HARRO 015 1919. HARROW-ON-THE-HILL URBAN DISTRICT COUNCIL. ANNUAL REPORT of DAVID SOMMERVILLE, B.A., M.Sc., M.D., M.R.C.P., D.P.H., Medical Officer of health for Harrow, For 1918. HARROW: Printed at the "Observer" Printing Works. HARROW-ON-THE-HILL URBAN DISTRICT COUNCIL. Estimated Civil Population 19,757. Birth Rate 10.9. Death Rate 10'3. Infantile Death Rate 32.2 per Thousand Births. Houses 3,911. Occupied 3,900. * Unoccupied 11. Flats, 284. Occupied 284. Unoccupied Nil. Average number of persons per house 4.6. Per Flat 3.7. Rateable Value £153,147. Population 1851, 2,813. Population 1891, 5,725. Area 1,000 Statute Acres. Population 1901 (Census), 10,220. Population, June 1906, 13,697. Population 1911 (Census), 17,074. Area 2028 Statute Acres. 5 Harrow-on-the-Hill Urban District Council. Annual Report on the Health Conditions of the District for the year 1918, by DAVID SOMMERVILLE, M.Sc., M.D. Medical Officer of Health. Gentlemen of the Harrow Urban District Council, I have the honour to submit the following brief Report on the Public Health of the District for the year ending 31st December, 1918. vital statistics. The Registrar General estimates the civil population for calculating the birth rate as 19,757 and for calculating the death rate as 17,633. Births:—There were registered during the year 217 births, viz., 102 males and 115 females. The birth rate per thousand of the population is therefore 10.9. In 1917 this rate was 14.9. The average for the previous live years is 18.6. The birth rate for England and Wales in 1918 was 17.7, and for the 148 smaller towns 17.9. 6 Deaths:—The total number of deaths during the year was 171, viz., 76 males, and 95 females. This gives a crude death rate of 97. The corrected death rate (i.e. the crude death rate multiplied by the Registrar General's factor for correction, viz., 1.0655 is therefore 10.3. The corresponding death rate for 1917 was 11. This figure for England and Wales in 1918 was 17.6 and for the 148 smaller towns 16.1 The causes of death are set out in the following table : CAUSES OF DEATH (CIVILIANS ONLY). Males Females Males Females Whooping cough 2 Pneumonia (all forms 8 6 Diptheria and Croup 12 Other respiratory diseases 1 Influenza 13 17 Diarrhoea under 2 years 1 Pulmonary Tuberculosis 10 5 Appendicitis & typhlitis 1 2 Other tuberculous diseases 1 1 Nephritis and Bright's disease 1 4 Cancer 10 18 Organic Heart Disease 6 7 Parturition (apart from Puerperal fever) 1 Bronchitis . 5 3 Congenital debility 3 Violence (apart from suicide) 1 1 Other defined diseases 17 24 47 53 76 95 Infantile Death Rate:—Of the 217 children born 7 died under one year of age. This gives an infant mortality rate of 32.2 per thousand born. The rate in 1917 was 59. In 1918 the rate for England and Wales was 97, and for thei.4.8 smaller towns 94. INFANT WELFARE. The work of the Health Visitors increases year by year. The attendance at the Baby Clinic held at the Wesleyan Schoolrooms on Tuesday afternoons proved so large that it became impossible to cope with it, and it is proposed to hold two sessions weekly in future commencing January, 1919. It was with great regret that Dr. Brady's resignation was received. As M.O. of the Clinic she had won the implicit confidence of the mothers. Her place has been filled by Dr. Doherty, of Queen Charlotte's Hospital. 7 Too much praise cannot be accorded to the band of voluntary workers attached to the Clinic. Not only have they been unremitting in their attendance but they have done much to make the Clinic attractive, so much so, that many mothers look forward to the afternoon there as the event of the week. Dried milks and other foods are on sale at reduced prices to approved purchasers. Free milk has been given in 17 instances where the M.O. certified the cases as necessitous. Forty-two sessions were held during the year with an average attendance of 49.2. Baby week was celebrated in the second week of July. A mother craft xhibition, opened by the Rev. Prebendary and Mrs. Joyce, was held at the Wesleyan Schoolroom. The mothers took an active part in the needlework and laundry competitions. A successful meeting was held at the Victoria Hall on July 12th, when Mrs. H. B. Irving spoke on "The Nation's young lives," J. Macandrew, Esq., in the chair. Eighty-five babies were entered for the Baby Show: Dr. Harley kindly acted as judge. The prizes and certificates of attendance were distributed by Dr. Brady, Dr. Darby in the chair. The work of the Dental Clinic has progressed in face of many difficulties, the numbers have increased, but the premises at Greenhill Schools are not at all suitable. It is hoped that in the new year it will be found possible to combine the activities of the Centre under one roof at 8, College Road. The Massage Clinic has been well attended. During the two sessions 712 attendances were made, about 53 per cent. of which were school children's Three sessions weekly will be held from the beginning of January, 1919, and it is hoped that it will be possible to put up some ribstalls and other apparatus for the treatment of round shoulders The work of Miss P. Helen Townsend and her assistants is greatly appreciated. The following tables set out summaries of the activities of the centre:— TABLE HARROW MATERNITY & INFANT WELFARE CENTRE. Summary of attendances, January—December, 1918. QUARTERS. TOTALS. 1st March. 2nd June. 3rd Sept. 4th Dec. YEAR Consultations A 204 223 180. 156 763 New cases (under 1) 30 36 30 18 114 Consultations B. 209 198 179 172 758 New cases (over 1 year). 86 24 17 16 93 Weighing only 83 130 112 193 518 Home Visits 303 298 531 604 1736 Feeding Breast New cases 14 23 13 10 60 ,, Bottle 16 1G \i 8 52 Mixed 9 6 5 6 26 Ante-Natal cases 1 2 2 4 9 ,, ,, consultations 1 2 4 5 12 ,, ,, visits 10 11 42 71 131 Number of new cases during quarter 67 62 49 37 216 Attendance of old cases 368 429 382 469 1648 ,, ,, new cases 129 122 93 57 401 Total of attendances 497 551 475 526 2049 Number of sessions 11 11 8 12 42 Individual attendance 186 198 190 175 749 Babies under care of Clinic 185 196 188 171 Cases attended but once 38 39 48 46 Average attendance 45.2 50.1 59.3 43.8 49.2 8 JOINT REMEDIAL DRILL AND MASSAGE CLINIC. January to December, 1918. Sessions Inspections Massage Exercises Clinic Cases School Cases Attendances. Total Attendances Under 5 Over 5 March Quarter 21 12 126 100 37 20 154 65 219 June ,, 20 8 135 88 35 21 104 90 194 *Sept. ,, 14 5 57 37 23 10 71 42 113 Dec. ,, 27 8 155 47 24 9 136 50 186 82 33 473 272 117 60 465 247 712 * Closed during the month of August. 9 10 JOINT DENTAL CLINIC SUMMARY. January—December, 1318. Quarter. Sessions. Extraction Days. Filling Days. Clinic Children. School Children. Mothers. Total No. of Cases. March 12 5 7 20 48 12 79 June 11 4 7 11 76 16 103 Sept 11 4 7 8 54 8 70 Dec 14 5 9 17 93 12 122 Totals 48 18 30 .56 271 48 374 Quarter. Attend. Fillings. Extraction Cases. Inspection. Dentures. Cases completed. Cases. Attend. March 182 34 95 83 17 72 71 June 238 42 95 93 19 33 72 Sept 223 52 77 100 5 22 65 Dec 227 54 83 80 2 13 80 Totals 870 182 350 356 33 140 298 HEALTH VISITORS SUMMARY. Total number of visits paid in connection with Infant Welfare 2,918 Ante-natal 176 Children under 1 1521 Children 1 to 5 1221 Of 180 babies visited 160 were breast fed, 4 breast and bottle and 16 bottle (chiefly cow's milk and barley water). Nursing visits were paid to 140 sick children suffering from broncho-pneumonia, empyema, bronchitis, tuberculous 11 glands, circumcision, umbilical hernia, tonsilitis, rickets, impetigo, fractured arm and clavicle, influenza, one case of opthalmia neonatorum ; all recovered. Infection Visits : measles 421, chicken-pox and mumps 96 PANDEMIC INFLUENZA. During October, November and December, Harrow had a share but not an unduly large share of the influenza pandemic. Most of the cases occurred in adults. The incidence amongst school children was never so large as to necessitate closure of schools or of individual classes in schools. At the beginning of the epidemic the following letter was addressed to the heads of the public and private schools of Harrow:— EPIDEMIC INFLUENZA. Influenza, and the pneumonia which frequently follows it, are caused by specific germs which pass from person to person for the most part in the spray which issues from the mouth and nose in coughing and sneezing. Such spray may be effective at a distance of several feet. It is of the utmost importance to the community that these infections be not spread through coughing and sneezing. If every case of influenza were isolated immediately it occurs, and kept in isolation till well, the disease would soon disappear. For his own sake, and that of the public every person attacked should at once go to bed, and remain there until well. This simple remedy would prevent many cases of fatal pneumonia. Influenza paves the way for pneumonia especially in those who remain at work too long or return to work too soon. All mouth spray and nose discharge should be received in a handkerchief which is afterwards thoroughly boiled. The hands should be carefully washed after handling such handkerchief. All bed and sitting rooms should be well ventilated and frequently flushed with fresh air. Children attacked should on no account be allowed to go to school. Every catarrh and illness associated with rise of tempera ture should be regarded as infectious and precautionary measures accordingly adopted. (Signed) DAVID SOMMERVILLE, M.Sc., MD„ Medical Office of Health, 12 Written instructions were issued to the District Nurses for their guidance in going in and out amongst patients. The medical practitioners of the District were communicatid with, and invited to send sputum for bacteriological examination to my laboratory at King's College, London, Clinically and bacteriologically the Harrow cases were identical with cases which I had the privilege of studying elsewhere in Surrey and Kent. From the middle of October till the end of December I investigated bacteriologically 55 cases. In every case a mixed infection was found—a combination of two or more of the following four organisms: Frankel's pneumococcus, A streptococcus, Pfeiffer's bacillus, M. catarrhalis. The sputa were all taken after the third day of the disease. Frankel's organism (the Gram-positive diplococcus responding to the carbohydrate fermentation tests generally received as characteristic of it) was isolated in 28 cases; the streptococcus in 10 cases; Pfeiffer's bacillus in 20 cases; and M. Catarrhalis in 18 cases. In ten fatal cases investigated the dominant organism in the sputum was either Frankel's diplococcus or the streptococcus. In one of these cases pus aspirated from the pleural cavity contained this streptococcus in pure culture. It clots milk, ferments saccharose, lactose, and raffinose; and is pathogenic to mice, Probably it is a modification of Frankel's diplococcus. Clinically the Disease presents a diminution of arterial tension with a pulse irregular and variable in amplitude; weakening of first sound of heart; early cyanosis of nails and fingers and in fatal cases of whole body; enlargement of spleen and occasionally of liver; delirium when temperature is high frequently persisting and increasing when temperature falls ; irritability combined with mental torpor; increasing difficulty in the coordination of ideas occompanied by sadness, fits of tears, and forebodings of death. Persistent sleeplessness cocurs in many cases. 13 The sputum is frothy and contains dull red streaks, later it becomes yellow changing to yellowish green. Hemorrhage may occur from any mucous membrane. The lungs are gradually swamped with fluid, but even until the end there is no precise localisation of the effusion. Profound oxygen-starvation coupled with an intense toxaemia quickly leads to cardiac syncope and the end. Thirty fatal cases occurred in Harrow up to 31st December, 1918. MILK SUPPLY. The dairy farms and milkshops were inspected several times during the year. The milkshops have been on the whole kept fairly clean. The dairy farms are not clean Cowsheds have been found anything but clean, and repeated inspection has often found no improvement. The excuse has always been "no hands to do the work." Six complaints were made during the year of dirty milk I had samples taken from the dairies named in the complaints and examined them bacteriologically and microscopically: two were found to be filthy. No legal action could be taken as in this country there are no standards of cleanliness. America possesses and acts on such standards: one can get clean milk in the State of New York but not in the County of Middlesex. One sample contained 21,000,000 bacteria per cubic centimetre, growing at 37°c. I tested 29 samples for the tubercle bacillus by animal innoculation : all were negative. FOODSTUFFS. I analysed for the Food Committee the following: 1 Sample of dripping Result.—Genuine 3 Samples of margarine „ All rancid. 1 Chocolate ,, Genuine. 1 Milk „ Fair. 1 Loaf ,, Good 2 Jams ,, 1 good 1 bad, but no metallic or other ingredient was discovered to account for the bitter taste. The water supply continued as in previous years. 14 SEWAGE DISPOSAL. The Sewage farms performed their functions satisfactorily and without nuisance THE ISOLATION HOSPITAL The total number of cases admitted and treated during the year was 38. This number is composed of the following Diphtheria 26 Scarlet fever 12. I carried out the following bacteriological investigations .— Throat swabs for the diphtheria bacillus 118 Sputa for the tubercle bacillus 18 HOUSING Owing to the air raids a small influx of aliens from London occurred but at no time was there any serious overcrowding from this cause. There is a distinct need of new houses for the middle and lower middle classes. The Council has under consideration a Housing and Town Planning Scheme. Appended are the following tables:— Cases of infectious diseases notified during the year. Inspection of Factories, Workshops, Workplaces and Homework. Registered Workshops Sanitary Work. Meteorological Observations by the Surveyor. Official table—Birth Rate, Death Rate, and Analysis of Mortality during the year 19:8. I am, Gentlemen, Your obedient Servant, DAVID SOMMERVILLE. NOTIFIABLE DISEASES. Notifiable Diseases Number of Cases Notified, Total Cases notified in each locality, e.g. Parish. No. of Cases removed to Hospital from each locality. Total No. of Cases removed to Hospital. At Ages—Years. At all Ages. Under 1. 1 and under 5. 5 and under 15. 15 ant under 25. 25 and under 45. 45 am under 65. 65 and over. Roxeth. St. Mary. Gre'nhill. St. Peter. St Geo. Rox eth. St Mary. Gre'nhill. St. Peter. St. Geo , Small-pox Cholera (c) Plague (p) Diphtheria (including Membranous Croup) 29 2 18 5 2 2 4 2 2 10 11 4 1 2 9 10 26 Erysipelas 2 2 1 1 Scarlet Fever 9 2 4 1 3 3 1 2 8 1 1 2 12* Typhus Fever Enteric Fever 2 1 1 1 1 Relapsing Fever (r) Continued Fever (c) Puerperal Fever Cerebro-spinal Meningitis Poliomyelitis Pulmonary Tuberculosis 22 2 3 11 5 1 5 1 7 5 4 Other forms of Tuberculosis 6 2 1 2 1 1 2 3 German Measles 7 1 4 2 1 2 4 . Measles 398 2 59 316 23 5 41 40 97 113 107 Chicken pox 9 2 7 5 3 1 484 2 60 353 34 26 7 2 59 54 111 138 122 2 3 11 10 33 * Five cases admitted from Hendon Rural District Council's Area. 15 16 FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Faotories (Including Factory Laundries) 84 5 Workshops (Including Workshop Laundries) 120 2 Workplaces (Other than Outworkers premises included in Part 3 of this Report) 32 7 Total 336 14 2. —DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions Pound. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:— Want of Cleanliness 1 1 Want of Ventilation Overcrowding Other Nuisances Sanitary accommodation insufficient unsuitable or defective 4 4 not separate for sexes Offences tinder the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) Breach of special sanitary requirements for bakehouses (ss. 97 to 100) Other offences Total 6 5 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Notices served on Occupiers as to keeping or sending lists Number of Inspections of Outworkers' premises. OUTWORK IN INFE< 1 ED PREMISES, SECTION 109-110. Lists received from Employers Numbers of Addresses of Outworkers received from other Councils. Numbers of Addresses of Out workers forwarded to other Councils. Instances Orders made Twice in the year. Once in the year. Lists. Outworkers. Workmen Lists. Outworkers. Workmen Wearing Apparel— (1) making, &c. 1 2 — — 16 7 — 7 —- ' — (2) cleaning and washing Furniture and Upholstering Leather Working Total 1 2 16 .7 — 7- 17 18 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. Bakehouses (retail) 13 Wheelwrights, etc. 3 Harness Maker 1 Motor Repair Shops 1 Milliners and Dressmakers 20 Laundries 6 Dentists Cycle Makers 3 Plumbers Tailors 11 Printers 2 Boot Repairing 7 Job Masters 2 Tinsmith 1 Workshops and Work places 27 Coach Builders Upholsterers 2 Other Trades Total number of workshops on Register 99 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories: — Failure to affix Abstract of the Factory and 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 (e. 5) Notified by H.M. Inspector Nil. Reports (of action taken) sent to H.M. Inspector. her Underground Bakehouses (S. 101):— Certificates granted during the year In use at the end of the year 19 SANITARY WORK. Number of Premises inspected on Complaint 155 Ditto re infectious Disease 70 Ditto under periodical Inspection 154 Total number of Inspections and Re-inspections made 2078 Intimation notices served 10 Statutory notices served 1 Number of houses let in Lodgings 4 Contravention of Byelaws 1 Number cf Common Lodging Houses 1 Ditto Inspections made 3 Ditto Bakehouses 14 Contravention of Factory Acts 2 Number of Slaughter houses 6 Ditto Inspections made 70 Ditto Cowsheds and Dairies 22 Ditto Inspections 230 Number of Offensive trades 5 Ditto inspections made 84 Number of drains tested 38 Ditto unstopped, repaired, etc 22 Ditto reconstructed Nil Number of rooms disinfected after infectious disease 606 „ „ „ Phthisis 29 Number of articles disinfected after infectious diseases 3010 „ Phthisis 247 Number of rooms stripped and cleansed 3 Ditto new dustbins provided 7 Ditto Complaints of non removal 42 Sundry nuisances 81 Overcrowding 1 Accumulation of Refuse 3 Dampness 8 20 METEOROLOGICAL OBSERVATIONS TAKEN AT HARROW DURING THE YEAR ENDING DECEMBER 31st, 1918. By J. PERCY BENNETRS, Engineer and Surveyor. Month. Hygrometer. Max. Temperature. Total Depth Rainfall Wind Dry Bulb Wet Bulb Min. Earth Greatest Fall in 24 Hours No. of Days on which .01 or more fell Prealling Wind 1 ft. 4 ft. Depth Date January. Means 37 00 36.58 44.00 32.83 37.19 42.00 ... ... ... ... ... Highest 50.00 49.00 55.00 46.00 43.00 43.00 2.79 1.20 15 14 s.w. Lowest ... 21.00 21.00 23.00 16.00 34.00 41.00 ... ... ... ... February. Means . . 41.00 40.00 47.32 37.25 41.57 43.32 ... ... ... ... ... Highest 51.00 49.00 56.00 48.00 45.00 44.00 l.20 .21 24 15 s.w. Lowest 27.00 27.00 36.00 24.00 38.00 41.00 ... ... ... ... March Means 37.29 38.90 51.54 35.16 41.25 43.25 ... ... ... ... ... Highest ... 50.00 46.00 71.00 43.00 44.00 44.00 .42 .25 28 4 s.w. Lowest 32.00 32.00 39.00 28.00 39.00 43.00 ... ... ... ... ... April. Means 41.20 40.17 51.60 37.17 44.14 44.24 ... ... ... ... ... H ighest 47.00 46.00 64.00 48.00 17.00 45.00 3.65 .87 15 18 N E. Lowest ... . 31.00 31.00 42.00 30.00 42.00 44.00 ... ... ... ... ... May. Means 54.70 51.29 66.16 47.00 52.38 48.35 ... ... ... ... s.e. Highest 67.00 60.00 83.00 58.00 57.00 57.03 1.97 .48 4 11 & Lowest 43.00 41.00 48.00 39.00 46.00 45.00 ... ... ... ... N E. Junk. Means 56.18 53.21 67.17 47.00 58.28 53.70 ... ... 18 ... ... Highest 64. 00 63.00 79.00 53.00 59.00 51.00 1.11 .20 & 11 w. Lowest , 51.00 47.00 60.00 38.00 56.00 51.00 ... ... 20 ... ... July. Means 50.15 56.40 70.40 53.14 59.93 55.61 ... ... ... ... ... Highest 66.00 68.00 79.00 66.00 64.00 57.00 3.38 56 26 19 s.w. Lowest . . 52.00 51.00 61.00 45.00 57.00 54.00 ... ... ... ... ... August. Means 59.67 57.90 70.00 53.19 61.38 58.00 ... ... ... ... ... Highest 70.00 65.00 88.00 31.00 63.00 59.00 1.36 .22 27 14 S w. Lowest 50.00 52.00 59.00 45.00 59.00 57.00 ... ... ... ... 21 Meteorological Observations (continued). Month Hygrometer Temperature. Rainfall Wind Dry Bulb Wet Bulb Max. Min. Earth Total Depth Greatest Fall in 24 Hours. No. of days on which 01 or more fell. Prevailing Wind 1ft. 4ft. Depth Date September. Means 51.00 49.77 60 16 46.54 54.06 55.35 ... ... ... ... ... Highest 61.00 60.00 7100 57.00 59 00 59 00 501 0.65 18 24 s.w. Lowest 42.00 41.00 47.00 36.00 52.00 51.00 ... ... ... ... ... October. Means 48.45 47.32 55.83 4719 50.74 50.96 ... ... ... ... ... Highest 57.00 56.00 6200 55.00 55.00 57.00 1.63 0.35 11 19 s.w. Lowest 34.00 34.00 48.00 3100 48.00 52.00 ... ... ... ... ... November. Means 41.06 36.76 48.46 37.06 45.23 50.26 ... ... ... ... ... Highest 56.00 53 00 57.00 59.00 5100 52.00 2.10 0.52 3 12 s.w. Lowest 32.00 3100 4100 29.00 41 00 48.00 ... ... ... ... ... December. Means 44.25 43.48 49.64 40.32 4519 47 06 ... ... ... ... ... Highest 65.00 53.00 57.00 54.00 49 00 48.00 2.80 0.27 10 25 s.w. Lowest 28.00 28.00 39.00 27.00 40.00 47.00 ... ... ... ... ... OFFICIAL TABLE. 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 purpose of this Table). Birth rate per 1,000 Total Population. Annual Death Rate, per 1,000 Civil Population. Death Rate per 1,000 Births. Percentage of Total Deaths All Causes Enteric Fever Measles Scarlet Fever Whooping Cough Diphtheria Violence Diarrhoea and Enteritis (under 2 years) Total Deaths under 1 year Deaths in Pub lic Iustitutions Certified Cases Inquest Cases Uncertified Causes of Death England and Wales 17.7 17.6 0.03 0.28 0.03 0.29 0.14 0.49 10.99 97 24.3 93.3 5.4 1.3 (96 great towns including London (Census Population exceeding 50,000) 17.6 18.2 0.02 0.36 0.04 0.34 0.15 0.49 14.46 106 28.4 93.4 5.8 0.8 148 smaller towns (Census Population 20,000.50,000) 17. 9 16.1 0.03 0.25 0.02 0.25 0.14 0.38 9.73 94 15.4 94.5 3 9 1.6 London 16.1 18.9 0.02 0.42 0.03 0.43 0.17 0.56 15.67 107 45.0 92.5 7.3 0.2 Non civilians are included in these figures for England and Wales but not for other areas. 22