THE URBAN DISTRICT COUNCIL OF ENFIELD. Annual Beport OF THE MEDICAL OFFICER OF HEALTH, FOR 1913. TOGETHER WITH THE ANNUAL REPORT OF THE INSPECTOR OF NUISANCES. INFIBLD : G. BROOKS AND CO., SOUTHBURY ROAD. '<> ;U * tj .1 ■ «f' V':;" ■"' : '^ - 4 a >■- >v:v.: , THE URBAN DISTRICT COUNCIL OF ENFIELD. Annual Report OF THE MEDICAL OFFICER OF HEALTH, FOR 1913. TOGETHER WITH THE ANNUAL REPORT OF THE INSPECTOR OF NUISANCES. ENFIELD : G. BROOKS AND CO., SOUTHBURY ROAD. Enfield Urban District. Area (including 412 acres water) 12,601 acres. Population at census of 1911 56,338 Population at middle of 1913 59,146 Number of inhabited houses 11,552 Vital Statistics. Birth-rate per 1,000 living 22 50 Recorded Death-rate per 1,000 living 9 75 Standardized Death-rate per 1,000 living 10 09. Infantile Mortality per 1,000 births 8715. Zymotic Death-rate per 1,000 living 0 52. Tuberculosis Death-rate per 1,000 living 101. Vital Statistics of Wards. Ward. Area in acres Persons per acre. Population. Birthrate. Standardized Deathrate. Infantile Mortality. Zymotic Deathrate. Tuberculosis Death rate. Town 1,717 4.2 7,219 13.71 8.02 40.40 0.26 .75 Chase 4,478 2.8 12,791 23.92 11.48 75.16 0.23 1.08 Ordnance 2,060 6.6 13,711 20.49 10.25 103.20 0.51 1.21 Green Street and Ponders End 1,330 9.5 12,692 26.47 11.41 119.04 1.10 .97 Bush Hill Park 762 15.4 11,791 24.25 8.24 69.93 0.59 .93 Hadley & Cockfosters 2,254 .4 942 8.49 9.89 0.00 0.00 .00 Urban District Council of Enfield. With the Compliments of the Medical Officer of Health. PUBLIC OFFICES, ENFIELD. PUBLIC OFFICES, ENFIELD, March 11th, 1914. Medical Officer of Health’s ANNUAL REPORT for 1913. To the Urban District Council of Enfield. Gentlemen, I have the honour to submit to you my Annual Report for the year 1913, 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 sevenand-a-half miles long from East to West, about three-and-ahalf 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 South by Edmonton and Southgate, and on the West by South Mimms and Hertfordshire. It contains 12,601 acres, including 412 acres of water, and naturally divides itself into three parts:—the Western; mainly 6 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. Enfield is well provided with parks and recreation grounds, the Council having purchased and devoted to the use of the public no less than 170 acres of land. There is a public park in the Ordnance, Green Street and Ponders End, and Bush Hill Park Wards respectively. The Town Ward boasts of a beautiful park (23 acres), as well as "Chase Green," and the Chase Ward owns the "North Enfield Cricket Ground," and a large park of 62 acres known as "Hilly Fields," a name which by no means does justice to its natural beauties. 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 318 per cent. for the ten years. At the last census it was found that the average number of inhabitants to each house was 5T2, and as on the 30th of June there were 11,552 inhabited houses, it follows that the population of Enfield at that date must be estimated at 59,146. There were 424 uninhabited houses available for habitation, and although from this it would appear that the housing 7 modation is sufficient, I am of the opinion that there is plenty of room for new houses in the District. In view of the natural increase of the population (i.e., the excess of births over deaths) the facilities offered for transport to and from London, and the continued increase of factories and horticultural work, both in our own District and in the neighbouring localities, there will, no doubt, be a considerable increase in the population in the near future. I hope, therefore, that we shall see more activity in the building trade,—as far as houses for the working class portion of the community are concerned,—in the next year or two than we have in the oast. Enfield is divided into six wards as follows:- Wards. Inhabited Houses. Uninhabited Houses. Total. Population. Town 1,410 62 1,472 7,219 Chase 2,498 98 2,596 12,791 Ordnance 2,678 81 2,759 13,711 Green Street and Ponders End 2,479 133 2,612 12,692 Bush Hill Park 2,303 38 2,341 11,791 Hadley & Cockfosters 184 12 196 942 11,552 424 11,976 59,146 VITAL STATISTICS. The number of births registered was :— Boys. Girls. Total. 659. 672 1,331, including 34 illegitimate births, i.e., 25 per cent, of the total births. This total is 70 less than that of the previous year, and gives a birth-rate of 22'50 per thousand of the population, which compares unfavourably with that of England and Wales, which was 23 9 per housand. The corresponding rate for London is 24'8. 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 13 12 11 10 19 9 14 42 57 99 13.71 Chase 33 44 43 42 34 37 30 43 140 166 306 23.92 Ordnance 36 28 51 34 43 31 28 30 158 123 281 20.49 Green St. & Ponders End 35 44 51 32 51 53 34 36 171 165 336 26.47 Hadley and Cockfosters 1 1 0 0 1 3 2 0 4 4 8 849 Bush Hill Pk. 34 34 36 30 43 43 24 42 137 149 286 24.25 Births outside the District 7 8 15 — 150 164 193 149 182 186 127 165 659 672 1331 22.50 for District. 314 342 368 292 1331 The births of boys and girls, also birth-rate for the last three years were:— Year. Boys. Girls. Total. Birth rate Illegitimate Birth-rate 1910 734 697 1,431 24.55 .67 1911 679 635 1,314 23.14 .47 1912 672 729 1,401 23.46 .61 1913 659 672 1,331 22.50 .57 9 DEATHS. The deaths registered in the District during the year were 493, of which 244 were males, and 249 females, giving a crude death-rate of 833. To these must be added 124 deaths of Enfield residents registered outside the District, and from this total must be subtracted 40 deaths of non-residents occurring in the District, which brings the nett number of deaths to 577 for the year, giving a recorded death-rate of 9.75. 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 gives a standardized death-rate of 1009. 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. Recorded Death-ra e. Standardized Death-rate. Infantile Death-rate. England & Wales 23.9 13.7 13.4 109.0 London 24.8 14.2 14.2 104.0 96 Great Towns, including London 25.1 14.3 14.7 116.0 ENFIELD 22.50 9.7 10.09 87.15 The previous year gave us a standarized death-rate of 10'39, and we congratulated ourselves on the fact that it was the lowest recorded in the District for many years, but tracing our records so far as they are available I cannot find any as low as this year. This low rate taken in conjunction with an Infantile deathrate of 87T5, and a Zymotic death-rate of .52, still further supports the claim of Enfield to be considered not only a suburban health resort, but entitles it to rank among the most distinguished in the kingdom. The Registrar-General publishes every week the death-rates of the 96 great towns of the country, and during last year on no less than four occasions Enfield stood lowest on the list, on two other occasions second lowest, and for six other weeks was included mongst the lowest half-dozen. 10 The corresponding figures for Enfield for the three previous years are:— 1910. 1911. 1912. 1913. Recorded death-rate 10.10 12.99 10.05 9.75 Standardized death-rate 10.62 13.66 10.40 10.09 The deaths occurred in the several wards as follows: Ward. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Total. Death-rate per 1,000, as recorded. Infantile Death-rate. Town 14 16 14 12 56 7.75 40.40 Chase 37 27 39 39 142 11.10 75.16 Ordnance 32 36 36 32 136 9.91 103.20 Green Street and Ponders End 49 38 30 23 140 11.03 119.04 Bush Hill Park 32 22 19 21 94 7.97 69.93 Hadley 2 2 5 0 9 9.56 0.00 Whole of District 166 141 143 127 577 9.75 87.15 The following table classifies the 577 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, 1913. Warp. Town. Chase. Ordnance. Green St. & Ponders End. Bush Hill Park. hadley & cockfosters. Quarter. 1st 2nd 3rd 4th I Total. 1st 2nd 3rd 4th Total. 1st 2nd 3rd 4th Total. 1st 2nd 3rd 4th Total. 1st 2nd 3rd 4th Total. 1st 2nd 3rd 4th Total. Totals each sex. 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 1 .. .. 1 1 3 1 6 4 .. 3 2 3 4 11 12 2 5 4 9 7 3 3 3 16 13 6 9 8 3 6 4 9 2 99 18 9 3 4 1 9 5 9 1 10 10 .. .. .. .. .. .. .. .. .. .. 60 56 116 1 to 5 yrs. .. .. .. 1 .. 1 .. .. .. 2 4 .. .. 1 1 91 1 1 6 4 9 .. .. 1 9 2 1 1 5 4 3 8 1 .. .. .. 1 1 5 9 .. .. 9 1 .. .. .. 1 2 9 .. .. .. .. .. .. .. .. .. .. 18 21 39 5 to 10 yrs. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. 2 .. 1 1 .. .. 9 .. 1 1 4 2 .. .. 1 .. .. .. 1 1 9 1 .. .. .. .. .. .. .. .. .. .. 8 1 12 10 to 15 yrs. .. .. .. 1 .. .. .. .. .. 1 .. 1 .. 2 .. 9 .. .. .. 5 .. 1 .. 1 .. .. .. .. .. 2 .. 1 .. 1 1 .. 1 1 2 3 .. .. .. .. .. 1 .. .. .. 2 .. .. .. .. .. .. .. .. .. .. 2 13 15 15 to 20 yrs. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 1 .. 1 1 3 .. .. .. 2 .. 1 .. .. .. 3 .. .. .. .. .. .. 1 .. 2 .. .. .. .. 1 .. 1 1 1 1 3 .. 1 .. .. .. .. .. .. .. 1 4 10 14 20 to 25 yrs. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 9 1 .. 1 1 3 3 .. .. .. 1 .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 3 5 8 25 to 35 yrs. .. .. .. .. 1 1 1 2 1 .. 9 1 1 .. .. 1 .. .. 3 1 1 9 1 1 .. 1 .. 5 2 1 1 1 .. 3 1 .. 1 5 3 9 1 .. l .. .. .. 1 9 3 .. .. .. .. .. .. .. .. .. .. 16 12 28 35 to 45 yrs. 1 1 .. .. .. .. .. 1 1 2 2 1 3 1 3 .. 1 3 9 5 2 1 3 .. 1 1 .. 1 6 3 3 .. 1 4 .. 1 1 .. 5 5 1 .. .. 2 2 1 .. .. 3 3 .. .. .. .. .. .. .. .. .. .. 24 18 42 45 to 55 yrs. 2 2 2 1 .. .. 1 .. 5 3 1 .. 2 .. 6 3 3 1 12 4 .. .. .. 1 .. 3 4 1 7 7 .. 5 4 .. 9 1 1 4 7 10 .. .. .. 1 .. 1 1 l 1 3 .. .. .. .. 1 1 .. .. 1 1 33 28 61 55 to 65 yrs. .. 2 1 1 1 2 2 .. 4 5 3 1 2 1 1 4 .. 3 6 9 1 1 2 3 2 2 2 2 7 8 1 .. 3 2 2 1 2 1 8. 4 2 3 .. 2 2 .. 1 .. 5 5 1 .. .. 1 .. 1 .. .. 1 2 31 33 64 65 to 75 yrs. 1 1 2 2 2 1 4 1 9 5 2 2 2 1 3 3 5 3 12 9 4 .. 1 2 2 2 2 5 9 9 2 .. 3 2 .. 1 1 1 6 4 3 6 2 2 .. .. 1 3 6 11 .. .. .. .. 1 1 .. .. 1 1 43 39 82 75 to 85 yrs. 2 .. 1 1 3 .. 1 .. 7 1 3 3 2 4 1 3 3 5 9 15 1 6 2 3 1 5 .. 9 4 16 1 3 9 1 .. 3 .. .. 3 7 3 5 .. 1 9 1 .. 3 5 10 .. .. 1 .. .. .. .. .. 1 .. 29 49 78 Over 85 yrs. 1 .. 2 .. .. .. .. .. 3 .. 3 1 .. .. .. .. 1 .. 4 1 .. .. .. 1 .. .. 1 .. 1 1 3 .. 1 .. 1 .. .. .. 5 .. .. .. .. .. .. 1 1 1 1 2 .. .. .. .. .. .. .. .. .. .. 14 4 18 Totai,s 7 7 8 8 8 6 9 3 32 24 19 18 16 11 19 20 18 21 72 70 15 17 17 19 17 19 16 16 65 71 21 28 24 14 18 12 11 12 74 66 13 19 9 13 8 11 8 13 38 56 1 1 1 1 2 3 .. .. 4 5 285 292 577 Total Deaths, each Ward 56 142 136 140 94 9 Standardized Death-rate 802 11.48 0.25 11.41 8.24 9.89 11 Fifty-five of the deaths registered were those of persons over 80 years of age, 24 being males and 31 females. Three of the women were over 90, the oldest being 92, their combined ages amounting to 273 years, and one of the men lived to see 93. The more important causes of death as registered were:— Heart Disease, 68; Pulmonary Tuberculosis, 51; Bronchitis, 50; Pneumonia, 42; Malignant Disease, 40; Old Age, 38; Bright's Disease, 14; Diphtheria, 6; and Scarlet Fever, 1; whilst among the children Premature Birth accounted for 53 deaths; Respiratory Diseases, 23 ; and Diarrhoea, 21. INQUESTS. Thirty-six inquests were held during the year, of which 8 were of non-residents. Twenty-three deaths were found to be due to natural causes, and 13 to accidents as follows:—5, drowning (3 non-residents); 1, burns; 1, scalding; 1, fall from horse (non-resident); 1, fall at pumping station (non-resident); 1, killed on railway (non-resident); 1, struck by baulk of timber (nonresident); 1 choked by grain of maize in glottis; and 1 infant suffocated. Fourteen inquests were held on Enfield residents who died in other districts, and death was due to:—1 natural causes; 11 to accident (2 scalds, 2 knocked down by motor-car, 1 knocked down by railway train, 1 fall from cycle, 1 fall from tree, 1 clay falling, 1 drowned at sea, 1 burns, 1 intracranial pressure); 2 suicide (by prussic acid, and by railway train). INFANTILE DEATHS. The total number of deaths that occurred among infants under one year was 116, giving a death-rate of 8715 per 1,000 births, as compared with a death-rate of 109 for England and Wales, and 116 for the 96 great towns, including London. The corresponding figures for Enfield for the last three years were:—1910, 8315; 1911, 140.79; and 1912, 76 30. The number of deaths of illegitimate children was 11, which gives a death-rate of 353.23 per thousand illegitimate infants. This forms a striking contrast to the legitimate death-rate, and shews what a very small fighting chance these unfortunate and unwanted children get in their struggle for life. 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 4 0.55 40.00 Chase 23 1.79 75.16 Ordnance 29 2.11 103.20 Green Street and Ponders End 40 3.15 119.04 Bush Hill Park 20 1.69 69.93 Hadley & Cockfosters 0 0.00 0.00 116 1.96 87.15 The chief causes of death were Premature Birth (including congenital defects), 53; Respiratory Diseases, 23; Diarrhoea, 21; Convulsions, 4; Tuberculous Diseases, 4. The accompanying diagram shews the relative proportions of these deaths in graphic form:— 13 NOTIFICATION OF BIRTHS. Although the Infantile death-rate is not so high as it has been some years, it is, nevertheless, capable of considerable reduction. With a falling birth-rate it is our bounden duty to conserve infant life as far as lies in our power; to shield the children from epidemic diarrhoea and other infectious diseases; and to take all practicable measures for the prevention of such diseases, and for promoting hygienic conditions in the feeding of infants. The machinery for doing this lies to our hand in the Notification of Births Act, 1907. I cannot conceive that anyone who has given the matter any consideration can doubt the value of systematic visitation of the homes of infants by a capable and experienced woman under the direction of the Medical Officer of Health. Such a woman would, inter alia:— (a) Give instructions to mothers:— (1) as to the rearing and feeding of infants ; (2) the importance of cleanliness of utensils used for the storage of milk, and of the child's bottle. (3) as to the keeping of food, especially milk. (4) as to the condition of the house with a view to the maintenance of cleanliness and ventilation, and the prevention of any accumulation of filth or other conditions harmful not only to all the residents, but especially so to young and delicate children. (b) Would make inquiry into the causes of deaths of infants with a view to the removal of any causes which may have had influence on the infant mortality of the District ; and, as I would only recommend the employment of a woman who was qualified as a Sanitary Inspector, she would, if she had any spare time:— (c) Assist the Sanitary Inspector by visiting places in which female labour is carried on, or in which female outwork is done, etc., etc. The expense of this would not be prohibitive. This Act is now in force in over 390 districts with a total population of over 20,000,000 or upwards of 56 per cent. of the population of England and Wales; and I would again seriously urge on the Council the importance of adopting the Act, and thus strengthening materially what is at present a weak link in their chain of defence against the lamentable and preventable loss of life which occurs year after year. At present, by the courtesy of the Registrar of Births, I am supplied with a list of births of all children registered ; the houses are visited and hand-bills giving advice on the feeding of babies 14 and a warning as to Summer Diarrhoea are given to the mothers, but I fear that these steps do not carry us very far towards a solution of the trouble. URBAN DISTRICT COUNCIL OF ENFIELD. Advice to Mothers. Keep yourself in good health. Take good and wholesome food at regular meals only. Do not take spirits, beer, stout, or much tea, but rather milk or cocoa. Keep your window open night and day. Feed your baby regularly. Breast Feeding.—Mother's milk is the best, cheapest, and safest food for infants. Keep the child at the breast about ½-hour at each feed. Do not feed more often than every two hours during the day, and once between 11 at night and 6 in the morning. Never let the baby feed too fast. Wake the baby if asleep at feeding times. The time between feeds should be gradually increased until by the begining of the third month the breast is given every three hours, and at the age of six months, five times in the day and not at all between 11 at night and 6 in the morning. The best times are 6 a.m., 10 a.m., 2 p.m., 6 p.m., and at 10 p.m. Weaning.—Keep the baby on the breast entirely for 9 months if possible. Never wean during July, August, or September, if you can help it. Rules for daily use.—Let the baby sleep in its own cot, and lie in it during the day. A banana crate, box, basket, or drawer serves equally well. If the child cries see if the napkin wants changing, or if the baby is cold and not properly covered up. Clothing.—-Give the baby a warm woollen vest with long sleeves, a soft knitted or flannel binder, a long flannel nightdress, and an outer dress. Do not use a tight or stiff binder. Never use flannelette. "Shorten" at 2-3 months old. Keep to the vest and one flannel petticoat and dress, but now put on warm stockings instead of socks. Bath the baby once a day, and wash it once a day as well, using very little soap. Dry thoroughly, especially in ears and all folds of skin. Undress and dress the baby quickly so that it does not catch cold. Babies must always be kept warm. The windows of the bedroom and living room, except at bath time, should always be kept open at the top as wide as the weather will allow. The baby should be kept out of doors in the day-time as much as possible, and may sleep out of doors in mild weather in a sheltered place. Do not give soothing syrups, teething powders or purges without the doctor's orders. 15 Bottle Feeding. Note.—These directions are not intended to apply to those babies who are ordered a special diet by a doctor. Bottle Feeding.—Give only milk until the baby is about nine months old. Do not give condensed milk or any other infant food unless ordered by the doctor. Never give separated or skimmed milk to a baby. Milk.—Get good fresh milk twice a day. Boil it at once, pour into a clean jug, cover with a clean cloth, and stand the jug in cold water. In hot weather the water should be changed often, so as to be as cool and fresh from the tap as possible. Bottle.—Bottles with long tubes should never be used. Wash the bottle and teat thoroughly in hot water after each feed, and keep them in clean cold water until the next feed. When washing the teat turn it inside out and hold it under the tap. Feeding.—At first the baby does not want more than one tablespoonful of milk and two tablespoonsful of water at each feed. By the time it is three weeks old it may be having 1 to 1½ tablespoonsful of milk and 2 of water. Give the milk warm. From three weeks to three months old.—Gradually increase the quantity at each feed up to 3 to 4 tablespoonsful of milk and 3 of water. From three months to six months old.—By the time the baby is six months old it should take 6 to 7 tablespoonsful of milk and 2 of water at each feed. From six to nine months old.—Gradually decrease the water until the baby is taking 8 to 10 tablespoonsful of milk and no water at each feed. A little orange juice or stewed apple may now be given. From nine to twelve months old.—Continue to give milk, but crusts of bread with butter or dripping, and a lightly boiled egg may be added. ENFIELD URBAN DISTRICT COUNCIL. Important Public Notice and Warnings as to SUMMER DIARRHŒA. 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. 16 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. Recently I came across a cutting from a Japanese newspaper, "How to live 100 years." So excellent are the rules laid down that they are worthy of reproduction:— "Spend as much time as possible in the open air. Go to bed "early and rise early. "Sleep at least six hours, and at most seven and a half, in "a dark room, with the windows open. "Be moderate with tea and coffee ; avoid tobacco and "alcohol altogether. "Take a bath as hot as can be borne every day. (A cold one is more stimulating to us). "Wear clothes made of very coarse cloth. "Observe in every week one day of rest on which you must "neither read or write. "Marry; widowers and widows marry again immediately. "Avoid rooms that are too hot, and above all those that are heated by steam pipes." A notable omission from these rules, the observance of which would not make merely for a longer life, but for a happier, fuller life, is any reference to the matter of over-eating. Probably it is regarded as superfluous. The Japanese are an extremely abstemious race, and the over-eating, bordering on gluttony, so common in this country would probably be regarded by them as impossible. The deaths for the last five years will be found in Table I. Table II shews the cases of infectious disease notified during the year. Table III. gives the various causes of death at all ages, and Table IV. those under one year. TABLE I. Vital Statistics of Whole District during 1913 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. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Nett. 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 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 23.14 622 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 1913 59,146 1,316 1,331 22 50 493 8.33 40 124 116 87.15 577 9.75 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. 17 TABLE II. Cases of Infectious Disease notified during the year 1913. Notifiable Disease. Number of Cases Notified. Total Cases Notified in Each Ward. Total cases removed to Hospital. At all Ages. At Ages—Years. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and nuder 65. 65 and upwards. Town. Chase. Bush Hill Park. Ordnance. Green St.and Pond's End. Hadley and Cockasters Small Pox - - - - - - - - - - - - - - - Cholera. Plague - - - - - - - - - - - - - - - Diphtheria (including Membranous Croup) 72 - 19 47 4 l l - 4 22 16 5 21 4 63 Erysipelas 32 - 1 5 4 11 7 4 1 5 13 6 6 1 - Scarlet Fever 158 - 24 111 18 5 — — 19 53 32 36 17 1 140 Typhus Fever — - — — — — — — — — — — — — — Enteric Fever 2 - — 1 — — 1 — 1 1 — — — — 1 Relapsing Fever (R) - - - - - - - - - - - - - - - Continued Fever (C) Puerperal Fever 5 - — — 3 2 — — — — 1 1 3 — — Cerebro-spinal Meningitis 1 - - - - - - - - - - - - - 1 Poliomyelitis 9 1 6 1 1 — — — — — 4 5 — — — Pulmonary Tuberculosis 118 1 4 16 23 46 22 6 2 26 20 25 45 — — Other forms of Tuberculosis 56 3 13 22 8 8 2 - 9 12 9 11 15 - - Totals 453 5 67 204 61 73 33 10 36 120 95 89 107 6 205 18 19 TABLE III. Causes of, and Ages at Death during the Year 1913. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total deaths whether of "Residents" or "NonResidents" in Institutions in the District. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. ! 15 and under 25 years. j 25 and under 45 years. | 45 and under 65 years. 65 and upwards. All causes Certified 576 116 20 19 27 22 70 124 178 63 Uncertified 1 .. .. .. .. .. .. 1 .. .. Enteric Fever .. .. .. .. .. .. .. .. .. 2 Small-pox .. .. .. .. .. .. .. .. .. .. Measles 8 .. 3 5 .. .. .. .. .. .. Scarlet Fever 1 .. .. .. 1 .. .. .. .. 3 Whooping Cough 3 1 1 .. 1 .. .. .. .. .. Diphtheria and Croup 7 .. .. 4 3 .. .. .. .. 17 Influenza 3 .. .. .. .. .. 1 1 1 1 Erysipelas .. .. .. .. .. .. .. .. .. .. Phthisis (Pulmonary Tuberculosis) 51 3 1 .. 4 4 21 15 3 l Tuberculous Meningitis 1 1 .. .. .. .. .. .. .. .. OtherTuberculous diseases 8 1 1 .. .. 1 3 1 1 .. Cancer, malignant disease 40 .. .. .. .. 1 4 14 21 1 Rheumatic Fever 3 .. .. .. 1 .. 1 .. 1 1 Meningitis 1 .. .. .. 1 .. .. .. .. 2 Organic Heart Disease 68 1 .. .. 2 1 9 26 29 3 Bronchitis 50 10 1 .. .. .. 3 7 29 5 Pneumonia (all forms) 42 13 5 7 1 3 1 9 3 2 Other diseases of Respiratory organs 8 .. 1 .. 1 .. .. 4 2 1 Diarrhoea and Enteritis 28 21 6 1 .. .. .. .. .. 1 Appendicitis & Typhlitis 11 .. .. .. 3 4 1 1 2 1 Cirrhosis of Liver 7 .. .. .. .. .. .. 6 1 .. Alcoholism 2 .. .. .. .. .. .. 2 .. .. Nephritis and Bright's Disease 14 .. .. .. .. .. 4 7 3 1 Puerperal Fever 1 .. .. .. .. .. 1 .. .. .. Other accidents and diseases of Pregnancy & Parturition 3 .. .. .. .. 1 2 .. .. 1 Congenital Debility and Malformation, including Premature Birth 53 53 .. .. .. .. .. .. .. .. Violent Deaths, excluding Suicide 15 1 1 .. 4 3 4 2 .. 3 Suicide 2 .. .. .. .. .. 2 .. .. .. Other Defined Diseases 147 11 .. 2 5 4 13 30 82 17 Diseases ill-defined or unknown .. .. .. .. .. .. .. .. .. .. Totals 577 116 20 19 27 22 70 125 178 63 Sub-Entries included in above figures- Cerebro.spinal Meningitis 1 .. .. .. 1 .. .. .. .. 2 Poliomyelitis .. .. .. .. .. .. .. .. .. .. Old Age 38 .. .. .. .. .. .. .. 38 2 Apoplexy 17 .. .. .. .. .. .. 7 10 .. 20 TABLE IV. Infant Mortality. 1913. Nett Deaths from stated causes at various Ages under One Year of Age. causes op 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 33 2 4 1 40 22 15 24 15 116 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... 1 ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... 1 Abdominal Trberculosis ... ... ... ... ... ... ... ... ... ... (=Other Tuberculous Diseases ... ... ... ... ... ... ... 1 ... 4 Meningitis (not tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... 1 1 1 1 ... 4 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 ... ... 1 2 2 5 ... 10 Pneumonia (all forms) ... ... ... ... ... 3 2 3 5 13 Diarrhœa ... ... ... ... ... ... ... 4 1 5 Enteritis 1 ... ... ... 1 1 4 7 3 16 Gastritis ... ... 1 ... 1 ... ... ... ... 1 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... 1 ... ... 1 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations 2 ... ... ... 2 2 ... ... 2 6 Premature Birth 16 1 1 ... 18 1 ... ... ... 19 Atrophy, Debility & Marasmus 10 1 1 12 11 4 1 ... 28 Other Causes 1 ... 1 2 1 1 ... 1 5 Totals 33 2 4 40 22 15 24 15 116 Nett Births in the year:—legitimate, 1297; illegitimate, 34. Nett Deaths in the year:—legitimate infants, 105; illegitimate infants, 11. 21 ZYMOTIC DISEASES. The following table shews the deaths registered in the District from the seven chief zymotic diseases during the past five years:— Disease. 1909 1910 1911 1912 1913 Small Pox 0 0 0 0 0 Scarlet Fever 9 10 4 3 3 Diphtheria 26 7 9 19 19 Measles 33 3 28 14 6 Enteric Fever 6 5 5 1 2 Whooping Cough 9 6 16 8 3 Epidemic Enteritis 19 11 94 9 13 102 42 156 54 46 The actual Enfield deaths were:—Scarlet Fever, 1; and Diphtheria, 6. The figures for Scarlet Fever, Diphtheria, and Enteric Fever include all the deaths that occurred at the Enfield and Edmonton's Joint Isolation Hospital, where patients belonging to other districts are also received. ENFIELD ZYMOTIC DEATH RATE. 22 The zymotic death-rate, after deducting 17 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 0 52 per thousand. Disease. 1912. 1913. Deaths. Death-rate. Deaths. Death-rate. Scarlet Fever 2 .03 1 .01 Diphtheria 7 .12 6 .10 Enteric Fever 2 .03 0 .00 Erysipelas 1 .01 0 .00 Measles 14 .24 8 .13 Whooping Cough 8 .13 3 .05 Epidemic Enteritis 9 .15 13 .22 43 .75 31 .52 A zymotic death-rate of 0.52 in a District the size of Enfield signifies two things; first, that the type of infectious disease prevalent in the District is a mild one as a whole, and secondly, that the treatment given by the Staff of the Isolation Hospital is exceedingly efficient, which, no doubt, is in a great measure due to the very effective and constant attention given by the Medical Superintendent. It is within the bounds of possibility that we may get even a lower rate another year, as Dr. Cook has now taken up his residence at the Hospital, and devotes his whole time to the service of the Joint Board. NOTIFICATION OF INFECTIOUS DISEASE. The cases of Infectious Disease notified each quarter in each ward were as set out in the accompanying table :— NOTIFICATION OF INFECTIOUS DISEASE, 1913. Disease. Town Ward. Chase Ward. Bush Hill Park Ward. Ordnance Ward. Green Street and Ponders End Warp. Hadley and cockfosters ward. Totals. Cases per 1000 population. 1st Qtr. 2nd Qtr. 3rd Qtr. 4 th 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 Qtr. Total. Scarlet Fever 3 9 4 3 19 7 2 33 11 53 8 6 3 15 32 4 1 10 21 36 6 3 2 6 17 .. .. .. 1 1 158 2.67 Diphtheria 2 1 1 .. 4 7 3 7 5 22 6 5 2 3 16 .. 1 2 2 5 1 3 3 14 21 .. .. .. 4 4 72 1.21 Enteric Fever .. 1 .. .. 1 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 .03 Erysipelas .. .. 1 .. 1 2 1 1 1 5 3 .. 2 8 13 .. 2 1 3 6 4 2 .. .. 6 .. .. .. 1 1 32 .54 Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. 1 1 .. 2 .. 1 3 .. .. .. .. .. 5 .08 Cerebro-Spinal Fever .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .01 Poliomyelitis .. .. .. .. .. .. .. .. .. .. .. .. 4 .. 4 .. .. 4 1 5 .. .. .. .. .. .. .. .. .. .. 9 .15 Totals 25 82 66 53 47 6 279 4.71 Diphtheria Carriers .. .. .. .. .. .. .. .. .. .. 2 6 .. 3 11 .. .. .. .. .. .. .. 2 4 6 .. .. .. .. .. 17 .28 Full Totals 25 82 77 53 53 6 296 5.00 The following table gives the number of cases of each infectious disease notified during the past five years:— Disease. 1909 1910 1911 1912 1913 Scarlet Fever 283 156 111 98 158 Diphtheria 222 105 53 77 72 Membranous Croup 1 0 1 0 0 Enteric Fever 2 4 8 2 2 Small Pox 0 0 0 0 0 Erysipelas 31 32 49 40 32 Continued Fever 0 0 0 1 0 Puerperal Fever 4 11 1 7 5 Cerebro-Spinal Fever 0 0 0 1 1 Poliomyelitis 0 0 0 0 9 543 298 223 226 279 SCARLET FEVER. I congratulate myself that the number of Scarlet Fever cases notified is not very considerably larger than 158. During the year a wave of Scarlet Fever has swept over the country, more particularly London and Suburbs, and I was quite prepared for an epidemic of the disease during the Autumn. The type was very mild, many cases not being diagnosed until the patient began to desquamate. In fact on more than one occasion this was the first symptom that gave rise to suspicion that anything had been the matter with the child. This is well shown in the case of a row of houses on the outskirts of the town, where four cases occurred in one house, two next 23 24 door, and one a few doors further along in the course of six days. As the result of a house-to-house visitation and a personal inspection of every child in the row, I discovered the original cause of the outbreak in the person of a small boy who had been indisposed for one day with a sore throat, and was kept at home that day, but was allowed to attend school the following day. A small outbreak in another isolated part of the parish comes under the same category. From information received. I visited a house and found four children recovering from what the mother supposed to be Measles; as a result of this I interviewed nearly all the children in the neighbourhood and found six others recovering from a slight attack of the disease. In connection with this little outbreak, I should like to acknowledge the very great assistance I received from the Head Mistress of the local elementary school. The 160 notifications received referred to 158 cases, which occurred in 116 houses, as follows:— No. of houses where 1 case occurred 93 ,, ,, ,, 2 cases „ 16 ,, ,, ,, 3 3 ,, ,, ,, ,, ,, 4 ,, ,, 2 ,, ,, ,, 5 ,, ,, 1 „ 11 ,, „ (a school) 1 Total No. of houses where cases occurred 116 Total number of cases 158 DIPHTHERIA. Seventy-two cases of Diphtheria occurred during the year in 64 houses, although I received 75 notifications. Number of houses where 1 case occurred 58 ,, ,, ,, 2 cases ,, 4 ,, ,, ,, 3 ,, ,, 2 Total number of houses where cases occurred 64 Total number of cases 72. A reference to the chart will shew that in 15 weeks, including 4 consecutive ones, no cases were reported, and for 18 weeks we only received one each week. On receipt of a notification it is my invariable custom to swab as many contacts as I can find, and by this means I was able to discover 17 carriers during the year, and I always swab every child URBAN DISTRICT COUNCIL OF ENFIELD. CHART SHEWING NUMBER OF CASES OF INFECTIOUS DISEASES NOTIFIED DURING EACH WEEK OF THE YEAR, 1913. 25 who has had an attack of the disease before allowing him to return to school. One slight outbreak of 4 cases occurred in an isolated part of the District, due to infection by a visitor, a small boy with a sore nose, who came down to the country to recuperate after a prolonged residence in an isolation hospital, where he had been suffering from Diphtheria. In his Annual Report of the Enfield and Edmonton Joint Hospital for 1912-13, the Physician Superintendent, Dr. Haldane Cook, writes very fully on the subject of the use of anti-toxin, and I very strongly recommend a perusal of this report to every member of the medical profession practising in the District. Dr. Cook complains of the few cases, 34 out of 171, which had had a dose of anti-toxin before admission to the Hospital, and strongly urges that the duty of the doctor is to administer this remedy at the earliest possible moment. ENTERIC FEVER. Two cases of this disease 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. POLIOMYELITIS. Poliomyelitis was a newcomer on our list of notifiable diseases on the 1st April, 1912, and the first case was notified to me on July 29th, 1913. The total number of cases during the year was 9, with no deaths. In accordance with a request from the Local Government Board, I prepared a special report on these cases, a copy of which is appended September 3rd, 1913.—"Seven cases of this disease were "notified in Enfield between July 28th and August 29th, the par" ticulars of which are set out below :— "A.B.—This child went to Bucks., on a visit to a Mrs. W . "near Aylesbury, on July 14th, and was taken ill whilst there. "A medical man saw her and thought she was suffering from "'General Malaise.' She returned home on July 25th, was seen "by Dr. S. next day, who found her suffering from Paralysis. "On the same day I saw the case with Dr. S. and agreed with him "that it was undoubtedly a case of Poliomyelitis." 26 "I communicated with the Medical Officer of Health, "and the following is a copy of his reply:— "4th August, 1913. "Dear Sir, "I thank you for your letter ye A.B. of Hertford Road, Enfield. "I saw Dr. G., who saw the above, and he informs me he saw "the child once or twice and that it appeared to him to be "General Malaise, etc. "The child came down ill, and stayed a few days, and they only "asked him to see the child if it was able to travel. "My district is free from A. A. Poliomyelitis. We had five "cases only in the district about 2 years ago last September, and "have had none since. "Should be glad if you can give any further information." "Yours faithfully, "(Signed) A.T.M." "E.Y.—This child appears to have been ill on about July 10th, "and was taken to Great Ormond Street Hospital on July 16th, "where she attended as an out-patient until July 29th. She was "then admitted as an in-patient, and discharged on August 2nd, "when she was notified from the Hospital- "Her early symptoms appear to have been vomiting, ulcerated "mouth, and feverishness. "Dr. H. was called in on August 3rd, and states that she "had then recovered all but paralysis." "W.D.—Dr. F. states ' The mother brought this child to my "surgery on August 13th, stating that on August 8th he went for "a long walk and on the following day was taken bad with what "appeared to her to be Acute Influenza, so she nursed him, but "finding on the 13th instant he could not stand, brought him to "me ; there was then no temperature.' " "I have since found out that August 4th (Bank Holiday), "the boy was at High Beech, Epping Forest, all day, where there "was a large crowd, and his mother had a vivid recollection of his "swallowing a fly." "H.F.—This boy was taken ill and seen by Dr. C. on August 7th, '' who states that his temperature was 101°, that he had an ulcerated 27 "mouth and sore throat and appeared ill. He did not see the case "again for 4 or 5 days, when the temperature was normal and "paralysis had supervened in the left leg." "This child is now an out-patient at Great Ormond Street "Hospital." "P.G.—This child was taken ill on August 2nd, and seen by "Dr. H. next day. Her temperature was 102° which lasted 4 days, "Paralysis showing itself on August 7th (5 days) in both legs. "The girl was taken in by the Great Ormond Street Hospital on "August 26th, and is there at present. "This case was not notified until August 23rd, the doctor ''stating he was unaware it was notifiable." "L.C.—This case lives next door to the previous one. She was "taken ill on August 19th, and seen by Dr. H. the same day. "He tells me that her temperature was normal and that "Paralysis had already supervened in the anterior muscles of her "left leg." "This case also was not notified until August 23rd." "B.B,—The history of this case is that on August 25th, when "apparently quite well, she was taken for a long walk to Epping "Forest; on the following afternoon her mother thought she had "'caught cold,' and put her to bed. The next morning it was found "that the child could not stand, so she was taken to Dr. F. at "6.30 p.m. that evening, who found her temperature 100°, and that "she had paralysis in the right leg. The next morning her tem"perature was normal." "All these children now appear to be convalescing. "The first house, is one of a row of four old cottages on the "main road from London to Hertford; all the others are side roads "with merely local traffic." Measures taken for Checking Spread of Disease. "On receipt of a notification the house is at once visited either "by myself or by one of the Sanitary Inspectors, instructions are "given as to isolation and precautions necessary, and disinfectants "are supplied. When the medical man certifies that in his opinion "the case is no longer infectious, the house is at once disinfected "with formalin, and the bedding and wearing apparel, etc., removed "to the Council's disinfecting station. The other members of the "family are kept under observation, and the children are not " allowed to attend either day or Sunday school." 28 Arrangement for Examination of Cerebro-Spinal Fluid, and other Pathological Material, and for the Treatment of Patients. "Any examination required would be carried out by myself "if necessary. "The question of treatment of patients has not specially "arisen up to the present. "All the cases have been under the care of local medical men, "and of the Great Ormond Street Hospital, and no suggestion of "poverty on the part of the parents has been made. It has not "appeared necessary to make any special arrangements for Hospital "treatment." September 24th, 1913.—"W.N.—The notification of this case "was received on September 16th, and the particulars are set out "below." "The boy was taken ill on the 10th of September with cold "and shivering, and on the 13th, Paralysis set in in all his limbs. "His temperature was 102° which was observed on the 3rd day of "the disease. "The boy had a fall on August 15th and cut the back of his "head, went to Finsbury Park on September 7th, and attended "Sanger's Circus at Waltham Cross in the afternoon of September "10th." December 30th, 1913.—" W.A.N.—The notification of this case "was received on December 18th, and the particulars with regard "to same are set out below. "The boy was taken ill on December 6th, with what was "supposed to be Influenza, was seen by a doctor on December 9th, "when he was found to be paralysed on right side,—Kernig's sign "was very marked. No temperature. "His previous history showed that he suffered from chorea "some 18 months ago, and had never properly recovered. "He had been living at North Mimms until September last, "and it appears that about 18 months ago, a girl of 19 years who "lived in the same house suffered from an illness with subsequent "paralysis." "In February of this year (1914) I inspected these children and "with only one exception, found little or no improvement in any of "them." '2 9 TUBERCULOSIS. The following table shews the number of notifications of Pulmonary and other forms of Tuberculosis received:— Ward. Pulmonary. Others. Fresh Cases. Old Cases re-notified. Duplicates. First Notification. Duplicates. Town 2 5 2 9 l Chase 26 5 7 12 0 Ordnance 25 6 14 11 3 Green Street and Ponders End 45 8 25 15 2 Bush Hill Park 20 2 8 9 0 Hadley and Cockfosters .. .. .. .. •• Total 118 26 56 56 6 First notifications 174 Old ones re-notified 26 Duplicate notifications 62 Total 262 notifications. Sex. Form. Men. Boys. Women. Girls. Pulmonary 51 8 46 13 Others 8 19 11 18 Totals 59 27 57 31 30 Deaths. The number of deaths from this disease during the year is shewn in the following table, viz.:— Ward. Pulmonary. Others. Deathrate. Male. Female. Male. Female. Town 2 1 .. 2 .70 Chase 12 3 1 1 1.33 Ordnance 9 6 3 1 1.38 Green Street and Ponders End 6 3 .. .. .70 Bush Hill Park .. 5 4 1 .. .85 Hadley and Cockfosters .. .. .. .. Total 34 17 5 4 1.01 Forty-two cases were removed during the year. Thirteen went into the Infirmary; 7 were discharged, and 3 died. Ten went into Hospitals; 7 were discharged and 2 died; while of the remainder, 19 went'into Sanatoria; 12 were discharged, and 7 are still there. There were also 6 cases of Home Treatment. The following facts, obtained when visiting the cases, are of interest:— Sixteen cases came into the District ill. One or both parents known to have died of Phthisis in 17 cases. Brother or sister known to have died from Phthisis in 12 cases. Relations known to have died from Phthisis in 2 cases. Wife known to have died from Phthisis in 1 case. Husband known to have died from Phthisis in 1 case. Phthisis known to be amongst members of the family and relations in 21 cases. 31 Two patients had been previously nursing Consumptive cases. Two patients worked where others were consumptive. Four patients had been in contact with cases of Phthisis. There were 106 instances where no Phthisis was known amongst the family. The conditions of the dwellings at the time of first visit after notification was:— Satisfactory 112 Damp 20 Other defects 39 These defects have since been remedied. Occupations of Patients. Factory and Workshop 24 Building lines, Labourer, or other Outdoor 24 Workers 25 Clerk, Shop Assistant, or Printer 10 Publicans 3 Glass-blower 1 Domestic Service 8 Police 2 Others 6 No Occupations 95 174 The Head Dispensary for Area No. 1, which includes Enfield under the Scheme of the Middlesex County Council for dealing with Tuberculosis is situated at No. 56, Silver Street, Edmonton, and is under the charge of Dr. Cogill, one of the Tuberculosis Medical Officers in the Public Health Department of the County Council, who sees patients brought there, visits them at their own homes, and is also, I believe, responsible for the detection of contact cases. 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 bottle and disinfectants are supplied, 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 32 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 75, and the articles—clothing, bedding, etc.— dealt with numbered 445. NON-NOTIFIABLE INFECTIOUS DISEASES. Measles. This disease which had been prevalent in Enfield during the latter end of the year 1912, abated in the town during February, but continued in the Eastern portion of the District up to May, when after a consultation with the School Medical Officer it was decided to keep the Chesterfield Road Infants' School closed for two weeks from the termination of the regular holidays, after which the disease appeared to die out. In accordance with a suggestion of the Local Government Board an arrangement has been 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. By this means we become aware of many cases of measles, which would otherwise escape us. We are 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. Six schools were also disinfected with formalin. Enteritis. Owing, no doubt, to the wet and unpleasant Summer we experienced during 1913, the deaths from this disease were almost negligible. Hospital Administration. 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 3½ miles from the centre of the town. The buildings consist of:— An Administration Block. Nine Pavilions. One Discharge Block. Mortuary. Laundry and Disinfecting Station. Medical Superintendent's Residence. Porter's Lodge. Five cottages. Bungalow. 33 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 diagonsis, 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 140 Diphtheria 63 Enteric Fever 1 Cerebro-Spinal Fever 1 205 Bacteriological Work. All the Bacteriological work is done in my own laboratory, including the preparation of media, cultivation of growths, etc. Every swab is '' planted,'' and grown in an incubator. No. Positive. Negative. Klebs Loeffler and Hoffman, included in Positive. Hoffman, included in Negative. Percentages of Positives. Swabs 911 103 808 14 58 11.19 Sputum 145 46 99 .. .. 31.72 Widal 7 1 6 .. .. 14.28 Cerebro-Spinal Fluid 1 1 •• .. 0.00 Totals 1,064 150 914 14 58 14.09 I should like to emphasize the fact that a negative result in the case of Sputum is by no means sufficient evidence to warrant the conclusion that Tubercle Bacilli are absent ; it not infrequently happens that five or six examinations must be made before the Bacilli can be demonstrated. In addition to the above, I made several Wasserman tests. Blood counts, estimation of Hæmoglobin, examination of pus, urine, etc., for various organisms, such as gonococci, B. Coli Communis, etc., etc. 34 Although the general opinion is that Hoffman's Bacillus is not pathogenic, I must confess that I look upon 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 proved Negative. WATER. Six samples of water were submitted to me for examination. One was found to be unfit for drinking purposes, and a supply taken from the main was substituted. A water main has also been extended to Botany Bay, and on the completion of the Tower tank, will be available for the supply of all the houses in that neighbourhood. 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 attendance telephones 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 Saturdays 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 that on every occasion we have complied with his wishes. 35 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 where 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 up to June 1913:— Number of cases on lists 656 Vaccinated 221 Exempted 248 Carried forward 187 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 the year the new Reservoir of the Metropolitan Water Board between Ponders End and Enfield Lock in this District, was inaugurated by His Majesty the King. It is the largest reservoir in the country, its area being 418 acres, with a capacity of 300,000,000 gallons, and it is two miles long. There are five 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, are connected with the Council's foul and surfacewater sewers, the former of which all discharge at the Sewage Farm at Ponders End. 36 Two men are employed daily (and devote their whole time to the work) to examine and flush the sewers, and any defect or obstruction is immediately dealt with. The sewers at Hadley Wood and Hertford Road, Freezywater, have been extended, and consist of 866 yards and 30 yards of 9-inch pipes respectively. New surface-water drains have been laid at the following places :— Parsonage Lane to Lancaster Road. Gordon Lane. Cracknell's Field to Baker Street. Painters Lane to Bullsmoor Lane. Camlet Way, Hadley Wood. Windmill Hill. Gordon Road. High Street, Ponders End to Mr. Hart's Estate, Southbury Road. Closet Accommodation. All the houses in the Urban portion of the District are supplied with w.c's of various types, the majority being those of the "washdown "pattern. In the Rural parts of the District the accommodation consists of water-closets connected with cesspools, earthclosets, 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 Carterhatch Lane, 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, a small charge being made for each emptying. PREMISES AND OCCUPATIONS. There are no Common Lodging Houses or Cellar Dwellings in the District. 37 OFFENSIVE TRADES. The Council has now, with the approval of the Local Government Board, adopted Bye-laws for the control of the following trades:— 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. During the year the Council has, in two instances, approved the establishment of the trade of a Fish Frier, the premises in each case being equipped with up-to-date appliances, which have proved most satisfactory, and shew that the trade can be carried on in populous districts without being a nuisance to the neighbourhood. SCHOOLS. There are 22 Public Elementary Schools in Enfield, including a Deaf Centre—52 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 are usually remedied without delay. I consider that the sanitary conditions are quite satisfactory. With one exception all the schools are supplied with water from the mains, the exception being the new school at Botany Bay, which I hope will be connected with the public main in the immediate future. 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. 38 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 460 cows in Enfield, owned by 23 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. The cows are inspected bi-annually by Mr. H. H. Hide, M.R.C.V.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. 17th April, 1913.—" I beg to report that I have completed the "inspection of the milch cows in the district. I carefully examined "each animal for symptoms of Tuberculosis, and, where necessary "took samples of milk for bacteriological examination, but in no "case was the characteristic bacillus present. The number of "cases of ordinary disease of the udder were few, as the practice "of disposing of such animals is general. This power under the "new Tuberculosis Order which comes into force next month will "be checked, as it will be compulsory on the part of the owner of "a cow having any induration or chronic disease of the udder to "give notice in order that the cow shall be inspected and if found " to be of a tuberculous nature the animal will be slaughtered. "I consider the cows, generally, are in a satisfactory con"dition of health, and appear to be well kept and cared for." 19th December, 1913.—" I beg to report that I have inspected "the whole of the milch cows in the District. I made a careful "examination of each udder, and found a certain number affected "with induration resulting from previous attacks of Mammitis, but "none of a tuberculous nature, and these were less in number than "in my last inspection. Where necessary, I took samples of milk "for bacteriological examination but in each case the Tubercle "bacillus was absent. "On previous visits 1 have occasionally noticed a cow whose "condition would at the present time bring her under my notice as "County Veterinary Inspector, as coming within the clause of "the Tuberculosis Order relating to suspected Tuberculosis with "emaciation, but although on the present occasion I met with a few unthrifty ones, emaciation was not sufficiently advanced to 39 "justify my taking such action. The owners evidently dispose "of them at an earlier period than before the Order came into "force, and this also applies to cases of affections of the udder. "Where I find an animal sufficiently emaciated and showing sus"picious symptoms of Tuberculosis, it is my duty, under the Order, "to instruct the owner to give notice that it may be dealt with by "me. "The cows may be considered, generally, as being in a healthy "condition, and satisfactorilv cared for." I have also 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 Act, in this District:— Article. No. of samples taken. No. found adulterated. Percentage. Butter 149 18 12.08 Milk 103 23 22.32 Self-Raising Flour 2 .. .. Totals 254 41 34.40 There were nine prosecutions resulting in a conviction in each case. This statement shows the necessity and importance of a sufficient staff of Inspectors to cope with the fraudulent dealers in milk and other articles of diet, for unfortunately it is the poor people and little children who suffer most by these adulterations. The sophistication of milk is not only an offence against the laws of the Realm, but—what is far worse—it is a deadly menace to the health of poor little children who are expected to live and thrive on it, and in my opinion any one found guilty of such an offence deserves and should receive condign punishment. If a beer dealer is convicted of adding a few gallons of water to a barrel of beer—whereby he does no injury to the health of any of his customers, rather, perhaps, the reverse—he is heavily fined, the fine often running into many pounds. A milk dealer, on the other hand, whose diluted and adulterated milk may hasten the death of any number of delicate children, may under similar circumstances escape with a fine of a few shillings. 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 819 such 40 visits, examined 2,791 carcases, and secured the surrender of 35 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 42 are in use, and found them all in a satisfactory condition. HOUSING. 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 684 Number of houses considered on inspection to be in a condition so dangerous as to be unfit for human habitation 12 Number of houses closed and demolished without orders 8 Number of houses closed 4 Number of houses closed and demolished following closing orders 0 Number of representations made to the Local Authority with a view to the making of Closing Orders 4 Number of Closing Orders made 4 Number of dwelling-houses where defects were remedied without service of Closing Orders 558 Number of houses which, after making of Closing Orders, were put in a fit state 10 In addition to all this work done under these Regulations, the following number of houses have also been inspected during the year:— On account of infectious disease 489 On account of complaint by occupants and otherwise 1,031 Total 1,520 making a gross total of house inspections for the year of 2,204, which gives a percentage of 19 per cent. of the total number of houses in the District. There will be found in the statement of the Report of the Inspector of Nuisances required to be included by Article 41 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 air-space about dwellings is generally sufficient, and although we find considerable difficulty in preventing the erection of sheds, fowl-pens, 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 excercised by the members of your Health Department. Twenty-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. In a Stevenson s screen in grounds of the Public Offices. Terrestrial Radiation Thermometer Earth Thermometer In the grounds of the Offices. Campbell-Stokes Sunshine Recorder- Rain Gauge Solar Radiation Thermometer. In the grounds of the Public Offices. Daily records have been taken by Mr. Boswell, assisted by Messrs. Smith and Coulter, and monthly returns have been sent to the Meteorological Office. I have to thank Mr. John McEwen, J.P., F.R.Met.Soc., who, as usual, has given me the benefit of his extensive knowledge and long experience of Meteorology. 42 The accompanying table gives the result of our operations for the year, in a condensed form:— METEOROLOGICAL STATISTICS, 1913. Month. Barometer. Temperature. Rainfall. Sunshine. Highest. Lowest. Highest. Lowest. Mean. January .. Ins. 30.352 on 26th - Ins. 29.202 on 20th 52.0 on 5th 25.0 on 25th 39.5 Ins. 2.33 Hrs. 24.1 February 30.738 on 12th 29.580 on 1st 56.0 on 4th 22.5 on 23rd 39.2 .77 48.7 March 30.526 on 9th 29.882 on 19th 58.5 on 6th 27.0 on 12th 44.0 1.74 90.2 April 30.218 on 9th 29.424 on 16th 66.0 on 29th 27.0 on 13th 55.5 2.82 127.5 May 30.282 on 25th 29.340 on 4th 81.0 on 26th 34.0 on 7th 59.0 1.48 197.6 June 30.376 on 14th 29.768 on 5th 82.5 on 17th 40.5 on 1st 61.5 0.90 206.6 July 30.368 on 1st 29.710 on 6th 75.0 on 28th 44.5 on 8th 61.0 1.94 100.7 August 30.300 on 26th 29.730 on 30th 79.5 on 28th 43.0 on 25th 63.0 1.40 147.2 September 30.330 on 8th 29.370 on 17th 75.0 on 27th 40.0 on 16th 61.0 1.45 120.1 October 30.480 on 13th 29.276 on 29th 68.0 on 2nd 32.0 on 24th 52.4 3.21 85.2 November 30.442 on 27th 29.148 on 13th 61.0 on 2nd 26.0 on 23rd 46.6 2.54 76.8 December 30.700 on 21st 29.444 on 28th 54.0 on 12th 28.0 on 22nd 41.1 .73 45.9 43 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 48 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 the following streets have been metalled, channelled, paved, etc., under Section 150 of the Public Health Acts, 1875:— Gordon Road, from College Road westwards (321 feet). Swansea Road. Glyn Road. Brimsdown Avenue. Lawson Road. Lancaster Avenue, Hadley Wood. Raynton Road, Western End (280 feet). Passage at rear of Fourth and Fifth Avenues, Bush Hill Park. Passage at rear of Fifth and Sixth Avenues, Bush Hill Park. 44 109,336 super yards of roadway have been treated by tar spraying. 6,416 super yards of flag-paving have been laid in Southbury Road, and 100 yards of kerbing laid in Cemetery Road. Widenings and improvements have been made at the following places :— Church Street, Enfield. Browning Road and Clay Hill Corner. Bulls Cross and Turkey Street Corner. East Lodge Lane and Cattlegate Comer. Cattlegate Road and Coopers Lane Corner. Bulls Cross and Bullsmoor Lane Corner. East Lodge Lane and Ridgeway Road Corner. Camlet Way and Cockfosters Road Corner. Hertford Road and Lincoln Road Corner. NEW BUILDINGS, Etc. Ninty-seven houses have been certified as completed and fit for human habitation, and 50 houses have had additions made thereto. These, together with 1 building of the factory class, and 63 other buildings constitute the full amount of building operations during the year. The disposal of sewage still continues to be satisfactory. SUCCESS. Mr. Coulter, Second Clerk in the Sanitary Department, has successfully passed the examination of the Royal Sanitary Institute for Inspectors of Nuisances. THANKS. 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. 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 urbanity 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 efficient manner in which they carry out their duties. I am, Gentlemen, Yours obediently, WILLIAM PENNEFATHER WARREN, Medical Officer of Health. 45 Public Offices, Enfield, March llth, 1914. REPORT OF THE INSPECTOR OF NUISANCES FOR THE YEAR, 1913. To the Chairman and Members of the Urban District Council of Enfield. Gentlemen, I beg to submit my report for the year ending December 31st, 1913, 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:— Number of houses inspected :— Inspections. Under Regulations, Sec. 17, Housing, Town-Planning Act, 1909 684 From house-to-house apart from this Act 556 On account of Infectious Disease 320 ,, „ ,, Phthisis 169 „ „ ,, complaint, by occupants or otherwise 475 2,204 22 Factories 101 127 Workshops and workplaces, including 12 laundries 515 52 Outworkers' premises inspected 60 44 Bakehouses in the District, of which 42 are in use ... 317 18 Slaughterhouses inspected frequently 819 31 Cowsheds inspected frequently 379 71 Dairies and Milkshops inspected frequently 428 22 Schools 142 69 Shops where Ice-cream is made 136 Inspections under the Rag Flock Act 4 Public House Urinals inspected 81 Conveniences at Railway Stations inspected 27 Fish Shops. Total number of visits 343 Coffee and eating houses. Total number of visits 20 Visits to absentees excluded from Elementary Schools 856 Visits in connection with cases of Infectious Disease 1,915 Visits in connection with cases of Phthisis 998 Other inspections, including works in progress11,979 Smoke observations 27 19,147 21,351 46 NOTICES ISSUED. Statutory:— For repairs to houses, drains, and abatement of nuisances 222 Providing sufficient water-closets 71 Provision of dustbins 66 Paving of yards 83 Overcrowding 7 Provision of sink waste pipes 17 466 Informal:— Notices 11 Letters sent in lieu of notices 1.361 1,372 Other notices issued under Infectious Diseases Acts:— To occupiers 614 To schools 1,465 2,079 3,917 Other letters sent 3,153 Result of service of statutory notices Number complied with 447 Number outstanding 19 466 As to these outstanding notices, in five the time given did not expire until after the end of the year, while with regard to 14 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 :— Houses or parts of houses cleansed, repaired, etc 340 Houses closed and demolished 8 Roofs repaired 301 Gutters and downpipes repaired 472 Cesspools emptied 178 House drains cleared, repaired, etc 338 House drains tested, examined, etc 327 House drains re-constructed 20 Soil-pipes and drains ventilated, including repairs to ventilators 97 Sink wastes disconnected or repaired 30 New sinks provided 7 47 Closets provided with proper flushing cisterns or water supply . 212 New closets provided 2 Closets repaired, covered, cleansed, etc 212 Storage cisterns repaired, covered, cleansed, etc 132 Water laid on or restored 10 Samples of water taken 6 New storage cisterns provided 4 Wells cleansed or covered 2 Wells closed 1 Yards paved, or existing paving made good 271 Forecourts repaired 13 Ventilation provided under ground floors, and causes of dampness removed 78 Dustbins repaired, or new ones provided 268 Manure heaps removed 55 Fowls and other animals removed 13 Stables, etc., cleansed 10 Other nuisances abated 27 Ditches cleaned out 1 Cases of overcrowding 24 DISINFECTION. Houses disinfected:— After infectious disease 227 After Phthisis 75 Verminous cases 9 311 Rooms stripped and re-papered, etc., after occupation by cases of infectious disease 28 Rooms stripped and re-papered, etc., after occupation by cases of Phthisis 48 Articles of clothing, bedding, etc., disinfected after infectious disease 2,338 Articles of clothing, bedding, etc., destroyed 12 2,350 Articles of clothing, bedding, etc., disinfected after Phthisis 439 Articles of clothing, bedding, etc., destroyed 6 - 445 Articles of clothing, bedding, etc., disinfected where found verminous 130 2,925 48 Library Books disinfected 66 Cases of Scarlet Fever removed to Hospital 140 ,, „ Diphtheria' ,, „ „ 63 ,, „ Enteric Fever „ „ ,, 1 „ ,, Cerebro-Spinal Fever ,, „ 1 205 Gipsy vans removed from District 27 Articles or parcels of unsound food destroyed 80 From these particulars it will be seen that we have inspected an increased number of dwellings during 1913, the figures being 1,240 in 1913, as against 1,136 in 1912. The great majority of the defects found to exist were remedied before the end of the year, and the few remaining are having attention. This result, I am pleased to say, has again been obtained without resource to legal proceedings during the year. The number of visits made in reference to children excluded from Elementary Schools during the year was 856, and the total number of inspections and visits for all purposes made by the staff of the Sanitary Department was 21,351. shewing an increase of 2,137 over the number for 1912. REMOVAL OF HOUSE REFUSE. The removal of house refuse has received very close attention in order to secure the collection and clearing of all refuse from houses and premises regularly each week. 7,685 loads were collected, an increase of 456 over the number collected in 1912. The greater portion of this refuse was taken to the Council's shoots, and the remainder to a brickfield. FACTORY AND WORKSHOPS ACTS, 1901 and 1907. A register of all workshops is kept, and at the end of 1913 there were 115 workshops. 12 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) 101 - - Workshops (including Workshop Laundries) 515 9 - Bakehouses 317 7 - 933 16 - 49 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 24 24 .. .. Want of Ventilation .. .. .. .. Overcrowding 1 1 .. .. Want of drainage of floors .. .. .. .. Other Nuisances 26 26 .. .. Sanitary accommodation:— Insufficient 6 6 .. .. Unsuitable or defective 27 27 .. .. Not separate for sexes .. .. .. .. Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse .. ... .. .. Breach of special sanitary requirements for bakehouses 48 48 .. .. Other offences .. .. .. .. Total 132 132 .. .. 50 Homework. Nature of Work. Sending twice in the year. Sending once in the year. Notices served on Occupiers as to keeping or sending Lists. Lists. Workmen. Lists. Workmen. Making Wearing Apparel 23 23 21 23 15 Lace Curtains, &c. .. .. 2 2 2 Umbrellas, &c. .. .. 2 2 .. Artificial Flowers .. .. 2 2 .. Brush Making, &c. 2 2 1 1 .. Feathers 2 2 .. .. .. Boxes 2 2 .. .. .. Total 29 29 28 30 17 Thirteen addresses of outworkers have been forwarded to other districts. EMPLOYMENT OF CHILDREN ACT, 1903. During the year 284 names were received of children employed out of school hours, and in 160 cases contraventions of the bye-laws were found, and remedied. Fifty-seven cases of illegal street-trading, etc., were found. The total number of interviews and visits made under this Act was 330. MILK. Frequent inspections have been made of the cowsheds, dairies, and milkshops in the District, and every endeavour made to secure compliance with the requirements of the Dairies, Cowsheds and Milkshops Orders, and Regulations in force in the District. The periodical cleansing and limewashing of premises as required by the Regulations was also strictly enforced. 51 ICE-CREAM. Sixty-nine shops where ice-cream was made or sold were inspected during the Summer, 136 visits being made to them, and where necessary instructions given in regard to the cleansing of utensils and premises. 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 :— Slaughter-houses 819 Shops 659 Stalls in Markets 1,100 2,578 The number of carcases examined during the visits to slaughterhouses is as follows :— Cows 93 Oxen 278 Calves 9 Sheep 1,955 Pigs 456 2,791 During the examination of these carcases while being dressed 35 organs, also the two forequarters, crop, flank, and brisket of a bullock, two forequarters, two wing ends of loin and flank of an ox, and the two hind quarters of a bullock, were found to be diseased. These were all surrendered by the owners and destroyed. The carcases generally were in good condition, and there was no case which necessitated the obtaining of a Magistrate's Order. The following articles were also submitted for inspection, and as in each case it was found that they were unfit for the food of man, 52 certificates to that effect were given, so that the owners could secure the return of the money paid from the wholesale traders:— February 10th 1 barrel of herrings. March 10th Trunk of coal-fish. June 23rd 1 box of mackerel. September 30th 41 rabbits. October 11th 1 basket of shrimps. HOUSE DRAINAGE. A large number of house drains have, again this year, been tested, also cleared and repaired. All new work has been closely supervised and wherever possible tested with water during its progress, also a final test with smoke and water 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 flushed 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 with the department. I am, Gentlemen, Your obedient Servant, A. J. MUNRO, M.R. San.I., Inspector of Nuisances.