Edmonton Urban District. Annual Reports ON THE Public Health and School Medical Services FOR THE YEAR 1916, SIDNEY C. LAWRENCE, Medical Officer of Health and School Medical Officer, M.B., Ch.B., D P.H. (Lond.), M.R.CS. (Eng.), L.R.CP. (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.R.San.I. Crusha & Son, Printers, Tottenham and Wood Green. EDM 53 Edmonton Urban District. Annual Reports ON THE Public Health and School Medical Services FOR THE YEAR 1916, BY SIDNEY C. LAWRENCE, Medical Officer of Health and School Medical Officer, M.B., Ch.B., D P.H. (Lond.), M.R.CS. (Eng.), L.R.CP. (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.R.San.I. Crusha & Son, Printers, Tottenham and Wood Green. 1.—THE REPORT ON THE PUBLIC HEALTH OF EDMONTON during 1916. 5 Edmonton Urban District Council. 1916—1917. 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—FREDK. W. CLAXTON, (appointed 28th March, 1916.) 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. 6 PUBLIC HEALTH DEPARTMENT. December 31st, 1916. 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. (died January 25th, 1917). 3.—Chief Male Inspector and Inspector of Canal Boats: R. J. BUTLAND, M.R.San.I.*‡ 4.—Second Male Inspector: J. E. WINTER.*†‡ 5.—Chief Woman Inspector : JENNIE HUDSON.*¶(C.M.B.). 6.—**Third Male Inspector: H. J. NIXON ¶† 7.—Fourth Male Inspector: G. H. BUCKLE. 8.—Second Woman Inspector : G. M. SHINER.¶ (C.M.B.). 9.—Third Woman Inspector: NORA PLAYNE, C.M.B. (also School Nurse). 10.—Senior Clerk : A. OADES (temporary). 11.—**School Medical Clerk: HAROLD DYER* 12.—**Junior Clerk : JOHN FARRAR, DORIS B. HILL (temporary, from January 1st). 13.—Disinfector, Sanitary Stores Keeper and Transport Officer: J MADLE. 14.—Mortuary Attendant, Laboratory, Disinfecting Station : C. HICKFORD (resumed 19th June, after war service). 15.—Caretaker of Emergency Hospital at Old Disinfection Station: J. MADLE (temporary). 16—Driver of Ambulance and Bedding Vans: A. SHEPHERD. 17.—Opener up of Old Drains, Urinal Cleanser and General Sanitary Workman : A. PASHALL. 18.—Opener up of Old Drains (part time): A man from Engineer's Department as required. 19—22.—Attendants at Sanitary Convenience at Angel Road : Two male and two female. 23—26.—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, 1916 (including 654 Belgians) 72,050 Density of Population per Acre of Land, 1916 18.7 Rateable Value, October, 1916 £232,856 Assessable Value, October, 1916 £219,080 General District Rate, 1916 4s. 2d. in the £ Poor Rate, 1916 4s. 5d. in the £ A Penny Rate produces about £890 VITAL STATISTICS. Birth-rate per 1,000 living (excluding Belgians) 22.87 Gross, or registered death-rate per 1,000 living (including Belgians) 14.03 Nett death-rate per 1,000 living (excluding Belgians) 10.17 Infantile Mortality per 1,000 births registered (excluding Belgians) 86.96 Zymotic death-rate per 1,000 living (excluding Belgians) 1.05 HOSPITAL ACCOMMODATION. For infectious cases Enfield and Edmonton Joint Isolation Hospital For smallpox South Mimms Smallpox Hospital and Claverings Farm, Edmonton. Electricity North Metropolitan Electric Power Supply Co., Ltd. Water Supply New River District, Metropolitan Water Board Gas Supply Tottenham District Light, Heat and Power Co. Sewerage Separate System Sewage Disposal Broad Irrigation and Bacterial Filters 8 " Temporamutantur, nos et mutamur in illis." Town Hall, Edmonton, N 9. To the Chairman and Members of the Edmonton Urban District Council. Gentlemen, I herewith present you with my eleventh Annual Report on the health and sanitary circumstances of Edmonton. It refers to the year 1916. The School Medical Clerk, John Farrar, who was acting for Harold Dyer, enlisted in November, 1915. In February I again advised that this important post be filled by the appointment of a man over military age, a disabled soldier or sailor, or by a woman, as the statistical and other work is much in arrears, thus interfering with the preparation of the Annual and other Reports. In May I drew attention to this once more, but without result, so the place is still vacant. On December 31st, 1916, owing to absence on war service, the following posts in my department were unfilled, and to them no temporary appointments have been made :— 1. Assistant and Deputy M.O.H. 2. Third Male Inspector (Housing). 3. Junior Woman Inspector (and School Nurse). .4. School Medical Clerk. On that date Mr. Huckle was the only man of military age still here and not at the front. I have not detained him. Apart from the question of economy, the depletion of my staff owing to the great war, which, since August 4th, 1914, has increased both in intensity and area, renders it impossible for me 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. I beg to draw your special attention to the articles on " Maternity and Child Welfare" and "The Measles Epidemic." Councillor S. J. Sanders has terminated a. three years' tenure of office as Chairman of the Sanitary Committee, during which time our relations were most harmonious; for his courtesy and his stalwart support of the maternity and child welfare movement, I tender him my sincere thanks. To my staff, and the heads of other departments, I am much indebted, and herewith gratefully acknowledge their help. I am, Your obedient servant, SIDNEY C. LAWRENCE, Medical Officer of Health. 12th June, 1917. 9 foreword. Local Conditions arising from the Great War Edmonton has become accustomed to war conditions, which have brought, at least, the compensation of high wages and constant employment. However, this long-continued struggle between the nations will leave its mark on the civilian population of Europe, especially the women, for the natural emotions are fully engaged, particularly those of anxiety, love and fear. To these are added the worry of food supplies, and the strain of over-work, often carried out in places poorly lit, inadequately ventilated, and short of sanitary requirements. The birth-rate is, of course, greatly affected by the absence of fathers, and it is further affected by an unusual number of miscarriages and abortions. On the 31st August, 1915, my Council appointed "an Economy Committee," composed of nine members of the Council, "to enquire into the working of the Council, with the object of reducing and re-organising the same to meet the present conditions brought about by the war." This was in response to the notorious "economy circular" of the Local Government Board, dated 4th August, 1915. It presented interim reports, dated 24th September and 22nd October. On January 25th, 1916, it presented a final report, advocating important changes, estimated to save £904 yearly, but the report was negatived by a large majority. The Edmonton Tribunal. It first, met on December 1st, 1915. It deals with voluntarily attested men and cases under the Military Service Act, 1916. On February 9th it was ordered to consist of 12 members instead of 7. As before, two members are not Councillors. Our Clerk, Mr. F. W. Claxton, was appointed Clerk of the Tribunal, with further assistance in his department. In March, Mr. G. Switzer was appointed to represent the Trades and Labour Council. Conscientious Objectors. Ill May the Council declined to employ them on any terms. Enemy Aliens. In June the Council passed a resolution urging the Government to intern all enemy aliens, and this was sent to the Prime Minister and the local M.P. Food Prices, Milk. In May the Council sent a resolution to the Prime Minister and the President of the Local Government Board, urging the Government to control the price of milk, in the interests of the public health and child welfare, suggesting particularly that the slaughter of young milch 10 cattle should be prohibited. In July the Council sent a request to the Government for action to arrest rising prices of food and other necessaries. Overcrowding". Conditions have never been so bad here, owing to a rush of munition workers from all parts, who desire to live near their work, and in many cases, two soldiers' wives limit their expenses by concentrating into one house instead of two. If stringent measures were taken to abate this, as no small houses are to be had, it would only lead to those dispersed producing over-crowding elsewhere. LEGISLATION. The Government's activities have been reflected here to the local authority, who, mainly through its Clerk's and Medical Officer's Departments, carry out in the district the various Acts and Orders issued. To some of these I now briefly refer :— Naval and Military War Pensions Act, 1916. In March the Council established a local Committee of 22 members, 9 of whom are Councillors, 5 women, and 4 Labour representatives. This first met on July 1st. It was decided not to join a Committee for the county as a whole. In August the Council resolved that " the provision of all pensions, grants, and allowances to sailors, soldiers and their dependents, is a national obligation, and, as a matter of national honour, ought not to be the subject of charitable appeals." This was forwarded to the Chancellor of the Exchequer and our M.P. On 12th October Mr. Pettipiere resigned his membership and became Secretary. War Saving's Committee. Ill March it was decided not to form a local Committee, and in June not to have a "War Savings Week." On July 25th a representative of the Central Committee addressed a special Council Meeting, after which it was decided that the Council do form itself into a local Committee, with power to add to their number. Councillor Taylor was appointed Secretary, and Councillor Cull as Chairman, Mr. Tonkin as Assistant Secretary. An Executive Committee first met on July 27th. In August an Association was formed for the Councillors, officials and workpeople, and affiliated to the National War Savings Committee. War Allotments. The Cultivation of Lands Order made by the Board of Agriculture under the powers of the Defence of the Realm Regulations, 1914, and circular of 12th December, led that month to a schedule being prepared of all unoccupied and unrated land in the district suitable for cultivation, which was found to amount to about 100 acres; application for allotments was invited by advertisement. No consent of owner is necessary. The matter is in the hands of a sub-committee of the Parks Committee. The plots vary from 10 poles to 5½ acres; rent, 2s. 6d. per year for 10 poles; tenants to erect fences.' Later, a letter was addressed to the old allotment occupiers urging the necessity for cultivating at least 75 per cent. of their plots for the production of food. A Special Committee of six Councillors and six outside persons was appointed to deal with these lands. 11 In March a local branch of the Middlesex War Agricultural Committee was formed, consisting of the three County Councillors for Edmonton, three Councillors and three outside members, with the assistance of the Architect. In December the County Committee began to interest themselves in the supply of seed potatoes. MUNITION WORKS. During the year the greatest activity prevailed in the manufacture of munitions, and a great deal of attention was required from my Department with reference to providing for each one proper and sufficient water supply, sanitary conveniences and collection of refuse. The Home Office complained of shortness of closet accommodation at an old-established factory, which report was unfounded. Whereas I received no complaints from the Home Office about newly-established factories where the accommodation was, for some time, grossly inadequate. In November, notwithstanding the protests of my Council and our Engineer, a large permanent munition building was placed over one of the main sewers; the site of the building is well below flood-water level of the neighbouring brook. Of course the extraordinary and heavy traffic to and from these munition works has badly affected the surface of certain of our roads. An application was made to the Government towards the cost of repairs, but it was not granted. BELGIAN REFUGEES At the old Strand School (Millfield House) there are mainly men, and those men who have been found to require strict discipline; whilst the men with families are mostly at the old Strand Workhouse near by. Dr. Beels (late of Antwerp) lives at Millfield House; he 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 1916 is taken as 654, 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 (as for 1915) 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 1916 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 children are supervised by a resident Roman Catholic priest; and a special school of two classes is held in St. Aldhelm's Sunday School. As regards Infectious Diseases. Thirty two cases were notified: 5 scarlet fever, 4 diphtheria, 4 puerperal fever, 1 erysipelas, and 18 (English) measles. 12 The infectious cases are usually moved to one or other of the Metropolitan Asylums Board Hospitals, but the erysipelas and puerperal fever were treated at Edmonton Workhouse Infirmary. Thirty-seven refugees were admitted to the Edmonton old infirmary for non-infectious diseases, and twenty-one births took place there during 1916, also one death. On January 1st, 1917, the refugees having been removed from Millfield House, it was re-opened by the Metropolitan Asylums Board for the reception of 300 male epileptics from Belmont Workhouse. Dr. Beels, Mr. and Mrs. Pallin act as Medical Officer, Superintendent and Matron respectively. EDMONTON MILITARY HOSPITAL. Lieut.-Col. Spencer Mort's responsibilities have largely increased, for in February plans were shown us of two temporary ward-blocks containing 180 beds in each. In March certain modifications of the proposed drainage plan were agreed to with our Engineer, and it is understood that these buildings are of an entirely temporary character, and the new drainage (as laid) is only there for the duration of the war. So there are now 1,488 beds for sailors and soldiers in this institution, and 1,446 in 30 auxiliary hospitals in outside areas, a total of 2,934 beds under the administration of Lieut.-Col. Mort. This is, I should think, the largest hospital organisation in the United Kingdom. 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. Col. 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. " 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, continued their work throughout 1916. As regards Infectious Disease amongst those on His Majesty's Service, sixteen cases were notified—6 scarlet fever, 1 diphtheria, 3 enteric fever, 1 cerebro-spinal fever, and 5 measles (3 Rubella). As regards tubercle, I received notice of seven cases of pulmonary disease—6 males and 1 female (a nurse), but no other. The deaths that occurred in the Edmonton Military Hospital totalled 61—40 from wounds, 20 from disease, and 1 naval man from an accident. Besides, 2 died in Edmonton homes—one by suicide and one from the effects of wounds followed by phthisis; one stranger by fall from aeroplane, and another whilst on guard duty. So altogether 65 deaths in Edmonton were due to the Great War, and are not included in Table III. 13 Edmonton Urban District. REPORT OF THE Medical Officer of Health For the YEAR 1916. 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 past two years 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. Therefore over-crowding is common. ALLOTMENTS. In April the Parks Committee recommended that a new regulation be passed, that in new tenancies allotments must be used for domestic purposes only, and not for trade purposes, but this was defeated in Council. The Ecclesiastical Commissioners agreed to let for seven years, land north and south of Chalfont Road. The Council entered into possession of the north part on September 29th. My colleague the Architect set this out into 99 plots, from 10 to 24 poles each. 14 DISTRESS COMMITTEE. The offices were closed last year, but in February the outer offices were used as a recruiting office for the Middlesex Regiment. Councillor Rowe, in September, was appointed to fill Rev. T. Warren's place, and in January, 1917, the Council filled up outside vacancies on the Committee for the coming year. PARKS AND OPEN SPACES. An interesting "early Victorian" carved-stone drinking fountain has been preserved to the inhabitants. In the year 1861, the late Thomas Angell erected this outside his nursery ground in Angel Road, for the use of the passer-by. For some years the Angell Nursery has been discontinued, and the fountain fallen into disuse and become derelict. Our Architect took great pains to secure this picturesque relic for the district, so it has been restored and re-fixed in a prominent position in the Council's beautiful Pymmes Park. The sculptor was J. Tolmie. The carving of a dolphin is in very bold relief, with a handsomely-moulded catch-basin. 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. Mr. B. Andrews is the master. In March, 1916, the estimated population of Edmonton Union was 489,506; rateable value, £2,552,475. Amongst a total of forty Guardians, Edmonton district proper has only four representatives. Dr. Gregorson is acting as Medical Superintendent at the old Infirmary. Since October, 1915, large portions of the Workhouse and old Infirmary have been given over to the military. Mental and maternity cases are taken in as before, but only acute or serious cases of illness or accident, as there are only about -350 beds now for sick paupers. Convalescents are evacuated to Enfield or Stepney Workhouses. The casual wards are still open. The New Infirmary and Nurses' Home became a military hospital in April, 1915; 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. No meeting has been held since 15 our Engineer was elected President on 8th November, 1915. Of course, some of the members are away on war service, but that is no cause for the apathy of those still here. "Heaven helps those who help themselves." VITAL STATISTICS. My statistics refer to 52 weeks ending on December 30th, 1916. I am much indebted to Mr. W. H. Miller, our Registrar of births and deaths, for information promptly afforded whenever asked for. The Registrar-General estimates our civil population at 66,800 for deathrate, and 72,680 for birth-rate, whereas I estimate our nett civil population, including 654 refugees, at 72,050, and the gross civil population (including institutions) at 72,536, plus an average military population of 1,419. My figures 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. The exit of men for His Majesty's Services has been quite compensated by the influx of munition workers. I estimate the nett population at the middle of 1916 as 72,050 persons, including 156 Edmonton people in Edmonton Workhouse and old Infirmary and 654 Belgian refugees and resident staff. Without the Belgians, our resident population is 71,396. The natural increase of the population, that is the excess of the nett total of births over the nett total of deaths, was 1,638 minus 726, equals 9 1 2 without Belgians. The figure was 849 last year. For four out of the five weeks ending December 30th, 1916, the births were less than the gross deaths for three times and exactly equal once. For the week ending December 23rd the births were three less than even the deaths amongst private residents. Measles was largely to blame for this. 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 18.7. 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 72,536. 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 642 persons, of whom 156 were Edmonton residents. 16 BIRTHS. The number of births registered by the Edmonton Registrar, Mr. W. H. Miller, was 1,708 (882 boys and 826 girls), which includes 12 births that took place in the Edmonton Workhouse born of mothers belonging to Edmonton, and 19 of Belgian Refugees. The figures for 1915, 1914 and 1913 were 1,725, 1,946 and 1,912. Sixty-three births born of mothers who are not Edmonton residents, are excluded from our statistics, just as foreign deaths are; of these, 55 occurred in the Workhouse. The Registrar-General has not reported this year any births which had taken place when Edmonton mothers were residing temporarily out of their district, but from other Medical Officers of Health I received notification of 9 births—3 boys and 6 girls; of these, one, at least, was illegitimate, and three still-born; one boy and one girl were Belgians born in Whitechapel Workhouse. Thus the nett total of births was 1,633, excluding 21 Belgians. Of these 1,633 births, 43 (or 2.6 per cent.) were illegitimate; there were six illegitimate Belgian births. With reference to the cry of " war-babies galore," it is a refutation of the rumour, as regards Edmonton, to find that the illegitimate birth-rate is 1.1 less than last year. The birth-rate per 1,000 inhabitants is therefore 22.87, compared with 23.88 last year; including 21 Belgian births, the rate would be 22.96. Notification of Births Acts, 1907 & 1916. During this year 1790 births were entered in our register; of these, 941 were males and 846 females; in three cases the sex was not declared; 88 (4.9 per cent.) of the whole number were born out of wedlock, and 13 more were of doubtful legitimacy. Sixty-five children were declared "still-born." Mr. Clement Bugg, Superintendent of the Cemetery, retired on July 10th, but the Accountant informs me that there were 54 children styled " still-born " buried during 1916, and for 1915, 1914 and 1913, the figures were 46, 62 and 63. 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 1,708 births were registered during 1916. 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-eight pairs of twins arrived, and once triplets. Besides, there were 16 births, 8 males and 8 females, amongst Belgian women who were confined in Edmonton Workhouse; of these, none were still-born, and four were illegitimate. The birth-rate, based on refugees, excluding their staff, would be 35.53 per 1,000 refugees! The birth-rate (22.87) for 1916 is 1.01 less than last year; but still it is higher than 21.6, the Birth-rate of England and Wales for 1916. The birthrate for the preceding ten years will be found in Column 5 of Table I. DEATHS. The gross total of deaths registered in the district during the year was 1,083; of these, 398 occurred among non-residents at Edmonton Workhouse and Infirmary, and 7 temporarily resident, while 91 deaths of Edmonton 17 residents, 9 Belgian refugees and 2 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 602, besides 9 Belgians and 2 vagrants. Of the 65 "war" deaths, all were registered here; 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 14.03 per 1,000 living. This rate is calculated on the estimated gross population of 72,536 (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 10.17 This rate is calculated on the estimated nett population of 71,396. 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. I have accepted 122 deaths returned in this way during the year, making the net total of deaths at all ages (including 2 vagrants) for the district proper 726, and 9 Belgians. The nett death-rates for the preceding ten years will be found on Table I., column 13. The nett death-rate for Edmonton is, as I have said, 10.17 per 1,000 living; it was 11.71 last year. It is 1.39 lower than the average of the five previous years, and is much better than 15.80, the rate for 1904. If 9 Belgian deaths be included, the rate is 10.20. The senile deaths (65 years and over) are 17 more than last year; in March 30 out of 64 deaths were in this period. Death Certification. All deaths were certified either by the medical attendant or by the Coroner. Inquests were held on 71 residents, or 11.8 per cent. of the total deaths amongst residents registered in the district. This percentage compares favourably with nearly 13 per cent. in 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 18 children under two years of age. There were 75 deaths from these diseases (excluding refugees) during the year, and the zymotic death-rate is therefore 1.05, as compared with 1.39 for the previous year. This figure is 0.34 less than last year. The zymotic death-rate for 1916 in London was 1.44. INFANTILE MORTALITY. The infantile mortality is a special death-rate, referring to the first ageperiod (0 to 1 year), and is expressed as the number of deaths that takes place amongst children under one year of age per thousand births registered. The number of such deaths occurring amongst Edmonton children and registered within (or without) the district was 142, and the births registered within (or without) the district, born of Edmonton mothers, numbered 1,633 (Belgians excluded); therefore the infantile death-rate, based on these figures, is 86.96 per thousand births. The lowest record is 74.55, in 1910. Nine of the 142 infantile deaths were those of illegitimate infants—that is 6.3 per cent. of the infantile deaths; two inquests were held. Inquests were also held on 15 of the other infants, making a total of 17. There were 3 infantile Belgian deaths, none of them illegitimate; including these, the rate would be 87.66. The infantile mortality rate for the year in England and Wales was 91; in London, 89; in the 96 great towns (which include Edmonton), 99; and in the 148 smaller towns, 90 per thousand births registered. Table IV. shows that 29.5 per cent. of the infantile deaths occurred within the first month of life, and that 28.87 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 29 and 29 per cent. I must also notice that the premature births were only 14, compared with 18, 32 and 26 for 1915-14-13. Conference. A very important meeting of representatives from all parts was held at the City Guildhall on 26th October, 1915. 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, 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. In 19 February it was left to the Chairman of the Council and Chairman of the Sanitary Committee to call a meeting after the issue, in April, of the first Annual Report of the Voluntary School for Mothers and Infant Welfare. No meeting was held. TABLE IV. Infant Mortality (excluding 3 Belgians), 1918. Nett deaths from stated causes at various Ages under one Year of Age. Cause of Death, Classification. 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. None Uncertified 'Small-pox 5 ... ... ... ... ... ... ... ... ... ... Chicken-pox 19c ... ... ... ... ... ... ... ... ... ... Measles 6 ... ... ... ... ... ... ... 1 2 3 Scarlet Fever 7 ... ... ... ... ... ... ... ... ... ... Whooping Cough 8 ... ... ... ... ... ... 1 3 3 7 Diphtheria and Croup 9a ... ... ... ... ... ... ... ... ... ... Erysipelas 18 ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis 30 ... ... ... ... ... ... 2 1 2 5 Abdominal Tuberculosis 31 ... ... ... ... ... ... 1 2 1 4 Other Tuberculous Diseases 29b ... ... ... ... ... 1 1 ... 1 3 32—35 Meningitis (not Tuberculous) 61 ... ... ... ... ... ... ... ... ... ... Convulsions 71 ... ... ... ... ... ... 1 ... ... 1 Laryngitis 87 ... ... ... ... ... ... ... ... ... ... Bronchitis 89—90b 1 ... 1 ... 4 2 4 1 2 13 Pneumonia (all forms) 91—92 ... ... ... ... ... 4 8 4 3 19 Diarrhoea or Enteritis 104—105 ... ... 1 ... 1 6 12 4 3 26 Gastritis 103a ... ... ... ... ... ... ... 1 ... 1 Syphilis 37 ... ... ... ... ... ... ... ... ... ... Rickets 36a ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 168 ... ... ... ... ... ... 1 ... ... 1 Injury at Birth 152C 2 1 ... ... 3 ... ... ... ... 3 153 Atelectasis 152b 5 1 1 ... 7 ... ... ... ... 7 Congenital Malformations 150 1 1 2 ... 4 ... 1 ... ... 5 | Premature Birth 151a 10 3 1 ... 14 2 ... ... ... 16 Atrophy, Debility and Marasmus 151b 3 4 ... ... 7 10 3 ... ... 20 C, d, e. Other Causes ... 1 1 ... 2 ... 4 1 1 8 Totals 22 11 7 2 42 25 39 18 18 142 Nett births during 1916—1,633 legitimate, 1,590 ; illegitimate, 43. Nett infantile deaths during 1916—142 ,, 133 ; ,, 9. 20 COMPARATIVE STATISTICS, 1916. The table of vital statistics for 1916, 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 Civil Population, middle of 1916. Annual rates per 1,000 of the population. Infantile Mortality per 1,000 births registered. Nett Births. Nett Deaths. Zymotic Deaths. England and Wales 36,250,000* 21.6 14.0 ... 91 The 96 great towns including London and Edmonton 17,312,295 Cannot be stated. 14.4 ... 99 The 148 smaller towns 4,546,755 130 ... 90 England and Wales, less the 244 towns as above 14,390,950 ... ... 80 London (including City) 4,310,030 14.3 ... 89 Acton 60,461 210 11.8 0.6 77 Wood Green 52,228 18.7 10.2 0.4 64 Enfield 61,450 22.2 96 0.4 57 Edmonton 71,396 22.87 10.17 1.05 86.96 *In round numbers. [See note of Registrar General's Report, p. 39.] 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 1916 was 15.4; the highest on record at 19.5 per 1,000 in 1915. The birth-rate is 0.2 less than last year, and is the lowest on record; the death-rate is 0.8 less than 1915, and 0.6 higher than 1913, which was the lowest on record. The infantile deathrate is 19 integers less than last year, and the lowest on record. The natural increase in the population of England and Wales, or the excess of births over deaths, is 277,227, or 68,892 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 1916. The bulk of their work falls into four correspondingly large divisions, viz. :— 1. The crusade against preventable 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, or measles. 21 INFANTILE MORTALITY. Month. After births. Re-visits. After 6 months. Neglected infants. After deaths. Diarrhœal diseases. January 69 14 36 ... 31 ... February 81 8 10 ... 12 ... March 98 10 5 ... 17 ... April 59 7 14 ... 16 ... May 80 6 5 ... 4 ... June 58 5 23 ... 4 ... July 80 11 8 ... 6 ... August 48 12 2 ... 8 3 September 96 38 5 ... 14 ... October 55 13 6 ... 3 ... November 23 23 4 ... 1 ... December 19 3 6 ... 5 ... Totals 766 150 124 ... 121 3 INSPECTIONS under FACTORY & WORKSHOPS ACTS. Month. Factories. Workshops. Laundries. Outworkers. Rooms measured up January 2 5 6 28 2 February ... 2 1 55 ... March 1 3 ... 67 ... April 1 2 7 51 ... May 6 10 1 90 18 June 4 1 ... 157 ... July 2 2 4 114 3 August ... 4 ... 35 ... September 1 3 2 55 ... October ... 1 ... 48 ... November ... ... ... 2 ... December ... 1 2 3 ... Totals 17 34 23 705** 23 ** Compared with 733 last year and 485 in 1914 ; mainly on war work. NOTIFIABLE DISEASES. Visits and re-visits to Measles cases 1,184 ,, re Measles disinfection 45 ,, and re-visits to Erysipelas cases 113 ,, re Erysipelas disinfection 12 ,, re Puerperal Fever cases 9 ,, re Puerperal Fever disinfection 4 ,, re Pulmonary Tuberculosis 275 ,, re Pulmonary Tuberculosis disinfection (after death or removal) 155 ,, re other forms of Tubercle 49 „ re Ophthalmia Neonatorum 64 Total 1,635 22 NON-NOTIFIABLE DISEASES. Months. Whooping Cough. Mumps. Chicken-pox Doubtful Cases. Totals. January 28 4 54 3 89 February 8 6 47 7 68 March 33 15 31 7 86 April 37 23 9 8 77 May 31 18 36 9 94 June 9 7 39 9 64 July 2 4 18 3 27 August* ... 1 1 3 5 September 2 10 6 1 19 October 2 6 11 3 32 November 3 7 5 7 22 December ... 1 3 7 11 Totals 155 102 260 67 584 * Schools closed for holidays. One visit re Cancer disinfection. Two visits re Scabies disinfection. Visits and re-visits re school notifications concerning measles and the non-notifiable diseases, such as whooping cough, chicken pox, etc., 1,735 to 2,058 children at 1,451 homes. Of this number, no less than 1,151 visits were for measles. This is an increase compared with last year, when the figures were 1,084, 1,415 and 893 respectively. (For further information see Annual Report of School Medical Officer.) GENERAL WORK. Visits to Private Schools 0 Enquiries re complaints 26 Miscellaneous visits (compared with 134 last year) 111 Visits paid to inspect work done after informal notice 195 ,, re Overcrowding 2 ,, re Fabric Misdescription Act 0 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 there are only two. Temporary officers do not stay long, and frequent change of officers is detrimental to the smooth progress of the work. Miss Shiner was only made a permanent officer in April, after the visits of Dr. Mivart from the Local Government Board. 23 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, 1916. Office Work. Statistical Work. Tuberculosis Accounts. Infant Welface Centre. Miss Hudson 164½ 12½ 4 — Miss Shiner 159 4½ — 94 afternoons. Total days 323½ 17 4 94 afternoons. Miss M. E. Sheffield began duty as temporary third Woman Inspector on 27th December, and visited 33 cases of measles and made 3 enquiries. This followed the visits of Dr. Hutchison from the Local Government Board. MATERNITY AND CHILD WELFARE. Under the Notification of Births Act, 1915, the local authority is empowered to open centres controlled by a committee, which shall include women and may include persons not Councillors, and this Committee shall hold office for a period not exceeding three years. The Council can fix the amount of expenditure of the ratepayers monies by the Committee, who shall keep the authority informed as to its expenditure. Our Voluntary Centre was opened on Tuesday, June 22nd, 1915. Dr. Rachel Mackenzie is Medical Adviser. Councillor Sydney J. Sanders, Chairman of the Sanitary Committee, presides over the Board of Control, and his wife is Honorary Treasurer. The M.O.H. is on the Board and two representatives of the medical practitioners. Miss Shiner, second Woman Inspector, replaced Mrs. Benjafield as Secretary on July 4th. 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. 24 In January the question was again considered by the Sanitary Committee as to how far, if at all, the Council should interest itself in the Centre. The matter was adjourned. On February 11th and on February 15th, Dr. Mivart, of the Local Government Board, visited our School. He expressed his complete satisfaction with the good work being carried on there. On the latter date he interviewed the Chairmen of the Council and of the Sanitary Committee, with our Clerk and myself, about (1) the under-staffing in the Public Health Department, especially on the women's side; (2) the carrying out of the Measles Regulations, 1915; and (3) the School for Mothers' and Infant Welfare. A letter was submitted in March, from the National Association for the prevention of Infant Mortality, asking for financial support, on which the Sanitary Committee reported : " We are well aware of the good work of this Association, but under the present circumstances we are not prepared to recommend a contribution." The Council applied for a grant in recognition of the time devoted by their (Woman Inspector and) Health Visitor to the Centre, and for visiting amongst mothers and infants. On 27th March the Local Government Board wrote granting £33 6s. 8d. for the year ending March, 1915; they took occasion to call attention to Dr. Mivart's report to them, which entitled them to say that the women's staff was inadequate and should be increased, as home visits should be paid to all children over and under 12) months old, and that ante-natal visits should be paid to expectant mothers. This was considered at the Sanitary Committee meeting of the 5th April, when the Chairman submitted the first Annual Report of the School for Mothers. The Committee recommended that the subjects of the Board's letter should have further consideration in six months; however, it was advised that Miss G. M. Shiner's appointment should be made permanent, with an increasing salary rising to £105 yearly. Seven weeks later, on receiving the assurance of its legality from the Board, the grant, £33 6s. 8d., was handed over to the School. On May 23rd a letter from the Local Government Board, dated the 13th, was submitted to the Council, stating that the Council ought to frame a comprehensive scheme for maternity and child welfare in Edmonton, including the appointment of an adequate home-visiting staff, this scheme to include any voluntary association already at work. In October the Sanitary Committee again considered the Board's letter of the 27th March, but this only lead to another adjournment for six months, i.e., to April, 1917. On December 9th the Board, in sending a grant of .£34 12s. 8d. towards 25 the expenses for the year ending March, 1916, especially urged on my Council the importance of frequent and regular home-visiting to mothers before and after their confinement, and that the children should be supervised up to five years of age. On December 17th and 18th Dr. J. H. Hutchison visited Edmonton with reference to the measles epidemic, but also to impress on the Council the necessity of arranging for supervising the welfare of mothers and young children. On the latter date he met the Chairman of the Council and the Chairman of the Sanitary Committee. As Medical Officer of Health here for eleven years, I can testify to the great scope there is for this work in Edmonton, The efforts of the ladies and gentlemen who form the Board of Control have been resultant of much good. The second Annual Report, for the year ending March 31st, 1917, shows— (1) That there is much need of such an institution; (2) that the place is much appreciated by the mothers of Edmonton; indeed, in January, 1917, the age was extended to two years, and in February the Medical Adviser began to attend once a week instead of fortnightly. HEALTH VISITING BY UNTRAINED VOLUNTARY WORKERS. The following short address I delivered at the Edmonton School for Mothers:— The proper frame of mind for beginners is a humble one. One that realises" I am not a medical officer of health, nor doctor, nor a professional (woman) sanitary inspector and health visitor, nor a midwife, nor a professional nurse, but within the limited sphere of action permitted to an amateur, I am eager and willing to assist in maintaining and improving the public health and the efforts of those mentioned." I congratulate you that it is within your power to be an influence for good in reforming the bad habits of the people. At the same time, you, in particular, can secure the progress and extended use of the School for Mothers. The observations I have the privilege of making to those ladies of the Board of Control, who have kindly volunteered to visit the homes are (as you will see) made with the purpose of enabling you to avoid the difficulties that beginners might encounter, and indeed often unthinkingly create for themselves. It is most important that you should not recommend to mothers any 26 particular doctor or midwife, although it will be often necessary for you to insist upon the wisdom of calling in a medical man to the home, or visiting one at his surgery. The former is the proper procedure in any illness when the case is supposed to be an infectious or contagious disease. Neither should you allow yourselves to criticise any treatment prescribed, or said to have been prescribed, by a doctor or midwife. You may hear all the mother is pleased to tell you, but only take "a thinking part" in the drama. On the other hand, you must not advise medical treatment yourselves, and even as regards clothing and diet of mother and children, it will be wise of you to first enquire what advice on this subject, if any, has been given by the family doctor. Should he not have given any, then you are free to give advice on the lines of the Council's handbook, " Advice to Mothers." This book is worthy of your own reading again and again, so that all the visitors' advice may be uniform, and not in as many different keys as there are visitors. When in doubt, refer the mother to the medical adviser at the centre. Uniformity is also necessary in the nature and extent of your enquiries— to secure this I advise that a schedule, as shown, be pasted in the front of every note-book. Reference to this will show the visitor what questions are to be asked, and prevent unnecessary questions. As you are not trained in women sanitary inspectors' work, nor armed with her authority, you cannot demand to be shown over the premises and back-yard of a house, although (if requested) you may accompany the mother to any part she is desirous to show you. On your visit, whilst conversing with the mother, you can use your powers of observation without comment, and note whether the house is kept in a clean, indifferent, or dirty condition; and the same with regard to the clothing of the mother and family, and so forth; also whether the windows are open or not. You can help the public health department by informing us of such conditions as obstructed sinks or water closets; lack of a dust-bin; the presence of measles, whooping cough, chicken-pox, mumps, ringworm, itch or vermin, etc., if such come under your observation, or are complained of by the mother. Above all, your visits are directed to secure the regular attendance of the mothers and infants at the Centre, and to ask if the directions of the medical adviser as to diet and clothing are being carried out. I hear that it has been decided by the Board of Control that provision of extra nourishment must be referred to the Visiting Committee, and that mothers shall not be visited until 12 days after their confinement. 27 SCHEDULE. Year 191 No. on books Name of baby (surname first) Address Age weeks (at time of visit). Advice at centre Date of visit Observations. Clothing of child ,, ,, mother Cleanliness of child ,, ,, mother „ ,, house Windows Questions. On breast'/ On bottle1 Other food Last attendance 1 Is advice being carried out1 Under a doctor now 'I If so, name Remarks for Visiting Committee Signs to be used:— G—good. M—medium. B—had. X—Yes. 0—No. The Board of Control I referred to is the Executive Committee of the Edmonton School for Mothers. BRITISH MEDICAL ASSOCIATION. On November 10th, the Association issued a circular to the Local Authorities, giving their views on the proper remuneration of the Medical Officers connected—part or whole-time—with the Centre, and urging the desirability of each Authority consulting with the local division of the Association, before finally adopting any municipal scheme. 28 SECTION II A. COMMUNICABLE DISEASES—NOTIFIABLE. The Infectious Diseases Notification and Prevention Acts have been in force in this district since March 31st, 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 110 103 93.6 2 1.8 Diphtheria and Mem. Croup 67 65 97.0 4 6.0 Enteric Fever 6 5 83 3 3 50.0 Totals 183 173 — 9 — Compared with last year, the table shows 171 less notifications of scarlet fever, and less fatal cases actually and relatively. There were 22 less notifications of diphtheria, and the percentage of fatal cases was about half; the notifications of enteric fever were one more, but the fatality was greater actually and relatively than last year. Besides those recorded in the above table—amongst the Belgian refugees there were 5 cases of scarlet fever, 4 cases of diphtheria, 1 of erysipelas and 4 of puerperal fever, also 18 (English) measles, making a total of 32 cases; all of them were removed to the institutions of the Metropolitan Asylums Board or the Edmonton Workhouse Infirmary; no deaths occurred. Foreigners. There were notified from the Edmonton Infirmary 2 scarlet fever, 4 erysipelas, 18 puerperal fever, 1 poliomyelitis and 2 ophthalmia neonatorum cases. Of these, 1 case each of scarlet fever and erysipelas, and 2 cases of puerperal fever, were former residents in this district, and are therefore included in the above table. Amongst the military I received notifications as follow.—6 scarlet fever, 1 diphtheria, 3 enteric fever and 1 cerebro-spinal fever; also 2 English and 3 German measles. 29 As last year the Charts dealing with scarlet fever, diphtheria, and enteric fever, based on the uniform plan of a temperature chart, are not published for economy's sake. Rats. These rodents becoming again too numerous, virus was laid down in December, in Pymmes Park, round the refuse heap at the Sewage Farm, and elsewhere. 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. On May 27th the War Office issued a memorandum on " The Diagnosis of Small-pox." Vaeeination. The following table of vaccination returns has been kindly supplied by Mr. Lowman, the Vaccination Officer. VACCINATION RETURNS FOR 1916. Births. Successful Vaccinations. Conscientious Certificates. Deaths under one year unvaccinated. Still un- vaccinated but address known. Postponed owing to illness. Certified unsusceptible. Removed and untraced. 1723 658 580 117 110 48 0 210 In 1907 there were only 72 certificates granted to parents who alleged they had conscientious objection to vaccination, but there were 580 this year. This large increase of persons unprotected from smallpox will gratify no one but an anti-vaccinationist. Scarlet Fever. 110 cases were notified, giving an attack rate of 1.54 per thousand. 281, 351 and 420 cases were notified in 1915-14-13. There were 2 deaths, giving a death-rate of 0.03 per thousand of the population. Besides, one case was notified from the Edmonton Infirmary, who was not an Edmonton resident, but was treated in our hospital. Not one was doubly notified, and one case of infection was mixed with diphtheria. There were also 5 Belgians notified. Secondary cases numbered 9 out of 110. 30 There were 3 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 67 cases during the year, compared with 89, 148 and 131 in 1915-14-13, and they represent an attack rate of 0.94 per thousand of the population. There were 4 deaths, giving a death-rate of 0.06 per thousand of the population. One case was mixed with scarlet fever. There were two duplicate notifications. Ten of the cases were secondary ones. Four cases occurred amongst the Belgians, and are not included in the table above; one had mumps and measles preceding the diphtheria. There were no cases notified from the Edmonton Infirmary who were not Edmonton residents, nor any former residents. 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. 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) the former can be had from our fire stations. Enterie Fever. 6 cases were notified, as against 5, 17, and 8 in 1915-14-13. This is equal to an attack rate of 0.08 per thousand of the population. There were 3 deaths, giving a death-rate of 0.04 per thousand of the population. There were no secondary cases. There were no cases amongst the Belgians. Acute Anterior Poliomyelitis. Seven cases were notified by ten notifications; three were doubly notified. One was a Tottenham boy in Edmonton Infirmary. Our own six were scattered over the area. No deaths took place. CEREBRO-SPINAL FEVER. There were two notifications received, one from Great Ormond Street and the other from Tottenham Hospital; besides a soldier at the Military Hospital, whose last private address was in Finchley. The girl, of 1½ years, and the boy, of 3 years, lived far apart. 31 Of the four deaths of residents from "meningitis," one of 18 months was classified as 61C "cerebro-spinal meningitis," although notified as "cerebrospinal fever." In this class also, were a girl l of 11 years, a boy of 14 years, and a woman of 63 years, from "meningitis." The Registrar-General should revise Class 61 and also Class 63, which requires more sub-division. Why should an important infectious disease like poliomyelitis be buried in 63 B, with forty other diseases 1 ENFIELD AND EDMONTON JOINT ISOLATION 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, 1917, was £5,648, compared with £6,228 the previous year. The Superintendent's report for the year ending March, 1916, reached me on January 16th, 1917. 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, 1916, was:— For Scarlet Fever, Blocks II., III., IV. and Y. 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. In February a small house was added to the laboratory, for housing guinea-pigs, who are inoculated to decide whether the bacilli of swabbings are virulent or not. This test enables many patients to be discharged earlier than formerly. Two inoculations proved positive, seven negative. Twelve nurses were inoculated with anti-typhoid serum. During 1915-16 the greatest number of patients resident on one day was 107; that is 54 less 3 than the normal accommodation. The patients admitted from other districts appear to have been numerous, viz.: 22 cases of scarlet fever, 32 with diphtheria, and 3 with typhoid; or 9.5 per cent. of all admissions. 32 Three cases of cerebrospinal fever were treated; the Edmonton case recovered (see my last report). 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, 3 sisters (1 for night duty), 4 staff nurses, 12 probationers and 4 ward maids; in 1915-16 the resident "staff numbered 44 and the out-door staff 4, compared with 57 and 3 the year before. Antitoxin. On December 6th, 1915, Dr. Cook attended my Sanitary Committee's meeting, and suggested a plan whereby the medical practitioners might be prevailed on to administer antitoxin before a patient's removal to hospital. I was absent owing to indisposition. His enthusiastic advocacy influenced the Committee to recommend that syringes should be kept at our three fire stations, which are continually open. The syringe, after use, is washed and left at the home, and conveyed with the patient to the hospital, when a sterilised syringe is handed to the transport officer in exchange, who takes it to the fire station from which the doctor obtained the first one. It was also advised that the practitioners be paid 3s. 6d. for each injection given, and reported on the notification; further, that the Enfield doctors be allowed to obtain antitoxin at our Bush Hill Park fire station on payment of its cost from their Council. This was referred back, and not ratified until the January meeting of the Council, when 2s. 6d. fee was offered, but the Edmonton Medical Society stipulated for the first-named fee, which was then agreed to on 22nd February. So seven syringes were purchased, and in May two were placed at each fire station and one held at the hospital (for exchange), sterilised, and in dust-proof envelopes. This plan is on its trial; it may prove difficult in practice to maintain the supply of syringes sterilised and fit for immediate use. In April it was arranged that antitoxin for use on Enfield patients should be issued from our Bush Hill Park fire station, and charged to that Council. Return Cases, During the year 1916 there have been five such of soarlet fever and one of diphtheria. Three of scarlet fever arose in a family, where the first case was sent home from the Metropolitan Asylums Board Hospital at Winchmore Hill, to which she was sent back. Dr. Cook estimates the percentage of return cases of scarlet fever during 1915-16 as 4.97, compared with 2.70 for the previous period. 33 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 (£341 for 1916-17; it was £225 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 temporary buildings have been used as a sanatorium for tuberculous cases since July 20th, 1912. The number of tuberculosis cases in the institution on December 31st, 1916, was 118, 11 of whom were residents in Edmonton Urban District. No cases of small-pox were treated during 1916 from any district. Small-pOX. On April 4th the Hospital Board expressed a wish to take over our Temporary Hospital at Pickett's Lock Lane, and on the 18th the agreement was sealed. On 3rd May the Board took possession. In November we agreed to allow the old disinfecting shed to be used as a laundry. On 27th May a memo. on the diagnosis of small-pox was issued by the Army Medical Department from the War Office. The following 18 urban districts are now shareholders in the Joint Hospital:— Acton Brentford Chiswick Edmonton Enfield Feltham Friern Baniet Greenford Hampton Wick Hanwell Harrow Southgate Staines Tottenham Wealdstone Wembley Wood Green Hendon was added, after the usual Government enquiry, on April 7th. DISINFECTION. On the advice of Councillor S. J. Sanders, it was decided, in June, that the shed for the ambulance and bedding vans be removed from the farm to the Town Hall yard. 34 Disinfecting- Station. In March, the Engineer announced the completion of the new one, commenced in November, 1915, in the Town Hall Yard, at the back of the Baths, but not communicating, the cost of which had been defrayed out of the current rate. It was taken over by the Public Health Department and put to use on 20th April. The mortuary keeper, C. Hickford, attends to it. There is a boiler, independent of steam supply from the Baths, and the Engineer devised an accessory fire outside, for consuming the fumes from the disinfector. Our methods of house disinfection are stated in my report for 1914. Disinfectants continue to be supplied to callers, mostly children, on the same lavish scale as heretofore. The saving of a few pounds in printing this report, by condensation and omission of interesting facts, does not compensate for the waste of several hundred pounds in mal-odorous compounds. PEURPERAL FEVER. Twenty-five cases were notified; of these, 4 were Edmonton women, of whom 3 died. Our death-rate is therefore 1.84 per thousand nett births; it was 3.00 last year. I must say a few words with reference to the very large increase of this serious disease, viz., 25 cases notified compared with only 7 last year. Of these, no less than 23 out of the 25 were received from the Edmonton Workhouse and Infirmary, of which only 2 were Edmonton women; there were also 4 Belgian refugees, and 17 from other districts of the Union, including 10 from Tottenham. I am inclined to think that the increase is more apparent than real,, and is largely due to the fact that the Acting Medical Superintendent (Dr. Gregorson) realises that the term "puerperal fever" in the Registrar-General's classification of deaths, Class "137," includes 30 septic conditions. [I am rather at a loss to know why "milk fever" should be one of them, as that term usually refers to a physiological condition merely arising with the onset of milk to the mover's breasts.] During 1915 there were 264 midwives practising privately in Middlesex and 447 not practising; besides, there were 15 engaged in poor-law infirmaries, who are exempt from the provisions of the Act. In Edmonton there were 16 practising at the beginning of 1915 and 12 at the end of that year. One midwife was removed from the midwives' roll by the Central Midwives' Board, and 5 were cautioned by letter and 14 verbally. During that year no uncertified women were prosecuted by the County Council for acting as midwives, but 15 were verbally cautioned by the Inspector of Midwives,. Miss Pollard. 35 OPHTHALMIA NEONATORUM. This disease was made compulsory notifiable on the 1st April, 1914. There were 11 cases notified during 1916 by 13 notifications, of whom 3 notified to me from the Edmonton Infirmary belonged to other districts. Of the 8 residents, 4 vere in Bury Street, 3 in Fore Street, and 1 in Church Street Ward. One child—L.G.—died of "malnutrition and bronchitis." Two cases were doubly notified, each by two doctors. Of the single notifications, all were from doctors and none from rnidwives. In July I was directed to caution a practitioner as to the necessity of complying strictly with the regulations. ERYSIPELAS. Sixty-three cases were notified, compared with 79 the previous year, besides one Belgian and 3 "foreigners" occurring in the Edmonton Union Infirmary. There were two deaths from this cause, both residents. Three cases were doubly notified. Thirteen cases occurred amongst people who were living in our district outside the Union Infirmary, and yet unable to provide proper attention for themselves. Under agreement with the Guardians, my Council received remuneration for the nurses and dressings provided for those unfortunate persons. The cases were most numerous in the last quarter of 1916. PHTHISIS AND OTHER TUBERCULOUS DISEASES. The deaths from phthisis numbered 69 (and one Belgian), as compared with 73, 74 and 72 during 1915-14-13. The death-rate from the disease is therefore 0 97 per thousand, compared with 1.04 last year. Of these deaths, 39 occurred among residents of the district in the Edmonton Workhouse. The total deaths from phthisis in the Edmonton Workhouse numbered 50 (including one Belgian). The other tubercular diseases together accounted for 31 deaths (excluding one Belgian), giving a death-rate of 0.43 per thousand. It was only 0.31 last year. Of these deaths, 3 were residents of the district in the Edmonton Workhouse. The total deaths from these diseases in the Edmonton Workhouse numbered 7, including one Belgian death. 36 In this way, tuberculosis contributed a total death-rate of 1.40 per thousand of our own population, or 13.8 per cent. of all the deaths, excluding Belgians and strangers; it was 11.2 last year. The Senior Woman Inspector paid to consumptives 430 visits and revisits during the year, compared with 518 the year before, and also 49 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 Asliford, Kent. (2) Refugee Cases.—These are sent to an institution provided by the Metropolitan Asylums Board, usually Bromley House, Bow. PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS, 1912. The total number of patients notified under these regulations was 203— 119 males and 84 females. The number of notifications was 310. Amongst the Belgian refugees there were three persons notified, all males, by five notifications; all for pulmonary tuberculosis; not included in tables below:— Lungs- Patients notified once 97 ,, ,, twice 33 ,, ,, thrice 24 ,, ,, four times 5 ,, ,, sis times 1 160 Other Forms- Patients notified once 37 ,, ,, twice 6 43 37 The notifications are thus analysed :— Received from— Private Practitioners (A) 51 36 8 7 S.M.I. (B) 2 1 1 0 Sanatoria (C and D) 75 42 1 2 Infirmary (A, C and D) 9 9 0 4 District Medical Officer 2 0 0 0 Hospitals (A, C and D) 10 6 16 10 Other Institutions (A, C and D) 3 1 0 0 *Dispensary 3 0 0 0 Voluntary 1 3 0 0 Military, from our own and other Hospitals 6 1 0 0 162 99 26 23 261 49 *No notifications have been received from the Tuberculosis Officer of our area (No. 1). Scholars. Four children were notified by the School Medical Inspector during the year as suffering from tuberculosis, 3 from pulmonary tuberculosis (2 boys and 1 girl), and a boy from another form of tubercle. 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 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 three medical men. So there are two members of the County Council on the Insurance Committee for each Parliamentary Division, besides the two women and the three medical men. 38 The Faculty of Insurance appointed a Commission to take evidence and report on the working of the National Insurance Act. The conclusion arrived at is:—"That the Tuberculosis Scheme cannot be regarded as a success, and that in all probability much better results would be arrived at if the existing overlapping control were brought to an end." The Government appointed a Departmental Committee to report on the same and to suggest reforms which would not involve any extra charge on the Treasury. DISPENSARIES. Edmonton, Tottenham and Enfield form No. 1 area of the five 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. Coghill, the Tuberculosis Officer; his assistant, Dr. Trevor Davies, is on war service. COUNTY COUNCIL. The Public Health Committee did not publish an Annual Report for the year ending March, 1916. The County Medical Officer's Report for 1915 was received on 17th March, 1917, and found to be, like mine, much condensed. NEW REGULATIONS. Two sets were issued during 1916. (See . Legal section.) MEASLES. The Measles Regulations, 1915.—This Order came into force on the 1st January, 1916. In December, 1915, 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 the number of visits necessary to supervise each family affected, will mean an enormous amount of work when an epidemic of measles arises, and a good deal, even if there is only a moderate number of oases. " The duties of the Council, and the Medical Officer of Health and 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 interest in the cases of tuberculosis. 39 "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." I offered to provide a motor car on terms very advantageous to the Council, but my offer was not entertained, so I have been unable to take the active part in this work which the Government require Medical Officers of Health to do. But the Council, on January 25th, endorsed my recommendation that our representatives should ask the Joint Hospital Board whether some beds (say half-a-dozen) could not be allocated to Edmonton for critical cases, or cases in bad homes, who might, therefore, be recommended by me for admission. The Hospital Board on February 29th declared that " it would not be desirable to receive such cases." In January, 1916, I also stated that:—"Notification is productive of much more good if provision can be made for 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 Counoil's responsibility under the regulations; and as regards death-rate, the average death-rate from measles for the past ten 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." THE MEASLES EPIDEMIC. There were 29 deaths, compared with 26, 12 and 48, in 1915-14-13. This number is equal to a death-rate of 041 per 1,000 living, compared with 0.37 last year. Three occurred in the first age period (under one year), 12 in the second age (one and under two years), 12 in the third age (two and under five years), and two over five years of age. There were no deaths amongst the Belgian children. I received notifications about 1,238 oases—1,171 being defined as English and 67 as Rubella (formerly "German measles"). Of these, 1,152 English and 66 Rubella were amongst residents; one each was notified amongst strangers at the Infirmary, and 18 English amongst the Belgians. The attack-rate was therefore 17.06 for every 1,000 inhabitants. Forty-three were doubly notified by doctor and parent, and one by two doctors. For incidence on the various age periods, see Table II. at end of this Report. There were also five military cases. 40 In my monthly reports I regularly kept my Sanitary Committee, the Council and the Education Committee, fully informed of the position as regards measles. In my report for July I presented the statistics for the previous five months of 1916. In my report as M.O.H. for November, presented on 6th December, I drew special attention to the fact that 203 notifications had been received during that calendar month in 139 houses, and that the two women inspectors had paid 201 visits on this account, so that they were suffering from over-work, and not able to give their other duties amongst women and children much attention. I said that "shortage of staff must produce shortage of work." Ata special meeting of the Sanitary Committee, on Dec. 13th,I presented further statistics, showing that during the first quarter of 1916 I had received 69 notifications, during the second quarter of 1916 I had received 283 notifications, during the third quarter of 1916 I had received 160 notifications, and that, for the fourth quarter, up to and including the 13th day of December, I had received 490 notifications; and that the visiting was already nine days in arrears, so there was regrettable delay in excluding contacts from School, and mothers from work in factories and workshops. Two important letters from the Local Government Board were the subject of discussion. One, dated 9th, was with reference to maternity and child welfare (quod vide). The other, dated 8th, enquired as to the measures the Council were taking to control the epidemic, and pointing out the urgent necessity for prompt visiting, especially where no doctor was in attendance; the Board were willing to contribute up to half the cost of the extra outlay. I then reported that I had taken steps, as empowered by the Regulations of 1915, to obtain the closure of all Sunday, private, public elementary and secondary schools, also of evening continuation classes held in our schools. On Monday, the 17th, and Wednesday, 19th, December, Dr.J.R. Hutchison, Medical Inspector, L.G.B., visited Edmonton with reference to the Council's arrangements about this epidemic, and also with reference to the provision for mother and' child welfare. On the latter occasion he was met by the Chairman of the Council and the Chairman of this Committee. On 19th December I circularised the medical practitioners informing them that my Council had provided a nurse to attend the worst cases at home, and asking the doctors to state on their notification whether her help would be needed. From December 14th to 31st, Miss Wrampling, our school nurse, taking advantage of the school closure, paid 109 visits to 44 cases. At the next ordinary Council Meeting (December 27th), the recommendations of the Special Sanitary Committee were confirmed, viz., the appointment of a third Woman Inspector (and Health Visitor) and the procuring of one or two fully-trained nurses. 41 During December, 448 visits were paid for measles, but only 23 on child welfare account. Nineteen deaths from measles were registered this month. Mr. Butland devoted much time to the disinfection of schools, churches, chapels, church halls, and similar buildings, and Mr. Oades and Miss Hill were fully engaged in clerical work relating to measles. Miss Sheffield began work on Wednesday, December 27th, when the visiting was 18 days in arrears. At the ordinary Sanitary Committee Meeting of January 3rd, 1917, I reported further particulars of the epidemic, that had new reached its maximum. During the five weeks ending December 30th, no less than 451 notifications were received from 357 houses, and the women inspectors paid 448 visits on this particular count. I expressed a strong conviction that the admission of children to cinemas, and other places of indoor entertainment, whilst the schools were closed, was a great factor in the persistence of the epidemic. On the 10th January, 1917, at a Special Meeting of the Sanitary Committee, I submitted particulars of measles cases notified during 1916, and for the New Year, up-to-date, when it was decided to re-open the public elementary and other schools on Monday. January 15th, but to keep the Infants' departments closed until January 22nd. On 6th January, 1917, the Middlesex County Council sent a circular letter to the proprietors of picture theatres or cinematograph shows in Edmonton, suggesting that, in the interests of public health, children under 14 years of age should not be admitted during the great prevalence of measles. This appeal only met with a partial response. When the Committee's report reached the Council, in Special Meeting on January 12th, 1917, our Solicitor in attendance, I reported five families where the disease had either not been notified at all, or not within the prescribed time; also the wilful exposure of two patients in public vehicles. The selection of cases for prosecution was left to the Chairman of the Sanitary Committee, our Solicitor, and myself. Those that were not prosecuted were requested to attend the Sanitary Committee. It was also decided that a letter from the Clerk be sent to medical practitioners requesting them to assist the Council in arriving at correct death returns, by the doctors stating definitely in their certificates the primary cause, as well as the immediate cause, of death. This was sent on 19th January, 1917. 42 SECTION II B. COMMUNICABLE DISEASES-NON-NOTIFIABLE. We can partly judge from the prevalence of these diseases by the death returns. The deaths from whooping cough have been 4 less; the deaths from diarrhoea have been 11 less than last year; from influenza 4 more 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. Some head teachers rely too much on their attendance officers, and so delay arises in my becoming aware of the suspected cases. DIARRHOEA. Thirty-four deaths occurred from diarrhoea and epidemic enteritis, as compared with 45, 58 and 54 for 1915-14-13. The death-rate from the disease is 0.48 per thousand of the population, as compared with 0.64 last year. Of these deaths, 26 occurred in children under one year of age, giving an infantile mortality rate for the year from this cause of over 15 per thousand nett births; the figures in 1915-14-13 were 22, 44 and 22 per thousand nett births. 28 deaths were in children under two years; these contribute to the zymotic death-rate. There was also one Belgian infant over one year, but under two years old. As in previous years, 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. On May 17th I addressed the Women's Co-operative Guild on " Flies and their evil habits." The Local Weather. The sunshine was well below the average allowance, and the number of sunless days was high. The rainfall, at 35.23 inches, was heavier even than the bad record of 1915, and has only once been exceeded in 20 years. The great blizzard on March 28th will not soon be forgotten, nor the blinding fog of Wednesday evening, December 27th.— [Abstracted from report of Mr. J. McEwan.] WHOOPING COUGH. There were 9 deaths from this cause, as compared with 13, 17 and 9 in 1915-14-13. This is equal to a death rate from the disease of 0.13 per 43 thousand living. All the deaths occurred amongst children under five years of age—7 in the first age period, one in the second and one in the third. Four in April, none after first week in July. INFLUENZA Seven deaths were registered from this cause, compared with 3, 4 and 7 for 1915-14-13. Three persons were over 65 years of age, and three were between 45 and 65 years, and one between 15 and 25 years of age. VENEREAL DISEASES. No deaths were recorded as due to these diseases in their primary forms, but deaths due to their later effects are recorded, e.g., general paralysis of insane, locomotor ataxy, stricture, etc. For the Regulations see "Legislation," Section V. I submitted them to my Sanitary Committee in September. The subject was before the Committee again in October and November. I stated that, in my opinion, the time for compulsory notification had not yet arrived. On my advice the Council passed the following resolutions:— "That, in view of the fact that the effects of venereal disease upon the individual and upon the race are grave and far-reaching, involving a heavy loss to the community in actual and potential population, this Council, being of the opinion that the conditions now existing require that action should be taken without delay for providing adequate treatment for all persons affected with venereal disease, do urge upon the Middlesex County Council the necessity for at once proceeding with the consideration and formulation of a scheme for the provision of the necessary facilities for diagnosis and treatment. "That the attention of the Middlesex County Council and the Middlesex Insurance Committee be drawn to the anomaly that whilst medical men are now obliged, under the National Insurance Act, 1911, to treat venereal diseases amongst the insured on contract terms, many Friendty Societies still retain the rule that sufferers shall not receive any sick pay whilst Buffering, and that the persistence in this rule is likely to prevent early and efficacious treatment of these diseases. "That these Authorities be requested to take steps to induce the Friendly Societies in the County to abolish this rule where it exists." Copies of these resolutions were sent to the Middlesex County Council and Insurance Committee, to all District Councils in Middlesex (asking them to 44 adopt similar resolutions) ; also to the National Health Insurance Commissioners, the Registrar of Friendly Societies and the Board of Trade. On December 29th I received the scheme of the Middlesex County Council, a circular letter addressed by the County M.O. to practitioners, and eight leaflets on the subject. OTHER DISEASES Alcoholism, One 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 56 more deaths than in 1915. The number was 215, giving a death-rate of 301 per 1,000, compared with 159, and a death-rate of 2.28, for the latter year. Also four Belgians. The death-rate from all diseases of respiratory organs was very heavy, both in 1915 and 1916. It was only 1.70 in 1914. Some of the deaths, without doubt, certified as only due to bronchitis or pneumonia, were primarily due to measles. [See the article thereon.] CaneeP. Fifty-five deaths of Edmonton residents were certified as being due to cancer, and this is equivalent to a death-rate of 0-77, compared with 0.75 last year. The deaths during 1915-14-13 were 52, 53 end 48. 45 SECTION III. SEWERAGE AND DRAINAGE. The district is sewered on the separate system. The surface water is conveyed into the Pymmes and Salmons Brooks. The sewage proper, together with that of the neighbouring district of Southgate, passes to the Counoil's sewage farm of 233 acres. Mr. Frank Rackham is the farm bailiff. A section of the northern main sewer, by " Halliwick," has been relaid and made watertight. THE SEWAGE FARM. 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. Our farm is in an interesting stage of passing by degrees from broad irrigation to a system of bacterial filters. The first filter bed started working in the gravel pit 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. This, in June, 1916, was reported in good Working order, and producing excellent results; the effluent therefrom is now passed over the fields before discharge into Salmon's Brook. The nature of the warm liquid sent down from the gas works, out of their sulphate of ammonia plant, causes our Engineer considerable trouble to deal with. The backing-up of the water in Pymmes Brook at Tottenham Hale is another chronic source of trouble from flooding. Samples of the sewage effluent have been taken from time to time by the Lea Conservancy Board and the County Inspectors, and we always have received a good report on analysis. When available, carts have been engaged carting house-refuse on to the site of the proposed No. 3 Filter, so as to raise the foundation to the necessary height. The old carrier on the high level, just east of the main effluent channel, has been cleaned out to a depth of 2 feet and filled in with clinkers; at the same time it was considerably narrowed; it ends in Plot 16, towards Angel Road. Several new valves and pots have been constructed at the inlet to the low-level bacteria bed (No.1) in the pit north of the Pegamoid Works, enabling a further supply of the sewage to be given to it, as the bed had not been working to its full capacity. The underground reservoirs of the Montagu Road Pumping Station have been cleaned out and two new 20-inch penstocks have been fitted. 46 An 18-inch main has been completed, which runs from the supply chamber of the high level (No. 2) bacteria bed, passes round the easterly and southerly sides of the bed towards the channel taking the effluent from that bed, from whence it proceeds parallel in a southerly direction to a point opposite the north-east corner of the Pegamoid Works, and thence across the two carriers and the main effluent channel to the bacteria bed No.1. A number of sluice-chambers have been constructed on this line of pipe for distributing the sewage over the adjaoent land. This main is cleverly designed so that it may be used for three purposes—(1) To convey sewage to the No. 1 bacteria bed; (2) To convey the sewage on to the land or to further new filters; or (3) To convey the effluent from the No. 2 bacteria 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 six bacteriological filters. House Refuse Disposal. Edmonton does not possess a destructor. The tender of Ernest Knifton for the collection of house refuse, for the year ending September 30th, 1917, at the price of £1,850, was accepted; that is £250 more than last year. In January the contractor's attention was drawn to the number of complaints of non-removal, and again in March. They alleged great difficulty in obtaining labour enough to ensure regular weekly removals. In December the Chief Inspector found serious neglect on the part of the new contractor, and, further, that loads of refuse had been shot on land other than our sewage farm. The Sanitary Committee of January 3rd, 1917, recommended that the penalties imposed in the contract be enforced against the contractor, E. Knifton. The British De-tinning Company has been formed to take up the work of a German firm, who collected the tin, salved the solder, and recovered the other metal. ROADS. No private streets have been made during the year under the 1892 Act. During the past year the main and some district roads have been sprayed with tar. Bury Street, east of the Nurses' Home, is to be widened to 60 feet. 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. 47 Our Engineer has prepared and printed a list of all the roads in the district, in alphabetical order, and classified as to their condition. A very useful booklet. WATER SUPPLY. At the old linoleum works of Ridley-Whitley, now being transformed into a margarine factory, a well of 400 feet deep has been sunk into the hard chalk. The water level is 88 feet from the surface. The well will supply 2,290 gallons an hour. The water which the Lea Conservancy Board controls runs from Hertford to Limehouse. They also took over the Stort navigation in 1912. 48 SECTION IV. HOUSING AND TOWN-PLANNING. Building's. In consequence of the war-regulations of the Ministry of Munitions respecting the limitation of any outlay to £500, unless by special provision, no large buildings other than factories for war work have been erected in Edmonton this year. Very few dwellings have been erected either, because of the scarcity of labour and the high prices for wood and other materials. No prosecutions for contraventions of the building bye-law 113 have taken place since 1907. In April, plans were submitted showing considerable alterations and additions to the old linoleum works in Angel Road, where the manufacture of margarine will be established. For the rest of the year, there has been a large number of men employed here. Amongst other matters, extended and improved sanitary conveniences, a large benzine store, and a deep well supply are in prospect. In October, plans were passed for the erection of a lodge, mortuary, waiting-rooms and chapel at the Jews' Cemetery, Montagu Road. These replace old ones. INSPECTION OF PREMISES. Number of premises inspected on complaint 341 Number of premises inspected in connection with infectious disease 294 Number under periodical inspection 779 Total number of inspections and re-inspeotions 13,340 ACTION TAKEN (OTHER THAN UNDER H. & T. P. ACT) Cautionary or intimation notices served 769 Statutory Orders issued 88 Summonses served 10 Convictions obtained 10 Nothing was done that can be recorded under Article V. of the Housing Regulations, 1910, as the Housing Inspector (Mr. H. K. Nixon) is on war service in Salonica, and no deputy has been appointed. 49 HOUSING AND TOWN-PLANNING COMMITTEE. The Housing and Town Planning Committee has been in a state of suspended animation for the past- two years. However, they met on April 25th, and re-elected Councillor Cadman as their Chairman. ARTERIAL ROADS. On the 23rd May, Councillor Cadman reported on a Conference he had attended with our Engineer on the 19th May, at the Middlesex Guildhall, when the line of the new Cambridge Road was agreed; also of the north circular road through Angel Road and Silver Street to Bowes Road, Southgate. The Conference made two important suggestions to the Government (see Minutes, pages 112-113). One was ' That all practicable steps should be immediately taken to induce Local Authorities to secure the reservation of the necessary land for main roads by the exercise of their powers under the Housing and Town-Planning, etc., Act, 1909." The purport of the other is condensed in the last paragraph :—This Conference is desirous of recording its opinion that it is imperative that steps should be immediately taken through the Local Government Board, or other Authority, to secure the routes of such new and improved thoroughfares as are set forth in the important traffic proposals contained in the report of the Conference on Arterial Roads in Greater London." At a Conference in July it was decided that a deputation from Greater London should ask Mr. Asquith (Prime Minister) to give a guarantee that compensation would be paid, if the arterial roads suggested by the Local Government Board were included in the town-planning schemes of Greater London. In October the Engineer was instructed by the Works Committee to prepare a register of all lands belonging to the Council. TOWN-PLANNING CONFERENCE. A Congress to consider housing problems after the war was held from 11th to the 14th April, at Caxton Hall. For Edmonton, Councillor Cadman (Chairman of the Housing and Town-Planning Committee), the Architect, the Engineer and the M.O.H. were appointed representatives. On the 3rd May I reported the proceedings to the Sanitary Committee. The one point so frequently impressed on the representatives was the wisdom of utilising the present time in preparing town plans and housing schemes, so that the authorities may be at once prepared to carry them out when this great war has come to an end. A deputation appointed by the Conference met Mr. Long, 50 the President of the Local Government Board, and pointed out the necessity of providing work, especially in the building trade, after the war, and asked the Government to provide .£20,000,000 towards the erection of houses; to their views Mr. Long is said to have given a sympathetic reply. BUSH HILL PARK. On the 18th April, a deputation presented a petition, signed by 128 residents, expressing a hope that the Council would not permit the triangle of land south-west of the station to be built on, especially for shops, and that the opportunity would be taken of securing the site in perpetuity, so that in the future, as in the present, that area may retain its name as " a garden city." Residents were willing to give £100 towards the cost. In September, the plan—No. 3,178—was disapproved. THE CORNISH ESTATE -Plan No. 3157. Public Health Department, Town Hall, Edmonton, London, N. 14th March, 1916. To the Chairman and Members, Plans' Committee, Town Hall, Edmonton. Gentlemen, I am unable to approve of the six houses proposed to be erected by Mr. J. F. Turner, for Councillor W. D. Cornish, in Delhi Road. I said in a previous letter to your Committee, dated 11th March, 1914, with reference to Plan No. 3062 : " That my approval or disapproval of any plans that come before me, is not limited by the question as to whether the said plans show houses which are in accordance with the local Building Byelaws or not. In the drafting of these bye-laws, your Medical Officer has, up to now, had no share, and has, therefore, no responsibility as to their execution by builders or speculators; but I have to give you and the Council an honest opinion as to whether I think the plan of a house is acceptable from a public health point of view, and in the interests of ' the Edmonton of the future." This plan—3062—is a plan that well shows the possibility of overcrowding dwellings on a limited area, and it is antagonistic to the hope we entertain of Edmonton being planned on wise and healthy lines. I also object to the back passages; I do so from the experience connected with these long, dark and narrow ways which already exist in some parts of Edmonton. The passages shown in this plan will, in a short time, become like the others, viz., an annoyance, nuisance and danger to the health, not 51 only of the tenants themselves, but also of their neighbours. These passages are difficult to supervise by my department, or by the police, and are in every way a bad substitution for the plan of semi-detached villas (i.e., villas with their own side entrances), where coal can be brought in and ashes and refuse taken out, without causing a nuisance or annoyance to one's neighbours or the public generally." These remarks apply to Plan No. 3157, and, indeed, with more force, as Delhi Road will form part of the new main road to Cambridge, 100 feet wide, which the Road Board intends to place along there in the immediate future. The Council will be wise to remember this, and not allow houses to be erected which will have to be bought and/or pulled down, at great cost to the ratepayers, if the road is now allowed to be made less than 100 feet wide between the two front building lines. The style of these houses is inferior to those in Porlock Road, as the sculleries are only a " lean-to," without bedrooms over them, and the so-called third bedrooms are only 8½ feet long by 6 feet wide, and 8½ feet high, and without a fireplace. The total cubic capacity is not much over 400 cubic feet, which is about the provision for one person in a common lodging-house. Your Committee (through the Council) is able to determine, in the western half of Edmonton, the development of which is now subject to the provisions of the Housing and Town Planning Act, and the Regulations thereof, the following matters :— 1. The width and direction of the roads. 2. The height and character of the buildings to be erected. 3. The number of houses that shall be erected per acre. On the side of the main road to Cambridge, which will be the most important thoroughfare (in the future) of Bush Hill Park, I think you will agree that not more than 12 houses per acre is a reasonable limit. The plan shows more than 21 houses per acre—a number that should be allowed only in back-streets for workmen's cottages, and not in areas in main roads, which should be occupied by residences of good rateable value. I trust that in the interests of the ratepayers and the public health, you will recommend the Council to use their Town-planning powers in this area. I am, Gentlemen, Your obedient servant, SIDNEY C. LAWRENCE, Medical Officer of Health. P.S.-—I understand that the erection of these houses has been commenced already—without waiting for your approval of the plans. S.C.L. Note.—Notwithstanding my protest, the plan was approved. 52 In September the Plans Committee considered Plan No. 3,177, for the erection of 29 houses in Porlock Road, showing 24 to the acre. Consideration was adjourned to allow Mr. Cornish to confer with the Engineer and Architect, and it was decided to disapprove the plans if the owner was not amenable. The plan showed no less than 24 houses to the acre, and is in the area being dealt with under the Housing and Town-Planning Act, 1909. 53 SECTION V. LEGISLATION OF 1916. ACTS, CIRCULARS, ORDERS, REGULATIONS, ETC. Local Government (Emergency Provisions) Act, 1916. With a circular letter, dated 26th May. Section 5 reduced the fee to medical practitioners for notifying infectious diseases from half-a-crown to one shilling each. The Act took effect on and from May 17th, when the Act received the King's assent. It lasts for duration of war, and further at the option of the Local Government Board. Section 10.—Authorising payments (or rebate) from County Councils, of salaries of M.O.H. and Inspector of Nuisances who are on war service, and of their locum tenentes. Section 15.—Authorising payments to registrars for statistical information furnished in pursuance of Section 2 of the Parliament and Registration Act, 1916. Section 19.—Authorises us, if we wish, to arrange for the storage of furniture whilst persons are serving with His Majesty's Forces, upon such terms as the Council may impose. Maternity and Child Welfare. On the 28th September the Local Government Board sent me a pamphlet, in convenient octavo size, containing :— (1) Circular and Memo., 30th July, 1914. (2) Circular and Memo., 29th July, 1915. (3) Memo, by the Chief Medical Officer, November, 1915. (4) Circular issued 23rd September, 1916. (5) Regulations about grants of above date. The Board of Education, in 1916, issued a reprint from the Report of their Chief Medical Officer for 1914, styled Circular 940, with the title of "Education and Infant Welfare." All these publications I heartily commend to your notice. Tuberculosis Regulations, 1916 (No. 1). Addressed to Local Sanitary Authorities, but not to County Boroughs, nor County Councils, dated 13th May, with circular letter dated 15th, from the Local Government Board. They last till the end of the war only. The object 54 is to prevent the enlistment of tuberculous men, whom I have to notify weekly to the War Office. A circular of 9th May asked County and County Borough Councils for the assistance of their Tuberculosis Officer in the examination of recruits, etc.. Tuberculosis Regulations, 1916 (No. 2). Addressed to County Councils, Local Sanitary Authorities and Insurance Committees of England, dated 19th September, with circular letter of 20th. This repeals the Order of July 26th, 1912, and institutes new methods of domiciliary treatment of insured persons suffering from tuberculosis. It comes into force on January 1st, 1917. A schedule is attached showing form of report on each case, once a quarter, by the practitioner to the County Tuberculosis Officer, who shall examine the patient at least once every year. Article II. (6) provides that practitioners shall inform the M.O.H. of any conditions which, in the practitioner's opinion, are insanitary and prejudicial to the patient. Venereal Disease Regulations. In September I submitted to my Sanitary Committee a pamphlet issued by the L.G.B. containing:— 1. Regulations of 12th July, which forthwith came into force throughout England and Wales. 2. Circular letter of 13th July from the Board to County Councils, County Borough Councils, the Common Council of the City of London, and to Boards of Guardians, and to managers of hospitals 3. A memorandum of the Chief Medical Officer of the Board. Of these documents little need be said, as the administration is left in the hands of the County Council. The Government contribute 75 per cent. of the cost. On 29th August the Local Government Board issued a circular to County Councils, County Borough Councils and the Common Council of the City of London, commending the advice of the British Medical Association that medical consultants and practitioners should be associated with these bodies in forming a scheme or schemes; also that the drugs should be distributed through the Medical Officer of Health free for intravenous administration by registered practitioners qualified to administer it. On December 29th I received from the County Council particulars of their scheme for Middlesex, a circular letter addressed by their M.O.H. to the medical practitioners, and eight forms or leaflets relating thereto. 55 SECTION VI. PLACES OVER WHICH THE COUNCIL EXERCISE SUPERVISION. 1.—Factories and Workshops. The premises coming under the Acts have been inspected periodically and at irregular intervals. A record of the work done has not been asked for this year by the Home Office. Munitions of war factories have added considerably to our responsibilities. (See " Foreword.'") 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 deputykeeper. 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. N. A. Barrett, 188, Fore Street, was granted a three years' licence from December, 1914. Tuberculous Meat. On May 18th half a carcase of a Jersey cow was seized at 25, Hertford Road, and the fellow half at 110, Fore Street. At this latter place there was also seized a rump and loin of another beast. The persons in charge of the two shops were prosecuted on 8th June, together with Ernest Knifton, who holds a licensed slaughter-house in Langhedge Lane. Professor Wooldridge, F.R.C.V.S., Eng., in his report to the Council said : " I may, perhaps, be permitted to state that in all my experience I have never seen any beef prepared for sale for human food in a more advanced state of emaciation, and more unfit for human food." On June 8th Ernest Knifton and Bugg were each fined £10 and £2 2s. costs, and Webb, of 25, Hertford Road, £5 and £1 1s. costs. On July 5th the Sanitary Committee 56 recommended that application be made to the Magistrates for the revocation of the slaughter-house licence granted to E. Knifton. This was confirmed by the Council on July 11th, but in September it was decided to defer this action. In 1917 Knifton was granted the licence again! On December 13th Inspector Winter found at a central slaughter-house that a well-nourished young bullock, on being opened, presented signs of acute peritonitis. I saw it that night, and on the following morning, with Professor Wooldridge, who was present this time on behalf of the trade. The parts affected were willingly surrendered by the butcher, sent to the Town Hall Yard, and destroyed. These two cases are an instructive contrast. 5. -KnaekePS. The yard, of which plans were approved on October 28th, 1914, and licence for one year granted in the next month, has not yet been erected as proposed on land south-west of Eastbournia Avenue. 6.—Pig's. In June the Chief Inspector reported that 30 residents had sent in a petition for the abatement of offensive smells from the piggery connected with Ernest. Knifton's slaughter-house. This was by no means the first time complaint had been made. It arises from the storage and boiling of waste food from workhouses and restaurants. The Council agreed that in the event of the nuisance being again created, legal proceedings be taken. They were not. 7. Dairies, Cowsheds and Milkshops. -There are only 2 cowkeepers now in the district, the same as last year; and only 25 cows are owned by these keepers. Veterinary inspection of the cows is not undertaken in this district, either by my Council or the County Counoil. There were 92 purveyors of milk on our register at the end of the year. Co-operative Dairy. In February, the plans of the Co-operative Society for an addition to their dairy of a loading room and cooling store were disapproved. However, in March, another plan was submitted for similar buildings, and a cooling house for bread adjacent to the existent bakehouse in Shrubbery Road. The Plans Committee then approved of the plans "as a building" on condition that the building, when erected, must not be used as a dairy without the consent of the Counoil. To the Sanitary Committee of the 5th April the plans were submitted in detail by Mr. F. Bethell, and it was recommended and agreed to by the Council, that on certain terms, permission be given to use the buildings as a dairy for a period not exceeding two years from the date of the conclusion of peace between Great Britain and her enemies. In September the licence was 57 transferred to the new buildings. In November it was agreed to use the front portion of the old dairy for the retailing of milk and bread until six months after the conclusion of peace. Milk Nuisance. In March I reported that for some months past I had received many complaints, mostly verbal, of the insanitary condition of the stairs and landings on the down (or west) side of the high level station at Lower Edmonton, and that this was due to the splashing of milk thereon from oans dragged down the 43 steps. These cans, when full, weigh nearly 2-cwt. The deposited milk, decomposing, gives rise to offensive smells, which are accentuated by the use of disinfectant. As far back as September, 1915, I drew the Great Eastern Railway Company's attention to this great nuisance. In March a legal notice was served on the Company, but in July I reported that nothing had been done to abate it. I met the stationmaster and a representative of headquarters at Liverpool Street on two occasions, and pointed out that the milk cans might easily be taken down the incline at the south end of the platform into Bridge Road, as the wet fish boxes have been for years past, but they appeared to favour some more expensive plan, if any. At the time of writing, this nuisance still annoys passengers and damages the stairs and landings of the Company by the cutting edges of the cans on the timber. 8.—Unsound Food. On September 20th rashers of bacon were seized in a shop at Lower Fore Street, and on prosecution £5 2s. Od. was the penalty paid. On August 5th unsound tomatoes were seized on a hawker's barrow, and .£5 fine or five weeks' imprisonment was the sentence. 9.—Offensive Trades—Gutseraper. Nothing to report. 10.—Marine Stores. Ill July our attention was drawn to offensive smells, arising from a huge collection of rags and some rabbit skins at a place in Claremont Street. A notice to abate the nuisance was served on the occupier, failing which he was to be prosecuted. The place was referred to in my previous Report. It ought to be shut up. 58 TABLE I. Vital Statistics of Whole District during 1916 and ten 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. Hate Out In 1 2 3 4 5 6 7 8 9 10 11 12 13 1906 56,818 1,881 1,822 32.07 915 15.55 256 124 248 131.84 783 13.78 1907 59,413 1,923 1,857 31.24 977 15.89 309 124 225 121.16 792 13.32 1908 60,182 2,000 1,931 32.09 902 14.50 297 129 227 117.41 732 12.16 1909 61,164 1,871 1,803 29.48 890 14.09 325 110 182 100.39 675 11.03 1910 61,741 1,961 1,878 30.42 872 13.56 376 94 140 74.55 587 9.51 1911 63,146 1,921 1,847 29.25 1,219 18.68 489 100 265 143.48 830 13.14 1912 65,084 1,844 1,765 27.12 1,126 16.76 563 103 149 84.42 666 10.23 1913 66,552 1,912 1,862 27.98 1,184 17.31 501 111 196 105.26 794 11.93 1914 68,203 1,922 1,859 27.25 1,233 17.67 591 94 159 85.53 736 10.79 Including 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 17.45 543 136 186 111.64 817 11.71 with Belgians 70,464 1,725 1,697 24.08 1,246 17.55 543 137 194 114.32 837 11.88 1916 71,396 1,689 1,633 22.87 1,009 14.04 405 122 142 86.96 726 10.17 with Belgians 72,050 1,708 1,654 22.96 1,018 14.03 405 122 145 87.66 735 10.20 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 distiict 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 II 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 at all ages 64,797 At Number of inhabited houses or tenements 12,491 Census Average number of persons per house or tenement 5.00 of including Institutions 5.19 1911. Or CO TABLE II.—All cases of Infectious Disease notified during the Year 1916. (Excluding the Military.) Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward or Institution. Residents Removed to our Hospital. At all Ages. At Ages - Years. 1 2 3 4 5 6 7 Bury Street Ward. Ch'rch Street Ward. Fore Street Ward. Rsdnts. Edm'ton Infirm'y Total of Rsdnts. Others in Edm'ton Infirrn'y Belgian Refug'es Under 1 1 to 5. 5 to 15. 15 to 25 25 to 45 45 to 65 65 and upwds. Diphtheria (including Membranous Croup) 71 ... 24 43 3 1 ... ... 8 23 36 ... 67 ... 4 65 Erysipelas 63 1 5 9 2 22 18 6 20 18 20 1 59 3 1* ... Scarlet Fever 116 2 45 58 7 4 ... ... 42 35 32 1 110 1 5 103 Enteric Fever 6 1 ... 2 1 2 ... ... 2 1 3 ... 6 ... ... 5 Puerperal Fever 25 ... ... ... 7 18 ... ... 2 ... ... 2 4 7 4* ... Cerebro-Spinal Meningitis 2 ... 2 ... ... ... ... ... 1 ... 1 ... 2 ... ... ... Poliomyelitis 7 1 5 1 ... ... ... ... 3 2 1 ... 6 1 ... ... Ophthalmia Neonatorum 11 11 ... ... ... ... ... ... 4 1 3 ... 8 3 ... ... Pulmonary Tuberculosis 160 see " Wo men Inspectors' Work " ... ... ... ... ... ... ... ... ... Other forms of Tuberculosis 43 ... ... ... ... ... ... ... ... ... Measles 1171 69 755 331 13 3 ... ... 425 455 272 ... 1152 1 18 none 67 3 26 26 6 6 ... ... 7 31 28 ... 66 1 ... ... Totals 1742 88 862 470 39 56 18 6 514 566 396 4 1480 17 32 173 * Treated in the Infirmary. The figures take account of any corrections made as a result of error in notification, or revision of diagnosis as a result of tlie further course of the disease. Isolation Hospitals and Sanatoria, etc. :— 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 Mimms rural district of Middlesex and belongs to the 18 Middlesex districts. 3. There is a building on Clavering's Farm, Edmonton, capable of taking 10 male and 6 female small-pox cases ; is now attached to No. 2. 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. TABLE III. Deaths registered during the calendar year 1916, classified by age and caus (The nine deaths among Belgian refugees are in brackets.) Causes of Death (All causes; none uncertified). Classification. Nett Deaths at the subjoined Ages of " Residents " whether occurring within or without the district. Total Deaths whether Residents or ' Nonresidents ' in Institutions in the District. All Ages. Under 1 Year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. NonResidents. Total. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) Enteric Fever 1 3 ... ... ... ... 1 2 ... ... ... ... Smallpox 5 ... ... ... ... ... ... ... ... ... ... ... Measles 6 29 3 12 12 2 ... ... ... ... ... ... Scarlet Fever 7 2 ... ... ... 1 1 ... ... ... ... ... Whooping Cough 8 9 7 1 1 ... ... ... ... ... ... ... Diphtheria 9a 4 ... ... 2 1 1 ... ... ... ... ... Influenza 10 7 ... ... ... ... 1 ... 3 3 ... ... Erysipelas 18 2 ... ... ... ... ... 2 ... ... ... ... Phthisis (Pulmonary Tuber.) 28 A, B and 29 A 70 (IB) 1 ... 3 23 22 18 2 10 50 Tuber. Meningitis 30 15 5 2 1 5 (1 B) 2 ... ... ... 3 6 Other T.B. 31-35, 29 b 17 7 1 ... 3 2 3 ... 1 ... 1 Cancer 39-45 55 ... ... ... ... ... 3 32 20 8 55 Rheumatic Fever 47 2 ... ... ... 1 1 ... ... ... ... ... Meningitis 61 4 ... 1 ... 2 ... 1 ... ... 1 1 Organic Heart Disease 79 75 ... ... ... 2 3 7 24 (1 b) 39 15 77 Bronchitis 89, 90 b 62 13 6 1 1 ... 2 10 (1 b) 29 3 9 Pneumonia 91, 92 77 21 (2b) 9 10 6 2 7 8 (1 V) 14 8 24 Other Respiratory Dis. 86-8,93-8 10 3 2 ... ... ... 1 1 3 ... 9 Diarrhoea and Enteritis 104, 105 35 26 3 (1 b) 3 ... ... ... 2 1 5 9 Appendicitis 108 3 ... ... ... 1 ... 1 1 ... ... 2 Cirrhosis Liver 113 7 ... ... ... ... ... 1 4 2 3 5 Alcoholism 56 1 ... ... ... ... ... ... 1 ... ... ... Nephritis 119-120 13 ... ... ... ... 1 2 3 7 (1 b) 3 24 Puerperal Fever 137 3 ... ... ... ... 1 2 ... ... 3 9 Pregnancy 134-6 6 ... ... ... ... 1 5 ... ... ... ... Parturition 138-141 ... ... ... ... ... ... ... ... ... ... ... Congenital Debility „Defects Premature Births, 16 150-1 41 41 ... ... ... ... ... ... ... ... ... 151A ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... Violent Deaths ... 28 1 ... 1 3 3 3 12 5 4 14 Suicide ... 2 ... ... ... ... ... ... 1 1 ... 1 Other Defined Diseases ... 152 17 3 2 ... 3 16 32 79 (IB) (l v) 36 201 III-defined ... 1 ... ... ... 1 ... ... ... ... ... ... Totals ... 735 145 41 33 32 46 80 152 206 102 500 Two vagrants are in the table, marked V. There were seven non-resident deaths which occurred in Edmonton amongst visitors to private homes. Sub-Entries included Cerebro-spinal Fever, 61 A None, see articles on these in above figures ... Acute Poliomyelitis subjects. 60 61 Edmonton Urban District Council. REPORT of the Chief Sanitary Inspector For the YEAR 1916. ♦ 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 carried out by your Sanitary Inspectors and Staff during the year 1916; but on this occasion I have omitted the usual statement explaining many of the details, in order to economise as far as possible, the cost of printing. During the year the Temporary Smallpox Hospital was taken over by the Joint Smallpox Hospital Board, so that the rates, taxes, repairs and upkeep are now borne by the Board. Your Transport Officer (temporary) lives on the premises, and I visit the same from time to time to see that all is in order. DISINFECTION AND REMOVAL OF PATIENTS TO HOSPITAL This year records the using of the new Disinfecting Station in the Town Hall Yard, which I need hardly say facilitates the work considerably. The Station is now under closer supervision, and the work of steam disinfection is well carried out by your Mortuary Attendant, as the Disinfector and Mortuary are practically together. 62 The following is a list of the work carried out during the year :— No. of journeys of ambulance to remove patients to hospital 169 No. of journeys of bedding van to remove infected bedding 198 No. of journeys of bedding van to return bedding 147 No. of journeys of brougham to fetch patients from hospital 137 No. of patients returned to their homes from hospital by brougham 189 No. of rooms disinfected after infectious disease 292 No. of articles of bedding, etc., disinfected 1737 No. of books disinfected 60 No. of articles of bedding destroyed 37 No. of rooms disinfected for phthisis 153 No. of articles of bedding, etc., disinfected after phthisis 696 No. of articles of bedding destroyed after phthisis 30 No. of rooms disinfected for verminous bedding and vermin 29 A quantity of blankets were also disinfected at the request of the militaiy authorities, and the whole of the schools and many public halls in the district were disinfected. The removal of patients to hospital continues to be carried out by your Disinfector, who also acts as attendant. The Inspectors assist when necessary, and they also take duty with the Disinfector on alternate Sundays. DISINFECTANTS The Council still afford the public the generous opportunity of obtaining disinfectant (fluid and powder), which I feel sure does a great deal to encourage cleanliness. The number of applicants supplied during the year was 26,250. ERYSIPELAS. Eleven cases of erysipelas were treated in their homes by a trained nurse during the year. The cost of nursing was £25, and the patients were very grateful for the attention they received. PUBLIC LAVATORIES. The lavatories for box sexes at the Green and Angel Road continue to be well patronised; free accommodation being provided for both sexes. The amount collected for the W.C.'s and Wash and Brush-up on the Green during the year was £209 16s. 9d., an increase of £34 11s. 4d. on the previous year. The amount collected from Angel Road was £297 2s. 8d., an increase of £88 13s. 6d. on the previous year. 63 MORTUARY During the year 89 bodies were received into your mortuary. 69 were either for post mortem or inquest; 14 were deposited by the undertaker, to await burial; 6 were deposited owing to the bodies being of an infectious nature; 5 were retained after inquests, for burial, owing to decomposition having set in. Your Mortuary Attendant has returned to his civil work, after having been away some 18 months on military duties. DUST COLLECTION. The collection of dust is still carried out by contract. The number of vans employed is certainly insufficient for a weekly collection. I can only reiterate my former remarks that at least 8 vans are required, besides the vans used for picking up refuse from the large institutions. The sheet used for the daily return of streets done show conclusively that a weekly collection is not carried out. No doubt the labour question is a difficult one, but better supervision is badly needed. The present shoot at the Sewage Farm will not be long before it is filled up, but I am hoping it will carry us over the present crisis. It will then need the Council's serious consideration as to the disposal of refuse. No doubt an up-to-date destructor would give good results, especially judging from those obtained in other districts. Owing to the shortage of labour at the Weighbridge Office, we were not able to keep an exact account of the amount of dust deposited on the shoot, but from our own observations about 4,000 van loads were deposited, and the approximate weight was 7,000 tons. The number of dust-bins supplied was 129. INSPECTIONS Herewith I append the number of inspections, both periodical and general, together with a summary of the sanitary improvements carried out:— Inspections re complaints 341 Inspections re infectious diseases 294 No. of premises under periodical inspection 779 Inspections and re-inspections 13340 Common lodging-house 118 Slaughter-houses 362 Milkshops 369 64 Cisterns (new) 6 Cisterns repaired, cleansed, covered, etc. 24 Water supply taken off main 11 W.C.'s supplied with water, repaired or improved 122 Drains examined, tested, etc. 218 Drains unstopped, repaired or trapped 329 New soil pipes or vents 9 Existing soil pipes or vents repaired 12 Chambers inserted 15 Drains re-constructed 19 Rooms stripped and cleansed after infectious disease 194 Overcrowding abated 9 Accumulations 27 Foul pigs and other animals 31 Yards and forecourts paved 42 Cautionary or intimation notices served 769 Statutory Orders issued 88 Summonses served 10 Convictions obtained 10 The following work has also been carried out for the prevention of dampness :— Roofs, gutters, and rainwater pipes repaired 273 Water fittings repaired 70 New sinks or existing sinks repaired 6 Sinks and bath waste pipes remedied 57 Wash-house floors re-paved or repaired 13 Floors ventilated 12 Yards and forecourts re-paved 42 Other dampness remedied 53 526 SLAUGHTER HOUSE AND FOOD INSPECTION. No change has taken place in the number or occupation of the slaughterhouses during the year. The periodical limewashing has been carried out, and in one slaughter-house the means of lighting have been improved. 362 inspections have been made, and the following number of carcases have been examined either during, or shortly after, slaughter:—132 oxen, 17 cows, 46 heifers, 5 bulls, 21 calves, 547 sheep, and 615 pigs, making a total of 1,383 animals. The following meat and organs were surrendered and destroyed :—1 pig's head, 2 pigs' plucks with mesenteric fat, 3 pairs of sheeps lungs, 4301bs. of beef. 65 The following goods were also brought to the Town Hall for inspection, and surrendered by dealers voluntarily, a certificate to the effect that the goods were unfit for food being given, to enable the dealers to get their money refunded:—48 frozen rabbits, 1 kit crabs, a quantity of eels, 6 boxes of kippers, 74 dry salted cod fish, 1 box of herrings, and 2 boxes of dabs. The following summonses were taken out against the vendors, and convictions obtained :— 1.—For exposing for sale rashers of bacon unfit for human food, fined £5 2s. Od. 2.—For selling to purchaser rashers of bacon unfit for food, fined £5 2s. Od. 3.—For exposing and offering for sale tomatoes unfit for human food, fined £5, or a month. 4.—For selling to purchaser four rashers of bacon unfit for food, £5 and costs. 5.—For depositing for the purpose of sale, diseased meat, £5 and £1 1s. costs. 6.—For depositing for the purpose of sale, diseased meat, £10, and £2 2s. costs. 7.—For depositing for the purpose of sale, diseased meat, £10, and £2 2s. costs. 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 Food and Drugs Department :— Article. Taken. Adulterated. Butter 142 30 Milk 64 22 New Milk 9 7 Castor Sugar 1 — Granulated Sugar 1 — Raspberry Jam 1 — Raisins 1 — Totals 219 59 No. of prosecutions 7 No. of convictions 5 Fines £14 5s. Od. 66 OFFENSIVE TRADES, PIG KEEPING The offensive trade, viz., the gut-scraper, is still carrying on the business, and we visit the premises to see they are kept as cleanly as circumstances permit. The position of the premises and the condition under which the work is carried out are anything but what they should be. He has had sufficient time to provide better premises in a more suitable position. Little trouble has arisen during the year from pig-keeping, but as most of the pig-styes are drained into cess-pools, the overflows in a few instances are causing trouble, and are being dealt with. DAIRIES, COWSHEDS AND MILKSHOPS The number of cowkeepers on the register remains the same—2. The The number of milk sellers is 92; these fluctuate from year to year. Nine persons were added to the register and 10 gave up selling milk owing to the action of the department. There were nine contraventions of the Orders and Regulations, all of which were dealt with satisfactorily. 361 inspections were made of premises. There were 39 inspections made of premises where ice-cream was usually sold, but there were very few people manufacturing this commodity, owing to the increased prices and the difficulty in obtaining material. SHOPS' ACT, 1912. Complaints were received that certain shopkeepers were evading the Act. Mr. Winter, Mr. Huckle and myself kept observations, and after some time found the offenders. Two were fined 10s. and costs and one was fined 20s. and costs. COMMON LODGING HOUSE. These premises, although very old, continue to be kept in as good a condition as circumstances will permit, and afford clean accommodation for 25 inmates. I am hoping to see a common lodging house of modern construction erected, as the present premises cannot last many more years. Such premises are essential in a district like Edmonton, and enable the Council to keep strict supervision over this class of people. 67 CANAL BOATS The number of registered canal boats inspected during the year was 17, a decrease of 6 on the preceding year. What few registered boats there are, are, generally speaking, well kept. A great many boats, both registered and unregistered, are now in the hands of the Government. The following contraventions of the Acts and Regulations were dealt with :— 2 dirty cabins, 1 cabin top defective, 1 cabin required painting, all of which have been remedied. FACTORIES, &c A great deal of time has been given to the inspection of factories, workshops, and outworkers' premises. 135 visits were paid to the factories, 268 to workshops, and 711 to outworkers; included in these inspections are bakehouses and laundries. The contraventions that existed were at once dealt with. Increased W.C. accommodation has been provided in four factories. One munition factory commenced with very crude sanitary accommodation and water supply, and we were not even aware that the factory was in use until we saw the erection of new wooden buildings. This old factory is situated on the north-eastern boundary of the district. However, after many inspections and much correspondence, we adopted the pail system, having no sewer within a mile of the premises, and with the assistance of the Council's Engineer an arrangement was made whereby the foul water and the contents of the pails were deposited in a closed cart and disposed of on the Council's sewage farm, the firm paying the cost of cartage, etc. The only water supply was from the Lea Navigation Canal; then a small pump was fixed and water was obtained from a shallow well, which was analysed and found to be totally unfit for dietetic purposes. A temporary arrangement was made for boiling the water until such time as a well could be sunk deep enough into the chalk to obtain a pure supply. The work of sinking this well is now in progress. The male employees have now been provided with one urinal and 5 pail closets. The females with 12 pail closets, and the floors of the closets rendered in cement and made to drain to a catchpit for washing-down purposes. Fifteen lavatory basins have been fixed and made to discharge to a properly covered cess-pool. 68 The gipsy nuisance is somewhat diminishing; the number of vans observed was 162, and 159 were removed, which necessitated 237 visits. One piece of land was fenced in during the year. One nuisance was created by the unloading of decomposing bacon at one of the wharves. The ship which brought it to this country was damaged at sea, and the bacon became immersed in salt water. I served a notice on the owner to discontinue the unloading, and he informed me he was acting under the instructions of the Government. The contents of this report are not so full as I should wish, but we are working under difficulties, with a very depleted staff, and endeavouring to keep pace with the most important and necessary work. We are still hoping that those who are away from the department, serving their King and Country, may be spared to return to their official duties when the war is at an end. My hearty thanks are due to all those in the department who have worked harmoniously with me during another arduous year. I also desire to thank the Chairman and members of my Committee for their kind consideration and support, and the officers of other departments who have rendered me any assistance. I have the honour to be, Gentlemen, Your obedient servant, RICHARD JOHN BUTLAND, Chief Sanitary Inspector. 69 ANNUAL REPORT for 1916 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; 2 R. H. STRONG School Medical Inspector. (Smce February 1st, 1915). Assistant School Medical Officer ; 3 NORA PLAYNE, School Medical Inspector. School Nurse. 3 S. A. G. WRAMPLING School Nurse (since September 4th, 1916). 4 †HAROLD DYER, School Medical Clerk. 4 None. Dr. Rock continued in the Royal Navy until January 25th, 1917. Miss Playne continued in the Nursing Service until September, 1916, she was then allowed leave of absence until February, 1917. t Still away in H.M. Army. 70 EDMONTON EDUCATION COMMITTEE. REPORT of the School Medical Officer for the Year ended December 31st, 1916. Town Hall, Edmonton. To the Chairman and Members. Ladies and Gentlemen, I herewith submit my fifth Annual Report. Dr. Strong continued acting as School Medical Inspector throughout the year, but at the end of July Mrs. Hobbs retired, having obtained a post as Infant Life Protection Visitor in the western half of the Edmonton Union. She was succeeded in September by Miss S. A. G. Wrampling. However, in the light of his last year's experience, Dr. Strong was enabled to make good progress with his work. The absence of a clerk has rendered my duties as School Medical Officer unduly onerous. In November, 1915, this Committee recommended that a temporary clerk be appointed, and so did the Sanitary Committee, but their advice was not followed by the Council. On February 1st, 1916, I brought this again to your notice, but no action was taken. I have, therefore, had to spend valuable time doing merely a clerk's work. Amongst other consequent inconveniences, you have been unable to receive typed copies of my reports to the monthly meetings. This I much regret. The late appearance of this Report is another. When the war is over, if not before, another woman officer should be appointed to visit the homes of scholars, as regards infectious, contagious, and other conditions affecting the attendance at school. Like the School Medical Clerk, half her salary might be paid by your Committee and half by the Council. I advised this last year. On January 25th, 1917, Dr. F. E. Rock was lost in H.M.S. "Laurentio," whilst serving his King and Country. I deeply deplore what is not only a heavy loss to Edmonton, but to myself personally. He inaugurated the School Medical Service work here in 1908, and since he joined my staff in 1912. our relations had been most ha.ppy. I am, Your obedient servant, SIDNEY C. LAWRENCE, 12th June, 1917. School Medical Officer. 71 THE SCHOOLS OF EDMONTON. (17 in Number.) Public Elementary Schools 11 Secondary Schools 1 Private Schools 5 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 April, 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, Miss Seward, is a headmistress. Since July, 1908, no children under 5 years of age have been admitted. 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 292 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, 1916-1917, 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. As in 1915, nothing has been done beyond the ordinary repairs necessary to keep the buildings in good order. 72 Attendance. Mr. Heap has kindly furnished me with the following figures for this and the next two tables :— End of June, 1915. End of June, 1916. Number on books. Average attendance. Number on books. Average attendance. Non-provided Schools 2276 3056.4 2268 2054.4 Council Schools 11219 10183.6 11013 10090.7 Totals 13495 13239.9 13281 12145.1 There were 13,281 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 292; so that there is in Edmonton one child in the public elementary schools for 5.2 inhabitants (reckoned on the nett population); 5.1 last year. The number of children on the books of the elementary schools of the district at the end of June, 1916, was 13,281; and the accommodation was 14,365. The accommodation and the number of children attending each school are given below :— School. Infants. Junior Mixed. Girls. Boys. Accom. No. on books. Accom. No. on books. Accom. No. on books. Accom. No. on books. Brettenham Koad 437 293 — — 458 405 459 426 Croyland Koad 369 284 420 414 369 350 537 515 Raynham Koad 576 502 600 502 540 458 660 583 Eldon Road 600 650 521 540 540 499 660 558 Silver Street 562 459 — — 562 549 592 543 Houndsiield Road 460 381 300 312 300 278 300 276 Montague 460 345 300 336 300 274 300 281 All Saints' 447 415 — — 455 493 — — Latymer — — — — — — 300 309 St. James's 220 236 — — 207 233 218 243 St. Edmund's 88 89 — — (248 250 Senior Mixed) These figures are not included in the totals. Totals 4219 3654 2141 2104 3731 3539 4026 3734 73 There were 160 less children attending school than last year. 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 118 boys and 23 girls; last year there were 58 boys and 19 girls. Note the war cry for boy labour. Expenses, Five precepts in April for £10,065 for elementary and £55 for higher education; 4 precepts in October for £9,835 for elementary and £55 for higher education, in all for £20,010, were served on the Overseers to meet the requirements of public education for the year ending March 31st, 1917. Besides, a very large necessitous grant has been received from a sympathetic Government, amounting to £16,375, the same as the last two years, or about a nineteenpenny rate; compare this with £9,216 for 1913, which was equal to only an elevenpenny rate. 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 o.f age), the 8-year-old group, and the leavers. Foup thousand four hundred and twelve children were passed through the routine inspection; exactly the same as last year. TABLE I. Of the Board of Education, The ages and numbers of children inspected were as follows :— Ages. Entrants. 8 year old group. Leavers. Totals. 5 6 7 12 13 and over. Boys 630 78 28 767 40 647 2190 Girls 678 84 29 744 91 596 2222 Totals 1308 162 57 1511 131 1243 4412 74 Re-inspection at the schools, 54 boys and 65 girls. The parents were present with 889 of the boys inspected and 1,040 of the girls. There were objections to medical inspection of 3 boys and 22 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. The number re-examined at the schools during the year was 1,048— 585 boys, 463 girls. SPECIALLY-REFERRED CENTRE. The room in use is the same ill-adapted one at the Education Office as in 1915. Tuesday afternoons and Saturday mornings are devoted to this work. The attendances of specially-referred cases and absentees due to illness was 3,639, compared with 2,488 for 1915. Of these, 1,048 were first attendances, and the balance was subsequent ones. Arrangements for following- up Children with Defects. On this subject, Dr. Strong reports to me as follows:— " Owing to the fact that neither the Temporary School Medical Inspector, nor the Temporary School Nurse, are on the Public Health staff, they have not " the right of entry," and therefore other arrangements have had to be made (a.part from the re-examinations at the schools) for the following-up of children with defects, to their homes. This was done by sending notices to the parents who were not present at the routine medical inspection, with instructions to attend with the child at the Specially Referred Centre. They then had the defect pointed out to them and the necessity for that defect being attended to. Where special treatment was judged to be required, the means of obtaining it was pointed out to the parents and, where necessary, a card given them to take to a hospital. When the parent or guardian was present at the routine medical inspection of the child, the same procedure was followed. In all cases the cards of the children with defects were marked for re-examination. Where the defect was such as to require exclusion (except in the case of acute illness or infectious disease), the parent was given notice, if present, or notice was sent to the parent if absent, to bring the 75 child to the Specially Referred Centre on the next appointed day, and the case kept under observation until a 'may return' certificate could be given. " The School Attendance Department has greatly helped the work by hunting up children absent or excluded from school for defects, who were irregular in their attendance at the centre, and in many cases, where the cause of the child's absence was doubtful, has, by causing the parent's or guardian's attendance with the child at the Centre, prevented what I should call ' inexcusable non-attendance.' " Taken as a whole, this method has given satisfactory results during the past year." MENTALLY DEFECTIVE CHILDREN. 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; but they have not. We have carried out our duty under section 31 (a., b, c), but the County Council have only taken action with respect to one chil,d, the girl S.H. However, it remains for my Education Committee to take up their duty towards these unfortunate children in the first 3 groups, 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. During 1916, seven children were dealt with by your Certifying Officers, Dr. Strong and myself j one case was nearly 16 years of age. Of these, four were cases adjourned from 1915, of whom one boy (J.R.) left Edmonton before his examination could be concluded. None were left unfinished at the end of the year. TUBERCULOSIS. The number of boys with a family history of consumption was 323, and 325 girls. During 1916 Dr. Strong sent four "B" notifications to the M.O.H. Of these, three—two boys and one girl—referred to pulmonary tuberculosis, and one—a boy—to another form of tubercle. 76 RETURN SHOWING PHYSICAL CONDITION OF CHILDREN INSPECTED— ROUTINE. Total Inspected, 4,412 Boys, 2,190; Girls, 2222. Ages 5—8, t,527—Boys, 736 ; Girls, 791. Ages 8—9, 1,5] 1—15oys, 767 ; Girls, 744. Ages 12 to end, 1,374—Boys, 687 ; Girls, 687. BOYS. GIRLS. Ages 5—6 Ages 6—7 Ages 7—8 Ages 8—9 Ages 12—13 Ages 13 and over. Ages 5—6 Ages 6—7 Ages 7—8 Ages 8—9 Ages 12—13 Ages 13 and over. Nutrition— Good 515 66 26 519 35 561 559 70 24 489 86 525 Fail- 114 11 2 244 5 79 177 13 4 250 5 68 Bad 1 1 — 4 — 7 2 1 1 5 — 3 630 78 28 767 40 647 678 84 29 744 91 596 Ages 5—8 Ages 8—9 Ages 12—13 Ages 13 and over Ages 5 -8 Ages 8—9 Ages 12—13 Ages 13 and over Clothing— Satisfactory 736 679 31 518 791 655 64 516 U nsatisfactory — 88 9 129 — 89 27 80 736 767 40 647 791 744 91 596 Footgear— Satisfactory 736 679 31 506 791 655 64 517 Unsatisfactory — 88 9 141 — 89 27 79 736 767 40 647 791 744 91 596 77 Clothing and Footgear. Dr. Strong writes :— " This table has been divided into groups, and I think is very instructive. " In spite of the fact that a great number of mothers were at work, it shows that the condition was satisfactory in the case of the young children; not so satisfactory in the group 8-9 years, where parental control was, to some extent relaxed; and a still larger percentage of unsatisfactory cases amongst the leavers, 12-14 years, where, presumably, the children were left to look after themselves; this last condition was more noticeable amongst the boys than the girls." Provision of Meals. During 1916 Mr. Piokrell died and the post of Hon. Secretary of the Canteen Committee was filled by Mr. T. G. Scott, to whom I am indebted for the following particulars :— During 1916 dinners were supplied to 89 children. Of these, 51 were children of widows, etc., 32 were children whose fathers were physically incapacitated from working, and 6 were children whose fathers were for a short time unable to find employment. The highest number of children fed in one week was 63, the lowest 33, the average number being just below 40. The total number of dinners partaken of was 10,721. The cost was £149 13s. lOd. for food, and .£42 15s. 6d. for service, etc. Each meal cost 4Ad.— 3£d. for food and Id. for service. The Central Investigation Sub-Committee met on five occasions during the year, and each application for meals was carefully considered. Meals were provided (as they were from May to December, 1915), at a cook-shop, the children having a room set apart exclusively for their use. Members of the Menu Sub-Committee and Members of the General Canteen Committee visited the shop (without notice of their visit being given) on several occasions while the meals were being served, and, without exception, found the arrangements for the preparation, serving, and supervision of the meals in every way most satisfactory. The methods of investigation into the parents' circumstances by the Canteen Committee continue on the same thorough lines. Vermin. As regards body vermin, 36 boys and 36 girls were found to be infested with lice on the inspection day. Nits (the eggs of lice) were found on the hair of 325 boys and 861 girls, and live lice on 53 boys and 89 girls. 78 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. She has looked over 2,620 this year. About cleansing station, refer to my report as M.O.H. Teeth. Of the boys 903, and 873 girls, had one to three teeth decayed, and 692 boys and 693 girls had four teeth or more decayed. Nose and Throat. Amongst the boys 374, and 470 girls, had either enlarged tonsils or adenoids, or both. Eye Disease. Squint was observed in 51 boys and 62 girls. 54 boys and 65 girls were wearing spectacles. Slight errors of vision were found in 102 boys and 90 girls, and marked errors in 107 boys and 112 girls. SCHOOL CLINICS. Our scheme was settled in 1914, but the approval of it has been formally withheld by the Board of Education until the end of the war. INFECTIOUS AND (or) CONTAGIOUS DISEASES. The number of children excluded at the routine inspection was 251— 111 boys and 140 girls, the reasons for exclusion being:— Boys. Girls. Boys. Girls Vermin— Bronchial Asthma 1 Head 35 75 Bronchial Catarrh — 1 Head and Body 14 13 Stomatitis 3 Body 21 23 Febricula 3 2 Head and Ragged 1 — Influenza — 1 Body and Incontin ence of Urine 1 — Follicular Tonsilitis — 2 Mumps 3 I Head and Eczema 1 1 Chicken Pox 5 1 Head and Eingworn 1 — Ulcer of Cornea 1 Ringworm—Head 11 10 Otorrhcea — 1 Impetigo—Face 3 1 111 140 „ Head 1 Eczema 2 2 Scabies 5 5 N.B.—None were excluded for Nits only. The total number of exclusion certificates (including the above) issued for contagious and other diseases by the School Medical Officers during the year was 1,689, the reasons for the exclusions being:— 79 Disease. No. of Certificates Disease. Certificates No. of Vermin 445 Mumps 14 Scabies 330 Pulmonary Tuberculosis 10 Ringworm 235 Other Tuberculosis 10 Other skin diseases 234 Dirt 8 Eye trouble 123 Epilepsy 6 Other causes 106 Whooping Cough 5 Impetigo 73 Diphtheria 2 Chorea 32 Measles 1 Bronchial Catarrh 23 1683 Ear disease 16 Chicken Pox 16 The number 1,689 is 59 more than last year; this increase is mainly due to the children being seen again and again at shorter intervals than formerly. Scabies is on the increase—228 last year—it may have been brought home by soldiers. During the summer holidays, and at special times for measles, the public elementary schools were well disinfected. Exclusion Of Contacts. The rules adopted for the exclusion of contacts are as before. Exclusion Notices. Without measles, in connection with the notifiable infectious diseases, notices were issued by the Medical Officer of Health excluding 279 children, as patients or contacts, from attending day or Sunday schools for definite periods. On account of measles and the non-notifiable infectious diseases, notices excluding 2,058 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 1915-14-13 were 1,415, 2,874, and 941 respectively. It is interesting to note the great variation in the number of children excluded from the schools during 1916. 1. National 344 2. Eldon Road 259 3. Brettenham Road 248 4. Montagu Road 242 5. Silver Street 237 6. Croyland Road 184 7. Raynham Road 156 8. St. James's 113 9. Houndsfield 83 10. St. Edmund's 83 11. Lower Latymer 8 12. Latymer Secondary 2 1957 Besides the following :—Enfield Council Schools, 8; Private Schools, 40 ; 12 children at various schools in Winchmore Hill, Tottenham, etc., and 40 children not attending (at the time) any school. 80 TABLE II. (for Board of Education.) RETURN OF DEFECTS FOUND DURING MEDICAL INSPECTION. Boys. Girls. Malnutrition 13 12 Uncleanliness :— Head 53 89 Body 36 36 Skin :— Ringworm—Head 11 10 Body — — Scabies 5 5 Impetigo 4 1 Other Disease 3 3 Eye :— Defective Vision and Squint 260 264 External Eye Disease 8 9 Ear :— Defective Hearing 83 62 Ear Disease 10 11 Teeth :— One—three decayed teeth 903 873 Four or more decayed teeth 692 693 Nose and Throat :— Enlarged Tonsils and/or Adenoids 374 470 Defective Speech 9 3 Heart and Circulation :— Heart Disease—Organic 8 4 Functional 3 1 Anaemia 8 4 Lungs:— Pulmonary Tuberoulosis—Definite — — Suspected 1 4 Chronic Bronchitis 12 5 Other Disease — — Nervous Systems- Epilepsy 1 1 Chorea 1 1 Other Disease — — Non-Pulmonary Tuberculosis.— Glands — — Bones and Joints — — Other Forms — — Rickets — 2 Deformities 2 — Other Defects or Diseases 8 9 81 Report of the School Medical Officer to the Education Committee. Meeting on Tuesday, 5th December, 1916. Ladies and Gentlemen, DAY NURSERIES. INFANT WELFARE. At the request of your Chairman (Councillor S. H. Platten) I withdrew this subject from my last report drawn up for your meeting of Tuesday, November 7th, 1916, with the hope that my remarks might be typed, duplicated and distributed before this meeting to all of you. But I regret to report that I have found this impossible. As you know, I have no school medical clerk, and your Secretary, Mr. Heap, has informed me that his staff of three clerks is unable to do this small amount of clerical work for your benefit. I therefore reproduce here what advice I had to offer you on a matter of great importance, which should be dealt with by you without further delay. On December 2nd, 1914, Circular 879, dated 26th November, 1914, was received by your Secretary from the Board of Education. It is a memorandum in regard to grants to day nurseries from the Board. These nurseries are primarily to provide for infants and children up to three years of age, at which age some Authorities admit them to school. You do not, until they are five years of age. I will read an extract from the report I made to you on the subject on February 2nd, 1915 " Certain considerations are tabulated by the Board of Education, " which should be borne in mind by the Local Authority which undertakes " to form and maintain a day nursery. The Medical Officer of Health " should be consulted as to the accommodation to be provided, and as to " the maximum number of children to be admitted. The grant from the " Board will be based on the number of attendances made during the "year. Close co-operation is desired with the School for Mothers, Baby " Clinics, and other institutions dealing with infant welfare in the neigh" bourhood." 82 " Claims for the grant should be supported by the assurance that " the Medical Officer of Health is satisfied with the work of the nurseries. " The cost of the food is to be defrayed from the payments of the mothers " for the care of the children. " The day nurseries, the Board says, ought not to provide for " children whose mothers might reasonably be expected themselves to " bestow on their children the necessary care and attention. The grants " from the Board may be paid at the rate of not more than J,d. for each " attendance, and the full grant shall not exceed one-half of the approved "expenditure." You postponed consideration of the Board's circular for 12 months, on February 2nd, 1915. The Sanitary Committee has also postponed the matter of Maternity and Infant Welfare Centres until April, 1917. Six or seven weeks ago I was filling up the schedule of work at the Edmonton School for Mothers and Infant Welfare (established in June, 1915), and it was with much regret that I had to state that this work, so very important in these times, when so many lives are being lost in warfare, had received no help whatever from this Education Committee. In April, 1916, the Council gave £33 6s. 8d. to the School, but £50 would have been more useful. I would suggest that three of your number be selected to-night to meet three members of the Sanitary Committee to discuss how the Local Authority, both on its public health and educational sides, can best assist in this lifesaving. Your Secretary and the Medical Officer of Health would attend this Special Committee, which should (on finishing its deliberations) present a report, with their recommendations, both to the Council and this Education Committee. As regards creches or day nurseries, the need for them at the present moment is very great. Whilst the cruel necessities of war are creating both day and night work, a nursery that will be always open, both day and night, will meet a great want of the mothers who have families of young children needing attention and supervision when both parents are at work away from home. Such cases I am meeting with not infrequently, where the home conditions and woeful state of the youngsters is sad to see, and must be produvui/3 of excessive sickness and a heavy death-rate in the immediate future. This Special Committee, I presume, would be open to receive and consider any suggestions or schemes that purport to deal with the subject of mother and child welfare. I have one in my mind now. 83 The main lines of it are 1. Raise the age for admission for education to 7 years. 2. Close all the Infant Departments as such and convert them into nurseries for children up to 7 years of age, serving the area surrounding each one. 3. In each case retain the Headmistress to act as Superintendent of the Centre, but draft the Assistant Teachers into the Junior Mixed and Senior Departments, where they would lelieve you of any further anxiety as to a dearth of permanent teachers, and you could then give up your present inseoure reliance on " supply" teachers. 4. Where there is at present no Junior Mixed Department, the vacated Infant one (or part of it) might be so used. 5. The Assistant-s of the Superintendent of the Infant Welfare Centre might be respectable widows (preferably those who had lost their husbands in the war). They could bring their own youngsters (under 7 years) to the Centre to which they are attached, and would be content with moderate wages. These nursery-schools would become models of their kind. At them the elder girls could learn practical lessons of MOTHERCRAFT, which would be most useful to them when they have babies and homes of their own. As regards raising the age of admission for ordinary education, I believe that this change could be brought about by an Administrative Order of the Board of Education. But if not, in these days of 24-hour legislation, Parliamentary powers could be soon obtained for such a necessary measure. The success, or otherwise, of these Infant Welfare Centres during the war could determine their continuance afterwards. SIDNEY C. LAAVRENCE, School Medical Officer. Ordered.—To be printed and circulated before discussion on February 6th, 1917. JR2/68