HOR 60 No. 24. HORNSEY URBAN DISTRICT COUNCIL. To the Chairman and Members of the Hornsey Urban District Council. Gentlemen, I have the honour to submit the Annual Report dealing with the sanitary condition of this District for the year 1898. In the Quarterly Reports for the same period the number of inhabitants has been estimated at 70,054, being an increase of 4,972 over that for the previous year. At the middle of the year 1897 the number of inhabited houses in the District was 10,847 giving a population of 65,082; whereas at the middle of 1898 the number of the houses had increased by 828, giving in round figures a population of 70,054. The increase in the Wards has been greatest in the Hornsey and least in the Crouch End Ward, but each Ward shows an increase as will be seen from the following table:— Ward. Population 1898. Population 1897. Increase 1898. Highgate 9,614 8,688 926 Muswell Hill 3,012 2,478 534 Crouch End 5,070 4,992 78 Hornsey 16,284 14,856 1,428 North Haringey 10,852 10,200 652 South Haringey 7,098 6,792 306 Stroud Green 10,386 9,438 948 Finsbury Park 7,738 7,638 100 70,054 65,082 4,972 2 The total area of Hornsey is 2,809 acres, divided into eight Wards, and the following table gives the area of each Ward with the number of bouses in it, the population of each with the number of persons to an acre and also the acres to a person:— WARD. Acres. Persons to an Acre. Acres to a Person. Number of Houses. Population. Highgate 709 13 0.07 1,602 9,614 Muswell Hill 599 5 0.19 502 3,012 Crouch End 376 13 0.07 845 5,070 Hornsey 423 38 0.02 2,714 16,284 North Haringey 125 86 0.01 1,808 10,852 South Haringey 109 65 0.01 1,183 7,098 Stroud Green 269 38 0.02 1,731 10,386 Finsbury Park 199 38 0.02 1,289 7,738 2,809 24.9 0.04 11,675 70,054 From this table it will be seen that the densest population is in North Haringey Ward, viz., 86 persons per acre, followed by South Haringey with 65 per acre, and then by Hornsey, Stroud Green and Finsbury Park, each with 38 persons per acre. Highgate and Crouch End had at this time (the middle of the year) 18 persons per acre, and Muswell Hill 5, but in the last named Ward building operations have been proceeding at such a rapid rate that the population there has now materially increased. In connection with the density of the population due regard must be given to the open spaces which exist in parts of the District, as these materially decrease the space which can actually be built on, and the population in the Wards in which such open spaces are situated must to a corresponding extent be more closely packed. These spaces have at various times been handed over to the authorities and dedicated to be kept as open spaces for ever. They consequently cannot be built over and serve the useful purpose of recreation grounds, at the same time assisting greatly in purifying the atmosphere. 3 They consist of the Finsbury Park of 120 acres; about two-thirds of this park is in Finsbury Park Ward, and the remaining one-third in South Haringey. The Highgate Woods, consisting of the Gravel Pit Wood of 69 acres, situated chiefly in the Highgate Ward, with a smaller portion in the Muswell Hill Ward; this Wood has now been open to the public for several years. The Queen's Wood of 50 acres was acquired and opened during the year; this Wood is almost entirely in the Highgate Ward, a very small portion being in Crouch End. The Pleasure Grounds of rather more than 9 acres are entirely situated in the Hornsey Ward. These spaces altogether amount to 248¼ acres. The Births during the year amounted to 1,342, being 5 more than were registered in 1897. This gives a birth-rate of 19.15 per 1,000 inhabitants, comparing with 20.54 for 1897, 20.84 for 1896, 21.2 for 1895, and with 29.4 per 1,000 for the whole of England and Wales. This rate is constantly getting lower, that for the past year being in fact the lowest so far recorded. The Deaths for the year from all causes amount to 579, giving a death-rate of 8.26 per 1,000 inhabitants, comparing with 8.11 per 1,000 inhabitants for 1897, 8.42 „ „ 1896, 10.49 „ „ 1895, and 9.85 „ „ 1894. This, however, has to be corrected as regards the deaths occurring outside the District amongst inhabitants belonging thereto, namely, 20 deaths at the Edmonton Workhouse and 2 at other places. Also the exclusion of 7 deaths occurring among non-residents dying within the District. Dr. Charles D. Green, the Medical Officer of Health for Edmonton, has again kindly sent to me details as to the number of inhabitants and the deaths occurring amongst inhabitants of Hornsey in the Edmonton Workhouse during the year in question, these being 42 and 20 respectively. These facts being taken into account, the population, of the District is increased to 70,096, and the deaths to 594, giving a corrected death-rate of 8.47. The death-rate for England and Wales for 1898 was 17.6 per 1,000 inhabitants, and that for London 18.3 per 1,000 inhabitants. 4 The death-rate for Hornsey is again very low, but rather higher than for last year. The death-rate for the first quarter of 1898 was 9.02 „ „ second „ „ 5.7 „ „ third „ „ 9.2 „ „ fourth „ „ 8. The following table gives the deaths which have been registered in each of the eight Wards of the District during the four quarters of the year:— 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total Deaths. Death rate. Highgate 81 11 23 15 80 8.82 per 1,000 Muswell Hill 6 1 5 4 16 5.31 „ Crouch End 11 5 7 7 80 5.91 „ Hornsey 42 29 54 43 168 10.31 „ North Haringey 18 10 34 35 97 8.96 „ South Haringey 16 6 16 12 50 7.04 „ Stroud Green 10 13 15 17 55 5.29 „ Finsbury Park 24 25 18 16 83 10.72 „ Total deaths 158 100 172 149 579 8.26 per 1,000 5 In this calculation 7 deaths which occurred at the Isolation Hospital in the Muswell Hill Ward were taken from the number of deaths occurring in that Ward and added to the deaths in the North Haringey, Crouch End, Hornsey (3), Finsbury Park and Highgate Wards from which the patients were received. The Ward death-rate for 1898 compared with that for 1897 anr 1896 is shown in the following table:— WARD. 1898 1897. 1896. Deaths. Death-rate per 1,000. Deaths. Death-rate per 1,000. Deaths. Death-rate per 1,000. Highgate 80 8.32 80 9.20 76 8.73 Muswell Hill 16 5.31 11 4.43 20 9.03 Crouch End 30 5.91 30 6.0 27 5.77 Hornsey 168 10.31 158 10.63 139 10.04 North Haringey 97 8.96 86 8.43 82 8.19 South Haringy 50 7.04 50 7.36 51 8.52 Stroud Green 55 5.29 42 4.45 62 6.80 Finsbury Park 83 10.72 71 9.29 66 8.75 From this table it will be seen that the deaths in the Highgate, Crouch End and South Haringey Wards were exactly the same in number as for the year 1897, while there were 5 more deaths in the Muswell Hill, 10 in the Hornsey, 11 in the North Haringey, 18 in the Stroud Green, and 12 in the Finsbury Park Wards, making up altogether the increase of 51 deaths as compared with 1897. It will be noted that the Wards which show the lowest death-rates are Stroud Green, Muswell Hill and Crouch End, whilst the highest is in Finsbury Park followed closely by Hornsey. North Haringey, with a density of population of 86 persons to the acre, has a higher death-rate when compared with South Haringey which is less densely populated, having 65 persons to the acre. The Zymotic Death rate amounts to 0.74 per 1,000 inhabitants, 52 deaths having been registered as due to the eight 6 principal Zymotic diseases. Twelve occurred in the first, 8 in the second, 80 in the third, and 7 in the fourth quarter. This death-rate compares with 0.98 for 1897, 0.93 for 1896, and 1.11 for 1895. and 112 for 1894. The following table shows the Deaths in the District from the eight principal Zymotic diseases for the last seven years:— 1892. 1893. 1894. 1895. 1896. 1897. 1898. Small Pox — — — — — — — Measles 7 5 5 13 6 7 14 Scarlet Fever 4 9 1 3 8 2 — Diphtheria 11 16 23 21 12 16 11 Fever 3 6 6 5 6 — 4 Whooping Cough 13 2 22 10 17 10 8 Diarrhœa 6 9 1 8 9 29 15 Cholera — — — — — — — Totals 44 47 58 60 58 64 52 No mortality from Small-pox or Cholera has occurred in the District for the last nine years. Measles has proved twice as fatal when compared with the previous year, 14 deaths having been attributed to it. It will be noted that 8 of the deaths occurred in the first quarter of the year, the disease at that time was prevalent in the District to a considerable extent, and 4 deaths had occurred from it in the last quarter of 1897. In the second quarter there was only one death from it. Then again it became more fatal, causing 5 deaths in the third, and finally, during the fourth quarter the cases became more mild in character and caused no mortality. 7 Scarlet Fever.— No mortality has been caused by this disease. This is, I believe, the first time that such a statement could be made, and it points to the fact that the type of this disease during the whole of the year must have been of a peculiarly benign nature. Diphtheria was credited with 11 deaths, 2 in the first, 1 in the second and 4 in each of the third and fourth quarters. These deaths were 5 less when compared with the previous year, and we must go back to the year 1892 before the mortality due to it was so small as for 1898. Typhoid Fever caused 4 deaths, compared with none for the previous year. The deaths from this disease are about the average for the last ten years, so that taking the increase of population into account the mortality per 1,000 inhabitants has considerably decreased. Whooping Cough has caused 8 deaths, 6 of them having occurred in the third quarter. Six of the cases were in children under 5 years of age. Diarrhœa was fatal to the extent of 15 cases, 13 being in the third and 2 in the fourth quarter. All the deaths occurred in children under 5 years of age. This mortality was considerably less than for the previous year, but still larger than that for any year from 1896 to 1892 inclusive. From the fact that most of the deaths occurred in the third or warmest quarter, and all in young children, it is very probable that a good deal of the disease was due to improper feeding, as milk—which is, or should be, the staple article of diet in young children—is under these circumstances very apt to become sour, and if taken more or less in that condition, proves a very fertile source of diarrhoea. In connection with the feeding of infants attention should also be drawn to the fact that milk is being sold as condensed separated milk. It cannot be too generally known that such milk is totally unfit to be given as the entire food of infants, as the fat necessary for nourishment has been partly taken out, leaving only about one per cent. instead of three and a-half to four per cent., and it follows that very much more of such milk has to be taken in order to get the amount of fat required for nutrition; in fact, it is stated that 8 ten half-pound tins of such condensed separated milk are required to make up as much fat as should be contained in one pint of good new milk. The use of such milk should be absolutely condemned, but it is cheap, and therefore likely to be used in the poorer parts of the District unless [intending buyers are warned in time as to its comparative worthlessness. The deaths from diseases other than zymotic are as follows:— 1892 1893 1894 1895 1896 1897 1898. From Pulmonary Consumption 28 35 40 43 30 43 36 „ Bronchitis, Pneumonia, and other Pulmonary Diseases 118 139 87 105 96 100 121 „ Brain Diseases 63 69 68 50 58 47 69 „ Heart „ 46 61 40 64 68 56 52 „ Rheumatism 1 5 4 4 3 1 5 „ Ague - - - - - - - „ Puerperal Diseases 10 3 2 — 1 2 — „ Pyæmia — — 1 — 1 — — „ Erysipelas 2 4 — — — 1 l „ Malignant Diseases, Cancer. &c. 24 37 31 22 31 30 31 „ Injuries 12 11 15 15 11 10 9 „ Various other Causes 160 139 153 202 166 174 203 Totals 464 503 441 505 465 464 527 The number of deaths from phthisis pulmonalis is 7 less than for 1897, but is about the average when compared with the six previous years. This cause of death does not include the deaths due to tuberculosis affecting other parte of the body than the lungs, these being included under the heading various causes, and affecting chiefly young children. In addition to this, many children die from lung and wasting diseases, where the cause of death, although not directly attributable 9 to tuberculosis, certainly is much influenced by the presence of the tubercle bacillus in the system The mortality amongst children from these tuberculosis diseases does not diminish, and for the last few years much attention has been paid in order that meat and milk shall be supplied to the public absolutely free from any suspicion of the tubercle bacillus. Public opinion has been so brought to bear upon this most important matter that many proprietors of the larger dairies are now prepared to guarantee that their herds are under the supervision of veterinary surgeons, and that any animal showing the slightest suspioion of tuberculosis is at once submitted to the tuberculin test, and condemned if found to re-act. The milk is also constantly tested both as to its quality and freedom from bacteriae. In the report on tuberculosis, issued by the British Medical Association in January of this year, exactly the same line of argument is used as appeared in my report for last year, viz.: That although the infection of tuberculosis in milk can be destroyed by boiling, or sterilisation, that as milk can be obtained free from tuberculous infection if the cows which yield it are ascertained to be free from tuberculosis by the tuberculin test, it appears to be undesirable to relieve wholesale and retail vendors of their responsibility in this regard, by recommending the boiling of milk as the only safeguard. As regards the risk of tuberculosis from eating meat from infeoted animals, the time will come when the carcasses of all animals slaughtered will have to be passed by competent inspectors as fit for consumption, and all imported meat will have to undergo the same ordeal, but at present, and so long as private slaughter-houses are in existence this inspection can hardly be said to be practicable. The question of notifying phthisis pulmonalis and other diseases of a tuberculous nature, can, I think, hardly be recommended from the standpoint of utility; but it would be decidedly advisable that the rooms vacated, from any cause, by patients suffering from pulmonary consumption should be thoroughly disinfected, and that during the treatment of a case due regard should be paid to the disposal of the sputa, and all such other precautions taken as to prevent, as far as possible, the spread of the disease. 10 The deaths from the other classes do not call for any particular remarks, as, taking into account the increased population, they only show about an average mortality. It is, however, satisfactory to note that there has been no death from puerperal disease. The deaths from various other diseases have been set out in detail in the reports of the Public Health and Hospital Committee, and it is unnecessary to refer to them again. Aoes at which the Deaths occurred. 1897. 1898. One year and under 188 168 One year to five years 58 55 Five years to fifteen years 22 17 Fifteen years to twenty-five years 86 17 Twenty-five years to sixty-five years 129 194 Sixty-five years and over 145 188 528 579 The deaths under one year to births registered works out at 117.73 for 1,000 inhabitants, and compares with London with 166 per 1,000 for the same period and with 103.21 for 1897 for Hornsey, and the deaths under five years to 168.71 against 146.67 for 1897, and the percentage of deaths under one year is 27.28 compared with 26.1 for 1897. The mortality under one year per 1,000 inhabitants amounts to 2.25, and under five years to 3.04, and he mortality for 65 years and over amounts to 1.96 per 1,000 inhabitants. For the purpose of comparison I again append a table giving the deaths, &c., in London (made up of 48 sanitary areas), Hampstead, St. Pancras, Islington, Finchley and Hornsey. From this will be seen the general sanitary condition of these districts compared one with another. I also state the annual general death and zymotic deathrates of the 33 largest English towns. Sanitary Area. Estimated population in the middle of 1898. Notified cases of Infectious Disease. Deaths from Principal Infectious Diseases. Deaths from all causes. Death-rate per 1,000 living. Deaths of Infants under One Year to 1,000 Births. Small Pox. Scarlet Fever. Diphtheria. * Typhus Fever. Enteric Fever. Other continued Fevers. Puerperal Fever. Erysipelas. Cholera. Total. Annual rate per 1,000 persons living. Small Pox. Measles. Scarlet Fever. Diphtheria. † Whooping Cough. Typhus Fever. Enteric Fever. Other continued Fevers. Diarrhoea. Total. Annual rate per 1,000 persons living. London 4,504,766 32 16,894 11,855 16 3,024 55 247 5,169 23 37,315 8.3 1 3,069 581 1,756 2,157 3 554 9 4,352 12,482 2.77 82,037 18.3 166 St. Pancras 243,416 2 980 499 — 220 2 18 321 4 2,046 8.4 — 111 53 96 87 — 41 — 214 602 2.49 4,651 19.2 170 Islington 344,616 — 1,336 545 2 237 1 19 280 — 2,420 7.0 — 334 26 90 180 1 36 — 291 958 2.78 5,712 16.6 159 Hampstead 78,755 — 242 135 — 47 — 1 41 — 466 59 - 26 3 19 27 — 10 1 24 110 1.40 917 11.7 125 Pinchley 21,007 — 91 12 — 9 — — 6 — 118 5.6 — 6 — — 6 — 3 — 24 39 1.85 218 10.3 136 Hornsey 70,054 — 168 100 — 31 — — 51 — 350 4.9 — 14 — 11 8 — 4 — 15 52 0.74 594 8.47 117 33 great town — - — - - - - - - - - - - - - - - - - - — 2.85 — 19.0 178 * Including cases of Membranous Croup. † Including deaths from Membranous Croup. 12 The Compulsory Notification of Infectious Diseases has been in force in this District since the 1st of January, 1890. and under the Act the following cases have been reported during the year— Scarlet Fever 168 in 1897 264 Diphtheria 99 „ 87 Typhoid Fever 31 „ 31 Puerperal Fever — „ 2 Erysipelas 51 „ 39 Continued Fever — — Membranous Croup 1 „ 3 and Small Pox — „ — 350 426 The number 350 compares with 426 for 1897, 709 for 1896, 615 for 1895, 410 for 1894, 618 for 1893, and 840 for 1892. 81 cases were reported in the first quarter of the year, 72 „ „ „ second „ „ 77 „ „ „ third „ „ 120 „ „ „ fourth „ 350 The following table gives in detail the cases of Infectious Disease as notified for each quarter of the year, and a comparison with other years— Scarlet Fever. Typhoid Fever. Diphtheria. Erysipelas. Small Pox. Continued Fever. Puerperal Fever. Membranous Croup. 1898 '97 '96 '98 '97 '96 '98 '97 '96 '98 '97 '96 '98 '97 '96 '98 '97 '96 '98 '97 '96 '98 '97 '96 During 1st quarter 29 95 40 2 8 4 31 21 23 19 14 10 — — 2 — — 1 — 1 2 — 1 — During 2nd quarter 37 54 139 6 4 3 18 9 16 11 4 13 — — 1 — — — - — 2 — 1 — During 3rd quarter 43 48 214 9??? 10 13 17 21 83 7 8 8 — — 1 — — — - — 1 1 — — During 4th quarter 59 67 137 14 9 14 33 36 23 14 13 8 — — — — — — — 1 — — 1 1 Total 168 264 530 31 31 34 99 87 95 51 39 39 — — 4 — - 1 — 2 5 1 3 1 No case of Cholera or Small Pox has been reported during the year, and the District has also been free from Continued and Puerperal Fever. 14 From the following table will be seen the various Wards in which the 350 cases notified occurred:— Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Small Pox. Membranous Croup. Continued Fever. Puerperal Fever. Total. Highgate 26 9 4 11 — - — - 50 Muswell Hill 9 3 1 2 — - — — 15 Crouch End 8 2 5 1 — — — — 16 Hornsey 45 34 7 17 — 1 — — 104 North Haringey 25 16 7 10 — — — — 58 South Haringey 20 28 1 5 — — — — 49 Stroud Green 20 9 3 3 — — — — 35 Finsbury Park 15 3 3 2 — — — — 23 Totals 168 99 31 51 — 1 - — 350 15 Scarlet Fever again shows a decrease, the number of cases reported being 96 less when compared with 1897, and 862 less when compared with 1896. The largest number of cases (59) were reported in the fourth quarter and the least in the first quarter (29). The Wards most affected were the Hornsey with 45 cases, Highgate with 26, North Haringey with 25, South Haringey and Stroud Green with 20, followed by Finsbury Park with 15, Muswell Hill with 9, and Crouch End 8. Diphtheria.— Twelve more cases were reported compared with 1897, and 4 more with 1896. Most of the cases occurred in the fourth quarter (33), followed by 81 in the first, 18 in the second, and 17 in the third. Four of the Wards show a decrease, viz.:— Finsbury Park 8, Highgate 5, Crouch End 4, and North Haringey 2, total 19. Whilst 19 more cases were reported in Hornsey, 6 in Stroud Green, 4 in South Haringey, and 2 in Muswell Hill, total 31. In looking at the map marked blue in the places where the disease has occurred, it will be noted that the great majority of the cases occurred in the thickly populated neighbourhood of the Boyton Road School. A great many children attend this school from outside Districts where diphtheria has been very prevalent, and in all probability the increased amount of this disease in the Hornsey Ward may be attributed to children from more or less infected Districts attending this and other large schools in the neighbourhood. These schools are constantly visited to ensure that they shall be kept in good sanitary condition, and whenever a case of diphtheria or other notifiable disease is known to exist amongst children in attendance, a notice is invariably sent to the Head Teacher informing him of the fact in order that scholars from the infected house, as well as the patient, shall be excluded until a medical certificate is received stating that the period of danger from infection is over. Typhoid Fever.— Exactly the same number of cases has been reported this year as for 1897, viz.:— 31. This compares with 84 for 1896, and 46 for 1895. Most of the cases (14) occurred in the fourth quarter and the least in the first quarter (2). Hornsey and North Haringey show the most cases (7 each), and Muswell Hill and South Haringey the least (1 each). No Ward has been free from this disease. In order to find out if possible the source of this disease (as well as is 16 also the rule in cases of diphtheria and puerperal fever), the Medical Officer personally visits the houses where the disease occurs. The causes to which it is attributed vary considerably—several of the cases were imported, 2 said to be caused by eating oysters, 1 from drinking bad water, and others from smells from gullies and drains. In three cases at least the diagnosis proved to be wrong, the patients respectively suffering from tubercular meningitis, abdominal influenza and appendicitis. Erysipelas.— 51 cases have been reported comparing with 89 for 1897 and 1896, and 45 for 1895. The notification of this disease is, in my opinion, of very doubtful use. Membranous Croup.— One case only has been reported—this occurred in the Hornsey Ward. Isolation Hospital.— 164 cases have been treated during the year, comparing with 202 for 1897, and with 298 for 1896. Of these 7 died, 138 left the Hospital well and 4 were discharged as ineligible, leaving on the 31st of December 20 still under treatment. Six deaths occurred from diphtheria and 1 from tubercular meningitis. Of the patients in the Hospital on the 1st of January, 18 were cases of scarlet fever, 4 of diphtheria, and at the termination of the year the 20 cases still under treatment consisted of 18 cases of scarlet fever and 2 of diphtheria. The following table shows the number of cases admitted during each of the twelve months of the year, and the diseases for which they were admitted:— Scarlet Fever. Diphtheria Typhoid Fever. Total. January 6 5 — 11 February 3 4 — 7 March 5 6 — 11 April 12 5 — 17 May 5 8 — 8 June 6 1 — 7 July 8 1 1 10 August 6 3 1 10 September 7 4 2 13 October 13 6 1 20 November 14 4 3 21 December 4 3 — 7 89 45 8 142 17 Scarlet Fever.— 89 cases were admitted during the year, 2 however of these proved to be measles and were discharged as ineligibleTwo cases were also transferred from the diphtheria ward. Rather more than half of the total cases notified were admitted to the Hospital and every case with the exception of those still under treatment at the end of the year left the Hospital well. Diphtheria.— Including the 4 cases in the Hospital at the commencement of the year 49 cases have to be accounted for. Of the 45 cases admitted during the year 1 was discharged as ineligible (Follicular Tonsillitis) and 2 transferred to the scarlet fever ward, 6 died, the remaining 88 were discharged cured and 2 were, at the end of the year, still under treatment but convalescent. Notwithstanding the fact that the antitoxin treatment when applied early to the cases is now undoubtedly acknowledged as the best, I must draw your attention to the fact that only 2 of the cases had been so treated before admission, and that in my opinion an unnecessarily long delay had occurred prior to admission. Only 1 of the cases was admitted on the 1st day of the disease, 7 on the 2nd, 14 on the 3rd, 8 on the 4th, 1 on the 5th, 8 on the 6th, 8 on the 7th, 2 on the 8th and 1 on the 9th. Tracheotomy was necessary in 4 of the cases owing to extension of the disease to the larynx, 2 of these recovered and 2 died. The fatal cases were 1 a child aged 8 years, admitted on the 9th day of the disease, antitoxin was injected but as expected, owing to the lengthened stage of the disease, without beneficial result, and the operation also failed to relieve. The other fatal case was that of an infant 10 months old, admitted in a nearly moribund condition on the 6th day of the disease. In neither of these cases had antitoxin been used before admission. The other fatal cases were:— 1. A child aged 12 years admitted on the 6th day of tha disease. 2. „ 3 „ „ „ 2nd „ „ 3. „ 4 „ „ „ 7th „ „ 4. „ 8 „ „ „ 3rd „ „ 18 In neither of these cases had diphtheritic antitoxin been injected before admission. I may here state that in order to prevent any delay in the early use of antitoxin the Council has given orders that a supply shall be kept at the Medical Department at Southwood Lane, where it can be obtained at cost price. A circular was sent out to the medical gentlemen practising in the neighbourhood to this effect last October, and five applications for it have been made. Typhoid Fever.— Application for admission were made for 8 patients suffering from this disease. Of these 1 was discharged as ineligible (abdominal influenza), 1 died (tubercular meningitis) and the remainder left the Hospital well. The case of tubercular meningitis was sent in as being one of typhoid, the symptoms of both these diseases being often very similar. Before the disease could with certainty be pronounced as not one of typhoid fever the patient became too ill for removal and, as is almst invariably the case with this disease, died. The diagnosis was verified by a post-mortem examination, Discharge Rooms and Baths.— During the year a great improvement has been effected as to the manner in which the patients take their final disinfecting baths. They now leave the bathroom for another small room, in which they put on perfectly clean and disinfected clothes, and then walk from this room into the open air, and so out of the Hospital without again entering either the bathroom or ward. Washing, &C.— As in previous years all the washing for the patients and resident staff has been done in the laundry, and the necessary disinfecting of clothes done on the premises, both the laundry and disinfector being in the Hospital grounds. The Nursing staff.— The great advantage of training nurses as adopted last year, has again proved very satisfactory, and the 19 nurses and probationers are at the present time a very capable and willing body of workers. During the autumn, when, for a considerable period, three diseases were being treated at the same time (necessitating the use of three block and five or even six wards), it was only by great tact on the part of the Matron and willingness shown by the Sister and nurses that the work was done without getting in any extra aid, but it necessitated united effort for all, and convinced me that it would not be well at any time to have less than the present number of nurses, and that if such times of pressure were to occur often, or to be of long duration, an increase to the nursing staff would be imperative. That the nursing staff must be kept up as regards numerical strength and efficiency is absolutely necessary, as at any time patients suffering from different infectious diseases may be admitted, and it would be false economy as well as disorganising to the Hospital generally to be under the necessity, as was formerly the case, of getting in extra nursing aid on every such occasion. In such a Hospital as this the nursing staff should, at any rate, be a little over the numerical strength required for the average number of patients, otherwise, what with the changes from night to day duty, relieving during meal times, half-holidays and holidays, also ambulance duty, which necessitates the absence of a nurse for some time, and the probability of illness among the staff, and above all the necessity of having many wards open, the work to be done collectively and individually becomes too bard and, possibly, altogether beyond what can reasonably be expected to be done, whereas, if the numerical strength is such that the Matron can apportion to each nurse her fair share of the work, and still have a little nursing strength in hand, then the work goes on better than it could if all were constantly working at high pressure, and when the necessity arises for this, all willingly comply with the demand. The Matron has, as usual, carried out her duties very efficiently, and I have much pleasure in testifying to the thorough efficiency of the Sister, who was appointed during the year, and who does her utmost for the patients and the nurses under her charge. Cost of Maintenance of Patients and Resident Staff at the Hospital.— This works out at 7s. 7d. for each person per week, comparing with 7s. 9d. for 1897, and with 7s. 10½d. for 1896. 20 Sanitary Defects, Nuisances and Sanitary Work.— I append tabular statements of the sanitary work carried out in the District during the year, and also Table A of the Deaths, and Table B of the Population, Births, and new cases of Infectious Disease coming to the knowledge of the Medical Officer of Health during the year. The number of complaints received are 51 in excess of the previous year, rather less houses have been inspected but the total number of inspections and re-inspections comes to within 22 of the year before. The District has been free from the nuisance caused hitherto by movable dwellings, caravans, tents, &c. The large schools in the District have been visited monthly and three found defective, and the defects remedied. The bake-houses, slaughter-houses, cow-sheds, dairies and milk-shops are periodically visited and the numbers are the same as for 1897. Sixty-nine houses have been visited from house-to-house. Of these 7 situated in Southwood Lane have been pulled down. In the case of 54 the necessary work to remedy the defects has been done and in 8. others part of the work has been done, the remainder being in hand. Special attention has again been given to the waterclosets which are without water supply, in order to see that they are kept properly hand flushed and clean. Thirty closets have been supplied with larger flushing tanks and the supply made efficient. Fourteen water-closets have been ventilated and 86 new constructed. Analysis Of Water.— The water has been ohemically examined at stated periods, and found on each oooasion to be of good quality. There has been no need for amy bacteriological examination. The Engineer and Surveyor has again kindly furnished me with details as to matters more particularly dealt with in his Department. Stable Manure.— Wherever new stabling is erected within the District, the applicants are advised to provide proper manure baskets or trolleys instead of constructing manure pits, which require frequent attention and watching, and if great care is not taken to keep them clean often become a nuisance. This is almost invariably done now in connection with new buildings of this kind with satisfactory results 21 as the limited capacity ensures the refuse being carted away with more regularity than when the larger manure pits are in use. Water Supply.— The extension of the area of constant supply during the year has been more in connection with newly laid-out estates than in the alteration of the supply to existing buildings. Pressure is, however, being brought to bear upon the New River Company in relation to this matter. Disposal of House Refuse.— The burning of the whole of the house refuse of the District has been carried out uninterruptedly throughout the year in the 12 cell Destructor furnaces at the Sanitary Depdt at Hornsey, and, as before, without causing a nuisance of any kind. The quantity of refuse consumed during the last four years has been as under :— Year 1895. Year 1896. Year 1897. Year 1898. Loads 7,846 9,451 11,260 12,788 Tons 10,092 12,106 14,267 16,105 The decision arrived at by the Council in January last that in future all trade vegetable refuse and the general sweepings of shops would, if taken to the Sanitary Depot, be burnt free of cost, is being taken advantage of by a number of tradesmen in the District, nearly 10 tons having been disposed of in this manner last month. The burning of refuse of such an objectionable character cannot fail to be of advantage to the District as a whole from a health point of view,' and is doubtless a great convenience to the tradesmen, who often experience considerable difficulty in getting rid of it. 802 applications for the removal of house refuse were received during the year, which gives an average of 5.8 per week. The complaints numbered 170, the average being 3.2 per week. 22 Sewer Flushing.— Careful attention has been paid to the flushing of the sewers and culverts, the quantity of water used for this purpose during the last three years being as under : — 1896. 1897. 1898. Gallons 19,866,000 18,765,000 24,084,000 The fortnightly flushing of the sewers in the Haringey District instead of monthly, as hitherto, accounts to a large extent for the increased quantity of water used during the past year. Care is taken that the brick culverts and open watercourses are kept in a cleanly condition, and all cases of pollution are followed up closely and disconnected. Gullies.— Wherever old gullies, mostly of brick construction and untrapped, have been found defective they have been replaced with stoneware pot gullies with proper water seal. Sewers.— The length of new sewers laid and reconstructed during the year is about 5½ miles, compared with 4 2/3 miles during the corresponding period of 1897. These figures are made up as follows :— 1897. 1898. Yds. Yds. New foul-water sewers 2680 8975 New surface-water sewers 4860 5025 7540 9000 Sewers reconstructed 670 620 Total ... 8210 say 4 2/3 miles. 9620 say 5½ miles. Sewer Ventilation.— The erection of vertical cast-iron ventilating shafts up the flank walls of buildings or in other suitable positions has been continued during the year, the total number erected 23 being 19 as compared with 16 in 1897. I am informed by the Engineer that a considerable number of positions have been agreed with estate owners for the erection of these shafts, and they will be put up at the expense of the owners, when the buildings to which they are to be affixed are erected. The efficient ventilation of the sewers is manifestly of the greatest importance, and it is satisfactory to note that every opportunity continues to be taken to secure this end. I remain, Gentlemen, Your obedient Servant, HENRY CLOTHIER, M.D. Lond., Medical Officer of Health. March l0th, 1899. (C I.) COUNTY OF MIDDLESEX.— SANITARY WORK, 1898. Sanitary Districts. Inspections. Notices. Dwelling Houses. Houses in separate Dwellings or Lodgings. Common Lodging Houses: Canal Boats used as Dwellings. Movable Dwellings, Caravans, Tents, Ac. Complaints Received. Cases of Infectious Disease Notified. Number of Premises Periodically Inspected. Houses Inspected from House-toHouse. Total Number of Houses, Premises, Ac., Inspected. Total Number of Rc-inspections after Order or Notioe. Total Number of Inspections and Re-inspections. Letters Written. Cautionery Notioes given. Statutory Orders Issued. Summonses Served. Convicti6ns Obtained. Houses, Premises, Ac., Cleansed, Repaired, Ac. Closed as Unfit for Habitation. Re-opened after Repairs, Alterations, Ac. Demolished. Illegal Underground Dwellings Vaoated. Number Registered under Bye-laws. Periodical, Frequency, or Number of Inspections. Number of Contraventions. Number Registered under Bye-laws. Periodical, Frequency, or 'umber 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. HORNSEY URBAN DISTRICT. 254 350 133 69 1206 4552 5578 Numerous. 368 142 — — 103 — - — (C II.) COUNTY OF MIDDLESEX.— SANITARY WORK, 1898. Sanitary Districts. Schools. Workshops and Work-places. Laundries. Bakehouses. Slaughterhouses. Cow-sheds. Dairies and Milk-shops. Unsound Food. Adulterated ' Food. Offensive Trades. Mortuaries. Number in District. Periodical Frequency or Number of Inspection. Number found defective. Number in district.- Periodical Frequev-cy or Number of Inspections. Contraventions of Factory Aots. Number in Distriot. 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 Frequenoy 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 geiaed. Samples taken. Found Adulterated. Number of premises in Distriot. Periodical Frequency or Number of Inspections. Contraventions of Bye-laws. Accommodation. Number of bodies received. HORNSEY URBAN DISTRICT. 12 Monthly. 3 33 Quarterly. 10 Fortnightly. 8 Monthly. 37 Quarterly. 3 6 34 (C III.) COUNTY OF MIDDLESEX.— SANITAEY WORK, 1898. Sanitary Districts. Water Supply and Water Service. Privy A Ash Pits, Ash & Earth Closets. Drainage and Sewerage. Wells. Houses, Water Laid on to. Percentage of Houses Supplied froin Mains. Cisterns. Flush Cisterns Provided to W.C.'s. Draw-Taps Removed from Cisterns to Mains. Percentage of Houses supplied on Constant System. Water Closets. Percentage of Houses Provided with Water Closets. Drains. Cesspools. Percentage of Houses Draining into Sewers. Sewers. New Sunk. Cleansed, Repaired, Ac. Closed as Polluted. New, Provided. Cleansed, Repaired, Covered, Ac. Overflow Pipes Disconnected from Drains. Above Ground Receptacles Substituted for Pits. Movable Receptacles Substituted for fixed. Water Closets substituted for Dry Receptacles. New Constructed. New Apparatus Provided. Repaired, Cleansed, Ac. Supplied with Water, or supply rendered efficient. Ventilated. Examined, Tested, Exposed* Ao. Unstopped, Repaired, Trapped, Ac. Waste Pipes, Rain Water Pipes, «o., Disconnected. Soil Pipes and Draias Ventilated. Disconnecting-Traps or Chambers Inserted. Reconstructed. New Laid. Rendered Impervious, Emptied, Cleansed, Ac. Abolished, and Drain Connected to Sewer. Yards of New Sewers Laid. Yards of Sewers Reconstructed. HORNSEY URBAN DISTRICT. - — 1 Ail excepting few isolated Cottages. 100 1 56 — 34 — - — — - 36 89 137 30 14 100 164 179 105 83 36 127 — 6 1 100 Surface water Sewers 5374 yards. 620 9437 Foul water Sewers 4063 yards. (C IV.) county of Middlesex.— Sanitary work, 1898. Sanitary Districts. Disinfection. Dust. Dampness. Sundry nuisances abated. Contagious Diseases of Animals. Infant Life Protection Act. Rooms fumigated. Rooms stripped and cleaned. Articles disinfected or destroyed. Dust-bins repaired. New bins provided. Movable receptacles substituted for fixed. Periodical freqnency of du?t removal. Number of complaints of nonremoval received. Roofs repaired, &c. Guttering and rain-pipes repaired, &c. Gardens, Areas, Ac., 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, Ac., 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. HORNSEY URBAN DISTRICT 294 142 5005 3 37 2 Weekly 170 26 70 2 55 9 — 27 2 5 8 61 - 10 91 — — — None — — M 3 (A) TABLE OF DEATHS during the Year1898, in the Hornsey Urban 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 and upwards. Smallpox. Scarlatina. Diphtheria. f embranous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough. Diarrhoea and Dysentery. Rheumatic Fever. Phthisis. Bronchitis, Pneumonia, and Pleurisy Heart Disease. Malignant Disease. Injuries. All Other Diseases. Total. Typhus. | Enteric or ryphoid. Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) (f) (g) (h) (i) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 HORNSEY URBAN DISTRICT Under 5 5 upwds. Under 5 5 upwds. Under 5 5 upwds. 579 158 55 17 17 194 138 Under 5 - - 7 - - - - - - - - 11 7 15 — 1 40 1 — 4 127 213 5 upwds — — 4 — — 4 — — — — 1 3 1 — 5 35 81 51 31 5 145 366 Area and Population of the District to which this Return relates. Area in acres, 2,809. Population 1891, 44,205. Estimated to middle of 1898. 70,054. Death rates— General, 8 47- per 1,000 population, estimated to middle of 1898. Infant (under 1 year of age). 117 73 per 1,000 births registered. Under 5 5 upwds. Under 5 5 upwds. Under 5 5 upwds. Under 5 5 upwds. Under 5 5 upwds. 1 Totals 579 158 55 17 17 194 138 Under 5 7 | 11 7 15 — ! 1 40 1 — 4 127 213 5 upwds. — — 4 — — 4 — _ | _ — 1 3 1 — 5 35 81 51 31 5 145 366 The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the district among persons belonging thereto. Under 5 - 5 upwds 2 Deaths occurring within the district among persons not belonging thereto. Under 5 1 5 upwds 6 HENRY CLOTHIER, M.D., Lond. M 11. (B) TABLE OF POPULATION, BIRTHS, AND OF NEW CASES OF INFECTIOUS SICKNESS, coming to the knowledge of the Medical Officer of Health, during the year 1898, in the HOBNSEY Urban 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. Population at all Ages. Registered Births. Aged under 5 or over 5. New Cases of Sickness in each Locality, coming to the knowledge or the Medical Officer of Health. Number of such Cases Removed fbom their Homes in the several Localities for Treatment in Isolation Hospital. Census 1891. Estimated to middle of 1898. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. - Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b.) (c.) (d.) (e) 1 2 3 4 5 6 7 8 9 10 11 12 13 1 2 3 4 5 6 7 8 9 10 11 12 13 44,205 70,054 1,342 Under 5 5 upwds. HIGHGATE WARD 9,014 Under 5 .... 26 9 .... .... 4 .... .... .... .... 11 .... .... .... 4 l .... .... — .... .... .... .... .... .... .... 5 upwds. 9 4 1 MUSWELL HILL WARD (H) 3,012 .... Under 5 .... 9 3 .... .... 1 .... .... .... .... 2 .... .... .... — — .... .... .... .... .... .... .... .... .... .... 5 upwds. 3 1 CROUCH END WARD .... 5,070 .... Under 5 .... 8 2 .... .... 5 .... .... .... .... 1 .... .... .... - — .... .... — .... .... .... .... .... .... .... 5 upwds. 4 1 3 HORNSEY WARD 16.284 .... Under 5 .... 45 34 1 .... 7 .... .... .... .... 17 .... .... .... 4 11 .... .... — .... .... .... .... .... .... .... 5 upwds. 22 12 1 NORTH HARINGEY WARD .... 10,852 .... Under 5 .... 25 16 .... .... 7 .... .... — .... 10 .... .... .... 2 1 .... .... — .... .... .... .... .... .... .... 5 upwds. 9 3 2 SOUTH HARINGEY WARD .... 7,098 .... Under 5 .... 20 23 .... .... 1 .... .... .... .... 5 .... .... .... 1 1 .... .... .... .... .... .... .... .... .... .... 5 upwds. 10 7 STROUD GREEN WARD .... 10,386 .... Under 5 .... 20 9 .... .... 3 .... .... — .... 3 .... .... .... 4 — .... .... — .... .... .... .... .... .... .... 5 upwds. 1 9 1 1 FINSBURY PARK WARD 7,738 .... Under 5 .... 15 3 .... .... 3 .... .... .... .... 2 .... .... .... 1 — .... .... .... .... .... .... .... .... .... .... 5 upwds. 7 2 Under 5 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 5 upwds. Under 5 .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... .... 5 upwds. Totals 44,205 70,054 1,342 Under 5 .... 168 99 1 .... 31 .... .... — .... 51 .... .... .... 16 14 .... .... - .... .... .... .... .... .... .... 5 upwds. 73 31 8 State here whether "Notification of Infectious Disease" is compulsory in the District.— Yes. Since when?—January 1890. Besides the above-mentioned Diseases, insert in the columns with blank headings the names of any that are notifiable in the District, and fill the columns accordingly. State here the name of the Isolation Hospital used by the sick of the District. Mark (H) the Locality in which such Hospital is situated ; and if not within the District, state where it is situated.— Isolation Hospital within the District, situated at Coppett's Road, Muswell Hill. HENRY CLOTH1EK M D Lond