HARRO 1Z 1911. HARROW-ON-THE-HILL URBAN DISTRICT COUNCIL. ANNUAL REPORT of JOHN FLETCHER LITTLE, M.B. Cantab., M.R.C.P. Lond , Medical Officer of Health for Harrow. HARROW Printed at the "Gazette" Printing Works. INDEX Page. General Statistics 3 Population 5 Birth- Rate 5 Death- Rate 6 Deaths at All Ages 6 Deaths of Harrow Paupers 6 Deaths of Residents Outside the District 6 Corrected Death- Rate 7 Infantile Death- Rate 8 Longevity of Harrow Residents 8 Health Visitors' Report 8 Earlier Registration of Births 10 Infectious Diseases 10 Diphtheria 10 Diphtheria Anti-Toxin 11 Enteric Fever 11 Bacteriological Examinations 11 Influenza 12 Isolation Hospital 12 Methods of Disinfection 12 Tuberculosis 12 Prevention of Consumption 13 Spitting in Streets 13 Disinfection of Rooms used by Tuberculous Patients 14 Prevention of Cancer 14 House Numbering 15 Houses Let in Lodgings 16 Common Lodging House 16 Scavenging 16 Dairy Farms, etc. 16 Milk from Outside the District 16 Veterinary Inspection of Milch Cows 17 Fish Frying 17 Water Supply 17 Ice Cream Premises 18 Slaughter Houses 18 Housing of the Working Classes 19 Housing and Town Planning Act, 1909 19 House to House Inspection 20 Factories and Workshops 21 Medical Inspection of School Children 21 Cottage Hospital 22 Harrow Boundaries 23 Surveyor's Report 23 Food and Drugs Act 24 Public Urinals 25 Meteorological Observations 25 HARROW ON- THE- HILL URBAN DISTRICT COUNCIL POPULATION (CENSUS 1911), 17,076. BIRTH-RATE, 20.6. DEATH-RATE, 7.8. CORRECTED DEATH-RATE, 8.4. INFANTILE DEATH-RATE, 79.5 PER THOUSAND BIRTHS. HOUSES AND FEATS OCCUPIED, 3,832 ; UNOCCUPIED, 313. AVERAGE NUMBER OF PERSONS PER HOUSE, 4.4. RATEABLE VALUE, £143,179. POPULATION 185!, 2,813. POPULATION 1891 (CENSUS), 5,725. AREA 1,000 STATUTE ACRES. POPULATION 1901 (CENSUS), 10,220, AREA 2,028 STATUTE ACRES. POPULATION JUNE, 1906 (CENSUS), 13,697. 5 Annual Report, 1911. r, Park Crescent, Portland Place, London, W. February 19TH, 19x2. To the Chairman and Members of the Harrow Urban District Council. Gentlemen, I have the honour to present to you my Report for the year ending December 31st, 1911. POPULATION. The population at the census taken in April was 17,076:—Males, 7,847 ; Females, 9,229. As the census returns will not be completed until the middle of this year, I am unable to give the number of occupied houses and flats. The Registrar General informs me:— "That there were 3,832 separate occupiers in" "April last." "The Urban District contains parts of the Eccle-" "siastical Parishes of Roxeth (Christ Church), Greenhill" "(St John the Baptist), Harrow-on-the-Hill (St. Mary)," "containing respectively 4,036, 6,604, and 6,437'' " persons." BIRTH RATE. The births of 182 boys and 170 girls were registered during the year, making a total of 352, as compared with 376 in 1910. This gives a birth rate of 20.6 per thousand. The average for the previous five years is 22.3. The birth rate for England and Wales in 1911 was 24.4, and for the 136 small towns 234. 6 DEATH RATE. There were 131 deaths registered—68 males and 63 females—the death rate being 7.8 per thousand. This is considerably more than that of 1910, when it was 5.8 per thousand. Of these 131 deaths 35 occurred in the March quarter, 36 in the June quarter, 35 in the September quarter, and 25 in the December quarter. There were 35 deaths in the parish of St. Mary. 55 in Roxeth, and 41 in Greenhill. The death rate for England and Wales was 14.6, and for the 136 small towns 13.8. DEATHS AT ALL AGES. The distribution of the 131 deaths according to age is as follows:— Under 1 year 28) Under 5 year of age 32 Over 1 year and under 5 4 Over 5 and under 15 8 Over 15 and under 25 5 Over 5 years 99 Over 25 and under 65 39 Over 65 47 131 131 DEATHS OF HARROW PAUPERS IN HENDON AND ST. PANCRAS WORKHOUSES. Eight Harrow paupers died in the Hendon and St. Pancras Workhouses, 7 males and 1 female. The causes of death and their ages are as follows:— Epilepsy and Syncope, 12½ years; Phthisis, 25 years; Cancer, 55 years and 42 years; Asthma, 67 years; Old age, 73 years ; 74 years ; 77 years. The average number of paupers belonging to the district in the Hendon Workhouse during 1911 was 35. DEATHS OF RESIDENTS OUTSIDE THE DISTRICT. Fifteen deaths of residents have occurred outside the district during the year: they are as follows 7 Friedenheim Hospital.—Pulmonary Tuberculosis, age 35 years. Friedenheim Hospital.—Cancer of Uterus, age 60 years. Napsbury Asylum.—Chronic Bronchitis and Heart Disease, 62 years. 14 Pembridge Square. Malignant disease of Larynx, age 51 years. Children's Hospital, Great Ormond Street.— General Tuberculus, age 5 months. Children's Hospital, Great Ormond Street.—111 fective Diarrhoea, age 9 months. Children's Hospital, Great Ormond Street,—Tuber culous Peritonitis, age 5½ years. National Hospital, Queen Square.—Cerebral Thrombosis, age 48 .years. 17, Portland Place, Bath.—Carcinoma of Earynx, age 75 years. Middlesex Hospital.—Carcinoma of Mammae, age 52 years. Charing Cross Hospital.—Carcinoma of Rectum, age 65 years. Middlesex County Asylum.—Epilepsy, age 15 years. In the Thames at Shepperton.—Found drowned, age 38 years. North Western Hospital. — lymphosarcoma of thigh, age 11 years. 21, Silverlands, Buxton.—Cerebral Thrombosis, age 68 years. CORRECTED AND STANDARD DEATH-RATES. There were 23 deaths of Harrow residents outside the district, including the 7 Harrow paupers in the Hendon Workhouse and 1 in the St. Pancras Workhouse. There were 10 deaths to be excluded as follows :— 1 Pinner and 3 Wealdstone residents in the Harrow Cottage Hospital, and 6 other non-residents, giving a net total of 144 and a corrected death-rate of 8.4. 8 The corrected death-rate for England and Wales was 14.6. and for the 136 small towns 14.4. For the purposes of comparison with other districts, which may have a more favourable or unfavourable population as regards its sex and age constitution, it is necessary to multiply the corrected deathrate by a factor supplied by the County Medical Offiecr of Health ; the result is the " Standard Death-rate." The Standard Death-rate for Harrow is 9.7. INFANTILE DEATH RATE. The Infantile death rate for the year was 79.5 per thousand births. There were 28 deaths of infants under one year of age out of 352 children born, giving an infantile mortality of 79.5 per thousand children born, or 8 per cent. Of the above 28 deaths, 11 were from Prematurity, which shows that two-fifths of the deaths were not caused by illness contracted after birth. In 1910 there were 15 deaths, giving an infantile mortality of 39.8 or 4 per cent. and in 1909 there were 20 deaths, giving an infantile mortality of 55.4 or 5½ per cent. The rate of infantile mortality in England and Wales was 130 and for the 136 small towns 133 per thousand. LONGEVITY OF HARROW RESIDENTS During the year 53 persons died over the age of 60, or 40 per cent of the deaths registered. Of these, 17 died between the ages of 60 and 70; 28 between 70 and 80; and 7 between 80 and 90, and 1 between 90 and 100. In 1910 the deaths over the age of 60 were 50 per cent, of the deaths registered. HEALTH VISITORS' WORK. The Health Visitors report as follows:— "Total number of visits, 481. Birth enquiries, 222 " "Death enquiries, 16; viz., 4 Broncho-Pneumonia.' 9 "3 Broncho-Pneumonia following Measles, I Broncho-" "Pneumonia following Whooping Cough, I Inanition," "I Neglect, I Convulsions, 2 Twins (premature), I" "Prematurity," "Infection enquiries, 259:—Measles, 152; Chicken " "Pox, 39; Whooping Cough, 7; Diarrhoea and" "Vomiting, 5; Septic Throats, 4." "52 cases of ' Contacts,' etc." "Of the babies visited 100 were breast fed; 21" "bottle fed ; 3 breast and bottle." "Fifteen babies have been visited from time to" "time. Two mothers have been helped to get extra" "nourishment (one by Members of the Council, the" "other by Roxeth Relief Committee) and so have been" "able to continue breast feeding. One baby was not" "doing at all well. but soon improved after advice" "given as to feeding, etc. Of the others, all are doing" 'well with the exception of one which is not getting" "on at all. The father is usually out of work, the" "mother has been and still is suffering from breast" "abscesses." "With regard to the infectious cases, Measles" "occurred in a very mild form. Three cases were" "severe, 2 followed by Bronchitis and 1 by Pneu-" "monia, in addition to the fatal cases mentioned" "before. In one case the child had severe eye trouble," "and no doctor had been seen. A doctor was called" "in, and the child finally sent to a London Hospital" "for treatment." "Chicken Pox cases were also very slight. Child-" "ren nearly all vaccinated; two children who had not" "been were very ill." The Health Visitors have continued their useful and beneficent work. By their tact and skill they have won the confidence of the mothers with whom they have had to do. Their training has fitted them admirably for imparting knowledge which must have excellent results. They are invaluable allies in promoting the sanitation of the district. They still feel that a fund for helping poor mothers to nourish themselves in order to feed their babies is 10 much needed. In cases where the father is unsatisfactory, and probably out of work through his own fault, it is impossible to get relief from the Guild of Help, the local Relief Committees or the Parish. In the latter case help being given only in actual illness. I believe that a little money judiciously spent in this way would do a great deal of building up the physique of the children. In Paris this plan has been found to work admirably. EARLIER REGISTRATION OF BIRTHS. In my reports I have frequently stated my reasons for desiring the earlier registration of births. Very few births are registered within six weeks of the event, the time limit permitted by the Registration Act, consequently the information reaches the Health Visitors in some cases too late to be of use. I am confident that the medical practitioners have urged the parents to registc the births at the earliest possible moment but without success. I am therefore reluctantly compelled to recommend the Council to adopt the Notification of Births Act. INFECTIOUS DISEASES. Ninety-eight cases of infectious disease were certified during the year. They were as follows:—Scarlet Fever, 50; Diphtheria, 18; Erysipelas, 10; Enteric, 2; Puerperal, 3; Chicken Pox, 15; there was one death from Scarlet Fever, and one from Typhoid (Enteric) Fever, but none from any other notifiable disease. There was one death from Influenza and three from Measles both of which are non-notifiable. The above shows that six deaths were caused by Infectious Diseases, and the population being 17,076 gives an Infectious Disease Death Rate of 0 29. DIPHTHERIA. Eighteen cases of this disease have been certified during the year (as compared with 25 in 1910). There was no death. 11 Diphtheria occurred in the latter part of the year 1910 in the centre of the town, and a thorough investigation was made. This resulted in the discovery of five cases of the disease. These "carriers" were in excellent health, and no evidence could be discovered of their having been recently ill, or having suffered from sore throat. Happily there were no fatal cases, which I attribute to the arrangements made by the Council for a bacteriological examination of swabs from suspected throats, and for the prompt administration of fresh antitoxin. DIPHTHERIA ANTI-TOXIN. A fresh supply of this valuable remedy has been kept, as usual, at the Council Offices day and night, also at the Sanitary Inspector's house, 28, Devonshire Road, off Pinner Road, Greenhill, aud at the Isolation Hospital, Roxeth. In cases of Diphtheria, if the antitoxin is injected during the first 24 hours the prospects of recovery are good, but every hour that is lost increases the danger. Therefore it is of vital importance that a supply should always be at hand. ENTERIC (TYPHOID) FEVER. Two cases were certified during the year, one of which was treated at the Isolation Hospital, and one at home. The latter case terminated fatally. BACTERIOLOGICAL EXAMINATIONS. Seventy-two specimens were sent for examination: —67 Diphtheria, 2 Enteric, and 3 Tubercle. Arrangements were made during the year that all specimens for bacteriological examination should be sent to the Clinical Research Association. This Association now supplies the medical men sending specimens with fresh outfits. 12 INFLUENZA. One death resulted from this disease. The public should be aware that they are guilty of culpable rashness in unnecessarily visiting cases of this disease. It is highly infectious, and even where death does not result, the after effects, such as mental derangement, sometimes cause suicide and even murder. ISOLATION HOSPITAL. Forty-five cases of Scarlet Fever (24 in 1910), 13 cases of Diphtheria (17 in 1910) ,and one case of Enteric Fever (2 in 1910) were treated in the Hospital. There was one death from Scarlet Fever but none from Diphtheria. In consequence of the larger number of Scarlet Fever cases admitted during the year the bath room in the Scarlet Fever block has been in continuous use. This bath room was intended to be used for the discharge of patients but has proved to be unsuitable for that purpose. I wish to draw the Council's attention to the inadequacy of the present arrangements. METHODS OF DISINFECTION. All articles of bedding, wearing apparel, curtains, rugs, etc., are removed to the Hospital and disinfected by means of steam in a Thresh's Saturated Steam Disinfecting Apparatus. Rooms are sprayed with formalin, and then fumigated with vapour of formaldehyde. The staircases, passages, etc., are always sprayed with formalin. Rooms were stripped after cases of infectious disease in fourteen instances. TUBERCULOSIS. Six deaths were caused by Phthisis, and 3 by other Tuberculous diseases, or 6.8 per cent. of the whole mortality. 13 In 1910 the percentage was 13; in 1909, 12.3; and in 1908, 11.5. PREVENTION OF CONSUMPTION. Twenty-two certificates of 17 cases were received during the year consisting of 10 certificates under the voluntary system and 12 under the Public Health (Tuberculosis in Hospitals) Regulations, 1911. I draw attention to the fact that out of 17 cases notified 9 work outside the district and only sleep in Harrow. In future reports I purpose showing the number of cases that have originated outside the district. Full use has not been made of the Council's three beds at Mount Vernon Sanatorium as there were only two cases suitable for admission. During the year five patients were sent to other Sanatoria through persons taking an interest in them. During the last two years all the patients sent by the Council to Mount Vernon Sanatorium with one exception have done well. The improvement in their health has been maintained and they have been able to continue their employment. The above mentioned patient that had benefitted greatly by sanatorium treatment relapsed immediately owing to taking to drink on his discharge. Pulmonary Tuberculosis became compulsorily notifiable on January 1st. 1912. In future I will know of all cases of the disease in the District. This will greatly assist me in taking steps to prevent the spread and diminish the ravages of the scourge. The Focal Government Board has approved an Order permitting the Middlesex Joint Small Pox Hospital Board to receive cases of Consumption into the Clare Hall Hospital, South Mimms. SPITTING IN STREETS, PUBFIC PEACES, ETC. There is great need for public notices with regard to the insanitary custom of spitting in public places, 14 and I recommend that such notices be posted up explaining the danger to the Public Health and forbidding the practice, and thus remove one cause of the spread of Consumption. DISINFECTION OF ROOMS USED BY TUBERCULOUS PATIENTS. Twenty-five rooms and 209 articles have been disinfected during the year. Cards of instructions, sputum bottles and disinfectants are provided free. It should be widefy known that the Council disinfect patients rooms and contents free of charge. I strongly recommend that all rooms occupied by tuberculous patients should be periodically disfected. PREVENTION OF CANCER. Whilst much is being done to prevent and eradicate Consumption, it is well that the attention of the public should also be directed to the prevention of Cancer. In Harrow during the last five years 63 deaths have been caused by Cancer and 49 by Consumption. Without going deeply or widely into the subject which is being extensively and minutely investigated by many surgeons and bacteriologists I would like to offer some brief and practical suggestions which I trust may prove useful. Medical observers are agreed that the chief predisposing cause of this disease is chronic irritation. When warts, moles, naevi (strawberry marks) and other growths are exposed to constant irritation they should be immediately removed. My first schoolmaster had a wart on One side of his nose which he pulled when irritated. When visiting him some years after leaving school I saw that one side of his face was eaten away by Cancer which had started from the wart. Irritation of the skin in certain occupations such as X Ray operators, workers who use tar or paraffin, and soot, in the case of sweeps, lead to Cancer. 15 Irritation of the alimentary canal and air passages is frequently followed by Cancer, for instance, excessive smoking predisposes to Cancer of the lips, gains, palate, tongue, tonsils, larynx, etc. Irritation of the tongue and cheek by a jagged tooth, the lips by certain kinds of inferior clay pipes, and the throat by excessively hot food and drink induces Cancer. A tribe was recently discovered in the Soudan the men of which suffered from Cancer of the throat whilst the women escaped. It was ascertained that the men habitually took their food at the highest possible temperature and the women had the food left by the men when it had subsequently cooled. Many parts of the alimentary canal, such as the throat, gullet, the entrance and outlet of the stomach as well as that organ itself, parts of the small and large intestines, especially the termination of the latter, are continuously irritated by the passage of imperfectly masticated food. This is owing to defective back teeth and hastily bolting unmasticated food. The use of alcoholic drinks is a powerful predisposing cause of Cancer. It is found that 100 deaths from this disease occur among non-abstainers to 71 among abstainers. I mention these few facts to interest the public in this subject, and to ask their help in diminishing the death rate from a disease which has caused 22 per cent, more deaths than Consumption in Harrow during the last five years. HOUSE NUMBERING. The south side of Alma Road has been numbered during the year, also Roxeth Hill and Middle Road. This now practically completes the numbering of the houses in the district. It only remains to see that the numbers are kept in a legible state and that the new streets are numbered on completion. 16 HOUSES LET IN LODGINGS. There are three houses registered. There was no cause for complaint when inspected. COMMON LODGING HOUSE. There is one Common Lodging House in the town which has been visited and found in a satisfactory condition. SCAVENGING. A weekly collection of refuse has been carried out during the year and only 8 complaints have been made. A circular letter from the Local Government Board with reference to Infantile Diarrhoea was received recommending the frequent removal of house refuse. The question of removal of house refuse more frequently than once a week should be considered by the Council. During the year applications were made by householders for a collection twice a week for which they offered to pay. This showr that at least some of the inhabitants would welcome this reform. I am glad the Council have the question of erecting a refuse destructor under consideration and hope in the near future that one will be provided. DAIRY FARMS, ETC. There are 7 Dairy Farms, 12 Milk Shops, 15 Bakehouses (2 underground) 7 Slaughter houses, 26 Butchers Shops, 11 Fish Shops and 7 Laundries. One of the underground bake-houses that has not been usee for three years has again been brought into use. The above premises on the whole have been kept in a Sanitary condition. MILK FROM OUTSIDE THE DISTRICT. Twenty-five samples of milk were submitted to the Analysts for bacteriological exrmination for Tubercle 17 Bacilli and all of them were found to be free from infection. ''he result appears satisfactory. I wish however, to draw attention to the fact that some of the dairies receive supplies from several farms and although a sample is taken from one of these and found free from infection any of the other supplies to the dairyman may be tuberculous. To guard against this danger I recommend that samples be taken from all the supplies to each dairy. Furthermore that if a cowkeeper has a suspected animal, and your Inspector is requested by him to take a sample of the milk for bacteriological examination, I recommend that you allow him to do so. VETERINARY INSPECTION OF MILCH COWS. In a previous Report I explained the reasons which caused me to urge the necessity of a Veterinary Surgeon being appointed to make an examination of the milch cows in the district. Dr. Young, County Medical Officer of Health has recommended the appointment of such an officer to examine the udders of all Cows with a view to eliminating any that may be found suffering from tuberculosis of the udder. The neighbouring districts of Wembley and Northwood have acted on this recommendation and appointed Veterinary Officers. FISH FRYING. This process is carried on at five establishments under the Bye Laws for regulating this business by Section 112 of the Public Health Act, 1875, as amended by Section 51 of the Public Health Act, Amendment Act, 1907. The premises were always found in a clean condition and no contravention of the Bye Laws found to exist. WATER SUPPLY. Analyses of the Public Water Supply (Colne Valley Water Co.) have been made four times during 18 the year, and showed that the samples of water submitted were of satisfactory organic purity and of moderate hardness. Ihe following is the latest report received from the Clinical Research Association:— ANALYSIS. Parts per 100,000. Grains per Gallon. Total Solids (dried at 120° C.) 217 15.2 Combined Chlorine 1 70 1.19 equivalent to Na C1 2.80 1.96 Nitric Nitrogen 0.46 032 Nitrous Nitrogen Nil Nil Ammoniacal Nitrogen Nil Nil Albumenoid Nitrogen 0.0014 0.0010 Oxygen absorbed in 4 hours at 27° C. 0.004 0 003 Lead or Copper Nil Nil Temporary Hardness (equivalent to Ca Co3) 9.0 6.3 Permanent Hardness (equivalent to Ca Co3) 5.0 3.5 Total Hardness (equivalent to Ca Co3) 14.0 9.8 ICE CREAM PREMISES. There are 16 Ice Cream premises in the District, most of which are sweet shops. Inspections were made during the summer, and the premises found in a satisfactory condition. SLAUGHTER HOUSES. There are seven Private Slaughter Houses in the District. Inspections have been carried out as in previous years when slaughtering is in progress. The butchers offer every help to the Inspector in this work with the result that 3 pigs (tuberculosis), 16 lbs of beef (tainted) and 6 sheep (tainted) were surrendered. Mr. Kramm, your Inspector, holds the Certificate of the Royal Sanitary Institute for Inspectors of Meat and other Foods. 19 HOUSING OF THE WORKING CLASSES. I feel I can do no other than repeat what I have said in previous Reports. " No action has been taken under the Housing of" "the Working Classes Act to provide less expensive" "housing accommodation. The rents paid by the" "working classes in Harrow bear far too high a propor-" "tion to their wages. Married men with large families" "have serious difficulty in finding adequate housing" "accommodation, and as our birth-rate is steadily" ''declining, I would recommend the Council to con"sider whether it is not desirable to provide at a " "moderate rent healthy house room for cases where " "working folk have large families. By doing so a" "great obstacle to maintaining and increasing the" " birth-rate would be removed." HOUSING AND TOWN PLANNING. A scheme called the South Hill Estates has been laid before the Council and received its approval. This when carried out will add three hundred houses and a probable population of 1800 inhabitants to Harrow. The site is on the southern slope of the hill and admirably situated from a public health and aesthetic point of view and when completed must add greatly to the attractions of Harrow. The plan shows that seven houses to the net acre will be erected (deducting roads and open spaces). The roads vary from 40 to 50 feet in width. Every advantage has been taken of the natural beauty of the estate, fine old trees will be preserved and straight roads avoided and one of the main roads has the picturesque name of " Winding Way." Some of the roads are not thoroughfares so that the tired brain worker can enjoy sound refreshing sleep. The main roads run from East to West which from a sunlight point of view in planning houses is the most suitable. 20 A considerable portion of the land is intended for the £250 workmen's cottages whilst there is ample room for the country house of the City man each in their respective areas. Open spaces and recreation grounds are provided and the necessary shops will be situated near the Great Central Railway Station. The Directors of the Company are well known Harrow residents whose chief desire is to preserve the amenities of our beautiful neighbourhood. The Council has instructed Mr. J. Percy Bennetts your Surveyor to prepare preliminary suggestions for Town Planning for the whole district; this will ensure that Harrow will be saved from the fate of other surburban districts and ever retain its charm. HOUSING AND TOWN PLANNING Etc. ACT, 1909. House to House Inspection. In my report for 1910 mention was made of Nos. 1 to 6, Walker's Cottages, Middle Road, and that the owner had decided to close the cottages rather than execute the necessary sanitary alterations. Correspondence was commenced in the Spring respecting the demolition of these cottages if the necessary work was not put in hand. This resulted in their being sold to an owner whose intention was to put them in a habitable condition. The new owner immediately commenced the work of remedying the many sanitary defects and thoroughly renovating the property, under the supervision of Mr. Kramm, your Inspector, and the houses are now in an excellent condition and let at the same rents as when the houses were insanitary. With regard to Alma Terrace and Alma Crescent the most urgent work has only just been completed and an improvement in the property is noticeable. The Council considered the question of accepting the specification of the owners for remedying some of the insanitary conditions that were found to exist at Trafalgar Terrace and the alternative that they be closed. 21 The owners could not see their way to carry out the work of providing damp courses and concreting the sites, and the Council agreed that this work be omitted from their requirements. Numbers 19 and 21, Middle Road, were dealt with under the Housing and Town Planning Act, which resulted in the premises being thoroughly overhauled and put in a habitable condition. A very large amount of the Inspector's time was taken up in re-inspecting and superintending the above work with the result that no further house to house inspection could be done during the year, but I hope in the near future to submit lists of houses the early inspection of which I think to be desirable. FACTORIES AND WORKSHOPS. The Factories, Workshops, Workplaces and Home Workers' premises have been periodically inspected and the number of inspections made and sanitary defects found to exist are shown in Table 6. On the whole the Factories and Workshops are in a satisfactory condition. To obtain the list of outworkers it was necessary to serve notices on the occupiers of workshops, etc. MEDICAL INSPECTION OF CHILDREN IN THE PUBLIC ELEMENTARY SCHOOLS IN HARROW. The County Medical Office of Health reports as follows:- "Three routine inspections of each school in the" "area were made during 1911." "Five hundred and fifty-eight children were ex- " "amined during the year." Age Group. Boys. Girls. 5 years 108 85 Routine Inspections. 7 and 8 years 54 57 13 and 14 years 109 116 ) 14 15* Various. 285 273 *Children presented for some special reason for medical inspection, and not coming within the groups required for routine inspection. 22 "No cases of ringworm of the scalp occurred" "during the year and only one of ringworm of the face." "All the schools were visited for ordinary inspec-" "tion in each term." "In addition to these, many other visits are" "made in order (1) to "follow up" those children" "whose parents have been recommended to consult" "their doctors for one or other condition found in the" "children at the time of inspection; (2) to examine'' "special children.” "In connection with the occurrence of infectious'' "disease amongst scholars, a system of intercom-" "muni ration between the Public Health Department" "and the District Council and the Medical Officer of " "the Education Department has been established on" "the lines suggested in the Memorandum of the" "Board of Education and Local Government Board "relating to "Closure of and Exclusion from School," "and by this means the two authorities have been of" "mutual and useful assistance to each other. The" "Education Authority has also provided for the" "prompt notification to the Medical Officer of Health'' "of the district on special forms of cases of non-noti-'' "fiable complaints, e.g., Measles, Whooping Cough,'' "etc. This information is of much value in connec-” "tion with the work of the Health Visitors, as they" "can visit the houses and impress on the parents the" "precautions they should take to prevent spread and" "the advisability of having medical advice for their " "affected children." HARROW COTTAGE HOSPITAL. This Institution is a great credit to the town. Being of the most modern type it affords the medical men of the neighbourhood the greatest facilities for obtaining the best results. It deserves the generous financial support of all who are interested in the health of Harrow and surrounding districts. There are 20 beds and 2 cots, all used alike for medical and surgical cases. 23 HARROW BOUNDARIES. An Inquiry was held by the Middlesex County Council into an application by the Wealdstone Council for an extension of the latter Council's district. The Wealdstone Council's application extended to a small portion of your Council's area, but this part of the application was subsequently withdrawn. I desire to draw your attention to the remarks in my Annual Reports for several years past with reference to the Mount Park area, and would again press upon the Council the necessity in the interests of the health of their district, of again endeavouring to get this area transferred to Harrow to which it geographically belongs. SURVEYOR'S REPORT. Mr. J. Percy Bennetts your Surveyor reports:— "The number of plans approved by the Council" was—New Houses 77, Shops and Dwelling Houses 17," "Alterations and Additions 33, New Buildings not" "Dwellings 13, New Roads 5, Church 1, and Church" “Hall 1." "86 Houses and 14 Combined Shops and Dwellings" "have been erected and approved for occupation." "Constant visits are made to all houses in course" "of erection and any defects found have been promptly" remedied." "The revised Bye Daws with respect to new streets" "and buildings have been approved by the Local Gov-" “ernment Board, and will soon be in operatiom." “The Mortuary has been used in 17 cases." "The efforts made for the mitigation of the dust" ''nuisance have been appreciated by the public; no" "complaints of dust blowing were received during last" year." "The Allotment area adjoining the Roxeth Recre-" “ation Ground has been well taken up and all the plots" "are let." "The effluents from both Sewage Works have been" "very satisfactory." 24 "Complaints have been received of smells arising" "from the farms during the hot weather.'' "The Council are now dealing with the Greenhill" "Sewage Farm; preliminary plans have been prepared" "and approved for alterations there, but the matter" "has been postponed pending negotiations with the" "Wealdstone Council on the question of their treating" "the sewage from Harrow on their Sewage Farm.” “Many thousand loads of ashes have been taken" "to Newton Farm, and dug into the new field and this" "treatment appears to be very successful, as the efflu-" "ent has kept excellent." "The question of the provision of Public Urinals" "is receiving the attention of the Council.” “The following roads have been declared highways" "repairable by the inhabitants at large:—Devonshire" ''Road, Oxford Road, Dorset Road, and part of Sussex" ''Road." "The Council have decided to enlarge the Public" "Offices, and public competition among architects" "is now taking place with regard to the plans." "Great improvements have and are being made" "by the Council on the Harrow Recreation Ground.” "Shelters and Conveniences have been erected and the” "pitches for tennis, bowls and other games levelled." FOOD AND DRUGS ACT. Dr. Young. the County Medical Officer of Health, has forwarded me the following particulars of the County Inspector's work during 1911. Milk 32 Butter 13 Coffee 5 Lard 3 Flour and Baking Powder 6 Drugs 7 66 No sample was adulterated. 25 PUBLIC URINALS. I am glad the Council is considering the provision of public urinals, as they are greatly needed in this district. It is intended that one of them will be in the new Council Offices when they are built. meteorological Observations. The rainfall for the year was 28.86 inches, which is .44 more than in 1910 when it was 28.42 inches. On May 31st. 3.19 inches of rain fell in two hours. The rainfall for each of the previous ten years is as follows:—1910, 28.42; 1909, 27.48; 1908, 27.47; 1907 25.37 1906, 26.33; 1905. 22.94; 1904. 25.56; 1903, 36.78; 1902, 22.05; 1901, 18.58. The average of those years is 26.09. It is remarkable notwithstanding the long drought during the Summer that the rainfall for the year in more than in 1910, and is 2.77 inches above the average for the previous ten years. The number of days on which .01 or more inches fell was December 28, November 20, March 18, February 14, October 14, January 13, April 12, June 11, May 10, August 9, September 9, July 6. The highest temperatures were 96° in August, 91° in September, 90° in July, 82° in June, 78° in May, 64° in April, 61° in October. The lowest temperatures were 21° in February, 24° in January, 25° in April, 27° in December. The highest mean temperatures were 81.93° in July, 77.87° in August, 70.50° in September, 66.35° in May, 66.06° in June. The lowest mean temperatures were 33.35° in January, 35.57° in February, 36.85° in March, 37.70° in December. I send the usual tables of vital statistics for five years, and also the appended sanitary and meteorological reports. In conclusion I beg to thank the Council for their 26 continued support in my work and also my indebtedness to Mr. Strachan, your Clerk, and to Mr. J. Percy Bennetts, your Engineer and Surveyor, and to Mr. Kramm, your Sanitary Inspector. I remain, Gentlemen, Your obedient Servant, JOHN FLETCHER LITTLE, M.B., Cantab., M.R.C.P., Lond. Medical Officer of Health for Harrow. 27 table I. VITAL statistics of whole district during 1911 and previous years. Year. Population estimated to Middle of each year. Births. Total Deaths registered in the District. Transferable Deaths. Net Deaths belonging to the District. Uncorrected Number. Net. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 year of age At all Ages. Number. Rate.* Number. Bate.* Number. Rate per 1,000 Net Births. Number. * 1906 13,697 ... 327 23.2 115 8.4 1 19 29 88.6 130 9.4 1907 14,860 ... 350 23.5 98 6.5 — 15 19 57.0 111 6.9 1908 16,132 ... 346 21.4 109 6.7 3 13 33 95.0 114 7.1 1909 16,800 ... 361 21.4 146 8.6 6 10 20 55.4 165 9.8 1910 17,000 ... 376 22.1 99 5.8 1 14 15 39.8 112 6.6 1911 17,076 9 352 20.6 131 7.8 10 23 28 20.6 144 8.4 Area of district in acres (exclusive of area covered by water), 2,028. At the Census of 1911 :—Total population at all ages, 17,076. Number of inhabited houses, 3,832. Average number of persons per house, 4.4 28 table II. cases of infectious disease notified during the year 1911. Notifiable Disease. Cases notified in whole District. Total Cases notified in each locality. No. of Cases removed to Hospital from each localtty. Total cases removed to Hospital. At all Ages. All Ages—Years. Under 1 1 to 5 5 to 15 15 to 25. 26 to 65. 65 and up'wds S. Mary's. Roxeth. Greenhill. S. Mary's. Roxeth. Greenhill. Diphtheria (including Membranous Croup) 18 4 10 4 9 5 4 4 5 4 13 Erysipelas 10 1 5 4 2 4 4 Scarlet Fever 50 14 29 6 1 13 7 30 13 7 25 45 Enteric Fever 2 1 1 1 1 1 1 Puerperal Fever 3 2 1 2 1 Chicken-pox 15 6 8 1 2 5 8 Totals 98 20 42 19 13 4 26 24 48 17 13 29 59 Isolation Hospital, Newton Fields, Harrow. Number of diseases that can be concurrently treated, 3. Total available beds, 24. Small-pox Hospital, Clare Hall, South Mimms. 29 table iii. causes of, and ages at death during the year 1911. Causes of Death. Nett Deaths at the subjoined ages of "Residents," whether occurring within or without the District Total Deaths whether of "Residents" or "NonResidents" in Institutions in the District All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5and under 15 yeurs. 15 and under 25 years. 25 and under 45 year. 45 and under 65 years. 65 and upwards. All Causes Certified Uncertified 141 30 2 2 9 5 18 26 52 Enteric Fever Small Pox Measles 3 1 2 1 Scarlet Fever 1 1 Diptheria and Croup 1 Influenza 1 1 Lead Poisoning 1 Phthisis (Pulmonary 7 5 2 Tuberculosis) 3 2 1 Tuberculous Meningitis 3 2 1 Other tuberculous diseases 3 1 1 1 Cancer, malignant disease 24 1 3 9 11 3 Bronchitis 6 1 1 4 Broncho-Pnuemonia 8 6 1 1 Pneumonia (all other farms) 2 1 Other diseases of Respira- tory organs 1 1 Diarrhoea and Enteritis . 5 5 1 Appendicitis and Typhiltis Alcoholism, Cirrhosis of Liver 1 1 Nephritis and Bright's Disease 3 1 2 1 1 Puerperal Fever 1 Other accidents and diseases of Pregnancy and Parturition 1 1 Congenital Debility and Malformation, including Premature Birth 12 12 Violent Deaths, excluding 4 1 9 1 2 suicides 2 1 1 Suicides 41 4 2 1 4 11 19 3 Other defined Diseases Diseases ill-defined or unknown 14 2 12 1 414 30 2 2 9 5 18 26 52 30 TABLE IV. INFANTILE MORTALITY DURING THE YEAR 1911. Cause of Death Nett Deaths from stated Causes under One Year of Age. Total Deaths under One Year Under 1 week. 1-2 weeks. 2-3 weeks 3-4 weeks Total number under 1 month. 1-3 months. 3-6 months. 6-9 Months. 9-12 months. All Causes Certified Uncertified 5 8 1 4 18 3 4 3 28 Chicken-pox Measles Scarlet Fever Diptheria and. Croup Whooping Cough . Diarrhoea 1 1 2 Fnteritis 1 1 1 2 Tuberculous Meningitis Other Tuberculous Diseases Congenital Malformations Premature Birth 3 7 1 11 11 Atrophy, Debility, and Marasmus Injury at Birth 1 1 1 2 Meningitis (not tnberculous) Convulsions 1 1 1 3 3 Gastritis Laryngitis Bronchitis Pneumonia (all forms) 3 3 6 Suffocation, overlying Other Causes 2 2 2 5 8 1 4 18 3 4 3 28 Births in the year: legitimate 347; illegitimate 5. Deaths in the year: legitimate 28; illegitimate 0. 31 METEOROLOGICAL, OBSERVATIONS TAKEN AT HARROW DURING THE YEAR ENDING DECEMBER 31ST, 1911. By J. PERCY BENNETTS, Engineer and Surveyor. Month Hygrometer. Temperature. Rainfall. Wiud. Dry Bulb. Wet Bulb. Max. Min. Eartli. Total D'p'h Greatest Fall in 24 hours. No. of Days on which .0l in. or more fell. Prevailing Wind. 1 ft. 4 ft. D'p'L Date. January. 36 48 35.74 42.48 33.35 37.90 43.87 N.W. Highest 47.00 47.00 51.00 45.00 41.00 46.00 1.48 .38 6th 13 N.E. Lowest 20.00 28.00 37.00 24.00 29.00 43.00 S.W February. Means 38.50 37.50 45.87 35.57 38.71 42.17 ... ... ... ... S.W. Highest 50.00 40.00 54.00 49.00 42.00 43.00 1.79 .44 27th 14 N.W. Lowest 23.00 23.00 37.00 21.00 36.00 42.00 ... ... ... ... N.E. March. Means 30.30 38.42 46.58 36.85 41.00 43.29 ... ... ... ... N.E. Highest 50.00 48.00 60.00 44.00 44.00 44.00 1.75 .50 12th 18 N.W. Lowest 33.00 32.00 35.00 30.00 39.00 43.00 ... ... ... ... N. April. Means 45.00 42.73 54.18 38.73 44.00 44.60 ... ... ... ... S.W. Highest 57.00 53.00 64.00 50.00 50.00 47.00 1.80 .50 1st 12 N.W. Lowest 32.00 31.00 42.00 25.00 38.00 43.00 ... ... ... ... May. Means 55.10 52.35 66.35 40.64 53.10 49.00 ... ... ... ... N E Highest 65.00 64.00 78.00 50.00 58.00 52.00 4.86 319 31st 10 S.W. Lowest 45.00 43.00 50.00 33.00 49.00 47.00 ... June. Means 59.86 59.13 60.00 50.33 59.26 54.35 ... ... ... ... Highest 71.00 65.00 82.00 59.00 63.00 55.00 3.31 .59 23rd 11 N.E. Lowest 50.00 47.00 57.00 40.00 56.00 52.00 ... ... ... ... S.E. July Means 66.77 59.48 81.93 56.25 62.48 57.12 ... ... ... ... N.E. Highest 77.00 70.00 90.00 65.00 66.00 59.00 .56 .26 5th 6 N.W. Lowest 57.00 49.00 65.00 46.00 55.00 55.00 ... ... ... ... S.W. August Means 66.61 63.10 77.87 57.32 64.16 66.45 ... ... ... ... N.W. Highest 80.00 72.00 96.0 66.00 67.00 61.00 1.62 1.17 21 st 9 W. Lowest 58.00 57.00 68.00 45.00 59.00 59.00 ... ... ... ... S.E. 32 Meteorological Observations (continued). Month. Hygrometer. Temperature. Rainfall. Wind. Day Bulb. Wet Bulb. Max. Min. Earth. Greatest Fall in hours. 1 No. of Days on which .01 in. or more fell. Pre. vailing Wind. 1 ft. 4 ft. total D'p'h D'p'h Date September. Means 59.73 56.80 70.50 49.66 58.80 60.30 ... ... ... ... S.E. Highest 72.00 66*00 91.00 60.00 64.00 61.00 1.33 .40 13th 9 N.W. Lowest 48.00 46.00 59.00 37.00 55.00 59.00 ... ... ... ... W October Means 48.03 46.61 56.45 43.67 51.48 56.32 ... ... ... ... N.E. Highes 58.00 57.00 61.00 55.00 53.00 59.00 2.72 .97 24th 14 Lowest 35.00 34.00 50.00 29.00 47.00 55.00 ... ... ... ... November. Means 42.33 41.00 49.07 38'63 14.53 51.40 ... ... ... ... s.w. Highest 52.00 52.00 57.00 49.00 47.00 54.00 3.34 .61 11th 20 N.E. Lowest 32.00 32.00 39.00 29.00 39.00 49.00 ... ... ... ... December. Means 43.06 30.93 51.38 37.70 42.54 46.87 ... ... ... ... S.W Highest 51.00 51.00 56.00 48.00 48.00 48.00 5.30 •61 20th 28 S.E. Lowest 28.00 28.00 42.00 27.00 39.00 46.00 ... ... ... ... Note.—On May 31st, 3.19 inches of rain fell in 2 hours. December :28 wet days out of the month. FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. 1.— INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices Prosecutions. Factories (Including Factory Laundries) 52 10 Workshops (Including Workshop Laundries 115 9 Workplaces (Other than Outworkers premises included in Part 3 of this Report) 56 12 Total 223 31 2.-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 Vention 1 1 Overcrowding Want of Drainage of Floors Other Nuisances 12 12 Sanitary accommo dation insufficient 1 1 unsuitab'e or defeative . 2 2 not separate for sexes Offences under the Factory and Workshop Act:- Illegal occupation of underground bakehouse (S.101) Breach of special sanitary requirements for bakehouses. 5 5 (as. 97 to 100). Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) Total 25 25 33 34 3—HOME WORK. NATURE OF WORK. OUTWOKERS' LIST, SUCTION 107. Notices served on Occupiers as to keeping or sending Lists. Lists received from Employers. Twice in the year. Once in the year. Lists. Outworkers. Workmen Lists. Outworkers. Workmen Wearing Apparel— 1) making. &c. 10 22 2 2 32 2) cleaning and washing 4 4 Total 14 26 2 2 32 35 4.-registered workshops. Workshops on the Register (S. 131) at the end of the year. Number. Important classes of workshops. such as workshop bakehouses, may be enumerated here. Dressmakers 25 Tailors 9 Bakehouses 15 Carpenters, etc, 9 Laundries 6 Bootmakers 10 Workplaces 22 Total number of workshops on Register 96 5. other matters. Class. Number Matters notified to H.M. Inspector of Factories:— 1 Failure to affix Abstract of the Factory & Workshop Act (S.133) Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5). Notified by H.M. Inspector 2 Reports (of action taken) sent to H.M. Inspector. 2 Other Underground Bakehouses (S. 101):— Certificates granted during the year In use at the end of the year 2 SANITARY WORK. 1911. Drainage avid Sewerage of Existing Buildings. Disinfecion. Dust. Sundry Nuisances Abated. Water Closets. Percentage of Houses provided with Water Closets Drains. Cesspools. Percentage of Houses draining into Sewers. Repaired, Supplied with Water, or otherwise Improved. Examined, Tested, Exposed, &c. Unstopped, Repaired, Trapped, &c. Waste Pipes. Rain V\ ater Pipes Disconnected, Repaired, &c. New Soil Pipes or Ventilatin Shafts Fixed. Existing Soil Pipes or Ventilating! Shafts Repaired Disconnecting Traps or Chambers Inserted. Reconstructed. Rendered Impervious, Emptied, Cleansed, &c. Rooms Disinfected, (a) Ordinary Infectious Disease. (b) Phthisis. Rooms stripped and Cleansed. Articles Disinfected or Destroyed, Ordinary Infectious Disease. New Bins Provided. Number of Complaints of NonRemoval Received. Method of Disposal, by Tipping. Method of Disposal, state methoc Smoke. Accumulation of Refuse. Foul Ditches, Ponds, See., and Stagnant Water. Foul Pigs and other Animals. Dampness. Yards Repaved or Repaired. Nuisances. 67 99% 112 47 66 5 22 20 16 1 99% (a) 257 (b) 25 22 38 50 8 Yes. Burnt in heap on Sewage Farm 6 31 3 3 40 39 269 SANITARY WORK, 1911. Particulars as to Staff employed in Sanitary Department, specify if Inspectors are engaged in any other duties, and if so, what. Inspections. Notices. Dwelling Houses Houses let in Lodgings (Tenement Houses;. Common Lodging Houses ALBERT B. KRAMM, Inspector. Number of Premise:. Inspected on Complaint. Number of Premises Inspected in connection with Infectious Diseases. Number of Premises under Periodical Inspection. Houses Inspected from Houseto-House. Total Number of Inspections and Re-inspections made. Cautionary or Intimation Notices Given. Statutory Orders Issued. Number of Houses found to be in a state Dangerous or Injurious to Health. Number of Houses made Habitable without Closing Orders. Number of Houses Closed Voluntarily. Number Registered under Bye Laws. Number of Contraventions. Number Registered under Bye Laws. Number of Inspections made. 132 96 161 47 1649 33 7 2 15 2 3 2 1 SANITARY WORK. 1911. Movable Dwellings, Caravans, Tents; &c. Bakehouses. Slaughterhouses. Cowsheds. Dairies and Milkshops. Unsound Food. Adulterated Food. Offensive Trades. Water Supply and Water Service. Cisterns. Draw-taps placed on Mains. Percentage of Houses supplied on Constant S\stem. Number of Samples obtained for analysis. Number Observed during the Year. Number of Nuisances therefrom Abated. Number Removed from District. Number in District. Contraventions of Factory Acts. Number on Register. Number of Inspections made. Frequency of Inspection Contraventions of Bye Law s. Number on Register. Number cf Inspections made. Frequency of Inspection. Contraventions of Regulations. Number of Milch Cows in District. Number on Register. Number of Inspections made. Articles or Parcels surrendered. Samples taken (if any) by the District Local Authority. Number of Piemises in District. Number of Inspections made. Percentage of Houses supplied from Public Water Service. New Provided. Cleansed. Repaired, Covered, &c. From Local Wells. From Public Supply. 12 1 9 15 12 7 205 When killing. 8 7 30 Quarterly 3 150 12 25 12 25 7 123 90% 3 7 a 100% 1 8 PHTHISIS: SANATORIUM AND HOSPITAL ACCOMMODATION. Classes for which accommodation is provided. By whom provided. Where situated. Total number of Beds. How are patients selected ? Are patients under the care of a resident Medical Officer ? What charge, if any, is made for the use of Beds ? Do the Sanitary Authority use — (1) their Isolation Hospital, or (2) their Small-pox Hospitai, for cases of Phthisis ? Do the Sanitary Authority reserve beds in any Phthisis Sanatorium: If so, how many, and in what Sanatorium ? Do the Sanitary Authority provide portable Openair Shelters or Tents ] (a) Early cases. The Mount Vernon Hospital, 7, Fitzroy Square, London, W. Hampstead and North wood. 2 By the Medical Officer of Health. Yes. The Council pay 30/per week per patient. No. 1. No. No. 2. The L.G.B. have approved of an Order for the Joint Small-pox Hospital Board to treat Consumption cases from this District. The Mount Vernon Hospital have arranged to take three cases at one time. Not at present, but a local Relief Committee do so. (b) Intermediate cases. No. No. - - - - - - (c) Advanced cases. No. No. - - - - - - Have the Council, or any Private Body provided a Dispensary. If so, give the necessary Particulars i No.