HARRO 17 : Harrow - on = the - Hill :: Urban District Council. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1920. printed by the " observer ' printing works, station road, harrow. Harrow-on=the=Hill Urban District Council. Annual Report OF THE MEDICAL OFFICER OF HEALTH, FOR THE YEAR 1920, BY DAVID SOMMERVILLE, M.Sc., M.D. Gentlemen, I have the honour to submit herewith the annual Report on the Public Health and Sanitary Conditions of the District for the year 1920. It is written under the instructions of the Ministry of Health and contains a record of the work of the Department as carried out under the Public Health Committee. I take the opportunity of expressing my grateful appreciation of the support and assistance I have received from the Chairman and members of the Public Health Committee of the Council during the year. I am glad also to have the opportunity of heartily acknowledging the work and loyal co-operation of every member of the staff of the Department. I am, Gentlemen, Your obedient Servant, D. SOMMERVILLE. 3 VITAL STATISTICS. Population:- The Registrar-General estimate? the population at 19,967. The population in 1851 was 2,813; in 1901 10,220, and in 1911, 17,074. The area is 2,028 statute acres; and the rateable value- £153.147. Births:—There were registered during the year 346 births, viz., 182 males and 164 females. The birth rale per thousand of pupulation is therefore 17.3. Last year this rate was 13'8. The birth rate for England and Wales for 1920 was 25'4, and for the 148 smaller towns 24'9. Of the above 346 births 14 were illegitimate, viz., 7 males and 7 females. Deaths:—The total number of deaths during the year was 174, viz., 92 males and 82 females. This gives a death rate of 87 per thousand of population. But this death rate is crude in that it takes no cognisance of the relative numbers of the sexes nor of the age distribution of the population. Yet this is necessary for purposes of comparison with other districts on account of the fact that the mortality among young children and old people is higher than amongst adults, and also higher among males than females. A factor of correction has been calculated, viz., 1'0655. The corrected death rate is therefore 8'7 x 1'o655=9'2. The corresponding figure for 1919 was 9'2. The corrected death for England and Wales in 1920 was 12'4, and for the 148 smaller towns 11'3. The corresponding figure for England and Wales in 19'9 was 13'8, and for the 148 smaller towns 12'6. 4 CAUSES OF DEATH (Civilians only):— All causes Males 92 Female 82 Enteric Fever 1 Measles 1 Diptheria and Croup 4 3 Influenza 3 i Erysipelas 1 Pulmonary tuberculosis 9 5 Tuberculous meningitis 1. Other tuberculous diseases 2 Cancer 18 13 Rheumatic fever 1 Meningitis 1 Organic heart disease 4 11 Bronchitis 5 3 Pneumonia—all forms 6 3 Other respiratory diseases 2 1 Appendicitis 1 Cirrhosis of liver 2 Nephritis 2 3 Congenital debility 5 4 Violence apart from suicide 5 2 Other defined causes 25 26 INFANTILE DEATH RATE. Of the 346 children born, 18 died under 1 year of age. The Infantile Mortality Rate is therefore 52 per thousand children born. In 1919 it was 61'3. The Infantile Death Rate for England and Wales for 1920 was 80, and for the 148 smaller towns 80. GENERAL CHARACTERS OF HARROW. Harrow is about 10 miles from London, in the Diocese of the Metropolis, in the Hendon Union, in the Watford County Court District and in the Gore Petty-Sessional Division of the County of Middlesex. The hill, which is 400ft. high, is capped -with Bagshot sand and lies on the London clay. The physical features resemble those of the neighbouring heights of Hampstead and Highgate. The London clay, a water-tight stratum, attains a depth of a hundred feet or more : immediately underneath are situated the Reading beds averaging in thickness forty to fifty feet. 5 The upper layers of the clay as seen in road cuttings and openings made for the foundations of houses present considerable variety in composition and colour. Brown beds intermingle with others containing yellow sands Dark smoke-coloured clay streaked with greensand, pyrites and pebbles lies underneath the superficial brown beds and occasionally outcrops through them. This prevalence of clay renders the district damp, a fact of some importance in connection with housing. WATER. The district is supplied with softened water by the Colne Valley Water Company from their works at Bushey. An analysis made in July 1920 showed that the water was satisfactory for drinking and for domestic purposes. The supply is constant and was quite sufficient throughout the year. DRAINAGE AND SEWERAGE. The sewage of the greater portion (about two-thirds) of the Urban District is purified by chemical precipitation followed by land filtration at the Newton Sewage Farm on the Western border of Roxeth. The effluent was quite satisfactory throughout the year. The sewage of the remainder of the District (about onethird) adjoining Wealdstone, is disposed of by the Wealdstone District Council to the satisfaction of all concerned. The effluents of these farms run into the Kenton and Yeading Brooks, tributaries of the Brent. CLOSET ACCOMMODATION. All the houses in the district are supplied with water closets. There are a dozen water closets without flushing cisterns. There are no earth closets or privies in the district. SCAVENGING. House refuse is stored in covered and movable ashbins. There are a few fixed receptacles It is removed by the Council once a week. During the year 20 complaints of non-removal were received. During the year 34 house-holders were called upon to provide new ashbins. I here are 3 houses in remote parts of the district whose drains empty into cesspools. The cesspools are emptied by the occupier. No nuisance has been detected in connection with any of these during the year. 6 SANITARY INSPECTION OF DISTRICT. The Sanitary inspector reports: (a) number of inspections and reinspections during the year, 941 ; (b) number of statutory notices served 20, and informal notices 80 ; (c) result of service of notices as follows: The 20 statutory notices were all complied with except one dealing with a case of overcrowding. GENERAL SYNOPSIS OF SANITARY WORK. Premises inspected on complaint 220 Premises inspected re infectious diseases 172 Premises inspected in periodical inspections 186 Inspections in connection with contraven'ion of bye- laws at houses let in lodgings (3 in district) 28 Inspection of common lodging house (only 1 in district) 3 Inspection of the 13 bakehouses (1 underground and little used) 53 Inspection of the 4 slaughterhouses (only one used during the year; 22 Inspection of 7 cowsheds and 18 dairies 130 Inspection of the 3 offensive trades (all fried fish shops) 68 Inspection of the 8 factories 102 Inspection of the 109 registered workshops 140 Inspection of the 20 workplaces 50 Cases of dampness in houses—all remedied 45 Drains tested 44. Drains unstopped and repaired 40 Drains reconstructed 3 Rooms disinfected after infectious disease 582 Rooms disinfected after phthisis 55 Articles of clothing, etc., disinfected after infectious disease 2039 Articles of clothing, etc., disinfected after phthisis 450 Rooms stripped and cleaned 40 Total number of inspections and re-inspections 941 HOUSES LET IN LODGINGS. The 3 houses let in lodgings are not in good hygienic condition. They have not separate sanitary accommodation, and structurally they are unsuitable for more than one tenant. 7 THE COMMON LODGING HOUSE. It was noticeable at the last inspection that the usual Clean condition of the premises had not been maintained. BAKEHOUSES. It is to be hoped that with an accession of labour in the coming year the sanitary condition of most of these will be considerably improved. Two informal notices referring to breaches of sanitary requirements were served, with the result that the defects were remedied. SLAUGHTER HOUSES. Only one of these was used, and that infrequently during the year. COWSHEDS AND DAIRIES. It is to be hoped that considerable improvement will be made in the condition of these, more especially in the matter of cleanliness, I held a conference with the dairy farmers of the district in May on the question of cleanliness in the production of milk. The difficulties of the problem were fully discussed. A further conference amongst the farmers themselves was held later, when all the recommendations suggested at the first meeting for improving the milk supply were unanimously agreed to. OFFENSIVE TRADES. The only offensive trades in the district are fried fish shops (3). No complaints were received concerning these, and on inspection the premises were always found clean. FACTORIES. There are 8 factories, viz., Greenhill laundry, School laundry, Kanok blades. Hack Saw, Leabome Motor Works, Ham Factory, Gas Works, and the Electric Light Station. The number of people employed in these is about 480. There are 100 workshops and 20 workplaces in the district. A record of inspections, notices, prosecutions, etc., of these three types of premises is set out in the following tables:— 8 FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. 1.—INSPECTION. lncluding Inspections made by Sanitary Inspectors. Premises. Inspections. Number of Prosecutions. Written Notices. Factories (Including Factory Laundries) 98 12 Nil. Workshops (Including Workshop Laundries) 140 20 Nil. Workplaces (Other than Outworkers premises included in Part 3 of this Report) 50 2 Nil. Total 288 82 Nil. 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions, Four.d. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:— Want of Cleanliness 8 8 Nil. Want of Ventilation Overcrowding Other Nuisances 10 10 insufficient 6 6 Sanitary accommo- dation unsuitable or defective 12 12 Nil not separate for sexes Offences under the Factory and Workshop Act :— Illegal occupation cf underground bakehoupe (S. 101) Breach of special sanitary requirements for bakehouses (ss. 97 to 100) Other offences Total 36 36 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. Numbers served on Occupiers as to keeping or sending lists. Number of Inspections of Outworkers' premises. OUTWORK IN INFECTED 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. Lists. Outworkers. Wearing Apparel— (1) making, &c 3 6 1 1 15 5 28 2) cleaning and washing Furniture and Upholstering Leather Working Total 3 6 1 1 15 5 28 9 10 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 enu meratcd here. Bakehouses (retail) 13 Wheelwrights, etc. 3 Harness Maker 1 Motor Repair Shops 6 Milliners and Dressmakers 26 Laundries 6 Dentists Cycle Makers 4 Plumbers 1 Tailors 11 Printers 2 Boot Repairing 7 Job Masters Tinsmith 1 Workshops and Work places 20 Coach Builders Upholsterers 3 Other Trades 6 Total number of workshops on Register 110 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and workshop Aot (S. 133) Actiontaken 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 Nil Reports (of action taken) sent to H.M. Inspector. Other Underground Bakehouses (S. 101):— Certificates granted during the year In use at the end of the year 11 THE ELEMENTARY SCHOOLS. . The sanitary condition and water supply of the 4 elementary schools in the district were good throughout the year. No school was closed by reason of infectious diseases during the year. FOOD. , Milk:—Milk is of all foods the most important in that it contains the whole of the chemical constituents of man's diet, viz., protein, carbohydate, fat and mineral salts ; and these in forms most easy of digestion lt is the only proper food of very young children, and of adults when suffering from various diseases. It is a highly delicate compound; an excellent medium for the growth of bacteria, many of which rapidly decompose it; and a most efficient vehicle of certain infectious diseases. In England to-day the production of milk on the dairy farm, its transport to the towns, its distribution to the consumer, and its treatment in the home of the consumer prior to use, are all far from ideal, especially in the matter of cleanliness. In a word, the bulk of the milk on the market is dirty and much of it old. It is only too frequently drawn from dirty cows by dirty hands into dirty vessels, and finally taken into dirty homes where it is further contaminated. A milk churn or milk can may appear to the ordinary observer quite clean and yet contain bacteria which in a few hours, in warm weather, will wholly destroy the milk. Everybody should be interested in the problem of clean milk, and insist on obtaining it. This is not a matter for the medical officer of health and public health committee only, but for every member of the community. The production and distribution of clean milk is a business requiring on the part of the workeissome education in the life l istories of certain germs, and the constant application of this knowledge at every step in the work from the first appearance of the milk on the farm to its consumption in the home. And withal in the hands of the right kind of teacher I know of no more fascinating or absorling subject for study. Any boy or girl of average intelligence in the leaving class of the elementary school could follow, and follow with intense enjoyment, a simple demonstration of the action of certain type-, of bacteria on milk, the important role played by temperature, time, etc., etc. Education rather than legislation is the one thing needful in this matter. Only when the public understand the n eaning of clean milk will they demand it, and only then will the milk dealer supply it. The milk of Harrow is no worse than that of other districts. 12 It is quite possible to produce clean milk ; the Americans have done it, A system of grading milk according to purity and cleanliness was instituted in January, 1912, in the City of New York. At that time 40 per cent. of the City's supply fell within the definition of the lowest grade, C (milk for cooking purposes). In two years this grade had practically disappeared ; and during 1918 15 per cent. of the total supply was grade A, and 85 per cent, grade B. For grade C there was no longer any demand, as the people had learnt to appreciate the value of higher grades. The milk traders removed the contaminating conditions when they had to publish the fact that the milk they sold was in the lowest category. The removal of the contaminating conditions were well within the capacity of all producers and dealers, and did not involve any increase in the cost of milk to the consumer. The milk sold in English towns if ordered in New York would be classed in Grade C. The great value of milk as a food is a cogent reason for largely increasing its supply. The consumption in New York per head per day is nearly twice that in London. Again, the poorer districts in New York use 40 per cent, more per head than do the wealthier districts. The bulk of the milk supplied to Harrow comes from various districts outside, some of which are at considerable distances. The few dairy farms in the district were inspected many times during the year: the findings were much the same as in 1919. The Veterinary Inspector's reports show that no animal suffered from tuberculosis. No action was taken during the year under the Dairies, Cowsheds and Milkshops Orders of 1885 and 1889. Under the Milk (Mothers' and Children's) Order, 1918, a sub-committee of the Public Health Committee enquires into the circumstances of applicants for milk either free or at a reduced price, and recommends accordingly. These necessitous people are for the most part discovered in the first instances at the Infant Welfare Centre or by the Health Visitors on their rounds. Some are recommended by medical practitioners. No. of mothers receiving free grants of milk 1 No. of children receiving free grants of milk 1 No. of mothers receiving milk at reduced price 11 No. of children receiving milk at reduced price 32 '1 he milk of a good dairy herd contains more than 3 per cent. of fat. It has been stated with apparently good reason that a carefully selected well fed and carefully kept herd will produce in the average for the year more than 4 per cent. fat. The present fat standard of 3 per cent. should therefore be raised. 13 The inspection of cowsheds has reference to cubic capacity, paving of shed and yard, litter, storage and removal of dung, water supply, drainage, lighting, general sanitation and method of milking. During the war the extreme shortage of labourmade it well nigh impossible for dairy-farmers to keep their cowsheds and*premises even moderately clean. From numerous visits which I made to the dairy-farms in the district I believe that the dairy men did their best to observe the regulations. Inspection of meat:—This begins at the slaughterhouse and takes note of the healthy or other condition of the animal to be slaughtered, and also the hygienic state of the slaughterhouse and its surroundings. After the animal is killed the carcase and all its parts are carefully examined with a view to detecting disease or any condition in the meat which would render it unfit for food. Should such condition be discovered, the meat is condemned, seized, and submitted to a magistrate, who orders its destruction. The butchers of the district for the most part voluntarily notify diseased meat so that few cases reach the magistrate. During the year there was no case to be brought before a magistrate. 'The slaughter houses have been regularly inspected. The premises are comparatively small and not well situated. They have, however, been kept clean and the paving and drainage in fairly good repair, General inspection of foods, fruits, vegetables and other commodities has been carried out as also the premises in which preparation of food takes place. All foods should be stored and exposed for sale in premises that are scrupulously clean. Dust, flies, gases of decomposition, etc., should be rigorously excluded. The covering by glass and otherwise of meat, butter, cheese, etc., should now be required of all vendors of these foods. The greengrocer also and fruiterer who expose their wares to the filthy dust of the street should be required to mend their ways. Once the consumer demands and refuses to be satisfied with anything other than clean foods a clean supply will follow. INFECTIOUS DISEASES. There were notified during the year 356 cases of Infectious disease. Examination of the accompanying table will show that four diseases accounted for 332 of these, viz., diphtheria no, scarlet fever 42, tuberculosis 36, and measles 144. The corresponding figures for last year were diphtheria 97, scarlet fever 45, tuberculosis 43, and measles 22. It will be noticed that the table shows the numbers occurring in the five parishes and at certain age periods, also the number of cases removed to the hospital. 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 Co Hospital. At all Ages. At Apes—Years. Under J. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and over. Roxeth. St. mary. Gre'nhiil. St. Peler. St. Gec. Roxeth. St Mary. Gre'nhill St. Peter. St. Geo, Diphtheria (i n c 1 u d i n g Membranous Croup) 110 1 16 76 10 7 69 19 12 6 4 67 18 12 6 4 107 Erysipelas 11 4 5 2 3 5 '2 1 Scarlet Fever 42 6 31 4 1 6 2 6 13 15 4 2 4 10 13 33 Pulmonary Tuberculosis 33 3 6 17 6 1 8 4 4 10 7 Other forms of Tubercu- 3 1 2 1 1 1 German Measles 9 1 4 3 1 3 2 4 Measles 144 1 20 116 3 4 49 23 13 25 34 1 1 Influenzal Pneumonia 1 1 1 Malaria 1 1 1 Encephalitis Lethargica 1 1 1 Continued Fever 1 1 1 1 1 356 2 44 230 29 37 11 3 138 56 35 61 66 73 20 16 16 17 142 15 Diphtheria:—The incidence of this disease was high in January and February, fell in March, rose again in May, and dropped to low figures in June and July. It rose again in September, was high throughout October and November and fell in December to an average figure. Amongst diphtheria patients there are some who carry the micro-organism of the disease an inordinately long time. There is now sufficient evidence to show that vaccine treatment with the dead organism is valuable in dealing with these cases. Vaccine emulsion is kept on hand for the use of the medical practitioners of the district. The spread of diphtheria is favoured by overcrowding, faulty ventilation, dirty and damp houses. Children under 15 are most susceptible. When a child gets a sore throat and fever it should be placed in a room by itself and a physician called. Delay breeds danger. The attack may occur two to four days after exposure, sometimes only twelve hours. School children should be taught not to use each others things—books, pencils, etc. Immediate isolation of the patient followed by disinfection of his surroundings are of the greatest importance. Some children are specially susceptible to diphtheria and acquire it where others less susceptible escape. In identifying diphtheria in the throat or nose the bacteriological test is of subsidiary value where the clinical features are at all distinctive ; and a negative result from a swab is of very little value indeed, unless confirmed by one or preferably two subsequent examinations, if possible on successive days. In suspicious cases the physician should not therefore wait but inject antitoxin early. Prophylactic doses of antitoxin for contacts is good practice. In very toxic cases intra-venous injection of antitoxin is desirable If the throat secretions of diphtheria convalescents be bacteriologically examined daily during the third and fourth weeks of their attack in more cases than not the results will prove contradictory. Thebacillus may not be recoverable for a day or two, perhaps more, to reappear the day following. In half a dozen cases observed in a large fever hospital in London in which h clinical and post mortem evidences were conclusive of diphtheria repealed bacteriological examination by an expert entirely failed to reveal the presence of the diphtheria bacillus. Vir lent diphtheria bacilli may often be und in the throat and quite harmless to their host, and only occasionally a source of infection to others. Patients who have had diphtheria should remain in hospital as long as an inflamma-. tory condition of the throat exists. 16 The most careful treatment of an epidemic does not affect its prevalence ; no matter what panaceas we cry up or down nor how many scapegoats we drive into the wilderness, one year will produce more cases than another. Of the conditions social or other which combine to standardise an infection which must continue to take toll of human life until in the course of time a new equilibrium is established, we have no exact knowledge. Scarlet fever:—Forty-two cases were notified. The number notified last year was 45. Tuberculosis:—The figures for all forms of the malady are 36. Forty-three cases were notified last year. The homes of the notified persons were visited and instructions left with the patients and their relatives concerningthehygienic management of the cases. Measles:—There were 144 cases of measles and 9 of German measles notified during the year, as against 14 cases of measles and 8 of German measles last year, and 39S of measles and 7 of German measles in 1918. THE ISOLATION HOSPITAL. The hospital can accommodate 30 patients. It was hard pressed during the diphtheria outbreak more especially as a fairly large number of scarlet fever cases occurred at the same time. The erection of another block in the near future should be borne in mind especially in view of the fact that bad cases of pneumonia and measles require hospital treatment. There is also urgent need for the enlargement of the administration block in the matter of more bedrooms, a common room for the nurses, and better accommodation for food, linen, etc. The total number of cases admitted during the year was 142, viz., 107 diphtheria, 33 scarlet fever, 1 measles and 1 continued fever. Small Pox:—Harrow is one of the local authorities who maintain a conjoint small pox hospital at South Mimms. Bacteriological and chemical analyses : — The following specimens were sent for investigation : Throat swabs for the diphtheria bacillus 2422 Sputa for tubercle bacillus 17 Blood for malarial parasite 2 Blood for typhoid 3 Blood for anthrax 1 Smear for gonococcus 1 Waters for chemical and bacteriological analysis 1 At present the Lister institute, Chelsia Bridge, London S.W.i., carries out this work. 17 MATERNITY AND CHILD WELFARE. This work in Harrow, has grown steadily from its inception nearly six years ago. At Homeleigh, 8 College Road are to be found the Harrow Baby Clinic (Municipal Centre), and the following co-ordinated activities radiating from it: Denial Clinic (Joint for Harrow and IVealdstone and Elementary Schools), 8, College Road. Saturdays, Dental treatment for mothers, clinic and school children ; dentures for mothers. Miss Goodman, L.D.S. Throat, Nose and Ear Clinic (Joint for Harrow and Wealdstone). Fridays, Dr. Eleanor Lowry. Eye Clinic (Joint for Harrow and Wealdstone). Fridays, Dr. Amy Shepard. Ante-natal Clinic (Joint for Harroiv and Wealdstone). Tuesdays, 4.30. Dr. Agatha Doherty. Minor Ailments Clinic (Joint for Harroiv and Wealdstone). Wednesdays (fortnightly), Dr. Agatha Doherty. Massage Clinic (Joint for Harrow and Wealdstone). Thrice weekly. Miss Townsend. The Maternity Hostel, 10, College Road (next door to above), for maternity in-patients, sent from the antenatal clinic and medical practioners. Dr. Agatha Doherty visits weekly. This scheme organised by Dr. Tchaykovsky and her executive committee, with the exception of the Baby Clinic, which is entirely municipal, is surported partly by local and government grants and partly by voluntary subscriptions. A second Child Welfare Clinic (municipal) was opened in March at the Wesleyan Hall, for Roxeth. Dr. Agatha Doherty attends on Fridays at 2. Her reports on the success of this Clinic are most cheering. Health Visitors:- The Council is fortunate in having the part-time services of three well qualified Health Visitors, members of the staff of the local Nursing Association. In addition it employs the whole-time services of a Maternity Nurse. 18 With the exception of the supervision of midwives, a duty of the Middlesex County Council, the Harrow Maternity and Child Welfare centre meets the requirements of all the elements of the complete scheme formulated by the L.G.B. in 1914 for the preservation of maternal and infantile health, viz., Ante-Natal: (a) Ante-Natal clinic for expectant mcthers. (b) The home visiting of expectant mothers, (c) A maternity hospital in which complicated cases of pregnancy can receive treatment. Natal: (a) Such assistance as may be needed to ensure the mother having skilled and prompt attendance during confinement at home. (b) Confinement of cases of contracted pelvis, etc., at a hospital. Post-Natal: (a) Treatment of complications arising after parturition in mother and infant. (b) The provision of systematic advice and treatment for infants at a Baby Clinic. (c) Continuance of such clinic so as to be available for children up to school age (d) The systematic home visitation of infants and children below school age. In addition to the visitation of infants and expectant mothers at their homes, and their regular sessional work at the maternity and child welfare centre, the Health Visitors also Visit and report on cases of measles. Ante-Natal work has for its object the application of preventive medicine to pregnancy in the common interest of both mother and infant. It secures the saving of infant life and the prevention of chronic diseases in childhood. Both ante-natal care and skilful midwifery are required in most instances to secure a healthy mother able to nurse her healthy infant. Lack of these may result in the death of the mother and infant or one of them ; or chronic invalidism of the mother and impairment of the health of the infant. At the ante-natal clinic the expectant mother is advised concerning the special hygiene of her condition and how best to meet the so-called minor troubles of pregnancy such as constipation, dyspepsia, defective teeth, varicose veins, etc.; and also the more serious troubles such as cardiac and pulmonary diseases, albuminuria, etc. This work supplemented by the sympathetic home visiting of the trained 19 Health Visitor secures a diminution in the number of miscarriages and still births, a better preparation for confinement, a greatly increased interest in the post-natal care of the infant, an increase in breast-feeding, a diminution of opthalmia neonatorum— in a word an increase, not to be measured, in the happiness of the home. The Health Visitor as she visits an earlier infant advises the mother to consult her own doctor or failing this to attend at the maternity centre ; she is thus a perennial recruiting agent for the clinic. Still Births;—Many people ask why with all our splendid modern midwifery machinery we should have still births any longer. The problem is complex. But it may be stated that a large number of still births have no relation to midwifery machinery. They are merely the postponed mortality of ante-natal maladies and deformities. An unborn infant may be very seriously diseased and yet continue to live on in the uterus ; he may even be born quite easily ; but immediately he enters his post-natal life the causes of death which were only potential before become active and for him birth is the gate of death. In this way it comes about that many of the deaths that ought to have been ante-natal come to swell the already high mortaity which exists after birth. There were only nine still births in the district during the year. A great future work lies along the lines of the Development of Ante-natal Preventive medicine; and the educated Health Visitor and the Staff of the Pre-maternity Hospital will fulfil it. There were no cases of puerperal fever and no cases of ophthalmia neonatorum in the district during the year. The Health Visitors paid the following visits during the year : Ante-natal 554 Children under 1 year 3057 Children 1-5 years 818 Measles 232 Sore throats and dipptheria carriers 684 The following tables represent in figures something of the activities of the Maternity and Infant Welfare Centres. HARROW Maternity & infant welfare centre. Greenhill Clinic, 8, College Road. Summary of attendances, January—December, 1920. QUARTERS. March. June. Sept. Dec. Totals. Consultations A. (under t year) 394 250 132 212 988 New cases 61 96 64 28 249 Consultations B. (over 1 year) 135 74 102 168 479 New cases 18 13 6 5 42 Weighing only 287 282 206 229 1004 Home Visits (under 1) 465 542 315 380 1702 First Visits 31 34 20 29 114 Home Visits (over 1) 294 144 126 75 639 Number of sessions 24 21 16 26 87 Cases attended but once 53 34 46 61 194 Average attendance per session 34 37'5 32 25 31'79 Deaths HARROW MATERNITY & INFANT WELFARE CENTRE. Roxeth Clinic. Summary of attendance, March—December, 1920. QUARTERS. March. June. Sept. Dec. Totals. Consultations A. (under 1 year) 111 110 126 347 New cases 34 16 23 73 Consultations B. (over 1 year) 31 31 54 116 New cases 7 3 4 H Weighing only 139 125 167 431 Home Visits (under 1) 208 312 288 808 First Visits 19 24 21 64 Home Visits (over 1) 238 51 49 138 Number of sessions 9 8 12 29 Cases attended but once 27 26 16 69 Average attendance per session 34.5 33 31.5 33 Deaths 21 22 JOINT DENTAL CLINIC SUMMARY. January—December, 1320. Quarter. ending Total Sessions. Extraction Sessions. Filling Sission. Clinic Children. School Children. Mothers Total No. of Cases. March 24 9 15 45 121 24 190 June 25 7 18 26 155 29 210 Sept. 20 6 14 49 90 29 168 Dec. 31 11 20 22 215 37 274 Totals 100 33 67 142 581 119 812 Qtr. Art. Fillings. Extraction Cases. Inspection. Dentures Cases completed. Total fee. New Cases Attend. Mar. 375 80 169 110 11 26 128 £ 16 s. 12 d. 0 June 312 80 116 95 13 44 94 13 13 6 Sept. 810 76 ??? 22 90 6 30 113 14 12 6 Dec. 31 84 216 101 6 22 15 21 16 6 't'ls l415 322 623 396 36 122 350 £66 14 6 HARROW AND WEALDSTONE JOINT ANTE-NATAL CLINIC. January to December, 1920. Sessions. New Cases. Individual Case-. Attendance. Harrow. Wealdstone. March 12 37 39 25 100 June 10 30 32 25 109 September 8 26 27 20 82 December 11 33 42 23 106 Totals 41 126 140 93 397 23 JOINT REMEDIAL DRILL AND MASSAGE CLINIC. January to December, 1920. Quarter. Sessions Inspections Massage Exercises Clinic Cases School Cases Attendances. Total Attendances Under 5 Over 5 j March 33 21 181 137 16 19 97 203 300 June 30 21 222 185 24 22 144 215 359 *Sept 24 14 218 103 20 30 125 202 327 Dec 34 10 343 162 13 24 146 360 496 121 6 964 587 73 95 512 70 1482 * Closed during the month of August. MASSAGE CLINIC. Individual Attendances for 1920. Mths. Yr. Mths. Yrs. Yrs. Yrs. Yrs. Yrs. Yrs. Yrs. Yrs. Yrs. Yrs. Yrs. Mothers Total. Ages 9 1 18 2 3 4 5 6 7 8 9 10 11 12 No. of Cases 7 9 3 6 8 12 8 2 6 3 5 9 2 87 40 Clinic cases. 47 School cases. 24 25 The conditions treated at the Massage Clinic are :— Infantile Paralysis, Rickets, Spinal Curvatures, Pigeon Chests, Weak Ankles, Flat Feet, Fractures of Limbs, Diphtheritic Paralysis, Talipes, Cases of Muscular Weakness and Cases requiring Breathing Exercises. Two trained voluntary workers assist Miss Townsend. HOUSING. Under the Housing, Town Planning, etc., Act, 1919, every local authority is required to consider the needs of their area with respect to the provision of houses for the working classes, and to prepare and submit to the Local Government Board (now Ministry of Health) a scheme specifying (a) the approximate number and the nature of The houses to be provided; (b) the approximate quantity of land to be acquired ; (c) the average number of houses per acre ; and (d) the time within which the scheme is to be carried into effect. About 125 more or less defective houses are under the observation of the Public Health Committee, and at opportune times will be dealt with so as to have them either close 1 or repaired without hardship to the occupants. Twelve of these in Wellington Terrace were put in temporary repair during the year. The Council's housing scheme under Sec. 1 of the Housing, etc., Act, 1919, provides for the erection of 200 houses ; 44 to comprise living-room, scullery and three bedrooms; 146 to comprise parlour, living-room, scullery and three bedrooms ; and ten to comprise parlour, living-room, scullery and four bedrooms. Area of land acquired, 22½ acres. The scheme is to be completed in three years. The total number of houses in the district is 4,266 ; number for the working classes, 1,460 ; and new houses for the working classes erected during the year, 47. Overcrowding, extent:—Number of houses intended for one family, which are now occupie by two or more families, 70. Cases of overcrowding dealt with during the year:—Two cases of overcrowding were dealt with by statutory notice and abated. One remains in statu quo. Fitness of Houses :—The general character of the defects existing in unfit houses may be summarised in the majority of cases as dampness, lack of proper ventilation, and lack of proper lighting in ground floor rooms, passages and stairways. Many houses are without damp-proof courses. 26 Bye-laws relating to houses, houses let in lodgings, tents, vans and sheds:—There are not and have not been any dwellers in tents, vans or sheds. There are three houses let in lodgings. The bye-laws relating to these appear to be quite good for the purposes for which they were formulated. Housing statistics for the 12 months ended Dec. 31st, 1920:— 1. Number of dwelling houses in respect of which complaints were made that they were unfit for human habitation by householders, one, 2. Action under section 17, Housing Act, 1909 : (a) Number of dwelling houses considered unfit for human habitation. Absolutely unfit, nil. (b) Number of dwelling houses the defects in which were remedied without making closing orders, nil. 3. Action under section 28, Housing Act, 1919: (a) Number of orders for repairs issued, nil. (b) Number of cases in which repairs were carried out by L.A., nil. (c) Number of dwelling houses voluntarily closed on notice by owner that they could not be made fit without re-construction, nil. 4. Closing orders: (a) Number of representations made to the L.A. with a view to the making of closing orders, nil. (b) Number of closing orders made, nil. (c) Number of dwelling houses made fit and closing orders accordingly determined, nil. 5. Demolition orders: (a) Number of demolition orders made, nil. 6. Number of dwelling houses demolished voluntarily, nil. 7. Obstructive buildings: (a) Number of representations made (Sect. 38 Housing Act, 1890), nil. (b) Number of buildings demolished, nil. (c) Number of representations still under consideration, nil. 8. Staff engaged in housing work: M.O.H. and Sanitary Inspector, who carrry out inspections together. 27 PUBLIC ANALYST'S REPORT FOR HARROW. Particulars relating to samples taken by Middlesex County Inspectors during the year ended 31st December, 1920. Article Taken Adulterated. Milk 77 4 Cream 1 Preserved Cream 3 Butter 3 Flour, self-raising 2 Baking powder 1 Custard powder 3 Pepper 2 Cream of Tartar 1 Carbonate of Soda 1 Blanc Mange 1 Cake mixture 3 Egg powder 1 Egg substitute 1 100 4 The four samples of milk reported against by the County Analyst included one informal sample and three formal samples in which the deficiency in no case exceeded 3 per cent. LIST OF ACTS ADOPTED IN HARROW URBAN DISTRICT. Infectious Disease Prevention Act 1890. Public Health Acts Amendment Act 1890. Do. Do. 1907. BYE-LAWS IN FORCE concern Common Lodging Houses, Slaughter Houses, Nuisances, Cleansing of Earth Closets, Privies and Ashpits, Removal of House Refuse, Houses let in Lodgings, Provisions of means of escape in case of fire. Factories and Workshops, Pleasure Grounds and Open Spaces, Fish Frying, New Streets and Buildings. 28 METEOROLOGICAL OBSERVATIONS TAKEN AT HARROW DURING THE YEAR ENDING DECEMBER 31st, 1920. By J PERCY BENNETTS, Engineer and Surveyor. Month Hygrometer. Temperature. Rainfall Dry Bulb Wet Bulb Max. Min. Earth Total Depth Greatest Fall in 24 Honrs No. of Days on which .01 or more fell 1 ft. 4 ft. Depth Date January. Means 40 61 39.54 47.58 35.19 41.32 44.35 Highest 52.00 51.00 56.00 47.00 4500 45.00 2.71 .46 28 19 Lowest 21.00 21.00 38.00 21 00 37.00 44.00 ... ... .... ... February. Means 40.03 38.96 49.37 34.89 41.5??? 13.08 ... ... ... ... Highest 48.00 47.00 58.00 41.00 43.00 44.00 .47 .08 3 11 Lowest 30.00 30.00 44.00 28.00 40.00 43.00 ... ... ... ... March Means 43.27 41.93 53.70 37.12 43.03 44.12 ... ... ... ... Highest 54 00 52.00 64.00 51.00 48.00 45.00 1.54 .25 14 15 Lowest 30.00 30.00 40.00 26.00 40.00 44.00 ... ... ... ... April. Means 4663 41.96 34.02 42.05 47.86 16.30 ... ... ... ... Highest 58.00 50.00 64.00 59.00 50.00 48.00 3.21 .49 1 20 Lowest 37.00 36.00 47.00 33.00 43.00 45.00 ... ... ... May. Means 53.90 50.45 64.16 46.58 52.35 49.19 ... ... ... ... Highest 65.00 62.00 80110 59 0(1 60 00 52.0 90 .17 6 12 Lowest 43.00 40.00 52.00 35.00 18.00 48.00 ... ... ... ... June. Means 5816 54.07 68.56 51.23 58.09 5.207 ... ... ... ... Highest 6900 68.00 76.00 59.00 62.09 56.00 2.14 1.01 12 10 Lowest 40.00 42.00 58.00 33.00 51.00 85.00 ... ... ... ... July. Means 57.41 55.80 66.54 51.70 59.61 57.38 ... ... ... ... Highest 62.00 62.00 73.00 60.00 62.00 58.01 5.06 1.07 23 19 Lowest 50.00 49.00 56.00 44.00 57.00 57.00 ... ... ... ... August. Means 55.45 53.96 05.35 49.29 57.90 56.93 ... ... ... ... Highest 61.00 59.00 74.00 56.00 60.00 58.50 1.75 85 2 ... Lowest 48.00 46.00 59.00 41.00 55.00 51..00 ... ... ... ... 29 Meteorological Observations (continued). Month Hygrometer Temperature. Rainfall Dry Bulb Wet Bulb Max. Miu. Earth Total Depth Greatest Fall in 24 Hours. No. o days on which 1ft. 4ft. Depth Date •01 or more fell. September 53.63 52.06 64.56 49.43 56.13 56.73 ... ... ... ... Highest 62.00 60.00 75.00 56.00 58.00 57.00 2.57 .60 17 10 Lowest 43 00 41.00 54.00 43 00 52.00 56.00 ... ... ... .. October. Means 48.16 48.67 59.35 43.90 52.16 55.16 ... ... ... ... Highest 59.00 58.00 71.00 58.00 57.00 56.00 1.96 .63 1 10 Lowest 36.00 36.00 51.00 30.00 45.00 50.00 ... ... ... ... November. Means 41.00 40.46 49.23 35.93 44.23 50.00 ... ... ... ... Highest 57.00 57.00 59.00 49 00 48.00 53.00 1.31 .69 28 6 Lowest 31.00 30.00 35.00 28.00 40.00 46.00 ... ... ... ... December. Means 42.22 38.67 45.80 35.45 41.96 46.48 ... ... ... ... Highest 53 00 53 00 56.00 4900 4600 48.00 2.27 .40 23 23 Lowest 20.00 2000 37.00 17.00 37.00 45.00 ... ... ... ... 30 staff of the public health department. medical officer of health: David Sommerville, M.Sc. M.D. SANITARY INSPECTOR: A. B. Kramm. assistant: Miss E. Coi.e. matron Isolation hospita: Miss E. Musker. disinfector: j. livy. maternity and child welfare. medical officer: Dr. Agatha Doherty. SUPERINTENDENTS: Nurse M. A. Byerley. Nurse E. Randall. health visitors: Nurse M. A. Byerley. Nurse E. Randall. Nurse G. Stevenson. MATERNITY NURSE: Nurse K. Kindell..