5049 004 Southgate Urban District Council. REPORT of the Medical Officer of Health, FOR THE YEAR 1904, 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. 1905. Printed at the “Barnet press" office. To the Members of the Southgate Urban District Council. Gentlemen, I have the honour to present to you my Report for the year 1904, to which is appended the Report of the Sanitary Inspector, Mr. J. W. H. Brown, which, as usual, constitutes an excellent record of good and useful sanitary work done by him and his assistant during the year, and to whom, as well as to Mr. C. J. Lawson, Surveyor, my thanks are due for valuable assistance in compiling this Eeport. I should also like to tender my thanks to the Health and Hospital Committee for their unfailing courtesy and support throughout the year. I am, Gentlemen, Your obedient Servant, A. SIDNEY RANSOME. February, 1905. 4 DESCRIPTION AND TOPOGRAPHY OF THE DISTRICT. THE Urban District of Southgate is formed by a number of Hamlets, previously—and some of them even now—called "villages." It is partly situated on what is sometimes called the Northern Heights, about eight miles from London, and is rapidly becoming essentially suburban in character. It may be conveniently divided into four localities— (i) Southgate, (2) Winchmore Hill, (3) a large part of New Southgate and Bounds Green, (4) Palmers Green and a large part of Bowes. The District comprises an area of 3,596 acres, and may be said to consist of three valleys, running from west to east, the northern areas being somewhat higher than the southern, and the whole consisting of very undulating ground dipping off to a rather flat area on the eastern boundary, adjoining the Edmonton District. The highest Ordnance level is on the Enfield Road, and is 302 feet; while the lowest is near the south-eastern boundary, and is 61 feet. The subsoil consists of various clays with large pockets of gravel and sand. On the south side is a grand bed of brick earth overlying a deep bed of gravel, which forms excellent building land, on which a building estate has recently been opened. Beneath these strata are beds of London clay, black sand, and chalk, more or less water bearing, and from which the deep wells and borings of the New River Company derive their supply. POPULATION. The census returns of 1901 shewed that in this District the number of inhabitants to each occupied house averaged from 5.1 to 5.3, according to the locality. Taking this as the basis of calculation, the population at Midsummer, 1904, was 19,000, an increase of 2,000 over that of the previous year. This is the largest increase in one year that has occurred in this District, and was due to the large number of new houses occupied; one-half of these were erected in Palmers Green, the remaining half being fairly evenly distributed through the rest of the District. The population of the four localities which make up the 5 District was as follows: Southgate, 4,550; New Southgate, 4,400; Winchmore Hill, 3,400; and Palmers Green and Bowes, 6,650. The natural increase of the population by excess of births over deaths was 270. BIRTHS.—BIRTH-RATE. During the year 441 births were registered, an increase of 74 on the preceding year. This gives a birth-rate of 23.4 per 1,000 of the population. The average rate for the 10 years, 1894 to 1903, was 24.6. The birth-rate of England and Wales in 1904 was 27.9, which is lower than the rate in any other year on record, and shows a decrease of 13 per 1,000 compared with the average rate of the previous 10 years. MORTALITY. General Mortality and Death-rate.—The number of deaths which occurred in the District during the past year, including the deaths of 11 "residents" who died outside the District (9 in Edmonton Union), and excluding the deaths of 15 "non-residents" who died in the District (10 in the Metropolitan Asylums Board Hospital at Winchmore Hill), was 172. The death-rate was therefore 9.0 per 1,000 of the population, an increase of 5 per 1,000 only on the rate of the preceding year, which was an exceptional one, and the lowest on record for this District. The rate for last year is also a very low one, and the next lowest on record to that of 1903. The average rate for the 10 years, 1894 to 1903, was 107. The death-rates of the separate localities were as follows:— Southgate, 9.4; New Southgate, 127; Winchmore Hill, 8.8; and Palmers Green and Bowes, 6.6. It will be seen that there is a remarkable difference in the death-rates of the different localities: that of New Southgate is considerably greater than the rest, and is, I think, accounted for by the fact that New Southgate is on the whole the poorest and most thickly populated part of the District. This is also borne out by the fact that there were exactly double the number of deaths from Phthisis and other tubercular diseases in New Southgate that there were in the other three localities put together. As a general rule, the poorer and more thickly populated a district is, the more prevalent are Phthisis and other tubercular diseases. As a contrast to this the death-rate of Palmers Green and Bowes is exceptionally low, and is due, I think, to the fact that 6 (i) it is an almost entirely newly built locality with excellent sanitation, and (2) the larger part of the population consists of persons in the middle period of life, which is, of course, least liable to diseases and illness. A large part of this population consists of young people of the well-to-do middle class with small or no families. Infantile Mortality.—There were 35 deaths of infants under one year of age, giving an infantile death-rate of 79.3 per 1,000 births registered, as against 87.1 in the preceding year, 83 in 1902, and 93 in 1901. The average rate for the 10 years 1894 to 1903 was 112. This is a very low rate, and the lowest on record for this District. The infantile death-rate for England and Wales was 146, which is 9 per 1,000 below the mean for the previous 10 years. Senile Mortality.—Among persons of 70 years of age and over 39 deaths occurred, and of these 14 were 80 years of age and over. This is a proportion of 22.8 per cent. of the total number of deaths at all ages, as against 25.3 in the preceding year. Zymotic Mortality.—This includes the deaths from the seven principal zymotic diseases, viz.:—Smallpox, Scarlet Fever, Diphtheria, Typhoid Fever, Measles, Whooping Cough, and Diarrhœa. This rate affords useful evidence as to the general healthiness of the District, and as to the efficiency of its sanitary administration. There were 15 deaths from these diseases, as follows: Scarlet Fever, 1; Diphtheria, 1; Measles, 4; Whooping Cough, 4; and Diarrhœa, 5. The zymotic death rate was, therefore, 79 per 1,000 of the population, as against 1.0 in 1903, 82 in 1902, and 1.3 in 1901. The average rate for the 10 years, 1894 to 1903, was 1.5. The zymotic death-rate for England and Wales was 1.94. The Causes of Death are fully set forth in Table 1. (i.) for the whole District at different age periods, and (ii.) for each of the four localities. Table I. shows the deaths during each quarter of the year. There was no marked incidence of any particular disease upon any one locality, with the exception of Phthisis and other Tubercular Diseases, from which there were 11 deaths in New Southgate, as against 5 in the whole of the rest of the District. The Public Mortuary.—During the year 9 bodies were deposited in the Mortuary, as against 8 in the preceding year and 15 in 1902. 7 Inquests held during the Year 1904 on Deaths occurring in the District. No. Month. Sex. Age. Condition of Life. Cause of Death. 1 January Male 49 Labourer Natural causes. 2 March Male 58 Platelayer Accidental Run over by railway engine. 3 April Male New Born Infant Misadventure — Want of attention at birth. 4 May Female 57 Cook Misadventure—Asphyxiation, coal gas. 5 June Female 46 Married Natural causes. 6 August Male 24 Clerk Suicide -Unsound mind. 7 August Female 68 Married Natural causes. 8 October Female 56 Widow Natural causes. 9 November .. Female 63 Married Natural causes. 10 December Male 27 Labourer Accidental—Run over by train. 11 December Male 65 Engraver Suicide—Unsound mind. 12 December Male 57 Retired Natural causes. 8 Table 1. Causes of and Ages at Death during the Year 1904. Causes of Death. Deaths in, or belonging to Whole District at subjoined Ages Deaths in Localities (at all Ages). Total Deaths in Public Institutions in the District. All ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Southgate. New Southgate. Winchmore Hill. Palmers Gr. and Bowes. Scarlet Fever 1 .. 1 .. .. .. .. 1 .. .. .. 5 Diphtheria 1 .. 1 .. .. .. .. .. 1 .. .. 4 Typhoid Fever .. .. .. .. .. .. .. .. .. .. .. .. Measles 4 .. 4 .. .. .. .. .. 2 1 1 .. Whooping Cough 4 2 2 .. .. .. .. .. 1 1 2 .. Diarrhœa 5 5 .. .. .. .. .. 1 1 1 2 .. Puerperal Fever 1 .. .. .. 1 .. .. .. 1 .. .. .. Influenza 5 .. .. 2 .. 2 1 1 2 2 .. .. Phthisis 12 .. .. .. 2 9 .. .. 8 1 3 .. Other Tubercular Diseases 4 .. 1 1 .. 2 .. .. 3 .. 1 .. Bronchitis 6 2 .. .. .. 2 2 .. 4 .. 2 .. Pneumonia 16 5 4 .. .. 4 2 5 1 5 5 1 Other Diseases of Respiratory Organs 3 .. 1 .. .. 1 1 1 2 .. .. .. Diseases of the Heart and Circulation 17 1 .. 1 .. 11 4 4 5 5 3 .. Bright's Disease 4 .. .. .. 1 1 2 2 1 1 .. .. Cancer 12 .. .. .. .. 8 4 4 4 1 3 .. Alcoholism—Cirrhosis of Liver 2 .. .. .. .. 2 .. 1 .. .. 1 .. Senile Decay 22 .. .. .. .. .. 22 7 7 2 6 .. Diseases and Accidents of Parturition .. .. .. .. .. .. .. .. .. .. .. .. Premature Birth 4 4 .. .. .. .. .. .. 2 1 1 .. Wasting and Debility from Birth 13 12 1 .. .. .. .. 6 3 2 2 .. Diseases of Nervous System, including Apoplexy and Convulsions 15 3 .. .. .. 3 9 4 2 3 6 .. Accidents & Found Dead 2 1 .. .. .. 1 .. .. 1 1 .. .. Suicide 1 .. .. .. .. .. 1 .. .. .. 1 .. All other causes 18 1 4 •• 2 10 1 5 5 3 5 •• All causes 172 36 20 4 7 56 49 42 56 30 44 10 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 1a. Showing the Causes of Death during each of the Four Quarters of the Year 1904. Causes of Death. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Scarlet Fever .. 1 .. .. Diphtheria .. 1 .. .. Typhoid Fever .. .. .. .. Measles 3 .. 1 .. Whooping Cough 1 .. 2 1 Diarrhœa .. .. 5 .. Puerperal Fever .. .. .. 1 Influenza 2 .. .. 3 Phthisis 3 2 3 3 Other Tubercular Diseases .. 1 1 2 Bronchitis 5 .. .. 1 Pneumonia 7 3 1 5 Other Diseases of the Respiratory Organs .. .. 1 2 Diseases of Heart and Circulation 7 5 2 3 Bright's Disease .. 2 2 .. Cancer 3 .. 6 3 Alcoholism, Cirrhosis of Liver 1 1 .. 1 Senile Decay 11 2 4 5 Diseases & accidents of parturition .. .. .. .. Premature Birth 2 .. 2 .. Wasting and Debility from Birth 2 1 5 5 Diseases of Nervous System, including Apoplexy & Convulsions 2 5 4 4 Accidents and "Found Dead" 1 1 .. .. Suicide .. .. .. 1 All Other Causes ., 5 4 4 5 Totals 55 28 43 45 171 10 Table 1b. The Causes of Infantile Mortality. Causes of Death. 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total Whooping Cough .. .. 1 1 2 Diarrhœa .. .. 5 .. 5 Diseases of Respiratory Organs 5 .. .. 2 7 Dentition •• .. .. 1 1 Convulsions 1 .. .. 1 2 Premature Birth 2 .. 1 .. 3 Wasting and Debility from Birth, including Developmental Defects 3 1 6 4 14 Asphyxiation — Misadventure .. 1 .. .. 1 Totals 11 2 13 9 35 11 Table II. Comparison of the Kates of the Southgate District with those of England and Wales, the 76 Great Towns, and England and Wales less the 218 Largest Towns. Kates per 1,000 of 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 27.9 16.2 146 1.94 .01 •11 •17 .36 .34 •86 76 Great Towns 29.1 17.2 160 2.49 •01 •12 •19 •47 •40 1.2 England and Wales less 218 Largest Towns 26.8 15.3 125 1.28 •01 •09 •14 23 •27 •46 Southgate District 23.4 9.0 79 3 .79 .00 .05 .05 .21 .21 .26 12 Table III. The Principal Vital Statistics of the Southgate District for the Ten Years 1894 to 1903. 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. Bate per 1,000 of the population. Number Bate per 1,000 of the population. Number. Bate per 1,000 Births registered. Percent age to Total D'aths 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 12.1 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 1902 15,800 396 25 163 10.3 33 83 20.2 •82 1903 17,000 367 21.5 146 8.5 32 87.1 21.8 1.0 Averages for years 1894-03 14,030 343 24.6 149 10.7 38 112 25.5 1.5 1904 19.000 441 23.4 172 9.0 35 79.3 20.4 •79 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. Casks of Infectious Disease Notified during the Year 1904. Notifiable Diseases. Cases Notified in the Whole District. Total Cases Notified in Each Locality. No. of Cases Removed to Hospital from Each Locality. Hospital. In the district At all Ages. At Ages—Years. Southgate. New Southgate. Winchmore Hill. Palmers Grn and Bowes. Southgate. New Southgate. Winchmore Hill. Palmers Grn. and Bowes. Southgate. Under 1 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upw'rds. Scarlet Fever 91 .. 26 59 5 1 .. 25 28 13 25 24 24 10 19 77 Diphtheria 23 1 9 9 2 2 .. 4 5 1 13 1 .. .. 4 5 Typhoid Fever 5 .. 1 .. 4 .. .. .. 2 2 1 .. 2 .. .. 2 Puerperal Fever 1 .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. Erysipelas 22 .. 1 3 5 12 1 9 4 3 6 .. .. •• .. .. Totals 142 1 37 71 17 15 1 38 40 19 45 25 26 10 23 84 Isolation Hospital, Tottenhall Road, Palmers Green (in the District). 14 Table IVa. Cases of Infectious Disease notified during each Month of the Year 1904. Scarlet Fever. Diphtheria. Typhoid Fever. Puerperal Fever. Erysipelas. Totals. January 12 7 1 .. 2 22 February 7 1 .. .. 2 10 March 3 2 .. .. 1 6 April 3 2 .. .. 3 8 May 3 2 .. .. 1 6 June 12 3 .. .. 3 18 July 2 1 .. .. 1 4 August 3 .. .. .. 2 5 September 10 .. .. .. 2 12 October 8 .. 1 .. 2 11 November 15 2 1 .. 2 20 December 13 3 2 1 1 20 Totals 91 23 5 1 22 142 15 INFECTIOUS DISEASES, AND THE MEANS TAKEN TO PREVENT THEIR SPREAD. It will be seen from Table IV. that 142 cases of infectious diseases were notified during the year, as against 136 in the preceding year, 110 in 1902, and 108 in 1901. Of these, 23 were Diphtheria, 91 Scarlet Fever, 5 Typhoid Fever, 1 Puerperal Fever, and 22 Erysipelas. These were notified from the different localities, as follows: 38 from Southgate, 40 from New Southgate, 19 from Winchmore Hill, and 45 from Palmers Green and Bowes. These 142 cases represent infection in 113 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 8 houses sanitary defects were found, consisting chieflyof 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 113 premises, and the remedy of insanitary conditions in 8. Eighty-four cases were removed to the Isolation Hospital at Palmers Green. Of these 77 were Scarlet Fever, 5 Diphtheria, and 1 Typhoid Fever. The Infectious Sickness Rate of the District was 7.5 per 1,000 of the population as against 8.o in the preceding year, 6.9 in 1902, and 7.1 in 1901. The rates for the separate localities were as follows: Southgate, 8.4; New Southgate, 97; Winchmore Hill, 5.3; and Palmers Green and Bowes, 6'8. Methods of Disinfection.—(1) For disinfection of rooms, Formalin is used (a) by spraying and (b) with "Paraform" tablets in the "Alformant'' lamp. (2) Bedding, etc., is disinfected in the steam disinfecting apparatus established on the premises of the Isolation Hospital. For taking the bedding, etc., to and fro, two special vans are kept, one for the infected, and the other for the disinfected articles. 16 (3) After rooms have been disinfected the wall papers are stripped from the walls and burnt, and ceilings, walls, and all surfaces are thoroughly washed. 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 Lister Institute of Preventive Medicine for bacteriological examination and report have been made extensive 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 51 specimens were sent and reports received as follows:— Date. Disease Suspected. Report. January 1 Diphtheria Negative. ,, 7 Enteric Fever Negative. ,, 23 Diphtheria Negative. ,, 27 Diphtheria Negative. February 2 Diphtheria Positive. ,, 4 Phthisis Positive. ,, 9 Diphtheria Positive. ,, 10 Diphtheria Negative. ,, 10 Diphtheria Negative. ,, 15 Enteric Fever Negative. ,, 17 Diphtheria Positive. ,, 19 Phthisis Negative. ,, 24 Diphtheria Negative. ,, 27 Enteric Fever Negative. March 4 Enteric Fever Negative. ,, 11 Phthisis Positive. ,, 11 Enteric Fever Negative. ,, 12 Phthisis Negative. ,, 15 Enteric Fever Negative. ,, 16 Enteric Fever Negative. ,, 21 Enteric Fever Negative. April 12 Diphtheria Positive. ,, 15 Diphtheria Negative. ,, 16 Diphtheria Negative. May 4 Diphtheria Negative. ,, 4 Diphtheria Negative. ,, 4 Diphtheria Negative. ,,5 Diphtheria Negative. ,, 11 Diphtheria Negative. ,, 12 Diphtheria Negative. ,, 20 Diphtheria Positive. ,, 25 Diphtheria Positive. ,, 31 Diphtheria Negative. June 3 Diphtheria Positive. ,, 11 Diphtheria Negative. 17 Date. Disease Suspected. Report. July 23 Diphtheria Positive. ,, 23 Diphtheria Negative. August 9 Diphtheria Negative. ,, 9 Phthisis Positive. ,, 10 Phthisis Negative. ,, 19 Diphtheria Negative. ,, 31 Phthisis Negative. September 26 Diphtheria Negative. November 8 Diphtheria Negative. ,, 14 Diphtheria Positive. ,, 16 Diphtheria Positive. ,, 17 Diphtheria Negative. ,, 23 Diphtheria Positive. December 1 Diphtheria Positive. ,, 12 Diphtheria Positive. ,, 24 Diphtheria Positive. N.B.—These were not all from different cases; but in many instances, chiefly of Diphtheria, were further specimens taken from the same cases at intervals for re-examination to determine when the case in question ceased to be infectious. In some cases this has to be repeated several times before a negative result is reported. Total.—51 bacteriological examinations, of which 17 gave positive and 34 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 required, 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 Phthisis. Measles, and Whooping Cough—net 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 Officers and the School Authorities. This system of notification of non-notifiable diseases by the School Attendance Officers and the School Authorities, instituted in 1898, continues to work satisfactorily. 18 SMALLPOX. No cases were notified. With regard to the effective isolation of cases of Smallpox, there is every probability of a number of local authorities, including Southgate, arranging for the joint accommodation of Smallpox cases occurring in their respective districts. SCARLET FEVER. There were 91 cases notified from 70 houses, as against 107 in the preceding year, 62 in 1902, and 57 in 1901. They were notified from the different localities as follows:—25 from Southgate, 28 from New Southgate, 13 from Winchmore Hill and 25 from Palmers Green and Bowes. In six houses sanitary defects were found. Three cases were imported, and 12 were secondary cases occurring in houses from which previous cases had been notified. Seventy-seven cases were removed to the Isolation Hospital. DIPHTHERIA. There were 23 cases notified from 15 houses, as against 9 in the preceding year, 22 in 1902, 20 in 1901, 32 in 1900, and 83 in 1899. They were notified from the different localities as follows:— 4 from Southgate, 5 from New Southgate, 1 from Winchmore Hill, and 13 from Palmers Green and Bowes, one of which was fatal; one was an imported case, and six were secondary cases. In one house only, sanitary defects were found. TYPHOID FEVER. During the year 5 cases were notified from 5 houses, and from the different localities as follows:—2 from New Southgate, 2 from Winchmore Hill, and 1 from Palmers Green and Bowes Park. In one case the infection was probably due to the consumption of shellfish. Another case was imported, but in the remainder I was unable to trace the source of infection. In one house sanitary defects were found. 19 TUBERCULOSIS. During the year there were 16 deaths from Tubercular diseases, 12 of these being from Phthisis. 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 every case carried out. The Council are considering the question of making arrangements for the maintenance of two beds, in a Sanatorium to be determined upon, for the reception of suitable cases of Consumption from this district. This will be, I feel sure, a very wise provision. Not only will such cases as have the advantage of Sanatorium treatment have every prospect of being restored wholly or partially to health, but they will, which is of the greatest importance, not only learn while undergoing the treatment how to live at home under the best possible conditions to keep them in health or continue the curative process there begun, but they will become centres for imparting and disseminating their experience and knowledge to others around them. ISOLATION HOSPITAL. This Hospital is built on a site of nine acres of land situated in Tottenhall Road, Palmers Green. It is a fine open and airy site admirably adapted for the purpose. Only a portion of the site is at present occupied by the Hospital premises, the remainder being let off in allotments. The Hospital premises are entirely closed by a close boarded fence, and there is one entrance only, in Tottenhall Road. The Hospital was opened in January, J902, and consists of (1) an administration block for the Staff; (2) a ward block; (3) an isolation block; (4) a laundry block with steam 20 disinfecting apparatus and mortuary attached; and (5) an entrance lodge. The following amounts were sanctioned by the Local Government Board to be borrowed for the purpose of the Hospital:- (1) Purchase of land £2,500 (2) Fencing, draining, etc., of site, and building entrance lodge 1,600 (3) Erecting Hospital Buildings 8,400 (4) Furniture 600 £13,100 The ward block is used entirely for Scarlet Fever cases, and consists of two wards, one 36ft. by 26ft. and 13ft. in height, for women and children, and the other 26ft. by 24ft. and 13ft. in height, for men, with a nurse's duty room between them, arranged so that the nurse-in-charge can look through a small fixed window into each ward. The male ward was designed to accommodate four beds and one cot, and the female ward six beds and one cot. But the air and floor space allowed was so ample that I find I can put up two extra beds or cots in each ward and still maintain sufficient air space. Lavatory and w.c. accommodation are provided at the ends of each ward, accessible from the ward only, but provided with a cross ventilation lobby. The wards are lighted and ventilated by large windows reaching to the ceiling on each side of the wards, and provided with fanlights which open inwards. Thorough cross ventilation is thus obtained. The wards are heated by special stoves in the centre of each, having downward flues carried under the floors to external chimney shafts attached to the building. The floors are of two kinds, that of one ward consisting of Terazzo, and the other of pitch-pine blocks. The walls are distempered with Duresco, with a dado of oil paint. There is also in this block a store cupboard for linen, bedding, etc., and a bath room, arranged with a door leading outside, 21 enabling it to be used as a discharging room. The bath is a portable one, and mounted on rubber wheels. The nurses' duty room is fixed with a kitchen stove with hot water apparatus, a sink, small larder, large cupboard, kitchen dresser, medicine cupboard, and a telephone communicating with the administration block. The Isolation Block is used for Diphtheria and Typhoid Fever, and consists of two wards, or half a block ; the other half to be completed when more accommodation is required. Each ward is 24ft. by 18ft. and rjft. in height, and accommodates three beds and a cot in each ward. A duty room similar to that of the ward block is provided between the wards. The sanitary accommodation is outside and separate from the block, but is under a verandah which runs along one side of the block. The doors of the wards and duty room open on to this verandah only. These wards are heated by open regenerating grates, and lighted and ventilated by windows similar to those of the ward block. All angles of walls, floors, ceilings, and woodwork in both blocks are constructed with rounded surfaces. The Administrative Block contains dispensary, Matron and Nurses' sitting room, store room, kitchen, scullery, coal store, and bedrooms for nine persons,—the nursing staff" and servants. The building is so designed that it can readily be enlarged to accommodate an increased staff". The Laundry Block is supplied with a high pressure boiler, which supplies steam for boiling all water required in the Laundry. All steeping and washing of clothes is done in glazed stoneware troughs. A set of clothes-horses 011 runners are provided in a special chamber, heated with steam, for drying and airing clothes and linen when outdoor drying is unavailable. The same boiler also supplies steam for the steam disinfecting apparatus. Adjoining the Laundry is a mortuary. The Entrance Lodge contains a parlour, kitchen-living-room 22 with enclosed sink and bath, and one bedroom with usual accommodation, all under one roof and on the ground floor. The sanitary arrangements of the whole premises are perfect. Provision is made for thoroughly flushing all the foul water drains, and special ventilating shafts have been erected. All refuse is either burnt or disposed of on the enclosed area. The water supply passes through a meter on a bye-pass into a four-inch main with three-inch branches, and is provided with a four-inch sluice valve which would be opened to supply the three hydrants in case of fire. Visitors are allowed to visit patients on Sundays from two to four o'clock, but are only allowed to communicate with the patients through the windows. If any patient is dangerously ill, special arrangements are made. The name of every person entering or leaving the premises, and the time of entry and exit, are entered in a book at the porter's lodge. Patients from outside districts are admitted when there is sufficient accommodation for them ; the authorities of the Districts from which they come paying the Southgate Council for their maintenance. The cost of feeding staff and patients varies from nd. to i/i per head per day. During the past year 59 cases were admitted ; of these 89 were Scarlet Fever, 8 Diphtheria, and 2 Typhoid Fever. Of these, 15 cases were admitted from outside the District: 13 of Scarlet Fever, and 2 of Diphtheria, all from Friern Barnet. There was one death from Scarlet Fever. The average times of detention in Hospital were:—For Scarlet Fever 47 days, for Diphtheria 28 days, and for Typhoid Fever 52 days. 23 The following table shows the average number of patients in Hospital for each month of the year, together with the smallest and greatest number in at one time in each month :— umber of Patients in Isolation Hospital during each Month, 1904. Average number. Lowest number. Greatest number. Jan. 15.7 12 20 Feb 20 18 25 Mar. 11.2 7 17 April 8.2 6 10 May 3.7 2 6 June 9.8 6 13 July 9.1 5 13 Aug 3.7 2 7 Sept 7.3 4 11 Oct 16.8 12 21 Nov 20.5 19 22 Dec 18.8 17 20 Average for year 12.0 9 14.5 It will be seen that the Hospital was never empty. The smallest number in at any time was two, namely for a few davs in May and August. Eut during five months, the first two and the last three months of the year, the hospital was full almost to its limits ; and once, indeed, in February was so almost beyond them. On one occasion it was impossible to take in a case that required it. This was due to the fact that the isolation block is only half completed, and I am of opinion that taking into consideration the rapidity with which the population of the district is increasing, it is very desirable that the other half of the block should be completed as soon as possible. At the present time the two wards of this block have to accommodate both Diphtheria and Typhoid Fever, whereas for two separate diseases two wards each are required, one for male and one for female cases. With the working of the staff I have again every reason to be very satisfied. 24 MISCELLANEOUS. Return of the Metropolitan Asylums Board.—During the past year 4,458 cases were admitted into this Hospital situated at Winchmore Hill; of these 3,737 were Scarlet Fever, and 721 Diphtheria. There were 10 deaths:—6 from Scarlet Fever, and 4 from Diphtheria. Sewerage and Sewage Disposal.—The District is drained by the dual system. The surface-water sewers discharge at convenient points into the nearest watercourses, and as the fields adjoining the smaller courses become converted into building land, suitable sewers and culverts are provided. Where possible and necessary the surface-water sewers are laid at such depths as will enable the subsoil under cellars and basements to be drained and connected thereto, thus ensuring dry dwellings and avoiding any accumulations of stagnant water inside any dwelling house. The main foul sewers traverse as much as possible the natural valleys, and run from the higher lands on the east towards the west, where they join up to the sewers of the Edmonton District at three points along the boundary between the Southgate and Edmonton Districts. At each of these points is a specially designed chamber, entirely constructed underground, for gauging the quantity of sewage that passes through. By the Edmonton Local Board Separation Act, 1881, by which Southgate became a separate District, the Edmonton District is required to receive, convey, and dispose of the sewage of Southgate, payment being made according to the quantity ascertained by a monthly system of gauging. After the separation from Edmonton it was found that the main sewers were in a very bad condition, and these have since been reconstructed upon the most approved principles. Only one length of sewer, apart from culverts, is now constructed of brickwork, that one being the southern main joining the Edmonton sewers. The sewers are laid principally in open trenches, but as their depth is in some cases as much as 25 feet below the surface, the driving of short tunnels as headings is occasionally resorted to. Pymnies Brook is crossed in several places by means of inverted syphons. These have been constructed with 25 iron pipes from special designs, which permit the smallest area of sewage being exposed in the manholes, and have worked satisfactorily. The sewers are also carried at several points under the New River, and recently the late New River Company insisted upon a special system being adopted, by which large cast-iron shield pipes are forced by means of powerful hydraulic jacks through the clay under the river, thus forming tunnels in which the sewer pipes are laid. In the case of new streets not a pipe is permitted to be covered up until the work has been thoroughly inspected and the foul sewers tested with water. The pipes used have special joints, are made of the strongest stoneware clays, and laid upon a thick bed of cement concrete. In addition they are laid to absolutely straight lines from point to point, and by means of manholes can be examined and seen through from end to end. At the head of every branch sewer means are provided by vertical shafts—lampholes and flushing chambers—through which thousands of gallons of clean water are systematically delivered in order to prevent any deposit within the sewers. There are upwards of 100 of these flushing chambers in the District. Fortunately, all the sewers in this District may be said to be self cleansing, and within an hour or two of any foul water being discharged into a drain or sewer it is delivered to the Edmonton Sewage Works. The sewers are ventilated by means of gratings over the manholes and by upcast shafts; but the gratings intended to be inlets for fresh air sometimes also discharge foul air, in consequence of which many of them have been closed in, and extia upcast shafts erected at points of vantage in their place. During the past 13 years no drains of any house have been permitted to be connected to the sewers unless they have been provided with a chamber just within the boundary adjoining the street or road containing a trapped interceptor. Although the District is scattered over so large an area there are very few houses which are not near a sewer, so that fortunately very few cesspools now exist, and they are becoming less every year. 26 In the District there are now 34¼ miles of foul sewers and 23¾ miles of surface-water sewers, and no less than 15 miles of these have been constructed during the past 3 years. Sewers.—During the past year a total of 9,151 yards of sewers were laid as follows: — New foul sewers 93 yards New surface-water sewers 1,670 „ New Estate Sewers. Foul sewers 3,243 ,, Surface-water sewers 3,363 „ Sewers Relaid. Foul sewers 366 „ Surface-water sewers 416 „ Water Supply.—Practically the whole District is now supplied by the New River Company, and very few hQuses are now dependent on wells for their water. 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 also of drainage from a factory and adjacent cottages recently erected in the District of East Barnet. The attention of the Middlesex County Council and of the East Barnet District Council has been called to this matter, which is one requiring as immediate attention as possible in the interests of this District. House Refuse Collection.—Refuse and dust are collected from almost every house weekly and taken to one of the Council's shoots, the principal one being situated at Barrowell Creen, the site of an old gravel pit. In consequence of the increase in the population of the district, 27 this pit is being rapidly filled up; moreover, the refuse is accumulating there more rapidly than can be efficiently dealt with, and at times causes considerable nuisance from the stench arising therefrom, and is probably the cause of the swarms of flies which infest this particular neighbourhood. Fortunately there are not many houses situated near this shoot. The time will soon come, and I think is now at hand, when the provision of a Dust Destructor must be seriously considered. Collection of Fish Offal.—Air-tight receptacles have been provided by the Council in which fish offal is collected from the fish shops from once to three times a week, according to the weather and the amount of fish being consumed. It is then carted to a convenient shoot acquired by the Council for the purpose, and there dealt with. A small charge is made to the fishmongers to cover the expenses. Housing of the Working Classes Act.—One cottage was closed at High Street, Southgate, and another at The Green, Winchmore Hill. In view of the number of old cottages being pulled down from time to time in different parts of the District to make room for villa and shop property, the necessity for providing suitable dwellings under this Act becomes every year more urgent, 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. Cowsheds, Dairies, Slaughter = houses, and Bakehouses.—These have been systematically inspected by the Sanitary Department, and have been kept in a satisfactory condition, in accordance with the Bye-laws. Unsound Food.—The following articles were brought to the office and certificates obtained, which the retailer might present to the wholesale trader as a guarantee of the bad condition of the articles when requesting to be reimbursed the amount paid for them, namely :— Two boxes of bloaters. Two boxes of fresh herrings. One box of plaice. 28 Factory and Workshop Act, 1901.—The workshops in the district have been visited, and the sanitary condition, etc., noted in the register. 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. 1. INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors ol Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 12 6 — Workshops ( ,, Workshop ,, ) 42 20 — Workplaces — — — Homeworkers' Premises 20 — — Total 74 26 — 2. DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecu tions. Found Remedied. Referred to H.M. Inspec tor. Nuisances under the Public Health Acts :—* Want of cleanliness 13 13 Want of Ventilation Overcrowding Want of drainage of floors 2 2 Other nuisances 1 1 Sanitary accommodations—Insufficient .. Unsuitable or defective Not separate for sexes Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) Breach of special sanitary requirements for bakehouses (ss. 97 to 100) Failure as regards list of outworkers (s. 107) Giving out work in premises which are:— Unwholesome (s. 108) Infected (s. 110) Allowing wearing apparel to be made in premises infected by scarlet fever or smallpox (s. 109) Other offences Total 16 16 *Including those specified in Sections ?, 3, 7, and 8 of the factory Act as remediable under the Public Health Acts. Section 22 of the Public Health Act Amendment Act, 1890, was adopted in 1890. 29 3. OTHER MATTERS. Clasb. Number. MattersNotified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 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 Reports (of action taken) sent to H.M. Inspectors Other Underground Bakehouses (s. 101):— In use during 1903 Certificates granted in 1903 in 1904 In use at end of 1904 Homework :— Number of Lists. Outw'bk's. List of Outworkers* (s. 107)— Lists received 7 14 Addresses of Outworkers— Forwarded to other Authorities Received from other Authorities Wearing Apparel. Other. Homework in Unwholesome or Infected Premises :— Notices prohibiting homework in unwholesome premises (s. 108) Cases of infectious disease notified in homeworkers' premises Orders prohibiting homework in infected premises (s. 110) Workshops on the Registar (s. 131) at the end of 1904— Important classes of Workshops, such as Workshop Bakehouses, may be enumerated here. Workshops WorkshopBakehouses Homeworkers' Premises 36 13 14 Total number of Workshops on Register 63 *The Liits slluitld be received twice in the year. 3° Urban District Council of Southgate. Table of Sanitary Work, 1904. Sanitary District, Sodthoate. INSPECTIONS. Complaints Received 41 Cases of Infectious Disease Notified 142 Number of Premises Periodically Inspected 89 Houses Inspected from House to House 147 Total Number of Houses, Premises, &c., Inspected 552 Total Number of Re-inspections after Order or Notice 2354 Total Number of Inspections and Re-inspections 2906 NOTICES. Letters Written 585 Cautionary Notices Given 79 School Notices (Infectious Disease) 96 Statutory Orders Issued 28 Summonses Served — Convictions Obtained DWELLING HOUSES. Houses, Premises, &c., Cleansed, Repaired, &c. 111 Closed as unfit for Habitation 2 Reopened after Repairs, Alterations, etc. — Demolished MOVABLE DWELLINGS, CARAVANS, TENTS, efce. Number of Nuisances therefrom Abated — Number Removed from District 229 31 Urban District Council of Southgate. Table of Sanitary Work, 1904. Sanitary District, Southgate. Premises. Number on Register. NUMBER OF inspections Written Notices. Prosecutions. Factories (including Factory Laundries) 8 12 6 — Workshops (including Workshop Laundries) 36 42 20 — Homeworkers' Premises 14 20 — Total 58 74 26 — BAKEHOUSES. Number in District 13 Number of Inspections 53 Contraventions of Factory Acts — SLAUGHTER-HOUSES. Number on Register 8 Number of Inspections 63 Contraventions of Bye-laws — COWSHEDS. Number on Register 9 Number of Inspections 38 Contraventions of Bye-laws — DAIRIES AND MILKSHOPS. Number on Register 15 Number of Inspections 43 Contraventions of Bye-laws — MORTUARIES. Accommodation 1 Number of Bodies received 9 32 Urban District Council of Southgate. Table of Sanitary Work, 1904. Sanitary District, Southgate. WATER SUPPLY AND WATER SERVICE. Wells. New, Sunk 0 Cleansed, Repaired, etc. 1 Closed as Polluted 1 Houses, Water Laid on to 2 Percentage of Houses Supplied from Main 0 Cisterns. New Provided 2 Cleansed,.Repaired, Covered, etc 18 Overflow Pipes Disconnected from Drains 0 Repaired, or New Flush Cisterns provided to W.C.'s 52 Draw-Taps Removed from Cistern to Mains 19 Percentage of Houses Supplied on Constant System 90% EARTH CLOSETS. Water Closets Substituted for Dry Receptacles 2 DRAINAGE AND SEWAGE. WaterCloaets New, Constructed 10 New Apparatus Provided 67 Repaired, Cleansed, etc 63 Ventilated 0 Percentage of Houses provided Water Closets Practically the whole. Drains. Examined, Tested, Exposed, etc. 79 Unstopped, Repaired, etc. 36 Waste Pipes, Rain Water Pipes, etc.. Disconnected 48 Soil Pipes and Drains Ventilated 42 Disconnecting Traps or Chambers Inserted 63 Cesspools. Reconstructed 75 Rendered Impervious, Emptied, Cleansed, etc. 1 Abolished and Drain connected with Sewer 2 Percentage of Houses Draining into Sewers 99% Sewers Yards of Sewers Laid 8,369 Yards of Sewers Reconstructed 782 J. W. H. BROWN, Sanitary Inspector. 33 Urban District Council of Southgate. Table of Sanitary Work, 1904. Sanitary District, Southgate. DISINFECTION. Rooms Fumigated 163 Rooms Stripped and Cleansed 127 Articles Destroyed 36 DUST. Dustbins Repaired — New Movable Bins Provided 91 Periodical Frequency of Dust Removal Weekly Number of Complaints of Non-removal Received 5 DAMPNESS. Roofs Repaired, &c. 38 Guttering and Rain Pipes Repaired, &c. 49 Gardens, Area, &c., Levelled and Drained — Yards Paved and Drained 76 Surface adjoining Houses Paved 2 Dry Areas Provided — Ventilation below Floor Provided 45 Basements Rendered Impervious 2 SUNDRY NUISANCES ABATED. Overcrowding 2 Smoke 1 Accumulation of Refuse 20 Foul Ditches, Ponds, &c., and Stagnant Water 3 Foul Pigs and other Animals 2 Other Nuisances 24