FRI 2 REPORT of the MEDICAL OFFICER 0F HEALTH of FRIERN BARNET, for 1895. barnet: e. cowing and son, "PRESS" office, 1896, ANNUAL REPORT of MEDICAL OFFICER OF HEALTH for the DISTRICT OF FRIERN BARNET. January 30th, 1896. Gentlemen, I have the honour to present my Twelfth Annual Report on the Health of the District of Friern Barnet. The report includes an account of Infectious Diseases, measures taken to prevent such illness; record of proceedings taken or advised to be taken to enforce various Clauses of the Public Health Acts in force in the District; the sanitary regulation of Factories, Workshops, and Bakehouses; also the Bye-laws of your Council, together with statistics relating to births, deaths, and sickness within the District. An account is also given of the sanitary condition of the District at the end of the year, and a record of the weather. The London County Asylum, Colney Hatch, is treated throughout this report as a separate locality. The year to which my report relates has not been unimportant for matters of sanitation generally. Considerable activity has been displayed. An important Act of Parliament was passed during the year, and will come into force on 1st of January, 1896. The Act is called the "Factory and Workshops Act, 1895." It is an attempt to consolidate and simplify the law relating to Factories and Workshops. The Act provides, among other things, that the Sanitary Authority is to inform the Factory Inspector of proceedings taken by the Authority in consequence of notice given by the Inspector. Laundries, excepting where members of the same family dwelling there, or in which not more than two persons dwelling elsewhere are employed, and excepting private laundries, come under the operations of the Act. It is to be regretted that at present there is no notification by a County Council to a Sanitary Authority of action taken under the "Contagious Diseases (Animals) Act," as well as under the "Adulteration of Foods and Drugs Act." Your Authority should be informed as to any action taken in your District by the Middlesex County Council under the above statutes. 2 Account of the Weather during the year 1896. During the first quarter of the year Nome very cold weather was experienced. In February the cold wag intense, causing considerable inconvenience to householders on account of the water-pipes being frozen, The cold spell began about the 21st of January, and extended through February until the 9th of March. In February the thermometer registered 9.9 degrees lower than the average for a similar period for 124 years. In the latter part of March the weather was warmer than usual. The amount of rainfall measured during the first, quarter was 3.465 inches. The prevailing wind was N.N.E. The excessive cold weather had a bad effect on the health of the district; the very young and elderly persons were most affected. Twenty-seven deaths wore registered during the first quarter—five from lung diseases; three from wasting diseases: two from consumption; six from convulsions; the remaining eleven from various diseases not dependent on the weather. In the second quarter of the year the mean temperature of the air was 55.1 degrees, which is 2.8 degrees above the average for the similar period of 124 years. The prevailing wind was N.N.W. The rainfall measured 1.86 inches, which is about one-third of the average amount in the second quarters of 80 years. The number of deaths registered was eleven. Scarlet fever and measles were prevalent in the district during this quarter, but no deaths were caused through those illnesses. In the third quarter of the year the mean temperature of the air was 62.3 degrees, which is 2.7 degrees above the average in the third quarters for 124 years. During the latter part of September the weather was remarkably hot, the mean temperature for the five days from the 24th to 29th being 12.9 degrees above the average. The amount of rain measured during this period was 7.18 inches. July was a wet month; in August and September the rainfall was deficient in quantity. The prevailing wind was W.S.W. During this quarter, throughout England and Wales, diarrhoea and diphtheria caused an excessive death-rate; but in the district of Friern Barnet these complaints ware not prevalent. In August and September five cases of typhoid fever occurred. During the fourth quarter of the year the mean temperature of air was 42.4, degrees, which is 2 degrees below the average. The amount of rain measured during this period was 8.215 inches; the rainfall was deficient in quantity. The prevailing wind was S.W.W. Fifteen deaths were registered. Two cases of Typhoid fever and twentythree eases of Measles were notified. The month of December was mild and damp, and favourable to the spread of infectious illness. The weather generally during the year 1895 has been favourable to health and agriculture, with the exception of the excessive cold during February. The rainfall during the year was deficient. The amount measured was 20.73 inches; the average for 45 years ending 1893 was 24.3 inches. For the last ten years there has been a deficiency in the rainfall; the effects of this deficiency has been the general lowering of the water in wells, so that Water Companies deriving their supply from this source are compelled either to sink new wells or to deepen the existing sources of supply. 3 Statement of Infectious Diseases Notified during the Year, together with Number of Notifications in previous Years. The "Infectious Diseases Notification Act" wan adopted by your Authority in the year 1890, and came into operation on January lst. 1891. The following are the diseases which are to be notified: Smallpox, cholera, diphtheria, membraneous croup, erysipelas, scarlet fever, typhus, typhoid, enteric, relapsing, continue 1, or puerperal fevers. Measles was added to this list in the year 1894. Scarlet Fever. Diphtheria Puerperal Fever. Typhoid. Erysipelas. Measles. Totals North Ward 5 4 0 0 1 7 17 Central Ward 10 0 1 2 2 16 87 South Ward 12 0 0 5 3 14 84 Lunatic Asylum 8 0 0 1 5 0 11 88 4 1 8 11 87 99 Months Showing the Numbers of Infectious Case Notified. Jan. Feb. Mar. April. May. June July. Aug. Sept. Oct. Nov. Dec. 1 1 0 2 5 0 0 2 0 0 8 1 88 Scarlet Fever. 4 0 0 0 0 0 0 0 0 0 0 0 4 Diphtheria 0 0 0 0 0 1 0 0 0 0 0 0 1 Puerpl Fever 0 0 0 0 0 0 0 2 8 2 0 1 8 Typhd Fever. 1 1 1 0 0 0 0 1 0 1 2 4 11 Ery- sipelas 0 0 2 11 0 0 0 1 0 0 3 20 37 Measles 6 2 9 18 5 7 0 6 3 9 13 26 99 Total. From the above tabulated statement of infectious illness, it is to be noticed that Small-pox, Membraneous Croup, and Cholera were absent from the District. Notification of Infectious Diseases received during the several years since adoption of the Act, with rate per 1,000 of the population. In 1891 received 48 notifications, equal to a rate per 1,000 of population of 6.3 In 1892 „ 50 „ „ „ „ ,, 7.9 In 1898 „ 99 „ ,, „ „ „ 13.4 In 1894 „ 07 „ „ „ „ „ 8.9 *In 1895 „ 99 „ „ „ „ „ 12.8 "This number (99) includes 37 measles, which became notifiable for first time during the year 1895. Without measles the number of notifications received was 62, equal to a rate per 1,000 of the population of 8.05. Scarlet Fever. Thirty-eight cases of illness were notified. In nearly all of the cases personal contact was traced as the cause of illness. Four cases in the Lunatic Asylum were caused by the admission of a patient suffering from this illness. Twelve cases occurred in the South Ward. In one family five children were affected. When only two children were affected an offer was made to remove 4 both to Enfield. The parents wished to keep one at home and remove the other. This I hesitated to sanction, as the case left at home would be a centre of infection to others. Some trouble was caused by this action of the parents, as the mother was about to be confined, and your Council desired to do all that was possible to prevent danger to the mother's life. Five cases occurred in the Central Ward; these children attended either the same Church or School. Fortunately, by prompt action and co-operation of the School Manager and Sunday School Superintendent, the illness was prevented from spreading. The cases were isolated. Two removed to hospital, and the sanitary state of school overhauled and put right. Scarlet fever was prevalent in London throughout the whole year. One death from this illness was registered, viz., an inmate of the Lunatic Asylum. Erysipelas. Eleven notifications relating to this illness were received. In the Asylum probably the general state of health of the insane may have a predisposing tendency to this illness. Measles. The seasonal peculiarity of this illness is well shown in your district. The illness appeared in April and May, 1895, then disappeared to again show itself in December, 1895. The northern suburbs of London seem to have been subject to a wide epidemic of measles. This illness occurs now and then in epidemics of large extent. Now that measles has been added to the list of notifiable diseases, your Council is better supplied with the knowledge as to the prevailing illness in your district. This certainly is an advantage. In all cases notified, visits are made to the houses, and instructions left to isolate cases. Unfortunately measles, unlike some other infectious diseases, is infectious during the stage immediately preceding the appearance of the rash, and as about twelve days elapse between the exposure to a case and development of disease, it is not unusual during this period for the illness to be disseminated. The practical course to adopt on account of this peculiarity of measles is to isolate a child who has been exposed to the contagion for at least 14 days, since measles is chiefly infectious through the breath. Diphtheria. Four cases were notified in the early part of the year, and were the remains of a series of cases reported upon in my last Annual Report. Typhoid Fever. An isolated case was reported from the Asylum. It was not possible to trace the cause in this case. Five cases occurred in the South Ward, in that part known as The Avenue. The first was that of a child, who had eaten ice-creams, and it was thought probable that this illness may have been contracted through this cause. A woman and two children probably contracted the illness through want of care in nursing the first case. Arrangements were made to remove the cases to a general Hospital. The ambulance from Barnet was used to remove them. The premises were disinfected, and sanitary defects ordered to be remedied. The sewers and house drains were flushed with carbolic; cisterns cleansed. An old sewer was examined and found faulty, and later on connections were made with new sewer. In two cases in the Central Ward the illness occurred in adjoining houses. The drain of one house joined under the kitchen with the other house and passed to sewer under the house. The drain was in direct communication with the sewer. No intercepting trap existed. The pipes were laid on the 5 clay without concrete, jointed with clay, and at the junction of one drain with the other was a broken pipe, allowing sewage matter to escape and to pollute ground and air. This air, probably infected with the specific germs from a case of typhoid in the adjoining house, was drawn by the kitchen fire through the soil into the room, as there was no impermeable material over the ground site of house to prevent escape of gases into the house, and the person who spent some of her time daily in the kitchen was infected. The rain water was connected with the sewer direct. These cases illustrate exactly the condition of things most likely to produce typhoid fever, as mentioned by Mr Parry Laws and Dr. Andrew in a report made by them to the London County Council on sewer gas and typhoid fever. They also illustrate the importance of an impervious covering over the ground site of a house, so as not to allow escape of ground air into the house; the jointing of pipes with cement and not clay; the laying pipes on concrete; and where passing under houses, surrounding same with concrete; the importance of disconnecting traps or inspection chambers on house drains to prevent pollution of air of houses with sewer gas; and the necessity of rain-pipes falling upon trapped gullies. After investigating these cases, I suggested to your Authority the need of making a complete examination of all house drains connected with the old system of sewers throughout the district, as if the above is an example of the way in which drains were laid some 13 years ago, the sooner they are discovered and re-laid the better. Your district cannot be considered to be in a good sanitary state until such examination is made and defects put right. Typhoid fever caused one death—a female, who died in a Hospital in London. Influenza. Influenza appeared in the district at the beginning of the year. The epidemic was of a mil l type. One death was registered from this illness. Puerperal Fever. One notification relating to this illness was received. The cause of the illness was inquired into, but not ascertained. Measures adopted for the Prevention of Infectious Diseases. Your Authority has an arrangement with the Enfield Local Authority and the Finchley Local Authority to receive into their Infectious Fever Hospitals cases of scarlet fever that cannot be isolated at home. A similar understanding exists with the Highgate Small-pox Hospital. As the population increases, it will be a matter for your Authority's consideration as to whether it is not better to have a building in your own district for the isolation of infectious diseases. Twelve cases were removed—eight (scarlet fever) to Enfield ; and four (typhoid) to the Royal Free Hospital. Removal of Infectious Cases. An ambulance is obtained from the Barnet Union to remove all cases of infectious illness. The delay in fetching this vehicle from Barnet (a distance of six miles) has been a matter which I have brought to your notice during the year. In order to prevent spread of infectious illness, it is important that delay in removal of infectious persons should not take place. Your Authority should take into consideration the advisability of procuring some form of ambulance. 6 Disinfection. At present your district is without an apparatus for the purpose of disinfecting clothes and bedding. Your Authority has considered the provision of a steam disinfector. Disinfection after infectious illness is carried out by the Sanitary Inspector. Sulphur candles are used to fumigate rooms, clothing, and articles of furniture. The rooms are afterwards cleansed, limewashed. and re-papered. During illness, where necessary, carbolic acid, soap, and oil are supplied. Printed instructions and precautions are given to persons in charge of infectious cases. Vaccination. The Guardians of the Barnet Union carry out the duties imposed under the Vaccination Acts throughout the district. From a return made in the Medical Officer's Report to the Local Government Board, it is gathered there were in the year 1891, 1,234 births in the Barnet district; 1,006 of these infants were successfully vaccinated; 92 died unvaccinated; in 33 vaccination was postponed; 3 were supposed to be insusceptible of vaccination; 100 remain not vaccinated; the unvaccinated, or these finally unaccounted for, including cases postponed, were equal to 10.8 per cent. of births. For comparison, we may quote the returns for England and Wales. In the year 1891 there were 914,079 births; 693,117 were successfully vaccinated; 1,806 were supposed to be insusceptible of vaccination; 9 had small-pox; 96,351 died unvaccinated; 13,823, vaccination postponed; 108,973 remaining to be accounted for. Children not finally accounted for, including cases postponed, were equal to a rate of 13.4 per cent. of the births. The highest rate of children not finally accounted for, including postponed cases, is Leicester, with 62.9 per cent. of births; the lowest is Westmoreland, with 2.9 per cent. of births. On the following sheet will be found a general summary of the work of the Sanitary Inspector. The report represents a good deal of sanitary work. The number of recorded visits made scarcely represent the actual number of visits and time spent in superintending work in progress. 7 FRIERN BARNET SANITARY DISTRICT. Inspector's Report of the Sanitary Work completed in the Year 1895. Results of Inspection House Drains Privies and Water closets Dust Bins Water Supply No. of Lodging Houses registered under 35th Section of the "Sanitary Act. 1866," or 90th Section of "Public Health Act, 1875." Miscellaneous 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. Dust Removal—No. of Communications received and attended to. Removal of Accumulations of Dung, Stagnant Water, Animal and other Refuse Animals Removed, being improperly kept. Regularly Inspected SANITARY DISTRICTS. No. of Complaints received during the year. No. of Houses, Premises, Ac., inspected. No. of Re-inspections of Houses, Premises, &c. Bakehouses. Licensed Cowsheds. Licensed Slaughter-houses. Legal Proceedings : i.e. Summonses. Notifications. Totals 24 418 772 104 14 63 42 14 38 4 12 9 8 7 27 2 - 7050 3 8 5 7 2 7 99 HUGH STOTT, Medical Officer of Health. 8 An Account of action taken or advised under the several Acts of Parliament and your Bye-laws affecting the Health of the District. During the year 167 inspections have been made by me either in company with the Sanitary Inspector or alone. As a result of these inspections, 45 certificates were written by me certifying, under the Housing of the Working Classes Act, that this number of houses, situated in different parts of the district, was unfit for human habitation. In all these cases, after consideration, your Authority directed the Clerk to take necessary steps to have the houses made fit for human habitation. In most cases owners complied with the statutory notice. In six cases action was taken by your Clerk before the Magistrates at Highgate, and after some delay the orders made by the Magistrates were carried out. At a later stage of my report, I shall again refer to this subject. The increased number of these certificates show that your Authority is determined to remedy sanitary defects of houses, and that when every other means has failed to persuade owners of property to put their houses in good sanitary state, your Council resorts to the extreme measure of taking legal action. A certificate was written by me, under Section 70 of the Public Health Act, 1875, declaring that a sample of water obtained from a well in the North Ward was polluted with sewage matter, and unfit for drinking purpose. Your Authority took the necessary steps to close the well and substitute the Barnet Company's water for the shallow well water. Four certificates were written under Section 46 of the Public Health Act, 1875, requiring houses to be cleansed and whitewashed. Laundries. Five Laundries were inspected during the year; they were found to be in a fair sanitary state. There are several houses in the district where washing is taken in. These houses have small convenience for washing and drying linen, consequently some injury to health is caused to inmates of the house by reason of the steam from boiler and dampness from clothes drying. Sooner or later bye-laws should be framed for regulating these small laundries, or your Authority might take into consideration the question of adoption of the "Baths and Washhouses Acts," and the building of suitable wash-houses. Schools. Inspection of the National Schools in the district have been made at regular intervals of three months, and at other times when necessary. An excellent new School, well lighted and well ventilated, has been built from plans approved by the Education Department. These Schools have taken the place of old buildings in Oakleigh Road, South Ward. In the Central Ward also some modern-built Schools, capable of enlargement as the necessity of the district requires it, are in good sanitary state. The same applies to the North Ward. In the district south of the Asylum the Schools are not of such recent construction as those in other parts of the district. The sanitary arrangements are satisfactory. As the cleanliness and good order of the water-closets and urinals depend so much on the caretaker, it is important that a capablc person should be employed to undertake this work. Dairies, Milkshops, and Cowsheds. Seven premises registered under the above heading have been inspected four times during the year. 9 Slaughter Houses. There are two slaughter houses in your district. Both were inspected four times during the year. In one a notice was served to repair floor, and to do other necessary work. Bakehouses. These have been inspected four times in the year. They are in a fairly good sanitary state. Examination of Foods, etc. During the year I visited and inspected from time to time the shops selling articles of food in the district. Also I have examined the fish, fruit, and vegetables hawked in the streets. There has been no cause for talcing any action. Particular care was taken in making these inspections, as during the year I received instructions from your Council to pay greater attention to Sections 116-119 of the Public Health Act, 1875, which clauses empower the Medical Officer of Health to inspect and examine at all reasonable times "Any animal, carcase, meat, poultry, game, flesh, fish, fruit, vegetables, corn, bread, flour, or milk exposed for sale, or deposited in any place for the purpose of sale, or of preparation for sale, and intended for the food of man." The list of articles mentioned does not include eggs, butter, and cheese, but in your district Part III. of the Public Health Acts Amendment Act, 1890, is in force, so that all articles of food are included. The attention of the Inspector of Foods and Drugs of the Middlesex County Council was drawn to the milk supply of the district. On three separate occasions samples were taken, and in one instance action was taken before the Magistrates at Highgate against a person for selling milk adulterated with water. Complaint as to Nuisance caused by Cartage of Dust and Refuse from a Railway Siding. A nuisance caused by carting dust and refuse from a Railway Siding through your district gave rise to several complaints. On the matter being reported to your Council, and certified as a nuisance dangerous to health, steps were taken by you to cause the nuisance to be abated. I drew your attention to the need there was to make fresh bye-laws in order to better regulate the carriage of manure, filth, etc., through your district, as the power was given to your Council by the Public Health Acts Amendment Act, 1890, Part III. of which was adopted by you. The consideration of these bye-laws was referred by your Authority to the " Special Committee as to Bye-laws." The Public Health Acts Amendment Act, 1890, confers the power on your Authorities to make bye-laws with respect to the following: — Paving of yards and open spaces in connection with dwelling houses ; Prevention of danger from whirligigs, shooting-galleries, etc. ; The alteration of buildings ; The keeping water-closets supplied with sufficient water for flushing. While considering the alteration of bye-laws, I trust your Council will make provision for the proper protection of water-pipes and cisterns, so that the danger to health which may arise from frozen pipes may be prevented. 10 As to Sketches of Sanitary Appliances most suitable for use in your District. After consultation with your Surveyor, I brought to your notice the desirability of printing sketches of approved sanitary appliances for use by builders in the district. I consider this a good way of giving assistance to builders, and making provision of something like a uniformity of sanitary appliances of the best kind. As to Bye-laws with respect to Houses Let in Lodgiugs. I had occasion to bring to your notice that although the bye-laws relating to houses let in lodgings formed a part of your general bye-laws, they had not been put in force. I consider among the smaller house property occupied by members of more than one family, these bye-laws would be a means by which cleanliness would be promoted and overcrowding prevented. Registration would effectually teach landlords to recognise the responsibility of house property, and occupiers that cleanliness forms a part of the ordinary daily duties. Under the bye-laws, the landlord is required to cause every part of the premises to be cleansed and the interior to be limewashed, except where impossible, once in every year. There need to be no friction in bringing these bye-laws into action. The class of house is provided for in the bye-laws. I would mention the following roads where, if these bve-laws were put into action, an improvement in the health of the inhabitants might be expected:—Oakleigh Road, Avenue, Holly Park Road, Alexandra Road, Cromwell Road, and Sydney Road. An Account of Sanitary state of District at the end of the Year. Scavenging and Removal of Dust. These duties have been carried out in a satisfactory manner during the year. Your Authority considered the matter of dust collection, and after careful investigation found that a collection once in three weeks seemed to meet the requirements of the district at present. In your district (a semi-rural district) dust and house refuse is collected from about two-thirds of the number of inhabited houses. One-third use the ashes for garden purposes. A frequent removal of house refuse from houses has many times proved of immense advantage to the public health. The dust-bins throughout the district are chiefly galvanized iron moveable bins. The fixed bins are gradually being discontinued. Your Authority has wisely provided a tarpaulin cover for the dust-carts, so that no effluvia from the dust shall give cause for complaint. Pollution of Watercourse. During the year a nuisance was caused by the overflow of cesspools from Clerkenwell detached district passing into a ditch in your district. The recurrent nuisance is dangerous to health. Your Council is in negotiation with Clerkenwell to take the sewage of this portion of the district, and this matter has been under your consideration. A further nuisance from a polluted ditch was brought before you. The nuisance was caused by an overflow from a manhole in an adjoining district emptying into a water-course. The sewer became olocked, and overflowed by the outlet into stream. The Surveyor of the district promised that the overflow should be stopped up, and the nuisance prevented from recurring. The Sanitary Inspectors attention was drawn to the possibility of pollution of the ditch from the overflow of a cesspool in a house in your district. 11 Sewage Works. The Sewage Disposal Works have been visited by me on several occasions. The system of treatment of sewage has worked efficiently. The effluent from filter-beds which discharges into a tributary of the Lea has been of a most satisfactory character. The treatment of sewage adopted in your district is first, straining; then treating with chemicals, alum, and lime, and passing into settling tanks. The fluid portion is filtered through artificially-prepared filter-beds, and discharegd finally into the stream. The solid portion is pumped on to the land and dug in. Water Supply. The water supplied to your district is obtained from deep wells in the chalk at Barnet. It is a remarkably pure water. Your Council is still considering the constant supply of water. This matter has already been the subject of two inquiries by the Local Government Board. By a wise and thoughtful provision your Council is endeavouring to obtain the sanction of the Local Government Board to the insertion in the regulations of the Water Company relating to a constant supply the following provision:—"Provided always that it shall not be deemed to be an offence against any of the foregoing regulations for any person to continue to use any pipe, cock, ferrule, valve, cistern, soil pan, bath or water-closet, or any other apparatus or receptacle fixed or fitted on any premises before the 18th December, 1889, which, though not in conformity with the requirements of any such regulations, is sufficient to prevent waste, misuse, undue consumption, and contamination of the water supplied by the Company." It is to be hoped the persistent endeavours of your Council in this matter will be successful. At the present time there are in the district 22 houses not supplied with water from the Barnet Company, but obtain their supply from wells or other sources. The number of houses not supplied with water from the Company is equal to a rate of 1.7 per cent. of the whole number of houses, the remaining 98.3 per cent. being supplied with the Company's water. Mortuary. Your district is without a building suitable for the reception of a dead body. As your district becomes more populous, it is important to make provision for such a building as a Mortuary. Complaints. During the year complaints were received of bad smells from ventilators and manholes in the roads in the Central Ward and South Ward. I inspected causes of smells. In one case I attributed the nuisance to the gradient in a sewer on the old system not being sufficient to keep the sewer self-cleansing. In another case the probable cause was the disturbance of sewage matter by the meeting of a high-level and low-level sewer in a manhole; also the disturbance of sewage in a manhole near the pumping station. Another cause of nuisance was that in a new street the few houses connected with sewers were insufficient to keep the sewer well flushed. I suggested your Authority should consult the Surveyor as to whether the erection of high ventilators at the places where complaints were most numerous would get rid of the nuisances; also that flushing sewers should be more frequently undertaken. An account of my inspections and suggestions were contained in a lengthy report which was submitted to your Council, and after consideration referred to a Committee. During the year I brought to your notice a report to the London County Council by Mr Parry Laws and Dr. Andrew on the "Result of investigations on micro-organism of sewage." The report states:— 12 (1) That there is no relationship between the micro-organisms of sewer air and sewage. (2) That the micro-organisms in sewer air that is in the air in sewers coming in contact with sewage and escaping from sewer ventilators are less in number than in fresh air in the immediate neighbourhood, and that the germs were apparently related to and derived from those of fresh air than from sewage. (3) That sewage was not able to give off germs to the air in contact with it. (4) In discussing the question of typhoid fever in its relation to sewage, the conclusions arrived at were briefly that typhoid fever is chiefly conveyed by water, milk, and sewage-polluted air, brought about by defective and badly laid drains or leaking cesspools. The polluted soil becoming a breeding and living place for germs that infect the subsoil air. Intercepting traps on house-drains I had occasion to report on the necessity of providing suitable traps on house-drains in order to prevent pollution of air of houses by sewer air. In my inspections of houses built before the institution of the Local Authority in your district, I found houses directly connected with the sewers, the house-drains consequently ventilating the sewers, but at the same time in an objectionable manner, as in many cases I have reason to believe the drains are laid with clay joints and on clay without concrete, the consequence being that where the drains pass under houses the air of the house is polluted with sewer air, and sickness must sooner or later attack the occupiers of the house. For this reason, then, I reported to your Authority the need for intercepting traps on house-drains, so as to prevent sewer air from passing direct from sewers into houess, and for providing a current of fresh air to circulate in house-drains. Your bye-laws passed in 1884 require "That there shall be a suitable trap provided at a point as distant as may be practicable from such bunding, and as near as may be practicable to the point at which such drain may be connected with such sewer or other means of drainage." In every house these provisions of your bye-laws should be carried out. The necessity of covering site of a house with some impermeable material, and the provision of damp-proof courses in order to render a house fit for human habitation. In the early part of the year, on inspecting some houses, it was found the site, on which houses were built, was wet clay. In some of the houses the joists were wet and rotten, and rested on the clav. The walls of the houses showed signs of dampness, due to want of damp-proof course. I certified these houses were unfit for human habitation, and could not be rendered healthy unless the clay was excavated, and some four to six inches of cement concrete placed beneath boards, leaving an air space, and providing a proper damp-proof course. Your Authority issued the necessary notice under the Housing of the Working Classes Act. The owner at first objected to allow an inspection to be made. Your Council very properly took action before the Magistrates at Highgate, where the case was ably argued by your Clerk, and your Authority convinced the Magistrate after some trouble, and gained the important point of the right of entry for the purposes of removing the flooring for inspection beneath. On three separate occasions this case was brought before the Magistrates. Eventually the owner agreed to do the work. There seemed to be some doubt as to the power of requiring a site of a dewlling house to be covered with some impervious material in order to make it healthy. There appeared also a difficulty as to whether the Magistrates could be convinced that it was necessary to cover a site with concrete in order to prevent dampness and the passage of noxious vapours through the ground into the house. It is clear the Housing of the Working Classes Act, Section 29 of which defines dwelling 13 house as meaning any inhabitable building, including any yard, garden, outhouse, etc., includes the site of the dwelling house. The importance of covering a site with cement concrete is far more considerable than is generally supposed. In Sir George Buchanan's report on the distribution of consumption as affected by dampness of soil, it is shown that wetness of the ground is a cause of consumption to the population living upon it. It has long been known that residence on a damp subsoil favours the prevalence of chest complaints, hence it is necessary to concrete sites if only on the score of dampness. The other reasons are that the air drawn into rooms by means of fires from beneath the floors may contain a large quantity of watery vapour, carbonic acid, and other gases from leaky drains or cesspools, and coal gas from a distance. In your district, where the subsoil is chiefly clay, it is most important for health that all sites of dwelling houses should be covered with some impervious material. I have previously had occasion to mention the fact that rheumatism and rheumatic diseases are prevalent throughout the district, and are probably in a great measure due to damp houses. The question has been discussed by your Authority as to the advantages or otherwise to health of drains passing under houses. Authorities are generally agreed that no drains should pass under houses where it is possible to lay them outside. In some cases it is necessary to lay drains under houses. In these every possible precaution should be taken to render joints of pipes perfect; to lay pipes on concrete and to surround them with concrete. The drains should be laid in straight lines, with an inspection chamber and intercepting trap. In laying drains under houses, the advantages in using iron pipes with joints caulked with lead are that iron pipes are cast in twelve feet lengths, whereas stoneware pipes are cast in two feet lengths. Consequently there are not so many joints, and the joints are probably made more perfect in the iron pipes. Unfortunately iron pipes cost more than twice as much as stoneware. A well known Authority writing on this subject says:—"With perfectly constructed and well ventilated house-drains, the evils of carrying drains through or under houses are more imaginary than real." The remarkably healthy state of London is pointed to as very conclusive evidence that no great evils arise from carrying sewers under houses, as nearly every house in London has a drain under it. If your Authority should desire that no houses should be allowed to be erected with a drain passing under it, then your Authority has the power to amend the bye-laws relating to new buildings so as to retain certain spaces about buildings, and where these spaces exist at the sides of buildings the drainage can be brought through them without passing under. The following amongst many Acts of Parliament are in force in your District. Public Health Act, 1875, and various Acts relating to Health incorporated therein. Housing of the Working Classes Act, 1890 and 1893, Part III. of which has been adopted by your Council. Customs and Inland Revenue Act, 1890. Public Health Acts Amendment Act, 1890, Part III. of which has been adopted by your Council. Infectious Diseases Prevention Act, 1890. Infectious Diseases( Notification) Act 1889. Contagious Diseases (Animals) Act. 14 Dairies, Cowsheds, and Milkshops Order, 1885. Isolation Hospitals Act, 1893. Factory and Workshops Act, 1878 1883. 1891, 1895. Allotments Act. Bye-laws. The Model Bye-laws relating to New Streets and Buildings :— Houses Let in Lodgings. Common Lodging Houses. Nuisances. Slaughter Houses. Occupation of Houses. Sanitary Regulations of Bakehouses. Sanitary Regulations of Dairies, Cowsheds, and Milkshops. Referring to an Authority who has written on the administration of the law relating to Public Health, he states:—"The Laws cope with nearly every conceivable sanitary difficulty. If their administration were perfect, it is scarcely an exaggeration to say that tnere would be no insanitary dwelling; no polluted water supply; no accumulation of filth ; and no unnecessary spread of infectious disease in any part of the country. It is in the direction of improved administration, and consolidation and simplification of existing statutes that reform is needed." Statistics relating to Births and Deaths Friern Barnet has an area of 1303.281 acres. The population, according to census 1891, was 9,174 persons; of this number over 2,000 persons living in the Asylum are included. The population of the Asylum is estimated as 2,488. In dealing with the vital statistics of the district, Colney Hatch Asylum is reckoned as a separate locality. There were at the end of the year 1895, 1,335 houses. Of these 1,277 were occupied and 58 unoccupied ; while four dilapidated houses have been demolished. The table shows inhabited houses, and those unoccupied for the several years:— Inhabited. Uninhabited. 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 1895 1277 58 Population Census 1871 2203 Population Census 1881 4405 Population Census 1891 6716 Estimated population to middle of 1895 7698 15 Total Deaths at all ages :— Deaths in District. Deaths in 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 1895 77* 200 *Including deaths of two persons in Hospitals situated outside the district. Deaths trom all causes during the year 1895: — Under 5 years. Over 5 yeas. Typhoid Fever 0 1* Diarrhœa 3 0 Pyæmia 1 0 Cancer 0 5* Tubercular Meningitis 1 0 Tubercular Peritonitis 1 1 Tubercular Disease of Bone 0 1 Phthisis or Consumption 0 5 Disease of the Nervous System 0 1 Convulsions 11 0 Heart Disease 3 6 Bronchitis 2 4 Diseases of Digestive Organs 2 5 Premature Birth 5 0 Wasting Diseases 3 1 Old Age 0 2 Accident 0 1 General Paralysis of Insane 0 1 Pneumonia 2 2 Influenza 0 2 Apoplexy 0 5 34 43 *Both of these deaths, one typhoid fever and one cancer, were registered in another district: but as the persons who died were residents of Friern Barnet, the deaths are included in Friern Barnet returns. Two hundred deaths were registered in the London County Asylum, Colney Hatch, during the year 1895; 95 males, 105 females. These deaths were equal to a rate of 89.2 per 1,000 of the population living in the Asylum at all ages. The causes of deaths in the Asylum were the following: — Exhaustion from General Paralysis 41 Exhaustion from Mania, Dementia, or Melancholia 107 Exhaustion from Epilepsy 14 Pneumonia 1 Cancer 9 Phithisis 6 Various Diseases 17 Scarlet Fever 1 Diarrhœa 4 200 10 Scarlet fever caused one death in the Asylum; while four cases of this illness were notified. The cause was attributed to a person admitted from an Infirmary suffering from scarlet fever. The measures adopted by the Medical Superintendent of the Asylum prevented the illness from spreading. Infantile Mortality. The rate of Infantile Mortality, or annual number of deaths of infants under one year of age to every thousand births registered during the same year, was: For the year 1895, 117: in 1894 the rate was 140 : in 1893 the rate was 114; in 1892 is was 78: in 1891 is was 105; in 1890 the rate was 108; in 1889 it was 132; in 1888 it was 120. According to the Registrar-General's latest annual report for 1893, the Infantile Mortality for England and Wales was 159 in a thousand. The average mortality of infants from all causes in the four decennia ending with 1890 had been in the proportions of 154, 154, 149, 142 respectively to 1,000 births. Zymotic Death-rate. The zymotic death-rate, or death-rate from chief infectious diseases, was equal to a rate of 0.9, or not quite one per 1,000 of the population for the year 1895. The chief specific febrile or zymotic diseases are: Small-pox, measles diarrhoea ; typhoid fever ; influenza; erysipelas, puerperal fever, and pyæmia. The number of deaths from zymotic diseases was seven; three from diarrhœa, ??? and pyæmia. The zymotic death-rate in previous years was: — 1884 2.1 1890 1.6 1885 1.2 1891 1.5 1886 2.7 1892 1.0 1887 0.8 1893 2.3 1888 1.5 1894 1.6 1889 0.7 1895 0.9 TABLE I. Showing population, inhabited houses, births, and deaths for years 1884 to 1895, inclusive. The population of the ten years (1884 to 1893) has been calculated in accordance with the census returns of the years 1881 and 1891, and corrected accordingly. The birth-rate and death-rate for the years 1884 to 1893 has also been corrected. No. of Inhabited Houses. Year. Populatn. to middle of year. No. of Births Birth rate per 1000. No. of Deaths Death rate per 1000 908 1884 5051 164 32.4 62 12.2 909 1885 5269 157 29.7 66 12.5 983 1886 5496 207 37.6 68 12.3 1022 1887 5733 204 35.4 53 9.2 1043 1888 5900 207 34.8 71 11.8 1076 1889 6238 219 35.1 75 12.0 1089 1890 6507 258 39. 6 94 14.4 1117 1891 6787 218 32.1 84 12.3 1179 1892 7079 191 26.9 79 11.2 1216 1893 7384 209 28.3 76 10.3 1264 1894 7467 206 27.5 77 10.3 1277 1895 7693 204 26.5 77 10.0 Mean annual rates per 1,000 for ten years, 1884 to 1893. Birth-rate, 33.0 per 1,000 of population. Death-rate, 11.8 per 1,000 of population living at all ages. 17 TABLE II. Deaths under 1 year. Deaths under 5 years. Deaths of Children under 1 year to per 1000 births. 1884 16 28 124 1885 20 23 125 1886 26 31 150 1887 20 32 98 1888 25 32 101 1889 28 35 127 1890 28 44 108 1891 23 34 105 1892 15 24 78 1893 24 42 114 1894 29 44 140 1895 24 34 117 TABLE III. Showing Deaths registered from all causes with ages at death during the Year 1895. Specific Febrile or Zymotic Diseases. No Ages. Diarrhœa 3 10 mths. 2½ mths. 6 mths. Enteric Fever 1 27 years* Pyæmia 1 14 months. Influenza 2 37, 81. Constitutional Diseases. Cancer 5 39 yrs., 37, 59, 52, 56* Phthisis or Consumption 5 18 yrs., 30, 27, 31, 44 Tubercular Meningitis 1 16 mths. Tubercular Peritonitis 2 4 yrs. 12 yrs. Tubercular Disease of Bone 1 49 yrs. Developmental Diseases. Premature Births 5 13hrs. 2hrs. 16hrs. 2½hrs. 1mth. Old Age 2 92, 80. Diseases of Nervous System. Apoplexy 5 57, 66, 50, 81, 50. Brain Disease 1 8 yrs. Convulsions 11 7mths., 21dys , 6wks., 9mths., 3mths., 3½mths., 10dys., 13mths., 3mths., 3mths., 13mths. General Paralysis of Insane 1 48. Diseases of Circulatory System. Heart Disease 9 4hrs., 52yrs., 3hrs., 56yrs., 61yrs., 26yrs., 11mths., 61yrs., 64yrs. Diseases of Respiratory Organs. Bronchitis 6 64yrs. 79, 74, 61, 13mths., 9mths. Pnuemonia 4 72yrs., 60, 4, 15mths. Diseases of Digestive System. Quinsy 1 13mths. Cirrhosis of Liver 2 49yrs. 50. Other Diseases of Digestive Organs 4 2½hrs., 45yrs. 59, 87. Accident or Negligence. Self-neglect 1 68. Suffocation 1 43. Ill-defined and not Specified Causes. Debility, Atrophy, Wasting 3 6mths., 9wks., 15mths. Total 77 "Both deaths have occurred outside the district. 18 The mean age at death for the year 1895 was 29.6 years : the mean age at death for England and Wales was. for the ten years ending 1893, 29.3 years. TABLE IV. Showing total deaths at all ages in 1895 from certain groups of diseases and proportions to 1,000 of population ; also number of infants under one year from other groups of diseases and proportions to 1,000 of population. Division I. Principal Zymotic Diseases— Total Deaths. Per 1.000 of Population. 1886 1887 1888 1889 18890 1891 1892 189 3 1894 1895 1886 1887 1888 1889 1890 1891 1892 1893 1894 1895 14 6 11 5 11 10 7 12 12 7 2.7 1.8 1.5 1.7 1.4 1.4 01 1.6 1.5 0.9 Pulmonary Diseases — 6 14 15 12 26 21 11 13 14 10 1.1 1.7 2.1 0.1 0.4 3.0 1.0 1.7 1.8 1.2 Principal Tubercular Diseases— 11 11 14 12 13 5 8 4 5 9 2.1 2.5 2.0 0.1 1.8 0.7 1.2 0.5 0.6 1.1 Division II. Infants under 1 Year. Wasting Diseases— 6 9 4 4 12 8 4 10 6 2 1.1 1.75 0.05 0.05 1.7 1.0 0.5 1.3 0.8 0.2 Convulsive Diseases— 4 1 0 7 3 4 2 6 3 9 0.76 0.35 0.0 0.1 0.4 0.5 0.2 1.3 0.2 1.1 South Central North Ward. Approximate population with number of deaths in each Ward, together with rate per 1,000 living at all ages in each Ward. 2,596 2,968 2,134 Population. 27 30 20 Deaths. 10.4. 10.1. 9.4. Rate per 1,000. 19 The Division of the Districts and the various Streets and Roads in those Localities. Your district is divided into three Wards—North, Central, and South Wards. North Ward is formed of the northern portion of the district. Oakleigh Park. Great North Road, Whetstone, Finchley Park, Myddleton Park, Friern Lane. Doncastsr Terrace, Scoreby Road, Bawtry Road, Oakleigh Road, Ada Cottages, and Lilly Villas. The houses are of a mixed class, some large, some cottages, and small house property There are 351 houses, and a population of 2.134 persons. Central Ward includes all houses situated in that portion of the district between the west side of the Railway Bridge, Friern Barnet Road, and Orange Tree Publichouse, Friern Lane, Torrington Park, and Friern Park. It contains about 494 houses, and has an estimated population of 2,968 persons. The houses are chiefly terrace-houses, many of which are occupied by more than one family; there are also some villas. South Ward is formed of all houses on the eastern side of the Railway Bridge, including Southgate Place, Southgate Villas, Avenue. Stanley Terrace, and Oakleigh Road, as far as the Pumping Station, Western Villas. Woodland Road, Colney Hatch Lane, and that part of the district south of the Lunatic Asylum. There are in the South Ward about 432 houses, having an estimated population of 2,596 persons. The houses in the South Ward are some villa property, with a large proportion of small house property. In that portion of the South Ward known as The Avenue, the houses are chiefly occupied by the working classes, and let out to members of more than one family. The area covered with houses of this portion of the district is a little more than eleven acres. The population is about 1,428 persons, so that there are about 139 persons to an acre. Such an aggregation of numbers must necessarily imply an increased risk of infection from infectious diseases; a high rate of mortality among children under one year of age. If we consider the infectious illness, we find in this area 24 cases have occurred during the year; this is nearly four times as much when compared with the same area in other parts of the district. Further, 9 deaths of infants under 5 years, out of a total (number of deaths under 5 years) of 31. The causes of deaths were convulsions, wasting diseases, and prematurity, one death of an adult from typhoid fever, and an adult from phthisis. This condition of increased illness points to certain sanitary defects. During the year some progress has been made with the better sanitary condition of houses. I would respectfully suggest the following as a means to improve the sanitary condition of this particular district: — (1) That there should be prepared a map showing the position of sewers, surface drains, and connections of house-drains with sewers, and position of interceptors. (2) That the cleansing of all mews, passages should be undertaken by your Authority, and when the bye-laws relating to paving yards and spaces about buildings are brought into existence by your Council, they should be enforced. (3) The bye-laws relating to houses let in lodgings should be put in force. (4) That frequent inspection of houses should be made. (5) The ventilation of the sewers might be assisted by some few ventilating columns. 20 In concluding this report, it is necessary briefly to refer to the account of statistics given relating to sickness and mortality in the district. There has been a small amount of illness and deaths caused through defective sanitation, such as typhoid fever ; this illness is entirely preventable. Scarlet fever and measles are chiefly spread by means of direct personal contact, and as the means of communication with surrounding districts are so easy, it is not to be surprised that these illnesses should rapidly spread when introduced into a district. Insanitary condition of premises is also a potent cause for the favourable extension of these diseases. Your Council, by adopting the necessary measures of notification, providing means for isolation, and disinfection has used your best endeavours to prevent infectious illness. The vital statistics of your district show a satisfactory state of affairs. The birth-rate, 26.5, is somewhat low. The mean annual birth-rate for the ten years 1883-1892 for England and Wales was 31.9 ; the mean annual birth-rate for the ten years 1884-1893 in your district was 33.0. The death-rate for the year 1895 is 10.0 per 1,000 ; this is a very low rate. The mean annual death-rate for England and Wales for the ten years 1883-1892 was 19.2 per 1,000. The mean annual rate in your district for the ten years 1884-1893 was 11.8 per 1,000. The zymotic death-rate was low, namely, 0.9 per 1,000. In England and Wales the zymotic death-rate was 3.1 per 1,000 in the year 1893. It will be noticed in the pages of the report that for the first time it has been possible to give a correct account of the population calculated on the census returns of the years 1881 and 1891, and a correct rate of births and deaths, and mean rate for ten years, 1884-1893. The Infantile Mortality was 117 to a thousand births, considerably lower than last year. Diarrhœa, a disease very fatal to young children, was markedly absent from your district during the year. Of diseases which caused deaths, it is to be noticed cancer and phthisis maintain about the same average each year. Cancer is supposed to be more prevalent on a clay subsoil than on other kinds of subsoil. A belief is also gaming ground that cancer may be due to a parasite; but in an exhaustive report by Dr. Klein, in the report of the Medical Officer to the Local Government Board, 1894, it is stated that the evidence at present it not sufficient to prove the assertion that cancer is due to a parasite. Convulsions caused eleven deaths in infants. These deaths illustrate how easy it is to disturb the delicate nervous system of a young child. Heart disease caused nine deaths, and probably points to the break-down in the principal organ of life as the result of increased exertions in the struggle for existence. My report contains a record of your Council's action in approaching, during the year, difficult questions relating to public health, namely. constant water supply, ventilation of sewers, prevention of dampness in buildings, etc. I would here gratefully acknowledge the invariable courtesy I have met at your hands, and the just consideration my reports have received. I have also to thank the officials of the Council for kind assistance I have in the course of my duties received from them. I have to subscribe myself, Your Obedient Servant, HUGH STOTT.