AC 439(1) EDMONTON Midd X Later Man B. Withthe Author Compliment EDM12 Edmonton Urban District. ANNUAL REPORTS on the Public Health and School Medical Services FOR THE YEAR 1915, by SIDNEY C. LAWRENCE, Medical Officer of Health and School Medical Officer, M.B., Ch.B., D.P.H. (Lond.), M.RC.S. (Eng.). L.R.C.P. (Lond.), Fellow of the Society of Medical Officers of Health. 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.S.San. I. 3 Edmonton Urban District Council. 1915-16. Chairman—W. A. CULL, J.P. THE SANITARY COMMITTEE. SYDNEY J. SANDERS, Chairman. H. BARRASS, C.C. E. D. RUSSELL. S. N. BERRIMAN. A. E. SHORTLAND. W. C. ELMS. C. SORRELL. J. A. KILBRIDE. H. WILLIAMS. Heads of Departments. Clerk (Acting)—FREDK. W. CLAXTON. 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.) The venerable Clerk of the Council, Mr. W. F. Payne, died on the 26th September, after 31 years' service; on the 28th, Mr. F. W. Claxton was appointed Acting-Clerk, pending the appointment of a permanent successor to Mr. Payne. I.—THE REPORT ON THE PUBLIC HEALTH OF EDMONTON during 1915. 6 PUBLIC HEALTH DEPARTMENT, December 31st, 1915. 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.*J 4.—Second Male Inspector: J. E. WINTER.* †‡ 5.—Woman Sanitary Inspector: JENNIE HUDSON.* (Certified Midwife). 6.—**ThirdMale Inspector: H. K. NIXON.† 7.—Fourth Male Inspector: G. H. HUCKLE (since August 4th). 8.—**Junior Woman Inspector: NORA PLAYNE (also School Nurse). 9.—Senior Clerk: A. OADES (temporary). 10.—**School Medical Clerk: HAROLD DYER.* 11.—**Junior Clerk: JOHN FARRAR. 12.—Disinfector, Sanitary Stores Keeper and Transport Officer: J. MADLE, C. ADAMS (temporary). 13- **Mortuary Attendant and L.aboratory Attendant: C. HICKFORD, J. MADLE (temporary). 14.—Caretaker of Emergency Hospital at Old Disinfection Station : J. MADLE (temporary). 15.—Driver of Ambulance and Bedding Vans: A. SHEPHERD. 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. ** Away on War Service. 7 SUMMARY. Area . 3,894 acres, including 31 of water Census Population, April 1911 64,797 Estimated Nett Population, June 30th, 1915 (including 690 Belgians) 70,464 Density of Population per Acre of Land, 1915 18 4 Rateable Value, October, 1915 £"228,378 Assessable Value, October, 1915 £214,690 General District Rate, 1915 4s. 6d. in the £ Poor Rate, 1915 . 4s. 11d. in the £ A Penny Rate produces about £865 VITAL STATISTICS. Birth-rate per 1,000 living (excluding Belgians) 23.88 Gross, or Registered Death-rate per 1,000 living (including Belgians) 17.55 Nett Death-rate per 1,000 living (excluding Belgians) 11.71 Infantile Mortality per 1,000 births registered (excluding Belgians) 111.64 Zymotic Death-rate per 1,000 living (excluding Belgians) 139 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. Watei 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 8 "Give me leave To speak my mind, and I will through and through Cleanse the foul body of th' infected world, If they will patiently receive my medicine." " As you Like it "—Shakespeare. To the Chairman and Members of the EDMONTON URBAN DISTRICT COUNCIL. Gentlemen— I herewith present you with my tenth Annual Report on the health and sanitary circumstances of Edmonton. It refers to the year 1915. The well-known "economy" circular of the Local Government Board, dated 4th August, 1915, has deeply impressed the minds of councillors in many places; its tenets have been received and adopted to an extent never contemplated (I venture to think) by the Board. The instructions of the Board, which (as usual) reached every M.O.H. in December, were not framed in a pamphlet but indited on one page of foolscap. This was a practical example of the desire that my report should be shortened this time as much as possible. This wish, as you will see, I have endeavoured to carry out, and I believe it coincides with your wish too. This report is therefore confined mainly to a hare "record of what has taken place during the year 1915," though it may lose thereby much of its comparative value with the reports of past and future years. Besides, the depletion of my staff owing to the great war, which since August 4th, 1914, has increased both in intensity and area, would have rendered it impossible to prepare an annual report on the usual lines, as my department, as now constituted, is not equal to dealing adequately with the current duties, much less to entering up fully the records of work done. The Home Office, too, did not issue their usual forms, "or propose to tabulate the usual statistics dealing with your Medical Officer's work under the Factory and Workshops Acts." In the article on "Measles" I refer to the necessity of your Medical Officer having a motor-car at his disposal, in order that he may make better use of his valuable time, and especially to enable him to take a more active part in visiting tubercular persons at their homes, and cases of measles who are not under the care of a medical man. This is a matter of great importance now, when there are so few left to cope with the work of my Department, which has been increased and not diminished by war conditions. After the war, if not before, I hope the Council will see their way to accede to my request. I am, Your obedient Servant, SIDNEY C. LAWRENCE, 7th June, 1916. Medical Officer of Health 9 FOREWORD. Local Conditions arising from the Great War. During the year Edmonton has shared the many new conditions that have affected other areas, such as diminished lighting, whitened kerbs and trees, restricted hours for the sale of alcohol, the reception of food gifts from Canada, frequent "flag days," the great increase of women workers, of rent and prices generally, but the last two have been compensated for by the increased wages. Wise precautions against air raids from hostile airships and aeroplanes, or for dealing with their results, were taken in June. By November a number of first-aid stations had been organised by the doctors and other voluntary workers. From March ist, the Great Eastern Railway Company re-opened its Cbeshunt branch from Lower Edmonton, mainly for the benefit of munition workers. Following a letter of the nth March, Mr. Eyles, of the Local Government Board, on April 14th had a consultation with the Chairman of the Council and the Heads of Departments as to the release of as many workmen as possible for munition works. In May I presented to the Sanitary Committee the Local Government Board pamphlet, "April, 1915," which combined recent documents on the co-operation of the military and civil authorities in sanitary matters, issued by the Home Office, War Office and the Local Government Board. A letter, dated 14th June, from the Local Government Board suggested that, during the war, some modification might be necessary in the usual provision of separate sanitary accommodation for each sex, in the smaller shops, by the provision of free use of public conveniences, or the closets of the neighbouring houses. In June the offices of the Distress Committee were utilised as a recruiting centre for munition workers; in August this work was transferred to Tottenham Labour Exchange. Then the rooms were utilised for recruiting under "the Lord Derby scheme." At the Sanitary Committee of 7th July, a circular letter was read from a property owners' association suggesting that, for the period of the war, all Loca1 Sanitary Authorities should hold their hands and discontinue sanitary notices and orders. With this proposal my Committee declined to agree. 10 On the 13th July the Council appointed a special Committee to carry out the formation of the National Register, ordered by the "National Registration Act," of 15th July. This was completed on September 14th, and on 12th October the Chairman, Cr. Cadman, presented a report of the vast amount of work done—mainly by voluntary workers. The Elections and Registration Act of 29th July, postponed the April 1916 elections of the Urban District Councillors for one year, and left casual vacancies to be filled by co-option. Thus the term of office of every Councillor was extended for one year. The elections in April, 1915, had taken place as usual. This act also dealt with the list of parliamentary and local government electors. The celebrated "economy circular" of the Local Government Board, dated 4th August, impressed upon local authorities the urgent need for strict economy in every branch of expenditure, whether capital or revenue; that whilst not unduly relaxing the standard of public health administration in their area, local authorities should as far as possible refrain from requiring the execution of work, the cost of which is to be borne by private individuals, unless the work is urgently necessary for the removal of nuisances, or for the protection of Public Health ; that every local authority should appoint a Committee to enquire and report what savings in public health expenditure can be effected; and asking for reports from time to time as to the nature and extent of any savings which local authorities may have been able to effect. When this was submitted on the 31st August, my Council appointed "an economy committee," composed of nine members of the Council," to enquire into the woiking of the Council with the object of reducing and re-organisin? the same to meet the present conditions brought al out by the war." It presented interim reports dated 24th September and the 22nd October, but had not finished its arduous labour by the end of the year. On the 26th October a letter was circulated by the Local Government Board as to the establishment of Local Tribunals to decide what men should be taken for war service. On the 4th November I offered to act, without fees, as medical adviser to our Edmonton Tribunal in cases where physical unfitness was alleged as a reason for non-enlistment, but my offer was not capable of acceptance. The first meeting of our tribunal was held on the 1st December. From December 14th Council meetings have only been held once a month, and the Education Committee likewise. THE STAFF OF THE PUBLIC HEALTH DEPARTMENT. C. Hickford, the mortuary and laboratory attendant, left for army service on January 4th; C. Adams took over J. Madle's work as disinfector and transport officer in order that the latter might replace C. Hickford. 11 A. Mettam, owing to ill-health and increasing age, ceased work at the old disinfecting station on August 28th, and J. Madle took over his duties as well as those of C. Hickford. A. Kirkman ceased duty as Senior Clerk on the 16th June. Mr. A. Oades, who is over military age, was appointed temporary clerk, and began work on the 15th July. Mr. W. O. Coates left on August 3rd to become Chief Inspector at Buxton ; then Mr. G. H. Huckle became a permanent general inspector, and ceased work as bousing inspector (temporary). Miss Agnes Fay left 011 October 30th, and on the 8th November Miss G. M. Shiner took over her duties as Junior Woman Inspector (pro tem). The School Medical Clerk.—The temporary one, J. Farrar, enlisted and ceased duty on 16th November. The Education Committee on November 2nd recommended that the question of providing a substitute should be left to the Sanitary Committee, and on November 9th the Sanitary Committee's recommendation to fill the vacancy by a man over military age, a clerk discharged from war Fervice, or a woman, was submitted to the Council, but this was not accepted. On November 23rd I wrote thereon to the members of the Council and Education Committee, and sent a copy to all of them, and included a list of the important duties of the School Medical Clerk, on both the Public Health and Educational sides, suggesting that the decision of the Council be rescinded. At the Education Committee of December 7th, the consideration of the vacancy of the School Medical Clerk was deferred until the next meeting on February 1st, 1916. Even at the date of writing this important post had not been filled up, and the statistical work is suspended, except in so far as I can give it some attention. The Junior Clerk, F. J. Wood, also left on 24th November. The Sanitary Committee of December 8th, after hearing the remarks in my monthly report on "The depletion of staff," recommended that Wood's place be filled. This was confirmed by the Council on 28th December, and Miss Doris B. Hill commenced her duties as temporary Junior Clerk on January 1st, 1916. On December 31st, 1915, the following posts in my department were vacant, and to the first four no temporary appointments have been made:— 1. Assistant and Deputy M.O.H. 2. Third Male Inspector. 3. Junior Woman Inspector (and School Nurse). 4. School Medical Clerk. 5. Junior Clerk. 12 6. Mortuary and Laboratory Attendant. 7. Caretaker of Smallpox Hospital and Disinfecting Station. Posts 6 and 7 are temporarily in charge of J. Madle, whose own work as disinfector and transport officer is temporarily being done by C. Adams. BELGIAN REFUGEES. At the old Strand School (Milltield House) are mainly men, and those men who have been found to rt quire strict discipline; whilst the men with families are mainly at the old Strand Workhouse near by. Here, Dr. Beels (late of Antwerp) lives, and he also acts as medical officer for both institutions, whilst Mr. S. Pallin is their lay superintendent. The average daily number of refugees and resident staff for 1915 is taken as 690, but the real numbers of the former are subject to fluctuation. 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 the Belgians, in order to allow the statistics of 1915 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. The men are working every day up to 2.30 p.m., at tailoring, wood-chopping, shoe repairs, carpentering, gardening, etc.; the women at the workhouse and the men at the school house as cleaners and in the laundry. Rooms for reading and recreation are at their disposal. The children are supervised by a resident Roman Catholic priest; nuns and voluntary workers come daily to teach. The women sew and knit, not only for themselves and families, but for their compatriots in the trenches who are fighting the modern Huns of Germany. Through Tottenham Labour Exchange the men obtain work outside and are absorbed into the general population, and so become real "Edmonton residents." Some couples have opened shops and restaurants in the neighbourhood. Perhaps horse flesh will become a regular article of diet in their homes and cafes, as in Belgium. Some young women and girls have taken up domestic service. As regards infectious diseases.—Thirty-two cases were notified: 20 scarlet fever, 4 diphtheria, 4 enteric and 4 erysipelas. A child, four years old, died of measles in the North-Eastern Hospital of the Metropolitan Asylums Board, and its death was recorded in the list of outside 13 deaths received from the Registrar-General. Two others, between two and five years, died of the same disease, and one of whooping cough. Four died of tuberculosis of the lungs, and one infant of diarrhoea. EDMONTON MILITARY HOSPITAL. On the ist April the Guardians wrote to inform me of the impending change, and that in no circumstances could any person suffering from infectious disease be admitted into any of their institutions. On the 20th April the new Edmonton Infirmary, which was opened on 4th August, 1 g 10, for 408 beds, and with a residential block for the medical superintendent (Dr. Spencer Mort), two medical officers and a matron, was taken over as a military hospital in the charge of Dr. Mort, with the rank of Lieut.-Colonel. He has to assist him nine medical men, two with the rank of Major, besides the registrar and the radiographer, who with four of the assistant medical officers are non-resident. The nurses number 102, of whom 70 are in the Nurses' Home adjoining, and 32 at Pymmes Park House, lent by my Council. Male orderlies and other members of the staff numbered 142, of whom 119 are non-resident. There are 680 beds provided and there are 326 more available in auxiliary hospitals outside the district. The first convoy of wounded soldiers arrived at our low-level station on 14th May, and from that date to 31st December, no less than 2,472 were admitted. At the end of 1915 there were 545 in this central hospital and 214 in the auxiliaries. In addition to dealing with the wounded from overseas, this hospital is a military centre for soldiers in the home area reporting sick, who are admitted, if necessary, for operation or special treatment. Colonel Mort and his colleagues, with the support of a special Hospital Committee of the Guardians, are doing a large amount of remedial work of national importance, in a manner which reflects credit on all concerned, including members of the Voluntary Aid Detachment and other volunteers. In May my Council set aside Section "F" in our cemetery for the burial of sailors and aoldiers. On the 31st August, our minutes first record the proceedings of "The Edmonton Green Committee," a band of voluntary workers who have developed much energy in collecting funds for the recreation and extra comfort of the men in this hospital. As regards infectious disease amongst those on His Majesty's Services, 5 cases were notified; 2 scarlet fever, 1 diphtheria, 1 enteric fever, 14 and i cerebro-spinal fever. The last case, an Enfield man, was transferred to the Edmonton Old Infirmary and there died. The deaths that occurred in the Edmonton Military Hospital totalled 34— 28 from wounds and 6 from disease. Besides three deaths of Edmonton persons received from the Registrar General; of one each from wounds or disease in the military hospitals at Leeds and Hackney, and one civilian in a Zeppelin raid. So that, including the cerebro-spinal fever, 38 deaths of our people must be credited to the Great War. 15 EDMONTON URBAN DISTRICT. REPORT OF THE Medical Officer of Health For the YEAR 1915. RECENT HISTORY. The district was divided into three Wards—Church Street, Fore Street and Bury Street—by an order of the Middlesex County Council in 1903, and is controlled by an Urban District Council of 27 members, nine of whom retire annually. It is represented on the Middlesex County Council by three members: Councillors Cornish, Green and Barrass. The population is 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. During the year there has been a great rush to munition works, old and new, in this area ; many of the workers have taken houses or apartments in Edmonton, so as to be near their work. On November 23rd the Standing Order 39 was altered, and the power of the Sanitary Committee to act on an emergency, such as an outbreak of small pox, was withdrawn. This is a retrograde step. THE DISTRESS COMMITTEE. The rainfall stopped the clearance of Pymmes Park lake by the unemployed for two or three weeks at the turnover of 1914-1915; there were 107 men at work. On the 5th March the work was completed, after delay by stress of weather and lack of workers. £500 was spent on this work, of which the Government found /400. Work on the improvement of Silver Street was paid for out of £1240, the first instalment of the Road Board's contribution; but after February, as the Local Government Board were not prepared to contribute £1500 because employment was now plentiful, the work here was dropped. On the 23rd February the Distress Committee's precept of £100 was granted, and on 23rd November a precept for £50. 16 On the gth March, Councillor Vincent (the Chairman) stated that the Distress Committee had decided to close their register and offices. On October 12th, the Clerk of the Council, at the request of the Committee, took over their books and other documents and the conduct of any business that may arise until the Committee is resuscitated. However, on January 25th, 1916, the Council filled up outside vacancies on the Committee for the coming year. POOR LAW INSTITUTION. The Institution belonging to the Edmonton Board of Guardians, which is in Fore Street Ward, receives a certain proportion of its inmates from this district, and such proportion is treated as part of our population for statistical purposes. The large bulk of the inmates, however, is derived from Tottenham, Southgate, Wood Green, Hornsey, Enfield, Cheshunt (Herts.), and Waltham Abbey (Essex), which places make up the large Poor Law Union of Edmonton, and these inmates, of course, do not enter into our vital statistics. In March, 1915, the estimated population of Edmonton Union was 479,001; rateable value, ^2,516,791. Amongst a total of forty Guardians, Edmonton district proper has only four representatives. The New Infirmary and Nurses' Home became a military hospital in April; for particulars of its work, see "The Foreword." In the same place will be found the account of the Belgian refugees in the former Strand Union buildings. N.A.L.G.O. The local branch of the National Association of Local Government Officers was established on the 19th March, 1914. I have the honour of representing it on the Executive Council of the Association. On 8th November, Mr. Cuthbert Brown was elected President, and I as Vice-President, and Mr. W. H. Tonkin as Hon. Secretary; this was the only meeting held in 1915. Its usefulness to its members will entirely depend upon the courage and energy of its Executive Committee. VITAL STATISTICS. My statistics refer to 53 weeks, i.e., they include the week ending January 2, 1915, and that ending January 1st, 1916. The Registrar-General took 53 weeks for the preceding year, so I end level with him. 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. On the 9th of November, 1914, Devonport was absorbed into Plymouth, thus reducing the number of great towns by one, 17 The number of small towns has been increased by three places, from 145 to 148, by the addition of Mitcham (Surrey), Eston and Spenborough (Yorks). On January 1st, 1915, Mr. W. H. Miller became the successor of Mr. Harman Judd as the registrar of births and deaths in Edmonton sub-district; the sub-district of Southgate being taken over by Mr. T. E. David. I am much indebted to Mr. Miller for information promptly afforded, whenever asked for. The Registrar-General estimates our civil population at 68,143, whereas I estimate our nett civil population, including 690 refugees, at 70,464, and the gross civil population (including institutions) at 70,998, plus an average military population of 676. So there is a difference of 2,855 our figures. Mine are more likely to be in accordance with the facts, as there are few (if any) houses vacant in Edmonton, and those occupied are more overcrowded than ever. Besides, many Belgians formerly in the refuge have become householders or lodgers, and thus absorbed into the general body of ratepayers. I understand that the estimate of the Registrar-General has been arrived at by a calculation based on the National Register of August 15th, 1915 excluding all those men who are on war service, persons between 18-41 years of age. But the exit of these men has been quite compensated by the influx of munition workers and Belgian refugees. The National Register.—This census differed from the ordinary decennial one in many particulars. It only recorded those persons between 15 and 65 years of age who were sleeping in the house on Sunday night, 15th August, 1915; soldiers and sailors and inmates of public institutions were not enumerated. Each individual was dealt with by a separate paper, not on one paper for each household. Everyone was asked to definitely state his or her occupation, and how many children or others were wholly or partially dependent on them. Every male between 18 and 41 years of age was specially listed for recruiting purposes. The papers were distributed through local authorities by voluntary workers, who also helped at the coding according to occupations, and the issue of certificates of registration. I estimate the nett population at the middle of 1915 as 70,464 persons including 396 Edmonton people in Edmonton Workhouse and old Infirmary and 690 Belgian refugees and resident staff. The natural increase of the population, that is the excess of the nett total of births over the nett total of deaths, was 1,666 minus 817, equals 849, without Belgians. The figure was 1,123 last year. 18 The area of the district is 3,864 acres (less 31 of water), and the density of the population, or the average number of persons per acre of land, is 18.4 This figure is calculated on the gross population, which includes the average populations of Edmonton Workhouse and old Infirmary, and the Belgian refugees, and amounts to 70,998. The patients, nurses, medical men, orderlies, etc., at the Military Hospital, are excluded. In the Edmonton Workhouse and old Infirmary there were estimated to be 930 persons, of whom 396 were Edmonton residents. BIRTHS. The number of births registered by the Edmonton registrar, Mr. W. H. Miller, was 1,725 (872 boys and 853 girls), which includes 11 births that took place in the Edmonton Workhouse, born of mothers belonging to Edmonton, and 31 of Belgian refugees. The figures for 1914, 1913 and I9i2were:—1,946, 1,912 and 1,844. Forty births which occurred at Edmonton Workhouse, born of mothers who are not Edmonton residents, are excluded from our statistics J just as foreign deaths are. The Registrar-General reported 12 births (7 males and 5 females) which had taken place when Edmonton mothers were residing temporarily out of their district; 9 of these infants were stated to be born in wedlock. Thus the nett total of births was 1,666, excluding 31 Belgians. Of these 1,666 births, 61 (or 3.7 per cent) were illegitimate; there were 5 illegitimate Belgian births. With reference to the cry of "war-babies galore" last year, it is a refutation of the rumour as regards Edmonton to find that the illegitimate birth rate is only o-i higher than in 1914, and 0.4 less than 1913 ! The birth-rate per thousand inhabitants is therefore 23.88, compared with 27.25 last year: including Belgian births, the rate would be 24.08. Notification of Births Act, 1907. This came into force here on April 28th, 1908. During this year 1,736 births were entered in our register; of these, 869 were males and 861 females; in 6 cases the sex was not declared; 101 (over 5 per cent.) of the whole number were born out of wedlock, and 2 more were of doubtful legitimacy. Fifty-nine 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 46 children styled "still-born" buried during 1915, and for 1914-13-12 the figures were 62, 63 and 69. 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 1,725 births were registered during 1915. 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 pairs of twins arrived, and no triplets. Besides, there were 32 births, 19 males and 13 females, amongst Belgian women who were 19 confined in Edmonton Workhouse; of these, none were still-born, i twin birth, six were illegitimate. The birth-rate based on 641 refugees, excluding their staff, would be nearly 50-00 per 1,000 refugees. The birth-rate (23.88) for 1915 is 3.37 lower than last year, but still it is higher than 21.8, the birth-rate of England and Wales for 1915. The birth-rate for the preceding nine years will be found in Column 5 of Table 1. Notification of Births' Act, 1915.—This Act came into force on the 1st September. It makes the adoptive Act of 1907 applicable to every district in the United Kingdom and Ireland, etc., and allows local sanitary authorities to open centres for maternity and infant welfare. DEATHS. The deaths registered in the district during the year were 1,281; of these, 543 occurred among non-residents at Edmonton Workhouse and Infirmary; while 126 deaths of Edmonton residents, 19 Belgian refugees and 4 vagrants, taking place in the Edmonton Workhouse and old Infirmary, are included in our nett deaths. Thus the number of deaths amongst "Edmonton residents" registered in the district amounted to 680, besides 19 Belgians and 4 vagrants. Of the 38 "war" deaths, 35 were registered here and 3 elsewhere; they are considered separately, as instructed by the Local Government Board. The gross death-rate is based upon the total number of deaths registered in the district, and is 17-55 per 1,000 living. This rate is calculated on the estimated gross population of 70,998 (excluding the military). The nett death-rate is based upon the total number of deaths of Edmonton residents occurring inside or outside the district, and is 11.71. This rate is calculated on the estimated nett population of 69,774. 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. 137 deaths (including 1 Belgian and 3 war deaths) were returned in this way during the year, making the nett total of deaths at all ages (including 4 vagrants) for the district proper 817 and 20 Belgians. The nett death-rates for the preceding nine years will be found on Table 1., column 13. The nett death-rate for Edmonton is, as I have said, 11.71 per 1,000 living; it was 10.79 last year. It is 0.59 higher than the average of the five previous years, but is much better than 15-80 the rate for 1904. If 20 Belgian deaths be included, the rate is 11.88. Death Certification. All deaths but one were certified eider by the medical attendant or by the Coroner: the one was a boy of 15 years (F N.G.) at 20 Middlesex County Asylum on 13th August, reported to have died of epilepsy; this is the first uncertified death in my ten years of office here. Inquests were held on 69 residents, or 10 per cent. of the total deaths amongst residents registered in the district. This percentage compares favourably with nearly 13 per cent, of 1913. For inquests on infants see next section. The ages at and causes of deaths are set out in detail in Table III. 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, enteric fever, measles, scarlet fever, whooping cough and diphtheria at all ages, also diarrhoea (and enteritis) in children under two years of age. There were 97 deaths from these diseases (excluding refugees) during the year, and the zymotic death-rate is therefore 1.39 as compared with 1.48 for the previous year. This figure is 0.09 less than last year. The zymotic death-rate for 1915 in London was 1.44. INFANTILE MORTALITY. The Infantile mortality is a special death-rate, referring to the first ageperiod (o to 1 year), and is expressed as the number of deaths that takes place amongst children under one year of age per thousand births registered. The number of such deaths occurring amongst Edmonton children and registered within (or without) the district was 186, and the births registered within (or without) the district, born of Edmonton mothers, numbered 1666 (Belgians excluded); therefore the infantile death-rate, based on these figures, is 111.64 per thousand births. The lowest record is 74.55 in 1910. 21 of the 186 infantile deaths were those of illegitimate infants—that is 11.3 per cent, of the infantile deaths; five inquests were held, two on newly-born babies abandoned in a ditch and front garden. Inquests were also held on 15 of the other infants, making a total of 20. There were 8 infantile Belgian deaths, one of them illegitimate. The Infantile Mortality Rate for the year in England and Wales was no; in London, 112; in the 96 great towns (which include Edmonton), 117; and in the 148 smaller towns, 114 per thousand births registered. Table IV shows that 29-57 Per cent, of the infantile deaths occurred within the first month of life, and that i6'I3 per cent, were due to what are termed "wasting diseases," viz.: premature birth, atrophy, debility, congenital defects, and marasmus. Last year the figures were over 39 and 31 per cent., so that the comparison is quite favourable. I must also notice that the premature births were only 18, compared with 32, 26 and 30 for 1914-13-12. 21 Conference. A very important meeting of representatives from all parts was held at the City Guildhall on 26th October. The proceedings were based on the text of "Saving the Future," and eminent speakers on the subject addressed a crowded audience of persons interested, or who ought to be interested, in Child Welfare. My Council refused to appoint a representative. Our attention was called to the meeting by a letter of 4th January, 1916, from the National Association for the Prevention of Infant Mortality, requesting the Chairman of the Council to follow the precedent of the Lord Mayor of London by giving, not only his personal support to this national movement, but making it a special feature for his year of office by initiating and presiding in the District at a meeting similar to that held in the Guildhall. Nett births during the year legitimate, 1605; illegitimate, 61. Nett deaths during the year legitimate infants, 165 ; illegitimate infants, 21. TABLE lV.—Infantile Mortality (excluding Belgians). 1915. Nett deaths from stated causes at various ages under 1 year of age. Causes of Death. None Uncertified. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months Total deaths under 1 year. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. 2 4 6 Scarlet Fever .. .. .. .. .. .. .. .. .. Whooping-Cough .. .. .. .. .. 2 1 1 2 6 Diphtheria and Croup .. .. .. .. .. .. .. 1 .. 1 Erysipelas .. .. .. .. .. .. 1 .. .. 1 Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. 1 .. 1 Other Tuberculous Diseases .. .. .. .. .. .. .. .. 1 1 Meningitis (not Tuberculous) .. .. .. .. .. .. 1 .. 1 2 Convulsions 1 1 .. .. 2 .. 1 .. .. 3 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. 4 3 5 1 13 Pneumonia (all forms) .. 1 .. .. 1 1 8 5 10 25 Diarrhœa .. .. .. .. .. q 12 12 .. 37 Enteritis .. .. .. .. .. .. .. .. .. .. Gastritis .. .. .. .. 1 2 .. 1 .. 4 Syphilis 1 1 3 1 6 .. 1 1 .. 8 Rickets .. .. .. .. .. .. .. .. 1 1 Suffocation, overlying .. .. .. 1 1 .. .. .. 1 2 Injury at Birth 1 .. .. .. 1 .. .. .. .. 1 Atelectasis 2 .. 1 .. 3 .. .. .. .. 3 j Congenital Malformations 1 1 .. 3 5 3 s .. .. 11 Premature Birth 16 1 .. 1 18 1 .. .. .. 19 Atrophy, Debility and Marasmus 2 .. 3 .. 7 11 2 1 3 24 Other Causes 4 .. 2 2 8 .. 4 3 2 17 Totals 28 5 10 10 53 33 37 33 30 186 22 COMPARATIVE STATISTICS, 1915. The table of vital statistics for 1915, 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 1915. 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 37,302,983 21.8 14.8 - 110 The 96 great towns including London and Edmonton 18,136,180 22.8 15.6 - 117 The 148 smaller towns 4,838,095 21.6 14.0 - 114 England and Wales, less the 244 towns as above 14,328,618 20.7 14.8 - 98 London (including City) 4,516,612 226 16.1 1.44 112 Acton 58,238 24.2 13.3 1 39 104 Wood Green 50.545 19.8 11.3 0.85 86 Enfield 61,173 21.6 11.7 1.06 87 Edmonton 69.774 23.9 11 .7 1.39 112 As regards 1911 and since, 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 marriage-rate of England and Wales for 1915 is the highest on record at 19.3 per 1000. The birth-rate is 1.8 less than last year, and is, of course, the lowest on record ; the death-rate is 1.2 higher than 1914, and 1.4 higher than 1913, which was the lowest on record. The infantile death-rate is 5 integers more than last year, which was the lowest on record. The natural increase in the population of England and Wales, or the excess of births over deaths, is 252,201 or 126,159 less than the average of the preceding five years. THE WOMEN INSPECTORS AND THEIR WORK. I give below an analysis of the number and nature of the visits paid by them during 1915. The bulk of their work falls into four correspondingly large divisions, viz.:— 1. The crusade against preventible infantile mortality; 2. The work done in factories, workshops, etc., where women and girls are employed, and amongst home-workers of 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. 23 INFANTILE MORTALITY. Month. After births. Re-visits. After 6 months. Neglected infants. After deaths. Diarrhœa diseases. January 48 ... 12 ... 1 ... February 137 7 14 ... 9 ... March 72 10 3 ... 10 ... April* 4 ... 2 ... 1 ... May 27 4 16 ... 21 ... June 38 7 25 ... 8 1 July 52 4 21 ... 5 ... August 18 1 7 ... 3 6 September 85 14 21 ... 15 9 October 56 4 22 ... 8 7 November 123 1 14 ... 13 3 December 135 8 11 ... 13 ... Totals 795 60 158 1 107 26 INSPECTIONS under FACTORY AND WORKSHOP ACTS. Month. Factories. Workshops. Laundries. Outworkers. January ... 1 ... 151 February 1 9 ... 32 March 1 9 7 82 April* ... ... ... 1 May 1 4 ... 47 June 9 8 7 50 July 1 3 1 58 August ... 1 ... 37 September 1 5 ... 89 October ... 5 ... 80 November ... 6 1 68 December ... 1 ... 38 Totals 14 52 23 733** *Miss Hudson was absent (ill) from April 8th to May ist, both inclusive. * * Compared with 485 last year ; mainly on war work. Workrooms measured up 18. Laundries measured up o. 24 NOTIFIABLE DISEASES. Visits and re-visits to Erysipelas cases 176 „ re Erysipelas disinfection 12 ,, re Puerperal Fever cases 7 „ ye Phthisis voluntarily notified 4 „ ye Pulmonary Tuberculosis compulsorily notified 347 ,, re Pulmonary Tuberculosis disinfection (after death or removal) 167 „ re other forms of Tubercle 91 „ ye Ophthalmia Neonatorum 48 Total 852 NON-NOTIFIABLE DISEASES. Months. Measles. Whooping Cough. Mumps. Chicken-pox. Doubtful Cases. Diarrhœa. January 29 15 1 11 7 ... February 52 4 ... 8 6 ... March 58 7 ... 7 5 ... April 151 21 ... 10 9 ... May 69 33 1 7 14 ... June 48 50 2 41 9 1 July 15 22 ... 31 6 ... August 3 5 ... 5 2 9 September ... 26 1 30 13 10 October 1 19 1 46 15 ... November 2 8 2 65 5 ... December ... 3 7 67 9 ... Totals 428 213 15 328 100 20 * Schools closed for holidays. One visit rc Cancer disinfection. Visits and re-visits re School notifications concerning non-notifiable diseases, such as measles, whooping cough, chicken pox, etc., 1084 to 1415 children at 893 homes; also to one teacher's home. This is a considerable decrease compared with last year, when the figures were 1922, 2874 and 1788 respectively. (For further information see Annual Report of School Medical Officer). GENERAL WORK. Visits to Private Schools 3 Private Schoolrooms measured 3 Enquiries re complaints 60 Miscellaneous visits (compared with 137 last year) 134 Visits paid to inspect work done after informal notice 535 „ re overcrowding 10 ,, re Fabric Misdescription Act 6 25 MORE WOMEN OFFICERS REQUIRED. It is usually considered that for every 500 births in any area, especially an industrial one, there should be one Woman Sanitary Inspector or Health Visitor. On these not unreasonable terms, there should be on my staff four permanent ones, whereas at present only one of two is permanent. Besides, temporary officers do not stay long, and frequent change of officers is detrimental to the smooth progress of the work. The need for more help in this direction is clearly shown by the following table, which shows how great an amount of their time was spent indoors, and not amongst the homes of the people. Women Officers' Indoor Work, 1915. Office Work. Statistical Work. Tuberculosis Accounts. Infant Welfare Centre. Miss Hudson 150½ 8 4½ - Miss Fay 94 1 - 30 afternoons. Miss Shiner 21 - - 14 afternoons. Total days 265½ 9 4½ 44 afternoons. MATERNITY AND CHILD WELFARE. On January 12th the Council decided to defer until January, 1916, the consideration of whether a centre should be established by the local authority. On the 9th February, the representatives of the Women's Co-operative Guild appealed at the Council meeting for the decision to be revoked; but in vain, for on 23rd February this decision was confirmed. This disappointment only strengthened the resolve of those ladies and gentlemen who were convinced of the great need of such a centre in Edmonton, which is an industrial suburb with a high birth-rate, but an infant mortality rate capable of being lowered appreciably. So on 26th March a meeting was held at 29, Church Street, to which all persons and organisations interested in the subject were invited, and Miss J. Halford, the Secretary of the National Association for the Prevention of Infant Mortality, and of the Association of Infant Consultations and Schools for Mothers, was good enough to give an inspiring address, which resulted in a resolution to start as soon as possible a 26 "School for Mothers and Infant Welfare" by a voluntary scheme, and under the management of a "Board of Control." At a meeting on 9th April the report of a Committee furnishing the first lines of action was approved. Then the Council began to take an interest in the project, as shown by their loan of the Town Hall on the 6th May for a whist drive, and a public meeting on the 17th June. On this latter occasion, Mrs. H. B. Irving, one of the founders of the St. Pancas School for Mothers, and a poor-law guardian, delivered a memorable speech, which thrilled every one present by its dramatic delivery and exhibition of a deep knowledge of the subject. On the nth May the Council (against the recommendation of the Sanitary Committee) gave permission for the Junior Woman Inspector (temporary) to devote two afternoons a week to the school which opened its doors for the first time on Tuesday, June 22nd. Dr. Rachel Mackenzie was appointed medical adviser and she attends every other Tuesday for two hours. How successful the School has been, can be best judged by reading the first " Annual Report" for the nine months ending 31st March, 1916, in which it is reported that—" there are now 136 infants on our books ; 108 have attended for advice on diet and clothing from Dr. Mackenzie; 22 mothers are in the needlework class; 32 mothers attend the health talks by Mrs. Benjafield (a certified midwife) and by the Council's Woman Health Visitor (now Miss Shiner); 200 visits have been paid to the homes." These visits encourage attendance regularly at the Centre, and are supplementary to the ordinary visits of the Council's officials ; in this respect Mrs. Beer, of Winchmore Hill, has been an early and persistent helper, whose services are much appreciated. Councillor Sydney J. Sanders, Chairman of the Sanitary Committee, is the Chairman of the Board of Control, Mrs. Benjafield, 29, Church Street, Lower Edmonton, is Honorary Secretary, and Mrs. Sanders is the Treasurer. The M.O.H. is a member ot the Board. As Medical Officer of Health here for ten years I can testify to the great scope there is for this work in Edmonton. The efforts of the 11 ladies and 4 gentlemen who form the Board of Control have been already resultant of good, and the Centre only requires time to be better known, when the Board will have to consider the possibility of extending its privileges (gradually, and as funds permit) from children under one year of age up to those under five years, when they will come under the observation of myself and my colleague, the School Medical Inspector. The Centre is open from 2.30 to 4.30 p.m. every Tuesday and Friday at the Charles Lamb Institute, Church Street, where capital accommodation has been afforded at a nominal cost by the kindness of the Rev. Prebendary Sanders. 27 SECTION II A. COMMUNICABLE DISEASES—NOTIFIABLE. The Infectious Diseases Notification and Prevention Acts have been in force in this District since March 3(st, 1891. 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 amongst residents and the number isolated, the percentage of these to the cases notified, and the fatality, i.e., the percentage of cases dying to those notified. Disease. Cases Notified. No. isolated in Hospital. Isolations per cent. Total Deaths. Fatality per cent. Scarlet Fever 281 264 9395 8 2.85 Diphtheria and Mem. Croup 89 86 9651 8 9.90 Enteric Fever 5 4 80 00 2 40.00 Totals 375 354 - 18 - Compared with last yeav the table shows 70 less notifications of scarlet fever, but more fatal cases actually and relatively. There were 59 less notifications of diphtheria, and the percentage of fatal cases was lower; the notifications of enteric fever were 12 less, but the fatality was much greater relatively than last year. Besides those recorded in the above table—amongst the Belgian refugees there were 20 cases of scarlet fever, 4 cases of diphtheria, 4 of erysipelas and 4 of enteric fever, making a total of 32 cases; all of them were removed to the institutions of the Metropolitan Asylums Board ; no deaths occurred. Foreigners. There were notified from the Edmonton Infirmary 4 scarlet fever, 3 diphtheria, 15 erysipelas, 3 enteric fever, 4 puerperal fever, 3 cerebro-spinal fever, 2 ophthalmia neonatorum cases. Of these 1 case each of scarlet fever, erysipelas and ophthalmia neonatorum, and 3 cases of puerperal fever were former residents of this district, and are therefore included in the above table. Amongst the military I received notifications as follows.—2 scarlet fever, 1 diphtheria, 1 enteric fever and 1 cerebro-spinal fever; the last one died in the Edmonton Infirmary. 28 THE GUARDIANS AND INFECTIOUS DISEASE. On January 12th, 1915, the Council adopted the Sanitary Committee's recommendation that the Council do consider a draft agreement, accepting the payment of 2d. per head of the Census (1911) population, in consideration of the Council dealing with cases of infectious disease, arising within the district, but excluding those occurring in the premises of the Edmonton Guardians; the nfectious diseases being those mentioned in the agreement of nth December, 1912, and the agreement to be determinable by either party on six months' notice. On 3rd February, 1915, the Sanitary Committee considered a draft agreement from the Guardians, sent on January 21st, 1915, and the Council agreed that four Councillors, the Clerk and the Medical Officer of Health, should accept an invitation to meet the representatives of Enfield to consider it. On the 18th the conference took place at Edmonton, and having considered the Guardians' draft, agreed upon a new draft, embodying what alterations were necessary in the interests of the two local sanitary authorities. This was ratified by my Council on 3rd February, except that the amount payable by the Guardians was to be 2d. per head, not 1d., of the estimated population each year. On March 9th the Clerk reported that the Clerk of the Guardians would not accept the alterations proposed. So my Council gave way and accepted Mr. Shelton's terms which, of course, are not favourable to the local sanitary authority ; when an epidemic of infectious disease arises, such as small-pox, the agreement will prove a very expensive one for us. It was sealed by us on the 13th April and by the Guardians on the 28th April, and came into force on the 6th May. We thereby undertake, for 2d. per head of our census population, to isolate and, if necessary, on account of destitution, to maintain persons suffering from all or any infectious disease, except the inmates of the Edmonton Workhouse and Infirmary, or any other building provided or maintained by the Guardians. The usual Charts dealing with scarlet fever, diphtheria, and enteric fever, based on the uniform plan of a temperature chart, are not published this year for economy's sake. In July it was resolved that all notifications requiring attention after 5 p.m. should be left with the caretaker of the Town Hall; but as this was soon found impracticable, in September the resolution was rescinded, and it was ordered that they be sent to the private residences of the M.O.H. or Chief Inspector. The week-end and public holiday arrangement continues as heretofore. 29 Small-Pox. A satisfactory feature of the infectious returns for the year is the absence of small-pox from amongst them; since 1904 the district has enjoyed a complete immunity from this disease. An epidemic of this dreadful disease is overdue, and judging from the returns of the Vaccination Officer there are many Edmonton children unprotected from infection and sure to die, if attacked. There were no deaths from chicken pox. Vaccination. The following table of vaccination returns has been kindly supplied by Mr. Lowman, the Vaccination Officer. VACCINATION RETURNS FOR 1915. Births, Successful Vaccinations. Conscientious Certificates. Deaths under one year unvaccinated. Still unvaccinated but address known. Postponed owing to illness. Certified unsusceptible. Removed and Untraced. 1725 601 573 120 175 27 1 228 In 1907 there were only 72 certificates granted to parents who alleged they had conscientious objection to vaccination, but there were 573 this year. This large increase of persons unprotected from smallpox will gratify no one but an anti-vaccinationist. Scarlet Fever. 281 cases were notified, giving an attack rate of 4.03 per thousand. 351, 420 and 211 cases were notified in 1914-13-12. There were 8 deaths, giving a death-rate of 0.11 per thousand of the population. Besides, 3 cases were notified from the Edmonton Infirmary, who were not Edmonton residents, but were treated in our Hospital. One case was doubly notified, and 1 case of infection was mixed with whooping cough. There were also 20 Belgians notified. Secondary cases numbered 37 out of 281. There were 7 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. I received notifications of 96 cases during the year, compared with T48, 131 and 136 in 1914-13-12, and they represent an attack rate of 1.37 per thousand of the population. There were 8 deaths, giving a death-rate of 0.11 per thousand of the population; the same as scarlet fever. There was 1 duplicate notification. 5 of the cases were secondary ones. 4 cases occurred amongst the Belgians. 30 Besides, 3 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 12 cases notified where subsequent observation did not confirm the diagnosis; they are not included in the above figures. At the Sanitary Committee of the 8th September, a father was severely admonished by the Chairman for his exposure of a child notified as suffering from diphtheria; but no legal action was taken. A little delay apparently occurred in notifying a case in September, 1914, and much consideration was given by the Sanitary Committee for the next three months to the conduct of the medical practitioner concerned. But in February the justices held that no offence had been committed. 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. 12 cases were notified, as against 17, 8 and 3 in 191413-12. This is equal to an attack rate of 0-17 per thousand of the population. There were 2 deaths, giving a death-rate of 0-03 per thousand of the population. There were no secondary cases. There were 4 cases amongst the Belgians. Moreover, 1 patient was notified as, but found not to be, suffering from enteric fever ; it is therefore not included in the above figures. Acute Anterior Poliomyelitis. Only 2 cases were notified: 1, in May, a boy of 14 months, at Westoe Road, and, in September, a girl of 4 years, at Montagu Road; two roads far apart. Both survived, but with permanent paralysis. CEREBRO-SPINAL FEYER. There were 7 notifications received ; 4 of these were from the old Infirmary, one of whom was a soldier whose last private address was in Enfield, and the others were residents in Hornsey, Tottenham and Enfield. The remaining 3 were Edmonton children, aged 7 years, 3 years and 1 J*years ; the last 2 were notified from London hospitals. The boy of 7 years in Sutherland Road was treated in our hospital and recovered after a lengthy illness, but became quite deaf, and he is now receiving his education at our Deaf School. Of the 9 deaths of residents from "meningitis," one (see *) of 19 months was classified as 61B "meningococcal meningitis" and 8 as 61C. In this 31 latter class were 2 deaths of infants under 12 months from "cerebral meningitis"; 4 (13 months, 8, 11 and 24 years) from "meningitis; 1 (2 years) from "cerebral meningitis"; 1 (3 years) from "meningitis and pleurisy." The spinal fluid of this last one was removed post-mortem and sent on the 26th March to the Local Government Board for examination; a negative report was received. The Enfield soldier died in the old Infirmary. 2 soldiers were discharged into this district after recovery elsewhere; 1 to Lowden Road and 1 to Vortis Road (no such road here). The Local Government Board, on the 22nd February, sent a circular letter and new memorandum to sanitary authorities. Copies of the latter I sent to every practitioner. In the former the Board offered to examine cerebrospinal fluid and asked us to have swabs from contacts examined and to report on each case to the Board by schedule provided. On May 5th, Dr. W. VV. Fletcher called here on the subject. On 22nd April, the County Council expressed their willingness to undertake, free of charge, bacteriological examinations, or to send an expert to take fluid or swabbings. ENFIELD AND EDMONTON JOINT ISOLATION HOSPITAL. This is situated on 27 acres of land in the Enfield district, on its Winchmore Hill border. The contribution of Edmonton towards the Hospital for the year ending 31st March, 1916, was £6,228, compared with £6,130 the previous year. The Superintendent's report for the year ending March, 1915, reached me on November 3rd following. He states:—"As Block I. is seldom in use, it has been handed over to a portion of the night-staff as sleeping quarters. At any time it can be used for the purpose for which it was originally intended." The Accommodation available on December 31st, 1915, 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. night staff. 161 beds. 32 During 1914.15 the greatest number of patients resident on one day was 170; that is 9 more than the normal accommodation. The patients admitted from other districts appear to have been numerous, viz.: 32 cases of scarlet fever and 33 with diphtheria; or over 7 per cent. of all admissions. 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, 4 sisters (1 for night duty), 5 staff nurses, 1 assistant nurse, 22 probationers and 6 ward maids; in 1914-15 the resident staff numbered 57 and the outdoor staff 3, as the year before, but differing a little in personnel. Antitoxin. On the 6th December, Dr. Cook attended my Sanitary Committee's meeting and suggested a plan by which the medical practitioners might be prevailed upon always to administer antitoxin before the patient's removal to hospital. Return Cases. During the year 1915 there have been 23 such of scarlet fever and 4 of diphtheria. Dr. Cook estimates the percentage of return cases of scarlet fever during 1914-15 as 2-70, compared with 1-49 for the previous period. In February, a case of scarlet fever was renotified and sent back. In April, a case of diphtheria was renotified and sent back ; the same day her sister was notified and removed as scarlet fever (cross infection ?). In April, too, a case discharged after scarlet fever was notified and sent back for diphtheria (cross infection ?); also another was renotified as diphtheria and sent back to complete her cure. SMALL-POX HOSPITAL ACCOMMODATION Since January 31st, 1907, the Middlesex Districts Joint Small-pox Hospital has been in existence at South Mimms. We must rejoice that although precepts have been made from time to time on the Edmonton treasury, no patients from the district have been sent there yet with small-pox. The money (^225 for 1915-16; it was ^"222 the year before) is a premium for an advantageous insurance. Dr. Ta'Bois, the Resident Medical Superintendent, informs me that there are 70 beds in the permanent buildings, and 143 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 143 beds in the 33 temporary buildings have been used as a sanatorium 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, 1915, was 108, 13 of whom were residents in Edmonton Urban District. In July a new administrative block was opened. No cases of small-pox were treated during 1915 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 June, the Middlesex District Joint Small-pox Hospital Board asked this Council to reconsider its decision of November, 1913, and allow them the use of our former small-pox hospital at Pickett's Lock Lane, if an outbreak of that disease exceeded the 12 beds available at Uxbridge. The Board had recently entered into an agreement to admit all small-pox cases for the Edmonton Guardians, and the number of tubercular patients at Clare Hall from the Middlesex County Council was likely to be added to by the admission of soldiers. On the 13th July the Sanitary Committee submitted to our Council the heads of an agreement for the use of the building until 1 year after peace has been signed, and thereafter determinable by 6 months' notice from either party. In September J. Madle went to live there, vice A. Mettam resigned, and took charge of the old disinfecting station. In October the agreement, as amended by the Hospital Board, was accepted and a sub-committee of the Sanitary Committee visited the spot and defined the boundaries of the area to be taken over. In October Dr. W. W. Fletcher of the L.G.B. inspected our hospital, and was afterwards furnished with a plan of the site showing the houses within a quarter and half mile radius. On November 22nd the Local Government Board wrote to the Hospital Board that the Local Government Board " cannot accept responsibility for the agreement proposed to be made with the Edmonton Urban District Council." We were not communicated with. The following 17 urban districts are now shareholders in the Joint Hospital:— Acton Enfield Hampton Wick Staines Brentford Feltbam Hanwell Tottenham Chiswick Friern Barnet Harrow Wealdstone Edmonton Greenford Southgate Wood Green Wembley was added after the usual Government enquiry on April 7th. 34 Our arrangements for transport are as stated in previous reports. Disinfecting and Cleansing Station. On January 13th, 1914, the Clerk was instructed to apply to the Local Government Board for approval of a loan of £670, i.e., £500 for the cleansing and £170 for the disinfecting station adjoining the Town Hall Yard. For the whole of 1914 the matter lay dormant, until the Sanitary Committee broached the subject to the Council on the 12th January, 1915. It was then stated that the cost would be £980 to build these stations in accordance with the plans acceptable to the Board's architect; thereupon a resolution was passed that application be made for the Board's sanction to a loan of £1,ooo. An enquiry, was held here on March 1st. But it was not until April 13th that the Council heard the letter of the Board, dated 31st March, 1915, stating that they could not sanction loans under the present conditions, except for cases of extreme urgency or necessity. In June, it was reported that the boiler at the old disinfecting station was nearly useless, and a conference ordered between the Engineer, the Inspector of Nu;sances and myself on the subject. In July we presented a statement from the Engineer that the cost of erecting the disinfecting station only, would be £350 and £8o for a new boiler. On the 13th July the Council endorser! the Sanitary Committee's recommendation that the sum of £450 be provided in two half-yearly sums out of the current rate. The plans and specifications were laid before the Works' Committee and the Council in September. Tenders were accepted in November, and at the end of the year the erection of the new disinfecting station was begun in the Town Hall Yard. I hope that it will be in use by Easter of 1916. DISINFECTION. Our methods are stated in my report for 1914. A gross of blankets were disinfected in January for Eley's military guard. Disinfectants continue to be supplied to callers, mostly children, on the same lavish scale as heretofore. PUERPERAL FEYER. 7 cases were notified ; of these 6 were Edmonton women, of whom 5 died Our death rate is therefore just over 3 per thousand nett births', it was 1.16 last year. The Hornsey case was notified from the Edmonton Infirmary, but two from Tottenham and Wood Green were not, although all three died there, t Edmonton case was notified both by the private doctor and the Infirmary—1 who died in the Infirmary had been notified by a private practitioner, another 35 was notified by two doctors of the Infirmary. The sole survivor of the Edmonton women was notified from the Infirmary. During 1914-15 there were 279 midwives practising privately in Middlesex and 476 not practising ; besides, there were 18 engaged in poor-law infirmaries who are exempt from the provisions of the Act. In Edmonton there were 21 practising at the beginning of 1914 and 15 at the end of that year. 2 midwives were removed from the midwives' roll by the Central Midwives Board, and 13 were cautioned by letter and 15 verbally. During that year no uncertified women were prosecuted by the County Council for acting as midwives, but cautionary letters were sent to 3 of them, and 1 was verbally cautioned. OPHTHALMIA NEONATORUM. This disease was made compulsory notifiable by Regulations which came into force on the 1st April, 1914. There were 11 cases notified during 1915 by 14 notifications, of whom 1 notified to me from the Edmonton Infirmary belonged to another district. 1 baby died of an intercurrent disease. I case was doubly notified, i.e., by doctor and midwife, and 1 by two doctors and a midwife. Of the single notifications, 9 were from doctors and 2 from midvives. 7 out of 10 were in Bury Street Ward. ERYSIPELAS. 79 cases were notified, compared with 77 the previous year, besides 4 Belgians and 14 " foreigners," occurring in the Edmonton Union Infirmary. There were 4 deaths from this cause, 3 of them being " foreigners." 1 case was a child under 1 year old. 1 case was doubly notified. II cases occurred amongst people who were living in our district outside the Union Infirmary, and yet unable to provide proper attention for themselves. As the agreement with the Guardians had been renewed, my Council received remuneration for the nurses provided for those unfortunate persons on and after May 6th. The cases were most numerous in the first quarter of 1915. PHTHISIS AND OTHER TUBERCULOUS DISEASES. The deaths from phthisis numbered 73 (excluding 4 Belgians), as compared with 74, 72 and 60 during 1914-13-12. The death-rate from the disease is 36 therefore 1.04 per thousand. Of these deaths, 15 occurred among residents of the district in the Edmonton workhouse. The total deaths from phthisis in the Edmonton workhouse numbered 76 (including 4 Belgians). The other tubercular diseases together accounted for 21 deaths (excluding 1 Belgian), giving a death-rate of 0.31 per thousand. Of these deaths 1 was a resident of the district in the Edmonton workhouse. The total deaths from these diseases in the Edmonton workhouse nnmbered 15, including 1 Belgian death. In this way, tuberculosis contributed a total death-rate of 1.35 per thousand of our own population, or 11-2 per cent, of all the deaths ; it was 13 last year. The Senior Woman Inspector paid on this account 518 visits and re-visits during the year, compared with 552 the year before, and also 91 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, as before, some overlapping of visits with those of the County official. Tuberculosis Meat and Milk. See Section VI. of this Report. Institutional Accommodation. I have received the following information with reference to this : (1) Edmonton Workhouse and Old Infirmary. A few chronic cases are retained here, but all cases likely to benefit are transferred to Grosvenor Sanatorium, Kennington, near Ashford, Kent. (2) Refugee Cases. These are sent either to the Edmonton Old Infirmary, or an institution provided by the Metropolitan Asylums Board. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912 The total number of patients notified under these regulations was 276— 143 males and 133 females. The number of notifications was 406. Amongst the Belgian refugees there were 6 persons notified, 4 males and 2 females, by 12 notifications; all for pulmonary tuberculosis. Lungs- Patients notified once 132 „ „ twice 52 „ „ thrice 29 ,, ,, four times 3 216 37 Other Forms— Patients notified once 50 „ „ twice 9 „ „ thrice 1 60 The notifications are thus analysed :— Received from— Lung. Oilier Forms. Private Practitioners (A) m. 69 f. 53 m. 7 f. 4 S.M.I. (B) 4 3 0 2 Sanatoria (C and D) 65 66 7 7 Infirmary (A, C and D) 33 15 0 2 District Medical Officer 1 0 0 0 Hospitals (A, C and D) 6 11 20 18 Other Institutions (A, C and D) 0 1 0 0 Dispensary* 5 3 0 0 Voluntary 3 0 0 1 186 152 34 34 338 68 6 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) until this year, when he sent me one pulmonary case. Scholars. 9 children were notified by the School Medical Inspector during the year, as suffering from tuberculosis, 7 from pulmonary tuberculosis (4 boys and 3 girls), and the rest from other forms of tubercle. SANATORIA. A circular, conveying a list of sanatoria approved by the Local Government Board, under the National Insurance Act 1911, was submitted to the Sanitary Committee in March and again in October. THE ADMINISTRATIVE CONTROL OF TUBERCULOSIS IN MIDDLESEX. THE INSURANCE COMMITTEE. The Insurance Committees are central authorities set up in counties and county boroughs by the National Insurance Act, 1911, which authorities consist 38 of between 40 and 80 members. Middlesex Insurance Committee now has 80 members; one-fifth of this number represent the County Council, of whom two must be women; in addition there are 3 medical men. So there are 2 members of the County Council on the Insurance Committee for each parliamentary division, besides the 2 women and the 3 medical men. "Apart from expenses rendered obligatory by the ever-changing orders and regulations, the ordinary working expenses of approved societies and insurance committees call for full enquiry. There is ground for believing that the administrative expenses of many insurance committees are quite unnecessarily high. Some committees are almost as lavish in their printing and postage accounts as the Commissioners, and from time to time instances of reckless waste come to light which would be ludicrous, if they were not signs of a carelessness leading to serious extravagance. Under sanatorium benefit there is little doubt that in some areas persons in advanced stages of phthisis have been sent to expensive sanatoriums simply to satisfy a popular fancy, without the least chance of cure and when much cheaper forms of treatment might have been used with equal benefit. It may not be easy or even possible to calculate how far the complexities that have been uselessly woven around the Act are responsible for the waste of money in administration, but it is quite certain that the working of the Act could be made infinitely simpler, and that the result would be an enormous saving in administration expenses." From " The British Medical Journal," 19th December, 1915. The scheme of the County Council provides for the treatment of both the insured and the non-insured over the whole County. The Insurance Committee pays to the County Council, so far as its sanatorium funds allow, the actua| cost of maintenance of insured patients in institutions, and a proportion of the upkeep of the dispensaries. The treatment of insured persons began in July, 1913, and of non-insured persons in November, 1913. A revised agreement for 60 years has been arrived at, limited to the provision of 60 sanatorium beds and 40 hospital beds. Above these 100 beds the cost of institutional treatment for insured persons will fall on the County rate. The funds available for the maintenance of patients come now from four sources :— 1. yd. per head per insured person per annum from the Insurance mittee, estimated to produce £10,500. 2. A contribution, where possible, from non-insured persons towards the cost of their treatment. 3. One moiety of the balance from the Imperial Exchequer. 4. One moiety of the balance from the County Fund. 39 Under the Finance Act, 1911, the Government set aside a sum not exceeding £34,025, towards the capital cost of the Middlesex scheme ; payments are being made out of this fund from time to time as capital expenditure is laid out. DISPENSARIES. Edmonton, Tottenham and Enfield form No. 1 area of the 5 into which Middlesex is divided. The head dispensary of the area was opened at 56, Silver Street on 22nd October, 1913 ; there is a branch at Tynemouth House, Tottenham, but none in Enfield. A second nurse has been added to the staff of Dr. Cogill, the Tuberculosis Officer; his assistant, Dr. Trevor Davies, is on war service. SANATORIA AND HOSPITALS. In July, 1 1913, the County Public Health Committee decided to secure a site whereon to build a sanatorium. The negotiations to erect a sanatorium at Eastwood in Essex failed, because the Local Government Board on 30th July, 1914, refused their approval; but by the end of March, 1915, the County Council had secured a site of 221 acres for £63,300 at Mayland, Essex. However, although the plans providing for 314 beds were passed by the Board, the County Council decided in January, 1915, for financial reasons, not to apply for a loan at present. Probably, like many other municipal schemes, it is deferred until the Great War ends. Meanwhile, 80 beds are in use at Clare Hall Smallpox Hospital, 12 at Fairlight Sanatorium, Hastings, and 7 at Whitmead, Tilford. A supply of further accommodation at Clare Hall has been delayed owing to a difficulty of providing for sporadic cases of smallpox and the immediate clearance of the tubercular patients, if necessary. At Brompton Hospital, the Royal Seabathing Infirmary of Margate, and many other places, some 46 male and 14 female beds are filled, as occasion offers. HOSPITALS. For advanced cases 50 beds are reserved at the Northern Hospital at Winchmore Hill, and 30 female beds at St. George's Home, Chelsea, both through the Metropolitan Asylums Board, and 20 beds at Willesden Isolation Hospital. The dispensary at Hounslow (Area No. 5) has 17 beds for observation cases ; Edmonton patients have been notified as residing there in 1915. At the date of the Annual Report of the County Public Health Committee, 31st March, 1915, there were on the waiting list for sanatorium treatment 37 males and 28 females, and for hospital beds 56 males and n females. 40 Results of Treatment. Since the scheme was begun in July, 1913, up to 31st December, 1914, of 678 persons in sanatoria 37 per cent. have had the disease arrested or their working capacity (fully) restored, and of 238 in hospitals, 10 per cent. DISTRICT INSURANCE COMMITTEE. On January, 25th, 1916, the Council was informed by the County Council that the Insurance Commissioners had decided that the scheme for District Committees would not be extended beyond 31st December, 1915, but that the termination of the scheme did not prejudice the Commissioners' power to reconstitute them at any future time. The last meeting of the Edmonton Committee was 13th February, 1914, and of its Executive on the 6th May, 1914. 41 SECTION IIB. COMMUNICABLE DISEASES—NON-NOTIFIABLE. We can paitly judge of the prevalence of these diseases by the death returns. The deaths from measles have been over double last year, and the deaths from whooping cough have been 4 less. The deaths from diarrhoea have been 13 more than last year ; from influenza 3, 1 less than last year. A prompter and 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, as they should be, in accordance with section 7 of "Instructions to Teachers" issued by the Education Committee. DIARRHCEA. 45 deaths occurred from diarrhoea and epidemic enteritis, as compared with 58, 54 and 19 for 1914-13-12. The death-rate from the disease is 0.64 per thousand of the population, as compared with 0.85 last year. Of these deaths, 37 occurred in children under 1 year of age, giving an infantile mortality rate for the year from this cause of over 22 per thousand nett births; the figures in 1914-13-12 were 44, 22 and 8 per thousand nett births. 40 deaths were in children under 2 years; these contribute to the zymotic death-rate. There was also 1 Belgian infant under 1 year. In May, posters were issued on hoardings warning the public of the dangers due to the prevalence of flies, especially in hot weather, as productive of fatal diarrhoea amongst young children. In June, the Education Committee supplied the 34 departments of the public elementary schools with a map for the teaching of the life history of the fly. The Local Weather. The year was a fairly normal one, excepting with regard to rainfall, which was excessive. In July and December it exceeded 5 inches, whilst 4 days (1 each in May, June, July and September) were responsible between them for 5.43 inches of rain. The remarkable fact about the rainfall is that very little of it came down during thunderstorms, certain periods being persistently wet, hour after hour; but fortunately much of it fell during the nights. The sunshine was good and well distributed; the temperatures were far from extreme, as frost was only registered on 58 nights: of which 36 were in the early part of the year, and 22 in the closing months, but there was no day throughout the year when the frost held for 24 hours. [Abstracted from report of Mr. J. McEwan.] 42 MEASLES. There were 26 deaths noted, compared with 12, 48 and 15 in 1914-13-12. This number of deaths is equal to a death-rate from measles of 0.37 yer 1,000 living, compared with 0.18 last year. 6 occurred in the first-age period (under 1 year) 8 in the second-age (1 and under 2 years), 8 in the third-age (2 and under 5 years), and 4 over 5 years of age. All occurred in the first 5 months of the year, 15 of them in April. 5 deaths also amongst Belgian children. The Urban District of Greenford, after 7 years' experience, in 1913 discontinued compulsory notifications as the results were disappointing, and notifications from school teachers resorted to instead. The population of this village was then estimated at 1,245. During the Whitsuntide vacation, Houndsfield, Eldon and Montagu Road schools were specially disinfected. MEASLES REGULATIONS, 1915. In April, I submitted a circular letter, dated 31st Match, from the Local Government Board, advising my Council to adopt the compulsory notification of Measles, Rubeola, (formerly called German measles or rotheln) and Whooping Cough. The first case in a household was to be notified by a doctor (if one was in attendance) and subsequent cases by the parent. The Board offered to include in their Order a clause empowering the Council to provide, or contract for, medical and nursing assistance for the poor, who may be suffering from these diseases But no action was taken. However, on the 8th December, I submitted to the Sanitary Committee the Regulations (Order) of 27th November with a circular letter and memorandum thereon, which were distributed to every Councillor. This Order of the Local Government Board made measles and rubeola compulsorily notifiable throughout England and Wales. It comes into force on the 1st January, 1916. We were instructed to take all possible means to make this Order known to the public before 17th December, and the Education Committee assisted by distributing 12,000 leaflets in the schools for the information to reach the homes of the people. I made recommendation as follows:—"Of course in previous years some amount of attention has been given to measles, when notified to me by teachers or attendance officers. One visit at least was paid to the home by a woman inspector, in order that I might arrange for the exclusion of patients and contacts from school, day and Sunday. But now compulsory notification of every case, followed by a number of visits necessary to supervise each family 43 affected, will mean an enormous amount of work when an epidemic of measles arises, and a good deal even if there are only a moderate number of cases. "The duties of the Council and the Medical Officer of Health and of his staff, are briefly defined in Article IX. of the Regulations. If the Medical Officer is to take an active part in this home visitation, it will be necessary to have a vehicle at my disposal, which I could also use to enable me to take a greater personal interesi in the cases of tuberculosis. I would be willing to arrange for a motor, if £150 yearly are allowed me for the services of chauffeur, petrol, renewal of tyres, and.running repairs. A similar arrangement is found to give satisfaction in neighbouring localities. "In any case, the services of another woman officer will be required in the Public Health Department. She should preferably be a three years' trained nurse, who has obtained a sanitary inspector's certificate." My offer was not entertained. So I am unable to take the active part in this work which the Government require Medical Officers of Health to do. However, a letter was addressed to the Local Government Board stating that: "Although the Council has issued the required notices, they consider it very hard for this Order to be forced upon them under the present circumstances, as the Medical Officer of Health has estimated it will entail an expenditure of at least £300 a year to carry out these regulations properly," and asking if the Order could be suspended for the duration of the war. To this the Board replied on 16th December, 1915, stating that "it was felt necessary to issue the Public Health (Measles and German Measles) Regulations, 1915, because of the recent heavy mortality from measles, especially among young children, more particularly among children under the age of school attendance, and of the large number of cases which have occurred amongst the troops stationed in various parts of the country, that all possible steps should be taken in order to reduce the incidence and fatality of the disease, and it was hoped that with a minimum of outlay much good might be attained by the procedure prescribed by the Order." At the Council meeting of the 28th December, this paragraph of the Sanitary Committee was referred back and further considered by my Sanitary Committee on January 5th, 1916, who then reported to the Council of the 25th that:—" In view of the reply received from the Local Government Board, this Committee takes this opportunity to explain that, of the expenditure of £"300 a year, £150 was associated with an offer of your Medical Officer to purchase a motor car, provided this latter sum was contributed yearly by your Council for its maintenance. He pointed out that the provision of a motor car would enable him to take an active personal interest in visiting both cases of tubercle and measles. 44 "Your Medical Officer reported that all the necessary notices and advertisements under the regulations had been published. "Your Committee recommend that our representatives be instructed to ask the Joint Hospital Board whether some beds (limited to say, half-a-dozen) could be allocated to Edmonton for critical cases, or cases with bad home conditions, who might, therefore, be recommended for admission by your Medical Officer of Health." "The Medical Officer pointed out that notification is productive of much more good if provision can be made for the isolation of the worst cases; it is the sickness-rate, and not the death-rate from measles which is the real criterion of the extent of the Council's responsibility under the regulations; and as regards death-rate, the average death-rate from measles for the past 10 years was 0.320, as compared with 0.116 from scarlet fever, and 0.200 from diphtheria per 1,000 inhabitants. "The actual number of deaths was—scarlet fever, 53; diphtheria, 129; and measles, 203, for the years 1905-14." WHOOPING COUGH. There were 13 deaths from this cause, as compared with 17, 9 and 23 in 1914-13-12. This is equal to a death-rate from the disease of 0.19 per 1,000 living. All the deaths occurred amongst children under 5 years of age—6 in the first-age period, 4 in the second, and 3 in the third. Also 1 Belgian. They were distributed throughout the year, 4 in September. INFLUENZA. 3 deaths were registered from this cause, compared with 4, 7 and 4 for 1914-13-12. 2 persons were over 65 years of age, and the other was between 25 and 45 years old. VENEREAL DISEASES Syphilis. 9 deaths were recorded as due to this disease; 8 of these were infants under 1 year of age, and 1 of 15 months. Another was a newly born Belgian. Gonorrhoea. No deaths from this disease are recorded. The Royal Commission will be shortly issuing a report on these diseases. Let us hope that there will be no delay on the Government's part in putting their recommendations into effect, or like the report on the Poor Law, its work will be barren of results. 45 OTHER DISEASES. Alcoholism, I death from this cause was recorded amongst the residents. The death returns of this disease, as in the instance of venereal diseases, are most deceptive. Respiratory Diseases, including bronchitis, pneumonia, pleurisy, and other non-tuberculous diseases of the respiratory system, gave rise to 43 more deaths than 1914. The figures are 159, giving a death-rate of 2.28 per 1,000, compared with 116 and a death-rate of 1.07 for the latter year. Also 3 Belgians. Cancer. 52 deaths of Edmonton residents were registered as being due to cancer, and this is equivalent to a death-rate of 0 75, as last year. The deaths during 1914-13-12 were 51, 48 and 51. 46 SECTION III SEWERAGE AND DRAINAGE. 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 Halstead Road along Montefiore Place to Salmons Brook near by; Sadler's Millstream culvert has been inverted from Bury Street bridge to the Roman Catholic Church, Hertford Road. 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 culvert over Salmons Brook, west of Winchester Road, has been repaired. The invert under Pymmes Brook at Angel Bridge has been reconstructed and a new retaining wall erected at the end of Cuthbert Road. The sewer up Union Row, whose southern side is in Tottenham district, was repaired and extended. The drainage of houses in Gilpin Grove was modernised. 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 are 150 feet long by 100 feet wide. The progress with this new filter was delayed by lack of money and later by non-delivery of the iron sprinklers due to the war. However, on 20th September, our Engineer announced its completion, and in November the acid effluent from the Pegamoid factory was diverted to this bed. 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 6 bacteriological filters. House Refuse Disposal. Edmonton does not possess a destructor. The tender of Messrs. S. South & Sons for the collection of house refuse, for the year ending September 30th, 1916, at the price of ,£"1,600, was accepted. Scavenging. A circular letter, dated May 1915, with a report on scavenging in urban districts, was received from the Local Government Board in June. It is based upon reports received from the Councils in the early part of 1914. The methods of scavenging at present in force coincide largely with those recommended by the Local Government Board. 47 ROADS. The following private streets have been made during the year under the 1892 Act:—Gardenia and Solna Roads at Bush Hill Park—a total length of 462 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 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. At the end of the year the Metropolitan Electric Tramways Ltd. were promoting a Bill in Parliament to extend the time for exercising railless traction powers and for more time to complete the road widenings to 60 feet in Edmonton, as agreed in 1905 between the Company and the District and the County Councils. The wooden bridge over Pymmes Brook at Weir Hall has been replaced by an iron one. Silver Street widening, including the culverting of the brook south of Pymmes Park, has been suspended until after the war. In January, the Engineer estimated that it would cost £"7,000 to make Angel Road equal to heavy traffic by paving it with 4 inch granite blocks, but only the expenditure of £"90 was authorised to make a kerbed footpath for 200 yards alongside Pymmes Brook. At Midsummer negotiations were opened to improve Montague Road where it crosses the Great Eastern Railway line from Angel Road to Lower Edmonton. WATER SUPPLY. In a letter of June 29th, 1915, from the Metropolitan Water Board, submitted to the Council on 13th July, this policy was definitely stated, "whilst the Water Board require the provision of storage cisterns, as a precaution against accidents to, or the necessary shutting down of, mains, they strongly encourage the provision of taps on the rising main, and afford all necessary facilities in that direction." In years gone by it was often stated by builders and owners to me that a drinking water supply was not laid from the main over the sink because the Water Board would not allow a house to have this hygienic method of obtaining water for drinking, otherwise than from a cistern, which was often to be found without a cover, and perhaps under a bedroom floor, or in other unsuitable position. 48 The water which the Lea Conservancy Board controls runs from Hertford to Limehouse. They also took over the Stort navigation in 1912. The Middlesex Council's representative is County Alderman Nield, K.C., M.P., who reports twice yearly to his authority. 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. Mr. Nield states (March 1915) that the Stort navigation has been placed in an efficient condition for half its length and that analytical reports show that the water above the intakes of the Metropolitan Water Board is in a high state of purity. COSTERS. In February, Boots' Drug Company on the Green complained of unfair competition of a coster's stall opposite their shop, and offered to rent the stall themselves. SEWAGE DISPOSAL. The Royal Commission on this matter, so important to growing urban districts like Edmonton, was appointed by Queen Victoria on the 7th May, 1898; it issued 9 reports in the course of an existence of 17 years, and a final one in February, 1915. 49 SECTION IV. HOUSING AND TOWN-PLANNING. 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. 300 copies of these by-laws were printed in June—without revision. INSPECTION OF PREMISES. Number of premises inspected on complaint 267 Number inspected in connection with infectious disease 504 Number under periodical inspection 854 Houses inspected 213 Total number of inspections and re-inspections 14,373 ACTION TAKEN (OTHER THAN UNDER H. & T. P. ACT) Cautionary or intimatory notices given 739 Statutory orders issued 583 Summonses served 1 Convictions obtained 1 HOUSING REGULATIONS, 1910. ARTICLE V. Number of dwelling houses inspected under Section 17 of the H. and T. P. Act, 1909 0 Number of them considered dangerous and injurious, so as to be unfit for human habitation 0 Number of representations made to local authority with a view to making of closing orders 0 Number of closing orders made 0 Number of houses where defects were remedied without making of closing orders 3 Number of premises closed voluntarily 0 Number of premises demolished voluntarily:— (a) Without closing order 0 (b) After closing order 0 50 Illegal underground rooms vacated 0 Number of premises dealt with under Section 15 of the H. and T. P. Act, 1909 0 Number of houses on which closing orders existed at end of year 0 Note.—The beggarly array of figures in the above table is due to the absence of our Housing Inspector on war service. Mr. Huckle was temporarily engaged until July 14 and thereafter this important work collapsed, as my Council decided not to fill the vacant post. From the date mentioned to August 4th Mr. Huckle was engaged, taking over the duties of a permanent general inspector. Overcrowding. During the investigations made by myself and staff into the origin of infectious diseases, many cases of overcrowding came to lightIn 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 ounty 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. ACTION UNDER HOUSING AND TOWN PLANNING ACT, 1909. 56, 64 and 68, West Street. These premises were taken in hand by the Council in December, 1914, as the owner had failed to repair them, and in March fresh notices were served on the owner under Section 15. As she refused to pay the Council's bill for repairs, on the 14th October the Magistrate at Tottenham Police Court made an order for the payment of the amount of £72and costs by £5 a month. HOUSING AND TOWN PLANNING COMMITTEE. The action of this body has been in suspense throughout the year. Whether there will be no further progress in this important work until Mr. Hembrow, the Town Planning Assistant, returns from war service, I cannot say. Meanwhile, builders and owners are allowed to proceed on the bad oldfashioned lines. In April copies of the report of an Investigation Committee on " Arterial Roads" were presented to my Council, who are greatly interested in the proposed North Circular road from W. to E., and the Cambridge road from S. to N. which will probably cross one another in the southern part of Edmonton. 51 Our Engineer has kept in close touch with the question of arterial roads through Middlesex and Essex. A conference of authorities in May, 1916, is expected to place the subject on a tangible basis. In November my Council became aware of the approaching development of the large Booker estate on the borders of Tottenham and Edmonton. This is the S.E. part of the area where factories exist, and is well provided with transport facilities by rail, road or the Lea Navigation. I hope that my Council will see that this area is developed on wise and healthy lines. TOWN-PLANNING CONFERENCE. This Conference, convened by the National Housing and Town-Planning Council, was held at the Westminster Palace Hotel on April 20th and 21st. I was one of 5 representatives of Edmonton. It considered (1) the various stages in the detailed preparation of town plan schemes (2) the administration of the Housing Act (No. 2) 1914, during the war. Representatives were invited from Greater London, Middlesex, Essex, Herts, Kent, and Surrey. 52 SECTION V. LEGISLATION OF 1915. ACTS, CIRCULARS, ORDERS, REGULATIONS, etc. The Slaughter of Animals Order of the Board of Agriculture, 22nd June, under the powers of the Slaughter of Animals Act, 1914. The Maintenance of Live Stock Order, 18th August, which superseded the before-mentioned Order; also a memorandum and a circular, 21st August. This was amended by Order of the 31st March, 1916, and comes into force 10th April, 1916. The Board of Agriculture supplied leaflets, which were distributed to occupiers of slaughter-houses in Edmonton. Measles. Local Government Board circular letter of the 31st March. Regulations (Order) of the 27th November; circular letter of the 29th and memorandum of the Chief Medical Officer. Cerebro-spinal Fever. Circular letter, 22nd February, memorandum and schedule from Local Government Board. Shellfish. Circular letter, 17th February, and regulations, 1915, which came into force on 1st March. Outworkers. Circular letter from the Home Office, 29th January advised Local Sanitary Authorities to strictly enforce the provisions of the Factory Acts as regards homework in connection with soldiers' clothing. Notification of Births (Extension) Act, 1915, came into force on 1st September in the United Kingdom and Ireland. Sanitary conveniences in shops. Circular letter from the Local Government Board of the 14th June. Scavenging in Urban Districts. Circular letter, May, from the Local Government Board and report thereon. Tuberculosis, Treatment of. Sanatoria, list of, approved in February and October. Circular of the Local Government Board, 29th April, with reference to the development of schemes, especially as regards children. Circular of Local Government Board of the same date, with reference to the same subject in London. Maternity and Child Welfare. Circular (joint) or memorandum of Local Government Board and Board of Education, 31st May, as regards 53 grants-in-aid of maternity centres and school for mothers. Regulations of the 7th July regarding grants to maternity centres by the Local Government Board. The Board will not pay grants to "schools for mothers." Regulations of the 6th July respecting grants to schools for mothers by Board of Education. Milk and Dairies (Consolidation) Act, 1915, empowers the Local Government Board to issue Orders for purposes there defined, and to stop supply, or sale of tubercular milk, &c.; it comes into operation one year after the war is ended. It only extends to England and Wales, and repeals the Act of 1914. 54 SECTION VI. PLACES OYER 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 has not been asked for this year by the Home Office. Section 22 of the Public Health Acts Amendment Act, 1890, has been adopted by the District Council. The standards of sufficiency and suitability of sanitary accommodation for persons employed in factories and workshops have been enforced, and are those advised by the Home Office. 2.—Common Lodging House. There is only one in the district. It has accommodation for men only, and is an ancient structure. Albert Denning has been registered under section 69 of the Public Health Acts Amendments Act, 1907, as keeper for one year, and Alfred Bowles as deputy keeper. 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 absence of a special inspector leaves this work in abeyance. 4 —Slaughter-Houses. There are five on the register, one of old registration. In April, annual licenses were issued to Mrs. Jane 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. In Knifton's case, the license was endorsed to prevent him permitting other people to slaughter there. N. A. Barrett, 188, Fore Street, was granted a 3 years' license from December, 1914. 5.—Knackers. The yard, of which plans were approved on October 28th, 1914, and license for one year granted in the next month, has not yet been erected as proposed on land south-west of Eastbournia Avenue. 6.—Pigs. Notices under bye-law 10 of the nuisance bye-laws were served, and the keeping of pigs discontinued in styes in Union Row, at 164, Hertford Road, and 36, Sebastopol Road. In May permission was given to erect 2 styes (under a temporary agreement) on the allotments off Weir Hall Road, and in August 6 styes were allowed to be built on 79 plot of Weir Hall allotments, and in November 2 styes at 226, Fore Street. 7.—Dairies, Cowsheds and Milkshops.—There are only 2 cowkeepers now in the district, the same as last year; and only 24 cows are owned 55 by these keepers. Veterinary inspection of the cows is not undertaken in this district, either by my Council or the County Council. There were 93 purveyors of milk on our register at the end of the year. The operation of the Milk and Dairies Act, 1914, was further postponed by a special Act to " not later than 1 year after the termination of the War," and now has been repealed by a third Act. 8.— Unsound Food. In August a tuberculous pig was surrendered. On November 25th unsound bacon was seized at a provision dealer's on The Green, for exposing which for sale he was fined £10 and costs. 9.—Gutscraper. In July, attention was drawn to the establishment of a second one of this offensive trade on the banks of the Lea Navigation, by Messrs. Dawkins & Co., without the written consent of the Council. In September the Council decided not to give such consent, and the business closed. 10.—Marine Stores. The Council exhibited posters, dated 7th April, notifying that proceedings would be taken against any persons commencing this business without its written consent, in accordance with the laws and byelaws regarding offensive trades. On the 7th June I expressed my objection to the extension of a rag, bone and skin store at 70, Claremont Street, which years ago was in a comparatively isolated situation, but has now houses close at hand. I therefore considered that the Council should do all that is possible to secure the removal of this business to a more suitable position. Complaints about offensive smells and rats harboured by this offensive trade reached me before and after this date. However, the Plans Committee approved of these plans on June 9th. In October a petition against the continuance of the business was received by the Sanitary Committee, who recommended that if the nuisance was not abated in 14 days, legal proceedings should be taken. In September, the Sanitary Committee recommended that permission to establish one at 16, Hertford Road, be refused. In October, from the same person, consent was withheld as regards 170, Town Road; at the same time a business was reported at 45, St. Mary's Gardens as established without consent, and it was decided to take legal proceedings if the business was not discontinued. 56 TABLE I. Vital Statistics of Whole District during 1915 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. Number. Rate per 1,000 Nett Births. Number. Rate. I 2 3 4 5 6 7 8 9 10 11 12 13 1906 56,818 1,881 1,822 3207 915 15.55 2 59 124 248 131.84 783 1378 1907 59.413 1.923 1,857 31 24 977 15.89 309 124 225 12.16 792 13.32 1908 60,182 2,000 1,931 3209 902 1450 297 129 227 117.41 732 1216 1909 61,164 1,871 1,803 29.48 890 14.09 325 110 182 100.39 675 11.03 1910 61,741 1,961 1,878 30.42 872 13.56 376 94 140 74.55 587 9.51 1911 63,146 1,921 1,847 29.25 1,219 18.68 489 100 265 143.48 830 13.14 1912 65,084 1,844 1,765 27.12 1,126 16.76 563 103 149 84.42 666 10.23 1913 66,552 1,912 1.862 27.98 1,184 17.31 501 111 196 105.26 794 11.93 1914 68.203 1,922 1.859 27.25 1,233 17.67 591 94 159 85.53 736 10.79 Includ'g. Belgians 68,908 1,946 1,883 27.41 1.238 17.67 591 94 159 85.53 741 10.79 1915 69.774 1,694 1,666 23.88 1,227 I7.45 543 136 186 111.64 817 11.71 with Belgians 70,464 1.725 1,697 24..08 1,246 I7.55 543 137 194 114.32 837 11.88 Notes.—This Table is arranged to show both the gross births and deaths in the district, and the births and deaths properly belonging to it with the corresponding rates. The rates in column 7 are calculated per 1,000 of the gross population. In this district in which large Public Institutions for the sick and infirm seriously affect the statistics, the rates in columns 5 and 13 are calculated on a nett population, obtained by deducting from the gross population the average number of inmates not belonging to the district in such institutions. The rate in column 11 is calculated on the nett births. *In column 6 are included the whole of the deaths registered during the year as having actually occurred within the district, but excluding the deaths of soldiers and sailors that have occurred in the district. Area of District in acres (land and 31 acres of inland water) 3,894 Total population of all ages 64,797 Number of inhabited houses or tenements 12,491 At census of Average number of persons per house or tenement 5.00 including Institutions 5.19 1911. TABLE II.—All Cases of Infectious Disease notified during the year 1915. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward or Institdtion. Residents Removd to our Hospitl At all Ages. At Ages'—Years. 1 2 3 4 5 6 7 Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwds. Bury Street Ward Ch'ch Street. Fore Street Resdnts. in Edmtn.. Workhse. Total of , Resdnts. Others in Edmtn. Workhse. Belgian Refugee. Diphtheria (including membranous croup) 96 1 35 53 4 3 .. .. 23 29 37 .. 89 3 4 86 Erysipelas 97 4 4 9 8 29 26 17 25 32 21 1 79 14 4 .. Scarlet Fever 304 1 60 197 33 12 1 .. 91 117 72 1 281 3 20 264 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 12 .. 1 2 4 4 1 .. .. 3 2 .. 5 3 4 4 Puerperal Fever 7 .. .. .. .. 7 .. .. 1 2 .. .. 6 1 .. .. Cerebro-Spinal Meningitis 6 .. 2 1 1 2 .. .. 1 .. 2 .. 3 3 .. 1 Poliomyelitis 2 .. 2 .. .. .. .. .. 1 1 .. .. 2 .. .. .. Ophthalmia Neonatorum 11 11 .. .. .. .. .. .. 7 1 1 1 10 1 .. .. Pulmonary Tuberculosis 222 see "Women Inspectors' Work" .. .. .. .. .. .. .. 6 .. Other forms of Tuberculosis 60 .. .. .. .. .. .. .. 0 .. Totals 817 17 104 262 50 57 28 17 149 185 135 6 475 28 38 355 57 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, solation Hospitals and Sanatoria, &c.:— 1. Enfield and Edmonton Joint Isolation Hospital at World's End, Winchmore Hill, is in the Urban District of Enfield. 2. Clare Hall Small Pox Hospital and Sanatorium for consumptive persons. This is situate in the South Mimmsrural district of Middlesex an belongs to the 17 Middlesex districts. ' 3. There is a building on Clavering's Farm, Edmonton, capable of taking of male and 6 female small-pox cases. Cases of infectious disease occurring amongst soldiers and sailors are not included in this table, but a separate Statement about these, as far as known, is given in the foreword. 58 TABLE III. Deaths registered during the Calendar Year 1915 classified by age and cause. The Belgian deaths are in brackets. Causes of Death. Nett Deaths at the subjoined Ages of "Residents" whether occurring within or without the District. Total Deaths whether Residents or ' non- Resid'nts' in Institutions in the District. All Ages Under 1 year. i and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 II All causes Certified 836 194 53 49 42 34 112 163 189 692 Uncertified One in County List. 1 NonResi dents Total Enteric Fever 2 .. .. .. .. 1 1 .. .. .. 2 Small-pox .. .. .. .. .. .. .. .. .. .. .. Measles 29 6 10 (2B) 9 (*IB) 4 .. .. .. .. •• 2 Scarlet Fever 8 .. 1 3 3 1 .. .. .. .. •• Whooping Cough 14 6 5 (IB) 3 .. . .. .. .. 1 2 Diphtheria and Croup 8 1 .. 3 3 1 .. .. .. .. .. Influenza 3 .. .. .. .. .. .. 1 2 .. .. Erysipelas 1 1 .. .. .. .. .. .. .. 3 3 Phthisis (Pulmonary Tuberculosis) 77 1 3 .. 5 (2B) 12 39 (IB) 15(IB) 2 56 76 Tuberculous Meningitis 11 4 4 3 .. .. .. .. .. 3 4 Other Tuberculous Diseases 11 2 (IB) 2 1 3 .. 2 1 .. 10 11 Cancer, Malignant Disease 52 .. .. 2 .. .. 6 31 13 61 69 Rheumatic Fever 3 .. .. .. .. .. 2 1 .. .. .. Meningitis 9 2 2 2 2 1 .. .. .. .. .. Organic Heart Disease 72 .. .. .. .. 3 11 25 33 85 106 Bronchitis 49 13 2 .. .. 1 2 8 23 35 43 Pneumonia (all forms) 103 29 (IB) 14 (IB) 12 (2B) 3 .. 10 15 20 24 33 Other Diseases of Respiratory Organs 13 1 1 1 .. .. 1 6 3 11 17 Diarrhoea and Enteritis 46 38 (IB) 3 1 3 .. .. 1 .. 13 20 Appendicitis and Typhlitis 4 .. .. 1 1 .. 2 • • .. 3 4 Cirrhosis of Liver 3 .. .. .. .. .. 1 2 .. 4 4 Alcoholism 1 .. .. .. .. .. .. 1 .. 3 3 Nephritis and Bright's Disease 26 .. 1 .. .. 2 7 8 8 17 27 Puerperal Fever 5 .. .. .. .. .. 5 .. .. 3 8 Other Accidents and Diseases of Pregancy and Parturition (Mother) 2 .. .. .. .. 1 1 .. .. 2 3 Congenital Debility and Malformation, including Premature Birth 57 57 (IB) .. .. .. .. .. .. .. 4 5 Violent Deaths, excluding Suicide 32 5 •• 3 5 3 4 8 4 12 16 Suicide 3 .. .. .. .. .. 1 1 1 .. .. Other Defined Diseases 188 28 (3B) 4 3 10 9 17 38 79 193 234 Diseases ill-defined or unknown 5 .. 1 2 .. .. .. 1 1 •• •• Totals 837 194 53 49 42 35 112 163 189 543 692 *This Belgian was returned among County deaths. Sub-Entries included in above figures Cerebro-spinal Fever 61 A Acute Poliomyelitis None: see article on subject. 59 Edmonton Urban District Council. REPORT of the Chief Sanitary Inspector For the Year 1915. 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 1915 by your Inspectors and Staff. The present year having been one of great stress, we have experienced many difficulties in getting work done, owing to the shortage of mechanical labour. Many owners have willingly endeavoured to find men to carry out this work, while some have taken the opportunity to do as little as possible under the pretence that "they cannot get labour." However, by tact and persuasion, we have got more work done than I anticipated. TEMPORARY HOSPITAL, DISINFECTION STATION AND REMOVAL OF PATIENTS TO HOSPITAL. Mr. Mettam, who occupied the Temporary Hospital since the close of the small-pox epidemic in 1902 and acted as caretaker and disinfector, owing to ill-health, resigned his position in September last, to take a well-earned rest; but he only lived a few weeks after leaving the premises. Although a sufferer for some time he stuck to his post, and we regret his loss. The Steam Disinfector and Mortuary Attendant has since occupied the premises. I trust that the proposal of the Small-pox Joint Hospital Board to take 6o over the premises as a temporary emergency hospital during the war will soon take effect, as the building is requiring some outlay on repairs. Owing to the mortuary attendant being on military service, the transport officer took over the duties of steam disinfector and mortuary attendant. The transport officer's duties have been taken over temporarily by Mr. Adams, who has carried out his work in a very creditable manner. As soon as the new disinfecting station, which is now in course of construction at the Town Hall yard, is finished, this will enable the work of steam disinfection to be carried out by the mortuary attendant, both buildings being in close proximity and will, I hope, facilitate the work generally. The following is a list of the work carried out in connection with infectious diseases:— No. of journeys of ambulance to remove patients to Joint Hospital, Winchmore Hill 282 No. of journeys of bedding van to remove infected bedding 245 No. of journeys of bedding van to return bedding after disinfection 233 No. of journeys of brougham to fetch patients from hospital 210 No. of patients returned to their homes from the hospital by the brougham 398 No. of rooms disinfected after infectious disease 450 No. of articles of bedding, etc., disinfected 4150 No. of articles of bedding, etc., destroyed 41 No. of books disinfected 60 No. of rooms disinfected after phthisis 186 No. of articles of bedding, etc , disinfected after phthisis 650 No. of articles of bedding, etc., destroyed after phthisis 21 No. of rooms disinfected for verminous bedding and vermin 53 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. ERYSIPELAS. During the year 11 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. The cost of nursing, etc., was £50 16s. 11d. Many expressed their gratitude for the attention they had received. DISINFECTANTS. The public continue to avail themselves of the opportunity generously afforded them by the Council, of obtaining disinfectants (powder and fluid) 61 This entails a great amount of labour, but no doubt the results are beneficial, if only to encourage cleanliness. Disinfectants are also supplied to all other departments when required. The number of applicants for the year was 26,410. MALE AND FEMALE LAVATORIES, PUBLIC AND PRIVATE URINALS, FOUNTAINS, WATER TROUGHS, &c. There are now 4 water troughs and 10 drinking fountains in the district, but owing to much wilful damage to the fountains, 4 were discontinued. Although I have communicated with the Police, this wilful damage has not diminished. The lavatories for both sexes at the Green and Angel Road continue to be much patronised; free accommodation being provided for both sexes. The amount collected from the W.C.'s and Wash and Brush-up on the Green during the year was £175 5s. 5d., an increase of £61 9s. 5d. on the previous year. The amount collected from Angel Road was £208 9s. 2d., an increase of £75 5s. 2d. on the previous year. I am hoping to see these lavatories self-supporting. If the Council erected a similar lavatory at the northern end of the district, which is no doubt needed, it would be wise to erect a greater number of W.C. accommodation than at present provided at Angel Road and the Green, as the call for these is great, and increases the returns considerably. No change has occurred among the permanant attendants during the year, and they continue to carry out their work in a satisfactory manner. The Sunday attendants are continually changing, chiefly due to the fact (although men advanced in years) that they can now get more regular employment. MORTUARY. During the year the total number of bodies received into your mortuary was 95. There were 50 bodies deposited by order of the Coroner, and 13 deposited by the Police. 64 post-mortem examinations were made. 23 bodies were deposited by undertakers to await burial, and 10 were detained owing to the bodies being of an infectious nature. 4 cases were notified to the Relieving Officer for burial by the Parish. 62 The mortuary attendant is away on active service and temporary arrangements have been made to carry on the duties, which have worked very satisfactorily. DUST COLLECTION. The collection of dust is still carried out by contract. The district for the purpose of collection is divided into 3 parts. The number of vans employed regularly is 6, with extra picking-up vans for holidays, and the clearing of refuse from the Edmonton Infirmary, and also from the Metropolitan Asylums Board institutions, now occupied by Belgian refugees, and I can only reiterate my former remarks that the number of vans is insufficient. The district should be divided into 4 parts, and there should be at least 8 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, prove 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 present crisis it is difficult to get labour. The Council's dust shoot at the Sewage Farm will become filled up in a year or two, and as it will make it too difficult and dangerous for the horses to deposit their loads if the shoot is raised, it will be necessary to provide another shoot or, better still, build a destructor. The number of van loads collected during the year was 3,910; approximate weight of refuse deposited was 6,812 tons. The number of complaints received was 31. The dust on the shoot is still spread, levelled and the sleeper road kept in repair, by a man who in return for his labour, gets the glass, bones, &c., that he finds on the shoot. I regret, however, we have not been able to dispose of the old iron and tin ware, as there is now a huge accumulation which would be better away from the shoot. The number of dustbins supplied was 282. SLAUGHTER HOUSE AND FOOD INSPECTION. The number of slaughter houses in the district in use is 5, 4 of which are licensed under the Public Health Acts Amendment Act 1890, and one registered, this having been in existence for a great number of years, in which for the past 3 years only pigs and sheep have been slaughtered. 63 The periodical lime-washing is carried out, indeed, many lime-wash much more often than is laid down by 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 Act 1917" having given the local authorities the power to license from year to year). The slaughter houses in the district are under regular inspection by MrWinter, the Chief-Assistant Sanitary Inspector, who endeavours to be present at the time of slaughter, but unfortunately there are no laws that compel a butcher to notify when he is killing animals, and we have frequently found killing taking place on Sunday mornings. Notice should, in my opinion, be given to the Inspector in all cases when slaughtering is about to take place, as this gives a better opportunity of observing the condition of the animals before the organs and offal are taken away. 310 visits have been made during the year. The number of animals inspected during the slaughtering operations was:30 oxen, 34 cows and heifers, 135 sheep and lambs, and 876 pigs. The following unsound meat and offal was surrendered and destroyed:— 3 pigs, 6 pigs' heads, 5 pigs' plucks, 1 sheep's pluck, 1 ox lungs, and mesenteric fat. During the year the following foods were examined, surrendered, and destroyed:—17 rabbits (frozen), 1 crate bananas, 12 boxes tomatoes, 2 trunks mackerel, 1 basket potatoes, 31 baskets strawberries, 1 box mackerel, 10 baskets red currants, 1 barrel of conger eel, 3 barrels of sprats, and 1 bag of mussels. Herewith I append a statement of the work done under the "Sale of Food and Drugs' Act" by the Middlesex County Council Inspector for this district, kindly supplied by the Chief of the County Food and Drugs Department. Articles. Samples taken. Samples adulterated. Butter 187 7 Milk 70 29 Tea 2 — Coffee 2 — Raisins 1 — Totals 262 36 No. of prosecutions 14 No. of convictions 9 pines £8 16s. 0d. 64 WATER SUPPLY. Daring the year a number of private houses that derived their drinking water from shallow wells by means of pumps, have now had a Metropolitan Water Board supply laid on. The storage cisterns are placed in a most objectionable position, and had your officials been consulted on the matter before the water was laid on, they would not have passed storage cisterns in such a situation. SHOPS' ACT, 1912. The work of administering this Act is carried out by Mr. Winter and myself, and much time has been spent in watching for offenders. A great majority of the traders adhere strictly to the Act, but we have received complaints from time to time of the mixed shops evading the Act. They serve to their known customers, while strangers are refused. This nefarious trading will not be stopped until all the mixed shops are made to close on the general closing day. I have endeavoured to get these traders to define their particular business, but the goods they sell are so varied, it is difficult to define. DAIRIES, COWSHEDS AND MILKSHOPS, &c. The number of cow-keepers on the register is 2; while the number of cows varies from time to time; at present there are only 24. The cow-keeper with whom we had trouble last year, owing to him keeping cows in unsuitable premises, has since given up the building, and reduced the number of cows kept in his cowshed. The number of milksellers on the register is 93, 29 of these are practically devoted to dairy produce, 9 were added during the year, and 12 removed. There were 29 inspections made to cowsheds and 253 to dairies and milkshops. There were 18 inspections made to premises where ice cream is sold. Most confectioners gave up the making of ice cream owing to the increase in the price of sugar and ice. OFFENSIVE TRADES, PIG KEEPING, &c. A firm commenced the business of a gut-scraper at the old varnish works, Lea Side. Fortunately we have got this particular offensive trade prohibited 65 from being established without the written consent of the Council. After some considerable correspondence they removed to another district. The offensive trade that commenced operations in 1911 in this district, viz., gut-scraper, is still in existence. The premises have been visited from time to time, but the work is not carried out under the conditions it should be. The premises are regularly visited, and are kept as cleanly as circumstances will permit. From pig keeping during the year very little trouble has arisen, no doubt, due to the fact that pigs have been scarce; but the boiling of the waste products from London restaurants, and extracting the fat has given rise to trouble. CANAL BOATS. The number of canal boats inspected was 23. Special difficulty exists in this district owing to the canal being some distance from dwelling houses generally, thus necessitating special and exclusive visits, which occupy much more time than would be the case if the canal ran through the more thickly populated part of the district, as the inspections could be carried out with the general work. The following contraventions of the Acts and Regulations were dealt with : 2 dirty cabins. 1 cabin required painting. All of which have have been remedied. Although the number of boats on the river is on the increase, the registered boats are on the decrease. Speaking generally, the canal boats registered by districts abutting on the Lea are in good condition, and are seldom occupied other than by males. The work done under this Act is annually supervised by H.M. Inspector of Canal Boats. In drawing this report to a close, I have endeavoured to curtail it as far as possible, and have only mentioned those matters on which I think some comment should be made. Although the tabulated statement attached will give some of the headings under which the work is done, it does not represent by any means the multifarious duties that come under the supervision of the Department. During the year proceedings were taken against the owner of three houses for the recovery of the sum of £72 11s. 5d., money expended in making the houses reasonably fit for human habitation, under Section 15 of the Housing and Town Planning Act, 1909. The defendant was ordered by the Court to pay £5 per month and the cost of the proceedings. However, no money has 66 yet been paid into Court, and what with the difficulty in carrrying out the work while the occupiers were on the premises, and in all probability, trouble in recovering the money, it is not much encouragement to proceed again under this Section. The systematic house to house inspection has practically ceased, as it has taken all the available time to keep pace with the ordinary routine work. The Gipsies nuisance has not been so great as in former years, although 135 vans have been removed, which necessitated 216 visits. The Common Lodging-house has been well kept during the year, and 113 visits have been made, but the matter of dealing with these old premises must be left till a later date. Two pieces of land, viz., one at the corner of Town and Marsden Roads, and one at the corner of Bounces and Eldon Roads, have been fenced in under Section 31, Public Health Acts Amendment Act 1907. This has done away with the many nuisances that occurred here. There are 34 factories and 70 workshops; also 540 out-workers. A number of contraventions were found to exist and these have been remedied. 98 visits were paid to the factories, 312 visits to the workshops, and 736 visits to the outworkers. The three unfortunate women who kept a number of cats in their living and sleeping room, under the most filthy and disgusting conditions possible, and who owing to their obstinacy caused the Department so much trouble, eventually had to be summoned to abate the nuisance. They were fined 5s. per day and costs for not abating the nuisance (£6 10s. in all). They never paid the fine, but I am pleased to say they disappeared from the district. A change took place in the Department during the year, Mr. Coates, the second Assistant Inspector, having obtained an appointment at Buxton, Mr. Huckle was appointed to fill the vacancy, who I am pleased to say, has carried out his work in a most satisfactory manner. During the year, Mr. Farrar left the office to serve his King and Country, being the fourth to leave this department, and we trust they may be spared to return to us when the war is over. It once more gives me 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. 67 Annual Report for 1915 II. On the Health of the Scholars in the Urban District of Edmonton. SIDNEY C. LAWRENCE School Medical Officer. 2 FRANK E. ROCK temporary officers: Deputy and Assistant School Medical Officer; Since February 1st, 1915. School Medical Inspector. 2 R H STRONG Assistant School Medical Officer; 3 NORA PLAYNE School Medical Inspector. School Nurse. 3 Mrs.HOBBS 4 HAROLD DYER School Nurse. School Medical Clerk 4 None. Nos. 2, 3 and 4 are on War Service. 68 EDMONTON EDUCATION COMMITTEE. REPORT of the School Medical Officer for the Year ended December 31 st, 1915. Town Hall, Edmonton, 5th June, 1916. To the Chairman and Members of the Edmonton Education Committee/ Ladies and Gentlemen, I herewith submit my fourth Annual Report as School Medical Officer. It is not one which affords me much satisfaction, as the conditions under which the work has been done have not kept it, either in quantity or quality, up to the standard of years prior to the outbreak of war in August, 1914. Some of the difficulties met with were unavoidable, but others could have been dealt with effectively. I refer to the depletion of my staff in the forword of my report as M.O.H., and particularly to the failure to fill the vacancy of School Medical Clerk after J. Farrar enusted in November, 1915. Dr. R. H. Strong and Mrs. Hobbs commenced duty on February 1st as the temporary officers, so that the routine inspection was carried out for 11 months only. His report to me on the subject is condensed as much as possible, and so is my own portion of this Annual Report, in accordance with the wishes of the Board of Education. These two officers have worked well, despite the novel conditions. The education of the Belgian children amongst the refugees is being looked after by Roman Catholic nuns, who speak Flemish. A few of these youngsters attend our Silver Street School. I am, Your obedient servant, SIDNEY C. LAWRENCE. School Medical Officer. 6g THE SCHOOLS OF EDMONTON. (17 in Number.) Public Elementary Schools number 11 Secondary Schools „ 1 Private„ 5 The boys' private school at Weir Hall has ended its short career. TECHNICAL INSTITUTE. The Technical Institute was opened on Saturday, September 28th, 1912; it was erected on the site of the old Latymer School in Church Street. Provision for extension of the building, when necessary, has been made. Mr. H. Farrands, M.A., is the Secretary. 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. A. Ashworth, B.A., Lond. A precept of £55 for higher education was issued by the Council on the Overseers in March and again in October. PUBLIC ELEMENTARY SCHOOLS. I. Non-provided 4 schools, 8 departments. II. Provided 7 schools, 26 departments. The management of these schools has been delegated by my Council to an Education Committee, which consists of 15 members of their own body and 2 ladies as co-opted members, one of whom is a headmistress. Since July, 1908, no children under 5 years of age have been admitted. Domestic Subjects. On 12th January, 1915, the Council agreed, on the recommendation of the Education Committee, to purchase a site for a domestic subjects and handcraft centre at the south-west corner of Croyland Road School, and in February the Board of Education provisionally approved of our Architect's plan. On the 13th April, the Council decided to abandon 70 negotiations owing to restrictions laid down by the vendors, which would have rendered the site useless for our purpose. At the request of the Education Committee, the Council, in 1914, 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, but the project will not be carried out during the war. Bush Hill Park. The rapid development of this northern part of the district necessitated an agreement in October, 1906, 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 286 this year. No Edmonton scholars under 5 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, 1915-1916, this wholesome practice has been continued as far as the boys are concerned. A woman instructress has been appointed for the girls, but the boys are taught by their class teachers. Building Operations. Nothing has been done beyond the ordinary repairs necessary to keep the buildings in good order. Attendance. Mr. Heap has kindly furnished me with the following figures for this and the next two tables:- End of June, 1914. End of June, 1915. Number on books. Average attendance. Number on books. Average attendance. Non-provided Schools 2300 2039.3 2276 3056.4 Council Schools 11162 10148..9 11219 10183.5 Totals 13462 12l88.2 13495 12239.9 There were 13,495 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 286; so that there is in Edmonton 1 child in the public elementary schools for 5.1 inhabitants (reckoned on the nett population); 4.9 last year. The number of children on the books of the elementary schools of the district at the end of June, 1915, was 13,495, and the accommodation was 4.365. 71 The accommodation and the number of children attending each school are given below:- School Infants. Junior Mixed. Girls. Boys. Accom. No. on Books. Accom. No. on Books. Accom. No. on Books. Accom. No. on Books. Brettenham Road 437 301 - - 458 408 459 446 Croyland Road 369 307 420 403 369 303 537 541 Raynham Road 576 500 600 508 540 468 660 585 Eldon Road 600 650 521 533 540 507 660 589 Silver Street 562 500 — — 562 556 592 552 Houndsfield Road 46O 384 300 312 300 279 300 279 Montagu Road 46O 451 300 246 300 268 300 283 All Saints' 447 454 — — 455 476 — - Latymer — — — — — - 300 308 St. James 220 225 — — 207 229 218 248 St. Edmund's 88 79 — — (248 257 Senior Mixed) These figures are not included in the totals. Totals 4219 3851 2141 2002 3731 3494 4026 3831 There were 33 more children attending school than last year. The average attendance during the last week of June, 1915, was 12239.9 the percentage of attendance to number on books being nearly 90.7. There were 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 58 boys and 19 girls. Expenses. 5 precepts in March, for £9,845 for elementary and £55 for higher education; 4 precepts in October for the same amount, in all for £19,800, were served on the Overseers to meet the requirements of public education for the year ending March 31st, 1916. Besides, a very large necessitous grant has been received from a sympathetic Government, amounting to £16,375, the same as last year, or about a nineteenpenny rate; compare this with £9,216 for 1913, which was equal to only an elevenpenny rate. 72 ARRANGEMENTS FOR AND SCOPE OF ROUTINE MEDICAL INSPECTION. Three age groups have been inspected, the entrants (the majority of whom were 5 or 6 years of age), the 8 year-old group and the leavers. In 1915 the last class embraced all children over 13 years of age. Four thousand four hundred and twelve children were passed through the routine inspection. TABLE I. Of the Board of Education. The ages and numbers of children inspected were as follows:— Ages. Entrants. 8 year old group. Leavers. Total. 5 6 7 13 and over. Boys 980 220 43 485 578 2036 Girls 774 284 113 445 490 2106 Total 1754 504 156 930 1068 4412 The parents were present with 1,113 of the boys' inspected and 1,048 of the girls. There were objections to medical inspection of 3 boys and 15 girls on the part of the parents. Visits were made to the schools for routine inspection in the case of Infants' departments twice a year, and in the case of other groups once a year. By the instructions of the Board of Education the group of children between their 8th and 9th birthdays was substituted for the ten-year old group. RE-EXAMINATIONS. The number at the schools during the year was only 165-62 boys, 103 girls. Dr. Strong states that this small number is accounted for by the fact that when it was advisable to follow up defective scholars, he caused them to be brought to the specially-referred centre. 73 SPECIALLY-REFERRED CENTRE. In February, the School Medical Office at the Town Hall was dismantled and the room taken over by the Council, as 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 couch was removed to this room, making it still more overcrowded, but the bookcase was transferred to my office at the Town Hall. The attendances of specially-referred cases and absentees due to illness was therefore increased by those attending for re-examination and amounted to 2488, compared with 1742 for 1914. In September, it was decided by the Committee to devote Tuesday afternoons, as well as Saturday mornings, to this work, thus (as I pointed out) using up a session every week that ought to be devoted to routine inspection at the schools. In that month, too, I instructed Dr. Strong to issue " may return " certificates at the centre, so as to avoid loss of school attendance for those children able to resume at once. Arrangements for following up children with defects. 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 on 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 Society for the Prevention of Cruelty to Children is advised, and the local Inspector, Mr. Jones, has given us much help in this direction. THE TEMPORARY OFFICERS. As the temporary school nurse is not, like Nurse Playne was, on the staff of the Public Health Department, she has no legal power of entry and cannot visit the homes of the scholars. Indeed, as her Saturday mornings are now engaged at the specially-referred centre, she would have but little time to do so. When the war is at an end, another woman officer should be appointed to visit the homes as regards infectious, contagious and other conditions affecting attendance 74 at school. Like the School Medical Clerk, half her salary might be paid by your Committee and half by the Council. As the temporary school medical inspector was not appointed also Assistant Medical Officer of Health, he suffers the same disability as the temporary school nurse. Both of them under the present arrangement have over 9 weeks' holiday yearly, not 3 weeks and 2 weeks respectively, as the permanent officers do. Consequently Table IV of the Board of Education is unfilled. GENERAL REVIEW OF FACTS DISCLOSED BY MEDICAL INSPECTIONS. Tuberculosis. The number of boys with a family history of consumption was 261, and 211 girls. The School Medical Inspector, during 1915, sent 9 "B" notifications to the M.O.H. Of these, 7—4 boys and 3 girls—referred to pulmonary tuberculosis, and 2 to other forms of tubercle (both girls). Nutrition. The number of boys whose nutrition was bad was 9, and the number of girls 4. It was only fair amongst 371 boys and 326 girls. PROVISION OF MEALS. I am indebted to Mr. Pickrell, the Hon. Secretary of the Canteen Committee, for the following particulars :— Dinners were served from January 1st to Match 4th at the following centres St. Michael's, The Parish Room, St. Edmund's and St. John's, and from March 7th to May 28th at St. Michael's and St. John's. From May 28th to December 31st dinners were provided at a central cook-shop, the children being accommodated in a special room. The total number of dinners served at the centres was 25,268. The cost of food at the centres to May 28th was £253 6s., making a cost per head 2.4d. The cost of preparation, apparatus, and serving was 1d. per head. The number of meals served at the cook-shop from 28th May to December 31st was 8,813, at a cost of 4½d. per head. 75 The methods of investigation into the parents' circumstances by the Canteen Committee and the conditions under which free meals are granted were the same as before. This charitable relief is not viewed always with appreciation. Observe this note I received from a married sister of a little girl who, since the death of the mother of both, has lived with her :— "Thank you very much for giving Lizzie a dinner ticket, but please don't give her any more, as I want her dinner time to mind the baby and fetch errands." MENTALLY DEFECTIVE CHILDREN. On the 6th March I gave to the School Medical Inspector a list of 64 children whose names had been recently forwarded to the Secretary of our Education Committee, in response to an enquiry made the previous November of the head teachers at the public elementary schools; also a list of 13 children not attending school (in March, 1915). The total of 77 was subsequently increased to 85. On Friday, 25th June, your Secretary, Dr. Strong and I attended a whole day conference at the City Guildhall of representatives from England and Wales, organised by "The National Association for the Feeble-minded." Dr. Laval, the special County Medical Officer, visited the Secretary and myself on July 30th. The information he asked for was :— The names and addresses of the children who:— 1. Are between the ages of 5 and 7 and are alleged to be mentally deficient; the only one was placed in Class III.; 2. Are reported by the Certifying Officers as being suitable for a special school; 3. Are reported by the Certifying Officers as being unsuitable for a special school; 4. Are between the ages of 14 and 16. This was supplied to him. My final report on the results of the examination by your Certifying Officers was presented to you on the 21st September. I stated then that the examinations as shown by the schedules F which had been filled up, had resulted in the following classification :— 1. For an ordinary public elementary school (with or without particular supervision or modification of curriculum) 17 76 2. For a special class for dull or backward children 28 3. For a special school (a) day school 10) (b) residential school 4 14 4. Unsuitable for a special school (i.e., not educable at all) 5 Total 64 There are 5 children whose cases have been adjourned for further examinations; 2 children will be dealt with as epileptics. 12 cases have left the district and 2 have left school and are at work. Thus the grand total your Certifying Officers have dealt with was 85. On October 12th, I sent Dr. Laval copies of the schedule F with reference to all those allocated to Classes III. and IV. Fortunately the work was nearly completed before the (temporary) School Medical Clerk enlisted and ceased duty on November 16th, 1915. On November 23rd, there were still 4 cases not finally dealt with : H.L., C.W., J.S., and J.R., all boys, whom I referred again to Dr. Strong. The County Council is "the local authority" under the Mental Deficiency Act of 1913, which came into force on 1st April, 1914. "The local education authority" is the Edmonton Education Committee, in so far as my Council may have transferred their powers under the Act to that committee. We have carried out our duty under section 31 (a, b, c), but the County Council have taken no action yet other than what I have mentioned; perhaps this is due to the present war. However, it remains for my Education Committee to take up their duty towards these unfortunate children in the first 3 classes, not only for their sakes but in order to clear them out of the ordinary classes, where their presence is a trial to the teachers and subversive of the good conduct and discipline of the other scholars. Government Communications. 1. Circular letter of the 9th February, from Board of Education. Minute setting out conditions under which grants are payable to Local Education Authorities not exceeding 50 per cent. of approved expenditure on residential schools for blind, deaf, epileptic, and mentally deficient children. 2. Regulations of 26th March, about grants in respect of medical inspection and medical treatment of scholars at public elementary schools, and certain special schools in England and Wales. 77 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 condition of the clothing was satisfactory in 2045 boys and 1875 girls, and unsatisfactory in 161 boys and 140 girls. It was bad in 100 boys and 91 girls. The number of children with unsatisfactory footgear was 112 boys and 115 girls. Vermin. As regards vermin, 61 boys and 101 girls were found to be infested with lice on the inspection day. Nits (the eggs of lice) were found on the hair of 425 boys and 1044 girls,and live lice on 28 boys and 66 girls. 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. Mrs. Hobbs has looked over 8,493 in 11 months of 1915. About cleansing station, refer to my report as M.O.H. Teeth. Of the boys 774 and 669 gins had 4 teeth or more decayed. Nose and Throat. Amongst the boys 472 and 451 girls had either enlarged tonsils or adenoids or both. Eye Disease. Squint was observed in 44 boys and 27 girls. 40 boys and 48 girls were wearing spectacles. SCHOOL 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 on some of 78 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 AND (or) CONTAGIOUS DISEASES. The number of children excluded at the routine inspection was 324—126 boys and 198 girls, the reasons for exclusion being:— Cause. Boys. Girls. Cause. Boys Girls Vermin of Head 28 66 Iritis 0 1 Vermin of Body 61 101 Conjunctivitis 0 1 Scabies or Itch 11 4 Broncho-pneumonia 2 0 Impetigo 7 5 Congenital Heart trouble 1 0 Dirt 2 1 Tonsillitis 2 0 Eczema 1 8 Diarrhæa 1 0 Dermatitis 1 0 Cancrum oris 0 1 Scarlet Fever 2 0 Otorrhæa 0 1 Mumps 3 1 Bronchitis 0 2 Chicken Pox 2 1 Nephritis 0 1 German Measles 0 1 126 198 Measles 0 1 Corneal Ulcer 1 1 Blepharitis 1 1 The total number of exclusion certificates (including the above) issued for contagious and other diseases by the School Medical Officers during the year was 1,630 the reasons for the exclusions being:— Measles 2 Impetigo 135 Diphtheria 2 Other Skin Diseases 135 Mumps 3 Eye Disease 101 Chickenpox 7 Ear Disease 18 Pulmonary Tuberculosis 31 Chorea 27 Other Tuberculosis 12 Epilepsy 4 Bronchial Catarrh 31 Mentally Deficient 6 Ringworm 253 Other causes 92 Dirt 8 Vermin 535 1,630 Scabies 228 The number 1630 is 156 more than last year; this increase is mainly due to the children being seen again and again at shorter intervals than formerly. 79 During the summer holidays the public elementary schools were well disinfected. At the end of May, Houndsfield, Eldonand Montagu Road schools were dealt with, as measles had been troublesome in their areas. Exclusion of Contacts. The rules adopted for the exclusion of contacts are as before. Exclusion Notices. In connection with the notifiable infectious diseases, notices were issued by the Medical Officer of Health excluding 676 children, as patients or contacts, from attending day or Sunday schools for definite periods. On account of the non-notifiable infectious diseases, notices excluding 1415 children as patients or contacts were issued by me, after enquiries had been made as to the real nature of the illness. The numbers excluded in 1914-13-12 were 2,874, 941 and 1684 respectively. It is interesting to note the great variation in the number of children excluded from the schools during 1915 Total number, 1415; previous year 2874. 1. Eldon Road 288 7. Houndsfield 55 2. Silver Street 269 8. Raynham Road 54 3 National 173 9. Croyland Road 49 4. Montagu Road 164 10. St. Edmund's 18 5. St. James 160 11. Lower Latymer 15 6. Brettenham Road 142 1387 Besides the following:—Enfield Council Schools, 1; Private Schools, 17; Tottenham Deaf and Dumb School, 1; St. Katherine's College, Tottenham, 1; and 8 children not attending (at the time) any school. i . ; ). ■ '