FINC 8 Urban District Council of Finchley. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, including the REPORT TO THE EDUCATION COMMITTEE, FOR THE YEAR 1908 by J. R. PRIOR, M.B., D.P.H. together with the ANNUAL REPORT of the INSPECTOR OF NUISANCES, by E. J. FRANKLIN, A.R.San.I., FINCHLEY. N. Warden & Co.. Ltd., "Finchley and Hendon Times" Office, 11, Regents Parade, North Finchley, N. 1909. TABLE OF CONTENTS. Vital Statistics— Population of the District and each of the Sub-Districts 6 Number of People to the Acre 6 Births and Birth Rate 7 Mortality, Death-Rates and Causes of Mortality 8—22 Infantile Mortality 13—16 Epidemic Mortality 17 Deaths in Various Institutions 18 Public Mortuary 19 Infectious Diseases and Measures Taken to Prevent Their Spread— Isolation Hospital 26—42 Bacteriological Diagnosis 26 Scarlet Fever 31 Diphtheria 31 Measles 31 Whooping Cough 33 Smallpox 34 Special Report on Outbreak of Enteric Fever 35—42 Consumption (Phthisis) 42 Cancer 47 School Hygiene 47 Water Supply 49 Meteorological Observations 50 Housing 51 Drainage and Sewage Disposal 52 Disposal of House Refuse 55 Analyses 55 Sanitary Work Performed During the Year 55—63 The Factory and Workshops Act, 1901 56 Milk Supply 59 Bakehouses 63 Sale of Food and Drugs Act 63 Adoptive Acts, Byelaws and Regulations 64 Medical Inspection of School Children 65—81 Rfport of the Sanitary Inspector 83—100 House Drainage 85 House to House Inspection 88 Complaints 90 Factory and Workshops Act, 1901 91 Dairies, Cowsheds and Milkshops 91 Ice Cream Premises 92 Slaughterhouses and Meat and Food Inspection 92 Infectious Disease and Disinfection 93 Game Licences 95 Petroleum Acts, 1871 to 1881 95 Summary of Work Done 97 To the Chairman and Members of the Finchley Urban District Council. Gentlemen,— I beg to present to you my report on the health of the Finchley Urban District for the year 1908. The Vital Statistics are very favourable. The death rate is the lowest on record for Finchley. The Infantile Mortality is also the lowest on record. The birth rate shows a distinct decline, and is the lowest recorded in Finchley. The rapid increase in the population has necessitated further Isolation Hospital accommodation. A special SubCommittee has been appointed to enquire into the whole matter. A properly constructed Refuse Destructor is needed, and the Surveyor has been instructed to report on the matter. The Finchley Urban District Council Act came into operation in 1908, which has entailed considerably more work on the Public Health Department, and before long additional assistance will probably be required. In December last Mr. Overed, M.R.C.V.S., was appointed Veterinary Surgeon to the Council in order to put the Model Milk Clauses contained in the Local Act, into full operation. It is with much pleasure that I record the highly efficient manner in which your Chief Sanitary Inspector, Mr. Franklin, has carried out his duties, and also the excellent work performed by your Assistant Inspector, Mr. Robinson. I am, Gentlemen, Your obedient Servant, J. R. PRIOR. Council Offices, Finchley, N. March, 1909. 6 Vital Statistics. Population.—The population of Finchley. taken at the last census, was 23,805. There are two methods generally adopted for estimating the population during the years between the census. The one adopted by the RegistrarGeneral is based upon the assumption that the rate of increase since 1901 is the same as in the years 1891-1901. The other method is to base the estimate on the number of occupied houses, assuming the number of inhabitants per house is the same as it was in 1901. Owing to the rapid increase in the population of Finchley, the first method is obviously inapplicable, and a more accurate estimate is obtained by adopting the second method. The average number of persons per house in 1901 was 5.6. Taking the number of occupied houses in the middle of the year as 7,053, and multiplying by 5.6, gives an estimated population of 39,499. The following table shews the number of inhabited houses, together with the estimated population for each district up to the middle of this year. Ward. No. of occupied Houses. Estimated 1907. Population. 1908. North Finchley 2117 10914 11858.8 East Finchley 2538 14431 14212 West Finchley 2398 10976 13428.8 7053 36321 39499.6 Density of Population.—The area of the district is 3,384 acres. At the census of 1901 the average number of persons per acre was 6.5. The number of persons to each acre is now estimated as 11.6. 7 The following table gives the density of population for each Ward in the district. Ward. Area in Acres Population. Density. North Finchley 1161 11858 10.1 East Finchley 1219 14212 11.6 West Finchley 1002 13428 13.3 Birth Rate. The number of births registered in 1908 was 888, being one less than in 1907. The birth-rate for the whole year was 22.22, as compared with a rate of 24.48 for 1907. The birth-rate for England and Wales for the year 1908 was 26.5. Of these 888 births 407 were females and 481 males. The number of births and birth-rate for each quarter is shewn in the following table:— No. of Births. Birth Rate. 1st Quarter 226 5.7 2nd „ 214 5.4 3rd „ 218 5.2 4th „ 230 5.8 888 22.22 The following table shews the number of births recorded and the birth-rate for each Ward of the District:— Ward. No. of Births. Birth Rate. North Finchley 268 23.4 East Finchley 378 26.3 West Finchley 242 18.3 The birth-rate of 1908 is the lowest recorded in Finchley. 8 Death Rate. The number of deaths registered in the district during the year 1908 was 289, as compared with 313 for the year 1907. This gives a gross death-rate of 7.31 per 1,000, as compared with 8.36 per 1,000 for last year; the death-rate for England and Wales being 14.7. From this 289 deaths six must be deducted as occurring amongst those persons dying in the various institutions in the district, but not residents of this district, and 56 deaths must be added of Finchley residents dying outside the district. This gives a nett or corrected death-rate of 8.58, as compared with 9.83 for last year. To arrive at a proper estimate of the death-rate of the district, in order to compare with other districts, it is desirable, as far as possible, to make allowance for age and sex distribution. This is obtained by multiplying the net deathrate by the factor for correction, which, in the case of Finchley, is 1.05, which gives a death-rate of 8.9, as compared with 10.32 for last year. From the above figures it will be seen that the death-rate is lower than last year, and is, in fact, the lowest ever recorded. The following table gives the gross death-rate, the nett death-rate, and the death-rate corrected for age and sex distribution:— 1908. 1907. Gross Death-Rate 7.31 8.36 Nett Death-Rate 8.58 9.83 Corrected for age and sex 8.9 10.32 On comparing Table A with the corresponding table of last year it will be seen that there are fewer deaths from Measles and Whooping Cough. The deaths 9 from diarrhœal diseases are the same as last year, but are very low and very much lower than in the year 1906. There have been no deaths from Enteric Fever during the year, although the number notified have been much larger, 25, as compared with 6 during the year 1907. The following table shews the population, number of deaths, and death-rate for each of the Wards of the District. Ward. Population. No. of Deaths. Death Rate. 1908. 1907. North Finchley 11859 136 10.1 10.2 East Finchley 14212 127 8.9 10.2 West Finchley 13428 76 5.6 8.8 39499 339 8.58 9.83 10 Table A. Causes of and Ages at Death during the Year 1908. Causes of Death. Deaths in Whole District at subjoined ages. Deaths in Localities (at all ages). Deaths in Public Institutions. All ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and | Upwards. North Finchley. East Finchley. West Finchley. Small-pox .. .. .. .. .. .. .. .. .. .. .. Measles 10 3 6 1 .. .. .. 10 .. .. 2 Scarlet Fever 4 .. 2 1 1 .. .. 2 1 1 .. Whooping Cough 3 1 2 .. .. .. .. 2 .. 1 2 Diphtheria and Membranous Croup 4 .. 4 .. .. .. .. 2 .. 2 .. Croup .. .. .. .. .. .. .. .. .. .. .. Fever Typhus .. .. .. .. .. .. .... .. .. .. .. Enteric .. .. .. .. .. .. .. .. .. .. .. Other continued .. .. .. .. .. .. .. .. .. .. .. Epidemic Influenza 14 1 2 1 .. 3 7 11 1 2 .. Cholera .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .... .. .. .. .. .. .. .. Diarrhœa 5 2 3 .. .. .. .. .. 4 1 .. Enteritis 3 3 .. .. .. .. .. .. 3 .. .. Puerperal Fever 1 .. .. .. .. 1 .. .. .. 1 .. Erysipelas .. .. .. .. .. .. .. .. .. .. .. Other Septic Diseases 4 .. 1 .. .. 1 2 .. 3 1 .. Phthisis 21 1 .. .. 2 16 2 11 9 l 1 Other Tubercular Diseases 8 3 3 .. .. 2 .. 5 2 l 2 Cancer, Malignant Diseases 21 .. .. .. .. 14 7 9 7 5 .. Bronchitis 27 6 4 .. .. 3 14 11 10 6 2 Pneumonia 22 6 3 .. 1 9 3 8 9 5 .. Pleurisy .. .. .. .. .. .. .. .. .. .. .. Other Diseases of Respiratory Organs .. .. .. .. .. .. .. .. .. .. .. Alcoholism 2 .. .. .. .. 2 .. 1 1 .. .. Cirrhosis of Liver Venereal Diseases .. .. .. .. .. .. .. .. .. .. .. Premature Birth 7 7 .. .. .. .. .. 4 1 2 .. Diseases and Accidents of Parturition 6 .. .. .. .. 6 .. 2 3 1 .. Heart Disease 24 .. .. 1 3 8 11 11 8 5 2 Accidents 10 3 2 1 1 3 1 2 6 2 1 Suicides 8 .. .. .. 1 7 .. 4 3 1 .. Old Age 28 .. .. .. .. .. 28 9 12 7 .. All other causes 107 18 3 3 2 42 39 33 44 30 13 All causes 339 54 35 8 11 117 114 137 127 75 25 11 Table AI. Showing the Causes of Death amongst Parishioners in the District of Finchley during each of the Four Quarters of the Year 1908. Causes of Death. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Totals. 1907. Small-pox ... ... ... ... ... ... Measles 2 2 ... 6 10 16 Scarlet Fever 2 ... 2 ... 4 2 Whooping-cough 2 ... 1 ... 3 14 Diphtheria & Membranous Croup 4 ... ... ... 4 4 Croup ... ... ... ... ... ... Fevers Typhus ... ... ... ... ... ... Enteric ... ... ... ... ... 2 Other continued ... ... ... ... ... ... Epidemic Influenza 9 3 1 1 14 9 Cholera ... ... ... ... ... ... Plague ... ... ... ... ... ... Diarrhœa ... ... 1 ... 5 7 Enteritis ... ... 3 ... 3 1 Puerperal Fever ... ... 1 ... 1 1 Erysipelas ... ... ... ... ... 1 Other Septic Diseases ... 2 ... 2 4 10 Phthisis 1 3 6 1! 21 21 Other Tubercular Diseases 1 2 4 1 8 9 Cancer, Malignant Disease 6 4 5 6 21 32 Bronchitis 10 5 2 10 27 32 Pneumonia 6 4 4 8 22 26 Pleurisy ... ... ... ... ... 2 Other Diseases of Respiratory Organs ... ... ... ... ... 3 Alcoholism, Cirrhosis of Liver 1 ... ... 1 2 4 Venereal Diseases ... ... ... ... ... 1 Premature Birth 3 1 2 1 7 14 Diseases & Accidts. of Parturition 3 1 ... 2 6 2 Heart Diseases 6 5 6 7 24 38 Accidents 2 ... 3 5 10 2 Suicides 1 2 3 2 8 ... Old Age 9 8 5 6 28 20 All Other Causes 26 26 21 35 107 84 Totals 93 68 70 108 339 357 12 Table A2.—Showing the District Mortality foe each Quarter of 1908. North. East. West. Quarters. Total Quarters. Total Quarters. Total 1 2 3 4 1 2 3 4 1 2 3 4 Small pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 2 2 ... 6 10 ... ... ... ... ... ... ... ... ... ... Scarlet Fever 2 ... ... ... 2 ... ... 1 ... 1 ... ... 1 ... 1 Whooping Cough 2 ... ... ... 2 ... ... ... ... ... ... ... 1 ... 1 Diphtheria and Membraneous Croup 2 ... ... ... 2 ... ... ... ... ... 2 ... ... ... 2 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 7 2 1 1 11 ... 1 ... ... 1 2 ... ... ... 2 Diarrhoea ... ... ... ... ... ... ... 1 3 4 ... ... ... 1 1 Enteritis ... ... ... ... ... ... ... 3 ... 3 ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Septic Diseases ... ... ... ... ... ... 2 ... 1 3 ... ... ... 1 1 Phthisis ... 1 3 7 11 1 2 2 4 9 ... ... 1 ... 1 Other Tubercular Diseases 1 2 1 1 5 ... ... 2 ... 2 ... ... 1 ... 1 Cancer 4 1 3 1 9 1 2 2 2 7 1 1 ... 3 5 Bronchitis 5 1 1 4 ii 3 4 ... 3 10 2 ... 1 3 6 Pneumonia 2 2 ... 4 8 4 1 3 1 9 ... 1 1 3 5 Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Respiratory Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism and Cirrhosis 1 ... ... ... 1 ... ... ... 1 1 ... ... ... ... ... Venereal ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 1 1 1 1 4 1 ... ... ... 1 1 ... ... ... 2 Diseases and Accidents of Parturition 2 ... ... ... 2 1 1 ... 1 3 ... ... ... 1 1 Heart Diseases 1 2 3 5 11 3 3 1 1 8 2 ... 2 1 5 Accidents ... ... 1 1 2 2 ... 1 3 6 ... ... 1 1 2 Suicides 1 1 1 1 4 ... 1 1 1 3 ... ... 1 ... 1 Old Age 3 3 1 2 9 3 4 2 3 12 3 1 2 1 7 All Other Causes io 4 9 10 33 9 14 6 15 44 8 7 6 9 30 Totals 46 22 25 44 137 28 35 25 39 127 21 10 19 25 75 13 Infantile Mortality. The number of deaths of infants under one year of age was 54, as compared with 888 births, giving an infantile mortality rate per 1,000 of 60.81, as compared with 84 deaths and a rate of 94.49 for last year. The rate for England and Wales for 1908 was 121. The Infantile Mortality rate is the lowest recorded. This low death-rate is largely due to the very few number of deaths from Zymotic Diseases. Although there was rather a severe outbreak of Measles during the Autumn, there were only three deaths recorded during the year from this disease in infants under one year of age; the deaths from diarrhœal diseases also was very low. The following table shews the number of deaths under one year of age, and the infantile death-rate for each Ward in the District:— Ward. No. of Deaths. Mortality Rate per 1,000. North Finchley 24 86.5 East Finchley 19 50.2 West Finchley 11 45.4 The Finchley Urban District Council have made a special effort to deal with the question of Infantile Mortality by adopting the Notification of Births Act, which came into force in this District in April last. The Notification of Births Act, 1907, makes provision for the notification of every birth in a district to be sent to the Medical Officer of Health within 36 hours of the birth. The duty of notifying lies with the father, if actually residing in the house at the time of the birth, or any person in attendance upon the mother at the time of or within six hours after the birth. Tho Act is an adoptive one, and was adopted by the Finchley Urban District Council, and came into operation in April, 1908. This Act in no way supersedes the Begistration 14 of Births and Deaths Act, 1874, which requires information concerning the birth of every child born alive to be given to the Registrar within 42 days next after the birth. The Act of 1907 is intended to assist the local authorities in endeavouring to reduce the rate of infantile mortality. It has been found that the advice of a properly trained Health Visitor is of much assistance to mothers in the poorer districts of large towns, the loss of infant lives being to a very large extent due to preventable causes such as ignorance on the part of the mother. In order to carry out this Act a Lady Health Visitor has been appointed whose duty it is to visit all parents of newly-born infants, whom the medical man in attendance thinks would benefit by advice and instruction. Letter cards are supplied to each medical man practising in the district who intimates whether they wish the Health Visitor to call. Her visits are much appreciated by some of the medical men, and by some of the parents, and it is hoped that when bettor known her services may be more often called upon. Since April, 635 notifications have been received, and 124 visits have been paid. 15 Table A3. Showing the Causes of Infantile Mortality in the District during each of the four quarters of the Year 1908. Cause of Death. 1st Quar. 2nd Quar. 3rd Quar. 4 th Quar Totals. All Causes Certified 11 9 14 20 54 Uncertified .. .. .. .. .. Common Infectious Diseases Small-pox .. .. .. .. .. Chicken-pox .. .. .. .. .. Measles .. .. .. 3 3 Scarlet Fever .. .. .. .. .. Diphtheria: Croup .. .. .. .. .. Whooping Cough 1 .. .. .. 1 Diarrhœal Diseases 'Diarrhoea, all forms .. .. .. 2 2 Enteritis (not Tuberculosis) .. .. 3 .. 3 Gastritis, Gastro-intestinal Catarrah .. .. .. .. .. Wasting Diseases Premature Birth 3 1 2 1 7 Congenital Defects 1 4 3 5 13 Injury at Birth .. .. .. .. .. Want of Breast-milk .. .. .. .. .. A trophy, Debility, Marasmus .. .. .. .. .. Tuberculous Diseases Tuberculous Meningitis .. .. .. .. .. Tuberculous Peritonitis .. .. .. .. .. Tabes Mesenterica .. .. .. .. .. Other Tuberculous Diseases 1 1 2 .. 4 Erysipelas .. .. .. .. .. Syphilis .. .. .. .. .. Rickets .. .. .. .. .. Meningitis (not Tuberculous) .. .. 1 .. 1 Convulsions .. .. .. .. .. Bronchitis 2 .. 1 3 6 Laryngitis .. .. .. .. .. Pneumonia 1 1 1 3 6 Suffocation over-laying .. .. .. .. .. Other Causes 2 2 1 3 8 Total 11 9 14 20 54 16 Table A 4.—Infantile Mortality During the Year 1908. Deaths from stated Causes in Weeks and Months under one Tear of Age. CAUSE of DEATH. Under 1 Week 1-2 Weeks 2 3 Weeks. 3-4 Weeks Total under 1 Month. 1-2 Months 2-3 Months 3-4 Months. 4-5 Months 5-6 Months. 6-7 Months 7-8 Months 8-9 Months. 9-10 Months 10-11 Months 11-12 Months Total Deaths under One Year. All Causes. Certified All 13 2 1 2 18 5 2 7 3 3 5 ... 1 1 6 3 54 Uncertified None ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Common Infectious Diseases. Small pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including | Membraneous Croup) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Diarrhœal Diseases Diarrhœa, all forms ... ... ... ... ... ... ... 1 1 1 ... ... ... ... 1 ... 4 Enteritis, not Tuberculous) ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Gastritis, Gastro intestinal Catarrh ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Wasting Diseases Premature Birth 5 1 ... ... 6 ... 1 ... ... ... ... ... ... ... ... ... 7 Congenital Defects 4 1 1 ... 6 2 ... 2 ... 1 1 ... ... ... 1 ... 13 Injury at Birth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast milk Starvation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Atrophy, Debility Marasmus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Diseases. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculous Peritonitis Tabes Mesenterica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... 1 ... 4 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... 1 1 1 ... 1 ... ... 2 ... ... ... ... 1 6 Laryngitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Pneumonia ... ... ... ... ... ... 1 2 ... 1 ... ... ... 1 1 ... 6 Suffocation, overlying 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 2 Other Causes 3 ... ... 1 4 1 ... ... ... ... ... ... 1 ... ... ... 6 13 2 1 2 18 5 2 7 3 3 5 ... 1 1 6 3 54 District of Finchley Legitimate, 872 Population estimated to middle of 1908 39,499. Births in the Year Illegitimate, 16 888 Deaths from all Causes at all Ages, 339 17 Senile Mortality. Of the 289 deaths of Finchley residents, 88 were of persons above the age of 70. The proportion of deaths occuring amongst those over 70 years of age to the total deaths was therefore 30.4. In 1907 the percentage 25.2, and in 1906 23.1. 65 and under 70. 70 and under 80. 80 and under 90. 90 and upwards. Total. First Quarter 4 18 9 1 32 Second Quarter 9 11 8 1 29 Third Quarter 8 6 3 — 17 Fourth Quarter 5 17 12 2 36 Total 26 52 32 4 114 Epidemic or Zymotic Mortality. The diseases grouped together in the Registrar General's Reports, under the term Principal Epidemic Diseases are Small Pox, Measles, Scarlet Fever, Whooping Cough, Diphtheria, "Fever" (including Typhus, Enteric or Typhoid Fever, and Simple Continued Fever) and Diarrhœa. The Epidemic Death-Rate in 1908 was .73, as compared with 1.22 in 1907, and 1.53 in 1906. The average for the ten years 1898-1907 was 1.19. The incident and fatality of the above-named diseases are dealt with separately. 18 Deaths in Various institutions within the District. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Home for Homeless Children, Fallow Corner 2 2 - 1 5 National Hospital Convalescent Home, East Finchley 1 2 l 2 6 Woodside Home, Whetstone 2 1 l 3 7 Convent of the Good Shepherd, East Finchley 1 - - 1 1 Home of the Good Shepherd, East Finchley 1 - - - 1 St. Joseph's Home, East Finchley — — ' — - - Finchley Cottage Hospital — — 2 3 5 6 5 4 10 25 19 The Public Mortuary. Thirty-three bodies were deposited during the year in the Public Mortuary in Summers Lane, as against twenty-seven in the preceding year; twenty-five of these had been parishioners of Finchley, seven of Friern Barnet, and one of Hornsey. INQUESTS, 1908. 1st Quarter. and Quarter. 3rd Quarter. 4th Quarter. Total. Heart Disease — — 2 - 2 Anæmia - - — 1 1 Convulsions - l - 1 2 Persistent Thymus l — — - 1 Accident 3 — 2 3 8 Whooping Cough 1 — — — 1 Congenital Disease — l — — 1 Epilepsy — l — — 1 Suicide — 2 3 3 8 Peritonitis — 1 — — 1 Disease of Stomach — — 1 — 1 Want of Attention at Birth - - 1 - 1 5 6 9 8 28 20 Table A8 Showing the Mortality in Finchley from the Principal Epidemic Diseases during a Series of Years. Estimated Population. Smallpox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping-cough. Fever. Diarrhoea. Total Deaths. Rate to every 1,000 Persons. Mean of 1871-1880 2.13 Ditto of 1881-1890 1.60 Ditto of 1891-1900 1.53 1891 16,419 ... ... ... 3 10 1 6 20 1.21 1892 17,002 ... 4 2 6 ... 1 11 24 1.41 1893 17,500 ... 18 4 12 10 1 4 49 2.80 1894 18,015 1 5 ... 4 11 1 4 26 1.44 1895 18,598 ... 1 ... 2 11 3 5 22 1.18 1890 19,218 ... 1 ... 5 5 2 11 24 1.24 1897 20,064 ... 11 ... 1 4 2 16 34 1.69 1898 20,907 ... 6 ... ... 6 3 24 39 1.86 1899 21,800 1 ... ... 6 7 ... 16 30 1.37 1900 22,750 ... 1 2 1 9 6 8 27 1.18 1901 22,500 ... 12 ... 2 1 3 6 24 1.06 1902 23,400 ... 2 1 4 9 1 7 24 1.02 1903 24,125 ... 1 ... 3 5 ... 4 13 0.54 1904 25,564 ... 17 1 3 10 ... 13 44 1.72 1905 28,716 ... ... ... 2 8 1 7 18 0.63 1906 30,750 ... 7 5 3 1 ... 31 47 1.53 1907 36,231 ... 16 2 4 14 2 1 45 1.22 Mean of 1898 1907 25,683 0.1 6.2 1.1 2.8 7.0 1.6 12.3 31.1 1.21 1908 39,499 ... 10 4 4 3 ... 8 29 0.73 21 Table A6 a Comparison of the rates of the finchley district with those of England and Wales, the 76 Great Towns, and London Generally, for the Year, 1908. General Death Rate. Rate of Infantile Mortality. Birth-Rate. Zymotic DeathRate. England and Wales 14.7 121 26.5 1.20 The 76 Great Towns 14.9 128 27.0 1.59 London Generally 13.8 113 25.4 1.35 The Finchley District 8.54 60.81 22.22 .73 Small-pox. Measles. Scarlet Fever. Whooping Cough. " Fever." Diphtheria. Diarrhoea and Dysentery. England and Wales 0.00 0.22 0.08 0.27 0.07 0.15 0.50 London Generally 0.00 0.31 0.1l 0.25 0.04 0.15 0.54 The 76 Great Towns 0.00 0.31 0.10 0.29 0.08 0.16 0.65 The Finchley District 0.00 0.25 0.10 0.07 0.00 0.10 0.20 22 Table A7. Vital Statistics of Whole District during 1908 and Previous Years. Year. Population estimated to middle of each year. Births Total Deaths Registered in the District. 1 eaths in Public Institutions in the District. Deaths of Non-residents registered in the District. Deaths of Residents registered beyond District. Deaths at all ages Nett. Under one year. All Ages. Number *Rate. Number. *Rate. Number. Rate per 1,000 Births registered. Number. *Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1891 16,419 481 29.5 42 86.8 ... ... ... ... ... 182 11.1 1892 17,002 477 28.0 43 90.1 ... ... ... ... ... 207 12.2 1893 17,500 486 27.7 52 107.0 224 12.4 ... ... ... 231 13.2 1894 18,015 515 28.6 57 110.7 ... ... ... 17 14 221 12.2 1895 18,598 466 25 0 46 98.7 220 11.8 ... 21 11 210 11.3 1896 19,218 496 25.8 46 92.7 197 10.2 ... 9 12 200 10.4 1897 20,064 501 24 4 51 101.8 204 10.1 ... 11 12 205 10.2 1898 0.907 498 238 68 136.5 216 10.4 ... 10 12 218 10.4 899 21,800 507 23.2 56 110.4 246 11.3 ... 19 22 249 11.4 1900 22,750 522 239 58 111.1 244 10.7 ... 17 17 244 10.7 1901 22,500 540 24.0 53 98.1 211 9.4 ... 12 20 219 9.7 1902 23,400 578 24.7 54 93 4 269 11.5 ... 27 17 259 11.0 1903 24,125 646 26.8 59 91.3 220 9.1 ... 15 29 234 9.7 1904 25,564 634 24.8 87 137.2 325 12.7 14 14 27 338 13.2 1905 28,716 743 25.9 68 91 5 266 9.3 19 11 30 285 9.9 1906 30,750 773 25.1 91 117.7 337 11.0 25 22 45 360 11.7 1907 36,321 889 24.5 84 94.5 313 8.6 22 10 54 357 9.8 Averages for years 1898-1907 25,683 636 24.6 67.8 108.1 264 10.4 ... 15.7 27.3 276 10.7 1908 39,499 888 22.22 54 60.8 289 7.31 25 6 56 339 8.58 Note.—The deaths 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 included in column 12 are the number in column 7, corrected by the substraction 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 illness and dying there; and by the term "residents" is meant persons who have been taken out of the district on account of illness, and have died elsewhere The "Public Institutions" taken into account for the purpose of these Tables are those into which persons are habitually received on account of 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 is appended. *Rates calculated per 1,000 of estimated population. 23 Table A7—Continued. Area of district' in acres(exclusive of area covered by water). 3,384 Total population at all ages 22,126 At Census of 1901. Number of Inhabited Houses 3,949 Average number of persons per house 5.6 1 2 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. Woodside Home, Whetstone National Hospital, Convalescent Home, East Finchley. Small pox Isolation Hospital. Union Infirmary, Barnet. Hornsey Isolation Hospital. Great Northern Hospital, Holloway. Children's Hospital, Great Ormond Street. St. Thomas' Hospital. University College Hospital. Middlesex Hospital. St. Bartholomew's Hospital. Charing Cross Hospital. Middlesex County Asylum, Napsbury. Middlesex County Asylum, Wandsworth Friedenhiem Hospital, Hampstead. St. Pancras Workhouse. Royal Free Hospital. London Hospital. Islington Infirmary. The Union Workhouse is situated in the Barnet Urban District. 24 Infectious Disease. The number of notifications of infectious disease received during the year was 229, as compared with 216 received during the year 1907. Looking at the figures given in the table below 2B, it will be seen that there have been 17 fewer cases of Diphtheria, 7 fewer cases of Erysipelas, an increase of 18 cases of Scarlet Fever, and 19 in the case of Enteric Fever. The highest number of notifications of infectious disease was received during the month of March—35 in number—and the fewest in December, when only 7 were received. The 229 cases represent the infection of 181 houses. The infectious sickness rate of the District was 5.7 to each 1,000 of the population, as compared with a rate of 5.9 for last year, and 6.2 in 1906, 4.9. in 1905, and 10.3 in 1904. The average for the last 10 years—1898-1907—was 6.5. Further powers for dealing with infectious disease are contained in the Finchley Urban District Council Act, 1908, by Section 42. The occupiers of any dwelling in the district which is used for human habitation, and in which there is or has been any person suffering from a dangerous infectious disease shall, on the application of the Medical Officer of Health at any time during the illness of such person, or within six weeks of the occurrence of such illness, furnish such information within his knowledge as the Medical Officer may reasonably require for the purpose of enabling measures to he taken to prevent the spread of the disease. The following table shews the number of cases of infectious disease occurring in each Ward:— Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas Puerperal Fever. Totals. North Finchley 49 11 14 8 - 82 East Finchley 50 13 4 5 - 72 West Finchley 44 18 7 4 2 75 143 42 25 17 2 229 25 Of these 229 cases 160 were removed to Hospital, or 69 per cent., as compared with 54 per cent. last year. The following table shews the number of cases removed to Hospital from each Ward of the District:— Scarlet Fever. Diphtheria. Enteric Fever. Puerperal Fever. Totals. North Finchley 42 10 13 - 65 East Finchley 42 5 2 - 49 West Finchley 33 10 2 l 46 117 25 17 l 160 The following table gives the number of notifications received during each month of the year:— Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas Puerperal Fever. Totals. January 8 4 2 l - 15 February 18 2 1 3 - 24 March 22 11 — 2 - 35 April 10 2 - 2 - 14 May 7 1 — - - 8 June 19 5 1 1 1 27 July 21 2 - 1 - 24 August 12 5 3 - l 21 September 8 - 9 - - 17 October 10 1 5 5 - 21 November 6 6 4 - - 16 December 2 3 - 2 - 7 143 42 25 17 2 229 26 Isolation Hospital. The agreement with the Hornsey Borough Council for the reception of Finchley patients suffering from infectious disease into their Isolation Hospital expires in April, 1913. Owing to the very rapid growth of the District, the number . of beds at the disposal of the Finchley District Council is at times quite insufficient, and it is satisfactory to report that a special Sub-Committee of the Council has been appointed to enquire into the whole question of isolation accommodation. The most noticeable feature during the year with reference to infectious disease has been the increase in the number of cases of Enteric Fever. This increase has been chiefly due to an outbreak of this disease in an outlying district of North Finchley, which accounted for 14 cases. Below is a full report on the outbreak which was presented to the Council on March 1st, 1909. Of the remaining 11 cases, two were clearly imported cases, which had been contracted by persons away on a holiday, and there is good reason to believe that at least two others were not contracted in Finchley. Several of these cases of Enteric Fever were attributed, with good reason, to the eating of oysters. Bacteriological Diagnosis. During the year 1908, 81 Bacteriological Examinations were made in order to determine the existence of diphtheria, phthisis, and enteric fever in doubtful cases. The results were as follows:— Positive. Negative. Total. Diphtheria 17 39 56 Enteric 12 4 16 Phthisis 5 4 9 27 Arrangements for the free examination of specimens forwarded by medical practitioners in the district have been in force for the past nine or ten years, and the increasing number of specimens sent to the Lister Institute each year for bacteriological examination proves the value which is set on this aid to diagnosis in doubtful cases. For several years a supply of anti-diphtheritic serum has been kept at the Public Health Offices, and doctors have been supplied with the same at cost price. In December, 1905, the Council agreed that the serum should be given free of charge when required for use in a case where the means of the patient did not enable him to pay for it. Advantage of this was taken in 9 instances during the past year, compared with 15 in 1907. The number of deaths and death-rate from the following diseases is shown in the table below:— N umber. Death Rate per 1,000. Death Rate England and Wales. Scarlet Fever 4 .10 .08 Diphtheria 4 .10 .15 Enteric — — .07 Erysipelas — — — Measles 10 .25 .22 Whooping Cough 3 .07 .27 28 Table B.—Cases of Infectious Disease Notified During the Year 1908. 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 Fast Finchley. 2 West Finchley. 3 North Finchley. 1 East Finchley. 2 West Finchley. 3 North Finchley. Total. Under 1 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 42 .. 18 13 8 3 .. 13 18 11 5 10 10 25 Membraneous Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 17 .. .. 2 .. 14 1 5 4 8 .. .. .. .. Scarlet Fever 143 .. 28 89 15 11 .. 50 44 49 42 33 42 117 Enteric Fever 25 .. 3 5 7 10 .. 4 7 14 2 2 13 17 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. 1 1 .. .. 2 .. .. 1 .. 1 Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 229 .. 49 109 31 39 1 72 75 82 49 46 65 160 29 Table B1. Showing the Number of Cases and Deaths from the Principal Infectious Diseases Notified from among Parishioners During the Year 1890—1908 (inclusive) Small-pox. Scarlet Fever. Diphtheria and Croup. Cases. Deaths Cases. Deaths. Cases. Deaths. 1890 ... ... 53 1 31 4 1891 ... ... 80 ... 32 3 1892 ... ... 125 2 37 6 1893 ... ... 189 3 30 9 1894 9 1 57 ... 66 4 1895 ... ... 27 ... 22 2 1896 ... ... 33 ... 25 5 1897 ... ... 54 ... 20 1 1898 ... ... 91 ... 12 ... 1899 8 2 58 ... 32 6 1900 1 ... 94 2 12 1 1901 7 1 98 ... 21 2 1902 15 1 115 1 31 3 1903 ... ... 67 ... 72 3 1904 ... ... 161 1 68 3 1905 ... ... 85 ... 32 2 1906 ... ... 128 5 30 3 1907 ... ... 125 2 59 4 1908 ... ... 143 4 42 4 Erysipelas. Puerperal Fever. Typhoid Fever Cases. Deaths. Cases. Deaths Cases. Deaths 1890 16 ... ... ... 7 1 1891 14 ... 1 ... 3 1 1892 17 ... 2 ... 3 1 1893 38 ... 1 ... 14 1 1894 22 ... 4 4 12 1 1895 15 2 1 1 12 3 1896 14 ... 1 ... 12 2 1897 15 ... 2 ... 13 2 1898 6 ... ... ... 9 3 1899 14 2 2 2 12 ... 1900 16 2 1 ... 7 3 1901 10 ... ... ... 15 3 1902 13 1 1 1 13 1 1903 15 ... 1 ... 4 ... 1904 30 2 2 2 4 ... 1905 15 ... ... ... 8 1 1906 18 ... 3 2 11 ... 1907 24 1 2 1 6 2 1908 17 ... 2 1 25 ... 30 Table B2. Cases of Infectious Disease Notified During Each Month of the Year 1908. Diphtheria. Erysipelas. Scarlet Fever. Enteric Fever. Puerperal Fever. Totals. January 4 1 8 2 - 15 February 2 3 18 1 - 24 March 11 2 22 — - 35 April 2 2 10 — — 14 May 1 — 7 — - 8 June 5 1 19 1 1 27 July 2 1 21 — - 24 August 5 — 12 3 1 21 September — — 8 9 — 17 October 1 5 10 5 - 21 November 6 — 6 4 — 16 December 3 2 2 - - 7 Totals 42 17 143 25 2 229 31 Scarlet Fever. Scarlet Fever has been prevalent throughout the year, 143 cases being notified, but shewed a considerable decrease in the months of January, November and December. The greatest number notified was during the month of March, and the fewest in Deoember. Of these 143 cases, four died, being equal to a death-rate per 1,000 of the population of .10, and a case mortality of 2.7 per cent. A class at one of the Elementary Schools was closed on account of Scarlet Fever, otherwise the school attendance was not seriously affected. These 143 cases represent infection in 110 houses. Diphtheria. The number of cases of Diphtheria notified during 1906 was 42. The greatest number occurring in March, viz., 11 cases, and the least in May and October, one; otherwise the disease has been fairly uniform from month to month. Of these 42 cases, four died, causing a death-rate of .10 per 1,000 of the population, and a case mortality of 9.5 per cent. These 42 cases represent infection in 39 different houses. Measles. The occurrence of Measles at the beginning of the year was very slight, but in the Autumn it broke out in several parts of the District and was especially prevalent in North Finchley, some streets being particularly affected. The Albert Street School was closed on account of the prevalence of this disease from October 9th to October 23rd, and again from November 9th to November 27th. 32 Holy Trinity School was also closed from November 9th to November 27th. Measles accounted for 10 deaths, as compared with 16 for last year, giving a death-rate of .25, as compared with a death-rate of .44 for last year. Two deaths occurred in the first quarter of the year, two in the second, and six in the fourth quarter. Of these deaths 2 occurred in March. 2 „ ,, April. 2 ,, ,, October. 3 ,, ,, November. 1 ,, ,, December. With one exception all these deaths occurred in children under the age of five years. Three were under the age of one year. Six were between the ages of one and two years. One was over five years of age. The following table shews the Wards in which the deaths occurred:— North Finchley 10 East Finchley — West Finchley — During an outbreak of Measles the schools are kept under constant supervision, and if any particular class or department is principally affected closure is advised. The following table shews the number of deaths and the mortality rate per 1,000 of the population during the last 18 years:— 33 Mortality from Measles during a period of 18 years. Estimated Population. Number of Deaths. Rate per 1000 of Population. 1891 16,419 0 ... 1892 17,002 4 .23 1893 17,500 18 1.03 1894 18,015 5 .28 1895 18,598 1 .05 1896 19,218 1 .05 1897 20,064 11 .55 1898 20,907 6 .29 1899 21,800 0 ... 1900 22,750 1 .04 1901 22,500 12 .53 1902 23,400 2 .08 1903 24,125 1 .04 1904 25,554 17 .66 1905 28,718 0 ... 1906 30,750 7 .23 1907 36,321 16 .44 Average of 10 years, 1898—1907 25,681 6.2 .24 1908 39,499 10 .25 Whooping Cough. During the year 1908 the district has been comparatively free from Whooping Cough. This disease accounted for three deaths, as compared with 14 for last year and one for 1906. This gives a mortality rate of .07 per 1,000 of the population, as compared with a mortality rate of .38 for last year. All these deaths occurred in children under the age of five years, and one occurred in on infant under one year of age. Two of these deaths occurred in February and one in July. 34 Small Pox. No cases of Small Pox have been notified in the district during the year. The Small Pox Hospital has been kept in continual readiness for use if required. At present there is an agreement with the Hornsey Borough Council to receive any cases which may occur in their district, but it was not required during the year. The agreement expires in 1913. 35 REPORT OF THE OUTBREAK OF ENTERIC FEVER AT PROSPECT COTTAGES, SUMMERS ROW, AND DUNGER PLACE. To the Chairman and Members of the Public Health Committee, Finchley Urban District Council. Gentlemen,— I have the honour to submit this further report to you on the serious outbreak of Enteric Fever, which occurred in Prospect Cottages, Summers Row, and Dunger Place, between August 6th and November 18th, 1908. I have also taken this opportunity to amplify the first report in a few details. These premises are situated on the easterly border of Finchley, and are approached from Summers Lane. Summers Row and Dunger Place are built on a steep incline; at the end of this street is an open ditch. It is well to remark that this street has never been taken over by the Council, and in consequence the roadway is not cleared by the Council's servants. This District consists of 25 separate dwellings, inhabited by 30 families, and at the beginning of the outbreak the number of inhabitants was 159, 89 being adults—that is, above the age of 12 years-the remaining 70 are children. Although several of these cottages are occupied by respectable persons earning a sufficient wage, in a majority of cases, however, the inhabitants are of quite the poorest class, and apparently have a struggle for existence, accompanied by all the evils of poverty. The first case of Enteric Fever was notified on August 6th, that of S., and within a few hours I was informed that two children, G. T. and R. T., shewed symptoms highly suspicious of Enteric Fever, which suspicions were afterwards 36 confirmed. Ten days previously these children had been living in the same house as S. A visit was at once made to the premises, and full enquiries instituted to trace the source of infection. S. had been out of work for some time, and had wandered about looking for work, but the two children had not been out of the District even for a single day. All the ordinary means of infection were carefully enquired into, but without result. A sample of water was taken from the drinking water cistern and also from the main, but no evidence of animal contamination could be detected either by chemical or bacteriological analysis; the sample from the main shewed a high degree of purity. Owing to the character of the District the opportunity was taken to make a house-to-house inspection, which was forthwith undertaken by myself and Mr. Franklin. The drainage and sanitary conveniences were examined and tested, but beyond slight defects nothing of a serious nature was discovered. The water cisterns were also looked to, and any other sanitary defects noted and brought to the notice of the person responsible. I shauld add here, that although these houses are inhabited by the poorer classes, the condition of these dwellings, from a sanitary point of view, was far better than I anticipated, and in no instance was any serious defect noted, this being due, doubtless, to the attention this district has received in the past. No further case of illness was notified till September 1st. On the afternoon of that date information was received of 3 cases of enteric fever, viz: 2 adults, L. and L.T., and one child, M.P. One adult was cousin of G.T. and R.T., but living in a different house. The two other cases, L. and M.P., grandmother and grandchild, occurred in the same house. On September 3rd two other cases were notified, viz: W1.C. and L.C., grandchildren of L., and next door neighbour of L.T. 37 On September 7th, on making my routine inspection, 1 found a lad R., age 20, suffering from enteric fever, be bad only taken to bis bed that day although he had been feeling unwell for a week, and had continued at his work. He was at once removed to the Hornsey Hospital, where he suffered from a most severe attack. This lad lived next door to 1. A fortnight previously he bad visited a seaside resort for a day, but I am of opinion that he contracted the disease from the same source as the others. On September 9th another case was notified, viz.: E.P, age 4, and on September 11th W.P., age 7, was removed to the Hornsey Hospital suffering from enteric fever. He is brother to M.P., and grandchild to L., and lived in the same house with them. No further cases were notified till October 15th, just 5 weeks after the last case. On making a visit to the district on this date I enquired why a child I saw wandering about was not at school, and was informed that the parents did not think she was well. Careful examination revealed the fact that she was suffering from enteric fever. This case is particularly remarkable in that this patient passed through an attack of typhoid fever without having a rise of temperature with the exception of a slight rise to 99 degrees Fahrenheit one evening; in other respects her attack although a mild one was quite typical. Apyrexial typhoid is well recognised, but it is generally considered to be of great rarity , although probably during an outbreak of typhoid it is more common than supposed, but seldom recognised. This case also shews the great difficulty in dealing with outbreaks of enteric fever, as, had she been an adult the probability is that she would never have come under observation, but would have been a fertile source of infection. On October 17th a further case occurred, and was immediately removed to Hospital, viz.: R.F. Over four 38 weeks passed by without any fresh cases, but on November 18th a further case occurred, viz.: M.L. Since that date no other notifications have been received. On September 1st steps were immediately taken to trace the source of infection and to prevent the spread of the disease. In the first place a detailed enquiry was made as to the milk and food supply, and this possible source of infection was soon eliminated. A chemical and bacteriological examination was made of the drinking water of the infected houses, but no evidence of animal contamination could bo detected. Enquiry elicited the fact that several of the inhabitants worked at large institutions, but this possible source of infection was also excluded after enquiry from the Medical Officers of Health of the Districts in which these institutions are situated. I was informed that the ditch at the end of this road took its origin from another ditch, which receives the sewage of two or three houses. Thinking that this might be a possible source of infection, as it was well known that the children are in the habit of playing about and paddling in this ditch, enquiry was made at these houses as to any recent illness, but without result. A chemical examination of the water from this ditch shewed pollution, but no specific organisms could be detected on bacteriological examination. Information was also obtained that second-hand clothes dealers were in the habit of frequenting this neighbourhood, and enquiry was made as to this possible source of infection, but without result. On making enquiries at every house as to any other cases of suspicious illness, information was gained that A.T., brother of L.T., and cousin of G.T. and R. T., and next door neighbour to W1.C. and L.C. had been ill, but had left for the country, not far from Finchley, for his health. Enquiries were made of the doctor who was then attending him, and 39 mation was obtained that A.T. had only recently come under his care, that he appeared to have gone through some severe illness, and he thought it quite probable that he had suffered from enteric fever. On visiting A.T. he was found to be in the condition described. A bacteriological examination of a specimen of his blood gave a typical enteric (Widal) reaction, and from other clinical signs there can be no doubt that he had suffered from an attack of typhoid fever, although judging from the account of his illness it had been of an irregular, anomalous and atypical character. The following precautions were also taken. All children from this District were excluded from school, the Sunday School was closed due to the courtesy of the Rev. H. G. Phillipson, in the absence of the Rev. J. T. Lang, of Christ Church. Leaflets containing simple instructions were left at every house, a visit was made daily or more frequently as occasion required by myself and Mr. Franklin, and pressure was brought upon the inhabitants to keep their houses in a cleanly state, to burn all household rubbish, and to destroy any accumulation which was likely to harbour flies, and one of the staff was especially detailed to see to the daily disinfecting of the sanitary conveniences. Any person shewing the slightest sign of illness was at once examined, and a bacteriological examination made of the blood. By these means eight cases were discovered at a very early period of the disease, and promptly removed to hospital. In order, further, to prevent the accumulation of rubbish, and to destroy as far as possible anything that was likely to harbour flies, the dust receptacles were emptied three times a week by the courtesy of the Surveyor, which was ratified by the Committee, and fly papers were distributed to every house. A careful watch was kept on all persons removing from the District. 40 On reviewing the outbreak as a whole, I am of opinion that there were two distinct sources of infection. There can be little doubt that S., G.T., and R.T. were all infected at the same time, from the same cause, which it has been impossible to trace, and it is almost certain that A.T. was also infected at the same time, although, owing to the irregular type and anomalous character the disease shewed in his case, apparently at no time was he sufficiently ill to raise suspicions that he was suffering from Enteric Fever. The medical man whom A.T. eventually consulted after the acute symptoms had passed off, is of opinion that it is very probable that he suffered from Enteric Fever; with this opinion I entirely agree. To A.T. I attribute the second outbreak, beginning on September 1st, and ending on November 18th, giving rise to 11 cases A.T.'s sister suffered from Enteric Fever, and also two children in the next house. In another house three persons were affected, one adult and two children, and two cases occurred in the next house to this. As to the manner in which infection was conveyed, it is difficult to speak with certainty, but of course where no suspicions exist no precautions will be taken, and consequently there must have been many ways by which infection could have been carried. It is now well known that the common house fly may be a carrier of disease, and this has been experimentally proved in fclie case of Typhoid Fever. The great number of flies affecting this district was very noticeable, and it is quite possible that these may have been the chief carriers of infection, and in consequence everything was done to inculcate cleanliness and to destroy any accumulation which was likely to harbour flies. The explanation of the occurrence of the last three cases presents more difficulty. The time which elapsed between September 11th and October 15th clearly shews that F.R. 41 and R.F. must have been freshly infected, and the same applies to the case of M L. Occurrence of late cases after an outbreak is common. It is now practically established that certain patients who have passed through an attack of Typhoid Fever may be sources of infection for a very long period, and it is possible that this may have been the cause of infection of these patients. The fullest enquiries were made to ascertain if there had been any mild cases of illness which might have been Enteric Fever, but without result. Several visits weekly were made to the District until the end of the year. In all, 14 cases were notified, and one case which came under observation after he had recovered was not notified. Of these 11 cases 9 were received in to the Hornsey Hospital. 2 ,, ,, Great Northern Hospital. 2 ,, ,, University College Hospital. 1 was ,, ,, Finchley Cottage Hospital. Arrangements had been made with the Enfield Fever Hospital to receive patients had any further cases of Enteric Fever occurred. Of the 25 houses in this District eight were affected. 3 cases occurring in house A 2 „ „ B 1 „ „ C 2 „ „ D 3 „ „ E 1 „ „ F 1 „ „ G 1„ „ H 42 Houses A and B belong to Prospect Cottages; houses C D E and F are situated in Summers Row; and houses G and II. are situated in Dunger Place, the other side of the street to Summers Row. The three cases at house A were related to the two cases at house D, and also to the case at house F. The two cases at house E were related to the one case at house C, at which house also lived A.T., which I believe to have been the infecting case in the second outbreak. In conclusion, I beg to submit the following suggestions for the consideration of the Committee. Firstly, I would suggest for your consideration the advisability of formally making up and taking over this road. By this means the inhabitants would be prevented to a great extent from throwing all kinds of rubbish into the street, and the road also would be properly swept and cleansed. Secondly, I would suggest the advisability of closing in the ditch at the end of this road and constructing a proper culvert in its place, or carrying off the water through pipes. I do not at all suggest that the prevalence of Enteric Fever can in any way be attributed to this ditch, but considering that the inhabitants who dwell close by use it as a receptacle for rubbish, and the children are in the habit of paddling in it, it certainly cannot bo conducive to good health, and would be far better done away with. Consumption (Phthisis). A voluntary system of notification of cases of Phthisis has been in force in the district for rather more than five years. During 1908 four notifications were received from medical practitioners; in 1907 the number was four, and in 1906 seven cases were notified. As the cases can only be notified with the consent of the patient, the certificates received represent only a small proportion of those affected. 43 Improved sanitation has undoubtedly assisted in bringing about a decline in the death-rate from Phthisis during the past few decades, and as the spread of infection can be controlled to a great extent if simple precautionary measures are taken by those affected with the disease, there is every reason to anticipate a further considerable reduction in the mortality. This year marks a distinct advance in Finchley in endeavouring to deal with and control the spread of Tuberculosis generally. In the Spring of this year the Finchley Urban District Council Act came into force, which gave the Council much greater power in dealing with milk infected with Tuberculosis, and with cows suffering from Tuberculous Udder. In December of this year a further advance was made generally throughout the country by an order from the Local Government Board obliging the Poor Law Authorities to notify cases of Pulmonary Tuberculosis to the Medical Officer of Health. It is generally believed that this measure will, if the proper steps are taken, do great good. The question of dealing with persons suffering from Pulmonary Tuberculosis is one of great difficulty, especially where it occurs amongst the poor. Undoubtedly Phthisis is a curable disease provided the disease is recognised sufficiently early, and the sufferer is in a position to place himself under suitable treatment. Unfortunately, very many have not the means at their disposal, and have to attend to their work, which produces a double evil, in the first place they themselves are getting worse, and in the second place they are transmitting the disease to others. Some four years ago the Finchley Urban District Council had the matter of treatment of those suffering from Pulmonary Tuberculosis under consideration, and agreed to maintain a certain number of beds in a sanatorium to be 44 erected by Public Authorities in Middlesex, providing sufficient money was forthcoming to enable the institution to be started. Unfortunately, the support given to the scheme has proved inadequate. Doubtless this matter will at some future time come under consideration again. Daring the year 1907 there were 21 deaths from Phthisis, which gives a mortality rate of .53, as compared with 21 deaths and a mortality rate of .57 for last year. The following table gives the ages at death from Phthisis:— Under one year 1 15—20 years 1 20-25 „ 1 25—30 „ 3 30—35 „ 5 35—40 „ 2 45—50 „ 2 50—55 „ 3 Over 55 ,, 3 21 The table below shews the number of deaths from Phthisis in each Ward:— North Finchley 11 East Finchley 9 West Finchley 1 45 The following table gives the number of deaths and death-rate per 1,000 of the population from Phthisis for the last 10 years:— No. of Deaths. Death Rate per 1,000. 1899 15 .66 1900 11 .47 1901 10 .42 1902 26 1.11 1903 13 .53 1904 24 .93 1905 20 .62 1906 30 .97 1907 21 .57 1908 21 .53 Average, 1898—1907 17.7 .69 The following is a summary of the Order issued by the Local Government Board in December, 1908, for dealing with and controlling paupers who are suffering from Pulmonary Tuberculosis. In effect the Regulation places the obligation of notification of Pulmonary Tuberculosis upon, 1. The Medical Officer of the poor law institutions who is to notify the Medical Officer of Health of the Sanitary district in which the person resided immediately before he became an inmate of the institution. 2. The District Medical Officer who shall notify the Medical Officer of Health of the Sanitary District the case of any poor person on whom he is in attendance. 3. The Superintending Officer of a Poor Law Institution who shall notify the Medical Officer of Health of the intended destination of any person leaving the institution in respect of which a notification has been made by the Medical Officer of the institution. 46 The Regulation also provides that the Relieving Officer shall notify any change of address of a person in respect of whom a notification has been made by a District Medical Officer. The Regulation provides for remuneration for such notifications. In the case of a Medical Officer the remuneration shall be at the rate of 1s., and in the case of every other officer at the rate of 3d. for every such notification. Under Article 9 of the Regulation the Council have certain powers for preventing the spread of infection from pulmonary tuberculosis. The Council may:— 1. Take all such measures or do all such things as are authorised in any case of infectious disease, or of dangerous infectious disease by an enactment relating to public health, and as have reference to the destruction and disinfection of infected articles or the cleansing or disinfecting of premises. 2. Take all such measures or do all such things as are appropriate for the safe disposal or destruction of infected material produced and discharged as a result of pulmonary tuberculosis and otherwise for the prevention of the spread of infection from any such material. 3. Afford or supply all such assistance, facilities or articles as, within such reasonable limits as the circumstances of the case require and allow, will obviate or remove or diminish the risk of infection arising from the conditions affecting the use or occupation of any room when used or occupied by the poor person as a sleeping apartment, and 4. Furnish for the use of the poor person on loan or otherwise any appliance, apparatus or utensil which will be of assistance for the purpose of any precaution against the spread of infection. 47 Cancer. During the year 1908 there were 21 deaths due to cancer, giving a mortality rate of .53, as compared with 32 and a death-rate of .88 for 1907. The following table gives the number of deaths and death-rate from cancer for the last 10 years. No. of Deaths. Death Rate per 1,000. 1899 11 .48 1900 19 .82 1901 20 .84 1902 16 .64 1903 22 .91 1904 19 .74 1905 23 .80 1906 24 .78 1907 32 .88 1908 21 .53 Average, 1898—1907 19.6 .76 School Hygiene. Education (Administrative) Provision Act, 1907, came into operation in 1908, which makes the subject of school hygiene of the greatest importance, including under this term every factor which goes to influence to health of the child during school life. In Finchley the Medical Officer of Health carries out the routine medical inspection; in April, 1908 the Council appointed a School Nurse, whose duty it is to assist the Medical Officer in the work of the schools. The custom in this district in regard to the exclusion of children living in homes where there is non-notifiable infectious disease, was altered in the year 1907, and the rule is now as follows:— 48 "No child should attend an Infants' School from a house in which there is a case of Measles, German Measles, Whooping Cough, Chicken-pox or Mumps, but in departments for older scholars children who have previously suffered from the disease in question need not be excluded under the circumstances, if the Medical Officer of Health is satisfied that proper precautions for isolation have been taken. "The School Nurse, on ascertaining the existence of any of the above-named diseases in a house from which children are attending one of the elementary schools, makes enquiries and reports the matter to the Medical Officer of Health, who decides whether the children who have been in contact with the patient may be permitted to attend school." School Closure.—Owing to the prevalence of epidemic diseases, the closure of one or both departments of several schools was found necessary during the year. School. Disease. Inclusive Dates. Christ Church Infants Measles and Whooping Cough Mar. 4 to 20. St. Mary s Infants Do. Mar. 9 to 20. Do. Do. Mar. 23 to Ap. 16 Christ Church Infants Do. Do. St. Mary's Mixed, Standard IIa Scarlet Fever May 11 to 15. Albert Street Infants, Babies' Class Measles Oct. 9 to 23. Do. Do. Nov. 9 to 27. Holy Trinity Infants, Class III. Do. Do. Under the Finchley Urban District Council Act, 1908, powers are granted to insist that the children attending any school provided or maintained by the Local Education Authority shall attend in a cleanly state, both as regards clothing and person. Under Section 38 the Medical Officer or any person authorised by the Medical Officer may examine the person or clothing of any such child, and if the person or clothing of 49 any such child is infected with vermin or is in a foul or filthy condition, the Medical Officer may give notice to the parents or guardian requiring the child to be properly cleansed within 24 hours after the receipt of such notice. A full and detailed report on School Hygiene and the medical examination of the school children will appear in the report to the Education Committee. Water Supply. The District is supplied from the mains of the Barnet. Water Company. From evidence given before the Parliamentary Bills Committee, it appears that the Company pump from five deep wells in the chalk—three at Barnet, one at Potters Bar, and one at Bast Barnet—and in addition can obtain a certain quantity of water from the New River Company. The quantity of water supplied has been estimated at about twenty gallons per head per day. No water-softening process is in use. 50 Surveyor's Meteorological Observations for the Year ending December, 1908. 1908. Barometer Therm'ter Rainfall Prevailing Winds. Lowest. Highest Min. Max. January 28.6 30.1 17 54 2.13 N.W. and S.W. February 28.8 30.3 29 54 1.86 W. and S.W. Match 28.8 29.8 23 60 3.01 N.W. and S.W. April 29.0 30.0 27 64 3 04 N.W. and S.W. May 29.0 30.2 38 77 1.96 N. and S.W. June 29.4 30.0 38 81 1.03 W. and S.W. July 29.1 30.1 47 86 4.37 N.W. August 29.2 30.0 43 84 2.65 N.W. and S. W. September 28.9 29.9 36 80 1.64 S.W. and N.W. October 29.6 30.1 31 79 1.92 S.W. and N.W. November 29.2 30.1 21 61 0.93 W. and S.W. December 28.5 30.1 11 52 2.35 S., S.W. and N.E. Total Rainfall, 26.89 51 Housing. During the year 1902 an enquiry was held by the Local Government Board with reference to an application for a loan proposed to be raised for the erection of Workmen's Dwellings under the Housing of the Working Classes Act, which application was granted. The scheme involved the erection of 60 houses, Class 1. There are 12 Cottages of this class having the following accommodation:— 1 Kitchen and 1 Scullery, 2 Bedrooms. The Cottages of this class are let at 5s. 9d. per week. Class II. There are 12 Cottages of this class containing the following rooms:— Kitchen, Scullery, Front Room, 2 Bedrooms. These Cottages are let at 7s. 6d. per week. Class III. There are 18 Cottages of this class having the following accommodation, the alternate cottage having a frontage of 14ft. 3in. and 16ft. 9in.:— Front Room, Kitchen, Scullery, 3 Bedrooms. These Cottages are let at a rental of 8s. 6d. per week. Class IV. There are 18 Cottages of this class having the following accommodation:— Front Room, Kitchen, Scullery, 4 Bedrooms. These Cottages are let at a rental of 10s. 6d. per week. There appears to be no lack of house accommodation for the well paid working man in Finchley. A very large number of small houses have been erected in recent years, but it is doubtful whether the rents of these dwellings are not beyond the means of the ordinary working man, for the fact remains that many houses which have only been put up in recent years are let off in tenements and occupied by members of 52 more than one family, which appears to show that the rents are beyond the reach of many, but it cannot be said that the housing of the very poor is an acute problem in Finchley, as with the exception of certain areas, the very poor do not seem to make their way here. The following table shews the number of houses passed since 1894, which has been supplied to me by the Surveyor:— 1894 47 1902 323 1895 60 1903 340 1896 101 1904 338 1897 123 1906 361 1898 142 1906 374 1899 189 1907 436 1900 213 1908 411 1901 289 1909 336 Drainage and Sewage Disposal. A dual system of drainage is in force in most parts of the district, the surface water sewers discharging into the natural water-courses. The present general sewerage scheme was commenced in 1885. Previous to this a considerable portion of the sewage appears to have passed directly into the streams, though most of the Church End sewage was chemically treated in tanks before being allowed to enter Dollis Brook. A large amount of the North End sewage was at the time being treated by irrigation on a farm lying west of Nether Street, and another portion was being treated both chemically and by filtration through coke on a piece of land at the lower end of Stanhope Road, but apparently without much success. 53 The two principal intercepting sewers, namely, those of the Mutton Brook Valley and the Dollis Valley, were nearly completed before the close of 1885, and three quarters of a mile were also constructed of the tunnel sewer, which takes the sewage of the western and southern sides of the district. The year 1889 saw the completion of the scheme. Sewage reaches the farm in Summers Lane by either the low or high level sewer. The sewage from the low level sewer passes through a screen, and is then pumped to join the high level sewage. The mixed sewage is screened, and, after the addition of lime and sulphate of iron, passes into one of three precipitation tanks (each having a capacity of 226,260 gallons). The tank effluent is next treated in a double set of rough contact beds, in each of which it remains standing about five hours. The effluent is finally run over several acres of meadow before entering the brook at the bottom of the valley. The sludge is drawn off after a precipitation tank has been used one week, and is pumped on to the land at the highest level of the farm. It is there left to drain and evaporate, and is then ploughed in, the land being used for crops of cabbages, etc. The dry weather flow of sewage is estimated at about 700,000 gallons per diem, in the proportion of about four of low level sewage to three of high level sewage. The storm flow may be any volume up to ten times the above. In times of storm a portion of the sewage is treated in the ordinary way, and the remainder by broad irrigation. The subsoil of the farm is stiff clay, and there is only a shallow surface soil over most of the area, so that considerably more land has to be utilised than would be required with more suitable soil. The total area of the farm comprises close upon 80 acres belonging to the Council, and 33 acres rented from the Burial Board. 54 The filter beds on the old portion of the works number 16, and cover a total area of about 27,000 square yards (about 5½ acres). Most of the beds are in a far from satisfactory condition, and require thorough reconstruction before efficient work can be expected from them. In their present state they are incapable of sufficiently purifying the sewage, consequently the effluent from them has to be treated by surface irrigation over a large area of land, with a view of further purification, before being discharged into the brook. Having regard to the rapid growth of the district, and the condition of the existing works, it has been evident for Some time past that further expenditure would be necessary. Various schemes have been considered by the Public Health Committee, and on November 12th, 1905, the Council resolved to proceed with the extension of the low level sewer and the construction of storm water filters, being an amendment of a scheme for which a loan had been sanctioned as far back as February, 1903. In addition, the Council decided to construct works capable of dealing with a portion of the low level sewage, and thus greatly relieve the present filter beds and heavy daily pumping. The extension of the low level, or tunnel, sewer was carried out by direct labour, and completed in March, 1906. The remainder of the work has been executed by contract, according to the plans and under the superintendence of the Council's Surveyor, Mr. C. J. Jenkin. The new installation consists of a coarse screen, detritus and Dortmund sludge tanks in duplicate, an open septic tank, and two primary and secondary percolating filter beds. The Public Health Committee has had under consideration the extension of this installation, so as to deal with a further portion of the low level sewage, and the Surveyor has prepared drawings for additional septic tanks and two double sets of primary and secondary circular filters with revolving distributors. Means 55 have also been provided for intercepting the fine superficial matter with septic sewage and filter effluents. The public inquiry has been held, but the sanction up to the time of writing the report had not yet been received. The outfall channel of the low level sewer has been formed in such a way that all storm-water from four to six times the average dry weather flow will be deflected on to the storm-water beds, whilst any quantity over six times the dry weather flow will be discharged direct into the brook. These storm-water beds are four in number, constructed of clinker, and intended to be used as percolating filters. Disposal of house Refuse. The Council contract for a weekly removal of all house refuse. The refuse is burnt in the open on the Sewage Farm. The Surveyor has been instructed to report on the question of the provision of a Refuse Destructor. A small charge, based on the estimated cost of removal, is made for the removal of trade refuse. Analysis Performed during the Year. The samples examined during the year included:—A sample of the public water supply taken each month. The samples were drawn from standpipes in various parts of the district, and on chemical analysis were found to conform in each instance to a high standard of organic purity. Notes upon Sanitary Work performed during: the Year. Inspection of the District has been systematically carried out, including visits to the dairies, cowsheds, slaughterhouses, bakehouses, workshops, houses in which epidemic disease had broken out, insanitary property, and routine house to house inspection. In all, some 7059 inspections were made, and nuisances to the number of 1,632 were discovered. 56 162 complaints with regard to alleged nuisances were received during the year, and prompt attention was given to each. 334 rooms were fumigated; and 6,410 articles, chiefly bedding and wearing apparel, were disinfected in the Council's steam apparatus. In addition to the above, 104 stovings of bedding, etc., were carried out and 64 patients were removed to hospital from the Friern Barnet District Council. A large number of house drains were reconstructed, the work being supervised in a thorough and satisfactory manner by the Sanitary Inspector. A plan of each drain re-laid is made by the Inspector, and this, together with all necessary particulars, is filed for future reference. The meat, fish, poultry, and fruit shops, and premises where food is prepared for sale, have been kept under observation. A full statement of the work done under the Nuisance Sections of the Public Health Acts, together with notes regarding the dairies, slaughterhouses, etc., will be found in the appended report of the Sanitary Inspector. Factories and Workshops. All the Workshops and Work-places in the District have been inspected during the year, and various sanitary defects remedied as a consequence. Very little home work appears to be given out in the District, and only a few names of out-workers have been received from other districts. At some of the Workshops the work done is for firms in London, but the total amount is not large. The following Tables are on the lines of those issued by the Secretary of State. Tables 1 and 2 are printed in full, the remaining Tables only so far as the particulars affect this District. 57 1. INSPECTION. Including Inspections made by the Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries). 18 ... ... Workshops and Workplaces (Including Workshop Laundries) 279 21 ... Total 297 21 ... 2. DEFECTS FOUND Particulars. Number of Defects. No. of Prosecution Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts*- Want of cleanliness 30 30 ... ... Want of ventilation ... ... ... ... Overcrowding ... ... ... ... Want of drainage of floors ... ... ... ... Other nuisances 48 48 ... ... †Sanitary accommodation insufficient ... ... unsuitable or defective 17 17 ... ... 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) 9 9 ... ... Other offences— (Excluding offences relating to out-work which are included in part 3 of this Report) ... ... ... ... Total 104 104 ... ... *Including those specified in sections 2, 3 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. †Public Health Acts Amendment Act 1890, Part 3, adopted October, 1890. 58 3. HOME WORK. Nature of Work. Outworkers' List, Section 107. Number of Inspections of Outworkers' premises. Lists received from Employers once in the Year. Numbers of Addresses of Outworkers received from other Councils. Numbers of Addresses of Outworkers forwarded to other Councils. Lists. Outworkers. Wearing Apparel— Making, &c. 9 12 11 3 19 4. REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year Number. Dressmakers and Milliners 37 Laundries 17 Bootmakers 27 Bakers 18 Restaurant Kitchens 14 Motor and Cycle Engineers 8 Stonemasons 6 Saddlers 4 Ironmongers 4 Farriers 9 Tailors 16 Picture Framers 2 Upholsterers 4 Other Workshops 15 Total number of Workshops on Register 181 59 Milk Supply. Each year a smaller proportion of the milk purveyed in Finchley is produced locally, and the actual number of dairy cows kept in the District appears to be diminishing. Towards the latter end of the year, the number was 140, as compared with 168 in the previous year, and I have no reason to doubt that considerably more than half the milk consumed is brought in by rail. With a view of dealing more efficiently with the milk supply, much greater powers have been obtained by means of the Finchley Urban District Council Act, 1908, which came into operation in November, 1908. In order to take the fullest advantages of the milk clauses contained in the Act a Veterinary Surgeon, Mr. Overed, M.R.C.V.S., was appointed in December, 1908, as Veterinary Surgeon to the Council. By means of this Act the Medical Officer of Health: (Firstly) May take samples of milk for examination for tubercle bacilli; (Secondly) If accompanied by a Veterinary Surgeon may enter the dairy within the district and inspect the cows therein, and if he suspects that any cow is suffering from tuberculosis of the udder he may require the cow to be milked in his presence, and may take samples of milk from any particular teat. If the Medical Officer of Health has reason to believe that milk from any dairy situated outside the District is likely to cause tuberculosis in persons residing within the District, the Medical Officer of Health, accompanied by a Veterinary Surgeon, may enter such dairy and inspect the cows therein, provided an order from a Justice having jurisdiction where the dairy is situated, is first obtained. By means of these clauses, the importation of tuberculosis can be dealt with. 60 The disputed question of the transference of bovine tuberculosis to man has been carefully investigated by the Royal Commission to consider this matter. In the second Interim Report issued in 1907 the Commission report as follows:— "There can be no doubt but that in a certain number of cases the tuberculosis occurring in the human subject, especially in children is the direct result of the introduction into the human body of the bacilli of bovine tuberculosis, and there can be no doubt that in the majority at least of these cases the bacilli is introduced through cow's milk. Cow's milk containing bovine tubercle bacilli is clearly a cause of tuberculosis, and of fatal tuberculosis to man." Further important information on this subject is contained in the third Interim Report of the Royal Commission, recently issued. The question before the Commissioners was "What danger, if any, attaches to milk of tuberculous cows in which the udder presents no evidence of the disease?" Cows used in the experiments were those only in which the presence of tuberculosis could be detected by means of the tuberculin test. It was found that milk from such cows contained tubercle bacilli, and the conclusion the Commissioners came to, was that the milk of such cows must be considered dangerous to man. It was also found that the intestinal excretion of these cows was affected with tubercle bacilli, and in consequence the Commissioners report that "the presence of tuberculous cows in company with healthy cows is dangerous, as some of the tubercle bacilli which escape from their bodies in the excrement are almost certain to find their way into the milk." This latter statement shews, moreover, the great necessity of keeping cowsheds well ventilated and in as cleanly a state as possible. 61 The following is a summary of the Milk Clauses contained in the Finchley Urban District Council Act, 1908:— Part V.—Milk Provisions. Section 46.—A person shall be liable to a Penalty not exceeding Ten Pounds for selling or offering to sell milk of any cow suffering from tuberculosis of the udder. Section 47.—Any person the milk of whose cows is sold failing to isolate any cow suffering from tuberculosis of the udder shall be liable to a penalty not exceeding Five Pounds. Section 48.—Every Dairyman shall give notice forthwith to the Medical Officer of Health of the fact that any cow in his dairy is affected with, or suspected of, or exhibiting signs of tuberculosis of the udder, under a penalty for non-compliance of not exceeding Forty Shillings. Section 49.—The Medical Officer of Health or any person duly authorised by him shall be empowered to take samples of milk produced or sold, or intended for sale within the District, and the like powers may be exercised outside the District on obtaining a Justice's order having jurisdiction in the place where the sample is to be taken. Section 50.— (1) The Medical Officer of Health, if accompanied by a Veterinary Surgeon, shall have power to enter Byres or Cowsheds or other places within or beyond the District where cows are kept from which milk is sent for sale within the District, to examine the cows therein and take samples of milk for the purpose of ascertaining whether such cows suffer from diseased or indurated udders or generalised tuberculosis, 62 (2) If the Medical Officer is of opinion that tuberculosis is caused or likely to be caused from consumption of the milk, he shall report to the Council and the Council may require the Dairyman to appear before them to shew cause why an order should not be made by them prohibiting him from supplying milk within the District until the order has been withdrawn. (3) The powers of the section may be exercised outside the District provided the Medical Officer has obtained from a Justice having jurisdiction in the place an order authorising entry and inspection. (4) The Dairyman and persons in his employ shall render assistance to the Medical Officer and others, and any person refusing assistance or obstructing shall be liable to a penalty not exceeding Five Pounds. (5) If in their opinion the Dairyman fails to shew cause why an order should not be made as aforesaid, the Council may make the said order, but the order shall be withdrawn on the Council or Medical Officer being satisfied that the milk supply has been changed or is not likely to cause tuberculosis. (6) If any person after such order has been made supplies or sells milk, he shall be liable to a penalty not exceeding Five Pounds, and a penalty of 40s. for every day the offence continues. (7) A Dairyman shall not be liable for breach of Contract if the breach be due to an order under this section. (8) The Council may repay to the Dairyman the whole or any part of the expenses incurred by him in attending before them, 63 (9) The Council shall at the time of service of notice on the Dairyman furnish him with copies of the report of the Medical Officer and Veterinary Surgeon, and to the County Council like copies where the dairy is situate outside their District. Section 51.—The Dairyman may appeal against an order of the Council under the foregoing powers either to a Petty Sessional Court having jurisdiction within the District, or, if the Dairy is situate outside the District, to the Board of Agriculture and Fisheries, and the Court or Board may vary the order and make directions as to costs. Section 52.—If an order is made without cause or if the Council refuse to withdraw the order the Dairyman shall be entitled to compensation from the Council for any damage sustained. Bakehouses. All the Bakehouses (17 in number) were inspected frequently during the year. There are at present in the District three underground bakehouses. After certain structural alterations had been made these were certified by the Sanitary Authority at the commencement of 1904 as suitable in regard to construction, light, ventilation, and all other respects. The minimum requirements for the Council'8 certificate included provisions against the entry of ground-air and moisture, and provision for ventilation, light and cleanliness of the premises. Sale of Food and Drugs Acts. The County Council is the responsible executive authority for carrying into effect the main provisions of the Sale of Food and Drugs Acts in this District. 64 Adoptive Acts, Byelaws and Regulations. The following Adoptive Acts are in force in the District:— The Infectious Diseases (Prevention) Act, 1890. The Public Health Acts Amendment Act, 1890, Parts 2, 3 and 5. The Housing of the Working Classes Act, 1890, Part 3. The Notification of Births Act, 1907. Also the Finchley Urban District Council Act, 1908. The following Byelaws are in force:— (The date when sanctioned by Local Government Board is given.) The cleansing of footways and pavements, the removal of house-refuse; and the cleansing of earth closets, privies, ashpits, and cesspools—24th November, 1879. The prevention of nuisances arising from snow, filth, dust, ashes and rubbish—24th November, 1879. The keeping of animals—24th November, 1879, and 6th July, 1897. Common Lodging Houses—24th November, 1879. New Streets and Buildings—19th Jaunary, 1884; 1st December, 1888; and 30th November, 1904. Paving of Yards and Open Spaces—8th August, 1903. Slaughterhouses—24th November, 1879. Houses let in Lodgings—17th January, 1884. Offensive Trades—17th January, 1884. Management of Mortuary—31st May, 1904. Public Recreation Ground—9th January, 1903. School Attendance—15th March, 1901. Employment of Children—24th May, 1906. Regulations are in force with respect to:— Dairies, Cowsheds and Milkshops—26th November, 1900. Allotments—11th February, 1897. 65 MEDICAL INSPECTION OF SCHOOL CHILDREN. FINCHLEY URBAN DISTRICT COUNCIL. To the Chairman and Members of the Education Committee. Miss Shoults and Gentlemen,— I have the honour to submit the following report on the Medical Examination of the children attending the Elementary Schools under your direction, as required by the Education (Administrative Provisions) Act, 1907. SCOPE OF THE ACT. The Act came into operation on January 1st, 1908. Its provisions have been supplemented by two circulars issued by the Board of Education, which set out in considerable detail the requirements of the Act and suggestions as to the scope of the Medical Examination. The first circular (issued at the beginning of last year) sets out the scope and purposes of the Act, and points out the advisability of its administration resting "upon a broad basis of Public Health, so that the examinations should become an integral factor in the health of the nation." The second circular requires, as a condition of Government Grant, that all children who will be leaving school at Midsummer, 1908, shall be examined before that date. MAIN FEATURES OF THE ACT. Although by means of this examination many anthropometric details of much interest and value can be obtained, yet the main feature is to recognise those conditions of health which unfit the child for school life, and those defects in the child which prevent it from benefiting to the fullest extent 66 from the teaching it receives, or which make school life absolutely harmful. It is unquestionable that a large amount of the disease and defects found amongst school children can be prevented or remedied, and the main purpose of the medical examination must be to prevent disease where possible, or, if disease be discovered, to see that measures are taken to alleviate or cure. Again, the medical examination of a child about to leave school may reveal such a state of health as to make the proposed occupation in life quite unsuitable or positively detrimental. PRESENCE OF PARENTS. Before the examination takes place, a note is sent to the parents cordially inviting them to be present. The presence of the parents is greatly to be desired, as much valuable information can be obtained concerning the child which otherwise is lost. The opportunity also arises of pointing out personally to the parent any defects which may be found, such a course being likely to have much more weight than simply giving the same information by letter. The occasion also occurs of advising the parents as to the occupation to be followed by their children on leaving school; how important this may be can be illustrated by the following instances:— In one case, a girl nearly 14 years of age was to learn needlework on leaving school: she was suffering from a high degree of myopia. It would be difficult to imagine a more unsuitable or harmful occupation. In a second case, a boy about to leave school was found to be suffering from heart disease: the family medical attendant was communicated with, who was thus able to advise as to the boy's future. As will be seen from the figures, only 372 (47.5 per cent.) parents were present at the examinations; it is a pity that a larger number did not attend, and it is hoped that, when the scope and purposes of the examination are better understood and recognised, a larger percentage of parents will make an effort to accompany their children. 67 ADVISING PARENTS OF DEFECTS. If any defect is discovered, a note is sent to the parents strongly urging them to obtain medical advice. It has been found in Finchley (in common with many other districts) that some parents will take no step in obtaining medical assistance, although in some cases the defect is of a serious nature. This neglect appears to arise mainly from two causes -either from the disregard of the child's welfare (coupled with the feeling that it is a matter which concerns the parents alone and that they will brook no interference from the School Authorities), or secondly, from poverty, the parents not being in a position to seek medical advice, or not being able to afford the time necessary to take the child to a hospital. Instances arising from the poverty of the parents are constantly met with, and are brought before the Children's Care Committee, the members of which body make enquiry and grant relief in certain cases. CHILDREN'S CARE COMMITTEE. The Children's Care Committee working, as it does, in conjunction with the Education Committee, is doing a useful and beneficent work. The members are truly interested in the welfare of the children, and include amongst their number the Headmasters of the Schools and the School Attendance Officers, who are generally thoroughly conversant with the home circumstances of each case. This Committee also arranges for the feeding of necessitous school children, the formation of boot clubs in connection with the various schools, the provision of spectacles, and other beneficent objects. THE SCHOOL NURSE. In March, 1908, a Nurse was appointed, part of whose time was to be devoted to the schools. Her duties consist of (a) being present and assisting at the Medical Examination; (b) visiting the parents of those children in whom defects have been found to ascertain if any steps have been taken to obtain 68 medical advice, and to persuade those who have done nothing to have such defects remedied; (c) making a periodical inspection once a month of the children in the schools with a view to personal cleanliness. STATISTICS AND RESULTS OF INSPECTION. Attached hereto are statistics showing the number of children examined at each school, along with the results of their inspection. It has been thought desirable to interpret these results by submitting short reports under the following heads:— (a) Cleanliness, (b) Ringworm, (c) Clothing, (d) Teeth, (e) Eyesight, (f) Diseases of the Throat, (g) Diseases of the Ear, (h) Heart Disease, (i) Skin Disease, (j) Tuberculosis, (k) Mentally Defective Children, (l) Treatment. CLEANLINESS. The urgent necessity of periodical inspection by the School Nurse is proved by the statistics. At the commencement of her work, the condition of the heads of many of the scholars (especially amongst the girls) was a matter for comment. The figures include all those who showed any traces of a verminous condition; many of course were slight, and, but for the examination, would doubtless have been overlooked. Naturally, the neglected children suffer most, yet many well-dressed and otherwise quite clean children suffer from this condition, the majority no doubt from contact with dirty children, and it behoves parents to recognise the necessity for constant supervision. This condition is by no means limited to children attending elementary schools, for in any institution where a large number of children congregate this state of things will arise except the most stringent precautions be taken. It is satisfactory to report that there is a very considerable improvement in this respect, doubtless due to the fact that parents are more alive to the necessity of supervision than was formerly the case. 69 It is a noteworthy fact that, whereas so many children's heads have been in the condition described, only in a very few instances (19 in all—10 boys and 9 girls) have the bodies been found to be in a similar state. A few children who were found to be in an exceedingly unclean condition were excluded from school, and a peremptory note sent to the parents or guardian requiring the child to be cleansed forthwith; in practically every case this has had the desired effect. By the Finchley Act of 1908 extensive authority is given to your Medical Officer (or to a person authorised by him) to inspect any child attending any school maintained or provided by the Council, and to exclude such scholar and give notice to the parents or guardian to cleanse such child within 24 hours; and if such parents fail to comply, your Medical Officer (or such person authorised by him) may cause such child to be removed and cleansed. It has not been found necessary to enforce these provisions, the peremptory notice mentioned above having had the desired effect hitherto. RINGWORM. In the Midsummer I had the honour to submit a report on the number of cases of ringworm, as the systematic inspection was bringing to light many cases which otherwise would have been overlooked. I thereupon received instructions from the Committee to make a special effort to deal with this troublesome complaint. The School Nurse was requested to bring to the notice of your Medical Officer any cases of a suspicious nature. In every case where ringworm is suspected a microscopical examination of the hair is made). Whenever ringworm was thus observed, the child was excluded and, according to the instructions of the Committee, was not readmitted to school till the parents produced a certificate from a medical man to the effect that the child was free from infection. At the same time your Medical Officer received instructions to examine any specimens of hair for ringworm at the request of any medical attendant. Many of the medical 70 men practising in Finchley have been kind enough to inform me when a child is about to be re-admitted to school, thus giving me the opportunity to examine the child's hair. Dr. Kerr (Medical Officer to the London County Council Education Committee) has pointed out that in a majority of cases a scurfy condition of the hair of children is due to chronic ringworm. Acting on this suggestion, ringworm spores have been found in many cases where it would hardly have been suspected, the scurfy condition being the chief or only macroscopical evidence. Ringworm can be correctly described as one of the most troublesome evils of school life; its intractability to treatment and the consequent exclusion of the affected scholar for a long period of time (frequently months) make it a formidable complaint. Many parents regard it as a slight ailment, and fail to obtain any treatment at all. Of the 4,000 scholars attending the Finchley Schools last year, 44 were found to be suffering from ringworm. The average absence of these children was 127 days each, so that the loss of grant is a serious matter. CLOTHING. An endeavour has been made to classify the clothing worn by the scholars under four heads, viz.: (a) Excellent, where the clothing is in every way satisfactory as to suitability, warmth and cleanliness; (b) Good, where the clothing falls a little below the first standard; (c) Fair, where it is indifferent both from the point of view of sufficiency and cleanliness; and (d) Poor or Bad, where it is hardly sufficient, or in some cases, quite insufficient. These standards are obviously quite arbitrary, and between Excellent and Good many gradations could be made, but, on the whole, this arrangement appears to be the most useful. This classification was not adopted from the commencement, and, in consequence, the different schools are not quite comparative; for instance—at Albert Street and Squires Lane the classification of Sufficient and Insufficient was adopted. At Albert Street School, of the 71 28 boys examined, the clothing of 27 was noted as sufficient, and in one case as insufficient. Of the 32 girls examined at this school, in all cases the clothing was noted as sufficient. At Squires Lane the clothing of all the boys and girls was noted as sufficient. Of the remaining 326 boys examined at other schools, in 39 instances the clothing has been noted as Excellent; in 155 as Good; in 99 as Fair; and in 33 cases as Poor, that is, insufficient or barely sufficient. Of the 380 girls examined (excluding those attending Albert Street and Squires Lane), in 106 instances the clothing has been noted as Excellent; in 142 as Good; in 72 as Fair; and in 20 cases as Poor. From this, it will be observed that the girls are better clad than the boys. This is to be expected as, amongst the elder children, the girls are accustomed to look after their personal requirements, and take more interest in their appearance than the boys. TEETH. At the commencement of the examination a classification of teeth was adopted into Excellent, Good, Fair, Bad, but this was too refined to be of any practical use, and now the condition of the teeth is simply noted as "good" or "require attention." Many enquiries were made as to the use of a tooth-brush, and in only comparatively a few instances were the teeth found to be regularly cleansed; quite a number of children stated that they cleaned their teeth on Sunday,— others that their teeth were cleaned once a week or fortnight. Few parents appear to recognise the real necessity of looking after their children's teeth, and many of them seem to take but little interest when the defective condition or the necessity for treatment is pointed out. There can be no doubt that defective teeth are a fertile source of trouble, especially in later life, and it is to be much regretted that so few parents recognise the need of dental treatment. Of the 380 boys examined 200 (52 per cent.) were found to have teeth which required attention; of the 403 girls 185 72 (45.9 per cent.) possessed teeth in a similar condition. These numbers represent teeth in all stages of decay, from a single tooth unsound to none which were sound. EYES. One of the most important matters in connection with the routine medical examination of school children is the testing of eyesight. Tt is a difficult matter to test correctly the sight of children under the age of 6 years (that is at a time when, as a rule, they are unable to read) by the method usually adopted: the circular issued by the Board of Education has suggested that the testing of sight of children under 6 years of age need only be carried out in a general way. In some instances, children have been found to have grave defects of vision, and in several cases this has already been pointed out to, and known by, the parents, yet no steps whatever had been taken to remedy the matter. Of the 380 boys examined, 24 (6.3 per cent.) were found to have defective vision, and of the 403 girls, 38 (9.4 per cent.). In many instances children were already wearing glasses, and these are not included. Up to December 31st, 1908, further advice had been obtained in 18 instances. Four boys and seven girls were found to be suffering from external diseases of the eye. These chiefly consisted of Conjunctivitis, Blepharitis and Corneal Scars. THROAT. Thirty-four children were found to be suffering from enlarged tonsils or adenoids, or both, viz.: 18 boys and 16 girls. In many of these cases deafness was detected in consequence, adenoid growths being a common cause of deafness in children. In each case the parents have been advised to consult their medical attendant. A recommendation for operation is seldom made, the advisability of an operation in many such cases being a matter over which there is much adversity of 73 opinion, and it is felt that such advice should come from the medical attendant. Enquiries are always carefully made to ascertain whether medical advice has been obtained. In 17 instances the parents have sought further advice, and in one instance at least information has been received that operative treatment has resulted in the greatest benefit, the child having improved mentally and physically. EARS. Ten children were found to be suffering from discharge from the ears, 6 boys and 4 girls. Otorrhœa (discharge from the ears) is a very common sequel to Measles and Scarlet Fever, and it is a matter of the greatest importance that this should be properly attended to. This is another of the complaints that parents are liable to treat lightly; in reality it is a matter of the greatest consequence, as in many cases it leads to permanent deafness, and often to diseased bone and other troublesome complications which may last for years. Every effort has been made to impress this upon the parents, but with what success remains doubtful. Twelve children (8 boys and 4 girls) were found to be suffering from deafness, not the result of otorrhohœ or adenoids so far as could be ascertained. In six instances, further advice has been obtained. HEART DISEASE. In 9 instances heart disease was found to exist (6 boys and 3 girls). In some cases this was already known to the parents, but in several instances it was only revealed by the medical examination. The parents have been urged to obtain medical advice, and in addition, the family medical attendant has been communicated with so as to ensure that the child comes under medical supervision. In the majority of cases the heart has been well compensated, and no special treatment—I have been informed by the Medical Attendant-—has been required. In one or two cases only have the heart lesions been of the more serious nature. 74 SKIN. Nine children were found to be suffering from some skin affection at the time of the examination, viz. 1 boy and 8 girls. These conditions were chiefly eczema and impetigo. TUBERCULOSIS. In no instance has a diagnosis of pulmonary tuberculosis been made where it has not been already known to exist, and there did not appear to be one case of active phthisis. In one case only was this condition seriously suspected, and the parents were advised to consult the medical attendant, the latter kindly communicating with me. He kept the child under careful observation, but was eventually able to exclude pulmonary tuberculosis. Three children (all boys) were suffering from tubercular glands, and in each case were already under treatment. MENTALLY DEFECTIVE CHILDREN. In a few instances children suffering from mental deficiency have been examined. (In one case only has a case of true imbecility been met with). Many children are pointed out by the teachers as dull and backward, which of course may arise from several causes such as prolonged absence from school or deafness. In all cases where a teacher has especially noted a boy as backward a careful examination of the hearing has been made. In one case a boy, who was very backward, was deaf, and was found to be suffering from enlarged tonsils and adenoids. He has since been operated upon, and the mother states she has already noticed much improvement. In two other cases (both boys) the backwardness is so marked as to appear to be due to mental deficiency, and in one case the child, I am informed, at times shows vicious tendencies. One or two other cases are under observation. 75 STATISTICS. Period covered by Report—19th May to 31st December, 1908. No. of Children Examined—380 Boys, 403 Girls; Total, 783. General Remarks.—The following Tables give the number of defects found amongst the boys and girls of each school. It will be seen that the numbers are too small for comparative purposes, the number examined at each school varying considerably. Uncommon and rare diseases are not classified under each school, but appear separately. (Table A.) Excluding the more uncommon diseases, and defects arising from uncleanliness and unsound teeth, 64 defects (16.8 per cent.) were discovered amongst the boys, the greatest number being due to defective eyesight, viz.: 24. Among the 403 girls examined, 84 defects (20.8 per cent.) were found, excluding the same complaints as in the case of the boys. The highest number again was due to defective eyesight, viz.: 38. TABLE A.—UNCOMMON DEFECTS. Boys. Girls. Total. Tubercular Glands 3 0 3 Defective Nutrition (without obvious cause) 8 6 14 Infantile Paralysis 1 1 2 Wry Neck — 1 1 Nasal Polypus 1 — 1 Ganglion of Wrist — 1 1 Rickets in early life (evidence of) 7 1 8 Other Diseases 1 1 2 Total 21 11 32 Table B.—Genkhat, Defects. School. N.F.C.S. S.M.V.S. H.T.V.S. c.e.v.s. S.J.V.S. K. F.C.S. S.L.C.S. Total. Percentage. Obtained Advice. Sex. B G B G B G B G B G B G B G Boys. (iirls. All. B G All. No. Examined 28 32 87 89 33 55 78 77 59 57 69 62 26 31 380 403 783 Tonsils and Adenoids 2 2 4 3 1 1 6 3 ... 3 3 0 2 2 18 16 34 4.7 3.9 4.3 17 External Eye ... ... 1 2 ... 1 2 ... ... 3 1 1 ... ... 4 7 11 10 1 8 1.4 2 Eyesight 4 3 7 3 2 7 ... 7 1 4 8 6 2 8 24 38 62 6.3 9.4 7.9 18 Deafness ... ... ... ... ... 1 2 ... ... 1 6 2 ... ... 8 4 12 2.1 .9 1.5 2 Otorrhoea ... 1 1 ... 2 3 1 ... ... ... 2 1 ... ... 6 5 11 1.5 1.2 1.4 3 Heart Disease ... 1 ... 2 1 1 2 ... ... 2 ... ... ... ... 3 6 9 .7 1.5 1.1 9 Skin ,, ... ... ... 2 ... 2 1 ... ... 2 ... 2 ... ... 1 8 9 .2 1.9 1.1 1 6 7 13 12 6 16 14 10 1 15 20 14 4 10 64 84 148 16.8 20.8 18.9 ... *No. obtaining advice 5 10 5 4 4 12 12 ... ... 52 ... ... ... 52 Teeth 20 21 55 53 14 20 38 24 19 17 33 28 21 22 200 185 385 52.6 45.9 49.1 ... *Note.—Endeavours have been made to trace the cases in which treatment or medical advice has been obtained. The result.* shown are up to 31st December, 1908, and doubtless many more have obtained advice by now (March, 1909). Nothing haw been left undone to persuade parents to obtain advice. In many cases active treatment at the moment may not be required, but the responsibility of treatment or otherwise must rest with the family medical attendant. LL Table " C."—Clothing. School. Boyp. Girls. All. Ex. Good. Fair. Poor. Ex. Good. Fair. Poor. Ex. Good. Fair. Poor. Albert Street Sufficient, 21 ; Insufficient, 1. Sufficient, 32 ; Insufficient, 0. ... ... ... ... Squires Lane ,, 26; ,, 0. ,, 31; ,, 0. ... ... ... ... St. Mary's 21 41 24 1 42 32 14 1 63 73 38 2 Holy Trinity... 2 14 10 7 22 21 8 4 24 35 18 11 Christ Church *11 24 31 12 *29 21 22 5 *40 45 53 17 St. John's 5 23 23 8 12 18 23 4 17 41 46 12 [ong Lane 10 43 11 5 21 30 5 6 31 73 16 11 Total 49 145 99 33 126 122 72 20 175 267 171 53 Same Statistics expressed as Percentages: St. Mary's 24.1 47.1 27.6 1.2 47.1 35.9 15.7 1.1 35.8 41.5 21.6 1. 1 Holy Trinity 6.0 42.4 30.3 21.2 40.0 38.1 14.5 7.2 27.2 39.9 20.4 12.5 Christ Church *14.1 30.7 39.9 15.3 *37.6 27.2 28.8 6.4 *25.8 29.0 34.2 10.9 St. John's 8.4 38.9 38.9 13.5 21.0 31.5 40.3 7.1 14.7 35.3 39.7 10.3 Long Lnne 14.5 62.3 15.9 7.2 33.9 48.4 8.0 9.6 23.7 55.7 12.2 8.4 Average per cent. 15.0 44.5 30.3 10.1 37.1 35.9 21.1 5.8 26.3 40.1 25.7 7.9 * Includes children from Fallow Corner Home. Table " D."—HEIGHT AND WEIGHT (Boy.). School. Age 4 Age 5. Age 6. Age 7. Age 8. Age 9. Age 10. Age 11. Age 12. Age 13. * it. ins. * it. ins. * ft. ins. * ft. ins. * ft. ins * ft. ins. * ft. ins. * ft ins. * u. ins * ft. ins Albert St. ... ... ... ... ... ... ... ... ... 19 3 10¾ 9 4 0¾ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Squires Lane ... ... ••• 3 3 6¼ 6 3 7½ 11 3 10½ 6 3 10 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Mary's ... ... ... 16 3 5 ½ 15 3 8 24 3 10 19 4 0 7 4 0½ 1 3 6½ 2 3 11¾ ... ... ... ... ... ... Holy Trinity ... ... ... ... ... ... 6 3 8 13 3 9 10 3 11 1 4 2½ ... ... ... ... ... ... 1 4 5½ 2 4 6½ Christ Chuich 9 3 2½ 19 3 5¼ 18 3 6½ 13 3 10½ 10 3 9 7 4 0½ ... ... ... 1 4 3¾ ... ... ... ... ... ... St. John's 12 3 3¾ 9 3 5¾ 14 3 7¼ 13 3 10 4 3 8¼ ... ... ... ... ... ... ... ... ... 1 4 7 6 4 7 Long Lane ... ... ... ... ... ... 3 3 10¼ 26 3 10 27 3 11 8 4 1 2 4 3½ ... ... ... ... ... ... ... ... ... Total 21 3 3¼ 47 3 5½ 62 3 7½ 119 3 10 85 3 11 23 4 0¾ 3 4 0 3 4 1 2 4 6¼ 8 4 7 * St lbs. * St lbs * st. lb s. * st lbs * st lbs. st lbs * st lbs. * st. lbs * st lbs * st. lbs ltert St ... ... ... ... ... ... ... ... ... 19 3 5¼ 9 3 11 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Squiies Lar.e ... ... ... 3 2 11¼ 6 3 0¼ 11 3 8½ 6 3 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... st. Mary's ... ... ... 16 2 11 15 3 0¼ 24 3 4¼ 19 3 9 7 3 12¾ 1 3 3½ 2 4 6½ ... ... ... ... ... ... Holy Trinity ... ... ... ... ... ... 6 3 2 13 3 8 10 3 9¼ 1 4 1 ... ... ... ... ... ... 1 5 1¼ 2 5 3¼ Christ Clutch 9 2 8¾ 19 2 12¼ 18 3 1¾ 13 3 7 10 3 6 7 3 12¾ ... ... ... 1 4 5½ ... ... ... ... ... ... st. John's 12 2 9½ 9 2 12¼ 14 3 2 13 3 6¾ 4 3 10¼ ... ... ... ... ... ... ... ... ... 1 4 6½ 6 5 4½ Long Lane ... ... ... ... ... ... 3 3 4½ 26 3 5½ 27 3 8 8 3 13½ 2 4 5½ ... ... ... ... ... ... ... ... ... Total 21 2 9 47 2 11¾ 62 3 2 119 3 6½ 85 3 9 23 3 13 3 4 0 3 4 6 2 4 10 8 5 4½ * No. of Children examined. Table " E."—HEIGHT AND WEIGHT (Girls). School. Age 4. Age 5. Age 6. Age 7. Age 8. Age 9. Age 10. Age 11. Age 12. Age 13 * ft. ins. ♦ ft. ins. * ft. ins. * ft. ins. ♦ ft. ins * ft. ins. * ft. ins. * ft ins * ft. ins * ft. ins Albert St. ... ... ... ... ... ... ... ... ... 15 3 11 16 4 0¼ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Squires Lane ... ... ... ... ... ... 1 3 7 17 3 9¾ 13 3 10¼ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Mary's 4 3 1½ 18 3 4¾ 16 3 7 24 3 9 13 4 0¼ 7 4 2½ 4 4 4¾ 1 4 5¼ ... ... ... ... ... ... Holy Trinity ... ... ... 6 3 5 12 3 8 21 3 10 4 3 11 2 4 1¾ ... ... ... ... ... ... ... ... ... ... ... ... Christ Church 8 3 2 15 3 3½ 16 3 6 13 3 8½ ... ... ... 5 3 10½ ... ... ... ... ... ... 1 4 5½ 4 5 1 St. John's 8 3 3 9 3 4 11 3 8 8 3 8¼ 3 4 0 3 4 1½ 2 4 3 3 4 3 ... ... ... 9 4 9¼ Long Lane ... ... ... ... ... ... 3 3 8½ 31 3 9¼ 20 3 11 1 3 10¾ 5 4 0 2 4 3 ... ... ... ... ... ... Total 20 3 2¼ 48 3 4½ 59 3 7¼ 129 3 9½ 69 3 11¾ 18 4 1½ 11 4 3 6 4 3½ 1 4 5½ 13 4 9½ * st. lbs. * st lbs. * st. lbs * st. lbs * st. lbs. st. lbs * st. lbs. # st lbs * st lbs * ... ... Albert St. ... ... ... ... ... ... ... ... ... 15 3 6 16 3 7¾ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Squires Lane ... ... ... ... ... ... 1 3 2 17 3 4 13 3 6½ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... St. Mary's 4 2 6¼ 18 2 12¼ 16 3 0 24 3 4¼ 13 3 13 7 4 0 4 4 0 1 4 10¾ ... ... ... ... ... ... Holy Trinity ... ... ... 6 2 9 12 3 2½ 21 3 4½ 4 3 9 2 4 2¼ ... ... ... ... ... ... ... ... ... ... ... ... Christ Church 8 2 8½ 15 2 11¼ 16 3 0 13 3 4¼ ... ... ... 5 3 12 ... ... ... ... ... ... 1 5 1 4 6 5 St. John's 8 2 8 9 2 11 11 3 2½ 8 3 5½ 3 3 12 3 4 3 2 4 7½ 3 4 4 ... ... ... 9 5 13 Long Lane ... ... ... ... ... ... 3 3 3 31 3 3½ 20 3 8 1 3 8½ 5 3 7 2 4 4½ ... ... ... ... ... ... Total 20 2 8 48 2 11¼ 59 3 2 129 3 4¼ 69 3 8 18 4 0 11 4 0 6 4 4¼ 1 5 1 13 6 0 * No. of Children examined. 80 TREATMENT. Under the Education (Administrative Provisions) Act, 1907, Local Education Authorities may undertake the treatment of children, provided the sanction of the Board of Education be first obtained. There does not appear to be such poverty or distress in Finchley as to require or necessitate such treatment being immediately undertaken as, apart from the seriousness of such a step, it is difficult at present to judge the cost of such an undertaking, or to estimate the ultimate effect it might have. With reference to the treatment of ringworm, however, I would suggest for your serious consideration whether some scheme of treatment might not be devised with advantage. Ringworm, from the educational standpoint is a most formidable complaint, its untractability to ordinary treatment, and its long duration makes it a serious matter for the child, and the loss of Government Grant making it an equally serious matter for the Education Authorities. Several Education Authorities have already undertaken the treatment of this complaint by means of the X Ray, and have found that the cost of such treatment is less than the loss sustained by the exclusion of the affected scholars. In bringing this matter prominently to your notice, I am not unmindful that any such a step is a matter for serious deliberation, as any treatment undertaken by the Council might, without strict supervision, lead to a serious abuse of public money. I would also like this opportunity of bringing before you the real need for a properly equipped laboratory. To keep pace with the increasing work of the schools, such a laboratory is almost essential; moreover it would lead to greater efficiency in many directions. It is hoped that some scheme may shortly be laid before a Special Sub-Committee appointed to enquire into this matter. 81 In conclusion. Finally, I beg to report the admirable manner in which your School Nurse has carried out her manifold and oft-times thankless duties, and I wish to gratefully acknowledge my indebtedness to the Head Teachers of your schools who have invariably received me with the greatest courtesy, and who have often given me information and assistance of great value. I have the honour to remain, Miss Shoults and Gentlemen, Your obedient Servant, J. R. PRIOR, Medical Officer. 83 REPORT OF THE SANITARY INSPECTOR For the Year 1908. To the Chairman and Members of the Finchley Urban District Council. Gentlemen,— I beg to submit my seventh Annual Report in which is recorded particulars of the work carried out by the Sanitary Department during the year 1908. The chief event of the year in regard to new Legislation was the placing on the statute Book of the Finchley Urban District Council Act, 1908. The most important section of this Act is doubtless that which relates to the amendment of the law in respect to combined drainage, but there are also several other clauses which will prove of material aid to your Inspectors in carrying out their duties. Some additional legal facilities were also anticipated in connection with the adoption by your Council of the Public Health Acts Amendment Act, 1907, but for some reason the necessary sanction of the Local Government Board had not been received at the end of the year. 84 The total number of inspections made in reference to the business of the department was 7,059. On 714 of the premises visited, nuisances to the number of 1,632 were discovered, and, in dealing with the sanitary defects from which they arose 136 "Intimation" and 148 "Statutory" notices were served. The number of Intimation notices served may perhaps appear small, but in many instances each of these notices deal with a number of different premises under the control of one person or agent. It is also customary for a large amount of Sanitary Work to be carried out as a result of interviews with, or, explanatory letters sent to the responsible parties. At the end of the year 1,356 of the nuisances discovered had been abated, the work of remedying 104 was in hand, and the remaining 172 were outstanding. In order to ascertain that the sanitary defects above referred to were being properly remedied 1,700 visits were paid to the respective premises while the necessary work was in progress. These visits are of the utmost importance, for it is only by following up the various stages of the work and close attention to detail that a good standard of sanitation can be obtained. Only a reasonable amount of the Inspector's time is taken up, as a rule, in respect to work which has been entrusted to person? who have become accustomed to the usual requirements of the department. There is usually, however, a proportion of cases in which the number of visits paid to premises is far greater than it should be, owing to the want of care or knowledge on the part of the workmen carrying out the necessary alterations or amendments. Generally speaking, but little difficulty has been experienced with owners of property in securing the abatement of nuisances and the carrying out of various sanitary improvements when the work was shown to be needful. Every endeavour is always made to obtain the execution of the maximum amount of work with the minimum amount of legal compulsion, and it is gratifying to record that in no case was it necessary to institute legal proceedings to enforce 85 the requirements of your Council. In fact most of the sanitary defects have been remedied without the necessity of serving statutory notices. As hitherto, all possible assistance has been afforded to owners when carrying out improvements, and, in a large number of cases, as a result of recommendations made by your inspectors, the standard of work executed has been much higher than that which could be strictly enforced under the provisions of the Public Health Acts. The following is a summary of the inspections made during the year:— House to House Inspections 338 Special Inspections 1038 Re-Inspections 1698 Visits to Works in Progress 1700 ,, ,, Factories and Workshops (including Bakehouses) 297 ,, ,, Slaughterhouses 243 ,, ,, Cowsheds, Dairies and Milkshops 146 ,, ,, Ice Cream Premises 46 ,, ,, Foodshops 169 ,, ,, Infectious disease 1112 Miscellaneous Visits 272 Total number of Inspections and Re-Inspections 7059 House Drainage, Previous to the passing of the Finchley Urban District Council Act, 1908, any person who repaired a drain was not required by law to give notice to the local authority of his intention to carry out such repair. This fact, together with the somewhat prevalent idea that any unskilled labourer was capable of altering or repairing a drain, often led to most 86 improper and negligent work being executed. Many examples of such improper work have come under the observation of your Inspectors, which, during the period they remained undiscovered, were a source of grave menace to the health of the occupants of the houses. Under Section 43 of the before-mentioned Act, twelve hours' notice must be given to the Council before commencing any such work, or, in case of emergency, similar notice must be given before covering up the work executed. Reasonable facilities must also be given to your Inspectors for the purpose of examining the new work. There can be no doubt that this section will prove of great help in discovering dangerously defective drains, and also be the cause of much needful supervision. During the year the drains of 121 houses were examined or tested by your Inspectors, and, as a result, 82 of these were found to be more or less defective. Altogether, the drains of 94 houses were entirely reconstructed, and the existing drains of 11 other premises were properly repaired. This work involved the laying of 2822 yards of stoneware and 232 yards of heavy cast iron coated pipe drains; 109 soil pipes and ventilating shafts, 4 3 intercepting traps, 251 stoneware gullies, 161 w.c. basins, and 28 flushing cisterns were fixed, and 101 manholes were built. In regard to existing sanitary fittings, 64 flushing cisterns, 40 water-closets, 19 soil pipes and 7 manholes were repaired ; 28 drains were unstopped and cleansed, 14 existing insanitary water-closets were abolished, and 3 new water-closet apartments were constructed. Some 97 bath, lavatory, and sink waste pipes were repaired or trapped, and 37 new waste pipes and 18 new glazed sinks were fixed. A large number of other miscellaneous items were also properly attended to. In connection with this work 354 water tests and 181 smoke tests were applied. The practice which has been adopted in the department in past years of testing all new drains with water after the ground has been filled in, and of passing a steel disc 87 through the pipes on completion of the work has been continued. A survey is also made of every premises where the drains are reconstructed, and plans of such drains are pre1 ared and filed for future reference. These plans, together with other tabulated particulars, form a complete and valuable record of the re-drainage work carried out in the district. Of the 94 houses re-drained during the year, 59 were provided for by means of 13 combined systems of drainage. Five of the main drains, receiving the drainage of some 37 houses, and 20 branch drains, were reconstructed by the Council at a total cost of £447 9s. 3d., and steps have been taken to recover this sum from the owners. With one exception, the whole of this work was carried out under contract, in accordance with plans and specifications prepared by your Inspector. With reference to the defective stoneware drains of no fewer than 9 houses which came under my observation, it was found upon examination that such drains had originally been well constructed, and were no doubt made watertight upon completion. The defects were evidently caused either by settlement of the soil or expansion of the cement, a matter which I have referred to in former reports. The cost of constructing these ten systems of drainage in the first instance would be approximately £350, but owing to the failure of the stoneware pipes to remain sound the whole of these drains had to be reconstructed. Similar experiences in other districts are becoming increasingly common, and proves that while glazed stoneware, from the point of view of cleanliness and being non-corrosive, is an exoellent material for drainage purposes, it nevertheless is seriously wanting in strength, and cannot therefore be relied upon to remain permanently watertight, a condition which is now generally regarded as an essential sanitary requirement. Drains constructed with heavy cast iron pipes do not possess this serious disadvantage, as evi- 88 dcnced by the fact that it is a great rarity to find such a drain leaky upon testing the same many years subsequent to its construction. The first cost is also only slightly in excess of a stoneware drain, but exception is occasionally taken to iron pipes owing to their alleged liability to more or less rapid oxidation. In practice, however, it is found that the protective solution with which the pipes are coated, and the greasy film which forms on the interior of such pipes from the sewage passing through them, prevents any appreciable oxidation. Iron pipes must not, however, be laid in contact with ashes or clinker, which has a destructive effect upon them, nor should they be used for conveying corrosive acids. Since it is becoming a very common practice for persons in occupation or about to take possession of dwelling-houses to require the drains to withstand an efficient water test, property owners will, in my opinion, be well advised to use for drainage purposes suitable heavy cast iron pipes in preference to glazed stoneware pipes, the former proving almost invariably to be ultimately the most economical. House to House Inspection. The special visits paid to dwelling houses by your Inspectors arise from some particular cause, such as a complaint alleging the existence of a nuisance, or the occurrence of infectious disease. On the occasion of such visits the premises are examined, and any existing defects are promptly dealt with. The method of procedure differs, however, to some extent from that employed when making systematic house-to-house inspections. The latter inspections are made on tho initiative of your Sanitary Department, and the areas selected for visitation are, of course, those considered to be most in need of attention. A thorough sanitary survey of each premises is made, and both good and bad conditions in respect to the structure generally and the sanitary arrangements are duly recorded in the Register, together with such particulars as the number of occupants and the name of the 89 owner of the house. Provision is also made for recording altered conditions on the occasion of re-visits, thus making a continuous record of the sanitary condition of the property. Owing to other pressing duties, it was not possible to carry on extensive operations on these desirable lines, and it need hardly be explained that immediately following such inspections, much work has to be done in connection with the preparation of communications to the owners containing specifications of necessary works, and the supervision of such works when carried out. Time is also taken up in interviewing owners, builders, and others, both at the office and on the property. 338 house-to-house surveys were made during the year, and, as an indication of their value, I append a list of the sanitary defects which were discovered as a result thereof Defective Drains, Requiring Reconstruction 7 Defective Ventilating Shafts to Drains 9 Dirty Ceilings and Walls of Rooms 147 Defective House Roofs 32 Defective Scullery Floors 28 Insanitary Stone Troughs 10 Defective Sink Waste Pipes 20 Defective Yard Paving 77 Gully Curbs out of Repair 26 W.C. Flush Boxes out of Order 37 Insanitary W.C. Basins 14 Blocked Drains 11 Defective Eaves Guttering, and Stack Pipes 29 Dirty Service Water Cisterns 13 Defective Ashbins 51 Miscellaneous Defects 114 90 Complaints. 162 complaints were received with respect to the following matters, viz.:— Non-Removal of House Refuse 18 Defective Drains 33 Smells from Public Sewer 17 Blocked Drains 6 Accumulations of Refuse or Manure 22 Nuisance from Animals 11 Nuisance from Overcrowding 5 Dirty Rooms 5 Burst Water Pipes 2 No Water to W.C. 3 Insanitary W.C. 2 Smell from W.C, 2 Nuisance from Dampness 2 Flooding of Cellar 1 Nuisance from Piggeries 3 No Water Supply 1 Smoke Nuisances 3 Insanitary Paving 3 Foul Pond or Ditch 5 Bad Smells on Premises 1 Untrapped Sink Waste Pipes 2 Other Complaints 15 The communications in regard to the non-removal of house refuse were acknowledged and handed to the Council's Surveyor who lias charge of the collection of this material. The other complaints were promptly investigated, and, in those cases in which the Council had power to interfere, the necessary steps were immediately taken to remove the cause of complaint. 91 Factory and Workshops Act, 1901. The factories, workshops and workplaces on the Register number 210, as compared with 196 at the end of 1907. The details of the work done by your Inspectors under the provisions of this Act are recorded, as far as practicable, in the tabulated statement included in the report of your Medical Officer of Health. The usual periodical visits by your inspectors have been maintained, and the sanitary defects discovered were promptly remedied by the persons responsible. Dairies, Cowsheds, and Milkshops. Twelve applications for registration under the Dairies, Cowsheds, and Milkshops Order of 1885, were received from two dairymen, one cowkeeper, and nine purveyors of milk. The business premises of seven of the purveyors of milk are outside the district. The proprietorship of one cowshed and three dairies changed hands, and the carrying on of the business of two cowkeepers and one dairyman was discontinued. At the end of the year there were 34 dairies and milkshops, and seven cowsheds in the district. 146 visits were paid to these premises, and the following matters were specially dealt with, vizNew milk stores provided, 3; use of unsatisfactory premises discontinued, 1; entirely new dairy constructed, 1; new cowshed constructed, 1; yard paving relaid, 1; drain repaired, 1; cover provided to storage cistern, 1 ; cleansing of premises, 4. Special attention was also directed to the grooming of the cows, but in two or three of the sheds, particularly during the winter months, the conditions of the cows was not entirely satisfactory. As recorded in previous reports the premises generally are maintained in a satisfactory condition, and the Regulations in force are, as a rule, carefully observed. 92 Ice Cream Premises. The confectioners' shops and other places where ice cream is manufactured or sold were visited, as usual, during the summer months, and the undermentioned infringements of the provisions contained in the County of Middlesex (General Powers) Act, 1906, were suitably dealt with, viz:—Existence of drain inlets in part of premises where ice cream was made, 2; premises insanitary and unfit, 1 ; name and address of manufacturer not exhibited on barrow, 1. In regard to the insanitary premises it was necessary to serve statutory notices requiring the execution of a considerable amount of work, including entire new drainage, paving, and the making good of general dilapidations. After some delay, however, this work was duly carried out. The other matters mentioned received proper attention at once. The premises now on the Register at which ice cream is manufactured or sold number 37. Slaughterhouses and Meat and Food Inspection. An application for a licence to erect a new slaughterhouse at Lodge Farm, Bishops Avenue, East Finchley, was received and reported upon. This application was granted by the Council, together with a licence to use the same, the latter being subject to renewal at the end of one year. The slaughterhouses in the District now number 13, eleven of these being licenced for an indefinite period. Two of the slaughterhouses are very seldom used, but killing usually takes place in the others on at least one day in each week. 243 visits were made to the premises by your Inspectors during the year, and in accordance with our usual practice, the visits were arranged to take plaoe at such times that slaughtering was likely to be in progress. A large number of carcases and organs thus came under observation, and those which were found to be diseased or unsound were destroyed. 93 Attention was also given to the requirements of the bye-laws in respect to these premises, and, as a rule, these were well observed. A Register is kept of the butchers, fishmongers, and fruiterers' shops, and other premises where food is prepared or kept for sale for human food, and these now number 122, as compared with 125 at the end of the previous year. The respective premises were occasionally inspected, and the necessary steps taken in regard to any existing insanitary condition which was discovered, or any food which was considered to be unwholesome. The following is a list of the unsound food destroyed during the year as a result of action taken by your Inspectors :— 1 Carcase and organs of a Heifer. 2 Carcases of Pork. 3 Ox livers, 1 Pig's ditto, 2 pairs Sheep's lungs. Abdominal organs of a Pig. Fore quarter of Mutton. 1 Piece of Beef and 1 Calf's head. 3 Parcels of Vegetables and 1 parcel of Fruit. 1 Box of Kippers. The duties under the Food and Drugs Acts are administered by the Middlesex County Council. Infectious Disease and Disinfection. 1,112 visits were paid in connection with the cases of infectious disease which occurred in the district during the year, in order to make the usual special enquiries in acordance with the instructions of your Medical Officer of Health, and to inspect the drains and sanitary fittings in connection with 94 the premises. These visits were rather more numerous than in previous years owing to the additional work caused by the outbreak of Typhoid Fever. In regard to the measures taken to prevent the spread of infectious disease, no fewer than 6,410 articles were removed to the Council's disinfecting station and passed through the steam disinfecting apparatus, 334 rooms were fumigated with formic aldehyde vapour, and the walls of the rooms were stripped and cleansed where necessary. In addition to the action taken in respect to the scheduled infectious diseases, every endeavour is made to prevail upon householders to allow proper disinfection to be carried out by the department after such diseases as Consumption and Cancer, for which no charge is made by the Council. As a result of the inspection of the infected houses the undermentioned sanitary defects were discovered by your inspectors and satisfactorily remedied by the owners or occupiers:— Defective Drains 6 Defective W.C's. 13 Defective soil pipes and ventilating shafts 13 Defective fresh air inlets to drains 4 Blocked drains 2 Defective curbs or paving round gullies 9 W.C. flush boxes out of repair 12 Defective and untrapped waste pipes 30 Insanitary stone troughs 9 Defective rain water guttering and stack pipes 9 Defective yard paving 17 Defective scullery floors 4 Defective house roofs 8 Dirty ceilings and walls of rooms 28 Dirty condition of service water cisterns 7 95 Absence of covers to service water cisterns 12 Defective ashbins 15 Miscellaneous defects 6 N.B.—In addition to the above work of disinfection, 104 stovings of bedding, etc., were carried out, and 64 patients were removed to Hospital for the Friern Barnet District Council. Game Licenses. Thirteen applications were received under Section 27 of the Local Government Act, 1894, from tradesmen in the District for licences to deal in game. A licence was granted in each instance. Petroleum Acts, 1871 to 1881. Mineral spirit and various compositions containing the same, which, when tested in a prescribed manner, gives off an inflammable vapour at a temperature below 73 degrees Fahrenheit, is defined as Petroleum within the meaning of the above Acts. It is sold under various names, such as benzoline, benzine, naphtha, carburine and gasoline, and can only be stored for sale in pursuance of a licence granted by the Local Authority, excepting where the total quantity kept does not exceed three gallons, and that it is stored in vessels each of which contains not more than one pint. The ordinary petroleum oil used in lamps, such as paraffin, kerosene, crystal oil, etc., flashes above the temperature of 73 degrees Fahrenheit, and is therefore exempt from the operation of the Acts. By an order in Council made in 1897, certain parts of the Acts of 1871 to 1881 apply to Carbide of Calcium in the same manner as if the said substance was petroleum, and in those cases where the quantity kept exceeds 28 lbs. a licence is necessary. Any smaller quantity has to be kept in accordance with the Regulations contained in an order in Council dated October 24th, 1904. 96 Eight applications for licences to keep petroleum spirit and one for Carbide of Calcium were received and reported upon, and in eight instances licences were granted. One application in respect to keeping petroleum spirit was refused on the ground that the premises were regarded as being unfit for the purpose. The licenced premises have been visited several times during the year and the conditions annexed to the licences have been generally well carried out. Small quantities of Carbide of Calcium are also kept at mcst of the cycle and motor shops in the district, but in no case was the quantity found to exceed 28 lbs., excepting on licenced premises. It is interesting to note that the Home Secretary has appointed a Departmental Committee to enquire into the sufficiency of the existing Regulations relating to the storage, use and conveyance of petroleum spirit and to report what further precautions, if any, are desirable as tending to diminish the dangers attendant thereon. I have again much pleasure in expressing my appreciation of the valuable help given by the Assistant Inspector, Mr. Robinson, and the other members of the sanitary staff in carrying out the work recorded in this report. I am, Gentlemen, Your obedient servant, E. J. FRANKLIN, A.R.San.I., Chief Sanitary Inspector. March, 1909. 97 SUMMARY OF WORK DONE IN CONNECTION WITH THE SANITARY INSPECTION OF THE DISTRICT. INSPECTIONS. House to House Inspections 338 Special Inspections 1038 Re-Inspection after Order or Notice 1698 Visits to Works in Progress 1700 ,, ,, Factories and Workshops (including Bakehouses) 297 ,, ,, Slaughterhouses 243 ,, ,, Cowsheds, Dairies and Milkshops 146 ,, ,, Ice Cream Premises 46 ,, ,, Foodshops 169 Visits re Infectious Disease 1112 Miscellaneous 272 Total number of inspections and re-inspections 7059 DRAINAGE. Number of old Drains examined, tested, exposed, etc. 121 Number of Houses and Premises re-drained 94 Defective Drains repaired 11 Drains unstopped and cleansed 28 Length in yards of Stoneware Drains laid 2822 Length in yards of Heavy Cast-iron Drains laid 232 Manholes provided 101 Manholes altered and repaired 7 Intercepting Traps fixed 43 New Fresh Air Inlets provided to Drains 2 Stoneware Gully Traps fixed 251 98 New Soil Pipes and Ventilating Shafts fixed 109 Soil Pipes and Ventilating Shafts repaired 19 New Impervious Sinks provided 18 New Waste Pipes fixed 37 Waste Pipes repaired 28 Waste Pipes trapped ... 69 New Gully Curbs 7 Water Tests applied 354 Smoke Tests applied 181 Number of Plans of Drainage drawn 48 WATER CLOSETS AND SANITARY CONVENIENCES. New W.C. Basins of the "Washdown" type fixed 161 W.C.'s cleansed and repaired 40 New Flushing Boxes fitted to W.C.'s 28 Existing Flushing Boxes repaired 64 New Urinals provided 1 Insanitary Urinal abolished 1 New W.C. Apartments provided 3 Insanitary W.C.'s abolished 14 MISCELLANEOUS. Roofs repaired 37 Eaves Guttering renewed 8 Eaves Guttering cleansed and repaired ... 17 New Stack Pipes provided 8 Existing Stack Pipes unstopped, repaired and cleansed 19 Existing Stack Pipes disconnected from Drains 23 Old Surface Wells filled in 2 Yards paved 107 Paving of Yards repaired 35 99 Dirty Yards or Mews cleansed 11 Stable Floors repaved 5 Floors of Rooms repaired 14 Floors of Rooms relaid 18 Bakehouses cleansed and limewashed every six months Improvements to Dairies and Cowsheds 4 Cowsheds cleansed and limewashed every six months Improvements to Slaughterhouses 1 Slaughterhouses cleansed and limewashed every three months. Manure Pits provided 3 Ditto, ditto, covered 1 Rooms repaired, cleansed and limewashed 226 Workrooms cleansed and repaired 10 Dirty Houses cleansed 1 Water service pipes repaired 16 Public water supply laid on to houses 4 New cisterns provided 6 Cisterns repaired, cleansed, and covered 166 Movable sanitary dustbins provided 95 Nuisances from overcrowding abated 5 Nuisances from animals abated 10 Accumulations of manure and refuse removed 18 Miscellaneous 49 INFECTIOUS DISEASE AND DISINFECTION. Cases of infectious disease notified 229 Number of rooms fumigated after infectious disease 314 Verminous rooms fumigated 20 100 Number of infected rooms stripped and cleansed ... 20 Number of articles disinfected 6410 N.B.—In addition to the above work of disinfection, 104 stovings of bedding, etc., were carried out, and 64 patients were removed to hospital for the Friern Barnet District Council.