Urban District Council of Enfield. ANNUAL REPORT Medical Officer of Health For 1923. TOGETHER WITH THE ANNUAL REPORT OF THE Sanitary Inspector. Crutha & Son, Ltd., Tottenham, Enfield and Wood Green. 1 PUBLIC OFFICES, ENFIELD, 1st March, 1924. Medical Officer of Health's ANNUAL REPORT For 1923. To the Urban District Council of Enfield. Gentlemen, This report is compiled in accordance with instructions received from the Ministry of Health. The health of Enfield still continues to be very favourable. The death-rate, 8 73 per 1,000, is less than that of the four previous years. The birth-rate is declining. 18T9 per 1,000. Infectious Diseases were moderate, with the exception of Measles, which numbered 507 cases. This disease not being notifiable in all districts, it is difficult to make a comparision as to its prevalence. Compulsory notification impresses on parents the seriousness of the disease, resulting in earlier medical attention, thereby preventing complications. The Ante-Natal and Infant Welfare Centres continue to render good service. The main object, namely, prevention of diseases, etc., is thoroughly carried out, and the individual attention given, both to the expectant mother and the young child, will doubtless contribute in seeming a healthier race in the future. With this report is included the report of your Sanitary Inspector, Mr. A. J. Munro, giving particulars of the work carried out under his supervision. I wish to thank you for your cordial support given to me at all times in carrying out my duties. I am, Gentlemen, Your obedient Servant, P. P. WARREN, Medical Officer of Health. 2 POPULATION. The estimated population for Enfield for 1923, which has been based on the adjusted 1921 figures, after allowance for the varying rates of natural increase as evidenced by births and deaths, and migrations as indicated from other sources of information, has been supplied by the Registrar-General as 62,380. BIRTHS. The number of births registered in the District was:— Boys, 511. Girls, 503. Total, 1,014, including 22 illegitimate births, i.e., 2.16 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. 1921 634 564 1,198 19.72 57 1922 616 647 1,263 20.36 51 1923 567 568 1,135 18.19 35 DEATHS. The deaths registered in the district during the year were 382, of which 188 were males and 194 females, giving a crude deathrate of 6.12. To these must be added 197 deaths of Enfield residents 3 registered outside the District, and from this total must be subtracted 34 deaths of non-residents occurring in the District, which brings the number of deaths to 545 for the year, giving a net death-rate of 8.73 per 1,000 population. Birth-rate. Recorded Death-rate. Infantile Death-rate. England and Wales 19.7 11.6 69.00 London 20.2 11.2 60.00 105 Great Towns (incldng. London) 20.4 11.6 72.00 157 Smaller Towns 19.8 10.6 69.00 Enfield 18.19 8.73 54.62 The corresponding figures for Enfield for the three previous years are:— 1920. 1921. 1922. Net death.rate 9.57 9.79 10.03 Sixty.one of the deaths registered in the District were those of persons over 80 years of age, 27 being males and 34 females, one man dying at the advanced age of 102. The more important causes of deaths as registered were:— Old Age, 58; Malignant Disease, 55; Pulmonary Tuberculosis, 50; Pneumonia, 47; Heart Disease, 45; Apoplexy, 41; Bronchitis, 38; Deaths from Violence (excluding Suicides), 23; whilst among the children, Inanition and Marasmus accounted for 20; Premature Birth, 11; and Enteritis, 9. 4 INQUESTS. Twenty-seven inquests were held in Enfield during the year, and the verdicts given were as follows:— Natural Causes 10 Misadventure 4 Accidental Causes 6 Open Verdict 5 Suicides 2 27 INFANTILE DEATHS. The total number of deaths that occurred amongst infants under 1 year, including 15 registered outside the District, was 62, giving a death-rate of 54.62 per 1,000 births, as compared with a death-rate of 69 for England and Wales, and 72 for the 105 great towns, including London. The corresponding figures for Enfield for the last three years were:—1920, 45.39; 1921, 66.77; and 1922, 63.34. The number of deaths of illegitimate children was 6, which gives a death-rate of 142.85 per 1,000 illegitimate infants. The chief causes of death were Premature Birth (including Congenital Defects), 35; and Enteritis, 9. I.—GENERAL STATISTICS. Area (acres) 12,602 Population (1923) 62,380 Number of inhabited houses (1921) 12,066 Number of families or separate occupiers (1921) 13,712 Rateable value £346,458 Sum represented by a penny rate £1,126 5 II.—EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Births:— Males. Females. Total. Legitimate 541 552 1,093 Illegitimate 26 16 42 Birth-rate=18.19 per 1,000 population. Deaths 283 262 545 Death-rate=8.73 per 1,000 population. Number of women dying in, or in consequence of, childbirth:— From Sepsis Nil From other causes 3 Deaths of infants under one year of age per 1,000 births:— Legitimate, 49.33; illegitimate, 5.28; total, 54.62. Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) Nil Deaths from Diarrhoea (under two years of age) 10 The following table shows the causes of death at all ages during 1922, and Table II. gives an analysis of the causes of death in infants under one year of age:— 6 TABLE 1. Causes of and Ages at Death during Year 1923. 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 Distriet 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 under 75. 75 and upwards. All Causes—Certified 545 62 11 8 12 27 67 137 96 125 48 Uncertified — — — — — — — — — — — Enteric Fever — — — — — — — — — — — Smallpox — — — — — — — — — — — Measles — — — — — — — — — — 2 Scarlet Fever 2 — — — 1 — 1 — — — 1 Whooping Cough — — — — — — — — — — — Diphtheria 4 — — 1 3 — — — — — 7 Influenza 4 — — — — 1 — 1 — 2 — Encephalitis Lethargica — — — — — — — — — — — Meningoccal Meningitis 3 1 — 1 — — 1 — — — — Tuberculosis of Respiratory System 50 1 — — — 15 18 15 1 — — Other Tuberculous Diseases 3 1 1 1 — — — — — — — Cancer, Malignant Disease 55 — — — — — 3 23 17 12 3 Rheumatic Fever 2 — — — — 2 — — — — 1 Diabetes 6 — — — — — 1 3 2 — — Cerebral Haemorrhage. etc. 41 — — — — — 3 11 16 11 2 Heart Disease 45 — — — — 1 5 21 7 11 9 Arterio-sclerosis 11 — — — — — — — 5 6 1 Bronchitis 35 2 1 — 1 — 1 5 8 20 2 Pneumonia (all forms) 47 3 2 — 3 2 6 17 11 3 1 Other Respiratory Diseases 4 — 1 — — — 1 1 1 — — Ulcer of Stomach or Duodenum 4 — — — — — 3 1 — — 1 Diarrhoea &c. (under 2years] 10 9 1 — — — — — — — — Appendicitis and Typhlitis 2 — — 1 — — — 1 — — — Cirrhosis of Liver 4 — — — — — — 3 1 — — Acute and Chronic Nephritis 8 — — — — — 1 5 2 — 3 Puerperal Sepsis — — — — — — — — — — — Other accidents & diseases of Pregnancy and Parturition 3 — — — — 1 9 — — — — Congenital Debility and Malformation, Premature Birth 37 34 3 — — — — — — — 1 Suicide 5 — — — — — 3 2 — — — Other Deaths from Violence 23 2 1 — 1 3 7 7 1 1 1 Other Defined Diseases 133 9 1 4 3 2 11 20 24 59 13 Causes ill-defined or unknown 1 — — — — — — 1 — — — Totals 545 62 11 8 12 27 67 137 96 125 48 Included in above:— Old Age 58 — — — — — — — 10 48 — Poliomyelitis 1 — — 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 22 7 1 2 32 14 8 2 6 62 Uncertified — — — — — — — - — — Small Pox - - - - - - - - - - Chicken Pox - - - - - - - - - 1 Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - Whooping Cough - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - Erysipelas - - - - - - - - - - Tuberculous Meningitis — - - - - - - - 1 1 Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - 1 Meningitis (not Tuberculous) - — — — — — 1 - — 1 Convulsions — 2 — — 2 1 1 - — 4 Laryngitis - - - - - - - - - - Bronchitis - - - - - - - - 2 2 Pneumonia (all forms) - - - - - - - - 1 3 Diarrhoea - - - - - - - - - - Epidemic Diarrhoea - - - - - - - - - - Enteritis — 1 1 — 2 3 2 1 1 9 Gastritis - - - - - - - - - - Syphilis - - - - - - - - - - Ricketts - - - - - - - - - - Suffocation, overlying - - - - - 1 - - - 1 Injury at Birth 1 — — — 1 — — - — 1 Atelectasis - - - - - - - - - - Congenital Malformation .. 1 — — — 1 2 1 - — 4 Premature Birth 8 1 — — 9 1 1 - — 11 Atrophy, Debility and Marasmus 10 3 - 2 15 4 - - 1 20 Other Causes 2 — — — 2 — 1 - — 3 Totals 22 7 1 1 2 32 14 8 2 6 62 Net Births in the year:—Legitimate, 1,093; Illegitimate, 42. Net Deaths in the year:—Legitimate Infants, 56; Illegitimate, 6. 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 1923. Notifiable Disease. Number of Cases Notified. Total cases removed to Hospital. Deaths. At Ages—Years. 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) 20 — 5 11 4 — — — 17 — — 1 3 — — — — 4 Diphtheria Carriers 5 — — 2 — 3 — — 1 — — — — — — — — — Erysipelas 10 — — — 1 3 4 2 — — — — — — — — — — Scarlet Fever 84 1 19 47 10 7 — — 67 — — — 1 — 1 — — 2 Typhus Fever — — — — — — — — — — — — — — — — — — Enteric Fever — — — — — — — — — — — — — — — — — — Paratvphoid Fever A 1 — — 1 — — — — — — — — — — — — — — Relapsing Fever — — — — — — — — — — — — — — — — — — Continued Fever Puerperal Fever — — — — — — — — — — — — — — — — — — Measles 507 16 143 338 4 6 — — — — — — — — — — — — German Measles 5 — 2 2 1 — — — — — — — — — — — — — Cerebro spinal Meningitis — — — — — — — — — — — — — — — — — — Poliomyelitis 1 — 1 — — — — — — — — — — — — — — — Ophthalmia Neonatorum 1 1 — — — — — — — — — — — — — — — — Pulmonary Tuberculosis 90 — 1 16 31 31 17 — — 1 — — — 15 18 15 1 50 Other forms of Tuberculosis 20 2 6 8 1 2 1 — — 1 1 1 — — — — — 3 Encephalitis Lethargica 1 — — — — — — — — — — — — — — — — — Malaria — — — — — — — — — — — — — — — — — — Pneumonia 52 4 7 7 7 10 13 4 — 3 2 — 3 2 6 17 14 47 Totals 803 24 184 432 60 62 35 6 85 5 1 3 2 7 17 25 32 15 106 9 Ophthalmia Neonatorum. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 1 1 - 1 — — — Scarlet Fever. 84 cases of Scarlet Fever occurred during the year in 70 houses, as follows:— Number of houses where 1 case occurred 61 „ „ 2 cases „ 6 „ „ 3 „ „ 2 „ „ 5 „ „ 1 Total number of houses where cases occurred 70 Total number of cases 84 Deaths 2 Diphtheria. 20 cases of this disease occurred during the year in 19 houses. Enteric and Paratyphoid Fever. There was one case of Paratyphoid Fever notified during the year. Poliomyelitis. One case of this disease was notified during the year, which proved fatal. Cerebro-Spinal Fever. Nil. 10 Encephalitis Lethargica. One case of this disease was notified during the year. There were 1,025 cases of this disease notified in various parts of the country in 1923. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Diphtheria. This disease was not so prevalent during the year, the cases notified being less than a third of the number notified in 1922. 5 Diphtheria Carriers were discovered. Smallpox. There were no cases of this disease during the year. Infectious Diseases and Schools. Following a suggestion of the Local Government Board, an arrangement is in force between the Council and Education Com mittee, under which the Head Teachers of the various schools notif} to the Medical Officer of Health all absentees suspected to be suffering from any infectious disease. By this means we become aware of many slight cases of infectious disease, 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 reported to the School Medical Officer. 11 DISINFECTION OF VERMINOUS PERSONS AND THEIR BELONGINGS. Four dwellings, and 6 articles of clothing, etc., were cleansed and disinfected. 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 Oases. Old Cases re-notified. Duplicates . Town 12 2 9 3 — — Chase 25 1 23 8 — 1 Ordnance 14 — 27 6 — 1 Green Street and Ponders End 28 5 53 2 - 2 Bush Hill Park 17 — 32 1 2 1 Hadley and Cockfosters - — - - — — Totals 96 8 144 20 2 5 First Notifications 116 Old Cases re-notified, i.e., some by fresh doctors, or coming into District, or under old regulations 10 Duplicate Notifications, i.e., those which report the entering and leaving of Sanatoria 149 Total Notifications 275 12 Sex (1st Notifications). Form. Males. Females. Pulmonary 52 44 Other 11 9 Totals 63 53 Deaths. The number of deaths from this disease during the year is shown in the following table, viz.:— Ward. Pulmonary. Other. Town 5 - Chase 11 2 Ordnance 9 — Green Street and Ponders End 15 1 Bush Hill Park 10 — Hadley and Cockfosters — - Totals 50 3 11.3 per cent, of the cases dying of tuberculosis had not previously been notified. Measles and German Measles. The following numbers of notifications of this disease were received from the different wards:— Ward. Measles. German Measles. Town 51 1 Chase 213 2 Ordnance 20 — Green Street and Ponders End 97 — Bush Hill Park 126 2 Hadley and Cockfosters — Totals 507 5 13 Measles was prevalent in the Chase and Bulls Cross and Bush Hill Park Wards during the Winter months, but, fortunately, the majority of the cases were of a mild type, and there were no deaths. Enteritis. Nine deaths occurred from this disease during the year, all of which were infants under one year. ZYMOTIC DISEASES. The following table shows the Deaths registered in the District from the seven chief zymotic diseases during the past five years:— Disease 1919 1920 1921 1922 1923 Small Pox - - - - - *Scarlet Fever 12 5 3 4 2 *Diphtheria 15 30 41 25 10 *Measles ] 8 1 1 2 *Enteric Fever — — 1 — — Whooping Cough 2 3 3 - — Epidemic Enteritis 1 — 5 — — Totals 31 46 54 30 14 *The actual Enfield deaths were: Scarlet Fever, 2; Diphtheria, 4; and Measles, 0. The figures for Scarlet Fever and Diphtheria 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 8 deaths of persons from outside the district who died in Institutions in the District, 14 and adding one death of an Enfield resident registered outside the District, is 0.09 per 1,000. Disease. 1922. 1923. Deaths. Death-rate Deaths. Death-rate Scarlet Fever 1 .01 2 03 Diphtheria 7 .11 4 .06 Enteric Fever — — — — Erysipelas — — — — Measles 1 .01 — — Whooping Cough — — — — Epidemic Enteritis — — — Totals 9 14 6 .09 IV.—CAUSES OF SICKNESS. Measles gave some anxiety, but, apart from this, other diseases were slight. 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. MIDWIVES. The Middlesex County Council is the supervising authority under the Midwives' Acts. There were 11 Midwives practising in the District. 15 CLINICS AND TREATMENT CENTRES. Maternity and Child Welfare Centres:— Four Infant Welfare Centres and two Ante-Natal Clinics are provided by the Council for the District, and are open as follows:— Ponders End.—Alma Road Council Schools, Monday afternoons, 2-5 p.m. Bush Hill Park.—St. Mark's Institute, St. Mark's Road, Tuesday afternoons, 2-5 p.m. Town and Chase.—Armfield Road Institute, Wednesday afternoons, 2-5 p.m. Ordnance.—Totteridge Road Baptist Sunday School, Thursday afternoons, 2-5 p.m. 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. 16 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, 17 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 67 Diphtheria 17 Diphtheria Carriers 1 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 (2), Public Offices, Enfield. Number of patients removed, 85. 18 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 .. .. 562 St. John Ambulance Brigade Ambulance. MATERNITY AND CHILD WELFARE. Medical Officers of Centres. P. P. Warren, M.R.C.S., Dr. Margaret Dunbar. M.D., B.S. The latter is also Medical Officerof the Ante-Natal Centres. Health Visitors. Miss H. Morrison, Miss N. K. Boss, Miss F. Hall. Maternity and Child Welfare Work. Baby Week. This was celebrated on June 27th and 28th. A Garden Party was held in the Manse Gardens, Chase Side, and another in the Garden of St. James's Lodge, Enfield Highway. Attendances at both were good. 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 19 Schools, Ponders End. Each-centre is opened once a month, and the attendances during the year were:— Centre. New Attend - ances. ReAttend ances. Total Attend - ances. Average Attendance per Meeting. Waldron Hall 100 103 203 16.9 Alma Road Council School 72 84 156 13.0 Totals 172 187 359 14.9 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. With the shortage of housing accommodation, this provision has been much appreciated by many mothers. The following table gives particulars of the work done by the Health Visitors during the year. Visits. Town and Chase. Bush Hill Park. Hadley. Ordnance. Ponders End. Totals. Birth Notification Visits 327 180 2 219 276 1,034 Ditto Re-visits 765 506 4 301 477 2,053 Children, 1-5 yrs. Visits 1,680 1,156 7 370 756 3,969 Infant Mortality Visits — — - 8 13 21 General Visits 162 110 — 337 364 973 Ante-Natal Visits 245 195 - 95 139 674 Post-Natal Visits 27 - 5 3 35 Blank Visits 197 147 - 147 179 670 Child Death Visits — — — — — — Ophthalmia Neonatorum Visits - - - - 1 1 Puerperal Fever Visits — — — — — — Totals 3,403 2,294 13 1 ,512 2,208 9,430 20 Feeding, etc. Feeding. Town and Chase. % Bush Hill Park. % Hadley % Ordnance. % Ponders End. % Totals. % Natural 288 88 157 87 2 100 208 83 239 86 894 86 Artificial 36 11 23 12 — — 20 8 21 7 100 9 Mixed 3 1 - - - - 21 8 16 5 40 3 CradleUsed 218 66 129 71 2 100 141 56 155 56 645 62 Attendances at Centres. Centre. New Attendances. ReAttend ances. No. on Register 1.1.23. No. on Register 31.12.23 No. of Meetings. Average Attendance per Meeting. Town and Chase 297 4,953 334 659 50 105.0 Bush Hill Park 168 4,389 313 657 51 89.3 Ordnance 184 3,987 316 707 50 83.4 Ponders End 200 3,652 295 625 49 78.6 Totals 849 16,981 1,258 2,648 200 89.1 Number of Births notified: 1,064, 97 per cent, of which were visited. VI —LABORATORY WORK. No. Positive. Negative. Percentages of Positives. Swabs 267 22 245 8.24 Sputum 253 31 222 12.25 Totals 520 53 467 10.19 21 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. 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.) 22 Slaughter-houses. (September 15th, 1887.) Cleansing of Earth-closets, Privies, Ashpits and Cesspools. (September 15th, 1887.) 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, 190U.) 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, Olfal, Blood, or other putrescible animal matter. 23 SANITARY ADMINISTRATION. Staff. Sanitary Inspector A. J. Munro, M.R.San.I. Assistant Sanitary Inspector Fred Wilson, M.R.San.I. * Assistant Sanitary Inspector T. M. Boswell, A.H.San.I. Assistant Sanitary Inspector Noel Smith, A.R.San.I. 1st Clerk Sydney Coulter, Cert .R.San .1. 2nd Clerk H. Wigcett. 3rd Clerk Miss M.J. Ridler. 4th Clerk Miss E. W. Bowyer. General Assistant J. Davis. Detailed particulars of the work will he found in the Report of the Sanitary Inspector attached to this Report. 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. 24 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.C.'s 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, under the direction of the Sanitary Inspector, 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. 25 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. 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 552 cows in Enfield owned by 22 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. 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 26 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, N.9, April 17 th, 1923. Dear Sir, 1 beg to report that I have completed the inspection of the milch cows throughout the district, as shown in the accompanying list. The examination of the udders showed that only a small proportion were affected with the ordinary complaints usually present among milking cows, and the few cases requiring bacteriological examination of the milk proved to be free from tuberculosis. The herds in general were in a satisfactory condition, and appeared well kept. Yours obediently, (Signed) H. H. HIDE. T. W. Scott, Esq. Holly House, Lower Edmonton, N.9, December 15th, 1923. 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. The results of the examination showed the udders, as a whole, to be very free from disease of any kind, and the few cases I met with were of the usual type found among milch cows. I made a bacteriological examination where necessary, and found them free from tuberculosis. The animals in general appeared to be in a satisfactory condition and properly kept. Yours obediently, (Signed) H. H. HIDE. T. W. Scott, Esq. 27 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 slaughter-houses in the District at the date specified is as follows:— 1914 January, 1923. December, 1923. Registered 10 8 8 Licensed 7 6 6 Total 17 14 14 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 520 such visits during the year, when they examined 1,313 carcases, and secured the surrender of 13 parcels of diseased organs. The constant supervision of the slaughter-houses greatly contributes to their maintenance in a satisfactory condition and in securing the examination of all animals killed. Bakehouses. The bakehouses in the District have been regularly inspected, and every endeavour made to see "that they are kept in proper order. 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. 28 8.—PUBLIC HEALTH STAFF. Medical Officer of Health. »P. P. Warren, M.R.C.S. Sanitary Inspector. *A. J. Munro, M.R.San.I. Assistant Sanitary Inspectors. 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 other Foods. T. M. Boswell, A.R.San.I., Diploma of R. San. Inst, for inspection of Meat and other Foods. Noel Smith, A.R.San.I. Health Visitors. *Miss H. M. Morrison Three years General Trained Nurses' Cert., Cert. R.San.1., 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). 29 Clerks. 1st Clerk Sydney Coulter, Cert.R.San.I. 2nd Clerk H. Wiggett. 3rd Clerk Miss M.J. Ridler. 4th 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. *Salary contribution made under the Public Health Acts or Exchequer Grants. 9.—HOUSING. Number of new houses erected during the year:— (а) Total 84 (б) With State assistance under the Housing Acts, 1919 or 1923:— (i) By the Local Authority 8 (ii) By other bodies or persons 0 1. Unfit Dwelling-houses. Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,696 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 None. .30 (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 1,053 (The number here given is of houses where any insanitary conditions were found.) 2. 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 827 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 31 B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respcct of which notices were served requiring defects to be remedied 150 (2) Number of dwelling-houses in which defects were remedied :— (a) By Owners 107 (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 32 Public Officer, Enfield, March 1st, 1924. REPORT OF THE SANITARY INSPECTOR FOR THE YEAR 1923. To the Chairman and Members of The Urban District Council of Enfield. Gentlemen, I beg to submit my report for the year ending December 31st, 1923, which includes particulars in tabular form as required by Article 19 (12) of the Ministry of Health Order No. 276, 1922, of the work done in connection with your Sanitary Department under my supervision. STATEMENT PREPARED BY SANITARY INSPECTOR UNDER ARTICLE XIX. (12), MINISTRY OF HEALTH ORDER, No. 276, 1922. Number of Houses Inspected. Inspections. Under Regulations, Sec. 17, Housing, Town Planning Act, 1909 0 From House-to-House apart from this Act 203 On Account of Infectious Disease 368 On Account of Phthisis 111 On Account of Complaint by occupant or otherwise 1,014 1,696 33 Inspections (Continued). Brought forward 1,696 80 Factories 111 122 Workshops and workplaces, including 2 laundries 218 Outworkers' premises inspected 32 55 Bakehouses, of which 37 are in use 181 18 Slaughter-houses, of which 10 are in use 520 28 Cowsheds inspected frequently 457 31 Dairies and Milkshops inspected frequently 346 22 Schools 98 Public-house urinals inspected 74 Conveniences at Railway Stations inspected 7 Fish Shops: Total number of visits 158 Coffee and Eating Houses: Total number of visits 26 Shops where ice-cream is made: Total number of inspections 97 2,325 Visits to absentees excluded from Elementary Schools 573 Visits in connection with cases of Infectious Disease 2,409 Visits in connection with Phthisis 719 Offensive Trades (excluding Fish Shops) 20 Smoke observations 21 Other inspections, including works in progress 7,355 Petroleum Stores inspected 185 Visits re Shops Act 804 Cinemas, etc., inspected 33 Visits and inspections re Rats 106 12,225 16,246 34 Notices Issued. Statutory:— Provision of dustbins 74 For repairs to houses, drains and abatement of nuisances 241 Providing sufficient water-closets 30 Paving of yards 8 Cleansing and Limewashing of Cowsheds 1 354 Informal:— Notices 0 Letters Sent in lieu of notice 647 647 1,001 Other Notices issued, under Infectious Diseases Acts : — To occupiers 172 To Education Committee and Head Teachers at Schools 1,448 1,620 2,621 Other letters sent 2,979 Result of Service of Statutory Notices :— Number complied with 324 Number outstanding 30 354 35 As to these outstanding notices, the work required was delayed on account of the weather or other reasonable cause. The general character of the defects found in the dwelling-houses inspected is as follows:— 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. 4 25 Roofs repaired 185 Gutters and downpipes repaired 267 Cesspools emptied 314 Cesspools abolished 1 House drains cleared, repaired, etc. 146 House drains tested, examined, etc. 92 House drains reconstructed 21 Soil-pipes and drains ventilated, including repairs to ventilators 39 Sink-wastes disconnected or repaired 21 Closets provided with proper flushing cisterns or water supply 145 New closets provided 5 Closets repaired, covered, cleansed, etc. 98 Water-closets substituted for earth-closets 1 Storage cisterns repaired, covered, cleansed, etc. 19 Storage cisterns provided 2 Water laid on or restored 9 Yards paved, or existing paving made good 39 Ventilation provided under ground floors and causes of dampness removed, etc. 36 36 Dustbins repaired, or new ones provided 206 Manure heaps removed 18 Fowls and other animals removed 5 Stables cleansed 1 Other nuisances abated 39 Cases of overcrowding abated 2 Disinfection. Houses disinfected:— After infectious disease 67 After Phthisis 79 After verminous cases 4 — 150 Rooms stripped and re-papered, etc., after occupation by cases of infectious disease 36 Ditto, ditto, by cases of Phthisis 38 Articles of clothing, bedding, etc., disinfected 1,089 Ditto, ditto, destroyed 40 Library Books disinfected 52 Number of Schools disinfected 4 Cases of Scarlet Fever removed to Hospital 67 Cases of Diphtheria removed to Hospital 17 Cases of Diphtheria Carriers removed to Hospital 1 85 Private Patients removed to Hospital or Infirmary 562 Gipsy Vans removed from District 3 Articles or parcels of unsound food destroyed or otherwise disposed of 18 It lias been our constant endeavour to secure the carrying out of works with as little delay as possible, and to this end many interviews with owners and others have been secured. In a few cases where there seemed unreasonable delay, a warning from the Council that legal proceedings would be taken, 37 proved sufficient to obtain the carrying out of the works required, except in one case, and in this the owner complied with the notices served following the issue of summonses, when these were withdrawn on payment of costs Visits paid re children excluded from Elementary Schools during the year numbered 573, and the total inspections and visits for all purposes made by the Staff of the Sanitary Department was 16,246. Removal of House Refuse. Our experience with the 2| ton Edison Electric Vehicle in use since March, 1921, continuing very satisfactory, a second vehicle of the same make was, with the approval of the Ministry of Health, obtained and commenced working on the 16th August, 1923. We have found that these vehicles contribute considerably to the efficiency and reduction of the cost of this work. In addition to these electric vehicles, six horsed vehicles are regularly employed. 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 9,982 tons, and the cost £4.026, or 8s. Id. per ton of refuse collected. Quantities of trade refuse were also collected from business premises, for which a charge was made. SALVAGE. It is still difficult to dispose of waste materials, and we were only able to sell 29 tons, 19 cwts., 3 qtrs.of waste tins, etc., collected from the refuse at 10s. per ton, the amount realised being £29 8s. 6d. 38 FACTORY AND WORKSHOPS ACTS, 1901 AND 1907. A register of all workshops is kept, and at the end of 1923 there were 89 workshops, 31 workplaces, 2 laundries, and 55 bakehouses registered. The following tables give details of the work done in connection with these places:— Inspections. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 111 — — Workshops (including Workshop Laundries) 151 — — Workplaces 67 — — Bakehouses 181 — — Total 510 — — 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 4 4 — Want of Ventilation — — Overcrowding — — — — Want of Drainage of Floors — — — Other Nuisances 1 1 — — Sanitary Accommodation:— Insufficient — Unsuitable or Defective 4 4 — 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 41 41 — — 39 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 5 9 12 6 8 Artificial Flowers 1 1 2 1 — Boxes — 2 1 Boot-making _ 2 1 Lamp Shades 1 1 — — — Embroidery — — — 2 Drapery 1 1 — — — Ties 1 1 — — Brushes 1 1 — — — Hat Making — 2 1 — Totals 10 14 20 10 10 Six addresses of Outworkers have been forwarded to other districts. PLACES OF PUBLIC ENTERTAINMENT. In accordance with the recommendation contained in the Circular of the Ministry of Health, dated August 25th, 1920, 33 visits to cinemas and other places of public entertainment were made. The sanitary accommodation at each place was found to be satisfactory and apparently sufficient. OFFENSIVE TRADES. The following offensive trades are established in the District:— Fish Friers 25 Rag and Bone Dealers 5 Glue Maker 1 Soap Boiler 1 40 and in connection with these 172 inspections were made during the year. With regard to the Fish-friers, 10 have been established with the consent in writing of the Council, and the majority of the oldestablished businesses have been fitted with up-to-date frying stoves. # 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. Licences as follows were in force on the 31 St December under the Milk (Special Designations) Order, 1922, Section 3 of the Milk & Dairies Amendment Act, 1922. Dealer's Licence to use the Designation "Certified" 1 ,, ,, ,, ,, "Pasteurised" 1 Supplementary Licence to use the Designation " Pasteurised " 1 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 520 Shops 168 Stalls in Markets 612 1,300 41 The number of carcases examined during the visits to slaughterhouses is as follows:— Cows 33 Oxen 163 Calves 29 Sheep 617 Pigs 471 1,313 During the examination of these carcases while dressing was proceeding, two carcases and eleven organs and parts of carcases 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. The number of parcels of food-stuffs (22 in all) purchased in the London Markets submitted for inspection as appearing unfit for food, were less than usual, and consisted of fish, rabbits, fruit, etc. Certificates were given in all cases, as it was found that the articles were unfit for the food of man, so that the owner might obtain replacement of the goods or return of the money from the wholesale dealer. 5 certificates in all were granted. 1 am, Gentlemen, Your obedient. Servant, A. J. MUNRO, M.R.San.I., Sanitary Inspector.