Ac 4345 II Library CHE 61 Metropolitan Borough of Chelsea Annual Report of the Medical Officer of Health J. H. WEIR, M.D., B.S., B.Hy., D.P.H. for the year 1963 - 1 - METROPOLITAN BOROUGH OF CHELSEA PUBLIC HEALTH AND BATHS COMMITTEE (at 31st December. 19631 Chairman: Councillor J.A. Paterson-Morgan, F.L.A.S., J.P. Vice-Chairman: Councillor Mrs. C. Mallet Alderman Miss M.D. Shufeldt Councillor Miss Katharine Acland, O.B.E., T.D. Councillor Mrs. G.K. Buxton Councillor Mrs. D.K. Clowes Councillor J.N. Crichton-Miller Councillor Miss Aimee Gibbings Councillor Miss P.D.J. Molloy Councillor M. Nadin Councillor A.J.S. Pringle Councillor A.H. Stevenson Councillor N.J.P. Wadley, M.C. Councillor T.S. Wood Councillor J.E. Woolford Ex-Officio Members The Worshipful the Mayor (Councillor Lady Heath, B.Sc.,J.P.) The Deputy Mayor (Councillor J.H. Villiers.) - 2 - Borough Representation on outside Committees and other Organisations concerned with Public Health work. (at 31st December. 1963.) Chelsea Deanery Moral Welfare Association: Councillor Mrs. G.K. Buxton Chelsea Chest Care Fund Committee: Councillor Mrs. G.K. Buxton Chelsea Youth Committee: Councillor W.K. Brown Councillor J„E. Woolford Family Welfare Association: Councillor Mrs. G.K. Buxton London County Council Divisional Health Committee (Division I): Councillor Mrs. G.K. Buxton Councillor A.H. Stevenson London County Council Divisional Tuberculosis Care Committee (Division I): Councillor Mrs. G.K. Buxton London and Home Counties Clean Air Advisory Council: Councillor Mrs. C. Mallet Chief Public Health Inspector National Society for Clean Air: Councillor Mrs. G.K. Buxton Councillor Mrs. C. Mallet Old People's Welfare Committee: The Worshipful the Mayor The Deputy Mayor Councillor J.A. Paterson-Morgan, F.L.A.S., J.P. Councillor Mrs. C. Mallet Councillor J. Elliott Brooks, L.C.C. Councillor Miss Elisabeth Stockwell Third Feathers Club Committee: Councillor Miss P.D.J. Molloy Westminster and Chelsea District Nursing Association: Councillor Miss Aimee Gibbings - 3 - STAFF OF THE PUBLIC HEALTH DEPARTMENT (at 31st December. 1963) Medical Officer of Health: J.H. WEIR, M.D., B.S., B.Hy., D.P.H. Deputy Medical Officer of Health: D.J. SHEERBOOM, M.B., B.S., D.P.H. Chief Public Health Inspector: H. HOYLAND Deputy Chief Public Health Inspector and Senior Housing Inspector: S.W. BARKER Public Health Inspectors: T.W. CAMSEY H.F. LEACOCK A.J. WHITE E.R. YOUNG Women Public Health Inspectors: (Miss) A.C.C. KAY (Miss) K.G. READER Drainage Assistant: E. BOSLEY Senior Rodent Officer: J.F. COOKE Rodent Officer: P. DRURY Public Health Inspectors' Assistant: A.E. ROTH Chief Disinfector: F.W. HILL Disinfector: R.J. WESTON Cleansing Station Attendant: (Mrs) J. LOBBAN (retired 2.11.1963) Chief Clerk: I.M. THOMSON Clerical Officers: P.M. MARGETTS H.G. HAMILTON L.A. POWELL (Miss) E. DEACON (resigned 17.9.1963) (Mrs.) B. STEVENS (commenced duty 23.9.1963) P.D. GRAINGER R.A. CLARKE (resigned 13.4.1963) (Miss) L. WILSON (commenced duty 22.4.1963) Social Worker: (Mrs.) O.M. BURKE Public Analyst: Thos. McLACHLAN, A.C.G.F.C.,F.R.I.C., M.I.Biol. % - 4 - METROPOLITAN BOROUGH OF CHELSEA. TELEPHONE: Public Health Department, FLAxman 8101 Town Hall, King's Road, CHELSEA, S.W.3. July, 1964. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Chelsea. My Lord, Ladies and Gentlemen, I have much pleasure in presenting my Annual Report on the health and environmental circumstances of the Borough of Chelsea for the year 1963. The home population of the Borough at mid-year was estimated by the Registrar-General to be 48,050, compared with 48,550 in 1962, a decrease of 500. Since 1950 the population has decreased by 4,440. 622 live births (males 322: females 300) were recorded, 3 fewer than in 1962 (625), representing a crude birth rate of 12.9 per 1,000 of the estimated population, and after applying the area comparability factor (0.73) the adjusted birth rate was 9.4, compared with 18.2 for England and Wales as a whole. Illegitimate live births numbered 75 or 12.1 per cent of the total live births registered, 2 less than in 1962 when 77 (12.3%) were recorded. Still births totalled 14, an increase of 3 on the previous year's figure (11), giving a rate of 22.0 per 1,000 live and still births. The rate for England and Wales was 17.3. Deaths at all ages numbered 791 (males 341: females 450), 83 more than in the preceding year (708), indicating a crude death rate of 16.5 per 1,000 of the estimated population, and the adjusted rate after employing the area comparability factor (0.72) was 11.9, compared with 12.2 for England and Wales. The main causes of death continued to be heart disease 260 (32.9%); cancer (all forms) 137 (17.3%)} pneumonia and bronchitis 116 (l4.7%); and vascular lesions of the nervous system 104 (13.1%). Diseases of the heart and cancer combined accounted for 397 deaths which represents 50.2% of the total deaths registered. It is regretted that there were 12 suicides during the year, compared with 11 in 1962, which is 1.5% of all causes of death, and 58.0% of the persons who ended their lives were within the 20 and under 45 age group. Tuberculosis caused 3 deaths (2 respiratory and 1 non-respiratory), as against 4 deaths in the previous year. The number of deaths from cancer of the lung and bronchus was recorded as 31 (males 23: females 8), 1 less than in 1962. Almost 50% died between the ages of 35 and 65 confirming once again to the sceptics that this disease is not purely a terminal one in old age. - 5 - Infant deaths under one year of age totalled 11, as against 16 in the preceding year, representing an infant mortality rate of 17.7 per 1,000 live births, compared with 20.9 for England and Wales. 9 deaths occurred before the age of one week indicating an early neo-natal mortality rate of 14.5 per 1,000 total live births. The number of still births registered was 14 which, added to the 9 deaths occurring in the first week of life, gives a perinatal mortality rate of 36.2 per 1,000 total live and still births. Unfortunately, one maternal death was recorded during the year, the first to occur since 1954. The mother was 30 years of age and death was attributed to peritonitis due to a septic abortion. The total number of infectious disease cases notified during the year was 454, compared with 151 in 1962, an increase of 303 cases. This increase was due to the biennial recurrence of measles, 352 notifications being received as against 63 during the previous year. Apart from the increase in measles and a rise of 18 in the number of whooping cough cases reported, the incidence of infectious disease in the Borough remained at the same low level as in 1962. Two cases of imported typhoid fever were notified, one of which was associated with the outbreak at Zermatt, Switzerland, and a special reference to these cases appears in the final section of the Report. It is most gratifying to report that for the first time in twenty years no case of poliomyelitis was notified. 27 new cases of tuberculosis were reported (22 respiratory and 5 non-respiratory), compared with 26 cases during the previous year. 13 of the respiratory cases concerned persons aged 20 and under 45 which represents 59.1% of all new respiratory cases notified. 300 samples of food and drugs were submitted to Mr. Thomas McLachlan, Public Analyst to this authority, for examination and report, and he advised that in 13 instances (4.3%) adulterations had been found or special comment was necessary. In all cases thorough investigations were pursued through the producers and retailers concerned, and after consideration by the Public Health and Baths Committee appropriate action was taken where necessary. 11 complaints were brought to the attention of the Inspectors regarding the sale of unsatisfactory foods and in one case, which concerned the sale of sliced bacon infested with maggots, successful legal proceedings were instituted against the Company who had previously been found guilty of a similar offence in 1961. Successful legal proceedings were also instituted against a shop assistant who, despite repeated warnings, continued to smoke cigarettes whilst handling open food contrary to the Pood Hygiene (General) Regulations, 1960. The routine work of the district Public Health Inspectors supervising and advising on the environmental conditions within their districts continued without incident during the year. Many of the day-to-day problems dealt with, particularly those concerning alleged noise nuisances and large modernisation and conversion schemes, have involved the Inspectors in lengthy periods of observation and numerous site meetings with owners, architects and builders. Thorough inspections were carried out to a number of properties in West Chelsea under the provisions of the Housing Act, 1961, to deal with their state of repair or to bring them to the - 6 - desired standard for houses in multiple occupation, and although only three formal notices have been served, a considerable amount of work has been carried out as the direct result of informal approach to owners who in the majority of cases have been most co-operative. All food shops and catering establishments continued to receive regular visits from the women Public Health Inspectors and a very considerable amount of their time has been devoted to educating catering staffs in matters of hygiene and food handling, and explaining and discussing with owners and caterers the provisions of the Food Hygiene Regulations. Many owners have shown the fullest co-operation by acting on advice concerning suggested improvements in the planning of kitchens and modernisation of equipment, and in some cases they have been persuaded to undertake modernisation schemes requiring structural alterations and the complete replanning of kitchens and food preparation rooms. This readiness on the part of most owners to co-operate has enabled the necessary works to be carried out expeditiously thereby ensuring that the highest possible standards of hygiene are, as far as possible, always maintained. The work in connection with the establishment of smoke control areas made good progress during the year and it is anticipated that the Council's third Smoke Control Order covering Royal Hospital Ward and Cheyne Ward will become operative in February, 1965. This area is a little over 300 acres in extent and contains some 6,593 dwellings and 444 commercial premises. Approximately 25% of the dwellings will require conversion or adaptation of their heating appliances in order to comply with the provisions of the Clean Air Act, 1956. Local services for old people have continued to expand and in October a Lunch Club for pensioners, inaugurated by the Old People's Welfare Committee, was opened in St. John's Church Hall and 60 lunches were served twice weekly on Tuesdays and Thursdays, at a charge of one shilling per head. The many and varied problems of elderly persons continue to receive the attention and support of the officers of the Public Health Department and an account of the work undertaken throughout the year is included in this Report. During the severe wintry conditions which were experienced in January and February, many pensioners were unable to obtain supplies of solid fuel. In the majority of cases the open fire was their only method of heating. In order to prevent undue hardship arrangements were made to stock a supply of bagged coal which was delivered to necessitous cases by the Council's Disinfecting Staff. Health Education was one aspect of the work of the Public Health Department which received special attention during the early months of the year. The clerical staff were required to devote a great deal of their time organising and preparing for an intensive "Smoking and Health" campaign which was held during the fortnight 11th to 23rd March, 1963. This campaign was held in response to appeals from the Minister of Health and its main feature was the distribution of a specially prepared anti-smoking booklet to every household in the Borough. In addition, members of the staff undertook the distribution of over 20,000 leaflets and posters throughout the Borough to doctors' and dentists' surgeries, shops, stores, offices, factories, hospitals, youth clubs, boys' clubs, and local voluntary - 7 - isations, etc. Three specially prepared displays were set-up in the main entrances of the Town Hall and the Public Library, and bookmarks were issued by the Library staff during the period of the campaign. Although it is difficult to assess the success of a campaign such as this it is most encouraging to report that the anti-smoking booklet created a great deal of local interest and was obviously read by a large section of the community. It is also pleasing to report that in consequence of excellent notices in the "Lancet", the Canadian Medical Association Journal and other medical journals, requests for booklets were received from all over the British Isles and from many parts of the world, resulting in over 1,400 copies being sent at home and abroad to government departments, local health authorities, medical institutes, research institutes, chest clinics, hospitals, schools, welfare centres, doctors and members of the general public. A detailed account of the campaign appears on pages 15 to 17. The Offices, Shops and Railway Premises Act, 1963, which received Royal Assent on the 31st July, makes provision for securing the health, safety and welfare of persons employed to work in offices, shops and certain railway premises. Certain sections of the Act, including the requirement to register premises, will be brought into force on 1st May, 1964, and most of the main provisions will come into operation on 1st August, 1964. The Council is responsible for the enforcement of the Act in all offices and shops (as defined in Section 1) with the exception of those special categories of premises which will be dealt with by H.M. Factory Inspector or the Fire Authority. The expected volume of administrative and other work involved in dealing with registrations and the inspection of premises will necessitate increasing the establishment of the Public Health Department by one additional Public Health Inspector and a Clerical Assistant. Mrs. J. Lobban, Cleansing Station Attendant, retired on 2nd November, after completing 22 years' service with the Borough Council. She continued to work for many years beyond normal retiring age for which we are all extremely grateful and we wish her a long and happy retirement. In conclusion, I would like to express my gratitude to the Members of the Council, and particularly to the Chairman and Members of the Public Health and Baths Committee, for their interest and support, and I also acknowledge the help and co-operation received from the other Chief Officers and the staffs of their departments. Finally, I wish to record my sincere thanks to the members of the Public Health Department for their loyalty and conscientious service during the year. I am, My Lord, Ladies and Gentlemen, Your obedient Servant, Medical Officer of Health. - 8 - GENERAL AMD VITAL STATISTICS 1963 Area of Boroughs: 659.6 acres General Rates: 19s.4d, in the £ (at 31st March, 1963) Product of a Penny Rate (net): £8,095 Rateable value of Borough as at 31st March, 1963: £2,043,649 Populations Registrar-General's estimate of the population of the Borough (mid-year 1963): 48,050 Density of population per acres: 72.8 Number of Dwellings (according to the Rate Books): 17,267 Live Births: Total Male Female Birth rate per 1,000 of estimated populations Legitimate 547 287 260 Illegitimate 75 35 40 622 322 300 12.9 Adjustment of birth rate by area comparability factor (0.73): 9.4 (Birth rate for England and Wales - 18.2) Illegitimate Live Births (per cent of total live births): 12.1 Still Births: Total Male Female Legitimate 11 7 4 Rate per 1,000 live and still births: 22.0 Illegitimate _2 2 1 14 9 5 (Still birth rate for England and Wales - 17.3) Total Live and Still Births: 636 Infant Deaths (deaths under one year): Total Male Female Legitimate 8 4 4 Rate per 1,000 live births: 17.7 Illegitimate 3 3 - 11 7 4 - 9 - GENERAL AND VITAL STATISTICS (Continued) Infant Mortality Rates - Total infant deaths per 1,000 total live births: (infant Mortality rate for England and Wales 20.9) 17.7 Legitimate infant deaths per 1,000 legitimate live births: 14.6 Illegitimate infant deaths per 1,000 illegitimate live births: 40.0 Neo-natal Mortality Rate (deaths under four weeks per 1.000 total live births): 14.5 Early Neo-natal Mortality Rate (deaths under one week per 1.000 total live births): 14.5 Perinatal Mortality Rate (still births and deaths under one week combined per 1,000 total live and still births): 36.2 Maternal Mortality (including abortion): Number of deaths: 1 Rate per 1,000 total live and still births: 1.6 Deaths: Total Male Female Death rate per 1,000 of estimated population (Males 7.1 Females 9.4): 16.5 791 341 450 Adjustment of death rate by area comparability factor (0.72): 11.9 (Death rate for England and Wales - 12.2) Tuberculosis: Deaths from Pulmonary Tuberculosis: 2 Deaths from Non-Pulmonary Tuberculosis: 1 Death rate from Pulmonary Tuberculosis per 1,000 of estimated population: 0.042 Death rate from Non-Pulmonary Tuberculosis per 1,000 of estimated population: 0.021 Marriages: Number of marriages solemnised in the Borough during the year: 826 Marriage rate per 1,000 of estimated populations: 17.2 - 10 - SUMMARY OF VITAL STATISTICS 1954-1963 (inclusive) Year Registrar-General's Estimate of Population Births Deaths Deaths under One Year Maternal Deaths No.* Rate No.* Rate No. * Rate No. * Rate 1954 52,060 787 15.1 734 14.1 21 27 2 2.5 1955 51,450 745 14.5 825 16.0 25 34 - - 1956 51,070 837 16.4 815 16.0 21 25 - - 1957 50,600 738 14.6 750 14.8 16 22 - - 1958 50,190 742 14.8 730 14.5 24 32 - - 1959 49,520 722 14.6 726 14.7 12 16 - - 1960 49,140 697 14.2 729 14.8 12 17 - - 1961 48,490 663 13.7 725 14.9 16 24 - - 1962 48,550 625 12.9 708 14.6 16 25 - - 1963 48,050 622 12.9 791 16.5 11 17 1 1.6 Averages for the ten years 1954 - 1963:- Births 718 Deaths 753 Deaths under one year of age 17 Maternal Deaths 0.3 * Totals arrived at after due allowance for inward and outward transfers. - 11 - CLASSIFICATION OF DEATHS OF CHELSEA RESIDENTS WITH AGE DISTRIBUTION FOR THE YEAR 1963 Causes of Death At all ages Under 4 weeks 4 weeks and under 1 year 1 and under 5 5 and under 15 15 and under 25 25 and under 35 35 and under 45 45 and under 55 55 and under 65 65 and under 75 75 and over 1. Tuberculosis, respiratory 2 - - - - - - - 1 - - 1 2. Tuberculosis other 1 - - - - - - - - - - 1 3. Syphilitic disease - - - - - - - - - - - - 4. Diphtheria - - - - - - - - - - - - 5. Whooping Cough - - - - - - - - - - - - 6. Meningococcal Infections - - - - - - - - - - - - 7. Acute Poliomyelitis - - - - - - - - - - - - 8. Measles - - - - - - - - - - - - 9. Other infective and parasitic diseases 1 - - - - - - - - 1 - - 10. Malignant neoplasm, stomach 17 - - - - - - 1 1 4 3 8 11. Malignant neoplasm, lung, bronchus 31 - - - - - - 1 4 9 9 8 12. Malignant neoplasm, breast 14 - - - - - - 1 1 2 5 5 13. Malignant neoplasm, uterus 7 - - - - - - - 1 2 3 1 14. Other malignant and lymphatic neoplasms 65 - - - 1 - - 3 6 14 15 26 15. Leukaemia and Aleukaemia 3 - - - - - 1 - - - 1 1 16. Diabetes 6 - - - - - 1 1 - - - 4 17. Vascular lesions of nervous system 104 - - - - - - 1 2 4 21 76 18. Coronary disease, angina 137 - - - • - - 1 6 29 32 69 19. Hypertension with heart disease 15 - - - - - - - - 2 3 10 20. Other heart diseases 108 - - - - - 3 2 - 5 11 87 21. Other circulatory diseases 45 - - - - 1 1 - 2 6 11 24 Carried forward 556 - - - 1 1 6 11 24 78 114 321 - 12 - CLASSIFICATION OF DEATHS OF CHELSEA RESIDENTS WITH AGE DISTRIBUTION FOR THE YEAR 1963 Causes of Death At all ages Under 4 weeks 4 weeks and under 1 year 1 and under 5 5 and under 15 15 and under 25 25 and under 35 35 and under 45 45 and under 55 55 and under 65 65 and under 75 75 and over Brought forward 556 - - - 1 1 6 11 24 78 114 321 22. Influenza 9 - - - - - - - - - 1 8 23. Pneumonia 69 1 1 - - - - - 2 2 9 54 24. Bronchitis 47 - - - - - - - 2 18 27 25. Other diseases of respiratory system 5 - - - - - - - - 1 1 3 26. Ulcer of stomach and duodenum 3 - - - - - - - 1 1 - 1 27. Gastritis, enteritis and diarrhoea 1 - - - - - - - - - - 1 28. Nephritis and nephrosis 3 - - - - - - - - 1 2 - 29. Hyperplasia of prostate 4 - - - - - - - - - 1 3 30. Pregnancy, childbirth, abortion 1 - - - - - 1 - - - - - 31. Congenital malformations 11 - - 5 3 1 2 - - - - - 32. Other defined and illdefined diseases 50 8 1 - 1 1 1 3 6 5 4 20 33. Motor vehicle accidents 7 - - - - 1 1 - - 1 2 2 34. All other accidents 13 - - - - - 1 - 6 2 1 3 35. Suicide 12 - - - - 1 3 3 2 2 - 1 36. Homicide - - - - - - - - - - - - TOTALS 791 9 2 5 5 5 15 17 41 95 153 444 AGE MORTALITY Number of Deaths Percentage of Total Deaths Number of Deaths Percentage of Total Deaths Under 4 weeks 9 1.14 35 and under 45 17 2.15 4 weeks and under 1 year 2 0.26 45 and under 55 41 5.18 1 and under 5 5 0.63 55 and under 65 95 12.01 5 and under 15 5 0.63 65 and under 75 153 19.34 15 and under 25 5 0.63 75 and over 444 56.13 25 and under 35 15 1.90 - 13 - INFANT MORTALITY During the year the number of infant deaths registered was 11, five less than the figure for the previous year, giving a rate of 17.7 per 1,000 live births. The infant mortality rate for England and Wales was 20.9. It will be noted from the following summary that of the 11 deaths recorded, 9 infants died before the age of one week indicating an early neo-natal mortality rate of 14.5. Cause of Death Under 1 week 1-2 weeks 2-4 weeks 1-3 months TOTAL M F M F M F M F M F Broncho Pneumonia 1 - - - - - 1 - 2 - Prematurity 4 - - - - - - - 4 - Cerebral Haemorrhage 1 - - - - - - 1 1 1 Haemolytic Disease - 1 - - - - - - - 1 Anoxia - 2 - - - - - - - 2 TOTALS 6 3 - - - - 1 1 7 4 - 14 - CANCER OF THE LUNG AND BRONCHUS 31 deaths (Males 23 and Females 8) were recorded during the year as compared with 32 deaths (Males 22 and Females 10) during the previous year. The following table briefly gives details of the deaths of Chelsea residents from lung cancer, compared with deaths caused by tuberculosis, during the ten year period 1954 to 1963:- CANCER OF THE LUNG AND BRONCHUS TUBERCULOSIS Year Males Females Total Males Females Total 1954 20 7 27 6 3 9 1955 21 8 29 5 4 9 1956 25 6 31 1 - 1 1957 16 6 22 1 1 2 1958 22 6 28 2 3 5 1959 31 5 36 3 - 3 1960 25 5 30 - 2 2 1961 22 5 27 5 5 10 1962 22 10 32 3 1 4 1963 23 8 31 2 1 3 TOTALS 227 66 293 28 20 48 It will be seen from the preceding table that during the past ten years 293 deaths were attributed to lung cancer, six times as many deaths as were caused by tuberculosis, and the incidence of lung cancer in men was over three times higher than in women. From the classified table of deaths which appears on pages 11 and 12 it will be observed that of the 31 deaths registered during the year, 13 occurred within the 45 and under 65 age group, and 17 at age 65 and over, and a study of the local death returns for the past ten years confirms that the 45 and under 70 age group has consistently been the period of highest mortality. Since 1954 the yearly totals of local lung cancer deaths have fluctuated very slightly resulting in an annual average of 29 but the national figures during the same period give cause for concern as will be seen from the following summary of deaths for Great Britain where the annual average increase has risen steadily by over 1,000:- Year GREAT BRITAIN Cancer of the Lung and Bronchus Number of Deaths Registered Increase over preceding year 1954 18,076 1,233 1955 19,001 925 1956 20,080 1,079 1957 21,109 1,029 1958 22,046 937 1959 23,393 1,347 1960 24,412 1,019 1961 25,288 876 1962 26,383 1,095 1963 27,350 967 - 15 - SMOKING AND HEALTH CAMPAIGN In March 1962, the Royal College of Physicians published a report which assessed the evidence about the relationship of smoking and health, and it proved beyond all reasonable doubt that smoking was a cause of lung cancer, as well as a cause of bronchitis and possibly certain heart and other diseases, findings which have since been confirmed by the American report published in January, 1964. The Minister of Health both publicly and in the House of Commons has on several occasions expressed his agreement with the recommendations of the Report, and he accordingly circularised all local health authorities asking them to use all their channels of health education to make the conclusions of the Report widely known and to take immediate steps to discourage smoking, particularly cigarette smoking, and to bring home to the public, especially young people, the resultant danger to health. In view of all the evidence, and having regard to the Minister's appeal to all local health authorities to engage in this work immediately, the Council at its meeting in October, 1962, authorised the Medical Officer of Health to conduct an intensive local "Smoking and Health" Campaign directed to the public at large. The campaign was held during the fortnight 11th to 23rd March, 1963, and its main feature was the distribution of 20,000 copies of a specially prepared anti-smoking booklet the title of which was "Ladies and Gentlemen, YOU MAY SMOKE if you so desire, BUT - in making your decision PLEASE GIVE CAREFUL CONSIDERATION TO THIS BOOKLET". A copy of the booklet was distributed to every household in Chelsea and the services of a professional distributing firm were engaged to undertake this work. In addition, all doctors and dentists were supplied with extra copies of the booklet for distribution through their surgeries. The staff of the Public Health Department undertook the distribution of over 20,000 various leaflets and 400 posters throughout the Borough to doctors' and dentists' surgeries, chemists' shops, large stores and offices, large shops, food shops, workshops, factories, hospitals, youth clubs, boys' clubs, scout groups, voluntary organisations and community centres. All the Council's offices and depots to which the public had access were also supplied with a variety of leaflets and pamphlets, and posters were displayed on sites throughout the Borough including the public conveniences, and on the Council's disinfecting vehicles. All food shops in the Borough were visited by the Food Inspector during the campaign and shopkeepers co-operated by displaying notices requesting customers not to smoke in the shop. Letters from the Chairman of the Publio Health and Baths Committee appeared in both local papers and the Press co-operated excellently by publishing several firstclass articles on the subject. Two specially prepared displays were setup in the east and west entrances of the Town Hall, and a further display was sited in the entrance of the Public Library where the staff gave valuable assistance by issuing 10,000 bookmarks during the period of the campaign. The display which attracted most attention incorporated a viewing box showing x-rays of a healthy lung and a diseased lung affected by cancer, and I am indebted to Dr. Batten, Medical Superintendent, St. Stephen's - 16 - Hospital, for making the x-rays and equipment available to me. Although it is extremely difficult to assess the success of a health education campaign such as this, the specially prepared anti-smoking booklet appears to have stimulated a great deal of interest and was obviously read by a large section of the community,, Numerous congratulatory letters were received from Chelsea residents many of which were from parents asking for further copies of the booklet to give to their teenage children. The number of critical letters received was surprisingly small and in practically every case they came from residents who were aggrieved by the recent increase in the Borough rate, In this respect it was unfortunate that the campaign coincided with the despatch of the new rate demands. Apart from the local interest created by the distribution of the anti-smoking booklet it is most gratifying to record that in response to an excellent write-up in "The Lancet", congratulatory letters and requests for booklets poured into the office from all over the British Isles and from many parts of the world including - Australia, Belgium, Canada, Denmark, Eastern Nigeria, Gibraltar, India, Kuala Lumpur, New Zealand, Norway, Southern Ireland, Southern Rhodesia, Sweden, United States of America and Western Germany, These requests resulted in over 1,400 copies of the booklet being sent at home and abroad to government departments, local health authorities, medical institutes, research institutes, chest clinics, hospitals, schools, large companies, universities, welfare centres, doctors and members of the general public. Besides the valuable publicity given in "The Lancet", many editorials and articles expressing approval of the booklet appeared in medical journals in other parts of the world, particularly in Canada and the United States of America, Complimentary references to Chelsea's campaign were made during 'Question Time' in the House of Lords on the 16th July, and letters were received from the Ministers of Health, and Housing and Local Government, stating how impressed they were with the Chelsea Borough Council's enterprise and initiative in producing such an excellent booklet. It is interesting to report concerning the supply of booklets to an anti-smoking clinic. Although the clinic provides a variety of leaflets and literature, it appears that the method of approach used in Chelsea's booklet has made a deep impression on many of the patients in their efforts to break the tobacco habit, and several requests have been received for additional copies of the booklet to meet the growing demand. It is difficult to judge the success of this venture but, if as a result of our efforts only one person has been saved from lung cancer, the Council's decision to proceed with this campaign, has been completely justified. Finally, the following extract from the Canadian Medical Association Journal has been selected from various editorials and articles which have appeared in medical journals at home and abroad:- "A Cool Breeze from Chelsea A particularly happy and, hopefully, successful blend of fact and - 17 - "soft-sell" has been achieved in the booklet "Ladies and Gentlemen, You May Smoke", distributed by the Council to every householder in the Metropolitan Borough of Chelsea. In 12 pages the case against cigarette smoking is presented in a clear, crisp "no-nonsense" style that could serve as a model in this difficult field. For example under "Mythology", common misconceptions or rationalizations about the habit are succinctly dealt with - "If I don't smokes I'll get fat - get bad tempered, nervy become irritable - feel miserable - go barmy - be unable to concentrate be unable to relax." "You may, if you indulge in introspection and selfpity. Don't brood over it - you'll actually be more alert and more clear thinking. Don't eat so much and cut out sugar, bread and potatoes". The scientific basis of the pamphlet is the report of the Royal College of Physicians of London, and careful selection, judicious emphasis and imaginative presentation has resulted in a unique and probably effective approach. The text is illustrated by a single chart and four cartoons from PUNCH. In one form or another the profession and the public will be exposed to educational material on cigarette smoking, lung cancer and other diseases until the millennium or until a safe cigarette is produced, so that the early appearance of sensible, attractive "propaganda" like the Chelsea booklet is to be welcomed. It is an encouraging sign that in this case the borough fathers took the initiative in warning its people of the dangers of cigarette smoking". - 18 - DRUG ADDICTION. This is a subject to which only recently the general public has given much consideration and even now probably with a mixture of disgust, horror or pity whenever they read about it in the newspapers. Fortunately, addiction to the Narcotic group of drugs, namely the Opiates which include Morphine, Heroin and their synthetic derivatives, Pethidine and Methadone, are rare in this country, a fact which was again confirmed by the recent report on Drug Addiction, published in 1961 which concluded that the prevalence of addiction was still very small and that there is no evidence that any definite increase is taking place. This state of affairs is of course, completely contrary to that which is found in the U.S.A. where the problem of illegal imports, large scale trafficking down to the small pedlar on the street corner is commonplace. This difference in the size of the problem is due mainly to the fact that in this country the addict is felt to be in need of medical help and can indeed obtain his drugs under the National Health Service, with suitable safeguards, thus doing away with the need of pedlars, whereas in the U.S.A. he is classed immediately as a criminal and sent to jail. However, it is not this group of drugs with which I am concerned but with the Amphetamines and their derivatives. These drugs are primarily stimulants, the best known being Benzedrine, which was used in the last war to overcome sleeplessness at moments of crisis, and Dexedrine (dexamphetamine sulphate) in cases of obesity, both of which may be combined with a Barbiturate. Illegally they are sold as "Purple Hearts" (Dexedrine and a barbiturate) and "Sweeties" (Phenmetrazine - an amphetamine substitute) at about ninepence per tablet. There appears to be no doubt at all that there has been a very definite increase in the number of people taking these drugs for both medical and non-medical reasons; they account for over 2.5 per cent of all National Health Service prescriptions and the amount sold illegally is now reaching alarming proportions. Although people of all ages and classes are taking them, unfortunately the most frequent users are late teenagers, students, young people living alone, and various types such as the beatniks and others. The majority probably never wish to begin taking them but under social pressure from their friends at coffee bars, cafes and parties etc. they do so in order that they may appear grown up and then find that they cannot do without them and so commences the downward path to physical, mental and social degradation. While precise figures as to the extent of habituation or addiction are obviously impossible to obtain and local statistics as to crime directly or indirectly related to these drugs are not available, nevertheless the local press have recently printed articles and statements made by Youth Club Leaders showing that the problem does exist. The drugs may lead to a progressive deterioration in character even to a frank psychosis necessitating treatment in a mental home, whereas should they be withdrawn there is a feeling of listlessness, depression and craving. It is this latter feeling, due to a now - 19 - physical dependence on the drug which drives them to anti-social acts to obtain a further supply. These include obtaining them without prescription from either small time pedlars or Soho racketeers; altering stealing or forging prescriptions, or calling in rotation on several doctors from whom they conceal their addiction. Often appalling financial debts are run up in trying to overcome this craving for a fresh supply. Undoubtedly the most important method of combating this problem is somehow to prevent these drugs from reaching the illegal market or for youngsters to be able to find ways of obtaining them from official sources. The Home Secretary is well aware of this and has already discussed the matter fully with both the Pharmaceutical Society and the industry as a whole regarding a closer watch being made on both the wholesale and retail trade. Similarly the medical profession have been warned to watch out for anyone who attends too regularly for this drug and to supply it only where there are definite medical indications and not to supply too many at any one time. Possibly the most effective means of control would be to make this group within the Dangerous Drugs Act, thus making it an offence to be in possession of them, since at present the powers of the police are severely limited. However, it is anticipated that during 1964 the Drugs (Prevention of Misuse) Bill will become law, which will make the unauthorised possession of these drugs punishable by fine or imprisonment or both, and will give extra powers to the police to tackle the illicit trade in cafes etc. Finally, there is a definite responsibility, especially on parents, but also on Youth Club Leaders, College and University teachers and anyone else who comes into contact with young people, to advise on the dangers of these drugs and if anyone is suspected, he should be made to see his own doctor before true addiction or mental illness commences. - 20 - PERSONAL HEALTH SERVICES - London County Council The London County Council is responsible for the day-to-day administration of these services. Division 1 of the County Council comprises the Boroughs of Chelsea, Fulham, Hammersmith and Kensington and Dr. B.E.A. Sharps, Divisional Medical Officer, has kindly supplied the following information relating to Chelsea:- Welfare Centres, Attendances at Ante-natal sessions during the year 1,039 Attendances at Post-natal sessions during the year 14 Attendances at Infant Welfare sessions during the year 6,517 Health Visiting - First Visits (including visits paid to premature infants) Children born in 1963 604 Children born in 1962 680 Children born in 1958/61 1,398 Persons aged 65 and over Number visited 9 Visited at special request of:- G.P. 1 Visited at special request of:- Hospital 6 Persons discharged from hospital (other than mental hospitals) Visited at special request of G.P. - Visited at special request of Hospital 2 Infectious households (other than T.B.) 3 Total visits: Effective 6,211 Unsuccessful 1,344 Foster mothers: child minders and private day nurseries at end of year: Number of foster mothers 4 Number of children fostered 4 Number of voluntarily registered child minders 10 Number of children minded 8 Number of registered private day nurseries 4 Number of children attending 77 Day Nursery attendances during the year 24,568 Home Help Service Number of cases receiving service at end of the year: Maternity — Tuberculosis 6 Chronic Sick 28 Others 500 Mothercraft and Relaxation Classes Total Attendances during the year 434 - 21 - Smallpox vaccinations 66 Inspections 58 Diphtheria injections 1,235 Poliomyelitis injections 1,106 Number of Premature infants born during the year 50 Number of Premature infant deaths under one month 6 Maternal deaths — Creche attendances during the year 1,065 Details of the facilities available at the Violet Melchett Infant Welfare Centre, Flood Street, S.W.3., are as follows- CLINICS Ante-natal and Post-natal : Monday p.m. (by appointment) Relaxation and Ante-natal Monday 6 p.m. to 7 p.m. Exercises: Friday 2 p.m. to 3 p.m. (followed by parentcraft) Parentcraft classes with Friday at 3 p.m. Demonstrations and Films: Infant Welfare: Tuesday & Thursday 2 to 4 p.m. Wednesday: 10.30 a.m. to 12 noon, at the Community Centre, 385, King's Road. S.W.10. Test feeds: arranged as required Vaccination against Smallpox Tuesday at 10 a.m. Immunisation against Diphtheria, Whooping Cough, Tetanus and Polio: Special Toddlers: By appointment on the first Thursday in each month. Dental Clinic (for children only): Monday 9.30 a.m. (by appointment) Children's Creche: Wednesday & Friday 30 a.m. to 12 noon. Health Visitors are available at the Centre for interview daily from 9 a.m. to 10.15 a.m. and from 4.30 p.m. to 5 p.m. and during these times may be contacted by telephone (FLAxman 8387). A Welfare Foods Department, whereat National Dried Milk, Orange Juice and Cod Liver Oil may be obtained, functions at the above Centre from 1.30 p.m. to 4.45 p.m. Monday, Tuesday and Thursday; Friday 9 a.m. to 12.30 p.m., closed on Saturday. - 22 - MASS RADIOGRAPHY The Organising Secretary of the South West London Mass X-Ray Service has kindly supplied the following report on the activities of the Service in Chelsea during 1963:- Ten visits were made to the Borough by Mobile Mass X-Ray Units of the South West London Service during the year under review. These included the annual visit to the Chelsea College of Technology to X-Ray students and staff; visits to Peter Jones Ltd., the Power Generating Station at Lots Road, the Royal Marsden Hospital and a residential hotel. Several hundred men in the over 45 years of age group, who live or work, in Chelsea, are making use of a six-monthly service. This was started in 1958 to provide regular chest X-Ray examinations in an effort to detect more cases of lung cancer, in the earlier stages of the disease, A Mobile Unit visited Manresa Road in May and November to provide the sixmonthly Service for this group. During 1963, a total of 33,964 examinations were made under this Service in South West London, 6,864 were X-Rays of men examined for the first time under the Service, and 27,100 were repeat examinations made at six-monthly intervals. The 6,864 initial examinations revealed 13 cases of lung cancer, i.e. l.88 per thousand men examined. The 27,100 repeat (six-monthly) examinations revealed 21 (radiologically new) cases of primary lung cancer, i.e. 0.77 per thousand examinations, A Mass X-Ray Unit was installed in St. Luke's Church Hall, St, Luke's Street, Chelsea, from the 16th October to 1st November, and Public Sessions were held daily during the mornings, afternoons and evenings. The total attendance was 1,262, and as a result of these examinations only one case was referred for further investigation. Many residents in Chelsea find it convenient to come to the Central Mass X-Ray Centre at the Western Hospital, Seagrave Road, S.W.6. This Centre is open all the year round to everyone over the age of 15 (irrespective of where they work or live), on Wednesday afternoons and evenings between 2 p.0m. - 4 p.m. and 5 p.m. - 7 p.m. No appointments are needed for these Public Sessions, but ante-natal patients, and children between the ages of 6 and 8 years, referred by a Clinic or General Practitioner, are X-Rayed at other times, and are required to make an appointment beforehand. Children aged 8-14 years can be brought to the Public Sessions, provided they have an X-Ray request form from a General Practitioner. The Ante-Natal Clinics serving the Borough oontinue to make regular use of the special large film service provided for their patients at the Western Hospital Mass X-Ray Centre, Parties of school children are also brought there for an X-Ray examination, by arrangements with the Divisional Medical Officer, if they are positive reactors to the tuberculin skin tests given in connection with the London County Council B.C.G, Innoculation Scheme. In 1963, over 16,000 people were X-Rayed at this Centre, of whom 5,987 were sent by their own Doctors, Figures relating to cases discovered are not kept separately for those attending from the Borough of Chelsea, but it -23- may be of interest to know that, in the year under review, a total of 102,208 X-Ray examinations were carried out by Mass X-Ray Units in South West London,, As a result of these examinations, 269 cases were referred to Chest Clinics with radiological abnormalities suggestive of clinically significant pulmonary tuberculosis, and 160 cases were referred which were suggestive of neoplasm, requiring further investigation,, In addition, 277 other examinees were found to have non-tuberculous miscellaneous conditions requiring further study,, In all, 706 cases were referred to Chest Clinics or Hospitals. Employers and Managements are asked to co-operate in the elimination of tuberculosis by notifying the Headquarters of the South West London Mass X-Ray Service whenever a case of tuberculosis occurs amongst those whom they employ, so that a Mobile Unit can be sent immediately to X-Ray everyone on the premises. The South West London Mass X-Ray Service invites all citizens in the Borough of Chelsea to make full use of the facilities available at the Central Mass X-Ray Centre at the Western Hospital, or at the Mobile Units at any time when they are in the Borough,. CENTRE FOR SPASTIC-CHILDREN - 61/62. Cheyne Walk. I am most grateful to the Secretary of the Chelsea and Kensington Hospital Management Committee who has kindly furnished the following report on the work of the Centre for Spastic Children during 1963:- This specialised unit for the treatment of young patients suffering from cerebral palsy has continued to develop under the aegis of the Chelsea and Kensington Hospital Management Committee. During the past year an average of about 70 children have been treated. Of these 25 of normal or even high intelligence attend the special (L.C.C.) school and in addition to their educational activities receive daily treatment as necessary from the physiotherapists, occupational therapists and speech therapist. A similar number attend the Special Care Unit; these are ineducable but trainable children who receive daily therapy and who are trained to become self-reliant in basic activities such as feeding, toilet, dressing etc. The balance are children who attend periodically for specific forms of treatment. In addition to routine neurological examination, all children are given full psychological, ophthalmological and audiological tests. Clinical films of each child's movements are routine, being repeated at intervals to provide a pictorial record of progress. An important role is played by the electro-encephalographic department, which is also used for adult patients of neighbouring hospitals and which produced more than 800 recordings during the year. Voluntary endeavour is a noticeable feature of the Centre. Apart from the loyal devotion of the highly skilled staff, the Centre is grateful for the - 24 - invaluable assistance it continues to receive from many voluntary sources. The Friends of the Centre continue to run the next-door hostel which houses a number of boarders and they have contributed generously in other ways. The King Edward's Hospital Fund paid for the installation of heaters under the garden verandah which enable the children to reap the benefits of fresh air even on cold days. A generous legacy enabled the central heating system to be modernised and extended. Many other volunteers assist in escort duties, transportation and in helping to care for the children at the hydrotherapy pool, classrooms etc. During the year, two six-weeks courses in cerebral palsy were held for qualified physiotherapists, occupational therapists and speech therapists, representative of many different countries and one post-graduate medical course was attended by more than 60 doctors from this country and abroad. During the year, well over 500 visitors were conducted round and saw some of the work which has earned for the Centre an international reputation. WELFARE OF OLD PEOPLE The investigation of the circumstances and living conditions of each old person is undertaken by the Council's Welfare Officer and, in this connection, 1,676 re-visits were made to 1,317 old people on the register and 173 new cases came to the notice of the department. Additional visiting by the British Red Cross Society, the Women's Voluntary Services and the St. John Ambulance Brigade in connection with the delivery of meals, recreation and personal cleansing, is of great value and provides a constant liaison with the Public Health Department. Grant The Borough Council makes a grant of £2,000 per annum to the Chelsea Old People's Welfare Committee. Chiropody - Old People's Clinic 1,692 treatments were given at the Chelsea Community Centre which is staffed by London County Council chiropody students. This is a twice weekly service and is free to the pensioners. Chiropody - Domiciliary Service 182 persons received 783 treatments given by two qualified chiropodists working six days a month between them. All applicants are approved by the Welfare Officer before informing the British Red Cross Society who administer the service. Incontinent Laundry Soiled linen is collected twice weekly from the homes of incontinent persons, and delivered to Fulham's disinfecting station where it is laundered and later collected for return to those using the scheme. During the year. - 25 - 29 persons have so benefited and some 6,170 lbs of soiled articles laundered. Provision of this service often discloses the urgent need for fresh beds, bedding and clothing, which were supplied by this Department and the voluntary services jointly. Home Personal Cleansing is a voluntary service performed by a nurse of the St. John Ambulance Brigade who visited a weekly average of 4 specially difficult cases during the year. Holidays During the Summer, holidays are arranged with the Women's Holiday Fund and various associations at seaside resorts, particularly Ramsgate, where a small hotel caters for old people. During six weeks of the year this hotel was occupied entirely by Chelsea residents. To make travelling easier, each party was taken by coach direct from the Town Hall to the hotel,, Number of assisted holidays 44 Self-paid holidays 56 100 The more infirm people needing holidays are referred to the Physically Handicapped Department of the London County Council. Domiciliary Library and Shopping Services are supplied by the Women's Voluntary Services and the British Red Cross Society on the recommendation of the Welfare 0fficer. Christmas Parcels Sufficient money was collected by the Christmas Dinner Fund Committee to provide 1,000 housebound and lonely old folk with a Christmas parcel. In addition to this number it is known that over 200 other pensioners received some form of parcel or gift. Coal During the year sums totalling £187 were received by the Old People's Welfare Committee and this enabled 102 old people to receive two cwts. of fuel. During the very severe winter the Welfare Officer came across pensioners unable to obtain fuel and in many cases had no other form of heating. It was decided, therefore, to stock a supply of bagged coal for use in such cases and this, no doubt, helped to relieve the hardship that these pensioners would have experienced. Accidents in the Home To prevent accidents, which may be caused by faulty gas appliances, - 26 - any defects are referred to the North Thames Gas Board, who inspect and advise on any improvements that are considered necessary. Whenever possible, gas and electric meters are lowered to positions within easy reach with a view to reducing the risks old people take in the home climbing on chairs, steps, etc. Fireguards are supplied by the Old People's Welfare Committee or on application to the London County Council and safety bath mats are also supplied. Old Time Dancing and Arts and Crafts Classes These classes are still very well attended and are of considerable therapeutic value to their members. The classes are sponsored by the London County Council who also provide the Instructors. Number attending Dancing Class 60 Number attending Arts and Crafts Class 32 Clothing Issues have been made through the Women's Voluntary Services and the Welfare Officer to 249 persons during the year. Outings Each of the four clubs held their annual outings to the sea and two additional invitations were received from the Women's Institutes. This enabled 60 pensioners to enjoy a day in the country. Additional trips were also arranged by the British Red Cross Society during the year and a number of pensioners were taken for outings to the country. Hospital Admissions and Institutional Care. Excellent relations exist between this Department and the local hospitals and patients are admitted with the minimum of delay. Every effort is made by the Old People's Welfare Services to maintain old people in their homes as long as possible with the result that only 16 people were admitted to Homes during the year and in only one case was it necessary to take action under statutory powers. Meals on Wheels This service has been efficiently administered by the Women's Voluntary Services and distributed by the voluntary organisations on five days a week. It not only ensures that housebound old people are certain of one meal a day, but provides an important link with all services available. - 27 - Number of meals issued during the year 13,510 Average weekly supply 260 Average number of old people supplied 60 Every weekend, voluntary helpers take homemade soup to old people who are too ill to eat solid food or have just come out of hospital. Lunch Club In response to an obvious need, a Lunch Club for pensioners sponsored and subsidised by the Old People's Welfare Committee opened on 1st October, 1963 at St. John's Church Hall by arrangement with the Church authorities. Additional equipment was found by the Committee and the Women's Voluntary Services who prepare and serve, mainly from bulk frozen foods, an average of 60 lunches each Tuesday and Thursday at a charge of one shilling per lunch. The majority of the old people come from West Chelsea and obviously benefit, not only from the food, but from the warm and friendly atmosphere of the Club, which is now working to capacity. At Christmas time the old people enjoyed a special lunch through the generosity of the Old People's Welfare Committee and the Women's Voluntary Services. HOSPITALS AND NURSING HOMES SERVING THE BOROUGH. Hospitals Type of Institution Brompton Hospital, Fulham Road, S.W. 3. Chest Diseases. Chelsea Hospital for Women, General Dovehouse Street, S.W.3. Granard House, 98, Dovehouse Street, Malignant Diseases S.W.3. (Part of Royal Marsden Hospital). Royal Marsden Hospital, Malignant Diseases Fulham Road, S.W.3. Royal Hospital, Royal Hospital Road, Home for Pensioners S.W.3. St. Luke's Hospital, Sydney Street, Chronic Sick. S.W.3. St. Stephen's Hospital, Fulham Road, General S.W.10. The Centre for Spastic Children, Treatment and research of 61, Cheyne Walk, S.W.3. cerebral palsy in the very young children. Victoria Hospital for Children, Children's Diseases Tite Street, S.W.3. Nursing Homes Belgravia-Chelsea Nursing Home, Private 39, Royal Avenue, S.W.3. - 28 - NATIONAL ASSISTANCE ACTS. 1948/1962 (a) National Assistance Act. 1948 - Section 47. and. National Assistance (Amendment) Act. 1951 - Section 1. Removal to Hospital and/or Institution of Persons in Need of Care and Attention. During the year action was necessary under the provisions of the above Acts for the compulsory removal of an aged and infirm person who was in need of proper care and attention. This case concerned an old lady, aged 86 years, who was living alone in insanitary conditions, and was suffering from the effects of selfneglect and malnutrition. (b) National Assistance Act. 1948 - Section 21. Provision of "Part III" Accommodation. It is the duty of a local authority, subject to and in accordance with the provisions of Section 21 of the Act, to provide residential accommodation for persons needing care and attention, and temporary accommodation for persons who are in urgent need thereof. The London County Council is, in this particular respect, "the local authority",and such accommodation is provided at "King's Mead", Dovehouse Street. During 1963, it was considered necessary to arrange for the admission of 16 persons to such accommodation and all but three of these admissions were made at "King's Mead". (c) National Assistance Act. 1948 - Section 50. Burial or Cremation of the Dead. Under Section 50 of the above Act the Borough Council is required to arrange for the burial or cremation of any person who has died, or who has been found dead in the Borough, if it appears in such cases that no other suitable arrangements can be made. Cremation is not carried out having regard to the many legal, religious, administrative and practical difficulties, and disposal is always by way of interment which obviates any suggestion that the Council has acted in an unauthorised manner. The Borough Council has power to recover from the estate of a deceased person the expenses incurred in carrying out this duty, in so far as these expenses are not covered by a Death Grant under the National Insurance Scheme. During the year three burials were arranged by the Council's Contractor as follows:- Males Females (Aged) 78 years Still-born child 85 years - 29 - ACCIDENTS IN THE HOME The following summary of home accidents occurring within the Administrative County of London during 1963 has been prepared from statistical information which has kindly been provided by the County Medical Officer of Health. During the year, 92 Chelsea home accident cases were removed to hospital by the London Ambulance Service compared with 91 and 111 cases in 1962 and 1961 respectively. The home accident figures for L.C.C. Health Division I (comprising the boroughs of Chelsea, Kensington, Hammersmith and Fulham) are shown separately, and it will be observed that falls in and about the home were again responsible for the highest casualty rate. Of a total of 1,199 accident cases reported in Health Division I during the period under review, 911 (76.0%) were due to falls. Summary of Home Accidents reported by the London Ambulance Service. Cause of accident Conty of London Division I comprising Chelsea, Kensington, Hammersmith and Fulham Fall On stairs 961 137 From ladder 102 12 From chair 132 14 Outside (i.e. windows, balconies, roofs, etc.) 233 44 In garden 174 10 In bath 23 2 From one level to another, (i.e. tables, boxes, beds, etc.) 400 52 On same level (i.e. in room, over objects) 866 105 Unspecified 4,009 535 Sub-Total 6,900 911 Hit by object 189 22 Cooking stove (saucepans, water, fats, etc.) 140 15 Teapot 52 9 Other boiling water 194 23 Electric shock 43 4 Poisoning (including foreign objects) 393 45 Gassing 294 39 Knife-like wounds (including spikes and cuts from glass) 319 38 Fires 267 44 Windows (trapping) 36 4 Suffocation 45 4 Not specified 436 41 TOTAL 9,308 1,199 - 30 - ROAD ACCIDENTS The total number of road accidents occurring within the Borough during 1963 was 468, causing 619 casualties, 2 of which proved fatal. Compared with the figures for the previous year when 452 accidents caused 542 casualties resulting in 5 deaths, the number of accidents increased by 16 and casualties rose by 77. It is once again most gratifying to record that there were no fatalities among children and only one child was seriously injured. 58 children sustained slight injuries. I am again indebted to the Town Clerk for making this statistica information available to me for inclusion in my Report. Month No. of Accidents Adult Children Total Killed Seriously Injured Slightly Injured Killed Seriously Injured Slightly Injured Killed Injured January 25 - 4 27 - - 2 - 33 February 23 - 2 24 - - 5 - 31 March 43 - 2 55 - - 5 - 62 April 31 - 4 25 - - 4 - 33 May 34 - 3 32 - - 4 - 39 June 43 - 6 46 - 1 6 - 59 July 50 - 3 49 - - 9 - 61 August 39 - 1 44 - - 6 - 51 September 46 1 8 49 - - 4 1 61 October 43 1 10 44 - - 8 1 62 November 43 - 6 46 - - 5 - 57 December 48 - 13 55 - - - 68 TOTALS 468 2 62 496 - 1 58 2 617 Accidents per mile of road 14.2 - 31 - BOROUGH CREMATION SERVICE In October 1957, the Borough Council entered into an agreement with the General Cemetery Company under the terms of which the Company provides cremation facilities at reduced rates at the West London Crematorium, Harrow Road, W.10., for persons who, at the time of death, resided or were normally resident in Chelsea, Since this service was introduced the relative or executor of the deceased has been required to pay a reduced standard charge of £4. 4s. Od. in such cases, but from 1st June, 1963, due to rising costs, this charge was increased by £1. lls.6d. to £5.15s.6d. The following table shows the number of cremations carried out in respect of Chelsea residents during the six years this scheme has been operative:- Year No. of Cremations Percentage of total recorded Deaths 1958 33 4.5 1959 24 3.3 1960 26 3.5 1961 31 4.3 1962 50 7.0 1963 51 6.4 The total number of cremations carried out in Great Britain and Northern Ireland during 1963 was 261,340, compared with 240,589 in 1962. In terms of recorded deaths these figures represent 41.00% compared with 38.70% for the preceding year. PUBLIC MORTUARY FACILITIES AND CORONER'S COURT There are no mortuary premises situate with the Borough but, under an agreement made with the Hammersmith Borough Council, excellent facilities are available at their mortuary in Fulham Palace Road, W.6., which is also adjacent to the Coroner's Court for this area. During the year, 248 post-mortems were carried out in respect of Chelsea residents. MEDICAL EXAMINATIONS During the year, fifty-six examinations were carried out on the Council's employees and new entrants to the superannuation scheme. As a result of the examinations, fifty-three proved successful, one was referred for re-examination within twelve months and two proved unacceptable for superannuation purposes. - 32 - CONFERENCES The Council was officially represented at the undermentioned Conferences dealing with matters within the purview of the Public Health and Baths Committee:- Association of Public Eastbourne 24th to 27th Health Inspectors September Central Consultative London 28th June Committee on the Welfare of Old People Institute of Baths Blackpool 24th to 27th Management September National Society for Scarborough 8th to 11th Clean Air October Royal Society of Health Eastbourne 29th April to 3rd May CONTRIBUTIONS TO VOLUNTARY ORGANISATIONS The Public Health and Baths Committee recommended payments to the funds of voluntary organisations during 1963, as follows:- £. s. d. Central Council for Health Education 6. 17. 6. Chelsea Old People's Welfare Committee 2,000. 0. 0. Family Planning Association 50. 0. 0. London and Home Counties Clean Air Advisory Council 2. 2. 0. National Society for Clean Air 8. 8. 0. Royal Society for the Prevention of Accidents 3. 3. 0. -33- SANITARY ADMINISTRATION OF THE BOROUGH The following section of the Report (pages 33 to 64 ) is devoted to the work of the Public Health Inspectors together with other associated officers. The Borough is divided into three areas - east, central and west - each being the responsibility of one Inspector. In addition, the Deputy Chief Public Health Inspector and one other Inspector are engaged on duties concerned with the establishment of smoke control areas under the provisions of the Clean Air Act, 1956. Two women Inspectors deal with the inspection and supervision of shops and food premises including food shops, food factories, canteens, restaurants, clubs, public houses, stalls, mobile ice-cream vendors, etc. They also undertake the sampling of articles of food, investigations in connection with food poisoning and infectious disease, and dealing with recording of atmospheric pollution. The majority of the work of the Inspectors has been carried out without recourse to statutory measures, and although 774 complaints were brought to the attention of the Public Health Department and some 24,609 inspections and re-visits were made to all types of premises, it was only necessary to institute legal proceedings in one case which concerned the sale of food unfit for human consumption. WATER SUPPLY-METROPOLITAN WATER BOARD Water for human consumption is, with one exception, supplied from the mains of the Metropolitan Water Board. With four exceptions, the same source supplies water for purposes other than human consumption. Routine samples of water submitted for analysis were in all cases satisfactory and no complaints were received regarding the unsatisfactory condition of supplies. Samples for analysis are in all cases submitted to the laboratory of the Metropolitan Water Board and certificates giving the result of the analysis are submitted to the Public Health Department. The prompt receipt of information from the Board regarding the proposed discontinuance of water supplies because of defects in the supply service or the non-payment of water rate, enabled the Public Health Inspectors to provide for continuity of supply in all but two of the ten cases referred to the Department. A further two supplies were repaired at the direct request of the Inspectors without requesting assistance from the Board. WATER SUPPLY-WELLS There are seven wells in existence in the Borough. One some 600 feet deep supplies water for both drinking and domestic purposes to a large block of flats. Two approximately 780 feet in depth provide water for industrial use, another 400 feet deep provides a supply for fire-fighting purposes, the water being lifted to a large roof storage tank. A further one of a depth of 446 feet supplies the water to the Council's swimming pools, and the remaining two at a depth of 600 feet are not in use, but held in reserve for use in industrial washing. PUBLIC BATHS The Public Baths were opened in 1907 and comprise two swimming pools, -34- one 100' x 30' having a capacity of some 100,000 gallons of water, the second pool is somewhat smaller 97' x 27' with a capacity of 90,000 gallons and, in addition, there are 38 personal baths (27 for men and 11 for women). The supply of water is obtained from a deep well situated beneath the baths and the water used in the swimming pools is treated by chlorination and continuous filtration. During the year twenty-nine samples of water were taken from baths, pools and sources of supply, for bacteriological examination, all of which were reported upon as satisfactory. During recent years considerable works have been carried out to improve the facilities at the Public Baths, the most receht of these being the improvement of the ladies personal baths and the modernisation of the facilities at the small pool. The latter consisted of removing the dressing boxes surrounding the swimming pool and the construction of new accommodation for both sexes in adjacent rooms. Bathers are now allocated a locker with a numbered disc where their clothes are locked-up whilst they are swimming and only the Attendant has the master key to open the lockers. Pre-cleansing showers and foot baths are provided for all bathers before they can enter the pool. It is intended to re-organise the dressing accommodation of the large pool on similar lines to the facilities provided at the small pool during 1964/65. During the winter months of 1963, the large pool was closed for swimming and a sprung maple floor was laid over the whole area of the pool. This provided an indoor sports area for youth clubs under the control of the London County Council. This facility has been well used during its first season and during morning sessions is available to schools other than those controlled by the London County Council. No complaints from residents were received in the Public Health Department during the year concerning the use of the personal baths or swimming pools. The total attendances at the private baths and the swimming pools during the financial year 1st April, 1963 to 31st March, 1964, were 33,550 and 143,292 respectively but these figures are exclusive of attendances in respect of swimming galas. I must express my thanks to the Borough Engineer and Surveyor for making this information available to me. -35- GENERAL SUMMARY OF THE WORK OF THE PUBLIC HEALTH INSPECTORS INSPECTIONS AND RE-VISITSDWELLINGS: After complaints 1,883 After infectious disease 319 House-to-house, underground rooms and overcrowding 431 Miscellaneous unclassified 237 2,870 FOOD PREMISES: Butchers 410 Fishmongers and fish friers 78 General provision shops and dairies 250 Ice cream vendors 271 Bakehouses and factories 44 Street traders 198 Hotels, restaurants and dining rooms 1,069 Premises in connection with unsound food and food sampling 253 Unclassified premises 166 2,739 FACTORIES AND OUTWORKERS: Factories other than Food Factories 377 Outworkers 13 390 MISCELLANEOUS: Animals, poultry and birds and Pet Animals Act, 1951 18 Open spaces and highways 88 Office premises 27 Merchandise Marks Act 128 Premises re Pharmacy and Poisons and Shops Act 303 Premises re voluntary works 6,510 Visits to owners, agents and builders' offices 430 Food poisoning 1 Visits to aged and infirm persons 82 Visits resulting in "no access" 807 Other Visits 1,465 Clean Air Act, 1956 including smoke observations and atmospheric pollution recording 7,957 Verminous persons 7 17,823 PREMISES FOR THE TESTING OF DRAINS BY: Air 164 Smoke 24 Water 599 787 TOTAL 24,609 -36- REPAIRS AMD INSTALLATIONS SUPERVISED INCLUDING BOTH VOLUNTARY WORK (V) AND WORK AS THE RESULT OF THE SERVICE OF NOTICE (N) UNDER VARIOUS ACTS. V. N. CLEANSING AND REDECORATING Rooms, passages and staircases 23 49 GENERAL REPAIRS Roofs, gutters and rainwater pipes 17 39 Yard and area pavings Walls and ceilings 6 147 Floors, staircases, window and door frames 1 93 Fireplaces and chimney flues - 8 Dampness remedied - 117 Miscellaneous - 4 DRAINAGE AND SANITARY CONVENIENCES Total and partial reconstructions including frontages 3 11 Obstructions cleared 7 l4 Inspection chambers and covers provided - 3 Interceptors provided 1 1 Soil, ventilation and waste stacks constructed and repaired 43 10 Waterclosets and waste water preventers repaired and renewed 388 53 Sinks provided or renewed 286 19 Baths provided 384 24 Wash-hand basins provided or renewed 276 33 Waste pipes cleared or repaired 2 3 Urinals repaired 3 3 Miscellaneous 3 4 WATER SUPPLY Supplies provided to tenements - - Taps supplied on main for drinking purposes - 2 Burst pipes repaired 2 Cisterns cleansed, covered or repaired Totals carried forward 1,445 637 37 REPAIRS AND INSTALLATIONS SUPERVISED INCLUDING BOTH VOLUNTARY WORK (V) AND WORK AS THE RESULT OF THE SERVICE OF NOTICE (N) UNDER VARIOUS ACT. MISCELLANEOUS PROVISIONS V. N. Brought forward 1,445 637 Soap and towels for staff - 1 Staff rest and changing rooms - 1 Constant hot water - - Refuse bins - 6 Covered display and counter screens provided — 2 Natural and mechanical ventilation 11 6 Natural and artificial lighting 1 3 Removal of offensive accumulations on open land and bomb sites 1 7 Totals 1,458 663 Grand Total 2,121 Notes: Included in this table are 122 dwelling houses repaired as a result of the service of Notices. - 38 - NOTICES SERVED Public Health (London) Act. 1936. Intimation 124 Nuisance 34 Section - Drainage 6 L.C.C. (General Powers) Act. 1954 Section 12 - Provision of dustbins - Intimation 9 Section 12 - Provision of dustbins - Statutory Notices 4 L.C.C. (General Powers) Act, 1955. Section 25 - Stopped up drains 7 Section 27 - Urgent nuisances 2 Factories Act, 1961. Health - general provisions 2 Food and Drugs Act. 1955. Defects at Food Premises 18 Shops Act. 1950. Sanitary Conveniences and Ventilation 8 Clean Air Act, 1956. Adaptation of fireplaces 6 Housing Act, 1961. Section 15 - Execution of works to render premises suitable for occupation by the occupiers. 3 TOTAL 223 NOTICES COMPLIED 172 notices were complied with during the year of which 126 were served under the Public Health (London) Act, 1936. - 39 - DRAINAGE Apart from frontage drains connecting a building to a sewer laid beneath the highway, all works of drainage are supervised by the Public Health Inspectors. This work continues to increase in both volume and complexity with the ever increasing number of building projects. New buildings tend to increase in height and be provided with more basement and sub-basement accommodation, resulting in many new features of drainage and ventilation requiring a different and wider approach than in the past when systems and materials were more restricted. There are a number of completely new types of materials and fittings installed in the Borough by way of experiment and these are under constant review by the Public Health Inspectors. During the year 164 applications were received for the drainage of premises and of this total 28 were in respect of combined schemes affecting two or more separate premises. TOWN AND COUNTRY PLANNING Close liaison continues to exist with both the Town Clerk's and Borough Engineer and Surveyor's Departments regarding all applications to either the London County Council or the Chelsea Borough Council referred to us for observations. The observations are then passed to the applicant either direct or through the other department concerned, thus ensuring that the person responsible for carrying out any accepted scheme is fully aware of the various requirements of the Public Health Department before any work is commenced. In certain cases our requirements indicate the unsuitability of the proposals and a scheme may be abandoned or amended, but all concerned are spared much waste of time and perhaps money, and the Inspectors ensure that any development which takes place is in accord with the relevant Acts and Bye-laws. During the year 516 applications were referred to the Public Health Department compared with 565 for the previous year. LAND CHARGES The number of enquiries dealt with was 1,345 compared with 1,319 during the preceding year. These concerned outstanding statutory or informal notices, combined drainage orders, smoke control orders and certificates of disrepair etc. - 40 - NOISE ABATEMENT 48 complaints were received concerning a wide range of noises some barely noticeable others of considerable volume particularly in regard to demolition or excavation works on building sites and the use of pneumatic drills. All complaints were investigated and in the majority of cases every co-operation was received in either reducing to reasonable levels or completely abating the noise. In no case was it necessary to suggest action by the Council but in a few cases complainants were advised of their rights by way of private action. In a number of cases pneumatic drills were provided with silencing baffles. Nuisance from noise is always difficult to assess for what is a nuisance to one person may have no effect on others, as for instance when persistent complaints are received from only one resident in a densely populated area of a noise which must equally affect his neighbours. Close observation is kept on all new buildings and conversions with regard to the siting of plant and equipment likely to give rise to noise and advice is given where necessary. FOULING OF PAVEMENTS BY DOGS This problem was again the subject of complaint from a number of Chelsea residents. If an improvement is to be brought about in an effort to rid the pavements of this most unpleasant nuisance, complainants should endeavour to obtain detailed information as to the offenders and be prepared to appear in Court to give evidence in support of their complaints. The results of any successful prosecutions under the Council's Bye-law receive the fullest publicity. Warning notices continue to be posted on lamp standards throughout the Borough but due to their deterioration by exposure to the weather have to be frequently renewed. The Council's Bye-law provides that - (i) No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway. (ii) Any person offending against this bye-law shall be liable on summary conviction to a fine not exceeding forty shillings. There were no prosecutions during the year. - 41 - RENT ACT. 1967 For the fifth successive year no applications were received or certificates issued in accordance with the provisions of the above Act. HOUSING ACT, 1967 - PART IV - OVERCROWDING. During the year under review 7 families were found to be living in overcrowded conditions and the following summary shows the number of cases relieved and the extent of overcrowding in the Borough at 31st December, 1963:- New cases investigated and recorded 7 Number of families involved 7 Number of persons involved 36 Cases relieved by:- (a) Rehousing Authorities 1 (b) Informal or formal procedure 6 Such action resulted in thirty-two persons being adequately housed. Cases on register at 31st December, 1963 22 Number of persons involved 129 Each complaint of overcrowding is fully investigated by the district Public Health Inspector concerned and apart from any official action that can be taken by the Borough Council or the London County Council to provide alternative accommodation, every possible channel is explored to effect an abatement by informal procedure. A number of cases have been abated during the year in houses in multiple occupation by reason of proposed directives under the Housing Act, 1961. In every case where overcrowding has been abated letters of warning against recurrence are sent to all owners or persons in charge of the premises concerned. NEW HOUSING Number of new dwellings completed during the year:- (a) by the Borough Council Nil (b) by other persons (private) 37 - 42 - HOUSING ACT. 1961 Part II of this Act which came into force on the 24th November, 1961, particularly affects the work of the Public Health Department for it deals with houses in multiple occupation previously known as houses let in lodgings, being occupied by members of more than one family. The new powers are considerably stronger than those of earlier Acts, but it is the desire of the Minister of Housing and Local Government that the new powers should be applied in a reasonable manner and management orders only made in respect of particularly bad or badly managed properties. Briefly the powers under Part II are divided into the following five groupss- (1) Imposition of management orders on houses in multiple occupation which fall very much below a proper standard of management. This entails the enforcement of Regulations prescribed by the Minister. (2) Power to require the provision of reasonable and sufficient facilities and amenities to permit of a decent standard of living, these include water supply, washing arrangements, drainage, water closets, food storage, preparation and cooking, sinks and disposal of waste water, lighting, ventilation and space heating. (3) Provision of means of escape in case of fire. (4) Power to carry out work in default and recover the cost. (5) Power for Local Authority to make a "direction" fixing the number of persons who may occupy a house, to prevent over-occupation. No extra staff has been engaged to deal with these new duties and no specific area has been selected to deal with by way of house-to-house inspection. The policy is to deal with known individual units of bad housing, premises known to have been recently let to multiple tenants or premises where there is knowledge of possible future multiple letting. In the latter category full compliance is being obtained in all cases as a result of informal action. 38 premises were inspected during the year involving 141 separate lettings. 3 formal notices were served on three separate houses where great difficulty was being experienced with the owners, and in respect of two of these houses management orders were served* resulting in both houses being offered for sale. In the third case the owner of the property undertook to recover possession from the tenant sub-letting and re-let the house for occupation by one family only. The work to the remainder of the properties has been or is being carried out without service of notice. UNDERGROUND ROOMS New regulations were made by the Council on the 7th November, 1963, and submitted to the Minister of Housing and Local Government for confirmation which is still awaited. Meanwhile existing regulations continue to be administered in a reasonable manner the policy being to deal with all unoccupied basements if possible before they are let or relet as dwelling accommodation^ many such premises come to the notice of the Public Health - 43 - Inspectors on receipt of copies of Town Planning applications. Site meetings follow and. where possible the underground rooms are made to comply with the requirements, or are put to alternative use. Very few cases call for the making of Closing Orders. With the present extreme shortage of alternative housing, only in exceptional cases are Closing Orders made in respect of premises occupied for living purposes, and in these oases the Order is made to prevent the premises being relet when the existing tenant is provided with other accommodation. No Closing Orders have been made during 1963 but in a large number of premises works have been carried out to obtain compliance with the regulations. APPLICATIONS FOR RE-HOUSING - Awarding of Points To assist the Council's Property Manager in arriving at a just consideration of the merits of each application received a "pointing" system was evolved, and became effective in May, 1953. As applicable, points were awarded under the following headings:- Sub-standard accommodation} Ill-health (excepting Tuberculosis); Tuberculosis; Overcrowding; and Other circumstances. During the year, 44 applications were referred to the Public Health Department, 40 originated from Chelsea residents and the remainder from applicants living in another area. Each case was investigated - 43 in connection with ill-health including tuberculosis, and one in respect of sub-standard accommodation, bringing the total number of cases since May 1953, to 425 residents and 110 non-residents. Twenty-two tenants in Council premises were also referred to this Department during the year for an opinion or pointing on medical grounds. A total of 391 such cases have been dealt with since 1955. 44 FACTORIES ACT, 1961. Under Section 153(1) of the above Act, a Medical Officer of Health is required to report annually as to the administration of Factories, Workshops and Workplaces in his district. The following three tables indicate the work carried out by the Public Health Inspectors during the years- 1. INSPECTIONS OF FACTORIES. WORKSHOPS AND WORKPLACES Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (l) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities: 51 59 - - (2) Factories not included in (l) in which Section 7 is enforced by Local Authorities: 172 347 2 - (3) Other premises in which Section 7 is enforced by Local Authorities * 41 15 - - TOTAL 264 421 2 - NOTEs- Outworkers® premises are not included in (3) above. * i.e. Electrical Stations - Section 123 (l), Institutions - Section 124, and sites of Building Operations and Works of Engineering Construction - Section 127. 45 FACTORIES ACT. 1961 (Continued) 2. CASES IN WHICH DEFECTS WERE FOUND Particulars Number of cases in which Defects were found Prosecutions Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of Cleanliness (Section l) 4 3 - - Overcrowding (Section 2) - - - - - Unreasonable Temperature (Section 3) - 1 - - - Inadequate Ventilation (Section 4) - - - - - Ineffective drainage of floors (Section 6) - - - - - Sanitary Conveniences (Section 7) (a)Insufficient (b) Unsuitable or defective (c) Not separate for sexes 13 13 - 2 - Other offences against the Act (not including Outworkers) - - - - - TOTAL 17 17 - 2 - - 46 - FACTORIES ACT. 1961 (Continued) OUTWORK Sections 133 and 134 Nature of Work No. of Outworkers in August list as required by Section 133 (l)(c) No of Cases of default in sending Lists to the Council No. of Prosecutions for failure to supply Lists No. of instances of work in unwholesome premises Notices served Prosecu tions Wearing Apparel making etc. 3 - - - - - Household Linen - - - - - - Curtains and furniture hangings 2 - - - - - Furniture and Upholstery - - - - - - Stuffed Toys - - - - - - Lampshades - - - - - - Jewellery 2 - - - - - TOTALS 7 - - _ _ — 47 FOOD HYGIENE Food shops and catering establishments are supervised by the two women Public Health Inspectors and absorb practically the whole of their time, for apart from day-to-day supervision, there are frequent changes of ownership with resultant changes in design and kitchen layouts. In addition, a number of new restaurants have opened during the year. These new and altered premises call for numerous detailed inspections regarding drainage work, the siting of equipment and mechanical ventilation. A great deal of work has been carried out to existing ventilation plants and in many cases the cause of complaints of the discharge of cooking odours has been completely eliminated. Many instruction talks have been given to kitchen staff on personal hygiene and hygienic practices in food handling and the response has in most cases been rewarding. Language difficulties do however arise in some establishments employing practically all foreign labour but in such cases it has always been possible to obtain the assistance of a member of the management. Modernisation schemes continue in many of the public houses including the provision of additional toilet and washing accommodation for both customers and staff. Many existing smaller type restaurants and coffee bars are without toilet facilities for customers and in a number of such cases it has been possible to provide additional water-closets and washing facilities. Further efforts in this direction will continue but in some of the very small premises the provision is structurally impossible. Pre-packing of goods for display continues to gain in popularity and calls for considerable checking of food preparation rooms. Much open food is still displayed in retail premises and in many cases protection of such foods from contamination has been made with marked success. INSPECTION AND SUPERVISION OF FOOD A register is maintained of all premises connected with the manufacture, storage and sale of food. The number of premises within the Borough remains reasonably static, and the only variations during the year worthy of mention were the increase in the number of premises retailing milk from 55 to 65, and of catering establishments of various types where the increase was from 218 to 252. The following table classifies the types of food premises, all of which are subject to regular routine inspection:- Bakehouses 7 Butchers 26 Horse-flesh butcher 1 Pood factories (flour mills, bottling-stores) 5 Milk retailers (including dairies) 65 General provision merchants (not selling milk) 14 48 Fruit and vegetable retailers 25 Hotels and Public Houses, Clubs, Restaurants, Dining Rooms, Canteens and miscellaneous catering establishments 252 Fried fish premises 2 Wet fish retailers 8 Miscellaneous premises (Bread and cake shops, sweets and confectionery shops, meat pie store) 48 Ice-Cream Premises Section l6(l) (a) of the Pood and Drugs Act, 1955, provides for the registration of premises used for the sale, manufacture, and storage for sale of ice-cream. The tendency is for this type of registration to drop and has reduced over the year from 109 to 96, a reduction of 13 premises, as against a reduction of 7 premises during the previous year. There are no manufacturers of ice-cream in the Borough, The one registered last year was a large outdoor catering concern and they have moved their ice-cream manufacturing plant to premises outside the Borough, The one large holding unit for an outside manufacturer has been discontinued. Apart from Restaurants there are only two retailers selling loose ice-cream and it is the policy of the Public Health Inspectors to encourage as far as possible the sale of pre-packed ice-cream. One retail shop has installed a machine for the sale of soft ice-cream but a number of such machines appear on the vehicles of itinerant traders. These are kept under close inspection and in no case has an Inspector had cause to complain. Preserved Food Premises. Section 16 (l) (b) of the Food and Drugs Act, 1955, provides for the registration of premises used for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale. 32 premises were registered at the end of the year, the same number as for the preceding year. 49 LEGAL PROCEEDINGS - FOOD AND DRUGS ACT. 1966 UNSATISFACTORY PURCHASES Eleven complaints were brought to the attention of the Public Health Department during the year concerning the sale of the undermentioned foodstuffs which were not of a satisfactory natures- (a) Sale of a bottle of soft drink the contents of which tasted and smelt of disinfectant. (b) Sale of a wrapped sliced loaf containing foreign matter. (c) Sale of a 'Wheatmeal' loaf containing foreign matter. (d) Sale of a mouldy fruit pie. (e) Sale of a tin of corned beef the contents of which were sour. (f) Sale of a small white loaf containing a foreign object. (g) Sale of mouldy sausages. (h) Sale of sliced bacon infested with maggots (i) Sale of a "Nut Ring" containing larvae skins. (j) Sale of a mouldy sliced loaf (k) Presence of foreign matter in a bottle of milk. Thorough investigations were carried out in respect of each adulteration and reported to the Public Health and Baths Committee for appropriate action. In case (a), no action was taken as the manufacturer had ascertained that the rubber band of the bottle cap had absorbed disinfectant, probably kept in the bottle by the previous consumer, and the washing process at the factory, when the bottle was returned had not dispelled the taste and smell. The manufacturers had acknowledged this defect and proposed to bring into use a non-absorbent bottle top which would prevent a recurrence of the complaint. In regard to case (d) it had not been possible to establish whether the mould growth had been there when the pie was sold or whether it had developed during the 24 hours it had been in the possession of the purchaser. The Committee decided to take no action in this matter in view of the uncertainty, but the retailer's attention was drawn to the necessity of careful checks being made on stock rotation. Follow up samples were taken over a period and all proved satisfactory. Concerning case (e), the condition of the contents of the tin was due to a faulty seam which would have been most difficult to locate by the retail staff handling the commodity. It was decided therefore that no further action could be taken. In cases (b) (c) (f) (g) (i) (j) and (k), legal difficulties or mitigating circumstances negatived the institution of legal proceedings and warning letters were sent to the firms concerned. With reference to case (h), legal proceedings had been taken against the shop concerned for a similar offence in December, 1961, when a fine of £60 plus £5. 5s. 0d. costs was imposed. Since the previous 50 offence the standard of the shop had not improved, and at the time of the Inspector's visit holes were found in the wire gauze panels of the door of the bacon cupboard large enough to allow flies to gain access. The Committee took a very serious view of a second offence of this nature and authorised the institution of legal proceedings. The defendant Company pleaded guilty to the offence and were fined £30 with costs totalling £5. 5s. 0d. LEGAL PROCEEDINGS - FOOD HYGIENE (GENERAL) REGULATIONS.1960SMOKING WHILST HANDLING OPEN FOOD, Legal proceedings were instituted against a shop assistant who, despite repeated warnings from the Food Inspector, continued to smoke cigarettes whilst handling open food contrary to Regulation 9(e) and 33 of the Food Hygiene (General) Regulations, 1960. This was the first offence of this nature to be brought before the Justices by the Council. The defendant pleaded guilty to the offence and was fined £3. 0s. 0d. the Council being awarded £l. ls. 0d. costs. UNSOUND FOOD Food unfit for human consumption is surrendered to the Council's Public Health Inspectors, removed from the premises and destroyed. During the year the following unsound foods totalling 3,437 lbs. were surrendered to the Public Health Inspectors:- Commodity Weight-lbs Butter and margarine 24 Cereals 34 Cheese 12 Coffee, ground 12 Pish, frozen 132 Fish, tinned 3 F1our 60 Fruit, frozen 21 Fruit, tinned 465 Jam 154 Meat, cooked 247 Meat, frozen l,440 Poultry, frozen 92 Sweets and pastries 4l3 Syrup and treacle 24 Vegetables, frozen 176 Vegetables, tinned 128 TOTAL 3,437 51 ANNUAL REPORT OF THE PUBLIC ANALYST for the year ended. 31st December. 1963. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Chelsea. Your Worship, Ladies and Gentlemen, During the year 1963, 300 samples of food, all submitted informally, were examined. The number adulterated or about which some comment was made was 13. The incidence of these criticisms may be classified as follows:- Number of samples Number of samples examined adulterated, etc. Milk 100 1 Other foods 200 12 The winter at the beginning of the year was extremely cold and there was much snow on the ground, causing trouble in the feeding of cattle. This was reflected in the poor quality of the milk obtained during the months of February, March and April. A sterilised milk was reported as satisfactory but inferior because the freezing point was - 0.532°C, although the solids - not-fat were only 8.43 per cent. Several foods were submitted because of complaints by members of the public. A bread roll was received with the complaint that it contained rodent excreta, but the foreign material was found to consist of burnt bread from a baking plate, due to carelessness in the bakery. Some raisins were reported to have an oily taste. The Mineral Oil in Food Order, 1954, allows any dried fruit to contain 0.5 per cent by weight of mineral oil, and although these raisins did not contain as much as this a poor quality liquid paraffin had been employed with the result that the raisins did in fact possess a slightly paraffiny odour and taste. They were reported as inferior. An apple pie and a blackcurrant pie were submitted because of mould growth. Examination showed that the mould growth in both cases had occurred after cooking, but they were stale when sold and had not been stored under satisfactory conditions. Two packets of skinless beef sausages were also badly attacked by mould, and had obviously been kept for too long under improper conditions. The manufacturers agreed that the sausages must have been sold out of time 52 and not in accordance with their agreement with the shopkeeper. Corned beef submitted in an opened can had a sour odour and a soft consistency. There was an extensive growth of Staphylococci throughout and the contamination was thought to have occurred due to cooling water seeping into the can after autoclaving and during cooling. A large number of meat and fish spreads containing butter were examined during the year and several of these were considered to be deficient in butter fat, if the labels were to be justified. A Real Crab Spread with Butter contained only 9.0 per cent of total fat including 4.7 per cent butter fat, and a further sample of the same brand contained 9.5 per cent total fat, and not more than 4.5 per cent butter fat. A Salmon Spread with butter contained total fat 9.5 per cent. and 4.2 per cent of butter fat whilst a Salmon and Shrimp spread with butter contained total fat 8.9 per cent and 5.2 per cent of butter fat. A Vitaminized Apple Juice was stated to contain not less than 35 mgs. of vitamin C per 100 cc. but in fact contained only 20.44 mgs. It was probable that the full quantity of vitamin C may have been present before canning, and had decomposed during sterilisation. The Labelling of Food Regulations, moreover, require the Vitamin content to be disclosed as the quantity present in each fluid ounce and not in 100 cc. Legislation issued or proposed during 1963. The year has been a comparatively quiet one regarding the issue of food regulations, but the following are of interestx- The Bread and Flour Regulations. 1963. These Regulations largely reinforce the provisions of the Flour (Composition) Order, 1956, with improvements but with restrictions on the sale of bread for dietetic purposes. It is now permissible to add iron to flour either as reduced iron or as iron and ammonium citrate, a provision which has been found necessary because the reduced iron has also been removed and has caused trouble with the magnets, when flour is passed under a magnet for manufacturing purposes in order to remove nails and other pieces of iron which may have got into flour. It is no longer necessary to add chalk to self-raising flours prepared with a calcium containing baking powder. Milk bread and skimmed milk bread must contain not less than 6 per cent of milk powder or skimmed milk powder, as the case may be, calculated on the dry weight of the bread. Protein enriched bread must contain not less than 20 per cent of protein, calculated on the dry weight, and starch-reduced bread, biscuits, rusks, and breakfast foods must not contain more than 50 Per cent of starch similarly calculated. No claims are permitted for slimming properties unless these are accompanied by a statement to the effect that the food forms part of a diet of which the calories intake is controlled. The Liquid Egg (Pasteurisation) Regulations, 1963, have been issued as a result of the number of food poisoning cases, which have been traced to the use of raw liquid or frozen egg. The test relies on the faot that an enzyme, amylase, present in fresh egg is destroyed by pasteurisation. 53 The Ice Cream (Heat Treatment etc.) (Amendment) Regulations. 1963. have been issued to permit the addition of sugar as well as water to an ice cream mix, which has been prepared according to the requirements of the main regulations. The Milk (Special Designations) Regulations, 1963. follow the main lines of previous regulations, but now introduce a test for the efficiency of the heating of so-called sterilised milk,, This test depends on the coagulation of a protein, lactalbumen, during the heating of the milk. The Soft Drinks Regulations, 1963. increase the quantity of fruit juice or comminuted fruit required to be present in fruit drinks and permit the sale of comminuted fruit drinks made from citrus fruits other than oranges They increase the quantity of sugar required to be present in soft drinks and reduce the permitted amount of saccharin. If present it is now necessary to declare the presence of saccharin on the label of any soft drink. Unfortunately it is still permissible to use acetic acid or phosphoric acid in soft drinks so long as they are not described as fruit squashes, fruit crushes, or comminuted citrus drinks, but it is now illegal to use any pictorial device or any wording to suggest the presence of fruit which is not represented in the flavouring of the drink. The Weights and Measures Act, 1963, and the Weights and Measures Regulations, 1963, mainly affect Weights and Measures Authorities, though attention will have to be paid to the net contents of pre-packed foods, when examining such articles. Report of the Food Standards Committee on Meat Pies. This report was issued during the year and at the beginning of 1964 draft regulations have been issued based on the recommendations as modified in view of comments received by the Minister. Essentially the proposals are that meat pies should contain not less than 25 per cent of meat, though pies weighing between 4 and 5½ ounces need contain only 1 ounce of meat and those weighing up to 3 ounces need contain only 5/8 ounce of meat. It is further suggested that in the event of the quality of larger pies, i.e. those over 8 ounces declining as a result of any regulations, it might be necessary to issue regulations for larger meat pies. Suggestions were included in the report regarding the absorption of fat from the meat of a meat pie into the surrounding pastry. Recommendations have been made to allow for fat in the pastry in excess of certain figures, as having been derived from the meat. A Circular, FSH/Circular 12/63 was issued by the Ministry of Agriculture, Fisheries and Food advising Local Authorities that the Customs and Excise are no longer testing for arsenic glucose or invert sugar used in brewing and that this duty now devolves on Local Authorities in which breweries are situate. Speaking generally manufacturers of these products see that they comply with the regulations because of the great value of the trade, which they have with brewers. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, THOMAS McLACHLAN, A.C.G.F.C., F.R.I.C.,M.I.Biol. Public Analyst. Notes A table showing the various samples submitted for analvsia appears on the following page. 54 Article Total analysed all taken informally Number adulterated etc. Bread Roll 1 1 Butter 38 Fish Paste 23 Flour 2 Fruit, dried 1 1 Fruit Juice 12 1 Jam and Conserve 18 Lard 1 Margarine 18 Marmalade 11 Meat Products 26 3 Milk 100 1 Pie, fruit 2 2 Soft Drinks 29 Spread, savoury 8 4 Suet, shredded 5 Vinegar 5 300 13 - 55 - BACTERIOLOGICAL EXAMINATION OF FOOD The bacteriological examination of samples is carried out by the Public Health Laboratory Service at County Hall. No charge is made to the Council for this service and during the year the following samples were submitted for examinations:- Water 29 Ice Cream 61 Steak and Kidney Pie 1 Meat Pie 1 Roasted Chickens 2 Shrimps 1 Total 95 All were reported upon as satisfactory with the exception of the steak and kidney pie which was found to contain food poisoning organisms. The large increase in the number of ice-cream samples submitted for examination, 61 as against 22 in the preceding year, was the result of a check on itinerant ice-cream vendors and in particular those selling soft ice-cream. The results proved this class of trader, mostly from outside the Borough, to be of satisfactory standard. THE MILK (SPECIAL DESIGNATION) REGULATIONS. 1960 The following table shows the number of dealers' licences in force at the 31st December, 1963:- Sale of tuberculin tested milk 56 Sale of pasteurised milk 64 Sale of sterilised milk 46 The expiry date of all licences is 31st December, 1965. THE MILK AND DAIRIES (GENERAL) REGULATIONS. 1969 At the end of the year there were 55 registered distributors with premises in the Borough and 65 premises within the Borough from which milk is distributed. ANALYSIS OF MILK During the year 100 samples of milk were submitted for examination to the Public Analyst whose report appears on pages 51 to 54 . - 56 - STREET TRADING Traders are licensed annually to operate from designated sites in accordance with the provisions of Part II of the London County Council (General Powers) Act, 1947. Renewal applications are granted provided the applicant has fully observed the requirements of the licence throughout the previous period,, New applicants have to submit their vehicles for examination and, in addition, all storage facilities must be inspected. In many cases both vehicles and food are stored in another borough and in this event a report is obtained from this borough as to suitability before a licence is considered. The two main problems in respect of stallholders are (i) smoking, and (ii) displaying or unloading of food too near the ground where there is a risk of fouling by dogs. The supervision of food stores is the responsibility of the woman Inspector responsible for food shops, but in addition constant observation is made by all Public Health Inspectors who are frequently passing during their daily routine work. 198 special inspections were made of stalls during the year, this is in addition to visits in this and other boroughs to premises where food for the stalls is stored, and the unrecorded casual visits by Inspectors in passing. Street trading from licensed sites in the borough is carried out as follows:- Fruit and vegetables 14 Refreshments (at coffee stalls) 3 Flowers 10 Newspapers 6 In addition, there are 3 stalls which are sited on private forecourts as under:- Fruit and vegetables 1 Shellfish 1 Clothing 1 SHOPS ACT, 1950 Regular inspections were carried out as required by Section 38 in regard to the provision of ventilation, lighting, reasonable temperature, adequate and suitable sanitary conveniences and washing facilities for the staff concerned, and the provision for the taking of meals on the premises should this be necessary. Various improvements were carried out during the year and it was only necessary to serve 8 notices throughout the year. 57 LICENSING ACT. 1961 From the 1st November, 1961, new types of licences were required for the sale of alcoholic drinks in restaurants, private hotels, guest houses, etc., and from the 1st March, 1962, more stringent controls were introduced in respect of clubs selling intoxicating liquor. Copies of both classes of application to the Justices for licences are referred to the Public Health Department and the premises concerned are inspected by the Public Health Inspector. Objection can be raised to the grant or renewal of a licence if the premises are found to be not suitable or convenient for the proposed use having regard to their character and condition. In practice the main objections likely to be raised would arise from breaches of the Food Hygiene Regulations or from insufficient or improperly sited sanitary accommodation for the use of patrons. It has not been found necessary in respect of any application to raise formal objection through the Public Health Department, appropriate accommodation having been provided in connection with newly constructed or adapted premises. In the case of some existing establishments previously licensed, additional accommodation has been provided when structurally possible. PHARMACY AND POISONS ACT. 1933 4O persons entitled to sell poisons included in Part II of the Poisons List were entered on the Council's Register at the 31st December, 1963. All premises were inspected as to their suitability and to ensure that records were properly maintained, labelling efficiently performed, and that sales are only made by employees nominated on the application forms. No infringements were reported during the year. RAG FLOCK AND OTHER FILLING MATERIALS ACT. 1951 At the end of the year six premises where filling material is used were registered under this Act. There are no premises in the Borough where rag flock is manufactured. PET ANIMALS ACT. 1951 This Act provides that no person shall keep a pet shop unless licensed by the local authority. During the year two renewal applications from licence holders were received and approved. No contraventions of the Aot were found during regular inspections of the premises and at all times the stock was well cared for and maintained in accordance with the conditions specified in the licence. 58 RODENT CONTROL - The Prevention of Damage by Peats Apt, 1949 There has been little variation in the number of investigations of infestations or the campaigns carried out for the destruction of both rats and mice as compared with the previous year,, In the case of rats a lesser number of infestations were traceable to defective drains and particularly frontage drains than previously, no doubt due to the many drains reconstructed during recent years. However, the policy continues of testing all frontage drains when infestations occur on the lowest floor of the building. There was an increase of rat infestations to empty or part empty buildings invariably due to the evaporation of the water seal of sanitary fittings on drainage systems not provided with an intercepting trap. In a number of such premises not likely to be re-occupied in the near future the fittings have been more securely sealed by the use of heavy oil to avoid the risk of evaporation. For the second year the sewers were treated by direct poisoning with Fluoracetamide. The four treatments were carried out with the assistance of sewermen from the Borough Engineer's Department and each of the 480 access points were successfully treated during each campaign. This may appear to be a far-reaching statement, but Chelsea is fortunate in having all baitable manholes located centrally on the highway and a few side entries on the footway, resulting in freedom from obstruction by parked vehicles, etc. During 1962 it was not possible to check on the takes from test baits owing to trouble from snow and ice, but this year the check was made and from the careful observations recorded it is clear that a considerable reduction of rat population has been achieved, indicating this method as an advance on methods adopted prior to 1962. Details of work carried out by the Rodent Officers during the year. 1963. 1. Treatment of Business and Private Business Private Premises (Rats and Mice) Premises Premises Number of visits 384 2,409 Number of infestations found 26 203 Number of treatments undertaken 23 193 Number of pre-baits laid 1,967 Number of poison baits laid 585 Number of complaints received 245 2. Sewer Maintenance Treatments (Rats) No. of poison Poison baits laid used No. 1 Treatment 480 Fluoracetamide No. 2 Treatment 480 Fluoracetamide No. 3 Treatment 480 Fluoracetamide No. of test baits laid No. 4 Treatment - Test baiting with sausage rusk 480 59 PIGEONS Section 121 of the Public Health (London) Act, 1936, empowers the local authority to seize and destroy pigeons believed to be ownerless and where they congregate in numbers in excess of that considered reasonable® Reducing the excessive number of pigeons is not obligatory although in years past the Council made use of direct labour for the trapping and destruction of birds in addition to the use of individual approved pigeon catchers who operated without charge. This practice was discontinued on the instruction of the Public Health Committee several years ago resulting in action being limited to advice as to methods of proofing buildings or supplying information in respect of firms either undertaking destruction or proofing buildings against roosting and nesting. Proofing is not by any means a solution it merely drives the birds from one building to a neighbouring one. Much time is spent interviewing persons known to feed pigeons and endeavouring to discourage the practice. Results unfortunately are not always rewarding for there appears to be a firm although misguided opinion that if not fed the pigeons will die of hunger and there is of course no legal grounds to enforce discontinuance of the practice. Unsuccessful attempts have been made elsewhere to deal with the feeding on the highway as an offence under the Litter Act, 1958. NEW LEGISLATION The following new Acts, Regulations and Orders, which relate to the work of the Public Health Department became operative during the year:- Animal Boarding Establishments Act, 1963. London Government Act, 1963. Offices, Shops and Railway Premises Act, 1963. London County Council (General Powers) Act, 1963. Bread and Flour Regulations, 1963. Ice Cream (Heat Treatment, etc.) (Amendment) Regulations, 1963. Liquid Egg (Pasteurisation) Regulations, 1963. Meat Inspection Regulations, 1963. Milk (Special Designation) Regulations, 1963. Public Health (Aircraft) (Amendment) Regulations, 1963. Public Health (Ships) (Amendment) Regulations, 1963. Poisons List Order, 1963. Poisons Rules, 1963. Soft Drinks Regulations, 1963. 60 DISINFECTION AMD DISINFESTATION The Disinfecting Station and Personal Cleansing Centre is situated at 9A, Lots Road, but the duties of the personnel extend beyond this limited field. The two disinfectors and the two vehicles are used for various duties in connection with the testing of drains and conveying equipment to and from the sites, assisting with food sampling and delivering samples to the Bacteriological, Chemical and Pathological Laboratories. They also undertake the collection and removal of the effects of deceased persons under Section 50 of the National Assistance Act, 1948, the collection and delivery of the laundry of incontinent persons, and the collection and destruction of verminous bedding and furniture, etc. The woman cleansing station attendant retired in November 1963, but in view of the small numbers of persons requiring treatment and having regard to the amalgamation of Chelsea and Kensington in April 1965 under the provisions of the London Government Act, 1963, it was considered that the appointment of a new attendant was not justified for such a short period. Kensington's Public Health Committee kindly offered to grant facilities for personal cleansing of Chelsea persons at their new medicinal baths and this arrangement comes into operation on 1st January, 1964. The following is a summary of specific work of disinfection and disinfestation carried out during the year:- SCABIES CASES TREATED Chelsea Residents 6 L.C.C. Schoolchildren 1 VERMINOUS CONDITIONS Adults 15 Children 3 L.C.C. Schoolchildren DISINFECTION OF ROOMS AND CONTENTS. CLOTHING. ETC. Number of rooms disinfected 212 Number of articles disinfected 595 DISINFESTATION OF ROOMS AND CONTENTS Number of rooms disinfested 373 Number of articles disinfested 2,323 61 ATMOSPHERIC POLLUTION RECORDING The Council maintains two measurement and. recording stations. The readings are submitted to the Department of Scientific and Industrial Research, who issue monthly bulletins indicating the national picture as regards atmospheric pollution,, The stations are situated at the Chelsea Polytechnic, Manresa Road, and the Chenil Galleries, King's Road. Chelsea Polytechnic The apparatus situated on this station consists of a deposit gauge for collecting the amount of soluble and insoluble deposits, and a lead peroxide apparatus for measuring the sulphur content of the air. The deposited matter is collected at the end of each month and forwarded to The Royal Institute of Public Health and Hygiene for analysis. The following tables show the results obtained from this station during the years:- Month 1963 Days Exposed Rainfall (ins) Total Deposits for period in tons per sq.mile Deposits per day in tons per sq. mile (av. ) Soluble InSoluble Total Soluble InSoluble Total January 31 0.28 7.30 6.20 13.50 .235 o200 .435 February 28 0.18 6.74 14.28 21.02 .240 .510 .750 March 31 2.35 8.50 14.62 23.12 .274 .471 .745 April 30 1.89 6.41 14.17 20.58 .231 .472 .685 May 30 1.55 4.40 8.99 13.39 .146 .299 .445 June 31 2.65 6.51 12.15 18.66 .210 .391 .601 July 31 1.47 5.72 10.87 16.59 .184 .350 .534 August 27 1.84 5.77 13.39 19.16 .213 .495 .708 September 32 2.67 6.22 9.16 15.38 .194 .286 .480 October 31 1.68 6.26 11.03 17.29 .201 .355 .556 November 31 3.78 6.60 12.75 19.35 .212 .411 .623 December 30 0.59 6.22 12.95 19.17 .207 .431 .638 TOTALS 363 20.93 76.65 140.56 217.21 - - - 62 Estimation of Atmospheric Sulphur Milligrams of Sulphur Trioxide per day. Month Days Exposed Chelsea Polytechnic January 31 7.01 February 28 6.16 March 31 3.84 April 30 3.55 May 30 2.17 June 31 2.26 July 31 1.96 August 27 1.26 September 32 2.29 October 31 2.43 November 31 3.63 December 30 2.99 Average for years:- 3.29 Chenil Galleries This station measures the amount of smoke suspended in the air and the sulphur dioxide content of the atmosphere. The apparatus consists of a smoke filter and a hydrogen peroxide bubbler,, Readings are taken daily by an officer of the Public Health Department and the results are averaged to produce figures for each month. All information obtained from these readings is forwarded to the Fuel Research Station for correlation with the results obtained from other sites throughout the country,. - 63 - ATMOSPHERIC POLLUTION RECORDING (Continued) The following table shows the results obtained from this station during the years- VOLUMETRIC ANALYSIS - SMOKE AND S02 Month Average daily total Microtframmes per cubic metre Smoke S02 January 255 557 February 264 573 March 75 320 April 129 332 May 77 221 June 42 175 July L^ 169 August 99 175 September 145 242 October 72 244 November 149 326 December 186 505 64 CLEM AIR ACTo 1966 SMOKE CONTROL ORDERS Cheyne Ward and Royal Hospital Ward. Smoke Control Area The Council at its meeting on the 19th December, 1962, agreed in principle to making Cheyne Ward and Royal Hospital Ward its third smoke control area. In accordance with the planned programme dealing with the whole of the Borough the next area comprised Royal Hospital Ward with only part of Cheyne Ward. After consideration it was decided that dealing with part of a ward would create difficulty in arriving at statistics in regard to area, premises, population and assessment of cost and that it would be preferable to deal with the two Wards in their entirety as one area. The simplification of administration by this procedure together with some extension of time being provided to deal with the additional premises involved, will result in a saving of time in completion of the overall programme,, These two Wards cover a little over 300 acres and contain 6,593 dwellings accommodating approximately l69654 persons. In addition there are 444 commercial premises, 12 industrial premises and 55 other premises. The detailed survey of the Area is now almost complete and the returns show that less than 25% of the dwellings inspected will require any conversion or adaptation of their heating appliances in order to comply with the Act,, There has been a marked trend in this Area towards the use of central heating and gas and electric room heaters,, During the year the Ministry of Housing and Local Government issued an important circular - 69/63. It stated that in view of technological changes in the gas industry there would be a consequent decrease in the future production of gas coke. This fuel has been widely used to replace raw coal in smoke control areas and revised arrangements were therefore necessary. It was emphasised however that sufficient supplies of solid smokeless fuel would continue to be available in existing smoke control areas. The circular contains certain revised grant arrangements. The installation of openable stoves, under-floor draught open fires or fixed gas, electric storage or oil heaters should now be regarded as "reasonably necessary" works and the full expenditure on such appliances should rank for grant. The provision will give householders in smoke control areas a much wider freedom of choice in selecting new appliances. A map of the Cheyne Ward and Royal Hospital Ward Smoke Control Area appears on the following page. THE CHELSEA (CHEYNE WARD AND ROYAL HOSPITAL WARD) SMOKE CONTROL AREA The Area is bounded on the west by the centre of Old Church Street; on the north-west by the centres of King's Road, Markham Street and Elystan Street; on the north by the centres of Whitehead's Grove, Cadogan Street, Cadogan Gardens and Ellis Street, then a line extending through to the centre of the northern end of Eaton Terrace; on the east by the centres of Eaton Terrace, Cliveden Place, Bourne Street, Whittaker Street, Holbein Place, Pimlico Road and Chelsea Bridge Road; on the south by the Chelsea Embankment. EPIDEMIOLOGY Incidence and Notification of Infectious Disease 65 NOTIFIABLE DISEASES The undermentioned diseases are notifiable to the Medical Officer of Health by general practitionersi- Anthrax Ophthalmia Neonatorum Cholera Plague Continued Fever Pneumonia, Acute Influenzal Diphtheria Pneumonia, Acute Primary Dysentery Poliomyelitis, Acute Encephalitis, Acute Puerperal Pyrexia Enteric (Typhoid or Relapsing Fever Paratyphoid) Fever Erysipelas Scabies Food Poisoning (or Scarlatina or Suspected Food Scarlet Fever Poisoning) * Leprosy Smallpox Malaria Tuberculosis Measles Typhus Fever Membranous Group Whooping Cough Meningococcal Infection * To be notified to: Chief Medical Officer, Ministry of Health, 66 NOTIFICATIONS. The following table shows the total (corrected) number of cases of Infectious Diseases received during the year. Disease Under 1 year 1 and under 5 yrs 5 and under 15 yrs 15 and under 25 yrs 25 and under 45 yrs 45 and under 65 yrs 65 and over TOTAL Dysentery 6 11 11 9 13 6 1 57 Food Poisoning _ _ _ _ 1 _ 1 2 Measles 7 181 154 5 5 _ _ 352 Pneumonia: Ac. Primary _ 1 _ 1 1 1 _ 4 Puerperal Pyrexia _ _ _ 1 1 _ _ 2 Scabies _ _ _ 4 _ _ _ 4 Scarlet Fever _ 3 3 1 _ _ _ 7 Typhoid Fever _ _ _ 1 1 _ _ 2 Whooping Cough _ 14 10 _ _ _ _ 24 TOTALS 13 210 178 22 22 7 2 454 67 SUMMARY OP NOTIFICATIONS Of INFECTIOUS DISEASES RECEIVED DURING THE YEARS 1959 - 1963 (inclusive) Disease 1959 1960 1961 1962 1963 Average for five years Dysentery- 62 69 39 67 57 58.8 Erysipelas 1 3 3 _ _ 1.4 Food Poisoning 5 15 1 2 2 5.0 Measles 416 15 564 63 352 282.0 Meningococcal Infection 2 3 2 1 _ 1.6 Pneumonias Ac. Influenzal 9 4 5 1 _ 3.8 Ac. Primary 9 2 3 _ 4 3.6 Poliomyelitis: Paralytic 2 1 1 1 _ 1.0 Non-paralytic 1 _ _ _ _ 0.2 Puerperal Pyrexia 36 19 4 3 2 12.8 Scabies 6 3 2 3 4 3.6 Scarlet Fever 31 20 4 3 7 13.0 Typhoid Fever _ _ _ 1 2 0.6 Whooping Cough 33 62 24 6 24 29.8 68 DIPHTHERIA No notification was received during the year. Two cases were confirmed in 1955, being the only cases since 1949. whilst there have been no deaths for eighteen years. Immunisation has played a major part towards the present excellent position, nevertheless it is constantly necessary to publicise the efficacy of such a service. Details of services provided during the year will be found on Page 21. DYSENTERY During 1963, 57 notifications were submitted compared with 67 in 1962 and 39 in 1961. Of this total, 11 were in an Institution in the Borough. The remaining 46 were mainly isolated cases which occurred during the year. MEASLES Three hundred and fifty-two notifications were received during 1963, as compared with 63 in 1962, due to the biennial recurrence of this disease. SCARLET FEVER Seven notifications of scarlet fever were received in the Public Health Department during the year, as compared with 3 in 1962. WHOOPING COUGH Twenty-four cases were notified during the year against 6 in 1962. SMALLPOX No case of smallpox has been notified to this Department as having occurred in the Borough since 1928 and there have been no deaths from this disease for over fifty years. Information was received during the year regarding four contacts who arrived in this country from declared smallpox locally infected/endemic areas and travelled to addresses in the Borough. They were kept under observation for the surveillance period and remained quite well. 69 POLIOMYELITIS For the first time in twenty years, not one case of this disease was notified to the Public Health Department. This is no doubt due to the general public taking advantage of the two types of vaccine now available. It appears that oral vaccine is proving more popular and it is hoped that the level of immunity already obtained in the Borough will increase still further. PUERPERAL PYREXIA Puerperal Pyrexia means a febrile condition in a woman in whom a temperature of 100.4° Fahrenheit (38° Centigrade) or more has occurred within fourteen days after childbirth or miscarriage. Two cases were notified during the year and all Occurred in hospital and both referred to patients residing outside the Borough. The following table shows the causes of pyrexia in the notified casesi- Cause No. of cases Urinary tract infection 1 Acute mastitis 1 Total 2 Two cases were brought to the notice of this Department by other local authorities; these concerned Chelsea residents whose confinements took place in hospitals in their area. ERYSIPELAS For the second successive year no cases of Erysipelas were notified. INTERNATIONAL CERTIFICATES In order to prevent the spread of infectious diseases, certain countries require visitors to be vaccinated against specified diseases under the International Sanitary Regulations. During the year,1,020 of these certificates were authenticated in Chelsea. 70 FOOD POISONING Two cases were notified during 1963, compared with 2 in 1962 and 1 in 196l, A summary of all cases occurring during the year under review is set out in identical form to that supplied to the Ministry of Health. ANNUAL RETURN OF FOOD POISONING Number of Food Poisoning notifications (corrected) as returned to Registrar General. 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr Total _ _ 2 _ 2 Number of cases otherwise ascertained _ _ _ _ _ Number of symptomless excreters _ _ _ _ _ Number of fatal cases _ _ _ _ _ Particulars of Outbreaks. Nil Particulars of Single Cases Causative Agent Total Salmonella Typhimurium 1 Salmonella Oranienburg 1 Salmonella Infections. Not Food-Borne Salmonella (type) Outbreaks No. of cases Single Cases Total No. of cases (outbreaks and single cases) Family Other (Outbreaks) Typhimurium - - _ 3 3 ENTERIC FEVER During the year, two cases of Typhoid Fever were notified to the Department both of which were imported. The first concerned an Italian "au pair" girl who arrived in this country suffering from the disease although showing no visible signs. Within a few days of arriving at her place of employment she was taken ill and admitted to hospital where Typhoid Fever was diagnosed. She was treated on routine lines and discharged after 6 negative specimens and returned home to Italy. Contacts of this case were kept under observation but no further cases developed. The second case referred to a women aged 32 who had returned from Switzerland. This case was connected with 45 confirmed cases in England and Wales associated with the outbreak at Zermatt. A total of 16 people returned to the Borough from the affected area and from these a further 12 contacts had to be traced. During the incubation period regular visits were made to all contacts and 137 specimens were taken. All were negative except one and in this case the contact was found to be suffering from Dysentery. All the other contacts remained well and no further cases developed. 71 TUBERCULOSIS Summary of Notifications during the period from 1st January, 1963 to the 31st December, 1963. Formal Notifications Age Periods Number of Primary Notifications of new cases of tuberculosis 0- l- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75+ Total (all ages) Respiratory, Males - - - - - 1 6 2 2 1 3 3 1 19 Respiratory, Females - - - - - - - - 1 1 1 — — 3 Non-respirator Males - - - - - - - 1 - - - - - 1 Non-respiratory Females - - - - - - 1 — 1 - 1 - 1 4 Number of deaths from tuberculosia - 3 Number of oases remaining on Register - 304 CASES NOTIFIED AND DEATHS FOR THE PREVIOUS TEN YEARS Year Pulmonary Non-Pulmonary Total No. of Deaths Number of Cases on Register at the end of each year. 1954 54 9 63 9 471 1955 40 7 47 9 425 1956 35 4 39 1 464 1957 42 5 47 2 441 1958 41 7 48 5 431 1959 35 3 38 3 410 1960 25 2 27 2 362 1961 19 2 21 10 358 1962 25 1 26 4 321 1963 22 5 27 3 304 Average number of cases for the ten years - 38.3 Average number of deaths for the ten years - 4.8 72 CHELSEA TUBERCULOSIS DISPENSARY. BROMPTON HOSPITAL The following statistics relating to the work of the Chelsea Tuberculosis Dispensary during the past four years have been supplied by the courtesy of the Secretary:- 1960 l96l 1962 1963 Population served by Dispensary 49,140 48,490 48,550 48,050 Number of notified cases in Borough at end of year 361 358 321 303 Number of these who at present do not attend Dispensary 185 152 120 145 Total attendances during year 1,278 1,1441 1,119 1,016 Total new patients seen 180 16 114 124 Number of these who were contacts 92 84 59 Number of contacts found to be tuberculous - 1 - - Number of cases newly notified to Medical Officer of Health (i.e. excluding inward transfers) 29 27 30 28 Number of cases diagnosed as tuberculous (for the first time) at the Dispensary 5 4 2 2 Number of X-rays 925 824 843 728 Number of Patients who received "Special treatment" at home during the year _ 1 1 1 Number of Patients given B.C.G. 88 52 28 41 Number of home visits by medical staff 3 2 _ _ Number of visits paid by Dispensary Nurse 1,250 1,121 973 890 Number of Clinic Sessions per week 2 2 1* 1* * + one extra session every month. 73 BACTERIOLOGICAL EXAMINATIONS All bacteriological examinations are carried, out at the Public Health Laboratory at County Hall under its Director, Dr. A.J.H. Tomlinson. No charge is made to the Council for these examinations and during the year 1267 were made as follows Throat/Nose Swabs Staphylococcus aureus found 1 Haemolytic Streptococci found 33 Monilia found 2 Negative results 93 Faeces Shigella sonnei found 38 Shigella flexner found 1 Salmonella typhimurium found 3 Salmonella saint paul found 1 Pathogenic Bact. coli 0111 found 11 Pathogenic Bact. coli 0119 found2 Negative results 1080 Foodstuffs Negative results 2 The Public Health Department has an arrangement with Chelsea Doctors whereby specimens left at the office by 3.0 p.m. Mondays to Fridays, and 11.0 a.m. on Saturdays are delivered by hand to the Laboratories the same day. This service is used extensively. INDEX Subject Page (s) Addiction Drugs 18 — 19 Accidents:- Home 29 Road 30 Analyst Publio - Report of 51 - 54 Area of Borough 8 Atmospheric Pollution - Recording Stations 61 - 63 Bacteriological Examinations 55 and 73 Baths and Swimming Pools 33-34 Births 8 Burials - Sect. 50 National Assistance Act, 1948 28 Campaign - Smoking and Health 15-17 Cancer - Lung and Bronchus 14 Chelsea Tuberculosis Dispensary 72 Clean Air Act, 1956:- Smoke Control Orders 64 Atmospheric Pollution Recording 61 - 63 Committee, Public Health and Baths:- Members 1 Representation elsewhere by Members 2 Conferences - Council representation at 32 Contributions to Voluntary Organisations 32 Cremation - Local service and progress 31 Deaths 8— 14 Diphtheria 21 and 68 Diseases, Infectious 65-73 Disinfection/Disinfestation 60 Drainage works 39 Drug Addiction 18-19 Dogs - Fouling of pavements by 40 Dwellings - Number in Borough 8 Dysentery 68 Early neo-natal mortality rate 9 Enteric Fever 70 Epidemiology 65-73 Erysipelas 69 Factories Act, 1961 44-46 Food and Drugs Act, 1955:- Bacteriology 55 Hygiene 47 Ice-Cream Premises 48 Inspection and supervision of premises 47-48 Legal Proceedings 49-50 Preserved Food Premises 48 Public Analyst's Report 51-54 Street Trading 56 Food Poisoning 70 Food - Unsound 50 Fouling of pavements by dogs 40 Subject Page (s) General Hate 8 General and Vital Statistics 8-10 Health Education - Smoking and Health 15-17 Health - Personal Services 20-21 Home Accidents 29 Hospitals, list of 27 Housing Act, 1957:- Overcrowding 41 Applications for re-housing 43 Housing Act, 1961 42 Housing, New - Local Authority and Private 41 Infant Mortality 8- lO; 13 Infectious Diseases 65-73 Inspections and works carried out 35-37 International Certificates of Vaccination 69 Introduction 4-7 Land Charges - Enquiries 39 Legal Proceedings - Pood and Drugs Act, 1955 49-50 Legislation, new 59 L.C.C. - Personal Health Services 20-21 Licensing Act, 1961 57 Lung Cancer 14 Marriages 9 Mass Radiography 22-23 Maternal Mortality 9 Measles 68 Medical Examination of Staff 31 Milk - Licensing and Supply 55 Mortuary Facilities 31 National Assistance Act, 1948:- Section 21 - Part III Accommodation 28 Section 47 - Removal to Hospital/institution 28 Section 50 - Burial of the Dead 28 Neo-natal Mortality Rate 9 Noise Abatement 40 Notices - Service of 38 Notifiable Diseases 65 Notification of Infectious Diseases 66-67 Offices, Shops and Railway Premises Act, 1963 7 Old People's Welfare 24-27 Overcrowding 41 Outworkers 46 Subject Page (3) Part III Accommodation - National Assistance Act, 1948 28 Perinatal Mortality Rate 9 Personal Health Services - L.C.C. 20-21 Pet Animals Act, 1951 57 Pharmacy and Poisons Act, 1933 57 Pigeons - Destruction of 59 Poisoning, Food 70 Poliomyelitis 69 Population 8 Public Analyst - Report of 51-54 Public Baths and Swimming Pools 33 -34 Public Health and Baths Committee Members 1 Representation elsewhere by Members 2 Representation at Conferences by Members 32 Public Health Department - Staff of 3 Public Health Inspectors - Work of 33-64 Public Houses 47 Public Mortuary Facilities 31 Puerperal Pyrexia 69 Rag Flock and Other Filling Materials Act, 1951 57 Rateable value of Borough 8 Rent Act, 1957 41 Road Accidents 30 Rodent Control 58 Sanitary Administration of Borough 33-64 Scarlet Fever 68 Shops Act, 1950 56 Smallpox 68 Smoke Control Orders 64 Smoking and Health Campaign 15-17 Spastic Children 23-24 Staff:- Medical Examination of 31 Public Health Department 3 Statistics General and Vital 8-10 Births, Deaths, Infant Mortality, Marriages Population, Stillbirths, etc. 8-14 Street Trading 56 Still births 8 Town and Country Planning - Applications 39 Tuberculosis 9; 71 — 72 Underground Rooms 42-43 Unsound Food 50 Subject Page (3) Vaccination 21 Vaccination - International Certificates of 69 Vital Statistics 8-10 Voluntary Organisations - Contributions to 32 Water Supply 33 Welfare of Old People 24 - 27 Whooping Cough 68