C.I AC 439 (1) ENFIELD (haten Mun b) THE URBAN DISTRICT COUNCIL OF ENFIELD. Annual Report of the MEDICAL OFFICER OF HEALTH, FOR 1915, together with the Annual Report of the INSPECTOR OF NUISANCES. enfield : stanley woodf1eld, windmill hill. THE URBAN DISTRICT COUNCIL OF ENFIELD. Annual Report of the MEDICAL OFFICER OF HEALTH, FOR 1915, together with the Annual Report of the INSPECTOR OF NUISANCES. enfield : stanley woodfield, windmill hill. Enfield Urban District. Area (including 412 acres water) 12,601 acres Population at census of 1911 56,338 Population at middle of 1915 61,173 Number of inhabited houses 11,948 Vital Statistics. Birth-rate per 1,000 living 21.64 Recorded Death-rate per 1,000 living 11.27 Standardized Death-rate per 1,000 living 11.66 Infantile Mortality per 1,000 births 86.85 Zymotic Death-rate per 1,000 living 1.06 Tuberculosis Death-rate per 1,000 living 1.04 Vital Statistics of Wards. Ward. Area in acres. Persons per acre. Population. Birthrate. Standardized Deathrate Infantile Mortality Zymotic Deathrate. 1uberulosis Death rate. Town 1.717 4,3 7.536 13,91 9,05 66,66 .26 .92 Chase 4.478 3,0 13.450 22,60 12,61 82,23 1.41 .59 Ordnance 2,060 6,7 13.977 20,17 10,73 88,65 1.21 .71 Green Street and Ponders End 1,330 10.0 13,312 26,51 13,90 104,81 1.65 .87 Bush Hill Park 762 15,4 11,802 21,60 IO,95 82,35 .33 1.18 Hadley & Cockfosters 2.254 ,4 1,096 10,03 IO,37 O,OO .91 o.oo PUBLIC OFFICES, ENFIELD. May 31st, 1916. Medical Officer of Health's ANNUAL REPORT FOR 1915. To the Urban District Council of Enfield. Gentlemen, I have the honour to submit to you my Annual Report for the year 1915, which, owing to the depletion of the Staff in the Office, is rather belated, but which I trust you will find satisfactory. The Report of your Sanitary Inspector, Mr. A. J. Munro, giving particulars of the work done in tne Sanitary Department, is also incorporated. As in a circular issued in December 1915, the Local Government Board stated that they considered that many of the usual details inserted in the Annual Reports, such as a description of the district and of the water supply, sewerage and sewage disposal, etc., may be omitted, and that the report may be confined to a record of what has taken place during the year, I propose to curtail this report very considerably as compared to former years. POPULATION. The number of inhabited houses in the district in June 30th, 1915, was 11,948, and as it was found at the last Census that the average number of inhabitants to each house was 5.12, I estimate the population on that date as being 61,173, although I have no doubt that this very considerably underestimates the number of people in the district in consequence of the War. 6 A very large number of men have left the District to join the Service, while, on the other hand, a still larger number,—accompanied in many instances by their families, have flocked into the District to work at the munition factories, consequently any approximately correct estimation of the population is out of the question. The result of this is that the Death-rates and the Infectious Diseases rates appear to be very much larger than they would be if we had the means of accurately gauging the exact population. Enfield is divided into six wards as follows :— Wards. Inhabited Houses. Uninhabited Houses. Total. Population. Town 1,472 52 1.524 7,536 Chase 2,627 46 2,673 13.450 Ordnance ... 2.730 H 2.744 13.977 Green Street and Ponders End 2,600 30 2,630 13.312 Bush Hill Park ... 2,305 16 2,321 11,802 Hadley & Cockfosters 214 6 220 1,096 11,948 164 12,112 61,173 VITAL STATISTICS. The Vital Statistics for the year are quite satisfactory, but in consequence of the considerable underestimation of the population our figures apparently this year are not so good as in 1914, but I am confident that if we had any means of obtaining a true estimate they would show much more favourably. The number of births registered was :— Boys. Girls. Total. 663 661 1,324 including 32 illegitimate births, i.e., 2*41 per cent, of the total. This total is one less than that of the previous year, and gives a birth-rate of 21.64 per thousand of the population, which compares favourably with that of England and Wales, which was 21.9 per thousand. The corresponding rate for London is 22.6. 7 The births were distributed among the various wards as follows:— Ward 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total each sex. Total each Ward. Birthrate. M F M F M F M F M F Town 16 9 10 23 13 12 10 12 49 56 105 I3'9I Chase 33 49 45 36 36 38 33 34 147 157 304 22 60 Ordnance 35 46 30 24 35 43 35 34 135 147 282 20-17 Green Street and Ponders End 52 48 5° 42 42 31 46 42 190 163 353 2651 Bush Hill Park 37 34 33 37 29 29 30 26 129 126 255 21-60 Hadley and Cockfosters 3 I 2 2 ... ... 1 2 6 5 11 10-03 Births outside the District ... 7 7 14 ... 176 187 170 164 155 153 155 '5° 663 661 1.324 21 64 for District 363 334 308 305 1.324 The births of boys and girls, also birth-rates for the last three years were :— Year. Boys. Girls. Total. Birth-rate. Illegitimate Birth-rate. 1913 659 672 1.331 22 50 .57 1914 688 637 1.325 21 83 .62 1915 663 661 1,324 21-64 .52 8 DEATHS. The deaths registered in the district during the year were 590, of which 310 were males and 280 females, giving a crude death-rate of 9.64. To these must be added 144 deaths of Enfield residents registered outside the district, and from this total must be subtracted 44 deaths of non-residents occurring in the district, which brings the nett number of deaths to 690 for the year, giving a recorded death-rate of 11.27. 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 n-66. Birth-rate. Recorded Death-rate. Standardized Death-rate. Infantile Death-rate. England & Wales 21.9 15.I 14.8 110.0 London 22.6 16.1 16.1 112.0 96 Great Towns, including London 22.8 15.6 15.9 117.0 ENFIELD 21.64 11.27 11.66 86.85 The corresponding figures for Enfield for the three previous years are :— 1912. 1913. 1914. 1915. Recorded death-rate 10.07 9.75 9.98 11.27 Standardized do. 10.40 10.09 10.32 11.66 NETT DEATHS, CLASSIFIED IN AGES, WARDS, AND QUARTERS, 1915. Ward. Town. Chase. Ordnance. Green St. & Ponders End. Bush Hill Park. Hadley 8c Cockfosters. Totals Totals Quarter. 1st 2nd 3rd 4th Total. 1st 2nd 3rd 4th Total. 1st 2nd 3rd 4th Total. 1st 2nd 3rd 4 th Total. 1st 2nd 3rd 4 th Total. 1st 2nd 3rd 4th Total. each sex 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 4 ... 1 ... 1 ... 1 ... 7 ... 5 4 3 3 3 1 5 1 16 9 3 4 2 2 5 4 5 15 10 6 8 4 5 3 6 3 2 16 21 3 4 3 5 1 1 2 2 9 12 ... ... ... ... ... ... ... ... ... ... 63 52 115 1 to 5 yrs. ... 1 ... ... ... ... ... ... 1 1 1 9 4 1 2 2 3 2 13 10 7 6 1 4 1 1 1 9 12 4 9 4 7 2 4 2 12 20 4 3 2 2 1 ... 5 7 1 1 ... ... ... ... ... 2 ... 42 50 92 5 to 10 yrs. ... 1 ... ... ... ... ... ... ... 1 1 ... 1 1 ... ... ... 3 ... ... 2 1 2 1 ... ... 1 2 5 ... ... 1 1 ... ... ... ... 1 1 1 ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... 8 7 15 10 to 15 yrs. 2 ... ... ... ... 1 ... ... 2 1 ... 1 ... ... 1 ... ] 1 2 ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 4 ... ... ... 4 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 8 5 13 15 to 20 yrs. 1 ... ... 1 ... ... ... ... 1 1 ... ... ... 2 ... ... 1 ... 1 2 1 ... ... ... 2 ... 1 2 4 2 1 1 ... ... ... 1 ... ... 1 2 ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 8 7 15 20 to 25 yrs. 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 ... ... ... 3 ... 1 ... ... ... 1 ... 1 ... 3 ... 2 ... ... 1 ... ... ... ... 2 1 1 1 1 1 ... ... 1 3 ... ... ... ... ... ... ... ... ... ... 10 4 14 25 to 35 yrs. ... 3 1 1 ... ... I 1 2 5 2 1 1 ... 1 ... 1 ... 5 1 1 ... 2 2 1 1 2 4 5 3 ... 3 ... 1 1 2 2 9 3 1 2 ... 1 I 2 ... 1 2 6 ... ... 1 ... ... ... ... ... 1 ... 23 20 43 35 to 45 yrs. ... ... ... ... ... 1 ... ... ... 1 1 1 ... 1 1 3 1 1 3 6 3 ... ... 1 2 ... 1 ... 6 1 2 1 1 1 4 ... 1 1 8 3 1 ... 3 ... 2 3 ... ... 6 3 ... ... ... ... ... ... ... ... ... ... 23 14 37 45 to 55 yrs. 1 ... ... ... ... 1 ... 1 1 2 3 3 1 1 1 2 ... 2 5 8 2 ... ... 2 3 3 3 ... 8 5 3 4 2 ... 1 ... 2 1 8 5 ... 2 ... ... 2 ... 2 1 4 3 ... 1 ... ... ... ... ... ... ... 1 26 24 50 55 to 65 yrs. 2 1 1 ... 1 2 2 6 3 4 4 3 3 1 4 3 1 11 12 2 •2 4 2 3 2 3 1 12 7 3 3 5 2 4 1 1 9 10 2 1 1 3 ... 1 1 3 4 8 ... ... ... ... ... ... ... ... ... ... 42 40 82 65 to 75 yrs. 3 2 2 3 ... 2 1 1 6 8 9 5 3 1 5 1 4 3 21 10 2 3 4 2 I 1 3 2 10 8 2 5 2 4 1 ... 5 1 10 10 5 5 2 2 2 2 2 3 11 12 ... 1 ... 1 ... ... ... ... ... 2 58 50 108 75 to 85 yrs. 3 1 2 ... 2 1 1 2 8 4 2 2 2 1 1 2 3 2 8 7 4 5 ... ... ... 2 1 ... 5 7 3 2 1 1 4 1 9 3 4 2 3 •2 2 1 3 3 12 8 2 ... ... 1 ... ... 2 ... 4 1 46 30 76 Over 85 yrs. 2 ... ... ... ... ... 1 1 3 1 ... 2 ... 1 ... ... 2 2 2 5 1 ... 2 ... ... ... ... 1 3 1 1 1 ... 3 2 ... 1 2 4 6 ... 2 1 ... 1 1 ... ... 2 3 ... ... ... ... ... ... ... ... ... ... 14 16 30 Totals 20 8 7 5 4 6 7 9 38 28 37 26 16 15 16 16 23 15 92 72 27 23 16 17 19 14 19 10 81 64 30 31 21 28 21 16 21 11 93 86 •22 22 14 16 11 14 13 13 60 65 3 2 2 2 ... ... 2 ... 7 4 371 319 690 Total Deaths, each Ward 66 164 145 179 125 11 Standardized Death-rate 9 05 12.61 1073 13.90 10.95 10.37 9 The deaths occurred in the several wards as follows:— Ward. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. Total. Death-rate per 1000 as recorded. Infantile Death-rate. Town 28 12 IO 16 66 8.75 66.66 Chase 63 31 32 38 164 12.19 82.23 Ordnance 5° 33 33 29 145 10.37 88.65 Green Street and Ponders End 61 49 37 32 179 13.44 104.81 Bush Hill Park 44 30 25 26 125 10.59 82.35 Hadley and Cockfosters 5 4 ... 2 11 10.03 0.00 Whole of District 251 59 137 143 690 11.27 86.85 The following table classifies the 690 deaths above mentioned according to their sex and age, and allots each death to its own ward :— 10 Fifty-nine of the deaths registered were those of persons over 80 years of age, 29 being males and 30 females. Five of the women were over ninety, the eldest being 99, their combined ages amounting to 461 years, while two of the men lived to see 91. The more important causes of death as registered were:— Malignant Disease 57 ; Heart Disease 60 ; Pulmonary Tuberculosis 54; Bronchitis 58 ; Old Age 49 ; Pneumonia 61 ; Bright's Disease 16; Diphtheria 10; and Scarlet Fever 3 ; whilst among the children Premature Birth accounted for 47 deaths; Diarrhoea 9; and Respiratory Diseases 18. INQUESTS. The following is a complete list of the Inquests held in Enfield during the year. Cause of Death. Sex. Age. Date. Verdict. Poisoning by carbolic acid, self administered F 33 yrs. Jan. 4 Suicide, insane. Drowning F 44 Jan. 24 Suicide, insane. Drowning F 25-30 Jan 25 Open verdict. Bronchopneumonia M 19 days Feb. 1 Natural causes. Fatty infiltration of the heart muscle. Heart failure M 68 yrs. Feb. 18 Natural causes. Dilated heart. Syncope M 63 „ Feb. 19 Natural causes. Chronic bronchitis and pneumonia F 65 .. Mar. 4 Natural causes. Rupture of the Coronary Artery M 75 .. Mar. 8 Natural causes. Internal injuries and shock. Crushed between buffers of trucks while shunting M 27 „ Mar. 12 Misadventure. Rupture of a Pelvic Vessel and Haemorrhage F 30 Mar. 15 Natural causes. Drowning F 25 Mar. 16 Open verdict. Acute inflammation of the ears. Coma. Exhaustion ... M 1 3/4 Mar. 17 Natural causes. Acute suffocative Cedema of the lungs F 69 Apr. 6 Natural causes. 11 inquests—continued. Cause of Death. Sex. Age. Date. Verdict. Drowned M 8 yrs. Apr. 10 Accidental death. Cerebral haemorrhage F 58 " Apr. 10 Natural causes. Syncope due to prolonged exertion acting on a weak and flabby heart M 59 " Apr. 15 Natural causes. Measles. Pneumonia F 34 " Apr. 24 Natural causes. Interstitial Nephritis. Arterial Sclerosis. Heart failure M 70 " May 15 Natural causes. Shock from scalds M 2 " May 15 Accidental causes. Syncope due to pressure on the heart of an over-filled stomach M 71 " May 19 Natural causes. Burns from the ignition of celluloid M 18 „ May 20 Misadventure. Distension of the stomach with gas. Convulsions M 10 wks. June 5 Natural causes. Fatty degeneration of the heart. Syncope. Rupture of a vessel on the brain F 68 yrs. June 9 Natural causes. Fracture of skull and laceration of brain sustained by falling from a window while cleaning the same M 14 .. June 23 Accidental causes. Perforation of a Pyboric ulcer. Peritonitis. Shock M 33 .. June 24 Natural causes. Arterio Sclerosis. Angina Pectoris. Syncope M 60 ,, June 25 Natural causes. Drowned M 64 " July 5 Open verdict. Drowning M 12 " Aug. 8 Misadventure. Serous effusion on brain M 39 " Aug. 11 Natural causes. Pulmonary Tuberculosis, consequent upon injuries received through being knocked down by a motor car M 8 ½ " Aug. 13 As "Cause of death." 12 Inquests—continued. Cause of Death Sex. Age. Date. Verdict. Tetanus Poisoning, consequent upon injuries received through falling over a stone ... M 51 yrs. Aug. 16 Misadventure. Rupture of an aneurism on the aorta F 61 " Aug. 20 Natural causes. Septic Peritonitis F 27 " Aug. 20 Death due to the insertion by the deceased of an instrument into the Uterus. Cerebral haemorrhage ... F 54 " Aug. 29 Natural causes. Fracture of skull & other injuries Fracture of neck and other injuries sustained by being drawn into machinery while at his work M M 27 yrs. 37 yrs. Sep. 3 Sep. 5 Killed on railway by a light engine Misadventure. Disease of Coronary Arteries of the heart. Heart failure F 66 yrs. Sep. 21 Natural causes. Bullet wound traversing the heart and lungs. Shock M 47 ys. Oct. 9 Accidental causes. Fracture of the skull. Haemorrhage on brain. Collision between a cycle and a motor car... M 41 yrs. Oct. 17 Accidental causes. Pressure of fluid on the heart. Collapse of lung. Syncope ... F 73 yrs Oct. 22 Natural causes. Haemorrhage on brain from a ruptured artery F 55 yrs. Oct. 27 Natural causes. Shock from burns F 75 yrs. Nov. 21 Accidental causes. Spasm of the heart from disease of the Coronary Artery and senile degeneration ... F 79 yrs- Dec. 1 Natural causes. Drowning F 18 yrs. Dec. 3 Open verdict. Shock from burns M 3 yrs. Dec. 6 Accidental causes. Inanition M 1 day Dec. 9 Natural causes. 13 INFANTILE DEATHS. The total number of deaths that occurred amongst infants under one year, including 10 registered outside the district, was 115, giving a death-rate of 86-85 Per thousand births, as compared with a death-rate of 110 for England and Wales, and 117 for the 96 great towns, including London. The corresponding figures for Enfield for the last three years were: —1912,76-30; 1913,87-15; and 1914, 80-75. The number of deaths of illegitimate children was 3, which gives a death-rate of 93-75 per thousand illegitimate infants. 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 7 0.92 66.66 Chase 25 1.80 82.23 Ordnance ... 25 1.79 88.65 Green Street & Ponders End 37 2.70 104.81 Bush Hill Park ... 21 1.77 82.35 Hadley and Cockfosters ... 0 O.OO 0.00 115 1.87 86.85 The chief causes of death were Premature Eirth (including congenital defects), 47; Diarrhoea, 9; Respiratory Diseases, 18; Whooping Cough, 5 ; Measles, 6. H The accompanying diagram shows the relative proportions of these deaths in graphic form. Comparing this diagram with the similar one for last year, we find Premature Births less by 3, Diarrhoea less by 17, and Respiratory Diseases increased by 6. 15 MATERNITY AND CHILD WELFARE. It may perhaps be within the recollection of the Council that this question was at their Meeting in October, 1914, deferred until November, 1915. In the meantime, on September 1st, 1915, the Notification of Births (Extension) Act, 1915, came into operation, and on November 26th I submitted the following Special Report:— Public Offices, Enfield, 26th November, 1915. SPECIAL REPORT OF THE MEDICAL OFFICER OF HEALTH. NOTIFICATION OF BIRTHS AND INFANT WELFARE Gentlemen, Pursuant to your resolution that I should bring up a Report and detailed estimate for a comprehensive scheme on lines indicated by the Local Government Board and capable of being put into force gradually, I now beg to submit the following:— Memorandum. Local Government Board. 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 a te-natal Clinic for expectant mothers. (2) The home visiting of expectant mothers. (3) A Maternity Hospital or beds at a hospital, in which complicated cases of pregnancy can receive treatment. Remarks by M.O.H. as under:— This is already done by the Middlesex County Council. Provided for in scheme submitted. do. Cases at present sent to Hospitals at Tottenham and London and no difficulty has been experienced. i 6 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 after parturition, whether in the mother or in 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, Crfeche, 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. The Board of Guardians' arrangements for dealing with this have so far been quite satisfactory. Cases at present sent to Hospitals at Tottenham and London and no dfficulty has been experienced. do. Provided for in the scheme submitted. do. do. 17 The consideration of the question of making provision for the care of mothers, expectant mothers, and young children in Enfield involves the establishment of not less than four Centres, known as "Maternity and Infant Welfare Centres." In the scheme I am now submitting I venture to think that the most suitable buildings for such purposes are to be found in the Sunday Schools or Mission Rooms of the various religious bodies in the district. The number of rooms required in a centre would be not less than three, one large, as reception room, a room for weighing babies, and a consultation room for the doctor. The following appear to me to be suitable for the work in the various populous parts of the district:— Ordnance Ward. The Totteridge Road Baptist Sunday School, or the St. George's Hall. Green Street and Ponders End Ward. The Church Hall in Durants Road, or the Congregational Sunday School, High Street, Ponders End. Bush Hill Park Ward. Congregational Sunday School Room, Main Avenue. The Town and Chase Wards. The Congregational Institute, Armfield Road, or St. Luke's Institute, Morley Hill. I have not consulted any of the authorities of these Institutes, but from inquiries made in different parts of London I find that the use of such like places is almost invariably given free, subject to a small charge for light and attendance. At the commencement of the scheme I think that each Centre should be opened not less than two consecutive hours once a fortnight, and when the attendance grows, once a week. Under this arrangement the Centres at Enfield Wash and Bush Hill Park would be opened one week, and those at Ponders End and Chase Side the following week. The Staff required at each Centre would comprise a Doctor, Superintendent (who would be the Health Visitor), an Assistant Superintendent, who would weigh the babies, assist the Superintendent in keeping records, and filling in cards. 18 This is the minimum amount of help required at each Centre when at work, but from the experience of places where such Centres are working, there appears to be no difficulty in obtaining as much voluntary help as is required by the Superintendent. When a Centre is opened babies are brought by their mothers for inspection and advice. It does not necessarily follow that the mother is under the impression that anything ails her baby. The baby is stripped and weighed, advice given to mothers on the clothing and general hygiene of the infant by the Superintendent, and if necessary the baby is taken in to see the doctor, who, in case of treatment being necessary, either in mother or child, would refer them to the family doctor, or special hospital, as the case may require. A special feature of the meetings is an address by the Superintendent, or some other specially qualified person, to both the expectants and mothers, on the care of their own health and that of their offspring, and on the general hygiene of the home and surroundings. I am given to understand that a certain amount of difficulty is experienced in finding out expectant mothers and inducing them toattend. To this we must trust to our Health Visitor, who, in the course of her visits, would doubtless come in touch with many. At the present moment we have no machinery for starting even one centre, and I venture to suggest as a preliminary that a Health Visitor should be appointed and the opening of the Centres deferred until such time as our Health Visitor shall have made herself acquainted with the district, and by the routine visiting entailed by the Notification of Births Acts shall have become acquainted with many mothers and infants. From all that has been said it will be evident that the appointment of a Lady Health Visitor is a matter of the utmost importanceShe should be qualified as a Health Visitor and Sanitary Inspector. Her duties, shortly, would be to visit houses where births had been notified, keep records, and generally to act as advised by the M.O.H.; also in case of necessity and in the ordinary course of her visiting to act as an Assistant Sanitary Inspector. I offer the suggestion that arrangements might be made with the Education Committee to allow the School Nurses to devote part of their time to assist the Health Visitor. This arrangement works very well in many parts of the country where it has been tried. The following estimate allows for the working of two of the proposed Centres per week, as I think that for a beginning fortnightly meetings would suffice. 19 Estimate. Per Annum. £ s. d. Medical Attendance, 2 hours per day at 10/6 per hour 109 4 0 One Health Visitor, including £5 allowance per annum for bicycle 105 0 0 Rent (if any) of buildings for Centres, and including fire, light and attendance 52 0 0 Printing and Stationery 20 0 0 Incidental Expenses 10 0 0 Total £296 4 0 to which must, of course, be added any payment made in respect of the School Nurses if my suggestion is approved by the Education Committee. The scheme adopted by the Council will require to be submitted to the Local Government Board for their approval. This scheme appears to me to be the minimum required if the recommendations of the Local Government Board are to be followed, and as a result of a series of visits made by myself and Mr. Munro to various Centres in London, I can recommend it for your adoption as a commencement and one easily capable of being enlarged as occasion arises. My feeling is that in a very short time after the thing is in full work, a second Health Visitor will be found necessary to carry it out efficiently. I am, Gentlemen, Yours obediently, W. P. WARREN, Medical Officer of Health. 20 At the Meeting of the Council in December the following motion was carried :— That subject to the approval of the Local Government Board, for which application be at once made, the scheme outlined in the foregoing report of the Medical Officer of Health be adopted. That a Health Visitor be immediately appointed, on the terms suggested, and that applications for such appointment be invited by advertisement in the Local Papers and Sanitary Record. That the Medical Officer of Health be instructed to:— (a) Submit a definite proposal in regard to Medical Attendance at four Centres; (b) Make enquiries as to whether the places mentioned are available as Centres fortnightly at first, and weekly should the need arise, and if so, on what terms; and (c) Confer with the Education Committee as to the practicability of giving effect to his suggestion in regard to obtaining part time services of the School Nurses, and if so, on what terms. The deaths for the last five years will be found in Table I. Table II. shows 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. 21 TABLE I. Vital Statistics of Whole District during 1915 and previous Years. Year Population estimated to Middle of each Year Births Total Deaths Registered in the District Transferable Deaths Nett Deaths belonging to the District Uncorrected Number Nett Under i Year of Age At all Ages Number Rate Number Rate of Nonresidents registered in the District of Residents not registered in the District Number Rate per 1,000 Neit Births Number Rate I 2 3 4 5 6 7 8 9 10 II 12 13 1910 58,282 1,431 ... 24.55 521 8.92 21 89 109 75.47 589 10.10 1911 56,344 1,290 1,314 23.14 622 11.03 24 134 185 140.79 732 12.97 1912 57.267 1,379 1,401 24.46 472 8.24 23 127 107 76.30 576 10.05 1913 59.146 1,316 1.331 22.50 493 8.33 40 124 116 87.15 577 9.75 I914 60,682 1,306 1,325 21.83 482 7.94 30 154 107 80.75 606 9.98 1915 61,173 1,310 1,324 21.64 590 9.64 44 144 115 86.85 690 11.27 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. 22 TABLE II. Cases of Infectious Disease notified during the year 1915. Notifiable Disease. Number of Cases Notified. Total Cases Notified in Each Ward. Total Cases Removed to Hospital. At Ages—Years. At all Ages. Under 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 Cockfosters. Small Pox 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera. Plague 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 93 ... 27 52 8 5 1 ... 19 1 36 12 23 ... 83 Erysipelas 37 ... 3 ... 4 14 14 2 6 4 10 10 7 ... ... Scarlet Fever 148 2 22 102 17 5 ... ... 40 14 75 13 6 ... 128 Typhus Fever 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 18 ... ... 8 7 2 1 ... ... ... 17 ... ... 1 17 Relapsing Fever (R) Continued Fever (C) 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 2 ... ... ... ... 2 ... ... ... ... 1 ... 1 ... ... Cerebro-spinal Meningitis 1 ... ... ... 1 ... ... ... ... ... ... 1 ... ... 1 Poliomyelitis 5 1 4 ... ... ... ... ... 1 ... 4 ... ... ... ... Ophthalmia Neonatorum 5 5 ... ... ... ... ... ... ... ... 3 2 ... ... ... Pulmonary Tuberculosis 102 ... 1 12 27 48 12 2 13 3 26 33 25 2 ... Other forms of Tuberculosis 51 3 11 24 6 3 4 ... 6 1 16 21 7 ... ... Totals 462 11 68 198 70 79 32 4 85 25 188 92 69 3 229 23 TABLE III. Causes of, and Ages at Death during Year 1915. Causes of Death. Nett Deaths at the subjoined ages of " Residents " whether occurring within or without the District Total Deaths whether of "Residents" or "NonResidents" in Institutions in the District All Ages Under i year 1 and under 2 l 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and und<r65 65 and upwards All causes Certified 690 115 44 48 28 29 80 132 214 67 Uncertified... ... ... ... ... ... ... ... ... ... ... Enteric Fever 1 ... ... ... ... 1 ... ... ... 4 Small Pox ... ... ... ... ... ... ... ... ... ... Measles 32 6 5 19 2 ... ... ... ... ... Scarlet Fever 3 ... ... ... 2 i ... ... ... 10 Whooping Cough 13 5 4 4 ... ... ... ... ... ... Diphtheria and Croup 10 ... 3 3 4 ... ... ... ... 13 Influenza 6 ... ... ... 2 ... 1 1 2 ... Erysipelas ... ... ... ... ... ... ... ... ... ... Phthisis Pulmonary Tuberculosis 54 ... ... ... 3 13 27 10 1 ... Tuberculous Meningitis 3 1 ... 1 ... 1 ... ... ... ... OtherTuberculousdiseases 7 2 ... 3 1 ... ... ... i 2 Cancer, malignant disease 57 ... ... 1 ... 1 4 ... 18 2 Rheumatic Fever 2 ... ... ... ... 1 1 ... ... ... Meningitis 5 2 ... 2 1 ... ... 18 ... ... Organic Heart disease 60 4 ... 1 3 2 7 25 3 Bronchitis 58 10 5 2 ... ... 10 31 5 Pneumonia (all forms) 61 8 17 4 1 ... 7 11 13 4 Other diseases of Respiratory Organs 7 ... 1 1 ... ... 2 ... 3 1 Diarrhœa and Enteritis 11 9 1 1 ... ... ... ... ... 1 Appendicitis & Typhlitis 4 ... ... ... 3 1 ... ... ... 1 Cirrhosis of Liver 5 ... ... ... ... ... 1 2 2 ... Alcoholism 2 ... ... ... ... ... ... 2 ... ... Nephritis and Bright's Disease 16 ... ... ... ... 2 3 7 4 3 Puerperal Fever ... ... ... ... ... ... ... ... ... ... Other accidents & diseases of Pregnancy and Parturition 1 ... ... ... ... ... 1 ... ... ... Congenital Debility and Malformation, including Premature Birth 47 47 ... ... ... ... ... ... ... ... Violent Deaths, excluding Suicide 17 ... 1 1 4 2 3 2 4 9 Suicide 2 ... ... ... ... ... 2 ... ... ... Other Defined Diseases 187 18 7 s 2 4 16 31 104 9 Diseases ill-defined or unknown 19 3 ... ... ... ... 5 5 6 ... Totals 690 115 44 48 28 29 80 132 214 67 Cerebro-spinal Meningitis 1 1 ... ... ... ... ... ... ... ... Poliomyelitis 2 1 1 ... ... ... ... ... ... ... Old Age 49 ... ... ... ... ... ... 1 48 4 Apoplexy 32 ... ... ... ... ... 2 8 22 4 24 TABLE IV. Infant Mortality. 1915. 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. 1 3-4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 months 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths, under One Year. All Causes Certified 39 8 8 5 60 20 12 14 9 115 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 1 2 3 6 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-Cough ... ... ... ... ... ... 1 1 3 5 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases 1 ... ... ... 1 ... ... ... 1 2 Meningitis (not Tuberculous) ... ... ... ... ... ... I 1 ... 2 Convulsions 2 1 1 ... 4 1 ... ... ... 5 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 ... ... ... 5 3 1 ... 10 Pneumonia (all forms) ... ... 1 1 2 2 1 2 1 8 Diarrhœa ... ... ... ... ... ... ... 3 1 4 Enteritis ... 1 1 2 2 1 ... ... 5 Gastritis ... ... ... ... ... 1 1 ... ... 2 Syphilis ... ... ... ... ... 1 ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at birth ... ... ... ... ... ... ... ... ... ... Atelectasis 2 ... ... ... 2 ... ... ... ... 2 Congenital Malformations 1 ... ... ... 1 ... ... ... ... 1 Premature Birth 23 2 1 ... 26 ... ... ... ... 26 Atrophy, Debility and Marasmus 3 2 3 4 12 6 2 ... ... 20 Other Causes 7 1 1 ... 9 2 1 3 ... 15 Totals 39 8 8 5 60 20 12 14 9 115 Nett Births in the year:—legitimate, 1292; illegitimate, 32. Nett Deaths in the year :—legitimate infants, 112 ; illegitimate infants, 5. 25 ZYMOTIC DISEASES. The following table shews the deaths Registered in the District from the seven chief zymotic diseases during the past five years:— Disease. 1911 1912 1913 1914 1915 Small Pox 0 0 0 0 0 Scarlet Fever 4 3 3 6 11 Diphtheria 9 19 19 24 20 Measles 28 14 6 8 32 Enteric Fever 5 1 2 5 4 Whooping Cough 16 8 3 8 13 Epidemic Enteritis 94 9 13 17 6 156 54 46 68 86 The actual Enfield deaths were :—Scarlet Fever 3, Enteric Fever 1, and Diphtheria 10. The figures for Scarlet Fever, Diphtheria and Enteric Fever include all the deaths that occurred at the Enfield and Edmonton Joint Isolation Hospital, where patients belonging to other districts are also received. 26 ENFIELD ZYMOTIC DEATH-RATE. The zymotic death-rate, after deducting 21 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 1.06 per thousand. Disease. 1914 1915 Deaths. Death-rate. Deaths. Death-rate. Scarlet Fever 3 .04 3 .04 Diphtheria 15 •24 10 •16 Enteric Fever 2 •03 1 •01 Erysipelas 0 •00 0 •00 Measles 8 •13 32 •52 Whooping Cough 8 •13 !3 •21 Epidemic Enteritis 17 •28 6 •09 53 •87 65 1.06 NOTIFICATION OF INFECTIOUS DISEASE. The cases of Infectious Disease notified each quarter in the various wards are as set out in the accompanying table :— NOTIFICATION OF INFECTIOUS DISEASE, 1915. Disease. Town Ward. Chase Ward. Bush Hill Park Ward. Ordnance Ward. Green Street and Ponders End Ward Hadley and Cockfosters Ward. Totals Cases per 1000 population. Quarters Total. Quarters Total. Quarters Total. Quarters Total. Quarters Total. Quarters Total. 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st 2nd 3rd 4 th Scarlet Fever 6 2 4 2 14 27 6 2 5 40 1 2 1 2 6 23 22 14 16 75 7 1 3 2 13 ... ... ... ... ... 148 2.41 Diphtheria ... 1 ... 2 3 5 4 1 9 19 6 6 4 7 23 6 5 6 19 36 ... 2 7 3 12 ... ... ... ... ... 93 1.52 Erysipelas ... 3 1 ... 4 2 1 1 2 6 1 1 3 2 7 1 3 4 2 10 2 ... 4 4 10 ... ... ... ... ... 37 0.60 Enteric Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 9 5 17 ... ... ... ... ... ... 1 ... ... 1 18 0.29 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 2 0.03 Poliomyelitis ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 ... 3 ... 4 ... ... ... ... ... ... ... ... ... ... 5 0.08 Ophthalmia Neonatorum ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 3 1 ... 1 ... 2 ... ... ... ... ... 5 0.08 Cerebro Spinal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 0.01 Totals 21 66 37 146 38 1 309 5.05 Diphtheria Carriers ... ... ... ... ... ... 1 ... 1 2 ... ... 1 ... 1 3 ... 3 6 12 ... ... ... 4 4 ... ... ... ... ... 19 0.31 Full Totals 21 68 38 158 42 1 328 5.36 27 The following table gives the number of cases of each infectious disease notified during the past five years :— Disease. 1911 1912 1913 1914 1915 Scarlet Fever 111 98 158 221 148 Diphtheria 53 77 72 84 93 Membranous Croup 1 ... ... ... ... Enteric Fever 8 2 2 7 18 Small Pox ... ... ... ... ... Erysipelas 49 40 32 39 37 Continued Fever ... 1 ... ... ... Puerperal Fever 1 7 5 7 2 Cerebro Spinal Fever ... 1 1 ... 1 Poliomyelitis ... ... 9 3 5 Ophthalmia Neonatorum ... ... ... 9 5 223 226 279 370 309 SCARLET FEVER. This disease showed a very considerable diminution in the number of cases as compared with the previous year—148 against 221. These 148 cases occurred in 103 houses, as follows :— No. of houses where 1 case occurred 92 „ „ „ 2 „ „ 5 „ „ „ 3 „ „ 3 „ „ „ 4 „ „ 1 „ „ „ 5 „ „ 1 „ „ „ 28 „ „ ...(a school) 1 Total number of houses where cases occurred 103 Total number of cases 148 28 Ninety-three cases of Diphtheria occurred during the year in 72 houses, as follows :— No. of houses where 1 case occurred 57 „ „ „ 2 „ „ 12 „ „ „ 3„ „ 1 „ „ „ 4„ „ 1 „ „ „ 5„ „ 1 Total number of houses where cases occurred 72 Total number of cases 93 In 11 weeks no cases were reported, and for 16 weeks we only received one each week. On receipt of a notification it is my invariable custom to swab as many contacts as I can find, and by this means I was able to discover 19 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. During the last three months of 1915 forty cases of this disease occurred, chiefly in the Eastern side of the district, and in the course of my inquiries I was fortunate enough to discover several inveterate carriers, who, no doubt, were the cause of the trouble, for shortly after I had detected and isolated them, the disease quieted down again. This entailed a large amount of work on my part, as several of the children had to be visited and swabbed not less than 9 times, at intervals of one week, before I was able to say they were free from infection. ENTERIC FEVER. Eighteen cases of this disease were notified during the year, of which one died. Ten of these cases, which occurred in two houses adjoining each other, were due to infection brought here by a soldier, who most probably had a mild unrecognised attack in camp, and was in a highly infectious condition on his return home on sick leave. 29 POLIOMYELITIS. Only five cases were notified during the year, and there were two deaths. TUBERCULOSIS. The following table shows the number of notifications of Pulmonary and other forms of Tuberculosis received :— Ward. Pulmonary. Other. Fresh cases. Old cases re-notified Duplicates. Fresh cases. Old cases re-notified Town 3 ... ... 1 ... Chase 13 3 20 6 1 Ordnance 26 3 25 16 3 Green Street and Ponders End 33 13 38 21 1 Bush Hill Park 25 3 14 7 ... Hadley and Cockfosters 2 ... ... ... ... Total 102 22 97 51 5 First Notifications 153 Old ones re-notified, i.e., some by fresh doctors, or coming into district, or under old regulations 27 Duplicate notifications, i.e., those which report the entering and leaving of Sanatoria 97 Total notifications 277 30 Sex (1st Notifications). Form. Males Females Pulmonary 59 43 Other 31 20 Totals 90 63 Deaths. The number of deaths from this disease during the year is shown in the following table, viz. :— Ward. Pulmonary. Others. Death-rate per 1,000 Population. Town 6 1 •92 Chase 6 3 •59 Ordnance 10 ... •71 Green Street and Ponders End 21 4 1•87 Bush Hill Park 11 3 1•18 Hadley and Cockfosters ... ... ... Totals 54 10 1•04 31 Occupations of Patients. Factory and Workshop 43 Building lines, Labourer, or other Outdoor workers 16 Clerk or Shop Assistant 8 Domestic Service 4 Married Women 11 Army 3 Children 49 Steward 1 Nurse 1 Chemist 1 Draughtsman 1 No occupation IS 153 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 see that the window of his room is always kept open. The cases are also visited periodically, and should any insanitary conditions be found to exist, their removal is at once seen to. The number of houses and rooms disinfected for this complaint during the year was 69, and the articles—clothing, bedding, etc.—dealt with numbered 407. MEASLES. This disease was most prevalent in Ponders End. I became aware of 349 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 has measles in the house until one or more of the children are suffering from Pneumonia, the most usual cause of death in this disease. 32 The following table shows the incidence of this disease in the various wards :— Ward. No. of cases which came to our notice. Ordnance 67 Ponders End 148 Bush Hill Park 61 Chase 58 Town 15 Hadley — 349 Measles and German Measles, by an Order of the Local Government Board, became notifiable on January 1st, 1916. ENTERITIS. Eleven deaths occurred from this disease during the year, of which 9 were infants under one year. 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 128 Diphtheria 83 Enteric Fever 18 33 BACTERIOLOGICAL WORK. All the Bacteriological work is done in my own laboratory, including the preparation of media, cultivation of growths, etc. Every swab is "planted," and grown in an incubator. No. Positive Negative Percentage of Positives. Swabs 987 109 878 11.04 Sputum 196 47 149 23.97 Widal 5 2 3 40.00 Totals 1,188 158 1,030 13.29 VACCINATION. I have received the following information from Mr. Inns, the Vaccination Officer, in respect of children vaccinated up to June, 1915 :— Number of cases on lists 1306 Vaccinated 399 Exempted 516 Removed 123 Dead 72 Not otherwise accounted for 196 SCHOOLS. There are 22 Public Elementary Schools in Enfield, including a Deaf Centre—52 departments in all. The Secondary Schools include the Boys' Grammar School and the County School for Girls, also one large and a number of small private establishments. There is also the Poor Law School, known as Chase Farm Schools, and a Roman Catholic Institution known as the St. Joseph's Home for Destitute Boys. Periodical examinations of the conditions of the Public Elementary Schools are made by one of the Inspectors, and any defects found are brought to the notice of the Education Committee and Managers, with the result that they are usually remedied without delay. I consider that the sanitary conditions are quite satisfactory. 34 FOOD. I am pleased to be able to make a favourable report this year of the way in which the dairy business is conducted. The improvement previously noted has been maintained, more especially in the retail milk shops, but I could wish some of the dairy farmers would appreciate still more the benefit of cleanliness. The cows are inspected bi-annually by Mr. H. H. Hide, M.R.C.V.S., the Veterinary Surgeon appointed by the Council, and I append copies of his two reports for the year, which are very satisfactory, and tend to show that the Enfield dairy-farmer is fully alive to the danger of keeping tuberculous cows on his premises. From his reports it appears there has been some reduction in the number of cows kept during the year, as in April he examined 452 cows—distributed among 19 cow-keepers, while at his December visit he only found a total of 409, which were distributed between 18 cow-keepers. (Copy.) Holly House, Lower Edmonton. April 21st, 1915. Dear Sir,— I beg to report that I have completed the inspection of the milch cows throughout the district as shown in the accompanying list. I made a careful examination of each udder, with very satisfactory results. There were very few cases of disease of any kind and those were of the usual description common to milch cows at all times, chiefly resulting from mammitis. In only two cases was it necessary to make a bacteriological examination of the milk and in neither was the germ of Tuberculosis present. A certain number of the animals were in rather poor condition, due in a great measure to the high price of food, and I also found a few affected with skin diseases, but this is not uncommon at this time of the year after being together in the sheds during the winter. These were under treatment and appeared to be progressing favourably. I think the cows, generally, may be considered as in a satisfactory state and properly kept. I am, dear Sir, Yours obediently, (Signed) H. H. Hide, M.R.C.V.S. T. W. Scott, Esq. 35 (Copy.) Holly House, Lower Edmonton. Dec. 17th, 1915. Dear Sir,— I beg to report that I have completed the inspection of the milch cows in the district, as shown in the accompanying list. I made a careful examination of each udder and found a few affected with induration of the quarter, resulting from previous attack of mammitis, a usual condition among milking cows. There were also two or three cases of mammitis, which, under treatment, appeared to be progressing favourably. With regard to Tuberculosis of the Udder, I did not meet with any cow showing symptoms of that disease, a very satisfactory condition which I think may be attributed to the effects of periodic inspection and the practice of owners of disposing of cows showing unaccountable symptoms of udder disease. The animals throughout the district had benefitted by the favourable conditions of pasture during the autumn, and their appearance was satisfactory. I am, dear Sir, Yours obediently, (Signed) H. H. Hide. M.R.C.V.S. T. W. Scott, Esq. I have also received from Dr. Young, County Medical Officer, the following return of work done during the year by the County Council Inspectors under the Sale of Food and Drugs Act, in this district:— Article. No. of samples taken. No. found adulterated. Percentage. Butter 26 6 23.07 Milk 81 45 55.55 Margarine 1 — — Raisins 1 — — Almond Oil 1 — — Zinc Ointment 1 — — Epsom Salts 1 — — Tincture of Iodine 1 — — 113 51 No. of Prosecutions 6 No. of Convictions 5 The figures for adulterated samples of milk (given above) include a number of samples very slightly below the standard. 36 OTHER FOODS. Mr. Fred Wilson and Mr. T. M. Boswell, the Assistant Sanitary Inspectors, who hold the Certificate of the Royal SanitaryInstitute for Inspector of Meat and Fords, visit the slaughterhouses, of which there are 18 in the district, every week, and as will be seen by a reference to the Sanitary Inspector's Report, they paid 819 such visits, examined 2,106 carcases, and secured the surrender of 17 parcels of diseased organs. The sanitary condition of the slaughter-houses is, on the whole, satisfactory. BAKEHOUSES. I visited the 46 bakehouses in the district, of which 41 are in use, the other 5 either being empty or used for other purposes, and found them all in a satisfactory condition. HOUSING. The Regulations issued by the Local Government Board, under Section 17 (1) Housing, Town Planning, etc., Act, 1909, are receiving close attention. The following are the particulars required by Article 5 of these Regulations to be included in my Report:— Number of dwelling-houses inspected 353 Number of houses considered on inspection to be in a condition so dangerous as to be unfit for human habitation 0 Number of houses closed and demolished without orders 0 Number of houses closed 0 Number of houses closed and demolished following Closing Orders 0 Number of representations made to the Local Authority with a view to the making of Closing Orders 0 Number of Closing Orders made 0 *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. 37 In addition to the work done under these Regulations, the following number of houses have also been inspected during the year:— On account of Infectious Disease 475 From house to house, or on account of complaints or otherwise 2,019 2,494 making a gross total of house inspections for the year of 2,847, which gives a percentage of 23.5 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. Thirteen 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 . In a Stevenson' s screen in Minimum thermometer grounds of the Public Offices. Standard Hygrometer Terrestial Radiation Thermometer In the grounds of the Earth Thermometer Offices. Campbell-Stakes Sunshine Recorder On the roof of the Solar Radiation Thermometer Public Offices. Daily records have been taken, and monthly returns sent to the Meteorological Office. 38 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:— 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 1. Sections 15, 16, 17, 20, 21, 23, 24, 25, 27, 29, 30, 31, 32 and 33 of Part 2. Sections 34, 35, 36, 37, 38, 43, 44, 46, 47, 48, 49, 50 and 51 of Part 3. Sections 52, 53, 54, 55, 56, 57, 59, 62, 63, 64, 65 and 68 of Part 4. All of Parts 5 and 6. Section 81 of Part 7. All of Parts 8 and 9. Section 95 of Part 10. 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 43 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 the Year 1915. During the year the following streets have been metalled, channelled, paved, etc., under section 150 of the Public Health Acts, 1875:— Queen's Road. Stanley Road. 39 METEOROLOGICAL STATISTICS, 1915. Month. Barometer. Temperature. Rainfall. Sunshine. Highest. Lowest Highest (Max.) Lowest (Min.) Mean. January 30.50 on 19th 28.74 on 3rd 56.0 on 15th 44.0 on 4th 48.4 INS. 3.39 HRS. 44.1 February 30.468 on 26th 28.768 on 13th 52.0 on 3rd and 4th 25.0 on 25th 39.5 2.90 66.3 March 30.450 on 9th 29.462 on 18th 57.5 on 6th 24.0 on 30th 41.7 1.06 98.2 April 30.35 on 2nd 29.266 on 7th 70.5 on 30th 29.0 on 1st, 15th & 18th 46.25 .92 181.3 May 30.458 on 9th 29.666 on 13th 78.5 on 26th 32.0 on 15th 53.0 2.83 231.5 June 30.298 on 12th 29.756 on 29th 87.0 on 8th 37.5 on 1st 59.2 1.33 229.2 July 30.272 on 2nd 29.356 on 17th 82.0 on 4th 46.0 on 13th 61.4 4.48 187.6 August 30.352 on 23rd 29.554 on 2nd 75.0 on 1st, IIth & 26th 44.0 on 30th 65.8 2.59 168.5 September 30.408 on 6th 29.492 on 29th 77.0 on 16th and 17th 35.5 on 30th 57.0 1.82 198.0 October 30.348 on 18th 29.374 on 31st 65.5 on 12th 31.5 on 30th 487 1.81 65.0 November 30.758 on 21st 29.187 on 9th 56.0 on 12th 21.0 on 9th 38.25 2.16 70.91 December 30.478 on 19th 28.943 on and 25th 56.0 on 10th 27.0 on 9th 40.7 6.09 33.1 40 Approximately 200,000 super yards of tar-spraying has been done to roads and footpaths. Thirty-nine houses have been certified as completed and fit for human habitation ; 20 houses have had additions made thereto; 19 factories and 16 other buildings constitute the amount of building operations during the year. 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. 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, W. P. WARREN, Medical Officer of Health. 41 Public Offices, Enfield. May 31st, 1916. REPORT OF THE INSPECTOR OF NUISANCES FOR THE YEAR 1915. 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, 1915, 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 353 From House-To-House apart from this Act 1,560 On Account of Infectious Disease 328 On Account of Phthisis 147 On Account of Complaint, by occupants or otherwise 459 2,847 23 Factories 92 107 Workshops and workplaces, including 12 laundries 392 44 Outworkers' premises inspected 56 46 Bakehouses in the district, of which 41 are in use 284 18 Slaughter-houses inspected frequently 819 26 Cowsheds inspected frequently 218 58 Dairies and Milkshops inspected frequently 262 22 Schools 75 39 Shops where ice-cream is made 1ll Public-house urinals inspected 99 Conveniences at Railway Stations inspected 8 Fish Shops : Total number of visits 306 Coffee and Eating Houses : Total number of visits 30 — 2,752 Visits to absentees excluded from Elementary Schools 753 Visits in connection with cases of Infectious Disease 2,205 Ditto, ditto, Phthisis 669 Other inspections, including works in progress 9,519 Smoke observations 11 13,157 18,756 42 NOTICES ISSUED. Statutory— Provision of dustbins 35 For repairs to houses, drains, and abatement of nuisance 82 Providing- sufficient water-closets 38 Paving of yards 19 Overcrowding 7 Provision of sink waste-pipes 4 185 Informal— Notices 16 Letters sent in lieu of notices 668 684 Other Notices Issued under Infectious Diseases Acts— To Occupiers 472 1,685 To Head Teachers at Schools 1,213 2,554 Other Letters Sent 2,716 The following are the works carried out as the result of the notices or letters:— Houses or parts of houses cleansed, repaired, etc. 379 Roofs repaired 325 Gutters and down pipes repaired 360 Cesspools emptied 246 House drains cleared, repaired, etc. 273 House drains tested, examined, etc. 441 House drains re-constructed 16 Soil-pipes and drains ventilated, including repairs to ventilators 89 Sink-wastes disconnected or repaired 19 New sinks provided 2 Ventilation provided to rooms, or windows made to open 47 Closets provided with proper flushing cisterns or water supply 255 New closets provided 19 43 Closets repaired, covered, cleansed, etc. 251 Storage cisterns repaired, covered, cleansed, etc. 71 Water laid on or restored 12 Samples of water taken 1 Yards paved, or existing paving made good 139 Ventilation provided under ground floors, causes of dampness removed, etc. 227 Dustbins repaired, or new ones provided 357 Manure heaps removed 110 Fowls and other animals removed 6 Other nuisances abated 14 Ditches cleaned out — Cases of overcrowding 13 DISINFECTION. Houses disinfected :— After infectious disease 240 After Phthisis 69 After Verminous cases 4 Rooms stripped and re-papered, etc., after occupa tion by cases of infectious disease 34 Ditto, ditto, by cases of Phthisis 26 Articles of clothing, bedding, etc., disinfected 3,483 Ditto, ditto, destroyed 4 3,860 Library Books disinfected 62 Cases of Scarlet Fever removed to Hospital 128 Cases of Diphtheria removed to Hospital 83 Cases of Enteric Fever removed to Hospital 17 — 228 Private patients removed to Hospital and Infirmary r 15 Gipsy vans removed from the district 21 Articles or parcels of unsound food destroyed 20 We have been able to inspect a large number of dwellings from house to house, a good number of these inspections being made at the commencement of the summer, when the opportunity was taken advantage of to impress upon occupiers the precautions necessary to keep their dwellings free from flies. 44 Defects found were remedied as speedily as possible, but in view of the difficulties existing in connection with the supply of labour and materials, delay in some cases was unavoidable, but where these difficulties were simply used as an excuse for postponement or evading requirements, the necessary steps were taken to compel the carrying out of works required. The number of visits paid re children excluded from Elementary Schools during the year was 753, and the total number of inspections and visits for all purposes made by the staff of the Sanitary Department was 18,756. REMOVAL OF HOUSE REFUSE. The removal of house refuse received very close attention, in order to secure the clearing of all refuse from houses and premises regularly each week. The numbers of loads collected were:— Cart loads, 4,884; van loads, 2,154. Total, 7,038. Quantities of trade refuse were also collected from business 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 1915 there were 95 workshops, 12 laundries, and 46 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 Writtt* n Notices. Prosecutions. Factories (including Factory Laundries) 92 Workshops (including Workshop Laundries) 392 15 Bakehouses 284 9 ... Total 768 24 ... 45 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 Clean lines 11 11 ... ... Want of Ventilation 1 1 ... ... Overcrowding 3 3 ... ... Want of Drainage of Floors ... ... ... Other Nuisances 9 9 ... ... Sanitary Accommodation: ... ... Insufficient 4 4 ... ... Unsuitable or Defective 11 11 ... ... Not separate for sexes ... ... ... ... Offences under the Factory and Workshops Act— Illegal occupation of underground bakehouse ... ... ... Breach of special sanitary requirements for bakehouses 61 61 ... ... Other Offences 8 8 ... ... Total 108 108 ... 46 Homework. Nature of Work Lists received from Employers. Notices served on Occupiers as to keeping or sending Lists. Sending twice in the year. Sending once in the year. Lists Workmen Lists Workmen Making Wearing Apparel 18 20 35 35 14 Lace Curtains, &c. ... ... ... ... 2 Artificial Flowers 2 2 ... ... ... Boot Making ... 1 2 ... Brush Making, &c. ... ... 1 1 ... Bells, &c. 1 1 ... ... ... Plating ... ... 1 1 ... Boxes 1 i ... ... Total 22 24 38 39 16 Nine addresses of outworkers have been forwarded to other districts. EMPLOYMENT OF CHILDREN ACT, 1903. During the year 240 names were received of children employed out of school hours, and in 95 cases contraventions of the bye-laws were found, and remedied. The total number of interviews and visits made under this Act was 331. MILK. Frequent inspections have been made of the cowsheds, dairies, and milk shops 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. 47 The periodical cleansing and lime washing 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-nine shops where ice-cream was made or sold were inspected during the summer, 111 visits being made to them, and, where necessary, instructions given in regard to the cleansing of utensils and premises. COFFEE AND EATING HOUSES. During the year an inspection was made of all the Coffee and Eating Houses, when the premises and arrangements were generally found to be in good order and condition. DISINFECTION. The articles disinfected included a large number of blankets and other articles belonging to troops quartered in the district. UNSOUND MEAT AND FOODS. In this connection Mr. Fred Wilson and Mr. T. M. Boswell, Assistant Inspectors, paid frequent visits to the slaughter-houses, shops, and markets, the number of inspections for this purpose being:— Slaughter-houses 819 Shops 629 Stalls in Markets 822 2,270 The number of carcases examined during the visits to slaughter-houses is as follows:— Cows 147 Oxen 188 Calves 9 Sheep 1,160 Pigs 602 2,106 During the examination of these carcases while being dressed 17 organs 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. 48 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:— May 1st.—Bag of winkles. Oct. 11th.—Box of salted herrings. HOUSE DRAINAGE. The drains of every house inspected under the Housing, Town Planning, etc., Act Regulations, and where infectious disease occurred, were examined and tested, and any defects found made good without delay. All new work was closely supervised and tested during progress, also a final test of smoke and water applied to all reconstructions on completion. A record, with plan, is kept of these. PUBLIC ELEMENTARY SCHOOLS. By an arrangement between the Council and Education Committee the Sanitary arrangements attached to the Non-provided Schools are regularly cleansed and flushed each, day by one of the out-door staff of the Sanitary Department, and periodical inspections were also made of the sanitary conveniences at the various Council Schools in the district. THE WAR. The following members of the staff and employees of the Sanitary Department have joined His Majesty's Forces:— T. M. Boswell, 2nd Assist. Inspector of Nuisances, 2nd London Sanitary Coy., R.A.M.C. N. Smith, 3rd Assist. Inspector of Nuisances, Sanitary Coy.,. R.A.M.C. S. Coulter, 1st Clerk, 2nd London Sanitary Coy., R.A.M.C. H. Wiggett, 2nd Clerk, Royal Bucks Hussars. F. Staker, Sewer Flusher, 13th Kensington Battn., London Regiment. J. Flack, Dustman, Royal Engineers. The Staff remaining have, with the assistance of one transferred from the Surveyor's Department, loyally co-operated in the endeavour to carry out the work of the Sanitary Department as thoroughly as possible under conditions which have at times proved difficult, and I am glad to take this opportunity to acknowledge and thank both them and the outdoor staff for all that they have done. I am, Gentlemen, Your obedient Servant, A. J. MUNRO, M.R. San. I. Inspector of Nuisances.