EDM 50 Edmonton Urban District. ANNUAL REPORTS on the Public Health and Education of Edmonton, FOR THE YEAR 1913, by SIDNEY C. LAWRENCE, Medical Officer of Health and School Medical Officer, M.B., Ch.B., D.P.H. (Lond.), M.R.C.S. (Eng.), L.R.C.P. (Lond.), Fellow of the Society of Medical Officers of Health, and Member of its Council. FRANK E. ROCK, M.D. (Lond.), D.P.H., Assistant and Deputy Medical Officer, Fellow of the Society of Medical Officers of Health. Also the Deport of the Inspector of Nuisances by RICHARD J. BUTLAND, M.R.San.l. Edmonton Urban District. ANNUAL REPORTS on the Public Health and Education of Edmonton, FOR THE YEAR 1913, by SIDNEY C. LAWRENCE, Medical Officer of Health and School Medical Officer, M.B., Ch.B., D.P.H. (Lond.), M.R.C.S. (Eng.), L.R.C.P. (Lond.), Fellow of the Society of Medical Officers of Health, and Member of its Council. FRANK E. ROCK, M.D. (Lond.), D.P.H., Assistant and Deputy Medical Officer, Fellow of the Society of Medical Officers of Health. Also the Report of the Inspector of Nuisances by RICHARD J. RUTLAND, M.R.San.I. 2 Edmonton Urban District Council. 1913-14. Chairman— H. P. LeMARE, Esq., J.P. Vice=Chairmari—W. A. CULL, Esq. THE SANITARY COMMITTEE. H. WILLIAMS, Esq., Chairman. H. BARRASS, Esq., C.C. Rev. Preb. E. A. B. SANDERS, M A. W. C. ELMS, Esq. S. J. SANDERS, Esq. R. GREEN. Esq., J.P., C.C. J. SIMKIN, Esq. J. A. KILBRIDE. Esq. C. SORRELL, Esq. Heads of Departments. Clerk—W. F. PAYNE, F.C.I.S. Engineer and Surveyor—CUTHBERT BROWN, A.M.I.C.E. Architect—H. W. DOBB, M.S.A. Accountant—G. W. FRANCIS, A.L.A.A. Secretary (Educational)—A. HEAP, B.A., LL.B. (Lond ) Representatives of the Council. Enfield and Edmonton Joint Hospital Board— W. D. CORNISH, Esq., J.P., C.C. C. SORRELL, Esq. H. P. LeMARE, Esq., J.P. Rev. T. WARREN. Middlesex Districts Joint Small-pox Hospital Board— W. A. CULL, Esq. S. H. PLATTEN, Esq Metropolitan Water Board— Councillor D. WESTON (of Enfield, and represents Edmonton and Southgate also). The Lea Conservancy Board—W. D. CORNISH, Esq., J.P., C.C. Middlesex Districts Councils' Association—Rev. Preb. E. A. B. SANDERS, M.A. Latymer Foundation Governors— W. A. CULL, Esq. H. P, LeMARE, Esq., J.P. I. THE REPORT ON THE PUBLIC HEALTH OF EDMONTON During 1913. 4 PUBLIC HEALTH DEPARTMENT, December 31st„ 1913. 1.—Medical Officer of Health: SIDNEY C. LAWRENCE, M.B., Ch.B., D.P.H.† 2.—Assistant and Deputy Medical Officer of Health: F. E. ROCK, M.D. Lond., D.P.H. 3.—Chief Sanitary Inspector and Inspector of Canal Boats: R. J. BUTLAND, M.R.San.I*‡ 4.—Second Male Inspector: J. E. WINTER.*‡| 5.—Woman Sanitary Inspector: JENNIE HUDSON* (Certified Midwife). 6.—Third Male Inspector: W. O. COATES*† (appointed fourth inspector, 8th July, 1912). 7.—Fourth Male Inspector (Housing): H. K. NIXONU¶† (since 17th March, 1913). 8.—Junior Woman Inspector: NORA PLAYNE (from June 2nd, 1913). 9.—Senior Clerk: ARTHUR J. KIRKMAN. 10.—School Medical Clerk: HAROLD DYER (since 1st March, ig 13). 11.—Junior Clerk: JOHN FARRAR (from 7th July, 1913). 12.—Disinfector, Sanitary Stores and Ambulance Attendant: J. MADLE. 13.—Mortuary Attendant and Laboratory Attendant: C. HICKFORD. 14.—Caretaker of Emergency Hospital and Disinfection Station: A. METTAM. 15.—Driver of Ambulance and Bedding Vans: A. SHEPHARD. 16.—Opener up of Old Drains, Urinal Cleanser and General Sanitary Workman: A. PASHALL. 17.—Opener up of Old Drains (part time); A man from Engineer's Department as required. 18—21.-—Attendants at Sanitary Convenience at Angel Road: Two male and two female. * Officers marked thus hold the Certificate of the Royal Sanitary Institute, † These officers have the Certificate of Meat and Foods Inspector. ‡ These officers are appointed as Inspectors under the Shops' Act, 1912. ¶ This officer also has the certificate of the Sanitary Inspectors' Board, 5 SUMMARY. Area 3,894 acres, including 31 of water Census Population, April 1911 64,797 Estimated Nett Population, June 30th, 1913 66,552 Density of Population per Acre of Land, 1913 17.7 Rateable Value, October, 1913 £226,936 Assessable Value, October, 1913 £212,968 General District Rate, 1913 4s. 7d. in the £ Poor Rate, 1913 5s. id. in the £ A Penny Rate produces about £840 VITAL STATISTICS. Birth-rate per 1,000 living 27-98 Gross or Registered Death-rate per 1,000 living 17.31 Nett Death-rate per 1,000 living 11.93 Corrected Nett Death-rate per 1,000 living 12.78 Infantile Mortality per 1,000 births registered 105.26 Zymotic Death-rate per 1,000 living 1.88 HOSPITAL ACCOMMODATION. For Fever Cases Enfield and Edmonton Joint Isolation Hospital For Smallpox South Mimms Smallpox 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 District Light, Heat and Power Co. Sewerage Separate System Sewage Disposal Broad Irrigation and Bacterial Filters 6 "If there's a hole in a' your coats I rede ye tent it; A chiel's amang ye taking notes And, faith, he'll prent it."—Robert Bums. To the Chairman and Members of the EDMONTON URBAN DISTRICT COUNCIL. Gentlemen, I have the pleasure of presenting you with my eighth Annual Report of the health and sanitary circumstances of Edmonton. It refers to the year 1913, The following changes have taken place on my staff:— Mr. A. E. Day, the 3rd (Housing) Inspector left on March 12th and Mr. H. K. Nixon was appointed as 4th (Housing) Inspector on the nth February and began duty on the 17th March. Harold Dyer was promoted to the new post of School Medical Clerk on nth February and commenced duty on 1st March. John Slee replaced him as Junior Clerk on March 10th to June 28th, to be followed by the appointment of John Farrar on 7th July. Mr. J. E. Winter was appointed to succeed Mr. Day as joint inspector, under the Shops Act, 1912. Mr. W. O. Coates obtained his certificate as food and meats inspector in December. The duties of your Public Health Department and your Medical Officer of Health are still on the increase. This is partly due to the activities of Parliament and the Government Departments, but also to the increase of the gross population of Edmonton from 56,578 in 1905 to 68,387 at the middle of 1913, which is a difference of 11,809 persons. The Local Government Board has a high opinion of the Annual Report of the Medical Officer of Health. It is as follows:—"The annual report may be made a valuable means of educating the public in matters of public health, of warning them against particular dangers and of securing co-operation between them and the sanitary authority and their officers. Much value also attache? to the exchange of annual reports between medical officers of health in order that experiences may be compared. These advantages can only be secured by having the report printed and distributed to each member of the sanitary authority and to other persons interested in its subject." I accept this annual opportunity of recording my high appreciation of the good work done for Edmonton by the Inspectors and other members of my staff (indoor and outdoor). They have done their utmost to uphold the reputation of the Department and to maintain and improve the health of the public. The cordial co-operation of my colleagues, the Heads of the other Departments, and the courtesy of all the Council's Officials are in the grateful remembrance of Your obedient Servant, SIDNEY C. LAWRENCE, June 30th, 1914. Medical Officer of Health. 7 REPORT OF M.O.I I. INDEX OF CONTENTS. Alcazar 69 Alcoholism 55 Allotments 14 Ambulance for non-infectious cases 41 Antitoxin 35, 38 Bacteriological laboratory 41 Bakehouses 76 Baths, the Public 17 Births 19 Births, notification of 19 Building by-laws 62 Canal Boats 106 Cancer 56 Cemeteries 14 Census of 1911, the 17 Cerebro spinal fever 36 Chicken-pox 33 Clerical work 108 Closing orders under H. and T. P. Act, 1909 65 Common lodging-houses 73 Communicable diseases—notifiable 26, 28-52 „ ,, —non-notifiable 26, 53-56 Conferences 24, 52, 66, 67 Costers 60 County Council tables 93-96 „ „ licenses 68 „ „ administration 69 „ ,, co-operation with 48-52 Cowsheds 74, 104 Dairies, cowsheds and milkshops 74,104 Deaths 20-24 Diarrhœa 53 Diphtheria 35 Disinfectants Order, 1913 71, 98 Disinfection 41, 97 8 Distress Committee 12 Drainage 57, 59 Dust collection 58, 100 Enfield and Edmonton Joint Isolation Hospital 37-39 Enteric fever 35 Erysipelas 42,98 Fabrics (mis-description) Act, 1913 70 Factories and workshops 25, 73, 75-79 Features, Physical, of the district 11 Fish offal 102 Food and Drugs Act 104 Food, unsound 74, 102 Gipsies 107 Gonorrhœa 54 Guardians, Edmonton 13, 18, 29-32, 34,43 „ Strand 13, 18, 43 Highways, obstructed 60 History, recent, of Edmonton 12 History, past, of Edmonton 11 Home Office tables 77-79 Hospital accommodation 37,39 Hospital, Officers of the 38 House, ideal workman's 64 House refuse 58,100 Houses let in lodgings 73,106 Housing accommodation 62-65 Housing Inspector 62, 105 Housing Congress, International 67 Housing, Municipal 64 Housing regulations, 1910 63 Infantile mortality 22-24 Infectious diseases 28-56 Influenza 54 Inquests 21 Institutions, Public 13 Institutional accommodation, tubercle 43 Isolation Hospitals 37, 39 Insurance Acts, the National, 1911 and 1913 70 Knackers 73 Laundries 25, 76 Lea Valley sewage disposal 59 Legislation affecting Edmonton 70-72 Library, the Free 17 9 Local Government Board Tables 24,80-91 Market 60 Measles 54 Mental Deficiency Act, 1913 70 Midwives 19, 42 Milkshops 74, 104 Mortuary, the 100 Nuisances 109 Offensive trades 74,101 Open spaces 13 Outworkers 25, 75 Overcrowding 64 Past history of Edmonton 11 Phthisis 43-52 Pigs 74, 101 Polio-myelitis, Acute 36 Public Health (Prevention and treatment of disease) Act, 1913 71 Puerperal fever 42 Quarantine funds 32 Railways 15 Recent history of Edmonton 12 Respiratory diseases (non-tubercular) 55 Return cases 39 Roads 16, 59 Sanitary conveniences 16, 99 Scarlet fever 34 „ „ at Edmonton Workhouse and Infirmary 34 Scholars, tuberculous 46 Sewage farm 57 Sewerage 57-59 Shops' Acts, 1912 and 1913 70, 106 Slaughterhouses 73, 102 Small-pox 33, 39 Smoke 107 Statistics, vital 5,17 „ comparative 27 Syphilis 54 Tables for the County Council 93-96 „ „ Home Office 77-79 „ „ Local Government Board 24, 80-91 Tenement Houses 73.106 The Green 16,59,60 Town planning Committee 65 10 Town planning Conference 66 Trades, offensive 74, 101 Transport, other forms of 15 Transport of patients to hospital 29, 40, 97 Tubercle 42-52 Tuberculosis, administrative control of 46-52 ,, Dispensary 47 „ District Committee 48, 51 „ Nurses 51 „ Conference on 52 „ regulations 44-46 ,, co-operation with County 48-52 „ (animals) Order, 1913 71 ,, Departmental Committee 72 Unsound food 74, 102 Urinals 99 Vital statistics 5, 17 Vaccination 33 Venereal diseases 54 Water supply 60 Weather 53 Whooping cough 54 Woman Inspector 25-27 Woman Inspector (temporary) 27 Workshops 25, 27, 75-79 Zymotic diseases 21 11 EDMONTON URBAN DISTRICT. REPORT OF THE Medical Officer of Health For the YEAR 1913. 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 south-east 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. PAST HISTORY. Edmonton is an ancient town mentioned in the Domesday Book as "Adelmeton" (or the town of Aldhelm). On some existing milestones the name is spelt "Edmondton." It is seven miles from London, in the Enfield Division of the County, Hundred, Petty Sessional Division, Union and County 12 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. "The diverting history of John Gilpin," by Cowper, with its reference to Edmonton as the best place for a pleasant picnic outside London, must be wellknown 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 Council of 27 members, nine of whom retire annually. It is represented on the Middlesex County Council by three members, Councillors Cornish, Green and Barrass. 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, several large works in Edmonton, notably the cartridge factory of Messrs. Eley Bros., Messrs. Ridley Whitley's linoleum works, the Gothic gas-meter works, the New Pegamoid Company, Aerators Ltd., and the Tottenham and Edmonton Gas Company, whose employees are, for the most part, residents of Edmonton. The latter company has extended its area of supply, and has absorbed the Enfield Company. Its title is now the "The Tottenham District Light, Heat and Power Company." POST OFFICE. In April the Postmaster-General again refused to provide a central branch post-office for Edmonton. THE DISTRESS COMMITTEE. The Distress Committee has been busy in finding useful work for the unemployed and putting to good use the monies supplied by the Government. The Unemployed Workmen Act was to be in operation for three years only, but has been renewed yearly since 1908 Unemployment has been as much as last year; from October to December, 1913, there were 414 names entered on the Committee's register, compared with 422 for the same period of 1912. Each man is given three weeks' work at 6d. an hour for 44 hours per week. The men have been employed in connection with the culverting of Sadler's mill stream in Montagu Road, and the culverting of Pymmes Brook. 13 The Chairmen of this Committee have been the Rev. E. A. B. Sanders, Mr. F. W. Mason, and Councillor F. Vincent, who is the present occupant of this responsible position. Mr. A. C. Church is the Clerk of the Committee. POOR LAW INSTITUTIONS. The workhouses of two large Unions are situated in Fore Street Ward. The one belonging to the Strand Union, London, to which is attached the Strand Union Schools, receives its inmates from the Strand and other Central London Districts; 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, is 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. In March, 1913, the estimated population of Edmonton Union was 463,586; rateable value, £2,425,366. Amongst a total of forty Guardians, Edmonton District proper has only four representatives. The Strand Union School was closed on the 31st July, 1913. This closure followed the amalgamation of three Unions, namely: Strand, Westminster and St. George's, Hanover Square, into one union known as the City of Westminster. The school premises are now empty and the former master, Mr. Dexter, is now taking care of them. On the 7th October, Mr. James A. Stronach died, who was the last to hold the office of Vestry Clerk of Edmonton; and that in conjunction with Southgate Urban District. A table showing the number of inmates of both the Strand and Edmonton Institutions, and the births and deaths that have taken place there, will be found in Table IIa. At the Edmonton Infirmary and Workhouse the general death rate is over 432 per thousand inmates, and the infantile mortality rate is over 691 per thousand births taking place there. The similar rates for the district generally (excluding foreigners) are nearly 12 per thousand inhabitants and slightly over 105 per thousand births. OPEN SPACES. The Ccunty Council has power to contribute to the cost of acquiring open spaces by (a) County Council of Middlesex Acts 1898 and 1908; (b) The Open Spaces Act 1906, It can assist any urban or district council or any 14 tion of these bodies. Under the latter Act the County Council may itself acquire open spaces and undertake the management of them—but they have not yet done so. Pymmes Park (53 acres) was purchased in i8gg for ^36,000, towards which the Middlesex County Council contributed £9,000. A garden has been laid out after the old English style within one of the walled enclosures adjoining the old Elizabethan mansion. The artificial lake provides scope for boating or skating. As, in the course of time, Edmonton becomes more densely populated, Pymmes Park will be an increasingly valuable factor in the good health of the people. During 1913 five new shrubberies have been formed and planted in Queen Anne's Gardens, Bush Hill Park. New trees have also been planted and the dead ones renewed in the several streets which have been "made-up" during the year. The total number of trees planted and maintained in our streets at the ratepayers' expense is now about two thousand. The Recreation Ground in Church Street (20 acres) was presented to the Council by the Ecclesiastical Commissioners in December, 1901, and affords room for cricket pitches and football grounds of the rising generation. Other spaces of service in their special way are the Sewage Farm of 235 acres, and the General Cemetery of 30 acres (which cost £20,590, and was consecrated in 1884). The Hebrews' Cemetery, in Montagu Road, was extended from 10 to 15 acres in 191:0. It was opened in 1884, and approved by the Home Secretary for the burial of persons of the Jewish faith only. This restriction has now been withdrawn as regards a portion of the land which has been sold to a private company, who have formed another general cemetery adjoining. 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 so-called "gipsy" or vagrant. ALLOTMENTS. A piece of land has been laid out situate at the south end of Brookfield allotments, which was originally intended for use as a depot, whereby 18 more plots of land, or about acres, were obtained for allotment purposes. Moreover, several private owners have turned their vacant land into allotments. Yet there still remains a large number of applicants unsatisfied. 15 The Barrowfield Estate of 21 acres with 126 plots. The Brookfield „ 22¼ ,, ,, 115 „ The Houndsfield „ 30 „ „ 144 „ The Weir Hall ,, 14 „ „ 97* „ *0f these plots, Nos. 76, 77, 78, 79, 93, 94, 95, 96, and 97 being unsuitable for gardening, are let, or to be let, for piggeries, etc. There is a total of 482 plots, which generally consist of 20 poles each, and have good sound approach-roads, 10 feet wide, and pathways 3 feet wide between each plot. Water is obtained on the spot by using Abyssinian pumps. In the report of the 19th November the Finance Committee recommended that the various pieces of vacant land, on which apportionments for expenses of street works are outstanding, be let for allotments or other purposes on quarterly or other short tenancies, the tenants to erect any necessary fencing. This suggestion was referred to the Allotments Committee. There can be few districts in the United Kingdom more adequately provided with allotments than Edmonton. The Council have taken much trouble in this respect, and are to be congratulated on the result. My colleague the Architect, with his department, has devoted much time to the development of the new estates into allotments. RAILWAYS. 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 the former at Angel Road station. The Bleak Hall Bridge over the Lea Navigation is a narrow and out-of-date structure. A few yards further, at Cook's Ferry, another narrow bridge spans the River Lea. The Tube Railway from Finsbury Park to Hammersmith provides a quick and easy transit from north to west of London. I hope to see it extended to Enfield—via Edmonton. OTHER FORMS OF TRANSPORT. There are electrical tram connections with Enfield Town, Waltham Cross, Ponders End, Stamford Hill and Finsbury Park, whence connection can be made with trains, trams, or omnibuses to all parts of London and suburbs. Halfpenny fares, after the initial penny stage, have been now introduced, and a rate for parcels. 16 \ In February, in conjunction with our neighbours of Tottenham and Enfield, we decided to request the Metropolitan Electric Tramways Company to adopt halfpenny fares on their system throughout these areas, but in March the Company declined to do so. On September 29th, delegates of the three Councils met in conference at Edmonton to arrange a joint appeal to the Great Eastern Railway Company for cheaper, more frequent and later trains. The Metropolitan Electric Tramways Company promoted a Bill for Railless Traction, and in March, several authorities, including Edmonton, asked their M.P.s' to oppose Clause 16, which sought to empower the Company to obtain from the Board of Trade power to instal this method of traction upon any street or road. Representatives of Enfield, Edmonton and Tottenham waited on the Directors of the Great Eastern Railway on the 17th November and laid before them the changes in the service that were deemed desirable. Motor Bus Service.—Edmonton is now favoured with a route from "The Angel" to Victoria Station by which travellers can reach that important terminus in about ij hours, via The Bank and Waterloo Station. ROADS. The main roads have a total length of 4 miles 3 furlongs and 122 yards, and the subsidised roads "A" 2 miles, 2 furlongs, and 158 yards. During 1913 the main road widenings consequent upon the installation of electric tramcars have made progress, but even at the end of the year some few had not been completed. SANITARY CONVENIENCES. There is a modern one at the important junction of Angel Road and Fore Street. By-laws with reference to these buildings were approved by the Local Government Board on 23rd January, 1909. Sanitary Convenience on the Green.—On the 22nd February 1913, the Local Government Board sanctioned a loan of £"1,300 for the erection of the convenience on the Green, adjoining the Electric Sub-station. In May, the builder's tender for £1,109 14s. 1d. was accepted, and also a tender for the plumbing and sanitary fittings at £"200. The building was nearly finished at the end of the year. In April the question arose as to whether the Urinal in Grove Street was a nuisance or not, and it was left to our Engineer to decide. He reported the 17 same month that it appeared to be a very insanitary building and quite inadequate for what was required of it. He made strenuous efforts to secure a piece of laud somewhere near in order to erect a proper convenience, and so do away with the existing one. In September, the Works Committee recommended that this urinal be removed. In November a suggestion was made that the Council should consider the advisability of approaching the Tottenham Council as regards the erection of a sanitary convenience on the triangular piece of waste land on the main road, which land is partly in Edmonton and partly in Tottenham; the Engineer reported that this iron urinal had been removed. In December a letter was submitted to the Sanitary Committee complaining of the trouble which had arisen in the neighbourhood owing to the removal of this urinal. In my opinion, the urinal should not have been removed until another was ready to carry on its useful work in the vicinity of the County Court. 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. Mixed bathing was instituted in April. It commenced on 28th April, and continued until the end of November; the Architect's report showed that a nett loss of about ^"50 was incurred on the innovation. 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. THE CENSUS OF 1911. Volume VI. with reference to "Housing," was published on April 30th, 1913- This is a novel report from the Census office. It contains statistics of the various kinds of buildings in each area, and shows not only if they are designed for habitation, but whether they were actually inhabited on April 1st, 1911. These figures are valuable to those interested in the housing problem. VITAL STATISTICS. Edmonton, since the census of April, 1911, has been promoted to the first class, i.e., in the weekly returns of the Registrar General, Edmonton appears as one of the g6 largest towns in England and Wales, and therefore enjoys the privilege of having her vital statistics published with the other 95 towns every week. 18 Edmonton's death-rate was the lowest of the 96 largest towns in England and Wales for the week ending March 29th with 8.3 per 1,000 living, and for week ending April 12th Edmonton shared with Tottenham the honour of the lowest death-rate, 7.5. To Mr. Harman Judd, the local Registrar, 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 table shows the population of the District, exclusive of the two Union Workhouses and Strand Schools, at the last four Census enumerations:— Year. Population. 1881 13,665 1891 23,437 1901 44,911 1911 62,289 For District Rate made November nth, 1913, there were found to be 12,388 houses in assessment, of which no less than 8,461 houses were of the rateable value of £10 per annum, or under. I estimate the nett population at the middle of 1913 as 66,552 persons including 301 Edmonton people in our public institutions. This population has been allocated to the three Wards as follows:— Bury Street 21,823 Church Street 22,861 Fore Street 21,868 66,552 In the Strand Workhouse and the Edmonton Workhouse and Infirmary there were estimated to be 2,136 persons, of whom 301 were Edmonton residents. The area of the district is 3,894 acres (less 31 of water), and the density of the population, or the average number of persons per acre of land, is 177. This figure is calculated on the gross population, which includes the average populations of the Strand Union and Edmonton Union Workhouses, the Edmonton Infirmary and Nurses' Home, and Strand Union School, and amounts to 68,387. The Registrar-General's estimate is 69,086. The natural increase of the population, that is the excess of the nett total of births over the nett total of deaths, in 1913 was 1862 minus 794, equals 1,068. 19 BIRTHS. The number of births registered by the Edmonton Registrar, Mr. Judd, was 1,912 (996 boys and 916 girls), which includes 17 births that took place in the Edmonton Workhouse, born of mothers belonging to Edmonton. The figures for 1912, 1911, and 1910 were:—1,844, 1,921, and 1,961. No births occurred at the Strand Workhouse. Sixty-four births which occurred at Edmonton Workhouse, born of mothers who are not Edmonton residents, are excluded from our statistics, just as foreign deaths are. The Registrar-General reported 14 births (8 males and 6 females) which had taken place when Edmonton mothers were residing temporarily our of their district; 9 of these infants were stated to be born in wedlock. Thus the nett total of births was 1,862. Of these births 58 (or 3.11 per cent.) were illegitimate. The birth rate per thousand inhabitants is therefore 27.98, compared with 27.12 last year. Notification of Births' Act, 1907. This came into force here on April 28th, 1908. During this year 1,998 births were entered in our register; of these 1,045 were males and 950 females; in 3 cases the sex was not declared; 120 (or 6 per cent.) of the whole number were born out of wedlock, and 11 more were of doubtful legitimacy. Sixty-two children were declared "stillborn." It will be interesting to note the future effect of this Act on the number of "still-born" burials at our Cemetery. Mr. Clement Bugg, Superintendent there, informs me that there were 63 children styled "still-born" buried during 1913, and for 1912-11-10 the figures were 69, 83, 80. For work donein visiting infants and their mothers, see section, "The Woman Inspector and her Work." In a previous paragraph it is noted that 1,912 births were registered during 1913. The figures of notification and registration will, of course, never coincide, but they show that few, if any, births escape notification in accordance with the Act. Twenty-six pairs of twins arrived, and one set of triplets. In my monthly report to the Sanitary Committee on the 8th January I reported a contravention of this Act by a midwife resident in the Council's area. The matter came under the consideration of the Sanitary Committee and Council several times, and ultimately on the 13th May they decided to take no legal action. The birth-rate (27.98) for 1913 is 0.86 higher than last year, and is much higher than 23.9, the birth-rate of England and Wales for 1913. The birthrate for the preceding six years will be found in Column 5 of Table I. 20 The births were distributed in the Wards as follows: Ward. Births. Birth Rates per 1,000 living in the Ward. Bury Street 658 30.15 Church Street 615 26.90 Fore Street 575 26.29 Fourteen births transferred to Edmonton by the Registrar-General could not be allocated, as the names and addresses of the parents were not given. The deaths registered in the district during the year were 1,184 of these 36 occurring in the Strand Workhouse, and 455 among non-residents at Edmonton Workhouse and Infirmary, and 10 "foreigners," outside institutions, are excluded; while 140 deaths of Edmonton residents taking place in the Edmonton Workhouse and Infirmary are included in onr nett deaths. Thus the number of deaths amongst Edmonton residents registered in the district amounted to 683. The gross death-rate is based upon the total number of deaths registered in the district, and is 17.31 per 1,000 living. This rate is calculated on the estimated gross population of 68,387. The nett death-rate is based upon the total number of deaths of Edmonton residents occurring inside or outside the district, and is 11.93 This rate is calculated on the estimated nett population of 66,552. I receive quarterly from the Registrar-General (through the County Medical Officer), particulars concerning Edmonton residents whose decease has taken place whilst they are away from their usual home. One hundred and eleven deaths were returned in this way during the year, making the nett total of deaths at all ages for the district proper 794. 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 1.0716, and the corrected nett death-rate is 12.78. The nett death-rates for he preceding six years will be found on Table I., column 13. DEATHS. 21 The nett death-rate for Edmonton is as I have said, 11.93 Per 1,000 living; it was 10.23 last year. It is 0.7 higher than the average of the five previous years, but is much better than 15.80 the rate for 1904. Ward Deaths. The following are the deaths 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 thev latelv resided. Three Institution deaths amongst residents, that could not be allocated, are entered in Column 15 on Table IIIa. Ward. Deaths. Death Rates per 1,000 living in the Ward. Bury Street 260 11.81 Church Street 270 11.81 Fore Street 261 11.94 Death Certification. All deaths were certified either by the Medical Attendant or by the Coroner; there were none uncertified. Inquests were held on 88 residents, or nearly 13 per cent. of the total deaths amongst residents registered in the district. This percentage is a lower one, and compares favourably with over 16 of last year. The causes of these deaths will be found on Table IIIa. Two inquests were held on the bodies of illegitimate children, or 9.09 per cent, of the total illegitimate deaths, which is a vast improvement upon 30.77 per cent. of last year. The ages at and causes of deaths are set out in detail in Table IIIa. 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 125 deaths from these diseases during the year, and the zymotic death-rate is therefore 1.88 as compared with 1.08 for the previous year. This figure is 0.8 more than last year, and the increased rate is mainly due to diarrhoea or measles. The zymotic death-rate for 1913 in London was 1.4. In the 96 great towns of England and Wales, which include Edmonton, and in the 145 small towns, the zymotic death rate has not been recorded by the Registrar-General since 1910. 22 The following table shows the deaths from these diseases distributed amongst the three Wards and Edmonton residents in the Workhouse. DISEASE. Whole District. Bury Street. Church Street. Fore Street. Edmonton Union Residents. Small Pox — — — — — Measles 48 13 19 16 2 Scarlet Fever 1 I — — Whooping Cough 9 4 4 1 — Diphtheria 15 4 4 7 — Enteric Fever 2 — 1 1 — Diarrhœa 50 26 11 13 6 Total 125 48 39 38 8 Rates i-88 2.19 171 174 26.58 The Average Zymotic Death-rate for the previous ten years was 2.16. In the following table are set out the Nett General Death-rate, Infantile and Zymotic Death-rates for 1913 and the previous ten years:— Nett Death-rate. Infantile Mortality. Zymotic Death-rate. 1903 13.7 *140.3 1.91 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 1909 11.0 100.39 1.29 1910 9.5 74.55 0.79 1911 13.1 143.48 3.17 1912 10.2 84.42 1.08 1913 11.9 105.26 1.88 *In calculating the Infantile Mortality for the year 1903, deaths due to premature birth were included for the first time. INFANTILE MORTALITY. The infantile mortality is a special death-rate, referring to the first ageperiod (0 to 1 year), and is expressed as the number of deaths that takes 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 196, and the births registered within (or without) the district, born of Edmonton mothers, 23 numbered 1,862, therefore, the infantile death-rate, based on these figures, is 105.26 per thousand births. The lowest record is 74.55 in 1910. Nineteen of the 196 infantile deaths were those of illegitimate infants—that is 9.69 per cent, of the infantile deaths. An inquest was held on one of the 19. Inquests were also held on 27 of the other infants, making a total of 28. The Infantile Mortality Rate at Edmonton Workhouse and Infirmary was 691.36 per 1,000 births there—a very high figure. A high general death-rate is expected in Workhouse Infirmaries, because they are the last resort of those without money and without hope of recovery; but the same explanation cannot be accepted for a heavy death-rate amongst children. The Infantile Mortality Rate for the year in England and Wales was 109; in London, 105; in the 96 great towns (which include Edmonton), 117; and in the 145 smaller towns, 112 per thousand births registered. The figures for the Wards are as follows:— Ward. Deaths under one year. Infantile Mortality Rate. Bury Street 73 in per nett 1,000 births in the ward Church Street 61 99 „ „ „ Fore Street 62 108 „ „ „ Table IV. enables the deaths 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. This Table shows that just under 30 per cent, of the infantile deaths occurred within the first month of life, and that just under 25 per cent. were due to what are termed "wasting diseases," viz., premature birth, atrophy, debility, congenital defects, and marasmus. Last year the figures were over 37 and 38 per cent. Wasting diseases 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, snch 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 later months of life that they begin to give rise to deaths in any significant numbers. I must also notice that the premature births tor 1913-12-11 were 26, 30 and 27, respectively. 24 Conference on Infantile Mortality.—The National Association for the prevention of infantile mortality held their Conference in Caxton Hall on the 4th and 5th August. As the Medical Officer of Health was on these days attending the conference on consumption, Miss Hudson, the senior Woman Inspector, represented Edmonton. Judging from her able report which appears in the minutes of the Council of the gth September, she spent a very useful and instructive time there, and obtained a useful addition to her knowledge of this class of work. TABLE IY. Infant Mortality during the Year 19 J 3. Nett deaths from slated causes at various ages under i year of age. Causes of Death. Under i week. i—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months Total deaths under 1 year. All aoses Certified 35 8 8 7 58 38 40 26 34 196 Uncertified .. .. .. .. .. .. .. .. .. .. f Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. 1 2 8 11 Scarlet Fever.. .. .. .. .. .. .. .. .. .. .. Whooping-Cough .. .. .. .. .. .. .. .. .. .. Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. ... .. .. .. .. .. .. Tuberculous Meningitis .. ... .. ... .. .. 1 .. 1 2 Abdominal Tuberculosis .. .. .. .. .. 1 2 .. 2 5 Other Tuberculous Diseases .. .. .. .. .. 1 1 1 .. 3 Meningitis (not Tuberculous) .. .. .. .. .. .. .. 1 .. 1 Convulsions 1 1 .. 1 3 2 .. .. .. 5 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. 3 .. 1 4 10 3 4 .. 21 Pneumonia (all forms) 1 .. 1 3 5 8 9 5 6 33 Diarrhoea or Enteritis .. .. 1 .. 1 8 11 10 11 41 Gastritis .. .. .. .. .. .. 3 1 2 6 Syphilis .. .. .. .. .. .. .. .. 1 1 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying 1 .. .. .. 1 .. .. .. .. 1 Injury at Birth 1 .. .. .. 1 .. .. .. .. 1 Atelectasis 5 1 .. .. 6 .. .. .. .. 6 Congenital Malformations .. .. .. 1 .. 3 1 1 .. 6 Premature Birth 20 2 2 i1 25 1 .. .. .. 26 Atrophy, Debility and Marasmus 5 1 2 .. 8 3 5 1 1 18 Other Causes 1 .. 2 .. 3 1 3 .. 2 9 Totals 35 8 8 7 58 38 40 26 34 196 Nett births in the year legitimate, 1799; illegitimate, 63. Nett deaths in the year legi.imate infants, 177; illegitimate infants, 19. 25 THE WOMAN INSPECTOR AND HER WORK. I give below an analysis of the number and nature of the visits paid by Miss Hudson during 1913. The bulk of her work falls into four correspondingly large divisions, viz.:— 1. The crusade against preventible infantile mortality; 2. The work done in factories, workshops, etc., where women and girls are employed, and amongst home-workers of her own sex. 3. The visitation of consumptives and other tubercular persons. 4. The visitation of scholars at home, when suffering from the non-notifiable infectious diseases. INFANTILE MORTALITY. Month. After Births. Re-visits. After 6 months. Neglected Infants. After Deaths. Diarrhceal Diseases. January 75 2 32 ... 4 ... February 11 1 13 ... 9 ... March 105 1 8 1 5 ... April I4 4 15 ... 9 ... May 73 3 9 ... 7 ... June 8 ... 9 ... 4 2 July 13 ... 18 1 1 ... August 97* ... 6 1 8 9 September 25 9 2 6 ... 11 11 October ... 4 ... 4 6 November 52 2 8 ... 3 ... December 27 3 3 ... ... ... Totals 509 18 131 3 65 28 *Schools closed and Miss Playne (the School Nurse) assisting. INSPECTIONS UNDER FACTORY AND WORKSHOP ACTS. Month. Factories. Workshops. Laundries. Outworkers. January ... 3 ... 15 February ... 23 ... 35 March ... 2 9 J7 April ... ... 2 9 May ... 1 ... 20 June ... 2 3 10 July 1 9 6 31 August ... 1 ... 11 September 2 12 4 78 October 1 9 6 48 November ... 2 ... 6 December ... ... ... 10 Totals 4 64 30 290 Workrooms measured up 7. Laundries measured up 0. 26 NOTIFIABLE DISEASES. Visits and re-visits to Erysipelas cases 71 Visits ye Erysipelas disinfection 7 Visits re Puerperal Fever cases 2 Visits re Phthisis voluntarily notified 3 Visits re Pulmonary tuberculosis compulsorily notified 366 Visits re Pulmonary Tuberculosis disinfection (after death or removal) 129 Visits re other forms of Tubercle 98 NON-NOTIFIABLE DISEASES. Months. Measles. Mumps. Whooping Cough. Chicken-pox. Doubtful Cases. January 277 12 27 28 9 February 112 23 3 18 10 March 26 7 14 12 8 April 32 12 16 19 7 May 42 39 28 19 18 June 14 47 27 9 2 July 6 75 25 11 12 August* ... ... ... ... ... September 1 9 13 5 3 October 3 18 6 3 13 November 3 9 15 15 7 December 1 12 2 34 9 Totals 5i7 263 176 173 98 'Schools closed for holidays. Visits and re-visits re School notifications concerning non-notifiable diseases, such as measles, whooping cough, chicken pox, etc., 1,227 to i,94' children at 1,310 homes. This is an increase compared with last year, when the figures were 1,172, 1,684 and 1,213 respectively. (For further information see Annual Report of School Medical Officer). There were more visits to more children in more homes than in 1912. GENERAL WORK. Visits to Private Schools 0 Enquiries re complaints 32 Miscellaneous visits (compared with 125 last year) 111 Visits paid to inspect work done after informal notice 237 Visits re overcrowding 4 8 Rooms measured w overcrowding4 27 The clerical work in connection with the Woman Inspector, like her practical work, has increased very much. During the year she spent 133 days in office work, days doing statistical work, and 4! days preparing the tubercle quarterly accounts. In addition, Miss Hall and Miss Johnson together spent 27J days in clerical work. WOMAN INSPECTOR (TEMPORARY). Miss Hall, who began duty as temporary Woman Inspector on December 9th, 1912, as measles was so prevalent, completed her three months' term on March 8th, 1913, and was fortunate enough to forthwith secure a permanent post; she became Woman Sanitary Inspector at Weston-super-Mare> and also dealt with tuberculosis cases in the adjacent area on behalf of the County of Somerset. COMPARATIVE STATISTICS, 1913. The table of vital statistics for 1913, 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, middle of 1913 Annual rates per 1,000 of the population. Infantile Mortality per 1,000 births registered. Mett Births. Nett deaths (corrected) Zymotic Deaths. England and Wales 36,919,339 23.9 13.4 .. 109 The 96 great towns including London and Edmonton 17,852,766 25.1 14.7 .. 117 The 145 smaller towns 4,669,918 23.9 13.0 .. 112 England and Wales, less the 241 towns as above 14,396,655 22.3 12.1 .. 96 London (including City) 4,518,191 24.5 14.2 1.4 105 Acton 60,000 2.53 12.28 1.24 83 Wood Green 50,300 24.05 10.13 0.77 08.59 Enfield 59.146 22.5 9.75 0.52 87.15 Edmonton 66,552 27.98 12.78 1.88 105.26 During 1913, as in 1911 and 1912, the aggregate death-rates from the principal epidemic diseases have not been recorded by the Registrar General; the zymotic death-rate is therefore not obtainable in all cases. The birth-rate of England and Wales is 0.1 above last year, which was the lowest on record; the death-rate is 0.4 higher than 1912, which was the lowest on record. The infantile death-rate is 14 integers more than last year, which was the lowest on record, but the figure of 109 is 13 per thousand births below the average of the ten years 1903-1912. The natural increase in the population of England and Wales, or the excess of births over deaths, is 376,454 or 17,394 less than the average of the preceding five years. 28 SECTION Ila. COMMUNICABLE DISEASES—NOTIFIABLE. The Infectious Diseases Notification and Prevention Acts have been in force in this District since March 31st, 1891. Table V. shows the number of cases notified and the deaths from the notifiable Diseases for 1913, and the ten preceding years. The same Table also shews the deaths that have occurred from non-notifiable diseases for this period. This is not a Local Government Board Table. Table II. shows details as to age-distribution and locality of the notified cases, and number of cases removed to hospital. The following Table shows the number 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 429 397 92.54 1 0.23 Diphtheria and Mem. Croup 131 125 95.52 15 11.45 Enteric Fever 8 8 100.00 2 25.00 Totals 568 530 — 18 — Foreigners. There were notified from Edmonton Union Infirmary 9 scarlet fever, 1 erysipelas, and 1 puerperal fever cases. Of these the puerperal fever case died. They were all, except the erysipelas and the puerperal fever cases, connected with other districts of the Union, and were not sent to our Hospital, except the scarlet fever cases; there was one case of erysipelas in the Strand Workhouse. Compared with last year the table shows 217 more notifications of scarlet fever, but, as in 1912, only one fatal case. There were 5 less notifications of diphtheria, but the percentage of fatal cases was slightly higher; the notifications of enteric fever were 4 less, but the fatality was less than half that of 1912. 29 GUARDIANS AND INFECTIOUS DISEASE. A new agreement with the Guardians to replace one of March, 1902, with reference to the treatment of poor persons suffering from infectious disease was accepted by my Council on December nth, 1912. I did not advise my Council to accept it, as its terms were most unfair and onerous to a degree. This agreement contained a clause excluding from its purview inmates of the Workhouse and Infirmary. An outbreak of scarlet fever on the Guardians' premises in March and April brought about difficulties connected with the transport of the patients to the Enfield and Edmonton Joint Isolation Hospital, as I declined to transport (at my district's expense) in-door paupers to the hospital. The matter of transport from the Infirmary and Workhouse to the Isolation Hospital could easily be dealt with by making an arrangement for the Hospital to send its own ambulance for the patients, who could then be removed without any delay, and the Medical Superintendent would always be able to send out a nurse or nurses with their ambulance. On April 7th, when discussing the cause and method of dealing with this outbreak of scarlet fever, I advised the Guardians' medical superintendent (Dr. Mort) that the proper course was for his Guardians to ask for terms of transport from the Enfield and Edmonton Joint Hospital Board, who for some years past have treated the Guardians' in-door pauper cases at a fixed rate of 4/6 per day per patient, paid by the Guardians. Dated 30th April, Mr. Shelton (Clerk of the Edmonton Guardians) addressed a circular letter to the Councils interested in the Union, informing them that "A most serious difficulty has arisen owing to the fact that the Councils of some of the districts in the Union recently refused to remove cases of infection from the Edmonton Workhouse and Infirmary." He goes on to say : "It is absolutely necessary that the Guardians should have an arrangement by which the patients can be removed promptly, and therefore they desired to alter the agreement by inserting a provision that patients in the Edmonton Workhouse and Infirmary suffering from infectious disease shall be removed, isolated and treated and maintained by and at the expense of the Council," to whom the patient is chargeable. He threatened that failing that, the Guardians would provide a hospital of their own for such cases. My Council replied that they saw no sufficient reason to end an agreement concluded so recently as the previous December. The provisions of that agreement, as I have said, were not satisfactory, but my Council accepted it in order to maintain by concessions a friendly attitude between these two public bodies. The draft agreement reached us on the 26th May, which was preceded by a letter from Mr. Shelton of the 22nd May, threatening to put an end to the present agreement by three months' notice, if my Council did not give way to the demands of the Guardians. In a report to my Sanitary Committee, dated 30 4th June, 1913, I said:— "I would not advise you to accept any additional responsibilities at any price likely to be paid by the Guardians." About the beginning of July, Mr. Shelton informed the Enfield Council that it was not intended to interfere with the existing agreement respecting cases arising in the establishments belonging to the Guardians in Enfield, which is that cases from this establishment are removed by the Enfield Council and treated at the Joint Hospital at Winchmore Hill at the Guardians' expense. Why should Edmonton not have the same ? In a letter dated 23rd July, Mr. Shelton gave us formal notice to terminate the existing agreement on the 25th December, 1913, and asked for the ratification of the proposed agreement. The district authorities within the Union (except Hornsey) discussed the subject at several meetings beginning on the 29th September. On 29th September, at Wood Green, this resolution was unanimously passed :— "That this conference is of opinion that none of the urban sanitary authorities whose areas of local government are situate within the Edmonton Union would be justified in agreeing to the revised terras suggested by the Guardians, and that the latter be requested to withdraw the formal notice to determine the existing agreement with a view to terms more acceptable to such authorities being arranged." A copy of this resolution was sent to the Guardians. On the 10th October the Guardians replied to this resolution and declined to withdraw their formal notice. A second meeting of the conference was arranged to take place at Wood Green on 17th November, 1913. Mr. Harding (Clerk of Wood Green) asked the Guardians if they would consent to receive a small deputation from the conference, and on the 13th November (per telephone), Mr. Shelton stated that the Finance Committee would be prepared to meet them on the 18th November. The conference ilecided not to meet merely a section of the Guardians. Besides the question of transport from the institutions to the isolation hospital, another difficulty is to decide upon the proper definition of the poor persons who, suffering from infectious diseases, have a right to be treated at the expense of the Guardians. The Guardians appear to wish to limit their assistance to those poor people who are materially destitute, that is, devoid of proper nourishment and clothing, but on the other band the Local Government Board in a letter to the Hon. Secretary of the Middlesex Districts' Councils' Association, dated 25th May, 1912, state that:— 31 "The test of the Guardians' duty in the matter is the destitution of the patient and this will not necessarily depend upon his being in the actual receipt of poor relief, but may consist in his being unable to obtain at his own cost the requisite medical attendance, nursing and accommodation." The latter definition appears to me to be the sensible one. The letter goes on to say :— "Where it devolves upon the Guardians to deal with cases of infectious disease which require hospital accommodation, they are not restricted to providing for the treatment of such cases in the Workhouse. On the contrary the Board consider it very desirable that the Guardians should arrange with the Sanitary Authority for the reception into their hospital, where necessary, of any destitute person suffering from infectious disease, upon such terms as may be mutually agreed upon between the Guardians and the Authority, and that this arrangement should include cases occurring amongst the inmates of the Workhouse. No sanction on the part of the Board is necessary to the agreement." By payments under agreements since 1902 with various authorities and in the case of Enfield since 1^94, the Guardians have admitted liability of the cost of treating outdoor paupers suffering from certain infectious diseases, and there is no doubt as to their liability to dealing with cases atising in their institutions. Financially it is better that this expense should be made out of the Poor Rate rather than out of the District Rate. Article 14 (2) of the Edmonton and Enfield Hospital Order provides that:— "If the Board of Guardians of the Edmonton Union and the Joint Board agree for the reception into the hospital of persons in the receipt of relief from that Board of Guaidians, any such person may be admitted into the hospital in the manner and terms prescribed in the agreement." Article 14 (2) of the Middlesex Smallpox Order says:— " If the Guardians of the Edmonton Union and the Joint Board agree for the reception into the hospital of persons suffering from smallpox and in receipt of relief from that Board of Guardians, any such person may be admitted into the hospital in the manner and on such terms prescribed in the agreement," 32 The proposed agreement, like the agreement of December, 1912, asks us to provide for 10 diseases, when the existing hospital arrangements only provide for 4 of them, viz.: scarlet fever, enteric fever, diphtheria and smallpox. For these other 6 diseases it would be better and cheaper for the Guardians to provide a hospital themselves, rather than that each district should provide separate hospital accommodation. The Enfield and Edmonton Joint Hospital Board have an arrangement with the Guardians to receive (when there is room) cases of scarlet fever, enteric fever and diphtheria at a reduced charge of 4s. 6d. per day, 7s. being the ordinary charge. This hospital is empowered to provide accommodation for all the 10 diseases mentioned in the proposed agreement except smallpox, cholera and plague, which can be provided by agreement between the Joint Hospital Board of Clare Hall at South Mimms and the Edmonton Guardians. In a report to the Sanitary Committee, dated 7th January, 1914, our Clerk (Mr. W. F. Payne) gave his opinion that:— "Any agreement should be between the Joint Board and the Guardians for cases of disease for which the Joint Board has provided, including conveyance to and from the hospital." It must be remembered that, as Edmonton has formed a joint hospital board both with Enfield at Winchmore Hill and other authorities at South Mimms, they have handed over their responsibilities (if any) (see section 281 of the Public Health Act, 1875), although by section 1 of the Public Health (Prevention and Treatment of Diseases) Act, 1913, the Local Government Board may by Order abrogate this. Edmonton requires special consideration more than the other seven districts in the Union, because two large institutions of the Guardians, viz., the Workhouse and the Infirmary, are situate in this district, and it is only my constant vigilance that prevents the district being saddled from time to time with the expense of some person or persons who have been admitted into these institutions from Tottenham, Enfield, Wood Green, Hornsey, Cheshunt, Waltham Abbey or Southgate. , Quarantine Funds.—The increase of scarlet fever and diphtheria during October, November and December placed the Medical Officer in an advantageous position for persuading large employers of labour to establish or re-establish these funds from which are provided support for employees who as contacts, are kept away from work in order to safeguard their fellow employees. In my report for December I was able to state that Messrs. Eley Bros., Ltd. had re-established their fund, which had been stopped on account of the National Insurance Act coming into force, and that the Metropolitan Electric Tramways, Ltd. were also commencing a fund. The workers of other NOTIFICATIONS of SCARLET FEVER IN 1912 AND 1913. TOTAL NOTIFICATIONS IN 1912= 212 : IN 1913 = 429 33 large firms in the district have enjoyed this privilege for some years and I have hopes of adding to the list of firms doing so, as I find that employees are quite willing to subscribe at least one penny per week to this useful fund, which is usually started by a donation from the firm. Charts are given 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 1912 and 1913. Small Pox. A satisfactory feature of the infectious returns for the year is the absence of small pox from amongst them; since 1904 the district has enjoyed a complete immunity from this disease. An epidemic of this dreadful disease is overdue, and judging from the returns of the Vaccination Officer there are many Edmonton children unprotected from infection, and sure to die if attacked. There were no deaths from chicken pox. Vaccination. The following table of vaccination returns for the year 1912 has been kindly supplied by Mr. Lowman, the Vaccination Officer. The returns for 1913 will not be available for some months. VACCINATION RETURNS FOR 1912. Births, Successful Vaccinations. Conscientious Certificates. Deaths under one year unvaccinated. Still unvaccinated but address known. Postponed owing to illness. Certified unsusceptible. Removed and Untraced. 1844 741 490 112 82 97 4 318* *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. In 1907 there were only 72 certificates granted to parents who alleged they had conscientious objection to vaccination, but there were 174 in 1908, 240 in 340 in 1910 and 396 in 1911. This large increase of persons unprotected from smallpox will gratify no one but an anti-vaccinationist. Exemption certificates, or declarations of conscientious objection to vaccination, received by vaccination officers have increased considerably since 1907. The numbers and the percentage of objections to total births registered during those years were given by the Government in July as follows Year. Exemptions. Percentage of Total Births Registered. 1907 57,675 6.3 1908 162,799 17.3 1909 190,689 20.9 1910 230,947 25.7 1911 248,483 28.2 1912 275,929 31.6 34 Scarlet Fever. 420 cases were notified, giving an attack rate of 6-31 per thousand. 211, 68 and 155 cases were notified in 1912-11-10. The patients were distributed amongst 340 houses and 124 streets. One case occurred in 283 houses; two cases occurred in 41 houses; three cases in 10 houses; four in five houses; five cases in one house. The removals to hospitals numbered 388, an isolation percentage of 92.8There was one death, giving a fatality of 0.24 per cent. of cases notified, and a death-rate of 0.15 per 1,000 of the population. Besides, nine cases were notified from the Edmonton Infirmary, who were not Edmonton residents, but were treated in our Hospital. There were no duplicated notifications, but one case of infection mixed with diphtheria. Secondary cases numbered 61 out of 420 (excluding nine cases from Edmonton Workhouse). In March there were 39 cases; the school most affected was Silver Street and the southern Sunday Schools, excepting St. John's. In the last four months of the year cases were unusually numerous as in the neighbouring County of London and most of its suburbs. It was the worst outbreak since 1906. It affected all the schools. The fever was, however, of a mild type and its mildness was a reason for the unusual spread of the disease, because, if the children had had more serious symptoms, the parents would have been more careful to prevent the spread of infection. There were 22 cases notified where subsequent observation did not confirm the diagnosis; they are not included in the above figures. Return Cases—See section on " Hospitals." Scarlet Fever Outbreak at the Workhouse and Infirmary — The first case was an Enfield child who was admitted on March 4th, and showed a rash 9 days later. Sixteen further cases followed. Notification was received of the first case on March 20th, and of the last case on April 24th. The contract for milk supply had terminated on the 31st March, and a new one entered into after that date with a fresh contractor. This I might say was not in consequence of the outbreak, but an ordinary business transaction. On April 7th, I visited Dr. Mort, medical superintendent, to discuss the circumstances, and I advised him to recommend to the Guardians the installation of a milk steriliser and a food refrigerator, which appliances have now been provided. I think that they should be established in all large public institutions, especially where the population consists to any extent of young children. I made special enquiries also into the source of the milk supply up to the 31st March, which were continued by the Medical Officer of Health ef NOTIFICATIONS of DIPHTHERIA. IN 1912 and 1913. 0TAL NOTIFICATIONS IN 1912 = 136 : IN 1913 =131 , 35 the district from whence it came. My colleague reported that after investigation he had found nothing to criticise in the sanitary condition of the depot or its arrangements for handling the milk. I might add that there had been no cases of scarlet fever in this institution previous to this outbreak and that only one succeeded it, which was notified on December 23rd, and was also an Enfield child. Two of the notifications are not in our register, as they were transferred to Wood Green. Further observation of the 15 cases showed that in 7 of them the diagnosis could not be confirmed. Diphtheria and Membranous Croup. The latter, membranous croup, is only an old-fashioned phrase for diphtheria, presenting symptoms mostly confined to the larynx. I received notifications of 131 cases during the year, compared with 136, 43 and 52 in 1912-11-10, and they represent an attack rate of 1.97 per thousand of the population. The cases occurred in 74 streets and 113 houses. One case occurred in 98 houses; two cases in 10 houses; three cases in five houses. The cases removed to hospital numbered 125, being 95.52 per cent, of those notified. There were 15 deaths, giving a death-rate of 0.23 per thousand of the population, and a fatality of 11.45 per cent, of those notified. One case was doubly notified. 15 of the cases were secondary ones. Return Cases.—See " Hospital Section." There were three cases notified where subsequent observation did not confirm the diagnosis; they are not included in the above figures. During the last three months of the year the number of cases were excessive, numbering 36, 21 and 16 in October, November and December, respectively, tor some months previously the number of cases had been below the average, and for the whole year only 5 more cases were notified than in 1912. However, the Local Government Board requested a report on this subject, which I sent hem on the nth December, and also a copy to the County Council. All suspected cases were swabbed by the medical practitioner in attendance, my deputy or myself, and the cultivation from the swabs examined in the Council's laboratory. Antitoxin in curative doses of 4,000 units and preventive doses of 1,000 units is supplied free to the practitioners any time during the day or night either from the Town Hall, or our fire-stations. Enteric Fever. Eight cases were notified, as against 3, 12 and 34 in 1912-11-10. This is equal to an attack rate of 0.12 per thousand of the population. These cases occurred in eight houses and eight streets. All cases occurred in separate houses. All were removed to our hospital—an isolation percentage of 100.00 here were two deaths, giving a fatality of 25.00 per cent, of the cases notified, and a death rate of 0.03 per thousand of the population, 36 There were no secondary cases. Moreover, three patients were notified as, but found not to be, suffering from enteric fever ; they are therefore not included in the above figures. Diet. Careful enquiries were made into every case reported, except the "foreigners," 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 or drink, special enquiries were made as to those articles of diet—such as shell-fish fried fish, watercress, etc.— that are most liable to contamination by the organism of this disease. It was found that among the eight 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. Three of them had eaten fried fish under similar circumstances, but not shell fish; one of them was fond of raw fruit. One had eaten freely of celery and watercress as well as fried fish. A young man was devoted to raw fruit. In three cases there was no evidence. Cerebro-Spinal Fever and Acute Polio-Myelitis. Cerebrospinal fever was first made notifiable in Edmonton by an emergency order for one month, from 22nd March, 1907, and then by four orders notification was continued up to May 21st, 1912. On my advice, these diseases were made permanently notifiable in Edmonton on 9th March, 1912. The Board sent us a circular dated 16th August, 1912, conveying an order, dated August 15th, making these diseases compulsorily notifiable in all areas. During the year I received 13 notifications of polio-myelitis, but no notifications of cerebro-spinal fever. I received 15 notifications about these 13 cases, as Nos. 4 and 7 were duplicated. I have had cards printed for use in investigations much like those which have been so long in use for scarlet fever, diphtheria, etc. In no case did the practitioner perform lumbar puncture or express the desire for examination of any pathological specimens. As regards locality, Nos. 1, 2, 3, 5 and 8, are in the same neighbourhood; Nos. 4, 6, 7 and 9 are in another focus; and Nos. 10,11, 12 and 13 are detached cases in four different parts of the district. There has been one death—No. 5—-two or three days after onset. There was no post-mortem examination. The boy had fallen out of his mail-cart four or five weeks before onset. The doctor noticed paralysis of left arm and "paresis of right face." This child had never been healthy. This case may be entered in the doubtful column. NOTIFICATIONS of ENTERIC FEVER. IN 1912 AND 1913 . TOTAL NOTIFICATIONS IN 1912=12: IN 1913 = 8 . 37 On the nth August, I wrote to the medical practitioners thereon, including a copy of the Local Government Board memorandum of 1911 with reference to this disease. Three cases occurred subsequent to my sending a special report to the Local Government Board dated August 14th. I have recently (June, 1914) visited all these cases and I did not find, I regret to say, a complete recovery in a single one of them. I find that the cases that had retrieved their powers most were those in which the mothers had persevered with massage and weekly or fortnightly application of interrupted electric current in the hospital out-patient departments. Even now I am unable to discover any common cause of the outbreak. ENFIELD AND EDMONTON JOINT ISOLATION HOSPITAL. This is situated on 27 acres of land in the Enfield District, on its Winchmore Hill border, and adjoining the large Convalescent Hospital of the Metropolitan Asylums Board. It consists of an administrative block, nine blocks of wards, a discharge block, porter's lodge, engineer's cottage, mortuary, laundry disinfecting station, and a bungalow. Blocks V. and VI. and the bungalow are constructed of wood and galvanised iron; all the other buildings are of a permanent character. The bungalow, which was formerly used as sleeping quarters for the staff, has since the addition of 16 beds to the administrative block, been used as a store-house and sewing-room. It has been moved from west of the administrative block to north of the cubicle block. In 1910, a well-equipped bacteriological laboratory was fitted up in the mortuary building. A Joint Board, consisting of four members from each Council, has been the controlling body since January 1st, 1906. It was mutually arranged 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 for the year ending 31st March, 1914, was ^"4,994 10s. od. The Accommodation available on December 31st, 1913, was:— For Scarlet Fever, Blocks II., III., IV. and V. 96 beds. For Enteric Fever, Block VIII. 14 beds. For Diphtheria, Blocks VI. and VII. 39 beds. For Observation, Block IX. 12 cubicles. For Observation, Block I. 2 beds. 163 beds. 38 During 1913, the demand of Enfield and Edmonton for beds was fully met. Neither district has preference over the other when beds are vacant, but during the year 1912-13 from other districts 19 cases of scarlet fever and one case of diphtheria were admitted out of 508 cases admitted, a total of 20 cases, that is, 4.0 per cent., compared with 1.5 per cent., during 1911-12. The following table gives the percentage of hospital isolation to cases cases notified, for the past five years :— 1909. 1910. 1911. 1912. 1913 Scarlet Fever 90.81 96.15 88.24 92.45 92.54 Diphtheria 90.00 84.62 86.36 90.44 95.52 Enteric Fever 83.33 81.08 73.33 16.66 100.00 Officers. Dr. Haldane Cook is the sole medical officer; the house built for him was completed in July, and on November 6th he became Resident Superintendent. The Clerk and Surveyor of the Enfield Council still act as Clerk and Architect of the Hospital. Miss Eardley is the matron; there are 1 assistant matron, 4 sisters (1 for night duty), 3 staff nurses, 16 probationers and 6 ward maids. Fire.—The Hospital is in telephonic communication with Edmonton Fire Station. Sewage. This is disposed of by a private system consisting of a separating chamber, a septic tank and filter beds, the effluent passing into the watercourse known as Hounsden Gutter, a tributary of Salmon's Brook. Antitoxin. During 1912-13, Dr. Cook used it in all cases where none, or an insufficient quantity had been administered to the diphtheria case before admission. In most cases 4,000 units were given, and some were given as much as 28,000 units. Drugs were only given for the treatment of complications. He again urged medical men to give antitoxin at once to cases of diphtheria or suspected diphtheria, and not to let them wait until hospital is reached. In October, the Joint Hospital Board called the Council's attention to this suggestion of Dr. Cook, and asked for the Council's help to secure ts more general adoption. I wrote a circular letter to the medical practitioners on this matter, dated November 25th. A reply thereto was received from the Edmonton Local Medical Committee, representing the practitioners of the district, wherein the Medical Committee stated that they agreed that prompt administration of antitoxin is desirable in all cases of diphtheria, and 39 that they are always ready to co-operate with the Medical Officer of Health in doing their best for all persons suffering from infectious disease; but they expressed the opinion that the provision of an ambulance, preferably a motor one, kept in readiness at the hospital would enable patients to have the escort of a trained nurse and to reach the hospital without delay and be promptly injected by the Superintendent (Dr. Cook) with antitoxin under more favourable conditions than can be obtained in the houses of the poorer people. Widal's Test was applied to all the cases of enteric fever. Return Cases. In his Report for 1910-11, Dr. Cook defines a "return case" to be "any person admitted from the same house to which we have discharged a scarlet fever patient within a period of six weeks." During the year 1913 there have been 11 families in which return cases have occurred. Dr. Cook estimates the percentage of return cases during 1912-13 as 4.56, compared with 2.63 for the previous period. Besides, one scarlet case occurred after the return from our hospital of a patient who had been treated for diphtheria; one diphtheria followed the return home of a case of scarlet fever; and a mother and child were attacked with diphtheria, after the latter had returned from hospital after treatment for scarlet fever. 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 from time to time on the Edmonton treasury, no patients from the district have been sent there yet with small-pox. The money (£219 16s. nd. for 1913-14) is a premium for an advantageous insurance. A motor ambulance was purchased in 1911-12 at a cost of £415. The Local Government Board issued an Order, dated 18th August, 1911, authorising the use of the hospital as a Sanitorium for phthisical persons. Dr. Ta'Bois, the Resident Medical Superintendent, informs me that there are 70 beds in the permanent buildings, and 126 more can be put in the buildings of wood and corrugated iron. The beds in the permanent building are supposed to be reserved for cases of small-pox. The 126 beds in the temporary buildings have been used as a sanitorium for tuberculous eases since July 20th, 19x2, and on August 10th, 1912, the first cases were received from the Middlesex Insurance Committee, on whose behalf the Public Health Committee of the County Council had secured certain accommodation. The 40 number of tuberculosis cases in the institution on December 31st, 1913, was 101, four of whom were residents in Edmonton Urban District. No cases of small-pox were treated during 1913 from any district. In addition, my Council still has the administrative block ot 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. In a letter of the 21st October, the Middlesex Districts Joint Small-pox Hospital Board inquired whether my Council would be willing to enter into an arrangement whereby they could have the use of these buildings for the treatment of small-pox, should emergency arise. In connection therewith a special meeting of the Sanitary Committee took place at the hospital, who thoroughly inspected the structure and the equipment. This letter was further considered by the Sanitary Committee in November and recommendation made, which the Council accepted, that the joint Board be informed that the application could not be entertained, but that the Council was willing to dispose of the beds, bedding, etc., on terms to be arranged. The following sixteen urban districts are now shareholders in the Joint Hospital:— Acton Enfield Hampton Wick Staines Brentford Feltham Hanvvell Tottenham Chiswick Friern Barnet Harrow Wealdstone Edmonton Greenford Southgate Wood Green TRANSPORT ARRANGEMENTS. The Council at present undertakes 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 is also 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. Unavoidable, but regrettable, delay occurs in the present system of transport to Winchmore Hill Hospital. The transfers should be undertaken by the Hospital Board, as advised by the Government years ago. On the nth November a question was raised at the Council meeting, as to the transport of patients to the fever hospital, and in reply the Chairman 41 of the Sanitary Committee, Councillor H. Williams, stated that "there was no objection to mothers or familiar friends accompanying sick persons in the Council's ambulance: and in cases where escort was desirable, Miss Hudson, the Senior Woman Inspector, was detached from her work for the purpose, but the difficulty would be finally settled by the provision of transport from the hospital itself, when the matron could always have a nurse to send out with it." AMBULANCE FOR NON INFECTIOUS CASES. On the 28th October the Council considered a letter from the Tradesmen's Association, suggesting the need of a public ambulance for the transport of cases of sickness and accident. This was referred to the Sanitary Committee who in December considered reports on the subject, which led the Committee to the conclusion that it would not be advisable for the Council to take any action in the matter. There has been for many years an ambulance kept at the service of the public at a nominal charge, and the Council took this opportunity of expressing to Mr. W. F. Middleton their appreciation of his voluntary services in connection with the storage and use of this ambulance. DISINFECTION. Rooms are disinfected after the removal of the patient by spraying with a i-in-20 solution of formalin. Linen and cotton articles are steeped in a disinfecting solution in the room previous to being washed, and articles of clothing, bedding, etc., are removed to the disinfecting station in a van provided for that purpose by the Council where they are treated in a WashingtonLyon steam disinfector. After treatment, the bedding, etc., are returned in a separate van used only for conveying disinfected articles. Disinfectants. These continue to be supplied to callers on the same lavish scale as heretofore. Disinfecting Station. The transfer of this from Pickett's Lock Lane to the Town Hall has been decided upon. (See report upon Education.) BACTERIOLOGICAL LABORATORY. During the year the following specimens were examined and reported upon :— Disease. Result Positive. Result Negative. Doubtful. Total. Diphtheria 36 101 3 140 Enteric Fever 1 7 — 8 Tubercle (sputum) 18 21 - 39 Totals 55 129 3 187 The numbers are much greater than last year. Since April 30th, 1912, Dr. Rock has been in charge of this work. 42 PUERPERAL FEVER. „ One case of this disease was notified during the year, who died (a resident in Edmonton Infirmary), so the death-rate is 0-54 per thousand nett births. (See Section "Births.") One case from Tottenham was notified from the Edmonton Infirmary and ended fatally. One case also died in the Infirmary who was not notified in this district, but in the Urban District of Enfield. One case was notified but is not included in the above figures, as it was not confirmed by subsequent observation. On the receipt of a notification of Puerperal Fever, the case is immediately investigated, and the facts communicated to the County Medical Officer of Health, who has the administration of the Midwives' Act, 1902. At the end of 1912 there were 18 registered mid wives residing and carrying on their work in our district, compared with 19 for the previous year. During 1912 there were 281 midwives practising in Middlesex and 358 not practising; four were removed from the midwives' roll by the Central Midwives' Board and one cautioned. During that year 4 uncertified women were prosecuted by the County Council for acting as midwives. The County Public Health Committee report that "there is no reason to think that in the County area there is inadequacy in the number of practising midwives." ERYSIPELAS. Fifty cases were notified, compared with 49 in the previous year, besides one "foreigner" occurring in the Edmonton Union Infirmary, and one in the Strand Union. All of our 50 cases were in separate houses. There were two deaths from this cause, but none of the " foreigners " died. Twenty-one cases occurred amongst people who were living in our district outside the Union Infirmary, and yet unable to provide proper attention for themselves. Under the Council's agreement with the Edmonton Union Guardians, nursing had to be provided for them, as such cases are not admitted into the isolation hospitals. The cases were most numerous in September, October and December. In May a proposal was considered from the neighbouring district of Tottenham as to the establishment of a central institution where cases of erysipelas occurring in the eight districts of the Edmonton Union could be removed to, isolated and treated. No action has been taken thereon. 43 PHTHISIS AND OTHER TUBERCULOUS DISEASES. The deaths from phthisis numbered 72, as compared with 60, 45 and 50 during 1912-11-10. The death rate from the disease is therefore 1.08 per thousand. Of these deaths, 19 occurred among residents of the district in Edmonton Workhouse. The total deaths from phthisis in the Strand and Edmonton Workhouses in the district numbered 96, or 15 less than last year. The other tubercular diseases together accounted for 31 deaths, giving a death rate of 0.47 per thousand. In this way tuberculosis contributed a total death rate of 1.55 per thousand, or nearly 13 per cent. of all the deaths; this compares with 12.0 per cent. the previous year. The Woman Inspector visits the houses not only where deaths have occurred, but where cases of phthisis have been notified, and she leaves a card of printed instructions, after giving such advice as she thinks may be useful. She paid on this account 495 visits and re-visits during the year, compared with 348 the year before, and also 98 visits and re-visits to other cases of tubercle. The disinfection of the room lately occupied by the patient, and of his clothes and bedding is carried out. Tuberculous Meat and Milk. See Section VI. of this Report. Institutional Accommodation. I have received the following information with reference to this : (1) Edmonton Workhouse. Medical Officer, Dr. Mort, states that there is no accommodation here. All cases, on being diagnosed, are transferred to the Infirmary. (2) Edmonton Infirmary. Superintendent, Dr. Mort, reports that there is a total of 128 beds reserved for consumptive patients—a flat of 64 beds for each sex. He states that cases are graduated as far as possible; that the very advanced cases are treated in the side wards. In favourable weather about 10 extra beds are placed on each balcony, for very early cases. (3) City of Westminster (late Strand) Workhouse. Dr. Bebb, Medical Officer (visiting) reports that there is no special accommodation provided; should cases be diagnosed, they are sent to their own Infirmary as soon as there is a vacancy. (4) Strand Union Schools. Dr. J. K. Brownlees, Medical Officer (visiting). Children are received from the Strand, Islington, Wandsworth, and St. Giles's Guardians. Dr. Brownlees states that there is no special accommodation provided, but that if any case of phthisis is discovered the patient is at once sent back to his (or her) own Guardians. This Institution was closed on July 31st. I received three voluntary notifications. 44 NOTIFICATIONS RECEIVED UNDER PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1908. These Regulations came into force on January 1st, 1909, throughout England and Wales. Form A. First notification from M.O., Edmonton Infirmary 6 „ „ Re-notifications „ „ 0 „ „ First notifications by M.O.'s of outside institutions 1 „ „ Re-notifications ,, ,, ,, 0 „ B. First notifications from D.M.O. of Edmonton 2 „ „ Re-notifications ,, ,, „ 0 „ C. First notifications by Superintendent Officer Edmonton Infirmary 1 „ „ Re-notifications „ „ „ „ „ 0 ,, „ Notifications or re-notifications from Superintendent Officer (Master) of Edmonton Workhouse 0 „ ,, First notifications by Superintendents of outside Institutions 0 „ ,, Re-notifications ,, „ ,, „ 0 „ D. Notifications by R.O. Edmonton District 0 Total notifications 10 The total number of persons notified under the regulations was 10—5 males and 5 females. For 1911 the figures were 60—41 and 19; and for 1912 they were 80—54 and 26. No patient was notified more than once. NOTIFICATIONS RECEIVED UNDER PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS MARCH, 1911. These Regulations came into force on May 1st, 1911. The total number of patients notified under these (hospitals) regulations was 8—4 males and 4 females. The number of notifications was 8; no patient was notified more than once. NOTIFICATIONS RECEIVED UNDER PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS NOVEMBER 1911. These Regulations came into force on January 1st, 1912. Patients notified once 12 „ „ twice 13 The total number of patients notified under these regulations was 13—7 males and 6 females. The number of notifications was 14. 45 During January, 1913, we had three different sets of regulations, each affecting a different kind of person, or perhaps the same person in different aspects, depending upon whether at the moment he was being treated by a poor law medical officer, the medical staff of a hospital, or by a private doctor. These complications increased our difficulties of administering the regulations with success, but my staff and I did the best we could in the circumstances. The great work thus involved may be judged best in the light of the following notes on the complications of only one month:— 1 person was notified under 1908 and 1911 (November) regulations. 5 persons were notified under 1911 (hospitals) and 1912 regululions. 3 persons were notified under the 1908 and 1912 regulations. 1 person was notified under 1911 (hospital), 1911 (Nov.),and 1912 regulations. 1 person was notified under 1911 (November) and 1912 regulations. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Lungs. Patients notified once 145 twice 47 thrice 31 „ „ four times 4 „ „ five „ 1 228 Other Forms. Patients notified once 64 „ „ twice 9 ,, ,, thrice 2 75 The total number of pitients notified under these regulations was 303— 163 males and 140 females. The number of notifications was 441. The notifications were made up as follows:— Lung. Other Forms. Received from— M. F. M. F. Private Practitioners (A) 83 61 16 12 S.M.I. (B) 1 1 3 3 Sanitoria (C and D) 63 19 – – Infirmary (A, C and D) 29 26 4 1 District Medical Officer (A) 2 1 1 – Hospitals (A, C and D) 22 37 20 28 Other Institutions (A, C and D) 4 1 – – Voluntary 3 – – – Totals 207 146 44 44 353 88 46 Scholars. Eight children were notified by the School Medical Inspector during the year, as suffering from tuberculosis, two from pulmonary tuberculosis and the rest from other forms of tubercle. LOCALITY OF TUBERCLE, OTHER THAN PULMONARY. [M., Male ; F., Female.] M. F. M. F. Brain [M. 5 months; F. 8] 1 1 Rib [M. 20] 1 – Meningitis [F. 11/12, 1 9/12,2] – 3 Intestine [M. 8 months] 1 – Lupus face [M. 9; F. 12, 41] 1 2 Peritoneum & intestine [M. 1 6/12] 1 – Lupus face and limbs [M. 20] 1 0 Peritoneum [M. 3; F. 3, 6] 1 2 Neck glands [M. 3, 6, 6, 7, 7, 9, 11, 11, 12, 12, 13, 24, 37; F. 5, 8, 8, 8, 11, 12, 14, 14] 13 8 Abdomen [M. 3, 4] 2 – Mesenteric glands [F. 2] – 1 Glands & lumbar abscess [F. 7] – 1 Neck, groin and hip [M. 16] 1 – Hip [M. 3, 7, 17, 46; F. 4, 5, 8, 9, 11, 22] 4 6 Spine [M. 5. 8, 31: F. 5, 6,10, 15] 3 4 Knee [M. 8, 10, [4, 17; F. 8, 38] 4 2 Larynx [M. 43, 62] 2 – Axillary glands [F. 44] – 1 General [M. 15] 1 — Elbow [M. 42] 1 – Glands [F. 7, 13] – 2 Forearm and thigh [M. 7] 1 – 40 35 Wrist [F. 21, 22] – 2 Pleura and glands [M. 44] 1 – THE ADMINISTRATIVE CONTROL OF TUBERCULOSIS. INSURANCE COMMITTEE. The Insurance Committees are central authorities set up in counties and county boroughs by the National Insurance Act 1911, which are to consist of between 40 and 80 members. Middlesex Insurance Committee has 70 members as follows:— Three-fifths, or 42, representing insured persons resident in the County. One-fifth, or 14, of whom two are women, appointed by the County Council. Two members appointed by the medical practitioners resident in the County. Two medical practitioners appointed by the County Council. Ten members appointed by the Insurance Commissioners. 47 The Public Health Committee of the Middlesex County Council act as the agents for the County Insurance Committee as far as insured persons are concerned. The Vice-Chairman of the latter, County Councillor Kelland, is also Chairman of the Public Health Committee. Of the five areas into which the County is divided, Edmonton is included in No. 1, of which these are interesting figures:– Area. Acreage. Population Census, 1911. Probable cases (4 years' deaths —all Tuberculosis). Staff. Tottenham 3,014 137,457 704 1 Tuberculosis Officer. Edmonton 3,894 64,820 319 1 Assistant Officer. Enfield 12,601 56,344 259 3 Nurses. Totals 19,509 258,621 1,282 The first report of the County Public Health Committee on the scheme was dated June, 1912. There were others of importance issued in October, 1912 and February 27th, 1913. On the 14th January the Local Government Board sent the County Council their approval generally of the County scheme, on the understanding that the Tuberculosis Officers would carry out at the dispensaries any treatment which could be properly given there and that the County Council would give effect to the Board's circular letter of 6th December, 1912, for securing co-operation with the sanitary authorities. I glean the following information from the annual report of the County Public Health Committee for the year ending March 31st, 1913. The institutions required are:— 1. Sanatoria of 150 to 200 beds with two medical officers, which can be more cheaply administered than small ones. 2. Hospital for advanced cases with about 150 beds. 3. Dispensaries for out-patients. Of the one and half million pounds available under section 16 of the Finance Act, 1911, the County of Middlesex expect to receive £34,025. A special sub-committee of the Public Health Committee was appointed to deal with tuberculosis. DISPENSARIES AND THEIR WORK IN MIDDLESEX. Under the scheme it is proposed to have five head dispensaries and 12 sub-centers.. The head dispensaries will require to be buildings of some 48 size, inasmuch as accommodation (in each) will have to be provided for one or more consulting rooms, a laboratory, a waiting room, dressing rooms for patients, an office, caretaker's quarters and the usual domestic offices, and, if possible, several bedrooms for observation beds, and sleeping quarters for the nurses. As regards sub-centres it will be found generally that two or three rooms will probably suffice for this purpose, as the sub-centres will mainly be required as places at which patients may attend to be examined by the Tuberculosis Officer. To enable the Committee to select the most suitable localities and to meet the wishes of the Local Authorities, conferences were arranged with the District Councils representing each of the dispensary areas. The work which will be carried out at or in connection with the dispensaries will include the following:— 1.—The examination of patients at the dispensary. 2.—The examination of the "contacts" to these patients. 3.—The treatment by tuberculin, or other means, of patients, and their supervision at home—if unsuitable for, or unable to go to, an institution. 4.—The selection of cases for institutional treatment, and the class of institution to which they should be sent. 5.—The supervision of cases after discharge from sanitorium or hospital. DISTRICT COMMITTEES, Under section 59 of the National Insurance Act, the Insurance Committee is required, after consultation with the County Council, to prepare a scheme for the appointment of District Committees. The section provides that a District Committee shall be constituted for each Borough within the County, and also for each Urban District with a population of not less than 20,000. A scheme of District Committees was accordingly prepared by the Insurance Committee and subsequently approved by the County Council. Each District Committee consists of 27 members, two of whom are appointed by the County Council. LOCAL CO-OPERATION DURING 1913. At the meeting of the Sanitary Committee on the 8th January, I submitted the new regulations of the Local Government Board, dated 20th December, 1912, and also an epitome of the additional work which these regulations would place on the Public Health Department. On the recommendation of the 49 Middlesex Districts Councils' Association and our Sanitary Committee the Council adopted the following resolution:— "That in their opinion (a) the County Council should be the organising authority generally; (b) the Tuberculosis Officers appointed by the County Council should be consultants only, and not undertake treatment or any administrative work; and (c) that the Local Public Health Service in each district should be used to the fullest extent in order to prevent friction and overlapping and unneccessary expense, and avoid what would be a separate and distinct Health Authority for one disease only." My special report on "The administrative control of tuberculosis in Edmonton" which outlined a plan for securing the co-operation of my Council with the Middlesex County Council and the County Insurance Committee was presented to my Sanitary Committee on January 8th, and to my Council on the 14th January, 1913. This report appears in the Council's minutes of the latter date, and was published as a special appendix to my Annual Report for 1912. The Council decided (by a majority) not to take any action in the matter, so that any attempt at co-operation was suspended. On February 11th, at the request of the County Insurance Committee, Councillors S. H. Platten and Rev. Preb. Sanders and W. A. Cull were re-elected members of the Local Insurance Committee up to the 15th July, 1913, and up to such later date as the scheme made on the 3rd February, 1913, by the County Insurance Committee shall remain in force. N.B.—This Committee had not then held their first meeting. The County Public Health Committee issued a report, dated 27th February, and I presented a synopsis of these proposals to the Sanitary Committee of the 2nd April. The Chairman of the Sanitary Committee, Rev. Preb. Sanders, and myself were appointed to attend a meeting of the County Committee at Caxton Hall, on Thursday, April 10th, with reference to the site of the tubercular dispensaries of area No. 1. These delegates presented a report to a special meeting of the Council on Tuesday, April 15th. The delegates' report protested against a totally different arrangement of the dispensary sites for area No. 1 being laid before them at a moment's notice, and their assent expected without further reference to their Council. The special meeting of the Council approved of the delegates' protest, and a letter was sent to the County Council approving and endorsing the views of the delegates. The County Council was also asked to receive a deputation from Enfield and Edmonton Councils. A copy of the delegates' report was sent to the Insurance Commissioners and they were also asked to receive a deputation from the same Councils as regards the proposed site of the head dispensary of area No. 1. The representatives of the two Councils on the Middlesex County Council were also asked to support this protest. At the Council meeting on the 22nd April, 50 a reply was read from the County Council that, whilst any proposals made by local authorities received most careful consideration, it would not be necessary for our Council to send a deputation. However, a deputation of five Councillors with the Clerk and the Medical Officer, was now appointed, showing that Edmonton was [quite earnest in the matter. At the Council meeting on the 13th May, a reply from the County Council was read still deprecating the necessity of a deputation. The Insurance Commissioners wrote stating that they had communicated with the Local Government Board, and the Local Government Board wrote us stating that they were in communication with the Middlesex County Council on the subject. In June the Accountant was instructed to prepare a report on the financial aspect of the new County scheme of 27th February, 1913. This was published in the Council's minutes of 8th July. In July the County Council were offered a vacant site in Silver Street for the central dispensary at a price of £600. At the same meeting on July 8th, on the invitation of the Governors of the Tottenham General Hospital, Councillors Williams, Warren and Taylor, with the Medical Officer and the Engineer, were appointed to attend a conference with representatives of Tottenham and Enfield. This conference took place at the Hospital on the 21st July, 1913, and the report thereon by our Clerk was submitted to our Council on the 26th August showing that the proposal of the Governors that the central tuberculosis dispensary should be at, or close to, the hospital, met with no support from the representatives of Edmonton and Enfield. So that project fell to the ground. At this Council meeting a further letter from the County Council was considered and (in consideration of the public benefit involved) the Council agreed to accept £300, or one-half its value, for the site at Silver Street. No answer had been received to this offer by the end of 1913. At the Council meeting of the 9th September, a letter dated 9th July was received from the County Council Insurance Committee enclosing a statement showing how the applications for sanitorium benefit from Edmonton had been dealt with and also a statement of the total number of applications received to date for sanitorium benefit, etc. On January 7th, 1914, I presented a report to my Sanitary Committee and Council on "The Tuberculosis Dispensary and its work in Edmonton," and suggested that the time had now arrived for us to know definitely what the status and duties of these nurses would be in view of the fact that since 1904 the work had been in the hands of the local medical officer of health and his woman inspector. My Committee recorded the following resolution thereon "The medical officer suggested that the time had now arrived for us to consider how co-operation in the work with the County Council could be best obtained and duplication of work and inspection avoided, but your Committee decided to take no action in the matter at present," 51 THE DISTRICT COMMITTEE OF EDMONTON. In the scheme made on February 3rd, 1913, by the County Insurance Committee, there was laid down the constitutions of these Committees, which defined the qualifications of members, the powers of the Committees, and the regulations of their proceedings. Each one is to hold office until July 15th, 1913, or longer if the scheme remains in force. Edmonton District Committee met for the first time on the 2nd May, when the Rev. Preb. Sanders, M.A., was elected Chairman, and an executive of six members appointed. Mr. Alfred E. Truscott is the Clerk. I am one of the three representatives of the medical practitioners. My Council is of the opinion that the local medical officer of health should be ex-officio a member of every district committee. A letter thereon from my Council dated September 25th, 1912, was answered by the County on 12th January, 1914 ! On the 9th December I received notification from the county medical officer that the head dispensary had been established at 56, Silver Street, Upper Edmonton, and was in charge of Dr. Cogill, one of the tuberculosis officers appointed by the County Council; also a schedule of hours for patients attendance. I believe that the work began there in October. The second meeting was on the 19th December. After a meeting of the executive, the Committee was divided into three Sub-committees to take up the work of after-care of all insured persons. Three members offered to deal with the domiciliary accounts. A deputation was appointed to wait on the Insurance Committee in order to ascertain when and what useful work the District Committee could do and so exercise the powers given them under the scheme of February 3rd, 1913. The Clerk was instructed to enquire if the County Council intended to establish tuberculosis nurses in the area No. 1 on the terms of their Public Health Committee reports of October, 1912, and February 1913, or not. TUBERCULOSIS NURSES. In the report of the County Public Health Committee for 27th February 1913, appears the following:— "Arrangements could be made for these officers to act under the District Medical Officer of Health for the purpose of enquiries regarding tuberculosis under the Public Health (Tuberculosis) Regulations, 1912. It may also be arranged with the respective District Councils that nurses could be appointed who could act partly as tuberculosis nurses and partly as health visitors for such work as arises under the Notification of Births Act, etc., but in this event the number of nurses proposed in the scheme would 52 then need to be increased. Under the latter circumstances a small part of the salary of such officers might be paid by the District Council." This is again mentioned on page 10 of the same report. In a report of the same Committee of October, 1912, appeared this definite statement:— "Where health visitors exist in any district arrangements will be made, where possible, to utilise the service of existing officers." At the end of 1913 an important question was still unsettled, viz., as to whether these officials should be under the control of the Council of the area i.n which they work, or that of the County Council. Their title is most misleading as "nursing" will not be the function of these women. I note that some authorities are altering the title to " tuberculosis inspector " or " visitor." Conference on Consumption. The National Association held a Conference at the Central Hall, Westminster, on the 4th and 5th August. On behalf of Edmonton Councillors Cull and Williams with the medical officer of health attended. A report from these delegates appeared in the minutes of the Council of the gth September, 1913. The discussion on the use of tuberculin disclosed a decided difference of opinion as to its utility and left the laydelegates, at least, in considerable doubt as to the propriety of allowing the use of tuberculin in their areas. The programme for the second day stated that there would be a public discussion open to all delegates on " The need for the co-ordination of anti-tuberculous measures." Such a public discussion would have been extremely useful had it taken place, but much to the disappointment of the delegates it did not. 53 SECTION II B. COMMUNICABLE DISEASES—NON-NOTIFIABLE. We can partly judge of the prevalence of these diseases by the death returns. The deaths from measles have been 33 more than last year, and the deaths from whooping cough have been 14 less. The deaths from diarrhoea have been 35 more than last year; from influenza, 7, three more than last year. A better knowledge of the prevalence of these diseases is gained from the notifications received from the head teachers, when they are sent in fully and regularly to the Medical Officer of Health. (See Annual Report on Education.) DIARRHŒA. Fifty-four deaths occurred from diarrhoea and epidemic enteritis, as compared with 19, 145 and 22, for 1912-11-10. The death-rate from the disease is 0.81 per thousand of the population, as compared with 0.29 last year. Of these deaths, 41 occurred in children under one year of age, giving an infantile mortality rate for the year from this cause of over 22 per thousand nett births; the figures in 1912-11-10 were 8, 61 and 9 per thousand nett births. Deaths from diarrhceal 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 Woman Inspector is very useful. In June 100 posters were published all over the district, and general instructions given to the Engineer and myself tc take such steps as may be necessary to check the spread of infantile diarrhoea. I requested the Engineer to have certain roads specially watered and gave him a list of the streets which were mostly affected in 1911. A circular was received from the Local Government Board on this subject on the 28th July, 1913. This arrived in time to be submitted to the Sanitary Committee on the 3rd September! We have for some years past carried out the measures indicated in this circular. Weather. This is best referred to here, as our figures shows its effect on infantile diarrhœa. The heat was more pronounced than last year, and prolonged into the autumn, so that only 31 out of the 54 deaths occurred in the third quarter and nine more in October. 54 MEASLES. There were 48 deaths noted, compared with 15, 31 and 3, in 1912-11-10. This number of deaths is equal to a death-rate from measles of 0.72 per 1,000 living. Eleven occurred in the first-age period (under one year), 20 in the second age (one and under two years), 9 in the third-age (two and under five), and eight over five years of age. All occurred in the first seven months of the year. In January this disease was epidemic in the district, especially affecting the infant departments at the National, Raynham Road and Silver Street schools. It began at the end of September, 1912, at the Eldon Road school, and by the end of January had worked its way south until all the schools were affected thereby. No schools were closed, but the infant departments were thoroughly disinfected. Several hundreds of special leaflets re measles were distributed by the Woman Inspectors, who visited the families attacked. WHOOPING COUGH. There were nine deaths from this cause, as compared with 23, 15 and 9, in 1912-11-10. This is equal to a death-rate from the disease of 0.14 per 1,000 living. All the deaths occurred amongst children under 15 years of age—none in the first-age period, 4 in the second, 3 in the third, and 2 in the fourth. Eight occurred in the first six months of the year. INFLUENZA. Seven deaths were registered from this cause, compared with 4, 3 and 3 for 1912-11-10. Two persons were over 65 years of age, and the others were beween 15 and 25 years old. Five were females. VENEREAL DISEASES. Syphilis. Three deaths were recorded as due to this disease; one of these was an infant under one year of age. Gonorrhoea. No deaths from this disease are recorded. As I have observed in previous Annual Reports, nothing is more misleading than the death returns of these diseases, 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. 55 OTHER DISEASES. Alcoholism. One death from this cause was recorded—a male in Church Street 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. Respiratory Diseases, including bronchitis, pneumonia, pleurisy, and other non-tuberculous diseases of the respiratory system, gave rise to 26 more deaths than in 1912. The figures are 140, giving a death-rate of 2.10 per 1000, compared with 114 and a death-rate of 1.75 for the latter year. Pneumonia, especially of the lobar variety, would be more correctly placed amongst the specific infectious diseases. In the Registrar General's manual such causes of death as "fibroid phthisis," "grinder's phthisis," are now classed amongst "other respiratory diseases." Table III. (old Table IV.) for 1913 is in the form according with the "Manual of Causes of Death," adopted by the Registrar-General for use in England and Wales from the International List. Cancer. Forty-eight deaths of persons belonging to the district were registered as being due to cancer, and this is equivalent to a death-rate of 0.72. The deaths during 1912-11-10 were 51, 55 and 33. In the table below, the deaths from cancer among residents only have been included, and the 48 deaths thus collected have been analysed according to the nature and position of the disease:— 56 CANCER, 1913. Seat of Disease. Carcinoma. Sarcoma. Cancer or Malignant. Total. M. F. M. F. M. F. M. F. Tongue 1a – – – 1 – 2 – Palate 1b – – – – – 1 – Pharynx 1 1 – – – – 1 1 (Esophagus 2 1f – – 1 – 3 1 Stomach and (or) Pylorus 3d 5ceg – – – 1g 3 6 Liver 1 4 – – – – 1 4 Pancreas 1a 1 – – – – 1 1 Rectum 3 5 – – 1 – 4 5 Colon 1 – – – – – 1 – Cœcum – – – – – 1 – 1 Ovary – 1 – – – – – 1 Pelvis – 1 – – – – – 1 Kidney – – 1 – – – 1 – Abdominal Glands 1 – – – – – 1 – Breast – 2h – – – – – 2 Uterus – 3 – – – – – 3 Vagina – – – 1 – – – 1 Vulva – 1 – – – – – 1 Tibia – – – 1i – – – 1 Total 15 25 1 2 3 2 19 29 a Secondary in Cervical Glands. b Do. Tongue and Throat. c Do. Omentum. d Do. Peritoneum. e Do. Liver and Transverse Colon. f Do. Neck. g Do. Liver. h Do. Liver and Pleura. i Do. Sacrum and Lung. 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 re-current, the original seat of the disease should also be given first. If there had been an operation, the date of it would be of great interest. 57 SECTION III. SEWERAGE AND DRAINAGE. I am much indebted to our Engineer and Surveyor, Mr. Cuthbert Brown, for his kind help with this section. There are 3 earth closets in the district, 1 pail closet at a cottage and 16 pail closets at a factory. Otherwise the whole of the district is provided with water closets. 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 235 acres, where it is treated by broad irrigation. Mr. Frank Rackham is the farm bailiff. The population whose sewage is treated on this farm, consists of 98,409 persons according to the last census; that is 64,797 persons in Edmonton and 33,612 in Southgate Urban district. The Sewage Farm. The whole of the 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 sewage which comes from the district of Southgate is brought by three main sewers to the Edmonton Boundary. The two Councils have agreed on terms which do away with the necessity of any monthly gaugings of the flow of sewage from Southgate into Edmonton. 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 Cambridge main line of the Great Eastern Railway and those in the district adjoining Tottenham. The sewage is delivered at the farm into an underground reservoir of a capacity of 2,000,000 gallons, and is lifted into three subsiding tanks of a total capacity of 600,000 gallons. The sludge from this reservoir and the tanks is periodically pumped out on to the land, where (after drying) it is ploughed in. In February the Allotment Holders' Association made an offer to take the sludge on to their ground. The sewage then flows by gravitation over the northern portion of the farm for preliminary treatment, and it is afterwards taken by carriers to a gravel pit of an area of 3½ acres for further purification before being allowed to pass down the effluent channel into the River Lea. In addition to the works which I have enumerated, there is a low-level pumping station at Angel Road, which 58 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 Road and the railway. The effluent is examined by the analysts of the Lea Conservancy Board and the Middlesex County Council at frequent but irregular intervals. In February the Engineer reported that there was a considerable difficulty in dealing with the effluent from the Tottenham and Edmonton Gas Company's works. On the 19th February it was resolved that the Clerk and Engineer "be directed to serve statutory notices upon the Tottenham and Edmonton Gas Company under section 68 of the Edmonton Urban District Council Act, 1898, and section 17 of the Public Health Acts Amendment Act, 1890." The company has established a filtration plant which it is hoped will improve the quality of this trade effluent. On the 25th March the Council were informed that the first filter bed near the Pegamoid factory was nearly finished, and that when complete, it would satisfactorily treat one and a half million gallons of sewage every 24 hours. It was started on the 9th June. In October another bacteria bed adjoining Deepham's Farm was commenced which will be 150 feet long by 100 feet wide. By this time the first bacteria bed near the gravel pit was working satisfactorily and producing a very good effluent. It was decided in May to remove the ventilation shaft at the junction of Bury Street and Hertford Road. The sewage farm of the Enfield Urban District extends over 109 acres, and is entirely situate in Edmonton, lying to the north of our own farm. There are five bacteriological filters. House Refuse Disposal. Edmonton does not possess a destructor. During the winter the house refuse was shot on the brickfields of Mr. Piggott, north of Bury Street, for which he paid 1/6 per load, and he let the Council shoot the refuse there for a little further time until the sleeper road was relaid. In September arrangements was made with the same gentlemen to receive the house refuse for the winter, 1913-14. In the same month the tender of Mr. E. Knifton for the collection of house refuse, for the year ending September 30th, 1914, at the price of £1,228 was accepted. On the 25th November, a deputation presented a petition signed by residents of Bury Street neighbourhood alleging that serious illness was due to the accummulation of house refuse on the brickfields. This was considered by the Sanitary Committee at their December meeting and they reported that the statements of the deputation could not be substantiated. 59 SEWAGE DISPOSAL IN THE ;LEA VALLEY. On January 14th my Council decided to withdraw from the Lea Valley Joint Sewage scheme, which, with provision for disposing of storm water, is estimated by our Engineer to cost ,£370,000. As I said last year, what is needed is a more comprehensive scheme than those which have been considered, which shall include not only Enfield, Southgate, Edmonton, Walthamstow and Leyton, but also Finchley, East Barnet Valley, Friern Barnet, and perhaps Hendon Urban District. This is worth waiting for and should receive the cordial support of all these local authorities and the Local Government Board. At the end of February Leyton was desirous of the Edmonton Engineer joining a conference to consider a scheme of Mr. Essex, the Leyton Engineer. A letter dated 17th April was received from the Local Government Board expressing the hope that our Council would instruct our Engineer to confer with those of Enfield, Leyton, Southgate, and Walthamstow. Our Engineer prepared a report on the 13th May, and in reply to the Local Government Board's letter, copies of this report were sent to the Board and the other local authorities ; but our officer did not confer. ROADS. The following private streets have been made up during the year under the 1892 Act:—Park Avenue (from Queen Anne's Place to Queen Anne's Grove), Sunnyside Road North, East and South, Seymour Road (and flank to Monmouth Road), Beamish Road (part of), Junction Road, Kenwood Road, and Cornwallis Grove—a total length of 1,676 yards taken over for future maintenance at the public expense. During the past year the tar dressing of the roads has been considerably extended, which has assisted to mitigate the dust nuisance and make the houses on either side of the roads more habitable. During 1913 our Engineer's attention has been devoted to endeavouring to complete the road widenings at Bury Street (near the Nurses' Home) and Montagu Road, and the widening of Angel Road and Town Road by taking in the forecourts of the small houses. On the nth November it was resolved that application be made to the Local Government Board for sanction to a loan of £2,000 for resurfacing The Green, Edmonton. During the winter of 1912-13 the unemployed have been busily engaged in connection with the culverting of Montagu Road boundary ditch from Bounces 60 Road to the Council's weighbridge house. During the winter of 1913-14 Pymmes Brook alongside the gas works is being covered in at a cost of £ 3,000. Obstructed Highways. I am happy to record that the case I mentioned in my report for last year has been so dealt with by the Works and Highways Committee that the well-known corner can now be negotiated safely without danger to the life and limb of the passer-by. There are other cases worth notice, although not as flagrant. WATER SUPPLY. The district generally is supplied by the Metropolitan Water Board (New River area). The only house for which the public supply is not at present available is a farmhouse in Firs Lane; there is also one group of forty-five houses supplied by shallow wells about 20 feet deep. Samples of the water in these wells are taken at intervals. The water supply of Messrs. Ridley and Whitley's factory is taken from the River Lea, and purified on the premises before use. At Eley's works a water of excellent quality is obtained from an artesian well 400 feet deep. The water which the Lea Conservancy Board controls runs from Hertford to Limehouse. They also took over the Stort navigation in 1912. In February Mr. Cornish presented a report on the work of this Board for the nine- months ended December 31st, 1912. He there states that during a considerable part of the year the river was in flood owing to the abnormal rainfall. Steady progress is being made putting in order the Stort navigation, the control of which the Board took over on September 1st, 1912. During the period reviewed Mr. Young, the chemist of the Board, had analysed 177 samples of river water, sewage or sewage effluent, of which 51 were found to be excellent, 60 good, 29 fair, 21 bad, and 16 very bad. With reference to the latter 14 notices were served. During the same period 36 carcases of animals were removed from the river Lea above the intake and 911 below. Mr. Cornish reports that the town of Hertford is pressing forward with a new scheme of sewage disposal. The new reservoir at Chingford close to our N.E. corner was opened by the King (George V.) on 15th March. MARKET ON THE GREEN.—THE COSTERS. This matter has been, throughout the year, in a state of suspended animation. The stall-holders in Leeds Street, Upper Edmonton, and adjoining streets give us the same trouble as those on The Green, but to a smaller extent. 61 On the 13th May it was reported to the Council that notices had been served on a number of shopkeepers and stallholders on The Green with reference to the nuisance arising from the deposit of shop refuse, sawdust, etc., on the carriage way. On the 30th June two letters were submitted to the Works Committee complaining of the nuisance of costers' stalls and the smell of fish offal therefrom in Leeds Street. On the 8th of that month the Council instructed the Inspector of Nuisances to see all the costers in Edmonton streets with a view of abating the nuisances and to inform them that, unless the nuisance was abated, the police would be communicated with as to the removal of the stalls. The Inspector reported to the Sanitary Committee on the 3rd September that he had interviewed most of the costers and that they had agreed in future to remove the refuse. He stated that the greatest nuisance arose from fish stalls, the owners of which he had informed that they must make provision for the collection of fish washings. Otherwise these horrid fish washings are emptied down the gullies into the surface water channels and so pollute Salmon's Brook. At the meeting of the Works Committee on the 1st December the Engineer submitted a complaint from the Middlesex County Council with reference to the surface water which flows from The Green into Salmon's Brook. Unsound fish was seized by the Chief Inspector exposed for sale on a coster's stall on The Green, and on the 12th June defendant was fined 20s. and costs. 62 SECTION IV. HOUSING ACCOMMODATION. The Census returns show that on April 2nd, 1911, there were 11,023 dwellings (12,491 separate occupiers), 763 unoccupied, and 27 in the course of erection in the district. During 1913 the Alcazar cinematograph and winter gardens was opened on 28th June; it was erected on the site of Eagle House where future Lord Mayors of London and M.P.'s were educated. Building By-laws. The Council's "By-laws with respect to the New Streets and Buildings" were revised in 1904, and sealed by the Local Government Board on the 8th June, 1904. Any contraventions of By-law 113 are reported to the Plans Committee by the Architect, and all correspondence and particulars connected with the contraventions are laid before them. The Committee then decide whether they shall recommend to the Council the prosecution of the offenders. During 1913 the Architect reported one contravention, but no legal action was taken thereon. No prosecutions have taken place since 1907. On September 25th, 1912, a letter of 29th August, 1912, from the Local Government Board, was submitted to the Plans Committee, which suggested the modification of existing by-laws with reference to buildings in re-inforced concrete, etc., in order to make provision for the new methods of building; a copy of the model by-laws was enclosed. In the Council's minutes of 24th June, 1913, are printed clauses which our Engineer and Architect recommend be added to our present by-laws. This left the important question of paving round a stable still unsettled. In the minutes of September 9th, it is reported that these two officers had conferred with the Local Government Board officials, with the result that the Council were advised to further consider the matter with a view to adopting an amended form of building by-laws in their entirety, and annulling altogether the existing by-laws. Housing Inspector. Mr. A. E. Day began his important duties on May 1st, 1912. He was succeeded by Mr. H. K. Nixon on the 17th March, 1913. As I have said in former years, there is plenty of work in this district for an industrious and conscientious Fourth Male Inspector, and the appointment of such a man will lead to a great improvement in the housing conditions of Edmonton. 63 INSPECTION OF PREMISES. Number of premises inspected on complaint 260 Number inspected in connection with infectious disease 622 Number under periodical inspection 539 Houses inspected 317 Total number of inspections and re-inspections made 15,198 ACTION TAKEN (OTHER THAN UNDER H. & T. P. ACT):— Cautionary or intimation notices given 5,948 Statutory orders issued 448 Summonses served 1 Convictions obtained 1 HOUSING REGULATIONS, 1910. ARTICLE V. Number of dwelling houses inspected under Section 17 of the H. and T. P. Act, 1909 1 Number of them considered dangerous and injurious, so as to be unfit for human habitation 1 Number of representations made to local authority with a view to making of closing orders 1 Number of closing orders made 1 Number of houses where defects were remedied without making of closing orders Nil. Number of houses where defects were remedied after making * closing order 16 The general character of defects See below* Number of premises closed voluntarily 7 Number of premises demolished voluntarily:— (a) Without closing order 1 (b) After closing order Nil 1 Illegal underground rooms vacated Nil. Number of premises dealt with under Section 15 of the H. and T. P. Act, 1909 Nil. Number of houses on which closing orders existed at end of year 1 There is a sufficiency of houses in the district for artizans and labourers. Edmonton, in the opinion of many ratepayers, has done more than its share to provide such dwellings; hence its high rates. '' Let other London suburbs take their part in catering for the working classes," is their comment. * The defects found are too varied and numerous for inclusion in any tabular statement, but they are detailed in our register. 64 On the relative advantages of public versus private building, Mr. Nettlefold, the well-known Birmingham housing reformer, in his book on " Practical Housing," has some very weighty remarks:—" The housing question is very largely a personal question, and cannot be successfully dealt with in the wholesale fashion, which is the only way possible when Local Authorities insist upon themselves building the actual houses required, instead of being content, and wisely content, to encourage others to build houses on proper lines, keeping themselves free to supervise and control what is done, which is, after all, their first and most important function." As a local authority aspires to be a model employer, so if a Council ventures into the building arena, it should build homes of such a character that they would be models for the private builder. I have recently seen municipal plans for dwelling houses in a neighbouring district that would make any "Jeremiah " blush with emulation. In an address which I delivered to the Institute of Sanitary Engineers on March 17th, I gave the following conditions showing my ideal workman's house, and these do not include anything usually required by the by-laws of the local authority. 1. No plot of land less than 20 feet frontage and 50 feet deep from the back of the house. 2. Every chimney in an inner wall. 3. A larder with openable window—on the north side if possible. 4. Each house with a backway, or sideway; so that coals may be taken in and refuse taken out by some way other than the front door. 5. A coal house and moveable dustbin in the backyard. 6. No quarters for animals within ten feet of the house. 7. Every room properly ventilated. 8. Not less than three bedrooms—the abolition of the "best parlour." g. A bath in the scullery. 10. A branch from the water main over the scullery sink. Overcrowding. During the investigations made by myself and staff into the origin of infectious diseases, many cases of overcrowding came to light. 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 65 the remainder, an informal notice, proved sufficient to produce abatement. Particulars of overcrowding, unconnected with infectious diseases, are to be found in the report of the Chief Sanitary Inspector. London County Council White Hart Lane Estate is mainly in Tottenham, but partly in Wood Green and Edmonton Urban Districts. About 35 acres of it are in Edmonton. CLOSING ORDERS. Sweet Briar Cottage.—A closing order was made on the 10th June under section 17 of the Housing and Town Planning Act 1909. Twenty-one days' notice to quit was given to the tenant in September, and in October it was reported that as soon as the tenant left the premises should be demolished. As the notice to quit was not complied with, in November it was decided to take the necessary proceedings under section 17 (4) to compel the occupier to quit the premises. In December the occupier was reported as removed to the Edmonton Union Infirmary, so that further proceedings are for the present stayed. St. Mary's Gardens—On the 13th May the Council decided to terminate the closing orders under section 17 (6) of the Housing and Town Planning Act with reference to Nos. 61, 62 and 63, as these premises had been made fit for human habitation. Other closing orders were also determined as follows:—On the 24th June with reference to Nos. 45 and 60; on the 8th July, Nos. 53, 58 and 59; on the 26th August, Nos. 56 and 57; on the 9th September, Nos. 51 and 52; and on the 14th October, Nos. 47, 48, 49 and 50. All these 16 houses were closed by order of the Council on 12th November, 1912. The Inspector reported to the Sanitary Committee on the 5th February that the cottage in Eaton Place belonging to the late Mr. Plummer had been demolished by his friends. TOWN PLANNING COMMITTEE. There were only two meetings held during the year. At the meeting on the 26th February the Engineer reported that the whole of the plans necessary for making an application to the Local Government Board to prepare a scheme were completed. The Committee recommended the appointment of an assistant, capable of preparing data for a town planning scheme, at a salary of £140 per annum; this assistant to prepare notices and private apportionments under the Private Streets Work Act and to carry out the whole of the referencing and surveying details in connection with the housing and town planning scheme, and to assist in the general office work of the Engineer, 66 The second meeting was held on the 28th April, 1913, and 49 applications for the new post were considered, and out of the three selected, Mr. James Hembrow, of Chelmsford, was selected by the Council on the 13th May, and began his duties on 16th June, 1913. TOWN PLANNING CONFERENCE. This Conference, convened by the National Housing and Town Planning Council, was held at the Westminster Palace Hotel on May 27th and 28th to consider practical town planning. It was attended by representatives of the London County Council and the suburban authorities within 15 miles radius of Charing Cross. The subjects discussed were (1) arterial roads and (2) open spaces; the general feeling of the meeting was that in matters of this kind, co-operation between the London County Council and the suburban authorities was absolutely necessary, and that they had every reason to look for financial and legislative support from the Government of the day, whatever its politics. The following important resolution was passed, viz.:— "That this Conference begs to represent to the Prime Minister and the President of the Local Government Board, that the Public Departments, which can by means of their powers co-operate and assist in the framing of town planning schemes and the provision of arterial roads, be asked to confer with the local authorities in Greater London collectively and give their assistance in every way possible in preparing town planning schemes for that area, and that the Prime Minister and the President of the Local Government Board be asked to receive a deputation from this Conference to urge more explicitly the necessity for such consultation." Following this Conference, on the 3rd July a deputation from the National Housing and Town Planning Council (including our Engineer and Councillor Cadman) interviewed the Prime Minister and Mr. John Burns, the President of the Local Government Board, with a view of securing co-operation and assistance (financial) in the making of schemes and provision of roads. On the reception of the deputation, four speakers selected from the north, south, east and west of Greater London gave their views, our Engineer speaking for North London. The Prime Minister in reply suggested that Local authorities should confer with the Local Government Board, and agree to take Mr. Burns as their mediator in regard to the matter, and they would try to arrange a plan for co-operation. Our Engineer pointed out that whilst the Traffic branch of the Board of Trade were anxious that main arterial roads 100 feet wide should be a feature of any town plan of Greater London these authorities were not 67 assured of any financial assistance towards the great expense that would have to be incurred in making roads that were too expensive from merely a local point of view. He urged that it was absolutely necessary that the lines of these roads should be definitely fixed, if the town planning of Greater London was to be homogenous, and that it would be a mistake to allow 80 districts to act independently of each other. Edmonton is especially interested in this question because the proposed new Cambridge highway extends from north to south of the district, a distance of 2½ miles, and the great east to west road, from Finchley to Wanstead, the same distance. It appeared to Mr. Brown that some central Government authority should be set up to deal with this huge problem. He suggested that the Government might perhaps draw up a scheme acceptable to the 80 local authorities within a radius of 15 miles of London, which would not only benefit them, but the City and County of London. In August the Local Government Board wrote stating that the President of the Local Government Board had consented to preside at a Conference of local authorities, and on the 25th August Councillor Cadman and the Engineer were appointed to represent Edmonton. This Conference met in October when it was decided to split the Greater London area into sections, with a view to the consideration of town planning in relation to the proposed arterial roads. So Mr. T. Adams, of the Local Government Board, and Colonel Hellard, of the Traffic Branch of the Board of Trade, mapped out these sectional areas. Since then each section has met for discussion. Edmonton is concerned in both the north-east and north sections. TRIENNIAL INTERNATIONAL CONGRESS. The tenth of this series was held at Scheveningen, the seaside suburb of the Hague, Holland. As in 1910 at Vienna, so in 1913 I attended (at my own expense and in my own time) as one of the 80 British delegates to the Congress. There were about 700 delegates present from all parts of the civilised world, but the British was the largest group. This was organised by the National Housing and Town Planning Council, of 41, Russell Square, London, W.C. Four subjects were submitted for consideration:— 1. The improvement, or clearance, of slums. 2. The improvement of rural housing. 3. Overcrowding, its definition and prevention. 4. Town planning; the power of local authorities to make and enforce schemes. The Congress of 1916 will be held in Rome. 68 MIDDLESEX COUNTY COUNCIL From report of Licensing Committee, 29th January, 1914. List of Persons holding Licenses of the Middlesex County Council for Music, Dancing, Stage Plays, or (and) Cinematograph Displays:— EDMONTON PETTY SESSIONAL DIVISION. PARISH OF EDMONTON. The numbers in brackets give the accommodation provided. M.—Music. D.—Dancing. S.P.—Stage Plays. Cin.—Cinematograph, 1. Ainsley, Allan Jacks, "The Golden Lion," Hertford Road. M. (136.) 2. Andrews, Horace Edward, " The King's Hall," Hertford Road. M. and Cin. (290.) 3. Bawn, Harry, "The Empire" Theatre. M., D., S.P. and Cin. (1,432.) 4. Chattey, Robert S., "The Two Brewers" grounds, Silver Street. M. 5. Cheeseman, Rev. J., St.Edmund's Hall, Millbrook Road. M. and D. (270.) 6. Dubowski, A. Davis. "The Theatre Royal." M., D., S.P. and Cin. (637.) 7. Garnett, Herbert Ralph, " The Blue Anchor," Angel Road. M. (60.) 8. Heap, Arthur, Raynham Road School. M. and D. (472.) 9. Henley, D. W., Cinema Theatre, Fore Street. M. and Cin. (580.) 10. Horlock, Robert, The New Hall, Knights Lane. Cin., M. and D. (411.) 11. Jones, Rev. H., St. James' Parish Hall, Gilpin Grove. M. and D. (387.) 12. Leigh, Samuel, "The Globe," Upper Fore Street. M. (60.) 13. Middleton, Wm. F., "The Golden Fleece," Fore Street. M. and D. (113.) 14. Payne, William Francis, The Town Hall. M., D. and S.P. (603.) 15. Pritchett, George P., All Saints' Parish Room. M., D. and S.P. (385.) 16. Rollason, C. A., " The Alcazar," Fore Street. M., D. and Cin. (841.) 17. Ryan, Rev. W. S., St. John's Church Hall, Dyson's Road. M. and D. (475.) 18. Sanders, Rev. E. A. B., " Charles Lamb " Memorial Hall. M. and D. (350.) 19. Sanders, Rev. E. A. B., St. Alphege Church Hall. M. and D. (300.) 20. Skinner, Rev. Thomas Henry, St. Michael's Church Hall. M. (520.) 21. Skinner, Rev. Thomas H., The Bassishaw Hall, Bury Street. M. and D. (400.) 22. Tattersall, Rev. S. O., Wesleyan Central Hall. M. (1170.) 23. Yates, Rev. E. Selwyn, St. Peter's Church Hall. M. and D. (312.) The Standing Orders of the Middlesex County Council, with reference to the provision of sanitary conveniences for Public Halls, are now under revision. 6g Alcazar. In September, on the recommendation of the Plans Committee, a strong protest was sent to the Middlesex County Council Licensing Committee that this place of entertainment should be allowed to be opened to the public before it had been completed and approved by the local sanitary authority, in contravention of building by-law 115. The Plans Committee further considered this contravention on the 10th September, and it was decided to take no further action. On the 14th October a reply was submitted from the Clerk to the County Council stating " That no license has yet been issued in respect of the premises, but that your protest would be submitted to the Licensing Committee." A temporary license had been issued on June 26th, 1913. On August 27th, the Architect was instructed to prepare a return showing the seating accomodation in the various places of amusement in the district. His report was presented to the Plans Committee on the 29th October. The County Council administers the following Acts of Parliament and By-laws in this district. Acts. By-Laws or Regulations. The Midwives, 1902. Food and Drugs, 1875-1907. Weights and Measures, 1878-1904. Weights and Measures (R), 1907. Sale of Coal (B). Explosives, 1875. Margarine, 1887. Butter and Margarine, 1907. Bread Acts, 1822 and 1836. County of Middlesex (General Powers), Employment Agencies (B). 1906 (Part iv.). Fertilisers and Food Stuffs, 1906. Merchandise Marks (when occasion requires). Poisons and Pharmacy, 1908. Inebriates', 1879-1898. The Public Health (Milk and Cream) Regulations, 1912. The powers of the County Officers as regards the by-laws made under the "Employment of Children Act, 1903," and as regards the employment of children in public entertainments under the "Prevention of Cruelty to Children Act, 1904," section 3, only extend to those parts of the County which are under the County's control in reference to elementary education. Edmonton is not. 70 SECTION Y. LEGISLATION OF 1913. ACTS, CIRCULARS, ORDERS, REGULATIONS. The Mental Deficiency Act comes into force on April 1st, 1914. This Act during its passage to the Statute Book met with considerable opposition from Members of Parliament and others, who regarded some of its provisions as an interference with the liberty of the subject. To this class of people liberty means unbridled license, each man to do as he pleases, regardless of his neighbour's comfort and welfare. For further remarks see the section on "Education." The Fabrics (Misdescription) Act. The title itself is, curious to state, a "mis-description." It is better known as "The Flannelette Act," and is designed to prevent the sale of this material, or any other textile fabric, as "non-flammable," if, on testing a piece thereof in a stated manner, it takes alight. This is the outcome of protests from countless coroners' juries and a report from a departmental committee of the Home Office issued as long ago as August, 1910. The penalties are heavy, i.e., £10 for the first offence and £50 for subsequent offences. Male or female inspectors are to be appointed by the Local Sanitary Authorities with power to institute and carry on proceedings. It comes in force on 1st April, 1914. The National Insurance (Amending) Act. This amends parts I. and III. of the Act of 1911. One important amendment secures the maternity benefit to the mother who may authorise the husband to receive it, but he must hand it over to his wife. More money is supplied by the Government, out of which the societies are to provide medical attention for their non-insured members. The National Insurance Act, 1911, came into force as regards payment of contributions by employed and employers and sanitorium benefits on July 15th, 1912, but as regards medical benefits not until January, 1913. Part I. is entitled "National Health Insurance"; Part II. "Unemployment Insurance"; Part III. contains some general provisions. Altogether there are 115 sections in this important measure, whose provisions are both complex and novel. Shops Act, 1913. This short Act amends the Act of 1912 in its application to premises for the sale of refreshments. 71 Public Health (Prevention and Treatment of Disease) Act, 1913. This is a very short one, but of great importance. Section I enables the Local Government Board by Order to authorise a local authority, notwithstanding section 281 of the Public Health Act, 1875, to exercise the powers of a joint hospital board as regards infectious diseases in the local authority's area. Section 2 empowers County Councils to execute and enforce regulations regarding epidemic diseases made by the Local Government Board under section 130 of the Public Health Act, 1875, as if it were a local sanitary authority. Section 3 empowers a County Council or any sanitary authority to make arrangements, subject to the approval of the Local Government Board, for the treatment of tuberculosis. Disinfectants Order. An Order of His Majesty's Council, dated nth October, 1912, was sent to Local Sanitary Authorities with a circular letter of 14th April, 1913, from the Local Government Board. This Order applies section 5 of the Poisons and Pharmacy Act, 1908, to certain liquid preparations containing less than 3 per cent. of phenols (e.g. carbolic acid). The container must be labelled "poisonous" or "not to be taken," and have the name of the substance thereon and the name and address of the seller. The penalty for each offence is £5. The letter states the opinion of the Board that the precautions used by retail sellers should be used in the gratuitous distribution of disinfectants by a local sanitary authority. Tuberculosis Order of 1913. This Order is dated 13th February, 1913, and issued by the Board of Agriculture with a circular letter, dated 17th February, 1913, addressed to local authorities under the Diseases of Animals Acts, 1894-1911. It came into operation on 1st May, 1913. It aims at "securing destruction of every cow found to be suffering from tuberculosis of the udder, or to be giving tuberculous milk, as well as of all bovine animals which are suffering from tuberculosis with emaciation, since these are known to disseminate freely the germs of the disease." The tuberculin test may be applied by the veterinary surgeon, subject to the written consent of the owner. This officer may take samples of urine, feces, milk, etc. 72 Compensation is payable by the local authority for a slaughtered animalits full value, and 20s. more if no tubercle is found on post-mortem—otherwise in proportion to the extent of the disease found.— The local authority, as in the act of 1894, is the Corporation of London or the boroughs of 10,000 population and upwards at the census of 1881. Precautions are to be taken with regard to the milk which comes from any cow which is, or appears to be, suffering from chronic disease of the udder or tuberculosis with emaciation. Suspected animals exposed for public sale can be dealt with by the veterinary inspector of the Authority. Publications on Tuberculosis. In March, 1913, the Departmental Committee issued their final report in two volumes. Their interim report, it will be remembered, was presented in April, 1912, and was chiefly concerned with the machinery suggested for the treatment of the disease. In this final report the Committee deal mainly with the measures which should, in their opinion, be taken for the prevention of tuberculosis in general, and a scheme for establishing special research work on the subject. The Committee gave it as their opinion that bovine tuberculosis is the cause of tuberculosis in man and to a greater extent in children, to whom it could be conveyed in the milk supply. The Committee therefore consider it very important that steps should be taken with a view to the ultimate eradication of tuberculosis from animals and rendering milk and milk products, as far as possible, free from tubercle bacilli. At the beginning of the year the "National Association for the Prevention of Consumption and Other Tubercle" issued a circular letter to local authorities on the subject of after-care of patients who had been in sanitoria. 73 SECTION VI. PLACES OVER WHICH THE COUNCIL EXERCISE 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. 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, and the Edmonton Workhouse and Infirmary are visited from time to time by Mr. Croasdell, Superintendent of our Fire Brigade, who, on request, tests the fire appliances. 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. Sidney Charles Slater has been registered under section 69 of the Public Health Acts Amendment Act, 1907, as keeper for one year. Mrs. Denning is about to take charge here. 3. Houses Let in Lodgings. The by-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 entails a vast amount of work at the first, and later on, owing to the constant changes taking place in this class of house, a good deal of time is devoted by the Housing Inspector—both out-of-doors to supervision of the tenements, and in the office to keeping the register correct and up-to-date in its formation. On the 3rd December, it was reported to the Sanitary Committee that Mrs. Denning had purchased Nos. 62a, 64a and 66a, Bridport Road and was letting them in furnished lodgings. On December 9th, the Council instructed the Clerk to give notice to the owner under No. 7 of the tenement by-laws, requiring her within a period of 7 days to furnish the Council with the required particulars for our register. 5. Slaughter-Houses. There are seven on the register, one of old registration, one who had a seven years' license granted him in 1908, and five with licenses renewed annually. Four annual licenses were renewed at the beginning of April. 5. Knackers. This trade was placed under new and stringent regulations by the "Protection of Animals Act, 1911," which came into force on January 1st, 1912, 74 6. Pigs. The sewer, in January, became blocked in Milton Road, and it was found to be due to solid matter coming from a piggery adjacent to a slaughterhouse in Langhedge Lane. After the blockage had been relieved the future chance of further blockage was prevented by the placing of a large catchpit on the drainage of this establishment. On the 22nd April plans were passed for two pigstyes on plot 94 of the Weir Hall allotments. Plans were passed in June for two pigstyes on plot 78 of Weir Hall allotments. In September three tenants in Sebastopol Road were found to be keeping pigs within 150 feet of a dwelling house and were given until Christmas to abolish them. 7. Dairies, Cowsheds and Milkshops. There are only two cowkeepers now in the district, the same as last year; and only 33 cows are owned by these keepers. Veterinary inspection of the cows is not undertaken in this district, either by my Council or the County Council. There were 96 purveyors of milk on our register at the end of the year. The President of the Local Government Board once more brought a Milk Bill before Parliament, but it did not reach the Statute Book. In November, the Edmonton Co-operative Society of Shrubbery House, Fore Street, was registered under the Dairies, Cowsheds and Milkshops Order. 8. Unsound Food. Inspectors Winter, Coates, 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 near Angel Bridge. Concerning seizure of unsound fish, see "Market on The Green." 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 the County Chemists. 9. Offensive Trades. Gutscraper. On the 26th August the Council sealed the new by-laws for the regulation of the offensive trade of gutscraper in Edmonton Urban District and they were confirmed by the Local Government Board on 15th September. 75 FACTORY AND WORKSHOP ACTS. WORK DONE DURING 1913. Outworkers' Premises— Overcrowding 0 Rooms cleansed 6 Walls and ceilings repaired 4 W.C. flushing cisterns repaired 6 W.C. flush pipe joints repaired 5 Joint between W.C. pan and trap repaired 1 W.C. pans cleansed 1 New W.C. pans fixed 1 Gully fixed in lieu of defective "lip" trap 1 Sink waste-pipe repaired 1 Fender constructed to gully 1 Water fittings repaired 4 Proper ventilation provided 2 New dust bins supplied 6 Yards repaved or repaired 4 Roofs repaired 5 Rain-water pipes repaired 2 Eaves' gutters repaired 1 Dampness remedied 2 — 53 Workshops and Workplaces— Workshops cleansed 7 Privy accommodation provided 1 Privies cleansed 1 New privy constructed 1 W.C. flushing cisterns repaired 4 W.C. pans cleansed 2 W.C. flush-pipe joints repaired 1 Joint between W.C. pan and trap repaired 1 Sink waste pipe repaired 1 Drains unstopped 2 Walls and ceilings repaired 1 Proper ventilation provided 1 Workshop of dilapidated wooden structure demolished 1 Cover supplied to water cistern 1 Water supply taken from main direct 1 New dust bin supplied 1 Yards repaved or paving repaired 3 Accumulations of refuse removed 3 — 33 76 Factories— Sufficient W.C. accommodation for females provided 1 Urinal accommodation for males provided 1 W.C.'s cleansed 19 W.C. flushing cisterns repaired 5 W.C. flush-pipe joints repaired 1 W.C. doors repaired 2 Pail closets emptied and cleansed 11 Drains unstopped 1 Urinals cleansed 4 Additional lavatory-basin accommodation provided 2 Fire extinguishers provided 1 Fire hose provided 1 — 49 Bakehouses- Bakehouses limewashed and cleansed 13 Walls and ceilings repaired 1 Floors cleansed 2 Accumulations under troughs removed 2 Lighting improved 1 New bakehouse erected in place of old and dilapidated bakehouse, the use of which is now discontinued 1 Eaves' gutters repaired 1 Guily provided to surface water drain 1 W.C. flushing cistern repaired 2 W.C. pan cleansed 1 New dust-bins supplied 5 Accumulations removed from yards 6 Yard paving repaired 1 Keeping of fowls, ducks, etc., discontinued 5 — 42 Laundries— Overcrowding abated 1 W.C. flushing cisterns repaired 1 W.C. flush-pipe joint repaired 1 W.C. seat repaired 1 Sink-waste pipe repaired 1 Sink repaired 1 Sink-waste pipe unstopped 1 Fender of gully repaired 1 Floor repaired 1 New dust-bin supplied 1 — 10 Total 187 77 I.—INSPECTION OP FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by the Sanitary Inspectors (Male and Female.) Premises. Number of Inspections. Number of Written Notices. Factories ... (including Factory Laundries) 70 3 Workshops... (including Workshop Laundries) 309 17 Workplaces (other than Outworkers' Premises included in Part III. of this Report) Total 379 20 II.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Found. Remedied. Nuisances under the Public Health Acts: Want of cleanliness 16 13 Want of ventilation 5 3 Overcrowding ... 1 1 Want of drainage of floors — — Other nuisances 80 80 †Sanitary accommodation: Insufficient 1 3 Unsuitable or defective 61 72 Not separate for sexes 1 0 Offences under the Factory and Workshop Act: Illegal occupation of underground bakehouse (s. 101) – – Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 13 13 Other offences (excluding offences relating to outwork which are included in Part III. of of this Report) – 2 Total 178 187 † 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 have been enforced, and are those advised by the Home Office. 78 HI.—HOME WORK. NATURE OF WORK* OUTWORKERS' LISTS, Sec. 107. OUTWORK IN UNWHOLESOME PREMISES (Sec. 108). OUTWORK IN INFECTED PREMISES (Sees, 109, 110). Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made S. 110. Prosecutions Sections 109, 110. Sending twice in the year. Sending once in the year. Lists.† Outworkers.† Outworkers. Failing to keep or permit inspection of lists. Failing to send lists. Contractors. Workmen. Lists. Contractors. Workmen. Wearing Apparel— Making 2 ... 27 1 ... 4 ... ... ... ... ... ... 3 3 ... Cleaning and washing ... ... ... ... ... ... ... ... ... ... ... ... ... Leather work (gas meter bellows makers) ... ... ... 1 ... 18 I ... ... ... ... ... ... ... ... Total 2 ... 27 2 ... 22 I ... ... ... ... ... 3 3 ... * If an occupier gives out work of more than one of the classes specified in column 1, and subdivides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in columns 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. † The figures required in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarily be even numbers, as there will be two lists for each employer. The figures in columns 3 and 4 will usually be (approximately) double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated. 79 IV. REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. Workshops and Workplaces 63 250 Outworkers' Premises 187 Bakehouses 30 Laundries 10 Total number of Workshops on Register 290 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 Workshop Acts (s. 5, 1901). Notified by H.M. Inspector 3 Reports (of action taken) sent to H.M. Inspector 3 Underground Bakehouses (s. 101):— In use at the end of the year 1 80 TABLE I Vital Statistics of Whole District during 1913 and previous years. Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. Number.* Rate. Of Non-residents registered in the District.† Of Residents not registered in the District.† Under 1 Year of age. At all Ages. Number.† Rate. Number.* Rate per 1,000, Nett Births. Number.* Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1906 56,8l8 1,881 1,822 32.07 915 15.55 256 124 248 131.84 783 13.78 1907 59,434 1,923 1,857 31.24 977 15.89 309 124 225 121.16 792 13.32 1908 60,182 2,000 1,931 32.09 902 14.50 297 129 227 117.41 732 12.16 1909 61,164 1,871 1,803 29.48 890 14.09 325 110 182 100.39 675 11.03 1910 61,741 1,961 1,878 30.42 872 13.56 376 94 140 74.55 587 9.51 1911 63,146 1,921 1,847 29.25 1,219 18.68 489 100 265 143.48 830 13.14 1912 65,084 1,844 1,765 27.12 1,126 16.76 563 103 149 84.42 666 10.23 1913 66,552 1,912 1,862 27.98 1,184 17.31 501 111 196 105.26 794 11.93 Notes.—This Table is arranged to show the gross births and deaths in the district, and the births and deaths properly belonging to it with the corresponding rates. The rates in column 7 are calculated per 1000 of the estimated gross population, but as Edmonton is a district in which large Public Institutions for the sick or infirm seriously affect the statistics, the rates in Columns 5 and 13 may be calculated on a nett population, obtained by deducting from the estimated gross population the average number of inmates not belonging to the district in such institutions. * In Column 6 are included the whole of the deaths registered during the year as having actually occurred within the district. ‡ "Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. The deaths of persons without fixed or usual residence, e.g., casuals, must not be included in Columns 8 or 9, except in certain instances under 3 (b) below. The following special cases arise as to Transferable Deaths:— (1) Persons dying in Institutions for the sick or infirm, such as hospitals, lunatic asylums, workhouses, and nursing homes (but not almshouses) must be regarded as residents of the district in which they had a fixed or usual residence at the time of admission. If the person dying in an Institution had no fixed residence at the time of admission, the death is not transferable. If the patient has been directly transferred from one such Institution to another, the death is transferable to the district of residence at the time of admission to the first Institution. (2) The deaths of infants born and dying within a year of birth in an Institution to which the mother was admitted for her confinement should be referred to the district of fixed or usual residence of the parent. (3) Deaths from Violence are to be referred (a) to the district of residence, under the general rule; (b) if this district is unknown, or the deceased had no fixed abode, to the district where the accident occurred, if known; (c) failing this, to the district where death occurred, if known ; and (d) failing this, to the district where the body was found. Area of District in acres (land and 31 acres of inland water) 3,894 Total population at all ages 64,797 At Number of inhabited houses or tenements 12,491 I Census Average number of persons per house or tenement 5.00 of including Institutions 5.19) 1911 81 TABLE 11a—Vital Statistics of separate Localities and of the Edmonton and Strand Union Workhouses and Strand Schools in 1913 and previous years. Names of Localities. 1 2 3 4 5 6 7 Whole District. Bury Street. Church Street. Fore Street. Undistributed. Edmonton Union and Infirmary. 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 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. 1 Population estimated to 1 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 a 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 1 1906 56816 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 65‡ 267 73 19499 621 242 65 20736 656 211 73 .. .. 12 .. 932 88 311 12 1280 6 63 1 1909 61164 1871 675 182 20157 655 230 67 19677 577 219 68 21101 571 222 47 .. .. 4 .. 1019 87 344 19 1214 2 53 1 1910 61741 1961 587 140 20482 655 218 49 20022 623 181 42 20920 600 184 48 .. .. 4 1 1740 98 432 32 1139 5 48 .. 1911 63146 1921 830 265 21867 644 294 99 20192 632 265 87 21087 564 268 79 .. .. 3 .. 1342 103 579 63 1079 1 44 .. 1912 65084 1844 666 149 21500 578 264 63 22166 612 218 55 21418 570 183 31 .. .. 1 .. 1407 106 647 49 978 1 38 .. 1913 66552 1912 794 196 21823 658 260 73 22861 615 270 61 21868 575 261 62 .. .. 3 .. 1376 81 594 56 760 .. 36 1 Deaths occurring in public institutions of the district are dealt with in columns 6 and 7—a certain proportion of those in column 6 are former residents of Edmonton Urban District. 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. 82 TABLE II.—Cases of Infectious Disease notified during the year 1913. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward or Institution. Total Cases Remov'd to Hospital At all Ages. At Ages—Years. 1 2 3 4 5 6 7 Under 1 1 to 5. 5 to 15. 15 to 25 25 to 45 45 to 65 65 and upwds. Bury Street Ward Ch'ch Street Ward Fore Street Ward Edmtn. Union Resdnts. Edmtn. Union Total. Strand Union Undis tributed Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera (C) Plague (P) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 131 2 32 83 5 9 .. .. 34 54 43 .. .. .. 125 Erysipelas 52 2 3 2 9 9 23 4 30 14 5 .. 1 1 1 .. Scarlet Fever 429 4 64 315 36 9 1 .. 119 99 202 .. 9 .. .. 397 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 8 .. .. 2 2 2 2 .. 1 2 5 .. .. .. .. 8 Relapsing (R) or Continued Fever (C) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. .. 2 .. .. .. .. 1 1 2 .. .. .. Cerebro-Spinal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Poliomyelitis 13 .. 10 2 .. .. 1 .. 6 4 3 .. .. .. .. .. Pulmonary Tuberculosis 247 .. 5 26 44 133 37 2 91 76 74 .. 6 .. .. .. Other forms of Tuberculosis 75 3 11 39 12 9 1 .. 27 22 26 .. .. .. .. .. Totals 957 11 125 469 108 173 65 6 308 271 359 1 18 1 1 530 The figures take account of any corrections made as a result of error in notification or revision of diagnosis as a result of the further course of the disease. Isolation Hospitals, Sanatoria, &c.:— Enfield and Edmonton Joint Isolation Hospital at World's End, Winchmore Hill, is in the Urban District of Enfield. Clare Hall Small Pox Hospital and Sanitorium for consumptive persons. This is situate in the South Mimms rural district of Middlesex and belongs to 16 Middlesex districts. There is a building on Clavering's Farm, Edmonton, capable of taking ten male and six female Small-pox cases. 84 85 TABLE IIIa.—Causes of, and Ages at Death, during the year, 1913. 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 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Bury Street. Church Street. Fore Street. Undistributed. Edmon ton U nion. City of Westminster Union and School. Other Institutions. Totals. M F T 1 Enteric fever 1 1 2 ... ... ... ... ... 1 1 ... ... 1 1 ... 2 ... ... ... ... ... ... ... 6 Measles 25 23 48 11 20 9 8 ... ... ... ... 13 19 16 ... ... 2 9 ... ... 9 1 1 7 Scarlet fever ... 1 1 ... ... ... 1 ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... 8 Whooping cough 3 6 9 ... 4 3 2 ... ... ... ... 4 4 1 ... 1 ... ... ... ... ... ... ... 9 Diphtheria 9 6 15 ... 3 4 8 ... ... ... ... 4 4 7 ... 15 ... ... ... ... ... ... ... 10 Influenza 5 2 7 ... ... ... ... 1 2 2 2 2 3 2 ... 1 ... ... ... ... ... ... ... 18 Erysipelas 1 1 2 ... ... ... ... ... ... ... 2 1 ... 1 ... ... ... ... ... ... ... ... ... 24 Tetanus 1 ... 1 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... 26 Pellagra ... 2 2 ... ... ... ... ... 1 1 ... 1 1 ... ... 2 ... ... ... ... ... ... ... 28 Pulmonary tuberculosis 37 32 69 1 2 ... ... 12 32 21 1 23 20 25 1 6 19 76 1 ... 77 ... 2 20 Acute phthisis ... 3 3 ... ... ... 1 ... 1 ... ... 2 ... 1 ... 1 1 ... ... ... ... ... ... 30 Tuberculous meningitis 7 8 15 2 1 4 6 1 1 ... ... 4 7 4 ... 6 ... 1 ... ... 1 ... ... 31 Tuberculosis of peritoneum and intestines 4 7 11 5 1 3 ... ... 1 ... 1 5 4 2 ... 2 3 5 ... ... 5 ... 2 32 Tuberculosis of spinal column 2 ... 2 ... ... ... ... 1 1 ... ... ... 1 1 ... ... ... 2 ... ... 2 ... ... 34 Tuberculosis of other organs ... ... ...... ... ... ... 1 ... ... 1 ...... ... 35 Disseminated tuberculosis 2 1 3 2 ... ... ... ... 1 ... ... 1 ... 2 ... ... ... ... ...... ... ... ... 1 36 Rickets, softening of bones 1 ... 1 ... ... 1 ... ... ... ... ... 1 ... ... ... 1 ... 1 ... ... 1 ... ... 37 Syphilis 2 1 3 1 ... ... ... ... 1 1 ... 1 ... 2 ... ... 2 6 ... ... 6 ... ... 39 Cancer of the buccal cavity 3 ... 3 ... ... ... ... ... ... 2 1 ... ... 3 ... ... 1 9 ... ... 9 ... ... 40 Cancer of the liver, stomach, etc. 8 12 20 ... ... ... ... ... 1 16 3 6 7 7 ... 2 4 9 1 ... 10 ... ... 41 Cancer of the peritoneum, intestines, and rectum 5 6 11 ... ... ... ... ... 1 6 4 1 5 5 ... 3 2 18 ... ... 18 ... ... 42 Cancer of the female genital organs ... 6 6 ... ... 1 ... ... ... 3 2 ... 3 3 ... 1 2 3 ... ... 3 ... ...... 43 Cancer of the breast ... 2 2 ... ... ... ... ... ... 2 ... ... 1 1 ... ... ... 2 ... ... 2 ... ... 45 Cancer of other or unspecified organs 3 3 6 ... 1 ... 1 ... 1 1 2 1 4 1 ... 2 ... 4 ... ... 4 ... ... 46 Other tumours (situation undefined) 1 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... 47 Rheumatic fever 1 3 4 ... ... 1 2 ... 1 ... ... 2 1 1 ... ... ... ... ... ... ... ... ... 48 Chronic rheumatism, Osteo-arthritis, gout ... 4 4 ... ... ... ... ... ... 2 2 1 1 2 ... ... 2 1 ... ... 1 ... ... 86 87 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 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Bury Street. Church Street. Fore Street. Undistributed. Edmonton Union. City of Westminster Union and School Other Institutions. Totals. M F T 49 Scurvy 1 ... 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 50 Diabetes 3 1 4 ... ... ... ... 1 1 1 1 2 1 1 ... ... ... 3 ... ... 3 ... ... 53 Leucocythsemia, Lymphadenoma 1 1 2 ... ... ... ... ... 1 1 ... 1 ... 1 ... 2 ... ... ... ... ... ... ... 54 Anaemia, chlorosis 1 1 2 ... ... ... ... ... 1 ... 1 ... ... 2 ... 2 ... 1 ... ... 1 ... ... 56 Alcoholism (acute or chronic) 1 ... 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 3 ... ... 3 ... ... 61 Meningitis 4 5 9 1 2 2 3 ... 1 ... ... 3 3 3 ... 1 2 ... ... ... ... ... ... 62 Locomotor ataxy 1 1 2 ... ... ... ... ... ... 1 1 1 ... 1 ... ... 2 ... ... ... ... ... ... 63 Other diseases of the spinal cord 4 ... 4 ... 1 ... ... ... ... 2 1 2 1 1 ... 1 1 3 ... ... 3 ... ... 64 Cerebral haemorrhage, Apoplexy. 13 14 27 1 ... ... ... ... 2 15 9 11 10 6 ... 1 6 22 2 ... 24 ... 4 65 Softening of the brain ... 1 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... 66 Paralysis without specific cause ... 2 2 ... ... ... ... ... ... 1 1 ... ... 2 ... ... ... ... ... ... ... ... ... 67 General paralysis of the insane 3 1 4 ... ... ... ... ... 4 ... ... 4 ... ... ... 4 ... ... ... ... ... ... ... 69 Epilepsy 1 3 4 ... ... ... ... ... 1 2 ... 2 ... 2 ... 2 ... ... ... ... ... ... 1 71 Infantile convulsions 3 3 6 5 1 ... ... ... ... ... ... 3 2 1 ... ... ... ... ... ... ... ... 3 73 Hysteria, neuralgia and neuritis ... 1 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 74 Other diseases of the nervous system 2 1 3 1 ... ... ... ... 2 ... ... 2 1 ... ... 1 1 4 ... ... 4 ... ... 75 Diseases of the eyes and annexa 1 ... 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 76 Other diseases of the ears 3 ... 3 1 ... ... 2 ... ... ... ... 1 2 ... ... 2 ... ... ... ... ... ... 1 78 Acute endocarditis 7 5 12 ... ... ... 2 ... 3 3 4 5 3 4 ... 1 6 22 ... ... 22 ... 1 79 Organic disease of the heart 31 42 73 ... ... ... 2 2 5 24 40 20 25 27 I 5 26 69 3 ... 72 1 8 81 Diseases of the arteries, atheroma, aneurysm, etc. 8 11 19 ... ... ... ... ... ... 5 14 7 5 7 ... 3 7 47 ... ... 47 ... 7 82 Embolism & thrombosis ... 5 5 ... ... ... ... ... ... 3 2 2 2 1 ... ... 2 9 ... ... 9 1 ... 87 Diseases of the larynx 1 ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 89 Bronchitis 18 28 46 21 3 1 ... ... ... 4 17 9 18 19 ... ... 10 18 5 ... 23 ... 3 90 91 Broncho-pneumonia 24 18 42 30 6 5 ... ... ... 1 ... 16 14 12 ... 5 3 13 1 ... 12 ... 6 92 Lobar pneumonia and undefined 23 19 42 3 5 3 4 ... 11 11 5 12 16 14 ... 1 7 16 ... ... 16 2 6 88 89 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 1nstitutions. 1nquests in district on Residents. All ages Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Bury Street. Church Street. Fore Street. Undistributed. Edmonton Union. City of Westminster Union and School. Other 1nstitutions. Totals. M F T 93 Pleurisy 2 2 4 ... ... ... ... ... ... 3 1 2 1 1 ... ... ... 1 ... ... 1 ... 1 96 Asthma 2 3 5 ... ... ... ... ... 1 2 2 3 2 ... ... ... ... ... 1 ... 1 ... ... 97 Pulmonary emphysema 1 ... 1 ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... 1 98 Other diseases of the respiratory system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 99 Diseases of the mouth and annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 102 Perforating ulcer of stomach 2 ... 2 ... ... ... ... ... 1 1 ... 2 ... ... ... ... ... ... ... ... ... ... 1 103 Other diseases of stomach 5 3 8 6 2 ... ... ... ... ... ... 2 2 4 ... 1 ... 1 2 ... 3 1 ... 104 Diarrhœa and enteritis 29 25 54 41 8 ... 2 ... 1 1 1 26 12 16 ... 7 6 19 ... ... 19 ... 1 105 108 Appendicitis 2 1 3 ... ... ... 2 ... 1 ... ... ... ... 3 ... 1 1 2 ... ... 2 ... 1 109 Hernia, intestinal obstruction 2 1 3 ... ... ... ... ... 1 ... 2 1 1 1 ... 3 ... 2 ... ... 2 ... ... 113 Cirrhosis of the liver 4 2 6 ... ... ... ... ... 2 4 ... 2 1 ... ... 1 1 ... ... ... ... 1 2 115 Other diseases of the liver ... 1 1 ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 117 Peritonitis (cause unstated) 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 120 Bright's disease 12 6 8 ... ... ... ... ... 5 10 3 5 8 5 ... 2 6 17 ... ... 17 ... 1 122 Other diseases of the kidney and annexa ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 125 Diseases of the urethra urinary abscesses, etc. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 2 ... ... 126 Diseases of the prostate 4 ... 4 ... ... ... ... ... ... ... 4 ... 3 1 ... 1 ... ... ... ... ... ... ... 130 Pelvic Cellulitis ... 1 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... 131 Ovarian cyst. tumour (non-cancerous) ... 1 1 ... ... ... ... ... ... 1 ... ... 1 ... ... 1 ... 1 ... ... 1 ... ... 134 Accidents of pregnancy ... 1 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... 136 Other accidents of childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ...... ... ... ... 1 ... ... 1 ... ... 137 Puerperal fever ... 1 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... 1 2 ... ... 2 ... ... 138 Puerperal albuminuria and convulsions ... 2 2 ... ... ... ... 1 1 ... ... ... 1 1 ... ... 1 ... ... ... ... ... 1 142 Gangrene 1 ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 2 ... ... 2 ... ... 144 Phlegmon, acute abscess 1 ... 1 ... ... ... ... ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 145 Diseases of the integumentary system 1 2 3 2 ... ... ... ... ... 1 ... 2 1 ... ... ... 2 1 ... ... 1 ... 1 90 91 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 1nstitution Deaths— Non-Residents. Non-Residents outside 1nstitutions. 1nquests in district on Residents. All ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45 45 and under 65. 65 and upwards. Bury Street. Church Street Fore Street Undistributed. Edmonton Union. City of Westminster Union and Schoo Other 1nstitutions. Totals. M F. T. 146 Diseases of the bones 1 ... 1 ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 149 Other diseases of locomotor system ... 1 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 150 Congenital malformations 6 1 7 6 1 ... ... ... ... ... ... 3 3 1 ... 3 ... 2 ... ... 2 ... 1 151 Premature birth, infantile debility, icterus, sclerema 28 18 46 45 1 ... ... ... ... ... ... 14 15 17 ... 2 1 2 ... ... 2 2 7 152 Other diseases peculiar to early infancy 3 3 6 6 ... ... ... ... ... ... ... ... 4 2 ... ... ... ... ... ... ... ... 3 153 Lack of care ... 1 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 154 Old age 4 9 13 ... ... ... ... ... ... ... 13 3 8 2 ... ... 1 10 18 ... 28 ... ... 157 Suicide by hanging or strangulation 1 ... 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 158 Suicide by drowning 1 ... 1 ... ... ... ... 1 ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 ... 162 Suicide by crushing 1 1 2 ... ... ... ... ... 1 1 ... 1 1 ... ... ... ... ... ... ... ... ... 2 167 Burns (conflagration excepted) 1 4 5 ... 1 2 ... ... ... 1 1 3 1 1 ... 1 3 3 ... ... 3 ... 4 168 Absorption of deleterious gases (conflagration excepted) 1 ... 1 1 ... .... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 169 Accidental drowning 5 ... 5 ... ... 1 2 1 1 ... ... 1 3 1 ... 1 ... ... ... ... ... ... 4 170 1njury by firearms ... 1 1 ... ... ... ... ... 1 ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 172 1njury by fall 3 ... 3 ... ... ... ... ... 1 1 1 ... ... 2 1 1 2 1 1 ... 2 ... 2 175 1njury by other crushing (vehicles, railways, landslides, etc) 7 1 8 ... ... ... 2 1 2 1 2 5 3 ... ... 4 1 1 ... ... 1 ... 4 180 Lightning 1 ... 1 ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 185 Fractures (cause not specified) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... 3 ... ... 186 Other violence 1 ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 ... ... 2 ... 1 189 Ill defined causes 1 ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... Grand Totals 408 386 794 196 63 44 51 23 103 164 150 260 270 261 3 111 140 455 36 ... 491 10 88 92 TABLE V.—Table showing the Number of Cases Notified and the Deaths from the principal Zymotic Diseases for the year 1913, and ten preceding years. Disease. 1913. 1912. 1911. 1910. 1909. 1908. 1907. 190b. 1905. 1904. 1903. Pop. 66,552 Pop. 65,084 Pop. 63,146 Pop. 6I.741 Pop. 61,164 Pop. 60,182 Pop. 59.434 Pop. 56,818 Pop. 54,606 Pop. 53.358 Pop. 52,139 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 .. † Scarlet Fever 429 1 211 1 68 .. .. 5 283 4 308 12 231 8 383 13 259 6 181 3 119 2 † Diphtheria and Membranous Croup 131 15 36 13 43 7 52 4 110 13 158 27 95 17 93 11 37 4 46 10 19 1 † Enteric Fever 8 2 3 I 12 2 34 6 30 7 35 6 29 5 25 7 44 6 38 8 28 6 Erysipelas 50 2 49 2 55 1 49 1 42 2 73 .. 54 .. 78 4 66 1 74 5 63 2 Puerperal Fever 1 1 1 1 .. .. .. .. 3 .. 3 2 3 3 5 2 3 2 1 .. 3 1 * Tuberculosis, Pulmonary 247 72 228 60 107 45 69 50 84 43 .. 54 .. 53 .. 65 .. 42 .. 71 .. 58 Tubercle, other forms 75 31 .. 20 .. 25 .. 31 .. 26 .. 35 .. 34 .. 38 .. 34 .. 40 .. 56 Non-notifiable † Diarrhœa .. 54 .. 19 .. 145 .. 22 .. 37 .. 41 .. 32 .. 114 .. 56 .. 151 .. 61 Enteritis .. .. .. .. .. 6 .. 1 .. 2 2 .. 5 .. 2 .. 10 .. 14 .. 8 † Measles .. 48 .. 15 .. 31 .. 3 .. 8 .. 19 .. 21 .. 19 .. 27 .. 28 .. 10 † Whooping Cough .. 9 .. 23 .. 15 .. 9 .. 13 .. 18 .. 39 .. 15 .. 30 .. 7 .. 19 Influenza .. 7 .. 4 .. 3 .. 3 .. 17 .. 9 .. 14 .. 9 .. 9 .. 10 .. 2 t The seven principal zymotic Diseases on the deaths from which the zymotic death-rate is based. Infectious 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 the 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. * Compulsory Notification of Phthisis began on January 1st, 1909, as far as paupers are concerned, on May 1st, 1911, as far as hospital patients are concerned, and on January 1st, 1912, for private patients. The populations quoted are nett, or exclusive of " foreigners " in institutions. 93 Urban District of Edmonton—County of Middlesex—Sanitary Work, 1913. Inspections. Action taken. (Other than under H. and T.P. Act). Action as regards dwelling houses under H. and T.P. Act, 1909. Houses let in lodgings, (tenement houses.) Common Lodging Houses. Canal boats used as dwellings. Movable dwellings, caravans, tents, &c. Number of premises inspected on complaint. Number of Premises inspected in connection with infectious diseases. Number of premises under periodical inspection Total number of inspections and re-inspections made. Cautionary or intimatory notices gi/en. Statutory orders issued. Summonses served. Convictions obtained. Houses inspected from house-to-house. Number of houses dealt with under Sect. 15. Number of houses found to be in a state dangerous or injurious 10 health (Sect 17). Number of repiesentations made by M.O.H (Sect. 17) or his staff. Number of houses made habitable without closing orders. Number of closing orders made by L.A. (Sect. 17). Number of houses closed voluntarily. Number of closing orders determined after repairs (Sect. 17). Number of houses demolished (a) by order of L.A. (Sect. 17), (b) voluntarily. Illegal underground rooms vacated. Number registered under bye-laws. Number of contraventions. Number registered under 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. 260 622 539 15198 5948 448 1 1 317 Nil 1 1 .. I 7 16 b 1 .. .. .. 1 102 2 This is not a registration authority. 3 421 Constantly moving them on. 421 94 Bakehouses. Slaughterhouses. Cow-sheds. The cows are out at pasture during the greater part of the year. Dairies and milkshops. Unsound Food. Offensive Trades. Number in district. Contravention of factory acts. Number on register. Number of Inspections made. Frequency of inspection. Contraventions of bye-laws. Number on register. Number of inspections made. Frequency of inspection. Contravention of regulations. 1 Number of milch cows in the district. 1 Number on register. Number of inspections made. Frequency of inspection. Contravention of regulations. Meat (including organs) seized or surrendered. (Approximate weight in pounds). Poultry and Game seized or surrendered. (Approximate weight in pounds). | Fish seized or surrendered. (Approximate weight in pounds). Fruit and Vegetables seized or surrendered. (Approximate weight in pounds). Other articles seized or surrendered. (Approximate weight in pounds). Method of disposal. Number of premises in district. Number of inspections made. Contravention of bye-laws. 30 13 6 249 When slaughtering expected. 2 2 13 Quarterly. 1 33 96 346 .. 20 Butchers' meat & organs, 71 lbs. Nil. Fish seized, 56 lbs. surr'nder'd321 lbs. Mixed vegetables surrendered, 2542 lbs. 646 rabbits surrendered, about 1615 lbs. Buried on Council's farm, 1 14 1 95 Water supply and water service. Drainage and sewerage of existing buildings. Wells. Percentage of houses supplied from public water service. Cisterns Draw-taps placed on mains. Percentage of houses supplied on constant system. Number of samples obtained for analysis. Water closets. Percentage of houses provided with water closets. Drains. Cesspools. Percentage of houses draining into sewers. New sunk. Cleansed, repaired, &c. Closed as polluted. New provided. Cleansed, repaired, covered, &c. Number of water closets substituted for dry receptacles. Repaired, supplied with water, or otherwise improved. Examined, tested, exposed, &c. Unstopped, repaired, trapped, &c. Waste pipes, rain water pipes, disconnected, repaired, &c. New soil pipes or ventilating shafts 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. From local wells. From public supply. .. .. .. 99.3 3 65 54 100% .. .. .. 336 99.9 607 288 112 32 20 58 67 emptied and cleansed periodically. .. 99.6 96 Disinfection. Dust. Sundry nuisances abated. Rooms disinfected. Rooms stripped and cleansed. Articles disinfected or destroyed. New bins provided. How frequently is dust removed from each house ? Number of complaints of non-removal received. Method of disposal. Ordinary infectious disease. Phthisis. Ordinary infectious disease. Phthisis. Destructor. By tipping. Other, state method. Overcrowding. Smoke. Accumulation of refuse. Foul ditches, ponds, &c., and stagnant water. Foul pigs and other animals. Dampness. Yards repaved or repaired. Other nuisances. 657 113 275 6775 636 205 Weekly. 40 .. Yes. .. 33 19 31 5 38 776 183 249 97 Edmonton Urban District. REPORT of the Chief Sanitary Inspector For the Year 1913. Public Health Department, Town Hall, Edmonton. To the Chairman and Members of the Edmonton Urban District Council. Mr. Chairman and Gentlemen, I have the honour to present to you my report on the work done in the Public Health Department for the year 1913 by your Inspectors and Staff. DISINFECTION, REMOVAL OF PATIENTS TO HOSPITAL, &c. During the year the following work has been carried out in connection with infectious disease:— No. of journeys of ambulance to remove patients to Joint Hospital, Winchmore Hill 507 No. of journeys of bedding van to remove infected bedding 285 No. of journeys of bedding van to return bedding after disinfection 285 No. of patients returned to their homes from the hospital by the brougham 537 No. of rooms disinfected after infectious disease 657 No. of articles of bedding, etc., disinfected 6775 No. of articles of bedding, etc., destroyed 61 No. of books disinfected 22 No. of rooms disinfected after phthisis 113 No. of articles of bedding, etc., disinfected after phthisis 636 No. of articles of bedding, etc., destroyed after phthisis 18 No. of rooms disinfected for vermin and verminous bedding 12 98 The removal of patients to hospital continues to be carried out by your Disinfector, who also acts as attendant. The Inspectors assist when necessary. Your Inspectors also take duty with the Disinfector on alternate Sundays. I had hoped that the new disinfecting station would have been in evidence before the year closed, but no doubt the coming year will see the new building erected. This will considerably facilitate the work of disinfection. I regret that the Joint Hospital Board have not yet seen their way clear to take over the removal of patients to hospital. I sincerely hope the time is not far distant when this will take place, for although every care is taken as far as possible in the removals, it could be much better carried out by the hospital authorities, as they have nurses at their disposal to accompany the patients to hospital. Some parents are quite indifferent about accompanying their children to hospital, and others are not at liberty to do so. In either of these circumstances a nurse's services would be a great boon. Your Woman Sanitary Inspector could do this when necessary, but the removals occur at times when her services are not available. To send for a nurse to the hospital (some three miles away) means unnecessary delay in removal, and for your men Inspectors to have to occupy this position is a somewhat delicate matter at times, although it has had to be done for some years. I really think that some serious consideration should be given to the subject. I may mention that Tottenham and Wood Green cases are moved by the hospital authorities, and not by the Disinfector or Inspectors. Year by year this work is increasing, and the amount paid in wages this year for extra assistance at removals was £37 14s. 3d. ERYSIPELAS. During the year 21 cases of erysipelas were treated at their homes by a fully qualified trained nurse, the Council not having any hospital for treatment of such cases. Many expressed their gratitude for the careful attention they received. DISINFECTANTS. The public continue to avail themselves of the opportunity generously afforded them by the Council of obtaining disinfectants (powder and fluid). This entails a lot of labour, but no doubt the results are beneficial, if only to encourage cleanliness. The number of applicants during the year was 25,614 (1912, 32,667), a decrease on last year of 7,053. 99 Instructions are given to applicants as to the proper and careful use of the disinfectants, and in many instances during the course of inspectorial work we have found the public making good use of them. Besides being distributed to the public generally, disinfectants are also supplied from the Department for disinfecting and deodorising of house refuse ; for the cleansing of street gullies ; flushing of sewers ; watering of roads in hot weather; spraying of dust vans during hot weather before leaving the shoot, and for all other purposes required by the Council. During the year some consternation for a time occurred among the callers for disinfectants, owing to the distribution of a typewritten pamphlet calling attention to the circular letter from the Local Government Board advising Local Authorities to comply with the regulations laid down for the selling of liquid poisons by the Pharmacy Act, 1868, the Poisons and Pharmacy Act, 1908, and the regulations made by the Orders in Council of the 5th June, 1912, and 22nd March, 1911, and that although the Council did not sell disinfectants, they should see that all disinfectants were supplied in regulation poison bottles. However, the public are now quite used to bringing the necessary bottles. SANITARY CONVENIENCES— PUBLIC AND PRIVATE URINALS, &c, GENERALLY. During the year the conveniences generally (both public and private) have received regular attention, and repairs and improvements have been effected from time to time. The male and female conveniences at Angel Road continue to be much patronised. The amount collected from the W.C.'s and "Wash and Brush Up" was £159 6s. 8d., an increase of £18 17s. on last year. Both male and female attendants continue to carry out their duties in a satisfactory manner. I am pleased to see the new convenience on The Green so well advanced, as male and female accommodation is badly needed here. I trust this will do away with the nuisances that have occurred for so many years past in the vicinity. If the Council should consider the erection of another convenience, the northern end of the district, near Tramway Avenue, would be a suitable situation as some such accommodation is really necessary in this locality. I regret to again report that much wilful damage has been done to the water fittings of the various drinking fountains and water-troughs. If the offenders could only be caught and prosecuted it might have a salutary effect. 100 MORTUARY. The Council's mortuary consists of a post-mortem room, with the necessary appliances, and an ante-room for medical practitioners, also two mortuary chambers, one for infectious bodies and one for non-infectious bodies. The interior of each is faced with white glazed bricks, and is disinfected and washed after the removal of each body. During the year 106 bodies were received into your mortuary. 87 inquests and 82 post-mortems were held. 8 bodies were deposited to await burial owing to the bodies being infectious. 6 bodies were left on deposit by undertakers to await burial, owing to there being no accommodation for the retention of them in the homes. 1 body I had removed to the mortuary as it was found that the parents had detained it with the expectation of receiving some insurance money for burial, but the money was not forthcoming. Eventually the body was buried by the Guardians. 2 bodies were detained after inquest, owing to them having rapidly decomposed. 20 remained in mortuary after inquest by request of relatives to await burial. 8 were buried by the Guardians. The mortuary attendant when not engaged in mortuary work assists in the Sanitary stores giving out disinfectants, and in delivering notices and letters in connection with the schools, and general notices in connection with sanitary work. He also assists in the laboratory when required. DUST COLLECTION. The collection of the house refuse is under the supervision of the Public Health Department, and the work of dust removal carried out by contract. The district is divided into six areas for the purpose of collection with one van to each area, and one special van for picking up any back work. The dust from the Edmonton Union is removed every morning before eight o'clock. During the six winter months of the year the dust was deposited in the brickfields, and during the six summer months on the Council's shoot at Deepham's Farm, 101 The number of complaints received during the year was 40. These were at once investigated, and it was not always found to be the fault of the dustmen. A list of all the streets in the district with the days of collection was given to the contractor on his commencing the work, but to check the various streets collected day by day would take up some considerable time, although we give as much time as possible to the supervision. A lad could well carry out this work, and this would ensure the regular removal from the various streets. The amount received for old iron and tin ware from April 1st to September 30th was £13 14s. 4d. No. of van loads of dust collected was 3,688 The weight of dust collected was 5,99 tons, 3 cwt. The practice of spraying with disinfectant the dust vans on the shoot in the summer time is still continued. This prevents the flies adhering to the vans when leaving the shoot. OFFENSIVE TRADES. The offensive trade, that of Gutscraper, is still carried on in the District. The premises have been visited from time to time. The business is carried on in a very crude manner, and although the occupier has tried to improve the ventilation, the conditions are anything but what they should be ; indeed the building was never originally intended for the carrying on of such a trade. When proceedings were taken before a Magistrate, the occupier agreed to carry out certain objectionable portions of the business elsewhere before bringing the offal on his premises. We have kept the premises under observation but have not detected any crude material. PIGS. FISH OFFAL. There are 35 pig-keepers in the District. The number of pigs fluctuates, but the pig-keepers have been informed that the keeping of pigs is only of a temporary nature. Four persons were found to be keeping pigs within the prescribed distance laid down by the by-laws, and notices were served to discontinue the keeping of Pigs, and the notices were complied with. The pigs are fed to a great extent on the waste products from London restaurants, after it has been boiled and the fat extracted. This latter operation will come under the proposed new by-laws. 102 The collection of fish offal from the various fishmongers in the District, which was for many years done by your Council under the supervision of the Public Health Department, and has since been taken over by a firm of artificial manure manufacturers, is, I am pleased to say, being carried out well, and no complaint from non-removal has been received during the year. SLAUGHTERHOUSES, UNSOUND FOODS, &c. We have in the district 7 slaughterhouses, one registered and having been in existence for a great number of years. Six are licensed under the Public Health Acts Amendment Act, 1890, which gives the Council power to license from year to year. Having control of the licensing of slaughterhouses annually gives the Council much more facility for establishing a public abattoir—should they so desire. At the present time there are only 5 slaughterhouses in use, one having been discontinued for some three or four years, and one about six months. There were 378 animals inspected during slaughter, as follows 1 bull, 55 oxen, 15 cows, 2 heifers, 7 calves, 175 sheep and 123 pigs. The registered slaughterhouse is kept clean, but the access to it is bad, and the owner now only kills sheep and pigs. Although the by-laws prescribe lime-washing four times a year, viz.:— March, June, September and December, this is done much more often by some of the occupiers. The following offal was surrendered on inspection :— 1 pig's head, 3 pigs' plucks, 1 sheep's pluck, and 2 ox livers and skirts. The practice of giving the retailers an opportunity of bringing articles of food to be examined at the Town Hall is still adhered to, and if the articles are unfit for human food, a certificate to the effect that the articles have been dealt with as prescribed by the Public Health Acts is given. The date and time the article was seen is also noted in the certificate. This enables the retailer to get his money returned from his wholesale dealer, and undoubtedly prevents to a large extent, food of such a nature being exposed for sale. The following is a list of foods destroyed :— Jan. 4th. 1 small bag of cod fish. Feb. 7th. 131 cauliflowers. Feb. 7th. 1 trunk skate. Feb. 13th. 8 boxes of tomatoes. Apr. 24th. 1 trunk herrings. 103 Apr. 29th. 1 crate of lettuces. May 6th. 1 case of herrings. May 10th. 1 flat of water cress. May 16th. 22 dabs. May 22nd. 48 boxes of tomatoes. June 19th. 1 cwt. 14 lbs. potatoes. June 20th. 58 lbs. potatoes. June 30th. 1 kit of boiled crabs. Aug. 22nd. 1 box mackerel. Aug. 29th. 1 box of kippers. Sept. 9th. 1 case onions. Sept. 13th. 13 boxes of tomatoes. Sept. 15th. 1 case of hake. Oct. 9th. 1 case of skate. Dec. 5th. 7 doz. bundles of celery. Dec. 13th. 646 rabbits. Dec. 29th. 1 case of skate "wings." The stalls and shops, where fish, fruit and foods generally are exposed for sale for human consumption, are regularly inspected. One person was summoned for exposing for sale herrings which were unfit for human food. He was fined £1 and costs. MODEL FOOD BY-LAWS. In connection with premises used for the sale and preparation of meat for human food there is room for improvement here. In New Zealand, especially the City of Auckland, not only must a license be obtained from the City Authorities before the premises can be used for the sale or preparation of meat for human food, but the person occupying the shop must also be licensed, and the licenses must be renewed in the month of January in each year. Most stringent by-laws and regulations are in force there, and these provide for the cleanliness and health of persons handling food stuffs, the protection of food from vermin, flies and dust, and the suitability of premises used in connection with the sale, manufacture, preparation, storage and packing of food for sale. They also provide for the protection of meat, &c., in course of conveyance to shops or delivery to customers. They further provide that every person, who engages in the manufacture, preparation, storage, packing, carriage or delivery of food for sale within the city, shall (when so engaged) maintain his clothing and his body clean. No person may use any animal, vehicle or receptacle in the carriage or delivery of any food within the city, unless he at all times keeps the same clean; nor may he use any such vehicle or receptacle which at any time may have been used for the carriage of any matter whereby the wholesomeness, cleanliness and freedom from contamination of any food carried, or usually 104 carried therein, would be endangered. Further—every person who sells within the city any meat or fish or any food which is ordinarily consumed in the state in which it is sold, shall protect such food, until it is delivered to a purchaser, from dust and flies, by storage in covered receptacles, by covering with gauze, or by other effectual means; no vendor may carry such food through the streets unless it is protected as aforesaid, and no person may sell any food within the city so packed that it can come into contact with paper or other material which is not clean. Also the whole of the external openings of any room or place used for the sale or preparation of meat for human food, which are not enclosed with glass must be completely covered with wire gauze, so as to prevent, as far as practicable, the access of flies or dust, and every external door must be kept closed, save when in use for ingress and egress. And these are not all of their by-laws respecting foods, but sufficient have been quoted to show that New Zealand is well in advance of us. Herewith I append a statement of the work done under the Sale of Food and Drugs Act, by the Middlesex County Council Inspector for this district, kindly supplied by the Chief of the County Food and Drugs Department. Article. Samples taken. Samples adulterated. Butter 137 9 Milk ... 87 23 Cream 9 Drugs 10 — Coffee 2 — 245 32 Prosecutions 9 Convictions 9 Fines £29 DAIRIES, COWSHEDS AND M1LKSHOPS, &c. The number of cowkeepers on the register remains the same as last year, viz., two ; but the number of cows have increased from 25 to 33. One owner not only contravened the Regulations by overcrowding the cows, but caused an old wooden building to be occupied without giving the Council the necessary notice as required by the Dairies, Cowsheds and Milkshops Order. The facts were reported to the Council and he has since promised to enlarge and improve the cowshed. The number of purveyors of milk on the register is 96. There are 32 who practically devote their business to dairy produce. 105 There were 20 contraventions which were all remedied. Many of the contraventions were due to storing other commodities not conducive to the good keeping of milk; four gave up selling milk, rather than comply with the Regulations. Periodical 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 by-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 any person permission to establish a milk business upon any premises, unless the same were suitable and the milk-seller, personally, of cleanly habits. There are 90 persons who sell ice-cream during the summer months. These were visited and various repairs and cleansing of premises effected. PAYING OF YARDS, &c. In connection with the systematic house-to-house inspection and the Public Health (Tuberculosis) Regulations, the following work has been carried out:— Roofs, eaves' gutters and rain-water pipes repaired 293 Water fittings repaired 47 New sinks supplied or existing sinks repaired 12 Sink and bath waste pipes repaired or new fixed 44 Scullery floors repaired 72 Ventilation under floors provided 19 Forecourts and yards paved, re-paved or repaired 245 External walls, brickwork repointed 18 Other dampness remedied 16 HOUSE-TO-HOUSE INSPECTION. During the year one inspector has been devoting his whole time to this work. A list of the dwelling houses in the worst streets and roads in the district, where it was desirable an early inspection should be made, was got out and taken first. Several streets have been done, and a great amount of time and energy has been spent to see that the necessary work required was carried out. In one well-known road a great amount of money must have been spent by the owners to bring the houses up to their present condition, but how long they will remain so I am afraid to speculate. The good tenant should be encouraged, but the dirty and destructive tenant seems to be still much in evidence. 106 The number of houses dealt with, and other information under the Housing, Town Planning, etc., Act, will be found included in your Medical Officer of Health's report. In the course of inspection a number of houses were found to come under the by-laws for "houses let in lodgings." I wrote the owners as to their liability, and they decided to let each house to one tenant only, so that the houses do not come within the by-laws. SHOPS' ACT, 1912. One small Amending Act came into force during the year, viz.:— the Shops' Act, 1913. This Act amends the Shops' Act, 1912, in its application to premises for the sale of refreshments. The work of administering this Act is carried out by Mr. Winter and myself. Systematic inspections are made from time to time, and contraventions found, and the offenders cautioned, but it is now quite time that the shopkeepers knew the Act, and should any more contraventions occur, proceedings should be instituted. It is the "mixed" shops that are the offenders. We have tried to make purchases, but they only serve to their known customers. If the Act is to be properly enforced, I can only reiterate my former remarks that I should certainly like to see it made compulsory to close all "mixed" shops, as the supervision of these shops is exceptionally difficult. CANAL BOATS. The number of canal boats inspected was 29, and the number of visits to the canal 64. Special difficulty exists in this district owing to the canal being some distance from dwelling-houses generally, thus necessitating special and exclusive visits, which occupies much more time than would be the case if the canal ran through the more thickly populated part of the district, as the inspection could be carried out with the general work. The following contraventions of the Acts and Regulations were dealt with: 1 boat; no certificate. 1 boat; certificate not in order. 1 boat required repairing. All of which have been remedied. Although the number of boats on the river is on the increase, the registered boats are on the decrease. Speaking generally, the canal boats 107 registered by districts abutting on the Lea are in good condition, and are seldom occupied other than by males. The work done under this Act is annually supervised by H.M. Inspector of Canal Boats. GIPSIES. During the year there were 421 vans seen and removed. This entailed 785 visits to a class of people that I have yet to learn are any good to the community, and do not even pay rates or taxes which the cottager cannot very well escape. The following lands have been dealt with during the year to prevent them encamping thereon, and to give the tenants, who live in the houses adjoining, a little peace. Brettenham Road and Cavendish Road Brettenham Road and Lawrence Road Brettenham Road and Montagu Road Montagu Road, adjoining level crossing Eastbournia Avenue St. Malo Avenue Corner of Firs Lane Granville Avenue Causeyware Road Brookfield Road Trenches made to prevent their vans crossing on to the land. „ „ „ „ „ „ „ „ „ „ „ „ „ „ & since fenced off Iron fence fixed. Gate fixed. Whatever is done seems of little effect, as they soon find other lands to encamp on, and the fencing of lands prevents the children of the resident population from enjoying an open space to play on. We have received many complaints as to the gipsies' filthy language and habits. Why some legislation has not been brought to deal effectively with these people passes my comprehension. It is a known fact throughout the country that they are a serious nuisance, and it is especially so in Middlesex. Proper registration would bring them into line, and a tax on them should be levied. SMOKE NUISANCES. There were a great many observations taken during the year, and 19 nuisances abated. One serious nuisance occurred from two blacksmith's fires. However, the owner eventually had the forges taken down and rebuilt under 108 better conditions, and the chimneys carried to a much greater height so as to obviate the nuisance. The particulars of inspections and work done by your Sanitary Inspectors under this Act, also the tabulated statement of work done under various headings in the form required by the Medical Officer of Health for the County of Middlesex, is included in your Medical Officer of Health's report. CLERICAL WORK. The following is a short summary of the clerical work done during the year:— Number of letters written 2,083 Number of letters, etc., filed for future reference 1,672 Number of notices sent to schools 3,218 Number of notices sent to Public Library 166 Preliminary notices 846 Statutory notices 448 Every care has been exercised to make the returns in this report as accurate as possible, also the number of visits shown in the tabulated statement in your Medical Officer of Health's report. There are a great number of things done which cannot well come under a definite heading, although they need the supervision of the Department. Every year the work of the Department is increasing and this applies not only to the outdoor work but to the inside clerical work as well. In the past few years I have been endeavouring to alter the records of the District from the old system of house-to-house registers to a system whereby the record of every house inspected can be seen at once, from its initial stage, without referring to a number of registers to find out how many inspections have been made from time to time, and the general condition of the premises. This work alone will take some years to complete, especially if all the returns on the old registers are brought forward, and I wish to personally record my thanks to Messrs. Winter, Coates, Nixon and Miss Hudson, Inspectors; and Messrs. Kirkman, Dyer and Farrar, Clerks in the Public Health Department, for the assistance they have given after office hours to help in bringing so far forward this important work. FACTORY AND WORKSHOPS ACT. NUISANCES. Many nuisances that arise are very difficult to effectually deal with, and in many cases the powers are very limited; especially does this apply to the nuisance of keeping animals, etc., near dwelling houses, and covering in the l09 open spaces near the house, thereby preventing proper ventilation for the back rooms. Some of the advertisement hoardings continue to cause much trouble as they generally seem to be used by the public as conveniences. These nuisances are abated, however, by the Council's man (who cleanses urinals, etc.), by digging over and disinfecting the contaminated soil. I hope to be able, during the coming year, to get up much useful information on these points with a view to revising the by-laws. As I have before mentioned I should much like to see all qualified and experienced Assistant Inspectors given similar powers as an Inspector of Nuisances under the Public Health Acts, 1875, as they could then act more independently. The present law curtails their powers to some extent, and necessitates your Inspector of Nuisances having to carry out details himself, which might well be done by your Assistant Inspectors. 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 my multifarious duties. I have the honour to be, Gentlemen, Your obedient Servant, RICHARD JOHN BUTLAND, Chief Sanitary Inspector. 111 Annual Report for 1913 II. On Education (In its Medical and Hygienic Aspects), in the Urban District of Edmonton. SIDNEY C. LAWRENCE School Medical Officer. Frank E. Rock Deputy and Assistant School Medical Officer; School Medical Inspector. Nora Playne School Nurse. Harold Dyer School Medical Clerk, 112 Edmonton Education Committee. 1913-14. (a) REPRESENTATIVES FROM THE COUNCIL The Rev. Preb. SANDERS, M.A. (Chairman). S. H. PLATTEN, Esq., J.P. (Vice-Chairman). W. HATCH, Esq. J. ANTHONY, Esq. E, D. RUSSELL, Esq. H. BARRASS, Esq., C.C. J. SIMK1N, Esq. H. J. BIRD, Esq. C. SORRELL, Esq. M. F. CADMAN, Esq. F. VINCENT, Esq. W. D. CORNISH, Esq., J.P., C.C. The Rev. T. WARREN. C. HART, Esq. H. WILLIAMS, Esq. (b) CO-OPTED. Mrs. CULL. Miss BARKER. Secretary: ARTHUR HEAP, LL.B., B.A. Lond., Education Office, Brettenham Road, Upper Edmonton. Superintendent of Attendance Officers: THOMAS YARROW, 113 EDMONTON EDUCATION COMMITTEE. REPORT of the School Medical Officer for the Year ended December 31st, 1913. " Ignorance is the curse of God, Knowledge the wing wherewith we fly to Heaven."— Shakespeare's "King Henry VI." Town Hall, Edmonton, 22nd June, 1914. To the Chairman and Members of the Edmonton Education Committee. Ladies and Gentlemen, I have the pleasure of submitting my second Annual Report as School Medical Officer. I desire, on behalf of my staff and myself, to express our thanks to Mr. Heap, the attendance officers, and the teachers, for their hearty co-operation at all times. The good work of medical inspection can only have its best results when we are all united in promoting the welfare of the children. The special articles in last year's Report by my colleague, Dr. F. E. Rock, on "Inheritance of Predisposition towards Scarlet Fever," "Temperatures of School Children," and ''Co-relation between Decayed Teeth and Enlarged Tonsils" have been much appreciated. This report and the tables at the end are in the form suggested by Sir George Newman, the Chief Medical Officer of the Board of Education. I am, Ladies and Gentlemen, Your obedient Servant, SIDNEY C. LAWRENCE, School Medical Officer. 114 Index of S.M.O. Report. Attendance 124 Bush Hill Park scholars 121 Baths 121 Blindness 15 Boots 133,151 Building operations 122 Cleanliness and cleansing station 133—135, 151, 155 Clothing 133, 151 Correlation with Public Health service 116 Deafness 142, 152, 156 Defects, arrangements made for following up 126 Deformities 144, 154,156 Epileptics 156 Exclusion of scholars and contacts 146 Expenses 125 Eye diseases, external 141, 152 Eyes and vision 141,155,156 Facts disclosed by medical inspection 127 Girls' Charity School 116 Glands enlarged 140 Hearing 142, 154 Heart and circulation 142, 153 Hernia 144 Heights of scholars 135-139 Hygienic conditions 120-123 Illnesses, history of previous 128 Infectious disease 145-147 Inspection, arrangements for and scope of 125 Intelligence 129, 156 Lungs 143, 153 Meals, provision of 128 Mental Deficiency Act, 1913 130-133, 156 Nervous system 143, 153 Nose and throat 140, 152 Notices, exclusion 147 Nutrition 128, 155 115 Playgrounds 120 Private schools 116 Public elementary schools 119 to end Rickets 143, 154 Ringworm 139, 153 School clinics 144 Secondary school (Latymer) 117 Skin diseases 139, 153 Speech 142, 154 Sunday schools 118 Tables, Board of Education 149-156 Teachers' notifications 146 Technical Institute 117 Teeth of scholars 139,152 Tuberculosis 127, 143, 153, 154, 156 Vermin 133-135, 151 Weights of scholars 135-139 116 GENERAL DESCRIPTION OF ARRANGEMENTS WHICH HAVE BEEN MADE DURING 1913 FOR THE CORRELATION OF THE SCHOOL MEDICAL AND PUBLIC HEALTH SERVICES. My staff was added to on February nth, 1913, by the appointment of a School Medical Clerk, half of whose time is occupied with public health work. This followed a report of mine dated the 8th January, and a room formerly occupied by the district-rate collector was placed at my disposal and equipped as the " School Medical Office." After a second report of mine, dated 5th April, the equipment of the office was completed; the large amount of important work which has since been carried on there has fully justified the outlay I recommended. Half the cost of furnishing the office was met by the Education Committee. The room at Brettenham Road is still retained for the " Medical Officer," as it is used for the routine inspection of the scholars at that school, and such records of all the schools as I may require for reference at the meetings of the Education Committee—still held there—and the storing of the blank forms used by the head teachers and attendance officers. Miss Nora Playne began duty as School Nurse on 2nd June, in succession to Miss Johnston, who had been with us since the work began in 1908. THE SCHOOLS OF EDMONTON. (18 in Number). Public Elementary Schools number 11 Secondary Schools ,, 1 Private Schools ,, 6 The Edmonton Union has two schools or homes for pauper children, both in the Enfield district. The Strand Union School ceased to exist on 31st July. Girls' Charity School. On the 27th March, the Eoard of Education sent a letter covering six copies of a draft scheme. Other copies were distributed to the Councillors. This was considered at a Special Meeting of the Council on the 29th April, when certain alterations were agreed to. The final scheme, dated 23rd July, 1913, together with a letter from the Board of Education was submitted to the Council on the 26th August. This scheme was made under the Charitable Trusts Acts, 1853-1894, which replaced a scheme dated the 1st August, 1906. The original foundation is now administered in two parts (a) the Girls' Sunday School Foundation, and (b) the Girls' Special Instruction Foundation. The trustees of Foundation "A" are the Rev. Preb. E. A. B. Sanders, Vicar of Edmonton, Messrs. H. W. 117 Dobb, J. R. Arming, H. E. Brown, W. D. Cornish and W. T. Paulin (of Winchmore Hill). These are appointed for life, subject to certain conditions. The trustees of Foundation "B" are appointed for a term of three years, four by the authority and three by the trustees of Foundation "A." The four representatives of the Council were appointed on 23rd September, and are Councillors Taylor, Vincent, Williams and Hart. The three appointed by Foundation "A" as trustees are the Rev. Preb. E. A. B. Sanders, Councillor W. D. Cornish, and H. E. Brown. The Private Schools are six in number and have nearly 200 scholars on their books. TECHNICAL INSTITUTE. The Technical Institute was opened on Saturday, September 28th, 1912; it was erected on the site of the old Latymer School in Church Street. Provision for extension of the building, when necessary, has been made. The heating is by low-pressure hot-water system, and the lighting by electricity. The present accommodation consists on the ground floor of three workshops, two classrooms, one lecture room, Secretary's room and sanitary conveniences and cloakrooms, and on the first floor of two lecture rooms, an art room and a domestic-subjects room with cooking apparatus. The floors and staircases throughout are of fire-proof construction. Mr. H. Farrands, M.A., is the Secretary. The institution is under the control of the Middlesex County Council, but there is a local Committee for technical instruction of fourteen members, two of whom are ladies. The classes are divided into two main divisions (1) intermediate, for students of both sexes from 16 to 18 years of age and over, with a two years' course of work; and (2) senior technical, for persons of 16 years of age and over. For 1913-14, the classes began on September 29th, 1913, and end on May 2nd, 1914. Some of these intermediate classes are held at Brettenham Road School. The subjects are wide: commercial arithmetic and book-keeping, carpentry, French, figure work and cardboard modelling, shorthand, typewriting, woodwork; besides cookery and dressmaking for the young women. The intermediate classes at Brettenham Road take commercial arithmetic, English, shorthand and business methods. THE SECONDARY SCHOOL. The original school in Church Street was founded in 1624 by Edward Latymer. The Secondary School is now managed by a Board of Governors acting under the Middlesex County Council, who are responsible for the financing of the school. The Elementary School is managed by the Vicar and Churchwardens, and is not under the control of the Board of Governors of the Secondary School. 118 The buildings in Hazelbury Road were opened on September 24th, 1910. The Headmaster is Mr. R. Ashworth, B.A. Lond. The site of six acres cost £1,500. A portion of the site surrounding the buildings is tar-paved for the purpose of exercise and drill, whilst the remaining portion (nearly 5 acres) is used as playing fields. A caretaker's cottage consists of ground and first floors. The school buildings themselves consist of the ground floor only, and whilst lacking the imposing air which height would give, the internal disposition provides all the essentials of an up-to-date school. The accommodation has been extended from 75 boys and 75 girls between the ages of 10 and 16 years, to 175 boys and girls up to 18 years of age. This has been made possible by transferring the manual training work to the Technical Institute. There were at the end of 1913, 184 boys and girls on the rolls, and 25 pupils in a preparatory class (between 8 and 10 years of age), who are taken at the Technical Institute on the site of the old school. The lighting is by inverted incandescent gas, the ventilation "natural," and the heating by hot water radiators. The school year is divided into three terms of about thirteen weeks each. The fees are £1 2s. 6d. per term, but special terms of £1 11s. 6d. are accepted from parents who live in the ancient parish of Edmonton. The school has a liberal supply of scholarships ; besides those provided by the County Council, there are also others which are provided by the ancient endowments, which will increase in value as time goes on. A precept for £bi 7s. 9d. for higher education was issued by the Council on the Overseers on 16th June and again on 1st November. The school, as you will see, is making rapid progress in efficiency and numbers. It has been inspected during the year by the London University. The question of enlargement is under consideration. SUNDAY SCHOOLS' REPORT, 1913. CHURCH OF ENGLAND. Name of Church. Boys. Girls. Infants. Totals. Parish Church including St. Alphege Mission 584 941 610 2135 St. Martin's 144 155 257 556 St. Aldhelm's 150 200 150 500 St. James' 158 183 118 459 St. John's 117 145 159 421 St. Peter's 282 338 340 960 *St. Michael's 80 100 100 280 St. Stephen's 71 122 55 248 St. Mary's 68 97 82 247 Grand Totals 1654 2281 1871 5806 "These figures are unreliable. 119 NONCONFORMIST SUNDAY SCHOOLS. Name of Chapel or Place. On the Books. 1911 1912 1913 Congregational, Fore Street 338 318 304 ,, Angel Road 418 347 304 People's Tabernacle 298 242 278 Tanner's End Mission 502 600 600 Wesleyan 290 426 540 Congregational, Lower Edmonton 450 *400 466 Baptist 469 630 395 Primitive Methodist 175 176 189 Belmont Hall Brethren 211 *200 J74 Totals 3151 3339 3250 *These figures are unreliable. Roman Catholic Sunday School, Hertford Road, attendance averages 273 children—boys, 98; girls, 100; and infants, 75. The Socialist Sunday School was reopened on February 15th. The attendance of boys, girls, and infants is about 50. Presuming that no scholars attend more than one Sunday School, there are something like 9,379 persons attending Sunday School in Edmonton, with varied regularity. As I have stated in previous years, 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 overcrowded than in day schools, and the meetings often take place in buildings not specially adapted for that purpose. It is urgently necessary that the powers of Local Sanitary Authorities for dealing with these institutions should be both enlarged and strengthened. In April, 1912, it was agreed by the Education Committee that no further schools should be let for Sunday School purposes, and that notice be given to those at present using the schools to terminate such use on March 31st, 1913. PUBLIC ELEMENTARY SCHOOLS. Mr. Arthur Heap, B.A., LL.B. Lond., is the Secretary of the Education Committee. The management of these schools has been delegated by my Council to an Education Committee, which consists of fifteen members of their own body, 120 and two ladies as co-opted members, one of whom is a head-mistress. Since July, 1908, no new children under five years of age have been admitted. On Tuesday, July 1st, Dr. Langdon, one of the medical inspectors of the Board of Education, was in Edmonton nearly all day; in the afternoon he spent some time witnessing the work of routine medical inspection at Montagu Road Infants' School. In August, 1913, my Council approved of this resolution forwarded from Cheshunt:— "It is the opinion of this Council that the local rates should be relieved of the amount now paid for national services in the matter of elementary and secondary education, the maintenance of the main roads and the administration of the Poor Law." Delegates attended a conference convened by West Ham at the Westminster Palace Hotel on the 2nd April to consider the case of the Government grant to necessitious schools, which at present consists of threequarters of any excess over 1s. 6d. On the 4th February the Committee considered a letter from the headteachers of boys' schools suggesting the provision of manual instruction and suggesting that arrangements might be made at the Technical Institute and Pymmes' Park House whereby 20 boys from each school might attend a class in woodwork once a week. GENERAL VIEW OF THE HYGIENIC CONDITIONS PREVAILING AT THE SCHOOLS. I.—Non-Provided. Four schools: eight 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 Latymer School, Maldon Road, Lower Edmonton, for boys; 4. St. Edmund's Roman Catholic School, corner of Hertford Road and Bounces Road, Lower Edmonton, for infants and senior mixed. Playgrounds—In August the playground of the All Saints' National Schools was tar-paved and enlarged, which is a very great improvement on the old state of things. At the same date a portion of the surface of the playground of the Lower Latymer Boys' School was tar-dressed; for a time this dressing made the surface somewhat better than the old gravel surface, but this method of dealing with playgrounds is only a temporary expedient and further expense must be incurred before long. 121 The playground of the St. James' School is also a gravel-surface playground and badly requires bringing up-to-date, i.e., tar-paving; it is true there are tar-paved paths from Grove Street to the school entrances, and from the entrances to the latrines, which thus enable the children to get into the building with some degree of comfort, yet the larger portion of the area is in a bad condition, for the water standing in pools after it has rained makes the playground very uncomfortable, if not unhealthy, for the children. The condition of playgrounds in non-provided schools, as these three are, is entirely a responsibility for the managers of each school. St. Edmund's School was first used on March 1st, 1912. There is an infants' department, accommodating 88 children, and a senior mixed department accommodating 208 boys and girls. This school is lit by electric light, and warmed by hot water pipes and radiators. There are no fireplaces to warm the scholars, if and when the hot-water system should temporarily break down. In March the hall of the infants' department of St. Edmund's school was sub-divided. 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. Montagu Road, Upper Edmonton 1904 „ †*1 „ .. B.— Boys. G.— Girls. I.— Infants. J.— Junior Mixed. *Extra wide corridors in some of the Departments. †Both these halls are in the Infants' Departments. ‡In the Junior Mixed Department. BUSH HILL PARK. The rapid development of this northern part of the district necessitated an agreement with the Enfield Urban District Council to provide accommodation for 81 scholars from this neighbourhood at the nearest Enfield School, but there was an average attendance of 280 this year. 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, 1913-14, this wholesome practice has been continued as far as the boys are concerned. A woman instructress has been appointed for the girls and the boys are taught by their class teachers. 122 During the year the boys made 25,235 and the girls 9,381 attendances. Fifty-two free passes are now given to scholars when they can swim 60 yards; of these 1790 were used during 1913. Building Operations. Nothing has been done beyond the ordinary repairs necessary to keep the buildings in good order, except the internal painting and distempering of the National and St. James' schools during the summer vacation. In February, in consequence of complaints of bad smells from Croyland Road schools, the old earthenware sink wastes were replaced by proper 1¼ in. lead wastes, with traps, which were made to discharge over a trapped gully outside the buildings. The playgrounds at Eldon Road, Raynham Road and Croyland Road were tar-dressed and sanded during the summer vacation. 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, flushing a system of separate closet pans with syphonic action opening into a common pipe. The excreta then falls 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. 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. Water Supply comes in 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. It has been difficult in the past to secure thorough cleansing of the cups attached to the drinking fountains, so that now the use of cups has been abolished altogether, and as opportunity serves the taps are all being set in an inverted position, so that the stream rises upwards into the scholar's mouth, and the back-wash, as it falls into the basin, keeps the mouth of the tap clean. One has to remember that the scholars who are most inclined to use the drinking fountains are those who are suffering from a febrile condition, possibly a forerunner of diphtheria, or some other infectious disease. 123 Lavatory and Cloakroom Accommodation 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 halfchannel pipe (which facilitates the removal of blockage), and so over gully outside. The hooks in the cloakrooms 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 cloakrooms, has been suggested, but scrubbing at least once a week with hot water and soap is the proper treatment. Heating of the Schools is effected partly by a hot-water circulation, and partly by Boyd's ventilating grates. In October the headmaster of Croyland Road School reported that the heating had not been satisfactory during the preceding winter. Artificial Lighting is produced from an ordinary gas installation, but by electricity at St. Edmund's. Incandescent gas-light burners are used in all the provided schools except Silver Street, and amongst the non-provided schools at St. James', National and Lower Latymer. Daylight Saving. At the beginning of December an interesting suggestion was made, that the schools might be opened earlier on winter afternoons, thereby affecting a saving in gas and coal. Of 34 head teachers, 24 were in favour of the change and 10 against. The reasons given on both sides form a document of some interest, but no change was made. Seating. The policy of gradually substituting new desks for the old ones has been continued; many new dual desks have been supplied during the year. Ventilation is in 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. Fire. 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. 124 Attendance. Mr. Heap has kindly furnished me with the following figures for this and the next two tables End of June, 1912. End of June, 1913. Number on Books. Average Attendance. Number on Books. Average Attendance. Non-provided Schools 2288 2114.9 2307 2083.2 Council Schools 10909 9973.5 11122 1004.9 Totals 13197 12088.4 13429 12132.2 There were 13,429 children on the books at the middle of the year, besides the children attending Enfield schools; the average number of children of the Edmonton district attending Enfield schools during the year was 280; so that there is in Edmonton one child in the public elementary schools for 4.9 inhabitants (reckoned on the, nett population), as compared with one child for 4.8 inhabitants last year. The accommodation in Edmonton schools at present is 14,365 places. The number of children on the books of the elementary schools of the district on 27th June, 1913, was 13,429, and the accommodation was 14,365. The accommodation and the number of children attending each school are given below:— School. Infants. Junior Mixed. Girls. Boys. Accom. No. on Books. Accom. No. on Books. Accom. No. on Books. Accom. No. on Books. Brettenham Road 437 309 — — 458 433 459 450 Croyland Road 369 329 420 410 369 353 537 512 Raynham Road 576 540 600 485 540 441 660 572 Eldon Road 600 635 521 534 540 526 660 609 Silver Street 562 525 — — 562 556 592 566 Houndsfield Road 460 334 300 297 300 272 300 288 Montagu Road 460 322 300 282 300 251 300 291 All Saints 447 482 — — 455 486 — — Latymer — — — — — — 300 308 St. James 220 244 — — 207 219 218 240 St. Edmund's 88 90 — — (248 238 Senior Mixed) These figures are not included in the totals. Totals 4219 3810 2141 2008 3731 3537 4026 3836 125 There is a total increase of 232 children attending school over last year. The average attendance during the last week of June, 1913, was 12132-2, the percentage of attendance to number on books being 90.3. There are no partial-exemption scholars. The number of children who obtained labour certificates enabling them, if they wish, to leave school at an earlier age than 14 was 35 boys and 4 girls. The admissions and withdrawals during the year, excluding transfers from one department to another, were :— Civil Year, 1912. 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 574 524 269 206 Council Schools 2924 2744 1331 1010 Totals 3498 3268 1600 1216 Expenses. Eight precepts on the Overseers, together amounting to £24,217, were issued to meet the requirements of the Education Committee for the year March, 1913, to March, 1914. Besides, a large necessitous grant has been received from a sympathetic Government, amounting to £9,216, or over an elevenpenny rate. Arrangements for and Scope of Medical Inspection. The arrangements have been the same as in former years. Three age groups have been inspected, the entrants (the majority of whom were five or six years of age), the ten-year-old group and the leavers. Four thousand, two hundred and seventy-one children were passed through the routine inspection. 126 The ages and numbers of children inspected were as follows:— Ages. Entrants. 10 year old group. Leavers. Total. 5 6 7 8 9 10 11 12 13 14 Boys 753 135 42 10 6 679 12 12 590 2 2241 Girls 680 156 48 4 9 581 16 7 528 1 2030 Total 1433 291 90 14 15 1260 28 19 1118 3 4271 The parents were present at 54.5 per cent, of the total inspections; at 43.8 per cent, of the elder boys', at 48.7 per cent, of the elder girls', at 66.8 per cent, of the infant boys', and at 69.8 per cent, of the infant girls' inspections. There were objections to medical inspection on the part of the parents in the case of 28 children, 12 boys and 16 girls; or 0-54 per cent, of boys and 0.79 per cent, of the girls. The number of re-inspections made during the year was 1693. The number of specially referred cases and absentees due to illness examined in the School Medical Office at the Town Hall was 1626. Visits are made to the Schools for routine inspection in the case of Infants' Schools twice a year, and in the case of other schools once a year. In the case of the latter schools however, a second visit is made in order to deal with cases which were absent from school at the previous inspection. Re-inspections take place twice a year at every school. Arrangements for following up children with defects. These have been the same as in former years. In cases where children have defects needing treatment, the parent is advised personally if she is present at the inspection, or by letter if she is not. The cards of these children are specially marked, so that they can be referred to with ease at future inspections. Plenty of space is given in the inspection card for fully describing any unusual conditions, and for making notes as to progress. A record is kept by the School Medical Officer of the names of children with defects, and a copy is given to the head teacher, who uses his or her influence to get the same remedied. The child is re-inspected at each visit to the school and fresh letters sent to parents, when necessary, until the defect is remedied. In special cases the nurse visits the home, or a notification is sent to the Society for the Prevention of Cruelty to Children. The local Inspector, Mr. Jones, has given us much help in this direction. 127 The total number of cases in which the parents were advised that medica] treatment was necessary was 1024, of which 567 were routine inspection cases and 457 were re-inspection cases. The principal defects for which treatment was advised were as follows:— Routine Cases. Re-inspection Cases. Boys Girls Boys Girls Total. Vision 157 150 159 140 606 Eye disease 7 6 6 9 28 Enlarged Tonsils and Adenoids 40 38 44 63 185 Ear disease 59 34 15 11 119 Bronchial Catarrh 7 2 1 3 13 Hernia 9 — — — 9 Other causes 30 28 4 2 64 Totals 309 258 229 228 1024 At the end of the year an enquiry was made in order to find out for how many cases treatment had been obtained. The following table gives the results as regards the most common defects :— Treatment obtained per cent. Treatment not obtained per cent. Left school or information unobtainable per cent. Vision— routine cases 19.9 52.5 27.6 re-inspection cases 20.0 61.5 18.5 Enlarged Tonsils and Adenoids— routine cases 16.7 56.4 26.9 re-inspection cases 27.0 58.0 15.0 Ear Disease— routine cases 9.7 55.0 35.3 re-inspection cases 30.8 57.7 11.5 Hernia— routine cases 22.2 44.4 33.4 GENERAL REVIEW OF FACTS DISCLOSED BY MEDICAL INSPECTION. Family History of Consumption. The number of boys with a family history of consumption was 294, and the number of girls 245. Based on the number of parents present at the inspection, the percentage of boys with a family history of consumption is 25.4, and the percentage of girls is 21.6; for both sexes taken together, the percentage is 24.2. 128 History of previous Illnesses. The percentage of cases in which there had been a previous history of the commoner illnesses of children is given below:— Age. Measles. Whooping Cough. Chicken Pox. Scarlet Fever. Diphtheria. Pneumonia. Boys— 5—6 87.2 47.6 35.6 4.8 2.5 4.2 6—7 93.5 59.2 44.8 2.6 2.6 2.9 10—11 95.8 60.5 54.0 15.9 4.7 3.7 13—14 96.5 62.2 50.9 11.8 4.1 7.3 All ages 92.5 56.0 45.6 9.7 3.6 4.6 Girls— 5—6 85.5 53.4 39.8 6.8 3.9 4.6 6—7 91.2 53.3 43.5 8.7 5.4 2.2 10—11 95.8 61.5 51.6 11.3 5.6 3.5 13—14 96.5 68.9 59.3 8.9 4.3 4.3 All ages 92.9 64.0 51.6 11.8 4.8 4.2 The table shows once more how very few children escape measles. I noticed scars of tracheotomy operations for diphtheria in the case of six children. Nine children had had mastoid operations and four had had operations for appendicitis. Three had had operations for empyema. Nutrition. The number of boys whose nutrition was bad was 16, and the number of girls 20, being 0.7 per cent, and 1.0 per cent, respectively of the children examined. See table at end. PROVISION OF MEALS. I am indebted to Mr. Pickrell, the Hon. Secretary of the Canteen Committee, for the following particulars:— Dinners were served to necessitous children throughout the year during the periods that the schools were open. All cases are enquired into by an Investigation Committee and local SubCommittees. The following show the genera! lines on which the granting of meals is determined :— 1. Each Local Committee to meet when necessary. Ten cases are a sufficient number to warrant the Local Secretary calling a meeting. 2. Cases occurring between meetings to be fed on the unanimous decision of Head Teachers and School Attendance Officers—until the next meeting, when they will be investigated. 129 3. If a parent does not attend the investigation meeting, and it is found that the non-attendance was due to illness, or other unavoidable cause, continue to feed, if the Head Teachers and School Attendance Officers are agreed, until the next meeting, when the parent will be called up again. 4. If the parents are undeserving, but the children apparently need food, supply it, if the School Doctor pronounces a child underfed, and Head Teachers and School Attendance Officers agree; report the case to the Central Committee. 5. If a child receiving tickets is found to be verminous, suspend the issue of tickets at once, and report the case to the Central Committee. 6. Without making a definite standard, if after paying rent and fares there is 16s. 2d. remaining for a family of five children and other sized families in proportion, as a rule meals should not be provided. 7. If the parents do not apply, and the School Doctor pronounces a child to be underfed, the parents are to be informed that the child apparently needs food, and asked to make application for meals. If the parents refuse to apply, report the case at once to the Central Committee. If application is made, feed the children and invite the parents to the next investigation meeting. Dinners were served at St. James' Hall in Upper Edmonton from January 8th to March 19th, and at St. Michael's Hall in Lower Edmonton from January 8th to April 30th. From April 1st to the end of December arrangements were made to feed the children at cook shops in the district. The total number of dinners received at the centres was 11,474, an average of 157 a day. The average cost of each dinner was 2.7d., the cost for food alone being 1.7d., and for preparation, apparatus and service, 1d. The total number of dinners received at the cook shops was 6067, an average of 37.6 a day. The average cost of each dinner was 3.5d., of which 2.5d. was estimated to be spent on food alone, and 1d. on service, etc. The total expenditure on the dinners during the year was £220, of which £145 was estimated to be sent on food alone. The total amount available to be spent on food alone is the produce of a ½d. rate, which is about £420. Intelligence. The intelligence of the child was recorded by the Head Teacher in consultation with the class teacher, the children being classed into seven grades. 130 The following table gives the percentage of children in each grade for the ten year old group and the leaver group:— Boys. Girls. 10 year old per cent. Leavers, per cent. 10 year old per cent. Leavers per cent. A. Mentally defective 0.5 0.5 0.2 0.0 B. Slow dull 2.5 2.1 1.7 5.2 C. Slow 17.5 12.5 10.2 13.7 D. Slow Intelligent 38.0 39.6 38.5 36.4 E. Fairly intelligent 32.5 36.6 43.0 30.3 F. Distinctly capable 8.4 8.0 5.8 6.9 G. Very able 0.6 0.7 0.6 1.5 It is not possible to class the children who have just entered with any accuracy, because as a rule they have not been sufficiently long under observation. However, in the case of four boys and two girls among the entrants, it was doubtful whether they were mentally defective or not. The total number of mentally defective children in the schools is abou 34 boys and 14 girls. MENTAL DEFICIENCY ACT, 1913. Previous to the coming in force of the Mental Deficiency Act of 1913 on April 1st, 1914, the powers of a Local Education Authority in dealing with these cases have been governed by the Elementary Education (Defective and Epileptic Children) Act, 1899. This latter Act provides:— Section 1. That the Education Authority may (with the approval of the Education Department*) make such arrangements as they think fit for ascertaining what children in their districts are mentally defective. If they make such arrangements, they must provide facilities for enabling a parent, who is of opinion that his child ought to be dealt with under the Act, to present his child for examination, or any parent may be required by the School Authority to present his child for examination. Section 2. Where a School Authority have ascertained that there are in their district defective children, they may make provision for their education by all or any of the following means:— (a) By classes in public elementary schools certified by the Education Department as special classes. *The Education Department is now " The Board of Education. 131 (b) By boarding out, subject to the regulations of the Education Department, any such child in a house conveniently near to a certified class or school. (c) By establishing schools, certified by the Education Department, for defective children. The Mental Deficiency Act, 1913, comes into force on 1st April, 1914. Definitions. The "Local Authority" is the County Council. The "Local Education Authority" is the District Education Committee— in so far as the District Council may have transferred their powers under this Act. Section 1 gives the classes of persons who can be considered mentally defectives within the meaning of the Act. Section 31 is as follows:— 1. The duties of a Local Education Authority shall include a duty to make arrangements, subject to the approval of the Board of Education:— (a) For ascertaining what children in their area are defective children within the meaning of this Act. (b) For ascertaining which of such children are incapable by reason of mental defect of receiving benefit, or further benefit, from instruction in special schools or classes. (c) For notifying to the County Council under this Act, the names and addresses of defective children with respect to whom it is your duty to give notice under the provisions hereinbefore contained. In case of doubt as to whether a child is or is not capable of receiving such benefit as aforesaid, or whether the retention of a child in a special school or class would be detrimental to the interests of other children, the matter shall be determined by the Board of Education. 2. The provisions of Section 1 of the Elementary Education (Defective and Epileptic Children) Act, 1899, shall apply with the necessary modifications for the purposes of this section. Section 2 (2) also provides that:— Notice shall, subject to regulations made by the Board of Education to be laid before Parliament as hereinafter provided, be given by the Local Education 132 Authority to the County Council in the case of all defective children over the age of seven years:— (a) Who have been ascertained to be incapable by reason of mental defect of receiving benefit, or further benefit, in special schools or classes, or who cannot be instructed in a special school or class without detriment to the interest of other children, or as respects whom the Board of Education certify that there are special circumstances which render it desirable that they should be dealt with under this Act by way of supervision or guardianship. (b) Who on or before attaining the age of 16 are about to be withdrawn or discharged from a special school or class, and in whose case the local education authority are of opinion that it would be to their benefit that they should be sent to an institution or placed under guardianship. Section 30 states:—Nothing in this Act shall affect the duties or powers of local education authorities under the Education Acts; and the duty of ascertaining what children over the age of seven and under the age of 16 (hereinafter referred to as defective children) are defectives, shall rest with the local education authority as hereinafter provided, and not with the local authority under this Act (the County Council); and such last mentioned authorities shall have no duties as respects defective children, except those whose names and addresses have been notified to them by the local education authority under the provisions of this Act. The Board of Education will shortly issue regulations under section 2 (2) of the Act, which will be provisional and no doubt will be altered and added to, as experience accumulates. The Board of Education will issue a set of model arrangements for dealing with mentally defective children. Memo. The work of the Education Committee that was formerly optional under the Act of 1899 is now compulsory. Thus the Education Committee must make arrangements for ascertaining what children in their area are defective; they must ascertain what children are incapable of receiving benefit, or further benefit, from instructions in special schools or classes. They must notify the latter children to the County Council as well as those children who are about to be withdrawn from special schools or classes on account of age limit. The Education Committee of Edmonton have so far not made any arrangements for the education of these children, and I can only repeat what has been said in previous Annual Reports of your School Medical Officer, that it is highly 133 desirable for the sake of the children themselves, and for the sake of other children alongside whom they have to be educated (as far as possible) in an ordinary elementary school, that the Education Committee should consider the question of providing special schools, either alone or in combination with the County Council. It is estimated that there are in this district 34 boys and 14 girls who are considered to be mentally defective attending our schools, and six boys and two girls not attending school. Note. —The Act, however, does not impose on the education authority the duty of providing for the education of children who are capable of being educated in special schools or classes. Condition of Clothing and Footgear. At the medical inspection almost all the children are scrupulously clean, both as regards body and clothing. The condition of the child as to clothing and cleanliness is recorded by the teacher on the medical inspection cards, the record being based on the condition in which the child usually comes to school. The presence, or absence, of nits or vermin is recorded by the medical inspector. The tables are given at the end of the report. The condition of the clothing was satisfactory in 72.4 per cent, of the children, and unsatisfactory in 27.6 per cent. The condition of the clothing does not vary much in the three different age groups of children, the clothing of the infants being the best. The condition of the clothing of the two sexes in the infants is about the same, the percentage of infant boys with unsatisfactory clothing being 24.6, as compared with 25.2 per cent, for infant girls. Among the elder children, however, the boys are much worse clothed than the girls, the percentage of the boy leavers with unsatisfactory clothing being 35.5, against 23.8 per cent, of the girl leavers; and in the intermediate group the percentage of boys with unsatisfactory clothing being 35.0, the percentage of girls 19.6. The number of children with unsatisfactory footgear is very much the same as for unsatisfactory clothing, the percentage for all the children being 27.4, and there are the same differences with regard to the two sexes. Cleanliness. As regards cleanliness of body, 6.4 per cent, of the children were dirty, that is, not necessarily dirty at the time of the medical inspection, but were considered by the teachers to be sent to school usually in a dirty condition ; 1.8 per cent, of the children were found infected with body lice at the time of inspection. 134 Vermin. The percentage of children with nits in the hair was 27.3. The following table will show the percentage in the two sexes and three age groups:— Entrants. Leavers. 10 year old group. Boys. Girls. Boys. Girls. Boys. Girls. Head clean 88.6 59.3 92.2 51.5 90.8 46.7 Very few nits 5.0 13.3 4.3 22.0 4.6 18.3 Many nits 6.4 26.7 3.5 26.0 4.6 33.2 Filthy — 0.7 — 0.5 — 1.8 Total per cent, unclean heads 114 40.7 7.8 48.5 9.2 53.3 At the three ages the percentage of boys with unclean heads is thus about 10 per cent., and of girls 50 per cent. The boys' heads are the dirtiest when they first come to school, and the girls' heads are the cleanest, but there is an improvement in both boys and girls between the ages of ten and the age of leaving. Fleas. Thirty-seven of the children were found extremely fleabitten, i.e., less than one per cent. Below is given a table showing the percentage of children with nits in the head at each of the schools. The Junior Mixed departments omitted, as the numbers inspected were too small to base a percentage thereon. Name of School. Boys. Girls. Infants. Seniors. Infants, Seniors. Brettenham Road 4.3 4.9 28.6 40.4 Croyland Road 5.3 8.7 21.1 41.0 Raynham Road 5.1 17.5 44.2 63.7 Eldon Road 10.5 5.5 47.0 54.1 Silver Street 4.6 8.1 21.0 43.0 Houndsfield Road 15.4 1.l 35.0 40.2 Montague Road 42.4 12.5 68.4 76.6 All Saints' 17.7 — 53.5 49.5 St. James' — 2.9 28.5 29.6 Latymer Elementary — 4.3 — — St. Edmunds' 14.8 2.5 50.0 67.6 All Schools 11.6 8.3 39.8 50.6 All Schools, 1912 9.8 6.8 41.8 44.0 All Schools, 1908 21.0 14.0 58.0 74.0 135 There has been a little going back during the last year, but we have improved enormously since the first year of medical inspection. In comparing different schools, regard must be had to the different class of children who come to the school, which can be gauged fairly by the percentage of children with nits among the infants. The School Nurse makes special visits to the schools to examine whole classes of children with a view to ascertaining their condition as to cleanliness. The children with nits are given cards to take home warning their parents of the condition and giving advice as to how to get rid of nits and vermin. This officer also visits the homes of scholars who are reported as verminous or suffering from sores, skin diseases, etc., by the head teachers to the School Medical Officer, and she obtains the assistance of her male colleagues to deal with dirty homes and foul bedding. This systematic visiting, which began on June 1st, 1912, when the School Nurse was transferred to the Public Health Departnlent, has produced good results—even although no legal action has yet been taken against neglectful parents. Cleansing Station. At the Council meeting on the 26th August, an intimation was received from the Local Government Board that there were some legal difficulties in the way of giving their sanction to the proposed loan of £600. Thereupon the Engineer and M.O.H. were instructed to seek an interview with the Local Government Board which took place on October 9th. The matter was still unsettled at the end of the year. As long ago as November, 1912, my Sanitary Committee and Council decided that it would be both economical and convenient to have the Disinfecting Station and the Cleansing Station in the Town Hall Yard. Measurements. The following table gives the average weights and height, in the metric system, of the children examined. Additional data given are the probable errors and the standard deviation. In the last columns English weights and measures are given. 136 Boys. Weight Height Age No. of children Average weight Probable error Standard Deviation Average weight Average height Probable error Standard Deviation Average height Kilogrmmes. + - Kilogrmmes. lbs. centimetres + - Centimetres Inches 5 753 17.55 .05 1.87 38.69 103.77 .11 4.65 40.85 6 135 18.36 .11 1.98 40.47 107.15 .31 5.39 42.18 7 42 20.23 .26 2.54 44.60 112.27 .63 6.06 44.19 8 10 22.10 .45 2.14 48.72 116.95 1.4 6.45 46.04 9 4 27.23 .85 3.10 60.03 128.08 .67 2.43 50.42 10 679 27.16 .08 3.06 59.87 128.53 .15 5.81 50.60 11 12 29.07 .55 2.70 64.08 132.58 1.01 5.16 52.19 12 12 30.73 .70 3.58 67.74 135.91 .87 4.47 53.51 13 590 34.87 .14 5.21 76.87 141.41 .20 7.15 55.67 14 2 38.00 — — 83.8 147.0 — — 57.87 Girls. Weight. Height. Age No. of children Average weight Probable error Standard Deviation Average weight Average height |Probable error Standard Deviation Average height Kilogrmmes. + - Kilogrmmes. lbs. centimetres + - Centimetres Inches 4 1 15.6 — — 34.4 96.5 — — 38.0 5 679 17.03 .05 1.96 37.55 103.08 .12 4.49 40.87 6 156 18.43 .11 2.13 40.63 107.96 .28 5.19 42.50 7 48 20.40 .28 2.99 44.97 113.08 .53 5.41 44.52 8 4 24.4 .7 2.2 53.8 122.3 1.8 5.4 48.2 9 9 22.7 .6 2.8 50-0 122.2 1.2 5.4 48.1 10 581 26.66 .10 3.47 58.77 129.06 .l8 6.49 50.81 11 l6 26.78 .48 2.86 59.o4 127.75 1.10 6.72 50.30 12 7 33.19 .83 3.29 70.96 141.89 1.27 4.97 55.86 13 528 36.14 .17 5.87 79.68 144.37 .23 7.65 56.84 14 1 36.2 — — 79.8 145.0 — — 57.1 On looking through the average heights and weights for the last five years we find that there has been a progressive increase in the heights and weights of the children of five years of age, and that this year the average height and weight of both boys and girls are higher than they have ever been before. 137 This will be seen in the following table, in which the probable errors are given:— Boys. Girls. Year. Weight. Probable Error. Height. Probable Error. Weight. Probable Error. Height. Probable Error. + - + - + - + - 1909 16.90 .05 101.79 .14 16.62 .05 101.81 .14 1910 17.24 .05 102.59 .13 16.73 .05 101.66 .12 1911 17.14 .05 102.81 .13 16.83 .05 102.33 .14 1912 17.43 .05 103.06 .12 17.01 .05 102.45 .12 1913 17.55 .05 103.77 .11 17.03 .05 103.48 .12 Average for five years 17.25 102.80 16.84 102.25 There is no doubt from these figures that there has been a decided mprovement in the physique of the children of this age. Among the ten years' old children there is also an improvement, though slight. With the thirteen years' old children, allowing for probable error, the measurements have been practically stationary during the five years. 138 Relative Heights and Weights of Children. It is useful, in judging the state of nutrition of a child, to have a table of relative heights and weights. A table was formed by taking the records of the past five years and calculating the mean weight for every two centimetre group of height. The total number of children included is 19,847. Boys. Girls. Central Height of Group. Centimetres. Number of Children. Average Weight. Kilogrammes. Number of Children. Average Weight. Kilogrammes. 86.75 9 13.57 88.75 8 13.15 90.75 28 13.76 21 13.95 92.75 56 14.44 52 14.09 94.75 146 14.82 118 14.61 96.75 273 15.39 267 15.21 98.75 366 15.91 363 15.74 100.75 655 16.59 526 16.31 102.75 716 17.16 577 16.97 104.75 589 17.98 57 17.53 106.75 609 18.40 503 18.05 108.75 506 19.01 403 18.91 110.75 320 19.65 293 19.35 112.75 292 20.28 250 20.10 114.75 243 21.16 199 20.94 116.75 230 22.24 214 21.74 118.75 263 22.92 179 22.32 120.75 275 23.79 224 23.19 122.75 295 24.59 240 23.92 124.75 375 25.67 273 24.65 126.75 47 26.24 294 25.80 128.75 407 27.40 318 26.59 130.75 408 28.45 342 27.61 132.75 421 29.55 319 28.50 134 .75 412 30.46 334 29.46 136.75 379 31.48 276 30.78 138.75 381 32.80 253 32.26 140.75 371 34.13 287 33.28 142.75 327 35.00 262 34.71 144.75 249 36.31 238 36.30 146.75 237 37.78 251 37.33 148.75 175 39.13 218 38.92 150.75 125 39.99 191 40.59 152.75 85 41.68 162 41.81 154.75 62 43.58 102 43.06 156.75 38 45.16 59 45.71 158.75 27 46.90 45 45.83 160.75 22 47.54 26 47.05 The first column gives the central height of the group for which the average weight has been found. The heights of the children are recorded at the medical inspection to the nearest half-centimetre. Thus the 92-94 group includes all children whose heights are between 91.75 and 93.75, the central height of the group being 92.75. The weights and heights of the boys follow very closely, from the height of 94 cm. to 160 cm. the equation:— W— 11.17 = .0039 (H — 64.07)2. 139 For the girls the equation is:— W—12.92 = .00452 (H — 73.23)2., the weight being expressed in kilogrammes and the height in centimetres. The relative heights and weights together with the height and weight curves from the equations given above are shown on the two accompanying charts. Ringworm. Of the children inspected, four had ringworm of the scalp and two had ringworm of the body. All were boys. The number of children away from school for ringworm at the end of the year was 78, 66 of these being for ringworm of the scalp and 12 for ringworm of the body. The children who are away from school for ringworm are inspected by the School Medical Officer at intervals of not less than a month in the School Medical Office. The exclusion certificate for cases of ringworm is never given for a period longer than a month. If the children do not present themselves for examination at the end of this period they are visited by the attendance officer. A child who has been excluded for ringworm is not admitted to school until a clearance certificate has been sent by the School Medical Officer. A child who has ringworm of the scalp is always away for several months, sometimes even for over a year. This prolonged exclusion from school is no doubt very detrimental to the child, and very trying for the parents, but it is the only course to prevent the disease spreading through the schools. Ninety-five samples of hair were examined in the Council's laboratory, of which 67 were found to be infected and 28 non-infected with the parasitic growth. Other Skin Diseases. Thirteen children had congenitally rough skins, in seven of whom the condition was very marked. One child had scabies, four had impetigo. Three children, one boy and two girls, had psoriasis, three had marked seborrhcea of the skin, and one of the scalp. One child had patches of alopecia areata on the scalp. Teeth. The number of children with decayed teeth is given in the table at the end of the report. It will be seen that 47.2 of the entrants had sound teeth, 48.4 per cent, of the leavers and 37.4 per cent, of the intermediate group; while 15.1 per cent, of the entrants, 5.2 per cent, of the leavers and 10.9 per cent, of the intermediate group had four decayed teeth or more. The above figures apply to both temporary and permanent teeth. 140 The following table gives the number of children with permanent teeth decayed for the ten years' old children and the leavers:— No. of Teeth decayed. 1 2 3 4 5 6 7 8 12 Total 10 year old group. Boys 113 66 28 8 3 1 .. .. .. 219 Girls 113 59 18 7 1 •• •• •• .. 198 Leavers. Boys 113 112 38 18 4 1 1 1 •• 288 Girls 125 87 41 12 1 1 1 1 1 270 Thus 31.4 per cent, of the 10 years' old boys, and 32.7 per cent, of the 10 years' old girls had one or more permanent teeth decayed. The percentages of children with decayed permanent teeth among the leavers was, for boys, 47.6, and for girls, 50 3. At both ages the teeth of the girls is a little worse than those of the boys. Nose and Throat. The number of children who had had operations for enlarged tonsils and adenoids before inspection was 171, or 7.4 per cent, of the children whose parents were present at the medical inspection and for whom only a history was available. Seven children had had two operations for this condition, and three children had had three operations. The percentage of children with marked enlargement of tonsils was 57, while 0.65 per cent, in addition showed evidence of adenoids without enlarged tonsils. The proportion of children with enlarged tonsils is greatest among the entrants, being 6.6 per cent., and least among the ten years' old group, being 5.1 per cent. The percentage of mouth breathers was 3.06 among the entrants, 1.23 among the 10 years' old group, and 0.97 among the leavers. The percentage of children with marked enlarged tonsils has very much decreased during the course of the last four years. In 1909 it was 10.8, almost double that for 1913. It is probable that increased attention to proper habits of breathing among the children will reduce the proportion still more. Enlarged Glands. The submaxillary glands were found enlarged in 81 boys (3.6 per cent.) and 42 girls (2.1 per cent.). 141 In only 20 boys (.9 per Cent.) and 16 girls (.8 per cent.) was the enlargement at all marked. In one case only there was suspected tuberculosis of the neck glands. Glandular enlargement was more common among the entrants than leavers, and more common among the boys than girls, the percentage for infant boys being 4.9, infant girls 2.6, thirteen year old boys 2.0, and thirteen year old girls 1.5. The posterior cervical glands were enlarged in 6 children, 3 boys and 3 girls. External Eye Disease. Squint was noted in 65 children, 33 boys and 32 girls. The squint was convergent, except in the case of 4 boys. Of the children who had squint, 12 or 18.5 per cent, were wearing glasses. The percentage of children with squint was: infant boys 1.8, ten year old boys 1.4, thirteen year old boys .95; infant girls 2.1, ten year old girls 1.3, and thirteen year old girls 1.1. Opacities of the cornea were noticed in 16 children. Other defects found were: stye, 2 cases; epiphora (or watering of the eyes) 4 cases; blepharitis, 21 cases; ptosis (drooping of the eyelids) 3 cases; conjunctivitis, 4 cases. Vision. The statistics concerning vision are given in the table at the end of the report in the form suggested by the Medical Officer of the Board of Education. The percentage of children with normal vision of each eye for leavers was 65.6, and for the intermediate group of children of ten—eleven years old, 62.4. Taking the boys and girls together, therefore, the eyesight is a little better at thirteen years old than at ten years old. Taking boys and girls separately, the percentage of boys with normal vision of each eye is for boys of ten, 65.5; and for boys of thirteen, 65.1. The percentage of girls with normal vision of each eye is: for the ten year old group, 58.7; and for the thirteen year old group, 61.6. Thus boys have better eyesight than girls; and while the boys' eyesight is about the same at both ages, the sight of the girls at thirteen years of age is better than the sight of the girls at ten years of age. These figures are satisfactory in some measure, since they afford no evidence of deterioration of vision caused by school influences, such as needlework. 142 The percentage of children with normal vision of one or the other eye was: for ten year old boys, 76.8; thirteen year old boys, 78.0; ten year old girls, 72.7; and thirteen year old girls, 43.6. Thus well over a fifth of the children examined had unsatisfactory eyesight. The percentages of children with acute vision, that is, who were able to see at six metres distance the test types which are seen at five metres only by the normal eye, were 10 year old boys, 30.3; 13 year old boys, 36.8; 10 year old girls, 19.6; and 13 year old girls, 23.9. Here again there is a marked difference between boys and girls, and a marked improvement in the elder children. The number of children from 10 to 13 years of age wearing glasses was 29 boys and 50 girls, or 15.1 per cent, of the boys and 24.7 per cent, of the girls who had eyesight of 6/18 or worse in one or both eyes. Ear Disease. This was present in 51 children, or 1.16 per cent. In 25 cases the right ear alone was affected, in 18 the left ear alone was affected, and in 8 cases both ears. There was a history of ear discharge with 49 children, or 1.17 per cent. The ears of the children were free from discharge at the time of examination, but were subject to it at more or less frequent intervals. The ears were obstructed by wax in 41 children. Hearing. The hearing was tested with a stop watch in the case of children over q years of age. The hearing was good in both ears in the case of 81.5 per cent, of the children examined. The hearing of the boys was a little better than that of the girls, and the hearing of the ten year old group was a little better than that of the thirteen year old group. Speech. Speech was defective in the case of 10 children, all of whom were under the age of eight. In these cases the defect was marked. Slight defects of speech in infants of five or six, where the child has not yet learnt to talk properly, are very common, and improve after they have been at school. The number of stammerers was n, all except one being boys. Heart and Circulation. Twelve children were anaemic, 3 to a slight extent only. Of the 12 children, 8 were boys and 4 girls. 143 Valvular disease of the heart was present in 21 children, of which 19 were cases of mitral regurgitation, and 2 were cases of mitral stenosis. Of the 21 cases, 6 were in boys and 15 in girls. The 2 cases of mitral stenosis were both boys. Two boys examined during the year in the ordinary routine were found to have the heart on the right side. In neither case was there any valvular defect. Lungs. Forty-three children, or one per cent., had bronchial catarrh at the time of examination. This was practically confined to the children of five years, which age accounted for 25 boys and 12 girls out of this number. Three children, all boys of ten years of age, were subject to attacks of spasmodic asthma. Tuberculosis. The School Medical Inspector, during 1913, sent eight "B" notifications to the M.O.H. Of these, two referred to pulmonary tuberculosis and six to other forms of tubercle. No case of pulmonary tuberculosis was found among the routine inspections. There were two cases of suspected pulmonary tuberculosis. There was one case of non-pulmonary tuberculosis, tubercular disease of spine; and one case of suspected tuberculous glands of neck. Four children had evidence of past joint tuberculosis, two of tuberculosis of knee, one of hip, and one of ankle. Eleven children had evidence of past tuberculosis of cervical glands. Nervous System. Five children were subject to epileptic fits, six children to attacks of sick headache or migraine. Two children, a boy of ten and girl of nine, were subject to " night terrors." Rickets. There was a history of rickets in 21 cases. In five cases only was there unquestionable evidence of previous rickets. In our experience rickets is of very small importance in children of school age. In cases where there is a history of it in infancy, by the time school age is reached any deleterious effects have for the most part ceased to operate. 144 Hernia. Inguinal hernia was present in 11 children—9 boys and 2 girls. Of the 11 cases 7 were right inguinal, 2 were left inguinal, and 2 double inguinal hernia. Three of the children with hernia were wearing trusses. Five children had been operated on for hernia. There were two cases of umbilical hernia, and one case of hernia in the linea alba. Other Defects or Deformities. Four children, three boys and a girl, had knock knee; five children, all boys, were "pigeon chested." Two children, a boy and a girl, had deformities which are the result of infantile paralysis. One child showed evidence of congenital syphilis. Two children had club foot, two children had marked flat foot. Nocturnal enuresis, "wetting the bed," was complained of in the case of 16 children, 12 boys and four girls. This complaint, distressing alike to parents and children, seems one of the most difficult to cure after the child has got to school age. One child, a girl, was a hœmophiliac. One child had six toes, another had a cervical rib. SCHOOL CLINICS. The third meeting of the Sub-Committee was held on Tuesday, February 4th. The School Medical Officers presented a report based on a new work on School Clinics, published by the National Physical League, showing the nature of the work and its extent in places where a school clinic is already established. The Deptford clinic was visited on Friday, June 13th, and the London County Council centre at Barnsbury on June 11th. A fourth and final report of the School Medical Officers was submitted to the Sub-Committee on nth July. This gave an estimate of the probable number of cases in Edmonton that would require treatment at the school clinic during the first year, based upon experience in routine medical inspection of an average of 4,000 children per year since 1908. Eight different methods of treatment were mentioned, coupled with a statement of their observations at visits to the two clinics above mentioned. On July 9th the Architect and Medical Officers visited Pymmes Park House and inspected the rooms suggested to be used. The Sub-Committee reported to the full Committee at their meeting on 7th October recommending that courses 2 and 3 be undertaken if possible. Course 2 provides treatment of minor ailments and skin troubles by a school nurse under medical supervision. Course 3 provides dental treatment by a whole or part-time dentist. The Architect also submitted plans showing the necessary alterations at Pymmes Park and his estimate of the cost 145 of adaptation. The Medical Officers submitted a report, dated 2nd October, to this meeting estimating the probable cost in capital expenditure and annual maintenance in order to carry out the recommendations of the Sub-Committee. On the 14th October the Council agreed to grant the Education Committee the use of two rooms at Pymmes Park House at the rent of £10 per annum, the Education Committee to bear the expense of maintaining and lighting the rooms, as the latter expect to receive back a maximum of 50 per cent, of the expenses incurred from the Board of Education. The Education Committee adjourned consideration of the subject until 1914. INFECTIOUS DISEASE. The number of children excluded at the routine inspection was 127, the reason for exclusion being:— ? Scarlet Fever 2 Vermin 97 Mumps 2 Ringworm 4 Whooping Cough 1 Scabies 1 Chickenpox 1 Impetigo 1 Bronchial Catarrh 3 Other Skin Diseases 5 Tubercular Glands 1 Eye Disease 4 Tubercular Spine 1 Other Diseases 4 The total number of exclusion certificates issued for contagious and other diseases during the year was 1,426 the reasons for exclusions being:— Scarlet Fever 2 Vermin 206 Whooping Cough 2 Scabies 54 Mumps 12 Impetigo 62 Chickenpox 2 Other Skin Diseases 133 Pulmonary Tuberculosis 8 Eye Disease 39 Tubercular Glands 6 Ear Disease 3 Tubercular Knee 1 Chorea 8 Tubercular Ankle 1 Epilepsy 2 Bronchial Catarrh 5 Other causes 129 Ringworm 751 1,426 The infant departments of the southern schools were thoroughly disinfected in January owing to the prevalence of measles. In February chickenpox was prevalent at the National Schools. About the middle of March measles was nearly over, but chickenpox was still troubling the National Schools. At the end of May mumps was predominent at Silver Street, and whooping cough at Montagu Road and Brettenham Road, and chickenpox was still affecting some scholars at the National School. 146 Daring the summer holidays all the public elementary schools were disinfected, and also the Latymer Secondary School; the same was done during the Christmas vacation of 1913. Exclusion of Contacts. The rules adopted for the exclusion of contacts are as follows. All children living in a house where there is a case of scarlet fever or diphtheria are excluded from school until the Medical Officer of Health certifies that they may attend. The same rule applies to contacts (i.e., children living in the same house) of measles, whooping cough, chickenpox, and mumps, in the case of children attending the Infants' Schools. In the case of children attending the schools for older children, however, the child is not excluded, if he or she has already had the disease in question sometime since. The danger is not altogether that he may in some way carry the disease about him and spread it, but that he may attend school while suffering from measles or such like in the incipient stage, and so spread it; if he had already had the disease this danger may be said to be much less. As stated in our last report, after considering figures which the head teachers had been at some trouble to collect with reference to whooping cough contacts throughout the year, we felt justified in recommending that all contacts with whooping cough might be allowed to attend the departments for boys and girls whether they had had the disease or not. Teachers' Notifications. Insufficient knowledge of the existence of the infectious diseases leads to their uncontrolled spread and to regrettable effects on the average attendance, which I wish to see as high as possibleconsistent with the health of the scholars and the younger relations at home. I am glad to be able to report again that our further experience of the system of notification advised by the Medical Officers in December, 1909, has been very satisfactory. The teachers and attendance officers, generally speaking, have spared no pains to do the work thoroughly, and therefore well. It is interesting to note the great variation in the number of children excluded from the schools during 1913. Total number, 1941; previous year, 1684. 1. Silver Street 374 7. Croyland Road 149 2. Raynham Road 288 8. St. James's 120 3. Montagu Road 263 9. Houndsfield 71 4. National 233 10. Lower Latymer 26 5. Eldon Road 188 11. St. Edmund's 19 6. Brettenham Road 178 Besides the following:—Enfield Council Schools 15; Private Schools 3; Tottenham Deaf and Dumb School, 1; and 13 children not attending (at the time) any school. 147 Exclusion Notices. In connection with the notifiable infectious diseases, viz., diphtheria, scarlet and enteric fevers, 1,500 notices were issued excluding contacts from attendance for definite periods. Notices were issued in 1912-11-10 to the number of 621, 396 and 778, respectively. These notices are now made out for the individual children, patients, and contacts, as they are for non-notifiable diseases, and not for infected houses. On account of the non-notifiable infectious diseases, notices excluding 1,941 children as patients or contacts were issued by me, after enquiries had been as to the real nature of the illness. The numbers excluded in 1912-11-10 were 1,684, 1,748 and 1,929 respectively. 149 TABLES I-IV. Arranged as desired by Board of Education, with reference to the 4271 children examined at the routine inspection. 150 TABLE I. No. of Children inspected 1st January, 1913 to 31st December, 1913:— A.—"Code" Groups. Entrants. Leavers. Grand Total. Age 4 5 6 Other ages. Total. 12 13 14 Total. Boys - 753 135 52 940 12 590 2 604 1,544 Girls 1 679 156 52 888 7 528 1 536 1,424 Totals 1 1,432 291 104 1,828 19 1,118 3 1,140 2,968 B.—Intermediate Group. Age 9 10 11 Total. Re-examinations. Boys 6 679 12 697 881 Girls 9 581 16 606 767 Totals 15 1,260 28 1,303 1,648 151 TABLE II.—RETURN SHOWING PHYSICAL CONDITION OF CHILDREN INSPECTED. Entrants. Leavers. Age 10. Total. Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent. Condition. Total Inspected 940 888 1828 - 604 536 1140 - 697 606 1303 - 2241 2030 4271 - Clothing. Satisfactory 694 664 1358 74.3 390 408 798 70.0 452 487 939 72.1 1536 1559 3095 72.4 Unsatisfactory 246 224 470 25.7 214 128 342 30.0 245 119 364 27.9 705 471 1176 27.6 Footgear. Satisfactory 689 658 1347 73.7 411 404 815 71.5 452 488 940 72.2 1552 155 0 3102 72.6 Unsatisfactory 251 230 481 26.3 193 132 325 28.5 245 118 363 27.8 689 480 1169 27.4 Cleanliness of Head. Clean 833 527 1360 74.4 557 276 833 73.1 633 283 916 70.3 2023 1086 3109 72.7 Very few nits 47 118 165 9.0 26 118 144 I2.6 32 111 143 11.0 105 347 452 10.6 Many nits present 60 237 297 I6.3 21 139 160 14.0 32 201 233 17.9 113 577 690 l6.2 Head filthy - 6 6 0.3 - 3 3 0.3 - 11 11 0.8 - 20 20 0.5 152 TABLE III. Entrants. Leavers. Intermediate. Total. Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent. Nose and Throat— No defect 730 692 1422 77.8 516 450 966 84.7 589 477 1066 81.5 1835 1619 3454 80.8 Mouth breathers 39 17 56 3.0 9 2 11 0.97 6 10 16 1.23 54 29 83 1.94 Tonsils slightly enlarged 111 126 237 13.0 47 54 101 8.9 75 92 167 12.8 233 272 505 11.8 Tonsils much enlarged 62 59 12 0 6.6 37 30 67 5.1 27 29 56 4.9 126 118 244 5.7 Adenoids 12 7 19 1.0 1 2 3 0.26 2 3 5 0. 38 15 12 27 0.65 External Eve Disease— No disease 930 872 1802 98.59 598 531 1129 99.03 686 603 1289 99.91 2214 2006 4220 98.81 Blepharitis 4 8 12 0.65 2 2 4 0.35 5 2 7 0.55 11 12 23 0.54 Conjunctivitis .. 2 2 0.11 1 .. 1 0.09 1 .. 1 0.08 2 2 4 0.09 Corneal Opacities 2 3 5 0.27 3 2 5 0.44 5 1 6 0.46 10 6 16 0.37 Other diseases 4 3 7 0.38 .. 1 1 0.09 .. .. 0 .. 4 4 8 0.19 Teeth— Sound 428 433 861 47.2 305 247 552 48.4 237 250 487 37.4 970 930 1900 44.5 Three or less decayed 364 326 690 37.7 264 265 529 46.4 377 310 687 51.7 1005 901 1906 44.6 Four or more decayed 148 129 277 15.1 35 24 59 5.2 83 46 129 9.9 266 199 465 10.9 Ear Disease- No disease 914 874 1788 97.75 564 509 1073 94.13 670 578 1248 95.78 2148 1961 4109 96.40 Obstruction—right 1 3 4 0.28 3 9 12 1.05 6 7 13 1.00 10 19 29 0.69 left 1 2 3 0.16 5 8 13 1.14 4 5 9 0.69 10 15 25 0.60 Otorrhœa—right 10 2 12 0.66 9 3 12 105 7 2 9 0.69 26 7 33 0.82 ,, left 7 5 12 0.66 10 2 12 1.05 2 .. 2 0.15 19 7 26 0.62 History of Otorrhœa 7 2 9 0.49 13 5 18 1.58 8 14 22 1.69 28 21 49 1.17 153 Table III.—continued. Entrants. Leavers. Intermediate. Total. Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent. Heart Disease- No disease 930 881 1811 99.07 598 525 1123 98.50 689 605 1294 99.32 2217 2011 4228 99.00 Organic disease 2 3 5 0.27 1 10 11 0.97 3 .. 3 0.23 6 13 19 0.44 Functional disease 5 1 6 0.33 4 1 5 0.44 1 .. 1 0.07 10 2 12 0.28 Anaemia 3 3 6 0.33 1 .. 1 0.09 4 1 5 0.38 8 4 12 0.28 Lungs- No disease 913 875 1788 97.82 601 536 1137 99.85 694 606 1300 99.77 2208 2017 4225 98.89 Chronic Bronchitis and Bronchial Catarrh 27 12 39 2.13 2 .. 2 0.17 .. .. .. .. 29 14 43 1.00 Tuberculosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Suspected Tuberculosis .. 1 1 0.05 1 .. 1 0.08 .. .. .. .. 1 1 2 0.04 Other diseases .. .. .. .. .. .. .. .. 3 .. 3 0.23 3 • • 3 0.07 Nervous Svstem— No disease 938 887 1825 99.85 603 536 1139 99.91 690 606 1296 99.48 2231 2029 4260 99.79 Epilepsy 2 1 3 0.15 .. .. .. .. 2 .. 2 0.15 4 1 5 0.11 Migraine .. .. .. .. 1 .. 1 0.09 5 .. 5 0.37 6 .. 6 0.14 Chorea • • .. • • .. .. .. • • • • • • .. • • • • • • • • • • Skin- No disease 928 887 1815 99.19 599 533 1132 99.30 689 603 1292 99.15 2216 2023 4239 99.18 Ringworm of body • • .. .. .. .. .. .. .. 2 .. 2 0.15 2 .. 2 0.05 Ringworm of head 2 .. 2 0.ll 1 .. 1 0.09 1 .. 1 0.08 4 .. 4 0.09 Impetigo 3 .. 3 0.16 .. .. .. .. 1 .. 1 0.08 4 .. 4 0.09 Scabies .. .. .. .. 1 .. 1 0.09 .. .. .. .. 1 .. 1 0.02 Other diseases 7 1 8 0.44 3 3 6 0.52 4 3 7 0.54 14 7 21 0.47 154 Table III.—continued. Entrants. Leavers. Intermediate. Total. Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent. Pickets— No disease 939 888 1827 99.95 603 535 1138 99.83 698 605 1303 99.85 2240 2028 4268 99.88 Evidence of (slight) 1 .. 1 0.05 1 1 2 0.17 1 1 2 0.15 3 2 5 0.12 Deformity— No deformity 940 886 1826 99.89 601 533 1134 99.47 697 602 1299 99.69 2238 2021 4259 99.70 Deformity present .. 2 2 0.11 3 3 6 0.53 .. 4 4 0.31 3 9 12 0.30 Tuberculosis Non=Pulmonary— No disease .. .. .. 100.0 .. .. .. 100.0 .. .. .. 99.84 .. .. .. 99.98 Disease present .. .. .. Nil .. .. ... Nil .. 1 1 o.16 .. 1 1 0.02 Speech— Not defective 929 887 1816 99.34 559 535 1094 99.47 694 606 1300 99.77 2182 2028 4210 99.51 Defective articulation. 9 1 10 0.55 .. .. .. .. .. .. .. .. 9 1 10 0.23 Stammering 2 .. 2 0.11 5 1 6 0.53 3 .. 3 0.23 10 1 11 0.26 Hearing— Good both ears 491 432 923 81.0 591 482 1073 82.2 1082 914 1996 81.5 Good right ear 510 451 961 84.4 609 500 1109 85.0 1119 951 2070 84.6 Good left ear 521 455 976 85.6 616 500 1116 85.6 1137 955 2092 85.5 Fair right ear 52 36 88 77 36 47 83 6.4 88 83 171 7.0 Fair left ear 37 32 69 6.0 36 56 92 7.1 73 88 161 6.6 Bad right ear 29 36 65 5.7 40 44 84 6.4 69 80 149 6.1 Bad left ear 33 35 68 5.9 36 36 72 5.5 69 7i 140 5.7 Very bad right ear 17 13 30 2.6 12 15 27 2.1 29 28 57 2.3 Very bad left ear 9 14 23 2.0 9 14 23 1.8 18 28 46 1.9 155 Table III.—continued. Entrants. Leavers. Intermediate. Total. Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent Boys. Girls. Total Per cent. Boys. Girls. Total. Per cent. Vision— 6/6 each eye .. .. .. .. 393 330 723 65.6 457 356 813 62.4 850 686 1536 63.0 6/6 right eye .. .. .. .. 427 364 791 69.6 494 402 896 68.8 921 766 1687 69.2 6/6 left eye .. .. .. .. 438 360 798 70.3 498 394 892 68.5 936 754 1690 69.3 6/9 right eye .. .. .. .. 73 75 148 13.0 108 111 219 16. 8 181 186 367 15.0 6/9 left eye .. .. .. .. 64 71 135 11.9 106 107 213 16.4 170 178 348 14.3 6/12 right eye .. .. .. .. 24 19 43 3.8 35 16 51 39 59 35 94 3.8 6/12 left eye .. .. .. .. 16 24 40 3.5 29 16 45 3.5 45 40 85 3.5 6/18 right eye .. .. .. .. 24 31 55 4.8 25 30 55 4.2 49 61 110 4.5 6/i8 left eye .. .. .. .. 24 24 48 4.2 26 37 63 4.8 50 61 11 4.6 6/24 right eye .. .. .. .. 16 18 34 3.0 14 18 32 2.5 30 30 66 2.7 6/24 left eye .. .. .. . 29 18 47 4.1 15 22 37 2.8 44 40 84 3.4 6/36 right eye .. .. .. . 23 15 38 3.3 14 19 33 2.5 37 34 71 2.9 6/36 left eye .. .. .. .. 15 21 36 3.2 15 13 28 2.2 30 34 64 2.6 6/60 right eye .. .. .. .. 8 6 14 1.2 3 5 8 0.6 11 11 22 0.9 6/60 left eye . .. .. .. 9 6 15 13 4 9 13 10 13 15 28 1.1 6/0 right eye .. .. .. .. 7 7 14 1.2 5 4 9 0.7 12 11 23 0.9 6/0 left eye .. .. .. .. 7 11 18 1.6 3 7 10 0.8 10 18 28 1.1 Cleanliness of Body— Clean 859 828 1687 92.3 572 505 1077 94.5 656 577 1233 94.6 2087 1910 3997 93.6 Dirty 81 60 141 77 32 31 63 5.5 41 29 70 5.4 154 120 274 6.4 Pediculi present 8 13 21 1.1 23 10 33 2.9 20 4 24 1.8 51 27 78 1.8 Nutrition- Excellent 581 583 1164 63.7 318 299 617 54.1 431 441 872 66.9 1330 1323 2653 62.1 Fair 352 297 649 35.5 284 229 513 45.0 257 161 418 32.1 893 687 1580 37.0 Poor 7 8 15 0.8 2 7 9 0.8 9 4 13 1.0 18 19 37 0.9 Bad .. .. .. .. .. 1 1 0.1 .. .. .. .. .. 1 1 0.02 156 TABLE V. NUMERICAL RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. Boys. Girls. Total. Blind, including Partially Blind— Attending Public Elementary Schools 1 1 2 Attending Certified Schools for the Blind 3 4 7 Not attending Schools - - Nil Deaf and Dumb, including Partially Deaf— Attending Public Elementary Schools - 2 2 Attending Certified Schools for the Deaf 6 4 10 Not at School - - Nil Mentally Deficient— A.—Feeble Minded— Attending Public Elementary Schools 34 14 48 Attending Certified Schools - - Nil Not at School 3 1 4 B.—Imbeciles— At School - - Nil Not at School 3 1 4 C.—Dull or Backward— Retarded two years 251 174 425 Retarded three years 86 64 150 Epileptics— Attending Public Elementary Schools 4 8 12 Not at School 2 1 3 * Pulmonary Tuberculosis— Attending Public Elementary Schools 5 4 9 Attending Certified Schools for Physically Defective Children Nil Not at School 15 6 21 *Other Forms of Tuberculosis— Attending Public Elementary Schools 10 10 20 Attending Certified Schools for Physically Defective Children - - Nil Not at School 5 9 14 Cripples, other than Tubercular— Attending Public Elementary Schools 19 12 31 Attending Certified Schools for Physically Defective Children - - Nil Not at School 5 5 10 * Includes all cases notified to M.O.H. as Tuberculosis. Weight Kgs. BOYS. •------------- Mean weights as observed -- Height and Weight curve from formula W- 11.17=.0039(H-64.07)2 Weight in kilogrammes. Height in centimetres. . We i q ht Kg s. GIRLS . Mean weights as observed ------- Height and Weight curve from formula W-12.92=.004.52 (H- 73.23)2 Weight in kilogrammes Height in centimetres