 3643 2391 1381 (6) By children between the ages of 1 and 5 years 2914 7535 554 (e) By Ante-Natal mothers 898 403 420 (d.) By Post-Natal mothers 26 21 14 /INCLUDES VISITS MADE BY Total Attendances MISS BROWN 4514 4650 2345 s ftirovM- 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 fill risk of disease and accident incidental to childbirth may be removed. Compensation to Midwives.—If the Medical Officer at the Antenatal Clinic finds it necessary to recommend hospital treatment for an expectant mother referred to him by a midwife, and the mother accepts such advice, the Council make a payment of 10/- to the midwife as compensation for loss of the case. No case occurred during the year in which such compensation was necessary. 33 1942 33 3 1135 256 1614 124 109 246 38 63 21 34 2 404 4582 425 130 2813 946 1232 21 5012 SUPPLY OF MILK TO MOTHERS AND YOUNG CHILDREN. From July, 1940, the National Kilk Scheme was introduced by the Ministry of Food and provided for fresh milk to be availQ/ble for mothers and children either free or at half price if the incorae scale exceeded a certe,in standard. As this scheme ran on similar lines to the council'3 own maternity and child welfare scheme the administration was transferred to the Food Control Department. The following table shows for the year 1939 and to the end of June,1940 the extent of the Council's 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 1940 678 700 176 1 1555 435 34 UNDER THE COUNCIL'S SCHEME The total quantity of milk supplied during tho year to expectant and nursing mothers and young children was as follows :— 1939. . 1940. COWS MILK. Free of cost 6437 gals .2559 gals. At reduced cost 1862 " 1342 " 8299 " 3901 " DRIED MILK. Free of cost 1087 lbs. 552 lbs. At reduced cost 441 " 253 " 1528 " 805 " INSTITUTIONAL PROVISION FOR UNMARRIED MOTHERS, ILLEGITIMATE INFANTS AND HOMELESS CHILDREN. (a) The Day Servants Hostel, 29-33, Danvers Street, Chelsea, provides accommodation for 15 unmarried mothers and their infants. Cases are not received until after birth of the child. Daily work is provided by the Hostel and the mothers reside with their babies at night. (THIS HOSTEL WAS EVACUATED AT COMMENCEMENT OF HOTILITIES-1939) (b) The Fanny Hobson Hostel, 497, King's Road, Chelsea, provides accommodation for 20 women on discharge from prison or if found homeless. Unmarried mothers, but not illegitimate infants, are received. An expectant mother is retained until the confinement approaches. Arrangements are then made for her admission to Hospital. If she is subsequently re-admitted to the Hostel, the infant is settled with a foster ( HOSTEL. CLOSLD AT COMMENCEMENT OF HOSTILITIES -1939) (c) St. Theresa's Shelter, 43, Smith Street, Chelsea, is a Rescue Home which provides accommodation for nine girls. Cases are detained for some weeks until some suitable employment can be found. In the case of an expectant mother, arrangements are made for her transfer to an appropriate Home or Institution elsewhere in the Metropolis. Homeless children in general are cared for by the Public Assistance Committee. 35 AMBULANCE FACILITIES. (a) Infectious Cases.—Under the Public Health (London) Act, persons in London suffering from certain notifiable diseases may be conveyed without payment to a hospital of the London County Council. The London County Council ambulances are also available, on payment, for the conveyance of persons suffering from infectious disease to places elsewhere in the metropolitan area. (b) Non-infectious and Accident Cases.—The efficient ambulance service of the London County Council is available for cases of accident, sudden illness and also for maternity cases. The ambulances of the London County Council may also be utilized, on payment, for the removal of non-infectious cases to hospitals or homes. CLINICS AND TREATMENT CENTRES. (a.) The Violet Melchett Infant Welfare Centre, Flood Walk, S.W.3.—Patroness: Her Majesty Queen Mary. Chairman of Council : Violet, Lady Melchett, D.B.E. Hon. Treasurer : Col. Sir Courtauld Thomson, K.B.E., C.B. Hon. Secretary : Miss M. Bowden-Smith. This Centre, controlled by a Voluntary Council with headquarters in Flood Walk, adjoining the Town Hall, was completed in February, 1931, and formally opened by Her Majesty Queen Mary on 26th March, 1931. The Violet Melchett Infant Welfare Centre maintains the Maternity and Child Welfare services in the Borough and embodies the activities of the Chelsea Health Society, the Chelsea Day Nursery and the Chelsea Mothercraft Home. The magnificent building, with the land on which it stands and a considerable portion of its equipment, was a gift of the late Lord Melchett as a memorial to Lady Melchett's life-long work for Infant Welfare. Three members of the Public Health Committee of the Borough Council and the Medical Officer of Health arc 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 19A1-19^3. Reference will now be made to the activities of the three organisations included in the Violet Melchett Infant Welfare Centre. (1) Chelsea Health Society.—Flood Walk, S.W.3. The accommodation provided includes a large central hall, with surrounding consulting-rooms and dressing rooms. There is also a perambulator store, an open-air court with a garden where children may play while awaiting medical inspection, and ample office accommodation. During the year five infant clinics were held weekly—four at Flood Walk and one at 484, King's Road. At Flood Walk one ante-natal clinic was held weekly. In addition, Play Mornings are held daily from 9.0 to 12.0 under the supervision of a Health Visitor, for children referred by the Medical Staff for observation, as being reported difficult, or needing companionship, fresh air or space. Details of the work carried out by the Society will be found on page 32 (Table No. 26). (2) Chelsea Day Nursery, Flood Street, S.W.3. Throughout the year the Nursery functioned at an address in Sussex. 1939 1940 1941 1942 Total number of attendances during the year 4316 FIGURES NOT AVAILABLE Average daily attendance (5 days a week) 40 Total number of individual children who attended 101 Nursery evacuated 1.9.39 and figures shown are up to that date. Nursery in Receiving Area. 37 The health of the children has been satisfactory. Dr. C. K. Hamilton is Medical Officer to the Nursery and makes a weekly inspection of the children. (3) Chelsea Mothercraft Home.—Chelsea Manor Street, S.W.3. The following table shows the work carried out in the tiome from the l3t. January,1939 to 1st.September,1939. Since then, the hone has been temporarily closed. YEAR 1939. Mothers Babies. Beds available 6 16 Admitted during above period 45 87 Discharged 49 98 Avar age length of stay 26 days 40 days. Daily average number of inpatients 4.2 16.5 Test Feed attendances 97 97 SUPPLEMENTARY COUPONS FOR EXPECTANT MOTORS. The Ministry of wealth in conjunction with the lioard of Trade agreed that Welfare Authorities should oo-operate in respect of a special issue of coupons to enable mothers to buy materials. This scheme came into operation on 5th.August,1941 and up to the end of December,1941, the number of expectant mothers issued with supplementary coupons was 15. For the year 1942, the number was 414. This service is undertaken by the RESPIRATORS FUR CHILDREN UNDER 5. By arrangement with the Civil Defence Services the Health Visitors at the Violet melchett Infant welfare Centre undertake the distribution of helmets and small child's respirators. During 1942, 198 helmets and 145 small child's respirators were issued. In each case instructions were given as to the fixing and the use of these appliances. DISTRIBUTION OF COD LIVER OIL AND FRUIT JUICES . Since December, 1941, a scheme of cooperation for the distribution of these preparations has been arranged with the Local Food Executive Officer. The preparations are distributed from the Infant Welfare Centre by a member of the public wealth Staff. The scheme is constantly being brought to the notice of eligible children by the wealth visitors. (B) Invalid Children's Aid Association.—Chairman : Lady Edward Gleichen. Hon. Secretary: Miss Aileen Woodroffe. The Chelsea branch of the Invalid Children's Aid Association is located at 2, Glebe Place, King's Road, SAV.3. The Association provides, for children referred to it, treatment in Hospitals, Sanatoria and Nursing Homes, according to need; convalescence in the country or at the seaside: orthopaedic appliances and surgical boots; massage, remedial exercises, surgical dressings and medical comforts ; help in training for suitable work: additional clothing, etc. Two members of the Public Health Committee of the Borough Council and the Medical Officer of Health are members of the local Committee of the Association. The Borough Council made a financial grant of £100 to the Association for the vear commencing 1st April. 1942. TABLE NO. 1939 1940 1941 1942 ACTUAL CASES - CHILDREN UNDER 5 YEARS OF AGE 110 46 48 35 CHILDREN ADMITTED TO L.C.C. BOARDING OUT HOME 46 14 14 10 UNDER TUBERCULOSIS CONTACT SCHEME SANATORIUM TREATMENT ARRANGED 2 _ 5 _ CHILDREN SUPPLIED WITH SURGICAL APPLIANCES 14 4 6 5 CHILDREN TREATED AT I.C.A.A. ORTHOPAEDIC CLINIC 4 _ _ _ EXTENSIONS GRANTEDMEDICAL AID GRANTED _ 3 4 5 MEDICAL AID GRANTED 30 21 _ _ MAINTAINED IN PERMANENT HOME _ 1 1 _ CHILDREN REFERRED TO L.C.C. SPCL CONVALESCENT HOSPITALS 10 _ _ 1 CHILDREN REFERRED TO OTHER AGENCIES FOR HELP 1 _ _ 1 CHILDREN REFERRED FROM HOSPITALS FOR SPECIAL REPORTS 4 6 8 13 CHILDREN GRANTED OUTFITS OF CLOTHING BEFORE GOING AWAY. 20 34 6 2 CHILDREN EVACUATED CASES FOLLOWED UP WITH REPORTS 8 4 1 6 APPLICATIONS WITHDRAWN-OWN ARRANGEMENTS MADE 8 5 4 2 APPLICATION FOR ASSISTANCE - TOTAL 149 94 54 46 CLINIC IN ABEYANCE SINCE SEPT 1939 39 (c) The Babies' Club.—35, Danvers Street, S.W.3. Chairman : Mrs. William Piercy, O.B.E. Secretary: Miss M. Burnaby. Medical Officers : Dr. Langdon Lloyd, Dr. J. H. Gibbens, Dr. Grosvenor Miliis and Dr. J. Chisholm. This Infant Welfare Clinic is controlled by(a voluntarv Committee. It is intended for the use of subscribers onlv. The prcFiXSen were closed at commencement of hostilities (1939) and re-opened at the latter end of 1942,X (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 Pour years is shown in Table No. 30. During the year nine 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. FREE REDUCED RATE TOTAL 23. 5.4 1939 34 6 6 9 1.15.0 1940 3 1 - 1 - 3. 2.0 1941 1 - 1 1 1.10.0 2. 0.0 1942 2 1 1 2 1.10.0 9. 9.9 1943 40 DENTAL TREATMENT. Children under Five Years of Age.- Dental Clinic hold at the violet Melchett Infant Welfare Centre for provision of preventive dental treatment• Attendances:- 1939,159: 1940,66: 1941,30: 1942 Children requiring extractions were referred to the London County Council School Clinic in Bramerton Street, Chelsea. Expectant and Nursing Mothers.—In conjunction with the Chelsea Branch of the Charity Organisation Society and the Chelsea Health Society, the Borough Council has formulated a scheme whereby dental treatment is provided for expectant and nursing mothers. Total No. of cases. Dentures provided. (Cases). Nett cost to Council. 1939 9 6 24. 2.0 1940 6 4 18. 1. 6 1941 2 - 4. 0 1942 34 4 21.14.0 * Note. In addition, a grant of £20 per annum, was made to the violet Lelchett Centre for the provision of PREVENTIVE dental treatment. This grant was discontinued during 1941 wh<3n arrangements were made with the London County Council for ALL dental treatment to be given at St,Stephen's Hospital. The scheme, as at present, is working quite satisfactory. Does not include cases of preventive dental treatment as arranged by the Violet Belchett Infant Centre. The following table shows the number of resident in the Borough during the year and the number of visits in connection with this work. TABLE No. 31. Foster Mothers, Foster Children. Child Life Protection Return. Number on register at beginning of year 5 4 Removed from register 3 9 Added to register Z 9 Remaining on register 4 4. Medical attendance arranged 5 Attended Maternity and Child Welfare Clinic - 11 Visits to foster mothers 34 Miscellaneous visits 36 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 arc 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 ease 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. (/.) The subsidisation of the voluntary Day Nursery in the Borough. (g.) The subsidisation of the Chelsea District Nursing Association for the home nursing of expectant and nursing mothers and young children. (h.) The provision of Home Helps. (i.) The provision of midwifery attendance, free or at reduced rates, for necessitous Chelsea women. (j) The provision of Convalescent Home accommodation for nursing mothers and infants. (£.) The provision of dental treatment for expectant and nursing mothers. (/) The supply of milk, free or at reduced rates, to necessitous nursing and expectant mothers, infants, and young children. (m.) The provision of sterile maternity outfits at cost price. (n.) The administration of the Widows', Orphans' and Old Age Contributory Pensions Acts, 1925 and 1929, in respect of deserted, abandoned or neglected children. 42 SECTION III- SANITARY CIRCUMSTANCES AND ADMINISTRATION. IN THE INNABITANTS COMPLAINT BOOK. Complaints.—The number of complaints ENTER during the year was 894 Compared with 600ast year. The complaints are in the majority of cases, from the occupiers of houses and deal with alleged nuisances. These complaints are investigated by the Sanitary Inspectors, who, when the circumstances justify, serve the necessary notices required for the abatement of the nuisances. Closet Accommodation.—The water carriage system is general throughout the Borough. Removal and Disposal of Refuse.—House refuse is removed by the Works Department of the Council. A bi-weekly collection is made. The refuse is conveyed to the Council's Wharf on the river Thames, whence it is barged away. Inoffensive trade refuse is removed by the Council on payment of a fee in accordance with the provisions of section 92 of the Public Health (London) Act. 1930. 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 34/ The number of HUISANCE notices was 44 These compared with 229 and 41 IN 1941. AVERAGE 10 YEARS. 1929-1938. Summary of Work carried out by Sanitary Inspectors during the Year. Inspections. 1939 1940 1941 1942 On complaint of nuisance 648 892 818 1126 454 On notification of infectious disease 243 146 242 329 303 House to House 99 _ _ _ 192 Re-inspection calls made 3468 3,309 3,205 3963 5083 Inspection of:— Bakehouses 121 46 26 13 36 Slaughterhouses 2 _ _ _ 14 Milkshops 46 95 86 95 122 Ice Cream Premises 28 20 5 8 40 Overcrowding 24 48 15 38 Houses Let in Lodgings 29 3 _ 8 42 Stables 4 9 _ 10 34 Restaurant Kitchens 55 68 12 58 64 Marine Stores 4 4 62 1 16 Food Premises other than above 120 466 4 484 104 Premises under Meat Regulations 141 149 640 100 40 Factories and Workshops 62 133 150 161 348 Outworkers' Premises 15 18 48 15 51 Common Lodging Houses 21 _ 5 _ 19 Other visits 504 2,139 1 5429 620 Verminous Premises 165 255 4,474 1434 155 Rat enquiries 114 141 433 553 84 Smoke observations 55 40 94 6 19 HOUSING ACTS ? ? 4 30 ? CHILD LIFE PROTECTION ? ? ? 43 ? DRAINAGE ? ? ? 441 ? 6,084 8344 10,339 14687 4914 43 Premises: Walls and Ceilings cleansed :— 1939 1940 1941 (a) Premises throughout 209 _ _ (o) Premises partial! 46 193 144 (c) Verminous rooms cleansed 254 63 44 Total number of roonis cleansed 5 300 161 Wash-house walls and ceilings cleansed 61 3 4 Walls and ceilings of water closets cleauscd and repaired 13 64 30 Wash-house roofs repaired 8 5 4 Dirty tenants'rooms cleansed 4 4 _ Yard and area walls cleansed 80 43 154 Defective roofs repaired _ 39 44 Defective gutters repaired 20 19 20 Defective rain water pipes repaired 45 113 56 D ampness abated 214 257 104 Miscellaneous repairs _ 2 1 Wash-house floors repaired 16 13 3 Yard surfaces repaired, paved, etc. _ _ _ Ashpits demolished 23 20 16 New and proper dustbins provided 8 1 _ Workrooms provided with light and ventilation or light and ventilation improved Drainage : 10 8 2 Reconstructed 1 8 5 Repaired 2 1 2 Cleansed 13 3 1 Inspection chambers and traps provided 14 14 _ Fresh air inlets provided or repaired 6 12 1 New soil pipes provided 4 10 1 New ventilation pipes provided 1 1 1 Soil and ventilation pipes repaired 5 1 _ Anti-syphonage pipes provided 2 _ _ Drains sealed off 4 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 66 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 . 24 32 10 Water closet pans (foul) cleansed 6 8 2 Choked water closet pans unstopped and cleansed' 4 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 4 24 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 14 1 Number of notices _ _ 1 Number of summonses _ _ _ 44 1939 1940 1941 1942 Nuisances abated arising from :— Keeping animals in an improper manner or place Defective manure cagcs _ 1 _ Accumulation of manure or refuse 1 _ _ Overcrowding 6 14 21 Rat nuisance 24 2 _ Underground roonis 114 141 94 Food Condemned and Destroyed. (See END OF REPORT - PAGE 88) Disinfection. Rooms disinfected after Zymotic diseases (Scarlet Fever, Diplitlieria, etc.) Rooms disinfected after Tuberculous disease Rooms fumigated for verminous and filthy conditions 184 169 142 234 Miscellaneous disinfection 434 315 481 1284 Certificates of disinfection given 44 5 14 10 School notices after disinfection 44 8 26 28 Notices sent to Public Library of Premises where infectious diseases have occurred 96 40 433 36 ROOMS DISINFECTED (CIVIL DEFENCE) Proceedings taken. 518 451 622 1398 Intimation Notices served 243 442 229 341 Statutory Notices under Public Health (London) Act, l936 44 155 41 44 Statutory Notices under Section'J of Housing Act, 1936 _ _ _ _ Statutory Notices under byelaws for provision of dustbins 10 8 3 2 Total number of samples purchased for analysis under the Food and Drugs (Adulteration) Act 232 210 211 312 Samples (informal) purchased Legal proceedings instituted in respect of defective sanitary conditions and nuisances 3 21 6 2_ Legal proceedings under Milk and Dairies (Amendment) Act, 1922 5 _ _ Legal proceedings in respect of unsound food 3 _ _ _ Certificates issued in accordance with " Rent Restrictions Act 440 892 600 894 Entries in Inhabitants' Complaint Book Cleansing and Disinfection. _ Number of adults cleansed 29 14 18 18 Number of children cleansed 558 498 249 320 NUMBER OF ADULTS TREATED FOR SCABIES 82 58 90 232 Number of CHILDREN treated for Scabies Number of articles (bedding, etc.) disinfected 9828 11,424 18485 40026 Number of articles (various) destroyed 814 3,394 2,236 1638 Disinfection Station Shelter. Persons accommodated :— Adults NIL NIL NIL NIL Children NIL NIL NIL NIL Mortuary. Number of bodies received _ 1 _ Number of infectious bodies received _ _ _ Number of bodies removed to Public Mortuary on Sanitary grounds _ _ _ Number of bodies detained in Mortuary Chapel _ _ _ _ 1942. ARTICLES DISINFECTED:- PUBLIC HEALTH SERVICES 26815 CIVIL DEFENCE 11536 FIRE WATCHES 2,645 1942. ROOMS DISINFECTED:- CIVIL DEFENCE 1039 FIRE WATCHERS 359 45 TABLE No. 32. Magisterial Proceedings during the Year. Situation of Premises. Nature of Nuisance of Complaint. Petty Sessions. Date of Hearing. Result. 8 DONNE PLACE (OCCUPIER) LIVING UNDER IN SANITARY CONDITIONS AND ANABLE TO GIVE HERSELF PROPER CARE. WEST- MINISTER 14.3.42 ORDER FOR REMOVAL TO HOSPITAL. 73 DOVE HOUSE ST. (OCCUPIER) DITTO DITTO 7.5.42 DITTO 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 5" 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. TH/fc£ complaints of smoke nuisance were received during the year and cautionary letters were sent to the offenders. Fouling of Footways by Dogs.—The Borough Council has obtained sanction for a byelaw to deal with this nuisance. This has already been found useful, the condition of footways having improved considerably since the measure came into operation. During the year /i'o prosecutions were taken for infringement of the byelaw, and a conviction obtained in each case. Rats and Mice (Destruction) Act, 1919.—A Sanitary Inspector is authorised under this Act to act as Rat Officer in his district. The Act places the responsibility for rat preventive measures upon the occupiers of premises. During the year the Council provided rat-catching vamish 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 bait? 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 1942 pigeons were captured and humanely destroyed. /V /yjy, ; y /f^/ TABLE No. 33. 1939. 1940. ON REGISTER AT END OF YOUR NO. OF INSPECT-IONS NO OF NOTES NO OF PROSE- CUTIOUS ON REGISTER AT END OF YEAR NO. OF INSPECT- INS NO OF NOTICES NO. OF PROSE- CUTIONS 1. Premises used for Business Purposes Milk Premises 81 46 1 _ 82 98 1 _ Cowsheds _ _ _ _ _ _ _ _ Ice Cream Premises ... 42 28 _ _ 40 20 _ _ Butter and Margarine 10 10 _ _ 10 10 _ _ Manufacturers and Dealers :— _ _ Fried Fish Premises 14 14 _ 14 14 _ _ Fish Curers 5 5 _ 5 5 _ _ Bakehouses 20 121 12 _ 26 46 _ _ Slaughterhouses _ _ _ _ _ _ _ Food Stalls 30 UNDER DAILY DISTURBANCES _ _ 30 UNDER DAILY OBSERVATION _ _ Offensive Trade Premises ... _ _ _ _ 2. Premises used for Human Habitation :— Houses let in lodgings 608 29 _ _ ? _ _ _ Common Lodging Houses ... 1 1 _ _ _ _ _ _ Canal Boats _ _ _ _ 47 Premises and Occupations Controlled by Byelaws and Regulations.—The preceding Table Mo. 33 summarises the number and character of premises and occupations in the borough which are controlled by byelaws and regulations. Underground rooms and underground sleeping rooms, although controlled, the former under the Public Health (London) Act, 1936, and the latter under the Housing Act, 1936, are net registered. Further reference to these premises and occupations will be found in the Sections of this report dealing with " Inspection and Supervision of Food and Housing." Eradication of bed bugs.—Three hundred and fifteen premises were found to be infested with bed bugs, 26 being owned by the Borough Council and 289 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 thirty-eight tenants was treated in this way. Cyanide fumigation is carried out by the Westminster City Council, under an agreement with the Borough Council. Factories, Workshops and Workplaces.—The Medical Officer of Health is required under Section 128 of the Factories Act, 1937, to include in his annual report details of the administration of this Act in his district. The total number of factories, workshops and workplaces on the register at the end of the year was 135. The number of inspections of these premises was 169, which compares with 260 in 1937. Sanitary defects were found in 24 instances. The following Table No. 34 is in the form requested by the Home Office in order to ensure uniformity in the presentation of returns :— TABLE No. 34 Factories, Workshops, Workplaces, and Homeworkers' Premises. I.—Inspection of Factories and Other Premises. (Including Inspections made by Sanitary Inspectors). Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers prosecuted. (4) Factories (with mechanical power) 104 _ — Workshops (without mechanical power) 54 _ — Other Premises under the Act (including works of building and engineering construction but not including Outworkers' premises) 7 Total 169 — — 48 2.—Deffects found in Factories and Other Premises. Particulars. Number of Defects. N umber of offences in respect to which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) 13) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 15 15 — — Want of ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 2 2 — — Sanitary accommodation:— Insufficient — — — — Unsuitable or defective 5 6 — — Not separate for sexes 1 1 — — 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 24 24 — — * Including those specified in Sections 2, 3, 7 and 8 of the Factories Act, 1937, as remediable under the Public Health Acts. 3.—Home Work. Outworkers' Lists, Section 110. Outwork in Unwholesome Premises, Section 111. Outwork in Infected Premises, Sees. 109, 110. Lists received from Employers. Number of Addresses of outworkers received from other Councils. Number of Addresses of outworkers forwarded to other Councils. Prosecutions. No. of Inspections of Outworkers Premises. Instances. Notices served. Prosecutions. Instances. Orders made (Sec. 109). Prosecutions. (Sec. 109, 110). Lists. Chelsea Outworkers 1937 13 7 20 122 — 30 — — — — — — 1938 13 9 20 160 — 33 — — — — — — 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 1938 50 1. To await Inquests:— (a.) Infectious— (b.) Non-infectious— 2. Sanitary grounds— Number of Post Mortem examinations 26 Number of bodies detained in Mortuary Chapel 31 Rag Flock.—No premises for the manufacture of rag flock are maintained in the Borough and no samples of rag flock have been taken during the year. Offensive Trades.—At the present time there are no offensive trades in the Borough. Swimming Baths and Pools.—There is one Swimming Bath owned by the Borough Council, located in Chelsea Manor Street, open to the public. No privately owned Swimming Baths are known to the Department. A chlorination filter system is in operation. Two samples of the Baths water were submitted for examination and the bacterial content was found to be in all respects satisfactory. Pharmacy and Poisons Act, 1933.—During the year, fifty-six applications were received from traders for entry in the Council's list of authorised sellers of poisons. In each case the application was approved, after investigation. 50 SECTION IV—HOUSING. In accordance with the instructions of the Ministry of Health, the following tabular statement has been prepared :— TABLE No. 35. HOUSING STATISTICS FOR THE YEAR. 1. Inspection of Dwelling-houses During the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 694 (b) Number of inspections made for the purpose 3067 (2) (a) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 140 (6) 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 (6) By Local Authority in default of owners — Proceedings under sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which Demolition Orders were made 3 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 3 (d) Proceedings under section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 4. Housing Act, 1936.—Part IV.—Overcrowding. (a) (i) Number of dwellings overcrowded at end of year 450 (ii) Number of families dwelling therein 490 (iii) Number of persons dwelling therein 2950 (b) Number of new cases of overcrowding reported during the year (due to increase of children's age) 9 (c) (i) Number of cases of overcrowding relieved during the year 81 (ii) Number of persons concerned in such cases 397 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding. None (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report. Although overcrowding conditions in Chelsea have been much less prevalent than in many other metropolitan boroughs, definite alleviation has taken place since the Housing Act of 1935 became operative. Sixtyone cases of overcrowding in houses owned by the Local Authority have been abated. 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.1 The process of reconstruction is still in progress, though largely suspended by the operation ot the Rent Restrictions Acts. The developments which have taken place have arisen from the fact that a very considerable proportion of Chelsea is comprised within the areas of two large estates—the Cadogan Estate and the Sloane Stanley Estate. Many of the building leases on these estates were granted early in the 19th century and a large number have already expired. A certain proportion of demolition of small property has been due to the acquisition of land by large trading corporations. Owing to the proximity of the eastern boundary of the Borough to Hyde Park and Belgravia, and to the attractiveness of the Embankment forming the southern boundary, residential values in these neighbourhoods have greatly appreciated in recent years, the price of land has been correspondingly increased, and the old type of small house, accommodating the small trader and the artizan or labourer, has been replaced by modern houses and mansions let in flats commanding high rents. The process of development has been largely in the hands of Estate Companies, who have purchased the reversionary interests of the ground landlords, and proceeded to carry out the demolitions and reconstructions as soon as the property came into their possession. Until subsequent to the War, no restriction operated, nor did any liability attach to Estate Companies conducting operations of this nature, to make any provision for rehousing the working classes displaced. Despite the difficulties of the problem, in Chelsea a considerable amount of accommodation had been provided for the working classes during the years preceding the outbreak of War. This had been effected by municipal undertakings, by private enterprise and by the operation of benevolent agencies and trusts. Sufficiency of Supply of Houses.—Municipal undertakings for the housing of the working classes carried out by the Borough Council prior to 1914 are shown in Table No. 36:— 53 TABLE No. 36. Pre-War Housing. Properties Owned and Managed by the Chelsea Borough Council. Property. No. of Flats Population (approx.) Rents. Sir Thomas More Buildings, Beaufort Street 262 725 4/11 to 13/10 per week Pond House, Pond Place 32 125 10/8 to 14/9 per week. Onslow Dwellings, Pond Place 108 312 6/6 to 8/7 per week. Grove Buildings, Chelsea Manor Street 120 220 4/2 to 7/8 per week. 522 1,382 Private enterprise, benevolent agencies and trusts had also made very important contributions to housing in Chelsea prior to 1914. These are shown in Table No. 37. TABLE No. 37. Properties erected by Private Enterprise, Benevolent Agencies, Trusts, etc. Property. No. of Flats. Population (approx.) Rents. Sutton Model Dwellings, Cale Street 660 2,037 3/5 to 10/10 per week. Lewis Trust Dwellings, Ixworth Place 398 1,299 3/1 to 10/3 per week. Marlborough Buildings, Walton Street 162 391 9/0 to 20/0 per week. Guinness Buildings, Draycott Avenue 303 711 2/3 to 7/5 per week. Peabody Buildings, Lawrence Street 68 163 3/8 to 8/4 per week. Chelsea Park Dwellings, King's Road 54 114 3/5 to 12/6 per week. It will be seen that in Chelsea at the outbreak of war there was available accommodation for about 7,000 persons of wage-earning class—an amount which, in proportion to population, was considerably higher than that obtaining in any other metropolitan borough. 54 Since the war, the economic situation and other factors, particularly the shortage of and greatly increased cost of building land in Chelsea have rendered an already difficult situation still more difficult. The Housing Committee of the Borough Council has been actively engaged in investigating possible sites in connection with further housing schemes and from time to time various schemes have been formulated by the Council and submitted to the Ministry of Health for approval. Of the schemes prepared and submitted to the Ministry, five have fortunately materialised, approval of the others not being obtained on the ground that the cost of the land was much higher than the price the Ministry could sanction for the purchase of land to be used for the erection of buildings to house the working classes. These buildings are now fully occupied. Details of each approved scheme 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 Borpugh Council subsequent to the war are 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 8'78for 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 rent's 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. 67 TABLE No. 38. Post-War Housing. Name of Undertaking. Area of Site. Total Cost. Date of Completion. Number of Flats. Population. Rents. Remarks. Hortensia House, Hortensia Road. 1 acre, 12 poles. £49,000 1925 56 202 persons. 22/10 to 31/per week. Rents drawn up on an economic basis on instructions of Ministry of Health. Guinness Trust Buildings, King's Road. 1 acre, 3 roods, 28½ poles. £21,200 (cost of site). 1929 160 747 persons. 4/- to 13/per week, exclusive of rates. Site leased for a term of 99 years at a nominal rent by the Borough Council to the Guinness Trust. Peabody Trust Buildings, Chelsea Manor Street. 1 acre, 16 poles. £19,000 (cost of site). 1931 112 510 persons. 5/- to 13/6 per week, exclusive of rates. Site leased for a term of 99 years at a nominal rent by the Borough Council to the Peabody Trust. World's End Passage Improvement Scheme. 2 acres, 17 poles. * £7,300 (approximate cost of site). 1935 64 327 persons. 5/- to 16/6 per week. Site leased for a term of 99 years at a nominal rent by the Borough Council to the Chelsea Housing Improvement Society. The Estate is managed by a representative of The Women House Property Managers. Chelsea Manor Buildings, Chelsea Manor Street. 2 acres, 35 poles. £61,862 — 94 214 persons 6/6 to 18/per week. Site purchased and buildings being erected by Borough Council. 486 2,000 58 SECTION V.—INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—In accordance with statutory enactments, the Council keeps a register of persons carrying on the trade of dairymen or purveyors of milk and no person is permitted to carry on the trade in the Borough unless he is registered. The Council is empowered to remove the name from or refuse to enter upon the register the name of any person selling or proposing to sell milk on premises which are for any reason unsuitable for the purpose. The Milk and Dairies (Amendment) Act, 1922, further empowers the Council to refuse to enter the name oi any person in the Register, or to remove the name of any person from that Register, if it is shown to the Council's satisfaction that the public health is or is likely to be endangered by any act or default of such person in relation to the quality, storage or distribution of milk. The premises at which registered purveyors of milk carry on their business have been subject to frequent inspection. During the year two applications were made for registration as purveyors of milk, which, after appropriate investigation, were approved by the Council. In Table No. 33 (page 46) is shown the alterations which took place in the Register of Milk Purveyors during the year. During the year there were 96 inspections of dairies and milkshops made in the Borough. Notices were served requiring remedy of defects found on two of the premises visited. There are no cowsheds in the district. Milk (Special Designations) Order, 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. 1938. To sell "Accredited" Milk 1 To sell "Tuberculin Tested" Milk 9 To sell "Pasteurised" Milk 15 Supplementary Licences 4 20 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 now only one private slaughterhouse in the Borough and 11 inspections of these premises were made during 1938. In compliance with the byelaws prescribing humane slaughtering, approved methods of slaughter are employed at these premises. There is no public abattoir in the Borough. Table No. 33 (page 46) shows, in the form required by the Ministry of Health, the number of private slaughterhouses in use in the Borough on the dates indicated. Bakehouses.—There are 20 bakehouses in the Borough, and 37 inspections of these premises were made during the year. One notice was served for the cleansing of walls and ceilings. 60 Ice Cream Vendors.—At the end of the year, 45 premises were shown in the Register as places where ice-cream is prepared or sold. There were 54 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 14 premises in which the frying of fish was carried on and 23 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. UNSOUNO Food. THE AMOUNT OF FOOD SEIZED OR VOLUNTARILY SURRREN OEREO AS UNFIT FOR HUMAN CONSUMPTION SHOWED A LARGE INCREASE TO THE PREVIOUS YEAR. TWO HUNDRED AND NIN ETEEN CONSIGNMENTS OF FOOD STUFFS OF VARIOUS KINDS WERE EXAMINED. A CERTIFICATE WAS GIVEN THE OWNERS AFTER THE ARTICLES WERE DESTROYED OR RENDERED UN SALE ABLE. (SEE PAGE 88 - FOR FOOD SURRENDERED 1939-1942) Food Poisoning.—No case of food poisoning occurred during the year. Food and Drugs (Adulteration) Act, 1928.—Four hundred samples, including 97 samples of milk and 5 samples of cream, were taken and submitted for analysis during*the year. These samples were investigated by the Public Analyst to the Borough, whose Report is set out in the appendix. Each of the four male Sanitary Inspectors is appointed an Inspector under the Acts. Under their direction, the taking of samples is effected by individuals temporarily employed for the purpose, the services of persons outside the Borough being frequently utilised. The samples procured are of two kinds—formal and informal. Formal samples are those taken strictly in conformity with the Act. Informal samples are those taken without these strict formalities and afford useful indication of the conditions without disclosing to the vendor that the object of purchase is analysis. 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 justifv legal action. In each of these cases a warning letter was sent to the Vendor concerned. The work carried out under the Food and Drugs (Adulteration) Act, during the year is summarized in the Public Analyst's Report in the appendix. The Public Health (Preservatives, etc., in Food) Regulations.— All samples of milk and cream taken during the year were submitted to examination for preservatives. No evidence of the presence of preservatives was obtained sufficient to warrant legal proceedings. Margarine.—No application for transfer of registration was received during the year from wholesale dealers in margarine. Bacteriological Examinations.—Arrangements have also been made with the Clinical Research Association for the bacteriological examination of samples of milk under the Milk (Special Designations) Orders. Nine samples were submitted for investigation during the year, each of which was found to be satisfactory in character. DISSEMINATION OF KNOWLEDGE AS TO NUTRITION. Advice as to the necessity for a high standard of purity and quality in relation to food is given by the staff of the Public Health Department. In addition, lectures and film demonstrations on Health topics, including Diet, are given from time to time at the premises of the Chelsea Health Society. Leaflets are also issued to expectant and nursing mothers which are of great assistance in focussing attention on this important subject. , The desire of the public to consume a natural product, or at least that they should be made aware if offered an artificial substitute, has found expression in the Artificial Cream Act, 1929. Shell-fish (Molluscan).—There are no shell-fish beds or layings in the Borough. No markets for the sale of shell-fish by wholesale exist in the district. 62 SECTION VI.—INFECTIOUS DISEASES. (a) Infectious Diseases Generally. DISEASES COMPULSORILY NOTIFIABLE IN THE BOROUGH. Acute Poliomyelitis. Acute Polio-encephalitis. Acute Encephalitis Lethargica. Acute Primary Pneumonia. Acute Influenzal Pneumonia. Cerebro-spinal Fever. Plague. Anthrax. Glanders. Hydrophobia. Cholera. Continued Fever. Ophthalmia Neonatorum. Food Poisoning. Diphtheria. Membranous Croup. Dysentery. *- Erysipelas. Malaria. Puerperal Fever and Puerperal Pyrexia. Relapsing Fever. Small-pox. Typhus Fever. Tuberculosis. Scarlatina or Scarlet Fever. Typhoid or Enteric Fever. Measles. Whooping Cough. NOTIFICATIONS DURING THE YEAR. The total number of notifications, excluding duplicates, was 374 Of this figure,48 were notifications of Pulmonary Tuberculosis and 9 of Non-pulmonary Tuberculosis 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. age 10 yrs 1929- 1938 Cases notified in Chelsea. Cases notified in each Ward. Removed to various Hospitals Cases Notified in Chelsea At all Ages. Under 1 Year. 1-2 Years. 1 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. TiS and Upwards. Stanley. Cheyne. Church. Hans Town. Royal Hospital. 1939 1941 Small-pox — — — — — — — — — — — — — — — — — — — — — — 86 Chicken-pox — — — — — — — — — — — — — — — — — — — 1 — — - RELAPSING FEVER — — — — — — — — — — — — — — — — — — — 1 — — 112 Diphtheria 18 1 6 1 1 1 2 — — 3 3 1 - 3 1 13 1 — 18 65 15 31 31 Erysipelas 16 — — — — — — — 1 2 3 8 2 4 3 5 2 2 12 15 9 16 146 Scarlet Fever 67 1 2 4 7 8 34 4 1 6 — — — 26 4 33 3 1 64 49 13 23 Typhus Fever — — — — — — — — — — — — — — — — — — — — — — 4 Enteric Fever 4 — — — — — — 2 — — 1 — 1 1 3 — — — 4 1 1 6 3 Puerperal Fever 1 — — — — — — — — 1 — — — — — 1 — — 1 2 2 — 8 Puerperal pyrexia 4 — — — — — — — — 3 — 1 — — 1 1 1 1 4 10 6 3 1 Cerebro-spinal Fever 3 — 1 — — — — — 1 1 — — — 1 — 2 — — 3 1 7 4 4 Ophthalmia Neonatorum 1 1 — — — — — — — — — — — 1 — — — — 1 5 3 4 1 Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — 0.1 Encephalitis Lethargica — — — — — — — — — — — — — — — — — — — — — — 0.1 Polio-encephalitis - — — — — — — — — — — — — — — — — — — — — — 1 Malaria — - — — — — — — — — — — — — — — — — — 1 — — 5 Dysentery 23 — — 3 1 — 5 - — 2 — 3 9 9 1 13 — — 23 4 6 95 88 Acute Primary Pneumonia 14 — — — 1 1 2 — — 2 4 2 4 11 1 1 1 2 3 43 59 64 15 Acute Influenzal Pneumonia 4 — — — — — — — — — 1 3 — — — 3 1 — 1 4 9 2 Food Poisoning — — — — — — — — — — — — — — — — — — — — 5 — 327 Measles 93 6 9 16 10 8 31 1 3 7 2 — — 46 17 24 4 2 30 16 150 40 75 Whooping Cough 67 13 6 13 11 8 15 1 — — — — — 27 7 26 3 4 21 74 4 44 505 Total 317 22 24 37 31 26 89 8 6 27 13 18 16 129 38 122 16 12 185 292 289 332 Tuberculosis:— 88 Pulmonary 48 — 3 — — — — — 8 18 4 6 6 19 10 9 6 4 75 49 57 17 Non-Pulmonary 9 5 3 1 2 1 3 1 2 5 5 5 105 Totals (Tuberculosis) 57 — 3 — — — — — 8 23 10 7 6 21 11 12 7 6 80 54 62 Totals 374 22 24 34 31 26 89 8 14 50 23 25 22 150 49 134 23 18 372 343 394 NOTE:- NOTIFICATIONS HAVE NOT BEEN CORRECTED FOR ANY SUBSEQUENT REVISION OF DIAGNOSIS & NOT NOTIFIABLE CASES REPORTED TO PHD 64 POLIOMMELITIS No cases of Small-pox, Cholera, Typhus Fever, Encephalitis Lethargica, Polio-Encephalitis, Malaria, Continued Fever, Relapsing Fever, Plague, Anthrax, Glanders or Hydrophobia were notified during the year. DIPHTHERIA. Notifications.—-During the year 18 cases of diphtheria were notified as compared with 31 in the previous year. Information was received from the London County Council that 5 of the cases sent to Hospital proved not to be suffering from Diphtheria. The actual number of cases was therefore 13. Deaths.—. No deaths from the disease occurred during the year. Return Cases.— NO "return" cases of the disease occurred during the year. The incidence of the disease during the past FOUR years is shown in Table No. 41. TABLE No. 41. Year Cases (Corrected) Percent age of Remov als. Deaths Case Mortality Rate. Percent age of cases of School age (3-13 years) Month of greatest prevalence. Bacterioscopic Diagnosis, Lister Institute. No. of Specimens submitted Positive. Percent age Positive. Negative. Percent age Negative. 1939 60 100 3 5.0 51 FEB 236 24 10.O 212 90.0 1940 10 100 - 0.0 53 JUNE 59 — 0.0 59 100.0 1941 21 1000 - 0.0 14 MAY 142 7 5.0 135 95.0 1942 13 100 - 0.0 31 MAY .66 1 1.5 65 98.5 DIPHTHERIA IMMUNISATION CLINIC. In April, 1934, the Borough Council approved an annual grant of £50 for immunisation against diphtheria and Schick testing to be carried out at the Violet Melchett Infant Welfare Centre for children under 5 years of age on the register of the Centre. Early in 1935, the Borough Council arranged to extend these facilities to children of school age, the Borough Council contributing towards the cost of this service. A weekly clinic has been held during the year. In co-operation with the London County Council, leaflets have been prepared and distributed at the various schools in the Borough. Attendances of elementary school children for immunisation against diphtheria at the clinic are allowed to count as attendances at school. 65 The following table gives details of the work of the clinic during the past FOUR years. TABLE 41A. Year No. of new cases. Preliminary Schick Tested. Commenced treatment without Schick Test. Naturally Immune Immunised. Discontinued treatment and removed from register. No. under treatment at end of year. CHILDREN IMMUNISED IN COUNTRY AND POST SCHICK AT CLINIC. Preschool Age. School Age. Preschool Age. School Age. 1939 241 3 36 202 16 164 22 10 125 — 1940 191 4 22 165 12 160 19 3 118 — 1941 754 5 396 353 149 151 420 29 29 — 1942 866 4 232 560 120 252 329 16 102 70 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, 6V cases of Scarlet Fever were notified, the figure for 1 (.)ht being J2& Information was received from the L.C.C. Hospitals that 4 of the cases proved not to be Scarlet Fever. The actual number of cases was therefore63. No '* return " case of the disease occurred during the year. Deaths.—There was /VO leath from Scarlet Fever during the year. Table 42 shows the incidence of the disease during the past FOUR 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 1942 63 95 — — 77 AUG Xo 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 i as 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 FOUR years:— TABLE No. 43. Year. Number of cases coming to the knowledge of the P.H. Dept. UN-NOTIFIED Cases notified Total cases. Deaths. Number of Visits and Re-Visits by Health Visitors, AND WOMAN SANITARY INSECTOR. Number of Visits by District Nurses. Under 5 years. Over 5 years Under 5 years Over 5 years Under 5 years Over 5 years Total Under S years Over 5 years Total 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 54 29 — 29 1942 9 11 49 44 113 1 115 48 193 21 3 24 WHOOPING COUGH. The incidence of the disease during the past FOUR years is shown in Table No. 44:— . TABLE No. 44. Year. Number of cases coming to the knowledge of the P.H. Dept. UN-NOTIFIED Cases notified Total cases. Deaths. Number of Visits and Re-Visits by Health Visitors. AND WOMAN ??? Number of Visits by District Nurses. 1939 36 74 110 — 213 134 1940 — 4 4 - 3 — 1941 — 44 44 _ 103 53 1942 33 67 100 — 180 28 1943 12 42 54 — 104 21 Removal to Hospital.—Cases of Measles and Whooping Cough are received in the hospitals of the London County Council. 67 ENTERIC FEVER. Notifications.—During the year FOURcases under the Enteric Fever Group were notified in Chelsea. ALL of these cases were treated in hospital. The history of each case was thoroughly explored, but it was found impossible to trace an unvarying causative factor between the various cases. Three specimens of blood were examined during the year for the Widal reaction. Deaths.—There was no death from this disease during the year. PNEUMONIA, MALARIA AND DYSENTERY. These diseases are compulsorily notifiable under the Public Health (Infectious Diseases) Regulations, 1927. The following table shows the number of notified cases during the past two years:— TABLE No 45. PNEUMONIA. MALARIA. DYSENTERY. Year Total Number of Cases Notified. Treatment in Hospital. Total Number of Cases Notified. Treatment in Hospital. Total Number of Cases Notified. Treatment in Hospital 1939 44 39 1 1 4 4 1940 68 68 — — 6 6 1941 66 47 — — 95 95 1942 20 4 — — 23 23 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. Two hundred and twenty-four visits wejp, made during the year. Deaths.—There were 38 deaths from Pneumonia (all forms) during the year. Malaria.—The Regulations provide that the Medical Officer of Health shall take all practical steps to ensure that persons suffering from Malaria are supplied with sufficient mosquito netting; receive adequate quinine treatment during the attack and subsequently; and receive appropriate advice as to precautions necessary to prevent the spread of the disease. No case of Malaria was notified during the year. Dysentery.—The forty-three cases notified during the year were due to infection from the Sonne bacillus. 68 PUERPERAL FEVER AND PUERPERAL PYREXIA. One case of Puerperal Fever and Foci cases of Puerperal Pyrexia were notified during the year. Details of these cases are set out in the following table :— TABLE No. 46. Total number of cases notified. Treatment in Hospital. District Nurses in attendance Council's Obstetrician called in. Deaths. PUERPERAL FEVER 1939 2 1 0 0 0 1940 2 2 0 0 0 1941 — — — — — 1942 1 1 — — — PUERPERAL PYREXIA 1939 10 8 0 0 1 1940 6 3 2 1 1 1941 3 3 — — — 1942 4 4 — — — * NON-PARISHIONER; DIED IN A CUELSEA HOSPITAL With the sanction ot the Ministry of Health the Borough Council has made arrangements for the services of a skilled obstetric consultant in puerperal cases and in cases of difficult labour, when desired by the medical practitioner in attendance. No case required consultation i during the year Arrangements have also been made for the utilization of the emergency obstetrical service of the London County Council. OPHTHALMIA NEONATORUM. Under the Public Health (Ophthalmia Neonatorum) Regulations, 1926, the duty of notifying a case of Ophthalmia Neonatorum is placed solely upon the medical practitioner in attendance. This disease is defined as a purulent discharge from the eyes of an infant, commencing within twenty-one days from the date of its birth. ONE case of Ophthalmia Neonatorum WASnotified during the year. As required by the Ministry of Health, particulars of the notified cases are set out in the following table:— TABLE No. 47. Ophthalmia Neonatorum. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Left District. Deaths. Year No. Notified. Treated. At Home. In Hospital. 1939 5 3 2 5 — — — — 1940 3 3 2 3 — — — — 1941 4 2 2 4 — — — — 1942 1 — 1 1 — — — — 69 Nursing -By arrangement with the Chelsea District Nursing Association, home nursing is provided for infants suffering from this disease. In addition to notified cases of Ophthalmia Neonatorum, 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. Three cases of Poliomyelitis were notified during the year and treated in hospital. ENCEPHALITIS LETHARGICA. No case of Encephalitis Lethargica was notified during the year. Two visits to old cases of Encephalitis Lethargica were made by the Woman Sanitary Inspector. Encephalitis Lethargica is undoubtedly infectious, but the infectivity is of very low nature. The sequelae may be serious, as in most cases some permanent damage to the brain tissue occurs. The disease was made compulsorily notifiable from 1st January, 1919. DEATHS. There were two deaths (Male 29 years, and Female 62 years) from this disease. during the year. CHICKEN POX. With the approval of the Ministry of Health, the Borough Council made the disease known as chicken pox notifiable in the Borough on, and from, the 12th August, 1929. Sixty-nine notifications were received during the year. Of these, 10 were treated in hospital. (Note By resolution of the Borough Council and approved by the Ministry of Health this disease will cease to be notifiable as an Infectious disease from 4th January, 1939). SMALL POX. No case of small pox was notified in Chelsea during the year. Appropriate action was taken as regards contacts of cases notified in other boroughs. Vaccination.—No vaccinations have been performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917. The following Table gives particulars as regards vaccination in respect of children whose births were registered in the Borough for the years The figures for the year 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 54.1 176 56.8 82 48.5 Insusceptible of vaccination 2 0.2 2 0.6 1 0.6 Had Small Pox - — ??? — — — Statutory Declaration of conscientious objection 153 18.9 55 14.4 15 8.9 Died unvaccinated 29 3.6 7 2.3 7 4.1 Postponed by medical certificate 2 0.2 ??? — — — Removed to other districts 77 9.5 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 1942 was 269. THE NUMBER FOR 1939 WAS 441; 1940, 213, 1941, 130. VENEREAL DISEASE. The London County Council is the Authority responsible for the provision of facilities for the diagnosis and treatment of venereal disease and special clinics are held in various hospitals. The nearest hospital for Chelsea residents is St. George's Hospital. ARRANGEMENTS FOR DISINFECTION AND DISINFESTATION AND THE EXTENT OF THEIR USE. The Borough Council maintains a Disinfecting and Cleansing Station situated at 9a, Lots Road, Chelsea, adjoining the river. Disinfection.—The disinfecting staff numbers three. A steam disinfector is provided. An appropriate motor vehicle is utilised for the conveyance of infected and disinfected articles to and from the Disinfecting Station. Disinfection in connection with the notifiable infectious diseases is carried out free of charge. Applications for special disinfection, not associated with the notifiable infectious diseases, are considered, and, if the work of the Department permits it, are carried out at the expense of the applicant. 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. S0A3I3S. The Scabies Order,1941, provides local authorities with extended powers for .dealing with verminous conditions. The incidence of' scabies has materially increased during the year. The number of cases was 403 and treatments 1356. Disinfection of the patients' personal clothing was carried out whilst the patients are being treated. The 2aones was visited by the Woman Sanitary Inspector who arranged for the examination of contacts and the disinfection of rooms at the home. The number of articles treated was 13,920 and the number of rooms disinfected was 434. 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. Lnder 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. L.C.C- SCHEME. CLEANSING OF VERMINOUS CHILDREN, ETC. ATTENDANCES. 1939 1940 1941 1942 VERMINOUS 554 298 233 306 SCABIES - — 54 405 IMPETIGO 1 — — 182 MINOR AILMENTS 394 91 - — AMOUNT RECOVER ABLE FROM L.CC. £45.90 £54.40 £26. £44.190 Thirty adults were cleansed at the Station during the year. (b) TUBERCULOSIS. This part of the report deals with the work of the Department under the Public Health (Tuberculosis) Regulations, 1930, and under the Dispensary scheme approved by the Ministry of Health and the London County Council. The latter contribute 25 per cent, of the nett expenditure of that scheme. Staff.—The staff of the Dispensary is set out on pages 5-6. NOTIFICATIONS AND NEW CASES. YEAR. NOTIFICATIONS. NEW CASES OTHERWISE THAN BY NOTIFICATION ON FORM A. TOTAL NEW CASES (ALL SOURCES) PRIMARY DUAL. TOTAL. . 1939 8O 8 88 43 123 1940 54 3 57 36 90 1941 62 5 67 13 75 1942 54 4 64 28 85 1943 76 6 82 20 96 72 TABLE No. 50. Tuberculosis. 1939 1940 1941 1942 Age Periods. NEW CASES. DEATHS NEW CASES. DEATHS NEW CASES. DEATHS NEW CASES. DEATHS TORY. NON TORY TORY. NON TORY TORY. NON TORY TORY. NON TORY TORY. NON TORY TORY. NON TORY TORY. NON TORY TORY. NON TORY M. F. M. F. M. F. M. F M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M F M. F. 0— 1 — 1 1 — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — 1—5 — — — — — — — 1 2 1 — — 1 — — — — 1 — — — — — — — 3 — — — — — 1 5—10 1 1 2 — — — 1 — 1 — — — — — — — — — — 1 — — — — — 1 — — — — — — 10—15 — 1 1 1 — — — — 1 1 — — — — — 1 1 — — — — — 1 — — — — — — — — — 15—20 4 5 — 1 — 1 — — 4 3 1 — — 2 1 — 1 4 — — 2 2 — — 2 5 — 1 — — — — 20—25 3 7 2 — 4 2 — — 6 9 1 — — 3 2 — 1 5 1 — — 2 — — 3 10 — 3 1 1 1 25—35 8 8 — 1 4 2 — — 11 7 — 2 4 — — — 5 9 1 2 2 1 1 — 7 10 2 1 1 4 — — 35—45 15 9 — — 3 — — — 8 7 1 — 4 6 — — 10 4 — — 2 1 — — 5 7 1 2 — 2 — — 45—55 15 6 1 — 8 3 1 — 4 1 — — 2 1 1 — 9 4 — 1 4 4 — — 6 2 1 1 3 1 2 — 55—65 13 1 — 1 9 — — 1 11 1 — — 6 1 — — 6 1 — 1 4 — — — 5 1 — — 1 1 — — 65 and upwards 11 2 1 — 7 3 — — 6 — — 1 6 1 — 1 3 4 — — 4 3 — — 5 — — 1 3 1 — 1 Totals 70 41 8 4 35 11 3 2 54 30 3 3 23 14 4 2 36 32 2 5 18 13 2 — 33 39 4 9 9 10 3 2 TABLE TUBERCULOSIS Year Death Rate Total Deaths Died Non-Notified or Prior to Notification Ratio Non-Notified 1939 1.0 51 17 1 To 3 1940 1.1 43 15 1 To 3 1941 1.2 33 6 1 To 5 1942. 0.9 24 4 1To 6 Cases of Tuberculosis in the Borough.—The Public Health (tuberculosis) Regulations, 1930, provide that the Medical Officer of Health shall furnish to the County Medical "Officer, as soon as practicable after the end of each quarter, a statement compiled from the register of notifications showing:— {a.) The number of cases of Tuberculosis on the Register at the commencement of the Quarter; (b.) The number of cases notified under the Regulations for the first time during the Quarter; (c.) The number of cases removed from the Register during a preceding Quarter which have been restored to the Register during the Quarter, giving the name and address of each such case and the reasons for the restoration; (d.) The number of cases added to the Register during the Quarter which have been brought to notice otherwise than by notification under the Regulations; (e.) The number of cases removed from the Register during the Quarter giving the name and address of each such case and the reason for such removal; and 73 (f.) The number of cases remaining on the Register at the end of the Quarter. The returns made in accordance with these Regulations show that the numbers of cases of Tuberculosis in the Borough on 31 st December last were as follows:- 1939 1940 1941 1942 MALES FEMALES TOTAL MALES FEMALES TOTAL MALES FEMALES TOTAL MALES FEMALES TOTAL Pulmonary 116 84 200 105 72 177 93 63 156 99 72 141 Non-pulmonary 23 15 38 20 15 35 16 15 31 15 16 31 139 99 238 125 84 212 109 78 187 114 88 202 (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 82 visits to nondispensary cases of Tuberculosis. 1939, 92: 1940.106: 1940, 65. 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 1942. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand Total. Adults. Children Adults. 1 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 19 21 — 3 2 6 — — 21 27 — 3 171 (b) Diagnosis not completed — — — — — — — — — — — — (c) Non-tuberculous 56 43 13 8 — — — — 56 43 13 8 B.—Contacts examined during the year:— (a) Definitely tuberculous — 1 — — — — — — — 1 — — 117 (b) Diagnosis not completed — — — — — — — — — — — — (c) Non-tuberculous 16 46 34 20 — — — — 16 46 34 20 C.—Cases written off the Dispensary Register as:— (a) Recovered 4 6 1 — — — — — 4 6 1 — 251 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) 72 91 47 28 1 1 — — 73 92 47 28 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous ... 77 63 6 2 5 13 1 2 82 76 7 4 169 (b) Diagnosis not completed — — — — — — — — — — — — 1. Number of cases on Dispensary Register on January 1st 155 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years ... 33 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 35 4. Cases written off during the year as Dead (all causes) 2/ 6. Number of Insured Persons under * Domiciliary Treatment on the 31st December 5. Number of attendances at the Dispensary (including Contacts) 921 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 5 7. Number of consultations with medical practitioners:— (а) Personal (b) Other 85 3 10. Number of:— (а) Specimens of sputum, etc., examined (b) X-ray examinations made in connection with Dispensary work 43 456 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 2140 11. Number of "Recovered" cases restored to Dispensary Register, and included in A(a) and A(b) above 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 94 B.—Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment):— Provided by the Council — Provided by Voluntary Bodies One (Signed) W. H. L. MCCARTHY, Chief Tuberculosis Officer. 77 Chelsea Tuberculosis Dispensary.—This Dispensary, located at Brompton Hospital, provides highly efficient treatment for all cases resident in the Borough. By agreement with the Borough Council, adequate Medical, Nursing and other necessary services are provided. The Tuberculosis Officer (Dr. M DAVIDSON) is Dean of the Medical A School and Honorary Consulting Physician to the Hospital and his services are available when required by any medical practitioner in the Borough. Social work in connection with the Dispensary cases is carried out systematically and well by a trained Social Worker. With the approval of the Ministry of Health, the Borough Council made a financial grant of £1,000 to Brompton Hospital for the year commencing 1st April, 1941. 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 Foirtyears, 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 PER CENT. 1, 563 1940 140 12 „ „ 1,046 1941 122 14 „ „ 904 19 42 141 14 „ „ 921 Average 10 YEARS. 1929-1938. 416 11 „ „ 2445 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 hospita.1 for cases of pulmonary tuberculosis (females). PERCENTAGE OF DEATHS (TUBERCULOSIS) - CHELSEA RESIDENTS - INSTITURIONS YEAR ST. LURES HOSPITAL OTHER PUBLIC INSTITUTIONS TOTAL 19 39 51 PER CENT 39 PER CENT 90 PER CENT 1940 44 „ „ 39 „ „ 86 „ „ 1941 21 „ „ 70 „ „ 91 „ „ 1942 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 wilh children. Many children are referred direct to the School Clinic for the treatment of minor ailments and dental caries. Co-operation with Medical Practitioners.— YEAR NO. OF CASES (INCLUDING PERSONAL CONSULTATIONS) VISITED BY THE TUBERCULOSIS OFFICER AT THE HOMES OF THE PATIENT NO. OF CASES REFERRED BY MEDICAL PRACTITIONERS TO TUBERCULOSIS OFFICER AT THE DISPENSARY. 1939 20 75 1940 18 51 1941 9 48 1942 5 88 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. YEAR NO. OF PATIENTS COST YEAR NO. OF PATIENTS COST 1939 30 £222.12.0 1941 22 £193.14.6 1940 28 £242.8.0 1942 31 £246.1.6 The Dispensary Nurse also visits the home for observation purposes. YEAR NO. OF VISITS BY NURSE TO HOMES OF PATIENTS 1939 2, 972 1940 2, 124 1941 1,658 1942 2,140 Extra Nourishment.- YEAR NO. OF CASES CERTIFIED BY TUBERCULOSIS OFFICER TOTAL COST 1930 19 £42.11.0 1940 25 £58.14.5 1941 26 £63.18.1 1942 17 £44.3.9 Home Nursing.— The Dispensary organisation includes nome nursing, which is much appreciated by such patients as are confined to bed. 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. 79 456/ Special Examinations.Four hundred and fifty six X-ray examinations 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 been made with the British Dental Hospital, 235, Hammersmith Road, W., for the provision of adequate dental treatment, including dentures, if necessary, for patients attending the Chelsea Tuberculosis Dispensary. In each case the certificate of the Tuberculosis Officer is required and dental treatment must be shown as necessary to render other treatment more completely efficacious. During the year 3 patients received dental treatment (including one case for dentures), the Borough Council making a contribution of £1. 17s. 6d. towards the cost. Bacteriological Examinations.—During the year, 43 specimens of sputum were examined in connection with the work of the Dispensary. In addition, 5 specimens were sent by medical practitioners to the Lister Institute for examination. Care Work.—The Chelsea Tuberculosis Care Committee, constituted on the basis advised by the Ministry of Health in 1922, took over in that year the work of the former Interim Care Committee which had been formed by the Borough Council in 1917. The Committee now includes the following representation and membership Chelsea Borough Council Alderman Lady Phipps. London County Council ... Dr. R. H. Simpson (Divisional Medical Officer). Miss Paddon (District Organiser of School Care Committees). Mrs. E. E. Potton (After-care Committee). Chelsea Invalid Children's Miss B. M. S.,Caudwell and Aid Association Miss A. Woodroffe. Public Assistance Mrs. E. Coote. Committee Mrs. L. Fraser. Chelsea Charity Organisation Miss Larken. Society. Chelsea District Nursing Miss N. D. Dixon. Association. Chelsea Health Society Mrs. Melville Miller. Brompton Hospital Miss Marx. Local Panel Committee Dr. M. Cutner. London Insurance Committee Mr. W. E. Fish. Local War Pensions Com- Miss Forbes. mittee and United Services Fund. 80 St. George's Hospital Lady Almoner. St. Luke's Hospital Miss Ellis. British Red Cross Society Miss M. A. Battye. Victoria Hospital Miss White. Ex-officio Members Dr. Leslie McCarthy (Medical Officer of Health). Dr. W. J. Fenton (Tuberculosis Officer). Miss M. Brown (Sanitary Inspector). Hon. Secretary Miss M. B. Streatfeild, Chelsea Tuberculosis Dispensary, Brompton Hospital, S.W. The duties of the Committee include enquiries into the economic position of the family of a patient suffering from tuberculosis as soon as the patient comes within the purview of the Tuberculosis Scheme. The Committee endeavours to ensure that as far as possible there shall be no difficulties to prevent the patient from carrying out the recommendations made by the Dispensary. Such advice and assistance is given as the circumstances of the case dictate, e.g., assistance in the provision, where necessary, of clothing required by the institution to which the patient is sent; pocket money; arrangements for the welfare of the family during absence of the father or mother; the securing of auxiliaries for domiciliary treatment which cannot be provided without charitable assistance, provision of extra nourishment and advising the Borough Council as to the extent to which assistance in this respect should be given; the rectification of unsatisfactory home conditions. The Committee also endeavours on the cessation of treatment to obtain suitable employment for the patient. The Care Committee meetings are held monthly at the Town Hall. Meetings of Committee 4 4 ^ Cases considered 114 118 Cases reported admitted to L.C.C. Institutions 68 65 Dental treatment given through Borough Council Scheme 3 1 Extra nourishment given through Borough Council Scheme 17 31 Extra nourishment given through other agencies 3 3 Other assistance given 56 36 Children boarded out through the L.C.C. Contact Scheme 4 3 Convalescence arranged 11 18 Patients' voluntary contributions towards the cost of Institutional treatment collected on behalf of the L.C.C. £ 32 Metropolitan Borough of Chelsea. Annual Report OF THE PUBLIC ANALYST For the Year ended 31st December, 1942 BY. THOMAS McLACHLAN, A.C.G.F.C., F.I.C. 82 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Chelsea. Mr. Mayor, Ladies and Gentlemen, Last year I had with regret to draw the attention of the Council to the increase in the amount of adulteration of food, since the outbreak of the war. The percentage of adulterated foods has increased again in 1942 with the result that the percentages of adulterated samples reported during the last few years are as follows:- 1938 1.0 per cent. 1939 2.25 " " 1940 4.5 " " 1941 7.0 " " 1942 12.75 " " * (Carry on page 83) Article. Taken Formally Adulterated. Taken Informally. Adulterated. Total Samples Analysed Total Samples Adulterated. centage trated ALES AND BEERS 8 — — — 8 — — BAKING POWDER & EGG SUBSTITUTES 8 — 13 7 21 7 33.3 BUTTER — — 1 — 1 — — CAREYPUDDING MIX: 20 1 11 2 31 3 9.6 CEREALS 9 2 7 2 16 4 25.6 CHEESE — — 2 2 2 2 100.0 COCOA 5 — 3 — 8 — — COFFEE 3 — 2 — 5 — — COFFEE & CHICORY 1 — — — 1 — — COFFEE EXTRACTS 1 — 4 1 5 1 20.0 CONFECTIONARY (SWEETS) 3 — — — 3 — — COROIALS 16 7 1 — 17 7 41.2 CREAM ARTIFICIAL — — 1 — 1 — — CUSTURD POWDERS 2 — 4 — 6 — — ESSENCES COLOURS AND FLAVOURS 1 — 3 1 4 1 25.0 FISH, BOTTLED & TINNED — — 5 1 5 1 20.0 FISH PASTE & ROLLS — — 2 — 2 — — FLOUR 4 — 1 — 5 — — FRUIT JUICE 1 — 1 — 2 — — GRAVY AND SOUP POWDERS 12 — 15 — 27 — — HERBS — — 1 — 1 — — HONEY ARTIFICIAL — — 1 — 1 — — CEREALS FOODS — — 2 — 2 — — CARRIED FORWARD 94 10 80 16 174 26 (Note Table shown follow report) 83 TABLE—continued. Article. Taken Formally. Adulterated. Taken Informally. Adulterated. Total Samples Analysed Total Samples Adulterated. centage trated. BROUGHT FORWARD 94 10 80 16 177 26 JELLY & DESERT POWERS — — 4 3 4 3 75.0 LEMON SUBSTITUTES — — 1 — 1 — — MEAT & VEG: EXTRACTS 2 — 2 — 4 — — MEAT PASTES 1 — 4 — 5 — — MEAT PIES 1 — — — 1 — — MILK 88 2 19 6 107 8 7.0 MILK MAILED TABLETS — — 1 — 1 — — MILK CONDENSED — — 1 — 1 — — MILK M/S „ — — 2 1 2 1 50.0 MILK POWDER — — 1 — 1 — — OAT MEAL 2 — — — 2 — — PICKLES AND SAUCES 8 — 12 3 20 3 15.0 RENNET TABLETS — — 1 — 1 — — SACCHARIN AND SUGAR SUBSTITUTES 2 2 — — 2 2 100.0 SAUSAGES — — 1 — 1 — — SCMOLINA 2 — — — 2 — — SOUP & VEG: TINNED 2 — 5 — 7 — — SPICES & CONDIMENTS 6 2 12 1 18 3 16.6 SUGAR — — 1 1 1 1 100.0 TEA — — 1 — 1 — — VINEGAR 3 1 4 1 4 2 28.6 YEAST SPREAD — — 1 — 1 — — DRUGS — — — — — — — ANTI GAS. OINTMENT — — 16 — 16 — — ASPIRIN TABLETS — — 9 — 9 — — GLAUBER SALTS — — 2 1 2 1 50.0 MAGNESIUM SULPHATE — — 4 — 4 — — NERUE TONIC — — 1 — 1 — — SODA MINTS — — 1 1 1 1 100.0 SODIUM BICARBONATE — — 2 — 2 — — 1 — — — 1 — — 212 17 188 34 400 51 12.75 * Part of this increase is due to the fact that the public are becoming more critical of food owing to the more restricted diet on which they have to live and, consequently, many more complaints are received at the Town Hall, which are passed to the Public Analyst. Whilst may of these samples are reported as adulterated, there is nothing to show their condition when received by the purchaser and a comlainant will think nothing of taking the top portion of milk from a bottle with the cream and asking for the remainder to be examined.Naturally the portion of milk lower in the bottle is deficient in fat, but it is seldom that a sample taken by the Sampling Officers, with proper precautions, in course of delivery, is found to be faulty. 84 Seven samples of egg substitute and baking powders were returned as adulterated. One of these samples was composed of 90 per cent. wheat flour, 8 per cent. soya flour and 2 per cent.sodium bicarbonate. Six of the samples were sold as a Yorkshire pudding Powder and were, apparently sold under licence from the ministry of Food. Even allowing for the formula approved by the Ministry the powders were 50 per cent. deficient in raiding properties. Four samples of cereals were reported on adversely. Two products sold as semolina were litttie more than coarse flour. A sample of spaghetti, which was slightly mouldy, was submitted for your analyst's opinion as to its possible use and it was suggested that it should bo incorporated into a poultry food. A sample of porridge mixture consisted of coarsely ground wheatmeal only and it was suggested that it should not be called porridge meal or,alternately, labelled as being wheatmeal only. Three samples of cake and Pudding mixtures were reported against. A pancake mixture was claimed to require "No Egg, Butter, or Flour", but consisted essentially of selfraising flour with a little added gum and colouring matter. A batter mixture was labelled in such a manner as to imply that it contained both milk and eggs,whereas it contained neither. A."real-egg" self raising flour contained 2.5 per cent.of egg powder only and this quantity was considered insufficient. The manufacturers claimed to add 3.25 per cent, of egg powder and three other samples of the same preparation examined by your Analyst have been satisfactory. Two samples of dessert powder consisted of slightly coloured and flavoured flour and your Analyst understands that the Licence for these products was withdrawn by the 85 Minister of Pood. A sample of strawberry flavoured Table Cream contained 400 parts per million of zinc and it is believed that this zinc originates from the use of galvanised iron net for drying purposes instead of aluminium, owing to the shortage of aluminium resulting from the war. A sample of powdered coffee extract was condemned because it had become damp and caked into a lamp at the bottom of the container. Preparations of this type are liable to coke in this manner and,in your analyst's opinion, should be labelled to the effect that they will be changed if unfit for use before a certain date. The public is then aware of what it is buying. A sample of sugar was found to contain 7 per cent. of ground rice, half-strength saccharin tablets were sold as fullstrength and a sweetening solution was 75 per cent. deficient in the sweetening power claimed for it on the label. Seven samples of cordials Were condemned as adulterated. During the last year your analyst has appeared in many courts on behalf of other Authorities,who have taken action in these cases. Unfortunately one or two analysts have seen fit to support these bogus preparations on which large profits have been made by certain firms and as a result of an Appeal the Divisional Court has held that the evidence of a Public Analyst should be supported by that of some representative of the public or of the trade. The situation thus caused is most unsatisfactory since, whilst no-one deprecates the appearance of numerous Public Analysts on either side in these cases more than your own analyst, the average member of the public is ignorant of what should be the composition of foods and representatives of the trade are unwilling to appear on 86 behalf of Local Authorities,even though they do not hesitate to approach Public Analysts privately to ask them to take action against certain fraudulent articles. In one case in which your Analyst appeared the retailer was brought in as a defendant and, fortunately, claimed that he was under the impression that a certain preparation was prepared from the fruit juice and Sugar. In another instance your analyst was invited by a friend to use a bogus blackcurrant cordial as a cure for a cold, so that whilst the Divisional Court may hold, that manufacturers have exercised due care and diligence, your analyst has little doubt as to what the public really expects. As pointed out in your analyst's report last year manufacturers can easily pay for the best defence,hoth legal and scientific,because the cost comes out of Excess Profits Tax and decisions of the Appeal Courts are making actions by Local Authorities more difficult without suggesting another method by which appropriate action can be taken. A sample of lemon essence should have been called a Lemon flavour,since it consisted of a solution of citric acid,whereas essence of lemon should be a solution of lemon oil in alcoholic solution. Eight samples of milk were found to be adulterated, but of these seven were Informal, having been submitted usually as the result of complaints, which could not be verified. In the same manner an opened tin of condensed milk was submitted and was bad on receipt at the laboratory, whilst an unopened tin obtained from the Same shop contained a perfectly fresh article. Two samples of cheese were submitted as the result of complaints by retailers that they were unfit for sale when received. Your analyst agreed with the complaint, although officials of the Ministry of Food did not appear to do so and several notes appeared 87 in the press to the effect that the public was becoming too particular. Cheese of the type submitted could be used in restaurants for cooked. dishes or in factories for blended cheese, but when goods are rationed the public may be expected to demand food of a certain standard. A sample of tinned Salmon, submitted to your analyst, had been opened by a householder,and taken to the Public Health Department with a complaint. Owing to the lapse of time the fish was bad on receipt at the laboratory, but an unopened tin obtained from the same shop contained a perfectly sound article. Horseradish cream and Horseradish and beetroot cream were condemned because they contained insufficient vinegar to keep them properly, with the result that they were fermenting. Forcemeat sold as requiring the addition of water only consisted of breadcrumbs with the addition of a small amount of salt, pepper and herbs and, when prepared according to the directions, yielded an unsavoury paste. Two samples of Salad Dressing powder were condemned because your analyst was of the opinion that the label was misleading. Two sets of instruction were given on the label, one for the use of all the contents of the tin at one time and these were satisfactory, but when only a portion of the contents were to be employed the recipe was unsatisfactory. The manufacturers submitted a sample of dressing stated to be prepared from the powder, but there was no proof of the method by which it had been made. A cample of mustard powder contained 70 per cent. of wheat flour whilst one of Madras Curry Powder was found to contain 15.per cent. of pea flour and 10 per cent. of salt. Some curry powders do contain salt, although this is really added as a diluent to the more expensive spices, but the addition of pea flour as well is quite unjustified. Two samples of Non-brewed vinegar were deficient in acetic acid. Drugs were on the whole satisfactory. One sample of Glauber salts was effloresced owing to improper packing and storage, whilst a nerve tonic possessed a distinctly metallic taste, making it disagreeable and therefore rendering it unsuitable for the purpose it was sold. I have the honour to be, Mr .Mayor, Ladies. & Gentlemen, Your obedient servant, Thomas McLachlan. « METROPOLITAN BOROUGH OF CHELSEA. CHE 46 ANNUAL (ABRIDGED) REPORT, of the MEDICAL OFFICER OF HEALTH for the year 1942. ----------------------------------------------------------------------------------------------------------- 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 and sanitary condition of the Borough for 1942. The health of the population was satisfactory. The incidence of infectious disease was again low, A large increase in the number of new cases attending the Diphtheria Immunisation Clinic is again reported. At the end of 1942 it was estimated that 81 per cent. of children under 5 and 71 per cent. of children between the ages of 5 and under 15 have been immunised. Sanitary administration of the Borough was adequately maintained thrbughout the year. Close attention was devoted to the supervision of food supplies. The Chelsea Health Socioty rendered valuable assistance in connection with the Maternity and Child Welfare work The attendances at the Ante-natal Clinic were much higher than in pre-war years. In November, the Ministry of Health sanctioned the proposal for a war-time Day Nursery located at the former Chelsoa Day Nursery promises. Adaptations wore in progress at the end of the year, (The nursery was opened in March, 1943 with accommodation for 47 children). 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. 24th July, 1943. STATISTICS. YEAR 1942. AREA. 660 acres. POPULATION. (Not available for publication). LIVE BIRTHS:- Male. Female. Total. Logitimate 148 147 295 Illegitimate 29 18 47 177 165 342 STILLBIRTHS. Male. Female. Total. 9 2 11 (Rate per 1,000 total (live and still) births = 31.1). DEATHS. Male. Female. Total. 247 255 502 DEATHS FROM PUERPERAL CAUSES:- Deaths. Rate per 1,000 total (live and still )births Puerperal Sepsis 1 2.8 Othor Puerperal causes — — INFANT MORTALITY. Male. Female. Total. + 8 9 W DEATH RATE OF INFANTS UNDER ONE YEAR OF AGE 1- All infants per 1,000 livo births 50 Legitimate infants per 1,000 logitimato livo births 41 Illogitimato infants per 1,000 illegitimate livo births 106 CLASSIFICATION OF DEATHS. Tho causos of deaths (502) were as follows:- Tuberculosis of rospiratory system 19; other forms of tuberculosis 5; Syphilitic disoases 8; Influonza 3; Moaslcs 1; Acuto InfoctiousEncephalitis 2; Cancer (various sitos) 79; Diabotos 1; Intra-Cranial Vascular lesions 33; Hoart disease 129; other diseases of circulatory system 19; Bronchitis 26; Pnoumonia 38 other rospiratory diseases 10; Ulceration of stomach or duoacnum 5; Diarrhoea under 2 years 2; Appendicitis 1; other digestive diseases 15; Nephritis 19; Puerperal sepsis 1; Premature Birth 8; Congenital malformations birth injurios, etc., 3; Suicide 6; Road Traffic accidents 2; other violent causes 23; all othor causes 44. PROVISION OF HEALTH SERVICES IN THE BOROUGH. BACTERIOLOGICAL EXAMINATIONS. The total number carried out was 83, including 66 for the bacillus associated with Diphtheria. NURSING IN THE HOME. The total number of visits paid by tho nurses from the Chelsea District Nursing Association was 1319 (167 cases). CLINICS MID_TREATMENT CENTRES. The total number of attendances at the Clinics by children under one year of age was 2813. 946 children attended between tho ages of 1 and 5 years. There were 1232 attendances by mothers at the ante-natal clinic and 21 mothers attended the post-natal clinic. INVALID CHILDRENS AID ASSOCIATION. The number of applications referred to the Association for assistance of childron under 5 years of age was 46 (actual cases 35). 2 HEALTH VISITORS. The total number of visits made was 4,582. The number of half-day attendances at Clinics was 725. CHILD LIFE PROTECTION. 73 visits (including 36 miscellaneous visits)were made to Foster Mothers. DENTAL TREATMENT. 42 cases attended the Dental Clinic at the Violet Melchett infant Center for the provision of preventive dental treatment for children under 5 years of ago. Arrangements were also made for 37 expectant mothers to receive dental treatment at St. Stephen's Hospital. Of those, 4 mothers were provided with dentures. CONVALESCENCE. Two nursing mothers with infants wore sent away to convalescent homes. SUPPLEMENTARY COUPONS FOR EXPECTANT MOTHERS. The number of expectant mothers issued with supplementary coupons was 417. This service was undertaken by the Superintendent Health Visitor at the Centre. DISTRIBUTION OF VITAMINS TO EXPECTANT MOTHERS AND CHILDREN. By arrangement with the local office of the Mninstry of Food these preparations were distributed from the Welfare Centre by a member of the Public Health Staff. SANITARY CIRCUMTANCES AND ADMINISTRATION. 14,657 inspections (including re-inspections) were carried out by the Sanitary Inspectors. Included in this total number were 1126 inspections on complaint of nuisance, 329 with reference to Infectious Disease and 161 as to conditions in Factories. 341 Intimation notices, 77 Nuisance notices under the Public Health (London) Act, 1936, and 2 Statutory notices under Byelaws for provision of dustbins were served during the year. LEGAL PROCEEDINGS. Two infirm persons were removed to Institutions under Soction 224 of the Public Health (London) Act, 1936. rooms after the occurrence of infectious disease was continued, as was also disinfestation for vermin. At the Disinfecting Station 40,026 articles were disinfected or disinfested and 1635 articles were destroyed in the incinerator. SCABIES. The incidence of scabies materially increased during the year. 232 Adults and 171 children were treated. The total number of treatments was 1356. Disinfection of the patients' personal clothing was carried out whilst the patients were being treated. Homes were visited by the Woman Sanitary Inspector who arranged for the examination of contacts and disinfection at the home. VERMINOUS PERSONS. 18 Adults and 320 children (including children attending elementary schools) wore cleansed at the Disinfecting Station. CONTROL OF VERMIN. During the year a scheme was submitted and approved by the Council as to the provision of temporary accommodation for Chelsea Residents while their flats were being treated for the extermination of vermin. This accommodation was opened in August and on fifteen occasions families were thus accommodated whilst their homes were being treated. INSPECTION AND SUPERVISION OF FOOD. The Inspectors made 761 inspections of premises where food is prepared, stored or sold. Unsound food was surrendered and destroyed or disposed of for purposes other than human consumption. 3 FOOD AND DRUGS ACT. 400 samples were submitted to the Public Analyst for analysis during the year. Of these 212 were taken as ''formal'' and 188 as "infomal", 51 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 374. These were as follows:- Diphtheria 18; Erysipelas 16; Scarlet Fever 67; Enteric Fever 4; puerporal Fever 1; Puerperal pyrexia 4; Cerobro-Spinal fever. 3; Ophthalmia Neonatorum 1; Dysentery 23; Acute Primary Pneumonia l6; Acute Influenzal Pneumonia 4; Measles 93; Whooping Cough 67; Pulmonary Tuberculosis 48; and Non-Pulmonary Tuberculosis 9, DIPHTHERIA. 18 cases were notified, of which 5 proved not to be suffering from this disease, There were no deaths. DIPHTERIA IMMUNAISATION CLINICS. 866 now cases attended. SCARLET FEVER. 67 cases were notified, of which 4 proved not to bo suffering from this disease. There were no deaths. OPHTHALMIA NEONATORUM. One case was notified and treated in hospital, The child made a complete recovery, SMALLPOX AND VACCINATION. No case of smallpox was notified. Of the 77 births registered in Chelsea during 1941, 36 were successfully vaccinated - a percentage of 46.7.(Figures for 1942 are not yet available). TUBERCULOSIS. 48 new cases of pulmonary and 9 cases of nonpulmonary tuberculosis were notified. In addition, 28 new cases came to the knowledge of the Medical Officer of Health through other sources. The total number was therefore 85. (Pulmonary - Males 33, Females 39; Non-pulmonary - Males 4, Females 9). The total number of deaths from all forms of Tuberculosis was 24, (Pulmonary 19, Non-pulmonary 5). PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS. 1930. The total number of cases of Tuberculosis in the Borough on the 31st December, 1942. was 202. (Pulmonary - Males 99, Females 72; Non-pulmonary Males 15, Females 16). The Tuberculosis Visitor paid 82 visits to non-dispensary cases. DISPENSARY AND SPECIAL CASES. New cases examined 171. Of these, 51 were found to be definitely tuberculous, 117 contacts also examined. The number of attendances (including contacts) was 921, and 2140 visits were made by the nurse to homes of patients. The Tuberculosis Officer visited 5 patients at their homes, and 88 patients were referred to him at the Dispensary by Medical Practitioners. 43 specimens of sputum examined, end 456 X-Ray examinations were made in connection with the work. The total number of cases on the Dispensary Register on the 31st December, 1942 was 169. CHELSEA TUBERCULOSIS CARE COMMITTEE. The Committee met 4 times and 114 cases were considered. Social services in co-operation with voluntary societies were continued. During the year 31 patients received artificial pneumothorax treatment, 17 patients were in receipt of extra nourishment provided by the Council, and 3 patients received dental treatment under the Borough Council scheme. 4 ANNUAL (ABRIDGED) REPORT of the MEDICAL OFFICER OF HEALTH For the year 1943. ___________________________________________________________________________________________________________________________________________________________________________________________________ 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 and sanitary conditions of the Borough for 1943. As in the three preceding years, by direction of the Ministry of Health, the present Report is an abridged and interim one, and omits the figures of the population, birth rate, and death rate, for reasons of security. The health of the population has continued to be satisfactory, notwithstanding prevailing conditions. There was no serious outbreak of infectious disease during the year under review. The number of notified cases of diphtheria continues small, and it is reasonable to regard this as mainly due to the immunisation work carried out in the past at the Chelsea Diphtheria Immunisation Clinic. None of the notified cases had completed a course of immunisation before the onset of the disease. There has been a progressive increase in Maternity and Child Welfare work, the number of attendances alone (1714), by mothers at the ante-natal clinic, constituting a notable record. Approval was given in November by the Ministry of Health for the establishment of a second war-time nursery, to accommodate 96 children, at Cheyne Hospital for Children. This was opened on 15th February, 1944. The scheme for Special allowances for those who have given up work to undergo treatment for Tuberculosis became operative on July 1st. Of the forty-six cases considered, forty-two have been granted allowances. I should like to thank members of the Council for the support and sympathetic consideration which they have 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, Town Hall, CHELSEA, S.W. 3. August, 1944. AREA. 660 acros. LIVE BIRTHS:- Male. Female. Total. Legitimate 205 184 389 Illegitimate 30 40 70 235 224 459 STILL BIRTHS. Male. Female. Total. 5 6 11 (Rate per 1,000 total (live and still) births = 23.4). DEATHS. Male. Female. Total. 267 287 554 DEATHS FROM PUERPERAL CAUSES: - Rate per 1,000 total Deaths. (Live and still) births, puerperal Sepsis - - Other puerperal Causes 1 2.1 INFANT MORTALITY. Male. Female. Total. 267 287 554 DEATH RATE OF INFANTS UNDER ONE YEAR OF AGE:- All infants per 1,000 live births 70 Legitimate infants per 1,000 legitimate live births 62 Illegitimate infants per 1,000 illegitimate live births 114 CLASSIFICATION OF DEATHS. The causes of deaths (554) were as follows:- Scarlet Fever 1 Bronchitis 36 Tuberculosis of respiratory system 22 pneumonia 44 Other respiratory diseases 8 Other forms of T.B. 2 Syphilitic disease 6 Ulceration of Stomach or duodenum 11 influenza 12 Cancer - various sites 99 Diarrhoea (under 2) 8 Diabetes 1 Appendicitis 2 Intra-cranial vascular lesions 30 Other digestive diseases 17 Nephritis 7 Heart disease 152 Maternal Causes 1 Other diseases of the circulatory system 18 Premature birth 10 Congcnital malformations, birth injuries 8 Suicide 7 Road Traffic accidents 3 Other violent causos 14 All other causes 35 PROVISION OF HEALTH SERVICES IN THE BOROUGH. BACTERIOLOGICAL EXAMINATIONS. The total number carried out was 115, including 67 for the bacillus associated with Diphtheria. NURSING IN THE HOME. The total number of visits paid by the nurses from the Chelsea District Nursing Association was 1,305 (160 cases). CLINICS AMD _TREATMENT CENTRES. The total number of attendances at the Clinics by children under one year of age was 3,298, and 963 children attended between the ages of 1 and 5 years. There were 1,714 attendances by mothers at the ante-natal clinic and 18 mothers attended the post-natal clinic. 2 STATISTICS. YEAR 1943 INVALID CHILDREN'S AID ASSOCIATION. The number of applications referred to the Association for assistance of children under 5 years of age was 26 (actual cases 26). HEALTH VISITORS. The total number of visits made was 5,769. The number of half-day attendances at Clinics was 600. CHILD LIFE PROTECTION. 90 visits (including 40 miscellaneous visits) were made To Foster Mothers, DENTAL TREATMENT. 70 cases attended the Dental Clinic at the Violet Melchett Infant Centre for the provision of preventive dental treatment for children under 5 years of age. Arrangements were also made for 64 expectant mothers to receive dental treatment at St. Stephen's Hospital. Of these, 8 mothers were provided with dentures. HOME HELPS. One case was attended by a Home Help - the nett cost to the Council being £4:0:0. DISTRIBUTION OF VITAMINS TO EXPECTANT MOTHERS AND CHILDREN. By arrangement with the local office of the Ministry of Food these preparations were distributed from the Welfare Centre by a member of the Public Health Staff. SANITARY CIRCUMSTANCES ADMINISTRATION. 12,825 inspections (including re-inspections) were carried out by the Sanitary Inspectors, Included in this total number were 1,376 inspections on complaint of nuisance, 463 with reference to Infectious Disease and 173 as to conditions in Factories. 442 Intimation Notices and 86 Nuisance Notices under the Public Health (London) Act, 1936 were served during the year. Legal proceedings under the Public Health (London) Act, 1936, in respect of sanitary conditions were undertaken in 17 instances. DISINFECTION OR DISINFESTATION. The routine disinfection of rooms after the occurrence of infectious disease was continued, and also disinfestation for vermin. At the Disinfecting Station 23,721 articles were disinfected or disinfested and 239 articles were destroyed in the incinerator. SCABIES. Scabies was made notifiable this year, and 217 Adults ana 158 children were treated at the Cleansing Station, The total number of treatments was 848, as compared with 1,356 in 1942. Disinfection of the patients' personal clothing was carried out whilst the patients were being treated. The Woman Sanitary Inspector visited homes, and arranged for examination of contacts. VERMINOUS PERSONS. 24 Adults and 251 children (including children attending elementary schools) were cleansed at the Disinfecting Station. HEAD LICE. To give effect to the recommendations contained in the Ministry of Health's Circular regarding infestation by head lice, special attention and advice is given by the Health visitors at the Welfaro Centre and when visiting homes. Suitable combs are made available whenever necessary. INSPECTION AND SUPERVISION OF FOOD. The Inspectors made 980 inspections of premises where food is prepared, stored or sold. Unsound food was surrendered and either destroyed or disposed of for purposes other than human consumption. 3 ??? Analyst for analysis during the year. Of these 200 were taken as "formal" and 200 as "informal". Seventeen samples ware 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 AND OTHER DISEASES. NOTIFICATIONS. The total number of notifications received during the year was 753 as follows:- Diphtheria 18 Acute primary Pneumonia 18 Erysipelas 10 Acute Influenzal pneumonia 6 Scarlet Fever 96 Measles 297 Enteric Fever 2 Whooping Cough. 42 Puerperal pyrexia 6 Scabies 62 Cerebro-Spinal fever 4 Food Poisoning 30 Ophthalmia Neonatorum 1 pulmonary Tuberculosis 72 Dysentry 85 Non-pulmonary Tuberculosis 4 DIPHTHERIA. 18 cases wra notified, of which one proved not to be suffering from this disease. There were no deaths, DIPHTHERIA IMMUNISATION CLINIC. 348 new cases attended. SCARLET FEVER. 96 cases were notified, of which two proved not to be suffering from this disease. There was one death - female 4 years. OPHTHALMIA NEONATORUM. One case was notified - the child made a complete recovery. SMALLPOX AND VACCINATION. No case of Smallpox was notified. Of The 179 births registered in Chelsea during 1942, 114 were successfully vaccinated - a percentage of 63.7. (Figures for 1943 are not yet available). TUBERCULOSIS. 72 new cases of pulmonary and 4 cases of nonpulmonary tuberculosis were notified. In addition, 20 new cases came to the knowledge of the Medical officer of Health from other sources. The total number was therefore 96, (pulmonary - Males 44, Females 45; Non-pulmonary-Males 2, Females 5). The total number of deaths from all forms of Tuberculosis was 24, (pulmonary 22, Non-pulmonary 2). PUBLIC HEALTH (TUBERCLOSIS) REGULATIONS, 1930. The total number of cases of Tuberculosis in the Borough on the 31st December, 1943, was 222, (Pulmonary - Males 103, Females 83; Non-pulmonary-Males 15, Females l6). The Tuberculosis Visiter paid 79 visits to nondispensary cases. DISPENSARY AND SPECIAL CASES. New cases examined l85. Of these, 24 wore found to be definitely tuberculous. 117 contacts also examined. The number of attendances (including contacts) was 1,156, and 2,679 visits were made by the nurse to homes of patients. The Tuberculosis Officer visited 17 patients at their homes, and 94 patients were referred to him at the Dispensary by Medical Practitioners, 152 specimens of sputum examined, and 552 X-Ray examinations were made in connection with the work. The total number of cases on the Dispensary Register on the 31st December, 1943 was 151. CHELSEA TUBERCULOSIS CARE COMMITTEE. The Committee met 4 times and 110 cases were considered. Social services in co-operation with voluntary societies were continued. During the year 35 patients received artificial pneumo-thorax treatment, 31 patients were in receipt of extra nourishment provided by the Council, and one patient received dental treatment under the Borough- Council scheme. 4