HORI BOROUGH OF HORNSEY. PUBLIC HEALTH AND HOSPITAL COMMITTEE. The Mayor (Alderman F. W. Lawson, J.P.). Chairman, Councillor C. D. Dixey. Alderman A. C. Melluish. Councillor G. A. Lewcock Councillor H. B. Brackenbury. (retired). „ H. E. Cooper. „ N. Reynolds. „ J. A. Hewson. „ W. T. Roberts. „ F. J. How. „ J. J. Toyne. „ R. Knox. „ J. M. Viney. J. F. Whyte and Councillor S. Wood (retired November, 1904). MEDICAL OFFICER OF HEALTH'S DEPARTMENT. Chief Sanitary Inspector Mr. W. Thorpe (Assoc. Royal San. Inst. Assistant do. Mr. W. H. Perks (Cert. Royal San. Inst.) Clerk Mr. S. Gilbert. Matron of the Borough Hospital. Miss A. Giles. Veterinary Inspector under Contagious Diseases of Animals Acts Mr.Wm. Lewis, M.R.C.V.S. Inspector under Shop Hours' Acts Mr. A. L. Bridge. Do. Employment of Children Act Mr. F. J. Pateman. Medical Officer of Health and Medical Superintendent of Borough Isolation Hospital Harold Coates, M.D., D.P.H. 2 To His Worship the Mayor, the Aldermen and the Members of the Council of the Borough of Hornsey. Gentlemen, I beg to present to you my Report on the Health of the Borough of Hornsey for the year 1904. The vital statistics of the Borough are extremely favourable. The general death-rate is almost the lowest on record, and easily the lowest of all the large towns. The infantile mortality is also very low, compared with other districts, although much of the present mortality is due to preventible causes. The incidence of infectious disease has been below the average. Almost the only point to which one cannot allude with feelings of satisfaction is the increased mortality from tuberculosis. Probably from 250 to 300 persons in the Borough are suffering from tuberculosis, 75 per cent. of these being affected with tuberculosis of the lungs, or consumption, as it is popularly called. In some towns a scheme for the voluntary notification of cases of consumption has been adopted. It has been the experience of most towns that a purely voluntary scheme largely fails, because, as long as notification is not compulsory, it is almost confined to poor law patients, and patients in the very poorest districts. This means that in Hornsey such a scheme would be almost inoperative. Much is to be hoped from the establishment of a Sanatorium, such as the proposed Middlesex Sanatorium, and a scheme of voluntary notification of consumption may be adopted in conjunction with this, with a better prospect of doing good. I am, Gentlemen, Your obedient Servant, HAROLD COATES. 3 BOROUGH OF HORNSEY, Summary of Statistics. Area in acres 2,874 Rateable value £603,431 Population Census 1901 72,056 Estimated Population 1904 84,227 Number of persons per acre, 1904 29.4 „ „ „ house, 1904 5.741 Estimated birth-rate per 1,000 living, 1904 19.69 Average birth-rate for previous 10 years 21.04 Estimated death-rate per 1,000 living, 1904 8.19 Average death-rate for previous 7 years 8.77 Deaths under 1 year of age, per 1,000 births, 1904 86 Death-rate from Zymotic diseases 1904 0.81 Infectious Disease (Notification) Act, 1889, adopted October, 1889. Infectious Disease (Prevention) Act, 1890, adopted October, 1890. Public Health Acts Amendment Act, 1890, Parts 2, 3 and 5 adopted October, 1890. Housing of the Working Classes Act, 1890, Part 3, adopted July, 1896. Population.—In a suburban district like Hornsey it becomes increasingly difficult to form a correct estimate of the population the longer the period which has elapsed since the census year. The method adopted by the Registrar General for estimating the population is based on the assumption that the present rate of 4 increase is the same as in the intercensal period 1881-1891. Calculated in this way, the estimated population of Hornsey at the middle of 1904 was 81,221. Owing to the extensive building operations that have gone on during the last few years in the districts surrounding London, it is considered that the Registrar General's method will not give a sufficiently accurate estimate of the population, and that a nearer approximation to the true figure will be got by basing the estimate on the number of inhabited houses. This estimate assumes that the average number of persons per inhabited house is the same now as in 1901, and on this basis the population of Hornsey at the middle of 1904 would be 84,227. At the date of the census the population was 72,056, so that the population of the Borough is estimated to have increased by 12,171 persons during the 3¼ years from April 1st, 1901, to June 30th, 1904. The following table shows the estimated population in each ward:— Ward. Number of inhabited houses, June 30th, 1904. Number of persons per house. Estimated population, 1904. Highgate 1,869 6.356 11,879 Muswell Hill 1,845 5.396 9,955 Crouch End 956 5.536 5,292 West Hornsey 1,852 6.012 11,134 East Hornsey 2,023 6.012 12,162 North Haringey 1,849 5.574 10,306 South Haringey 1,145 5.145 5,891 Stroud Green 1,917 5.384 10,352 Finsbury Park 1,213 5.982 7,256 Hornsey 14,669 5.741 84,227 The land area of the Borough is 2,863.4 acres, so that the density of population is equal to 29.4 persons per acre. The density of population in the Wards is given in the following table: — 5 Ward. Area in acres. Population. Number of persons per acre. H ighgate 709.5 11,879 16 Muswell Hill 663.5 9,955 15 Crouch End 376 5,292 13 West Hornsey 227.5 11,134 49 East Hornsey 195.5 12,162 62 North Haringey 125 10,306 82 South Haringey 109 5,891 54 Stroud Green 269 10,352 38 Finsbury Park 199 7,256 36 2,874 84,227 294 The most rapidly growing Ward is Muswell Hill, where very extensive building operations have been carried out in recent years. West Hornsey is also increasing at a good rate, and in Highgate also the increase is considerable. In Crouch End and Stroud Green and East Hornsey the increase is less marked, while in North and South Haringey and Finsbury Park the change in numbers is trifling, and, indeed, in South Haringey there is apparently a slight decrease in numbers. In these last mentioned Wards there is no room for the erection of new houses, and increase of population, if it occurs at all, must be by an increase of the number of inhabitants per house, either by the conversion of single houses into two or more flats, or by the accommodation of lodgers. It is a general impression that the number of inhabitants per house is on the increase in certain districts, particularly in South Haringey, and probably the population of this Ward is underestimated. We cannot definitely prove or disprove this until after the next census, unless an independent enumeration is undertaken. The desirability of a more frequent census is generally admitted. 6 The following table shows the Ward populations at the census, the estimated population 1904, and the increase (or decrease) in 3¼ years:— Ward. Population, Census 1901. Estimated Population. June 30th, 1904. Variation in Increase. 3¼ years. Decrease. H ighgate 10,176 11,879 1,703 Muswell Hill 5,833 9,955 4,122 Crouch End 4,761 5,292 531 West Hornsey 11,134 ) 18,662 4,634 East Hornsey 12,162 ! North Haringey 10.129 10,306 177 South Haringey 5,917 5,891 26 Stroud Green 9,356 10,352 996 Finsbury Park 7 222 7,256 34 72,056 84,227 Births.—The number of births recorded during 1904 was 1,659, being 88 more than the number registered in 1903. Twelve of these births occurred in the Edmonton Workhouse. This gives a birth-rate of 19.69 per thousand persons living in 1904, as compared with 19.91 in 1903. The accompanying chart shows graphically the great, and almost continuous, decline in the birth-rate during the last 23 years:— 7 8 The birth-rates in certain other towns are given below:— Towns of approximately equal London and Greater London population to Hornsey. London 28.00 Reading 25.87 Croydon 26.10 Wolverhampton 29.80 Willesden 32.86 Coventry 31.40 Tottenham 29.50 St. Helens 37.33 West Ham 32.16 Huddersfield 23.70 East Ham 31.70 York 28.15 Leyton 30.70 Newport 32.70 Walthamstow 32.79 Swansea 30.50 Hornsey 19.69 Stockport. 26.63 Rochdale 22.80 England and Wales 27.9 76 Great Towns 29.1 Deaths. —The total number of deaths registered within the Borough during 1904 was 660, being 71 in excess of the number registered in 1903. There were also 28 deaths in the Edmonton Workhouse of persons belonging to Hornsey, 4 deaths in the Middlesex County Asylum at Wandsworth, and one death of a Hornsey resident in a Hospital outside the district. These must be added to the number of deaths registered. There are to be deducted 2 deaths of Finchley patients in the Borough Hospital and one death, being that of a child belonging to another district, which occurred in one of the public institutions in the Borough. The nett number of deaths, therefore, is 690. This is equal to a death-rate per thousand persons living of 8.19. This compares with a corresponding death-rate of 7.69 for the previous year. The death-rate for 1904 is the second lowest on record, and is only 0.50 per thousand above the death-rate for 1903, which is the lowest ever recorded in Hornsey. The accompanying chart shows graphically the variations in the death-rates for the past 23 years:— 9 10 1904. 1903. The death.rate in Hornsey during the first quarter was 8.45 9.26 „ „ second „ 8.45 7.42 „ „ third „ 7.59 6.76 „ „ fourth „ 8.26 7.32 The following table gives the deaths which have been registered in each Ward during the four quarters of the year, with the corresponding death.rates:— Ward. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total Deaths. Death rate per 1,000 persons living. Deaths. Death rate. Deaths. Death rate. Deaths. Death rate. Deaths. Death rate. Highgate 20 6.73 26 8.75 31 10.43 27 9.09 104 8.75 Muswell Hill 17 6.81 21 8.43 13 5.22 27 10.84 78 7.83 Crouch End 9 6.80 5 3.77 5 3.77 7 5.29 26 4.91 West Hornsey 29 1041 38 13 65 23 8.26 34 12.21 124 11.13 East Hornsey 24 7.89 27 8.88 32 10.52 18 5.92 101 8.30 North Haringey 26 10.09 25 9.70 25 9.70 25 9.70 101 9.80 South Haringey 15 10.18 5 3.39 8 5.43 8 5.43 36 6.11 Stroud Green 21 8.11 13 5.02 11 4 .25 11 4.25 56 5.40 Finsbury Park 17 9.37 18 9.92 12 6.61 17 9.37 64 8.82 Total deaths 178 8 .45 178 8.45 160 7.59 174 8.26 690 8.19 The deaths in public institutions have been referred to the Wards from which the patients were removed, on entering the public institutions. The Ward death.rates for the last 4 years are as follows: 11 Ward. Death rates per 1,000 1904. 1903. 1902. 1901. Higligate 8.75 7.47 9.66 7.80 Mils well Hill 7.83 4.81 6.54 6.38 Crouch End 4.91 5.69 6.47 6.68 We9t Hornsey 11.13 9.34 9.43 9.34 East Hornsey 8.30 North Haringey 9.80 9.30 7.97 6.58 South Haringey 6.11 607 510 7.95 Stroud Green 5.40 5.23 5.54 8.48 Finsbury Park 8.82 8.67 12.63 9 64 Every census return shows that the death.rate among persons of the middle ages is lower than the rates among persons at the two extremes of age, and, further, that for nearly all ages the death.rate of females is lower than that of males. Consequently an excess of females, and especially of young adult females (as occurs in Hornsey, which is largely a residential neighbourhood, with a large number of domestic servants), must tend to lower the death.rate of the district, apart from other considerations which might affect the death.rate. To enable a more correct comparison to be made between different districts, a correction is applied to the death.rate as calculated on the nett number of deaths, which has the effect of eliminating any differences that arise from variations in the age and sex distribution of the population. The effect of this correction is to raise the death.rate of places like Hornsey, which have an unduly favourable class of population (as far as age and sex is concerned) and to lower the death.rate of places which have an excess of infants, or old people, or an excessive male population. The following table gives the recorded and the corrected death. rates in the 76 great towns (as far as they are at present to hand): 12 Death rate per 1,000 persons living. Town. Recorded death rate. Death rate corrected for age and sex distribution. Hornsey 8.19 9.34 King's Noiton 11.02 11.53 Tottenham 11.50 12.40 Walthamstow 11.95 12.78 Barrow-in-F urness 12.04 Willesden 12.22 13.10 Smethwick 12.40 13.54 Hastings 13.14 12.65 East Ham 13.50 14.40 Croydon 13.80 14.20 Southampton 13.83 13.76 Reading 13.89 14.39 Leicester 14.56 15.55 Wolverhampton 14.61 15.29 Burton-on-Trent 15.05 16.54 Derby 15.15 16.33 Cardiff 15.20 16.50 Bristol 15.44 15.86 Halifax 15.50 16.60 Coventry 15.52 15.54 Newport (Mon.) 15.70 17.00 West Bromwich. 15.90 16.05 Wallasey 16.05 17.57 London 16.10 17.00 York 16.18 16.66 West Hartlepool 10.30 14.20 West Ham 16.76 17.91 Bolton 16.90 19.12 Great Yarmouth 17.02 15.62 Bury 17.14 19.20 Blackburn 17.20 19.40 Nottingham 17.50 18.40 Huddersfield 17.51 18.81 Bradford 17.54 19.39 Swansea 17.70 18.90 Preston 17.83 19.52 Leeds 17.92 19.56 Hull 18.00 18.20 South Shields 18.10 19.20 Oldham 18.30 20.60 Bootle 18.61 20.56 Plymouth 18.74 18.21 Rhondda 19.10 21.00 Birmingham 19.30 20.80 Sunderland 19.40 20.00 Tynemouth 19.44 20.06 Wigan 19.46 21.49 13 Death rate per 1.000 persons living. Town. Recorded death rate. Death rate corrected for age and sex distribution.[] Warrington 19.47 21.00 Merthyr Tydfif 19.70 20.86 Birkenhead 19.87 21.20 Middlesborough 19.94 20.00 Stockport 19.98 21.56 St. Helens 20.39 22.10 Salford 21.00 23.22 Hanley 21.20 23.13 Liverpool 21.90 23.40 England and Wales 16.20 — 76 Great Towns. 17.20 — The following table shows the crude and corrected death-rates in Hornsey for past years:— Crude death rate. Recorded death rate (Corrected for Institutions). Death rate corrected for age and sex distribution. 1882 11.90 1883 12.70 1884 13.34 1885 12.66 1886 11.82 1887 11.57 1888 10.18 1889 9.45 1890 11.20 1891 (Census taken) 11.11 1892 10.78 1893 10.90 1894 9.42 1895 10.15 1896 8.88 1897 8.54 8.86 9.98 1898 8.94 9.22 10.39 1899 10.08 10.25 11.55 1900 8.77 8.84 9.96 1901 (Census taken) 8.12 8.38 9.56 1902 8.20 8.44 9.63 1903 7.51 7.69 8.87 1904 7.81 8.19 9.34 Causes of Death.—The relative importance of the various diseases, as causes of death, is shown graphically below:— 14 Fewer deaths occurred from the following causes as compared with 1903:— 1904. 1903. Decrease. Whooping Cough 17 19 2 Diphtheria 7 8 1 Cancer 49 62 13 Debility from birth 17 22 5 From Scarlet Fever (1) and Epidemic Influenza (14) the number of deaths during 1904 was the same as in the preceding year. From the following causes there were more deaths than in 1903:— 1904. 1903. Increase. Measles 18 15 3 Enteric Fever 2 1 1 Diarrhoea 24 1 23 Enteritis 19 7 12 Phthisis and other Tubercular Diseases 77 66 11 Bronchitis and Pneumonia 109 85 24 Alcoholism and Cirrhosis of the Liver 15 8 7 Premature birth 24 22 2 Heart diseases 64 52 12 Accidents and Suicides 14 11 3 15 Measles and Whooping Cough have between them caused 35 deaths, and of these 34 have been deaths of children under 5 years of age. As these diseases are not compulsorily notifiable, we have no direct information as to the number of children who have been affected with one or other of these diseases during the year, but, taking an average case mortality, the number cannot be less than 1,000, and is probably more. There is no doubt that much of this serious amount of illness is caused by school infection, and is directly due to the practice of sending children of 3 and 4 years of age to the public elementary schools. The heavy incidence of the diseases, and the large number of deaths caused annually, are very strong reasons for prohibiting the admission of children under 5 years of age to the public elementary schools. Epidemic Diarrhcea caused 24 deaths, 21 of these deaths being of infants under one year of age. In 1903 only one death arose from this cause, and in preceding years, 1 (1902), 6 (1901), 9 (1900), 32 (1899), 15 (1898) and 29 (1897). This is a disease which has been found to be very largely influenced by climatic conditions. In summers with a very heavy rainfall and with no considerable spells of hot weather, as in 1901 and 1902, few deaths are recorded from this cause, whereas in hot summers the disease is prevalent. There is no doubt that the disease is due to food contamination, the food most largely concerned being milk. It has been suggested that flies play an important part in carrying infected matter to milk stored in open vessels, and other 16 channels of contamination include dirty vessels, dust blown in from streets and passages. Hence all milk should be kept in covered vessels, to protect it from flies and dust. Strict cleanliness, personal or otherwise, is essential. The cleansing and watering of streets and passages in hot, dusty weather is very important. The surfaces of yards and about gullies should be kept repaired with impervious material so as to prevent saturation of the soil with organic liquids. The Wards in which the deaths from diarrhoea occurred were, Highgate 3, Muswell Hill 1, Crouch End 0, West Hornsey 8, East Hornsey 6, North Haringey 3, South Haringey 1, Stroud Green 1 and Finsbury Park 1. Diphtheria caused 7 deaths, out of 101 cases notified. This is one less than the number of deaths from the same cause in the previous year. The case mortality is equal to 6.93 per cent. Three of the deaths occurred in the Hospital, out of 59 cases removed from Hornsey, equal to a mortality of 5.09 per cent. Four of the deaths occurred among the 42 cases treated at home, being equal to a mortality of 8.14 per cent. Enteric Fever caused 2 deaths, out of the 16 cases notified, this being a case mortality of 12.5 per cent. Pulmonary Consumption.—54 deaths occurred from consumption of the lungs, and 23 deaths from other tubercular diseases, making a total of 77 deaths from tuberculosis during the year. That is to say, one death out of every nine that occurred was due to tuberculosis. If we examine the ages at death, we find that the majority of deaths occur in the middle period of life. Years 1-15 15-25 25-35 35-45 45-55 55-65 over 65 Deaths from Phthisis 1 15 8 14 9 2 5 17 Year. Number of deaths from consumption of the lungs. Death rate per 1,000 persons living from consumption of the lungs. Death rate per 1.000 persons living from all tubercular diseases. Total deaths from the 7 principal zymotic diseases, viz. :--Diphtheria, Scarlet Fever. Diarrhoea, Whooping Cough, E iteric Fever, Measles, and Small Pox. Death rate per 1,000 persons living, from the 7 principal zymotic diseases, viz.:— Diphtheria, Scarlet Fever, Diarrhoea, Whooping Cough, Enteric Fever, Measles, and Small Pox. 1904 54 •653 •914 69 •819 1903 46 •591 •842 48 •613 1902 45 .595 •886 33 •436 1901 45 •612 •857 40 •544 1900 87 •525 •688 52 •738 1899 56 .828 65 •961 1898 36 •556 52 •803 1897 43 •694 64 1.036 1896 30 •527 58 •985 1895 43 •769 — 60 1.073 1894 40 •768 58 1.095 1893 35 •700 47 •938 The death-rate from Phthisis, and from all forms of Tuberculosis, is shown in the above table, side by side with the total death-rate from the seven principal zymotic diseases. It will be seen that tuberculosis is more deadly than all the commoner infectious diseases put together, and that in 1901 and 1902 the deaths from Consumption of the lungs alone exceeded in number the deaths from the seven principal zymotic diseases. Among infectious diseases, tuberculosis is the disease about which our knowledge is greatest, and therefore the disease towards the prevention of which most ought to be accomplished. In the case of the commonest form of tuberculosis, consumption of the lungs, it has been shown that infection is spread by the dissemination of minute particles of sputum during the acts of coughing or speaking, and by spitting under conditions which favour the drying of the sputum, and its subsequent pulverisation and dispersion in the air. 18 By proper care and training sufferers from consumption can be taught to so conduct themselves as to avoid the danger of infecting their fellow workers, or members of the family or others brought in frequent association with them. The adoption of such measures also promotes the ultimate recovery of the patient, as constant self re-infection is prevented. One of the great benefits to be expected of the proposed Sanatorium for Middlesex is the education of patients, so that on their discharge they will not be a source of danger to those around them. There is a considerable reduction in the number of deaths from Cancer (49) as compared with the previous year (62). The following table shows the Wards in which deaths from Cancer have occurred during the last 5 years:— Year. Highgate. Muswell Hill. Crouch End. West Hornsey. East Hornsey. North Harinjjey. South Haringey. Stroud Green. Finsbury Park. Total. Death rate per 1000 .from Cancer. 1904 7 8 3 7 5 5 2 5 7 49 •581 1903 6 4 6 12 15 6 7 6 li'2 •790 1902 8 3 •2 15 8 1 8 6 51 •674 1901 8 ' 3 1 5 6 •5 11 8 47 •653 1900 5 5 •2 8 3 4 9 5 41 •581 Although much patient work has been done to investigate the cause of cancer, we possess very little information, and are able to do practically nothing in the way of prevention. In a number of cases we have disinfected bedding and clothing at houses where a death from cancer has occurred. The Zymotic death-rate is the total number of deaths, per 1,000 persons living, from the 7 principal zymotic diseases, viz.:— Small-pox, Measles, Scarlet Fever, Diphtheria, Enteric Fever, Whooping Cough and Diarrhoea. The following table gives the number of deaths from these causes during 1904 and the 10 preceding years:— 19  1904 1903 1902 1901 1900 1899 1898 1897 1896 1895 1894 Small-pox 0 0 2 0 0 0 0 0 0 0 0 MeaBles 18 15 7 8 4 6 14 7 6 13 5 Scarlet Fever 1 1 2 0 I 3 0 2 8 3 1 Diphtheria 7 12 9 10 14 4 11 16 12 21 23 Enteric Fever 2 0 5 2 6 0 4 0 6 5 6 Whooping Cough 17 19 9 14 18 20 8 10 17 10 22 Diarrhoea 24 1 1 6 9 32 15 29 9 8 1 Totals 69 48 35 40 52 65 52 64 58 60 58 The Zymotic death-rates in Hornsey and in England and Wales for the past years are as follows:— Zymotic death rate Hornsey. England and Wales. 1904 0.81 1.94 1903 0.61 1.46 1902 0.44 1.64 1901 0.54 2.05 1900 0.66 2.00 1899 0.89 2.21 1898 0.74 2.22 1897 0.98 2.15 1896 0.93 2.18 1895 1.11 2.14 1894 1.12 2.25 1893 0.96 3.16 1892 0.94 2.76 1891 0.70 1890 1.15 1889 0.60 1888 1.05 1887 0.88 1886 1.42 1885 1.80 1884 1.91 1883 1.05 1882 1.77 The increase in the zymotic death-rate for the year 1904 as compared with the years immediately preceding it is almost entirely due to the absence of the summer outbreak of Diarrhoea in those years. 20 Measles is responsible for a larger number of deaths than in any of the 10 years since 1894. Nearly all the deaths were of children between 1 and 5 years of age (15 out of 18), and this heavy mortality is largely due to the increasing popularity of the practice of sending children of 3, 4 and 5 years of age to the day schools. The same remarks apply largely in regard to whooping cough, which caused 17 deaths. There was only one death from Scarlet Fever, that of a child in the East Hornsey Ward. There were 7 deaths from Diphtheria, three of them being deaths of Hornsey patients in the Isolation Hospital, 4 of patients not removed to the Hospital. Enteric Fever caused 2 deaths, one in the Hospital and one outside. Ages at Death.—The ages at which deaths occurred are as follows:— 1904. 1903. Under 1 year 145 132 1 year and under 5 years 66 53 5 years and under 15 „ 24 17 15 „ 25 „ 28 19 25 „ 65 „ 203 216 65 years and over 224 167 Total deaths 690 604 More than half the total number of deaths was of persons at the extreme ages, i.e., under one year, or 65 years and over. Nearly one-third (32.4 per cent.) of the deaths were of persons of 65 years of age or over. The principal causes of death among persons of 65 years and over were Cancer 28, Bronchitis 38, and Heart diseases 31. Less frequent causes of death among this section of the population were Influenza 7, Phthisis 5, and Pneumonia 7. 21 The accompanying chart shows graphically the variations in the infantile mortality for 11 years:— 1904 1903 1902 1901 1900 1899 1898 1897 1896 1895 1894 INFANTILE MORTALITY. Total number of Deaths under 1 year of age 143 130 129 127 153 156 158 138 133 144 103 ,, „ „ Births registered 1,659 1,561 1,565 1,511 1,493 1,461 1,342 1,337 1,294 1,142 1,186 Infantile mortality (deaths per 1 000 births) 86 83 82 84 102 106 117 103 102 133 86 ,, ,, England and Wales 146 132 133 151 154 „ „ 76 Great Towns 160 144 145 22 23 The principal causes of death among infants under one year of age were:— Equal to a death rate per 1,000 births of Measles 2 1.20 Whooping Cough 9 5.68 Diarrhoea 21 12.64 Enteritis 11 6.88 Tubercular diseases 5. 3.00 Bronchitis & Pneumonia 20 12.01 Premature birth 24 14.96 Debility 22 13.76 Accident 2 1.20 The infantile mortality of London and Greater London and of a number of towns of population approximately equal to that of Hornsey is shown in the following table:— London and Greater London. Towns of approximately equal population to Hornsev. London 144 Reading 133 Croydon 129 Wolverhampton 152 Willesden 115 Coventry 137 Tottenham 138 St. Helens 174 West Ham 165 Huddersfield 136 East Ham 140 York 170 Leyton 138 Newport 149 Walthamstow 135 Swansea 172 Hornsey 86 Stockport 201 Rochdale 152 England and Wales 146 76 Great Towns 160 Compared with other towns, the infantile mortality may be considered a very low one. Nevertheless, nearly one-fourth of the total deaths are those of infants under one year of age. The deaths from diarrhoea, enteritis and debility are to be chiefly associated with improper feeding or want of cleanliness, and an effort is being made to bring about an improvement in these respects. 24 By the instructions of the Public Health and Hospital Committee I have drawn up and had printed a leaflet giving simple directions as to the feeding and care of infants, and, by the kind co-operation of the Lady District Visitors connected with the Churches in the poorer parts of the Borough, a large number of the leaflets were distributed in those homes where they were most likely to prove useful. Notification of Infectious Disease.—The cases of infectious disease notified to the Medical Officer of Health during 1904 number 359, as compared with 309 in 1903, 466 in 1902 (excluding cases of Chicken Pox), and 725 in 1901. The following table gives the cases notified during the past years:— Disease. 1904 1903 1902 1901 1900 1899 1898 1897 1896 1895 1894 Scarlet Fever 197 203 261 501 186 "49 168 264 530 420 189 Diphtheria 101 62 99 134 107 101 99 87 96 93 117 Enteric Fever 16 15 38 35 32 22 31 31 35 48 44 Puerperal Fever 5 2 0 5 2 1 0 2 5 4 6 Erysipelas 40 25 33 40 45 42 51 39 39 45 51 Small Pox 0 2 35 10 0 2 0 0 4 5 3 Total 359 3i 9 639 725 372 517 349 423 709 615 410 The number of cases is 50 greater than in the previous year, but, with the exception of 1903, is smaller than in any year of the 10 years preceding 1904. 62 cases of infectious disease were reported during the first quarter of the .year. 60 cases of infectious disease were reported during the second quarter of the year. 97 cases of infectious disease were reported during the third quarter of the year. 140 cases of infectious disease were reported during the fourth quarter of the year. The following table gives in detail the cases of infectious disease notified for each quarter of the year:— 25  Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Small-Pox. Puerperal Fever. Chicken Pox. 1904 1 03 1902 1901 1904 1903 1902 1901 1904 1903 1902 1901 1904 1903 1902 19C1 1904 190 i 1902 1901 1904 1903 1902 1901 1904 1903 1902 1901 During 1st quarter 29 56 88 53 15 20 31 19 5 3 7 4 13 4 7 7 — 2 15 - — 2 — 1 — — 31 — During 2nd quarter 35 58 60 84 13 15 28 23 4 3 8 3 7 6 7 12 — — 19 - 1 — — 2 — — 107 During 3rd quarter 54 49 44 159 32 18 16 36 4 6 8 13 6 9 9 12 — — 1 — 1 — — 1 — — 35 — During 4th quarter 79 40 69 205 41 9 24 56 3 3 15 15 14 6 10 9 — — - 10 3 - — 1 -- - - — Total 197 203 261 501 101 62 99 134 16 15 38 35 40 25 33 40 — 2 35 10 5 2 - 5 — - 173 — The occurrence of the cases in the different Wards is shown in the following table:— Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Small Pox. Puerperal Fever. Total. Highgate 23 29 1 9 — — 62 Muswell Hill 13 10 2 2 — 1 28 Crouch End 8 1 1 — — — 10 West Hornsey 59 20 3 5 — 1 88 East Hornsey 22 10 2 6 — 1 41 North Haringey 17 12 — 5 — — 34 South Haringey 11 11 1 2 — — 25 Stroud Green 19 4 5 7 — 1 36 Finsbury Park 25 4 1 4 — 35 Total 197 101 16 40 — 5 359 26 27 The attack rate per 1,000 of the population for the chief of ???ese diseases during the last six years was as follows:— 1904 1903 1902 1901 1900 1899 Scarlet Fever 2.33 2.58 3.45 6.81 2.63 5.16 Diphtheria 1.19 0.79 1.81 1.82 1.52 1.49 Enteric Fever 0.18 0.19 0.50 0.47 0.45 0.32 Erysipelas 0.47 0.31 0.43 0.53 0.63 0.61 Small Pox 0 0 .006 0.47 0.13 0 0.019 Scarlet Fever shows a decrease of 6 in the cases notified, and of 0.25 in the attack rate. The type of the disease was for the most part very mild, only one death having occurred. The cases were most numerous in the second half of the year, and the West Hornsey Ward was the district chiefly affected. However, taking increased population into account, the prevalence of Scarlet Fever during 1904 was much below the average year. Diphtheria also was more prevalent in the second than in the first half of the year. But with this disease also the number of cases was relatively smaller than usual. Highgate Ward suffered more than the others, owing to an outbreak connected with one of the day schools there. The number of cases of Enteric Fever was considerably below the average. Two of the 16 cases notified proved fatal. Source of infection. Two of the patients were infected while travelling abroad, two others while at the seaside, and three other patients at other places outside the Borough, making altogether seven imported cases out of the 16 notified. Of the cases arising within the district there is some evidence that one of these was due to the consumption of shell fish. Erysipelas, though showing an increase over the previous year, is below the average for recent years. There was no case of Small Pox notified during the year. 28 Mr. Dew, the Vaccination Officer, has supplied me with the following particulars as to Vaccination, for the 12 months ended December 31st, 1904: — Number of births notified to Vaccination Officer 1,625 Successfully vaccinated 1,016 Insusceptible to vaccination 11 Dead unvaccinated 96 Exempted through "Conscientious objection" 25 Postponed by Medical Certificate 38 Left the district and reported elsewhere 15 Lost sight of 67 Unaccounted for 357 1,625 1,625 If we deduct those who died, who left the district and were elsewhere reported, those who were insusceptible, and those in whom the operation was postponed by Medical Certificate, altogether 160, we find that 1,016 children were vaccinated out of a possible 1,465, or about 69 per cent. Isolation Hospital. 1904 1903 Patients in Hospital January 1st 24 43 ,, admitted during the year 341 253 . 365 . 296 ,, discharged during the year 305 263 ,, dying during the year 7 9 . 312 . 272 ,, remaining in Hospital December 31st 53 24 Of the 24 patients in the Hospital on January 1st, 1904, 14 were cases of Scarlet Fever and 10 were cases of Diphtheria. The following table shows the number of cases admitted dur. ing each of the twelve months of the year, for each of the diseases treated:. 29  Hornsey Cases. Finchlry Cases. Grand Total for the month. Scarlet Fever. Diphtheria. Enteric Fever. Total. Scarlet Fever. Diphtheria. Enteric Fever. Total. January 7 3 0 10 9 4 1 14 24 February 8 2 0 10 3 6 0 9 19 March 7 4 1 12 8 4 0 12 24 April 12 2 0 14 6 4 0 10 24 May 6 0 0 6 0 2 0 2 8 June 9 2 0 11 16 1 0 17 28 July 6 2 0 8 16 4 0 20 28 August 13 8 2 23 10 1 0 11 34 September 20 12 0 32 9 0 1 10 42 October 13 3 0 16 13 5 0 18 34 November 17 7 0 24 10 2 0 12 36 December 15 11 0 26 11 3 0 14 40 Total for the year 133 56 3 192 111 36 2 149 341 Of the total number of cases admitted during the year (341), 149 were from Finchley, and 192 from Hornsey. The Finchley cases were, therefore, nearly 44 per cent. of the total cases admitted. The number of cases admitted per month varied from 8 during May to 40 during December, but averaged about 28 per month. Speaking generally, cases from both districts were more numerous in the second half of the year, but the periods of maximum demand do not strictly correspond. Thus the average monthly admissions for Hornsey was 16 and for Finchley 12½ The months during which the admissions were above the average were : — HORNSEY. FINCHLEY. August. January. September. June. November. July. December. October. December. 30 The heaviest month for Finchley (July 20 cases admitted) happened to be nearly the lightest month for Hornsey (8 cases admitted), and Hornsey's heaviest month (September 32 cases admitted) was a month in which the number of Finchley cases admitted was below the average (10 cases admitted). Cost of Maintenance of Patients and Resident Staff at the Hospital.—This works out at 7s. 7d. per head per week, as compared with 8s. 7¼d, for the previous year, and 8s. 2d. for 1902. Scarlet Fever. Number of cases notified in Hornsey 197 Number of cases removed to the Borough Hospital 133 The proportion of cases removed to the Borough Hospital was about 67 per cent. of the cases notified. In addition to the 133 cases removed from Hornsey, there were 111 cases of Scarlet Fever admitted to the Hospital from Finchley, making 244 cases of Scarlet Fever admitted during the year. There were two deaths during the year, one being a Finchley patient and one a Hornsey patient. Diphtheria.—There were 102 cases of Diphtheria under treatment during the year, 59 being Hornsey patients, and 43 from Finchley. Of these 4 patients died, 3 of the fatal cases being Hornsey patients and one from Finchley. Of the 4 fatal cases, 3 were admitted at such a late stage of illness as to be incapable of deriving benefit from antitoxin treatment, and, in fact, were practically moribund. One patient was sent in suffering from extreme laryngeal obstruction, and tracheotomy was performed shortly after admission, and the patient made a good recovery. The following table gives the number of cases of Diphtheria notified in Hornsey and the cases admitted to Hospital and the mortality for each year since the Hospital was opened:—  1889 1890 1891 1892 1893 1894 1895 1896 1897 1898 1899 1900 1901 1902 1903 1904 Number of cases of Diphtheria notified in Hornsey . 50 63 43 138 117 89 95 87 99 101 107 134 99 62 101 Death rate per 1,000 of the population . . . . . 0.43 0.37 0.20 0.25 0.17 0.05 0.19 0.10 0.11 0.10 0.08 Number of cases of Diphtheria admitted to the Isolation Hospital 3 1 20 2 15 29 8 24 15 45 37* 45* 30* 50* 71* 92* Mortality per cent. of cases treated in the Hospital 0 0 15% 50% 20% 24% 25% 4% 20% 13% 13% 11% 16% 14% 11% 4% * Cases admitted to Hospital from districts outside the Borough are included in these figures. 31 32 The number of outside cases were : — 1899 1 case from outside the Hornsey Borough (or Urban District) 1900 8 cases do. 1901 2 „ do. 1902 15 „ do. 1903 36 „ do. 1904 36 „ do. During 1904, out of 101 cases of Diphtheria notified in Hornsey, 56 (or 55 per cent.) were admitted to Hospital. Practically all the patients were treated with antitoxin. Typhoid Fever. —Five cases were removed to the Hospital during the year, 3 being from Hornsey and 2 from Finchley. Of the 5 cases one proved fatal. The following table shows the cases admitted from each district, and the number of deaths from each disease for the past 6 years: — NUMBER OF CASES TREATED. NUMBER OF CASES TREATED FROM DEATHS. Scarlet Fever. Diphtheria. Typhoid Fever. Total. Finchley. Friern Barnet. Hornsey. Total. Scarlet Fever. Diphtheria. Typhoid Fever. Total. 1904 258 102 5 365 162 - 203 365 2 4 l 7 1903 204 82 10 296 92 l 203 296 1 8 - 9 1902 298 50 16 364 81 10 273 364 2 7 2 11 1901 349 31 7 387 2 2 383 387 - 5 - 5 1900 138 50 9 197 5 4 188 197 1 5 3 9 1899 177 39 - 216 1 2 213 216 3 5 - 8 33 34 FACTORY AND WORKSHOP ACT, 1901. Register of Workshops.—The number of workshops on the register at the end of 1904 was 231, a decrease of 43 as compared with the previous year. The decrease is due to the fact that during a systematic inspection of the workshops it was found that many workshops on the register had ceased to be used as such. These were chiefly small workshops used by dressmakers and milliners who employed one or two assistants, and who frequently change their addresses or leave the district entirely. The total number of workshops taken off the register on account of discontinuing the use thereof was 76. The new workshops added numbered 33, giving a net decrease as stated, of 43. The register now includes the following workshops:— 1904. 1903. 68 Dressmakers 109 20 Milliners 27 6 Bootmakers and repairers 8 7 Cycle makers and repairers 11 5 Farriers 5 3 Picture Frame Makers 4 3 Children's Outfitters 3 10 Tailors 8 16 Laundries 15 2 Tie makers 3 17 Restaurant Kitchens 14 40 Bakers 39 34 Miscellaneous 28 Sanitary Condition of Workshops and Workplaces.— The principal defect found on inspection was want of cleanliness. In 54 instances it was necessary to call the occupier's notice to the dirty condition of the premises, but in no case was there any further action necessary, as the matter received satisfactory attention. In 6 workshops the ventilation was inadequate, but in each case sufficient means of ventilation were provided on request. Overcrowding was not found to any considerable extent. In the 4 cases where there was some degree of overcrowding the nuisance was remedied. 35 In 8 out of the 16 laundries, the means provided for draining off the wet from the floors were insufficient. In every case the defects have been remedied. Home Work.—There are 36 persons on the list of Homeworkers, all except one being employed by firms not carrying on business in the Borough. Only two cases of infectious disease have occurred in homeworker's premises. In both cases the nature of the work and other circumstances made it necessary to prohibit the carrying on of the occupation for a time. Four written notices have been served in respect of defects, and were at once complied with. Bakehouses.—There are 40 bakehouses in the Borough, 6 of these being underground bakehouses. The latter were reported on in detail last year by Dr. Clothier, then Medical Officer of Health, and certificates granted in respect of 4 of them in 1904 and a fifth at the beginning of the year. The remaining bakehouse, No. 106, Archway Road, has been practically re-constructed, and has been made into one of the best of underground bakehouses, and has now been certified. Both underground and overground bakehouses have been frequently inspected. In one case the drainage arrangements were not satisfactory, and the drainage system has been re-constructed. In a few cases it has been necessary to require whitewashing to be done and accumulations of litter to be removed, but as a whole the premises are in a satisfactory condition and the business properly conducted. The dairies, milkshops and cowsheds, numbering 70, have been regularly inspected, and in 22 instances the attention of the occupier has been called to contraventions of the bye-laws and the matter remedied. It is worthy of note that the premises now on the list for periodical inspection (e.g., dairies, slaughterhouses, bakehouses, workshops, etc.) number 412. Twelve months ago the number of such premises was 152. 36 There has been a large increase in the number of preliminary notices issued (901 as compared with 340 in 1903) and of statutory notices (138 as against 73). In only 4 cases has it been necessary to proceed by summons before the Magistrates. One of these summonses was withdrawn on payment of costs by the defendant, and in the other cases the Magistrates granted the order asked for. Water Supply.—Nine samples have been sent to Professor Kenwood for analysis, and in each case a satisfactory report was made. Practically the whole of the Borough receives its water supply from the New River, but a few isolated cases have been discovered where the source of supply was a well sunk on the premises. Four of these have been found during the year and closed. Sale of Food and Drugs Acts.—The administration of these Acts rests with the Middlesex County Council. The Clerk to the County Council (Sir Richard Nicholson) has kindly supplied me with the following information as to samples of food taken by the County Council Inspector in the Borough of Hornsey during the 12A months ended December 31st, 1904 : — Article. No. Genuine. Adulterated. Summonses eforMafiis trates- Convictions. Dismissed or Withdrawn. Milk 172 168 4 4 3 1 withdrawn Butter 41 41 Margarine 5 5 Cocoa 2 2 Lard 17 17 Sugar 5 5 Pepper 8 8 Wines 4 4 Spirits 6 6 Drugs 12 12 Crushed linseed 6 6 Cheese 4 4 Sweets 2 2 Ground mace 1 1 Vinegar 1 1 Prawns 1 1 Fine oatmeal 2 2 Kidneys 1 1 Total samples 290 286 4 4 3 1 withdrawn 37 The samples found to be adulterated are equal to 1.4 per cent. of the total samples taken. The percentage of adulteration to samples taken for the country generally in recent years has been:— Per centage of adulteration. 1899 9.4 1900 8.8 1901 8.8 1902 8.7 1903 7.9 In Hornsey one sample was taken for every 290 of the population. This is a larger proportion than is taken in the country generally, but is about the same as the proportion taken in London. The number of samples of milk taken was 172. The number of registered milk sellers in the Borough is 66. There are, of course, many persons who sell milk in Hornsey whose premises are registered in other districts. Inspections under the Shop Hours Acts and Seats for Shop Assistants.—Mr. A. L. Bridge is the Inspector appointed under these Acts. During the 12 months ended December 31st, 1904, about 300 cards containing an abstract of the provisions of the Acts have been distributed. About 100 have been sent to replace those lost or destroyed. About 600 visits have been made under the Acts, but no direct infringement of the provisions of the Statutes has been discovered. The weekly half holiday has to a large extent been the means of causing compliance with the Statutory requirements. The limit of employment is 74 hours per week, including meal hours. The legal week for the purposes of the Statutes is from Saturday midnight to the following Saturday midnight. A typical example of the hours allowed by the Statutes is from 8 a.m. on the first five days of the week, to 8 p.m. in the evening, and from 8 a.m. to 10 p.m. on the remaining day. These hours are fairly long. Two complaints have been received, but after enquiry were found to be outside the scope of the Acts. 38 With regard to Seats for Shop Assistants, the Inspector finds that seats are universally provided. But it is rarely one finds them occupied. The statute applies to places where females are employed alone, and one seat is to be provided for every three persons. The statute aims at eliminating those very distressing maladies due to long and weary standing in shops, etc. Mr. Bridge remarks, "I have pleasure in calling attention to the humane in"stincts and kindness of heart of one gentleman in business in the "heart of Hornsey. He has a room set apart for rest and recrea"tion of his female employees, and he finds it pays, too, in the "increased energy and business ability exhibited." Diseases of Animals Acts.—Under the Rabies Order, 1897, 277 dogs have been seized during the 12 months ended December 31st, 1904. Of these 9 were claimed by the owners and 268, after being kept the requisite time and not being claimed, were destroyed. Glanders.—There have been twelve outbreaks of Glanders in the Borough. In each case the affected horses have been destroyed, and the premises disinfected, and a spread of the disease prevented. Eight of the cases occurred at the North Metropolitan Tramway Co.'s Stables at Finsbury Park. The other 4 cases were, 1 at North Hill, 2 at Victoria Terrace, Finsbury Park, and 1 at Duke's Head Yard, Highgate. The number of horses destroyed during the year was 12. The sidings, gangway, etc., at the Hornsey Station have been frequently inspected, and always found in a satisfactory condition. TABLE 1. VITAL STATISTICS OF WHOLE BOROUGH DURING 1904 AND PREVIOUS YEARS. Name of District:—HORNSEY. Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institu tions in the District. Deaths of Nonresi dents registered in Public Institutions in the District Deaths of Residents registered in Public Institu tions beyond the District. Nett Deaths at all Ages belonging to the under One Year of Age. at all A«es. Number. Rate.* Number. Rate per 1,000 Births registered. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1894 52,977 1,186 22.38 103 86 499 9.42 11 4 1895 55,908 1,142 20.43 144 126 565 10.15 7 2 1896 58,839 1,294 21.99 133 102 523 8.88 6 1 1897 61,818 1,337 21.64 138 103 528 8.54 3 5 25 548 8.86 1898 64,743 1,342 20.74 158 117 579 8.94 9 7 22 594 9.22 1899 67,664 1,461 21.60 156 106 68.2 10.08 8 5 17 694 10.25 1900 70,597 1,493 21.15 153 102 619 8.77 11 9 14 624 8.84 1901 73,649 1,511 20.55 127 84 597 8.12 5 2 22 617 838 1902 75,623 1,565 20.71 129 82 620 8.20 7 6 25 639 8.44 1903 78,452 1,561 19.91 130 83 589 7.51 13 7 22 604 7.69 Averages for years 18941903 ii6,017 1,389 21.04 137 98 580 8.78 8 4 — 617 8.77 1904 84,227 1,659 19.69 145 86 660 7.81 8 3 33 690 8.19 *Rates in columns 4, 8 and 13 calculated per 1,000 of estimated population. 1. Institutions within the District receiving sick and infirm persons from outside the District. Isolation Hospital, Muswell Hill. Cromwell House Convalescent Home. Santa Claus Home. All Saints' Convalescent Home. Union Workhouse not in Borough. Area of District in acres (exclusive of area covered by water) 2,863.441 Total population at all ages 72,0561 Number of inhabited houses 12,571 Average number of persons per house 5¾ At Census of 1901. 2. Institutions outside the District receiving sick and infirm persons from the District. Workhouse and Infirmary, Edmonton. Small Pox Hospital, Summers Lane, Finchley. Fever Hospital, Liverpool Road. Middlesex County Asylum, Wandsworth. The various general Hospitals in London. 3. Other Institutions, the deaths in which have been distributed among the several localities in the District. TABLE III. Cases of Infectious Disease notified during the Year 1904. Name of District:—HORNSEY. Notifiable Disease. Casks notified in Whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from each Locality 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 At all Ages. At Ages—Years. Highgate. Muswell Hill. Crouch End. West Hornsey. East Hornsey North Haringey. South Haringey. Stroud Green. Finsbury Park. Highgate. Muswell Hill. (H) Crouch End. West Hornsey. East Hornsey North Haringey South Haringey. Stroud Green. Finsbury Park. Under 1. 1 to 5 5 to 15 15 to 25 25 to 65 65 and upwards. Small-pox - - - - - - - — — — — — — — — — — — — — — — — — — Cholera — — — — — — — — — — — - - - - - - - - - - - - - - Diphtheria 101 — 29 51 10 11 — 29 10 1 20 10 12 11 4 4 18 3 - 17 8 4 5 - 1 Membranous croup - - - - - — — — - — — — — — — — — — — — — — — - - Erysipelas 40 1 1 4 2 29 3 9 2 — 5 6 5 2 7 4 - - - - - - - - - Scarlet fever 197 1 42 123 20 11 — 23 13 8 59 22 17 1 19 25 18 5 5 50 18 11 2 6 18 Typhus fever — — — — — — — — — — - - - - - - - - - - - - - - - Enteric fever 16 — 1 3 5 7 — 1 2 1 3 2 - 1 5 1 - - - 1 1 - 1 - - Relapsing fever — — - - - - - - - - - - - - - 1 - - - - - - - - - Continued fever — — - - - - - - - - - - - - - - - - - - - - - - - Puerperal fever 5 — — — — 5 — - 1 - 1 1 - - 1 - - - - - - - - - - Plague - - - - - - - - - - - - - - - - - - - - - - - - - Totals 359 2 73 181 37 63 3 62 28 10 88 41 34 25 36 35 36 8 5 68 27 15 8 6 19 The Isolation Hospital for the Borough is in Coppett's Road, Muswell Hill, N. TABLE IV.—CAUSES OF, AND AGES AT, DEATH DURING YEAR 1904. Name of District:—HORNSEY. Causes of Death. Deaths in or belonging to whole District at subjoined aoes. Death» in or belonging to Wards (at all Ages). Total Deaths in Public Institutions in the District. All ages. Under 1. 1 and under 5 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Highgate. Muswell Hill. Crouch End. West Hornsey. East Hornsey. North Haringey. South Haringey. Stroud Green. Finsbury Park. (1) (2) (3) (4) (5) (6) (17) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 18 2 15 1 .. .. .. 4 1 .. 7 4 .. 1 1 .. .. Scarlet fever 1 .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. 2 Whooping-cough 17 9 8 .. .. .. .. 4 l 1 6 2 2 .. 1 .. .. Diphtheria and membranous croup 7 .. 2 5 .. .. .. 4 .. .. .. 1 2 .. .. .. 4 Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Fever Typhus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric 2 .. 1 .. .. 1 .. .. .. .. 1 1 .. .. .. .. 1 Other continued .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic influenza 14 1 2 .. .. 4 7 .. 3 .. 3 1 2 .. 3 2 .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa 24 21 3 .. .. .. .. 3 1 .. 8 6 3 1 1 1 .. Enteritis 19 11 2 .. .. 2 4 4 l 2 4 4 3 .. 1 .. .. Puerperal fever 1 .. .. .. .. 1 .. .. l .. .. .. .. .. .. .. .. Erysipelas 1 .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. Other septic diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Phthisis (Pulmonary Tuberculosis) 54 .. .. 1 12 36 5 9 7 2 5 11 10 3 2 5 .. Other tubercular diseases 23 5 7 4 2 4 1 1 2 .. 8 7 2 .. 1 2 .. Cancer, malignant disease 49 .. .. .. .. 21 28 7 8 3 7 5 5 2 5 7 .. Bronchitis 66 14 4 .. .. 10 38 9 4 2 11 9 10 5 5 11 .. Pneumonia 43 6 11 1 2 16 7 5 2 2 14 4 7 .. 6 3 .. Pleurisy 1 .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. Other diseases of Respiratory organs 8 2 .. .. 1 2 3 .. 3 .. 2 .. .. .. 2 1 .. Alcoholism. Cirrhosis of liver 15 .. .. .. .. 12 3 1 1 .. 2 1 4 2 3 1 .. Venereal diseases 1 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. Premature birth 24 24 .. .. .. .. .. 1 7 1 3 3 4 3 1 1 .. Diseases and accidents of parturition 1 .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. Heart diseases 64 1 .. 1 1 31 30 13 8 4 2 10 12 4 4 7 .. Accidents 9 2 2 2 2 .. 1 .. .. .. 2 4 .. 3 .. .. .. Suicides 5 .. .. .. .. 5 .. 1 .. 1 1 .. .. 2 .. .. .. Debility from Birth 22 22 .. .. .. .. .. 5 2 .. 5 3 4 2 .. 1 1 All other causes 201 24 8 9 7 56 97 33 26 8 31 23 30 8 20 22 .. All causes 690 145 66 24 28 203 224 104 78 26 124 101 101 36 56 64 8 C (I.) COUNTY OF MIDDLESEX—SANITARY WORK, 1904. Name of Sanitary District. Inspections. Notices. Dwelling Houses. Houses let in separate Dwellings or Lodgings. Common Lodging Houses. Canal Boats used as Dwellings. Movable Dwellings, Caravans, Tents, &c. Complaints Received. Cases of Infectious Disease Notified. Number of Premises Periodically Inspected. Houses Inspected from Houseto-House. Total Number of Houses, Premises, &c., Inspected. Total Number of Re-inspections after Order or Notice. Total Number of Inspections and Re-inspections. Letters Written. Cautionary Notices given. Statutory Orders Issued. Summonses Served. Convictions Obtained. House:,, 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. Ntimber Registered under Bye-laws. Periodical Frequency or Number of Inspections. Number of Contraventions. Numbn* 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. 251 359 412 471 2,243 4,936 7,179 1,613 901 138 4 341 Summons withdrawn on payment of costs. 110 - - 2 - - - - - - - - - - - - - C (II). COUNTY OF MIDDLESEX.—SANITARY WORK, 1904. Name of Sanitary District. Schools. Workshops and Work-places. Laundries. Bakehouses. Slaughter Houses. Cow-sheds. Dairies and Milk-shops. Uns'nd Food. Adulterated Food. Offensive trades. Mortuaries. 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. Number of bodies received. HORNSEY. 56 10 0 231 570 67 20 Frequently. 15 40 96 20 10 59 15 4 9 0 66 162 22 0 6 290 4 0 0 0 6 42 C (III). COUNTY OF MIDDLESEX—SANITARY WORK, 1904. Name of Sanitary District. Water Supply and Water Service. Privy & Ash Pits, Ash and Earth Closets. Drainage and Sewerage. Wells. Houses, Water Laid on to. Percentage of Houses Supplied from Mains. Cisterns. Flush Cisterns Repaired ana Provided to W.C.'s. Draw-Taps Removed from Cisterns to MainK. 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, &c. Closed as Polluted. New, Provided. Cleansed, Repaired, Covered. &c. 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 Provide.1 Repaired, Cleansed, &c. Supplied with Water, or supply rendered efficient.. Ventilated. Examined, Tested, Exposed, &c. Unstopped, Repaired, Trapped, &c. Waste Pipes, Rain Water pipes, &c., Disconnected and Repaired. Soil Pipes and Drains Ventilated. Disconnecting-Traps or Chambers Inserted. Reconstructed. New Laid. Rendered Impervious, Emptied, Cleansed, &c. Abolished, & Drain Connected to Sewer. Yards of New Sewers laid. Yards of 8ewers Reconstructed. HORNSEY. 0 0 4 8 All excepting few Isolated Cottages. 8 37 3 78 9 All excepting few Isolated Cottages. 0 15 1 4 177 88 30 43 100 357 167 153 101 35 142 12 0 9 100 - — C (IV). COUNTY OF MIDDLESEX —SANITARY WORK, 1904. Name of Sanitary District. Disinfection. Dust. Dampness. Sundry nuisances abated. Contagious Diseases of Animals. Infant Life Protection Act. Rooms fumigated. Rooms Stripped & 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, Ac. Guttering & rain-pipes repaired, &c. Gardens, Areas, &c., levelled and drained. Yards paved and drained. Surface adjoining bouses 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. i Animals Infected. ; Animals Destroyed. j Number of licensed premises. j Number of children. | Number of deaths. HORNSEY. 346 30 9,222 2 92 15 Weekly. Tenements & Flats twice a week. — 36 35 25 87 46 11 56 13 9 3 101 13 9 5 12 12 12 0 0 0 ANNUAL REPORT OF MEDICAL OFFICER OF HEALTH FOR 1904, FOR THE BOROUGH OF HORNSEY. FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOME WORK. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories 47 4 0 (Including Factory Laundries.) Workshops 380 46 0 (Including Workshop Laundries). Workplaces 44 13 0 Homeworkers' Premises 99 4 0 Total 570 67 0 2.—DEFECTS FOUND. Particulars. Numb( r of Defects. Number of Prosecutions. Found. Remedied Referred to H M. Inspector. Nuisances under the Public Health Acts * Want of cleanliness 54 54 0 0 Want of ventilation 6 6 0 0 Overcrowding 4 4 0 0 Want of drainage of floors 8 8 0 0 Other nuisances 41 41 0 0 †Sanitary accommodations insufficient 2 2 0 0 unsuitable or de fective 5 5 0 0 not separate for sexes 2 2 0 0 Offences under the Factory and Workshop Act:— Illegal occupation ot underground bakehouse (S 101) 0 0 0 0 Breach of special sanitary require ments for bakehouses (SS. 97 to 100) 1 1 0 0 Failure as regards lists of outworkers (S. 107) 0 0 0 0 Giving out work to be done in premises which are unwholesome (S. 108) 0 0 0 0 infected (S. 110) 0 0 0 0 Allowing wearing apparel to be made in premises infected by scarlet fever or smallpox (S 109) 0 0 0 0 Other offences 1 1 0 0 Total 124 124 0 0 *Including those specified in Sections 2, 3, 7, and 8 of the Factory Act as remediable under the Public Health Acts. †For districts not in London state here whether Section 22 of the Public Health Acts Amendment Act, 1S90, has been adopted by the District Council; and, if so, what standard of sufficiency and suitability of sanitary accommodation for persons employed in factories and workshops has been enforced. 3.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (S. 1331 2 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory Act (S. 5) Notified by H.M. Inspector 11 Reports (of action taken) sent to H. M.Inspectors 11 Other 5 Underground Bakehouses (S. 101):— In use during 1903 6 Certificates granted in 1903 4 in 1904 2 In use at the end of 1904 6 Homework:— Number of Lists of Outworkers * (S. 107):— Lists. Outworkers. Lists received 9 26 Addresses of outworkers forward to other Authorities 25 received from other Authorities 51 Homework in unwholesome or infected premises Wearing Apparel. Other. Notices prohibiting homework in unwholesome premises (S. 108) 0 0 Cases of infectious disease notified in homeworkers' premises 2 0 Orders prohibiting homework in infected premises (S.110) 2 0 Workshops on the Register (S. Important classes of workshops, such as workshop bakehouses, may be enumerated here. 131) at the end of 1904. Bakehouses 40 Laundries 20 Restaurant Kitchens 17 Miscellaneous 154 Total number of workshops on Register 231 *The Lists should be received twice in the year. The year's figures required in the Table are then obtained by adding together the two half-yearly totals. Public Health Acts Amendment Act 1890, Part 3 adopted October, 1890.