EDM 8 Edmonton Urban District. ANNUAL REPORT OF THE Medical Officer of Health, For the Year 1908, BY SIDNEY C. LAWRENCE, M.B., Ch.B„ D.F.H. (Lond.), M.R.C.S. (Eng.), L.R.C.P. (Loud.) TOGETHER WITH THAT OF THE Inspector of Nuisances, BY Richard J. Rutland, M.R.San.I. Tottenham: Printed by Crusha & Son (Trade Union), "Herald" Office. Edmonton Urban District Council. 1908—1909. Chairman—CHARLES SORRELL, Esq., J.P. Vice-Chaipman—Rev. E. A. B. SANDERS, M.A. The Sanitary Committee. W. B. BENJAFIELD, Esq., M.B., Chairman (also of Education Committee)~ LOUIS CHINN, Esq. W. A. EDMUNDS, Esq. R. GREEN, Esq., C.C. F. W. MASON, Esq. W. F. MIDDLETON, Esq. LEWIS PETTIPIERRE, Esq. R. RANDALL, Esq. H. E. SNELLING, Esq. Heads of Departments. Clerical—W. F. PAYNE, F.C.I.S. Engineering and Surveying—G. EEDES EACHUS, M.I.C.E. Building Inspection—H. W. DOBB, M.S.A. Financial—G. W. FRANCIS, A.L.A.A. Educational—JOHN MOULE. Representatives of the Council. Enfield and Edmonton Joint Hospital Board— W. D. CORNISH, Esq., J.P., C.C. R. GREEN, Esq., C.C. W. F. MIDDLETON, Esq. CHAS. SORRELL, Esq., J.P. Middlesex Districts Joint Small Pox Hospital Board—- Rev. T. C. COLLINGS. F. G. LACEY, Esq. Metropolitan Water Board— Councillor SANDERS (of Enfield). The Lea Conservancy Board— W. D. CORNISH, Esq., J.P., C.C. Middlesex District Councils Association— Rev. E. A. B. SANDERS, M.A. PUBLIC HEALTH DEPARTMENT. 1.—Medical Officer of Health : SIDNEY C. LAWRENCE, M.B., Ch.B., D.P.H.; 2.—Chief Sanitary Inspector and Inspector of Canal Boats : R. J. BUTLAND, M.R.San.I. 3.—Second Male Inspector: J. E. WINTER. 4.—Lady health Visitor and Woman Inspector : FLORENCE TETTENBORN.† 5.—Third Male Inspector: R. F. GRAVES (Since December 7th, 1908). 6.—Senior Clerk: ARTHUR J. KIRKMAN (Since December 10th, 1908). 7.—Junior Clerk: ARTHUR W. HUNT. 8.—Disinfector, Sanitary Stores and Ambulance Attendant: J. MADLE. 9.—Mortuary Attendant and Laboratory Assistant : G. WAGNER. 10.—Caretaker of Emergency Hospital and Disinfection Station: A. METTAM. 11.—Driver of Ambulance and Bedding Vans: C. MORLEY. 12.—Opener up of Old Drains, Urinal Cleanser and General Sanitary Workman: A. PASHALL. 13.—Trade Refuse and Fish Offal Collector (part time): C. TOLFTS (otherwise employed at Sewage Farm). 14.—Opener up of Old Drains (part time): C. JOBSON (otherwise employed in Engineer's Department). 15—18.—Attendants at Sanitary Convenience at Angel Road : Two males and two females. * Officer marked thus holds the certificate of the Royal Sanitary Institute. † Officer marked thus holds certificates of the Sanitary Inspectors' Board and of the Central Midwives' Board. ‡ These Officers have the certificate of Meat and Foods Inspector. Edmonton Urban district. SUMMARY OF ANNUAL REPORT. Area 3,894 acres, including 31 of water Estimated Nett Population 60,182 Number of Inhabited Houses 10,522 Average Number of Inhabitants per house 5.72 Density of Population per Acre of Land 16 Rateable Value £212,829 General District Rate 5s. in the £ Poor Rate 4s. 11d. in the £ A Penny Rate produces about £740 VITAL STATISTICS. Birth-rate per 1,000 living 32.09 Gross or Registered Death-rate per 1,000 living 14.50 Nett Death-rate per 1,000 living 12.16 Corrected Nett Death-rate per 1,000 living 12.37 Infantile Mortality per 1,000 births registered 117.41 Zymotic Death-rate per 1,000 living 1.99 HOSPITAL ACCOMMODATION. For Fever Cases Enfield and Edmonton Joint Isolation Hospital. For Small-Pox South Mimms Small-Pox Hospital. For contingencies Claverings Farm, Edmonton. Electricity North Metropolitan Electric Power Supply Co., Ltd. Water Supply New River District, Metropolitan Water Board. Gas Supply Tottenham and Edmonton Gaslight and Coke Co. Sewerage Separate System. Sewerage Disposal Broad Irrigation. Motto: "Nemo me impune lacessit." Public Health Department, Town Hall, Edmonton, London, N. To the Chairman and Members of the Urban District Council, Gentlemen, I have the pleasure of presenting you with my Third Annual Report of the Health and Sanitary circumstances of Edmonton. It refers to the year 1908. The following changes in my Staff have taken place during the year. Early in December, the third male Inspector, Mr. A. J. Furnivall, left us to assume the duties of Sanitary Inspector to Reigate Rural District in Surrey. He had rendered loyal and efficient service under three Medical Officers of Health since March, 1902. On certain conditions, his place was taken by Mr. R. F. Graves, the Senior Clerk, and the vacancy thus made was filled by Arthur Kirkman. Four additions have been made to my Staff as attendants at Angel Road Sanitary Convenience. I prepared no "Special" Reports during the year. It will afford you great satisfaction to know that, whilst recording a slight increase in the birth rate, I have the pleasure of publishing the lowest rates on record in Edmonton, both for the nett death-rate and the gross death rate. The infantile death-rate is also the lowest on record, whether based on the deaths registered in the District or not. The zymotic death-rate equals the previous lowest record of 1903. I give my hearty thanks to the members of my Staff who have loyally supported my continued efforts to improve the health of the inhabitants of Edmonton by the straightforward discharge of their respective duties, indoor or outdoor. For the cordial co-operation of my colleagues, the Heads of the other departments, in all matters where it has been required, and the courtesy of all the Council's officials, I am much obliged. I am, Gentlemen, Your obedient servant, SIDNEY C. LAWRENCE. May 20th, 1909. INDEX OF CONTENTS. Page Alcoholism 37 Babyshow, the 22 Bacteriological Laboratory 34 Baths, the Public 13 Births 14-16 Canal Boats 91 Cancer 38 Cerebro-spinal Fever 27 Clerical Work 92 Closure of Schools 44 Common Lodging-houses 59 Communicable Diseases—Notifiable 21, 23-34 ,, ,, —Non-notifiable 22, 35-37 Costers 51 County Council Tables 77-80 Cowsheds BO, 78, 88 Croup, Membranous see Diphtheria Dairies, Cowsheds and Milk shops 60, 80 Deaths 16-19 Diarrhœa 35 Diphtheria 26, 31 Disinfectants 33 Disinfection 33, 83 Ditches 88 Drainage 49, 50, 84, 85 Dust Collection 50,86,87 Enteric Fever 26 Erysipelas 34 Factories and Workshops 21,59,61,64 Features, Physical, of the District 9 Fish Offal 87 Food Unsound 60, 78, 81, 89, 90 Free Library 13 Gonorrhoea 37 History, Recent, of Edmonton 10 ,, Past ,, 10 Home Office Tables 61-64 Hospital Accommodation 27-32 ,, Extension 28 ,, Weekly Reports from 28 ,, New Officers at 27 Houses let in Lodgings 59 Housing Accommodation 53-56, 86 Ice-Cream 91 Infantile Mortality 18,21,74 Infectious Diseases 23-37 Influenza 36 Inspection of School Children, Medical 44-47 Institutions, Public 11 Lady Health Visitor 20-22 Legislation affecting Edmonton 57, 58 Page Library, the Free 13 Local Government Board Tallies 65-75 Measles 35, 44 Milk shops 60, 88 Mortuary, the 85 Notifications from School Teachers 35, 43 Obstructed Footways ami Highways 51 Offensive Trades 60, 88 Open Spaces 11 Outworkers 59 61, 63 Overcrowding 56, 90 Past History of Edmonton 10 Phthisis 36, 37 Public Institutions 1 ,, Elementary Schools 39-47 Puerperal Fever 34 Railway Facilities 1 Recent History of Edmonton 10 Respiratory Diseases 38 Return Cases 29-31 Sanitary Conveniences 13, 83 'Scarlet Fever 24 ,, Convalescents, Inspection of 24,25 Schools, the 39-48 School Children, the Medical Inspection of 44-47 Sewerage 49, 50 Slaughter-houses 59, 60, 78, 87 Small-pox 23 ,, Hospital 32 Smoke Nuisance 88 Statistics, Vital 4, 13 „ Comparative 20 Sunday Schools. 47,48 Syphilis 37 Tables for the County Council 77-80 ,, ,, Home Office 61-64 ,, ,, Local Government Board 65-75 Teachers' Notifications 35, 43 Tenement Houses 59 Trades, Offensive 60. 86 Tramways 12 Transport of Patients to Hospital 32,83 "Tuberculous Milk 60 Tubercle 36, 37 Unsound Food 60, 78, 81, 89, 90 Vaccination 24 Venereal Diseases 37 Watercourses 51, 88 Water Supply 50,51 Whooping Cough 36,44 Woman Inspector 20-22 .Zymotic Diseases 19, 76 9 Edmonton Urban District. REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 190S. PHYSICAL FEATURES OF THE DISTRICT. The Urban District of Edmonton has an area of 3,894 acres, including ' 31 of water. It is situated in the County of Middlesex, on the west bank of the River Lea. The chief watercourses are Salmon's Brook, which takes a southeasterly course across the northern part of the district to the Sewage Farm, but there turns due south and joins Pymmes Brook on the extreme southwest corner of the district. Pymmes Brook flows through the southern part of Edmonton and Pymmes Park in an easterly direction as far as Angel Road Station, but a little further on it takes a southern course and is joined by Salmon's Brook; the combined waters ultimately fall into the River Lea below Tottenham Lock. The New River lies on the western boundary. The soil is loam and the subsoil consists of brick-earth and gravel of varying depth overlying the London clay. This Urban District is bounded by Enfield Urban District on the north, and the Urban Districts of Southgate and Tottenham on the west and south respectively. Chingford Urban District of the County of Essex lies on the east, on the opposite bank of the River Lea. The district is for the most part flat, rising slightly from the river marshes on the east, to the higher ground to the westward. 10 PAST HISTORY. Edmonton is an ancient town mentioned in the Domesday Book as "Adelmeton" (or the town of Aldhelm). It is seven miles from London, in the Enfield Division of the County, Hundred, Petty Sessional Division, Union and County Court District of Edmonton, Rural Deanery of Enfield, and Archdeaconry and Diocese of London, in the Northern Metropolitan Postal District, and was added to the Metropolitan Police District on the 13th October, 1840. The parish adopted the Public Health Act of 1848 on the 21st June, 1859, but by the operation of the Edmonton Local Board (Division of District) Act, 1881, it was divided into two Urban Sanitary Districts, Edmonton and Southgate. Two well-known men resided in Edmonton, viz.:— Keats and Lamb. The latter and his sister, Mary, are both buried in All Saints' Churchyard. The little house in which they lived is still in use, as also the mansion built by Sir Hugh Myddleton, the constructor of the New River, which runs through the grounds. A large house in Bury Street is said to have been the country residence of the infamous Judge Jeffries. Many large houses have within recent years been dismantled, and their grounds occupied by rows of smaller ones. "The diverting history of John Gilpin," by Cowper, with its references to Edmonton as the best place for a pleasant picnic outside London, must be well-known to all my readers. RECENT HISTORY. The district was divided into three Wards— Church Street, Fore Street and Bury Street— by an order of the Middlesex County Council in 1903, and is controlled by an Urban District of 27 members, nine of whom retire annually. It is represented on the Middlesex County Council by three members. The population is now almost entirely industrial, and a large proportion of the workers travel daily by train and tram to their employment in the City and other parts of London. There are, however, in Edmonton, several large works, notably the cartridge factory of Messrs. Eley Bros., Messrs. Ridley Whitley's linoleum works, the Gothic gas-meter works, the New Pegamoid Co., and Aerators, Ltd., whose employees are, for the most part, residents of Edmonton. In the first-mentioned factoiy, however, where most of the workers (about 1,100) are women, nearly one-quarter of their number reside in London, and come daily to their work by tram and rail. The Distress Committee, under the Chairmanship of Councillor Mason, has been exceedingly busy in finding useful work for the unemployed and in putting to good use the monies supplied by the Government. All the men " set on " have been given three weeks' work at 6d. per hour. Some selected families have been assisted to emigrate to Canada. 11 INSTITUTIONS. The workhouses of two large Unions are situated in Fore Street Ward. The one b?longing to the Strand Union, London, to which is attached the Strand Union Schools, receives its inmates from the Strand District alone: its population, therefore, does not enter into our statistics. The Institution belonging to the Edmonton Board of Guardians receives a certain proportion of its inmates from this district, and such proportion is treated as part of our population for statistical purposes. The large bulk of the inmates, however, are derived from Tottenham, Southgate, Wood Green, Hornsey, Enfield, Cheshunt (Herts.), and Waltham Abbey (Essex), which places make up the large Poor-Law Union of Edmonton, and these inmates, of course, do not enter into our vital statistics. Amongst a total of forty Guardians, Edmonton District proper has only four representatives. The Guardians of Edmonton Union have decided to build a new Infirmary on land adjacent to their present buildings. A portion of a larger scheme has been started this year. This is the erection of an administrative block, a porter's lodge, two pavilions for patients, and a nurses' home, at a cost of £72,724. The plans were laid before our Plans Committee, and approved on 2nd April 1908. A table shewing the number of inmates of both Institutions, and the births and deaths that have taken place there, will be found in Table II. OPEN SPACES. Pymmes Park (53 acres) was purchased in 1899 for £36,000. A garden has been laid out after the old English style within one of the walled enclosures adjoining the old Elizabethan mansion, which last is used for technical classes by the Middlesex County Council. These classes are to be held in future in a new building on the site of Brookfield House, adjoining our Town Hall. The artificial lake provides scope for boating or skating. As, in course of time, Edmonton becomes more densely populated, Pymmes Park will be an increasingly valuable factor in the good health of the people. The Recreation Ground in Church Street (10 acres) was presented to the Council by the Ecclesiastical Commissioners in December, 1901, and affords room for the cricket pitches and football grounds of the rising generation. The Barrowfield Allotments extend to 18 acres, and should enable many industrious men to grow their own vegetables and thus usefully occupy their spare time. 12 One open space off the Fore Street, viz., "Moree's Pond," has been filled' in. However useful and picturesque this may have been in years gone by,, no one will now regret its disappearance. Other spaces of service in their special way are the Sewage Farm of 235 acres, and the General Cemetery of 30 acres (which cost £20,500, and was consecrated in 1884), and the Hebrews' Cemetery of 10 acres in Montague Road. Waste lands and possible building sites are not mentioned in detail, but they contain area enough for 100,000 more inhabitants. Some of them, are at present utilized as brickfields or market gardens, but others are ranged over by the gipsy and vagrant. RAILWAY FACILITIES. The railway connection with London starts from the Liverpool Street terminus of the Great Eastern Railway Company, and there are five stations in the district, viz.:—Silver Street, Lower Edmonton and Bush Hill Park on the branch to Enfield, and Lower Edmonton on a low level connecting link between the main line and the Enfield line, which link branches off from theformer at Angel Road station. A bridge conveying the road over the main line at this station is in process of erection by the Great Eastern Railway Company. This will be a great convenience to the ever - increasing traffic at this point. TRAMWAY FACILITIES. There are direct electrical connections with Stamford Hill and Finsbury Park, whence connection can be made with trains, trams or omnibuses to all parts of London and suburbs. The Tube Railway, from Finsbury Park to Hammersmith, provides a quick and easy transit from north to west of London. TRAMWAY EXTENSION. The widening of Fore Street has proceeded at such a rate as the necessarily lengthy negotiations for the acquirement of the land required would permit, and before long we shall have in this main road a handsome avenue for the increasing traffic of the district. This work is not yet completed. Some widening operations at certain points in the road remain to be carried out before the whole scheme can be said to be complete. In the meantime the inhabitants are benefitting: 13 immensely by the improved means of transit, and the greater cleanliness of the new road adds materially to their comfort and plays, I am convinced, an important part in the conservation of their health. Within a short time the travelling facilities throughout the northern neighbourhood of London will be much increased, and in a few years' time we may see a circular route running from Finsbury Park through Wood Green, Palmers Green, Winchniore Hill, Enfield, Edmonton and Tottenham, back to Finsbury Park, and perhaps a short connecting line between Edmonton Green and Green Lanes, via Church Street. SANITARY CONVENIENCES. One has been erected at the important junction of Angel Road and Fore Street; and another, on The Green, will be built next year. Bye-laws with reference to these buildings were approved by the Local Government Board on 23rd January, 1909. BATHS. These were opened in 1903, the cost being £28,245 (this amount included the cost of the new Council Chamber, Mortuary, Stores and Offices). There are no public wash-houses in connection with the baths. FREE LIBRARY. This library was opened in 1897. The cost was .£5,000, which was chiefly borne by Mr. Passmore Edwards. Mr. Farmborough is the Librarian; and the Management Committee, elected annually, consists of ten Councillors and ten gentlemen chosen by the Council. There are no ladies on the Committee. VITAL STATISTICS. To the various Registrars, especially Mr. J. Harman Judd, I owe thanks for the care and promptness exercised in the returns to me, on which foundation the whole fabric of my statistics is raised. Population. The following tables shew the population of the district, exclusive of the two Union Workhouses, for the last three Census years :— Year. Population. 1881 13,065 1891 23,437 1901 44,911 The estimated population for the year is arrived at by multiplying the number of inhabited houses at the middle of the year, by the number of inhabitants per house as given in the last Census Report. This figure for 14 Edmonton, excluding Workhouses, in 1901, was 5.76, but it is only 5.72 this year. The number of inhabited houses in the district in the middle of 1908 was 10,522. To the figure thus obtained (59,974) is added the average number of Edmonton residents in the Edmonton Union Workhouse, which, for the year, was found to be 208, as compared with 209 and 226 for 1907 and 1906 respectively. The estimated nett population of the District, and that on which the various rates that follow are calculated, is therefore 60,182. The population of the three Wards, estimated in the same way:— Was in 1907. Is in 1908. Bury Street Ward 18,981 19,739. Church Street Ward 19,522 19,499 Fore Street Ward 20,722 20,736 The area of the district is 3,894 acres (less 31 of water), and the density of population, or the average number of persons per acre of land, is over 16.0. This figure is calculated on the gross population, which includes the average populations of the Strand and Edmonton Union Workhouses and Strand Union Schools, and amounts to 62,186. The natural increase of the population, that is, the excess of nett total of births over the nett total of deaths in 1908, was 2,000 minus 902, = 1,098. BIRTHS. The number of births registered by the District Registrar, Mr. Judd,. was exactly 2,000, which includes 20 births that took place in the Edmonton Workhouse, born of mothers belonging to Edmonton. Add 5 births that occurred in outside Institutions. Six births which occurred at the Strand Workhouse and 68 which occurred at Edmonton Workhouse, born of mothers who are not Edmonton residents, are excluded from our statistics, just as foreign deaths are. Thus the nett total of births was 1,931. Of these births 43, or 2.24 per cent., were illegitimate. The birth-rate per thousand inhabitants is therefore 32.09, compared with 31.24 last year. Notification of Births Act, 1907. On February 5th, 1908. the Sanitary Committee, on the third consideration of the subject, recommended the adoption of this Act. On March 24th the Council passed a resolution in favour of this course, and, by the direction of the Local Government Board, the Act came into force on April 28th, 1908. Previous to this date I circularised all the medical men and midwives and "handy women" practising in the District, informing them as to the best method of accurately 15 notifying all live and still births to me. In strict accordance with the words of the Act, post-cards are nsed, but I prefer forms similar to those used for notification of Infectious Diseases. These latter are in books with counterfoils, which would form a useful record of their obstetric work for the doctor or midwife. I regret that the Act has only been in use for part of a year, as I shall not be able to utilise the results of 1908 for comparison with future vears. Although possessing a legitimate grievance in being asked to notify without even the smallest of fees for rendering a great service toPublic Health, I am pleased to say that, with few exceptions, the information required by the Act has been promptly sent me. It is an important fact that the Act applies to still-born children, or any child of over seven lunar months maturity in the womb. During the past three years as many as 63, 85, and 85 children styled "still-born" were buried in Edmonton Cemetery. I think that two columns might be usefully added to Local Government Board Table I. for number and rate of births really belonging to the District. In a district like Edmonton, with two large institutions therein, the figures in Table I., columns 3 and 4, are most deceptive, if based only on the births registered in the District. The birth-rate (32.09) for 1908 is higher than last year, and it is much higher than 26.5, the birth-rate of England and Wales for 1908. The birthrate for the preceding 10 years will be found in Column 4 of Table I. The births were distributed in the Wards as follows :— Ward. Births. Birth Rate per 1,000 living in the Ward. Bury Street Ward 654 33.15 Church Street Ward 621 31.84 *Fore Street Ward 656 31.63 *Contains Edmonton Workhouse, where there were 20 babies born of Edmonton mothers during 1908. The Midwives' Aet, 1902, is now in the "melting pot" of a Departmental Committee appointed by the Government. Let us hope that their deliberations will result in a new Act of Parliament, free from the defects of the old one! Under date February, 1908, I received that month, from His Majesty's Privy Council Office, a leaflet of two sheets, said to be "Extract from Circular 16 Letter of the Local Government Board to Clerks to the Guardians, dated 29th July, 1907." In this extract the Local Government Board pointed out to the Boards of Guardians that under Section 2 of the Poor Law Amendment Act, 1848, it was competent for the Guardians to pay the fee of any medical man called in on the advice of a midwive to attend upon a poor person in difficult cases. Further, the Board suggested that medical men and certified midwives practising in each Poor Law Union should be informed that in cases arising under Rule 18 of the Midwives Act, 1902, entitled, "Conditions in which medical help must be sent for," the Guardians will, on being satisfied that the woman is too poor to afford to pay the medical fee, be prepared to pay a reasonable remuneration to the medical man called in. "Any such payments should be," the Local Government Board adds, "on a definite scale, which should be suitable to the local circumstances and to the services rendered, and which should be duly notified to the local medical practitioners." So far as I can ascertain, the Edmonton Guardians took no action on the lines advised by the Local Government Board. DEATHS. The deaths registered in the District during the year were 902. Of these, 63 occurring in the Strand Union Workhouse and Schools, and 233 among non-residents at the Edmonton Union Workhouse, and 1 in an Inebriates' Home, and two of vagrants, are excluded, while 79 deaths of Edmonton residents taking place in the Edmonton Workhouse are included in our nett deaths. Thus the number of deaths amongst Edmonton residents registered in the District amounted to 603. The notorious baby farmer, who in 1906 was proved to have had relations with the deaths of six infants and received a mild sentence of imprisonment from a merciful judge, resumed her business (soon after her release) in a neighbouring district, but she was, before long, in prison again for an offence under the Infant Life Protection Act. The gross death-rate is based upon the total number of deaths registered in the District, and is 14.50 per 1,000 living. This rate is calculated on the estimated gross population of 62,186. An arrangement exists with the County Medical Officer of Health and with Somerset House and with the District Registrars of Tottenham and Enfield, whereby the deaths of all residents of Edmonton outside the district are returned to me for inclusion in our statistics. The greater accuracy arrived at by this arrangements accounts partly, I believe, for the large increase of late years of the figures in Column 11, Table I. 129 deaths were returned in these ways during the year, making the nett total of deaths at all ages for the district proper 732. 17 The nett death-rate is based upon the total number of deaths of Edmonton residents occurring inside or outside the District, and is 12.16. This rate is calculated on the estimated nett population of 60,182. The corrected nett death-rate is only an ideal or standardised figure. When the factor for correction is applied to the nett death-rate we get the figure that would represent the death-rate in Edmonton if its inhabitants were distributed in the same proportion as regards age and sex as are the inhabitants of the country generally. This factor for Edmonton is 1.01785, and the corrected nett death-rate is therefore (12.16 by 1.01785) 12.37. The nett death-rates for the preceding ten years will be found on Table I., Column 13. The nett death-rate for Edmonton is, as I have said, 1216 per 1,000 living; it is lower than the last year (13.32). It is the lowest of any recorded, and is 3.16 lower than the average of the ten previous years. Ward Deaths. The following are the death and death-rates in the three Wards. Deaths occurring amongst residents in the Institutions and of residents dying outside the district have been debited to the Wards in which they lately resided. Twelve Institution deaths amongst residents, that could not be allocated, are entered in Column 15 on Table IVa. Ward. Deaths. Death Rate per 1,000 living in the Ward. Bury Street Ward 267 13.52 Church Street Ward 242 12.45 Fore Street Ward 211 10.17 Death Certification. All deaths were certified either by the Medical Attendant or by the Coroner; there were none uncertified. Inquests were held on 104 residents, or over 14 per cent. of the total deaths. This percentage is unusually high. The causes of these deaths will be found on Table IVa. Seven inquests were held on the bodies of illegitimate infants, or about 32 per cent. of he total illegitimate deaths. The ages at, and causes of, deaths, are set out in detail on Table IVa. 18 INFANTILE MORTALITY. The infantile mortality is a special death-rate referring to the first age period (0 to 1 year), and is expressed as the number of deaths that take place amongst children under one year of age per thousand births registered. The number of such deaths occurring amongst Edmonton children, and registered within or without the District within the year, was 227, and the births registered within or without the district, born of Edmonton mothers, numbered 1931; therefore the infantile death-rate, based on these figures, is 117.41 per thousand births. This does not tally with the rate in Column 6, Table I. of the Local Government Board, because there the total deaths registered in the District are recorded, and they only amount to 213, which produces a death-rate of 106.50; this is the lowest record on Table I., and no less than 41.08 below the average of the ten previous years. But the true infantile death-rate, 117.41, is 3.75 lower than last year. The Infantile Mortality Rate for the year, in England and Wales, was 121; in London, 113; in the 76 great towns, 128; and in the 142 smaller towns (which include Edmonton), 124 per thousand births registered. The figures for the Wards are as follows:— Ward. Deaths under one year. Infantile Mortality Rate. Bury Street Ward 83 127 per nett 1000 births in the ward Church Street Ward 70 113 „ „ „ Fore Street Ward 74 ,, ,, ,, Table V. was first issued by the Local Government Board in 1905. It enables the death among infants under one year of age from certain causes to be recorded in weeks and months of age. The information collected by this means for the whole country will prove of great value in indicating the true significance that should be attached to the mortality in the various age - groups. The Table shows that in the first month over 80 per cent. of the deaths were due to what are termed "wasting diseases." This is a great advance over last year, when the percentage was 68. These are conditions that for the most part manifest themselves at the birth of the infant, and depend on bad ante-natal circumstances, associated with the health of the mother, such as factory work, drink, venereal disease, and the use of abortifacients, rather than on any external influence to which the child becomes subject after birth, such as improper feeding, clothing, or exposure. Although adverse external influences may begin to operate from the moment of birth, it is not, as shown by the Table, until the second month of life that they begin to 19 give rise to deaths in any significant numbers. The rise of deaths due to premature birth, from 34 to 48, is startling! Is the use of abortifacients becoming more popular in Edmonton, or are the other ante-natal causes on the increase ? The Children Act, 1908, is referred to in the section "Legislation." Zymotic Death-Rate. This rate is a statement of the number of deaths from the seven principal zymotic diseases per thousand of the population. There were 120 deaths from these diseases during the year, and the zymotic death-rate is therefore 1.99, as compared with 2.08 for the previous year. This figure is a reduction on last year, and equals the previous lowest record of 1903. The zymotic death-rate for 1908 in London was 1.35; in the 76 great towns, 1.59; in England and Wales, 1.29; and in the 142 smaller towns (which include Edmonton) the zymotic death-rate was 1.26. The following Table shows the deaths from these diseases distributed amongst the three Wards:— DISEASE. Whole District. Bury Street. Church Street. Fore Street. Small pox – – – – Measles 19 9 8 2 Scarlet Fever 12 6 3 3 Whooping Cough 15 10 3 2 Diphtheria 27 11 12 4 Enteric Fever 6 2 3 1 Diarrhœa 41 21 9 11 Total 120 59 38 23 Rates 1.99 2.98 1.90 1.10 The average Zymotic Death-Rate for the previous ten years was 3.64. In the following table is set out the Death - rate, Infantile Mortality and Zymotic Death-rate for 1908 and past ten years:— Nett Death-rate. Infantile Mortality. Zymotic Death-rate. 1898 16.8 195.8 5.08 1899 17.4 161.8 4.6 1900 16.0 168.1 2.6 1901 14.3 139.0 2.4 1902 17.8 143.6 4.7 1903 13.7 140.3* 1.9 1904 15.8 161.8 3.87 1905 13.3 128.0 2.36 1906 13.7 131.8 3.03 1907 13.3 121.1 2.08 1908 12.1 117.4 1.99 *In calculating the Infantile Mortality for the year 1903, deaths due to premature birth were included for the first time. 20 PUBLIC HEALTH ACTS AMENDMENT ACT, 1907. On February 11th, 1908, the Council accepted the reports of the Clerk, Engineer, and Medical Officer of Health, as to the adoption of certain portions of this useful Act. No further progress has been made. COMPARATIVE STATISTICS. The Table of Vital Statistics for 1908, showing the various rates for the whole country, and for several of the Urban Districts of Middlesex, is given for the purpose of comparison. Estimated Population, 1908. Annual Rates per 1,000 of the population. Infantile Mortality per 1,000 births registered. Nett Births. Nett Deaths, (corrected) Zymotic Deaths. England and Wales 35,348,780 26.5 14.7 1.29 121 The 76 Great Towns over 100,000 people 16,234,952 27.0 15.8 1.59 128 The 142 Smaller Towns over 50,000 people (these includeEdmonton) 4,997,447 26.0 14.7 1.26 124 England and Wales, less the 218 towns as above 14,116,741 26.2 13.8 0.99 110 London 4,795,757 25.4 13.8 1.35 113 Acton 55,000 28.5 13.1 2.2 120 Wood Green 51,551 25.38 9.05 0.53 81 Enfield 56,185 25.18 11.18 0.88 90 The birth-rate of England and Wales is 0.2 higher than last year, which was the lowest on record, and the infantile death-rate is 3 integers higher, but the death-rate is 0.3 lower than in 1907, and the lowest recorded; so that the natural increase in the population of England and Wales, or the excess of births over deaths, is 420,968, or 13,742 more than the average of the preceding five years. THE LADY HEALTH VISITOR AND HER WORK. I give below an analysis of the number and nature of the visits paid by Miss Tettenborn during 1908. She acts in the dual capacity of Lady Health Visitor and Woman Inspector, and it will be seen that the bulk of her work falls into two correspondingly large divisions, viz.:— 1. The crusade against Preventable Infantile Mortality, as Lady Health Visitor; and 2. The work done as Woman Inspector in Factories, Workshops, etc. 21 INFANTILE MORTALITY. Month. After Births. Re-visits. Neglected Infants. After Deaths. Diarrhœal Diseases. January 100 6 2 *100 – February 157 10 4 13 – March 120 15 – 8 – April 86 20 – 6 – May 110 20 – 10 – June 85 2 – 2 – July 80 – – – – August 45 10 – 4 5 September 112 10 2 14 9 October 108 8 – 10 – November 50 10 5 10 – December 50 10 – 8 – Totals 1193 121 13 185 14 *Many of these deaths occurred in 1907. INSPECTIONS UNDER FACTORY AND WORKSHOPS ACTS. Factories. Workshops. Laundries. Outworkers. January 1 3 3 4 February – 4 2 9 March 2 4 3 24 April 1 2 3 15 May 1 6 7 25 June 4 1 2 21 July 2 – – 4 August 2 1 7 17 September 2 5 2 36 October 1 5 2 16 November – 2 5 8 December – 4 2 45 Totals 16 37 38 224 NOTIFIABLE DISEASES. Visits and re-visits to Erysipelas cases, 50. Visits to Puerperal Fever cases, 1. Disinfecting midwives' bags and appliances, 4. Assisting in the removal of patients to Hospital, 3. 22 NON-NOTIFIABLE DISEASES. Visits re Phthisis voluntarily notified, 27. Visits paid re School Notifications concerning non-notifiable diseases, such as measles, whooping cough, chicken pox, etc., to 921 children at 714 homes. GENERAL WORK. Visits to Creche, 2. Visits to Private Schools, 4. Enquiries re complaints, 40. Miscellaneous visits, 298. THE BABY SHOW. A most successful function was held on July 16th, for which over 400 babies under 18 months of age were entered by their fond mothers, each of whom have the "best baby in the world," much less in Edmonton. Many more entries could have been made, but I felt sure that 400 were enough to deal with, and events proved I was right. The idea originated with the Lady Health Visitor, who worked hard in the cause, and the Show received the hearty recognition of my Council, who appointed the Vice-Chairman, the Chairman of the Sanitary Committee, and myself, as a Committee to assist in the promotion of Miss Tettenborn's plans. The infants were divided into ten sections, according to age, and prizes were given in each section. Special prizes were awarded to (1) the best twins, (2) the prettiest baby, (3) the neatest dressed baby, and (4) the healthiest baby in the Show. None of the babies were weighed—the pale, fat baby, reared on patent foods, had little chance of a prize. The Show received excellent notices in the London Press, with the result that for months afterwards the Lady Health Visitor and myself were the recipients of enquiries and congratulations from correspondents in the United Kingdom, the Colonies, and abroad. 23 COMMUNICABLE DISEASES-NOTIFIABLE. The Infectious Diseases Notification and Prevention Acts have been in force in this District since March 1st, 1891. Table VI. shows the number of cases notified and the deaths from the notifiable diseases for 1008 and the ten preceding years. The same table also shows the deaths that have occurred from non-notifiable diseases for this period. This is not a Local Government Board Table. Table III. shows details as to age - distribution and locality of the notified cases, and the number of cases removed to hospital from each Ward. In May the cases of Scarlet Fever and Diphtheria notified were unusually numerous. They amounted to 54, as compared with 13 for May, 1907. There were no special foci of either disease, but the cases were generally distributed over all parts of the District. The following Table shows the numbsr of cases notified and the number isolated, the percentage of these to the cases notified, and the fatality, i.e., the percentage of cases dying to those notified:— Disease. Cases Notified. No. isolated in Hospital. Isolations per cent. Total Deaths. Fatality per cent. Scarlet Fever 308 275 89.28 12 3.89 Diphtheria and Mem. Croup 158 124 78.48 27 17.08 Enteric Fever 36* 25* 69.44* 7* 19.44* Totals 502 424 – 46 – *This includes a Waltham Ahbey case notified from, treated and died at the Edmonton Union Infirmary. Compared with last year, the figures show 77 more notifications of Scarlet Fever, and a slightly greater fatality; there were 63 more notifications of Diphtheria, with a smaller percentage of fatal cases; the notifications •of Enteric Fever were 7 more, but the disease was more fatal in its results. A chart is given with each section of this Report dealing with Scarlet Fever, Diphtheria, and Enteric Fever, based on the uniform plan of a temperature chart. These charts graphically show the weekly incidence of these diseases, both for 1907 and 1908. Small-Pox. A satisfactory feature of the infectious disease returns for the year is the absence of Small-pox from amongst them; as in 1905, 1906 and 1907, the district has enjoyed complete immunity from this disease during the year. 24 Vaccination. The following table of vaccination returns for the year 1907 has been kindly supplied by Mr. Lowman, the Vaccination Officer. The returns for 1908 will not be available for some months. VACCINATION RETURN FOR 1907. Births. Successful Vaccinations. Conscientious Certificates Deaths under one year un vaccinated. Still un vaccina ted but address known. Postponed owing to Illness. Certified unsusceptible. Removed and Uutraced. 1922 1266 72 153 24 53 3 351* *Some of the cases removed are known to have been vaccinated, but as the certificates were not received, they could not be included in the return. It should be noted that omitting to forward the certificate is as much an offence against the Vaccination Acts as neglecting to have the child vaccinated. Scarlet Fevep. 308 cases were notified, giving an attack rate of 5.11 per thousand. 231, 383 and 259 cases were notified in 1907-6-5. The patients were distributed amongst 247 houses and 112 streets. One case occurred in 205 houses; two cases occurred in 26 houses; three cases in 13 houses; four cases in 3 houses. The removals to hospital numbered 275, an isolation percentage of 89.28. There were 12 deaths, giving a fatality of 3.89 per cent. of cases notified, and a death-rate of 0.19 per thousand of the population. Secondary Cases numbered 61 out of 308. These are often due to the parents not dealing with the first case in their family on wise and intelligent lines. It is unreasonable to expect any mother to say definitely whether a given case is one of Scarlet Fever or not, but it is not an unreasonable requirement—indeed, it is one of her first duties as a mother—that she should be able to recognise the common warning signs of the ordinary infectious diseases and take them as a signal for separating the affected child from other members of the family, and keeping the other children from school until a medical man diagnoses the real nature of the illness. Return Cases.—See section on "Hospitals." INSPECTION OF SCARLET FEVER CONVALESCENTS. On March 10th the Council adopted the Sanitary Committee's recommendation that these people should be asked to come to the Town Hall on their way home from hospital, and be there examined by the Medical Officer NOTIFICATIONS OF SCARLET FEVER IN 1907 AND 1908. TOTAL NOTIFICATIONS IN 1907—231 ; IN 1908—308. The Black Tracing denotes the rise and fall in 1907 ; the Red Tracing shows the same for 1908. 25 of Health as to their freedom from peeling and discharges. This recommendation followed, or resulted from, the report of numerous return cases by the M.O.H. during the two previous years. At the Sanitary Committee of the 8th April, I advised that the proposed inspection was difficult to carry out, and inadvisable for other reasons, and the Hospital Board of Management wrote on the 31st March, stating that they could not be parties to, nor recognise in any way, the suggested examination of their patients at our Town Hall; further, I reported that I was unable to find any room in the Town Hall suitable for the purpose, but the Committee recommended the instruction of the M.O.H. to carry out the resolution of the 10th March, and ordered that in cases of ear and nose discharge, or peeling, the M.O.H. do send the children home, order isolation, and report to the Chairman of the Committee (Dr. Benjafield), who would see such cases with him. On September 2nd I reported that, in accordance with the instruction of my Council, based on the recommendation of the Sanitary Committee, the system of inspection at the Town Hall had commenced on 28th August. I also presented to my Sanitary Committee a letter from the Local Government Board, dated 10th August, in which the Board expressed their strong disapproval of the Town Hall inspections, but the Committee recommended that they be continued for six months. From 28th August up to the end of last year, 82 persons have been discharged from our Hospital after treatment for Scarlet Fever :— Inspected by M.O.H. at Town Hall 25 Not inspected by M.O.H. 57 82 (1) Because objection was made by patient or parents 48 (2) Because they were taken home by friends direct 4 (3) Because the M.O.H. was engaged on outside duty 5—57 So that for various reasons only a little over 30 per cent were inspected before reaching home. 26 Diphtheria and Membranous Croup. The latter, Membranous Croup, is only an old-fashioned phrase for Diphtheria, presenting symptons mostly confined to the larynx. I received notifications of 158 cases during the year, compared with 95, 93 and 37, in 1907-6-5, and represents an attack rate of 2.26 per thousand of the population. The cases occurred in 75 streets and 121 houses; one case occurred in 97 houses; two cases in 15 houses; three cases in 6 houses; and four cases in 2 houses. The cases removed to hospital numbered 124, being 78.48 per cent of those notified. There were 27 deaths, giving a death - rate of 0.44 per thousand of the population, and a fatality of 17.08 per cent, of those notified. I regret to report that Edmonton has not maintained its good reputation with regard to the incidence of Diphtheria. As you will see, the number •of cases notified is 63 more than in 1907, although the fatality percentage is less. Return Cases.—See " Hospital Section." Enteric Fever. Thirty-six cases were notified, as against 29, 25 and 44, in 1907-6-5. This is equal to an attack rate of 0.59 per thousand of the population. These cases occurred in 30 houses and 27 streets. Two of the cases were inmates of the Edmonton Infirmary, one of whom was a person from Waltham Abbey. The removals to our hospital numbered 24—an isolation percentage of 66.66; there were 6 deaths, giving a fatality of 16.66 per cent, of the cases notified, and a death-rate of 0.09 per thousand of the population. The man from Waltham Abbey also died. Careful enquiries were made into every case reported, with a view to ascertaining the source of infection. Owing to the fact that Enteric Fever is invariably conveyed by the mouth, and in most cases through the agency of contaminated food and drink, special enquiries were made as to those articles of diet—such as shell - fish, fried fish, water - cress, etc.—that are most liable to contamination by the organism of this disease. It was found that among the 36 cases reported, one had been an habitual shell-fish eater, and had partaken of this food in some form at a date that admitted of its being reasonably entertained as a possible source of infection. Nine patients had eaten fried fish under similar circumstances, and there was a history of two patients having eaten water-cress. In one case shell-fish and fried fish were the favourite articles of diet; in two cases, shell-fish and water-cress, and in two cases fried fish and water-cress. NOTIFICATIONS of DIPHTHERIA in 1907 and 1906. TOTAL NOTIFICATIONS IN 1907-95; IN 1908—158. The lilack Tracing denotes the rise and fall in 1907 ; the Red Tracing show s the same for 1908. NOTIFICATIONS OF ENTERIC FEVER in 1907 and 1908. TOTAL NOTIFICATIONS IN 1907—29; IN 1908-36. Tlie Black Tracing denotes the rise and fall in 1907 ; the Hed Tracing shows the same for 1908. 27 Cerebro-Spinal Fever. This disease was first made notifiable in Edmonton by an emergency order for one month, from 22nd March, 1907, then for six months, arid finally from November 30th, 1907, for eighteen months. This harmonised with the action of our big neighbour, the London County Council. No notification was received during 1908. ENFIELD AND EDMONTON JOINT ISOLATION HOSPITAL. This is situated in the Enfield District, on its Winchmore Hill border, and adjoining the large Convalescent Hospital of the Metropolitan Asylums Board. A Joint Board, consisting of four members from each Council, has been the controlling body since January 1st, 1906. It was mutually arranged in June, 1907, that the share of the precept payable by each Council should be, in future, based on the estimated population, calculated on the number of houses found inhabited by the Vestry Clerks in May of each year. Besides, a contribution of 30s. per case admitted is made by the District from which the patient is sent in. The contribution of Edmonton towards •the Hospital during 1908 was about £4,694. The accommodation available on December 31st, 1908, was :— For Scarlet Fever 78 beds. For Enteric Fever 14 beds. For Diphtheria 13 beds. For Mixed Infections 18 beds. For Observation 2 cubicles. Total 125 beds. Neither District has preference over the other when beds are vacant. New Officers. In May, Dr. J. J. Ridge, who had been Medical 'Superintendent (non-resident) for many years, died, and one of his sons, Dr. Manners Ridge, took over the duties from April until July (inclusive). On August 1st, Dr. Haldane Cook (of Enfield) began duty as Visiting Superintendent, and Dr. T. Strain as Resident Medical Officer. It is not 28 too much to say that the advantage of a physician with a diploma in PublicHealth being resident at a hospital of this size has already proved as good in practice as it is in theory. The Clerk and Surveyor of the Enfield Council act, as heretofore, as Clerk and Architect to the Hospital, respectively. Weekly Returns from the Isolation Hospital. In September I reported that in times past neither I nor my Council had been made fully aware of the welfare of Edmonton patients sent to the Hospital we share with Enfield. Deaths of children were rarely heard of, until weeks afterwards from the Enfield Registrar, and I advised my Sanitary Committee to ask the Joint Board to instruct their Medical Superintendent to send me every Monday a list showing the admissions, discharges, and deaths during the past week, and the number of Edmonton patients remaining in hospital on the previous Saturday night, classed according to their diseases. I regret to say that my Committee recommended that this information be regularly supplied me as regards the deaths of patients only. The other information is both useful and necessary to the Edmonton Medical Officer of Health. Fire. The Hospital is in telephonic communication with Edmonton Fire Station. Extension of Hospital. On January 28th I attended a Local Government Board inquiry at Enfield with reference to this subject. A loan of £5,200 was asked for to build a block of two wards to replace a temporary building, half of which was destroyed by fire on January 26tli, 1907; the total gain of beds, when the latter building was dispensed with, being fourteen. I gave evidence thereat, and expressed a firm opinion, from my knowledge of the history of the Edmonton cases treated there for nearly twoyears past, that extension of accommodation was needed, but that the loan asked for would be better spent in erecting a block on the glass cubicle plan. I added that I had satisfied myself that this Walthamstow pattern was as cheap—if not cheaper—than the conventional and old-fashioned one, and was certainly much more efficient in checking cross-infection and persistent ear and nose discharges, which latter are the cause of so many return cases. These views met with opposition from more than one quarter, but subsequent events have justified all I then said. Under date December 17th, the Hospital Board advised us that the- accommodation for Diphtheria was fully occupied. Since then we have availed ourselves, when necessary, of beds at the Walthamstow Isolation Hospital. 29 The following table gives the percentage of hospital isolation to cases notified, for the past five years. 1904. 1905. 1906. 1907. 1908. Scarlet Fever 72.9 80.7 88.00 82.25 89.28 Diphtheria 50.0 54.0 77.42 86.31 78.48 Enteric Fever 57.9 68.0 64.00 82.75 69.44 I had hoped to incorporate here particulars from the Medical Superintendent's Report of the work of the Joint Isolation Hospital during 1908 as far as Edmonton patients are concerned, but as his Report usually covers a period from March to March, it is therefore of no service to us. This is unfortunate, as no monthly nor other regular reports of the work of the liospital reach either the Sanitary Committee or the Council of Edmonton. Return Cases. In 1905 there were only nine cases, in 1906 thirty. three cases, in 1907 twenty-nine cases, and in 1908 twenty cases. As last year, I have omitted all cases where the interval between the discharge of the previous case and the onset of the next one was more than 30 days. Cross Infection? I am glad to say that there were no diphtheria return cases, but from March to May (inclusive) thirteen cases of diphtheria were removed from seven houses, all under similar circumstances, viz., a relative had returned home after treatment in our Hospital for Scarlet Fever. For particulars, see special table. Memoranda. No. of Cases. Notified by a Practitioner as Certified to have died in Hospital of One Enteric Fever Pleurisy. One Scarlet Fever Scarlet Fever and Croup. Three Diphtheria Diphtheria and Scarlet Fever. *One „ Measles. One „ Croup. *One „ Scarlet Fever. One Membranous Croup Catarrhal Laryngitis. In all these cases I have drawn the attention of the notifying practitioner to the death certificate, and refusal to withdraw or alter notification having been made (except in two cases marked*), I have recorded the case as one such as the practitioner notified to me. RETURN CASES OF SCARLET FEVER FOR THE YEAR 1908. Return Cask. Prkvious Cask. Interval between discharge of previous case and onset of next one. Condition of previous case after return from Hospital. No. in Register. (190s). Onset. No. in Register. (1907). Date of Discharge. No of (lavs in Hospital. 19 18/1/08 369 13/1/08 49 5 days Nose sore and discharging. 64 7/2/08 369 13/1/08 49 25 days 77 11/2/08 382 3/2/08 56 8 days Free peeling on both soles. 161 4/4/08 (1908). 17 9/3/08 52 26 days Nothing noticed. 160 6/4/08 17 9/3/08 52 28 days 192 24/4/08 133 18/4/08 26 6 days Nose sore with bloody scabs inside. Small sore at angle of left jaw. 232 19/5/08 109 24/4/08 45 25 days Both hands "scurfy." 236 21/5/08 109 24/4/08 45 27 days 269 29/5/08 141 2/5/08 37 27 days Father removed his son whilst his nose was discharging, against Superintendent's advice. 268 30/5/08 141 2/5/08 37 28 days 291 17/5/08 208 15/6/08 44 2 days Nose discharging freely after two days. 317 6/7/08 210 15/6/08 42 21 days Finger peeling ; throat felt sore. 319 8/7/08 215 22/6/08 56 18 days Nose discharge after ten days. 368 13/8/08 256 15/7/08 44 29 days Nothing noticed. 404 13/9/08 Da247 4/9/08 24 9 days Toes peeling. SF357 Shins scurfy. Nose sore and discharging after seven days. 410 15/9/08 302 24/8/08 59 22 days Mother noticed nothing. 492 10/11/08 410 26/10/08 39 15 days Shins scurfy. 493 12/11/08 410 26/10/08 39 17 days 535 7/12/08 362 11/11/08 92 26 days Nose sore and discharging after one week. 561 26/12/08 454 18/12/08 58 8 days Nothing noticed. 31 DIPHTHERIA OCCURRING IN HOUSE AFTER SCARLET FEVER. FOR THE YEAR 1908. Return Cask. Pkkvious Cask. Interval between discharge of previous case and onset of next one. Condition of previous case after return from Hospital. No. in Register. Onset. No. in Register. Date of Discharge. No. of days in Hospital. Da 103 5/3/08 SF376 24/2/08 87 9 (lays Nose sore and discharging freely. Da 102 3/3/08 SF376 24/2/08 87 7 days Dal 15 12/3/08 SF376 24/2/08 87 16 (lays Da 70 7/4/08 SF67 27/3/08 46 11 days S.F. 67 sickened six days after nursing No. 369 N.F. Da 169 7/4/08 SF67 27/3/08 46 11 days Da 174 14/4/08 SF67 27/3/08 46 14 days Nothing noticed after her coining home. Da 182 18/4/08 SF67 27/3/08 46 20 days Da l97 28/4/08 SF133 18/4/08 26 10 days Nose sore with bloody scabs inside. Small sore at angle of left jaw. Da l81 19/4/08 SF55 30/3/08 54 20 days Nose sore, little or no discharge. Da 180 17/4/08 SF59 3/4/08 57 14 days Ear discharge began four days later. Da 245 20/5/08 SF101 6/5/08 91 14 days Nose discharge after 1 week. Da 247 21/5/08 SF101 6/5/08 91 15 days Da 264 28/5/08 SF114 15/5/08 63 13 days Nose sore. 32 SMALL-POX HOSPITAL ACCOMMODATION. Since January 31st, 1907, the Middlesex Districts Joint Small Pox Hospital has been in existence at South Mimms. We must rejoice that, although precepts have been made on the Edmonton treasury, no patients from the District have been sent there yet. The money (£402 for 1908) is a premium for an advantageous insurance. Feltham Urban District joined the Board on 1st August, 1908. In addition, the Council still have the administrative block of the Small Pox Hospital at Clavering's Farm, erected in 1902, where, at the shortest notice, accommodation of a satisfactory kind to meet an emergency could be arranged for ten male and six female patients. A neighbouring District, towards the end of the year, suggested to the other constituent Authorities that the Hospital, which has been fortunately without patients since its opening in January, 1907, might be utilised for other diseases. I am glad to record that my Council, whilst anxious to keep the maintenance expenses as low as possible, consistent with efficiency when cases of Small Pox occur, declined to support the idea. The expense incurred is a premium for insuring prompt and effective dealing with a dread disease the moment a case occurs, and is, in my opinion, money well spent. TRANSPORT ARRANGEMENTS. The Council at present undertake the removal to our Hospital, free of charge, in our own ambulance, of all cases of infectious disease which require it. Separate vehicles are kept for Small Pox and for other infectious diseases. A closed conveyance has also been provided for bringing patients home again after their discharge from Hospital. This arrangement is very valuable in protecting the health of children whose parents are unable to afford a suitable conveyance when discharged from Hospital during cold and wet weather. These conveyances are disinfected each time after use. At the end of October the Joint Hospital Board sent us a schedule of questions that the Medical Superintendent suggested might be filled up by our Transport Officer before removing the patient from his home. This schedule contained over 30 questions. My Council replied that they were unable to agree with the suggestion. Many of the questions were such as could only, with propriety, be put by a nurse or medical man. Should the Board at any time adopt our suggestion of November, 1906, that transport could be more conveniently and cheaply and quickly effected from the Hospital, then one of the Board's hospital nurses could always travel in the ambulance and fill up such schedules of questions as the Superintendent may think fit to devise. The Metropolitan Asylums Board conduct the transport of patients in this way. 33 DISINFECTION. Rooms are disinfected after the removal of the patient by spraying with a 1 in 20 solution of formalin. Linen and cotton articles are steeped in a solution of Jeyes' Fluid in the room previous to being washed, and articles of •clothing, bedding, etc., are removed in a van provided for that purpose by the Council to the disinfecting station, where they are treated in a WashingtonLyon steam disinfector of the latest pattern. After treatment, the bedding, etc., are returned in a separate van used only for conveying disinfected articles. DISINFECTANTS. Disinfectant fluid or powder have been, for some years past (on an instruction of the Council) supplied to any member of the public who cared to ask for it at the sanitary stores. This indiscriminate supply has its disadvantages. In 1907, no less than 36,370 people (chiefly children) were so served, and in the one month of May, 1908, as many as 4,6-18 people. So one may say that in the year before this every other man, woman and child in the District had a parcel of disinfectant given them. One is not then surprised to learn that £240 is annually spent in Edmonton for disinfectants! Besides, a very great deal of time, which might be more advantageously occupied, is spent by my staff in distributing the same. "A nasty smell" is Nature's warning to the householder and house-wife that some cleansing is necessary and that the yard and gullies want clearing. It is an expensive and futile business to supply one smell to counteract another. After full consideration, in December I recommended my Council to place some restriction on the supply of disinfectants to casual callers, and assured them that no danger to the Public Health will subsequently arise. REMOVAL OF DISINFECTING STATION. In June a Councillor suggested that this should be removed from Covering's Farm to Deepham's Farm. The Sanitary Committee considered the matter, but reported that the time was not opportune. With this I agree, but when the removal takes place I hope that opportunity will be taken to build a cottage for the Disinfector not far off, and to erect a building for the treatment of verminous persons, especially those suffering from Itch. Whole families are attacked by this miserable insect, and it is impossible to deal with them by ordinary medical means. A building on the plan of the discharge block at an Isolation Hospital is required : a bath-room in the centre, and an undressing room at one end and a re-dressing room at the other. Whilst the verminous person is having a sulphur bath, his or her clothes can be placed in a disinfector close by, and be found ready in the re-dressing room after the half-hour in the bath is over. 34 Remember that the ordinary steam disinfector is not the one best adapted for this purpose. No one yet seems to have placed on the market an apparatus suitable for the purpose. Nothing like the heat of a WashingtonLyon disinfector is required, and a kind of gas-heated oven is what I am looking for. BACTERIOLOGICAL LABORATORY. During the year the following specimens were examined and reported upon :— Disease. Result Positive. Result Negative. Total. Diphtheria 22 34 56 Enteric fever 2 4 6 Totals 24 38 62 PUERPERAL FEVER. Two cases of this disease were notified during the year, and one casewas. not notified; this latter died, and one of those notified terminated fatally, so that the death-rate is 1.03 per thousand nett births. (See Section "Births.") On the receipt of a notification of Puerperal Fever, the case is immediately investigated, and the facts communicated to the County Medical Officer, who has the administration of the Midwives' Act, 1902. ERYSIPELAS. Seventy-three cases were notified, compared with 53 in the previous year; two of the cases occurred in the Edmonton Union Infirmary, and one in the Strand Union, and of the remaining 70 cases, all were in separate houses. There were no deaths from this cause. Five cases occurred amongst people who were living outside the Union Infirmary, and yet unable to provide proper attention for themselves. Under the Council's agreement with the Edmonton Union Guardians, nursinghad to be provided for them, as such cases are not admitted into the isolation hospitals. 35 COMMUNICABLE DISEASES NON-NOTIFIABLE. We can partly judge of the prevalence of these diseases by the death returns. The deaths from measles have been two less than last year, and the deaths from whooping cough have been less than half. The deaths from diarrhoea have been 11 more than last year; from influenza, 9 instead of 14; and from phthisis only 1 more; and from other forms of tubercle, 5 more than last year. A further knowledge of the prevalence of these diseases can be gained from the notifications received from the head teachers, when they are sent in fully and regularly to the Medical Officer of Health. DIARRHCEA. Forty-one deaths occurred from diarrheva and epidemic enteritis, as compared with 32, 114 and 56, for 1907-6-5. The death-rate from the disease is .68 per thousand of the population, as compared with .53 last year. Of these deaths, 31 occurred in children under one year of age, giving an infantile mortality rate for the year from this cause of just over 16 per thousand nett births, instead of 13 as in 1907, and 49 in 1906. Deaths from diarrhoeal diseases occur mainly between one month and nine months of age, a period when the infant who could be breast-fed with entire safety, is tested with unclean cows' milk, and samples of grown-up persons' diet. The advice on diet, personally given by the Lady Health Visitor, has been very useful. MEASLES. There were 19 deaths noted, compared with 21, 19 and 27, in 1907-6-5. This number of deaths is equal to a death-rate from measles of 0.31 per thousand living. As in previous years, the greatest mortality occurred in the second age-period (one to five years), and in this group it accounted for 13 out of the 19 deaths, five of the others being infants, and one death occurred in a child over five years of age. " It is during the second ageperiod that school attendance in the baby classes is first commenced, and owing to the high susceptibility of these children to measles, and to the favourable conditions which school attendance offers for its spread amongst them, it is not to be wondered at that these school infants not only suffer themselves, but also form the chief channel through which infection is carried, often with fatal results, to the still younger babies at home." This last sentence is a 36 quotation from my Annual Report of 1907. Now children under five years of age are excluded from school attendance, the sickness and death-rate from measles will decrease. During the last three months of the year this disease was prevalent in the southern part of the District, and the Infants' Departments of the St. James', Silver Street and Montague Road Schools were disinfected under my supervision with formalin vapour. In the class-rooms of the latter school it is difficult to retain the vapour for any length of time, as the large outlets in the ceilings have no closing shutters. WHOOPING COUGH. There were 15 deaths from this cause, as compared with 39, 8 and 30, in 1907-6-5. This is equal to a death-rate from the disease of 0.24 per thousand living. All the deaths occurred amongst children under five years of age—7 in the first age-period and 8 in the second. My remarks above, regarding incidence of death from measles, apply markedly to whooping cough. INFLUENZA. Nine deaths were registered from this cause, compared with 14, 9 and 9, for 1907-6-5. Four persons were over 65 years of age, and there were no deaths amongst infants of the second age-period attributed to this cause. PHTHISIS AND OTHER TUBERCULOUS DISEASES. The deaths from Phthisis numberered 54, as compared with 53, 65 and 42, during 1907-6-5. The death-rate from the disease is therefore 0.89 per thousand. Of these deaths, 15 occurred among residents of the district in Edmonton Workhouse. The total deaths from Phthisis in the Strand and Edmonton Workhouses in the district numbered 54, or one more than last year. The accommodation for Phthisical cases in the Edmonton Workhouse Infirmary is about 24 beds for males and 8 for females; at the Strand Institution chronic cases are treated in the general wards, and any acute case is returned to the London depot. The other tuberculous diseases together accounted for 35 deaths, giving a death-rate of 0.58 per thousand. In this way tuberculosis contributed a total death-rate of 1.47 per thousand, or over 12 per cent of all the deaths. No progress has been made in the establishment of a County Sanitorium. The Notification of phthisis ill my district will be compulsory after January 1st, 1909, as far as paupers are concerned. 37 In April I began to receive voluntary notifications of the indoor paupers of the Edmonton Workhouse. This arrangement was instigated by the County Medical Officer of Health : eighteen cases were notified by him, and two by Dr. Burton, a private practitioner. In the absence of any compulsory system of notification, the work done in connection with this disease has been confined to visiting the houses where deaths have occurred and leaving a card of printed instructions and the giving of such advice as may help to prevent further cases occurring in the family. The disinfection of the room lately occupied by the patient is offered and usually accepted. The prevention of Phthisis is of special concern to Boards of Guardians, as it is calculated that tubercle accounts for 10 per cent, of the persons driven to seek parish relief, and the form known as " Consumption," or tubercle of the lungs, affects adults just at the time of their highest wage-earning capacity, and when many young children are dependent on them. In Germany, the workmen's assurance companies find it pays them to send 9,000 consumptives each year into sanitoria to restore them quickly to wage-earning capacity rather than leave them to remain in sick-pay-receiving condition. Tuberculous .Milk.—See Section " Dairies." VENEREAL DISEASES. Syphilis. Three deaths are recorded as due to this disease; two of them are infants under one year old. Gonorrhoea. Only one death from this disease is entered. As I observed in my last Annual Report, nothing is more misleading than the death returns of these diseasss, and it will be so, until arrangement is made for medical practitioners to send their certificates of death direct to the Registrar. Meanwhile, the deaths really due to these causes are to be sought under such headings as " Locomotor Ataxy," " Stricture of Urethra," " General Paralysis of the Insane," etc., etc. OTHER DISEASES. Alcoholism. Three deaths only from this cause are recorded, one in each Ward. The death returns of this disease, as in the instance of venereal diseases, are most deceptive. The number (male and female) can be considerably added to by looking back into the life - history of some of the cases certified as dying from cirrhosis of the liver, ascites, neuritis, etc., etc. 38 Respiratory Diseases, including bronchitis, pneumonia, pleurisy, and other non-tuberculous diseases of the respiratory system, gave rise to 21 less deaths than in 1907. The figures arc 131, giving a death-rate of 2.17 per thousand, compared with 147, and a death-rate of 2.47, for the latter year. Pneumonia, especially of the lobar variety, would be more correctly placed amongst the specific infectious diseases. Cancer. Thirty-five deaths of persons belonging to the district were registered as being due to Cancer, and this is equivalent to a deathrate of 0.58. The deaths during 1907-6-5 were 47,37 and 31; during 1902 non-residents were included. In the table below, the deaths from Cancel amongst residents only have been included, and the 35 deaths thus collected have been analysed according to the nature and position of the disease :— Seat of Disease. Carcinoma. Sarcoma. Cancer or Malignant. Total. M. F. M. F. M. F. M. F. Nose ... 1 ... ... ... ... ... 1 Cervical Glands 1 ... ... ... ... ... 1 ... Tongue 1 ... ... ... ... ... 1 ... (Esophagus 2 ... ... ... 2 1 4 1 Stomach and Pylorus 4 1 ... ... 1 1 5 2 Liver 1 ... ... ... ... 1 1 1 Colon 1 1 ... ... ... 1 1 2 Rectum 1 ... ... ... 1 1 2 1 Bladder ... ... ... ... ... 1 ... 1 Uterus and Vagina ... ... ... 1 ... 2 ... 6 Breast ... 1 ... ... ... 1 ... 2 Ovary ... ... ... ... ... 1 ... 1 Face ... 1 ... ... ... ... ... 1 Knee ... 1 ... ... ... ... ... 1 Totals 11 9 0 1 4 10 15 20 Note.—A better classification might be made if my medical brethren would be more definite in the terms of their death certificates and avoid the use of " Cancer "or" Malignant." If the disease were recurrent, the original seat of the disease should also be given first. If there has been an operation the date of it would be of great interest. 39 THE SCHOOLS OF EDMONTON (17 in Number). Public Elementary Schools number 10 Secondary Schools 1 Private Schools 5 Strand Union School 1 The Edmonton Union has two schools or homes for pauper children, both in the Enfield District. The Private Schools arc five in number. The Secondary School was founded in 1642 by Edward Latymer, and forms part of the " Latymer Foundation," which is administered by a body of trustees. It has an income of about £1,000 yearly. There are about 50 boys in attendance. The Latymer Elementary School is administered by the same trustees. The present school buildings, erected in 1811, are dilapidated, and only about half of these are in use, the other half being used as a covered playground. A building at the far end of the pebbly playground was erected a few years ago, with five w.c.'s and a urinal, and is in good condition. The old installation of two w.c.'s and a three-stalled urinal is not now used. The Head Master's house (adjoining) is much in need of repair and shows many signs of dampness. In 1906 plans were prepared for new buildings on a site of six acres. Another year has gone by, but not a brick of the new buildings has been laid ! The Strand Union School has an average number of 300 children resident, belonging to the Strand and other districts of Central London. PUBLIC ELEMENTARY SCHOOLS. The management of these schools has been delegated by my Council to an Education Committee, which consists of fifteen members of their own body and two ladies as co-opted members, one of whom is a liead-mistress. On 21st July the Education Committee decided not to admit new children after August under the age of five years. This course is much to be commended, from my point of view, as it will have a marked effect on the sick-rate—if not the death-rate—from infectious diseases in future years. I. —Non-Provided. Three schools : six departments. (1) St. James', Upper Edmonton, for boys, girls and infants; (2) The National Schools, Sweet Briar Walk, Lower Edmonton, for girls and infants; (3) The Lower 40 Latymer School, Maldon Road, Lower Edmonton, for boys. Mr. Jifkin's lease of the orchard at the back of the National Schools expires in 1910,. and I hope the opportunity will then be taken to add to the area of the playground, which is not sufficiently large. II.—Provided. Seven schools : twenty-six departments. Name. Built. Departments. Last Enlarged. 1. Brettenham Road, Upper Edmonton 1882 B.G.I. 1892 2. Croyland Road, Lower Edmonton 1884 B.G.J.I. 1 Hall 1901 3. Raynham Road, Upper Edmonton. 1896 4 Halls 1902 4. Eldon Road, Lower Edmonton 1899 4 „ ... 5. Silver Street, Upper Edmonton 1901 B.G.I. 3 „ ... 6. Houndsfield Road, Lower Edmonton 1903 B.G.J.I. *1 „ ... 7. Montague Road, Upper Edmonton 1904 „ *1 „ ... B.—Doys. G.—Girls. I.—Infants. J.—Junior Mixed. "Extra wide corridors in the Infant Departments. BUSH HILL PARK. The rapid development of this northern part of the District has necessitated an agreement with the Enfield Urban District Council to provide accommodation for 81 scholars from this neighbourhood at the nearest Enfield School. This agreement was sealed in October, 1906. No Edmonton scholars under five years of age are now admitted. BATHS. The elder children are taken from the schools to learn swimming once a week in the Summer months. During the present winter, 1908-9, this wholesome practice has been continued—as far as the boys areconcerned. Classes are also held to teach the boys life-saving. Building* Operations. Nothing has been done beyond the ordinary repairs necessary to keep the buildings in good order. Closets are in some cases of the trough pattern, with a weir at the lower end and a tank of sixty gallons and upwards at the upper end of the system, which the caretaker can discharge four times daily, and oftener in the Summer months. Others have the same kind of tank Hushing a system of separate closet pans with svphonic action opening into a common pipe. The excreta then fall through a trapped pipe into an adjacent inspection-chamber,, and so to the road sewer. In all these cases there is a man-hole chamber at the end of the main drain with a fresh air inlet, and an intercepting trap with raking arm between the chamber and the road sewer. 41 Urinals. In some of the older schools, sparge pipes are still fixed; but now, in all cases, flushing three or four times daily from a length of hose is relied on to give the stalls, floors and channels a cleansing much more thorough than can be obtained by a sparge pipe sprinkling down the front of the stalls. Watep Supply comes ill all cases from the Metropolitan Water Board. In 1906 I advised the Education Committee that the drinking fountains in all the schools should be taken directly off the main; but this has only been done at Silver Street and St. James's Schools. Alongside each drinking place has been placed a permanent notice : " Please U ash the Cups Before Drinking." The caretakers have been instructed in times of epidemic to detach the cups and submit them to disinfection with boiling water every morning. This should be done regularly, whether epidemic exists or not. Lavatory and Cloak Room Aceommodation is provided at all the schools. The washing basins are all on the intermittent - flow principle, and the waste pipes in some cases discharge under the basins into a half-channel pipe (which facilitates removal of blockage), and so over gully outside. The hooks in the cloak-rooms are in two or three tiers, and twelve inches apart; so that if the clothing does not touch at the sides yet they overlap one another considerably. Fumigation, more or less often, of the cloak-rooms, has been suggested, but scrubbing at least once a week with hot water and soap is the proper treatment. Warming" of the Schools is effected partly by a hot water circulation and partly by Boyd's ventilating grates. Lighting" is produced from an ordinary gas installation. Ventilation is ill no case maintained by a mechanical or "plenum" system, but on the " natural" plan, which is cheaper and more effective. I have never yet seen a school, or other public institution, where the "plenum" system is a success from a hygienic point of view. It is certainly expensive to establish and a continuing heavy expense to maintain. FIRK. The fire appliances at all the Schools are tested by drill in the presence of Mr. Croasdell, the Superintendent of our Fire Brigade. These drills serve the useful purpose of showing up the defects that require remedy. 42 Attendance. The Secretary of the Education Committee kindly furnished me with the following figures for this and the next table:— End of June, 1907. End of J line, 1!K)8. Number on Hooks. Average Attendance. Number on Books. Average Attendance. Non-provided Schools 2153 1919.4 2187 2016 Council Schools 11807 10571.4 11737 10730.8 Totals 13960 12490.8 13924 12746.8 There were 13,924 children on the books at the middle of the year; so that there is in Edmonton one child in the public elementary schools for every 3.13 of the inhabitants. Civil Year 1908. No. of Admissions. No. of Withdrawals No. of Admissions to the Lowest Class of Infants. No. left on account of Age Limit. Non-provided Schools 575 617 152 123 Council Schools 3828 4090 765 1008 Totals 4403 4707 917 1131 Expenses. Two precepts on the Overseers, together amounting to £22,000, were issued to meet the requirements of the Education Committee for the year March, 1908 to March, 1909. Besides, a large necessitous grant has been received from the Government. Education (Provision of Meals) Act, 1906. On November 21st, 1907, the Council adopted the recommendation of the Education Committee that the Council adopt Section I. of this Act. The cost of food is obtained at present by voluntary contributions. 43 TEACHERS' NOTIFICATIONS. Insufficient knowledge of the existence of infectious diseases leads to their uncontrolled spread and to regrettable effects on the average attendance, which I wish to see as high as possible — consistent with the health of the scholars and the younger relations at home. In February, 1906, my predecessor presented a Report to the Education Committee suggesting a definite procedure in dealing with " Communicable Diseases amongst the Scholars." This was received and adopted by that Committee. This arrangement provides definite periods of exclusion from school attendance of scholars who are themselves ill or living in infected houses. Six rules are laid down. The last two are—" Children living in houses infected (with non-notifiable disease) and excluded from school under Rule 3, must be excluded for like periods, except in the case of whooping •cough, for which the period need only be four weeks. 6. A daily list of new cases of infectious diseases that have come under the notice of school teachers or attendance officers shall be sent by them, either by telephone or on a form to be supplied to the Medical Officer of Health, who will in turn notify the Head Teachers as to when the children affected may resume school attendance." In an edition of the " General Instructions to Teachers," received 15th April, 1908, Rules 5 and 6 were inserted for the first time. It is interesting to notice the great variation in the number of children notified from the schools during 1908 : — 1. Silver Street, 196. 2. Raynham Road, 192. 3. Montagu Road, 186. 4. Eldon Road, 121. 5. St. James's, 113. 6. Croyland Road, 48. 7. Brettenham Road, 13. 8. Houndsfield, 7. 9. Lower Latymer, 0. 10. National, 0. Most of the notifications from Nos. 1, 2 and 3 referred to Measles. The last four schools occupied the same lowly position last year, but seven cases attending the National Schools and five attending Houndsfield were discovered indirectly, and excluded by me. Exclusion Notices. Ill connection with the notifiable diseases, viz., Diphtheria, Scarlet and Enteric Fevers, 2,046 notices were issued excluding contacts from attendance for the definite periods agreed upon between the Education Committee and the Medical Officer of Health. Only l;574 notices were issued in 1907. On March 30th I inspected Classes I. and Y. in Croyland Road J. M. Department (128 scholars) with the object of detecting any '"missed" cases of Scarlet Fever. On account of the non-notifiable diseases, notices excluding 921 children as patients or contacts were issued by me, after enquiries had been made as to the real nature of the illness. There were 1,147 children excluded in 1907. 44 SCHOOL CLOSURE. In February I received a Memorandum from the Local Government Board on the circumstances under which the closing of schools, or exclusion therefrom of particular children, may be required. Reference is several times made to the Code for 1907, but important alterations were made in that for 1908. By this latter the Schools' Medical. Officer is authorised to exclude individual children "on the ground that their exclusion is desirable to prevent the spread of disease," but the power toclose a school or department is still wisely left to the Local Sanitary Authority, acting on the advice of the Medical Officer of Health; there isnow no appeal from the Managers to the Board of Education. The diseases for which action on the part of the Sanitary Authority may be called for are specified to be scarlet fever, diphtheria, measles, German measles, whooping cough, small - pox, and epidemic influenza; more rarely, for diarrhoeal diseases and enteric fever. Individual scholars with contagious diseases, such as vermin, are evidently left to the School Medical Officer. The Board point out that the Sanitary Authority, when considering the closure of a school, should do so with a view to preventing the spread of disease, and not in the financial interests of the school. Measles and Whooping" Cough. I fear many teachers, especially at Sunday Schools, fail to realise the seriousness of measles and whooping cough, because, although the death-rates of these two diseases are always much heavier than from the dreaded scarlet fever and diphtheria, this fact is not brought to the notice of the teachers, who, although they may know that measles or whooping cough, or both together, are prevalent, see few of their scholars' places subsequently rendered vacant by death therefrom. Of the long list of deaths amongst the children under school age the teachers can have no direct knowledge, and in this year under review all the death save one (viz., 33) from measles and whooping cough were of children under five years of age. See Section " Measles," on a previous page. THE MEDICAL INSPECTION OF CHILDREN IN THE PUBLIC ELEMENTARY SCHOOLS. The Education (Administrative Provisions) Act, 1907, came into forceon January 1st, 1908, but only Section 13b is of interest to us here. The first part is compulsory and the latter part optional. Section 13b is as follows:—"The duty of the Local Education Authority is to provide for the medical inspection of children immediately before, or at the time of, or as soon as possible after, their admission to a. 45 public elementary school (and on such other occasions as the Board of Education may direct) and the power to make such arrangements as may the sanctioned by the Board of Education for attending to the health and physical condition of the children." There has been no specific delegation of the powers of my Council under this Act to the Education Committee. This has been done in neighbouring Districts. In a letter dated December 2nd, 1907, I clearly expressed to my Council and to the Education Committee my willingness to undertake the work as laid down in the Memorandum from the Board of Education dated November 22nd, 1907. On December 10th following a motion was proposed in Council:— "That this Council instruct the M.O.H. to advise the Education Committee in carrying out the Memorandum of the Board of Education, and also to supervise such officers as they may appoint to carry it out." The Chairman of the Council said "he could not accept the motion until the Education Committee had considered the Memorandum and reported thereon to the Council." No such report has yet been made. At their meeting on December 17th, 1907, the Education Committee passed the following resolution:— "That the Education Committee do consult with the M.O.H. with a view of taking steps to carry out the duties devolving upon the Education Authority in accordance with the terms of the Memorandum dated 22nd November, 1907." I accordingly presented a statement of my views on the proper way of carrying out the intentions of the Act (as supplemented by the above mentioned Memorandum), with due regard to the number of the scholars and other local circumstances. This was delivered to •every member of the Education Committee, and, by invitation, I attended a private meeting of the Committee on February 1th, 1908, when I once more expressed my willingness to undertake the supervision of the work and, if necessary, a share of the actual inspection. In December, 1907, a resolution was passed by the Education Committee that the M.O.H. should be appointed supervisor of the medical inspection of children in the public elementary schools of Edmonton. This, so far as I know, has never been rescinded; it has certainly not been acted on. But in March a report was made that Mr. McKenna, then President of the Board of Education, had said that whilst in the judgment of the Board of Education it was desirable that the work should be supervised by the M.O.H., the Act did not compel it, and the matter would therefore be left in the hands of the Education Committee. But this report was never verified; and at a meeting on March 31st, the Committee (by a majority) decided to advertise for a whole-time School Medical Officer, independent of the M.O.H. 46 This was in direct opposition to the Memorandum of the Board of Education. Of the selected candidates in attendance on May 5th at a meeting of the Committee, two gentlemen at once withdrew on hearing that the appointment was not subordinate to the M.O.H. On May 5th Dr. Rock was appointed by the Committee as School Medical Officer, and assumed office on June 15th. Actual inspection did not commence until September 2nd. In my monthly report for April, 1908, I pointed out to my Sanitary Committee and Council that the Local Education Authority is responsible for the efficient carrying out of Section 13b of the Act to the satisfaction of the Board of Education, and that the amount of the grant in aid depends upon the degree of efficiency. The Local Government Board has stated that all expenses incurred in the carrying out of this Act must be paid out of the Poor Bate. Note.—The expenses of the Public Health Department come out of the General District Rate. In my Report for August, 1908, I pointed out to my Sanitary Committee and Council that as the Education Committee had now appointed a School Nurse and Medical Officer of their own, the time had arrived when notification of contayioug diseases of the skin and eye—such as ring-worm and ophthalmia—should be sent to the School Medical Officer, and not to the Public Health Department ; but that notifications of infections diseases should be sent to me as heretofore. In the Circular of December 2nd, 1908, addressed by the Local Government Board to my Council, re the Annual Report of the M.O.H. for 1908,. occurs this paragraph :—" I am at the same time to state that the Board desire to be informed what arrangements have been made for the medical inspection of school children under the Education (Administrative Provisions) Act, 1907, and if the Council are the Local Authority for the purposes of this Act, the Board will feel obliged if they will instruct the M.O.H. to include in his Annual Report this information, together with any account he may be able to give of the work done under the Act." I brought this paragraph to the notice of my Sanitary Committee and Council and asked for instructions thereon. But the paragraph was referred to the Education Committee for consideration and report, and the following letter was received Edmonton Education Committee, Office—Bhkttenham Road, Upper Edmonton. 3rd February, 1909. Dear Sir, In reply to your letter of the 15th ultimo, I am directed to state that for the Medical Inspection of School Children under the Education 47 trative Provisions) Act, 1907, my Committee have appointed a Doctor and Nurse to carry out the whole of the work under Section 13 of the above mentioned Act and the explanatory Memoranda of the Board of Education thereon, that the necessary apparatus has been obtained and that the actual work of inspection has been in progress since the 31st August, 1908. Dr. Rock, the School Medical Officer, in accordance with the instructions of the Education Committee to act in conjunction with the Medical Officer of Health, will forward a copy of his report upon the work up to the 31st December, 1908, after it has been approved by my Committee. Yours faithfully, (Signed) JOHN MOULE, Secretary. W. Fhancis Payne, Esq.. Clerk to the U.D.C., Town Hall, Edmonton, N. This letter, therefore, embodies all the information I am able to give as regards Medical Inspection of School Children in the public elementary schools of my District. SUNDAY SCHOOLS' REPORT. CHURCH OF ENGLAND, 1908. Boys'. Girls'. Infants'. Total. Parish Church 519 632 333 1484 S. Martin's Mission 135 139 217 491 S. Alphege Mission 147 199 148 494 S. Aldhelm's 160 320 190 670 S. James' 161 188 128 477 8. John's 132 169 171 472 S. Peter's 105 140 190 435 S. Michael's 206 180 300 686 S. Stephen's 57 67 21 145 S. Mary's 80 120 100 300 Grand Total 1702 2154 1798 5654 Roman Catholic Sunday School, Hertford Road ; attendance averages about 140 children—Boys, 40, Girls, 60, and Infants, 40. 48 NON-CONFORMIST, 1907. Infant Classes. Intermediate Classes. Senior Classes. Totals. Average Attendances. Morning. Afternoon. Congregational, Fore St. 305 164 71 540 88 357 ,, Angel Ed. 180 164 28 372 150 288 People's Tabernacle 90 210 40 340 110 310 Tanner's End Mission 160 140 65 365 80 270 Wesleyan 26 198 43 267 110 220 Hyde Mission 60 50 36 146 30 107 Congregational, Lower Ed. 150 275 50 475 73 350 Baptist 87 253 56 396 None 262 Primitive Methodist 30 58 9 97 28 79 Belmont Hall Brethren 85 98 34 217 None 196 Totals 1173 1610 432 3215 569 2439 Note.— The above table is over a year old, but the one for 1908 is not yet issued. I regret that the up-to-date figures are not yet available. There is also a Socialist Sunday School, which meets at The Crescent, Hertford Road. Presuming that no scholars attend more than one Sunday School, there are something like 9,000 persons attending Sunday School in Edmonton with varied regularity. Sunday School attendance may be, if not supervised, a considerable factor in the spread of contagious and infectious diseases. The scholars in Sunday Schools are often more over-crowded than in day schools, and the meetings often take place in buildings not specially adapted for their purpose. It is urgently necessary that the powers of Local Sanitary Authorities for dealing with these institutions should be both enlarged and strengthened. 49 SEWERAGE AND DRAINAGE. The district is sewered on the separate system. The surface water is conveyed into the Pymmes and Salmons Brooks, whilst the sewage proper, together with that of the neighbouring district of Southgate, passes to the Council's sewage farm of 233 acres, where it is treated by broad irrigation. Mr. Frank Rackham is the farm bailiff. The whole of this land rests on the blue clay at a depth below the surface varying from about 14 feet to about 40 feet; above the blue clay is a bed of gravel, supposed to have been washed down from the Southgate Hills and deposited in the valley. The sewerage which conies from the district of Southgate is brought by three main sewers from the Southgate District to the Edmonton Boundary, and at the points where these sewers cross the boundary there is in each case a provision for measuring the flow of sewage from the Southgate District into the Edmonton sewers. The three sewers are called the Northern, Middle, and Southern sewers. The Middle joins the Southern in Edmonton, and all the mains meet at the west end of Town Road, passing down Town Road in a common outfall sewer to the pumping station. This outfall sewer, which is a brick egg-shaped sewer, is joined at the pumping station by a low level iron pipe sewer, which does not extend as far as the Southgate District, but takes the houses built on the low-lying ground west of the Cambridge Main Line of the Great Eastern Railway and those in the District adjoining Tottenham. The sewage then falls into an underground covered reservoir. Next it is pumped through the rising main into and through open tanks, from which it is distributed over the surface of the land, where, after a few days' drying, the sludge is ploughed in; the remainder is discharged into a sludge-bed, and farmers are allowed to cart this away (when dry) for their own use. In addition to the works which I have enumerated, there is a low-level pumping station at Angel Road, which receives the sewage from the factories and the few cottages which have been built on the east side of the railway, also from a new estate lying between Dyson's Lane and the railway. The effluent enters Salmons Brook near Angel Road, and, later, reaches the Lea below Tottenham Lock, two miles further down, and well below any drinking -water intake. Sewage Disposal. During 1908 my Council have further improved the outlets for their effluent from the sewage farm, but the effect of these improvements is not so good as it would be if Tottenham were to widen that portion of Pymmes Brook where the area is restricted before going into the River Lea and to deepen the channel of the brook up to the Edmonton Boundary. The improvements in our District for the same reason have much benefitted Enfield, who have handsomely recognised the fact. During the year, also the greater part of the sewage farm has been steam - ploughed and cultivated, so as to freshen the ground and improve its filtering capacity. 50 Satisfactory arrangements have been concluded with Southgate, so that my Council is no longer dealing with the sewage of Southgate at the heavy loss they had previously incurred under the Local Government Board Award of 1881.' It is recognised by the Edmonton Council that, in consequence of the growth of our population, and especially that of Southgate, some supplementary scheme will have to be introduced in the near future to deal with the increasing amount of sewage. Negotiations were opened in 1907 with the London County Council, with a view to getting an out-fall for the sewage of Edmonton into the London system of sewers, and some progress in the matter can be recorded. It is hoped that, before long, terms may be submitted by the London County Council sufficiently favourable to enable the sewage of Edmonton, Southgate, Enfield. Walthamstow and Leyton to pass to the northern outfall at Barking. The sewage farm of the Enfield Urban District extends over 110 acres, and is entirely situated in Edmonton, lying to the north of our own farm. In November an agreement between Enfield and Edmonton as to the former taking some sewage from houses in the neighbourhood of St. Mark's Road and within Edmonton District, was terminated, after lasting 14 years. The sewage from these houses is now dealt with in our own system. Dust Removal. Edmonton does not possess a dust destructor. An arrangement with a fresh contractor for removal of the house refuse was settled for twelve months ending 30th June, 1909, at a price of £1,693. The refuse is removed once a week. In November a commencement was made of digging trenches on the farm and laying down therein the house refuse that was heaped up there. Private Streets. By resolution of the Council, the Private Street Works Act, 1892, came into operation in the Urban District of Edmonton on 1st September, 1908. Three roads, as regards portions thereof, were taken over by the Council during the year for future maintenance at the public expense, amounting toa length of 1,216 feet. WATER SUPPLY. The District is supplied by the Metropolitan Water Board (New River area). The only house for which the public supply is not available at present is a farmhouse in Firs Lane; there is also one group of nearly fifty 51 houses supplied by shallow wells about 20 feet deep. Samples of the water in these wells are taken at at intervals. The present sources of supply are regarded by the Board as adequate for the next ten years, provided that the amount of storage capacity is in some districts increased. On 11th April, 1908, a commencement was made of a new reservoir, part of which will be in the N.E. corner of my district. When completed, in about four years' time, this reservoir will cover over one thousand acres of land, with a water area of 416 acres, and will hold 3,000 millions of gallons of water, gathered from the River Lea and the Lea Navigation. The policy of the present Hoard is based on the reports from Dr. Houston, which show that one week's storage will destroy 99 per cent, of the bacilli present in the water when collected. WATERCOURSES. During the winter of 1907-8 the inverting and culverting in of a considerable length of the Sadlers Mill Stream, between the Hertford Road to Bury Street Bridge, was accomplished. North of Bury Street Bridge this watercourse has been straightened, and runs, partly in an open cutting and partly covered in, up to the Enfield Boundary, thus lowering considerably the water level in all the district through which it passes. The whole of the watercourse, sometimes called " Beaconsfield Brook," has also been culverted in; it is really an overflow of Salmon's Brook, starting at the Town Hall and ending in Pymmes Brook at the south end of Montague Road. This watercourse, when open, favoured a great nuisance; passing as it did at the back of a number of cottage gardens, it was a handy refuse bin for all the occupiers, and at the part passing through unfenced lands the banks were being continually broken in, and water made stagnant in malodorous pools. In 1906 cases of diphtheria were occurring at these cottages with unusual frequence. Negotiations are practically complete for covering in the portion of Salmon's Brook between the Cross Keys public-house on the Green and the Town Hall. This will be a very important improvement. OBSTRUCTED FOOTWAYS AND ROADWAYS. In my monthly report for May I said : "I am glad to notice that the Highways Committee are taking this matter in hand. I feel that their action will receive the support of my Sanitary Committee, because the exposure of textile goods outside shops is likely to do harm, whether the goods are new or second-hand. If new and sterile, all kinds of noxious germs and vermin may be left on the goods by the people passing by, not to mention the small percentage of persons who handle them with a view to purchase; 52 if the goods are second-hand, it is possible that not only the handlers of them, but the hundreds who endeavour to pass along the narrow portion of the footway left at their disposal will carry away home more than they bargained for." Another question cognate to the obstruction of the footways by shopkeepers is the presence of costers in our streets. They only frequent the busiest thoroughfares. The ratepayers provide the road staff to remove the rubbish these people leave behind them. A report on an aggravated instance of this nuisance was reported by the Road Foreman in May. The Highways Committee, in July, had another complaint of a footway seriously obstructed by a bootseller, and a letter complaining of the condition of The Green due to the paper and litter left by the costers. This led the Committee to recommend that notices be served on the stall-holders informing them that if they did not properly clear up the roadways when they left, the Council would be obliged to take steps to have all their stalls removed from the footways. (See Section 58 of our own Act). In September, the Council resolved to summons, under this Section, the owner of a fish stall, who cleansed and gutted his fish in the roadway (which was damaged thereby), whilst the foul water ran into a gully of the surface-water system. Towards the end of 1908 a census of the stalls and stall-holders on the roads of the District was prepared. This is an interesting document, as it shows that the owners of the stalls are not always Edmonton ratepayers, but take Edmonton money away to pay rates in places such as Wood Green, Tottenham and Enfield, or even as far away as Mile End. I think no ratepayer would lament the disappearance of the coster who pays no rent nor rates for his stall, which obstructs the free and unrestricted use by the public of the footways and roadways, and who leave his rubbish to be cleaned up at the ratepayers' expense. The damage and pollution of the roads and paths, especially by fish - stalls, is a serious matter from a Public Health point of view, and I hope to see this matter firmly dealt with by my Council in the near future. I have not noticed that the Police give my Council any assistance in keeping the roads and footways free from obstructions of the kind referred to. NUMBERING OF THE HOUSES. This is always a difficulty in a rapidly growing suburb like Edmonton, and my Inspectors are very glad progress is being made in this matter. In one short street I know of there are four No. 5's—this leads to delay and confusion in paying visits. 53 HOUSING ACCOMMODATION. It was estimated that at the middle of the year there were 10,522 houses occupied and 1,276 unoccupied in the district, compared with 10,215 and 1,296 last year. During 1908 the following public buildings were erected:—St. Peter's Church Hall and the Charles Lamb Memorial Hall and Institute. The Congregational Chapel at Snells Park has had its interior renovated to a large extent. The Council's " Bye - Laws with respect to New Streets and Buildings " were revised in 1904, and sealed by the Local Government Board on the 8th June, 1904. They are carried out under the supervision of the Engineer, Building Inspector and Medical Officer of Health. By a resolution of the Council, dated April 12th, 1905, it was decided that the Medical Officer of Health should be the officer authorised to grant the certificate of fitness referred to in Bye-Law 113, which reads as follows: "A person shall not let or occupy any new dwelling-house until the drainage thereof shall have been made and completed, nor until such dwellinghouse shall, after examination, have been certified by an officer of the Council so authorised to be in his opinion in every respect fit for human habitation." (The italics are mine.) The placing of any furniture in a house by the tenant is occupation in a legal sense, even if he or his family do not sleep there On my appointment on April 30th, 1906, I was especially asked by the Council to undertake this duty in addition to my definite statutory duties, and I therefore visit and inspect all newly-built dwellings, after receiving certificates from my colleagues, the Engineer and Building Inspector, that "as far as my department is concerned, the bye - laws have been carried out." When satisfied as to the fitness, in every respect, for human habitation, I have forwarded my certificate to the person signing the notice of completion. If, on the other hand, I have observed any insanitary condition or defect likely to prove dangerous to the health of future inmates, my certificate has been witheld, until at a subsequent inspection the condition has been found improved and the defects made good. Any contraventions of Bye-Law 113 are reported to the Sanitarv Committee at their next meeting, and all correspondence and particulars connected with the contraventions are laid before them; the Committee then decide whether they will recommend to the Council the prosecution of the offenders. The following tables give an account of the work I have clone in seeing the Bye - Law carried out :— 54 1908. 1907 Houses inspected once and passed 121 127 204 212 Houses inspected once and not passed up to end of December 6 8 Houses inspected twice and passed 16 16 33 33 Houses inspected twice and not passed 0 Houses inspected three times and passed 4 0 2 Houses inspected four times and passed 2 4 4 Total houses inspected during the year 157 251 Total number of Inspections 183 300 Contraventions reported to the Sanitary Committee 1 7 Prosecutions for same taken by the Council 0 0 A LIST of some of the defects and bad conditions noticed on Inspection during- 1908: — DAMPNESS 4 WATER CLOSETS. Leakage at putty joint 11 Joint leaks between trap and soil pipe 1 Joint of w.c. cistern and flushing pipe leaks 3 Soil pipe alongside larder windows 2 Cesspool leaks 1 Drinking water cistern in upstairs w.c. 1 Cistern, no cover 1 Cistern cover not screwed on 2 Soil pipe ventilator too short 1 URINALS. Badly flushed 2 Without flush 1 Ventilating into stage 1 Safe tray insufficient 1 Absent in two Public Halls. 55 KITCHEN OR SCULLERY SINKS. Waste pipe leaks at head 4 Waste pipe overflows gully 13 Waste pipe leaks at screw cap 5 BATHS. Waste pipe leaks at bath . . 6 Waste overflows gully . . 12 Waste overflows at hopper 1 •Overflow pipe leaks at bath 1 Waste pipe leaks between hopper and gully 1 Tap loose 1 <3old water supply insufficient 2 Hot water supply insufficient 1 LAVATORIES. Waste pipe leaks under basin 6 "Waste pipe leaks at screw joint 2 Overflow pipe leaks at basin 1 Hot and cold water taps leak at basin 2 RAINWATER PIPES. Pipe too short 1 Water overflows gully 5 Pipe delivering into sewer 1 DRINKING WATER CISTERNS. Covers not present or not properly fitted 41 Hot water exhaust pipe not through cover 9 Deposits in cisterns 7 VENTILATION. No outlet over stage 1 No outlet over class-room 1 Floor ventilators too low 13 56 VARIOUS. Manhole covers unsealed 10 Hoof defective from lost or broken tiles or slates 5 Gutters filled up with builder's rubbish 2 Yard paving spalled by frost 3 Hot water pipe leakages 9 Intercepting chamber inlet badly fixed 1 Intercepting chamber inlet absent 1 Waste pipe from fishmonger's sink passing under parlour floor 1 Defective pumps for cellar sumps 2 In my monthly report for October, 1906, I said : " although the Bye Law has been in force for over two years, all the owners, agents, and builders do not appear to have seen the necessity of rigidly adhering to the Bye-Laws. However, in the course of a little longer time I expect all contraventions of this kind to disappear when they clearly understand that the Council intend their Bye-Laws to be faithfully carried out." If, in the first table, attention be paid in regard to the figures for 1908, compared with those for 1907, it will be noticed that the total number of houses inspected is much less for this year under review, but that the number of re-inspections wereslightly greater in proportion. Overcrowding. During the investigations made by myself and staff into the origin of infectious diseases, many cases of over-crowding came to light. These I made personal inquiry into. It is usually caused by a man with a family of his own quite numerous enough to fill the rooms intended for bedrooms, receiving a second family to assist in paying the rent. In most cases good advice, patiently given, and in the remainder an informal notice, proved sufficient to produce abatement. Particulars of over-crowding, unconnected with infectious diseases, are to be found in the Report of the Chief Sanitary Inspector. Housing- of the Working- Classes Act. Under Section 32 of this Act notices were served with reference to three houses. 57 LEGISLATION IN 1908 AFFECTING EDMONTON. Of the 73 Acts placed in the Statute Book, I only write here of those whose results are expected to benefit the Public Health. All social reforms have some relation to my special subject. 1. OLD AGE PENSIONS ACT. If the old adage, " Annuitants live long," is true, one effect of this Act will be to prolong the span of old life in proportion to the comfort provided by the pension. This Act is a recognition by the State of services rendered by the veterans of industry, male and female, and is in no sense a form of charitable relief. 2. THE CHILDREN ACT. This does not come into force until 1st April, 1909. It makes important provisions for the protection of children and infants, and makes more stringent regulations for the management of homes where infants and young children are boarded. It remedies one great defect in the Infant Life Protection Act (1897), as it now applies to people "farming" one child, and notice must be given the Local Authority within 48 hours of the reception of the infant. Notice of the infant's death must be also given within 48 hoursof its death, both to the Local Authority and the Coroner. Section 10 defines the Guardians as the " Local Authority." I consider that the better one is the Local Sanitary Authority, who, I believe, could have administered the Vaccination Act and the Infant Life Protection Act (1897) much better than any other body. This latter Act, and many others concerning reformatories and industrial schools, are hereby repealed. The Prevention of Cruelty to Children Act, 1904, is also much altered. The foster parents are not allowed to insure the life of the child. I am glad to read that imprisonment can be inflicted, as well as fines, on offenders. Overlaying of children under 3 years of age will not be so common now it is a punishable offence; no less than 7 children met their death in this way in Edmonton during 1908. Section 122 gives the Local Educational Authority and their School Medical Officer power to examine verminous children in public elementary schools; to cleanse the children themselves, if the parents will not within 24 hours; the use of premises and appliances of the Sanitary Authority for cleansing verminous persons and their clothing, if such premises and appliances exist, can be obtained by the Educational Authority on request, for 58 which the latter may be called on to pay; a fine not exceeding ten shillings may be inflicted, if the parent or guardian allows the child to become reinfested with vermin after the first cleansing. Without the help of the Medical Officer of Health, the homes cannot be dealt with; but this difficulty disappears, if the Medical Officer of Health (as advised by the Government) is appointed also School Medical Officer. 3. POISONS AND PHARMACY ACT. This places further safeguards on the sale of morphia : the schedule of poisons, which can only be sold by qualified chemists and under certain restrictions, is considerably enlarged. 4. THE TUBERCULOSIS PREVENTION ACT. This only applies to Ireland, but it is the forerunner of compulsory notification of consumption in the United Kingdom. 5. THE WHITE PHOSPHORUS MATCHES ACT. This prohibits the use (after a certain date) of this dangerous material in the manufacture of matches. The disease known as " matchmaker's jaw" will then cease to exist. 59 PLACES OVER WHICH THE COUNCIL HAVE SUPERVISION. 1. Factories and Workshops. The premises coming under the Acts have been inspected periodically and at irregular intervals. A record of the work done will be found in the form supplied by the Home Office. The Act of 1907, which chiefly affects laundries, came into force on January 1st, 1908. It is the duty of employers to notify the Local Sanitary Authorities twice a year of the names and addresses of their out-workers. These out - workers are visited, and particulars kept in the appropriate register. Fire. The factories, as well as public halls, are visited from time to time by Mr. Croasdell, Superintendent of our Fire Brigade, who, on request, tests • the fire appliances. My Council has superseded an old manual by a new fire engine of the latest pattern; oil is the fuel, and it will pump 300 gallons a minute. 2. Common Lodging- Houses. There is only one in the district. It has accommodation for men only and is an ancient structure, but I have always found it nicely kept. 3. Houses let in Lodging's. The bye-laws were revised and sealed by the Council in September, 1906. A large number of houses come within their scope. The formation of a register thereof containing all the required particulars will entail a vast amount of work at the first, and, later on, owing to the constant changes taking place in this class of house, good deal of time must be devoted by the Inspectors — both out-of-doors to supervision of the tenements, and in the office to keeping the register correct and up-to-date in its information. This will produce a great increase in the work of the Sanitary Department and will necessitate the appointment of at least one additional male inspector to carry it out satisfactorily. This is the fourth year this recommendation has appeared in the Annual Report. 4. Slaug-hter-Houses. There are six on the register, two of old registration, one who had a seven years' license granted him in 1908, and three with licenses renewed annually. The annual licenses expire at the beginning of March. One butcher was cautioned for selling meat not in the primest condition. 30th March, 1908, was the date of a circular of the Local Government Board on " The humane slaughtering of animals." This recommend s the stunning of all animals, without exception, before slaughtering them. The Board suggested that, to enforce this, our Bye - Laws be altered or added to. 60 Slaughtering methods for animals intended for the food of Jews are excepted, I brought this circular to the notice of our slaughterers by sending them a. copy of the Board's circular, and I asked them for an expression of their views. Only one of the six responded, and his opinion was that, in the case of sheep, no improvement in the present method was necessary. 5. Dairies, Cowsheds, and Milkshops. There are two cow-keepers now in the district, two less than last year; and only twenty-four cows are owned by these keepers. It is to be regretted that building operations are slowly but surely pushing the dairy farmers further afield. The bulk of the milk supply of Edmonton is brought in from places many miles distant, Derbyshire for instance, and of the circumstances connected with the health of the cows, their stabling, and the handling of the milk from the cow to* the consumer, we are absolutely ignorant ; and there are still Rural District Councils in existence who have not adopted the Dairies, Cowsheds and Milkshops Orders, and more who have adopted them, but do not encourage their officers to see them properly carried out. So far as is known, Edmonton does not send any milk into the County of London. There were 31 purveyors of milk on our register at the end of the year. My Council, two years ago, and again this year, informed the County Council that in their opinion the regular examination of milch cows for tuberculous disease of the udder should be undertaken by the veterinary surgeon employed by the County. 6. Unsound Food. In September, 1908, the Local Government Board used their powers under Sec. I., Public Health (Regulations as to Food)' Act, 1907. and issued two sets of Regulations accompanied by an explanatory circular. These are directly interesting to Port Sanitary Authorities, but indirectly to Inland Authorities, whoss poor people purchase and eat large quantities of food imported from overseas. Inspector Winter and myself hold! the certificate of the Royal Sanitary Institute as Inspector of Meat and Foods. My Inspectors regularly, and I myself at (purposely) irregular intervals, visit the coster stalls on the Green and at Angel Bridge. The officials of the Middlesex County Council frequently take samples of milk, food and drugs from tradesmen in Edmonton, and successful prosecutions have been instituted by the County when adulteration or substitution was revealed on analysis by theCounty Chemists. 7. Offensive Trades. None of the six trades specified in Section. 112 of the Public Health Act, 1875, are carried on in the District, unless it be whale-bone boiling, of which there is one small business here. 61 FACTORY AND WORKSHOP ACTS. The work done during 1908 is set out in the list below :— Outworkers' Premises- Rooms cleansed 5 New w.c.'s 1 Cisterns covered 10 Dust-bins supplied 8 Roofs repaired 1 Yards paved 1 Rooms ventilated 4 W.C.'s repaired 3 New sinks supplied 1 Drains cleared 1 Overcrowding abated 1 Work-rooms— Rooms cleansed 3 Cisterns covered 2 Roofs repaired 1 R.W. gutter repaired 1 Dust-bins supplied 1 Drains repaired and cleared 1 W.C. rendered efficient 1 Rooms ventilated 5 Flushing cisterns repaired 2 Walls repaired 1 Workroom ceiling match-lined 1 Hood fixed over copper 1 W.C.'s repaired 1 Factories- New w.c.'s 5 Flushing apparatus repaired 10 New traps to w.c.'s 4 Paving to w.c.'s 1 W.C.'s repaired 2 Urinals repaired 2 W.C.'s cleared 1 Vent shaft raised 1 New lavatory basin 1 Laundries- Cleansed 2 Re-drained 1 Ventilating shaft supplied 1 Bake-houses— Limew ashed 10 Properly ventilated 1 Stable drained 1 Stable paved 1 Yard paved 1 62 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES and HOMEWORK. I. INSPECTION. Including Inspections made by the Sanitary Inspectors (Male and Female). Premises. Number of Inspections. Number of Written Notices. * Factories (including Factory Laundries) 54 ... Workshops (including Workshop Laundries) 230 4 Workplaces (other than Outworkers' premises included in Part III. of this Report) Total 284 4 In most cases verbal notice lias produced the desired result without written notices being required. II. DEFECTS FOUND. Particulars. Number of Defects. Found. Remedied. *Nuisances under the Public Health Acts :— Want of cleanliness 5 5 Want of ventilation 6 6 Want of drainage of floors o 9 Other nuisances 12 12 † Sanitary accommodation :— Insufficient 3 3 Unsuitable or defective 15 15 Not separate for sexes 1 1 Total 44 44 Including those specified in sections 2, 3. 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. † Section 22 of the Public Health Acts Amendment Act, 1890. has been adopted by the District Council. The standards of sufficiency and suitability of sanitary accommodation for persons employed in factories and workshops has been enforced, and are those advised by the Home Office. 63 III.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS. Inspections of Outworkers' Premises. Lists received from Employers. Twice in the Year. Addresses of Outworkers. Lists. Outworkers. Received from other Councils. Forwarded to other Councils. Contractors. Workmen. Wearing Apparel— (1) Making, &c. 4 ... 15 151 1 221 Furniture and Upholstery ... ... ... 1 ... 3 Paper bags and boxes ... ... ... 8 ... 8 Brush making ... ... ... 3 ... 4 Total 4 ... 15 163 1 236 64 IV.- REGISTERED WORKSHOPS. Workshops on the Register at the end of the year. Number. Workshops and Workplaces 56 186 Outworkers 130 Bakehouses 31 Laundries 16 Total number of Workshops on Register 233 V.— OTHER MATTERS. Class. Number. Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshops Act (s. 5) Notified by H.M. Inspector 2 Reports (of action taken) sent to H.M. Inspector 2 Underground Bakehouses in use at the end of the year 1 65 TABLE I.— Vital Statistics of Whole District during' 1908 and previous Years. Year Nett Population estimated to Middle of each Year. Total Births Registered in the District Total Deaths Registered in the District Total Deaths in Public Institutions in the District. Deaths of Non-residents registered in the District. Deaths of Residents beyond the District. Nett Deaths at all ages Belonging to the District Under 1 Year of Age. At all Ages. Number. Rate. * Number. hate.* Number. Rate.† Number. Rate per 1000 Births registered in the District. 1 2 3 4 5 6 7 8 9 10 ii 12 13 1898 35.836 1,148 31.03 217 195.84 783 21.80 272 221 44 606 16.81 1899 39,523 1,146 34.90 242 161.87 831 21.00 207 175 32 688 17.40 1900 47,160 1,606 34.00 301 168.10 983 20.80 307 268 42 757 16.00 1901 44,911 1.640 36.50 271 139.00 787 15.20 233 183 70 674 15.00 1902 50,358 1,747 34.67 251 143.67 1006 19.90 270 161 56 901 17.88 1903 52,139 1,846 35.40 259 140.30 844 15.60 248 194 74 724 1.88 1904 53,358 1,891 35.40 306 161.80 1050 18 .90 361 293 93 845 15.80 1905 54.600 1,947 35.63 250 128.00 868 15.20 304 248 108 728 13.34 1906 60,818 1,881 33.10 235 124.93 915 15.55 337 256 124 783 13.78 1907 59,434 1,923 31.28 216 112.32 977 15.89 392 309 124 792 13.32 Averages for years 1898-1907 49,417 1,677 34.19 254 147.58 904 17.98 293 231 76 749 15.32 1908 60,182 2.000 a 32.16 213 106.50 902 14.50 376 297 129 732 12.16 * Rates in Columns 4 and 8 are calculated per 1,000 of estimated gross population, and in Column 13 on estimated nett population. The deaths included in Column 7 of this Table are the whole of those registered during the year as having actually occurred within the district. The deaths to be included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10 and the addition of the number in Column 11. By the term " Non-residents" is meant persons dying in the district whilst away from their permanent home; and by the term " Residents" is meant persons who at the time of their decease were temporarily residing outside Edmonton. The " Public Institutions " to be taken into account for the purposes of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses and lunatic asylums. A list of the Institutions in respect of the deaths in which corrections have been made are given below. + This rate is the nett one, uncorrected for age and sex. a Births registered in the District, uncorrected for Public Institutions. The nett births of children from Edmonton mothers inside and outside the district numbered 1931. This figure produces a birth-rate per 1,(100 of the nett population of 32.09. Area of District in acres (exclusive of area covered by water) 3,863 Total population at all ages 46,899 At Census of 1901. 44,911 Number of inhabited houses 7,795 Average number of persons per house (excluding Workhouses) 5.76, I. Institutions within the District receiving sick and infirm persons from outside the District. II. Institutions outside the District receiving sick and infirm persons from the District. III. Other Institutions, the deaths in which have been distributed among the several localities in the District. Edmonton Union Workliou.se Infirmary. Strand Union Workhouse Infirmary. Enfield and Edmonton Joint Hospital at Winchmore Hill. Middlesex Districts Joint Small Pox Hospital (South Minims). Middlesex County Asylums. Tottenham Hospital. Metropolitan Hospitals. Weir Hall Inebriate Home, etc. The Edmonton Union Workhouse is within the District. TABLE II.—Vital Statistics of separate Localities and of the Edmonton and Strand Union Workhouses and Strand Schools in 1908 and previous years. Names of Localities. 1 2 3 4 5 6 7 Whole District. Bury Street. Church Street. Fore Street. Undistributed. Edmonton Union- Strand Union and School. Year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each j ear. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. a b c d a b c d a b c d a b c d a b c d b c d a b c d 1904 53358 1891 845 306 18468 632 287 114 16593 596 295 106 18297 663 257 86 ... ... 6 ... 831 50 311 15 1339 5 50 ... 1905 54606 1947 728 250 19014 660 240 99 16468 621 262 76 19124 666 219 74 ... ... 7 1 897 70 263 4 1481 6 41 ... 1906 56818 1881 783 248 18570 643 264 91 18415 575 230 64 19607 585 278 89 ... ... 11 2 898 73 290 2 1350 5 47 ... 1907 59434 1924 792 225 18981 703 256 74 19522 559 257 70 20722 662 272 81 ... ... 7 ... 911 77 339 15 1339 3 54 1 1908 60182 2000 732 227 19739 654 267 73 19499 621 242 65 20736 656 211 73 ... ... 12 ... 932 88 311 12 1280 6 63 1 Deaths of residents occurring in public institutions beyond the district are included in sub-columns r. of this table, and those of non-residents registered in public institutions in the district excluded. Deaths of residents occurring in public institutions, whether within or without the district, are allotted to the respective localities according to the last private addresses of the deceased. 66 TABLE III.—Cases of Infectious Diseases notified during- the Year 1908. Notifiable Diseases. Cases Notified in whole District. Total Cases Notified in each Locality. No. of Cases removed to Hospital fkom each Locality. At all Ages. At Ages Years. 1 2 3 4 1 2 3 4 U nder 1 1 to 5. 5 to 15. 15 to 25 25 to 65 65 and upwds. Bury Street Ward. Church Street Ward. Fore Street Ward. 2 w. Edmonton Union. Bury Street Ward Church Street Ward. Fore Street Ward. 2 w. Total cases removed to Hsptl. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 158 1 71 65 9 12 ... 54 65 39 ... 43 46 35 124 Erysipelas 73 5 2 9 48 9 23 28 22 ... 1 ... 1 Scarlet fever 30S 4 83 190 18 13 95 101 112 ... 90 87 98 ... Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever † 36 ... 1 12 6 16 1 ] l 14 10 1† 7 10 7 24 Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 2 ... ... ... ... 2 ... 1 ... 1 ... ... ... 1 ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 577 5 160 269 42 91 10 184 208 185 1 140 144 141 425 † One case (man 46 years) brought from Waltham Abbey, was notified as Enteric Fever by Edmonton Workhouse Infirmary. Isolation Hospitals 1. Middlesex Districts Joint Small Pox Hospital in South Minims Rural District. There are 250 beds available for Patients from the areas of the constituent Authorities, and no others are admitted. The beds are not apportioned in any way to particular districts. 2. Enlield and Edmonton Joint Isolation Hospital at World's End, Winchmore Hill, in the Urban District of Enfield. The accommodation on December 31st, 1908, was stated by the Medical Superintendent to be Scarlet Fever, 78 beds: Diphtheria, 13 beds; Mixed Infection, 18 beds : Enteric *ever, 14 beds ; and Observation, 2 beds = Total, 125 beds. 3 Clavering's Farm (Edmonton District) has emergency Building for ten males and six females. 68 69 TABLE IVa.—Causes of, and Ages at Death, during- yean 1908. No. Diseases. Deaths at the subjoined Ages of " Residents " whether occurring in or beyond the District. Deaths of "Residents" in or beyond the District according to the Locality. Residents beyond the district. Edmonton Union Residents. Institution Deaths— Non-residents. Non-residents outside Institutions. Inquests in district on Residents. All Ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. J Bury Street. Church Street. Fore Street. Undistributed. Edmonton Union. Strand Union and School. Other Institutions. Totals. M. F. T. 2 Measles 11 8 19 5 13 1 ... ... ... 9 8 2 ... 1 ... ... ... ... ... ... ... 3 Scarlet Fever 4 8 12 ... 3 8 ... 1 ... 6 3 3 ... 11 ... ... ... ... ... ... ... 5 Epidemic Influenza 3 6 9 ... ... 1 1 3 4 2 5 1 1 1 ... 2 2 ... 4 ... ... 6 Whooping Cough 8 7 15 7 8 ... ... ... ... 10 3 2 ... 1 ... 1 ... ... 1 ... ... 7 Diphtheria 10 17 27 1 19 6 1 ... ... 11 12 4 ... 20 ... ... ... ... ... ... ... 8 Enteric Fever 1 5 6 ... ... 1 1 4 ... 9 3 1 ... 4 1 1 ... ... 1 1 10 Diarrhoea, Dysentery 16 12 28 21 6 1 ... ... ... 11 7 10 ... 4 ... ... ... ... ... ... 4 11 Epidemic Enteritis 6 7 13 10 3 ... ... ... ... 10 2 1 ... ... ... ... ... ... ... ... 2 15 Tetanus 1 ... 1 ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 18 Syphilis 2 1 3 2 ... ... ... 1 ... ... 3 ... ... ... ... ... ... ... ... ... ... 19 Gonorrhoea 1 1 ... ... ... ... 1 ... l ... ... ... ... ... ... ... ... ... ... 1 22 Puerperal Fever ... 2 2 ... ... ... ... 2 ... ... 1 1 ... 1 1 ... ... ... ... ... ... 23 Pyaemia 2 1 3 1 ... 1 ... 1 ... ... 9 1 ... ... ... 2 ... ... 2 2 24 Infective Endocarditis. ... 1 1 ... ... ... ... 1 ... ... 1 ... ... 1 ... ... ... ... ... ... ... 25 Other Allied Diseases 1 1 2 ... 1 ... ... 1 ... 2 ... ... ... 2 ... 3 ... ... 3 ... ... 27 Rheumatic Fever ... 1 1 ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 29 Tuberculosis of Brain 9 12 21 8 10 2 ... 1 ... 9 5 7 ... 5 2 ... ... ... ... ... 2 31 Phthisis 30 24 54 ... 1 2 12 39 ... 21 14 18 1 5 15 34 5 ... 39 3 32 Abdominal Tuberculosis 4 2 6 1 3 1 ... 1 ... 1 9 3 ... 2 ... ... ... ... ... ... ... 33 General Tuberculosis 3 5 8 1 4 1 ... 2 ... 3 3 2 ... 1 ... 1 ... ... 1 ... ... 34 Other forms Tuberculosis 3 1 4 1 ... 2 ... 1 ... 3 1 ... ... 2 1 1 2 ... 3 ... ... 39 Scurvy 1 ... 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 42 Chronic Alcoholism 2 1 3 ... ... ... ... 3 ... 1 1 1 ... ... ... 1 ... ... 1 ... 1 45 Osteo-arthritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 47 Cancer 15 20 35 ... ... ... ... 23 12 5 18 11 1 5 7 25 ... ... 25 ... ... 48 Diabetes Mellitus 2 1 3 ... ... ... ... 3 ... 1 ... ... ... ... 1 3 ... 1 4 ... ... 49 Purpura Hæmorrhagica ... 1 1 ... ... ... 1 ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 51 Anæmia 2 1 3 ... ... ... ... 3 ... 1 ... 2 ... 1 2 ... ... ... ... ... ... 53 Premature Birth 24 24 48 48 ... ... ... ... ... 20 14 ... ... 1 ... ... 1 ... 1 ... 7 54 Injury at Birth 3 ... 3 3 ... ... ... ... ... ... 2 1 ... ... ...... ... ... ... ... ... 2 55 Debility at Birth 7 4 11 11 ... ... ... ... ... 3 4 4 ... ... 2 ... ... 2 ... 1 56 Atelectasis 4 2 6 6 ... ... ... ... ... 1 1 4 ... ... ... ... ... ... ... ... 3 57 Congenital Defects 4 7 11 9 ... 2 ... ... ... 4 3 4 ... 1 ... ... ... ... ... ... 2 58 Want of Breast Milk ... 2 2 2 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 59 Atrophy, Debility, Marasmus 5 8 13 13 ... ... ... ... ... 2 5 6 ... 3 ... 9 ... ... 9 ... 1 60 Dentition ... 1 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 61 Rickets ... 1 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 62 Old Age, Senile Decay 9 24 33 ... ... ... ... 33 ... 11 9 1 3 11 59 16 ... 75 ... 3 70 71 TABLE IVa.—Causes of, and Ages at Death, during year 1908. No. Diseases. Deaths at the subjoined Ages of " Residents" whether occurring in or beyond the District. Deaths of "Residents" in or beyond the District according to the Locality. Residents beyond the district. Edmonton Union Residents. Institution Deaths— Non-residents. Non-residents outside Institutions. Inquests in district on Residents. All Ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Bury Street. Church Street. Fore Street. Undistributed. Edmonton Union. Strand Union and School. Other Institutions. Totals. M. F. T. 63 Convulsions 4 1 5 5 ... ... ... ... ... 2 2 1 ... ... ... ... ... ... ... ... 2 64 Meningitis 6 3 9 6 2 1 ... ... ... 4 1 3 1 1 1 ... ... ... ... ... 1 66 Apoplexy 3 4 7 ... ... ... ... 3 4 3 1 3 ... ... ... ... 1 ... 1 ... 3 67 Softening of Brain 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... ... ... ... 68 Hemiplegia 1 1 2 ... ... ... ... 2 ... ... 1 1 ... ... ... 2 3 ... 5 ... ... 69 General Paralysis of Insane 4 ... 4 ... ... ... ... 4 ... 1 2 l ... 4 ... ... ... ... ... ... ... 70 Other Forms of Insanity ... 1 1 ... ... ... ... ... 1 ... 1 ... ... ... ... 2 1 ... 3 ... ... 72 Cerebral Tumour 1 2 3 ... 1 ... ... 2 ... 1 ... 2 ... 2 ... ... 1 ... ... ... ... 73 Epilepsy 1 1 2 ... ... ... 1 1 ... ... 1 1 ... 1 1 ... 1 ... 1 ... 1 76 Paraplegia 4 2 6 1 1 ... ... 2 2 3 3 ... ... ... 2 7 ... ... 8 ... ... 77 I o Other forms, Brain Diseases 2 1 3 1 ... ... 1 1 ... 2 1 ... ... 1 1 ... 3 ... 1 ... ... 78 Otitis 4 ... 4 ... ... 2 ... 2 ... 3 ... 1 ... 3 ... ... ... ... ... ... ... 82 Endocarditis 16 11 27 ... ... 1 2 13 11 8 9 9 1 3 7 11 ... ... 14 ... 6 83 Hypertrophy of Heart 1 ... 1 ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... ... ... ... 1 85 Aneurism 1 ... 1 ... ... ... ... 1 ... 1 ... ... ... 1 ... 1 1 ... 1 ... ... 86 Senile Gangrene 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... 2 ... 3 ... ... 87 Embolism, Thrombosis 1 3 4 ... ... 1 ... 1 2 3 1 ... ... ... ... ... ... ... ... ... 1 90 Other Diseases, Heart and Vessels 17 16 33 ... ... 2 1 18 12 7 16 8 2 4 7 20 7 ... 27 ... 5 91 Laryngitis 1 ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 94 Acute Bronchitis 8 13 21 12 5 ... ... 3 1 3 12 6 ... ... 1 1 ... ... 1 ... 2 95 Chronic Bronchitis 16 10 26 ... ... ... ... 3 23 9 6 11 ... 1 3 15 9 ... 24 ... 1 96 Lobar Pneumonia 10 3 13 1 5 1 ... 5 1 7 4 2 ... 4 1 4 ... ... 4 ... ... 97 Lobular Pneumonia 26 12 38 21 13 1 1 1 1 15 10 12 1 5 1 2 ... ... 2 ... 3 98 Pneumonia 14 11 25 7 2 2 2 8 4 12 5 7 1 1 3 2 1 ... 3 ... 7 99 Emphysema, Asthma ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 2 ... ... 100 Pleurisy 3 3 6 ... ... 1 ... 2 3 2 4 ... ... 1 2 1 ... ... 1 ... 1 101 Other Diseases, Respiratory System 1 ... 1 ... ... ... ... 1 ... ... ... ... 1 ... 1 1 ... ... 1 ... ... 106 Other Diseases of Stomach 2 2 4 4 ... ... ... ... ... 1 1 2 ... ... ... ... ... ... ... ... ... 107 Enteritis ... 2 2 1 1 ... ... ... ... 2 ... ... ... 1 ... 2 ... ... 2 ... ... 108 Appendicitis 1 ... 1 ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 109 Obstruction of Intestine 4 4 8 ... ... ... 2 3 3 4 2 2 ... 6 1 1 ... ... 1 ... ... 111 Cirrhosis of Liver 5 2 7 ... ... ... ... 2 2 3 2 2 ... ... ... ... 2 ... 2 ... ... 112 Other Diseases of Liver 1 1 2 1 ... ... ... ... ... ... ... 2 ... ... ... 1 ... ... ... ... ... 113 Peritonitis ... 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 72 73 TABLE IVa.— Causes of, and Ages at Death, during- year 1908. No. Diseases. Deaths at the subjoined Ages of " Residents" whether occurring in or beyond the District. Deaths of "Residents" in or beyond the District according to the Locality. Residents beyond the district. Edmonton Union Residents. Institution Deaths— Non-residents. Non-residents outside Institutions. Inquests in district on Residents, All Ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Bury Street. Church Street. Fore Street. Undistributed. Edmonton Union. Strand Union and School. Other Institutions. Totals. M. F. T. 116 Acute Nephritis 4 1 5 1 ... ... 2 2 ... ... 3 2 ... 2 1 1 ... ... 1 ... 1 117 Bright's Disease 2 5 7 ... ... ... ... 5 2 3 2 1 1 1 2 4 4 ... 8 ... ... 118 Calculus 1 ... 1 ... ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... 119 Diseases of Bladder and Prostate 2 ... 2 ... ... ... ... ... 2 2 ... ... ... ... ... 3 ... ... 3 ... ... 128 Puerperal Convulsions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 129 Placenta Prievia, Flooding ... 2 2 ... ... ... ... 2 ... 1 1 ... ... ... ... ... ... ... ... ... ... 132 Arthritis, Ostitis, Periostitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 134 Ulcer, Bedsore ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 136 Pemphigus 1 ... 1 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... Accidents and Negligence: ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 139 In Vehicular Traffic 1 1 2 ... 1 ... ... 1 ... ... ... 2 ... 1 ... ... ... ... ... ... 2 142 In Building Operations 2 2 ... ... ... ... 2 ... 1 ... 1 ... 1 ... ... ... ... ... ... 2 145 Burns and Scalds 1 3 4 1 1 2 ... ... ... 1 3 ... ... 4 ... ... ... ... ... ... 4 150 Drowning 1 ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 1 151 Suffocation, Overlaid in Bed 3 4 7 7 ... ... ... ... ... 2 2 3 ... ... ... 1 ... ... 1 ... 7 152 Suffocation otherwise 2 1 3 1 1 1 ... ... 1 2 ... ... ... ... ... ... ... ... 3 153 Falls not specified 1 2 3 ... ... ... ... 2 1 1 2 ... ... ... 1 ... ... ... ... ... 3 155 Otherwise, not stated ... 2 2 1 ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... 2 Suicides : 159 By Hanging and Strangulation 1 ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 160 By Drowning 2 1 3 ... ... ... ... 3 ... 1 ... 2 ... 1 ... ... ... ... ... ... 3 165 By other and unspecified methods 1 ... 1 ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... 1 168 111 defined and ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... unspecified causes 2 2 4 3 ... ... ... 1 ... 1 1 2 ... ... 1 1 ... ... 1 1 4 Totals 380 352 732 227 106 44 31 198 126 267 242 211 12 129 79 233 63 1 297 2 104 74 TABLE V. Infantile Mortality during- the Year 1908. Deaths from stated causes in weeks and months under one year of age. Cause of Death. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 1 month. 1—2 months. 2—3 months. 3—4 months. 4—5 months. 5—6 months. 6—7 months. 7—8 months. 8—9 months. 9—10 months. 10—11 months. 11—12 months. Total Deaths under One Year. All Causes Certified 52 8 15 11 86 14 24 15 11 5 10 16 12 9 9 16 227 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... none Common Infectious Diseases. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 2 5 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 Whooping Cough ... 1 ... 1 1 ... 1 1 ... ... ... ... ... ... 3 7 ii. Diarrheal Diseases. Diarrhea, all forms 1 5 3 4 4 4 4 3 2 1 31 Enteritis, Much-enteritis Gastro-enteritis ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 Gastritis, Gastro - intestinal Catarrh ... 1 ... ... 1 ... 3 ... ... ... ... ... ... ... ... ... 4 iii. Wasting Diseases. Premature Birth 29 2 8 3 42 3 1 2 ... ... ... ... ... ... ... ... 48 Congenital Defects 10 1 2 2 15 ... ... ... ... ... ... ... ... ... ... ... 15 Injury at Birth 3 ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... 3 Want of Breast-milk, Starvation ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... ... ... 2 Atrophy, Debility, Marasmus 3 2 ... 3 8 2 7 3 1 ... 1 1 ... ... 1 ... 24 iv. Tuberculous Diseases. Tuberculous Meningitis ... ... ... 1 1 ... ... 1 2 1 ... ... 2 ... 1 8 Tuberculous Peritonitis : Tabes Mesenterica ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Other Tuberculous Diseases ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... 2 v. Other Causes. Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis ... ... 1 1 2 ... ... ... ... ... ... ... ... ... ... ... 2 Rickets ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Meningitis (not Tuberculous) ... ... ... ... ... ... 1 ... ... ... 2 1 1 ... ... 1 6 Convulsions 1 ... ... ... 2 ... 1 ... 1 ... ... ... ... ... 1 ... 5 Bronchitis ... ... ... ... ... 2 1 1 1 2 1 1 ... ... 2 1 12 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia ... ... ... 1 1 2 9. 1 2 ... 1 5 5 2 2 6 29 Suffocation, overlaying 1 ... 1 ... 2 1 1 2 ... 1 ... ... ... ... ... ... 7 Other Causes 5 1 1 ... 7 1 ... ... 1 ... ... 1 1 1 1 13 52 8 15 11 86 14 24 15 11 5 10 16 12 9 9 16 227 75 Estimated Population to middle of 1908. Gross 62,186 Nett 60,182 Births in the year (Edmonton Mothers). Legitimate 1,890 Illegitimate 43 1,933 Deaths in the year. Legitimate Infants 209 Illegitimate Infants 18 Deaths from all Causes at all Ages. Gross 902 Nett 732 TABLE VI. Table showing the Number of Cases Notified and the Deaths from the principal Zymotic Diseases for the year 1908, and ten preceding years. Disease. 1908. 1907. 1906. 1905. 1904. 1903. 1902. 1901. 1900. 1899. 1898. Pop. 60,182 Pop. 59,434 Pop. 56,818 Pop. 54,606 Pop. 53,358 Pop. 52,139 Pop. 50,388 Pop. 44,911 Pop. 47,166 Pop. 39,523 Pop. 35,836 Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Notifiable. † Small Pox ... ... ... ... ... ... ... ... 4 ... 1 ... 701 120 13 3 ... ... ... ... ... ... † scarlet Fever 308 12 231 8 383 13 259 6 181 3 119 2 179 6 56 6 136 4 167 4 124 2 † Diphtheria and Membranous Croup 158 27 95 17 93 11 37 4 46 10 19 1 60 13 42 8 43 10 39 12 34 7 Erysipelas 73 ... 54 ... 78 4 66 1 74 5 63 2 66 3 54 1 66 4 ... 4 44 ... † Enteric Fever 36 6 29 5 25 7 44 6 38 8 28 6 86 14 ... 5 67 6 43 8 ?3 2 Simple Continued Fever ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 3 2 3 3 5 2 3 2 1 ... 3 1 4 2 4 ... 3 ... 8 3 6 2 Non-notifiable. † Diarrhoea and Epidemic Enteritis ... 41 ... 32 ... 114 ... 56 ... 151 ... 61 ... 46 ... 71 ... 68 ... 126 ... 195 Enteritis ... 2 ... 5 ... 2 ... 10 ... 14 ... 8 ... 29 ... 39 ... 74 ... ... ... ... Measles ... 19 ... 21 ... 19 ... 27 ... 28 ... 10 ... 19 ... 15 ... 7 ... 16 ... 16 Whooping Cough ... 15 ... 39 ... 8 ... 30 ... 7 ... 19 ... 20 ... 3 ... 30 ... 2 ... 24 Influenza ... 9 ... 14 ... 9 ... 9 ... 10 ... 2 ... 8 ... 6 ... 55 ... 9 ... ... Phthisis ... 54 ... 53 ... 65 ... 42 ... 71 ... 58 ... 45 ... 38 ... 64 ... 48 ... 38 Other tuberculous Diseases ... 35 ... 34 ... 38 ... 34 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 76 † The seven principal Zymotic Diseases on the deaths from which the Zymotic death-rate is based. Infections Diseases Notification and Prevention Acts have been in force since March 1st, 1891. Before 1906, although their notifications were included, deaths in the Strand Union and amongst non-residents in the Edmonton Union were excluded from this table. Deaths of Residents occurring outside the District are included, Our Isolation Hospitals are all outside the District, 77 District of Edmonton—County of Middlesex Sanitary Work, 1908. Name of Sanitary District. Inspections. Notices Dwelling Houses. Houses let in Lodgings. (Tenement Houses.) Common Lodging Houses. Canal Boats used as Dwellings. Moveable Dwellings, Caravans, Tents, &c. Number of Premises Inspected on Complaint. Number of Premises Inspected in connection with Infectious Diseases. Number of Premises under Periodical Inspection. Houses Inspected from House-to-house. Total Number of Inspections and Re-inspections made. Cautionary or Intimation Notices Given. Statutory Orders Issued. Summonses Served. Convictions Obtained. Houses, Premises, &c,, Cleansed, Repaired, &c. Closed as Unit for Habitation. (a) As result of action under H. W.C. Acts. (b) Otherwise. Re-opened after Repairs, Alterations, &c. Demolished. Illegal Underground Dwellings Vacated. Number Registered under Bye-Laws. Number of Contraventions. Number Registered under Bye-Laws. Number of Inspections made. Number of Contraventions. Number Registered under the Acts. Number of Contraventions of Regulations. Number Observed during the Year. Number of Nuisances therefrom Abated. Number Removed from District. EDMONTON. 591 570 394 372 13470 2978 352 8 8 151 8 a3 ... 2 ... ... ... 1 97 3 Not a Registration Authority. 4 668 ... ... b5 78 District of Edmonton County of Middlesex-Sanitary Work, 1908. Name of Sanitary District. Bakehouses. Slaughterhouses. Cow-sheds. Dairies and Milk shops. Unsound Food. Adulterated Food. Offensive Trades. Number in District. Contraventions of Factory Acts. Number on Register. Number of Inspections made. Contraventions of Bye-Laws. Number on Register. Number of Inspections made. Contraventions of Regulations. Number of Milch Cows ill District. Number on Register. Number of Inspections made and frequency of inspection. Contraventions of Regulations. Condemned by Magistrate. Articles or Parcels surrendered. Samples taken (if any) by the District Local Authority. Found Adulterated. Number of Premises in District. Number of Inspections made. Contraventions of Bye-Laws. EDMONTON. 31 7 6 163 2 3 44 1 24 51 221 5 All 4 trunks herring 5 boxes bloaters. 8 cod. 3 lots mixed fish, 9 bags onions, 1 barrel grapes, 1 trunk hake 16 baskets cherries. 3 trunks haddock. 1 trunk whiting, 1 box kippers, 2 barrels apples. 1 lot bananas, | 1 pad shrimps. ... ... Nil. ... ... [only two occupied by cows. 79 District of Edmonton County of Middlesex Sanitary Work, 1908. Name of Sanitary District. Water Supply and Water Sen ice. Drainage and Sewerage of existing Buildings. Wells. Percentage of Houses supplied from Public Water Service. Cisterns. Draw-Taps placed on Mains. Percentage of Houses supplied on Constant System. Number of Samples obtained for analysis, (n) from Local Wells (b) from Public Supply. Water Closets. Percentage of Houses provided with Water Closets. Drains. Cesspools. New Sunk. Cleansed, Repaired, &c. Closed as Polluted. New Provided. Cleansed, Repaired, Covered, &c. Number of Water Closets substituted for Dry Receptacles. Repaired, Supplied with Water, or otherwise Improved. Examined, Tested, Exposed, &c. Unstopped, Repaired, Trapped, &c. Waste I'ipes, Rain Water I'ipes Disconnected, Repaired, &c. New Soil I'ipes or Ventilating Shafts fixed. Existing Soil Pipes or Ventilating Shafts repaired. Disconnecting Traps or Chambers Inserted. Reconstructed. Rendered Impervious, Emptied, Cleansed, &c. Abolished, and Drain connected to Sewer. Percentage of Houses Draining into Sewers. EDMONTON. ... ... ... 99.3 ... 70 10 All houses supplied on constant system. ... ... 309 99.9 589 301 33 42 14 47 99 9 1 99.1 tht-se are emptied and cleansed periodically. 80 District of Edmonton—County of Middlesex—Sanitary Work, 1908. Name of Sanitary District. Disinfection. Dust. Sundry Nuisances Abated. Rooms Disinfected (a) Ordinary Infectious Diseases, (6) Phthisis. Rooms Stripped and Cleansed. Articles Disinfected or Destroyed, (a) Ordinary Infectious Disease. (b) Phthisis. | New Bins provided. | How frequently is dust removed from each house ? | Number of Complaints of Non-Removal received. Method of Disposal (a) Destructor, (b) by Tipping (c) Other, state method. Overcrowding. Smoke. Accumulation of Refuse. Foul Ditches, Ponds, &c., and Stagnant Water. Foul Pigs and other Animals. Dampness. Yards Re-paved or Repaired. Other Nuisances. EDMONTON. a 573 186 a 6333 129 Weekly. 43 Tipping on Council's Sewage Farm. 30 6 44 6 17 2.24 57 20 b 8 b 148 81 Edmonton Urban District. REPORT of the INSPECTOR OF NUISANCES For the Year 1908. Public Health Department, Town Hall, Edmonton. To the Chairman and Members of the Edmonton Urban District Council. Gentlemen, I have the honour to present to you the report of the work done by myself and your Inspectors in the Department for the Year 1908. Very little legislation of 1908 has any direct relation to Public Health Administration. In view of the passing of the Public Health Act, 1907, we must, no doubt, wait a little longer for the general measures of revision and consolidation of the numerous Public Health Acts, but the need of such a measure still exists and continues to grow. REGULATION AS TO FOOD. In pursuance of the Public Health (Regulation as to Food) Act, 1907, the Local Government Board have made two sets of regulations, one called the Public Health (First Series: Unsound Food) Regulations, 1908, and the other the Public Health (Foreign Meat) Regulation, 1908. These regulations come into operation on the 1st January, 1909. The regulations relating to unsound food have been framed with the object of securing that articles of food which are unsound, unwholesome, or unfit for human consumption, and which, as part of the cargo of a ship are brought to a place in this country, either as a place of destination, or as a place of deposit for transmission to a place -of destination elsewhere in the United Kingdom, shall be dealt with at the port of discharge. The regulation relating to Foreign Meat is divided into classes. 82 CLASS I. is designed to deal with foreign boneless meat, which is imported in the form of scraps, trimmings, or other parts not sufficientlyidentifiable with definite parts of a carcase, and which has not before importation been made ready for human consumption, in the form of a sausage, etc. Also dealing with other parts of animals not prepared before importation, and not contained in a package, with an official certificate stating that the meat has been certified by a competent authority in the place of origin tobe free from disease at the time of slaughter. CLASS II., amongst other things, deals with stopping the importation of carcases of pigs, etc., from which the lymphatic glands about the throat and elsewhere are absent, thereby preventing the detection of tuberculosis and other disease in the carcase. CLASS III. (Foreign Meat) includes meat contained in a package with an official certificate, and this, and foreign meat unclassed, is also subject to examination under certain conditions. TEMPORARY HOSPITAL BUILDINGS, CLAVE RINGS FARM. Another year has passed and I am pleased to say this building has not been required for the purpose for which it was intended, viz., Small - Pox. It was suggested that these buildings could be better utilised, and as I have previously reported, while the disinfecting apparatus adjoins the Temporary Hospital, a resident disinfector is essential. A man should live on the spot so as to keep a watch on such a valuable asset; but should the disinfecting apparatus be removed to Deepham's Farm, near the present pumping station (where steam is available night and day), no doubt a saving could be effected. The Council have power, under the Cleansing of Persons Act, 1897, toestablish a proper station for disinfection, where tramps, etc., can be cleansed. The time is not far distant when the Council will be in a position to usefully discuss the advisability of establishing a disinfecting station, laundry, baths and dressing rooms for cleansing verminous children, indeed, Section 122 of the Children Act, 1908, which comes into force on April 1st, 1909, gives power to the Sanitary Authority and the Education Authority to enter into an agreement for the cleansing of persons and clothing of persons infected with vermin, and gives the Education Authority power to use such premises and appliances for such purpose, upon payment, etc. SANITARY CONVENIENCES. This year records the installation of the first Convenience in the district for the accommodation of both sexes, and, judging from the results, especially when we consider that the portion for the males was not opened 83 until May 1st, 1908, and the females June 6th, 1908, the Council's consideiation has been been justified. There is free accommodation for males and females. The "Wash and Brush up " has not, up to the present, been well patronised, but probably when the place is more known we may get better results. The hours during which the male convenience is open are from 6 a.m. till 12 p.m. on week-days, and from 7 a.m. till 11 p.m. on Sundays. The female convenience, from 7 a.m. till 11 p.m. on week-days, and from 9.30 a.m. till 10.30 p.m. on Sundays. The management of the place having been specially placed under my supervision, I am pleased to report that both the male and female attendants have carried out their duties to my satisfication, that I have not received any complaints, and have always found them courteous and obliging. Plans have been prepared by your Engineer for a Convenience for both sexes to be placed upon the Green. There is no doubt a Convenience here will be very niuch appreciated, as the number of persons who pass to and fro, especially on Friday and Saturday evenings, need some such consideration. The amount collected for the use of water-closets, etc., was £59 7s. 6d. The whole of the public urinals, and other urinals connected with public houses, etc., have been periodically inspected, and much additional attention has been given to the cleansing, and with good results. REMOVING PATIENTS TO HOSPITAL AND DISINFECTION. The work of removing patients to hospital is not confined to the Disinfector (who also acts as attendant), but to your Inspectors, as it is impossible for one man to remove all the patients. The Inspectors and Disinfector take duty in turns every Saturday, from 1 p.m. to Monday morning, and on Bank Holidays, so as to be in readiness to remove a patient should necessity arise. The letter-box for notifications of infectious disease is examined at 4 p.m. on Saturday afternoons, and at 10 a.m. and 4 p.m. on Sundays, also on Bank Holidays, and any notification then found is dealt with immediately. The bulletin as to the condition of patients in hospital is posted outside the Town Hall at 10 a.m. every morning, Sundays included, so that parents and friends can ascertain the condition and progress of patients. I can only reiterate my former remarks upon the matter. I earnestly look forward to the time when the Joint Hospital Board will have an Ambulance Service directly connected "with the hospital, properly equipped with nurse and attendant. This will help the department considerably, and the collection of 84 ding, disinfection and returning of the same, could be done by one man, incidentally effecting a saving of expense. The following items show the nature of the work carried out, viz. :— Number of Journeys of ambulance to remove patients to Joint Hospital, Winch more Hill 293 Number of Journeys of ambulance to remove patients to other hospitals 8 Number of Journeys of bedding van to remove infected bedding 467 Number of Journeys of bedding van to return bedding after disinfection 377 Number of journeys of brougham to fetch patients from hospital to their homes 180 Number of patients returned to their homes from the hospital by the brougham 300 DISINFECTANTS. For some years past the Council have generously allowed the free distribution of disinfectants to the inhabitants of the district, but during the last three months under report it has been found necessary to curtail the expense, and callers have been informed that the giving of disinfectants will be discontinued. As I have before reported, the address of every applicant has been taken, and kept for reference if necessary. Disinfectants are only supplied to those bringing tin vessels, it having been found that glass bottles brought for the purpose were broken about the district and waste occurred. No doubt some of the disinfectant is misapplied, but its use must, to a great extent, encourage cleanliness and cause much more water to be used than otherwise would be. On looking through the register of callers I find 41,167 persons applied for disinfectants during the year. It has been suggested that the supply of disinfectants might be discontinued without any detriment to the health of the district. I might say this would be a great relief of responsibility to me, but, personally, I should be loth to recommend such a course, knowing full well that much good has been done in the past. DRAINAGE, &e. During the year several large groups of houses have been re-drained. Several other groups of house drainage have been examined, but owing to the complex nature of legal opinions and decisions of what is or what is not " a sewer," the work is much hampered. 85 It is one continued worry even to arrive at a compromise with the owner to get the nuisance abated. The following work has been carried out:— Number of drains re-constructed 99 New inspection chambers provided 47 New soil pipes and ventilating pipes 42 Drains examined, tested and exposed 589 Drains unstopped, repaired, trapped 301 There are only nine cesspools in the district, six belonging to private houses and three to a factory. These are periodically emptied and cleansed. MORTUARY. I inspect these premises personally almost daily, and am pleased to say have found them at all times to be in a satisfactory condition. During the year the total number of bodies received was 128, an increase of 49 on the previous year. There were Post Mortems made in 90 instances, and Inquests held in 94. The number of bodies left in the Mortuary (after inquest) until burial was 15. It was necessary in 14 cases to detain the bodies (after inquest) until burial, owing to decomposition having set in. Undertakers deposited 25 bodies to await burial, and facility is given them to do so, as in many instances there is insufficient accommodation at the residence of the relatives. In all there were 17 bodies buried by the Guardians, and in three cases it was found necessary to have the bodies removed to the Mortuary, owing to the parents or responsible parties not being in a position to bury. The facts were at once communicated to the Relieving Officer and arrangements made for burial. I regret to say that many bodies were received in a dirty and verminous condition. In my last Report I mentioned that the mortuary attendant's residence was some ten minutes' walk from the mortuary. His duties call him there both by day and by night. May I, therefore, again suggest that a residence adjoining the Town Hall be provided for him and his salary adjusted accordingly. This would facilitate his operations generally, and being on the spot he could keep a closer watch on the Council's property. 86 HOUSING OF THE WORKING CLASSES ACT. During the year there were under observation nineteen houses to be dealt with under this Act. In the case of ten houses in Silver Street, the owner at once stepped in and made them fit, but being old houses, a few years hence will see them in a similar condition. Four houses in Silver Street were voluntarily closed. The three houses in Eaton Place (Nos. 9, 10 and 11) would liave been dealt with but for the fact that the lessee dropped out and the superior landlord cannot be found. The three houses adjoining (Nos. 6, 7 and 8), which belong to the same owner, will soon be in a similar condition. The tenants pay the rates and do little repairs, but are not called upon to pay rent. However, the premises are being kept under regular observation, and on the first opportunity they will be dealt with. One house in Montague Road is now being made fit for human habitation, this had long remained empty. Nos. 1 and 2 Rose Cottages, Bury Street, closed last year, have now been demolished. OFFENSIVE TRADES. There are no offensive trades as laid down by the Public Health Act. But the business of pig-keeping seems to be on the increase, and especially is this so at the north end of the district, on the allotment land. Notices have been served to abate nuisances, and some of them have been abated, but in two instances, at least, something will have to be done, or it will be necessary to take proceedings. DUST COLLECTION. The collection of house refuse is still carried out by contract, and the refuse deposited at the Council's Sewage Farm. The refuse during the year has been utilised for raising the farm lands, etc. The number of van loads deposited at the farm was 3,560, and the weight, 6,442 tons 9 cwt. 3 qrs. Some of the spreading of the dust is still carried out by a man, who has the privilege of collecting and disposing of the bones, rags, glass, etc., in return for his labour. The condition is, that that the materials collected on the shoot shall be taken directly out of the district to a place where they are to be dealt with. The quantity of waste iron and tin-ware, 112 tons 12 cwt. 3 qrs., collected with the dust, is sorted out and removed by a Company, at their own expense, and for which the Council received £22 14s. 2d. This product is 87 useless to the Council, and therefore well out of the way. The complaints of non-removal of dust were few, and in every instance investigated. As I have before remarked, the work cannot be thoroughly supervised unless a dustforeman be appointed to follow the dust rounds of the district, there being so many difficulties to overcome. In many instances the occupiers are out at times of call, while for others the time is inconvenient. In the hot weather I noticed numbers of house flies clinging to the dust vans when leaving the dust shoot. I tried various remedies, and eventually found that spraying the dust vans with a solution of chlorinated water had the desired effect, and disinfecting the dust vans on their return journey. Number of dust-bins supplied during the year—129. COLLECTION OF FISH OFFAL. The collection of this offal continues to be much appreciated by the fish dealers, and the advantage gained by minimising the nuisance inseparable from such a business justifies the Council's action in continuing the collecting of the same, although the price charged for the use of the Council's air-tight receptacles and the collection does not cover the cost. Much time is also taken up in supervising the collection of pails, the disposal of offal, and the collection of money. This offal is still dealt with on the Council's Sewage Farm, being buried after first being treated with lime. Should the Council at any time build a Destructor, a proper incinerating chamber attached thereto would do away with the necessity for the burying process and expedite the work of cleansing the pails. As I have before reported, in some districts the fish offal is collected by private firms, who utilise the offal in the manufacture of artificial manure, charging the fishmongers according to the quantity of offal removed. I have been endeavouring to bring about a similar arrangement, but the distance from the factory and the fluctuations in the quantity of the offal collected, would not pay a contractor at present; still, I am hoping in the near future that some such arrangement will be possible. During the year there were 33 fishmongers on the register, but six have ceased to carry on the business. The number of pails dealt with was 3,182, and the amount of money collected—at 4d. per pail—£36 6s. 0d. SLAUGHTER-HOUSES. The number of slaughter-houses on the register remains the same as last year, viz., six, four being licensed under the Public Health Amendment Act, 1890, the other two having been used as slaughter - houses (registered) for a great number of years. Two are of modern construction; two are, considering the age of the premises, good; and two are fairly good; but the access to one of those registered is bad. They are all regularly inspected and kept in a cleanly condition. Many repairs have been effected during the year, the occupiers being generally willing to comply with any reasonable request. 88 DITCHES AND WATERCOURSES. These have received regular inspection, and four foul water drains were found discharging into the watercourses. Two of these nuisances were abated, and two are receiving attention. These watercourses are still used as dumping grounds for anything undesirable. I am pleased to say the culverting in of the watercourses from Beaconsfield Road, Felixstowe Road to Montague Road, has done away with many nuisances, that adjoining Felixstowe Road was always a source of trouble. It would be greatly beneficial if the watercourse adjoining Eldon Road School was dealt with in a similar manner. Much good has been done, and much is being done, to remedy these nuisances, by culverting in these watercourses, and no one is able to appreciate the good effect more than myself. There were 310 dead animals, foul deposits, etc., removed from the ditches and watercourses generally. SMOKE NUISANCES. The nuisances that arise from smoke in this district are few. Observations have been made on many occasions, and I have called on offenders, drawing their attention to their liability, with the result that the nuisancehas been greatly diminished. The trouble generally arises from irregular and improper stoking. It is difficult to understand why owners do not pay more attention to regular stoking—a very important matter—as by firing lightly and often, and by admitting the necessary air to the furnace to assist combustion, fuel would be saved and better results obtained. I should very much like to see the Council take into consideration somemethod of smoke prevention from the various shafts belonging to them,, thereby saving fuel and setting an example to owners of other factories in the district. DAIRIES COW-SHEDS AND MILK-SELLERS. The number of cow-keepers on the register is two, two having been taken off the register last year; the number of cows kept being 21, which are out to graze during the greater part of the year. I called one cow-keeper's attention to the necessity for properly repairing his cow-sheds, but he stated the milk business was not paying, and gave up keeping cows and has since been struck off the register. The number of milk-sellers on the register is 51, but during the year five were removed from the register, the conditions under which the milk was stored being unsatisfactory. 89 There are four dairymen using steam apparatus for scalding and cleansing the cans, etc., and another one of them is making the necessary arrangements to the same end. Regular inspections are made of all premises where milk is stored, and, year by year, we are endeavouring to raise the standard of the premises generally, but much more stringent Bye-laws are needed before the desired result can be obtained. In my opinion, no person should be allowed to sell milk except under special conditions and under a special certificate granted by the Sanitary Authority, who should have power to absolutely refuse to permit any person to establish a milk business upon any premises unless the same were suitable and the milk-seller of cleanly habits. SALE OF FOOD AND DRUGS. For the Council's information, and by the courtesy of the Clerk of the Middlesex County Council, I herewith append a statement of the work done under this Act in the district for the year. Owing to the re-organisation ofthe staff, I am unable to give detailsfor the year. Quarter ended 31st June, 1908 :— No. of samples taken 45 ,, „ adulterated 11 Quarter ended 30th September, 1908 :— No. of samples taken 50 ,, „ adulterated — Quarter ended 31st December, 1908 :— ] Formal Samples. Informal Samples. Informal Samples. Taken. Adult'd. Taken. Adult'd. ] Butter 6 2 ... ... ... ... Milk 14 2 ... ... ... ... Butter ... ... 47 9 ... ... Milk ... ... 20 5 ... ... Beer ... ... ... ... ... ... Tartaric Acid ... ... ... ... ... ... Whisky ... ... ... ... 2 ... Coffee ... ... ... ... ... 1 Glycerine ... ... ... ... ... 2 Alum ... ... ... ... ... 3 Borax ... ... ... ... ... 4 Epsom Salts ... ... ... ... ... 2 No samples, other than milk and butter, have been certified as adulterated, from Edmonton. 90 FOOD DESTROYED. The shops and stalls where food is exposed for sale are regularly inspected, and I am glad to say that retailers still continue to take advantage of the opportunity afforded them of bringing unsound or doubtful foods (as to wholesomeness) to the Town Hall, that they can be examined, and, if unlit for food, be dealt with under a Magistrate's order and subsequently destroyed. This enables the retailer to recover the amount paid for the goods, and prevents the tendency that would otherwise exist to expose such food for sale. During the year the following goods have been examined, condemned, and ordered to be destroyed :— Jan. 20th, 5 boxes bloaters. Jan. 22nd, 1 trunk herrings. Jan. 22nd, 3 cod. Jan. 29th, 1 trunk herrings. Jan. 31st, 3 ling and 6 coalfisli. Feb. 4th, 9 bags onions. Mar. 19th, 2 cases fresh herrings. Mar. 28th, 1 barrel grapes July 9th, 1 trunk hake. July 24th, 16 baskets cherries. July 31st, 1 trunk mixed fish. Aug. 5th, 1 gross haddocks. Sept. 7th, 1 trunk whiting. Sept. 22nd, 1 box kippers. Oct. 5th, 2 barrels apples. Oct. 7tli, 2 trunk haddock. Dec. 16th, 2 cases bananas. Dec. 19th, 1 pad shrimps. July lOtli, 1 trunk mixed fish. OVERCROWDING AND FILTHINESS. During the year 30 cases of overcrowding were discovered, which have all been abated. Eight places were not only overcrowded, but were also verminous. In seven instances the bedding was taken away, disinfected, and returned; and in three cases was destroyed. Some of the verminous cases came to my knowledge through the schools, and these were kept under observation, but some of the families have left the district. In some dwellings there has been a marked improvement in the cleanliness of the premises and bedding, and the condition of the children. In one instance the home was in a cleanly condition, no nuisance existed that could be dealt with by the Sanitary Authority. The persons who cause the worst overcrowding and fifthiness are generally old oSenders, who, as soon as they are discovered, clear away and commence similar operations elsewhere; this class, in my opinion, should be compelled to live in one street by themselves, to ensure their regular supervision. Several cases have occurred where the overcrowding was caused by persons who were clean, but exceedingly poor, but who, being out of work, were obliged to sacrifice the greater portion of their belongings and take shelter in inferior places. 91 PREVENTION OF DAMPNESS. Roofs, rain-water pipes and gutters repaired 143 Wash-houses paved H Water fittings, etc., repaired 35 New sinks provided and sink waste pipes repaired 32 Ventilation under floors and new damp-courses 3 224 Yards paved and repaired 37 281 ICE CREAM VENDORS. The premises where this commodity is manufactured were each inspected twice during the year, and found clean. Four defects were found and remedied. There are 36 persons on the register ; 30 shops, 3 persons make it in private houses and sell it in the streets, and in three cases the ice cream is manufactured outside the district and brought here to be sold. CANAL BOATS ACT. During the year I inspected thirty-three boats and found four contraventions, all of which were remedied. The contraventions were as follows :— One cabin - top defective. Two cabins dirty. One, no certificate produced. The canal is situated practically on the outskirts of the district, and away from any populous part, consequently the inspection takes up much more time than would otherwise be the case if the canal passed through the centre of the town. GIPSIES. During the year there were 668 seen and removed, and 118 notices served. On several occasions their vans were removed by the Council's horses. There were seven summoned, and in each case the full penalty of £5 and costs was imposed, but, as usual, they cleared off, did not pay the fine and, in some cases, subsequently returned again under assumed names. There 92 are 48 committals awaiting them, but whatever is clone is a waste of time anil energy, the present powers of the law, Police, and Sanitary Authority being simply unable to effectually deal with them. There are a few respectable gipsies who give little or no trouble, but the majority are nothing else but a filthy, lazy, blackguardly lot. Wherever they camp the fences of the land soon disappear. Their habits are of the crudest nature, and how much longer they are to be permitted to roam the country under present conditions, is a question which should receive the serious consideration of respectablecitizens. There are very few vans which are not overcrowded, and morality is practically an unknown quantity. If it were not for the fresh air and open life they lead, serious trouble would result to the community. To see twenty vans and tents together is a common occurrence, and this means nearly 100hunian beings without water supply or sanitary convenience of any kind. In my opinion every owner, or responsible owner of a van should be registered,, and be compelled to have a registered number on the van and a certificateidentifying the owner and the number of the van, similar to canal boats used as dwellings. This would prevent them assuming fictitious names and continually evading the law. The bona-fide showman, who has a valuable equipment and lives in a van, keeping it in a most creditable condition, is subject to expensive license, rent of land, payment of water rate, and strict supervision ; yet the so-called gipsy is allowed to go scot free. FACTORY AND WORKSHOP ACT, &e. The number of inspections of bakehouses, workshops, factories, etc.,. is included in your Medical Officer's Report, as required by the Factory and Workshop Act, 1901; also, the tabulated statement of work done under its various headings, in the form required by the Medical Officer of Health for the County Council of Middlesex. CLERICAL WORK. The following is a short summary of the clerical work done during the year :— Number of letters written 1572: Number of letters, etc., filed for future reference 1347 Number of notices sent to Schools 2046 Number of notices sent to Public Library 177 Preliminary notices 2978 Statutory notices 332 I have curtailed this Report as much as possible, most of the work done in the Department being quoted by your Medical Officer of Health in hisAnnual Report. 93 CONCLUSION. All possible care has been taken to prevent discrepancies as to the number of visits shown in the tabulated statement. There are a great many things done which cannot well come under any definite heading, all of which take time, and need the supervision of the Department. A great many nuisances have been abated from the keeping of chickens, rabbits, pigeons, dogs, goats, etc., close to the backs of houses. In some instances where the occupier's attention has been called by your inspectors to the seriousness of such nuisance, the animals have been at once removed further away from the premises. Each case is, however, dealt with on its merits. Many improvements and additions are necessary to be added to the powers of the Sanitary Authority for dealing with the keeping of animals about dwelling - houses. I should like to see a bye-law for preventing the keeping of animals, except in yards of a sufficient open character, and under regulated conditions as to structures and distance from a dwelling. This I consider is a question connected with the sanitary progress upon which a large number of the public require enlightenment. At the close of the year Inspector Furnival obtained an appointment under the Reigate Rural District Council, and the Council's action in appointing one of the staff to fill the position (pending his qualifying by examination) will, I feel sure, have good results. My assistants, I am pleased to say, continue to carry out their duties— which at times require the utmost tact and courtesy—in a most satisfactory manner. I desire to express my grateful thanks for the continued support I have received from my Committee and the Council, in the discharge of multifarious duties. I have the honour to be, Gentlemen, Your obedient servant, RICHARD JOHN BUTLAND, Inspector of Nuisances.