AC 439(3) EWFIELD Middy (hater mun B.) ENF 16 Urban District Council of Enfield ANNUAL REPORT of the Medical Officer of Health for 1929 together with the ANNUAL TEPORT of the Chief Sanitary Inspector. Crusha & Son, Ltd. Totteuham, Enfield, Wood green and Polmers Green. PUBLIC OFFICES, ENFIELD. 7th April, 1930. Annual Report of the Medical Officer of Health for 1929. To the Chairman and Members of the Urban District Council of Enfield. Mrs. Heath and Gentlemen, I beg to place before you my Annual Report for the year 1929. This year has been marked by a much lessened amount of infectious disease with very low mortality resulting therefrom. Steady progress has been made in the various branches of the work carried out by my Department, and whilst no new inovations can be recorded, increased work has been carried out in its respective branches. I do not propose this year to dilate in my opening remarks at any length on the health of Enfield during the past year, but I am increasing the length of my observations under the various headings that will be found in the report. It is my pleasant duty once more to thank the Members of the Council for the courtesy and help I have received, and to express my appreciation for this. In addition I wish to pay a tribute to the excellent help of Mr. Wilson, the Chief Sanitary Inspector, and the rest of the Staff whose loyal co-operation I have received on all occasions. Dr. Dunbar has carried out her duties, as in the past, in the efficient and kindly manner one has learnt to expect from her, whilst I have also to thank Dr. Cook and the General Practitioners of Enfield for the help they have given me during 1929. I beg to remain, Your obedient servant, D. H. GEFFEN, Medical Officer of Health. 2 PUBLIC HEALTH STAFF. Medical Officer of Health *D. H. GEFFEN, M.D., D.P.H. Chief Sanitary Inspector *FRED WILSON, M.R.San, I., M.S.I.A., Cert. Sanitary Inspector's Examination Hoard (London), Faudell-Phillips Medallist, King's College, London University, Silver and Bronze Medallist, Carpenters Company, Diploma of R. San. Inst. for Inspection of Meat and other Foods., Cert. Practical Sanitary Science. Sanitary Inspectors: *T. M. BOSWELL, A. R. San. I., M.S.I.A., Diploma of R.San. Inst., for Inspection of Meat and other Foods. *NOEL SMITH, A. R. San. I. *HARRY WIGGETT, Cert. R. San. I., Diploma of R. San. Inst., for Inspection of Meat and other Foods. *H. C. T. DARLEY, Cert. R. San. I., M.S.I.A., Diploma of R. San. Inst., for Inspection of Meat and other Foods. Health Visitors: ♦Miss M. E. NEWBEGIN, General Trained Nurses Certificate, C.M.B., Member of Royal College of Nursing, State Registered Nurse, Certificate of Queen's Nurses. *Miss M. GARLICK, C.M.B., Medical and Surgical Nursing, Invalid Cookery. *Miss E. DURRANS, C.M.B., General and Fever Trained Nurse. Clerks. Chief Clerk-SYDNEY COULTER, Cert., R. San. I. 2nd Clerk—Miss E. W. BOWYER. 3rd Clerk—Miss L. GOSFORD. 4th Clerk—S. H. BEYER 5th Clerk—H. C. COUTTS. 6th Clerk—L. R. GODFREY. Maternity and Child Welfare. *Dr. MARGARET PROUDLOCK DUNBAR, M.D., B.S., (Part time Medical Officer). *Mr. C. E. JAMES, L.D.S., Eng. (Part time Dental Surgeon.) *Salary contribution made under the Public Health Acts or Exchequer Grants 3 POPULATION. The estimated population for Enfield for 1929, based on the adjusted 1921 census, 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 65,100. BIRTHS. The number of births registered in the District was:— Boys, 475. Girls, 413. Total, 888. including 13 illegitimate births, i.e., 1.46 per cent. of the total. In addition to the above, 11 male and 10 female stillborn births were registered. The births of both sexes, live and still-births including those registered outside the District, also birth-rates for the last five years, were:— Year. Boys. Girls. Total. Birth-rate per 1,000 Population. Illegitimate Birth-rate per 1,000 Population. 1925 552 499 1,051 16.48 .47 1926 484 522 1,006 15.80 .34 1927 534 518 1,052 16.39 .54 1928 544 481 1,025 15.79 .43 1929 561 512 1,073 16.48 .58 In this respect one notes the increase in births of males over females, 62 more boys were born during the year than girls; in 1928 this figure was 63, and in 1927 only 16. There were 48 more births this year than in 1928. 4 DEATHS. The deaths registered in the district during the year were 488, of which 231 were males and 257 females, giving a crude deathrate of 7.49. To these must be added 266 deaths of Enfield residents registered outside the District, and from this total must be subtracted 63 deaths of non-residents occurring in the District, which brings the number of deaths to 688 for the year, giving a net death-rate of 10.56 per 1,000 population. Birth-rate. Recorded Death-rate. Infantile Death-rate. Live Births. Still Births. England and Wales 16.3 0.68 13.4 74.00 London 15.7 0.53 13.8 70.00 107 Great Towns 16.6 0.69 13.7 79.00 (including London) 150 Smaller Towns 16.0 0.71 12.3 69.00 Enfield 16.08 0.39 10.56 59.21 The corresponding figures for Enfield for the five previous years are:— 1924. 1925. 1926. 1927. 1928. Net death-rate 9.39 9.91 10.05 11.08 9.92 Seventy-six deaths registered in the District were persons over 80 years of age, 23 being males and 53 females, one woman dying at the age of 96. The more important causes of deaths registered were:— Malignant Disease, 84; Bronchitis, 46; Heart Disease, 105; Old Age, 49; Tuberculosis of Respiratory System, 47; Pneumonia, 96; Arterio-Sclerosis, 19; Nephritis, 21; Cerebral Haemorrhage, 44; Deaths from Violence (excluding Suicides), 24; whilst among the children, Premature Births accounted for 5; Inanition and Marasmus, 5; Congenital Malformations, 9; and Pneumonia, 14. 5 It is to be noted that of the 688 deaths that occurred during the year, 266 took place outside the District of Enfield; most of these were Enfield residents who died at the North Middlesex Hospital, Edmonton. Once again one notes the large number of deaths from Malignant Disease that have occurred during the year, 84 out of a total of 688. Tuberculosis of the Respiratory System account for 47 deaths. This means that these two dire diseases have caused 131 deaths out of 688, or 19 per cent. INQUESTS, ETC. Eighteen inquests and twenty P.M.'s without inquests were held in Enfield during the year, and the verdicts were as follows:— Natural Causes 19 Accidental Causes and Misadventure 12 Open Verdict 1 Suicides 6 38 I regret to see the increase in the number of suicides that have occurred during the year. It occurs to me that this is largely due to the continued reports in the newspapers of these oases of suicides, and the method by which life was taken. One must remember that if 6 individuals succeeded in committing suicide during the year, there is a large number of others who have attempted suicide and failed. To those whose lives are unhappy and who feel the strain of life under modern conditions, the repeated reading of these reports of suicides acts as an incentive to the commission of this felony, and I feel very strongly that steps should be taken to prevent newspapers reporting at any length, if at all, on these cases. 6 INFANTILE DEATHS. The total number of deaths which occurred amongst infants under 1 year, including 26 registered outside the District, and deducting 5 of non-residents occurring in the District, was 62, giving a death-rate of 59.21 per 1,000 births, as compared with a death-rate of 74.00 for England and Wales, and 79.00 for the 107 great towns, including London. The corresponding figures for Enfield for the last four years were:—1925, 51.66; 1926, 65.60; 1927, 59.89; and 1928, 58.53. It will be seen that the infantile death-rate remains much the same as it has for the past 2 years. The number of deaths of illegitimate children was 1, which gives a death-rate of 27.77 per 1,000 illegitimate infants. When considering what steps should be taken to lessen infantile mortality, one naturally turns to the chief causes of death, and asks oneself how best they can be dealt with. In this respect 19 cases were due to premature birth, a cause that can only be dealt with by better ante-natal care of the expectant mother. It is to be hoped that the increased number of ante-natal clinics that are now being held in Enfield will materially help in this direction. Diarrhoea and Enteritis accounted for another 14 deaths. This is a disease that occurs chiefly amongst children artificially fed. At all our Centres breast feeding is strongly advocated on all occasions, and every attempt made to prevent the too early weaning of babies. Fourteen children died from Pneumonia, an increase of 7 on the previous year. I.—GENERAL STATISTICS. Area (acres) 12,575 Population (Census, 1921) 60,743 ,, (Estimated for 1929) 65,100 Number of inhabited houses (1921) 12,066 7 Number of families or separate occupiers (1921) 13,712 Rateable value £472,199 Sum represented by a penny rate £2,080 11.—EXTRACTS FROM VITAL STATISTICS FOR THE YEAR. Births:— Males. Females. Totals. Live Births. Legitimate 528 488 1,011 Illegitimate 20 16 36 Still Births. Legitimate 12 12 24 Illegitimate 1 1 2 Birth-rat«=16.48 per 1,000 population. Deaths 360 328 688 Death-rate=10.56 per 1,000 population. Number of women dying in, or in consequence of, childbirth:— From Sepsis — From other causes 3 These three deaths occurred outside the District, two in the North Middlesex Hospital, and one in Bury House, Bury Street, Edmonton. Deaths of infants under one year of age per 1,000 births:— Legitimate, 58.26; illegitimate, 0.95; total, 59.21. Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 8 Deaths from Diarrhoea (under two years of age) 11 The following table shows the causes of death at all ages during 1929, and Table II. gives an analysis of the causes of death in infants under one year of age:— 8 TABLE I. Causes of and Ages at Death during Year 1929. Causes of Death. Net 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 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and upwards. All Causes—Certified 688 62 8 11 8 13 45 48 174 319 114 Uncertified — — — — — — — — — — — Enteric Fever — — — — — — — — — — — Smallpox — — — — — — — — — — — Measles — — — — — — — — — — — Scarlet Fever 1 — — 1 — — — — — — 1 Whooping Cough 8 3 2 3 — — — — — — 6 Diphtheria — — — — — — — — — — 12 Influenza fi — — — — — 2 1 2 1 2 Encephalitis Lethargica 1 — — — — — 1 — — — — Meningoccal Meningitis 3 — — 1 1 — — — 1 — — Tuberculosis of Respiratory System 47 — — — — 4 17 14 10 2 1 Other Tuberculous Diseases 2 — — 1 1 — — — — — 1 Cancer, Malignant Disease 84 — — — 1 — 2 3 40 33 8 Rheumatic Fever 3 — — 1 — 1 1 — — — 2 Diabetes 3 — — — — — — — 1 2 — Cerebral Hæmorrhage, etc. 44 — — — — — — 2 13 29 10 Heart Disease 105 — — — — 1 3 2 28 71 13 Arterio-sclerosis 19 — — — — — — — 3 16 — Bronchitis 46 1 — — — — 1 — 13 31 5 Pneumonia (all forms) 96 14 5 2 1 1 2 7 26 38 16 Other Respiratory Diseases 16 — — 1 — — — 2 6 7 3 Ulcer of Stomach or Duodenum 5 — — — — — — 1 2 9 — Diarrhoea &c. (under 2 years) 11 11 — — — — — — — — 1 Appendicitis and Typhlitis 2 — — — — — — 1 — 1 1 Cirrhosis of Liver 1 — — — — — — 1 Acute and Chronic Nephritis 21 1 3 11 6 2 Puerperal Sepsis — — — — — — — — — — — Other accidents & diseases of Pregnancy and Parturition 3 — — — — 1 2 — — — Congenital Debility and Malformation, Premature Birth 19 19 — — — — — — — — 2 Suicide 5 1 1 1 1 1 — Other Deaths from Violence 24 — 1 1 8 2 5 7 2 Other Defined Diseases 113 14 1 1 3 4 5 7 11 67 26 Causes ill-defined or unknown — — — — — — — — — — — Totals 688 62 8 11 8 13 45 48 174 319 114 Included in above:— Old Age 49 — — — — — — — — 49 8 Erysipelas — — — — — — — — — — 4 9 TABLE 11. 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 19 5 4 1 29 6 13 5 9 62 Uncertified — — — — — — — — — — Smallpox — — — — — — — — — — Chickenpox — — — — — — — — — — Measles — — — — — — — — — — Scarlet Fever — — — — — — — — — — Whooping Cough — — — — — 1 — — 2 3 Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — — — — — — — Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — — — — — Convulsions — — — — — — 1 — — 1 Laryngitis — — — — — — — — 1 1 Bronchitis — — — — — — — — — 1 Pneumonia (all forms) — 1 1 — — 4 3 3 2 14 Diarrhoea — — — — — — 2 1 1 4 Enteritis — — — — — — 5 — 2 7 Epidemic Diarrhoea — — — — — — — — — — Gastritis — — — — — — — — — — Syphilis — — — 1 1 — — — — 1 Rickets — — — — — — — — — — Suffocation, overlying — — — — — — — — — — Injury at Birth — — — — — — — — — — Atelectasis 3 — — — 3 — — — — 3 Congenital Malformation 7 2 — — 9 — — — — 9 Premature Birth 3 — 1 — 4 — — 1 — 5 Atrophy, Debility and Marasmus 3 1 1 — 5 — — — — 5 Other Causes 3 1 1 — 5 1 1 — 1 8 Totals 19 5 4 1 29 6 13 5 9 62 Net Births in the year:-—Legitimate: Live births, 1,011; Stillbirths, 24. Illegitimate : Live births, 36; Still-births, 2. Net Deaths in the year:—Legitimate Infants, 61; Illegitimate, 1. III.—INFECTIOUS DISEASES. The following table shows the cases of infectious diseases notified during the year, and the number of death? which occurred. 10 TABLE III.—Oases of Infectious Diseases notified during the year 1928. 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 (inc. Membranous Croup) 91 — 15 53 16 7 — — 90 — — — — — — — — — Diphtheria Carriers 4 — — 3 — 1 — — 3 — — — — — — — — — Erysipelas 18 — — 1 1 6 6 4 5 — — — — — — — — — Scarlet Fever 171 — 35 96 25 11 4 — 144 — — 1 — — — — — 1 Typhus Fever — — — — — — — — — — — — — — — — — — Enteric Fever — — — — — — — — — — — — — — — — — — Paratyphoid Fever B. 1 — — — 1 — — — — — — — — — — — — — Relapsing Fever — — — — — — — — — — — — — — — — — — Continued Fever Puerperal Fever 1 — — — — 1 — — 1 — — — — — — — — — Puerperal Pyrexia 6 — — — — 5 — — 1 — — — — — — — — — Measles 55 3 9 26 12 4 1 — 1 — — — — — — — — — German Measles 482 4 44 306 88 39 1 — 7 Cerebro-spinal Meningitis — — — — — — — — — — — — — — 1 — — 1 Poliomyelitis — — — — — — — — — — — — — — — — — — Ophthalmia Neonatorum 4 4 — — — — — — — — — — — — — — — — Pulmonary Tuberculosis 47 — — — 15 23 7 2 — — — — — 7 28 10 2 47 Other forms of Tuberculosis 10 — 4 4 1 -— 1 — — — — 1 1 — — — — 2 Encephalitis Lethargica 2 — — — 1 — 1 — 1 — — — — — 1 — — 1 Malaria — — — — — — — — — — — — — — — — — Pneumonia 102 7 26 15 14 16 15 9 — 14 5 2 1 3 7 26 38 96 Totals 993 18 133 504 174 113 36 15 253 14 5 4 2 10 36 36 40 147 11 Ophthalmia Neonatorum. Cases. Vision Unimpaired. Vision Impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 4 4 - 4 - - - It is the duty of the midwife who discovers that a child is suffering from discharge from the eyes, to notify the County Medical Officer of Health immediately. A local practitioner is then called into the case, whose duty it is to notify me forthwith. The child is visited by one of the Maternity and Child Welfare nurses who reports thereon to me, and the information is passed on to the County Medical Officer of Health. Scarlet Fever. One hundred and seventy-one cases of Scarlet Fever occurred during the year in 123 houses, as follows:— Number of houses where 1 case occurred 94 ,, 2 cases ,, 16 3 „ „ 8 4 „ „ 4 5 „ „ 1 Total number of houses where cases occurred 76 Total number of cases 171 Deaths 1 This is the first death that has occurred from Scarlet Fever in Enfield for the past 5 years. Diphtheria. Ninety-one cases of this disease occurred during the year in 76 houses, as follows:— 12 Number of houses where 1 case occurred 4 ,, ,, 2 cases ,, 7 3 4 Total number of houses where cases occurred. 76 Total number of cases 91 Deaths None I am pleased to be able to report that the lessened number of cases of Diphtheria that were occurring towards the end of 1928 continued to diminish during 1929, while 91 cases were recorded in 1929, there were 211 in 1928, and 276 in 1927, but still more encouraging is it to be able to record that no deaths were due to this disease. This is the first occasion for 12 years that no death from Diphtheria has occurred in Enfield. The same routine as reported last year has been carried out in the control of Infectious Disease in Enfield. Diphtheria Carriers. Four cases of this disease occurred during the year in 4 houses, as follows:— Number of houses where 1 case oocurred 4 Total number of houses where cases occurred 4 Total number of cases 4 Enteric and Paratyphoid Fever. One case of Paratyphoid Fever, B, was notified during the year. 13 Poliomyelitis. No cases of this disease were notified during the year. Cerebro-Spinal Fever. No case of this disease was notified during the year. Encephalitis Lethargica. Two cases of this disease were notified during the year, one of which proved fatal. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Diphtheria. This disease was less prevalent than last year. Ninety-one cases in all were notified as against 211 for last year; 4 Diphtheria Carriers were discovered. Smallpox. No cases of Smallpox occurred during the year, but unfortunately during the early months of 1930 we have been continuously fighting an epidemic of this disease. I take this opportunity of mentioning the fact that the continued freedom from Smallpox infection which Enfield has enjoyed, has resulted in a smaller number of vaccinations taking place each year among new born children. The enquiry that took place as regards the danger from vaccination has reported, that such danger as there was did not exist if vaccination was carried out during the early weeks of life, and one would, therefore, strongly urge all parents to get their children vaccinated during the first weeks after birth. 14 I personally feel that although better housing may have helped in the control of infectious disease in general, it will only be by vaccination that Small Pox will be eradicated. Although at the present time the Smallpox that is occurring is of a mild variety, there is no guarantee that a more serious type may not develop at any time. An experience of this may be found in the Influenza epidemic of 1918; just as the germ causing influenza took on an increased virulence during that year and caused an enormous mortality, so it is possible at any time that the Small Pox germ may do likewise. Should this occur, the mortality in an unprotected community like Enfield may be high, and this will be all the more regrettable, inasmuch as that it was preventable. Infectious Diseases and Schools. Following a suggestion of the Local Government Board (now Ministry of Health), an arrangement is in force between the Council and Education Committee, under which the Head Teachers of the various schools notify the Medical Officer of Health all absentees suspected to be suffering from any infectious disease. These absentees are then visited, and the cause of absence ascertained. By this means we have become aware of many slight cases of infectious disease which would have otherwise escaped us, and in addition got to know of oases in their earliest stages. We are thus able to give the necessary instructions and take precautions to prevent the spread of the disease. DISINFECTION OF VERMINOUS PERSONS AND THEIR BELONGINGS. Three dwellings and 15 articles of clothing ,etc., were cleansed and disinfected during the year at the request of the Education Committee. TUBERCULOSIS. The following table shows the number of notifications of Pulmonary and other forms of Tuberculosis received during the year:— 15 Ward. Pulmonary. Other. Fresh Cases. Old Cases re-notified. Duplicates. Fresh Cases. Old Cases re-notified. Duplicates. Town 4 2 2 — — Chase 8 3 17 1 — 1 Ordnance 11 — 27 3 — 2 Green Street and Ponders End 13 2 26 2 — 4 Bush Hill Park 11 2 24 2 — 3 Hadley and Cockfosters — — — — — — Totals 47 7 96 10 — 10 First Notifications 57 Old Cases re-notified, i.e., some by fresh doctors, or coming into District, or under old Regulations 7 Duplicate Notifications, i.e., those which report the entering and leaving of Sanatoria 106 Total Notifications 170 The following table gives particulars of the ages of the new cases notified, and deaths from this disease during the year:— Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary . M. F. M. F. M. F. M. F. Under 1 — — — — — — — — 1 to 5 — — 3 1 — — 1 — 5 to 10 — — 1 2 — — — 1 10 to 15 — — — 1 — — — — 15 to 20 3 4 1 — 2 2 — — 20 to 25 5 3 — — 1 2 — — 25 to 35 5 8 — — 5 9 — — 35 to 45 6 4 — — 9 5 — — 45 to 55 2 1 1 — 5 — — — 55 to 65 4 — — — 4 1 — — 65 and upwards 1 1 — — 1 1 — — Totals 26 21 6 4 27 20 1 1 16 Sex (1st Notifications). Form. Males. Females. Pulmonary 26 21 Other 6 4 Totals 32 25 Cases and Deaths. The number of cases, also deaths from this disease, in the different Wards during the year is shown in the following table, viz.:— Ward. Pulmonary. Other. Cases Deaths Cases Deaths Town 4 3 2 Chase 8 9 1 — Ordnance 11 10 3 1 Green Street and Ponders End 13 14 2 — Bush Hill Park 11 11 2 1 Hadley and Cockfosters — — — — Totals 47 47 10 2 20.4 per cent. of the cases dying of tuberculosis had not previously been notified. The striking fact in this report is that only 47 fresh cases of Pulmonary Tuberculosis were notified during the year. This figure compares very favourably with that of 72 for 1928. 17 Public Health (Prevention of Tuberculosis) Regulations, 1925. It was not found necessary to take any action, under the above Regulations, with regard to tuberculous persons employed in the milk trade. Public Health Act, 1925, Section 62. No action was taken during the year under this Section. Measles and German Measles. Measles was less prevalent than last year, but German Measles cases increased in numbers, 55 cases of Measles and 482 of German Measles having been notified as against 796 Measles and 8 German Meales for 1928. The following numbers of notifications were received from the different wards:— Ward. Measles. German Measles.[/##] Town 6 70 Chase 16 182 Ordnance 4 67 Green Street and Ponders End 16 71 Bush Hill Park 13 92 Hadley and Cockfosters — — Totals 55 482 Enteritis. Sevens deaths occurred from this disease during the year; all were infants under one year of age. ZYMOTIC DISEASES. The following table shows the Deaths registered in the District from the seven chief zymotic diseases during the past five years:— 18 Disease 1926 1926 1927 1928 1929 Smallpox — — — — — *Scarlet Fever — — — — 1 *Diphtheria 43 34 16 7 12 *Measles 1 12 — 2 — *Enteric Fever 1 1 — — — *Whooping Cough 2 3 4 1 9 Epidemic Enteritis — — — — — Totals 47 50 20 10 22 *The actual Enfield deaths were: Diphtheria, 0; Whooping Cough, 7; and Scarlet Fever, 1. The figures for Scarlet Fever and Diphtheria include all the deaths which occurred in the Enfield and Edmonton Joint Isolation Hospital, which is situate in the Enfield district. Patients belonging to other districts are also received, so the actual figures are therefore smaller than the apparent. ENFIELD ZYMOTIC DEATH-RATE. The zymotic death-rate, after deducting 14 deaths of persons residing outside the district who died in Institutions in the District, and adding 1 death of an Enfield resident who died outside the District, is 0.13 per 1,000 population. Disease. 1928. 1929. Deaths. Death-rate Deaths Death-rate Scarlet Fever — — 1 .01 Diphtheria 2 .03 — — Enteric Fever — — . — — Erysipelas — — — — Measles — — — — Whooping Cough 1 .01 8 .12 Epidemic Enteritis — — — — Totals 3 .04 9 .13 19 IV.—CAUSES OF SICKNESS. In the case of Diphtheria it has usually been possible to trace the source of infection to a carrier in the School classroom or a neighbour, and sometimes to a case in the house of so mild a nature that it had not been diagnosed. An attempt has been made to cope with this by zealous swabbing of throats, and this accounts for the large number of swabs examined during the year. 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' Act. There are 12 Midwives practising in the District. CLINICS AND TREATMENT CENTRES. Maternity and Child Welfare Centres:— Four Infant Welfare Centres and four 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. 20 Bush Hill Park.—St. Mark's Institute, St. Mark's Road. Tuesday and Thursday afternoons, 2—5 p.m. Town and Chase.—Amfield Road Institute, Wednesday afternoons, 2—5 p.m. Ordnance.—Totteridge Road Baptist Sunday School, Thursday afternoons, 2—5 p.m. Ante-Natal Clinics:— Town and Chase.—Armfield Road Institute, second Tuesday in each month, 9.30-11.30 a.m. Ponders End.—Alma Raod Council Schools, first and third Fridays in each month, 2-4 p.m. Bush Hill Park.—St. Mark's Institute, St. Mark's Road, first and third Wednesdays in each month, 9.30 a.m.— 12 noon. Ordnance.—Totteridge Road Baptist Sunday School, second and fourth Fridays in each month, 2-4 p.m. Dental Clinic:— Southbury Road Council School, Saturday mornings, 9.30— 11.30 a.m. Tuberculosis Dispensary (Middlesex County Council):— 279, Fore Street, Upper Edmonton. HOSPITALS. 1. Tuberculosis (County of Middlesex Scheme). There are some 555 beds, available for the treatment of this disease in the following Institutions:— County Sanatorium, Clare Hall, South Mimms. County Council Dispensary, Bell Road, Hounslow. County Sanatorium, Harefield. Heatherwood Hospital, Ascot. Victoria Home, Margate. 21 In addition to the beds reserved in Institutions in the above list, cases have also been sent to others, as follows:— Sanatoria.—Brompton Hospital and Frimley; Daneswood; Eversfield, Sussex; Fairlight, Hastings; King Edward VII., Midhurst; King George's, Bramshot; Maltings Farm, Nayland, Suffolk; National, Benenden; Marillac, Warley; Chilton Hill, Sudbury; Royal National, Bournmeouth; Royal National, Ventnor. Colonies.—British Legion Village, Preston Hall, Kent; Papworth Village Settlement, Papworth Hall, Cambridge. Homes for very advanced cases.—St. Luke's Hospital, Bayswater. Hospitals.—All Saints', London; Atkinson Morley Convalescent, Wimbledon; Hendon Cottage; Prince of Wales's, Tottenham; Royal National Orthopaedic, London; Royal Sea-Bathing, Margate; St. Anthony s, Cheam; St. Mary's, Paddington; St. Thomas's, London; University College, London; Alexandra Hospital for Hip Diseases, Swanley, Kent; Children's Hospital, Barnet; Children's Hospital, Sevenoaks Lord Mayor Treloar Cripples', Alton; Royal National Orthopaedic, Country Branch, Stanmore; St. Nicholas' and St. Martin's Orthopaedic Hospital, Pyrford; St. Vincent's, Pinner; Wingfield Orthopaedic, Oxford. 2. Maternity (Maternity Hostel, North Middlesex Hospital, Edmonton).—There is an arrangement between the Edmonton Board of Guardians and the local authority by which a fee of £2 2s. Od. per week is paid by the local authority for persons admitted from this District under the auspices of the Council, and persons taking advantage of this are required to contribute according to their means. In recent years little or no use has been made of this scheme, for the following reasons:— 22 (1) The Council does not deal with Poor Law cases, which can be admitted direct by the Guardians. (2) It has been found that it is more expeditious for those who are able to pay the full £2 2s. Od. per week to apply for admission direct through the Guardians. Under these two headings practically all cases can be admitted direct, for the Maternity Benefit received under the National Insurance Act practically covers the fee required by the Hospital. 3. Children.—At the local War Memorial Hospital a Ward containing 20 beds has been set aside for children. 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 Super intendent's Residence. Porter's Lodge, Ten Workmen's Cottages, Bungalow, Garage, for Ambulances, and contain 160 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. 23 The following cases of notifiable infectious disease were removed there from the Enfield District:— Scarlet Fever 144 Diphtheria 90 Diphtheria Carriers 3 Erysipelas 4 Pnuemonia 10 Measles 0 German Measles 6 The removal of cases of Smallpox is arranged for by the Middlesex County Council. Such cases as occur are removed firstly to South Wharf Hospital, and then from there, if the case is confirmed, to the Joyce Green Hospital, Dartford. 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. Contributions are made to the Enfield War Memorial Hospital and Prince of Wales's Hospital, Tottenham, the grants being the product of a ¼d. rate amounting to approximately £500 per annum, and £50 respectively. 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.—Two motor ambulances are now stationed at the Isolation Hospital for the removal of cases from the Enfield and Edmonton Districts. Number of patients removed from Enfield—257. 24 For Non-Infectious Cases:—Urban District Council of Enfield Ambulance, Fire Station. Ponders End. Number of patients removed 1,253 St. John Ambulance Brigade Ambulance. MATERNITY AND CHILD WELFARE. Medical Officers of Centres. D. H. Geffen, M.D., D.P.H., Dr. Margaret Dunbar, M.D., B.S. The latter is also Medical Officer of the Ante-Natal Centres. Dental Surgeon. Mr. C. E. James, L.D.S., Eng. Health Visitors. Miss M. E. Newbegin. Miss M. Garliek. Miss E. Durrans. Miss Durrans resigned her post as Health Visitor, and left the services of the Council on the 30th November, to take up the duties as Matron of the Wath, Swinton and District Joint Isolation Hospital. Miss Durrans has served the Council since 9th May, 1927. During her time in Enfield she worked conscientiously, and devoted her full energy, and a most pleasing personality to the carrying out of her duties, which she did most successfully. On her resignation, the Council congratulated her on her new appointment, and wished her every success in her new post. 25 I wish to take this opportunity of mentioning the excellent services that have been rendered by the Voluntary Helpers at our Centres. May I also tender my best thanks to the Members of the Maternity and Child Welfare Committee for the co-operation and help I have received from them during the past year. Maternity and Child Welfare Work. Baby Week. This was celebrated on June 24th, 25th, 26th and 27th. Garden Parties and Meetings were held at the Red Triangle Club, and St. George's Hall. Attendances at all were good, the total attendances at the four Meetings being 398 mothers and 57G babies. Ante-Natal Clinics. There are four Ante-Natal Clinics under the charge of Dr. Margaret Dunbar. They are situated as follows:— (а) For the Town and Chase Wards Armfield Road Institute. (b) For the Green Street and Ponders End Ward Alma Road Council Schools. (c) For the Bush Hill Park Ward St. Mark's Institute, St. Mark's Road. (d) For the Ordnance Ward Baptist Sunday School, Tot- teridge Road. Commnecing with the 1st January, 1929, the Clinics for Bush Hill Park and Ordnance Wards were opened twice a month, and the one for the Town and Chase Ward is the only one which is now held once a month. 26 The attendances during the year were as follows:. Centre. New Attendances . Re. Attendances. Total Attendances . Average Attendance per Meeting. Armfield Road Institute 71 98 169 14.0 St. Mark's Institute 113 218 331 13.7 Alma Road Council School 138 236 374 15.5 Totteridge Road Baptist Sunday School 130 182 312 13.5 Totals 452 734 1186 14.2 The following table gives particulars of the work done by the Health Visitors during the year. Visits. Town, Chase and Hadley. Bush Hill Park. Ordnance. Ponders End. Totals. Birth Notification Visits 271 162 256 259 948 Ditto Re.visits 623 485 773 752 2,633 Children, 1.5 yrs. Visits 1,717 756 1,883 1,149 5,505 Visits re Insanitary Conditions 10 5 6 11 32 General Visits 38 16 40 26 120 Ante.Natal Visits 106 52 103 115 376 Post.Natal Visits 53 62 58 66 239 Blank Visits 192 56 87 86 421 Infectious Disease Visits 158 138 86 132 514 Ophthalmia Neonatorum Visits 4 6 I - 11 Puerperal Fever Visits 1 — — - 1 Puerperal PyrexiaVisits 1 — — - 1 Totals 3,174 1,738 3,293 2,596 10,801 27 Feeding, etc Feeding. Town, Chase and Hadley % Bush Hill Park. % Ordnance. % Ponders End. % Totals. % Natural 234 86 148 91 243 94 232 89 857 90 Artificial 37 13 14 8 8 3 24 9 83 8 Mixed - - - - 5 1 3 1 8 - Cradle Used 1 80 69 128 79 154 60 173 67 644 67 Attendances at Centres. Centre. Total Attendances. Individual Attendances. New Attendances . No. seen by Dr. Town and Chase 4,615 2,030 167 1,119 Bush Hill Park 6,982 2,898 213 2,252 Ordnance 5,957 2,211 230 974 Ponders End 3,818 1,653 160 766 Totals 21,372 8,792 770 5,111 The attendances at the Centres were most satisfactory. In this connection I should like to mention the excellent work done by the Health Visitors; the zeal and energy they have displayed in the discharge of their duties is most praiseworthy and deserves special notice. Number of Births notified : 997, which includes 143 born outside the District 95.0 per cent. of which were visited. Dental Treatment. The Dental Clinic for Mothers and Children under 5 years of age, is open on Saturday mornings, and the attendances have been exceptionally good. 28 The following particulars show the work which has been carried out:— Mothers. Children. Total. Attendances 486 59 545 Treated 105 40 145 Administrations: Local Anaesthetics 77 34 111 Extractions with local anaesthetics 176 81 257 Administrations: N20 139 11 150 Extractions under N20 500 28 528 Total extractions 676 109 785 N20 Sessions 20 — 20 Ordinary Sessions 22 — 22 Total Sessions 42 — 42 Dentures fitted 61 — 61 Patients receiving Dentures 35 — 35 Other operations 248 13 261 No. of patients having extractions under N20 63 10 73 do. do. under Local Anaesthetics 40 28 68 It is hoped that the number of children attending this Clinic will increase during 1930, and dimish the large number of children who attend school at the age of five years with their teeth in so bad a condition that it is almost impossible to attempt to give them a satisfactory set of teeth in adult life. The quantity of Fresh and Dried Milk supplied to necessitous cases under the assisted milk supply scheme during the year was as follows:— Fresh Milk 6,250 7/8 gals., costing £600 3s. 10½d. Dried Milk 2,200 lbs., costing £166 6s. 9d. Co-operation with the Education Committee. One of the most important pieces of work that has been carried out during the year in co-operation with the Head Teachers, has been the visits by our Health Visitors to the Senior Girls' Departments for the purpose of demonstrating to the older girls in our Schools how to bath a baby. 29 The following work was carried out:— Miss Newbegin—5 demonstrations at Bush Hill Park, and 2 at Ponders End. Miss Garlick—3 demonstrations at Chesterfield Road. Miss Durrans—1 demonstration at Lavender Road, and 1 at Chase Side. At these demonstrations our senior girls are shewn the proper and scientific method of clothing and bathing a baby. It must be remembered in Enfield this duty often devolves on girls of the ages of 13 and 14. These demonstrations are very much liked and appreciated, and immense interest is shown in this very important matter. I can imagine no better method of securing right ideas as to the upbringing of babies by the young mothers of Enfield than by dealing with the matter among young girls of this impressionable age, and I look for increased work in this direction. I hope that many more Head Teachers will come forward with requests for these demonstrations. VI .—LABORATORY WORK. Specimen. No. Positive. Negative. Percentages of Positives. Swabs 1,440 101 1,339 7.01 Sputum 205 20 185 9. 75 Totals 1,645 121 1,524 7.35 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. 30 VII—SANITARY ADMINISTRATION. 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. Public Health Act, 1925. The folowing Sections came into force on February 1st, 1926:—Sections 13, 14, 15, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33 and 35 of Part II. Sections 36, 37, 38, 39, 40, 41, 42; 43 and 44 of Part III. Sections 45, 46, 47, 48, 49 and 50 of Part IV. Sections 51, 52, 53, 54 and 55 of Part V. 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.) Slaughter-houses. (September 15th, 1887.) Cleansing of Earth-closets, Privies, Ashpits and Cesspools. (September 15th, 1887.) 31 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.) Milk and Dairies (Consolidation) Act, 1915. With respect to:— The Milk and Dairies (Amendment) Act, 1922. (September 1st, 1922.) The Milk (Special Designations) Order, 1923, made under Sections 3 and 6 of the Milk and Dairies (Amendment) Act, 1922. (July 1st, 1923.) The Milk and Dairies Order, 1926. (October 1st, 1926). 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), 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-fryer. Fish-skin-dresser. Manufacturer of Manure from Fish, Offal, Blood, or other putrescible animal matter. 32 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. 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 receptables. I am not aware of any middens in the District. 33 REMOVAL AND DISPOSAL OF HOUSE AND TRADE REFUSE. This work is carried out by the Public Health Department. Arrangements are made whereby a weekly collection is made throughout the whole of the District. For this purpose the Council possesses:— 4 2½ ton Edison Electric Vehicles. 1 S.D. Freighter. 3 Horses and carts. I cannot in any way state that these vehicles are satisfactory for the purpose. I consider them to be out of date, inasmuch as it is not possible to keep the refuse covered in its entirety as the vehicle passes through the town. More modern and better types of vehicles for this purpose are now available, and as the present stock gets worn out and becomes disused, I hope it will be replaced by a more modern type. I do not think that a weekly collection is sufficient during the summer months, when vegetable matter rots quickly andi becomes offensive, and I hope that it will be possible shortly for the Council to help me in arranging for a more frequent collection. Refuse has been disposed of by controlled tipping at the following places:— Moat, Seaford Road, from January 28th to May 11th, 1929. Goat Lane, from July 30th to October 9th, 1929. Brown's Brickfields from October 9th, 1929, to date. I wish to make special mention of the following concerning the Moat, Seaford Road. For many years this site had consisted of a ditch, the bottom of which was filled with water into which it had been customary 34 for local residents to throw old cans, tins, and general refuse. In addition to these, there were large numbers of old tyres, cycle wheels and cisterns. The result of this was that the Moat became a breeding ground for flies and vermin, and had, for long, been a source of offence and complaint. During the first three months of the year, this moat was filled in with refuse by my Department. Whilst refuse was being actually discharged into the Moat no single complaint from local residents was received. I consider that this was due to the fact that I had sufficient labour available to cover immediately all refuse. The moat as such now exists no longer, but I understand that shortly in its place will arise an open air beauty spot in Enfield. I especially mention this fact as I consider it to be the best evidence of the fact that if sufficient labour is employed it is possible to dispose of refuse by controlled tipping without offence or nuisance at a price which is decidedly economic, apart from the fact that useless land can thus be re-claimed. In addition to the above method of refuse disposal, a large amount of refuse was dumped on the fields of local brickmakers. This method of refuse disposal continued till the end of March, 1930, when it completely ceased. My short experience of this method of refuse disposal has convinced me that it is unsound, unscientific, and should not be employed. It means that refuse is kept uncovered for a long period. A brickmaker's dump becomes a breeding ground for flies and vermin, and until such time as brickmakers will break away from their hide-bound traditions and find a method of keeping crude refuse on their fields in such a way as to be inoffensive, I cannot recommend that refuse be deposited on their fields. 35 A brickmaker claims that if refuse is covered it does not rot and therefore cannot be utilised in the making of stock bricks. I believe this to be entirely incorrect, and I can see no reason why the brickmaker should not utilise sifted inoffensive refuse for the covering of crude refuse, and I believe this proposition would be economical and worthy of his consideration. 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 practise for some years has been to require movable receptables to be provided, and where any house is found without this provision, the owner is required to make it good. Cesspools. The Council has provided suitable vans and pumps, and undertakes the emptying of cesspools on the application of householders. A small charge is made for each emptying, and all cesspools are kept under observation. SCHOOLS. There are 20 Public Elementary Schools in Enfield, 45 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. 36 Rag Flock Acts, 1911 and 1928. There are no premises in Enfield where Rag Flock is manufactured, used or sold. FOOD. Milk. Previous to the latter part of 1928, examination of Milch cows in Enfield was carried out by Mr. Hide, who during the course of the year reported twice on the conditions he found. In the latter part of 1928 this work was taken over by the Middlesex County Council, who appointed their own Veterinary Inspector to carry out this work. Dr.Tate, the Medical Officer of Health for the County, has supplied me with the following report:— “ MILK AND DAIRIES ORDER, 1926. “ TUBERCULOSIS ORDER, 1913. “Dear Sir,, “With reference to your letter of the 5th instant, I have “ pleasure in forwarding to you for the purpose of your “Annual Report information regarding the activities of the “ County Council under the above Orders during: the year “1929. “In the latter part of 1928 the County Council appointed “ Mr. Sydney Villar, F.R.C.V.S., as wholetime Veterinary “ Inspector under the Milk and Dairies Order to carry out “ routine veterinary examinations of all milch cattle in the “ County of Middlesex. Mr. Villar commenced duty on “January 1st, 1929, and endeavours, so far as possible, to “ visit every farm in the County three or four times in the “ course of a year. 37 “During 1929, 48 routine visits were paid by Mr. Villar “ to the various farms in the Urban District of Enfield, and “1,178 examinations of cows and other bovine animals were “made. As the result of these examinations 4 cows were “found to be tuberculous within the meaning of the “Tuberculosis Order, and these were slaughtered. “Seventeen other cows were found to be suffering from “ various diseased conditions, and the milk from these animals “was, on Mr. Villar's instructions, withheld from sale. “In addition to the four tuberculous cows mentioned “above, the attention of the County Council's Veterinary “Inspectors under the Tuberculosis Order was drawn to the “existence of two other cows suspected by their owners to “be suffering from tuberculosis. Of this number, one was “deemed to come within the terms of the Order and was “ slaughtered. “Fifty-nine samples of milk were taken from producers “or retailers in the Urban District of Enfield in the course “of the year and were submitted to animal inoculation at “the Lister Institute. In 5 instances living tubercle bacilli “were found. This work was a means of detecting 3 further '' cows upon Enfield farms who were found to be yielding “ tuberculous milk, and these also were slaughtered. “It will thus be seen that, in all, eight tuberculous cows “ were removed from Enfield herds in 1929. “Yours faithfully, •/ ' “ J. TATE, County Medical Officer.“ From the above report it will be seen that 8 tuberculous cows were removed from Enfield during the year 1929. This appears to me a large number, and it is to be hoped that the activities of the County Council will result in improved conditions in subsequent years. 38 The Milk (Special Designations) Order, 1923. Under this Act it is the duty of the Local Authority to take samples of Certified Milk at the request of the Ministry of Health in order that they may be analysed to see if they fulfil the requirements of the Act, and if they come up to the standard necessary for Certified Milk. During the year, no such request was made by the Ministry of Health. Meat. There are no public abattoirs in the District. Quite a large quantiy 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, 1929. December, 1929. Registered 10 8 8 Licensed 7 5 5 Total 17 13 13 Mr. Fred Wilson, Chief Sanitary Inspector, Mr. T. M. Boswell, Mr. H. Wiggett and Mr. H. C. T. Darley, Sanitary Inspectors, who hold the Certificate of the Royal Sanitary Institute as Inspectors of Meat and Foods, visit the slaughter-houses at very frequent intervals, and, as will be seen by a reference to the Sanitary Inspector's Report, they paid 1.887 such visits during the year, when they examined 12,322 carcases, and secured the surrender of 9 carcases and 113 parcels of diseased organs. Public Health (Meat) Regulations, 1925. Systematic inspection of all butchers' shops and other premises for the sale of meat and offal has been made during the past year 39 to see that the requirements of the Regulations are strictly complied with, and while these regulations are not definite enough to enable us to carry out properly what is intended, there has been further improvement generally. Bakehouses. All bakehouses in the District are inspected regularly. Other Foods. Every shop selling provisions is inspected frequently. The Sale of Foods and Drugs Act is under the control of the Middlesex Council Council. A report thereon, kindly supplied by R. Robinson, Esq.. Chief Officer of the Public Control Department, follows:— URBAN DISTRICT COUNCIL OF ENFIELD. List of Samples purchased during the year ended 31st December, 1929. Article Taken. Adulterated. Milk 201 6 Butter 13 — Cream 1 — Meat 10 — Preservatives 1 — Sausages 9 1 Rum 4 — Whisky 15 1 Totals 254 8 Number of Prosecutions None. Sub-letting in Council Houses. The terms of the agreement under which the Council's houses are let does not allow the tenant to sublet. 40 During the year I have continued to consider and determine the cases in which sub-letting was to be allowed in Council houses, in accordance with the Resolution passed by the Council on December 13th, 1927. The following work was carried out:— Total number of applications dealt with 113 Number granted permission to sub-let 83 Number refused permission 30 Number of letters sent 331 Number of visits made by Sanitary Inspector 554 During 1928 this work was only carried out during the latter months of the year. As a result 554 visits were made by the Sanitary Inspectors during 1929 as compared with 178 in 1928, and 331 letters were written as compared with 135 in 1928. During the year 3 cases were referred to the Council owing to the fact that tenants had sublet without my permission, and did not get rid of their lodgers as requested. I have tried on every occasion to deal with these applications to sublet sympathetically, and whenever it has been possible to grant such permission without detriment to health or the property of the Council, I have done so. IX.—HOUSING. Although the Council by building houses has done much to mitigate conditions of overcrowding in Enfield, there is still a large amount of overcrowding in the District. This is due to the fact that although Bye-laws have been made under the Public Health Act, 1875, in connection with houses let, in lodging, no step has been taken for many years to put these Bye-laws into operation. 41 These Bye-laws make registerable certain houses let in lodgine, and provide for their inspection, cleansing, and the number of occupants they are to contain. In actual practice, as overcrowded families are housed in the new Council houses so are their previous premises let to new families who come into the District, and the previous condition of overcrowding remains. In three years time these new families are eligible for Council houses, and should they obtain them, a still further batch of new residents enter and overcrowd the same premises. Thus a vicious circle is obtained, and the improvement which the Council should get by building new houses is not obtained. This could be remedied if all houses let in lodging were registered and visited by my Staff. So far it has not been possible to carry this out, as it would need an extra Sanitary Inspector and an extra Clerk. I trust that in the near future these may be obtained in order that the overcrowding at present pertaining in Enfield may be abated as new houses are erected. The number of new houses erected during the year was:— (a) Total 646 (b) With State assistance under the Housing Acts, (1) By the Local Authority 322 (ii) By other bodies or persons 1 Without State assistance 323 1. Unfit Dwelling-houses. Inspection—(1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,814 (2) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 540 42 (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 1,365 (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 879 3. Action under Statutory Powers. A.—Proceedings under Section 3 of the Housing Act, 1925:— (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. B.—Procedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 164 43 (2) Number of dwelling-houses in which defects were remedied— (a) By Owners 145 (b) By Local Authority in default of Owners None. C.—Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925:— (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. The number of house-to-house inspections made was :— Under Housing Regulations, 1925 540 Apart from the do. 88 Total 628 Meteorology. The following instruments are installed at the Public Offices:— Standard Fortin Barometer. Maximum Thermometer In a Stevenson's screen in Minimum .thermometer grounds of the Public Offices, standard Hygrometer 44 Terrestrial Radiation Thermometer In the grounds of the Earth Thermometer In the grounds of the Offices. Campbell-Stokes Sunshine Recorder Rain Gauge On the roof of the Public Offices. Daily records have been taken, and monthly returns sent to the Meteorological Office. The accompanying table gives the result of our operations for the year in a condensed form. METEOROLOGICAL STATISTICS, 1929. Month. Barometer. Temperatures. Rainfall. Millimetres. Sunshine hours. Thunderstorms. Fogs on days. Frosts on days. Snowfalls. Prevailing Winds. Highest Lowest Earth Means. Grass Min. Highest Maximum. Lowest Minimum. Means of latter. Jan. 30.838 on 9th. 20.824 on 15th. 41.4 19° on 27th. 49° on 30th 22° on 13th. 35 31.9 1 .33 inches. 36.5 — 4 20 9 N. Feb. 30.730 on 28th. 29.674 on 15th. 39.3 10° on 15th. 51° on 1st. 13° on 15th. 32 16.0 0.61 inches. 57.9 — 8 23 5 S.E. Mar. 30.848 on 16th. 29.994 on 21st. 39.1 17° on 3rd. 71° on 28th & 29th. 22° on 3rd. & 5th 44 Nil 172.9 — 1 18 — N.E. April 30.378 on 17th. 29.420 on 29th. 44.1 22° on 6th. & 22nd 73° on 19th. 26° on 6th. 45 29.2 1 .33 inches. 156.6 — — 7 4 N.W. May 30.310 on 30th. 29.340 on 6th. 48.6 25° on 1st. 81° on 23rd. 29° on 1st. 55 38.6 1 .59 inches. 237.8 4 — 4 — S.W. June 30.450 on 21st. 29.346 on 6th. 54.5 37° on 12th. 81° on 19th. 42° on 29th. 58 26.3 0.93 inches. 200.2 1 — — — S.W. July 30.430 on 13th. 29.412 on 31st. 57.1 38° on 8th. 87° on 20th. 43° on 8th. 62 52.1 1 .93 inches 249.1 2 — — — S.W. Aug. 30.271 on 19th. 29.378 on 1st. 59.1 40° on 3rd. 88° on 31st. 44° on 3rd. 63 33.4 1 .30 inches. 188.2 — — — — S.W. Sept. 30.502 on 25th. 29.660 on 20th. 59.6 34° on 27th. 89° on 8th. 36° on 27th. 64 9.4 0.35 inches. 195.4 — — — — S.W. Oct. 30.453 on 15th. 29.130 on 24th. 55.5 27° on 27th. 66° on 16th. 31° on 27th. 48 54.2 3.21 inches. 122.0 — — 3 — S.W. Nov. 30.494 on 4th. 29.022 on 16th. 49.0 23° on 15th. 60° on 8th. 25° on 15th. 43 133.4 5.21 inches. 55.5 — 12 11 — S.W. Dec. 30.734 on 17th. 29.910 on 7th. 46.6 24° on 20th. 57° on 14th. 25° on 19th. 41 129.3 5.01 inches. 47.0 1 6 8 — S.W. Totals 550.8 22.80 inches 1719.1 hrs. 8 31 94 18 45 Public Offices, Enfield, April 7th, 1930. REPORT OF THE CHIEF SANITARY INSPECTOR FOR THE YEAR 1929. To the Chairman and Members of The Urban District Council of Enfield. Mrs. Heath and Gentlemen, I beg to submit my report for the year ending 31st December, 1929, which includes particulars in tabular form as required by Article XIX (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 the Housing Consolidated Regulations, 1925 540 From House-to-House apart from this Act 88 On Account of Infectious Disease 292 On Account of Phthisis 99 On Account of Complaint by occupant or otherwise 1,795 104 Factories 125 126 Workshops and workplaces, including 2 laundries 115 Outworkers' premises inspected 30 56 Bakehouses, of which 38 are in use 100 3,184 46 Inspections—(continued). Inspections. Brought forward 3,184 18 Slaughterhouses, of which 10 are in use 1,887 28 Cowsheds inspected frequently 324 31 Dairies and Milkshops inspected frequently 244 22 Schools 38 Public conveniences inspected 691 Conveniences at Railway Stations inspected 35 Fish Shops: Total number of visits 68 Coffee and Eating Houses: Total number of visits 7 Shops where ice-cream is made: Total number of inspections 36 Meat Shops: Total number of inspections 662 Food Stalls in Markets: Total number of inspec tions 772 4,764 Visits to absentees excluded from Elementary Schools 383 Visits in connection with cases of Infectious Disease 3,736 Visits in connection with Phthisis 616 Visits re verminous premises, etc. 67 Offensive Trades (excluding Fish Shops) 20 Smoke observations 165 Other inspections, including works in progress 8,866 Petroleum Stores inspected 358 Visits re Shops Act 146 Cinemas, etc., inspected 32 Visits and inspections re Rats 107 Visits re Sub-letting in Council Houses 554 Visits re Gypsy Vans, &c. 72 15,122 23,070 47 Notices Issued. Statutory:— Inspections Provision of dustbins 34 328 For repairs to houses, drains and abatement of nuisances 224 Providing sufficient water-closets 70 Paving of yards 0 Cleansing and Limewashing of Cowsheds 0 - Informal:— Notices 1,166 1,166 - 1,494 Other Notices issued under Infectious Diseases Acts:— To occupiers 342 5,587 To Education Committee and Head Teachers at Schools 5,245 - 7,081 Other letters sent 3,628 No. of Certificates issued in connection with plans 220 Result of Service of Statutory and Informal Notices:— Statutory Informal Number complied with 290 755 Number outstanding 38 411 328 1,166 48 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. 582 Roofs repaired 169 Gutters and downpipes repaired 114 Cesspools emptied 354 Cesspools abolished 0 House drains cleared, repaired, etc. 230 House drains tested, examined, etc. 663 House drains reconstructed 10 Soil-pipes and drains ventilated, including repairs to ventilators 17 Sink-wastes disconnected or repaired 22 New sinks provided 2 Closets provided with proper flushing cisterns or water supply 128 New closets provided 5 Closets repaired, covered, cleansed, etc. 171 Water-closets substituted for earth-closets 0 49 Storage cisterns repaired, covered, cleansed, etc. 46 Storage cisterns provided 2 Water laid on or restored 71 New wells provided 0 Wells closed 0 Wells cleansed and repaired, etc. 3 Samples of Water taken from Wells 0 Do. do. from Main 0 Yards paved, or existing paving made good 72 Ventilation provided under ground floors and causes of dampness removed, etc. 139 Dustbins repaired, or new ones provided 132 Manure heaps removed 14 Fowls and other animals removed 0 Stables cleansed 0 Other nuisances abated 153 Cases of overcrowding abated 57 Ditches cleaned out 3 Gipsy vans removed 4 Disinfection. Houses disinfected:— After infectious disease 300 After Phthisis 71 After verminous cases 94 465 Rooms stripped and re-papered, etc., after occupation by cases of infectious disease 52 Ditto, ditto, by cases of Phthisis 28 Articles of clothing, bedding, etc., disinfected 1,327 Ditto, ditto, destroyed 75 50 Library Books disinfected 104 No. of Certificates issued re disinfection of clothing and premises 27 Number of Schools disinfected 2 Private Patients removed to Hospital or Infirmary 1,253 Gipsy Vans removed from District 1 Articles or parcels of unsound food destroyed or otherwise disposed of 172 It has 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, proved sufficient to obtain the carrying out of the works required. Visits paid re children excluded from Elementary Schools during the year numbered 383. and the total inspections and visits for all purposes made by the Staff of the Sanitary Department was 23,070. Removal of House Refuse. A weekly collection of house refuse throughout the District finds employment for:— 4 2½-ton Edison electric vehicles. 1 "S.D." Freighter (petrol) dust wagon. 3 horsed vehicles; and 27 Dustmen. The electric vehicles, kept at the charging station at the North Metropolitan Electric Power Supply Company's premises, Ladysmith Road, are charged by the Company. I am glad to have the opportunity of again expressing our appreciation of the expert advice 51 and assistance given so readily by Mr. A. H. Bennett, the Resident Engineer and his Staff. The petrol van, and the horses, are kept at the Council's Lincoln Road Depot. The year's working of the various forms of transport has confirmed the view that the economic value of the types of vehicles in use is dependent upon the distances to the different disposal points. Our experience has shown that the mobility of mechanical traction shows a great advantage over horse haulage. The rapid development of the District, particularly in the outer areas, will naturally necessitate additional plant to deal with the refuse, and it will be a matter for consideration whether, besides obtaining extra mechanical transport it will be economical to replace the horses by motor vehicles. Every effort is made to keep the dumps free of rats. The Department has the necessary pump and Cyanogas for dealing with rats in open spaces. During the larger portion of the year refuse was dumped in two brickfields, but owing to trouble with fire following the excessive heat in the summer months one was closed; the other one was continued until the end of the year. Towards the end of the year the use of what is known as "Brown's Brickfield," adjoining Palmers Lane, Old Road, was recommenced as a dumping site for household refuse. The method in dealing with this was the one known as the North country system. Small quantities of trade refuse are removed free of charge, but where larger quantities are dealt with or a special collection is arranged, a proportionate charge is made. The income from this source during the year was £62 7s. 0d. The quantity of refuse collected during the year was 14,607 tons, and the cost £6,655. This expenditure equals 9s. 1.3d. per ton 52 of refuse collected and disposed of, as against 9s. 3d. in 1928. This equals 2s. 0.5d. per annum, or 0.47d. per week per head of the population. The cost for each house is 9s. 2.1d. per year, or 2.1d.each week. These figures compare very favourably with those of other districts of a similar nature, and especially so when it is remembered that Enfield is the second largest urban district in England. We thus have to contend with very long haulage distances, which materially increase the cost of collection in comparison with other districts. The matter of haulage is receiving further attention by this Department in view of any question of buying a further vehicle, and a re-arrangement of the collection in the district will have to be gone into. As against the cost shown above, there is again a consideration, that during the past year about half an acre of land has Been reclaimed. 53 FACTORY AND WORKSHOPS ACTS, 1901 AND 1907. A register of all workshops is kept, and at the end of 1929 there were 83 workshops, 45 workplaces, 2 laundries, and 56 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) 115 - - Workshops (including Workshop Laundries) and Workplaces 115 - - Bakehouses 100 — — Total 340 — — 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 — — — — 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 20 20 - - Other Offences — — — — Totals 33 33 — — 54 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 10 14 8 8 12 Brushes — — 2 2 — Boot-making 1 1 — — — Umbrellas 1 1 — — — Paper Hats 1 1 — — — Totals 13 17 10 10 12 Eleven 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, 32 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 Fryers 27 Rag and Bone Dealers 5 Glue Maker Soap Boiler 1 and in connection with these 88 inspections were made during the year. 55 With regard to the Fish-fryers, 12 have been established with the consent in writing of the Council, and the majority of the oldestablished businesses have now been fitted with up-to-date frying stoves. MILK. As a result of the usual inspections of cowsheds under the Milk and Dairies (Consolidation) Order, 1926, during the past year, it has been found that the grooming of cows and the cleansing of their udders prior to milking is receiving proper attention. It is felt that the former prejudice shown by farmers against these precautions is dying out, and that they are paying greater attention to the cleansing of their hands and garments and the grooming of their cows. I am glad to say that as greater attention is being paid to the permanent paving of yards so a more cleanly method of removing manure is facilitated. More drinking bowls are being installed and better arrangements for licking salt found. Thus, a large amount of effort is being shown to help forward a more hygienic condition of cowsheds and better consideration for the cows. The care taken in the sterilising of churns and cans, and the covering of milk shows much improvement. Whilst the samples of milk taken demonstrate their present percentage of bacteria, it cannot be suggested that we have yet reached a perfect stage of cleanliness. There is still much work to be done in the future and further improvement made, before the condition of milk can be termed ideal. Licences as follows were in force on the 31st December under the Milk (Special Designations) Order, 1922, Section 3 of the Milk and Dairies Amendment Act, 1922:— Dealer's Licence to use the Designation "Grade A" 1 Dealer's Licence to use the Designation "Certified" 3 Dealer's Licence to use the Designation "Pasteurised" 3 56 Dealer's Licence to use the Designation Grade A (Tuberculin Tested)" 4 Supplementary Licence to use the Designation ''Pasteurised'' 3 Supplementary Licence to use the Designation "Grade A" 1 Supplementary Licence to use the Designation ''Certified'' 1 Supplementary Licence to use the Designation "Grade A (Tuberculin Tested)" 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:— Slaughterhouses 1,887 Shops 662 Stalls in Markets 772 3,321 PUBLIC HEALTH (MEAT) REGULATIONS, 1924. The procedure of the method of inspection of meat under the above Regulations continues as in the past four years. While every effort is made to secure the cleanly handling of such foodstuffs as come under the Meat Regulations, the bad old system of tradesmen being allowed to deposit bread, milk, etc., on people's doorsteps and sills continues in the district, and unfortunately there are no Regulations to govern the matter. The amount of slaughtering has increased to such an extent that it. continues till late hours on week-day evenings as well as Saturday afternoons and evenings and part of Sunday. 57 Animals slaughtered on any one day, the carcases of which are intended for sale at the Central Meat Markets, London, cannot be left over until the next morning if the slaughtering is done at a late hour, and this means, therefore, the attendance of an Inspector at the slaughterhouses until late in the evening. Another difficulty in this matter is that animals coming by rail are sent to the Crews Hill Station, with the result that they do not arrive at the slaughterhouses until the day is so far advanced that slaughtering is delayed. The amount of meat surrendered and destroyed on account of disease being present is larger during the past year, but not out of proportion to the increased number of animals slaughtered. A large proportion of the meat slaughtered in Enfield is taken to the Central Meat Markets, London, whilst much of the meat sold in Enfield is bought at the Central Meat Markets. The number of carcases examined during the year under these Regulations are as follows:— Cows 11 Organs or parts of carcases found diseased 2 Oxen 649 ,, ,, ,, ,, 8 Calves 209 ,, ,, ,, ,, 0 Sheep 5,165 ,, ,, ,, ,, 4 Pigs 6,288 ,, ,, ,, ,, 108 Totals 12,322 ,, ,, ,, ,, 122 These organs or parts of carcases found to be diseased were surrendered and destroyed. The weight of the meat destroyed was 1 ton 7 owts. 1 qt. 7 lbs. The carcases generally were in good condition, and there was no case which necessitated the obtaining of a Magistrate's Order. 58 As in previous years, foodstuffs purchased in the various London Markets were submitted for inspection, and 50 parcels were found to be unfit for human consumption; these 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. Twenty certificates in all were granted. I can only repeat that the subject of overcrowding in Enfield still remains a serious one, and though the Council in building and providing houses are doing all in their power to meet the trouble, the fact still remains that almost as fast as people are removed from one and two rooms to Council houses, these rooms are again sublet to new families with continuance of the old evil. I should like to take this opportunity of again stating that I appreciate the kindly consideration of Doctor Geffen, the Medical Officer of Health, and of thanking the Members of the Council for their courtesy, also all the members of the Public Health Staff for their willing help during the past year. I am, Mrs. Heath and Gentlemen, Your obedient Servant, FRED WILSON, M.R.San.I., M.S.I.A., Chief Sanitary Inspector.