HARRO 18 1921. :: Harrow - on = the = Hill :: Urban District Council. ANNUAL REPORT OF CHARLES E. GODDARD, O.B.E., M.D., MEDICAL OFFICER OF HEALTH. printed at the "observer" printing works, station road, harrow. 2 PUBLIC HEALTH DEPARTMENT. STAFF. Charles E. Goddard, O.B.E., Medical Officer of Health M.D. (Part-time). Ethel Mary Brand, L.S.A. Medical Officer to the Maternity and Infant Welfare Clinics (Part-time). Cyril F. Mayne, O.B.E., Hon. Surgeon Massage Clinic M.A., B.S. (Part-time). Harold E. Thorne, M.B., B.S., Anaesthetist to Dental Clinic M.R.C.S., L.R.C.P. (Fart-time). Florence Goodman, L.D.S., Dentist ,, R.C.S. Helen Townsend Masseuse „ Albert B. Kramm Sanitary Inspector(Whole-time) Edith Cole Sanitary Inspector's Assistant (Whole-time). Rose Vowles Junior Clerk ,, Kate Kindell Maternity Nurse „ Margaret Byerley Health Visitor (Part-time). Superintendent Greenhill Baby Clinic. Elizabeth Randall Health Visitor (Part-time). Superintendent Roxeth Baby Clinic. Gertrude Stevenson Health Visitor (Part-time). Nurse Pitcairn Health Visitor „ HARROW-ON-THE-HILL URBAN DISTRICT COUNCIL. Area, 2028 Statute Acres. Population (Census) 1921, 19,460. Birth Rate 16.5 Death Rate 9.5. Infantile Death rate 52 7 per thousand Births. Total Number of Houses June, 1921, 4,238 Occupied 4,182. Unoccupied 56. Number of families or separate occupiers 1921, 4,43 Average number of persons per house 4 6 Rateable value of District £167,575. Assessable Value for General District Rate Purposes £163,705 Sum represented by a penny rate £682. Population 1851, 2,813. Population 1891 (Census) 5,725 Area 1000 Statute Acres. Population 1901 (Census) 19,220. Population June 1906 (Census) 13,697. Population 1911 (Census) 17,074. HARROW-ON-THE-HILL URBAN DISTRICT COUNCIL. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH, FOR THE YEAR 1921, by CHARLES E. GODDARD, O.B.E., M.D, To the Chairman and Members of the Harrow Urban District Council. Gentlemen, I have the honour to submit the Annual Report of the General Health Conditions of the Harrow Urban District for the year 1921, being a record of work done during my first year of office. AREA. The area of the district is 2028 acres. POPULATION. The population of the district last year on the taking of Census was 19,460; in 1911 it was 17,074; in 1901 it was 10,220 ; in 1891 it was 5,725 ; and in 1851 it was 2,813, BIRTH-RATE. During 1921 there were registered as belonging to Harrow 322 births, of these 151 were males, and 171 females (including live illegitimate males and seven females). The birth-rate for the district was 16.5. In 1920 it was 17.3. The average for the last five years has been only 14.3. 6 DEATH-RATE. One hundred and eighty-six deaths were registered as having occurred in the Harrow district, or were allotted to Harrow, of these 95 were males, and 91 females ; 26 persons (9 males and 17 females) died over the age of 80 years ; one woman reached the age of 104. The average death-rate for the last five years has been g.5, and that is also the deathrate for 1921, viz., 9.5. Among the chief causes were :— Cancer 36 Heart Disease 17 Pulmonary Tuberculosis 11 Pneumonia 16 Bronchitis 11 Diphtheria 5 No woman died in, or in consequence of child-birth. Tables of vital statistics will be found at the end of the Report. With reference to the chief causes of death we ought not to be satisfied with the mere statement that so many died from malignant disease or cancer, It is acknowledged that this dire complaint is on the increase, and doubtless more active measures should be taken if possible to arrest the incidence of the disease. A Special Commission should be held, perhaps International, to co-ordinate the good work already done, and to demand from every practitioner full details of all cases attended. We hear of real progress being made in 1921, but it is evident that no definite causes have been found, much less a remedy. No money would be ill spent to fight so grave a menace to the public health, or to engage the best brains of the country to work out schemes to that end. Until sufficient funds are forthcoming every Public Health Office in the Kingdom should have in a conspicuous place a collecting box labelled " For Cancer Research," to receive the smallest contribution of the many who would give if only they knew where to send. At the present time a large percentage of cases are hopeless, because advice is sought too late! PULMONARY TUBERCULOSIS. I am not at all satisfied about our mortality from consumption or pulmonary tuberculosis. It seems impossible to fix the causation except in a few cases. It is said that two cows in every 100 are tubercular, and that the milk is capable of infecting the susceptible, but this is certainly not the whole story. 7 Every case notified is referred by the County Medical Officer to the Tuberculosis Officer (Dr. Bruce), who. then takes charge of the patient. I have formed a high opinion of his work and that of his assistants. The patients are placed under treatment at once and are sent to Sanatoria at the earliest date possible. We hear of excellent results from the Working Colony or Settlement for tuberculosis at Papworth, and shall look forward to further reports after another year's experience. INFANTILE MORTALITY. During 1921 17 infants died in their first year (of whom three were illegitimate), giving an infantile mortality of 527. The average infantile rate for the past five years has been 467. For England and Wales for 1921 it stood at 83. In 1916 the infantile rate was only 29.7 in Harrow. The higher rate was probably due to the six infants who died from congenital causes, and who might easily have been "stillborn" instead. We may quite hope for a lower rate when the ante-natal work is more firmly established, and expectant mothers are taught to realise more fully their responsibilities, and consult their doctors in time. The ignorance of the senior schoolgirl and young wife of their anatomy and internal economy is appalling! One is not surprised that the question of the desirability for couples about to marry obtaining a certificate of fitness, after a rigid medical examination, is again being freely discussed ! THE WATER SUPPLY. The Harrow district is served by the Colne Valley Water Company. The supply is constant and, as a rule, good, but in the lower lying parts of the district the water on first being drawn became milky, and appeared full of chalk, depositing a sediment, on being allowed to settle. The matter was brought before the notice of the Company's Secretary and Manager on several occasions, explanations were given and some improvement certainly took place, but at the end of the year the trouble was often apparent. Before the War the Colne Valley Water was of excellent quality, and was moderately soft. During the War and since there has been a marked hardness and this deposit of chalk, but the water on analysis is still good, and it is hoped soon that it will return to pre-war standard. SCAVENGING. Weekly house to house collections were made during 1921. Several complaints of non-collection of house refuse were received, and also of overloading. The present system of collection is not really satisfactory,, and it is understood that the Council will shortly give the matter their further consideration. GENERAL SYNOPSIS OF SANITARY WORK. Premises inspected on complaint 272 Premises inspected re infectious diseases 168 Premises inspected in periodical inspections 178 Inspections in connection with contravention of bye-laws at houses let in lodgings (3 in district) 32 Inspection of common lodging house (only 1 in district) 3 Inspections of the 11 bakehouses (1 underground) 78 Inspections of the 4 slaughterhouses 53 Inspections of 8 cowsheds and 11 dairies 214 Inspections of the 3 offensive trades (all fried fish shops) 74 Inspections of the 8 factories 120 Inspections of the 112 registered workshops 200 Inspections of the 20 workplaces 62 Cases of dampness in houses, all remedied 30 Drains tested 29 Drains unstopped and repaired 33 Drains reconstructed 2 Rooms disinfected after infectious disease 463 Rooms disinfected after phthisis 32 Articles of clothing, etc., disinfected after infectious disease 2564 Articles of clothing, etc., disinfected after phthisis 320 Rooms stripped and cleaned 88 Total number of inspections and re-inspections 1126 COMMON LODGING HOUSES. Harrow has only one Common Lodging House which is regularly inspected. 9 BAKEHOUSES. In the earlier part of 1921, we had many faults to find with the methods prevailing in some of the bakehouses, such as unwashed hands, absence of soap, towel or basin, dirty floors, sour smelling troughs, accumulations and cockroaches in corners, filth in cupboards, lack of limewash, &c. We have now got them into fair order, but personally I am not satisfied with results especially in the shops. The exposure of enormous quantities of food to road dust, flies, and wasps is a menace to health. In the large cities of the United States, you will find all the confections under glass, why not here ? Instead, we find cakes, bread and all kinds of food passed through many hands, often dirty and perspiring. In the smaller sweet shops sweets are often dribbled out of the hand, till the scale-pan sinks, and this, at a time when all are keen that no infection of scarlet fever, diphtheria, and tuberculosis shall be communicated. There is no byelaw to control these evils. There is no remedy but public opinion and until people protest against the pollution of food, especially in bread delivery, we must continue to suffer from these and other diseases till better counsels prevail. SLAUGHTER HOUSES. Four in number, two licensed, two registered. Two of these slaughterhouses required much supervision, but the sanitary defects found were rectified before the end of the year. COWSHEDS AND MILK. During 1921 there were eight cowsheds with about 150 cows. You have been informed of the condition of the sheds and the faulty methods prevailing therein at the beginning of the year. I am glad now to report that owing to the vigorous support of the Public Health Committee a better system prevails. This improvement such as it is, has only been achieved by frequent early morning inspections at the time of milking. Now, instead of a filthy sack encircling the waist, the milker is provided with a clean smock or overall, hands are washed, utensils are sterilised, stools and strainers are cleaned ; not only the teats and udders but all parts of the animals are now cleansed, in fact the cowkeepers of the district are beginning to realise that the Council mean to insists on better methods. Much of course remains to be accomplished 10 and a higher standard should be attained by constant and vigilant inspection. The Dairy Farmer may not produce milk of a degree of purity comparable with the Grade A Certified standard, but the Council are going to have the best possible under existing circumstances. It will interest you to knowthat Grade A Certified milk has recently been produced at an ordinary farm at Reading by experts, showing what can be done by greater care. At the Public Health Congress, held at Folkestone last July I read a paper advocating a stricter and more vigorous supervision of the cowshed and demanding that a prosecution should follow in all cases in which it was found that the requirements of the Milk Regulations under the Dairy Milkshop and Cowshed Order had not been complied with. I am still much concerned with the dirty condition of the imported railway milk. On arrival at the dairies I have frequently found the surface of the milk covered with hair, smuts, hay and straw, particles of manure, dust and filth. I have written to the County Medical Officers complaining of the milk sent into our district, and have given the names of the farms from which the milk is obtained, asking for their cooperation. I am also anxious about the further pollution that occurs in the home, and note that it is evident that the publicdo not yet realise what a dust-laden, germ-swarming fluid milk is by the time it reaches the child's stomach! With regard to the railway milk, I am glad to notice that the old-fashioned churns are gradually being replaced by some that do not permit the entrance of dust and foreign matter in transit. SHORT MEASURE DELIVERED. During the year 1921 complaints were made that in the distribution of milk short measure was often given. One has no sympathy with the consumer in this regard, If he will not use a jug or measure graduated in pint, half pints, quarterpints, the fault is entirely his Some people are quite content to rub along with the ancient methods of the 18th or 19th centuries and seem incapable of imbibing any new ideas.! We have offered to have the Inspector under the Food and Drugs Act actually in the house at the time of delivery of the milk to check the shortage, but this has been declined several times. I suppose there is no trade which lends itself to fraudulent practices more than the milk trade does when employees are so 11 disposed, though this is not so noticeable in Harrow as elsewhere, I refer particularly to the itinerant vendor from other districts. Indeed they are always suspect ! It is one thing to have a milk microscopically impure, it is an added insult to receive it in short measure with the minimum amount of fat and the maximum legal quantity of water ! The County Council carefully and regularly inspects and analyses samples in the shops and on the rounds and frequently prosecutes, though the public may not hear of it; indeed great efforts are being made all over the country by officials that the public shall be served with the purest milk. To sum the matter up, the question of the production and the distribution of milk in this country requires to be overhauled and placed on at least as good a footing as in America. Now that we know that a pure milk can be produced at an ordinary farm of the Standard of Grade A certified, that this milk, when rapidly cooled, will keep a week without going sour if stored in sterile bottles and sealed, and at the same time retain all its vitamines, we feel that it behoves us all to insist upon having such milk produced at our farms in the future. It is only fair to add that this very pure milk cannot be sent out to the public at the low charge of only fivepence a quart, the bottles and other plant increasing the cost. Those who are interested in the production of Grade A Certified Milk should obtain an introduction to Mr. G. Titus Barham (one of the chief pioneers in this work), with a view to visiting his experimental and model farm at Finchley. The cows of the district have been regularly inspected by your Veterinary Surgeon, who has not reported any case of tuberculosis during the year. OFFENSIVE TRADES. There are 3 Fried Fish Shops in Harrow. In 1921 two of these shops were found in an unsatisfactory condition, but at the end of the year were working under much better conditions. FACTORIES AND WORKSHOPS. These have been systematically inspected, and all defects remedied at once. 12 FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices Prosecutions. Factories (Including Factory Laundries.,) 120 5 Nil. Workshops (Including Workshop Laundries) 200 3 ” Workplaces (Other than Outwo kers premises included in Part 3 of this Report) 62 5 ” 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 10 10 Nil. Want of Ventilation Overcrowding Other Nuisances 8 8 Sanitary accommodation insufficient unsuitable or defective 7 7 ” 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 (ss. 97 to 100) 16 16 ” Other offences Total 41 41 Nil. 13 3.—HOME WORK. nature of work. OUTWORKERS' LISTS, SECTION 107. Notices served on Occupiers as to keeping or sending lists. Number of Inspections of Out workers 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. 6 12 3 8 13 5 3 30 Nil. Nil. (2) cleaning and washing Furniture and Upholstering Leather Working Total 6 12 3 8 13 5 3 30 14 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) 11 Wheelwrights, etc 3 Harness Maker 1 Motor Repair Shops 4 Milliner and Dressmakers 22 Laundries 6 Cycle Makers 3 Plumbers 1 Tailors 16 Printers 2 Boot Repairing 19 Tinsmith 1 Workshops and Work Places 20 Upholsterers 3 Total number of workshops on Register 112 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 (s. 5) Notified by H.M. Inspector 2 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 15 OVERCROWDING. Although there were no definite complaints of overcrowding, there can be little doubt that it existed, from the number of applications for Council Houses. It will probably be many years before the needs of the town are fully satisfied in this respect. May I take the opportunity of expressing approval, from the Public Health aspect, of the different types of houses erected by the Council on the Honeybun Estate. NOTIFIABLE INFECTIOUS DISEASES. There were notified during the year 220 cases of Infectious Disease. Examination of Table 2 will show that three diseases accounted for 207 of these, viz., diphtheria 83, scarlet fever 78, tuberculosis 46. The corresponding figures for last year were diphtheria 110, scarlet fever 42, and tuberculosis 36. DIPHTHERIA. During 1921 there were 83 cases of diphtheria notified, there were 110 in 1920. The epidemic fortunately was not of a severe type. Medical practitioners are now recognising that it is often desirable to inject much larger doses of anti-toxin than heretofore, and they wisely do not wait for the result of the swab examination if satisfied that they are dealing with a case of diphtheria. We have recently had from the Medical Officer of Health, of Bristol a valuable memorandum on the subject in which it is stated that, when the City of Bristol was visited by a very virulent form of diphtheria, most of the cases proved hopeless if left untreated for more than 48 hours, it was then found necessary to inject enormous doses as much as 20,000 units immediately on seeing the patient, and to inject the serum into the muscles of the outer side of the thigh, the absorbtion by the subcutaneous method being too slow to be effective. Dr. Peters, of the Ham Hospital, Bristol, has given particulars of his testing his nursing staff to the number of 135, by comparatively simple methods to ascertain whether any are susceptible to diphtheria so that they can be inoculated at once, a great desideratim for schools, large staffs and communities. 16 CASES OF NOTIFIABLE DISEASES DURING THE YEAR. Disease. Number of Cases Notified. At all ages. Under 1. 1-5. 5-15. 15-25. 25-45. 45-65. 65 and over. Total No. Removed. Total. Deaths. Diphtheria 83 10 57 11 4 1 73 5 Scarlet Fever 78 9 48 13 6 2 64 Erysipelas 7 1 1 4 1 T.B. Pulmonary Notified 46 4 26 2 8 Measles 2 1 1 Basic Posterior Meningitis 1 1 1 Puerperal Fever 1 1 Ophthalmia 1 1 Enteric 1 1 1 17 ISOLATION HOSPITAL. This Hospital will accommodate 30 patients, and during 1921 138 cases were admitted from the District, 73 diphtheria, 64 scarlet fever, and 1 enteric fever, and 13 cases from neighbouring districts viz., Hendon Rural 2 cases of scarlet fever, Hanwell 9 cases of scarlet fever, Wembley 1 case of scarlet fever and one case of diphtheria. In the Administration Block, one or two more bedrooms and a common room for the Nurses are required. This Hospital is very carefully and economically conducted. I am frequently in attendance there and can testify to the efficiency of the work of the Matron and her staff and to their uniform kindness to the patients. LABORATORY WORK. Total number of examinations made by the Lister Institute are as follows:—Diphtheria 999, Tuberculosis 6, Typhoid fever 4, Total examinations made 1,009. THE HARROW CLINICS. Harrow has reason to be proud of its Clinics. The majority of these Clinics organised nearly seven years ago by Dr Tchaykovsky and her Executive Committtee have fully justified the hopes of the founders in the matter of useful work, and at no extravagant cost to the ratepayers. With the exception of the Baby Clinic, which is entirely municipal, the rest are supported partly by grants from the Ministry of Health, and local Council, partly by voluntary subscriptions. It was feared at one time that the work of these Clinics might infringe on the good relationship always existing between patient and doctor in the district, and the resident medical practitioners were certainly getting a little restless at the preference apparently shown to non-resident doctors employed in the different activities; but I am glad to note that since two of their number have been appointed to assist it is realized that no slight was intended and that the chief promoters would endeavour, in serving the best interests of the public, to recognise the just claims and rights of the resident doctors of Harrow, who, after all, must always have the closest medical touch with the people of the District. On a separate sheet you will find the lists of these Clinics with full particulars that may be seen at a glance. 18 MATERNITY AND INFANT WELFARE REPORT. It was with much regret that one had to report the retirement of Dr. Doherty on the occasion of her marriage. She had most efficiently carried on the work of the Centre for the past four years, and will he much missed by the mothers and the workers alike. The Clinic is fortunate in having Dr. Brand as her successor, one who is already fully identified with the special work required. The newly-formed Centre at Roxeth has increased its numbers substantially during the year and is undoubtedly greatly appreciated. The general health of the infants has been good. Of fifteen difficult cases five were transferred to the Observation Ward, Holmleigh, where they have all done well and increased in weight. Two of these were premature and weighed only 3½ and 33/4 lbs. respectively at birth. It is to be regretted that so many of the new cases are artificially fed on arrival. If the mother's friends would assist her to persevere with the breast feeding, or persuade her to take the advice of her doctor before giving it up, there would be many more physically fit babies at the end of the year. It is of course recognised that many mothers from the first, are quite unable to nurse their infants. Very sincere thanks are due to the Superintendents, Health Visitors, and the Voluntary workers for their wholehearted efforts on behalf of the mothers and Infants. MASSAGE CLINIC. With regard to this Clinic, Miss E. Helen Townsend reports that 43 cases received Massage Treatment viz.. 7 cases of Infantile Paralysis, 3 Talipes, 1 Congenital Dislocation, 5 Fractures, 2 Rickets, 8 with fiat feet, 7 with weak ankles, 1 with bowleg, 2 with knock-knee, 1 general debility, 5 with paralysis, 1 with pigeon breast. 26 cases received Remedial Treatment, 2 for muscular back weakness, 14 referred for breathing exercises after tonsils and adenoid operations. Miss Townsend states that the school cases were almost invariably spinal curvature, faulty posture, and bad general development or paralysis. It will be seen how very important the treatment of these children is, since they had no other means of obtaining the remedial gymnastics so necessary to their cure. 19 She speaks gratefully of the help afforded by Dr. C. F. Mayne, the Hon. Surgeon to the Clinic, and states that he has given much valuable time by inspecting the patients and reporting as to their progress. She refers to Miss Werner's good work and the great personal interest she has taken in all the children. Saturday morning treatments have been undertaken by Miss Werner, Miss Wilson or Miss Hill. MILK GRANTS. The supply of milk to mothers and children has been continued during the year, and the total amount of milk supplied under this scheme was 18,875 pints, to 66 children, In consequence of Orders received from the Ministry of Health, reductions were made in the amount of milk granted in April and again in September. At the end of the year 6 mothers were receiving milk free of cost and 9 at a reduced rate. These necessitous cases were recommended by the Medical Officer at the Clinic and in a few cases by medical practitioners. No. of chilcren receiving free grants of milk during year. 14 No. of children receiving milk at reduced price during year 52 No. of nursing and expectant mothers. 12 VOLUNTARY FUND FOR DFNTURES, CONVALESCENT TREATMENT, &c., Early in the year Nurse Randall started a Fund to help necessitous mothers to provide themselves with teeth, also with Convalescent treatment and nourishment where necessary. Funds have been raised by jumble sales, organised by the Health Visitors and Voluntary Workers, and also by voluntary contributions, Altogether 4 mothers have been sent to convalescent homes, 10 mothers have been helped with dentures, and many other necessitous cases have been given Virol, Glaxo, Cod. liver oil and malt or other foods ordered by the doctor at the Clinic, but which the mother has been unable to afford. 20 NEEDLEWORK CLINICS. The Needlework Clinics at Greenhill and Roxeth are still proving a boon to the mothers who attend them. The Clinics are held once a week, at each Centre, and the garments are cut out from approved patterns by Mrs. Hewett, an experienced voluntary worker, the mothers paying for the material, mostly by small instalments. Thanks are due to Mrs. Hewitt, who gives so much time' and thought to both these clinics. It is unfortunate that the number attending the Greenhill Needlework Clinic has to be limited in Winter, as the only available room is so small. In the Summer, weather permitting, the Clinic is held in the garden of Holmleigh. The total number of garments made at both Clinics during the year was 363. NURSING. The Harrow District Nursing Fund has a staff of four Nurses who are responsible for the general nursing of the district. Their names are: Nurse Byerley, Nurse Randall, Nurse Stevenson and Nurse Pitcairn, The numbers of patients visited during 1921 were as follows : —Harrow 84, Roxeth 84, St. Peter's 82, Greenhill 138. Total number of patients visited 388,. A grant is paid by the Council to the District Nursing Fund for the services of the nurses as part time Health Visitors, On special forms these nurses keep me informed of cases of infectious diseases, sore throats, epidemic diarrhoea, etc. Indeed their Health work for the district is excellent, so quietly, so tactfully carried out. May I take this opportunity to ref( r to the courtesy and ready help afforded to the Health Department by the Hon. Secretary of the Fund, Miss Colbeck. COUNCIL'S MATERNITY NURSE. The services of Nurse Kindell are much appreciated, but it is regretted that her services are not more frequently required, THE HARROW CLINICS AND TREATMENT CENTRES. Name of Clinic. Address. Nature of Accommodation. When held. By whom provided. Doctor. Harrow Baby Clinic "Holmleigh,"College Road Hut in rear of " Holmleigh." Tuesday and Wednesday afternoons Harrow . on . the . Hill Urban District Council Dr. Brand. Roxeth Baby Clinic Wesley Hall, Lower Road I large hall, 2 small rooms Thursday afternoon do. Dr. Brand. Ante.natal Clinic "Holmleigh,''College Road Consulting room waiting room Tuesday afternoon Joint Harrow. Urban District Council and Council of Child Dr. Doherty. Dental Clinic do. Ground floor of " Holmleigh." Saturday Welfare do. Dr. Thorn, Anaesthetist. Miss Goodman, Dental. Massage do. do. do. Tuesday, Thursday & Saturday do. Miss Townsend, Masseuse. Throat, Nose and Ear Clinic do. do. As cases accumulate Council of Child Welfare Dr. Lowry. Eye Clinic Observation Ward for do. do. do. First floor of " Holmleigh." do. do. do. Dr. Sheppard. Dr. Beaumont. Ailing Babies Needlework Clinic do. Ground floor Tuesday afternoons Harrow Urban Dis. Council Mrs. Hewitt. Superintendent. Needlework Clinic Wesley Hall. Lower Road 1 large hall Wednesday afternoons do. do. 21 22 HARROW MATERNITY & INFANT WELFARE CENTRE. GREENHILL CLINIC. Summary of Attendance. January to December, 1921. Quarter ending Total. March. June. Sept, Dec. Consultations A 230 213 239 297 1079 New Cases (under one year) 24 43 33 21 121 Consultations B 117 220 164 191 692 34 New Cases (over one year) 5 17 5 7 Weighing only 172 144 69 112 497 Home Visits (under one year) 625 651 408 392 2076 1st Visits. 44 56 33 32 165 Home visits (over one year 153 217 176 245 791 Feeding, Breast New cases 17 30 17 12 76 „ Bottle 4 10 14 7 35 „ Mixed 3 3 3 2 11 No. of New Cases during Quarter 29 60 38 28 155 Attendance of New Cases 58 97 97 56 308 Attendance of Old Cases 493 582 373 544 1992 Total attendance 551 679 470 600 2300 No. of Sessions 22 24 18 22 86 Individual attendance Cases attended but 120 100 179 179 578 once 57 59 60 54 230 Average attendance per session 25 28 26 30 29 23 HARROW MATERNITY & INFANT WELFARE CENTRE. ROXETH CLINIC. Summary of Attendance. January to December, 1921 Quarters ending Total. March. June. Sept. Dec. Consultations A. 115 130 118 129 492 New cases (under one year) 8 16 21 14 59 Consultations B. 63 66 91 103 323 New cases (over one year) 3 6 1 3 13 Weighing only 103 107 51 114 375 Home visits (under one 254 258 264 224 1000 First visits 26 23 25 26 100 Home visits (over one year) 104 156 189 137 586 Feeding, Breast new cases 6 12 12 10 40 ,, Bottle 2 3 7 4 16 „ Mixed 1 2 3 5 No. of new cases during Quarter 11 22 22 17 72 Attendance of new cases 24 60 58 47 189 Attendance of old cases 263 243 202 299 1007 Total attendance 287 303 260 346 1196 No. of Sessions 11 12 9 11 43 Individual attendance 84 93 94 106 377 Cases attended but once 24 30 26 26 106 Average attendance per session 26 25 26 31 27 JOINT DENTAL CLINIC SUMMARY, JANUARY.DECEMBER, 1921 Quarter Ending. Total Sessions. School Inspection Sessions. Extraction Sessions. Filling Sessions. Clinic Children. School Children. School Inspection cases, Mothers. Total No. of cases. March 29 8 7 14 40 134 439 63 676 June 36 9 11 16 35 132 489 74 730 September 24 6 6 12 22 99 338 40 499 December 37 9 12 16 37 147 576 75 835 Totals 126 32 36 58 134 512 1842 252 2740 Quarterly Attendances. Inspections. Extractions. Fillings. Dentures. New cases Attend. £ s. d. March 325 94 137 84 6 22 16 1 0 June 374 94 75 186 9 33 19 12 0 September 258 63 117 61 6 34 13 3 6 December 394 86 209 92 4 11 22 0 6 1351 337 538 268 25 89 £70 17 0 24 HARROW AND WEALDSTONE JOINT ANTE.NATAL CLINIC. January to December, 1921. months Sessions. New Cases. Attendances. Total. Harrow. Wealds tone March 12 34 70 58 128 June 12 32 66 55 121 September 8 19 38 25 63 December 11 32 6O 41 101 Totals 43 117 234 179 413 25 26 MASSAGE SUMMARY for 1921, Quarter. Sessions New cases. Treatments. Attendances. Totals. Massage Exercises. Baby Clinic. School. March 33 14 285 116 111 292 403 June 34 11 243 68 125 197 322 Sept. 24 7 146 16 48 123 171 Dec. 34 5 273 60 110 216 326 Totals 125 37 947 260 394 828 1222 No. of new cases 37 No. of cases attended 69 viz. 30 Clinic cases up to 5 yrs. 39 School cases. No. of sessions held 125 No. of attendances made 122 Average attendance per session 10 ANALYSIS. Ages 1 2 3 4 5 6 7 8 9 10 11 12 13 No. of cases 11 712968674332 Total Baby Clinic cases . 30. School cases . 39. 27 AMBULANCE FACILITIES. (a) For Infectious cases, Two ambulances, one for cases of diphtheria ,and one for cases of scarlet fever. {b) For non.infectious and accident cases. The Council's ambulance is housed in the Fire Station, High Street, and is driven by the firemen, who are on call at any time of the day or night The number of cases removed during the year was 108. The ambulance travelling 1,782½ miles. Of these 108 cases 27 were taken to Harrow Cottage Hospital, 19 to Hendon Infirmary and the remainder to various Hospitals in London and district. HOSPITALS PROVIDED OR SUBSIDISED BY THE LOCAL AUTHORITY OR BY THE COUNTY COUNCIL. supported by 1. Tuberculosis. Clare Hall Sanitorium, Middlesex South Mimms, Barnet. County Council. 2. Maternity. The Maternity Hostel, Council of Child 10. College Road, Welfare, Council Harrow. annually subscribe £300. 3. Children. Observation Ward, Council of Child Holmleigh Welfare. College Road. 4. Fever. Isolation Hospital, Harrow.on.the.Hill Rayners Lane, Urban District South Harrow. Council. 5. Smallpox. The Smallpox Hospital, Middlesex Joint South Mimms, Barnet. Smallpox Hospital Board. 6. Other. Cottage Hospital, Local Committee Roxeth Hill, of Management. Harrow. With regard to the Cottage Hospital, it is right to add that this well.equipped, well.managed Hospital was of the greatest service to the district and neighbourhood during 1921. It is entirely supported by Voluntary Contributions. The Medical Practitioners of the district give their services. 28 SAMPLES TAKEN IN MARROW DURING THE YEAR. Article. Taken. Adulterated. Milk 92 6 Cream 3 2 Butter 8 ... Self.raising Flour 2 ... Lemonade Powder 2 ... 107 8 Prosecution 1 Conviction 1 The six samples of milk reported against included four informal samples and two formal samples in which the deficiency in no case exceeded 3 per cent. One Trader was prosecuted for selling cream containing boric acid. LIST OF ACTS ADOPTED IN HARROW URBAN DISTRICT. Infectious Disease Prevention Act, 1890. Public Health Acts, Amendment Act, 1890. Do. Do. T9°7. BYE.LAWS IN FORCE. 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, Dairies, Cowsheds and Milkshop Regulations. 29 At the commencement of this Report you will find a list of the Staff of the Public Health Department, and at the end all the tables required by the Ministry of Health. In conclusion, Gentlemen, I desire to place on record my great appreciation of the courtesy shewn by every member of the Council and by every member of the Staff during 1921, my first year of office in Harrow, and especially are my thanks due to my loyal and very efficient colleague, Mr. A. B. Kramm. I am, Gentlemen, Yours obediently, CHARLES E. GODDARD, Medical Officer of Health. Fellow of the Society of Medical Officers of Health. Fellow Royal Institute of Public Health. Fellow Royal Sanitary Institute. VITAL STATISTICS OF THE WHOLE DISTRICT DURING 1921 AND PREVIOUS YEARS. TABLE I. Ye Total Birth?. Total Deaths registered in the District Transferable deaths Nett deaths belonging to the District. Estimated ropulation Number Rate Number Bate of Nonresidents registered in the District of Residents not registered in the District Under 1 year of age At all ages Number Rate per 1000 nett Births Number Rate 1916 Birth Kate 18,636. Death Kate 10,655. 336 18.0 138 12.9 11 38 10 29.7 165 10.2 1917 Birth Kate 111,202 Death Kate 17,253. 268 13.9 141 8.1 10 41 17 59.0 180 11.0 1918 Birth Rate r.),757. Death Rate 17,633. 217 109 135 7.6 8 44 7 32.2 171 9.7 1919 20,003 277 13.8 142 7.0 10 36 17 61.3 168 8.7 1920 19,967 346 173 138 6.9 12 48 18 52.0 174 8.7 1921 19,460 322 16.5 153 7.8 15 48 17 52.7 186 9.5 30 31 TABLE II. CAUSES OF AND AGES OF DEATH DURING THE YEAR 1921. Causes of Death Deaths at the subjoined ages or' Residents " whether occuring within or without the district. Total deaths wh'th'r Resident or Non.resident inlnsti. tutions iu the Dislret At all Ages Under 1. 1 to 2. 2 to 5. 5 to 15. IS to '25. 25 to 45. 45 to 65. 65 and upw'ds All causes Certified and uncertified 186 17 1 2 7 9 24 44 82 24 Diphther 5 4 1 3 Influenza 1 1 1 Pulmonary Tuberculosis 11 2 7 2 Other Tub. Dis. 3 2 1 Cancer 36 7 14 15 2 Rheumatic fever 1 1 1 Heart Disease 17 5 12 1 Menincocal Meningitis 1 1 Diabetes 5 1 1 3 Cerebro Haemorrhage 6 2 4 Arterior Sclerosis 7 1 6 1 Bronchitis 11 1 2 8 1 Pneumonia 16 1 1 1 1 3 6 3 1 Other Res. diseases 3 3 Ulcer of Stomach 1 1 Diarrhoea 2 2 2 Appendicitis 1 1 1 Nephritis and Brights disease 6 1 S Congenital Debility and prematurity 6 6 3 Suicide 1 1 Other deaths from violence 5 1 1 2 1 Other defined diseases 41 6 1 2 5 6 21 7 32 TABLE III. INFANT MORTALITY DURING THE YEAR 1921. Cause of Death Total Deaths under One Year Under 1 Week 1.2 Weeks 2.3 Weeks 3.4 Weeks Total under 1 Month. 1.3 Months 3.6 Months 6.9 Months 9.12 Months All Certified Causes Uncertified 4 1 2 2 9 1 2 4 1 17 Diarrhoea 1 1 1 2 Basic Meningitis 1 1 Pneumonia 1 1 Congenital Debility 3 2 5 1 6 Other Defined Diseases 1 1 1 3 1 2 6 Deaths from Violence 1 1 4 1 2 2 9 1 2 4 1 17 33 METEOROLOGICAL OBSERVATIONS TAKEN AT HAEEOW DUEING THE YEAE ENDING DECEMBEE 31st, 1921. By J. PERCY BENNETTS, Engineer and Surveyor. Month Hygrometer. Temperature. Rainfall Dry Bulb Wet Bulb Max. Mill. Earth Total Depth Greatest Fall in 24 Hours No. of Days on which •01 or more fell 1ft. 4 ft. Depth Date January. Means 44.19 43.25 50.45 40.41 44.16 45.83 2.97 Highest 53.00 51.00 55.00 52.00 47.00 47.00 .55 7 23 Lowest 29.00 28.00 42.00 24.00 39.00 40.00 ... ... ... February. Means 37.89 36.64 48.21 34.32 40.96 44.89 ... ... ... ... Highest 47.00 45.00 79.00 44.00 44.00 46.00 .14 .09 26 5 Lowest 30.00 27.00 40.00 26.00 39.00 44.00 ... ... ... ... March Means 43.84 41.87 54.56 36.64 40.99 45.13 ... ... ... ... Highest 50.00 49.00 66.00 46.00 46.00 46.00 1.37 .30 6 13 Lowest 34.00 32.00 40.00 25.00 40.00 45.00 ... ... ... ... April. Means 45.16 42 90 57.26 11.56 45.40 16.00 ... ... ... ... Highest 58.00 56.00 72.00 6000 50.00 47.00 1.13 .39 13 8 Lowest 35.00 33.00 38.00 30.0C 32.00 40.00 ... ... ... ... May. Means 53.29 50.2.2 64.83 55.80 53.54 48.93 ... ... ... ... Highest 65.00 60.00 76.00 66.00 59.00 53.00 .98 .15 3 14 Lowest 40.00 39.00 46.00 45.00 48.00 47.00 ... ... ... ... June. Means 58.43 54.80 70.60 59.10 58.53 53.93 ... ... ... ... Highest 69.00 64.00 85.00 65.00 62.00 56.00 .12 .06 3 4 Lowest 54.00 48.00 61.00 51.00 56.00 53.00 ... ... ... ... July. Means 65.06 61.09 78.90 64.19 64.06 54.80 ... ... ... ... Highest 75.00 71.00 91.00 75.00 67.00 60.00 25 .07 80 6 Lowest 54.00 52 00 64.00 56.00 59.00 56.00 ... ... ... ... August. Means 59.54 58.32 71.32 60.12 61.80 60.00 ... ... ... ... Highest 67.00 66.00 81.00 69.00 65.00 60.00 2.38 1.04 23 8 Lowest 51.00 50.00 63.00 49.00 58.00 60.00 ... ... ... ... 34 Meteorological Observations (continued). Month Hygrometer Temperature. Rainfall Dry Bulb Wet Bulb Max. Min. Earth Total Depth Greatest Fall in '24 Hours. No. of days on which .01 or more fell. 1ft. 4ft. Depth Date September. Means 55.36 54.23 68.50 57.20 57.70 59.40 ... ... ... ... Highest 64.00 63.00 84.00 66.00 60.00 60.00 2.65 2.05 11 7 Lowest 42.00 42.00 56.00 47.00 50.00 59.00 ... ... ... ... October. Means 52.90 52.12 66.03 54.83 54.58 57.29 ... ... ... ... Highest 67.00 65.00 82.00 67.00 59.00 58.00 .84 .42 19 7 Lowest 39.00 38.00 48.00 41.00 48.00 56.00 ... ... ... ... November. Means 38.16 37.40 45.56 36.10 43.83 52.36 ... ... ... ... Highest 56.00 55.00 57.00 52.00 51.00 55.00 1.67 .39 2 9 Lowest 28.00 28.00 38.00 23.00 40.00 50.00 ... ... ... ... December. Means 42.54 41.67 49.87 37.22 41.97 47.77 ... ... ... ... Highest 55.00 50.00 56.00 48.00 45.00 48.00 1.32 .23 14 14 Lowest 28.00 27.00 41.00 28.00 39.00 47.00 ... ... ... ...