??? ??? ENFI2 AC 439(3) ??? THE URBAN DISTRICT COUNCIL OF ENFIELD. Annual Report of the MEDICAL OFFICER OF HEALTH FOR 1920, together with the Annual Report of the INSPECTOR OF NUISANCES. ENFIELD: STANLEY WOODP1ELD, WINDMILL HILL. Urban District Council or Enfield. With the Compliments of the Medical Officer of Health. PUBLIC OFFICES ENFIELD. THE URBAN DISTRICT COUNCIL OF ENFIELD. Annual Report of the MEDICAL OFFICER OF HEALTH FOR 1920, together with the Annual Report of the INSPECTOR OF NUISANCES. ENFIELD: STANLEY WOODFIELD, WINDMILL HILL. PUBLIC HEALTH STAFF. Medical Officer of Health:W. P. Warren, D.P.H. Inspector of Nuisances:A. J. Munro, M.R.San.I. Inspector of Nuisances' Staff:— 1st Assistant Fred Wilson, M.R.San.I. 2nd do. T. M. Boswell, A.R.San.I. 3rd do. Noel Smith, A.R.San.I. 1st Clerk Sydney Coulter, Cert.R.San.I. 2nd do. H. Wiggett. Pupil do. Miss M. J. Ridler. Outdoor Assistant and Ambulance Attendant J. Ellis. General Assistant J. Davis. Enfield Urban District. Area (including 412 acres water) 12,601 acres. Population at Census 1911 56,338 Population at middle of 1920 61,629 Number of inhabited houses 12,037 Vital Statistics. Birth-rate per 1,000 living 22.87 Recorded Death-rate per 1,000 living 9.57 Standardized Death-rate per 1,000 living 9.90 Infantile Mortality per 1,000 births 45.39 Zymotic Death-rate per 1,000 living 00.40 Tuberculosis Death-rate per 1,000 living 1.13 Vital Statistics of Wards. Ward. Area in Acres. Persons per Acre. Population. Birthrate. Standardized Deathrate Infantile Mortality. Zymotic Deathrate. Tuberculosis Deathrate Town 1,717 4.5 7,880 16.37 8.52 46.51 .50 1.01 Chase 4,478 2.9 13,430 23.08 10.55 68.75 .29 0.89 Ordnance 2,060 6.7 13,896 19.86 10.12 43.47 .43 1.51 Green Street and Ponders End 1,330 10.1 13,455 28.01 9.91 58.35 .44 1.26 Bush Hill Park 762 15.7 11,970 20.80 10.19 48.19 .41 1.00 Hadley & Cockfosters 2,254 00.4 998 12.02 5.18 00.00 .00 0.00 PUBLIC OFFICES, ENFIELD. June 21st, 1921. Medical Officer of Health's ANNUAL REPORT FOR 1920. To the Urban District Council of Enfield. Mrs. Newman & Gentlemen, I have the honour to submit to you my Annual Report for the year 1920, which I trust you will find satisfactory. The Report of your Sanitary Inspector, Mr. A. J. Munro, giving particulars of the work done in the Sanitary Department, is also incorporated. In accordance with the memorandum of the Ministry of Health as to the Annual Reports of Medical Officers of Health, I propose in the first instance to give some particulars of the physical features and general character of the District and condition of its population. Physical Features. Enfield is one of the largest parishes in England, being sevenand-a-half miles long from east to west, about three-and-a-half miles across from north to south, and comprises about 20 square miles. It is situated ten miles north of London, and is bounded on the north by Hertfordshire, on the east by Essex, on the South by Edmonton and Southgate, and on the west by South Mimms and Hertfordshire. 5 It contains 12,601 acres, including 412 acres of water, and naturally divides itself into three-parts:—the Western, mainly agricultural, with centres of population at Hadley Wood and Cockfosters, is situate on the London clay, and is hilly in character, the highest point in the District being at "Stormont" (near Potters Bar) 418 feet above Ordnance Datum. The Central, including the Ridgeway, Old Town, Bush Hill Park, Clay Hill and Forty Hill, is, like the Western, partly on the London clay, and the remainder on soil of a loamy nature with gravel below. Bush Hill Park is now almost entirely built upon, the inhabitants being mostly industrial. The Eastern part of the District, the lowest point of which (41 feet above Ordnance Datum) is found near the Flour Mills, Ponders End, lies in the Lea Valley. The soil is of loam, lying on a deep substratum of gravel. There are two principal centres of population, viz., Ponders End and Enfield Lock, and the inhabitants are mainly employed in local factories, horticulture and market gardening. In addition to the Royal Small Arms Factory at Enfield Lock, there are the following works: The Edison and Swan Electric Light Co., The Enfield Ediswan Cable Co., the General Iron Foundry, The Cosmos Lamp Works, the Ruberoid Co., the Corticine Floor Covering Co., the Brimsdown Lead Works, Messrs. T. Morson and Sons, Messrs. Edwardson's Patent Glue Works, the Titchfield Works, the Auto-Tool Co., the Vulcan Works, Messrs. T. Reddaway and Co., the Portable Tool Co., while there are also many smaller works and several steam laundries in the District. In addition to the employment found in the above mentioned factories, also in agriculture and horticulture, a large number of Enfield residents find their occupation in London, for which purpose the district is served by two Railway Companies, also two lines of tramways. I am not aware of any particular occupation which exercises any influence on the public health. 6 Enfield is well provided with parks and recreation grounds, the Council having purchased and devoted to the use of the public no less than 170 acres of land. There is a public park in the Ordnance, Green Street and Ponders End, and Bush Hill Park Wards respectively. The Town Ward boasts of a beautiful park (23 acres) as well as "Chase Green," and the Chase Ward contains the "North Enfield Cricket Ground" lately enlarged, and a large park of 62 acres known as "Hilly Fields," a name which by no means does justice to its natural beauties. Population. The number of inhabited houses in the district on June 30th, 1920, was 12,037, and allowing 5.12 inhabitants per house, I estimate the population on that date as being 61,629. When the results of the Census are published we shall then obtain a reliable figure once more.— Enfield is divided into six wards as follows:— Ward. Inhabited Houses. Uninhabited Houses. Total. Population. Town 1.539 13 1,552 7,880 Chase 2,623 22 2,645 13,430 Ordnance 2,714 14 2,728 13,896 Green Street and Ponders End 2,628 18 2,646 13,455 Bush Hill Park 2,338 8 2,346 11,970 Hadley & Cockfosters 195 4 199 998 12,037 79 12,116 61,629 7 Vital Statistics. The number of births registered in the District was:— Boys. Girls. Total. 686 677 1,363 including 37 illegitimate births, i.e., 2.71 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 22 14 20 14 19 16 8 16 69 60 129 16.37 Chase 44 49 44 46 43 33 29 32 160 160 320 23.08 Ordnance 36 35 31 23 43 41 26 41 136 140 276 19.86 Green Street and Ponders End 59 51 51 45 45 40 45 41 200 177 377 28.01 Bush Hill Park 36 36 36 35 22 30 22 32 116 133 249 20.80 Hadley and Cockfosters 2 1 2 1 ... 2 1 3 5 7 12 12.02 Births outside the District 24 23 47 Totals 199 186 184 164 172 162 131 165 710 700 1,410 22.87 for District 385 348 334 296 1,410 The births of boys 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. 1918 517 454 971 15.78 .79 1919 519 528 1,047 16.98 .79 1920 710 700 1,410 22.87 .87 8 Deaths. The deaths registered in the district during the year were 504, of which 252 were males and 252 females, giving a crude deathrate of 8.17. To these must be added 151 deaths of Enfield residents registered outside the district, and from this total must be subtracted 65 deaths of non-residents occuring in the district, which brings the nett number of deaths to 590 for the year, giving a recorded death-rate of 9.57. 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 9.90. Birth-rate. Recorded Death-rate. Standardized Death-rate. Infantile Death rate. England & Wales 25.4 12.4 — 80.00 London 26.3 12.4 — 75.00 96 Great Towns, including London 26.2 12.5 — 85.00 ENFIELD 22.87 9.57 9.90 45.39 The corresponding figures for Enfield for the three previous years are:— 1917. 1918. 1919. Recorded death-rate 10.68 12.48 9.92 Standardized do. 11.05 12.79 10.27 9 The deaths occurred in the several wards as follows:— Ward. 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total. Death-rate per 1,000 as recorded. Infantile Death-rate. Town 23 12 14 l6 65 8.24 46.51 Chase 56 28 28 25 137 10.20 68.75 Ordnance 41 33 28 34 136 9.78 43.47 Green Street and Ponders End 45 25 28 31 129 9.58 58.35 Bush Hill Park 41 23 20 34 118 9.85 48.19 Hadley and Cockfosters 1 1 1 2 5 5.01 00.00 Whole of District 207 122 119 142 590 9.57 45.39 Fifty-two of the deaths registered in the District were those of persons over 80 years of age, 31 being males and 21 females, one woman dying at the advanced age of 94. The more important causes of deaths as registered were:— Malignant Diseases, 68; Heart Disease, 58; Pulmonary Tuberculosis, 54; Old Age, 43, Bronchitis, 36; Pneumonia, 33; Apoplexy, 22; Bright's Disease, 18; Influenza, 16; Other Respiratory Diseases, 10; whilst among the children Premature Birth accounted for 23 deaths; Atrophy, Debility and Marasmus, 15; Bronchitis, 10, and Congenital Malformations 6. Inquests. Thirty-three inquests were held in Enfield during the year and the verdicts given were as follows:— Natural Causes 16 Misadventure 6 Accidental Causes 6 Open Verdict 4 Suicides 1 33 10 Infantile Deaths. The total number of deaths that occurred amongst infants under 1 year, including twelve registered outside the district, was 74, giving a death-rate of 45.39 per thousand births, as compared with a death-rate of 80 for England and Wales, and 85 for the 96 great towns, including London. The corresponding figures for Enfield for the last three years were:—1917, 88.10; 1918, 66.94; and 1919, 56.35. The number of deaths of illegitimate children was 8, which gives a death-rate of 148.14 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:— This rate is very much lower than last year. Ward. Number of Deaths. Death-rate per 1.000 population. Death-rate per I 000 births. Town 6 0.76 46.51 Chase 22 1.63 68.75 Ordnance 12 0.86 43.47 Green Street and Ponders End 22 1.63 58.35 Bush Hill Park 12 1.00 48.19 Hadley and Cockfosters 0 0.00 00.00 Whole of District 74 1.20 45.39 The chief causes of death were Premature Birth (including Congenital Defects) 44, and Bronchitis 10. Poor Law Relief, 1920. In reply to an enquiry, I am informed by Mr. E. Ridley, Clerk to the Edmonton Board of Guardians, that the amount of poor Law Relief given in the Enfield District was £6,206 17s. 11d. 11 Hospital Accommodation. In addition to the local War Memorial Hospital, accommodation for ordinary cases of illness is afforded by the North Middlesex Hospital, Edmonton, and the Prince of Wales Hospital, Tottenham, and many patients also go to the various London Hospitals. Towards the end of the year the Council, through the instrumentality of the Chairman, succeeded in obtaining a motor ambulance from the Joint Council Home Service Ambulance Committee. This was installed at the Fire Station, Ponders End, and arrangements made for it to be available day and night for cases of ordinary illness and accidents. The usefulness and need of this service was speedily appreciated, and by the end of the year 26 cases had been removed to various Hospitals and Institutions. Sanitary Circumstances of the District. Water Supply. With the exception of Hadley and Cocktosters, which derive their water from the mains of the Barnet Gas and Water Company, the District is almost entirely supplied by the Metropolitan Water Board. The supply of water with the possible exception of some few private wells in the rural portions of the District, is ample, the quality good, and the supply practically constant. Streams and Water-Courses. Turkey Street Brook and other streams in the District are under the control of the Middlesex County Council, and observation is also kept on them by your Sanitary staff, but no sources of contamination were detected. Drainage and Sewerage. The populous parts of the District are all provided with sewers, with outfall to Cuckoo Hall Farm, where it is dealt with by septic tanks, filters and part by irrigation. During the War difficulty was experienced in extending the works. The Council now have the matter in hand, application having been made to the Ministry for a loan of £3,790 for temporary works to carry on until the works generally have been re-modelled. The plans for the larger works are now in course of preparation. Two men are employed daily who devote their whole time to the work of examining and flushing the sewers, and any defect or obstruction found is immediately dealt with. 12 Closet Accommodation. All the houses in the Urban portion of the District are supplied with W.Cs. of various types, the majority being those of "washdown" pattern. In the Rural parts of the District the accommodation consists of water-closets connected with cesspools, or earthclosets or privies with movable receptacles. I am not aware of any middens in the District. Scavenging. Removal of House Refuse. This work is carried out by the Council's own staff, a weekly collection being made throughout the greater part of the District. Part of the stuff collected is disposed of to brickmakers, and the remainder taken to the Council's Depot at Carterhatch Lane, where it is levelled and covered with earth. Every week one man in the employ of the Council attends to some few earth-closets in a rural part of the District. There are only a few fixed ashpits left, the practice for some years has been to require movable receptacles to be provided, and where any house is found without this provision, the owner is required to make it good. Cesspools. The Council has provided suitable vans and pumps, and undertakes the emptying of cesspools on the application of house-holders, a small charge being made for each emptying, and they are all kept under observation. Statement Prepared by Sanitary Inspector under Article XX. (16) Local Government Board's General Order, 1910. Number of houses inspected:— Inspections. Under Regulations, Sec. 17, Housing, Town Planning Act, 1909 0 From House-to-House apart from this Act 490 On Account of Infectious Disease 799 On Account of Phthisis 99 On Account of Complaint by occupant or otherwise 1,042 2,430 13 Inspections (continued). 60 Factories 107 73 Workshops and workplaces, including 7 laundries 224 43 Outworkers' premises inspected 66 55 Bakehouses, of which 37 are in use 114 18 Slaughter-houses, of which 13 are in use 578 28 Cowsheds inspected frequently 331 31 Dairies and Milkshops inspected frequently 152 22 Schools 39 Public-house urinals inspected 275 Conveniences at Railway Stations inspected 10 Fish Shops:Total number of visits 333 Coffee and Eating Houses:Total number of visits 21 Shops where ice-cream is made:Total number of inspections 161 2,311 Visits to absentees excluded from Elementary Schools 1,197 Visits in connection with cases of Infectious Disease 4,773 Visits in connection with Phthisis 490 Offensive Trades (excluding Fish-Shops) 19 Smoke observations 21 Other inspections, including works in progress 10,549 Petroleum Stores inspected 196 Visits in respect of Food Control matters 2,461 Visits re Shops Act 8 19,714 24,455 Notices Issued. Statutory:— Provision of dustbins 160 For repairs to houses, drains, and abatement of nuisances 433 Providing sufficient water-closets 51 Paving of yards 46 Overcrowding 2 Provision of sink waste-pipes 17 Cleansing of bake-house 0 To remove offensive accumulation 0 709 14 Notices Issued (continued). Informal:— Notices 10 Letters sent in lieu of notice 981 991 Other Notices issued under Infectious Diseases Acts:— To Occupiers 1,368 To Head Teachers at Schools 1,316 2,684 4,384 Other letters sent 4,187 Result of service of statutory notices:— Number complied with 600 Number outstanding 109 709 As to these outstanding notices, in 20 the time given did not expire until after the end of the year, while with regard to the other 89 the work required was delayed on account of the weather or other reasonable cause. Detailed particulars of the work done in the Sanitary Department will also be found in the report of the Sanitary Inspector attached hereto. PREMISES AND OCCUPATIONS WHICH CAN BE CONTROLLED BY BYE-LAWS OR REGULATIONS. Offensive Trades. Bye-laws are in force in the District for the control of the following trades:— Blood Drier. Fat Melter or Fat Extractor. Leather Dresser. Tanner. Glue Maker. Size Maker. Gut Scraper. Manufacturer of Manure from Fish, Offal, Blood, or other putrescible animal matter. Fish Frier. Fish Skin Dresser. Dealer in Rags and Bones. 15 During the year the Council, in two instances, approved the establishment of the trade of a Fish-frier, the premises in each case being equipped with up-to-date appliances, which have proved most satisfactory, and show that the trade can be carried on in populous districts without being a nuisance to the neighbourhood. Schools. There are 22 Public Elementary Schools in Enfield, including a Deaf Centre, 52 departments in all. The Secondary Schools include the Boys' Grammar School and the County School for Girls. In addition there are a number of private establishments. We have also the Chase Farm Schools belonging to the Edmonton Board of Guardians, and a Roman Catholic Institution known as St. Joseph's Home for Destitute Boys. Periodical examinations of the conditions of the public elementary schools are made by the Sanitary Inspector, 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. FOOD. Milk. There are some 426 cows in Enfield owned by 23 cowkeepers, and I am pleased to be able to make a favourable report this year of the way which the dairy business is conducted. The majority of the retail milk sellers are continuing their endeavours to maintain a satisfactory condition in their business, while a few who do not yet seem to realise the importance of strict attention to detail and cleanliness, are being brought into line with the others. The cows are inspected bi-annually by Mr. H. H. Hide, M.R.C.V.S., the Veterinary Surgeon to the Council, and I append copies of his two reports for the year, which are very satisfactory, and shew that the Enfield dairy-farmer is fully alive to the danger of keeping tuberculous cows on his premises. 16 Holly House, Lower Edmonton, April 12th, 1920. Dear Sir, I beg to report that I have inspected the whole of the milch cows throughout the district, as shown in the accompanying list. Careful examination of the udders showed a very satisfactory absence of even the commoner forms of disease incidental to milking cows, and I only met with three cases in which bacteriological examination was necessary. These all proved to be free from Tuberculosis. The absence of disease may be attributed, in a large measure, to the high price of cows which does not allow of neglect in treatment of disease, nor the retention of such as fail to yield a sufficient quantity of milk. The number of animals is somewhat lower than on previous inspections. They all appear healthy and in satisfactory condition. I am, dear Sir, Yours obediently, (Sd.) H. H. Hide. T.W. Scott, Esq. Holly House, Lower Edmonton, April 26th, 1920. Dear Sir, I beg to report that I have examined the cows belonging to the cowkeepers mentioned in your additional list of the 20th inst. Among the whole of them I found only one abnormal udder, and that a case of ordinary induration resulting from an injury caused by barbed wire. They were all free from Tuberculosis. I am, dear Sir, Yours obediently, (Sd.) H.H. Hide. T.W. Scott, Esq. 17 Holly House, Lower Edmonton, 20th December, 1920. Dear Sir, I beg to report that I have inspected the whole of the milch cows throughout the district, as shown in the accompanying list. I made a careful examination of the udders and found them, on the whole, satisfactorily free from disease. A small proportion of cases of induration and other conditions resulting from mammitis or injury frequent among milch cows were found, and one udder proved to be affected with Tuberculosis. This I reported at the time. In other respects the herds all appeared healthy and in satisfactory condition. I am, dear Sir, Yours obediently, (Sd.) H. H. Hide. T. W. Scott, Esq. With regard to the cow referred to in the Veterinary Inspector's December report, enquiries were made as soon as I received information of this, when we found that this cow. with others, had been sold to a dealer in another District, but in spite of endeavours we were unable to trace it further. 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. 18 PARISH OF ENFIELD. Samples taken during the year ended, 31st December, 1920. Article. Taken. Adulterated. Percentage Milk 180 26 14.4 Cream 1 — — Butter 9 — — Lemonade Powder 3 — — Fish Paste 2 — — Custard Powder 2 — — Baking Powder 1 — — Egg Substitute Powder 1 — Cream of Tartar 1 — — Vinegar 1 — — Totals 201 26 12.9 Number of Prosecutions 6 (six). Number of Convictions 6 (six). The figures given for adulterated samples include some adulterated informal samples in respect of which no proceedings could be taken. The supply of milk is generally satisfactory, and there seems to be more endeavour on the part of the suppliers than there used to be to keep up the quality. Milk (Mothers and Children) Order, 1919. On the issue of this Order it was considered by the Council and following the lines laid down in a circular received from the Ministry of Health, a scheme was prepared under which the Medical Officer of Health and the Medical Officers of Centres were empowered to supply milk in necessitous cases, i.e., cases where the total earnings of the family were found, after strict investigation, to be below a scale adopted by the Council. During the year under review the total quantities of fresh and dried milk supplied free were as follows:— Fresh Milk 5,786¼ gallons. Dried Mi k (Glaxo) 1,770 lbs. 19 Meat. There are no public abattoirs in the District. Quite a large quantity of meat slaughtered at the Caledonian Market is brought into the District. The number of slaughterhouses in the District at the dates specified, is as follows:— 1914 January, 1920 December, 1920 Registered 10 8 8 Licenced 7 5 5 Total 17 13 13 Mr. Fred Wilson and Mr. T. M. Boswell, Assistant Sanitary Inspectors, who both hold the Certificate of the Royal Sanitary Institute as Inspectors of Meat and Foods, visit the slaughterhouses at very frequent intervals, and as will be seen by a reference to the Sanitary Inspector's Report, they paid 577 such visits during the year, when they examined 1,321 carcases, and secured the surrender of 17 parcels of diseased organs. The sanitary condition of the slaughterhouses is, on the whole satisfactory, and every endeavour is made to examine all meat killed before it is offered for sale. BAKEHOUSES. The 55 bakehouses in the District, of which 37 are in use, have been regularly inspected, and all are kept in a satisfactory condition. OTHER FOODS. The butchers' shops, eating houses, fish shops, etc., are also frequently inspected, and care taken to see that every place where cooked meats and other foods are prepared, with their utensils, are kept clean and in good order. 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. 20 TABLE I. Vital Statistics of Whole District during 1920 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. of Nonresidents Registered in the District. of Residents not Registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1,000 nett Births. Number. Rate. 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 7.91 582 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 1920 61,629 1,363 1,410 22.87 504 8.17 65 151 74 45.39 590 9.57 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. 21 TABLE II. Cases of Infectious Diseases notified during the year 1920. Notifiable Disease. Number of Cases Notified. Total Cases Notified in Total Cases Removed to Hospital. At Ages—Years. Each Ward. 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 wards Town. Chase. Ordnance. Green St. and Ponders End. Bush Hill Park. Hadley and Cockfosters. Small Pox 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera. Plague 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membraneous Croup) 129 1 42 69 10 7 ... ... 8 24 19 44 34 ... 97 Diphtheria Carriers 24 1 1 18 1 1 2 ... ... 3 3 *3 5 ... ... Erysipelas 34 ... ... ... 3 9 15 7 2 7 5 9 11 ... ... Scarlet Fever 306 1 40 219 36 7 2 1 31 115 47 62 42 9 229 Typhus Fever 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 1 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... Relapsing Fever 0 ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever Puerperal Fever 4 ... ... ... ... 4 ... ...... ... ... 2 ... 2 ... 2 Measles 133 7 40 78 6 2 ... ... 28 4 45 30 25 1 ... German Measles 23 ... 2 18 3 ... ... ... 2 6 3 ... 12 ... ... Cerebro-spinal Meningtis 1 ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 Poliomyelitis 0 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 5 5 ... ... ... ... ... ... ... 2 1 1 1 ... ... Pulmonary Tuberculosis 90 ... ... 9 22 38 20 1 13 10 23 32 ... ... ... Other forms of Tuberculosis 25 ... 7 10 3 3 2 ... 2 6 12 2 3 ... ... Encephalitis Lethargica 3 ... 1 1 1 ... ... ... ... 1 ... 1 1 ... 2 Malaria 4 ... ... ... 1 3 ... ... ... ... 1 1 2 ... ... Pneumonia 77 3 22 10 6 26 7 3 9 15 25 19 9 ... 1 Totals 859 18 155 433 92 101 48 12 95 193 188 214 159 10 332 TABLE III. Causes of, and Ages at Death during Year, 1920. Causes of Death. Nett Deaths at the subjoined ages of " Residents," whether occurring within or without the District. Total Deaths, whether of "Residents" or "Non-residents" in Institutions in the District All Ages. Under 1 year 1 and under 2 2 and under 5 5 and under 15 15 and under 23 25 and under 45 45 and under 63 65 and upwards All causes (Certified 590 74 16 20 29 37 95 132 187 95 (Uncertified ... ... ... ... ... ... ... ... ... ... Enteric Fever ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ... ... Measles 8 ... 2 4 2 ... ... ... ... ... Scarlet Fever 1 ... ... 1 ... ... ... ... ... 5 Whooping Cough 3 1 1 1 ... ... ... ... ... ... Diphtheria and Croup 13 ... 2 4 7 ... ... ... ... 30 Influenza 16 ... ... ... ... 2 11 3 ... ... Erysipelas ... ... ... ... ... ... ... ... ... Pulmonary Tuberculosis 54 1 2 13 25 10 3 1 Tuberculous Meningitis 12 1 2 2 5 ... 1 1 ... 1 Other Tuberculous Diseases 4 ... ... ... 1 ... 1 1 1 ... Cancer, Malignant Disease 68 ... ... ... ... 2 6 36 24 3 Rheumatic Fever 6 ... ... ... 2 ... 1 3 ... ... Menigitis 2 ... ... ... 1 ... 1 ... ... ... Organic Heart Disease 58 ... ... 2 5 6 21 24 5 Bronchitis 36 10 1 1 ... ... ... 5 19 6 Pneumonia (all forms) 33 5 3 3 1 ... 9 8 4 3 Other Diseases of Respiratory Organs 10 ... 1 1 ... ... ... 4 4 2 Diarrhoea and Enteritis 4 3 1 ... ... ... ... ... ... 1 Epidemic Diarrhoea ... ... ...... ... ... ... ... ... ... ... Appendicitis and Typhlitis 6 ... ... 1 2 3 ... ... ... 4 Cirrhosis of Liver 2 ... ... ... ... ... ... 2 ... ... Alcoholism 1 ... ... ... ... ... ... 1 ... ... Nephritis & Bright's Disease 18 ... ... ... ... 2 2 6 8 6 Puerperal Fever 2 ... ... ... ... ... 2 ... ... ... Other accidents & diseases of Pregnancy and Parturition 4 ... ... ... ... 1 3 ... ... ... Congenital Debility and Malformation, including Premature Birth 44 44 ... ... ... ... ... ... ... 3 Violent Deaths, excluding Suicide 15 1 ... ... ... 1 3 2 8 1 Suicides 2 ... ... ... ... 1 1 ... ... ... Other Defined Diseases 166 7 3 2 4 7 23 28 92 24 Diseases ill-defined or unknown 2 1 ... ... ... ... ... 1 ... ... Totals 590 74 16 20 29 37 95 132 187 95 Included in above — Old Age 43 ... ... ... ... ... ... ... 43 2 Apoplexy 22 ... ... ... ... ... ... 6 16 1 Cerebro-spinal Meningitis 1 ... ... ... 1 ... ... ... ... ... Poliomyelitis ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica 1 ... ... 1 ... ... ... ... ... ... 23 TABLE IV. Infant Mortality. Nett Deaths from stated causes at various Ages under One Year of Age. Causes of Death. Under 1 week. 1 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 18 10 7 3 38 13 11 9 3 74 Uncertified ... ... ... ... ... ... ... ... ... ... Small Pox ... ... ... ... ... ... ... ... ...... ... Chicken Pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 1 ... ... ... 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... 1 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... 1 ... 1 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions ... ... ... ... ... ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 ... 1 2 2 3 2 1 10 Pneumonia (all forms) ... ... ... ... ... ... 1 3 1 5 Diarrhoea ... ... ... ... ... ... 1 ... ... 1 Epidemic Diarrhoea ... ... ... ... ... ... ... ... ... ... Enteritis ... ... ... ... ... ... ... ... 1 2 Gastritis ... ... ... ... ... ... ... ... ... Syphilis ... ... 1 ... 1 1 1 ... ... 3 Ricketts ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... 1 ... ... ... 1 Injury at Birth ... 1 ... ... 1 ... ... ... ... 1 Atelectasis ... ... ... ... ... ... ... ... ... Congenital Malformation ... 1 1 ... 2 3 1 ... ... 6 Premature Birth 10 5 4 ... 21 2 ... ... ... 23 Atrophy, Debility and Marasmus 6 2 1 ... 9 2 3 1 ... 15 Other Causes 2 ... ... ... 2 1 1 ... ... 4 Totals 18 10 7 3 38 13 11 9 3 74 Nett Births in the year:—Legitimate, 1,356; Illegitimate, 54. Nett Death; in the year:—Legitimate Infants, 66; Illegitimate, 8. 24 ZYMOTIC DISEASES. The following Table shows the Deaths Registered in the District from the seven chief zymotic diseases during the past five years Disease. 1916 1917 1918 1919 1920 Small Pox ... ... ... ... ... *Scarlet Fever. 5 1 ... 12 5 *'Diphtheria 10 11 3 15 30 Measles ... 16 2 1 8 *Enteric Fever 3 1 4 ... ... Whooping Cough 5 4 12 2 3 Epidemic Enteritis 8 2 ... 1 ... Totals 31 35 21 31 46 *The actual Enfield deaths were:—Scarlet Fever 1, and Diphtheria 13. The figures for Scarlet Fever, Diphtheria and Enteric Fever include all the deaths that occurred in the Enfield and Edmonton Joint Isolation Hospital, which is situate in the Enfield district, and where patients belonging to other districts are also received. 25 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), is 0.40 per thousand. Disease. 1919. 1920. Deaths. Death-rate. Deaths. Death-rate. Scarlet Fever 1 .01 1 .01 Diphtheria 6 09 13 .21 Enteric Fever ... .00 ... .00 Erysipelas 3 .04 ... .00 Measles 1 .01 8 .12 Whooping Cough 2 .03 3 .04 Epidemic Enteritis 1 .01 ... .00 Totals 14 .22 25 .40 INFECTIOUS DISEASES. Scarlet Fever. Three-hundred-and-six cases of Scarlet Fever occurred during the year in 234 houses, as follows:— No. of houses where 1 case occurred 193 „ „ 2 cases „ 27 „ „ 3 „ „ 10 „ „ 4 „ „ 3 „ „17 „ „ 1 Total number of houses where cases occurred 234 Total number of cases 306 26 The mildness of the 306 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. One-hundred-and-twenty-nine cases of this disease occurred during the year in 112 houses, as follows:— No. of houses where 1 case occured 100 „ „ 2 cases „ 8 „ „ 3 „„ 3 „ „ 4 „ „ 1 Total number of houses where cases occurred 112 Total number of cases 129 Enteric Fever. One case of this disease was 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. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Diphtheria. This disease was considerably more prevalent this year than last, this I attribute to the number of Diphtheria Carriers discovered —24, and to the fact that there is a good deal of intercommunication between this and neighbouring districts, where to my knowledge the disease was more prevalent than with us. As soon as a case was notified, I interviewed practically all the contacts and took what swabs I thought necessary, and in this way discovered the "carriers," a number of whom necessitated the taking of quite a number of swabs before the cases were cleared up, while in the meantime, I insisted on strict isolation of all such cases. Diphtheria Anti-toxin is supplied by the Council free of charge, and in addition to the Public Offices, supplies and swabs are kept at various points in the district within easy reach of Medical Practitioners. To indicate its use, I may say that no less than 164 bottles, each containing 4,000 units were supplied during the year. 27 Encephalitis Lethargica. Only three cases of this disease were notified during the year, one of which was fatal. I am not at all sure that the cases were all genuine. Official forms requiring information about these cases were filled up without delay and forwarded to the Chief Medical Officer of the Ministry of Health. Small Pox. There b;ing no cases of this disease there was no necessity for me to vaccinate any one during the year. In view of the fact that Measles and German Measles were notifiable during the year and Chicken Pox for the greater part of the time, there remained little in the way of non-notifiable infectious disease to be notified. In accordance with a suggestion of the Local Government Board an arrangement has been made between the Council and Education Committee, under which the Head-teachers of the various schools notified to the Medical Officer of Health all absentees suspected to be suffering from any infectious disease. By this means we become aware of many cases of measles and other infectious diseases, which would otherwise escape us. We are thus able to visit the houses, and give instructions as to the precautions necessary to be taken. These cases are also all reported to the School Medical Officer A Health Visitor was appointed by the Council in February to take charge of cases of Measles, Chicken-pox and non-notifiable infectious and contagious diseases generally, also to visit suspected cases reported from the schools. I find that her work is of great assistance to the staff in controlling these diseases, while the mothers all appreciate her visits, which have proved of great value in a number of severe cases. During the year her visits were as follows:— Visits re cases of Measles, Chicken-pox, Whooping Cough, Mumps and Pneumonia 1026 Visits re suspected cases of Infectious Disease 804 Infant Welfare Visits 42 Ante-Natal Visits 8 Inspections on complaint by occupiers 210 Other visits 216 Visits, but no reply obtainable 53 Total 2359 28 DISINFECTION OF VERMINOUS PERSONS AND THEIR BELONGINGS. Four dwellings, and 87 articles were cleansed and disinfected at the Council's disinfecting station in cases of verminous persons. 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. Duplicates. Town 13 ... 14 2 ... ... Chase 10 2 19 6 ... 3 Ordnance 23 1 28 12 ... 1 Green Street and Ponders End 32 1 52 2 ... ... Bush Hill Park 12 1 20 3 1 1 Hadley and Cockfosters ... ... ... ... ... ... Totals 90 5 133 25 1 5 First Notifications 115 Old Cases re-notified, i.e., some by fresh doctors, or coming into District, or under old regulations.. 6 Duplicate Notifications, i.e., those which report the entering and leaving of Sanatoria 138 Total notifications 259 29 Sex (1st Notifications). Form. Males. Females. Pulmonary 47 43 Other 13 12 Totals 60 55 Deaths. The number or deaths from this disease during the year is shown in the following table, viz.:— Ward. Pulmonary. Other. Death-rate per 1,000 Population. Town 6 2 1.01 Chase 10 2 0.89 Ordnance 17 4 1.51 Green Street and Ponders End 14 3 1.26 Bush Hill Park 7 5 1.00 Hadley and Cockfosters ... .... 0.00 Totals 54 16 1.13 30 Measles and German Measles. The following numbers of notifications of this disease were received from the different wards:— Ward. Measles. German Measles. Town 28 3 Chase 4 6 Ordnance 45 3 Green Street and Ponders End 30 ... Bush Hill Park 25 12 Hadley and Cockfosters 1 ... Totals 133 23 There were eight deaths from this disease during the year, and these of children between the ages of 1 and 15 years. Enteritis. Two deaths occurred from this disease during the year, both of which were infants under one year. Epidemic Diarrhoea. There were no deaths from this disease during the year. MATERNITY AND CHILD WELFARE. Medical Officers of Centres. W. P. Warren, D.P.H. Dr. Margaret Dunbar, M.D., B.S. The latter is also Medical Officer of the Ante-natal Centres. Health Visitors. Miss H. Thorpe. Miss M. Briscoe. Miss H. Morrison. 31 Maternity and Child Welfare Work. 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 November we opened the Ordnance Centre twice a week instead of once a week, and this was followed by the opening of the Bush Hill Park Centre twice a week in December. The attendance at once showed the necessity of such a step, and arrangements were also made to open both the Town and Chase and Ponders End Centres twice a week early in the new year. I am glad to say we have a full supply of Voluntary Helpers, who are most regular in their attendance, and take the greatest interest in the work. Baby Week. This was celebrated on July 7th and 8th. A Garden Party was held in the Manse Gardens, Chase Side, and another 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. Ante-Natal Clinics. There are two Ante-Natal Clinics under the charge of Dr. Margaret Dunbar. That for the Western portion of the District being held at Waldron Hall, near the Great Eastern Railway Station, Enfield Town, and that for the Eastern at the Alma Road Council Schools, Ponders End. Each centre is opened once a month and the attendances during the year were:— Centre. New Attendances. ReAttendan es. No. on Register. Average Attendance per Meeting. Waldron Hall 97 66 149 14.4 Alma Road Council School 74 60 114 11.1 Totals 171 126 263 17.3 It is pleasing to find these Clinics are so appreciated that the attendance is more than one hundred per cent. above that of last year. 32 MATERNITY HOSTEL. The arrangements 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, 1918, 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 on their return home. The Motor Ambulance previously referred to has proved of great service in securing the speedy removal of urgent cases to the Hostel. HOME HELPS. The Council with the approval of the Ministry of Health appointed two Home Helps who commenced duty on July 18th, 1920. Their work is going on very well and appears to be of great help tothe mothers who secure their services. One works in the Town District, which includes the Chase and Bush Hill Park Wards, and the other on the Eastern side which embraces the Ponders End and Ordnance Wards. The following scale of charges was adopted for the service of these helps:— Scale of Charges for Services of Home Helps. To be paid weekly. Wages over 50/- with 1 or without children 2/6 weekly ., 50/- with 2 to 5 children — „ 60/- with 1 or without children 5/- „ „ 60/- with 2 to 5 children 2/6 „ „ 70/- with 1 or without children 7/6 „ „ 70/- with 2 to 5 children 5/- „ 80/- 7/6 „ In each scale if more than 5 children lower the fee 2/6 The above charges may be remitted or reduced in individual cases when in the opinion of the Maternity and Child Welfare Committee circumstances justify it. The Health Visitors give special attention to still-births and Infant-deaths, and report to me specially on each case. The following statistics of the work of the Health Visitors will be found worthy of careful consideration. 33 Visits. Town and Chase Bush Hill Park. Hadley. Ordnance Ponders End. Totals. Birth Notification Visits 296 262 7 180 201 946 Do. Re-visits 413 237 — 233 283 1,166 Children, 1- 5 yrs. Visits 658 568 2 343 390 1,961 Infant Mortality do. — — — 5 7 12 General Visits 50 32 — 116 99 297 Ante-Natal Visits 92 43 — 76 73 284 Post-Natal Visits — — — — — — Blank Visits — — 54 83 137 Child Death Visits — — — 2 2 4 Ophthalmia Neonatorum Visits 30 — — — I 31 Puerperal Fever Visits — 18 — 2 — 20 Totals 1,539 1,160 9 1,011 1,139 4.858 Feeding, etc. Feeding. Town and Chase. % Bush Hill Park. % Hadley. % Ordnance. % Ponders End. % Totals. % Natural 229 77 188 71 5 71 138 76 166 82 726 76 Artificial 46 15 46 17 2 28 35 19 32 15 l6l 17 Mixed 21 7 28 10 — - 7 3 3 1 59 6 Cradle Used 143 48 126 48 6 86 83 46 98 48 456 48 34 Attendances at Centres. Centre. New Attendances. Reattend ances. No. on Register 1.1.20. No. on Register 31.12.20. No. of Meetings. Average attendance per Meeting. Town and Chase 193 3,538 331 523 51 73.1 Bush Hill Park 217 2,664 288 469 54 52.3 Ordnance 203 3,323 477 529 58 60.8 Ponders End l8l 1,649 333 387 48 38.1 Totals 794 11,174 1,429 1,908 211 56.7 No. of Births notified :—1,408, 67% 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. SANITARY ADMINISTRATION. Staff. The Inspector of Nuisances has three Assistant Inspectors in addition to Clerical Staff (3), and particulars of their work will be found in his statement attached to this report. It will be seen from the particulars given 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. HOSPITAL ACCOMMODATION. Small Pox. Enfield is included in the Middlesex Joint Hospital District, and should any case occur it would be removed to the Hospital, Clare Hall, South Mimms. 35 Other Infectious Diseases. The Distict is served by the Enfield and Edmonton Joint Isolation Hospital, which is situated upon 27 acres of land at Winchmore Hill, about three-and-half miles from the centre of the town. The buildings consist of:— An Administrative 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 229 Diphtheria 97 ADOPTIVE ACTS. There are no local Acts. The following are the Adoptive Acts in force in the District Public Health Acts (Amendment) Act, 1890. Came into force February, 1st, 1891. Infectious Disease (Prevention) Act, 1890. Came into force February 1st, 1891. Public Health Acts (Amendment) Act, 1907. The following sections came into force on July 27th, 1909. All sections in Part I. Sections 15, 16, 17, 20, 21, 23, 24, 25, 27, 29, 30, 31, 32 and 33 of Part II. Sections 34, 35, 36, 37, 38, 43, 44, 46, 47, 48, 49, 50 and 51. of Part III. Sections 52, 53, 54, 55, 56, 57, 59, 62, 63. 64, 65 and 68 of Part IV. All of Parts V. and VI. Section 81 of Part VII. All of Parts VIII. and IX. Section 95 of Part X. 36 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. Percentages of Positives. Swabs 608 95 513 18.51 Sputum 105 17 88 19.31 Totals 7.3 112 601 15.70 I should like to emphasize the fact that a negative result in the case of Sputum is by no means sufficient evidence to warrant the conclusion that Tubercle Bacilli are absent; it not infrequently happens that five or six examinations must be made before the Bacilli can be demonstrated. In addition to the above, I made several Widal tests, Blood counts, estimation of Haemoglobin, examination of pus, urine, etc., for various organisms, such as gonococci, B. Coli Communis, etc., etc. Although the general opinion is that Hoffman's Bacillus is not pathogenic, I must confess that I look upon it with the greatest amount of suspicion, and I do not allow any child showing it to return to school until two consecutive swabs taken at about one week's interval proved Negative. GENERAL HOUSING CONDITIONS. It has been recognised that a shortage of houses existed in this District, and the matter has been receiving the close attention of the Housing Committee of the Council, as a result of which arrangements were made for the erection of about 250 houses in different parts of the District. Of this number 30 were to be built on a site approved between Lavender Hill and the Cemetery, but I understand no definite arrangements were made for the erection of the other houses. Overcrowding. Considerable sub-letting took place during the War to accommodate the large influx of workers required at the several factories in the District. A large number of the people still remain with the 37 result that considerable overcrowding continues. It is difficult to determine how this can be dealt with effectually until more houses are provided, but every endeavour is made in any serious case that comes to the knowledge of your Sanitary Officers to secure the best possible arrangements for sleeping accommodation. Fitness of Houses. The classes of houses in the District vary considerably, some both large and small having been erected many years. As, owing to the restriction of labour and materials during the War, repairs which up to that time had received continued attention came practically to a standstill, with the result that since the Armistice a good deal of leeway has had to be made up, but your Officers as a rule find owners ready to carry out the repairs necessary, with the result that a considerable amount of work has been carried out. The principal defects found were in connection with roofs, gutters, yard paving and sanitary fittings; there was also dampness in waJls and in a number of cases internal repairs and cleansing were necessary. Housing. The detailed statistics as to action under this Act is given in the form specified:— 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 »N umber 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. 38 FACTORY AND WORKSHOP ACT, 1901. The information under this heading is set out on pages 46 and 47 of the Inspector of Nuisances Report, where full details as to the administration of the Acts are given, and the necessary forms have been filled in and will be sent with my Report to the Home Office, Whitehall. PRIVATE ROADS AND STREETS. I have received the following details from Mr. H. R. Crabb, Engineer and Surveyor to the Council:— During the year 226,396 super yards of roadway, and 13,530 super yards of footpaths have been treated by tar spraying. A new sewer has been laid in Goat Lane, Ponders End. Duck Lees Lane level crossing and footbridge have been widened and improved. Work has been commenced on a new surface water sewer in Baker Street. NEW BUILDINGS. Fourteen new houses have been certified as completed and fit for human habitation during the year. The disposal of sewage still continues to be satisfactory. 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, Mrs. Newman and Gentlemen. Yours obediently, W. P. WARREN, Medical Officer of Health.- 39 APPENDICES. HOUSING CONDITIONS. Statistics. Year ended 31st December, 1920. 1—GENERAL. (1) Estimated population 61,629 (2) General death-rate 9.90 (3) Death-rate from tuberculosis 1.13 (4) Infantile mortality 45.39 (5) Number of dwelling-houses of all classes 12,116 (6) Number of working-class dwelling-houses 9,693 (Estimated) (7) Number of new working-class houses erected 10 2.—UNFIT DWELLING-HOUSES. I.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,430 (2) Number of dwelling-houses which were ed and recorded under the Housing (Inspection of District) Regulations, 1910 None. (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation None. (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 1,767 The number here given is of houses where any insanitary conditions were found. II.—Remedy of Defects without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 1,656- 40 III.—Action under Statutory Powers A. Proceedings under section 28 of the Housing, Town Planning, etc., Act, 1919. (1) Number of dwelling-houses in respect of which notices were served requiring repairs None. (2) Number of dwelling-houses which were rendered fit— (a) by owners None. (b) by Local Authority in fault of owners None. (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close None. B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 433 (2) Number of dwelling-houses in which fects were remedied— (a) by owners 394 (b) by Local Authority in default of owners None. C. Proceedings under sections 17 and 18 of the ing, Town Planning, etc., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders None. (2) Number of dwelling-houses in respect of which Closing Orders were made None. (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit None. (4) Number of dwelling-houses in respect of which Demolition Orders were made None. (5) Number of dwelling-houses demolished in pursuance of Demolition Orders None. 41 3.—UNHEALTHY AREAS. Areas represented to the Local Authority with a view to Improvement Schemes under (a) Part I., or (b), Part II., of the Act of 1890:— None. (1) Name of area – (2) Acreage – (3) Number of working-class houses in area – (4) Number of working-class persons to be displaced – 4.—Number of houses not complying with the building byelaws erected with consent of Local Authority under section 25 of the Housing, Town Planning, etc., Act, 1919 None. 5.—Staff engaged on housing work with, briefly, the duties of each officer Chief Inspector and 3 Assistants 42 Public Offices, Enfield. 21st June, 1921. REPORT OF THE INSPECTOR OF NUISANCES FOR THE YEAR 1920. To the Chairman and Members of The Urban District Council of Enfield. Mrs. Newman and Gentlemen, I beg to submit a report for the year ending December 31st, 1920, including particulars in tabular form as required by Article 20 (16) of the General Order of the Local Government Board, of the work done in connection with your Sanitary Department under my supervision. Number of houses inspected :— Inspections. Under Regulations, Sec. 17, Housing, Town Planning Act, 1909 0 From House-to-House apart from this Act 490 On Account of Infectious Disease 799 On Account of Phthisis 99 On Account of Complaint, by occupant or otherwise 1,042 2,430 60 Factories 107 73 Workshops and workplaces, including 7 laundries 224 43 Outworkers' premises inspected 66 55 Bakehouses, of which 37 are in use 114 18 Slaughter-houses, of which 13 are in use 578 26 Cowsheds inspected frequently 331 31 Dairies and Milkshops inspected frequently 152 22 Schools 39 Public-house urinals inspected 275 Conveniences at Railway Stations inspected 10 Fish Shops : Total number of visits 333 Coffee and Eating Houses: Total number of visits 21 Shops where ice-cream is made : Total number of inspections 161 2,311 43 Inspections (continued). Visits to absentees excluded from Elementary Schools 1,197 Visits in connection with cases of Infectious Disease 4,773 Visits in connection with Phthisis 490 Offensive Trades (excluding Fish-Shops) 19 Smoke observations 21 Other inspections, including works in progress 10,549 Petroleum Stores inspected 196 Visits in respect of Food Control matters 2,461 Visits re Shops Act 8 19,714 24,455 NOTICES ISSUED. Statutory — Provision of dustbins 160 For repairs to houses, drains, and abatement of nuisances 433 Providing sufficient water-closets 51 Paving of yards 46 Overcrowding 2 Provision of sink waste-pipes 17 Cleansing of bake-house 0 To remove offensive accumulation 0 709 Informal:— Notices 10 Letters sent in lieu of notices 981 991 Other notices issued under Infectious Diseases Acts:— To Occupiers 1,368 To Head Teachers at Schools 1,316 2,684 4,384 Other letters sent 4,187 44 The following are the works carried out as the result of the notices or letters:— Houses or parts of houses cleansed, repaired, etc 703 Roofs repaired 265 Gutters and downpipes repaired 240 Cesspools emptied 251 House drains cleared, repaired, etc 186 House drains tested, examined, etc 130 House drains reconstructed 21 Disconnecting traps or chambers inserted 6 Soil-pipes and drains ventilated, including repairs to ventilators 47 Sink-wastes disconnected or repaired 10 Closets provided with proper flushing cisterns or water supply 108 New closets provided 2 Closets repaired, covered, cleansed, etc. 169 Storage cisterns repaired, covered, cleansed, etc. 55 Storage cisterns provided 2 Water laid on or restored 9 Samples of water taken from wells 0 Wells cleansed, repaired, etc 1 Yards paved, or existing paving made good 86 Ventilation provided under ground floors and causes of dampness removed, etc 18 Ventilation provided to rooms, or windows made to open 16 Dustbins repaired, or new ones provided 476 Manure heaps removed 35 Fowls and other animals removed 9 Other nuisances abated 20 Ditches cleaned out 0 Cases of overcrowding abated 0 Stables cleansed 5 DISINFECTION. Houses disinfected:— After infectious disease 431 After Phthisis 91 After verminous cases 4 Rooms stripped and re-papered, etc., after occupation by cases of infectious disease 135 Ditto, ditto, by cases of Phthisis 54 Articles of clothing, bedding, etc., disinfected 4,223 Ditto, ditto, destroyed 16 4,954 45 Disinfections (continued). Library Books disinfected 115 Number of Schools disinfected 5 Cases of Scarlet Fever removed to Hospital 229 Cases of Diphtheria removed to Hospital 97 326 Private Patients removed to Hospital or Infirmary 27 Gipsy Vans removed from District 13 Articles or parcels of unsound food destroyed, or otherwise disposed of 52 Realising the importance of securing as speedily as possible the iamoval of all insanitary conditions, especially in connection with dwellings, our constant endeavour has been to obtain the carrying out of necessary works without delay. While labour seemed more abundant we found ourselves frequently hampered by the difficulties which owners experienced in procuring the materials and fittings required. It was only in a comparatively few cases where legal proceedings had to be threatened, and a warning from the Council proved sufficient in each case in securing the carrying out of the works required. The number of visits paid re children excluded from Elementary Schools during the year was 1,197, and the total number of inspections and visits for all purposes made by the Staff of the Sanitary Department was 24,455. REMOVAL OF HOUSE REFUSE. During the year the question of adopting Motor Transport was under consideration and after the matter was gone into very carefully by the Council the approval of the Ministry of Health was received for the purchase of a two-ton Edison Electric Vehicle. Unfortunately however, the makers were unable to promise delivery before the early part of the new year. A good quantity of refuse was disposed of in the brickfields, and the remainder taken to the Council's Depot, Carterhatch Lane, where it is levelled and covered with earth, which afterwards becomes useful for allotments. The quantity of refuse collected during the year was approximately 8,307 tons. Quantities of trade refuse were also collected from business premises for which a charge was made. 46 SALVAGE. I regret that owing to the serious drop in prices it has become practically impossible to dispose of waste materials that might be collected from the refuse. We have, however, done our best to continue with the following results :— Kinds of Refuse. Amount Collected. Amount Realised. Tons Cwts. Qrs lbs. £ s. d. Waste Paper 2 19 0 0 12 4 9 Old Iron, Tins, etc. 80 13 0 0 66 11 0 Unsound Foodstuffs, etc. 1 14 0 26 19 1 9 Totals 85 6 0 26 97 17 6 FACTORY AND WORKSHOPS ACTS, 1901 & 1907. A register of all workshops is kept, and at the end of 1919 there were 66 workshops, 7 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) 107 1 ... Workshops (including Workshop Laundries) 224 ... ... Bakehouses 114 ... ... Total 445 1 ... 47 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 21 21 ... ... Want of Ventilation ... ... ... ... Overcrowding ... ... ... ... Want of Drainage of Floors ... ... ... ... Other Nuisances 2 2 ... ... Sanitary Accommodation:— Insufficient ... ... ... ... Unsuitable or Defective 2 2 ... ... Not separate for sexes ... ... ... ... Offences under the Factory and Workshops Acts:— Illegal occupation of underground bakehouse ... ... ... ... Breach of special sanitary requirements for bakehouses 3° 30 Other Offences ... ... ... ... Totals 55 55 ... ... 48 Homework, Nature of Work. L'sts received from Employers. Notices served on Occupiers as to keeping or sending Lists. Sending once in the year. Sending twice in the year. Lists Workmen. Lists Workmen. Making Wearing Apparel 20 21 10 12 12 Artificial Flowers 2 2 1 1 ... Boot making ... ... 1 1 ... Embroidery 4 4 ... ... 2 Fancy Goods 2 2 ... ... ... Totals 28 29 12 14 14 Fourteen addresses of Outworkers have been forwarded to other district®. 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. 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:— Slaughter-houses 577 Shops 159 Stalls in Markets 386 1,122 49 The number of carcases examined during the visits to slaughterhouses is as follows:— Cows 108 Oxen 259 Calves 24 Sheep 718 Pigs 211 Bullocks 1 1,321 During the examination of these carcases while dressing proceeding, 5 carcases or parts of, and 12 organs were found to be diseased. These were all surrended 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 35. I am, Mrs. Newman and Gentlemen, Your obedient Servant, A. J. MUNRO, M.R. San .1. Inspector of Nuisances. .