5049 002 SOUTHGATE URBAN DISTRICT COUNCIL. REPORT of the MEDICAL OFFICER OF HEALTH, FOR THE YEAR, 1900. by A. SIDNEY RANSOME, B.A., M.B., B.C., D.P.H. Cantab. Fellow of the Royal Institute of Public Health. Member of the Incorporated Society of Medical Officers of Health. Medical Officer of Health. To the Members of the South crate Urban District Council. G ENTLEMEN, I have the honour to present to you my report for the year 11)00. Taken as a whole the general health of the District has been good throughout the year, and there has been no serious outbreak of any disease. Consequently the death returns are considerably below the average all along the line and show a great improvement on those of the previous year whose record was not so good. Last year the Local Government Board issued new and improved tables for recording vital statistics; some alterations will therefore be noticed in this respect as compared with previous reports. The subject of Diphtheria has again received my careful attention, and it is to be hoped that the measures I have advocated may do much towards lessening the occurrence and preventing the spread of this disease in the District. The Report of the Sanitary Inspector Mr. Brown is appended to this report and in my opinion constitutes avery excellent record of good and useful sanitary work done by him and the Assistant Inspector, Mr. Still, during the year. I have also to thank Mr. Brown and Mr. Still for valuable assistance in compiling this report. I am, Gentlemen, Your obedient servant, A. SIDNEY RANSOME. February, 1901, 4 POPULATION. THE population of the District at the middle of the year, 1900, was estimated to be 15,000 (excluding the occupants of the Metropolitan Asylums Board Hospital, at Winchmore Hill). This estimate was arrived at by taking the number of occupied houses on the rate books at that time, and allowing 5½ occupants to each, which is considered to be a fair average for this district. This is the meet reliable method of estimating the population in a growing district such as this, increasing unequally year by year. Calculated on this basis the population works out at 15,334; but the lower figure is purposely taken as a basis for compiling the vital statistics, so as not to make them appear more favourable than they really are, as would be the case if the population were over estimated. As it is now nine years since the last census, it is possible that this estimate is not as accurate as is desired, but it is as near the truth as it is possible to make it, and any miscalculation there may be will be corrected when the census is taken this year. The populations of the various localities which make up the District were estimated to be as follows Southgate, 4,194 ; New Southgate, 3,548 ; Winchinore Hill, 2,698 and Palmers Green and Bowes, 4,560. This was an increase of 500 over that of the previous year, due chiefly to the increase of occupied houses in the District. The Natural Increase of the population by excess of births over deaths during the year was only 175. Number of People to the Acre.—The area of the District is 3,587 acres, which, with a population of 15,000 gives an average of 41 people to the acre. The distribution of the population is, however, very uneven, there being several large areas in the District very sparsely populated, while some parts, more especially at New Southgate, are somewhat densely populated. BIRTHS—BIRTH-RATE. During the year, 320 births were registered ; a decrease of 46 on the previous year. This gives a birth-rate of only 21.3 per 1000 of the population. This is a very low birth-rate, and the lowest on record in this District, the next lowest being 22.1, which was the birth-rate in 1898. The average rate for the previous 10 years was 26.1. The birth-rate for the whole country is steadily decreasing. The rate for England and Wales last year was 28.9, which was lower than that in any other year on record, while the average rate for the previous 10 years was 30.2. 5 MORTALITY. General Mortality and Death Rate.—The number of deaths registered in the District during the past year (excluding two which occurred at the Metropolitan Asylums Board Hospital, at Winchmore Hill, and four of persons non-resident in the District) was 147. This was a decrease of 35 on that of the preceding year and of 4 on the average of the previous 10 years. The death-rate was therefore 9.8 per 1.000 of the population. This is the lowest death-rate on record for this District excepting that in 1896, which was 9.3. The average rate for the previous 10 years was 12.5. The death-rate for England and Wales last year was 18.3 and for the previous 10 years 18.4. The death-rate for each of the four localities was as follows :— Southgate 9.3, New Southgate 12.9, Winchmore Hill 10.3, and Palmers Green and Bowes 7.4. It is satisfactory to note that the death-rate of Southgate was materially less than that of the preceding year, when it was 15.4, which somewhat high rate was due chiefly to the prevalence of diarrhoea and to the epidemic of diphtheria during that year. It is also worthy of note that in Palmers Green and Bowes, the newest part of the District, the death-rate was again the lowest of the four localities. This very marked difference cannot I think but be due to a great extent to the necessarily better sanitary conditions that obtain in this locality. Infantile Mortality.—There were 38 deaths registered of infants under one year of age, giving an infantile death rate of 118 per 1,000 births registered, as against 140 in the preceding year, 119 in 1898, and 147 in 1897. The average rate for the 10 years 1890-1899 was 119. The infantile death-rate for England and "Wales last year was 151. These deaths under one year of age form 26.2 per cent of the total deaths at all ages, whereas in the preceding year the proportion was 28 per cent, in 1898 24.6 per cent, and in 1897 30.3. 3 per cent. Senile Mortality. Among persons of 70 years of age and over, 38 deaths occurred, and of these 18 were of persons of 80 years of age and over. This is a proportion of 26.2 per cent of the total deaths at all ages —a high rate of senile mortality and one which speaks well for the general healthiness of the District. Zymotic Mortality.—This includes the deaths from the seven, principal Zymotic diseases, viz: Small Pox, Scarlet Fever, Diphtheria Typhoid Fever, Measles, Whooping Cough and Diarihœa. This rate affords useful evidence as to the general healthiness of the District and as to the efficiency of its sanitary administration. fi There were 16 deaths from these diseases as follows :—Scarlet Fever 1, Diphtheria 5, Whooping Cough 4, and Diarrhoea 6. The Zymotic death-rate was therefore 1 per 1,000 of the population as against 2.7 in 1899 and 1.9 in 1898. The average rate for the previous 10 years was 2. The Zymotic death-rate for England and Wales last year was 1.0. The Causes of Death are fully set forth ill Table I, (i) for the whole District at different age periods, and (ii) for each of the four localities. Table Ia shows the deaths during each quarter of the year. It will be noted that the five deaths from Diphtheria occurred in Southgate. Four of these took place in January and marked the end of the epidemic of Diphtheria which broke out in Southgate in the previous year. Of the four deaths from Whooping Cough it will also be seen that three occurred at Southgate, where this disease was more or less prevalent during the year. Apart from these, there was no marked incidence of any particular disease upon any one locality. The Causes of Infantile Mortality are shown in Table In. Apart from the fact that the general mortality was low, it is gratifying to note that whereas Diarrhœa is usually one of the chief causes of death in infants under one year of age, last year there were only four deaths from this cause. In Table II some vital statistics of the District for the past year are given along with the corresponding rates for the country as a whole. It will be noticed that the comparison is in every case favourable to this District. In Table III are set down the principal vital statistics of the District for the past 10 years. The Public Mortuary. -During the year 17 bodies were deposited in the Mortuary as against 12 in the preceding year. Six of these were of persons not resident in the District. Eleven post mortem examinations were made. The Mortuary has now been in use for two years, and these figures show how much need there was for one in the District. INQUESTS HELL) DURING THE YEAR 1900 ON DEATHS OCCURING IN THE DISTRICT. Number. Month. Sex. Age. Condition of Life. Cause of Death. 1 March Male 48 years Blacksmith Natural—Alcoholism- Heart Disease. 2 March Female 6 months Infant Natural Spasm of Throat. 3 April Female 20 years Unknown Suicide by Poisoning with Carbolic Acid 4 April Female 76 years Married Natural Heart Disease. 5 April Female 7 years Child Natural—Pneumonia. 6 April Female 74 years Married Natural—Senile Decay. 7 June Female 2 months Infant Accident—Fractured Skull. 8 June Male 10 weeks Infant Natural– Pneumonia. 9 July Male 33 years Porter Accident—Run Over. 10 July Male 69 years Painter Natural—Heart Disease-Heat Stroke. 11 August Male 79 years Chemist Natural- Heart Disease. 12 August Female 52 years Widow Found Drowned. 13 November Female 88 years Widow Accident—Fractured Thigh. TABLE I. Causes of, and Ages, at Death during the year 1900. Causes of Death. Deaths in the whole District at subjoined Ages. Deaths in Localities (at all Ages.) All Ages. Under 1. 1 & under 5. 5& under 15. 15& under 25 25 & under 65 upwards Southgate. New Southgate. Winchmore Hill. Palmers Green and Bowes. Scarlet. Fever 1 - - - - - 1 - — 1 — Whooping Cough 4 2 2 - - - - 3 1 — - Diphtheria 5 - 1 4 - - - 5 - - - Rheumatic Fever 3 - 1 1 - 1 - - - 1 2 Epidemic Influenza 8 - - - 1 4 3 1 4 - 3 Diarrhoea 6 4 1 - - - 1 - 2 - 4 Phthisis 8 - - 1 - 7 - 2 3 1 2 Other Tubercular diseases 5 1 1 1 - 2 - 1 4 - - Bronchitis 6 - - - - 2 4 - 4 1 1 Pneumonia 17 8 1 1 - 6 1 5 2 1 3 Other Diseases of Respiratory Organs 2 1 - - - 1 - 1 1 - — Cancer, malignant disease 9 - - - - 4 5 1 3 2 3 Alcoholism- Cirrhosis of Liver 4 - - - - 4 - 2 2 - - Heart Disease 10 - - 1 - 5 4 1 3 4 2 Disease of Digestive Organs 1 1 - - - - - - 1 - — Diseases of Nervous System, (includ'g Convulsions, Apoplexy) 16 4 1 - - 9 2 6 3 - 7 Diseases of Urinary Organs 8 - - - - 2 6 1 2 1 4 Premature Birth 9 9 - - - - - 1 5 2 1 Diseases and Accidents of Parturition 2 - - - - 2 - 1 1 - - Wasting and Debility (including Developmental Defects) 7 7 - - - - - 3 - 3 1 Senility 14 - - - - - 14 3 5 5 1 Accidents 2 1 - - - - 1 2 - - - All causes 147 38 8 9 1 49 52 39 46 28 34 N.B.—Two deaths from Scarlet Fever which occurred at the Metropolitan Asylum's Board Hospital at Winchmore Hill are not included in this Table. There is no other Public Institution in the District. TABLE IA. Showing causes of deaths in the District of Southgate during each of the four quarters of the year 1900. Causes of Death. 1st Qtr. •2nd Qtr. 3rd Qtr. 4th Qtr. Scarlet Fever — - 1 — Diphtheria 4 - — 1 Whooping Cough 1 1 1 1 Diarrhœa — — 6 — Influenza 6 - - - Rheumatic Fever 1 1 1 - Phthisis (“ Consumption ”) 3 2 - 3 Other Tubercular Diseases — 2 2 1 Pneumonia 4 5 3 5 Bronchitis 3 1 1 1 Other Diseases of Respiratory Organs 2 - - - Heart Disease - - 5 3 Diseases of Digestive Organs 1 — — — Diseases of Nervous System (including Apoplexy and Convulsions) 5 2 4 5 Diseases of Urinary Organs 2 4 - 2 Cancer 1 4 2 2 Alcoholism and Cirrhosis of Liver 2 1 — 1 Diseases and Accidents of Parturition - 1 — 1 Premature Birth 4 2 3 - Wasting and Debility (including Developmental Defects) 1 2 2 2 Senility 5 6 2 1 Accidents - 1 - 1 Totals 45 37 35 30 147 TABLE Ib. The Causes of Infantile Mortality. Cause of Death. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Totals. Diseases of Respiratory Organs 4 0 - 3 9 Premature Birth 3 3 3 - 9 Wasting and Debility (including Developmental Defects) 1 2 0 0 7 Diarrhoea — — 4 - 4 Convulsions - 1 1 1 3 Whooping Cough 1 1 — — 2 Tuberculosis — — 1 - 1 Other Diseases 1 1 1 - 3 Totals 10 10 12 6 38 TABLE II. Comparison of the Rates of the Southgate District with those of England and Wales, the 33 Great Towns, and England and Wales less the 100 Largest Towns. Rates per 1000 of the Population. Birth-rate. Death-rate. Deaths under 1 year per l,000 Births. Zymotic Death-rate. Small Pox. Scarlet Fever. Diphtheria. Measles. Whooping Coughs. Diarrhœa. England and Wales 289 18.3 154 2.0 .00 .12 .29 .39 .34 .69 The 33 Great Towns 19.5 172 2.5 .00 .13 .35 .43 .45 .94 England and Wales, less the 100 Largest Towns 18.1 166 2.25 .00 .12 .29 .51 .34 .81 Southgate District 21.3 9.8 118 1.0 .00 .06 .33 .00 .26 .40 TABLE III. The principal Vital Statistics of the Southgate District for the past Ten Years. Year. Population estimated to middle of each year. Births. Deaths at All Ages. Deaths Under One Year of Age. Zymotic death.rate per 1 1,000 of the Population. Number. Rate per 1000 of the Population. Number. Rate per 1000 of the Population. Number. Rate per 1000 Births registered. Percentage to Total Deaths. 1890 10900 262 24 126 11.5 32 122 25.3 1.7 1891 10970 316 28.8 157 14.3 36 114 22.9 1.2 1892 10980 302 27.5 182 16.5 35 115 24.3 .78 1893 11000 304 27.7 148 13.4 29 95 19.5 1.4 1894 11300 292 25.8 131 11.5 30 103 22.9 2.3 1895 12000 364 30.3 161 13.4 57 156 35.4 .8 1896 12500 315 25.2 117 9.3 25 80 21.3 1.0 1897 13000 326 25.2 158 12.1 48 147 30.0 2.4 1898 14000 310 22.1 150 10.7 37 119 24.6 1.9 1899 14500 366 25.2 182 12.5 51 140 28.0 2.7 Averages for years 1890.1899 12115 315 261 151 12.5 38 119 25.4 1.6 1900 15000 320 21.3 147 9.8 38 118 26.2 1.0 N.B.—Deaths in Public Institutions (Metropolitan Asylums Board Hospital at Winchmore Hill) and deaths of non.residents registered in the District are not included in this table. TABLE IV. Cases of Infectious Disease notified during the year 1900. Notifiable Disease. Cases notified in whole District. Total Cases notified in each Locality. No. of Cases removed to Hospital from each Locality. At all Ages. At Ages—Years. Southgate. New Southgate. Winchmore Hill. Palmers Green and Bowes. Southgate. New Southgate. Winchmore Hill. Palmers Green and Bowes. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 & upwards. Scarlet Fever 50 — 9 30 7 3 1 2 13 16 19 1 6 4 9 Diphtheria 32 — 8 21 — 3 - 18 5 5 4 — — — — Typhoid Fever 1 - - 1 - - - - 1 - - - - - - Erysipelas 7 — — — — 6 1 2 1 2 2 — — — — Totals 90 — 17 52 7 12 2 22 20 23 25 1 6 4 9 The Isolation Hospital used by the District is situated at Entield (outside the District.) TABLE IVA. Cases of Infectious Illness Notified during each Month of the Year 1900. Scarlet Fever. Diphtheria. Typhoid Fever. Erysipelas. Total. January 8 7 — 1 16 February 8 5 - 2 15 March 5 8 - 1 14 April 1 3 - 1 5 May 6 1 - — 7 June 4 — 1 - 5 July 3 — — 1 4 August 5 — — 5 September 2 — — — 2 October 4 2 — — 6 November 3 3 — — 6 December 1 3 — 1 5 Totals 50 32 1 7 90 15 INFECTIOUS DISEASES AND THE MEANS TAKEN TO PREVENT THEIR SPREAD It will be seen from Table IV that 90 cases of infectious disease were notified during the year, as against 170 in the preceding year, 79 in 1898, and 102 in 1897. Of these 50 were Scarlet Fever, 32 Diphtheria, 1 Typhoid Fever, and 7 Erysipelas. They were notified from the different localities as follows:—22 from Southgate, 20 from New Nouthgate, 23 from Winchmore Hill, and 25 from Palmers Green and Bowes. The 90 cases represent infection in 68 houses, all of which were subsequently disinfected by the Sanitary Authority. In all cases disinfectants were supplied, instructions given as to the carrying out of isolation as efficiently as possible under the existing circumstances and the sanitary condition of the premises inspected. In 23 houses sanitary defects were found, consisting chiefly of defective water closets and unpaved yards. These defects have all been remedied under the supervision of the Sanitary Authority. Twenty cases, all Scarlet Fever, were removed to Isolation Hospitals—15 to the Enfield Hospital, 3 to the Finchley Hospital, and 2 to the Liverpool Road Hospital. Diagnosis Outfits.—The Diagnosis Outfits provided by the Council for the use of Medical Practitioners in the District for sending morbid specimens from suspected cases of Diphtheria, Typhoid Fever, and Phthisis ("Consumption") to the Jenner Institute of Preventive Medicine for bacteriological examination and report have been taken full advantage of and have proved very useful. During the year 27 specimens were sent and reports received as follows:— Date. Disease Suspected. Report. January 25 Diphtheria Diphtheria. „ 29 „ „ February 12 „ „ „ 20 Phthisis Phthisis. March 12 Typhoid Fever Not Typhoid Fever. „ 13 Phthisis Phthisis. April 2 Diphtheria Diphtheria. „ 26 Phthisis Not Phthisis. May 4 „ Phthisis. June 1 Diphtheria Not Diphtheria. „ 19 Phthisis Phthisis. „ 25 Typhoid Fever Not Typhoid Fever. 16 Date. Disease Suspected. Report. July 12 Phthisis Not Phthisis. „ 12 „ „ „ August 21 Typhoid Fever Not Typhoid Fever. „ 21 „ „ „ „ September 27 Phthisis Not Phthisis. October 15 Diphtheria Not Diphtheria. „ 23 „ Diphtheria. „ 24 „ Not Diphtheria. „ 26 Phthisis Phthisis. „ 31 „ Not Phthisis. November 3 Diphtheria Not Diphtheria. „ 14 Phthisis Not Phthisis. „ 15 Diphtheria Diphtheria. December 12 „ „ „ 18 Phthisis Not Phthisis. N.B.—These were not all from different cases, but in some instances were further specimens from same cases sent up after varying intervals for re-examination. In Diphtheria cases, specimens of throat secretion are sometimes taken at intervals to see if the serins are still present and the case therefore still infectious. In some cases of Phthisis the germs are not present in all samples of sputum so that re-examinations are sometimes necessary. Total, 27 bacterological examinations (including re-examinations of some cases) of which 12 gave positive and 15 negative results. Positive. Negative. Total. Diphtheria 7 4 11 Typhoid Fever 0 4 4 Phthisis 5 7 12 Total 12 15 27 Diphtheria Antitoxin.—The supply of Diphtheria Antitoxin provided by the Council for the use of Medical Practitioners in the District has been made full use of as occasion required to the inestimable advantage of the victims of this disease, and has doubtless been the means of saving many lives, and of cutting short the length and severity of illness in all cases in which it was used sufficiently early. Handbills concerning Infectious Disease.- Handbills giving instructions as to the danger of and precautions to be taken to avoid spreading infection in the cases of Consumption, Measles, and Whooping Cough 17 (not being notifiable diseases) are always kept in readiness and have been left at all houses where it came to my knowledge that these diseases were present, and in the case of the two latter, have also been distributed at all other houses in the immediate neighbourhood. This is, I think, the best way of dealing with such diseases as Measles and Whooping Cough. The necessary knowledge as to where these diseases are present is supplied to me chiefly by the School Attendance Officer and the School Authorities. This system of notification by the School Attendance Officer and the School Authorities, instituted in 1898, works satisfactorily as far as can be judged at present. Small Pox.—No cases were notified in this District. The Vaccination Act of 1898, which came into force at the end of that year, continues, there is reason to believe, to produce good results in this District. I have been unable to obtain the statistics as to the relative number of successful vaccinations performed before and since the Act came into operation, but there is no reason to doubt that the same comparative results have been obtained in this District as in the country as a whole. The following facts will therefore prove interesting and instructive:— Last year the Local Government Board prepared a return of the comparative number of successful vaccinations recorded during the years 1898 and 1899. This return shows that while in 1898 there were 500, 314 successful vaccinations, in 1899 there were 669,349. The increase in the number of vaccinations in 1899 as compared with 1898 was therefore 169,035 or 33.8 per cent. Now the number of births registered in England and Wales during 1898 was 923,265, and during 1899 was 928,640, so that the ratios of successful primary vaccinations to births registered were 54.2 per cent in 1898 and 72.l per cent in 1899, an increase of 33 per cent in 1899 as compared with 1898. These results are, I think, very satisfactory, and it is gratifying to feel that so many more persons are now protected from Small Pox than was the case before the Act came into force. Scarlet Fever. There were 50 cases notified from 39 houses, as against 55 in the preceding year, and 35 in 1898; they were notified from the different localities as follows:—2 from Smthgate, 13 from New Southgate, 16 from Winchmore Hill, and 19 from Palmers Green and Bowes. In 15 houses sanitary defects were found. Three cases were imported, and 5 were secondary cases occurring in houses from which pre- 18 vious cases had been reported. In the remainder of the cases I was unable to trace the source of infection. This disease caused one death (a person of 80 years of age) and was an indirect cause of the death of two children, who succumbed to Rheumatic Fever, following an attack of Scarlet Fever. The majority of the cases were of a mild type. Diphtheria. During the year 32 cases were notified from 21 houses as against 83 in the preceding year (when an epidemic occurred in Southgate) and 26 in 1898. These 32 cases were notified from the different localities as follows:- 18 from Southgate, 5 from New Southgate, 5 from Winchmore Hill, and 4 from Palmers Green and Bowes. In 7 cases sanitary defects were found and subsequently remedied. Seven cases were secondary ones, the infection having been taken from previous cases in the same houses. In the remainder of the cases I was unable to satisfactorily trace the direct origin of infection, but have little doubt that school attendance was a potent factor. Of the 18 cases which occurred at Southgate, 14 were children attending school. The important part played by school attendance in the spread of Diphtheria was clearly shown in my last annual report. In that report I also pointed out the difficulty there was in effectually checking the spread of Diphtheria, owing to the fact that the germs of the disease may remain in the throat for a long time after the person affected is apparently quite well (in exceptional cases it may be even as long as six months) and so be communicated to other susceptible persons. You decided, therefore, early hist year, on my recommendation, that as far as Southgate was concerned, school children who had Diphtheria, or who came from infected houses, should not be allowed to return to school for three months after the date of notification, so as to ensure as far as possible that such children were quite free from infection before mixing again with other children. This measure has, I am sure, been a very beneficial one, and was an important factor in bringing the epidemic of 1899-1900, to an end, and preventing its recrudescence. I would now recommend that this measure be extended as far as possible to the whole District, and to all persons affected, but with this modification, that if before the expiration of the three months a report is received by me from the Jenner Institute of Preventive Medicine, or other responsible source, that a bacteriological examination of secretion from the throat shows that the case is no longer infectious, then, and not till then, the person affected may be allowed to mix with others Until such a report is received, infected persons should not be allowed to mix with others for the full three months. In illustration of the length of time the throat of a person affected with Diphtheria may remain infectious, I will mention the following case 19 which came recently under my own observation:—A lad who worked in a dairy was taken ill with a sore throat, which was thought to be Diphtheria. A bacteriological examination of secretion taken from the throat was made by the Jenner Institute, and the report confirmed the diagnosis. Further samples of throat secretion were taken and examined bacteriologically at intervals of a few weeks, but not until three months had elapsed was the throat declared to be free from infection. Of the 18 cases at Southgate, 16 occurred during the first five months of the year, 8 in January, 4 in February 3 in March, 2 in April, and 1 in May. These cases were a continuance, and marked the end of the epidemic, which began in March of the previous year (1899). Excepting two cases, one in October, and one in November, no other cases occurred in Southgate throughout the remainder of the year. Of the 14 cases which were notified from other parts of the District, 5 occurred at Winchmore Hill iu March. The remaining 9 cases were almost equally divided between New Southgate, and Palmers Green and Bowes, during the first and last quarters of the year. There were 5 fatal cases, all of which occurred in Southgate, 4 in January and 1 in December. The lives of several of these would most probably have been saved if a doctor had been called in earlier than was the case. Antitoxin could then have been used when its beneficial action is greatest, namely, during the first day or two of the disease; whereas in several of these cases, no medical aid was sought until it was too late for antitoxin to be of any use: little or nothing could therefore be done for them. That the extreme value of antitoxin as a curative agent in Diphtheria is fully recognised by the Medical Practitioners of the District, in common with the Profession in general, is shown by the fact that while 32 cases of Diphtheria were notified during the year, 30 boxes of antitoxin were used, each box containing enough for one case, unless very severe when two or more injections are necessary. With regard to the occurence of secondary cases of which there were seven, I am sure that in the majority of cases these might be entirely prevented if on the occurrence of a case in any house, all others in the same house received a prophylactic dose of antitoxin. In those houses in which I know this has been done, no secondary cases have occurred. Typhoid Fever. -Only one case was notified throughout the year, as against 12 in the preceding year, and 10 in 1898. This case was an imported one, the person alfected contracting the disease at Margate, where he had been staying to within a few days of the date of notification. This is a very satisfactory state of things to record, and is good evidence as to the efficiency of the general sanitation of the District. Diarrhœa.—Compared with previous years there was very little illness from this disease throughout the District, and there were only 20 six deaths from this cause, whereas in the preceding year there were 27 deaths, and in 1898, 13 deaths. This is equal to a rate of .4 per 1000 of the population. The same rate for England and Wales was .69. Of the 6 deaths, 2 occurred in New Southgate and 4 in Palmers Green and Bowes; while in Southgate and Winchtnore Hill, not a single death from this cause was registered. This also is a very satisfactory record, even taking into consideration that throughout the country diarrhoea was less prevalent than is usually the case. Measles.-During the past year the District has been exceptionally immune from Measles, and no deaths from this disease were recorded. No outbreak of Measles has occurred since the end of 1897 and the beginning of 1898, when the majority of the then existing susceptible children suffered from this complaint. As during the three years that have elapsed since then, a number of children have been born, a large amount of susceptible material has consequently accumulated. Now Measles usually re-appears epidemically every three or four years; another outbreak may therefore be expected at any time, and it is very probable it may occur this year. Whooping Cough, of a mild type in general, was somewhat in evidence, in Southgate chiefly, more or less during the year, but at no time did it assume an epidemic chafacter. Four deaths were caused by this disease, three of which occurred at Southgate. Influenza was very prevalent during the early part of the year, more especially in January, when it was generally epidemic, whilst throughout the year cases occurred at intervals. Altogether, Influenza accounted for 8 deaths, 5 of which occurred in January. I would again remind the public of the highly infectious nature of this disease, and of the necessity that exists for isolating all sufferers as carefully as in the case of other Infections Fevers. Only those actually in attendance on the sick should be allowed to visit the sickroom, and the whole household should abstain from visiting and mixing with other people as much as possible. Tuberculosis. During the year there were 13 deaths from Tubercular diseases including 8 from Phthisis ("Consumption.") In all cases of Phthisis that have come to my knowledge, leaflets have been left pointing out fully the nature and danger of the disease and the means to be taken for the prevention of the spread of infection to others. And where rooms occupied by consumptive persons have been evacuated by death or otherwise, a visit has been paid by one of the Sanitary Officials and an offer to disinfect free of cost by the Sanitary Authority has been made, and in most cases carried out. Infectious Hospital.—The necessary sanction of the Local Government Board having been obtained, the erection of this Hospital was commenced in June last, and it is very satisfactory to be able to report that 21 the buildings are now well advanced. It is fully expected that the work will be finished by next June, and that the Hospital will be ready for occupation by the Autumn and possibly earlier. The benefit and convenience of this Infectious Hospital to the District will be great, not only as a ready means of isolating such infectious cases as require it conveniently and efficiently, but also for the facilities which we shall have for thoroughly disinfecting infected bedding, clothing, and other articles from infected houses, in the steam disinfector which will be established on the premises. MISCELLANEOUS. Return of the Metropolitan Asylums Board Hospital. During the past year 2,714 eases were admitted into this Hospital, situated at Winchmore Hill. Of these, 2,217 were Scarlet Fever, and 497 Diphtheria. There were only 2 deaths, both from Scarlet Fever. Sewers.-Several defective branch sewers at Winchmore Hill and Southgate have been taken up and relaid. The flushing of sewers in all parts of the District has been carefully and systematically carried out and throughout the year certain sewers were flushed daily. Very few com plaints have consequently been received of offensive smells arising therefrom. Water Supply.—Practically, the whole District is now supplied by the New River Company, the quality and constancy of whose water supply is all that can be desired. Very few houses, or outlying cottages even, are now dependent on wells for their water, at least 97 per cent. having the New River Company's supply. The few wells that remain in use have caused no trouble. Water Courses.-Several complaints were received during the year of Pymmes Brook, and although the pollution caused by the overflow of a cesspool on the premises of Brook House was stopped as a result of your negotiations with the East Barnet Council, and some improvement generally has taken place, yet the condition of the Brook is still far from satisfactory Even now it is at times polluted by the effluent from the sewage farm situated in East Barnet. I would therefore recommend that such further steps as you think fit should be taken to prevent this altogether. Housing of the Working Classes Act.- During the year 5 cottages were closed as being unfit for human habitation, and 4 of them have since been demolished. All of these were situated in Sonthgate, viz., 2 in the High Street, 1 in Reservoir Road, and 1 in Hoppers Road. The 12 new cottages erected by you under this Act, in Highfield Row were occupied last Spring. The applications received exceeded the cottages in number. The original occupants still remain in them, and express themselves as very pleased with them, finding them healthy and convenient. 22 These facts clearly show the great need there is in the District for sound healthy cottages such as these. In parts of the District a number of old unhealthy cottages still remain, many of which ought to be pulled down, and which would be straightway condemned except for the fact that there are no others for the occupants to go in to if this were done. This state of things is far from satisfactory and hampers our efforts for sanitary improvements in this direction. It is the cause of much ill health and lowered vitality amongst those that inhabit them, and an indirect danger to the whole community. There is no more useful or necessary sanitary reform you could undertake than the erection of good, wholesome cottages, and I strongly recommend you to seriously consider the question of building more of them in the immediate future. In the meantime with regard to old existing cottages, owners could do a great deal more than is at present done towards making this class of property more sound and healthy by carrying out requisite repairs and cleansing more frequently than is now the case, without waiting for the Sanitary Authority to enforce those necessary measures which property owners ought to carry out on their own responsibility. Roads. The following roads are being made up under the 150th section of the Public Health Act:—Palmerston Crescent and Elandale Road, at Palmers Green, and the Westbury, Goring, and Queen's Roads, at Bowes Park. With regard to the paving and draining of the back entrance ways to shops and business premises in different parts of the District on1 which I reported in my last Annual Report, I regret to say that up to the present time nothing has been done except that notices to pave, &c., have been served on the owners of one of these. The condition of these backways is worse than ever, and I am of opinion that this matter should not be allowed to drift, but that they should be paved and drained as soon as possible. Avenue Road.-This road has for a long time been in a deplorable condition, and in the winter months is frequently almost impassable for ordinary traffic. There are now a considerable number of houses and cottages on either side of the road and in its immediate neighbourhood. The traffic along it is considerable and would be much greater if it were in a better condition. I recently reported on this matter in Committee, and think that something ought soon to be done to improve this road. Food and Drugs Act.—Seeing that very few samples for examination and analysis appear to be taken in this District by the County Council, in whose hands the administration of this Act is, and that in the interests of the Public Health it is desirable that more such samples should be taken, I venture to suggest that you communicate with the County Council generally on the matter. 23 Manure. —The unloading of London manure and refuse at the railway stations in this District was fast becoming a nuisance during the past year, and gave us a considerable amount of trouble. I am glad to be able to state that at your request the Railway Company stopped the traffic of the manure and refuse during the summer months. Allotments at New Southgate. Many complaints were received of the keeping of large numbers of pigs and also horses on these allotments, and not unfrequently persons were found living and sleeping in some of the large sheds erected on them and intended for the keeping of stores and implements. The owner, at your request, gave notice to the allotment holders to discontinue the keeping of pigs and to remove the pigsties and sheds in question. For the sake of those living in the immediate neighbourhood it is to be hoped that the general management of these allotments will receive such attention as will entirely do away with, and effectually prevent a repetition of such serious nuisances. Cowsheds, Dairies, Slaughter-houses and Bakehouses. These have all been inspected systematically and have been kept, on the whole, in a satisfactory condition in accordance with the Bye-Laws. URBAN DISTRICT COUNCIL OF SOUTHGATE. Table of Sanitary Work, 1900. Sanitary District, Southgate. INSPECTIONS. Complaints Received 65 Cases of Infectious Disease Notified (visits) 275 Number of Premises Periodically Iuspected 188 Houses Inspected from House to House 95 Total Number of Houses, Premises, &c., Inspected 550 Total Number of Re Inspections after Order or Notice 2980 Total Number of Inspections and Re-Inspections 3530 NOTICES. Letters Written 458 Cautionary Notices Given 111 School Notices (Infectious Disease) 130 Statutory Orders Issued 60 Summonses Served — Convictions Obtained — DWELLING HOUSES. Houses, Premises, &c., Cleansed, Repaired, &c. 53 Closed as unfit for Habitation 5 Re-Opened after Repairs, Alterations, &c. 6 Demolished 4 MOVABLE DWELLINGS, CARAVANS, TENTS, &c. Number of Nuisances therefrom Abated — Number removed from District 326 URBAN DISTRICT COUNCIL OF SOUTHGATE. Table of Sanitary Work, 1900. Sanitary District, Southgate. SCHOOLS. Number in District 20 Periodical Frequency, or Number of Inspections - Number found Defective nil. BAKEHOUSES. Number in District 11 Periodical Frequency, or Number of Inspections Freqt. Contraventions of Factory Acts - SLAUGHTER-HOUSES. Number on Register 7 Periodical Frequency, or Number of Inspections Freqt. Contraventions of Bye-Laws - COWSHEDS. Number on Register 12 Periodical Frequency, or Number of Inspections Freqt. Contraventions of Bye-Laws - DAIRIES AND MILKSHOPS. Number on Register 16 Periodical Frequency, or Number of Inspections Freqt. Contraventions of Bye-Laws MORTUARIES. Accommodation 1 Number of Bodies Received 17 URBAN DISTRICT COUNCIL OF SOUTHGATE Table of Sanitary Work, 1900. Sanitary District, Southgate. WATER SUPPLY AND WATER SERVICE. Wells. New, Sunk — Cleansed, Repaired, &c. — Closed as Poluted — Houses, Water Laid on to — Percentage of Houses Supplied from Main — Cisterns. New, Provided — Cleansed, Repaired, Covered, &c. 17 Overflow Pipes Disconnected from Drains — Repaired, or New Flush Cisterns provided to W.C.'s 74 Draw-Taps Removed from Cistern to Mains 25 Percentage of Houses Supplied on Constant System 97% EARTH CLOSETS. Water Closets Substituted for Dry Receptacles 1 DRAINAGE AND SEWAGE. Water Closets. New, Constructed 15 New Apparatus Provided 109 Repaired, Cleansed, &c. 57 Ventilated — Percentage of Houses provided Water Closets Practically the whole. Drains. Examined, Tested, Exposed, &c. 67 Unstopped, Repaired, &c. 32 Waste Pipes, Rain Water Pipes, &c., Disconnected 107 Soil Pipes and Drains Ventilated 79 Disconnecting Traps or Chambers Inserted 89 Reconstructed 81 Cesspools. Rendered Impervious, Emptied, Cleansed, &c. — Abolished and Drain connected with Sewer — Percentage of Houses Draining into Sewers 99% Sewers. Yards of Sewers Laid 734 Yards of Sewers Reconstructed 695 URBAN DISTRICT COUNCIL OF SOUTHGATE. Table of Sanitary Work, 1900. Sanitary District, Southgate. DISINFECTION. Rooms Fumigated 91 Rooms Stripped and Cleansed 82 Articles Disinfected or Destroyed 30 DUST. Dust-bins Repaired — New Movable Bins Provided 63 Periodical Frequency of Dust Removal Weekly Number of Complaints of Non-Removal Received 26 DAMPNESS. Roofs Repaired, &c. 57 Guttering and Rain Pipes Repaired, &c. 54 Gardens, Area, &c., Levelled and Drained 3 Yards Paved and Drained 66 Surface adjoining Houses Paved — Dry Areas Provided — Ventilation below Floor Provided 49 Basements Rendered Impervious 2 SUNDRY NUISANCES ABATED. Overcrowding 2 Smoke 1 Accumulations of Refuse 6 Foul Ditches, Ponds, &c., and Stagnant Water 3 Foul Pigs and other Animals 5 Other Nuisances — J. W. H. BROWN, Sanitary Inspector.