FRI 3 REPORT OF THE MEDICAL OFFICER OF HEALTH OF FRIERN BARNET, FOR 1896. friern barnet: g. c. grammer, printer, and gate street, london, w.c. 1897. ANNUAL REPORT of MEDICAL OFFICER OF HEALTH FOR THE DISTRICT OF FRIERN BARNET. January 25th, 1897. Gentlemen, I have the honour herewith to present my Annual Report on the Health of the District of Friern Barnet. This is the Thirteenth that has been presented by me, and includes an account of Infectious illness, 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, and the Byelaws of your Council. An account is also given of the Sanitary state of the District at the end of the year, and the statistics relating to Births, Deaths and Sickness are included in the Report, as well as a record of the weather as noticed at Friern Barnet during the period under review. The London County Asylum, Colney Hatch, is treated throughout this report as a separate locality. 2 During the past year the same activity in regard to public health has been displayed as of late years, and it is satisfactory to know that zeal in this direction is not abating. According to the quarterly returns of the Registrar General the health of the inhabitants of England and Wales during the year 1896 has been generally good. The death-rate has been below the average. Some diseases, such as Scarlet Fever, Typhoid Fever, Relapsing Fever and Diarrhoea have decreased, their fatality also has been less. In regard to Sanitary administration, it is a fact that the increase or decrease of such fevers and infantile diarrhoea in a district is a true indication as to whether that administration is bad or good. Fever and diarrhoea are preventable diseases, inasmuch as they are encouraged by defective drainage, bad water and filth. The year 1896 will be marked by the increased deaths from Small-pox; in the City of Gloucester alone over 400 persons died from that disease during the year. Such a terrible experience forcibly illustrates the result of neglect as regards vaccination. It will be remembered that in the summer of 1896 the Royal Commission on Vaccination, which had met on several occasions during seven years, issued its report, and the pith of the report may be stated in the words of an authority who says "the proof of the value of vaccination as a preventive of Small-pox was never more strongly put forward than it has been in that document." Another Royal Commission which is sitting at the present time, and which is likely to find means to control food-supplies in order to prevent the spread of consumption caused by the flesh or milk of animals affected by Tuberculosis, is the Commission on Tuberculosis Acts of Parliament passed during the year 1896 relating to Public Health have been few; the only Act of importance is the "Public Health Act, 1896," which repeals the Acts relating to Quarantine. Two very complete reports, one dealing with "Measles" and the other "on oyster culture in relation to disease" have been issued by the Local Government Board. In regard to Measles, it has been noticed that the fatality from this disease has been on the increase during the last few years, nearly 13,000 deaths are caused through Measles in England and Wales yearly, a greater number than by Small-pox, Scarlet Fever or Typhoid. Undoubtedly the cause of this fatality is due to want of knowledge on the part of parents to look upon the illness as infectious and serious, to its rapid spread by means of schools, and to its being confined chiefly to young children. The Medical Officer to the Local Government Board suggests the importance of compulsory notification of Measles combined with prompt systematic visitation, and information obtained from school authorities, together with 3 measures adopted with a view to isolation and disinfection, as well as restrictions placed on attendances at Elementary Schools, by the effectual carrying out of all these measures, it may be possible to lessen the extent of the illness and its effects. The Report on Oysters deals with the fact that illness of a dangerous nature such as Typhoid Fever has been traced to the consumption of oysters; the Report has shown that some oysters are cultivated and stored in waters subject to sewage pollution; it is to be hoped as the result of this Report that merchants will themselves take action to prevent a continuation of this bad system of cultivation and storage. In noting the important matters in regard to Sanitation which have been brought before the public during 1896, it would be out of place not to refer to the valuable work done by the London County Council in regard to the "Analytical investigation of London Water Supply;" in a report relating to this subject several matters have been made clear, such for instance as the advantage for filtration purposes of not renewing filter-beds frequently, and that the purification of water by means of filtration depends upon the amount of animal life in the filter-beds. The weather during 1896 as noted in Friern Barnet by the Resident Engineer at the Sewage Works. In the first quarter of the year the weather generally was mild, dull and dry. The mean temperature of air was 42°.4, or about 40 higher than the average over the whole country in the first quarters for 125 years. The rainfall was deficient, only 3.87 inches were registered at the Sewage Works which is 1.05 inches below the average in 81 first quarters. The prevailing wind was W.N.W. Fifteen deaths were registered in the first quarter. The weather in the second quarter of the year was warmer than usual, the mean temperature was 55°.6 or 3°.3 above average in second quarters for 125 years, the weather generally was warm and bright, and May was remarkable for the small quantity of rain that fell. The rainfall was 2.605 inches, which is 3.05 below the average in 81 second quarters. The prevailing wind was N.W. The deaths registered were twelve in number. In the third quarter the mean temperature was 6o°.4 or 0.7 above the average in third quarters for 125 years. September was remarkable for excessive rainfall. The amount of rain which fell measured 8.39 inches; this was 1.13 inches above average in 81 third quarters. In September the fall was 6.o inches, which was more than half the amount in the previous eight months. The prevailing wind was W.S.W. The number of deaths registered was 24. The last quarter of the year was characterised by the continuance of dull, 4 cold and wet weather. The mean temperature was 420.4, or 1°.2 below the average in fourth quarters for 125 years. The rainfall was 7.38 inches, which is .26 inches above the average in 81 fourth quarters. The prevailing wind was W.S.W. The total rainfall in the District for the year measured 21.79 inches, being 1.06 inches more than that which fell in 1895, and 2.51 below the average for 45 years over the whole of England and Wales. The deaths registered numbered 21. Statement of Infectious Illness Notified During the Year Together with Number of Notifications in Previous Years. The "Infectious Diseases Notification Act" came into operation on January 1st, 1891. Small-pox, Cholera, Diphtheria, Membranous Croup, Erysipelas, Scarlet Fever, Typhus, Typhoid or Enteric, Relapsing, Continued or Puerperal Fevers. Measles was added to this list in 1894 for a period of two years, and was again added at end of year 1896. Scarlet Fever. Diphtheria. Puerperal Fever. Typhoid. Erysipelas. Measles. Totals. North Ward 4 5 1 3 1 7 -21 Central Ward 12 3 0 1 2 58 — 76 South Ward 4 4 0 1 3 44 — 56 Lunatic Asylum 1 0 0 2 2 1 — 6 21 12 I 7 8 110 159 Table showing number of Infectious Cases notified each month:— Jn. Fb. Mr. Ap. My. Ju. Jy. Ag. Spt. Ot. Nv. Dc. Measles 39 11 6 9 7 2 16 6 11 2 1 0=110 Scarlet Fever 2 0 1 1 1 3 3 3 1 1 1 4= 21 Typhoid 0 0 0 0 2 0 0 1 1 2 1 0= 7 Erysipelas 1 0 0 1 0 3 0 0 1 1 0 1= 8 Diphtheria 1 0 0 0 0 2 3 3 0 0 3 0= 12 Puerperal Fever 0 0 0 0 0 1 0 0 0 0 0 0= 1 43 11 7 11 10 11 22 13 14 6 6 5=159 5 Notifications received in years:— 1891— 43, equal to a rate of 6.3 per 1,000 of population. 1892 56, „ „ 7.9 „ „ „ 1893— 99, „ „ 13.4 „ „ „ 1894 67, „ „ 8.9 „ „ „ 1895— 99, „ „ 12.8 „ „ „ 1896 159, „ „ 18.6 „ „ „ Without Measles 49 notifications were received, which would be equal to a rate of 5.6 per 1,000 of the population. Scarlet Fever. Twenty-one cases of Scarlet Fever were notified. Investigation was made into all the cases directly the notifications were received. Contact with persons suffering from illness appeared to be the general cause; in some of the cases the insanitary state of the patient's house, or the ground surrounding same, contributed its share in being the indirect cause. No deaths were registered from this illness. Erysipelas. Eight notifications were received relating to this illness. In one case no doubt the direct cause was the filthy state of house and premises. Measles. The epidemic of Measles which appeared in December, 1895, still spread throughout January; no doubt the holiday season was the means of the illness being so prevalent. Measures were taken to instruct parents to keep their children at home and not to allow infected children to mix with healthy ones. The schools were visited and information was received from this source as to a number of children away sick, and many visits were paid to the houses occupied by them. The illness abated gradually, but during the year three deaths were registered therefrom. The advantages of the notification of Measles being compulsory, were shewn by the knowledge gained of the number of cases and the localities, and when the period of two years, for which Measles was to be retained as one of the notifiable diseases, was up in October, I made a report to your Council and urged you to extend the time, which you decided to do. The means at your Council's disposal to deal with an epidemic of Measles in a satisfactory manner are 6 limited. Notification, isolation, visitation and disinfection, to be of any use, must be thoroughly carried out. This means increased cost, but it is to be hoped as people become acquainted with the serious nature of the illness through the means of notification and visitation, they may be more careful in regard to isolation and disinfection. Diphtheria. Twelve cases of this illness came to my knowledge. Three cases occurred in one house during the year, and in the same premises a year or so previously a similar case happened. There can be little doubt that the insanitary state of the house was the cause of the illness. A defective drain was found when the ground was opened, and a leaky joint causing soakage of sewage matter into ground. The back yard was very dirty from fowls being kept close to the house. On my inspection a chicken appeared ill, it had been affected with what is commonly known as "Roup." One of the sick children had attended to this fowl. Suspecting the illness might have been caused through this channel, I purchased the bird and sent it to the Laboratory of the College of Surgeons, the Curator kindly examined the bird and reported that he could not find any trace of the bacillus of diphtheria. In the other cases the insanitary state of the premises was the likely cause of the illness. Unfortunately the mortality from this illness was considerable, namely four. In three cases removal to a London hospital was made. Typhoid Fever. In five out of the seven cases of Typhoid Fever it was possible to trace, with almost a certainty, the cause of illness; in the remaining two the cause of illness was not so apparent. In the case of a female nurse in the County Asylum, it was ascertained that some short time previously she, together with two friends, visited Southend and partook of some oysters. On arriving home all three persons were taken ill, her two friends escaped with severe diarrhoea and sickness, but she developed Typhoid. I communicated with the Medical Officer of Health of Southend, but it was not possible to trace other cases of Typhoid Fever to the same source. However, at this period, investigations were going on by the Local Government Board into the possibilities of oysters subject to sewage pollution giving rise to Typhoid, and from the report on the. subject to the Local Government Board it is clear that the condition of things in regard to the care of oysters at Southend was not what it ought to be. In another case the probable cause was ascertained to have been contracted while visiting away from district. In three other cases that occurred in one house the cause was traced to a leaky drain polluting soil through which passed a pipe conveying drinking water to the house; the pipe was constantly under pressure, as this part of Friern Barnet lies at a lower level than the surrounding district, 7 and the water supply is practically constant. Some two years previously an adult contracted Typhoid Fever, and it is more than probable the soil polluted with the specific germ by means of faulty drain, infected the drinking water through the supply pipe. The persons affected were children who were in the habit of drinking water direct from the cistern, whereas, adults generally drank water boiled in form of tea or other beverages. The investigation of these cases showed the importance of ascertaining the state of drains laid under ground, and in every case of infectious illness it is of the utmost importance to ascertain the state of the drain leading from the house drain, as a leakage of sewage polluting the surrounding soil is more frequently the direct cause of illness, or at any rate by lowering the vitality of persons living in the house, prepares them very thoroughly for the reception of disease germs. On many occasions during the year I have brought this matter to your notice. Puerperal Fever. One case was notified during the year. No cause could be ascertained. Whooping Cough Was prevalent throughout the year. Attention was drawn by reports in the Press urging parents to isolate their sick children. The education in the public schools in one part of district was disturbed through prevalence of this illness. Chicken Pox Was prevalent in parts of the district during the year. Measures Adopted for the Prevention of Infectious Diseases. Scarlet Fever cases that cannot be isolated at home and under certain conditions are removed to the Enfield Local Authorities' Isolation Hospital, or failing this to Finchley. Three cases of Scarlet Fever were removed to Enfield. Small-pox cases are removed to Highgate Small-pox Hospital, an arrangement being made with the Authorities. Two cases of Diphtheria and two of Typhoid were removed to general hospitals in London. You will doubtless continue to consider the necessity of providing a suitable building within your own district for isolating cases of infectious diseases. An ambulance would be extremely useful for the removal of cases to hospitals, as there is a delay at times in procuring the ambulance from the Barnet Union. 8 7 disinfection. Your Authority has still under consideration the provision of a suitable apparatus for the purpose of disinfecting clothes and bedding. Disinfection in cases of 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 and limewashed. During illness, where necessary, carbolic acid, soap and oil are supplied. Printed instructions and precautions are given to persons in charge of infectious cases. The Sanitary Inspector's report is herewith appended; a considerable amount of work is represented therein. An Account of Action Taken or Advised to be Taken under the several acts of parliament, and the Bye-Laws Affecting the Health of the District. During the year 325 inspections of houses and premises have been made by me. As a result of these inspections I have written 18 certificates under the Housing of the Working Classes Act, declaring these 18 houses to be unfit for human habitation. In 113 cases I have certified each house to be in such a condition as to be a nuisance, injurious to health, under section 91 of the Public Health Act, 1875. Five certificates have been given under section 46, Public Health Act, 1875, calling upon owners to cleanse and whitewash premises. In 8 cases action was taken by the Council before the Magistrates at Highgate. On 6 separate occasions I appeared before the Bench to support the action of your Authority. Laundries and Bake-houses. Four Laundries and 5 Bake-houses have been inspected regularly during the year. Schools. Inspection of the National Schools throughout the District have been made systematically. Dairies, Milkshops and Cowsheds. Six premises have been inspected 4 times during the year. Slaughter Houses. Two Slaughter Houses have received regular attention. FRIERN BARNET URBAN SANITARY DISTRICT. Inspector's Report of the Sanitary Work completed in the Year, 1896. 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 36th Section of the "Sanitary Act, 1866," or 90th Section of Public Health Act, 1876." Dust removals. No. of Dust Bins Cleared. 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 8 436 872 113 11 43 41 17 23 - - 8 - 7 36 3 11,648 4 17 5 6 2 8 159 HUGH STOTT, Medical Officer of Health. 10 Examination of Foods. Attention has been given to the articles of food exposed for sale in the several shops in the District, as also the fish, fruit and vegetables hawked in the streets. An Account of Sanitary State of District at the End of Year. Scavenging and Removal of Dust. Your Council has taken into consideration the collection and removal of Dust during the year, and by the employment of an additional cart the work has been satisfactorily carried out. The matter of Road-sweeping has also received your attention, and the suggestion of the Surveyor to provide suitable barrows for the men so that the dust may be quickly collected has been put into practical form with advantage. Sewage Works. The Sewage Disposal Works have now been carrying on their work for more than ten years, and the filter beds still perform their work thoroughly. The effluents from these filters is the admiration of all persons who visit the Works. The longer the beds are in use, and the less they are disturbed, the better the effluent; this is due to the animal life residing in the beds. There does not appear to be any great necessity at present to enlarge the area of the filter beds. Water Supply. On account of the extreme dryness of the season and little rainfall, your Council became troubled with the question of scarcity of water. The Barnet Water Company, which supplies your District with water, wisely called upon consumers to be careful in using water, which, for other than strictly domestic purposes, was limited. I reported upcn the matter fully to your Council, although there did not appear to be any cause for alarm that the supply would fail ; at the same time I made the suggestion that the New River Company should be approached, so as to be prepared before hand, in event of difficulties. The Barnet Water Company are sinking new wells in order to keep pace with the ever increasing District over which they have powers of supply. That there is plenty of water in the chalk is certain, but on account of the extraction of enormous quantities of water by the New River Company over the whole of the area of 11 Hertfordshire, which is not used in the area but carried some distance away, this large withdrawal has the effect of lowering the water in all the wells in the immediate neighbourhood, and compels the Barnet Company to deepen the present wells and sink new ones. It is to be hoped the Company may be able to increase the supply in the near future, and give to your District a constant supply. Your Council has paid considerable attention to the water supply during the year, and formed a joint committee with an adjoining District supplied by the Barnet Company, in order to leave nothing undone in regard to the water question. The result of the enquiry held by the Local Government Board into the question of the constant supply of water during the latter end of the year 1895 and beginning of year 1896, was that the Local Government Board refused to sanction the following regulation:—"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, nuisance, undue consumption, and contamination of the water supplied by the Company." The water obtained from the Barnet Company is of a wholesome and pure character, and although of a hard nature, on account of its source from deep wells in the chalk, is superior for dietetic purposes to river water. Nuisance Caused by Burning Ballast. A nuisance cause 1 by burning ballast close to houses in your District was reported upon by me. Ballast burning should not be undertaken in such close contact with houses in future. Pollution of Water Course. Inspection was made of water course flowing through Asylum grounds; it was evident that pollution from manure heaps, stables, &c., took place. Suggestions were made to prevent the pollutions and to straighten course of brook, so as to prevent the deposit of matter in the bed of the brook. The Bye-Laws as to Houses Let in Lodgings. During the year, in reporting on a case of Diphtheria that occurred in a house in the Central Ward, I made the following remarks. In this case the importance of carrying into effect your Bye-Laws relating to houses let in lodgings is well illustrated, The family lodge upstairs; there is no separate sink or scullery; 12 refuse and slops are put into a back room. If this house had been registered in conformity with your Bye-laws, the lodger would have known that it was his duty to remove filth and refuse from his rooms, and to empty them in the common dust-bin. The landlord would have taken more notice of complaints of lodgers as to defective water fittings, drainage, and the inspection on application for registration would doubtless have led to the above faults being remedied. I do earnestly urge you, for the benefit of the health of the District to immediately carry out the Bye-laws relating to houses let in lodgings. These Bye-laws, passed by your Authority and sanctioned, remain a dead letter. The Bye-laws of your Authority are under revision by a sub-committee, so no doubt this question will have its careful attention The Necessity for Covering Site of Houses with some Impermeable Material. Last year I drew attention to the importance of rendering a house free from dampness by covering the site with concrete. During the year no opportunity has been lost in supplying concrete beneath the floors of houses where the ground showed signs of dampness, so as to remedy any injury to health of inhabitants from dampness. In all 43 houses have complied with the notice requiring site to be covered with concrete. Dampness of Site of Dwelling Houses Caused by Wet State of Ground. Your Bye-laws provide that in case of building site being damp the ground shall be drained by suitable means. In parts of the District where buildings are about to be put up. it is of the greatest importance that the sites should be drained, in order to prevent dampness. It is necessary that this matter should receive your careful consideration, as the ground contains a considerable amount of water, and an undrained soil is highly injurious to health. If an authority is wanted for this, the late Sir J. Simon, Medical Officer to the Privy Council states that a damp state of soil answers the legal definition of a "Nuisance," and Sanitary Authorities "are bound to provide that such a state shall not continue through want of proper constructions for the drainage." The Want of Cleansing Gully Traps from Time to Time. In the course of my inspections I have been struck with the fact of the utmost disregard the public pay to traps, provided on their private drains, to prevent pollution of the atmosphere of the house with sewer gas. In some cases I have traced sore throat to the dirty state of traps; at times, especially the kitchen sink trap is coated with a thick black layer of fat and scum giving off 13 an intolerable nuisance, probably worse than sewer gas itself. All traps on drains shall be periodically cleaned out—traps on watercloset pans, baths, wash basins, sinks, rain-water pipes, &c. Anybody who took the trouble to examine these gully traps would be surprised to find the amount of filth they contain, if neglected; dead worms and slugs, decayed leaves, bird manure and soot at foot of rain pipes, fat and vegetable matter at foot of kitchen sink, &c. No traps will keep themselves clean, and the best system of drainage may become a veritable source of danger ; the public should learn this. The Following Among 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. Parts I. and II. Customs and Inland Revenue Act, 1890. Public Health Acts Amendment Act, 1890. Part III. Infectious Diseases Prevention Act, 1890. Infectious Diseases Notification Act, 1889. Contagious Diseases (Animals) Act. Dairies, Cowsheds, and Milkshops Order, 1885. Isolation Hospitals Act, 1893. Factory and Workshops Act, 1878, 1883, 1891, 1895. Allotments Act. Bye-Laws. Model Bye-laws relating to New Streets and Buildings. Houses let in Lodgings. Common Lodging Houses. Nuisances. Slaughter Houses. Occupation of Houses. Sanitary Regulation of Bake-houses. Sanitary Regulation of Dairies, Cowsheds and Milkshops, Statistics Relating to Births and Deaths. Friern Barnet has an area of 1,303.281 acres. The population according to census 1891 was 9,174 persons, this number included over 2,000 persons living in the County Asylum. The population of Asylum is estimated as 2,850. In dealing with the vital statistics of the District, Colney Hatch Asylum is reckoned as a separate locality. 14 The number of houses at the end of the year 1896 was 1,356, of these 1,337 were occupied and 19 unoccupied. The following table shows inhabited houses and those unoccupied for the several years:— Inhabited. Unoccupied. 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 1896 1337 19 The population according to Census 1871 was 2,203, according to Census 1881 was 4,405, according to Census 1891 was 6,716. The estimated population to middle of 1896 was 8,377. If the population of Asylum be added to this, the population of whole District is estimated at 11,227. Total Deaths at all ages during the several years:— Friern Barnet. 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 1896 72 216 The number of deaths that occurred in the District during 1896 was 72, the deaths occurring outside District of persons belonging to it, and those occurring inside District, of persons not belonging to it, have been taken into consideration. The number of births was 102 males, 111 females, making a total of 213. 15 Deaths from all Causes During the Year 1896. Under 5 Years. Over 5 Years. Measles 3 o Diphtheria 3 1 Whooping Cough 4 o Diarrhœa 2 o Cancer o 4 Tubercular Meningitis 2 o Phthisis (Consumption) o 4 Disease of Nervous System 4 1 Convulsions 4 o Heart Disease 1 11 Bronchitis 5 6 Disease of Stomach o 1 Disease of Kidney o 4 Premature Birth 4 o Old Age o 4 Accident 1 o Pneumonia o 1 Apoplexy o 2 33 39 Two hundred and sixteen deaths were registered in the Colney Hatch Asylum during the year—126 males, 90 females; these deaths were equal to a rate of 75 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 40 Exhaustion from Mania, Dementia or Melancholia 10 Exhaustion from Epilepsy 17 Phthisis 19 Pneumonia 1 Cancer 1 Various Diseases 29 216 Infantile Mortality. The rate of Infantile Mortality, or annual number of deaths of infants under one year of age to every thousand births registered in the year was 1896 84 1893 114 1890 108 1895 117 1892 78 1889 132 1894 140 1891 105 1888 120 16 Zymotic Death Rate. The Zymotic death rate, or death rate from chief infectious diseases was equal to a rate of 1.5 per 1,000 of the population for the year 1896. The chief Zymotic Diseases are Small-Pox, Measles, Diarrhoea, Typhoid Fever, Pyœmia, Puerperal Fever, Erysipelas, Scarlet Fever, Whooping Cough, Diphtheria. The number of deaths from Zymotic Diseases was 13—Measles, 3; Diphtheria, 4; Whooping Cough, 4; Diarrhœa, 2. The Zymotic death rate in previous years was:— 1884 2.1 1888 1.5 1892 1.0 1885 1.2 1889 0.7 1893 2.3 1886 2.7 1890 1.6 1894 1.6 1887 o.8 1891 1.5 1895 0.9 1896 1.5 TABLE I. Showing Population, Inhabited Houses, Births and Deaths for the years 1884 to 1896. Year No. of Inhabited Houses. Population to middle of Year. No. of Births. Birthrate per 1.000. No. of Deaths Deathrate per 1,000. 1884 908 5,051 164 32.4 62 12.2 1885 909 5,269 157 297 66 12.5 1886 983 5,496 207 37.6 68 12.3 1887 1,022 5,733 204 35.4 53 9.2 1888 1,043 5,900 207 34.8 71 11.8 1889 1,076 6,238 219 35.1 75 12.0 1890 1,089 6,507 258 39.6 94 14.4 1891 1,117 6,787 218 32.1 84 12.3 1892 1,179 7,079 191 26.9 79 11.2 1893 1,216 7,384 209 28.3 76 10.3 1894 1,264 7,467 206 27.5 77 10.3 1895 1,277 7,698 204 26.5 77 10.0 1896 1,377 8,377 213 25.4 72 8.5 TABLE II. Year. Deaths under 1 year. Deaths under 5 years. Deaths under 1 year per 1,000 Births. 1884 l6 28 I24 1885 20 23 125 1886 26 31 150 1887 20 32 98 1888 25 32 120 1889 28 35 132 1890 28 44 108 1891 23 34 105 1892 15 24 78 1893 24 42 114 1894 29 44 140 1895 24 35 117 1896 18 33 84 17 Table III. Showing deaths registered from all causes, with ages at death, during the year 1895. Specific Febrile or Zymotic Diseases— No. of Deaths Ages. Measles 3 19 mos. 11 mos. 7 mos. Diphtheria 4 7 yrs. 4 yrs. 2 yrs. 14 mos. Whooping Cough 4 4 yrs. 2 yrs. 1 yr. 14 days Diarrhœa 2 5 mos. 4 mos. Constitutional Diseases— Cancer 4 66. 60. 50. 45 yrs. Tubercular Meningitis 2 19 mos. 16 mos. Phthisis (Consumption) 4 46. 42. 32. 25 yrs Diseases of Nervous System— Diseases of Nervous System (other than Convulsions) 5 39. 5. 1 yr. 17. 6 mos. Apoplexy 2 68. 64. Convulsions 4 11. 7. 3 mos. 3 dys. Diseases of Circulatory System— Heart Disease 12 79. 29. 47. 70. 49. 44. 64. 61. 73. 70. 15 yrs. 4 hrs. Diseases of Respiratory Organs— Bronchitis 11 73. 72. 65. 60. 43. 34. 1 yr. 1 yr. 5 mos. 1¾ mos. 1¼ mos. Pneumonia 1 40 yrs. Disease of Digestive System— Disease of Stomach 1 68 yrs. Diseases of Urinary Organs— ' Disease of Kidneys 4 74. 66. 44. 12 yrs. Accident or Negligence— Suffocation 1 1 yr. Developmental Diseases— Premature Births 4 11 hrs. 3 dys. 3 hrs. 1¼ms. Old Age 4 97. 88. 85. 80. 72 The mean age at death for the year 1896 was 30.2 years. The mean age at death for England and Wales was 29.3. 18 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 2,227 21 9.4 Central 3,290 18 5.4 South 2,860 33 11.8 8,377 72 26.6 TABLE IV. Showing total deaths at all ages, 1896, from certain groups of diseases and proportions to 1,000 of population; also number of deaths of infants under one year from other groups of diseases and proportions to 1,000 of population. DIVISION 1.—All Ages. DIVISION II.— Infants under 1 year. Principal Zymotic Diseases. Pulmonary Diseases. Principal Tubercular Diseases. "Wasting Diseases. Convulsive Diseases. Year. Total Deaths. Death rate per 1000. Total Deaths. Death rate per 1000. Total Deaths. Death rate per 1000. Total Deaths. Death rate per 1000. Total Deaths. Death rate per 1000. 1886 14 27 6 1.1 11 2.1 6 1.1 4 0.76 1887 6 1.8 14 1.7 11 2.5 9 1.75 1 0.35 1888 11 1.5 15 2.1 14 2.0 4 0.05 o 0.0 1889 5 1.7 12 2.0 12 2.0 4 0.05 7 0.1 1890 11 1.4 26 4.o 13 2.0 12 1.7 3 0.4 1891 10 1.4 21 3.o 5 0.7 8 1.0 4 0.5 1892 7 o.1 11 1.0 8 1.2 4 0.5 2 0.2 1893 12 1.6 13 1.7 4 0.5 10 1.3 6 1.3 1894 12 1.5 14 1.8 5 o.6 6 0.8 3 0.2 1895 7 0.9 10 1.2 9 1.1 2 0.2 9 1.1 1896 13 1.5 12 1.4 6 0.7 0 0.0 4 0.4 In commenting on the Statistics dealing with births, sickness and deaths, it is important to bear in mind the conditions of the District which is now becoming a new suburb of London, composed chiefly of young married persons, and therefore selected lives. The Statistics relating to sickness in your District indicate that in regard to Measles, a disease that can only be prevented by the most vigilant means, the methods adopted to prevent the spread of this illness have been partially successful; in future more strict methods must be taken to obtain isolation of infected children at home; disinfection too must be carried out as in other infectious illnesses ; this may entail increased cost, by employment 19 of more labour to carry out the work, but in order to prevent loss of life and injury to health caused by this illness, it should receive your careful consideration. The reinstatement (the time for which it was placed on the list expired during the year) of this illness, Measles, on the list of notifiable diseases has been a wise course to adopt, and it is certain this course, if it does not appear to have answered as satisfactorily as you could have wished, has been the means of parents looking upon Measles as a more serious disease than hitherto, and so taking greater care with the children. The same remarks apply to Whooping Cough, which although not yet placed on the list of notifiable diseases, I trust will receive the same wise consideration from you as Measles has, and before long will become compulsorily notifiable. Although the serious attention of parents was called to the dangerous and infectious nature of this illness in my fortnightly reports, abstracts of which were printed by you in the Press circulating in the District, I am sorry to say little notice was taken, and the illness spread. The re-opening of schools was delayed on account of this illness. Measles and Whooping Cough were both very prevalent throughout the North of London during the year. With regard to the other preventable diseases dependent more directly on sanitary defects of dwellings, such as Typhoid Fever, Scarlet Fever, Diphtheria, Puerperal Fever, Diarrhœa and Erysipelas, statistics show that with exception of Diphtheria, the other diseases were somewhat less in number than previous years. The Zymotic death rate of 1.5 is somewhat high. This may be accounted for by the number of deaths from Whooping Cough and Measles, such mortality affecting the District on account of the inhabitants of District consisting of young married persons with young children, who are particularly susceptible to these diseases. The death rate last year was 0.9; the death rate for the whole of England and Wales was 2.1 per 1,000. The death rate from the list of notifiable diseases was 0.7 per 1,000. The general death rate of 8.5 is extremely low and would appear to be fallacious if it were not for what has been stated previously—the neighbourhood at present consists of selected lives, although on the other hand this low death rate taken in conjunction with the somewhat high birth rate, the low death rate from Diarrhoea and Fevers(excluding Measles and WhoopingCough)together with the small infantile mortality tends to show that good sanitary measures such as good system of sewers, sewage disposal works, pure water supply, good scavenging and removal of dust, improved roads, energetic inspection of houses, combined with decisive action for sanitary condition such as the substitution of dry basements improved for wet sites, the proper disconnection of house-drains from sewers, 20 and the notification of infectious diseases and provision of means for isolation, must have a good effect on the health of the District, and it is not altogether surprising the death rate should be so low. It is a matter for congratulation to your Council that your endeavours to improve the sanitary welfare of the District should be crowned with success thus far. In regard to one portion of the District—that known as the Avenue—unfortunately statistics show that in this neighbourhood on account of the density of population, sickness and mortality appear in proportion of about three times as much as in any other portion of District; it is here that care should be exercised in inspection of houses, the remedying of any sanitary defects, increased attention to scavenging, flushing of sewers, examination and relaying of old sewers where necessary, and the putting in force of the Bye-Laws relating to houses let in lodgings, already adopted by you; because in this locality the houses are chiefly occupied by the labouring classes and are let out in rooms; and your Surveyor might be consulted as to the advantages of substituting the present form of ventilation of sewers for the system of high ventilating shafts above the windows of the houses; these methods should improve this portion of District. I should like to see formed some kind of Sanitary Association of ladies who would voluntarily undertake to visit the houses in this locality, and by various ways encourage the inhabitants in appreciating sanitary improvements. The infantile mortality, or deaths of infants under 1 year of age, was for the year 18, the third lowest number for a period of 13 years; the rate of infantile mortality was 84 per 1,000 births; this rate is very low, and it has been considered to be a test of the sanitary state of a District Diarrhoea was absent from the District, in spite of the hot and dry weather. Cancer and Consumption seem to claim the same number of deaths each year. Finally my report ends with my sincere acknowledgment of the close attention your Council has paid to all matters I have brought to your notice in my reports during the past year; the amount of work such reports have entailed are known to yourselves and I trust at some future time the records of such on the minutes of your Council may be referred to with some satisfaction to your Council; for myself, the reception and consideration of them encourages me and stimulates my energies to renewed exertion. And again thanking the Officials of the Council for the kindly help I have received, I have to subscribe myself, Your Obedient Servant, HUGH STOTT.