SOUA 016 Southgate Urban District Council. REPORT OF THE Medical Officer of Health, FOR THE YEAR 1921, 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, TOGETHER WITH THE AN NUAL REPORT OF THE CHIEF SANITARY INSPECTOR. 1922. printed at the "barnet press" office. To the Chairman and Members of the Southgate Urban District Council. Mb. Chairman, Mrs. Fairfield, and Gentlemen, I have the honour to present to you my Report for the year 1921. The Minister of Health will not require in future Reports of a full and detailed character, designated "Survey Reports," more than once in every five years. The Report for 1920 will be treated as constituting the first of the series of "Survey Reports." The Report for 1921 will, therefore, be what is designated an Ordinary Report,' omitting details as to conditions which do not vary from year to year, and curtailing the information asked for in " Survey " year. 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. I should also like to tender my thanks to the Public Health, and Maternity Committees, for their courtesy and support throughout the year. I am, Mrs. Fairfield and Gentlemen, Your obedient Servant, A. SIDNEY RANSOME. 1922. 3 POPULATION. The Census taken List year showed that the population in June was 39,120, as against the Registrar-General's estimate of 40,550 for the previous year. The number of inhabited houses in July last was 9,642, which gives an average of between 4.1 and 4.2 persons per house. To be on the conservative side, I have based the statistics for iast year on a population of 39,000. The natural increase of the population by excess of births over deaths was 290, as against 344 in the previous year. BIRTHS- BIRTH-RATE. The nett total of births accredited to this District is 603, a decrease of 96 on the preceding year; of these 296 were males and 307 females (10 males and 9 females being illegitimate). The birth-rate was, therefore, 15.4 per 1,000 of the population, as against 17 in 1920 and 1.13 in 1919. The birth-rate for England and Wales was 22 4. MORTALITY. General Mortality and Death-rate.—The nett number of deaths accredited to this District was 307. This gives a death-rate of 7.8 per 1,000 of the population, a decrease of 0 9 on the rate of the previous year. The average rate for the previous ten years was 8.7. The death-rate for England and Wales was 121. Infantile Mortality.—There were 22 deaths of infants under 1 year of age (3 of them illegitimate), which gives an infantile death-rate of 36.4 per 1,000 births registered, as against 35.7 in the preceding year, 52.1 in 1919, and 26.8 in 1918. The average rate for the 10 years 1912-1921 was 46.4. 4 In Table II 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 50 per cent. of the deaths were of newly-born infants in the first week of life, and were due chiefly to premature birth, congenital defects, debility, and wasting. It should also be noted in this connection that there were 15 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. This is, however, no reason why our efforts 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 the ante-natal care of prospective mothers should receive more attention generally than has hitherto usually obtained. The establishment of a separate ante-natal clinic in connection with the maternity and child welfare centres as soon as financially practicable would be of great value. Senile Mortality.—Among persons of 70 years of age and over, 84 deaths occurred, and, of these, 31 were 80 years of age and over. This is a proportion of 27 per cent. of the total number of deaths at all ages. 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 9 deaths from these diseases, as follows Diphtheria, 4; Whooping Cough, 1; and diarrhoea. 4. The Zymotic death-rate was therefore 0.23 per 1,000 of the population, as against 0.12 in the preceding year, 0.12 in 1919 and 0.19 in 1918. The average rate for the previous 10 years was 0-33. 5 Table 1. Causes of Death during the Year 1921. Causes of Death. Male. Female. Total. All Causes (Civilians only) 163 144 307 1 Enteric Fever .. .. .. 2 Small-pox .. .. .. 3 Measles .. .. .. 4 Scarlet Fever .. .. .. 5 Whooping Cough 1 .. 1 6 Diphtheria 4 .. 4 7 Influenza 5 2 7 8 Encephalitis Lethargica .. 1 1 9 Meningococcal Meningitis .. 1 1 10 Tuberculosis of Respiratory System 16 12 28 11 Other Tubercular Diseases 1 3 4 12 Cancer, Malignant Disease 22 24 46 13 Rheumatic Fever 1 .. 1 14 Diabetes 3 1 4 15 Cerebral Hæmorrhage, etc. 7 11 18 16 Heart Disease 16 23 39 17 Arterio-Sclerosis 13 6 19 18 Bronchitis 2 3 5 19 Pneumonia (all forms) 13 9 22 20 Other Respiratory Diseases 3 1 4 21 Ulcer of Stomach or Duodenum .. 1 1 22 Diarrhoea, etc. (under 2 years) 3 1 4 23 Appendicitis and Typhlitis 1 2 3 24 Cirrhosis of Liver . . . . . . 25 Acute and Chronic Nephritis 6 5 11 20 Puerperal Sepsis . . 3 3 27 Other Accidents and Diseases of Pregnancy and Parturition . . 2 2 28 Congenital Debility, Malformation, and Premature Birth 8 4 12 29 Suicide 1 1 30 Other Deaths from Violence 5 2 7 31 Other defined Diseases 32 27 59 32 Causes ill-defined or unknown . . . . . . Totals 163 144 307 6 Table II Infantile Mortality. 1921. Nett Deaths from stated causes at various Ages under 1 Year of Age. CAUSES OF DEATH. Under .1 Week. 1—2 Weeks. 2—3 Weeks. 3—4 Weeks. Total under ??? Month. 1—3 Months. 3—6 Months. 1 6—9 Months. 9—12 Months. Total Deaths under One Year. All Causes 11 ... 1 1 13 4 2 2 1 22 Small-pox Chicken-pox Measles Scarlet Fever Whooping Cough ... ... ... ... ... 1 ... ... ... 1 Diphtheria and Croup Erysipelas Tuberculous Meningitis Abdominal Tuberculosis Other Tuberculous Diseases Meningitis (not Tuherculous) Convulsions Laryngitis Bronchitis Pneumonia ... ... ... 1 1 ... ... 1 ... 2 Diarrhœa ... ... ... ... ... 1 1 ... ... 2 Enteritis ... ... ... ... ... ... 1 ... ... 1 Gastritis Syphilis Rickets Suffocation 1 ... ... ... 1 ... ... ... ... 1 Want of attention at Birth Atelectasis Congenital Malformations 2 ... ... ... 2 ... ... 1 ... 3 Premature Birth 6 ... ... ... 6 ... ... ... ... 6 Atrophy, Debility and Marasmus 1 ... ... ... 1 2 ... ... ... 3 Other Causes 1 ... 1 ... 2 ... ... ... 1 3 Totals 11 ... 1 1 13 4 2 2 1 22 7 1 GENERAL STATISTICS. Area (acrcs) 3,597 Population (1921) 39,120 Number of inhabited houses (1921) 9,642 Average number of persons per house (1921; 4.1 Rateable value £310,160 Sum represented by a penny rate £1,225 II. EXTRACTS FROM VITAL STATISTICS OF THE YEAR Total. Male. Female. Births Legitimate 584 286 2981 Birth Rate (R.G.), 15 4 Illegitimate 19 10 9 Totals 603 296 307 Death Rate(R.G.). Deaths— 7'8 Number of women dying in, or in consequence of, childbirth— From Sepsis 3 „ Other causes 2 Deaths of Infants under 1 year of age per 1,000 births — Legitimate, 19 ; Illegitimate, 3; Total, 22. Deaths from Measles (all ages) 0 „ ,, Whooping Cough (all ages) 1 ,, ,, Diarrhoea (under 2 years of age) 4 8 Table III. Vital Statistics of Whole District during 1921 and Five Previous Years. Year. Population estimated at Middle of each Year. Nett Births belonging to District. Nett Deaths belonging to the District. At all Ages. Under 1 Year of Age. Number. Rate per 1,000 Population. N umber. Rate per 1,000 Population. Number. Rate per 1,000 Nett Births. 1 2 3 4 5 6 7 8 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 1921 39,000 603 15.4 307 7.8 22 36.4 9 Table IV. Comparison of the Rates of the Southgate District with those of England and Wales and London, for the Year 1921. Birth rate per 1,000 Population. Death rates per 1,000 Population. Death-rate under 1 year per l,000 births. All Causes. Enteric Fever. Scarlet Fever. Diphtheria. Measles. Whooping Cough. England & Wales 22.4 12.1 0.02 0.03 0.12 0.06 0.12 83 London 22.3 12.4 0.01 0.06 0.25 0.05 0.12 80 Southgate 15.4 7.8 0.00 0.00 0.10 0.00 0.02 36.4 10 III. INFECTIOUS DISEASES. It will bo seen from Table V. that 357 cases of infectious diseases were notified during the year, as compared with 286 in the preceding year. These 357 casus represent infection in 314 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 77 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 260 premises, and the remedying of insanitary conditions in 77. Two hundred and three cases were removed to the Isolation Hospital at Palmers Green. Of these 173 were Scarlet Fever, 29 Diphtheria, and 1 Enteric Fever. There were also 2 cases of Scarlet Fever and 1 of Diphtheria admitted as patients from amongst the staff of the Hospital, making the total number of patients 206. The Infectious Sickness Rate of the District was 90 per 1,000 of the population, as against 7.0 in the preceding year. 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 8 in the month of January, and the maximum 32 in the month of May. The type of the disease was, generally speaking, mild, a few cases being of a more severe type. There were 224 cases notified, as against 135 in the preceding year, 126 in 1919, and 38 in 1918. 11 Five cases were "imported," 31 were "secondary" cases occurring in houses from which previous cases had been notified, and 4 were "return" cases from houses to which previous cases had returned directly or indirectly after discharge from the Isolation Hospital. One hundred and seventy-three 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 August and December. In all 50 cases were notified, against 50 in the preceding year, 19 in 1919, and 39 in 1918. There were 3 cases "imported" from other Districts, and 7 " secondary " cases. Twenty-nine eases were removed to the Isolation Hospital. A few of the cases were of a severe type, and there were 4 deaths, 3 of which occurred in the Isolation Hospital. Typhoid Fever.—One case was notified, as against 2 in the preceding year, 1 in 1919, and 1 in 1918. Tuberculosis.—The number of cases of Phthisis notified under the Public Health (Tuberculosis) Regulations, 1912, was 35. The cases of other forms of Tuberculosis notified numbered 4. The figures for 1920 were—Phthisis, 38; other forms, 11. There were 32 deaths, 10 of which had not been previously notified—a ratio of 31 per cent. With regard to the efficiency of notification of Tuberculosis in the District:— (1) Sometimes, though not often, the first intimation of the occurrence of a case of Tuberculosis is received through the notification of the patient's admission into a sanatorium. 12 (2) It appears that sometimes practitioners refrain from notifying certain cases with the object of safeguarding their patients from possible annoyance from official visits, or from a knowledge as to the actual cruise of illness. ISOLATION HOSPITAL. During the year 286 cases were admitted—203 from Southgate, 67 from Friern Barnet, and 13 from Wood Green, and 3 from amongst the staff. Of these, 228 were notified as scarlet fever, 53 as diphtheria, 4 as typhoid fever, and 1 as encephalitis lethargica. In 3 cases sent in as diphtheria the diagnosis was not confirmed by subsequent bacteriological examinations. During July an outbreak of chicken-pox occurred in one of the scarlet fever wards, necessitating the placing of this ward in quarantine for several weeks. There were 8 deaths—2 from scarlet fever, 1 belonging to Friern Barnet, and 1 to Wood Green; and 6 from diphtheria, 2 belonging to Friern Barnet, and 1 to Wood Green. Two of the cases from Southgate were moribund on admission, and died in 2½ and 4 hours respectively. Number of Patients in Isolation Hospital during each Month of 1921. Greatest number. Lowest number Average number. Jan 20 14 17 Feb 26 18 20 Mar 34 23 30 April 29 16 21 May 53 21 42 June 54 25 42 July 85 23 30 Aug 35 26 32 Sept 43 27 34 Oct 44 36 41 Nov 44 34 39 Dec 39 29 33 Table V. Notified cases of Infectious Diseases, 1921. Disease. At all Ages. Under lyr. 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and over. Cases removed to Hospital. Total Deaths. Diphtheria 50 .. 2 1 1 3 12 17 5 5 4 .. .. 29 4 Scarlet Fever 224 .. 2 4 9 7 117 50 20 8 2 5 .. 173 .. Enteric Fever 1 .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. Puerperal Fever 3 .. .. .. .. .. .. .. .. 2 .. 1 .. .. 3 Erysipelas 13 .. .. .. .. .. .. 1 .. 3 4 4 1 .. .. Ophthalmia Neonatorum 3 3 .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 2 .. .. .. .. .. 1 .. 1 .. .. .. .. .. 1 Acute Poliomyelitis 2 .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. Cerebro-spinal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 20 1 4 3 2 2 5 3 22 Tuberculosis:— 39 Pulmonary M 22 .. .. .. .. .. .. 1 11 5 4 1 J16 F 13 .. .. .. .. .. 1 1 1 6 1 3 .. 12 Total 35 .. .. .. .. .. 1 1 2 17 6 7 1 28 Non-Pulmonary M .. .. .. .. .. .. .. .. .. .. .. .. .. 1 F 4 .. .. .. .. .. 2 1 .. .. 1 .. .. 3 Total 4 .. .. .. .. .. 2 1 .. .. 1 .. .. 4 Totals 357 3 6 5 11 10 137 70 32 37 19 22 5 203 62 Table Va. Ophthalmia Neonatorum Cases. Vision Unimpaired. Vision Impaired. Total Blindness Deaths. Notified. Treated. At Home. In Hospital. 3 1 2 3 .. .. .. Table Vb. Casus of Infectious Disease Notified each Month of the Year 1921. 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 8 1 .. .. 6 .. 1 .. 2 .. .. 2 1 21 February 11 10 .. 2 .. .. 1 .. 4 .. .. 1 .. 29 March 12 6 .. .. 1 1 .. .. 3 .. .. 3 1 27 April 15 7 1 .. 2 .. .. .. .. .. .. 1 .. 26 May 32 3 .. .. 1 .. .. .. 3 .. .. 4 .. 43 June 10 3 .. 1 .. .. .. .. .. .. 2 5 .. 21 July 22 4 .. .. .. 1 .. .. .. .. .. 5 .. 32 August 19 .. .. .. .. .. .. .. 2 .. .. 1 .. 22 September 21 3 .. .. .. .. .. .. .. .. 1 5 .. 30 October 27 6 .. .. 1 .. .. 1 .. .. 2 1 38 November 24 5 .. .. .. .. .. .. 2 .. .. 3 1 35 December 23 2 .. .. 2 .. .. .. 3 .. .. 3 .. 33 Totals 224 50 1 3 13 2 2 20 .. 3 35 4 357 16 IV. CAUSES OF SICKNESS. Apart from the prevalence of scarlet fever throughout the year in all partis of the district, there was no prevailing cause of sickness. V. SUMMARY OF NURSING ARRANGEMENTS, HOSPITALS, AND OTHER INSTITUTIONS AVAILABLE FOR THE DISTRICT. Professional Nursing in the Home.— (a) A District Nurse is provided in Old Southgate by a local Committee, " The Southgate Village Nurse Fund Committee," supported entirely by voluntary subscriptions, and is not in any way connected with the Local Authority except that in her spare time she serves on the Maternity and Child Welfare Committee, and acts as a voluntary helper at the Southgate Centre. (b) No Nurse is provided for infectious diseases, measles, etc., in the home. Midwives.—These come under the supervision of the County Authority. There are 7 midwives practising in the district, though some evidently do very little. For a time, until October last, the Local Authority employed a midwife in Old Southgate to take the place of the deceased midwife practising privately in that neighbourhood, when the work was taken up privately again. Welfare Centres and Clinics. 1. Maternity and Child Welfare Centres (consultations only) :— 1. Southgate: Village Hall, High Street; small hall and consulting room. Alternate Mondays, 2-4 p.m. 2. New Southgate : Baptist Hall, Grove Road ; large hall and consulting room. Wednesdays, 2-4 p.m. 3. Winchmore Hill: Wesleyan Hall, Green Lanes; large hall and consulting room. Thursdays, 2-4 p.m. 17 4. Bowes Park : St. Michael's Church Parish Hall; large hall and consulting room. Tuesdays, 2-4 p.m. These are provided by the Local Authority, and supported by voluntary helpers. Statistics. 1921. 1920. Number of Centres 4 4 Number of Sessions 158 172 New cases registered 406 434 Total attendance, Children 6,852 6,813 Total attendance, Ante-natal 272 233 Average attendance per session 42 38 N.B.—The number of new cases during 1921 consisted of 245 under 1 year, and 161 over 1 year of age. The number of new cases under 1 year of age, therefore, represents 40.6 per cent. of the total births. II. School Clinics. (a) For minor ailments: Winchmore Hill; Holly Park (outside the district, but at which Southgate children receive treatment). (b) Ophthalmic Clinic: Garfield Road School, New Southgate; held weekly. (c) Dental Clinic: Holly Park School. These are provided by the Middlesex County Council. Public Elementary Schools. SOUTHGATE. 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 carried out by an Assistant Medical Officer. Arrangements for these visits are made beforehand, and the parents are summoned to them. 18 Total number of Children inspected at the Schools:— Boys. Girls. Total 5-years-old group 167 141 308 8-years-old group 248 206 454 12-years-old group 186 142 328 13-years-old group 19 20 39 14-years-old group 1 1 2 Specials 50 31 81 671 541 1212 Southgate Children Inspected at Winchmore Minor Ailment Treatment Centre 370 358 728 Southgate Children Inspected at Holly Park Minor Ailment Treatment Centres 74 81 155 444 439 883 Southgate Children Inspected at Schools and Minor Ailment Treatment Centres. Total, 2095 In connection with the work of the School Medical Inspection, Centres for treatment have been open as follows :— (I). Fob 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, 1921, was 578. The number of Southgate Children treated at Holly Park Centre from January to December, 1921, was 169. Total 747. 19 (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 12 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 Schools. 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. III. Tuberculosis Dispensary, provided by the Middlesex County Council:— Alexandra Road, Hornsey; Chester Villa, High Road, Finchlcy. IV. Venereal Disease Clinic (Middlesex County Council) :— Prince of Wales'' Hospital, Tottenham. Hospitals provided or subsidised by the Local Authority or by the County Council:— (1.) Tuberculosis.—No Hospital provided by the Local Authority. All cases requiring hospital or sanatorium treatment are dealt with by the Middlesex County Concil. (2.) Maternity.—An arrangement is in force with the Edmonton Board of Guardians for the reception of Maternity cases at the Maternity Home at Edmonton. The charge is £2 2s. per week. In necessitous cases the Local Authority remits part or whole of the charge according to circumstances. Sixteen mothers availed themselves of the Home during the year. 20 (3.) Children.—By reason of the Council's affiliation with the National League for Health, etc., children from this district are admitted to the various homes supported and organised by the League at a charge of 15s. per week. In cases of distress this charge is remitted, wholly or in part, by the Council, according to circumstances. (4.) Fever.—The Isolation Hospital provided by the Local Authority is situated in Tottenhall Road, Palmers Green. The total available beds are officially 30, but practically 48. There are two blocks for scarlet fever and one isolation block for diphtheria and typhoid fever. An agreement is in force with the Friern Barnet Urban District Council whereby 12 beds are reserved for the exclusive use of Friern Barnet patients. (5.) Small-pox.—Southgate, being one of the constituent Local Authorities in the district of the Middlesex Joint Hospital Board, has the right to send cases to the Clare Hall Hospital, South Mimms. (6.) Other Hospitals.—(a) The Passmore Edwards Hospital, Wood Green, for general medical and surgical cases, contains 30 beds, serves this district, and receives an annual grant of .£200 from the Southgate District Council. (b) The Royal Northern Hospital, the Prince of Wales' Hospital, Tottenham, and the North Middlesex Hospital, Edmonton, also receive patients from this district. All these hospitals are outside the district. (7.) Institutional provision for unmarried mothers, illegitimate infants, and homeless children.—Nil. (8.) Ambulance facilities.—(a) For infectious cases a horse-drawn ambulance is provided for conveyance of infectious cases to the Isolation Hospital, (b) For non-infectious and accident cases a motor ambulance, which was presented to the Council by the Middlesex Voluntary Aid Organisation, is available at all times on application by telephone or otherwise to the Fire Station. 21 VI. LABORATORY WORK. Pathological and bacteriological examinations are carried out by the laboratory at St. George's Hospital, by arrangement with the District Council. During the year, 457 specimens were sent and reports received as follows:— Disease Suspected. Positive. Negative. Total. Diphtheria 71 260 331 Typhoid Fever 4 9 13 Phthisis 21 89 110 Cerebro-spinal Meningitis ... 2 2 Gonorrhoea ... 1 1 Total 96 361 457 Diphtheria Antitoxin is always kept in stock at the Public Health Department at the Town Hall and issued to all medical practitioners on application at anv time. Influenza vaccine for prophylactic use is also available. Via. ADOPTIVE ACTS, BYE-LAWS, AND LOCAL REGULATIONS RELATIVE TO PUBLIC HEALTH IN FORCE IN THE DISTRICT. Local or Adoptive Acts. The Infectious Diseases (Prevention) Act, 1890. The Southgate Urban District Council Act, 1913. Public Health Acts (Amendment) Act, 1890, parts 2, 3, and 5. 22 Public Health Acts (Amendment) Act, 1907 (whole ot Act with the exception of Sections 82, 83, and 94). Baths and Wash-houses Acts, 1846-1899. Bye-laws and Regulations. Public Health Act 1875, with respect to (a) The cleansing of footways and pavements; (b) the removal of house refuse; (c) the cleansing of earth closets, privies, ash pits, and cesspools. Public Health Act, 1875, for the prevention of nuisances arising from snow, filth, dust, ashes, and rubbish. Public Health Act, 1875, with respect to common lodging houses. Public Health Act, 1875, with respect to slaughterhouses. Public Health Act, 1875, with respect to new streets and buildings. Public Health Act, 1875, with respect to houses let in lodgings or occupied bv members of more than one family. Public Health Act, 1875, with respect to the paving of vards and open spaces. Contagious Diseases (Animals) Act, 1866 and 1885; the Dairies, Cowsheds, and Milkshops Order, 1885. Public Health Acts (Amendment) Act, 1890, with respect to alteration of buildings. VIII. SANITARY ADMINISTRATION. Inspections. Action taken. (Other than under H. and T.P. Act ) Houses Let in Lodgings (Tenement Houses). Common Lodging Houses. Canal Boats used as Dwellings. Movable Dwellings, Caravans, Tents, &c. Number of Premises Inspected on Complaint. Number of Premises Inspected in connection with Infectious Discuses. 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 Notices Given. Statutory Orders Issued. Summonses Served. Convictions Obtained. Houses, Premises, etc. cleansed. Number Registered under Byelaws Number of Contraventions. Number Registered under Byelaws. Number of Inspections made. Number of Contraventions. Number Registered under the Act. Number of Contraventions of Regulations. Number Observed during the Year. Number of Nuisances therefrom abated. Number Removed from District. (1) (2) (3) (4) (8) 113 324 206 296 7737 381 50 Nil. Nil. 256 Nil. Nil. Nil. Nil. Nil Nil. Nil. 7 7 7 * N.B.—(3) Includes all classes of premises under periodical supervision, such as Cowsheds, Dairies, Slaughterhouses, Workshops, Workplaces, &c. (5) Includes all visits and re-visits made by Sanitary Inspectors in connection with I—4. Bakehouses. Slaughterhouses. Cow-sheds. Dairies and Milk-shops. Unsound Food. Offensive Trades. 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. 16 6 7 262 When Slaughtering expected. 6 8 40 — 9 About 200 24 45 — 5 1390 lbs. Nil. 127 lbs. 24 lbs. Nil. Destructor. Nil. Nil. Nil. Water Supply and Water Service. Drainage and Sewerage of existing Buildings. Wells. Percentage of Houses supplied from Public Water Service. Cisterns. Draw-Taps placed on Mains. Percentage of Houses supplied on Constant System. Number of Samples obtained for analysis. Water Closets. Percentage of Houses provided with Water Closets. Drains. Cesspools. Percentage of Houses Draining into Sewers. New Sunk. Cleansed, Repaired, Ac. Closed as Polluted. New Provided. Cleansed, Repaired, Covered, &c. Number of Water Closets substituted for Dry Receptacles. Repaired, Supplied with Water, or otherwise Improved. Examined, Tested, Exposed, Ac. Unstopped, Repaired, Trapped, Ac. Waste Pipes, Rain Water Pipes Disconnected, Repaired, &c. 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. From Local Wells. From Public Supply. Nil. Nil. Nil. Practically all. Nil. 17 5 Practically all. Nil. Nil. Nil. 81 Practically all. 678 66 186 12 10 47 21 2 Nil. Practically all. 26 Disinfection. Dust. Sundry Nuisances Abated. Rooms Disinfected. Rooms Stripped and Cleansed. Articles Disinfected or Destroy'd New 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. Phthisis 625 77 178 1207 212 61 Weekly. 29 Destructor. Nil. 1 7 4 9 158 99 198 27 PREMISES UNDER PERIODICAL INSPECTION. The following premises are under periodical inspection. With the exception of a few minor breaches of the Regulations (which were at once remedied on the attention of the occupiers being drawn to them), they have been satisfactorily carried on. Description of Premises. No. in District. Dairies, Cowsheds, and Milkshops 32 Bakehouses 16 Dining Rooms 13 Slaughter-houses 7 Fried Fish Shops 5 Workshops and Workplaces 114 Public-house Conveniences 19 Total 206 Slaughterhouses. In 1914. In Jan., 1921. In Dec., 1921. Registered Nil. Nil. Nil. Licensed 8 7 7 12 cwts. 1 qr. 18 lbs. of meat were surrendered and destroyed. 1 cwt. 15 lbs. of fish were voluntarily surrendered. 24 lbs. of fruit and vegetables were voluntarily surrendered. The fish and fruit shops are kept well under observation. The duties under the Food and Drugs Acts are administered by the Middlesex County Council. One of the Slaughter-houses at Southgate is an old building. This has now become insufficient for present-day needs. Plans have been prepared for a new building designed in accordance with modern ideas, and they are to be placed before the Council early in the New Year. The structure will have walls of brick, the slaughter-chamber will be lined with glazed bricks, and there will be proper 28 vision for adequate drainage and ventilation. Suitable accommodation for cooling the meat and new lairage for the cattle and sheep will be provided. This new building will be erected as soon as the plans have been approved. Of the remaining six slaughterhouses two are situated at Southgate, two at Winchmore Hill, one at New Southgate, and one at Bowes Park. DISINFECTION AND DISINFESTATION. The Council have at the Isolation Hospital site a Thresh's steam disinfector, which is used for the disinfection of articles of clothing, bedding, etc., consequent upon cases of infectious disease. The Council were given powers by their private Act to enforce the occupiers of infested premises to cleanse and disinfest them. A supply of sulphur candles is at all times available to applicants at the Public Health Department, but requests for assistance in this respect are very few. Sale of Foods and Drug's Acts. The duties under the Food and Drugs Acts are administered by the Middlesex County Council. The following are particulars of samples taken in the District during last year:— Article. Samples Taken. Found Adulterated. Milk 41 3 Separated Milk 3 — Cream 9 4 Preserved Cream 5 2 Butter 7 1 Lemonade Powder 3 — Sugar 1 — Total 69 10 Prosecutions 2 Convictions 2 29 RENT RESTRICTION ACT. Under the provisions of litis 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 intention to increase the rent. This adds yet another responsibility to the Public Health Department and its officers. During the year a total of fifty inspections under its provisions were made. In 49 instances the premises were found to be "not in a reasonable state of repair," and certificates to this effect were granted. In the remaining case the premises were in "a reasonable state of repair," and a certificate was refused. VIII. PUBLIC HEALTH STAFF. (Part time) Medical Officer of Health, B.A., M.B., B.C., D.P.H.Camb. * (Whole ,, ) Senior Sanitary Inspector, A.R.S.I. ( ,, ,, ) First Assistant Inspector, Cert. R.S.I. ( ,, ,, ) Second Assistant Inspector, Cert. R.S.I. ( „ ,, ) Clerk. ( ,, ,, ) Disinfector. *( ,, ,, ) Health Visitor, C.M.B. *(Part ,, ) Medical Officer, for Maternity Centres, M.B., etc. *( ,, ,, ) Clerk for Maternity Centres. ( ,, ,, ) Veterinary Inspector, for the inspection of milch cows. *These Officers' salaries are repaid to the Council, in part, by the Ministry or the County Council. IX. HOUSING. Number of New Houses erected during the year:— (a). Total 209 (b). As part of a Municipal Housing Scheme 64 30 1.—Unfit Dwelling-houses. Inspection. (1) Total Number of Dwelling-houses Inspected for Housing Defects (under Public Health or Housing Acts) 670 (2) Number of Dwelling-houses which were Inspected and recorded under the Housing (Inspection of District) Regulations, 1910 296 (3) Number of Dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 8 (4) Number of Dwelling-houses (exclusive of those referred to under the preceding subheading) found not to be in all respects reasonably lit for human habitation 363 II.—Remedy of Defects without service of formal notices. Number of defective Dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 313 III.—Action under Statutory Powers. A. Proceedings under Section 28 of the Housing, Town Planning, &c., Act, 1919. (1) Number of Dwelling-houses in respect of which notices were served requiring repairs 18 (2) Number of Dwelling-houses which were rendered fit — (a) By Owners 18 (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. 31 B. Proceedings under Public Health Acts. (1) Number of Dwelling-houses in respect of which notices were served requiring defects to be remedied 50 (2) Number of Dwelling-houses in which defects were remedied— (a) By Owners 50 (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. (6) Number of Dwelling-houses Closed Voluntarily 7 (7) Number of Dwelling-houses Demolished Voluntarily 6 W. C. KILBY, A.R.S.I., M.S.I.A., Sanitary Inspector.