WOOD 14 Urban District of Wood Green. REPORT OF THE Deputy Medical Officer of Health For 1919. W. E. PORTER, M.D., D.P.H., Fellow of the Royal Institute of Public Health, Deputy Medical Officer of Health. 27th July, 1920. Crusha & Son, Tottenham and Wood Green. Wood Green Urban District Council HEALTH AND SANITARY COMMITTEE, 1919. Councillor Gilbert (Chairman). The Chairman of the Council. The Vice-Chairman of the Council. Councillor Bundy. Councillor Haigh. ,, Haines. ,, Hossent. ,, James. ,, Knott. Councillor Peasant. Sanitary Staff— Medical Officer of Health—T. Slater Jones, M.D., M.R.C.S., L.R.C.P. Deputy Medical Officer of Health—W. E. Porter, M.D., D.P.H., C.M., M.R.C.S.; Fellow of the Royal Inst, of Public Health; Member of the Incorporated Society of Medical Officers of Health. Chief Sanitary 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, Cert. Bldg. Construction, Physiology, Hygiene, etc. Assistant Inspectors—S. C. Stanbury, Cert. R. San. Inst. W. R. Drake, Cert. R. San. Inst. Clerks—G. Billing, A. E. Gooday. Temporary Clerk—Miss I. G. Minett. Health Visitors—Mrs. Parnell; Sister Terheggen, C.M.B., Q.C.H.; Sister Hildyard, C.M.B., Med. and Surg, one year; Sister Wadds, Med. and Surg., C.M.B. 2 Sanitary Department , Town Hall. To the Chairman and Members of the Urban District Council of Wood Green. Mr. Chairman, Ladies and Gentlemen, I beg to submit to you my Annual Report on the Health of the Wood Green Urban District for the year 1919. 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 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 the 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) is uneven and hilly, and 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; it 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. 3 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, Glass Bottle Factory, and Laundry. 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 Walters' 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 1919 was approximately £1,402 0s. 0d. Means of Transit. The District is served by two railways, viz., the Great Northern Railway, with three stations—Wood Green, Bowes Park, and Alexandra Palace; the Great Eastern Railway, with two stations— Noel Park and Palace Gates. There is also a frequent service of trams from London to Finchley, Enfield, Palmers Green and Stamford Hill, running through the District. A motor bus service between Victoria Station and Southgate also goes through the District. 4 Both tram and bus services have a main stopping place at the corner of Lordship Lane and High Road, which is convenient to nearly the whole of the District. There is also a tram service from this stopping place to the Alexandra Palace, making a connecting link for a portion of the Alexandra Park Ward with the tram and bus service at Lordship Lane and High Road. 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 supplv 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, Section 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." Water Courses. There are two water courses in the District, namely, the Muswell Stream and the Moselle Brook. The former takes the surface water from the Muswell Hill District of Hornsey and Wood Green, and pursues a meandering course from Hornsey to the West side of the District, discharging into Pymmes Brook, Southgate, on the North side of the District. 5 This stream is open where it passes through fields in Albert Road and at the rear of Imperial Road, and at the latter point has been the cause of several complaints during heavy rains, the water flooding the gardens of the houses in this road. The question of enlarging the culvert taking this stream was before the Council previous to the war, and of course any contemplated works had to be suspended during that period. The Moselle Brook also takes surface water from Hornsey and Wood Green, entering the District on the South side, flowing under the High Road, and leaving the District on the East side, through Tottenham, finally discharging into the River Lea. Portions of this Brook are still unculverted, and the same remarks apply as to the Muswell Stream. Sewage. The system of drainage is dual, i.e., separate sewers for soil and surface water. Although this method of drainage is not in accord with recent recommendations, the Council are bound by the Wood Green and Tottenham Separation Act to adhere to this method of drainage. The soil drains are 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 the main sewers 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, and are taken into natural water courses, namely, the 6 Muswell Stream and the Moselle Brook, and finally discharged into the River Lea. The public 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 sewers, soil and surface water, is, roughly, 102 miles. 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 and two cottages which are situated on the extreme Eastern boundary of the District, a part yet to be developed. This portion of the District forms part of the Council's Housing and Town Planning Scheme, and negotiations are now proceeding with the London County Council for the development of what is now vacant land, when proper sewers will be provided. Scavenging. The collection of house refuse is undertaken by direct labour so far as the dustmen are concerned, but the carmen and horses are provided by a contractor, the vans being the property of the Council. 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 the destructor was erected. 7 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. 1 may add here that the Council, since the war, have had under consideration the question of house refuse collection by direct labour, and come to the conclusion that it will be more effectively carried out by employing their own carmen and having their own horses. At the time of writing this has already been affected. Number of loads removed 7384 ,, ,, visits to carts on the District 1391 ,, ,, carts employed 9 Weight of refuse removed 7441 tons 12 cwts. Average load per cart 1 ton 17 lbs. The fish offal is collected by a contractor, who deals direct with the fishmongers, making a charge according to the quantity of offal collected. 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. House inspection was entirely suspended during the war, due to the fact that the whole of the staff, with the exception of the Chief Inspector, joined the Army. The Assistant Inspectors were not released until towards the latter end of March, and commenced duties on the 1st of April, although we made strenuous efforts for their release immediately on the signing of the armistice. In common, of course, with other Districts, the arrears of work to be made up in connection with the House Inspection are somewhat heavy. The cost of materials and labour in connection 8 with repairs greatly militates against having the work done in connection with our notices as quickly as we could wish. FOOD INSPECTIONS. There are four slaughter-houses in the District, all of which have been frequently inspected. Three 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 owing to food control they have been, and are, very little used at the present for slaughtering. One slaughter-house is built on modern lines, and the whole of the slaughtering in the District has been carried out here during the year. In the course of inspection the following have been surrendered: Meat:— 44 lbs. of beef. Kidneys and offal of heifer. 16 lbs. ham. 343 lbs. bacon. 201 rabbits. 25 lbs. of sausages. 3 tins of corned beef. 5 tins of tinned meat. Fish:— 2 cases of herrings. 10 boxes of kippers. 10 stone skate. 2 boxes of skate. 1 box hake. 1 box cod. 1 trunk rock salmon. 3 stone mackerel. 9 Fruit:— 9 boxes dates. 1 parcel raisins. 77 lbs. tomatoes. 3 lbs. greengages. 15 lbs. black currants. 7 lbs. butter. 17½ lbs. cheese. The Chief Inspector and Chief Assistant both hold the Certificate of Meat and Food Inspection. Milk Supply. There is one Registered Cowkeeper in the District, but no cows have been kept for some years. There are 38 purveyors of milk. During the year there have been 6 applications for Registration by purveyors of milk, these all being for changes of premises. These premises are periodically inspected, and on the whole are kept in a satisfactory condition, and no infectious or other disease has been traced to the milk supply. Bakehouses. All the bakehouses (22) have been periodically inspected during the year. There is one underground bakehouse in the District, certified by the Sanitary Authority. I am of opinion that with reference to bakehouses, the Council should have power to make by-laws to regulate the conditions of 10 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. 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:— Article. Taken. Adulterated. Milk 57 4 Milk, Evaporated 3 — Self-raising Flour 2 — Baking Powder 1 — Custard Powder 1 — Coffee 1 — 65 4 Number of Prosecutions 2 Number of Convictions 2 Amount of Fines imposed £1 10s. Od. Ice Cream. There are 68 Ice Cream premises in the District, most of which are small sweet shops, and all of which have been regularly inspected. Fried Fish Shops. There are 11 fried fish shops in the District, all of which have been periodically visited, and are, for the most part, maintained in a satisfactory condition. 11 WORKSHOPS, WORK-PLACES, AND HOMES OF OUTWORKERS. The workshops, work-places and outworkers' homes are kept under constant supervision, and precautions are taken to ensure that the work done in these places is carried out under the best possible conditions. There are four large workshops in the District, employing about 100 females in blouse-making for firms in London. Beyond this the workshops are small, employing from 2 to 6 hands, as occasion may require. On the whole they have been kept in a satisfactory condition. ISOLATION HOSPITAL. Infectious cases are removed to the Hornsey Isolation Hospital, by an agreement entered into between the two Councils. This agreement will expire on the 6th June, 1920, and negotiations are in progress with the Southgate District Council for making additions to their Hospital with a view to providing sufficient accommodation for cases from the District of Wood Green. This Hospital is almost on the Wood Green boundary, and would be very convenient for the greater part of our District. I have already pointed out that this is an urgent matter, as when our agreement expires with Hornsey, and if the negotiations with Southgate are not complete by the 6th June, 1920, we shall only have at our disposal any beds which may be vacant at the Hornsey Hospital, or by permission of any other Hospital which will accept our patients. This is a serious matter in a District with our population. 12 The following eases have been removed during the year:— Hospital. Scarlet Fever. Diphtheria. Enteric. Cerebro Spinal Fever. Hornsey 106 80 1 1 Southgate — 3 1 – Enfield 1 1 – – 107 84 2 1 INFECTIOUS CASES REMOVED TO HOSPITAL. Ward. Diphtheria Scarlet Fever. Enteric Fever. C.S.M. Total. Percentage of Cases. Removed. Town Hall 18 32 1 – 51 92.72 Bowes Park 5 12 – – 17 89.47 Central 27 18 – – 45 83.33 Noel Park 34 35 1 – 70 90.90 Alexandra Park – 10 – 1 11 42.30 84 107 2 1 194 83.98 Errors in Diagnosis— Town Hall 1 – – – 1 Central 1 – – – 1 Noel Park – – 1 – 1 13 The following deaths have occurred in the Isolation Hospitals:— Age. Disease. No. of Day after Admission. Cause of Death. Hornsey 3 Diphtheria 8 Diphtheria Hornsey 4 Diphtheria 6 Diphtheria Hornsey 5 Diphtheria 2 Diphtheria Hornsey 8 Diphtheria 8 Diphtheria Hornsey 2 Diphtheria 1 Diphtheria Laryngeal Hornsey 16 Cerebro Sp. M. 4 Cerebro Sp. M Southgate 1½ Diphtheria 26 Diphtheria Southgate 10 Enteric 10 Enteric ZYMOTIC DISEASES. The seven principal Zymotic Diseases caused 14 deaths, which corresponds to an annual rate of .27 per 1,000 of the population, against 21 deaths, or .43 per 1,000, in 1918. The following are the numbers of deaths from each of these diseases for the years 1919 and 1918:— Disease. Number of Deaths— 1919. 1918. Small Pox - - Scarlet Fever 1 - Diphtheria 9 5 Enteric Fever 1 1 Measles - 5 Whooping Cough 1 6 Diarrhoea 2 4 14 21 14 BACTERIOLOGICAL EXAMINATIONS. The number of examinations made during the year was as. follows:— Positive. Negative. Total Diphtheria 50 174 224 Enteric Fever — 1 1 Pulmonary Tuberculosis 26 68 94 Ringworm 7 2 9 Water — — 1 83 245 329 Smallpox and Typhus Fever. No cases of Smallpox or Typhus Fever have been notified during the year. Acute Anterior Poliomyelitis. One case of Poliomyelitis was reported from the Central Ward, a boy aged 8 years. Had not been attending school for about three months, being delicate; was first noticed with severe cold and headache; a few days afterwards his right arm was found to be paralysed, when he was taken to see a medical practitioner, who advised his removal to St. Bartholomew's Hospital, where the disease was diagnosed. There was absolutely no history of infection; the boy had not been away from home, and there were no known cases in the District. The patient has made a good recovery, his arms being slightly affected, which the hospital authorities are of the opinion will be all right in time, with treatment. 15 Cerebro Spinal Meningitis. There were two cases notified, one, a male aged 16 years, whowas employed in town; notified on the 22nd February. Patient had a history of " obstinate nasal cold " for two or three months, and had been attended by a Medical Practitioner for the whole of that period. He was suddenly taken with a very severe headache, and removed on the same day that the disease was notified, to the Isolation Hospital, where he died four days later. The second case was that of a female, aged 9 months, notified on the 7th March. There was a history of the patient being noticed with a cold " six days previously, but the doctor was not called in until the 5th March, when the patient had lost consciousness. The case was diagnosed as pneumonia, but after death notified as Cerebro Spinal Meningitis. The father, who was in the Army, stationed at Salisbury, had not been home since the previous January. Encephalitis Lethargica. Two cases of Encephalitis Lethargica were notified during the year, both of which were removed to the Prince of Wales's Hospital, Tottenham. The first case was reported from hospital as an error in diagnosis, the child, aged 4 years, found to be suffering from "Acidosis. " The second was a male, aged 44 years, who was employed on the railway. He had complained of being "seedy," and having pains at the back of his eyes for some three weeks previously to notification, and had been attended throughout by a medical practitioner. 16 There was no history of infection, and the patient made a good recovery and was able to go back to his employment. Enteric Fever. There were two cases of Enteric Fever notified during the year, with one death, against two cases, with no deaths, in 1918. The first case was a male patient, aged 37 years, living and employed in the Central Ward. There was a history of this patient attending a dinner in town, about three weeks previously to his illness, and having partaken of oysters for the first time in his life; no definite history of infection could be traced. The second case was a boy, aged 11 years, who had been suffering with diarrhoea for about a month, and was attended by a medical practitioner off and on during the whole period. When I saw the boy he was in a state of collapse, and I ordered his immediate removal to the Isolation Hospital, where he died ten days later. In this case no sort of history of infection could be' traced, and the patient was too ill to give any account of his movements . Erysipelas. There were 24 cases of Erysipelas notified, with one death, against 16 cases, with one death, in 1918. Puerperal Fever. Three cases of Puerperal Fever were notified during the year. The first was in the Town Hall Ward, notified in February, and proved fatal. The patient was attended in her confinement by a medical man and a nurse. 17 The second, also in the Town Hall Ward, notified in May, and attended in her confinement by a medical practitioner, made good recovery. The third, in the Bowes Park Ward, was removed to the Edmonton Infirmary, and proved fatal; in this case also, a medical practitioner was in attendance. CASES REFERRED FROM THE EDUCATION DEPARTMENT. The Education Secretary daily forwards to this Department all cases of sore throat, etc., which come to the knowledge of the School Attendance Officers during their enquiries. The number of cases reported during the year were:— Sore Throats 690 Chicken Pox 85 Whooping Cough 155 Other Cases 933 1863 Investigations into 124 of the above cases were made by the Inspector, where I was of the opinion that such inquiry was necessary, and severe cases of sore throats were referred to me for examination and taking swabs. 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. 18 Day and Sunday Schools are notified, also the Librarian, of all cases and contacts, if thought necessary. No scholar from any family affected is allowed to return to school 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 Disinfector, 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 90 tubes (180,000 units) were supplied during the year. (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 always 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. 19 SCARLET FEVER AND DIPHTHERIA. Schools Attended. Scarlet Fever. Diphtheria. NOEL PARK:— Boys 7 - Girls 5 - Infants 14 4 26 4 WHITE HART LANE:— Boys 4 6 Girls 5 2 Infants 7 6 16 14 HIGHER GRADE:— Boys 2 - Girls 3 2 5 2 BOUNDS GREEN:— Boys 1 - Girls 3 1 Infants 3 3 7 4 20 ALEXANDRA:— Boys 2 3 Girls - 1 Infants 3 3 5 7 LORDSHIP LANE:— Scarlet Fever. Diphtheria: Boys' 1 1 Girls' 3 1 Infants' 3 9 7 11 ST. MICHAEL'S:— Mixed 4 2 Infants' 4 4 8 6 MUSWELL HILL MIXED 11 - ST. PAUL'S 2 5 SECONDARY 1 - PRIVATE 4 1 SCHOOLS OUTSIDE DISTRICT 6 3 NOT ATTENDING SCHOOL - 2 OVER SCHOOL AGE 11 14 UNDER SCHOOL AGE 25 20 21 26.86 per cent. of Scarlet Fever cases notified did not attend School. 8.2 percent. of Scarlet Fever cases notified were patients above School age. 38.7 percent. of Diphtheria cases notified did not attend School. 15.05 per cent. of Diphtheria cases notified were patients above School age. SANITARY CONVENIENCES. Three Sanitary Conveniences are provided for the public:— (1) At the junction of High Road and Lordship Lane, the accommodation being:—Males—6 W.C.'s, 12 Urinals, Wash and brush up. Females—4 W.C.'s, Wash and brush up. (2) Station Road, opposite Wood Green Station and the bridge over the G.N. Railway leading to the Alexandra Palace. Males—2 W.C.'s, 6 Urinals. Females— 2 W.C.'s. (3) Town Hall Park, nearly opposite Sidney Road, with entrances from the High Road and the Town Hall Park. Males—2 W.C.'s, 3 Urinals. Females—2 W.C.'s. The accommodation at the latter has been found to be quite inadequate, and the Health Committee have recommended that an addition should be made to this convenience. At the time of writing this Report the Works Committee have the matter in hand, with a view to carrying out that recommendation. BATHS. An Open-air Swimming Bath is provided, adjoining the Alexandra Park Race Course, which was open from about the beginning of May to the end of September. 22 The closed-in bath, situated in Western Road, has been open since August, 1911. In addition to the large pond, provision is made at the latter for slipper and spray baths, both male and female. One evening in the week has been set apart for Mixed Bathing at the Western Road Baths, under proper rules and regulations, and has proved most popular. The provision of another swimming pond, and additional slipper baths, at Western Road, is under consideration. The Surveyor has kindly supplied me with the following figures:— (a) OPEN-AIR BATHS (Alexandra Park Ward):— Number of Attendances 13,343 (b) WESTERN ROAD BATHS:— Month. Adults. School Children January 3,304 — February 3,229 — March 4,948 — April 7,403 — May 20,616 3,441 June 18,323 3,452 July 14,587 2,176 August 19,487 — September 14,707 30 October 7,004 — November 5,453 — December 5,507 — 124,568 9,099 23 POPULATION. The Registrar-General has supplied me with the estimated population for the year 1919, which is, for the purposes of Birthrate, 52,410, and for the Death-rate, 50,312. The estimated population for each Ward, based on the above figures, is as follows:— Birth Rate. Death Rate. Town Hall 11,864 11,460 Bowes Park 7,996 7,670 Alexandra Park 7,559 7,200 Central 10,970 10,450 Noel Park 14,021 13,532 52,410 50,312 The Census population in 1911 was 49,369. The area of the District is 1,631 acres, or 1,625 exclusive of that covered by water. The average number of persons per acre for the year 1911 was 30.38, and for the year 1919, 32.25. Average Number or Persons per Acre in Wards. 1911. 1919. Increase. Alexandra Park 11.77 12.72 0.95 Bowes Park 28.33 32.44 4.11 Central 47.82 50.09 2.27 Noel Park 83.94 88.18 4.24 Town Hall 28.60 30.57 1.97 24 BIRTHS. There were 750 Births, as against 691 in 1918 and 882 in 1917. The births were:—289 males and 361 females; of these, 29 were illegitimate (viz., 15 males and 14 females). This corresponds to an annual rate of 14.31, compared with 12.88 per thousand in 1918, and 16.96 per thousand in 1917. The Birth-rate for England and Wales was 18.5. The following table gives the number of births registered within and without the District, and the Birth-rate for each Ward— Births Registered. BirthBate. Town Hall 196 16.52 Bowes Park 139 17.38 Alexandra Park 81 10.71 Central 178 16.22 Noel Park 156 11.12 750 14.31 DEATHS. There were 405 deaths registered within the District during the year, and there were 157 residents died outside the District, making a total of 562, from which must be deducted 18 deaths of non-residents. The correct number is therefore 544, which is equal to an annual rate of 10.81 per 1,000 of the population, as compared with 13.8, the death-rate for England and Wales for the same period. 25 The following are the number of deaths and the death-rate per 1,000 for each Ward:— Ward. No. of Deaths. Death Rate. Town Hall 125 10.91 Bowes Park 82 10.69 Alexandra Park 87 12.08 Central 112 10.71 Noel Park 138 10.19 There were 51 deaths of children under one year, which corresponds to a rate of 68 for every 1,000 births, against 39 deaths or a rate of 56.43 last year. The rate for the whole of England and Wales was 89 (90 in smaller towns, i.e., with census population of 20,000 to 50,000). The deaths of children under five years was 67, which corresponds to a rate of 1.13 per 1,000 of the general population, against 73, or a rate of 1.52 per 1,000 in 1918. 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. Houses Inspected (systematic inspection) 333 Complaints with respect to Alleged Nuisances 8 Visits to Infectious Cases 296 Visits to Tuberculosis 149 Visits to Slaughter-houses 58 Rooms Disinfected 238 Articles Disinfected 7745 Letters Written 1215 Enquiries into Births 776 Letters Received and Filed 1234 Birth Cases Followed up and Re-visited 1345 Enquiries into Deaths of Children under 1 year 51 2G INFECTIOUS DISEASE (NOTIFICATION AND PREVENTION) ACTS. Number of articles Disinfected at the Disinfecting Station:— Articles Disinfected after Infectious Disease 1519 „ „ „ Phthisis 105 „ „ „ Cancer 36 „ „ „ Measles 15 „ „ „ Scabies 24 „ „ „ Vermin 17 „ „ „ Puerperal 34 1750 „ „ for Alexandra Palace 5995 7745 „ Destroyed 64 7809 PUBLIC MORTUARY. Bodies deposited during year 29 Inquests held 28 Post Mortem Examinations made 24 Causes of Death :— Natural 14 Accidental 5 Misadventure 4 Suicide 5 Inattention at Birth 1 29 27 HOUSE-TO-HOUSE INSPECTION. No. of Houses. No. of Rooms. Families. Persons per room. Adults. Children. Alexandra Terrace 4 25 29 7 1.44 Blenheim Road 1 5 7 2 1.80 Commerce Road 3 21 20 12 1.52 Elm Lane 4 16 11 5 1.00 Granville Road 115 512 411 181 1.15 Meads Road 35 150 133 32 1.10 Lordship Cottages 5 20 18 12 1.50 Station Road 2 13 10 4 1.07 Selborne Road 75 260 230 92 1.24 Wolseley Road 89 262 232 120 1.30 Totals 333 1284 1101 467 1.22 HOUSING AND TOWN PLANNING ACT. In common with other Districts, the housing problem is one of the greatest difficulties with which we are faced in the sanitary work of the District, and new houses are an urgent necessity. During the year we have come across many houses which though legally may not be classed as over-crowded, yet there is no doubt that they are occupied by more persons than they should be from a health point of view. It is very hard, of course, to give an accurate estimate of the number of houses occupied by more than one family, but perhaps it would not be too much to say that at least 70 per cent. are so occupied. Many of these houses were built to accommodate only one family, and the conveniences, etc., for two or more families, are far from satisfactory, to say the least. 28 Under these conditions it is almost impossible to take proceedings for over-crowding, which would only mean that the familywould probably move from one house to another similar, and consequently the conditions would remain the same. I submit a list of the roads and houses inspected during the year, showing the number of persons per room, and although this does not tend to show to any marked degree over-crowding, there is no question that many of the houses inspected are not suitable for more than one family. The Council have under consideration the Ministry of Health's requirements for the building of one thousand houses, and I trust that it will not be long before a start is made in this direction. Many of the houses inspected have naturally been neglected during the war on account of the want of labour, and now our difficulty appears to be with respect to having repairs done, the cost of labour and material, and the difficulty experienced in obtaining the latter. OPEN SPACES. The District is to be congratulated upon the foresight of former Councils in making provision of open spaces, and the present Council following the same lines in acquiring further land for open spaces, in view of the fact that no doubt as London extends, and the District becomes more developed, these spaces will prove a great asset from a health point of view. The total area of open spaces in Wood Green, including the Alexandra Palace Park, is 242 acres. Several of these open spaces are laid out as playing fields, others as gardens, and prove an ornament to the District, as we'll as breathing spaces. 29 Negotiations are in progress with respect to further land in the Noel Park Ward. ACTS OF PARLIAMENT ADOPTED. Infectious Disease (Notification) Act, 1889. Infectious Disease (Prevention) Act, 1890. Public Health Acts Amendment Act, 1890 (Parts 2 and 3). Public Libraries Acts. Housing of the Working Classes Act, 1890 (Part 3). Baths and Wash-houses Acts. Notification of Births Act, 1907. BY-LAWS, REGULATIONS, ETC. (Made by the Urban District Council). (1) 1889.—Standing Orders for the Regulation of Proceedings and Business of the Council. (2) 1891.—By-laws with respect to Slaughter-houses. (3) 1891.—Regulations under the Contagious Diseases (Animals) Act, 1886, and the Dairies', Cowsheds' and Milkshops' Order, 1885. (4) 1892.—By-laws for the Regulation of the Wood Green Commons. (5) 1893.—By-laws with respect to New Streets and Buildings. 30 (6) 1901 .—By-laws with respect to New Buildings and the Alterations of Buildings. (7) 1901.—Regulations with respect to Allotments. (8) 1901 .—By-laws under the Public Health Act Amendment Act, 1890, with respect to telegraph and other wires. (9) 1901 .—By-laws for the Prevention of Nuisances arising from Snow, Filth, Dust, Ashes and Rubbish, and for the Prevention of the Keeping of Animals on any Premises so as to be Injurious to Health. (10) 1908.—By-laws under the Employment of Children Act, 1903. (11) 1908.—By-laws as to New Streets and Buildings (amending By-laws 10, 16 and 21 of the series of 1893 relating to the Construction of External and Party Walls). (12) 1908.—By-laws with respect to the Management, Use and Regulation of the Open-air Public Swimming Bath. (13) 1909.—Regulations with respect to the Management, Use and Conduct of the Bowling Green. (14) 1909.—By-laws with respect to Tents, Vans, Sheds, and similar structures, Used for Human Habitation. (15) By-laws with respect to Houses Let in Lodgings or occupied by persons of more than one family. (16) Regulations with respect to Dairies, Cowsheds and Milkshops (in substitution for the Regulations made in 1891). 31 MATERNITY AND CHILD WELFARE. For the purposes of this work I have thought it advisable todivide the town into Eastern and Western Districts, placing a Health Visitor in charge of each area, and for the sake of convenience they are known respectively as Sister East and Sister West. During the year we opened two centres—one, St. John's Hall, Brook Road (Fridays, from 1.30 to 4 p.m.), and one at the Congregational Hall, Alexandra Park Road (Mondays, 1.30 to 4 p.m.). I regret to report that the latter centre did not prove the success, with respect to the attendances, that the Committee had anticipated, and we had, reluctantly, to close the same after being opened for twelve months. So that during the year Child Welfare Centres were opened at:— Monday.—Congregational Church Hall, Arcadian Gardens— 1.30 p.m. to 4 p.m. Tuesday.—Trinity Hall, Trinity Road—9.30 a.m. to 12 noon, 1.30 p.m. to 4 p.m. Wednesday.—Congregational Hall, Lordship Lane—1.30 p.m. to 4 p.m. Thursday.—Congregational Hall, Lordship Lane—9.30 a.m. to 12 noon, 1.30 p.m . to 4 p.m. Friday.—St. John's Hall, Brook Road—1.30 p.m. to 4 p.m. The Alexandra Centre, to which I referred above, was opened on Mondays, from 1.30 to 4 p.m. 32 The Lordship Lane Centre was opened on the 3rd May, 1917: the Trinity Road Centre in January, 1919; the Brook Road Centre on the 1st August, 1919; and the Arcadian Gardens Centre on the 20th October, 1919. It will be seen from the figures which 1 give below that the centres have proved very popular, and that the attendances have increased in a considerable degree. Miss Wadds, who was primarily appointed as a nurse for pneumonia and measles, has assisted during the year at the centres and with the home visiting. It is also satisfactory to note that the notifications of births have risen to 94.66 per cent. I have once more to thank the voluntary workers at the Child Welfare Centres for their work in connection therewith, and must mention that a Clothing Club has been started, by which mothers pay in a small sum per week and receive garments for themselves and children at cost price. This has been greatly appreciated, and I have no doubt has helped to make the centres more popular and encouraged the attendances at the centres, which is one of the objects at which we aim. The day on which the Annual Garden Party was given, in connection with Baby Week, proved unfortunately to be wet, and consequently we had to have an indoor meeting in the Trinity Hall, Trinity Road, which was kindly lent free of charge by the Trustees, and I have to acknowledge their kindness in this direction. All arrangements had been made for the out-door party, and having suddenly to alter our arrangements made a great deal of work for the helpers in connection therewith. 33 Whilst the rooms were more crowded than we anticipated, everyone did their best to make it a success, and we have to thank the ladies for providing the entertainment. Number of Births Registered within the District 750 Number of Births Notified within the District 710 (Notifications equal 94.66 per cent. of Births registered within the District.) Number of visits paid to homes (birth cases) 2093 Number of visits paid to homes (pre-natal cases) 178 Enquiries into deaths of children (under one year) 51 Number of visits paid to homes (1 to 5 years) 2593 Enquiries into Ophthalmia Neonatorum 8 Special visits 38 Special visits to Puerperal Fever cases 6 6427 During the period under review, 511 pre-natal cases were under our care, 462 babies were born, leaving 49 pre-natal cases at the end of the year. One hundred and two of the above visited the centres, and made a total of 412 attendances. 34 Attendances at Maternity and Child Welfare Centres. 1919. 1918. January 598 234 February 491 435 March 651 526 April 710 483 May 1053 444 June 755 858 July 744 602 August 804 664 September 967 604 October 1007 549 November 1380 598 December 856 409 10,016 6,406 1919. 1918. Number of Babies Visiting Centres 479 382 Number of Children Visiting Centres (ages from 1 to 5 years) 455 367 Number of Pre-Natal Cases Visiting Centres 102 38 1,036 787 35 Children. Total Attendances Habits. Ages 1—5 25 28 made 1 attendance 53 33 54 „ 2 attendances 174 22 33 „ 3 „ 165 29 33 ,, 4 „ 248 34 31 ,, 5 „ 325 24 18 ,, 6 „ 252 23 31 ,, 7 „ 378 21 24 .. 8 ,, 360 20 23 ,, 9 „ 387 16 15 ,, 10 ,, 310 15 12 ,, 11 ,, 297 15 12 „ 12 „ 324 202 141 made over 12 attendances 6743 479 455 10,016 Attendances by Pre-natal Cases 412 10,428 The number of Still-births during the year was 17 Attended by Medical Practitioners 5 Attended by Mid wives12 17 36 DENTAL TREATMENT. Arrangements were made during the year for the dental treatment of expectant, nursing mothers, and children under 5 years of age. As an experiment, we were enabled, through the courtesy of the Education Committee, to utilise the School Dental Clinic for this purpose, and to obtain the services of the School Dental Surgeon. We have not been quite so successful as one could have wished in persuading the women to have dental treatment, but useful work has been done, and I trust that in the future this will grow. Dentures have been supplied at a reduced rate, and in one or two eases free, on the recommendation of the Maternity and Child Welfare Committee. The numbers dealt with have been as follows:— New Dentures Provided 8 Extractions 170 Fillings, Scalings, etc. 8 PROVISION FOR CONFINEMENTS. We have made arrangements with the Edmonton Board of Guardians for lying-in accommodation, normal as well as abnormal, iu the Special Ward which they have opened for Council cases. This Ward is quite separate and distinct from the Poor Law administration, with entirely separate entrance, and only Council oases are admitted upon payment by the Councils concerned, 37 In cases of necessity I have made arrangements for women going into the Maternity Home to be conveyed thereto by motor ambulance, be it during the day or the night. Nine cases were admitted from Wood Green during the year, most of whom contributed towards the cost of their maintenance. In concluding the Report, I should like to tender my thanks to all the members of the Public Health, also the Maternity and Child Welfare Committees, for their kind consideration and support in all matters I have had the honour to submit to them. I have also to acknowledge my thanks to the staff of the Public Health Department for their valuable assistance. I am, Ladies and Gentlemen, Your obedient servant, W. E. PORTER, Deputy Medical Officer of Health. Infantile Mortality during the Year 1919. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 1 month. 1 to 3 months. 3 to 6 months. 6 to 9 moDths. 9 to 12 month?. Total under 1 year. Small Pox - - - - - - - - - - Chicken Pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever - - - - - - - - 1 1 Diphtheria and Croup - - - - - - - - - - Whooping Cough - - - - - - - 1 - 1 Diarrhœa - - - - - 1 - - - 1 Enteritis - - - - - 1 - - - 1 Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous - - - - - - - - - - Diseases Congenital Malformations 3 1 1 - 5 4 - — - 9 Premature Birth 8 1 1 - 11 4 - — — 15 Atrophy, Debility and Marasmus - 1 2 - 3 1 - 1 - 5 Atelectasis - - - - - - - - - - Injury at Birth - - - - - - - - - - Erysipelas - - - - - - - - - - Syphilis - - - - - 1 - - - 1 Rickets - - - - - - - - - - Meningitis - 1 - - 1 - 2 2 2 7 Convulsions 1 - - 1 2 - 1 - - 3 Gastritis - - - - - - - - - - Laryngitis - - - - - - - - - - Bronchitis - - - - - - 1 - - 1 Pneumonia (all forms) - - - - - - - - - - Suffocation, overlying - - - - - - - - - - Other Causes 1 1 1 - 3 1 1 - 1 0 13 5 5 2 25 13 5 4 4 51 Causes of, and ages at death during the year 1919, in the Urban Sanitary District of Wood Green. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. Enteric Fever 1 - - - 1 - - - - Small-pox - - - - - - - - - Measles - - — - - - - - - Scarlet Fever 1 1 - - - - - - - Whooping Cough 1 1 - - - - - - - Diphtheria and Croup 9 - - 4 5 - - - - Influenza 66 4 1 2 3 10 30 7 9 Erysipelas 1 - - - - 1 - - - Pulmonary Tuberculosis 32 - - - 2 6 17 4 3 Tuberculous Meningitis - - - - — - - - - Other Tuberculous Diseases 5 - - 1 1 1 2 - - Cancer, Malignant Disease 56 - - — — — 3 31 22 Rhumatic Fever 2 - — — 1 — 1 - - Meningitis 7 7 - — — — — - - Organic Heart Disease 54 - — - 1 5 8 16 24 Bronchitis 55 1 1 - — — 2 10 41 Pneumonia (all forms) 30 - 1 - — 3 8 11 7 Other Respiratory Diseases 6 - - - — — - 2 4 Diarrhœa, etc. (under 2 years) 2 2 — - - — — — — Appendicitis and Typhlitis 5 - - - 2 — 1 1 1 Cirrhosis of Liver - — — — — — — — — Alcoholism - — — — — - — — — Nephritis and Bright's Disease 13 - - — - 1 — 6 6 Puerperal Fever 2 - - - - - 2 - - Parturition, apart from Puerperal Fever 1 - - - — - 1 - — Congenital Delility, etc. 20 29 — — — - — — - Violence, apart from Suicide 13 - 1 1 2 — 2 4 3 Suicide 5 - - - - - 3 2 — Other Defined Diseases 143 6 - 4 2 1 12 39 84 Causes Ill-defined or Unknown - - - - - - - - - Totals 544 51 4 12 20 28 92 133 204 40 INFECTIOUS DISEASES IN WARDS—1919. Town Hall. Noel Park. Central Bowes Park. Alex. Park. Totals Diphtheria 20 33 31 6 3 93 Erysipelas 7 3 6 I 7 24 Scarlet Fever 34 43 22 13 22 134 Pneumonia 4 — 7 2 5 18 Malaria 13 7 6 2 2 30 Puerperal Fever 1 — — 2 — 3 Phthisis 18 17 17 9 8 69 Other T. B. 4 6 — 3 3 16 Measles 46 23 13 13 7 102 German Measles 13 4 3 5 13 38 Ophthalmia Neon. 3 1 — — — 4 Influenzal Pneu. 4 7 6 3 4 24 Encephalitis Leth. — — - — 1 1 Cerebro S. F. — 1 — — 1 2 Poliomyelitis — — 1 — — 1 Enteric Fever 1 — 1 — — 2 Dysentery — — 1 — — 1 Totals 168 145 114 59 76 562 Alexandra Palace (German Prisoners of War;. Erysipelas 1 Pneumonia 2 Phthisis 6 Other T. B. 1 Influenzal Pneu. 47 57 41 INFECTIOUS DISEASES IN AGE GROUPS—1919. All ages Under 1 year 1 to 5 years 5 to 15 years 15 to 25 years 25 to 45 years 45 to 65 years 65 and upwards Diphtheria 93 1 18 61 9 4 — - Erysipelas 25 - 1 — 3 10 6 5 Scarlet Fever 134 1 25 97 10 1 — - Pneumonia 20 1 2 — 5 5 6 1 Malaria 30 — — — 5 24 1 - Puerperal Fever 3 - — - - 3 — — Phthisis 75 — — 2 10 46 14 3 Other T.B. 17 — — 8 4 4 1 — Measles 102 1 31 66 2 2 — — German Measles 3S 1 5 21 10 1 — — Ophthalmia Neon. 4 4 - - - - - - Influenzal Pneu 71 - 1 1 14 49 3 3 Encephalitis Leth. 1 - - - — 1 — — Cerebro S.F. 2 1 - - 1 — - — Poliomyelitis 1 - - 1 — - — — Enteric Fever 2 - — 1 — 1 — — Dysentery 1 — — — 1 - — — Total 619 10 83 258 74 151 31 12 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK. 1.—Inspection. Including Inspections made by the Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Prosecutions. Inspections. Written Not ices. Factories— 1 1 - (Including Factory Laundries.. Workshops— (Including Workshop Laundries) 311 3 — Workplaces— (Other than Outworkers' premises, included in Part 3 of this report) 163 - - Total 475 4 — 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied Referred toH.M. Inspector Notices under the Public Health Acts— Want of Cleanliness 4 4 — — Want of Ventilation — — — — Overcrowding — — — — Want of Drainage of Floors — — — — Other Nuisances — — — — Sanitary Accommodation— Insufficient — — — — Defective - —- — - Not separate for Sexes — — — - Offence under the Factory and Workshop Act— Illegal Occupation of Under ground Bakehouse (s. 101) - - - - Breach of Special Sanitary Requirements for Bakehouses (ss. 97 to 100) 3 3 - - Other Offences (excluding Offences relating to Outwork which are included in part 3 of this Report) - - - - Total 7 7 — — 43 3.—Homework, Wearing Apparel, Making, &c.—Outworkers' Lists, Section 107. lists received from Employers twice in the year. Lists—Outworkers, Contractors Outworkers, Workmen Numbers of addresses of Outworkers received from other Councils 273 Numbers of addresses of Outworkers forwarded to other Councils — Numbers of Inspections of Outworkers' Premises 164 4.—Registered Workshops. Workshops on the Register (S. 131) at end of Year. Important Classes of Workshops, such as Workshop Bakehouses may be enumerated here Dressmakers 10 Milliners 6 Blouse Makers 9 Dining Rooms 13 Laundries 4 Bakehouses 22 Other Workshops (various) 65 Total number of Workshops on Register 129 44 5.—Other Matters. Matters Notified to H.M. Inspector of Factories:— Failure to affix Abstract of Factory and Workshop Act (S 133) 7 Action taken in matters referred to by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (S.5) Notified by H.M. Inspector 4 Reports (of action taken) sent to H.M. Inspector 4 Other — Underground Bakehouses (S.101):— Certificates granted during the year — In use at the end of the year 1 45 SANITARY WORK, 1919. Inspections— Number of Premises Inspected on Complaint 8 Number of 1'remises inspected in connection with Infectious Diseases 296 Number of Premises under Periodical Inspection 239 Houses Inspected from House-to House (H. and T.P. Act, Sect. 17) 333 Total Number of Inspections and Ke-inspections made 2682 Action Taken (Other than under H. and T.P. Act)— Cautionary or Intimation Notices Given 565 Statutory Orders Issued 306 Summonses Served 3 Convictions obtained 1 Bakehouses— Number in District 22 slauchterhouses— Number on Register 4 Number of Inspections made 58 Cowsheds— Number on Register (not in use), (see Dairies, etc.) 1 Dairies and Milkshops— Number on Register 38 Number of Inspections made 131 Unsound Food— Meat (including organs) seized and surrendered. (Approximate weight in pounds) 858 Fish seized and surrendered. (Approximate weight in pounds) 316 Fruit and Vegetables seized and surrendered. (Approximate weight in pounds) 658 Other Articles seized and surrendered. (Approximate weight in pounds) 24½ Method of disposal : Burnt in Destructor, 46 Water Supply and Water Service— Draw-Taps placed 011 Mains 19 Percent ige of Houses supplied on Constant System 100% Number of Samples obtained for Analysis from Public Supply 1 DRAINAGE AND SEWERAGE OF EXISTING BUILDINGS— Water Closets Repaired, Supplied with Water, or otherwise Improved 94 Percentage of Houses provided with Water Closets 100% Drains—Unstopped, Repaired, Trapped, etc 44 Waste Pipes, Rain Water Pipes Disconnected, Repaired, etc. 109 New Soil Pipes or Ventilating Shafts Fixed 5 Disconnecting Traps or Chambers Inserted 2 Re-constructed 12 Percentage of Houses Draining into Sewers 100% Disinfection— Rooms Disinfected—Ordinary Infectious Diseases 227 Phthisis 11 Rooms Stripped and Cleansed 144 Articles Disinfected or Destroyed—Ordinary Infectious Diseases 7704 Phthisis 105 Dust— New Bins Provided 222 Removed from each house once per week. Number of Complaints of N011-Removal received 8 Method of Disposal : Destructor. Sundry Nuisances Abated— Accumulations of Refuse 15 Foul Pigs and Other Animals 6 Dampness 13 Yards Repaved or Repaired 14 Other Nuisances 615