Beaconsfield House Hanwell W. ???. 1919. To the chairman & Members of The Greenford U. D. Council Gentlemen, I regret that owing to unavoidable circumstances, my Twenty Second Annual Report should have been so long delayed: During the year 1918. , as in the 3 previous years everything (excepting matters of urgency) was sacrificed owing to the exisencies of the War so that there is very little to report as to what has been done, but to consider the steps to be taken for the future:- and this will require time, for it is obvious that destruction of any kind can be affected much quicker than the opposite (construction) and unless the latter is carried out after due consideration of the necessities and variations required in each District the peculiarities of which vary so much that the test made plans drawn up by one not being ??? of the needs of a locality, may, and probably will prove a failure as may be seen by referring to the return appended hereto from the General Register office and an explanation referring thereto the population of the District for the purpose of calculating the Birth rate. is 140l whereas that for calculating the Death date is 1250 and when divided into the several perishes and estimate it as follows:- For Birth Rate For Death Rate Greenford 1201 1100 Perivale 150 85 West Twyford 50 65 Total 140l 1250 The number of Deaths (Civilians only) was 23 viz: 12 males and 11 females, the death rate is therefore 18.4 per 1000. The figures are so small as Pre-quently stated in my previous Reports that very little reliance can be placed upon them in estimating the public Health of the District, the infantile Fortality and any increase of deaths in any one particular class of disease may be relied on with more confidence. There was only one death in the former a male under 1 year (and legitimately born) so the the infantile Mortality rate (the numbers of deaths of infants under 12 months old out of the number of Births during the year) in this instance 16 gives a rate for this class of 62.5 per 1000 Births. There was no incidence of deaths from any special disease:- Influenza so prevalent and fatal in the surrounding Districts caused only 3 deaths (all females) although the complaint was very prevalent especially during the last few months of the year and carried on to the following 1919. A comsiderable number of deaths (at pointed cut in my previous Reports) ??? at a Home for Invalids carried on at Twyford Abby, some of these are transferred to the place from which they come by the Registrar General, but not in every instance, probably owing to the difficulty in tracing their original address, in this way the numbers of deaths credited to this District is greater then it would otherwise be. School Closing, Only on one occasion was it found necessary to advise the closing of the Elementary public school in June I reported to you as follows:- "I am pleased to be able to report that the result of closing the School on account of measles was highly successful, There was no outbreak amongst the scholars and only 5 cases occured during the whole month. I think it is practically certain that had the school net been closed there would have been a number of cases and probably some deaths therefrom". Births. By referring to the figures supplied by the General Register office, it will be seen that of the 16 Births recorded, 12 were Boys, and 4 were girls, of which 10 Boys and 3 Girls were legitimate and 2 Boys and 1 Girl illegitimate Of the Births 13 were notified according to the Act for this purpose, 7 By Midwives 5 By Medical practitioner and 1 by parent. Copies of cach Notification were forwarded to the County Mo 0. The question as to the best means of dealing with Maternity and Child Welfare is most pressing. Owing to the rural oharactor of the District the houses being scattered in isolated areas with considerable distances between and there being no ordinary public means of Transport and there being no practising qualified Medical Man or Woman and no trained or qualified Midwife residing in the District, these individuals when required have to journey from the nearest adjacent Town, either Hanwell Ealing Harrow or Southall, all about 3 miles or more distant. It can be readily understood that some extra inducement must be offered in order to obtain their services. This matter has been very serious for some years and is becoming even more serious so that I am pleased to find that the Central Authority The Middlesex County council is at last taking the matter up and I hope the difficulty and danger to expecting Mothers will soon be a matter of the past, and with the object in view I attended Meeting on February 27th of lica1 Medial officers of Hea1th and the County M. O. with the result that Health Visitors were appointed and on Saturday 13th April I received and had an interview with miss Harris appointed Health visitor for Greenford accompanied by Miss ??? the County Councils inspector of Midwives. There however remains the difficulty arising from the fact that there is no one residing in the District qualified or competent to even attend a Woman in her confinement, this difficulty I have no doubt will be overcome and ill be materially assisted when in accordance with sec 14 of the Midwives Act 1918., The county council undertake to Pay fees ( as I understand they are about to do) and fix a ??? for attendance of Medical practitioners for this purpose. Infectious Disease During the year under consideration 4 cases of Diphtheria, 2 cases of Scarlet Fever 1 opthalmia ??? and one of Post. Influenza Messingities were notified. There were also 11 cases of measles reported all notified by Medical practitioners and six oases of Tuberculosis all pulmonary, three were new cases and three the remaining three had been reported on previous occasions on admission to or or discharge from a public Institution, There were 4 deaths from this disease. This disease was very prevalent especially during the last few months of the year, there were 3 deaths from this cause, and the ??? case of ??? recorded followed . ,3 - on an attack of this complaint. Housing and Town planning Act 1909. in accordance with Sec 17 Sub Secs (1) and (2) in the course of my inspections of the District, I found many of the Cottages very dilapidated, but owing to the scarcity of Housing accommodation, there being absolutely no where else for people to go, should they be compelled to leave the premises they have occupied for many years, that I had to be very ohary in advising the Council to issue closing orders, in one instance however where the ??? were ??? bad the owner made an attempt ??? remidy them. I had ??? ??? and the Council accordingly made a Closing order for the premises known as Ravener Cottage, but great difficulty has been found for the reasons I have already stated viz: that the people could not find any other accommedation in the district. From plans received and correspondence it appears certain that this district will in a few years became in Industrial centre of considerable magnitude and it behaves the Council to be exceedingly careful in using the powers with which they are entrusted to see that offensive Trades and businesses of a disagreeable nature are prohibited, bearing in mind the future development of the ared and it must be remembered that when the Council once grant a Liceace it cannot be revoked and the duty of enforcing the carrying on the business in a manner So as not to create a nuisance is fraught with difficulty and means generally nimerous visits to the police Court as has been the case with the one offensive trade viz, that of a bone boiler and tallow matter etc, which has been carried on for some years at Greenford Green. Another matter which is most pressing and will have to be settled before much development can be made is the provision of a sewerage system, this matter has been discussed for some years but nothing definite has yet been done. I am Gentlemen your obedient Servant (Signed) George Hope. ??? 1918 ??? The annul distribution of Ms returns of births and deaths and estimates of population for the past year affords the Register General an opportunity of directing the attention of Medical officers of health and others using the returns to some points upon which experience has shewn that miss understanding's tend to arise. 1. The year to which these returns' refer is the calendar year 1918. The numbers of births and deaths registered must differ slightly on this account from the records for the most nearly corresponding fifty two weeks. 2. The "death - rate population" excludes all non - civiliansmales, whether serving at home or abroad. This is necessary for the purposes of local death - rates because it has proved impossible to transfer the deaths of non - civilians to their areas of residence or to deal in any other satisfactory Manner with the Local mortality of this element in the population. These estimates are based mainly upon the rationing returns kindly placed at the Registrar General's disposal by the Ministry of Food. The "birth - rate (and marriage - rate) population" on the other hand is intended to include all the elements of the population contribution to the birth and marriage rates. It consists therefore of the death - rate or civilian population plus all non - civilians enlisted from this country, whether serving at home or abroad. This non - civilian element has been distributed over all the districts in the country in proportion to their estimated civilian population. 3. The classification of some deaths is modified in the light of fuller information obtained from the certifying practitioner in response to special enquiries. The principal subjects of these inquiries are indicated in a table published in the yearly reports of the Registrar General. and this possible source of discropency between the returns of the Registrar General and those complied locally should be borne in mind particularly in regard to the cause of death dealt with in that table. 4. If it is desired to ??? criticise the figures supplied this should be done at an early data. Every effort wil1 made in that case to clear up any points of serious difference from locally complied returns and to amend the Registrar General's figures if those prove to be in error, put it will be impossible for him to entertain any suggestion for their alteration unless made within a few weeks of their circulation to local authorities. General Register office, Somerset House London W. C. 2. 31st March 1919. Table X V. Birth - Rate, Death - Rate, and Analysis of Mortality during the Year 1919. (Provisional figures. populations estimated to the middle of 1918 have been use I for the purposes off this Table Birth- Rate per 1,000 Total Population. Annual Death - Rate per 1,000 Civilian population. ALL Causes Enteric Fever Small Pox. Measles Scarlet Fever Whooping Cough Diphtheria Viclence England and Wales. 17.7 17.6 0.00 0.00 0.280 0.03 0.20 0.14 0.40 6 Great Towns including London (??? Populations exceeding 50,000) 17.6 18.2 0.02 0.00 0.36 0.04 0.34 0.15 0.??? 1 smaller Towns, (??? Populations 20,000 - 50,000) 17.0 ???.1 0.03 - 0.25 0.02 0.25 0.14 0.38 London 16.1 18.9 0.02 - 0.42 0.03 0.43 0.17 0.56 x - civilians are included inthese figures for England and wales but not for other ares Table X. V, Birth- Rate, Death - Rate and Analysis of Mortality during the year 1918 (Provisional figures. Populations estimated to the middle of 1918 have been used for the purposees of this Table) Rate Per 1,000 Births. percentage of Total Deaths. diarrhœa and Enteritis (under 2 years) Total Deaths under One year Deaths in public Institutions Certified Causes Inquest Cases Uncertified Causes of Death. England and Wales 10.99 97 24.3 97.3 5.4 1.3 96 Great Towns including London (Censes Populations exceeding 50,000) 14.46 106 28.4 93.4 5.8 0.8 a Smaller Towns 9Censes Populations 20,000 - 50,000) 9.73 94 15.4 94.5 3.9 1.6. London 15.67 107 45.0 92.5 7.3 0.2 Non - civilians art included in these figures for England and wales but not for other areas. Causes of Death in 41/07 Greenford U. D. 1918. Causes of Death Civilians only Males Females All Causes 12. 11. 1. Enteric Fever 2. Small Pox 3. Measles 4. Scarlet Fever 5. Whooping - cough 6. Diphtheria and croup 7. Influenza 3. 8. Erysipelas 9. Pulmonary tuberculosis 2. 2. 10. Tuberculous meningitis 11. Other tuberculous diseases 12. Cancer, malignant disease 2. 1. 15. Rheumatic Fever 14. Meningitis 1. 15. Organic heart disease 1. 16. Bronchitis 17. Pneumonia (all forms) 1. 18. Other respiratory diseses 19. Diarrhœa &c (under 2years) 20. Appendicitis & typhlitis 21. Cirrhosis of liver 22. Alcoholism 23. Nephritis and Bright's disease 1. 24. puerperal Fever 24. parturition apart from puerperal fever 25. Congenital debility &c 26. Violence, apart from suicide 1. 27. Suicide 28. Other defined diseases 6. 2. 29. Causes ill defined or unknown Special Causes (included above) Cerebro-spinal fever Poliomyelitis Deaths of infants under 1 year Total 1, - Illegitimate - - Total births 12. 4. Legitimate 10 3. Illegitimate 2 1. population for Birth - Rate 1401 "for Death - Rate 1250 General Register office Somerset House London W. C. April 1919.