Ac. 4345 CHE 62 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 1964 Presented to the Council of the Royal Borough of Kensington and Chelsea in accordance with the provisions of paragraph (l) of Article 8 of the London Authorities (Health and Welfare Services) Order, 1964. 1 METROPOLITAN BOROUGH OF CHELSEA PUBLIC HEALTH AND BATHS COMMITTEE (at 31st December, 1964) Chairman: Councillor J.A. Paterson-Morgan, F.L.A.S., J.P. Vice-Chairman: Councillor Mrs. C. Mallet Alderman Miss Katharine Acland, O.B.E., T.D. 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 J.E. Woolford (3 vacancies) Ex-Officio Members The Worshipful the Mayor (The Right Hon. Earl Cadogan, M.C., D.L., J.P.) The Deputy Mayor (Alderman Mrs. G.K. Buxton). 2 Borough Representation on outside Committees and other Organisations concerned with Public Health work. (at 31st December, 1964) Chelsea Deanery Alderman Mrs. G.K. Buxton Moral Welfare Association: Chelsea Chest Care Fund Alderman Mrs. G.K. Buxton Committee; Chelsea Youth Committee: Councillor W.K. Brown Councillor J.E. Woolford Family Welfare Association: Alderman Mrs. G.K. Buxton London County Council Alderman Mrs. G.K. Buxton Divisional Health Councillor A.H. Stevenson Committee (Division I): London County Council Alderman Mrs. G.K. Buxton Divisional Tuberculosis Care Committee (Division I): London and Home Counties Councillor Mrs. C. Mallet Clean Air Advisory Chief Public Health Inspector Council: National Society for Alderman Mrs. G.K. Buxton Clean Air: 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 Councillor Miss P.D.J. Molloy Committee: Westminster and Chelsea Councillor Miss Aimee Gibbings District Nursing Association: 3 STAFF OF THE PUBLIC HEALTH DEPARTMENT (at 31st December, 1964) 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 S.W. BARKER (retired 26.8.1964 Inspector and Senior Housing Inspector: Senior Public Health Inspector: H.F. LEACOCK Public Health Inspectors: T.W. CAMSEY (resigned 30.4.1964 E. CARSON (commenced duty 24.8.1964 J.E. DRAKE (commenced duty 23.11.1964) J.T. HEALY (commenced duty 6.7.1964 E. KILLBY (commenced duty 17.8.1964 J.W. PARTON (commenced duty 13.4.1964) A.J. WHITE E.R. YOUNG (resigned 23.2.1964) Women Public Health Inspectors: (Miss) A.C.C. KAY (Miss) K.G. READER (resigned 31.5.1964) Drainage Assistant: E. BOSLEY Senior Rodent Officer: J.F. COOKE Rodent Officer: P. DRURY Public Health Inspectors' A.E. ROTH Assistant: Chief Disinfector: F.W. HILL Disinfector: R.J. WESTON Chief Clerk: I.M. THOMSON Clerical Officers: P.M. MARGETTS H.G. HAMILTON L.A. POWELL M.W. SPICKSLEY (commenced duty 17.7.1964) (Mrs.) B. STEVENS P.D. GRAINGER (Miss) L. WILSON 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 Health and Welfare Department, WEStern 7211 25A, Kensington Square, LONDON, W.8. September, 1965. To the Mayor, Aldermen and Councillors of the Royal Borough of Kensington and Chelsea. Your Worship, Ladies and Gentlemen, The amalgamation of the boroughs of Kensington and Chelsea on 1st April, 1965, under the provisions of the London Government Act, 1963, means that this will be the last occasion on which I shall have the pleasure to prepare an Annual Report on the health and environmental circumstances of the Borough of Chelsea as a Metropolitan Borough Council, and in accordance with the provisions of paragraph (l) of Article 8 of the London Authorities (Health and Welfare Services) Order, 1964, I have the honour to present to the Council of the Royal Borough of Kensington and Chelsea my Annual Report for the year 1964. 1964 was a year of considerable activity behind the scenes, particularly during the latter half of the year, when plans were formulated for the integration of the two boroughs. Much time was devoted to the detailed planning of the Health and Welfare Department for the new borough in order to ensure that all the local health services including the personal health services transferred by the London County Council, are administered efficiently so as to provide the best possible service to the public. The Registrar General's estimate of the mid-year home population of Chelsea was 46,200, a decrease of 1,850 on the previous year's estimate of 48,050. Live births numbered 621 (317 males: 304 females) 1 less than in 1963 (622), indicating a crude birth rate of 13.4 per 1,000 of the estimated population, and the adjusted rate after employing the area comparability factor (0.73) was 9.8, compared with 18.4 for England and Wales. Illegitimate births totalled 88 or 14.2 per cent of the total live births registered, 13 more than during the previous year when 75 (12.1%) were recorded. Still births were returned as 11, compared with l4 during 1963, which represents an annual rate of 17.4 per 1,000 live and still births. The rate for England and Wales was 16.4 The total number of deaths recorded was 704 (323 males: 381 females) 87 less than the figure for the previous year (791), representing a crude death rate of 15.2 per 1,000 of the estimated population, and after applying the area comparability factor (O.89) the adjusted rate was 13.5, compared with 11.3 for England and Wales. It will be observed from the classified table of deaths which appears on pages 11 and 12, that the principal causes of death were heart disease 192 (27.3%); cancer (all forms) 158 (22.4%); pneumonia said bronchitis 94 (13.4%); and vascular lesions of the nervous system 82 (11.6%). 5 Heart disease and cancer continue to cause the highest mortality rates and together (350 deaths) they account for 50% of the total number of deaths. 39 deaths were attributed to accidents or violence which represents 5.5% of the total deaths recorded. The number of deaths from cancer of the lung rose from 31 in 1963 to 49 in 1964 (39 males: 10 females). 10 deaths occurred in persons in the 35 and under 55 age group, 25 between 55 and under 75 years, and 14- at age 75 and over. Infant deaths under one year of age numbered 16 as against 11 in the previous year, indicating an infant mortality rate of 25.8 per 1,000 live births, compared with 20.0 for England and Wales. 10 deaths occurred within the first week of life giving an early neo-natal mortality rate of 16.1 per 1,000 live births. The increase in deaths during the year under review was due to the incidence of prematurity, 11 deaths being recorded as against 4 in the preceding year. 11 still births were registered which, added to the 10 deaths occurring in the first week of life, gives a perinatal mortality rate of 33.2 per 1,000 total live and still births. It gives me much satisfaction to report that there were no maternal deaths or deaths from causes associated with childbirth during the year. In view of its internationally famous work it is fitting in this final report to pay tribute to the part played by the Violet Melchett Centre in pioneering Child Welfare in Chelsea. I have accordingly briefly recounted this on pages 18 to 20. The incidence of infectious disease in the Borough reached the lowest level on record when the total number of notifications received was 86, surpassing the previous lowest total recorded in 1962 when 151 cases were notified. Measles cases totalled 50, which represents 58.l% of all notifications received. It is pleasing to report that for the second successive year no case of poliomyelitis was notified and this excellent record is no doubt due to the general public taking full advantage of the vaccine which is now available to adults as well as children. 9 cases of dysentery were reported throughout the year compared with 57 in 1963. One imported case of Typhoid Fever was notified which concerned a patient who had felt ill before leaving Pakistan. After arrival in London he stayed at various addresses and was taken ill again whilst visiting friends in Chelsea. He was admitted to hospital where he received routine treatment and was finally discharged. 12 new cases of tuberculosis were notified during the year (11 respiratory and 1 non-respiratory) compared with 27 cases in the previous year. 7 of the respiratory cases concerned persons aged 20 and under 55 which represents 64% of all new cases notified. It is particularly satisfying to record that the 12 new cases notified during 1964 is the lowest total returned in any year, and the gradual decline in the incidence of this disease reflects the vast improvement in the general health of the nation during the post war period, in which improved housing conditions and higher social standards have contributed in no small measure. - 6 - Throughout the year, the Public Analyst (Mr. Thomas McLachlan) examined and reported upon 301 samples of food all of which were submitted informally, and in 14 cases (4.6%) he advised that adulteration had been found or special comment was necessary. Each case was investigated and reported to the Public Health and Baths Committee, appropriate action being taken where necessary. 15 complaints from residents were brought to the attention of the Public Health Department concerning the sale of foods which were not of a satisfactory nature. In two instances successful legal proceedings were instituted and the defendants, who pleaded guilty to the offences, were fined £5. 0. 0. in each case, plus costs. I would like to take this opportunity to express my appreciation and thanks to Mr. McLachlan for the valuable work he has undertaken as Public Analyst to the Borough of Chelsea during past years, and for the co-operation and assistance which he has so readily given me at all times. The many and varied tasks of the Public Health Inspectors concerned with the supervision of environmental conditions within the Borough continued to be dealt with in a keen and energetic manner, and a great deal of attention was given to plumbing and drainage works, the inspection and supervision of food shops and catering establishments, and the investigation of noise complaints. Steady progress has continued regarding the establishment of smoke control areas, and the Council's third Order comprising the Cheyne and Royal Hospital Wards was confirmed by the Minister of Housing and Local Government on 13th October, 1964, and became operative on the 1st July, 1965. The officers of the Public Health Department continued to show a keen interest in dealing with the care of old people, and the Social Worker undertook some 1,467 routine visits throughout the year. In addition, special visits were made by the Public Health Inspectors at the request of the Social Worker and other voluntary workers to check on living conditions and to give advice on various problems. A happy relationship exists between the Council's officers and the local voluntary organisations, and I am grateful for the close co-operation which has always been forthcoming from the Old People's Welfare Committee. During December, the Borough Council supported the London County Council in its autumn campaign alerting the public to the danger to children from the use or misuse of oil heaters. In this connection, a specially designed leaflet supplied free by the County Council was distributed to the Borough Council's housing estates and other groups of dwellings. As an additional measure, all local traders retailing paraffin were approached, and they agreed to co-operate by issuing to every customer a copy of the County Council's leaflet, together with a copy of a further leaflet supplied by the Oil Appliance Manufacturers' Association, giving simple instructions on the use of oil heaters. Although the extent of this campaign was fairly limited it is hoped that it will have resulted in many parents becoming more aware of their responsibilities to ensure that oil heaters comply with present day safety standards. The Offices, Shops and Railway Premises Act, 1963, makes provision for the Council to register, with certain exceptions, all offices and shops within its area, and the Council is also responsible for enforcing the provisions for securing the health, safety and welfare - 7 - of persons employed in such premises. Certain sections of the Act, including the requirement to register premises, came into force on the 1st May, and most of the main provisions became operative three months later on the 1st August. In order to deal with the registration of premises and the increased volume of administrative work arising from the considerable number of new inspections which were necessary, the Council agreed to the establishment of the Public Health Department being varied to provide for one additional Inspector and one Clerical Assistant. Full details of registrations received and inspections carried out during the year are incorporated in this Report. Mr. S.W, Barker, Deputy Chief Public Health Inspector, retired on the 26th August after almost 17 years' service with the Borough Council. He joined the staff of the Public Health Department in October, 1947, when he was appointed for specific duties under the Housing Act, 1936, to obtain the repair and improvement of houses in West Chelsea which had deteriorated due to neglect and war damage. He was a very capable and dependable officer whose hard work has proved of great benefit to the Borough, and his colleagues in the Department join with me in hoping that his well-earned retirement will be long and enjoyable. In conclusion, I would like to take this opportunity to pay tribute not only to the Members of the Council during the past year but to all their predecessors whom I have had the pleasure to serve since I was appointed Medical Officer of Health in 1950. I am indeed most grateful for the help and support they have given me over the years. I am particularly appreciative of the interest and enthusiasm shown by the respective Chairmen of the Public Health and Baths Committee, and their kindness towards me and the staff of the Public Health Department. I should also like to express my appreciation of the close co-operation and assistance which has always been so readily forthcoming from the other Chief Officers and their staffs. To the present members of my staff, and to the many who have served with me during the past fifteen years, I would like to extend my sincere thanks for their loyalty and the valuable services they have rendered to the citizens of Chelsea. I wish them every success and happiness in the future. I have the honour to be Your obedient Servant, J.H. WEIR Medical Officer of Health. 8 GENERAL AND VITAL STATISTICS 1964 Area of Borough: 659.6 acres General Rate: 7s.0d. in the £ (at 31st March, 1964) Product of a Penny Rate: £27,742 Rateable value of Borough as at 31st March, 1964: £7,137,503 Population: Registrar-General's estimate of the population of the Borough (mid-year 1964): 46,200 Density of population per acre: 70.04 Number of Dwellings (according to the Rate Books): 17,129 Live Births: Total Male Female Birth rate per 1,000 of estimated population: 13.4 Legitimate 533 267 266 Illegitimate 88 50 38 621 317 304 Adjustment of birth rate by area comparability factor (0.73): 9.8 (Birth rate for England and Wales - 18.4) Illegitimate Live Births (per cent of total live births): 14.2 Still Births: Total Male Female Rate per 1,000 live and still births: 17.4 Legitimate 9 5 4 Illegitimate 2 2 - 11 7 4 (Still birth rate for England and Wales - 16.4) 632 Total Live and Still Births: Infant Deaths (deaths under one year): Total Male Female Rate per 1,000 live births: 25.8 Legitimate 14 8 6 Illegitimate. 2 2 - 16 10 6 - 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 20.0) 25.8 Legitimate infant deaths per 1,000 legitimate live births: 26.3 Illegitimate infant deaths per 1,000 illegitimate live births: 22.7 Neo-natal Mortality Rate (deaths under four weeks per 1,000 total live births): 19.3 Early Neo-natal Mortality Rate (deaths under one week per 1,000 total live births): 16.1 Perinatal Mortality Rate (still births and deaths under one week combined per 1,000 total live and still births): 33.2 Maternal Mortality (including abortion): Number of deaths: Nil Rate per 1,000 total live and still births: - Deaths: Total Male Female Death rate per 1,000 of estimated population (Males 7.0 Females 8.2): 15.2 704 323 381 Adjustment of death rate by area comparability factor (0.89): 13.5 (Death rate for England and Wales - 11.3) Tuberculosis: Deaths from Pulmonary Tuberculosis: 2 Deaths from Non-Pulmonary Tuberculosis: Nil Death rate from Pulmonary Tuberculosis per 1,000 of estimated population: 0.043 Cancer of the Lung: Deaths from Lung Cancer: 49 Death rate from Lung Cancer per 1,000 of estimated population: 1.1 Marriages: Number of marriages solemnised in the Borough during the year: 764 Marriage rate per 1,000 of estimated population: 16.5 - 10 - SUMMARY OF VITAL STATISTICS 1955-1964 (inclusive) Year Registrar-General's Estimate of Population Births Deaths Deaths under One Year Maternal Deaths No.* Rate No.* Rate No.* Rate No.* Rate 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 1964 46,200 621 13.4 704 15-2 16 25 - - Averages for the ten years 1955 - 1964:- Births 701 Deaths 750 Deaths under one year of age 17 Maternal Deaths 0.1 * Totals arrived at after due allowance for inward and outward transfers. - 11 - CLASSIFICATION OF DEATHS OF CHELSEA RESIDENTS WITH AGE DISTRIBUTION FOR THE YEAR 1964 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 — — — — — — — — — - — - 3. Syphilitic disease 1 - - - - - - - - 1 - - 4. Diphtheria - - - - - - - - - - - - 5. Whooping Cough - - - - - - - - - - - - 6. Meningococcal Infections "" - - - — - - — - — - - 7. Acute Poliomyelitis - - - - - - - - - - - - 8. Measles - - - - - - - - - - - — 9. Other infective and parasitic diseases — — — — — — — — - - - - 10. Malignant neoplasm, stomach 12 - - - - — - - 1 2 3 6 11. Malignant neoplasm, lung, bronchus 49 — — — — — — 2 8 12 13 14 12. Malignant neoplasm, breast 16 — - - - - - — 4 6 - 6 13. Malignant neoplasm, uterus 5 - - — - - - 1 1 1 1 1 14. Other malignant and lymphatic neoplasms 71 — - 2 - 1 2 " 12 21 15 18 15. Leukaemia and Aleukaemia 5 - - - 1 - ' " - 1 - 3 16. Diabetes 6 - - - - - - - - 2 3 1 17. Vascular lesions of nervous system 82 - - - - - - 1 3 6 17 55 18. Coronary disease, angina 121 - - - - - 2 1 8 21 25 64 19. Hypertension with heart disease 4 - - - - - - - - - 1 3 20. Other heart diseases 67 — — — — - 2 - 1 5 9 50 21. Other circulatory diseases 48 - - - - — — 1 1 2 9 35 Carried forward 489 - - 2 1 1 6 6 39 81 97 256 - 12 - CLASSIFICATION OF DEATHS OF CHELSEA RESIDENTS WITH AGE DISTRIBUTION FOR THE YEAR 1964 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 489 - - 2 1 1 6 6 39 81 97 256 22. Influenza 1 - - - - - - - - - — 1 23. Pneumonia 55 1 3 1 - - - - 1 - 9 40 24. Bronchitis 39 - - - - - — - — 5 11 23 25. Other diseases of respiratory system 4 - - - - - - - - 2 1 1 26. Ulcer of stomach and duodenum 6 - - - - - - - - 1 2 3 27. Gastritis; enteritis and diarrhoea 3 - - — - - - - - - 1 2 28. Nephritis and nephrosis 2 - - - - - - - - 1 - 1 29. Hyperplasia of prostate 2 - - - - - - - - 1 1 - 30. Pregnancy, childbirth, abortion - - - - - - - - - - - - 31. Congenital malformations 5 1 1 - - - - - 1 - 1 1 32. Other defined and ill- defined diseases 59 10 — 2 — 1 1 — 3 7 16 19 33. Motor vehicle accidents 5 - - - - 1 - - - — 1 3 34. All other accidents 19 - - - - 1 1 - 4 5 - 8 35. Suicide 14 - - — — 1 1 5 1 2 3 1 36. Homicide 1 - - — — 1 - — - - - - totals 704 12 4 5 1 6 9 11 49 105 143 359 age mortality Age Group Number of Deaths Percentage of Total Deaths Age Group Number of Deaths Percentage of Total Deaths Under 4 weeks 12 1.70 35 and Under 45 11 1.56 4 weeks and under 1 year 4 0.57 45 and under 55 49 6.96 1 and under 5 5 0.71 55 and under 65 105 14.91 $ and under 15 1 0.14 65 and under 75 143 20.31 15 and under 25 6 0.86 75 and over 359 51.00 25 and under 35 9 1.28 - 13 - INFANT MORTALITY During the year the number of infant deaths registered was 16, five more than the figure for the previous year, giving a rate of 25.8 per 1,000 live births. The infant mortality rate for England and Wales was 20.0. It will be observed from the following summary that of the 16 deaths recorded, 12 occurred before the age of four weeks, which gives a neo-natal mortality rate of 19.3, and 10 infants died before the age of one week indicating an early neo-natal mortality rate of 16.1. The increase in deaths during the year was mainly due to the incidence of prematurity which was returned as 11, compared with four in the previous year. Cause of Death Under 1 week 1-2 weeks 2 - 4 weeks 1-3 months 3-12 months TOTAL m f m f m f m F m f m f Broncho Pneumonia - - - - - - 1 1 - 1 1 2 Prematurity 6 4 1 - - - - - - - 7 4 Congenital Heart Disease - - - - 1 - - - 1 - 2 - TOTALS 6 4 1 - 1 - 1 1 1 1 10 6 CANCER OF THE LUNG AND BRONCHUS 49 deaths (Males 39 and Females 10) were recorded during the year as compared with 31 deaths (Males 23 and Females 8) 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 1955 to 1964:- - 14 - CANCER OF THE LUNG AND BRONCHUS TUBERCULOSIS Year Males Females Total Males Females Total 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 1964 39 10 49 2 — 2 TOTALS 246 69 315 24 17 41 It will be observed from the preceding table that during the past ten years 315 deaths were attributed to lung cancer, almost eight times as many deaths as were caused by tuberculosis. During the year under review 49 Chelsea residents died from lung cancer which is the highest number recorded in any year. 79.6% of the deaths were in respect of males whilst 20.4% concerned females, the ratio of mortality being k males to 1 female. From the classified table of deaths which appears on pages 11 and 12, it will be noted that of the 49 deaths registered during the year, 10 occurred within the 35 and under 55 age group, 25 between 55 and under 75 years and 14 at age 75 and over. This significant increase in local lung cancer deaths is reflected in the national figures which rose by 886 over the preceding year, and the following is a summary of deaths for Great Britain since 1955.:- GREAT BRITAIN Year Cancer of the Lung and Bronchus Number of Deaths Registered Increase over preceding year 1955 19,001 925 1956 20,080 1,079 1957 21,109 1,029 1958 22,046 937 1959 23,393 1,347 1960 24,4l2 1,019 1961 25,288 876 1962 26,383 1,095 1963 27,350 967 1964 28,236 886 - 15 - PERSONAL HEALTH SERVICES - London County Council The London County Council was responsible for the day-to-day administration of these services. Division I of the County Council comprised the Boroughs of Chelsea, Fulham, Hammersmith and Kensington, and the Divisional Medical Officer kindly supplied the following information relating to Chelsea:- Welfare Centres Attendances at Ante-natal sessions during the year 223 Attendances at Midwives sessions during the year 446 Attendances at Post-natal sessions during the year 14 Attendances at Infant Welfare sessions during the year 7,429 Health Visiting - First Visits (including visits paid to premature infants) Children born in 1964 606 Children born in 1963 550 Children born in 1959/62 1,043 Persons aged 65 and over Number visited 18 Visited at special request of:- G.P. 3 Visited at special request of:- Hospital 6 Mentally disordered Number visited 1 Visited at request of:- Hospital 1 Persons discharged from hospital (other than mental hospitals) Number visited 4 Visited at special request of:- G.P. Visited at special request of:- Hospital 4 Infectious households (other than T.B.) Total visits: Effective 6,024 Unsuccessful 1,317 Foster mothers: child minders and private day nurseries at end of year: Number of foster mothers ) 6 Number of children fostered ) Child Perotection 6 Number of voluntarily registered child minders 6 Number of children minded 9 Number of registered private day nurseries 3 Number of children attending (authorised to receive) 50 Day Nursery attendances during the year 24,974 - 16 - Home Help Service Number of cases receiving service at end of the year: Maternity 1 Tuberculosis 4 Chronically sick (under 65 years) 25 Others 398 Mothercraft and Relaxation Classes Total Attendances during the year 345 Smallpox vaccinations 185 Inspections 155 Diphtheria injections 1,390 Poliomyelitis injections 1,162 Number of Premature infants born during the year 39 Number of Premature infant deaths under one month 8 Maternal deaths Creche attendances during the year 1,395 Details of the facilities available at the Violet Melchett Infant Welfare Centre, Flood Walk, 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) - 17 - Children's Creche: Wednesday and Friday 9.30 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. - 18 - VIOLET MELCHETT INFANT WELFARE CENTRE It is appropriate in this final report on the Health Services of this Metropolitan Borough to review the development of Child Welfare in Chelsea in which the Violet Melchett Centre has played such an important part. To put it in perspective, let us look at the position when the public health services started in 1856. In those days the population was nearly one and a half times as great as it is today. It was not, however, so evenly distributed. The big houses now in multiple occupation were then occupied by single families. Many of them have been replaced by blocks of flats. The great bulk of the poorer population were crowded into slum areas which existed, for example, on the sites now occupied by Sutton Dwellings, by Wray House, and the area to the west of Lower Sloane Street now occupied by Sloane Court East and West, and Burton Court. This last area was a rabbit warren of courts, alleys and mews, where 2,700 people lived at a density of about per acre as opposed to the Chelsea average of 62 per acre. The Medical Officer of Health of the time wrote: "....there were found in one house of four rooms in George-place - the average capacity of each room being only about 350 cubic feet - so large a number as 21 persons; each house contained on an average 10 individuals; in most instances each room was the dwelling of a separate family". 153 of every 1,000 babies died in the first year of life - i.e. 22.2% of the total deaths, and in the poorer areas these figures were substantially greater. Of children under one, 20 died from scarlet fever, measles or whooping cough, and 40 from diarrhoea, dysentery or cholera. By the beginning of this century little improvement was manifest. 148 of every 1,000 babies died under 1 year, the total infantile deaths numbering 333 out of a total population more than double what it is today. The deaths were due in the main to the diarrhoeal diseases which accounted for 90 deaths (excluding typhoid, which, incidentally, caused 20 deaths among the population), respiratory diseases 48, tubercular diseases 19, scarlet fever, measles and whooping cough accounting for 18. Compare these with the figures in this present annual report which records only 16 infant deaths under the age of one year. Of these 16, 10 virtually due to incurable causes, occurred under the age of 1 week and none was attributable to diarrhoea or other infectious diseases. Why this tremendous improvement, which you will note has only occurred during this century? This has only been achieved by hard and prolonged work. Work often humdrum and discouraging, with no early obvious results. Work which indeed had only long term benefits; which could only have been commenced and carried through by those with abundant and far-seeing vision and self sacrifice. - 19 - Improvements in the public health and in social conditions, slum clearance, progress in medical science and treatment, cleaner food, water and especially safer milk, immunisation against infectious disease and, above all, Child Welfare. In Chelsea this had its beginning by the Borough Council's appointment of a Lady Sanitary Inspector in 1902, whose duties included the inspection of the many workshops where female labour was employed, house to house inspection of the poorer districts and the investigation of infant mortality. Regarding the last, her findings included such appalling facts as: 22% of the families occupied one room only: 19% of the deaths were in firstborn: in one family 10 children had previously died under the age of 2 years: in four cases two infantile deaths had occurred in the same family within the year. It became evident that much of this was due to ignorance and improper feeding. By 1905 a by using the information from birth registration, the Lady Sanitary Inspector and Lady Visitors connected with St. George's Hospital, subsequently called St. George's Maternity and Health Society, were visiting outdoor maternity cases, giving advice and distributing leaflets on infant rearing and management. In 1906, by means of private philanthropy, a Mrs. W.E. Gordon provided dinners for nursing mothers at one penny per head at 2 centres - one in Dovehouse Street and the other in Denyer Street, where the mothers could attend for the dinners which had to be eaten on the premises. This was later extended to malnourished expectant mothers two months before their confinement. At these centres fortnightly baby weighing is first mentioned. In 1907 another centre was added at World's End. By 1910 a Dr. Tribe commenced free "Infants' Consultations" one afternoon a week at one of Mrs. Gordon's dinner centres at 85, Sydney Street. In 1911 there was founded the Chelsea Health Society under the patronage of Lord Cadogan and the Chairmanship of Lady Maud Hoare. Working in co-operation with the Public Health Department this Society promoted the health of mothers, expectant mothers and infants by visits, demonstrations, advice and infant consultations held in a room at the Wesleyan Methodist Hall, King's Road. Premises at 19 Sydney Street were rented in 19114 enabling books, records, office and clerical work to be carried on under one roof, but offset against this advantage was the unsuitability of rooms on the 1st and 2nd floors for infant consultations, entailing carrying babies up and down narrow, steep stairs. In 1916 an suite natal clinic was started, and by 1917 infant consultations, clinics and the ante natal clinic were being held by two women officials of the Borough Council, a newly appointed Health Visitor and officers of the Chelsea Health Society. A school for mothers followed in 1918, and in 1922 the Society moved to la, Manor Street, where a new venture was started by the admission of nursing mothers with their babies, where breast feeding difficulties had occurred. In 1926 Lady Melchett succeeded Lady Maud Hoare as Chairman. The difficulty of finding bigger and better premises was solved by the most generous gift by Lord Melchett of a site and the present - 20 - centre building, opened by H.M. Queen Mary on 31st March, 1931 Here clinics and offices were housed and the Nursing Mothers' rooms expanded into the Mothercraft Home. Accommodation was found for the Chelsea Day Nursery established since 1915 in a gardenless house in Sydney Street. Here also were established the Training College to train nursery nurses, the Day Nursery and the Nursery School. The Centre suffered many vicissitudes during the 2nd World War - the Mothercraft Home was closed, the Day Nursery evacuated but, like the Windmill Theatre, "We Never Closed." Despite serious air raid damage less than 50 yards away in Flood Street, the Centre remained open for the distribution of milk free or at a reduced rate to mothers and children under five, an "appointment only" clinic was held, and a war time nursery was held in the East Wing. On the greatly lamented death of Lady Melchett in 1945 she was succeeded by the Marchioness of Reading under whose wise guidance and advice the Centre was restored to its full range of pre-war activities and has continued to increase and improve its sphere of usefulness. Its activities are now world famous and minister most efficiently to the needs of mothers and children - an average of some 300 weekly a far cry from the early days of the Chelsea Health Society when only 20-25 mothers and babies were seen. From 1948 until the reorganisation of London Government, it has continued as a voluntary organisation with financial aid from the London County Council. There is no doubt that it will continue its beneficent work for the benefit of the mothers and children of the new Royal Borough of Kensington and Chelsea. - 21 - 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 1964:- Mobile Mass X-Ray Units of the South West London Service made nine visits to the Borough of Chelsea during 1964. These included the annual visit to the Chelsea College of Science and Technology and to the College of St. Mark and St. John, to X-ray students and staff. Visits were also made to X-ray staff of two large stores, the Power Station at Lots Road, and one engineering firm where a case of tuberculosis had occurred on the premises. Several hundred men in the over 45 years of age group, who live or work in Chelsea, are attending the special six-monthly service, which 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. In connection with this service, a Mobile Unit visited a site in Manresa Road in April and November. Residents in Chelsea are making use of the facilities available to all members of the public at 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.m. 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 - 8 years, referred by clinics or general practitioners, are required to make an appointment beforehand. Children aged 8 - 14 years sure X-rayed at the public sessions, if it is requested by their general practitioner. 20 general practitioners in the Borough of Chelsea use the G.P. Referral Service, and send patients to this Centre for chest X-ray examinations. Ante-Natal Clinics in the Borough continue to send their patients to the large film sessions which are provided for them at the Western Hospital Mass X-Ray Centre. During the year, many parties of school children, who were positive reactors to tuberculin skin tests given in connection with the London County Council B.C.G. Innoculation Scheme, came to this Centre for chest X-ray examinations. Cases of tuberculosis discovered amongst those attending from the Borough of Chelsea are not recorded separately, but in the year under review, a total of 104,000 people were examined in South West London by Units of the Mass X-Ray Service, as a result of which, 178 cases of active pulmonary tuberculosis were referred to Chest Clinics for treatment. Employers and Managements are asked to co-operate in the elimination of tuberculosis in offices, factories and other places of work, by notifying the Headquarters of the South West London Mass XRay 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. 22 Everyone who lives or works in Chelsea is invited to make full use of the public sessions at the Mass X-Ray Centre at the Western Hospital, Particulars about the visits of Mobile Units in the Chelsea area can be obtained from the Headquarters Office, Western Hospital, Seagrave Road, S,W,6,, telephone: FULham 9311 Ext, 39, CENTRE FOR SPASTIC CHILDREN - 61/62 Cheyne Walk, The Secretary of the Chelsea and Kensington Hospital Management Committee has kindly supplied the following report on the work of the Centre for Spastic Children during 1964:- One of the establishments under the control of the Chelsea and Kensington Hospital Management Committee, the Centre has had another busy year treating children suffering from cerebral palsy, Over 70 children attend regularly and receive treatment as necessary in the form of physiotherapy, hydrotherapy, occupational therapy and speech therapy, Routine neurological examination is coupled with psychological and audiological tests and the specialist services of other Consultants in the hospital group are readily available, e,g, ophthalmology, orthopaedic surgery, etc, The London County Council Special School which forms part of the Centre comprises two classes, both of which have their full complement of fifteen children and for the first time in ten years there is a waiting list of children for admission, Until such time as they can be accepted for the School these children attend the Centre for therapy, The Special Care Unit which deals with ineducable children has also had a busy year, These children, who cannot benefit from normal educational activities, are trained to acquire self-reliance in basic functions such as feeding, toilet, dressing, etc, An interesting development here has been the acceptance for assessment of a small group of children whose mothers contracted Rubella during pregnancy and who have severe hearing and visual defects and a defective heart condition, It is an underlying principle that children attending the Centre shall not be resident and thus shall not be deprived of the benefit of their home environment, This presents a great problem in transportation to and from the Centre daily and a second vehicle was acquired during the year which now enables children to be collected from contiguous areas north and south of the Thames, Other children are brought to the Centre by parents and by the Ambulance and Hospital Car Services, The Hostel, next door, which is run by the Friends of the Centre, provides accommodation from Monday to Friday for up to six children for whom the daily journey would be impracticable or for a mother and child who have to attend for a few days for complete assessment of the child, Owing to increasing demand for this facility, the Friends have agreed to extend the accommodation, 23 A new project was started during the Christmas holidays, This takes the form of a holiday Youth Club for handicapped children between 7 and 16 years of age who can avail themselves of the equipment and facilities of the classrooms during the school holidays and, incidentally, provide welcome relief to their parents, About thirty children attend, the majority being former patients of the Centre, With the exception of a paid organiser, this project functions entirely with voluntary help and has already proved a great success, Not only does the Centre fulfil an important role in caring for spastic children but it has achieved wide renown for its knowledge and experience in this field, Its postgraduate courses for therapists attracts participants from many countries, large numbers of doctors have attended medical courses, visitors come from far and wide, and there is a constant demand for information and for the loan of library material and films which have been made at the centre, WELFARE OF OLD PEOPLE The investigation of the circumstances and living conditions of each old person was undertaken by the Council's Social Worker and, in this connection, 1,467 re-visits were made to the 1,200 old people on the register and 188 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 was of great value and provided a constant liaison with the Public Health Department, Grant The Borough Council made a grant of £2,500 per annum to the Old People's Welfare Committee, 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 ensured that housebound old people aire certain of one meal a day, but provided a valuable link with all services available, Number of meals issued during the year 14,082 Average weekly supply 271 Average number of old people supplied 66 To cover the weekend, voluntary helpers took homemade soup to old people just discharged from hospital or who were too ill to eat solid food, 24 Chiropody - Domiciliary Service 190 persons received 607 treatments given by two qualified chiropodists working six days a month between them, All applicants were approved by the Social Worker before informing the British Red Cross Society who administer the service, Chiropody - Old People's Clinic 1,855 treatments were given at the Chelsea Community Centre which was staffed by London County Council chiropody itudents, This twice weekly service was free to the pensioners, Domiciliary Library and Shopping Services were supplied by the Women's Voluntary Services and the British Red Cross Society on the recommendation of the Social Worker, Holidays Throughout the Summer, holidays were arranged with the Women's Holiday Fund, and Hotel and Boarding House Associations at seaside resorts particularly Ramsgate, where a small hotel caters for old people, During eight weeks of the year this hotel was occupied entirely by Chelsea residents, and to make travelling easier, each party was taken by coach direct from the Town Hall to the hotel, Number of assisted holidays 59 Self-paid holidays 65 Total 124 The more infirm people requiring holidays were referred to the Physically Handicapped Department of the London County Council, Incontinent Laundry 31 people took advantage of this twice weekly service and some 5,612 lbs of soiled articles were laundered, This service often disclosed a need for beds, bedding and clothing which were supplied by the Department and the voluntary services jointly, Christmas Parcels The Christmas Dinner Fund Committee collected sufficient money to provide 1,000 lonely old folk with a Christmas parcel, In addition to this number it is known that over 500 other pensioners received some form of parcel or gift, Coal During the year various sums totalling £175 were received by the Old People's Welfare Commitee and this enabled 120 old people to receive two cwts, of fuel, 25 Clothing Issues have been made through the Women's Voluntary Services and the Social Worker to 159 persons during the year, Old Time Dancing and Arts and Crafts Classes Both these classes were very well attended and proved of considerable therapeutic value to their members, The classes were sponsored by the London County Council who provided the Instructors and charged a small fee of ls,6d per term and 2s,Od per annum respectively, Number attending Dancing Class 60 Number attending Arts and Crafts Class 32 Hospital Admissions and Institutional Care Difficulty in securing accommodation for the chronic sick continued but as excellent relations exist between the Department and the local hospitals, patients were admitted with the minimum of delay, Every effort was made by the Old People's Welfare Services to maintain old people in their homes as long as possible, with the result that only 21 people were admitted to Homes during the year, and in only one case was it necessary to take action under statutory powers, Outings The clubs, as usual, held their annual outings to the sea, and four additional outings were arranged, This enabled 135 persons to enjoy a day in the country, Additional trips were arranged by the British Red Cross Society during the year and a number of persons were taken for outings to the country, 26 HOSPITALS AND NURSING HOMES SERVING THE BOROUGH Hospitals Type of Institution Brompton Hospital, Fulham Road, S,W,3, Chelsea Hospital for Women, Dovehouse Street, S,W,3, Granard House, 98, Dovehouse Street, S,W,3, (Part of Royal Marsden Hospital), Royal Marsden Hospital, Fulham Road, S,W,3, Royal Hospital, Royal Hospital Road, S,W,3, St, Luke's Hospital, Sydney Street, S,W,3, St, Stephen's Hospital, Fulham Road, S,V,10, The Centre for Spastic Children, 6l, Cheyne Walk, S,W,3, Victoria Hospital for Children, Tite Street, S,W,3, Chest Diseases General Malignant Diseases Malignant Diseases Home for Pensioners Chronic Sick General Treatment and research of cerebral palsy in the very young children, Children's Diseases Nursing Homes Belgravia-Chelsea Nursing Home, 39, Royal Avenue, S,W,3, Private 27 NATIONAL ASSISTANCE ACTS, 19W1962 (a) National Assistance Act, 1948 - Section 47, and National Assistance (Amendment) Act, 1931 - 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 76 years, who was living alone, and was suffering from the effects of self-neglect 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 was, in this particular respect, "the local authority", and such accommodation was provided at "King's Mead", Dovehouse Street, During 1964, it was considered necessary to arrange for the admission of 21 persons to such accommodation and all but five 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 was required to arrange for the burial or cremation of any person who died, or who had been found dead in the Borough, if it appeared in such cases that no other suitable arrangements could be made, Cremation was not carried out having regard to the many legal, religious, administrative and practical difficulties, and disposal was always by way of interment which obviated any suggestion that the Council had acted in an unauthorised manner, * The Borough Council had 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 (Aged) 58 years 68 years 85 years 28 ACCIDENTS IN THE HOME The following summary of home accidents occurring within the Administrative County of London daring 1964 has been prepared from statistical information which has kindly been provided by the County Medical Officer of Health, During the year, 85 Chelsea home accident cases were removed to hospital by the London Ambulance Service compared with 92 and 91 cases in 1963 and 1962 respectively, The home accident figures for L,C,C, Health Division 1 (comprising the boroughs of Chelsea, Kensington, Hammersmith and Fulham) are shown separately, and it will be observed that falls in and about the home continued to cause the highest casualty rate, Of a total of 1,139 accident cases reported in Health Division 1, 853 (75,0%) were due to falls, Summary of Home Accidents reported by the London Ambulance Service Cause of accident County of London Division 1 comprising Chelsea, Kensington, Hammersmith and Fulham Fall On stairs 824 122 From ladder 98 14 From chair 146 14 Outside (i,e, windows, balconies, roofs, etc,) 198 28 In garden 175 11 In bath 21 1 From one level to another, (i,e, tables, boxes, beds, etc,) 341 4l On same level (i,e, in room, over objects) 470 59 Unspecified 4,509 563 Sub-Total 6,782 853 Hit by object 218 23 Cooking stove (saucepans, water, fats, etc,) 170 21 Teapot 59 6 Other boiling water 199 26 Electric shock 49 4 Poisoning (including foreign objects) 473 58 Gassing 185 22 Knife-like wounds (including spikes and cuts from glass) 373 44 Fires 221 24 Windows (trapping) 23 5 Suffocation 27 4 Not specified 412 49 TOTAL 9,191 1,139 29 ROAD ACCIDENTS The total number of road, accidents occurring within the Borough during 1964 was 483, causing 614 casualties, 5 of which proved fatal, Compared with the figures for the previous year when 468 accidents caused 619 casualties resulting in 2 deaths, the number of accidents increased by 15 but casualties fell by 5, It is once again gratifying to record that there were no fatalities among children, but five children were seriously injured, 44 children sustained slight injuries, I am again indebted to the Town Clerk for making this statistical information available to me for inclusion in my Report, Month Accidents Adult Children Total Killed Seriously Injured Slightly Injured Killed Seriously Injured Slightly Injured Killed Injured January- 35 - 3 35 - - 3 - 41 February 38 - 16 38 - - 4 - 58 March 31 - 5 24 - - 5 - 34 April 43 1 6 42 - 1 7 1 56 May- 50 - 3 52 - - 6 - 61 June 4o - 7 48 - 1 1 - 57 July 43 1 3 36 - 2 5 1 46 August 32 1 14 23 - - 2 1 39 September 40 1 7 42 - - 4 1 53 October 47 - 7 48 - 1 4 - 60 November 39 1 9 39 - - 2 1 50 December 45 - 12 41 - - 1 - 54 TOTALS 483 5 92 468 - 5 44 5 609 Accidents per mile of road 14,6 30 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 £l,lls, 6d to £5,15s, 6d, The following table shows the number of cremations carried out in respect of Chelsea residents during the seven 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 1964 23 3.3 The total number of cremations carried out in Great Britain and Northern Ireland during 1964 was 255,613, compared with 261,340 in 1963, In terms of recorded deaths these figures represent 43,2% compared with 41,0% for the preceding year, PUBLIC MORTUARY FACILITIES AND CORONER'S COURT There are no mortuary premises situate within 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, 246 post-mortems were carried out in respect of Chelsea residents, MEDICAL EXAMINATIONS During the year sixty-three examinations were carried out on the Council's employees and new entrants to the superannuation scheme, As a result of the examinations, sixty-two proved successful and one was referred for re-examination within twelve months, 31 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 Health Inspectors Portsmouth 15th to 18th September Central Consultative Committee on the Welfare of Old People London 23rd October Institute of Baths Management Eastbourne 29th September to 2nd October London Council of Social Service London 21st February and 17th November National Society for Clean Air Harrogate 20th to 23rd October National Women Citizens' Association London 30th October Royal Society of Health Torquay 27th April to 1st May CONTRIBUTIONS TO VOLUNTARY ORGANISATIONS The Public Health and Baths Committee recommended payments to the funds of voluntary organisations during 1964, as follows £, s, d Central Council for Health Education 7, 11, 3 Chelsea Old People's Welfare Committee 2,500, , 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 The Samaritans 50, 0, 0 32 OIL HEATERS - DANGER TO CHILDREN The Council at its meeting on l8th November, considered an extract from the minutes of the meeting of the Metropolitan Boroughs' Standing Joint Committee on 12th October, referring to the launching by the Health Committee of the London County Council of an autumn campaign to alert the public to the danger to children from the use or misuse of oil heaters, The County Council were arranging for 450,000 copies of a specially designed leaflet to be printed and distributed to tenants on its housing estates, the County Council bearing the cost of printing and arranging delivery of the required quantities to a central address, The Council agreed that it would support such a campaign and would arrange for the distribution of leaflets not only at its housing estates but also in the Town Hall, Public Library and other public buildings, Arrangements were therefore made for the distribution of the leaflets at the Council's housing estates and other dwellings during the fortnight commencing 13th December, distribution being carried out entirely by the housing estates porters and the staff of the Public Health Department, Three small displays were sited in the Public Library and the main entrances of the Town Hall and Chenil Galleries, In addition, posters and leaflets were displayed at the Old People's Clubs, and the local voluntary organisations co-operated by displaying posters and issuing leaflets, As an additional measure, all local traders retailing paraffin were approached, and they agreed to co-operate by issuing to every customer a copy of the County Council's leaflet, together with a copy of a further leaflet supplied free by the Oil Appliance Manufacturers' Association giving simple instructions on the use of oil heaters, SANITARY ADMINISTRATION OF THE BOROUGH The following section of the Report (pages 32 to 65 ) is devoted to the work of the Public Health Inspectors together with other associated officers, The Borough is divided into five areas, each being the responsibility of one Inspector, In addition, one Public Health Inspector was engaged on duties concerned with the establishment of small control areas under the provisions of the Clean Air Act, 1956, The woman Inspector dealt with the inspection of premises under the Offices, Shops and Railway Premises Act, 1963, the supervision of food premises including food shops, stalls, etc,, and also undertook the sampling of articles of food, The majority of the work of the Inspectors was carried out without recourse to statutory measures, and although 690 complaints were brought to the attention of the Public Health Department and some 18,517 inspections and re-visits made to all types of premises, it was only necessary to institute legal proceedings in two cases which concerned the sale of foods unfit for human consumption, 33 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, All samples, excepting samples of well water, were submitted for analysis to the laboratory of the Metropolitan Water Board and certificates giving the result of the analysis were 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 one of the ten cases referred to the Department, A further supply was repaired at the direct request of the Inspector 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, 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 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-eight samples of water were taken from baths, pools and sources of supply, for bacteriological examination, all of which were reported satisfactory, During recent years considerable works have been carried out to improve the facilities at the Public Baths, the most recent of these being the improvement of the men's and women's personal baths and the modernisation of dressing accommodation in both swimming pools, 34 During the winter months the large pool is closed for swimming and a sprung maple floor laid over the whole area of the pool, This provides an indoor sports area for youth clubs under the control of the London County Council, This facility is well used and during morning sessions is available to schools other than those controlled by the London County Council, The total attendances at the private baths and the swimming pools during the financial year 1st April, 1964 to 31st March, 1965 were 32,089 and 141,773 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, 35 GENERAL SUMMARY OF THE WORK OF THE PUBLIC HEALTH INSPECTORS INSPECTIONS AND RE-VISITS DWELLINGS: After complaints 2,419 After infectious disease 154 House-to-house, underground rooms and overcrowding 381 Miscellaneous unclassified 322 3,276 FOOD PREMISES: Butchers 298 Fishmongers and fish friers 33 General provision shops and dairies 235 Ice cream vendors 132 Bakehouses and factories 60 Street traders 167 Hotels, restaurants and dining rooms 1,039 Premises in connection with unsound food and food sampling 137 Unclassified premises 168 2,269 FACTORIES AND OUTWORKERS: Factories other than Food Factories 208 Outworkers 30 238 MISCELLANEOUS: Animals, poultry and birds and Pet Animals Act, 1951 ,,, 39 Open spaces and highways 84 Office premises 9 Merchandise Marks Act 74 Premises re Pharmacy and Poisons and Offices, Shops and Railway Premises Act 1963 981 Premises re Voluntary works 5,580 Visits to owners, agents and builders' offices 379 Food poisoning - Visits to aged and infirm persons 88 Visits resulting in "no access" 801 Other Visits 1,246 Clean Air Act, 1956 including smoke observations and atmospheric pollution recording 2,779 Verminous persons 42 12,102 PREMISES FOR THE TESTING OF DRAINS BY: Air Smoke Water 106 46 480 6,52 TOTAL 18,517 36 REPAIRS AND INSTALLATIONS SUPERVISED INCLUDING BOTH VOLUNTARY WORK (V) AND WORK AS THE RESULT OF THE SERVICE OF NOTICE (N) UNDER VARIOUS ACTS, CLEANSING AND REDECORATING V. N. Rooms, passages and staircases 20 65 GENERAL REPAIRS Roofs, gutters and rainwater pipes 24 45 Yard and area pavings - 2 Walls and ceilings 6 166 Floors, staircases, window and door frames 3 106 Fireplaces and chimney flues - if Dampness remedied - 126 Miscellaneous 1 3 DRAINAGE AND SANITARY CONVENIENCES Total and partial reconstructions including frontages 1 10 Obstructions cleared 6 10 Inspection chambers and covers provided - 2 Interceptors provided 3 3 Soil, ventilation and waste stacks constructed and repaired 35 16 Waterclosets and waste water preventers repaired and renewed 421 47 Sinks provided or renewed 274 11 Baths provided 339 9 Wash-hand basins provided or renewed 307 23 Waste pipes cleared or repaired - 4 Urinals repaired - - Miscellaneous 2 3 WATER SUPPLY Supplies provided to tenements _ _ Taps supplied on main for drinking purposes _ _ Burst pipes repaired _ _ Cisterns cleansed, covered or repaired _ 1 Totals carried forward 1,442 656 37 REPAIRS AND INSTALLATIONS SUPERVISED INCLUDING BOTH VOLUNTARY WORK (V) AND WORK AS THE RESULT OF THE SERVICE OF NOTICE (N) UNDER VARIOUS ACTS, MISCELLANEOUS PROVISIONS V. N. Brought forward 1,442 656 Soap and towels for staff 3 — Staff rest and changing rooms - - Constant hot water 3 1 Refuse bins 1 5 Covered display and counter screens provided 2 - Natural and mechanical ventilation 7 11 Natural and artificial lighting 3 3 Removal of offensive accumulations on open - land and bomb sites 1 3 First aid equipment provided - 21 Thermometers provided - 15 Totals 1,462 715 Grand total 2,177 Note: Included in this table are 148 dwelling houses repaired as a result of the service of Notices, 38 NOTICES SERVED Public Health (London) Act, 1936 Intimation 120 Nuisance 46 Section 40 - Drainage 23 L,C,C, (General Powers) Act, 1954 Section 12 - Provision of dustbins - Intimations 2 L,C,C, (General Powers) Act, 1955 Section 25 - Stopped up drains 19 Section 27 - Urgent Nuisances 3 Factories Act, 1961 Health - general provisions 3 Food and Drugs Act, 1955 Defects at Food Premises 32 Offices, Shops and Railway Premises Act, 1963 Defects in offices, shops etc, 148 TOTAL 396 NOTICES COMPLIED 219 notices were complied with during the year of which 165 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 244 applications were received for the drainage of premises and of this total 48 were in respect of combined schemes affecting two or more separate premises, TOWN AND COUNTRY PLANNING Close liaison continued 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 522 applications were referred to the Public Health Department compared with 516 for the previous year, 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 continued to be posted on lamp standards throughout the Borough but due to their deterioration by exposure to the weather had to be frequently renewed, - 40 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, NOISE ABATEMENT 50 complaints concerning alleged noise nuisances were received throughout the year and the following summary sets out the various nuisances dealt with by the Public Health Inspectors:- Noise nuisance from Number of complaints Air conditioning plant 2 Boiler flues 3 Building operations on sites 10 Circular saws 1 Compressors 2 Dance bands 4 Dog barking 1 Factory machinery 3 Garage at rear 1 Launderettes 4 Neighbours 4 Pneumatic drills 3 Power station generator 4 Printing presses 1 Refrigerator 1 Restaurants 3 Roadworks 1 Traffic 1 Ventilating shaft 1 50 All the complaints were thoroughly investigated and our representations to the various offenders were in the majority of cases received in a most co-operative manner and every assistance was given in either reducing the noise or completely abating the nuisance, It will be observed from the foregoing summary that noise caused by building operations gave the greatest cause for complaint and usually an approach to the site contractors resulted in the noise being reduced in intensity but in a few cases no noticeable improvement could be effected, In the few cases where complainants were not satisfied with the action taken by the officers of the Public Health Department, their rights under private action were explained to them, No cases were considered suitable for legal action by the Council and no proceedings were instituted by private individuals, 41 LAND CHARGES The number of enquiries dealt with was 1,365, compared with 1,345 during the preceding year, These concerned outstanding statutory or informal notices, combined drainage orders, smoke control orders and certificates of disrepair etc, RENT ACT, 1957 For the sixth successive year no applications were received or certificates issued in accordance with the provisions of the above Act, HOUSING ACT, 1957 - PART IV - OVERCROWDING During the year under review 6 families were found to be living in overcrowded conditions and the following summary shows the extent of overcrowding in the Borough at 31st December, 1964:- New cases investigated and recorded 6 Number of families involved 6 Number of persons involved 33 Cases on register at 31st December, 1964 28 Number of persons involved 162 Each case of overcrowding was fully investigated by the district Public Health Inspector concerned, and apart from any official action that could be taken by the Borough Council or the London County Council to provide alternative accommodation, every possible channel was explored to effect an abatement by informal procedure, NEW HOUSING Number of new dwellings completed during the year:- (a) by the Borough Council Nil (b) by other persons (private) 91 HOUSES IN MULTIPLE OCCUPATION No extra staff has been engaged to deal with this class of property in accordance with the requirements of the Housing Act, 1961, and the further requirements of the Housing Act, 1964, which became operative during this year, Without the appointment of additional staff it was not possible to deal with specific streets or areas by house-to-house inspections, but during the year 39 premises comprising 149 separate lettings were inspected, 31 premises were being converted by the owners and all were by informal action made to comply with the standard adopted for houses in multiple occupation, 42 UNDERGROUND ROOMS The new regulations made by the Council on the 7th November, 1963, became operative on the 10th February, 1964, The policy of previous years has been continued of dealing with occupied basements only where conditions are particularly bad, by reason of the difficulties of finding alternative accommodation for the occupiers, During the year no Closing Orders were made, 219 unoccupied underground rooms were inspected in premises where alterations, improvements or conversions were to be carried out, and after site meetings with architects or builders, all were made to comply with the requirements of the regulations or put to alternative permitted use, 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; and Other circumstances, During the year, 62 applications were referred to the Public Health Department, 46 originated from Chelsea residents and the remainder from applicants living in another area, Each case was investigated and all were in connection with ill-health including tuberculosis, bringing the total number of cases since May 1953, to 471 residents and 126 non-residents, Twenty-six tenants in Council premises were also referred to this Department during the year for an opinion or pointing on medical grounds, A total of 417 such cases have been dealt with since 1955- 43 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 year:- 1, INSPECTIONS OF FACTORIES, WORKSHOPS AND WORKPLACES Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (1) Factories in which Sections 1, 2, 3,4 and 6 are to be enforced by Local Authorities: 43 21 2 - (2) Factories not included in (1) in which Section 7 is enforced by Local Authorities: 177 239 1 - (3) Other premises in which Section 7 is enforced by Local Authorities 17 8 - Total. 237 268 3 - NOTE:- Outworkers' premises are not included in (3) above, *i,e, Electrical Stations - Section 123(1), Institutions - Section 124, and sites of Building Operations and Works of Engineering Construction - Section 127 44 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 1) 1 _ _ _ _ Overcrowding (Section 2) - _ _ _ _ Unreasonable Temperature (Section 3) _ _ _ _ _ Inadequate Ventilation (Section 4) _ _ _ _ _ Ineffective drainage of floors (Section 6) _ _ _ _ _ SanitaryConveniences (Section 7) (a) Insufficient _ _ _ _ _ (b) Unsuitable or defective 14 6 _ 2 _ (c) Not separate for sexes _ _ _ _ _ Other offences against the Act (not including Outworkers) 1 _ _ _ _ TOTAL 16 6 _ 2 _ 45 FACTORIES ACT, 1961 (continued) OUTWORK Sections 133 and 134 Nature of Work No, of Outworkers in August list as required by Section 133(1)(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 _ _ _ _ _ _ Furniture and Upholstery _ _ _ _ _ _ Stuffed Toys _ _ _ _ _ _ Lampshades _ _ _ _ _ _ Jewellery _ _ _ _ _ _ TOTAL 3 _ _ _ _ _ 46 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 The Offices, Shops and Railway Premises Act, 1963, makes provision for the safety, health and welfare of people employed in these premises, Certain sections of the Act, including the requirement to register premises, came into force on the 1st May this year, and most of the main provisions on the 1st August, Set out below is a brief summary of the number of premises registered, inspected and notices served etc, REGISTRATIONS AND GENERAL INSPECTIONS Class of premises Number of premises registered during year* Total number of registered premises at end of year* r of registered premises receiving general inspections during the year Offices 326 320 81 Retail shops 429 4l4 130 Wholesale shops, warehouses 22 22 4 Catering establishments open to the 136 135 35 public, canteens Fuel storage depots _ _ _ *These figures differ due to premises closing down and cases where premises have been classified as factories and were referred to H,M, Inspector of Factories, ANALYSIS OF PERSONS EMPLOYED IN REGISTERED PREMISES BY WORKPLACE Class of workplace Number of persons employed Offices 4,888 Retail shops 3,853 Wholesale departments, warehouses 546 Catering establishments open to public 1,405 Canteens 102 Fuel storage depots — TOTAL 10,794 TOTAL MALES 5,269 TOTAL FEMALES 5,525 NUMBER OF NOTICES SERVED 148 - 47 - Three applications for exemptions were received during the year; two were subsequently withdrawn by the applicants and the remaining one will be considered by the Council early next year. 14 accidents were reported during the year (none was fatal), seven of which were investigated by this department and advice given where necessary. Main causation of the accidents Stepping on or striking against object or person 5 Using cutting or piercing instruments 3 Handling materials or articles 3 On or from fixed stairs 2 Falls on same level 1 FOOD HYGIENE Food shops and catering establishments were supervised by the two women Public Health Inspectors and absorbed practically the whole of their time, until the resignation of one at the end of May, to take up a similar appointment with the Westminster City Council. Apart from day-to-day supervision, there are frequent changes of ownership with resultant changes in design and kitchen layouts. In addition, 12 new restaurants 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 was carried out to existing ventilation plants and in many cases the cause of complaints of the discharge of cooking odours was completely eliminated. Many instruction talks were 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 it has always been possible to obtain the assistance of a member of the management. Simple instruction sheets on food hygiene were prepared in ten languages for distribution and display in such establishments. Modernisation schemes continued 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 sufficient toilet facilities for customers and in a number of such cases it has been possible to provide additional water-closets, urinals and washing facilities. Efforts in this direction continue but in some of the very small premises structural difficulties make the provision of full standard requirements impossible. - 48 - Pre-packing of goods for display is still gaining in popularity and calls for considerable checking of food preparation rooms. Open food is still displayed in retail premises and a great deal of the Inspectors' time was occupied in ensuring the protection of such foods from contamination. During the year five premises retailing bread, cakes and other confectionery ceased trading. 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 remained reasonably static, and the only variations during the year worthy of mention were the increase in the number of clubs, restaurants, canteens and miscellaneous catering establishments, etc., from 252 to 273 and the reduction in the number of miscellaneous premises (bread and cakes, confectionery, etc.) from 48 to 43. The following table classifies the types of food premises, all of which are subject to regular routine inspections:- Bakehouses 7 Butchers 25 Food factories (flour mills, bottling stores) 3 Milk retailers (including dairies) 67 General provision merchants (not selling milk) 14 Fruit and vegetable retailers 23 Hotels and Public Houses, Clubs, Restaurants, Dining Rooms, Canteens and miscellaneous catering establishments 273 Fried fish premises 2 Wet fish retailers 7 Miscellaneous premises (Bread and cake shops, sweets and confectionery shops, meat pie store) 43 Ice-Cream Premises Section l6(l)(a) of the Food and Drugs Act, 1955, provides for the registration of premises used for the sale, manufacture, and storage for sale of ice-cream. At the end of the year the premises so registered numbered 94. There are no manufacturers of ice-cream in the Borough, and apart from restaurants there are only two retailers selling loose icecream. It is the policy of the Public Health Inspectors to encourage as far as possible the sale of pre-packed ice-cream, but machines for the sale of soft ice-cream appear on the vehicles of a number of itinerant traders, and these were kept under constant supervision by the Public Health Inspectors. - 49 - Preserved Food Premises Section l6(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. 33 premises were registered at the end of the year. LEGAL PROCEEDINGS - FOOD AND DRUGS ACT, 1955 UNSATISFACTORY PURCHASES Fifteen 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 nature:- (a) Sale of a mouldy 8-oz. packet of pork sausages. (b) Presence of a foreign object in a bottle of milk. (c) Presence of a key in a bottle of milk. (d) Sale of a currant cake containing a small stone. (e) Sale of a sliced loaf three slices of which were mouldy. (f) Presence of a beetle in a chicken vol-au-vent. (g) Sale of a jar of apricot jam containing a maggot. (h) Sale of a polythene packet of bread rolls which were spotted with mould. (i) Sale of a packet of streaky bacon which on opening was found to be sour. (j) Sale of a mini pork pie containing a live earthworm. (k) Sale of a packet of 'pasta' infested with weevils. (l) Sale of a half-pint bottle of sour milk. (m) Sale of alleged unsound cheese. (n) Sale of a cheese and chutney sandwich containing a piece of glass. (o) Sale of casserole steak not of the quality demanded. The aforementioned adulterations were thoroughly investigated and reported to the Public Health and Baths Committee for appropriate action. In cases (f) (g) (j) (k) (l) (m) and (o) the Committee decided, having regard to all the circumstances, that no further action could be taken. In regard to cases (b) (c) (d) (e) (i) and (n), legal difficulties or mitigating circumstances negatived the institution of legal proceedings and warning letters were sent to the firms concerned. With reference to case (a), the sausages had been delivered to the shop on the 20th December but had not been sold until the 28th December, and the Committee had some months previously given a strong warning to this shop concerning the sale of bacon containing maggots, stating that any repetition could result in legal proceedings. The Committee authorised that legal proceedings be instituted against the Company concerned who pleaded guilty to the offence and were fined £5 plus £5. 5. Od costs. - 50 - Concerning case (h), when the rolls were examined shortly after purchase they were found to be spotted with green mould. Following complaint, a further packet was found in the same store likewise contaminated. From enquiries made, it appeared that the growth of the mould was due to the fact that the rolls had been packed in polythene while too hot. As there had been previous complaints concerning this particular store the Committee authorised that legal proceedings be instituted against the Company concerned who pleaded guilty to the offence and were fined £5 with costs totalling £3. 3. Od. 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 5,256 lbs. were surrendered to the Public Health Inspectors:- Commodity Weight - lbs Butter 28 Fish, frozen 149 Fish, tinned 2 Flour 90 Fruit, tinned 115 Ice cream 56 Meat, cooked 2,240 Meat, frozen 1,694 Poultry, frozen 325 Rice 88 Sugar 149 Sweets and pastries 16 Vegetables, frozen 279 Vegetables, tinned 25 TOTAL 5,256 - 51 - ANNUAL REPORT OF THE PUBLIC ANALYST for the year ended 31st December, 1964. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Chelsea. Your Worship, Ladies and Gentlemen, During the year 1964, 301 samples of food, all submitted informally, were examined. The number adulterated or about which some comment was made was l4. The incidence of these criticisms may be classified as follows:- Number of samples Number of samples examined adulterated, etc. Milk 97 - Other foods 204 14 A sample submitted as "Lemon Cream" did not comply with the Food Standards Preserves Order for Lemon Curd, as it contained only 64 per cent instead of the minimum requirement of 65 per cent of sugar. As, however, it contained much more egg than is required or normally present, it was reported as satisfactory. An Apricot Nectar was labelled as containing "Apricots, water, sugar", but contained only 39 per cent of apricots and 20 per cent of sugar including the sugars natural to the apricots which are probably about 8 per cent. It therefore contained not less than 4l to 45 per cent of added water, and although it is not necessary to declare the presence of added water, the water, if declared, must be in the correct position. Some Celery Salt containing 55.8 per cent of salt, was incorrectly labelled "Ground Celery, Salt." The manufacturers agreed to increase the proportion of celery seed to 51 per cent. A "Pure Grape Juice" contained added colour, Amaranth Fast Red and Green S, without a disclosure of their presence. The bottlers have not yet decided on what action to take as they are anxious not to have to inform customers that their product contains added colour. A can of Mixed Vegetables was stated to contain "Carrots, potatoes, peas, and swedes", but in fact contained 30.9 per cent of peas, 24.7 per cent of potatoes, 20 per cent carrots and 14.4 per cent swedes, showing that the above order of disclosure is incorrect. Some Turtle Soup Tablets were stated to contain wine, but no wine was present. As soup tablets are a dry product without even the necessary oily constituents required to retain any semblance to wine - 52 - flavour, it is doubtful whether any appreciable quantity could have been added to allow for the pretence that it can affect the flavour. A chutney possessed an unpleasant odour and was stated to have a slimy taste. Chemical examination showed the chutney to be satisfactory in the ordinary way, but the unpleasant odour was thought to be due to a fair percentage of wild mango being employed. Wild mangoes possess a turpentiney flavour and some are actually poisonous and should not be employed for chutney. Several food samples and dust from scaffolding were submitted in connection with a complaint that a salmon mousse eaten at a party had caused illness. They were examined for lead, arsenic, and other poisonous metals, although the scaffolding dust contained enormous quantities of lead and appreciable quantities of arsenic, it was difficult to believe that this could have gained access to the food. Only traces of trace metals could be detected in the food and though the amount of arsenic was about 2 to 2.4 parts per million in the salmon of one of the samples submitted, this was not high for salmon. All the food samples were tasted and only the salmon possessed an abnormal flavour but this was attributed to the fi6h not being too fresh before canning. It was considered that some accidental contamination must have gained access to the mousse during or subsequent to its preparation, but, as the remains had been thrown away, the matter could not be usefully pursued. The purchaser of a packet of Pasta complained that it was infested with insects, and examination showed these to be common grain weevils or Calandra grania. The initial period of infestation was estimated to be not less than three months previously, and as the packets were not completely sealed the infestation could have taken place anywhere. A portion of a meal served in a restaurant was stated to contain a small insect. The restaurant concerned specialised in Indian dishes and the meal contained a small pupa of a member of the Coleoptera (beetle family), possibly the Mexican grain beetle. A complaint was also made about some brown foreign matter in a bottle of Orange Crush. This was vegetable in origin and probably crushed material from the calyx of an orange. Another complainant stated that some meat purchased as "casserole steak" possessed a peculiar odour and remained pink when cooked. Salted beef containing nitrate had been supplied whereas a good quality fresh beef should be used to make a casserole. A complaint was received regarding some cheese purchased in Chelsea and to your analyst it possessed an unpleasant odour and flavour, though several people considered it satisfactory. It was therefore reported as inferior. Two apple puffs submitted for examination contained patches of mould and yeasts. In view of the cold weather at the time, and the rate of growth of moulds and yeasts at low temperatures, it appeared - 53 - that the puffs must have been kept for at least ten days before reaching your analyst's laboratory. Legislation issued or proposed during 1964 The year 1963 was a comparatively quiet one as regards food legislation, but the year 1964 was busy, not because of the number of Statutory Instruments issued, but on account of fresh legislation, which is being initiated. The following items are of interest:- Food Additives and Contaminants Committee The Minister of Agriculture, Fisheries and Food decided to make the above Committee a committee in its own right on account of the importance that this aspect of food has assumed. He asked the Committee among other things, to examine the leeching out of poisonous substances into foods from any wrapping materials that might be employed. Urgent attention, however, is needed about the presence of lead and other toxic substances in children's toys and paints, which children are likely to suck or chew. It is believed that lead and mercury are causing more ill-health among children than was formerly recognised. The Committee have also been asked to examine the whole subject of food preservatives. Colouring Matter in Food Regulations The Colouring Matter in Food Regulations 1957 were considered and the Food Standards Committee issued a report making recommendations for amendments to these regulations. The Ministry is now adopting the policy of keeping Statutory Instruments constantly under review and amending them, if necessary, fairly frequently. It is now suggested that six of the existing food colours should be withdrawn from the list, that titanium dioxide should be permitted only for the surface colouring of food, that the colouring of citrus fruit should be forbidden, and that specifications of purity should be introduced. On the other hand it is suggested that another black colour should be provisionally added to the permitted list and that two named carotenoids should be permitted. It is noted that no organic blue colour will now be permitted in food if the recommendations are adopted and it is a remarkable thing that no natural food appears to be coloured blue. Probably the most important proposed piece of legislation is the suggestion that the control of foods should be separated from that of drugs and that the whole of drug legislation should be brought under one main umbrella. The present proposals would, however, retain many of the present anomalies of control, and doubtless more consideration will be given to this in the near future. During the year The Food Standards Committee issued a Report on Food Labelling and, although the recommendations included some 72 provisions, there is little doubt that many of the proposals will have to be modified. -54- The Meat (Treatment) Regulations, 1964, prohibit the addition of ascorbic acid, erythorbic acid, nicotinic acid, nicotinamide, and any of their salts or derivatives to raw and unprocessed meat intended for human consumption. Unfortunately the definition of the word 'processed' does not clarify exactly whether products such as sausages and salamis would be considered as processed or not. Proposals were issued for canned meat products and also for meat pies. Doubtless many of these proposals are being contested behind the scenes, but it will be a great advantage if the drafts can come into force without too much amendment. The Dried Milk Regulations, 1964, come into operation on the 11th March, 1965. The chief modifications introduced are the maximum and minimum percentages of milk fat required for grades of milk powder other than full cream powder, and regulations for the labelling of such products. There is also a proposal to amend the present Skimmed Milk with Non-Fat Regulations, 1960. During the year the Ministry issued a provisional method for the testing of milk for the presence of antibiotics. It is very seldom, however, that the presence of antibiotics can be proved in bulk milk. Fresh Mineral Hydrocarbons in Food Regulations were issued during the year. Besides increasing the amount of paraffin hydrocarbons permitted in or on foods, they also lay down specifications for the quality of such hydrocarbons. The difficulty of enforcing in Great Britain regulations regarding the quality of liquid paraffin employed for coating citrus or dried prunes, currants, sultanas or raisins in other countries will be appreciated. The Soft Drinks Regulations, 1963, which should have come into force in 1964, were revoked and replaced by the Soft Drinks Regulations, 1964, which will come into operation on the 2nd June, 1965. These Regulations will permit the use of cyclamates for sweetening soft drinks and presumably, therefore, Regulations will be introduced to permit the use of these compounds in other foods such as diabetic jams. These Regulations also require the disclosure of the presence of artificial sweeteners in soft drinks and prescribe standards for semi-sweet and low calorie soft drinks. 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. Note: A table showing the various samples submitted for analysis appears on the following page. - 55 - SUMMARY OF SAMPLES SUBMITTED FOR ANALYSIS Article Number Examined Number Adulterated, etc. Formal Informal Total Formal Informal Total Aspic 1 1 Aspic Jelly 1 1 Baby Foods 1 1 Best of the milk 1 1 Bread Crumbs 1 1 Butter 15 15 Butter Milk 1 1 Cheese 3 3 1 1 Chicken, minced 1 1 Chicken, bone 1 1 Coffee Extract 2 2 Custard Powder 1 1 Dust 1 1 1 1 Fish, canned 12 12 1 1 Fish Paste 13 13 Flour 7 7 Fruit, canned 8 8 Fruit, dried 6 6 Fruit Juice 11 11 1 1 Gravy Powder 1 1 Herbs, mixed 1 1 Honey 2 2 Jam 12 12 Jelly Powder 1 1 Lemon Curd 3 3 Macaroni Products 2 2 1 1 Margarine 10 10 Marmalade 10 10 Meal served in Restaurant 1 1 1 1 Meat Extract 1 1 Meat Paste Meat Products 5 5 Casserole steak l 1 1 1 Chicken, canned 2 2 Steak & Kidney Pudding 1 1 Stuffed Pork Roll 1 1 Mincemeat 1 1 C/forward - 142 142 - 7 7 - 56 - ###]Article Number Examined Number Adulterated, etc. Formal Informal Total Formal Informal Total B/forward 142 142 7 7 Milk 97 97 Milk condensed 1 1 Milk evaporated 2 2 Milk separated 2 2 Milk powder skimmed 1 1 Milk shake syrup 1 1 Mustard, prepared 1 1 Oil-olive 1 1 Pastries 1 1 1 1 Pickles, chutney 2 2 2 2 Salt 3 3 1 1 Sauce 4 4 Scone Mix 1 1 Seasoning 1 1 Shandy 1 1 Soft Drinks 9 9 1 1 Soup Powder 2 2 Soup Tablets 1 1 1 1 Spice, pickling 1 1 Spreads, savoury 2 2 Suet, shredded beef 1 1 Sugar 1 1 Tea 5 5 Tea, foreign matter l 1 Tomato Juice 3 3 Vegetables, canned 2 2 1 1 Vegetables, dried 8 8 Vegetables, pickled 1 l Vinegar 2 2 Wine 1 1 - 301 301 - 14 14 - 57 - BACTERIOLOGICAL EXAMINATION OF FOOD The bacteriological examination of samples was carried out by the Public Health Laboratory Service at County Hall. No charge was made to the Council for this service and during the year the following samples were submitted for examination:- Water 28 Ice Cream 36 Red Salmon 8 Total 72 All were reported upon as satisfactory. THE MILK (SPECIAL DESIGNATION) REGULATIONS, 1963 The following table shows the number of dealers' licences in force at the 31st December, 1964:- Sale of tuberculin tested milk 55 Sale of pasteurised milk 64 Sale of sterilised milk 42 The expiry date of all licences is 31st December, 1965. THE MILK AND DAIRIES (GENERAL) REGULATIONS, 1959 At the end of the year there were 56 registered distributors with premises in the Borough and 67 premises within the Borough from which milk is distributed. ANALYSIS OF MILK During the year 97 samples of milk were submitted for examination to the Public Analyst Whose report appears on pages 51 to 56. STREET TRADING All 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, and renewal applications are granted provided the applicant has fully observed the requirements of the licence throughout the previous period. New applicants concerned with the retailing of food have to submit their vehicles for examination and, in addition, particular attention is given to the suitability of storage accommodation and the hygienic condition of equipment. In many cases - 58 - both vehicles and food were stored in another borough and in this event a report was obtained from the borough concerned as to suitability before a licence was considered. The displaying or unloading of food too near the ground where there is a grave risk of contamination by dogs was the main problem with street traders and the Public Health Inspectors were constantly impressing on all stall-holders the dangers of this practice. 167 special inspections were made of stalls during the year, this was 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 during their daily routine work. 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 LICENSING ACT, 1961 Applications to the Justices for licences for the sale of alcoholic drinks in restaurants, private hotels, guest houses, etc., 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 37 persons entitled to sell poisons included in Part II of the Poisons List were entered on the Council's Register at the 31st December, 1964. All premises were inspected as to their suitability and to ensure that records were properly maintained, labelling efficiently performed, - 59 - 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 Act 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. RODENT CONTROL - The Prevention of Damage by Pests Act, 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 as in previous years, there was again a decline in the number of infestations traceable to defective drains and particularly frontage drains due to the many drains reconstructed during recent years. The policy continues of testing all frontage drains when infestations occur at either ground floor or basement levels. Infestations of rats to empty buildings are 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 reoccupied 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 third 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. Checks were made on takes from test baits in the sewers, and from the careful observations recorded it is evident that the reduction of the rat population continues. - 6o - Details of work carried out by the Rodent Officers during the year, 1964. 1. Treatment of Business and Private Business Private Premises (Rats and Mice) Premises Premises Number of visits 706 1,740 Number of infestations found 48 176 Number of treatments undertaken 44 170 Number of pre-baits laid 1,884 Number of poison baits laid 533 Number of complaints received 247 2. Sewer Maintenance Treatments (Rats) No. of poison Poison baits laid used No. 1 Treatment 152 Fluoracetamide No. 2 Treatment 480 Fluoracetamide No. 3 Treatment 480 Fluoracetamide No. 4 Treatment 480 Fluoracetamide No. 6 Treatment 68 Fluoracetamide No. of test baits laid 480 No. 5 Treatment - Test baiting with sausage rusk PIGEONS Section 121 of the Public Health (London) Act, 1936, empowered 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 some years ago 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. Although one pigeon catcher still retains an authority to catch pigeons on the highways and open spaces, he rarely operates in Chelsea, being fully occupied in localities and on premises where he receives payment for his services. The use of direct labour for this purpose 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 feeding on the highway as an offence under the Litter Act, 1958. - 6l - At three separate meetings of the Public Health and Baths Committee during the year consideration was given to complaints of the ever increasing pigeon nuisance, and on each occasion it was decided that no direct action should be taken by the Council. DISINFECTION AND DISINFESTATION The Disinfecting Station is situated at 9A, Lots Road, but the duties of the personnel extend beyond this limited field. The two disinfectors and the two vehicles were 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 undertook 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 new arrangement with the Royal Borough of Kensington regarding personal cleansing facilities for Chelsea residents came into operation on the 1st January, since when all cases have been treated at the Disinfecting Station and Medicinal Baths, Silchester Road, W.10. The following is a summary of specific work of disinfection and disinfestation carried out during the year:- DISINFECTION OF ROOMS AND CONTENTS, CLOTHING, ETC. Number of rooms disinfected 182 Number of articles disinfected 807 DISINFESTATION OF ROOMS AND CONTENTS Number of rooms disinfested 487 Number of articles disinfested 1,267 NEW LEGISLATION The following new Acts, Regulations and Orders, which relate to the work of the Public Health Department became operative during the year:- Housing Act, 1964 Riding Establishments Act, 1964 Scrap Metal Dealers Act, 1964 Children's Nightdresses Regulations, 1964 Dried Milk Regulations, 1964 Meat (Treatment) Regulations, 1964 Mineral Hydrocarbons in Food Regulations, 1964 Poisons (Fluoroacetamide and Fluoroacetanilide) Rules, 1964 Poisons Rules, 1964 - 62 - Poisons (No.2) Rules, 1964 Poisons List Order, 1964 Poisons List (No.2) Order, 1964 Rent Restrictions (Amendment) Regulations, 1964 Soft Drinks Regulations, 1964 Offices, Shops and Railway Premises Act, 1963:(Commencement No.l) Order, 1964 (Commencement No.2) Order, 1964 (Exemption No.l) Order, 1964 (Exemption No.2) Order, 1964 Annual Reports Order, 1964 Forms Order, 1964 First Aid Order, 1964 Notification of Employment of Persons Order, 1964 Prescribed Dangerous Machines Order, 1964 Washing Facilities Regulations, 1964 Sanitary Conveniences Regulations, 1964 ATMOSPHERIC POLLUTION RECORDING The Council maintained two measurement and recording stations. The readings were 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 year:- - 63 - Month 1964 Days Exposed Rain fall (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 30 0.40 5.71 9.40 15.11 .190 .313 .503 February 31 0.80 6.71 12.63 19.34 .216 .407 .623 March 30 2.84 5.69 11.02 16.71 .189 .367 .556 April 30 2.96 6.52 10.30 16.82 .217 .343 .560 May 31 1.95 6.42 9.88 16.30 .213 .318 .531 June 30 3.58 12.26 7.47 19.73 .408 .249 .657 July 30 1.06 4.81 5.13 9.94 .160 .171 .331 August 32 1.43 6.40 8.59 14.99 .200 .468 .668 September 30 0.57 4.82 10.93 15.75 .160 .525 .685 October 29 1.54 6.17 9.64 15.81 .212 .332 .544 November 32 1.33 7.79 9.47 17.26 .243 .295 .538 December 31 0.95 6.17 11.43 17.60 .199 .368 .567 TOTALS 366 19.41 79.47 115.89 195.36 - - - Estimation of Atmospheric Sulphur Milligrams of Sulphur Trioxide per day. Month Days Exposed Chelsea Polytechnic  January 30 4.74 February 31 3.96 March 30 4.42 April 30 2.95 May 31 2.13 June 30 2.13 July 30 1.41 August 32 1.62 September 30 2.20 October 29 3.10 November 32 3.93 December 31 4.95 Average for year:- 3.13 - 64 - 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 were 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 was forwarded to the Fuel Research Station for correlation with the results obtained from other sites throughout the country. The following table shows the results obtained from this station during the year:- VOLUMETRIC ANALYSIS - SMOKE AND S02 Month Average daily total Microgrammes per cubic metre Smoke S°2 January 208 500 February 208 503 March 120 470 April 160 333 May 136 211 June 4l 158 July 42 l4l August 45 123 September 60 199 October 179 412 November l4l 358 December 190 422 - 65 - CLEAN AIR ACT, 1956 SMOKE CONTROL ORDERS The Chelsea No.3 (Cheyne Ward and Royal Hospital Ward) Smoke Control Order, 1964. The Council made a Smoke Control Order in respect of the Cheyne and Royal Hospital Wards at its meeting on the 29th April, 1964. This is the third Order to be made by the Council. The two preceding Orders covering Church Ward and Hans Town Ward have been operative since 1st November, i960 and 1962 respectively. The third area comprises over 262 acres and contains 6,593 dwellings and 511 industrial and commercial premises. Confirmation of the Order by the Ministry was dated the 13th October, 1964 and it will come into operation on the 1st July, 1965. In view of the amended grant arrangements set out in the Ministry Circular No.69/63 estimates of cost originally submitted with the Order were revised and duly received approval. The results of the detailed survey revealed that 1,807 dwellings contained appliances requiring adaptation or replacement in order to burn an approved smokeless fuel. The cost of this work was estimated at £31,900. The Ministry issued Circular No.60/64 on the l8th December, 1964. It stated that in view of the strain on existing supplies of electricity the Minister had decided that until further notice the expenditure incurred in the installation of electrically operated space heating appliances would not attract grant. The exception to this ruling is the thermal storage heater which takes its current wholly from a circuit designed to operate at an off-peak electricity tariff. The Minister will continue to keep the position under review in the light of changes in the fuel supply situation. Certain amendments to the Clean Air Act, 1956 were contained within Section 95 of the Housing Act, 1964. Among other changes in administrative procedure for smoke control areas, new legislation was introduced with regard to the conditions for grant to be paid for gas and electric ignition. It had been formerly a stipulation that work of adaptation must accompany the provision of ignition in order to qualify for grant. The effect of subsection (9) is that subject to the usual conditions, expenditure on the provision of ignition is eligible for grant, whether or not attendant work is involved. A map of the Cheyne Ward and Royal Hospital Ward Smoke Control Area appears on the following page. EPIDEMIOLOGY Incidence and Notification of Infectious Disease - 66 - NOTIFIABLE DISEASES The undermentioned diseases are notifiable to the Medical Officer of Health by general practitioners 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. - 67 - 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 - 2 - 2 3 1 1 9 Erysipelas - - - - - - 1 1 Measles 2 27 18 1 1 1 - 50 Puerperal Pyrexia - - - 1 3 - - 4 Scabies - 1 2 1 3 1 - 8 Scarlet Fever - 3 2 - - - - 5 Typhoid Fever - - - - 1 - - 1 Whooping Cough - 4 4 - - - - 8 TOTALS 2 37 26 5 11 3 2 86 - 68 - SUMMARY OF NOTIFICATIONS OF INFECTIOUS DISEASES RECEIVED DURING THE YEARS I960 - 1964 (inclusive) Disease 1960 1961 1962 1963 1964 Average for five years Dysentery 69 39 67 57 9 48.2 Erysipelas 3 3 - - 1 1.4 Food Poisoning 15 1 2 2 - 4.0 Measles 15 564 63 352 50 208.8 Meningococcal Infection 3 2 1 - - 1.2 Pneumonia: Ac. Influenzal 4 5 1 2.0 Ac. Primary 2 3 - 4 - 1.8 Poliomyelitis: Paralytic 1 1 1 - - 0.6 Puerperal Pyrexia 19 4 3 2 4 6.4 Scabies 3 2 3 8 4.0 Scarlet Fever 20 4 3 7 5 7.8 Typhoid Fever - - 1 2 1 0.8 Whooping Cough 62 24 6 24 8 24.8 - 69 - DIPHTHERIA No notification was received during the year. The last two cases were confirmed in 1955, whilst there have been no deaths for nineteen years. Immunisation has played a major part towards the present excellent position, but it is still necessary to publicise the efficacy of such a service. Details of services provided during the year will be found on Page 16. DYSENTERY During 1964, 9 notifications were submitted compared with 57 in 1963 and 67 in 1962. MEASLES Fifty notifications were received during 1964, as compared with 352 in 1963. SCARLET FEVER Five notifications of Scarlet Fever were received during the year, as compared with 7 in 1963. WHOOPING COUGH Eight cases were notified during the year against 24 in 1963. SMALLPOX No case of smallpox has been notified 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 thirty-two contacts who arrived in this country from declared locally infected/ endemic areas and travelled to addresses in the Borough. They were kept under observation for the surveillance period and remained quite well. - 70 - POLIOMYELITIS For the second successive year, not one case of this disease was notified to the Public Health Department, due, no doubt, to the general public taking advantage of the vaccine now available. ERYSIPELAS One case was notified during the year, the first since 1961. PUERPERAL PYREXIA Puerperal Pyrexia means a febrile condition in a woman in whom a temperature of 100.4º Fahrenheit (38º Centigrade) or more has occurred within fourteen days after childbirth or miscarriage. Four cases were notified during the year and all occurred in hospital and referred to patients residing outside the Borough. The following table shows the causes of pyrexia in the notified cases Cause No. of cases Phlebitis 1 Haemolytic Streptococci infection 1 Urinary tract infection 1 Not known 1 Total 4 Two cases were brought to the notice of the department by other local authorities; these concerned Chelsea residents whose confinements took place in hospitals in their area. 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, 931 of these certificates were authenticated in Chelsea. - 71 - FOOD POISONING 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 - - - - - Number of cases otherwise ascertained - - - - - Number of symptomless excreters - - - - - Number of fatal cases - - - - - Particulars of Outbreaks. Nil Particulars of Single Cases. Nil 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 - - - 4 k ENTERIC FEVER During the year, one imported case of Typhoid Fever was notified to the Department. The patient arrived at London Airport but he had felt ill before leaving Pakistan. On arriving in London he stayed at various addresses, but was taken ill again whilst visiting friends in Chelsea. He was treated on routine lines in hospital and finally discharged. SUSPECTED CASES OF FOOD POISONING On Tuesday evening, 28th July, four guests and the host at a dinner party in Chelsea were taken violently ill within minutes of eating a salmon mousse prepared by the hostess. She herself had felt and looked very ill after eating some of the mousse at the conclusion of its preparation some eight hours earlier. In the interval it had been kept refrigerated in a fireproof casserole. The guests abruptly developed violent and continued vomiting, a strange loss of limb control, and, in two cases, what were described as writhing and epileptiform convulsions, culminating in unconsciousness lasting in one instance 45 minutes and in the other 90 minutes. All recovered within a couple of days, but some had residual symptoms of loss of concentration, lethargy, sickness and depression which lasted a week to ten days longer. - 72 - When this incident was brought to my notice on the afternoon of Friday, 31st July, an immediate visit was paid to the household, but further enquiries could not be pursued as the occupants had left for a fortnight's holiday. Nevertheless steps were taken forthwith to stop the sale of the tinned salmon which had been used in preparing the mousse. Two brands purchased in different shops were involved. In one case the shopkeeper had already had a complaint from the affected purchaser, as a result of which the wholesalers had withdrawn his complete stock and sent it to their Liverpool laboratories for examination,, In the other case, eight tins, including one recovered from the purchaser's premises, were taken at random from the remaining stock and sent for bacteriological and chemical examination. Although some of the mousse had remained uneaten, it had been disposed of before the doctor summoned to attend the victims could take a sample for examination. He did, however, retrieve the two salmon tins which had been in the refuse pail and a dustbin during the previous ten hours. Despite the fact that in one of these tins some germs were, not surprisingly, discovered, these were not of a type likely to cause food poisoning. In any event, the sudden and violent features of the illnesses were quite different from the history, timing, mode of onset and symptoms encountered in bacterial food poisoning. These illnesses indeed suggested acute poisoning by a substantial amount of some powerful tasteless, odourless, non-corrosive chemical agent. The results of the bacteriological examinations of the tins of salmon taken from stock showed no evidence of contamination with food poisoning germs. Both the Liverpool analyst and the Chelsea Public Analyst found no trace of poisonous chemicals in the tins of salmon. Other ingredients of the mousse were submitted to chemical analysis with negative results, as also was some wine of the type consumed by the guests in the early stages of the meal. No other items of food or drink common to all the sufferers could be inculpated. However, a further consideration of the symptoms complained of suggested the possibility of a chemical poisoning, most likely of the organo-chlorine type. The only substance of this kind that I was able to discover in the flat was gammexane in the form of Aerovap tablets. I accordingly communicated with the manufacturers, who advised me that the Aerovap tablets each contained 1 gram of gamma isomer of benzene hexachloride. They stated that the median lethal dose for a man weighing 60 Kg. would be expected to be 12 tablets. On the basis of a previous instance they assumed that the symptoms complained of by the guests at the dinner party could have been produced if they each had three or four tablets. They continued:"Since they had previously consumed wine the rate of absorption would presumably be increased and the solubility of this kind of substance in the stomach contents would be increased also. It is conceivable that symptoms of toxicity under these circumstances might supervene in 15 minutes or so, although the usual interval is said to be one to two hours." At the suggestion of the Director of the National Poisons Information Centre, I sent a sample of blood from one of the more severely affected sufferers for examination. I received a report as follows:- - 73 - "The assay of the blood sample from the patient which you sent us showed normal levels of the organo-chlorine compounds Dieldrin and D.D.T. For gamma-BHC the figure was a little higher than a previous sample examination, but I really do doubt whether this is of any significance. In all, therefore, the evidence from this test is against organo-chlorine poisoning of this patient." I also received a report from the Public Analyst on the sample of aspic jelly powder, which was stated to be quite satisfactory and contained no excess of chemicals. The dust from the scaffolding was reported as containing quantities of lead and arsenic, which was to be expected as doubtless most of this had arisen from paint scraping operations. The Analyst commented that he found it difficult to believe that any appreciable quantity of dust from the scaffolding could have gained access to the salmon mousse. In passing, I would observe that the symptoms complained of bore no resemblance to acute lead or arsenic poisoning. I am afraid that no definite conclusion could be reached in connection with this incident, and I think the problem will have to remain unsolved. As no portion of the mousse could be examined, it was impossible to decide what was the substance responsible for these alarming illnesses. - 74 - TUBERCULOSIS Summary of Notifications during the period from 1st January, 1964 to the 31st December, 1964. FORMAL NOTIFICATIONS Age Periods Number of Primary Notifications of new cases of tuberculosis 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75+ Total (all ages) Respiratory Males - - - - - - 1 1 2 3 - 3 - 10 Respiratory Females - - - - - - - - - l - - - 1 Nonrespiratory Males — — - - — - — - 1 - - - 1 Nonrespiratory Females - - - - - - - - - - - - - - Number of deaths from tuberculosis - 2 Number of cases remaining on Register - 274 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. 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 I960 25 2 27 2 362 1961 19 2 21 10 358 1962 25 1 26 4 321 1963 22 5 27 3 304 1964 11 1 12 2 274 Average number of cases for the ten years - 33.2 Average number of deaths for the ten years - 4.1 - 75 - 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:- 1961 1962 1963 1964 Population served by Dispensary 48,490 48,550 48,050 46,200 Number of notified cases in Borough at end of year 558 321 303 273 Number of these who at present do not attend Dispensary 152 120 145 120 Total attendances during year 1,144 1,119 1,016 896 Total new patients seen 161 114 124 86 Number of these who were contacts 80 84 59 33 Number of contacts found to be tuberculous 1 _ _ 1 Number of cases newly notified to Medical Officer of Health (i.e. excluding inward transfers) 27 30 28 12 Number of cases diagnosed as tuberculous (for the first time) at the Dispensary 4 2 2 2 Number of X-rays 824 843 728 669 Number of patients who received "Special treatment" at home during the year 1 1 1 _ Number of patients given B.C.G. 52 28 41 30 Number of home visits by medical staff 2 _ _ _ Number of visits paid by Dispensary Nurse 1,121 973 890 817 Number of Clinic Sessions per week 2 1* 1* 1* * + one extra session every month. ** The evening session will cease after the next Thursday clinic on the 4th February, 1965. - 76 - BACTERIOLOGICAL EXAMINATIONS All bacteriological examinations were carried out at the Public Health Laboratory at County Hall under its Director, Dr. A.J.H. Tomlinson. No charge was made to the Council for these examinations and during the year 955 were made as follows Throat/Nose Swabs Staphylococcus aureus found 2 Haemolytic Streptococci found 26 Proteus found 1 Negative results 97 Faeces Salmonella typhi found 2 Salmonella typhimurium found 2 Shigella sonnei found 27 Pathogenic Bact. coli 055 found 1 Pathogenic Bact. coli 026 found 2 Pathogenic Bact. coli 0111 found 1 Pathogenic Bact. coli 0119 found 2 Pathogenic Bact. coli 0128 found 1 Pathogenic Bact. coli 0127 found 4 Negative results 787 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 was used extensively. INDEX Subject Page (s) Accidents:- Home 28 Road 29 Analyst Public - Report of 51-56 Area of Borough 8 Atmospheric Pollution - Recording Stations 62-64 Bacteriological Examinations 57 and 76 Baths and Swimming Pools 33-34 Births 8 Burials - Sect. 50 National Assistance Act, 1948 27 Campaign - Oil Heater Safety 52 Cancer - Lung and Bronchus 13 - 14 Chelsea Tuberculosis Dispensary 75 Clean Air Act, 1956:- Smoke Control Orders 65 Atmospheric Pollution Recording 62-64 Committee, Public Health and Baths:- Members 1 Representation elsewhere by Members 2 Conferences - Council representation at 31 Contributions to Voluntary Organisations 31 Cremation - Local service and progress 30 Deaths 8— 14 Diphtheria 16 and 69 Diseases, Infectious 66-76 Disinfection/Disinfestation 6l Drainage worlcs 39 Dogs - Fouling of pavements by 39 _ 40 Dwellings - Number in Borough 8 Dysentery 69 Early neo-natal mortality rate 9 Enteric Fever 71 Epidemiology 66 — 76 Erysipelas 70 Factories Act, 1961 43 - 45 Food and Drugs Act, 1955?- Bacteriology 57 Hygiene 47-48 Ice-Cream Premises 48 Inspection and supervision of premises 48-49 Legal Proceedings 49 - 50 Preserved Food Premises 49 Public Analyst's Report 51-56 Street Trading 57-58 Food Poisoning 71-73 Food - Unsound 50 Fouling of pavements by dogs 39 _ 40 Subject Page (s) General Sate 8 General and Vital Statistics 8-10 Health Education - Oil Heaters 32 Health - Personal Services 15-17 Home Accidents 28 Hospitals^ list of 26 Housing Act, 1957:- Overcrowding 4l Applications for re-housing 42 Housing Act, 1961 - Houses in Multiple Occupation 4l Housing, New - Local Authority and Private 4l Infant Mortality 8 - 10; 13 Infectious Diseases 66-76 Inspections and works carried out 35-37 International Certificates of Vaccination 70 Introduction 4—7 Land Charges - Enquiries 4l Legal Proceedings - Food and Drugs Act, 1955 49 - 50 Legislation, new 61-62 L.C.C. - Personal Health Services 15-17 Licensing Act, 1961 58 Lung Cancer 13 — 14 Marriages 9 Mass Radiography 21-22 Maternal Mortality 9 Maternity and Child Welfare - Violet Melchett Infant Welfare Centre 18-20 Measles 69 Medical Examination of Staff 30 Milk - Licensing and Supply 57 Mortuary Facilities 30 National Assistance Act, 1948:- Section 21 - Part III Accommodation ... 27 Section 47 - Removal to Hospital/Institution 27 Section 50 - Burial of the Dead 27 Neo-natal Mortality Rate 9 Noise Abatement 40 Notices - Service of 38 Notifiable Diseases 66 Notification of Infectious Diseases 67-68 Offices, Shops and Railway Premises Act, 1963 46-47 Oil Heaters - publicity 32 Old People's Welfare 23-25 Overcrowding 4l Outworkers 45 Subject Page (s) Part III Accommodation - National Assistance Act, 1948 27 Perinatal Mortality Rate 9 Personal Health Services - L.C.C. 15 - 17 Pet Animals Act, 1951 59 Pharmacy and Poisons Act, 1933 58-59 Pigeons - Destruction of 60-6l Poisoning, Food 71-73 Poliomyelitis 70 Population 8 Public Analyst - Report of 51 -56 Public Baths and Swimming Pools 33-34 Public Health and Baths Committee:- Members 1 Representation elsewhere by Members 2 Representation at Conferences by Members 31 Public Health Department - Staff of 3 Public Health Inspectors - Work of 33-65 Public Houses 47 Public Mortuary Facilities 30 Puerperal Pyrexia 70 Rag Flock and Other Filling Materials Act, 1951 59 Rateable value of Borough 8 Rent Act, 1957 41 Road Accidents 29 Rodent Control 59-60 Sanitary Administration of Borough 32-65 Scarlet Fever 69 Shops and Offices 46 - 47 Smallpox 69 Smoke Control Orders 65 Spastic Children 22-23 Staff Medical Examination of 30 Public Health Department 3 Statistics:- General and Vital 8-10 Births, Deaths, Infant Mortality, Marriages, Population, Stillbirths, etc. 8-14 Street Trading 57-58 Still births 8 Town and Country Planning - Applications 39 Tuberculosis 9;74 - 75 Underground Rooms 42. Unsound Food 50 Subject Page (s) Vaccination ]_6 Vaccination — International Certificates of 70 Violet Melchett Infant Welfare Centre 18 - 20 Vital Statistics 8-10 Voluntary Organisations - Contributions to 31 Water Supply 33 Welfare of Old People 23-25 Whooping Cough 69 R6/68