EBAR 031 THIRTY-FOURTH ANNUALREPORT OF THE Sanitary Condition OF THE EAST BARNET VALLEY URBAN SANITARY DISTRICT, FOR THE YEAR 1 907, BY WALTER HOUGHTON, F.R.C.S., (ENG.) (Diplomate in Public Health), MEDICAL OFFICER OF HEALTH. 1908. Printed by W. W. Morgan, Fleet Steam Works, Bulwer Road, New Barnet. REPORT. The District of East Barnet Valley (Urban) is situate in the administrative county of Hertford, and comprises the sub-districts of East Barnet, Barnet Vale, and Monken Hadley, the area being 2,636 acres. It lies on the sides of a valley extending from Hadley on the north, to Brunswick Park on the south, where it adjoins the parishes of Southgate and Friern Barnet. It is bounded on the east and west, respectively, by the main roads leading from London northwards, through Southgate and Barnet. The general character of the District is residential, changing from Rural to Urban, or to that which is generally termed suburban; the houses for the most part consisting of detached or semi-detached villa residences, together with a number of small houses and cottages sufficient at present for the needs of the working classes. I am glad to be able to report that the health of the District has been good, and has not been affected by any special outbreak of disease. In 4 fact there was less infectious disease than in the previous year, and, although the death rate is higher than that of any year since 1902, there is no particular reason to account for the increase, except that the deaths in the later decades of life were much more numerous than in the corresponding period of the previous year. I estimate the population to be 11,800. The rate of increase in the District appears to be about 250 per annum, and 1 have assumed that the rate still obtains. The growth of the District is not rapid, and not more than about sixty houses have been erected during the year—chiefly at the extreme southern end, near New Southgate. During the year 1907, 232 births were registered. Of these 118 were boys, 114 girls. Of this total 6 were illegitimate. The birth rate was 19 6 per 1,000. The number of births registered was less by 1 than that of the previous year, and on the calculated increase of population the birth rate is less by over 1 per 1,000. Diminution of birth rate seems to be general in Urban Districts throughout the county, and indeed throughout the country, the causes for which need not be alluded to here, as they are fully set forth in County Medical Officer's Report for the year 1906. 5 The number of deaths that were registered as having occurred during the year within the District was 119, giving a death rate of 10 per t,ooo. But 17 deaths of Residents occurred in Public Institutions: viz., the Barnet Workhouse, Victoria Cottage Hospital, and County Lunatic Asylum, so that the total number of deaths credited to the District was 136, and the corrected death rate 11.5 per 1,000. The Infant mortality was slightly lower than in the previous year. The summer was cool and wet. Epidemic Diarrhoea was not very prevalent, only three deaths being caused by this disease. Phthisis and other Tubercular Diseases caused 18 deaths, or 9 more than in the previous year. Measles were rather prevalent at Hadley during the month of May, and necessitated the closing of the Infant School for a fortnight, just before the Whitsuntide holidays. Infectious Diseases.—96 cases of infectious diseases were notified in the year : Small Pox 0 Diphtheria and Membranous Croup 11 Scarlet Fever 38 Erysipelas 5 Enteric Fever 1 Chicken Pox 41 6 None of the cases of Diphtheria proved fatal. This happy result I attribute to the fact that a quantity of Antitoxin is kept at the Council Offices for the use of medical practitioners, who readily avail themselves of it. Since the Council is prepared to undertake the bacteriological examination of swabs from throat in case of suspected disease, it is a pity that medical men do not avail themselves more readily of this privilege. More frequent resort to bacteriological examination would probably prove some mild cases of sore throat to be diphtheria, whilst some cases of apparent diphtheria would be proved to be otherwise, and the trouble and vexation of isolation avoided. Scarlet Fever was of a mild type as a rule, but two cases proved fatal—both adults. The only case of Enteric Fever was due to infection outside the District, the patient being taken ill the day after arrival from a provincial town. The epidemic which occurred in Southgate Urban District at the end of the year 1906, and caused three cases in that year in our District, was a source of anxiety for some time, but fortunately no cases occurred in 1907, and prompt measures, though ready, were not required. Twelve cases were removed to the Isolation Hospital in Mays Lane. 7 One case of Scarlet Fever was removed privately to Stanmore. The case of Enteric Fever was removed to University College Hospital by the patient's employer. Three patients were sent to the Hospital supposed to be suffering from Scarlet Fever, but were shortly afterwards dismissed when it was proved that they were suffering from German Measles. There is every reason to hope that the trouble in connection with Isolation and Infectious cases will soon be disposed of, as I understand that a suitable hospital is to be erected immediately by the Joint Hospital Committee, with all modern appliances and requisites. Disinfection of Rooms and Schools is carried out by spraying Formaldehyde on the walls and bulky articles of furniture, &c., and the destruction of clothing and bedding where necessary. This is done under the immediate supervision of the Sanitary Inspector, and appears to answer well, for no second cases of infectious disease occurred, after disinfection, within the ordinary period of incubation. There is no steam disinfector in the District, nor at the Isolation Hospital. 8 To meet the convenience of medical practitioners in this District, the Council decided to keep a small stock of Diphtheria Antitoxin. It is expected that practitioners who avail themselves of this will return the same quantity of Antitoxin as they obtain, at as early a date as possible. Arrangements exist with the Clinical Research Association, enabling practitioners to have bacteriological examinations made in suspected cases of Diphtheria and Typhoid Fever, at the expense of the Council. The Water Supply is in part constant and in part intermittent. Brunswick Park, a portion of Hadley, the greater part of Barnet Vale, and nearly the whole of East Barnet have a constant supply, and arrangements are being made for a constant service in all parts of the District which are not more than 270 feet above sea level. The water is derived from deep wells sunk in the District, and is of remarkable purity, and I believe the quantity is now sufficient to warrant the constant supply being given throughout. No water is supplied from private wells. The Milk Supply is chiefly from outside the District, and but few cows are kept to supply milk for home consumption. The milk shops and 9 dairies are all in good condition, and reasonable precautions are taken to keep the milk from contamination. With regard to cowsheds, in one case the Council took action to enforce compliance with the regulations, and obtained a conviction, but owing to some technical point, the magistrates refused to enforce the penalty, and the action failed. The Council are again taking steps to enforce compliance with the regulations. The new regulations issued by the Local Government Board were adopted in July. The following Bye-laws are in force in the District: Common Lodging Houses. New Streets and Buildings. Slaughter Houses. Dairies, Cowsheds, and Milkshops. Nuisances. Cleansing Footways and Pavements. Offensive Trades. Adoptive Acts in force : Infectious Diseases (Prevention) Act, 1890, The Public Health (Amendment) Act, 1890. Notice has been given to adopt practically the whole of the Public Health (Amendment) Act, 1907. 10 Sewage Disposal.—The steady growth of the District will render the satisfactory disposal of sewage an increasingly difficult matter. However, the Council has now under consideration a large scheme which will render the Sewage Farm equal to any demands that may be made upon it in the future. The effluent from the Farm continues to be very satisfactory. The Sewage Farm has an available area of about forty-six acres, for an estimated population of 11,800. It was originally intended and used as a brodd irrigation farm. But this method of treating the sewage has for all practical purposes become obsolete, and the sewage is now doubly treated, first by irrigation, followed by filtration through beds of coke breeze. Disposal of House Refuse.—This is effected by carts which make house to house , collections once a week, except in the centre, for shops, where a daily removal of trade refuse is practised. I would again suggest that the carts should be covered in to prevent dust and filth being scattered about by strong winds. The Education Act of 1907, which requires the Medical inspection of Children in Public Elementary Schools, opens up a new era in 11 Public Sanitation. The work demanded is so intimately mixed up with the duties carried out by every Sanitary Authority that there can be no doubt that the work of School Inspection should be entrusted to the Medical Officers of Health in their respective Districts. They are of necessity intimately acquainted with the health requirements of their Districts, and are best qualified to watch over the health of the children with whom they are more or less in daily contact. 12 The whole of the following summary is compiled from works done and notices served by Mr. W. G. Cook, Sanitary and Building Inspector. Total No. for year. Complaints received 22 Nuisances abated by notice 69 Notices served 69 Drains reconstructed under notice 42 Drains without notice 11 New W.C.'s provided 11 New Closet Pans provided 17 New Flushing Apparatus provided 28 New Soil Pipes 12 Sink Wastes repaired 12 Paving in yards repaired 21 Floors ventilated 11 Roofs repaired 12 Dampness abated 6 Rooms cleansed 108 New Dustbins provided 16 Fowl Houses removed 3 Manure removed 3 Lodging-houses inspected 1 Slaughter-houses inspected 4 Bake-houses inspected .. 6 Dairies and Milkshops inspected 14 Cowsheds inspected 10 Workshops inspected 22 Houses disinfected 62 Overcrowding abated 0 Houses connected to Sewer 0 Certificates granted for New Houses 45 TABLE I. Vital Statistics of Whole District during 1907 and Previous Years. Name of District.—EAST BARNET VALLEY URBAN DISTRICT. 1.—Year. 2.—Population estimated to Middle of each Year. Births. Deaths under One Year of Age. Deaths at all Ages. Total. 9.—Deaths in Public Institutions. 10.—Deaths of Non-Residents registered in District 11.—Deaths of Residents registered beyond District. Deaths at all Ages. Nett. 3.—Number. 4.—Bate.* 5.—Number. 6.-Rate per 1,000 Births registered 7.—Number. 8.—Rate.* 12.—Number. 13.—Rate.* 1897. 9190 195 21.2 24 123 93 10.1 3 96 10.4 1898. 9420 242 26 27 111.5 86 9.1 7 93 9.8 1899. 9650 231 24 24 106 89 9.2 4 93 9.6 1900. 9880 220 22.2 22 100 86 8.7 12 98 9.9 1901. 10200 236 23.3 22 93 89 8.9 7 96 9.4 1902. 10440 240 23 19 79 112 10.7 10 122 11.7 1903. 10660 268 25.1 17 64 94 8.8 10 104 9.8 1904. 11050 227 20.5 26 114 104 9.4 10 114 10.3 1905. 11300 233 20.6 18 77 87 7.7 12 99 8.7 1906. 11550 239 20.7 25 104 6 101 8.7 8 109 9.4 Averages for years 18971906. 10334 233 22.7 22.4 97.2 94 9.1 0 0 8.3 102 9.9 1907. 11800 232 19.6 24 103.4 119 10 0 0 16 136 11.5 *Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population. TABLE I, continued. Note.—The deaths to be included in Column 7 of this table are the whole of those registered during the year as having actually occurred within the district or division. The deaths to be included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term "Non-Residents" is meant persons brought into the district on account of sickness or infirmity, and dying in public institutions there; and by the term "Residents" is meant persons who have been taken out of the district on account of sickness or infirmity, and have died in public institutions elsewhere. The "Public institutions" to be taken into account for the purposes of these Tables are those into which persons are habitually received on account ot sickness or infirmity, such as hospitals, workhouses and lunatic asylums. A list of the Institutions in respect of the deaths in which corrections have been made should be given on the back of this Table. Total population at all ages 10,094 At Census of 1901. Area of District in acres (exclusive of area covered by water). 2,636 Number of inhabited houses 1,918 Average number of persons per house 5.3 I. II. III. Institutions within the District receiving sick and infirm persons from outside the District. Institutions outside the District receiving sick and infirm persons from the District. Other Institutions, the deaths in which have been distributed among the several localities in the District. The Clock and Watchmaker's Asylum. The Victoria Cottage Hospital, Barnet. Barnet Isolation Hospital. Workhouse, Barnet. Herts County Asylum. TABLE III.—Cases of Infectious Disease notified during the Year 1907. EAST BARNET VALLEY URBAN DISTRICT. Notifiable Disease. Cases notified in Whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from each Locality. At all Ages. At Ages—Years. 1.—East Barnet. 2.—Barnet Vale. 3.—Monken Hadley. 4. —Brunswick Park. 5. 6. 7. 1.— East Barnet. 2.—Barnet Vale. 3.—Monken Hadley. 4.—Brunswick Park. 5. 6. 7. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small Pox ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Cholera ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Diphtheria (including Membranous Croup) 11 1 1 9 ...... ...... ...... 8 1 1 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Erysipelas 5 ...... ...... ...... 1 4 ...... 4 ...... 1 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Scarlet Fever 38 ...... 9 21 3 5 ...... 23 6 2 7 ...... ...... ...... 10 ...... 1 ...... ...... ...... 11 Typhus Fever ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Enteric Fever 1 ...... ...... ...... 1 ...... ...... 1 ...... ...... ...... ...... ...... ...... 1 ...... ...... ...... ...... ...... 1 Relapsing Fever ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Continued Fever ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Puerperal Fever ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Plague ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Chicken Pox 41 4 11 25 ...... 1 ...... 29 1 11 ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... ...... Totals 96 5 21 55 5 10 ...... 65 8 15 8 ...... ...... ...... 11 ...... 1 ...... ...... ...... 12 TABLE IV. Causes of, and Ages at, Death during Year 1907. EAST BARNET VALLEY URBAN DISTRICT. Causes of Death. Deaths in or belonging to whole District at subjoined Ages. Deaths in or belonging to Localities (at all Ages). Total Deaths in Public Institutions in the District. All Ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. East Barnet. Barnet Vale. Monken Hadley. Brunswick Park. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... Scarlet Fever 2 ... ... ... ... 2 ... 2 ... ... ... ... ... ... ...... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... Diphtheria and Membranous Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... Fever Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... Enteric ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... Other continued ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... Epidemic Influenza 3 ... ... 1 ... 1 1 2 ... 1 ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa 3 3 ... ... ... ... ... 3 ... ... ... ... ... ... ...... Enteritis 2 ... ... ... ... ... 2 1 1 ... ... ... ... ... ...... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... Other Septic Diseases 4 1 ... ... ... 3 ... 2 1 1 ... ... ... ... ...... Phthisis 11 ... ... ... ... 11 ... 6 2 1 2 ... ... ... ...... Other Tubercular Diseases 7 3 3 ... ... 1 ... 5 ... 1 1 ... ... ... ...... Cancer, Malignant Disease 9 ... ... ... ... 2 7 6 2 ... 1 ... ... ... ...... Bronchitis 16 6 1 ... 1 1 7 14 ... 1 1 ... ... ... ...... Pneumonia 5 ... 1 ... ... 3 1 3 2 ... ... ... ... ... ...... Pleurisy 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ...... Other Diseases of Respiratory Organs 2 ... 1 ... ... 1 ... 1 ... ... 1 ... ... ... ...... Alcoholism 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ...... Cirrhosis of Liver Venereal Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... Premature Birth 3 3 ... ... ... ... ... 3 ... ... ... ... ... ... ...... Diseases and accidents of parturition 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ...... Heart Diseases 12 ... 1 ... ... 7 4 4 3 3 2 ... ... ... ...... Accidents 9 1 2 ... 2 4 ... 9 ... ... ... ... ... ... ...... Suicides l ... ... ... ... ... 1 1 ... ... ... ... ... ... ...... Congenital Debility 5 5 ... ... ... ... ... 4 ... ... 1 ... ... ... ...... Convulsions 2 2 ... ... ... ... ... 2 ... ... ... ... ... ... ...... All other causes 37 ... 2 1 1 17 16 20 5 8 4 ... ... ... ...... All causes 136 24 11 2 4 54 41 90 17 16 13 ... ... ... TABLE V. EAST BARNET VALLEY URBAN DISTRICT. Deaths from stated Causes in Weeks and Months under One Year of Age. Cause of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Tot. und. 1 mth. 1-2 mths. 2-3 mths. 3-4 mths. 4-5 mths. 5-6 mths. 6-7 mths. 7-8 mths. 8-9 mths. 9-10 mths. 10-11 mths. 11-12 mths. Tot. und. 1 year. ALL CAUSES. Certified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 24 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria : Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœal Disease Diarrhoea, all forms ... 2 1 3 Enteritis (not Tuberculous) Gastritis. Gastrointestinal Catarrh Wasting Diseases. Premature Birth 8 3 8 Congenital Defects Injury at Birth Want of Breast-milk ... Atrophy, Debility, Marasmus a 4 ... 1 5 Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 2 Tuberculous Peritonitis: ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Tabes Mesenterica Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Convulsions ... ... 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... 2 Bronchitis ... ... 1 ... 1 2 ... ... 1 1 1 ... ... ... ... ... 6 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlaying ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Other Causes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 3 2 2 2 9 2 1 1 6 1 1 ... 1 1 1 ... 24 District (or sub-division) of East Barnet Valley Urban. Population—Estimated to middle of 1907, 11,800. Births in the Year—Legitimate, 226; Illegitimate, 6 Deaths in the year of Legitimate infants, 23; Illegitimate infants, 1. Deaths from all Causes at all Ages, 136. Annual Report of Medical Officer of Health for 1907, FOR THE URBAN DISTRICT OF EAST BARNET VALLEY. FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES AND HOMEWORK. I.- INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries.) 9 1 none. Workshops (Including Workshop Laundries.) 60 1 none. Workplaces - - - Homeworkers' Premises 6 — — Total 75 2 none. 2.-DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:—* 2 2 Want of cleanliness Want of ventilation Overcrowding Want of drainage of floors Other nuisances †Sanitary accommodation insufficient unsuitable or defective not separate for sexes Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101). Breach of special sanitary requirements for bakehouses (SS. 97 to 100). Failure as regards lists of outworkers (S. 107). Giving out work to be done in premises which are unwholesome (S. 108). infected (S. 110). Allowing wearing apparel to be made in premises infected by scarlet fever or smallpox (S. 109). Other offences Total 2 2 * Including those specified in Sections 2, 3, 7 and 8, of the Factory Act as remediable under the Public Health Acts. † For districts not in London state here whether Section 22 of the Public Health Acts Amendment Act, 1890, has been adopted by the District Council; and if so what standard of sufficiency and suitability of sanitary accommodation for persons employed in factories and workshops has been enforced. 3.-OTHER MATTERS. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (S. 133). Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (S. 5). Notified by H.M. Inspectors Reports (of action taken) sent to H.M. Inspectors. Other Underground Bakehouses (S. 101):- Certificates granted during the year In use at the end of the year 3 Homework:— Number of Lists of Outworkers* (S. 107):— Lists. Outworkers. Lists received 6 3 Addresses of outworkers forwarded to other Authorities 0 0 received from other ities 3 0 Homework in unwholesome or infected premises:— Wearing Apparel; Other. Notices prohibiting homework in unwholesome premises (S. 108). 0 0 Cases of infectious disease notified in homeworkers' premises 0 0 Orders prohibiting homework in infected premises (S. 110). 0 0 Workshops on the Register (S. 131) at the end of the year Six Workshop Bakehouses are included in this register of Workshops 25 Total number of Workshops on Register 25 *The Lists should be received twice in the year. The year's figures required in the Table are then obtained by adding together the two half-yearly totals.