FR11 (3-4) REPORT OF THE MEDICAL OFFICER OF HEALTH OF FRIERN BARNET, FOR 1894. FRIERN BARNET: G. C. GRAMMER, PRINTER, AND GATE STREET, LONDON, w.c. 1895. With Best Compliment ANNUAL REPORT OF MEDICAL OFFICER OF HEALTH FOR THE DISTRICT OF FRIERN BARNET. January 24th, 1895. Gentlemen, Herewith I have the honour to present my Eleventh Annual Report on the Health of the District of Friern Barnet. This Report marks the commencement of a new decade, as well as the disappearance of the Friern Barnet Local Board and the first year of the regime of the Friern Barnet District Council. In the pages of the Report will be found an account of Infectious Diseases; means adopted to prevent such illness; a record of proceedings taken or advised to be taken to enforce various clauses of the Public Health Acts, the Sanitary Regulation of Factories, Workshops and Bakehouses, as well as the Bye-laws of your Board, together with statistics relating to Births, Deaths and Sickness within your District. The London County Lunatic Asylum, Colney Hatch, is treated throughout my Report as a separate District. 2 Statement of Infectious Diseases Notified During the Year with that of Previous Years. The Infectious Diseases Notification Act was adopted and put in force by your Authority January, 1891. The Diseases to be notified are Small-pox, Cholera, Diphtheria, Membraneous Croup, Erysipelas, Scarlet Fever, Typhus, Typhoid, Relapsing, Continued and Puerperal Fevers, and to those Diseases was added, during the year 1894, Measles. Scarlet Fever. Diphtheria. Puerperal Fever. Typhoid Fever or Enteric Fever. Smallpox. Erysipelas. Measles. Totals North Ward 9 l 0 2 0 3 2 17 Central Ward 10 8 1 2 1 4 0 26 South Ward 8 2 0 2 0 4 0 16 Lunatic Asylum 1 0 0 0 0 7 0 8 28 11 1 6 1 18 2 67 Notifications received in years:— 1891—43, equal to a rate per 1,000 population, 4.6 1892-56, „ „ „ „ 6.2 1893—99, „ „ „ „ 10.7 1894-67, „ „ „ „ 6.6 The Infectious Illness was distributed throughout the year in the several months as under:— Jan. Feb. March. April. May. June. July. Aug. Sept. Oct. Nov. Dec. 4 2 6 1 l 1 3 1 3 3 2 1 Scarlet Fever. 0 0 4 0 0 2 0 0 0 0 2 3 Diphtheria. 0 1 0 0 0 0 0 0 0 0 0 0 Puerperal Fever. 1 1 0 0 1 0 0 1 0 0 2 0 Typhoid. 0 0 0 0 1 0 0 0 0 0 0 0 Small-pox. 3 1 3 2 1 4 0 0 1 0 0 3 Erysipelas. 0 0 0 0 0 0 0 0 0 1 1 3 Measles. 8 5 13 3 4 7 3 2 4 4 7 7 67. Scarlet Fever was present in a slight degree throughout the year, it spread by personal contact, but from various centres. Typhoid Fever produced six cases, in two of these the exciting cause seemed to be the accumulation of filth and vegetable matter around and in the houses occupied. In the other cases enquiries made did not give any clue to the origin of the illness, they were distributed evenly in the three wards. One case of Small-pox appeared in the Central Ward, the origin of this illness was contact with a similar case in the country; owing to immediate removal of the person to the Highgate Small-pox Hospital, the disease 3 did not spread. Puerperal Fever, one notification of this illness was received, the immediate cause was not ascertainable, but the accumulation of soiled linen was the agency by means of which the disease was supposed to be conveyed to the lying-in person. Erysipelas was certified in eighteen cases. Seven of these were reported from the Colney Hatch Lunatic Asylum upon enquiry and investigation this illness was not produced by insanitary condition nor spread by personal contact or infection, the cases were more prevalent during December, January, February and March, and no doubt the impaired nutrition of the inmates of the Lunatic Asylum made them susceptible to this illness, this disease was not confined to any particular portion of the building. Measles—In consequence of the number of cases of Measles in the South Ward the schools were closed, and acting on my suggestion your Authority added Measles to the list of notifiable diseases. The cause of outbreak of Measles was the return to school of a child not sufficiently recovered, in order to prevent such recurrence I urged the importance of gaining knowledge of the first cases of Measles in order to prevent spread and the only reliable way was to place this disease on the list of notifiable diseases, I am aware the time is short to say whether or no there has been any advantage gained, but already two cases have been notified and these have been isolated, so that the illness has not spread. Diphtheria—this illness gave rise to considerable anxiety on account of the number of cases notified. Four cases occurred in the earlier part of the year in one house, a recently-built house, the cause was attributed to the miasma from a hole partly filled with decaying vegetable matter and forming a collecting chamber for the rain-water of the land around, the children played on the sides and frequently stirred the stagnant water, in two other cases notified the cause was attributed to the filthy condition of back yard adjoining house, the yard was covered with black mud and excreta from fowls. In four cases of Diphtheria, the supposed cause was milk supply. In the early part of November there appeared in the District several cases of sore throat illness with here and there some well-defined cases of Diphtheria; I investigated this illness and wrote several reports, the sickness was not confined to your District but was also prevalent in an adjoining district. Between November 13 and 20 about 16 houses in all were affected with either Diphtheria or Sorethroats, which the medical men in attendance attributed to a particular milk supply, after careful investigation I ascertained that in all these houses, the water, milk, and drainage were common; also that the water and drainage were common to all the other houses in the neighbourhood which had no illness. The number of houses supplied with milk by one dairy was ascertained to be about 25 per cent. of the houses in the District and of these about 17 per cent. were affected with sore throats or Diphtheria. Bacteriological examination of the exudation on the throat in many cases did not show the presence of the Lœffler's Bacillus. On 4 November 19th I communicated with the dairyman who supplied milk and asked for particulars and suggested that the milk supplied to this particular District should be procured from another source pending further enquiry, this suggestion was cordially agreed to, and information was given that lead to later enquiries, in the meanwhile, the medical officer of Health of an adjoining district was energetically carrying on a close examination. On December 4th I visited and inspected the dairyfarm where part of milk supplied to this District was drawn. I was accompanied by the proprietor and Professor Axe, this visit mas made by the permission of the owner, and every facility was afforded for examination of the cows and men, and this action did not require the uses of the Infectious Diseases Prevention Act, which is in force in your District The farm and buildings were situate on high ground, the farm was not of modern construction, the shed for cows had been recently constructed and was built to accommodate between 30 and 40 cows, the ground had recently been disturbed to lay drains. The cows drank water from a trough supplied with water from wells, also from water in a shallow pond, which at time of visit was dirty and foul. In the further corner of the shed three cows had been isolated on account of the appearance on the teats of papules which in two days had become vesicles the size of a sixpence situated at base of teat, the surrounding vesicle was red when I examined the cows the teats of two had two or three vesicles. From the other cow the vesicles had disappeared and become pustules and in one the sore was covered with a hard brown scab, which, when removed showed an irregular ragged sore, bleeding excavated and the edges raised and thickened, I was told these had been slightly raised papules two days, before there were also to be seen cracks or chaps totally distinct from vesicles. These cows had been purchased at Derby a fortnight previously. The cows were not off feed, but the owner remarked he thought they had a slight cold and cough. The milk obtained from these cows the man had used in his own house with no illness following, in the three children who drank the milk. It was discovered later that one child had suffered from a sore throat, there was no evidence of illness amongst the farm-servants or the cow-man who milked the cows and whose hands were free from sores of any kind. I drew off a portion of milk into a sterilized bottle, into another sterilized bottle was placed a portion of scab, and into a third bottle some pus from base of ulcer was placed, these bottles were carefully packed and delivered by hand to the bacteriologist of St. Mary's Hospital, who, after cultivations and microscopical examination, reported that "the milk was free from any growths and practically sterile." Cultivations from scab and pus "showed a grey growth on gelatine which under microscope did not show characters of Diphtheria Bacillus, the Bacilli were square-ended instead of dumbbell shaped." The question to determine was whether this illness in the cows was the cause of sore-throat illness and Diphtheria, that is, was it a similar disease to that already described as being cause of epidemics of Milk Diphtheria at Camberly Yorktown, Enfield and Croydon? The answer to this question is that the Diphtheria bacillus could not be found either in 5 the milk, in the scab or the purulent matter from base of sore. That certain cows whose milk was mixed with other milk and distributed chiefly to this district suffered from a papular eruption, quickly becoming vesicular and then pustular is a fact, that the unboiled milk consumed by persons appeared to produce sore-throat and Diphtheria is equally a fact, also that where a baby in a family got boiled milk and other members of the same family took milk, unboiled, the baby escaped but the other persons suffered, the difficulty has been to demonstrate the presence of the Bacillus Lœffler in the milk or the eruption on the cow's teat, it therefore cannot be stated with certainty that the cows were suffering from a disease that could produce Diphtheria in the human subject. The practical conclusion to be drawn from this illness and investigation is that the cows in dairy-farms should be inspected from time to time by a veterinary surgeon who should hold office under a Local Authority. Whooping Cough. This illness was present in the South Ward in the early part of the year and later in the Centre Ward. Five deaths were registered from this disease. I attribute the prevalence of this illness entirely due to the fact that parents allow infected children to mix freely with healthy children. It should be well-known Whooping Cough is an infectious disease and spreads rapidly amongst young persons, also that it is most fatal to infants under one year of age. It would be an immense advantage to include this illness in the Schedule of Notifiable diseases. Measures Existing in the District for the Prevention of Infectious Diseases. Isolation. Your Authority has considered the question of Isolation, and made further arrangements in the event that the Enfield Local Authority should not be able to take cases of Scarlet Fever that the Finchley Local Authority would be willing to receive any cases of Scarlet Fever, this arrangement has so far not failed, but it is a matter for your future consideration to erect a building in your own District for your separate use. No district in my opinion can be sufficiently fortified to resist the spread of infectious illness, that does not possess a building of its own to isolate such illness. The arrangement with the Highgate Small-pox Hospital to receive any cases of Small-pox still exists. Disinfection. Disinfection after infectious illness is superintended by the Sanitary. Inspector, Sulphur is burnt, the rooms thoroughly cleansed, lime-whited, and re-papered. The provision of some means of disinfecting bedding, clothes, etc., is necessary. 6 Vaccination. The Guardians of the Barnet Union discharge the duties of the Vaccination Acts throughout the district. An Account of Sanitary State of District at the End of the Year. During the year 274 inspections have been made by me, either in company with a Sanitary Inspector or alone. As a result of these inspections, 12 certificates in accordance with Housing of Working Classes Act have been written by me testifying that 12 houses were unfit for human habitation, notices were served on the owners and houses repaired. Inspection of Laundries. Five Laundries have been inspected twice in the year, they are in a fair sanitary condition. Schools. The National Schools within the District have been inspected four times, they are in a very good sanitary condition, with the exception of that used as a temporary Infants' School in Ely Place, this building answers the purpose of a temporary building, but should not be used for any length of time. In part of the year Measles was prevalent in the South Ward and the Managers closed the school for a period of three weeks; in the North Ward, owing to the prevalence of this illness, the schools in this Ward were not re-opened for a week after the Summer Vacation. Slaughter Houses. Two Slaughter Houses were inspected twice in the year, they were in a fairly sanitary condition, in one the owner's attention was drawn to the bye-laws requiring a proper covered receptable for removal of offal. Bake-houses. These were inspected four times during the year at the suggestion of your Authority. At my request, your Authority had printed some notices calling attention of owners to the various requirements of the Factories' Act, and the special sections relating to Bake-houses. A notice was sent to the Factory Inspector calling attention to the employment of a child in a bake-house. 7 Examination of Foods, &c. I visited and inspected six shops in South Ward selling Margarine, in two only was the Act relating to Margarine, properly carried out, your Authority wrote a caution to delinquents that unless the Act was carried out further notice would be taken. In all, ten visits have been made by me to the butcher shops in District and slaughter houses in order to examine meat and carcasses, on four occasions I have examined tish and fruit hawked about streets on barrows, and visited fruit shops in District, in my inspections I have found no reason to take action, otherwise it would have been brought to your notice. Certificates, &c. Six certificates were written under Section 46 Public Health Act, 1875, requiring premises to be cleansed and purified. Six certificates have been given by me for admission of persons suffering from Infectious diseases to Hospitals. Five relating to Scarlet Fever, one to Small-pox. I gave a certificate under Section 70 P. H. A. 75 certifying that the water from a well was so polluted as to be injurious to health. Complaints. Complaints were received of bad smells from sewers in North Ward, the sewers were examined and cause of smell was probably decomposition of sewage in house drains, also at one particular spot at the junction of the high level with the low level sewer the fall of the sewage causing a disturbance of the matter, this was the suggestion of the Surveyor, I recommended more flushing and freer ventilation when possible. Excavations left after Building Operations. Excavations in different parts of District, which have been left after building operations gave rise to nuisances on account of the collection of rain water and refuse of all kinds, three have been done away with during the year. It is a matter for congratulation that at length the means for efficiently flushing house drains has been supplied to a number of cottages in North Ward by the substitution of Barnet Company water for watt r from wells. By request of your Authority I made a special Report "as to whether any, and if any, what nuisances exist in connection with premises in Cromwell Road," in my inspection I was accompanied with Sanitary Inspector, the nuisances were collections of foul water, drainings from piggeries and stables at the rear of premises, caused by want of drains to pigstyes and stables, and the blocking up of water course. I certified that in some instances the pigs were kept so as to be a nuisance injurious to health, and also a cow. I suggested the complete separation of drains from pigstyes with surface drain, and the provision of proper receptacles for manure and filth. 8 From my inspections of the District I am more than ever convinced that thorough systematic and frequent inspection of the class of house property in parts of the District is the most efficient means of preventing nuisances injurious to health, and the spread of disease; frequent and continuous inspection is a greater dread to persons who wilfully neglect property, than any legal action. Scavenging and Removal of Dust. These duties have been satisfactorily performed throughout the year. Sewage Works. The Sewage Disposal Works have been inspected by me from time to time, the system for treatment of sewage worked efficiently, the effluent from the filter beds discharged into a tributary of the Lea has been exceedingly good. Pollution of Watercourse. The pollution of a ditch in South Ward by the flow of Sewage from Clerkenwell District was at one time abated, but on its re-appearing my attention was drawn to the matter, and I reported the existence of a nuisance dangerous to health from this cause, the matter was considered by you, and nuisance abated, it is to be hoped that negociations to prevent the recurrence of this nuisance may end satisfactory. The Sanitary Inspector's Report Appended. The Report of the Sanitary Inspector shows a great deal of good work recorded. 1 Workshops, several times. 3 Laundries, „ 7 Roofs repaired. 5 Guttering and rainwater pipes repaired. 4 Yards paved. 6 Ventilation below floor. 14 Basements rendered impervious. 1 Overcrowding. 3 Stagnant water. 23 Gipsy encampments removed. FRIERN BARNET URBAN SANITARY DISTRICT. Inspector's Report of the Sanitary Work completed in the Year. 1894. No. of Complaints received during the year. No. of Houses, Premises, &c., inspected. No. of Re-inspections of Houses, Premises, &c. Results of Inspection House Drains Privies and Waterclosets Dust Bins Water Supply Miscellaneous Notifications. Orders issued for Sanitary Amendments of Houses and Premises. Houses, Premises, &c., Cleansed, Repaired, Whitewashed, &c. Houses Disinfected after illness of an Infectious Character. Repaired, Cleansed, Trapped, &c Ventilated. Repaired, &c. Supplied with Water. New provided. New provided. Repaired, Covered, &c. Cisterns (new) erected. Cisterns Cleansed, Repaired and Covered. Waste Pipes connected with Drains, &c., abolished. No. of Lodging Houses registered under 35th Section of the "Sanitary Act, 1866," or 90th Section of ' "Public Health Act, 1875." I Dust removals. Removal of Accumulations of Dung, Stagnant Water, Animal and other Refuse. Animals Removed, being improperly kept. Regularly Inspected Legal Proceedings: i.e., Summonses. Bakehouses. Licensed Cowsheds. Licensed Slaughter-houses. Totals 64 815 1,236 168 8 57 13 19 12 33 - 15 8 33 51 6 . 6,409 3 5 7 2 2 67 HUGH STOTT, Medical Officer of Health. 10 Water Supply. The water supplied to your District by the Barnet Company from deep wells has maintained its purity. I am hopefully looking forward to the time when you will have obtained the constant water supply, I am fully aware of the difficulties you have had to contend with. During the year complaint was made on account of the turbidity of water, I examined the water and visited the supply works at Barnet, the cause of the turbidity was the disturbance of the water on account of driving heading into the chalk in order to increase the supply, there was no danger to health in this turbidity. I would suggest for your consideration the provision of more fire-hydrants. The number of houses supplied with water from the Barnet Company are 1,251. The number of houses drawing supply from wells and other sources are 13 equal to a little over one per cent. of the whole number of houses. I have analysed water from a well that supplied two cottages and certified the water was not potable, after some persuasion the owner agreed to close well and obtain supply from Barnet Co. Thirty-three houses have had water laid on to water-closets and in twenty-three houses water for drinking purposes has been obtained from the Barnet Water Company instead of from shallow wells as previously. Mortuary. The provision of a building suitable for removal of a dead body to, has received your consideration, but I respectfully suggest the re-consideration of this matter so that a building may be erected in your District. The district of Friern Barnet has an area of 1303.281 acres—the population according to Census 1891 was 9,174 persons, this number included persons living in the Colney Hatch Asylum. The population of Friern Barnet, exclusive of the Asylum, calculated to the middle of 1894 was 7,467. There were at end of year 1,264 inhabited houses and 56 uninhabited. The table shows inhabited houses, empty houses and population in several years. Inhabited Houses. Uninhabited Houses. 1885 909 237 1886 983 183 1887 1022 106 1888 1043 125 1889 1089 86 1890 1076 108 1891 1117 84 1892 1179 118 1893 1216 72 1894 1264 56 Population Census 1871 2,203 „ „ 1881 4,405 „ „ 1891 6,716 Estimated to middle of 1894 7,467 11 Statistics Relating to Births and Deaths. During the year there were registered in Friern Barnet 206 births, 119 boys, 87 girls; 77 deaths were registered, 46 male, 31 females. The population registered within the Asylum is reckoned as 2,535, and this is not included in the general population of District. The Asylum for purpose of statistics is reckoned as a separate building. The births were equal to an annual rate of 27.5 per 1,000 living at all ages. The deaths were equal to an annual rate of 10.3 per 1,000 living at all ages. Table Showing Birth-rate and Death-rate in the several Years. Birth-rate. Death-rate. 1884 33.0 12.5 1885 31.1 13.1 1886 39.7 13.0 1887 29.7 8.0 1888 30.0 10.0 1889 31.7 11-5 1890 37.4 13.6 1891 32.5 12.5 1892 27.2 11.2 1893 28.8 10.5 1894 27.5 10.3 The annual average rainfall throughout district was— 1887 20.5 inches. 1888 25.835 „ 1889 25.49 „ 1890 22.95 „ 1891 28.215 „ 1892 24.75 „ 1893 18.60 „ 1894 54.73 „ For the account of weather I am indebted to the Engineer of the Sewerage works. Number of Deaths in the various quarters of the year— Friern Barnet Asylum 1894. 1893. 1892. 1894. 1893. 1892. First quarter 17 24 35 47 59 162 Second 21 11 12 52 62 45 Third 21 17 14 40 56 26 Fourth 18 24 18 38 54 23 77 76 79 177 231 259 12 Total Deaths at all ages Friern Barnet. Colney Hatch Asylum. 1884 62 181 1885 66 179 1886 68 194 1887 53 190 1888 71 194 1889 75 229 1890 94 243 1891 84 233 1892 79 259 1893 76 231 1894 77 177 177 deaths were registered in the London County Asylum, Colney Hatch. These deaths were equal to a rate of 78.9 per 1,000 of population living in the Asylum at all ages. The chief causes of deaths in the Asylum during the year were the following:— Exhaustion from General Paralysis 30 Exhaustion from Mania, Dementia or Melancholia 96 Exhaustion from Epilepsy 22 Pneumonia 4 Cancer 4 Phthisis 12 Various Diseases 9 177 Infant Mortality. The rate of Infant Mortality measured by the proportion of deaths under 1 year to registered births for the year 1894, was 140 per 1,000 births. The number of deaths of infants under 1 year of age was 29. In 1893 rate was 114, in 1892 rate was 78,1891, 105, 1890 it was 108, 1889, 27, and in 1888, 101. Zymotic Death-rate. The Zymotic Death-rate or death-rate from chief infectious diseases was equal to a rate of 1.6. The Zymotic Diseases are Small-pox, Whooping Cough, Scarlet Fever, Measles, Diphtheria, Enteric Fever, Typhus, Diarrhœa. The number of deaths from Zymotic Disease was 12, 5 from Whooping Cough, 2 from Measles, 3 from Diphtheria, 1 Enteric Fever, 1 Diarrhœa. 13 The Zymotic Death-rate was in 1884 2.1 1885 1.2 1886 2.7 1887 0.8 1888 1.5 1889 0.7 1890 1.6 1891 1.5 1892 1.0 1893 2.3 1894 1.6 Deaths from all causes during the year. Under 5 Years. Over 5 Years. Measles 1 1 Diphtheria 2 1 Whooping Cough 5 0 Enteric Fever 0 1 Diarrhoea 1 0 Tubercular Meningitis 1 0 Meningitis 0 1 Cancer 0 3 Phthisis 0 4 Tabes Mesenterica 1 0 Disease of Nervous System 0 3 Convulsions 3 0 Heart Disease 0 4 Bronchitis 7 3 Disease of Digestive Organs 3 5 Disease of Urinary Organs 0 3 Puerperal Fever 0 1 Premature Birth 8 5 Wasting 5 0 Old Age 0 1 Accident 3 0 Pneumonia 3 0 Influenza 4 0 Apoplexy 1 1 44 38 14 Table I. Showing Population, Inhabited Houses, Births, Deaths for years 1884 to 1894 inclusive. Population. Inhabited Houses. Births. Deaths. Deaths under 1 year. Deaths under 5 years. 1884 4,628 908 164 62 16 28 1885 4,948 909 157 66 20 23 1886 5,215 983 207 68 26 31 1887 6,881 1,022 204 53 20 32 1888 6,896 1,043 207 71 25 32 1889 6,896 1,089 219 75 28 35 1890 6,896 1,076 258 94 28 44 1891 6,716 1,117 218 84 23 34 1892 7,004 1,179 191 79 15 24 1893 7,236 1,216 209 76 24 42 1894 7,467 1,264 206 77 29 44 Table II. showing Annual Birth-rate, Death-rate and proportional Death-rate of Children in 1,000 Births for year 1894 and previous years. Birth-rate. Death-rate. Deaths of Children under 1 year of ape per 1,000 of registered births. 1884 33.0 12.5 - 1885 31.1 13.1 125 1886 39.7 13.0 150 1887 29.7 18.0 98 1888 30.0 10.2 101 1889 31.7 11.5 127 1890 37.4 13.6 108 1891 32.5 12.5 105 1892 27.2 11.2 78 1893 28.2 10.5 114 1894 27.5 10.3 140 Table III. Showing Deaths registered from all causes, with ages at deaths during the year 1894. Specific Febrile or Zymotic Diseases— Diphtheria 3 6 yrs. 3 yrs. 23 ms. Measles 2 2 yrs. 4 ms. Whooping Cough 5 4 yrs. 16 ms. 4 ms. 6 ms. 3 ms. Enteric or Typhoid Fever 1 35 yrs. Diarrhoea 1 17 ms. Constitutional Diseases— Cancer 3 74. 72. 43. Phthisis 4 48. 48. 45. 21. Tubercular Meningitis 1 11 ms. 15 Developmental Diseases— Atrophy 5 16 dys. 1½ ms. 3 dys. 2¾ ms. 1¼ ms. Premature Birth 8 6 ms. 6 ms. 7 ms. 7 ms. 6 ms. 7 ms. 6 ms. 8 ms. Old Age 1 83. Congenital Malformation— Cleft palate 1 7 dys. Influenza 1 63 yrs. Local Diseases— 1. Brain— Convulsions 3 4 dys. 5 ms. 7 ms. Meningitis 1 6 yrs. Other diseases of Brain 3 49. 52. 12. Apoplexy 1 63. 2. Circulation— Heart 4 76. 68. 58. 44. 3. Respiration— Pneumonia 11 14 ms. 6 ms. 2 ms. 3¾ yrs. 3 ms. 2½ ms. 6 ms. 5 ms. 2¾ yrs. 1 yr. Bronchitis 3 79. 71. 83. 4. Disease of Stomach— Stomach diseases 8 86. 72. 2. 55. 1 mth. 57. 52 2 ms. 5. Diseases of Urinary Organs— Brights Disease 3 37. 39. 7 yrs. Parturition— Puerperal Fever 1 31. Scrofula— Tabes Mesenterica 1 4 yrs. Violence- Accidents Scald 1 20 ms. Fall 1 14 ms. Total 77 The mean age at death for the year 1894 was 21 years; 1893 it was 24 ; 1892, 23, 1891, 28 years. Table IV. Showing total deaths at all ages in 1894 from certain groups of diseases and proportions to 1,000 of population; also number of infants under 1 year from other groups of diseases and proportion to 1,000 of population. 16 Division I. Principal Zymotic Diseases— Total Deaths. Per 1000 of Population 1886 1887 1888 1889 1890 1891 1892 1893 1894 1886 1887 1888 1889 1890 1891 1892 1896 1894 14 6 11 5 11 10 7 12 12 2.7 1.8 1.5 1.7 1.4 1.4 0.1 1.6 1.5 Pulmonary Diseases— 6 14 15 12 26 21 11 13 14 11 1.7 2.1 0.1 0.4 3.0 1.0 1.7 1.8 Principal Tubercular Diseases— 11 11 14 12 13 5 8 4 5 2.1 2.5 2.0 0.1 1.8 0.7 1.2 0.5 0.6 Division II. Infants under 1 Year. Wasting Diseases— 6 9 4 4 12 8 4 10 6 1.11 1.75 0.05 0.05 1.7 1.0 0.5 1.3 0.8 Convulsive Diseases— 4 1 0 7 3 4 2 6 3 0.76 0.35 0.0 0.1 0.4 0.5 0.2 1.3 0.2 Approximate population with number of deaths in each Ward, together with rate per 1,000 living at all ages in each Ward. Ward Population Deaths Rate per 1,000 North 2,086 20 9.5 Central 2,901 28 9.6 South 2,480 29 10.1 7,467 77 29.2 The vital statistics here set out show satisfactory state of the general Sanitary condition of your District. Zymotic death-rate below the average Urban District Zymotic death-rate of 2.4; deaths from Diarrhoea very small number infantile mortality in your District was 140, in Urban Districts the average is 141, the reason of infantile mortality may be to some extent accounted for by the large number of premature births, namely 8, nearly a third of the whole number of infant deaths. Enteric Fever caused one death, this was probably contracted, or the condition, precedent to the reception of the specific germs induced, by the filthy surrounding of a dwelling-house. The death-rate is not higher than last year, in calculating death-rate allowance has been made for persons residing in institutions within District, but not belonging to District and those dying in institutions out of the District but belonging to District. In conclusion it is satisfactory to know that your District is progressing in matters Sanitary, before very long your labours in respect to a constant supply of water will I trust be crowned with success. I would recapitulate that in order to prevent the spread of infectious disease I still consider the provision of a separate hospital in your District more satisfactory than the present arrangement; that there is need of a disinfecting chamber to disinfect infected clothing, and a Mortuary for reception of dead bodies. I have the honour to Subscribe myself, Gentlemen, Your Obedient Servant, HUGH STOTT.