148 EDM 19 Urban District Council of Edmonton. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1 9 2 8. T. J. JOLLY, PRINTER, 23a. PORE STREET, EDMONTON, N.1B Urban Dtstrirt Council of Edmonton. REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1 9 2 8 . T. J. JOLLY. PRINTER, 238, FORE STREET, EDMONTON, N.18. Eimonton Urban Distrirt Council. 19 2 8. Chairman A. J. G. HOLLYWOOD, J.P. Vice-Chairman Mrs. ITHELL. PUBLIC HEALTH COMMITTEE. Chairman - - - - - H. BARRASS. Mrs. BARRASS, Mrs. COE, Mrs. DARLING, Mrs. HEARN, T. J. McMANUS F. C. MOORE, Mrs. SANDERS, W. W. VENABLES. MATERNITY AND CHILD WELFARE COMMITTEE. Chairman - Mrs. COE. Vice-Chairman MrsTABRAHAM. Mrs. BARRASS, Mrs. DARLING, J. J. GIBAUD, Mrs. HEARN, Mrs. ITHELL, Mrs. LONG, T. J. McMANUS, F. C. MOORE, H. W. NORMAN, W. PREYE Mrs. SANDERS, Mrs. YOUNG. Co-opted Members (not being Councillors)— Mrs. AUDUS, Mrs. ALLAN, Mrs. BEER, Mrs. CUDWORTH, Mrs. ELMS, Mrs. JENNER, Mrs. KEY. 3 STAFF OF THE PUBLIC HEALTH DEPARTMENT. *H. W. Harding, M.D. (Lond.), D.P.H., M.R.C.S., and L.R.C.P., Medical Officer of Health, School Medical Officer and Supervisor for the Maternity and Child Welfare Committee. *ab J. E. Winter, Senior Sanitary Inspector, Inspector of Canal Boats, and Inspector under the Petroleum Acts. ab G. H. Huckle, Sanitary Inspector, and Inspector under the Petroleum Acts. ab W. Tillcock, Sanitary Inspector, and Inspector under the Petroleum Acts. ab J. P. Farrar, Sanitary Inspector, and Inspector under the Petroleum Acts. ab F. Beilby, Inspector for the Housing Regulations. a Mrs. H. Fowler, Woman Sanitary Inspector. S. Clayton, Shops Acts Inspector. F. J. Nash, Senior Clerk. R. F. Lomax. J. L. A. Saunders (half-time School Medical Clerk). MATERNITY AND CHILD WELFARE. * Mrs. G. F. Fleetwood-Outram, M.B., Ch.B. (Glas.) (part-time), in charge of the Ante-Natal Clinic and Child Welfare Centres. * W. H. Willis, L.D.S., R.C.S., B.Sc., Dentist (part-time). * J. B. Barnett, F.R.C.S., Orthopaedic Surgeon. †*aeMiss A. Bintcliffe, C.M.B., Superintendent. *a Miss A. Naylor, C.M.B., Health Visitor. * Mrs. C. Boothby, C.M.B., *e Miss J. Anderson, C.M.B., * Miss R. S. Saunders, Senior Clerk. * Miss N. A. Eyres, Junior Clerk. * Moiety paid under Public Health Act, or by Exchequer Grants. a Certificated Sanitary Inspector. b Certificate of Meat and Food Inspector. e Maternity and Child Welfare Certificate. † Certificate as prescribed by the Board of Education. 4 To the Chairman and Members of the Edmonton Urban District Council. Ladies and Gentlemen, I beg to present you my Report for the year 1928 on the sanitary conditions of the District of Edmonton and its vital statistics. The Report is drawn up in accordance with the suggestions made in Circular 939 of the Ministry of Health, dated December 13th, 1928. There are no unusual events to chronicle in either the Public Health or the Maternity and Child Welfare Departments: each day has furnished its own quota of problems and work. The housing problem, in spite of the efforts of the Council, is still not solved: on the one hand are folk living under sordid conditions and quite contented ; on the other are families, often with one or more of its members in poor health, living under conditions of overcrowding which must sap the vitality of the strongest. Rents are high, and so-called "furnished" rooms are let at an exorbitant figure. Overcrowding leads to increased wear and tear, with the result that the interior of houses rapidly become dilapidated; the services of the sanitary inspector are invoked, and this official has to decide how much is fair wear and tear, defects which the owner of the house is responsible for. One of the outstanding features of the year was the plague of flying beetles which invaded the houses of a road adjoining agricultural ground; the matter is referred to later on. At the time of writing, the Council have an offer to take over the Day Nursery, which is now run privately. If this were done, and the adjoining ground also purchased, it would be a tempting proposition to erect on the site premises suitable for a Child Welfare centre. Our present premises in Brookfield House are inadequate on account of the large numbers attending. I beg to thank the members of both Committees for their cordial help during the past year; also all members of the staff for their ever-ready and loyal co-operation. I am, Your obedient servant, H. W. HARDING. 5 GENERAL STATISTICS. Area (including 31 acres of water) 3,895 acres Population, census of 1921 66,807 „ estimated by the Registrar-General for the mid-year 1928 74,460 Number of inhabited houses, 1921 11,891 Number of families or separate occupiers, 1921 14,654 The Accountant has kindly furnished the following figures relating to 1928 :— Houses Tenements. Year ended 1927 13,237 835 Houses erected during 1928 676 2 Year ended 1928 13,913 837 making a grand total of 14,750 Assessable Value for purposes of Poor Rate £281,852 „ „ „ District Rate £275,226 Sum represented by a Penny Rate. For the Poor Rate £1,170 For the General District Rate £1,135 Rates in the £. April. October. For Poor Rate 5/8 5/8 For District Rate 3/11 3/11 SOCIAL CONDITIONS. Edmonton is one of the dormitories of London, many of its inhabitants travelling to and from town daily. Full details as regards occupations were given in the Report for 1925, but the following are the more commonly followed occupations:—Agricultural (including nurserymen), brick-makers, metal workers, electrical apparatus makers, textile goods and dress, wood workers, printers and book-binders, builders and bricklayers, painters, transport workers, commercial (not clerks), hotels and clubs, clerical, warehousemen. The Clerk to the Guardians has kindly furnished me with the following figures relating to relief in the district during the year 1928:— Outdoor Relief— Cases. Cash and Kind. Ordinary 1,671 £41,094 Unemployed 1,393 £21,411 3,064 £62,505 Building operations are still going on in the Western portion of Edmonton on the Winchmore Hill border: these houses, together with those on the Council's housing estate, are rapidly transforming Edmonton's semi-rural aspect to one wholly urban. 6 Industrial development has also taken place along the Lea River in the Southern portion of its course through the district: two large firms and several smaller ones have commenced operations during the year : the number of operatives in this part of the district is roughly estimated to be about 4,000. VITAL STATISTICS. Births. Total. Male. Female. Legitimate ... ... ... ... 1,275 652 623 Illegitimate 54 27 27 The population for 1928 is estimated by the Registrar-General as 74,460 ; non-residents of Edmonton in the North Middlesex Hospital and the M.A.B. Epileptic Colony, Silver Street, amount to 1,433 ; this gives a net population of 73,027, upon which figure the births and deaths are based. The birth rate per 1,000 of population is thus 18.2. Deaths. Males, 365 ; females, 358 ; total, 723. Death rate per 1,000 population' 9.9. Number of women dying in, or in consequence of, child-birth:— From sepsis 2 From other causes 2 Deaths of infants under one year of age per 1,000 births :— Legitimate, 69.0 ; illegitimate, 78.4 ; total, 69.4. Deaths from Measles (all ages) 23 ,, „ Whooping Cough (all ages) 3 ,, ,, Diarrhoea (under 2 years of age) ... ... 8 Deaths of children under the age of one year numbered 96, 62 males and 34 females ; of these deaths 2 males and 2 females were illegitimate children. Still Births. The registration of still births has been compulsory since July, 1927 ; during 1928 there have been registered 98 still-births, 76 by midwives and the remainder by doctors. Any analysis of the death returns from a small district as this would be of little value, but the following points are of interest:— In the first place, the number of males and females dying during the year are nearly equal: generally there is a marked excess in the number of male deaths, but obviously this cannot happen every year. Secondly, the number of females dying from heart disease and arterio-sclerosis is in excess of the number of males dying from the same causes : as both these causes are associated with senility, it is possible that these two observations are complementary. Thirdly, the deaths from violence are 50 to 100 per cent, greater than those occurring in recent and previous years. Reference to the deaths from typhoid fever is made under infectious diseases. 7 Total Number of Deaths for the Year 1928. Causes of Death. ALL AGES. Under 1 year 1 & under 2 years 2 & under 5 years 5 & under 15 years 15 & under 25 years 25 & under 45 years 45 & under 65 years 65 and upwards I 2 3 4 5 6 7 1 8 9 10 All causes Certified 724 93 25 24 26 41 75 171 269 Uncertified Enteric Fever 2 1 1 Small Pox .. Measles 23 2 8 12 1 — — — — Scarlet Fever I — 1 — Whooping Cough .. .. 2 1 1 Diphtheria and Croup 6 — — 1 5 — — — — Influenza .. 9 — — — 1 2 2 4 Erysipelas .. 2 — — — — — — 1 1 Phthisis (Pulmonary Tuberculosis) .. 56 2 — 2 1 18 21 10 2 Tuberculous Meningitis 1 — 1 — — — — — — Other Tuberculous Diseases 7 — 1 — — 2 1 1 2 Cancer, malignant disease .. 89 — — — — 2 8 }8 41 Kheumatic Fever .. '4 — — — 5 1 5 Meningitis .. .. .. .. — — — — — Cerebro-spinal Meningitis .. .. — — — — — — — — — Organic Heart Disease 104 — — — 1 4 6 27 G6 Bronchitis 37 — 1 — " 2 10 21 Pneumonia (all forms) 7i 20 8 4 3 1 3 15 17 Other diseases of respiratory organs .. 13 1 — — — — 1 5 6 Diabetes .. .. 4 — — — — — — 1 3 Cerebral-Haemorrhage '5 — — — — 1 1 3 10 Diarrhoea and Enteritis (under 2 years) 8 7 1 Appendicitis and Typhilitis .. 2 — — — 1 — 1 — Cirrhosis of Liver 2 Alcoholism 1 — Nephritis and Bright's Disease 27 — — — — 2 1 10 x4 Puerperal Fever .. < .. 2 — — — — 1 1 — Other accidents and diseases of Pregnancy and Parturition 2 1 1 Congenital Debility and Malformation, including Premature Birth 45 4") Violent Deaths, excluding Suicide 34 4 — — 4 1 4 10 11 Suicide .. .. 13 — — 1 8 1 Poliomyelitis .. Tetanus .. .. .. Syphilis .. . • .. .. Old Age 16 1 1.5 Arteriosclerosis 32 8 24 Ulcer of Stomach or Duodenum Encephalitis Lethargica — — — — — — — — — Epilepsy .. .. ,. 8 — — 1 1 2 3 — 1 Other Defined Diseases 62 4 2 4 2 10 if 22 Diseases ill-defined or unknown .. — — — — — Totals 724 93 25 24 26 4i 75 171 269 8 The following list of causes of death have been supplied by the RegistrarGeneral. They differ slightly from the preceding list, as they are those actually registered during the calender year (January 1st to December 31st), the prior list being those registered for fifty-two weeks. Some alteration in the classification of deaths is owing to fuller information being obtained from the certifying doctor in response to special enquiries. Causes of Death. M. F. Total. Enteric Fever 0 2 2 Scarlet Fever 0 1 1 Measles 13 10 23 Whooping Cough 0 3 3 Diphtheria 4 2 6 Influenza 5 4 9 Encephalitis Lethargica. 0 0 0 Tuberculosis of Respiratory System 23 33 56 Other Tuberculous Diseases 3 3 6 Cancer, Malignant Disease 40 49 89 Rheumatic Fever 1 3 4 Diabetes ... 3 1 4 Cerebral Haemorrhage, etc 8 12 20 Heart Disease 56 81 137 Arterio-Sclerosis 16 20 36 Bronchitis 17 10 27 Pneumonia (all forms) 38 25 63 Other Respiratory Diseases 3 3 6 Ulcer of Stomach or Duodenum 3 4 7 Diarrhoea, etc. (under 2 years) 6 2 8 Appendicitis and Typhlitis 2 0 2 Cirrhosis of Liver 0 2 2 Acute and Chronic Nephritis 14 6 20 Puerperal Sepsis 0 2 2 Other Accidents and Diseases of Pregnancy and Parturition 0 2 2 Congenital Debility and Malformation, Premature Birth 22 18 40 Suicide 8 5 13 Other Deaths from Violence 25 7 32 Other Defined Diseases 52 47 99 Causes Ill-defined or Unknown 0 0 0 Total 365 358 723 9 COMPARATIVE STATISTICS. The Registrar-General has forwarded provisional figures relating to the rest of the country, enabling the following comparisons to be made:— Birth-rate per 1,000 of population Death rate per 1,000 births From diarrhoea, &c., under 2 years. Total deaths under 1 year. England and Wales 167 7.0 65 London 15.9 10.2 67 Edmonton 17 8 6.0 69.4 Annual Death Rate per 1,000 population. All Causes. Enteric Fever. Smallpox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. England and Wales 11.7 .01 .00 .11 .01 .07 .06 .19 London 11.6 .01 •00 .30 .02 .09 .09 .13 Edmonton 9. 9 .02 .00 .31 .0I .04 .08 .12 The birth-rate and death-rate for the last few years are as follows:— Birth-rate. Infantile Death-rate. Death-rate. 1920 24.9 67.7 9.2 1921 24.5 69.6 10.1 1922 22.7 69.0 10.8 1923 22.4 55.0 9.5 1924 19.7 56.5 10.1 1925 19.9 56.1 9.7 1926 19.0 69.2 9.7 1927 17.8 60.7 10.9 1928 18.2 69.4 9.9 10 HOSPITALS PROVIDED OR SUBSIDISED by the Local Authority or by the County Council. Fever. The Isolation Hospital is a combined one for the two adjoining districts, Enfield and Edmonton, and is situated in Enfield, on the Winchmore Hill border. The number of beds is 163, divided into nine blocks, whilst the acreage is 27. In addition to scarlet fever, diphtheria and typhoid fever, the Joint Hospital Committee are prepared to accept cases of erysipelas, ophthalmia neonatorum and puerperal fever, provided there is the requisite accommodation. The cost to this Authority for the year ending March 31st, 1930, is estimated to be £10,150, slightly lower than that for the previous year. The number of patients admitted during the year was 294, thus making the average cost per patient £34. The Hospital is four miles away from the centre of Edmonton, and the cost of removing patients to the Hospital, bringing them home, and taking to and from the Hospital visitors to patients on the dangerously-ill list also adds to the cost. Smallpox, Edmonton was one of the twenty-six districts forming the Middlesex Districts Joint Smallpox Hospital Board. Under the operation of the Middlesex Districts Joint Smallpox Hospital Order, dated January 4th, 1929, the above Hospital Board was dissolved, and its duties and liabilities were transferred to the County Council: this latter body is now responsible for smallpox cases occurring in the whole of Middlesex with the exception of the Urban District of Willesden. Tuberculosis. The County of Middlesex makes provision for the treatment of tuberculosis, and the majority of the cases of pulmonary disease are treated at:— (a) County Council Sanatorium, Harefield. Accommodation : 129 males, 129 females and 64 children. (b) County Council Dispensary, Hounslow. Accommodation : 9 males and 7 females. (c) Clare Hall Hospital, South Mimms. Accommodation : 120 males and 66 females. 11 The Council has not provided any Institution of its own for the treatment of "surgical" tuberculosis, but has reserved 25 cots at Heatherwood Hospital, Ascot, and six cots at the Victoria Home, Margate, for children suffering from this form of the disease. Advantage is taken of beds at existing institutions, and patients have been maintained by the Council at various hospitals, among which are Mount Vernon Hospital, Northwood; Royal Sea-bathing Hospital, Margate; St. Anthony's Home, Cheam; Alexandra Hospital, Swanley; Headington Orthopaedic Hospital; Royal National Orthopaedic Hospital, Stanmore; Lord Mayor Treloar Cripples' Hospital; Children's Hospital, Sevenoaks; Hendon Cottage Hospital; Pawling Home, Barnet; Prince of Wales' Hospital , Tottenham ; and various London Hospitals. Maternity. No hospital accommodation is provided by the Local Authority for maternity cases, but an arrangement is made with the Guardians for the admittance of such to the maternity wards of the North Middlesex Hospital. The Council is responsible for the fee at the rate of 6s. per day, and the total amount is collected from the patient prior to the order of admittance being given. This order is signed by Dr. Outram, who is in charge of the Ante-natal Clinic, and who sees each case before admission. Some cases are partly and some are wholly assisted by the Maternity and Child Welfare Committee. The following gives details of the cases dealt with during 1928 :— Whole cost borne by patient 17 Partly assisted by the Committee 9 The expenditure incurred by the Committee for those assisted was £31 7s. Od. Children. There is no special children's hospital in the area, but children are received into the North Middlesex Hospital and the Prince of Wales' Hospital in Tottenham, an adjoining district. The various hospitals in London for children and adults, are taken advantage of by Edmonton residents to a' considerable extent. The County is responsible for the treatment of venereal diseases: the nearest hospital is the Prince of Wales' Hospital, but facilities are available at most of the London Hospitals by arrangement with the County. 12 Apart from the North Middlesex Hospital and the adjoining workhouse, there are no institutions for unmarried mothers, illegitimate infants and homeless children. ORTHOPEDIC. The North Middlesex Hospital, situated in Edmonton, and controlled by the Guardians, has an orthopaedic department: the Council, however, has made, through the Education Committee and the Maternity and Child Welfare Committee, arrangements for the in-patient treatment of children under the age of 14 at the Royal National Orthopaedic Hospital or at its country branch at Stanmore. OTHER HOSPITALS. The Prince of Wales' Hospital is situate in Tottenham, convenient of access for Edmonton residents. It is a General Hospital with out-patient and special departments, and is affiliated to other London Hospitals for the purpose of post-graduate study. AMBULANCE FACILITIES. (a) For Infectious Disease. The Enfield and Edmonton Joint Hospital Board possess two ambulances, housed at the Hospital, with two drivers : there is no delay in the removal of patients. The Council have a small bus, which is used to bring patients home, and to take to the Hospital relatives of any patient on the dangerously ill list. The following gives some idea of the useful work done by this bus :— Number of journeys: To bring patients home 198 Special journeys for visitors to Hospital 188 Number of patients returned to their homes315 (b) For Non-infectious and Accident Cases. A motor ambulance is housed at the Fire Station and run by the Brigade ; the following figures given by the Superintendent show the extent to which it was used during 1928 :— Surgical and Private Cases 1,164 Illness in Street and Accident 253 Maternity Cases 87 Adenoids and Clinic Cases 295 Parents' urgent visits to Isolation Hospital 133 Total cases removed 1,932 13 The school clinic cases are children brought home from the North Middlesex Hospital after the operation for the removal of tonsils and adenoids. A school nurse accompanies the patients home. The total distance covered was 9,277 miles. CLINICS AND TREATMENT CENTRES Situation. Accommodation. Authority Maternity and Child Welfare Brookfield House, adjoining the Town Hall Five sessions weekly, including one antenatal session Edmonton Council. Maternity and Child Welfare At the School Clinic, Pymmes Park One dental session weekly Edmonton Council. Day Nursery Fore Street 30 children Private. School Clinic Pymmes Park Minor Ailments: Dental, Ophthalmic Edmonton Education Committee. School Clinic Houndsfield Road School Minor Ailments Edmonton Education Committee. Orthopaedic Clinic Brookfield House Three sessions weekly Education Committee and Council Tuberculosis Fore Street, Edmonton Dispensary Middlesex County Council. Venereal Disease Prince of Wales's Hospital, Tottenham, and many London Hospitals — Middlesex County Council. Details regarding the orthopaedic clinic are given under the work of the Maternity and Child Welfare Department, as is also that relating to the dental session for mothers and children under five years of age : the work of the school clinics is given fully in the report of the School Medical Officer. DAY NURSERY. This is situated in Fore Street, convenient of access: the charge is 9d. per day, or 3s. 6d. per week; residential boarders are admitted, the charge being 10s. weekly. The Maternity and Child Welfare Committee avail themselves of these facilities, as will be seen by the'report under that section. 14 The following report for the year has been kindly sent me by Mr. A. E. Beer, the Hon. Secretary:— Short Report of the Work of the Edmonton Day Nursery. January-December, 1928. The attendances at the Nursery are slightly lower, due chiefly to the fact that the Nursery had to be closed for a period during April on account of an epidemic of measles. If that time were taken out of account, the attendances would work out fully up to the average. The Resident Children Scheme has continued, and has been of great service; practically the same number of children have been accommodated (in every case during the incapacity or absence through illness of the mother), but the total number of weeks' residence was 95, as against 57 weeks last year. The Classes for instruction in Mothercraft have also been continued, with great success, and in sending a donation of £50 towards the funds of the Nursery, the Education Committee expressed great satisfaction at the results obtained, and a warm tribute is due to the Matron for her able conduct of these Classes. Of the Probationers in training at the Day Nursery, during the past year four have passed the Preliminary Examination set by the National Society of Day Nurseries, and one has passed the Elementary. The Management of the Nursery mainly rests in the hands of the House Committee, comprising:— Miss Bintcliffe, Mrs. Elms, and Mrs. Beer, who desire to express their very high appreciation of the services of the Matron, Miss Biggs, who has so well conducted all branches of the work, both as regards the children and the house management. Nurse Carlin is also still with us, and has contributed valuable assistance. The Nursery was open to visitors as usual during Health Week, and while the lectures were being held in the Town Hall, a number of the younger children of mothers attending them, were accommodated at the Nursery and well looked after. The Christmas Party was held as usual in December, and a very enjoyable entertainment was given to the children and their parents. As it happened to fall on the date of Mr. Jarrett's birthday, a very enjoyable incident in the proceedings was the presenting to him of an address by Father Christmas, which he greatly appreciated and acknowledged with his usual eloquence. 15 The total expenditure of the Nursery was slightly less than last year, namely, £864, and was met as follows :— Attendance Fees paid by mothers £209 Payments for Resident Children by the Council (for children sent by them) £27 Grant from the Ministry of Health £344 Grant from the Edmonton Education Committee in recognition of Training in Mothercraft for Council Schoolgirls £50 The balance of about £235 was met by voluntary contributors. Included in this amount was a sum of £20, being the result of a Concert organised by Mrs. Wrigglesworth; a donation of three guineas from the Winchmore Hill Congregational Sunday School; and a further donation of 18s. 6d., the result of a Carolling Party by the Young People's Section of the same Church. The health of the children has been remarkably good, with the exception of the period above mentioned, when measles was prevalent. PROFESSIONAL NURSING IN THE HOME. An arrangement is made with the Bury House branch of the Cottage Benefit Nursing Association, by which trained nurses are sent to those cases of infectious disease which are not usually received into an Isolation Hospital, and to other cases, on application to the Medical Officer of Health. The Council pay a retaining fee of £20 yearly; 1s. for each of the first three visits per case, and 6d. for subsequent visits. The total cost for the year was £100 13s. 6d. Nurses are also sent to other cases, such as those suffering from cancer, tuberculosis, senility, etc. Altogether 37 patients have had the benefit of the-free services of a trained nurse, many of these for several months, and four for the whole year. Midwives. The Middlesex County Council is the local supervising authority under the Midwives' Acts, and Dr. Tate, the County Medical Officer of Health, has furnished me with the fallowing particulars:— During the year 1928, twenty midwives have been practising in the district, of whom nine removed, leaving eleven on the register at the end of the year. Of this number, four were employed at the North Middlesex Hospital, ten by the Nursing Association, and six were in private practice. 16 The number of claims for fees received by the County during the year from doctors called to Edmonton patients by midwives in accordance with the rules of the Central Midwives' Board was 130, and the fees claimed totalled £148 16s. Od. Chemical Work. The County is the Local Authority under the Sale of Food and Drugs Act, and a summary of the work undertaken in the district is given under the section dealing with the supervision of food. LIST OF ADOPTIVE ACTS, BYE-LAWS, ETC., IN FORCE IN THE DISTRICT. Date of Adoption. Infectious Disease Notification Act, 1899 13-1-1891 Infectious Disease Prevention Act, 1890 13-1-1891 Baths and Washhouses Acts of 1847-78-82 26-2-1901 Public Health Acts (Amendment) Act, 1890:— Parts 2 and 3 9-12-1890 Part 5 23-4-1895 Public Health Acts (Amendment) Act, 1907 Sections 35, 36, 37, 38, 39, 40, 41, 42, 43, 46 to 51 inclusive, comprising Part 3 relating to Sanitary Provisions, the whole of Part 4 relating to Infectious Diseases, and the whole of Part 5 relating to Common Lodging Houses. The Order of the L.G.B., made Dec. 24th, 1909, declaring these Sections to be in force in Edmonton, came into operation Feb. 11th, 1910. Date when Confirmed by the Board (L.G.B.). Bye-laws with regard to removal of house refuse and with respect to nuisances 31-8-1903 Bye-laws with respect to Slaughter-houses 21^-1904 Bye-laws with respect to Pleasure Grounds 13-9-1904 By-laws with regard to Houses let in Lodgings 19-10-1906 Bye-laws with respect to the Management of Sanitary Conveniences and Lavatories 23-1-1909 Bye-laws for the Regulation for the offensive trade of a Gut-scraper 15-9-1913 Bye-laws with regard to New Streets and Buildings 21-11-1927 Bye-laws with regard to Common Lodging-houses 21-4-1904 At the time of writing, a private bill is being promoted in Parliament dealing with various matters, among which is a section dealing with infectious disease and sanitary provisions. 17 SANITARY CIRCUMSTANCES OF THE AREA. Water. The district is in the Metropolitan Water Board area, there being a constant supply for all houses. Rivers and Streams. The Enfield sewage farm is in Edmonton; this and our own sewage farm discharge their effluents into the River Lea. The following short report by Mr. Cuthbert Brown, Engineer and Surveyor to the Council, is of value, as it bears more or less directly on the health of the district:— "One hundred and eighty-six additional houses have been erected on the Council's Housing site between Hazelbury Road and Victoria Road. "A spectators' stand, additional cubicles for bathers, and a clubroom have been built at the open-air swimming bath in Houndsfield Road. Four additional hard tennis courts have been constructed at the Recreation Ground, Church Street, and two hard courts at the Henry Barrass Sports Ground, Houndsfield Road. "Twenty-one acres of land at Firs Farm have been sown with grass seed in preparation for further playing pitches. "An open space of 1} acres at the corner of Bush Hill Road and Village Road has been laid out and planted with shrubs. "Ten new streets have been taken over by the Council as public highways during the year, and about a mile of roads made up on the Council's Housing Estate." Scavenging. The removal of house refuse is carried out by the Council under the supervision of the Surveyor's department; the collection is once weekly, and refuse is dumped on the Sewage Farm near the River Lea, on the eastern boundary of the district. An agreement is made with the County of Middlesex whereby the latter undertake to keep down the rats on this dump for the sum of £50 per annum. Owing to the success obtained by using gas for rat destruction, the estimate for the forthcoming year has been reduced to £30, and the charge for the year ending March 31st, 1928, has been reduced to a similar sum. The supply of dustbins, where necessary, is obtained under Section 36 of the 1875 Act; two dustbins have been supplied by this authority, and the cost recovered from the owner, as provided by the Act. 18 Waste lands in the district frequently become a nuisance owing to the deposition of litter, old iron, vegetable refuse by van dwellers, itinerant stallholders, etc. Fortunately, as houses are being put up and waste land reclaimed, this type of nuisance should become less prevalent. A sanitary workman is employed to deal with the more obvious nuisances such as dead dogs, cats, etc. There are eight cess-pools in the district, four of which are emptied regularly by the Council. During the coming year the provision of new sewers will probably eliminate three of these. Sanitary Inspection in the Area. The district is divided into three areas, each with its own district Sanitary Inspector, who acts as inspector under the Petroleum Acts. A fourth Inspector is responsible for carrying out house-to-house inspection, taking usually a street at a time. A woman Sanitary Inspector commenced duties in January, and is responsible for the infectious diseases, out-workers' premises, sanitary conditions of factories where women are employed, women's lavatories, supervision of ice-cream makers, etc. The Senior Sanitary Inspector supervises the work of the district, and is also Inspector under the Canal Boats Acts. The streets inspected during the past year under the Housing Regulations were Bridport Road, Claremont Street, Claremont Place, Woolmer Road (portion of), Raynham Avenue and Raynham Terrace. No action was taken under the Rent Restrictions Acts. The following tabular statement gives the number and the nature of the inspections made by the Inspectors during the year:— Complaints 937 Infectious Disease 329 Tuberculosis 253 House-to-House 355 Factories 131 Workshops 94 Workplaces 10 Outworkers 117 Schools 35 Dairies, Cowsheds and Milkshops 108 Offensive Trades 49 19 Shops and Stalls 234 Common Lodging-house 51 Sanitary Conveniences, Urinals, etc. 674 Stables 35 Piggeries 79 Gipsies 130 Petroleum 197 General Inspections 460 Re-inspections 6,285 Sundry Visits 1,975 Cinemas and Halls 25 Visits to Canal 28 Inspections of places where Food is prepared :— Butchers 179 Fish Shops 28 Coffee Shops 8 Ice Cream Shops 98 Dairies, Cowsheds and Milkshops 108 Slaughter-houses 256 Bakehouses 72 The number of notices served were :— Preliminary or Informal Notices 1,637 Statutory Notices 484 The work carried out as the result of these Notices :— Houses or parts of Houses repaired or cleansed 737 Drinking water cisterns covered, cleansed or repaired 25 Water fittings repaired 50 Water taken from main 2 Drains examined, tested or exposed 298 Drains cleared, trapped or repaired 343 Drains reconstructed 9 Chambers inserted 12 Chambers sealed down 31 Soil and ventilation pipes renewed or repaired 38 Water closets repaired, cleansed or improved 222 Flushing cisterns repaired 212 20 Waste pipes renewed or repaired 115 Sinks repaired 34 Roofs repaired 424 Gutters and rainwater pipes repaired 393 Yards paved or repaired 212 Scullery floors repaired 111 Spaces under floors ventilated 19 Dampness remedied 165 Floors repaired 146 Coppers and stoves repaired 405 New dustbins supplied 237 Accumulation of refuse removed 67 Nuisances from animals abated 1 Gipsies removed 112 Other nuisances abated 768 Rooms cleansed after infectious disease 33 Smoke Abatement. The number of factories in Edmonton is small, and no action has been necessary during the year : twenty-five smoke observations were taken during the year. Premises, etc., controlled by Bye-laws. These are common lodging-houses, houses let-in-lodgings, slaughterhouses and the offensive trade of gut-scraper. There is one common lodging-house for men and, though an antiquated building, it serves a useful purpose and is kept sanitary. There are five slaughterhouses—one registered and four licensed—and are kept under supervision. There is one business of gut-scraper and fat extractor; the premises are modern, and modern machinery and ventilating apparatus are installed. The bye-laws relating to houses-let-in-lodgings are practically a dead letter, as they refer only to lodgings let for 8s. Od. per week or under if unfurnished, and 10s. if furnished. SCHOOLS. The majority of the schools are satisfactory: the others are unsatisfactory, inasmuch as they are old buildings, and there is not the free access of air which obtains in modern schools. 21 There has been no closure of school or department during the year on account of infectious illnesses: individual sufferers from the notifiable forms of infectious disease, scarlet fever and diphtheria, are removed to the Isolation Hospital, and are seen by me before returning to schools: contacts of these are excluded one week, and in the case of diphtheria have the throat and, if necessary, the nose swabbed. Sufferers from the non-notifiable infectious illnesses and their contacts are excluded in accordance with the Memorandum of 1927. When measles is prevalent, the school nurses visit cases notified by the Head Teacher or the Attendance Department, provided the notice is early enough ; that is within a few days of the onset of symptoms. HEALTH EDUCATION. Health and Baby Week was held in the last week in October, when health films were shown and popular talks on health subjects were given. Leaflets on health subjects—measles, whooping cough, teeth, summer diarrhoea, etc.—have been distributed among the mothers attending the Child Welfare Centres at appropriate seasons. INSECT PLAGUES. An unusual plague of flying beetles appeared in one part of the district in the early part of the month of May. The locality affected was mostly Cheddington Road, but Eileen Terrace and Hazelbury Road also suffered. The beetles (Harpalus Ruficorius) were noctural in their habit, and swarmed in myriads against the backs of the houses in the above-mentioned roads, evidently coming from agricultural ground in the immediate neighbourhood. The Ministry of Agriculture willingly gave us all the assistance that lay in their power, but the trouble lasted almost two months. The backs of the houses and the strip of land adjoining the premises were sprayed daily with a mixture of paraffin oil, creosote, lysol, etc., but this measure only killed those which had crept into crannies in the wall and other suitable crevices. A quarter of a ton of naphthalene was spread over the adjoining agricultural land, the farmer assisting by having this hoed into the ground between the rows of potatoes—which formed the crop. 22 The senior Sanitary Inspector and myself went over the land when the crop of potatoes was raised, and found extremely few signs of insect life; incidentally it was a good crop of potatoes. Acting on the advice of the Ministry, the farmer planted his land with wheat, which would stand heavy rolling, the idea being to crush any beetles that remained in the ground. At the time of writing, April, 1929, there have been no signs of a recurrence of the plague, but the month has been extremely cold, and it would be unwise to suggest that the land is wholly free. It has been suggested that the wholesale migration was due to the exhaustion of the natural pabulum of these insects, which are carnivorous in habit. HOUSING. I.—NUMBER OF NEW HOUSES ERECTED DURING THE YEAR. (a) Total 676 (b) With State assistance:— (1) By the Local Authority 186 (2) By other bodies or persons 24 II.—UNFIT DWELLING-HOUSES. I. Inspection :— (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts). 1,439 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Consolidated) Regulations, 1925 355 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 4 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation . 1,126 II. Remedy of Defects Without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 890 23 III. Action under Statutory Powers :— A. Proceedings under Section 3 of the Housing Act, 1925:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 169 (2) Number of dwelling-houses which were rendered fit:— (a) By Owners 143 (b) By Local Authority in default of Owners 3 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by Owners of intention to close 3 B. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 41 (2) Number of dwelling-houses in which defects were remedied:— (a) By Owners 36 (b) By Local Authority in default of Owners 1 C. Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925 — (1) Number of representations made with a view to making Closing Orders 3 (2) Number of dwelling-houses in respect of which Closing Orders were made 3 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit (4) Number of dwelling-houses in respect of which Demolition Orders were made (5) Number of dwelling-houses demolished in pursuance of Demolition Orders — INSPECTION AND SUPERVISION OF FOOD. Milk Supply. Dairies and milkshops have been kept under supervision during the year, 108 visits having been made for that purpose. There are no cows kept in the district. Regarding the designated milks, there are three dealers who sell Grade A (Tuberculin-tested) milk, one who sells pasteurised milk in bulk and another who sells both certified and pasteurised milk 24 During the year fifteen samples have been taken of the Grade A milk for bacteriological examination: all have passed the test, which is one solely for the purpose of assessing cleanliness. Considering the hot summer which we had, I think that such a record is a most excellent one. The total number of milk retailers in the district whose names are on the Register is 72. There has been no refusal during the year to register any applicant as a purveyor of milk: neither has there been any action under the Milk and Dairies Order, 1926. Meat. There are five slaughter-houses in the district, one registered and four licensed. During the year 256 visits of inspection have been paid to these during or shortly after slaughter for the purpose of meat inspection, and the following carcases were examined:— Sheep or Lambs 85 Pigs 409 The Inspectors also paid 179 visits to butchers' shops. Many butchers' shops are glazed, and it is possible to display meat in the window to a large extent: customers have the benefit of knowing that the joint they select has not been previously handled by anyone unauthorised, and that there has been little chance of contamination from the street. Other butchers keep within the limits of the law by not allowing their meat to project beyond the limits of the wall or screen of the shop, but the protection against contamination cannot compare with that afforded by a window. It is a remarkable thing that the exposure of carcases in a butcher's shop does not offend sentiment, but one supposes that the custom is sanctioned by age, and the individual is inured to the sight : at any rate, the display would harden the heart of the vegetarian. It is to be noted, however, that in many cases where the shop is protected by a window, that the display is less revolting and, shall we say, more artistic! Bakehouses. During the year 72 visits of inspection have been paid to bakehouses, none of which are of the basement variety. In accordance with the Bakehouses Welfare Order, 1927, reasonable washing facilities have been provided in all the bakehouses. 25 Fish Shops, Coffee Shops and Ice-cream Shops are also kept under supervision, a total of 134 visits being made. Unsound Food. The following is a list of food which has been surrendered by the retailer and found to be unsound:— 2 bags of winkles. 6 boxes of haddock. 1 box of codfish. 1 box of roker. 1 box of halibut. 1 box of herrings. 17 crabs. 10 boxes of tomatoes. 82 pomegranates. 2 boats of cherry plums. 50 lbs. of apples. 77 boxes of confectionery. Sale of Food and Drugs Acts. Middlesex County is the Authority under these Acts, and the following particulars given me by the Chief Officer of the Public Control Deparment relate to goods purchased in Edmonton during 1928:— No. of Samples Found to be taken. Adulterated. Milk 216 11 Arrowroot 1 — Bacon 3 — Butter 6 - Cake 16 1 Cinnamon 1 - Linseed 1 - Meat 13 - Minced Beef 1 — Mustard 1 - Pepper 2 - Sausages 12 - Sponge Cakes 1 — Whisky 2 - The figures given for adulterated samples include some adulterated informal samples in respect of which no proceedings could be taken. Number of prosecutions 2 Number of convictions 2 Fines and costs imposed £2 14s. 0d. 26 It may be noted that in 1927, of 24 samples of sausages examined, nine were found to be adulterated; that convictions numbered three, and that the fines and costs imposed amounted to £16 18s. 0d. Whatever the cause, it is cheering to note that the sausages in our district are living up to the reputation which the district has gained—that of honesty : at any rate, they have not been found out. Other examinations of a chemical or bacteriological nature have been those previously mentioned under designated milk and carried out at the Counties Public Health Laboratories. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Measles. This disease appeared in the early part of the year, and was responsible for eight deaths in the first quarter of the year and fifteen deaths in the second quarter: of these 23 deaths, 22 occurred in children under five years of age. Whooping Cough has appeared in sporadic fashion in different parts of the district during the year, but towards the end of the year became slightly more common in the northern area. Mumps, prevalent in 1927, died down in 1928; whilst odd cases of Chicken Pox appeared at intervals. None of these illnesses are notifiable; in the case of children of school age, information is through the attendance department, and in the cases of measles and whooping cough visits are paid to the homes by the school nurses if no doctor is in attendance. During the outbreak of measles, pamphlets dealing with the nature of the disease, etc., were distributed at the Child Welfare Clinics. Diphtheria. There were 151 cases of this disease notified during the year. This is a welcome decrease in a complaint which one had begun to regard as endemic. The deaths numbered six, the rate per 1,000 population being thus 0.08 ; the rate for 1926 was 0.45, and that for 1927, 0.12. Judging by the number of carriers at the beginning of the year, it certainly appeared as if 1928 was going to rival 1926 in numbers. 27 During the first three months of the year there were 39 carriers under treatment, of whom one was received into the Isolation Hospital; during the next three months twelve more were detected, and the autumn months concluded with fifteen. It was certainly an uncommon experience to get so many carriers in comparison to the number of cases notified. Regarding preventive inoculation, no children were immunised during the year. Anti-diphtheritic serum in phials of 4,000 and 8,000 units is stocked at the Town Hall and at the Fire Station in Church Street for the use of local medical men, who are paid 3s. 6d. for its administration whilst waiting the results of a swab. During the year twelve phials of 4,000 units and 46 phials of 8,000 units have been distributed. The Council maintain a laboratory, and the following is the result of swabs examined during the year:— Suspected cases Positive 105 Negative 798 Contacts of Cases Positive 43 Negative 572 Carriers and Old Cases Positive 100 Negative 220 Total 1,838 Scarlet Fever. One hundred and forty-eight cases of scarlet fever were notified during the year : one death occurred from the disease. The large majority of the cases were removed to the Isolation Hospital, but where isolation could be made at home, and the parents wished it, patients were nursed at home. The number of cases regarded as return cases numbered thirteen. The relation between the incidence of these two latter diseases and room population is as follows (percentage distribution):— Scarlet fever. Diphtheria. Less than one person per room 20.4 12.2 One to two persons per room 64.6 72.3 More than two persons per room 15.0 15.5 28 Corresponding figures for 1927 for scarlet fever were 25.6, 67.8 and 6.6; and those for diphtheria, 15.4, 75.0 and 9.6. It is difficult to deduce anything from these figures, but they strongly suggest that overcrowding is more serious than it was in 1927. Small Pox. One case was notified—that of a tramp who passed through the Casual Ward of the Workhouse. It occurred at that time when several mild cases appeared amongst tramps in the southern counties. No further cases occurred. Enteric or Typhoid Fever. Three cases of this disease were notified, one in July and two in August. Two were of the para-typhoid variety : one contracted the complaint in Lancashire, the other probably in London. In the third case, that of typhoid, the source of the infection was not traced. The three patients were females, and, unfortunately, there were two deaths. Other notifiable diseases, excluding tuberculosis, include 35 cases of erysipelas, 2 of puerperal fever, 5 of puerperal pyrexia, 53 of pneumonia, 8 of ophthalmia neonatorum. There was no special incidence of pneumonia, showing that there was no epidemic of respiratory infectious disease. On notification, the homes are visited, and a leaflet, containing advice re isolation and precautionary measures, is left. Terminal disinfection is not carried out. Where the doctor requests, a district nurse is obtained, and who pays one or more visits daily according to the urgency of the case. Severe cases of erysipelas or those occurring in aged folk are admitted on request to the Isolation Hospital. Ophthalmia neonatorum, puerperal fever and puerperal pyrexia are indicated below. The following table gives the age incidence of the above infectious complaints :— 29 Disease. Total No. of cases. Number Removed. Under 1 year. 1 — 2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 65 & over. Small Pox— Cases 1 1 - - - - - - - - - 1 - - Deaths - - - - - - - - - - - - - - Scarlet Fever— Cases 148 127 0 4 6 7 14 72 23 7 12 3 — — Deaths 1 1 — 1 — — — — — — — — — — Diphtheria— Cases 151 147 2 6 4 14 9 64 27 9 14 1 1 — Deaths 6 6 — — — 1 - 4 1 — - - - - Enteric Fever Cases 3 2 — — — — - — — 1 2 — — — Deaths 2 1 — — — — - — — 1 1 - - - Puerperal Fever— Cases 2 2 - - - - - - - - 1 1 — — Deaths 2 2 - - - - - - - - 1 1 — - Pneumonia— Cases 53 — 1 2 5 2 1 3 1 3 18 6 9 2 Deaths 71 32 20 8 2 1 1 2 1 — 2 2 15 17 Erysipelas— Cases 35 4 — 1 1 — 1 — 1 1 8 7 13 2 Deaths 1 1 - - - - - - - - - - 1 — Ophthalmia Neonatorum— Cases 8 2 8 - - - - - - - - - - - Deaths - - - - - - - - - - - - - - Encephalitis Lethargica— Cases - - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - Cerebrospinal Meningitis— Cases - - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - Malaria— Cases - - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - Puerperal Pyrexia— Cases 5 2 - — — — — — — 1 4 — — — Deaths - - - - - - - - - - - - - - Anterior Poliomyletis— Cases - - - - - - - - - - - - - - Deaths - - - - - - - - - - - - - - 30 Prevention of Blindness. Under Section 66 of the 1925 Public Health Act, a local authority has power to make arrangements for assisting in the prevention of blindness and for the treatment of persons resident within their area suffering from disease of or injury to the eyes. So far, the only work done by the Council in this direction is that carried out by the Maternity and Child Welfare Committee, who, through its staff, give active treatment in cases of ophthalmia neonatorum and "discharging eyes." The former complaint is notifiable, whilst information regarding the latter is received via the County, who is the authority under the Midwives' Acts: the midwife is responsible for notifying the County when she calls in medical aid for discharging eyes in the new-born. Practically the difference appears to be one of degree, a slight discharge from the lids of a new-born child not being regarded as ophthalmia; microscopically, however, pus cells are usually seen in a smear made from the discharge. A more important difference is the response to treatment: cases of ophthalmia require extraordinary attention, whilst the other cases respond to simple treatment. There were eight cases of ophthalmia neonatorum, two of these being removed to Hospital. 31 TUBERCULOSIS. Details as to the form and age of patients affected, etc., are given in the subjoined table:— Age Periods. New Cases. Deaths. Pulm. Non-Pulm. Pulm. Non-Pulm. M f M F M F m F Under 1 year — — — — 1 1 — — 1— 5 years 3 — 4 1 — 2 — 1 5-10 „ 6 — 3 2 — — — — 10—15 „ 3 5 2 — - 1 — 1 15—20 „ 8 13 4 2 1 6 1 — 20—25 „ 4 11 — 1 1 10 — — 25-35 „ 14 17 — — 8 7 1 — 35—45 .. 9 4 2 1 4 2 — — 45—55 „ 3 1 — — 4 2 1 — 55—65 „ 7 1 — — 3 - - — 65 and upwards 1 — — — 1 1 — 1 Totals 58 52 15 7 23 33 4 3 The Public Health (Prevention of Tuberculosis) Regulations, 1925, relate to tuberculous employees in the milk trade. In order to obtain the necessary information, the occupation of all tuberculous persons are carefully enquired into and transmitted to the Medical Officer of Health by the doctor in charge of the local tuberculosis dispensary. No person notified during the year was engaged in the milk trade. The following deaths from tuberculosis occurred without prior notification:— Male. Female. Total. Pulmonary 5 5 10 Non-Pulmonary 4 3 7 32 The non-pulmonary forms of tuberculosis were:— Male. Female. Total. Bones and Joints 4 1 5 Glandular 2 2 4 Spine 2 — 2 Other forms 7 4 11 The notifications of the pulmonary form were received from the following : General Practitioners 45 Tuberculosis Medical Officers 25 Various Hospitals 27 Asylum Medical Officers 1 Removals into District 7 Sanatoria 5 Military Authorities — 110 The number of cases on the Tuberculosis Register at the end of the year was 780, made up as follows:— Male. Female. Pulmonary forms 336 263 Non-pulmonary forms 90 91 The corresponding total for 1927 was 768. Dr. Tate, the County Medical Officer of Health, has kindly furnished me with the following particulars which relate to Edmonton patients. The dispensary is in Fore Street, under the charge of Dr. Evans. Number of new cases seen at the Dispensary during 1928 405 Number diagnosed as suffering from tuberculosis 101 Total number of persons suffering from tuberculosis and treated or supervised at or in connection with the dispensary during 1928 541 Number of cases sent to Sanatoria 83 „ „ Hospital 8 „ ,, Surgical Hospital 24 „ „ Observation Hospital 25 Number of sputa examined 286 „ „ found positive 57 The Public Health Act, 1925, Section 62, deals with the compulsory removal to Hospital of persons suffering from pulmonary tuberculosis in an infectious state and who are living under such conditions as to accommodation 33 that proper precautions to prevent the spread of infection cannot be taken, and that serious risk of infection is thereby caused to other persons. No action has been taken under this Section during the past year, as there has been brought to the notice of the Department no case where it was applicable. SHOPS ACTS. The whole-time Inspector under the above Acts has kept the shops in the district under supervision as regards hours of closing, half-holidays, hours of employment, seating accommodation, etc. Proceedings were taken against three shopkeepers, and fines imposed as follows : one of twenty shillings, and two, each of five shillings. CANAL BOATS ACTS. Mr. Winter, the Officer specially appointed under the above Acts, reports as follows:— Visits made to Canal 28 Boats Inspected 9 Contraventions Nil. Repairs to three boats were noted, namely:— Cabin Tops Repaired 2 Exterior Repainted 1 A boat previously registered is not now used as a dwelling; the registration marks have been removed and the certificate withdrawn from the boat. The condition of the boats inspected during 1928 was generally good, cleanly kept, and the occupants were healthy. DISINFECTION. Disinfection of the patients' rooms, bedding and clothing is carried out as a routine in cases of scarlet fever and diphtheria after removal of the patient or after recovery if the case is nursed at home : the rooms are sprayed with formalin, and the bedding and clothes removed for disinfection by steam under pressure. The following are details:— Number of journeys made to collect bedding 200 „ „ return bedding 208 Number of rooms disinfected after infectious disease 385 „ „ in connection with phthisis 76 „ „ in connection with cancer 15 „ „ in connection with vermin 44 34 Number of articles disinfected in connection with infectious disease 2,565 Number of articles disinfected in connection with phthisis 326 Number of articles disinfected in connection with other cases 346 Nurses' outfits disinfected (for nurses) 24 Number of books disinfected 290 Number of articles of bedding destroyed 77 The Council distribute a liquid disinfectant and a carbolic powder to all who apply : the number of applicants during the year were 10,008. The liquid contains 10 per cent. phenols. MORTUARY. This is situated in the Town Hall yard. The number of bodies received during the year was 55; 44 upon order by the Coroner or police, and 11 for sanitary reasons. FACTORY AND WORKSHOP ACTS. The following work has been carried out under the Factory and Workshop Acts:— 1—Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 131 0 0 Workshops (including Workshop Laundries) 94 0 0 Workplaces ((other than Outworkers' Premises) 10 0 0 Total 235 0 0 35 2.—Defects found in the above. Particulars. Number of Defects. No. of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts— Want of cleanliness 9 9 - - Want of ventilation - - - - Overcrowding — — — — Want of drainage of floors — — — — Other Nuisances 9 9 - - Sanitary = Insufficient - - — — Accommodation = Unsuitable or defective 23 19 — — = Not separate for sexes - - — — Offences under the F. & W. Acts— Illegal occupation of underground bakehouses - - - - Other offences — — — — Total 41 37 — — The details of the nuisances remedied are:— Water closets cleaned, repaired, etc. 10 „ „ flushing apparatus repaired 12 Water closet ventilation improved 1 „ „ screened 1 „ „ door repaired 1 Drains cleared and cleansed 3 Washing sink provided 1 Sink waste pipe repaired 1 Eaves, gutters and roof repaired 2 Yard cleansed 1 Workshops limewashed 4 Under the Ministry of Health (Factory and Workshops Transfer of Powers) Order, 1921, 19 bakehouses were limewashed. 3.—Outwork in Unwholesome Premises. Notices Nature of Work. Instances. Served. Prosecutions. Wearing Apparel Umbrellas Artificial Flowers Nil Nil Nil Brushmaking Haversacks Cosaques 36 MATERNITY AND CHILD WELFARE. The following clinics are held for the benefit of nursing and expectant mothers and for children under the age of five:— One ante-natal clinic weekly. Four sessions for children weekly. Three sessions for orthopaedic cases weekly. One dental session weekly. The first three are held at Brookfield House adjoining the Town Hall ; the dental clinic is held at the School Clinic in Pymmes Park. Births Notified during the year were:— Live births, by midwives 1,655 „ „ by doctors and parents 380 Still-births, by midwives 76 „ by doctors and parents 22 Total 2,133 The North Middlesex Hospital, with its Maternity wards, is in the Edmonton district : births occurring there are notifiable in the district in which the births occur. Deducting births from residents of other districts brings the number of Edmonton births to 1,329. The work carried out at the various clinics, tabulated according to attendances, etc., may be summarised:— Number of Sessions. New Cases. Total Attendances. Ante-natal Clinic 43 157 665 Infant Welfare 167 671 12,358 Dental Clinic 39 184 441 Orthopaedic Clinic 133 62 501 Sewing Class 34 — 433 Towards the end of the year, arrangements were being made for the establishment of a Child Welfare Clinic in the Bush Hill Park area: this came into operation early in 1929. The average attendance at the Infant Welfare Clinic for the year was 74. This is a large average, for it means that on occasions the numbers run up to 100, and sometimes appreciably over that figure. Unfortunately, the premises are rather cramped on these occasions, and the limitation of room makes the work far more harassing than it might be if the conditions were more favourable. 37 That this is so is recognised by the Committee, and I suggest that during the current year this matter be seriously considered by the Council with a view to the building of suitable premises. This confusion is added to by the uncertainty with which the voluntary workers arrive on the scene—if at all. The following data refer to the week prior to that in which this is written : On two days on which four voluntary workers were expected, one was absent on the one day, and three were absent on the next day, the sole worker turning up at 2.45: on this particular afternoon there was an attendance of 110 children. On two days on which five workers were expected, three were absent on one afternoon, and two on the next: on this latter day there were none until 2.40. These ladies assist by weighing the babies, selling dried milk and wool, etc., and it would be of great service to the salaried staff if they would consider their obligations—once they have promised to assist—as sacred. The Dental Clinic is held at Pymmes Park weekly, the statistical report being:— Mothers. Children. No. of cases seen 108 105 Total attendances 268 173 Attendances for treatment 222 132 Fillings (number of teeth) 47 53 Scalings (number of teeth) 28 0 Extractions (number of teeth)— Under gas 636 344 Local anaesthetic 11 1 Number of gas cases 158 92 The gas extractions are reserved for the last hour of the session, gas— nitrous oxide—being given by the Medical Officer of Health. There were 18 applications for assistance towards procuring dentures : of these 13 were assisted. The total cost of dentures was £100 4s. 0d., towards which the Council contributed £27 0s. 3d. A scale of income is used for assessing the extent of assistance granted, and five of the applicants were beyond this scale. 38 Visits Paid to Homes by the Health Visitors are as follows:— To expectant mothers— First visits 139 Total visits 183 To children under one year— First visits 1,305 Total visits 5,787 Visits to children, 1 to 5 years 5,061 Visits re milk enquiries 63 Visits re puerperal pyrexia 10 Dental 1 Total 11,105 Maternity Cases are received into the North Middlesex Hospital through the agency of the Committee. Contributions are accepted before the date expected, and on reaching the sum of £4 10s. 0d., an order is given the prospective mother for admission. Seventeen mothers adopted this procedure, whilst nine others were partly assisted by the Committee. The total sum involved was £120 0s. 0d., of which £31 7s. Od. was paid by the Committee. The Day Nursery, as previously mentioned, receives resident children under the age of five. The Committee had several applications from mothers who had to go into Hospital, with the result that twelve children went into residence for varying lengths of time. The total cost was £26 10s. 6d., towards which the Committee contributed £18 3s. 0d., the remaining sum, £8 7s. 6d. being paid by the parents. The Orthopaedic Clinic is run in conjunction with the Education Committee. Mr. Barnett, of the Royal National Orthopaedic Hospital, attends fortnightly, and a specially trained nurse from the Hospital carries out massage and remedial exercises three mornings a week: the clinic is held at Brookfield Hall, adjoining the Town Hall, and is conveniently situated on the main road. The total number of visits paid by Mr. Barnett was 19, those paid by the nurse were 133. 39 Attendances were as follows:— Children Under 5. Children Over 5. New cases 62 79 Total attendances 501 1,932 Three children under the age of five were sent into Stanmore, the country branch of the Royal National Orthopaedic Hospital for in-patient treatment. Infectious Complaints relating to motherhood and young infant life were the following:— No. of Cases. No. of Visits. Removed to Hospital. Puerperal pyrexia 5 13 2 Puerperal fever 1 — 1 Opthalmia neonatorum 8 44 2 Discharging eyes (not notifiable) 27 95 Nil. Arrangements are made with the Metropolitan Asylums Board for the admission of babies suffering from ophthalmia and their mothers into St. Margaret's Hospital at a cost of 10s. per day each for mother and child. It has not been possible to arrange with the Guardians for the reception into the North Middlesex Hospital of patients suffering from puerperal fever, though, on the other hand, such cases are accepted, and I have heard of none being refused. Cases of "discharging eyes" and of puerperal pyrexia are kept under observation till recovery: if necessary, arrangements are made for daily treatment by the Health Visitor, the latter either visiting the home, or the baby is brought to the Town Hall. MUNICIPAL MILK SUPPLY. A Sub-Committee of the Maternity and Child Welfare Committee meet fortnightly to consider applications for the above ; details are as follows:— Number of applicants 1,207 „ recipients 1,147 ,, pints granted free 3,528 „ „ „ quarter cost 40,007 „ „ „ half cost 504 PUPIL MIDWIVES. Thirty-one nurses from the North Middlesex Hospital, and nine from the Bury House Nursing Association have attended the child welfare centres as part of their curriculum ; the total attendances of these pupils were 79. 40 ARTIFICIAL SUNLIGHT TREATMENT. In the early part of 1927, arrangements were made with the Guardians, with the sanction of the Ministry, for the treatment of cases of rickets, marasmus, etc., at the North Middlesex Hospital by ultra-violet rays, the cost to this Committee being 1s. per exposure. The following analysis of the cases sent and treated during the year has been made possible by the kindness of the Medical Superintendent of the Hospital and his staff, who have supplied the necessary facts. Class A.—Cured Cases. Rickets. Total number of cases 20 Total number of exposures 790 Average number of exposures per case 39 Average length of time, assuming three exposures per week 20 weeks. Average increase in weight 3 lbs. 3 ozs. Marasmus. Total number of cases 8 Total number of exposures 326 Average number of exposures per case 41 Average length of time 19 weeks. Average increase in weight 2 lbs. 7 ozs. Miscellaneous. Total number of cases 12 Total number of exposures 402 Total number of exposures per case 33 Average period of time 16 weeks. Average increase in weight 2 lbs. 11 ozs. Class B. Absentees. Total number 78 Total number of exposures 1,721 Average number of exposures per case 22 Class C. Still Attending. Total number 10 Total number of exposures 136 Average number of exposures per case 13 41 The total number of children treated during this period was 128, the total cost to this Committee being £168 15s. 0d., making an average per case of £1 7s. 5d. The absentees in Class B are those who left attending before the doctor in charge regarded the case as satisfactory: it is very unsatisfactory that out of 128 patients sent to the Hospital for special treatment and paid for by the Council, that such a large proportion as 78 should discontinue treatment contrary to advice. It is likely that in some of the cases an excellent reason would be forthcoming to explain the non-attendance, but it is doubtful whether such a remark is applicable to the large majority. 42