EDM 014 Edmonton Urban District. (PARLIAMENTARY BOROUGH). Annual Reports ON THE Public Health and School Medical Services FOR THE YEAR 1919. BY SIDNEY C. LAWRENCE, Medical Officer of Health and School Medical Officer, M.B., Ch.B., D.P.H. (Lond.), M.R.C.S. (Eng.), L.R.C.P. (Lond.), Fellow of the Society of Medical Officers of Health. R H. STRONG, L.R.C.P. & S. (Edin.), L.F.P.S. (Glasg.), Assistant and Deputy S.M.O.—S.M.I. 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, 1919. 1.—Medical Officer of Health: SIDNEY C. LAWRENCE, M.B., Ch.B., D.P.H.† 2.—Assistant and Deputy Medical Officer of Health: (Vacant since July, 1914.) 3.—First Male Inspector and Inspector of Canal Boats: R. J. BUTLAND* ‡ 4.—Second Male Inspector: J. E. WINTER. *† ‡ 5.—Third „ „ H. K. NIXON, † ¶ 6.—Fourth „ „ G. H. HUCKLE.* ¶ 7.—First Woman Inspector: JENNIE HUDSON (died September 3rd). 8.—Second „ „ 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. (alsoSch. Nurse) 12.—Sixth „ „ AMY SIMPSON,**¶ C.M.B. (since Oct. 1st). 13.—Senior Clerk: A. OADES (temporary). 14.—School Medical Clerk: JOHN P. FARRAR (since March 24th). 15.—Junior Clerk: DORIS B. HILL (temporary). 16.—Disinfector, Sanitary Stores Keeper and Transport Officer: J. MADLE. 17.—Mortuary Attendant, Laboratory, Disinfecting Station: C. HICKFORD. 18.—Caretaker of Emergency Hospital: J, MADLE (temporary). 19.—Driver of ambulance and bedding vans: S. GWYNN. 20.—Opener-up of old drains, urinal cleanser and general sanitary workman: A. PASHALL. 21.—Opener-up of old drains (part-time): A man from Engineer's Department as required. 22-25.—Attendants at Sanitary Convenience at Angel Road: Two male and two female. 26-29.—Attendants at Sanitary Convenience on The Green: Two male and two female. * Officers marked thus hold the certificate of the Royal Sanitary Institute. † These officers have the certificate of Meat and Food Inspector. ‡ These officers are appointed as Inspectors under the Shops' Act, 1912. ¶ These officers have the certificate of the Sanitary Inspectors' Board. ** A nurse with 3 years' training. 4 SUMMARY. Area 3,894 acres, including 31 of water Census Population, April, 1911 64,797 Estimated Nett Population, June 30th, 1919 75,744 Density of Population per acre of land , 1919 19.9 Rateable Value, October, 1919 £247,072 Assessable Value, October, 1919 £233,346 General District Rate, 1919 4s. l1d. in the£ Poor Rate, 1919 6s.0d.inthe£ A Penny Rate produces (about) £950 VITAL STATISTICS. Birth-rate per 1,000 living 16.33 Gross, or Registered, Death-rate per 1,000 living 12.75 Nett Death-rate per 1,000 living 9.25 Infantile Mortality per 1,000 births registered 67.91 Zymotic Death-rate per 1,000 living 0.55 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 Company, Limited. Water Supply.—New River District, Metropolitan Water Board. Gas Supply.—Tottenham District Light, Heat and Power Company. Sewerage.—Separate System. Sewage Disposal.—Broad Irrigation and Bacterial Filters. 5 " Now join our hands, and with our hands our hearts, That no dissension kinder government." —Shakespeare's " King Henry VI." Town Hall, Edmonton, N. 9. To the Chairman and Members of the Edmonton Council. Ladies and Gentlemen, I herewith present my 14th Report on the health and sanitary circumstances of this urban district. It refers to the year 1919. In my preface to the Report for 1918, I said: " In justice to the work and in view of the strain on my health thereby involved, I cannot continue this overwork indefinitely." This statement was fulfilled. The year 1920 has been a tragic one for me. Overworked, underpaid, and rudely treated, I staggered along until on February 10th, I was compelled to seek a respite owing to a serious breakdown in health, and was unable to resume duty for nearly 3 months, viz., on April 29th. I was then faced with the huge accumulation of business and official correspondence for a quarter of a year, besides keeping up with current affairs. This accounts mainly for the late appearance of this Report, which no one regrets more than myself. The MSS. was ready on November 3rd, but the printing was held up for 3 weeks longer, owing to the embarrassing action of a row of critics -if two persons can be said to make a row. Since December, 1919, I have added to my responsibilities the supervision of Municipal Milk Supplies and the School Clinic, two branches of work which keep increasing in importance and popularity. However, in April, 1920, a Council was established, which has displayed the intention to treat me with the consideration and courtesy which your Principal Medical Officer has a right to expect. You have already done your utmost to rectify the great mistake of your predecessors as regards the post of Supervisor of the Maternity and Child Welfare Centre, for which I herewith tender you my grateful thanks. AVith your continued goodwill and support we can cordially co-operate in improving the efficiency of the public health and school medical services of 6 Edmonton. With this object in view, I invite your sympathetic consideration of my Special Report on Reorganisation dated November 26th, 1919, which is herewith published for your convenience of reference- I gratefully acknowledge the help received from the loyal members of my staff and the Heads of other departments. I am, Ladies and Gentlemen, Your obedient Servant, November, 1920. SIDNEY C. LAWRENCE, Medical Officer of Health. 7 FOREWORD. Local Conditions arising from the Great War. The birth-rate for 1919 was, of course, still affected by the absence of fathers, the majority of whom were not demobilised until after March. The War Pensions Committee (Secretary, Mr. L. W. C. Pettipiere) continued their arduous labours during the year. Overcrowding.—Conditions are still bad here. 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. Peace Celebrations.—Notwithstanding a protest from the Labour Party, the Council and Education Committee jointly contributed £1,000 to provide a festive meeting for the school children on 24th July. Exeunt.—The military quitted the Baths on the 3rd March, the Town Hall on the 5th March, the Recreation Ground in September, and Pymmes Park on Saturday, July 31st. Air-Raid Stations.—In January it was reported that the equipment of the air-raid stations had been collected and checked, and a record made of articles missing or moth-eaten; further, that the bedding, sheets, etc., had been washed before their return to our temporary hospital at Picketts Lock Lane; also that the artificial darkening had been removed from the windows of the Town Hall. Allotments.—In December the War Allotments Committee suggested that any land of the Council, when available, should be let as permanent allotments, and arrangements were proposed for continuing war allotments as long as possible. War Memorial.—The proposals referred to in my Report for 1918 met with a luke-warm reception, and the project was abandoned. Munition Works.—The Armistice established on 11th November, 1918, was, of course, not long after followed by great changes in these, which either became disused and the materials disposed of; but the old works, in most cases, reverted to their old use or established fresh trades—such as pen-making—to provide work for their employees and machinery. Strange to say, these changes appear to have had little effect upon the over-crowding in Edmonton houses. I suppose the families that flocked here to engage in war work are not able to move out owing to their inability to find work and house accommodation elsewhere. 8 EDMONTON MILITARY HOSPITAL. Lieut.-Col. Spencer Mort's responsibilities continue, if they do not increase. At the end of 1919 there were 1,460 beds for sailors and soldiers in this institution . The auxiliary hospitals in outside areas are closed. At the end of 1919 the number of inmates was 943, and resident staff 120—a total of 1,063 persons. Lieut.-Col. Mort has kindly furnished me with some interesting particulars, from which I gather that the status of this Hospital has very largely changed; that is to say, it has come into full work as an orthopaedic hospital. Large numbers of patients are being transferred from all military hospitals in England to this one. Many ex-service men are also treated as out-patients. The special departments which are now in working order are:—Massage and electrical; curative workshops and educational (in which 80% of the patients in the hospital have special training); gymnastic treatment for developing fine movements, and general gymnastic treatment; nerve testing; plaster work; casting and making special splints, to fit the patients accurately; also, as another method of correcting a deformity for the time, that is to say, plastic operations, as apart from surgical operations, are carried out. A change has taken place by the vacation by the military patients of wards at Edmonton Infirmary—formerly the Annexe and Sections—and this has resulted in the occupation of the old Strand Workhouse completely, except for one ward (vacant), to be filled up by patients in certain curative trades, which are being expanded daily. The number of operations for the period stated was 1,362. The hospital has been visited by two General Officers Commanding-inChief, namely, Lord Robertson and Lord Horne, who expressed great appreciation of the work. This is now the biggest hospital in the Eastern Command, and the only Special Surgical Hospital left in England. As regards Infectious Disease amongst those on His Majesty's service, 6 cases were notified—1 scarlet fever, 1 diphtheria, 1 erysipelas, 1 pneumonia, and 2 measles. As regards tubercle, I received notice of 4 cases of pulmonary disease—all males—but no other forms of tubercle. The Deaths that occurred in the Edmonton Military Hospital totalled 78 (six of them residents)—9 from wounds, 1 from a fall in the neighbourhood out of an aeroplane, 1 suicide from cut-throat, and 67 from disease, of which 14 were from influenza and 8 from pneumonia. There were 5 deaths due to the war which occurred outside this institution, viz., from an explosion at the Edmonton Munition Company's Works, Weir Hall. So altogether 83 deaths in Edmonton were due to the Great War, compared with 116 last year. These deaths are not included in Table III. 9 EDMONTON URBAN DISTRICT. REPORT . of the Medical Officer of Health For the YEAR 1919. 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. The elections were suspended during the war, since the last one in 1915, but revived in 1919. To fill vacancies', Messrs. George Rowe, E. T. Rhymer, W. F. Middleton and Mrs. Norman Benjafield had been coopted It is represented on the Middlesex County Council by three members: Councillors Cornish, Cull 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. The Representation of the People Act, 1918, made Edmonton a Parliamentary Borough, with one member of its own, although the population of 191-1 was estimated to be a little less than 70,000, viz., 68,203 (excluding refugees and military). The County Medical Officer's Report for 1918 was received in March, 1920. Distress Committee.—In April, four members were appointed to fill vacancies, and five persons (including at least one woman) from the general public, and in May, eight from the Board of Guardians. Rates.—In September the Council agreed to the proposal of the Guardians for combining the collection of the Poor and District Rate, and in December an agreement was arrived at which takes effect from April 1st, 1920. Hospitals.—On September 23rd the Council passed this resolution:— " The time is more than ripe for the taking over of the hospitals by the "State (at present supported by voluntary aid). We contend that these 10 "institutions are too valuable to be left to charity, seeing that it is impossible, "by past experience, to raise sufficient funds by begging for their proper "upkeep, maintenance and administration: therefore we hope that the whole "of the hospitals of this country will be taken over by the State and properly "provided for at the earliest possible moment." "Further, that copies of this resolution be sent to all administrative bodies "in the London area, asking for their endorsement of the same, and to forward "this resolution to their respective Members of Parliament; a copy shall also "be sent to the Prime Minister, Chairman of the Labour Party, and Press, "local and national." In December the Clerk announced that only 21 out of 95 Local Authorities in the London area had agreed with this resolution. NATIONAL CHARGES. In December, at the suggestion of the Labour Party, it was resolved that:— "This Council is of opinion that the present system of placing on the "localities a large proportion of the cost of meeting our national responsi"bilities, in the matter of education, housing, maintenance of the poor and "infirm, unemployed relief, asylums, infectious hospitals, etc., and the many "optional powers given to Local Authorities, is unjust and oppressive. It "further results in many of those urgent obligations being inadequate) met, "or altogether evaded, to the great detriment of the community. "This Council therefore demands that the whole of these charges should "be placed on the National Exchequer, and that for administrative purposes "the money so raised should be allocated to the local authorities in proportion "to the requirements of their districts. "Further, A.—To instruct the Clerk to the Council to have copies of this "resolution sent to the Prime Minister, the Minister of Health, the Chancellor "of the Exchequer, the Ministry of Education, and the Ministry of Labour. Further, B.—To instruct the Clerk to the Council to have circular "letters printed and forwarded to all local bodies in the country, embodying "the enclosed resolution, asking them to take similar action to that of the "E.U.D.C. in the matter; also to take joint action with the E.U.D.C.in urging "the Minister of Health to call a National Conference of all local bodies "responsible to his department, to consider the whole question of the rating "basis of meeting local charges, and the unfairness of the incidence on this "basis to areas inhabited mainly by working people." Greater London.—On April 11th the Middlesex County Council convened a meeting between their Parliamentary Committee and representatives of the Local Sanitary Authorities in Middlesex, to consider the proposed extension of the County of London; two of our Councillors attended, with the Engineer. 11 Later (May), two representatives, with the Clerk and Engineer, were appointed to attend a conference in London, convened by the Borough of Ealing, which would organise resistance to the absorption of their area, said to be desired by the London County Council. I cannot trace in the Council's Minutes any report from either set of representatives. In November, a report of the L.C.C., dated 10th October, 1919, was presented to every Councillor, setting out the proposals of that Council regarding the administration of Greater London. POOR LAW INSTITUTIONS. The Institution belonging to the Edmonton Board of Guardians, which is in Fore Street, and covers an area of 22 acres, receives a certain proportion of its inmates from this district, and such proportion is treated as part of our population for statistical purposes. The large bulk of the inmates, however, is derived from Tottenham, Southgate, Wood Green, Hornsey, Enfield, Cheshunt (Herts), and Waltham Abbey (Essex), which places make up the large Poor Law Union of Edmonton, and these inmates, of course, do not enter into our vital statistics. Mr. B. Andrews is the master. In March, 1919, the estimated population of Edmonton Union was 494,739 ; rateable value £2,576,846. Amongst a total of forty Guardians, Edmonton district proper has only four representatives. Dr. Gregorson has been acting as Medical Superintendent at the old Infirmary (since April, 1915). The beds at the Workhouse and old Infirmary were given up by the military in June. There are about 530 beds now for sick adult paupers, and 38 cots for children. Those who had been boarded out in Metropolitan and provincial workhouses are back again. Convalescents are sent to Margate; tubercular cases to the Grosvenor Sanatorium, Ashford, Kent. The new Infirmary and Nurses' Home became a military hospital in April, 1915: for particulars of its work see " The Foreword." Millfield House has been occupied since January, 1917, by the Metropolitan Asylums Board as a male epileptic colony. It accommodates 243 patients from other districts, therefore these people are excluded from our Vital Statistics. Dr. Bebb is the visiting Medical Officer, and Mrs. S. Pallin is the Matron. THE PUBLIC HEALTH DEPARTMENT. Return of Staff.—On their return from war service in March, Messrs. Nixon and Huckle, sanitary inspectors, were re-graded as to salary, and Mr. J. P. Farrar was promoted from junior clerk to school medical clerk. The first two posts were salaried at £150 per annum, rising by annual increments 12 of £5 to £180, and the School Medical Clerk (with the approval of the Education Committee) was placed on a salary of £100, rising by yearly increments of £10 to £130 per annum. It was decided to defer the new appointment of a chief clerk for six months. Mr. Nixon resumed February 14th, Mr. Huckle on March 1st, and Mr. Farrar on March 24th. Miss Hudson.—Her last day on duty was May 22nd. She died on Wednesday, September 3rd, after nine useful and honourable years of service in Edmonton; her salary was paid up to the date of her death. Miss Amy Simpson commenced duty on October 1st. Sanitary Inspector.—In January, Mr. A. Ede, of 51, Edenbridge Road, was permitted to join my department for his practical training, but the Council would not extend this privilege later to any ex-soldier who was not a resident in the district. Bicycle.—In September, on his suggestion, Mr. Rutland was provided with a motor-bicycle (at a cost not exceeding £55) to replace his ordinary bicycle stolen from the Town Hall Yard. In October it was agreed to supply a push " bicycle to Mr. Nixon. Increase of Staff.—This was recommended, as regards women officers, by a letter of the Maternity and Child Welfare Committee, in October, to the Council, which was referred to the Public Health Committee; in the same letter the Council were asked to instruct the women inspectors to advise mothers whom they visited to attend our Centre. Chief Clerk.—In October I presented a report on the urgent need of appointing one with the best qua lifications and experience for such an important post, who (under my supervision) could control all the clerical work and release the Sanitary Inspectors from all indoor office work as much as possible, so as to enable them to devote their energies in the proper sphere, i.e., the homes of the people. I pointed out that in 1918 the Women Inspectors spent no less than 60 working days out of 296 at clerical work, and that a similar condition prevailed amongst the male inspectors. The Public Health Committee of the 8th October recommended the appointment of one of my present clerks, but this was referred back by the Council on the 29th. Reorganisation.—On December 3rd I presented a report to the Public Health Committee, advising in detail the measures necessarv to bring the working of my department efficient and up-to-date. I pointed out the importance of maintaining the M.O.H., not only in theory, but in practice, as sole head of the public health (sanitary) work in 13 the district. This change would carry out the wishes of the Government as expressed in the circular of the Local Government Board conveying the Sanitary Officers' Order of December, 1910. This was not considered at that meeting, but my oldest male inspector (Mr. R.J. Butland) was asked to state his views on the report of his superior officer ! The two documents were submitted on January 7th, 1920, to the Public Health Committee, who recommended that they be considered by the Council (in Committee). On January 27th, 1920, the Council decided to leave to the Chairman the fixing of such a special meeting in Committee on the first convenient date. However, owing to my illness compelling me to go on sick leave on February 10th, 1920, the further consideration was postponed at a special Council Meeting on February 9th, until my return." I returned on April 29th, but on December 3rd. 1920, the matter had not been settled ! This special report is available at the end of the report of the M.O.H. PUBLIC HEALTH CONFERENCE.—A conference organised by the Royal Institute of Public Health, was held at the Guildhall, London, E.C., on the 26th, 27th and 28th June. Councillor Barrass and the Medical Officer of Health attended to represent Edmonton. On July 28th the delegates presented their report to the Council. The subjects discussed were:— 1.—The work of the Ministry of Health. 2.—Venereal Disease: its prevention and arrest. 3.—Housing in relation to health. 4.—Maternity and child welfare. 5.—Tuberculosis after the war. The debates were instructive and interesting, and the views of the (majority of the) delegates were expressed in these resolutions, amongst others:— I. Ministry of Health. 1.—That in the view of this meeting, Sanitary Inspectors, Health Visitors, and similar classes of Public Health Officials, should be adequately trained, and that the present system of examinations should be coordinated so as to secure one qualifying examination for the whole country. 2.—That this Conference views with satisfaction the contemplated creation of Advisory Councils in connection with the work of the Ministry of Health, and urges that the services of those who have had long, wide and practical experience in administrative and executive Public Health work should be secured upon these Councils. 3.—That in view of the large national demands which will be made on the Ministry of Health as an organizing and controlling centre, it is desirable that it should not be burdened with functions of details which 14 may result m depriving the Local Authorities of a sense of responsibility and a sense of initiative. 4,—That in view of the invaluable services rendered by women who are serving as elected or co-opted members upon Local Authorities, or as officers of such Authorities, this Conference is of opinion that women should he included in larger numbers on all advisory bodies, and that greater facilities be provided for the training of expert women workers in the homes of the people. —That this Conference respectfully invites all the smaller Sanitary Authorities, Urban and Rural, to consider the advantages which have already resulted from the combination of similar areas, to secure the whole-time services of Medical Officers of Health and of other Sanitary Officials In the opinion of the Conference an adjustment of this character will result advantageously. II. Venereal Disease. That in the opinion of this Conference it is absolutely essential, alike from the military and civilian standpoint, including also the interests of women and children, that legislation affecting venereal disease should be amended and harmonised, so far as it possibly can be, with legislation affecting other forms of communicable disease, the aims being to ensure continuity of treatment and the prevention of the spread of infection. III. Housing. 1.—That the Conference is of opinion that the Housing and Town Planning Bill should include provision for the more effective control of the future registration and sub-letting of dwelling-houses, so that adequate provision may be made for proper washing, larder, laundry and lavatory accommodation. 2.—That the Conference is of opinion that the erection of dwellinghouses in the congested parts of cities and towns should be minimised, and that every facility should be provided to ensure their erection in open suburban areas, and that adequate, rapid and cheap means of locomotion between the dwelling-houses and places of occupation should be provided. 3.—That in the view of this Conference, a wider and more liberal interpretation of the by-laws of many districts is necessary, and that full discretionary power should be given to the Ministry of Health to authorise modifications to meet local requirements. IV. Maternity and Child Welfare. 1.—That this Conference views with great satisfaction the results already obtained from efforts made to promote the welfare of motherhood in and infancy, and welcomes the prospect of fuller appreciation of the services which can be rendered by properly trained Midwives find Health Visitors, 2,—That the Conference considers the proper distribution of Midwives and Health Visitors should come within tin- purview of the Ministry. V. Tuberculosis. I .—That in the opinion of thin Conference, schemes for tin- prevention of tuberculosis must he of general application, and it recognises that Sanatoria, Colonies, and other establishments for treatment and segregation, are of the utmost value in the prevention of tuberculosis. 2.—That the Conference recognises the obligation to provide, not only for the tuberculous soldier, but for the tuberculous wife or child of the soldier or civilian, or for any other member of the population. With III. (3) I do not entirely agree. I think that the Local Sanitary Authority should take the initiative in proposing modification of their own by-laws, such modification being subject to the approval of the Ministry of Health before final adoption. The Local Authority, through its own officers, e.g., the Medical Officer of Health and the Engineer, is in the best position to know what alterations or relaxations are advisable in its own area. Markets.—In August the Labour Party requested the Council to move in the direction of fixing a public market place for Edmonton on similar lines to Ilford and Barking. This was referred to the Works Committee. The object of this appeared to be the provision of stalls for discharged service men to get a living. The Works Committee, on September 15th, considered this letter and one from the Workers' Union, and also one from the National Union of Corporation Workers. This latter asked for a permanent municipal market. The "Seafords" Company, Ltd., asked for a fish stall. The Engineer suggested three sites, viz., the Broadway, Silver Street, and Knights Lane. It was stated that 6s. a week was charged at Tottenham and Ilford for clearance of refuse. The Council agreed, on 23rd September, to stalls being provided at the Broadway and Silver Street. In November, after a protest from the Women's Co-operative Guild, it was decided to make no charge for the stalls on the Broadway. In December it was decided to allow the stalls to continue for another three months, and that 2s. a week be charged for Silver Street stalls. Allotments.—No further land has been obtainable for permanent allotments. Most of the "war allotments" are still in cultivation. There is a great demand for plots in our Bush Hill Park area. 16 Pymmes Park.—In December the Architect's scheme was adopted for providing 6 W.C.'s, 8 urinals and 3 lavatory basins at the north end of the Park, at an estimated cost of £750. VITAL STATISTICS. My statistics refer to 52 weeks ending on December 27th, 1919. I am much indebted to Mr. W. H. Miller, our Registrar of Births and Deaths, for information promptly afforded whenever asked for. On October 4th he wrote informing me that, in future, deaths at the Edmonton Workhouse and Infirmary would have "77, Bridport, Road," as their registered address. The Registrar-General estimates our civil population at 70,711 for deathrate and 73,660 for birth-rate, whereas I estimate our nett civil population at 75,744, and the gross civil population (including institutions) at 76,835, plus an average military population of 1,063. My figures are more likely to be in accordance with facts, as there are few, if any, houses vacant in Edmonton, and those occupied are more over-crowded than ever. Besides, many Belgians (formerly in the Refuge) have become householders or lodgers, and thus absorbed into the general body of ratepayers. The 1,063 persons at the Military Hospital are not dealt with by my statistics, gross or nett. I estimate the nett population at the middle of 1919 as 75,744 persons, including 121 Edmonton people in Edmonton Workhouse and old Infirmary. The gross total number of births registered in Edmonton was 1,321, i.e., 687 boys and 634 girls; of these 111 (55 boys, 56 girls) were illegitimate. The gross total number of deaths registered here was 980, i.e., 501 males, 479 females. So the births exceeded the deaths by 341. You will remember that 1918 presented an unique record for Edmonton, viz., the gross total of deaths exceeded that of the births by nine. The natural increase of the population, that is the excess of the nett total of births over the nett total of deaths, was 1,237, minus 701, equals 536. The figure was 291 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 19,9. This figure is calculated on the gross population, which includes the average populations of Edmonton Workhouse and old Infirmary, and the Epileptic Colony, and amounts to 76,835. The patients, nurses, medical men, orderlies, etc., at the Military Hospital, are excluded. 17 In the Edmonton Workhouse and old Infirmary there were estimated to be 957 persons, of whom 121 were Edmonton residents. In the Epileptic Colony, where the inmates are admitted from Central London areas, mainly the metropolitan boroughs, there was estima'ted to be a population of 255 persons, including 12 on the resident staff. During 1919 there were 6 deaths but no births. There were 108 admissions during the year. STATISTICS OF REGISTRAR-GENERAL. The following rates are provisional: The marriage rate for England and Wales for 1919 was 19.7, the highest on record. The birth-rate, 18.5, compared with 17.7 last year, which was the lowest on record. The death-rate at 13.8 is 3.8 higher than in 1918. The infantile death-rate, at 89 per 1,000 births, compared with 97 last year, is the lowest on record. The natural increase in the population of England and Wales, i.e., the excess of births over deaths, is 188,426, or 104,019 less than the average of the preceding five years. A letter from the Royal Statistical Society, dated the 10th July, 1919, stated:— "1.—It is a matter of common knowledge to all who have had occasion to use official statistics, whether published or departmental, that the national and imperial equipment for obtaining and publishing statistical data is very imperfect in its scope and inadequate in its machinery." "2.—Further, the efforts made are departmental, are under no common controlling or directing authority, and suffer very gravely from lack of co-ordination." "3.—The Council of the Royal Statistical Society have appointed a Special Committee to deal with the subject." "4.—It is proposed to petition His Majesty's Government to set up a Parliamentary Committee to examine the whole question of the collection and presentation of public statistics, and to report on the means of improvement." COMPARATIVE STATISTICS, 1919. This table of vital statistics for 1919 shows the various rates for the whole country and for several of the Urban Districts of Middlesex, and is given for the purpose of comparison. 18 Estimated Population middle of 1919. Annual rates per 1,000 of the population. Infantile Mortality per 1,000 births registered. Nett Births. Nett Deaths. Zymotic Deaths. England and Wales *35,993,000 18.5 13.8 — 89 The 96 great towns including London and Edmonton *17,806,093 19.1 13.8 — 93 The 148 smaller towns *4,713,660 18.4 12.6 — 90 London (including City) *4,358,309 18.6 13.4 — 85 Acton *61,732 17.1 10.4 — 65 Wood Green 53,120 14.31 10.81 0.27 68 Enfield .. 61,645 16.98 10.27 0.17 56.35 Edmonton 75,744 16. 33 9.25 0.55 67.9 *Civilian Population estimated at middle of 1919 by the Registrar-General. Note.—Since 1911 the aggregate death rates from the principal epidemic diseases have not been recorded by the Registrar-General; the Zymotic death-rate is therefore not obtainable in all cases. BIRTHS. The number of births registered by the Edmonton Registrar, Mr. W. H. Miller, was 1,321 (687 boys and 634 girls), which includes 26 births that took place in the Edmonton Workhouse and one in the Maternity Home, born of mothers belonging to Edmonton. The figures for 1918-17-16 were 1,248. 1,376 and 1,708. Ninety-two births born of mothers who are not Edmonton residents, are excluded from our statistics, just as foreign deaths are; of these, 58 occurred in the Workhouse, besides 17 in the Maternity Home. 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 notifications of eight births—four boys and four girls. Thus the nett total of births was 1,237. Of these 1,237 births, 64 (5.2 %) were declared illegitimate; this rate is 0.3% more than last year. The birthrate per 1,000 inhabitants is therefore 16.33, compared with 16.09 last year. My lowest record of births in Edmonton for a lunar month was for the four weeks ending 19th April, and numbered only 71. Notification of Births Acts, 1907 and 1915.—During this year 1,467 births were entered in our register; of these, 781 were males and 686 females; 114 (7.8%) of the whole number were born out of wedlock, and one more was of doubtful legitimacy. Thirty children were declared "stillborn." Mr. H. Weston, Superintendent of the Cemetery, informs me that there were 39 children styled "stillborn" buried during 1919; for 1918-17-16 the figures were 34, 35 and 54. For work done in visiting infants and their mothers, 19 see section, "The Women Inspectors and Their Work." In a previous paragraph it is noted that 1,321 births were registered during 1919. The figures of notification and registration will, of course, never coincide, but they show that few, if any, births escape notification in accordance with the Act. Twenty-one pairs of twins arrived, but no triplets. The birth-rate (16.33) for 1919 is 0.24 more than last year, and is 2.17 lower than 18.5, the birth-rate of England and Wales for 1919. The birthrate for the preceding ten years will be found in Column 5 of Table I. It has been estimated that the war caused a loss of 543,000 births in England and Wales. Edmonton is said to have sent 7,862 men away to fight our country's battles. DEATHS. The gross total of deaths registered in the district during the year was 980—501 males and 479 females of these, 395 occurred among non-residents at Edmonton Workhouse and Infirmary, one at the Guardians' Maternity Home in Bull Lane, and 6 at the Epileptic Colony, and 5 temporarily resident, while 97 deaths of Edmonton residents and 3 vagrants, taking place in the Edmonton Workhouse and old Infirmary, are included in our nett deaths. Thus the number of deaths amongst "Edmonton residents" registered in the district amounted to 567, besides 6 vagrants, of whom 3 died at the Infirmary. Of the 83 "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 12.75 per 1,000 living. This rate is calculated on the estimated gross population of 76,835 (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 9.25. This rate is calculated on the estimated nett population of 75,744. I receive quarterly, from the Registrar-General (through the County Medical Officer), particulars concerning Edmonton residents whose decease has taken place whilst they are away from their usual home. I have accepted 128 deaths (including 1 vagrant) returned in this way during the year, making the nett total of deaths at all ages (including 6 vagrants) for the district proper 701. 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, 9.25 per 1,000 living; it was 12.18 last year. It is 1.52 lower than the average of the five previous years, and the lowest on record. 20 The senile deaths (65 years and over) are 17 less than last year. Death Certification.—All deaths, except one, were certified either by the medical attendant or by the Coroner. Inquests were held on 52 residents, or 9.1 per cent, of the total deaths amongst residents registered in the district; 26 of them during each 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 111. 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 0.55. as compared with 0.57 for the previous year. This figure is 0.02 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 amongst children under one year of age per thousand births registered. The number of such deaths occurring amongst Edmonton children and registered within (or without) the district was 84, and the births registered within (or without) the district, born of Edmonton mothers, numbered 1,237; therefore the infantile death-rate, based on these figures, is 67.91 per thousand births. This is the lowest on record ; the previous lowest was 74.55 in 1910. Seven of the 84 infantile deaths were those of illegitimate infants—that is 8.3 per cent, of the infantile deaths; two inquests were held. Inquests were also held on 8 of the other infants, making a total of 10. The one death uncertified was that of an infant, and one took place in a caravan. The infantile mortality rate for the year in England and Wales was 89; in London, 85; in the 96 great towns (which include Edmonton), 93; and in the 148 smaller towns, 90 per thousand births registered. Table IV. shows that 47.6 per cent. of the infantile deaths occurred within the first month of life, and that 40.5 per cent. were due to what are termed "wasting diseases," viz., premature birth, atrophy, debility, congenital defects, and marasmus. Last year the figures were 47.9 and 39.6 per cent. I must also notice that the premature births were 26, compared with 25, 21 and 16 for 1918-17-16. 21 TABLE IV.—Infantile Mortality, 1919. Nett deaths from stated causes at various ages under 1 year of age. Causes of Death (1 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 undor 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year.  Smallpox 5 - - - - - - - - - - Chicken -pox 19c - - - - - - - - - - Measles 6 - - - - - - - - - - Scarlet Fever 7 - - - - - - - - - - Whooping Cough 8 - - - - - 1 2 - - 3 Diphtheria and Croup 9a - - - - - - - - - - Erysipelas 18 - - - - - 1 - - - 1 Tuberculous Meningitis 30 - - - - - - - - - 2 Abdominal Tuberculosis 31 - - - - - - - - 1 1 Other Tuberculous Diseases 28—29 - - - - - - - - - - 32—35 Meningitis (not tuberculous) 61 - - - - - - - - - - Convulsions 71 - - 1 1 2 - - - - - Laryngitis 87 - - - - - - - - - - Bronchitis 89—90 - - - - - 2 1 - 1 4 Pneumonia (all forms) 91—92 - - - - - 3 4 6 3 16 Diarrhoea 104 - 1 - - 1 - 1 - 1 3 Enteritis 105 - - - - - - 1 2 - 3 Gastritis 103a - - - - - - - - - - Syphilis 37 - - 1 - 1 1 1 - - 3 Rickets 36a - - - - - - - - - - Suffocation—overlaying 168 - - - - - 2 - - - 2 152c— Injury at Birth 153 3 1 - - 4 - - - - 4 Atelectasis 152b 3 - 1 - 4 - - - - 4 Congenital malformations 150 - - - - - - - - - - Premature Birth 151a 19 1 4 - 24 1 1 - - 26 Atrophy, Debility, and 151 Marasmus b c d e 2 1 - - 3 3 - - - 8 Other causes — 1 - - - 1 - - 1 - 2 Totals 28 4 7 1 40 14 13 9 1 8 84 Nett Births in the year.—Legitimate, 1,173; illegitimate, 64. Nett Deaths in the year.—Legitimate infants, 77; illegitimate* infants, 7 THE WOMEN INSPECTORS (HEALTH VISITORS). I give below an analysis of the number and nature of the visits paid by them during 1919. The bulk of their work falls into four large divisions, viz:— 22 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 nonnotifiable infectious diseases or measles. INFANTILE MORTALITY. Month. After Birth. Revisits. After 6 mths. After Death. F.xpctnt. Mothers. Stillbirths. Nglctd. Children Over 1 year. January 78 88 19 7 29 1 3 20 February 95 68 2 8 46 - 2 - March 127 103 37 16 42 4 - 16 April 58 75 32 5 12 1 - 48 May 88 24 6 6 13 - - 7 June 59 20 14 5 7 - - 35 July 2 69 61 1 13 - - 124 August 5 132 2 3 6 - - - September 52 12 85 0 21 2 - - October 94 15 10 8 27 1 — - November 20 - - - 16 - - - December 45 28 91 20 19 - - 3 Totals 723 644 359 86 251 9 5 255 INSPECTIONS UNDER FACTORY AND WORKSHOPS ACTS. Month. Factories. Workshops Laundries. Outworkers. Rooms Measured. January - 1 - 71 - February — — — 91 — March 3 — — — — April — — — — — May — — — — — June — — — — — July — — — — — August — — — — — September — — — 1 — October — — — 2 — November — — — — — December - - - - - Totals 3 1 — 165 — Note.—The lamented death of Miss Jennie Hudson, in September, after some months' illness, accounts for the small amount of work done. 23 NOTIFIABLE DISEASES. Month. Measles. Doubtful. Phthisis. Other forms of Tubercle. Erysipelas. Ophthalmia Neonatorum. Puerperal Fever. Totals January 17 - 12 4 8 15 - 56 February 5 - 13 3 11 4 — 36 March - - 27 8 2 - - 44 April 15 - 3 - - 9 - 27 May 61 - 14 1 - - - 83 June 157 - 27 - 2 16 9 204 July 234 2 5 - - 8 - 254 August 293 - 21 - 17 1 - 332 128 September 112 4 2 - 6 4 - October 178 9 1 9 12 - 4 199 November 520 16 - - 14 - - 555 December 327 4 - - 21 25 1 378 Total 1926 28 125 18 105 87 7 2296 For the arrangement of disinfection afterwards, the following further visits were paid:—Measles, 7; Phthisis, 112; Erysipelas, 4. NON-NOTIFIABLE DISEASES. Month. Mumps. Whooping Cough. Chicken pox. Doubtful. Total. January 1 - 2 - 3 February 6 — 21 3 30 March 15 1 28 7 51 April 2 1 11 12 26 May 3 9 57 15 84 June 5 19 75 23 122 July — 17 45 7 69 August* — 2 4 '— 6 September 1 16 — 0 23 October 4 D 20 20 49 November 19 12 43 3 77 December 14 15 27 3 59 Totals 70 97 333 99 599 *School closed for holidays. 24 SCHOOL NOTIFICATIONS. Visits and re-visits concerning measles and the non-notifiable diseases, such as whooping cough, chicken-pox. etc. 2,532 to 3,209 children at 2,109 homes. Of this number, 1,933 visits were for measles. Last year the figures were 1,923, 2,823 and 1,725 respectively. (For further information see Annual Report of School Medical Officer.) GENERAL WORK. Visits to Private Schools 0 Enquiries re Complaints 23 Miscellaneous Visits 126 Visits re Nuisances 68 Visits re Overcrowding 1 Total 218 WOMEN OFFICERS' INDOOR WORK, 1919. Office Work. Statistical Work. Tuberculosis Accounts. Infant Welfare Centre. Miss Hudson 39 74 ½ Miss Shiner 158¾ 5½ - 81 half-days Miss Bintcliffe 117 10½ - 43 half-days Mrs. Hobbs 114½ — - — Miss Simpson 481 - - - Total days 477½ 23½ 4 124 half-days MUNICIPAL MILK SUPPLY. On October 28th the Council considered a resolution of the Labour Party, viz.:—"That this Edmonton Trades Council and Labour Party calls upon the Edmonton Urban District Council to make provision for the supply of milk at reduced price, or free (if circumstances prove necessity) for the use of children, invalids, and nursing mothers, as provided for in the various Milk Orders of 1918-19." Also a letter to the same effect from the Maternity and Child Welfare Committee, and stating that the Committee unanimously agreed to assist the Council, if required, to carry out the particulars of the Milk Order No. 89, 1918. Also a letter from the Ministry of Health, of the 14th October, with reference to the supply of milk for necessitous mothers and young children. 25 The Council resolved to put this Order into force, and that the subject be referred to the Public Health Committee, with instructions to draw up a scheme for the consideration of the Council and the Ministry of Health. In November, the Public Health Committee reported that, after giving consideration to the above-mentioned letters, it had been decided (on the advice of the M.O.H.) to convene a conference of that Committee with the representatives of the medical practitioners, midwives, milk retailers, War Pensions Committee, Canteen Committee, Food Control Committee, Maternity and Child Welfare Committee, and the Relieving Officer of the Guardians, for the purpose of obtaining the views of the various parties interested. This conference was held on Monday, 17th November, when it appeared that the only other source of distribution which might overlap the Council's was that by. the Guardians through the Relieving Officers, who at that time were distributing milk at the value of £8 8s per week, but this supply was distributed not only to those the Council proposed to deal with, i.e., expectant and nursing mothers and children under five years of age, but also to invalids, old people and weakly children over five years of age. To avoid over-lapping in this direction, the special meeting of the Public Health Committee of the 21st November recommended that the Guardians be requested to furnish the Medical Officer of Health, every four weeks, with a list of the names and addresses of the families in the Edmonton Urban District who have received milk from the Guardians, and the quantity per day allowed. At this special meeting of the Public Health Committee, the Medical Officer of Health presented a Report on "Municipal Milk Scheme," dated 20th November, as follows:— To the Chairman and Members of the Public Health Committee. Mrs. Benjafield and Gentlemen, At your special meeting for to-morrow, 1 propose to read to you, for remembrance, a condensed transcript of the shorthand notes of the conference between you and the representatives of the various bodies in the district on Monday last, the 17th instant. As regards the scheme itself, the basis is, of course, the circular of the Ministry of Health, dated the 11th October, 1919, and addressed to County Councils and Sanitary Authorities. Herein the Ministry asks that Local Authorities (who have hitherto not made arrangements) should carefully consider the question without delay, after receiving the report on the local circumstances from their Medical Officer of Health. Any scheme adopted in pursuance of this circular should be communicated to the Ministry with the estimate of the cost. If our scheme 26 is approved we may expect a grant from the Government, nof exceeding onehalf of the expenditure. The Council may provide the milk for expectant and nursing mothers and children under five years of age, at cost price, less than cost price, or for nothing, according to the circumstances of each case. With reference to the charges, if any, I submit to you a scale of economic circumstances on a separate sheet, which is already in force in Willesden and Tottenham. QUANTITIES. The following quantities must not, as a rule, be exceeded:— (a) For children under 18 months, not more than one and a half pints daily. (b) For children between 18 months and 5 years, not more than one pint daily. (c) For expectant and nursing mothers, the quantity specified by me. If dried milk or preparations of milk are used, the quantity should be such as would, when properly re-constituted, be approximate to the quantities of fresh milk given above. MATERNITY AND CHILD WELFARE CENTRE. The representative at the conference informed you that milk in a dry form (Glaxo) has been for a Ions time distributed to the mothers there. The distribution amounts to one to two cases each week, one case containing 48 packets. As this distribution does not appear to incur any charge on the rites, the matter may be regarded as one outside, and not interfering with, your scheme. PROCEDURE. I propose that this should be as simple as possible consistent with efficiency and precautions against abuse. I propose to circularise the medical men and midwives residing or practising in the district, asking them to inform me of any case coming before their notice where the supply of municipal milk seems desirable at cost price,, less than cost price, or free. These recommendations, or any others reaching me from other sources, will be subject to enquiries by the Health Visitors, on receipt of whose reports as to the home and economic circumstances of the family, I shall be able to issue orders upon the milk retailers. These orders will be served upon the milkman who ordinarily supplies the family, and for a period not exceeding one month. For this service I shall prepare special cards of enquiry for the Women Inspectors, which, when filled up 27 and filed, will furnish a record of the scheme's progress, and thereon I shall prepare a report to you at each monthly meeting. You will note that on Page 3 of the Ministry's circular it says:— "It is important that the health visiting staff should be sufficient " to enable all children under five to be kept under supervision for "this and other purposes." I am, Mrs. Benjafield and Gentlemen, Your obedient servant, SIDNEY C. LAWRENCE, Medical Officer of Health The Committee recommended the Council of the 25th November to adopt the proposals of the Medical Officer of Health contained in the last section of his fieport ("Procedure"), and that a scale be adopted for the supply of milk free, or at half-cost to suitable cases. These proposals of the Committee were adopted by the Council. At the same meeting a deputation was received from the Women's Section of the Labour Party with regard to the present price and supply of milk in the district: also a letter was received from the Workers' Union calling upon the Council to inaugurate a municipal milk supply under Article 4 of the Profiteering Act, 1919, and to apply to the Ministry of Health for half-cost. The deputation urged the establishment of municipal milk depots as a means to improve the distribution of milk and to lower the price. The Public Health Committee of the 3rd December reported that pending the Ministry of Health's approval to the Council's scheme, they had authorised the Medical Officer of Health to commence to supply the milk. On the 10th December a conference of Local Authorities was held at the Guildhall, London, E.C., at which Edmonton was represented by four Councillors who, on the 23rd December, reported thereon to the Council that the conference demanded an immediate reduction of the prices of milk, and called upon the Government to introduce legislation extending the operation of Clause 12 of the Milk and Dairies (Consolidation) Act, 1915 so that. Local Authorities might establish and maintain depots for the sale of milk to all members of the community at not less than cost price; further, this conference urged upon Education Authorities the supreme necessity of supplying necessitous children attending the public elementary schools with milk free of charge; and that they be asked to instruct their Care Committees accordingly; the conference also appointed a deputation, consisting of one representative of each Local Authority of Greater London, to wait upon the Prime Minister at the earliest possible date in furtherance of the above resolutions. 28 On December 17th the Ministry of Health sent their approval of the Council's scheme, but pointed out that the income limits laid down in the scheme are high in comparison with similar scales in force in other urban areas, and trusting that the practical working of the scale would be kept under careful observation, and asking that the Ministry might be furnished with the estimated cost of the scheme as soon as this can be ascertained. On December "23rd the Council adopted a resolution from Rhondda District Council, and agreed to forward the same to the Prime Minister, the Minister of Health, Food Controller, and Edmonton's Member of Parliament, viz.:— " That in view of the diminution in the consumption of milk owing to the present high price thereof and the consequent inability of the milk vendors to earn a living wage, and their intention at an early date to suspend their businesses unless immediate steps are taken by the Government to reduce the price allowed to be charged by the wholesale dealers, this Council appeal to the Government to reduce forthwith the prices authorised to be charged by wholesale and retail dealers in milk, so as to obviate the threatened suspension of deliveries by the retail dealers and the consequent hardship which would be involved thereby to the public of this large industrial area. That this Council requests that in view of the subsidy of Is. 8d. per gallon allowed on the milk to be made into Grade 'A' cheese, that 8d. per gallon be paid on all milk supplied to dealers and wholesalers, thereby allowing milk to be retailed at 10d. per quart.'' MATERNITY AND CHILD WELFARE. When the Council, on December 19th, 1917, decided to take over the Centre, it was stipulated that a report should be presented every month from the Committee, but this has not been adhered to; the number of reports presented at Council meetings of 1919 varied from none to three! A report dated January 24th was presented on February 25th. It stated that the Committee had now extended its work to the treatment of minor ailments, and had under consideration the further extension of the work with regard to (a) dental treatment and (b) ante-natal treatment. The next one, dated February 28th, was submitted on March 25th, in which it was announced that the County Council had suggested a conference with the District Councils on maternity and child welfare schemes. The Committee also announced that they had agreed to start ante-natal treatment— the clinic to be held half-an-hour before the present session at the Centre, viz., from 2—2.30 p.m., and that Mrs. Outram be paid half-a-guinea per session of one hour or less; that an advertisement be issued for a dentist to attend fortnightly, the fee to be one guinea per session of two hours; (antenatal equipment to cost £10, dental equipment £65); that to comply with 29 the requirements of the Maternity and Child Welfare Act, 1918, the Council be recommended to increase the number of the Committee to 27 members— 7 ladies, 2 medical practitioners and 18 Councillors; but on 22nd April the new Council resolved that the new Maternity and Child Welfare Committee should consist of 30 members—20 Councillors and 10 co-opted members; the latter to consist of seven ladies, two medical practitioners and one gentleman. It was further resolved that Drs. Shaw and Moss be the medical practitioners and that Mr. S. J. Sanders act as "the gentleman." The last-named had lost his seat at the election. No less than three reports—dated March 31st, April 15th and 29th—were submitted on May 27th. A balance-sheet purported to show that the Committee had received from the Council during that year .£100. and from the Local Government Board £111 3s. 10d., making a total of £211 3s. 10d., and that the expenditure had amounted to £455 19s. 9d. The last report stated that Mr. George Rowe had been elected chairman and Mr. S. J. Sanders to the new post of vice-chairman for the ensuing twelve months; that the Standing Orders of the Council were adopted for the guidance of the Committer, and that two sub-committees were appointed for the ensuing year, i.e., the Centre Sub-Committee, to deal with the actual work amongst the mothers and children attending the Centre, and (2) the Supervisory and Finance Sub-Committee, to deal (in consultation with the Supervisor) with the business affairs and policy of the Centre. The Chairman and Vice-Chairman of the Committee to serve on the Sub-Committees ex-officio. Then a report, dated October 26th, was submitted on November 25th, which conveyed reports from the Medical Adviser (Mrs. Outram) and the Secretary (Miss Shiner). The Committee announced that they had abandoned their plans for a separate dental clinic and hoped to co-operate with the Education Committee (which was following the advice given them by the Supervisor long ago). Finally, it was stated: "The work is only now limited by the accommodation provided, a matter which the Council must, at an early date, be asked to take into consideration." At this meeting the recommendation of the Finance Committee of the Council was adopted, that (as suggested by the Government Auditor) the accounts of the Maternity and Child Welfare Committee should be kept by the Council's Accountant and embodied in the Council's accounts; so that in future all accounts of this Committee will come before the Finance Committee of the Council. So far as I can ascertain these were all the reports presented during 1919 by the Committee of whose proceedings, after June, I was not officially made aware, owing to my temporary disassociation from the work. In July, Miss Bintcliffe was permitted to join Miss Shiner in Centre work. The attendance is said to average 71 per session; a very small proportion of the 984 mothers available for education. 30 Maternity Beds at Infirmary.—In January the Public Health Committee reported that a letter of the 17th January had been received from the Clerk of the Board of Guardians, enclosing a copy of a report of the conference between the Guardians and representatives of the Tottenham and Southgate Urban District Councils with reference to the admission of patients from these areas to the maternity wards at the Infirmary; details were given of the conditions governing such admissions. It was decided to leave the Maternity and Child Welfare Committee to submit a report on this subject to the Council. In April the latter Committee advised the Council not to enter into an agreement with the Guardians for the admission of patients to the maternity wards of the Infirmary at present. Edmonton Guardians—Infant Life Protection.—On the 26th November the Guardians conferred with the Medical Officers of Health of the eight districts of the Union, on a letter received from the Ministry of Health vaguely suggesting some alteration in the present method of entrusting this important work to women officers of the Guardians. Nothing was done, as the Guardians had no proposals to submit. By an Order of the Privy Council the Central Authority under Part I. of the Children's Act has been transferred from the Home Office to the Ministry of Health. Your Medical Officer's opinion is that "this should be followed by the transfer (locally) of the powers from the Guardians to your Council, but the transfer must be complete." The Ante-Natal Clinic.—It was opened on October 7th, after spending over £16 on equipment, at the Fore Street Centre, under the care of Mrs. Outram. It takes place every Thursday afternoon. The attendance is said to average only eight! The Ministry of Health.—Drs. McNalty and (Miss) Lambert, at 24 hours' notice, visited me on Wednesday, December 3rd, and again on Tuesday, December 9th. On the latter occasion they visited (without me) the Centre in Fore Street; they interviewed various people, but not the representatives of the medical practitioners nor the midwives, so far as I am aware. Baby Week was held from July 7th to lltn, and the usual demonstrations were arranged, including a baby show. Concerning this function, some doubts are being expressed as to its utility. Dr. Ransome, M.O.H. of Southgate, has expressed the opinion that jealousy and ill-feeling are created by baby shows. Supervisor.—I received no salary whatever for the year ending March, 1918, the first year of the Council's administration, but from April 1st, 1919, to June 24th, 1919, I received some at the rate of £100 a year with bonus. On the latter date the Council passed a resolution purporting to dismiss me 31 forthwith from the post of Supervisor. This action was taken in my absence on holiday and without notice given, or any complaint being stated against my work. This extraordinary action led to the resignation from the Committee of Councillor (Mrs.) Benjafield, the representative of the midwives, Drs. Moss and Shaw, the representatives of the medical practitioners, as a protest thereat. These resignations marked the correctness of my statement in the report for 1918, that " the Committee has failed to secure the confidence and co-operation of all the medical practitioners and midwives." Earnest protests were also sent to the Council by the British Medical Association and its North Middlesex Division, the National Association of Local Government Officers and its Edmonton branch, and the Edmonton Medical Society. I was much gratified to know that the injustice done to me was highly resented by my professional brethren and municipal colleagues. Mrs. A. E. Beer also resigned from the Committee. In my defence I was compelled to take legal proceedings against my Council, which resulted in the issue of a writ in December, and the matter is still in suspense. Rivalry.—In January, 1920, I reported that the Roman Catholics contemplated opening a Centre at St. Edmund's, Hertford Road, which would be open to all mothers residing in our Northern area; thereupon the Public Health Committee recommended the Council to protest to the Ministry of Health against its establishment. THE DAY NURSERY. This is still continuing at "The Rosary," Fore Street, which is opposite our Centre. I have received no report as to its operations from the promoters, Mr. and Mrs. A. E. Beer. I resigned my position as Chairman of the Managers in May. 32 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 eases notified amongst residents and the number isolated, the percentage of these to the cases notified, and the fatality, i.e., the percentage of cases dying to those notified. Disease. Cases Notified. No. isolated in Hospital. Isolations per cent. Total Deaths. Fatality per cent. Scarlet Fever 619 595 96.1 12 1.9 Diphtheria & Mem. Croup 108 102 94.4 10 9.3 Enteric Fever.. nil nil nil nil nil Totals 727 697 — 22 - Compared with last year (1918) the table shows 533 more notifications of scarlet fever, and 11 more fatal cases actually, but only 0.7 per cent, more relatively. There were 72 more notifications of diphtheria and five more deaths but the percentage of fatal cases was 4.2 per cent, less; there were no cases of enteric fever notified and no deaths, so the fatality was nil, compared with 40 per cent, last year amongst five cases. Foreigners.—Eight cases of non-residents were notified from the Edmonton Infirmary—1 diphtheria, 3 erysipelas, 2 puerperal fever, 1 ophthalmia neonatorum and 1 rubella. Besides these, 1 diphtheria, 3 erysipelas, 1 puerperal fever, 2 influenzal pneumonia and 4 primary pneumonia,, were former residents in this district: the 1 diphtheria is therefore included in the above table . There were 1 scarlet fever. 2 primary pneumonia and 1 measles notified from the Epileptic Colony, all non-residents. Amongst the military, I received 6 notifications, as follows:—1 scarlet fever, 1 diphtheria. 1 erysipelas. 1 primary pneumonia and 2 English measles. Cases of tubercle are referred to in another part of my report. Notifications.—For the four weeks ending 22nd November the total number of notifications touched the record for Edmonton at 782, they were distributed as follows:—Scarlet fever, 79; diphtheria, 23; measles, 653; erysipelas, 11; pneumonia, 13; malaria, 2; ophthalmia neonatorum, 1. 33 RATS. In February the County Council approached us, asking for the assistance of the Inspector of Nuisances to undertake the duty of verifying the number killed and checking the claims for payment, which would be met by the County Council; this was agreed to. In March the County Council sent a large quantity of handbills and posters. Note that the "Rats Order, 1919," provides : ' 'It is the duty of owners and occupiers to get rid of rats." So it was proposed to report to the County Council the land and premises in Edmonton that were badly affected . In April it was reported that 121 rats had been paid for at £1 0s. 2d., and that 12 tins of Virus had been received from the War Agricultural Committee. In April the County Council stated that a more recent Order had given power to the County Council to delegate its powers to the District Council, and a further letter in May stated that the bulk of the expenses would still be paid by the County Council; so my Council agreed to carry out the provisions of the new Rat Order in Edmonton. In June it was reported that 127 rats had been paid for at £1 1s. 2d. In July it was reported that 131 rats had been paid for at £1 1s. 10d.; complaint of rats on the dust shoot in Park Road led to an expenditure of £10 on Virus, and a suggestion that the railway company allow rat-catching on the shoot. A dozen tins of Virus were received from the County Agricultural Committee. In September the Council learnt of a letter of the 28th July from the County Council, stating that the latter had decided to appoint an official rat-catcher and two assistants for six months, and that the system of payment for rats would end after the 9th August, and that posters would be issued inviting the public to apply for the services of the said rat catchers. The Inspector reported that up to that date 482 rats had been brought to the Town Hall and paid for. In October a suggestion for holding a rat week was made So from the 20th to the 27th October poison was laid down in many parts of the district, this poison having been supplied mostly by the County Council. Smallpox.—A satisfactory feature of the infectious returns for the year is the absence of smallpox 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 were many Edmonton children unprotected from infection and sure to die if attacked. There were no deaths from chicken-pox. 34 Vaccination.—The following table of vaccination returns for 1919 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. 1354 435 481 85 67 58 nil 149 SCARLET FEVER. Six hundred and nineteen cases were notified, giving an attack rate of 8.17 per 1,000 of the population; 86, 51 and 110 were notified in 1918-17-16. There were 12 deaths, giving a death-rate of 0.16 per 1,000 of the population. No cases were notified from the Edmonton Infirmary, but one from the Epileptic Colony. The latter is not included in the above figures. One case was doubly notified. Secondary cases numbered 118 out of 619. Cases Nos. 433 and 434 were re-notified and sent back to hospital. There were 21 cases notified where subsequent observation did not confirm the diagnosis; they are not included in the above figures. Return Cases.—See section on "Hospitals." In my report for March I reported an epidemic of this disease after some years' interval. During the five weeks ending 29th March there were 37 cases in 28 houses, all of whom were removed to hospital, thus making a sudden demand upon its accommodation. The schools mostly affected were the National and Houndsfield Road Infants'. For the four weeks ending 26th April there were 56 cases in 45 houses. The outbreak had increased in numbers and area, mostly in Lower Edmonton. During the Easter holidays all the elementary schools were thoroughly disinfected. There was no evidence that the spread was due to milk. On the 5th May the Local Government Board asked for a special report on the outbreak of scarlet fever from the M.O.H. For the four weeks ending 24th May there were 51 cases in 41 houses. The type continued of a mild character, so that a number of cases were not notified until they were in the peeling stage; this explained somewhat the spread of the disease, which was now extending towards Upper Edmonton. Croyland Road Infants' School was closed for 21 days owing to measles and scarlet fever. For the five weeks ending 28th June there were 70 cases in 52 houses, many cases being now in Upper Edmonton. There were 6 return cases during the five weeks; this amounted to 8.5 per cent, of the cases notified. The Clerk was instructed to write to the Joint Hospital Board directing their attention to this fact. 35 During the four weeks ending 26th July there were 40 cases in 31 houses. One ease was re-notified and sent back. For the four weeks ending 23rd August there were 56 cases in 45 houses; there were 8 return cases. At the Council meeting of the 26th August, a letter of the 21st August from the Joint Hospital Board, concerning return cases was read, stating "that the Board was satisfied that every care was observed before the patients were discharged from hospital." This report enclosed a report on the subject from Dr. Cook, the Medical Superintendent, dated 1st August. There were 86 cases in 70 houses for the five weeks ending 27th September, and 9 return cases. In October the Joint Hospital Board was asked to allow Dr. Cook, the medical superintendent, to attend the next meeting of the PublicHealth Committee, with reference to one of the return cases. For the four weeks ending 25th October there were 83 cases in 70 houses. For four weeks ending 22nd November there were 79 cases of scarlet fever in 71 houses, and 6 return cases. A letter was sent, in December, to the Joint Hospital Board with reference thereto. For the five weeks ending 27th December there were 53 cases in 46 houses— 4 return cases. Another letter was sent to the Joint Hospital Board in January, 1920. DIPHTHERIA AND MEMBRANOUS CROUP. I received notifications of 109 cases during the year, compared with 37, 20 and 67 in 1918-17-16, and they represent an attack rate of 1.43 per thousand of the population. There were 10 deaths, giving a death-rate of 0.13 per thousand of the population. There were no cases doubly notified. There were 16 secondary cases. There were two cases notified from the. Edmonton Infirmary—one an Edmonton resident and one a non-resident. Cases Nos. 8 and 503 were re-notified and sent back to hospital. There were two 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. Return Cases.—See section on " Hospitals." In March a boy of 6 years was re-notified and sent back to hospital, still suffering from nasal trouble. In May the M.O.H. reported the case of a medical practitioner who handed over a swab to, and directed the mother of the patient to use it herself on her daughter. The Clerk was directed to write a letter of severe remonstrance, and report the matter to the Local Government Board, who did not advise any further action. 36 In November, on the recommendation of the Public Health Committee, it was arranged for a special messenger to take swabs direct to the laboratory, and so avoid delays in cultivation reports thereon. 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.—No cases were notified. Acute Anterior Poliomyelitis.—No cases were notified. Cerebro-Spinal Fever.—The last case was notified on 7th December, 1918. None in 1919. One death of a resident was certified as due to basal meningitis, class 61 ; a boy of two years. 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, 1920, was £7,768, compared with £4,806 for the previous year. The Superintendent's report for the year ending March, 1919, reached me on August 3rd, 1920. The Accommodation.—The Hospital contains 163 beds, as follows:— Block I.—Beds, 2 Observation. Block II.—Beds, 26 Scarlet Fever. Block III.—Beds, 26 Scarlet Fever. Block IV.—Beds, 26 Scarlet Fever. Block V.—Beds, 18 Scarlet Fever. Block VI.—Beds, 13 Diphtheria. Block VII.—Beds, 26 Diphtheria. Block VIII.—Beds, 14 Enteric Fever. Block IX.—Beds, 12 Cubicles, for doubtful or mixed cases. 163 "As Block I. (two beds) is seldom in use, it has been handed over to a portion of the night staff as sleeping quarters, and being in a quiet spot, answers admirably. At any time it can be used for the purpose for which it was originally intended." 37 During 1918-19 the greatest number of patients resident on one day was 66, that is 97 below the normal accommodation; the smallest number was eight. The patients admitted from other districts appear to have been 11, viz., 4 scarlet fever and 7 diphtheria, or 3.9 per cent, of all admissions; it was 2.1 in 1917-18. 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, four sisters (one for night duty), four staff nurses, five probationers, and three ward-maids. In 1918-19 the resident staff numbered 38 and the outdoor staff four, compared with 34 and four the year before. Three of the staff contracted scarlet fever. Treatment of Diphtheria.—The Superintendent again 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 were 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 1919 there have been 33 such of scarlet fever and 1 of diphtheria. Dr. Cook estimates the percentage of return cases of scarlet fever during 1918-19 as 4.76, compared with 1.11 for the previous period. 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." In April, Mr. W. A. Cull was appointed for three years to the Joint Board, vice Mr. Cornish. On the 28th March the Board wrote the Council that The Board at their meeting yesterday decided to set apart one of the blocks at their Hospital for the reception of cases of malaria, dysentery, trench fever, and such cases of pneumonia as are contemplated on Page 5 of the memorandum of the Local Government Board, dated January, 1919, on the understanding that each case is recommended by the Medical Officer of Health of one of the constituent districts.'' On the 15th May the Enfield Council wrote declining to arrange for a conference with my Council with the object of urging the Joint Hospital Board to admit measles cases, and remarking that our representatives could bring the matter before the Joint Hospital Board, if they thought fit, or were requested by my Council to do so. 38 In October the Public Health Committee instructed the Clerk to ask the Board to permit the attendance of Dr. Cook, the Medical Superintendent, at their November meeting, in reference to a return case, but on November 28th the Board wrote stating that whilst admitting that a mistake had been made, no good would result from allowing Dr. Cook to attend. On December 3rd I reported to the Public Health Committee that great difficulty was being experienced in obtaining hospital accommodation for the isolation of cases of scarlet fever and diphtheria, our hospital at Winchmore Hill being quite full. Every effort had been made by the Medical Superintendent and Clerk of the Joint Board, but they had only been able to provide additional accommodation for diphtheria at the Cheshunt Isolation Hospital, and in order to help Cheshunt, bedsteads and bedding were sent from our store at Picketts Lock Lane. A statement was submitted by me showing the number of cases (11 to date) which had not been removed to hospital. Instructions were given for a letter to be sent to the Enfield and Edmonton Joint Isolation Board, pointing out the number of cases which had not been received there, and asking for every possible step to be taken to obtain accommodation for the same. In December it was decided that the weekly infectious returns to the Government from England and Wales should be laid before the Public Health Committee at every meeting; also that the Ministry of Health be asked" to hold a Government enquiry owing to the continual epidemic of infectious disease occurring in the district." Arrangements had to be made in some cases to provide nursing in the homes at the cost of the ratepayers. On 7th January, 1920, I was able to report that there were only nine cases of diphtheria in the Cheshunt Hospital, and I pointed out that for the past three months a mixed incidence of scarlet fever and measles had caused trouble at our hospital, and that finally a ward or wards had been set aside for such cases. The Board wrote that every endeavour would be made to find accommodation in our hospital or elsewhere for cases requiring isolation. Transport.—This continues on the old-fashioned lines by the Council's horse-drawn vehicle. As I have been saying for the past 14 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 Smallpox Hospital Board. Motor Ambulance.—In June a report was presented from a sub-committee of the Public Health Committee who had joined the Inspector of Nuisances in considering the advisability of motorising all vehicles used by the Public Health Department. This question, in course of time, had merged into the provision of vehicles to enable the Council to collect house refuse without the 39 intervention of a contractor. The consideration of this report was referred to a special meeting of the Council, but at the end of the year the subject was not settled. In September it was stated that the ambulance had run something like 2,680 miles to convey patients from their homes to our Isolation Hospital during 12 months' use. During this time it had met with some vicissitudes, needing repairs, and in December £26 was spent on a complete overhaul. Accident Ambulance.—In September it was agreed that in future no charge be made to residents for its use. SMALLPOX HOSPITAL ACCOMMODATION. Since January 31st, 1907, the Middlesex Districts Joint Smallpox Hospital has been in existence at South Minims. 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 (£242 for 1919-20—it was £237 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. During 1919, six cases (all from Finchley) were admitted to Oxbridge. Twenty-two urban districts are now shareholders in the Joint Hospital. In April, Mr. George Rowe was appointed for three years on this Board, vice Mr. S. J. Sanders. In June the urban districts of Finchley and Kingsbury, and the rural districts of Staines and South Mimms, were included in the constituent authorities of the Middlesex Districts Joint Smallpox Hospital Board. In August, our Engineer was permitted to advise on the treatment of sewage at Clare Hall. During the year I had under observation contacts with cases which had occurred on board ship, or in London and suburbs, etc., but no developments arose. The number of tuberculosis cases in the institution on December 27th, 1919, was 163, 18 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. 40 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. Their unlimited use does not prevent outbreaks of infectious disease as this report shows; it discourages cleanliness. In my own home, during 15 years' residence in Edmonton, I have used none and yet kept it clean and free from infectious disease. BACTERIOLOGICAL LABORATORY During the year the following specimens were examined and repoited upon:— Disease. Result Positive. Result Negative. Doubtful. Total. Diphtheria 43 68 - 1ll Enteric Fever — 2 — 2 Tubercle (sputum) 2 2 — 4 Cerebro-spinal Fever - 1 - 1 Totals 45 73 — 118 PUERPERAL FEVER. Four residents were notified, including one from the London Hospital and one from the Infirmary. There were 2 deaths. Our death-rate is therefore 1.62 per 1,000 births; it was nil last year. Moreover, two women, one of Tottenham and one of Wood Green, were notified as inmates of the Infirmary. During 1918 there were 233 midwives practising privately in Middlesex and 556 not practising; besides, there were 22 engaged in poor-law infirmaries, who are exempt from the provisions of the Act. In Edmonton there were 14 practising at the beginning of 1918 and also at the end of the year. One midwife, reported to the Central Midwives Board in 1917, was struck off the roll in 1918, and nine were cautioned verbally. During that year no uncertified women were prosecuted by the County Council for acting as midwives, but eleven were verbally cautioned by the Inspector of Midwives, Miss Pollard, who now has an assistant. 41 Training of Midwives.—On the 10th October I received from the Ministry of Health a circular drawing attention to the new regulations made by the Board of Education. It points out that grants will be made by that Board not exceeding £20 for each probationer who is taking a six months' course for the C.M.B. Grants will also be paid for a course for midwives in practice, lasting two to six weeks. Grants towards maintaining an adequate midwifery service remain in force, as advised in the .Local Government Board's circular of 9th August, 1918, to Maternity and Child Welfare Centres. This circular is addressed to Supervisory Authorities under the Midwives Act and to Local Authorities conducting Maternity and Child Welfare Centres. There are (November, 1919) only seven midwives residing and practising in Edmonton, of whom only two are untrained. I drew the attention of these two midwives to the facilities now at hand for their benefit. OPHTHALMIA NEONATORUM. There were 14 cases, all residents, notified during 1919 by 16 notifications; also one, a Hornsey infant, was notified to me from the Edmonton Infirmary. Of the 14, four were in BuryStreet,5 in Fore Street and 5 in Church Street Ward. One case was doubly notified by two doctors and one by a doctor and a midwife. Of the single notifications, all were from doctors and none from midwives. Miss Shiner paid 87 visits in connection with these cases; last year she paid 45 visits to 7 cases. ERYSIPELAS. Fifty-five cases were notified, compared with 34 in the previous year, none occurring in the Edmonton Union Infirmary. There was one death— an infant from this cause. No cases were doubly notified. Eight 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 1919. PHTHISIS AND OTHER TUBERCULOUS DISEASES. The deaths from phthisis numbered 59, as compared with 69, 86 and 69 during 1918-17-16. The death-rate from the disease is therefore 0.78 per 1,000, compared with 0.93 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 31. 42 The other tubercular diseases together accounted for 18 deaths, giving a death-rate of 0.23 per 1,000. It was 0.27 last year. Of these deaths, four were residents of the district in the Edmonton Workhouse. The total deaths from these diseases in the Edmonton Workhouse numbered seven. In this way, tuberculosis contributed a total death-rate of 1.02 per 1,000 of our own population, or 11.0 per cent. of all the deaths, excluding strangers; it was 9.8 last year. The Women Inspectors paid to consumptives 237 visits and re-visits during the year, compared with 593 the year before, and also 18 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.—See Section VI., "Unsound Food." Institutional Accommodation.—I have received the following information with reference to this:— 1.—Edmonton Workhouse and Old Infirmary.—A few chronic cases are retained here, but all cases likely to benefit are transferred to Grosvenor Sanatorium, Kennington, near Ashford, Kent. 2.—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 250— 157 males and 93 females. The number of notifications was 448. Lungs— Patients notified once 83 ,, twice 66 ,, ,, thrice 29 ,, ,, four times 16 ,, ,, five times 1 ,, ,, six times 1 196 Other Forms— Patients notified once 40 ,, ,, twice 11 ,, ,, thrice 3 54 43 The notifications are thus analysed:— Received from— Pulmonary. Other forms M. F. M. F. Private Practitioners (A) 30 20 6 5 S.M.I. (B) 3 2 3 2 Sanatoria (C and D) 114 66 5 4 Infirmary (A, C and D) 4 8 3 0 District Medical Officer 1 0 1 0 Hospitals (A, C and D) 3 0 0 0 Other Institutions (A, C and D) 13 19 11 9 Dispensary (No. 1 and other areas) 55 32 15 6 Voluntary 2 1 0 0 Military, from our own and other Hospitals 4 0 0 0 229 148 45 26 377 71 The National Association for the Prevention of Tuberculosis.— The 7th Annual Conference was held at the Centra] Hall, Westminster, on the 16th, 17th and 18th October. The Chairman of my Council and the Engineer were deputed to attend for Edmonton. I have no useful deductions to draw from their report. The highly technical nature of the debates must have prevented much enlightenment reaching the lay representatives present. The opening address was given by the Minister of Health, the Right Honourable Christopher Addison, M.D., M.P., with Lord Glenconner in the chair. I was favoured with a special invitation from the Association, but pressure of work prevented me fully attending this interesting gathering. It was endeavoured to limit the discussions to "The completion of tuberculosis schemes throughout the country," in relation to—(1) the Ministry of Health, (2) Local Authorities and Insurance Committees, (3) War Pensions Boards and Committees, (4) medical practitioners, (5) Red Cross and other voluntary activities, (6) training of doctors and nurses, (7) training of voluntary workers. The Public Health (Tuberculosis) Regulations, 1918, were withdrawn in March by the Government; they had provided for a weekly return from the M.O.H. of all cases of tubercle amongst men between the ages of 16 and 41 years to the Ministry of National Service. Scholars.—Ten children—6 boys and 4 girls—were notified by the School Medical Inspector during the year as suffering from tuberculosis, 3 boys and 2 girls from pulmonary tuberculosis, and the same from other forms of tubercle. 44 In regard to the provision to be made for tuberculous discharged soldiers and sailors, the report to the Government of the inter-departmental committee over which Sir Montague Barlow presided, recommended, amongst other things, that a grant of a million sterling should be made to finance village settlements of a permanent kind. How far the Treasury will go remains to be ascertained, but an immediate additional grant of £10,000 for work that can be done within the present financial year has been sanctioned by Parliament. THE MEASLES EPIDEMIC. There were 10 deaths, compared with 7, 17 and 29, in 1918-17-16. This number is equal to a death-rate of 0.13 per 1,000 living, compared with 0.09 last year. The rate was 0.10 in England and Wales, 0.08 in London, and 0.13 in the 96 Great Towns (including London). None occurred in the first age-period (under one year), two in the second period (one and under two years), four in the third (two and under five years), and four between five and fifteen years of age. There was none in the Infirmary. I received notifications about 2,495 cases—2,357 being defined as English and 138 as Rubella (formerly "German measles"). Of these, 2,356 English and 137 Rubella were among residents; one English and one Rubella were notified amongst strangers at the Infirmary. The attack-rate was therefore 32.91 for every 1,000 inhabitants. Doctors notified 1,430 English and 85 Rubella, and parents 927 English and 53 Rubella. Thirty-five 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 two military cases; both of these were English. For the four weeks ending 24th May, 60 cases in 56 houses (4 G) were reported, compared with 14 cases in 13 houses during the previous four weeks. During the five weeks ending 28th June, 207 cases in 158 houses (17 G.). The closure of Croyland Road Infants' School for a fortnight was extended for another week. The M.O.H. addressed a circular to the Managers of the Sunday Schools. For the four weeks ending 26th July there were 298 cases in 231 houses (33 G.). The type of disease was mild. I was not aware until a few days before, that Peace Celebrations on Thursday, July 24th, would involve the use of school buildings. I had thought that the festivities were confined to the open spaces of Pymmes Park. On July 22nd, as M.O.H., I addressed a circular to all the head teachers of the public elementary schools, asking them to help the Council and myself by remembering that exclusion notices affecting patients and contacts beyond July 24th have effect in preventing such persons invading the school buildings on that date, and by announcing this fact to their scholars at once. 45 For the four weeks ending 23rd August there were 387 cases in 285 houses (31 G). The type of disease was still mild. In August all schools and church halls were thoroughly disinfected. For the five weeks ending 27th September there were 164 cases in 122 houses (9 G.). For the four weeks ending 25th October there were 348 cases in 273 houses (11 G.). Disinfection again at Brettenham Road, Silver Street and Houndsfield Road Schools. For the four weeks ending 22nd November there were 653 cases in 519 houses (16 G.). Closure of all junior mixed and infants' departments was carried out a week earlier than usual before Christmas, in order to give more time for the thorough disinfection and aeration of all class-rooms. For the five weeks ending 27th December there were 339 cases in 270 houses (15 G.). The epidemic seemed now declining. On December 12th I issued a circular to the Sunday School managers advising them to limit the use of their buildings during Christmas time, and to refuse admission to their entertainments of children under 8 years of age. Measles Regulations, 1915.—On the 27th November an Order of the Ministry of Health was issued, withdrawing at the end of 1919 these Regulations. On the advice of the M.O.H., the Council decided to obtain an Order continuing the Regulations up to March 31st, 1920. An Order of the Ministry of Health, dated 31st December, 1919, continued the Regulations as desired. In January, 1920, the M.O.H. advised that compulsory notification be continued permanently, or at least until the end of 1920, but no action was taken thereon. The M.O.H. distributed to the Councillors copies of his leaflet on the subject, which are distributed by the Health Visitors amongst affected families, hoping that the perusal would give them (judging from the respective death-rates) an idea of the really serious nature of measles compared with scarlet fever or diphtheria. PUBLIC HEALTH (ACUTE ENCEPHALITIS LETHARGICA AND ACUTE POLIO-ENCEPHALITIS) REGULATIONS, 1918. which were only in force for 1919, were, by circular of the Ministry of Health, dated 31st December, 1919, continued until further notice. None were so notified. PNEUMONIA, ETC., REGULATIONS, 1919. Order dated 7th January, 1919. Its object is to secure notification throughout England and Wales, of pneumonia (primary, or after influenza), malaria, dysentery and trench fever. It confers considerable powers and duties upon Local Sanitary Authorities and their Medical Officers of Health. The Order was accompanied by a circular and a memorandum on pneumonia. The Regulations came into force on March 1st, 1919. 46 In May, the Joint Hospital Board set apart one of the blocks for cases of pneumonia, malaria, dysentery, and trench fever which are selected by the M.O.H. District Nursing Service.—In March the Public Health Committee appointed a sub-committee to consider the Pneumonia, etc., Regulations, the Ministry of Health Bill, the Influenza Regulations, 1918, the Lousiness and Itch circular, 1919, and the duties of the Council thereunder. This subcommittee met on the 14th March, and in default of a special meeting of the Public Health Committee, its report was presented at the ordinary Committee in April, when they advised that negotiations be opened with Bury House for the provision of district nurses as and when required. In July, I submitted the outlines of a suitable agreement, and a sub-committee was appointed to consider the matter; meanwhile I was empowered to obtain trained nurses' assistance, if necessary and possible. This sub-committee reported on September 2nd, but at the end of the year nothing had been settled. In September plans were passed for alteration and additions to Bury House. In October I again pointed out the importance of settling this matter before winter set in, and warned my Committee that (failing provision for home nursing) the number of deaths might be considerable. The following notifications under this Order were notified by the end of 1919:— Pneumonia, 102 cases—primary, 74; after influenza, 28. Malaria, 38 cases, all contracted abroad in the first instance; one case was complicated with dysentery. Trench Fever.—The first and only case was notified in July. 47 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 10 less; the deaths from diarrhœa have been 6 less than last year; from influenza 160 less than last year, when they numbered 212. 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. Eleven deaths occurred from diarrhœa and epidemic enteritis, as compared with 17, 22 and 34 for 1918-17-16. The death-rate from the disease is 0.15 per 1,000 of the population, as compared with 0.23 last year. Of these deaths, 6 occurred in children under one year of age, giving an infantile mortality rate for the year from this cause of just under 5 per thousand nett births; the numbers in 1918-17-16 were 12, 9 and 15. Six deaths were in children under two years; these contribute to the zymotic death-rate. The Local Weather.—Total rainfall was considerable. Temperature was moderate. The total sunshine was good—better than in London. A heavy snowfall on Sunday, April 27th, and cold nights in May, accounted for the poor fruit season of 1919. WHOOPING COUGH. There were 4 deaths from this cause, as compared with 14, 13 and 9 in 1918-17-16. This is equal to a death-rate from the disease of 0.95 per 1,000 living, compared with 0.19 last year. All the deaths occurred amongst children under five years of age—3 in the first age-period and 1 in the third. One in May, June, July and August. INFLUENZA. Fifty-eight deaths amongst residents were due to this cause, compared with 218, 6 and 7 in 1918-17-16. The 58 deaths were divided into the following age-periods:—0 under one year, 1 between one and two, 4 between two and five, 2 between five and fifteen, 7 between fifteen and twenty-five, 20 between twenty-five and forty-five, 12 between forty-five and sixty-five, 12 sixty-five and upwards. Total, 58. 48 The death-rate was 0.77 per 1,000 inhabitants, compared with 2.93 in 1918. Besides, there were 20 deaths amongst non-residents in the Infirmary, none in the Epileptic Colony, and 14 amongst the military. In March I reported that this disease was much in evidence again. During the four weeks ended February 22nd, there were 17 deaths, compared with 6 for the previous four weeks. The new outbreak presented similar characteristics to the last one, i.e., it was most fatal between the ages of 18 and 45, and the secondary cause of death was usually pneumonia. The Local Government Board sent a specimen leaflet of advice, dated February, 1919, similar to the one issued in November, 1918, 7,000 of which were distributed. The Board also sent a memorandum on the prevention of influenza, containing directions as to the action to be taken by the Authority. Under the Pneumonia, etc., Regulations, which came into force on the 1st March, 17 cases of pneumonia following influenza were notified during the five weeks ending 29th March. None were removed to our Hospital. The deaths among residents from influenza number 20 for the same period; there were 17 for the previous four weeks. In a circular of the Local Government Board of the 13th March I was instructed to forward each week a separate return, on a card provided by the Board, of the number of deaths registered weekly as due to influenza, beginning with the week ending 22nd March. In a letter of the 28th March, from the Joint Hospital Board, it was announced:— "That the Board, at their meeting yesterday, decided to set apart one of the blocks at their hospital for the reception of cases of malaria, dysentery, trench fever, and such cases of pneumonia as are contemplated on Page 5 of the memorandum of the Local Government Board, dated January, 1919, on the understanding that each case is recommended by the Medical Officer of Health of one of the constituent districts," of Enfield and Edmonton. The deaths amongst residents for the four weeks ending 26th April were only five, compared with 20 for the previous five weeks, so that the third wave of this disease since last July appeared to have spent its force. There were five cases of influenzal pneumonia in five houses. There were only two deaths from influenza amongst the residents of Edmonton for the four weeks ending May 24th. By an Order of the 6th May, the Local Government Board rescinded the Public Health (Influenza) Regulations, 1918, both sets, so that the power of Local Authorities over picture palaces is withdrawn. On the 23rd December the Medical Officer received from the Ministry of Health a circular letter, dated the 20th, accompanied by a memorandum on 49 the prevention of influenza, and a pamphlet of instructions to Medical Officers of Health on Influenza Vaccine. The memorandum is a revision of the one issued by the Local Government Board in February, 1919. There were few cases of the disease in the district at that time, but the Ministry advised that the Council's plans for dealing with it should be determined in advance of any fresh epidemic. The Council was authorised thereby to provide medical, including nursing assistance to the poor inhabitants, and to supply medical practitioners with preventive vaccine. A copy of the memorandum was sent by me to each Councillor. VENEREAL DISEASES. Four deaths were recorded as due to these diseases in their primary forms, viz., 1 gonorrhoea and 3 from congenital syphilis, but deaths due to their later effects are recorded, e.g., general paralysis of insane, locomotor ataxy, stricture, etc. On April 24th I received a circular from the Middlesex County Council accompanying a revised list of hospitals in the London area which give free and confidential treatment; also copies of leaflets. In September, 50 large posters, provided by the County Council, were exhibited on our hoardings. OTHER DISEASES. Alcoholism.—One death from this cause was recorded in Church Street Ward. The death returns of this disease, as in the instance of venereal diseases, are most deceptive. Anthrax.—Amongst the deaths registered outside the district was one of a man aged 54 years, on the 29th April. At the inquest, held at St. Bartholomew's Hospital, the verdict was that he had died from anthrax contracted during his employment as foreman of a horse-hair factory. Tetanus.—On November 5th I received from the Ministry of Health a circular, dated 31st October, with a memorandum of the same date. The Ministry proposed to place some Army stock of anti-toxin at my disposal (over a limited period) for distribution to practitioners; fortunately there was no need to apply for any, as the disease is practically unknown here. Foot-and-Mouth Disease.—On November 5th I received a circular from the Ministry of Health and a copy of a handbill setting out the characteristic symptoms of this disease now prevailing in parts of the country. Rabies.—On April 17th I received from the Local Government Board a circular letter of the 16th enclosing a memorandum marked "revised December, 1918," hitherto circulated only in the West of England, where cases had 50 occurred in the latter half of the year. The letter asked every M.O.H. to at once forward to the Local Government Board any particulars of any person in his area bitten by a presumably mad dog, with a view to the treatment at Plymouth. On April 29th I received another revision of the memorandum providing treatment at St. Thomas's Hospital in London. The expenses of persons bitten may be paid by the Local Authority. On June 24th a third memorandum was issued by the Local Government Board on the procedure recommended to be followed in the event of persons being bitten by dogs suspected or ascertained to be rabid, showing that treatment was now available also at Newcastle, Cardiff and Manchester. Respiratory Diseases, including bronchitis, pneumonia, pleurisy, and other non-tuberculous diseases of the respiratory system, gave rise to 46 less deaths than in 1918. The number was 114, giving a death-rate of 1.51 per 1,000, compared with 160 and a death-rate of 2.14 for the latter year. Some deaths, certified as due to pneumonia in the last quarter, had influenza as the primary cause. Cancer.—Sixty-five deaths of Edmonton residents were certified as being due to cancer, and this is equivalent to a death-rate of 0.86. compared with 0.7 last year. The deaths during 1918-17-16 were 52, 49 and 55. 51 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 district of Southgate, passes to the Council's Sewage Farm of 233 acres. Mr. Frank Rackham is the farm bailiff. In December, 1918, the Enfield Council sent a deputation to view it. The two huts left by the military at Pymmes Park camp, were removed to the farm in November. THE SEWAGE FARM. Filter Beds.—A new one has been commenced on the north side of the last one constructed. The bed will be 150ft. X 100ft. The Engineer reported in October and November that its completion was delayed owing to the difficulty in getting cement; on the second occasion the attention of the Housing Board and the Ministry of Transport was drawn to the difficulty. In January the Stepney Borough Council supplied clinkers at a cost only of 1s. 7d. per ton for carriage. In May two bads were being worked alternately and satisfactorily. In July the third bed was completed. In November a mechanical raking screen was bought, and in December a light railway was started. Sludge Beds.—The under-draining of the sludge beds has been completed. The beds consist of four sections, divided by air duct and sludge channels, and each section is capable of being worked independently. The drains are open to the air at both ends. The drying of the sludge is thus greatly facilitated. Effluent.—In June the effluent was affected by water from tarred roads fouling Sadler's stream. In November the Council's attention was directed to an old trouble, which the Gas Company once more promised to stop— outflow of sulphate of ammonium. Gravel.—The Engineering Inspector from the Ministry of Health visited the farm on September 3rd re further removal of material from the Council's pit. In October the Ministry of Health agreed to gravel and sand being excavated from an area not exceeding 1½ acres, provided that none be sold, but only used by the Council for public works. Enfield asked if Edmonton would renew consideration of the Lea Valley drainage scheme. On the 25th November our Council decided in the negative. 52 Southgate.—At the end of 1918 our Council applied for £1,301 towards the increased cost of dealing with Southgate sewage during the four vears ending 1918. In June the offer was submitted from Southgate to pay £164, but in December £256 was offered and accepted, and another agreement for three years, ending 31st March, 1921, as regards increased contributions in the future from Southgate, was agreed on. Enfield.—The sewage farm of the Enfield Urban District extends over 109 acres, and is entirely situate in Edmonton, lying to the north of our own farm. There are six bacteriological filters. HOUSE REFUSE DISPOSAL. Edmonton does not possess a destructor; the sad but eventful story below will show the necessity for it, as well as for an efficient collection. In December, 1918, and up to March, 1919, the house refuse was still deposited on the waste land in Park Road belonging to and lying west of the Great Eastern Railway. In January, 40 complaints were received, and the Council empowered the Public Health Committee to enforce the terms of the contract. In February there were 36 complaints, and a number of streets were not cleared at all during the month, and others only partially; so in March the Public Health Committee recommended that vans be purchased to pick up arrears at the cost of the Contractor, and that two be bought for £72, the horses and men to be provided by the Engineer's Department. The contract with Knifton was to be submitted to the Council's Solicitor. In March there were 37 complaints. - In April there were three complaints. The refuse began to be deposited on the farm. It was reported that no horses or men were available from the Engineer's Department, and it was decided to hire a horse. In May there were 13 complaints. A petition was received with reference to the non-collection of dust from St. Mary's Road. In June the Public Health Committee considered the question of the collection directly by the Council with ten horses and vans and 20 men. Mr. Butland estimated the cost of his scheme at £2,855 capital expenditure; eight vans to be purchased to add to the two already bought; and he estimated that the annual charges would be £2,892 for labour, £1,100 for horse keep, £25 for repairs, and £100 for contingencies. This scheme was recommended to the Council on the 24th June, together with a recommendation that the two horsedrawn bedding vans be replaced by two motor vans, for £550, and a motor brougham be provided for transport from hospital at £500, and that the Joint Hospital Board be requested to provide motor transport to the hospital. On that date the Engineer's report to the Works Committee was presented, 53 advocating electric motors for the removal of house refuse. Mr. Brown advised the purchase of an electric vehicle at £1,400, for the roads and other work; also a mechanical tractor for the collection of house refuse, the quantity of which is estimated at 7,000 tons per annum, or 23 tons a day. He maintained that by this horse system the collection and transport cost 13s. 7d. a ton; the cost of Knifton's system is 10s. per ton; he proposed four electric carts, which would cost to run 11s. 7d. a ton. This report was referred to a Special Council Meeting. During June, seven complaints were received, but several streets were not collected at all. On the 6th June a horse and two men were hired to clear Westoe Road and Harton Road (at one house three-quarters of a load of refuse was found waiting removal). On the 13th June, Seymour Road and Eastbournia Avenue were cleared. Thus four loads, weighing eight tons, were collected in these two days. The Public Health Committee, in July, recommended that the cost of this be recovered from the Contractor. A Special Council Meeting of July 22nd considered the report of a Special Committee, dated 23rd July (!), based on visits to Sheffield, Nottingham, Dover and Ipswich. This Committee recommended that five Edison electric vehicles be purchased at £1,309 each— four for house refuse and one for use on the roads—and that £1,900 be further expended for building and charging plant at our farm. This report was adopted. The expenses of this Special Committee were £50. The current contract with Knifton, at a cost of £3,462, expired in September, 1919, so the Engineer was, in September, instructed to see the contractor and arrange for six months 'extension at £1,997. 6s. 0d., as the Engineer expected to have the electric vehicles ready by the 1st April, 1920. In July and August there were nine complaints, but the daily dust sheets were not accurate. Extra collections (to be charged to the contractor) were made in three roads. The Ministry of Health was asked for a loan of £8,500 and in September the Ministry asked for full details. There were few complaints in September, but three roads were cleared by the Council. In October there were twelve complaints, and no dust sheets were received at all. In November an agreement with Knifton was. accepted for £1,997. 6s. 0d. for six months, subject to additions for men's bonuses or increases in wages, and the provision of a chain-horse on the shoot, and the deletion of any clause in the contract about fines and penalties. This was sealed in December. In November, eight complaints were received, two roads being very much neglected. In December, 13 complaints were received, also a petition with reference to the non-collection from Junction Road. It was decided that the contractor 54 was to have 48 hours' notice of the Council's intention to collect in case of his default, and at his expense. WATER SUPPLY. The Metropolitan Water Board took over, in 1904, the control of the public water supplies provided by eight independent water companies and two urban district councils in London and certain of the surrounding areas. The Water Board is responsible for the public water supply of an area of 558 sq. miles extending from Hertford in the north to Westerham in the south, and from Northfleet in the east to Hounslow in the west; it includes a few urban and many rural districts in the outer ring of Greater London. The revenue of the Water Board is mainly derived from charges—controlled by Act of Parliament— made for domestic and other supplies; its capital debt is met by Metropolitan Water Stock, for the issue of which the Act of 1902 provided. Sinee 1908-9 there has been an annual deficiency, which grew from £224,153 in 1915-16 to £964,852 in 1919-20; the deficiency of the Water Fund is made good under the Act by an apportionment on the rates of the boroughs and districts of the area controlled by the Water Board. It was the rapid growth of this deficiency and the increasing burden on the rates of the contributory areas which led, in 1919, to the institution by the Ministry of Health of a Departmental Committee to enquire into the provisions and effect of the Metropolitan Water Act, 1902. In 1892 Lord Balfour's Commission, and in 1897 Lord Llandaff's Commission, estimated the increase of population which was likely to occur in London during the on-coming forty years. The reservoir accommodation provided by the Water Board was planned in accordance with the reports of these Commissions; but in 1911, as a consequence of the census, which showed that the anticipated rate of increase had not been attained, the proposed extensions were curtailed. The existing storage accommodation consists of 11,524 million gallons nett (12,587 gross). The engineer to the Water Board estimates that in a maximum period of continuous drought (a repetition of the 142 successive dry days of 1899) the present storage, together with the supplies available for abstraction from the Thames, the Lea, and the New River, and from wells, would permit an average daily supply of 287.9 million gallons. This figure must be compared with the average daily call on the Board during the 142 days of maximum demand in 1919—namely, 291.3 million gallons; if a drought like that of 1899 were to coincide with the period of maximum demand, there would be an average daily deficit of 3.4 million gallons. By new works, in progress or in immediate contemplation, the service reservoir capacity will be increased by almost 7,000 million gallons nett; when these new reservoirs and certain new wells are in use, the average daily supply in times of drought will be 338.5 million gallons—enough to supply a population of, roughly, eight millions, with water at the rate of 42.63 gallons a head a day, which was the average daily demand for each person among an estimated population of 6,832,967 in 1919. 55 SECTION IV. ROADS. No private streets have been made up during the year under the 1892 Act. The usual tar-spraying of main and other roads was carried out during the summer months, and the systematic repair of roadways and footpaths has been carried on throughout the year, when material has been available. 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 In January, Messrs. Eley wrote us again about Angel Road Bridge. On this subject our Engineer consulted the Great Eastern Railway Company and the Road Board. To pave with granite setts an estimated cost was £2,500, towards which the Road Board promised £1,000 and the Railway Company nothing. In March, the Works Committee recommended the acceptance of an offer of the Road Board to contribute £700 towards the estimated cost of using asphalte macadam, viz., £2,115. In April, Edmonton made in application, through the County Council, to the Road Board for £73,000 out of a fund provided to reconstitute roads worn by war traffic. Another effort was made to secure something from the Railway Company towards Angel Road Bridge. In May, we accepted the offer of £1,000 from the Railway Company on condition of extending an old agreement for ten years after its expiry in 1921; granite setts to be used. The cost of these was now estimated at £3,000. Messrs. Griffiths' tender was accepted at £2,781. In July a complaint was received from Messrs. Straker-Squire's about the state of Angel Road Bridge. In August it was decided to get a loan for the Council's share of the cost, viz., £1,000, and in November another loan of £2,200 for wood-paving Fore Street from Tottenham Boundary to the Town Hall; in this latter expense the County Council is interested. In December, the Engineer reported that the re-surfacing of Angel Road Bridge had been completed at a cost of £3,070, of which the ratepayers found £1,070. HOUSING AND TOWN-PLANNING. Buildings.—Very few dwellings have been erected, because of the scarcity of labour and the high prices for wood, glass and other materials. In April the plan was approved for the erection of the first house since 1914 by a private builder; this was in Bush Hill Park. In May, plans for three houses were approved. 56 No prosecution for contraventions of building by-law 113 has taken place since 1907. No notices were served under the Housing and Town Planning Act, 1909, from my Department. In May, Mr. Butland expressed his opinion that the row of ten houses, called Crescent Cottages, off Hertford Road, should be demolished; these wretched dwellings are still occupied. Inspector.—Mr. Huckle resumed systematic house inspection on 1st May, after his return from a German prison, and commenced with the ten Crescent Cottages and nine in Banowfield Lane. The following is a brief summary of his other inspections:— In July 35 houses in St. Mary's Road. In August 36 houses in St. Mary's Road. In September 16 houses in St. Mary's Road. In October 66 houses in St. Mary's Road and Gardens. In November 14 houses in Bridport Road. In December 44 houses in Bridport Road. Brickfields.—In May (by a majority of one vote) the Council resolved that "This Council, in view of the shortage of material, which is making "the housing problem more acute than ever, seeks power to carry on local "brickfields (now standing idle) as a municipal undertaking." No further progress in this direction can be recorded. Transport.—In July the Council considered the electrifying of suburban railways, and the need for the extension of the Tube from Finsbury Park through Edmonton to Enfield, showing that my authority is quite alive to the importance (in relation to housing schemes) of expediting and improving transport by tram and train. In August the Tramway Company were requested to run a service of cars between Finsbury Park and Edmonton. It appears that the difficulty lies with the L.C.C., who own the short piece of line between the Manor House and Finsbury Park, and refuse more extended use of it by our Metropolitan Company. In December our representatives had a conference with the G.E.R. Company with a view of relieving congestion of the passenger traffic between Edmonton and Liverpool Street. HOUSING AFTER THE WAR. The Minister of Health (Dr. Addison) stated in the House of Commons recently (August, 1920) that the capital sum required to make good the shortage of houses in the United Kingdom will amount to approximately £120.000,000 a year. He also stated that housing in Scotland and Ireland does not come within the purview of his department, but in England and Wales the total 57 estimated need, as disclosed by surveys made by Local Authorities in pursuance of Section I. of the Housing Act, 1919. amounted in round figures to 800,000 houses, taking account of replacements of existing unsatisfactory houses. Conferences.—On February 27th and 28th the National Housing and Town Planning Council convened one to consider ''After-the-war Housing Schemes in Greater London." Edmonton sent its Architect and Engineer, who presented a report in March. The principal matter discussed appeared to be a circular of the L.G.B. dated February 6th, 1919, defining the terms on which financial assistance will be given to Local Sanitary Authorities for housing schemes. But these were also discussed:—(1) The financial terms of the Government; (2) the production and supply of materials; (3) problems of administration. It was stated that out of 50,000 houses, 12,500 were required for the E. and N.E. areas, and the further formation of dense, purely working-class, districts, was deprecated. Block dwellings or cottage flats were also tabooed. It was hoped that the Government would deal with Greater London, with reference to new houses, as a single unit, and that the rateable burden should be distributed over the whole area. The Conference, by a large majority, advised the setting up of a Housing and Town Planning Government Commission, who should exercise housing and town-planning powers over the whole area, including the present County of London. A further conference, held on the 10th April, at the offices of the L.C.C., advocated the formation of a joint committee, which should be arranged by the L.G.B., for an area (mainly) coincident with the Metropolitan Police District for the purpose of providing a complete scheme, and controlling the financial arrangements. A Conference organised by the National Housing and Town Planning Council, was held on December 10th, to discuss the financial and other aspects of housing schemes. Two Councillors and the Engineer attended. THE HOUSING AND TOWN-PLANNING COMMITTEE. The Housing and Town Planning Committee held its first meeting for the year on 25th June, when Councillor Cadman was re-elected Chairman. At this meeting it was reported that the L.C.C. had decided to carry out their own scheme without co-operation with the Local Sanitary Authorities of Greater London, and that pending the passing of the new Housing and Town Planning Act, most of the latter were not moving in the matter It will be remembered that about 35 acres of the L.C.C. White Hart Lane Estate are in our area, at the S.W. corner, and that the cost of administration of the estate when inhabited, e.a., the maintenance of the roads and the education of the children, will fall entirely on this poor Authority. At this meeting the Architect (Mr. H. W. Dobb) submitted a lay-out plan of the Council's Brookfield Estate, showing how 146 houses could be built thereon at not more than 12 to the acre. 58 At a special meeting of the Council on September 30th, a report of the Housing and Town Planning Committee, dated 24th September, was considered, and the report of the Engineer on the development of the Hyde Estate, belonging to the Ecclesiastical Commissioners. The Committee disapproved of the proposal of the Tottenham Council to co-operate in developing land on our southern boundary, around Waggon Lane, Tottenham. The area is six acres, and will accommodate 72 houses, half in each district. On the other hand, the Committee recommended the consideration of the Engineer's report on the Hyde Estate. It was reported that, exercising their powers under the new Housing and Town Planning Act, the City of London Corporation had evolved a scheme for building outside their own area, viz, accommodation for 10,000 people at Chingford, Essex, due east of Edmonton on the other side of the River Lea; also that the new Housing Act had limited the expenditure of the Local Sanitary Authorities in housing schemes to a penny rate, all costs above that to be borne by the taxpayers at large. In his report of September 24th to the Committee, Mr. Brown advised negotiations with the Ecclesiastical Commissioners about the Hyde Estate, where some roads with kerbs had been made years ago, and sewers and gas mains laid down therein. £70,684 for 172 acres was the price asked. He estimated that after the proceeds had been received from Edmonton—a penny rate at £950 for 80 years—a balance of £59,971 per annum would be paid by the general taxpayer. Mr. Brown stated that the London Housing Commissioner viewed his scheme with favour, and declared that the Treasury and Public Works Commissioners would assist in raising the money, and that the Board of Education might materially assist in providing two new public elementary schools. The report of the Committee was adopted, including the Hyde Estate scheme of our Engineer, and it was ordered that the Government District Valuer be asked to co-operate, and that other necessary steps be taken. Hyde Estate.—On the 5th November a Special Council Meeting was held to discuss a report of the Housing and Town Planning Committee, dated 31st October. To the Committee the Engineer reported that the Government Valuer had fixed the value of the 172 acres of the Hyde Estate as £63,839; that the Ecclesiastical Commissioners had now offered 170 acres for £60,000, subject to corn rent of £17 per annum and to settling with various tenants, each side to pay its own costs; that the post-war cost of roads and sewers already made was £41,000, leaving £19,000 for the land itself, which amounts to £111 per acre; assuming 2,046 houses at 12 to the acre, the site cost works out at £9 per house; that the Ministry of Health objected to the Council's own Architect (Mr. H. W. Dobb) being engaged on the scheme, and thereupon Messrs. Niven and Wigglesworth had taken up the position of Architects to the scheme and prepared a lay-out, and that preliminary sketches had been submitted to Mr. Unwin, Chief Architect of the Government's Housing Board. The Committee adopted this report of the Engineer. At this meeting I submitted to 59 the Committee a letter I had received, dated September 15th, of the London Housing Commissioner, referring to the forthcoming survey of the District, and stating that: "It is essential that as soon as the provision of new houses is sufficiently advanced, the Local Authority should be in a position to deal " comprehensively with houses unfit for human habitation and with insanitary areas." Further, he asked for my help with a thorough survey of the existing conditions as regards housing in Edmonton, and for copies of my Annual Reports for the past nine years. The Council passed a resolution asking for sanction from the Ministry of Health to a loan of £60,000 to purchase the Hyde Estate. It was understood that the Council's liability of a penny rate would extend to the period covered by the loan. On November 10th the Clerk and Engineer, with two Councillors, interviewed the London Housing Board to discuss the raising of a loan. The Board was told that £500,000 were required to enable us to proceed with the first 500 houses, but that eventually £2,000,000 would be required to complete the scheme for the erection of 2,000 houses. The Board suggested that the loan for the land be raised apart from that for the houses, and that for the former, the Ecclesiastical Commissioners be approached; also that after the Ministry of Health's sanction had been obtained, terms for £500,000 should be invited by advertisement, on the security of the General District Rate, the subsidy from the Government to commence with the first financial year during which expenses are incurred. On November 13th the Ministry of Health sent sanction for loan of £60.000 for the purchase of the Hyde Estate, and on November 25th the Council accepted the offer of the owners to lend the money at 6% interest for 80 years, repayable by half-yearly instalments of principal and interest combined, and resolved that the Ministry of Health be asked for sanction to borrow £500,000 for erecting 500 houses. On the 25th November the Education Committee asked the Council to provide sites on the Hyde Estate for a Central School and two elementary ones; this request was referred to the Housing and Town-Planning Committee. The Housing and Town Planning Committee reported on 26th November (submitted to the Council on December 23rd) that the lay-out plan of the Hyde Estate had been put before them by the Engineer, that the Committee be granted full powers to act, and the Committee be enlarged by co-opting three married women in an advisory capacity. This report was referred back. On 25th August, 1920, I received this note from our Engineer:—"A Housing Scheme has been drawn up for Edmonton, providing for 1,700 to 1,800 houses, containing from three to six rooms excluding the scullery. The site occupies a little over 170 acres, and is situated on the easterly side of the district, between Victoria Road and Firs Lane, and is already partly sewered and several 60 good roads constructed, which will enable building operations to be commenced at any time. The lay-out plan shows a Central Avenue running from east to west, 120 feet wide, with two 16ft. carriageways for east and west traffic. Provision is made for the main arterial Cambridge Road (100ft. wide) crossing this avenue at right angles; 60ft. roads with 24ft. carriageways give access to the estate at the N.E. and S.E. corners and similarly at the N.W. and S.W. This provides through communication from Edmonton to Winchmore Hill and Enfield. Spaces are left for public buildings, and provision made for shopping centres. A site of 54 acres is left for a school on the north side of the Latymer Secondary School. Co-operative Society's Estate.—In October, a plan was accepted for a factory on the Oakthorpe Estate off Blind Lane in our S.W. corner. Brookfield Estate.—A housing scheme for this area was submitted by our Architect (Mr. H. W. Dobb) in July. On 28th October it was proposed that "the Housing and Town Planning Committee be instructed to prepare a "scheme for the erection of houses on this estate under the provisions of the "Housing and Town Planning Act, 1919, and report thereon to the next Council "meeting," but only two voted for it. This estate of 18½ acres was bought years ago by the Council for £523 per acre, and the Houndsfield Estate of 21 acres, for £500 per acre to erect an Isolation Hospital. The Engineer stated that the cost of the site of a house in each case would be:— at Brookfield £43, at Houndsfield £40, at the Hyde £9 or less than £200 per acre; as on the last estate, some roads and sewers had been already put in. In October my Council adopted this resolution of Southgate's Authority, viz.:—"In view of the grave evils that are likely to arise from the prevalence "of profiteering in houses, other buildings and land, this Council is of opinion "that sales of the above should be based upon pre-war assessments, also that "profiteering tribunals should be required to deal with all cases of alleged excess "profits arising from sales or hirings of houses, other buildings and lands ; that "copies of this resolution be forwarded to the Leaders of the Coalition, Liberal "and Labour Parties, the local Member of Parliament, and to the Board of "Trade." Landlords and Agents.—In November it was agreed that I should draw their attention to Sections 28 and 29 of the Housing Act, 1919. By-Laws.—In November an Order (65569) of the Ministry of Health was received whereby the Council's Building By-laws are relaxed for three years from July 31st, 1919. Bridport Road.—In December it was decided to serve notices under Sections 28 of the Housing and Town Planning Act, 1919, on the owners (agents, 61 Messrs. Guiver & Co.), requiring them to place Nos. 11 to 29 (odd numbers) in a fit and proper condition; also on the owners of 59 to 87 (odd), St. Mary's Road. In December the Council supported this resolution from Llanelly:—"That having regard to the present national emergency in respect of housing, no scheme will, in the opinion of this Council, be effective unless it includes the advancing of the necessary moneys to Local Authorities free of interest, and that representation be made accordingly to the Ministry of Health." Cornish's Estate.—In September it was reported that Mr. Cornish proposed to develop his Bury Farm Estate and make a road from the west side of Bury Street Bridge to Alberta Road, Bush Hill Park. He consulted our Engineer as to the number of houses per acre and the make-up of the roads, but (so far) this has not been proceeded with. In December, Plan No. 3295, for four pairs of houses in Amberley Road were approved, although their construction did not comply with our Building By-Laws. Thus opportunity was taken by the owner of the relaxation allowed by the Ministry of Health. At the end of the year our Engineer, at the request of Mr. Cornish, sent him a plan showing how his estate near the Nurses' Home should be laid out, and how a road 45ft. wide could be made from Porlock Road to Wellington Road, crossing Amberley Road. Mr. Cornish would not agree to these proposals, and therefore the Council decided to leave the matter in abeyance. Endeavour was made during the year to persuade the owner to develop his estate between the Nurses' Home, Bury Street, and Wellington Road, Bush Hill Park, on lines conforming to the Council's town plan of that area, as it is most desirable for the public convenience that there should be a good direct road between these two points. 62 SECTION V. LEGISLATION OF 1919. Acts, Circulars, Orders, Regulations, etc. 1.—Ministry of Health Act, 1919. The Ministry of Health is not a new one, but merely a re-organisation of the old Local Government Board, which has transferred, or will transfer, some of its former powers to other departments of the Government, and in return has (or will) take over some powers from these departments, which can be better exercised by the Ministry. Circular No. 1, dated 30th June, 1919, informed the Local Authorities of England that:—(1) under the provisions of Sec. II (1) of the Ministry of Health Act, 1919, an Order in Council had been made fixing July 1st, 1919, as the day upon which the Act came into operation; (2) on that day all the powers and duties of the Local Government Board would pass to the Ministry of Health. Organisation.—It is well for us all to clearly understand the outlines of the basis on which this Ministry was organised. In March the following announcement was made:—"In view of the impending retirement of Sir Horace Munro, K.C.B., Permanent Secretary to the Local Government Board, and in order to facilitate the unification of the departments which will be brought together in the Ministry of Health on the passage of the bill now before Parliament, the President of the Local Government Board has appointed Sir Robert Morant, K.C.B., Chairman of the National Health Insurance Commission, and Mr. John Anderson, C.B., Secretary to that Commission and at present acting as Secretary to the Ministry of Shipping, to be additional secretaries to the Local Government Board, with special functions and responsibilities in relation to the organisation of the new department, continuing their insurance functions. Sir Robert Morant and Mr. Anderson have been designated as First and Second Secretary respectively in the new Ministry." Sir George Newman was appointed to be the Principal Medical Officer of the Local Government Board early in 1919, whilst he still remains in his old position of Chief Medical Officer of the Board of Education, when it was announced that he would have the status of a Secretary of the Board, and would have administrative responsibilities in respect of the work of his department. The new Ministry absorbs the functions of the Local Government Board in health matters, and it retains the Poor Law administration, until this can be dealt with differently; it takes over the insurance services which previously formed a large and sometimes overlapping department. It has also become responsible for the medical inspection and treatment of young children, while delegating its authority in this regard to the Education Board, which has hitherto had 63 this duty. Further, it has taken over the powers of the Privy Council under the Midwives Act, and the powers for infant life protection which were vested in the Home Secretary. The Act, moreover, was wisely framed to enable further transfers to be made by Order in Council, so that as time and opportunity allow, the operations of the Ministry of Health shall be really comprehensive and complete. Dr. Addison has been prompt in setting up Consultative Councils and in re-organising administrative machinery, but the benefits of the change cannot be expected yet to be felt. I submitted the Bill to the Public Health Committee in March, remarking that it was the most important one associated with their work which had been presented to Parliament since the Public Health Act, 1875 ; I also presented a useful memorandum from the Society of Medical Officers of Health, indicating how this Bill might be amended with public advantage, but no action was taken thereon. In November I was informed that by arrangement with the Chancellor of the Exchequer and with the Prime Minister's approval, the Ministry of Health would now be responsible for the whole administration of the department of the Registrar General and the organisation of the census of 1921. By Order of the Privy Council towards the end of the year, the Ministry of Health took over the powers of the Home Office under Part I of the Children Act, 1908. This should have been followed by the complete transfer locally of the powers from the Edmonton Guardians to my Council. 2.—Rats and Mice (Destruction) Act, 1919. This comes into force on January 1st, 1920. It requires every person to take such steps as may be necessary from time to time to destroy rats and mice on land of which he is the occupier, and to prevent such land becoming infested with these vermin. The County Council can delegate to District Councils their functions under the Act. 3.—Pneumonia, Etc., Regulations, 1919. This Order was dated January 7th, 1919, and came into force on March 1st, 1919. For further information see Section II A. 4.—Rag Flock Act, 1911. A Circular dated 26th May, 1919, from the Local Government Board stated that complaints had been made that the above Act is not uniformly administered throughout the Country, and that consideration was necessary to two points in connection therewith, namely, the definition of "flock" in Section I (1), and (2) whether re-made mattresses come within the scope of the Act. 64 5.—Health Visitors. On July 10th, the Board of Education issued a memorandum and draft regulations for the training of the above. 1 do not understand why they were not issued by the Ministry of Health, who issued a circular letter dated July 14th. The object, of course, is to secure the appointment of women, who possess a good general education, followed by a course of special training ; with this object I cordially agree. 6.—Housing Acts 1 and 2. The general effects of these Acts is to give extended powers to the Government and further, to place upon every local authority the duty of considering the erection of working-class houses in their neighbourhood and to make a report thereon to the Government. Neither time or space will permit me now to discuss these two Acts in detail and perhaps it is well that I should not do so, until I have had the advantage of seeing them for some time in operation. Medical Officers of Health are impressed more than ever with the necessity of passing an Act consolidating all the Acts and Regulations which have been enacted since "The Housing of the Working Classes Act, 1890." On November 29th, the Ministry of Health issued a volume on "Unfit houses and unhealthy areas," which indicates the policy and practice to be adopted by us in dealing with these matters; a second one (to follow) will set out the law and regulations and procedure on these subjects. 7 —Increase of Rent and Mortgage Interest (Restriction) Act, 1919 Section II is one of special interest to us. It gives the tenant the right to apply to the Local Sanitary Authority for a certificate as to whether his house is, or is not, reasonably fit for human habitation—or is, or is not, kept in a reasonable state of repair. No doubt the Medical Officer of Health is the officer intended to act for the Sanitary Authority and it would have been better if this view had been definitely stated in the Act. I presume that the nominal fee of 1s. payable to the Sanitary Authority with such applications is merely an indication of its bona fide character. I do not envy my Authority's position as referee between landlord and tenant. 8—Nursery Schools. Regulations under Section 19 of the Education Act, 1918, were issued by the Board of Education at the end of 1919. 8,—Maternity and Child Welfare In November, the Ministry of Health issued a circular accompanied by (1) a memorandum with regard to Day Nurseries and (2) a memorandum with reference to Maternity and Child Welfare Centres. 65 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. 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. The Government munition factory, known as "No. 4," in Angel Road was taken over in April by Messrs. Straker-Squire for the making of motors. My Chief Inspector (Mr. Butland) reports to me as follows:— The number of inspections of factories was 49 „ „ „ „ „ workshops 72 Defects Remedied in Factories— Defective washing sinks removed 3 Drains repaired 5 New chambers put in 1 Floors repaired—rendered in cement 2 Defects Remedied in Workshops— Drains repaired 3 „ cleared 4 Bakehouse limewashed (after notice) 4 Want of cleanliness 2 „ „ proper drainage to floors 1 Sanitary accommodation defective 16 Separate accommodation for sexes 1 Other nuisances abated 4 The usual periodical inspections were carried out. No. of intimation notices served 2789 „ „ statutory „ „ 1419 In September a temporary agreement lasting 6 months, was entered into with Mr. Elwell Smith, for the erection of two buildings to be used as a toy factory, close to an existing (temporary) building, allowed during the war for making small aeroplane parts. At the same time, the old Huxley Mill was converted into a glass works. 2.—Common Lodging House. There is only one in the district. It has accommodation for men only, and is an ancient structure. Albert Denning 66 has been registered under Section 69 of the Public Health Acts Amendment Act, 1907, as keeper for one year from February, 1919. 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. 4.—Slaughterhouses. There are five on the register, one on the old terms. In January, 1918, the licence of N. A. Barrett, of 188, Fore Street, was renewed for another three years. In April, 1919; 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. The Public Health Committee granted permission to keep pigs in February to Mr. Fores, 27, Rays Road; Shipman, 150, St. Mary's Gardens; and J. Holly, 12, Pretoria Road. In October permission was granted to Mr. Hussey, of Firs Lane, for keeping 20 pigs; but in the same month Mr. Richardson was not permitted to keep pigs in Bury Street. On May 27th, the Plans Committee recommended that the agreement with Mr. Fairey be renewed. In October, this Committee recommended a renewal of the agreement to keep six pigs by Mr. Bell, St. Mary's Gardens, and, in November, they recommended the renewal of Mr. Faulkner's for six pigstyes. The Park Committee recommended, in November, that the tenant of plot 21 in Weir Hall allotments be allowed to keep a few pigs. It seems strange that no less than three Committees were dealing with pigstyes, and it is my opinion that the whole subject should be dealt with by one Committee, namely, the Public Health Committee, whether new styes or old ones are being considered. In October, the Tottenham Council complained of nuisances reported by residents in North Tottenham alleged to arise from the boiling of food for pigs at Knifton's in Langhedge Lane. In December, two persons were found to be slaughtering pigs in unlicensed premises; they were warned by the Clerk. 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 62 purveyors of milk in our register at the end of the year. In November, the Public Health Committee recommended that legal proceedings be taken against a person for keeping cows in Cuckoo Hall Lane without having registered, as required by Section 7 (2) of the Dairies, Cowsheds and Milkshops Order, 1885. 67 7.—Unsound Food. In March my Council passed this resolution:— "That this Council is of opinion that the time is now opportune for the Government to consider the urgent necessity of immediately making all diseases of animals that are communicable to human beings compulsorily notifiable, and of providing adequate compensation to be paid subsequent to any action that may, in the public interests, be determined; and consider that in any scheme of National reconstructions, there should be a Public Abbatoir for every Urban District, and that in every such district, powers should be granted to the Local Authority to compulsorily close private slaughter-houses." Copies were sent to the Prime Minister and the President of the Board of Agriculture and Fisheries. I heartily endorse this resolution and trust that the day is not far distant when there will be a public slaughterhouse in Edmonton. In May, two carcases were surrendered owing to general tuberculosis, and in August the carcase and organs of a cow were surrendered for the same reason. In October an ox carcase, and in December the carcases of two cows were found to be tubercular. In August one hind quarter of imported beef was found to be unsound, and in October an imported lamb and 20 cases, each containing 5 cwt. of bacon, were surrendered; they were originally of fine quality but suffered from bad storage. In December 2½ tons or more of bad meat and offal were delivered at Angel Road Station from Southampton on their way to a fat factory at Chingford. 8.—Bakehouses. In January a plan was passed for an additional bakehouse to be erected by Mr. A. Curnock, of 2.7, Silver Street. 9.—Offensive Trades. All those people carrying on these trades such as fish-curers, rag, bone and skin dealers, were warned by posters in August of the necessity of securing the written consent of the Council to the establishment of such businesses. In May, 1912, the Local Government Board consented to Edmonton's scheduling 13 trades as "offensive," but bye-laws were only made with reference to gutscrapers. It is estimated that no less than 35 persons are carrying on as rag, bone or skin dealers in this area . Fish Frying.—Mrs. Repman, of 95, Fore Street, in November, was allowed to establish a business there "provided that the trade shall be conducted in such a manner is not to be a nuisance to the occupiers or residents in the vicinity." Fish Offal.—For some years this has been collected by the Belvedere Fish Guano Company; and in June it was decided, in the event of this method proving inadequate, to allow fishmongers to deposit it on our sewage farm. 68 In December, on the advice of the Plans Committee, permission was refused to erect a glue factory at the east end of Cuckoo Hall Lane. 10.—Gipsies. The return of peace conditions seems to have brought the vagaries of these wanderers to the front again—at least in Edmonton, where for years van-dwellers have worried myself and inspectors who have a consciousness of lack of power in dealing with them. It would help us if special and stringent bye-laws were enacted such as have long been in use in a northern area:— (a) The occupier of a tent, van, shed, or similar structure used for human habitation shall provide for the same a sufficient receptacle for refuse. (b) An occupier of a tent, van, shed or similar structure used for human habitation shall not cause or suffer any solid or liquid filth to be retained therein. He shall not deposit or cause any solid or liquid filth to be deposited within thirty feet of such tent, van, shed or structure, except in a proper receptacle. He shall not deposit or cause any solid or liquid filth to be deposited in any place so as to cause a nuisance. He shall cause every vessel, utensil or other receptacle provided or used for the purpose of containing or removing any solid or liquid filth to be sufficiently cleansed immediately after it shall have been used for that purpose. (c) The person by agreement with, or by licence from, whom any tent, van, shed, or similar structure used for human habitation shall be erected, brought or used on any land, shall, in any case in which nuisance is likely to arise from the want of privy accommodation and of a receptacle for refuse for the use of the occupants of the tent, van, shed or structure, provide for their use on such land in a suitable situation sufficient privy accommodation, and a sufficient covered ashpit, dustbin, or other receptacle for refuse and shall maintain the same in good repair and order and in a reasonably clean and wholesome condition. (d) The owner of the land on which persons are occupying or have erected any tent, van, shed or similar structure used for human habitation shall forthwith provide each person with a continuous and adequate supply of good drinking water. At present it is perhaps farcical to report on this subject under the heading "Places over which the Council exercise supervision," until local authorities have more stringent powers and a willingness to use them. 11.—Marine Stores. 12.—Knackers. Nothing of importance with reference to these transpired during the year. 69 TABLE 1. Vital Statistics of Whole District during 1919 and ten previous Years. Year. Nett Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. able Deaths. Nett Deaths belonging to the District. Number registered here. Nett. Of Nun Residents Registered in the District. Of Residents not registered in the District. Under 1 Year of Age. At all ages. Number. Kate. * Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. Out. In. 1 2 3 4 5 6 7 8 9 10 11 12 13 1909 61, l64 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 80.27 905 12.18 1919 75,744 1,321 1,237 16.33 980 12.75 407 128 84 67.91 701 9.25 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 s?riously 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 two camps, or of residents, due to the war. Area of District in acres (including 31 acres of inland water) 3,894 Total population at all ages 64,797 Number of inhabited houses or tenements 12,491 Average number of persons per house or tenement 5.00 Including Institutions 5.19 At Census of 1911. 70 TABLE II. All Cases of Infectious Disease Notified during the year 1919 (excluding military). Notifiable Diseases. 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 wards. 1 2 3 4 5 6 7 Enteric Fever None — — — — — — — — — — — — — — — Scarlet Fever 620 3 143 425 37 12 — — 195 254 169 — 619 — 1 595 Diphtheria (including Membraneous croup) 109 2 32 69 4 2 — — 25 41 32 1 108 1 — 102 Erysipelas 55 2 1 6 9 18 14 5 20 19 13 3 52 3 - — Puerperal Fever 6 — — — 1 5 — — 3 — 1 1* 4 2* — — Cerebro-spinal Fever None — — — — — — — — — — — — — — — Poliomyelitis None — — — — — — — — — — — — — — — Ophthalmia Neonatorum 15 15 — — — — — — 4 5 5 — 14 1 — — Pulmonary Tuberculosis See Women Inspector's Report. Other Forms „ Measles, English 2357 67 914 1354 15 7 — — 887 701 768 — 2356 — 1 — „ German 138 3 40 88 4 3 — — 16 45 76 — 137 1 — — Influenza-Pneumonia 28 — — 2 9 9 6 2 16 3 9 9 28 — — — Acute Primary „ 74 2 13 21 7 14 12 0 20 21 31 4 72 — 2 — Malaria 38 — — — 9 27** 2 — 9 12 17 — 38 — — — Trench Fever 1 — — — — 1 — — 1 — — — — — — — Totals * Treated at Infirmary. ** One case complicated with dysentry. 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 Mimms rural district of Middlesex and belongs to the 18 Middlesex districts. 3. There is a building on Clavering's Farm, Edmonton, capable of taking 10 male and 6 female small-pox cases; is now attached to No. 2. Cases of infectious disease occurring amongst soldiers and sailors are NOT included in this table, but a separate statement about these, as far as known, is given in the foreword. 71 TABLE III. Causes of. and Ages at, Death during the Year 1919. (Classified by age and cause; excluding military.) Causes of Death. (One uncertified by Doctor or Coroner.) 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 M.A.B. Infy. Total. Enteric Fever 1 - - - - - - - - - - - - Smallpox 5 - - - - - - - - - - - - Measles 6 10 - 2 4 4 - - - - - - - Scarlet Fever 7 12 - 3 3 6 - - - - - - - Whooping Cough 8 4 3 - 1 - - - - - - - - Diphtheria and Croup 9a 10 - 1 6 3 - - - - - — — Influenza 10 58 - 1 4 2 7 20 12 12 - 20 20 Dysentery 14 2 - - - - - 1 - 1 - - - Erysipelas 18 1 1 - - - - - - - - 1 1 Anthrax 22 1 - - - - - - - - - - - Phthisis (Pulm. Tub.) 28a b 29a 59 - - 1 4 14 17 19 4 - 25 25 Tub. Meningitis 30 5 2 - 2 1 - - - - - - - Other Tuberculous Diseases 29b 31—35 13 1 - 3 5 1 - 2 1 - 2 2 Cancer, malignant disease 2v 39—45 65 - - - - 1 11 34 19 - 46 46 Rheumatic Fever 47 3 - - - - 2 1 - - - - - Meningitis 61 1 - - 1 - - - - - - - - Org. Heart Disease 79 77 — — - 3 5 3 20 46 - 62 62 Bronchitis lv. 89—90b 43 4 2 - 1 - 1 13 22 - 32 32 Pneumonia (all forms) lv. 91—92 57 16 8 7 5 4 4 7 6 1 9 10 Other diseases of respiratory organs 86—88 93—98 14 - 1 1 - - 1 8 3 - 8 8 Diarrhœa & Enteritis 104—5 11 6 - 3 1 - — - 1 - 7 7 Appendicitis and Typhlitis 108 5 - - 1 - 3 1 - - - - - Cirrhosis of Liver 113 2 - - - - - - 1 1 - - - Alcoholism 56 1 - - - - - 1 - - - - - Nephritis and Bright's Disease 119— 20 27 - - 2 1 3 6 6 9 - 20 20 Accidents and Diseases of Pregnancy 134—6 2 - - - - - 2 - - - 1 1 Puerperal Fever 137 2 - - - - - 2 - - - 1 1 Ditto, Parturition 138—141 1 - - - - 1 - - - - 1 1 Infantile Diseases 151—3 16 16 - - - - - - - - - - Congenital Diseases 150 2 - - 1 1 - - - - - 2 2 Premature Birth 151a 26 - - - - - - - - - 1 1 Violent Deaths— excluding Suicide lv. 164—86 22 2 - 3 3 2 1 4 7 - 8 8 Suicide 155—63 6 - - - - 1 2 2 1 - 2 2 Other Defined Diseases. lv. — 143 7 3 3 6 3 15 31 75 5 147 152 Diseases ill-defined or unknown 187 - 89 - - - - - - - - - - 1 1 Total - 701 84 21 46 48 46 88 160 208 6 396 402 Five deaths of non-residents, not in institutions of Edmonton, are not included in this Table. Six vagrants are in Table marked "V." 72 The Work of the Sanitary Inspectors, Male and Female, during 1919. Inspections. Number of Premises Inspected on Complaint 678 Number of Premises Inspected in connection with Infectious Diseases 715 Number of Premises under Periodical Inspection 178 Houses Inspected from House-to-House (H. and T.P. Act. 1909, Section 17) 277 Total Number of Inspections and Re-inspections made 10251 Action taken under H. and T.P. Act, 1909 Nil Action Taken (other than under H. and T.P. Act):— Cautionary or Intimation Notices Given 2789 Statutory Orders Issued 1419 Summonses Served 1 Convictions Obtained 1 Houses Let in Lodgings (Tenement Houses):— Number Registered under By-Laws 7 Number of Contraventions 2 Common Lodging Houses:— Number registered under By-Laws 1 Accommodation—Male 24 Number of Inspections Made 62 Number of Contraventions Nil. Canal Boats used as Dwellings:— Number registered under the Acts—Not a Registration Authority. Number of Contraventions of Regulations 2 Movable Dwellings, Caravans, Tents, etc.:— Number Observed during the year 129 Number of Nuisances therefrom Abated 9 Number Removed from District 93 Bakehouses:— Number in District 28 Contraventions of Factory Acts 3 73 Slaughter-houses:— Number on Register 5 Number of Inspections Made 275 Frequency of Inspection When slaughtering expected. Contraventions of By-laws Nil Cow sheds:— Number on Register 2 Number of Inspections Made 17 Frequency of Inspection Not stated. Contravention of Regulations Nil. Number of Milch Cows in District 26 Dairies and Milkshops:— Number on Register 62 Number of Inspections Made 165 Frequency of Inspection Not stated. Contravention of Regulations Nil. Unsound Food:— Meat (including organs) seized or surrendered. (Approximate weight in pounds) 5419 Rabbits seized or surrendered (ditto) 526 Fish seized or surrendered (ditto) 1233 Fruit and Vegetables seized or surrendered (ditto) 500 Other Articles seized or surrendered (ditto)— Dates 2548 Cheese 224 Method of Disposal.—Part fed to pigs, part to fat dealers, part buried. Offensive Trades:— Number of Premises in District 51 Nature of Trades— Gutscraper 1 Fishfryers 16 Marine Stores 34 Number of Inspections Made 64 Contraventions of By-Laws Nil. Water Supply and Water Service:— Percentage of Houses Supplied from Public Water Service 99.3 New Cistern Provided 1 Cisterns—Cleansed, Repaired, Covered, etc. 13 Draw-taps Placed on Mains 3 Percentage of Houses Supplied on Constant System 100 74 Number of Samples Obtained for Analysis:— From Local Wells 3 From Public Supply Nil. Water Closets:— Repaired, Supplied with Water, or otherwise Improved 191 Percentage of Houses Provided with Water Closets 99 Drainage and Sewerage of Existing Buildings—Drains:— Examined, Tested, Exposed, etc. 369 Unstopped, Repaired, Trapped, etc. 356 Waste Pipes, Rain Water Pipes Disconnected, Repaired, etc. 62 Existing Soil Pipes or Ventilating Shafts Repaired 13 Disconnecting Traps or Chambers Inserted 7 Cesspools Rendered Impervious, Emptied, Cleansed, etc. 5 Percentage of Houses Draining into Sewers 99.6 Disinfection:— Rooms Disinfected:— Ordinary Infectious Diseases 740 Phthisis 128 Rooms Stripped and Cleansed 625 Articles Disinfected or Destroyed:— Ordinary Infectious Diseases 6881 Phthisis 585 Dust:— New Bins Provided 179 Dust Removed from each House Weekly and Fortnightly. Number of Complaints of Non-Removal received 178 Method of Disposal—by Tipping. Sundry Nuisances Abated:— Overcrowding 1 Accumulations of Refuse 24 Foul Ditches, Ponds, etc., and Stagnant Water 15 Foul Pigs and other Animals 14 Dampness 979 Yards Re-paved or Repaired 12 Other Nuisances 478 75 SPECIAL REPORT OF M.O.H. ON Reorganisation OF THE Public Health Department. 76 Edmonton Urban District Council. To the Chairman and Members of the Public Health Committee, and the Council. 26th November, 1919 Mrs. Benjafield and Gentlemen, PUBLIC HEALTH DEPARTMENT RE-ORGANISATION. A Contrast with the Past. The work is done now by the same methods which existed in 1892, that is, 27 years ago, when Edmonton's population was about 25,000 (Census population for 1891, 23,437). The M.O.H. was only a part-timer, who gave as much time to the work as was proportionate to his small salary, and he left all he could to the Senior Inspector (Mr. R. J. Butland). But in 1919 Edmonton is one of the 96 large towns of England and Wales, with a population of 70,000—80,000 persons, a Parliamentary Borough with an M.P. of its own, and a whole-time M.O.H. Since 1892 the amount of legislation by Acts of Parliament, or by the Orders and circulars issued by the Local Government Board, Home Office, and other Government offices, is treble in quantity and of first-class importance. Consider carefully this vivid contrast between 1892 and 1920—an interval well over a quarter of a century—and I am sure you will decide that the time has arrived when I should be assisted in carrying out my responsible and extensive duties by an adequate staff of men and women, working hard (as now), but with an economy of effort that can only be obtained by a re-allocation of duties, and the adoption of modern methods. The methods of 1892 are waiting to be scrapped! RECONSTRUCTION FOR THE FUTURE. I have the honour of laying before you what I consider are the main steps to be taken in reorganising my Department:— 1.—Assistant M.O.H. To this post Dr. Rock was appointed in 1912 at a salary of £50 yearly, as most of his time was engaged as Assistant S.M.O. Since July, 1914, when he rejoined the Royal Navy, I have had no one to take his place. As I have stated in my Annual Report for 1918, it is highly necessary that a Deputy should be beside me. The position is ridiculously one-sided. I have a Deputy S.M.O. but no Deputy M.O.H., whereas the necessity for the latter is greater, 77 as a little thought will convince you how dangerous it is to the public health that in my absence, however long or frequent, on holiday or through illness, there is no medical man to carry on, and the Department is left without a Director. Every time the Council runs the risk of a great scandal arising. During the past six months an Assistant M.O.H. could have found ample employment in dealing with the control of contacts with infectious diseases, with thousands of which I have had to deal single-handed. My absorption in this work has prevented me giving adequate time to other important matters that call for my attention as Head of this Department and the School Medical Service. As Edmonton grows a larger and more important town, my duties as administrator become greater, and I have less time for the routine executive work, which is less responsible and more suitable to a junior medical man of less experience than I have. This junior M.O.H. could resume Dr. Rock's work in your bacteriological laboratory, so saving the fees of the Institute in London. He could act as Medical Adviser at the Maternity and Child. Welfare Centre, and save the £117 a year paid to Mrs. Outram. So that about £140 would be at hand towards his salary of £400—£500 a year. [Later note in November, 1920.] Mrs. Outram's salary is £340 4s. 0d. yearly for two days' work each week, or at the rate of more than £1,000 a year ! The minimum salary of an Assistant M.O.H. is now £500. 2.—The Men Inspectors. They should be "warded," as has been the case in progressive districts for 15 years or more. Messrs. Butland and Winter should have a choice. Supposing Mr. Butland wishes to have Church Street Ward, and Mr. Winter Fore Street, Mr. Nixon will undertake Bury Street Ward. For the sanitary condition of each ward, one of these three would be responsible, and he would thoroughly know and be known to the inhabitants of his ward. This arrangement would prevent overlapping, and the possibility (as at present) of all three calling at one house the same day, or the same week. You have a special inspector, Mr. Huckle, who should confine his attention to his special subject, i.e., systematic housing inspection, and not (as now) have his attention diverted to other matters. Mr. Huckle would then be able to get on with his work at double the rate he does now. Another special inspector should arrive with the establishment of a municipal slaughter-house, where all the animals will be killed in one place, under the regular supervision of this inspector, who should have had early experience as a butcher, e.g., Mr. Nixon. Then all private slaughter-houses can be abolished. The same officer would supervise all places, including costers' stalls, where meat and other foods are on sale, and dairies and milkshops. We should soon see the disappearance of bad food, or that of third-rate quality 78 offered to Edmonton housewives. Possibly he would be entrusted with the duties under the Shop Hours Acts. Reports of the men inspectors should reach me monthly, which I would incorporate in my reports to the Public Health Committee. This is the method which has always been followed in the case of the women inspectors. My Annual Report would contain an abstract of all the Inspectors' reports. It is the only one regularly expected by the Government from any Department at the Town Hall or Education Office. Except when specially necessary, the Inspectors would not attend the meetings of the Committee or Council. 3.—Transfer. The above arrangement of your men inspectors would be facilitated by the transfer to your Engineer of the collection and disposal of house and trade refuse; and the sanitary conveniences and their attendants. 4.—Disinfectants. On the other hand, the ordering and distribution of disinfectants should be reserved to the M.O.H., who alone has intimate knowledge of their chemical and bacteriological values. This would lead to a saving of hundreds of pounds yearly. The present great outlay has not (as you are aware) kept Edmonton free from scarlet fever and measles in 1919. 5.—The Women Inspectors (Health Visitors). Similarly these officers should, as to three of them, have one ward allotted to each, so that she may acquire an intimate knowledge of the mothers and all children under five years of age in her particular ward. If, on the basis of one for every 400 births, two more are required, the district should be sub-divided accordingly. All three (or five) Health Visitors should attend the Maternity and Child Welfare Centre, so that the mothers will flock there in large numbers if they are assured of receiving a hearty welcome there from the very lady who visited them shortly after their last confinement—a sacred time which begets friendly confidence between them. Mrs. Hobbs, as "following-up" officer, has special duties, which she can continue to discharge with much advantage to children of school age. Accommodation for the four women inspectors now at the Town Hall is quite insufficient. When they are all at work in their little room there are only 275 cubic feet air space for each—which is 25 cubic feet less than the minimum for inmates of common lodging houses. Further accommodation is highly necessary, and can be found by utilising for them:— 79 (1) The room at present used by Mr. Butland, who could be provided for in the General Office; or (2) The room formerly used as the inspection clinic for school children, and later (up to a year ago) by the War Pensions Committee; or (3) The room on the first floor called "The Chairman's Room." 6.—The Clerical and Yard Staffs. I have quite recently advocated the need of a Chief Clerk, for good reasons which you all remember. He must be a man of 35-45 years, who has the experience gained in a progressive borough, which will enable him to command the respect of the clerical and yard staffs, of whom he will—under my supervision—be the "leading hand." Such a man can expect and deserve a salary of at least £170 to £200 a year. There should be— In the Office— 1.—Records Clerk, for which position I have recommended Mr. Oades. 2.—School Medical Clerk—Mr. Farrar. 3.—Junior Clerk, for which post I advise the retention of Miss Hill, to undertake also the clerical work of the Maternity and Child Welfare Committee, who will repay such a proportion of her salary as may be agreed on between the two Committees. 4.—An office boy, who, from his entry after his school-days are over, will be in training for the higher berths, if he develops good qualities. In the Town Hall Yard— 1.—The Sanitary Store-keeper and House Disinfector—Mr. J. Madle. 2.—The Mortuary, Laboratory Attendant, and Steam Disinfector— Mr. Hickford. 3.—The Ambulance and Bedding Van Driver—Mr. Gwynn. Transport. I say what I have said repeatedly about this—indeed, every year since 1906—that you should insist upon the Hospital undertaking this to and from the Hospital by motors. This is the system which has been in vogue by the Metropolitan Asylums Board and our own Hospital at Clare Hall for years past. Why should Winchmore Hill lag behind? Offer them our motor ambulance as an inducement for the Enfield and Edmonton Joint Board to 80 start this method. This will save many delays in removal, especially out of office hours. When a medical man meets with a case, he telephones Dr. Cook to send for it, and an ambulance with a nurse therein is at the door in half-anhour or less. At present Mr. Madle has to be on duty every week-end and public holiday, whoever else is nominally on duty, because neither Messrs. Winter, Nixon or Huckle can drive our motor ambulance. In Conclusion. This plan of reconstruction is a drastic change, I admit, from the oldfashioned methods, and full of detail. Therefore, I do not propose that your Committee should accept it on short acquaintance, but I would advise the reference of it for discussion in detail between myself and a small sub-committee, who can report thereon to the next or an early meeting of the Public Health Committee. I am confident that my Department, re-organised oil these up-to-date lines, and with only the addition of two (the Chief Clerk and an office boy) to my present male staff, will prove equal to all reasonable demands on its efficiency and energy, and will fully justify its existence. On me, your Senior Medical Officer of Health, will fall a greater responsibility as administrator, but unification of control is essential. To use a naval analogy—no ship can run a good and true course with more than one captain aboard. Under Providence I was placed in that position bv the Edmonton Council in 1906. I shall feel fortified and encouraged to do my best for the inhabitants of Edmonton, if my Councillors will always afford me their hearty sympathy and support. I am, Mrs. Benjafield and Gentlemen, Your obedient servant, SIDNEY C. LAWRENCE, Medical Officer of Health 81 EDMONTON URBAN DISTRICT COUNCIL. ANNUAL REPORT OF THE Chief Sanitary Inspector For the YEAR 1919. Public Health Department, Town Hall, Edmonton. 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 on the work done in the Public Health Department for the year 1919 by your Inspectors and staff. REMOVAL OF PATIENTS TO HOSPITALS AND DISINFECTIONS. No. of journeys of motor ambulance to remove patients to Winchmore Hill Hospital 374 No. of journeys of horse ambulance to hospital 120 No. of journeys of bedding van to remove infected bedding 318 No. of journeys of bedding van to return bedding 306 No. of journeys of brougham to fetch patients from hospital 205 No. of patients returned to their homes from hospital by brougham 614 No. of rooms disinfected after infectious disease, etc. 740 No. of articles of bedding, etc., disinfected 6852 No. of articles of bedding destroyed 29 No. of books disinfected 40 No. of rooms disinfected after phthisis 128 No. of articles of bedding, etc., disinfected after phthisis 580 No. of articles of bedding, etc., destroyed after phthisis 5 No. of rooms and bedding disinfected for vermin 65 The removal of patients to hospital is still carried out by your Disinfector, who also acts as an attendant. The Inspectors assist when necessary; they also take duty with the Disinfector on alternate Sundays. The Library, all Day Schools and all Sunday Schools were disinfected. 82 I sincerely hope that the Joint Hospital Board will soon take over the removal of patients to hospital by an ambulance service directly connected with the hospital and properly equipped with a nurse and attendants. Although at present, when a case is notified at night every means is adopted to get the ambulance out as speedily as possible, the advantage gained by the Hospital Board removing patients would expedite matters, and would be to the benefit of all concerned. Motor Vehicles.—The Council have decided to adopt motor bedding vans for the removal of infectious and non-infectious bedding, and also a motor brougham to convey the patients from the hospital to their homes, after recovery. I trust these will be in evidence during the coming year; they will enable us to do away with the horse-drawn vehicles. ERYSIPELAS. During the year only 8 cases of erysipelas were treated in their homes (one less than last year) by a qualified trained nurse. Many expressed their thanks for the treatment received. The cost of nursing was £16 10s. Od. DISINFECTANTS. For some years past the Council have generously allowed free disinfectants to the inhabitants of the district, and the public continue to avail themselves of the opportunity given them. The address of every applicant is taken and kept for reference, if necessary, as we find several persons coming here from adjoining districts. Disinfectants are only supplied to persons bringing proper poison bottles. No doubt some of the disinfectant is misapplied, but its use must, to a great extent, encourage cleanliness and cause much more water to be used than otherwise would be. On looking through the register of callers 1 find that 33,869 persons applied for disinfectants during the year, which is an increase of 6,383 on the previous year. It has been suggested that the supply of disinfectants might be discontinued without any detriment to the health of the district. I might say that this would be a great relief of responsibility to me, but, personally, I should be loth to recommend such a course, knowing full well that much good has been done in the past. 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 the disinfecting and deodorising of house refuse, for the cleansing of street gullies, flushing of sewers, watering of roads in hot weather, and for all other purposes required by the Council. 83 MORTUARY. During the year 89 bodies were received into your mortuary; 53 inquests were held and 49 post mortem examinations were made. Twenty-four bodies were left on deposit after inquest proceedings, to await burial; 18 bodies were deposited by undertakers to await burial; 15 were deposited owing to being of an infectious nature. Three bodies 1 had removed to await burial owing to insufficient accommodation at the house. PUBLIC LAVATORIES, WATER TROUGHS, ETC. During the year the lavatories have received regular attention and the necessary repairs carried out. I regret to again have to record the fact that much wilful damage has been done to-the water-troughs and drinking fountains. The public lavatories at Angel Road and The Green continue to be well patronised. The amount collected from Angel Road lavatories during 1919 was £483 13s. 2d., an increase of £21 12s. 11d. on the previous year. The amount collected from The Green lavatories during 1919 was £362 5s. 9d., an increase of £54 6s. 9d. on the previous year. I hope in the near future to see a public lavatory in evidence at the north end of the district—Tramway Avenue; a convenience for both sexes would be of great public benefit. DUST COLLECTION. During practically the whole of the year the dust collection was carried out by contract, and after the contract expired the Council decided to do the work by direct labour. Considerable time was given to the various parts of the district where the dust collection had been neglected, and I was authorised to put on extra horses and vans with extra men, to collect those streets that had been neglected, and deduct the costs from the contractor. I sincerely hope that the coming year will see at least a weekly collection throughout the district. In pre-war days the old tins found on the dust shoot were collected by a firm, for which they paid the Council a small amount per ton. This realised between £20 and £30 per annum. I recently again approached several firms with a view of disposing of this old metal, but found the price offered for this waste material would not compensate for the outlay in collecting and transit. The dust-shoot being a favourable breeding ground for rats, I hope the Council will seriously consider the question of providing an up-to-date dust destructor, as, judging from the results obtained from the working of destructors in several districts, this would be an advantage and enable a very offensive accumulation to be effectually disposed'of, and incidentally (which is of great importance) do away with a favourite haunt and breeding ground for rats. 84 During the year much time was given to the extermination of rats by using poisons and Virus, and for about five months the Middlesex County Council gave permission to pay 2d. each for all rats brought to the Town Hall by the public. I anticipated a very large number, knowing full well that rats were numerous in the district, but there were only 481 brought in, for which we paid £4 0s. 2d., this amount being refunded by the Middlesex County Council. If the rat population is to be exterminated, some regular and systematic method must be adopted, for if only a few are left it is not long before the place becomes again infested. The Rats and Mice Destruction Act, 1919, will come into force on January 1st, 1920, making owners and occupiers of land or buildings responsible for preventing lands or buildings becoming infested with rats or mice. SLAUGHTER-HOUSES AND UNSOUND FOODS. One transfer of licence took place in the occupation of a slaughter-house. The number of slaughter-houses on the register remains the same, viz., 6— 5 licensed under the Public Health Acts (Amendment) Act, 1890, and renewed yearly, and one registered that has been in existence a great number of years, and this will no doubt in a few years be non-existent. The advantages of slaughter-houses being licensed annually is obvious, especially so should the Council in the near future provide a public abbatoir. The tendency of the butchers is to facilitate the work of the Inspector, and should any carcase be doubtful, it is put on one side for inspection. Fourteen cases occurred like this during the year. The periodical lime-washing was carried out. The number of animals inspected during or shortly after slaughter was:— Oxen, 145; cows, 14; heifers, 19; calves, 11; sheep and lambs, 449; pigs, 937. Total, 1,576. The following diseased meat and offal were surrendered during inspection :— 1 cow and organs, 1 ox and organs, 1 cow and organs, 1 cow and organs, 1 cow and organs, 1 ox and organs, 2 cows; total, 8 carcases. One pig's head, 1 ditto, 1 ditto, 1 ditto; total, 4. Offal—381b., 601b., 161b., 201b., 141b. Total, 1481b. One frozen sheep; also one hind-quarter frozen beef. During the year the following foods were examined, surrendered and destroyed:— January 4th, 9 wild rabbits. February 3rd, 61b. bacon; 25th, 561b. herrings. March 10th, 2 tins corned beef; 17th, 5cwt. 2qr. 21.1b. dates; 18th, 2cwt. herrings; 24th, 1 case herrings. April 4th, 1 box dates; 8th. lewt. 1qr. herrings; 8th, 5 boxes dates; 23rd, 3 boxes dates; 24th, 1 case haddocks. 85 May 2nd, 3 boxes dates; 8th, 20 boxes dates; 13th, 2 boxes dates; 14th, 1 case haddocks; 15th, 1 box dates; 20th, 51b. bacon, 1 tin corned beef; 21st, 1 box dates; 27th, 1 box dates; 28th, 1 trunk of dog-fish; 28th, 4 boxes tomatoes. June 6th, 1 case bananas; 10th, 181b. bacon; 11th, 2 cases rabbits; 30th, 1| boxes kippers. July 4th, 40½lb. bacon; 24th, 1½ boxes dates; 29th, 2cwt. cheese; 30th, 1 tin crab. August 16th, 39 rabbits; 18th, 32 rabbits. September 1st, 161b. bacon; 8th, 221b. bacon; 8th, 1 case rabbits; 23rd, 3 boxes kippers. November 27th, 351b. rabbits. December 5th, 2 trunks skate; 10th, 3 boxes dates; 12th, 40 boxes tomatoes; 13th, 38 rabbits. The stalls and shops where fish, fruit and foods are exposed for sale for human consumption are regularly inspected. Herewith I append a statement of work done under the Sale of Food and Drugs Act by the Middlesex County Council Inspector for this district, kindly supplied by the Chief Officer of the Public Control Department. Article. Taken. Adulterated. Milk 118 17 Cream 4 4 Vinegar 6 3 Self-raising Flour 2 — Coffee 1 — Evaporated Milk 1 — Total 132 24 Number of Prosecutions 8 Number of Convictions 4 Fines £17 The figures given for adulterated samples include some adulterated informal samples in respect of which no proceedings could be taken. GIPSIES. I have received a number of complaints as to the disgusting habits and filthy language of the nomads, some of whom are of foreign extraction. Occasionally we get a clean, bona fide showman, or gipsy, and these only stay the night; but the generality are a low type of vagrant, who manage to exist in a box on four wheels, under over-crowded and filthy conditions, and evade all responsibility of law and order. They are a nuisance to the residents in the 86 vicinity of their camps, and blackguard the inhabitants who refuse to give them anything they ask for. Why some legislation has not been brought about to deal effectually with this class of people I cannot understand. The cottager is taxed, but these people go scot free. As much of the vacant land has been used for allotments, this has prevented them from causing the nuisances they did in former years. Number observed 129 Nuisances abated 9 Removed from district 93 COWKEEPERS, DAIRIES, ETC. The number of registered cow-keepers remains the same as last, i.e., two. The number of cows kept varies from time to time; in all there are not more than 26. The periodical inspections and lime-washing have been carried out; the cows are out to graze for the greater part of the year. The number of dairymen and milk-sellers on the register is 62—11 of them devote their business to dairy produce, 25 have given up the sale of milk, and 8 businesses have changed hands. 165 inspections were made during the year. Sanitary Authorities require much more stringent powers before they can get the desired results. Licences should be granted from year to year, and renewed only when the conditions have been carried out satisfactorily THE COMMON LODGING-HOUSE. These premises are kept in a fair and cleanly condition, especially considering that it is such very old property. The by-laws regulate the accommodation, and give the Council and their officers much more control over this class of persons than they could exercise in a private dwelling. I look forward to the time when these premises, together with those adjoining, are demolished, but to condemn them now, under the present circumstances, would mean driving 2i inmates into the street, or into lodgings over which, in all probability, the Council would have very little control. OFFENSIVE TRADES, ETC. The marine-store dealers require a good deal of attention, as many of them take up dealing for a few weeks, then disappear, and turn up in some different capacity. There are 51 persons on the register, including rag, bone and skin dealers, fish friers and curers, etc. By-laws dealing with these trades generally, are very much needed. 87 HOUSE-TO-HOUSE INSPECTION. The systematic house-to-house inspection was resumed in May, but the progress was not so fast as one could wish, as owing to the general complaints a great deal of attention had to be paid in other directions. The defects discovered are very numerous owing to the neglect of the property; there is great difficulty in getting materials, and the cost is high, all of which is seriously handicapping the work and giving the inspectors a trying time. The by-laws should be brought up to date so as to facilitate the work; especially does this apply to keeping W.C. 's supplied with sufficient water for flushing, and keeping yards and forecourts in good repair. A number of houses have been temporarily repaired which, under normal conditions, should have been demolished. The combined drain and sewer question is most important. I would strongly suggest that two or three of the worst blocks of drainage, for which the Council might be liable, be dealt with each half-year. A few years would then clear those up that are an ever recurring nuisance. PIG-KEEPING. Very few nuisances have arisen during the year from this business, as the pigs, generally, were well-kept and in a clean condition. The numbers are on the decrease, due, no doubt, to the difficulty of obtaining restaurant waste and to the present cost of meal. CANAL BOATS. There were 14 registered boats inspected during the year, and the boats met with were well kept. The following"contraventions were dealt with:— 1 cabin top defective. 1 dirty cabin. These defects have since been remedied. THE SHOPS ACT. The Shops Act was fairly well observed, but there are a few shop-keepers who surreptitiously supply goods to their known customers at the side doors. It was found necessary to take proceedings in one case only, and a small fine of 7s. 6d. was imposed. The following is a summary of the most important work done in connection with the abatement of nuisances:— Complaints 655 Infectious Disease 715 Common Lodging House 62 Bakehouses 39 88 Factories and Workshops 82 Slaughter-houses 275 House-to-house Inspections 277 Offensive Trades 87 General Inspections 160 Public and Private Sanitary Conveniences 389 Petroleum Acts 46 Schools 59 Houses or Parts of Houses Cleansed or Repaired 208 Cisterns Covered, Cleansed or Repaired 13 W.C.'s Repaired or Improved 132 Drains tested or examined 269 Drains repaired, cleared or trapped 356 Waste pipes, Rain-water Pipes Repaired 34 New Soil or Ventilation Pipes 13 Chambers Inserted 7 Chambers Sealed Down 12 Rooms Stripped or Cleansed after Infectious Disease 625 New Dustbins Supplied 179 Waste Preventors Repaired 77 Accumulations, Stagnant Water, etc. 40 Water Fittings Repaired 76 Water Restored to Premises 2 Water Supply put on Main 3 Scullery Floors Repaired 14 Coppers Repaired 22 Roofs, Gutters and Rainwater Pipes Repaired 290 Yards Paved or Repaired 12 Nuisances from Animals Abated 14 Other Nuisances Abated 207 Total Number of Inspections and Re-inspections 10,138 We were glad to see Messrs. Nixon and Huckle on their safe return from the war—especially the latter, as he was for some time a prisoner of war. In closing this Report I desire to express my thanks for the support I have always received from my Committee and Council. I have the honour to be, Mrs. Benjafield and Gentlemen, Your obedient Servant, RICHARD JOHN BUTLAND, Chief Sanitary Inspector. 1 ANNUAL REPORT for 1919. On the Health of the Scholars in the Urban District of Edmonton. Sidney C. Lawrence, School Medical Officer. 2. R. H.. STRONG, Deputy and Assistant School Medical Officer School Medical Inspector. 3. A. A. C. WILLIAMS, 1st School Nurse. 4. (Mrs.) J. A. HOBBS, 2nd School Nurse (half-time). S J. p. FARRAR, School Medical Clerk (half-time). 2 Edmonton Education Committee. REPORT of the School Medical Officer for the year ended December 31st, 1919. Town Hall, Edmonton, N.9. To the Chairman and Members. Ladies and Gentlemen, I herewith submit my Eighth Annual Report. From July 1st Dr. R. H. Strong was appointed permanently as School Medical Inspector and Assistant School Medical Officer. As mentioned in my preface to the M.O.H. Report, I was absent for nearly three months owing to ill-health, due to over-work long endured. This has delayed the preparation of this Report, but it was unavoidable. In my last report I said:— " 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." Further experience convinces me that one-third of my time is required, now the School Clinic is at work. I had proposed to include in this report a commentary on the Education Act, 1918, in its medical aspects, but I refrained from doing so, owing to (partly) lack of time, and also with a view of keeping down the cost of producing this Report. I hope I may be able to carry out my intention in the Report of 1920. It is interesting to note that several Local Authorities are approaching the Government with the suggestion that the provisions of this Act involving great expense should be postponed in their operation. I am, Ladies and Gentlemen, Your obedient servant, November, 1920. SIDNEY C. LAWRENCE, School Medical Officer. 3 SECTION 3 (1) (d) OF THE MINISTRY OF HEALTH ACT, 1919. On the 25th November, 1919, an Order in Council was made, under Section 11 of the Ministry of Health Act, 1919, fixing the 1st December, 1919, as the appointed day for Section 3 (1) (d) of that Act. The terms of this section are as follows:— There shall be transferred to the Minister all the powers and duties of the Board of Education with respect to the medical inspection and treatment of children and young persons under paragraph (b) of sub-section (1) of Section 13 of the Education (Administrative Provisions) Act, 1907, as amended and extended by the Education Act, 1918. Provided that for the purpose of facilitating the effective exercise and performance of these powers and duties, the Minister may make arrangements with the Board of Education respecting the submission and approval of schemes of local education authorities and the payment of grants to local education authorities, so far as such schemes and payment relate to or are in respect of medical inspection and treatment; and the powers and duties of the Minister may, under any such arrangements be exercised and performed by the Board on his behalf and with his authority under such conditions as he may think fit. The Minister of Health has decided to exercise his discretion under this section to make arrangements with the Board of Education respecting the submission and approval of schemes of local education authorities and the payment of grants to local education authorities, so far as such schemes and payments are related to or are in respect of medical inspection and treatment. Under these arrangements— (1) The Minister of Health will retain the ultimate right to determine— (a) What is necessary in regard to the work of medical inspection and medical treatment: and (b) The standards to be adopted from time to time in regard to the character, adequacy and efficiency of the provision made. Under this arrangement effective control, both of the work which is done and of the way in which it is done, will be in the hands of the Minister. (?) Subject thereto, the Board of Education will be responsible for receiving and approving, on behalf of the Ministry of Health, all schemes of local education authorities and for the payment of grants in aid of medical inspection and treatment, and will exercise in this regard the powers and duties of the Minister of Health. 4 Under these arrangements all communications relating to medical inspection and treatment will be addressed as heretofore to the Board of Education, whose officers will continue to carry on the work of inspection. Arrangements have also been made to secure continuous and effective co-operation and co-ordination between the two Departments, not only in respect of medical inspection and treatment (under Section 13 (1) (b) of the Education (Administrative Provisions) Act, 1907, as amended and extended by the Education Act of 1918) but also in respect of the other functions of the Board of Education and local education authorities which directly and intimately concern the health of children and young persons. The two Departments are actuated by the desire that there shall be a comprehensive, consistent and progressive policy for promoting the health and physical welfare of children and young persons, and that this policy shall be reflected in the administration of the departments so as to facilitate to the utmost extent the development of health services by local authorities, whether under the Education Acts, the Public Health Acts, the Maternity and Child Welfare Act, or otherwise. ATTENDANCE OFFICERS. The general experience is, that in-95% of the cases of non-attendance at school the real or alleged reason is the ill-health of the scholar. This experience has led a number of progressive authorities to place the Attendance Officers on the staff of the School Medical Officer, so that he will be able to maintain close co-operation, and in cases of vacancies arising from resignation, death, or any other cause, these vacancies have been filled by school nurses, whose training enables them to investigate and appreciate the causes of absence. I feel that this would be a wise course for you to adopt when vacancies arise amongst the Attendance Officers of Edmonton. THE SCHOOLS OF EDMONTON. (17 in Number.) Public Elementary Schools 11 Secondary School 1 Private Schools 5 TECHNICAL INSTITUTE. The Technical Institute was opened on Saturday, September 28th, 1912; it was erected on the site of the old Latymer School in Church Street. Provision for extension of the building, when necessary, has been made. Mr. H. Farrands, M.A., is the Secretary. 5 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 Headmistress. 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 234 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, 1919-20, 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. Since 1914 nothing has been done beyond the ordinarv repairs necessary to keep the buildings in good order. Central Schools.—In January, this extended form of education was introduced at Brettenham Road Girls' School by Miss Seward, and at Croyland Road Boys' School by Mr. Belton. 6 ACCOMMODATION AND ATTENDANCE. I have extracted the following interesting information from the Committee's Year Book for 1920-21:— Council Schools. Nonprovided Schools. Totals. Accommodation—March, 1920 12122 2183 14305 1917-18 No. of scholars on rolls 10485 2225 12710 Average attendance 9339 1936 11275 1918-19 No. of scholars on rolls 10217 2233 12450 Average attendance 8909 1941 10850 1919 20 No. of scholars on rolls 10318 2267 12585 Average attendance 9126 1992 11118 DETAILS OF EACH SCHOOL FOR YEAR ENDING 31st MARCH, 1920. Council Schools. Accommodation. Average Attendance. Boys. Girls. Junr. Mixed Infts. Boys. Girls. Junr. Mixed Infts. Raynham Road 660 540 600 576 475 360 401 398 Brettenham Road 459 398 — 437 369 365 — 270 Silver Street 592 562 — 562 433 438 376 Montague Road 300 300 300 460 239 228 244 312 Croyland Road 537 369 420 369 392 292 335 282 Eldon Road 660 540 521 600 500 417 437 475 Houndsfield.Road 300 300 300 460 259 250 288 291 Total 3508 3009 2141 3464 2667 2350 1705 2404 Non-Provided Schools. Accommodation. Average Attendance. Boys. Girls. Senr. Mixed ■ Infts. Boys. Girls. Senr. Mixed Infts. St. James's 218 207 – 220 216 201 – 197 All Saints' – 455 – 447 – 433 – 374 Latvmer Elementary 300 – – – 285 – – – St. Edmund's, R.C. – – 248 88 – – 215 71 Total 518 662 248 755 501 634 215 642 Grand Total 4026 3671 2389 4219 3168 2984 1920 3046 There were 12,450 children on the books for the year ending 31st March, 1919, besides the children attending Enfield Schools; the average number of children of the Edmonton district attending Enfield Schools during the year was 234, so that there is in Edmonton one child in the public elementary schools for 6.0 inhabitants (reckoned on the nett population); it was 5.7 last year. 7 There were 125 less children attending school than last year, and 682 less than in 1915. The number of children who obtained labour certificates enabling them, if they wish, to leave school at an earlier age than 14, was 75; 79 last year. Expenses. Five precepts in April for £12,950 for elementary and £50 for secondary education, and in October for £33,097 for elementary and £50 for higher education, in all for £46,147, were served on the Overseers to meet the requirements of public education for the year ending March 31st, 1920; the amount last year was £33,683. Besides, a very large necessitous grant has been received from a sympathetic Government, amounting to £68,479, of about a 6s. Od. rate; compare this with £47,850 (a 4s. 0d. rate) last year and with £16.375 (a 1s. 7d. rate) for 1914-15-16-17, and with £9,216 for 1913, which was equal to only an 11d. rate. In April the Edmonton Teachers' Association requested the Council to appoint a local teacher on the Education Committee, but the scheme of December 14th, 1903, does not allow for this, and one of the two co-opted women is a headmistress. On July 8th the Council granted permission to the Education Committee to appoint Dr. Strong permanently; he had been acting as my junior colleague since February 1st, 1915. Councillor (Mrs.) Benjafield resigned from the Education Committee in July; this was accepted on 26th August, and the vacancy filled by Councillor Elms in September. Girls' Charity School. On the 28th October the Council appointed four of their number to be trustees of the Special Instruction Foundation for a period of three years, in accordance with the scheme of July 23rd, 1913. Washing. In December the Council agreed to washing towels, dusters, etc., for the Education Committee, and that this Committee be charged with the wages of a " laundress and 10% for the use of the apparatus.'' This relieved the school caretakers. 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 and seventy-seven children were passed through the routine inspection; the number last year was 5,345. 8 Of the Board of Education. The ages and numbers of children inspected were as follows:— Ages. Entrants. Totals 8 year old group. Leavers. Total. Grand Total. 5 6 7 12 13 and over. Central School. Boys 617 92 7 716 487 590 621 80 1291 2494 Girls 621 87 9 717 495 579 716 76 1371 2583 Totals 1238 179 16 1433 982 1169 1337 156 2662 5077 "B'' —GROUPS OTHER THAN CODE. Intermediate other than 8 years. Special cases. Re -examinations. Boys nil 835 2248 Girls nil 713 2237 Totals nil 1548 4485 Re-inspection at the schools, immediately following the routine, 84 boys and 67 girls. The parents were present with 955, or 38.3 per cent., of the boys inspected, and 1,231, or 47.7 per cent., of the girls. There were no objections to medical inspection of the boys, but regarding 4 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 4,485—2,248 boys and 2,237 girls, compared with 1,962—960 and 1,002 in 1918. 9 SPECIALLY-REFERRED CENTRE. The room in use is the same ill-adapted one at the Education Office as in the four previous years. Tuesday afternoons and Saturday mornings are devoted to this work. This work will be absorbed into the Minor Ailments section of the School Clinic in 1920. The attendances of specially-referred cases and absentees due to illness were 4,082, compared with 3,566 for 1918. Of these, 1,537 were first attendances, and the balance was subsequent ones. Arrangements for following-up Children with Defects. The following visits were paid in " following-up " cases reported to me by the School Medical Inspector, or Head Teachers, or Attendance Officers. January. February. March. April. May. June. July. August. September. J October. November. December. TOTAL. P. Corp 9 9 33 21 10 9 13 5 23 37 33 12 214 P. Capt. 4 9 22 21 9 — 15 3 14 25 6 12 140 P. Capt. and Corp. 16 1 — — — — — 2 — 3 — — 22 Neglect 9 11 4 4 2 1 24 S 15 14 5 2 99 Dirt — — 2 — — — — — — 2 — — 4 Scabies 3 6 2 — 3 — 5 — 12 7 1 12 51 Impetigo — 6 3 6 1 4 2 1 4 1 1 4 33 Ringworm — 7 3 11 2 5 12 5 i 1 4 1 55 Vision — 3 — 3 5 2 2 1 5 6 1 3 31 Otorrhœa 1 1 1 — — — — — 1 — — — 4 Chorea — 2 2 — — — — — — — — — 4 Mental Deliciency — — 6 — 1 — — — —. — 1 — 8 Enlarged Glands — — — 4 3 4 3 — — 1 2 2 19 Pvorrhœa — — — — — 3 2 1 — — — — 6 Tonsils — — — — — — — — 2 — — — 9 Clothing — — — — — — — — 4 — — — 4 Under Weight — — — — — — — — — — — — 2 Doubtful Cases — — — 8 1 — — — — 5 — 14 Enquiries 5 — 18 7 22 10 12 2 2 7 7 13 105 TOTALS 47 55 96 85 59 38 90 _ 28 86 106 66 61 817 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. 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 10 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; ineducable. It is only those cases allotted to the last class which are dealt with by the County Council. During the year two cases—W.C., 15 years, and D.H.P., 9 years—were sent to institutions by the Middlesex Council. During 1919, Dr. Strong examined 20 cases, which were classified as follows:— Class I. 1 case. Class II. 5 cases. Class III. 10 cases. Class IV. 2 cases. One case was adjourned and one (L.G.C.) was placed in Class IV, but had not been dealt with by the County Council at the end of the year. M.D. School.—In June a draft agreement was submitted to the Council which was recommended by a joint provisional committee meeting (with the two Secretaries and two S.M.O.'s) on the 29th May. This day school will be established under the provisions of the Elementary Education (Defective and Epileptic) Act, 1914, for Enfield and Edmonton scholars, and be under the financial control of the two Councils. It was resolved by the Edmonton Council " that steps be taken in conjunction with the Enfield Council to secure Nassau House, Enfifeld Highway, by lease or purchase, for the establishment of this school.'' On December 23rd, 1919, the Council's seal was affixed to the agreement with Enfield Council re the purchase of Nassau House, and the appointment of a Joint Board of Managers. The Board of Managers will consist of eight members, four (of whom one shall be a woman) from each Education Committee, chosen at each annual meeting, to hold office from May 1st to April 30th. The managers will appoint and dismiss all officers, teachers and servants, and fix their salaries and duties, arrange transport of children, and make all necessary rules and regulations. Expenses to be equally shared as regards sites, buildings, rents, rates, repairs, furniture and transport of children; that other expenses be shared in proportion to the average number of children on the roll, out of a common fund, supported out of rates and Government grants. A copy of the Minutes to be submitted regularly to the two Education Committees. Clause 13 of the agreement states that " The Managers shall, at all reasonable times, admit to the school the M.O.H., S.M.O., and all other accredited officers of the two Educational Authorities." 11 EPILEPSY. 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 352, or 14.1 per cent., and 378 girls, or 14.6 per cent. During 1919 Dr. Strong sent ten "B" notifications to the M.O.H. Of these, the reports on three boys and two girls referred to pulmonary tuberculosis, and the same number to other forms of tubercle. RETURN SHOWING PHYSICAL CONDITION OF CHILDREN INSPECTED AT ROUTINE MEDICAL INSPECTION. Total inspected, 5077. Boys, 2494; Girls, 2583. Ages. Boys. Girls. Entrants 8-9 Leavers. Entrants 8-9 Leavers. Clothing: Satisfactory 716 483 1290 717 492 1369 Unsatisfactory — 4 1 — 3 2 Footgear: Satisfactory 715 485 1289 717 493 1369 Unsatisfactory 1 2 2 — 2 2 Total for either 716 487 1291 717 495 1371 NUTRITION. Ages. Boys. Girls. Entrants 8-9 Leavers. Entrants 8-9 Leavers. Good 661 460 1090 628 453 1154 Fair 55 27 201 89 42 217 Bad — — — — — — Totals: 716 487 1291 717 495 1371 Out of the children in the several groups for routine medical inspection the cards of 1,031 were marked for re-examination by reason of their weight and physique being unsatisfactory. All were called up for re-examination —771 showed improvement, 7 showed further loss of weight, 16 stationary, 237 were absent. 12 EDMONTON CANTEEN COMMITTEE. REPORT FOR 1919. During 1919 meals were supplied to 180 children. (The number in 1918 98, and in 1917 was 81.) Of these, 130 were the children of widows, 43 were children whose fathers were temporarily out of work, and 7 were children whose fathers' wages were not sufficient to allow the children to be properly fed at home. The number of children receiving meals each week was as follows:— January 53, 57, 56, 57. February 56, 58, 62, 64. March 63, 59, 65, 57, 55. April 54, 60, 62, 62. May 58, 63, 63, 63, 72. June 70, 66, 70, 72. July 71, 72, 90, 92. August 87, 84, 75, 76, 75. September 74, 75, 76, 75. October 72, 77, 89, 90. November 83, 73, 75, 71, 78. December 81, 79, 99, 77. All the dinners were supplied at the Feeding Centre in Fore Street, Upper Edmonton. Owing to the increase in the cost of foodstuffs, etc., the price paid for each dinner was raised from 6d. to 7d. in December, 1919. The conditions of investigation were the same as in recent years. The Central Investigation Committee met on six occasions during the year. List of Menus, February, 1920. Note.—Quantities for 50 children are given in Dinner No.l. Quantities in other dinners should be similar, and so arranged that each child receives 14£ozs. of food cooked and ready to be eaten. Monday.—Dinner No. 1.—Stew.—beef, 61bs.; haricots, 3 pints; bread, 81bs.; potatoes, 161bs.; onions, l1b.; carrots, l1b.; turnips, 41bs. Baked rice pudding.—rice, 61bs.; milk, 1 quart; sugar, l1b. Tuesday.—Dinner No. 2.—Roast beef or mutton, greens, potatoes, bread; boiled plum roll. Wednesday.—Dinner No. 3.—Shepherd's Pie.—meat, potatoes, onions, bread ; suet roll and jam. Or (in summer)—Dinner No. 4.—cold meat, potatoes, bread; suet roll and jam. 13 Thursday.—Dinner No. 5.—Fried liver, thick gravy, potatoes, greens, bread; baked rice pudding. Friday.—Dinner No.6.—Boiled Fish and melted butter,potatoes, haricots, bread; boiled currant roll. Saturday.—Dinner No. 1.—Stew. (Or, if preferred, Irish Stew in lieu of No. 1 above.) When possible, stewed fruit to be given once or twice a week as second course, in place of the puddings mentioned above. T. G. SCOTT, Hon. Sec., 27, Queen's Road. VERMIN. Boys. Girls. cleanliness of hkad. Clean 1659 2357 Nits 803 195 Pediculi 32 31 Cleanliness of Body. Clean 2479 2554 Pediculi 15 29 Totals for either 2494 2583 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 6,008 this year; the number was 983 last year. Mrs. Hobbs, second school nurse, deals with the verminous homes. The Cleansing Station still remains unfinished, although the walls were erected last year and utilised as a temporary shed for a motor ambulance for. infectious disease. It is quite time that it was completed and in proper use. In September I requested the Public Health Committee to draw the Council's attention to the urgent necessity of completing this building in the Town Hall Yard, not only to deal with lice amongst scholars, but with itch amongst the inhabitants of all ages, which loathsome disease has been much on the increase, owing to Service men bringing it home when on leave. TEETH. Of the boys, 1,109, and 1,125 girls, had one to three teeth decayed, and as many as 622 boys and 542 girls had four teeth or more decayed. 14 NOSE AND THROAT. Among the boys, 282, and 316 girls, had either enlarged tonsils or adenoids, or both. EYE DISEASE. Fifty-one boys and 90 girls were wearing spectacles. Slight errors of vision were found in 59 boys and 82 girls, and marked errors in 77 boys and 104 girls. Thirty-four boys and 46 girls had squint. SCHOOL CLINIC. In September the Architect reported that the nurses at the Military Hospital had vacated Pvmmes Park House, and that the Guardians were carrying out the necessary repairs. The Council then agreed to rent three rooms on the first floor to the Education Committee, at £25 a year. 15 INFECTIOUS AND (or) CONTAGIOUS DISEASES. The number of children excluded at the routine inspection was 56—11 boys and 15 girls, the reasons for exclusion being:— Boys Girls Boys Girls V erm in. Head — 1 Contag. Skin Dis. ' Body 22 4 Head and Body 6 1 Ringworm .. 2 1 Scabies 3 — Impetigo 1 2 Infec. Dis. German Measles 1 — Mumps 1 — Measles — 1 Other Conditions 2 3 Chicken Pox 1 2 Scarlet Fever 2 — Totals 41 15 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 728, compared with 657 the year before. The reasons for the exclusions were:— No. of Cert. No. of Cert. Impetigo 170 Pulmonary Tuberculosis 9 Ringworm 120 Chicken-pox 6 Vermin 112 Other Tubercular Diseases 5 Scabies 99 Anaemia 4 Other causes 57 Mumps 2 Tonsilitis 34 Epilepsy 2 Skin Diseases 22 Influenza 2 Eye trouble.. 21 Whooping Cough 2 Febricula 18 Measles 2 Bronchial Catarrh .. 13 Diphtheria 2 Chorea 12 Scarlet Fever 1 Ear Disease 12 Mental Defective 1 Total 728 The number, 728, is 71 more than last year. Scabies numbered 109 last year. II.—For Infectious Diseases (Notifiable and Non-Notifiable). Without measles, in connection with the notifiable infectious diseases, 1,369 notices were issued by the Medical Officer of Health excluding 1,510 16 children, as patients or contacts, from attending day or Sunday schools for definite periods. The numbers last year were—189 notices excluding 211 children. On account of measles and the non-notifiable infectious diseases, notices excluding 3,209 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 1918-17-16 were 2,779, 2,044 and 2,058 respectively. It is interesting to note the great variation in the number of children excluded from the schools during 1919:— 1 —Eldon Road 607 7 —Brettenham Road 217 2 —Silver Street 502 8 —Montagu Road 194 3 —Raynham Road 392 9 —St. James 141 4 —National 367 10 —St. Edmund's 38 5 —Croyland Road 300 11 —Lower Latymer 35 6 —Houndsfield Road 226 12 —Upper Latvmer 9 Total 3028 Besides the following:—Enfield Council Schools, 3; other Enfield Schools, 17; our private schools, 74; 28 children at various schools in Tottenham, etc. There were 59 children not attending (at the time) any school. Exclusion of Contacts.—The rules adopted for the exclusion of contacts are as before. DISINFECTION. During the Easter vacation all the eleven public elementary schools were thoroughly disinfected, and, during the long vacation, the Public Library, all the public elementary schools and most of the church halls were disinfected. In October, Brettenham Road Girls' Department and classrooms at Silver Street and Houndsfield Road Schools were again disinfected. In November, two private schools, classrooms at Croyland Road and Houndsfield Road, and the Junior Mixed Hall at Montagu Road were disinfected. In December, nine elementary schools and eight church halls were dealt with. Closure.—Croyland Road Infants' School was closed for 14 days, and then for a third week, re-opening Monday, June 30th, as half the measles and a quarter of the scarlet fever cases during May were connected with this school. 17 TABLE II. (of Board of Education.) RETURN OF DEFECTS FOUND IN THE COURSE OF MEDICAL INSPECTION IN 1919. 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 69 — Uncleanlinesg of body 44 6 SKIN- Ringworm of head 4 — Ringworm of body 3 — Scabies 7 — Impetigo 10 — Other disease 15 — Eye— Defective vision and squint .. 427 95 External eye disease 69 3 Ear— Defective hearing 204 81 Ear disease 140 19 Teeth— Dental disease no clinic 3280 Nose and Throat— Enlarged tonsils and or adenoids 569 197 Defective speech 20 11 Heart and Circulation— Heart disease—organic 6 — Heart disease—functional 42 10 Anjemia 55 15 Lunos— Pulmonary tuberculosis—definite 5 — Pulmonary tuberculosis—suspected.. 11 4 Chronic bronchitis 23 9 Other disease 34 14 Nervous Svstem— Epilepsy 5 — Chorea 4 — Other disease 4 3 Non-pulmonary tuberculosis—glands 2 — bones and joints 2 — other forms 1 — Rickets 6 3 Deformities 15 2 Other defects or disease 29 5 18 TABLE III. (of Board of Education). NUMERICAL RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA IN 1919. Boys. Girls. Total. Blind (including partially blind) Attending public elem. schools 13 14 27 Attending certified schools for the blind 2 2 4 Not at school Deaf and Dumji (including partially deaf) Attending public elem. schools 27 22 49 Attending certified schools 8 8 16 Not at school Mentally Deficient— Feeble-minded .. Attending public elem. schools 37 23 60 Attending certified schools - — - Notified to the Local Control Authority during the year 1 1 - I mbeciles At school 5 8 13 Mentally Deficient (inclusive) N ot at school 2 9 11 Epileptics Atttending public elem. schools 6 8 14 Attending certified schools — — — N ot at school 1 1 Physically Defective— Pulmonary tuberculosis.. Attending public elem. schools 13 7 20 Attending certified schools - — — Not at school 3 1 4 Other forms of tuberculosis Attending public elem. schools 8 4 12 Attending certified schools — — — Not at school 2 4 6 Cripples (other than tubercular) Attending public clem, schools 30 18 48 Attending certified schools — — — Not at school 12 13 25 Dull or Backward (judged according to age and standard) Retarded 2 years 340 175 515 Retarded 3 years 116 71 187 19 TABLE IV. (of Board of Education).—TREATMENT OF DEFECTS OF CHILDREN DURING 1919. Condition. No. of defects found for which treatment was considered necessary. No. of defects for which no report is available. No. of defects treated. Result of treatment. No. of defects not treated. Percentage of defects treated. From previous years. New. T otal. Remedied . Im- proved. Unchanged . Clothing 19 10 29 3 24 7 14 3 2 82.8 Footgear 14 9 23 3 20 9 9 2 — 87.0 Cleanliness of head 186 63 249 20 194 106 55 33 35 77.9 Cleanliness of hody 44 44 88 5 72 40 16 16 11 81.8 Nutrition - - - - - — — — — — Nose and throat 343 569 912 184 455 250 96 109 273 49.8 External eye disease 36 69 105 19 83 39 24 20 3 79.0 Ear disease 124 140 264 19 212 120 51 41 33 80.3 Teeth - - - - - — — — — — Heart and circulation 92 103 195 13 144 60 51 33 38 73-8 Lungs 92 83 175 6 126 62 40 24 43 72.0 Nervous system 14 13 27 2 20 5 13 2 5 74.0 Skin 42 39 81 5 76 50 20 6 — 93.8 Rickets 5 6 11 - 8 - 7 1 4 72.7 Deformities 19 15 34 - 31 3 27 1 2 91.2 Tuberculosis (non-pulmonary) 9 5 14 2 12 1 9 2 5 85.7 Speech 14 20 34 2 16 11 4 1 11 47.1 Mental condition 4 8 12 4 8 - 8 — — 66.7 Vision and squint 279 427 706 60 511 119 259 133 135 72.4 Hearing 228 204 432 26 295 157 108 30 111 68.3 Miscellaneous 23 29 52 9 34 14 10 10 9 65.4 Totals 1587 1856 3443 382 2341 1053 821 467 720 68.0 20 TABLE V. (of Board of Education). INSPECTION, TREATMENT, ETC., OF CHILDREN DURING 1919. 1.—The total number of children medically inspected, whether code, group, special or ailing 11,267 2.—Number of children in (1) suffering from defects other than uncleanliness or defective clothing or footgear 3,853 3.—Number of children in (1) who were referred for treatment, excluding uncleanliness, defective clothing, etc. 2,424 4.—Number of children in (3) who received treatment for one or more defects, excluding uncleanliness, defective clothing, &c. 1,825