HEN2 Hendon Urban District Council Sanitary Report FOR THE YEAR 1898, BY F. W. ANDREW, M.R.C.S., L.R.C.P., medical officer of health for hendon, Fellow of the Incorporated Society of Medical Officers of Health. hEndon: J II. Warden ;an Co., " Hendon and Finchley Times" Office, Hendon. 1899. INDEX. Page Table of Acreage, Number of Houses, and Population of Parish Summary 7 Vital Statistics 9 Population 11 Table of Population, Births, and New Cases of Infectious Sickness 12 The Death Rate 13 Infant Mortality 16 Birth Rate 17 Zymotic Diseases 18 Drainage, &c. 27 Infectious Diseases Hospital 28 Sewage 29 Dusting 30 Water Supply 31 Inspection of Cowsheds 31 Table—Cowsheds, Dairies, Laundries, &c. 32 Table—Vaccination Statistics, 1892 to 1898 33 Tables—Sanitaiy Work Table of Acreage, No. of Houses, and Population of Parish. Locality. Acreage. Number of Houses. Population. 1879 1891 1897 (To Dec. 31st). 1898 (To Dec. 31st). lucrease during year. 1879. 1891. 1897 (To Dec. 31st). 1898 (To Dec. 31st). Increase during year. (Formation of Board). Hen don Ward, comprised as follows: 3383 800 1278 1515 1620 105 4800 7706 10307 11075 768 Including 500 in Institutions. West Hendon ... ... ... 462 567 105 ... ... 3150 3918 768 Central Hendon ... ... ... 938 938 0 ... ... 5880 5880 0 Burnt Oak ... ... ... 111 111 0 ... ... 777 777 0 Public Institutions ... ... ... 4 4 0 ... ... 500 500 0 Child's Hill Ward, comprised as follows: 1999 350 950 1044 1070 26 2200 6072 7117 7282 165 Child's Hill ... ... ... 424 431 7 ... ... 2960 3017 57 North End Golder's Green ... ... ... 16 16 0 ... ... 112 112 0 Golders Green (including HighHeld School) ... ... ... 51 51 0 ... ... 456 456 0 Temple Fortuue ... ... ... 46 46 0 ... ... 298 298 0 Cricklewood ... ... ... 507 526 19 ... ... 3285 3399 114 Mill Hill Ward 3000 ... ... 320 328 8 ... ... 1746 1794 48 Without Institutions. Institutions ... ... ... 3 3 0 ... ... 532 532 0 Totals 8382 1400 2515 2879 3018 139 8500 15843 19702 20083 981 sanitary report, 1898. To the Chairman and Members of the Hendon Urban District Council. Gentlemen, I have the honour to present to you my Sanitary Report for the year 1898. During the year a good deal of sickness has occurred, a mild type of Scarlet Fever having prevailed in Central Hendon, extending over a long period. So mild was it that numerous cases were found parading the streets and attending the schools, without having had to lay up. This, of course, spread the disease about broadcast, and great difficulty was experienced in eliminating it. During the excessive heat that was experienced during August and September a very serious epidemic of Diarrhoea occurred in nearly every quarter of the parish, and caused a very high mortality in children under one year of age. 8 With respect to all other diseases the parish has been particularly free. Fewer cases of Diphtheria and Typhoid Fever have not been reported for some years, which speaks well for the Sanitary condition of the parish. Measles and Whooping Cough have not occurred in anything like an epidemic form, comparatively few cases coming to my knowledge. The question of Drainage and Sewage treatment has occupied the attention of the Council to a large extent, and I am glad to be able to report that with the exception of a small portion of the district (which is now in the contractor's hands), all the parish now drains to the Works. The large increase in population in the West Hendon district has necessitated a further extension of filtration area at the Works, and extensive filters have been completed as well as a large area of land laid down for filtration purposes. These alterations have had the effect of greatly improving the condition of the effluent. Building has been progressing rapidly in the West Hendon district, but other parts of the parish have remained more or less at a standstill. Systematic inspection of the district has been carried out by the Sanitary Inspector, and some good work has been done in this direction. The necessity for providing further accommodation for burial has prominently come before you, and the Council have entered into negotiations for the purchase of a site for a Cemetery. The matter has not yet been settled, but is still under consideration. 9 VITAL STATISTICS. Number of Deaths.—The total number of deaths in the parish for the year is 382, as against 360 in the year 1897; 116 of these occurred in the Hendon Workhouse Infirmary, 29 of which were chargeable to the Hendon Parish, the remainder being from Willesden, Harrow, Great and Little Stanmore, Edgware and Kingsbury. Deducting 87, the number belonging to other parishes, it leaves 295 to be accounted for in Hendon proper, as against 340 in 1897, or 45 more persons died in 1897 than in 1898. Considering that the population has increased by something like 1,400 people, this is a satisfactory result. Of the number 295 who died in 1898, 73 occurred in Central Hendon, 56 in West Hendon, 55 in Child's Hill, 27 in Cricklewood, 30 in Mill Hill, 8 in Burnt Oak, 5 in Temple Fortune, and 12 in St. Vincent's School. One hundred and six deaths occurred under one year as against 113 in 1897. This is again, I am sorry to say, a very high number, bringing the infant mortality up to a high figure, of which mention will be found later on in my report. The district showing the highest increase in the number of deaths is West Hendon, and this is only to be expected, as this part of the parish is the only one where building has been going on. Fifty-six deaths were recorded as against 31 in the previous year. Thirty-four of these died under the age of one year, an unusually high number, the deaths being due mainly to a severe form of diarrhoea which occurred in the summer, whereby 13 deaths were recorded, and a rather severe outbreak of whooping cough during the autumn months taking off five children, besides seven of the deaths being recorded under the heading of inanition and marasmus. Only six deaths occurred from disease of the respiratory organs. In the Central Hendon district, with the exception of the 10 diarrhoea epidemic in the summer, resulting in 12 deaths, the deaths—73 in number—were pretty evenly distributed under the different headings, as will be seen by looking at Table A. At Child's Hill 55 deaths occurred, as against 86 in 1897; of this number 7 died from diarrhoea and 10 from diseases of the respiratory organs, which is an unusually high number when it is considered that as many deaths from this cause occurred in Child's Hill as in Central Hendon, West Hendon and Cricklewood together, which comprise a district having a population four times as great as Child's Hill. In Cricklewood,27 deaths occurred, as against 36 in 1897, and are mainly accounted for by 6 from diarrhoea, 5 from marasmus, and 5 from diseases of the respiratory organs. This part of the parish has been particularly free from disease during the year, In Mill Hill 30 deaths occurred, being 9 more than in 1897. In former years St. Vincent's Orphanage was included, but this institutiou is now taken separately. Of this number 5 died from cancer and 3 from measles, the remaining deaths being fairly distributed over the list. At Burnt Oak only 8 deaths occurred, and at Temple Fortune 5. At St. Vincent's Orphanage, Mill Hill, 12 deaths occurred, a high number when it is considered that the average number is about tw o hundred. The children at this institution are in the majority of cases feeble, debilitated, and tubercular when admitted, and very often are taken from the London streets to the Orphanage until their healths are improved, and after a stay o" a year or two, may-be, return. Under these circumstances I think that these inmates cannot rightly be classed as residents, and I therefore take them separately. At the Infirmary 116 deaths took place, as against 96 in 11 1897, 29 of which were chargeable to the Hendon district. Of the total number 46 died between the ages of twenty-five and sixty-five, and 56 over sixty-five years. Only 8 occurred under one year. Eighteen died from consumption, 14 from diseases of the respiratory organs, 9 from heart disease, 24 from cancer, 17 from senile decay, and the remainder constitute the deaths from all other diseases. POPULATION. The total population estimated to December 31st, 1898, is 20,683, as against 19,702 in the previous year, or an increase of 981 persons. This increase has mainly occurred in the West Hendon District, where building has been going on apace, 105 new houses having been erected, having an estimated population of 768 persons. The land in this quarter is rapidly being filled up, the houses being of the small tenement class. At Central Hendon and Burnt Oak building has come to a complete standstill for the year, not a single fresh house having been recorded as completed and occupied, although the new Cleveland Street Asylum situated in the Colindale district will shortly be opened. This will add some hundreds to the population in this quarter. At Child's Hill matters here have not progressed rapidly, only 7 houses having been built. Cricklewood shows an increase of 114 persons. At Mill Hill eight houses have been built, with an estimated population of 58 people. This district, especially round the station, is most desirable property for houses, the roads being sewered. At Cricklewood the Midland Eailway have in course of erection 150 houses for their own men. This will, I am given to understand, relieve the congested state somewhat in West Hendon, as the men now in the Midland employ there have orders to move in when the houses are completed. Table of Population, Births, and of New Cases of lnfeetious Sickness, coming to the knowledge of the Medical Officer of Health, during the year 1898, in the Hendon Urban Sanitary District; classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics; Public Institut i o n s being shown as separate localities. Population at all ages. Registered Births. Aged under 5 or over 5. New Cases of Sickness in each Locality, coming to the knowledge of the Medical Officer of Health. Number of such esses removed from their Homes in the several Localities for treatments Isolation Hospital. Last Census. Estimated to middle of 1898. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Typhus. Enteric or Typhoid. Continued. Relapsing. Peurperal. Scarlatina. Central Hendon 15843 5880 164 ... 20 1 ... ... ... ... ... ... ... ... 11 5 upwds. ... 59 ... ... ... 5 ... ... ... ... ... 52 West Hendon 3918 126 Under 5 ... 4 ... ... ... ... ... ... ... ... 4 3 5 upwds. ... 10 2 ... ... ... ... ... ... ... ... 8 Child's Hill 3585 114 Under 5 ... 4 1 ... ... 1 ... ... ... ... ... 2 5 upwds. ... 9 ... ... ... 1 ... ... ... ... 1 6 Cricklewood 3399 62 Under 5 ... 1 2 ... ... ... ... ... ... ... ... 1 5 upwds. ... 2 6 ... ... 2 ... ... ... ... ... 3 Mill Hill 2326 33 ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... 2 ... ... ... ... ... ... ... ... ... ... Burnt Oak 777 20 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... 1 ... Temple Fortune 298 14 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... Infirmary and Schools 500 29 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... Totals 15843 20683 562 Under 5 ... 29 4 ... ... 2 ... ... ... ... ... 17 5 upwds. ... 82 8 ... ... 7 ... ... ... ... 6 69 13 THE DEATH RATE. In estimating the death-rate for the year, it may be well to again remark that the Hendon Workhouse, besides Hendon, accommodates the parishes of Willesden, Harrow, Great and Little Stanmore, Edgware and Kingsbury. The following table gives the average number chargeable to Hendon during the past year:— (a) Average number of inmates in Union for year 336 (b) ,, ,, ,, chargeable to Hendon 66 (c) Number of Deaths in Union for year 116 (d) ,, ,, chargeable to Hendon 29 (e) Number of Births in Union for year 29 (f) ,, ,, chargeable to Hendon.. 8 Deducting all the deaths which belonged to other parishes, and deducting also from the population the average number of inmates in the Union from other parishes, it brings the deathrate for Hendon to 13.6 per 1,000. St. Vincent's Orphanage, Mill Hill, has been omitted in estimating this result, for the children at this institution are a moving population, and after a short stay are discharged. Under these circumstances I think it only fair not to include this institution in estimating the rate. The number at this Orphanage is about two hundred. I have differentiated the various localities in the parish, giving the number of houses and population with the death-rate in order of merit. 14 District. 1 No. of Houses. Population. Deathrate per 1,000 Deathrate per 1,000 1897. 1898. Cricklewood 526 3,434 10.9 7.8 Burnt Oak 111 777 5.1 9.1 Central Hendon 938 5,987 12.7 12 .7 West Hendon 567 3,982 9.8 14.1 Mill Hill (including institutions) 331 20,971 13.1 14.3 Child's Hill (with Golders Green) 498 3,644 24.1 15.0 Child's Hill (without Golders Green) 431 3,062 27.0 15.6 Mill Hill (without institutions) 328 1,799 9 .6 16.1 Temple Fortune 46 303 10.0 16.7 St. Vincent's Orphanage — about 200 — 60.0 On looking at the above table it will be seen that Cricklewood, Burnt Oak, and Central Hendon have kept at about the same rate as 1897, Central Hendon coming out at exactly the same figure. Child's Hill shows a very large drop, being 27.0 per 1000 in 1897 and only 15 0 last year. Mill Hill shows a large increase from 9 6 to 16.1, and Temple Fortune rises from 10.0 to 16.7. West Hendon has also experienced a considerable rise. St. Vincent's Orphanage I have placed separately. There have been twelve deaths in this institution during the year, and this works out to the high figure of 60 per 1,000, taking the population at 200. This is a very high mortality, but it must be remembered that this institution acts the part of what one might term a charitable hospital, although not in the strict sense, for the children admitted are obtained mostly from the slums and streets of London, and are generally very scrofulous and debilitated generally; this is shown by the return of deaths, when every year a large proportion, 4 out of 12, die from tuberculous disease. Of the 12 deaths this year 3 died from measles, 1 consumption, 2 from heart disease, 3 from tubercular meningitis, TABLE A.—Deaths during the Year 1898, in the Hendon Urban Sanitary District, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics; public institutions being shown as separate localities. Mortality from all causes, at subjoined Ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 aud upwards. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia, and Pleurisy. Heart Disease. Drowned. Injuries. All other Diseases. Total. Typhus. 1 Enteric or Typhoid. Continued Relapsing Puerperal Central Hendon 73 22 8 1 2 20 20 under 5 ... 3 ... ... ... ... ... ... ... ... ... ... 1 12 ... ... 4 ... ... ... 8 28 5 upwds. ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 5 2 29 45 West Hendon 56 34 4 3 1 10 4 under 5 ... 1 ... ... ... ... ... ... ... ... ... ... 5 13 ... ... ... ... ... ... 17 39 5 upwds. ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 4 3 ... ... 4 17 Child's Hill 55 17 13 2 1 11 11 under 5 ... ... 1 ... ... ... ... ... ... ... ... 2 2 8 ... ... 10 ... ... 1 7 30 5 upwds. ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 5 9 2 ... ... 8 25 Cricklewood 27 14 2 1 ... 8 2 under 5 ... ... 1 ... ... ... ... ... ... ... ... ... ... 6 ... ... 1 ... ... ... 5 13 5 upwds. ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 4 ... ... ... 8 14 Mill Hill 30 2 5 1 1 9 12 under 5 ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... 1 ... ... 1 4 9 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 3 3 1 12 21 Burnt Oak 8 5 1 ... ... 1 1 under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 4 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... 3 Temple Fortune 5 2 1 ... ... 2 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 1 3 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 2 Infirmary 116 8 2 1 3 46 56 under 5 ... ... ... ... ... ... ... ... ... ... ... ... 1 3 ... ... ... ... 1 ... 7 12 5 upwds ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 18 14 9 ... 6 55 104 St. Vincent's Schools 12 2 5 2 ... 1 2 under 5 ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... 1 ... ... ... 3 7 5 upwds ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... 2 5 Totals 382 106 41 11 8 108 108 under 5 ... 4 2 ... ... ... ... ... ... ... ... 8 9 44 ... 1 20 ... 1 9 56 147 5 upwds ... 2 2 ... ... ... ... ... ... ... 2 ... ... 1 1 32 40 25 2 10 118 325 16 1 from blood poisoning, 1 from disease of chest, and 1 from cancer. This home is a most worthy one, and one that is kept in most excellent order and is in a sound sanitary condition. *List of deaths during 1898 from diseases mentioned in Table A. under all other diseases: Influenza 6 Gangrene 2 Cancer 37 Septicoemia 5 Tubercular disease 13 Gastric ulcer 3 Premature birth 8 Curbosis of liver 5 Marasmus 26 Apoplexy 15 Convulsions 6 Alcoholism 4 Poisoning (accidental) 3 Bright's disease 7 Diabetes 3 Senile decay 29 Laryngitis 1 Syphilis 1 Total 174 INFANT MORTALITY. One hundred and six children died under one year, as against 105 in 1897. This gives the rather high infant mortality of 151 per 1,000, which is still an improvement upon the last two years, when the figures stood at 200 in 1897 and 160 in 1896. The highest rate was at West Hendon, the figure there being 268 per 1,000. This may not be exactly correct, but is approximately so, as the returns of the births in this particular district were mixed up with Burnt Oak and Central Hendon during the first two months of the year. Burnt Oak comes next with 250 per 1,000, and Mill Hill is at the bottom with only 60 per 1,000. I append a statement with the different rates, namely:- 17  1897. 1898. Infant death-rate for whole parish 200 151 per 1,000 Hendon, including West Hendon and Burnt Oak 82 203 „ Hendon (Central only) .. 134 „ Hendon (West only).. .. 268 „ Child's Hill 341 149 „ Cricklewood 131 233 „ Burnt Oak .. 250 „ Temple Fortune .. 142 „ Mill Hill .. 60 „ The mortality in Cricklewood and West Hendon has much increased, in comparison with former figures. This has been mainly due to a very severe epidemic of diarrhoea which pervaded these districts during the summer months and which caused such a high mortality in Child's Hill in 1897. BIRTH RATE. Five hundred and sixty-two children were registered, as against 583 in the previous year, or 21 less. This is not what one would have expected, especially in a district like West Hendon, which consists of mostly a young growing population. The excess of births over deaths is 180. The following are the births in the different Wards:— Central Hendon 164 West Hendon 126 Child's Hill 114 Cricklewood 62 Mill Hill 33 Hendon Workhouse 29 Temple Fortune 14 Burnt Oak 20 562 18 Of the 29 in the Workhouse only 8 are chargeable to the Hendon District. Deducting the other 21, it leaves 541 to be accounted for in Hendon Parish proper. This is equal to a birthrate of 25.9 per 1,000, as against 29.5 in the previous year. The following is a table giving the death and birth-rates for the whole parish since the year 1889:- 1889 Death-rate 14.6 Birth-rate 38'4 1890 ,, 15.0 „ 36.7 1891 „ 13.9 „ 32.3 1892 „ 12.3 „ 26.9 1893 „ 13.4 „ 33.2 1894 „ 13.5 „ 32.1 1895 „ 12.4 „ 31.2 1896 „ 13.8 „ 31.2 1897 „ 14.5 „ 29.5 1898 „ 13.6 „25.9 ZYMOTIC DISEASES. scarlet fever. This disease has been very prevalent during the year in Central Hendon : 79 cases being notified as against 4 in the previous year and 108 in 1S96. This was mainly due to undetected cases parading the streets and attending the schools. Fourteen cases occurred in West Hendon, 13 in Child's Hill, 3 only from Cricklewood, 2 from Mill Hill, and none from Burnt Oak, Temple Fortune, or any institution. Scarlet Fever in Central Hendon.—This part of the parish has been visited by a very severe epidemic, and has formed the subject of more than one special report to the Council. The first outbreak occurred in the early months of the year, and on investigation proved to have affected mainly the scholars of a private school. This school was closed on my recommendation, and the 19 The following table gives the number of cases of Scarlet Fever admitted to the Hendon Isolation Hospital during the different months of the year from the different districts. Total Number Notified Jan. Feb March April May June July Aug. Sept. Oct. Nov. Dec. Total Central Hendon 79 3 2 3 4 14 14 14 2 4 5 63 West Hendon 14 2 2 2 1 1 2 1 11 Child's Hill 12 2 1 1 1 3 8 Crieklewood 3 1 1 1 1 4 Mill Hill 2 0 Burnt Oak 0 0 Temple Fortune 0 0 Total 111 5 1 2 7 6 15 16 16 2 6 3 9 86 20 scholars from the school immediately ceased getting affected. The water and milk supply was good and beyond suspicion. The accommodation was quite the reverse, and, in my opinion, the house is unsuitable for the large number of boys attending the school. The second outbreak commenced on May 31st, when four cases were notified from Foster Street, all attending the British Schools. On June 4th, two cases were notified, one from 6, Foster Place, and one from Bell Vue Road, both attending at the same school. On the 7th another case was notified from 3, New Brent Street, the boy attending at the National Schools, but the Sunday School at the British Schools. It will be seen later that this case was connected with the originator of the outbreak. I visited the British Schools, having previously sent written certificates to the teachers as the cases occurred. I found that of the five cases only two were in the same standard, and two cases were in the Infant School, which was entirely shut off from the rest of the School. This did not look as if the School was the source of infection. I gave strict instructions to the head teacher to closely examine the children. In the afternoon I was called suddenly, and found that Mr. Butler had isolated two boys for my inspection. These boys had that day attended school for the first time for 19 days and were peeling freely with scarlet fever. On investigating the easel found the following history. A month previous a younger child, three and-a-half years old, "sickened with measles." A week later the two boys just mentioned, and who were of the same family, sickened with some complaint, which the mother put down as measles also. They came out in a rash, but no doctor was sent for. They were ill a few days, and then sent out as well, and up to the day they were found (a period of three weeks) were parading the streets peeling freely with scarlet fever, but did not go to school. To make matters worse, one of the boys invested in a mouth organ and gave other children the pleasure of blowing it, and at the same time doubtless of contracting scarlet 21 fever. The child that had the measles was found on investigation to be peeling, and was removed to the hospital with the others. I have little doubt that these cases were instrumental in starting this epidemic. In the cases from Bell Vue Road and Foster Street, I obtained evidence of these having all associated with one another. As was only to be expected, these cases were merely the commencement of the outbreak, and I found it necessary to close the British Schools and Sunday School; and the complaint spreading to children at the National Schools,these were closed also by order of my Council. At Christ Church one of the boys became affected, and one after another the boys in the choir became affected, and out of a total of fifteen boys seven were affected with the disease. I had the cassocks and hymn books and other music destroyed, and the Church choir stalls thoroughly disinfected, and this appeared to check any further spread. On July 23rd I was called to see a young boy in New Brent Street, and found him suffering from scarlet fever. The mother made a statement, in which she inferred that a certain family in the same street had had it. I went to the house, and found that a child upstairs was ill with a bad throat. I asked about the other members of the family, and, pointing to a boy in the street, she said, "That boy has had a bad throat." I called the boy to me, and on examining him found him peeling freely with scarlet fever, and the child upstairs proved to have got the disease as well. It is very hard to have to cope with this disease when cases are permitted to run about in this way. In this latter instance the woman was not to blame, as a doctor was called in to the boy I discovered in the street, and the throat was described as a sore throat, and nothing more was said, and naturally the mother thought the other child was suffering from the same. It is regrettable that mothers, having the care of children, do not in many cases take proper precautions to ascertain from a medical man what their children are suffering from. In order to impress upon them the necessity of doing so, I had, with the sanction of my Council, handbills printed and delivered to all houses in the district, warning parents 22 of the necessary steps to be taken when their children were ill. Had more care been taken in the first instance 1 feel sure this outbreak would not have occurred. After all these precautions, on the schools re-opening on July 4th, the Master found a boy looking suspicious, and on being taken to a doctor was discovered to be full out with scarlet fever. I am thankful to say, thanks to the prompt action of Mr. Butler, this was the means of checking another outbreak. As regards the question of milk being the carrier of the disease in this epidemic, 1 am thankful to say I am absolutely able 15 exclude this as having anything to do with it, for in one investigation of 15 cases there were eleven different milk supplies. phthisis. This disease, together with tuberculosis in general, is now occupying the attention of the whole kingdom, and endeavours are being strenuously made to combat with the disease in a sensible way. Hitherto, people have always considered that the disease is hereditary, but this is not the case. There is one undoubted fact—that in many ways the disease can be warded off by taking steps which hitherto have not been considered necessary. The importance of fresh air is not nearly sufficiently taken into account, and the necessity for the erection of hospitals and sanatoriums for the treatment of cases in suitable districts is, I feel sure, of great importance, and would provide a means whereby the afflicted ones would have the advantage of the best treatment of modern times. Our primary object is prevention of disease, and in many ways by attention to the various means at our disposal we shall, I soon hope, gradually eliminate this disease. One important matter is now before the public, and that is the conveying of tubercular disease to young babies through the medium of milk and thus sowing the seeds of disease in the human being from birth. This has and is being strenuously gone into by Public Health 23 ties, and it has been shown that a very large proportion of milking cows do suffer from tuberculosis, and that this shows itself in the milk and is in all likelihood conveyed to the child. A toxin has been found which is able to test the cow as to whether it is free from the disease or no. It is only from cows proved healthy by this test that the milk is considered fit for human consumption. In the absence of this test it is, of course, of the utmost importance " that all milk should be boiled." As regards other means at our command in the treatment of consumption, it is, of course, of the utmost importance that all discharges should be as soon as possible destroyed, small pieces of rag being used for the purpose, such rags being conveyed to a bag after use. The habit of spitting should be absolutely disallowed, especially about a house, as, on drying, the particles permit of a ready means of conveying the disease. All spittle in spittoons should be thoroughly disinfected. Attention to cleanliness in every way is of the utmost importance, as also is the prevention of overcrowding. The confinement of consumptive patients in close stuffy rooms is most detrimental, and the enormous amount of benefit gained by the administration of plenty of fresh air cannot be over-estimated. In Hendon, during the year, thirty-three persons have died by this disease. Of this number it is only fair to state 18 were persons in the Infirmary, leaving 15 to be accounted for in Hendon proper. Of this number Child's Hill, a very overcrowded part, heads the list with 5, West Hendon 4, Central Hendon 2, Cricklewood 1, Mill Hill 2, and Burnt Oak 1. It would, I think, be of great benefit to have this disease compulsorily notified, as all cases could be then visited and instructions given as to the means they should pursue, and periodical visits could be paid to see they were carried out. typhoid fever. Nine cases of this disease were notified, as against 15 in the 24 previous year; 5 of these occurred in Central Hendon, 2 in Child's Hill, and 2 in Cricklewood. No case occurred in Mill Hill, Burnt Oak, West Hendon, or Temple Fortune. The disease at no period gave me any anxiety, as the cases occurred singly at different times of the year, and in most cases conveyed by some outside source; 2 occurred in May, 1 in July, 1 in October, 1 in November, and 3 in December. The drains in all cases were investigated, and in some cases found defective and remedied. I consider the district has been particularly free during the year from this dreaded complaint. No death resulted from any case. ERYSIPELAS. Only 6 cases have been reported, against 15 last year, 4 of which occurred in Hendon, 1 in Child's Hill, and 1 in Burnt Oak. Two fatal cases resulted. DIPHTHERIA. The district has been very free from this disease during the year, only 12 cases having been reported, as against 27 in the previous year. Of this number 1 occurred in Central Hendon, 2 in West Hendon, 9 in Cricklewood; 1 case was reported from Child's Hill, but no case from any other of the districts not already mentioned. Child's Hill last year was the seat of a slight epidemic which resulted in a large number of deaths, and it is therefore gratifying to find this part so particularly free. Of the 12 cases 5 died. The mortality of this disease is very light, and I think it important that all cases of diphtheria, except in the well-to-do classes, should be removed to a hospital, in order that the patients may at once have administered to them the anti-toxin treatment, which, it is well known, has a powerful action in checking the disease. Situated as the majority of the poor are, it is impossible to properly treat their children, and I hope the time will not be far distant when proper accommodation may be obtained for all these cases. 26 measles and whooping cough. These diseases are not notifiable, but I am able through the School Attendance Officer to give you a fairly correct idea of the number of cases of these two diseases, occurring in the children of school age, namely:- Measles. Whooping Cough. Central Ward. 53 46 Child's Hill Ward 68 74 Mill Hill Ward 3 5 Total 124 125 In the previous year the district was particularly free from these complaints, and it cannot be said that this year there has been any epidemic form of these diseases, for in 1896 there were 601 cases of measles alone. diarrhœa. This disease has been very prevalent during the year. During very hot seasons, such as that we experienced during July, August, and September, diarrhoea becomes prevalent, as a rule, more or less according to the degree of temperature reached. The past year was one of exceptional severity and resulted in a large mortality all over England. Hendon suffered severely, it commenced at the beginning of August and continued without intermission up to the end of September. As this complaint is not notifiable I am unable to give you a return of the number of cases or the proportion of deaths to attacks. In the death returns it was variously named under such terms as dysenteric diarrhoea, choleraic diarrhcea, gastro-enteritis, &c. During the period of the epidemic a large number of children were assigned by the different medical men as dying from "Atrophy," and I have little doubt some of these cases had diarrhœcal symptoms as well. 26 The following deaths occurred from the 1st August to the end of September:- Central Hendon 12 West Hendon 10 Child's Hill 6 Crieklewood 5 Mill Hill 0 Burnt Oak 0 Temple Fortune 2 Infirmary 3 Total 38 The weekly returns of deaths were as follows:— Week ending August 6 1 13 3 20 0 27 3 ,, September 3 8 10 7 17 10 24 6 Of this number 35 occurred under one year of age, the other 3 being persons over 65 years of age. This shows how particularly fatal this complaint is in young infants during the first year of life. Besides the above number 13 children died from "Atrophy" during the same period. The infant mortality from all causes under one year for the eight weeks ending September 27th was equal to 522 per 1,000. On looking at the above returns, it will be seen that all parts of the district were visited by the disease, except Mill Hill and 27 Burnt Oak, in which districts no death occurred, and curiously enough on reference to a similar epidemic in 1897 these two districts were the only ones where no death was recorded, showing how very free from this complaint they have been. The largest number of deaths occurred in Hendon Ward, namely, 22 out of a total of 38, but it must be remembered that by far the larger number of births have been registered from this Ward. As to the origin of the epidemic, I think this must be put down to the extreme tropical heat, for as I have before pointed out, one of the main causes of these diarrhœa epidemics resides in the soil, and that when the soil rises to a certain temperature for a given depth, micro-organisms are given off from its surface and obtain access to non-living organic matter, such as food, and so convey the complaint to the individual. Other causes have undoubtedly been instrumental in causing its spread, such as improper food, ordinary cows' milk being frequently at fault, owing to the rapid fermentation it so readily undergoes. Want of cleanliness, maternal neglect, and want of proper ventilation are other operative causes. Density of population. This fact has undoubtedly had some influence in producing the epidemic, the parish at the present time being particularly overcrowded owing to the scarcity of houses. During the prolonged drought the sewers have doubtless been giving off their fair share of foul gases ; this has been dealt with by your officers by repeated flushings and disinfectants. All dust and filth accumulations tend to produce diarrhoea, especially in hot weather, and these were dealt with as efficiently as possible. DRAINAGE, Etc. Burnt Oak.—This district, I am pleased to be able to report, is now drained entirely to your works; all the houses having been connected to the public sewer. The roads have been done up under the Council's supervision, and this part of the parish is now in a sound sanitary condition. 28 Hyde Sewerage.—The extension of your low level sewerage has been completed, and the property along its route connected therewith. This sewer has long been needed, as the state of the Brent at the point where the fouling took place was abominable in the hot weather. This to a great extent still exists owing to the fouling of the ditch by Kingsbury parish, but the matter, J believe, is now being gone into, and it is to be hoped that before very long all Kingsbury will be drained. Mill Hill Sewerage.—The Bittacy Hill and Mill Hill Road line of sewer has been finished, and the work of connecting the drainage of the houses with the same is progreasing rapidly. INFECTIOUS DISEASES HOSPITAL. Owing to a severe epidemic of Scarlet Fever in Hendon, extending over several months, the accommodation at the Hospital has been severely taxed; so much so that in June I found it necessary to advise you to increase such accommodation forthwith. Acting on your instructions I purchased a hospital tent, with the aid of which I was able to admit every case requiring admission. The weather being very hot, the tent was preamble to the great heat in the iron building, and the patients progressed excellently, and in every way was a qualified success. Eighty-six patients were admitted during the year, as against twenty-three in the previous year. This is a larger number admitted by far than any time since the Hospital has been built, the largest number previously being seventy in 1893. It was fortunate that during the three hottest months of the year the larger number of cases were admitted, namely, in June, 15; July, 16; and August, 16. Of the 86 patients admitted 63 came from Central Hendon, 1I from West Hendon, 8 from Child's Hill, and 4 from Cricklewood. No case was received from Mill Hill, Burnt Oak, or Temple Fortune. 29 I regret to say that two cases terminated fatally from scarlet fever, both young children under 5 years of age. Both were very bad on admission. The new Ward has proved of great service during the year. The temporary provision in cases of emergency for diphtheria cases is not satisfactory, and at an early date I trust the Council will see their way to erecting a separate block for this disease. I append a statement of expenses incurred during the year ending December 31st. Doctors Fees. Nurses Fees. Caretaker's Fees. Maintenance and Provisions, &c Assistant Nurse aud extra help. Disinfectants, Coals, &c. Hire of Horse for Ambulance. Total Cost. £ s d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. 50 0 0 65 0 0 65 0 0 110 6 0 36 0 0 18 0 0 13 11 6 357 17 6 SEWAGE. The treatment of the sewage has again occupied the serious attention of the Council. In my last report I mentioned that the Council had just completed the purchase of 19 acres more land for the treatment of the effluent. This land was dug up to a depth of 22 inches, on 12 acres of which the effluent has been treated after passing through the tanks, carriers being constructed to convey it. The sludge has been pumped on to the other seven acres, the old ground having been thoroughly overdone and incapable of taking more for the present. In addition to this treatment, two large biological filters have been completed, invented by Mr. Grimley, your surveyor. These filters, which cover a surface of 800 yards square each, consist below upwards of clean broken bricks, burnt ballast, coke breeze, pea gravel, and it was proposed to place sand on the top, but the expense was too great, and so finely-sifted ballast was substituted. All the under drains are well ventilated. These filters are now in good working order, and I am able to state from numerous analyses periodically 30 made that the effluent from them is very good and shows signs of continuous improvement. The effect of these two filters and the treatment over the newly-purchased land of the sewage has had considerable effect upon improving the effluent, and I am glad to say your Council is now turning out one that well complies with all the conditions laid down by the Rivers Pollution Act and Thames Conservancy. I have made numerous analyses during the year, and have never known the albumenoid ammonia to exceed .14 parts per 100,000, the oxygen consumed in two hours amounting to about .56 grains per gallon. Owing to the large amount of washing done in the district the effluent often appears turbid, owing to the soap used, and which often gives a detrimental effect to outsiders. Owing to the large increase in population in the West Hendon district, the Low Level pumping station has had a very large increase of work to perform, and this will be additionally increased when the New Cleveland Street Asylum and Hyde sewerage is completed. DUSTING. The proper collection and disposal of the dust in the district is an important point in connection with the general health. This is still being performed by contract, and the Sanitary Inspector has spent considerable time in seeing it carried out, but the district extends over so large an area that this takes some time to cover. My Council have under consideration the plan I have recommended for some time, namely, that of doing the work themselves. The refuse could, I think, be taken to the works, which are situated so far from any house that no inconvenience would accrue; in fact it may, I feel sure, be worked into the land with advantage. 31 WATER SUPPLY. The Water Supply has been analysed by me and found on each occasion to be of good quality, and free from organic pollution. I am glad to say that the West Middlesex Water Works have at last conceded a boon to the inhabitants by giving a constant supply. I hope that the time will soon come when every house will have a supply pipe direct from the main, and so do away with the risk that is necessary entailed by the use of, in most cases, dirty unwholesome water from foul cisterns. INSPECTION OF COWSHEDS. In view of the result of experiments recently investigated, it is of the utmost importance that rigid inspection of all cowsheds in the districts should take place periodically as well as a pathological inspection of the milk itself. As regards the cowsheds, they have all been inspected. In many cases the cubic space was not sufficient, and in some cases the ventilation of the sheds was at fault. Cleanliness, another important factor, was in many cases wanting. Another important alteration in the law is also required, and that is that local authorities should have the power to inspect at any time cowsheds and dairies situated outside their own district, when the milk from such cowsheds or dairy is imported into their district. 32 TABLE P.—Tabular Statement as to the number of Cowsheds, Dairies, Laundries, Bakehouses, Butchers' Shops, and Slaughter Houses, under the Act, visited by the Medical Officer. Wards. Cowsheds. Dairies and Milk Shops. Laundries. Bakehouses. Butchers' Shops. Slaughter Houses. Hendon Ward 10 9 18 9 7 9 Child's Hill Ward 9 7 47 3 3 0 Mill Hill Ward 3 4 0 1 2 1 Totals 22 20 65 11 12 10 33 TABLE E—Giving the various statistics with regard to Vaccination for the years 1892 to 1898. Year. Total number of Births. Total number successfully Vaccinated. Insusceptible of Vaccination. Dead and Unvaccinated Postponed. Removed or gone away. Children unvaccinated in Union. No. of those who remain unvaccinated 1892 504 414 4 33 13 28 11 Not given. 1893 534 359 8 29 17 4 9 Not given. 1894 533 373 12 34 21 17 12 64 1895 551 440 5 50 5 40 11 1896 589 395 10 48 30 35 71 1897 550 374 5 60 18 12 20 71 1898 562 262 3 63 17 5 18 176* *The number of Conscientious Objection Certificates handed in is 18. 34 Appended will be found tables giving an account of the sanitary work done during the year. In conclusion, I beg to thank the Members of the Council for the continued kindness and confidence they have always shewn me, which has greatly helped me in my endeavours to do my utmost for the health of the district. I have the honour to be, Gentlemen, Tour obedient servant, F. W. ANDREW, M.R.C.S., L.R.C.P. BENDON URBAN DISTRICT COUNCIL-SANITARY WORK, 1808. Sanitary Districts. Water Supply and Water Service Privy and Ash Pits, Ash and Earth Closets. Drainage and Sewerage. Wells. Cisterns. Draw-Taps Removed from Cisterns to Mains. Percentage of Houses Supplied on Constant System. Water Closets. Percentage of Houses Provided with Water Civets. Drains. Cesspools. Percentage of Houses Draining into Sewers. Sewers. Note.—Asterisks or other signs appearing opposite a District signify that those columns of the District are taken together. New Sunk. Cleansed, Repaired, Etc. Closed as Polluted. Houses, Water Laid on to. Percentage of Houses supplied from Mains. New, Provided. Cleansed, Repaiied, Covered, Etc. Overflow Pipes Dieconnected from Drains. Flush Cisterns provided to W.C.'s. Above Ground Receptacles, Substituted for Pits. Movable Receptacles Substituted for fixed. Water Closets Substituted for Dry Receptacles. New Constructed. New Apparatus Provided. Repaired, Cleansed, Etc. Supplied with Water, or Supply Rendered Efficient. Ventilated. Examined, 'J ested, Exposed, Etc. Unstopped, Repaired, Trapped, Etc Waste Pipes, Rain Water Pipes, Etc., Disconnected. Soil Pipes and Drains Ventilated. Disconnecting-Traps or Chambers Inserted. Reconstructed. New Laid. Rendered Impervious, Emptied, Cleansed, Etc. Abolished, and Drain Connected to Sewer. Yards of New Sewers Laid. Yards of Sewers Reconstructed. Hendon Urban District Council ... ... ... 4 98 4 12 ... 31 ... 98 ... 56 ... 7 15 43 122 ... 99 53 36 23 47 18 14 18 60 52 95 4276 Yds HENDON URBAN DISTRICT COUNCIL-SANITARY WORK, 1898. Sanitary Districts. Inspections. Notices. Dwelling Houses. Houses let in separate Dwellings or Lodgings. Common Lodging Houses. Canal Boats used as Dwellings. Movable Dwellings, Caravans, Tents, etc. Note—Asterisks or other signs appearing opposite a District signify that those columns of the District are taken together. Complaints Received. Cases of Infectious Disease Notified. Number of Premises Periodically Inspected. Houses Inspected from House-toHouse. Total Number of Houses, Premises, etc., Inspected. Total Number of Re-inspections after Order of Notice. Total Number of Inspections and Re-inspections. Letters Written. Cautionary Notices Given. Statutory Orders Issued. Summonses Served. Convictions Obtained. Houses, Premises, &c., Cleansed, Repaired, &c. Closed as Unfit for Habitation. Re-opened after Repairs, Alterations, &c. Demolished. Illegal Underground Dwellings Vacated. , Number Registered under Bye-laws. Periodical Frequency, or Number of Inspections. Number of Contraventions. Number Registered under Bye-laws. Periodical Frequency, or Number of Inspections. Number of Contraventions. Number Registered under the Acts. Periodical Frequency, or Number of Inspections. Number of Contraventions of Regulations. Number Observed during the Year. Number of Nuisances therefrom Abated. Number Removed from District. Hendon Urban District Council 54 138 163 231 337 641 875 170 51 453 ... ... 71 ... ... ... ... 90 Half-Yearly. ... ... ... ... ... ... 50 ... 50 HENDON URBAN DISTRICT COUNCIL-SANITARY WORK, 1898. Sanitary Districts. Disinfection. Dust. Dampness. Sundry nuisances abated. Contagious Diseases of Animals. Infant Life Protection Act. Note.—Asterisks or other signs appearing opposite a District signify that those columns of the District are taken together. Rooms fumigated. Rooms stripped and cleansed. Articles disinfected or destroyed. Dust-bins repaired. New bins provided. { Movable receptacles substituted for fixed. Periodical frequency of dust removal. Number of complaints of nonremoval received. Roofs repaired, &c. |Guttering and rain-pipes repaired, &c. Gardens, Areas, &c., levelled and drained. . Yards paved and drained. Surface adjoining houses paved. . Dry areas provided. Ventilation below floor provided. Basements rendered impervious. Overcrowding. Smoke. . Accumulations of refuse. Foul ditches, ponds, &c., and stagnant water. | Foul pigs and other animals. Other nuisances. Outbreaks. Animals infected. Animals destroyed. Number of licensed premises. Number of children. Number of deaths. Hendon Urban District Council 124 23 Lots. 32 54 25 Weekly. 34 36 9 2 ... ... ... 3 3 8 2 17 12 2 72 1 15 15 ... ... ... HENDON URBAN DISTRICT COUNCIL-SANITARY WORK, 1898. Sanitary Districts. Schools. Workshops and Work-places. Laundries. Bakehouses. Slaughter-houses. Cow-sheds. Dairies and Milkshops. Unsound Food. Adulterated Food. Offensive trades. Mortuaries. Note.—Asterisks or other signs appearing opposite a District signify that those columns of the District are taken together. Number in District. Periodical Frequency or Number of Inspections. Number found defective. Number in District. Periodical Frequency or Number of Inspections. Contraventions of Factory Acts. Number in District. Periodical Frequency or Number of Inspections. Contraventions of Factory Acts. Number in District. Periodical Frequency or Number of Inspections. Contraventions of Factory Acts. Number on Register. Periodical Frequency or Number of Inspections. Contraventions of Bye-laws. Number on Register. Periodical Frequency or Number of Inspections. Contraventions of Bye-laws. Number on Register. Periodical Frequency or Number of Inspections. Contraventions of Bye-laws. Animals seized. Articles or parcels seized. Samples taken. Found Adulterated. Number of Premises in District. Periodical Frequency or Number of Inspections. Contraventions of Bye-laws. Accommodation. 1 Number of bodies received. Hendon Urban District Council 11 Frequently. ... ... ... ... 65 Frequently. ... 13 Frequently. ... 10 Frequently. ... 22 Frequently. 2 20 Half-yearly. ... ... ... ... ... ... ... ... 1 20