enfo 11 THE URBAN DISTRICT COUNCIL OF ENFIELD. Annual Report of the MEDICAL OFFICER OF HEALTH FOR 1919, 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 1911 56,338 Population at middle of 1919 61,645 Number of inhabited houses 12,040 Vital Statistics. Birth-rate per 1,000 living 16.98 Recorded Death-rate per 1,000 living 9.92 Standardized Death-rate per 1,000 living 10.27 Infantile Mortality per 1,000 births 56.35 Zymotic Death-rate per 1,000 living 00.17 Tuberculosis Death-rate per 1,000 living 00.94 Vital Statistics of Wards. Ward. Area in Acres. Persons per Acre. Population. Birthrate. Standardized Deathrate Infantile Mortality. Zymotic Deathrate. losis Deathrate. Town 1,717 4.5 7,834 10.21 8.71 37.50 .OO 0.63 Chase 4,478 2.9 13.419 17.28 12.56 77.58 .07 0.96 Ordnance 2,060 6.7 13.937 17.22 9.12 41.66 .14 0.64 Green Street arid Ponders End 1,330 10.1 13,481 18.32 9.97 60.72 .29 1.26 Bash Hill Park 762 15.7 11,976 15.78 1o.88 68.77 .33 1.16 Hadley & Cockfosters 2,254 00.4 998 10.02 4.13 OO.OO .00 O.OO PUBLIC OFFICES, ENFIELD. June 9th, 1920. Medical Officer of Health's ANNUAL REPORT FOR 1919. To the Urban District Council of Enfield. Mrs. Newman & Gentlemen, I have the honour to submit to you my Annual Report for the year 1919, 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. POPULATION. The number of inhabited houses in the district on June 30th, 1919, was 12,040, and allowing 5.12 inhabitants per house, I estimate the population on that date as being 61,645, although I have no doubt that this very considerably underestimates the number of people in the district in consequence of the War. Enfield is divided into six wards as follows:— Ward. Inhabited Houses. Uninhabited Houses. Total. ation. Town 1.530 19 1,549 7,834 Chase 2,621 22 2,643 13,419 Ordnance 2,722 7 2,729 13.937 Green Street and Ponders End 2,633 13 2,646 13,481 Bush Hill Park 2,339 7 2,346 11,976 Hadley & Cockfosters 195 4 199 998 12,040 72 12,112 61,645 4 VITAL STATISTICS. The number of births registered in the District was:— Boys. Girls. Total. 499 499 998 including 26 illegitimate births, i.e., 2.6o per cent, of the total. The births, including those registered outside the District, 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 11 13 8 9 8 6 12 13 39 41 80 10.21 Chase 22 21 35 26 30 30 39 29 126 106 232 17.28 Ordnance 24 33 26 33 24 34 42 24 116 124 240 17.22 Green Street and Ponders End 26 24 25 27 32 35 42 36 125 122 247 18.32 Bush Hill Park 15 16 25 22 25 33 26 27 91 98 189 15.78 Hadley and Cockfosters ... ... 1 ... 1 2 ... 6 2 8 10 10.02 Births outside the District ... 20 29 49 Totals 98 107 120 117 120 140 161 135 519 528 1,047 16.98 for District 205 237 260 296 1,047 The births of hoys and girls, including those registered outside the District, also birth-rates for the last three years, were:— Year. Boys. Girls. Total. Birth-rate per 1,000 pop. Illegitimate Birth-rate per 1,000 pop. 1917 560 541 1,101 17.91 .60 1918 517 454 971 15.78 .79 1919 519 528 1,047 16.98 .79 5 DEATHS. The deaths registered in the district during the year were 575, of which 269 were males and 306 females, giving a crude death-rate of 9.32. To these must be added 139 deaths of Enfield residents registered outside the district, and from this total must be subtracted 102 deaths of non-residents occurring in the district, which brings the nett number of deaths to 612 for the year, giving a recorded death-rate of 9.92. 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 the standardized death-rate of 10.27. Birth rate. Recorded Death-rate. Standardized Death-rate. Infantile Death-rate. England & Wales 18.5 — — 89.00 London 18.6 — 13.6 85.00 96 Great Towns. including London 19.1 — 13.9 93.00 ENFIELD 16.98 9.92 10.27 56.35 I regret that I am unable, through circumstances not under my control, to quote the Standardized Death-rate for England and Wales. The corresponding figures for Enfield for the three previous years are:— 1916. 1917. 1918. Recorded death-rate 9.60 10.68 12.48 Standardized do. 9.93 11.05 12.79 6 The deaths occurred in the several wards as follows:— Ward. I St Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total. Death-rate per 1,000 as recorded. Infantile Death-rate. Town 29 9 10 18 66 8.42 37.50 Chase 56 39 34 34 163 12.14 77.58 Ordnance 40 23 31 29 123 8.82 41.66 Green Street and Ponders End 42 27 28 33 130 9.64 60.72 Bush Hill Park 50 26 21 29 126 10.52 68.77 Hadley and Cockfosters 1 — 1 2 4 4.00 00.00 Whole of District 2l8 124 125 145 612 9.92 56.35 Sixty-five of the deaths registered were those of persons over 80 years of age, 25 being males and 40 females, one woman and one man dying at the advanced ages of 97. The more important causes of deaths as registered were:— Influenza 72; Heart Disease 69; Malignant Disease 69; Bronchitis 60; Pulmonary Tuberculosis 49; Old Age 47; Pneumonia 39; Apoplexy 34; Other Respiratory Diseases 22; Bright's Disease 14; whilst among the children Premature Birth accounted for 16 deaths;' Respiratory Diseases 8; Atrophy, Debility and Marasmus 7; Enteritis 4, and Congenital Malformations 4. INQUESTS. Thirty-three inquests were held in Enfield during the year, and the verdicts given were as follows:— Natural Causes 17 Suicides 9 Misadventure 3 Accidental Causes 2 Open Verdict 2 Total 33 7 INFANTILE DEATHS. The total number of deaths that occurred amongst infants under 1 year, including ten registered outside the district, was 59, giving a death-rate of 56.35 per thousand births, as compared with a death-rate of 89 for England and Wales, and 93 for the 96 great towns, including London. The corresponding figures for Enfield for the last three years were:—1916, 57.83; 1917, 88.10; and 1918, 66.94. The number of deaths of illegitimate children was 9, which gives a death-rate of 183.67 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 3 0.38 37.50 Chase 18 1.34 77.58 Ordnance 10 0.71 41.66 Green Street and Ponders End 15 1.11 60.72 Bush Hill Park 13 1.08 68.77 Hadley and Cockfosters 0 0.00 00.00 Whole of District 59 °'95 56-35 This rate is very much lower than last year. The chief causes of death were Premature Birth (including Congenital Defects) 27 ; Respiratory Diseases 8 ; and Enteritis 4. 8 MATERNITY AND CHILD WELFARE. I am very pleased to be in a position to report most favourably on the progress this work has made during the year; the appended figures show how the attendance has increased. The mothers appreciate more and more the care and attention given to the Babies, and spread the good news among their neighbours. The result of this was that in April we opened each Centre once a week instead of every other week, and the attendance at once showed the necessity of such a step. In the "Daily Sketch" Competition three of our babies were selected to go to London for the final trial, and all three came home with prizes. Baby Week. This was celebrated on July 9th and 10th. A Garden Party was held in the Manse Garden, Chase Side, and another one in the garden of St. James' Lodge, Enfield Highway. The weather was beautiful. A Band was present on each occasion. Tea was appreciated by the large number of people present, and photographs were taken of mothers and babies. Our most pressing need at present is a further supply of Voluntary Helpers. Ante-Natal Clinics. It was thought wise to move both of these from Lancaster Road and The Library, Enfield Highway, to Waldron Hall, Enfield Town, and the Alma Road Schools, Ponders End, respectively; the change proved successful as the increased attendance shows. Maternity Wards. The arrangement entered into with the Edmonton Board of Guardians as to the supply of beds for Maternity cases, necessitous or otherwise, came into force in June last, and has, so far, been a great success ; the shortage of housing accommodation has sent in women who in ordinary circumstances would not have required it, and they invariably speak well of their treatment there on their return home. The following statistics are worthy of careful study:— 9 Visits. Town and Chase Bush Hill Park. Hadley. Ordnance Ponders End. Totals. Birth Notification Visits 145 138 — 174 193 650 Do. Re-visits 234 245 6 191 212 888 Children, 1-5 yrs. Visits 153 150 — 186 198 687 Infant Mortality do. — — — 1 9 10 General Visits 66 36 — 103 81 286 Ante-Natal Visits — — — 37 42 79 Post-Natal Visits — — — 4 2 6 Blank Visits 75 63 — 82 103 323 Child Death Visits — — — 4 — 4 Ophthalmia Neonatorum Visits 2 3 — 2 1 8 Totals 675 635 6. 784 841 2.941 Feeding, &c. Feeding. Town and Chase. % Bush Hill Park. % Hadley. % Ordnance. % Ponders End. % Totals. % Natural 105 72 100 72 — — 109 62 128 66 442 68 Artificial 35 24 30 21 — 40 23 45 23 150 23 Mixed 5 3 8 6 — — 25 14 20 10 58 9 Cradle Used 53 36 45 32 — — 72 41 54 28 224 34 10 Attendances at Centres. Centre. New Attendances. Reattend ances. No. on Register 1.1.19. No. on Register 31.12.19. No. Or Meetings. Average attendance per Meeting. Town and Chase I30 1,690 178 331 43 42.5 Bush Hill Park 101 1,219 181 288 43 30.6 Ordnance 175 2,515 313 477 50 53.8 Ponders End 139 1,289 198 333 40 35.7 Totals 545 6,713 870 1,429 176 41.2 Ante-Natal Clinics. Centre. New Attendances. Reattendances. No. on Register. Average attendance per Meeting. Waldron Hall, Genotin Road 54 15 68 5.7 Alma Road Council School, Ponders End 26 12 39 1.8 Totals 80 27 107 3.2 No. of births notified:—1,035, 62% of which were visited. It was found impossible to re-visit systematically all cases, but re-visits were paid where considered to be of special importance, such as:—First Babies; Twins; Babies artificially fed, or likely to be; Illegitimate; Dirty houses; Ill-health in mother or baby. We deeply regret the loss of Mrs. McEwan, the Chairman of the Committee, who passed away on the 18th February, 1920. Her enthusiasm for the work was marvellous, and she never begrudged time or money to forward it in every way that she could. I am afraid it will be very hard 10 fill her place. 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. 11 TABLE I. Vital Statistics of Whole District during 1919 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 1 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 nett Births. Number. Rate. 1914 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 1916 61,450 1,336 1,366 22.22 495 8.05 54 149 79 57.83 590 9.60 1917 61,470 1,064 1,101 I7.9I 582 9.46 75 150 97 88.10 657 10.68 1918 61,506 948 971 15.78 683 11.10 73 158 65 66.94 768 12.48 1919 61,645 998 1,047 16.98 575 9.32 102 139 59 56.35 612 9.92 Area of District in acres (land and inland water), 12,601. Total population at ali ages, 56,338; Total families or separate occupiers, 12,040, at Census 1911. 12 TABLE II. Cases of Infectious Diseases notified during the year 1919. Notifiable Disease. Number of Cases Notified. Total Cases Notitied in Each Ward. Total Cases Removed to Hospital. At Ages—Years. At all Ages. Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards Town. Chase. nance Green st. and ponders End. Bush Hill Park. Hadley and Cockfasters. Small Pox 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera. Plague 0 ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membraneous Croup) 56 1 15 35 3 2 ... ... 1 8 9 22 15 1 45 Diphtheria Carriers 2 ... ... 2 ... ... ... ... ... ... 1 1 ... ... ... Erysipelas 26 1 1 2 4 8 9 1 2 6 5 4 9 ... ... Scarlet Fever 276 1 32 213 22 8 ... ... ... 95 49 78 33 7 184 Typhus Fever 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Relapsing Fever Continued Fever 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 454 6 175 267 5 1 ... ... 33 183 21 192 22 3 ... German Measles 38 ... 9 24 5 ... ... ... 5 9 8 8 7 1 ... Cerebro-spinal Meningitis 1 ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... Poliomyelitis 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 8 8 ... ... ... ... ... ... ... 2 2 1 3 ... ... Pulmonary Tuberculosis 106 ... ... 10 25 57 ... 1 9 18 26 37 16 ... ... Other forms of Tuberculosis 21 1 6 4 7 3 ... ... 3 6 7 4 ... ... ... Encephalitis Lethargica 3 ... ... ... 1 1 1 ... 1 ... ... 1 1 ... ... Malaria 2 ... ... ... 1 1 ... ... ... ... 1 1 ... ... ... Totals 993 18 238 558 73 8l 23 2 68 327 129 350 107 12 229 TABLE III. Causes of, and Ages at Death during Year 1919. Causes of Death. Nett Deaths at the subjoined ages of "Residents," whether occurring wiihin 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 I5and under 25 25 and under 45 45 and under 65 65 and upwards All causes Certified 609 59 23 17 22 40 81 141 226 136 Uncertified 3 I 2 Enteric Fever ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... Measles 1 ... ... ... ... ... ... ... ... ... Scarlet Fever 1 ... ... 1 ... ... ... ... ... 12 Whooping Cough 2 1 ... 1 ... ... ... ... ... ... Diphtheria and Croup 6 ... ... 2 4 ... ... ... ... 13 Influenza 49 2 2 3 2 9 14 11 6 30 Erysipelas 3 2 ... ... ... ... ... 1 ... ... Pulmonary Tuberculosis 48 ... ... ... 2 12 22 11 1 1 Tuberculous Meningitis 5 2 2 1 ... ... ... ... ... 1 Other Tuberculous Diseases 5 ... ... 1 ... ... 2 2 ... 1 Cancer, Malignant Disease 66 ... ... ... ... 1 5 34 26 3 Rheumatic Fever 4 ... ... ... ... 2 1 1 ... ... Menigitis 5 ... 1 ... 1 1 1 ... 1 1 Organic Heart Disease 63 ... ... ... ... 4 7 20 32 11 Bronchitis 46 2 1 ... ... ... 2 7 34 17 Pneumonia (all forms) 39 6 13 3 2 2 6 3 4 2 Other Diseases of Respiratory Organs 18 ... ... 1 ... 1 1 6 9 5 Diarrhoea and Enteritis 8 6 2 ... ... ... ... ... ... 1 Epidemic Diarrhœa 1 1 ... ... ... ... ... ... ... ... Appendicitis and Typhlitis 2 ... ... ... ... 1 1 ... ... 2 Cirrhosis of Liver 2 ... ... ... ... ... ... 1 1 ... Alcoholism 2 ... ... ... ... ... 1 1 ... ... Nephritis & Bright's Disease 12 ... ... ... ... ... 1 4 7 3 Puerperal Fever 1 ... ... ... ... ... 1 ... ... 1 Other accidents & diseases of Pregnancv and Parturition 3 ... ... ... ... 1 2 ... ... ... Congenital Debility and Malformation, including Premature Birth 28 27 ... ... ... ... ... 1 ... ... Violent Deaths, excluding Suicide 9 ... ... ... 3 1 2 3 ... ... Suicides 7 ... ... ... ... 1 2 3 1 ... Other Defined Diseases 173 10 1 4 7 4 10 31 106 28 Diseases ill-defined or unknown 3 ... ... ... 1 ... 1 1 ... 4 Totals 612 59 23 17 22 40 82 141 228 136 Included in above — Old Age 43 ... ... ... ... ... ... 1 42 3 Apoplexy 32 ... ... ... ... ... 2 4 26 3 Cerebro-spinal Meningitis 2 ... ... ... 1 ... ... ... ... Poliomyelitis 1 ... ... ... ... ... ... 1 ... ... Encephalitis Lethargica 2 ... ... ... ... ... 1 1 ... ... 14 TABLE IV. Infant Mortality. Nett Deaths from stated causes at various Ages under One Year of Age. causes of death. Under 1 week I to 2 weeks. 2 to 3 weeks. 3 to 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 25 6 1 1 33 8 10 5 3 59 Uncertified ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... Chicken Pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... 1 ... ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... 2 ... ... ... 2 Tuberculous Meningitis ... ... ... ... ... ... 1 1 ... 2 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ...... ... 1 ... 1 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 ... ... 1 1 ... ... ... 2 Pneumonia (all forms) ... ... ... ... ... 2 3 ... 1 6 Diarrhœa ... ... ... ... ... 1 1 ... ... 2 Epidemic Diarrhœa ... ... ... ... ... ... 1 ... ... 1 Enteritis ... ... ... ... ... 1 1 1 1 4 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... ... ... ... 1 Ricketts ... ... ... ... ... ...... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 2 1 ... ... 3 ... ... ... ... 3 Congenital Malformation 2 1 ... ... 3 ... 1 ... ... 4 Premature Birth 14 1 ... ... 15 1 ... ... ... 16 Atrophy, Debility and Marasmus 5 1 1 ... 7 ... ... ... ... 7 Other Causes 2 1 ... 1 4 ... 1 1 1 7 Totals 25 6 1 1 33 8 10 5 3 59 Nett Births in the year Legitimate, 998; Illegitimate, 49. Nett Deaths in the year:—Legitimate Infants, 50; Illegitimate, 9. 15 ZYMOTIC DISEASES. The following table shows the deaths Registered in the district from the seven chief zymotic diseases during the past five years:— Disease. 1915 1916 1917 1918 1919 Small Pox ... ... ... ... ... *Scarlet Fever 11 5 1 ... 12 * Diphtheria 20 10 11 3 15 Measles 32 ... 16 2 1 *Enteric Fever 4 3 1 4 ... Whooping Cough 13 5 4 12 2 Epidemic Enteritis 6 8 2 ... 1 Totals 86 31 35 21 31 * The actual Enfield deaths were:—Scarlet Fever 1, and Diphtheria 6. The figures for Scarlet Fever, Diphtheria and Enteric Fever include all the deaths that occurred in the Enfield and Edmonton Joint Isolation Hospital, where patients belonging to other districts are also received. 16 ENFIELD ZYMOTIC DEATH-RATE. The zymotic death-rate, after deducting 4 deaths of persons from outside the district who died in the Isolation Hospital (which is situate in Enfield), is 0.22 per thousand. Disease. 1918. 1919. Deaths. Death-rate. Deaths. Death-rate. Scarlet Fever ... .00 . .01 Diphtheria ... .00 6 .09 Enteric Fever 3 .04 ... .00 Erysipelas 1 .01 3 .04 Measles 2 .03 1 .01 Whooping Cough 12 .19 2 .03 Epidemic Enteritis ... .00 1 .01 Totals 18 .29 14 .22 INFECTIOUS DISEASES. Scarlet Fever. Two hundred and seventy-six cases of Scarlet Fever occurred during the year in 176 houses, as follows:— No. of houses where 1 case occurred 143 ,, ,, ,, 2 cases ,, 24 ,, ,, ,, 3 ,, ,, 5 ,, ,, ,, 4 ,, ,, 2 ,, ,, ,, 5 ,, ,, 1 ,, ,, ,, 57 ,, ,, 1 Total number of houses where cases occurred 176 Total number of cases 276 17 The mildness of the 276 cases of this disease which occurred during the year may be judged by the fact that only one death occurred. This is an exceptionally low rate of mortality in this disease. Diphtheria. Fifty-six cases of this disease occurred during the year in 49 houses, as follows:— No. of houses where 1 case occurred 43 ,, ,, ,, 2 cases ,, 5 ,, ,, ,,3 ,, ,, 1 Total number of houses where cases occurred 49 Total number of cases 56 The incidence of this disease was also slight, and the deaths few in number. I think that this is entirely due to the extra care and attention given by the Medical Practitioners in the District. They are all most particular to swab all suspicious cases of sore throat, and the infective cases are dealt with immediately. Enteric Fever. There were no cases of this disease notified during the year. Poliomyelitis. There were no cases of this disease notified during the year. Cerebro-Spinal Fever. There was one case of this disease notified during the year, which proved fatal. Chicken Pox. This disease was made notifiable in May for a period of 3 months, and there were 31 cases notified. This notification was enforced on account of the prevalence of Small Pox in London. No case, however, of the latter disease fortunately occurred in this District. Encephalitis Lethargica. This disease, a new comer, became compulsorily notifiable on the 1st of January, and there were three cases notified, two of which were fatal. 18 Tuberculosis. The following table shows the number of notifications of Pulmonary and other forms of Tuberculosis received during the year:— Ward. Pulmonary. Other. Fresh Cases. Old Cases re-notified. Duplicates. Fresh Cases. Old Cases re-notified. Duplicatels. Town 9 8 3 ... ... Chase 18 2 20 6 ... ... Ordnance 26 ... 31 7 ... ... Green Street and Ponders End 37 5 54 4 2 ... Bush Hill Park 16 2 31 1 I 2 Hadley and Cockfosters ... ... ... ... ... ... Totals 106 9 144 21 3 2 First Notifications 127 Old Cases re-notified, i.e., some by fresh doctors, or coming into District, or under old regulations 12 Duplicate Notifications, i.e., those which report the entering and leaving of Sanatoria 146 Total notifications 285 Sex (1st Notifcations). Form. Males. Females. Pulmonary 63 43 Other 8 13 Totals 7i 56 19 Deaths. The number of deaths from this disease during the year is shown in the following table, viz.:— Ward. Pulmonary. Other. Death-rate per 1,000 Population. Town 3 2 0.63 Chase 10 3 0.96 Ordnance 7 2 0.64 Green Street and Ponders End 16 1 1.26 Bush Hill Park 12 2 1.16 Hadley and Cockfosters — — 0.00 Totals 48 10 0.94 Measles and German Measles. The following numbers of notifications of this disease were received from the different wards:— Ward. Measles. German Measles. Town 33 5 Chase 183 9 Ordnance 21 8 Green Street and Ponders End 192 8 Bush Hill Park 22 7 Hadley and Cockfosters 3 1 Totals 454 38 20 There was only one death from this disease during the year, and this of a child between the ages of 1 and 2 years. Although this disease was fairly prevalent throughout the year, the figures show that only one child died of it. The question of appointing a Visitor for looking after these cases of Measles was considered by the Council towards the latter end of the year, and no doubt the arrangement will come into effect during the coming one. Enteritis. Four deaths occurred from this disease during the year, all of which were infants under one year. Epidemic Diarrhœa. One death of an infant under one year occurred from this disease during the 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, 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 184 Diphtheria 45 FOOD. 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. The total number of cows referred to in these reports were 456 in April, and 426 in December. 21 [Copy] Holly House, Lower Edmonton, N. April 19th, 1919. 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 carefully examined each udder and again found a satisfactory absence of disease of any kind among them, even the ordinary cases of chronic udder lesions being fewer than usual. This is due, to a certain extent, to the loss involved at the present time in retaining cows that are unable to produce their full amount of milk. There was no case of tuberculosis of the udder, and the samples of milk bacteriologically examined gave negative results. The herds throughout the district appeared, under the present difficult conditions of food and labour, to be in a sufficiently satisfactory condition. I am, Dear Sir, Yours obediently, (Signed) H. H. Hide, M.R.C.V.S. T. W. Scott, Esq. [Copy] Holly House, Lower Edmonton, N. 12th December, 1919. 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, and found only a small proportion of them affected with disease of any kind, and those were of the usual description, chiefly resulting from ordinary mammitis. Where necessary I made a bacteriological examination of the milk, but all proved to be free from tubercle. Under the present conditions of cow-keeping it is more economical to dispose of those having defective quarters which do not give a full yield of milk, and with the exception of cows otherwise valuable for breeding purposes, this course is generally adopted. The herds, generally throughout the district, appear to be well kept and in a satisfactory condition. I am, Dear Sir, Yours obediently, (Signed) H. H. Hide, M.R.C.V.S. T. W. Scott, Esq. 22 Messrs. Fred Wilson and T. M. Boswell, the Assistant Sanitary Inspectors, who hold the Certificates of the Royal Sanitary Institute for Inspectors of Meat and Foods, visit the slaughter-houses, of which there are 12 in the District, every week, and, as will be seen by a reference to the Sanitary Inspector's Report, they paid 686 such visits, examined 1,974 carcases, and secured the surrender of 47 parcels of diseased organs, etc. The sanitary condition of the slaughterhouses is, on the whole, satisfactory. BAKEHOUSES. I visited the 55 bakehouses in the district, of which 37 are in use, the other 18 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 (i) Housing, Town Planning, etc., Act, 1908, 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 0 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 appears 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. 23 The following number of houses have also been inspected during the year:— On account of Infectious Disease 819 From house to house, or on account of complaint or otherwise 1,667 2,486 making a gross total of house inspections for the year of 2,486, which gives a percentage of 20.5 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. NUISANCES, ETC. It will be seen from the particulars given in the Sanitary Inspector's Report that a 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. FACTORY AND WORKSHOP ACT, 1901. The information under this heading is set out on pages 29, 30 and 31 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. 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 Diseases (Prevention) Act, 1890. Came into force February ist, 1891. Public Health Acts (Amendment) Act, 1907. The following Sections came into force on July 27th, 1909:— 24 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, 40, 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. Every advantage is taken of the powers given by these Acts to secure the improvement of the sanitary condition and well-being of the District and its inhabitants. PRIVATE ROADS AND STREETS. I have received the following details from Mr. J. T. Briscoe, Engineer and Surveyor to the Council:— During the year 190,049 super yards of roadway have been treated by tar spraying. 1,500 super yards of flag-paving have been laid in Lincoln Road. THANKS. My thanks are again offered to the members of the Medical profe?sion 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, Mrs. Newman and Gentlemen, Yours obediently, W. P. WARREN, Medical Officer of Health. 25 Public Offices, Enfield. 9th June, 1920. REPORT OF THE INSPECTOR OF NUISANCES FOR THE YEAR 1919. To the Chairman and Members of The Urban District Council of Enfield. Mrs. Newman and Gentlemen, I beg to submit my report for the year ending December 31st, 1919, 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 0 From House-to-House apart from this Act 491 On Account of Infectious Disease 702 On Account of Phthisis 117 On Account of Complaint, by occupant or otherwise 1,176 2,486 56 Factories 118 67 Workshops and workplaces, including 4 laundries 217 • 40 Outworkers' premises inspected 62 55 Bakehouses, of which 37 are in use 157 18 Slaughter-houses, of which 12 are in use 686 26 Cowsheds inspected frequently 244 29 Dairies and Milkshops inspected frequently 165 22 Schools 84 Public-house urinals inspected 137 Conveniences at Railway Stations inspected 0 Fish Shops : Total number of visits 241 Coffee and Eating Houses : Total number of visits Shops where ice-cream is made:Total number of inspections 53 2,181 26 Inspections (continued). Visits re Employment of Children 15 Visits to absentees excluded from Elementary Schools 800 Visits in connection with cases of Infectious Disease 2,416 Visits in connection with Phthisis 475 Offensive Trades (excluding Fish-Shops) 62 Smoke observations 5 Other inspections, including works in progress 9,631 Petroleum Stores inspected 102 Visits in respect of Food Control matters 3,026 Visits re Shops Act 1,027 17,559 22,226 NOTICES ISSUED. Statutory:— Provision of dustbins 192 For repairs to houses, drains, and abatement of nuisances 175 Providing sufficient water-closets 121 Paving of yards 7 Overcrowding 0 Provision of sink waste-pipes 4 Cleansing of bake-house 0 To remove offensive accumulation 0 499 Informal:— Notices 3 Letters sent in lieu of notices 1,158 1,161 Other Notices issued under Infectious Diseases Acts:- To Occupiers 647 To Head Teachers at Schools 798 1,445 3,105 Other letters sent 2,785 27 The following are the works carried out as the result of the notices or letters:— Houses or parts of houses cleansed, repaired, etc. 552 Roofs repaired 284 Gutters and downpipes repaired 301 Cesspools emptied 244 House drains cleared, repaired, etc. 199 House drains tested, examined, etc. 132 House drains reconstructed 6 Disconnecting traps or chambers inserted 1 Soil-pipes and drains ventilated, including repairs to ventilators 32 Sink-wastes disconnected or repaired 57 Closets provided with proper flushing cisterns or water supply 173 New closets provided 3 Closets repaired, covered, cleansed, etc. 204 Storage cisterns repaired, covered, cleansed, etc. 47 Storage cisterns provided 8 Water laid on or restored 25 Samples of water taken from wells 1 Yards paved, or existing paving made good 49 Ventilation provided under ground floors and causes of dampness removed, etc. 77 Ventilation provided to rooms, or windows made to open 9 Dustbins repaired, or new ones provided 463 Manure heaps removed 52 Fowls and other animals removed 7 Other nuisances abated 20 Ditches cleaned out 4 Cases of overcrowding abated 1 Stables cleansed 5 28 DISINFECTION. Houses disinfected:- After infectious disease 313 After Phthisis 94 After verminous cases 3 Rooms stripped and re-papered, etc., after occupation by cases of infectious disease 70 Ditto, ditto, by cases of Phthisis 33 Articles of clothing, bedding, etc., disinfected 3,721 Ditto, ditto, destroyed 13 4,247 Library Books disinfected 50 Number of Schools disinfected 3 Cases of Scarlet Fever removed to Hospital 184 Cases of Diphtheria removed to Hospital 45 229 Private Patients removed to Hospital or Infirmary 1 Gipsy Vans removed from District 30 Articles or parcels of unsound food destroyed, or otherwise disposed of 95 Defects found were remedied as speedily as possible, but with difficulties still existing in connection with the supply of labour and materials, delay in some cases was unavoidable. Where necessary, however, 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 800, and the total number of inspections and visits for all purposes made by the staff of the Sanitary Department was 22,226. REMOVAL OF HOUSE REFUSE. The removal of house refuse received close attention, in order to secure the clearing of all refuse from houses and premises regularly each week. The quantity of refuse collected was approximately 8,293 tons. Quantities of trade refuse were also collected from business premises for which a charge was made. SALVAGE. The conditions with regard to this have altered very materially since the Armistice, waste paper soon became a drug in the market, and it was found that the collection of vegetable refuse for the feeding of pigs find to be discontinued, and difficulties arose also in the disposal of iron, tins and other waste matters. 29 We have, however, done our best to continue with the following results:— Kind of Refuse. Amount Collected. Amount Realised. Tons. cwts. qrs. lbs. £ s. d. Waste Paper 2 16 1 27 12 18 3 Old iron, tins, leather, etc. 23 i 1 5 24 17 0 Unsound foodstuffs, etc. 9 19 3 3 28 13 11 Totals 35 17 2 7 66 9 2 The remainder of the refuse was disposed of at the Council's shoots. FACTORY AND WORKSHOPS ACTS, 1901 & 1907. A register of all workshops is kept, and at the end of 1919 there were 63 workshops, 4 laundries, and 55 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) 118 6 ... Workshops (including Workshop Laundries) 217 ... ... Bakehouses 157 ... ... Total 492 6 ... 30 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 5 5 ... ... Want of Ventilation ... ... ... ... Overcrowding 1 1 ... ... Want of Drainage of Floors ... ... ... ... Other Nuisances 3 3 ... ... Sanitary Accommodation:— Insufficient 2 2 ... ... Unsuitable or Defective 14 14 ... ... Not separate for sexes ... ... ... ... Offences under the Factory and Workshops Acts:— Illegal occupation of underground bakehouse ... ... ... ... Breach of special sanitary requirements for bakehouses 33 33 ... ... Other Offences 5 5 ... ... Totals 63 63 ... ... 31 Homework. Nature of Work. Lists received from Employers. Notices Sending once in the year. Sending twice in the year. Occupiers as to keeping or sending Lists. Lists. Workmen. Lists. Workmen. Making Wearing Apparel 15 19 6 7 8 Artificial Flowers 2 2 2 2 ... Boot Making 1 1 ... ... ... Brush Making, &c. 2 2 ... ... ... Millinery 2 2 ... ... ... Embroidery 2 6 1 1 1 Paper Bags 1 1 ... ... ... Totals 25 33 9 10 9 Thirteen addresses of Outworkers have been forwarded to other districts. EMPLOYMENT OF CHILDREN ACT, 1903. During the year 45 names were received of children employed out of school hours, and in 4 cases contraventions of the Bye-laws were found and remedied. The total number of interviews and visits made under this Act was 15. MILK. Frequent inspections were 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. 32 UNSOUND MEAT AND FOODS. In this connection frequent visits were paid to the slaughterhouses, shops and markets, the number of inspections for this purpose being:— Slaughther-houses 686 Shops 213 Stalls in Markets 265 1,164 The number of carcases examined during the visits to slaughterhouses is as follows:— Cows 204 Oxen 402 Calves 2 Sheep 1,148 Pigs 218 Bullocks 0 1,974 During the examination of these carcases while dressing proceeding, 6 carcases or parts of, and 47 organs were found to be diseased. These were all surrendered by the owners, and either destroyed or disposed of in such a manner that they could not be used for food. The carcases generally were in good condition, and there was no case which necessitated the obtaining of a Magistrate's Order. There was also submitted for inspection various articles of food including dates and other fruits, fish, rabbits, bacon, parcels of meat, offal, etc., and as in each case they were found to be unfit for the food of man, a certificate to that effect was given so that the owner could secure replacement or return of the money paid from the wholesale dealer. The applicants for these certificates total 42. I am, Mrs. Newman and Gentlemen, Your obedient Servant, A. J. MUNRO, M.R.San. I. Inspector of Nuisances.