ENF 6 THE URBAN DISTRICT COUNCIL OF ENFIELD Annual Report OF THE MEDICAL OFFICER OF HEALTH, FOR 1912, TOGETHER WITH THE ANNUAL REPORT OF THE INSPECTOR OF NUISANCES. ENFIELD: JAS. W. HATCH AND SON, PRINTERS, PALACE GARDENS. ENF 6 THE URBAN DISTRICT COUNCIL OF ENFIELD Annual Report of the MEDICAL OFFICER OF HEALTH, FOR 1912, together with the ANNUAL REPORT of the INSPECTOR OF NUISANCES. enfield: jas. w. hatch and son, printers, palace gardens. Enfield Urban District. Area (including 112 acres water) 12,601 acres Population at census of 1911 56,338 Population at middle of 1912 57,267 Number of inhabited houses 11,185 Vital Statistics. Birth.rate per 1,000 living 2446 Recorded Death.rate per 1,000 living 1005 Corrected Death.rate per 1,000 living 1039 Infantile Mortality per 1,000 births 76.30 Zymotic Death.rate per 1,000 living 75 Pulmonary Tuberculosis Death.rate per 1,000 living 69 Vital Statistics op Wards. Ward. Area in acres. Persons per acre. Population. Birthrate. Corrected Death. rate. Infantile Mortality Zymotic Death. rate. Phthisis Death. rate. Town 1,717 4.0 6,876 11.92 7.82 12.19 0.00 •29 Chase 4,478 2.7 12,303 25.11 11.60 61.48 1.13 •81 Ordnance 2,060 65 13,517 23.37 10.55 113.92 0.96 •36 Green Street and Ponders End 1,330 9.3 12,400 30.88 10.67 80.93 0.64 •96 Bush Hill Park 762 14.7 11,270 23.95 10.18 74.07 0.70 •97 Hadley & Coekfosters 2,254 .4 901 21.08 10.32 0.0 0.00 0.00 PUBLIC OFFICES, ENFIELD. March, 1913. Medical Officer of Health's ANNUAL REPORT for 1912. To the Urban District Council of Enfield. Gentlemen, I have the honour to submit to you my Annual Report for the year 1912, which I trust you will find satisfactory. The Report of your Sanitary Inspector, Mr. A. J. Munro, giving particulars of the work done in the Sanitary Department, is also incorporated. In accordance with the Memorandum of the Local Government Board as to the Annual Reports of Medical Officers of Health, which inevitably leads to a certain amount of repetition each year, I propose in the first instance to give some particulars of the physical features and general character of the District and condition of its population. Enfield is one of the largest parishes in England, being seven and a half miles long from East to West, and about three and a half miles from North to South, and comprises about 20 square miles. It is situated ten miles North of London, and is bounded on the North by Hertfordshire, on the East by Essex, on the 6 South by Edmonton and Southgate, and on the West by South Mimms and Hertfordshire. It contains 12,601 acres, including 112 acres of water, and naturally divides itself into three parts:—the Western; mainly agricultural, with centres of population at Hadley Wood and Cockfosters, is situate on the London clay, and is hilly in character, the highest point in the District being at "Stormont" (near Potters Bar), 418 feet above Ordnance Datum. The Central; including the Ridgeway, Old Town, Bush Hill Park, Clay Hill and Forty Hill, is, like the Western, partly on the London clay, and the remainder on soil of a loamy nature with gravel below. There is a considerable population in the neighbourhood of the Town, partly of a residential and business, also industrial nature. Bush Hill Park is now almost entirely built upon, the inhabitants being mostly industrial. The Eastern part of the District, the lowest point of which (41 feet above Ordnance Datum) is found near the Flour Mills, Ponders End, lies in the Lea Valley. The soil is of loam, lying on a deep substratum of gravel. There are two principal centres of population, viz., Ponders End and Enfield Lock, and the inhabitants are mainly employed in local factories, horticulture and market gardening. In addition to the Royal Small Arms Factory at Enfield Lock, there are the British Stone and Marble Company, the Corticine Works, Edison and Swan United Electric Light Company's Works, Enfield Gas Works, Metallic Tube Works, and the Velvril-Bonnaud Works, Ponders End; also the Brimsdown Lamp Works, North Metropolitan Electric Power Station, Ruberoid Works, and White Lead Works at Brimsdown, Enfield Highway. In addition to these there are many smaller works and steam laundries in the District. POPULATION. The population of Enfield at the census of 1901 was 42,738, a figure which at the census of 1911 was altered to 56,338, showing an increase in the population of 13,600, or 31.8 per cent. for the ten years. At the last census it was found that the average number of inhabitants to each house was 5.12, and as on the 30th of June there were 11,185 inhabited houses, it follows that the population of Enfield at that date must be estimated at 57,267. In addition to the above there were 632 uninhabited houses, nearly all available for habitation, thus shewing that the housing accommodation is still sufficient for the needs of the District, and that there is no excuse for overcrowding. 7 Enfield is divided into six wards as follows :— Wards. Inhabited Houses. Uninhabited Houses. Total. Population. Town 1,343 94 1,437 6,876 Chase 2,403 162 2,565 12,303 Ordnance 2,640 107 2,747 13,517 Green Street and Ponders End ... 2,422 161 2,583 12,400 Bush Hill Park 2,201 88 2,289 11,270 Hadley & Cockfosters 176 20 196 901 11,185 632 11,817 57,267 VITAL STATISTICS. The number of Births registered was:— Boys. Girls. Total. 672 729 1,401 including 35 illegitimate births. This total is 87 more than that of the previous year, and gives a birth-rate of 24.46 per thousand of the population, which compares favourably with that of England and Wales, which was 23 8 per thousand. The corresponding rate for London is 247. 8 The births were distributed among the various wards as follows :— Ward. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total each sex. Total each Ward. Birth rate. M F M F M F M F M F Town 11 12 9 10 8 15 8 9 36 46 82 11 92 Chase 40 43 48 41 32 31 45 29 165 144 309 25.11 Ordnance ... 37 38 34 45 43 46 43 30 157 159 316 23.37 Green St. & Ponders End 51 53 48 41 41 52 42 55 182 201 383 30.88 Bush Hill Pk. 32 38 34 35 32 45 19 35 117 153 270 23.95 Hadley and Cockfosters 2 4 ... 2 2 4 5 6 13 19 2108 Births outside the District ... 9 13 22 173 188 173 174 156 191 161 163 672 729 1401 24.46 for District 361 347 347 324 1401 9 The births of boys and girls, also birth.rates for the last three years were:— Year. Boys. Girls. Total. Birth.rate. 1909 704 696 1,400 24.36 1910 734 697 1,431 24.55 1911 679 635 1,314 2314 1912 672 729 1,401 24.46 DEATHS. The deaths registered in the District during the year were 472, of which 221 were males and 251 females, giving a crude death. rate of 8.24. To these must he added 127 deaths of Enfield residents registered outside the District, and from this total must be subtracted 23 deaths of non.residents occurring in the District, which brings the net number of deaths to 576 for the year, giving a recorded death.rate of 10.05. We have, however, to suppose that the age and sex constitution of the population of Enfield is identical with that of England and Wales as enumerated at the census of 1911, for which purpose the recorded death.rate must be multiplied by a "factor for correction" supplied by the Registrar General, viz., 1.0348, and this drives a corrected death.rate of 10.39. This rate is the lowest obtained in the District for many years, and speaks eloquently for the claims of Enfield to be considered a suburban Health Resort. Birth.rate. Crude Death.rate. Corrected Death.rate. Infantile Death.rate. England & Wales 23.8 13.3 13.3 950 London 24.7 13.6 14.3 90.0 ENFIELD 24.46 10.05 10.39 76.30 The corresponding figures for Enfield for the last three years are:— 1909. 1910. 1911. Recorded Death Rate ... 11.62 10.10 12.99 Corrected Death Rate ... 12.22 10 62 13.66 10 The deaths occurred in the several wards as follows:— Ward. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Death.rate per 1000. Infantile Death.rate. Town 16 12 11 13 52 7.56 12.19 Chase 40 25 29 44 138 11.21 61.48 Ordnance 46 29 39 24 138 10.20 113.92 Green Street and Ponders End 42 33 33 20 128 10.32 80.93 Bush Hill Park 19 26 36 30 111 9.84 74.07 Hadley and Cock. fosters 4 1 3 1 9 9.98 0.00 Whole of District 167 126 1.51 132 576 10.05 76.30 The following tabic classifies the 576 deaths above.mentioned according to their sex and age, and allots each death to its own ward:— NETT DEATHS, CLASSIFIED IN AGES, WARDS, AND QUARTERS, 1912. Ward. Town. Chase. Ordnance. Green St. & Ponders End. Bush Hill Park. hadley & cockfosters. Totals each sex. Total. Quarter. 1st 2nd 3rd 4th Total. 1st 2nd 3rd 4 th Total. 1st 2nd 3rd 4th Total. 1st 2nd 3rd 4th Total. 1st 2nd 3rd 4th Total. 1st 2nd 3rd 4th Total. Sex. M f M f M F M f M f M f M f M f M f M f M f M f M f M f M f M f M f M f M f M f M f M f M f M f M f M f M f M f M f M f M f Under 1 year ... 1 ... ... ... ... ... ... ... 1 3 1 4 1 2 2 3 2 12 6 6 6 5 ... 5 8 5 ... 21 14 4 5 7 3 1 5 1 5 13 18 1 ... 4 2 ... 6 4 4 9 12 ... ... ... ... ... 1 ... ... ... 1 55 52 107 1 to 5 yrs. ... ... ... 1 ... ... ... ... ... 1 2 ... 2 2 1 ... 7 6 12 8 4 3 ... ... 1 1 ... ... 5 4 3 2 ... ... 2 2 ... 2 5 6 2 ... ... 1 1 4 3 2 6 7 ... ... ... ... ... ... ... ... ... ... 28 26 54 5 to 10 yrs ... ... 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... 1 ... 1 1 2 1 2 ... 1 ... 1 ... 6 1 ... ... ... 1 ... ... ... ... ... 1 ... ... 1 ... ... 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... 9 4 13 10 to 15 yrs. ... 1 ... ... ... ... ... ... ... 1 1 ... ... 1 ... ... ... ... 1 1 ... ... ... 1 ... ... ... ... ... 1 1 ... 1 ... ... 1 ... ... 2 1 ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 3 5 8 15 to 20 yrs. ... 1 ... ... ... ... 1 ... 1 1 1 2 ... ... ... ... ... ... 1 2 ... ... 1 ... ... 1 ... ... 1 1 3 ... 1 ... 1 ... ... ... 5 ... ... 2 ... ... 1 1 ... ... 1 3 ... ... ... ... ... ... ... ... ... ... 9 7 16 20 to 25 yrs. ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... 1 2 2 ... ... ... ... 1 1 ... 2 1 3 1 1 ... ... ... ... ... 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 7 11 25 to 35 yrs. ... ... 1 ... ... ... ... ... 1 ... 3 ... ... 1 1 2 1 ... 5 3 2 ... 1 ... 1 ... ... 2 3 3 1 ... 1 2 ... 2 ... ... 2 4 ... ... 1 ... ... 1 ... 3 1 4 ... ... ... ... ... ... ... ... ... ... 12 14 26 35 to 45 yrs. ... 1 ... ... 1 ... ... 1 1 2 2 ... ... ... 2 2 3 2 7 4 ... 2 ... 1 ... 1 1 ... 1 4 2 1 1 2 ... 1 1 ... 4 4 ... 2 2 1 1 2 1 1 4 6 1 ... ... ... ... ... ... ... 1 ... 18 20 38 45 to 55 yrs. ... 1 1 1 1 1 ... 1 2 4 4 3 1 ... 1 ... 2 ... 8 3 3 2 4 1 ... 4 ... 2 7 9 2 1 ... ... 5 1 ... 2 7 4 1 1 1 1 2 2 2 1 6 5 1 ... ... ... 1 ... 1 ... 3 ... 33 25 58 55 to 65 yrs. 2 1 1 ... 1 1 2 ... 6 2 2 2 2 1 4 ... ... 1 2 4 4 1 1 2 2 4 1 1 8 8 4 1 2 3 1 3 ... 1 7 8 ... 1 2 4 1 2 2 2 5 9 ... ... ... ... ... ... ... ... ... ... 37 31 68 65 to 75 yrs. 2 2 1 3 3 1 3 ... 9 6 3 5 1 1 4 2 ... 6 11 14 2 5 3 ... 2 4 1 3 8 12 3 2 2 1 2 3 2 1 9 7 3 2 ... ... 5 2 1 2 9 6 1 ... ... ... ... ... ... ... 1 47 45 92 75 to 85 yrs. 1 3 ... 2 ... ... 1 2 2 7 2 2 ... 3 3 3 ... 1 6 9 2 1 1 5 ... 1 1 3 4 10 1 4 3 2 2 ... 1 2 7 8 1 3 1 2 3 1 2 ... 7 6 ... ... ... 1 1 ... ... ... 1 1 27 41 68 Over 85 yrs. ... ... ... ... ... 2 ... 2 ... 4 ... ... 1 2 ... ... ... ... 2 2 ... ... ... 1 1 ... ... 1 1 2 ... ... ... 1 ... 1 ... 1 ... 3 ... ... ... 2 ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... ... 1 3 14 17 Totals 5 11 5 7 6 5 7 6 23 29 24 16 12 13 18 11 2.3 19 79 59 25 21 18 11 14 25 10 14 66 72 25 17 18 15 14 19 5 15 62 66 8 11 12 14 14 22 15 15 49 62 3 1 ... 1 2 1 1 ... 6 3 285 291 576 Total Deaths, each Ward 52 138 138 128 111 9 Death-rate 7-82 11.60 10.55 10.67 10.18 10.32 11 Fifty-seven of the deaths registered were those of persons over 80 years of age, 18 being males and 39 females. Five of the women were over 90, the oldest being 95, their combined ages amounting to 462 years; and one of the men also lived to see 95. The more important causes of death as registered were:— Heart Disease, 56; Pneumonia, 46; Malignant Disease, 44; Pulmonary Tuberculosis, 40 ; Bronchitis, 32 ; Brights Disease, 18; Old Age, 47; whilst among the children Premature Birth accounted for 51 deaths, Measles 14, Diarrhoea 11, Diphtheria 7, Scarlet Fever 2. It must be a source of gratification to total abstainers to note that there was no death from Alcoholism during the year, and only three from Cirrhosis of the Liver. INQUESTS. Forty-six inquests were held during the year—a decrease of 10 on last year. In 34 instances death was found to be due to natural causes, in 8 to accidents (1 to fall, 5 to suffocation, 1 to drowning, and 1 knocked down by motor-car), in 3 to suicide (drowning 2, cut throat 1), and one due to murder by poisoning. INFANTILE DEATHS. The total number of deaths that occurred among infants under one year was 107, giving a death-rate of 76.30 per 1,000 births, as compared with a death-rate of 95 for England and Wales, and 101 for the 95 great towns, including London. The corresponding figures for Enfield for the last three years were 1909, 111.42; 1910, 83.15 ; and 1911, 140.79. The very great improvement in the rate for last year is no doubt to be accounted for by the absence of Diarrhoea, due to the cold and wet summer. The following table assigns the number of infantile deaths to each ward, and also gives the Infantile Death-rate per thousand population, and per thousand births:— 12 Ward. Number of Deaths. Death rate per 1000 population. Death.rate per 1000 births. Town 1 0.14 12.19 Chase 19 1.54 61.48 Ordnance 36 2.66 113.92 Green Street & Ponders End 31 2.5 80.93 Bush Hill Park 20 1.77 74.07 Hadley and Cockfosters 0 0.00 0.00 107 1.81 76.30 The chief causes of death were Premature Birth (including congenital defects), 51 ; Diarrhoea, 10; Respiratory Diseases, 14; Whooping Cough, 6 ; and Measles, 3. The accompanying Diagram shews the relative proportions of these deaths in graphic form :— 13 The deaths for the last five years will be found in Table I. Table II. shews the cases of infections disease notified during the year. Table III. gives the various causes of death at all ages, and Table IV. those under one year. 14 TABLE I. Vital Statistics of Whole District during 1912 and previous Years. Year. Population estimated to Middle of each Year. Uncorrected Number. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1907 54,688 1,432 ... 26.1 614 11.4 9 62 167 116.0 639 11.68 1908 56,185 1,420 ... 25.18 621 11.05 60 64 134 90.1 625 11.18 1909 57,453 1,400 ... 24.36 617 10.73 26 77 156 104.2 668 11.62 1910 58,282 1,431 24.55 521 8.92 21 89 109 75.47 589 10.10 1911 56,344 1,290 1,314 2314 622 11.03 24 134 185 140.79 732 12.97 1912 57,267 1,379 1,401 24.46 472 8.24 23 127 107 76.30 576 10.05 Area of District in acres (land and inland water), 12,601. Total population at all ages, 56,338; Number of inhabited houses, 10,992; Average number of persons per house, 5.12, at Census of 1911. TABLE II. Cases of Infectious Disease notified during the year 1912. Notifiable Disease. Number of Cases Notified. At Ages—Years. Total Cases Notified in Each Ward. Total cases removed to Hospital. At all Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 upwards. Chase. Town. Oldnance Green St. and Pond's End. Bush Hill Park. Hadley it Cockfosters Small Pox — — — — - - - - — - — — — — — Cholera. Plague - - - - - - - - - - - - - - - Diphtheria (including Membranous Croup) 77 — 17 51 6 3 — — 22 6 25 13 11 — 73 Erysipelas 40 1 4 5 3 9 12 6 7 4 4 10 14 1 — Scarlet Fever 98 — 23 67 7 1 — — 37 3 30 11 16 l 91 Typhus Fever — — — — — — — — — — - - — — — Enteric Fever 2 — — 1 - 1 — — 1 — — - 1 — 2 Relapsing Fever (R) Continued Fever (C) lc - - - 1c - - - - - - - - - - Puerperal Fever 7 — — — 1 6 — — 2 - 1 1 3 — 6 Cerebro spinal Meningitis 1 - - - 1 - - - - - 1 - - - - Poliomyelitis — — — — — - - - - - - - - - - Totals 226 1 44 124 19 20 12 6 69 1.3 61 35 46 2 172 TABLE III. Causes of, and Ages at Death during the Year 1912. Causes of Death. Nett Deaths at the subjoined ages of 'Residents' whether occurring in or without the District. Total deaths whether of ' residents' or ' Non- Residents' in Institutions in tinDistrict. 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. All causes Certified 576 107 32 22 21 27 64 126 177 ... Uncertified ... ... ... ... ... ... ... ... ... ... Enteric Fever 2 ... ... ... ... ... 2 ... ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... Measles 14 3 5 6 ... ... ... ... ... ... Scarlet Fever 2 ... ... ... 2 ... ... ... ... 2 Whooping-cough 8 6 1 1 ... ... ... ... ... ... Diphtheria and Croup 7 ... ... 6 1 ... ... ... ... 16 Influenza 2 ... ... ... 1 ... ... ... ... ... Erysipelas 2 ... ... 1 ... ... ... 1 ... 1 Phthisis 40 ... ... ... 1 7 19 10 3 ... Pulmonary Tuberculosis Tuberculous Meningitis. 7 1 5 l ... ... ... ... ... ... OtherTuberculous diseases 8 ... 2 l 2 1 ... 1 1 1 Cancer, malignant disease 44 ... ... ... ... 1 4 19 20 2 Rheumatic Fever 3 ... ... ... 2 1 ... ... ... ... Meningitis ... ... ... ... ... ... ... ... ... ... Organic Heart Disease 56 ... ... ... ... 2 6 26 22 4 Bronchitis 32 4 3 1 1 ... ... 4 19 3 Pneumonia (all forms) 46 9 9 l 4 3 4 7 9 5 Other diseases of Respiratory organs 9 1 ... ... ... ... 1 7 ... ... Diarrhœa and Enteritis 11 11 ... ... ... ... ... ... ... ... Appendicitis & Typhlitis 5 ... ... 1 ... 1 ... 2 ... 2 Cirrhosis of Liver 3 ... ... ... ... ... ... 2 1 ... Alcoholism ... ... ... ... ... ... ... ... ... ... Nephritis and Bright's Disease 18 ... ... l ... 2 2 5 8 ... Puerperal Fever 3 ... ... ... ... ... 3 ... ... ... Other accidents and Diseases of Pregnancy and Parturition 3 ... ... ... ... 1 2 ... ... ... Congenital Debility and Malformation including Premature Birth 51 51 ... ... ... ... ... ... ... ... Violent Deaths excluding Suicide 11 3 ... ... 2 ... ... 2 2 1 Suicide 3 ... ... ... ... ... 1 1 1 ... Other Defined Diseases 184 18 6 2 4 1 19 39 89 12 Diseases ill-defined or known 4 ... 1 ... ... 1 1 ... 1 1 576 107 32 22 21 27 64 126 177 51 Old Age (included above) 47 ... ... ... ... ... 1 1 45 5 17 TABLE IV. Infant Mortality. 1912. Nett Deaths from stated causes at various Ages under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under One Year. All Causes Certified 39 11 3 4 57 13 13 10 14 107 All Causes Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 3 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 2 ... 3 1 6 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... 1 ... ... 1 Abdominal Tuberculous ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases .. ... ... ... ... ... ... ... ... ... ... Meningitis (not tuberculous) ... ... ... ... ... ... ... 1 2 3 Convulsions 2 2 ... ... 4 1 ... 1 ... 6 Laryngitis ... ... ... ... ... ... ... ... 1 1 Bronchitis ... 1 ... ... 1 1 1 ... 1 4 Pneumonia (all forms) ... ... ... ... ... ... 3 3 3 9 Diarrhœa ... ... ... ... ... ... ... ... ... ... Enteritis ... 2 ... ... 2 2 3 1 2 10 Gastritis ... ... ... ... ... ... ... l ... 1 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... 1 ... ... 1 2 Injury at Birth 2 ... ... ... 2 ... ... ... ... 2 Atelectasis 2 ... ... ... 2 ... ... ... ... 2 Congenital Malformation 6 ... 1 2 9 ... ... ... ... 9 Premature Birth 16 3 2 ... 21 ... ... ... ... 21 Atrophy, Debility &Marasmus 10 2 ... 1 13 5 3 ... ... 21 Other Causes 1 1 ... 1 3 1 2 ... ... 6 39 11 3 4 57 13 13 10 14 107 Nett Births in the year:—legitimate, 1,366; illegitimate 35. Nett Deaths in the year of legitimate and illegitimate infants, 107. 18 ZYMOTIC DISEASES. The following table shews the deaths registered in the District from the seven chief zymotic diseases during the past five years:— 1908 1909 1910 1911 1912 Small Pox 0 0 0 0 0 Scarlatina 16 9 10 4 3 Diphtheria 53 26 7 9 19 Measles 6 33 3 28 14 Enteric Fever 2 6 5 5 1 Whooping Cough 3 9 6 16 8 Epidemic Enteritis 4 19 11 94 9 84 102 42 156 54 The figures for Scarlet Fever, Diphtheria, and Enteric Fever include all the deaths that occurred at the Joint Board's Isolation Hospital, where patients belonging to other districts are also received. The actual Enfield deaths were:—Scarlatina 2, Diphtheria 7, and Enteric Fever 2. NOTIFICATION OF INFECTIOUS DISEASE, 1912. Disease. Chase Ward. Town Ward. Ordnance Ward. Ponders End and Green StreetWard. Bush Hill Park Ward. Hadley and Cockfosters Ward. Totals Cases per 1000 population. 1 st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qcr. Total. Scarlet Fever 2 7 8 20 37 3 ... ... ... 3 6 4 9 11 30 4 3 2 2 11 2 3 4 7 16 ... 1 ... ... 1 98 1.36 Diphtheria 8 4 4 6 22 ... 3 1 2 6 11 6 2 6 25 10 ... 2 1 13 3 1 2 5 11 ... ... ... ... ... 77 1.36 Enteric Fever ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 2 .03 Erysipelas ... 3 3 1 7 2 1 ... 1 4 ... 1 2 1 4 4 2 2 2 10 4 2 3 5 14 ... ... ... 1 1 40 .70 Puerpural Fever ... 1 ... 1 2 ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 ... ... 2 1 3 ... ... ... ... ... 7 .12 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 .01 Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 .01 Totals 69 13 61 35 46 2 226 3.59 Diphtheria Carriers 1 1 1 ... 3 ... ... ... 1 1 4 ... ... 3 7 2 ... 1 ... 3 1 ... ... 3 4 ... ... ... ... ... 18 .31 Full Totals 72 14 68 38 50 2 244 3.90 19 ENFIELD ZYMOTIC DEATH-RATE. The Zymotic Death-rate, after deducting 14 deaths of persons from outside the District who died in the Isolation Hospital (which is situate in Enfield), and adding two Enfield residents who died outside the District, is '75 per 1,000. A Zymotic Death-rate of only '75 in a District the size of Enfield is one to be proud of. Disease. 1911. 1912. Deaths. Death-rate. Deaths. -rate. Scarlatina 4 .07 2 .03 Diphtheria 5 .08 7 .12 Enteric Fever 3 .05 2 .03 Erysipelas. 0 .00 1 .01 Measles 28 .49 14 .24 Whooping Cough... 16 .27 8 .13 Epidemic Enteritis 94 1.49 9 .15 15O 2.66 43 .75 NOTIFICATION OF INFECTIOUS DISEASE. The cases of Infectious Disease notified each quarter in each ward were as set out in the accompanying table :— 20 The following table gives the number of cases of each infectious disease notified during the past five years:— 1908 1909 1910 1911 1912 Scarlatina 202 283 156 111 98 Diphtheria 369 222 105 53 77 Membranous Croup 2 1 0 1 0 Enteric Fever 5 2 4 8 2 Small Pox 0 0 0 0 0 Erysipelas 36 31 32 49 40 Continued Fever 0 0 0 0 1 Puerpural Fever 3 4 11 1 7 Cerebro-Spinal Fever 0 0 0 0 1 617 543 298 223 226 SCARLET FEVER. It will be seen that the decrease noted in previous years has been steadily maintained. The majority of the cases notified were removed and treated at the Joint Board's Isolation Hospital, Winch more Hill, to the staff of which every credit is clue for the very successful result of their treatment. DIPHTHERIA. For the previous five years the average number of cases of this disease notified was 164 per annum, the actual figures for the last three years being 1909, 222; 1910, 105; and 1911, 53; and although the number this year has risen to 77, this increase is more apparent than real, owing to multiple cases occurring in one house in several instances as shewn in the subjoined table:— Total number of cases of Diphtheria notified 77 Total number of houses where Diphtheria notified 65 21 Most of the multiple cases were very mild ones, and probably would not have been detected in the absence of bacteriological examination, the clinical symptoms being very slight. These examinations also brought to light the fact that there were a considerable number of "carriers" amongst the children. On the receipt of a notification I always endeavoured to trace the infection back to its source; the work in this connection necessitating the visitation of 258 contacts and suspects; and although impossible in every case, I was able in many instances to prove that some apparently healthy child was the innocent source of the trouble, and was carrying Diphtheria germs in the throat or nose; while in other cases 1 found that a child who had at some previous time suffered from the disease and quite recovered, had again become infected with the bacillus. The following special report which I made to the Council on 23rd October tends to support this view :— "The history of three cases of Diphtheria which occurred "recently in the District so clearly demonstrates the indispensa"bility of careful bacteriological examination of all contacts, and "at the same time so aptly illustrates the difficulties besetting the "path of the Medical Officer of Health in his efforts to check and "prevent the spread of infectious diseases, that it seems to me "worthy to be made the subject of a special report to the Council. "The facts are shortly as follows :— "S.D., a small boy, 7 years of age, was taken ill on June "17th, and was treated at home by his parents until the 26th, "when they, not being satisfied with the way he was progressing, "called in a doctor; a throat swab was taken, sent to me for "examination, and gave a positive result; the case was accordingly "notified as Diphtheria, and removed to Hospital on June 28th." "E.C., a boy aged 4½ years, living next door, was taken ill "on June 24th, and the mother called in the doctor in attendance "on S.D. A swab from this case also proving positive, the boy "was removed to the Hospital on June 29th. All other children "were swabbed, with a negative result. The strictest inquiries "failed to show where S.D. had contracted the disease. The "usual steps were taken for disinfecting the houses." "S.D. returned home on August 10th, and a swab taken on "August 20th proved negative. E.C. returned home on September "23rd, but owing to some mischance I was not made aware of the "fact until October 12th. "On October 10th, T.D., aged 5 years, a brother of S.D., was "taken ill with Diphtheria, and removed to Hospital on the 12th. "On October 14th I visited the houses and swabbed the throats "and noses of all the children in both houses—six in all—with the "following remarkable results:— 22 "E.C., the boy who had returned from the Hospital on Sep"tember 23rd, had Diphtheria Bacilli in his nose ; his brother, a "baby of 8 months, was in a similar condition; and P.D., a boy "next door, was also carrying Diphtheria Bacilli in his nose. All "these children were perfectly well, in good condition and high "spirits, and there were absolutely no indications from a clinical "point of view to show that there was any difference between them "and the other children in the houses, but the fact is made quite "clear that out of seven children four were in an infectious condi"tion and liable to spread Diphtheria far and wide, and that this "condition of affairs could only have been discovered by the "science of Bacteriology. "As the result of my investigations I am inclined to believe "that T.D. was the original cause of all the trouble, and that "though he gave a negative result in June this may be accounted "for by the fact that "carriers" often do give negative results "alternating with positive ones. "It is only fair to the medical man in charge of the cases to "state that every credit is due to him for diagnosing the disease "on June 26th, as it was a most obscure case with few or none "of the ordinary symptoms of Diphtheria." CHRONOLOGICAL RECORD OF THE ABOVE1912. MENTIONED CASES OF DIPHTHERIA. June 28. S. D. Taken ill on June 17 with sickness, sore throat on 26th. Notified as suffering from Diphtheria and moved to Hospital. June 29. E. C. Taken ill on June 24th. Swab reported Positive. Notified as Diphtheria and moved to Hospital. June 29. P. D. L. D. H. D. T. D. C. D. Swabs of all proved Negative. Aug. 10. S. D. Discharged from Hospital. Aug. 20. S. D. Swab reported Negative. Sept. 9. S. D. Returned to School. Sept. 23. E. C. Discharged from Hospital. Oct. 12. T. D. Taken ill Oct. 10. Swab proved Positive. Notified as Diphtheria and removed to Hospital. Oct. 15. S. D. L. D. H. D. Swabs of each proved Negative. Oct. 15. P. D. Swab of nose proved Hoffman and Positive. Swab from throat Negative. Oct. 15. E. C. Swab from nose showed Positive and Hoffman. Swab from throat Negative. Oct. 16. Baby Swab of nose Positive and Hoffman. Chart Shewing Number of Cases of Infectious Disease Notified During Each Week of the Year 1912. diphtheria shewn thus scarlet fever enteric fever 23 I would draw particular attention to the chart shewing the number of cases of infectious disease notified, which shews that no cases of infectious disease occurred during the weeks ending January 14th, April 15th, June 3rd, August 5th and 19th, and September 9th, while there were other eight weeks in which there were only two cases notified each week. ENTERIC FEVER. Two cases were notified during the year, but a careful investigation failed to shew the source of infection in either case. The sanitary condition of both houses was quite satisfactory. PULMONARY TUBERCULOSIS. The following table shews the number of notifications of Pulmonary Tuberculosis received:— Ward. Medical Practitioners Hospital. Poor Law. School Total. Primary Supplemental. Primary Supplemental. Primary Supplemental. Primary Supplemental. Town 12 1 4 i 1 14 5 Chase 16 1 3 2 2 2 ... 21 5 Ordnance 17 2 9 7 4 1 3 33 10 Green Street and Ponders End 23 1 8 4 1 3 1 33 8 Bush Hill Park 27 2 5 3 1 3 2 35 8 Hadley arid Cockfosters ... ... ... ... ... ... ... ... ... Total 95 7 25 20 9 9 7 136 36 Total notifications, 172. 18 primary notifications had also been notified in previous years. 24 Sex. Men 66 Women 58 Boys 4 Girls 8 136 Deaths. The number of deaths from this disease is shewn in (lie following table:— Ward. Male. Female. Total. Death-rate. Town 1 1 2 .29 Chase 2 8 10 .81 Ordnance 4 1 5 .36 Green Street and Ponders End 8 4 12 .96 Bush Hill Park 4 7 11 .97 Hadley and Cockfosters ... ... ... .00 19 21 40 .69 The number of cases known to be living in the District at the end of the year was 87, and the number away at Sanatorium or Infirmary at the same date was 30. The following facts, obtained when visiting the cases, are of interest:— The number of cases which came from other districts shortly before being taken ill was 15, and the number which came while ill was 18. One or both parents known to have died of Phthisis in 16 cases. Children known to have died of Phthisis in 2 cases. 25 Brother, sister or relation known to have died of Phthisis in 23 cases. Wife known to have died of Phthisis in 2 cases. One patient worked where others were consumptive. Six patients had been previously nursing consumptive cases. One case was interesting as inquiry shewed that the infection may have been due to vermin. A fatal case occurred in a house in April, 1911, and when the room was disinfected, vermin, which were very numerous, migrated from this house into the one next door, where a cripple, who was practically confined to the house altogether, resided. This unfortunate individual was taken ill with the disease the following December, and died after a few weeks' illness. Occupations of Patients. Factory, Workshop, Office or Warehouse 37 Outdoor workers 15 School cases 9 Public House 3 Domestic Service 3 Laundry 2 French Polisher 1 Pawnbroker's Shop 1 Cab Driver 1 Gas Works 1 There were 54 rapid, 28 chronic, and 54 mild or recovered cases. The condition of the dwellings at the time of first visit after notification was:— Satisfactory 87 Very damp 6 Other defects 25 These defects have since been remedied. Under the provisions of the National Insurance Act patients were removed to Clare Hall Sanatorium by the Middlesex Insurance Committee, and many cases await removal. On receipt of a notification the case is invariably visited within twenty-four hours. Full inquiries are made with a view to ascertaining the existence of other cases in the same house or amongst the relatives and associates of the patient, and also as to the conditions under which he works and lives; printed instructions are given as to the precautions necessary to be taken to prevent the spread of infection; spitting bottles and disinfectants are supplied, 26 and when the case is kept at home every endeavour is made to impress on the patient and family the importance of adhering strictly to the instructions, and more especially to see that the window of his room is always kept open. The cases are also visited periodically, and should any insanitary conditions be found to exist, their removal is at once seen to. The number of houses and rooms disinfected for this complaint during the year was 63, and the articles—clothing, bedding, etc.— dealt with numbered 471. NON-NOTIFIABLE INFECTIOUS DISEASES. Measles. This disease became prevalent in Enfield, in common with most districts in North London, in the latter part of the year, when it first made its appearance on the Western side, and afterwards shewed itself on the Eastern side, especially in the Ponders End Ward. I have no means of knowing the number of cases that occurred, but evidently the epidemic was of a very mild type, as only 14 deaths were registered during the year. I was in communication with Dr. Boyd, the School Medical Officer, in regard to the schools affected, with the result that the St. Michael's Infants' School was closed for two weeks, with satisfactory results. In accordance with a suggestion of the Local Government Board an arrangement was made between the Council and Education Committee, under which the Head-teachers of the various schools notified to the Medical Officer of Health all absentees suspected to be suffering from any infectious disease. This arrangement came into force on the 1st of January, and by this means we became aware of many cases of Measles, which would otherwise have escaped us. We were thus able to visit the houses, and give instructions as to the precautions necessary to be taken. These cases were all reported to the School Medical Officer. Four Schools were also disinfected with Formalin. Enteritis. Owing, no doubt, to the wet and unpleasant Summer we experienced during 1912, the deaths from this disease were almost negligible. I cannot, however, shut my eyes to the fact that we are open to an epidemic at any time the climatological conditions are favourable to one. I would again venture to urge the Council to take into serious consideration the suggestion 1 made in a special report on Enteritis in February last year, that is the adoption of the Notification of Births Act, an Act which has now been adopted by a 27 large majority of sanitary, authorities in the country, with good results, and which would, I feel, give an equally good result in our hands. Not having the advantage of being able to work under the above Act, I took what steps occurred to me to strengthen our defences in case of need. With the approval of the Council a list of births was obtained each month from the Registrar, each house was visited, and a copy left of the following circular, 5,000 of which were also distributed amongst other houses in those parts where they appeared to be most needed. ENFIELD URBAN DISTRICT COUNCIL. Important Public Notice and Warning as to SUMMER DIARRHCEA. This is a serious Infectious Disease which usually prevails in July, August and September, causing much preventable suffering and loss of life among Infants. Precautionary Measures. 1.—All food should be stored in a clean, cool place, and protected from flies and dust. (Flies carry the seeds of disease and deposit them on milk and other foods.) 2.—Milk should be boiled shortly before use in hot weather. 3.—No stale or unwholesome food, unripe or over-ripe fruit should be eaten. 4.—Where the drinking water is open to suspicion it should be boiled before use. Personal cleanliness is important. Babies and their clothing should be kept specially clean. Do not give them dirty toys nor allow them to play in dirty places. Household cleanliness is also necessary. Give extra attention to the living-room floor, pantry, sink, and utensils for food. Baby's feeding "bottle and teat require scrupulous cleaning every time they are used. Ventilate the house well day and night. The yard and outside premises should be kept clean and free from rubbish. Drains should be flushed with water. Foul ashpits and privies or other nuisances should be reported. Animal and vegetable refuse should be burned. Dirty water should not be thrown on to the yard or street, and slops should never be put into the ash place. If a child gets Diarrhoea, send for a Doctor, Summer Diarrhoea is rapidly fatal in young children. I have also under consideration a more important handbill giving advice on the feeding of babies, which will be distributed early in the new year. 28 HOSPITAL ADMIXISTRATION. "The District is served by the Enfield and Edmonton Joint Board's Isolation Hospital, which is situated upon 27 acres of land at Winchmore Hill, about miles from the centre of the Town. The buildings consist of :— An Administration Block. 9 Pavilions. 1 Discharge Block. Mortuary. Laundry and Disinfecting Station. Porter's Lodge. Engineer's Cottage. Bungalow. and contain 163 beds, 12 of which are in a special cubicle block which has been found to be of great service in the treatment of cases of doubtful diagnosis, and in the isolation of patients who are admitted suffering from more than one infectious disease. The following cases of infectious disease were removed there from the Enfield District Scarlet Fever 91 Diphtheria 73 Enteric Fever 2 166 In his Annual Report of the Enfield and Edmonton Joint Isolation Hospital, 1911-1912, the Physician Superintendent, Dr. Cook, gave a most interesting and useful dissertation on the use of Anti-toxin, which I would recommend to the serious perusal of the medical profession in the District, and I would like to direct special attention to his statement that "out of a total of 131 cases only 34 were sent in having had a dose of anti-toxin." I think every medical man practising in the parish of Enfield knows that he can procure a gratuitous supply of anti-toxin at any hour, either at the Public Offices; at my house, 175, Enfield Highway; and at the Inspector of Nuisances' residence, 12, Fyfield Road, Enfield Town; in addition to which he can always take the precaution of having an adequate supply in his own house by sending in a request for some to the Public Health Department at the Public Offices. I am quite aware that owing to great pressure of work on the part of the Medical Practitioner, and also—if 1 may say so—the rapidity with which cases are removed to Hospital on receipt of the notification, in many instances there is no opportunity to administer the remedy prior to removal, but I have known of cases where there was a doubt about the diagnosis, and where valuable 29 time was lost in waiting for the result of the examination of a swab. On the other hand, I know some men who, when called in to a doubtful case invariably give a dose of anti-toxin, send me on a swab, and take charge of the patient until the twelve to eighteen hours necessary for the full examination of the swab have elapsed, before notifying the case, and except in some exceptional cases— such as boarding-schools—this is the course that 1 would venture to suggest as being the ideal one. As regards the prophylactic use of anti-toxin, which in my opinion is of the greatest importance, I would again remind my professional brethren that I am always at their service, more particularly in the poorer parts of the District, if through stress of work or other causes they are unable to make another visit and carry out what may sometimes prove to be a rather disagreeable series of small operations. BACTERIOLOGICAL WORK. Diphtheria. All the bacteriological work is done in my own laboratory, including the preparation of media, cultivation of growths, etc. livery swab is "planted," and grown in an incubator; and in cases of urgency I have lately adopted a method of diagnosis from the "direct" smear, advocated by Dr. Ponder, County Bacteriologist for Kent, which gives satisfactory results in a number of cases. I examined 1,002 swabs from cases of suspected Diphtheria and from contacts during the year, with the following result :— Hoffman's Bacillus Swabs. Positive. Negative. (Included in Negative.) 1,002 110 892 70 This gives a percentage of 10.97 positive swabs, as against 10.73 last year, and 10 85 in 1910. Although the general opinion is that Hoffman's Bacillus is not pathogenic, I must confess that I look on it with the greatest amount of suspicion, and I do not allow any child shewing it to return to school until two consecutive swabs taken at about one week's interval prove negative. Pulmonary Tuberculosis. Ninety specimens of sputum were sent to me for examination : Sputum. Tubercle Bacillus present. Tubercle Bacillus absent. 90 38 52 giving a percentage of 42.22 positive results, against 37 per cent, last year. 30 WIDAL. I examined five samples of blood in cases of suspected Enteric Fever, one of which gave a positive result, one a doubtful, and three were negative. Water. Six samples of water were submitted to me for examination. Three were found to be unfit for drinking purposes, and a supply taken from the main was substituted in each case. PREVALENCE OF, AND CONTROL OVER ACUTE INFECTIOUS DISEASES. Although we have happily experienced such a large decrease in the number of notifications of acute infectious diseases during the last few years, we have in no way weakened the completeness of the administrative action which we have heretofore adopted to gain information as to the source and method of spread of infection, and to restrain its spread. When a case of infectious disease is notified, the house is at once visited, full inquiries made, and all necessary steps are taken to secure the isolation of the patient either by immediate removal to Hospital or otherwise; disinfectants are supplied, and the necessary examination and disinfection of premises carried out. All contacts are kept under observation, children excluded from school, and any other precautions which may in my opinion be necessary are adopted. Notifications are usually left by hand or come by post to the offices, and in many instances the Medical man in attendancetelephones immediately on becoming aware that he has an infectious case to deal with. The following special arrangements have also been made to remove and deal with cases notified out of Office hours:—An Inspector attends (when the Office is closed) on Saturday at 3.30 p.m., and on Sundays and Holidays at 9.30 a.m. and 3.30 p.m., and in the intervals notifications may be left with the Caretaker of the Public Offices. In addition to this I am not infrequently rung up on the telephone at my private house, sometimes as late as 11.30 p.m., by some Medical man with an urgent entreaty to remove a case at once, and I am happy to be able to say lhat on every occasion we have complied with his wishes, even on one particular occasion when a call was received at 1 a.m., and promptly responded to. 31 METHOD OF DISINFECTION—ROOMS, ETC. Rooms are sprayed with Formalin, and also fumigated with Formalin gas or sulphur. Owners or occupiers are also required to strip and cleanse rooms in all cases where patients have been isolated at home, or w here otherwise necessary. Bedding and other articles that cannot be properly washed and boiled are disinfected in a Washington-Lyons steam disinfecting apparatus. This apparatus stands at the Council's sewage farm. Two vans are used, one for conveying the infected articles from houses to disinfecting station, and the other for returning them. VACCINATION. I have received the following information from Mr. Inns, the Vaccination Officer, in respect of children vaccinated during the year:— Number of cases on lists „ 1,368 Vaccinated 620 Exempted 471 Carried forward 277 SANITARY CIRCUMSTANCES OF THE DISTRICT. Water Supply. With the exception of Hadley and Cockfosters, which derive their supply of water from the mains of the Barnet Gas and Water Company, the District is almost entirely supplied by the Metropolitan Water Board. There are, however, some private wells still in use. In the early part of 1913 the New Reservoir of the Metropolitan Water Board between Ponders End and Enfield Lock in this District, is to be inaugurated by His Majesty the King. It is the largest reservoir in the country, its area being 416 acres, with a capacity ol 300,000,000 gallons, and it is two miles long. There are live pumps, four of which are capable of lifting forty million gallons of water a day, and the other twenty million gallons. Streams and Water Courses. Turkey Street Brook and other streams in the district are kept under observation by the Sanitary Staff, but no sources of contamination were detected. Sewerage. All the houses in the urban part of the district, including Hadley Wood and Cockfosters, are connected with the Council's 32 foul and surface-water sewers, the former of which all discharge at the Sewage Farm at Ponders End. Two men are employed daily (and devote their whole time to the work) to examine and flush all the sewers, and anv defect or obstruction is immediately dealt with. Sewers have been constructed at the follow ing places:— 9 inch diameter, Main Avenue to Boundary Sewer at East of Landseer Road, Bush Hill Park. 9 inch diameter, Gilbert Street, Enfield Wash. 9 inch diameter, Kingswell Avenue, Ponders End. New surface water drains have been laid at the following places:— Ordnance Road (Ferndale Road to Malvern Road). Ordnance Road (near the "Greyhound," Enfield Lock). Brimsdown Avenue. Hoe Lane (Hertford Road end). Main Avenue to Boundary ditch, Bush Hill Park (3 ft. culvert). Falcon Road to Sewage Farm, Ponders End. Extension of surface water culvert to Parsonage Lane. Lavender Hill ditch piped in. Rear of premises, High Street, Ponders End. Lancaster Avenue, Hadlev Wood. Closet Accommodation. All the houses in the urban portions of the district are supplied with w.c.s of various tvpes, the majority being those of the "wash-down" pattern. In the rural parts of the district the accommodation consists of water-closets connected with cesspools, earth-closets, and privies with movable receptacles. I am not aware of any middens in the district. SCAVENGING. Removal of House Refuse. This work is carried out by the Council's own staff, a weekly collection being made throughout the greater part of the district. Part of the stuff collected is disposed of to brickmakers, and the remainder taken to the Council's depot at Caterhatch l.ane, where ' it is levelled and covered with earth. Every week one man in the employ of the Council attends to some few earth-closets in a rural part of the district. CESSPOOLS. The Council has provided suitable vans and pumps, and undertakes the emptying of cesspools on the application of householders. 33 a small charge being made for each emptying. The number of these is gradually being reduced each year. PREMISES AND OCCUPATIONS. There are no Common Lodging Houses, or Cellar Dwellings in the District. In my last Report I mentioned that the Council had made application to the Local Government Board for their approval to the adoption of an Order under Section 51 of the Public Health Acts (Amendment) Act, 1907, extending the number of offensive trades as set out in Section 112 of the Public Health Act, 1875, tvhich must not be established in the District without the consent of the Council, with the result that the following trades were included:— Blood Drier. Fat Melter or Fat Extractor. Leather Dresser. Tanner. Glue Maker. Size Maker. Gut Scraper. Manufacturer of Manure from Fish, Offal, Blood or other prutrescible animal matter. Fish Frier. Fish Skin Dresser. Dealer in Rags and Bones. The Council had also under consideration the question of adopting Bye-laws for thr control of Offensive Trades. SCHOOLS. There are 22 Public Elementary Schools in Enfield, including a Deaf Centre—53 departments in all. The Secondary Schools include the Boys' Grammar School and the County School for Girls, also one large and a number of small private establishments. There is also the Poor Law School, known as Chase Farm Schools, and a Roman Catholic Institution known as the St. Joseph's Home for Destitute Boys. Periodical examinations of the conditions of the public elementary schools are made by one of the Inspectors, and any defects found are brought to the notice of the Education Committee and Managers, with the result that they arc usually remedied without delay. I consider that the sanitary conditions are quite satisfactory. With one exception all the schools are supplied with water from 34 the mains, the exception being the one at Botany Hay, where there is no public water main at present, although the Council are negotiating with the Metropolitan Water Board with a view to having a supply installed; and the Education Committee are erecting a new school there. The action taken in relation to the health of the scholars, and for preventing the spread of infectious disease, is as follows :— If more than one case of infectious disease occurs in a class that room is sprayed with Formalin and thoroughly cleaned afterwards. Cases notified are at once reported to the Head Teacher of the department affected, all contacts are excluded, and the patient is not allowed to return to school until I have quite satisfied myself that he is free from infection. FOOD. Milk. There are some 487 cows in Enfield, owned by 20 cowkeepers, and I am pleased to be able to make a favourable report this year of the way in which the dairy business is conducted. The improvement previously noted has been maintained, more especially in the retail milk shops, but I could wish some of the dairy farmers would appreciate still more the benefit of cleanliness. I was particularly pleased to find an up-to-date Pasteurizing and Cooling Plant installed in one dairy. The plant comprises a boiler for supply of steam steam turbine separator; improved Danish Pasteurizer in which the milk is heated whilst in motion to 160 degs., and immediately cooled down to 45 degs., thus rendering it free from acid-forming or other injurious bacteria. An electrically driven refrigerating machine, by which the temperature of the milk can be reduced to 40 degrees or less, completes the installation of a plant which is unique in Enfield, and which I trust will be copied by many milk retailers in the near future. The cows are inspected bi-annually by Mr. H. H. Hide, M.R.C.Y.S., the Veterinary Surgeon appointed by the Council, and I append copies of his two reports for the year, which are very satisfactory, and tend to shew that the Enfield dairy-farmer is fully alive to the danger of keeping tuberculous cows on his premises. 30th April, 1912.—"I beg to report that during March and "April I inspected the whole of the milch cows. I made a careful "examination of each udder, and found the usual percentage "affected with Mammitis and the resulting induration. I took "samples of the milk for bacteriological examination where neces"sary, and in one case I found the animal to be affected with "Tuberculosis of the udder. This I reported at the time to the 35 "Medical Officer of Health. The remainder proved to be free from "that disease. "A certain number were affected with skin disease, a condition "often found at this time of year after being together in the sheds "during the winter, but they are under treatment and appeared to "be on the way to recovery. "The cows generally were in good condition, and appeared "well cared for, although many were showing the effects of the "abnormal cost of food." 9th December, 1912.—"I beg to report that during November "I inspected the whole of the milch cows in the District. "I made a careful examination of each udder, and found the "number of cases of the ordinary diseases of that organ incidental "to milch cows to be less than on any previous occasion, as a "result of periodic inspection the practice of disposing of animals "so affected at an earlier stage of the disease is becoming more "general. There was also a marked diminution in the number ot "cases of skin disease which was prevalent at the beginning of "the year. "Where necessary I took samples of the milk for bacterio"logical examination, but in no case was the bacillus of Tuber"culosis present. "I consider the Cows, generally, are in a satisfactory condition "as regards health, and were well kept and cared for." With regard to the animal mentioned in the first report as being affected with Tuberculosis of the udder, steps were taken to see that milk from this cow was not sold or used for food for animals without being boiled. The cow was soon disposed of by the owner, and in spite of every endeavour on our part its destination could not be ascertained. I have received from Dr. Young, County Medical Officer, the following return of work done during the year by the County Council Inspectors under the Sale of Food and Drugs Acts, in this District:— Food. No. of Samples taken. No\found adulterated. Butter 69 1 Milk 59 10 Borax 5 — Lard 5 — Coffee 4 1 Cocoa 3 — Glycerine of Borax 3 — Jam 1 — Baking Powder 1 — 150 12 36 There were two prosecutions, resulting in conviction in each case. OTHER FOODS. Mr. Fred Wilson and Mr. T. M. Boswell, the Assistant Sanitary Inspectors, who hold the Certificate of the Royal Sanitary Institute for Inspector of Meat and Foods, visit the slaughterhouses, of which there are 18 in the district, every week, and as will be seen by a reference to the Sanitary Inspector's report, they paid 785 such visits, examined 1,924 carcases, and secured the surrender of 33 parcels of diseased organs. The sanitary condition of the slaughter-houses is on the whole satisfactory. BAKEHOUSES. I visited the 44 bakehouses in the District, of which 41 are in use, and found them all in a satisfactory condition. HOUSING. At the Census of 1901 it was found that the average number of persons inhabiting a house in Enfield was 5 35, w hereas in 1911 the number was reduced to 5T2. It therefore seems to me that in view of this, and the fact that there has been no sudden influx of population, nor any great increase in the number of inhabited houses, and from the personal knowledge of your sanitary staff, that the housing accommodation is sufficiently adequate for the needs of the District. The Regulations issued by the Local Government Board under Section 17 (1) Housing, Town Planning, etc. Act, 1909, are receiving close attention. A list was prepared of houses and streets, the early inspection of which was, in my opinion, desirable, those being first selected which had not been inspected for some time, and where there was evidence that attention was again needed. The following are the particulars required by Article 5 of these Regulations to be included in my Report:— Number of dwelling-houses inspected 727 Number of houses considered on inspection to be in a condition so dangerous as to be unfit for human habitation 26 Number of houses closed and demolished without orders 6 Number of houses closed and demolished following closing orders 0 37 Number of representations made to the Local Authority with a view to the making of Closing Orders 10 Number of Closing Orders made 10 Number of dwelling-houses where defects were remedied without service of Closing Orders 578 Number of houses which, after making of Closing Orders, were put in a fit state 0 With regard to the ten houses for which Closing Orders were made, the owner is arranging to carry out the whole of the works necessary to put them in proper repair. The same can also be said of ten other cottages in regard to which like proceedings were proposed. In addition to all this work which has been done under these Regulations, the following number of houses have also been inspected during the year:— On account of infectious disease 422 On account of complaint by occupants and otherwise 830 Total 1,252 making a gross total of house inspections for the year of 1,979, which gives a percentage of 17.6 of the total number of houses in the district. There will be found in the statement or report of the Inspector of Nuisances required to be included by Article 20 (16) of the General Order of the Local Government Board, minute details of the defects found on inspection of the dwellings, all of which have been remedied during the year. Plans of new houses and alterations to buildings have to be submitted for the approval of the District Council. The erection of dwellings and other buildings is closely supervised by the Council's Engineer and Building Inspectors. The Bye-laws require that no house is to be occupied until the drainage has been completed, and each dwelling certified as in every respect fit for human habitation. This requirement is very strictly observed, and a close watch is also kept to prevent alterations which might be surreptitiously made. There are no back-to-back houses in the District, the airspace about dwellings is generally sufficient, and although we find considerable difficulty in preventing the erection of sheds, fowlpens, rabbit-hutches, etc., in back yards and gardens, the figures I have already given are, I think, a sufficient proof that constant and adequate supervision is being exercised by the members of your Health Department. 38 Thirty-four cases of overcrowding were discovered during the year, in connection with which the usual notices were issued, which secured the abatement of the nuisance. NUISANCES, Etc. It will be seen from the particulars given in the Sanitary Inspector's Report that a very large amount of work has been carried out during the year in securing the removal of nuisances and the improvement of sanitary conditions of the dwellings, which must tend not only to the benefit of the district, but to the happiness and well-being of the inhabitants. METEOROLOGY The following instruments are installed at the Public Offices : Standard Fortin Barometer. Maximum Thermometer Minimum Thermometer Standard Hygrometer Terrestrial Radiation Thermomete Earth Thermometer Campbell-Stokes Sunshine Recorder Rain Gauge Solar Radiation Thermometer. In a Stevenson's screen in the grounds of the Public Offices. In the grounds of the Offices. On roof of the Public Offices. Daily records have been taken by Mr. Boswell, assisted byMessrs. Smith and Coulter, and monthly returns have been sent to the Meteorological Office. I have to thank Mr. John McEwan, J.P., F.R. Met. Soc., who, as usual, has given me the benefit of his extensive knowledge and long experience of Meteorology. The accompanying table gives the result of our operations for the year, in a condensed form:— 39 METEOROLOGICAL STATISTICS FOR 1912. Month. Barometer. Temperature. Rainfall. Sunshine. Highest. Lowest. Highest. Lowest. Mean. Ins. Ins. ° ° ° Ins. Hrs. January 30.352 on 29th 29.172 on 7th 51.5 on 9th 17.5 on 29th 39.5 3.27 34.2 February 30.214 on 27th 29.026 on 8th 57.0 on 29th 16.0 on 13th 42.0 1.75 28.8 March 30.358 on 12th 28.848 on 18th 62.0 on 25th 31.0 on 11th 46.2 3.18 88.3 April 30.500 on 12th 29.538 on 8th 71.0 on 21st 30.0 on 12th 48.8 .08 242.1 May 30.406 on 8th 29.534 on 15th 79.8 on 11th 35.0 on 26th 56.0 1.05 171.8 June 30.150 on 27th 29.434 on 4th 80.0 on 19th 39.5 on 3rd 58.6 2.79 183.9 July 30.280 on 4th 29.603 on 28th 87.0 on 12th 45.5 on 9th 72.4 1.50 129.5 August 30.166 on 22nd 29.262 on 26th 68.0 on 29th 43.0 on 3rd 61.0 4.97 101.6 September 30.500 on 19th 29.386 on 30th 68.0 on 4th 33.0 on 27th 51.7 2.35 112.6 October 30.672 on 4th 29.326 on 21st 61.5 on 1st 27.0 on 5th 46.0 2.18 105.6 November 30.440 on 1st 29.148 on 29th 56.5 on 8th 26.5 on 4th 42.4 1.8 32.9 December 30.468 on 3rd 29.064 on 26th 57.0 on 14th 22.5 on 1st 44.0 2.53 25.7 40 ADOPTIVE ACTS. There are no local Acts. The following are the Adoptive Acts in force in the district:— Public Health Acts (Amendment) Act, 1890. Came into force February 1st, 1891. Infectious Disease (Prevention) Act, 1890. Came into force February 1st, 1891. Public Health Acts (Amendment) Act, 1907. The following sections came into force on July 27th, 1909 :—All sections in Part I. Sections 15, 16, 17, 20, 21, 23, 24, 25, 27, 29, 30, 31, 32 and 33 of Part II. Sections 34, 35, 36, 37, 38, 43, 44, 46, 47, 48, 49, 50 and 51 of Part III. Sections 52, 53, 54, 55, 56, 57, 59, 62, 63, 64, 65 and 68 of Part IV. All of Parts V. and VI. Section 81 of Part VII. All of Parts VIII. and IX. Section 95 of Part X. It is very difficult, if not impossible, to give any detailed account in this Report of the manner in which these Acts are administered, but every advantage is taken of the powers given by them to secure the improvement of the sanitary condition and well-being of the district and its inhabitants. FACTORY AND WORKSHOP ACT, 1901. The information under this heading is set out on page 47 of the Inspector of Nuisances Report, where full details as to the administration of the Acts are given, and the necessary forms have been filled in and will be sent with my Report to the Home Office, Whitehall. PRIVATE ROADS AND STREETS. I have received the following details from Mr. R. Collins, Engineer and Surveyor to the Council:— During the year one private street has been laid out—Park Crescent, Walsingham Road. The following streets have been metalled, channelled, paved, etc., under Section 150 of the Public Health Act, 1875 Ladysmith Road; Kynaston Road; Mayfield Road; Jasper Road ; Rosemary Avenue; Durants Road (part); Farr Road, and Malvern Road. 65,000 super yards of roadway have been treated by tar spraying. A footpath has been made across Bush Hill Park Recreation Ground from Lincoln Road to Cecil Avenue ; one from Cockfosters to Camlet Way, Hadley Wood; and one from Chase Side to Chase Green Avenue. 41 Widenings and improvements have been made at the following places:—Passage, Chase Side to Holtwhite Avenue; Footpath, Falcon Road to Sewage Farm, Ponders End; Duck Lees Lane, Ponders End; Ordnance Road (near "Greyhound"), and Lavender Hill. 600 chairs have been provided to parks and open spaces. Extensive new allotment grounds at Bush Hill Park have been laid out. Over 2,000 yards of kerbing and channelling, and 5,000 super yards of paving have been done in the following public streets:— Parsonage Lane; Lavender Hill; Silver Street; Forty Hill; Goat Lane ; South Street; Scotland Green Road ; Carterhatch Lane, and Connop Road. NEW BUILDINGS, Ere. 129 houses have been certified as completed and fit for human habitation and 37 houses have had additions made thereto. These, together with 18 buildings of the factory class, 3 public buildings, and 68 other buildings, constitute the full amount of building operations during the year. In addition to the above there are the buildings connected with the new Reservoir of the Metropolitan Water Board at Enfield Lock, to be opened by the King on March 15th, which also come under our jurisdiction. The new Central Library has been completed, and opened during the year. THANKS. During the past year, to my great regret, the School Medical Officer, Dr. Prudence E. Gaffikin, left the district to take up another—I hope a better—appointment in Dublin. On many occasions Dr. Gaffikin put me under a debt of obligation to her which I was unable to liquidate, and I can now only thank her for the great help she gave me, more particularly during the time when Diphtheria was rife among the children. My relations with the present School Medical Officer, Dr. Boyd, are of an equally pleasant description. My thanks are again offered to the members of the Medical Profession in the district. I am indebted to them for many acts of kindness and help during the past year. 42 Mr. A. J. Munro, Chief Sanitary Inspector, has again given me of his best, and it affords me great pleasure to thank him once more for the never varying urbanitv and modesty with which he gives me the benefit of his long experience. The other members of the staff are to be commended for the effiicient manner in which they carry out their duties. I am, gentlemen, Yours obediently, William Penkefather Warren, Medical Officer of Health. 43 Public Offices, Enfield, March, 1913. REPORT OF THE INSPECTOR OF NUISANCES FOR THE YEAR 1912. To the Chairman and Members of the Urban Distrct Council of Enfield. Gentlemen, I beg to submit my Report for the year ending December 31st, 1912, including particulars in tabular form as required by Article 20 (16) of the General Order of the Local Government Board, of the work done under my supervision in connection with your Sanitary Department:— Inspections. N umber of houses inspected :— Under Regulations, Sec. 17, Housing, Town Planning Act, 1909 727 From house to house apart from this Act 409 On account of infectious disease 301 ,, ,, Phthisis 121 ,, ,, complaint, by occupants and otherwise 421 1,979 Other houses and premises inspected 237 22 Factories 76 129 Workshops and workplaces, including 13 laundries 512 52 Outworkers' premises inspected 62 44 Bakehouses in the District, of which 42 are in use 270 18 Slaughterhouses inspected frequently 785 31 Cowsheds, inspected frequently 377 68 Dairies and Milkshops, inspected frequently 400 23 Schools 85 62 Shops where ice-cream is made 93 Inspections under the Rag Flock Act 8 Publichouse urinals inspected 49 Conveniences at Railway Stations inspected 29 Fish-shops. Total number of visits 144 Coffee and eating houses. Ditto 33 3,160 Carried Forward 5,139 44 Brought Forward 5,139 Visits to absentees excluded from Elementary Schools 1,042 Visits in connection with cases of Infectious Disease 982 ,, ,, ,, Phthisis 585 Other inspections, including works in progress 11,449 Smoke observations 17 14,075 19,214 NOTICES ISSUED. Statutory — For repairs to houses, drains and abatement of nuisances 199 Providing sufficient water closets 70 Provision of dustbins 89 Paving of yards 68 Overcrowding 10 Provision of sink waste pipes 15 451 Informal:— Notices 20 Letters sent in lieu of notices 1,351 1,371 Other notices issued under Infectious Diseases Acts:— To occupiers 389 To schools 895 1,284 3,106 Other letters sent 3,077 Result of service of statutory notices:— Number complied with 422 Number outstanding 29 451 As to these outstanding notices, in twelve the time given did not expire until after the end of the year, with with regard to 17 the work required was delayed on account of the weather or other reasonable cause. The following are the works carried out as the result of the notices or letters:— 19,214 45 Houses or parts of houses cleansed, repaired, etc. 419 Houses closed and demolished 6 Roofs repaired 412 Gutters and downpipes repaired 493 Cesspools emptied 229 House drains cleared, repaired, etc. 253 House drains tested, examined, etc. 225 House drains reconstructed 41 Soil-pipes and drains ventilated, including repairs to ventilators. 82 Sink wastes disconnected or repaired. 44 Closets provided with proper flushing cisterns or water supply. 218 New closets provided 8 Closets repaired, covered, cleansed, etc. 288 Storage cisterns repaired, covered, cleansed, etc. 110 Water laid on or restored 19 Samples of water taken 6 New storage cisterns provided 14 Wells cleansed or covered 7 Yards paved, or existing paving made good 309 Ventilation provided under ground floors, and causes of dampness removed 48 Dustbins repaired, or new ones provided 317 Manure heaps removed 57 Fowls and other animals removed 23 Stables, etc., cleansed 3 Other nuisances abated 9 Ditches cleaned out 4 Cases of overcrowding abated 34 DISINFECTION. Houses disinfected:— After infectious disease 165 After Phthisis 63 After Cancer 4 232 Rooms stripped and re-papered, etc., after occupation by cases of infectious disease 67 Articles of clothisg, bedding, etc., disinfected after infectious disease 2,142 Articles of clothing, bedding, etc., destroyed 20 Carried Forward 2,162 46 Brought Forward 2,162 Articles of clothing, bedding, etc., disinfected after Phthisis 463 Articles of clothing, bedding, etc., destroyed 8 471 Articles of clothing, bedding, etc., disinfected after Cancer 25 2,658 Library books disinfected 42 Cases of Scarlet Fever removed to Hospital 91 ,, Diphtheria ,, ,, 73 ,, Enteric Fever ,, ,, 2 ,, Puerperal Fever ,, ,, 6 172 Gipsy vans removed from District 35 Articles or parcels of unsound food destroyed 59 From these particulars it will be seen that we have found it possible during 1912 to increase the number of inspections of dwellings, the figures being 1,236 in 1912, as against 1,136 in 1911. The majority of the defects found to exist were remedied before the end of the year, and the remainder are having attention. This result, I am pleased to say, has again been obtained without resource to legal proceedings during the year. As will be seen, the number of visits has also been increased by the visits made in reference to children excluded from Elementary Schools, the total for the vear of inspections and visits being 19,214. REMOVAL OF HOUSE REFUSE. The removal of house refuse has received very close attention in order to see that the weekly collection and clearing of refuse from all houses was maintained. 7,129 loads were collected and taken to the Council's shoots or disposed of to brickmakers. 47 FACTORY AND WORKSHOPS ACTS, 1901 & 1907. A register of all workshops is kept, and at the end of 1912 there were 116 workshops, 13 laundries and 44 bakehouses registered. The following tables give details of the work done in connection with these places, as required by the Home Office. Inspections. Premises. Number of Inspections. Written Notices. Prosecutions Factories (including Factory Laundries) 76 2 ... Workshops (including Workshop Laundries) 512 11 ... Bakehouses 270 23 ... Total 858 36 ... Factory and Workshops Act (Continued.) Defects Found. Particulars. Number of Defects Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:— Want of cleanliness 10 10 ... ... Want of Ventilation ... ... ... ... Overcrowding 3 3 ... ... Want of drainage of floors ... ... ... ... Other Nuisances 35 35 ... ... Sanitary accommodation:— Insufficient 2 2 ... ... Unsuitable or defective 14 14 ... ... Not separate for sexes ... ... ... ... Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse ... ... ... ... Breach of special sanitary requirements for bakehouses 35 35 ... ... Other offences ... ... ... ... Total 99 99 ... ... 49 Homework. Nature of Work. Lists received from Employers. Notices served on Occupiers as to keeping or sending Lists. Sending twice in the year. Sending once in the year. Lists. Workmen. Lists. Workmen. Making Wearing Apparel 40 42 28 26 18 Lace, Curtains, &c. 4 2 2 2 2 Umbrellas, &c. 4 4 — — — Artificial Flowers 2 2 1 1 — Brush Making 2 2 1 1 - Total 52 52 32 30 20 In one instance a case of infectious disease occurred at the house of an outworker. The case was removed to Hospital at once, and all articles and materials for making them were thoroughly disinfected before being returned to the employers. Thirteen addresses of outworkers have been forwarded to other districts. EMPLOYMENT OF CHILDREN ACT, 1903. During the year 306 names were received of children employed out of school hours, and in 177 cases contraventions of the Byelaws were found, and remedied. MILK. Frequent inspections have been made of the dairies and milkshops in the district, in order to see that the requirements of the Dairies, Cowsheds and Milkshops Orders, and the Regulations in force in the district were complied with. 50 ICE CREAM. Sixty-two shops where ice-cream was made or sold were inspected during the Summer, 93 visits being made to them, and where necessary instructions given in regard to the cleansing of utensils and premises. The Summer being cold and wet, less trade was done with this article. COFFEE AND EATING HOUSES. During the year an inspection was made of all the Coffee and Eating Houses, when the premises and arrangements were generally found to be in good order and condition. UNSOUND MEAT AND FOODS. In this connection Mr. Fred Wilson and Mr. T. M. Boswell, the Assistant Inspectors, have paid a weekly visit to the slaughterhouses, shops and markets, the number of inspections made for this purpose being:— Slaughterhouses 785 Shops 753 Stalls in Markets 1225 2763 The number of carcases examined during the visits to slaughterhouses is as follows:— Cows 79 Oxen 188 Calves 21 Sheep 1176 Pigs 460 1924 During the examination of these carcases while being prepared for food 33 organs were found to be diseased, and these were surrendered by the owners and destroyed. The carcases generally were in good condition, and there was no case found which necessitated the obtaining of a Magistrate's Order. 51 The following articles were also submitted for inspection, and as in each case it was found that they were unfit for food of man, certificates to that effect were given, so that the owners could secure the return of the money paid from the wholesale traders:— March 27th—2 boxes kippers. Sept. 14th—24 rabbits. HOUSE DRAINAGE. It will be seen that a large number of house drains have, again this year, been tested, also cleared and repaired. All new work has been closely supervised, and in every possible instance tested with water during its progress, while a final test with smoke and water is also applied on completion. PUBLIC ELEMENTARY SCHOOLS. By an arrangement between the Council and the Education Committee, I have all the sanitary arrangements attached to the non-provided schools regularly cleansed and Hushed each day, while we also make periodical inspections of the sanitary conveniences at the provided schools, and report as to their condition to the Education Committee. The motor car provided by the Council for the use of Mr. Collins, the Council's Engineer and myself, has continued to prove a great advantage, enabling the whole of the District to be kept under observation, and frequent visits made to any part requiring special attention. The staff of the Sanitary Department remains the same as last year, and I am glad to take the opportunity afforded by this Report to acknowledge and thank them all for their hearty cooperation throughout the year, and the real interest displayed in their work, which acknowledgment includes the outdoor staff connected wih the department. I am, Gentlemen, Your obedient Servant, A. J. Mlnro, M.R.Sati.l., Inspector of Nuisances.