Edmonton Urban District. ANNUAL REPORTS on the Public Health and Education of Edmonton, FOR THE YEAR 1914, by SIDNEY C. LAWRENCE, Medical Officer of Health and School Medical Officer, M.B„ Ch,B„ P.P.H. (Lond.), M.R.C.S. (Eng.), L.R.C.P. (Lond.), Fellow of the Society of Medical Officers of Health, Member Of its Council, President of the Home Counties Branch, 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. BUTLAND, M.R.San.I, EDM 11 Edmonton Urban District. ANNUAL REPORTS on the Public Health and Education of Edmonton, FOR THE YEAR 1914, 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, Member of its Council, President of the Home Counties Branch. 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. BUTLAND, M.R.San.I. Edmonton Urban District Council. 1914-15. Chairman—W. A. CULL, J.P. Vice-Chairman—CHARLES HART. THE SANITARY COMMITTEE. SYDNEY J. SANDERS, Chairman. H. BARRASS, C.C. S. N. BERRIMAN. W. C. ELMS. R. GREEN, J.P., C.C. J. A. KILBRIDE. E. D. RUSSELL. C. SORRELL. H. WILLIAMS. 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, J.P., C.C. W. A. CULL, J.P. C. SORRELL. Rev. T. WARREN. Middlesex Districts Joint Small-Pox Hospital Board— W. A. CULL, J.P. S. H. PLATTEN. Metropolitan Water Board— Councillor D. WESTON (of Enfield, and represents Edmonton and Southgate also). The Lea Conservancy Board—W. D. CORNISH, J.P. C.C. Middlesex Districts Councils Association—Rev. Preb. E. A. B. SANDERS, M.A. Latymer Foundation Governors— W. A. CULL, J.P. H. P. LeMARE. I. THE REPORT ON THE PUBLIC HEALTH OF EDMONTON During 1914. 4 PUBLIC HEALTH DEPARTMENT, December 31st, 1914. 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.*† 7.—Fourth Male Inspector (Housing); H. K. NIXON.¶† 8.—Junior Woman Inspector: NORA PLAYNE (also School Nurse). 9.—Senior Clerk: ARTHUR J. KIRKMAN. 10.—School Medical Clerk: HAROLD DYER.* 11.—Junior Clerk: JOHN FARRAR. 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. 22—25.—Attendants at Sanitary Convenience on The Green : Two male and two female. * Officers marked thus hold the Certificate of the Royal Sanitary Institute, † These officers have the Certificate of Meat and Food Inspector. ‡ These officers are appointed as Inspectors under the Shops' Act, 1912. ¶ These officers also have 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, 1914 (including 705 Belgians) 68,908 Density of Population per Acre of Land, 1914 18.1 Rateable Value, October, 1914 £230,351 Assessable Value, October, 1914 £216,689 General District Rate, 1914 4s. 8d. in the £ Poor Rate, 1914 5s. od. in the £ A Penny Rate produces about £860 VITAL STATISTICS. Birth-rate per 1,000 living (excluding Belgian?) 27 25 Gross, or Registered Death-rate per 1,000 living (including Belgians) 17.67 Nett Death-rate per 1,000 living (excluding Belgians) 10.79 Corrected Nett Death-rate per 1,000 living (excluding Belgians) 11.56, Infantile Mortality per 1,000 births registered (excluding Belgians) 85.53 Zymotic Death-rate per 1,000 living( excluding Belgians) 1.48 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 "Dulce et decorum est pro patria mori." To the Chairman and Members of the EDMONTON URBAN DISTRICT COUNCIL. Gentlemen, I have the pleasure of presenting you with my ninth Annual Report of the health and sanitary circumstances of Edmonton. It refers to the year 1914. The Senior Woman Inspector (Miss Hudson) has passed the examination of the Sanitary Inspectors' Board, and Mr. Harold Dyer, the School Medical Clerk, obtained the certificate as Sanitary Inspector from the Royal Sanitary Institute a week after he had attained his 21st birthday, and so was eligible for the examination. On June 18th, 1914, at the House of Commons in Committee of Supply, when the vote of £192,356 for the salaries and expenses of the Local Government Board was being considered, Mr. Herbert Samuel, then President of the. Local Government Board, said:— " The Government are of opinion, that it is of importance to the efficient administration of the health laws of the country that all Medical Officers of Health should have a proper degree of security of tenure, and I am contemplating the issue of a new General Order which will make use of the powers the Board possesses for securing this admirable object." About the same time the President repeated this view to a very influential deputation of laymen and Medical Officers of Health, but the cloud of war burst shortly afterwards and nothing has been done. The following extract from Mr. J. M. M'Lachlan's book on "Urban District Councils," is worthy of a place here, as he writes from long municipal experience, and was the Chairman of the Levenshulme Urban District Council, 1908-9. "Let me utter a word of warning to 'reformers' who gain entrance to the Council, and bait rhe officials under the impression that they are fulfilling a public service in so doing. It will be many years before we grow out of the truly British habit of regarding public officials as our natural enemies. To the newcomer I whisper, ' Don't do it!' "I have had many intimate dealings with Council officials of all grades, and I say without hesitation that, considered as a class, they compare favourably with any other class of employe. They are men who would rather do their duty than shirk it. Unfortunately, the business interests of some of their employers—the Councillors—render rigid adherence to duty a matter of personal risk to themselves. (It is not every inspector who dare report Councillor—'s property as being insanitary). And whenever an official discerns among his ' masters ' one who will stand by him in the doing of his public duty, he can be of great assistance to that Councillor. " Help your officials, and they will help you." I accept this annual opportunity of recording my high appreciation of the good work done for Edmonton by Mr. Butland and other members of my staff (indoor and outdoor). They have done their utmost, under unusual conditions, 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 SIDNEY C. LAWRENCE, Medical Officer of Health. July 27th, 1915. REPORT OF M.O.H. ♦ INDEX OF CONTENTS. Alcoholism 61 Allotments 17 Antitoxin 43 Bacteriological laboratory 46 Bakehouses 90 Baths, the public 19 Belgian refugees 12D, 16 Births 22 Births, notification of 22 Brickfields nuisance 65 Budget speech, 1914 81 Building by-laws 68 Building plots vacant 72 Canal Boats 120 Cancer 61 Cemeteries 17 Census of 1911, the 19 Cerebro-spinal fever 41 Chicken-pox 29,38 Clerical work 30 Closing orders under H. and T. P. Act, 1909 72 Common lodging-house 86, 114 Communicable diseases—notifiable 29, 33-58 „ „ non-notifiable 29, 59-61 Conferences 27, 75, 77 Costers 67,121 County Council tables 107-110 „ „ licenses 78 „ „ administration 79 „ „ co-operation with 54_58 Dairies, cowsheds and milkshops 87, 116 Deaths 23-28 Diarrhoea 59 Diphtheria 39 Disinfection 45,111 8 Distress Committee 15 Drainage 63-65 Dust collection 65,113 Enfield and Edmonton Joint Isolation Hospital 41-43 Enteric fever. 40 Erysipelas 47, 112 Factories and workshops 28, 85, 89-93 Features, physical, of the district 13 Fish offal 118,121 Food and Drugs Act 116 Food, unsound 88, 115 Fourth disease 59 Gipsies 67, 120 Gonorrhœa 61 Guardians, Edmonton 15, 16, 26, 34-37, 47 ,, Strand 15 History, recent, of Edmonton 14 History, past, of Edmonton 13 Home Office tables 89-93 Hospital accommodation 42 Hospital, officers of the 43 House refuse 65, 113 Houses let in lodgings 86 Housing and Townplanning 68-77, 118 „ Committee 73-75 Housing, No. 2 Act, 1914 82 Housing tables 69-71 Imperial Health Conference 77 Infantile mortality 25-28 „ „ Edmonton Workhouse 16,26 Infectious diseases 29, 33-61 ,, ,, Edmonton Guardians 34-37 Influenza 60 Inquests 24 Institutions, Public 15, 48,83 Institutional accommodation, tubercle 48,82 Isolation Hospitals 41-44 Knackers 87 Laundries 28, 89 Legislation affecting Edmonton 81-84 Library, the Public. 19 Local Government Board Tables 27, 69-71,94-106 9 Markets 67, 121 Maternity and Child Welfare 30,83 Meals Act, 1914 83 Measles 60 Midwives 22,46 Milkshops 87, 116 Mortuary, The 114 N. A. L. G. O. 15 Nuisances 65,119 Nurseries' Day 84 Offensive trades 88,117 Open spaces 16 Ophthalmia Neonatorum 46 Outworkers 28, 85, 90, 92 Overcrowding 71 Phthisis 48-58 Pigs 87, 118 Polio-myelitis, Acute 41 Puerperal fever 46 Railways 18 Respiratory diseases (non-tubercular) 61 Return cases 43 Roads 18,65 Sanitary conveniences 19, 113 Scarlet fever 39 Scholars, infectious diseases amongst 29 Scholars' meals 83 Scholars, tuberculous 50 Sewage farm 63 Sewerage 63-65 Shops' Acts 119 Slaughterhouses 87, 115 Small-pox 38,43 Stables 88 Statistics, vital 5,20 ,, comparative 31 Syphilis 61 Tables for the County Council 107-110 „ „ Home Office 89-93 „ ,, Local Government Board 27, 69-71, 94-106 Tenement Houses 86 The Green 66, 67, 121 10 Town Hall, The 19 Town-planning Committee 73-75 Town-planning Conference 75 Trades, offensive 88, 117 Transport, other forms of 18 Transport of patients to hospital 44, 111 Tubercle 48-58 Tuberculosis, administrative control of 51_58 „ Dispensary 53 ,, District Committee 54-58 ,, Institutional accommodation. 48, 82 „ Nurses 48,56 ,, Conference with Insurance Committee on 56 ,, Regulations, 1912 49 ,, Co-operation with County 54-58 ,, (animals) Order, 1914 82 ,, among scholars 50 Unsound food 88, 115 Urinals 113 Vital statistics 5, 20 Vaccination 38 Vacant building plots 72 Venereal diseases 61 War, local conditions arising from the European 11-12f Water supply 66, 119 Weather 60 Whooping cough 60 Women Inspectors and their work 28-31 Women Inspectors (temporary) 30 Workmen's dwellings 76 Workshops 28, 85, 89-93 Zymotic diseases 24 11 FOREWORD. Local Conditions arising from the European War. My deputy Medical Officer of Health and School Medical Officer, Dr. F. E. Rock, was called out on mobilisation of the Royal Naval Reserve on July 13th, 1914, and has not been here since. The first meeting after the declaration of war on August 4th was a special one of the Fire Brigade and Parks Committee : (I presume) because so many employed in this department are reservists of the navy or army. On the gth August I wrote to the Chairman and Secretary of the Education Committee in view of the meeting as below. Therein I drew their attention to the likelihood that Dr. Rock, my deputy Medical Officer, would not be able to return to duty on the 17th August, as had been arranged when his holiday time was fixed, or even at any later date which could then be mentioned. I further pointed out that the schools re-opened on the 31st August, when the medical inspection (routine and special) of the scholars should recommence, and I advised that the Committee should consider the matter on the 11th, or as soon as possible, with a view of securing a temporary substitute for Dr. Rock nt once. On the nth August a special meeting of the Education Committee was held to consider a letter from the Board of Education in reference to the provision of meals for the school children, but nothing more was done. A special Council meeting was held on nth August, when it was resolved: "that the payment of wages to the wives of those called out for service of the Government shall continue as long as the war lasts." It was rescinded on 27th October, 1914, and this substituted: "that the Council do make up their money to the amount of the wages received whilst employed by the Council and that their positions be kept open for them." It was also resolved to offer the War Office the use of Pymmes Park House and the beds at the old small-pox hospital at Claverings Farm. This offer was referred by the Government to the British Red Cross Society, who declined it in September. After the Council meeting of the nth, a meeting was held to establish the Edmonton branch of the Prince of Wales' National Relief Fund, to which representative men and women of the district had been summoned by the Chairman of the Council. 12 On the 13th August our Clerk received a circular letter, dated 12th, from the Local Government Board "calling the attention of the authorities to the great importance of maintaining the efficiency of the sanitary service of the country at the present time. On this account it is important that all vacancies in the minor sanitary staff should be filled up." The Board also asked to be informed "of the steps taken to arrange for the temporary discharge of the duties" of the Medical Officer of Health or Chief Sanitary Inspector, if absent on war service. I sent copies of this letter to the Chairman of the Council, the the Chairman of the Sanitary Committee and the Chairman and Secretary of the Education Committee on the 13th. About this time a circular of the Board of Education gave local authorities a free hand in providing accommodation for children, where the schools had been requisitioned for military purposes. On the 25th August, at the suggestion of the Home Office, it was ordered that 200 copies be distributed to shopkeepers of the following resolution: "That it is neither desirable nor necessary in existing circumstances to dismiss any assistants ; but that if economies in the carrying on of business are necessary, they should be made up by other means." The Edmonton Medical Society wrote to the Council expressing their readiness to co-operate in any scheme for assisting the Government during the present crisis. On September 2nd, I submitted to the Sanitary Committee instructions from the Local Government Board of August 31st as to co-operation of myself and staff with the military medical officer in charge of troops, who are (or are likely to be) stationed in Edmonton, also a circular letter (received September 1st) and two memoranda from the Board about small pox ; also two documents re vaccine treatment of enteric fever; cerebro-spinal or "spotted fever" was not referred to. In November, I submitted another instruction from the Local Government Board, dated 21st October, re co-operation. I reported that Dr Rock had been called up, whilst on holiday, for active war service. The letter of the Local Government Board of 12th August, and circular 862 of the Board of Education were submitted, and I advised that, as desired by the two Government departments, the vacant post should be filled up at once by the appointment of some qualified person to assume Dr. Rock's duties in public health and school medical work, until he is able to re-enter the service of the Council; but it was decided to defer action until the Education Committee had discussed the matter. Harold Dyer, the School Medical Clerk, asked for permission to enlist; permission was given with half-pay and his post to be kept open ; this was confirmed by the Education Committee on September 21st, who recommended the appointment of a temporary school medical clerk. On the 16th September, the Finance Committee recommended the same terms for H. K. Nixon, the Housing Inspector. I2A On the 7th September, the Board of Education wrote enquiring what the Education Committee were doing with reference to the filling of vacant posts. On September 15th I wrote advising my Chairman to summon a special meeting of the Sanitary Committee. I received no reply.. On that date I received from the County Medical Officer of Health, a letter, dated nth September, referring to the circular of the Local Government Board about co-operation. At the Education Committee of the 15th September, I presented circular 86?, dated 28th August, from the Board of Education. This was in similar, but not such emphatic, terms to that of the Local Government Board before mentioned, and referring to the absence of officers in the School Medical Service. I advised them to fill up Dr. Rock's vacancy at once, also that of the School Medical Clerk, but the subject was not dealt with until a special meeting on the 21st. At the special Education Committee of the 21st September, the Committee decided to postpone for six months the question of appointing an Assistant School Medical Officer to act during the absence of Dr. Rock; this was submitted to the Sanitary Committee of 7th October, who recommended that no appointment be made to fill up the post of Assistant Medical Officer of Health. In view of the special Education Committee on the 21st, and the ordinary Council meeting of the 22nd, I sent a report, dated 18th September, to all Councillors, pointing out that the absence of three officers had reduced my staff to an extent which had rendered the Public Health and School Medical Service inadequate and inefficient ; that the additional responsibility of 1,000 refugees rendered the services of a full staff most necessary; and that the advice of the Local Government Board and Board of Education was being ignored by them. "In these unusual times" (I said) "economy may be judged to be meanness and delay in filling up vacant posts as wilful neglect." Special meetings of the Education and Sanitary Committees should have been held, so that their cooperation with me might have been obtained. As it was, I had to meet the critical situation single-handed. At the adjourned special meeting of the Education Committee on September 29th, a resolution was passed requesting me to inspect speciallyreferred children twice weekly as previously, until such time as further arrangements were made. This I had been doing, as far as my own duties permitted, since Dr. Rock left. I2B The Local Government Board sent a letter to my Council, dated October 6th, asking what arrangements the Council had made for the discharge of the duties of the absent officers. This was considered by the Sanitary Committee on the 7th, together with that of August 12th, and a special report (dated 3rd October) which had been sent by me to all the Councillors on the sad results of the absence of officers on war service, showing also that the Authority was now saving at the rate of over £391 per annum, owing to these posts not being filled up, but at the risk of the health of the inhabitants. Yet vacancies on the Fire Brigade were filled up at once. However, the Committee recommended:— 1. That no appointment be made to fill up the place of Dr. Rock, as Assistant Medical Officer of Health. 2. That a substitute be provided in place of the Housing Inspector, Mr. H. K. Nixon, at a salary of £2 per week. 3. That a temporary School Medical Clerk be provided at a weekly salary of £110s. in place of Mr. Harold Dyer. These recommendations were endorsed by the Council on October 13th, who also instructed the Clerk to reply to the letter of October 6th from the Local Government Board, but the Board's letter of August 12th was withheld from the Council and never answered. On October 13th, Councillor Sorrell asked that the Councillors should be supplied with particulars of the terms of appointment, the date of my appointments and the date on which any notice should be given and lapse. On October 27th, the Board of Education wrote to warn the Education Committee that further delay might involve loss of the Government grant for the ratepayers. The Sanitary Committee on November 2nd recommended that G. H. Huckle be appointed as temporary Housing Inspector at £1 per week, and J. Farrar temporary School Medical Clerk at the rate of £50 yearly; the vacancy thus created of temporary junior clerk at the rate of £30 yearly was filled up by F. J. Wood on 30th November. Note.—Dr. Rock left us on July 13th; Inspector Nixon on September 9th. School Medical Clerk Dyer on September 10th; School-nurse Playne on 9th December ; and C. Hickford, the mortuary attendant, on 4th January, 1915. The latter was replaced without delay by disinfector Madle and his post filled by C. Adams. The post of Assistant Medical Officer of Health is still unfilled and the salary of £50 yearly saved—at my expense. I2C On December 1st the Education Committee rescinded Mr. Cull's resolution of 21st September, and to the Council of 8th December a resolution of that Committee was submitted asking the Council to grant them powers to appoint a temporary Assistant School Medical Officer (and that such officer be a lady). A resolution to that effect—excluding the bracket—was negatived in favour of a special Council meeting (in Committee) "to go in to the whole question with regard to the appointment of Medical Officer of Health and School Medical Officer. On December 7th, the Board of Education wrote again deprecating further delay in appointing a locum tenens for Dr. Rock. On December 8th, the Council resolved that a special committee of the Council (in committee) should be held to go into the whole question with regard to my appointments as Medical Officer of Health and School Medical Officer. This was later arranged to be held on December 16th, when I was ill and in bed, so I requested to be furnished with a transcript of the shorthand notes of the proceedings that evening and at any future dates, when the appointments I hold are the subject of debate. This request was granted me in 1911-12, when I was in good health and able to be present, but now it was refused. The Clerk reported to this meeting of the 16th the result of his enquiries from the Local Government Board and the Board of Education as to the date of termination of my appointments. The latter Board wisely declined to express any opinion. Then Councillor Sorrell moved and Councillor Oliver seconded that I be given three months' notice to terminate my appointments ; this resolution was carried by ten votes to three, nine councillors not voting and five were absent. This showed that (one more than) one-third of the Council were in favour of this vindictive idea. No date for expiry of this notice was stated. At the same meeting the Education Committee (at their request) were granted the power (for this occasion only) of appointing a temporary School Medical Inspector, pending Dr. Rock's return and a temporary School Nurse in place of Miss N. Playne> who had left for a military hospital on December 9th. After the routine medical inspection ceased on July 13th, Miss Playne was usefully employed in class examinations for vermin and more extensively in public health work after Miss Lewin left on 29th August. So at the end of 1914 this discreditable chapter of the Council's history was still open. The vulgar abuse and virulent attacks upon me of the three or or four Councillors, who headed this campaign, naturally aroused my indignation, but I did not permit their behaviour to influence me in abetting their schemes, or to interrupt the course of the important work of the Public Health Department. 12D THE REFUGEES. From September 7th onwards, these unfortunate people were placed in the old Strand workhouse at the request of the Government. This building had been purchased by the Metropolitan Asylums Board as a home for mentally deficients, and Dr. Leslie Gordon was engaged in preparing it for that purpose when he was suddenly placed in the position of Medical Superintendent of Refugees, with the assistance of Dr. Beels (from Antwerp) and later of Dr. Figord also. The institution was used as a clearing house from which parties of them were drafted to provincial centres, when they were ready to receive them. So the numbers fluctuated from 750 to 1,100 persons, of whom about one-half were children and one-third women. The children were naturally inflammable material for infectious and contagious diseases of all kinds to attack readily, more especially after their cruel treatment, exposure and starvation by the German army in Belgium. To the Sanitary Committee of October 7th I fully reported on the advent of these Belgians and pointed out that this sudden addition of over 1,000 persons to our population, many of them very 'susceptible to infectious disease, had added considerably to the responsibilities of my department and myself. Many questions regarding the control of infection and the promotion of sanitation in and around the institution soon needed enquiry and settlement between Dr. Gordon and myself. On the 13th October, the Metropolitan Asylums Board took over the old Strand School buildings for more refugees under the care of Dr. Beels, late of Antwerp, whose linguistic abilities have been as valuable as those of the Junior Woman Inspector, Miss Fay. Infectious cases arising amongst the Belgians have been transferred at once to the hospitals of the Board, and the bedding disinfected in the old fashioned gas-heated oven of the workhouse. My Council did not see their way to help in this direction. The Chief Sanitary Inspector arranges for the frequent removal of the refuse by our contractors, and Dr. Gordon appointed sanitary pickets to keep the W.Cs. and urinals in good order. The Local Government Board has directed me to include the refugees amongst the resident population, so that the vital statistics of this report have been made out in two forms, i.e., with or without Belgians, in order to allow the statistics of 1914 to be comparable with past and future years. In the past the poor people in the buildings of the Strand Guardians have been regarded as "foreigners" from a statistical point of view. 128 ADDENDA. Some effects of the war felt throughout the country generally were a considerable rise in the price of disinfectants, and also in that of drugs; with reference to the increased price and scarcity of drugs, a circular letter was issued from the Home Office, dated 17th August, 1914. In November, fifty men, said to be out of employment owing to the war, were found work in clearing out the mud from the lake in Pymmes Park, which work was much interfered with by the heavy rains of December. On 21st August, the Local Government Board issued a circular as to the power of local authorities to grant leave of absence to their officers on war service and to pay them and their substitutes. On the 10th October, the Government Committee on the prevention and relief of distress issued a circular conveying to all Councils, except rural ones, a memorandum of the Local Government Board explaining a scheme originating in a generous offer from medical practitioners and chemists through the British Medical Association and the Pharmaceutical Society to provide free medical attendance and treatment to dependents of soldiers and sailors on active service. The Committee recommended that, in recognition of this great favour, representatives of the doctors and chemists should be appointed on the local organisation of the Prince of Wales' National Relief Fund. Were they so invited ? In October the Council granted the use of the second-class baths for the establishment of a branch of the Queen Mary's Needlework Guild as a room for work by the unemployed women and girls in the district. The use of the wash-houses was granted later and gas for radiators. Work began about November 19th. A lady inspector from the Home Office visited them once. On November 2nd, the Government Committee issued a circular to the same Councils regarding relief to expectant and nursing mothers who are in distress arising from the war. No discrimination is to be made between married and unmarried mothers. The Committee suggested the training and employment of "household or sick-room helps" under the guidance of "the Central Committee on Women's Employment." lii In September a circular of the Local Government Board advised the use of syrup glucose at the rate of 1½ lbs. instead of 11 lbs. of sugar for making jam. Jam so made to be labelled accordingly by the makers. So my gloomy prologue ends on a sweet note—"Jam satis." 13 EDMONTON URBAN DISTRICT. REPORT OF THE Medical Officer of Health For the YEAR 1914. 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. Pymme9 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 Court District of Edmonton, Rural Deanery of Enfield, and Archdeaconry and 14 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. John Keats, the famous poet, when fifteen years old, was apprenticed to Dr. Hammond of 7, Church Street; he was there from 1810-15 and then " walked" the hospitals in London until his death in 1821. REGENT HIST0RY. 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., the Gothic gas-meter works, the new Pegamoid Company, Aerators Ltd., and the Tottenham District Light Heat and Power Company, whose employees are, for the most part, residents of Edmonton. In April the Secretary of Ridley Whitley & Co. appealed to my Council for an effort to save this old-established business of linoleum and oilcloth making from collapse. On the 27th a public meeting was held in our Town Hall to consider if anything could be done to save the business which provided a good deal of employment for Edmonton ratepayers and contributed a goodly sum to the rates. But alas! every effort proved fruitless and many persons lost a lifelong occupation at an age when engaging in other work was well-nigh impossible. Some relief to such cases was afforded by local philanthropists. The aspiration of Edmonton Council for a central Post Office, a Labour Bureau and a Police Court still remains unsatisfied. A memorial tablet to Mr. G. Eedes Eachus, our late Engineer, in All Saints' Church was dedicated by a service on July 14th, 1914. i5 N.A.L.G.O. On 19th March, at a crowded and enthusiastic meeting, it was decided to form a local branch of the National Association of Local Government Officers. I have the honour of representing it on the executive council of the Association. Mr. Wm. F. Payne (our Clerk) was elected President and Mr. F. W. Claxton as Hon. Secretary. Its usefulness to its members will entirely depend upon the courage and energy of its executive committee. 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 during 1914 was affected by two factors : one unfavourable, the closing of Ridley Whitley's works ; one favourable, the extra hands, male and female, taken on by factories in Enfield and Edmonton producing rifles, cartridges, shells and gunpowder for Great Britain and her Allies against Germany and Austria. The unemployed men were engaged up to May in widening Silver Street and culverting a part of Pymmes Brook at the south-west end of the Park. Abour 285 were employed 44 hours a week at sixpence an hour; each man had three weeks' work. In September the register was re-opened and 993 names entered (including 112 females). Of these, 107 men had work in cleaning out the lake in Pymmes Park and some of the women were taken on by the branch of the Queen Mary's Needlework Guild at our Baths. 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 LIIW 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, received its inmates from the Strand and other Central London Districts; its population, therefore, did 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 16 the large Poor-Law Union of Edmonton, and these inmates, of course, do not enter into our vital statistics. In March, 1914, the estimated population of Edmonton Unior. was 472, 205; rateable value, £2,489,264. Amongst a total of forty Guardians, Edmonton District proper has only four representatives. The Strand workhouse was closed on June 30th, 1914, and the School 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 workhouse was taken over by the Metropolitan Asylums Board on the 15th August as a place for mentally deficient children, but that and the school were subsequently occupied by Belgian refugees on the 7th September and the 13th October respectively. Dr. Leslie Gordon was the medical superintendent at the workhouse until December 19th, when Mr. S. Pallin succeeded him. Dr. Beels (late of Antwerp) is superintendent at the school, Millfield House. 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 508 per thousand inmates, and the infantile mortality rate is over 575 per thousand births taking place there. The similar rates for the district generally (excluding foreigners) are nearly 11 per thousand inhabitants and slightly over 85 per thousand births. ©PEN SPH6ES. The County 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 combination 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 1899 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 ; a large deposit of mud washed down from the watercourses is being removed by the work of unemployed clients of the Distress Committee. As, in 17 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 1914, Park Avenue, Bush Hill Park, has been provided with shrubberies on both sides, from Queen Anne's Gardens to Village Road. All new roads are now set with plane trees on both sides. 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 39 acres (which cost £20,590, and was consecrated in 1884). The Hebrew's Cemetery, in Montagu Road, was extended from 10 to 15 acres in 1910. It was open 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. The Barrowfield Estate of 21 acres with 126 plots. The Brookfield ,, 22½ ,, ,, 115 ,, The Houndsfield ,, 30 ,, ,. 144 ,, The Weir Hall ,, 14 ,, ,, 97* „ * Of 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 March the Architect suggested that the rent be paid monthly in advance and that in the event of the tenant being one month in arrear the ground should be surrendered. In April the Committee recommended that the tenants m the Houndsfield estate, where arrears of rent were considerable, should be put on quarterly tenancy terms. In May this wise principle was extended to the Brookfield estate. 1 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. A special committee, co-operating with those of Tottenham and Enfield, who had interviewed the directors of the Great Eastern Railway Co. in November, 1913, failed to obtain any substantial concessions as regards workmen's trains. So in March it was decided to approach the Board of Trade. 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. 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. The mileage of roads maintained by the Council is 22 miles. During 1914 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. 19 THE TOWN HULL. A new cement shed and a men's mess-room are being provided in the yard. The disinfecting and cleansing station has not yet materialised. Mr. C. Abrams and wife became joint caretakers on February 14th ; their advent has been followed by an improvement in cleanliness and temperature which has been much appreciated by all of us using the buildings. SANITARY CONVENIENCES. There is a modern one at the important junction of Angel Road and Fore Street; also on The Green. By-laws with reference to these buildings were approved by the Local Government Board on 23rd January, 1909. From March, persons desiring to use the W.C.s without charge were absolved from signing the book ; this will facilitate abuse of this privilege. The new one on The Green was opened, without ceremony, on 27th January. In June more urinal slabs were fitted at Angel Road. Urinals.—In February the Sanitary Committee recommended that the old urinal on the west side of the low-level station at The Green be moved further back so as to clear the footway, but the Works Committee preferred the erection of a new one at an estimated cost of £94, which was carried out by direct labour and finished in June. In May it was decided to move the urinal at the north-east corner of Pymmes Park to the corner of the central footpath from Victoria Road to Sweet Briar Walk ; in its new position it is more capable of supervision and usuable day and night. 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. PUBLIC 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. Its maintenance is provided out of the district rate. THE CENSUS OF 1911. At the end of 1913, Volume XI. was published. It is a very interesting leturn of persons who were, in April 1911, recorded as totally blind, totally 20 deaf, deaf and dumb, lunatic, imbecile, or feeble-minded. On page 67 the particulars of Edmonton Urban District are to be found :— Totallv Blind. Totally Deaf. Deaf and Dumb. Lunatic. Imbecile. Feebleminded. Combined Infirmities. Total. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 28 31 22 40 15 16 2 — 15 3 39 39 1 3 122 132 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 97 largest towns in England and Wales, and therefore enjoys the privilege of having her vital statistics published with the other 96 towns every week. Owing to extension in 1913 Exeter is transferred to the group of Great Towns and St. Albans (Herts) added to that of smaller towns, the number of which, therefore, remains at 145. For the weeks ending March 28th, May 30th, and July 4th, Edmonton's death rate was the lowest of all the large towns in England and Wales. 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. He retired at the end of 1914 to enjoy a well-earned rest after nearly 40 years' service for the public benefit. We hope that he may find leisure to compile a history of Edmonton, which would be a notable sequel to the book of Robinson, published in 1819. On October 30th the Registrar-General informed the Council that with the concurrence of the Edmonton Guardians he proposed to issue an order, subject to the approval cf the Local Government Board, separating Soutbgate from Edmonton; but that meanwhile he asked for the Council's views on his proposal. The Council on November 10th resolved that "The RegistrarGeneral be informed that the Council approve of the proposed separation of the Edmonton and Southgate Urban Districts and to constitute each of those Districts a separate Registration Sub-District, that they are of opinion that provision should be made for the appointments to be given to persons not holding municipal appointments, that they should be whole-time officers, and that the remuneration should be a fixed yearly sum of a moderate amount," but 21 at the next meeting the Registrar-General's reply was submitted stating that the appointment rested with the Guardians, the hours of attendance with the Registrar-General and that the registration fees were fixed by statute. So the Council's views are on record merely as " a pious opinion." 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 13,065 1891 23.437 1901 44,911 1911 62,289 For District Rate made 27th October, 1914, there were found to be 12478 houses in assessment, of which no less than 7981 houses were of the rateable value of £10 per annum, or under. I estimate the nett population at the middle of 1914 as 68,908 persons including 316 Edmonton people in Edmonton Workhouse and Infirmary and 705 Belgian refugees and resident staff. This population has been allocated to the three Wards as follows, dividing the paupers equally amongst them :— Bury Street 22,101 Church Street 24,078 Fore Street (705 Belgian refugees) 22,729 68,908 The nett population, excluding Belgians, is 68,203 In the Edmonton Workhouse and Infirmary there were estimated to be 1,452 persons, of whom 316 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 18.1. This figure is calculated on the gross population, which includes the average populations of Edmonton Workhouse, the Edmonton Infirmary and Nurses' Home, and the Belgian refugees, and amounts to 70,044. The RegistrarGeneral's estimate is 69,294, his earlier one was 71,024. The natural increase of the population, that is the excess of the nett total of births over the nett total of deaths, in 1914 was 1859 minus 736, equals 1)123, without Belgians. BIRTHS. The number of births registered by the Edmonton registrar, Mr. Judd, was 1,946 (989 boys and 957 girls), which includes 17 births that took place in the Edmonton Workhouse, born of mothers belonging to Edmonton, and 24 of Belgian refugees. The figures for 1913, 1912 and 1911 were:—1,912, 1,844 at|d 1,921. No births occured at the Strand Workhouse. Seventy-two 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 9 births (6 males and 3 females) which had taken place when Edmonton mothers -frere residing temporarily out of their district; 6 of these infants were stated to be born in wedlock. Thus the nett total of births -of births was 1,859, excluding 24 Belgians. Of these 1,859 births, 67 (or 3-60 per cent) were illegitimate; there were no illegitimate Belgian births. The birth-rate per thousand inhabitants is therefore 27 25, compared with 27-98 last year; including Belgian births, the rate would be 27-41. Notification of Births Act, 1907. This came into force here on April 28th, 1908. During this year 1,928 births were entered in our register; of these, 968 were males and 959 females; in one case the sex was not declared; 104 (or 5 per cent.) of the whole number were born out of wedlock, and 5 more were of doubtful legitimacy. Eighty-two children were declared "still-born." 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 62 children styled "still-born" buried during 1914, and for 1913-12-11 the figures were 63, 69 and 83. For work done in visiting infants and their mothers, see section "The Women Inspectors and their Work." In a previous paragraph it is noted that 1,946 births were registered during 1914. 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-one pairs of twins arrived, and no triplets. Besides, there were 26 births amongst Belgian women who were confined in Edmonton Workhouse; of these, one was still-born. The birth-rate (27.25) for 1914 is 0.73 lower than last year, but is much higher than 23.8, the birth-rate of England and Wales for 1914. The birth-rate for the preceding six years will be found in Column 5 of Table 1. The births were distributed in the Wards as follows: Ward. Births. Birth Rates per 1,000 living in the Ward.[/##3] Bury Street 647 29.27 Church Street 647 26-87 Fore Street 556 25'25 Amongst the 705 Belgian refugees there were 24 births; the addition of these would make Fore Street Ward birth-rate 25.52. The Belgian birth-rate is 34-04. Nine births transferred to Edmonton by the Registrar-General could not be allocated, as the names and addresses of the parents were not given. DEATHS. The deaths registered in the district during the year were 1,238 ; of these, 10 occurring in the Strand Workhouse, and 577 among non-residents at Edmonton Workhouse and Infirmary, and 4 "foreigners," outside institutions, are excluded ; while 160 deaths of Edmonton residents, and 5 Belgian refugees, taking place in the Edmonton Workhouse and Infirmary, are included in our nett deaths. Thus the number of deaths amongst Edmonton residents registered in the district amounted to 642, and 5 Belgians. The gross death-rate is based upon the total number of deaths registered in the district, and is 17-67 per 1,000 living. This rate is calculated on the estimated gross population of 70,044. The nett death-rate is based upon the total number of deaths of Edmonton residents occurring inside or outside the district, and is 10 79. This rate is calculated on the estimated nett population of 68,203. 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. Ninety-four deaths were returned in this way during the year, making the nett total of deaths at all ages for the district proper 736 and 5 Belgians. 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 11-56. 24 The nett death-rates for the preceding six years will be found on Table I., column 13. The nett death-rate for Edmonton is as I have said, 10.79 per 1,000 living; it was 11.93 last year. It is 0.38 lower than the average of the five previous years, and is much better than 15.80 the rate for 1904. If five Belgian deaths be included, the rate remains practically the same. 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 they lately resided. they lately resided. One Institution death amongst residents, that could not be allocated, is entered in Column 15 on Table IIIa. Ward. Deaths. Death Rates per 1,000 living in the Ward. Bury Street 280 12.67 Church Street 228 9.47 Fore Street 227 10.31 Amongst the 705 Belgian refugees there were 5 deaths; the addition of these would make Fore Street death-rate 10.21. Death Certification. All deaths were certified either by the Medical Attendant or by the Coroner : there were none uncertified. Inquests were held on 62 residents, or 9.65 per cent, of the total deaths amongst residents registered in the district. This percentage is a lower one, and compares favourably with nearly 13 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 15.38 per cent, of the total illegitimate deaths, which is an increase upon 9.09 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. These diseases are small-pox, measles, scarlet fever, whooping cough and diphtheria at all ages, also diarrhoea (and enteritis) in children under two years of age. There were 101 deaths from these diseases during the year, and the 23 zymotic death-rate is therefore 1.48 as compared with 1.88 for the previous year. This figure is 0.4 less than last year. The zymotic death-rate for 1914 in London was 1.44. In the 97 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. 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 12 5 2 5 — Scarlet Fever 3 2 — 1 - Whooping Cough 17 10 4 - - Diphtheria 16 9 3 4 - Enteric Fever 4 1 1 2 1 Diarrhoea 49 23 14 12 14 Total 101 50 24 27 15 Rates 1.48 2.26 1.00 1.19 47'47 There were no Belgian deaths from these diseases. The Average Zymotic Death-rate for the previous ten years was 2.15. 2-15. In the following table are set out the Nett General Death-rate, Infantile and Zymotic Death-rates for 1914 and the previous ten years:— Nett Death-rate. Infantile Mortality. Zymotic Death-rate. 1904 15.8 l6l.8 3.87 1905 13.3 128.0 2.36 1906 13.7 131.8 3.03 I907 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 10.79 85.53 1.48 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. 26 The number of such deaths occurring amongst Edmonton children, and registered within (or without) the district was 159, and the births registered within (or without) the district, born of Edmonton mothers, numbered 1859 (Belgians excluded) ; therefore the infantile death-rate, based on these figures, is 85.53 per thousand births. The lowest record is 74.55 in 1910. There were no infantile Belgian deaths. Thirteen of the 159 infantile deaths were those of illegitimate infants—that is 8.18 per cent, of the infantile deaths. Two inquests were held. Inquests were also held on 20 of the other infants, making a total of 22. The Infantile Mortality Rate at Edmonton Workhouse and Infirmary was 575 22 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 105 in London, 104 ; in the 97 great towns (which include Edmonton), 114 ; and in the 145 smaller towns, 104 per thousand births registered. The figures for the Wards are as follows :— Ward. Deaths under one year. Infantile Mortality Rate. Bury Street 64 99 per nett i,ooo births in the ward Church Street 47 73 ,, ,, ,, Fore Street 48 86 ,, ,, ,, Table IV. enables the deaths among infants under one year of age from certain causes lo 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 over 39 per cent, of the infantile deaths occurred within the first month of life, and that just over 31 per cent, were due to what are termed "wasting diseases," viz., premature birth, atrophy, debility, congenital defects, and marasmus. Last year the figures were under 30 and 25 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, such as improper 47 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 for 1914-13-12 were 32, 26 and 30, respectively. . Conference on Infantile Mortality.—Miss Hudson, the Senior Woman Inspector, attended the National Conference, which was held this year at Liverpool on July 2nd and 3rd. TABLE IV.—Infantile Mortality during 1914. Nett deaths from stated causes at various ages under 1 year of age. Causes of Death. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 4 weeks and under 3 months. j 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months Total deaths under 1 year. All causes Certified 35 11 10 7 63 23 24 27 22 159 Uncertified .. .. .. .. .. .. .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. 1 1 Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping-Cough .. .. .. .. .. 3 .. 1 2 6 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. .. 1 .. .. 1 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. 1 1 2 Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. .. Convulsions 2 .. .. .. 2 .. .. .. 1 3 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. 1 3 3 .. 7 Pneumonia (all forms) .. .. 1 .. 1 1 1 6 6 15 Diarrhoea or Enteritis .. .. 1 1 2 6 16 11 9 44 Gastritis .. .. .. 1 1 .. 1 1 1 4 Syphilis .. 2 .. .. 2 3 .. 1 .. 6 Rickets .. .. .. .. .. .. .. .. .. .. Suffocation, overlying .. .. 1 .. 1 2 .. .. .. 3 Injury at Birth 4 .. .. .. 4 .. .. .. .. 4 Atelectasis 4 1 .. .. 5 .. .. .. .. 5 Congenital Malformations 3 3 1 .. 7 2 1 1 .. 11 Premature Birth 19 3 4 4 30 2 .. .. .. 32 Atrophy, Debility and Marasmus .. 2 .. 1 6 2 1 2 .. 11 Other Causes .. .. 2 .. 2 1 .. .. 1 4 Totals 35 11 10 7 63 23 24 27 22 159 Nett births in the year .. legitimate, 1792 ; illegitimate, 67. Nett deaths in the year .. legitimate infants, 146 ; illegitimate infants, 13. 28 THE WOMEN INSPECTORS AND THEIR WORK. I give below an analysis of the number and nature of the visits paid by them during 1914. The bulk of their work falls into four correspondingly large divisions, viz. :■—• 1. The crusade against preventible infantile mortality ; 2. The wofk done in factories, workshops, etc., where women and girls are employed, and amongst home-workers of their 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. Diarrhœal Diseases. January 37 1 8 ... 3 ... February 10 1 11 ... 1 ... March 20 1 16 ... ... ... April 33 ... 8 ... ... ... May 12 ... 8 ... 1 ... June 150 2 11 ... 3 ... July 74 ... ... ... . 5 August 79 1 52* ... ... 18 September 123 ... 7 ... 10 15 October 27 1 4 ... 3 1 November ... ... ... 1 ... December 8 ... 2 ... ... ... Totals 573 7 / 127 ... 22 39 'Schools closed and Miss Playne (the School Nurse) assisting as Junior Inspector. INSPECTIONS under FACTORY & WORKSHOP ACTS. Month. Factories. Workshops. Laundries. Outworkers. January ... 8 9 21 February ... ... ... ... March ... ... ... 5 April ... 1 5 3 May ... 2 4 5 June ... 5 ... 102 July ... 2 ... 7 August ... 16 8 86 September ... 3 1 24 October 1 ... ... 15 November ... ... ... 71 December ... 4 7 146 Totals 2 41 34 485 Workrooms measured up 5. Laundries measured up 0. 29 NOTIFIABLE DISEASES. Visits and re-visits to Erysipelas cases 121 Visits re Erysipelas disinfection 11 Visits re Puerperal Fever Cases 4 Visits re Phthisis voluntarily notified 5 Visits re Pulmonary tuberculosis compulsorily notified 35o Visits re Pulmonary Tuberculosis disinfection (after death or removal) 202 Visits re other forms of Tubercle ... 57 Visits re Ophthalmia Neonatorum ... 38 NON-NOTIFIABLE DISEASES. Months. Measles. Mumps. Whooping Cough. Chicken-pox. 4th Disease. Doubtful Cases. January 2 40 30 23 ... 12 February 4 89 32 28 12 17 March 10 123 62 47 12 19 Aprd H 116 49 27 14 14 May 15 75 57 5 4 11 June... 20 48 43 22 ... 1 July... 48 20 17 38 ... ... August* I 1 ... ... ... September 20 5 19 1 ... 2 October 159 5 18 J3 ... 8 November 146 14 25 58 ... 4 December 151 5 30 ... 17 Totals 590 .535 348 302 42 105 "Schools closed for holidays. Visits and re-visits re School notifications concerning non-notifiable diseases, such as measles, whooping cough, chicken pox, etc., 1,922 to 2,874 children at 1,788 homes. This is a considerable increase compared with last year, when the figures were 1,227, 1,941 and 1,310 respectively. (For further information see Annual Report of School Medical Officer). There were many more visits to more children in more homes than in 1913. GENERAL WORK. Visits to Private Schools 0 Enquiries re complaints 33 Miscellaneous visits (compared with 111 last year) 137 Visits paid to inspect work done after informal notice 317 Visits re overcrowding 0 30 The clerical work m connection with the women inspectors, like their practical work, has increased very much. During the year Miss Hudson spent 134 days in office work, 7½ days in statistical work and 5½ days in preparing the tubercle quarterly accounts. In addition Misses Playne, Lewin and Fay spent 11, 36 and 12 days respectively in clerical work. TEMPORARY WOMEN INSPECTORS. During April a great number of school notices were received with reference to scholars suffering from, or in contact with, non-notifiable infectious diseases, especially mumps. As Miss Hudson had to devote a great deal of time visiting the homes of scholars, her other work fell into arrears. To deal with this, Miss Gladys Lewin was appointed on the 25th May and remained until the 29th August. A sudden and huge increase of out-workers for Government contractors occurred in October, which lead to the appointment of Miss Agnes Fay on the 9th November. Miss Fay's arrival was the more opportune as Miss Hudson unfortunately met with an accident whilst on duty, which kept her off work from 31st October until she resumed on the 30th November. SENIOR WOMAN INSPECTOR. Miss Hudson became executive officer under the provisions of the Fabrics (Misdescription) Act, 1913, and its Regulations which came into force April 1st, and the Ophthalmia Regulations, 1914. On 4th March the Sanitary Committee recommended that in recognition of the considerable increase of duties and her (over) 3½ years excellent service, Miss Hudson should receive an immediate advance of £10 per annum, and that her maximum be raised from £105 to £120. MATERNITY AND CHILD WELFARE. On September 2nd I submitted to the Sanitary Committee a circular letter of July 30th, 1914, and a memorandum of the Local Government Board. The Board stated their opinion that it is clearly desirable that local authorities should be in touch with a child over the whole period from before its birth up to the time the child enters school and passes into the care of the Education Committee. The Board desires that an adequate staff of women inspectors should be established in charge of a medical officer. The Government is prepared to pay a maximum of 50 per cent, of any expenditure in this direction. It is difficult to distinguish this from the efforts of the Board of Education regarding Schools for Mothers and Day Nurseries. No action was taken thereon, but at the Council meeting of October 27th, three letters were submitted from the three branches of the Women's Co-operative Guild calling attention to the views of the Board and suggesting that something should be done by the local authority. This led to the renewed consideration of the subject by the Sanitary Committee on November 4th, and I was instructed to prepare a report thereon, which I presented to the Commitee on December 2nd, but it was not considered until 6th January, 1915, when it was decided to defer a decision until January, 1916. In the hope of securing unity of administration and preventing overlapping the Society of Medical Officers of Health forwarded in May to the Chancellor of the Exchequer and to the President of the Local Government Board the following unanimous resolution: "That the Society of Medical Officers of Health welcomes the proposals contained in the Budget statement for the development of child welfare work, but is of opinion that this work should come within the scope of the public health administration. As a great deal of such work has already been done by a large number of public health authorities, the Society is of opinion that with grants-in-aid very rapid developments in the same direction will take place. Further, the Society desires to secure the amalgamation of all health matters in one authority, administered by one Board, and is of opinion that the administration of the grants should be by that Board." COMPARATIVE STATISTICS, 1914. The table of vital statistics for 1914, 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 1914. Annual rates per 1,000 of the population. Infantile Mortality per 1,000 births registered. Nett Births. Nett deaths (corrected) Zymotic Deaths. England and Wales 36,960,684 23.8 13.7 - 105 The 97 great towns including London and Edmonton 17,980,576 25.0 15.0 - 114 The 145 smaller towns 4,655,326 23.9 13.1 — 104 England and Wales, less the 242 towns as above 14,324.782 22.2 12.4 - 93 London (including City) 4,508,021 24.3 14.4 1.44 104 Acton 64,369 22.8 10.7 0.82 98 Wood Green 51.833 23.03 9.74 0.77 70.41 Enfield 60.682 21.83 10.32 0.87 80.75 Edmonton 68,203 27.25 11.56 1.48 85.53 32 During 1914, as in 1911, 1912 and 1913, 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 0.3 less than last year, and is the lowest on record ; the death-rate is 0.2 higher than 1913, which was the lowest on record. The infantile death-rate is 4 integers less than last year, and the lowest on record. The natural increase in the population of England and Wales, or the excess of births over deaths, is 362,044 or 23,109 less than the average of the preceding five years. 33 SECTION 11A 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 1914, 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 Ila used to be. 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. ity per cent. Scarlet Fever 351 314 89.45 3 0.85 Diphtheria and Mem. Croup 148 138 92.00 16 10.81 Enteric Fever 17 16 94.12 4 23.52 Totals 516 468 — 23 Amongst the Belgian refugees there were eight cases of scarlet fever (one notified from Edmonton Infirmary), one case of diphtheria and two cases of erysipelas; all these cases were removed to the institutions of the Metropolitan Asylums Board. Foreigners. There were notified from Edmonton Infirmary 8 scarlet fever, 3 diphtheria, 5 erysipelas, 1 enteric fever, 1 puerperal fever and 1 ophthalmia neonatorum cases. Of these the enteric fever and puerperal fever cases died in the Infirmary. They were all, except 1 case each of scarlet fever, diphtheria, enteric fever, erysipelas and puerperal fever, connected with other districts of the Union, and were not sent to our Hospital, except the scarlet fever and diphtheria cases ; the one case of scarlet fever was a Belgian refugee who was removed to a M.A.B. hospital. There was one case of erysipelas in the Strand Workhouse before the war. These are all excluded from the above table, except one case each of diphtheria and enteric fever, who were formerly private residents in Edmonton proper. 34 Compared with last year the table shows 69 less notifications of scarlet fever, but three fatal cases instead of one. There were 19 more notifications of diphtheria, but the percentage of fatal cases was slightly lower ; the notifications of enteric fever were 9 more, but the fatality was less than last year. THE GUARDIHNS AND INFECTIOUS DISEASE. The agreement with my Council accepted on December nth, 1912, only lasted until December 25th, 1913—barely 12 months—when it was terminated by notice from the Guardians given in a letter of their Clerk (Mr. Shelton) on July 23rd, 1913. During 1914 my Council received no payment whatever for dealing with outdoor paupers suffering from infectious diseases, but the Enfield and Edmonton Joint Hospital Board have continued receiving paupers resident in the Guardians institutions in Enfield and Edmonton at 7s. instead of 4s. 6d. a day, when there is room for them. In July the Joint Hospital Board informed the Guardians that the latter charge would be reverted to, if and when the Guardians renewed payment to the District Councils of Enfield and Edmonton for outdoor pauper cases. In January I submitted a report as to the past history and present position of the subject and advised the Council as to the best course to pursue, and our Clerk presented a statement as to the legal aspect; he gave his opinion that " Any agreement should be between the Joint Board and the Guardians for casep of disease for which the Joint Board has provided, including conveyance to and from the hospital." I received the Sanitary Committee's instructions as to dealing with infectious outdoor paupers whilst the agreement was in abeyance. The Clerk was instructed to confer with the Clerk of the Guardians, which he did on January 29th. In January there were four cases of scarlet fever in a poor family and in February a case of diphtheria in another. The latter case was ultimately removed to our hospital, but the former four remained at home under the care of the pauper medical officer. I drew the attention of the relieving officer and the clerk of the Guardians to them, as owing to the expiration of an agreement with the Guardians in December 1913, the responsibility for the care of these five persons rested with the Guardians. In February the Clerk reported that Mr. bhelton maintained that his Board were not liable for the isolation of any cases outside the workhouse premises and that his Board would not enter into an agreement with the Council, unless it provided for the isolation of all cases of infectious disease within and without the workhouse premises. The Clerk and I were then instructed to interview 35 the Local Government Board for the purpose of drawing attention to the serious menace to public health induced by the unreasonable attitude of the Guardians, and to ask for their intervention in the interests of the poor people affected. This had been my advice in January. On the 18th February our Clerk and I visited the Local Government Board and in March presented a report on the interview to the Sanitary Committee. At our suggestion the Guardians were informed that the Council have been advised that they have not legal power to enter into any agreement with them with reference to the isolation of cases of infectious disease, but that the proper authority with whom the Board should endeavour to make an agreement is the Enfield and Edmonton Joint Hospital Board. The Sanitary Committee of 8th April considered a letter received from Mr. Shelton of the 2ist March, to which only a formal acknowledgment was sent by us. On 19th June a conference was held at the Local Government Board between the local sanitary authorities and the Edmonton Guardians and three representatives of the Board. A letter of Mr. Shelton, dated July 23rd, reached the Sanitary Committee (after the long vacation) on September 2nd, inviting representatives of the Sanitary Authorities to meet a committee of six Guardians at the workhouse with a view to making arrangements for the maintenance and isolation of persons suffering from infectious disease and chargeable to the common fund of the Union. Councillor S. J. Sanders (Chairman of the Sanitary Committee), Councillor Charles Sorreli, the Clerk and I attended on 27th October and 24th November (without Mr. Sorrell). At this conference I suggested the following heads of agreement which might meet with the approval of the Medical Officers of Health concerned:— 1. Outdoor. The Guardians to pay to the Edmonton District Council Id. per head of the population of the Edmonton District according to the last census, for isolation of cases of scarlet fever, diphtheria, enteric fever and small-pox, arising in the District of Edmonton outside the premises belonging to the Edmonton Guardians without enquiring whether such cases are or are not pauper cases. This is subject to accommodation at the hospitals being available. The Medical Officer of Health to be the judge of what cases should be isolated. 2. Indoor. With reference to the persons resident within the institutions of the Edmonton Guardians, they shall be removed, isolated, treated and maintained by the Council concerned on the 36 condition that all the expenses in connection therewith be repaid by the Guardians, and this subject to the provisions of clause i. 3. The payments by the Guardians to the District Council to be half-yearly on the 30th June and the 31st December in each year. 4. The Agreement to be determinable by either party by a three calendar months' notice in writing, expiting on either of the usual quarter days in March, June, September or December. 5. The Agreement to be without prejudice to the rights of either party. 6. A.ny dispute between the parties to be settled by the Local Government Board. Mr. Harding, Clerk of Wood Green, presented a draft agreed on at a meeting of the Sanitary Authorities at Wood Green on the previous day, which met with the approval of the Medical Officers of Health present, but Mr. Cole, Chairman of the Infirmary Committee, proposed the following resolution :— A. " That the representatives present recommend their Councils to enter into an agreement to receive, isolate and provide for all the ten kinds of infectious disease arising outside the Guardians premises for a payment of 3d. per head of the population or such additional sum as the Local Government Board may decide on ; and to receive, isolate and provide medical attendance for the four diseases mentioned by Dr. Lawrence, viz.: scarlet fever, diphtheria, enteric fever and small-pox for 2d. per head of the population." On being put to the representatives, seven of them held up their hands in favour of the proposal and none against ; the officials did not vote, only Councillors. On 26th November, Mr. Shelton sent a copy of " what he understood to be" the resolution passed at the meeting of 24th November. This was as follows : B. " That in the opinion of this conference of representatives of the several Sanitary Authorities in the Middlesex portion of the Edmonton Union, the Guardians should pay annually to the Councils 3d. per head of the population, according to the last census, for dealing with all cases of infectious disease without enquiry as to whether 37 any such case is or is not maintainable at the expense of the Guardians and that if the said Sanitary Authorities undertake to deal only with enteric fever, diphtheria, scarlet fever and smallpox, then the sum to be paid by the Guardians should be 2d. per head of the population instead of 3d." At the Sanitary Committee of December 2nd our Clerk presented a report on the two conferences. At this meeting the Committee recommended that the Guardians be informed that the Council is prepared to consider a draft form of agreement for the isolation of cases of scarlet fever, diphtheria, enteric fever and small-pox arising outside the Guardians' premises on a basis of 2d. per head of the population of the District and with reference to the words " dealing with " in the resolution B, as put forward by Mr. Shelton, our Clerk was instructed to obtain from the Clerk to the Guardians his definition of these words. On the 4th December Mr. Shelton replied :— " I cannot say what the words " dealing with" are intended to mean, but from the Guardians point of view it ought to include proper accommodation, maintenance, clothing and medical treatment, and relieve the Guardians from all expenses in connection with the patient." The Guardians at their last meeting for the year passed the following resolution C. " That the Guardians do agree to pay the several Sanitary Authorities an annual sum of 2d. per head of the population according to the last census for undertaking the treatment of all cases of infectious disease arising within their respective districts without enquiring as to whether any such cases are or are not pauper cases, or to pay one penny per head on the same basis for the treatment of all cases suffering from enteric fever, diphtheria, scarlet fever and small-pox." So the year ended without a new agreement being signed. N.B.—My readers will observe the subtle variations B and C of resolution A, passed at the conference of Sanitary Authorities with the Guardians on November 24th, I914. 38 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 1913 and 1914. The Local Government Board issued on the 19th August, 1914, a circular letter to sanitary authorities of Greater London, stating their wish that interchange of information regarding infectious diseases should take place directly between Medical Officers of Health and not through the Clerk's department. Country Holidays for City Children.—A circular of the Local Government Board, dated 25th June, to County Councils and Sanitary Authorities embodied complaints from rural authorities that infectious diseases were imported into their areas by these youngsters who also caused overcrowding in the cottages. The Board remarked that more care should be exercised by organisers and made several recommendations thereon. This applies somewhat to our Education Committee when dispatching children to the seaside under the benefits of King Edward's Memorial Fund of Middlesex. We take every care in selecting the children from amongst those recommended by the head teachers. 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. Yaccination. The following table of vaccination returns has been kindly supplied by Mr. Lowman, the Vaccination Officer. The top row of figures applies to the year 1913. VACCINATION RETURNS FoR 1913-14. Births, Successful Vaccinations. Conscientious Certificates. Deaths under one year unvaccinated. Still unvaccinated but address known. Postponed owing to illness. Certified unsusceptible. Removed and Un traced. 1915 739 569 131 89 61 0 326* 1959 673 6lO 118 154 83 2 319* * 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 m 1909, 340 in 1910, 396 in 1911 and 490 in 1912. This large increase of persons unprotected from smallpox will gratify no one but an anti-vaccinationist. 39 SCARLET FEVER AND DIPHTHERIA. Jan. Feb. Mar Apl. May June July Aug Sept Oct Nov Dec. Total. S.F. 1913 19 23 39 16 12 27 26 19 49 72 66 67 435 1914 27 23 32 14 26 15 26 32 34 33 59 43 364 Dip. 1913 12 11 10 4 7 2 4 3 5 36 21 16 131 1914 11 18 10 10 8 16 9 12 13 !3 21 11 152 These are unrevised figures from monthly reports, excluding foreigners, but including Belgians. Scarlet Fever. 351 cases were notified, giving an attack rate of 5.15 per thousand. 420, 211 and 68 cases were notified in 1913-12-11. The patients were distributed amongst 271 houses and 114 streets. One case occurred in 219 houses; two cases occurred in 33 houses; three cases in 13 houses; four in three houses; five cases in three houses. The removals to hospitals numbered 314, an isolation percentage of 89.45. There were three deaths, giving a fatality of 0.85 per cent. of cases notified, and a death-rate of 0.04 per thousand of the population. Besides, six cases were notified from the Edmonton Infirmary who were not Edmonton residents, but were treated in our Hospital. One case was doubly notified, and one case of infection mixed with diphtheria and five with measles. There were also eight Belgians notified. Secondary cases numbered 61 out of 351 (excluding six cases from Edmonton Workhouse). » There were four cases notified where subsequent observation did not confirm the diagnosis ; they are not included in the above figures. Return Cases—See section on "Hospitals." 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 148 cases during the year, compared with 131, 136 and 43 in 1913-12-11, and they represent an attack rate of 2.17 per thousand of the population. The cases occurred in 72 streets and 129 houses. One case occurred in 112 houses; two cases in 16 houses; three cases in one house. The cases removed to hospital numbered 138, being 92.0 per cent. of those notified. There were 16 deaths, giving a death-rate of 0.23 per thousand of the population, and a fatality of 10.81 per cent. of those notified. 40 There were no duplicate notifications. Eleven of the cases were secondary ones. One case occurred amongst the Belgians. Besides, two cases were notified from the Edmonton Infirmary who were not Edmonton residents, but were treated in our hospital. Return Cases.—See section on "Hospitals." There were six cases notified where subsequent observation did not confirm the diagnosis; they are not included in the above figures. During March the diphtheria was of a severe type, accompanied by a high death rate. In September, an outbreak at Silver Street Infants' Department had to be taken in hand by myself—in the absence of Dr. Rock on war service. I paid two visits and twice examined the whole of the class affected, about 57 boys and girls, and swabbed all suspicious noses and (or) throats; of these, from the first visit, two were found to give positive results and two from the second visit. The outbreak then ceased. A little delay apparently occurred in notifying a case in September, and much consideration was given by the Sanitary Committee for the next three months to the conduct of the medical practitioner concerned. 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 when this is closed, our fire-stations. Enteric Fever.—Seventeen cases were notified, as against 8, 3, and 12 in 1913-12-11. This is equal to an attack rate of 0.24 per thousand of the population. These cases occurred in 14 houses and 13 streets. One case occurred in 13 houses; four cases occurred in one house. Sixteen cases were removed to our hospital—an isolation percentage of 94.12. The one not removed, an Edmonton resident, died in the Infirmary. There were four deaths, giving a fatality of 23.52 per cent. of the cases notified, and a death-rate of 0.06 per thousand of the population. There were three secondary cases. There were no cases amongst the Belgians. Moreover, one patient was notified as, but found not to be, suffering from enteric fever; it is 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 - NOTIFICATIONS OF ENTERIC FEVER IN 1913 AND 1914. TOTAL NOTIFICATIONS IN 1913=8; IN 1914=17. (All Residents.) 1913 1914 The Black tracing denotes the rise and fall in 1913; the Red tracing shows the same for 1914. NOTIFICATIONS OF DIPHTHERIA IN 1913 AND 1914. TOTAL NOTIFICATIONS IN 1913=131; IN 1914=151. (Including 1 Belgian and 2 Non-Residents.) 1913 1914 The Black tracing denotes the rise and fall in 1913; the Red tracing shows the same for 1914. 41 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 amongst the seventeen cases, one had been in the habit of eating mussels and fried fish. One had fried fish regularly once or twice a week and celery occasionally. Another was fond of fried fish and raw fruit, and one liked both of these with the addition of watercress; one was a fried fish eater only and another of watercress only; seven were gluttons for raw fruit, one of whom added watercress to his bill of fare. Four children of one family in King Edward's Road bought fruit from a coster's stall on The Green and used celery from their own garden. In two cases there was no direct evidence ; in one of these at Bush Hill Park illness followed a visit in the country, where he drank well-water. The case at Goodwin Road had been "hopping" in Kent. The man at Folkestone Road had been waiting on the Belgian refugees at Alexandra Palace, Wood Green. Case 361 was an immigrant from Canada where the disease contracted, whilst case 645 was suddenly removed to a general hospital where he underwent an abdominal section for peritonitis. Cerebro-Spinal Fever and Acute Polio-Myelitis.—On my advice, these diseases were made permanently notifiable in Edmonton on 9th March, 1912. There were no notifications of cerebro-spinal fever. I received three notifications of acute polio-myelitis. They were notified in June, September and November, in three different localities ; one male of 14 months and two females of 2 years. 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, discharge blocks, porter's lodge, mortuary, laundry and 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 wellequipped bacteriological laboratory was fitted ujp in the mortuary building. A 42 joint Board, consisting of four members from each Council, has been the controlling body since January 1st, 1906. It was mutually arranged in June, 1907, that the share of the precept payable by each Council should be, in future, based on the estimated population, calculated on the number of houses found inhabited by the Vestry Clerks in May of each year. Besides, a contribution of 30s. per case admitted is made by the district from which the patient is sent in. The contribution of Edmonton towards the Hospital for the year ending 31st March, 1915, was £6,130, compared with £4,994 the previous year. The Accommodation available on December 31st, 1914, 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. During 1913-14 the greatest number of patients resident on one day was 216; that is 53 more than the normal accommodation. The only strangers admitted during 1913-14 appear to have been two cases of enteric fever. Four workmen's cottages have been erected on the estate and are occupied by the engineer, the stoker, head gardener and assistant porter. The Medical Superintendent, Dr. Haldane Cook, on November 6th, 1913, entered into the residence which had been erected for him. During January, there was much difficulty in getting cases admitted into our Isolation Hospital; partly because of the large number of cases sent in the previous quarter, and partly because the occurrence of cross-infection had led to the longer detention of cases and clearance of wards for some days at a time. In February there was the same trouble and two cases of diphtheria were sent to Cheshunt. In December, owing to lack of room in the cubicle ward, two cases of scarlet fever (with mixed infection) were unable to be received. The following table gives the percentage of hospital isolation to cases notified, for the past five years:— 1910. 1911. 1912. 1913 1914. Scarlet Fever 96.15 88.24 92.45 92.54 89.45 Diphtheria 84.62 86.36 90.44 95.52 92.00 Enteric Fever 81.08 73.33 16.66 100.00 94.12 43 Officers.—Dr. Haldane Cook is the resident medical superintendent and sole medical officer. 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, 5 sisters (1 for night duty), 3 staff nurses, 1 assistant nurse, 18 probationers and 7 ward maids; in 1913-14, the resident staff numbered 57 and the outdoor staff 3, compared with 46 and 6 the previous year. 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 1913-14, 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 48,000 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. Dr. Cook says, "The mortality is far too great, and I maintain that this is entirely due to the delay by practitioners in administering antitoxin." 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 1914 there have been 21 such of scarlet fever and 5 of diphtheria. Dr. Cook estimates the percentage of return cases of scarlet fever during 1913-14 as 1.49, compared with 4.56 for the previous period. In my report for November, I was obliged to draw the attention of the Sanitary Committee to the number of return cases and instances of crossinfection amongst Edmonton children. This report was ordered to be sent to the Joint Board. SMALL POX HOSPITAL ACCOMMODATlON. 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 (£222 for 1914-5; it was £219 the year before) is a premium for an advantageous insurance. 44 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 137 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 137 beds in the temporary buildings have been used as a sanitorium for tuberculous cases since July 20th, 1912, 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 [see "Tubercle"]. The number of tuberculosis cases in the institution on December 31st, 1914, was 125, seven of whom were residents in Edmonton Urban District. No cases of small-pox were treated during 1914 from any district. In addition, my Council still has the administrative block of the Small-pox Hospital at Clavering's Farm, erected in 1902, where (at the shortest notice) accommodation of a satisfactory kind to meet an emergency could be arranged for ten male and six female patients. In a letter of the 21st October, 1913, 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, 1913, and recommendations 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 Hanwell 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. 45 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. In March I reported to the Sanitary Committee that the driver and transporter were out with the ambulance from 8.45 p.m. to 1 a.m. on the following morning. The notification arrived late, and at that time of night it is not easy to assemble the men, the horse and the ambulance, all four of whom reside in different places. The child died soon after reaching the hospital. In April, a new and larger notice board was placed outside the Town Hall, directing attention to the provision made for dealing with cases of infectious disease notified during the week-ends or public holidays. When the Town Hall is closed, an inspector calls mornings and afternoons and attends to any notifications that have arrived; four persons take the duty in turn. DISINFECTION. Rooms are disinfected after the removal of the patient by spraying with a 1-in-20 solution of formalin. Linen and cotton articles are steeped in a 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 Washington-Lyon 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, mostly children, on the same lavish scale as heretofore. It is supplied undiluted, but in proper bottles and with labels as prescribed by "The Disinfectants Order," of nth October, 1912, and circular letter of the Local Government Board of 14th April, 1913. Much of it is lost as the youngsters carry it home, or whilst "skylarking." Suitable restrictions on its supply would save hundreds of pounds of the ratepayers' money and many hours of the valuable time of my inspectors and clerks. Disinfecting Station.—The transfer of this from Pickett's Lock Lane to tbe Town Hall has been decided upon. (See report of S.M.O.). 46 BACTERIOLOGICAL LABORATORY. During the year the following specimens were examined and reported upon:— Disease. Result Positive. Result Negative. Doubtful. Total. Diphtheria.. 38 108 — 146 Enteric Fever — 5 — 5 Tubercle (sputum) 5 19 2 26 Totals 43 132 2 177 The numbers last year were 140, 8 and 39=187. PUERPERAL FEVER. Five cases of this disease were notified during the year. Three died, one a resident in Edmonton Infirmary, and one in the London Hospital; so the deathrate is 1.61 per thousand nett births. (See Section "Births.") One case from Tottenham was not notified from the Edmonton Infirmary and ended fatally. One case was doubly notified. 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 1913, there were 20 registered midwives residing and carrying on their work in our district, compared with 18 for the previous year. During 1913, there were 273 midwives practising privately in Middlesex and 417 not practising; besides, there were 21 engaged in poor-law infirmaries who are exempt from the provisions of the Act. No midwives were removed from the midwives' roll by the Central Midwives Board, but four were cautioned. During that year no uncertified women were prosecuted by the County Council for acting as midwives, but cautionary letters were sent to two of them. 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," OPHTHALMIA NEONATORUM. This disease was made compulsory notifiable by Regulations which came into force on the 1st April. 47 On February 10th, I received the Regulations from our Clerk and a lette of the Local Government Board, dated February 6th, 1914. One of the duties of mid-wives under the Regulations of the Central Midwives' Board is, and always has been, to advise medical aid in cases of inflammation of the eyes, however slight, and report to the County Medical Officer of Health. He reports that in 1913, of the 36 cases reported in the County, the eyesight was permanently injured in 3 cases, i.e., over 8 per cent. In accordance with Article V. of the Regulations, I issued a circular letter, dated 20th March, 1914, to all the medical men residing or practising in the District, and one to all midwives residing in the District, reminding them of the chief features of the Regulations, and asking them to state the average yearly number of cases during the past five years each one had met with. I also, in accordance with Article III., prepared and issued to the midwives books of notification forms, 25 in each with counterfoil. The Medical Officer of Health is an expositor of preventive and not curative medicine. Therefore under these Regulations he cannot do more than endeavour to see that an infant notified as suffering from ophthalmia neonatorum has prompt treatment at the hands of a private practitioner, or in a public institution. If the parent or guardian of the child does not provide this, the Medical Officer of Health can either urge his Authority to prosecute the offender under Section 12 of the Children's Act, 1908, or (that failing) bring the case to the notice of the Society for the prevention of cruelty to children. This disease is responsible for a great deal of lifelong blindness and will, I expect, come under the consideration of the present Royal Commission on venereal diseases. The Women Sanitary Inspectors deal in this way with these cases under my supervision. There were 16 cases notified during 1914, of whom one was notified to me from the Edmonton Infirmary which belonged to another district. Three cases were doubly notified, i.e., by doctor and midwife, and one by two doctors. ERYSIPELAS. Seventy-seven cases were notified, compared with 50 the previous year, besides two Belgians and four "foreigners," occurring in the Edmonton Union Infirmary, and one in the Strand Union. All of our 77 cases were in separate houses. There were five deaths from this cause, three of them being "foreigners." Eight cases occurred amongst people who were living in our district outside the Union Infirmary, and yet unable to provide proper attention for themselves. 48 As the agreement with the Guardians had lapsed, my Council received no remuneration for the nurses provided for those unfortunate persons. The cases were most numerous in October, November and December. In September, the Enfield and Edmonton Joint Hospital Board was asked if accommodation could be found for delirious cases of erysipelas, as two such cases had recently caused us much trouble, and the Guardians offered no provision for them. PHTHISIS MO OTHER TUBERCULOUS DISEASES. The deaths from phthisis numbered 74 (excluding Belgians), as compared with 72, 60 and 45 during 1913-12-11. The death-rate from the disease is therefore 1.09 per thousand. Of these deaths, 24 occurred among residents of the district in the Edmonton workhouse. The total deaths from phthisis in the Strand and Edmonton workhouses in the district numbered 90 (including three Belgians), or six less than last year. The other tubercular diseases together accounted for 21 deaths, giving a death-rate of 0.31 per thousand. Of these deaths five occurred among residents of the district in the Edmonton workhouse. The total deaths from these diseases in the Strand and Edmonton workhouses in the district numbered 13, or one more than last year. There were no Belgian deaths from these diseases. In this way, tuberculosis contributed a total death-rate of 1.39 per thousand of the population, or marly 13 per cent. of all the deaths; this was the same as the previous year. The Senior 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 552 visits and re-visits during the year, compared with 495 the year before, and also 57 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. There was some overlapping of visits with those of the County official. 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. 49 (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 was no special accommodation provided ; if cases were diagnosed, they were sent to their own Infirmary as soon as there was a vacancy. This place was closed on June 30th, and taken over by the Metropolitan Asylums Board on the 15th August and used for Belgian refugees since 7th September. (4) Strand Union School. This Institution was closed on July 31st, 1913, and reopened for Belgian refugees by the Metropolitan Asylums Board on the 13th October. Tubercular cases amongst the refugees are sent into the Edmonton Infirmary. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. Lungs— Patients notified once 144 ,, ,, twice 66 „ „ thrice 39 ,, ,, four times 9 „ „ five „ 1 259 Other Forms— Patients notified once 52 „ „ twice 4 ,, „ thrice 1 57 The total number of patients notified under these regulations was 316— 176 males and 140 females. The number of notifications was 493 and three Belgians. The notifications were made up as follows:— 50 Received from— Lung. Other Forms. M F M. F. Private Practitioners (A) 82 58 7 12 S.M.I. (B) 1 1 3 — Sanitoria (C and D) 85 45 — — Infirmary (A, C and D) 51 44 7 2 District Medical Officer 2 4 — — Hospitals (A, C and D) 21 29 15 10 Other Institutions (A, C and D) 1 — 7 — Dispensary 1 — — — Voluntary 4 1 — — 248 182 39 24 430 63 Three Belgians were notified, all from the Edmonton Infirmary (not included in the above figures). No notifications have ever been received from the Tuberculosis Officer of our area (No. 1). Scholars.—Five 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. Meningitis [M. 11/12; 14/12; 8; F. 13/12; 8] 3 2 Mesenteric glands [M. 27/12 1 — Kidney [M. 34] 1 — Neck Glands [M. 15, 16, 6, 8, 6, 8, 29, 7; F. 15, 16, 14, 1, 11, 6, 24, 6, 9, 23, 13, 37] 8 12 Glands of the groin [M. 11] 1 — Hip [M. 38, 9, 6, 14; F. 4, 21] 4 2 Knee joint [M. 18, 8½, 9, 14 F. 4. 15] 4 2 Spine [M. 6, 22, 10, 5, 12; F. 6] 5 1 Elbow [M. 42] 1 — Glands and skin [M. 14] 1 — Breast [F. 27] — 1 General [M. 5] 1 — Peritoneum & Intestines [M. 1] 1 — 34 23 Peritoneum [M. 9, 17/12, 2; F. 23, 12½] 3 2 Enteritis [F. 15] — 1 51 SANATORIA. A circular, dated 10th February, conveying a list of sanatoria approved by the Local Government Board, under the National Insurance Act 1911, up to 31st January, 1914, was submitted to Sanitary Committee of 4th March. Another list was submitted on November 4th, together with a model scheme of the treatment of tuberculosis from the British Medical Association. THE ADMINISTRATIVE CONTROL OF TUBERCULOSIS IN MIDDLESEX. INSURANCE COMMITTEE. The Insurance Committees are central authorities set up in counties and county boroughs by the National Insurance Act 1911, which consist of between 40 and 80 members. Middlesex Insurance Committee had 70 members; in June, 1913, this was increased to 80. This enabled one more medical man and two laymen to join on behalf of the County Council. 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, 1913, 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; their final approval was dated February 6th, 1913. The scheme provides for the treatment of both insured and uninsured over the whole country. The Insurance Committee pays to the County Council, so far as its Sanitorium Fund allows, the actual cost of maintenance of patients in institutions and a proportion of the cost of up-keep of the dispensaries. 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:— 52 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 64,797 319 1 Assistant Officer. Enfield 12,601 56,344 259 1 Nurse, 1 Woman Clerk dispenser, 1 Portercaretaker. Totals 19,509 258,598 1,282 The Tuberculosis Officer was appointed in April, 1913, the Nurse and Clerk-dispenser in October, 1913. The Divisional Clerk, Mr. Truscott, appointed by the Insurance Committee (one for each area, November, 1913) is accommodated at the head dispensary. The Tuberculosis Officer is supposed to work in consultation with the medical practitioners and in intimate relationship with the local Medical Officer of Health. Dr. Trevor Davies began duty as Assistant Tuberculosis Officer on July 9th, 1914, in No. 1 area. The institutions required by Middlesex 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. In May, plans were passed by the Middlesex County Council for the erection of a tuberculosis sanitorium at Eastwood in Essex, to accommodate 220 adults, 74 children, and a staff of 86. The total cost of the building will be £53,890. The nett cost to the County rate is estimated at £16,219, the balance being provided from the funds of the County Insurance Committee and the Treasury grant. A special sub-committee of the County Public Health Committee was appointed to deal with tuberculosis, 53 The County death-rate of Middlesex in 1910 was 0.72 per 1,000 living for consumption and 1.08 for all forms of tubercle, including consumption; in 1913 the consumptive rate was higher at 076 and all forms lower at 1.00. Perhaps it is too soon to expect good results from the County scheme. An agreement was entered into with the Middlesex Districts Joint SmallPox Hospital Board for the use of not less than 80 beds from July 1st, 1913, upon terms varying with the number under treatment; at the same time 12 beds were reserved for one year at Fairlight Sanitorium, Hastings. Thirty beds for advanced cases have since been reserved at the Northern Hospital, Winchmore Hill, by agreement with the Metropolitan Asylums Board and a few at the Brompton Hospital when possible. It is proposed to provide for 20 cases at the Willesden Fever Hospital. In July, 1913, the County Public Health Committee decided to look out for a site to build a sanitorium of their own. In the annual report of the County Public Health Committee for 1913-14, pages 84-5, the desirability of ascertaining the home conditions of patients and their families is mentioned and the formation of voluntary aid committees and women workers suggested; further that extra nourishment might be provided through the medium of the Poor Law. DISPENSARIES AND THEIR WORK IN MIDDLESEX. The Head Dispensary at 56, Silver Street, Upper Edmonton (Dr. Cogill is the Tuberculosis Officer here for the County), serves Enfield also; Tottenham has a sub-dispensary at Tynemouth House, Tottenham. The work which is carried out at, or in connection with the dispensaries, is said to 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. 54 LOCAL CO-OPERATION DURING 1914. 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 was to hold office until July 15th, 1913, or longer if the scheme remained in force. Edmonton District Committee met for the first time on the 2nd May, 1913, when the Rev. Preb. Sanders, M.A., was elected Chairman, and an executive subcommittee of six members appointed. Mr. Alfred E. Truscott was the Clerk. I was one of the three representatives of the medical practitioners and on the executive sub-committee. The second meeting was on 19th December, 1913. 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." The year before, my Committee had arrived at the same decision. The third meeting of this committee was held on Friday, 30th January, 1914, to consider recommendations of the County Insurance Committee that the Insurance Commissioners be asked to agree to delete the rule that every District Committee shall meet at least every two months and that clause 20, sub-clause 1 (e) be amended by adding the words "if and when referred by the County Committee to the District Committee," and that sub-clause 2 (c and d) be deleted and to (f) be added the above words too; that sub-clause 3 be deleted. Our local Committee felt that any opposition to these changes was useless, but they passed a resolution set out below. A letter, dated the 16th January, was addressed by the County Insurance Committee to all District Committees which contained the above recommendations and further remarked that— 55 "The Committee resolved that before applying to the Commissioners, the views of the various district committees should be ascertained; the Committee had no option under the Act of Parliament but to set up these District Committees, although when they did so they felt that their action was premature. These views have turned out to be correct, and it has been a matter of regret to the County Committee that the District Committees in the area should have been set up, and they sympathise with the views expressed by many of these, that they have practically very few duties to perform. Some of the duties delegated to the District Committees cannot be performed by them, and the performance of other duties delegated would create a large amount of duplication of work and considerable additional expense. The General Purposes Sub-Committee have therefore suggested these modifications with a view to simplifying the procedure and leaving to the District Committees only such work as the methods prescribed by the Commissioners enable them to really carry out." The Enfield Local Committee sent the following reply:— "That this District Committee strongly disapproves the recommendation of the General Purposes Committee of the County Committee restricting the duties of District Committees, and urges that, rather than curtail the duties, additional ones should be delegated. It also strongly presses upon the County Committee the fact that District Committees are in closer touch with insured persons in their respective areas, and therefore consider they can work the Act more efficiently in the interests of insured persons than the County Committee." The Edmonton Committee replied as follows:— "The Edmonton District Insurance Committee entirely dissent from the resolutions of the County Committee curtailing the duties of of the District Committees, and are strongly of opinion that so far from the advisability of lessening the functions of the District Committees, it would be in the best interests of the insured were the District Committees given additional duties and a larger scope for the exercise of their judgment." The Tottenham Insurance Committee replied as follows:— "That the Tottenham District Insurance Committee strongly protests against, and entirely disagrees with, the recommendations of the 56 General Purposes Sub-Committee of the County Committee with regard to the curtailment of their powers and duties, and is of opinion that further powers should be delegated." On February 2nd, representatives of the three Authorities attended a meeting of the Middlesex Insurance Committee and supported their views enunciated in the above resolutions. On February 13th, the Edmonton representatives presented their report on the conference of February 2nd to the local Committee, and the draft of a letter was adopted and sent to the County Committee. In that letter the District Committee said:— "We submit that diminution of the powers of District Committees would before long produce apathy, instead of enthusiasm, amongst the members of these Committees, and a lessening of respect for the Committee by the inhabitants of the district." They endorsed the opinion of the Edmonton Council recorded in September, 1912, that all Medical Officers of Health should be co-opted on the local Committees appointed for their respective areas, as this was the best way to secure real co-operation between the local Medical Officers of Health and the County Medical Officer; in the final paragraph of the local Committee's letter a hope was expressed that the County Council would co-operate with the District Council and not seek to work on independent lines. At the same meeting, a reply was read from the County Council to the District Committee's enquiry of December, 1913 (forwarded through the Clerk of the County Insurance Committee), which only gave us a synopsis of the duties of tuberculosis nurses in the service of the County and completely evaded a direct reply to the enquiry "Do the County Council intend to establish tuberculosis nurses in area No. 1 on the terms of their Public Health Committee's reports of October, 1912, and February, 1913, or not"? [We may surmise, therefore, that such is not the intention of the County Council or its Public Health Committee.] It was decided, on the motion of the Chairman and Councillor S. H. Flatten, that Dr. Cogill., the Tuberculosis Officer for Area No. 1, be asked to state what his methods of dealing were with cases of which he was advised otherwise than through the district committee. He (the Chairman) had reported three cases and nothing whatever had been done. On 10th February, the County Council sent a letter as to co-operation in the administrative treatment of Tuberculosis between the District Council and the County Council, asking the District Council to submit full details of any suggestions which they might have to offer for co-operation in this matter, and stating that any suggestions would receive full consideration. 57 A report dated the 2nd March, 1914, was submitted to the Sanitary Committee of the 4th, from the Medical Officer of Health, a copy of which was sent to each member of the Council, setting out in detail his suggestions whereby co-operation could be effected with the County Council and over-lapping of work avoided. The Sanitary Committee recommended that the report be adopted and a copy forwarded to the Clerk of the Middlesex County Council as a reply to their letter. I attended a meeting of the executive committee on 6th May at the Central Dispensary, 56, Silver Street, Edmonton. On 7th May the County Council again approached us, and on the recommendation of the Sanitary Committee, the Edmonton Council on 9th June replied that the Council was willing to furnish to the County Council, free of charge, "all the information with reference to tuberculous persons which is in the possession of the Council." The following letter was sent to all members of the District Committee on the 29th May from the Chairman (Rev. E. A. B. Sanders):— "I beg to inform you that the recommendations of this District Committee have been duly forwarded to the County Committee for consideration, and they, in their turn, have passed the suggested alterations on to the Commissioners. We now await their reply. Pending this reply no meeting of the District Committee is necessary, but it will be called at the earliest possible date. "In the meantime, the Chairmen of Enfield, Edmonton and Tottenham District Insurance Committees have met and discussed the future policy of District Committees and their relation with the County Committee. This matter will be brought up at the next meeting." The County Insurance Committee, on the 17th June, wrote on the question of obtaining suitable employment in hygienic surroundings for insured persons who have been in receipt of Sanitorium benefit and who have since been found tit for work, and asking if the Council would be prepared to give employment to such men, to whom a Tuberculosis Officer of the District is prepared to give a certificate stating that they are non-infectious. The matter was referred to the Works Committee for consideration. On the 15th August, Mr. Truscott informed me that Mr. S. H. Platten and myself had been nominated to serve on the Edmonton Committee of the 58 Prince of Wales' National Relief Fund as representatives of Edmonton Insurance Committee, but I have never received a summons to any meeting ! Note.—The sudden end of the District Committee accords with the centralising policy of the County Council, the wisdom of which policy is open to question. In connection with this sad story of a young lite prematurely extinguished, I cannot help recalling this epitaph on the young child's tombstone:— Here lies the body of E.D.C., aged 12 months. "Here am I, so early done for, I wonder what I was begun for!" 59 SECTION 11 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 36 less than last year, and the deaths from whooping cough have been 8 more. The deaths from diarrhœa have been 4 more than last year ; from influenza, 4, three less than last year. The Fourth Disease.—During February, and up to the beginning of May there were about 50 cases of a curious disease, chiefly amongst young children of Silver Street School. I call it the "Fourth disease" for want of a better name; it was not scarlet fever, measles or german measles. It is characterised by a sudden onset of feverishness without catarrh, a scarlet rash showing mostly on the face, which lasts from one hour to twenty-four, and is not followed by peeling. The total length of illness lasts only from two to four days, but it is undoubtedly infectious. It is not a virulent disease and there were no deaths therefrom. 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-eight deaths occurred from diarrhœa and epidemic enteritis, as compared with 54, 19 and 145 for 1913-12-11. The death-rate from the disease is 0.85 per thousand of the population, as compared with 0.81 last year. Of these deaths, 44 occurred in children under one year of age, giving an infantile mortality rate for the year from this cause of over 24 per thousand nett births; the figures in 1913-12-11 were 22, 8 and 61 per thousand nett births. Fortynine deaths were in children under two years ; these contribute to the zymotic death-rate. Deaths from diarrhœal 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 Women Inspectors is very useful. In July I was authorised to issue posters as in previous years, and in conjunction with the Engineer to take such steps to prevent the spread of the disease as may be necessary. 6o On September 2nd I was able to submit a circular letter dated July 10th from the Local Government Board, in which the Board emphasized the importance of visits to mothers during the hot weather ; the Board also asked the Council to consider without delay the increase of the staff of women inspectors, if insufficient for the work. Of course by this time the hottest weather was over. No action was taken thereon. Weather.—This is best referred to here, as our figures shows its effect on infantile diarrhoea. The mean temperature for 1914 at Tottenham Observatory was 52.0° Fah., and the rainfall 23.3 inches. The year 1914 was the hottest for 75 years, but also the wettest for a century; as far as English recoi'ds go. The rainfall for December was enormous. MEHSLES. There were 12 deaths noted, compared with 48, 15 and 31 in 1913-12-11. This number of deaths is equal to a death-rate from measles of 0.18 per 1,000 living. One occurred in the first-age period (under one year), 6 in the secondage (one and under two years), 2 in the third age (two and under five), and 3 over five years of age. All occurred in the last six months of the year. Special leaflets re measles were distributed by the women inspectors, who visited the families attacked. The Urban District of Greenford, after 7 years experience, has discontinued compulsory notification as the results were disappointing, and notifications from school teachers resorted to instead. The population of this village in 1913 was estimated at 1,245. Patriotic children will not now admit that they are suffering from " German measles," but they have christened the disease " Hun-pox." WH00PING C0UGH. There were seventeen deaths from this cause, as compared with 9, 23 and 15 in 1913-12-11. This is equal to a death-rate from the disease of 0.25 per 1,000 living. All the deaths occurred amongst children under 15 years of age— 6 in the first-age period, 5 in the second, 5 in the third, and 1 in the fourth. Thirteen occurred in the first six months of the year. INFLUENZA. Four deaths were registered from this cause, compared with 7, 4 and 3 for 1913-12-11. Three persons were over 65 years of age, and the other was between 25 and 45 years old. Three were females. 6i VENEREAL DISEASES. Syphilis.—Seven deaths were recorded as due to this disease; six of these were infants 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," " striccure of urethra," " general paralysis of the insane," etc. OTHER DISEASES. Alcoholism.—No deaths from this cause were recorded amongst the residents. 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 24 less deaths than in 1913. The figures are 116, giving a death-rate of 1.07 per 1000, compared with 140 and a death-rate of 2-10 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 1914 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.—Fifty-one deaths of persons belonging to the district were registered as being due to cancer, and this is equivalent to a death-rate of 0.75. The deaths during 1913-12-11 were 48, 51 and 55. In the table below, the 51 deaths from cancer among residents only have been analysed according to the nature and position of the disease. 62 CANCER, 1914. Seat of Disease. Carcinoma. Sarcoma. Cancer or Malignant. Total. M. F. M. F. M. F. M. F. 1. Skull . — 1 — — — 1 — 2, Eyeball — — — 1 — — — 1 3. Lower Jaw — — 1 — — — 1 — 4. Breast — 1 — — — — — 1 5. Cervical Glands — 1 — — — — — 1 6. Tongue 1 — — — — — 1 — 7. œsophagus 2 — . — — — — 2 — 8. Mediastinum — — 1 — — — 1 — 9. Lung — — 1 — — 1 1 1 10. Stomach and (or) Pylorus 4 8 — — 1 — 5 8 11. Intestines 1 1 — — — — 1 1 12. Omentum — 1 — — — — — 1 13 Colon — 1 — — — — — 1 14. Rectum 3 — — — — — 3 — 15. Liver 1 4 1 — — 1 2 5 16. Anus — 1 — — — — — 1 17 Perineum 1 — — — — — 1 — 18. Sacrum — — 1 — — — 1 — 19. Kidney — — — — 1 — 1 — 20. Bladder 1 — — — — — 1 — 21. Uterus — 5 — — — 1 — 6 Total 14 23 6 1. 2 3 22 27 "Recurrent malignant growth of the throat," and (i) "carcinoma left side of neck (2) clefts," are examples of certificates so badly phrased that it is impossible to classify them. They are therefore not included in the above table. 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. 63 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, I 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. A new surface water main has been laid from Bury Lodge to Winchester Road for a distance of 723 yards, and the surface drains of the houses connected thereto. The sewage proper, together with that of the neighbouring district of Southgate, passes to the Council's sewage farm of 233 acres, where it is treated by broad irrigation. Mr. Frank Rackham is the farm bailiff. The 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. There is a daily dry-water flow of three millions, and a storm-water flow of five to six million gallons. 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 Scuthgate district, but takes the sewage of 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 24 feet 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. The sewage then flows by gravitation over the northern portion of the farm for preliminary treatment, passes in an aqueduct to a bacterial bed of three-quarters of an acre, 64 and it is afterwards filtered through a gravel pit of an area of 3½ acres for further purification before being allowed to pass down the effluent channel into Salmons Brook, a tributary of the River Lea. In addition to the works which I have enumerated, there is a low-level pumping station at Angel Road, which receives the sewage from the factories and the few cottages which have been built on the east side of the railway, also from a new estate lying between Dyson's Road and the railway. The only crops now grown on the Farm are rye grass and mangolds, as broad irrigation is gradually being displaced for filters of clinker. Only about 170 out of 233 acres is being used for broad irrigation. The first filter bed was started working on the 9th June, 1913. In October, 1913, another bed, adjoining Deepham's Farm, was commenced ; its dimensions will be 150 feet long by 100 feet wide. The progress with this new filter has been slow and it remained unfinished by the end of 1914. Its progress was delayed by lack of money and later by non-delivery of the iron sprinklers due to the war. In September a six-inch tile drain was laid round the sludge bed, which expedites drying. Eighteen-inch pipes were laid alongside the gravel pit recently. The abnormal rainfall of December produced difficulties at the sewage farm, which our Engineer successfully overcame. The effluent is examined by the analysts of the Lea Conservancy Board and the Middlesex County Council at frequent, but irregular intervals. Ninety-three visits were paid and 15 samples taken during 1914. In January an unfavourable report of the effluent was received from the County Council, although our analysts reported it satisfactory. In October another unfavourable report was received from the Counly Council, accompanied by a three months' notice to discontinue the flow into Salmon's Brook of injurious effluent. It was decided in January to remove the ventilation shaft near " Fleecefield," Brettenham Road. In December investigation was made into the utility of shafts in Church Street and elsewhere. The telephone wirers and repairers objected to the use of the poles as ventilation shafts. 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, and a new one was made this year. 65 House Refuse Disposal. Edmonton does not possess a destructor'. During the first three months of the year the house refuse was shot on the brickfields of Mr. Piggott, north of Bury Street, for which no payment was received. The tender of Mr. S. South for the collection of house refuse, for the year ending September 30th, 1915, at the price of £1,395 was accepted. Brickfields.—In January the Sanitary Committee drew the attention of the owners to many complaints received of nuisances arising from the burning of papers and rubbish and calling on them to discontinue the practice. Two owners attended the Committee on 4th March to state their views thereon, and expressed the hope that nothing would be done to restrict the amount of employment given on their works. In June a petition was presented from about sixty residents of Bush Hill Park, and the owners complained of were again warned that burning of this refuse must not take place. Since a visit to the brickfields in June by the Chairman of the Sanitary Committee, the Chief Sanitary Inspector and myself, no further complaints have been received. Letters were then sent to the offenders that burning of this refuse must not take place in future. In November the Chairman of the Sanitary Committee and the Chief Inspector were asked to interview Mr. Pigott re his offer of sixpence per load for the dustbin contents, and to try and arrange with him, terms for the screening and removal of the old rubbish heap on the farm, but he declined the business. So now all our house refuse is tipped on the Council's sewage farm. ROADS. The following private streets have been made up during the year under the 1892 Act:—Abbey Road (Edmonton portion) and Church Lane (part of)—a total length of 371 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. The portion of Lower Fore Street extending from Bridge Road to the highlevel station and the low-level crossing has been renamed "The Broadway." A great improvement has been made here (1) by the setting back of the fence at the corner of Bridge Road and the adaptation of " Rhine House" for the Edmonton show-rooms of the Tottenham District Light Heat and Power Co. (2) the rounding off of the waste piece resulting from the culverting of Salmon's Brook, which land has been planted with shrubs. 66 Town Road has been much improved by the relaying of the drains and putting into the road the forecourt of the houses on the lower part of the southern side. Church Street from " Rowantree," the residence of Councillor LeMare, to Ridge Road is being widened to 50 feet and Angel Road near Montagu Road also. In January the Local Government Board approved of two loans amounting to £1,520 at 4½ per cent. for the purpose of resurfacing The Green. The west side was laid with roadament and the rest with Trinidad asphalte macadam. In March the work was in hand and completed in April at a cost of about £1,890. Silver Street and the bridge passing over Pymmes Brook have been widened to 60 feet. This involved taking a slip of ground from Pymmes Park. Further improvement is here contemplated at an ultimate cost of about £11,200. In April, a strip of garden and orchard was taken into Bury Street at the front of the Nursing Home to enlarge the road at two very awkward corners. The name " Folkestone Road," formerly distinguished as a street running to ali points of the compass, is now extinguished, in so far as it is now restricted to the north side, the east side has been called Sandgate Road and the south and west sides have been transferred to Lyndhurst Road. 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 in Sutherland Road supplied by shallow wells about 20 feet deep. Water from the wells at Bunces farm, Firs Lane, 370, Fore Street and several houses in Sutherland Road were examined by Professor Kenwood, of University College, and certified as unfit for domestic purposes. Notices were served on the owners, under section 62 of the Public Health Act, 1875, to obtain and maintain a sufficient supply of good water to these [premises. In May, samples from further wells in Sutherland Road were taken and as the analyses were not satisfactory, I was instructed to press the owner of all these houses to negotiate for a supply from the mains of the Metropolitan Water Board ; this was not completed by the end of the year. 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. 67 The water which the Lea Conservancy Board controls runs from Hertford to Limehouse. They also took over the Stort navigation in 1912. The Middlesex County Council's representative is County Alderman Nield, K.C., M.P. The last report of our representative, Mr. Cornish, on the work of this Board appears to be one for nine months, ended December 31st, 1912. Pymmes Brook near the Gasworks has been culverted-in by two arches of 14 feet diameter at a cost of about £4,000, most of which sum was found by the Company. In July, six Doulton-ware drinking fountains offered us by the Metropolitan Association were placed in various parts of the district. MARKET ON THE GREEN.—THE COSTERS. 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. At the Farm Committee of 19th July a further complaint was received from, the County Council with reference to the pollution of Salmons Brook which is produced by the washings from the costers' stalls, especially the fish stalls, on the Green. At the Works Committee of 16th March a second complaint was received. In April, after the Green was re-surfaced at great expense, the Engineer circularised the costers warning them against damaging the asphalte. In August a quantity of unsound plums were seized by the Chief Inspector on a coster's stall, and later the seller was fined at Tottenham Police Court. GIPSIES. In February, the Council, in common with other districts around London, passed a resolution drawing the attention of the Home Secretary to the inadequate power of the law as regards these wanderers. Few of them are the real Romany, beloved of George Borrow, but merely men with families tramping the country in vans; they are people whose insanitary habits worry my inspectors and disgust the ratepayers whose neighbourhood they patronise. The Government should display no misplaced sentiment in dealing with these vagrants. The Home Office referred us to section 34 of the County of Middlesex Act, 1906. In April the County Council were requested to declare that section in force in Edmonton, and on the 28th May this was done. In July action was taken in a case under this section. Time will show the usefulness of this section or otherwise. 68 SECTION IY. HOUSING AND TOWN-PLANNING. 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. 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. No prosecutions have taken place since 1907. In April, Mr. Herbert Samuel, President of the Local Government Board, appointed a Departmental Committee " to consider the control at present exercised in England and Wales over the erection of buildings and the construction of streets by means of by-laws and local regulations, and their effect on building and development, and to make recommendations." The Committee consists of the following 12 members:— Mr. J. Herbert Lewis, M.P. (Chairman). Sir Randolf L. Baker, M.P. Mr. A. E. Collins, City Engineer, Norwich. Mr. Eustace Fiennes, M.P. Mr. E. J. Gowen, Clerk to Croydon Rural District Council. Mr. E. V. Hiley, Town Clerk of Birmingham. Mr. W. T. Jerred, C.B-, Assistant Secretary, L.G.B. Mr. F. H. Harding Newman, land agent. Mr. J. Pointer, M.P. Mr. W. T. Postlethwaite, Clerk to Swinton and Pendlebury Urban District Council. Mr. Raymond Unwin, Architect. Mr. Henry Vivian, Chairman of Co-partnership Tenants, Ltd. With A. N. C. Shelley, Esq., of the Local Government Board, as Secretary. You will see that the composition of the Committee is as follows:—four members of Parliament, one garden city or suburb developer, three clerks (legal advisers to Sanitary Authorities), one land agent, one engineer (municipal), one Local Government Board representative and one architect (private). 69 It appears strange that no Medical Officer of Health was appointed on this Committee, because the effect of lax building by-laws or of stringent by-laws badly carried out, is shown more conclusively in the annual reports of the Medical Officers of Health by their death-rates and sickness-rates than in any other publication. HOUSING TABLES OF LOCAL GOVERNMENT BOARD. At the end of April I dealt with no less than four schedules from the Local Government Board, requesting information for year ending March 31st, 1914. To obtain the desired information involved some considerable time and work for me and my department at a time when we were fully occupied completing the Annual Report for 1913. I hope that the result will be commensurate with the trouble involved. Some of the questions it was impossible to answer. The Schedules may be briefly described as follows:— 1. Circular to Local Government Board's accompanying schedule of three pages headed "Housing of the Working Classes Act, particulars as to inspection of houses and housing conditions." Information is desired " with a view to determine the precise method by which Parliament and the administrative departments can best assist the Local Authorities." Dated 27th February, 1914, received by me 3rd March, 1914. 2. A schedule annually prepared in accordance with Section 44 of the " Housing of the Working Classes Act 1890," to show what has been done during the year ending March 31st, 1914, and an account of all monies received and paid during that period, with a view to carrying into effect the purposes of Part II. of the above Act (as amended by the Housing and Town Planning Act 1909). A schedule of four pages and circular dated 14th April, 1914, received by me 24th April, 1914. 3. A schedule asking for information as to the operation of Sections 14 and 15 of the Housing and Town Planning Act 1909, and the action taken by this Authority during the year ending March 31st, 1914, under the latter section. A schedule of two pages with circular dated 14th April, 1914, received by me 24th April, 1914. 4. A circular and draft regulations, dated 17th April, received by me 23rd April, 1914, with reference to the use of underground rooms as bedrooms. The Council was asked to consider if regulations such as those referred to in Section 17 (7) of the Housing and Town Planning Act 1909, are needed in Edmonton, and asking your Medical Officer of Health to report upon the 70 extent to which any houses in the district come within the terms of the subsection. [Such regulations are not needed here at present.] The Mansion House Council, in July, published an important report on "London Housing," and on the 26th July a deputation waited on the President of the Local Government Board to discuss, explain and expand the proposals mentioned in this report. We suggested that a small committee should be formed on the lines of the Central Health Committee for London, presided over by one of the Secretaries of the Local Government Board or the head of the Housing Department. Such a committee might help to secure co-operation between various local authorities of Greater London, owners, and other interested parties ; it may be also useful in suggesting amendments of the law, found in practical work to be necessary, and other useful functions. I regret that we were unable to convince Mr. Herbert Samuel fully of the practicability of our suggestions. In March, 1915, in reply to a question in Parliament, Mr. Herbert Samuel, the President of the Local Government Board, said that the number of town planning schemes made by local authorities and finally approved by the Board was four ; three other schemes had been made by local authorities and submitted to the Board for approval, and the Board had authorised ninety-one other schemes to be prepared. It might be roughly estimated that the area of land comprised in town planning schemes approved, or in contemplation, was equal to about half the area of land already built upon in England and Wales. The Board had no information with respect to the number of houses built, or to be built, in connection with these schemes. The schemes did not require the erection of houses, but limited the number of houses to be erected on particular areas. It rested with the owners of the land within the area of the schemes to decide when building should take place, and, subject to the restrictions referred to, what number of houses should be erected. INSPECTION OF PREMISES. Number of premises inspected on complaint 371 Number inspected in connection with infectious disease 584 Number under periodical inspection 808 Houses inspected 449 Total number of inspections and reinspections made 16,307 ACTION TAKEN (OTHER THAN UNDER H. & T. P. ACT):— Cautionary or intimatory notices given 8,071 Statutory orders issued 494 Summonses served 6 Convictions obtained 6 71 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 (railway carriage) 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 Nil. The general character of defects See below* Number of premises closed voluntarily Nil. Number of premises demolished voluntarily :—• (a) Without closing order Nil. (b) After closing order 1 Illegal underground rooms vacated Nil. Number of premises dealt with under Section 15 of the H. and T. P. Act, 1909 10 Number of houses on which closing orders existed at end of year Nil. 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 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. The Southgate Urban District Council in July applied to the Local Government Board for sanction to borrow £40,000 with which to carry out a workmen's dwellings scheme, comprising 160 houses. They erected 82 houses for the working classes which are let to carefully selected tenants at the following rents :—16 at 5/6, 4 at 6/6, 46 at 7/-, and 2 at 8/-, yielding a total The defects found are too varied and numerous for inclusion in any tabular statement, but they are detailed in our register, 72 rental of £1,448 per annum. The losses in respect of empties and irrecoverables are expected to be practically nil. The plans of these houses do not commend themselves to me. In April, Messrs. Hodden & Stoughton published at one shilling the urban report of the Land Inquiry Committee appointed by the Chancellor of the Exchequer (Mr. Lloyd George) in 1912. Considerations of space prevent me quoting from it, but I strongly recommend my readers to obtain and read a copy. VACANT BUILDING PLOTS. Far too many exist in Edmonton, especially corner sites. The Finance Committee recommended that the Council should take possession of those to which the ownership was undiscoverable and let them for allotments or other purposes on short tenancies, the tenants to erect any necessary fencing. On these lands monies are due to the Council for street expenses. As far back as June 10th, 1913, the Council resolved that proceedings be and are hereby authorised to be taken before the expiration of six months by summons in Petty Sessions, or by action in the County Court, for recovery of any instalment and interest at 4 per cent, per annum, in respect of private street works which may be in arrear. In January, the Architect presented two reports to the Allotments Committee, who in March recommended that "where advisable, all the vacant pieces of land on which apportionments are outstanding and where fencing is required, be let on yearly tenancies at a nominal rental of 1s. per annum, provided the tenants are prepared to erect the fencing." My department takes a great interest in these lands, as they are a source of danger to the public health. When not occupied by muddy stagnant pools they are made a deposit ground by the neighbouring children and vagrants for offensive matter, or used as a sorting office by ragpickers. If there are no legal difficulties, I would suggest that after due advertisement, such sites be sold by the Council to the highest bidde on condition that the necessary fencing is erected and maintained in good order. ACTION UNDER HOUSING AND TOWN PLANNING ACT, 1909. In February, Brettenham Road, Nos. 303-5-7-9-11-21-35, were dealt with under Section 15 (3) of the Act, and 21 days' notice given to the owners to carry out the work necessary to make the houses fit. These houses then changed ownership, and the new owners were granted two months from the 24th April to comply with the notices. This they did. 73 In February, the Council, on the recommendation of the Highways Committee, passed a statutory resolution to make up under the Private Street Works Act, 1892, certain roads across the brickfield north of the Bury Street Nursing Home. In March, the Plans Committee disapproved of plans for the erection of 66 houses on this area for one owner, but a fortnight later approved of plans for the erection of 161 houses by the same owner on the east side of the railway to Enfield. I signed my disapproval of both sets. In May, notice was given to the owner of Sweet Briar Cottage, under Section 18, that the Council would resume consideration of the demolition of this cottage as the occupier had returned from the Infirmary (see Annual Report for 1913). On June 23rd a formal resolution for demolition was passed under Section 18 (2) of the Act. By September the owner had demolished it. In May, Nos. 18 and 20, Argyle Road, were dealt with under Section 15 (3) of the Act and the owner given 21 days' notice. A man and his family occupied an old railway carriage placed east of Second Avenue, Montagu Road. Of course there was neither water supply nor sanitary conveniences, so in July an order was made under Section 17 (2) of the Housing and Town Planning Act, 1909, prohibiting the use of the building as a dwelling-house. As no notice was taken of this closing order, notice was served under Section 17 (4) of the above Act giving the occupier 14 days' notice to quit. He cleared out at the end of October. In September, Nos. 56, 64 and 68, West Street, belonging to the same owner as 18 and 20, Argyle Road, were dealt with under Section 15, and 15 days' notice given to execute necessary repairs, failing which the Council in December stepped in to do the work and recover the expenses from the owner. HOUSING AND TOWN PLANNING COMMITTEE. At its first meeting of the year, on January 13th, a notice was submitted from the Wood Green Urban District Council that they had included the south-west corner of Edmonton, and a meeting to consider the matter was held at Wood Green on January 26th. The Housing and Town Planning Committee recommended that formal notice of objection to this scheme be given on the ground that our Council was preparing to deal with the area itself. On the same day, Map No. 1, prepared by our Engineer, was considered, on which the whole area proposed to be town-planned was shown surrounded by a red border, and on the 27th the Council authorised the Committee to issue the necessary notices and take such steps as are authorised by the Housing and Town Planning Act 1909 and the Procedure Regulations (England and Wales) 1910. 74 The conference of the Authority with the owners interested in our Town Planning scheme was held on 5th March, and a report thereon presented to the Council on the 10th March by Councillor Cadman, Chairman of the Housing and Town Planning Committee who presided at the Conference. About 60 persons attended the conference who were interested as owners, agents, occupiers or ratepayers. The Council then passed this resolution :— " That application be made to the Local Government Board for authority to prepare a town planning scheme for the area enclosed with a red border on the Map No. 1 now before the Edmonton Urban District Council, which area is entirely in the District of the said Council, and defined in the said map " ; and they authorised the advertisement of the Council's intentions in the local papers. One member opposed—Councillor Cornish ; Councillors Bird, Shortland and Russell did not vote. At the second meeting, on April 20th, the Committee heard that all the notices had been served and a statutory meeting of the owners held. The whole of the plans and particulars were then submitted by the Engineer. He also reported that the Local Government Board had split up the area of Greater London into six sections as regards arterial roads, Edmonton being in both the North and North-east sections. Sectional conferences commenced in March to deal with the question of arterial roads across Greater London (see my last Annual Report). The Clerk submitted the application which was to be sent to the Local Government Board. The Council on 12th May formally resolved to apply to the Local Government Board for authority to prepare a town planning scheme, and Map No. 2 was submitted by the Engineer, whereon the area proposed to be dealt with was bordered red and the portion excluded coloured blue. Councillor Cornish did not vote ; against, none. The third meeting of the Committee was held on 27th May when Mr. Councillor Cadman was re-elected chairman for 1914-15. On 16th June, the Local Government Board Inspector, Mr. Thomas Adams, held the local enquiry and heard any objections to the scheme from owners or agents of the property affected. A fourth meeting of the Committee on 28th October, received the consent of the Local Government Board, dated 9th and 23rd October subject to the exclusion of:- 75 1. The Workhouse lands belonging to the Edmonton Guardians. 2. Strand Union Workhouse, Westminster Board of Guardians. 3. Millfield House, Westminster Board of Guardians. 4. St. Aldhelms Church and Vicarage. 5. Pymmes Park. 6. All Saints' Church. 7. The Cemetery and Recreation Ground. 8. The group of six houses in Queen Annes' Grove. 9. The lands and buildings formerly belonging to the Guardians of the Strand Union, Silver Street, and 10. St. Stephen's Church and Church Room. Thereafter the necessary notices and advertisements were issued. On November 5th, Mr. Hembrow, the Townplanning Assistant, enlisted and his position has not been filled up. TOWN PLANNING CONFERENCE. This Conference, convened by the National Housing and Town Planning Council, was held at the Westminster Palace Hotel on April 1st and 2nd, to consider the practical town planning of Greater London as a whole. Whether the London County Council was represented or not I could not ascertain. It was attended by representatives of the suburban authorities within 15 miles radius of Charing Cross. Councillor Cadman, the Architect, the Engineer and the Medical Officer of Health attended to represent Edmonton. As the one nearly a year before considered the Birmingham (Harborne and Quinton) town planning scheme, which had received the approval of the Local Government Board, so this time the Ruislip—Northwood scheme, then nearly at its final stage, was described by Councillor Elgood, Chairman of the Town Planning Committee, and Mr. E. R. Abbott, Clerk of the Ruislip—Northwood Council. Besides, it was felt generally that as the town planning movement is making great progress in London and suburbs, it was quite worth while for the representatives of Greater London to meet together for two days and exchange information on their plans for improving each area. Many points of difficulty in administration and procedure were elucidated during the debates that occurred between the reading of the papers submitted. Interesting papers were :— 1. " The designing and construction of workmen's cottages in urban areas under town planning schemes," by Councillor Harold Shawcross, of Lancashire. 76 2. "Report of the Joint Committee of the Urban District Councils of Chadderton, Royton and Crompton as to the desirability of combined planning of these neighbouring areas. The Town Planning procedure regulations of the Local Government Board dated February 12th, 1914, and circular letter of the Local Goverment Board were submitted too. This interesting resolution was moved by the Clerk of Carshalton, but unfortunately barred on technical grounds by the Chairman of the Conference, Alderman Thompson:— "That in the opinion of this Conference, when powers are given in a Town Planning scheme to lay out and construct roads of less than by-law width or not of standard construction, provision should be made for treating the user of such roads on lines to be clearly defined in the scheme." Arising out of this Conference a deputation waited on the President of the Local Government Board with reference to the administration of the Housing Act (No. 2), 1914, and its report was presented to my Council on 13th October. WORKMEN'S DWELLINGS. A motion on the 13th of January that "the Council do instruct the Engineer to prepare a scheme for the erection of workmen's dwellings on the Brookfield Estate," was lost by one vote. On February 24th, a deputation from the Tenants' Defence League appeared before the Council and urged them to put in force their powers under Section 10 of the Housing and Town Planning Act, 1909, and under Part III. of the Housing of the Working Classes Act, 1890. They reported that rents were increased and vacant houses few. One of the deputation stated that a decent house could be built in Edmonton for £100 and let at 7/6 weekly, which would provide a profit for the Council after paying rates and providing for maintenance. This league organised a meeting in the Town Hall two days later, which passed a protest against increasing rents, and calling upon the Council to proceed at once with house building on the Brookfield Estate, which was bought for that purpose. Another deputation came before the Council on 12th May to urge similar views. On 9th June the Council instructed the Architect to prepare a scheme for the erection of workmen's dwellings on the Brookfield Estate. This officer prepared and published in August, 1914, a report with two 77 schemes and five detached plans showing the best development of this land. This was submitted to the Plans Committee in September, and the Architect was then instructed to prepare further plans of scheme A (amended) " so that when the opportune time arrives, the Council will be in a position to consider the question without delay." On June 17th, the Finance Committee considered a letter asking upon what terms the Council would be prepared to lend money under the Small Dwellings Acquisition Act, 1899, for the purchase of a house in the district. The Clerk was instructed to submit a report on the subject. IMPERIAL HEALTH CONFERENCE. I attended this Conference held at the Imperial Institute, London, from 18th to 21 st May, when important subjects were discussed by delegates from Great Britain, her Dominions and Crown Colonies. It was convened by the Victoria League. My report thereon was published in the Council minutes for 9th June, 1914. It was here that Mr. Herbert Samuel, President of the Local Government Board, announced that as schemes were not being adopted in areas where they were obviously required, Parliament would be asked to make townplanning compulsory in such areas, and that the Board of Trade was interesting itself in the improvement of transit from the home to the workshop or business. I spoke on the last afternoon immediately after the Viscount Peel, the Chairman of the London County Council. I thereupon took the opportunity to deplore the stepmotherly attitude of this central authority towards the local authorities around the County of London. I also urged the Victoria League to give its immediate attention to several difficulties which have for years hampered the work of municipalities and their officers, e.g., need of consolidation (with amendment) of all the Acts of Parliament dealing with sanitation since 1875, and of all the countless Orders, Regulations, and thousands of circular letters issued by the Government Departments regarding the Public Health Department since that date. These should all be concentrated within the covers of two volumes, portly perhaps, but easy of reference. During this Conference came (to our regret) the sudden death of Alderman W. Thompson, of Richmond, Chairman of the National Housing and Townplanning Council. His reputation as a practical town-planner was world-wide, and his loss leaves a gap in the forefront of housing reformers which will not soon be filled up. 78 SECTION V. MIDDLESEX COUNTY COUNCIL. From Report of Licensing Committee. 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. Johnson, James, " 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.andD. (270.) 6. Dubowski, A. Davis, " The Theatre Royal." M., D., S.P. and Cin. (637.) 7. Heap, Arthur, Raynham Road School. M. and D. (472.) 8. Stedman, C. W., Cinema Theatre, Fore Street. M. and Cin. (580.) 9. Langbridge, J. C., The New Hall, Knights Lane. Cin., M. and D. (411.) 10. Jones, Rev. H., St. James' Parish Hall, Gilpin Grove. M. and D. (387.) 11. Leigh, Samuel, "The Globe," Upper Fore Street. M. (60.) 12. Middleton, Wm. F., " The Golden Fleece," Fore Street. M.and D. (113.) 13. Payne, William Francis, The Town Hall. M., D. and S.P. (603) 14. Barrett, Jas. A., All Saints' Parish Room. M., D. and S.P. (385.) 15. Chambers, E. A. & Co., "The Alcazar," Fore Street. M., D. and Cin. (84i.) 16. Ryan, Rev. W. S., St. John's Church Hall, Dyson's Road. M. and D. (475-) 17. Sanders, Rev. E. A. B., " Charles Lamb" Memorial Hall. M. and D. (35o). 18. Sanders, Rev. E. A. B., St. Alphege Church Hall. M. and D. (300.) 19. Skinner, Rev. Thomas Henry, St. Michael's Church Hall. M. (520.) 20. Skinner, Rev. T. H., The Bassishaw Hall, Bury Street. M. and D. (400.) 21. Tattersall, Rev. S. O., Wesleyan Central Hall. M. (1,170.) 22. Yates, Rev. E. Selwyn, St. Peter's Church Hall. M. and D. (312.) 79 The Standing Orders of the Middlesex County Council, with reference to the provision of sanitary conveniences for Public Halls were revised and adopted on the 30th July, 1914. They are as follows :— 6i. Proper cloak-rooms, W.C's. and lavatory accommodation shall be provided for both sexes, and in premises licensed for stage plays there shall be provided sufficient dressing room and lavatory accommodation for each sex, for sole use of the performers. Lavatories and W.C's. for the use of the audience must be kept lighted during entertainments. For the audience the minimum number of W.C's. and urinals shall be based on the total number of persons for which the premises are licensed, in the following manner:— For Males— One W.C. and one 3-stall glazed urinal for every 500 persons, or part of that number. For Females—One W.C. for every 300 persons, or part of that number. The urinals shall be provided with automatic flushing apparatus, and all W.C's. and lavatories must be effectively ventilated direct to the open air. 62. Where grounds are licensed, the lavatory and cloak-room accommodation shall be conveniently and properly screened. 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. 8o 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. 81 SECTI0N VI. LEGISLATI0N OF 1914. ACTS, CIRCULARS, ORDERS, REGULATIONS, etc. The Budget Speech of 1914. Mr. Lloyd George, then Chancellor of the Exchequer, on Monday, May 4th, made a speech full of important points and worthy of the notice of all local authorities like Edmonton. " There has hardly been a year of the last 40 years that successive parliaments have not cast new functions of an onerous and costly character on the local authorities, and rarely was any provision made to meet the financial liabilities. We think we have done our duty in this House the moment we have passed a beneficial measure and handed over the responsibility of administering it to the local authorities. The credit is ours, the burden is theirs. We take no further thought in the matter, and we are surprised when we discover that many of our precious statutes are really dead letters. In some districts where the rateable value is low, and the needs of the district are great, municipal activities are practically at a standstill." Mr. Lloyd George continued by declaring that therefore it was highly necessary that there should be a readjustment of the relations between local and imperial taxation in order to impart energy to the local authorities. He therefore proposed that a national system of valuation for local taxation should be set up in which site value should be differentiated from the cost of improvements to buildings, and annual values from capital values. He stated that the system of assigned revenues would be abolished and money distributed so as to give most relief to the necessitous districts, but that in every case efficient service will be a condition of a grant. He proposed that the grant for Public Health should be 15 per cent. of the gross and 25 per cent. of the nett expenditure ; for treatment of tuberculosis the State would find 50 per cent, of any deficiency; a substantial sum annually for supplying district nurses ; for establishing pathological and bacteriological laboratories in local authorities' centres; for health lectures ; and for housing. The State would pay the whole instead of part of the cost of killing diseased animals. The State grant for maintenance of main roads would be divided into three classes—class 1, half; class 2, quarter; class 3, none. Larger grants would be given to the necessitous school areas. As regards education authorities, he proposed that the State should provide 50 per cent. of the expenses for provision of meals to needy scholars; that a grant should be given for physical training and open-air 82 schools ; that the epidemic grant should be renewed to enable schools to be closed without loss of grant. This was stopped in 1903. Schools for mothers would receive grants. The Chancellor also foreshadowed the appointment of medical referees (or consultants) and local treatment-clinics for panel work. Housing (No. 2) Act, 1914. A circular was published by the Local Government Board on 21st August 1914, transmitting a copy of the above Act. By this Act the Local Government Board in urban and the Board of Agriculture in rural districts were authorised to make arrangements with Local Sanitary Authorities or authorised Societies for the provision, maintenance, improvement and management of dwellings or gardens and other works or buildings for, or for the convenience of, persons belonging to the working classes. The Treasury will devote four millions of money to this purpose. Any advance will be repayable within 60 years for substantial building and 80 years for land purchase. The Board asked to be informed if there was any scope, or not, in the Council's area for the operation of this Act. Underground Rooms as Sleeping Places. A circular of the Local Government Board was dated 17th April, 1914, together with a copy of draft regulations suitable for a Local Sanitary Authority and prescribed by Section 17 (7) of the Housing and Town Planning Act, 1909. Pulmonary Tuberculosis. A memorandum for the provision of new residential institutions for the treatment of " consumption " was published under date of "February, 1914," signed by the Medical Officer and Architect of the Local Government Board on this subject. It gave advice as to the site, plans and construction of buildings for the accommodation of—A. cases in which permanent improvement, or recovery, may usually be anticipated ; B. cases in which temporary, though probably prolonged, improvement may be anticipated. Tuberculosis (Animals) Order of 1914. It came into force July 1st, 1914. A circular letter was published by the Board of Board of Agriculture on 23rd June, 1914. In the new order which replaced that of 1913, "emaciation due to tuberculosis" is the term substituted for " tuberculosis with emaciation " But other alterations are more important than that. 83 Milk and Dairies act, 1914. I do not propose to more than mention this Act now, because by special order of the Local Government Board dated 17th December, 1914, its date of operation was postponed from 1st January to 1st October, 1915. Poor Law Institutions Order, 1913. Poor Law Institutions (Nursing) Order, 1913. A circular letter dated 31st December, 1913 of the Local Government Board conveyed these orders which do not apply to institutions provided wholly for the sick or for children. They both came into force 31st March, 1914. These orders were issued as a result of the report of the Departmental Committee, which advised the consolidation with amendment of the multitudinous regulations hitherto in force. This will no doubt lead to considerable improvement in poor-law administration. The Elementary Education (Provision of Meals) Act. 1914. The Act of 1906 (See. 3) limited the expenditure on meals by the local educational authorities to a halfpenny rate. This new Act removes that limit. It permits the provision of meals during holidays and at other times when the schools are not open. It abolishes-the necessity of obtaining the sanction of the Board to any expenditure out of the rates for the provision of food, but the usual two resolutions must still be passed annually by the Council. Half the expenditure will be repayable through Government grants, if the work is satisfactory. Regulations regarding grants for year ending 31st March, 1915, were issued by the Board of Education on the 19th June, 1914. In a circular of 7th August, 1914, the Board expressed a fear that war conditions might cause exceptional distress from want of employment amongst the parents ; the local education authority was therefore urged to forthwith start, or (if already started) to invigorate their organisation for the provision of meals to the children. Circular 856 was a Memorandum on meals and dietaries from the Board of Education, 15th August, 1914. Maternity and Infant Welfare. The circular letter of the 30th July and a memorandum from the Local Government Board addressed to " County Councils and Sanitary Authorities " 84 is referred to under the heading of "The women inspectors and their work." In October, I received a circular and form of application for a grant in aid of any expenditure during the six months ending 30th September, 1914, which in our case was nil. Day Nurseries. On December 2nd the Secretary of the Education Committee received circular 879 from the Board of Education dated 26th November, which is a memorandum " in regard to the Regulations for payment of grants to day nurseries." It also conveyed regulations under which these grants would be made during the year ending 31st March, 1915. The total grant will in no case exceed one-half of the approved nett expenditure and will be based on the number of attendances. The day nurseries are to provide primarily for infants and children under three years of age. My Education Committee decided, like the Council, to defer consideration of this subject until next year. Mental Deficiency. For information on this subject reference should be made to the appendix of the School Medical Report. 85 SECTION VII. 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. In November plans were approved for alteration to and extension of the Edmonton Workhouse laundry. Outworkers.—In October we received lists from the Medical Officer of Health of Tottenham of over 350 women which was receiving work at home from a Tottenham firm, who were executing work at low rates for the Government. Kit-bags and bed-ticks for the soldiers were, I understand, the articles being mostly made. Early in November I discovered that work for a City firm was being done in a house where diphtheria was present. It was therefore important that the houses of these outworkers should be visited as soon as possible to ascertain if the people were suffering from infectious diseases or not, what the sanitary conditions of the houses were and under what circumstances the work was being done. Amongst the 350 homes in the Tottenham list we found several where work had been taken in, affected with infectious disease, such as scarlet fever, diphtheria, measles, etc., and in all cases I took steps to prevent further spreading of infectious disease, and also disinfected such work as these outworkers had in hand. It was necessary to protect the health of our soldiers who would be shortly using the goods. I brought these facts on Monday the 2nd November to the notice of the Chairman of the Sanitary Committee and the Chairman of the Council and they authorised me to get assistance in this direction as soon as possible. Many of these outworkers had not done homework before and did not therefore appear in our register. I should have liked to have received from my colleagues in Central London lists of these persons, but I did not do so. No doubt, like myself, they were much occupied with other business. 86 Therefore I was not altogether surprised to hear of the following return supplied to the House of Commons in March, 1915, showing cases of scarlet fever, diphtheria and measles:— Expeditionary Force (a) Troops in U.K. (b) Disease Cases. Deaths. Cases. Deaths Scarlet fever 196 4 1,379 22 Diphtheria * * 783 6 Measles 175C 2C 1,045 65 a Up to February 11th, 1915. b Up to January 31st, 1915. c Including Indian troops, cases 5; deaths, o. * Returns not at present available. 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. Mrs. Denning has been registered under section 69 of the Public Health Acts Amendments Act, 1907, as keeper for one year. She has provided new beds and bedding, the old having been destroyed. 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. Nos. 62a, 64a and 66a, Bridport Road, and Nos. 12, 14, 16 and 18, Gilpin Crescent are about to be placed on the register, Mrs. Denning (as above) is the proprietor. The houses in Bridport Road were referred to a year ago. Tenements.—In July a suggestion was made by the agents to reconstruct an old mansion called "Lion House" in Church Street for the accommodation 87 of three separate families. I am thankful to say the matter was not pursued further. 4. Slaughter-Houses.—There are seven on the register, one of old registration. In April, annual licenses were issued to E. J. Howes, 19, The Green; E. Knifton, The Langhedge; and T. H. Chester, 3, The Green, on the terms of the Public Health Act (Amendment Act), 1890. The license of 31, Hertford Road was put in abeyance, as it is not used as a slaughter-house now, nor the one in 194, Fore Street. In December the seven years' license of N. A. Barrett, 188 Fore Street having expired, he was favoured with a renewal for three years. A circular letter from the Local Government Board dated 21st April, 1914, renewed their advice of 10th July, 1912 as to my department exercising strict supervision over slaughter-houses and butcher shops. A leaflet from the Board of Agriculture was enclosed. 5. Knackers.—On September 8th, the Council refused an application for permission to erect a knacker's yard on land south-west of Eastbournia Avenue, close to Salmons Brook. On October 14th and 28th to the Plans Committee a plan was submitted endorsed with my disapproval, and at the latter meeting approved on the grounds that the plans were in accordance with the building by-laws! On November 10th, on the recommendation of the Sanitary Committee, the Council agreed to grant a license for one year. 6. Pigs.—In February, Mr. Withers' plans for six styes east of St. Mary's Gardens were passed under a temporary building agreement, and the agreement with Mr. H. Fergusson for styes in the same locality was transferred to Mr. F. Shirley, of Ponders End, Enfield. Another plan of Mr. Withers for two styes north-east of St. Mary's Gardens was accepted in July. During the summer, complaints of smells from boiling pigs' food were received from Langhedge Lane, Snell's Park; in December, as in January, 1913, this yard was responsible for blocking the surface-water drains at the Boundary with Tottenham. At the end of September, Mr. Wm. Field's plan for four styes and food store in plot 95 of Weir Hall allotments was approved. 7. Dairies, Cowsheds and Milkshops—There are only two cowkeepers now in the district, the same as last year; and only 32 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 100 purveyors of milk on our register at the end of the year. One cowkeeper has been troublesome, because of his persistence in keeping his cows overcrowded. I hope the Council will deal with him as he deserves. 88 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 plums, see " Market on The Green." On May 19th, at Clerkenwell Police Court, one of our butchers and one of our holders of a slaughter-house license were summoned with regard to tuberculous meat being sent for sale to Finsbury meat market. The former was convicted and fined. 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, 1913, 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 of that year. In May, instructions were given to serve a nuisance notice on our one trader under the Public Health Act, 1875, and the Factory and Workshop Act, 1890. In July there was a consultation between the Chairman of the Sanitary Committee, the Inspector of Nuisances and the Medical Officer of Health with the Council's solicitor, when it was decided that the latter should take counsels' opinion on some legal points. In December, several persons who had commenced the business of rag and bone dealers contrary to an Order of the Local Government Board, dated 9th May, 1912, were warned by our Clerk that they must not carry on such an offensive trade without the written consent of the Council. In April, advertisement was made that the by-laws of the London County Council for regulating the business of a curer or a vendor of fried fish respectively would then come into force throughout the administrative County of London. 10. Stables —In January, a set of stables was erected in Maldon Road. From May to December, there was trouble and delay caused by the unauthorised erection of a 3-stall stable and carl shed near the gutscrapers. The building was finally unroofed. In October, a successful prosecution was taken against a man in Monmouih Road for using an improper building for a horse. 89 FHETORY AND WORKSHOP ACT. WORK DONE DURING 1914. Factories- Factories cleansed 4 Walls and ceiling repaired 1 New inspection chamber to drains constructed 1 New vent-shaft to drains fized 1 New bath provided 1 Drains unstopped 2 Accumulations of refuse removed 2 W.C. flush-pipe joints repaired 1 W.C. doors repaired 1 W.C.'s cleansed and limewashed 87 W.C. flushing cisterns repaired 6 New W.C. pedestal fixed 1 W.C. floors repaired 1 Urinal disconnected from surface drain and connected to sewage drain 1 Urinals cleansed 2 Separate accommodation for sexes provided 1 113 Workshops and Workplaces- Workshops cleansed 8 Overcrowding abated 1 Dilapidated and insanitary workshop demolished 1 Walls and ceilings repaired 1 External walls repointed 1 Roof repaired 1 Drains unstopped 2 New dustbin supplied 1 Privy emptied and cleansed 1 W.C. flush-pipe joint repaired 1 W.C. pan cleansed 3 W.C. floor repaired 1 22 Laundries— Workrooms cleansed 2 Walls and ceilings repaired 2 Water fittings repaired 1 Yard paving repaired 1 Rain-water pipe repaired 1 W.C. cisterns repaired or new cisterns fixed 3 90 W.C. flash-pipe joint repaired 1 W.C. seat repaired 1 12 Bakehouses— Bakehouses limewashed 13 Accumulations under troughs removed 5 Lighting improved 1 Water-storage cistern covered 1 Walls and ceiling repaired 1 FJour store repaired 1 Rain-water pipes and eaves gutters repaired 3 Sink-waste pipe trapped 1 Channel and fender to gulley repaired 1 Surface-water drain to yard provided 1 Yard paved 1 New dustbins supplied 2 Accumulations of refuse in yards removed 4 Improper-keeping of animals discontinued 1 W.C. flushing cistern repaired 1 W.C. pans cleansed 2 39 Outworkers' Premises- Rooms cleansed 10 Overcrowding abated 2 Walls and ceilings repaired 3 Roofs repaired 1 Waten fittings repaired 6 Water cisterns covered or water taken off the main direct 3 Drains unstopped 2 Yards paved or paving repaired 4 New dustbins supplied 5 Ashpit repaired 1 Improper keeping of animals discontinued 1 W.C. flushing cisterns repaired 6 W.C. flush-pipe joints repaired 1 W.C. seat repaired 1 W.C. floor repaired 1 47 233 91 I.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including inspections made by sanitary inspectors (male and female). Premises. Number of Inspections. Number of Written Notices. Factories (including factory laundries) 52 — Workshops 244 21 (including workshop laundries) Workplaces (other than outworkers' premises included in Part III. of this Report) Totals 296 21 11.— DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Found. Remedied. Nuisances Under the Public Health Acts: Want of cleanliness 17 24 Want of ventilation 1 0 Overcrowding 3 3 Want of drainage of floors - - Other nuisances 63 70 Sanitary accommodation: Insufficient — — Unsuitable or defective 120 122 Not separate for sexes 0 1 Offences under the Factory and Workshop Act: Illegal occupation of underground bakehouse Breach of special sanitary requirements for bakehouses — — 14 13 Other offences (excluding offences relating to outwork) — — Total 218 233 92 III.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS. OUTWORK IN UN WHOLE-OUTWORK IN INFECTED SOME PREMISES (Sec. 108). PREMISES (Sees. 109, no). 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, no. Sending twice in the year. Sending once in the year. Lists. Outworkers. Lists. Outworkers. Failing to keep or permit inspection of lists. Failing to send lists. Contractors. Workmen. Contractors. Workmen. Wearing Apparel making ... ... ... 1 ... 16 1 ... ... ... ... ... 3 2 ... Leather bellows making ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Brush making ... ... ... 1 ... 3 1 ... ... 1 1 ... ... ... ... Total ... ... ... 2 ... ... 2 ... ... 1 1 ... 4 2 ... 93 IV.—REGISTERED WORKSHOPS. Workshops on the Register at the end of the year. Number. Workshops and Workplaces 57 542 Outworkers' Premises 485 Bakehouses 29 Laundries 9 Total number of Workshops on Register 580 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 Reports (of action taken) sent to H.M. Inspector 3 3 Underground Bakehouses (s. 101):— In use at the end of the year 1 94 TABLE I. Vital Statistics of Whole District during 1914 and previous years. Year Nett 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. Nunlber. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1906 56,818 1,881 1,822 32.07 915 15.55 259 124 248 131.84 783 13.78 1907 59,413 1,023 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 32.5 110 182 100.39 675 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 1012 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 1914 68,203 1,946 1,859 27.25 1,238 17.67 591 94 159 85.53 736 10.79 Includ's. Belgians 68,908 1,946 1,883 27.41 1,238 17.67 591 94 159 85.53 741 10.79 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 are calculated per 1000 of the estimated population as stated in Column 2, without the use of the standardising factor for the district given in the Annual Report of the Registrar-General. In a district in which large Public Institutions for the sick or infirm seriously affect the statistics, the rates in Columns 5 and 13 are 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; (e) 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 At Census of 1911. Total population at all ages 64.797 Number of inhabited houses or tenements 12,491 Average number of persons per house or tenement 5.00 including Institutions 5.19 95 TABLE IIa.—Vital Statistics of separate Localities and of the Edmonton and Strand Union Workhouses and Strand Schools in 1914 and previous years. Names of Localities. 1 Whole District. 2 Bury Street. 3 Church Street. 4 Fore Street. 5 Undistributed. 6 Edmonton Union and Infirmary. 7 Belgian Refugees.* Year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under i year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered, Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. 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 1905 54606 1947 728 250 19014 660 240 99 16468 621 262 76 19124 666 219 74 .. .. 7 1 897 70 263 4 .. .. .. .. 1906 56816 1881 783 248 18570 643 264 91 18415 575 230 64 19607 585 278 89 .. .. 11 2 89b 73 29c 2 .. .. .. .. 1907 59434 1974 792 225 18981 703 256 74 19522 559 257 70 20722 662 272 81 .. .. 7 .. 911 77 339 15 .. .. .. .. 1908 60182 2000 732 227 19739 651 267 73 19499 621 242 65 20736 656 211 73 .. .. 12 932 88 311 12 .. .. .. .. 1909 61164 1871 675 182 20157 655 230 67 19677 577 219 68 21101 571 222 47 .. .. 4 .. 1019 87 344 19 .. .. .. .. 1910 61741 1961 587 140 20482 655 218 49 20022 623 181 42 20920 600 184 48 .. .. 4 1 17410 98 432 32 .. .. .. .. 1911 63146 1921 830 265 21867 644 294 99 20192 032 265 87 21087 564 268 79 .. .. 3 .. 1342 10.3 579 63 .. .. .. .. 1912 65084 1844 666 149 21500 578 264 63 22166 612 218 55 21418 570 183 31 .. .. 1 .. 1407 106 647 49 .. .. .. .. 1913 66552 1912 794 196 21823 658 260 73 22861 615 270 61 21868 575 261 62 .. .. 3 .. 1376 81 594 56 .. .. .. .. 1914 68203 1946 736 159 22101 647 280 64 24078 647 228 47 22024 556 227 48 .. .. 1 .. 1452 89 737 65 705 24 5 .. 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. * Ten deaths occurred at the Strand Workhouse before it was occupied by the Refugees on September 7th, but there were no births and no infantile deaths. The Strand School was closed from July 13th, 1913, until it was occupied by Refugees on October 13th, 1914. 96 TABLE II.—All Cases of Infectious Disease notified during the year 1914. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward or Institution. At all Ages. At Ages—Years. 1 2 3 4 5 6 7 Total Cases Remov'd to Hspitl. 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. Belgian refugees Wstmstr. (lte. Stnd. Union). Diphtheria (including Membranous Croup) 151 3 33 95 16 4 .. .. 50 48 50 1 3 1 .. 141 Erysipelas 84 4 1 10 12 24 23 10 29 23 25 1 5 2 1 .. Scarlet Fever 365 1 86 211 51 14 2 .. 130 111 110 1 8 8 .. 328 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 17 .. 1 4 6 4 2 .. 6 5 6 1 1 .. .. 16 Puerperal Fever 5 .. .. .. 5 .. .. .. 1 2 2 1 1 .. .. .. Cerebro-Spinal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Poliomyelitis 3 .. 3 .. .. .. .. .. 2 1 .. .. .. .. .. .. Ophthalmia Neonatorum 16 16 .. .. .. .. .. .. 6 5 4 .. 1 .. .. .. Pulmonary Tuberculosis 428 .. 8 48 86 216 65 5 145 145 130 1 5 3 1 .. Other forms of Tuberculosis 63 .. 9 37 12 5 .. .. 15 18 30 .. .. .. .. .. Totals 1132 24 141 405 188 267 92 15 384 358 357 6 24 14 2 585 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 Dist ict of Enfield. Clare Hall Small Pox Hospital and Sanitorium for consumptive persons. This is situate in the South Mimms rural district < f 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. 98 99 TABLE IIIa.—Causes of, and Ages at Death, during the year, 1914. 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. Institution Deaths— Non-Residents outside Institutions Inquests in district on Residents. Residents. Non-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. Belgian Refugees. Edmonton Union. City of Westminster Union and School. Totals. M F T 1 Enteric fever 4 ... 4 ... ... ... 1 1 2 ... ... 1 1 2 ... 3 1 ... ... ... ... ... ... 6 Measles 6 6 12 1 6 2 3 ... ... ... ... 5 2 5 ... ... ... ... 1 ... 1 ... 1 7 Scarlet fever ... 3 3 ... 1 ... 2 ... ... ... ... 2 ... 1 ... 2 ... ... ... ... ... ... ... 8 Whooping cough 9 8 17 6 5 5 1 ... ... ... ... 10 4 3 ... ... ... ... ... ... ... ... ... 9 Diphtheria 6 10 16 ... 1 8 7 ... ... ... ... 9 3 4 ... 10 ... ... ... ... ... ... 1 10 Influenza 1 3 4 ... ... ... ... ... ... 1 3 1 2 1 ... ... ... ... ... ... ... 1 ... 18 Erysipelas ... 2 2 ... ... ... ... ... ... 2 ... 2 ... ... ... ... ... ... 3 ... 3 ... ... 20 Pyaemia, Septicaemia 1 1 2 ... ... ... ... ... 1 1 ... 1 ... 1 ... ... ... ... 3 ... 3 ... 1 28 Pulmonary tuberculosis 48 27 75 1 3 ... 7 9 39 13 3 28 28 16 ... 7 22 3 63 ... 63 ... 4 29 Acute phthisis 2 2 ... ... ... ... ... 1 1 ... 1 1 ... ... ... 2 ... ... ... ... ... ... 30 Tuberculous meningitis 7 6 13 1 5 1 6 ... ... ... ... 6 3 4 ... 3 3 ... 3 ... 3 ... ... 31 Tuberculosis of peritoneum and intestines 3 2 5 ... 2 2 ... 1 ... ... ... 2 1 2 ... 2 1 ... 2 ... 2 ... ... 32 Tuberculosis of spinal column 1 1 2 ... ... ... ... 1 1 ... ... 11 ... 1 ... ... 1 ... 2 ... 2 ... ... 33 Tuberculosis of joints ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 34 Tuberculosis of other organs 1 ... 1 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... 2 ... 2 ... ... 37 Syphilis 5 2 7 6 ... ... ... ... 1 ... ... 2 1 4 ... 1 1 ... 6 ... 6 ... 1 39 Cancer of the buccal cavity 2 ... 2 ... ... ... ... ... ... 2 ... 1 ... 1 ... ... 1 ... 8 ... 8 ... ... 40 Cancer of the liver, stomach, etc. 10 13 23 ... ... 1 ... 1 1 10 10 10 7 6 ... ... 2 ... 14 ... 14 ... ... 41 Cancer of the peritoneum, intestines, and rectum 4 4 8 ... ... ... ... ... 1 4 3 4 3 1 ... 1 5 ... 11 ... 11 ... ... 42 Cancer of the female genital organs ... 6 6 ... ... ... ... ... 2 4 ... 1 1 4 ... ... ... ... 13 ... 13 ... ... 43 Cancer of the breast ... 1 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 7 ... 7 ... ... 45 Cancer of other or unspecified organs 7 4 11 ... ... ... ... ... 3 6 2 4 4 3 ... 2 6 ... 14 ... 14 ... ... 46 Other tumours (situation undefined) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 47 Rheumatic fever ... 1 1 ... ... ... ... ... 1 ... ... ... 1 ... ... .. 1 ... 1 ... 1 ... ... 48 Chronic rheumatism, Osteo-arthritis, gout ... 2 2 ... ... ... ... ... 1 1 ... 1 ... 1 ... ... ... ... 1 1 ... ... 50 Diabetes 3 5 8 ... ... ... ... ... 5 1 2 4 2 1 ... 1 1 1 1 ... 1 ... ... 53 Leucocythaemia, Lymphadenoma 1 ... 1 ... 1 ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 54 Anaemia, chlorosis ... 1 1 ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 100 101 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. Institution Deaths— Non-Residents outside Institutions. Inquests in district on Residents. Residents. Non-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. Belgian Refugees. Edmonton Union. City of Westminster Union and School. Totals. M F. T. 55 Purpura ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 56 Alcoholism (acute or chronic) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 ... ... 61 Meningitis 2 1 3 ... ... ... 3 ... ... ... ... 2 1 ... ... 1 ... ... ... ... ... ... 1 63 Other diseases of the spinal cord 1 1 2 ... ... ... ... ... ... 2 ... 1 1 ... ... ... 2 ... ... ... ... ... ... 64 Cerebral haemorrhage, Apoplexy. 16 17 33 ... ... ... ... 1 1 11 20 11 8 14 ... 1 9 ... 30 1 31 ... 1 65 Softening of the brain ... 1 1 ... ... ... ... ... ... 1 ... ... 1 ... ... 1 ... ... ... ... ... ... ... 66 Paralysis without specific cause 1 ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... 1 ... 1 ... ... 67 General paralysis of the insane 3 2 5 ... ... ... ... ... ... 5 ... 3 1 1 ... 3 ... ... 2 ... 2 ... ... 68 Other forms of mental alienation 1 ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 69 Epilepsy 2 2 4 ... 1 ... ... ... 2 1 ... 3 ... 1 ... 3 ... ... 1 ... 1 ... ... 71 Infantile convulsions (under 5 years of age) 3 ... 3 3 ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... 3 73 Hysteria, neuralgia and neuritis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 74 Other diseases of the nervous system 1 ... 1 ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... 1 ... ... 76 Diseases of the ears ... 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... 77 Pericarditis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... ... 78 Acute endocarditis ... 3 3 ... ... 1 1 ... 1 ... ... ... 2 1 ... ... ... ... 8 ... 8 ... ... 79 Organic disease of the heart 27 39 66 1 ... ... 1 5 10 19 30 24 23 18 1 3 29 ... 104 4 108 1 8 81 Diseases of the arteries, atheroma, aneurysm, etc. 12 14 26 ... ... ... ... ... 1 2 23 9 9 8 ... ... 22 ... 80 ... 89 ... ... 82 Embolism & thrombosis 3 3 6 ... ... ... ... ... ... 1 5 1 3 2 ... 1 2 ... 16 ... 16 ... ... 84 Diseases of the lymphatic system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 86 Diseases of the nasal fossae 1 1 2 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... 87 Diseases of the larynx ... 1 1 ... ... 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 88 Diseases of the thyroid body ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 89 90 Bronchitis 18 16 34 7 3 2 ... ... 1 7 14 11 9 14 ... 2 6 ... 39 2 41 ... ... 102 103 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. Institution Deaths— Non-Residents outside Institutions. Inquests in district on Residents. Residents. Non-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. Belgian Refugees. Edmonton Union. City of Westminster Union and School. Totals. M F T 91 Broncho-pneumonia 14 11 25 10 8 3 1 ... ... 1 2 8 8 8 ... ... 4 1 6 ... 6 ... 2 92 Lobar pneumonia 21 25 ... 5 4 2 3 1 8 15 8 18 11 17 ... ... 3 ... 18 ... 18 ... 9 93 Pleurisy 1 1 2 ... ... ... ... 1 ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... 94 Pulmonary congestion or apoplexy 2 1 3 ... ... ... ... ... ... ... 3 1 1 1 ... ... 1 ... 2 ... 2 ... ... 96 Asthma 4 ... 4 ... ... ... ... ... ... 1 3 1 1 2 ... ... ... ... ... ... ... ... ... 97 Pulmonary emphysema ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 ... 6 ... ... 98 Other diseases of the respiratory system ... 2 2 ... ... 1 ... ... ... 1 ... 2 ... ... ... 1 ... ... ... ... ... ... 1 99 Diseases of the mouth and annexa ... 1 1 ... ... ... ... ... ... 1 ... ... 1 ... ... 1 ... ... ... ... ... ... ... 102 Perforating ulcer of stomach 2 1 3 ... ... ... ... ... ... 1 2 1 1 1 ... 1 ... ... ... ... ... ... ... 103 Other diseases of stomach 3 5 8 4 1 1 ... ... ... ... 2 ... 3 5 ... ... ... ... 1 ... 1 ... 1 104 105 Diarrhoea or enteritis 34 24 58 44 5 1 3 1 1 1 2 31 15 12 ... 7 14 ... 28 ... 28 ... 4 108 Appendicitis 1 3 4 ... ... ... 1 2 ... 1 ... 1 ... 3 ... 1 2 ... 2 ... 2 ... ... 109 Hernia, intestinal obstruction ... 3 3 ... ... ... ... ... ... ... 3 ... 2 1 ... ... 2 ... 3 ... 3 ... ... 110 Other diseases of the intestines 2 ... 2 ... ... ... ... ... ... 1 1 ... 2 ... ... 1 ... ... 1 ... 1 ... ... 111 Acute yellow atrophy of liver ... 1 1 ... ... ... 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 112 Hydatid of liver ... 1 1 ... ... ... ... ... 1 ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... 113 Cirrhosis of liver 3 1 4 ... ... ... ... ... ... 3 1 2 1 1 ... 1 ... ... 1 ... 1 ... ... 114 Biliary calculi 1 ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 1 ... 1 ... ... 117 Peritonitis (cause unstated) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 119 Acute nephritis 1 3 4 ... 1 ... ... ... 2 1 ... ... 3 1 ... 1 ... ... ... ... ... ... ... 120 Bright's disease 17 14 31 ... ... ... ... ... 7 5 19 11 11 9 ... 4 11 ... 18 ... 18 ... 1 122 Other diseases of the kidneys and annexa ... 1 1 ... ... ... ... ... 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 126 Diseases of the prostate 1 ... 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... 3 ... 3 ... ... 134 Accidents of pregnancy ... 1 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 2 ... 2 ... ... 135 Parturition ... 1 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 136 Other accidents of childbirth ... 1 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 137 Puerperal fever ... 3 3 ... ... ... ... 1 2 ... ... 1 1 1 ... 1 1 ... 1 ... 1 ... ... 104 105 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. Institution Deaths— Non-Residents outside Institutions. Inquests in district on Residents. Residents. Non-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. Belgian Refugees. Edmonton Union. City of Westminster Union and School. Totals. M F. T. 138 Puerperal albuminuria and convulsions ... 1 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 139 Puerperal phlegmasia albadolens, embolism ... 2 2 ... ... ... ... ... 2 ... ... ... 2 ... ... ... ... ... 1 ... 1 ... 1 142 Gangrene ... 1 1 ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 143 Carbuncle, boil ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 144 Phlegmon, acute abscess 2 ... 2 ... ... ... 1 1 ... ... ... 1 1 ... ... 2 ... ... 3 ... 3 ... ... 145 Diseases of the integumentary system ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 146 Diseases of the bones 2 ... 2 ... ... ... ... ... 2 ... ... 1 1 ... ... 2 ... ... ... ... ... ... ... 150 Congenital malformations 8 4 12 11 ... ... ... ... ... 1 ... 6 5 1 ... 3 ... ... 3 ... 3 ... 2 151 Premature birth, infantile debility, icterus, sclerema 16 27 43 43 ... ... ... ... ... ... ... 14 14 15 ... 1 2 ... 5 ... 5 ... 4 152 Other diseases peculiar to early infancy 6 3 9 9 ... ... ... ... ... ... ... 2 4 3 ... ... ... ... 1 ... 1 ... 4 154 Old age 8 4 12 ... ... ... ... ... ... ... 12 5 4 3 ... ... ... ... 1 3 4 ... 1 155 Suicide by poison ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 158 Suicide by drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 160 Suicide by cutting or piercing instruments ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 165 Otheracute poisonings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 167 Burns (conflagration excepted) 1 5 6 ... 3 2 1 ... ... ... ... 1 2 3 ... 2 2 ... 1 ... 1 ... 4 168 Absorption of deleterious gases (conflagration excepted) 1 2 3 3 ... ... ... ... ... ... ... 1 1 1 ... ... ... ... ... ... ... ... 3 169 Accidental drowning 2 ... 2 ... ... 1 ... ... ... 1 ... ... ... 2 ... 2 ... ... ... ... ... ... ... 172 Injury by fall 2 1 3 ... ... ... ... ... ... 2 1 ... 1 2 ... 2 ... ... 2 ... 2 1 1 175 Injury by crushing (vehicles, railways, landslides, etc.) 7 ... 7 ... ... ... 1 3 ... 2 1 3 2 2 ... 5 ... ... 4 ... 4 ... 2 178 Excessive cold 1 ... 1 ... ... ... ... ... ... ... 1 ... ... 1 .. ... ... ... ... ... ... ... 1 189 111 defined causes 2 ... 2 1 ... ... ... ... ... 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... Grand Totals 377 364 741 159 50 35 44 30 106 137 180 280 228 227 1 94 160 5 577 10 587 4 62 106 TABLE V.—Table showing the Number of Cases Notified and the Deaths from the principal Zymotic Diseases for the year 1914, and ten preceding years. Disease. 1914. 1913. 1912. 1911. 1910. 1909. 1908. 1907. 1906. 1905. 1904. Pop. 68,203 Pop. 66,552 Pop. 65,084 Pop. 63,146 Pop. 61,741 Pop. 61,164 Pop. 60,182' Pop. 59.434 Pop. 56,818 Pop. 54,606 Pop. 53.358 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 ... † Scarlet Fever 351 3 420 1 211 1 68 ./. 155 5 283 4 308 12 231 8 383 13 259 6 181 3 † Diphtheria and Membranous Croup 148 16 131 15 136 13 43 7 52 4 110 13 158 27 95 17 93 11 37 4 46 10 † Enteric Fever 17 4 8 2 3 1 12 2 34 6 30 7 35 6 29 5 25 7 44 6 38 8 Erysipelas 77 .. 50 2 49 2 55 1 49 1 42 2 73 .. 54 .. 78 4 66 1 74 5 Puerperal Fever 5 3 1 1 1 1 .. .. .. .. 3 .. 3 2 3 3 5 2 3 2 1 .. *Tuberculosis, Pulmonary 20 77 247 72 228 60 107 45 69 50 84 43 .. 54 .. 53 .. 65 .. 42 .. 71 Tubercle, other forms 63 21 75 31 .. 20 .. 25 .. 31 .. 26 .. 35 .. 34 .. 38 .. 34 .. 40 Cerebro-Spinal Meningitis .. .. .. .. .. .. .. .. 3 1 .. .. .. .. .. .. .. .. .. .. .. .. Poliomyelitis 3 .. 13 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Non-notifiable. Ophthalmia Neonatorum 15 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. † Diarrhosa .. 58 .. 54 .. 19 .. 145 .. 22 .. 37 .. 41 .. 32 .. 114 .. 56 .. 151 Enteritis .. .. .. .. .. .. ... 6 .. 1 .. 2 .. 2 .. 5 .. 2 .. 10 .. 14 † Measles .. 12 .. 48 .. 15 .. 31 .. 3 .. 8 .. 19 .. 21 .. 19 .. 27 .. 28 † Whooping Cough .. 17 .. 9 .. 23 .. 15 .. 9 .. 13 .. 18 .. 39 .. 15 .. 30 .. 7 Influenza .. 4 .. 7 .. 4 .. 3 .. 3 .. 17 .. 9 .. 14 .. 9 .. 9 .. 10 † 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. Neither the notifications nor deaths of non-residents are included in 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" or Belgians in institutions. 107 Urban District of Edmonton—County of Middlesex—Sanitary Work, 1914. Inspections. Action as regards dwelling houses under H. and T.P. Act, 1909. Action taken. (Other than under H. and T.P. Act). Houses let in lodgings, (tenement houses.) Common Lodging Houses. Canal boats used as dwellings. Number of premises inspected on complaint. Number of premises inspected in connection with infectious diseases. Number of premises under periodical inspection. Total number of inspections and re-inspections made. 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 to health (Sect 17). Number of representations made to the local 1 authority by M.O.H. or his staff (Sect. 17)- Number of closing orders made by L.A. (Sect. 17). | Number of houses mace habitable without closing orders. Number of houses closed voluntarily. Number of closing orders determined after repairs (Sect. 17). Number ot houses demolished (a) by order of L.A. (Sect. 17), (b) voluntarily. Illegal underground rooms vacated. Cautionary or intimatory notices given. Statutory orders issued. Summonses served. Convictions obtained. Number registered under bye-laws. Number of contraventions. Number registered under bye-laws. Accommodation Number of inspections made. Number of contraventions. Number registered under the acts. Number of contraventions of regulations. Male. Female. Children. 371 584 808 16307 449 10 .. 7 .. .. .. .. (a) 1 .. 8071 494 6 6 .. .. 1 25 Nil Nil 100 Nil This is not a registration authority. 3 801 Movable dwellings, caravans, tents, &c. Bakehouses. Slaughterhouses. Cow-sheds. Dairies and milkshops. Unsound food. Offensive trades. Number observed during the year. Number of nuisances therefrom abated. Number removed from district. 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. Contraventions of regulations. Number of milch cows in the district. Number on register. Number of inspections made. Frequency of inspection. Contraventions 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. Nature of trades. Number of inspections made. Contravention of bye-laws. 147 .. 147 29 14 5 300 When slaughtering expected. 1 2 19 .. 3 32 100 318 .. 12 1151 lbs. beef and organs. Nil. 392 lbs. mixed fish. 2564 lbs. None. Buried on Council's farm. I Gutscraper. 39 .. 109 Water supply and water service. Drainage and sewerage of existing buildings. Wells. Cisterns Percentage of houses supplied on constant system. Number of samples obtained for analysis. Water closets. Drains. Cesspools New sunk. Cleansed, repaired, &c. Closed as polluted. Percentage of houses supplied from public water service. New provided. Cleansed, repaired, covered, &c. Draw-taps placed on mains. Number of water closets substituted for dry receptacles. Repaired, supplied with water, or otherwise improved. Percentage of houses provided with water closets. 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. Percentage of houses draining into sewers. From local wells. From public supply. .. .. 2 99.3 1 77 21 100% 11 Nil Nil 322 99.9 541 304 151 21 31 21 40 emptied and cleansed 9 periodically. .. 99.6 110 Disinfection. Dust. Sundry nuisances abated. Rooms disinfected. Articles disinfected or destroyed. Method of disposal. Ordinary infectious disease. Phthisis. Rooms stripped and cleansed. Ordinary infectious disease. Phthisis. New bins provided. How frequently is dust removed from each house? Number of complaints of non-removal received. Destructor. .2 By tipping. S 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. 605 160 355 4712 948 267 Weekly. 13 No. Yes. None. 51 16 24 4 26 753 142 443 111 Edmonton Urban District Council. REPORT of the Chief Sanitary Inspector For the Year 1914. 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 1914 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 377 No. of journeys of bedding van to remove infected bedding 276 No. of journeys of bedding van to return bedding after disinfection 240 No. of journeys of brougham to fetch the patients from hospital 299 No. of patients returned to their homes from the hospital by the brougham 490 No. of rooms disinfected after infectious disease 605 No. of articles of bedding, etc., disinfected 4,666 No. of articles of beddings, etc., destroyed 22 No. of books disinfected 24 112 No. of rooms disinfected after phthisis 160 No. of articles of bedding, etc., disinfected after phthisis 923 No. of articles of bedding, etc., destroyed after phthisis25 No. of rooms disinfected for vermin and verminous bedding 17 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. When the station is erected it would be well to consider the advisability of adopting a Motor Ambulance Service as judging from the cost of Horse Vehicles a Motor Ambulance might be run almost as cheaply, besides there would be a distinct advantage by the quick transit of patients which is at times of vital importance. The number of journeys to hospital with patients was 377, and taking the mileage of a return journey to the hospital from Claverings Farm, is approximately 2,639 miles for the removal of patients only. ERYSIPELAS. During the year 10 cases of erysipelas were treated at their homes by a fully qualified trained nurse, the Council not having any hospital for the treatment of such cases. Many expressed their gratitute for the attention they received. DISINFECTHNTS. The public continue to avail themselves of the opportunity generously afforded them by the Council of obtaining disinfectants (powder and fluid). This entails a great amount of labour, but no doubt the results are beneficial, if only to encourage cleanliness. The number of applicants for the year was 31,035, for 1913 25,614, an increase of 5,421 on the last year. The "Pharmacy Acts and Regulations" have been strictly adhered to, and callers now recognise the rule laid down that:—No disinfectants will be given out other than in a proper poison bottle." 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 by the Department to the dustmen for disinfecting and deodorising of house refuse: for the cleansing of 113 street gullies; flushing of sewers; watering of roads in hot weather; spraying of dust vans during the hot weather before leaving the shoot, and for all other purposes required by the Council. MALE AND FEMALE LAVATORIES, PUBLIC AND PRIVATE URINALS, WATER TROUGHS, ETC. During the year the conveniences generally (both private and public) have received regular attention, and repairs and improvements have been effected from time to time; one new urinal has been erected near the Low Level Railway Station, an improvement on the old iron obsolete urinal that previously existed. This year has also seen the opening of male and female lavatories on The Green. This has supplied a much felt want In this locality, and minimised the nuisance that was so prevalent in the vicinity. Free accommodation is provided for both sexes, and although it has not paid so well as I anticipated, probably when the place is more known we may expect better results. The amount collected during the year from the w.c.'s and Wash and Brush Up on The Green was £113 16s. The amount collected from the male and female lavatories at Angel Road was £133 4s. Both male and female attendants continue to carry out their duties in a satisfactory manner. I regret to have 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, DUST COLLECTION. The collection of dust is still carried out by contract. The district for the purpose of collection, is divided into three parts. The number of vans employed regularly is six, with extra picking up vans for holidays, and the clearing of refuse from the Edmonton Infirmary and the Metropolitan Asylum's Board Institutions now occupied by the Belgian Refugees. The number of vans is insufficient, the district should be divided into four parts, and there should be at least eight vans regularly employed besides the vans used for picking up refuse from the institutions, etc. The sheets that I adopted for the dust contractor to fill up, showing the daily collection, proves conclusively that some of the streets do not get a weekly collection. The contractor states that he is doing the best he can, but owing to the war he cannot obtain more labour at present. 114 The whole of the dust is deposited on the Council's Shoot at the Sewage Farm and judging from the land allotted for the dust shoot the time is not far distant when it will be necessary to provide another shoot, or to construct a Dust Destructor which will enable a very offensive product to be effectively disposed of. The number of van loads collected during the year was 3,896; approximate weight of refuse deposited was 7,000 tons. There were only 13 complaints received. In April, a man agreed to give the Council 30s. per week for the old metal, rags and bones that he found on the shoot, also to keep the sleeper road in repair and to spread and level the dust. The man carried out the agreement for a few months, but owing to the war he was unable to dispose of the rough metal, so the Council agreed to forego the 30s. per week until he was able to sell the metal; he, however, still keeps the road in repair and levels and spreads the dust in return for the rags and bones he finds on the shoot. Already there is a large heap of old metal some 20 or 30 tons. MORTUARY. During the year the total number of bodies received into your mortuary was go, a decrease on the preceding year of 16. There were 66 bodies deposited by order of the coroner, and 7 deposited by the Police. 67 post-mortem examinations were made. 17 bodies were deposited by undertakers to await burial. It was necessary to detain the bodies in 32 instances as there was no proper accommodation at the homes of the relatives, and 15 were detained owing to the bodies being of an infectious nature. 8 cases were notified to the Relieving Officer for burial by the Parish. The Mortuary Attendant is away on active service and temporary arrangements have been made to carry on the duties, which up to now have worked very satisfactorily. COMMON LODGING HOUSES. This year the common lodging house passed into new hands. I must say that the new registered keeper has endeavoured to keep the premises in good condition, and provided 25 new bedsteads and bedding complete, besides new kitchen utensils, and had the premises generally repaired and overhauled. I had hoped that some enterprising man would have found some premises of more modern construction for a common lodging house, as I have before remarked the present premises are very old, and cannot ever be made into a modern lodging house, indeed, it will soon have to be dealt with, together with other houses adjoining, under the " Housing and Town Planning Act," but before so doing it requires the careful consideration of the Council, as to condemn the premises before arrangements have been made to provide for the 25 inmates, means driving them into lodgings over which, in all probability, the Council would have very little control. SLAUGHTERHO-HOUSES AND FOOD INSPECTION. The number of slaughter-houses in the district remain the same as last year, viz:—7. At the present time there are only five in use, one having been discontinued for four or five years, and one about eighteen months. The twelve months for which these two were licensed having expired, they are now unlicensed premises. The tendency of the butcher is to facilitate the work of the inspectors, and should any carcase be doubtful it is put on one side for inspection. The periodical limewashing is carried out, indeed many limewash much more often than is laid down in your bye-laws. When defects have occurred very little trouble is experienced in getting them remedied. (This is no doubt a great deal to do with the "Public Health Acts Amendment Acts" having given the local authorities the power to license from year to year.) Electric light has been installed in one instance. There were 568 animals inspected during, and shortly after, slaughter as follows:—3 bulls, 49 oxen, 43 cows, 17 heifers, 6 calves, 192 sheep, 25 lambs and 233 pigs. The following offal was surrendered on inspection:— I ox liver, I pig's head, I pig's pluck, I cow's lungs, liver, spleen and mesenteric fat. 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 116 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 the wholesale dealer, and undoubtedly prevents to a large extent food of such a nature being exposed for sale. I think some compensation should be given to the retailer when food is bought from a wholesale dealer and found to be unfit for human consumption ; although he may get the money returned he paid for the goods, he gets nothing for the time he loses going to and from the place where the goods are sold. The following is a list of foods destroyed:— 1 box of grapes. 3 boxes of herrings. 2 boxes of mackerel. 1 trunk of conger-eel. 3 boxes of kippers. 2 boxes of potatoes. I trunk of cod fish. The stalls and shops where foods are generally exposed for sale for human consumption are regularly inspected. One stall-holder was summoned for selling unsound plums, and was fined 40/- or one month. Herewith I append a statement of the work done under the "Sale of Food and Drugs Act" by the Middlesex Connty Council Inspector for this district, kindly supplied by the Chief of the County Food and Drugs Department. Articles. Samples taken. Samples adulterated. Milk 101 14 Butter 54 Castor Sugar2 Drugs 23 180 18 Prosecutions 4. Convictions 4. Fines£3 10s. DAIRIES, COWSHEDS, MILK and ICE-CREAM SH0PS. The number of cowkeepers on the register is two. The number of cows 32. During the greater part of the year the cows are out to graze. One cowkeeper 117 was notified that he was contravening the Acts by overcrowding the cows. After some considerable correspondence, he proposed to increase the size of the building, but afterwards stated that he could not pay the cost of a new building. However he turned the cows out till late in the year, and took some premises that were originally stables. These stables are not suitable for cowsheds, being badly lighted and ventilated, and too near dwelling houses, and his attention was at once called to these defects, and if they are continued to be used, proceedings will have to be taken against him. There are 100 persons on the register who sell milk, seven were added and 18 removed. Some have businesses of a varied nature ; in these latter cases care is taken to see that the nature of the business does not interfere with the sale of milk. These premises require regular inspection to see that cleanliness is observed. There are 32 who devote their business practically to dairy produce, eight of which are using special steam apparatus for scalding and cleansing milk utensils. One has provided improved plant for sterilizing and improving milk. In one case, owing to the condition the business was carried on not being satisfactory, the occupier erected a new brick building, with the necessary provision for heating water for cleansing the milk utensils, repaved the whole of the yard area and put in proper drainage. There were several contraventions for which notices were served and the defects remedied. There were 19 inspections made to cowsheds and 318 visits to dairies and milkshops. Sanitary Authorities require much more stringent powers before they can get the desired results, as only those certificated and likely to be endorsed should be allowed to sell milk or other foods. There were 99 inspections made to premises where ice-cream was sold, and where defects existed steps were taken to have these remedied. OFFENSIVE TRADES, PIG KEEPERS. The offensive trade, that of a gut scraper, is still carried on in the district. The premises are visited from time to time, but the work is still carried out under conditions that are anything but satisfactory. However we have not had complaints of any nuisance of late, but no doubt the time is not far distant when the land laid out for buildings will be developed and then trouble will be sure to arise. He has not availed himself of the opportunity to put up a building on a spot farther away. 118 Marine store shops are now within the scope of Offensive Trades, and we have had many commence this business without the written consent of the Council, but they move, and remove, and instead of taking their goods home, they have resorted to sorting their rags, etc., on some of the vacant lands. I am now preparing a register as I find it will be necessary to take proceedings against some of them. The Pig Keepers premises are periodically inspected and most of their styes are of a temporary nature. During the year one man commenced to keep pigs within the prescribed distance of the bye-laws; he was at once notified of the contravention and discontinued keeping them. Since the Council gave up the collection of fish offal, the work continues to be well carried out by the Belvedere Fish Guano Co., and no cause for complaint has been observed during the year. HOUSE T© HOUSE INSPECTION. During the year the Inspector who was appointed to carry out the house to house inspections joined the "Queen's Westminsters," the Council appointed a temporary inspector to continue the work, there has been a great deal done, but thorough inspection takes up some considerable time, as the work involves the making out of preliminary and statutory notices and the service of same, under the various Acts and Regulations, watching the work of remedying defects from day to day, and entering in the work records the results of the inspection and the work carried out. For the first time since the Act came into force the the Council proceeded at the recommendation of their officers to carry out work under Section 15 of the "Housing and Town Planning Act," and three houses were selected as an experiment in a well known street. The men employed were paid by the Council day work as it was impossible to get a contract for such repairs; as soon as the defective woodwork and plastered walls were touched they simply fell to pieces. The workmen were much handicapped as the tenants were in the house all the time. However when the work is done we hope the desired result will be attained, viz.; A house made reasonably fit for human habitation, but the work and worry it has been will not I am afraid give your officers much energy to proceed again under this Section of the Act. The house to house inspection has again found that continual nuisance from converting little sheds in the back yards into stables without paving or drainage; notices have been served to abate the nuisance. One man we had 119 considerable trouble with, as he would for a time discontinue keeping the animal in the shed and when he thought it was forgotten, commence again. However, on watching him on several occasions late at night, we found he was continuing the nuisance. This man was eventually summoned and ordered to abate the nuisance and to pay the costs. WATER SUPPLY. The whole of the district is practically supplied with water from the Metropolitan Water Board, there being only 74 private houses supplied for dietic purposes by pumps from shallow wells. At one time the water from the shallow wells, proved on analysis to be of good quality, and fit for drinking purposes, but owing to the district becoming more densely populated some of these wells were showing signs of contamination. Eleven samples of this pump water was submitted to an analyst and returned unfit for drinking purposes. The owner is taking steps to provide a proper supply. One sample was taken from a farm on the boundary of the district and returned as unfit for human consumption, and the Ecclesiastical Commissioners went to some considerable expense to have the Board's water main extended about a hundred yards so that the occupants of the farm should have a good water supply. During the year there were 21 houses where water was supplied from the main direct for drinking purposes, and 77 cisterns were supplied with proper covers and cleansed. SHOPS H6T. During the year your inspectors have given much time to this Act, the majority of the trades adhere strictly to the Act, but some of the mixed shops, surreptitiously supply goods to their known customers. During the year the Hairdressers and Barbers applied for an order to be made to close their shops at 9 p.m. on Mondays and Tuesdays, 10 p.m. on Wednesdays and Fridays, and 11 p.m. on Saturdays. If this is to be enforced it will need the co-operation of the trades concerned. It was necessary to take proceedings in three instances, one man was summoned for two offences and fined 10/- and costs in each case. Two others were summoned and fined 5/- each. PREVENTION OF DAMPNESS. The following is a summary of the work done in connection with the remedying of nuisances from dampness under the Public Health Acts (and Tuberculosis Regulations), but these Acts require much amendment before the desired results can be attained. 120 Roofs, rainwater pipes and gutters repaired 288 Water fittings repaired 52 New sinks or existing sinks repaired 27 Sink and bath waste pipes repaired or new fixed 89 Washhouse floors paved or repaired 40 Ventilation under floors provided 23 Yards or forecoarts paved or repaired 142 External walls, brickwork repaired 51 Other dampness remedied 41 753 CANAL BOATS ACT. During the year I inspected 26 canal boats, and found three contraventions, all of which were remedied. The contraventions were as follows:—3 cabins required painting, 1 cabin was repainted, 2 boats ceased to be used as dwellings. The canal is situated practically on the outskirts of the district and away from any populous part, consequently the inspection takes up much more time than would otherwise be the case if the canal passed through the more thickly populated part of the district. There is no other canal boat inspector on the river between Hackney and Ware. The canal boats on the Lea, speaking generally, are kept in a good condition. The work done in connection with canal boats is annually supervised by H.M. Inspector of Canal Boats. FACTORY AND WORKSHOPS' ACT. The number of inspections of bakehouses, workshops, factories, etc., is included in your Medical Officer of Health's Report, as required by the "Factory and Workshops' Act, 1901," also the tabulated statement of work done under its various headings, in the form required by the Medical Officer of Health for the County of Middlesex. GIPSIES. The year has again brought forth complaints from the filthy class of persons who call themselves Gipsies ; some are respectable, but most of them I generally 121 meet are low type vagrants, who manage to live in a box on four wheels under overcrowded and filthy conditions and to evade all responsibilities of law and order. There were 147 vans removed, and 261 visits paid to these people, which means taking up the time of your Inspectors when they might be better employed. The following vacant lands have been fenced in:—Granville Avenue, a small part fenced in ; Croyland Road, a small part fenced in, and the whole of the land on the corner of Bounces Road and Hertford Road fenced in. I have curtailed this report as much as possible, most of the work done in the Department being quoted by your Medical Officer of Health in his Annual Report. I sincerely hope that during the year some steps will be taken to deal with the nuisances caused by many of the stall-holders on The Green. Much of the nuisance arises from the fish washings soaking into the roadway, and lying in the channels and gullies. This necessitates the channels being washed down on Saturday mornings (and on Sundays during the hot weather) by the Council's flushing men. Since the erection of so many advertisement hoardings in the district many nuisances have arisen by the public using the back portions as a convenience, or as a dumping ground for refuse. It is a most difficult nuisance to deal with as it cannot be well said that it is by the owners' act, cause or sufference. However, at present the Council's man who cleanses the urinals, watertroughs, etc., etc., makes periodical visits and deals with the nuisances. During the year Messrs. Nixon, Dyer and Hickford have left the department to serve their King and Country, and we heartily wish them a speedy and safe return. I trust ere the next report is in print that the depression caused by the present war will have passed away. It gives me much pleasure to express my appreciation of the valuable help given by the Sanitary staff in carrying out the work recorded in this report. I also wish to thank the Chairman and Members of the Sanitary Committee for their kind consideration and support, and the officers of other departments who are always very willing to render all possible assistance. I have the honour to be, Gentlemen, Your obedient servant, RICHARD JOHN BUTLAND, Chief Sanitary Inspector, 123 Annual Report for 1914 II. On Education (In its Medical and Hygienic Aspects), in the Urban District of Edmonton.' 124 Edmonton Education Committee. 1914 -15. (a) REPRESENTATIVES FROM THE COUNCIL. S. H. PLATTEN (Chairman). F. VINCENT (Vice-Chairman). W. HATCH. J. ANTHONY. E. D. RUSSELL. H. BARRASS, C.C. The Rev. Preb. SANDERS, M.A. M. F. CADMAN. A. E. SHORTLAND. W. D. CORNISH, J.P., C.C. C. SORRELL. W. A. CULL, J.P. The Rev. T. WARREN. C. HART. H. WILLIAMS. (b) CO-OPTED. Mrs. CULL. Miss BARKER. Secretary : ARTHUR HEAP, LL.B., B.A. Lond., Education Office, Brettenham Road, Upper Edmonton, 125 EDMONTON EDUCATION COMMITTEE. REPORT of the School Medical Officer for the Year ended December 31st, 1914. - "The wisest masters are those who debate least."— Deucalion. Town Hall, Edmonton, 29TH July, 1915. To the Chairman and Members of the Edmonton Education Committee. Ladies and Gentlemen, I herewith submit my third Annual Report as School Medical Officer. It is not one which affords me much satisfaction, as it relates only to a trifle more than half the year as regards routine medical inspection, which ceased when the School Medical Inspector, Dr. Rock, left for war service on July 13th. From July 13th, 1914, to February 1st, 1915, you—deliberately and against the advice of the Board of Education and your own expert Officer—abandoned the routine medical inspection of the children in the public elementary schools; the valuable work on specially-referred children was only continued by myself undertaking it in addition to my own duties, already increased by the war (see the foreword to my report as M.O.H.). At your adjourned special meeting on September 29th this resolution was passed:— " That circular letters, orders and instructions to the teachers, attendance officers and heads of other departments should pass through the hands of the Secretary to the Committee." It is not a wise resolution, as no difficulty should be placed in the way of the School Medical Officer communicating directly with the other members of the school service; it savours altogether too much of the " Circumlocution' Office " satirised by Charles Dickens, The education of the Belgian children amongst the refugees at Millfield House has been looked after by Roman Catholic nuns, who speak Flemish. I desire on behalf of my staff and myself, to express our thanks to Mr. Heap, the attendance officers, and the teachers for their co-operation. The good work of medical inspection can only have its best results when we are all united in promoting the welfare of the children. SIDNEY C. LAWRENCE, School Medical Officer. 126 Index of S.M.O. Report. Attendance 135 Bush Hill Park scholars 133 Baths 133 Blindness 160 Boots 144. 155 Building operations 132,133 Cleanliness and cleansing station 144, 145, 155 Clothing 144, 155 Deafness 147, 160 Defects, arrangements made for following up 139 Deformities 149, 158, 160 Domestic subjects 132 Ear disease 147,156 Exclusion of scholars and contacts 150 Expenses 137 Eye diseases, external 147, 156 Eyes and vision 147, 159 Girls'Charity School 128 Glands enlarged 147 Hearing 147, 158 Heart and circulation 148,157 Hernia 148 Hygienic conditions 132-135 Illnesses, history of previous 139 Infectious disease 149-151 Inspection, arrangements for and scope of 138 Intelligence 143 Lungs 148) 157 Meals, provision of 140-143 Mental deficiency 160—see Appendix Nervous System 148,157 Nose and throat 146,156 Notices, exclusion 15° Nutrition 140,155 Office, the school medical 128 Private Schools 128 Public elementary schools 131 to end Rickets 148, 158 Ringworm 146, 157 127 School clinics 149 Secondary school (Latymer) 129 Skin diseases 146, 157 Speech 148) 158 Sunday Schools 130 Tables, Board of Education 153-160 Teachers' notifications 150 Technical Institute 129 Teeth of scholars 146,156 Tuberculosis 139, 148, 158, 160 Vermin 144 128 SGH00L MEDICAL ©FFIGE. In March, an eight-coil radiator was supplied by the Education Committee and fixed at the expense of the Council, as I had reported in January that the room was too cold in winter for the examination of specially-referred scholars. In February, 1915, the School Medical Office at the Town Hall was dismantled and the room taken over by the Chairman of the Council, as he desired a third room for use in connection with the National Relief Fund; the women inspectors' retiring room had already been appropriated. I endorse the opinion of Dr. Strong, the acting School Medical Inspector, that the small room now in use at the Education Office is quite unfit for the purpose of specially-referred children, many of whom require careful examination in a well-lighted room. THE SCHOOLS OF EDMONTON. (18 in Number). Public Elementary Schools number II Secondary Schools „ I Private „ 6 The Edmonton Union has two schools or homes for pauper children, both in the Enfield district. Girls' Charity School.—It is now managed under a scheme dated 23rd July, 1913. It is 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. Dobb, J. R. Anning, 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, 1913, for three years, 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 Mr. H. E. Brown. The Private Schools are six in number and have nearly 200 scholars on their books. 129 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 necegsary, has been made. 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 14 to 16 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 1914-15, the classes began on September 28th, 1914, and end on May 1st, 1915. Some of their intermediate classes are held at Brettenham Road and Croyland Road Schools. The subjects are many : art, commercial arithmetic and bookkeeping, carpentry, French, shorthand, typewriting, woodwork ; besides cookery and dressmaking for the young women. The intermediate classes take arithmetic and book-keeping, English, shorthand and business methods in a commercial course, and workshop-arithmetic, English, metal work, carpentry and joinery in a trade course ; and for girls a domestic course in cookery and dressmaking. 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. 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 lighting is by inverted incandescent gas, the ventilation "natural," and the heating by hot water radiators. The accommodation has been extended from 75 boys and 75 130 girls between the ages of 10 and 16 years, to over 200 boys and girls up to 18 years of age. This has been made possible by transferring some classes to the Technical Institute and a preparatory class (between 8 and 10 years of age). Plans for considerable extension of the Hazelbury Road premises are under consideration by the Governors. The school year is divided into three terms of about thirteen weeks each. The fees are £2 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 of £50 for higher education was issued by the Council on the Overseers on 24th March and again on 13th October. It has been inspected during the year by the Board of Education, and a very favourable report has been received. In August notice was received from the Board of Education that the County Council proposed to sell property in Hammersmith belonging to the Latymer Foundation for the sum of £23,000. SUNDRY SCHOOLS' REPORT, 1914. GHUROH OF ENGLAND. Name of School. Boys. Girls. Infants. Totals. Parish Church including St. Alphege Mission 738 1102 621 2461 St. Martin's 134 166 203 5°3 St. Aldhelm's 150 150 150 45° St. James 123 170 114 407 St. John's 83 110 181 374 St. Peter's 259 323 37° 952 St. Michael's 40 50 5° 140 St. Stephen's 80 136 67 283 St. Mary's 71 91 84 246 Grand Totals 1678 2298 1840 5816 *These figures are unreliable. I31 NONCONFORMIST SUNDAY SCHOOLS. Name of Chapel or Place. On the Books. 1912 1913 1914 Congregational, Fore Street 318 3°4 278 ,, Angel Road 347 3°4 274 People's Tabernacle 242 278 291 Tanner's End Mission 600 600 500 Wesleyan 426 54° 53o Congregational, Lower Edmonton *400 466 400 Baptist 630 395 500 Primitive Methodist 176 189 207 Belmont Hall Brethren *200 174 155 Totals 3339 3250 3135 *These figures are unreliable. 132 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 November 25th, Dr. Langdon, one of the medical inspectors of the Board of Education was in Edmonton, but he was unable to see any routine inspection as this had ceased to exist since Dr. Rock left to join the Royal Navy for War Service. New School Site.—On 23rd March there was a special Council meeting to consider a communication from the Education Committee as to the provision of a site for a new public elementary school in the north-west part of the district. A sub-committee of the Education Committee had been considering various sites and now one of 8| acres was to be put to auction, but the Council (by a large majority) decided not to entertain the idea of purchase. Cookery, etc.—At the request of the Education Committee, the Council have agreed to grant the use of a room in Pymmes Park house for teaching domestic subjects to the elder girls. This will provide for the training of those in the southern half of the district, and at the end of the year the Education Committee were on the point of securing a site for erecting a domestic subjects and handicraft centre in northern ( or lower) Edmonton. GENERAL VIEW OF THE HYGIENIC CONDITIONS PREVAILING HT 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. 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. 133 H.—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. I 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. *i ,, 7. Montagu Road, Upper Edmonton 1904 *i „ B.—Boys. G.—Girls. I.—Infants. J.—Junior Mixed. * Extra wide corridors in some of the Departments. fBoth 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 284 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 past winter, 1914-1915, this wholesome practice has been continued as far as the boys are concerned. A woman instructress has been appointed for the girls for the boys are taught by their class teachers. Building Operations.-interior Houndfield Road School has been redecorated, the walls and cellars distempered. Otherwise nothing has been done beyond the ordinary repairs necessary to keep the buildings in good order. Closets are in some cases of the trough pattern, with a weir at the lower end, and a tank of sixty gallons and upwards at the upper end of the system, which the caretaker can discharge four times daily, and oftener in the summer months. Others have the same kind of tank, 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. 134 Urinals.—-In some of the older schools, sparge pipes are still fixed ; but now, in all cases, flashing 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. Lavatory and Cloakroom Accomodation 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. 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. Seating. The policy of gradually substituting new desks for the old ones has been continued; new dual desks have been supplied during the year to Raynham Road Infants', Croyland Road Infants', and Silver Street Girls' Departments. In consequence of the Education Committee not now admitting children under five years of age, the galleries in the "babies' rooms " are too small for 135 larger children, so these galleries are being weeded out from time to time and replaced by small tables and chairs. The wall space thus exposed has been rendered to a fine face and painted dull black for use as a sketching board. 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. Caretakers. The caretakers' assistants are now employed directly by the Education Committee. This new system is found to possess many advantages. Attendance. Mr. Heap has kindly furnished me with the following figures for this and the next two tables:— End of June, 1913. End of June, 1914. Number on Books. Average Attendance. Number on Books. Average Attendance. Non-provided Schools 2307 2083-2 2300 2039.3 Council Schools 11122 10049'O 11162 10148.9 Totals 13429 12132*2 13462 12188.2 There were 13,462 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 284; so that there is in Edmonton one child in the public elementary schools for 4.9 inhabitants (reckoned on the nett population), the same as last year. The number of children on the books of the elementary schools of the district on 27th June, 1914, was 13,462, and the accommodation was 14,365. The accommodation and the number of children attending each school are given below:— 136 School. Infants. Junior Mixed. Girls. Boys. Accom. No. on Books. Accom. No. on Books. Accom. No. on Books. Accom. No. on Books. Brettenham Road 437 347 – – 458 379 459 417 Croyland Road 369 378 420 418 369 298 537 484 Raynham Road 576 527 600 519 540 457 660 527 Eldon Road 600 640 521 534 540 511 660 585 Silver Street 562 569 — — 562 516 592 509 Houndsfield Road 460 431 300 310 300 269 300 269 Montagu Road 460 412 300 300 300 234 300 265 All Saints' 447 474 — — 455 472 — — Latymer — — — — — — 300 298 St. James' 220 245 — — 207 220 218 222 St. Edmund's 88 91 — — (248 241 Senior Mixed) These figures are not included in the totals. Totals 4219 4114 2141 2081 3731 3356 4026 3576 There are 37 more children attending school than last year. The average attendance during the last week of June, 1914, was 12188.2, the percentage of attendance to number on books being 90.5. 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 44 boys and 11 girls. The admissions and withdrawals during the year, excluding transfers from one department to another, were:— Civil Year, 1914. 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 602 589 337 203 Council Schools 2676 2615 1399 1050 Totals 3278 3204 1736 1253 137 Expenses.—Five precepts on the 24th March, 1914, for £13,450 for elementary and £50 for higher education; four precepts on the 13th October, 1914, for £9,400 for elementary and £50 for higher education, together amounting to £22,950, were served on the Overseers to meet the requirements of public education for the year March, 1914, to March, 1915. Besides, a very large necessitous grant has been received from a sympathetic Government, amounting to £16,375, or about a nineteen penny rate; compare this with £9,216 for last year, which was only an eleven penny rate. 138 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. In 1914 the last class embraced all children over twelve years of age. Two thousand four hundred and nine children were passed through the routine inspection. 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 438 112 34 0 0 2 5 100 606 1 1298 Girls 446 112 31 6 0 0 3 323 188 2 1111 Total 884 224 75 6 0 2 8 423 794 3 2409 The parents were present at 42.4 per cent. of the total inspections; at 18.6 per cent. of the elder boys', at 35.1 per cent. of the elder girls'; at 56.8 per cent. of the infant boys', and at 62.5 per cent of the infant girls' inspections. There were objections to medical inspection on the part of the parents in the case of 10 children, 7 boys and 3 girls; or 0.54 per cent. of boys and 0.27 per cent of the girls. The number of re-inspections made during the year was 1441. The attendances of specially-referred cases and absentees clue to illness at the School Medical Office at the Town Hall was 1,712, compared with 1,626 last year. I carried this work on myself after Dr. Rock left in July. In non-war times 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. 139 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. Treatment. In the absence of the School Medical Inspector and the School Nurse I have not been able to find any records as to the principal defects for which treatment was advised, or what proportion was remedied at hospitals or by private practitioners. GENERAL REVIEW OF FACTS DISCLOSED BY MEDICAL INSPECTIONS. Family History of Consumption. The number of boys with a family history of consumption was 172, and the number of girls 156. Based on the number of parents present at the inspection, the percentage of boys with a family history of consumption is 37.0, and the percentage of girls is 28.2; for both sexes taken together, the percentage is 32.2 History of previous Illnesses. The number of cases in which there had been a previous history of the commoner illnesses of children is given below:— 140 Age. Measles. Whooping Cough. Chicken Pox. Scarlet Fever. Diphtheria. Pneumonia. Boys— 5—6 186 131 92 7 8 10 6— 7 41 27 14 2 5 2 7—8 12 8 11 — 2 8—9 — — — — — — 9—10 — — — — — 10—11 2 1 2 — — 1 11—12 2 2 2 — 1 -— 12—13 34 23 21 5 1 1 13—14 291 180 175 41 18 15 14 1 1 1 — — All ages 569 373 318 55 33 31 Girls— 5—6 216 145 108 12 4 6 6—7 44 37 23 4 1 5 7—8 11 5 6 1 — 2 8—9 2 2 1 1 — — 9—10 — — — — — — 10—11 — — — — — — 11—12 2 2 1 1 — — 12—13 185 135 137 41 14 8 13—14 112 68 71 21 9 7 14 1 1 — — — All ages 573 395 347 8c 28 28 I noticed scars of tracheotomy operations for diphtheria in the case of two boys. Nutrition. The number of boys whose nutrition was bad was nil, and the number of girls 1, being nil per cent. and 0.04 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:— All cases are enquired into by an Investigation Committee and local SubCommittees. The following show the general 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. 141 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. 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, meals shall not as a rule be provided if after paying rent and fares there is remaining 12/- for a family of 4 persons. 14/2 „ „ 5 „ 16/3 „ „ 6 „ 18/1 ,, „ 7 „ 19/7 „ „ 8 „ 21/- „ „ 9 „ 22/- „ „ 10 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 26th to May 8th, and at St. Michael's Hall from January 19th to June 26th. During the early part of January and (after the closing of the two centres) until the end of July, necessitous school children were fed at cook shops. Circular 856 of the Board of Education, dated 15th August, 1914, related to important alterations. Whereas under the 1906 Act, the amount spent out of 142 the rates on food for children who (by reason of lack of food) are unable to take full advantage of the education provided for them in a elementary school of a Local Authority, was limited to the produce of a half-penny rate, there is now no statutory limit on the amount which an Authority can expend under the Acts. They are moreover expressly authorised to provide meals during the holidays and on other days when the school is not open. The necessary two annual resolutions were passed by the Council on the 24th March. An emergency Canteen Committee meeting was called for August 13th, because of local distress caused by the war, and to consider the new powers granted by recent legislation. This happened in the midst of the summer holidays when most of the teachers were away from Edmonton. It was decided:— 1. To give meals on seven days a week. 2. That members of the Committee shall attend at each school daily, except Sundays, for the rest of the holidays from 10 to 11 a.m., to receive applications and issue tickets to carry on to September 5th, the date of the re-opening of the schools. 3. A notice of these arrangements to be placed prominently on every school and in other public places. Since August 16th, free dinners have been served at the following centres:— Gilpin Hall, accommodating 200 children, September 1st to November 20th. St. John's, ,, 130 „ September 28th to end of year. Parish Room, ,, 250 „ September 1st to end of year. St. Edmund's, ,, 220 ,, September 21st to end of year. St. Michael's, ,, 220 ,, August 24th to end of year. St. Alphege „ 100 „ September 1st to November 20th. For the first seven months, 18,949 dinners were served at the centres and 6,323 at the cook-shops, making a total of 25,272. From the week ending August 22nd to the 31st December, the number served at the centres was 78,725 and at the cook-shops 19,350, making a total number of 98,075. From January 1st to the end of July, the expenditure on food only amounted to:— 143 £ s. d. (a) At centres at 1.7d. per head 34 4 0 (b) At cook-shops at 2½d. per head 65 17 3 Total 200 1 3 From August 17th to December 31st, 1914, the expenditure on food only amounted to:— £ s. d. (a) At centres at 2.1dd. per head 674 0 0 (b) At cook-shops at 2½d. per head 201 11 3 Total 875 11 3 In both periods the cost of service at centres or cook-shops was 1d. per head. It will be seen that since the war began, there has been an increased call for the service of free dinners to needy children. The number of dinners required reached its maximum in the middle of September, since when there has been a steady falling off. 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. The following table gives the percentage of children for the leaver group, the number in the ten year old group was too small to deal with:— Boys. Girls. Leavers, per cent. Leavers per cent. A. Mentally defective 0.6 0.0 B. Slow dull 2.8 5.8 C. Slow 12.9 13.8 D. Slow Intelligent 36.1 25.9 E. Fairly intelligent 40.9 50.9 F. Distinctly capable 6.6 3.3 G. Very able 0.1 0.2 144 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. The total number of feeble-minded children in the schools is 43 boys and 26 girls, and three boys stated to be imbecile (see table III. at end). 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 81.7 per cent. of the children, and unsatisfactory in 18.3 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 8.6,0 as compared with 11.4 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 37.6, against 109 per cent. of the girl leavers. The number of children with unsatisfactory footgear is very much the same as for unsatisfactory clothing, the percentage for all the children being 10.9, and there are the same differences with regard to the two sexes. Cleanliness. As regard cleanliness of body, 8.3 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; 0.7 per cent. of the children were found infected with body lice at the time of inspection. Vermin. The percentage of children with nits in the hair was 23.0. The following table will show the percentage in the two sexes and two age groups:— 145  Entrants. Leavers. Boys. Girls. Boys. Girls. Head clean 91.3 60.2 95.8 52.6 Nits 8.2 39.0 4.2 46.8 Lice 0.5 0.8 0.6 Total per cent. unclean heads 8.7 39.8 4.2 47.4 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 Department, has produced good results—even although no legal action has yet been taken against neglected parents by the Education Committee. 61eansing Station. On October 9th, 1913, the Engineer and Medical Officer of Health visited the Local Government Board and discussed the subject with an Architect and Engineer, as in the previous August the Local Government Board had intimated that the loan of £600 could not be obtained under the Public Health Act, £1875, at least as far as regards a cleansing station. In January of this year the Engineer reported to the Works Committee that with a view to obtaining a loan under the Baths and Washhouses Act, fresh plans and drawings were being prepared for a renewed application to the Board. The Council on January 13th instructed the Clerk to apply to the Board for sanction to a loan of £670—£500 for the cleansing station, and £170 for the disinfecting station. In March it was reported to the Sanitary Committee that the boiler at the old disinfecting station much needed repairs to make it usable. Nothing further is recorded in the minutes of 1914, and our cleansing station still remains in embryo, although as long ago as November, 1912, my Sanitary Committee and Council decided that it would be both economical and convenient to have a new disinfecting station, and a cleansing station in the Town Hall yard. 146 Ringworm. Of the 2,409 children inspected, five had ringworm of the scalp but none had ringworm of the body. Two were boys, and three were girls. The number of children away from school for ringworm at the end of the year was 94, 79 of these being for ringworm of the scalp and 15 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. Other Skin Diseases. No children had scabies, two had impetigo; fifteen children had other skin diseases. Teeth. The number of children with decayed teeth is given in the table at the end of the report. It will be seen that 42.7 of the entrants had sound teeth, 51.89 per cent. of the leavers, while 18.5 per cent. of the entrants, 5.82 per cent of the leavers had four decayed teeth or more. The above figures apply to both temporary and permanent teeth. Nose and Throat. The number of children who had had operations for enlarged tonsils and adenoids before inspection was 93, or 9.1 per cent. of the children whose parents were present at the medical inspection and for whom only a history was available. The percentage of children with marked enlargement of tonsils was 0.16, while 1.04 per cent. showed evidence of marked adenoids. The proportion of children with enlarged tonsils is greater among the entrants than leavers. The 147 percentage of mouth-breathers was 4.07 among the entrants, 2.38 among the leavers. Enlarged Glands. The submaxillary glands were found enlarged in 38 boys (2.9 per cent.) and 11 girls (1.0 per cent.). The posterior cervical glands were enlarged in 3 children, 2 boys and 1 girl. External Eye Disease. Opacities of the cornea were noticed in 9 children; Blepharitis in six cases but no conjunctivitis. 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 68.44. The vision of the entrants was not tested. Ear Disease. Obstruction in the right and (or) left ear was found in eight cases amongst the entrants, or 0.68 per cent.; 43 amongst the leavers, or 3.52 per cent.; altogether, 3.12 per cent. There was ear discharge present from the right and (or) left ear in four cases, 0.32 or per cent., amongst the entrants; and the leavers in 19 cases, or 1.56 per cent., and the total, 23 cases, or 1.00 per cent. Hearing. The hearing was tested with a stop-watch in the case of leavers. The hearing was good in both ears in the case of 87.95 Per cent. of the children examined. The hearing of the boys was a little better than that of the girls. If congenitally deaf children have been kept from school until they have learned to make inarticulate sounds, they have a great deal to unlearn before hey can be taught to speak at the deaf school. 148 Speech. Speech was markedly defective in the case of 11 entrants, 8 boys and 3 girls; and 4 leavers, 1 boy and 3 girls. Slight defects of speech in infants of five or six, where the child has not learnt to talk properly, are very common, but improve after they have been at school. The number of stammerers was 6, 4 boys and 2 girls. Heart and Circulation. Four children were anaemic, three to a slight extent only. Of these four, two were boys and two girls. Valvular disease of the heart was present in 11 children. Of these 11 cases 3 were in boys and 8 in girls. Lungs. Thirty-eight children, or 1.58 per cent., had bronchial catarrh at the time of examination. This was practically confined to the infants. Tuberculosis. The School Medical Inspector, during 1914, sent five "B" notifications to the M.O.H. Of these, two referred to pulmonary tuberculosis and three to other forms of tubercle. One case of pulmonary tuberculosis was found among the routine inspections. There was eight cases of non-pulmonary tuberculosis, four of glands, and four of joints. Nervous System. Three children were subject to epileptic fits, all boys. One boy had chorea. Rickets. There was a history of past rickets in three cases, all boys. 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. Hernia. Inguinal hernia was present in 4 children—3 boys and 1 girl. Of the 4 cases 1 was right inguinal, and 3 double inguinal hernia. 149 Other Defects or Deformities. Seven children, six boys and one girl were "pigeon chested." Nocturnal enuresis, "wetting the bed," was complained of in the case of 5 children, 1 boy 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, had a cervical rib. SCH00L CLINICS. A scheme was agreed upon by the Education Committee in 1914 and sent to the Board of Education. I disarmed the criticism of the Board in some of the details of the scheme, and we believe that its formal approval by the Board is now only withheld until the conclusion of the European war. There is no scheme which can be applied universally, and any scheme to be successful must be framed with the knowledge of the peculiar needs of the area concerned. INFECTIOUS DISEASE. The number of children excluded at the routine inspection was 70, the the reason for exclusion being :— Mumps 2 Ringworm 6 Whooping Cough 1 Impetigo 2 Chickenpox 1 Other Skin Diseases 4 Bronchial Catarrh 1 Eye Disease 1 Tubercular Spine 1 Other Diseases 4 Vermin 47 The total number of exclusion certificates including the above issued for for contagious and other diseases during the year was 1,474 the reasons for exclusions being:— Scarlet Fever 2 Vermin 370 Diphtheria 1 Scabies 61 Whooping Cough 9 Impetigo 83 Mumps 21 Other Skin Diseases 158 Chickenpox 5 Eye Disease 78 Pulmonary Tuberculosis 19 Ear Disease 9 Tubercular Glands 1 Chorea 8 „ Knee 1 Epilepsy 4 ,, Ankle 1 Mentally Deficient 3 „ Spine 1 Other causes 115 Bronchial Catarrrh 3 – Ringworm 521 1,474 150 The number 1,474 is 48 more than last year, shswing that my efforts to carry on the work of inspection of specially-referred scholars at the School Medical Office in the Town Hall were quite successful. During 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 1914. Exclusion of Contacts. The rules adopted for the exclusion of contracts 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 would be said to be much less. As stated in our report for 1912 all contacts with whooping cough are 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, 1999, has been very satisfactory. The teachers and attendance officers, generally speaking, have spared no pains to do the work thoroughly, and therefore well. Exclusion Notices.—In connection with the notifiable infectious diseases, viz., diphtheria, scarlet and enteric fevers, 1,844 notices were issued excluding contacts from attendance for definite periods. Notices were issued in 1913-12-11 to the number of 1,500, 621 and 396, 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 2,874 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 1913-12-11 were 1,941, 1,684 and 1,748, respectively. 151 It is interesting to note the great variation in the number of children excluded from the schools during 1914. Total number, 2,874; previous year, 1941 1. National 478 7. Coyland Road 210 2. Silver Street 470 8. Houndsfield 85 3. Brettenham Road 467 9. St. James's 82 4. Montagu Road 342 10. St. Edmund's 74 5. Eldon Road 335 11. Lower Latymer 31 6. Raynham Road 262 Besides the following:—Enfield Council Schools 5; Private Schools 8; Tottenham Deaf and Dumb School, 2; and 23 children not attending (at the time) any school. ■ 153 TABLES I-III. Arranged as desired by Board of Education, with reference to the 2409 children examined at the routine inspection. ROUTINE INSPECTION. TABLE I.—No. of Children inspected 1st January, 1914, to 13th July, 1914 = 2409. A.—" Code " Groups. Age Entrants. Leavers. Grand Total. 4 5 6 Other ages. Total. 12 !3 H Total. Boys — 438 112 34 584 100 606 1 707 1291 Girls — 446 112 37 595 323 188 2 5i3 1108 Totals — 884 224 71 1179 432 794 3 1220 2399 Age B.— Intermediate Group. Children re-examined. 9 10 11 Total. Boys — 2 5 7 745 Girls — — 3 3 696 Totals — 2 8 10 1441 54 155 TABLE II.—Return showing Physical Condition of Children Inspected. Condition. Entrants. Leavers. Intermediate ages 9-11. Total. * Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent. Boys. Girls. Total. Per cent. Number Inspected 584 595 1179 — 707 513 1220 — 7 3 10 — 1298 1111 2409 — Clothing. Satisfactory 534 527 1061 90.0 441 457 898 73.6 7 3 10 100.0 982 987 1969 81.7 Unsatisfactory 50 68 118 10.0 266 56 322 26.4 — — — — 316 124 440 18.3 Footgear. Satisfactory 546 549 1095 92.9 582 459 1041 85.3 7 3 10 100.0 1135 1011 2146 89.1 Unsatisfactory 38 46 84 7.1 125 54 179 14.7 — — — — 163 100 263 10.9 Cleanliness of Head. Clean 533 358 891 75.6 677 269 946 77.5 7 — 7 700 1217 627 1844 76.5 Nits 48 232 280 23.7 30 241 271 22.2 — 3 3 30.0 78 476 554 23.0 Pediculi 3 5 8 0 7 — 3 3 0.3 — — — — 3 8 11 0.5 Cleanliness of BodyClean 522 551 1073 91.0 619 490 1109 90.9 7 3 10 100.0 1148 604 2192 91.0 Dirty 62 41 103 8.7 88 9 97 8.0 — — — — 150 50 200 8.3 Pediculi present — 3 3 0.3 — 11 400 1.1 — — — — — 17 17 1 7 NutritionExcellent 1 2 3 0.3 4 5 9 0.7 — — — — 5 7 12 0.5 Normal 574 589 1163 98.6 702 502 1204 98.7 7 3 10 100.0 1283 994 23 77 98.7 Below normal 9 4 13 1.1 1 5 6 6.6 — — — — 10 9 19 0.8 Bad — — — — — 1 1 00.8 — — — — — 1 1 0.04 156 TABLE II.—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. Nose and Throat— No defect 461 459 920 78.03 577 414 991 81.23 6 2 8 80.0 1044 875 1919 79.66 Mouth breathers 27 21 48 4.07 19 10 29 2.38 .. .. .. .. 46 31 77 3.20 Tonsils slightly enlarged 86 104 190 16.12 90 76 166 13.61 1 1 2 20.0 177 181 358 14.86 Tonsils much enlarged .. 2 2 0.16 1 1 2 0.17 .. .. .. .. 1 3 4 0.16 Adenoids, slight 3 1 4 0.34 16 6 22 1.80 .. .. .. .. 19 7 26 1.08 „ marked 7 8 15 1.27 4 6 10 0.82 .. .. .. .. 11 14 25 1.04 External Eye Disease- No disease 574 583 1157 98.13 693 507 1200 98.36 7 3 10 100.0 1274 1093 2367 98.26 Blepharitis 2 1 3 0.26 2 1 3 0.25 .. .. .. .. 4 2 6 0.25 Conjunctivitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Corneal Opacities 3 3 6 0.51 3 .. 3 0.25 .. .. .. .. 6 3 9 0.37 Other diseases 5 8 13 1.10 9 5 14 1.15 .. .. .. .. 4 13 27 1.12 Teeth- Sound 231 272 503 42.7 396 237 633 51.89 4 1 5 50.0 631 510 1141 47.36 Three or less decayed 232 226 458 38.8 273 243 516 42.30 3 .. 3 30.0 508 469 977 40.56 Four or more decayed 121 97 218 18.5 38 33 71 5.82 .. 2 2 20.0 159 132 291 12.08 Sepsis of mouth .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ear Disease- No disease 575 592 1167 98.98 676 482 1158 94.92 7 2 9 90 .00 1258 1076 2324 96.47 Obstruction—right 3 1 4 0.34 8 13 21 1.72 .. .. .. .. 11 14 25 1.04 „ left 3 1 4 0.34 10 12 22 1.80 .. .. .. .. 13 13 26 1.08 Otorrhœa—right 2 ., 2 0.16 7 2 9 0.74 .. 1 1 10.00 9 3 12 0.50 „ left 1 1 2 0.16 6 4 10 0.82 .. .. .. .. 7 5 12 0.50 Other diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 157 TABLE II. — 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.[/##3] Heart and Circulation— No disease 581 591 1172 99.4 703 507 1210 99.18 7 3 10 100.00 1291 1101 2392 99.29 Organic disease 2 4 6 0.51 1 4 5 0.41 .. .. .. .. 3 8 11 0.46 Functional disease .. .. .. .. 1 .. 1 0 .08 .. .. .. .. 1 .. 1 0.04 Anaemia.. 1 .. 1 0.09 1 1 3 0.25 .. .. .. .. 2 2 4 0.16 Other defects .. .. .. .. 1 2 1 0.08 .. .. .. .. 1 .. 1 0.04 Lungs- No disease 569 576 1145 97.12 703 511 1214 99.51 7 3 10 100.0 1279 1090 2369 98.34 Chronic bronchitis and bronchial catarrh 15 19 34 2.88 2 2 4 0.33 .. .. .. .. 17 21 38 1.58 Tuberculosis .. .. .. .. 1 .. 1 0.08 .. .. .. ... 1 .. 1 0.04 Suspected tuberculosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other diseases .. .. .. .. 1 .. 1 0.08 .. .. .. .. 1 .. 1 0.04 Nervous System— No disease 582 594 1176 99.75 699 509 1208 99.02 7 3 10 100.0 1288 1106 2394 99.38 Epilepsy (major or minor) 2 .. 2 0.16 1 .. 1 0.08 .. .. .. .. 3 .. 3 0.12 Chorea .. .. .. .. 1 .. . 1 0.08 .. .. .. .. 1 .. 1 0.04 Other diseases .. 1 1 0.09 6 4 10 0.82 .. .. .. .. 6 5 11 0.46 Skin— No disease 580 592 1172 99.41 696 509 1205 98 .78 7 3 10 100.0 1283 1104 2387 99.09 Ringworm of body .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ringworm of head 2 2 4 0.34 .. 1 1 0.08 .. .. .. .. 2 3 5 0.21 Impetigo .. 1 1 0.09 1 .. 1 0.08 .. .. .. .. 1 .. 2 0.08 Scabies .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Other diseases 2 .. 2 0.16 10 3 13 1.06 .. .. .. .. 12 3 15 0.62 158 TABLE II.—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. Rickets- No disease 581 595 1176 99.75 707 513 1220 100.0 7 3 10 100.0 1995 1111 2406 99.88 Evidence of (slight) 1 .. 1 0.09 .. .. .. .. .. .. .. .. 1 .. 1 0.04 ,, ,, (marked) 2 .. 2 0.16 .. .. .. .. .. .. .. .. 2 .. 2 0.08 Deformity— • No deformity 581 592 1173 99.49 703 508 1211 99.26 7 3 10 100.0 1291 1103 2394 99.38 Deformity present 3 3 6 0.51 4 .5 9 0.74 .. .. .. .. 7 8 15 0.62 Tuberculosis Non=PuImonary— No disease 583 594 1177 97.82 702 509 1211 99.50 7 3 10 100.0 1292 1109 2401 99.68 Glands .. 1 1 0.09 2 1 3 0.25 .. . . .. .. 2 2 4 0.16 Joints 1 .. 1 0.09 3 .. 3 0.25 .. .. .. .. 4 .. 4 0. 16 Other forms .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Speech— Not defective .. 576 591 1167 98.98 702 509 1211 99.26 7 3 10 100.0 1285 1103 2388 99.13 Detective articulation.. 8 3 11 1.03 1 3 4 0.33 .. .. .. . . 9 6 15 0.62 Stammering .. 1 1 0.09 4 1 5 0.41 .. .. .. .. 4 2 6 0.25 Hearing— 1 Good both ears .. .. .. .. 583 490 1073 87.95 .. .. .. .. 583 490 1073 87.95 Good right ear .. .. .. .. 21 18 39 3.20 .. .. .. .. 21 18 39 3.20 Good left ear .. .. .. .. 29 32 61 5.00 .. .. .. .. 29 32 61 5.00 Fair right ear .. .. .. .. 61 40 101 8.28 .. .. .. .. 6l 40 101 8 .28 Fair left ear .. .. .. .. 54 37 91 7.46 .. .. .. .. 54 .. .. 7.46 Bad right ear .. .. .. .. 34 32 66 5.41 .. .. .. .. 34 32 66 7.41 Bad left ear .. .. .. .. 33 21 54 4.43 .. .. .. .. 33 21 54 4.43 Very bad right ear .. .. .. .. 8 13 21 1.72 .. .. .. .. 8 13 21 1.72 Very bad left ear 8 13 21 1.72 8 13 21 1.72 159 TABLE II.—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 (normal vision) .. .. .. .. 509 326 835 68.44 .. .. .. .. 509 326 835 68.44 6/6 right eye .. .. .. .. 34 24 58 4.75 .. .. .. .. 34 24 58 4.75 6/6 left eye .. .. .. .. 44 27 71 5.82 .. .. .. .. 44 27 71 5.82 6/g right eye .. .. .. .. 62 76 138 11.31 .. .. .. .. 62 76 138 11.31 6/9 left eye .. .. .. .. 64 75 139 11.30 .. .. .. .. 64 75 139 11.30 6/12 right eye .. .. .. .. 17 15 32 2.62 .. .. .. .. 17 15 32 2.62 6/12 left eye .. .. .. .. 14 19 33 2.70 .. .. .. .. 14 19 33 2.70 6/18 right eye .. .. .. .. 28 20 48 3.13 .. .. .. .. 28 20 48 3.13 6/18 left eye .. .. .. .. 25 24 49 4.02 .. .. .. .. 25 24 49 4.02 6/24 right eye .. .. .. .. 17 19 36 2.95 .. .. .. .. 17 19 30 2.95 6/24 left eye .. .. .. .. 16 15 31 2.51 .. .. .. .. 16 15 31 2.51 6/36 right eye .. .. .. .. 26 18 44 3.61 .. .. .. .. 26 18 44 3.61 6/36 left eye .. .. .. .. 24 17 41 3.36 .. .. .. .. 24 17 41 3.36 6/60 right eye .. .. .. .. 8 7 15 1.23 .. .. .. .. 0 7 15 1.23 6/60 left eye .. .. .. .. 4 4 8 0.66 .. .. .. .. 4 4 8 0.66 6/0 right eye .. .. .. .. 5 7 11 0.90 .. .. .. .. 5 7 11 0.99 6/0 left eye .. .. .. .. 6 6 12 0.99 .. .. .. ..• 6 6 12 0 .99 160 Numerical Return of all Exceptional Children in the area. Boys. Girls. Total. Blind, including Partially Blind— Attending Public Elementary Schools 28 14 42 Attending Certified Schools for the Blind 2 3 5 Not attending Schools — 1 1 Deaf and Dumb, including Partially Deaf— Attending Public Elementary Schools 29 36 65 8 Attending Certified Schools for the Deaf 4 4 Not at School - - Nil Mentally Deficient— A.—Feeble Minded— Attending Public Elementary Schools 43 26 69 Attending Certified Schools - — Nil Not at School ... 6 2 8 Notified to the Local (control) Authority in 1914 — — Nil B.—Imbeciles or Idiots— At School 3 - 3 Not at School 3 2 5 C.—Dull or Backward— Retarded two years 315 259 574 Retarded three years 102 33 135 Epileptics— Attending Public Elementary Schools 6 6 12 Attending Certified Schools —. — Nil Not at School — — Nil *Pulmonary Tuberculosis — Attending Public Elementary Schools ... 15 17 32 Attending Certified Schools for Physically Defective Children - - Nil Not at School 12 8 20 "Other Forms of Tuberculosis— Attending Public Elementary Schools 15 9 24 Attending Certified Schools for Physically Defective Children - - Nil Not at School 10 16 26 Cripples, other than Tubercular— Attending Public Elementary Schools 14 18 32 Attending Certified Schools for Physically Defective Children - - Nil Not at School 3 3 6 * Includes all cases notified to M.O.H. as Tuberculosis. 161 MENTAL DEFICIENCY. Appendix to S. M. O. Report. 162 The School Medical Office, Town Hall, Lower Edmonton, 1st May, 1914. To the Chairman and Members of the Education Committee. Ladies and Gentlemen, The three documents I propose to deal with are: — 1. The Mental Deficiency (notification of children) Regulations, 1914, under section 2 (2) of the Mental Deficiency Act, 1914, dated 24th March, 1914; 2. Model Arrangements under section 1 (1) of the Elementary Education (defective and epileptic children) Act, 1899, and section 31 (1) of the Mental Deficiency Act, 1913, undated; 3. Memorandum relating to both of the foregoing, dated 30th March, 1914. ELEMENTARY EDUCATION (DEFECTIVE AND EPILEPTIC CHILDREN) ACT, 1899. 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 above Act. This 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 district 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 authoritiy 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." 163 (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. MENTAL DEFICIENCY ACT, 1913. This Act came into force on 1st April, 1914. Definitions.—The "Local Authority " is the County Council. The "Local Educational Authority" is the District Education Committee— in so far as the District Council may have transferred their powers under this Act to that Committee. Section 1 gives the classes of persons who can be considered mentally defectives within the meaning of the Act. Section 31 is as follows:— (i) 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 herein-before 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. Section 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. 164 (2) also provides that:—Notice shall, subject to regulations made by the Board of Education to be laid before Parliament as herein-after provided, be given by you 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 7 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 REGULATIONS. The Board of Education have recently issued regulations under section 2 (2) of the Act, which are only provisional and no doubt will be altered and added to, as experience accumulates. These regulations provide that the School Medical Officer (and such other medical practitioner as approved by the Board of Education as you may nominate) shall be the "Certifying Officers" under the Act. They provide also that if such Officers certify that a mentally defective child cannot receive benefit, or further benefit, at a special school or class, or cannot be instructed without detriment to other children, your Committee shall notify the case to the County Council. If you are satisfied that a mentally defective child who is capable of receiving instruction at a special school should be dealt with by way of supervision or guardianship, you must notify to the Board of Education, and if the 165 Board certify that the child should be so dealt with, you must notify the County Council. You must also notify to the County Council any mentally defective child who on or before attaining the age of 16 years is about to be withdrawn or discharged from a special school, and who you think should be sent to an institution or placed under guardianship. If notwithstanding the certificate of the Certifying Officer the Education Committee is of opinion that the name of the child should not be notified to the County Council, or if you think that a child should be notified who has not been certified, the case must be determined by the Board of Education. MODEL ARRANGEMENTS. The Board of Education have also issued a set of Model Arrangements for dealing with mentally defective children. They for the most part deal with the matters dealt with in the regulations. They provide further that the Head Teachers shall report to you all children they come across attending school, who appear or are reputed to be mentally defective, and the same applies to Attendance Officers for children not attending school. The School Medical Officers shall report to you all children found by them to be mentally defective. This Committee will make arrangements for the examination by the Certifying Officer of any child reported by these Officers or a parent. The child shall be examined within three months of the age of 7 years and at such other times as may appear to you desirable. You must also arrange for the examination by the Certifying Officer of all children attending special schools at least once a year (or once in six months if the parent desire it) in order to determine whether (1) he can be discharged from the special school or class to an ordinary elementary school, or (2) is capable of receiving further benefit from the special school or class, or (3) whether he cannot be instructed there without detriment to the interests of the other children. The Certifying Officers will after examination furnish you with one of five certificates and a full report on form "F." This has 8 headings and 63 sub-headings and occupies over two pages of closely written foolscap, so that it is quite a formidable document. The blank forms of certificates A, B, C, D and E and report F, will be supplied by the Board of Education. MEMORANDUM. The Board of Education have issued also a memorandum explanatory of the Regulations and Model Arrangements, which documents have the approval of the Board of Control, the central authority under the Act. The Board of Education is of opinion that (speaking generally) children who are rightly classified as "idiots or imbeciles" are ineducable, while children rightly 166 classified as "feeble minded" are educable to a greater or less degree. In cases where the Certifying Officer reports that a child is ineducable on account of idiocy or imbecility, his report should be sent to the Board of Education and not notified to the Local Authority until a reply is received from the Board. Under section 68 of the Act the Regulations are binding on all local education authorities; they refer to notification only, whilst "the model arrangements" are intended for the guidance of these authorities. Doubtful cases may be tested by a term in a special school, preferably residential, to ascertain if they are educable or not, or whether they are a source of moral danger to the other children. In cases of blind or deaf children, it is advised that the Certifying Officer obtain the opinion of specialists in cases of an intricate nature. Besides formal notification under section 2 (2) of the Act, it is suggested that the County Council should be notified of cases under the age of 7 years. REMARKS AS TO THE WORKING OF THE ACT. So 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 instruction 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. NOTE.—The Act, however, does not impose 011 the education authority the duty of providing for the education of children who are capable of being educated in special schools or classes. 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 desirable for the sake of the children themselves, and for the sake of other children alongside whom they now have to be educated (as far as is 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. At date of writing 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. 167 The Board request that the Authority will inform them at an early date whether they propose to adopt the Model Arrangements drawn up by the Board or not and with that, information might go as to your selection of Certifying Officers. If you think fit, I advise that a resolution be passed to adopt the Model Arrangements and to appoint your School Medical Officers as Certifying Officers under the Regulations and as the medical men to act under the Elementary Education (Defective and Epileptic Children) Act, 1899, the Elementary Education (Blind and Deaf Children) Act, 1893, and under these Model Arrangements. I am, Ladies and Gentlemen, Your obedient Servant, SIDNEY C. LAWRENCE, School Medical Officer. CHRONOLOGICAL DEVELOPMENT 0F THE SUBJECT. On 9th March an order of the Privy Council transferred the powers and duties of the Commissioners in Lunacy and their officers to the Board of Control. On 20th March the Mental Deficiency Act (Lunatics) provisional rules 1914 were published by the Home Secretary. The "Form of Scheme" was published by the Lord Chancellor Haldane and provisional rules on 20th March, 1914 with schedule for the use of Justices of the Peace. Provisional regulations made by the Home Secretary (Mr. McKenna) with the concurrence of the Local Government Board under Section 30, proviso II. of the Act, were published on March 20th, 1914 with reference to the Guardians. The Mental Deficiency (notification of children) Regulations 1914, under Section 2 (2) of the Mental Deficiency Act 1914, were issued by the Board of Education dated 24th March, 1914. Model Arrangements under Section 1 (1) of the Elementary Education (Defective and Epileptic Children) Act, 1899, and Section 31 (1) of the Mental Deficiency Act 1913, undated, were also issued by the Board of Education about this time. A Memorandum relating to both of the foregoing was issued by the above Board, dated 30th March, 1914. 168 A circular of Local Government Board was sent to Guardians on 31st March, 1914. Provisional regulations made by the Home Secretary ve certified institutions or homes and approved homes, the duties of Guardians, etc., were issued on 2nd April, 1914, forms and schedules therewith. A circular of the Board of Control issued on 2nd April, 1914, as a sequel to that of December, 1913, again called the attention of County Councils and County Boroughs to their powers and duties under the Act. Regulations with reference to mental deficiency (notification of children) were issued by the Board of Education under date 26th June, 1914, and on the 17th July a Minute, the main purposes of which latter are (a) to provide for the payment as from 1st April, 1914, of increased grants for schools for blind, deaf, defective and epileptic children, (b) to establish a uniform school year commencing on 1st April, 1915. A Memorandum of the Board of Education and revised Regulations were dated 31st August, 1914, which take the place of the provisional regulations of 24th March, 1914; and revised model arrangements under section 31 (1) of the Act and Section 1 (1) of the Elementary Education (defective and epileptic children) Act, 1899. In reply to an enquiry addressed to them on the subject, the Local Government Board have stated that they and the Board of Control concur in the view that the Mental Deficiency Act, 1913, is not retrospective and that it operates only in respect of those defectives who are found—since its operation—neglected, abandoned, etc., and in respect of whom the necessary steps under the Act are taken within a reasonable time after the finding takes place. THE ELEMENTARY EDUCATION (defective and epileptic children) ACT, 1914, placed on Local Educational Authorities the duty of providing instruction for educable mentally defective children. It comes into operation on January 1st, 1915.