EBAR028 TWENTY-SECOND ANNUAL REPORT of the SANITARY CONDITION of the EAST BARNET VALLEY URBAN SANITARY DISTRICT, FOR THE YEAR 1895, by WALTER ROUGHTON, F.R.C.S. (Eng.), (Diplomate in Public Health), Medical Officer of Health. 1896. TWENTY-SECOND ANNUAL REPORT of the SANITARY CONDITION of the EAST BARNET VALLEY URBAN SANITARY DISTRICT, FOR THE YEAR 1895, BY WALTER ROUGHTON, F.R.C.S. (Eng.), (Diplomate in Public Health), Medical Officer of Health. 1896. PRINTED BY W. W. MORGAN, FLEET STEAM WORKS, BULWER ROAD, NEW BARNET. REPORT. THE Area of the District is 2,636 acres: Barnet Vale 268 acres. East Barnet 1,699 „ Monken Hadley 660 ,, South Mimms 9 ,, It will be observed that the arrangement of the subdistricts differ slightly from that given in previous Reports, that portion hitherto known as "Enfield Detached" having been absorbed into the Parish of Monken Hadley. The method usually adopted in estimating the population of a district not being applicable to small numbers, I have ascertained the number of houses occupied, and multiplied this by 5.5 on the assumption that this latter figure would represent approximately the average number of persons in each inhabited house. This assumption is warranted by the fact that according to the census of 1891 there were 1,392 houses in the 4 district, containing a population of 7,750, giving an average of 5.5 persons per house. The number of houses in the different portions of the district, according to the latest returns, are as follows : East Barnet 1,105 houses. Monken Hadley 260 ,, Barnet Vale 308 ,, 1,673 the whole being brought up to a total of (in round numbers) 1,700 by the addition of the few houses in South Mimms. The total, multiplied by 55, gives a population of 9,350. During the year 124 deaths were registered. This is a considerable increase on that of the previous year, when 84 deaths were registered. The increase is found principally in the death of children under one year of age, and those of persons advanced in life. Thirty-seven deaths occurred in children under one year, an increase of 17, as compared with 20 in the previous year— 1894. Of this number 12 deaths appeared to be due to improper feeding, and 8 to conjenital defects. Thirty-one deaths occurred at the age of 65 or over, the corresponding number for the year 1894 being 21. Five deaths were due to injuries. Calculating the population at 9,350, the deathrate is 131 per 1,000. 5 Twenty-one deaths were registered under the seven chief Zymotic: Small Pox 0, Measles 0, Scarlet Fever 3, Diphtheria 1, Whooping Cough 6, Fever (continued, including Influenza) 3, Diarrhoea and Dysentry 8. The Zymotic death-rate was 2.2. All the deaths were certified. The deaths of infants under one year of age were in the proportion of 164 per 1,000 births. During the year 220 births were registered, 122 boys, 98 girls, giving a birth-rate of 23.5 per 1,000. The following table will be found useful in comparing the vital statistics during the last fifteen years : Year. Population. Birth rate. Death rate. *Infantile mortality. Zymotic death rate. 1881 5,788 34.2 11.5 7.5 1.4 1832 5,808 31.1 14.9 11 3.2 1883 6,054 31.3 11.5 10.5 1 1884 6,176 31.7 13.4 12.2 1.4 1885 6,298 26.5 12.8 11.9 0.3 1836 6,420 28.5 12.7 9.2 0.7 1887 6,542 26.4 13.2 9.8 1.8 1888 6,664 28.0 11.5 8.5 1.5 1889 6,786 27.5 11 9 0.29 1890 7,590 25 12 9.5 2.7 1891 7,750 25 12 7 2.4 1892 8,300 27 11.7 6.2 1.08 1893 8,500 23.8 10 6.4 1.06 1894 8,700 22.6 9.5 10.4 1.29 1895 9,350 23.5 13.1 16.4 2.2 * Infantile Mortality = ratio of deaths under one year to 100 births. 6 During the year, 93 cases of infectious diseases were notified :— Scarlet Fever 82 Diptheria 11 In the early part of the year fever made its appearance amongst the children attending the Board Schools, and when some half dozen cases had been notified the Schools were closed for a period of three weeks. This had the effect of checking the spread of the disease for a time, but on the Schools being re-opened the disease steadily advanced again. The Schools were not closed again until the Christmas holidays, the Sanitary Authority apparently fearing lest the grant to School Board should be jeopardised thereby. The source of the outbreak was doubtless due to some children suffering from the disease—though thought to be suffering only from a cold—being allowed to attend School. There was nothing else common to all the cases, with very few exceptions, except that the patients had attended School. The disease was on the whole of a mild character, and only three deaths were attributable to it, two directly, and one indirectly. It appears to me that there is a serious defect in Education Act. For whilst parents are bound under penalty to send their children to School, no steps are taken to insure that the children shall be in good health, and free from infection. Hence it happens that a child may be suffering from a slight attack of Scarlet Fever or Diptheria, which the parents imagine to be, and treat as a cold—they being in all 7 probability too poor to incur the expense of medical advice; and after the child gets a little better it is sent back to School, hurried back, perhaps, by a visit from the School Attendanco Officer, before it is free from infection, to distribute the disease amongst its fellow pupils. If some system were adopted by which absentees would not be allowed to return to School without medical evidence, to the effect that they were free from infection, the spread of disease would be materially checked, and the necessity for closing the Schools would, in many instances, be obviated. The problem of how to provide the district with an Isolation Hospital, appears to be as far off solution as ever. The question has been discussed frequently during the last few years, and Committees have been appointed, and have met to consider the subject, but all to no purpose, possibly because the Committees have been divided amongst themselves as to whether it would be better to provide a hospital for the district alone, or to combine with some adjoining Authority to form a conjoint scheme. The need for an Isolation Hospital has been painfully felt on several occasions. To give one—Scarlet Fever broke out in a four-roomed cottage in East Barnet, occupied by seven or eight persons. The disease was of a very malignant type, and one patient died in a few days, and two others were dangerously ill. The hygeinic conditions of the cottage were appalling. On reporting the very grave state of affairs to the Council, I was instructed to convert two cottages on the Sewage Farm into a temporary hospital, and thanks to 8 the able assistance of the Acting Surveyor, Mr. Railton, I was able to remove the labourers and their families to other cottages, to furnish the hospital, and convey the patients with their parents, in an ambulance, thereto in 24 hours. The infected cottage was then thoroughly disinfected and cleansed, and the parents were able to return as soon as two efficient nurses could be obtained. The prompt action of the Council on this occasion undoubtedly stamped out a very virulent form of the disease, which, had it not been so successfully attacked, would have proved to be a source of great danger to the immediate neighbourhood. Lessons like this should not be thrown away. It clearly proves the need for an Isolation Hospital, and the immense amount of good it would do when used. The cost need not be great. But whatever it might be, I feel sure that the ratepayers would not begrudge the money, knowing that in the feeling of security thus obtained they would be receiving good value for their money. The success of the temporary hospital above alluded to, confirms me in the opinion I have always expressed, that a small hospital of our own would best meet the requirements of our district. A brick building large enough to afford accommodation to the adminstrative department and about five or six patients would suffice, and in time of need, temporary buildings could easily be put up as required, in close proximity to it. 9 Moreover, this is the kind of provision that is recommended by the Local Government Board in their circular on the subject issued in 1895. It is there stated that for large villages, or for groups of villages, a small building will suffice; or the requisite accommodation for (say) four cases of infectious disease in a village away at a time be got in fairly isolated and otherwise suitable four-room or six-room cottage which has been acquired by the Authority. This is the kind of accommodation I have frequently recommended. But as the growth of the district may be said to put it into the class Town, it would be well to adopt the advice given under this heading, which is to the effect that permanent provision should be made to consist of not less than four rooms in two separate pairs, each pair to receive the sufferers from one infectious disease, men and women of course separately. For a town the hospital provision ought to consist of wards in one or more permanent buildings, with space enough for the erection of other wards, temporary or permanent. Considerations of ultimate economy make it wise to have permanent buildings sufficient for somewhat more than the average necessities of the place, so that recourse to temporary extension may less often be necessary. In any case it is well to make the administrative offices somewhat in excess of the wants of the permanent wards; because thus, at little additional cost, they will be ready to serve when occasion comes for the wants of temporary extensions. 10 The advantages of an Isolation Hospital would be still further enhanced by the erection of a Disinfection Chamber. At present all articles requiring disinfection must be burnt or taken to Hornsey, where, by the kindness of the Officials, they are disinfected, provided they are not too busy on their own special work. This method is necessarily very unsatisfactory, for it entails a great deal of trouble and inconvenience, and expense too, and being purely an act of grace, is liable to cease at any moment. I wish to emphasise what I have so often stated in my Reports, namely, the impossibility of getting a patient suffering from Infectious Disease (except Small Pox) removed to a Fever Hospital in London. As some members of the Council have at different times talked vaguely of sending such cases to the Fever Hospital, I wrote to every Fever Hospital on the north side of London, inquiring if they would admit patients from this district. In every case I was met with a refusal, and was told in effect that we must look after our own. This was just the kind of answer I had anticipated. It has been truly said that a Sanitary Authority which neglects to provide suitable isolation accommodation fails in one of its principal duties, and, indeed, loses some of its claims to be considered a Sanitary Authority. I sincerely trust that the Council will at once find a way of removing such a reflection upon their office. There have been very few complaints of late concerning evil smells from the man-holes and ventilators of the sewers. This, no doubt, is due to the relief afforded 11 by the thorough cleansing of the main sewer, which had become almost completely choked up in some places. With efficient flushing there ought to be no smells at all. But the method employed is by no means efficient, for it is absurd to suppose that a nine-inch sewer can be properly flushed by a stream of water falling from a three or four-inch hose attached to a water-cart. The Water supply of the district is furnished by the Barnet District Gas and Water Works Company, from a deep well, and although rather hard is almost absolutely pure. It is still on the intermittent system, which is much to be regretted, as there is no doubt that an unlimited supply of water is most conducive to cleanliness, and can only be obtained by the use of a constant service. The bake-houses, slaughter-houses, and dairies have been frequently inspected, and found to be in fairly good condition on the whole. TABLE OF DEATHS during the Year 1895, in the EAST BAENET VALLEY URBAN SANITARY DISTRICT. Classified according to Diseases, Ages and Localities. Names of Localities adopted for the purpose of these Statistics ; public institutions being shown as separate localities. mortality from all causes, at subjoined ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Fevers. Whooping Cough. Diarrhcea and Dysentry. Rheumatic Fever. Phthisis. Bronchitis. Pneumonia & Pleurisy. Heart Disease. Influenza. Injuries. A11 other Diseases Total. Smallpox. Scarlatina. Diphtheria. Membranous Group. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Cholera. Erysipelas. Measles. East Barnet 71 26 5 3 3 20 14 Under 5. ... 1 ... ... ... ... ... ... ... ... ... ... 6 4 ... ... 7 1 ... ... 11 30 15 upwards. ... 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... 5 5 7 ... 3 18 41 Chipping Barnet 14 2 ... 1 ... 7 4 Under 5. ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 2 5 upwards. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... 1 8 12 Brunswick Park 16 7 2 ... 1 2 4 Under 5. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 8 9 5 upwards. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 ... 3 7 South Mimms 4 1 1 ... ... ... 2 Under 5. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 2 5 upwards. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 2 Cottage Hospital 3 ... ... ... 2 1 Under 5. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 Workhouse 3 ... ... ... ... 3 ... Under 5. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 2 3 Clockmaker's Asylum 2 ... ... ... ... ... 2 Under 5. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 2 Hadley, Monken 11 1 1 ... ... 4 5 Under 5. ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 5 upwards. ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 1 ... 1 3 9 Totals 124 37 9 4 6 37 31 Under 5. ... 2 ... ... ... ... ... ... ... ... ... ... 6 6 ... ... 8 1 1 21 45 5 upwards. ... 1 l ... ... ... ... ... ... ... ... ... ... 2 ... 8 11 11 2 5 38 79 TABLE OP POPULATION, BIRTHS, AND OP NEW CASES OP INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health, during the Year 1895, in the EAST BARNET VALLEY URBAN SANITARY DISTRICT. Classified according to Diseases, Ages and Localities. Names of Localities adopted for the purpose of these Statistics; public institutions being shown as separate localities. Population at all Ages. Registered Births New Cases of Sickness in each Locality, coming to the knowledge of the 'Medical Officer of Health. Number of such Cases Removed from their Homes in the several Localities for treatment in Isolation Hospital. Census 1891. Estimated to middle of 1895. Fevers. Fevers. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Cholera. Erysipelas. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Cholera. Erysipelas. East Barnet 5126 9350 122 Males, 98 Females. Under 5. ... 13 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards. ... 49 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chipping Barnet 1347 Under 5. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards. ... 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hadley, Monken 1028 Under 5. ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards. ... 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brunswick Park ... Under 5. ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... NIL. ... ... ... ... 5 upwards. ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... South Mimms 212 Under 5. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cottage Hospital ... Under 5. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Workhouse ... Under 5. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Clockmaker's Asylum ... Under 5. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 7713 9350 220 Under 5. ... 17 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwards. ... 65 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... State here whether "Notification of Infectious Disease" is compulsory in the District—Yes. Since when ?—January 1st, 1890. Besides the above Diseases, insert in the columns with blank headings the names of any that are notifiable in the District, and fill the columns accordingly. State here the name of the Isolation Hospital used by the sick of the District. Mark (H) the Locality in which such Hospital is situated ; and if not within the District, state where it is situated—Nowhere—there is not one. Tv. ~