ENF 13 Urban District Council of Enfield. ANNUAL REPORT of the Medical Officer of Health FOR 1921, together with the ANNUAL REPORT of the Inspector of Nuisances. crusha Son, Tottenham, Enfield and Wood Green. PUBLIC OFFICES, ENFIELD, April 6th, 1922. Medical Officer of Health's ANNUAL REPORT For 1921. To the Urban District Council of Enfield, Gentlemen, I have the honour to submit to you my Annual Report for the year 1921, 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. The Minister of Health having stated in a Circular No. 269, dated the 28th December, 1921, that Annual Reports of a full and detailed character referred to as "Survey Reports" will normally be required at periods of not more than five years, that the Annual Reports of 1919 and 1920 will be treated as constituting the first of the series of these Reports, and that for 1921 is to be treated as an ordinary report and to contain certain particulars specified in the Circular above referred to, I have only included the details required. 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 daring the past year. I am, Gentlemen, Yours obediently, W. P. WARREN, Medical Officer of Health. 2 POPULATION. The Registrar-General, from data collected at the Census taken in June, 1921, has fixed the population of Enfield at 60,743. The actual figures fall somewhat below the estimates that had been made in previous years, with the result that rates calculated for a few years prior to 1921 have been based on too large a population and have, therefore, in some respects appeared unduly favourable to the District. BIRTHS. The number of births registered in the District was:— Boys, 583. Girls, 529. Total, 1,112. including 20 illegitimate births, i.e., 1.79 per cent, of the total. 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 Population. Illegitimate Birth-rate per 1,000 Population. 1919 519 528 1,047 16.98 .79 1920 710 700 1,410 22.87 .87 1921 634 564 1,198 19.72 .57 DEATHS. The deaths registered in the district during the year were 479, of which 237 were males and 242 females, giving a crude deathrate of 7.88. To these must be added 175 deaths of Enfield residents 3 registered outside the district, and from this total must be subtracted 59 deaths of non-residents occurring in the District, which brings the net number of deaths to 595 for the year, giving a recorded death-rate of 9.79. 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 standardised death-rate of 10.13. Birth-rate. Recorded Death-rate. Standardised Death-rate. Infantile Death-rate. England and Wales 22.4 12.1 — 83.00 London 22.3 12.4 — 80.00 96 Great Towns (incldng. London) 23.3 12.3 — 87.00 Enfield 19.72 9.79 10.13 66.77 The corresponding figures for Enfield for the three previous years are:— 1918. 1919. 1920. Recorded death-rate 12.48 9.92 9.79 Standardised death-rate 12.79 10.27 10.13 Forty-eight of the deaths registered in the District were those of persons over 80 years of age, 16 being males and 32 females, one woman dying at the advanced age of 95. The more important causes of deaths as registered were:— Malignant Diseases, 65 ; Heart Disease, 56 ; Pulmonary Tuberculosis, 46; Bronchitis, 44; Pneumonia, 36; Apoplexy, 34; Old Age, 24; Influenza, 17; Diarrhoea and Enteritis, 14; Diphtheria and Croup, 4 12; Bright's Disease, 11; Other respiratory diseases, 11; whilst among the Children Premature Birth accounted for 21; Diarrhoea and Enteritis, 12; Pneumonia, 9; Atrophy, Debility and Marasmus, 8; Bronchitis, 7. INQUESTS. Thirty-five inquests were held in Enfield during the year, and the verdicts given were as follows:— Natural Causes 19 Misadventure 4 Accidental Causes 3 Open Verdict 4 Suicides 5 35 INFANTILE DEATHS. The total number of deaths that occurred amongst infants under 1 year, including 16 registered outside the District, was 80, giving a death-rate of 66.77 per 1,000 births, as compared with a death-rate of 83 for England and Wales, and 87 for the 96 great towns, including London. The corresponding figures for Enfield for the last three years were: 1918, 66.94; 1919, 56.35; and 1920, 45.39.. The number of deaths of illegitimate children was 10, which gives a death-rate of 285.71 per 1,000 illegitimate infants. The chief causes of death were Premature Birth (including Congenital Defects), 31; Diarrhoea and Enteritis, 12; Pneumonia, 9; and Bronchitis, 7. 5 I.—GENERAL STATISTICS. Area (acres) 12,602 Population (1921) 60,743 Number of inhabited houses 12,066 Rateable value £329,498 Sum represented by a penny rate £1,116 17s. 8d. II.—EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Births:— Males. Females. Total. Legitimate 611 552 1,163 Illegitimate 23 12 35 Birth-rate=19.72 per 1,000. Deaths 317 278 595 Death-rate=Recorded, 9.79 ; Standardised, 10.13. Number of women dying in, or in consequence of, childbirth:— From Sepsis Nil. From other causes 2 Deaths of infants under one year of age per 1,000 births:—66.77 . Legitimate, 70; illegitimate, 10; total, 80. Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) 2 Deaths from Diarrhoea (under two years of age) 14 The following table shows the causes of death at all ages during 1921, and Table II. gives an analysis of the causes of death in infants under one year of age:— 6 TABLE I. Causes of and Ages at Death during Year 1921. Causes of Death. Nett Deaths at the subjoined ages of " Residents," whether occurring within or without the District. Total Deaths,whether of "Residents" or "Non residents" in Institutions in the District All Ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. All Causes— Certified 594 79 20 14 25 31 74 146 205 96 Uncertified 1 1 — — — — — — — — Enteric Fever 1 - - - - - - 1 — 1 Smallpox - - - - - - - - - - Measles 1 — — — — — — 1 — — Scarlet Fever - - - - - - - - - 3 Whooping Cough 2 2 - - - - - - - 1 Diphtheria and Croup 12 — 1 2 7 — 2 — — 39 Influenza 17 — 1 — — 2 5 6 3 3 Erysipelas — — — — — — — — — — Pulmonary Tuberculosis 46 — — — 3 14 16 13 — — Tuberculous Meningitis 8 — 1 2 4 1 — — — 1 Other Tuberculous Diseases 7 — — —- 1 1 2 1 2 1 Cancer, Malignant Disease. 65 - - - - - 3 30 32 4 Rheumatic Fever 2 - - - - - - 1 1 — Meningitis 3 1 1 — 1 — — — — — Organic Heart Disease 56 — — — 2 1 7 16 30 5 Bronchitis 44 7 2 — — — 2 7 26 9 Pneumonia (all forms) 36 9 7 1 — 1 6 6 6 2 Other Diseases of Respiratory Organs 11 - 1 1 - 1 1 2 5 — Diarrhoea and Enteritis 9 7 2 - - - - - - 3 Epidemic Diarrhoea 5 5 - - - - - - - 1 Appendicitis and Typhlitis. 4 — - — — 1 i 2 — 2 Cirrhosis of Liver 1 - - - - - - - 1 — Alcoholism - - - - - - - - - Nephritis & Bright's Disease 11 - - - - - 2 6 3 2 Puerperal Fever - - - - - - - - - Other accidents & diseases of Pregnancy and Parturition 2 - - - - 1 1 - - 1 Congenital Debility and Malformation, including Premature Birth 32 31 1 - - - - - - 1 Violent Deaths, excluding Suicide 19 1 - 2 2 3 3 6 2 - Suicides 3 — — — — — 2 — 1 1 Other Defined Diseases 194 15 2 6 5 5 21 47 93 16 Diseases ill-defined or unknown 4 2 1 — — — — 1 — — Totals 595 80 20 14 25 31 74 146 205 96 Included in above:- Old Age 24 - - - - - - - 24 1 Apoplexy 34 - - - - - - 8 26 2 Cerebro-spinal Meningitis - - - - - - - - - - Poliomyelitis - - - - - - - - - - Encephalitis Lethargica. 2 — — 1 1 - - - - - 7 TABLE II. Infant Mortality. Net 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 27 5 1 3 36 19 12 8 4 79 Uncertified 1 - — - 1 - - - - 1 Small Pox - - - - - - - - - - Chicken Pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - Whooping Cough - - - - - 2 - - - 2 Diphtheria and Croup - - - - - - - - - - Erysipelas - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis (not Tuberculous) - - - - - - - 1 — 1 Convulsions 1 - — - 1 - - - — 1 Laryngitis - - - - - - - - - - Bronchitis - - 1 - 1 3 2 1 — 7 Pneumonia (all forms) —- - — 2 2 2 2 1 2 9 Diarrhoea - - — — — 2 — - — 2 Epidemic Diarrhoea - - - - - 3 1 1 - 5 Enteritis - - - - - 2 2 1 — 5 Gastritis - - - - - - - 1 1 2 Syphilis - - - - - - 1 - 1 2 Ricketts - - - - - - - - - - Suffocation, overlying - - - - - - 1 - - 1 Injury at Birth 3 - — - 3 — — 1 — 4 Atelectasis 2 1 — — 3 — — — — 3 Congenital Malformation 2 - — — 2 — — — — 2 Premature Birth 16 3 — 1 20 1 — — — 21 Atrophy, Debility and Marasmus 2 ] - - 3 3 1 1 - 8 Other Causes 2 — — — 2 1 2 — — 5 Totals 28 5 1 3 37 19 12 8 4 80 Net, Births in the year:—Legitimate, 1,163; Illegitimate, 35. Net Deaths in the year:—Legitimate Infants. 70: Illegitimate, 10. III.—INFECTIOUS DISEASES. The following table shows the cases of infectious diseases notified during the year, and the number of deaths that occurred. 8 TABLE III.—Cases of Infectious Diseases notified during the year 1921. Notifiable Disease. Number of Cases Notified. At Ages—Years. Total cases removed to Hospital. Deaths. 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. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Totals. Smallpox - - - - - - - - - - - - - Cholera—Plague - - - - - - - - - - - - - - Diphtheria (including Membraneous Croup) 128 1 24 90 7 4 2 - 106 - 1 2 7 - 2 — - 12 Diphtheria Carriers 11 - 2 9 — — — - — - - — — - — — - — Erysipelas 27 - — 3 2 6 13 3 - - - - - - - - - Scarlet Fever 218 - 20 161 29 6 2 — 157 - - - - - - - - - Typhus Fever - - - - - - - - - - - - - - - - - - Enteric Fever - - - - - - - - - - - - - - - - - - Relapsing Fever - - - - - - - - - - - - - - - - - - Continued Fever Puerperal Fever 1 - - 1 - - - 1 - - - - - - - - - Measles 37 3 7 23 2 1 1 - - - - - - - - 1 - 1 German Measles 93 — 21 64 6 2 - - - - - - - - - - - - Cerebro-spinal Meningitis - - - - - - - - - - - - - - - - - - Poliomyelitis 1 — 1 - - - - - - - - - - - - - - - Ophthalmia Neonatorum 3 3 — — — — — — — - - — — - — — - — Pulmonary Tuberculosis 82 — — 11 17 36 17 1 — - - — 3 14 16 13 - 46 Other forms of Tuberculosis 27 — 4 13 4 5 1 - - - - 2 5 2 2 1 2 15 Encephalitis Lethargica 7 — 1 2 2 — 2 — — - - 1 1 - — - - 2 Malaria — — — — — — — — — - - 1 — — — — - — Pneumonia 49 3 8 5 7 12 11 3 — 9 7 - 1 6 6 6 36 Totals 684 10 88 381 77 72 49 7 264 9 9 6 16 17 26 21 8 112 9 Ophthalmia Neonatorum. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 3 3 - 3 - - - Scarlet Fever. 218 cases of Scarlet Fever occurred during the year in 180 bouses, as follows:— Number of houses where 1 case occurred 150 2 cases ,, 24 „ „ „ „ 4 „ „ 4 „ „ 2 Total number of houses where cases occurred 180 Total number of cases 218 The mild character of the cases of this disease which occurred during the year may be judged by the fact that there were no deaths. Diphtheria. 128 cases of this disease occurred during the year in 106 houses, as follows:— Number of houses where 1 case occurred 93 ,, ,, 2 cases ,, 8 „ „ 3 „ „ „ 4 „ „ 7 „ „ 1 Total number of houses where cases occurred 106 Total number of cases 128 10 Enteric Fever. There were no cases of this disease notified during the year. Poliomyelitis. One case of this disease was notified during the year. Cerebro-Spinal Fever. There were no cases of this disease notified during the year. Encephalitis Lethargica. Seven cases of this disease were notified during the year, two of which were 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. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Diphtheria. This disease continued to be fairly prevalent during the year, and in connection with this 11 Diphtheria Carriers were discovered. 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 11 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. Small Pox. There being 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 of 1920 to take charge of cases of Measles, Chicken Pox, and nonnotifiable 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. 12 During the year her visits were as follows:— Visits re cases of Measles, Chicken Pox, Whooping Cough, Mumps, and Pneumonia 1,168 Visits re suspected cases of Infectious Disease 704 Infant Welfare Visits 672 Ante-Natal Visits 24 Inspections on complaint by occupiers 186 Other visits 198 Visits, but no reply obtainable 223 Total 3,175 DISINFECTION OF VERMINOUS PERSONS AND THEIR BELONGINGS. Eight dwellings and 74 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 9 1 7 4 - - Chase 13 1 20 13 — 1 Ordnance 11 1 18 3 1 — Green Street and Ponders End 35 5 36 7 1 Bush Hill Park 14 — 16 — — — Hadley and Cockfosters - - - — — — Totals 82 8 97 27 1 2 13 First Notifications 109 Old Cases re-notified, i.e., some by fresh doctors, or coming into District, or under old regulations 9 Duplicate Notifications, i.e., those which report the entering and leaving of Sanatoria 99 Total Notifications 217 Sex (1st Notifications). Form. Males. Females. Pulmonary 44 38 Other 11 16 Totals 55 54 Deaths. The number of deaths from this disease during the year is shown in the following table, viz.:— Ward. Pulmonary. Other. Town 4 4 Chase 8 3 Ordnance 6 2 Green Street and Pondera End 21 5 Bush Hill Park 7 1 Hadley and Cockfosters — — Totals 46 15 14 29.5 per cent, of the cases dying of tuberculosis had not previously been notified. It is to be observed that the number of cases of this disease notified and deaths reported is appreciably less than in the preceding year. Measles and German Measles. The following numbers of notifications of this disease were received from the different wards:— Ward. Measles. German Measles. Town 6 7 Chase 16 43 Ordnance 2 7 Green Street and Ponders End 2 3 Bush Hill Park 11 33 Hadley and Cockfosters — — Totals 37 93 There was only one death from this disease during the year, and that of an adult over 45 years of age. Enteritis. Five deaths occurred from this disease during the year, all of which were infants under one year. Epidemic Diarrhœa. There were five deaths from this disease during the year, all of infants under one year of age. 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. 1917 1918 1919 1920 1921 Small Pox - - - - - *Scarlet Fever 1 — 12 5 3 *Diphtheria 11 3 15 30 41 Measles 16 2 1 8 1 *Enteric Fever 1 4 — — 1 Whooping Cough 4 12 2 3 3 Epidemic Enteritis 2 — 1 — 5 Totals 35 21 31 46 54 *The actual Enfield deaths were: Scarlet Fever, 0; Diphtheria 10; Enteric Fever, 0: and Whooping Cough, 2. 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. ENFIELD ZYMOTIC DEATH RATE. The zymotic death-rate, after deducting 36 deaths of persons from outside the district who died in Institutions in the District, and adding three deaths of Enfield residents registered outside the District, is 0.34 per 1,000. Disease. 1920. 1921. Deaths. Death-rate Deaths . Death-rate. Scarlet Fever 1 .01 - .00 Diphtheria 13 .21 12 .19 Enteric Fever - .00 1 .01 Erysipelas - .00 — .00 Measles 8 .12 1 .01 Whooping Cough 3 .04 2 .03 Epidemic Enteritis - .00 5 .08 Totals 25 .40 21 .34 16 IV.—CAUSES OE SICKNESS. Apart from a considerable amount of notifiable infectious disease prevalent in the district during the year, the only important cause of sickness was a widespread epidemic of influenza with low mortality. Altogether, 17 deaths from influenza were registered. V—SUMMARY OF NURSING ARRANGEMENTS, HOSPITALS AND OTHER INSTITUTIONS AVAILABLE FOR THE DISTRICT. HOME NURSING. The Ponders End and District Nursing Society provides two Nurses for the assistance of the sick poor. No financial contribution is paid to the Society by the Local Authority. MID WIVES. The Middlesex County Council is the supervising authority under the Midwives' Acts. There were 12 Midwives practising in the District. CLINICS AND TREATMENT CENTRES. Maternity and Child Welfare Centres:— Ponders End.—Alma Road Council Schools, Monday and Tuesday afternoons, 2.4 p.m. Bush Hill Park.—St. Mark's Institute, St. Mark's Road, Tuesday and Thursday afternoons, 2.4 p.m. Ordnance.—Totteridge Road Baptist Sunday School, Wednesday and Thursday afternoons, 2.4 p.m. Town and Chase.—Armfield Road Institute, Wednesday and Friday afternoons, 2.4 p.m. 17 Ante-Natal Clinics:— Town.—Waldron Hall, Genotin Road, second Tuesday in each month, 9.30-11.30 a.m. Ponders End.—Alma Road Council Schools, second Friday in each month, 2-4 p.m. Tuberculosis Dispensary (Middlesex County Council):— 56, Silver Street, Upper Edmonton. HOSPITALS. 1. Tuberculosis (County of Middlesex Scheme).—There are some 365 beds available for the treatment of this disease in the following Institutions:— Clare Hall Sanatorium. Fairlight Sanatorium, Hastings. Oak Bank Sanatorium, Sevenoaks. Northern Hospital, Winchmore Hill. St. George's Home, Chelsea. Victoria Home, Margate. County Council Dispensary, Bell Road, Hounslow. Chilton Hill House, Sudbury. Merivale Sanatorium, Chelmsford. County Council Hospital, Isleworth. At the end of October, 1921, some beds (for females and children) were opened at the County Sanatorium, Harefield , and, concurrently with this, notice of termination of agreement for the reservation of beds at Fairlight, Oak Bank, Chilton Hill House, and Merivale Sanatoria, Northern Hospital, and St. George's Home was given. The remaining beds at Harefield are being made available as quickly as possible. 18 In addition to the beds reserved in Institutions in the above list, cases are also sent to others, as follows:— Benenden Sanatorium. Brompton Hospital. Frimley Sanatorium. Grosvenor Sanatorium. Eversfield Chest Hospital. Royal National Sanatorium. Bournemouth. Firs Home, Bournemouth. Ventnor Sanatorium. Mount Vernon Sanatorium. Maltings Farm Sanatorium. Midhurst Sanatorium. Woodhurst Sanatorium. Hendon Cottage Hospital. Royal Sea-Bathing Hospital. Cranbrook. Sevenoaks Hip Hospital. Harpenden Sanatorium. Church Army (Fleet) Sanatorium. 2. Maternity (Maternity Hostel, North Middlesex Hospital, Edmonton).—This is provided by the Edmonton Board of Guardians, and the local authority pays £2 2s. per week for each person admitted from this District. Persons taking advantage of this are required to contribute according to their means. 3. Children.—None. 4. Fever.—The District is served by the Enfield and Edmonton Joint Isolation Hospital, which is situated upon 27 acres of land at Winchmore Hill, about three and a 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. 19 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 157 Diphtheria 106 5. 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. 6. Other Hospitals.—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's Hospital, Tottenham, and many patients also go to the various London hospitals. None of these are in any way supported by the Local Authority. OTHER INSTITUTIONS. 1. Unmarried Mothers.—None. 2. Illegitimate Infants and Homeless Children.—Chase Farm Schools and Fortescue Villas, provided by the Edmonton Board of Guardians; no contribution is made by the Local Authority. AMBULANCE FACILITIES. For Infectious Cases.—Urban District Council of Enfield Ambulances, Public Offices, Enfield. Number of patients removed, 263. 20 For Non-Infectious Cases.—Urban District Council of Enfield Ambulance, Fire Station, Ponders End (provided by Joint Council, Home Service Ambulance Committee). Number of patients removed 294. St. John Ambulance Brigade Ambulance. 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 Centress Health Visitors. Miss H. Thori'e, Miss M. Briscoe, Miss H. Morrison, Mis, N. K. Ross, Miss F. Hall. Maternity and Child Welfare Work. T 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 of 1920 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 of the same year. The attendance at once showed the necessity of such a step, and both the Town and Chase and Ponders End Centres were opened twice a week in the early part of the 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. 21 Baby Week. This was celebrated on June 22nd and 23rd. A Garden Party was held in the Manse Gardens, Chase Side, and another in the Garden of St. James's 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 ReAttendances. No. on Register. Average Attendance per Meeting. Waldron Hall 94 79 112 14.4 Alma Road Council School 106 71 116 16.4 Totals 200 150 228 14.5 It is pleasing to find these Clinics are so appreciated that the attendance is still increasing. 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 22 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 to great service in securing the speedy removal of urgent cases to the Hostel. 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. Visits. Town and Chase. Bush Hill Park. Hadley. Ordnance. Ponders End. Totals. Birth Notification Visits 265 185 6 222 262 940 Ditto Re-visits 1,228 853 8 957 833 3,879 Children, 1-5 yrs. Visits 1,237 1,089 5 870 646 3,847 Infant Mortality Visits — — — 8 9 17 General Visits 41 129 — 506 509 1,185 Ante-Natal Visits 90 154 2 252 54 552 Post-Natal Visits — — — 2 3 5 Blank Visits .. 176 328 2 267 243 1,016 Child Death Visits — — — 1 4 5 Ophthalmia Neonatorum Visits - - - 1 - 1 Puerperal Fever Visits 1 — — — — 1 Totals 3,038 2,738 23 3,086 2,563 11,448 23 Feeding, etc. Feeding. Town and Chase. % Bush Hill Park. % Hadley % Ordnance. % Ponders End. % Totals. % Natural 228 86 165 89 6 100 169 75 210 80 778 81 Artificial 29 10 17 10 — — 37 16 39 14 122 13 Mixed 8 3 3 1 - - 16 7 13 5 40 4 Cradle Used 178 67 109 66 5 83 110 50 104 39 506 53 Attendances at Centres. Centre. New Attendances. ReAttend ances. No. on Register 1.1.21. No on Register 31.12.21. No. of Meetings. Average Attendance per Meeting. Town and Chase 188 3,588 523 596 102 37.0 Bush Hill Park 221 3,728 469 577 99 39.8 Ordnance 198 3,657 529 536 100 38.5 Ponders End 252 3,400 387 505 92 38.8 Totals 859 14,373 1,908 2,214 393 38.7 Number of Births notified: 1,100, 85 per cent, 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. 24 VI—LABORATORY WORK. All the Bacteriological work is done in my own laboratory, including the preparation of media, cultivation of growths, etc. Every sw ab is ''planted'' and grown in an incubator. No. Positive. Negative. Percentages of Positives. Swabs 1,105 113 992 10.22 Sputum 99 15 84 15.11 Totals 1,204 128 1,076 10.63 I should like to emphasise 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 live 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. 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 150 bottles, each containing 4,000 units, were supplied during the year. 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. BYE LAWS AND REGULATIONS. Public Health Act, 1875. With respect to:— Nuisances arising from snow, filth, dust, ashes, and rubbish, and for the prevention of keeping animals on any premises so as to be injurious to health. (September 15th, 1887). Common Lodging Houses. (September 15th, 1887). Houses let in Lodgings. (September 15th, 1887.) Slaughterhouses. (September 15th, 1887.) Cleansing of Earth-closets, Privies, Ashpits and Cesspools. (September 15th, 1887.) 26 With respect to New Streets and Buildings and Alterations to Buildings. (July 5th, 1916.) Housing of the Working Classes Act, 1885. With respect to:— Tents, Vans, Sheds, etc. (February 14th, 1912.) Dairies, Cowsheds and Milkshops Order, 1885. With respect to:— Dairies, Cowsheds and Milkshops. (February 15th, 1900.) Public Health Act, 1875, Sec. 112, as amended by Sec. 51 of the Public Health Acts Amendment Act, 1907. With respect to:— Offensive Trades (February 26th, 1913), as follows:— Blood-boiler and Blood-drier. Bone Boiler. Fellmonger, Tanner and Leather-dresser. Soap-boiler. Tallow-melter, Fat-melter, or Fat-extractor. Tripe-boiler. Glue-maker and Size-maker. Gut-scraper. Dealer in Rags and Bones. Fish-frier. Fish -skin -dresser. Manufacturer of Manure from Fish, Offal, Blood, or other putrescible animal matter. 27 SANITARY ADMINISTRATION. Staff. Inspector of Nuisances ]st Assistant Insp. of Nuisances 2nd Assistant Insp. of Nuisances 3rd Assistant Insp. of Nuisances 1st Clerk 2nd Clerk Pupil Clerk Junior Clerk General Assistant.. A. J. Munro, M.R.San.I. Fred Wilson, M.R.San.I. T. M. Boswell, A.R.San.I. Noel Smith, A.R.San.I. Sydney Coulter, Cert.R.San.I. H. Wiggett. Miss M.J. Ridler. Miss E. W. Bowyer. J. Davis. Particulars of their work will be found in the Report of the Inspector of Nuisances attached to this Report. It will be seen that a very large amount of work has been carried out during the year in securing the removal of nuisances and in other ways which must tend not only to the benefit of the District, but to the happiness and well-being of the inhabitants. SANITARY CIRCUMSTANCES OF THE DISTRICT. Water Supply. With the exception of Hadley and Cockfosters, 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. 28 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. 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. 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. 29 Cesspools. The Council has provided suitable vans and pumps, and undertakes the emptying of cesspools on the application of householders, a small charge being made for each emptying, 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 363 On Account of Infectious Disease 344 On Account of Phthisis 100 On Account of Complaint by occupant or otherwise 1,511 2,318 Inspections. 60 Factories 93 76 Workshops and workplaces, including 7 laundries 190 20 Outworkers' premises inspected 34 55 Bakehouses, of which 37 are in use 128 18 Slaughter-houses, of which 13 are in use 566 28 Cowsheds inspected frequently 423 31 Dairies and Milkshops inspected frequently 132 22 Schools 149 Public-house urinals inspected 273 Conveniences at Railway Stations inspected 12 Fish Shops: Total number of visits 321 Coffee and Eating Houses: Total number of visits 11 Shops where ice-cream is made: Total number of inspections 133 2,465 30 Visits to absentees excluded from Elementary Schools 1,929 Visits in connection with cases of Infectious Disease 3,555 Visits in connection with Phthisis 539 Offensive Trades (excluding Fish Shops) 20 Smoke observations 5 Other inspections, including works in progress 9,853 Petroleum Stores inspected 104 Visits re Shops Act 80 Cinemas, etc., inspected 10 16,095 20,878 Notices Issued. Statutory:— Provision of dustbins 120 For repairs to houses, drains, and abatement of nuisances 268 Providing sufficient water-closets 95 Paving of yards 0 Overcrowding 0 Provision of sink waste-pipes 2 Cleansing of bake-house 0 To remove offensive accumulation 0 Cleansing and Limewashing of Cowsheds 4 Provision of water supply 2 491 Informal:— Notices 0 Letters sent in lieu of notice 988 988 31 Other Notices issued under Infectious Diseases Acts:— To occupiers 791 To Education Committee and Head Teachers at Schools 2,6-10 3,434 4,913 Other letters sent 4,544 Result of Service of Statutory Notices:— Number complied with 433 Number outstanding 58 491 As to these outstanding notices, the work required was delayed on account of the weather or other reasonable cause. Detailed particulars of the work done in the Sanitary Depart ment will also be found in the report of the Sanitary Inspector attached hereto. 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. 32 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 471 cows in Enfield owned by 21 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 show that the Enfield dairy-farmer is fully alive to the danger of keeping tuberculous cows on his premises. Holly House, Lower Edmonton, April 6th, 1921. Dear Sir, I beg to report that I have completed the inspection of milch cows throughout the District, as shown in the accompanying list. The result of my examination proved the animals to be, in general, satisfactorily free from disease of the udder. I found one cow suffering from Tuberculosis of that organ, which I reported 33 at the time. With this exception there were few cases of affection of any kind, and they were of the usual character incidental to milking cows. The total number of cows is slightly larger than on previous occasions, and they appeared, generally, to be in good condition and well kept. I am, dear Sir, Yours obediently, (Signed) H. H. Hide. T. W. Scott, Esq. Holly House, Lower Edmonton, December 12th, 1921. 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 the udders, and in one case the animal proved to be affected with Tuberculosis of that organ. I found a small number of the usual affections incidental to milking cows, and where necessary made a bacteriological examination of the milk, but these all proved to be free from Tuberculosis. Apart from these, there is a satisfactory absence of udder disease among the herds. The animals in general, although in some cases showing the effects of the difficulties the owners have experienced owing to the 34 abnormal season, appear well kept and in satisfactory condition. The numbers remain about the same as at the period of my last inspection. I am, dear Sir, Yours obediently, (Signed) H. H. Hide. T. W. Scott, Esq. With regard to the cows referred to above, enquiries were made as soon as I received information of these, when we found that the one mentioned in the April report had, with others, been sold to a dealer in another District, and in spite of endeavours we were unable to trace it further. With regard to the one referred to in the December report, this cow was destroyed by the owner and buried. 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,1921. December, 1921. Registered 10 8 8 Licensed 7 5 5 Total 17 13 13 35 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 566 such visits during the year, when they examined 1,167 carcases, and secured the surrender of 6 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, hava 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. 8.—PUBLIC HEALTH STAFF. Medical Officer of Health. *W. P. Warren, D.P.H. Inspector of Nuisances. *A. J. Munro, M.R.San.I. 36 Assistant Inspectors of Nuisances. 1st Assistant .. Fred Wilson, M.R.San.I., Cert. Sanitary Inspector's Examination Board (London). Faudell - Phillips Medallist, King's College, London University. Silver and Bronze Medallist, Carpenter's Company. Diploma of R. San. Inst, for Inspection of Meat and and other foods. 2nd Assistant .. T. M. Boswell, A.R.San.I., Diploma of R. San. Inst, for inspection of meat and other foods. 3rd Assistant .. Noel Smith, A.R.San.I. Health Visitors. *Miss H. Thorpe . C.M.B., Cert.R.San.I., First Aid and Home Nursing Cert. *Miss M. V. Briscoe C.M.B., Cert. Sanitary Inspector's Examination Board (London), Infants' Hospital, Vincent Square, London, six months. *Miss H. M. Morrison Three years General Trained Nurses' Cert., Cert. R.San.I., C.M.B. *Miss N. K. Ross .. C.M.B., Cert. Sanitary Inspector's Examination Board (London), 1st Class Cert., Health Visitors and Infant Welfare Workers, Battersea Polytechnic , Honours Cert., Clapham School Midwifery. *Miss F. Hall .. C.M.B., Cert.R.San.I., Cert. Sanitary Inspector's Examination Board (London). 37 Clerks. 1st Clerk .. .. Sydney Coulter, Cert.R.San.I. 2nd Clerk.. .. H. Wiggett. Pupil Clerk .. Miss M.J. Ridler. Junior Clerk .. Miss E. W. Bowyer. General Assistant J. Davis. Part-time Officers. (Maternity and Child Welfare Clinics.) *Dr. Margaret Proudlock Dunbar, M.D., B.S. H. H. Hide, M.R.C.V.S., Veterinary Surgeon. 9—HOUSING. Number of new houses erected during the year:— (a) Total 68 (b) As part of a municipal housing scheme 30 1. Unfit Dwelling-houses. Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,318 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 None. *Salary contribution made under the Public Health Acts or Exchequer Grants. 38 (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 . 1,586 (The number here given is of houses where any insanitary conditions were found.) 2. Remedy of Dejects without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers . 1,491 3. 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 default 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 39 B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 175 (2) Number of dwelling-houses in which defects were remedied:— (a) By Owners 158 (b) By Local Authority in default of owners None C.—Proceedings under Sections 17 and 18 of the Housing, 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 40 Public Offices, Enfield, April 6th, 1922. REPORT OF THE INSPECTOR OF NUISANCES FOR THE YEAR 1921. To the Chairman and Members of The Urban District Council of Enfield. Gentlemen, I beg to submit a report for the year ending December 31st, 1921. The particulars in tabular form 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, being included in the Report of the Medical Officer of Health, I have omitted them to avoid repetition. The general character of the defects found to exist in the dwelling houses inspected were:— Defective drains and ventilating pipes, etc.; W.C. flushing cisterns and pipes out of order; cracked and broken W.C. pans; broken, cracked and porous scullery sinks and waste pipes; leaking roofs; defective gutters; absence of, or broken, paving around houses; defective plaster of ceilings and walls; damp walls; want of ventilation under ground floors and general uncleanly conditions. The following are the works carried out as the result of the notices or letters:— Houses or parts of houses cleansed, repaired, etc. .. 581 Roofs repaired .. 230 Gutters and downpipes repaired .. 185 Cesspools emptied . . 273 House drains cleared, repaired, etc. .. 245 41 House drains tested, examined, etc. 192 House drains reconstructed 5 Disconnecting traps or chambers inserted 2 Soil-pipes and drains ventilated, including repairs to ventilators 34 Sink-wastes disconnected or repaired 25 Closets provided with proper flushing cisterns or water supply 168 New closets provided 7 Closets repaired, covered, cleansed, etc. 108 Storage cisterns repaired, covered, cleansed, etc. 49 Storage cisterns provided 9 Water laid on or restored 22 Samples of water taken from wells 1 Wells cleansed, repaired, etc. .. 0 Yards paved, or existing paving made good 75 Ventilation provided under ground floors and causes of dampness removed, etc... 67 Ventilation provided to rooms, or windows made to open 1 Dustbins repaired, or new ones provided 337 Manure heaps removed 18 Fowls and other animals removed 6 Other nuisances abated 47 Ditches cleaned out 0 Cases of overcrowding abated 10 Stables cleansed 1 Disinfection. Houses disinfected,:— After infectious disease 358 After Phthisis 54 After verminous cases 8 — 420 42 Rooms stripped and re-papered, etc., after occupation by cases of infectious disease .. 113 Ditto, ditto, by cases of Phthisis 30 Articles of clothing, bedding, etc., disinfected 1,945 Ditto, ditto, destroyed 47 Library Books disinfected 127 Number of Schools disinfected 4 Cases of Scarlet Fever removed to Hospital 157 Cases of Diphtheria removed to Hospital 106 263 Private Patients removed to Hospital or Infirmary 294 Gipsy Vans removed from District 24 Articles or parcels of unsound food destroyed or otherwise disposed of.. 28 Realising the importance of securing as speedily as possible the removal of all insanitary conditions, especially in connection with dwellings, our constant endeavour has been to obtain the carrying out of necessary works without delay. 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 1,929, and the total number of inspections and visits for all purposes made by the Staff of the Sanitary Department was 20,878. Removal of House Refuse. Early in March we received delivery of the 2½-ton Edison Electric Vehicle referred to in the Report for 1920, and it has proved a great acquisition. We found it practically took the place of three horses and carts, and by its use we have been able to secure an efficiency and control of the work that was not possible with horses alone, while for the outlying portions of the District it has proved of inestimable benefit. 43 A weekly collection has been maintained at practically all houses with the exception of a few outlying ones, throughout the year, and the complaints received were very few. A good quantity of the 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 9,950 tons. Quantities of trade refuse were also collected from business premises for which a charge was made. SALVAGE. I regret that, owing to the serious drop in prices, we were unable to dispose of waste materials collected from the refuse. FACTORY AND WORKSHOPS ACTS, 1901 AND 1907. A register of all workshops is kept, and at the end of 1921 there were 69 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) 93 - - Workshops (including Workshop Laundries) 145 2 — Workplaces 45 5 — Bakehouses 128 — — Total 411 7 - 44 Deft ;cts Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:— Want of Cleanliness 4 4 - — Want of Ventilation - - - — Overcrowding - - - - Want of Drainage of Floors - - - — Other Nuisances - - - — Sanitary Accommodation:— Insufficient 2 2 - - Unsuitable or Defective 7 7 - — Not separate for sexes - - - - Offences under the Factory and Workshops Acts:— - - - - Illegal occupation of underground bakehouse - - - - Breach of special sanitary requirements for bakehouses 32 32 - - Other Offences — — — - Totals 45 45 — - Homework. Nature of Work. Lists 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 9 12 7 7 8 Artificial Flowers 4 4 1 1 — Games 1 1 - - — Boot-making - - 1 1 — Buttons 1 1 - - — Embroidery - 1 — — 2 Paper Bags, etc. - 1 — — — Ties - 1 — — — Brushes - 1 — — — Totals 19 22 9 9 10 45 Seven addresses of Outworkers have been forwarded to other districts. PLACES OF PUBLIC ENTERTAINMENTS. In accordance with the recommendation contained in the Circular of the Ministry of Health, dated August 25th, 1920, 10 visits to cinemas and other places of public entertainment were made, and the sanitary accommodation at each place found to be satisfactory and apparently sufficient in all cases. No standard as to sufficiency has been laid down. OFFENSIVE TRADES. The following offensive trades are established in the District:— Fish Friers 24 Rag and Bone Dealers 5 Glue Maker 1 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 .. 566 Shops .. 131 Stalls in Markets .. 684 1,381 46 The number of carcases examined during the visits to slaughterhouses is as follows:— Cows 30 Oxen 139 Calves 19 Sheep 701 Pigs 278 1,167 During the examination of these carcases while dressing proceeding, three carcases or parts of, and three 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 fish, rabbits, parcels of meat, 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 22. I am, Gentlemen, Your obedient Servant, A. J. MUNRO, M.R.San.I., Inspector of Nuisances.