Soug 005 Southgate Urban District Council. REPORT of the Medical Officer of Health, for the year 1905, by A. SIDNEY RANSOME, B.A., M.B., B.C., D.Ph., Cantab., Fellow of the Royal Institute of Public Health, Member of the Incorporated Society of Medical Officers of Health, MEDICAL OFFICER OF HEALTH. BOWES PARK, N. Printed by Hayllar & Cole, Printers and Stationers, 103, Myddleton Road. 1906. To the Members of the Southgate Urban District Council. Gentlemen, I have the honour to present to you my Report for the year 1905, 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. G. Lawson, Surveyor, my thanks are due for valuable assistance in compiling this Report. 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, 1906. 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—(1) 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 showed 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, 1905, was 22,400, an increase of 3,400 over that of the previous year. This is by far the largest increase in one year that has occurred in this District (see Table III.), and was due to the large number of new houses occupied, more especially in Winchmore Hill and Palmers Green, where 281 and 235 new houses were respectively erected and occupied. In Southgate 117 new houses, mostly at the Palmers Green end, were occupied ; and in New Southgate 20. The populations of the four localities which make up the District were as follows :—Southgate, 5,100 ; New Southgate, 4,500 ; Winchmore Hill, 4,900 ; and Palmers Green and Bowes 7,900. The natural increase of the population, by excess of births over deaths, was 286. 5 BIRTHS—BIRTH-RATE. During the year 463 births were registered, an increase of only 22 on the preceding year, in spite of an increase in the population of 3,400. This gives a birth-rate of 20.6 per 1,000 of the population, a decrease of 2.8 per 1,000 on the preceding year. The average rate for the 10 years 1895 to 1904 was 24.3. The birth-rate of England and Wales in 1905 was 27.2, which was lower than the rate in any other year on record, and compared with the average in the previous 10 years shows a decrease of 1.8 per 1,000. MORTALITY. General Mortality and Death-rate.—The number of deaths which occurred in the District during the past year, including the deaths of 29 " residents" who died outside the District (15 in Edmonton Union), and excluding the deaths of " non-residents" who died in the District (13 in the Metropolitan Asylums Board Hospital at Winchmore Hill), was 178. The crude death-rate was therefore 7.9 per 1,000 of the population. In order to obtain the corrected death-rate, for the purposes of accurately comparing the death-rate with that of other Districts and so on, it is necessary, in addition to the above corrections, to take into consideration the age and sex distribution of the population. The " factor for correction'' for this District, which has hitherto not been available, is now known to be 1.045. The corrected rate is obtained by multiplying the crude or recorded death-rate by this factor. The corrected death-rate, therefore, was 8.2, which is a decrease of 1.2 per 1,000 on the rate of the preceding year, and the lowest rate on record for this District. The average recorded rate for the 10 years 1895 to 1904 was 10.4. The death-rates of the separate localities were as follows:— Southgate, 7.4 ; New Southgate, 11.3 ; Winchmore Hill, 7.3 ; and Palmers Green and Bowes, 6.8. As was the case last year, it will be seen that there is a considerable difference in the death-rate of New Southgate as compared with the other three localities. The higher rate of this locality 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 again exactly double the number of deaths from Phthsis and other Tubercular diseases in New Southgate than there were in the whole of the rest of the District ; and again is reflected in the fact that there were more deaths from Infantile Diarrhoea in New Southgate than in the three other localities together. The poorer and more thickly populated a district is, the more prevalent are the deaths from these diseases. 6 The death-rate in England and Wales in 1905 was 15.2 per 1,000, which is lower than the rate in any previous year on record, and compared with the average of the previous 10 years shows a decrease of 2.0 per 1,000. Infantile Mortality.—There were 36 deaths of infants under one year of age, which gives an infantile death-rate of 777 per 1,000 births registered as against 79.3 in the preceding year, 87.1 in 1903, and 83 in 1902. This is a very low rate, and the lowest on record for this District. The average rate for the 10 years 1895 to 1904 was 110. The infantile death-rate for England and Wales was 12.8, which is 18 per 1,000 below the rate in 1904, and lower than the rate in any other year on record. Senile Mortality.—Among persons of 70 years of age and over, 48 deaths occurred, and of these 20 were 80 years of age and over, and 3 were 90 years of age and over. This is a proportion of 27 per cent. of the total number of deaths at all ages as against 22.8 per cent. in the preceding year. This is a high rate of senile mortality, and is good evidence as to the healthiness of the District. 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 16 deaths from these diseases as follows:—Diphtheria, 4; Typhoid Fever, 1; Measles, 2; Whooping Cough, 2; and Diarrhcea 7. The zymotic death-rate was therefore .71 per 1,000 of the population, as against 79 in 1904, 1.0 in 1903, and .82 in 1902. The average rate for the 10 years 1895 to 1904 was 1.3. The zymotic death-rate for England and Wales was 1.52. The Causes Of Deaths are fully set forth in Table I. (i.) for the whole District, and (ii.) for each of the four localities. Table Ia. shows the deaths during each quarter of the year, and in Table Ib. are set forth the causes of infantile mortality. There was no marked incidence of any particular disease either upon the District as a whole, or upon any one locality; but as usual Phthsis and other Tubercular diseases were far more prevalent in New Southgate than in the three other localities, as shown by the proportionate number of deaths from these causes. The Public Mortuary.—During the year 17 bodies were deposited in the Mortuary, as against 9 in the preceding year and 8 in 1903. 7 INQUESTS HELD DURING THE YEAR 1905 ON DEATHS OCCURRING IN THE DISTRICT. No. Month. Sex. Age. Condition of Life. Cause of Death. I January Female 2½ Infant Natural Causes. 2 January Male 66 Builder Heart Failure. 3 February Male 43 Gardener Hemorrhage of the Brain. 4 March Female 55 Widow Natural Causes. 5 March Male 51 Gardener Accidental Death. 6 April Female 33 Widow Suicide—Unsound Mind. 7 June Female 76 Widow Heart Failure. 8 July Male 45 Accountant Suicide—Unsound Mind. 9 July Male 41 Labourer Heart Failure. 10 July Female 3 Infant Accidental Death. 11 July Female 11 Married Natural Causes. 12 July Female 2 Infant Accidental Death. 13 August Male New Born Infant Misadventure—Want of attention at birth. 14 August Male 25 Medical Student Suicide—Unsound Mind. 15 September Male 5 Infant Natural Causes. 16 September Female New Born Infant Wilful Murder. 17 November Male 55 Engraver Heart Failure. TABLE I. Causes of, and Ages at, Death during the year 1905. Causes of Death. Deaths at the subjoined Ages of " Residents," whether occurring in or beyond the District. Deaths at all Ages of " Residents " belonging to Localities whether occurring in or beyond the District. Total Deaths, whether of Residents or " Non-Residents" 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. New Southgate. Winchmore Hill. Palmers Green and Bowes. Measles 2 1 1 — — — — — 1 — 1 — Scarlet Fever — — — — — — — — — — — 12 Whooping Cough 2 2 — — — — — — 1 — 1 — Diphtheria 4 — 2 2 — — — 1 1 2 — — Croup 1 — 1 — — — — — 1 — — — Typhoid Fever 1 — — — 1 — — 1 — — — — Epidemic Influenza 6 — 1 — — 1 4 — — 2 4 — Diarrhœa 8 4 4 — — — — — 5 1 2 — Enteritis 1 1 — — — — — — 1 — — — Puerperal Fever 1 — — — — 1 — — 1 — — — Erysipelas 1 — — — — 1 — — 1 — — — Phthisis 9 — — 2 — 6 1 1 4 1 3 — Other Tubercular Diseases 3 1 2 — — — — — 2 — 1 — Cancer 12 — — — — 7 5 2 4 — 6 — Bronchitis 9 2 — — — 2 5 2 2 2 3 — Pneumonia 11 4 — — — 4 3 2 4 3 2 — Pleurisy — — — — — — — — — — — — Other Diseases of the Respiratory Organs 2 1 — — — 1 — — — 1 1 — Heart Diseases 16 — 1 — 1 9 5 8 2 4 2 — Alcoholism—Cirrhosis of Liver 2 — — — — 2 — — — — 2 — Senile Decay 22 — — — — 5 17 6 2 7 7 — Diseases of the Nervous System, including Apoplexy and Convulsions 19 1 1 1 1 6 9 3 6 5 5 — Brights Disease 5 — — — — 5 — 1 3 — 1 — Appendicitis 6 — — 2 3 1 — 2 — 1 3 — Premature Birth 6 6 — — — — — 2 1 2 1 — Wasting and Debility from Birth 10 10 — — — — — 1 4 2 3 — Accidents 5 — 2 — — 3 — 2 2 — 1 — Suicides and Murder 3 1 — — — 2 — — 1 2 — — All other causes 11 2 — 1 — 6 2 4 2 1 4 — All Causes 178 36 15 8 6 62 51 38 51 36 53 13 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 1905. Cause of Death. 1st quarter 2nd quarter 3rd quarter 4th quarter Measles — 2 — — Scarlet Fever — — — — Whooping Cough — — 2 — Diphtheria 3 — — 1 Croup — 1 — — Typhoid Fever — — — 1 Epidemic Influenza 5 — — 1 Diarrhœa — — 7 1 Enteritis 1 — — — Puerperal Fever 1 — — — Erysipelas — — — 1 Phthisis 3 2 2 2 Other Tubercular Diseases — 2 — 1 Cancer 2 2 5 3 Bronchitis 4 1 1 3 Pneumonia 5 3 1 2 Pleurisy — — — — Other Diseases of the Respiratory Organs — 1 — 1 Heart Diseases 3 4 1 8 Alcoholism & Cirrhosis of Liver 1 1 — — Senile Decay 7 8 3 4 Diseases of the Nervous System, including Apoplexy and Convulsions 3 — 11 5 Bright's Disease — — 1 4 Appendicitis — 2 4 — Premature Birth 1 1 4 — Wasting and Debility from Birth 4 — 3 3 Accidents 1 1 3 — Suicides and Murder — 1 2 — All other causes 4 2 2 3 All causes 48 34 52 44 178 10 TABLE ib. Infantile Mortality. Deaths from Staled Causes in Weeks and Months under One Year of Age. Cause of Death. Under 1 week. 1 week and under 1 month. 1 month and under 3 months 3 months and under 1 year. Total Deaths under 1 year. Measles — — — 1 1 Whooping Cough — — — 2 2 Diarrhœal Diseases — — 1 4 5 Premature Birth 5 — 1 — 6 Wasting and Debility from Birth 3 3 2 2 10 Tubercular Meningitis — — — 1 1 Convulsions 1 — — — 1 Bronchitis — — 2 — 2 Pneumonia — — — 4 4 Periostitis — — — 1 1 Intussusception — — — 1 1 Infantile Paralysis — — 1 — 1 Murder 1 — — — 1 Totals 11 3 7 16 36 District of Southgate. Population, estimated to middle of 1905, 22,400. Births in the year Legitimate 434 Illegitimate 7 Deaths from all Causes at all Ages 178 11 TABLE II. Comparison of the Rates of the Southgate District with those of England, and Wales, the 76 Great Towns, and England and Wales less the 218 Largest Towns. Rates 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 27.2 15.2 128 1.52 .00 .11 .16 .32 .25 .59 76 Great Towns 28.2 15.7 140 1.88 .00 .13 .16 .39 .29 .83 England and Wales less 218 Largest Towns 26.3 14.9 113 1.09 .00 .09 .15 .24 .20 .32 Southgate District 20.6 8.2 77.7 .71 .00 .00 .17 .08 .08 .35 12 TABLE III. The Principal Vital Statistics of the Southgate District for the Ten Years 1895 to 1904. Year. Population estimated to the middle of each year. Births. Deaths at all Ages. Deaths under 1 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. 1895 12,000 364 30.3 161 13.4 57 156 .8 1896 12,500 315 25.2 117 9.3 25 80 1.0 1897 13,000 326 25.2 158 12.1 48 147 2.4 1898 14,000 310 2 2.1 150 10.7 37 119 1.9 1899 14.500 366 25.2 182 12.5 51 140 2.7 1900 15,000 320 21.3 147 9.8 38 118 1.0 1901 15,200 375 24.6 142 9.3 35 93 1.3 1902 15,800 396 25 163 10.3 33 83 .82 1903 17,000 367 21.5 146 8.5 32 87.1 1.0 1904 19,000 441 23.4 172 9.0 35 79.3 .79 Averages for years 1895-1904 14,800 358 24.3 153 10.4 39 110 1.3 1905 22,400 463 206 177 8.2 36 77.7 .71 13 TABLE IV. Cases of Infectious Disease notified during the year 1905. Notifiable Diseases. Cases notified in the whole of District. Total Cases notified in each Locality. No. of Cases removed to Hospital from each Locality. Hospital. At all Ages. At Ages—Years. Southgate. New Southgate. Winch more Hill. Palmers Green and Bowes. Southgate. New Southgate. Winchmore Hill. Palmers Green and Bowes. In the District. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Southgate. Small Pox — — — — — — — — — — — — — — — — Scarlet Fever 69 — 23 40 6 — — 14 24 3 28 11 23 4 22 60 Diphtheria 23 — 9 10 2 2 — 3 7 6 7 — 1 — 2 3 Typhoid Fever 4 — — — 2 2 — 2 1 — 1 1 1 — 1 3 Puerperal Fever 1 — — — — 1 — — — — 1 — — — — — Erysipelas 25 — 2 4 2 13 4 9 6 1 9 — — — — — Totals 122 — 34 54 12 18 4 28 38 10 46 12 25 4 25 66 Isolation Hospital, Tottenhall Road, Palmers Green (in the District). 14 TABLE IVA. Cases of Infectious Disease notified during each Month of the year 1905. Notifiable Diseases. Small Pox. Scarlet Fever. Diphtheria. Typhoid Fever. Puerperal Fever. Erysipelas. Totals. January — 11 5 — — 2 18 February — 9 3 — — 2 14 March — 5 2 — 1 5 13 April — 10 1 — — — 11 May — 12 2 — — 3 17 June — 2 1 — — 3 6 July — — 1 — — 2 3 August — 2 2 — — 2 6 September — 3 — — — — 3 October — 4 2 3 — 2 11 November — 4 1 — — 2 7 December — 7 3 1 — 2 13 Totals — 69 23 4 1 25 122 15 INFECTIOUS DISEASES, AND THE MEANS TAKEN TO PREVENT THEIR SPREAD. It will be seen from Table IV. that 122 cases of infectious disease were notified during the year, as against 142 in the preceding year, 136 in 1903, and 110 in 1902. Of these 69 were Scarlet Fever, 23 Diphtheria, 4 Typhoid Fever, 1 Puerperal Fever, and 25 Erysipelas. These were notified from the different localities as follows :— 28 from Southgate, 38 from New Southgate, 10 from Winchmore Hill, and 46 from Palmers Green and Bowes Park. These 122 cases represent infection in 107 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 6 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 107 premises, and remedy of insanitary condition in 6. Sixty-six cases were removed to the Isolation Hospital at Palmers Green. Of these, 60 were Scarlet Fever, 3 Diphtheria, and 3 Typhoid Fever. The Infectious Sickness Rate of the District was 5 4 per 1,000 of the population as against 7.5 in the preceding year, 8 0 in 1903, and 6.9 in 1902. The rates for the separate localities were as follows : Southgate, 5.4 ; New Southgate, 8.4 ; Winchmore Hill, 2.0 ; and Palmers Green and Bowes, 5.8. 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, &c., is disinfected in the steam disinfecting apparatus established on the premises of the Isolation Hospital. For taking the bedding, &c., to and fro two special vans are kept, one for the infected and the other for the disinfected articles. (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. 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 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 52 specimens were sent and reports received as follows :— Date. Disease Suspected. Report. January 3 Diphtheria Negative. ,, 4 Diphtheria Negative. ,, 13 Diphtheria (Pseudo) Positive. ,, 17 Diphtheria Negative. ,, 25 Diphtheria (Pseudo) Positive. ,, 28 Diphtheria Negative. ,, 28 Diphtheria Negative. February 1 Diphtheria Negative. ,, 1 Diphtheria Negative. ,, 17 Diphtheria Negative. ,, 27 Diphtheria Negative. March 2 Diphtheria (Pseudo) Positive. ,, 3 Diphtheria Negative. ,, 8 Diphtheria Negative. ,, 9 Diphtheria Positive. ,, 11 Phthisis Negative. ,, 21 Diphtheria (Pseudo) Positive. April 12 Phthisis Positive. ,, 12 Diphtheria Negative. ,, 28 Diphtheria Positive. May 5 Phthisis Positive. ,, 11 Diphtheria Positive. ,, 19 Diphtheria Positive. ,, 19 Diphtheria Negative. ,, 23 Diphtheria Negative. ,, 25 Diphtheria Negative. June 7 Diphtheria Negative. ,, 8 Diphtheria Negative. ,, 23 Diphtheria Negative. ,, 24 Diphtheria Negative. ,, 26 Typhoid Fever Negative. ,, 27 Diphtheria Negative. ,, 29 Typhoid Fever Negative. ,, 30 Diphtheria Negative. July 6 Diphtheria Negative. ,, 7 Diphtheria Negative. „ 26 Phthisis Positive. ,, 27 Diphtheria Negative. August 9 Diphtheria Positive. ,, 29 Diphtheria Negative. 17 Date. Disease Suspected. Report. September 11 Diphtheria Negative. October 18 Diphtheria Negative. ,, 23 Typhoid Fever Positive. ,, 31 Diphtheria Negative. ,, 31 Diphtheria Negative. November 1 Typhoid Fever Positive. ,, 20 Diphtheria (Pseudo) Positive. ,, 21 Diphtheria Positive. ,, 23 Diphtheria Positive. ,, 23 Diphtheria Positive. December 8 Diphtheria Negative. ,, 23 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.—52 bacteriological examinations, of which 19 gave positive and 33 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—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 to 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. SMALL-POX. No cases were notified. With regard to the provision of accommodation for the effective isolation of cases of Small-pox reported on in my last Report, the matter at the present time stands thus :—This District is one of the constituent authorities, composed of a number of the Urban and Rural Districts of Middlesex, included in the Provisional Order for the formation of the " Middlesex District Joint Small-pox Hospital," under Section 279, Public Health Act, 1875. 18 SCARLET FEVER. There were 69 cases notified from 61 houses, as against 91 in the preceding year, 107 in 1903, and 62 in 1902. They were notified from the different localities as follows :—14 from Southgate, 24 from New Southgate, 3 from Winchmore Hill, and 28 from Palmers Green and Bowes Park. In four houses sanitary defects were found. Two cases were imported, and eight were secondary cases occurring in houses from which previous cases had been notified. Sixty cases were removed to the Isolation Hospital. DIPHTHERIA. There were 23 cases notified from 22 houses, as against 23 in the preceding year, 9 in 1903, and 22 in 1902. They were notified from the different localities as follows :— 3 from Southgate, 7 from New Southgate, 6 from Winchmore Hill, and 7 from Palmers Green and Bowes Park ; three cases were imported, and one was a secondary case. Four cases ended fatally. In two houses sanitary defects were found. TYPHOID FEVER. During the year 4 cases were notified from 4 houses, and from the different localities as follows :—I from New Southgate, 2 from Southgate, and one from Palmers Green and Bowes Park. One case was fatal. In one case the infection was probably due to the consumption of shell fish. Another case was imported, but in the remainder I was unable to trace the source of infection. TUBERCULOSIS. During the year there were 12 deaths from Tubercular diseases, 9 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. 19 ISOLATION HOSPITAL. This Hospital is built on a site of nine acres of land situated in Tottenhall Road, Palmers Green. It is a fine cpen 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, 1902, and consists of (1) an administration block for the Staff; (2) a ward block ; (3) an isolation block ; (4) a laundry block with steam 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. 20 There is also in this block a store cupboard for linen, bedding, etc., and a bath-room, arranged with a door leading outside, 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 13ft. 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 on 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 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. 21 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. The Medical and Nursing Staff consist of Medical Superintendent (non-resident), Matron (nursing), two Staff Nurses, and one Probationer Nurse; and the Domestic Staff of Cook, Wardmaid, Laundry maid, Housemaid, and Entrance Lodge Porter and his wife. The Medical Superintendent's residence is connected with the Hospital by telephone. The Porter's duties consist of looking after the Entrance Lodge, checking all entries and exits, and working the steam disinfector, etc. His spare time is spent in the gardens. The Porter's wife assists, when required, in the Laundry, etc. 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 10d. to 1/3 per head per day. During the past year 71 cases were admitted; of these 62 were Scarlet Fever, 6 Diphtheria, and 3 Typhoid Fever. Two of the cases of Scarlet Fever were "return" cases. Five of these cases were admitted from outside the District— two of Scarlet Fever from Friern Barnet, and three of Diphtheria from Hornsey. There were no deaths. The average times of detention in Hospital were:—For Scarlet Fever, 46 days; for Diphtheria, 27 days; and for Typhoid Fever, 43 days. 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:— 22 Number of Patients in Isolation Hospital during each Month, 1905. Average number. Lowest number. Greatest number. Jan. 18.0 16 22 Feb. 18.0 15 23 Mar. 10.0 7 16 April 9.0 6 12 May 13.0 10 17 June 13.0 8 18 July 3.0 1 7 Aug. 1.5 1 2 Sept. 2.5 2 4 Oct. 5.5 4 6 Nov. 9.0 8 10 Dec. 7.0 6 10 Average for year 9.1 7 12.2 It will be seen from the above Table that the Hospital was never empty, although very nearly so during part of July and August. Throughout the whole year the admissions were lower than those of the previous year by 29. Taking into consideration the large increase in the population during the past year, this must be considered a very small number of admissions, and it is unlikely with the rapidly increasing population that it will ever be so low again. In spite of the comparatively small number of admissions, it will also be seen that in January and February the Hospital was full almost to its utmost limits ; 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 Isolation Block should be completed by the addition of the other half 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. MISCELLANEOUS. Return of the Metropolitan Asylums Board.— During the past year 7,044 cases were admitted into this Hospital situated at Winchmore Hill; of these 6,564 were Scarlet Fever, and 480 Diphtheria. There were 13 deaths:—12 from Scarlet Fever, and 1 from Diphtheria. 23 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. Pymmes Brook is crossed in several places by means of inverted syphons. These have been constructed with 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 24 of clean water are systematically delivered in order to prevent any deposit within the sewers. There are upwards of joo 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 matter 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 extra upcast shafts erected at points of vantage in their place. During the past 14 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. In the District there are now 36 miles of foul sewers and 26½ miles of surface-water sewers, and no less than 19 miles of these have been constructed during the past 4 years. Sewers.—During the past year a total of 9,848 yards of sewers were laid as follows:— New foul sewers 410 yards New surface-water sewers 1,478 „ New Estate Sewers. Foul sewers 2,793 „ Surface-water sewers 3,530 ,, Sewers Re-laid. Foul sewers 630 „ Surface-water sewers 1,007 „ Water Supply.—Pratically the whole District is now supplied by the Metropolitan Water Board. Two more wells have recently been closed, and very few houses 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 25 the discharge into them of sewage effluents from neighbouring Districts. The attention of the Middlesex County Council has been frequently called to this matter, and an immediate action as possible should be taken by them 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 Green, the site of an old gravel pit. In consequence of the increase in the population of the District, 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. The number of houses, too, in the immediate neighbourhood, although not great at present, are increasing in number, which also makes the erection of a Dust Destructor continually more urgent ; and I am glad to report that this matter is now receiving your practical attention. 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. Roads.—In the District there are now over 40 miles of Roads, made up as follows:— Miles Yds. County Main Roads 4 1,356 Other Roads (Repairable by the inhabitants at large) 25 887 Private Roads (Repairable by the owners of property abutting 011 such Roads) 10 545 Total 40 1,028 The following roads were made up during the year:— Brownlow Road, Hardwicke Road, Beech Road, and Elvendon Road in Palmers Green and Bowes; and Station Road, Compton Road and Cedar Road in Winchmore Hill; and Victoria Mews in New Southgate. This latter is one of the backways reported on in my Annual Report of 1902. This is a great improvement, and every similar backway should be paved in the same manner. 26 Housing of the Working Classes Act.—One cottage was closed at Highfield Road, Winchmore Hill. There are many other old cottages remaining in different parts of the District which ought to be pulled down, and which would be condemned except for the fact that there are no better ones for the occupants to go into if this were done, which clearly shows the need there is in the District for the erection of sound healthy cottages at a reasonable rent. Such cottages as are from time to time demolished are at once replaced by villa and shop property, so that the necessity for providing suitable dwellings for the working classes 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 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. Factory and Workshop Act, 1901—The workshops in the district have been visited, and the sanitary condition, &c., 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. I.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 18 9 — Workshops ( „ Workshop „ ) 75 23 — Workplaces — — — Homeworkers' Premises 28 — — Total 121 32 — 27 II.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:—* Want of cleanliness 26 26 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors 3 3 — — Other nuisances 3 3 — — Sanitary accommodations— Insufficient — — — — Unsuitable or defective 6 6 — — 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 — — — — Totals 38 38 — — * Including those specified in Sections 2, 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. 28 Ill—OTHER MATTERS. Class. MATTERS NOTIFIED TO H.M. INSPECTOR OF FACTORIES. Number 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 2 Reports (of action taken) sent to H.M. Inspectors 2 Other - UNDERGROUND BAKEHOUSES (s. 101). In use during 1903 Nil Certificates granted in 1903 „ in 1904 „ In use at end of 1904 „ HOMEWORK. Number of Lists. Out- w'rk's. List of Outworkers* (s. 107)— Lists received 7 8 Addresses of Outworkers— Forwarded to other Authorities — — Received from other Authorities — 7 HOMEWORK IN UNWHOLESOME OR INFECTED PREMISES. Wearing Apparel. Other. 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 Register (s. 131) at the end of 1905— Important classes of Workshops, such as Workshop Bakehouses, may be enumerated here. Workshops 37 Workshop Bakehouses 15 Homeworkers' Premises 14 Total number of Workshops on Register 66 * The Lists should be received twice in the year. 29 URBAN DISTRICT COUNCIL OF SOUTHGATE. Table of Sanitary Work, 1905. Sanitary District, Southgate. INSPECTIONS. Complaints Received 61 Cases of Infectious Disease Notified 122 Number of Premises Periodically Inspected 110 Houses Inspected from House to House 187 Total Number of Houses, Premises, &c , Inspected 665 Total Number of Re-inspections after Order or Notice 2137 Total Number of Inspections and Re-inspections 3102 NOTICES. Letters Written 655 Cautionary Notices Given 98 School Notices (Infectious Disease) 75 Statutory Orders Issued 15 Summonses Served — Convictions Obtained — DWELLING HOUSES. Houses, Premises, &c., Cleansed, Repaired, &c. 126 Closed as Unfit for Habitation 1 Re-opened after Repairs, Alterations, &c. — Demolished — MOVABLE DWELLINGS, CARAVANS, TENTS, &c. Number of Nuisances therefrom Abated — Number Removed from District 167 30 URBAN DISTRICT COUNCIL OF SOUTHGATE. Table of Sanitary Work, 1905. Sanitary District, Southgate. Premises. Number on Register Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 9 18 9 - Workshops (including Workshop Laundries) 37 75 23 — Homeworkers' Premises 14 28 — — Total 60 121 32 — BAKEHOUSES. Number in District 15 Number of Inspections 62 Crontraventions of Factory Acts. — SLAUGHTER-HOUSES. Number on Register 8 Number of Inspections 60 Contraventions of Bye-laws — COWSHEDS. Number on Register 10 Number of Inspections 52 Contraventions of Bye-laws — DAIRIES AND MILKSHOPS. Number on Register 17 Number of Inspections 45 Contraventions of Bye-laws — MORTUARIES. Accommodation 1 Number of Bodies Received 17 31 URBAN DISTRICT COUNCIL OF SOUTHGATE. Table of Sanitary Work, 1905. Sanitary District, Southgate. WATER SUPPLY AND WATER SERVICE. Wells. New, Sunk — Cleansed, Repaired, &c. 2 Closed as Polluted 2 Houses, Water Laid on to 2 Percentage of Houses Supplied from Main — Cisterns. New Provided 1 Cleansed, Repaired, Covered, &c. 14 Overflow Pipes Disconnected from Drains — Repaired or New Flush Cisterns provided to W.C.'s 48 Draw-taps Removed from Cistern to Mains 16 Percentage of Houses Supplied on Constant System 90% EARTH CLOSETS. Water Closets Substituted for Dry Receptacles 1 DRAINAGE AND SEWAGE. Water Closets. New, Constructed — New Apparatus Provided 76 Repaired, Cleansed, &c. 56 Ventilated — Percentage of Houses provided Water Closets practically the whole. Drains. Examined, Tested, Exposed, &c. 85 Unstopped, Repaired, &c. 29 Waste Pipes, Rain-water Pipes, &c., Disconnected 36 48 Soil Pipes and Drains Ventilated Disconnecting Traps or Chambers Inserted 52 Reconstructed 49 Cesspools. Rendered Impervious, Emptied, Cleansed, &c. 1 Abolished and Drain Connected with Sewer 1 Percentage of Houses Draining into Sewers 99% Sewers. Yards of Sewers Laid 8211 Yards of Sewers Reconstructed 1637 32 URBAN DISTRICT COUNCIL OF SOUTHGATE. Table of Sanitary Work, 1905. Sanitary District, Southgate. DISINFECTION. Rooms Fumigated 133 Rooms Stripped and Cleansed 103 Articles Destroyed 25 DUST. Dustbins Repaired — New Movable Bins Provided 45 Periodical Frequency of Dust Removal Weekly Number of Complaints of Non-removal Received 15 DAMPNESS. Roofs Repaired, &c. 30 Guttering and Rain Pipes Repaired, &c. 34 Gardens, Area, &c., Levelled and Drained — Yards Paved and Drained 46 Surface adjoining Houses Paved 5 Dry Areas Provided — Ventilation below Floor Provided 16 Basements Rendered Impervious — SUNDRY NUISANCES ABATED. Overcrowding 1 Smoke 1 Accumulation of Refuse 3 Foul Ditches, Ponds, &c., and Stagnant Water 5 Foul Pigs and other Animals 6 Other Nuisances 32 J. W. H. BROWN, Sanitary Inspector.