CI Maddx ENF 8 AC. 439 (B) ENFED ( hater Mun B.) The Urban District Council of Enfield. Annual Report of the MEDICAL OFFICER OF HEALTH for 1914 together with the Annual Report of the INSPECTOR OF NUISANCES. enfield : bennett and starling, ltd printers (t.u.) The Urban District Council of Enfield. Annual Report OF THE MEDICAL OFFICER OF HEALTH FOR 1914 TOGETHER WITH THE Annual Report OF THE INSPECTOR OF NUISANCES. ENFIELD: BENNETT AND STARLING, LTD., PRINTERS (T.U.) CHASE SIDE GARDENS, ENFIELD. Reproduced by kind Permission of KELLY'S DIRECTORIES, Ltd., 182-3-4. High Holborn, London, W.C Enfield Urban District. Area (including 412 acres water) 12,601 acres. Population at census of 1911 56,338 Population at middle of 1914 60,682 Number of inhabitated houses 11,852 Vital Statistics. Birth-rate per 1,000 living 21.83 Recorded Death-rate per 1,000 living 9.98 Standardized Death-rate per 1,000 living 10.32 Infantile Mortality per 1,000 births 80.75 Zymotic Death-rate per 1,000 living 0.87 Tuberculosis Death-rate per 1,000 living 1.08 Vital Statistics of Wards. Ward. Area in acres. Persons per acre. Population. Birthrate. Standardized Death rate. Infantile Mortality. Zymotic Deathrate- Tuberculosis. Death-rate. Town 1,717 4.3 7,444 11.01 7.91 73.17 0.13 0.40 Chase 4,478 2.9 13,276 22.89 10.44 72.36 0.67 1.12 Ordnance 2,060 6.7 13,880 20.24 9.31 71.17 0.43 1.08 Green Street and Ponders End 1,330 9.9 13,232 26.14 12.90 109.82 1.51 1.58 Bush Hill Park 762 15.6 11,889 23.38 9.91 75.53 0.92 0.84 Hadley & Cockfosters 2,254 .4 963 15.57 11.81 0.00 0.00 2.07 Urban District Council of Enfield. With the Compliments of the Medical Officer of Health. PUBLIC OFFICES, ENFIELD. PUBLIC OFFICES, ENFIELD. March 25th, 1915. Medical Officer of Health's ANNUAL REPORT For 1914. To the Urban District Council of Enfield. Gentlemen, I have the honour to submit to you my Annual Report for the year 1914, 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, 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 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 agricultural, with centres of population at Hadley Wood and Cockfosters, is situate on the London Clay, und is hilly in character, the highest point in the District being at "Stormont" (near Potters Bar), 418 feet above Ordnance Datum. The Central; including 6 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 Corticine Works, Edison and Swan United Electric Light Company's Works, Enfield Gas Works, Metallic Tube Works, Velvril-Bonnaud Works, and the Rees Roturbo Company's Works, Ponders End; also the Brimsdown Lamp Works, North Metropolitan Power Station, Ruberoid Works, Enfield Electric Cable Construction Company's Works, Remington Arms Company's 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 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 11,852 inhabited houses, it follows that the population of Enfield at that date must be estimated at 60,682. At the present time in consequence of the War, I have no doubt the population is very considerably in excess of the estimated figure, the Royal Small Arms Factory, which is working night and day, has increased the number of its employees by some thousands, and several other factories which are working for the Government, have followed suit. 7 I pointed out in my report for last year that 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 past. Enfield is divided into six wards as follows:— Ward, Inhabited Houses Uninhabited Houses. Total. Population. Town 1,454 67 1,521 7,444 Chase 2,593 59 2,652 13,276 Ordnance 2,711 63 2,774 13,880 Green Street and Ponders End 2,584 57 2,641 13,230 Bush Hill Park 2,322 21 2,343 11,889 Hadley & Cockfosters 188 14 202 963 11,852 281 12,133 60,682 VITAL STATISTICS. The number of births registered was :— Boys. Girls. Total. 688 637 1,325 including 38 illegitimate births, i.e., 2.8 per cent., of the total births. This total is 6 less than that of the previous year, and gives a birth-rate of 2T83 per thousand of the population, which compares unfavourably with that of England and Wales, which was 23.6 per thousand. The corresponding rate for London is 24.6. 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 9 11 12 8 8 9 14 11 43 39 82 11.01 Chase 50 32 38 32 47 43 35 27 170 134 304 22.89 Ordnance 21 39 45 50 36 32 28 30 130 151 281 20.24 Green St. and Ponders End 42 35 50 41 54 42 39 43 185 161 346 26.14 Bush Hill Pk. 41 35 28 38 40 32 37 27 146 132 278 23.38 Hadley and Cockfosters 2 1 0 4 0 2 3 3 5 10 15 15.57 Births outside the District ... 9 10 19 165 153 173 173 185 160 156 141 688 637 1,325 21.83 for District. 318 346 345 297 1,325 9 The births of boys and girls, also birth-rates for the last three years were:— Year. Boys. Girls. Total. Birth-rate. Illegitimate Birth-rate. 1911 679 635 1,314 23.14 .47 1912 672 729 1,401 23.46 .61 1913 659 672 1,331 22.50 .57 1914 688 637 1,325 21.83 .62 DEATHS. The deaths registered in the District during the year were 482, of which 237 were males, and 245 females, giving a crude death-rate of 7.94. To these must be added 154 deaths of Enfield residents registered outside the District, and from this total must be subtracted 30 deaths of non-residents occurring in the District, which brings the nett number of deaths to 606 for the year, giving a recorded death-rate of 9.98. 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 10.32. This rate, though slightly higher than that for last year, is still a low one and is the sixth lowest of the 97 Great Towns. Birth-rate. Recorded Death-rate. Standardized Death-rate. Infantile Death-rate. England & Wales 23.6 13.9 13.6 105.0 London 24.6 14.4 14.4 103.0 97 Great Towns, including London 24.9 14.6 14.9 113.0 ENFIELD 21.83 9.9 10.32 80.75 This low rate taken in conjunction with an Infantile death-rate of 80.75, and a Zymotic death-rate of 0.87, still further supports the claim of Enfield to be considered not only a suburban health resort, 10 but entitles it to take rank among the most distinguished resorts in the kingdom. The Registrar-general publishes every week the death-rates of the 97 Great Towns of the Country, and during last year on no less than two occasions Enfield" stood lowest on the list, on one other occasion second lowest, and for six other weeks, and two quarters was included amongst the lowest half-dozen. The corresponding figures for Enfield for the three previous years are:— 1911. 1912. 1913. 1914. Recorded death-rate 12.99 10.05 9.75 9.98 Standardized death-rate 13.66 10.40 10.09 10.32 The deaths occurred in the several wards as follows:— Ward. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Death-rate per 1,000 as recorded. Infantile Death-rate. Town 12 16 13 16 57 7.65 73.17 Chase 39 32 36 27 134 10.09 72.36 Ordnance 52 27 14 32 125 9.00 71.17 Green Street and Ponders End 44 34 41 46 165 12.47 109.82 Bush Hill Park 22 31 27 34 114 9.58 75.53 Hadley and Cockfosters 2 2 4 3 11 11.42 0.00 Whole of District 171 140 135 158 606 9.98 80.75 The following table classifies the 606 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, 1914. Ward. Town. Chase. Ordnance. Green St. & Ponders End. Bush Hill Park. Hadley & cockfosters. Totals Quarter. 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 1st 2nd 3rd 4th Total. each sex. Totals. 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 ... 2 ... 1 1 ... 2 ... 3 3 5 1 3 1 3 4 2 3 13 9 3 4 2 3 ... 1 4 3 9 11 6 4 5 ... 12 1 7 3 30 8 2 4 2 2 6 2 2 1 12 9 ... ... ... ... ... ... ... ... ... ... 67 40 107 1 to 5 yrs. 1 ... 1 ... 1 1 ... ... 3 1 2 ... 1 ... ... 1 2 1 5 2 4 2 1 ... 1 ... ... 3 6 5 1 4 ... 3 2 2 1 4 4 13 ... 1 2 1 ... 2 2 4 4 8 ... ... ... ... ... ... ... ... ... ... 22 29 51 5 to 10 yrs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 1 1 1 2 4 1 1 ... 2 ... 1 ... ... 1 4 1 ... ... 1 ... ... 4 ... 5 1 ... ... ... ... ... ... ... ... ... ... 8 9 17 10 to 15 yrs. ... ... ... ... ... ... ... ... ... ... ... 2 1 ... 1 ... ... ... 2 2 ... ... 1 1 ... ... ... ... 1 1 2 ... ... ... ... 1 1 1 3 2 1 ... 1 ... ... 1 ... ... 2 1 ... ... ... ... ... ... ... ... ... ... 8 6 14 15 to 20 yrs. ... ... 1 ... ... ... 1 ... 2 ... ... ... 2 ... 2 ... 1 ... 5 ... 2 ... ... ... ... ... 1 ... 3 ... ... ... 1 ... ... ... ... 1 1 1 ... ... 1 ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... 13 1 14 20 to 25 yrs. ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... 3 1 ... 2 ... ... ... ... ... 1 ... 3 ... ... 2 ... 1 ... ... 2 3 2 ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 6 8 14 25 to 35 yrs 1 ... ... 2 ... 1 ... ... 1 3 ... 1 ... 1 3 1 ... 2 3 5 ... ... ... 1 ... 1 1 1 1 3 1 ... 1 ... 2 3 3 ... 7 3 1 ... ... 1 1 ... 1 1 3 2 ... ... ... ... ... ... ... ... ... ... 15 16 31 35 to 45 yrs ... ... 1 1 2 ... 1 1 4 2 2 ... 1 3 1 ... ... ... 4 3 3 2 2 ... 1 ... 2 1 8 3 2 1 1 3 2 ... 1 2 6 6 ... 1 4 3 3 ... 1 ... 8 4 ... 1 ... ... ... ... ... ... ... 1 30 19 49 45 to 55 yrs. 1 ... ... ... ... ... 1 ... 2 ... 5 1 2 2 2 2 1 2 10 7 2 4 ... 1 1 ... 9 2 5 7 2 1 1 ... 1 1 1 1 5 3 1 ... 1 2 3 2 1 1 6 5 ... ... ... ... ... 1 ... ... ... 1 28 23 51 55 to 65 yrs. 2 2 2 4 1 2 1 1 6 9 3 1 2 1 2 1 1 ... 8 3 1 3 1 2 ... 1 1 2 3 8 1 5 6 2 5 ... 4 2 16 9 1 2 2 2 ... 2 3 4 6 10 ... ... 1 ... ... 1 ... ... 1 1 10 40 80 65 to 75 yrs ... 1 ... 1 ... 1 3 1 3 4 3 3 1 1 3 5 3 3 10 12 6 5 3 1 1 3 1 1 11 10 3 4 4 1 2 1 3 5 12 11 1 3 1 1 3 1 1 2 6 7 ... ... ... 1 ... 1 2 ... 2 2 44 46 90 75 to 85 yrs. 2 ... 1 1 ... 2 ... 3 3 6 4 4 7 3 ... 3 ... 3 11 13 3 5 3 2 1 2 2 1 9 10 ... 4 1 1 3 1 1 3 5 9 2 1 1 2 ... ... 1 3 4 6 ... 1 ... ... ... ... ... 1 ... 2 32 46 78 Over 85 yrs. ... ... ... ... ... 1 ... 1 ... 2 1 1 ... ... ... ... 1 ... 2 1 ... ... ... 1 ... ... ... 1 ... 2 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... 2 8 10 Totals 7 5 6 10 5 8 9 7 27 30 25 14 20 12 18 18 13 14 76 58 24 28 14 13 5 9 15 17 58 67 19 25 22 12 30 11 22 24 93 72 10 12 15 16 16 11 17 17 58 56 ... 2 1 1 ... 4 2 1 3 8 315 291 606 Total Deaths, each Ward 57 134 125 165 114 11 Standardized Death-rate 7.91 10.44 9.31 12.90 9.91 11.81 11 Forty-seven of the deaths registered were those of persons over 80 years of age, 16 being males and 31 females. Two of the women were over 90, the oldest being 101, their combined ages amounting to 194 years, and one of the men lived to see 91. The more important causes of death as registered were:— Malignant Disease, 61; Heart Disease, 60; Pulmonary Tuberculosis, 48; Bronchitis, 37; Old Age, 36; Pneumonia, 23 ; Bright's Disease, 20; Diphtheria, 15; and Scarlet Fever, 3; whilst among the children Premature Birth accounted for 50 deaths; Diarrhoea, 26, and Respiratory Diseases, 12. INQUESTS. The following is a complete list of the Inquests held in Enfield during the year. Cause of Death. Sex. Age. Date. Verdict. Rupture of Auricle of the Heart Syncope. M 83 yrs. Jan. 12 Natural causes. Heart failure following on a diphtheritic sore throat. F 10 „ Jan. 13 Natural causes. Injuries received in accident on tram-rails. Tubercular disease. Peritonitis. M 51 „ Jan. 17 Misadventure. Angina Pectoris. M 64 „ Jan. 27 Natural causes. Pleurisy. Aortic Heart Disease. Syncope. M 72 „ Feb. 4 Natural causes. Disease of the Aortic and Coronary Arteries. F 71 „ Mar. 3 Natural causes. Fatty Degeneration and Valvular Disease of the Heart. F 69 „ Mar. 8 Natural causes. Rupture of an Aneurism of the Heart. M 78 „ Mar. 21 Natural causes. Serous Apoplexy. M 70 „ Mar. 24 Natural causes. 12 Inquests—continued. Cause of Dearth. Sex. Age. Date. Verdict. Hæmorrhage on the Brain due to a blow sustained by a fall against a bath. F 61 yrs. April 1 Misadventure. Congestion of the Lungs and fatty Degeneration of the Heart. F 70 „ April 9 Natural causes. Oxalic Acid Poisoning. Acute Alcoholism. M 41 „ April 17 Suicide, insane. Prematurity. Convulsions. M 3 days. April 17 Natural causes. Fatty Degeneration of the Heart. M 73 yrs. May 24 Natural causes. Contusion and Hæmorrhage at base of Brain sustained by a fall from a scaffold. M 49 „ May 26 Misadventure. Suffocation by Drowning. F 5 „ July 11 Accidental causes. Asphyxia from Drowning. M 48 „ July 18 Open verdict. Diarrhœa and Sickness. Pneumonia. Heart Failure. M 39 „ Aug. 22 Natural causes. Fatty Degeneration of the Heart accelerated by a fall downstairs. Heart Failure. F 58 „ Aug. 22 Accidental causes. Fracture of Ribs and Lumbar Vertebræ and Rupture of Spleen and Hæmorrhage. M 54 „ Aug. 28 Misadventure. Fatty Degeneration of the Heart. Heart Failure. M 64 „ Sept. 23 Natural causes. Meningeal Hæmorrhage. M 6 days. Oct. 10 Natural causes. Run over by a Railway Engine. M 43 yrs. Oct. 17 Accidental causes. Premature Birth and want of Vitality. F 2 days. Oct 25 Natural causes. Aortic Valvular Disease of the Heart. M 59 yrs. Oct. 27 Natural causes. Congestion of the Lungs. Heart Failure. M 58 „ Nov. 28 Natural causes. Fatty Degeneration of Heart. M 58 „ Dec. 18 Natural causes 13 whilst particulars of the Inquests held on Enfield residents outside the District are contained in the following table. Cause of Death. Sex. Age. Date. Verdict. Violent Hæmorrhage supervening on fractured ribs and other injuries caused by being knocked down by a travelling crane. M 68 yrs. Jan. 28 Accidental causes. Heart Failure. Disease of Heart Muscle. Aortic stenosis. M 52 „ Feb. 6 Natural causes. Carcinoma of Pancreas, Liver and Stomach. M 49 ,, Feb 14 Natural causes. Osteomyelitis of Femur and Humerus. M 11 mths Feb. 17 Natural causes. Hæmorrhage with cerebellum secondary to high blood pressure and degenerate arteries while suffering from Chronic Nephritis. M 49 yrs. Mar. 6 Natural causes. Fractured Rib. Septic Pneumonia M 32 „ Mar. 30 Accidental causes. Fracture of Leg and Ribs and internal injuries caused by falling from his bicycle under the wheel of a motor lorry. M 16 ,, April 27 Misadventure. Cerebral Haemorrhage due to rupture of vessel at base of brain. M 31 July 2 Natural causes. Poisoning by Hydro chloric acid; self-administered. M 73 ,, July 13 Suicide whilst insane. Shock from Gun-shot Wound. M 17 ,, Aug. 18 Misadventure. Fracture of Base of Skull due to motor cycle overturning. M 39 „ Aug. 23 Misadventure. Concussion of Brain and Shock due to fall in street. M 54 „ Sept. 28 Accidental causes. Accidentally killed by discharge from a rifle. M 31 Nov. 24 Misadventure. Epilepsy. Colitis. F 58 ,, Nov. 24 Natural causes. Arterio Sclerosis. Cardiac dilatation and failure. F 60 Nov. 26 Natural causes. Violent Chronic Nephritis due to Chronic Plumbism. M 55 ,, Dec. 18 Misadventure. 14 INFANTILE DEATHS. The total number of deaths that occurred amongst infants under one year, including 15 registered outside the District, was 107, giving a death rate of 80.75 per thousand births, as compared with a death-rate of 105 for England and Wales, and 113 for the 97 Great Towns, including London. The corresponding figures for Enfield for the last three years were 1911, 140.79; 1912, 76.30, and 1913, 87.15. The number of deaths of illegitimate children was 8, which gives a death-rate of 210.52 per thousand illegitimate infants. This forms a striking contrast to the legitimate death-rate, and shows 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:— Ward. Number of Deaths. Death-rate per 1,000 population Death-rate per 1,000 births. Town 6 0.80 73.17 Chase 22 1.65 72.36 Ordnance 20 1.44 71.17 Green Street & Ponders End 38 2.87 109.82 Bush Hill Park 21 1.76 75.53 Hadley and Cockfosters 0 0.00 0.00 107 1.76 80.75 The chief causes of death were Premature Birth (including congenital defects), 50; Diarrhoea, 26; Respiratory Diseases, 12; Whooping Cough, 4. 15 The accompanying diagram shews the relative proportions of these deaths in graphic form. Comparing this diagram with the similar one for last year, we find Premature Birth less by three, Diarrhoea increased by five, Respiratory Diseases diminished by eleven, while Tuberculous Diseases and Convulsions were too few to call for notice. 16 MATERNITY AND CHILD WELFARE. In July last the Local Government Board issued the following Circular and Memorandum to County Councils and Sanitary Authorities. LOCAL GOVERNMENT BOARD, Whitehall, S.W. 30th July, 1914. MATERNITY AND CHILD WELFARE. Sir, I am directed by the Local Government Board to state that an estimate has been laid before Parliament for a grant to be distributed by the Board in aid of the Expenditure of local authorities and voluntary agencies in respect of institutions or other provision for maternity and child welfare. This grant, if voted by Parliament, will be made in aid of expenditure in respect of clinics, dispensaries or other institutions primarily concerned with the provision of medical and surgical advice and treatment, as well as in respect of the salaries of health visitors and other officers engaged for this work. The Local Government Board have in recent years devoted considerable attention to questions connected with infant welfare and they have observed with much satisfaction that efforts have been made by many local authorities and voluntary agencies, to deal with the matter. These efforts have undoubtedly helped to secure improved conditions for children and have played an important part in the campaign for the reduction of infantile mortality. It is evident from the reports issued by the Medical Department of the Board and those of many Medical Officers of Health that more extended and systematic measures than have hitherto been generally adopted are necessary, and it is hoped that the grant of assistance from the Exchequer will stimulate those local authorities who have not yet taken action to give the matter their earnest consideration and will encourage those already engaged in the work to develop it still further. Up to the present local authorities, in their infant welfare work, have concerned themselves more especially with the child in its first year of life; the matter is, however, one which needs to be dealt with on a more comprehensive basis and it is clearly desirable 17 that there should be continuity in dealing with the whole period from before birth until the time when the child is entered upon a school register, i.e., the register of a public elementary school, nursery school, creche, day nursery, school for mothers, or other school. Extension of the existing work is accordingly needed in two directions; on the one hand it is necessary that measures should be taken for securing improved ante-natal and natal conditions, and on the other, provision should be made for continuing the work in relation to children beyond the first year of life. The accompanying memorandum, which has been prepared by the Board's Medical Officer with a view to assisting the formulation of schemes or extending the work already undertaken, sets forth in outline the matters needing consideration in the preparation of a comprehensive scheme. It will been seen that the memorandum contemplates that medical advice and, where necessary, treatment should be continuously and systematically available for expectant mothers and for children till they are entered on a school register, and that arrangements should be made for home visitation throughout this period. The work of home visitation is one to which the Board attach very great importance and in promoting schemes on the lines laid down in the accompanying statement the first step should be the appointment of an adequate staff of Health Visitors. It will be desirable, at all events in the case of the larger urban authorities to provide consultation centres which may fitly be termed Maternity Centres, to which expectant mothers and mothers with infants and little children may be referred for advice and treatment; the operation of these maternity Centres will be rendered most effective if co-operation is secured with the midwives of the district and with any local hospital having a maternity department. It will be necessary to arrange for a medical officer to be in charge of such a Centre and for the attendance at the Centre of members of the Staff engaged in home visiting. Careful records, for which the medical officer should be responsible, will need to be kept, and in regard to children the records should be in such a form that they may subsequently be available for the information of the School Medical Officer when the child is entered at a school. For the rural and smaller urban areas the Board think it will generally be found desirable to develop a county organisation, but in all cases the county work should be intimately related with that of the local sanitary authority, and on the other hand any work separately undertaken by a sanitary authority should be co-ordinated with the county scheme. It is not expected that all local authorities will be able at once to initiate complete schemes, but it is important that any partial arrangements that may be made shall be such as can ultimately form part of a more extended organisation. 18 Subject to the estimate now before Parliament being accepted by Parliament, the Board will be willing to consider applications for grants in respect of any work falling within the scope of the schemes outlined in the memorandum accompanying this letter; the giants will normally amount to one-half the approved expenditure on any of these purposes, but may be less if the Board so decide. Grants to institutions of the nature of Schools for Mothers, the object of which is primarily educational, which provide training and instruction for mothers in the care and management of infants and little children, and which may include systematic classes, or home visiting, or infant consultations (the provision of specific medical and surgical advice and treatment, if any, being only incidental), will be administered by the Board of Education. Any cases of doubt or difficulty will be investigated by a Joint Committee of Officers of the two Boards, which will include women Medical Officers. In sending a copy of this circular to voluntary agencies engaged in infant welfare work, the Board will state that applications for grants in respect of voluntary work may be made by a voluntary agency either directly or through a local authority. The grant now presented to Parliament will be appropriated in aid of the expenditure of the half-year ended 30th September, 1914, and applications for grants should be accompanied by an account of the work undertaken by the authority, and by a detailed statement of the expenditure incurred, certified by the officer of the local authority in charge of the accounts. I am to add that the Board will be happy to afford advice and assistance to local authorities in the initiation of schemes or the extension of existing schemes. I am, Sir, Your obedient Servant. (Signed) H. C. Monro, Secretary. The Clerk to the Council. 19 MEMORANDUM. MATERNITY AND CHILD WELFARE. A complete scheme would comprise the following elements each of which will, in this connection, be organised in its direct bearing on infantile health. 1. Arrangements for the local supervision of Midwives. 2. Arrangements for:— ANTE-NATAL. (1) An ante-natal Clinic for expectant Mothers. (2) The home visiting of expectant Mothers. (3) A Maternity Hospital or beds at a hospital, in which complication cases of pregnancy can receive treatment. 3. Arrangements for:— NATAL. (1) Such assistance as may be needed to ensure the Mother having skilled and prompt attendance during confinement at home. (2) The confinement of sick women, including women having contracted pelvis or suffering from any other condition involving danger to the mother or infant, at a hospital. 4. Arrangements for:— POST-NATAL. (1) The treatment in a hospital of complications arising afterparturition, whether in theMother orin the infant. (2) The provision of systematic advice and treatment for infants at a Baby Clinic or Infant Dispensary. (3) The continuance of these Clinics and Dispensaries, so as to be available for children up to the age when they are entered on a school register, i.e., the register of a Public Elementary School, Nursery School, Creche, Day Nursery, School for Mothers or other school. (4) The systematic home visitation of infants and of children not on a school register as above defined. LOCAL GOVERNMENT BOARD, Whitehall, S.W. July, 1914. 20 Following the receipt of this Circular, at the direction of the Council, I laid this special report before them on October 31st. Public Offices, Enfield. October 3lst. 1914. Special Report of the Medical Officer of Health — re — Infantile Mortality, Notification of Births Act, Maternity and Child Welfare. The Notification of Births Act, 1907, provides for the giving of notice in writing to the Medical Officer of Health of the District, by the father (and) or any person in attendance on the Mother at the time of the birth of a child. This notice is to be given within 36 hours of the event by posting a prepaid letter or postcard addressed to the Medical Officer of Health, giving the necessary information, or by delivering a written notice of the birth at the office or residence of the Medical Officer of Health within the same time. Section 3, provides a penalty for any person who fails to give notice, with the proviso that he shall not be liable if he satisfies the court that he had reasonable grounds to believe that notice had been duly given by some other person. The Act applies to any child born after the 28th week of pregnancy, whether alive or dead. The object of this Act is that special attention may be given to infants, and that Mothers may be instructed in the best methods of rearing their children. Among the lower animals (and perhaps among human beings in prehistoric times) maternal instinct may be relied upon to a great extent to shield the little ones from many dangers, but the present conditions of life are so complex and so artificial, we are all so dependent on our environment, and so utterly incapable of carrying on a separate and independent existence, that instincts of all kinds have become more or less atrophied, and I regret to say that the maternal instinct is no exception to the general rule. The mother of the present day cannot expect to know instinctively what is the best food to give her infant, what are the best surroundings in which it should be placed, and what hygienic conditions will give it the best chance of surviving its advent into the world. 21 I am a strong believer in the doctrine that woman's highest work in the world, and the one for which she was primarily created is to give birth to and rear a healthy family ; but in this family business as in any other which one wishes to make a success, it is necessary to undergo a training, and it is with this object that the Notification of Births Act has been made a law of the Realm. When this Act has been adopted in an area the first step is to appoint a "Health Visitor", a lady with a Sanitary and a "Health Visitor's" Certificate, and preferably one who has some knowledge of nursing and midwifery. The services of such a woman can be obtained at a salary of . £80 to £100 per annum, with a prospect of an increase in due time. The duties of the Lady Sanitary Inspector and Health Visitor would be as follows:— 1. To make all enquiries under the direction of the Medical Officer of Health with reference to the births and deaths in general and infant mortality in particular. To keep the register of the Notification of Births Act in order and up-to-date. To visit and instruct Mothers (who need it) in the care and feeding of infants. 2. Infectious Diseases. Chiefly non-notifiable, and women and children with Erysipelas, also cases of Puerperal Fever. To visit and enter up particulars on the proper cards. 3. Schools. To visit Scholars reported by teachers as absent from school on account of Infectious Disease, or contact therewith. 4. Factories & Workshops. To inspect places where females are employed eitherin Factoriesand Workshops,or as Homeworkers. 5. To accompany female patients or children to Hospital when necessary. 6. To hold her services generally during office hours at the disposal of the Medical Officer of Health and Sanitary Inspector. I entertain no doubt that if this Act is adopted by the Council, Infant Mortality in the District would be lowered, and what is of almost equal importance the standard of the survivors would be raised. I would therefore ask the Council to give the matter their very serious consideration, bearing in mind the tremendous loss of life occuring amongst our best and finest men at the present time, and the consequent need of taking the greatest possible care of the lives of the rising generation, so that the Empire may not suffer in the future. MATERNITY AND CHILD WELFARE. In accordance with your instructions, I beg to put forward the following scheme for Maternity and Child Welfare as defined by the Memo, of the Local Government Board of July 30th, 1914. 22 It is a scheme which no doubt is open to improvement, but it would probably serve our turn for the present. In it I have made no allusion to such matters as provision of nourishment for expectant and nursing Mothers, provision of doctor or midwife at confinement where necessary, and provision of help in the home for the weeks after confinement. These are matters which will require consideration in the future, but as a commencement I venture to think that the scheme as outlined would, if adopted, prove satisfactory. A small Maternity Centre could be started in a very simple way. Two rooms are necessary, one where the women could wait and the babies would be weighed, the other where they could see the doctor. The furniture could be of the simplest, a couple of tables and some chairs ; special equipment would consist of a weighing machine adapted for both mothers and babies, which could be bought for 19/-, and a weighing basket costing 7/6, and simple drugs and remedies, (as a matter of fact I believe I know where I could get these machines for nothing). A couple of rooms might cost perhaps 10/- a week, that is a year. A staff of 3 persons would be required if one Centre, and 4 if two Centres, but two of these would be only part time. 1. A doctor who might be the Medical Officer of Health, or an Assistant Medical Officer of Health. A lady doctor would be preferable. 2. A fully qualified Health Visitor. 3. A competent woman (two required if 2 Centres) to take down names and addresses, post the cards, keep the accounts and help in various ways. This woman would be paid say 5/- a week = £13 a year. Cleansing and attendance would mean about 8/- to 10/-a week, which is another £20 to a year, and something must be allowed for fires and lights, stationery etc. These would be covered by about £10. If a lady doctor were engaged it would probably add to the annual cost. Of this expenditure whether for salaries or upkeep the Local Government Board will now pay one half. Certain days or hours should be set apart for expectant Mothers. Health Visitors, Midwives and Doctors would be asked to forward the names and addresses of these expectant Mothers to the Public Health Department or the Maternity Centre, and to encourage these patients to attend. Minor troubles or difficulties would be dealt with by the Health Visitor, who acts as the superintendent of the Centre and if graver ills are suspected the woman would be seen by the Maternity Centre Doctor, who would then communicate with the doctor in charge of the case. 23 At other times the Centre would be open to nursing Mothers to bring their babies to be weighed and to get from the Health Visitor, and where necessary from the Doctor, advice as to feeding and treatment which would serve to prevent sickness. In the large District of Enfield, I think that at least two Centres would be necessary as it is desirable that the Mothers should not have too far to travel, it being difficult for them to go far or spend much on trams. The advice and treatment given at the Maternity Centres is needed for the wives of skilled artisans as well as by the very poor. To make this scheme a success the co-operation of working women's organisations, the Women's Co-operative Guild, Relief Committee, etc. etc., should be obtained. I would draw the attention of the Council to the fact that the new Grant-in-Aid for Maternity and Child Welfare now passed by Parliament enables the Local Government Board to pay 50% of all costs connected with this work to Municipal and Voluntary Organisations. This would include half-salaries of all Health Officials connected with Maternity work, half expenses of rent, light, heat, etc., of a Maternity Centre or Infant consultations ; half cost of drugs and treatment. The sum of £12,000 has already been voted to cover these half expenses for the six months ending September 1914. The following is the total estimated expenditure per annum allowing for 2 Maternity Centres. £ 1 Health Visitor 100 2 Centres (Rent) £26 each 52 2 Women 26 Cleansing and Attendance 50 Fire, Light, Stationery Etc. 10 Incidentals 10 248 Half of this amount, as already stated, would be refunded by the Local Government Board. If as I have already mentioned, a lady doctor were engaged £50 should be added to this. The matter was discussed very fully by the Council, and eventually it was decided to defer consideration of the question until November, 1915. 24 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 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 the 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 windows 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 ¼-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 beginning 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 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. 25 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. 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 tablespoonfuls of water at each feed. By the time it is three weeks old it may be having 1 to l½ 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 tablespoonfuls 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 teed. 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. 26 ENFIELD URBAN DISTRICT COUNCIL. Important Public Notice and Warning 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. 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. URBAN DISTRICT COUNCIL OF ENFIELD. SUMMER DIARRHŒA AND FLIES. Hundreds of babies die every year from Summer Diarrhoea. This disease comes on suddenly, accompanied by vomiting and baby rapidly becomes worse, very often in spite of medical attention. It is therefore much more important to prevent Summer Diarrhoea from coming than to endeavour to cure it after the patient is attacked. 27 Summer Diarrhoea is always due to contamination of food, especially milk, by dirt of every description, and it has been proved that this dirt is almost always conveyed by flies who walk over and feed on filth and carry infection about on their bodies, legs, and probosces. Flies spread many diseases in this way, such as Summer Diarrhoea, Cholera, Consumption, Typhoid Fever, etc. It is therefore most important to get rid of flies. This is more easily done if we attack their breeding places, as the following account of the development of the fly shows. In the spring the female fly lays her eggs on manure heaps, ashpits, or any collection of moist refuse, and lays about 120 eggs at each sitting, of which there may be several. From these eggs in the course of a few hours, especially in the presence of heat and moisture, a maggot or grub issues and feeds on the filth it lives in, and in about five days becomes a chrysalis which is a "minute rolled up bean-like body" with a hard covering about ¼-inch in length ; in another five days the fly emerges from the chrysalis and begins searching for food. The best way therefore of exterminating flies is to prevent the accumulation of any dirt in or about the house where flies can breed or feed. 1.—Keep all food which is not consumed at meal times in a cool cupboard where flies cannot reach it. 2.— All garbage and vegetable matter which cannot be burnt should be put in the dustbin and carefully covered. 3.— See that all back yards are properly paved and regularly swept, so that no dirt will be about. 4.—All manure should be sprinkled with carbolic or some other disinfectant, and removed daily. 5.— Fly papers and traps are very useful, but it is much more important not to leave food and other materials about that they can feed and breed on. 6.—Sugar, treacle, and jams should not be left about uncovered. 7.—-Milk vessels should be carefully covered with a damp cloth when not in use. 8.—Scrupulous cleanliness in the house, especially where food is prepared, eaten, or stored, is most important. 9.—Scrupulous cleanliness outside in yards and outhouses is also very important. 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. 28 TABLE I.—Vital Statistics of Whole District during 1914 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. Under 1 Year of Age. At all Ages. Nett. Number. Rate. of Nonresidents registered in the District. of Residents not registered in the District. Number. Rate per 1,000 Nett Births. Number. Rate. Number Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1,311 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 1914 60,682 1,306 1,325 21.83 482 7.94 30 154 107 80.75 606 9.98 Area of District in acres (land and inland water), 12,601. Total population at all ages, 56,338. Total families or separate occupiers, 12,040. At Census, 1911. 29 TABLE II.—Cases of Infectious Disease notified during the year 1914. 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 under 65. 65 and upwards. Chase. Town. Ordnance. Green St and Ponders End. Bush Hill Park. Hadley and Cockfoster. Small Pox 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera and Plague 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 84 3 21 51 7 2 ... ... 26 5 20 18 14 1 74 Erysipelas 39 ... ... ... 7 15 14 3 8 ... 11 9 11 ... ... Scarlet Fever 221 1 40 153 17 10 ... ... 80 18 87 13 23 ... 186 Typhus Fever 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 7 ... ... 3 ... 1 1 2 1 2 1 2 ... 1 4 Relapsing Fever (R) Continued Fever (C) 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 7 ... ... ... 1 6 ... ... 1 ... ... 5 1 ... ... Cerebro-spinal Meningitis 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis 3 ... ... 3 ... ... ... ... ... 1 1 ... 1 ... ... Ophthalmia Neonatorum 9 9 ... ... ... ... ... ... 3 1 3 1 1 ... ... Pulmonary Tuberculosis 102 ... ... 11 30 51 10 ... 16 1 23 38 23 1 ... Other forms of tuberculosis 52 ... 12 25 11 3 1 ... 9 ... 21 13 9 ... ... Totals 524 13 73 246 73 88 26 5 144 28 167 99 83 3 264 30 TABLE III. Causes of, and Ages at Death during the Year 1914. CAUSES OF DEATH. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether of Residents' or Non-Residents in Institutions in the District. All ages. Under 1 year. 1 and under 2. 2 and under 5 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. All causes Certified 606 107 29 23 31 28 79 131 178 60 Uncertified ... ... ... ... ... ... ... ... ... ... Enteric Fever 2 ... ... 1 1 ... ... ... ... 4 Small-pox ... ... ... ... ... ... ... ... ... ... Measles 8 2 2 3 1 ... ... ... ... ... Scarlet Fever 3 ... 1 1 1 ... ... ... ... 6 Whooping-cough 8 4 3 1 ... ... ... ... ... ... Diphtheria and Croup 15 ... 3 6 6 ... ... ... ... 17 Influenza 4 ... ... ... ... ... 1 3 ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) 48 ... ... ... 2 10 27 8 1 ... Tuberculous Meningitis 9 ... 3 2 3 1 ... ... ... ... Other Tuberculous diseases 9 ... ... 3 ... 2 2 ... ... ... Cancer, malignant disease 61 ... ... ... ... ... 7 32 22 3 Rheumatic Fever 3 ... ... ... 1 1 1 ... ... ... Meningitis 3 1 1 ... 1 ... ... ... ... ... Organic Heart Disease 60 ... ... ... 4 1 3 16 36 4 Bronchitis 37 9 1 ... ... ... 2 11 14 3 Pneumonia (all forms) 23 3 4 2 ... 1 8 3 2 2 Other diseases of Respiratory Organs 9 ... 2 1 ... ... 1 2 3 1 Diarrhœa and Enteritis 30 26 4 ... ... ... ... ... ... 1 Appendicitis and Typhlitis 3 ... ... 1 ... 1 1 ... ... 2 Cirrhosis of Liver 3 ... ... ... ... ... ... 2 1 ... Alcoholism 1 ... ... ... ... ... l ... ... ... Nephritis & Bright's disease 20 ... ... ... 1 1 3 10 5 4 Puerperal Fever 1 ... ... ... ... 1 ... ... ... ... Other accidents and Diseases of Pregnancy and Parturition 4 ... ... ... ... ... 4 ... ... 1 Congenital Debility and Malformation, including Premature Birth 50 50 ... ... ... ... ... ... ... ... Violent Deaths, excluding Suicide 11 ... ... ... 1 2 2 5 1 2 Suicide 2 ... ... ... ... ... 1 ... 1 ... Other Defined Diseases 175 11 4 2 6 7 14 39 92 10 Diseases ill-defined or unknown 4 1 1 ... 1 ... 1 ... ... ... Totals 606 107 29 23 31 28 79 131 178 60 Old Age (included above) 36 ... ... ... ... ... ... ... 36 2 Apoplexy ,, ,, 10 ... ... ... ... ... ... 4 6 1 31 TABLE IV. Infant Mortality. 1914. Nett Deaths from stated causes at various Ages under One Year of Age. CAUSES 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 1 year. All Causes Certified 32 3 7 6 48 10 15 19 15 107 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 1 1 2 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... 2 2 ... 4 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... 1 1 Convulsions 1 ... ... ... 1 1 ... ... ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... 1 1 1 2 3 2 9 Pneumonia (all forms) ... ... ... ... ... ... ... 1 2 3 Diarrhœa ... ... ... 1 ] ... ... ... 2 3 Enteritis ... ... 1 ... 1 4 ... 5 4 23 Gastritis ... ... ... ... ... 1 ... 1 ... 2 Syphilis ... ... ... ... ... ... ... ... ... ... Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations 4 1 1 ... 6 1 ... 1 ... 8 Premature birth 20 ... 1 1 22 ... ... ... ... 22 Atrophy, Debility & Marasmus 4 2 4 2 12 1 2 4 1 20 Other Causes 2 ... ... 1 3 1 ... 1 2 7 Totals 32 3 7 6 48 10 15 19 15 107 Nett Births in the year:—legitimate, 1,287; illegitimate, 38. Nett Deaths in the year legitimate infants, 99; illegitimate infants, 8. 32 ZYMOTIC DISEASES. The following table shews the deaths Registered in the District from the seven chief zymotic diseases during the past five years:— Disease. 1910 1911 1912 1913 1914 Small Pox 0 0 0 0 0 Scarlet Fever 10 4 3 3 6 Diphtheria 7 9 19 19 24 Measles 3 28 14 6 8 Enteric Fever 5 5 1 2 5 Whooping Cough 6 16 8 3 8 Epidemic Enteritis 11 94 9 13 17 42 156 54 46 68 The actual Enfield deaths were:—Scarlet Fever 3, Enteric Fever 2, and Diphtheria 14. 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. NOTIFICATION OF INFECTIOUS DISEASE, 1914. Disease. Town Ward. Chase Ward. Bush Hill Park Ward. Ordnance Waud Green Street and Ponders End Ward Hadley and Cockfosters Ward. Totals Cases per 1000 population. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total. 1st Qtr. 2nd Qtr. 3rd Qtr. 4 th Qtr. Total. 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. 4 th Qtr Total. Scarlet Fever 4 4 1 9 18 19 11 31 19 80 9 4 2 8 23 20 21 18 28 87 5 4 ... 4 13 ... ... ... ... ... 221 364 Diphtheria 1 1 1 2 5 1 10 6 9 26 3 3 2 6 14 4 3 6 7 20 9 5 1 3 18 ... ... 1 ... 1 84 1.38 Enteric Fever ... 2 ... ... 2 ... ... ... 1 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... 2 2 1 ... ... ... 1 7 .11 Erysipelas ... ... ... ... ... 3 2 ... 3 8 3 3 1 4 11 5 3 3 ... 11 1 3 2 3 9 ... ... ... ... ... 39 .64 Puerperal Fever ... ... ... ... ... ... 1 ... ... 1 ... 1 ... ... 1 ... ... ... ... ... ... 3 ... 2 5 ... ... ... ... ... 7 .11 Poliomyelitis ... 1 ... ... 1 ... ... ... ... ... 1 ... ... ... 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 3 .04 Ophthalmia Neonatorum ... 1 ... ... 1 ... 2 1 ... 3 ... ... 1 ... 1 ... 1 ... 2 3 ... ... 1 ... 1 ... ... ... ... ... 9 .14 Totals 27 119 51 123 48 2 370 6.09 Diphtheria Carriers ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 1 ... ... 1 2 3 1 1 1 ... 3 ... ... ... ... ... 8 .13 Full Totals 27 120 52 126 51 2 378 6.22 33 ENFIELD ZYMOTIC DEATH-RATE. The zymotic death-rate, after deducting 16 deaths of persons from outside the District who died in the Isolation Hospital (which is situate in Enfield), and adding one Enfield resident who died outside the District, is 0.87 per thousand. Disease. 1913. 1914. Deaths. Death-rate. Deaths. Death-rate. Scarlet Fever 1 .01 3 .04 Diphtheria 6 .10 15 .24 Enteric Fever 0 .00 2 .03 Erysipelas 0 .00 0 .00 Measles 8 .13 8 .13 Whooping Cough 3 .05 8 .13 Epidemic Enteritis 13 .22 17 .28 31 .52 53 .87 A zymotic death-rate of 087 in a District of 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. NOTIFICATION OF INFECTIOUS DISEASE. The cases of Infectious Disease notified each quarter in the various wards are as set out in the accompanying table:— 34 The following table gives the number of cases of each infectious disease notified during the past five years:— Disease. 1910 1911 1912 1913 1914 Scarlet Fever 156 111 98 158 221 Diphtheria 105 53 77 72 84 Membranous Croup 0 1 0 0 0 Enteric Fever 4 8 2 2 7 Small Pox 0 0 0 0 0 Erysipelas 32 49 40 32 39 Continued Fever 0 0 1 0 0 Puerperal Fever 11 1 7 5 7 Cerebro-Spinal Fever 0 0 1 1 0 Poliomyelitis 0 0 0 9 3 Ophthalmia Neonatorum 0 0 0 0 9 298 223 226 279 370 SCARLET FEVER. I congratulate myself that the number of Scarlet Fever cases notified is not very considerably larger than 221. During the year the wave of Scarlet Fever which had swept over the country more particularly London and Suburbs during 1913, had not abated, and I quite expected 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. The two-hundred and twenty-four notifications of Scarlet Fever received referred to 221 cases, which occurred in 153 houses as follows:— URBAN D/STR/CT COUNCIL OF ENF/ELD. CHART SHEW/MG NUMBER OF CASES OF /NFECT/OUS D/SEASES NOT/F/ED DUR/NG EACH WEEK OF THE YEAR 19I4. 35 No. of houses where 1 case occurred 127 ,, ,, ,, ,, 2 cases „ 14 ,, ,, ,, ,, 3 „ 10 ,, ,, ,, ,, 5„ 1 ,, ,, ,, ,, 31 ,, ,, (a school). 1 Total number of houses where cases occurred 153 Total number of cases 221 DIPHTHERIA. Eighty-four cases of Diphtheria occurred during the year in 73 houses, although I received 85 notifications. No. of houses where 1 case occurred 66 ,, ,, ,, ,, 2 cases ,, 5 ,, ,, ,, ,, 3 ,, ,, 1 ,, ,, ,, ,, 5 ,, ,, (a school) 1 Total number of houses where cases occurred 73 Total number of cases 84 A reference to the chart will shew that in 8 weeks no cases were reported, and for 25 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 1 was able to discover 8 carriers during the year, and I always swab every child who has had an attack of the disease before allowing him to return to school. ANTI-TOXIN. The following remarks of Dr. Haldane Cook the PhysicianSuperintendent of the Enfield and Edmonton Joint Hospital Board, in his Annual Report for 1913-14, are so admirable that I feel constrained, with his permission to embody them in this Report. "The circulation of Annual Reports amongst members of the "medical profession, for the purpose of comparison, is one of their "most useful features. An Annual Report which was sent to me "last year by a Medical Officer of Health contained the information "that in the hospital of which he had charge, the operation of "tracheotomy had been performed on 14 per cent., of all cases of "diphtheria admitted to his wards. During the past two years we "have treated 378 cases of Diphtheria with two tracheotomies, just "over one half per cent. The mortality has been much the same "at both hospitals. While not in any way presuming to criticise the "treatment as described in the report to which I have referred, the 36 "operation having been doubtless imperative in every case, my own "experience has been that Antitoxin alone will obviate the necessity "for operativ e measures in the majority of cases. "Patients with laryngeal symptoms are continually being "admitted here, often with a message from the certifying doctor "that an operation is urgently required; yet, in the course of a few "hours, with only Antitoxin to help them, they are on the high "road to recovery. Seldom a week passes that we do not get one "or more laryngeal cases of diphtheria, which looks as if they could "go from bad to worse only. The child is cyanosed, all the extra"ordinary lespiratory muscles are in full use, the breathing is "stridulous, and the cough is croupy. On looking at the throat and "nose, no signs of Diphtheria are to be found, perhaps only blue, "swollen tonsils; and the diagnosis is to ail intents and purposes "made by the administration of Antitoxin and the observation of its "action, while it is confirmed later on by the microscope. The child is "immediately put into a steam tent, and a large dose of Antitoxin is "given,—say, 10,000 or 12,000 units. Usually sleep supervenes in "the course of half-an hour, and gradually the acute dyspnoea gives "over, the cyanosis fades to a natural colour, and in six hours or "less, the child is out of immediate danger. Such cases in pre-anti"toxin days must either have been operated on or must have died. "If they are operated on now, and get Antitoxin, they stand "a very good chance of recovery ; but if they get Antitoxin "alone, they have at least in my opinion, a still better chance. "One must never forget that the conditions calling for tracheotomy "imply grave poisoning of the system, and that to super"impose a serious operation on such a state of affairs, is to add "still another obstacle to recovery. Of course, I am not discussing "such cases as are absolutely demanding operation to avert impend"ing death. These must be operated on, on the spot, with or "without preparation of the patient or his surroundings. During "the past two years we have had very many severe cases, out of all "proportion to those which have been mild or moderately severe, "and I am certain, if tracheotomy had been done as frequently as "apparently was necessary, that our mortality would have been very "much greater. "From the above remarks it is fairly evident that I place a firm "belief in the efficacy of Antitoxin, and I have striven year by year "to make it plain to the medical men who send us cases for "treatment and isolation, that this institution should be regarded, so "far as diphtheria is concerned, mainly as an isolation hospital, and "that the treatment should be begun before the patient is sent in. "Were this done in all cases, I believe our death-rate would fall to "2 per cent., or 3 per cent., or even less. Our mortality is far too "great, and I maintain that it is entirely due to the delay inadminis- 37 "tering Antitoxin. It is, however, satisfactory to find that during "the year, out of a total of 195 cases discharged, 50 were admitted "already injected with Antitoxin—one in every four—while the "figures for the previous year were only one in every five. Still, I "am looking forward to the time when every case will come in "with the treatment begun." ENTERIC FEVER. Seven cases of this disease were notified during the year, and I venture to think it is doubtful whether all were genuine. Careful investigation failed to shew any source of infection in some of the cases, and the sanitary condition of all the houses was quite satisfactory. Enteric Fever has become almost obsolete in this District, and whenever a genuine case does occur, it can almost invariably be traced to outside causes. POLIOMYELITIS. Only three cases were notified during the year, and there were no deaths. Particulars of each case were carefully collected and forwarded to the Local Government Board. One of the cases, a boy of 12 years, turned out to be Landry's Disease; another, a girl of 6½ years, proved to be Acute Rheumatism, while the other, a boy of 7 years, was notified as suffering from Poliomyelitis having paralysis in both legs. He has now quite recovered. OPHTHALMIA NEONATORUM. This disease became notifiable by an Order of the Local Government Board on the 1st April, 1914. The expression "Ophthalmia Neonatorum" means a purulent discharge from the eyes of an infant commencing within 21 days of the date of its birth, and it was a matter of much importance that the disease should become compulsorily notifiable, as a large proportion of the blindness contracted in childhood is due to the neglect of proper precautions against the disease. Nine cases were notified during the year by Midwives and and Medical men. 38 TUBERCULOSIS. The following table shews the number of notifications of Pulmonary and other forms of Tuberculosis received:— Ward. Pulmonary. Others. Fresh cases. Old cases le-noiifiecl Duplicates. First notification. Duplicate. Town 1 2 1 0 0 Chase 16 3 9 9 0 Ordnance 23 9 7 21 0 Green Street and Ponders End 38 19 39 13 4 Bush Hill Park 23 2 11 9 0 Hadley and Cockfosters 1 0 0 0 0 Total 102 35 67 52 4 First notifications 154 Old ones re-notified, i.e., some by fresh doctors, or coming into District, or under old regulations 35 Duplicate notifications, i.e., those which report the entering and leaving of Sanatoria 71 Total 260 notifications. 39 Sex. Form. Men. Boys. Women. Girls. Pulmonary 56 6 35 5 Other 4 22 10 16 Totals 60 28 45 21 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 3 — — — .40 Chase 7 4 1 3 1.12 Ornance 3 4 3 5 1.08 Green Street and Ponders End 11 6 - 4 1.58 Bush Hill Park 5 3 1 1 .84 Iladley and Cockfosters — 2 — — 2.07 Totals 29 19 5 13 1.08 40 Fifty-four cases were remov ed during the year. Fourteen went into the Infirmary; one was discharged and four died. Nineteen cases went into Clare Hall, eleven to Winchmoie Hill, and ten to other Sanatoria. Seven were discharged from Clare Hall, six from Winchmore Hill, and four from other places. Five deaths occurred at Winchmore Hill, and two of those discharged from here died at home. The following facts, obtained when visiting the cases are of interest:— Twenty-nine cases came into the District recently. One or both patents known to have died of Phthisis in eleven cases. Brother or sister known to have died from Phthisis in 9 cases. Relations known to hav e died from Phthisis in 9 cases. Eight patients had been in contact with cases of Phthisis. The conditions of the dwellings at the time of first visit after notification was:— Satisfactory 110 Damp 9 Other defects 28 Overcrowding 2 OCCUPATIONS OF PATIENTS. Factory and Workshop 20 Building lines, Labourer, or other Outdoor Workers 20 Clerk or Shop Assistant 11 Publicans 2 Domestic Service 11 Police 2 Married Women 21 Army 5 Children 27 No occupation 35 154 I should like to draw attention to the fact that although the total number of notifications of this disease are 260 as against 262 in the previous year, the drop in primary notifications is very considerable being 154 instead of 174, that is 102 Pulmonary, instead of 118, and 52 other instead of 56. This is most satisfactory, as it is the first year since this Disease became notifiable that we have noticed any diminution in the number of first notifications. The Head Dispensary for Area No. 1, which includes Knfield under the Scheme of the Middlesex County Council for dealing 41 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 pei iodically, 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 59 and the articles—clothing, bedding, etc.— dealt with numbered 378. NON-NOTIFIABLE INFECTIOUS DISEASES. Measles. This disease was prevalent both in the Bush Hill Park and Ordnance Wards, but on the whole was of a mild type, eight deaths occuring in the whole District I became aware of 228 cases which were notified to us from the various Schools under an arrangement made between the Council and the Education Committee, but there can be no doubt that the total number of cases was much in excess of this, for the working class mother does not as a rule trouble to send for the doctor when she ha4 Measles in the house until one or more of the children are suffering from Pneumonia, the most usual cause of death in this disease. The following table shews the incidence of this disease in the various wards:— Ward. No. Ordnance. No. of cases of Measles which came to our knowledge 74 Ponders End ,, „ ,, ,, 14 B. H. Park. ,, „ ,, ,, 112 Chase ,, ,, ,, ,, 22 Town ,, ,, ,, ,, 6 Hadley ,, ,, ,, „ 0 Total 228 Six schools were disinfected with formalin. 42 ENTERITIS. Thirty deaths occurred from this disease during the year, of which 26 were infants under one year. I have very little doubt the cause of this must often be looked for in the ignoiance of mothers, many of whom think kippers and sausages are quite a suitable diet for small children. 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. and contains 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 186 Diphtheria 74 Enteric Fever 4 BACTERIOLOGICAL WORK. All the Bacteriological work is done in my own laboratory including the oreDaration of media, cultivation of growths, etc. Every swab is "planted," and grown in an incubator. No. Positive. Negative. Percentage of Positives. Swabs 1,348 138 1,210 10.92 Sputum 140 35 105 25.00 Widal 7 2 5 28.57 Totals 1,495 175 1,320 8.77 43 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 niust 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. 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 1 do not allow any child shewing it to return to school until two consecutive swabs taken at about one week's interval proved Negative. The following excerpt, "A Diphtheria Carrier,'' from the Sanitary Record for February 19th, 1915 is most interesting:— THE SANITARY RECORD. February 19th, 1915. Page 157. "A DIPHTHERIA CARRIER." Dr. Hamer states that the "facilities" afforded by the existence of a laboratory as part of the public health organisation have proved to be of great value in arriving at an accurate diagnosis as to the cause of illness in scholars"—an opinion which will be endorsed by Medical Officers generally. In this section an interesting account is given of a "chronic intermittent carrier of diphtheria germs," known by the initials of R.C. This girl was referred to in the report for 1912, and she is still in one of the Metropolitan Asylums Board Hospitals, where she was admitted in June 1912. She has grown quite sturdy. A number of methods of treatment for the elimination of the Klebs-Loeffler bacillus from the child's throat and nose have been tried, but cultures from her throat still exhibit the diphtheria bacilli, which on several occasions have proved virulent or partially so. The methods tried have been:—Segregation with thorough feeding and regular hygiene of nose and throat; inoculation with an autogenous vaccine of twenty-four hours' growth; spraying and swabbing with various antiseptics: spraying and swabbing with broth cultures of staphyloccus pyogenes aureus; and lastly, swabbing and spraying with protargol, a silver compound, so strongly recommended in carrier cases of cerebro-spinal fever. The complete enucleation of the tonsils and removal of adenoids have been found efficacious in many cases. ' R.C.', has not much tonsillar tissue, but it would appear to be worth while to remove this, and the consent of her parents is being sought for this purpose." It is not difficult to imagine the interest this case has aroused in medical circles. 44 WATER. Two samples of water were submitted to me for examination. Both were found to be unfit for drinking purposes, and supplies taken from the main were substituted. A water main has been extended to Botany Bay, the Tower Tank completed, and the supply is now available for 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. 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. 45 VACCINATION. I have received the following information from Mr. Inns, the Vaccination Officer, in respect of children vaccinated up to June, 1914:— Number of cases on lists 1,316 Vaccinated 472 Exempted 509 Removed 153 Dead 71 Not otherwise accounted for Ill 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. The King George Reservoir of the Metropolitan Water Board between Ponders End and Enfield Lock in this District, was inaugurated by His Majesty the King in 1913. It is the largest reservoir of its kind in the Country, being two miles long, with an area of 418 acres, and a capacity of 300,000,000 gallons. Streams & Water Courses. Although the Middlesex County Council is the Authority responsible in the County for Water-courses in the District, the Turkey Street Brook and other streams are kept under observation by your 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. 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. Closet Accommodation. All the houses in the Urban portion of the District are supplied with W.Cs., of various types, 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. 46 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. 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. 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. 47 Periodical examinations of the conditions of the Public elementary schools ate 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. All the schools are supplied with water from the mains. 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 483 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 ihe 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. COPY. Holly House, Lower Edmonton. April 25th, 1914. Dear Sir, I beg to report that I have completed the inspection of the whole of the milch cows in the district, as shown in the accompanying list. I found the usual percentage of cases of induration of the udder, and, where necessary, made a bacteriological examination of the milk for the purpose of discovering the Tubercle bacillus, in the absence of which it cannot be stated that the organ is tuberculous, but in none of them was the bacillus present. The induration in most of the cases resulted from previous attacks of Mammitis. I noticed there were fewer cases of emaciation than on previous visits. This I think is probably due to the working of the Tuberculosis Order which discourages the retention of animals until they reach that stage. There were a few cows affected with 48 skin diseases usual at this time of the year after being housed together during the winter, but they were under treatment and appeared to be making satisfactory progress. I consider the cows, generally, are in good health and condition and properly cared for. I am, dear Sir, Yours obediently, T. W. Scott, Esq. (Signed) H. H. Hide. Copy. Holly House, Lower Edmonton. December 16th, 1914. Dear Sir, I beg to report that I have inspected the whole of the milch cows in the district, as shewn in the accompanying list. I made a careful examination of the udders and found a marked diminution in the number affected with the ordinary diseases met with among milch cows at all times, and there were fewer cases in which the presence of Tuberculosis might be suspected. Where necessary I took samples of the milk for bacteriological examination, but in none of them was the Tubercle bacillus present, showing them to be free from that disease. The custom of disposing of animals shoeing disease of doubtful origin, at an early stage, has become general, with satisfactory results to the herds throughout the district. The effect of the scarcity of pasturage in the early autumn was seen in some of the animals, but as a whole they were in satisfactory condition and well kept. I am, dear Sir, Yours obediently, T. W. Scott, Esq. (Signed) H. H. Hide. 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. Number of Samples taken. Number found adulterated. Percentage. Butter 2 ... ... Milk 76 20 26.31 Butter-substitute 1 ... ... Totals 79 20 26.31 There were eleven prosecutions resulting in a conviction in each case. 49 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. 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 837 such visits, examined 2,517 carcases, and secured the surrender of 32 parcels of diseased organs. The sanitary condition of the slaughterhouses is, on the whole, satisfactory. BAKEHOUSES. I visited the 43 bakehouses in the District, of which 38 are in use, the other 5 either being empty or used for other purposes, and found them all in a satisfactory condition. I was particularly pleased to find an up-to-date Automatic Plant of Bread making Machinery installed in one bakehouse. This installation consists of four principal machines, viz:—a Dough Divider, a Hander-up, an Automatic prover, and a Finishing Moulder. The dough (previously kneaded by a machine kneader) is placed into the hopper of the dough divider in bulk, and this machine divides it into individual pieces of the exact weight required for the loaves, this doing away with the usual hand cutting and weighing. The loaves are delivered from this machine in lots of two at a time, at the rate of 1,200 per hour. From the divider the loaves pass automatically on to the hander-up, which moulds them (in a manner identical with hand moulding) in a suitable form for the proper development of fermentation. From this machine the loaves are passed, automatically, into the prover, which resembles a large square glass case. This is fitted with shelves or trays, each of which hold 8 loaves. As each tray is filled it moves forward mechanically, and its place is taken by an empty tray, until, by the time the whole of the fifty trays are filled, the first one has arrived at the point where the loaves emerge from the prover. They are then passed on, again automatically, to the finishing moulding machine, upon which the loaves are moulded into the required shapes ready for baking. All that is then required to complete the process is for the loaves to be placed upon boards or shelves, which are then placed upon trolleys and wheeled to the ovens. The latter being of the draw-plate tvpe are "set" or filled by the simple action of tilting the loaves off the aforesaid shelves on to the oven plates. 50 It will therefore be seen that, except at the points where the dough is put into the divider and taken from the finishing moulder, the loaves are untouched by hand during the whole process of manufacture. In addition to the above new machinery there is also in use in this bakery a machine Dough Kneader which converts two sacks of flour into dough at a time. Four additional drawplate ovens have also been installed. These are heated by steam tubes. No flame, smoke, or ashes can enter the baking chambers, and the baking plates can be swept clean prior to being filled with loaves for each baking. The additions to the bakery building have been designed with a view to providing a thoroughly clean, light and airy bakehouse. The walls are tiled, and the floors are solid (concrete) and the building and plant are in accordance with the most modern ideas for ensuring the production of bread under the best possible hygienic conditions and with a minimum amount of handling by the human hands. The bakery is lighted and the machinery driven by electricity. HOUSING. The Regulations issued by the Local Government Board, under Section 17 (1) Housing, Town Planning, etc., Act, 1909, are receiving close attention. The following are the particulars required by Article 5 of these Regulations to be included in my Report:— Number of dwelling-houses inspected 1,372 Number of houses considered on inspection to be in a condition so dangerous as to be unfit for human habitation 5 Number of houses closed and demolished without orders 0 Number of houses closed 5 Number of houses closed and demolished following Closing Orders 5 Number of representations made to the Local Authority with a view to the making of Closing Orders 5 Number of Closing Orders made 5 *Number of houses where defects were remedied without service of Closing Orders 0 Number of houses which, after making of Closing Orders, were put in a fit state 0 * This inquiry would appear to refer to dwellings, which, on inspection were found to be unfit for human habitation, and although defects were found at some of the houses inspected, they were not such as to require the issue of Closing Orders. 51 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 388 On account of complaint by occupants and otherwise 723 1,111 making a gross total of house inspections for the year of 2,483, which gives a percentage of 20.9 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 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 exercised by the members of your Health Department. Sixteen 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 In a Stevenson's screen in grounds of the Public Offices. Standard Hygrometer 52 Terrestrial Radiation Thermometer In the grounds of the Offices. Earth Thermometer Campbell-Stokes Sunshine Recorder Rain Gauge On the roof of the Public Offices. Solar Radiation Thermometer 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 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:— 53 METEOROLOGICAL STATISTICS, 1914. Month Barometer. Temperature. Rainfall. Sunshine. Highest. Lowest. Highest. (Max.) Lowest (Min.) Mean. Ins. Ins. º º º Ins. Hrs. January 30.616 on 1st 29.604 on 6th 55.0 on 9th 18.0 on 24th 37.6 .64 41.6 February 30.234 on 28th 28.676 on 22nd 58.0 on 14th 25.5 on 28th 43.2 2.33 5.86 March 30.262 on 31st 28.764 on 20th 66.0 on 31st 26.5 on 22nd 43.3 4.35 9.24 April 30.614 on 26th 29.390 on 7th 75.0 on 21st 32.0 on 16th 50.2 .74 23.20 May 30.422 on 2nd 29.498 on 7th 79.5 on 26th 34.5 on 26th 53.6 1.48 20.40 June 30.408 on 26th 29.620 on 9th 86.0 on 30th 39.5 on 8th 59.6 1.54 27.03 July 30.216 on 9th 29.592 on 20th 86.5 on 1st 46.0 on 5th 62.6 1.56 16.10 August 30.362 on 12th 29.578 on 2nd 79.0 on 13th 47.0 on 8th 60.6 1.23 16.77 September 30.468 on 30th 29.528 on 17th 79.5 on 7th 33.0 on 23rd 57.3 1.17 20.99 October 30.438 on 5th 29.392 on 31st 67.0 on 3rd 32.0 on 12th 51.5 1.08 7.24 November 30.606 on 18th 29.136 on 15th 60.0 on 5th 32.0 on 25th 46.5 3.23 6.88 December 30.324 on 25th 29.864 on 14th 56.0 on 2nd 30.0 on 6th 42.5 6.45 3.70 54 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 60 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:— SURVEYOR'S REPORT FOR YEAR, 1914. During the year the following streets have been metalled, channelled, paved, &c., under section 150 of the Public Health Acts, 1875:— Raynton Road (part of); Drapers Road; Chase Court Gardens; Trinity Street; Warwick Road; Waverley Road; Old Park Road ; Crescent Road. Approximately 200,000 super yards of tar-spraying has been done to roads and footpaths and the following widenings and improvements have been made :— Bullsmoor Lane; Lincoln Road; Cockfosters Road from Southgate boundary to Chalk Farm Lane leading to "The Cock" P.H., reconstructed with Tarred Macadam. 55 The water main has been extended at Bulls Cross and to Botany Bay so that all the Ridgeway is now supplied with water to the Potters Bar boundary. Sewage Farm. The disposal of sewage still continues to be satisfactory. With a view of maintaining it so, the system of under drainage has been extended by the laying of about 350 yards of 9in. pipe drain and about 3,000 yards of field drains; cleaning out the Sludge Lagoons and forming a Humus Tank. Surface water drains have been laid as follows:— Waverley Road, 290yds. of 9in.; Crescent Road, 161yds. of 9in.; Old Park Road, 203yds. of 9in.; Old Park Farm Road, 180yds. of 9in.; Bullsmoor Lane, 655yds. of 9in; Back of British Schools, 70yds. of 21in.; Stanley Road, 85yds. of 9in. The 9in. sewer for 105yds. in Stanley Road has been re-laid in order to accommodate an extended area. A Public Convenience, providing accommodation for both sexes has been erected at the junction of Church Street and Little Park. A mess room for the men has been built at the Little Park Depot. A Band Stand has been erected in the Town Park. A Motor Syren has been fixed at the Fire Station, Ponders End. Fifty-two houses have been certified as completed and fit for human habitation; 22 houses have had additions made thereto; 3 factories, 10 additions to factories, 3 new Public Buildings; 5 additions to Public Buildings and 25 other buildings constitute the amount of building operations during the year. Two new streets have been laid out. March, 1915. THE WAR. The following Medical Men from Enfield have joined H.M. Service since the War began:— C. H. Browne, Esq., Surgeon, R.N.; E. M. Ridge, Esq., Lieut., R.N.V.R. (killed at Antwerp); A. M. Ross, Esq., Lieut., R.A.M.C.; H. F. Vandermin, Esq., Lieut., R.A.M.C.; P. P. Warren, Esq., Lieut., R.A.M.C.; W. W. Wood, Esq., Lieut, R.A.M.C. The following have also gone from the Staff and employees of the Council:— Clerk's Department. J. Ellis, Clerk's 4th Assistant, Royal Bucks. Hussars: J. Brooks, Pupil Clerk, Royal Naval Volunteer Reserve. 56 Surveyor's Department. W. R. Collins, 2nd Draughtsman, Lieut. Royal Fusiliers. E. Clark, General Man, Royal Fusiliers. Sanitary Department. N. Smith, 3rd Assistant Inspector of Nuisances, Sanitary Company, R.A.M.C. H. Wiggett, 2nd Clerk, Royal Bucks. Hussars. F. Staker, Sewer Flusher, 13th Kensington Battalion, London Regiment. J. Flack, Dustman, Royal Engineers. The Government took over Beech Hill Park Mansion at the commencement of the War, as barracks for troops in training, and it has been occupied by soldiers belonging to the Royal Engineers, and later by the Royal Fusiliers. Your Sanitary Staff took charge of the sanitary arrangements of the Camp, much to the satisfaction of the O.C., and I venture to think that the good health enjoyed by the troops while they have been there is due in no small measure to the admirable manner in which the work has been carried out by the Council's Staff. 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. 57 Public Offices, Enfield. March 25th, 1915. REPORT OF THE INSPECTOR OF NUISANCES FOR THE YEAR 1914. 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, 1914, 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 1,372 From house-to-house apart from this Act 278 On account of infectious disease 242 „ „ Phthisis 146 „ „ complaint, by occupants or otherwise 445 2,483 23 Factories 83 109 Workshops and workplaces, including 12 laundries 443 35 Outworkers' premises inspected 55 43 Bakehouses in the District, of which 38 are in use 314 18 Slaughterhouses inspected frequently 837 33 Cowsheds inspected frequently 357 70 Dairies and Milkshops inspected frequently 481 22 Schools 125 . 38 Shops where ice-cream is made 121 Inspections under the Rag Flock Act 3 Publichouse urinals inspected 89 Conveniences at Railway Stations inspected 9 Fish shops. Total number of visits 437 Coffee and Eating Houses. Total number of visits 44 3,398 Visits to absentees excluded from Elementary Schools 951 Visits in connection with cases of Infectious Disease 2,415 „ „ „ Phthisis 1,026 Other inspections, including works in progress 11,465 Smoke observations 22 15,879 21,760 58 NOTICES ISSUED. Statutory:— For repairs to houses, drains, and abatement of nuisances 168 Providing sufficient water-closets 55 Provision of dustbins 52 Paving of yards 10 Overcrowding 13 Provision of sink waste pipes 7 305 Informal:— Notices 20 Letters sent in lieu of notices 1,156 1,176 Other Notices issued under Infectious Diseases Acts:— To occupiers 666 To schools 1,639 2,305 3,786 Other letters sent 2,979 Result of service of statutory notices:— Number complied with 263 Number outstanding 42 305 As to these outstanding notices, in five the time given did not expire until after the end of the year, while with regard to the other 37 (referring to 13 houses) 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. 413 Houses closed and demolished 5 Roofs repaired 183 Gutters and downpipes repaired 332 Cesspools emptied 206 House drains cleared, repaired, etc. 389 House drains tested, examined, etc. 1,053 House drains re-constructed 55 Soil-pipes and drains ventilated, including repairs to ventilators 136 Sink wastes disconnected or repaired 50 New sinks provided 6 Ventilation provided to rooms, or windows made to open 53 59 Closets provided with proper flushing cisterns or water supply 249 New closets provided 6 Closets repaired, covered, cleansed, etc. 210 Storage cisterns repaired, covered, cleansed etc. 134 Water laid on or restored 11 Samples of water taken 2 Wells cleansed or covered 1 Yards paved, or existing paving made good 239 Ventilation provided under ground flooors, causes of dampness removed, etc. 242 Dustbins repaired, or new ones provided 271 Manure heaps removed 83 Fowls and other animals removed 21 Stables, etc., cleansed 8 Other nuisances abated 43 Ditches cleaned out 6 Cases of overcrowding 18 DISINFECTION. Houses disinfected:— After infectious disease 319 After Phthisis 59 Verminous cases 2 380 Rooms stripped and repapered, etc., after occupation by cases of infectious disease 54 Rooms stripped and repapered, etc., after occupation by cases of Phthisis 31 Articles of clothing, bedding, etc., disinfected after infectious disease 3,035 Articles of clothing, bedding, etc., destroyed 2 3,037 Articles of clothing, bedding, etc., disinfected after Phthisis 378 Articles of clothing, bedding, etc., destroyed 8 386 Articles of clothing, bedding, etc., disinfected where found verminous 101 3,524 Library Books disinfected 82 Cases of Scarlet Fever removed to Hospital 186 „ Diphtheria „ „ 74 „ Enteric Fever „ „ 4 264 Gipsy Vans removed from the District 15 Articles or parcels of unsound food destroyed 82 60 From these particulars it will he seen that we have inspected an increased number of dwellings during 1914, the figures being 1,650 in 1914, as against 1,240 in 1913. The majority of the defects found to exist were remedied before the end of the year, but though some delay was occasioned on account of the continued wet weather we experienced during the last quarter, those remaining are receiving attention. I am pleased to say there was no case that required legal proceedings during the year. The number of visits made in reference to children excluded from Elementary Schools during the year was 951, and the total number of inspections and visits for all purposes made by the staff of the Sanitary Department was 21,760, shewing an increase of 409 over the number for 1913. 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. 7,850 loads were collected, an increase of 165 over the number obtained in 1913. Quantities of trade refuse were also collected from Trade premises, for which a charge was made. The greater portion of the refuse was taken to the Council's shoot, and the remainder to brickfields. FACTORY AND WORKSHOPS ACTS, 1901 & 1907. A register of all workshops is kept, and at the end of 1914 there were 97 workshops, 12 laundries and 43 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) 83 ... ... Workshops (including Workshop Laundries) 443 7 ... Bakehouses 314 5 ... Total 840 12 ... 61 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 16 16 ... ... Want of Ventilation ... ... ... ... Overcrowding ... ... ... ... Want of Drainageof Floors ... ... ... ... Other Nuisances 21 21 ... ... Sanitary Accommodation: Insufficient ... ... ... ... Unsuitable or Defective 21 21 ... ... Not separate for sexes 1 1 ... ... Offences under the Factory and Workshops Act— Illegal occupation of underground bakehouse ... ... ... ... Breach of special sanitary requirements for bakehouses 44 44 ... ... Other Offences ... ... ... ... Total 103 103 ... ... 62 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. men. Lists. Workmen. Making Wearing Apparel 20 31 12 21 11 Lace Curtains, &c. ... ... ... ... 2 Artificial Flowers ... ... 1 1 ... Brush Making, &c. ... ... 1 1 ... Carding, &c. ... ... 1 1 ... Boxes 2 2 ... ... ... Total 22 33 15 24 13 Eight addresses of outworkers have been forwarded to other districts. EMPLOYMENT OF CHILDREN ACT, 1903. During the year 564 names were received of children employed out of school hours, and in 329 cases contraventions of the Bye-laws were found, and remedied. The total number of interviews and visits made under this Act was 672. 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. Notices are issued twice yearly to the occupiers of cowsheds pointing out the requirements of the Regulations as to the limewashing of cowsheds during the months of May and October. ICE-CREAM. Thirty-eight shops where ice cream was made or sold were inspected during the Summer, 121 visits being made to them, and where necessary instructions given in regard to the cleansing of utensils and premises. 63 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 837 Shops 587 Stalls in Markets 1,093 2,517 The number of carcases examined during the visits to slaughter-houses is as follows:— Cows 123 Oxen 260 Calves 13 Sheep 1,254 Pigs 335 1,985 During the examination of these carcases while being dressed 32 organs, also part of a fore-quarter of beef with lungs and liver 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, certificates to that effect were given, so that the Owners could secure the return of the money paid from the wholesale traders:— April 9th—1 tub of Skate. April 25th—Box of smoked Codlings. May 18th—6 boxes of Filletted Haddocks. June 18th—Barrell of Crabs. June 22nd—Bushel of Winkles. Aug. 10th—1 Barrel of Herrings. Aug. 18th—24 Rabbits. Nov. 21st—2 Boxes of Fillets. 64 HOUSE DRAINAGE. A large number of house drains, including those to every house inspected under the Housing, Town-Planning, etc., Act Regulations have been tested, also where necessary cleared and re-constructed by the Owners of the property concerned. 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. A record with plan is kept of all drains re-constructed. PUBLIC ELEMENTARY SCHOOLS. By an arrangement between the Council and the Education Committee, I have all the sanitary arrangements attached to the nonprovided 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 was re-arranged during the year and increased help given in order that we might proceed more rapidly with the inspections under the Housing, Town-Planning etc., Act, Mr. N. Smith being promoted from the position of 1st Clerk to 3rd Assistant Inspector of Nuisances, Mr. S. Coulter from 2nd to 1st Clerk, Mr. H. Wiggett from 3rd to 2nd Clerk, and H. Gerken appointed as Pupil Clerk. I am glad to take the opportunity afforded by this Report to acknowledge and thank them all for their hearty co-operation, and the real interest displayed in their work, which acknowledgement includes the outdoor Staff connected with the depattment. I am, Gentlemen, Your obedient Servant, A. J. Munro, M.R.San.I., Inspector of Nuisances.