S04G003 mrlc Southgate urban District Council. REPORT of the Medical Officer of Health FOR THE YEAR 1902, 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. EnffelO: printed by jas. w. hatch and son, palace gardens. 1903. SOUTHGATE URBAN DISTRICT COUNCIL. REPORT of the medical officer of health FOR THE YEAR 1902. by R. SIDNEY RAJNLSOmE, 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 Healthy medical officer of health. TO THE MEMBERS OF The Southgate Urban District Council. Gentlemen, I have the honour to present to you my Report for the year 1902, to which is appended the Report of the Sanitary Inspector, Mr. Brown, which as usual constitutes an excellent record of good and useful sanitary work done by him and his assistant during the year. My thanks are due to Mr. Brown for valuable assistance in compiling this Report. I am, Gentlemen, Your obedient Servant, A. SIDNEY RANSOME. February, 1903, 4 POPULATION. CHE Census returns of 1901 showed that in this District the average number of inhabitants to each occupied house is as 'near as possible 5.1. Taking this as the basis of calculation, the population at the middle of last year was estimated to be 15,800, an increase of 600 over that of the previous year. This increase was almost equally distributed between the localities of Winchmore Hill, New Southgate, and Palmers Green and Bowes ; there having been an increase of 37 occupied houses in Winchmore Hill, 40 in New Southgate, and 48 in Palmers G reen and Bowes ; whereas in Southgate there was an increase of only 4. The population of the four localities which makeup the District was estimated to be as follows:—Southgate, 4,220 ; New Southgate, 3,790 ; Winchmore Hill, 2,960 ; and Palmers Green and Bowes, 4,830. BIRTHS—BIRTH-RATE. During the past year 396 births were registered ; an increase of 21 on the previous year. This gives a birth-rate of 25 per 1,000 of the population. The average rate for the 10 years, 1892 to 1901 was 25.4. The birth-rate for England and Wales in 1902 was 28.6, which is lower than the rate in any other year on record, excepting that in 1901, which was 28.5. MORTALITY. General Mortality and Death .Rate.—The number of deaths registered in the District during the past year (excluding seven which occurred at the Metropolitan Asylum Board Hospital at Winchmore Hill) was 159. To these must be added four deaths of " residents " who died in the Edmonton U nion, outside the District, making a total of 163. The death-rate, was, therefore 10.3 per 1000 of the population, an increase of 1 per 1000 on the rate of the preceding year, which was with that of 1896 the lowest yet recorded in this District. The average rate for the 10 years, 1892 to 1901, was 11.8. The death-rate for England and Wales last year was 16.3, which 5 is the lowest rate on record, and 1.6 below the average rate for the ten years, 1892.1901. The death.rates for each of the four localities were as follows:— Southgate, 9.7 ; New Southgate, 10.5 ; Winchmore Hill, 9.3, and Palmers Green and Bowes, 11.1. Infantile Mortality.—There were 33 deaths of infants under one year of age, giving an infantile death.rate of 83.5 per 1000 births registered as against 93.6 in the preceding year, and is the lowest on record for this District, excepting that of 1896, which was 80. The average rate for the ten years 1892 to 1901 was 116. The infantile death.rate for England and Wales was 133, which is 21 per 1000 below the mean for the previous 10 years. The deaths from 20.2 per cent. of the total deaths at all ages, whereas, in the preceding year the proportion was 24.6 per cent.; in 1900, 26.2 per cent.; and in 1899, 21 per cent. Senile Mortality.—Among persons of 70 years and over, 38 deaths occured, and of these 13 were persons of 80 years and over. This is a proportion of 23"3 per cent. of the total deaths at all ages, as against 30"9 per cent. in the preceding year, which was a very high rate. Zymotic Mortality.—This includes the deaths from the seven principal Zymotic diseases, viz., Small.pox, Scarlet Fever Diphtheria, Typhoid Fever, Measles, Whooping Cough, and Diarrhoea. This rate affords useful evidence as to the general healthiness of the District, and as to the efficiency of its Sanitary administration. There were 13 deaths from these diseases, as follows:—Diphtheria, 1 ; Typhoid Fever, 1 ; Measles, ] ; Whooping Cough, 5 ; and Diarrhoea, 5. The Zymotic death.rate was, therefore, .82 per 1000 of the population, as against 1.3 in 1901, 1.0 in 1900, and 2.7 in 1899, and is a very satisfactory rate. The average rate for the 10 years, 1892 to 1901 was 1.5. The Zymotic death.rate for England and Wales was 1 .6. The Causes of Death are fully set forth in 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. 6 It will be noticed in Table I that there were 11 deaths under the heading of "accidents" and "found dead." These include 3 newly-born infants found in fields, etc., 2 persons found drowned, and 2 infants suffocated whilst in bed with their mothers. The remaining were ordinary accidental deaths. It is also to be noted that of the 12 deaths from Phthisis, 11 occurred in Southgate and New Southgate. In 1900 the proportion was 5 out of 8, and in 1899 9 out of 12. It appears, therefore, that there is a marked prevalence of this disease in these two localities, as compared with the remainder of the District, but I am unable to satisfactorily account for this. A part from this there was no marked incidence of any particular disease upon any one locality. The Causes of Infantile Mortality are shown in Table Ib, and call for no special remarks. The Public Mortuary. During the year 15 bodies were deposited in the mortuary, as against 4 in the preceding year, and 17 in 1900. 7 INQUESTS HELD DURING THE YEAR 1902 ON DEATHS OCCURRING IN THE DISTRICT. No. Month. Sex. Age. Condition of Life. Cause of Death. 1 January Female 63 Spinster Accidental—Fell off chair. 2 January Female 3 weeks — Accidental—Suffocation in bed with mother. 3 March Female New born — Suffocation by some person unknown. 4 May Male 63 Clerk Suicide. 5 May Female 2 Accidental—Supposed to have taken berries of a poisonous nature. 6 June Male 48 Chemist Accidental—Heat stroke. 7 J une Male 2½ — Found Drowned. 8 June Male 40 Labourer Found Drowned. 9 July Female 62 Married Accidental—Shock. 10 July Female New born — Open verdict—Insufficent evidence. 11 July Male 88 Blacksmith (retired) Natural causes. 12 August Female 6 months — Accidental—Suffocation in bed with mother. 13 October Female New born — Suffocation by some person unknown. 14 November Male 58 Clerk Found Drowned. 15 December Male 25 Clerk Suicide. TABLE I. Causes of, and Ages at, Death during the year 1902. Causes of Death Deaths in, or belonging to, whole District at subjoined Ages, DeathsinLocalities at all Ages. Total Deaths in Public Institutions in the District. All Ages. Under 1 year 1 & under 5. 5 & under 15. 15 & under 25 25 & under 65 65 & upwards Southgate. c w Southgate. W inchmore Hill. Palmer's Gr. and Bowes. Scarlet Fever - - - - - - - 1 - - - 5 Diphtheria 1 - - 1 - - - 1 - - - - Typhoid Fever 1 — - - 1 - - - - - 1 - Measles 1 - 1 - - - - - 1 — - 2 Whooping Cough 5 4 1 - — - - 2 2 — 1 - Diarrhoea 5 4 1 — — - - 1 - - 4 — Puerperal Feve 1 - - - 1 - - - 1 - - - Influenza 6 — - — - 1 5 1 1 3 1 — Phthisis 12 - - 1 - 11 - 7 4 - 1 - Other Tubercular Disease 2 - 1 1 - — - - 2 - - - Bronchitis 7 — — — 3 4 1 2 1 1 3 — Pneumonia 7 3 1 — 1 2 — 1 3 1 2 - Other Diseases of the Respiratory Organs 7 1 - — - 4 2 - 1 3 3 - Diseases of the Heart and Circulation 11 — - - - 6 5 1 2 2 6 — Brights Disease 6 — — — 4 2 3 - 2 1 - Cancer 14 — — — — 10 4 4 1 2 7 — Alcoholism—Cirrhosis of Liver 4 — - - - — 4 1 1 2 Senile Decay 16 - - - - - 16 6 1 5 4 — Diseases and Accidents of Parturition 2 2 - - — - - - 1 - 1 — Premature Birth... 4 4 - - - - - - 2 1 1 — Wasting & Debility from Birth 6 6 — - - - - - 3 1 2 — Diseases of Nervous System including ApoplexyA Convulsioions 20 3 1 1 - 5 10 7 4 3 6 — Accidents & "Found Deac 11 5 2 - — 4 •2 2 1 6 Suicide 2 - - — — 2 — — 1 - 1 — All other causes 12 1 3 1 2 3 2 3 6 2 1 1 — All causes 163 33 11 5 5 55 54 41 | 40 28 54 7 N.B.—The public institution included in above Table refers to the Metropolitan Asylums Board Hospital at Winchmore Hill. This is the only public institution in the district. 9 TABLE IA. Sihowiny causes of deaths during each of the Jour quarters of the year 1902. Causes of Death. 1st quarter 2nd quarter 3rd quarter 4th quarter Scarlet Fever — — — — Diphtheria — — — 1 Typhoid Fever — — — 1 Measles 1 — — — Whooping Cough 2 1 — 2 Diarrhoea — 1 4 — Puerperal Fever — 1 — — Influenza 3 1 — 2 Phthisis 3 2 2 5 Other Tubercular Diseases 1 — — 1 Bronchitis 5 1 — 1 Pueumonia 4 2 — 1 Other Diseases of the Respiratory Organs 3 2 2 Diseases of Heart and Circulation 2 1 7 1 Brights Disease 1 2 1 2 Cancer 1 3 7 3 Alcoholism and Cirrhosis of Liver 2 1 — 1 Senile Decay 5 4 1 6 Diseases & Accidents of Parturition — — 2 — Premature Birth 1 1 2 — Wasting and Debility from Birth 2 1 1 2 Diseases of Nervous System (including Apoplexy & Convulsions) 4 6 2 8 Accidents and "Found Dead" 2 4 3 2 Suicide — 1 — 1 All other causes 6 2 3 1 Totals 48 37 35 43 163 10 TABLE Ib. \ The Causes of Infantile Mortality. Causes of Death. 1st quarter. 2nd quarter. 3rd quarter. 4th quarter. Total. Whooping Cough 1 1 — 2 4 Diarrhoea — 1 3 — 4 Diseases of Respiratory Organs 1 2 — 1 4 Dentition 1 — 1 Convulsions 2 — — 1 3 Premature Birth 1 1 2 —■ 4 Prolonged Birth — — 2 — 2 Wasting and Debility from Birth 2 1 1 2 6 Accidental 1 — 1 — 2 Found Dead 1 — 1 1 3 Totals 9 6 11 7 33 11 TABLE II. Comparison oj the Rates oj the Southgate District with those oj England and Wales, the 76 Great Towns and England and Wales less the 179 Largest Towns. Rates per 1,000 oj the Population. Birth Rate. Death Rate. Deaths under 1 year per 1,000 Births. Zymotic Death.rate. Small.pox. Scarlet Fever. Diphtheria. Measles. Whooping Cough. Diarrhœa. England and Wales 28.6 16.3 133 1.64 .08 .15 .23 .38 .29 .38 7 6 Great Towns - 17.4 145 2.12 .12 .19 .26 .49 .37 .54 England and Wales less 179 Largest Towns - 15.3 119 1.14 .03 .10 .20 .27 .22 .22 Southgate District 25 10.3 83.5 .82 .00 .00 .06 .06 .31 .31 12 TABLE III. The principal Vital Statistics of the Southgate District for the Ten Years 1892 to 1901. Year. Population estimated to the middle of each year. Births. Deaths at all Ages. Deaths under One Year of Age. Zymotic death.rate per 1,000 of the population. Number. Rate per 1,000 of the population. Number. Rate per 1,000 of the population. Number. Rate per 1,000 Births registered. Percentage to Total Deaths. 1892 10,980 302 27.5 182 16.5 35 115 24.3 •78 1893 11,000 304 27.7 148 13.4 29 95 19.5 1.4 1894 11,300 292 25.8 131 11.5 30 103 22.9 2.3 1895 12,000 364 30.3 161 13.4 57 156 35.4 •8 1896 12,500 315 25.2 117 9.3 25 80 21.3 1.0 1897 13,000 326 25'2 158 121 48 147 30.0 2.4 1898 14,000 310 22.1 150 10.7 37 119 24.6 1.9 1899 14,500 366 25.2 182 12.5 51 140 28.0 2.7 1900 15,000 320 21.3 147 9.8 38 118 26.2 1.0 1901 15,200 375 24.6 142 9.3 35 93 24.6 1.3 Averages for years 1892.1901 13,045 327 25.4 151 11.8 38 116 25.6 1.5 1902 15,800 396 25 163 10.3 33 835 20.2 •82 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. 13 TABLE IV. Cases of Infectious Disease notified during the year 1902. Notifiable Diseases. Cases notified in the whole District. Total Cases notified in each Loiality. No. of Cases removed to Hospital from each Locality. Hospitals. At all ages. At Ages—Years. Southgate. New Southgate. Winchmore Hill. Palmers Green and Bowes. Southgate. New Southgate. Winchmore Hill. Palmers Green and Bowes. In Dist. Outside Dist rict. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 & upwards. Southgate. Enfield. South Mimms. Small-pox 8 — 1 — 2 5 — 2 1 2 3 2 1 2 3 — — 8 Scarlet Fever 62 — 17 34 7 4 — 11 25 6 20 10 18 5 13 46 — — Diphtheria 22 — 7 12 1 2 12 3 2 5 9 — 2 — 8 3 — Typhoid Fever 8 — 1 5 1 — 1 1 4 — 3 — 3 — — 3 — — Puerperal Fever 1 - - - 1 - - - 1 - - - - - - - - - Erysipelas 9 — — — 3 5 1 2 2 3 2 - - - - - - - Chicken Pox 105 5 53 43 3 1 — 15 34 15 41 - - - - - - - Totals 215 5 79 94 18 17 2 43 70 28 74 21 22 9 16 57 3 8 Isolation Hospital, Tile Kiln Lane, Palmers Green (in the District). 14 TABLE IVa. Cases of Infectious Disease notified during each Month of the Year 1902. Small Pox. Scarlet Fever. Diphtheria. Typhoid Fever. Puerperal Fever. Erysipelas. Chicken Pox. Totals. January 3 3 1 — — 7 February 2 7 — — — — 6 15 March — 6 3 — — — 8 17 April — 8 1 -- 1 3 8 21 May 5 1 — 24 30 June 3 1 1 1 — 37 43 July — 1 2 — — 9 12 August — 10 — 2 1 9 22 September 9 2 1 — 2 4 18 October 4 3 — — — — 7 November — 6 2 3 — 1 — 12 December 2 6 1 — 2 — 11 Totals 8 62 22 8 1 9 105 215 15 INFECTIOUS DISEASES, AND THE MEANS TAKEN TO PREVENT THEIR SPREAD. It will be seen from Table IV. that 215 cases of infectious diseases were notified during the year, as against 108 in the preceding year, 90 in 1900, and 170 in 1899. Of these, 8 were Small-pox, 22 Diphtheria, 02 Scarlet Fever, 8 Typhoid Fever, 1 Puerperal Fever, 9 Erysipelas, and 105 Chicken-pox. It will be seen at once, therefore, that this large total, as compared with previous years, was due to the inclusion of Chicken-pox amongst the " notifiable diseases," which accounted for nearly half the total number of infectious diseases notified, and was made notifiable for a definite period only, and for a special purpose, namely, in order that no case of Small-pox mistaken for Chicken-pox might be overlooked. For comparative purposes, therefore, I shall consider that there were 110 cases of ordinarily notifiable diseases ; these were notified from the different localities, as follows :—28 from Southgate, 30 from New Southgate, 13 from Winchmore Hill, and 33 from Palmers Green and Bowes. The 110 cases represent infection in 87 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 in cases of non-removal to the Hospital, and the sanitary condition of the premises inspected. In 20 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. The notification of these diseases was, therefore, the means of causing the inspection, apart from ordinary inspections, of 87 premises, and the remedy of insanitary conditions in 20. Sixty-eight cases in all—8 Small-pox, 40 Scarlet Fever, 11 Diphtheria, and 3 Typhoid Fever were removed to Isolation Hospitals, 57 to the Southgate Council's Hospital, 3 to the Enfield Hospital, and 8 (small-pox) to the South Minims Small-pox Hospital. The Infectious Sickness Rate of the District excluding the 105 cases of Chicken-pox was G-9 per 1000 of the population, as against 7-l in the preceding year, 0 in 1900, and 11.7 in 1899. The rate for the separate localities was as follows:—Southgate 6.6, New Southgate 9.4, Winchmore Hill 4.3, and Palmers Green and Bowes, 6.8. 16 Diagnosis Outfits.—The diagnosis outfits provided by the Council for the use of the medical practitioners in the District for sending morbid specimens from suspected cases of Diphtheria, Typhoid Fever, and Phthisis to the Jenner Institute of Preventive Medicine for bacteriological examination and report have been made full use of, and continue to prove of great service in establishing a correct diagnosis in these diseases, to the advantage of the general public health, as well as of those more immediately concerned. During the year 47 specimens were sent and reports received as follows:— Date. Disease Suspected. Report. January 3 Phthisis Negative. „7 Diphtheria Positive. „14 Diphtheria (2) Positive. „14 Diphtheria (Negative. „21 Diphtheria Negative. „30 Phthisis Positive. March 1 Diphtheria Negative. „7 Typhoid Fever Negative. „18 Phthisis Negative. „21 Diphtheria' (2) . Negative. „21 Diphtheria Negative May 1 Phthisis Positive. „13 Phthisis Negative. June 7 Diphtheria Negative. „25 Typhoid Fever Negative. July 19 Diphtheria Positive. „29 Diphtheria (2) . Positive. „29 Diphtheria Positive. August 6 Diphtheria Negative. „7 Diphtheria Positive. „12 Diphtheria Positive. „20 Diphtheria Positive. „27 Diphtheria Positive. September 4 Diphtheria Negative. October 17 Diphtheria Positive. „29 Diphtheria Positive. November 6 Diphtheria Negative. „7 Phthisis Negative. „8 Diphtheria Positive. „12 Phthisis Positive. „19 Diphtheria Negative. „27 Diphtheria (3) Positive. „27 Diphtheria Negative. „27 Diphtheria Negative. December 5 Phthisis Negative. „12 Diphtheria Negative. „15 Diphtheria (2) Positive. „15 Diphtheria Positive. „16 Diphtheria (2) Positive „16 Diphtheria Negative 17 Date Disease Suspected. report. December 19 Diphtheria Positive 23 Diphtherial (2) Negative. 23 Diphtheria 1 Negative. 30 Diphtherial Negative. 30 Diphtherial (4) Pseudo Diphtheria 30 Diphtherial Negative. 30 Diphtheria Negative N. B.—These were not all from different cases, but in some instances were further specimens taken from same cases at intervals for re-examination. Total.—47 Bacteriological Examinations (including re-examination in some cases), of which 21 gave Positive, and 26 Negative results. Diphtheria Antitoxin.—The supply of diphtheria antitoxin provided by the Council and kept available for use at any time at the Council Offices, has been made full use of as occasion requires, to the great advantage of those suffering from the disease and the public in general. Handbills concerning infectious Diseases.—Handbills giving instructions as to the danger of, and precautions to be taken to avoid spreading infection in, cases of Consumption, Measles, and Whooping Cough, (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. The necessary knowledge as to where the two latter diseases are present is supplied to me chiefly by the School Attendance Officer and the School Authorities. This system of notification of non-notifiable diseases by the School Attendance Officer and the School Authorities, instituted in 1898, continues to work satisfactorily. SMALL-POX. Eight cases of Small-pox were notified from 7 houses, 3 in January, 2 in February, aud 3 in June. These occurred in the different localities as follows:—2 in Southgate, 1 in New Southgate, 2 in Winchmore Hill, and 3 in Palmers Green and Bowes. All the cases were removed to the Small-pox Hospital at South Mimms. In three of these cases the infection was almost certainly contracted in London, and in two other cases I was unable to trace the source of infection. Of the remaining three cases, one apparently 18 became infected through the medium of his daughter, who was a servant employed in a house where a case had recently occurred ; another probably contracted the disease by visiting a house from where a case had been removed 21 days previously, and the third from a previous case in the same house, removed a fortnight before. In every case the strictest measures were taken against the spread of the disease. All the cases were removed to the Small-pox Hospital at South Minims, on the same day as the notification was received, and the vacated rooms immediately fumigated and closed up for 48 hours, after which all the bedding, clothing, hangings, etc., which were worth keeping were taken away with all due precaution and disinfected in the steam disinfector attached to the Council's Isolation Hospital. Worthless articles were removed and burnt, and the whole premises thoroughly disinfected and cleansed. All " contacts " had the clothes they were wearing disinfected, and, excepting those who had been recently done, were re-vaccinated before leaving the premises, and were visited and kept under observation for three weeks. In those cases in which visitors had come from other districts the names and addresses were taken, and the Sanitary Authorities of the district to which they returned were notified of the facts, so that these contacts could be kept under observation. It is a significant fact that of these 8 cases, 7, varying in age from 20 to 42, had never been re-vaccinated, and in the remaining case, a child of 4, who had been thoroughly exposed to infection from a previous case in the house, the disease was extremely mild, due doubtless to the fact that she had been vaccinated in infancy, 4 years previously, and it is safe to assume that if she had been re-vaccinated when the previous case occurred, she would have escaped altogether. This was not done as, at the time, it was not considered necessary. SCARLET FEVER. There were 62 cases notified from 43 houses as against 57 in the preceding year, and 50 in 1900. They were notified from the different localities as follows:—11 from Southgate, 25 from New Southgate, 6 from Winchmore Hill, and 20 from Palmers Green and Bowes. In G houses sanitary defects were found. Four cases were imported, and 19 were secondary cases occurring in houses from which previous cases had been notified. 19 In the remainder of the cases I was unable to trace the source of infection. The cases were fairly equally distributed over each locality in which they occurred, and there was no marked incidence upon any one particular block of houses or streets. DIPHTHERIA. There were 22 cases notified from 19 houses, as against 20 in the preceding year, and 32 in 1900. They were notified from the different localities as follows:—12 from Southgate, 3 from New Southgate, 2 from Winchmore Hill, and 5 from Palmers Green and Bowes. In 8 cases sanitary defects were found, 1 case was imported, and 3 were secondary cases, the infection having been taken from previous cases in the same houses. There was one death. TYPHOID FEVER. During the year 8 cases were notified, from 8 houses, and from the different localities as follows:—1 from Southgate, 4 from New Southgate, and 3 from Palmers Green and Bowes. In 3 cases sanitary defects were found. Two cases were imported. Of the remaining cases, 4 were children living in two streets in New Southgate, namely Albert Street and Palmers Road, both close to Bounds Green Brook, a common resort of children of this neighbourhood, known to be much polluted at times by the sewage effluents of neighbouring districts, and which was suspected to be the cause of infection of 5 cases in the previous year, all of whom were children who had played in and about the brook as reported on in my last Annual Report. Whether in the present cases, there was any direct connection with this brook case I am unable to say, but the associations are at any rate suggestive. TUBERCULOSIS. During the year there were 14 deaths from tubercular diseases, 12 of these being 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, 20 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 coat by the Sanitary Authority has been made, and in every case carried out. Whooping Cough was very prevalent in all parts of the District, more or less throughout the year, and was epidemic in Southgate during November and December, necessitating the schools being kept closed an extra week at the end of the Christmas holidays. There were 5 deaths from this cause in all. Chicken,Pox was also prevalent in all parts of the District, more especially in New Southgate, Palmers Green and Bowes, during the middle portion of the year. Owing to the general prevalence of Small-pox also about London, Chicken-pox was made notifiable in the District in common with other Districts about London, from February 22nd to September 21st, owing to the similarity that exists between Chicken-pox and some cases of modified Small-pox, and the difficulty that sometimes arises in distinguishing between the two. But in no instance, as far as 1 am awrare, did this notification of Chicken-pox lead to the discovery of any unsuspected case of Smallpox in this District. Isolation Hospital. —This Hospital, situated at Tile Kiln Lane, Palmers Green, was formally opened on January 4th. It consists of a Scarlet Fever block of two wards, and half an isolation block of two wards, and was designed to accommodate 10 beds and 2 cots in the Scarlet Fever Wards, and 4 beds, and 2 cots in the isolation block, but I find that there is ample room, if necessary, to put up 4 extra beds in the Scarlet Fever block, and 2 in the isolation block, and still maintain the proper amount of air space per bed. There is also an administrative block, a laundry, and disinfecting block, with mortuary attached, and a porter's lodge. Owing to the fact that only half the isolation block has been built at present I am sometimes prevented from taking in cases that I otherwise should do because if I have one patient of each sex suffering from the same disease at the same time there I am unable to take in any case of any other disease. For instance, if I have two cases of Typhoid Fever, one of each sex, I am unable to take in any 21 Diphtheria cases, and vice versa. It is obvious, therefore, that our capacity to deal with the isolation of infectious diseases in the District is limited to this extent, and T think it would be advisable, taking into consideration the rapidity, with which the District is increasing in population, to complete this isolation block as soon as is practicable. The first case was admitted on February 7th, and from that date to the end of the year 03 cases in all were admitted, namely, 50 Scarlet Fever, 9 Diphtheria, and 4 Typhoid Fever. Four of these cases were admitted from outside the District, 3 of Scarlet Fever from Friern Barnet, and 1 of Typhoid Fever from East Barnet. The average times of detention in hospital were for Scarlet Fever cases 50 days, Diphtheria cases 20 days, and Typhoid Fever 51 days. The greatest number in hospital at any one time was 18, and the smallest number 2. There were no deaths. I think it is a matter for congratulation that yon have secured the services of so able a matron as Miss Ogden lias proved, in my opinion, to be, and who together with the staff under her, have carried out their duties to my entire satisfaction. MISCELLANEOUS. Return of the Metropolitan Asylums Board Hospital. —During the past year J-,167 cases were admitted into the hospital, situated at Winchmore Hill; of these, 3,800 were Scarlet Fever, and 307 Diphtheria. There were 7 deaths, 5 from Scarlet Fever and 2 from measles. Sewers.—During the year 1725 yards of new foul sewer were laid in Bowes Road West, Hardwicke Road, Jones's Lane, Stanley Road, Highworth Road, and Union Road, and 2,878 yards of new surface water sewers in Jones's Lane, Highfield Road, Bowes Road, Green Lanes Compton Road, Bowes Road (West), Hardwicke Road, Stanley Road, Highworth Road, and Union Road. The sewers have been regularly flushed throughout the year, and very few complaints of offensive smells arising therefrom have been made. A number of tall ventilating shafts have been erected. Water Supply.—Practically the whole District is now supplied by the New River Company, and very few houses are now dependent on wells for their water. 22 Watercourses.—Bounds Green Brook and Pymmes Brook remain in about the same condition. The periodical cleaning by the Middlesex County Council helps to keep them from getting very foul, but they are still much polluted owing to the discharge into them of sewage effluents from neighbouring districts, and in dry weather they are sometimes very offensive. Housing of the Working Classes Act.—With regard to the block of cottages in Tile Kiln Lane previously reported on as condemned, one of these has been demolished, and the remainder are being rendered more fit for habitation. The condemned block of cottages at Church Hill, Winchrnore Hill, are now empty and will be shortly demolished. At Harwood^Yard, Winchrnore Hill, owing to representations made to the owner, 4 cottages have been pulled down, and 3 good cottages erected on the same site. At Chase Side, Southgate, I inspected a block of old cottages, and as a result the owner decided to demolish them during the ensuing year, and erect a good class of property, probably shops, in their place. In view of the number of old cottages being pulled down in different parts of the District to make room for villa and shop property, the necessity for providing suitable dwellings under this Act become more and more imperative, and I trust that you will not lose sight of this important matter. As I have several times urged before, there is no more useful or necessary sanitary measure you could undertake. Roads.—The following roads were made up during the year :— Warwick Road, Stanley Boad, Highworth Road, and Union Road, all in New Southgate. I regret to state that the paving and draining of certain back entrance ways to shops and premises in different parts of the District, the necessity of which I have urged in my last three annual reports, has not yet been done. It would appear that the difficulties which the Council have met in dealing with this are so great that they cannot be overcome. The necessity for doing it, however, still remains. Public Park.—The Council will shortly become the owners of 23 Broorafield Park, consisting of about 54 acres, the Local Government Board having sanctioned the purchase thereof by the Council at the sura of £25,000, of which amount the Middlesex County Council has agreed to contribute £0,250. The acquirement of this Park in the centre of, what will eventually become, a large and populous neighbourhood, will doubtless be very beneficial to the District, as a permanent open space and recreation ground, more especially in the future. Cowsheds, Brains, Slaughter-houses, and Bake, houses.—These have all been systematically inspected, and have been kept in a satisfactory condition, in accordance with the Bye-laws. Factory and Workshop Act, 1901.—The workshops in the District have been visited, and the sanitary condition, &c., noted in the register now being kept under the above Act. The lists of outworkers have been received from the different Authorities, and the houses of such outworkers were visited and found in a satisfactory condition. Underground Bakehouses.—There is only one underground bakehouse in the District, which the Council will have to deal with when the time arrives. 24 URBAN DISTRICT COUNCIL OF SOUTHGATE. Table of Sanitary Work, 1902. Sanitary District, Southgate. INSPECTIONS. Complaints Received 54 Cases of Infectious Disease Notified 215 Number of Premises Periodically Inspected 44 Houses Inspected from House to House 88 Total Number of Houses, Premises, &c., Inspected 656 Total Number of Re-Inspections after Order or Notice 2060 Total Number of Inspections and Re-Inspections 2716 NOTICES. Letters Written 434 Cautionary Notices Given 81 School Notices (Infectious Disease) 150 Statutory Orders Issued 11 Summonses Served — C mvictions Obtained — DWELLING HOUSES. Houses, Premises, &r.., Cleansed, Repaired, &c. 75 Closed as unfit for Habitation 9 Re-Opened after Repairs, Alterations, &c. — Demolished 5 MOVABLE DWELLINGS, CARAVANS, TENTS, &c. Number of Nuisances therefrom Abated 12 Number removed from District 375 25 URBAN DISTRICT COUNCIL OF SOUTHGATE. Table of Sanitary Work, 1902. Sanitary District, Sodthgate. LAUNDRIES. Number in District 8 WORKSHOPS AND WORK PLACES. Number in District 29 BAKEHOUSES. Number in District 12 Number of Inspections 48 Contraventions of Factory Acts — SLAUGHTER-HOUSES. Number on Register 7 Number of Inspections 51 Contraventions of Bye-Laws — COWSHEDS. Number on Register 10 Number of Inspections 36 Contraventions of Bye-Laws — DAIRIES AND MILKSHOPS. Number on Register 15 Number of Inspections 40 Contraventions of Bye-Laws — MORTUARIES. Accommodation 1 Number of Bodies received 15 26 URBAN DISTRICT COUNCIL OF SOUTHGATE. Table of Sanitary Work, 1902. Sanitary District, Soutiic/ate. WATER SUPPLY AND WATER SERVICE. Wells. New, Sunk — Cleansed, Repaired, &c 1 Closed as Polluted — Houses, Water Laid on to — Percentages of Houses Supplied from Main — Cisterns. New Provided — Cleansed, Repaired, Covered, &c 10 Overflow Pipes Disconnected from Drains — Repaired, or New Flush Cisterns provided to W.C.'s 56 Draw-Taps Removed from Cistern to Mains 8 Percentage of Houses Supplied on Constant System 97% EARTH CLOSETS. Water Closets Substituted for Dry Receptacles DRAINAGE AND SEWAGE. Water Closets. New, Constructed 7 New Apparatus Provided 60 Bepaired, Cleansed, &c 36 Ventilated Percentage of Houses provided Water Closets practically tlie whole. Drains. Examined, Tested, Exposed, &c 93 Unstopped, Repaired, &c. 36 Waste Pipes, Rain Water Pipes, &c., Disconnected 46 Soil Pipes and Drains Ventilated 50 Disconnecting Traps or Chambers Inserted 66 Reconstructed 76 Cesspools. Rendered Impervious, Emptied, Cleansed, &c. 1 Abolished and Drain connected with Sewer I Percentage of Houses Draining into Sewers 99% Sewers. Yards of Sewers Laid 4603 Yards of Sewers Reconstructed 669 27 URBAN DISTRICT COUNCIL OF SOUTHGATE. Table of Sanitary Work, 1902. Sanitary District, Southgate. J. W. H. BROWN, Sanitary Inspector. DISINFECTION. Rooms Fumigated 154 Rooms Stripped and Cleansed 140 Articles Destroyed 333 DUST. Dust-bins Repaired — New Movable Bins Provided 46 Periodical Frequency of Dust Removal Weekly Number of Complaints of Non-Removal Received 10 DAMPNESS. Roofs Repaired, &c 26 Guttering and Rain Pipes Repaired, &c. 34 Gardens, Area, <fec., Levelled and Drained — Yards Paved and Drained 53 Surface adjoining Houses Paved — Dry Areas Provided — Ventilation below Floor Provided 35 Basements Rendered Impervious — SUNDRY NUISANCES ABATED. Smoke 1 Accumulation of Refuse 17 Foul Ditches, Ponds, &c., and Stagnant Water 8 Foul Pigs and other Animals 4 Other Nuisances 34