5049015 Southgate Urban District Council. REPORT OF THE Medical Officer of Health, FOR THE YEAR 1920, 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. 1921. 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 1920. The Report of the Sanitary Inspector, Mr. W. C. Kilby, is included, and which, as usual, constitutes an excellent record of good and useful sanitary work done by him and his assistants during the year, and to whom my thanks are due for valuable assistance in compiling this Report. My thanks are also due to Dr. Westlake, Medical Officer to tlie Welfare Centres, for valuable data in relation to Maternity and Child Welfare, included in my Report under this heading. I should also like to tender my thanks to the Public Health Committee for their unfailing courtesy and support throughout the year. I am, Gentlemen, Your obedient Servant, A. SIDNEY RANSOME. May, 1921. 3 NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. THE Urban District of Southgate is formed by a number of hamlets, previously—and two of them, Southgate and Winchmore Hill, even now—called " villages." It is partly situated on what is sometimes called the Northern Heights, about eight miles from London, and is now for the most part essentially suburban, of a residential character. The District comprises an area of 3,597 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; whilst 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 bed of brick earth overlying a deep bed of gravel, which forms excellent building land, on which a building estate has been partially developed. 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 Metropolitan Water Board derive their supply. The District may be roughly divided into four localities : (1) Southgate, (2) Winchmore Hill, (3) a large part of New Southgate and Bounds Green, and (4) Palmers Green and a large part of Bowes; hitherto more or less distinct localities, but which have now become merged one into the other, more especially the two latter. The District is now, however, more conveniently dealt with in the two county divisions of North and South Southgate, the dividing line of which passes from the Edmonton boundary in Hedge Lane, along Hedge Lane, and up Bourne Hill to Chase Side Corner, Southgate. This is a more or less natural boundary line, with the major part of Southgate and 4 Winchmore Hill, the more rural parts of the District, on the north side of the line, and Palmers Green, Bowes Park, and New Southgate, the more urban parts of the District, on the south side. For the purposes of local administration the District was in 1906 divided into four wards, which correspond roughly with the four localities above-mentioned, two wards in North Southgate and two in South Southgate. The District is largely an essentially residential one, and the greater part of the inhabitants are engaged in a professional or business capacity in the Metropolis. There are very few really poor. The few factories include. Dyeing and Cleaning Works, a Colour Works, a Photographic Plate Works, an Enamelled Sign Works, an Engineering Works, and a factory producing Wire Stitching Machines. These give employment in normal times to 360 hands. POPULATION. In a memorandum dated March 1st, 1921, the RegistrarGeneral says that in 1920 demobilization had reached a stage at which it is felt that the distinction between "birth-rate populations" and "death-rate populations" made during the period when a large part of the male population was under arms might in general be discontinued, and that for most districts a single estimate of the population applicable to both births and deaths might be made. He estimates the population of this district for the year 1920 to be 40,550. The number of inhabited houses in July, 1920, was 9,526, which gives on this estimate an average between 4.2 and 4.3 persons per house. Now the census of 1911 showed that the average number of persons per house in that year was 4 4. Owing to the shortage of houses generally now obtaining it is difficult to believe that the average per house is not at any rate as much as it was in 1911, in spite of the shortage of domestic servants, which makes some difference, and must be taken into 5 account. However, the census about to be made will clear this up; meanwhile, it is best as a basis for vital statistics to take the more conservative, figure, so as not to obtain results too flattering to the district. The natural increase of the population by excess of births over deaths was 344 as against 76 and 44 in the two previous years, and shows a return to the more normal excess of births over deaths which obtained before the war. The population, on the basis of the Registrar-General, for North Southgate was 11,230, and that of South Southgate was 29,320. BIRTHS- BIRTH kATE. The nett total of births accredited to this District is 699, an increase of 239 on the preceding year, and in proportion to the population approximately the same as in 1914; of these 338 were males and 361 females, and 17 were illegitimate. The birth-rate was, therefore, 17 per 1,000 of the population, as against 11.3 in 1919, 10 3 in 1918, and reaches approximately the pre-war rate of 17.3 in 1914. The birth-rate for England and Wales was 25.4. MORTALITY. General Mortality and Death-rate.—The nett number of deaths accredited to this District was 355. As regards the causes of death as compared with the previous year, the most noticeable feature was the absence of an excessive number of deaths from Influenza, which obtained in 1919—nine as against 52. The death-rate was 8.7 per 1,000 of the population, a decrease of 1.1 on the rate of the previous year. The average rate for the previous ten years was 8.5. The death-rate for England and Wales was 12.4. 6 Infantile Mortality.—There were 25 deaths of infants under 1 year of age 62 of them illegitimate), which gives an infantile death-rate of 357 per 1,000 births registered, as against 521 in the preceding year, 26.8 in 1918, 55.7 in 1917, and 36 in 1916. The average rate for the 10 years 1910-1919 was 531. In Table IV. are set forth the causes of deaths of infants under one year of age (in weeks and months) from which it will be seen that 60 per cent. of the deaths were of newly born infants in the first week of life, and 84 per cent. under one month old, and were due to premature birth, congenital defects, debility, and wasting. It should also be noted in this connection that there were 18 still-births notified. Theoretically most, and practically some at least of these deaths should be preventible: but there is little evidence in this Table of any gross ignorance or neglect of personal health or care for their offspring on the part of the mothers. It is doubtful whether it is possible to reach a much lower infantile death-rate than 25 per 1,000 births in any ordinary average community until human nature becomes so perfect in physique, morals, and education as to be beyond attainment—in the present age at any rate. I am of opinion that prohibition of alcohol, if it were feasible, or from every point of view desirable in this country as a whole, would do more towards lowering the infantile deathrate than any other measure. This opinion is supported by the experience of Canada during the last few years. This is, however, no reason why our efforts in otherdirections should relax, but rather the reverse. It is necessary to constantly strive after the ideal, by constant effort all along the line and from every point of view. With this aim, it is desirable, in order to help to reduce the infantile mortality within the first month of life to the lowest possible rate, that an ante-natal clinic in connection with the maternity and child welfare centres should be established as soon as practicable. Senile Mortality.—Among persons of 70 years of ige and over, 118 deaths occurred, and, of these, 40 were 80 years of age and over. This is a proportion of 33 per cent, of the total number of deaths at all ages. 7 Zymotic Mortality.—This includes the deaths from the seven principal Zymotic diseases, viz.:—Smallpox, Scarlet Fever, Diphtheria, Enteric Fever, Measles, Whooping Cough, and Diarrhœa. The rate affords useful evidence as to the general healthiness of the District, and as to the efficiency of its sanitary administration. There were 5 deaths from these diseases, as follows:—Diphtheria, 2; Scarlet Fever, 1; and Measles, 2. The Zymotic death-rate was therefore 012 per 1,000 of the population, the same as in the preceding year, and as against 0.19 in 1918 and 0.24 in 1917, and together with that of the previous year is the lowest recorded in this district. The average rate for the 10 years, 1910 to 1919, was 0.35. The Public Mortuary.—During the year 14 bodies were deposited in the Mortuary, as against 19 in the preceding year and 30 in 1918. 8 Inquests held during the Year 1920 on deaths occurring in the District. No. Month. Sex. Age. Condition in Life. Cause of Death. 1 March Male 7 Scholar Accidental. 2 March Male 59 Professional Gymnast Suicide whilst of unsound mind. 3 April Female 41 Housewife Suicide whilst of unsound mind. 4 June Male 2 — Accidental. 5 June Male 50 Printer's Machinist Misadventure. 6 June Male 65 Stockbroker's Clerk Suicide whilst of unsound mind. 7 July Male 39 Accountant Natural Causes. 8 September Female 54 Housewife Open verdict. 9 September Female 20 Typist Accidental. 10 September Female 20 Spinster Misadventure. 11 November Female 69 Independent Means Natural Causes. 12 November Male 50 Commercial Clerk Natural Causes. 9 Table 1. Vital Statistics of Whole District during 1920 and Five Previous Years. Year. Population estimated at Middle of each Year. Nett Births belonging to District. NettDeaths belonging to the District. At all Ages. Under 1 Year of Age. Number. Rate per 1,000 Population. Number. Rate per 1,000 Population. Number. Rate per 1,000 Nett Births. 1 2 3 4 5 6 7 8 1915 38,230 696 17.1 319 8.2 31 44.3 1916 37,414 635 15.5 320 8.5 23 36.2 1917 37,107 502 12.1 335 9.0 28 55.7 1918 35,350 410 10.3 366 10.0 11 26.8 1919 39,000 460 11.3 384 9.8 24 52.1 1920 40,550 699 17.0 355 8.7 25 35 7 Area of District in acres (exclusive of area covered by water). 3,597. Total population at all ages 33,613 Number of Inhabited Houses 7,621 Average number of persons per house 4.4 At Census, 1911. 10 I. Institutions within the District receiving sick and infirm persons from outside the District. II. Institutions outside the District receiving sick and infirm persons from the District. III. Other Institutions, the deaths in which have been distributed among the several localities in the District. Edmonton Infirmary. Metropolitan Asylums Board Hospital, Middlesex Asylum, Napsbury. Great Northern Hospital, Holloway. Winchmore Hill. Prince of Wales' Hospital, Tottenham. - Southgate Isolation Passmore Edwards Hospital, Wood Green. Hospital. Various London Hospitals. The Union Workhouse is outside the District. 11 Table II. Cases of Infectious Disease Notified during the Year 1920. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Locality. Total Cases Removed to Hospital. At all Ages. At Ages—Years. North Southgate. South Southgate. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards Small-pox .. .. .. .. .. .. .. .. .. .. .. Cholera (C) Plague (P) .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 50 .. 6 28 9 6 1 .. 14 36 31 Erysipelas 11 .. .. 2 1 3 4 .. 1 10 .. Scarlet Fever 135 .. 15 97 15 G 2 .. 27 108 102 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 2 .. .. .. 1 1 .. .. .. 2 .. Pneumonia 33 .. .. .. l 14 .. .. 12 21 .. Malaria 4 .. .. .. 2 2 .. .. 1 3 .. Encephalitis Lethargica 1 .. .. .. .. 1 .. .. .. 1 .. Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Meningitis .. .. .. .. .. .. .. .. .. .. .. Acute Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 1 .. .. .. .. .. .. .. .. .. .. Pulmonary Tuberculosis 38 .. .. .. 6 23 9 .. 5 33 .. Other forms of Tuberculosis 11 .. 1 3 3 1 3 .. 2 9 .. Totals 286 1 24 133 38 57 27 6 62 224 133 Isolation Hospital—Name and Situation : Southgate Isolation Hospital, Tottenhall Road, Palmers Green (in the District), provided by the Southgate Urban District Council. Total available Beds, officially 30, but practically 48. Number of Diseases that can be concurrently treated, 3. 12 Table 11a. Cases of Infectious Disease Notified each Month of the Year 1920. Notifiable Diseases. Scarlet Fever. Diphtheria. Typhoid Fever. Puerperal Fever. Erysipelas. Acute Poliomyelitis Encephalitis Lethargica. Cerebro-spinal Meningitis Pneumonia. Malaria. Ophthalmia Neonatorum. Tuberculosis. Totals. Pulmonary. Other Forms. January 29 5 .. .. 2 .. .. .. 2 1 .. 4 2 45 February 6 7 .. .. 4 .. 1 .. 4 .. .. 2 2 26 March 9 3 .. .. 1 .. .. .. 8 .. .. 8 .. 30 April 6 .. .. .. .. .. .. .. 4 1 .. 2 .. 13 May 4 1 .. .. 1 .. .. .. 2 .. .. 1 0 31 June 4 2 .. .. 1 .. .. .. 1 1 .. 2 1 12 July 18 7 .. .. .. .. .. .. 4 1 .. 3 1 35 August 4 4 .. .. .. .. .. .. 3 .. .. 5 1 17 September 6 3 .. .. .. .. .. .. 2 .. .. 2 1 14 October 24 6 .. .. .. .. .. .. .. .. .. 5 1 36 November 16 6 1 .. 1 .. .. .. .. .. .. 3 .. 27 December 9 6 .. .. 1 .. .. .. 3 .. .. 1 .. 20 Totals 135 50 2 .. 11 .. 1 .. 33 4 1 38 11 286 13 Table III. Causes of and Ages at Death during the Year 1920. Causes of Death. Nett Deaths at subjoined ages of "Residents" whether occurring within or without the District. Total deaths whether of "Residents'' or "Non-Residents" in Public Institutions in the District. All ages. Under year. 1 and Under 2. 2 and under 5. 5 and under 15 15 and under 25 25 and under 45. 45 and under 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 All Causes— Certified 855 25 3 3 3 15 50 94 158 40 Uncertified Enteric Fever •• •• •• •• •• •• •• •• •• •• Small-pox •• •• •• •• •• •• •• •• •• •• Measles 2 1 1 •• •• •• •• •• •• Scarlet Fever 1 •• •• •• 1 •• •• •• •• •• Whooping Cough •• •• •• •• •• •• •• •• •• •• Diphtheria and Croup 2 •• •• 1 1 •• •• •• •• 1 Influenza 9 •• •• •• •• 1 2 4 2 •• Erysipelas 1 1 •• •• •• •• •• •• •• •• Phthisis (Pulmonary tuberculosis) 24 •• •• •• •• 3 14 7 •• 39 Tuberculous Meningitis 1 •• •• 1 •• •• •• •• •• •• Other Tuberculous Diseases 1 •• •• •• 1 •• •• •• •• •• Cancer (malignant disease) 52 •• •• •• •• •• 4 25 23 •• Rheumatic Fever 9. •• •• •• 9 •• •• •• •• •• Meningitis •• •• •• •• •• •• •• •• •• •• Organic Heart Disease 48 •• •• •• •• 2 9 13 31 •• Bronchitis 9 1 •• •• •• .. •• •• 8 •• Pneumonia (all forms) 16 •• 1 •• •• 9 5 3 5 •• Other Diseases of Respiratory Organs 7 •• •• •• •• •• •• 2 5 •• Diarrhoea, etc. (un'r2yrs.) •• •• •• •• •• •• •• •• •• •• Appendicitis & Typhlitis 3 •• •• •• 1 2 •• •• •• •• Cirrhosis of Liver 1 •• •• •• •• •• •• 1 •• •• Alcoholism 1 •• •• •• •• •• 8 1 •• •• Nephritis and Bright's Disease 16 •• •• •• •• •• 3 5 8 •• Puerperal Fever •• •• •• •• •• •• •• •• •• •• Parturition, apart from Puerperal Fever •• •• •• •• •• •• •• •• •• •• Congenital Debility and Malformation, including Premature Birth 21 20 1 •• •• •• •• •• •• •• Violent Deaths, excluding Suicide 16 •• •• 1 1 5 2 5 2 •• Suicides 2 •• •• •• •• •• 1 1 •• •• Other defined Diseases 112 2 •• •• 1 •• 15 25 70 •• Diseases ill-defined or unknown 8 •• •• •• •• •• 2 2 4 •• Special Causes (included above): Poliomyelitis •• •• •• •• •• •• •• •• •• •• Totals 355 25 3 3 8 15 50 94 158 40 14 Table IV. Infant Mortality. 1920. Nett Deaths from stated causes at various Ages under 1 Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3—4 Weeks. Total under 1 Month. 1—3 Months. 3—0 Months. 6-9 Months. 9—12 Months. Total Deaths under One Year. All Causes— Certified 15 4 1 1 21 2 2 ... ... 25 Uncertified /Small-pox Chicken-pox ] Measles ... ... ... ... ... 1 ... ... ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... Whooping Cough \Diphtheria and Croup Erysipelas ... ... 1 ... 1 ... ... ... ... 1 | Tuberculous Meningitis J Abdominal Tuberculosis (Other Tuberculous Diseases Meningitis^not Tuberculous) ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... Laryngitis Bronchitis ... ... ... ... ... 1 ... ... 1 Pneumonia (all forms) ... ... ... ... ... ... ... ... ... j Diarrhoea ... ... ... ... ... ... ... ... ... (Enteritis .. ... ... ... ... ... ... ... ... ... Gastritis ... 1 ... ... ... 1 ... ... ... ... 1 Syphilis ... ... ... ... ... ... 1 ... ... ... 1 Kickets Suffocation, misadventure ... ... ... ... ... ... ... ... ... Want of attention at Birth ... ... ... ... ... ... ... ... ... Atelectasis 2 ... ... ... 2 ... ... ... ... 2 (Congenital Malformations .. 1 1 ... ... 2 ... ... ... ... 2 j Premature Birth .. 10 1 ... ... 11 ... ... ... ... 11 1 1 ... 1 3 ... 1 ... ... 4 Other Causes ... 1 ... ... 1 ... ... ... ... 1 Totals 15 4 1 1 21 2 2 25 Nett Births in the Year legitimate 682 illegitimate 17 Nett Deaths in the Year of infants 25 15 Comparison of the Rates of the Southgate District with those of England and Wales and London, for the Year 1920. Birth-rate per 1,000 Population. Death-rates per 1,000 Population. Death-rate under 1 year per 1,000 births. Table V. All Causes. Enteric Fever. Scarlet Fever. Diphtheria. Measles. Whooping Cough. England & Wales 25.4 12.4 0.01 0.04 0.15 0.19 0.11 80 London 26.5 12.4 0.01 0.05 0.22 0.22 0.17 75 Southgate 17.0 8.7 0.00 0.02 0.04 0.04 0.00 35.7 16 SANITARY CIRCUMSTANCES OF THE DISTRICT. Water Supply.—Practically the whole District is now served by the Metropolitan Water Board with a "constant'' supply from high-pressure mains. There are now only 7 wells left from which water is obtained for drinking. These are principally in North Southgate. Watercourses—Bounds Green Brook and Pymmes Brook remain in about the same condition. The periodical cleansing by the Middlesex County Council greatly improves their condition. Open=Air Swimming Bath —This Bath, situated at Barrowell Green, was opened to the public on 14th August, 1913. The length of the bath is 150ft. and the width 50ft. The accommodation comprises attendants' offices, slipper-bath, laundry, foot-bath, sanitary conveniences, and enclosed dressing accommodation including family dressing-boxes. Further dressing accommodation has recently been provided. Provision has been made for the heating of the water by means of the boiler in the adjoining Destructor Works. The Bath has been most successful. Broomfield Park Swimming Lake.—The large lake at Broomfield Park, which on my recommendation was closed to bathers in 1911 owing to such pollution as in the opinion of the highest sanitary authority rendered it unsafe for bathing, was re-opened last summer for bathing and swimming to meet the earnest desire of many residents, after the question of rendering it safe had been earnestly considered and dealt with. Suspecting that the surface witter which came from the Alderman's Hill Estate, and which forms the main source of its supply, was also the chief cause of its pollution, this was cut off for a time. A sample of the water from the lake then taken and analysed showed great improvement. Steps were then taken to filter and aerate this surface water before it entered the lake. Further samples of water then taken from the lake and settling tanks were submitted for analysis, and the analyst's reports stated that the water in the bathing lake, although unfit for drinking, was quite suitable for bathing purposes. Dressing accommodation has been provided by the Council, and a large number of bathers have availed themselves of the 17 privilege and health-giving pleasure of swimming and bathing in this beautiful lake set in such charming and natural surroundings. Samples of the water are taken, and will continue to be taken, at intervals during the season, and submitted for analysis, in order to ascertain that the water remains sufficiently unpolluted. 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 therewith, thus ensuring dry dwellings and avoiding any accumulations of stagnant water inside or beneath any dwelling-house. The main sewage sewers traverse as much as possible the natural valleys, and run from the higher lands on the west towards the east, where they are joined to the sewers of the Edmonton District at three points along the boundary between the Southgate and Edmonton Districts. 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. Only one length of sewer, apart from culverts, is now constructed of brickwork, that length 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 30 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 very satisfactorily. The sewers are also carried at several points under the New River, and a few years ago the late New River Company insisted upon a special system being adopted, by which large cast-iron shield 18 pipes are forced by means of powerful hydraulic jacks through the soil under the river, thus forming tunnels in which the sewage pipes are laid. In the case of new streets, no new sewers are permitted to be covered up until the work has been thoroughly inspected and 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 for Hushing are provided by 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 within the district. Fortunately, all the sewers 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 at 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 twenty-six years no drains of any house have been permitted to be connected with the sewers unless they have been provided with a chamber containing a trapped interceptor just within the boundary adjoining the street or road. In the District there are now 49 miles 822 yards of sewage sewers, and 45 miles 1,080 yards of surface-water sewers, Public Convenience.—A Public Convenience with accommodation for both sexes has been erected in Green Lanes opposite Alderman's Hill. The receipts from it do not meet the expenditure, but its usefulness is unquestionable. There is still pressing need for similar provision in Southgate and also at New Southgate. Particularly is this the case at Southgate Village, to which many hundreds of visitors are brought weekly by the omnibuses. 19 Efforts have been made to secure a piece of laud at New Southgate, but so far they have not been successful. Roads.—In the District there arc now upwards of 48 miles of roads, made up as follows:— Miles. Yards. County Main Roads 4 562 Other Roads (repairable by the inhabitants at large) 38 700 Private Roads (repairable by the owners of property abutting on such Roads) 5 1,701 Total 48 1,203 Closet Accommodation.—Water closets obtain throughout the District and are connected with the Council's sewers. Only 4 cesspools, situated on the extreme edges of the Council's administrative area, remain. There arc no earth closets. Scavenging.—All houses are provided with portable covered ashbins. The refuse has been collected weekly, and the number of vanloada collected was 5,255, as against 4,692 in the previous year. During the year 351 vanloads were taken to Barrowell Green shoot while the Destructor was under repair. Very few genuine complaints of non-collection were received. Collection of Fish Offal.—The fish offal from fish shops is removed in air-tight receptacles at regular intervals weekly, by a Contractor, who charges the fishmongers a certain sum per week, according to the quantity of fish offal collected. Premises controlled by Bye-law or Regulations.— There are 7 slaughterhouses, 18 bakehouses, 107 factories, workshops and workplaces, 25 dairies and milk-shops in the District, all of which are periodically under inspection. 20 There are 469 shops in the District registered under the Shops Act. The figures for the four Districts are:— Palmers Green 221 Winchmore Hill 112 New Southgate 69 Southgate 67 Total 469 These shops have been visited by your Inspectors, and some minor breaches of the Act were found, and in each case remedied on verbal notice being given to the occupier. 21 SANITARY INSPECTION OF THE DISTRICT. REPORT OF SANITARY INSPECTOR. On the Administration of the Factory and Workshop Act, 1901, in connection with Factories, Workshops, Laundries, Workplaces and Homework. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (including Factory Laundries) 24 — — Workshops (including Workshop Laundries) 106 12 — Workplaces (other than Outworkers' premises, included in Part 3 of this Report) 18 — — Total 148 12 — 2.—DEFECTS FOUND. Particulars. Number of Defects. Number Prosecutions. Found. Remedied. Referred to H.M. Inspector. (D (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of Cleanliness 4 4 — — Want of Ventilation — — — — Overcrowding — — — — Want of Drainage of Floors — — — — Other Nuisances — — — — Sanitary Accommodation Insufficient — — — — Unsuitable or Defective 8 8 — — 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) 6 6 — — Other Offences — — — — (Excluding offences relating to outwork which are included in Part 3 of this Report). Total 18 18 — — * Including those specified in Sections 2, 3, 7, and 8 or the Factory and Workshop Act as remediable under the Public Health Acts. † Section 22 of the Public Health Acts (Amendment) Act, 1890, was adopted in 1890. 22 HOME WORK. Outworkers' Lists, Section 107. Prosecutions. Outwork in Unwholesome Premises, Sec. 108. Outwork in Infected Premises, Secs. 109 & 110. Lists received from Employers. Notices served on Occup'rs as to keeping or sending lists Failing to keep or permit inspection of lists Failing to send lists. Twice in the year. Once in the year. In- st'nc's N'tc's Serv'd Prosecuti'ns In- st'nc's Orders Made (S.110) Prosec'tions (S. 109 110). Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel —(l)Making, Ac. 7 .. 39 .. .. .. 2 .. .. .. .. .. .. .. .. 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of year. Number. (1) (2) Workshop Bakehouses 18 Laundries 6 Other Workshops 100 Total number of workshops on Register 124 5.—OTHER MATTERS. Class. (1) Number. (2) Matters notified 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. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector 4 Reports (of action taken) sent to H.M. Inspector 4 Other Underground Bakehouses (s. 101):— Certificates granted during the year In use at the end of the year Nil 23 SANITARY WORK, 1920. DISTRICT OF SOUTHGATE. (1) Adoptive Acts, (i) Byelaws. in force in District. Particulars as to Staff employed in Sanitary Department. * Inspections. Action taken. (Other than under H. and T.P. Act.) Dwelling Houses and Action under H. and T.P. Act, 1909. Houses Let in Lodgings (Tenement Houses). Common Lodging Houses. As previously recorded, the Public Health Acts Amendment Act, 1907, came into force in April, 1912. Baths and Washhouses Acts in July, 1912, and Museums and Gymnasiums Act, 1891, in November, 1913, Medical Officer of Health, Chief Inspector, 2 Assistant Inspectors, 1 Clerk, 1 Disiufector. Number of Premises Inspected on Complaint. Number of Premises Inspected in connection with Infectious Diseases. Number of Premises under Periodical Inspection. Houses Inspected from House-toHouse (H. and T.P. Act, Sect. 17). Total Number of Inspections and Re-inspections made. Cautionary or Intimation NoticesGiven' Statutory Orders Issued. Summonses Served. Convictions Obtained. Number of Houses dealt with under Sect. 15. Number of Houses found to be in a state Dangerous or Injurious to Health (Sect. 17). Number of Representations made by M.O.H. (Sect. 17). Number of Houses made Habitable without Closing Orders. Number of Closing Orders made by L.A. (Sect. 17). Number of Houses closed Voluntarily. Number of Closing Orders determined after Repairs (Sect. 17). Number of Houses Demolished (a) by order of L.A. (Sect. 17), (b) Voluntarily. Houses Premises, etc., Cleansed. Number Registered under Byelaws. Number of Contraventions. Number Registered under Byelaws. Number of Inspections made. Number of Contraventions. in (2) (3) (4) (5) (a) Nil. 106 167 162 319 8755 415 Nil. Nil. Nil. 273 Nil. 23 Nil. 1 Nil. (b) Nil. 262 Nil. Nil. Nil. Nil. Nil * N.B.—(3) Includes all classes of premises under periodical supervision, such as Cowsheds, Dairies, Slaughterhouses, Workshops and Workplaces, &c. (5) Includes all visits and re-visits made by Sanitary Inspectors in connection with 1—4. 24 Sanitary Work, 1920. District of Southgate. Canal Boats used as Dwellings. j Movable Dwellings, Caravans, Tents, &c. Bakehouses. Slaughterhouses. Cow-sheds. Dairies and Milk-shops. Unsound Food. Offensive Trades. Number Registered under the Act. Number of Contraventions of Regulations. Number Observed during the Year. Number of Nuisances therefrom abated. Number Removed from District. Number in District. Contraventions of Factory Acts. Number on Register. Number of Inspections made. Frequency of Inspection. Contraventions of Bye-laws. Number on Register. Number of Inspections made. Frequency of Inspection. Contraventions of Regulations. Number of Milch Cows in District. Number on Register. Number of Inspections made. Frequency of Inspection. Contraventions of Regulations. Meat (including organs) seized and surrendered. (Approximate weight in pounds.) Poultry and Game seized and surrendered. (Approximate weight in pounds.) Fish seized and surrendered. (Approximate weight in pounds.) Fruit and Vegetables seized and surrendered. (Approximate weight in pounds.) Other Articles seized and surrendered. (Approximate weight in pounds.) Method of Disposal. Number of Premises in District. Number of Inspections made. Contraventions of Bye-laws. Nil. Nil. 5 6 5 18 6 7 302 When Slaughtering expected. 3 10 51 - 7 About 200 21 61 - 6 1846 lbs. Nil. 588 lbs. 82 lbs. Nil. Destructor. Nil Nil. Nil. 25 Sanitary Work, 1920. District of Southgate. Water Supply and Water Service. Drainage and Sewerage of existing Buildings. Wells. Percentage of Houses supplied from Public Water Service. Cisterns. Percentage of Houses supplied on Constant System. Number of Samples obtained for Water Closets. Drains. Cesspools. Percentage of Houses Draining into Sewers. New Sunk. Cleansed, Repaired, Ac. Closed as Polluted. New, Provided. Cleansed, Repaired, Covered, Ac. Draw-Taps placed on Mains. From Local Wells. From Public Supply. Number of Water Closets substituted for Dry Receptacles. Repaired, Supplied with Water, or otherwise Improved. Percentage of Houses provided with Water Closets. Examined, Tested, Exposed, Ac. Unstopped, Repaired, Trapped, Ac. Waste Pipes, Rain Water Pipes Disconnected, Repaired, Ac. New Soil Pipes or Ventilating Shafts fixed. Existing Soil Pipes or Ventilating Shafts Repaired. Disconnecting Traps or Chambers Inserted. Reconstructed. Rendered Impervious, Emptied, Cleansed, Ac. Abolished, and Drain connected to Sewer. Nil. Nil. Nil. Practically all. Nil. 12 9 Practically all. Nil. Nil. Nil. 131 Practically all. 579 43 180 6 16 25 6 3 Nil. Practically all 26 Sanitary Work, 1920. District of Southgate. Disinfection. Dust. Sundry Nuisances Abated. Remarks as to any other matters or in explanation of previous columns. Rooms Disinfected. j Rooms Stripped and Cleansed. Articles Disinfected or Destroy'd Mew Bins provided. How frequently is Dust Removed from each house? Number of Complaints of Non-Removal received. Method of Disposal. Overcrowding. Smoke. Accumulations of Refuse. ! Foul Ditches. Ponds,&c., and Stagnant Water. Foul Pigs and other Animals Dampness. Yards Re-paved or Repaired. Other Nuisances. Ordinary Infectious Diseases. Phthisis. Ordinary Infectious Diseases, j Phthisis. 364 61 78 1407 133 106 Weekly. 24 Destructor. Nil. 1 13 5 4 248 85 39 W. C. KILBY, A.R.San I., M.S,I.A. Sanitary Inspector. 27 SCHOOLS. There are eight Public Elementary Schools and two Secondary Schools. These are supplied by the Public Water Supply, and all have adequate and modern Sanitary arrragcments. On the occurrence of any infectious disease, a careful watch is kept upon the schools, and, as occasion requires, classes are examined by me. All contacts are excluded from School Attendance, and there is always close co-operation maintained between the Public Health Department and the School Authorities. In consequence of an outbreak of Scarlet Fever amongst the children in the infants' department of one of the Elementary Schools a section of this department was closed for 14 days at the end of October. Medical Inspection under the Education Act, 1907. The County Medical Officer is the School Medical Officer for this District, and organises and supervises the work. The inspections are earried out by an Assistant Medical Officer. Arrangements for these visits are made beforehand, and the parents are summoned to them Total number of Children inspected:— Boys. Girls. 5 years-old group 125 117 8 years-old group 185 149 12 years-old group 133 120 13 years-old group 41 49 14 years-old group 8 7 Specials 25 33 517 475 Total 992 Southgate Children Inspected at Winchmore Treatment Centre 245 Southgate Children Inspected at Holly Park Treatment Centre 165 1,402 28 In connection with the work of the School Medical Inspection, Centres for treatment have been open as follows:— (1). For the Treatment of Minor Ailments. Winchmore Hill School and Holly Park School. These are temporary centres. The number of new cases from the District of Southgate treated at the Winchmore Hill Centre from January to December, 1920, was 482. The number of Southgate Children treated at Holly Park Centre from January to December, 1920 was 223. Total 705. (2). Ophthalmic Centres. An Ophthalmic Clinic is held weekly at Garfield Road School, and Children are seen by arrangement by Mr. Tyrrell, Ophthalmic Surgeon. An average of 10 Children per session is seen. Glasses are prescribed and provided at cost price if the parents are in a position to pay. The children attend again when the glasses are ready, so that the Surgeon may see that they are suitable. (3). Dental Clinic. A Dental Clinic is held at Holly Park School. The Dental Officer inspects Children in the various Schools, and since the opening of the Clinic all Schools in Southgate have been inspected by the Dentist, and those Children needing treatment referred to the Treatment Centre. FOOD. Milk Supply.—There are approximately 200 dairy cows kept in the Urban area. These are periodically inspected by the Council's Veterinary Inspector, and their general condition has been satisfactory. No case of tuberculosis of the udder was found during the year. The bulk of the milk supply is "imported." The average weekly supply of milk is approximately 5,000 gallons. Samples are taken at irregular intervals. 29 Meat and other Foods.—There are seven slaughter-houses (all licensed) in the District, and all of them, though well kept and well conducted, are in unsuitable positions owing to their close proximity to dwelling-houses. Some of them are little used, but all have been systematically inspected, particularly at night when slaughtering is in progress. This gives a better opportunity of observing the condition of the animals before the organs and offal are taken away. The tendency of the butchers is to facilitate the work of the Inspectors, and should any carcase be doubtful it is put on one side for inspection. Three hundred and two visits were made to these premises by your Inspectors during the year. The scattered nature of the District and its proximity to London markets does not lend itself to the establishment of a Public Abattoir in the immediate future. Slaughterhouses. In 1914. In Jan.. 1920. In Dec., 1920. Registered Nil. Nil. Nil. Licensed. 8 7 7 16 cwts. 1 qr. 26 lbs. of meat were surrendered and destroyed. 5 cwt. 1 qr. of fish were voluntarily surrendered. 82 lbs. of fruit and vegetables were voluntarily surrendered. The fish and fruit shops arc kept well under observation The duties under the Food and Drugs Acts are administered by the Middlesex County Council. 30 The following are particulars of samples taken in the District during last year:— Article. Samples Taken. Found Adulterated. Milk 80 7 Separated Milk 1 — Cream 4 1 Butter 1 — Egg Substitute Powder 2 — Carbonate of Soda 1 — Coffee 1 — Flour (self-raising) 1 ... — Lard Compound 1 — Total . 92 8 Prosecutions 1 Convictions 1 The figures given for adulterated samples include informal samples in respect of which no proceedings could be taken. Bakehouses.—All the Bakehouses (18 in number) were inspected frequently during the year. There are no underground Bakehouses in use in the District. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. It will be seen from Table II. that 286 cases of infectious diseases were notified during the year, as compared with 444— which total included Measles, not now notifiable—in the preceding year. Of these 135 were Scarlet Fever, 50 Diphtheria, 11 Erysipelas, 2 Enteric Fever, 33 Pneumonia, 41 Malaria, 1 Encephalitis Lethargica, 1 Ophthalmia Neonatorum, and 49 Tuberculosis. Of these, 72 were notified from North Southgate, and 214 from South Southgate. 31 These 286 cases represent infection in 250 houses. 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 33 houses sanitary defects were found, consisting chiefly of defective water-closets, dampness, and want of cleansing. These defects have all been remedied under the supervision of the Sanitary Authorities. The notification of these diseases was the means of causing the inspection, apart from the ordinary inspections, of 191 premises, and the remedying of insanitary conditions in 33. One hundred and thirty-three cases were removed to the Isolation Hospital at Palmers Green. Of these 102 were Scarlet Fever and 31 Diphtheria. One case was removed to the Enfield Isolation Hospital. The Infectious Sickness Rate of the District was 7.0 per 1,000 of the population, as against 11.3 in the preceding year. Methods of Disinfection.— For disinfection of rooms "Formalin" is used (a) by spraying and (b) by fumigation with lamps. Bacteriological Work.—The Bacteriological Work required is carried out by the Bacteriological Laboratory at St. George's Hospital by arrangement with the Council. 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 St. George's Hospital 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. 32 During the year, 372 specimens were sent and reports received as follows:— Diseases Suspected. Report. Total. Positive. Negative. Diphtheria 70 184 254 6 Typhoid Fever 1 5 Phthisis 21 91 112 Total 92 280 372 N.B.—These were not all from different cases, but in many instances, chiefly of Diphtheria, further specimens were taken from the same cases at intervals for re-examination to determine when the case in question ceased to be infectious. In many cases this has to be repeated several times before a negative result is reported. Diphtheria Antitoxin.—The supply of diphtheria antitoxin provided by the Council and kept available for use at any time at the Council's 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 Measles and Whooping Cough, are always kept in readiness, and have been left at all houses where these diseases were present. The necessary knowledge as to where the diseases are present is supplied to me chiefly by the School Authorities. This system of notification of non-notifiable diseases by the School Authorities, instituted in 1898, continues to work as satisfactorily as can be expected. Small-pox.—No cases were notified. Two cases of "contacts" with Small-pox were notified and were kept under observation. 33 With regard to the provision for the effective isolation of casts of Small-pox, Southgate is one of the thirteen Councils comprised in the district of the Middlesex Joint Small-pox Hospital Board by which the Clare Hall Small-pcx Hospital has been purchased for the use of the inhabitants of the constituent district. No private vaccinations or re-vaccinations by me under the Public Health (Small-pox Prevention) Regulations, 1917, have been required. Scarlet Fever.—As in the previous year, this disease was again prevalent throughout the District, and no month passed without some notifications, the minimum being 4 in the months of May, June, and August, and the maximum 29 in the month of January. The type of the disease was, generally speaking, mild, a few cases being of a more severe type, resulting in one death. There were 135 cases notified from 114 houses, as against 126 in the preceding year, 38 in 1918, and 26 in 1917. Of these, 27 were notified from North Southgate, and 108 from South Southgate. In 28 houses sanitary defects were found. Six cases were "imported," 17 were "secondary" cases, occurring in 15 houses from which previous cases had been notified, and four were "return" cases from houses to which previous cases had returned directly or indirectly after discharge from the Isolation Hospital. One hundred and two cases were removed to the Isolation Hospital. Diphtheria.—This disease was also somewhat prevalent throughout the District during the greater part of the year, excepting April, May and June, during which months only 3 cases occurred. In all 50 cases were notified from 35 houses, against 19 in the preceding year, 39 in 1918, and 63 in 1917. Of these, 14 were notified from North Southgate, and 36 from South Southgate. There were 6 cases " imported " from other Districts. In 4 houses sanitary defects were found. 34 Thirty-one cases were removed to the Isolation Hospital, and one case to the Enfield Isolation Hospital by friends of the patient. A few of the cases were of a severe type, and there were 2 deaths, which occurred in the Isolation Hospital. Typhoid Fever.—Two cases were notified, both from South Southgate, as against 1 in the preceding year, 1 in 1918, and 6 in 1917. Measles.—The Compulsory Notification of Measles Order was withdrawn by the Ministry of Health on December 31st 1919. Erysipelas.—Eleven cases were notified, as against 10 in the preceding year. Tuberculosis.—The number of cases of Phthisis notified under the Public Health (Tuberculosis) Regulations, 1912, was 38. The cases of other forms of Tuberculosis notified numbered 11. The figures for 1919 were—Phthisis, 37 ; other forms, 9. 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 all cases accepted and disinfection carried out. Arrangements have been made by the Hospital Board at Clare Hall Small-pox Hospital, at South Minims, to receive cases of Phthisis. Provision has been made by the Council to supply portable shelters in necessary cases, but so far none have been required. In one house sanitary defects were found. 35 The requirements as to Notification of Tuberculosis appear to be fully observed by the medical practitioners in the district. The number of Notifications received on Form "C" was 36, and on Form " D " 22. During the year there were 26 deaths from tubercular di-eases, 24 of these being from Phthisis, as against 24 and 20 respectively in the previous year. Encephalitis Lethargica.—One case from South Southgate was notified and was visited. Cerebro-Spinal Meningitis.—No cases were notified. Acute Poliomyelitis.—No eases were notified. Pneumonia.—Thirty-three cases were notified—12 from North Southgate, and 21 from South Southgate; 16 cases proved fatal. Ophthalmia Neonatorum.—One case was notified, from South Southgate. MATERNITY AND CHILD WELFARE. Notification of Births Acts.—During the year 624 notifications of births were received (of which 18 were stillbirths), as against 453 in the previous year. There were 664 births registered in the district, of which 48 were un-notified, giving a percentage of 92.7 of notified births. The apparent discrepancy in the figures of the births notified and of those registered is due to the fact that some of the births occurring and notified at the end of the year were not registered until the beginning of this year. A Health Visitor was appointed in July, 1916, and, ever since, her work has been and is continually increasing, especially since the establishment of the Infant Welfare 36 Centres, where she is entirely responsible for maintaining the stocks of food, etc., and the keeping of the books and registers. The work also entails a large amount of "following up " of ailing children, and the "looking up "of parents and children attending irregularly. Since the termination of the War, the number of births also has greatly increased. There is consequently more work than is possible for one Health Visitor to do. An Assistant Health Visitor was, therefore, appointed in February last year, who, besides her health visiting duties, was required to relieve the Midwife, when the latter is off duty, on her holiday, or in an emergency. The Assistant Health Visitor resigned in November, and, as the Midwife's time was not by any means fully occupied with midwifery, it was decided that she should occupy her spare time in the capacity of Assistant Health Visitor for a period of six months as an experiment. The plan, however, does not work well, as, of necessity, the time she is able to devote to health visiting and Centre work is irregular; and such work, to be efficient, should be regular and constant. The question of appointing another full-time Assistant Health Visitor should, therefore, be seriously considered. In my opinion, it is absolutely necessary if this work is to be carried out with efficiency, and the full benefit of the Maternity and Child Welfare Work in this district is to be obtained. Midwives.—The supervising authority in this District is the Middlesex County Council. There are eight midwives practising privately in the District. A municipal midwfe was appointed by the District Council in November, 1919, to reside and work chiefly in Southgate, to take the place of a midwife practising privately and now deceased. She is also required to attend cases in any part of the Urban District when applied for. During this time, she has attended an average of 60 cases per annum, chiefly in South- 37 gate. The number of cases in other parts of the District averages 8 per annum. It is not to be expected that her services will be applied for to any extent other than in Southgate, as there are midwives practising privately in the other localities, and it is a long way to send to Southgate, where she must reside, from other parts of the District. Maternity and infant Welfare Centres.—A Maternity Committee was first established by the Council in June, 1917, composed of two representatives of the Council and four ladies, representing Winchmore Hill, Palmers Green, New Southgate, and Southgate. One Centre was opened at New Southgate, meeting monthly under the charge of Dr. Louisa Westlake. It was soon found that fortnightly meetings were necessary, and in June, 1918, a second Centre was opened at Old Southgate, meeting fortnightly. At the end of the year, fortnightly Centres were also opened at Winchmore Hill and Bowes Park, so that now, with a Centre in each of the four localities, a Centre is within easy reach of every resident. During 1918 the Maternity and Child Welfare Act was passed, and, in accordance with that Act, the Committee was reconstituted, and now consists of ten members of the Council, four ladies and one ex-Councillor. It was also found necessary, during 1919, owing to the increase of numbers attending, to have weekly meetings of the Centres at New Southgate, Winchmore Hill, and Bowes Park. In February, 1918, the Milk (Mothers and Children) Order was issued, and under its powers, the Committee make grants of milk, free of cost, or at half price, to various expectant and nursing mothers and infants. Under this Order 95 mothers have received milk either free or at half-price, and marked benefit to the children has resulted. The amount of milk granted amounted to 2,538 gallons. In considering the applications for milk, the following scale of income (prepared in the first instance bv the Ministry of Pensions) has been adopted:— In order to receive milk free, or at a reduced price weeklv income must not exceed:— £ s. d. For 1 child 2 17 6 For 2 children 3 3 6 For 3 children 3 9 6 and so on, reckoning 6s. for each additional child. 38 Great care is taken to verify the statements as to income made by the applicants, and the arrangements work satisfactorily. Maternity Home.—The arrangement made with the Edmonton Board of Guardians for the reception of maternity cases at the District Maternity Home at Edmonton, in January, 1919, continues to work satisfactorily, and eleven mothers were admitted during the year. This is a great advantage to those who are unable to make adequate provision at home, or whose place of residence is unsuitable for their confinements, and for cases of exceptionally difficult or abnormal labour. The charge, which was originally 28s. per week, is now raised to 42s. In necessitous cases the Council remits part or whoie of the charge, according to circumstances. The Medical Officer, Dr. Louisa Wcstlake, who is not in general practice, attends all the Centres at every sitting, and carries out her duties with great zeal and efficiency. Continuity of advice and supervision is thus assured, and the confidence of the mothers is gained. She is ably supported by the Health Visitor and voluntary helpers, who are very enthusiastic and do excellent work. The model garments they make and sell at cost price are a great attraction. The premises at which they are held answer their purpose very well, and the necessary apparatus is provided at each Centre. The year has seen steady progress in the Maternity and Child Welfare work. The four Centres meeting weekly at New Southgate, Winchmore Hill, and Bowes Park, and fortnightly at Southgate, have all shown increasing attendances, and a high standard of interest on the part of the mothers. A satisfactory feature is the fact that infants are being brought increasingly in the earliest months of life, so that they are under supervision from the start. 39 The number of Sessions during the year was 172. All the Centres closed for a week at Easter. Whitsuntide, in August, and at Christmas. The registers are revised every quarter, w hen the names of children who attain school age or who leave the district or cease to attend the Centres are removed. The number on the register at the beginning of the year was 276, at the end 443. The total number of attendances during the year was 6,813, the highest on any day was 65, the lowest 11, and the average 38. The highest number seen by the doctor on any one day was 40, and the average number 22. Comparative table tor the last three years:— Year. No. of Centres. No of Sessions. No. of New Cases Regd. Total Attendances of Children Total Attendances of pre-natal Mothers. Average Weekly Attandance Children. Average Attendance at Centre. 1918 2 63 214 1213 52 39 19 1919 4 105 253 2193 118 92 23 1920 4 172 434 6813 233 154 38 Of the children brought to the doctor for consultation the following classification has been made:- No. 1920 Percent. 1920 Percent. 1919 General advice as to feeding and management 2,349 73.6 68 Disorders of digestion 274 8.5 9 Rickets 76 2.4 5 Referred to hospital 71 4 1.7 Referred to private doctor 43 1.4 1 Other cases 397 12.4 13 Advice to mothers 294 — — In connection with the continually increasing number of attendances, although this is no doubt largely due to the spreading of the knowledge of the good work done at the Centres, it should be borne in mind that, to quote from the memorandum in regard to Maternity and Infant Welfare. 40 Centres by the Ministry of Health, "The number of children in attendance is not the only or even the chief index of success." There is some reason to believe that a certain proportion of those who attend come in whole or in part for treatment which they hope to receive for themselves or children, Whereas it should never be forgotten that the maintenance of health in the normal child is the primary object of the consultation. Also, the regarding of the Centre to some extent as a convenient shop for the sale of cheap articles of infant foodstuffs and garments, combined with the means of spending a pleasant afternoon of gossip and tea, should constantly be discouraged. Pre-natal Work.—Seventy-four prospective mothers have been registered on the books, and later have brought their children to the Centres. This work would be very much more satisfactory if a separate Pre-natal Clinic were held. The attendance would be better, and the attention given to the mothers would be more thorough. In this connection attention may be called to the high proportion of infant deaths occurring during the first month of life, referred to earlier in this Report under the heading of Infantile Mortality. Illegitimate and Foster Children.—There are four illegitimate and two foster children on the books, all in good care. Mentally Deficient Children.—There are five such on the registers, and they are put into touch with proper organisations as and when required. Feeding or Infants.—Of the'children of nine months and under, 63 per cent. were wholly or partially breast fed, and 37 per cent. were artificially fed (weaned before the fifth month.) Breast feeding is encouraged in all cases, and the free supply of milk to necessitous nursing mothers has been valuable in retaining or restoring the natural function. Dried milk, cod liver oil and malt, etc., are supplied at cost price, and these arc very much appreciated by the mothers. 41 Convalescent Homes.—During the year an arrangement was made to send suitable cases from the Centres to the Babies' Convalescent Home at 15, Brent-road, Shooters Hill, at a cost of 15s. a week, payable by the parent. The Council agreed to remit part or the whole of the expense in necessitous cases. Two children have been sent to this Home, with great benefit in each case Dental Treatment.—Dentures have been supplied at half price to two nursing mothers, and, with the help of the Dental Club, five others have received much needed dental treatment. There is a difficulty in educating the mothers to the need of dental treatment, and much better work would be done if we were able to have a Dental Clinic, but which is hardly practicable at present. Tuberculosis.—Three cases came under observation, one of tuberculous ankle, and two of tuberculous glands. These cases were referred to hospital for treatment, and instructions given as to personal and domestic hygiene, followed up by visits by the Health Visitor to the homes. Educational and Social Work.—The primary object of Centre work is educational, and it is interesting to note the cumulative effect of the instruction given on the mothers as a whole. The teaching given to the individual mother in reference to her own child becomes knowledge which is not only used in her own home, but is discussed between the mothers themselves, and in this way a more correct standard is set up generally. Class teaching has been given in lectures at four Socials, which were held during the year, one in each of the four localities, and which were largely attended. This is good as far as it goes, but the educational side is still not strong enough. There should be more class instruction, simple talks on health and hygiene at the Centres at each session, by the Health Visitor. This important feature of our work is now receiving more special attention. Educational Competitions were held in the Summer. These included an examination in Mothercraft based on the text-book, which is issued at the Centres, "To Wives and Mothers." Prior to the examination, Mrs. Sauer, one of our voluntary helpers, very kindly conducted a weekly 42 class, which was attended by about 15 mothers. Other competitions included dressmaking' for young children, renovating, and laundry work. The competitions proved popular, and will probably be repeated. The Voluntary Committee.—This Committee has rendered splendid help in attending loyally and regularly at the Centres and in devising new ways for helping the mothers. Model garments are made and sold at cost price. A Dental Club is in existence to help the mothers to save, and those mothers who do not come under the Council scheme received financial aid from the Voluntary Committee. This is very valuable work. There is a Social Club which provides instruction with enjoyment, and a Savings Club. A cup of tea and a biscuit are provided at the cost of 1d. to all who attend the Centres. STAFF. The Staff of the Public Health Department consists of a part-time Medical Officer of Health, Chief Inspector, two Assistant Inspectors, a Clerk, and a Disinfector. The duties of the Chief Inspector are chiefly of a supervisory nature in the office and throughout the district. He is also responsible for the inspection of slaughter houses, dairies, milkshops, and bakehouses. One Assistant Inspector is engaged entirely upon house-to-house inspection. The general routine work of the Department is carried out by the other officers. ISOLATION HOSPITAL. The Hospital is built on a site of nine acres of land situated near the S.E. corner of the District, 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 as allotments. The Hospital premises are entirely enclosed by a close-boarded fence, and there is one entrance only, in Tottenhall Road. The Hospital was opened in January, 1902, and enlarged in 1910. .43 The buildings now consist of the following:— (1) Entrance Lodge. (2) Administrative Block. (3) Two Ward Pavilions, designed to contain 10 and 12 beds respectively. (4) Isolation Pavilion, a block of four wards designed to contain 8 beds. (5) Laundry Block with steam disinfector, mortuary patients' ambulance and clothing van sheds (the two latter were provided without a loan). The following amounts have been variously sanctioned by the Local Government Board to be borrowed for the purposes of the Hospital:— (1) Purchase of land £2,500 Fencing, drainage, gas, water- (2) mains,, levelling, drives, etc. 15.100 Erecting Hospital Buildings (3) Furniture 1,100 Total £18,700 The ground occupied has been laid out with drives, flower beds, trees, shrubs, lawns, kitchen gardens, and greensward. Paved airing-courts have been provided to each pavilion. The Ward Pavilions are used entirely for Scarlet Fever cases, and each contains two wards, one for women and children and one for males. The old wards measured 36ft. by 26ft. by 13ft. (female ward), and 26ft. by 24ft. by 13ft. (male ward) ; while the new wards are both 36ft. by 26ft. by 13ft. The accommodation provides for 22 patients, and each adult patient is provided with 150 square feet of floor space, and 2,028 cubic feet of air space. There are also provided in each Ward Pavilion, stores, cupboards for linen, etc., and bath-rooms arranged with glazed doors opening to the outside, so that they may be used as discharging rooms. 44 Sanitary annexes are constructed at the ends of each ward, accessible from the ward only, and provided with cross ventilation lobbies. The Isolation Pavilion is used for Diphtheria, Typhoid Fever, and doubtful cases which require isolation, and consists of a double block and containing four wards in all, designed to contain two beds in each ward and cots for young children. Each adult patient is provided with 216 square feet of floor space, and 2,808 cubic feet of air space. Each half of this pavilion has an independent entrance on opposite sides of the building, with separate verandahs, and externa! w.c., with special slop closets. All wards are lighted by gas and ventilated upon the most improved principles, so that thorough cross-ventilation may be well maintained. All wards are heated by regenerating stoves ; those in the Scarlet Fever Wards being fixed in the centre of each ward, and having double fires connected to downward flues which are carried under the floors to ordinary external chimney shafts. Duty Rooms in both Ward and Isolation Pavilions are centrally arranged so that the nurse-in-charge can look into each ward through special inspection windows. They contain kitchen ranges with hot-water apparatus, white glazed sinks, small larders, kitchen dressers, medicine cupboards, and a telephone communicating with the administrative block. The floors are of various kinds, Terrazzo, wood block, and jointiess flooring, the latter having been applied to the wards, duty and bath-rooms, and sanitary annexes of the new buildings. The interior walls are plastered with Keene's cement on Portland cement, and have been coloured with washable distemper and oil-painted dadoes. All internal angles of walls and woodwork have been coved and rounded. The Administrative Block contains dispensary, Matron's and Nurses' sitting-rooms, dining-room, waiting-room for patients' relatives and friends, store room, kitchen, scullery, coal store, two bath-rooms, and nineteen bedrooms (two of which contain two beds each) for the nursing staff and servants. The building is so designed that it can readily be enlarged still further to accommodate an increased staff. 45 The Laundry Block is fitted with a high-pressure boiler, which supplies steam for boiling all water required in the Laundry. 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. Three separate coach-houses are also provided. The Entrance Lodge contains a parlour, kitchen-living-room with enclosed sink and hath, 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 burned or disposed of on the enclosed area. The water supply passes through a meter on a bye-pass into a 4-in. main with 3-in. branches, and is provided with a 4in. sluice valve which would be opened to supply the four hydrants in case of fire. As an additional protection against fire, tanks and buckets, always containing water, are provided in each block of buildings; and there is also a hose reel carrying fire-hose, stand-pipes, etc., in a special shed on the premises. Communication with the Council's Chief Fire Station can be made by telephone. The Medical and Nursing Staff consist, at present, of Medical Superintendent (non-resident), Matron (nursing), three Staff Nurses, and two Probationers; and the Domestic Staff of Cook, Wardmaid, Laundrymaid, Housemaid, General, and Entrance Lodge Porter and his wife. When all the wards are fully occupied a larger staff of nurses is required. 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, 46 The Porter's Wife assists, when required, in the Laundry, etc. Relatives and friends are allowed to visit patients on Sunday afternoons between two and 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. An agreement has been entered into with the Friern Barnet Urban District Council, whereby from March 25th, 1920, twelve beds are reserved for the exclusive use of Friern Barnet patients, in consideration of. an annual payment by the Friern Barnet Council of £720, and in addition Is. 6d. a day for each patient in respect of the patient's maintenance. Patients from outside Districts, other than Friern Barnet, with whom there is a special agreement, 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 average cost per patient per day during the past year was 16s. 6d. as against 16s. 2d. during the previous year. During the year 190 cases were admitted ; of these 136 were notified as Scarlet Fever, 52 as Diphtheria, one as Encephalitis Lethargica, and one as Mumps. In 4 cases sent in as suffering from Diphtheria, the diagnosis was not confirmed by subsequent bacteriological examinations, and they were discharged after 7, 25, 5, and 7 days respectively. Fifty-two of the cases were sent in by Friern Barnet and 5 by Wood Green. There were 3 deaths, one from Scarlet Fever 3 days after admission, and 2 from Diphtheria, 4 and 2 days after admission respectively. It should be noted that these cases of Diphtheria were not seen by a doctor until the third and fourth day of the disease respectively. They proved to be severe cases, and consequently, though they received large doses of antitoxin immediately on arrival at the Hospital, it was too late to be of any service, as the poison of the disease had got too long a start. 47 It cannot be too widely known by, or impressed upon the public that the efficacy of antitoxin is in direct proportion to the earliness in the course of the disease in which it is administered, so that when injected on the first day" of the disease the mortality is less than 1 per cent, whereas, if delayed till the 3rd or 4th day, the mortality leaps up to 20 to 25 per cent. If this was more widely known and realised, surely no one would hesitate in any case of throat affection to seek medical advice at once. Then, if there was the least suspicion of Diphtheria, the doctor should at once give an adequate dose of antitoxin, and then confirm or otherwise the suspicion or diagnosis by taking a swab of the throat and submitting it for bacteriological examination. If the case should not prove to be one of Diphtheria, the antitoxin is quite harmless. Antitoxin and diagnosis outfits are always kept at the Council Offices, and supplied to all medical practitioners in the District free of charge. The expense of bacteriological examination is also borne by the Council. The average times of detention in Hospital, excluding those who died within a day or two of admission, and those the diagnosis of which was not confirmed, were:—For Scarlet Fever 47 days, and for Diphtheria 49 days. Number of Patients in Isolation Hospital during each Month, 1920. Greatest number. Lowest number. Average number. Jan. 42 28 33 Feb 43 36 32 Mar 34 23 27 April 25 19 22 May 23 19 20 June 19 10 15 July 24 9 15 Aug 27 14 21 Sept 16 7 11 Oct 36 14 26 Nov 48 31 40 Dec 36 20 25 Average for year 31 19 24 48 The greatest number of Friern Barnet patients in the Hospital at one time was 14. The daily average for the year was 7. MISCELLANEOUS. $ Return of the Metropolitan Asylums Board.— During the past year 4,773 cases were admitted into this Board's Hospital at. Winchmore Hill; of these, 2,747 were Scarlet Fever, 1,185 Diphtheria, 839 Phthisis, and 2 other diseases. There were 40 deaths—1 from diphtheria and 39 from Phthisis. Local and Adoptive Acts.—The Council have adopted the Public Health (Amendment) Acts, 1890 and 1907, Baths and Washhouses Act, 1912, Museums and Gymnasiums Act, 1891. The Council further possess Special Powers under a Private Act passed in 1913. Poor Law.—The number of persons, adult and children, in receipt of outdoor relief during the year averaged 54 per week, at a cost of £758 11s. 7d. OTHER SERVICES. The Council make an annual contribution of £200 to Passmore Edwards Hospital, Wood Green, into which a number of residents in the Southgate District are admitted, in recognition of which they have four representatives on the Hospital Council. HOUSING. Ceneral Housing Conditions in the District There are 9,526 occupied houses in the District. The major portion of these are of the villa type. There are no purely workingclass areas. There are a few isolated cases of congestion, but there is no overcrowding. Of 92 houses to be erected at Highfielcl Road, under an Assisted Housing Scheme, each with ample garden ground attached, 39 are completed and occupied. These houses are of differing types, ranging from the " workman's dwelling " to the " small villa." The rentals vary 49 from 22s. upwards, inclusive of rates. On a site at Southgate, on what is known as Nursery Road Extension, it is proposed to build a further 140 houses of a similar class to those at Winchmore Hill, on sites 10 to the acre. These two schemes will only touch the fringe of this difficult problem of housing, and there will remain pressing need for further accommodation, both of the villa type and of houses to let at moderate figures. The Council has been inundated with applications for houses, but, despite every effort they may make, much must be left to private enterprise. The Housing (Inspection of District) Regulations, under Sec. 17, came into operation in 1910. Under the Act local authorities are required to carry out the systematic inspection of dwellinghouses throughout their Districts, to take all necessary action, and to keep detailed records. During the past year inspections have been carried out in each Ward of the District, and a summary of the results attained is appended. Special care and attention has been devoted to the working of this Act, and following the inspection of any particular property the owner or owners have been invited to meet the Inspectors, and a number of interviews have, taken place. The powers and obligations contained in the Act have been explained generally, and all due consideration has been given to individual circumstances. This attitude hits in several instances decided the owners to carry out the various specified requirements, and the serving of Closing Orders has been rendered unnecessary. Tn a neighbourhood such as Southgate, where the development of villa property is assured, very few cottages suitable for the working classes are likely to be erected by private enterprise. The Council had prior to 1914 erected 82 cottages under the Housing Acts, which are now let at extremely moderate rents. RENT RESTRICTION ACT. Under the provisions of this Act, the tenant of a house may, on payment of the fee of one shilling, obtain from the Sanitary Authority an inspection and report upon the condition of his house, in cases where the landlord has given the tenant notice of 50 intention to increase the rent. This adds yet another responsibility to the Public Health Department and its officers. During the six months of last year in which the Act was in force, a total of twenty inspections under its provisions were made, and certificates as to the condition of the various premises—in each case favourable to the tenant—were issued. HOUSING CONDITIONS. 1 .—General. (1) Estimated Population 40,550 (2) General Death-rate 8.7 (3) Death-rate from Tuberculosis 6.4 (4) Infantile Mortality 36 0 (5) Number of Dwelling houses of all classes 9526 (6) Number of Working-class Dwelling-houses 1500 (7) Number of New Working-class Houses erected 30 2.— Unfit Dwelling-houses. I.— Inspection. (1) Total Number of Dwelling-houses Inspected for Housing Defects (under Public Health or Housing Acts) 506 (2) Number of Dwelling-houses which were Inspected and recorded under the Housing (Inspection of District) Regulations, 1910 319 (3) Number of Dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (4) Number of Dwelling-houses (exclusive of those referred to under the preceding subheading) found not to be in all respects reasonably fit for human habitation 338 II.—Remedy of Defects without service of formal notices. (1) Number of defective Dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 305 (2) Number of Dwelling-houses closed voluntarily 1 51 III.—Action under Statutory Powers. A. Proceedings under Section 28 of the ing, Town Planning, &c., Act, 1919. (1) Number of Dwelling-houses in respect of which notices were served requiring repairs Nil. (2) Number of Dwelling-houses which were dered fit — (a) By Owners Nil. (b) By Local Authority in default of Owners Nil. (3) Number of Dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to-close Nil. B. Proceedings under Public Health Act. (1) Number of Dwelling-houses in respect of which notices were served requiring defects to be remedied 33 (2) Number of Dwelling-houses in which defects were remedied— (a) By Owners 33 (b) By Local Authority in default of Owners Nil. C. Proceedings under Sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders Nil. (2) Number of Dwelling-houses in respect of which Closing Orders were made Nil. (3) Number of Dwelling-houses in respect of which Closing Orders were determined, the Dwelling-houses having been rendered fit Nil. (4) Number of Dwelling-houses in respect of which Demolition Orders were made Nil. (5) Number of Dwelling-houses Demolished in pursuance of Demolition Orders Nil. 52 3.—Unhealthy Areas. Areas represented to the Local Authority with a view to Improvement Schemes under (a) Part I. or (b) Part II. of the Act of 1890, (1) Name of area (2) Acreage Nil (3) Number of Working-class houses in area (4) Number of Working-class persons to be displaced Number of houses not complying with the building byelaws erected with consent of Local Authority under section 25 of the Housing, Town Planning, &c., Act, 1919:—Nil. Fitness of Houses.—The general standard of houses is good. The defects found as the result of inspections under the Housing Acts have been for the most part dampness (due in some measure to the nature of the subsoil of the larger part of the District), leaky roofs, defective yard paving, defective floors and want of cleansing. Serious dilapidation is infrequently met with. A total of 8,755 visits and re-visits was paid by the Inspectors during the year. These included 319 houses inspected under Housing and Town Planning Act (House to House), 187 in connection with cases of infectious disease, and 106 in consequence of complaints received. Altogether 415 preliminary notices and 33 statutory notices were served. Legal proceedings were not necessitated in any case. In each of the 33 instances the work required was carried out.