ENF 2 THE Urban District Council or Enfield. ANNUAL REPORT OF THE Medical Officer of Health FOR 1905. Enfield: PRINTED BY JAS. W. HATCH AND SON. 1906. ANNUAL REPORT OF THE Medical Officer of Health, FOR 1905. To the Chairman and Members of the Urban District Council of Enfield. Gentlemen, I beg to submit my annual report for 1905. The number of houses in the middle of the year was as follows:— Inhabited. Uninhabited. Total. Town Ward 2271 167 2438 Chase Ward 2225 245 2470 Ordnance Ward 2363 272 2635 Green St. Ward 2697 364 3061 9556 1048 10604 2 Allowing 5.37 persons to each house, as at the census of 1901, this gives a population of 51,315 There were 301 more inhabited houses than in June, 1904, and 1,616 more inhabitants. Births. The births registered were:— Males, 713; females, 644: total, 1357-giving a birth-rate of 26.44 per 1,000. Deaths. The deaths registered were 532, namely, 276 males and 256 females, giving an excess of births over deaths of 825. To the number of deaths must be added 50 others which were deaths of residents of this district occurring in hospitals and other institutions outside, and from it must be taken 12 deaths of outsiders which occurred in the Isolation Hospital, or a nett addition of 38. This makes the total number 570, and gives a death-rate of 11.1 per 1,000. This needs some correction, however, so as to be comparable with that of other districts. The figure 11.1 has to be multiplied by 1.05198, a factor which has been calculated by Dr. Young, the County Medical Officer of Health, allowing for the special average age of the inhabitants of this district, and the proportion of males and females. This gives the Corrected Death-rate 11-67. The death-rate for England and Wales is 16.2, for London 16.1, and for the 76 great towns, 17.2 so that we compare very favourably with all these. Analysing the ages at death there were 159 under 1 year of age—81 males & 78 females, 3 55 between 1 & 5 years—33 males & 23 females. 17 „ 5 „ 10 „ — 9 „ 8 „ 4 „ 10 ,,15 „ — 3 „ 1 „ 7 „ 15 „ 20 „ — 2 „ 5 „ 14 „ 20 ,, 25 „ — 7 „ 7 „ 30 „ 25 ,, 35 „ —22 „ 8 „ 40 „ 35 „ 45 „ —17 „ 23 „ 48 „ 45 ,, 55 „ —30 „ 18 „ 66 „ 55 ,, 65 „ —43 „ 23 76 „ 65 ,,75 „ —36 „ 40 „ 45 „ 75 „ 85 „ —16 „ 29 „ 16 over 85 ,, — 5 ,, 11 ,, The death-rate of children under one year per 1,000 births was 117.17, against 158.3 in 1904. Classifying the causes of death and giving the three preceding years for comparison we have as follows:— 1905 1904 1903 1902 Specific Febrile or Zymotic Diseases 94 177 89 92 Parasitic Diseases 0 1 0 0 Dietic Diseases 12 4 3 2 Constitutional Diseases 105 107 98 95 Developmental Diseases 89 108 73 76 Local Diseases 257 192 275 298 Deaths from Violence 23 20 10 25 Deaths from ill-defined causes 2 2 2 20 Total 582 611 550 608 4 The zymotic death-rate was 1.8 per 1,000. The following table shows the deaths of residents from the chief zymotic diseases during the last five years, omitting, that is, the deaths in the Isolation Hospital of patients from other districts:- 1905 1904 1903 1902 1901 Whooping cough 15 18 19 7 7 Scarlatina 4 3 8 2 8 Diphtheria 2 1 6 4 7 Measles 12 6 13 4 13 Enteric fever 0 3 4 13 9 Epidemic Enteritis 36 105 27 34 35 There were 34 deaths from cancer, 10 male and 24 female ; 45 from phthisis ; 16 from other forms of tuberculosis. There were 67 deaths from diseases of the nervous system, 22 being due to apoplexy, 9 to meningitis and 11 to convulsions. Diseases of the circulatory system caused 44 deaths, 24 being due to endocarditis. From diseases of the respiratory organs there were 110 deaths, 60 from bronchitis, 45 from pneumonia and 2 from pleurisy. Diseases of the digestive system caused 18 deaths, of which 4 were due to cirrhosis of the liver, all females, and there was 1 from chronic alcoholism. There were 24 deaths from violence, 3 being due to suffocation through overlaying and 3 to suicide, 5 The cases of infectious disease reported were:- 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total. Scarlatina 46 44 35 69 194 Diphtheria 16 7 10 6 39 Enteric Fever 0 2 3 4 9 Small Pox 1 0 0 0 I Erysipelas 10 5 6 10 31 Puerperal Fever 1 0 0 0 1 Total 74 58 54 89 275 The following table shows the number of cases of each infectious disease notified during the past five years:— 1905 1904 1903 1902 1901 Scarlatina 194 140 204 258 216 Diphtheria 39 53 47 45 76 Enteric Fever 9 10 22 48 33 Small Pox 1 1 2 102 3 Erysipelas 31 28 26 23 35 Puerperal Fever 1 5 1 2 1 Membranous Croup 0 1 0 0 3 Continued Fever 0 0 0 1 1 Total 275 244 302 479 368 6 The most noticeable features of this table are the further reduction in the cases of diphtheria and of enteric fever : these are largely drain-diseases and the improvement is probably due to improved drainage of the district. The cases of scarlatina rose again to nearly the average of the five years, and nearly all the cases were removed to the Isolation Hospital. The only case of small pox was taken to South Mimms Hospital. It has been suggested at a meeting of the Medical Officers of Health of this County that diphtheria antitoxin should be supplied free of charge for cases in which the parents are not able to pay for it. This is, in my opinion desirable, and is already done in several other districts. The cases of epidemic diarrhoea were much fewer than in the previous year, due to the absence of prolonged heat. I think that a still further reduction would be effected by the appointment of a female sanitary inspector, as in some other districts, who should specially attend to houses and families in which there are young infants, as it is among these that the mortality is so great. I have reported on 6 samples of well water submitted to me by the Sanitary Inspector, with the result that 4 of these were found to contain recent sewage. These were all suitably dealt with without legal proceedings. I have made 16 bacteriological examinations for diphtheria bacilli for various medical men in the 7 district, only one of the specimens was found to be true diphtheria. The dairies, cowsheds and milk-shops have been kept under observation and the regulations have been enforced. There has been no case of disease traced to any milk-infection. In August last, 1 made a special report on the refuse heaps collected by the Council's carts in a field adjoining Southbury Road. A complaint of these heaps had been made, but I was unable to find that there was any reasonable ground for it. The time must come ultimately, however, when the refuse will have to be got rid of by means of a dust destructor. Six private roads have been made up and adopted as public. A new sewer has been laid from London Road through the Town Park, under the New River and the Great Northern Railway, joining the sewers from Uplands Park, Hadley and Cockfosters, and dispensing with the pumping station at the bottom of Slade's Hill. The new sewage works described in my last report have been nearly completed and will be ready for use at an early date. Surface Water. The open watercourse between the Town Park and the London Road has been diverted, widened and deepened, and the small pipes carrying the water from the higher part of this watercourse have been replaced by four-foot tubes and a large concrete culvert, where it has passed through the Town Park. 8 Bathing Pond. A pond approximately 80 yards long by 50 yards wide and holding 600,000 gallons of water has been constructed in the Town Park, bathing being allowed between the hours of 7 a.m. and 9 a.m. every day for the six months from April to September. Towards the end of the season the new pond was found to be in a very insanitary condition, owing to stagnation of the water and want of constant change of the water. Some improvement in that respect was effected but it remains to be seen in the coming season whether this is sufficient. 9 THE ISOLATION HOSPITAL. The number of cases admitted was as follows : Scarlatina 400 Diphtheria 76 Enteric Fever 37 Other diseases 9 Total 522 Six of the 400 cases of Scarlatina were fatal, giving a mortality percentage of 1.5 per cent. But one of these cases only lived 2 hours after removal to hospital and deducting this, as is usual, the percentage was 1.25. The average number of days in hospital was 51.7. There were three deaths among the 76 diphtheria cases, or 3.94 per cent. The average number of days in hospital was 23.7. There were 4 deaths of enteric patients, or 10.8 per cent., but one of these was only in hospital 12 hours, and without it the percentage was 8.1. The average number of days in hospital was 35.7. The other cases were tuberculosis, cellulitis (died), otorrhœa, abscess of cavernous sinus (died), dyspepsia, measles, pneumonia, septic laryngitis (died), and 2 convalescent, probably from influenza. Of the 522 cases, 207 were from Enfield, 257 from Edmonton, 23 from Wood Green, 14 from Waltham Abbey (Holy Cross), 13 from Friern Barnet, and 8 from Cheshunt. 10 At the close of the year the Joint Hospital Board formed with Edmonton District Council came into operation. The following is the statistical summary of the work done by the Sanitary Department under the supervision of the Chief Sanitary Inspector, Mr. A. J. Munro. INSPECTOR OF NUISANCES REPORT For the Year ending December 81st, 1905. I beg to submit the following particulars of the work done under my supervision, in the Sanitary Department, during the year. Inspections :- Houses inspected from house to house 724 Other houses and premises inspected 1,376 23 factories inspected 23 158 workshops and workplaces, including 7 laundries inspected quarterly. Total number of inspections 509 38 bakehouses inspected frequently. Total 196 16 slaughterhouses inspected frequently. Total 249 32 cowsheds inspected frequently. Total 169 11 76 dairies and milkshops inspected frequently. Total 587 26 schools inspected twice. Total 57 Other inspections made while works in progress, also visits in connection with cases of infectious disease, etc. 10,944 Smoke observations made 83 Total number of inspections 14,917 Notices issued:— For repairs to drains and abatement of nuisances 194 Under Infectious Diseases Acts:- To occupiers 144 To schools 1,293 Total number of notices issued 1,631 Letters sent:— In lieu of notices 695 Other letters 1,275 Total 1,970 Houses and parts of houses cleansed, repaired, etc. 251 Houses closed 2 Roofs repaired 212 Gutters and downpipes repaired 185 Cesspools emptied 265 Cesspools abolished 5 12 Houses connected with sewer, and new drains constructed 10 House drains cleared, repaired, etc 352 House drains tested, examined, etc. 214 House drains reconstructed 59 Manholes provided on drains 29 Soil-pipes and drains ventilated 52 Ventilating pipes repaired 20 Waste pipes repaired 12 Closets provided with flushing cisterns or water supply 15 Flush cisterns put in order 324 New closets provided 5 Closets repaired, cleansed, etc. 93 Houses provided with proper water supply 25 Storage cisterns repaired,covered,cleansed, etc. 86 New storage cisterns provided 14 Yards paved 171 Paving over yards made good 61 New dustbins provided 155 Dustbins repaired 12 Manure heaps removed 59 Fowls and other animals removed 30 Cases of overcrowding abated 23 Houses fumigated 222 Rooms stripped 59 Articles of clothing and bedding, etc., disinfected 2,878 Library books disinfected 85 Cases of scarlet fever removed to hospital 169 Cases of diphtheria removed to hospital 23 13 Cases of enteric fever removed to hospital 8 Cases of small pox removed to hospital 1 Total 201 Gipsy vans removed 62 Ventilation provided under floors 84 Dampness in walls remedied 46 Other nuisances abated 25 Articles or parcels of unsound food destroyed 8 The removal of house refuse has received close attention, and 4,958 loads have been collected and disposed of. Factory and Workshops Act, 1901. A register of all workshops is kept, and at the end of 1905 there were 151 workshops, 7 laundries, and 38 bakehouses (including 1 underground bakehouse) registered. These have all been inspected at least four times in the year, and the following contraventions were found requiring action which was taken. Workshops. W.C's. with defective flushing put in order 16 Cleansed and limewashed 3 Provided with proper closets 7 Dustbins provided 2 Abstracts not fixed where persons under 18 employed 7 Factories. Sanitary conveniences put in order 4 14 Bakehouses. W.C's. with defective flushing remedied 6 Cleansed and limewashed 18 Homework. Three lists have been received enclosing addresses of outworkers. Twenty addresses of outworkers have been received from other districts. Five addresses of outworkers have been forwarded to other districts. An inspection was made of the residences of all outworkers living in this district. Seven notifications have been sent to H.M. Inspector of Factories of workshops where abstract not fixed. UNSOUND FOOD. During the year a regular inspection has been made of meat slaughtered and offered for sale in he district, including the stalls in market every week. Six parcels of organs found to be affected with disease were surrendered by the owners, and with their permission destroyed. The following articles were also brought by the owners to the office and certificates obtained which the retailer might present to the wholesale trader as a guarantee of the bad condition of 15 the articles when requesting to be reimbursed the amount paid for them, viz. : 1 trunk of haddocks. 4 rabbits. A. J. MUNRO, A.R. San. I., Inspector of Nuisances. Yours obediently, J. J. RIDGE, M.D. and M.L). (State Medicine) B.S., B.A., B.Sc. Lond., L.R.C.P. Lond., M.R.C.S. Eng., Medical Officer of Health and Medical Superintendent of Enfield Isolation Hospital.