WOOD 012 Urban District Council of Wood Green. Annual Report of the Medical Officer of Health, FOR THE YEAR 1913, by T. SLATER JONES, M.D., M.R.C.S., L.R.C.P. together with the ANNUAL REPORT of the . INSPECTOR OF NUISANCES by A. E. ADAMS, Assoc. R. San. Inst, WOOD GREEN, N.: Crusha & Son, Printers, 210, High Road. Urban District Council of Wood Green. HEALTH AND SANITARY COMMITTEE, 1913. Councillor C. W. PAYNE (Chairman). The Chairman of the Council. The Vice-Chairman. Councillor Ardley. Councillor Gilbert Councillor Marshall. Councillor Palmer. Councillor Stanley. SANITARY STAFF. Medical Officer of Health. T. Slater Jones, M.D., M.R.C.S., L.R.C.P. Chief Sanitary Inspector and Inspector of Nuisances. A. E. Adams, Assoc. R. San. Inst., R.C.P., Cert. R. San. Inst., Cert. Meat and Food Insp., Cert. Plumbers' Work, Certs. Building Construction, Physiology, Hygiene, &c. Assistant Inspectors. S. C. Stanbury, Cert. Royal San. Inst., Cert. Meat and Food Insp. W. R. Drake, Cert. Royal San. Inst. Health Visitor. Mrs. Parnell. Clerks. G. C. Billing, B. Burr. Urban District Council of Wood Green. REPORT of the MEDICAL OFFICER OF HEALTH For the Year 1913. Sanitary Department, Town Hall. To the Chairman and Members of the Urban District Council of Wood Green. Gentlemen, I beg to submit to you my Annual Report on the Health of the Wood Green Urban District for the year 1913. Physical Features of the District. The District of Wood Green has an area of 1,625 acres. The subsoil consists of various clays with a shallow pocket of gravel in the Muswell Hill District, beneath which are beds of London clay. The highest point is the site of the Alexandra Palace, which is 300 feet above the ordnance datum, and the lowest point is 56 feet above ordnance datum, at the junction of the Eastern end of the District with Tottenham. The Western portion of the District, known as the Alexandra Park District, in uneven and hilly, and 6 has the highest altitude. Roughly, the District North of Lordship Lane averages 108 feet above ordnance datum, and the portion South of the Lane about 70 feet above ordnance datum. It is situated in the County of Middlesex, to the North of London ; is bounded on the North side by the Parish of Southgate, on the South almost wholly by the Borough of Hornsey, on the East by the Parish of Tottenham, and on the West by Hornsey and Friern Barnet. Social Conditions. The inhabitants of the District are chiefly those of the Artisan Class, and those employed in commercial pursuits in London. Very few of the inhabitants generally, are employed in the District, with the exception of the Tradesmen and their assistants. There is one large Factory in the District, viz., Messrs. Barratt and Co., Confectioners, employing about 1.800 hands; of these a very large portion reside outside the District of Wood Green. The only other factories of any size are a Screw Factory and Glass Bottle Factory. There are no offensive trades, cellar dwellings or Common Lodging Houses within the District. There is one Hospital, the Passmore Edwards Hospital, containing 24 beds, situated within the District, and four Institutions— The Fishmongers' and Poulterers' Institution, the Fullers' Almshouses, the Porters' and Waiters' Almshouses, and the Printers' Almshouses, none of which have inmates from this District. The Poor Law is administered by the Edmonton Board of Guardians, and the amount of out-relief for the Wood Green Parish for the year 1913 was, approximately, £1,420 6s. 5d. 7 Sanitary Circumstances of the District. Water Supply. The whole of the water supply in the District is obtained from the Metropolitan Water Board (New River District); the supply is a constant service, water being laid on to each house. The whole of the houses on the Noel Park Estate have their supply direct from the main service pipe, without any storage cisterns. By the Wood Green District Council Act, 1903, sect. 42:— "Any cistern used for the supply of water for domestic purposes "so placed, constructed or kept as to render the water therein "liable to contamination causing or likely to cause risk to health "shall be deemed a nuisance within the meaning of the Public "Health Act, 1875." It will be seen from my previous reports and from the details in the Inspector's Report, that we are gradually getting the remaining houses in the District to take supply direct from the main service pipe, for dietary purposes. In August we had complaints from two householders on the Noel Park Estate that "insects" were being found in the drinking water. The houses concerned were next each other, and form part of a long row of houses in the same Road, all are supplied with water from separate branches taken direct from the main service pipe in the Road, without any storage cisterns. There is only one water tap in these houses for dietary purposes, situated over the scullery sink; in each case they had affixed to the taps "anti-splashes," which caught the "insects" complained of. I had enquiry made and found that none of the other houses were affected. 8 I took samples of the water on different occasions, and had them analysed, and they were found to be quite satisfactory. I also met the Chemist and District Superintendent of the Metropolitan Water Board on the property, they took several samples of the water, and at different times, for analysis, which confirmed our previous report. The District Superintendent had the main service pipes flushed out; this apparently had the desired effect for, after this, only one "insect" was found at one of the houses. From microscopic examination, I found the "insect" to be a small crustacean, a Gammarus, probably Gammarus pulex (common in fresh water.) I have not been able to satisfactorily account for these two houses being affected—when hundreds of branches are taken from the same service main, other houses were also using "anti-splashes "— and our enquiries failed to find any other householder who had noticed anything of this character. Watercourses. The water courses remain as in my report of the year 1911. With respect to the Muswell Hill Stream, referred to in my report of last year, I am glad to say that the portion of this stream from the foot of the Avenue (Alexandra Park) to a point in Albert Road, a little beyond the Muswell Hill School has. during the past year, been culverted and a great improvement effected thereby. Also a portion of the same stream has been culverted at the rear of Imperial Road (Central Ward). This will obviate the flooding of the gardens of the houses in this portion of the District, which used to take place during exceptionally heavy rains. 9 House Drainage. A great many house drains were entirely re-constructed, and a large number repaired during the year—a detailed statement of which appears in the Inspector's Report. This work is carried out under the supervision of the Sanitary Inspector, and the drains and fittings are water and smoke tested before being passed. Sewage. The system of drainage is dual, the soil drains being connected to the main sewers, which are continued through Tottenham to a pumping station in that District, from which the sewage is pumped into the London County Council sewers by arrangement with that Council. The pumping station and main sewer in Lordship Lane are under the control of a Joint Committee, consisting of representatives (from Tottenham and Wood Green. The surface water drains discharge into the Surface Water Sewers, which are taken into natural water courses, namely, the Moselle and Muswell Brooks, and finally discharge into the RiverLea. The public soil sewers are periodically flushed and cleansed by the Surveyor's Staff, a gang of men being continually employed throughout the year on this work. The length of public soil sewers is 36 miles 868 yards. The length Of public surface water sewers is 35 miles 472 yards. Closet Accommodation. Practically all the houses in the District are connected to the public sewers, the closets being arranged on the water carriage system; the only exceptions being two factories, which are situated on the extreme Eastern boundary of the District, a part yet to be developed, consequently there is no sewer at present to which they could be connected. 10 Scavenging. The District is divided into eight divisions for the purposes of the collection of house refuse, which is collected weekly, with a daily collection, before 9.30 a.m., from shops and business premises. Eight vans are employed in the collection of house refuse. The vans are the property of the Council. The horses and carmen are supplied by contract, while the dustmen are employed by the Council. Each house is supplied with a galvanised iron portable dustbin, properly covered, which greatly facilitates the work of dust collection. All the refuse is carted to the Destructor, erected almost in the centre of the District, in Western Road. The Refuse Destructor is the Heenan and Froude type, and is well able to destroy for many years all the refuse that will be brought from the District, the Council having wisely provided two sets of cells when they were erecting the Destructor. The heat generated by the Destructor is used for supplying Electric Light to the Depot and Bath, and heating the water used in connection with the Bath. Public Elementary Schools. The Medical Officer of Health is also School Medical Officer. In this latter work he is assisted by a School Nurse, and arrangements are made whereby the School Attendance Officers notify this Department of any cases of suspected infectious disease, including Measles, Ringworm, etc. It has not be found necessary to close any of the Schools during the year on account of Infectious Disease. Further details of work under this heading appear in my Report to the Education Committee. 11 Sanitary Inspection of the District. The detailed statement at the end of my report will give some idea of the work done under this heading during the year:— 289 Houses Inspected (Systematic Inspection.) 59 Complaints with respect to alleged Nuisances. 304 Visits to Infectious Cases. 194 Visits to Tuberculosis Cases. 305 Visits to Slaughterhouses. 421 Rooms disinfected. 2356 Articles disinfected. 1146 Letters written. 1196 Enquiries into births. 1184 Letters received and filed. 1009 Birth cases followed up and re-visited. 83 Enquiries into Deaths of children under one year. It will be noted that the number of houses inspected is slightly lower than last year, but the other work is more than maintained. This was due to unforeseen circumstances. Towards the end of August, Mr. Hill, the Assistant Inspector, left. About the same time, Mr. Stanbury, the Chief Assistant Inspector, was taken ill with "sewer gas poisoning," and Mr. Adams, the Chief Inspector, had to be brought back to town before the completion of his well-earned holiday, to carry on the work. The Chief Assistant was off duty for five weeks, while we were without an Assistant Inspector for just over two months, the Chief Inspector having to carry on all the out-door work until the return of Mr, Stanbury. I desire here to record my thanks to Mr. Hill (the late Assistant Inspector), who had already left the Council's employ, but who came 12 back to the office until such time as we could communicate with the Chief Inspector and secure his return to town. I also think Mr. Stanbury (the Chief Assistant) is to be commended for sticking to his work to the last minute, although he was seriously ill. Milk Supply. There are four Registered Cowkeepers in the District, with eight milch cows altogether, kept in two cowsheds. The other two, although Registered as Cowkeepers, do not keep any cows. There are 45 Purveyors of Milk. During the year there have been four applications for registration by Purveyors of Milk, all being for changes of occupation of premises. These premises are periodically inspected and, on the whole,, are kept in a fairly satisfactory condition. No infectious or other disease has been traced to the milk supply. Food Inspection. There are five slaughter-houses in the District, to which frequent visits have been made. Four of these premises are old and have been in use for many years, but generally speaking they are kept in a clean and satisfactory condition, and beyond the slaughtering of a few sheep and an occasional bullock, are not extensively used. One slaughter-house is of modern construction, and which I reported in my last Annual Report. Owing to the proximity of the London Cattle Markets most of the meat is presumably inspected before coming into this District; nevertheless, we do not relax our vigilance with respect to Butchers' and other shops where meat or other food is deposited for sale. 13 In the course of meat inspection the following have been surrendered:— 5 Pigs for Tuberculosis. 35 Pigs' heads for localised Tuberculosis. 11 Parts of carcasses for various diseases. Offal, livers, tongues, etc. In the course of other food inspection:— 1 Box of Skate. 1 Box of Haddocks. 1 Box of Mackerel. 2 Boxes of Pears. 1 Box of Flat Fish. 1 Box of Hallibut. 1 Bushel of Apples. 1 Box of Codlings. 220 Cauliflowers. have been surrended. The Chief Inspector and Chief Assistant Inspector both hold the Certificate of Meat Inspection. Bakehouses. All the bakehouses (20) have been periodically inspected during the year. There is one underground bakehouse in the District, certified by the Sanitary Authority. The use of this will probably be discontinued early in the new year, as the occupier has taken other premises and is building an overground bakehouse more suited to modern methods. I am of opinion that with reference to bakehouses, the Council should have power to make byelaws to regulate the conditions of these places, for while on the whole they are kept in a fairly clean condition, I frequently find that the floors and surroundings are not swept and cleansed as often as they should be, and there is much room for improvement in this direction. 14 Ice Cream Dealers. There are 69 premises where Ice Cream is made. All these premises are shops at which Ice Cream is retailed over the counter. I am glad to report that there appears to be a general desire on the part of the occupiers of these premises to meet our wishes with respect to cleanliness, etc. Sale of Food and Drugs Act. The Middlesex County Council being the Authority for taking samples under the above Act, Mr. R. Robinson, Chief Officer under the Food and Drugs Act, has kindly supplied the following figures:— Samples Taken. Samples Adulterated. Milk 111 17 Butter 8 — Linseed 7 — Cream 1 1 127 18 A number of the above were "informal" samples. One vendor received an official caution in respect of the sale of adulterated milk. Housing and Town Planning Act, 1909. No houses for closing have been reported to the Council during the year under the Housing and Town Planning Act, 1909. With reference to the 19 houses referred to in my last year's Report, 17 of them have been thoroughly renovated throughout, larders have been provided, yards paved, roofs repaired, water supply taken direct from the main, etc., etc., leaving two, which require extensive structural repairs, to be dealt with. 15 Of the 26 houses bought for Railway Imporvement (see last year's report) 17 have been demolished, while 9 have been thoroughly repaired and renovated on much the same lins as above, and are now occupied. There has been no addition to the Noel Park Estate, and for information I include the accommodation and rents in the Report of this year. NOEL PARK ESTATE. Houses and Flats on the Estate. Number. Accommodation. Rentals. 1st Class 115 3 sitting rooms, 3 bedrooms, kitchen, scullery, etc. Some have bathroom, A few of the higher priced houses have 4 bedrooms. 12/6 to 18/3. 2nd Class . 193 2 sitting rooms, 3 bedrooms, kitchen, scullery, etc. Some have bath. 10/9 to 13/9. 3rd Class 924 Sitting room, 3 bedrooms, kitchen, scullcry, etc. Some have bath. 10/- to 13/(corner houses, 14/ and 15/-) per week. 4th Class 349 4 rooms, kitchen, scullery, etc. Some have bath. 8/6 to 9/9. 5th Class 255 * 1 rooms,kitchen,scullery,etc. 7/3 to 8/-. Flats 451 2 to 5 rooms each. Some have bath. 5/- to 12/6 (according to number of rooms). During the year 289 houses have been inspected, including 1,657 rooms, the list of which is set out in the Sanitary Inspector's Report. 16 Most of the houses were those occupied by the working class, and the average rent for a home with three bedrooms and two sitting rooms (including kitchen) is about 10s. per week; in many cases a lodger or lodgers are taken to assist in paying the reat. There has been no prevalence of overcrowding in the District. For the purpose of the Census an "overcrowded tenement" is defined as being inhabited by more than two persons per room. From the figures obtained during the course of house inspection, I find 1.16 is the average number of occupants per room in Wood Green. Richmond Road is as low as .88 per room, while certain houses in Commerce Road reach 2 per room. It is unfortunate that the Public Health Act, 1875, does not contain any definition of overcrowding; we are therefore guided by the space allowed in Common Lodging Houses, viz., 300 cubic feet for an adult and 150 cubic feet for a child under ] 0, and, while I am of opinion that this is too low a standard, I am afraid any legal proceedings would fail in trying to force any higher standard in face of there being no legal definition for overcrowding. There can be little doubt that the character of part of the District is changing. I refer particularly to the Bowes Park and Town Hall Wards, where houses, which a few years ago were let to one family, are now occupied by two families. This is due, in a great measure, to the advent of the Motor-bus and Tramway giving cheaper and better facilities for people to move out to the suburbs. The opening of the London General Omnibus Garage at Palmers Green, which is not far from our boundary, brought an influx of motor men, who naturally wish to reside near their employment, and their wages not being equal to the rents, two of them join in taking one house. I am pleased to say, so far, we have not come across any overcrowding in consequence, but instance it as a changing condition of things in the District. 17 Town Planning. During the year a Town Planning Scheme has been prepared by the Council, and Notices served thereunder. Open Spaces. The open spaces, which are a feature of Wood Green, still remain as last year. It is expected that the playing fields on the North side of White Hart Lane will be ready for opening early in the year 1914. The Council, I am pleased to say, contemplate purchasing land in the Alexandra Park Ward, adjoining Albert Road, for further open space and playing fields for that side of the District, and which would also serve a large population in the Bowes Park Ward. A Provisional Order has been obtained in connection with the purchase of this land, which, from a Public Health point of view, cannot but be of further benefit to the District. Having regard to the fact that the District must of necessity in the future become more Urban in character, too many open spaces, in my opinion, cannot be provided while the land is available.. Workshops and Workplaces. All the Workshops and Workplaces in the District have been inspected during the year, and any sanitary defects remedied forthwith. There is very little homework given out in the District, most of the out-workers being employed in connection with firms in London. As last year, there are only four workshops of any size, and these are occupied by blouse makers. The Health Visitor takes charge of workshops and out-workers where female labour is 18 ployed. The number of visits paid to the above premises, together with the class of work in them, will be found in the Table annexed to my Report, as required by the Home Office. There are four large Workshops in the District employing about 60 girls at blouse making for Firms in London, beyond these, the workshops are small, employing from two to six hands as occasion may require. On the whole, they have been kept in a satisfactory condition, and we have had to ask in several instances for the cleansing of the walls and ceilings. In one Laundry we found that the Occupier had commenced to employ males without a separate W.C. accommodation, which was remedied directly we called his attention to the matter. There is a considerable amount of work involved in visiting workshops and Out-workers, and finding that the Occupiers have removed and the premises used for other purposes; in some instances we are able to find out the new address and so keep in touch with them—particularly is this the case with Out-workers sent from other Districts. I presume the old address is apparently left on the books of the employers. Out of 83 Out-workers sent from other Districts we found 18 had removed from the address given (or 21 per cent.) and 8 had given up taking work in, but their names were apparently still on the employer's Out-workers' List (or 9 per cent.) Isolation Hospital. The accommodation at the Hospital has been quite sufficient to meet all the cases requiring removal from this District. The arrangement with the Hornsey Borough Council for the reception of infectious cases into their Hospital is still in force, and expires on the 6th June, 1920, but can be terminated by either 19 Council on the 6th June, 1915. In the event of the Hornsey Borough Council terminating the agreement on the latter date they are to pay the Wood Green District Council £1,000. The following cases have been removed during the year 1913. 1912. Scarlet Fever 159 96 Diphtheria 57 34 Enteric Fever — 2 Poliomyelitis 3 — 219 132 The cases of Poliomyelitis were removed to the following Hospitals, respectively:— Middlesex Hospital. Tottenham Hospital. Passmore Edward's Hospital, Wood Green. The following deaths have occurred in the Hornsey Isolation Hospital:— Age. Disease. Number of Days after Admission. Cause of Death. 4 Diphtheria 11 Diphtheria. Heart Failure, 4 „ 1 „ Toxoemia (Tracheotomy). 6 „ 9 „ Heart Failure. 4 „ 1 „ „ 7 „ 6 „ „ 8/12 „ 10 „ „ 3 „ 8 „ „ 9 „ 2 „ Toxoemia. 2 „ 4 Scarlet Fever. I am pleased to report that no "Return Cases" from the Hospital have occurred during the year. 20 ERRORS IN DIAGNOSIS. Seven cases sent to the Hospital, notified as Diphtheria, were found after observation not to be suffering from this complaint, making 12.28 per cent. of errors in the admitted cases. Removals to Hospital, according to Wards:— Ward. Scarlet Fever. Diphtheria. Total. Town Hall 33 15 48 Bowes Park 16 9 25 Alexandra Park 11 4 15 Central 31 18 49 Noel Park 6 11 79 159 57 216 Bacteriological Examinations. The Council still continue to have special terms with the Clinical Research Association for the examination of swabs, etc. The number of examinations made during the year were as follows:— Positive. Negative. Total. For Diphtheria 32 . 116 148 „ Enteric Fever 1 2 3 ,, Pulmonary Tuberculosis 17 54 71 ,, Ringworm 14 8 22 „ Other cases (Water, etc.) — — 6 64 180 250 Zymotic Diseases. The deaths from the seven chief Zymotic Diseases of the Registrar General were 39, which corresponds to an annual rate of .77 per 1,000 of the population, against .56 per 1,000 in 1912. 21 Acute Anterior Poliomyelitis. The histories of the four cases reported during the year are:— (1) Sex, female; age, 5½ years; notified on the 2nd March. Previous history of fits. Doctor called in for fit with high temperature and paralysis of both legs and partial paralysis of both arms. She was treated in the Passmore Edward's Hospital by massage and drugs (strychnine, etc.) No examination of the cerebrospinal fluid was made. Patient discharged with Paralysis of both lower limbs and wasting of muscles. (2) Sex, female; age 5 years; notified on the 21st Sept. Symptoms came on with sickness, drowsiness and high temperature. Patient was removed to the Prince of Wales's Hospital the same day. No record of a Bacteriological examination of cerebrospinal fluid can be got. The paralysis of the lower limbs much improved on date of discharge. (3) Sex, female; age, 11 years: treated at home; notified 3rd October. This case came on with drowsiness, high temperature (103 F.), pains in the limbs and paralysis of both lower extremities (left worse) and of the left arm, stiffness at the back of the neck. An examination of the cerebro-spinal fluid was made at a Bacteriological Laboratory. Treatment by drugs (urotropine, etc.) and skilled massage. At the end of the year the patient had recovered the complete use of the right leg and of the left arm. the left leg being only slightly paralysed and thinner than the other, but still improving. (4) Sex, male; age 8 years; notified on the 14th October. Said to be quite well after a holiday; legs suddenly gave way when out walking. He was seen by a Consulting Physician four days afterwards and sent to the Middlesex Hospital, where he remained to the latter end of December. No Bacteriological examination of the cerebro-spinal fluid was made. He was dicharged with paralysis of both legs and right arm. The Hospital Physicians 22 after some weeks observation, came to the conclusion that he was suffering from General Tuberculosis, and are doubtful whether the first diagnosis was correct. Small Pox and Typhus Fever. No cases of Small Pox or Typhus Fever have been notified during the year. Scarlet Fever. There has been 185 cases during the year with one death, against 127 cases with no deaths in 1912. This year we have had the highest number since 1909, when there were 300 cases; in 1910 they dropped to 85 cases and in 1911 127 cases. The chart appended to my Report shows the rise and fall of this disease for a period of ten years. The chart of Notifications for each week, at the end of this Report, shows a sudden rise for the week ending 28th September, and has continued up more or less since that date. There was no epidemic. Careful enquiry was made into each case and no connection could be traced to the milk supply, or any particular school; indeed, it will be seen from my returns that a large proportion of the cases were under or over school age. So far as Schools are concerned, Noel Park Infants' School showed the largest number of cases, viz., 21, but when it is considered that over 600 children attend this school, and all of a susceptible age, the percentage of cases (3 per cent.) to the number of children in attendance is not alarming. In my Report as School Medical Officer I give the figures of children in the Schools who have not had this disease. I can only put it down to the prompt measures taken to isolate and discover each case that the District has so far been free from an epidemic. Chart showing Notifications of Scarlet Fever and Diphtheria received each week during 1913. SCARLET FEVER in Black. DIPHTHERIA in Red 23 I may mention that the Eastern part of the District appears to have been the portion most affected during the year under review. The number of cases of Scarlet Fever notified in each Ward was:— Town Hall 41 Bowes Park 16 Alexandra Park 15 Central 36 Noel Park 77 185 Diphtheria. There have been 70 cases during the year, with 11 deaths, making a case mortality of 15.71 per cent., against 54 cases with 6 deaths, a case mortality of 11.11 per cent in 1912. It will be noticed that while Noel Park Schools show the highest return with respect to Scarlet Fever, it has the lowest return with respect to Diphtheria. In connection with Bounds Green School, I found three children present at School with Diphtheria, and I wonder that there were not more cases notified from this School. In all these cases there was the usual history of a "bad cold." In one case the typical membrane was actually present when I examined the child; the other two cases were suspicious and confirmed by bacteriological examination. During my enquiries at the same Schools I also learned that four brothers were at home with "bad colds" and, from my knowledge of the family, I asked their Medical Attendant to call and take swabs from their throats, which proved "positive," thus one was able to account for 7 cases out of 17 at this particular School. 21 The above instances only go to prove the difficulty in dealing with cases of Infectious Disease among the thousands of children who attend our Schools, not only, of course, in Wood Green, but throughout the Country. In another instance it was found that the father was a carrier. A child was taken to the Hospital with Diphtheria, and about three weeks after, the baby (there were only two children in the house) was notified. As disinfection, etc., had been most carefully carried out, I got the Medical Practitioner in attendance to swab the throats of parents, when the bacilli was found in the father's throat. This instance shows another example of how infectious disease may be spread. The number of cases of Diphtheria in each Ward was Town Hall 19 Bowes Park 18 Alexandra Park 5 Central 19 Noel Park 9 70 Scarlet Fever and Diphtheria. SCHOOLS ATTENDED. Noel Park. Scarlet Fever. Diphtheria. Boys' 7 1 Girls' 9 — Infants' 21 — 37 1 25 White Hart Lane. Scarlet Fever. Diphtheria Boys' 5 1 Girls' 6 — Infants' 2 1 13 2 Higher Grade. Boys' 5 — Girls' 3 — 8 Bounds Green. Boys' 2 4 Girls' 4 5 Infants' 3 8 9 17 Alexandra. Boys' 2 — Girls' 1 3 Infants' 2 5 5 8 Lordship Lane. Boys' 3 1 Girls' 2 — Infants' 9 2 14 3 St. Michaels'. Mixed 1 6 Infants' 3 2 4 8 26 Scarlet Fever. Diphtheria. Muswell Hill Mixed 3 — St. Pauls' 5 — Secondary 2 2 Private 9 3 Schools outside District — 1 Not attending School 5 1 Over School Age 30 5 Under School Age41 19 30 per cent. of Scarlet Fever cases notified did not attend School. 16 per cent. of Scarlet Fever cases notified were patients above School age. 35 per cent. of Diphtheria cases notified did not attend School. 7 per cent of Diphtheria cases notified were patients above School age. Enteric Fever. There was only one case of Enteric Fever notified during the year; no deaths, against six cases with two deaths in 1912. The case of Enteric Fever was a male patient, aged 39, living in the Alexandra Park Ward (Victoria Road.) He was employed as a Commercial Traveller,, travelling on the Continent, and returned home in December, 1912 from Hamburg, on account of not feeling well; and early in January the case was diagnosed. There is no doubt that the disease was contracted out of England. There was no history of shell.fish, but the patient had partaken freely of salads. A careful inspection of the house failed to reveal any sanitary defects. 27 Erysipelas. There were 33 cases of Erysipelas notified, with one death, making a case mortality of 3 per cent; against 29 cases, with one death, in 1912. General Methods of Dealing. with Infectious Cases. Upon receipt of Notification, prompt investigations are made into each case and efforts made to discover any contacts. Those cases requiring removal are taken to the Isolation Hospital by ambulance as expeditiously as possible. Day and Sunday Schools are notified, also the Librarian, of all cases and contacts (if thought necessary.) No scholar is allowed to return to the Council Schools without an authorising certificate from this Department. Directly the patient is removed the room or rooms are disinfected with Formaldehyde gas, or sprayed with Formalin, as may be more convenient. The bedding is removed to the Depot for disinfection in a Washington Lyons Apparatus, then returned to the house in a separate bedding van. In most cases a notice is served upon the owner to strip the walls of paper, etc. (a) ANTI.TOXIN. A supply of Anti.toxin is kept at the Council Offices, and the residences of the Medical Officer of Health and Chief Sanitary Inspector, where it can be obtained at any time. About 80 tubes (160,000 units) were supplied during the year. 28 (b) SWABS FOR DIPHTHERIA, Etc. The Medical Practitioners are supplied with swabs, sputum bottles and pipettes, for the purpose of assisting in the diagnosis of the different diseases mentioned, and a further supply can alwayB be obtained at the addresses given above. (c) NON.NOTIFIABLE INFECTIOUS CASES, SUCH AS MEASLES, Etc. I have drawn up a code of instructions for the guidance of Teachers in the Council Schools (and others), showing what may be the preliminary symptoms of Notifiable and Non.notifiable Infectious Diseases and the time that such cases are to be excluded from School attendance. Diarrhoea. There were 9 deaths of children under one year from Diarrhoea; against 6 deaths in 1912 and 43 deaths in 1911. The circular which I prepared under this head has been left by the Health Visitor at each house where she has made enquiry into births during the Summer months. Tuberculosis. There were 45 deaths from Pulmonary Tuberculosis, 7 from Tubercular Meningitis, and 8 from other Tuberculous Diseases. The number of Pulmonary Tuberculosis cases reported during the year was 127, or 2.52 per 1,000 of the population. The ages of the cases are given in the table at the end of my Report, from which it will be seen that the patients between the ages of 25 and 45 greatly exceeds that of any other age period. 29 It will be noted that Noel Park Ward, which is essentially an Artizan Ward, has the highest number of Tubercular cases reported, viz., 56; as against 48 Town Hall Ward, 33 Central Ward, 24 Bowes Park Ward, and 11 Alexandra Park Ward. The Town Hall and Central Wards, which also contain a large proportion of Artisans, are the next in point of numbers. THE SEX OF PATIENTS. MALES 63 FEMALES 65 Married 43 Married 17 Single 20 Single 48 Five cases had received Sanatorium treatment' at some time previous to notification, but were primary cases so far as notification was concerned. In 19 cases there was a history of a near relative having Pulmonary Tuberculosis. Thirteen cases have been removed to the Edmonton Infirmary for treatment. Thirteen cases have been admitted to Clare Hall Sanatorium, making a total of 35 cases removed from their homes; or 20.34 per cent. of cases notified. This, of course, does not represent the total number receiving Hospital treatment. Thirty.one cases have been discharged from Sanatorium, Hospital or Infirmary during the year. Four of these were admitted in 1912. Ten primary cases were reported direct from Hospitals. OTHER FORMS OF TUBERCULOSIS. Forty.five cases of other Tubercular Diseases have been reported, including ten cases which I found during School Medical Inspection. 30 The parts of the body affected were as follows: — Neck Glands 19 Pleura 3 Knee 3 Spine 4 Hip 4 Larynx 1 Bones of right arm 1 Femur 1 Radius 1 Wrist 1 Abdomen 1 General Tubercnlar Meninges 3 Two cases were only diagnosed upon Post Mortem examination, viz., one case of Tubercular Meninges and the case of Tuberculosis in the abdomen. During the progress of Medical Inspection in the Schools 17 children were found in attendance with Tuberculosis Disease, viz.: — Pulmonary Tuberculosis 7 Other Form of Tuberculosis Disease 10 (Included in the above list.) Four of the children with Pulmonary Tuberculosis were sent to Clare Hall Sanatorium by the Council, and were greatly benefited. The remaining children are all receiving treatment at London and local Hospitals. I make further reference to treatment in my Report to the Education Committee. All cases of Tuberculosis have been visited, except those where I have been assured by the Medical Practitioner in attendance that every care was being exercised or that for some other valid reason a visit was not desirable. 31 To Primary Notifications about 119 visits have been made. Ninety.seven subsequent visits have been made, principally to children and young persons. In each instance a circular which I prepared on the precautions to be adopted has been left at the houses visited, and spitting flasks supplied in cases where found necessary. The rooms and bedding in all fatal cases have been disinfected, also in cases where a request has been made, or in which I considered absolutely essential. A Local Dispensary has been established by the County Council in the latter part of the year. It is too early to express any opinion upon the benefits so far conferred upon the patients that have been referred to the Tuberculosis Officer for treatment. Non.Notifiable Diseases. The School Attendance Officers still continue to send us notice each day of all cases of Sore Throat, etc., which come to their knowledge during the course of their enquiries concerning absentees. These cases are scheduled on separate sheets for the different Schools, so that I can see at a glance whether any particular School is being affected. The number of cases reported during the year were:— Sore Throats 777 Measles 465 Chicken Pox 82 Whooping Cough 168 Other Cases (such as Ringworm, etc.) 884 2376 At no time was there any epidemic or necessity to close any of the Schools. 32 There were 12 deaths from Measles, against 8 deaths in 1912; and 6 deaths from Whooping Cough, against 6 deaths in 1912. Investigation into 204 cases were made by the Inspectors during the year, where I thought special enquiry was necessary, or more than double the enquiries that were made last year. Population. The records of the Surveyor show that 48 houses were completed and fit for occupation during the year. Deducting 7 per cent. for houses not occupied and calculating 5.4 persons for each occupied house, we get an increase of population of 243 for the year. Adding this to 50,098, the estimated population for last year, a population of 50,341 is arrived at. I have therefore taken 50,300 as the average population for the present Report. The estimated population for each Ward is as follows: — Town Hall. Bowes Park. Alexandra Park. Central. Noel Park. 11,437 7,664 7,379 10,521 13,460 New dwelling houses have been erected in the following Wards:— Alexandra Park 19 Town Hall 24 Bowes Park 5 48 Since the date of the Census only 203 houses have been erected in the district, so that the population is not increasing at the rapid rate of a few years ago. Various reasons are given for the slow progress of building, one of which is the great increase in the price of building materials. 33 The Surveyor has kindly furnished me with the following particulars as to new buildings in the District for the year: — Dwelling houses in the course of erection 81 Factories and Warehouses 2 Stables and Sheds 17 Public Buildings 2 Alterations and Additions 16 Lock.up shops 2 Births. There were 1,193 Births Registered in the District and 17 Outside Births sent to us by the Registrar General, making a total of 1,210, against 1,204 in 1912. The Births were 601 males and 609 females; of these 37 were illegitimate (28 born within the District and 9 outside.) This corresponds to an annual rate of 24.05 per 1,000 of the population, as compared with 24.80 per 1,000 in 1912. The following table shows the number of Births registered in the District and the Birth Rate for each Ward:— Ward. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total. Birth Kate. 1913. 1912. Town Hall 83 64 57 63 267 23. 42 26. 53 Noel Park 79 94 79 82 334 24.92 27.64 Central 70 66 62 64 262 24.94 20. 32 Bowes Park 40 39 51 50 180 23. 64 23. 69 Alexandra Park 38 32 38 42 150 20. 32 20.03 310 295 287 301 1193 23.71 24.80 A number of the illegitimate children registered in the District were born in a Nursing Home, which has been established by a 34 Midwife. Some of the mothers simply come here to be confined, so that strictly speaking all the illegitimate births registered do not belong to Wood Green. For comparative purposes I have shown the Birth.rate for each Ward, together with the year 1912, by which it will be seen that there is a drop of 3 per cent. in the Town Hall and Noel Park Wards and an increase of 4 per cent. in the Central Ward. The births in the Bowes Park and Alexandra Park Wards remain much the same. Deaths. There were 398 deaths Registered within the District during the year, and there were 133 residents died outside the District, making a total of 531, from which must be deducted 21 deaths of non.residents. The correct number is therefore 510, which is equal to an annual rate of 10.13 per 1,000 of the population; against 498 (an annual rate of 9.96) for the year 1912. To compare this death.rate with that of England and Wales, allowance must be made for the more favourable age and sex distribution of the population of Wood Green. This is done by multiplying the recorded death.rate by a factor for correction (which is 1.0158.) The corrected death.rate is therefore 10.27 per 1,000 for the year, against 10.11 for 1912. The following are the number of deaths and the death.rate per 1,000 for each Ward: — Ward. Number of Deaths. Death Rate. Town Hall 95 8.33 Noel Park 138 10.25 Central 138 13.14 Bowes Park 78 10.23 Alexandra Park 61 8.26 35 There were 83 deaths of children under one year, which corresponds to a rate of 68.59 for every 1,000 births; against 68 or a rate of 66.48 in 1912. The deaths of children under five years was 133, which corresponds to a rate of 2.64 per 1,000 of the general population, against 106 deaths in 1912 (a rate of 2.12 per 1,000.) Notification of Births Act, 1907. The above Act was adopted on the 1st December, 1908, but the Council had appointed Mrs. Parnell as Health Visitor in October, 1907—twelve months before the adoption of the Act. The number of births notified under the Act were 883, or 73.83 of Births registered; against 71.81 notified in 1912. Total number of enquiries into registered births during 1913 1196 Number of children entirely breast fed at time of enquiry 890 Number of children entirely hand fed at time of enquiry 148 Number of children partly hand fed at time of enquiry 68 The ages of children when enquiries were made were as follows : One week 382 Ten days 276 Two weeks 282 Three weeks 176 Four weeks and upwards 80 Number of re.visits to Births 1009 Number of Still.birtlis 22 Attended by Medical Practitioners 15 Attended by Midwives 7 Baths. The Baths at Western Road are opened all the year, while the Open.air Bath was opened on the 27th May and closed on the 30th September. 36 The Surveyor furnishes the following figures of persons using the Baths:— OPEN AIR BATHS. WESTERN ROAD BATHS. General. School Children. General. School Children. January — — 2,839 — February — — 2,472 — March — — 3,125 — April — — 4,420 — May — — 11,077 956 June 2,790 2,175 12,534 3,336 July 2,055 1,468 11,366 2,259 August 1,865 1,186 9,776 417 September 1,144 381 8,915 2,927 October — — 5,688 — November — — 3,736 — December — — 2,508 — 7,854 5,210 78,458 9,895 The experiment first tried by the Education Committee in 1912 and referred to in my Report last year has proved, as I surmised, an unqualified success; no less than 15,105 attendances were made by school children during the year. No less than 86,310 attendances were made by the general public. I am pleased to learn that the Baths Committee have under consideration an addition to the existing building in Western Road for Slipper Baths and an additional Pond. The pressure upon the acommodation at Western Road during the months of May, June and July has been phenominal. The attendance at Western Road works out at about 1,508 per week, against 950 in 1912 (not including School children.) I am sure the above figures must be more than gratifying to the Members of the Council, not merely from the financial point of view, but as tending towards healthy exercise and the teaching 37 of habits of cleanliness, which cannot be directly measured in financial terms, except in so far that the healthy body and a sound mind is a distinct gain to the whole community. Sanitary Conveniences. The number of Sanitary Conveniences for the use of the public has not been increased since my Report of last year. The Council have, however, under consideration the provision of a Public Convenience at the junction of High Road, Mayes Road and Alexandra Road. This neighbourhood has become a very busy part of the District, particularly on Friday and Saturday nights, and there is no question that a Public Convenience in this immediate neighbourhood will have to be provided. Plans have been submitted by the Surveyor for an underground Convenience; but water pipes, electric cables, etc, have to be considered, so that this matter will of necessity take time in negotiating with the different Authorities affected. Public Mortuary. Bodies deposited during year 40 Inquests held 39 Post Mortem examinations made 37 Causes of Death:— Natural 23 Accidental 5 Misadventure 8 Suicide 1 Foetus 1 Still.born 1 Chronic Alcoholism 1 40 38 Summary. Area of District 1,631 acres. Estimated population 50,300 Census population 49,369 Average number of persons per house (Census) 5.40 Death Rate, 1913 10.13 Birth Rate, 1913 24.05 Infantile Mortality Rate, 1913 68.59 per 1,000 births Zymotic Death Rate, 1913 .77 Wards. Estimated population for each Ward:— Town Hall 11,400 Noel Park 13,400 Central 10,500 Bowes Park 7,621 Alexandra Park 7,379 50,300 Death and Birth Rate: — Death Rate. Birth Rate. Town Hall 8.33 23.42 Noel Park 10.25 24.92 Central 13.14 24.94 Bowes Park 10.23 23.64 Alexandra Park 8.26 20.32 Tuberculosis. Cases notified:— Ward. Pulmonary Tuberculosis. Other Tuberculous Diseases. Town Hall 37 11 Bowes Park 14 10 Alexandra Park 7 4 Central 28 5 Noel Park 41 15 127 45 39 Diphtheria, Scarlet Fever, Enteric Fever and Poliomyelitis. Ward. Cases of Diphtheria. Cases of Scarlet Fever. Cases of Enteric Fever. Cases of Poliomyelitis. Removals to Hospital. Per cent of Cases Removed. Town Hall. 19 41 — 1 48 93 Bowes Park 18 16 — 1 26 74 Alexandra Park 5 15 1 . 15 75 Central 19 36 — — 49 89 Noel Park 9 77 — 2 81 92 70 185 1 4 219 84.23 It is with great pleasure that I have again to express my thanks to your Chief Sanitary Inspector, the Assistant Inspectors, the Lady Health Visitor, and the Clerical Staff for the efficient manner in which they have carried out their duties generally. In conclusion, I would gratefully acknowledge the attention which is always given by the Members of the Public Health Committee to any matters brought before them for their consideration. I am, Gentlemen, Your Obedient Servant, T. SLATER JONES, M.D. Medical Officer of Health. 40 Meteorological Statistics. Month, 1913. Total Rainfall Maximum Rainfall. No. of . wet days. Maximum Temperature Minimum Temperature. ins. ins. date deg. date. deg. date. January 2.34 •64 11th. 18 55 5th. 26 12th, 13th, 26th. February . .74 16 9th. 10 54 4th. 21 22nd. March 2 .04 •41 16th. •22 58 5th. 6th. 26 17th April 2.57 •39 11th. 21 65 29th. 28 12th. May 1.36 •47 29th. 8 82 26th. 37 6th. June •94 •53 20th. 1 83 17th. 44 8th, 20th. July 1.92 •63 10th. 11 76 12th. 44 7th. August 1.19 •36 31st. 13 80 •28th. 45 24th, 25th. September •92 ■20 1st. 16 th 10 75 26th. 41 15th. October 2.74 •73 26th 17 67 2nd. 34 23rd, 24th. November 2.38 •58 21st. 16 59 17th. 33 8th. December •74 ■21 26th 8 54 9th. 12th. 26 31st. 1913. 1912. 1911. Total rainfall for year 19.88". 24.94". 23.93". Total number of wet days 161. 170. 147. Maximum rainfall in one day •73". 1". 1.25 Maximum rate of rainfall (approximate) 1" per hour. 1" per hour. 1.25" per hour. Maximum temperature (shade) 83°. 88*. 96°. Minimum temperature (shade) 21°. 16°. 22°. 41 Vital Statistics of Whole District during 1913 and previous Years. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett. of Nonresidents register'd in the District. of Residents not register'd in the District. Under 1 Year of Age. At all Ages. Number Rate. Number. Rate per 1,000 Nett Births. Number Rate. Number Rate. 1908 50,500 1,282 25.38 384 7.60 3 76 105 81.90 457 9.05 1909 50,500 1,207 23.90 4.20 8.31 10 95 91 75 505 10.0 1910 51,000 1,142 22.39 364 7.13 5 101 74 64.71 465 9.19 1911 49,369 1,197 1,205 24 22 462 9.37 17 108 123 102 553 11.20 1912 50,000 1,161 1,204 24.80 381 7.62 20 137 68 56.48 498 9.96 1913 50,300 1,193 1,210 24 05 398 7.71 21 133 83 68.59 510 1013 Area of District in acres (land and Total population at all ages 49,309 1 inland water), 1,631. Number of inhabited houses 9,132 Average number of persons per house 5"40 J Institutions within the District receiving sick and infirm persons from outside the District—Passmore Edwards' Cottage Hospital. Institutions outside the District receiving sick and infirm persons from the District—Hornsey Isolation Hospital, Edmonton Workhouse. At Census of 1911. 42 Cases of Infectious Disease notified during the Year 1913 in the Urban Sanitary District of Wood Green. NllIIFIABLF. DISEASE. NUMBER OF CASES NOTIFIED. CASES NOTIFIED IN EACH WAliD. TOTAL CASES REMOVED TO HOSPITAL At all Ages. At Ages—Years. Alex. Park Ward. Noel Park Ward. Central Ward. Bowes Park Ward. Town Hall Ward. Under 1 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup). 70 1 18 46 4 1 5 9 19 18 19 57 Erysipelas.. 33 2 6 9 12 4 6 12 4 3 8 Scarlet Fever 185 1 34 117 23 10 15 77 36 16 41 159 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 1 ... ... ... ... 1 ... ... 1 ... ... ... ... ... Relapsing Fever Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 3 ... ... ... 2 1 ... ... ... 1 ... ... 2 ... Cerebro spinal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis 4 ... ... 4 ... ... ... ... ... 2 ... 1 1 3 Pulmonary Tuberculosis 127 ...... 8 24 29 54 12 ...... 7 42 28 13 37 ... Otlierfonnsof Tuberculosis 45 1 7 25 8 3 1 4 15 5 10 11 ... Totals 468 3 67 218 72 79 24 5 38 158 92 61 119 219 43 Causes of, and Ages at Death during the Year 1913, in the Urban Sanitary District of Wood Green. Causes of Death. NETT DEATHS ATTHE SrR.IOlNKD A0E8 OF " RESIDENTS,' WHKTIIER OCCURRING WITHIN OR WITHOUT THE DISTRICT Total Deaths whether of Residents or Non. Residentfl in Institutions in the District. All ages. Under 1 year 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. i 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. Knteric Fever ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... Measles 12 2 3 6 1 ... ... ... ... ... Scarlet Fever 1 i ... ... ... ... ... ... Whooping Cough 6 3 2 i ... ... ... ... ... ... Diptheria and Croup 11 1 5 5 ... ... ... ... ... Influenza 5 ... ... ... ... 2 2 i ... Frysipelas 1 ... ... ... ... ... ... i ... Phthisis (Pulmonary Tubererculosis 45 1 2 5 23 13 1 ... Tuberculous Meningitis 7 1 ... 2 3 1 1 Other Tuberculous Diseases 8 ... 3 2 1 ... 2 ... 1 Cancer, malignant disease 47 ... ... ... ... 6 17 24 4 Rheumatic Fever ... ... ... ... ... ... ... ... Meningitis 1 1 ... ... ... ... ... ... ... ... Organic Heart Disease 50 ... ... ... ... 3 14 33 2 Bronchitis •28 6 ... ... ... ... 2 2 18 ... Pneumonia (all forms) 46 8 14 2 1 5 12 4 4 Other diseases of Respiratory organs lfi 2 ... ... 2 ... 1 6 5 ... Diarrhoea and Enteritis 10 9 ... ... ... ... ... ... ...1 ... Appendicitis and Tpyhlitis 4 ... ... ... 1 2 ... 1 I Cirrhosis of Liver 5 ... ... ... ... 1 3 1 Alcoholism 1 ... ... ... ... ... 1 ... ... Nephritis and Bright's Disease 17 ... ... ... ... ... 8 9 ...I Puerperal Fever ... ... ... ... ... ... ... Other accidents and diseases of Pregnancy and Parturition 1 ... ... ... ... 1 ... ... ... Congenital Debility and Malformation, including Premature Birth 33 32 ... ... 1 ... ... ... ... ... Violent Deaths, excluding suicide 8 1 ... 1 3 2 1 3 Suicides 3 1 2 1 Other Defined Diseases 143 18 3 4 7 4 in 97 70 5 Diseases ill.defined or unknown 1 1 All Causes 510 83 24 26 23 17 60 107 170 23 Pneumonia 33 7 7 1 4 11 3 44 Infantile Mortality during the Year 1913. Nett Deaths from stated causes at various ages under 1 year of age. Cause of Death. Under 1 week. 1.2 weeks. 2.3 w eeks. 3.4 weeks. lotal under 1 month. 1.3 months. 3.6 months. 6.9 months. 9.12 months. Total Deaths under I year. All Certified ... ... ... ... ... ... ... ... ... ... Causes U ncertified ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... Chicken Pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 2 2 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 ... ... 2 3 Diphtheria and Croup ...... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... 1 ... ... 1 ... ... ... ... 1 Convulsions 2 ... 1 ... 3 ... ... ... ... 3 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 3 ... 1 2 6 Pneumonia (all forms) 1 ... ... ... 1 2 2 2 1 8 Diarrhoea, ... ... ... ... 1 1 ... 1 ... 3 Enteritis 1 ... ... ... 1 2 1 9, ... 6 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... 1 ... ... 1 Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 4 ... 1 ... 5 ... I ... ... 6 Congenital Malformations. 1 ... ... ... 1 ... ... ... ... 1 Premature Birth 9 5 1 1 16 1 ... ... ... 18 Atrophy, Debility and ... ... ... ... ... ... ... ... ... Marasmus. 2 ... 1 2 5 7 ... 1 ... 13 Other Causes ... 1 ... ... 1 2 3 3 2 11 Totals 20 7 4 4 35 20 8 11 9 83 0Nett Births in Legitimate, 1173. the year Illegitimate, 37. Nett Deaths in Legitimate Infants, 82. the year Illegitimate Infants, 1. 45 Factories, Workshops, Laundries, Workplaces, and Homework. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspector of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions Factories 20 - - (Including Factory Laundries) workshops 285 15 - (Including Workshop Laundries) Workplaces 83 - - (Other than Outworkers' premises included in Part 3 of this Report) - - - Total 388 15 — 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under Public Health Acts:— Want of Cleanliness 4 4 — — Want of Ventilation — — — — Overcrowding — — — — Want of Drainage of Floors — — — — Other Nuisances 9 9 — - Sanitary dation Offices under the Factor)/ and Workshop Act:— Illegal Occupation of Underground Bakehouse (s. 101) — — — — Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) — — — — Other Offences — — — — (Excluding Offences relating to Outwork which are included in Part 3 of this Report). Total 15 15 — — 46 3.—HOME WORK. Wearing Apparel—Making, Etc. Outworkers' Lists, Section 107— Lists Received from Employers— Twice in the Year—Lists 3 Outworkers—Contractors — Outworkers—Workmen 8 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of Year. Tailors 7 Dressmakers 14 Blouse Makers 7 Root Repairers 8 Ladies' Tailors 2 Bakehouses 20 Other Workshops 75 Total Number of Workshops on Register 123 5.—OTHER MATTERS. Matters notified to H.M. Inspector of Factories— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 2 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 — Reports (of action taken) sent to H.M. Inspector — Other — Underground Bakehouses (s. 101)— Certificates granted during the year — In use at the end of the year 1 County of Middlesex.—SANITARY WORK, 1913. District of Wood Green. *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. Canal Boats used as Dwellings. 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). Total Number of Inspections and Re-inspections made. Cautionary or Intimation Notices Given. 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. Illegal Underground Rooms Vacated. Number Registered under Bye- Laws. Number of Contraventions. Number Registered under ByeLaws. Number of Inspections made. Number of Contraventions. Number Registered under the Acts. ' Number of Contraventions of Regulations. (1) (2) (3) (4) (5) 59 82 380 289 10,712. 650 361 ... ... ... ... ... 26 ... ... ... (b) 17 ... ... ... ... ... ... ... ... *N.B.—(3) Includes all classes of premises under periodical supervision, such as Cowsheds, Dairies, Slaughterhouses, Workshops and Work-places, &c. (5) Includes all visits and re-visits made by Sanitary Inspectors in connection with 1—4. 47 48 County of Middlesex.—SANITARY WORK, 1913. District of Wood Green. Movable Dwellings, Caravans. Tents, &c. Bakehouses. Slaughterhouses. Cow-sheds. Dairies and Milkshops. Unsound Food. 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. ... ... ... 20 ... 5 305 ... ... 4 16 ... ... 8 45 177 ... ... 1,680 ... 336 84 ... Destructor 49 County of Middlesex.—SANITARY WORK, 1913. District of Wood Green. Offensive Trades. 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. No. of Samples obtained for analysis. Water Closets. Percentage of Houses provided with Water Closets. Drains. Cesspools. Percentage of Houses Draining into Sewers. Number of Premises in District. Number of Inspections made. Contraventions of Bye-Laws. New Sunk. Cleansed, Repaired, &c. 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, &c. Unstopped, Repaired, Trapped, &c. Waste Pipes. Rain Water Pipes, Disconnected, Repaired, &c. New Soil Pipes or Ventilating Shafts Repaired. Existing Soil Pipes or Ventilating Shafts Repaired. Disconnecting Traps or Chambers Inserted. Re-constructed. Rendered Impervious, Emptied, Cleansed, &c. Abolished. From Local Wells. From Public Supply. ... ... ... ... ... ... ... 2 26 139 100 % ... 3 ... 192 100 % 73 109 120 34 58 48 50 ... 2 100 % 50 County of Middlesex.—SANITARY WORK, 1913. District of Wood Green. Disinfection. Dust. Sundry Nuisances Abated. Rooms Disinfected. Rooms Stripped and Cleansed. Articles Disinfected or destroyed. New Bins provided. How frequently is dust removed from each house. Number of Complaints of NonRemova received. Method of Disposal. Ordinary Infectious Diseases. Phthisis. Ordinary Infectious Disease. Phthisis. Destructor. By Tipping. Other, state method. Overcrowding. Smoke. Accumulations of Refuse. Foul Ditches, Ponds, &c., and Stagnant Water. Foul Pigs and other Animals. Dampness. Yards repaved or repaired. Other Nuisances. 297 40 260 2,011 267 333 Once per week. 12 Yes. ... ... 15 32 26 5 18 119 90 1245 51 SNITARY DEPARTMENT. Town Hall, Wood Green, January, 1914. To the Chairman and Members of the Urban District Council of Wood Green. Gentlemen, I beg to submit my Annual Report of the work in this Department for the year 1913. There have been 59 complaints of various nuisances received at the office. These have been entered in the Complaint Book, and the results recorded in the Journal, according to the orders of the Local Government Board. The following are some of the nuisances dealt with upon complaint, and inspection of houses in connection with Infectious Disease:— No. of Drains opened and examined 73 ,, Drains unstopped and repaired 94 „ Drains re-constructed 50 ,, Disconnecting Traps or Chambers 41 „ Waste Pipes 120 „ Soil Pipes ventilated 34 ,, W. C. Apparatus 63 ,, W. C. Apparatus repaired 2 „ Water supplied to W.C 26 „ Sanitary Dust-bins 290 ,, Roofs repaired 18 „ Gutters and Rain Water Pipes repaired 28 „ Rooms cleansed 202 ,, Sites of Houses concreted 17 52 No. of Air-bricks provided and remedies for dampness 13 „ Water Supplies taken from main 18 „ Yards paved 28 ,, Nuisances from overcrowding 12 „ Accumulations of Refuse removed 26 ,, Nuisances in connection with the keeping of animals 18 „ Smoke observations 32 ,, New W.C.'s constructed 2 „ Houses provided with water 3 „ Privies removed in connection with new buildings 3 „ Floors and Bedding Cleansed 7 „ Dirty Bedding destroyed 1 ,, Sash Cords and Window Sashes repaired 8 „ Larder Accommodations provided to Coffee Shops 1 ,, Other Nuisances 302 Infectious Disease (Notification & Prevention) Acts. The increase in the number of Notifications under the above Acts has increased the work under this head during the year, which is carried out in accordance with, and under the direction of your Medical Officer of Health. Number of articles disinfected at the Disinfecting Station:— Articles disinfected after infectious disease 1929 After Phthisis 267 „ Measles 63 „ Scabies 16 „ Vermin 81 2356 53 Articles Destroyed 106 Number of Rooms disinfected 293 After Phthisis 122 „ Cancer 3 ,, Scabies 1 ,, Vermin 2 421 In addition the whole of the Schools have been disinfected during the Midsummer and Christmas Holidays, and the Wards of the Passmore Edwards Hospital after Erysipelas. Visits to Infectious cases 304 Enquiries into suspicious cases of illness 261 Visits to Tuberculosis cases 194 Visits to Verminous cases 31 (Reported from the Education Department.) REMOVALS TO HOSPITAL. Hornsey Isolation Hospital:— Scarlet Fever 159 Diphtheria 57 The drains and fittings of all the houses where a case of Diphtheria or Enteric Fever has occurred have been tested and any defects removed. Slaughter-Houses and Food Inspection. The number of Slaughterhouses on the Register remains as in previous years, viz:— Four Licensed Slaughterhouses (under P.H.A., 1875). One Licensed Slaughterhouse (under P.H.A.A.A., 1890). 54 The names and addresses are as follows:— 1. Knight, Wm., 301, High Road. 2. Brown, G. H., 103, High Road. 3. Fillary, E. A., 45, Finsbury Road. 4. Jones, F. G., 141, Myddleton Road. 5. Edwards, J., 201, High Road. Only one of these Slaughterhouses is used to any extent, but each of the premises is kept under close observation, and visits paid at times of slaughtering; which, more often than not, is done in the late afternoon and evening; and a large number of carcases was inspected. The following is the list of articles surrendered and destroyed during the year in connection with inspection at Slaughterhouses:— 5 Pigs for Tuberculosis. 35 Pigs' Heads for Tuberculosis (15cwt., 3qrs., 131bs.) 11 Parts of Carcasses. Offal, Livers, etc. Three hundred and live visits have been paid to the above, and 2,235 animals inspected with viscera at time of slaughter. These inspections naturally take up a great deal of the time of your Inspectors, and necessitate attendances long after the Office hours. FOOD INSPECTION. The Butchers, Fishmongers, Fruiterers and other shops where food is prepared or sold have been visited at regular intervals, as well as the stalls in the High Road on Friday and Saturday evenings. 55 The following articles have been surrendered and destroyed:— 1 Box Skate. 1 Box Haddocks. 1 Box Mackerel. 1 Box Flat Fish (3 cwt.) 1 Box Halibut. 1 Box Codlings. 2 Boxes Pears (3 qrs.) 1 Bushel Apples. 1 Coster's Barrow of Cauliflowers (about 300.) Visits paid to premises other than Slaughterhouses 255 Your Chief Inspector and Chief Assistant both hold the Special Certificate for Meat and Food Inspection. Removal of House Refuse. The collection of House Refuse is under the control of this Department, while the disposal of the same at the Destructor is under the control of the Surveyor. The District is divided into eight divisions, with one van, driver and dustman to each division. The vans are the property of the Council, a Contractor supplying the horse and driver. We find this a most economical method of collecting, and the dustmen being under our direct control ensures efficiency in the work. The evidence of this is that during the year only 12 complaints were received of non-collection of House Refuse, while in 1912 the number was 20. Enquiry into each of these complaints was made, and it was found that the fault was not always with the Dustman. The Refuse is collected weekly, with a daily collection from shops and business premises, when the Refuse is placed on the footway for collection. 56 Number of visits to Dust Vans 2057 Number of Loads received 7424 Weight of the Refuse removed 8406 tons, 2 cwt. Average load per van 1 ton 2 cwt. 2 qrs. Vans employed 8 The Fish Offal from fish shops is removed at night by a Contractor who is paid direct by the fishmongers, according to the amount of offal removed. I am pleased to report that the arrangement has worked satisfactorily and with the minimum of nuisance. Clerical Work. There are two Clerks employed in the Office work of the Department. By arrangement with the Education Department, part of the time of the Senior Clerk is occupied in preparing and tabulating for the School Medical Officer in connection with Medical Inspection of School Children. Their time is fully occupied in keeping records, filing, etc., which cannot be tabulated. The following are a few of the details:— No of Letters written 1146 „ Letters received and filed 1184 ,, General Notices issued 600 ,, Statutory 361 ,, Notices to Librarian of Infectious Diseases 410 ,, Notices to Schools of Infectious Diseases 811 ,, Exclusion Notices filed, etc 324 ,, Reports to Committee 15 „ Records of Measles, etc 1890 57 Legal Proceedings. I am glad to be able to report that it was not found necessary to take any legal proceedings during the year. House to House Inspection. The Council have always made a special point of Systematic House Inspection, and the following will give some idea of the work done under this heading during the year. Roads Inspected. No. of Houses. No. of Rooms. Families. Adults. Children. Persons. per room. Commerce Road 14 91 75 107 2.00 Eldon Road 9 46 31 29 1.0 Granville Road 27 162 92 103 1.20 Hornsey Park Road 81 490 292 224 1.05 Kings Road 36 200 112 127 1.19 Richmond Road 37 184 79 83 .88 Selborne Road 8 49 29 43 1.47 Wellesley Road 15 76 35 61 1.26 White Hart Lane (part of). 10 36 19 25 1.22 Winkfield Road 52 323 177 183 1.11 Totals 289 1657 941 985 1.16 A systematic record is kept of all houses inspected under this head. A slight diminution in the number of houses inspected will be noted this year, which is due to being without an Assistant Inspector for two months, owing to the resignation of Mr. Hill, and before Mr. Drake was appointed and could take up his duties. 58 In connection with House Inspection the following nuisances have been dealt with:— Number of Drains repaired 15 ,, ,, New Apparatus to W.C.'s 56 „ „ Water supplied to W.C.'s 22 „ ,, Sanitary Dust-bins supplied 43 „ ,, Roofs repaired 45 ,, ,, Rain water pipes and gutters repaired 73 „ „ Rooms stripped and cleansed 352 ,, „ Houses provided with Air-Bricks, etc., remedy for dampness 189 „ ,, Water Supplies taken direct from main 121 „ „ Yards paved 62 „ „ Nuisances from overcrowding 2 „ ,, New Check Cisterns to W.C.'s 3 „ „ Cisterns cleansed and provided with covers 26 „ ,, Windows made to open 22 ,, ,, Windows provided with sash-cords 31 „ „ Scullery Floors paved 16 „ „ Other Nuisances 264 Drains and Drainage Work. Our usual practice has been followed this year in re-construction work, viz., to test all drains with water, and when the sanitary fittings are involved, to test the whole of the work with smoke, making a sketch plan of the work for future reference. This necessarily occupies a great deal of time. This year, by resolution of the Health and Sanitary Committee, I have had to be present at the final test of all new house drains. The work is carried out, as hertofore, under the supervision of the Surveyor's Department, and the Certificate of Occupation given by the Surveyor. 59 These final tests with smoke and water, although not numerous, take a considerable amount of time, particularly if a block of several houses are under test at the same time; but it was felt by the Committee that as these drains might have to come within their purview under the Public Health Acts, they ought to be represented at the final test. I am pleased to report that this work has been carried out without the least friction between the Surveyor's and Sanitary Departments. The inspection book is signed by me as having been present at the test, otherwise, the Surveyor has sole control of the work. General. I am pleased to be able to report that Mr. Hill in August of this year was successful in obtaining the position of Inspector of Nuisances to the Hitchin District Council. The Committee appointed Mr. Drake from Huddersfield to the vacancy thus created, and he came to us with excellent testimonials from both of his previous positions. We were without an Assistant for just over two months, and the unfortunate sudden illness of Mr. Stanbury, the Chief Assistant, from " sewer gas poisoning" left the Department with myself as sole Inspector for five weeks. The summary of visits given below will give an idea of the multifarious duties which are now thrown upon the Health and Sanitary Departments of Urban Districts. Some of us are old enough to remember when drains and work in connection therewith were almost the Alpha and Omega of the work of the Sanitary Staff but, very wisely, circumstances and legislation now enable us to see that the house generally is 60 " reasonably fit for habitation," and among the reports of Health Officers now appear such items as " windows made to open" etc. The next advance, I trust, will be still more directly concerned with the occupiers of the houses that " the windows made to open '* shall be opened, and that houses made " reasonably fit for habitation " shall be kept so. It has always appeared to me to be somewhat unfair to be able to deal with the owner of property without being able to bring home to the occupier his (or her) responsibility. Summary of Visits during Year. Number of Houses inspected under the Housing and Town Planning Act 289 Number of Visits to Bakehouses 67 ,, „ Slaughterhouses 305 ,, „ Cowsheds 16 ,, „ Milkshops 177 „ ,, Ice Cream Dealers 73 „ ,, Butchers, Fruiterers, etc 551 ,, „ Workshops and Workplaces 247 ,, „ Outworkers 183 „ ,, Infectious cases 304 „ ,, Suspicious cases (from Education Dept.) 261 ,, „ Tuberculosis Cases 209 ,, „ Verminous Cases 31 „ ,, Dust Vans 2057 ,, „ Petrol Stores 48 , ,, Births 1196 Re-visits 1009 7423 Re-inspections 3598 Total 10712 61 It is with much pleasure that I take this opportunity of again expressing my appreciation of the valuable help given by each member of the Staff in carrying out the work recorded in this Report. I am, Gentlemen, Your Obedient Servant, A. E. ADAMS. Inspector of Nuisances.