EDM 13 Edmonton urban District Annual Reports on the Public Health and School Medical Services FOR THE YEAR 1918. by SIDNEY C. LAWRENCE, Medical Officer of Health and School Medical Officer, M.H., Ch.B., D.P.H. (Lond.), M.R.C.S. (Eng.), L.K.C.P. (Lond.), Fellow of the Society of Medical Officers of Health, and member of its Council. Also the Report of the Inspector of Nuisances RICHARD J. BUTLAND, M. R.San. I. ^ Crusha & Son, Tottenham and Wood Green. 3 PUBLIC HEALTH DEPARTMENT. December 31st, 1918. 1.—Medical Officer of Health: SIDNEY C. LAWRENCE, M.B., Ch.B., D.P.H.t 2.—Assistant and Deputy Medical Officer of Health: Vacant since July, 1914. 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.*H (C.M.B.) 6.—**Third Male Inspector : H. K. NIXON.† 7.-—-"Fourth Male Inspector : G. H. HUCKLE.* 8.—Second Woman Inspector : G. M. SHINER.* (C.M.B.) 9.—Third ,, A. BINTCLIFFE.* (C.M.B.) 10.-—Fourth ,, ,, A. A. C. WILLIAMS (also School Nurse). 11.—Fifth ,, „ Mrs. J. A. HOBBS, C.M.B. ( „ „ ). 12.—Senior Clerk: A. OADES (temporary). 13.—"School Medical Clerk: HAROLD DYER.* 1 4.—** Junior Clerk: JOHN FARRAR ; DORIS B. HILL (temporary). 15.-—Disinfector, Sanitary Stores Keeper and Transport Officer: J. MADLE 16.—Mortuary Attendant, Laboratory, Disinfecting Station : C. HICKFORD 17.——Caretaker of Emergency Hospital: J. MADLE (temporary). 18.—Driver of ambulance and bedding vans: S. GWYNN. 19.—Opener up of old drains, urinal cleanser and general sanitary workman : A. PASHALL. 20.—Opener up of old drains (part time): A man from Engineer's Department as required. 21—24.—Attendants at sanitary convenience at Angel Road: Two male and two female. 25 28.—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. IF These officers have the certificate of the Sanitary Inspectors' Hoard. ** Away on War Service. 4 SUMMARY. Area 3,894 acres, including 31 of water. Census Population, April, 1911 64,797 Estimated Nett Population, June 30th, 1918 74,330 Density of Population per acre of land, 1918 19.4 Rateable value, October 1918 £242,307 Assessable value, October, 1918 £228,567 General District Rate, 1918 5/5 in the £ Poor Rate, 1918 5/9 in the £ A Penny Rate produces about £935 VITAL STATISTICS. Birth-rate per 1,000 living 16.09 Gross, or registered death-rate per 1,000 living 15.23 Nett death-rate per 1,000 living 12.18 Infantile Mortality per 1,000 births registered 80.27 Zymotic death-rate per 1,000 living 0.57 HOSPITAL ACCOMMODATION. For infectious cases Enfield and Edmonton Joint Isolation Hospital. For smallpox South Minims Smallpox Hospital and Clavering's 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 5 "There is perhaps no profession, however useful; no pursuit, however meritorious, which can escape the petty, attacks of vulgar minds."— Charles Dickens. Town Hall, Edmonton, N. 9. To the Chairman and Members of the Edmonton Council. Mrs. Benjafield & Gentlemen. I herewith present my 13th Annual Report on the health and sanitary circumstances of this Urban District. It refers to the year 1918. The second Ministry of Health Bill has now been placed in the Statute book as the Act of 1919, and District Councils have received a welcome infusion of "new blood" in April last. The two factors are expected by some optimists to be certain to produce a sanitary millenium. I am not so sanguine, as I know that other reforms are necessary to achieve this ideal—(I) The consolidation of all the Public Health Acts since 1875, with amendment, where necessary, to bring them up to date, and the removal of redundant or contradictory clauses; (2) that every Councillor should be honest and intelligent, if not highly educated; (3) that the officials, who have to faithfully carry out the measures ordained by legislation and the Government, should be secure of tenure and superannuation. On December 31st, 1918, owing to absence on war service, the following posts in my department were still unfilled and to them no temporary appointments have been made :— 1. Assistant and Deputy M. O. H. 2. School Medical Clerk. 3. Housing Inspector 4. General (4th) Male Inspector. I myself have carried out, as far as possible, the duties of the first two since they joined the forces. For these and other extra services I have neither asked for, nor received payment. But in justice to the work, and in view of the strain on my health thereby involved, I cannot continue this overwork indefinitely. The Education Act of 1918 and the establishment of a School Clinic in the immediate future will certainly bring more work and responsibility for administration on me as S. M. O. and it is probable that one sixth of my time will not suffice for carrying out my old and new duties. This can easily be arranged for, if I am relieved of most of the routine executive work by an Assistant M. O. H. I gratefully acknowledge the help received from members of my staff and the heads of other departments. I am Your obedient servant, SIDNEY C. LAWRENCE, 28th August 1919. Medical Officer of Health. 6 FOREWORD. Local Conditions arising from the Great War. The active operations ceased on Armistice Day, November llth, 1918, but Edmonton had become accustomed to war conditions, which brought, at least, the compensation of high wages and constant employment. However, this long-continued struggle between the nations has left its mark on the civilian population of Europe, especially the women, for the natural emotions were fully engaged, particularly those of anxiety, love and fear. To these were added the worries of food supplies, and the strain of overwork, often carried out in places poorly lit, inadequately ventilated, and short of sanitary requirements. The birth-rate for 1918 was, of course, greatly affected by the absence of fathers, and it was further affected by an unusual number of miscarriages and abortions. The Tribunal (Clerk, Mr. F. W. Claxton) ceased its work after Armistice Day, but the War Pensions Committee (Secretary, Mr. L. W. C. Pettipiere) continued their arduous labours during the year. On the latter I serve (voluntarily) as a member of the Disablement Sub-Committee. Early in 1918 it was reconstructed, so as to provide seats for two disabled men and a woman. After Armistice Day windows were unscreened, lights cleared, lampheads re-erected (both gas and electric), and shelters dismantled, so the people of Edmonton were able to reassume some of the amenities of peace time. On November 2'3rd, the Clerk was instructed to write for early release of employees. In December the local Government Board was urged by my Council to release labour and material for house repairs. 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."—Annual Report, 1916. This statement continues true at time of writing. Legislation. The Government's activities continue to be 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. 7 SALARIES IN WAR TIME. From August 27th, Mr. Butland's (Chief Sanitary Inspector) salary was increased from £300 to £325 per annum. In September he was also granted an honorarium of £25 for extra services during the war. In September, Mr. Winter's (2nd Male Inspector) salary was raised from £180 to £200 per annum. He received his last increase as far back as 1910. This appreciation of his good services was thoroughly deserved. My salary as S.M.O. was raised, on my application, from £50 to £100 per annum from 1st April. Regarding my salary its M.O.H. In September, Councillor Rowe proposed, and Councillor Kilbride seconded, that the question of giving my Chief Sanitary Inspector an honorarium of £25 be referred back to the Public Health Committee, with an instruction that an honorarium be granted to the M.O.H. to the same extent as the Heads of other Departments. This resolution was not carried, so my salary as M.O.H. remains at £400—which it has been since 1910—and I remain the poorest paid (whole-time) M.O.H. in England and Wales. In December, the British Medical Association and the Society of Medical Officers of Health, requested all Local Authorities to increase the salaries of their Medical Officer by one third, owing to war conditions, to take effect from July 1st. Many authorities accepted the suggestion, but of course Edmonton did not. Return of Staff. Soon after the armistice was signed, I approaohed my Public Health Committee in this matter with the result that a subcommittee was formed in December to meet as and when necessary and arrange for the re-adjustment of the duties and salaries of the four concerned, Messrs. Nixon, Huckle, Dyer and Farrar. War Allotments In February the western portion of the Recreation Ground off Church Street and other lands were taken over for cultivation. The Clerk reported that out of 986 allotments provided, 958 were let. More were taken over in March. Coal. By the middle of February, 1,070 tons of coal were lying in the Town Hall Yard for the benefit of small consumers, and in July the Board of Trade agreed to pay Coal Overseers and their staffs in the Engineer's Department for this special work. A new order came into force on the 1st June providing for the householders sending in requisitions for coal and gas to our Engineer. New Businesses. In March the Director General of National Service issued an order prohibiting the opening of a new retail trade or business without a licence issued by him. In June the Architect- was authorised to supply the Local Government 8 Board with monthly returns of all plans submitted to and approved by the Council, in order to facilitate dealing with applications for licenses under D.O.R.A. Shops. Compulsory early closing was continued by the Home Office from May 1st to September 30th, 1918. Salvage. A Conference at the Local Government Board on 5th April was convened by the National Salvage Council. Posters and handbills were distributed in August, and in September nearly 5,000 handbills were well distributed through the elder scholars. Reports. On April 23rd, on the suggestion of Councillor Rowe, the Clerk was directed to condense the reports of Committees to the Council as much as possible. In April the supply of officers' reports to Committees and notices of meetings were much reduced, as stationery had become expensive and difficult to obtain, but in December this limitation was raised. Since September, 1917, the waste paper, which is not inconsiderable in municipal offices, has been saved .and sold for 6s. to 8s. per cwt. Air Raids. In September the firemen were fitted with gas masks and hooters were fixed at head fire station and sewage farm. In November the bedding and dressings were collected from all air-raid stations, disinfected and washed. In December, to all who had worked on air raid service, the Council's engrossed thanks under seal were sent. WAR MEMORIAL. A Committee was appointed early in the year and presented a full report in June reporting that the idea receiving most support was the erection of an Institute where ex-service men could meet their particular friends and the public and also where rooms could be hired by societies, etc., for meetings. The Institute was expected to be practically self-supporting. A public meeting was held on 9th May at the Wesleyan Central Hall. Our Architect was requested to draw up plans. In August another report advised that instead of erecting an Institute, one be adapted at the "Elms," which Mr. Rice offered at £3,500, then £3,000 with option to 1st October. The Committee recommended that "The Elms" be purchased and vested in a corporate body of Governors who would have full control thereof. In December application was made to the Local Government Board for permission to contribute up to 1d. rate (£980) towards the fund. Death. The death of Lieut. A. B. Lismer, Chief Assistant of our Engineer, was reported on the 23rd November to have occurred at Daventry, from pneumonia on 2nd November. I deplore the death of a loyal colleague. FOOD CONTROL. On 22nd October, the Food Control Committee was reconstituted as follows:—Councillors 9, Labour 3, Co-operator 1, Food trader 1, Women 2, 9 total 16. At the same time the old Committee presented a report of their first year's work ; a most interesting document, which I wish I had room to fully quote. In March the rent of £50 was agreed to be paid to the Council for the premises of the Committee. National Kitchens. On March 16th the Canteen Committee asked the Council to consider the establishment of one under the National Kitchens Order, 1918. On March 26th a special Committee was appointed consisting of three Councillors and two members of the Canteen Committee. In May this Committee recommended the provision of one at £200 worked (if possible) in co-operation with the Education Committee's training in domestic economy. However nothing further transpired. Meat Rationing Order, 1918. In June I was requested by the Ministry of Food, through the Local Government Board, to secure the collection of cards after death. Lectures, with practical demonstration, on food and vegetable preservation at the Town Hall were arranged by the Food Production Department of the Board of Agriculture; they were not successful. Our Education Committee asked the County Education Committee to arrange another series of 3 lectures on economical cookery in February. In January, the Council was asked by the Local Food Control Committee to instruct the Public Health Committee to continue inspection under the various orders; this was not acceded to, perhaps because the efforts of my Department under the Sugar (Domestic Preserving) Order were prolonged, but futile. So the power to admonish and 'prosecute offenders under the many food orders, past and future, remained with the Local Food Control Committee. Potatoes. In January, 100 tons of seed were delivered into the 2nd class baths for sale to the public as in 1917. Some of the old potatoes in hand were sold to the bakers in March. Tomatoes were grown at the Park and Cemetery and sold to the greengrocers. In March sunflowers were sown in the Park and Recreation Ground; for some useful purpose or other. FISH. In February, I found that tradesmen embarking for the first time in the sale of fish, such as kippers and bloaters, were handicapped by want of knowledge and proper means of storing. As such waste of food could be dealt with by the Food Control Committee under the special Order of February 21st. 1918, on my advice, the matter was so referred. In April, the Fishmongers Company were approached also about the delivery into Edmonton of much unsound fish, probably due to delay in transit. In February too, the Public Health Committee caused a letter to be sent to Lord Rhondda, the Chief Food Controller, complaining of the delivery of 10 unsound meat into Edmonton and asking for his serious attention to the wholesale markets. The Ministry, in April, assured us that it should not happen again. MUNITION WORKS. During the year, up to November 11th, 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. Of course the extraordinary and heavy traffic to and from these munition works has badly affected the surface of certain of our roads, and created them into dusty tracks or muddy pools according to the weather. In May the N.E. part, and in August the N.W. part of Pymmes Park was handed over to the Royal Air Force as a camp for employees at the Government Factory in Angel Road, and the Ministry promised to reinstate or compensate at the end of their occupation. Later the Edmonton Laboui Party protested, but in vain. In September hutments for winter use in Pymmes Park were planned, but on September 30th the cold weather compelled the men to seek warm quarters at our Town Hall, Baths and other public halls. On November 23rd, material was announced for sale at Pymmes Park Camp and on the same date the Council accepted gift of two huts. 80 feet by 26 feet, one completed, in return for shifting 1,000 loads of clinker; in December, the Parks Committee considered how to use these two huts. They are still unused in August, 1919. In April the Leaside works were cleaned up after work stopped; the plant and buildings were disposed of by auction in September. Infectious Diseases. On July 30th, I visited the Aircraft Repair Depot in Angel Road and endeavoured to regularise the notification, transportation and isolation of the cases arising there or at the camp in Pymmes Park. Disinfection. In April we carried out the disinfection of 626 blankets, etc.. of the Balloon Camp in Hazel bury Road; in May and June many articles were disinfected from there and Angel Road Factory. Population. In the camp at Pymmes Park and in the camp of the Balloon Section off Hazelbury Road I estimate that there were as many as 2,000 persons. These, like the 1,596 in the Military Hospital, are not included in our vital statistics. 11 BELGIAN REFUGEES. In May, the late Strand Workhouse was finally cleared of refugees and taken over by the Military Authorities with a view of the buildings being utilised in connection with the military hospital at the Edmonton Infirmary, which is immediately south of it. The small number of refugees still in hand were transferred to the camp at Earls Court. I am therefore now able, for the first time since 1914, to present the vital statistics of this report without reference to our Belgian visitors. As regards infectious disease, I received no notifications from January to May, except two of pulmonary tuberculosis. Four births were notified to me as having occurred amongst the Belgian refugees, two at the Whitechapel and two at the City of London Infirmary. EDMONTON MILITARY HOSPITAL. Lieut.-Col. Spencer Mort's responsibilities continue, if they do not increase. At the end of 1918 there were 1,405 beds for sailors and soldiers in this institution, and 1,502 in the 14 auxiliary hospitals in outside areas, a total of 2,907 beds under the administration of Lieut.-Col. Mort. The total number of inmates and resident staff in this central hospital was 1,596. This is, I should think, the largest hospital organisation in the United Kingdom. Lieut.-Col. Mort has kindly furnished me with some interesting particulars from which I gather that there has been no material change in the central hospital, except that accommodation has been made for 300 beds for treatment of compound fracture of the femur, where the results have been most satisfactory in producing useful limbs. The whole of the Strand Union Workhouse is being handed over by the War Office, now that it is no longer needed as a Belgian Refuge, and at the end of the year three sections were in occupation, namely the Nurses' Home, a curative gymnasium and accommodation for members of the R.A.M.C. Accommodation is being provided for massage, electric treatment, baths, workshops and educational schools, so that (after operative treatment) the men can be prepared to take a useful part on their discharge as civilians. As regards Infectious Disease amongst those on His Majesty's Service, 11 cases were notified—1 scarlet fever, 7 erysipelas and 3 measles (1 rubella). As regards tubercle, I received notice of 6 oases of pulmonary disease, five males and one female, but no other forms of tubercle. The Deaths that occurred in the Edmonton Military Hospital totalled 111—23 from wounds, 3 from gas poisoning incurred on service abroad, 1 from an explosion in munition factory, 1 from being run over by 12 tramcar outside, 3 from falls in the neighbourhood out of aeroplanes, 1 suicide from hydrochloric acid taken outside; and 79 from disease, of which 39 were from influenza and 8 from pneumonia. There were 5 deaths due to the war which occurred outside this institution, viz.:— 2 voluntary firemen of Southgate at a fire and explosion at the Edmonton Munition Company's works. Weir Hall, 1 from fall of aeroplane on the Enfield Sewage Farm, 1 from a tram accident outside and 1 from heart failure at the Royal Aircraft Repair Depot. Angel Road. So altogether 116 deaths in Edmonton were due to the Great War, compared with 93 last year. These deaths are not included in Table III. 13 EDMONTON URBAN DISTRICT. report of the Medical Officer of Health For the YEAR 1918. 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 should retire annually. But the elections have been suspended during the war, since the last one in April, 1915. To fill vacancies Messrs. Geo. Rowe, E. T. Rhymer W. F. Middleton, and Mrs. Norman Benjafield, have been co-opted. 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 three 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 overcrowding is common. The Representation of the People Act, 1918, made Edmonton a Parliamentary borough with one member of its own, although the population of 1914 was estimated to be a little less than 70,000, viz., 68,203 (excluding refugees and military). Mrs. Benjafield, our first and only woman Councillor, at the Annual Meeting of the Council in April, was appointed to serve on the Public Health, Housing and Town Planning and Maternity and Child Welfare Committees The Countv Medical Officer's report for 1917 was received on December 13th, 1918. The Middlesex Insurance Committee, in November, asked for copies of Minutes and Reports of the Council's work; they also suggested that in preparing statistics for 1919 the Council should keep record of the persons dealt with, specifying whether they were (a) insured persons, (b) dependents 14 of insured persons. On the advice of the Public Health Committee, the Council declined both suggestions. POOR LAW INSTITUTIONS. The Institution belonging to the Edmonton Board of Guardians, which is in Fore Street, 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, Hornsev, 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, 1918, the estimated population of Edmonton Union was 498,923; rateable value £2,567,082. 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 Margate. 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." Millfield House, formerly the Strand Union School, and later a refug for Belgians, has been occupied since January, 1917, by the Metropolitan Asylums Board as a male epileptic colony. It accommodates 243 patients. These people are excluded from our Vital Statistics. Dr. Bebb is the visiting Medical Officer, and Mrs. S. Pallin is the Matron. VITAL STATISTICS. My statistics refer to 52 weeks ending on December 28th, 1918. 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 63,761 for deathrate and 71,442 for birth-rate, whereas I estimate our nett civil population at 74,330, and the gross civil population (including institutions) at 74,914, plus an average military population of 3,596. 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 from His Majesty's Services has been quite compensated by the influx of munition workers. T estimate the nett population at the middle of 1918 as 74,330 persons, including 98 Edmonton people in Edmonton Workhouse and Old Infirmary. 15 The gross total number of births was 1,248, i.e., 627 boys, 621 girls; of these, 102 49 boys, 53 girls) were illegitimate. The gross total number of deaths was 1,257, i.e., 680 males, 577 females. You will therefore perceive that on these figures is based an nnique record for Edmonton, viz., the gross total of deaths exceeds that of the births by nine. The total number of deaths registered in Edmonton for the year exceeded the number of births in no less than 22 out of the 52 weeks. In six weeks of the year during the epidemic of influenza, the deaths resulting from this disease exceeded the number of births registered. The 1,596 persons at the military hospital, and 2,000 in the two camps, are not dealt with by my statistics, gross or nett. The natural increase of the population, that is the excess of the nett total of births over the nett total of deaths was 1,196, minus 905, equals 291. The figure was 635 last year. The area of the district is 3,894 acres (less 31 of water), and the density of the population, or the average number of persons per acre of land, is 19.4. This figure is calculated on the grass population, which includes the average populations of Edmonton Workhouse and Old Infirmary, and the Epileptic Colony, and amounts to 74,914. The patients, nurses, medical men, orderlies, etc., at the Military Hospital, are excluded; so are those in the two camps of the Royal Air Force. In the Edmonton Workhouse and Old Infirmary there were estimated to be 429 persons, of whom 98 were Edmonton Residents. In the Epileptic Colony, where the inmates are admitted from central London areas, mainly the metropolitan boroughs, there was estimated to be an average population of 253 persons, including 10 on the resident staff. During 1918 there were 28 deaths but no births. STATISTICS OF REGISTRAR GENERAL. The following rates are provisional. The marriage rate for England and Wales for 1918 was 15.3; the highest on record was 19.4 per 1,000, in 1915. The birth-rate, 17.7, is the same as last year, and is the lowest on record; the death-rate at 17.6 is 3.2 higher than in 1917 and 3.8 higher than in 1913, which was the lowest on record. The infantile death-rate, at 97 per 1,000 births, is the same as last year; the lowest record is 91 in 1916. The natural increase in the population of England and Wales, or the excess of births over deaths, is 50,782, or 236,882 less than the average of the preceding five years. BIRTHS. The number of births registered by the Edmonton Registrar, Mr. W. H. Miller, was 1,248 (627 boys and 621 girls), which includes 17 births that took place in the Edmonton Workhouse born of mothers belonging to Edmonton. The figures for 1917-16-15 were 1,376, 1,708 and 1,725. Fifty-five births born 16 of mothers who are not Edmonton residents, are excluded from our statistics, just as foreign deaths are ; of these, 47 occurred in the Workhouse. The Registrar-General has again not reported any births which took place when Edmonton mothers were residing temporarily out of their district, but from other Medical Officers of Health I have received notification of seven births— four boys and three girls; of these, four (two boys and two girls) were Belgians, two of whom were born in the Whitechapel Workhouse and two in the City of London, of mothers sent from the Refuge. Thus the nett total of births was 1,196, excluding the four Belgians last mentioned. Of these 1,196 births, 59 (4.9 per cent.) were declared illegitimate; this rate is 0.8 per cent, more than last year. The birth-rate per 1,000 inhabitants is therefore 16.09, compared with 18.20 last year. My lowest record of births in Edmonton for a lunar month was for the four weeks ending June 16th, and numbered only 88. Notification of Births Acts, 1907 and 1915. During this year 1,293 births were entered in our register; of these 651 were males and 643 females; 97 (7.5 per cent.) of the whole number were born out of wedlock, and one more was of doubtful legitimacy. Forty-two children were declared "stillborn." Mr. H. Weston was appointed Superintendent of the Cemetery vice Mr. Bugg, in March. He informs me that there were 34 children styled ''stillborn'' buried during 1918; for 1917-16-15 the figures were 35, 54 and 46. For work done in visiting infants and their mothers, see section "The Women Inspectors and their work." In a previous paragraph it is rioted that 1,248 births were registered during 1918 The figures of notification and registration will, of course, never coincide, but they shew that few, if any, births escape notification in accordance with the Act. Twenty-two pairs of twins arrived, and one set of triplets. No Belgian women were confined in Edmonton Workhouse and Refuge. The birth-rate (16.09) for 1918 is 2.11 less than last year, and is 1.61 lower than 17.7, the birth-rate of England and Wales for 1918. The birthrate for the preceding ten years will be found in Column 5 of Table 1. DEATHS. The gross total of deaths registered in the district during the year was 1,257—680 males and 577 females: of these, 368 occurred among non-residents at Edmonton Workhouse and Infirmary, and 10 temporarily resident, while 103 deaths of Edmonton residents and 2 vagrants, taking place in the Edmonton Workhouse and old Infirmary, are included in our nett deaths. Thus the number of deaths amonszst "Edmonton residents" registered in the district amounted t.o 733, besides 2 vagrants. Of the 116 ' 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 15.23 per 1,000 living. This rate is calculated on the estimated gross population of 74,914 (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 12.18. This rate 17 is calculated on the estimated nett population of 74,330. 1 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 170 deaths returned in this way during the year, making the nett total of deaths at all ages (including 2 vagrants) for the district proper 905. 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, 12.18 per 1,000 living; it was 9.50 last year. It is 1.36 higher than the average of the five previous years, but is better than 15.80, the rate for 1904. Influenza took a heavy toll of this district. The senile deaths (65 years and over) are 45 more than last year. Death Certification. All deaths were certified either by the medical attendant or by the Coroner. Inquests were held on 61 residents, or 8.3 per cent. of the total deaths amongst residents registered in the district, thirty-four of them during the first half of the year. This percentage compares favourably with nearly 13 per cent. in 1913. For inquests on infants see next section. The ages at, and causes of, death 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 1,000 of the population. These diseases are small-pox, enteric fever, measles, scarlet fever, whooping cough, and diphtheria, at all ages, also diarrhoea (and enteritis) in children under two years of age. There were 42 deaths from these diseases during the year, and the zymotic death-rate is therefore 0 57, at compared with 0.66 for the previous year. This figure is 0.09 less than last year. 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 take place Bmongst 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 96, and the births registered within (or without) the district, born of Edmonton mothers, numbered 1,196; therefore the infantile death-rate, based on these figures, is 80.27 per thousand births. The lowest record is 74.55, in 1910. Eleven of the 96 infantile deaths were those of illegitimate infants—that is 11.5 per cent. of the infantile deaths; three inquests were held. Inquests were also held on 11 of the other infants, making a total of 14. 18 The infantile mortality rate for the year in England and Wales was 97; in London, 107; in the 96 great towns (which include Edmonton), 106; and in the 148 smaller towns, 91 per thousand births registered. Table IV. shows that 47.9 per cent, of the infantile deaths occurred within the first month of life, and that 39.6 per cent, were due to what are termed "wasting diseases," viz., premature birth, atrophy, debility, congenital defects, and marasmus. Last year the figures were 30.1 and 32.2 per cent. I must also notice that the premature births were 25, compared with 21, 16 and 19 for 1917-16-15. TABLE IV Infantile Mortality, 1918. Nett deaths from stated causes at various ages under 1 year of age. Causes of Death. (None uncertified). 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. Small-pox 5 .. .. .. .. .. .. .. .. .. .. Chicken-pox 19c .. .. .. .. .. .. .. .. .. .. Measles 6 .. .. .. .. .. .. .. .. 1 1 Scarlet Fever 7 .. .. .. .. .. .. .. .. Whooping-Cough 8 .. .. .. .. .. i i .. 2 4 Diphtheria and Croup 9a .. .. .. .. .. .. .. .. .. .. Erysipelas 18 .. .. .. .. .. .. .. .. .. .. Tuberculous Meningitis 30 .. .. .. .. .. .. .. i .. 1 Abdominal Tuberculosis 31 .. .. .. .. .. .. .. .. .. .. Other Tub. Diseases 28, 29, 32—35 .. .. .. .. .. .. .. .. .. .. Meningitis (not Tuberculous 61 .. .. .. .. .. .. .. .. .. .. Convulsions 71 .. 1 .. .. i .. .. .. 1 .. Laryngitis 87 .. .. .. .. .. .. .. .. .. .. Bronchitis 89—90b .. .. .. 1 1 .. .. 1 .. 4 Pneumonia (all forms) 91—92 .. .. 2 2 4 5 3 5 19 Diarrhoea 104 and .. .. .. .. .. 5 3 3 1 12 Enteritis 105 .. .. .. .. .. .. .. .. .. .. Gastritis 103a .. .. .. .. .. 1 .. .. .. 1 Syphilis 37 .. .. .. 1 1 .. .. .. .. 1 Rickets 36a .. .. .. .. .. .. .. .. .. Suffocation, overlying 168 1 .. .. .. 1 .. .. .. .. 1 Injury at birth 153152c 3 .. .. .. 3 .. .. .. .. 3 Atelectasis 152b 2 2 1 .. 5 .. .. .. .. 5 Congenital Malformtns 150 .. .. 1 .. 1 2 .. .. .. 3 Premature birth 151a 20 3 .. 2 25 .. .. .. .. 25 Atrophy, Debility and 151 1 .. .. .. .. .. .. .. .. Marasmus b,c,d,e 4 1 1 .. 6 4 .. .. .. 10 Other causes - .. .. .. .. .. .. 3 1 .. 4 Totals - 30 7 5 4 46 19 12 9 10 96 Nett Births in the year.—Legitimate, 1,137; illegitimate, 59. Nett Deaths in the year.—Legitimate infants, 85; illegitimate infants, 11. 19 THE WOMEN INSPECTORS (HEALTH VISITORS). I give below an analysis of the number and nature of the visits paid by them during 1918. The bulk of their work falls into four large divisions, viz.:— 1. The crusade against preventible infantile mortality. 2. The work done in factories, workshops, etc., where women and girls are employed, and amongst home-workers of their own sex. 3. The visitation of consumptives and other tubercular persons. 4. The visitation of scholars at home, when suffering from the noil- notifiable infectious diseases, or measles. In December the salaries of the Woman Inspectors and School Nurses were settled on a graduated scale to begin with £120 and rise by £5 yearly to £150 per annum. As before, the school nurses receive £5 yearly towards maintenance of overalls and bicycle. This places these officers in a sound and equitable financial position, comparable with other districts. On September 2nd, Mrs. J. A. Hobbs commenced duty as 5th Woman Sanitary Inspector and 2nd School Nurse. INFANTILE MORTALITY. Month. After birth. Re-visits. After 6 months. After death. Diarrhoeal disease. Expectant Mothers Stillborn Infants January 37 40 8 20 - - - February 52 22 18 9 - — — March 69 17 7 11 - — — April 26 11 17 o - — — Mav 16 55 — 6 - — — June 57 37 125 — - — — July .. .. 49 17 101 — - — — August 123 22 1 3 24 3 — September .. 203 87 2 6 2 7 1 October 128 63 4 6 — 1 1 November .. 34 59 9 16 — 9 1 December .. 115 50 27 22 — 4 1 Totals 939 480 319 101 26 17 4 With reference to children over one year, 32 visits were paid, namely:— 1 each in August, September and November, and 29 in December. 20 INSPECTIONS UNDER FACTORY AND WORKSHOP ACTS. Month. Factories. Workshops. Laundries. Outworkers. Rooms Measured. January 1 - - 3 — February 4 - 1 15 — March 10 3 3 31 — April — — — 6 — May — — — — — June 2 5 — 9 — July 4 — — 4 — August 14 — 1 — — September — — — 45 — October — — 1 27 — November 1 — 1 — — December — — - 28 - Totals 36 8 7 208 — NOTIFIABLE DISEASES. Month. Measles. Phthisis. Other forms Tubercle. Erysipelas. Ophthalmia Neonatorum. Puerperal Fever. Totals. January 10 21 3 1 2 37 February 14 27 4 4 3 2 54 March 51 54 8 2 — — 115 April 73 42 — 4 5 — 124 May 42 28 — 2 2 — 74 .June 116 47 3 5 — — 171 July 98 32 4 2 — — 136 August 27 44 11 — 5 — 87 September 4 39 6 3 24 — 76 October 5 34 3 8 3 — 53 November 4 33 5 4 — — 46 December 5 21 9 2 37 Totals 449 422 47 43 45 4 1010 For the arrangement of disinfection afterwards, the following visits were paid:—16 to measles; 171 to pulmonary tuberculosis; 12 to erysipelas: 1 to puerperal fever. 21 NON-NOTIFIABLE DISEASES. Month. Mumps. Whooping Cough. Chicken Pox. Doubtful Cases. Influenza. Totals. January 83 59 66 9 — 217 February 83 62 44 18 — 207 March 125 46 63 14 — 248 April 55 79 19 10 — 163 May 30 46 28 18 — 122 June 55 68 45† 15 — 183 July 16 29 76† 8 — 128 August* 2 9 9† 1 — 21 September 8 52 15 — — 75 October 1 1 7 15 16 40 November — 1 10 11 20 42 December 2 2 7 1 — 12 Totals 460 454 388 120 36 1458 *Schools closed for holidays. †Notifiable. SCHOOL NOTIFICATIONS. Visits and re-visits concerning measles and the non-notifiable diseases such as whooping cough, chicken-pox, etc., 1923 to 2823 children at 1725 homes. Of this number 465 visits were for measles. Last year the figures were 2130, 3125, and 1689 respectively. (For further information see Annual report of School Medical Officer.) GENERAL WORK. Visits to Private Schools 1 Enquiries re complaints 94 Miscellaneous visits (see last year) 205 Visits re nuisances 234 ,, ,, overcrowding 1 Total 535 WOMEN OFFICERS' INDOOR WORK, 1918. Office Work. Statistical Work. Tuberculosis Accounts. Infant Welfare Centre. Miss Hudson 144 17 4 — Miss Shiner 152½ 2 — 84 afternoons Miss Bintcliffe 126 7½ — 1½ afternoons Mrs. Hobbs 27¾ — — — Total Days 450¼ 26½ 4 85½ afternoons 22 MATERNITY AND CHILD WELFARE. To the Public Health Committee, of the 5th December, 1917, Councillor S. J. Sanders, Chairman of the Board of Control, submitted a comprehensive scheme for transferring the voluntary centre into a municipal one, over which I "should exercise, on behalf of the Council, general supervision." This was approved by the Council on the 19th December, with the stipulation of a monthly report to the Council, and the Maternity and Child Welfare Committee were empowered to incur expenses up to a limit of a half-penny rate. In January, larger accommodation was provided at the Wesleyan buildings in Fore Street at the rent of £1 weekly. This position was regarded as more central, but the premises are not so suitable for the work, or as well kept, as those formerly used in the Charles Lamb Institute, Church Street. On the 22nd January, 1918, the Council agreed to appoint a Maternity and Child Welfare Committee. It was resolved that the members of the Committee do hold office for twelve months ending March 31st, 1919; also that the transfer of the management of the existing Voluntary Centre to the Local Authority do take effect on the 1st April, 1918. The Committee of the Municipal Centre was to consist of 17 members, viz., 8 ladies (including Councillor (Mrs.) Benjafield and four wives of Councillors), 2 medical men, and 7 Councillors. It is affiliated to the Association of Infant Welfare and Maternity Centres. On February 21st, 1918, the Local Government Board wrote congratulating the Council on the establishment of a municipal centre and requesting the appointment of more women officers. The Board also pointed out that the constitution as stated above did not provide a majority of Councillors. To this my Council replied that they did not consider it necessary to alter the composition of the Committee. The first report was dated April 20th and was presented to the Council on May 28th, in which it was stated that "Your Committee have unanimously agreed that Dr. Sidney C. Lawrence, Medical Officer of Health, be appointed Supervisor, and Miss 6. M. Shiner, Secretary of the Centre," A banking account was opened on which cheques are drawn by any two members and the Secretary. At the meeting I pointed out that a secretary was not needed at a municipal centre, as all the correspondence should be dealt with by the Supervisor. The local baby week was held from July 1st to 6th (both dates inclusive) and was organised by a sub-committee of ladies. The Council granted the use of the Town Hall for baby shows on 1st and 3rd July, and the park for a pram-parade and distribution of prizes. Our centre did not achieve much success at the National proceedings of 1918, in London. In July my Council, on the advice of the State Children Association, urged the Ministry of Reconstruction that a system of mothers' pensions was desirable, which will enable necessitous widows to look after their own children. On Friday, July 25th, Mrs. Outram, M.B., succeeded Miss Rachel Mackenzie 23 as Medical Adviser; she attends twice a week, Tuesdays and Fridays. I represented the Centre at a conference in London and presented a report thereon to the Committee on 26th July, 1918. Dated August 6th, the Local Government Board sent my Council a copy of the Maternity and Child Welfare Act just passed into law, with a circular letter again calling attention to the constitution of the Committee, which did not comply with the definite terms of the Act, Section 2. This was referred to the Committee for consideration and report, but nothing had been done by end of 1918. In September, the Chairman of the Council and I presented a report on a conference we attended on July 9th, of Local Authorities in the Middlesex portion of the Edmonton Parish, with the Guardians, which considered proposals of Tottenham as to the provision of maternity beds without the taint of pauperism. The meeting produced no result, as it was soon evident that it should have been preceded by a meeting of the Local Sanitary Authorities without the Guardians; neither were the Guardians prepared with any statement as to the terms on which all or any of the Authorities could retain the use of beds for mothers recommended by the Medical Officer of Health. In October, the Committee decided to adopt Clause 5 of the Regulations in the circular, re grants, of the Local Government Board dated 9th August, viz.: "The expenses of a Centre." What the meaning of this resolution is I fail to understand. I am not responsible for the minutes of the Committee, or its report to the Council. I regret to report that the Committee has failed to secure the confidence and co-operation of all the medical practitioners and midwives; opportunities which I pointed out were usually missed. The work at the Centre is not conducted in the best way to be of educative value to the mothers. On January 22nd, 1919, the Accountant reported that the Government had sent a cheque for £111 3s. l0d. towards the expenses of the Centre for 1917-18, which had been paid into the Committee's bank. At the end of the year I was still without any salary as Supervisor. On the other hand many difficulties were placed in the way of my carrying out the duties to my satisfaction. THE DAY NURSERY. On the 28th March, the Council considered a letter from Mr. Beer, dated 5th March, stating that he had bought the freehold house, "The Rosary," Fore Street. N. 9, with the intention of preparing it as a day nursery and had formed a Committee to carry out the plan. He offered the Council an opportunity of taking it over when ready. In the alternative, he asked for the goodwill and support of the Authority. In a further letter of 20th May he stated that £2,350 would be the amount he would expend to start his scheme. The matter was referred to the Public Health Committee, who formed a subcommittee to discuss the proposal with Mr. Beer. The plan of buildings and site submitted is No. 3,219 and was approved in June. 24 In July, on the advice of the Public Health Committee, the Council decided not to accept the responsibility, but promised the scheme "their moral support and goodwill." On the 25th July, the institution was inaugurated by a public meeting at the Town Hall, followed by a visit to "The Rosary," where the place was dedicated to its work by Mrs. Evill, wife of the Vicar of Edmonton, and the Rev. Chas. Knight, vicar of St. Martin's. I was (voluntary) Chairman of the Creche Committee at the outset and did my utmost to help a scheme which promised much benefit to my district, if worked in cooperation with the maternity and child-welfare centre and on cordial terms with the medical practitioners and midwives of the district, and any other similar institutions of the present or future. Later the Chairman of the Council (Mr. S. J. Sanders) joined the Committee, to which Miss Carter and Miss Skinner were attached as Welfare Superintendents at two of our largest factories. A revised version of the regulations under which grants are payable by the Board of Education to day nurseries in England and Wales was issued in July. The revision provided for the payment of a grant at a rate not exceeding 50 per cent. of the nett expenditure, after deducting any payments made for the care of children, and other similar receipts. The increased grants payable during the current financial year were based on the expenditure incurred during the twelve months ending on March 31st, 1918. In fixing the rate of grant, the Board have particular regard to the provision for (a) the medical inspection and supervision of the infants and young children; (b) the number and qualifications of the staff; (c) the provisions for promoting physical welfare; (d) and the prevention of infectious diseases; (e) the suitability of the premises and equipment; (f) and the methods adopted for confining the benefits to infants and young children who, by reason of the necessary absence of the mother at work or other similar cause, cannot be adequately cared for at home. As regards (b) and (e) I am quite satisfied, but I have received no recent information as regards (a. c. d and f). 25 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 oases 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 86 78 90.7 1 1.2 Diphtheria & Mem. Croup 37 32 86.5 5 13.5 Enteric Fever 5 4 80.0 2 40.0 Totals 128 114 — 8 — Compared with last year, the table shows 35 move notifications of scarlet fever, and the same number of fatal cases actually, but less relatively. There were 17 more notifications of diphtheria and more deaths, and the percentage of fatal cases was 8.5 per cent. more; the notifications of enteric fever were 3 more, but the fatality was actually more, but relatively 10 per cent. less than last year. Foreigners. Four cases were notified from the Edmonton Infirmary; 2 scarlet fever, one puerperal fever, and one rubella. Of these one scarlet fever was a former resident in this district and is therefore included in the above table. Amongst the military, I received 11 notifications as follows:—One scarlet fever, 7 erysipelas, 2 English measles and one rubella. Cases of tubercle are referred to in another part of my report. Since 1914 the Charts dealing with scarlet fever, diphtheria, and enteric fever, based on the uniform plan of a temperature chart, have not been published for economy's sake. Cholera. In September I received a circular from the Local Government Board placing me on guard as to the possible introduction of this disease from Russia. Rats. These rodents becoming again too numerous, virus was laid 26 down in various places, at a cost of £5, in August. In March complaint about them was received from Elsiedene Road. Small-Pox. A satisfactory feature of the infectious returns for the year is the absence of small-pox from amongst them; since 1904 the district has enjoyed a complete immunity from this disease. An epidemic of this dreadful disease is overdue, and, judging from the returns of the Vaccination Officer, there are many Edmonton children unprotected from infection and sure to die, if attacked. There were no deaths from chicken-pox. Vaccination. The following table of vaccination returns for 1918 has been kindly supplied by Mr. Lowman, the Vaccination Officer. Births Successful Vaccinations. Conscientious Certificates. Deaths under one year unvaccinated Still unvaccinated but address known. Postponed owing to illness. Certificate unsusceptible. Removed to other districts & untraced. 1247 447 374 85 84 71 2 184 In 1907 there were only 72 certificates granted to parents who alleged they had conscientious objection to vaccination, but there were 374 this year, and 494 in 1917. Small-Pox. In March the occurrence of cases in the County of London led us to look over our equipment, that all may be ready in case of need. For some time I received supplies of fresh lymph from the Government for my use under the Public Health (Smallpox Prevention) Regulations, 1917. Inspector Winter and I were re-vaccinated. In June the Middlesex County Council submitted a plan for a new drainage system at Clavering Farm Hospital: it was not approved by me, but the Council raised no objections. In September we declined to approve of modification of plan that would reduce the estimated cost of £700, but probably produce an inefficient system of drainage. Chicken-Pox. On March 26th I informed the Council that I had received warning of nearly 30 cases of smallpox in the County of London and its vicinity and they accepted my advice to make chicken-pox notifiable for three months on and after May 11th. I circularised all the medical practitioners thereon. During the 3 months 79 cases were notified by doctors and 75 by parents. Scarlet Fever. Eighty-six cases were notified, giving an attack rate of 1.16 per 1,000. 51, 110 and 281 were notified in 1917-16-15. There was one death, giving a death-rate of 0.01 per thousand of the population. Two cases were notified from the Edmonton Infirmary, one resident and one nonresident. The latter is not included in the above figures. Not one was doubly notified. Secondary cases numbered 4 out of 86. One case was complicated with chicken-pox. Case No. 49 was re-notified and sent back to hospital. There were seven cases notified where subsequent observation did not confirm the diagnosis: they are not included in the above figures. Return Cases.—See section on "Hospitals." 27 Diphtheria and Membranous Croup. I received notifications of 37 cases during the year, compared with 20, 67 and 89 in 1917-16-15, and they represent an attack rate of 0.50 per thousand of the population. There were five deaths, giving a death-rate of 0.07 per thousand of the population. One case was complicated with whooping cough. There was one case doubly notified. There were 4 secondary cases. There were no cases notified from the Edmonton Infirmary, neither Edmonton residents nor non-residents. Return cases.—See section on "Hospitals." There were 6 cases notified where subsequent observation did not confirm the diagnosis; one case was transferred to the scarlet fever list; they are not included in the above figures. Anti-Toxin, 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. An injection-syringe for the doctors use lies at each fire-station. Enteric Fever. Five cases were notified as against 2, 6 and 5 in 1917-16-15. This is equal to an attack rate of 0.07 per thousand of the population. There were 2 deaths, giving a rate of 0.03 per 1.000 of the population. There were no cases notified from the Infirmary. There was one secondary case. Four cases were notified which were not confirmed by further observation. Acute Anterior Poliomyelitis. No cases were notified. CEREBROSPINAL FEVER. The last case in 1917 was notified on 16th December. One notification was received in 1918, on December 7th, from Great Ormond Street Hospital, where the girl of 14 months died 15 days later. Six deaths of residents were certified as due to meningitis, class 61; none of these were under a year old. The one girl notified under the Cerebro-spinal Fever Order died and was certified as "epidemic cerebro-spinal meningitis, 1 month.'' Of the remaining five— not notified under cerebro-spinal fever or tuberculosis regulations—one meningitis meningococcus, male, 8 years; one cerebral meningitis, male, 2 years; one idiopathic meningitis, female, 17 years; one meningitis, male, 6 years, and one septic meningitis, female, 50 years. In January our Joint Hospital Board agreed that (pending further consideration) cases of this disease would be admitted when room and staff were available. ENFIELD AND EDMONTON JOINT ISOLATION HOSPITAL. This is situated on 27 acres of land in the Enfield district, on its Winchmore Hill border. The contribution of Edmonton towards the Hospital for the year ending 31st March, 1919, was £4,806 compared with £4,748 for the previous year. The Superintendent's report for the year ending March, 1918, reached me on August 9th, 1919. 28 The Accommodation was not stated; presumably it was the same as the two previous years. During 1917-18 the greatest number of patients resident on one day was 31; that is 130 below the normal accommodation; the smallest number was nine. The patients admitted from other districts appear to have been four, viz.: One of diphtheria and three of enteric fever, or 2.1 per cent. of all admissions. It was 0.81 in 1916-17. No case of cerebro-spinal fever was treated. 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 one assistant matron, three sisters (one for night duty), three staff nurses, seven probationers and two ward maids; in 1917-18 the resident staff numbered 34 and the outdoor staff 4, compared with 31 and 4 the year before. Eight nurses were inoculated against Enteric Fever. None of the staff contracted scarlet fever, diphtheria or enteric fever. Treatment of Diphtheria. The Superintendent states that "Antidiphtheritic serum was used in all cases where none, or an insufficient quantity had been administered previous to admission. In most cases 4,000 units was given, but some received as much as 32,000 units. Drugs were rarely used, and then only for complications." Enteric Fever. Widal's test was made in all cases. Return Cases. During the year 1918, there have been 4 such of scarlet fever and one of diphtheria. Dr. Cook estimates the percentage of return cases of scarlet fever during 1917-18 as 1.11, compared with 2.28 for the previous period. Council's Representatives. On November 23rd, Mr. W. D. Cornish was appointed on the Judith Alston Charity, subject to him agreeing to submit a report to the Council. This proviso, suggested by Councillor Middleton and passed unanimously, I entirely agree with. It should be made to apply to our representatives on every outside body. I have, in earlier reports, drawn attention to this point, especially in regard to the Joint Isolation Hospital Boards at Winchmore Hill and South Minims. Supervision. By order of the Local Government Board, 29th July, 1910, one of the duties of the County Medical Officer of Health is stated to be that "He shall from time to time enquire into and report upon the isolation hospitals in his County." Transport. This continues on the old-fashioned lines by the Council's horsedrawn vehicle. As I have been saying for the past 13 years, the proper and prompt method is by motor transport from our hospital. That is the method of the Metropolitan Asylums Board and of our own Small-pox Hospital Board. The horse-ambulance for non-infectious cases, late in charge of Mr. Middleton, was taken over by our Fire Brigade on 20th July, 1917, and has been much appreciated by those meeting with accidents or desiring removal to London Hospitals. 29 Motor Ambulance. In January Messrs. Tillings increased the hire of a horse from £40 to £50. It was suggested that a horse should be bought, but in February the Public Health Committee recommended that infectious disease cases should be transported by the Council to our hospital in a motor vehicle. In March, Councillors Barrass, Sanders and Elms were appointed as a subcommittee to draw up a specification prior to advertisement for tenders. In June the tender of Messrs. E. and C. Ardley, at £145, was accepted for converting the old horse ambulance into a motor vehicle; the engine is a late pattern Deasy with enclosed valves for silent running and two spare wheels. In September a temporary shed, costing £128, was arranged for it on the site of the proposed cleansing station in the Town Hall yard. The doors of the shed cost an additional £40. The Engineer has so constructed it as to be easily adapted for its permanent use as a cleansing station. The motorconverted ambulance was delivered on September 18th. The Chief Inspector and J. Madle have licences as drivers. 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 smallpox. The money (£237 for 1918-19—it was £462 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 number of tuberculosis cases in the institution on December 28th, 1918, was 147, 13 of whom were resident in Edmonton Urban District. Beds at Uxbridge and Picketts Lock, Edmonton, are available for sporadic cases of smallpox. If there should appear a prospect of a larger number, the tuberculous patients at Clare Hall would be cleared out at once. During 1918, 4 cases (3 from Enfield and I from Hanwell) were admitted to Uxbridge, but found to be only suffering from chicken-pox. Eighteen urban districts are now shareholders in the Joint Hospital. DISINFECTION. Our methods of house disinfection are stated in my report for 1914. Disinfectants continue to be supplied without charge 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. 30 PUERPERAL FEVER. One resident was notified and 1 Hornsey woman at the Infirmary. There were no deaths. Our death-rate is therefore nil; it was 0.75 last year. During 1917 there were 241 midwives practising privately in Middlesex and 492 not practising; besides, there were 14 engaged in poor-law infirmaries, who are exempt from the provisions of the Act. In Edmonton there were 13 practising at the beginning of 1917 and 12 at the end of that year. One midwife, reported to the Central Midwives Branch in 1916, was struck off the roll in 1917, and seven were cautioned verbally. During that year no uncertified women were prosecuted by the County Council for acting as midwives, but seven were verbally cautioned by the Inspector of Midwives, Miss Pollard. OPHTHALMIA NEONATORUM. There were seven cases, all residents, notified during 1918 by nine notifications. None were notified to me from the Edmonton Infirmary. Of the seven, four were in Bury Street, one in Fore Street, and two in Church Street Ward. Two cases were doubly notified by two doctors. Of the single notifications, all were from doctors and none from midwives. Miss Shiner paid 45 visits in connection with these cases; last year she paid 144 visits to 20 cases. ERYSIPELAS. Thirty-four cases were notified, compared with the same number in the previous year; none occurring in the Edmonton Union Infirmary. There were three deaths from this cause. No cases were doubly notified. Nine 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 1918. PHTHISIS AND OTHER TUBERCULOUS DISEASES. The deaths from phthisis numbered 69, as compared with 86, 69, and 73 during 1917-16-15. The death-rate from the disease is therefore 0.93 per thousand, compared with 1.18 last year. Of these deaths, six occurred among residents of the district in the Edmonton Workhouse. The total deaths from phthisis in the Edmonton Workhouse numbered 34. 31 The other tubercular diseases together accounted for 20 deaths, giving a death-rate of 0.27 per thousand. It was 0.29 last year. Of these deaths, two were residents of the district in the Edmonton Workhouse. The total deaths from these diseases in the Edmonton Workhouse numbered six. In this way, tuberculosis contributed a total death-rate of 1.20 per thousand of our own population, or 9.8 per cent. of all the deaths, excluding strangers; it was 15.4 last year. The Chief Woman Inspector paid to consumptives 593 visits and re-visits during the year, compared with 466 the year before, and also 47 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. Tuberculous Meat and Milk. In March the organs of an ox were surrendered from a slaughterhouse. Institutional Accommodation. I have received the following information with reference to this:— (1) Edmonton Workhouse and Old Infirmaht.—A few chronic cases are retained here, but all cases likely to benefit are transferred to Grosvenor Sanatorium, Kennington, near Ashford, Kent. (2) Epileptic Colony.—When found to be tubercular, a man is sent back to his own area. TUBERCULOSIS REGULATIONS, 1912. The total number of patients notified under these regulations was 288— 162 males and 126 females. The number of notifications was 452. Amongst the Belgian refugees there were two males notified for pulmonary tuberculosis; not included in tables below:— Lungs— Patients notified once 146 ,, ,, twice 64 ,, ,, thrice 26 ,, ,, four times 14 250 Other Forms— Patients notified once 34 ,, „ twice 2 ,, ,, thrice 2 38 32 The notifications are thus analysed:— Received from— Pulmonary. Other forms. Private Practitioners (A) M. F. M. F. 51 52 4 3 S.M.I. (B) 1 0 1 0 Sanatoria (C and D) 89 75 2 2 Infirmary (A, C and D) 3 6 2 0 District Medical Officer 1 0 0 0 Hospitals (A, C and D) 16 12 5 7 Other Institutions (A, C and D) 2 2 0 1 *Dispensary (No. 1 and other areas) 54 44 4 5 Voluntary 0 2 0 0 Military, from our own and other Hospitals 5 1 0 0 222 194 18 18 416 36 *Notifications have been received weekly from the Tuberculosis Officer of our area. (No. 1) ever since November, 1917, on form C. These are very helpful. Scholars. Two children, both boys, were notified by the School Medical Inspector during the year as suffering from tuberculosis, one from pulmonary tuberculosis, and one from other form of tubercle. The Local Government Board held an enquiry concerning certain complaints made by patients and ex-patients at the Clare Hall Sanatorium, South Mimms. In the report of the Board the following paragraph occurred:—"In general it would appear to the Board that the complaints made by the patients at the Sanatorium are to some extent the outcome of a spirit of restlessness and discontent, which may have been fostered by the failure of the Sanatorium Authorities, either to provide sufficient occupation for the patients or to insist on the work provided being properly carried out." County Councils in all parts of the country have the duty of administering the Public Health Regulations of 1912 through their medical officers. The extent to which this duty is carried out locally can only be judged from the official reports, but no uniform system of recording cases or of registering results has yet been adopted, and each report has to be judged upon its merits. Certain features, however, are common to them all. The better average of results following early treatment, the liability to relapse on returning to home conditions, the urgent need for segregation of actively infective cases, and finally, the complete failure of the regulations (as at present administered) to be an effective means of hastening the eradication of the disease in large urban areas. THE MEASLES EPIDEMIC. There were seven deaths, compared with 17, 29 and 26, in 1917-16-15. This number is equal to a death-rate of 0.09 per 1,000 living, compared with 0.23 last year. The rate was 0.28 in England and Wales, 0.42 in London, and 0.36 in the 96 Great Towns (including London). 33 One occurred in the first age period (under one year), five in the second age (one and under two years), and one between five and fifteen years of age. There was none in the Infirmary. I received notifications about 477 cases—448 being defined as English and 29 as Rubella (formerly "German measles"). Of these, 448 English and 28 Rubella were among residents; one Rubella was notified amongst strangers at the Infirmary. The attack-rate was therefore 6.4 for every 1.000 inhabitants. Fifteen were doubly notified by doctor and parent. For incidence on the various age periods, see Table II. at end of this Report. There were also three military cases; one of these was Rubella. January, 4 weeks, 10 cases in nine houses, seven in Lower Edmonton. February, 4 weeks, 13 cases in 10 houses, 11 in Lower Edmonton. March, 5 weeks, 53 cases in 43 houses. This number, however, compared favourably with 93 cases in 72 houses for the same period in 1917. The type of the disease was mild and mostly in Lower Edmonton. I only received six notices from the schools during these five weeks. In March I received from the Local Government Board a pamphlet of 86 pages on the subject dated December, 1917. April, 4 weeks, 69 cases in 48 houses. This was better than 165 cases in 120 houses last year. The disease was now moving southwards, and Raynham Road and Montagu Road Schools appeared to be mostly affected, judging from the returns received from the head teachers and attendance officers. A mother was cautioned by the Public Health Committee about non-notification. On my advice my Council on April 23rd directed the attention of all Urban District Councils in Middlesex to the action of the Leicestershire County Council in attaching to all licences of picture palaces a condition giving that Authority power to exclude children of school age or under. These Urban District Councils were asked to join Edmonton in urging Middlesex Council to do the same. May, 4 weeks, 45 cases in 38 houses. The disease mostly appeared to be in Bush Hill Park and Upper Edmonton. June, 5 weeks, 127 cases in 99 houses. July, 4 weeks, 113 cases in 90 houses. August, 4 weeks, 33 cases in 26 houses. September, 4 weeks, 3 cases in 3 houses. I did not take steps to close any schools during the year, as, under the circumstances, no great advantage presented itself. 34 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 one more; the deaths from diarrhœa have been 5 less than last year; from influenza 212 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. DIARRHŒA. Seventeen deaths occurred from diarrhœa and epidemic enteritis, as compared with 22, 34 and 45 for 1917-16-15. The death-rate from the disease is 0.23 per thousand of the population, as compared with 0.30 last year. Of these deaths, 12 occurred in children under one year of age, giving an infantile mortality rate for the year from this cause of just over ten per thousand nett births: the figures in 1917-16-15 were 9, 15 and 22. Thirteen deaths were in children under two years; these contribute to the zymotic deathrate. The cool autumn did not favour this disease; however, a leaflet dated 11th July, from the Local Government Board, urged upon Councils and voluntary agencies the importance of taking steps to prevent the spread of this disease, which is so fatal amongst children under two years of age. In connection with an outbreak the Board was willing to give a grant towards Health Visitors seeing bad cases at home, or hospital treatment. The Board urged regular scavenging as one of the best preventive methods. A letter was read from the Clerk of our Joint Hospital Board, dated 30th July, intimating that the Board was prepared to receive into the hospital serious cases of epidemic diarrhœa, when there was accommodation and staff available. The Local Weather. The year was fairly normal in most respects The total sunshine was good, but the large allowance in March was followed by a much reduced ration in April; this accounted for the poor fruit season in 1918. During the year on less than four days there was over an inch of rainfall. WHOOPING COUGH. There were 14 deaths from this cause, as compared with 13, 9 and 13 in 1917-16-15. This is equal to a death-rate from the disease of 0.19 per thousand living, compared with 0.18 last year. All the deaths occurred amongst children under five years of age—four in the first age period, four in the second and six in the third. One in January, three in February, two in April, one in May, one in June, three in July, one in August, one in September and one in October. 35 INFLUENZA. 218 deaths amongst residents were due to this cause, compared with six, seven and three in 1917-16-15. The 218 deaths were divided into the following age-periods:— 3 under one year, 10 between one and two. 24 ,, two and five. 19 ,, five and fifteen. 27 ,, fifteen and twenty-five. 91 ,, twenty-five and forty-five. 26 ,, forty-five and sixty-five. 18 sixty-five and upwards. 218 Total The death-rate was no less than 2.93 per thousand inhabitants. Besides, there were 49 deaths amongst non-residents in the Infirmary, 9 in the Epileptic Colony, and 39 amongst the military. On 6th November I reported to the Public Health Committee as follows:— "There was a slight outbreak during the four weeks of July and the first week in August which caused 10 deaths, but the weather at this time of year favours the after-disease of pneumonia, which has been the secondary cause of death in many cases. "In the week ending September 28th there were four deaths, three amongst the residents and one at the Military Hospital. For the succeeding four weeks ending October 5th, 12th, 19th and 26th, the number of deaths kept rising. They amounted to 11, 14, 39 and 48. The highest number of deaths was for the week ending 2nd November, viz., 53. From now onwards your Medical Officer anticipates a decline in the death rate. "The public elementary schools were closed for a fortnight on and from Monday, 21st October, but re-opened on Monday, November 4th. This action was taken on administrative, not on medical grounds, because the number of teachers and scholars absent dislocated the work. I drew up a leaflet, which, to the number of 7,000, on Friday, October 18th, was distributed to the homes by the boys and girls who attended the senior classes. Between the 21st and 26th October, Mr. Butland secured the disinfection of all the public elementary schools and church halls and picture palaces. "There have been no complaints from friends or relatives as to undue delay in burial, although some delay was unavoidable owing to the large number of funerals to be dealt with. In those cases where it was found necessary, accommodation in the Council's mortuary was given, and at no time was its accommodation exceeded. "Two Medical Inspectors of the Local Government Board called on the Medical Officer, viz., Dr. McEwen, on Friday, November 1st, and Dr. McNalty, on the 6th November. They were quite satisfied with the measures 36 taken to control the epidemic, and the Medical Officer had secured some preventive vaccine from the Board for the use of the local medical practitioners." On the 4th December I reported:—"For the four weeks ended 2nd, 9th, 16th and 23rd November, the total number of deaths from influenza were 53, 34, 26 and 16 respectively, making a total of 129 and 14 deaths from pneumonia; these figures include institutions as well as residents. "During the previous four weeks the total number of deaths from influenza was 112, and from pneumonia 34. The male deaths still predominate, but the certification of deaths has become more precise. "Only one child of school age died, and that was a stranger in the Infirmary. "Two Orders have been issued by the Local Government Board, dated 18th and 22nd November, entitled the Public Health (Influenza) Regulations, 1918. "Order No. 1 provides that in every place of public entertainment, every consecutive three hours play must be followed by an interval for ventilation. These regulations may be relaxed on the advice of the Medical Officer of Health. Order No. 2 amends the above by extending the period of continuous play to four hours. It empowers the Local Authority to obtain the exclusion of children from picture palaces during an epidemic of influenza. This power, in your Medical Officer's opinion should have been extended to measles. These Orders came into' force on the 25th November, 1918. "The Local Government Board has published a pamphlet on influenza recently issued by the Royal College of Physicians of London. "Half the stock of the anti-influenza vaccine provided by the Local Government Board has been called for by medical practitioners." On January 8th, 1919, I reported:—"The influenza epidemic appears to be nearly at an end. In the five weeks ending December 28th the deaths of residents were ten, nine, six, two and three, a total of 30, compared with 80 for the previous four weeks." 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. OTHER DISEASES. Alcoholism. No death from this cause was recorded either amongst the residents or strangers. The death-returns of this disease, as in the instance of venereal diseases, are most deceptive. 37 Respiratory Diseases, including bronchitis, pneumonia, pleurisy, and other non-tuberculous diseases of the respiratory system, gave rise to 34 more deaths than in 1917. The number was 160, giving a death-rate of 2.14 per 1,000, compared with 126 and a death-rate of 1.73 for the latter year. Some deaths, certified as due to pneumonia in the last quarter, had influenza as the primary cause. The death-rate from all diseases of respiratory organs was very heavy, both in 1915 and 1916. It was only 1.70 in 1914 and 1.73 in 1917. Cancer. Fifty-two deaths of Edmonton residents were certified as being due to cancer, and this is equivalent to a death-rate of 0.70 compared with 0.67 last year. The deaths during 1917-16-15 were 49, 55 and 52. 38 SECTION III. SEWERAGE AND DRAINAGE. The district is sewered on the separate system. The surface water is conveyed into the Pymmes and Salmon's Brooks. The sewage proper, together with that of the neighbouring distriot of Southgate, passes to the Council's sewage farm of 233 acres. Mr. Frank Rackham is the farm bailiff. THE SEWAGE FARM. The provision for the sludge has been developed during the year on the lines indicated in my last report. Nurserymen and allotment holders appear to appreciate the products of our sewage farm more than formerly, as I note that in January, 43 loads of sludge and 34 loads of stable manure were carted away to allotments by the Council and more sludge still removed by those requiring it. Dated January 25th, a notice was received from Lea Conservancy Board to discontinue flow of injurious matter from the sewage farm into the River Lea. Our Engineer stated that owing to floods, it was impossible to obtain a true sample of our effluent at that time. In February a main sewer was placed down Cuckoo Hall Lane. In March attention was drawn to the fouling of Sadlers Mills stream, a tributary of the Lea, by water from the Snowden Fibre Company's premises in Balham Road, which passed into our surface water drains. The Company later constructed screens better calculated to prevent rags passing away, but colouring matter went through; therefore notices were served by the Council on the Company under the Public Health Acts Amendment Act, 1890, Sections 16 and 17. In May the Engineer reported that a very acid water oozed from the Pegamoid Works and greatly damaged the concrete floor and walls of the filter bed in the gravel pit. In May, on the advice of the Engineer, £1,000 was provided in the rate estimate for 1918-19 to establish another filter bed on the farm. In November the Council decided to approach Southgate with a view to the latter district paying more towards the cost of sewage disposal for the four years ending March 31st, 1918. In December our Engineer was allowed to advise Enfield re sewage disposal. 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. 39 HOUSE REFUSE DISPOSAL. Edmonton does not possess a destructor; I hope that it will before long. I have recorded how unsatisfactory the collection was during 1917. In January, 1918, 65 complaints were received. The Clerk was instructed to write E. Knifton that unless he carried out the terms of the contract, the Council would put into operation the penalty clause. The refuse-shoot was changed in February from Silver Street, beyond Weir Hall, to the brickfields at Bush Hill Park East. In the interim, the refuse was discharged into Tottenham. In February 50 complaints, in March 26 and in April 17 were received. In April a farmer of Bush Hill Park was served with a notice for receiving refuse from London and depositing it on land in Park Avenue. As there was increasing difficulty of getting dustbins, in May the Council decided to get some for the convenience of landlords. A sub-committee of the Public Health Committee was appointed on June 5th to consider the collection by the Council itself. On that date the Inspector reported large accumulation in the back yards. At mid-summer, owing to complaints, Mr. Cornish closed off the brickfields for deposit of refuse, so in July the Council waived this clause of the contract requiring the contractor to find his own shoot, and Mr. Knifton was allowed to use the old place at our sewage farm, if he kept the sleeper road in repair. In August it was suggested at a Council meeting that the collection be once a fortnight instead of once a week. Fortunately this idea was not adopted. On 24th September the contract with E. Knifton was renewed for one year at a cost of £3,150 subject to increase of wages or bonus to workers, Council to find the shoot. The price for the previous year was £2,850. At the end of October a Bush Hill Park resident complained to the Local Government Board about the non-collection of dust. The Board forwarded this complaint to my Council for investigation. In December, on the suggestion of the Chief Inspector, the refuse was shot on the Great Eastern Railway's land in Park Road, there to be covered up by clinkers from the camp in Pymmes Park close by. This is not a suitable, nor desirable place for the purpose. WATER SUPPLY. On January 28th, the Council received the report of Councillor W. D. Cornish, their representative, on the Lea Conservancy Board. It reviewed 40 the work up to December 31st, 1918, since his last report for 9 months ended December 31st, 1912, a period of six years. The towing paths, locks, river walks and wharfing have been kept in repair as far as difficulties arising from the war would permit. The Stort navigation is being improved and is now opened up to Sawbridgeworth Lock, 8½ miles from the Lea. Very severe floods occurred in the Lea Valley during the winter 1917-18. 866 samples of river water or effluent have been examined of which 156 were excellent, 227 good, 344 fair, 81 bad and 58 very bad. Twenty pollution notices were served in the six years under the Boards special Acts and one under the Rivers Pollution Act. The next elections to the Board take place in March, 1919. 41 SECTION IV. HOUSING AND TOWN PLANNING. Buildings. 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, glass and other materials. No prosecution for contraventions of the building bye-law 113 have taken place since 1907. 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, and no deputy has been appointed. Sir Alfred Warren, our first M.P., has stated that "the houses to be built in the future must be much better than many houses now in Edmonton. There has been a bit of jerry-building going on here." I am glad to note that I shall have his support in reforming house conditions in this area. 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. 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. The widening of Angel Road at the front of Eley's land where the Government erected a large factory for making munitions of war, was a matter under consideration from the beginning of 1918. The estimated cost was £1,667, of which the County Council promises one-third and the Road Board agreed to advance the two-thirds free of interest and repayable in five equal yearly sums. In February the Council sealed an agreement with Elliott's Trustees which secured strips of land for widening Church Street between Little Bury Street and Bush Hill Road. Notices were given about March under Public Health Acts (Amendment Act), 1890, Section 41, about 51 streets which had been made up under the Public Health Act, 1875, and notices of adoption were posted up in 11 streets which had been made up under the Private Street Works Act, 1892. Thus the total length of over seven miles has been added to the roads kept under repair by the Council. 42 In March the attention of the County Council was called to the damage created by the heavy traffic over Pickett's Lock Lane to the Leaside Munition Works, which was estimated to cost £2,030 to repair. The road surface over Angel Road Bridge suffered even more so. A service of motor busses was arranged by the War Transport Department of the Government from Fore Street down Angel Road to carry munition workers to the factories. On May 18th the Council authorised our Engineer to carry out works to strengthen two bridges at Ponders End in the Enfield Urban District for the Government at the request of the Road Board. HOUSING AFTER THE WAR. A conference for authorities within 30 miles of Charing Cross, organised by the National Housing and Town Planning Council, was held on 14th and 15th March, at Caxton Hall, Westminster. The Chairman of the Committee and our Engineer attended on behalf of the Council. I was present on behalf of the Society of Medical Officers of Health. The meeting was addressed by Mr. Hayes Fisher, the President of the Local Government Board, who foretold financial assistance from the State. The following resolutions were carried:— (a) "To urge all Local Authorities in Greater London with suitable land in their areas, to enter upon the preparation of housing schemes, and (b) "Also to urge the London County Council to use with vigour their supplemental powers to buy land and prepare housing schemes for the building of houses outside the area of the County of London, wherever it can be shown to the satisfaction of the Local Government Board and the London County Council, that, in the interest of London as a whole, such action should be taken." On 9th July the Chairman of the Committee and of the Council, with the Architect and the Engineer were appointed to represent Edmonton on a Housing and Town Planning Advisory Committee for Greater London and the Home Counties, which met on July 26th. This was organised by the National Housing and Town Planning Council. On 27th August our Engineer presented a report announcing that an Executive Committee had been appointed of 27 members, and that Edmonton had secured a seat out of nine as representing Urban District Councils. The work of this Committee is to organise co-operation between Local Sanitary Authorities, to direct and concentrate their views on post-war housing, especially as regards finance, and to unite in representations to the Government on important issues, e.g., the terms on which the Government in a recent circular offered financial assistance. Mr. Brown expressed his emphatic opinion that the housing of London and Greater London should be treated as an indivisable unit with the co-operation of the London County Council and other County Councils concerned, and that the balance of cost (after receiving the Government subsidy) should be borne by the County rates. The conference appointed a deputation to interview the President of the Local Government Board. 43 A conference on '29th June, organised by the Labour Housing Association, was attended by Councillor Barrass and our Architect. It considered the Government proposals of financial assistance and the alternative of loans free of interest, also the taxation of site values. Our Engineer and Architect attended a conference convened by the London County Council on 30th October at Spring Gardens, S.W., and in November presented a report showing that one resolution had been carried nem. con.:— "That it is desirable that all the Local Authorities of Greater London should work together in carrying out, as a co-ordinated whole, any schemes that have been, or may be, adopted by such authorities"; and, further, "that this conference, representative of all housing authorities in and around London, within a radius of 15 miles, desires to urge upon His Majesty's Government the prime importance of (I.) applying to all buildings erected under Parts I., II., and III. of the Housing of the Working Classes Act, 1890, the financial assistance mentioned in the Local Government Board circular of the 18th March, 1918, and (II.) passing the long promised legislation for accelerating and cheapening the acquisition of slum property." The Middlesex County Council arranged a conference of local authorities for 22nd November, when this resolution was passed:—"That the area of London and Greater London within fifteen miles of Charing Cross or thereabouts, should form a unit with a single Authority for housing purposes, and a proportion of the cost thereof charged upon that area." The Engineer and Architect attended a meeting of the North Eastern section at the Middlesex County Guildhall on 28th November. In December our Public Health Committee advised "that the Local Government Board be urged to take the necessary steps to release labour and materials as soon as possible for repairing and renovating property which, owing to the war, had got into a bad condition." OUR HOUSING AND TOWN PLANNING COMMITTEE. On December 9th the Housing and Town Planning Committee held their only meeting during 1918, at which Councillor Cadman was re-appointed Chairman, and the circular of the Local Government Board of 14th November was considered. To the five questions from the Government, the following answers were made (which I quote from our minutes without any acceptance of responsibility for their literary? form, or all their meaning.):— 1. Q.—Are the Local Authority prepared to provide any necessary houses for the working classes for their district, so far as not otherwise provided, at an early date? A.—In view of the fact that it is thought desirable by the major portion of Greater London that a Single Housing Authority should undertake the whole of the work for the housing of the workers of London, this Authority are not prepaired to build any houses in this district until some definite decision is arrived at. 44 2. Q.—Are they prepared to do so on the terms set out in the Board's circular of the 18th March last? A.—This Council have fully considered the Board's circular letter of 18th March last, and as the question of finance is not so much a matter of the building of the houses as the administration thereof, this Council are not prepared to build a number of small houses in this district which would become a very heavy burden, and one to which the London County Council and the Middlesex County Council do not contribute with reference to the Education Rate, which at the present time is 2s. 9½d. in the £, and would thereby be very much increased, as this is one of the poorest Urban District Councils in England, taking into consideration the rateable value with the population, and we somewhat hesitate to launch upon a huge scheme without some definite ruling as to the equalization of rates. [What is the real meaning of this long and involved sentence? I know not.] 3. Q.—When will their schemes be ready for submission to the Board with the particulars asked for in the circular above referred to, and for how many houses will they provide? A.—The answer to this question is governed by the answers to questions Nos. 1 and 2. 4. Q.—Have the necessary sites been (a) selected; (b) acquired? A.—As No. 3. 5. Q.—Is there any work such as the development of the housing sites and the construction of roads, sewers, etc., which can be put in hand immediately when demobilization begins, without waiting for the final approval of the plans of the houses? A.—As No. 3. A Latin scholar would describe this attitude as "non possumus." In March the Public Health Committee were informed of the views of the Bishop of Willesden as regards the houses in the eastern end of Bridport Road. They were not laudatory, or flattering to the Council. In the same month the Council refused an offer of 8 acres of land off Cavendish Road at £330 per acre, and wrote off as irrecoverable a debt of £72 odd due from Mrs. E. Toplis for repair to 52, 54, and 68, West Street. PorlockRoad. I referred to the proposal to build houses here in my Annual) Report of 1916. The plan No. 3,177 was submitted in September, 1916, for the erection of 29 houses at rates of no less than 24 to the acre, i.e., double the maximum number now permitted by the Local Government Board. In April our Architect (Mr. H. W. Dobb) reported that six houses had been built in Porlock Road, and he reminded the Plans Committee " that nowhere in the bylaws, nor in any Local Government Act, is it incumbent upon a builder to await the approval of the Local Authority to the deposited plans before commencing the erection of such buildings!" 45 The Edmonton Co-operative Society is thinking of developing a small area at Langhedge Lane for houses and small workshops, and in October the Society's attention was drawn to the relations of their property to the proposed North Circular arterial road. Dated October, 1917, a memorandum of the Advisory Housing Panel of the Ministry of Reconstruction was published about August, 1918 During December I received (1) from the Ministry of Reconstruction an Interim Report on Public Utility Societies by the Housing (Finańcial Assistance) Committee; (2) from the Local Government Board, a Report of the Departmental Committee with 23 recommendations, mostly of a highly technical character affecting building bye-laws. Almost everyone of the recommendations of the latter involves legislation to give them effect; and we must not forget that there was no M.O.H. on the Committee. Verbum sap. sat. 46 SECTION V. LEGISLATION OF 1918. Acts, Circulars, Orders, Regulations, etc. 1.—Public Health (Notification of Infectious Disease) Regulations, 1918. These regulations, dated January 19th, were accompanied by a circular of same date. They came into force on March 1st, 1918. Two forms for notification by medical praotitioners are presented, one for use in the Metropolis and the other in the provinces. These forms are to be used for all forms of infectious disease. I circularised the midwives and medical practitioners thereon. The notification by midwives under the Ophthalmia Neonatorum Regulations, 1914, remains as heretofore. It is permitted (with a view to economy) that the stock of old forms should be used up. 2.—Representation of the People Act, 1918. In February, the Clerk submitted this Act to the Council, together with the circular of the Local Government Board of 16th February. Within one month of the passing of the Act (sections 31 and 39) the Council had to put its terms into effect. The Clerk was instructed to prepare a scheme, which he submitted on March 1st, to a special meeting, and as revised to one on the 6th. On the 26th March, 10 polling districts were agreed to and polling places. By a letter of April 6th, the Local Government Board fixed a scale of registration expenses. 3.—Poor Law. In April I drew attention to the report on the Poor Law by the Local Government Committee of the Ministry of Reconstruction, dated 17th January, 1918. It advised the transfer of the functions of poor-law authorities in England and Wales to the larger Public Health Authorities, e.g., County, County Borough and District Councils of areas with over 50,000 inhabitants. 4.—Blind. In response to a circular of the Local Government Board which defined blind people as "All those too blind to perform work for which eyesight is essential," my Council, in April, advertised for such persons in the "Tottenham Herald." Forms of particulars, when filled in, would form a register for the information of the Board who were considering what can best be done for these unfortunate persons. Strange to say, I only received one application ! 5.—Public Health (Tuberculosis) Regulations, 1918 (No, 1). with circular of same date, 4th July. This Order of the Local Government Board met the alterations in the age limits of males liable for military service and rescinds the orders of 1916 and 1917. 47 6. Public Health (Tuberculosis) Regulations, 1918 (No. 2), Dated 6th September with circular of the 9th, provided for the notification of cases to me by the Chairmen of the National Service Boards, who receive a fee of one shilling for each case, unless the notifier is in H.M. Forces. 7.—Ministry of Health, This matter was brought before us on the 4th December by the Urban District Councils' Association, but no action was advised by the Public Health Committee. The Association protested against the proposed Bill of the National Insurance Committee and supported the proposal to make the present Local Government Board the basis of the New Ministry. The Association welcomed the coming Maternity and Child Welfare Act. 8. The Public Health (Acute Encephalitis Lethargica and Acute Polio-Encephalitis) Regulations, 1918. This Order of the Local Government Board dated the Nth December, 1918, came into force the 1st day of Janaury, 1919, for one year, during which the notification of this disease will be compulsory. Accompanying the Order was a circular of the 18th December. A Government report thereon is also forthcoming later. N.B.—Acute polio-myelitis became notifiable in 1912. 9.—Midwives Act, 1918. came into operation on January 1st, 1919, so that I shall reserve my observations thereon to my next report. 10 and 11.—Public Health (Influenza) Regulations (No, 1), 18th Nov,, and (No. 2), 22nd Nov, See "Influenza" section. 12 and 13.—Education Act, 1918—Maternity and Child Welfare Act, 1918. These I shall deal with fully in my report for 1919 in the light of some experience in their application. The pamphlet of the Local Goverment Board, 9th August, embodies their views on the latter subject up to date. 14. The Milk (Mothers and Children) Order. Dated 8th February, 1918, made by the Food Controller under D.O.R.A. It provides that the Council may, and (when required by the Ministry of Health) shall supply food and milk to expectant and nursing mothers and milk to children under 5 years old. The cases to be selected by the Medical Officer of Health. In May a Committee, appointed by the Food Controller, recommended that the Government should assume direct control of the wholesalers. 48 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. My Chief Inspector (Mr. Butland) reports to me as follows:—"The number of inspections of factories (apart from those of the Women Inspectors), is 37, and the number of workshops inspected is 32, but we found on our visits that a great deal of work had been done in the way of putting up buildings, drainage, etc., without any notice to the sanitary authority. "However, we have called attention to the main work, i.e., of keeping the lavatories clean, ventilation and overcrowding, and the factory people seemed quite anxious to carry out the work we asked them to do. "The usual periodical inspections were made, and complaints attended to, and everything was done to keep pace with the general work, as far as we could under the existing conditions. "The following notices were served:— Intimation notices 510 Notices in connection with infectious disease 165 Final notices 16 Total 691 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 Amendment Act, 1907, as keeper for one year from February, 1918. 3.—Houses Let in Lodgings. The bye-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. Slaughterhouses. There are five on the register, one on the old 49 terms. In January the licence of N. A. Barrett, of 188, Fore Street, was renewed for another three years. In April the licences of Howes, 19, The Green, and Chester, 3, The Green, were granted for one year. In May the licence of E. Knifton's slaughterhouse was renewed for a year. 5.—Pigs. An order of the Privy Council of the 11th May amended the D.O.R.A. regulations, 1914, by which it was made lawful to keep pigs (for 5 years) irrespective of the distance from a street or public place, providing the Local Sanitary Authority agrees; also every authority is empowered to itself establish and conduct piggeries. It was decided in September not to keep pigs on our sewage farm. Owing to these alterations of the law, the Public Health Committee consented to the erection of pig-styes at 7, Raynham Avenue, 27, Rays Road, (bottom of) Lowden Road, 12', Pretoria Road, Hazlebury Road (Church Street end), 98, Hertford Road and "Glenbrook," Angel Place; the Plans Committee also agreed to pig styes being erected at 60, Lyndhurst Road. The two styes at the rear of 226, Fore Street have been removed. 6.—Dairies, Cowsheds, and Milkshops. There are only two cowkeepers now in the district, the same as the last three years; and about 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 Council. There were 94 purveyors of milk in our register at the end of the year. As regards letters in April from the Workers' Union and the local Food Vigilance Committee, the Public Health Committee advised a reply that in view of the fact that the Ministry of Food was making arrangements for the distribution of milk in the locality, the moment was inopportune for the Council to intervene and the writers were referred to the milk department of the Ministry. In June the agreement for a temporary building at the rear of 17, The Green, was renewed to Mr. Elms until six months after the conclusion of the war. At the Trade Union Congress, on September 3rd, a resolution was unanimously adopted, declaring that the national control of milk should be made absolute at the earliest possible moment, and that the whole supply and distribution of milk should be nationally owned and managed. Mr. Stewart Bunning, in moving the resolution on behalf of the Parliamentary Committee, said that the Consumer's Council had been told that milk prices must go up and milk supplies decrease; under the present system it was impossible to ensure for children cheap, sufficient, or anything like pure milk. 7.—Unsound Food. In March, the tuberculous organs of an ox were surrendered from a slaughterhouse. In May, both unsound meat and fish came into our possession. In July, two carcases of beef were found diseased at slaughterhouses. Also in July, seven trucks of mutton carcases arrived during this torrid month at Angel Road station. I understand that the carcases had been salved from a torpedoed steamer, and were on their way to 50 a fat factory at Chingford. We received several complaints from factories and house-holders in this neighbourhood as to offensive smells, so we made every effort to get the mutton unloaded as quickly as possible 8.—Offensive Trades. 9. Marine Stores. 10. Bakehouses. 11. Knackers. Nothing of importance with reference to these transpired during the year, and the limitations of space and cost prevent me extending my report. 51 TABLE I. Vital Statistics of Whole District during 1918 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. Number registered here. Nett. 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. Number Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 Out. 8 In. 9 10 11 12 13 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 1915 69,774 1,694 1,666 23.88 1,227 17.45 543 136 186 111.64 817 11.71 1916 71,396 1,689 1,633 22.87 1,009 14.04 405 122 142 86.96 726 10.17 1917 72,974 1,376 1,328 18.20 947 12.86 390 136 115 86.59 693 9.50 1918 74,330 1,248 1,196 16.09 1,141 15.23 406 170 96 80.03 905 12.18 Notes.—This table is arranged to show both the gross births and deaths in the district, and the births and deaths properly belonging to it with the corresponding rates. The rates in column 7 are calculated per 1,000 of the gross population. In this district, in which large Public Institutions for the sick and infirm seriously affect the statistics, the rates in columns 5 and 13 are calculated on a nett population, obtained by deducting from the gross population the average number of inmates not belonging to the district, in such institutions. The rate in column 11 is calculated on the nett births. *In column 6 are included the whole of the deaths registered during the year as having actually occurred within the district, but excluding the deaths of soldiers and sailors that have occurred in our hospital, in the two camps, or of residents, due to the war. 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. 52 TABLE II—All Cases of Infectious Disease notified during the year 1918. (Excluding Military). Notifiable Disease. Number of Cases Notified. Total cases notified in each Ward or Institution. Total Cases Removed to Hospitals. At all ages At Ages—Years. Bury Street Ward. Church Street Ward. Fore Street Ward. Residents Edmonton Infirmary. Total Residents. Others in Edmonton Infirmary. Epileptic Colony. Under 1 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards 1 2 3 4 5 6 7 Diphtheria (including Membranous croup) 37 .. 14 17 3 3 .. .. 5 10 22 .. 37 .. .. 32 Erysipelas 34 .. 1 3 6 11 9 4 21 8 5 .. 34 .. .. .. Scarlet Fever 87 .. 19 60 6 2 .. .. 15 32 38 1 86 1 .. 78 Enteric Fever 5 .. 1 2 2 .. .. .. .. 4 1 .. 5 .. .. 4 Puerperal Fever 2 .. .. .. 1 1 .. .. .. .. 1 .. 1 *1 .. .. Cerebro-spinal Fever 1 .. 1 .. .. .. .. .. .. 1 .. 1 .. .. .. Poliomyelitis None .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 7 7 .. .. .. .. .. .. 4 2 1 .. 7 .. .. .. Pulmonary Tuberculosis Other forms of „ See Woman Inspector's Report. Measles F 448 29 224 181 11 3 .. .. 108 229 111 .. 448 .. .. .. G 29 5 8 11 7 .. .. .. 2 13 13 .. 28 1 .. .. Chicken Pox(for 3 mths.) 79 4 22 52 .. 1 .. .. 45 20 14 .. 79 .. .. .. Totals *Treated in the Infirmary.†Also 75 cases notified by parents. The figures take account of any corrections made as a result of error in notification, or revision of diagnosis as a result of the further course of the disease. Isolation Hospitals 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 Minims 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. 53 TABLE III. -Causes of, and Ages at Death during the year 1918. Classified by age and cause (excluding Military). Causes of Death. Class. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the district. Total deaths of Non-residents "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. Foreign Total. M.A.B. Infy. Enteric Fever 1 2 .. .. 1 1 .. .. .. .. .. .. .. Malaria 4 1 .. .. .. .. .. 1 .. .. .. .. .. Small Pox 5 .. .. .. .. .. .. .. .. .. .. .. .. Measles 6 7 1 5 .. 1 .. .. .. .. .. .. .. Scarlet Fever 7 1 .. .. .. 1 .. .. .. .. .. .. .. Whooping Cough . 8 14 4 4 6 .. .. .. .. .. .. .. .. Diphtheria & Croup 9a 5 .. .. 1 3 1 .. .. .. .. .. Influenza 10 218 3 10 24 19 27 91 26 18 9 49 58 Dysentery 14 4 .. .. .. .. .. 1 3 .. .. .. .. Erysipelas 18 3 .. .. .. .. 1 2 .. .. .. .. .. Phthisis (Pul. Tub. 28a. b 69 .. .. .. 3 1 1 38 15 2 1 28 29 —29a Tub. Meningitis 30 7 1 1 .. 4 .. 1 .. .. .. 1 1 Other Tuberculous Diseases 29b, 31 —35 13 .. 1 3 5 3 1 .. .. .. 3 3 Cancer, malignant disease 39—45 52 .. .. .. .. .. 6 27 19 .. 50 50 Rheumatic Fever . 47 2 .. .. .. .. .. .. 1 1 .. .. .. Meningitis 61 6 .. 1 1 2 1 .. 1 .. 1 i Org. Heart Disease 79 71 .. 1 .. 2 1 .. 17 42 1 56 57 Bronchitis 89—90 48 4 2 1 .. .. .. 5 34 1 16 17 Pneumonia (all forms) 91—92 105 19 24 13 9 4 11 14 11 .. 8 8 Other diseases of respiratory organ 86—88 93—98 7 .. 1 1 .. .. 1 .. 4 .. 2 2 Diarrhoea and Enteritis 104—105 17 12 1 1 1 2 3 3 Appendicitis and Typhlitis 108 7 .. .. .. 3 2 1 1 .. .. .. .. Cirrhosis of Liver . 113 2 .. .. .. .. .. .. 1 1 1 .. 1 Alcoholism 56 .. .. .. .. .. .. .. .. .. .. .. Nephritis and Bright's Disease. 119—120 15 .. .. 1 1 .. 1 9 3 .. 14 14 Puerperal Fever 137 .. .. .. .. .. .. .. .. .. .. 1 1 Other accidents anc diseases of Preg nancy 135—6 .. .. .. .. .. .. .. .. .. .. .. .. Ditto, Parturition 138—141 .. .. .. .. .. .. .. .. .. .. .. .. Infantile Diseases . 151—3 19 18 .. 1 .. .. .. .. .. .. 5 5 Congenital Disease 150 7 3 1 1 2 .. .. .. .. .. 1 1 Premature Birth 151a 25 25 .. .. .. .. .. .. .. .. 2 2 Violent Deaths, ex eluding Suicide . 164—186 20 1 .. .. 3 1 5 6 4 .. 7 7 Suicide 155—163 3 .. .. .. .. .. 3 .. .. .. .. .. Other Defined Diseases - 152 5 2 2 7 5 15 (iv.) 32 (iv.) 84 15 121 136 Diseases ill-defined or unknown 187—189 3 .. 1 .. .. .. .. .. 2 .. .. .. Totals .. - 905 96 55 57 67 57 188 160 225 28 368 396 Ten deaths of non-residents, not in institutions of Edmonton, are not included in this table. Two vagrants are in table marked V. SUB-ENTRIES included in above table Cerebro-spinal Fever, 61 A One. Acute Poliomyelitis None. 55 EDMONTON URBAN DISTRICT COUNCIL. REPORT For the YEAR 1918 of the Chief Sanitary Inspector Public Health Department, Town Hall, Edmonton, N. 9. To the Chairman and Members of the Edmonton Urban District Council. Mr. Chairman, Mrs. Benjafield and Gentlemen, I have the honour to present to you my Report oil the work carried out by your Sanitary Inspectors and staff during the year 1918. The work of the year has been very arduous with a depleted staff, and the difficult task of getting even the most important work done was very trying. I earnestly hope that the coming year will enable us to get some of the projierty into something like a decent state of repair, for the conditions in some instances are appalling. The laws of Public Health become more and more complex, and the need for consolidation and amendment is more felt. Especially does it apply to that ever vexed question of what is, or is not, a " sewer," although a great deal has been done in the reconstruction of old sewers and combined drains in the past by the Council, and by owners, at the present legal difficulties are continually cropping up. The Council may be legally liable in some cases, but in the majority it is morally the owner's liability, and I hope ere long the question will be definitely settled. Perhaps the proposed new Ministry of Health will, amongst other things, help us in this direction REMOVAL OF PATIENTS TO HOSPITAL, AND DISINFECTIONS. This year records the first motor vehicle to be adopted by the Council, i.e., an ambulance for the removal of patients to hospital, and although the Council did not purchase a new motor ambulance, but had one of their old 56 horse-drawn ambulance bodies fitted to a second-hand motor chassis, it is certainly an improvement and a step in the right direction. But if we are to continue the motor ambulance service, it will be necessary to have another motor ambulance, as it often happens that something goes wrong when the vehicle is most needed. Better still would it be for the Joint Hospital Board to take over the ambulance work entirely, as far as the removal of patients to hospital is concerned. The Council might then adopt a motor brougham for conveying the patients from the hospital to their homes after convalescence, and also adopt motor bedding vans, and so do away entirely with the present horse-drawn vehicles. The motor ambulance was delivered on September 18th, 1918, and the first case was removed to hospital, in this ambulance two days later, 20th September; compared with the horse-drawn vehicle it is certainly more expeditious. I herewith append a statement of the work carried out in connection with infectious disease:— No. of journeys of motor ambulance to remove patients to Hospital, Winchmore Hill 38 No. of journeys by horse-drawn ambulance to hospital 138 No. of journeys of bedding van to remove infected bedding 298 No. of journeys of bedding van to return bedding 280 No. of journeys of brougham to fetch patients from hospital 1,109 No. of patients returned to their homes from hospital by brougham 127 No. of rooms disinfected after infectious disea.se 216 No. of articles of bedding, etc., disinfected 3,404 No. of books disinfected 30 No. of articles of bedding destroyed 37 No. of rooms disinfected after phthisis 185 No. of articles of bedding, etc., disinfected after phthisis 928 No. of articles of bedding, etc., destroyed after phthisis 58 No. of rooms disinfected for venninous bedding and vermin 12 No. of blankets, etc., disinfected at the request of the military authorities 1,101 The library, all day schools, and Sunday schools were disinfected. ERYSIPELAS. Isolation and Nursing of Patients. During the year nine cases were treated at their homes by a qualified nurse, the Council not having a hospital for the treatment of such cases. The cost of nursing was £30 4s. 10d. 57 MORTUARY. The Council's mortuary consists of a post-mortem room and an ante-room for the medical practitioners, also two mortuary chambers, one kept for infectious bodies and one for non-infectious bodies. These premises, owing to the war, have been neglected in the matter of repair and paint, and it is now time they were thoroughly renovated and repaired, as some of the wood-work is in a very bad condition. A small additional roof, or a temporary building attached to the mortuary, would be of great service for storing purposes, as, at the present time, the mortuary shells and requisites are often in the way when many bodies have to be accommodated. Owing to the severe influenza epidemic, I visited the undertakers in the district from time to time, with a view to ascertaining what burials they had in hand. Difficulties did occur in many instances, as to when the interments would take place, although the undertakers did their level best to cope with the emergency, and where it was found difficult to expedite matters, every facility was given them to deposit the bodies at the mortuary. A number of houses were visited, and several bodies were found to be decomposing, some coffined, and some uncoffined. Arrangements were made for speedy interment or the bodies removed to the mortuary to await burial, and the rooms were disinfected. During the year 105 bodies were received into the mortuary, 65 inquests were held, and 56 psot-mortems made. Twenty-two bodies were left on deposit by undertakers to await burial, owing to insufficient accommodation at the houses. Twenty-two were left after inquests to await burial for various reasons. Nine were deposited by my order for speedy interment, and 4 were deposited owing to the bodies being of an infectious nature. DUST COLLECTION. The dust collection is still carried out by contract, and during a portion of the year the Contractor had to find his own shoot, and for a time deposited the refuse in another district. However, this he had to discontinue, and finding a difficulty in obtaining a shoot, the Council allowed him to deposit the dust on the Sewage Farm. In December the dust was deposited in the pit on the land belonging to the G.E.R. and adjoining Park Road, and although I should much like to see this pit filled up, as the water lying in the bottom is a favourable breeding ground for the mosquito, it is not a desirable spot on which to shoot house refuse, being too near a Public Park. I therefore trust the time is not far distant when a destructor will be in evidence, or some other method adopted whereby we could do away with a permanent dust shoot, as this refuse creates a happy hunting ground for rats. There is much valuable material on a dust shoot which could be salved and utilised. Screened house refuse, cinders and ashes will be a valuable commodity to those engaged in the brick industry, and considerable quantities of screened house refuse have, in the past, been brought into this district for the purpose of brick-making. 58 For some years a firm engaged a man to pick out the old waste iron and tin-ware found on the dust shoot, and carted it away, paying the Council from 1s. 6d. to 4s. 6d. a ton for this material. The amount collected annuallyexceeded 100 tons, but during the war we were unable to dispose of it, owing to the cost of transit. During the year, we have endeavoured to salve as much as possible, all the old dirty paper on the shoot, rags, bones, glass, etc., have been collected and disposed of. We have no means of weighing this material at the shoot, but I estimate the approximate amount to be at least 40 to 50 tons of paper, and 60 to 70 tons of rags, bones, glass, bottles, etc., per annum. There is now a large quantity of old scrap metal lying on the shoot, which I hope will be disposed of shortly. I have collected by the clean bedding van (when the opportunity occurred) from private shops between two and three tons of clean paper and cardboard, which was sold with the Council's waste paper. There are six vans engaged in collecting the refuse from the various parts of the district, and an additional van occasionally to pick up some of the work left undone. Also a special van for clearing the refuse from the institutions. There are not sufficient vans for a weekly collection. During the year, 198 complaints were received of non-removal, and these with others made by your Inspectors, were all verified and the Contractor notified. PUBLIC LAVATORIES, WATER TROUGHS, AND DRINKING FOUNTAINS. I regret to say that much wilful damage has again been done to the fountains and water troughs, and we have not been able to catch the offenders. There are six water troughs, two with drinking fountains attached. We had 8 separate drinking fountains in all, but 4 have been so damaged (although repaired many times) that they have got beyond repair, so that there are now four drinking fountains in use. The public lavatories, both at Angel Road and the Green continue to be much patronised. The amount collected from Angel Road lavatories during the year was £462 0s. 3d., an increase of £127 18s. 9d. on the previous year. The amount collected from the Green lavatories during the year was £287 19s., an increase of £88 11s. 4d. on the previous year. A public lavatory at the north end of the district is needed, especially in the vicinity of Tramway Avenue. 59 DISINFECTANTS. The public continue to avail themselves of the opportunity generously afforded them by the Council of obtaining disinfectants (powder and fluid). This entails a lot of labour, but no doubt the results are beneficial, if only to encourage cleanliness. The number of applicants during the year was 24,786 (20,228 in 1917). an increase of 4,558 on the previous year. Instructions are given to applicants as to the proper and careful use of the disinfectants, and in many instances, during the course of inspectorial work, we have found the public making good use of them. Besides being distributed to the public generally, disinfectants are also supplied from the department for disinfecting and deodorising house refuse; for the cleansing of street gullies, flushing of sewers, watering roads in hot weather, and for all other purposes required by the Council. DAIRIES, COW SHEDS, AND MILK SHOPS. The number of cowkeepers on the register is 2. The number of cows kept varies from 20 to 30, and these are out to graze during the greater portion of the year. The number of milk-sellers on the register is 94. The whole of these have been inspected from time to time, with a view to seeing that cleanliness is observed; owing to the shortage of milk a great many discontinued selling it. In my opinion, no person should be allowed to sell milk or handle it, except under special conditions, and licenses should be granted from year to year, and renewed only on condition that the licensee had carried on the business to the satisfaction of the authority concerned. New legislation for this, and other matters in connection with the milk supply is badly needed. The warranty defence, and the difficulties of proving adulteration, are all against public good. Sterilisation of all milk, and a good scheme for distribution would tend to reduce adulteration, and give the public a much purer milk. In pre-war days we had between 70 and 80 ice cream vendors in the district, but this business has, up to the present, practically ceased. SLAUGHTER HOUSES AND UNSOUND FOODS. There are at present 5 slaughter-houses in use. One is an old registered slaughter-house, and has been in existence for over 50 years. It is now rarely used for other than killing sheep and pigs. 60 Four are licensed under the Public Health Act Amendment Act, 1890. This Act gives the Council the option of licensing the premises from year to year, to erect a public abbatoir and to discontinue licensing private slaughterhouses. There are two slaughterhouses in the district which have not been used for several years, and before they can again be used for slaughtering, they must obtain a licence from the Council. The periodical lime-washing was carried out, and the premises generally kept in a cleanly condition, and a special effort is made to visit them during the time of slaughtering. In my opinion, it should be compulsory to give notice to the Inspector in all cases when slaughtering is about to take place, as this gives a better opportunity of observing the condition of the animal before the organs and offal are taken away. The number of animals inspected was:— Oxen130 Bulls 2 Cows and Heifers 29 Calves 77 Sheep and Lambs 373 Pigs 470 1,081 The following diseased meat and offal was surrendered during inspection:—10 cwt. 1 qr. 9 lbs. of tubercular beef, 1 pig's head and pluck. We experienced some difficulty in dealing with a quantity of frozen beef, allocated to the district. However, it was carefully examined, and that found to be decomposing, or in any way unfit for human food, was seized. In some cases it was only necessary to cut away certain parts affected, and in one or two instances I advised the butchers to send it back to those who consigned it. During the year, the following foods were examined and destroyed, or otherwise disposed of:—12 cwt. 1 qr. 14 lb. of beef, 5 barrels of herrings, 1 case of herrings, one box of herrings, 12 tins of corned beef, 74 lbs. of cheese, 19 lbs. rashers of bacon, 1 box of bloaters, 1 trunk of whiting, 1 trunk of cod, 7 boxes of mackerel, 2 bags of shrimps, 1 tin of salmon, 2 tins of crab, 1 barrel of crabs. In 46 cases advice was given to purchasers of articles, and where the articles purchased were found to be undergoing a change, or decomposing, the retailers were advised to return the purchase money, or give goods in exchange. Herewith I append a statement of work done under the Sale of Food and 61 Drugs Act, by the Middlesex County Council Inspector for this district, kindly supplied by the Chief of the Weights and Measures Department:— Article. Taken. Adulterated. Milk 68 25 Cocoa 3 — Coffee 3 — Carbonate of soda 1 — 75 25 Number of prosecutions 13 Number of convictions 9 Fines £14 0s. Od. INSPECTIONS AND GENERAL WORK. The sewers and combined drains have received the periodical flushing by the Council's men. The special flushing of the channels in the main road on Saturday mornings, during the hot weather, especially where the costers' barrows stand, was continued. The following is a summary of the work done in connection with the abatement of nuisances :— Inspections of complaint 261 ,, infectious disease 158 „ common lodging house 74 ,, bakehouses 43 ,, milkshops 114 ,, slaughterhouses 326 Total inspections and re-inspections, including secondary visits 10,790 Houses, premises, etc., repaired or cleansed 58 Cisterns covered, cleansed or repaired 19 W.C's. improved, repaired or supplied with water 55 Drains tested or examined 168 Drains unstopped, repaired, trapped, etc 341 Waste pipes, rainwater pipes, repaired 10 Drains reconstructed 4 New soil or vent pipes fixed 12 Existing ditto repaired 4 Chambers inserted 10 Chambers re-sealed 1 Rooms stripped and cleansed after infectious disease 249 New dustbins supplied 54 Overcrowding abated 2 Waste preventors repaired 17 Accumulations, stagnant water, etc 44 Water fittings repaired 37 62 Washhouse floors repaired 5 Roofs, gutters and rain water pipes repaired 90 Water restored to premises 2 Yards paved or repaired 13 Pigs or other animals 17 Water put on main 8 Washhouse coppers repaired 8 GENERAL REMARKS. I sincerely hope that the question of housing will soon be seriously taken up. The defects in some of the old houses are so numerous that they are practically beyond repair, and must eventually be demolished. Under the present circumstances, the closure and demolition must unfortunately be postponed until some suitable accommodation can be provided. There is very little material available for repairing the existing houses, and the cost is excessive. Something should be done to control the price of building material, which, to my mind, is almost as important as the prevention of food profiteering. The bye-laws need revising in many ways, and increased powers given us, such as the keeping of garden fences in repair, amongst others, and penalties for those wilfully destroying them. Some stated period of time should be adopted for the cleansing of the interior of houses. The filthy tenant gets the house done up owing to it becoming a nuisance, while the clean and respectable tenant, who asks for rooms to be cleansed, even after 10 to 15 years' occupation, is often refused. The Order confirmed by the Local Government Board on the 9th May, 1912, with respect to offensive trades, will need the consideration of the Public Health Committee, as the Council in the past, have had little control over the establishing (until a nuisance existed), of the businesses, among others, of rag and bone dealers, fish fryers and fish curers, as hitherto these businesses could be established without application to the Council; now they must get their written consent. It is imperative that persons should not carry on the business of a rag and bone dealer in or near a dwelling house. Fish frying businesses need well ventilated premises, with a large open space at the rear, well paved and drained for fish washing and the storing of fish boxes, when necessary, if it is to be carried on without becoming a nuisance to anyone. Also an up-to-date apparatus for frying so as to effectually consume all fumes and to carry off all smoke. These remarks also apply to fish curers as regards premises and the open space at the rear. The smoke hole should be so situated as not to be near a dwelling house. One man commenced in the fish business, and I found he had sealed up the scullery windows, and was using it for fish curing. However this was soon discontinued. There were also two troublesome men who opened-up the business of rag and bone dealers (Miller and Ditkofsky, from Commercial Road, E.). On 63 making enquiries about these men, I found they were not an adjunct to the district. I then visited the Regional Officer under the National Service Regulations, and acquainted him with the facts. The business was soon closed and I have not seen these men in the district since. It will be necessary to adopt bye-laws to deal with those businesses thar were established previous to the confirmation of the Order. The Shops' Act during the year has been well observed, and the traders generally seem to be agreed that early closing is a benefit. Long and late hours are, I hope, a thing of the past, and it is to be hoped they will never return. The Rag Flock Act. In this district rag ttock is not manufactured, those doing upholstery work and who sell mattresses and other articles containing flock, buy the flock under a guarantee, samples of which I have taken. The mattresses generally are stamped as follows :—"The filling of this article is guaranteed sanitary, having been thoroughly washed, and is of the standard of cleanliness required by the Local Government Board Regulations." Pig keeping by allotment holders did not expand to the extent I anticipated, no doubt this was partly due to the price of meal. The pigs generally were kept in a very clean condition. Gipsies. These nomads, towards the end of the year, began to give us a deal of trouble, especially a party of French and Swiss gipsies, who were much overcrowded and filthy. We were continually moving them, but they soon returned; however, at last I had to take proceedings against them, but they cleared off just before the summons was served. Canal Boats. There were II registered boats inspected during the year, and only one contravention found, i.e., a defective cabin top. This has since been remedied. The tendency is to discontinue the using of boats as dwellings, and year by year the number of registered boats decreases. Although there has been very great traffic on the river during the year, the boats seen were generally those doing work for the Government. The canal boats work could be more efficiently performed by an officer having control of the whole of the waterway. Frequently I spend many hours waiting for boats without any good results. The rat nuisance received much attention. We laid down a large quantity of various poisons, also a quantity of virus, and from my own observations a great number of rats have been destroyed. To keep these pests down it will be necessary to continue the operation, for if only a few are left, it is not long before the place becomes again infested. It gives me much pleasure to express my appreciation of the valuable assistance given me by Mr. Winter, and the hearty co-operation of the female inspectors and clerical staff, in the carrying out of the work of the Department through another trying year. 64 I also desire to thank the Chairman and Members of my Committee fo their kind consideration and support. I have the honour to be, Mrs. Benjafield and Gentlemen, Your obedient Servant, RICHARD JOHN BUTLAND. 1 ANNUAL REPORT for 1918. II. On the Health of the Scholars in the Urban District of Edmonton. SIDNEY C. LAWRENCE, School Medical Officer. 2 VACANT. TEMPORARY OFFICERS: Deputy and Assistant School Medical Officer; 2 R. H. STRONG, School Medical Inspector. (Since February 1st, 1915). Assistant School Medical Officer; 3. A. A. WILLIAMS, School Medical Inspector. 1st School Nurse. 4 (Mrs.) J. A. HOBBS, 2nd School Nurse (since September 2nd). 5 tHAROLD DYER. School Medical Clerk. 5 None. † Still away in H.M. Army. 2 EDMONTON EDUCATION COMMITTEE. REPORT of the School Medical Officer for the year ended December 31st, 1918. Town Hali., Edmonton, N. 9. To the Chairman and Members. Ladies and Gentlemen, I herewith submit my seventh Annual Keport. Dr. K. H. Strong continued acting as School Medical Inspector throughout 1918, and again his work was made more difficult by the absence of the permanent School Nurse for some months. The Education Act of 1918, and the establishment of a School Clinic, will bring more work and responsibility of administration on me, your School Medical Officer, and it is probable that one-sixth of my time will not suffice for carrying out my old and new duties. This can easily be arranged for, if I am relieved of the routine executive work as M.O.H. by the appointment of an Assistant Medical Officer of Health. I am drawing my Council's attention to this point in my first preface to this volume. In April Mr. E. 0. Taylor of St. Helen's, Lanes, was appointed to succeed Mr. Arthur Heap as Secretary. Since then two standing sub committees have been formed:—(l) The School Management and (2) The Finance. Time will show the value, or otherwise, of these additional meetings. Sir George Newman, Chief Medical Officer at the Board of Education, in his report for 1917, said " The School Medical Service should not be regarded only as an agency Super-imposed on other agencies for the public benefit. It is not concerned merely with picking out the noticeable defects and ailments of school children, and remedying or mitigating them ; it is concerned to watch over the normal as well as the abnormal growth of children and neutralise, as far as possible, the obstacles of environment, constitution and habits which impede natural growth." Rate per thousand inhabitants. The births numbered 1862 in 1913 27'98 1196 in 1918 16'09 666 less. 11'89 less. The effect of this terrible lowering of the birthrate will, from now onwards, be seen in the diminishing number of scholars entering school at the age of five years. The number will be smaller and smaller until September, 1924. This fact must be borne in mind, when making calculations about new developments in the immediate future. I am, Ladies and Gentlemen Your obedient Servant, 25th August, 1919. SIDNEY C. LAWRENCE, School Medical Officer. 3 THE SCHOOLS OF EDMONTON. (17 in Number). Public Elementary Schools 11 Secondary Schools 1 Private Schools 5 The Belgian School in St. Aldhelms' Church Hall was closed in March. 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 Headmaster is Mr. R. A. Ashworth, B.A., Lond. Its remarkable success will necessitate considerable extension of its accommodation at an early date. A precept of £50 for higher education was issued by the Council on the Overseers in April, and of £50 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 two ladies as co-opted members, one of whom, Miss Seward, is a Head-mistress. Since July, 1908, no children under five 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 Council to provide accommodation for 81 scholars from this neighbourhood at the nearest Enfield School, but there was an average attendance of 249 this year. No Edmonton scholars under five years of age are now admitted. Baths. The elder children are taken from the schools to learn swimming once a week in the summer months. During the past winter, 1918-19, 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 1917, 1916 and 1915, nothing has been done beyond the ordinary repairs necessary to keep the buildings in good order. 4 ACCOMMODATION AND ATTENDANCE I have extracted the following interesting information from the Committee's year book for 1919-20. There was none issusd for 1916-17 or 1917-18. Council Schools. Nonprovided Schools. Totals. Accommodation—March, 1919 12122 2183 14305 1916-17 No. of scholars on rolls 10899 2240 13139 Average attendance 9796 1992 11788 1917-18 No. of scholars on rolls 10485 2225 12710 Average attendance 8909 1941 10850 1918-19 No. of scholars on rolls 10217 2233 12450 Average attendance 8909 1941 10850 Details of each School for Year ending 28th February, 1919. Council Schools. Accommodation. Average Attendance. Boys. Girls. Junr. Mixed Infts. Boys. Girls. Junr. Mixed Infts. Ravnham Road 660 540 600 576 441 379 382 373 Brettenham Road 459 398 - 437 347 324 - 245 Silver Street 592 562 — 562 437 453 — 354 Montagu Road 300 300 300 460 236 222 243 298 Croyland Road 537 369 420 369 413 266 308 252 Eldon Road 660 540 521 600 510 423 455 465 Houndsfield Road 300 300 300 460 252 252 284 295 Total 3508 3009 2141 3464 2636 2319 1672 2282 Non-provided Schools. Accommodation. Average Attendance. Boys. Girls. Senr. Mixed Infts. Boys. Girls. Senr. Mixed Infts. St. James' 218 207 - 220 218 195 - 191 All Saints' — 455 - 447 - 426 - 352 Latymer Elementary 300 — - - 286 - — _ St. Edmund's R.C. — — 248 88 — - 213 60 Total 518 662 248 755 504 621 213 603 Grand Total 4026 3671 2389 4219 3140 2940 1885 2885 There were 12,710 children on the books for the year ending 28th February, 1918, besides the children attending Enfield Schools; the average number of 5 children of the Edmonton district attending Enfield schools during the year was 249, so that there is in Edmonton one child in the public elementary schools for 5.7 inhabitants (reckoned on the nett population) ; it was 5.5 last year. There were 174 less children attending school than last year, and 731 less than in 1915. 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 79; it was 124 last year. Expenses. Five precepts in March for £14,950 for elementary and £50 for secondary education ; four precepts in October for £18,633 for elementary and £50 for higher education, in all for £33,683, were served on the Overseers to meet the requirements of public education for the year ending March 31st, 1919 ; the amount last year was £25,130. Besides, a very large necessitous grant has been received from a sympathetic Government, amounting to £47,850or about a four-shilling rate ; compare this with £16,375 (a nineteen-penny rate) for 1914-15-16-17, and with £9,216 for 1913, which was equal to only an eleven, penny rate. At the Council meeting in October, it was suggested that when submitting future estimates, particulars of receipts and expenditure under the various heads should be furnished by the Education Committee. On 4th February a special Council meeting was held at the request of Councillors Rowe, Elms, and Shortland, to consider the resolution of Councillor Geo. Rowe :—" That so much of the resolution passed by the Council on 26th day of April, 1904 as purports to delegate to the Education Committee the powers of the Council under the Education Act, 1902 be rescinded." It was seconded by Councillor Sorrell. On being put to the meeting no one supported the resolution, not even the proposer ! In April the Council resolved that, owing to the heavy rates for elementary education, it is impossible for Edmonton to bear the burden of secondary education. On 28th May the Council resolved that " The Works and General Purposes Committee be instructed to consider the advisability of making bye laws for regulating the employment of children and for the regulation of street trading by persons under the age of 16, under Sections 1 and 2 of the Employment of Children Act, 1903, and to report thereon to the Council." In June this Committee appointed a Sub-Committee to draft the bye-laws under the Employment of Children Act, 1903, for regulating the employment of children in Edmonton. However by December, the Education Act, 1918 had transferred the subject to the Education Committee. In December the Education Committee asked the Council for one of the two huts (left in Pymmes Park by the Military) for urgent educational purposes. The Park Committee recommended that the application be not entertained, but the matter was referred back to the Park Committee for re-consideration. 6 SCHOOL NURSES. During the Easter holidays, Miss A. A. C. Williams, 1st School Nurse, met with a severe accident. Steps were taken as soon as possible to find a deputy, and Mrs. Sloper, a fully trained nurse and midwife, began duty on 22nd April. Miss Williams was not able to resume until August 31st. 2nd School Nurse. In April the Education Committee asked the Council to join them in appointing a woman officer to combine the duties of School Nurse and Woman Sanitary Inspector. This was agreed to in May, and that such post should be filled at the same salary and allowances as Miss Williams, half to be paid by each body. Mrs. J.A. Hobbs commenced duty on September 2nd, as 2nd School Nurse and 5th Woman Inspector. She was not unacquainted with our area and its parents and children, as she acted as Temporary School Nurse from February 1915 to the end of July 1916. This Officer works equally for both the Public Health and Education Committees, and fills the useful post I referred to in my Annual Reports for 1915 and 1916, i.e., a Woman Officer to visit the homes of scholars absent from school for infectious, contagious, verminous, or minor ailments. Before the end of 1918 it was fully demonstrated that great moral and material results were being obtained by this " following up" officer. ARRANGEMENTS FOR AND SCOPE OF ROUTINE MEDICAL INSPECTION. Three age-groups have been inspected, the entrants (the majority of whom were 5 or 6 years of age), the 8-year-old group, and the leavers. Five Thousand Three Hundred and Forty-five children were passed through the routine inspection. TABLE I. Of the Board of Education. The ages and numbers of children inspected were as follows :— Ages. Entrants. Totals 8 year oldgrp Leavers. Totals Grand Totals 5 6 7 12 13 and over. Boys 689 116 25 830 685 560 640 1200 2715 Girls 664 119 26 809 625 586 610 1196 2630 Totals 1353 235 51 1639 1310 1146 1250 2396 5345 7 Re-inspection at the schools, immediately following the routine, 137 boys and 150 girls. The parents were present with 1,119, or 40.8 per cent., of the boys inspected and 1,187, or 45.1 per cent., of the girls. There were objections to medical inspection of 6 boys and 10 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 1,962—960 boys and 1,002 girls, compared with 1,343 and 1,488 in 1917. SPECIALLY REFERRED CENTRE. The room in use is the same ill-adapted one at the Education Office as in the three previous years. Tuesday afternoons and Saturday mornings are devoted to this work. The attendances of specially referred cases and absentees due to illness were 3,566, compared with 4,173 for 1917. Of these 1,312 were first attendances, and the balance was subsequent ones. Arrangements for following up Children with Defects. They are mentioned in my report for 1916. On November 6th, 1917, the Committee gave me authority to prosecute parents or guardians under Section 12 of the Children's Act, 1908; and in December, 1917, to engage the Council's Solicitor to prepare and conduct the legal proceedings. 2nd SCHOOL NURSE. The following visits were paid in following up cases reported to me by the School Medical Inspector, or Head Teachers, or Attendance Officers. September October. November December Totals. P. capt. corp... 5 4 6 7 22 P. capt. 7 10 8 13 38 P. corp. — 5 5 10 20 Ringworm 9 5 8 — 22 Scabies R 2 6 — 16 Impetigo 4 2 2 — 8 Blepharitis 2 — — — 2 Neglect 7 5 3 12 27 Other visits 9 — 70 3 82 Cellulitis 1 — — 1 Eczema — 1 — — 1 Re-visits — 92 — — 92 Totals 51 127 108 45 331 8 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. Your certifying officers, Dr. Strong and myself, on receipt of information from the head teachers, summon the child and mother for prolonged examination and enquiry lasting for an hour, or over, in each case We are thus enabled to answer, more or less, the 68 questions in Schedule "F." It concludes with the treatment recommended ; and the child is placed as fit for one of four classes:— 1. An ordinary public elementary school. 2. A special class for dull or backward children. 3. A special school (day or residential), 4. Unsuitable for a special school. It is only those cases allotted to the last class which are dealt with by the County Council. During the year three cases ; D M.T. 14 years, I.L M.E. 12 years, and F.M.H. 7 years, were sent to institutions by the County Council I am glad to say that there appeared at the end of the year some probability of joint action being taken to provide a special day school for children in class 3, in co-operation with our neighbour, Enfield. 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 own 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 1918, no other children were dealt with by us, except the three above mentioned who were allotted to class 4. Of the 30,000 mentally defective children capable of profiting by education in England and Wales more than 15,000 fail to receive any educational facilities. Others from this total stay at home, or enter ordinary schools where they fail to learn. Not until 1913 did Parliament pass an Act compelling the provision of special schools. This Act has not been generally enforced. Villages and small towns throughout the country include in their population " reasonable " defectives who receive no education. Urgent need exists to erect additional special schools, day or residential. No practical steps have yet been taken to meet this need. Neither has any provision been made for backward children ; as yet, these pupils form hindances to school progress as members of ordinary schools. Special schools of England and Wales in 1918 numbered 177. Eighteen of these were residential places, voluntary societies provided sixteen, and local educational authorities accounted for two only. 9 EPILEPSY. During the year Dr. Strong reported to me two cases—H. B., 11 years; W. R. B., 10 years. There is insuperable difficulty in finding institutions willing to take in sane epileptic children. Their presence in the public elementary schools, as with mentally deficients, is a trial to the teachers, and, when fits occur, disturbing to the scholars. The number of institutions in England is small and the cost beyond the means of poor parents. TUBERCULOSIS. The number of boys with a family history of consumption was 375, or 13.8 per cent. ; and 355 girls, or 13.5 per cent. During 1918 Dr. Strong sent two "B" notifications to the M. O. H. Of these, both boys, one referred to pulmonary tuberculosis and one to tubercular sub-maxillary glands. RETURN SHOWING PHYSICAL CONDITION OF CHILDREN DURING ROUTINE MEDICAL INSPECTION. Total inspected : 5345. Boys, 2715 ; Girls, 2630. Ages. Boys. Girls. Entrants 8-9. Leavers Entrants 8-9 Leavers. Clothing: Satisfactory 823 681 1198 807 622 1195 Unsatisfactory 7 4 4 2 3 1 Footgear: Satisfactory: 826 680 1196 808 624 1195 Unsatisfactory 4 5 4 1 1 1 Totals for either 830 685 1200 809 625 1196 NUTRITION. Ages. Boys. Girls. Entrants 8-9 Leavers Entrants 8-9 Leavers. Good 741 653 1058 715 590 1084 Fair 89 32 142 94 35 112 Poor — — — — — — Totals 830 685 1200 809 625 1196 10 NUTRITION. Out of the children in the several groups for routine medical inspection, the cards of 833 were marked for re examination by reason of weight and physique being unsatisfactory. Of these, 677 were called for re-examination—429 showed mprovenient; 40 showed loss of weight; 23 stationary ;185 were absent. A cookery centre was opened at Brettenham Road in September, under Miss Mary Bunker, with places for 18 pupils. EDMONTON CANTEEN COMMITTEE. REPORT FOR 1918. During 1918 meals were supplied to 98 children, an increase of 21 per cent on the number fed in 1917. The average weekly number receiving meals was 55, the highest number in any one week 67, and the lowest 39. Of these 87 were the children of widows, and 11 had dinners while their fathers were physically incapacitated from working. The conditions of investigation etc. were the same as in recent years. The Central Investigation Sub-Committee met on six occasions during the year. The dinners were supplied at the Feeding Centre in Fore Street, Upper Edmonton. As a natural result of the food shortage difficulties were encountered, and it was not always possible to adhere to the list of menus, but a nourishing and appetising meal was provided each day. In March 1918 the question of establishing Central Kitchens for school children was considered. Circulars on the subject were sent out to parents, but the demand for children to be supplied with meals at such kitchens was so small that it was not considered desirable to proceed in the matter. The total number of meals provided in 1918 was 15359 and the total cost was £383 19s, 6d. T. G. SCOTT, Hon. See., 27, Queens Road." VERMIN. At the. routine inspection, as regards body vermin, 24 boys and 15 girls were found to be infested with lice on the inspection day. Nits (the eggs of lice) were found on the hair of 283 boys and 901 girls, and live lice on 74 boys and 70 girls. Last year the figures were 33 boys and 13 girls infested with bodylice, 269 boys and 689 girls found with nits, and 63 boys and 72 girls with live lice on their scalps. The first School Nurse makes special visits to the schools to examine whole classes of children, with the view to ascertaining their condition as to cleanliness. The children with nits or vermin are given cards to take home, warning their parents of the condition and giving advice as to how to get rid of them. She has looked over 983 this year, the number was 5,795 last year. (Miss Williams was off duty, owing to an accident, for several months ) Now we have another School Nurse who deals with the verminous homes. The Cleansing Station still remains unfinished, although the walls were erected this year and utilised as a temporary shed for a motor ambulance for infectious disease. It is quite time that it be completed and in proper use. 11 TEETH. Of the boys 1229, and 1168 girls, had one to three teeth decayed, and as many as 692 boys and 591 girls had four teeth or more decayed. NOSE AND THROAT. Among the boys 307, and 304 girls, had either enlarged tonsils or adenoids, or both. EYE DISEASE. Thirty-seven boys and 78 girls were wearing spectacles. Slight errors of vision were found in 44 boys and 74 girls, and marked errors in 119 boys and 114 girls. Forty three boys and 37 girls had squint. SCHOOL CLINIC. Our scheme was settled in 1914, but the approval of it has been formally withheld by the Hoard of Education until the end of the war. INFECTIOUS AND (or) CONTAGIOUS DISEASES. The nnmber of children excluded at the routine inspection was 106 — 55 boys and 51 girls, the reasons for exclusion being :— Boys. Girls. Boys. Girls. Vermin. Head 19 17 Contag. Skin Dis. Ringworm Body 1 0 Head and Body 9 8 Ringworm Head 3 4 Body 15 8 Impetigo 1 4 Body Vermin and Scabies 3 4 Scabies 2 — Other conditions 1 1 Infec. Dis. German Measles... 1 — — — Measles — 1 55 51 Influenza - 3 — - N.B.—None were excluded for Nits only. EXCLUSION CERTIFICATES. I. For Contagious and other Diseases. The total number of exclusion certificates (including the above) issued by the School Medical Officers during the year was 657, compared with 940 the year before. The reasons for the exclusions being :— Disease. No. of Certificates. Disease. No. of Certificates. Impetigo 152 Pulmonary Tuberculosis 8 Vermin 125 Mumps 7 Scabies 109 Chicken-pox 6 Other Causes 95 Epilepsy 5 Ringworm 87 Ear Disease 4 Skin Diseases 14 Influenza 4 Bronchial Catarrh 13 Other Tubercular Diseases 3 Chorea 10 Whooping Cough 3 Eye Trouble 9 Mental Defective 2 Measles 1 Total 657 12 The number 657, is 283 less than last year. Scabies numbered 99 last year. During the summer holidays and at special times for measles, the public elementary schools were well disinfected. 11. For Infectious Diseases (notifiable and non-notifiable). Without measles, in connection with the notifiable infectious diseases, 189 notices were issued by the Medical Officer of Health excluding 211 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 2779 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 1917-16-15 were 2,044, 2,058, and 1,415 respectively. It is interesting to note the great variation in the number of children excluded from the schools during 1918. 1. Montagu Road 747 7. Croyland Road 196 2. Silver Street 407 8. St. James 101 3. Eldon Road 357 9. Houndsfield Road 45 4. National 299 10. St. Edmunds 41 5. Raynham Road 236 11. Lower Latymer 40 6. Brettenham Road 225 12. Latymer Secondary 10 Total 2704 Besides the following : —Enfield Council Schools, 38; other Enfield Schools, 15our private schools, 16 ; 6 children at various schools in Tottenham etc. There were 44 children not attending (at the time) any school. Exclusion of Contacts. The rules adopted for the exclusion of contacts are as before. 13 TABLE II. (of Board of Education.) RETURN OF DEFECTS FOUND IN THE COURSE OF MEDICAL INSPECTION IN 1918. Defect or Disease. Code Groups. Number referred for treatment. Number requiring to be kept under observation, but not referred for treatment. (1) (2) (3) Malnutrition — Uncleanliness of head 180 15 Uneleanliness of body 44 o Skin- Ringworm of head 7 — Ringworm of body 1 — Scabies 8 — Impetigo 14 — Other disease 12 — Eye— Defective vision and squint 279 267 External eye disease 36 25 Ear— Defective hearing 228 96 Ear disease 124 6 Teeth— Dental disease no clinic 3680 Nose and Throat— Enlarged tonsil? 146 221 Adenoids 3 1 Enlarged tonsils and adenoids 195 45 Defective speech 14 6 Heart and Circulation— Heart disease—organic 15 4 Heart disease—functional 39 9 Anaemia .. 38 10 IjUNGS— Pulmonary tuberculosis—definite 6 — Pulmonary tuberculosis—suspected 6 4 Chronic bronchitis 19 5 Other disease 31 12 Nervous System— Epilepsy 7 1 Chorea 5 — Other disease 2 — Non-pulmonary tuberculosis—glands 2 — bones and joints 5 2 other forms 2 — Rickets 5 — Deformities 19 2 Other defects or diseases 23 4 14 TABLE III. NUMERICAL RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA IN 1918. Boys. Girls. Total. Blind (including partially Attending public elem. schools 8 16 24 blind) Attending certified schools for the blind 2 3 5 Not at school - - - Deaf and Dcmb (including Attending public elem. schools 40 37 77 partially deaf) Attending certified schools 4 5 9 Not at school - - - Mentally Deficient— Feeble-minded Attending public elem. schools 37 18 55 Attending certified schools - - Notified to the Local (Control) Authority during the year - 3 3 Not at school — — Imbeciles At school 2 — 2 Not at school — — Idiots - — — Epileptics Attending public elem. schools 9 6 15 Attending certified schools — — — Not at school - - — Physically Defective— Pulmonary tuberculosis .. Attending public elem. schools 19 18 37 Attending certified schools — — — Not at school — — — Other forms of culosis Attending public elem. schools 14 12 26 Attending certified schools — — — Not at school — — — Cripples other than Tubercular Attending public elem. schools 25 23 48 Attending certified schools — — — Not at school Dull op. Backward (judged according to age and Retarded 2 years 328 122 450 standard) Retarded 3 years 95 27 122 TABLE IV.—TREATMENT OF DEFECTS OF CHILDREN DURING 1918. (Board of Education.) Condition. No. of defects found for which treatment was considered necessary. No. of defects f'r which no report is available!. No. of defects treated. Result of treatment. No. of defects not treated. Per centage of defects treated. From previous years. New. Total. Remedied. Improved. Unchanged Clothing .. - 19 19 3 14 2 8 4 2 73.6 Footgear — 14 14 2 12 6 5 1 — 85.7 Cleanliness of head — 186 186 20 131 66 40 25 35 70.4 Cleanliness of body — 44 44 — 39 20 9 10 5 88.6 Nutrition (see special table) .. — — — — — — — — — — Nose and throat — 343 343 — 267 152 45 70 76 77.8 External eye disease — 36 36 11 25 13 5 7 — 73.5 Ear disease — 124 124 10 90 40 29 21 24 72.6 Teeth (no dental clinic) — — — — — — — — — — Heart and circulation — 92 92 3 76 33 28 15 13 82.6 Lungs — 92 92 — 76 40 22 14 16 82.6 Nervous system — 14 14 — 12 1 10 1 2 85.7 Skin — 42 42 — 42 25 13 4 — 100.0 Rickets — 5 5 — 5 — 5 — — 100.0 Deformities — 19 19 — 18 1 16 1 1 94.7 Tuberculosis (non-pulmonary) — 9 9 1 8 — 7 1 — 88.9 Speech — 14 14 — 9 5 3 1 5 61.4 Mental condition — 4 4 1 3 — 3 — — 75.0 Vision and squint — 279 279 8 231 78 79 74 40 82.8 Hearing — 228 228 16 182 87 75 20 30 79.8 Miscellaneous 23 23 5 14 4 4 6 4 60.9 Totals 1587 1587 80 1254 573 406 275 253 79.0 t This column includes (I.) those absent at the re-examination: (II.) those who have left the school or the district. 16 TABLE V. of Board of Education. INSPECTION, TREATMENT ETC., OF CHILDREN DURING 1918. (1.) The total number of children medically inspected (whether Code Group, special or ailing child) * 8806 (2.) The number of children in (1) suffering defects (other than uncleanliness or defective clothing or footgear) who require to be kept under observation (but not referred for treatment).. 1690 (3). The number of children in (1) who were referred for treatment (excluding uncleanliness, defective clothing, etc.) 1962 (4). The number of children in (3) who received treatment for one or more defects (excluding uncleanliness, defective clothing, etc.) 1701 * At routine, re-inspections, re-examinations and specially-referred centre.