CHE 47 Annual Report on the Health of the Metropolitan Borough of Chelsea. Year ending 3 1st December, 1944. SECTION I.—STATISTICS AND SOCIAL CONDITIONS OF THE BOROUGH. GENERAL STATISTICS. TABLE No. 1. 1939 1940 1941 1942 1943 1944 1945 Area 660 660 660 660 660 660 660 Resident Population :—Registrar-General's estimate, 55,400 38,100 26,470 27,430 30,330 30,990 35,310 Number of Inhabited Houses (end of year according to Rate Books 12,503 12,492 11764 12557 12978 30990 35,310 Rateable value, October, £1,332,360 £1,332,428 £1,225,438 £1,178,012 £1,188,731 Sum represented by a penny rate, October. -£4,850 £4,257 £3,492 £3,565 £3,873 POPULATION IN WARDS. (Census 1931.) Males. Females. Total Cheyne 3,319 5,436 8,785 Church 4,390 5,929 10,319 Hans Town 2,961 5,830 8,800 Royal Hospital 2,550 4,833 7,383 Stanley 10,696 13,048 23,744 23,946 35,085 59,031 (Note.—All vital Statistics given in this Report are calculated on the Resident Population of the Borough as Estimated by the Registrar General for 1944,v12 30,990 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 smail compact borough, less than two miles in length, by about three-quarters of a mile in width. Over nearly the whole area the soil consists of gravel and sand, highly permeable to water. In a small portion of the western side of the Borough there is a thin loamy deposit of brick earth resting upon the gravel. There is a narrow strip of alluvial deposit extending along the Embankment from Battersea Bridge westwards. The northern portion of the area is largely built over. The central zone comprises a number of pleasant squares occupied by people in affluent circumstances. The grounds of the Royal Hospital, with the River Thames and Battersea Park beyond, render the southern zone unusually open. Social Conditions.—The density of population (number of persons per acre) as shown by the 1931 Census, is 89.4, the corresponding figure for London, as a whole, being 58.7. The density of population of each of the five Wards in the Borough is as follows:—Church Ward, 111.0; Stanley Ward, 123.7; Hans Town Ward, 78.6; Cheyne Ward, 76.4; Royal Hospital Ward, 49.9. Analysis of the 1931 Census figures shows that there is a greater proportion of unoccupied and retired persons in Chelsea than in any other Metropolitan borough. There is, however, a considerable "working class "population. Thus, of a total of 19,600 adult males, about 16,750 are occupied. The chief occupations are transport work (2,704), personal service (2,224), metal work (1,036), and clerical work (1,260). Over one half of the 30,800 adult females are occupied. Of these, domestic servants account for 8,746, dressmakers number 1,243, shop assistants 1,090, and clerks 1,471. There are no dangerous or offensive trades carried on in the Borough. There is no evidence that any of the occupations of the inhabitants exerts a deleterious influence on the public health. VITAL STATISTICS. In accordance with the requirements of the Ministry of Health, the following extracts from the Vital Statistics of the year are shown below:— TABLE No. 2. Total M. F. Live Births:— Legitimate 353 186 167 Birth rate per 1,000 of the estimated resident population. Illegitimate 63 37 26 1945 158 13  Total M. F. 1945 Still Births 7 2 5 Rate per 1,000 total (live and still) births 16.5 262 Deaths 572 279 293 Death rate per 1,000 of the estimated resident population 18.4 152 Deaths from Puerperal Causes:— Deaths. Rate per 1,000 total (live and still) births. Puerperal Sepsis 1 2.4 1 4.4 Other Puerperal Causes - - 3 5.2 Total 1 2.4 Death rate of Infants under one year of age :— All infants, per 1,000 live births 50 45 Legitimate infants per 1,000 legitimate live births 42 32 Illegitimate infants per 1,000 illegitimate live births 95 109 Deaths from Cancer (all ages) 41/ 92 Deaths from Measles (all ages) — 3 Deaths from Whooping Cough (all ages) —- - Deaths from Diarrhoea (under 2 years of age) 6 2 BIRTHS. The total number of births of Chelsea residents during the year was 574, equivalent to a birth rate of 10 2 per 1,000 of population. The birth-rate for England and Wales in 1938 was 15.1, while that for London as a whole was 13.4. The following Tables are self-explanatory:— TABLE No. 3. Registered Births. Legitimate and Illegitimate Births. 1939 1940 1941 1942 1943 1944 Average 10 years 1929-38 1945 Births Registered in the Borough 310 109 78 181 231 163 951 215 Births of Non-Parishioners 119 35 31 94 104 69 531 70 191 134 47 87 127 94 420 145 Births of Chelsea Mothers in Lyingin Hospitals and elsewhere outside of the Borough 348 294 259 255 332 322 244 412 Nett Chelsea Births 539 428 306 342 459 416 664 554 TABLE No. 4. Births, Birth-Rates, Births in Wards and Inward Transfer Births. Year. Births. BirthHate Per 1,000 of Population Births in Wards. Inward Transfer Births. Leg. Illeg. Total. Hans Town. Royal Hospital. Church. Cheyne. Stanley. Hospitals. Nursing Homes. Private Addresses. 1 Total. 1939 490 49 539 9.7 51 57 85 71 275 275 55 18 348 1940 389 39 428 11.0 48 34 66 61 219 194 73 27 294 1941 272 34 306 11.6 28 25 57 48 148 169 70 20 259 1942 295 47 342 12.6 56 25 65 64 132 192 48 15 255 1943 389 70 459 15.1 57 37 90 77 198 239 83 10 332 1944 353 63 416 13.4 62 33 98 69 154 210 94 18 322 Average 10 years 1929-1938 603 61 664 11.3 79 64 96 101 324 183 48 13 244 1945 465 42 557 158 71 41 77 106 262 298 101 13 412 1946 705 111 316 178 102 70 134 135 375 256 120 10 386 15 TABLE No. 5. Births in Hospitals and Nursing Homes. Chelsea Births in Hospitals and Nursing Homes Within the Borough. Chelsea Births in Hospitals and Nursing Homes Outside the Borough. London County Council:— London County Council:— St. Luke's Hospital - ST MARY ABBOUS 66 St. Stephen's Hospital - OTHER HOSPITAL 58 Voluntary:— Chelsea Hospital for Women 5 MISCELLANLOUS HOSPITAL INCLOSING PROUINES 58 Nursing Homes:— Wilbraham 4 NURSING HOMES 94 Royal Avenue 3 PRIVATE ASORCESS 18 Total 12 Total 322 From Table No. 4 it will be observed that the number of births of Chelsea Infants in Hospitals and elsewhere outside Chelsea accounted for 56 per cent. of the total births. In the preceding year the percentage was 57 NOTIFICATION OF BIRTHS. Under the Act, all live and stillbirths occurring after the 28th week of pregnancy must be reported within 36 hours to the Medical Officer of Health of the district in which the birth takes place. This information is extremely valuable, as it enables the Health Visitor to exercise supervision of the mother and child shortly after confinement. TABLE NO. 6 1939 1940 1941 1942 1943 1944 1945 1946 BIRTHS, INCLUDING STILL BIRTHS NOTIFIED IN THE BOROUGH 278 143 70 171 210 146 209 1170 BIRTHS OF NON-PARISHIONERS 109 22 31 89 91 61 69 740 169 121 39 82 119 85 140 430 INFORMATION RECEIVED OF BIRTHS, INCLUDING STILLBIRTHS, AMONGST CHELSEA NOTHERS IN HOSPITAL AND ELSESENHERE OUTSIDE THE BOROUGH 315 197 121 232 316 275 356 324 NETT CHELSEA NOTIFIED BIRTHS 484 318 160 314 435 360 496 767 NOTIFIED BY MEDICAL PRACTITIONERS 102 48 35 103 106 74 90 70 ,, ,, MIDWIVES 101 95 34 67 102 72 115 130 ,, ,, POOR LAW INSTITUTIONS 69 - 1 - - - 967 ,, ,, PARENTS L/C 6 - - 1 2 4 3 16 Illegitimate Births.— The following table shows the number of illegitimate births and the percentage of the total births. TABLE NO. 7. Year. Number of Illegitimate Births. Percentage of Total Births. Male. Female. Total. 1939 23 26 49 9.09 1940 16 23 39 9.11 1941 22 12 34 11.11 1942 29 18 47 13.74 1943 30 40 70 15.25 1944 37 26 36 15.14 1945 51 41 92 16.15 STILLBIRTHS. Year. 1939 1940 ,1941 1942 ,1943 .1944. 1945. Number 14 10 4 11 11 7 15 Rate per 1,000 of civilian population 0.25 0.25 0.15 0.40 0.36 0.22 0.42 MARRIAGES. Year. 1939. 1940. 1941. 1942. 1943. 1944. 1945. Number registered in Borough. 1065 839 491 490 434 528 712 Rate per 1,000 of civilian population 19.2 21.6 18.5 17.8 14.3 170 22.9 DEATHS. The total number of deaths of chelsea Residents during the year was 572, equivalent to a death rate of 18.4per 1,000 of population. 17 The following tables are self-explanatory :— TABLE No. 8. Registered Deaths. 1939. 1940. 1941. 1942. 1943. 1944. 1945 1946 Deaths registered in the Borough 1662 1885 1157 997 1335 1532 1281 1344 Non-parishioners 1085 1216 746 672 938 1111 918 978 577 667 411 325 397 421 363 369 Deaths of Chelsea residents in hospitals and elsewnere outside the Bord. 166 184 189 177 157 151 173 181 Nett Chelsea deaths 743 851 600 502 554 572 536 550 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 421 Chelsea deaths registered in the Borough, 210 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. 1939 1940 1941 1942 1943 1944 1945 1946 1941 1942 1943 1944 1945 1946 London Countv Council :— St. Luke's Hospital and Institution 223 251 92 3 31 25 3 28 24 110 100 72 92 106 St. Stephen's Hospital and Institution 81 54 115 154 214 175 164 150 20 14 8 17 15 15 St. George's Home for Tuberculosis - - - - - - - - - - - - - - Voluntary :— Chelsea Hospital for Women . - 1 3 - - - 1 - - - - - - - Cheyne Hospital for Children - - - - - - - - - - - - - - Brompton Hospital 2 6 7 - 1 2 - 2 6 4 4 4 6 4 Royal Hospital for Pensioners. 52 40 44 5 1 3 7 3 4 6 5 7 5 5 Royal Cancer Hospital 5 5 8 3 3 4 3 7 21 20 26 29 1 33 Victoria Hospital for Children 2 2 - - - 1 1 3 14 23 14 22 14 18 365 359 269 168 250 210 179 293 189 177 154 151 173 181 18 TABLE No. 10. Deaths, Death Rates, Deaths in Wards and Seasonal Mortality. Year. Deaths. Death- Rate per 1,000 of Population. Deaths in Wards. Seasonal Mortality Rate. Hans Town. Royal Hospital. Church. Cheyne. Stanley. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. 1939 743 14.6 69 109 130 124 311 19.8 14.3 12.7 11.7 1940 851 22.0 67 93 159 163 369 23.3 16.4 19.3 28.9 1941 600 22.7 60 110 124 84 222 31.7 13.6 29.0 16.3 1942 502 18.3 62 60 81 78 221 23.0 18.1 14.1 18.0 1943 554 18.3 88 50 101 90 225 22.4 16.4 11.7 22.5 1944 572 18.4 62 84 88 60 278 31.1 14.4 14.3 13.6 Average 10 years 1929-1930 797 13.6 96 131 135 131 304 17.7 12.9 10.8 13.0 1945 536 15.2 61 73 92 104 206 196 124 124 16.3 1946 550 12.0 81 69 119 80 201 150 105 10.8 11.8 19 TABLE No. 11. Birth-rates, Death-rates, Analysis of Mortality,") Maternal Death-rates and Case-rates for certain Infectious Diseases in the year 1938. England and Wales, London, 123 Great Towns and 148 Smaller Towns. (Provisional figures based on Weekly and Quarterly Returns.) England and Wales. 126 County Boro's and Great Towns including London. 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census). London Administrative County. Rates per 1,000 Population. Births :— Live 15.1 15.0 15.4 13.4 Still 0.60 0.65 0.60 0.48 Deaths:— All Causes 11.6 11.7 11.0 11.4 Typhoid and Paratyphoid fevers 10.00 0.00 0.00 0.00 Smallpox 0.00 — 0.00 — Measles 0.04 0.05 0.03 0.06 Scarlet fever 0.01 0.01 0.01 0.01 Whooping Cough 0.03 0.03 0.02 0.03 Diphtheria 0.07 0.07 0.06 0.05 Influenza 0.11 0.10 0.11 0.06 Notifications :— Smallpox 0.00 0.00 0.00 — Scarlet fever 2.41 2.60 2.58 2.05 Diphtheria 1.58 1.85 1.53 1.90 Enteric fever 0.03 0.03 0.04 0.05 Erysipelas 0.40 0.46 0.39 0.46 Pneumonia 1.10 1.28 0.98 0.98 Rates per 1,000 Live Births. Deaths under 1 year of age 53 57 51 57 Deaths from Diarrhoea and Enteritis under 2 years of age 5.5 7.8 3.6 13.1 Maternal Mortality :— Puerperal Sepsis 0.89 Not available. Others 2.19 Total 3.08 Rates per 1,000 Total Births (i.e.. Live and Still). Maternal Mortality :— Puerperal Sepsis. 0.86 Not avail able. Others 2.11 Total 2.97 Notifications:— Puerperal fever 14.42 18.08 12.51 3.53 Puerperal pyrexia 15.46 20 TABLE No. 12. Deaths of Chelsea Residents Registered during the Year. Classified by Age and Cause. (In accordance with Registrar-General's Return.) Nett deaths whethert occurring within or without the borough. 1939 1940 1941 1942 1943 1944 1945 1946 1947 Reference No. ALL AGES Under 1 year 1-5 5-15 15-45 45-65 65+ ALL AGES Under 1 year 1-5 5-15 15-45 45-65 65+ ALL AGES Under 1 year 1-5 5-15 15-45 45-65 65+ ALL AGES Under 1 year 1-5 5-15 15-45 45-65 65+ ALL AGES Under 1 year 1-5 5-15 15-45 45-65 65+ ALL AGES Under 1 year 1-5 5-15 15-45 45-65 65+ Reference No. ALL AGES Under 1 year 1-5 5-15 15-45 45-65 65+ ALL AGES Under 1 year 1-5 5-15 15-45 45-65 65+ ALL AGES Under 1 year 1-5 5-15 15-45 45-65 ALL CAUSES 743 17 5 6 55 180 480 854 15 4 9 154 226 443 600 9 2 3 54 170 362 502 17 3 - 42 126 314 554 32 3 5 46 151 314 572 21 4 12 79 162 294 536 25 11 7 48 128 314 560 36 5 4 46 122 337 611 43 5 2 80 150 361 Typhoid and paratypphoid - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - 1 - - - - 1 - - - - - - - - 1 Cerebro spinal fever 2 1 1 - - - - 1 - - - - 1 - - - - - - - - - - - - - - - - - - - - - - 2 - 1 - - - 1 2 2 2 1 - 1 - - 2 1 1 - - 1 1 - - - - - 2 Scarlet fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - 3 - - - - - - - - - - - - - - - - - - 3 Whooping cough - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4 - - - - - - - - - - - 2 1 1 - - - - 4 Diptheria 3 1 - 2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 5 1 - - - 1 - - - - - - - - - - - - - - 5 Tuberculosis resp. system 46 - - - 16 20 10 37 - 1 - 19 10 7 31 - - - 12 12 7 19 - - - 9 6 4 22 - - - 13 7 2 30 - - - 10 14 6 6 27 - - - 14 10 3 14 - - - 9 6 4 22 - - - 11 10 1 6 Ither forms of Tuberculosis 5 1 1 1 - 2 - 6 - - 1 3 1 1 2 - - 1 1 - - 5 - 1 - 1 2 1 2 - - - - 2 - 4 - - 1 2 1 - 7 2 - - - 1 1 - 7 1 - 1 4 - 1 3 - - - 2 1 - 7 syphilitic Diseases 1 - 1 - - - - 5 - - - - 4 1 6 - - - - 2 4 8 1 - - 1 4 2 6 - - - - 3 3 6 - - - 2 2 2 8 1 - - - - - 3 2 - - - - - 2 3 - - - - 3 8 Influenza 20 - - - 2 3 15 12 1 - - 4 5 2 5 - 1 - 1 2 1 3 - - - 2 - 1 12 1 - - 1 3 7 2 - 1 - - 1 - 9 3 - - - - 2 1 2 - - - - 2 - 8 - - - 1 3 4 9 Measles - - - - - - - - - - - - - - - - - - - - - 1 - 1 - - - - - - - - - - - - - - - - - - 10 3 1 2 - - - - - - - - - - - - - - - - - - 10 Ac. Poliomyelitis, Etc. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11 - - - - - - - 1 - - - 1 - - 1 - - - 1 - - 11 Ac. Inf. Encephalitis 1 - - - - - 1 2 - - - 1 - 1 - - - - - - - 2 - - - 1 1 - - - - - - - - - - - - - - - 12 - - - - - - - 1 - - - - 1 - - - - - - - - 12 Cancer buccal cavity and oesoph (M) uterus (F) 103 - 1 1 10 31 60 15 - - - 1 6 8 11 - - - - 3 8 7 - - - 1 4 2 9 - - - - 3 6 7 - - - - 6 1 13 16 - - - 2 7 7 7 - - - - 2 5 10 - - - 1 4 5 13 Cancer stomach Duodenum 19 - - - - 8 11 13 - - - 1 3 9 15 - - - 1 3 11 12 - - - 2 4 6 9 - - - 1 3 5 14 8 - - - 1 2 5 15 - - - 1 6 8 14 - - - 1 3 10 14 Cancer of breast 10 - - - - 6 4 11 - - - 1 6 4 8 - - - 2 2 4 8 - - - 1 3 4 5 - - - 1 2 2 15 6 - - - - 2 4 12 - - - 3 5 4 9 - - - - 4 5 15 Cancer of other sites 62 - - - 2 26 34 41 - - - 3 20 18 49 - - - 1 20 28 70 - - 1 4 29 36 50 - - - 5 14 31 16 62 - - - - 22 34 61 - - - 4 19 38 66 - - - 6 25 35 16 Diabetes 13 - - - - 3 10 5 - - - 1 4 - 3 - - - - 2 1 1 - - - 1 - - 1 - - - - - 1 6 - - - - 1 5 17 1 - - - - - 1 4 - - - - 1 3 2 - - - - 1 1 17 Intracranial vascular lesions 38 - - - - 8 30 42 - - - - 8 34 31 - - - - 6 25 33 - - - 1 10 22 30 - - - - 9 21 44 - - - 1 8 35 18 51 - - - - 10 41 60 - - - - 8 52 61 1 - - 1 15 41 18 Heart Disease 246 - - - 2 48 196 204 - - - 4 33 167 141 - - - 3 30 138 129 - - - 1 17 111 152 - - - 5 29 118 131 - - - 2 25 106 19 140 - - 1 - 25 442 128 - - - 4 20 104 175 - - 1 4 37 153 19 Other Dis. Cire. system 55 - - - - 11 44 26 - - - - 7 19 20 - - - 1 3 16 19 - - - - 4 15 18 - - - 1 3 14 11 - - - 2 3 6 20 18 1 - - 1 1 15 26 - - - - 3 23 38 - - - - 8 30 20 Bronchitis 20 1 - - 1 7 11 31 1 - - - 10 20 38 - - - 1 13 24 26 2 - - 1 6 17 36 1 - - - 8 27 29 - - - - 9 20 21 34 1 - - - 9 24 24 1 - - - 6 17 28 1 - - - 8 19 21 Pneumonia 39 11 - - 3 7 25 48 3 1 - 2 11 28 40 1 - - 5 10 24 37 4 - - 2 6 26 44 6 - - 1 14 23 30 3 1 - 2 9 15 22 29 4 - 1 - 6 18 49 8 - - 1 13 27 36 5 1 - 1 4 25 22 Other resp. Diseases 6 - - - - 2 4 8 - - - 2 2 4 5 - - - - 3 2 10 - - - - 4 6 8 - - - 1 3 4 5 - - - 1 3 1 23 6 - - - 1 1 2 4 - - - - 3 1 4 - - - - 2 2 23 Vlcer stomach Nuedenum 9 - - - 2 4 3 11 - - - 2 3 6 10 - - - - 3 7 5 - - - - 3 2 11 - - - - 6 5 7 - - - 1 4 2 24 8 - - - - 3 2 5 - - - 1 1 3 8 - - - - 6 2 24 Doarrhœa under 2 years 1 1 - - - - - 1 1 - - - - - - - - - - - - 2 2 - - - - - 8 6 2 - - - - 6 6 - - - - - 25 2 2 - - - - - 8 8 - - - - - 10 9 1 - - - - 25 Appendicitis 8 - - - - 3 5 3 - 1 - - 2 - 3 - - 1 - 4 - 1 - - - - 1 - 2 - - - - 1 1 - - - - - - - 26 4 - - - - 4 - 1 - - - - 1 - 1 - - - - 1 - 26 Other Digestive Diseases 16 - - - 1 3 12 9 - 1 - 1 2 5 10 - - 1 - 4 5 15 - 1 - 1 2 11 17 - - - 3 7 7 12 - - - - 5 7 27 10 1 - - 1 1 7 13 - 1 - 1 4 7 14 - - - 3 4 7 27 Nephritis 8 - - - 1 1 6 7 - - - 1 5 1 13 - - - 1 5 7 19 - - - 2 9 8 7 - - - 1 3 3 8 - - - - 2 6 28 11 - - - 1 2 8 7 - - 1 - 3 3 13 - - - 2 4 7 28 Puerperal sepsis - - - - - - - 2 - - - 2 - - - - - - - - - 1 - - - 1 - - - - - - - - - - - - - 1 - - 29 1 - - - 1 - - - - - - - - - - - - - - - - 29 Other Maternal causes 1 - - - 1 - - 1 - - - 1 - - - - - - - - - - - - - - - - 1 - - - 1 - - - - - - - - - 30 3 - - - 3 - - 1 - - - 1 - - - - - - - - - 30 Premature Births 5 5 - - - - - 3 3 - - - - - 4 4 - - - - 8 - - - - - - 10 10 - - - - - 7 7 - - - - - 31 4 4 - - - - - 6 6 - - - - - 8 8 - - - - - 31 Cong. Male Births Injuries, Infant Diseases 3 3 - - - - - 4 14 - - - - - 5 3 - 1 - - 1 3 - - - 1 2 - 8 7 - - 1 - - 5 2 - - 2 - - 32 11 8 1 - - 2 - 10 8 - - 1 1 - 15 14 1 - - - - 32 Suicide 8 - - - 3 2 3 13 - - - 5 5 3 3 - 1 2 - 6 - - - 1 4 1 7 - - - 3 3 1 4 - - - 2 1 1 33 4 - - - 1 3 - 11 - - - 6 3 2 7 - - - 6 - 1 33 Road traffic accidents 26 - - 2 5 7 12 11 - - - 4 4 3 1 - - - - - 1 2 - - 1 1 - 3 - - - - 1 2 3 - - - - 1 2 34 7 - 1 1 2 2 1 5 - 1 - 2 1 1 11 - 1 - 2 1 7 34 Other violent causes 209 2 - 6 90 56 55 91 1 1 - 22 30 37 23 - - - 6 4 13 14 - - 2 1 3 8 114 2 1 11 40 40 20 35 32 2 5 2 5 6 12 24 3 1 2 2 4 12 16 1 - 1 3 4 7 35 All other causes 60 - 1 - 8 18 33 47 - - 2 9 7 29 32 - - - 1 8 23 44 - - - 4 11 29 35 1 - 2 7 7 18 34 - - - 4 10 20 36 30 1 1 2 2 7 17 34 - 1 - 5 8 20 25 2 - - 5 5 13 36 743 17 5 6 55 180 480 851 15 4 9 154 226 443 600 9 2 3 54 170 362 502 17 3 - 42 126 314 554 32 3 5 46 151 347 572 21 4 12 79 162 294 606 25 11 7 48 128 317 550 36 5 4 46 122 334 611 43 5 2 50 150 361 21 CAUSES OF DEATH. Table No. 12 shows that 209 deaths were due to Organic Heart Disease, 119 to Cancer, 22 to Bronchitis, 37 to Pneumonia, 39 to Pulmonary Tuberculosis, 46 to Circulatory Diseases, 33 to Cerebral Hæmorrhage, 8 to Influenza and 23 to Congenital Debility and Malformation. Fifty-three per cent. of all deaths occurred in persons over 65 years of age. RESPIRATORY DISEASES. Table No. 13 shows the number of deaths from respiratory diseases during the past two years. The annual death rate, the number of deaths under 5 years, and the percentage of deaths occurring in children under 5 years of age is also shown :— TABLE No. 13. Year. Bronchitis. Pneumonia Other Respiratory Diseases. Total. Deathrate. No. of deaths under 5 years. Percentage under 5 years. 1939 20 39 6 65 1.3 5 7.7 40 31 45 8 84 2.2 5 6.0 41 38 40 5 83 3.2 1 1.2 42 26 38 10 74 2.4 6 8.0 43 36 44 8 88 2.9 7 7.9 44 29 30 5 64 2.6 4 6.2 45 34 29 6 69 1.9 5 7.3 46 24 49 4 77 1.7 9 1.7 DEATHS OF CHILDREN 1-5 YEARS OF AGE. The number of deaths of children between 1-2 years of age was 7 and between 2-5 years, 2. In the previous year these figures were 7 and 3 respectively. The causes of death are given during the past two years. TABLE No. 14. Child Mortality (1-5 Years). Year. Infectious Fevers. Tuberculosis. Respiratory Diseases. Diarrhœal Diseases. All other causes. Total Deaths. 1937 2 2 3 2 1 10 1938 4 — 2 — 3 9 22 INFANT MORTALITY. 1939 1940, 1941 1942 1943 1944. Deaths of Infants under 1 yr. of age 17 15 9 17 32 21 INFANT MORTALITY RATE (under 1 yr. of age per 1,000 live births) 33 40 38 50 70 50 The causes of death in the various age groups are set out in table No.15:- TABLE No. 15. 1944 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 1939 1940 1941 1942 1943 1944 1945 1946 1947 Deaths under 4 weeks Total death under one year Deaths under 4 weeks Total death under one year Deaths under 4 weeks Total death under one year Deaths under 4 weeks Total death under one year Deaths under 4 weeks Total death under one year Deaths under 4 weeks Total death under one year Deaths under 4 weeks Total death under one year Deaths under 4 weeks Total death under one year Small pox - - - - - - - - - - - - - - - - - - - - - - - - - - - Chicken pox - - - - - - - - - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - - - - - 1 - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - 1 - - - - - - - - - - - - - - - Cerebro-Spinal Fever - - - - - - - - - - - 1 - - - - - - - - - - - - - 1 - Influenza - - - - - - - - - - - - - 1 - - - - - 1 - - - - - - - Erysipelas - - - - - - - - - - - - - - - - - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - - 1 - - - - - - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - - - - - - - - - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - - - - - - - - - - - - - - - 1 - Meningitis - - - - - - - - - - - - - - - - - - - - - - - - - - Convulsions - - - - - - - - - - - - - - - - - - - 1 - - - - - - - Laryngitis - - - - - - - - - - - - - - - - - - - - - - - - - - - Bronchitis - - - - - - - - - - - 1 - 1 - - - 2 - 1 - - - 1 - 1 - Pneumonia - - - - - 1 2 - - 3 2 4 1 3 - - - 4 - 6 - 3 1 4 3 2 - Diarrhoea and Enteritis - - - - - 2 1 3 - 6 - 1 1 1 - 1 - 2 - 6 - 6 - 2 2 8 - Gastritis . - - - - - - - - - - - - - - - - - - - - - - - - - - Syphilis - - - - - - - - - - - - - - - - 1 1 - - - - - - - - - Rickets - - - - - - - - - - - - - - - - - - - - - - - - - - - Suffocation - - - - - 1 1 - - 2 - - - - - - - - 1 1 - 2 1 2 - 1 - Injury at Birth - - - - - - - - - - - - - - - - - - - - - - - - - - - Atelectasis - - - - - - - - - - - - - - - - - - 1 1 - - 3 3 2 2 - Congenital Malformations 3 - - - 3 - - - - 3 2 2 - - 3 3 - - 3 5 3 3 2 3 3 8 - Premature Birth 6 - - - 7 - - - - 7 5 5 3 3 4 4 8 8 9 9 7 7 4 4 6 4 - Atrophv, Debility and Marasmus - - - - - - - - - - - 1 2 4 - - - - - 1 - - - 2 - - - Other causes - - - - - - - - - - - - 1 2 1 1 - -- - - - - - 3 2 2 - 9 1 - - 10 4 4 3 21 9 17 8 15 8 9 9 17 14 32 10 21 11 25 18 36 - Nett Births registered during the calendar year Legitimate 519 Illegitimate 55 Nett Deaths (under 1) registered during the calendar year Legitimate 33 Illegitimate 13 24 The following table shows the Maternal Mortality in Chelsea during the past SIX 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 1943 - 2.1 2.1 1944 2.4 - 2.4 APPARENT EXCESSIVE MORTALITY IN THE BOROUGH. The Census Returns have consistently shown that there is a considerably higher percentage of persons of advanced age living in Chelsea than in any other Metropolitan Borough. The 1931 Census Returns showed that in London generally 7.3 per cent. of the total population were included in the age-group 65 and upwards. In Chelsea, however, no less than 10.2 per cent. of the total population constituted the agegroup 65 and upwards. These facts must be borne in mind in any analysis of the Chelsea mortality rate. as they are naturally reflected in the death returns. For many years past more than half the deaths in Chelsea have occurred in persons over 65 years of age. CAUSES OF SICKNESS IN THE BOROUGH. The Ministry of Health directs that any causes of sickness and invalidity which have been specially noteworthy in the area during the year should be specified. There was no unusual or excessive mortality during the year, nor was the amount of sickness and invalidity as far as could be ascertained, such as to call for any special comment in this report. No special effects of any particular occupation, prejudically affecting the health of workers therein, have been reported. 1945 1.7 5.2 6.9 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, are tabulated on pages 5-7, in the form required by the Ministry of Health. NURSING ARRANGEMENTS. (a) General Nursing in the Home.—This is carried out by the Chelsea, Pimlico and Belgravia District Nursing Association, located at 10, Sydney Street, Chelsea. The Borough Council makes a grant at the rate of £400 per annum to the Association for nursing services undertaken on behalf of the Council; the position being subject to review in the event of the number of nurses' visits exceeding 3,000 in any year. For this remuneration the Association has undertaken the nursing of all cases of illness occurring in expectant and nursing mothers and also, on the requisition of the Medical Officer of Health, the nursing of all children in the Borough under five years of age suffering from any illness. Patients are expected to make payment to the Association according to their means, but no patient, on account of inability to do so, is refused the services of a nurse. The only stipulations are that the patient must be under medical supervision, require nursing and be unable to pay the fees of a private nursing institution. Two members of the Public Health Committee of the Borough Council are members of the Council of the Association. Details of the work undertaken by the Association on behalf of the Borough Council are shown in Table No. 20 by the number of home visits for the past six years 26 TABLE No. 21. Nursed by District Nurses 1939 1940 1941 1942 1943 1944 1945 1946 Visits Cases Visits Cases Visits Cases Visits Cases Visits Cases Visits Cases Visits Cases Visits Cases Bronchitis 159 18 67 8 133 15 138 10 179 15 112 11 73 12 128 11 Burns - - - - - - - - - - - - 12 1 44 1 Chicken Pox 11 1 18 1 - - - - 5 1 2 1 - - - - Circumcision 104 13 58 7 29 4 36 4 86 8 140 17 161 17 342 36 Diarrhœa 4 1 1 1 10 1 3 1 8 2 - - - - - - Eye Trouble 106 7 202 14 234 10 131 9 107 8 65 6 236 9 272 12 Ear Trouble 98 6 13 1 11 2 28 5 32 3 155 4 117 9 79 12 Expectant and Nursing Mothers 144 11 122 12 242 22 300 30 108 14 69 7 133 15 60 4 Pneumonia (under 5) 40 3 93 4 78 5 22 2 38 3 25 2 - - 124 10 Pneumonia (over 5) 131 2 77 3 109 4 33 3 12 1 42 2 -- - 17 1 Impetigo - - 119 4 38 5 - - 5 1 - - 8 3 10 2 Meningitis and Peritonitis - - - - - - - - - - - - - - - - Measles (under 5) - - 2 1 29 3 21 4 61 10 33 3 181 30 83 13 Measles (over 5) - - 10 3 - - 3 1 83 9 - - 73 10 3 1 Ophthalmia Neonatorum 61 3 82 2 26 2 - - - - 96 1 98 3 16 1 Pemphigus Neonatorum - - - - - - - - 25 1 - - -34 2 - - Pemphigus - 8 4 16 1 - - - - - - - - - - Poliomyelitis - - - - - - - - - - - - - - - - Post-Vaccination 303 54 149 31 143 20 270 48 243 39 491 59 98 19 - - Puerperal Fever - - - - - - - - - - - - - - - - Puerperal Pyrexia - - 24 2 - - - - - - - - - - - - -- - - - - - - - - - - - 87 3 91 4 Septic sores 33 7 47 4 166 8 76 12 104 14 65 8 13 2 42 6 Tonsils and Adenoids 23 4 - - 3 1 2 1 6 1 - - - - 19 2 Whooping Cough 137 7 - - 53 3 28 2 21 2 - - 23 2 83 5 Worms 44 8 65 12 - - 39 8 47 9 13 4 30 6 96 18 Miscellaneous 97 13 167 21 163 29 189 21 135 19 21 6 55 18 94 25 1498 158 1404 135 1483 135 1319 167 1305 160 1329 132 1432 161 1605 164 (b) Nursing of Infectious Disease Cases.—In the case of all patients suffering from notifiable infectious disease, it is the practice of the Department to advocate admission to an appropriate hospital for isolation and treatment. Under the Borough Council's Maternity and Child Welfare Scheme, arrangements have been made with the Chelsea District Nursing Association for the nursing of selected cases of infectious disease. In this category are included ophthalmia neonatorum, pneumonia, measles and German measles, whooping cough, epidemic diarrhoea, poliomyelitis, puerperal fever and puerperal pyrexia. Arrangements are also in operation for the home nursing of cases of tuberculosis. This is carried out by the Tuberculosis Nurse to the Dispensary. Further details will be found on page 78. MATERNITY NURSES AND MIDWIVES. (From 1st January, 1938, the provisions of the Midwives' Act, 1930, came into operation). 27 Provision has been made by the Borough Council whereby necessitous women may obtain the services of a Maternity Nurse or Midwife at a reduced rate, the balance of the fee being paid by the Council. The fees charged are £2 for Primipara cases, and £1 10s. for Multipara cases. Arrangements on this basis were in operation during the year. All cases must in the first instance be approved by the Milk and Welfare Sub-committee. The Sub-committee meets weekly to consider applications and assess cases according to the income of the family. Contributions by patients towards the cost of midwifery assistance are collected by the Maternity Nurse or Midwife who undertakes the case. In the following Table No. 22 is shown, for the past two years, the number of applications for midwifery attendance, the number provided with such attendance, the amount of assessment on cases attended and the nett expenditure by the Council for this service. Thirteen of the cases were provided with a Midwife free of charge, the remainder contributed according to their resources. TABLE No. 22. Year. (1) No. of applications for services of (2) Total number provided with a Amount of Assessment on cases attended. Nett Cost to Council. Maternity Nurse Midwife. Maternity Nurse. Midwife. Maternity Nurse. Midwife. Maternity Nurse. Midwife. £ s. d. £ s. d. £ s. d. £ s. d. 1937 - 25 — 24 — 13 14 0 — 22 6 0 1938 - 23 - 23 — 4 14 6 - 29 15 6 Note.—(1) Includes applications refused and cases subsequently withdrawn. (2) Includes cases assessed during previous year. The London County Council is the Authority responsible for the supervision of midwives in the Borough. Through the courtesy of Sir Frederick Menzies, the County Medical Officer of Health, I have been able to ascertain that 9 midwives gave notice during the year of their intention to practise as midwives in Chelsea. Of these, two are engaged in private practice, the remainder being employed on the staffs of various hospitals, institutions and maternity homes within the Borough. HOME HELP IN MATERNITY CASES. Home Helps are employed by the Borough Council for service in the homes of necessitons women during confinement. The following Table No. 23 shows, for the past Six years, the number of applications received for Home Help service, the number of cases attended, the amount of assessment on cases attended and the nett expenditure by the Council for this service:— 28 TABLE No 23. Year. No. of applications for services of Home Help, including extension over the usual period of 2 weeks. Total number of cases attended by the Home Helps. Amount of Assessment on cases attended. Nett Cost to Council. 1939 16 4 5.7.0 15.13.0 1940 2 1 15.0 4.10.0 1941 1 1 - - - 5.5.0 1942 - - - - - - - - 1949 4 1 1. 5.0 4. 0.0 1944 2 1 1.7.0 3.18.0 1945 18 12 19.14.6 45.1.6 necessary in connection win payment of benents unaer 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. BACTER 10 LOGICAL AND OTHER EXAMINITIONS. NATURE OF SPECIHENS. 1939 1940 1941 1942 1943 1944 SWABS FOR DIPHTHERIA BACILLI 236 59 142 66 64 86 ” ” HAEMOLYTIC STREPIOCOCCI 4 = 1 - 26 3 SPUTUM - TUBERCLE BACILLI 31 13 11 5 6 5 URINE ” ” ” = - - - 3 - STOOL OR BLOOD For TYPHOID 1 2 5 - 2 - ” FOR DYSENTERY 1 - - - 1 3 WATER AT PUBLIC BATH 2 2 2 2 2 - MILK UNDER (SPECIAL DESIGNATION) ORDER - 4 6 4 5 3 MILK ON SELIVERY = 2 = 2 2 - FOOD AND DRUG INVESTIGATION. HEAT = - = 4 1 - 248 85 164 83 115 100 TOTAL COST TO BOROUGH COUNCIL 52.11.0 19.2.10 33.3.2 19.15.3 35.15.4 20.11.6 Anti-toxin.— Diphtheria anti-toxin is available at the Town Hall daily during office hours. It may also be obtained at the premises of Messrs. Timmis and Richards, 432, King's Road, S.W., at any hour, day or night. It is supplied free of charge, both in prophylactic and in curative doses, to medical practitioners for use in connection with patients resident in Chelsea. The amount supplied during the year was 48,500 units. An anti-toxin syringe, needles and steriliser are also available on loan. 29 The total cost to the Council for anti-toxin supplied during the year was £3 1s. Od. PUBLIC HEALTH LEGISLATION IN FORCE IN THE BOROUGH. The powers under which the Council work are those contained in the Public General Acts, the London County Council (General Powers) Acts, and the Bye-laws under the Public Health Acts. In addition the Council on the 28th April, 1937, made the following bye-law for the good rule and government of Chelsea:— NUISANCES BY DOGS. (1) No person being in charge of a dog shall allow the dog to foul the footway of any street or public place by depositing its excrement thereon. Provided that a person shall not be liable to be convicted of an offence against this bye-law, if he satisfies the Court that the fouling of the footway by the dog was not due to culpable neglect or default on his part. (2) For the purposes of this bye-law the owner of the dog shall be deemed to be in charge thereof, unless the Court is satisfied that at the time when the dog fouled the footway it had been placed in or taken into the charge of some other person. (3) Any person offending against this bye-law shall be liable on summary conviction to a fine not exceeding forty shillings. (4) This bye-law shall cease to be in force on 1st June, 1939, unless a bye-law re-enacting its provisions has come into operation before that date. (5) As from the date on which this bye-law comes into operation, the bye-law made by the Council on 2nd February, 1927, under Section 23 of the Municipal Corporations Act, 1882, as to nuisances by dogs upon the public footways shall be and is hereby repealed. This bye-law has proved of considerable assistance in preventing serious nuisance. HOSPITAL SERVICES. The Borough is singularly well provided with facilities for hospital treatment, both general and special. In addition, several important general and special hospitals are situated in the immediate neighbourhood. Over 80 per cent. of the inhabitants suffering from serious illness or disease seek and obtain in-patient hospital accommodation. The following Hospitals and Institutions are located within the Borough. None of these are controlled or supported wholly or in part by the Borough Council. Brompton Hospital for Consumption. The Royal Cancer Hospital. Chelsea Hospital for Women. Cheyne Hospital for Children. Royal Hospital for Pensioners. St. George's Home for Tuberculosis. St. Luke's Hospital and Institution. St. Stephen's Hospital and Institution. Victoria Hospital for Children. The following table No. 24 shows, in the form required by the Ministry of Health, particulars of the hospitals, public and voluntary, within and without the Borough, which are utilised by inhabitants of the Borough. 30 TABLE No. 24. Name. Situation. Nature of Cases Treated. Available Beds. If used by persons resident outside the Borough. Management. Brompton Hospital for Consumption Fulham Road, S.W.3 Pulmonary Tuberculosis 339 Yes By Voluntary Committee The Royal Cancer Hospital Fulham Road, S.W.3 Malignant Disease 128 Yes Chelsea Hospital for Women Arthur Street, S.W.3 Obstetric and Gynaecological 104 Yes / Cheyne Hospital for Children Cheyne Walk, S.W.3 Children's Diseases 71 Yes Princess Beatrice Hospital Richmond Road, S.W.5 General Medical, Surgical and Maternity 78 Yes Royal National Orthopaedic Hospital Great Portland Street, W.l Deformities and Malformations 170 Yes St. George's Hospital Hyde Park Corner, S.W.1 General Medical, Surgical and Maternity 437 Yes St. Luke's Hospital Cale Street, S.W.3 Medical and Surgical 890 Yes By Hospitals and Medical Services Committee of L.C.C. St. Mary Abbots Hospital Marloes Road, W.8 Medical, Surgical and Maternity 565 Yes St. Stephen's Hospital Fulham Road, S.W.10 Medical, Surgical and Maternity 718 Yes St. George's Home Milman's Street, S.W.10 Tuberculosis 50 Yes Victoria Hospital for Children Tite Street, S.W.3 Children's Diseases 138 Yes By Voluntary Committee West London Hospital Hammersmith Road, W.6 General Medical and Surgical 234 Yes 31 All the hospitals included in the foregoing table are fully equipped for operative surgery on modem lines. Each of them also provides special departments for X-ray investigation, dental, ophthalmic, massage and pathological work. MATERNITY AND NURSING HOMES. There is no Municipal Maternity or Nursing Home in the Borough. HEALTH VISITORS. Duties.— The duties allotted to the Health Visitors are as follows:— 1. To visit the homes of all newly-born children amongst the working classes within 21 days after birth, and subsequently as circumstances dictate. 2. To visit the homes and make investigations in regard to stillbirths and infant deaths. 3. To visit and give advice to parents in cases of ophthalmia, zymotic enteritis and other diseases causing deaths amongst infants. 4. To visit and report upon all cases of puerperal fever and puerperal pyrexia. 5. To investigate, when required, homes in which overcrowding is alleged to exist. 6. To investigate, when required, applications for the supply of milk free or below cost price. 7. To co-ordinate their efforts with those of the voluntary workers attached to the Maternity and Child Welfare organizations in the Borough. 8. To investigate cases under the Widows', Orphans' and Old Age Contributory Pensions Acts where the children are under school age. Work of the Health Visitors.— The following tabular statement (Table No. 26) gives an outline of the work of the Health Visitors and of the Chelsea Health Society and School for Mothers during the past two years. The visits enumerated are those paid by the trained officer of the Borough Council (one part-time Health Visitor) and the trained officers of the Chelsea Health Society and School for Mothers (two whole-time and two part-time Health Visitors). It does not include work done by voluntary workers attached to the Society. 32 TABLE No. 26. Summary of Reports of Health Visitors. 1939 1940 1941 1942 1943 1944 1945 1946 1944 (1) Work of the Health Visitors. First visits to Infants under one year of age 319 249 188 333 340 343 442 668 440 Return „ „ „ „ 1252 1110 724 1135 1484 1882 1781 1859 2061 First visits to Children between the ages of 1 and 5 years 245 184 145 256 286 207 363 2o6 482 Return visits to Children between the ages of 1 and 5 years 2196 1440 949 1514 2234 3113 2425 2655 2845 Ante-natal visits to Expectant Mothers:— Primi-para cases 103 103 48 124 130 100 182 244 250 Multi-para 164 142 43 109 113 91 153 191 223 Return visits 590 440 259 246 312 487 700 851 668 V isits to Enteritis cases amongst children 1 - - - - - 3 6 6 Return visits „ „ „ „ - - - - - - 5 - - Visits to Ophthalmia Neonatorum cases 5 3 - - - - - - - Return visits „ „ „ 5 7 . - - - - - - - Visits to Whooping Cough cases 110 3 25 38 10 10 26 33 16 Return visits „ „ „ 103 - 34 63 32 4 20 14 34 Visits to Measles cases (under 5 years of age) 11 21 3 21 44 10 19 11 24 Return visits „ „ „ - 3 14 37 154 24 203 55 158 Visits to Measles cases (over 5 years of age) 6 42 - - 10 - - - - Return visits „ „ „ - 4 - 2 14 - - 4 - General additional visits 648 589 414 404 594 454 340 1442 2144 Total visits 5458 4400 2945 4582 5769 6428 6402 8245 9414 Half-day attendances at Infant Welfare Centres 624 484 617 725 600 640 749 950 995 Half-day attendances at Play Centre 135 - - - - - - - - Hygiene inspections - feathers club - - - 130 251 263 258 63 - (2) Infant Welfare Centres. Total number of attendances:— (a) By children under one year of age 3643 2391 1381 2813 3298 2528 3400 5646 6418 (b) By children between the ages of 1 and 6 years 2914 1535 554 946 963 735 1104 1283 1615 (c) By Ante-Natal mothers 896 703 420 1232 1714 1428 2302 3311 2862 (d) By Post-Natal mothers 26 2/ 17 21 18 31 51 50 65 *MISS BROWN VISITS INCLUDED (PART-TIME HEALTH VISITOR) Total attendances 7514 46 So 2345 5012 5993 4722 7154 10332 11260 ANTE-NATAL WORK. Close attention is devoted to the work of ante-natal consultations, as the figures in Table No. 26 demonstrate. Sound advice, based on the most recent scientific investigation, is provided by the Medical Officer of the Ante-natal Clinic. Every effort is being made to ensure that mothers will take full advantage of the excellent arrangements made by the Chelsea Health Society so that as far as possible all risk of disease and accident incidental to childbirth may be removed. Compensation to Midwives.— If the Medical Officer at the Antenatal Clinic finds it necessary to recommend hospital treatment for an expectant mother referred to him by a midwife, and the mother accepts such advice, the Council make a payment of 10/- to the midwife as compensation for loss of the case. No case occurred during the year in which such compensation was necessary. 33 SUPPLY OF MILK TO MOTHERS AND YOUNG CHILDREN. Provision is made under the Public Health (London) Act, 1936, whereby milk is provided in necessitous cases, free or at less than cost price. The Milk and Welfare Sub-committee meets weekly at the Town Hall to consider applications. Milk is supplied on the following basis:— Number of persons in family. Weekly income per head (after deduction of rent, fares and insurance). Assessment. 3-4 Up to 8/- Free 8/- Id. per pint 9/- 2d. per pint 10/- 3d. per pint 5-6 Up to 7/- Free 7/- 1d. per pint 8/- 2d. per pint 9/- 3d. per pint 7-8 Up to 6/- Free 6/- 1d. per pint 7/- 2d. per pint 8/- 3d. per pint 9-10 Up to 5/- Free 5/- 1d. per pint 6/- 2d. per pint 7/- 3d. per pint The following table shows for the past two years, the extent of this service:— TABLE No. 27. Year. Milk Orders issued and taken up. Approx. Cost. March quarter. June quarter. Sept. quarter. Dec. quarter. *Total. 1937 503 537 470 529 2039 £ 607 1938 598 664 650 830 2742 884 *These totals do not include orders subsequently cancelled or withdrawn, which average 80 or more during each year. It will be observed that in 1938 there was a large increase in the cost of milk. Cows' milk was supplied to 83 per cent. of the applicants, dried milk being supplied to the remaining 17 per cent. 34 The total quantity of milk supplied during the year to expectant and nursing mothers and young children was as follows:— Cows Milk, free of cost 6052 gallons Cows Milk at reduced cost 1598 „ 7650 „ Dried Milk, free of cost 1266 lbs. Dried Milk at reduced cost 534 „ Total 1800 „ The arrangements for the supply of milk in the Borough are working satisfactorily. Families in receipt of out-relief do not come under the Council's scheme for the supply of milk to necessitous mothers and children. These cases are dealt with entirely by the Public Assistance Committee, who grant the necessary extra milk on a certificate signed by a Doctor at the Welfare Centre. This scheme obviates the undesirable practice of an individual being granted a somewhat similar form of relief by two different authorities. The supply of milk under the Borough Council Scheme has undoubtedly effected very marked improvement in the general health of both mothers and children. INSTITUTIONAL PROVISION FOR UNMARRIED MOTHERS, ILLEGITIMATE INFANTS AND HOMELESS CHILDREN. (a) The Day Servants Hostel, 29-33, Danvers Street, Chelsea, provides accommodation for 15 unmarried mothers and their infants. Cases are not received until after birth of the child. Daily work is provided by the Hostel and the mothers reside with their babies at night. (b) The Fanny Hobson Hostel, 497, King's Road, Chelsea, provides accommodation for 20 women on discharge from prison or if found homeless. Unmarried mothers, but not illegitimate infants, are received. An expectant mother is retained until the confinement approaches. Arrangements are then made for her admission to Hospital. If she is subsequently re-admitted to the Hostel, the'infant is settled with a foster mother. (c) St. Theresa's Shelter, 43, Smith Street, Chelsea, is a Rescue Home which provides accommodation for nine girls. Cases are detained for some weeks until some suitable employment can be found. In the case of an expectant mother, arrangements are made for her transfer to an appropriate Home or Institution elsewhere in the Metropolis. Homeless children in general are cared for by the Public Assistance Committee. 35 AMBULANCE FACILITIES. (a) Infectious Cases.— Under the Public Health (London) Act, persons in London suffering from certain notifiable diseases may be conveyed without payment to a hospital of the London County Council. The London County Council ambulances are also available, on payment, for the conveyance of persons suffering from infectious disease to places elsewhere in the metropolitan area. (b) Non-infectious and Accident Cases.— The efficient ambulance service of the London County Council is available for cases of accident, sudden illness and also for maternity cases. The ambulances of the London County Council may also be utilized, on payment, for the removal of non-infectious cases to hospitals or homes. CLINICS AND TREATMENT CENTRES. (a.) The Violet Melchett Infant Welfare Centre, Flood Walk, S.W.3.— Patroness: Her Majesty Queen Mary. Chairman of Council: Violet, Lady Melchett, D.B.E. Hon. Treasurer: Col. Sir Courtauld Thomson, K.B.E., C.B. Hon. Secretary: Miss M. Bowden-Smith. This Centre, controlled by a Voluntary Council with headquarters in Flood Walk, adjoining the Town Hall, was completed in February, 1931, and formally opened by Her Majesty Queen Mary on 26th March, 1931. The Violet Melchett Infant Welfare Centre maintains the Maternity and Child Welfare services in the Borough and embodies the activities of the Chelsea Health Society, the Chelsea Day Nursery and the Chelsea Mothercraft Home. The magnificent building, with the land on which it stands and a considerable portion of its equipment, was a gift of the late Lord Melchett as a memorial to Lady Melchett's life-long work for Infant Welfare. Three members of the Public Health Committee of the Borough Council and the Medical Officer of Health are members of the Executive Committee. The Violet Melchett Infant Welfafe Centre is supported by (1) voluntary contributions (2) an endowment of £500 per annum generously provided by Lady Melchett herself (3) financial grants from the Borough Council. A further source of income arises from the fees paid by pupils and parents. The Medical and other staff, appointed by the Voluntary Committee, are as follows:— (a) Chelsea Health Society. Four part-time Medical Officers, one part-time Dental Surgeon, two whole-time and two half-time trained Health Visitors, together with clerical and domestic assistance. (b) Chelsea Day Nursery and Mothercraft Home. Two Honorary Consultants, an Honorary Medical Director, an Assistant Medical Officer, Matron, four Sisters, four Staff Nurses, twenty-six resident Student 30 Nurses and six non-resident London County Council Scholarship students. There is also a whole-time Secretary, and a Nursery School teacher for the older children in the Day Nursery. In addition, much valuable work is done by voluntary workers attached to the Society. Under section 101 (6) of the Local Government Act, 1929, the Borough Council made an annual contribution of £3,535 to the Violet Melchett Infant Welfare Centre for services in respect of Maternity and Child Welfare work for the financial year 1938-1939. Reference will now be made to the activities of the three organisations included in the Violet Melchett Infant Welfare Centre. (1) Chelsea Health Society.—Flood Walk, S.W.3. The accommodation provided includes a large central hall, with surrounding consulting-rooms and dressing rooms. There is also a perambulator store, an open-air court with a garden where children may play while awaiting medical inspection, and ample office accommodation. During the year five infant clinics were held weekly— four at Flood Walk and one at 484, King's Road. At Flood Walk one ante-natal clinic was held weekly. In addition, Play Mornings are held daily from 9.0 to 12.0 under the supervision of a Health Visitor, for children referred by the Medical Staff for observation, as being reported difficult, or needing companionship, fresh air or space. Details of the work carried out by the Society will be found on page 32 (Table No. 26). (2) Chelsea Day Nursery, Flood Street, S.W.3. The Chelsea Day Nursery provides accommodation for fifty children. In addition to two large nurseries with verandahs for toddlers and children also nursery for infants, there are bathrooms, a kitchen and an enclosed courtyard for the children to play in. The Nursery is ably administered and is much appreciated in the Borough. The attendances at the Nursery during the past two years were as follows:— TABLE No. 28.. 1937. 1938. Total number of attendances during the year 11,997 11,319 Average daily attendance (5 days a week) 45 45 Total number of individual children who attended 85 98 The Nursery was closed for two weeks during the year owing to infectious disease. 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 Home from the 1st. January,1939, to 1st.September,1939. SINCE THEN,THE HOME HAS BEEN TEMPORARILY CLOSED. TEAR 1939. Mothers. Babies Beds available 6 16 Admitted during above period 45 87 Discharged 49 98 Average length of stay 26 days 40 days Daily average number of in-patients 4.2 16.5 Test Peed attendances 97 97 RESPIRATORS FOR 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 1944, helmets and small child's respirators were issued. In each case instructions were given as to the fixing and the use of these appliances. DISTRIBUTION OP 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 Pood Executive Officer. The preparations are distributed from the Infant Welfare centre by a member of the Public Health Staff. The scheme is constantly being brought to the notice of eligible children by the Health Visitors. 38 (b) Invalid Children's Aid Association.— Chairman: Lady Edward Gleichen. Hon. Secretary: Miss Aileen Woodroffe. The Chelsea branch of the Invalid Children's Aid Association is located at 2, Glebe Place, King's Road, S.W.3. The Association provides, for children referred to it, treatment in Hospitals, Sanatoria and Nursing Homes, according to need; convalescence in the country or at the seaside; orthopædic appliances and surgical boots; massage, remedial exercises, surgical dressings and medical comforts; help in training for suitable work: additional clothing, etc. Two members of the Public Health Committee of the Borough Council and the Medical Officer of Health are members of the local Committee of the Association. The Borough Council made a financial grant of £100 to the Association for the year commencing 1st April, 1938. ACTUAL CASES-CHILDREN UNDER 5 YEARS OF AGE 1939 1940 1941 1942 1943 1944 1945 1946 110 46 48 35 26 32 29 30 CHILDREN SENT OUT OF LONDON FOR CONVALESCENE 46 14 14 10 8 8 10 14 CHILDREN ADMITTED TO L.C.C. BOARDING OUT HOMES UNDER TUBERCULOSIS CONTACT SCHEME 2 - 5 - - 2 2 2 SANTORIUM TREATMENT ARRANGED 2 2 2 1 - - - - CHILDREN SUPPLIED WITH SURGICAL APPLIANCE 14 4 6 5 4 2 3 2 *CHILDREN TREATED AT I.C.A.A ORTHOPAEDIC CLINICS 4 - - - - - - - EXTENSIONS GRANTED - 3 4 5 2 3 4 - †MADICAL AND GRANTED 30 2! - - - - - - MAINTAINED IN PARMANENT HOME - / / - - - - - CHILDREN REFERRED TO LCC. SPEL. CONVALESCENT HOSPITOPS 10 - - 1 - - - - ” ” ” OTHER AGENCIES FOR HELP 1 - - 1 3 2 2 - ” ” FROM HOSPITOLS FOR SPECIAL REPORTS 4 6 8 13 5 12 4 4 ” GRANTED OUTFITS OF CLOTHING BEFORE GOING AWAY 20 34 6 2 - - - 3 ” EVACUTED, CASES FOLLOWED UP WITH REPORTS 8 4 1 6 - 1 - - APPLICATIONS WITHDRAWN-OWN ARRANGEMENTS MADE. 8 5 4 2 4 2 1 2 APPLICATIONS FOR ASSISTANCE. TOTAL 149 94 54 46 26 32 29 30 *CLINIC IN ABEYANCE SINCE SEPT.1939 †NO APPLICATIONS SINCE 1940. DUE TO GOVERNMENT FACILITIES 38 (c) The Babies' Club.— 35, Danvers Street, S.W.3. The premises were closed at commencement of hostilities (1939) and re-opened at the latter end of 1942. This Infant Welfare Clinic is controlled by a voluntary Committee. It is intended for the use of subscribers only. Infant consultations are held weekly at the premises of the Club. (d) Charity Organisation Society.— Chairman: E. F. Dent, Esq., Hon. Secretaries: Miss Larken and Miss Fairtlough. The Chelsea branch of the Charity Organisation Society is located at 2, Glebe Place, King's Road, S.W.3. This Society arranges for convalescent treatment when necessary; for the supply of dentures and surgical appliances and for various forms of temporary assistance during disablement, etc. In connection with the Society there is a Women's Holiday Fund and a large number of Chelsea women are thus enabled to obtain holidays in the country or at the seaside during the summer months. (e) Chelsea Tuberculosis Dispensary.— This Dispensary, located at Brompton Hospital, affords skilled diagnosis and efticient 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 Six years is shown in Table No. 30. 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 £ s. d. £ s. d. 1939 24 6 3 9 1 15 6 23 5 4 1940 3 1 - 1 - 3 2 6 1941 1 - 1 1 1 10 0 2 0 0 1942 2 l 1 2 1 10 0 9 9 9 1943 1 - - - - - 1944 - - - - - - 40 DENTAL TREATMENT. CHILDREN UNDER FIVE YEARS OF AGEPreventive dental treatment is provided for children under 5 years of age at the violet Melchett infant Welfare Centre. Year. No.of cases attended. 1939 159 1940 66 1941 30 1942 42 1943 70 1944 66 1940 ... 6 4 18. 1. 6* 1941 ... 2 - 4. 0 1942 ... 37 4 21.14. 0 1943 ... 64 8 48. 9. 0 1944 ... 50 4 26.18. 6 1945 ... 54 5 28.9.9 *Note. In addition, a grant of £20 per annum was made to the Violet Melchett Centre for the provision of PREVENTIVE dental treatment. This grant was dis continued during 1941 when 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 oases of preventive dental treatment as arranged,by the violet Melchett Infant Centre. (Year 1944. Foster Mothers. Foster Children. Number on register at beginning of year 9 12 Removed from register 9 12 Added to register 3 3 Remaining on register 3 3 Medical attendance arranged - 5 Attended Maternity and Child Welfare Clinic • 6 Visits to foster mothers 42 50 Miscellaneous visits 40 61 41 BLIND PERSONS ACT, 1920. At the request of the London County Council, the Borough Council has arranged for the home visiting of blind children under five years of age to be carried out by the Health Visitors. Reports are furnished to the County Council as occasion arises, when the home conditions are found to be unsuitable for blind children or where it is considered necessary that the child should be admitted into a suitable institution. No case came to the knowledge of the department during the year. SUMMARY OF ARRANGEMENTS REGARDING MATERNITY AND CHILD WELFARE. The Borough Council's scheme for Maternity and Child Welfare includes the following activities:— (a.) The issue of pamphlets giving advice on various matters concerning the welfare of mothers and infants. (b.) The co-ordination of the work of the voluntary Maternity and Child Welfare agencies in the Borough. (c.) The home visitation of expectant and nursing mothers and infants by a staff of Health Visitors who work (a.) from the Town Hall, and (b.) from the Centres of the Chelsea Health Society. (d.) The subsidisation of the Chelsea Health Society's Maternity and Child Welfare Centres and Clinics for mothers, infants and young children. (e.) The subsidisation of the local branch of the Invalid Children's Aid Association. (/.) The subsidisation of the voluntary Day Nursery in the Borough. (g.) The subsidisation of the Chelsea District Nursing Association for the home nursing of expectant and nursing mothers and young children. (h.) The provision of Home Helps. (i.) The provision of midwifery attendance, free or at reduced rates, for necessitous Chelsea women. (j) The provision of Convalescent Home accommodation for nursing mothers and infants. (k.) The provision of dental treatment for expectant and nursing mothers. (l) The supply of milk, free or at reduced rates, to necessitous nursing and expectant mothers, infants, and young children. (m.) The provision of sterile maternity outfits at cost price. (n.) The administration of the Widows', Orphans' and Old Age Contributory Pensions Acts, 1925 and 1929, in respect of deserted, abandoned or neglected children. 42 SECTION III.— SANITARY CIRCUMSTANCES AND ADMINISTRATION. Complaints.— The number of complaints received during the year was 358, compared with 298 last year. The complaints are, in the majority of cases, from the occupiers of houses and deal with alleged nuisances. These complaints are investigated by the Sanitary Inspectors, who, when the circumstances justify, serve the necessary notices required for the abatement of the nuisances. Closet Accommodation.— The water carriage system is general throughout the Borough. Removal and Disposal of Refuse.—House refuse is removed by the Works Department of the Council. A bi-weekly collection is made. The refuse is conveyed to the Council's Wharf on the river Thames, whence it is barged away. Inoffensive trade refuse is removed by the Council on payment of a fee in accordance with the provisions of section 92 of the Public Health (London) Act, 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 280. The number of statutory notices was 41. These compared with 349 and 23 in 1937. Summary of Work carried out by Sanitary Inspectors during the YeAR Inspections. 1939 1940 1941 1942 1943 1944 AVERAGE 10 YEARS. 1929-1938 On complaint of nuisance 648 892 818 1126 1346 1132 454 On notification of infectious disease 243 146 242 329 463 514 303 House to House 99 - - - - - 192 Re-inspection calls made 3468 3,309 3,205 3963 4,834 3,244 5,083 Inspection of:— Bakehouses 121 76 26 13 26 44 36 Slaughterhouses 2 - - - - 14 Milkshops 46 95 86 95 211 186 122 Ice Cream Premises 28 20 5 8 - - 40 Overcrowding 24 48 - 16 80 81 38 Houses Let in Lodgings 29 3 - 8 12 - 42 Stables 4 9 12 10 16 16 34 Restaurant Kitchens 55 68 62 58 168 140 64 Marine Stores 4 7 4 1 2 2 16 Food Premises other than above 120 766 640 484 480 549 104 Premises under Meat Regulations 141 149 150 100 90 158 40 Factories and Workshops 62 133 78 161 143 82 348 Outworkers' Premises 15 18 5 15 10 12 51 Common Lodging Houses 21 - 1 - - = 19 Other visits 554 2,139 4,474 5,429 2,513 4006 620 Verminous Premises 165 255 433 1,434 804 544 155 Rat enquiries 114 141 94 552 784 479 84 Smoke observations 55 40 4 5 18 4 19 HOUSING ACTS - 8 30 90 14 - CHILD LIFE PROTECTION - 8 73 70 112 - DRAINAGE - - 441 494 56 - 6,084 8,344 10,339 14,654 12,825 11,408 4,914 43 Premises: Walls and Ceilings cleansed:— (a) Premises throughout — (6) Premises partially 152 (c) Verminous rooms cleansed 16 (d) Total number of rooms cleansed 265 Wash-house walls and ceilings cleansed 7 Walls and ceilings of water closets clcanscd and repaired 53 Wash-house roofs repaired 1 Dirty tenants' rooms cleansed 6 Yard and area walls cleansed — Defective roofs repaired 38 Defective gutters repaired — Defective rain water pipes repaired 16 Dampness abated 44 Miscellaneous repairs 105 Wash-house floors repaired - Yard surfaces repaired, paved, etc. 3 Ashpits demolished — New and proper dustbins provided 26 Workrooms provided with light and ventilation or light and ventilation improved 3 Drainage: Reconstructed 0 Repaired 1 Cleansed 3 Inspection chambers and traps provided 15 Fresh air inlets provided or repaired 12 New soil pipes provided 10 New ventilation pipes provided 8 Soil and ventilation pipes repaired 4 Anti-syphonage pipes provided — Drains sealed off — Drains cleared (obstruction removed) 2 New covers provided to inspection chambers 16 Rainwater pipes disconnected and caused to discharge over properly trapped gullies - Sink wastes provided with traps 1 Sink waste pipes cleanse — New sink wastes provided 30 New sinks provided 9 New bath and lavatory basin wastes provided 27 Water Closets. Improvements in sanitary conveniences (factories, workshops, etc.) — New water closet pans provided 38 Water closet pans (foul) cleansed 2 Choked water closet pans unstopped and cleansed 2 Water waste preventers renewed 11 Water waste preventers repaired 3 Water closet roofs repaired 3 Ventilation and light provided or improved 1 W.C. floors repaired - Water supply. Water supply to premises reinstated 2 Water supply provided to upper storeys of tenement houses 3 New drinking water cisterns provided 1 Drinking water cisterns cleansed 9 Drinking water cisterns provided with new covers or covers repaired 4 Smoke Nuisance. Number of observations 32 Number of nuisances and complaints 15 Number of notices - Number of summonses - 44 Nuisances abated arising from:— 1939 1940 1941 1942 1943 1944 1945 1946 1947 Keeping animals in an improper manner or place - - - Defective manure cages - - - Accumulation of manure or refuse 1 - - Overcrowding 6 14 21 Rat nuisance 24 2 Underground rooms 114 141 94 Food Condemned and Destroyed. (SEE END OF REPORT) Disinfection. Rooms disinfected after Zymotic diseases (Scarlet Fever, Diphtheria, etc.) 184 /69 142 234 283 121 150 242 252 Rooms disinfected after Tuberculous disease 46 48 30 34 14 20 36 53 69 Rooms fumigated for verminous and filthy conditions 434 315 481 1284 679 333 351 811 1269 Miscellaneous disinfection 56 101 38 95 77 89 43 144 128 Certificates of disinfection given 77 5 14 10 3 School notices after disinfection 74 8 26 28 110 Notices sent to Public Library of Premises where infectious diseases have occurred 95 40 43 36 56 48 *Rooms Disnfected-civil defence Proceedings taken. 518 451 622 1398 794 233 3 Intimation Notices served 273 442 229 341 442 248 362 Nuisance Notices under Public Health (London) Act, 1130 97 155 71 77 86 64 82 Statutory Notices under Section 9 of Housing Act, 1930 - - - - - - - Statutory Notices under byelaws for provision of dustbins 10 8 1 2 - - - Total number of samples purchased for analysis under the Food and Drugs (Adulteration) Act 252 210 211 212 200 200 200 Notices under see 13 food drugs ACT 1938 - - - - - 28 5 Samples (informed) purchased 148 190 189 188 200 200 200 Legal proceedings instituted in respect of defective sanitary conditions and nuisances 3 21 6 2 17 4 9 Legal proceedings under Milk and Dairies (Amendment) Act, 1922 - - - - - - - Legal proceedings in respect unsound food - - 1 - - - 2 Certificates issued in accordance with "Rent Restrictions Act" 3 5 1 - - - 5 Entries in Inhabitants Complaint Book 440 892 600 894 1160 1132 1364 Cleansing and Disinfection. Number of adults cleansed 29 14 18 18 24 68 25 51 16 Number of children cleansed 558 498 249 32o 251 288 296 402 410 Number of adults treated for scabies - - 90 232. 214 191 242 249 94 Number of children treated for scabies 82 58 30 141 158 124 149 180 82 Number of articles (bedding,etc) or disinfested 9328 11424 18458 40,026 23421 28395 15092 17733 11848 Number of articles (various) destroyed 814 3394 2236 1635 239 - Disinfection Station Shelter. Persons accommodated:— Adults NIL. NIL NIL NIL NIL NIL NIL Children NIL NIL NIL NIL NIL NIL NIL Mortuary. Number of bodies received Number of infectious bodies received Number of bodies removed to Public Mortuary on Sanitary grounds Number of bodies detained in Mortuary Chapel 1944 ARTICLES DISINFECTED OR DISINFESTED PUBLIC HEALTH SERVICES 15,148 CIVIL DEFENCE 13,214 47 Premises and Occupations Controlled by Byelaws and Regulations.—The preceding Table No. 33 summarises the number and character of premises and occupations in the borough which are controlled by byelaws and regulations. Underground rooms and underground sleeping rooms, although controlled, the former under the Public Health (London) Act, 1936, and the latter under the Housing Act, 1936, are net registered. Further reference to these premises and occupations will be found in the Sections of this report dealing with "Inspection and Supervision of Food and Housing." Eradication of bed bugs.—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 disintestation 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) 16 — — Workshops (without mechanical power) 146 — — Other Premises under the Act (including works of building and engineering construction but not including Outworkers' premises) 7 - - Total 169 — — 48 2.—Defects found in Factories and Other Premises. Particulars. (1) Number of Defects. Number of offences in respect to which Prosecutions were instituted. (5) Found. (2) Remedied. (3) Referred to H.M. Inspector. (4) Nuisances under the Public Health 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 5 — 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 oflences 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 oi 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 accordancc with the instructions of the Ministry of Health, the following tabular statement has been prepared:— TABLE No. 35. HOUSING STATISTICS FOR THE YEAR. 1. Inspection of Dwelling-houses During the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 694 (b) Number of inspections made for the purpose 3067 (2) (a) Number of dwelling houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 140 (b) Number of inspections made for the purpose 1120 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found 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 oi dwelling houses in respect of which notices were served requiring defects to be remedied 236 (2) Number of dwelling houses in which defects were remedied after service of formal notices:— (a) By owners 41 (b) By Local Authority in default of owners — (c) Proceedings under sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling houses in respect of which Demolition Orders were made 3 (2) Number of dwelling houses demolished in ance 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 (c) 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. 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 ancl by the operation of benevolent agencies and trusts. Sufficiency of Supply of Houses.—Municipal undertakings for the housing of the working classes carried out by the Borough Council prior to 1914 are shown in Table No. 36:— 53 TABLE No. 36. Pre-War Housing. Properties Owned and Managed by the Chelsea Borough Council. Property. No. of Flats Population (approx.) Rents. Sir Thomas More Buildings, Beaufort Street 262 725 4/11 to 13/10 per week Pond House, Pond Place 32 125 10/8 to 14/9 per week. Onslow Dwellings, Pond Place 108 312 6/6 to 8/7 per week. Grove Buildings, Chelsea Manor Street 120 220 4/2 to 7/8 per week. 522 1,382 Private enterprise, benevolent agencies and trusts had also made very important contributions to housing in Chelsea prior to 1914. These are shown in Table No. 37. TABLE No. 37. Properties erected by Private Enterprise, Benevolent Agencies, Trusts, etc. Property. No. of Flats. Population (approx.) Rents. Sutton Model Dwellings, Cale Street 660 2,037 3/5 to 10/10 per week. Lewis Trust Dwellings, Ixworth Place 398 1,299 3/1 to 10/3 per week. Marlborough Buildings, Walton Street 162 391 9/0 to 20/0 per week. Guinness Buildings, Draycott Avenue 303 711 2/3 to 7/5 per week. Peabody Buildings, Lawrence Street 68 163 3/8 to 8/4 per week. Chelsea Park Dwellings, King's Road 54 114 3/5 to 12/6 per week. It will be seen that in Chelsea at the outbreak of war there was available accommodation for about 7,000 persons of wage-earning class-an amount which, in proportion to population, was considerably higher than that obtaining in any other metropolitan borough. 54 Since the war, the economic situation and other factors, particularly the shortage of and greatly increased cost of building land in Chelsea have rendered an already difficult situation still more difficult. The Housing Committee of the Borough Council has been actively engaged in investigating possible sites in connection with further housing schemes and from time to time various schemes have been formulated by the Council and submitted to the Ministry of Health for approval. Of the schemes prepared and submitted to the Ministry, five have fortunately materialised, approval of the others not being obtained on the ground that the cost of the land was much higher than the price the Ministry could sanction for the purchase of land to be used for the erection of buildings to house the working classes. These buildings are now fully occupied. Details of each approved scheme arc shown in table No. 38 (Page 57). Reviewing the history of the past 40 years, it would appear that the housing policy of the Borough Council has been firstly to preserve, where possible, in areas threatened with demolition, such working class accommodation as was of reasonably good type; and secondly, to provide accommodation by means of new buildings in an accessible situation within the Borough for those persons of the working class who are average representatives of their class, and for whom the necessities of their trade or calling render residence within the Borough desirable or necessary. It cannot be disputed that at the present time in Chelsea, as in other Metropolitan Boroughs, there is considerable dearth of accommodation both for the working classes, and for the classes in receipt of small salaries or earnings, and that, as elsewhere, this situation is primarily due to the restrictions imposed upon the building trades during the war and the economic disturbances which have succeeded it. It will, however, be evident from the details already given that the existing shortage of housing accommodation in Chelsea is being most adequately dealt with and that the extremely difficult problems which confronted the Borough Council subsequent to the war 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 8,496, and judged by the standard laid down in the Housing Act, 1935, 749 of these families were found to be living in overcrowded conditions—a percentage of 8.78 for the Borough as a whole. The problem of abating overcrowding is receiving close consideration by a Special Committee of the Council. Many cases when approached as to the desirability of having their names submitted to the County Council,with a view to provision of housing on one of the Council's Estates, decline to consider the proposition, on the ground that the distance of the County Council's Estates from their work is too great. Others have become attached to the district and will not contemplate forsaking existing 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, 1936. The purpose of the survey was to ascertain the permitted number of persons entitled under the Act to occupy a working-class dwelling. This necessitated the measurement of each room in 5,112 houses. Under Section 62 of the Housing Act, a Landlord or Occupier of a dwelling-house may apply to a Local Authority, and it is the duty of the Local Authority to inform the applicant, in writing, of the number of persons constituting the permitted number in relation to the house. Fitness of Houses.—The general standard of housing in the Borough is satisfactory. There has been a very definite improvement in housing conditions during the past ten years. The vast majority of houses have an adequate internal water supply and adequate sanitary accommodation within their own curtilage. The constant vigilance of the Sanitary Inspectors has impressed upon both owners and tenants their determination that every dwelling house shall be maintained in a reasonable state of repair and that there shall be systematic observance of cleanliness. While the great majority of these houses arc structurally sound, a number of them are old, worn out and below the modern standards of sanitation and convenience. It is probable that only a minority of the tenants would be able to pay economic rents for alternative accommodation, having regard to the rents that require to be fixed for new dwellings, owing to the greatly increased cost of land and construction during recent years. Another problem is caused by certain old people, usually women. Many of these live alone in a single room with no one to look after them. Frequently they rely almost entirely on the Old Age Pension for sustenance. Gradually growing feebler with the passage of time, they eventually become unable properly to care for themselves or their homes. Although every means of persuasion is tried, these cases usually decline to enter a Poor Law Institution and the condition often persists for a lengthened period. Fortunately, this problem has now been met by legislation. Under the Public Health (London) Act, 1936, it is possible to arrange for the removal of such cases to a suitable institution. 56 While in the majority of instances the defects found to exist in unfit, houses are due to the lack of proper management and supervision by owners, from time to time complaints are made by the owners regarding the difficulties they experience in keeping their property in a reasonable state of repair because of the dirty and destructive habits of a number of their tenants. It is alleged that, through carelessness or wilful damage by tenants, repairs and cleansing have to be carried out with unreasonable frequency and that, as a consequence, it is impossible to maintain even the minimum requirements of the Local Authority without incurring financial loss. Investigation has shown that these statements are often well-founded, especially in the poorer class tenement lodging houses where no responsible caretaker or landlord is resident. To lighten the difficulties of the owner in these cases, effort is made, as far as possible, to keep in view such powers as a Local Authority has of holding the tenant responsible for defects resulting from his neglect or default. The total number of dwelling houses inspected for housing defects was 694, the number found not to be in all respects reasonably fit for human habitation being 236. The number rendered fit in consequence of informal action by the Sanitary Inspectors was 195, and the number in respect of which statutory notices were served requiring defects to be remedied was 41. No case came to the knowledge of the Department in the course of the year of an underground room being illegally used for sleeping purposes. No application under the Increase of Rent and Moitgage 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. 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 90 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 67 58 SECTION V.—INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—In accordance with statutory enactments, the Council keeps a register of persons carrying on the trade of dairymen or purveyors of milk and no person is permitted to carry on the trade in the Borough unless he is registered. The Council is empowered to remove the name from or refuse to enter upon the register the name of any person selling or proposing to sell milk on premises which are for any reason unsuitable for the purpose. The Milk and Dairies (Amendment) Act, 1922. further empowers the Council to refuse to enter the name of any person in the Register, or to remove the name of any person from that Register, if it is shown to the Council's satisfaction that the public health is or is likely to be endangered by any act on 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 90 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, 1936and 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 liccnces 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 29 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 26 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. Unsound Food.-On one occasion during the year, unsound food was surrendered and destroyed. Included in the unsound food surrendered and destroyed during the year was:— 119 lbs. Beef. 3 stones Plaice. No carcases were destroyed on account of Tuberculosis. Food Poisoning.—No case of food poisoning occurred during the year. Food and Drugs (Adulteration) Act, 1928.—Four hundred samples, including 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 justify legal action. In each of these cases a warning letter was sent to the Vendor concerned. The work carried out under the Food and Drugs (Adulteration) Act, during the year is summarized in the Public Analyst's Report in the appendix. The Public Health (Preservatives, etc., in Food) Regulations.— All samples of milk and cream taken during the year were submitted to examination for preservatives. No evidence of the presence of preservatives was obtained sufficient to warrant legal proceedings. Margarine.—No application for transfer of registration was received during the year from wholesale dealers in margarine. Bacteriological Examinations.—Arrangements have also been made with the Clinical Research Association for the bacteriological examination of samples of milk under the Milk (Special Designations) Orders. Nine samples were submitted for investigation during the year, each of which was found to be satisfactory in character. DISSEMINATION OF KNOWLEDGE AS TO NUTRITION. Advice as to the necessity for a high standard of purity and quality in relation to food is given by the staff of the Public Health Department. In addition, lectures and film demonstrations on Health topics, including Diet, are given from time to time at the premises of the Chelsea Health Society. Leaflets are also issued to expectant and nursing mothers which are of great assistance in focussing attention on this important subject. ' The desire of the public to consume a natural product, or at least that they should be made aware if offered an artificial substitute, has found expression in the Artificial Cream Act, 1929. Shell-fish (Molluscan).—There are no shell-fish beds or layings in the Borough. No markets for the sale of shell-fish by wholesale exist in the district. 62 SECTION VI.—INFECTIOUS DISEASES. (a) Infectious Diseases Generally. DISEASES COMPULSORILY NOTIFIABLE IN THE BOROUGH. Acute Poliomyelitis. Diphtheria. Acute Polio-encephalitis. Membranous Croup. Acute Encephalitis Lethargica. Dysentery. Acute Primary Pneumonia. Erysipelas. Acute Influenzal Pneumonia. Malaria. Cerebro-spinal Fever. Puerperal Fever and Puerperal Chicken Pox. Pyrexia. Plague Relapsing Fever. Anthrax Small-pox. Glanders Typhus Fever. Hydrophobia Tuberculosis. Cholera Scarlatina or Scarlet Fever. Continued Fever Typhoid or Enteric Fever. Ophthalmia Neonatorum *Measles. Food Poisoning *Whooping Cough. SCABIES (FROM 1.8.43) NOTIFICATIONS DURING THE YEAR. 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. 1944 Corrected Cases notified in Chelsea. 1944 Cases notified in each Ward. Removed to various Hospitals *Casestified. Averrage 10 years 1929-38. At all Ages. Under Year. 1-2 Years. 2-3 Years. 3-4 Years. 4-5 Years. 5-10 Years. 10-15 Years. 15-20 Years. 20-35 Years. 35-45 Years. 45-65 Years. 65 and Upwards. Stanley. Cheyne. Church. Hans Town. Royal Hospital. 1939 1940 1942 1943 1944 1945 ► Scabies 165 9 4 12 5 5 6 11 21 36 21 25 4 66 34 57 8 6 28 - - - 62 165 156 86 Chicken-pox . — - - - - - - — _ - - - - - - - - - - - - - - - - - Relapsing Fever - - - - - - - - - - - - - - - - - - - 1 - 18 18 12 8 112 Diphtheria 12 2 1 - - - 1 - 1 4 3 - - 3 - 8 1 - 12 65 15 16 10 14 9 31 Erysipelas 14 - - - - - - - 1 4 - 6 4 8 2 4 - - 9 15 9 64 96 35 48 146 Scarlet Fever 35 - 2 1 2 1 16 5 2 4 2 - - 10 5 14 2 4 32 49 13 - - - - - Typhus Fever - - - - - - - - - - - - - - - - - - - - - - - - - - Enteric Fever - - - - - - - - - - - - - - - - - - - 1 1 1 - - 2 3 Puerperal Fever - - - - - - - - - - - - - - - - - - - 2 2 4 6 4 3 8 Puerperal pyrexia 4 - - - - - — - - 4 - - - 1 1 1 1 - 3 10 6 3 4 4 2 1 Cerebro-spinal Fever 4 - - - - - - - - 3 - - 1 1 1 - 2 - 3 1 4 1 1 4 3 4 Ophthalmia Neonatorum 4 4 - - - - - - - - - - - 2 - 1 1 - 2 5 3 — - 1 1 1 Poliomyelitis 1 - - - - - - - 1 - - - - - - - - 1 1 - - - - - - 0.1 Encephalitis Lethargica - - - — — - - - - - - - - - - - - - - - - - - - - 0.1 Polio-encephalitis - - - - - - - - - - - - - - - - - - - - - - - 1 1 1 Malaria 1 - - — - — - - - 1 - - - - - - - 1 1 1 - 23 85 56 53 5 Dysentery 56 4 14 15 3 1 5 - 1 1 2 1 9 8 1 46 - 1 56 4 6 16 18 14 11 88 Acute Primary Pneumonia Acute Influenzal 14 - - - - - 1 - - 3 2 8 3 6 4 4 1 2 4 43 59 4 6 5 1 15 Pneumonia 5 - — - - — — - - - 2 - 3 2 2 1 - - - 4 9 - 30 3 - - Food Poisoning 3 — - - - - - - - 1 - 1 1 3 - - - - - - 5 93 294 40 - 324 Measles 40 13 14 9 1 8 12 3 4 3 3 - - 38 4 24 2 2 23 16 150 64 42 51 38 45 Whooping Cough 51 12 18 8 2 6 5 - - - - - - 14 4 29 1 31 44 4 34 42 51 38 45 Total 442 44 56 45 13 21 46 19 31 66 33 40 28 161 61 183 19 14 208 292 289 289 42 442 649 505 Pulmonary 54 - 1 - 1 1 4 1 4 24 10 9 4 25 8 10 13 3 - 45 49 48 42 59 69 88 Non-Pulmonary 5 - - - - - 2 - 1 1 - - - 2 - 2. - 1 - 5 5 9 4 5 6 14 Totals (Tuberculosis) 64 - 1 - 2 1 6 1 5 25 10 9 4 24 8 12 13 4 - 80 54 54 46 64 45 105 Totals 506 44 54 45 15 22 52 20 36 91 43 49 32 189 69 195 32 21 - 342 343 344 453 506 454 610 ions nave not been *note. Up and including year 1943, notifili of diagnosis, corrected for any subsequent revisl 64 DIPHTHERIA. NotIfications.Eighteen cases (including 2 noncivilians) were notified during the year. Information was received that 4 of the civilian cases proved not to be suffering from Diphtheria. The actual number of cases was therefore 12. Deaths.—NO deaths from the disease occurred during the year. Return Cases.—NO "return" case ot the disease occurred during the Year. The incidence of the disease during the past six 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 sub- mitted Positive. Percent age Positive. Negative. Percent age Negative. 1939 60 100 3 5.0 51 Feb. 236 24. 10.0 212 90.0 1940 10 100 - - 53 Jan 59 - 0.0 59 100.0 1941 21 100 - - 14 May 142 4 5.0 135 95.0 1942 13 100 - - 31 MaY 66 1 1.5 65 98.5 1943 14 94 - 6 May 64 1 1.5 66 98.5 1944 12 100 - - 8 feb 86 1 1.2 85 98.8 1945 8 100 1 12.5 34 Sep 84 1 1.2 83 98.8 No case of Diphtheria came to the knowledge of the public Health Department during the year in which the child was known to have completed the course of immunisation not less than 12 weeks before the onaet of the disease. 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. 1946. 14 14 - -14 May 65 The following table gives details of the work of the clinic during the past six 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 inn in coutry and post 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 4 232 560 126 252 329 16 102 70 1943 348 2 14 305 13 215 104 2 89 27 1944 309 - 26 272 8 209 51 - 30 11 1945 386 - 6 350 5 244 36 6 32 30 are also available. Furtner details will-Be found on page 28. SCARLET FEVER. Notifications. Forty-two cases (Including six non-civilians) were notified during the year. Information was received that one of the civilian cases proved not be be Soarlet fever. The actual number of civilian oases was therefore 35. 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 1943 94 95 1 1.1 70 Oct 1944 35 91 - - 66 Jan 1945 48 43 - - 66 Mar 1946 80 64 - - 68 Apr 66 Information as to cases occurring in the Borough was derived by notification, the school authorities and the Health Visitors in the course of their duties. Children suffering from the disease are visited by the Health Visitors at frequent intervals and advice is given as to the steps necessary to avoid complications. On request by the School Medical Officer of Health of the London County Council, advice leaflets are supplied to the Head Teachers of schools in the area affected with an outbreak of Measles. These leaflets are distributed to the parents and guardians of the children attending such schools. Co-operation between the school nurses and the Borough Health Visitors has been arranged. MEASLES. Table No. 43 shows the incidence of the disease during the past two years:— TABLE No. 43. Year. Number of cases coming to the knowledge of the P.H. Dept. Cases notified from 1/10/38. Total cases. Deaths. M B plus Number of Visits and Re-Visits by Health Visitors. Number of Visits by District Nurses. Under 5 years. Over 5 years Under 5 years Over 5 years Under 5 years Over 5 years Total • Under 5 years Over 5 years Total 1939 6 - 5 11 22 - 11 6 14 — - - 1940 - - 84 63 156 - 24 46 40 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 1943 13 14 144 150 324 -- 342 294 636 61 83 144 1944 - - 45 25 40 - 42 34 106 33 - 33 1945 - - 230 132 342 3 416 124 546 181 43 254 Year. Number of cases coming to the knowledge of the P.H. Dept. Cases notified of Number of from 1/10/38 Total cases. Deaths. Number Visits and Re-Visits by Health Visitors. Number Visits by District Nurses. 1939 36 44 110 - 213 134 1940 - 4 4 - 3 - 1941 - 44 44 - 103 53 1942 33 64 100- 180 28 1943 12 42 54 - 104 21 1944 - 51 51 - 33 - 1945 - 38 38 - 86 23 67 ENTERIC FEVER. Notifications.—During the year nine cases under the Enteric Fever Group w£re notified in Chelsea. Seven 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. Year PNEUMONIA. MALARIA. DYSENTERY. Total Number of Cases Notified. Treatment in Hospital. Total Number of Cases Notified. Treatment in Hospital. Total Number of Cases Notified. Treatment in Hospital 1937 68 68 — - 5 4 1938 64 57 — — 43 43 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 were made during the year. Deaths.—There were 37 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. 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 — — — 1940 2 2 - - - 1941 - - - - - 1942 1 1 - - - 1943 - - - - - 1944 - - - - - Pucerperal Pyrexia. 1939 10 8 — — 1* 1940 6 3 2 1 1 1941 3 3 - - - 1942 4 4 - • - 1943 6 6 - - - 1944 4 3 - - - • Non-Parishioner, Died in a Chelsea Hospital, upon the medical practitioner in attendance. This disease is defined as a purulent discharge from the eyes of an infant, commencing within twentv-one davs from the date of its birth. TABLE No. 47. Ophthalmia Neonatorum. YEAR. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Left District. Deaths. No. Notified. Treated. At Home. In Hospital. 1939 5 3 2 5 - - - - 1940 3 3 - 3 - - - - 1941 4 2 2 4 - - - - 1942 1 - 1 1 - - - - 1943 1 1 - 1 - - - - 1944 4 2 2 3 - - - - 1945 3 3 - 3 - - - - 1946 4 - 4 3 - - - - 69 Nursing By arrangement with the Chelsea District Nursing Association. home nursing is provided for infants suffering from this disease. Year. cases. No.of Visits. l939 3 61 1940 2 82 1941 2 26 1942 - - 1943 - - 1944 2 96 1945 3 98 Three cases or Punomyenns were notinea during tne year and treated in hospital. ENCEPHALITIS LETHARG1CA. SCABIES. The notification of scabies came into force on the lst. August, 1943. The Regulations make it compulsory for a medical practitioner to notify to the local authority any person to whom he is called, on becoming aware that such person is suffering from scabies, unless any member of the same family shall have been notified within a period of four weeks. 165 cases of scabies were notified up to the end of the year. TABLE NO. YEAR NO. OF CASES TREATED TOTAL NO. OF TREATMEANTS NO OF ARTICLAS DISINFECTED 1939 82 140 2060 1940 58 110 2046 1941 120 258 2594 1942 403 1346 13920 1943 345 848 10284 1944 318 643 4524 70 TABLE No. 48. Vaccinations. 1938 1939 1940 1941 1942 1943 Number % Number % Number % Number % Number % Number % Births registered in 1937 811 100 310 100 169 100 44 100 149 100 228 100 Successfully vaccinated 463 54.1 146 56.8 82 48.5 36 46.4 114 63.4 133 58.3 Insusceptible of vaccination 2 0.2 2 0.6 1 0.6 - - 1 0.6 2 0.9 Had Small Pox - - - - -- - - - - - - - Statutory Declaration of conscientious objection 153 18.9 55 14.4 15 8.9 13 16.9 21 11.4 25 10.9 Died unvaccinated 29 3.6 4 2.3 4 4.1 4 5.2 9 5.0 8 3.5 Removed to other distaicts and to unknwon dirtricts etc. 104 20.2 40 22.6 64 34.9 24 31.2 34 19.0 60 26.4 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 1938 was 797. 1939,441i. 1940 ,213i. 1941,130i. 1942,269i.1943,304i. 1944,263i. 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 lor 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. 0d. On page 44 will be found a summary of the work done by the disinfecting staff during the year. Infectious Disease Shelter.—Under the Public Health (London) Act, 1936, Section 195 (4), temporary house accommodation with necessary attendance is provided by the Borough Council free of charge at 9a, Lots Road, for families in which cases of dangerous infectious disease have occurred, and who have been compelled to leave their dwellings for purposes of enabling such dwellings to be disinfected. Two families were accommodated at the shelter during the year. . 72 71 Disinfestation. The female shelter attendant is also employed in connection with the work of the Cleansing Station. In 1022. the London County Council entered into an arrangement with the Borough Council for the use of the Station on specified days during the school year for the purpose of cleansing the heads of verminous school children. Under the L.C.C. Scheme, the work of cleansing is supervised by the school nurses, who also make all arrangements for the attendances of the children. The children cleansed are those attending schools situated west of a line running down the centre of Sydney Street and Oakley Street. The Borough Council receives payment from the London County Council at the rate of 2s. per child attendance. TABLE NO. L.C.C. SCHEME. CLEANSING OF VERNINOUS CHILDREN E.T.C. 1939 1940 1941 1942 1943 1944 1945 1946 VERMINOUS 554 298 233 306 245 264 258 346 SCABIES - • 54 405 319 209 239 310 IMPETIGO 1 - - 182 88 4 16 82 MINOR AILMENTS 394 .91 - - - - 5 - AMOUNT RECOVERABLE FROM L.CC. 75.90 54.70 36.0 .0 74.90 42.70 37.10 38.168 57.40 (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 nettexpenditure of that scheme. Staff.—The staff of the Dispensarv is set out on Dages 5-6. NOTIFIC ATIONS AND NEW CASES. YEAR NOTIFICATIONS. NEW CASES OTHERWISE THANBY NOTIFICATION ON FORM A. TOTAL NEW CASES (ALL SOURCES) PRIM. WUAL TOML 1939 80 8 88 43 123 1940 64 3 57 36 90 1941 62 5 67 13 45 1942 57 7 64 28 85 1943 76 6 82 20 96 1944 64 8 72 37 101 1945 75 7 82 54 - 132 72 ' Officer of Health during the year, otherwise than by notification on Form A or Form B under the Public Health (Tuberculosis) Regulations. Tuberculosis. New Cases and Mortality. Age Periods. 1939 1940 1941 1942 1943\ 1944 1945 1946 NEW CASES DEATHS NEW CASES DEATHS NEW CASES DEATHS NEW CASES DEATHS NEW CASES DEATHS NEW CASES DEATHS CASES DEATHS CASES CASES DCATHS RESAIRA TORY NOW RESPORT TORY RESAIRA TORY NON- TORY RESAIRA TORY NOW RESPORT TORY RESAIRA TORY NOW RESPORT TORY RESAIRA TORY NOW RESPORT TORY RESAIRA TORY NOW RESPORT TORY RESAIRA TORY NOW RESPORT TORY RESAIRA TORY NOW RESPORT TORY RESAIRA TORY NOW RESPORT TORY RESAIRA TORY NOW RESPORT TORY M F NOW RESPORT TORY RESAIRA TORY NOW RESPORT TORY ilRESAIRA TORY NOW RESPORT TORY RESAIRA TORY NOW RESPORT TORY RESAIRA TORY NOW RESPORT TORY RESAIRA TORY NOW RESPORT TORY RESAIRA TORY NOW RESPORT TORY RESAIRA TORY NOW RESPORT 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 MF M F M F M F M F 1 0—1 - 1 1 - • - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - M F M F M F M F M F M F M F M F M F M F M F M F 1— 5 - - - - — . - - 1 2 1 - • 1 - - - - 1 - - - - - - - 3 - - - - 1 - - - - - - - - 3 1 - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - 0.1 5—10 1 1 2 - - - 1 - 1 - - - - - - - -» - - 1 - - - - - 1 - - - - - - - - - - - - - - 4 2 - 1 - - - 1 1 3 - - - - - - 1 2 - - - - - - 1 1 1 - - - - 1.5 10—15 - 1 1 1 - - - - 1 - - - • 1 - 1 1 - - - • 1 - • - - - - - - - 1 - - - - - - 1 - - - - - - - - 2 - 1 - - - - 1 2 1 - - - - - 2 2 1 1 - - - - 5.10 15—20 -4 5 - 1 - 1 " - 4 3 1 - * 2 1 - 1 4 - • 2 2 - - 2 5 * 1 - • - - 7 8 1 1 - - - - 3 4 1 1 - - - 2 1 - - - - - 1 1 - 1 - - - 1 1 1 - 1 - - - - 10.20 20—25 3 7 2 - 4 2 - - 6 9 1 1 - 3 2 - 1 .5 1 - - 2 - - 3 10 — 3 1 1 1 - 2 10 - 1 - - - - 1 9 - - - - - - 4 7 - - - - - - 1 5 2 - - - - - 6 5 - 2 - 1 - - 15.35 25—35 8 8 • 1 4 2 11 4 - - 4 - - - 5 9 1 2 2 1 1 - 7 10 2 1 1 4 - - 4 14 - 1 4 2 - - 8 19 - 2 1 2 - 2 5 15 - 3 2 - - - 8 6 - 2 1 1 - 1 9 - - - - 1 - - 20.25 35—45 - 15 9 - - 3 - — - 8 7 - - 4 6 - - 10 4 - - 2 1 - - 5 7 1 2 - 2 - - 10 8 - - 4 3 - - 14 3 - - 1 2 - 2 15 22 - 1 7 - - 11 10 - 3 - 1 1 - 10 22 - - 3 1 - - 25.35 45—56 15 6 1 - 8 3 1 - 4 1 - - 2 1 1 - 9 4 - 1 4 4 - - 6 2 1 1 3 1 2 - 10 1 1 1 3 * 1 - 5 6 - - 3 4 - 1 12 7 1 1 1 3 - - 8 8 - 1 6 - - 1 16 10 1 2 1 3 1 1 35.45 55—65 13 1 1 9 - - 1 11 1 - • 6 1 - - 6 1 - 1 4 - • 5 1 - - 1 1 - 6 3 - 1 4 - 1 5 - - 4 3 - - 4 4 1 1 2 - 1 - 7 7 - - - 2 - - 16 9 - 1 3 2 1 - 45.55 65 and upwaids 11 2 1 - 7 3 * - 6 • - 1 6 1 - 1 3 4 - -- 4 3 - - 5 - - 1 3 1 - 1 1 - - - 1 1 - - 3 4 - - 3 3 - - 6 4 - - 5 3 - 1 1 3 - - 4 - - - 5 1 - - 2 3 - - 65.65 Totals 70 41 8 4 35 11 3 2 54 30 3 3 23 14 4 2 36 35 2 5 18 13 2 • 33 39 4 9 9 10 3 2 44 45 2 5 16 6 1 1 44 47 4 3 16 14 - 4 54 1 - -~ 3 - - - 4 1 - - 4 - 1 - 2 1 1 - 1 - - - 654 - 65 3 7 14 13 1 - 44 54 3 7 15 4 4 3 53 65 4 8 10 12 2 1 The death rate from all forms of Tuberculosis in Chelsea was per 1,000. Of the total number of deaths ( ) from all forms of Tuberculosis, 10 died non-notified or prior to notification. The ratio of nonnotified tuberculosis deaths to total tuberculosis deaths was therefore as 1 is to 4. The corresponding ratio for 1937 was 1 : 3. Making allowance for difficult and doubtful cases in which a diagnosis cannot be established until after death, the notification of tuberculosis is carried out fairly efficiently in the Borough. Cases of Tuberculosis in the Borough.—The Public Health (Tuberculosis) Regulations, 1930, provide that the Medical Officer of Health shall furnish to the County Medical Officer, as soon as practicable after the end of each quarter, a statement compiled from the register of notifications showing :— (a.) The number of cases of Tuberculosis on the Register at the commencement of the Quarter ; (b.) The number of cases notified under the Regulations for the first time during the Quarter ; (c.) The number of cases removed from the Register during a preceding Quarter which have been restored to the Register during the Quarter, giving the name and address of each such case and the reasons for the restoration ; (d.) The number of cases added to the Register during the Quarter which have been brought to notice otherwise than by notification under the Regulations; (e.) The number of cases removed from the Register during the Quarter giving the name and address of each such case and the reason for such removal; and 73 (f) The number of cases remaining on the Register at the end of the Quarter. Regulations show that TABLE NO. 51 year 1940 1941 1942 1943 1944 1945 MALES FEMELS TOTAL. MALES FEMELS TOTAL. MALES FEMELS TOTAL. MALES FEMELS TOTAL. MALES FEMELS TOTAL. MALES FEMELS TOTAL. MALES FEMELS TOTAL. PULMONARY 116 84 200 105 72 177 93 63 156 99 72 141 108 83 191 111 90 201 120 130 250 NON-PULMONARY 23 15 38 20 15 35 16 15 31 15 16 31 15 16 31 18 15 33 14 19 36 TOTALS 139 99 238 125 84 212 109 78 184 114 88 202 123 99 222 129 105 234 134 149 286 Home Visiting.—The duties of Tuberculosis Visitor in the Borough are undertaken by the staff of Brompton Hospital. A grant of per annum is paid by the Borough Council for this service. The Tuberculosis Visitor in the course of the year paid visits to .nondispensary cases of Tuberculosis. Visits made to Dispensary cases of Tuberculosis are recorded in Table No. 52. Public Health (Prevention of Tuberculosis) Regulations, 1925.— The Regulations provide, inter alia, that no person suffering from respiratory tuberculosis who is in an infectious condition, shall be engaged in any form of dairy work involving the milking of cows, the treatment of milk or the handling of milk containers. Investigations in connection with these Regulations have been made in the Borough but no case calling for action has thus far been discovered. Chelsea Tuberculosis Scheme.—Table No. 52, subjoined, is prepared in accordance with the requirements of the Ministry of Health. . The Table includes:— (a.) Summary of cases dealt with at the Chelsea Tuberculosis Dispensary, Brompton Hospital, and (b.) Special Cases .which were accepted for institutional treatment by the London County Council, but which were not dealt with by the Chelsea Tuberculosis Dispensary. Prior to 1929 this Table comprised cases dealt with at the Chelsea Tuberculosis Dispensary only. TABLE No. 52. Treatment of Tuberculosis, Year Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New cases examined during the year (excluding contacts)— < (a) Definitely tuberculous 18 20 3 2 — — 4 — 18 20 7 2 249 (b) Diagnosis not completed - - - - - - - - - - - - (c) Non-tuberculous 72 1007 12 11 — — - - 42 107 12 11 B.—Contacts examined during the year :— (a) Definitely tuberculous 1 — 4 — — — — - 1 — 4 - (b) Diagnosis not completed — — - - — — — — — — 120 (c) Non-tuberculous 15 37 37 26 15 37 37 26 C.—Cases written off the Dispensary Register as:— (a) Recovered 6 4 1 - - 1 - — 6 5 1 - 329 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) 87 114 49 37 - - - - 87 144 49 307 D.—Number of Cases on Dispensary Register on December 31st •— (a) Definitely tuberculous 83 75 9 2 5 11 3 1 88 86 12 3 189 (b) Diagnosis not completed _ - - - - — — — - - — — 1. Number of cases on Dispensary Register on January 1st 185 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 24 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of" 42 cases written off during the year as Dead (all causes) 21 6. Number of Insured Persons under Domiciliary Treatment on the • 31st December 4 6. Number of attendances at the Dispensary (including Contacts) 1184 7. Number of consultations with medical practitioners:— 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 15 (a) Personal ... 8 (6) Other 44 10. Number of:— 9. Number of visits by Nurses or (a) Specimens of sputum, etc., examined 11l Health Visitors to homes for Dispensary purposes ... 1404 (b) X-ray examinations made in connection with Dispensary work 632 11. Number of " Recovered " cases restored to Dispensary Register, and included in A (a) and A (b) above NIL 12. Number of " T.B. plus " cases on Dispensary Register on December 31st 50 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. 74 77 Chelsea Tuberculosis Dispensary.—This Dispensary, located at Brompton Hospital, provides highly efficient treatment for all cases resident in the Borough. By agreement with the Borough Council, adequate Medical, Nursing and other necessary services are provided. The Tuberculosis Officer (Dr. W. J. Fenton) is Dean ef-the Medical Schooland Honoraronsulting Physician to the Hospital and his services are available when required by any medical practitioner in the Borough. Social work in connection with the Dispensary cases is carried out systematically and well by a trained Social Worker. With the approval of the Ministry of Health, the Borough Council made a financial grant of £1,000 to Brompton Hospital for the year commencing 1st April, 1938. An additional sum of £160 for Nurses visits to homes of patients was also granted by the Council to the Hospital and approved by the Ministry of Health. Table No. 54, summarises, for the past two years, the number of persons examined at the Dispensary for the first time, the percentage of these cases in which definite tuberculosis was found and the total attendances at the Dispensary. TABLE No. 54. Work done at the Dispensary. Year. Newcases examined during the year. Definite Tuberculosis. Total attendances at Dispensary. 1939 208 10 per cent .1563 1940 140 12 " " 1046 1941 122 17 " " 904 1942 141 14 " " 921 1943 185 13 " " 1156 1944 217 7 " " 1184 2 ' Cnelsea, as a receiving nuSpiidi iui tdsca ui uuuuuai iuLAak.uiw (females). 51 42 33 24 '3., DJZfirstS 77V/3JZACC/L&SjS /a/ /A/SrtTor/a*-5 Year Total Qorm ST-LUNES WOSP OTWER IN STAUTIONS TOTAL OF DEATHS ANTY TROM MOME A/O A'O % 2S yo '9 84 3Y J2o iy *9 85 /9A! 3o y 23 y° 91 2o - — 2o f! 81 /jWr3 2/ / * 2o n 3X *• — 3X 94 20 — — V// 74 78 Tuberculosis, which require treatment. These cases are advised as to obtaining such treatment, either from private practitioners or at general hospitals. Many children are found to be suffering from anaemia, malnutrition and similar diseases and are referred to the Chelsea branch of the Invalid Children's Aid Association with a view to provision of convalescent home treatment. Co-operation with the School Medical Service.—The relationship with the School Medical Service continues to be satisfactory. The School Medical Authorities frequently afford valuable help in deciding what supervision is desirable in connection with children. Many children are referred direct to the School Clinic for the treatment of minor ailments and dental caries. 120 Co-oderation with Medical Practitioners.- YEAR NO OF CASES (INCLUDING ) PERSONAL CONSULTATIONS VISITED BY THE TUBERCULOSIS OFFICER AT THE HOMES OF THE PATIENT. NO OF CASES REFER RE D BY MEOICAL ARACTI TIO TO TUBERCULOSIS OFFICER AT THE DISPENSARY. 1939 20 75 1940 18 51 1941 9 48 1942 5 88 1943 17 94 1944 15 85 Artificial Pneumo-thorax Treament.-On the recommendation of the Tuberculosis Officer patints are supplied with refills in con-nection with artficial pneumo-thorax treatment. YEAR NO OF PATIENTS. COST YEAR NO OF PATIENTS COST 1939 30 222.120 1942 31 246. 1 6 1940 28 242.8.0 1943 35 363 0 0 1941. 22 193.14.6 1944 42 461.10 / NO. OF VISITS BY NURSE To HOMES of PATIENTS. YEAR VISITS YEAR VISITS 1939 2972 1942 2,140 1940 2124 191943 2,679 194l 1658 1944 1,407 YEAR TUBEREULOSIS OFFICER. COST. 1939 19 42.11.0 1940 25 58.145 1941 26 63.181 1942 17 44.3.9 1943 31 8l.10.3 1944 38 78.15.0 79 Special Examinations.— X-RAY EXAMINATIONS MAOE AT THE DISPENSARY WERE FOLLOWS - 1939, 538,1940,303,1941,395 ,1942,456,1943,552,1944,632. + 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. YEAR NO. OF PATIENTS RECEWED TRETMENT DENTURES PROVIDEN (CASES) COST To COUNCIL 1939 4 2 10.120 1940 4 2 8.146 1941 5 5 14.50 1942 3 1 1.176 1943 1 - 10.0 19444 3 3 12.126 1945 7 1 8.46 1941 59 11 1942 43 5 1943 152 6 1944 111 6 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 Tuber- |l culosis 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 T Cases reported admitted to L.C.C. Institutions Dental treatment given through Borough Council Scheme E xtra nourishment given through Borough Council Scheme Extra nourishment given through other agencies ... _ Other assistance given Children boarded out through the L.C.C. Contact Scheme Convalescence arranged GOVERNMENT ALLOWAMRES ^ TUBERCULOS1S SPKCIAL ALLOWANCES. During the year, 52 patients received allowances classified as follows:- Maintenance allowances 45* Special allowances only Discretionary allowances ( see note below ) The amount disbursed was 1,202: 1: 5. Of these 10 pat ients received a special Metropolitan Borough of Chelsea. ■ Annual Report OF THE PUBLIC ANALYST For the Year ended 31st December, 1938. THOMAS McLACHLAN, A.C.G.F.C., F.I.C. 82 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Chelsea. Mr. Mayor, Ladies and Gentlemen, During the year ended 31st December, 1938, four hundred samples were submitted to me for analysis by the Sampling Officers appointed under the Act. Of these 261 samples were taken as " Formal," and 139 were purchased informally. It has not been the custom for your Sampling Officers to discuss the nature of samples submitted with the Public Analyst, and the wide range of substances chosen reflects credit on them. In the tables are shown the names and numbers of samples examined, whether submitted formally or informally, and the number of each type reported as " Adulterated " or " Inferior." Only two samples were returned as adultered, and the Borough is to be congratulated that the percentage of adulteration is only 0.5 per cent. Two other samples were reported to be inferior because they did not comply with the standard, which your Analyst expects, although they could not be described as adulterated. All samples not reported as adulterated or inferior were returned as " Genuine." Article. Taken Formally Adulterated. Taken Informally. Adulterated. Total Samples Analysed Total Samples Adulterated. Milk 88 0 9 0 97 0 Milk, Condensed 0 0 2 0 2 0 Milk, Malted 0 0 1 0 1 0 Milk, Soured 0 0 1 0 1 0 Almonds, Ground or Salted 1 0 1 0 2 0 Baking Powder 2 0 0 0 2 0 Barley 1 0 1 0 2 0 Blanc-Mange and Custard Powders 7 0 0 0 7 0 Butter 11 0 15 0 26 0 Cake and Pudding Mixtures 10 0 2 0 12 0 Cereal Food 1 0 0 0 1 0 Cheese 0 0 1 1 (I) 1 1 (I) Cherries, Glac6 1 0 0 0 1 0 Cocoa 9 0 2 0 11 0 Cocoa, Malted 0 0 1 0 1 0 Coffee 5 0 0 0 5 0 CoSee and Chicory 6 0 0 0 6 0 Cream, Fresh 0 0 4 0 4 0 Cream, Tinned 0 0 1 0 1 0 Fish, Preserved 6 0 6 0 12 0 Fish Paste 0 0 2 0 2 0 Flour 8 0 0 0 8 0 83 TABLE—continued. Article. Taken Formally. Adulterated. Taken Informally. Adulterated . Total Samples Analysed Total Samples Adulterated. Flour, Self-raising 4 0 0 0 4 0 Fruit, Canned 16 0 2 0 18 0 Fruit Pies 0 0 3 0 3 0 Ginger, Ground 1 0 1 0 2 0 Gravy Powder 1 0 4 0 5 0 Honey 1 0 1 0 o 0 Jam 0 0 1 0 1 0 Jelly Crystals 2 0 0 0 2 0 Junket, Fruit 0 0 1 0 1 0 Lard 0 0 15 0 15 0 Lard Substitute 1 0 0 0 1 0 Lemon Barley Crystals 2 0 0 0 2 0 Macaroni 2 0 0 0 2 0 Margarine 7 0 10 0 17 0 Mayonnaise 0 0 1 0 1 0 Meat, Cooked. 4 0 8 0 12 0 Meat Extract 0 0 1 0 1 0 Meat Paste 0 0 3 1(A) 3 1(A) Mint Sauce 0 0 1 0 1 0 Mustard 8 0 0 0 8 0 Oats 0 0 o 0 2 0 Pastry-, Pufif 4 0 2 1 6 0 Pepper 0 0 1 0 1 0 Pickles 0 0 2 0 o 0 Raisins 2 0 0 0 2 0 Rice 8 0 0 0 8 u Sago 2 0 0 0 2 0 Salt 1 0 0 0 1 0 Sauce, Tomato 0 0 1 0 1 0 Sausages 1 0 12 0 13 0 Semolina 3 0 0 0 3 0 Soup, Canned 0 0 4 0 4 0 Soup, Powder 2 0 0 0 2 0 Spaghetti 0 0 1 0 1 0 Spices 3 0 0 0 3 0 Suet, Shredded 1 0 0 0 1 0 Sugar 3 0 0 0 3 0 Syrup 0 0 1 0 1 0 Tapioca 6 9 0 0 5 0 Tea 12 1 . 0 13 0 Vegetables, Canned 6 0 6 0 12 0 Vegetables, Dried 2 0 1 1 (1) 3 1 (1) Spirits— 0 Whisky 1 0 0 0 1 0 Drugs— 0 Aspirin 0 0 1 0 1 0 Soft ParafTin 0 0 1 0 1 0 Syrup of Figs 0 0 1 0 1 1 Tincture of Iodine 0 0 1 1(A) 1 1(A) Totals 261 0 139 4 400 4(2A, 21) Percentages of Total 65.25 .0 34.75 .0 100 1.0 The actual percentages given by the data in the Table are as follows :— Genuine Composition 99 per cent. Adulterated 0.5 per cent. Inferior 0.5 per cent. 84 MILK. Of the 97 samples of milk examined, 88 were submitted formally and 9 informally, and all were found to be in genuine accordance with the requirements of the Sale of Milk Regulations, 1901, and the Milk and Dairies Act, 1922. In the Borough of Chelsea, milks are described as "Good," "Fair," and "Poor," according to the following percentages of fat:— Good Quality ... Over 3.8 per cent. of fat. Fair „ Between 3.35 and 3.8 per cent. of fat. Poor „ Between 3.0 and 3.35 per cent. of fat. Fourteen of the samples examined were described as of " Good " quality, 61 as " Fair," and 22 as " Poor." This is fairly satisfactory, but it is doubtful whether there is any real necessity for milks of " Poor " quality to come on to the market. The probability is that most milk as it comes from the cow is at least of " Fair " quality. SOURED MILK. One sample of specially fermented milk was submitted for analysis, and was found to contain only 2.44 per cent. of fat, as compared with 3.0 per cent., the minimum amount required to be present in milk. As this product is only stated to be prepared with pure milk constituents, no exception could be taken. ALMONDS. It is satisfactory to note that in spite of the Spanish Civil War, and the consequent tendency to pass off mixtures containing nuts other than almonds in the ground condition, or ground almonds mixed with various starches, all samples examined for Chelsea have been found to be genuine. The sample of salted almonds was quite satisfactory. BUTTER AND MARGARINE. In the report last year, mention was made of the fact that the water content of butter and margarine had increased, and it has been noticed that this larger amount of water has been present again this year in almost every sample examined. CAKE AND PUDDING MIXTURES. Twelve samples of cake and pudding mixtures and seven samples of custard and blanc-mange powders were examined, and all were found to be satisfactory. CEREALS AND LEGUMES. It is generally found that dried cereals are free from attack by maggots, but samples of dried legumes frequently show signs of their presence, and your Analyst makes it a practice to report as adultered any samples of which 10 per cent. have been so attacked. A sample of split peas was reported as inferior because over 7 per cent. of the peas were maggotty. 85 CHEESE. A sample of Kraft cheese was returned as inferior, because it contained only 23.8 per cent, of butter fat, calculated on the dry cliccsc. Kraft cheese was originally a re-worked cheese cmade from cheese prepared from whole milk, but, there being no standards for this country, it is difficult to insist that because it was so prepared originally, it must always be so prepared. This would appear to be a good example of the advisability of having certain standards for recognised food names, the sample under discussion having been prepared from a partially skimmed milk. COCOA. It has been noticed during the year that the amount of arsenic in cocoa is increasing, and four samples were found to contain one two-hundredth of a grain per pound. Some years ago, it was found that cocoa was becoming contaminated with arsenic as a result of the sodium carbonate added to render it more soluble. COFFEE AND COFFEE AND CHICORY. Six samples of coffee and four samples of coffee and chicory were examined, and all were found to be satisfactory. CREAM. Four samples of fresh cream and one of tinned cream were examined. The average milk fat present in the fresh cream was 48 per cent., whereas that in the tinned sample was only 23 per cent., rather less than half that in the fresh cream. The thickness of tinned cream is obtained by homogenisation, and is increased during sterilisation. FRUIT JUNKET. A sample of fruit junket was found to consist of a coloured and orange flavoured solution of rennet. GROUND GINGER. A sample of ground ginger was examined during the year, and found to be quite satisfactory. During the last few years there has been an appreciable amount of Nigerian ginger on the market, which has had a large amount of water-soluble extract removed during its preparation. Ginger is grown in Nigeria by very primitive races, and in their endeavours to prepare an article which they imagined to be suitable for the British 4 market, they have been far too drastic in its treatment for sale. The result is that the British spice merchants are nervous of handling Nigerian ginger, and the Nigerian agricultural authorities are finding it difficult to explain to the natives that the market has been ruined by good intention, and that ginger must be placed on the market without making it look quite so white. 86 LARD SUBSTITUTES. A sample of lard substitute was examined and found to be quite satisfactory. All samples of lard substitute examined by vour Analyst have been satisfactory, but certain products have been placed on the market which contain water, and which cannot therefore be held to be lard substitutes. LEMON BARLEY CRYSTALS. Two samples of Lemon Barley Crystals were examinel. and both were found to have been prepared with normal iagreSients, containing powdered barley or barley flour, citric acid and lemon flavouring. MEAT PASTE. Of three samples of Meat Paste, one (Wild Duck Paste) was returned as adulterated on the ground that it appeared to contain a small quantity of sulphur dioxide. Certain samples of meat and fish pastes are found to give reactions for the presence of sulphur dioxide. Whilst the packers claim that no sulphur dioxide is present, and your Analyst agrees that no sulphur dioxide had been added originally, he is of the opinion that it is formed during processing ; it is usually found that after attention had been drawn to the matter, future samples do not respond to the tests. SARDINES. Two tins of sardines were received as the result of a complaint made at the Town Hall. They were found to be sterile and to contain only the merest traces of lead, so that no complaint could be made with regard to the samples examined. PRESERVATIVES. Nearly all samples received, including cream, milk, butter, cereals, cheese, pastes and sausages, were examined for added preservatives, and no sample, apart from that of Wild Duck Paste mentioned above, was found to be contrary to the Preservatives Regulations. TINNED FOODS. No sample of tinned food was found to contain an excess of tin. WHISKY. The sample of whisky submitted was found to have been diluted to the absolute lowest limit permitted by the Food and Drugs (Adulteration) Act. 87 DRUGS. Four samples of Drugs were submitted for examination, and one of these, a sample of Tincture of Iodine, was found to be adulterated. In the case of this sample, the tincture was placed in a very small bottle, and it has been noticed that the amount of liquid held by these bottles varies considerably, some bottles holding twice as much as others. They may be in stock in grocers' and similar shops for long periods, and lose much of their strength before being sold. In the case of the sample under review, it was 9.6 per cent. deficient in iodine according to the requirements of the British Pharmacopoeia, and it is suggested that it would be wiser if preparations of this type were definitely labelled as being of " approximately of British Pharmacopoeia Strength " only. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, THOMAS McLACHLAN, A.C.G.F.C., F.I.G. Public Analyst. CHE 47 METROPOLITAN BOROUGH OF CHELSEA. AMUA! (ABRTXSHD) REPORT of_.th3 MEDICAL CFFICER OF HEATH._ for the year 1944. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Chelsea. My Lord, Mr. Mayor, Ladies arid Gentlemen, I have the honour to submit my .Annual Report on the health and sanitary conditions of the Borough for 1944. In accordance with instructions from the Ministry of Health the report has again been prepared in abridged form. The health of the population was satisfactory. There was no serious outbreak of infectious disease during the year. The number of notified cases of diphtheria continues to be small. None of these cases had completed a course of immunisation prior to onset of the disease, Maternity and Child Welfare work has continued to grow in extent and usefulness. The attendance by mothers at the ante-natal clinic was 1428, As in former years, much attention has been devoted to the supervision of food supplies. 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, My Lord, Mr. Mayor, ladles 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.h w. 3 August, 1945. METROPOLITAN BOROUGH OF CHELSEA. ANNUAL (ABRIDGED) REPORT OF THE MEDICAL OFFICER OF HEALTH for the year 1944.' POPULATION. Registrar-General's estimate of civilian population, mid - 1944 30.990 Total. M. F. LIVE. BIRTHS. Legitimate 353 186 167 Birth rate per 1,000 Illegitimate 63 37 2-6 estimated civilian 416 223 193 population 13.4 STILL BIRTHS. 7 2 5 Rate per 1,000 Total (live and still births) 16.5 DEATHS. .572 279 293 Death rate per 1,000 estimated civilian population 18.4 DEATHS FROM PUERPERAL CAUSES - Deaths. Rate per 1,000 total (live and still births). Puerperal Sepsis 1 2.4 Other puerperal causes DEATH RATE OF INFANTS UNDER CNE YEAR OF AGE:- All infants "per 1,000 live births 50 Legitimate infants per 1,000 legitimate live births 42 Illegitimate infants per 1,000 illegitimate live births 95 CLASSIFICATION OF DEATHS. The causes of deaths (572) were as follows:- Corebro-spinal fever 2 Other respiratory diseases 5 Tuberculosis (respiratory) 30 Ulceration of Stomach or Other forms of duodenum 7 Tuberculosis 4 Diarrhoea (under 2 years) 6 Syphilitic disease 6 Other digestive diseases . 12 Influenza' 2 Nephritis 8 Cancer - various sites 71 Maternal causes 1 Diabetes 6 Premature birth 7 Intra-cranial vascular Congenital malformations, lesions 44 birth injuries, etc. 5 Heart Disoase 131 Suicide 4 Oc.ft.or diseases of' the Road Traffic accidents 3 circulatory system 11 Othor violent causes 114 Bronchitis 29 All other causes 34 Pneumonia 30 INFANT MOLALITY. (Under 1 year of age). The causes of deaths (21) were as follows:- Pneumonia 3 Diarrhoea 6 Premature births 7 Congenital malformations 3 Other violent causes.. 2 NOIXFICATION OF BIRTHS. The total number of notified Chelsea birtl including still births, from all sources was 360. Of this number, 72 were notified by midwives. PROVISION CF HEALTH SERVICES IN THE BOROUGH. BAC TERICLOGICAL EXAMINTIONS . The total number carried out was 100, including-86 for the bacillus associated with diphtheria. NURSING, IN "THE HO.C. " The arrangement with the Chelsea District Nursing .Association to undertake the n .rsing of cases of illness occurring in expectant and nursing mothers and the nursing "of children under 5 years of agc suffering from any illness was continued throughout the year, the total number of visits being 1329. (132 cases). CLINIC AND TREATMENT CENTRES. The Violet Molchott Infant Welfare Contro maintains the maternity and child welfare services in the Borough. Tho total number of attendances at the clinics by infants under one year of ago was 2,528, and 735 children attended between the ages of 1 and 5 years. There were 1,428 attendances by mothers at tho ante-natal clinic and 31 mothers attended tho post-natal clinic. INVALID CHILDRE'S AID ASSOCIATION. The arrangement with the Association was continued through tho year. The number of applications referred to them for assistance of children under 5" years of age was 32 (actual cases 32), HEALTH VIS ITORB, Tho total number of visits and re-visits made by the Health Visitors was 6;728. The number of half-day attendances at clinics was'640, and 203 Hygiene inspections wore made at the Third Feather's Club. CHILD. LIFE PROTECTION. 112 visits (including 40 miscellaneous visits) were made to Foster Mothers. DENTAL TREATMENT. 66 cases attended tho Dental'Clinic at the Violet Molchett Infant WeIfare Contro for tho provision of preventive dental treatment for children undor 5 years of age. Arrangements 'were also made for 50 expectant or nursing mothers to receive dontal treatment at St. Stephens' Hospital. Of those, 4 mothers were provided with dentures. HOI-IE HELPS. One caso was attended by a Homo Help - the nott cost to tho Council being £3. 18. 0. DISTRIBUTION OF VITAMINS TO EXPECTANT MOTHERS AND CHILDREN. By arrangement with the local office of the Ministry of Food, these preparations wore distributed from tho Welfare Contro by a member of tho Public Health Staff. WAR_THE.DAY NURSERIES A second war-time day nursery, (accommodating 96 children)was opened in Fobruary of 1944 at tho Chcync Hospital for Children. ' Tho total accommodation at tho tv/o war-time ' nurseries is 143, and tho attendances during the year numbered 22,399• INSU TNFOR_DLABETIC PATIENTS. In accordance with tho Ministry of Health's Circular 2734, one applicant v/as supplied with insulin, free of cost, during the year. CARE OF ILLEGITIIATE CHILDREN. With tho approval of tho Ministry of Health the Council adopted a scheme of guaranteed payments to foster mothers. Arrangements were also made for provision of furnished accommodation for unmarried mothers immediately before and after confinement,. -3- SANITARY CIRCUMSTAN CSS AND ADMINISTRATION. 11,403 visits (including re-visits) wore carried cut by tho Sanitary Inspectorso 278 Intimation Nodtices, 67 Nuisances Notices under the Public Health (London) Act, 1936 and 28 Notices under the Food and Drugs Act, 1938 (Section 13) wore served during the year. Legal proceedings under the Public Health (London.) Act,193 in respect of sanitary conditions were undertaken in 4 instances. CTICH. .OR DISHTF^STATIQM. Tho routine disinfection of rooms afc tho occurrence of infectious disease v;as continued, and also d.L: 'Infestation for vermin. At the Council's Disinfecting Station, 28395 articles v/ere disinfected or disinfostcd. 191 Adults and 127 children wore treated at tho Cleansing Station.- The ' total number of treatments was 643 • Disinfection of'the patients"' personal clothing v/as carried out whilst the patients were being treated. ' Tho Woman Sanitary Inspector inspcctci the homes, and arranged for examination of contacts. VEHMTOUS PERSONS. 68 Adults and 288 children (including children attending elementary schools) were cleansed at tho Disinfecting Station. IITFZS TAT IOLTBY HEAD LICE, Special attention and advice is given by the Health Visitors at the Welfare Centre and when visiting homes. Suitable combs are made available whonever necessary DESTRUCTION OF RATS AND MICE!. Early in 1944, a second campaign for the extermination of rats in sowers v/as carried out with good results. Since April, 1944 a full time Rodent Officer has been employed by tho Council. The following is a summary of work up to the end of the years- Poisoning campaigns were carried out in 31 .business premises and in 98 private dwellings for rats and in 4 business premises and in 34 private dwellings for mice. Advice was given to owners or occupiers undertaking their own campaigns in 107 instances. Preliminary inspections totalled 4 69 Laying Pro-baits 809. Laying poison baits 168. Visits as to clearing all unconsumod bait l62. Laying post-baits 156. Smoke teating of drains 25. INSPECTION AND SUPERVISION OF FOOD. The Inspectors carried out routine 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. F.Q.C' ND. DRUGS. ACT. 400 samples were submitted to the Public Anajfor-analysis during the year. Of these, 200 v/ere taken as fo.! '•alt1' and 200 as "informal". Eighteen samples were returned'as adult crated. In each 01 these cases a warning letter was sent to the Vendor concerned. All other samples v/ere returned as genuine. INFECTIOUS AND OTHER DISEASES. The total (corrected) number of notifications received during the year (506) was made up as follows :- Diphtheria. 12 Malaria 1 Erysipelas 14 Acute Primary Pneumonia 17 Scarlet Fever 35 Acutc Influenzal " 5 Puerperal pyrexia 4 Measles 70 Cerebro-spinal fever 4 Whooping Cough 51 Ophthalmia Neonatorum 4 Scabies 165 Dysentery 56 Food Poisoning 3 Poliomyelitis 1 Pulmonary Tuberculosis 59 Non-Pulmonary " 5 -4- DIPHTHERIA BftlUNISATION CLINIC. 309 new cases attended. SM ALLPOX AND VACCINATIC1T. No case of Smallpox was notified. Of the-228 births registered in Chelsea during 1943 , 133 were successfully vaccinated - a percentage of 58.3. (Figures for 1944 are not yet available). TUBSHCULOSIS. 59 new cases of pulmonary and 5 cases of nonpulmonary tuberculosis were notified. In addition, 37 new cases cams to the knowledge of the Medical Officer of Health from other sources." The total number was therefore 101 (Pulmonary - Hales 47 , Females 47; Non-pulmonary - Mal.es 4, Females 3) • The total number of deaths from all forms of Tuberculosis was 34, (Pulmonary 30, Non-pulmonary 4). PUBLIC HEALTH (TUBERCULOSIS) BEGULATTGTS. 1930. The total number of cases of Tuberculosis in the Borough on the 31st. December, 1944, was 234, (Pulmonary - Males 111, Females Non Pulmonary - Males l8. Females 15). The Tuberculosis Visitor paid 87 visits to non-dispensary cases. DISPESARY AND SPECIAL CASUS. New cases examined 249. Of these, 47 were found to be definitely tuberculous. 120 contacts also examined. The number of attendances (including contacts) v/as 1,184, and 1,407 visits were made by the nurses to homes of patients. The Tuberculosis Officer visited 15 patients at their homes, and 85 patients were referred to him at the Dispensary by Medical Practitioners. Ill specimens of sputum were examined, and 632 X-ray examinations were made in connection with the work. The total number of cases on the Dispensary Register on the 31st Decomber, 1944 was 189. CHELSBA TUBERCULOSIS CARE CCMMITTEE. The Committee met 4 times and 103 cases were considered. Social Services in co-operation with voluntary societies wore continued. During' the year 42 patients received artificial pneumothorax treatment, 30 patients were in receipt of extra nourishment provided by the Council, and 3 patients received dental treatment under tho Borough Council scheme. TUBERCULOSIS - SPECIAL ALLOWANCES. The Government's scheme to give maintenance allowances to tuberculous persons undergoing treatment continued satisfactorily throughout the year. During the year, 52 patients received allowances classified as follows:- Maintenance allowancep 45 + Special allowances only 7 + Note. Of these, 10 patients also ree'eivod 3 special allowanco and 3 patients discretionary allowances in addition. The amount disbursed during tho year was £1,202. 1. 5. -5-