WOOD 015 Urban District of Wood Green. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1920. W. E. PORTER, M.D., D.P.H. (Fellow of the Royal Institute of Public Health), Medical Officer of Health. April, 1921. Crusha & Son, Tottenham and Wood Green. Wood Green Urban District Council. HEALTH AND SANITARY COMMITTEE, 1920. Councillor Gilbert (Chairman). The Chairman of the Council. The Vice-chairman of the Council. Councillor Mrs. Bolster. Councillor Hossent. „ Haigh. „ James. „ Haines. „ Knott. Councillor Peasant. MATERNITY AND CHILD WELFARE COMMITTEE, 1920 Councillor James (Chairman). Councillor Rhys, J.P. Councillor Mrs. Bolster. „ „ Hodge. „ Brown. ,, Gilbert. Mrs. Brown, (appointed Chairman, June, 1920.) ,, Denham, „ Duncan, ,, Reid, ,, Rhys, Councillor Haines. ,, Peasant. ,, Ricketts. „ Salt. Co-opted Members. 2 Sanitary Staff— 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, and 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. Building Construction, Physiology, Hygiene, etc. Assistant Inspectors.—S. C. Stanbury, Cert. R. San. Inst. A. J. Nichols, Cert. R. San. Inst. Clerks.—G. Billing, G. W. Jones. A. E. Gooday. Maternity and Child Welfare Clerk.—Mrs. Whatmough. Health Visitors.—Mrs. Parnell; Sister Terheggen, C.M.B., Q.C.H.; Sister Hildyard, C.M.B., Med. and Surg. one year; Sister Wadds (Resigned June, 1920); Sister Rich. Cert. Gen. Training, C.M.B. Cert., V.D. Cert. 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 1920. 3 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 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 Condition. 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 laundry. 4 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 1920 was approximately £2,465 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. 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 gates, making a connecting link for a portion of the Alexandra Park Ward with the tram and bus service at Lordship Lane and High Road. 5 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. 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. 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. 6 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 the 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 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 soil and surface water drain are being laid in this portion of the district in connection with the Council's Housing Scheme referred to in my last report, and I am hoping that provision will be able to be made for taking the factories and cottages as above into this system of drainage, and provide water closets for the premises in question. 7 Scavenging. In the early part of the year the Council purchased horses for dust collection and employed their own carmen, so that now the collection of house refuse is done by direct labour. Some years ago the Council purchased stables and Depot in Glendale Avenue, which have been utilised to house the horses purchased, thus avoiding the heavy expense of having to erect any new buildings or stables. The Council also purchased a motor lorry and trailer so that the number of horses and carts employed might be reduced and thus increased the efficiency of the collection of house refuse. These vehicles were at work early in 1921. A foreman was appointed to give his whole time to the supervision of dust collection, with a view to further economy and efficiency. All the refuse is taken to the destructor, erected almost in the centre of the district, in Western Road. The Refuse Destructor is of the Heenan and Froude type, and 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. The heat generated by the destructor is used for supplying electric light to the Depot and Public Baths, also heating the water used in connection with the Baths. Number of loads removed 8,195 Number of visits by Foreman to carts in the distinct 6,393 Number of carts employed 10 Weight of refuse removed 8,018 tons. Average load per cart 1956 cwts. 8 The fish offal is collected by a contractor, who deals direct with the fishmongers, making a charge according to the quantity of offal collected. Food Inspection. There is one licensed and three registered slaughter-houses in the district; these latter are old premises and have been in use for many years. Generally speaking they are kept in a clean and satisfactory condition. The following were surrendered as unfit for human food:— Meat:— 1 hind quarter beef (144 lbs.). 52½ lbs. bacon. 15 tins corned beef. Fish:— 6 stone skate. 1 stone rock salmon. 1 barrel kippers. 1 box herrings. 6 tins sardines. 5 tins salmon. 4 tins fish paste. Fruit:— 56 tins tomatoes. 10 tins pineapple. 1 tin peaches. Sundries:— 512 eggs. 32 lbs. butter. 158 tins milk. 8 tins baked beans. 3 tins spaghetti 9 The Chief Inspector and his two Assistants each hold the Certificate of Meat and Food Inspection. Sale of Foods 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 135 8 Butter 3 — Margarine 1 — Dripping 1 — Baking Powder 1 — Compound Liquorice Powder 2 — Cream of Tartar 1 — Custard Powder 2 — Egg Substitute Powder 1 — Fish Paste 2 — Flour, Self-Raising 3 — Green Peas 1 — Lemonade Powder 2 — Tea 1 — 156 8 The eight samples of milk reported against by the County Analyst included four "informal" samples and four formal samples in which the deficiencies, as compared with the presumptive standards, were insufficiently serious to justify legal proceedings. 10 Milk Supply There is one Registered Cowkeeper in the district, but no cows have been kept for some years. There are 29 purveyors of milk. During the year there have been 2 applications for registration by purveyors of milk, both being for change of occupiers of premises. They are periodically inspected, and on the whole kept in a satisfactory condition, no infectious or other disease has been traced to the milk supply. 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. 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 inspected, and are, for the most part, maintained in a satisfactory condition. 11 WORKSHOPS, WORK-PLACES, AND HOMES OF OUT-WORKERS. The workshops, work-places and outworkers' homes are kept under constant supervision, and precautions are taken to ensure that the work done in these plaoes is carried out under the beet possible conditions. There are four workshops in the district, employing about 40 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 still continue to be removed to the Hornsey Isolation Hospital, although the agreement made between the Hornsey Corporation and this Council expired on the 6th June, 1920. Since the agreement expired the cost of patients has been calculated on the actual cost, plus certain expenses for establishment charges. The following cases have been removed during the year Hospital. Scarlet Fever. Diphtheria. Enteric Fever. Hornsey 120 55 1 Southgate — 4 — Enfield 1 — — 121 59 1 12 INFECTIOUS CASES REMOVED FROM THE VARIOUS WARDS TO ISOLATION HOSPITAL. Ward. Diphtheria. Scarlet Fever. Enteric Fever. Total. Percentage of Cases Removed. Town Hall 22 33 — 55 71.4 Bowes Park 5 18 1 24 60.0 Central 11 26 — 37 77.0 Noel Park 21 36 — 57 81.4 Alexandra Park — 8 — 8 20.5 59 121 1 181 66.0 Five deaths have occurred in the Isolation Hospitals of patients removed from this disrict. Hospital. Age. Disease. No. of Days after Admission Cause of Death. Hornsey 4 Diphtheria 1 Diphtheria Hornsey 3½ Scarlet Fever 22 Scarlet Fever Hornsey 2½ Diphtheria 5 Diphtheria Hornsey 6 Diphtheria 3 Diphtheria Southgate 1½ Diphtheria 26 Diphtheria ZYMOTIC MORTALITY. The seven principal Zymotic Diseases caused 27 deaths, which corresponds to an annual rate of .51 per 1,000 of the population, against 14 deaths, or 27 per 1,000 in 1919. 13 The following are the numbers of deaths from each of these diseases for the years 1920 and 1919:— Disease. Number of deaths. 1920. 1919. Small Pox — — Scarlet Fever 2 1 Diphtheria 5 9 Enteric Fever - 1 Measles 5 - Whooping Cough 5 1 Diarrhœa 10 2 27 14 An increase of '24 per 1,000; measles, whooping cough and diarrhœa being the cause of the increase. BACTERIOLOGICAL EXAMINATIONS. The number of specimens examined during the year were as follows:— Positive Negative Total. Enteric Fever — 4 4 Diphtheria 73 179 252 Pulmonary Tuberculosis 34 85 119 Ringworm 11 5 16 118 273 391 Small Pox and Typhus Fever. No cases of Small Pox or Typhus Fever have been notified during the year . 14 Encephalitis Lethargica. Five cases of Encephalitis Lethargica were notified during the year, with four deaths. Two of the cases were removed to the Edmonton Infirmary and one to the National Hospital, Queen's Square; the remaining cases proved fatal before removal could be effected. Enteric Fever. There were two cases of Enteric Fever notified, with no deaths, against two cases with one death in 1919. The first case was a nurse employed at the Passmore Edwards' Hospital, and the second was employed as a housekeeper in the Alexandra Park Ward. Not the slightest history of infection could be traced in either case. The nurse from the Passmore Edwards' Hospital was removed to the Isolation Hospital, and the second case, a very mild one, was nursed at home; both made good recovery. Erysipelas. There were 20 cases of Erysipelas notified with one death, against 24 cases with one death in 1919. Puerperal Fever. There were two cases of Puerperal Fever, as against three in 1919. One case occurred in the Noel Park Ward and the other in the Central. Both cases were attended at their confinement by medical men, and made good recovery. 15 CASES REFERRED FROM THE EDUCATION DEPARTMENT. The Education Secretary 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 during the year were:— Sore Throats 123 Chicken Pox 183 Whooping Cough 103 Measles 469 Other Cases 254 1,132 Investigations into 324 of the above cases were made by the Inspector, where I was of 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 the history of infection and any contacts. 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. 16 No scholar from any family or house 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 complete disinfection by stripping the walls of paper, etc. (a) Diphtheria 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 75 tubes (150,000 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 indicated, 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's Schools (and others), showing what may be the preliminary symptoms of Notifiable and Non-notifiable Infectious Diseases, and the time that svch cases are to be excluded from school attendance. 17 SCARLET FEVER AND DIPHTHERIA. Schools Attended by Patients. NOEL PARK:— Scarlet Fever. Diphtheria. Boys 3 1 Girls 9 2 Infants 8 4 20 7 WHITE HART LANE:— Boys 2 1 Girls 1 4 Infants 6 1 9 6 HIGHER GRADE:— Boys 4 — Girls 7 - 11 BOUNDS GREEN:— Boys 4 1 Girls 1 2 Infants 8 1 13 4 18  Scarlet Fever. Diphtheria. ALEXANDRA :— Boys 4 1 Girls 5 - Infants 5 - 14 1 LORDSHIP LANE:— Boys 2 3 Girls 5 3 Infants 4 9 11 15 ST. MICHAEL'S:— Mixed 7 3 Infants 7 8 14 11 MUSWELL HILL MIXED 6 4 ST. PAUL'S 3 1 SECONDARY - - PRIVATE 9 1 SCHOOLS OUTSIDE DISTRICT 21 4 NOT ATTENDING SCHOOL 5 1 OVER SCHOOL AGE 15 18 UNDER SCHOOL AGE 31 17 28.02 per cent. of Scarlet Fever cases notified did not attend School. 19 8.24 per cent. of Scarlet Fever oases notified were patients above school age. 40.0 per cent. of Diphtheria cases notified did not attend School. 20.0 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.o'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 entrance from the High Road and the Town Hall Park:—Males, 2 w.c's., 3 urinals. Females, 2 w.c's. BATHS An Open-air Swimming Bath is provided, adjoining the Alexandra Park Racecourse, which was open from about the beginning of May to the end of September. 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. 20 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 Bath (Alexandra Park Ward):— Number of attendances 11,438 (b) Western Road Baths:— Month. Adults. School children January 6,761 — February 7,179 — March 9,669 — April 11,272 — May 23,267 2,808 June 25,353 4,611 July 23,359 2,639 August 18,790 748 September 16,888 3,034 October 11,954 190 November 7,567 209 December 6,039 138 168,098 13,377 POPULATION. The Registrar-General estimates the population for the year 1920 at 52,317 persons. 21 The population for each Ward, based on this figure is as follows:— Ward. Estimated population. Town Hall 11,843 Bowes Park 7,982 Alexandra Park 7,546 Central 10,950 Noel Park 13,996 52,317 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 for the whole district was 30.38, and for the year 1920, 32.18. Average number of persons per acre in Wards. 1911. 1920. Increase. Alexandra Park 11.77 12.70 0.93 Bowes Park 28.33 30.12 1.79 Central 47.82 50.00 2.18 Noel Park 83.94 88.02 4.08 Town Hall 28.60 30.52 1.92 In 1911 the number of occupied houses was 9,132. In the nine years ending the 31st December, 1920, the Surveyor informs me that 292 houses were certified as fit for occupation, making a total 22 of 9,424 houses at the end of 1920. Taking the occupants of each house at 5.4 per house (the census figure), the total population would be 50,889, which is manifestly too low having regard to the overcrowded state of the district due to want of sufficient housing accommodation. The Registrar-General's figure is probably nearer correct, and I have based my figures in this Report on that given by him, i.e., 52,317, as stated above. BIRTHS. There were 1,164 births, as against 750 in 1919 and 691 in 1918. The births were:—614 males and 550 females; of these 31 were illegitimate (viz., 22 males and 9 females). This corresponds to an annual rat of 22.25, compared with 14.31 per thousand in 1919, and 12.88 per thousand in 1918. The following table gives the number of births registered within and without the district, and the birth rate for each Ward. Births Registered. Birth Rate. Town Hall 291 24.57 Bowes Park 167 20.92 Alexandra Park 115 15.23 Central 298 27.2??? Noel Park 293 20.93 1,164 22.25 The number of births over the number of deaths was 555. 23 DEATHS. There were 363 deaths registered within the district during the year, and there were 173 residents who died outside the district, making a total of 536, from which must be deducted 27 deaths of non-residents. The correct number is therefore 509, which is equal to an annual rate of 9.73 per 1,000 of the population, as compared with 12.4, the death rate for England and Wales for the same period. 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 102 8.62 Bowes Park 85 10.65 Alexandra Park 58 7.67 Central 129 11.78 Noel Park 135 9.64 There were 56 deaths of children under one year, which corresponds to a rate of 48.11 for every 1,000 births, against 51 deaths, or a rate of 68 last year. The rate for the whole of England and Wales was 80 (80 also being the figure in smaller towns, i.e., with census population of 20,000 to 50,000). The deaths of children under five years was 76, which corresponds to a rate of 1.45 per 1,000 of the general population, against 67, or a rate of 1.13 per 1,000 in 1919. 24 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) 418 Complaints with respect to alleged nuisances 258 Visits to Infectious Cases 358 Visits to Tuberculosis 126 Visits to Slaughter Houses 39 Rooms Disinfected 378 Articles Disinfected 2236 Letters Written 1643 Enquiries into Births 1164 Letters Received and Filed 1971 Birth Cases followed up and Re-visited 1164 Enquiries into Deaths of Children under 1 year 40 INFECTIOUS DISEASES (NOTIFICATION AND PREVENTION) ACTS. Number of articles disinfected at the Disinfecting Station:— Articles disinfected after infectious disease 2,119 „ „ Phthisis 167 ,, ,, Cancer 20 „ „ Influenza 14 ,, ,, Vermin 5 2,325 Articles destroyed 78 2,403 25 PUBLIC MORTUARY. Bodies deposited during the year 30 Inquests held 29 Post-mortem examinations 17 Causes of death— Natural 13 Accidental 4 Misadventure 4 Suicide 5 Inattention at birth 2 Still-born 1 29 HOUSE TO HOUSE INSPECTION. Road. Inspected. No. of houses. No. of rooms. Families. Persons per room. Adults. Children. Acacia Road 62 351 329 125 1.29 Buckingham Road 12 91 65 12 .84 Commerce Road 63 298 275 106 1.27 Meads Road 61 258 222 56 1.07 Ranelagh Road 33 117 98 56 1.31 Selborne Road 72 254 247 93 1.33 Terrick Road 14 83 77 11 1.06 Wellesley Road 16 78 70 29 1.27 Winkfield Road 85 498 416 140 1.12 Totals 418 2,028 1,799 628 1.19 26 HOUSING AND TOWN PLANNING ACT. The housing problem, in common with other districts, remains in the acute stage. The Surveyor informs me that the total number of dwelling houses in the course of erection during the year was 23, of these 8 were completed and fit for occupation, a totally inadequate number to deal with the overcrowding which exists in the district. I submit a list of the roads and houses inspected during the year, showing the number of persons per room, this does not, however, convey any idea of the overcrowding which exists in the district. At the time of writing this report the Council are erecting 50 houses on the Durnsford Road site, and have under consideration the erection of further houses on an adjoining Estate and in White Hart Lane, but many more houses will have to be built before the question can be considered adequately dealt with. OPEN SPACES. The total area of open spaces in Wood Green, including the Alexandra Palace Park, is 242 acres. These open spaces are a great asset to the district and negotiations are in progress for further land in connection with playing fields for the school children. MOTOR AMBULANCE During the year the Council purchased a motor ambulance for the use of ratepayers in the distriot, which is kept at the Fire Station and manned by members of the Fire Brigade so that it. is available by day and night as well as on Sundays. 27 Application for the use of the ambulance during the day is made through the Public Health Department, at night and during Sunday by direct communication with the Fire Station. The ambulance is available not only for accidents, but also for conveying residents of the district to and from the various hospitals in the Metropolitan area. If conveyance is required to any institution outside the Metropolitan area a special charge is made. The ambulance came into use on the 22nd November, and from that date until the 31st December had been requisitioned 34 times. I need hardly add that the value of its services has been greatly appreciated, and it has supplied a long felt want. In a district of this character many occupants have to be conveyed to and from hospitals in the London area. Hitherto we have been dependent on ambulances kept by neighbouring authorities, and there has been delay as well as considerable expense in making arrangements for the use of same. With our own ambulance, it is only a question of a few minutes before arrangements oan be completed for its use. Perhaps I should add that it is. of course, only available for non-infectious cases. Infectious cases are removed in the ambulance from the Isolation Hospital, and the use of the same is included in the charges made by the Hornsey Council for maintenance. ACTS OF PARLIAMENT. During the year the Council obtained from Parliament extensive powers in a Private Act, with respect to several important matters 28 connected with infectious disease and sanitary provisions, including houses infested with vermin and the cleansing of verminous persons These sections of the Act give the Council power to deal directly with occupiers of houses instead of the cumbersome method of the Public Health Act, 1875. There are other sections equally valuable, and will, I have no doubt, materially assist in dealing with the sanitary condition of the district generally. 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. Public Health Acts Amendment Act, 1907. Part 2 (which relates to streets and buildings, other than Sections 15, 16, 19, 23, 26, 27, 30 and 33; Part 3 (which relates to sanitary provisions), other than Sections 39 to 44 inclusive, 46 and 47; Part 4 (which relates to infectious diseases), other than Sections 52 to 59 inclusive and 67; and Part 10 (miscellaneous provisions). 29 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. (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. 30 (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). The attention of the Council has been called to the somewhat antiquated By-laws and Regulations, and I am glad to' say these have been referred to the appropriate Committee with a view of bringing them up to date. MATERNITY AND CHILD WELFARE. Infant Welfare Centres were open at the following premises:— Arcadian Gardens.—Monday afternoons, 1.30 to 4 p.m. Trinity Road.—Tuesday, 9.30 to 12 noon, 1.30 to 4 p.m.; Monday, 1.30 to 4 p.m. 31 Brook Road.—Friday, 1.30 to 4 p.m. (changed from Friday to Thursday in November, 1920). Lordship Lane.—Wednesday, 1.30 to 4 p.m.; Thursday, 9.30 to 12 noon. 1.30 to 4 p.m. From the tables which I give below it will be seen that the attendances have considerably increased at all the Centres. The total attendances at the Child Welfare Centres in 1916 were 3,113, the attendances for 1920 have been 16,953. I have taken 1916, being the first year when a fully qualified Maternity Nurse was first employed in the work of child welfare, it will thus be seen the enormous increase there has been in the number attending the Centres. I perhaps ought to mention that in the year 1916 there was only one Centre established. Miss Wadds resigned during the year, having obtained another appointment, and Miss Rich took her place. The Annual Garden Party was held in conjunction with Housing Bond Week, and fortunately the weather proved all that could be desired. In addition, later on in the year, a Social and Concert were held at the Trinity Hall Centre, and proved a great success. I have again to thank the Voluntary Helpers for their work in connection with the Child Welfare Centres, and the social functions which I have mentioned above. 32 Without their valuable assistance it would have been impossible to carry on the work with such a degree of success. The Clothing Club, which was started last year, still continues and is much appreciated by the mothers attending the Centres. Towards the close of the year the Council considered the question of a Lady Doctor to attend the various centres, and by the time that this report is in print, I have no doubt that she will be at work. Number of Births Registered within the district 1164 Number of Births Notified within the district (Notifications equal to 87.11 per cent. of Births registered within the district.) 1020 Number of visits paid to homes (birth cases) 2158 Number of visits paid to homes (pre-natal cases) 183 Enquiries into deaths of children (under one year) 40 Number of visits paid to homes (1 to 5 years) 2514 Enquiries into Ophthalmia Neonatorum 10 Special visits 261 Special visits to Puerperal Fever cases 2 7352 33 Attendances at Maternity and Child Welfare Centre. 1920. 1919. January 1448 598 February 1262 491 March 1465 651 April 1171 710 May 1757 1053 June 1411 755 July 1255 744 August 1497 804 September 1335 967 October 1841 1007 November 1322 1380 December 1189 856 16953 10016 Number of babies visiting Centres 612 479 Number of children visiting Centres (from 1 to 5 years) 561 455 Number of Pre-Natal Cases visiting Centres 220 102 1393 1036 34 Babies. Children ages 1—5. Total attendances 27 41 made 1 attendance 68 57 42 ,, 2 attendances 198 42 35 ,, 3 ,, 231 39 43 ,, 4 ,, 328 43 27 ,, 5 ,, 350 28 33 ,, 6 ,, 366 29 29 ,, 7 ,, 406 33 25 ,, 8 ,, 464 26 22 „ 9 ,, 432 23 24 „ 10 ,, 470 12 19 „ 11 ,, 341 18 25 „ 12 ,, 516 235 196 made over 12 attendances 12,783 612 561 16,953 Attendances by Pre-natal cases 750 17,703 The number of Still-births during the year was 26 Attended by Medical Practitioners 21 Attended by Midwives 5 26 35 Milk (Mothers and Children) Order, 1919. ' The amount expended during the year under the above Order has been Dried Milk, etc. £ s. d. Qtr. to 31st March, 1920 108 5 0½ ,, „ 30th June „ 74 11 2 ,, „ 30th Sept. „ 78 3 3 ,, ,, 31st Dec. ,, 69 5 3 £330 4 8½ Cows' Milk £440 0 0 Making a total of £770 in round figures. There was a considerable reduction in the expenditure during the last three quarters of the year; due in a great measure to the more minute enquiries into the applications for free milk, made by the Ladies' Committee (to whom my thanks are due), and to the fact that all applications had to be made on a special form giving particulars as to the source of income of the families concerned, thus in a great measure anticipating the Order of the Ministry of Health dated the 31st March, 1921. Home Help. In connection with the circular issued by the Ministry of Health, the Committee appointed a Home Help. We were rather led to expect that sufficient work would be found for two Home Helps, but on my recommendation the Committee appointed one as an experiment, and very careful selection was made of the person appointed. 36 I regret to say that her services have not been utilised to anything like the extent anticipated, and she has had to fill up her time by giving assistance at the Day Nursery. I must express surprise that she has not been in greater demand; it would appear, however, that the women of the District, during their confinement, prefer to employ a neighbour or other friend rather than a stranger, however homely and competent she may be. PROVISION FOR CONFINEMENTS The same arrangements remain as last year. A formal agreement has now been entered into with the Edmonton Board of Guardians for lying-in cases, normal as well as abnormal, in the special ward, known as the Council's Maternity Ward, Bull Lane, Edmonton, in which only cases recommended by the Medical Officers of Health of the surround, ing Districts concerned are admitted. Arrangements are made for the women to be conveyed to the Maternity Home by the Council's Motor Ambulance which is available at all times. Twenty-two cases were admitted from Wood Green during the year, most of whom contributed something towards the cost of maintenance. Hospital Treatment. During the year the Great Northern Hospital, Holloway Road, opened a special clinic in connection with Maternity and Child Welfare Work for North London, and the following cases have been referred to and treated thereat:— Expectant mothers 5 Children under five years Out-patients 25 In-patients 7 37 It has certainly been a great advantage to be able to obtain specialised advic6 in such cases. DENTAL TREATMENT. The arrangements for Dental Treatment remain as last year The numbers dealt with have been as follows:— New Dentures Provided 5 Extractions 61 Fillings, Scalings, etc. 8 GENERAL During the year I was appointed by the Council as Medical Officer of Health in place of Dr. Slater Jones, resigned As the Council are aware he has been ill for a considerable time, and the nature of his incapacity will prevent him from ever resuming duty again. Before his appointment as Medical Officer of Health he assisted your first Medical Officer (Dr. Conolly) in the inspection of school children, and thus gave many years of his life to public service. I should like to take this occasion of expressing my sympathy towards him in the catastrophe which has overtaken him in the nature of his serious illness, and it has given me great pleasure to act as his Deputy. Mr. W. R. Drake, Assistant Sanitary Inspector, left your employ to take up the position of District Inspector in the Borough of Greenwich, and Mr. A. J. Nichols, who came to us with excellent testimonials from Huddersfield, was appointed to fill the vacancy and commenced duty at the beginning of August. Mr. E. A. Hillier, who was a local discharged disabled soldier attending theoretical classes at the Battersea Polytechnic, was allowed by the Council to have practical training in the Public Health 38 Department, and obtaining his certificate under the London Public Health Act, was appointed a District Inspector in the Borough of Hackney. Miss Wadds, to whom I have referred in another part of the Report, resigned in order to take up a position as Health Visitor in the Borough of Lambeth, and Miss Rich, from the London Hospital, was appointed in her place. The clerical work of the Department having increased to such an extent as to be incapable of being dealt with by the former staff, it was felt that further assistance in this direction was absolutely necessary, and Mr. G. W. Jones, of the Clerk's Department, was transferred and added to the staff of clerical assistants. In concluding this Report I wish to thank the members of the Public Health and Maternity and Child Welfare Committee for their courtesy in all matters that I have had the honour to bring before their notice. I desire also to again acknowledge with gratitude my indebtedness to the whole of the Staff of my department and for their everready and willing help, but especially to the Chief Sanitary Inspector, Mr. Adams, whose long experience in public health work, together with his intimate knowledge of this district, has made him a very valuable colleague, and who has always given me most loyal and genial assistance ever since my appointment in 1916. I remain, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, W. E. PORTER, Medical Officer of Health. 39 Infantile Mortality during the Year 1920. 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 months. 9 to 12 months. Total under 1 year. Small Pox - - - - - - - - - - Chicken Pox - - - - - - - - - - Measles - - - - - 1 - 1 - 2 Scarlet Fever - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - Whooping Cough - - - - - 1 - 1 - 2 Diarrhœa - - - - - - 1 - - 1 Enteritis - - - 2 2 1 3 3 - 9 Tuberculous Meningitis . - - - - - - 2 1 - 3 Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous - - - - - - - - - - Diseases Congcnital Malformations - - - - - - - - - - Premature Birth 4 - - - 5 - 1 - - 6 Atrophy, Debility and Marasmus 6 3 - 2 11 2 2 1 - 16 Atelectasis 2 - - - 2 - - - - 2 Injury at Birth - - - - - - - - - - Erysipelas - - - - - - - - - - Syphilis - - - - - 1 - - - 1 Rickets - - - - - - - - - - Meningitis - - - - - - - - - - Convulsions 1 - - - 1 - - - - 1 Gastritis - - - - - - - - - - Laryngitis - - - - - - - - - - Bronchitis - - - - - 2 2 1 1 6 Pneumonia (all forms) - - - - - - 1 - 2 3 Suffocation, overlying - - - - - - - - - - Other Causes 1 - - 1 2 1 - 1 - 4 14 4 - 5 23 9 12 9 3 56 10 Causes of, and ages at death during the year 1920, 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 - - - - - - - - - Small-pox - - - - - - - - - Measles 5 2 1 1 1 - - - - Scarlet Fever 2 - - 1 1 - - - - Whooping Cough 5 2 1 1 1 - - - - Diphtheria and Croup 5 - 2 2 1 - - - - Influenza 7 1 1 - - - 3 2 - Erysipelas 1 - - - - - - 1 - Pulmonary Tuberculosis 44 - - 1 3 6 22 12 - Tuberculous Meningitis 7 3 - 1 1 1 1 - - Other Tuberculous Diseases 2 - - 1 1 - - - - Cancer, Malignant Disease 74 - - - - - 2 42 30 Rheumatic Fever 3 - - - 1 2 - - - Meningitis - - - - - - - - - Organic Heart Disease 71 1 - - - 2 6 24 38 Bronchitis 47 6 - - - - 4 11 26 Pneumonia (all forms) 32 3 3 - - - 4 8 14 Other Respiratory Diseases 5 - - - 1 - 1 1 2 Diarrhœa, etc. (under 2 years) 10 10 - - - - - - - Appendicitis and Typhlitis 4 - - 1 - 2 - 1 - Cirrhosis of Liver 5 - - - - - - 3 2 Alcoholism - - - - - - - - - Nephritis and Bright's Disease 12 - - - - - 2 7 3 Puerperal Fever - - - - - - - - - Parturition, apart from 1 - - - - - 1 - - peral Fever Congenital Delility, etc. 22 22 - - - - - - - Violence, apart from Suicide . 11 - - - 2 2 2 1 4 Suicide 5 - - - - 1 2 2 - Other Defined Diseases' 129 6 1 2 3 3 18 23 73 Causes Ill-defined or Unknown - - - - - - - - - Totals 509 56 9 11 16 19 68 138 192 41 INFECTIOUS DISEASES IN WARDS-1920. Town Hall. Noel Park. Centra! Bowes Park. Alex. Park. Totals Diphtheria 30 26 17 10 7 90 Erysipelas 4 6 4 5 1 20 Scarlet Fever 47 44 31 29 31 182 Enteric Fever - - - 1 1 2 Puerperal Fever - 1 - 1 - 2 Ophthalmia Neonatorum 1 2 6 1 - 10 Phthisis 13 13 10 9 7 52 Other T. B. 3 2 3 - - 8 Measles 22 17 4 4 8 55 Pneumonia 8 14 16 5 4 47 Malaria 2 2 3 - - 7 Encephalitis Lethargica - 1 2 1 1 5 Totals 130 128 96 66 60 480 42 INFECTIOUS DISEASES IN AGE GROUPS—1920. 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 90 — 15 58 13 2 2 — Erysipelas 20 — — — 5 5 8 2 Scarlet Fever 182 — 28 138 11 5 — — Enteric Fever 2 — — — 1 1 — — Puerperal Fever 2 — — — — 2 — — Ophthalmia Neon. 10 10 — — — — — — Phthisis 52 — — 2 17 25 7 1 Other T. B. 8 3 1 3 — 1 — — Measles 55 6 — 49 — — — — Pneumonia 47 2 5 6 4 20 10 — Malaria 7 — — — 1 5 1 — Encephalitis Leth. 5 — 1 — 1 3 — — Total 480 21 50 256 53 69 28 3 43 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK. I.—Inspection. Including Inspections made by the Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Prosecutions. Inspections. Written Notices. Factories— (Including Faclorv Laundries — — — Workshops— (Including Workshop Laundries) Workplaces— (Other than Outworkers' prem ises, included in Part 3 of this report) 358 14 — 276 — — Total 634 14 — 2.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts— Want of Cleanliness 7 7 — — Want of Ventilation — — — — Overcrowding — — — — Want of Drainage of Floors — — — — Other Nuisances — — — Sanitary Accommodation— Insufficient. — — — — Unsuitable or Defective 3 3 — — Not separate for Sexes — — — — Offences under the Factory and Workshop Act— — Illegal Occupation of Under ground Bakehouse (s. 101) — — — — Breach of Special Sanitary Requirements for Bake houses (ss. 97 to 100) 4 4 — — Other Offences (excluding Offences relating to Out Work which are included in part 3 of this Report) — — — — Total 14 14 — — 44 3.—Homework. Nature of Work. Outworkers' Lists, Section 107. Lists received from Employers. Sending twice in the yr Sending once in the yr. Lists. Outworkers. Lists. Outworkers. Contr'ct'rs Workmen. Contr'ct'rs Workmen. Wearing Apparel— making, etc. 70 — 230 - — Lace, lace curtains and nets - - - 2 2 Electro-plate .. - - - 1 1 Umbrellas, etc. - - - 2 — 2 Artificial flowers - - - 1 — 1 Paper, etc., boxes, paper bags - - - 1 - 1 Brush making - - - 5 — 5 Stuffed toys - - - 2 - 2 Total 70 - 230 14 — 14 45 4.—Registered Workshops. Workshops on the Register (S. 131) at the end of the Year. Important Classes of Workshops, such as Workshop Bakehouses, may be enumerated here. Dressmakers 13 Milliners 4 Blouse Makers 9 Dining Rooms 13 Laundries 5 Bakehouses 20 Other Workshops (various) 67 Total number of Workshops on Register 131 5.—Other Matters. Matters Notified to H.M. Inspector of Factories:— Failure to affix Abstract of Factory and Workshop Act (S. 133 1901) Action taken in matters referred toby H.M. Inspector as remediable under the Public Health Acts, but not under the Factory & Workshop Act (S.5) 1901 Notified by H.M. Inspector 3 Reports (of action taken) sent to H.M. Inspector 3 Other — Underground Bakehouses (S.101):— Certificates granted during the year — In use at the end of the year 1 46 SANITARY WORK, 1920. Inspections— Number of Premises Inspected on Complaint 258 Numberof Premises Inspected in Connection with Infectious Diseases 378 Number of Premises under Periodical Inspection 405 H mses Inspected from IIouse-to-Housa (H T. P., etc., Act, Sect. 17) 418 Total Numberof Inspections and Re inspections made 4841 Action Taken (Other than under H.T.P., etc., Act)— Cautionary or Intimation Notices Given 640 Statutory Orders Issued 307 Summonses Served — Convictions Obtained — Bakehouses— Number in District 20 Slaughterhouses— Number on Register 4 Number of Inspections made 39 Cowsheds— Number on Register (not in use) 1 Dairies and Milkshops— Number on Register ... 29 Number of Inspections made 81 Unsound Food— Meat (including organs) seized and surrendered. (Approximate weight in pounds) 200 Fish seized and surrendered. (Approximate weight in pounds) 180 Fruit and Vegetables seized and surrendered. (Approximate weight in pounds) ... 70 Other Articles seized and surrendered. (Approximate weight in pounds) 250 Method of Disposal : Burnt in Destructor. 47 Water Supply and Water Service— Draw-Taps placed on Mains 50 Percentage of Houses supplied on Constant System 100% Drainage and Sewerage of Existing Buildings— Water Closets Repaired, Supplied with Water, or otherwise Improved ... 129 Percentage of Houses provided with Water Closets 100% Drains—Unstopped, Repaired, Trapped, etc. 52 Waste Pipes, Rain Water Pipes Disconnected, Repaired, etc. 96 New Soil Pipes or Ventilating Shafts Fixed 13 Disconnecting Traps or Chambers Inserted 3 Reconstructed 4 Percentage of Houses Draining into Sewers 100% Disinfection— Rooms Disinfected—Ordinary Infectious Diseases 361 Phthisis 17 Rooms Stripped and Cleansed 157 Articles Disinfected or Destroyed—Ordinary Infectious Diseases . 2236 Phthisis 167 Dust— New Bins Provided 612 Removed from each house once per week Number of Complaints of Non-Removal received.. — Method of Disposal : Destructor. Sundry Nuisances Abated— Accumulations of Refuse 8 Foul Pigs and Other Animals 8 Dampness 90 Yards Repaved or Repaired 33 Other Nuisances 815 48 APPENDICES. HOUSING CONDITIONS. Statistics. Year ended 31st December, 1920. 1.—GENERAL. (1) Estimated population 52,317 (2) General death-rate 9.73 (3) Death-rate from tuberculosis 1.01 (4) Infantile mortality 48.11 (5) Number of dwelling-houses of all classes 9,424 (6) Number of working-class dwelling-houses 6,316 (7) Number of new working-class houses erected 8 2 —UNFIT DWELLING HOUSES. I.—Inspection. (1) Total number of dwelling houses inpected for housing defects (under Public Health or Housing Acts) 418 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 418 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unlit for human habitation - (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 246 II.—Remedy of Defects without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 146 III.—Action under Statutory Powers. A. Proceedings under Section 28 of the Housing, Town Planning, &c-, Act, 1919 (1) Number of dwelling-houses in respect of which notices were served requiring repairs 100 (2) Number of dwelling-houses which were rendered fit- (a) 1 y owners 31 (b) by Local Authority in default of owners- (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close - 49 B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 33 (2) Number of dwelling-houses in which defects were remedied- (a) by owners 33 (b) by Local Authority in default of owners - C. Proceedings under Sections 17 and 18 of the Housing, Town Planning, &c., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders (2) Number of dwelling-houses in respect of which Closing Orders were made (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling'houses having been rendered fit (4) Number of dwelling-houses in respect of which Demolition Orders were made (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 3.—UNHEALTHY AREAS. *Areas represented to the Local Authority with a view to Improvement Schemes under (a), Part I., or (b), Part II , of the Act of 1890:- (1) Name of area (2) Acreage (3) Number of working-class houses in area (4) Number of working-class persons to be displaced 4.—Number of houses not complying with the building bye-laws erected with consent of Local Authority under Section 25 of the Housing, Town Planning, &c., Act, 1919 5.—Staff engaged on housing work with, briefly, the duties of each officer Chief Sanitary Inspector and two Assistants.