AC 439(1) AARROW M middy (hatn Miss.B.) HARRI The Urban District Council of Harrow Annual Report OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1934 E. W. CARYL THOMAS, M.D., B.Sc., D.P.H., Barrister-at-Law 68595 The Urban District Council of Harrow Annual Report OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1934 E. W. CARYL THOMAS, M.D., B.Sc., D.P.H., Barrister-at-Law 3 TABLE OF CONTENTS. page Officers of the Public Health Services 8 General Statistics 9 General Provisions of Health Services for the Area Hospital Provision 14 Ambulance 16 Clinics and Treatment Centres 17 Nursing in the Home 18 Laboratory Facilities 19 Legislation in Force 19 Sanitary Circumstances of the Area 23 Sanitary Inspection 30 Housing Statistics 32 Statistics of Inspections 32 Inspection and Supervision of Food 35 Isolation Hospitals 38 Infectious and Other Diseases 42 Diphtheria 43 Scarlet Fever 44 Other Diseases 48 Tuberculosis 50 Maternity and Child Welfare 52 Development of Services 52 Infant Mortality 54 Maternal Mortality 56 Infant Welfare Centres 58 Maternity Services 59 5 MEDICAL OFFICER'S REPORT. To the Chairman and Members of the Urban District Council of Harrow. Mrs. Webb and Gentlemen, In presenting this report on the Health and Sanitary Circumstances of the District for the year 1934, it is my pleasure to be submitting my first Annual Report as your first full-time Medical Officer of Health. By the Middlesex Review Order, 1934, made in pursuance of powers under Section 46 of the Local Government Act, 1929, the Urban Districts of Harrow-on-the-Hill and Wealdstone and the Rural District of Hendon were abolished as from April 1st, 1934, the new Urban District of Harrow being formed. This new district, comprising some 12,500 acres, is roughly rectangular in shape, of dimensions five by three to four miles, lying in north-west Middlesex, being bounded on the east by Hendon Borough, on the south by Wembley Urban District and Ealing Borough, on the west by Ealing and Ruislip-Northwood, and to the north by Watford Rural District. The Harrow-on-the-Hill area of some 2,000 acres lies in the southern portion of the new district, with Wealdstone, of some 1,000 acres, lying to its north and north-east. Fringing these districts to north-east, north and west is the former Hendon Rural District, of some 9,000 acres, which included the parishes of Great Stanmore, Little Stanmore, Harrow Weald and Pinner. In all these districts development has been taking place of recent years. The population of Harrow-on-the-Hill, 19,460 at the 1929 census, was estimated to be 31,690 in 1933; Wealdstone, from 13,439 in 1921 grew to 29,680 in 1933—but the greatest development has been in the former Hendon Rural District. This had a mid-year population in 1921 of 17,440 but one of 43,611 in 1931, while its estimated population in 1932 was 50,810 and 58,560 in 1933. During the year 1934 4,331 houses were erected, of which 896 were in Harrow-on-the-Hill, 113 in Wealdstone, and the remainder, a figure of 3,322, in the former Hendon Rural District. The district is divided into twelve wards. The area of the Harrow-on-the-Hill and Greenhill Ward is 938 acres and the estimated Local Government Electorate on the 1933 Register was 5,264. The corresponding figures for the other wards are : Harrow Weald—1,659 and 4,157, Headstone—618 and 4,981, Kenton—724 and 5,295, Pinner North—1,648 and 4,769, Pinner South—1,055 and 4,548, Roxeth—737 and 5,123, Stanmore North —2,823 and 3,841, Stanmore South—825 and 4,955, Wealdstone North—505 and 6,758, Wealdstone South—441 and 5,914, and West Harrow—555 and 5,062. The extent of the health services provided by the three constituent districts differed somewhat. Harrow-on-the-Hill area, 6 whose Medical Officer of Health was Dr. C. E. Goddard, was an autonomous maternity and child welfare authority, carrying out much of the work through the part-time services of the local District Nursing Association. This Council maintained its own Isolation Hospital at Rayners Lane, the patients in hospital being under the care of their own medical attendants, the Council paying the medical fees of necessitous cases. The Wealdstone Council (Medical Officer of Health, Dr. R. N. B. Bluett) was also a maternity and child welfare authority. The home visiting was undertaken by a single full-time health visitor. This Council in recent years erected two clinics at which all the infant welfare and ante-natal sessions were held. Infectious cases requiring hospital treatment were admitted to the hospitals of other authorities. In the Hendon Rural District (Medical Officer of Health, the late Dr. R. L. Romer) the maternity and child welfare services were provided by the Middlesex County Council. The local Council maintained its own Isolation Hospital at Honeypot Lane, the patients being under the care of the Medical Superintendent, the local Medical Officer of Health. In spite of the opposition of the Middlesex County Council, the new Harrow Council became the maternity and child welfare authority for this area. In the former Hendon Rural District, these services continued to be administered on behalf of the Harrow Council by the County Council up to 31st January of this year. The earliest steps were to promote a uniform service throughout the whole district, and to provide for all parts of the area the essentials of a service providing for home visiting of expectant and nursing mothers, and children under five, and infant welfare and ante-natal clinics. A number of full-time Health Visitors have been appointed, each of whom attends the infant welfare centre and ante-natal clinic for her own area, and also acts as Infant Protection Visitor for her own district, the arrangements previously operating in Harrow-on-the-Hill of health visiting by district nurses being terminated. A number of clinic buildings are to be erected, which, besides being of use for the holding of maternity and child welfare clinics, will be used by the school authorities for the provision of treatment for school children. One of the pressing needs of the district is for maternity beds. Not one of the three authorities was a Local Education Authority, with the result that the Middlesex County Council is responsible for the education for the whole district. The County Council was approached on the question of the provision of a combined nursing service, by which the same staff would act as school nurses for the Education Committee and as health visitors for the Maternity and Child Welfare authority. Such an arrangement, apart from the general advantages inherent in the same staff supervising the child at pre-school and at school ages, would have 7 been particularly advantageous in a rapidly growing district such as this, in that the members of the staff, each dealing with a smaller population, would the more readily have become known to the mothers. The proposal, however, did not find favour with the County Council, with the result that the health visiting and the work of the school nurses are carried out by separate staffs. Each of the Sanitary Inspectors has an allotted district, in respect of which he carries out all the duties of the District Inspector. Complaints of nuisances are numerous and investigations take up much of the time of the staff. The increased duties resulting from recent legislation in connection with the Shops Acts has also added much work—though the more recent of these added duties are more closely allied to the work of the sanitary inspector than were most of the previous duties which call more for a policeman's than for a sanitary inspector's outlook, and for this reason it is now more rational for the duties in connection with the Shops Acts to be undertaken by the sanitary inspectors rather than by special officers. The value of those vital statistics by which the health of a district is gauged is negatived to a certain extent by reason of the abnormality of the age distribution of the population. A high proportion of low-aged persons in the population lowers the crude death rate, and is often associated with a high birth rate. The infant mortality rate for the district is slightly below that for the country as a whole, but the maternal mortality rate is distressingly high. Of the notifiable infectious diseases, scarlet fever displayed, especially towards the end of the year, a high incidence, but the figures for diphtheria were low throughout the year. Notifications from tuberculosis in a growing district tend to be high, as over a short period of time cases are brought to the notice of the Authority which have contracted the infection not necessarily recently but over a period of years. I desire to thank the members of the Council and the administrative staff for the help they have given me. I have the honour to be, Mrs. Webb and Gentlemen, Your obedient servant, E. W. CARYL THOMAS, Medical Officer of Health. Council Offices, Harrow-on-the-Hill. 24th June, 1935. 8 OFFICERS OF THE PUBLIC HEALTH SERVICES. Full-time Staff. Medical Officer of Health: E. W. CARYL THOMAS, M.D., B.Sc., D.P.H., Barrister-at-Law. Assistant Medical Officer of Health: O. C. DOBSON, M.D., B.Hy., D.P.H. Senior Sanitary Inspector: A. B. KRAMM, M.R.San.I., Cert. R.S.I., Meat Inspector's Cert., Cert. Sanitary Inspector's Examination Board. Sanitary Inspectors: H. DRABBLE, Cert. R.S.I., Meat Inspector's Cert. A. C. GROOM, A.R.San.I., Cert. R.S.I., Meat Inspector's Cert. J. E. JOHNSON, Cert. R.S.I., Meat Inspector's Cert. S. N. KING, Cert. R.S.I., Meat Inspector's and Smoke Inspector's Cert. P. SCHOFIELD, Cert. R.S.I., Meat Inspector's Cert. Senior Health Visitor: MRS. D. BRACE, General trained, C.M.B., New H.V.'s Cert. Health Visitors: MISS COUZENS, General trained, C.M.B., New H.V.'s Cert. MISS DOULL, General trained, C.M.B., New H.V.'s Cert. MISS LEE, General trained, C.M.B., New H.V.'s Cert. MISS MARSHALL, General trained, C.M.B., New H.V.'s Cert. MISS REED, General trained, C.M.B., New H.V.'s Cert. Matron of Isolation Hospitals: MISS V. R. THOMAS, S.R.N., C.M.B. District Fever Nurse: MISS V. G. ROBERTSON. Part-time Staff. Consultant Gynæcologists: MARGARET BASDEN, M.D., F.R.C.S., F.C.O.G. R. CHRISTIE BROWN, M.S., F.R.C.S., M.C.O.G. Consultant Surgeon: R. TREVOR JONES, B.Sc., M.B., B.S., F.R.C.S. Medical Officers, Infant Welfare Centres: N. BEAUMONT, M.B., B.S. E. M. BRAND, L.M.S.S.A. L. PARKER, M.D., M.R.C.P. 9 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 12,558 Registrar-General's estimate of resident population, mid-year, 1934 132,049 Number of inhabited houses (end of 1934) according to Rate Books 38,024 Rateable value £1,439,859 Sum represented by a penny rate £5,530 Social Conditions of Inhabitants. Taken as a whole the district is residential in character, most of the employed working outside the area. Industry in the former Harrow-on-the-Hill area is practically limited to one small group of factories and workshops, employing less than 100 together, the only concern in this part of the district being a laundry engaging some 250 workers. The former Hendon Rural area, once arable land, has been converted into pasture land, and this in its turn is very rapidly being encroached on by the erection of housing estates. Most of the recent rapid development in the district has occurred in the 9,000 acres of this part, of which at the end of the year there were some 3,500 acres available for development. Wealdstone, of the three constituent districts, is the most industrialised. Its 1,000 acres at the end of 1933 held 7,643 houses, inhabiting some 30,000 persons. The industries, most of which are centrally situated, leaving the outlying areas residential in character, include printing works, photographic works, brush making works, sheet metal works, cabinet making works, glass works, and joinery works. None of the local forms of employment prejudicially affect the health of the workers. There is comparatively little unemployment in the district. The winter (December) figures reach 1,800 males and some 200 females, the number of unemployed males falling in the spring (April) to about half this figure. This reduction is chiefly due to the engagement of employees in the building trades. Extracts from Vital Statistics for the Year. Live Births:— Total. Male. Female. Legitimate 2,109 1,065 1,044 | Birth Rate per 1,000 of the estimated resident population, 16.4 Illegitimate 58 36 22 Stillbirths:— Legitimate 69 40 29 Rate per 1,000 total (live and still) births, 3.17 Illegitimate 2 1 11 10  Total. Male. Female. Deaths 1,076 540 536 Death rate per 1,000 of the estimated resident population, 8.1 Deaths from puerperal causes:— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 5 2.23 Other puerperal causes 8 3.57 Total 13 5.80 Death rate of Infants under one year of age:— All infants per 1,000 live births 47.0 Legitimate infants per 1,000 legitimate live births 43.6 Illegitimate infants per 1,000 illegitimate live births 172.6 Deaths from Measles (all ages) 12 „ Whooping Cough (all ages) 3 ,, Diarrhœa (under 2 years of age) 12 There was no noteworthy cause of sickness or invalidity during the year except the rather high incidence of scarlet fever in the latter part of the year. In the earlier months influenza was prevalent and exacted its toll, as did measles in those of younger ages. The incidence of diphtheria remained low throughout the year. Population. The mid-year estimate of population for the year 1933 was 119,930 and for 1934 132,049. The increase is partly due to the natural increase of population (i.e. the excess of births over deaths, this figure being 919 in 1933 and 1,091 in 1934) and partly to the occupation of the new houses erected (3,636 in 1933 and 4,331 in 1934). The number of inhabited houses at the mid-year was 35,805, the average number of persons per house being therefore 3.68, a figure lower than that previously recorded for the three constituent districts. Applying the same figure to the number of houses occupied at the end of the year gives a population figure of 139,480. Birth Rate. 2,167 births were registered during the year, the birth rate per thousand population being therefore 16.4, compared with the figure of 14.8 for England and Wales. This relatively high figure is to be accounted for, as is the low death rate referred to in the next paragraph, by the relative weighting of a young adult population. During the years 1930-33 the birth rate figures ranged in the Hendon Rural District from 13.74 to 18.08, in Wealdstone from 16.30 to 21.2, and in Harrow-on-the-Hill from 12.4 to 18.3. 11 Death Rate. Total deaths in the district 678 Outward transfers 61 Inward transfers 459 Deaths of residents 1,076 Of the 61 deaths of non-residents occurring in the district, 13 took place at the Orthopaedic Hospital, 7 at the Harrow and Wealdstone Hospital, and 31 in various local nursing and maternity homes. Of the 459 deaths of local residents which occurred outside this area most occurred in institutions, 155 taking place at Redhill Hospital and 69 at other county hospitals. 110 deaths occurred at various general hospitals in and about London. Six deaths took place in London maternity institutions, 5 at mental hospitals, 4 at isolation hospitals, and 20 at institutions for the treatment of tuberculosis. Twenty deaths occurred in different nursing homes. 1,076 deaths in the population of 132,049 represents a death rate per 1,000 population of 8.1, compared with 11.8 for England and Wales. This low rate must not be entirely construed as an indication of an extraordinary healthiness of the district, being due partly to the unusual age distribution of the population, a feature found in rapidly growing areas, in which the growth of population is largely determined by an influx of a section of population, who, because of their ages, possess a low death rate. That this is so can be seen from the following sets of figures in which the percentage distribution of the deaths amongst the various age groups for this district last year is compared with the corresponding figures for England and Wales for the year 1933. Percentage of Deaths. Under 1 year 1-2 2-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 Over 75 Local 9.3 0.9 2.3 3.5 3.1 7.4 7.3 9.2 13.9 20.9 21.9 England and Wales 7.5 2.0 1.9 2.3 3.4 4.1 4.9 9.9 17.2 22.7 23.9 It will be noticed in general, that for ages below 45 the percentage distribution in the column of local deaths is higher than the corresponding figures for the country as a whole, whereas for ages above 45 the reverse holds. If the local over-45 figures are raised to the general figure, the discrepancy between the two sets of figures for the under-45's is still more marked. That is to say, assuming the local over-45's to be dying at the rate the corresponding age groups do in the country, the under-45's show an appreciably higher rate, a fact which must be attributed to there being a relatively greater proportion of population at these age groups. 12 The fact that the 15-24 age group does not show the same excess as do the other under-45 groups is of significance, suggesting that there is not the same relative excess of persons at these ages as occurs in the other groups under 45. Amongst those under 45 there were 384 deaths. In 1933 in England and Wales the under-45's contributed 26.1 per cent. of the deaths. If the population were normally constituted and those over-45 were here in the same proportion as those under-45, applying this ratio there should have been in the district 1,471 deaths (as against the 1,076 which actually occurred), giving a death rate of 11.1 as compared with the figure of 11.8 for the country as a whole. On this basis much of the low rate can therefore be ascribed to the abnormal age distribution of the population. The Registrar-General now issues a comparability factor for adjusting local mortality rates for the purpose of making comparison between districts, the object being to eliminate variations in the death rates due to abnormal features in the age distribution of the population. The figure of the crude death rate multiplied by this factor gives a corrected death rate, which is a hypothetical figure indicating the death rate that would have occurred in the standard population, which standard is taken as the present age distribution of the population of the country as a whole. Owing to the changes consequent on amalgamation, three figures have been issued, namely, one of 1.07 for Harrow-on-the-Hill for the first quarter of the year, one of 1.25 for Wealdstone for the same period, and one of 1.17 for the whole district for the rest of the year and including Hendon Rural District for the first quarter. Applying these figures to the various groups gives a corrected death rate of 9.5, compared with a national figure of 11.8. The development of the area has of recent years taken place mostly in the former Hendon Rural District. The census figures for 1921 and 1931 in the Harrow-on-the-Hill area were 19,460 and 26,990, the figure of estimated population in 1933 being 31,690. The corresponding figures for Wealdstone were 13,439, 27,001, and 29,680, but for the Hendon Rural District were 17,440, 34,611, and 58,560. The district with relatively the smallest development, namely Harrow-on-the-Hill, showed the highest death rate, the figures for the years 1930-33 ranging from 7.58 to 9.45. Wealdstone gave an intermediate figure ranging from 7.1 to 8.45, whilst Hendon Rural gave the lowest, with the range of 5.85 to 7.57. As long as the population of the district continues to grow by reason of the influx of a relatively low-aged population, the death rate figure will remain low, and might even fall below that at present recorded. On cessation of development, for a time the effect of the child population will tend to keep it down. But thereafter with the ageing of the population the rate will steadily rise. 13 Of the deaths due to the infections expressed per 1,000 population, scarlet fever showed a marked excess over the figure for the country as a whole, having a rate of 0.07 compared with 0.02. The local fatalities from the other infections were similar to the national rates, being identical at 0.09 in the case of measles, and slightly less for whooping-cough (0.02 compared with 0.05), influenza (0.12 as against 0.14), and diphtheria (0.06 as against 0.10). Deaths from tuberculosis, pulmonary and non-pulmonary, in proportion to the population were at a lower rate than those for the country as a whole. The infant mortality rate for the district was below the average, while the maternal mortality rate was high. 156 deaths from cancer were registered during the year, 70 being of males and 86 females. The stomach was the site most commonly affected, accounting for 15 females and 18 males, the colon being the next most frequently affected site, accounting for the deaths of 13 males and 18 females. Eighteen females died of breast cancer, 11 from a lesion of the uterus, and seven of the ovary. Ten deaths, equally divided in the sexes, were due to carcinoma of the lung, and nine, four male and five female, to cancer of the rectum. Carcinoma of the pancreas was limited to males, accounting for six deaths. In 1933 the recorded deaths from cancer per million living in England and Wales were 1,526, the deaths amongst females being slightly commoner than those amongst males. The corresponding rate for this district for last year was 1,151. The figure of 23 suicides gives a rate of 16 per 100,000 population, compared with a figure of 14 for the country as a whole in 1933—but whereas the figure for England and Wales is divided in the proportion to three males to one female, the figure of 23 is comprised of 19 males and 4 females. The means most commonly used was coal gas poisoning, this method being favoured by six males and two females. Three male suicides were by cut-throat and three by hanging. One male and one female each chose death by drowning, and one of each sex by lysol poisoning. The age of half the males was in the decade 45 to 54, the oldest male suicide being 77 and the youngest 20. 14 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Hospitals provided or subsidised by the Local Authority or by the County Council. a. (1) Fever. There are two Isolation Hospitals in the district, that at Rayners Lane previously maintained by the Harrow-on-the-Hill Council, and that at Honeypot Lane, previously maintained by the Hendon Rural District Council. (2) Smallpox. The Middlesex County Council is the Authority for the provision of hospital accommodation for smallpox for the whole of the administrative county. By agreement with the London County Council, cases of smallpox in Middlesex are removed to the observation station at South Wharf, Rotherhithe, thence for treatment to one of the River Hospitals. b. Tuberculosis. The Middlesex County Council is the Authority by whom arrangements are made for the treatment of those in the county suffering from tuberculosis. The number of tuberculous patients in hospitals and sanatoria under the County Council's Tuberculosis scheme ranged in 1933 from 900 to 1,000. This is apart from the number of patients undergoing treatment in public assistance and general hospitals. The County Council possesses in its own sanatoria some 500 beds for the treatment of tuberculosis. At the County Sanatorium, Harefield, an institution for pulmonary cases, there are 129 beds for males, 129 beds for females, and 56 for children, and in addition, 12 beds for observation cases. The County Sanatorium, Clare Hall, South Mimms, for late sanatorium and hospital pulmonary cases, has 120 male and 66 female beds. Non-pulmonary disease in children is treated at one of the 25 beds at Heatherwood Hospital, Ascot, or at one of the 6 beds reserved at Victoria Home, Margate. Tuberculous patients for whom institutional accommodation is required and who cannot be accommodated at these institutions are admitted to various voluntary hospitals and sanatoria, where the cost of their maintenance is met by the County Council. Hospitals for General Cases. (1) Hospitals for Medical and Surgical Cases. There are two hospitals in the district, the Cottage Hospital, Stanmore, an institution of eight beds for the treatment of local cases of disease, and the Harrow and Wealdstone Hospital with a complement of seventy-one beds, comprised of twenty male beds, 15 twenty-five female beds and thirteen children's cots in the public wards, and thirteen private beds. The out-patients' department is maintained chiefly for casualties and consultations, though the hospital provides massage, electrical and sunlight treatment for out-patients at "Tyneholme." The total number of in-patients admitted during the year 1934 was 1,321, and the total number of out-patients was 3,396, of whom 2,752 were seen at the hospital (350 accidents, 1,166 consultations and treatment, and 1,236 X-ray examinations), and 644 at "Tyneholme" (436 for massage and 208 for sun-ray treatment). The other hospital most used by local inhabitants is the Redhill County Hospital. This building, originally planned to contain 175 beds and cots and eighteen maternity cradles was by certain additions between 1928 and 1933 extended to its present complement of 215 beds. This figure is made up of seventy-one male beds (32 medical, 32 surgical and 7 ear, nose and throat), sixtythree female beds (29 medical, 29 surgical and 5 ear, nose and throat), twenty-six maternity beds, twenty cradles and six isolation beds, twenty-six general beds for children and six for ear, nose and throat, and two beds for sick nurses. At the Redhill Institution there are thirty-four male beds and seventy-seven female beds for the chronically sick. The hospital draws its patients mostly from Harrow, Hendon and Wembley, the distribution in 1933 being that of 3,782 patients admitted, 1,083 came from Harrow, 1,904 from Hendon and 733 from Wembley, the remaining sixty-two coming from other Middlesex districts. Of the other county hospitals, the only one used to any extent by local patients is the Central Middlesex County Hospital, an institution of 831 beds, of which 187 are for acute male cases, 192 for acute female cases and 114 for children. Of the 5,042 patients admitted in 1933 to this Institution, 638 came from Harrow and Hendon. Three other smaller hospitals near the boundaries of the district are used to a certain extent. The Northwood, Pinner and District Hospital has eight male, twelve female and six children's beds in the public wards, and eleven private beds, totalling thirty-seven. An out-patients' department is maintained and there are also the following special departments: X-ray (diagnostic), light treatment and massage. The Wembley hospital contains fifty-five beds. The out-patients department is limited to casualties only. The special departments include X-ray (diagnostic), electrical and light treatment. At Windmill Lane, Bushey Heath, is the Bushey Heath Cottage Hospital with twenty-four beds. (2) Hospitals for Maternity Cases. Arrangements are made for the admission of maternity cases to various of the London Maternity and General Hospitals. The 16 Council pays the fees of necessitous cases for whom such arrangements have been made. Cases of puerperal infection are admitted either to the London County Council North-Western Fever Hospital, or to Queen Charlotte's Isolation Hospital. (3) Hospitals for Children. Apart from the arrangements by which cases of ophthalmia neonatorum are admitted to St. Margaret's Hospital, Hampstead, there was at the end of the year no provision made for the admission of children to hospital. (4) Orthopædic Hospitals. No provision is made for the admission of orthopaedic patients to institutions. Ambulance Facilities. (a) For Infectious Cases. Infectious cases are removed either by the Morris ambulance at the Rayners Lane Hospital, or by the Austin ambulance at the Honeypot Lane Hospital. (b) For Non-infectious Cases and Accidents. Harrow-on-the-Hill Council maintained a 20-h.p. Austin ambulance, housed at the Fire Station, driven by the firemen, who are on call at all times. The Wealdstone Council housed at the Fire Station a 14-h.p. Morris ambulance. In December, 1934, a 20-h.p. Talbot ambulance was put into commission at the Wealdstone Fire Station, the Morris ambulance from that time being used as a stand-by. The ambulance service provided by the Wealdstone Council was free to residents, though a charge was made to non-residents, whilst for the use of the Harrow-on-the-Hill ambulance a charge was made to all. Arrangements were in operation by which patients in the Hendon Rural area were removed by the Harrow ambulance. The Council at their meeting on July 31st decided that no charge be made to residents within the Harrow Urban District for the use of any ambulance under the control of the Council. Reciprocal arrangements were entered into with the neighbouring authorities of the Borough of Hendon, the Urban District of Ruislip-Northwood, the Borough of Ealing, the Urban District of Wembley, and the Borough of Watford. 17 Clinics and Treatment Centres. The following is a summary of the various clinics and treatment centres in the district: Infant Welfare Centres. All sessions at the infant welfare centres are held in the afternoons. St. Hilda's Hall, Northolt Road, South Harrow—Thursday and Friday. Conservative Club, Lowlands Road—Tuesday and Friday. (These clinics were previously maintained by the Harrowon-the-Hill Council.) Elmwood Clinic, Kenton—Wednesday and Friday. Broadway Clinic, Wealdstone—Tuesday and Thursday. (These clinics were previously maintained by the Wealdstone Urban District Council.) The following clinics were provided by the Middlesex County Council, by whom they were maintained until the end of the year : Memorial Hall, High Road, Harrow Weald—Monday and Thursday. St. George's Hall, Headstone—Tuesday and Wednesday. Free Church Lecture Hall, Paines Lane, Pinner—Friday. Whitchurch Institute, Whitchurch Lane, Stanmore—Friday. Ante-Natal Clinics. An ante-natal clinic was provided by the Wealdstone Urban District Council at the Elmwood Avenue Clinic, being held on the afternoon of the second Monday of each month. The Middlesex County Council provided an ante-natal clinic at St. George's, Headstone, on the afternoon of the last Thursday of the month. In June, 1934, a monthly session was opened at the Broadway Clinic, being held on the fourth Monday of the month. At "Tyneholme" a weekly ante-natal clinic was held on Tuesday afternoons. Owing to the large attendances, this service was supplemented by holding an evening session in addition. Treatment Centres. Provision for treatment is made mainly at "Tyneholme," Headstone Drive, Wealdstone, run by the Council of Child Welfare. The scope of the work includes dental treatment, massage, sunlight treatment, and treatment of visual defects. The following is a list of the clinics and the times they are held:— Dental Clinic Saturday, 10 a.m., 2 p.m. Eye Clinic First Tuesday of the month, 1.30 p.m. Massage Clinic Mondays, Wednesdays, Fridays, 1.30 p.m. Sunlight Clinic Tuesdays and Thursdays, 9 a.m. 18 The following clinics for adults are held on behalf of the Harrow and Wealdstone Hospital:— Massage Clinic Mondays, Wednesdays and Fridays, 5 p.m. Sunlight Clinic Mondays, Wednesdays and Fridays, 5 p.m. School Clinics. Minor Ailment Clinics are held once weekly at Roxeth Hill Council School, Harrow, and twice weekly at the Baptist Church Parlour, Wealdstone. Dental treatment is provided for Harrowon-the-Hill and Wealdstone school children at "Tyneholme," and for the Hendon Rural District children at the Whitchurch Institute. Treatment of visual defects amongst school children is carried out at a clinic in Wembley. Tuberculosis Clinic. A local Tuberculosis Dispensary is maintained at 25, Greenhill Crescent, Harrow, on Thursday afternoons. This is a branch dispensary, the main one which serves an area which includes Harrow, Wembley, Willesden and Ruislip-Northwood, being situated at Pound Lane, Willesden. The work carried out at the tuberculosis dispensary is mainly consultative and advisory in character, active treatment not being undertaken to any considerable extent. Venereal Diseases. There is no treatment provided locally for persons suffering from venereal disease. Provision is made under the London and Home Counties Scheme, the only centre in the county providing this treatment being the Prince of Wales's Hospital, Tottenham. Professional Nursing in the Home. (a) General. There are three Nursing Associations in the district, one at Pinner, one at Stanmore, and the Harrow, Wealdstone and Harrow Weald Nursing Association. Each of the first two employs one nurse-midwife. The other now covers most of the rest of the Harrow Urban District. In the Harrow-on-the-Hill area years ago there was a nurse at work, and from 1898 a regular report of the Harrow District Nursing Fund was issued. The work was carried out in association with the Harrow Hospital, being managed by the Managers of the Hospital. From early 1933 this close association with the Hospital ceased, a new body being formed as the Harrow District Nursing Association, affiliated to the Queen's Institute of District Nursing. In August, 1932, a similar Association was formed in Wealdstone, and in January, 1933, the service was extended to Harrow Weald, a Committee being formed which worked in conjunction with the Wealdstone Committee. In January, 1934, the service was completely remodelled by the 19 merging of these associations into the Harrow, Wealdstone and Harrow Weald Association, a Nurses' Home being opened in February at 17, Hindes Road. The staff now consists of five nurses working under a superintendent. During the first year the nurses paid 19,703 nursing visits, and also carried out 2,705 visits under the maternity and child welfare services of the Harrow-on-the Hill Council. The Association has a Provident Scheme which entitles families to free nursing for the husband and wife and children under 16, open to all whose incomes are within the National Health Insurance limit, for 5s. a year. (b) Nursing of Cases of Infectious Diseases. The former Wealdstone Urban District Council employed a nurse to carry out a modification of the Milne treatment to cases of scarlet fever who remained at home. As from October this practice has been discontinued, the nurse now being engaged in advising those home treated cases in such matters as sick nursing and, particularly, concurrent disinfection. Midwives. There are no midwives in the district directly employed by the local authority, though arrangements are in force under which the midwife is paid by the Council her fees for attendance on necessitous patients. At the end of the year there were 28 midwives practising in the district. Laboratory Facilities. Examination of clinical material is undertaken at the Laboratories of the Clinical Research Association. During the year 987 swabs were examined for the diphtheria bacillus, and 78 for hæmolytic streptococci, 119 samples of sputum for the tubercle bacillus, and 22 other samples for various purposes. The same laboratory also undertakes the bacteriological examination of milk, of which 48 samples were examined during the year. Legislation in Force. The following is a summary of the various adoptive Acts in operation in the three former districts:— Infectious Disease (Prevention) Act, 1890: In all three districts. Public Health Acts Amendment Act, 1890: Parts II and III in Harrow-on-the-Hill; Part III in Wealdstone; and the following sections of Part III in Hendon Rural: 16-19, 21, 25, 26 (2), 28, 32, 33, 47, and 49. 20 Public Health Acts Amendment Act, 1907: In Harrow-on-the-Hill: Parts II and III, ss. 52-65, 67, 68 of Part IV; Parts V and VI; ss. 81 (modified), 84 and 86 of Part VII; Parts VIII and IX; and s. 95 of Part X. In Wealdstone, Parts II, IV and VI, ss. 34-38, 43-45, 47, 50 and 51 of Part III, ss. 81 (modified) and 86 of Part VII, and s. 95 of Part X. In Hendon Rural : ss. 15, 17, 19, 20, 29, 30 and 33 of Part II, ss. 34-38, 43-46, 49 and 50 of Part III, ss. 52-59 and 61-67 of Part IV, and ss. 76 and 77 of Part VI. Maternity and Child Welfare Act, 1918, by Harrow-on-the-Hill, and Wealdstone. Local Government and Other Officers' Superannuation Act, 1922, by Harrow-on-the-Hill and Wealdstone. Public Health Act, 1925, by Harrow-on-the-Hill, and by Wealdstone, and the following sections by Hendon Rural: ss. 13-21, 23, 25, 26, 29-43, 56, 77, 83, and 84. Baths and Washhouses Acts, 1846-1899, by Harrow-on-the-Hill. Private Street Works Act, 1892, by Hendon Rural. The following sections of the Public Health Act, 1875, were in operation in the Hendon Rural District: 44, 47, 66, 112-114, 154, 159 (2) and (3), 160 (1) and (3), 170 and section 34 of the Middlesex County Council (General Powers) Act, 1906. Bye-laws were in force in all three districts in respect of Common Lodging Houses, Slaughter Houses, Prevention of Nuisances, Houses let-in-Lodgings, and New Streets and Buildings. In Harrow-on-the-Hill there were also bye-laws with regard to Cleansing of Earth Closets, Privies and Cesspools, Removal of House Refuse, Provision of Means of Escape in Case of Fire, Factories and Workshops, Pleasure Grounds and Open Spaces, and Fish Frying. In Wealdstone, there were bye-laws with regard to Public Cemeteries and Public Recreation Grounds; and in the Hendon Rural District with regard to Removal of House Refuse, Cleansing of Footways and Pavements, and Recreation Grounds. THE FOLLOWING SECTIONS OF THE MIDDLESEX REVIEW ORDER, 1934, RELATE TO LEGISLATION OF THE DISTRICT. Acts or Orders Affecting Boroughs and Districts. 42 (1) Subject to the provisions of this Order, the unrepealed provisions of (a) any local Act or provisional order confirmation Act affecting any borough or urban district which is altered but not abolished; and (b) any Order having the force of an Act which affects any such area, shall apply to the altered area, and any reference therein which is applicable to the existing area shall be considered as a reference to the altered area. 21 Adoptive Acts. 45 (1) The provisions of any public general Act in force throughout an abolished district (Harrow-on-the-Hill Urban District) by virtue of an adoption by the Council thereof, and any order under any such Act in force shall apply to the new Urban District (Harrow Urban District). (2) The provisions of any public general Act in force throughout any borough or district which is altered but not abolished by virtue of an adoption by the Council thereof shall apply to the altered borough or district, and any order so in force under any such Act shall apply to the altered borough or district; provided that such statutory provisions and such order shall, subject to the provisions of this Article, cease to have effect in any area transferred from the borough or district. (3) Any reference in this Article to a council shall be deemed to include reference to the predecessors of that council. Burial Areas. 46 (1) The Burial Acts, 1856 to 1906, shall be in force force throughout the altered Urban District of Harrow. (2) The Council of . . . such new or altered urban district shall be the burial authority for the new or altered area and shall exercise or perform within it (to the exclusion of any other burial authority) all the powers, duties and liabilities of a burial board under the Burial Acts. 51 (1) The Harrow burial board and Roxeth burial board shall be dissolved. Infectious Disease (Notification) Act, 1889. 54 (1) Any order in force under the Infectious Disease (Notification) Act, 1889, throughout the urban district of Harrowon-the-Hill shall apply and be in force within the new urban district of Harrow. Acts Relating to Midwives and Maternity and Child Welfare. 55 (2) For the purposes of the Notification of Births Acts 1907 and 1915, and the Maternity and Child Welfare Act, 1918, the Council of the new urban district of Harrow shall be the authority for the . . . new district. Orders under Public Health Acts Amendment Act, 1907, and Public Health Act, 1925. 59 Subject to any order which the Minister or Secretary of State may make to take effect on or after the appointed day, the following provisions shall have effect as regards orders made under the Public Health Acts Amendment Act, 1907, and the 22 Public Health Act, 1925:—(a) Any order by virtue of which any Part or Section of either of these Acts is in force throughout the urban district of Harrow-on-the-Hill, and any other order under either of those Acts so in force shall apply to the new urban district of Harrow. County Bye-laws. 62 (5) Subject as aforesaid, any bye-laws made by the County Council and in force within any borough or district which is altered but not abolished shall apply to the altered borough or district. Borough and District Bye-laws. 63 (1) Subject to the provisions of the (County bye-laws) any bye-laws which were made made by . . . (b) the Council of any borough or urban district which is altered but not abolished and confirmed by the Secretary of State, other than bye-laws which would now require to be confirmed by the Minister, (c) the council of any borough or urban district which is altered but not abolished with respect to any park, pleasure ground, or open space, or under the Education Act, 1921, or any enactment repealed by that Act, or under the Public Libraries Act, 1901, shall apply to the altered borough or district until the bye-laws are repealed or altered. (2) Save as aforesaid, any bye-laws in force which were made by the council of any borough or district which is altered or abolished shall continue to apply to the area to which the byelaws extend:— (a) If made before the 1st day of January, 1924, for one year after the appointed day (unless previously repealed or altered) but no longer; (b) If made on or after the 1st day of January, 1924, until they are repealed or altered; and any bye-laws so continued in force in a transferred area shall have effect as if they had been made by the council of the borough or district to which the area is transferred. 23 SANITARY CIRCUMSTANCES OF THE AREA. Water. Most of the district is served by the Colne Valley Water Company, a small portion only of the southern part of the Roxeth Ward known as Wood End Estate being served by the Rickmansworth and Uxbridge Valley Water Company. A constant supply is laid on to each house. Occasional complaints are received from occupants of premises supplied by the Colne Valley Water Company in respect of chalky or ferruginous deposits. The supply from the Rickmansworth and Uxbridge Valley Water Company proves unsatisfactory in quantity at times, apparently due to the tapping of the supply nearer its source, the part of the district served by this company being at the end of the main. The company anticipates the deficiency will be rectified by the installation of a booster. The results of analysis of any samples taken have proved satisfactory. Drainage and Sewage. The separate system of drainage is in operation in practically the whole district, the flow from the soil sewers being to the sewage farms, and from the surface sewers direct to water courses. There are five sewage farms in the district:— Harrow Sewage Farm, Newton Farm, Rayners Lane, Harrow.—The treatment consists, after passage through screening chambers, in the flow through detritus tanks (four with a total capacity of 17,600 gallons), to sedimentation tanks (four with a total capacity of 517,000 gallons), followed by broad irrigation, 51 of the 60½ acres of the farm being used for this purpose. In addition there are 5½ acres for treatment of storm water. The effluent discharges into streams leading to the Yeading Brook. The estimated population draining to this farm in 1932 was 20,500, being most of the Harrow-on-the-Hill area, a small part of Pinner and some property in Ealing. Wealdstone Sewage Disposal Works, Elmgrove Road, Wealdstone.—These works, which occupy 31¾ acres are divided into High and Low Level Systems, and comprise screening chambers in duplicate, detritus and sedimentation tanks, and 24 percolating filters, fed by rotary distributors. After passage through humus tanks, the effluent discharges into the brook. Sludge is treated in lagoons. 12,536 houses drained into the works, being 7,561 in the Wealdstone area, 1,827 from the Greenhill district of the Harrow area, and 3,148 in the Hendon Rural area. Cannons Lane, Pinner.—After passage through sedimentation tanks, the sewage passes through percolating filters and humus tanks, the effluent discharging into the Yeading Brook. This area of the farm is 49 acres, part of the higher ground being used for the ploughing in of the sludge. These works take the sewage from the Parish of Pinner and part of Harrow Weald. 24 Honeypot Lane, Great Stanmore.—Most of the Parish of Great Stanmore drains to the sewage works at Honeypot Lane, being treated here by sedimentation and broad irrigation, the effluent discharging into the Edgware Brook. Little Stanmore Sewage Works.—These works, which occupy a site of 24½ acres near Honeypot Lane, treat the sewage from Little Stanmore, the lower part of Great Stanmore, and part of Harrow Weald. The treatment consists of the passage of the sewage through sedimentation tanks, percolating filters and humus tanks, the effluent being discharged into the Kenton Brook. Sludge is pumped on to high ground and is ploughed in. All the sewage works will be abandoned when the West Middlesex Branch Scheme is completed by, it is anticipated, the end of the current year. Rivers and Streams. The river Pinn rises in the Royston Park Estate near the northern boundary of the district. Running in a southerly direction to High Street, Pinner, during which part of it is partly open and partly culverted, it changes its direction, running westerly to cross the district boundary between Cuckoo Hill and Eastcote Road. The Yeading Brook rises in two sources, the one near the Recreation Ground, Pinner Road, the other near Moat Farm. These two streams, which are partly culverted, join at Hooking Green Bridge, from where the Brook runs in a south-westerly direction to the Hendon Rural District Sewage Works at Pinner, this portion of its length being open. Rising in Harrow Weald, the Wealdstone Brook runs in an easterly direction through Wealdstone, crossing out of the district at the Kenton Road near Kenton Grange farm. The Kenton Brook, rising in Kingsbury, passes near the Little Stanmore Sewage Farm to flow in a southerly direction out of the district, later joining the Wealdstone Brook. The Edgware Brook, which rises in two sources south of the Stanmore village, flows in a southerly direction to the Great Stanmore Sewage Works, then easterly towards Edgware, later to run into the Silk Stream. The water courses, which are in many places culverted, receive the flow from the surface water sewers. Owing to the admission to these channels of yard washings, etc., nuisances arise where the watercourses are exposed. Closet Accommodation. There are no houses in the Harrow-on-the-Hill area without closet accommodation, only one in Wealdstone, and a few in the Hendon Rural District. Public Cleansing. Refuse Collection. In Harrow-on-the-Hill and Wealdstone domestic dry refuse was collected by direct labour, the plant in the case of the former 25 district being three S. and D. freighters (10 c. yards), one Morris van (14 c. yards) and one horse and cart (part time), and in the case of the latter, one S. and D. freighter (12 c. yards), one Fordson Tractor and three trailers, and one 30-cwt. Dennis lorry. Weekly collections were made to 7,900 private and 700 business premises in Harrow, and 7,284 private premises in Wealdstone, the annual amount of refuse collected being in the two districts respectively 6,450 and 5,146 tons, being a weekly average of 124 and 97 tons, the cost of collection per ton being 11s. and 8s. lOd. In the Hendon Rural District a weekly collection was carried out by contract, the annual amount of 9,360 tons, or 180 tons weekly, being collected from 16,000 premises at a cost of 11s. 1d. per ton. In May, 1934, the Council resolved that the collection of refuse for the whole area be carried out by direct labour, and in July resolved on the purchase of six 15-c. yard rear-loading movablefloor vehicles for collection. The arrangement for the collection of trade refuse differed in the three districts. In Harrow-on-the Hill eight bins were collected free, a charge being made for collecting over this number up to sixteen, and a charge was also made for any extra weekly collections. Disposal at the works was permitted up to one ton, a charge of 4d. per cwt. being made for amounts exceeding this. In Wealdstone a charge of 6s. per load of 2¼ cubic yards was made to cover collection and disposal, and a charge of 3d. per cwt. for disposal only if delivered at the works. In Hendon Rural District traders made their own arrangements for collection and delivery at the shoots. In December, 1934, the following conditions were agreed on as governing the arrangements for the collection of trade refuse: (a) That the following arrangements and charges for collection and disposal of refuse from shops be approved:— (i) One free collection per week of two bins. (ii) Additional collections per week to be made, if required, at a cost of £3 3s. Od. each per annum. (iii) All bins in excess of two at any collection to be charged at the rate of 6d. per bin. (b) That a charge of £3 3s. Od. per annum be made for each collection of fish offal per week. (c) That a charge of 6s. 8d. per ton (or 4d. per cwt.) be made for the disposal of refuse delivered at the destructor. Refuse Disposal. At Harrow, refuse is dealt with by total incineration at a 4-cell Heenan and Froude Destructor, erected in 1932, at Rayners Lane. 8,250 tons per year, or 159 tons weekly, are disposed of at a cost of 4s. 1d. per ton. Wealdstone dry refuse has since 1928 been treated at a 3-cell Heenan and Froude Separation Plant adjoining the sewage works at Wealdstone. The refuse is tipped into a hopper, raised by an enclosed elevator, and discharged into circular rotatory screens, passing from these to a travelling picking 26 belt where it is sorted by hand and iron waste removed by a magnetic selector. The tailings are discharged on the floor near the destructor furnace which is hand fed. 5,266 tons a year, or 99 tons a week, were disposed of at a cost of 6s. 2d. a ton. The refuse from the Hendon Rural District is disposed of by controlled tipping at a shoot in Pinner. Cesspool Emptying. In Wealdstone there is one cesspool and three in the Hendon Rural District. All are emptied by the owners. Disinfection. In the former Hendon Rural District, on the occurrence of a case of infectious disease, infected rooms were fumigated with formalin, and bedding, etc. removed to the Isolation Hospital for steam disinfection. In the Wealdstone district, infected premises were disinfected by formalin gas and sprayed, the work being similarly undertaken in premises occupied by patients suffering from cancer or tuberculosis. No charge was made for the work which was carried out by the Sanitary Inspectors. In the former Harrow-on-the-Hill district, disinfection of infected premises was carried out by the Fever Hospital staff at the time they called to remove the bedding, etc., to the hospital for steam disinfection. Fumigation was also carried out by members of the Hospital staff of premises infested with bugs or other vermin, and bedding and clothing were removed for stoving after scabies. Premises and bedding were also disinfected on the occurrence of non-notifiable disease, a charge being made for the latter class of work. In November, 1934, it was agreed that fumigation and stoving be carried out free of charge at premises infected with a notifiable disease; in other cases fumigation only to be undertaken when demanded, an appropriate charge being made in each case. These charges were later fixed at 7s. 6d. per room fumigated and for stoving 10s. for the first and 5s. for each subsequent load. MORTUARIES. The following is a copy of the report submitted on the mortuaries in the district:— "There are three mortuaries in this district, situated at Paines Lane, Pinner, at Pinner Road, Harrow, and at Peel Road, Wealdstone. "The Pinner Mortuary is a brick structure with tiled roof 16 feet by 12 feet. It has a concrete floor, centrally drained to a cesspool. The lower parts of the walls are tiled and the upper parts are painted. There is a cold water supply to a sink and a separate sink without a tap which drains to a cesspool. Hot water is available by baling from a coke heated copper which is not drained. Natural lighting is poor, and the building is artificially 27 lighted by an oil lamp. There is no provision for heating. The fittings consist of one table with a trestle for relief. The mortuary is used about once a month, only for coroners' cases. The building is in good general repair, but if it is retained it should be provided with proper lighting and heating arrangements. "The Harrow Mortuary is a brick building 18 feet by 12 feet with a slate roof. It has a concrete floor centrally drained to a cesspool. The walls are distempered. There is a cold water supply to a sink which is drained to the cesspool, and hot water is obtained from a gas ring. Lighting is by gas, and heating by a gas stove. There is one table, with trestles as relief. This mortuary is used about once a week, being used not only for coroners' cases but also, to a limited extent, for depositing bodies from hospitals or from homes of limited accommodation. "The Wealdstone Mortuary consists of two brick buildings, the one being only used for the reception of bodies and the other as a post-mortem chamber. Both have white tiled walls and concrete floors. The latter building has a separate doctors' room with a sanitary annexe and is fitted with a revolving slab centrally drained to the sewer. Cold water is laid on to a drained sink and hot water obtained from an electric geyser. Lighting is by electricity and heating by an electric stove. The second building is fitted with four slabs and has a separate viewing chamber. This mortuary is used about once a week, chiefly for coroners' cases, being used for undertakers' cases only to a limited extent. "The Pinner and Harrow Mortuaries, while presenting no glaring deficiencies, do not bear comparison with the Wealdstone building. As this is centrally situated and has facilities for the reception of a number of bodies, there does not appear to be any reason for continuing the use of the other two buildings. It would be otherwise if more use were made of either for the reception of undertakers' cases, but apparently the practice is growing for local undertakers to provide their own reception chambers." In December, 1934, it was agreed that the use of the mortuaries at Pinner and at Harrow be discontinued. SWIMMING BATHS. There are two open-air swimming baths in the district, one at Charles Crescent, Honeybun Estate, Harrow, and the other at Christchurch Avenue, Wealdstone. The former, constructed in 1923, measures 165 feet by 75 feet with a depth of 7 feet to 3 feet 6 inches. The water is filtered by Turn-over Filter Company's filters and then treated by chlorination. Dressing accommodation, shower and foot baths, and sanitary conveniences are provided. The total cost was £12,450. The Wealdstone bath, constructed in time for the 1934 season, measures 165 feet by 75 feet, with a depth of 8 feet 6 inches to 2 feet 6 inches. In addition, there is a shallow semi-circular beginners' pool. Suitable dressing accommodation, 28 with shower and foot baths, and sanitary conveniences, are provided. The water is treated by passing through Candy Gravity filters and subsequently chlorinated. The baths cost £8,740. COUNCIL HOUSING. A total of 457 houses were erected by the Harrow-on-the-Hill Council, comprising 202 at the Honeybun Estate (180 under the 1919 Act and 22 under the 1923 Act), and 255 at the Eastcote Lane Estate (under the 1923 Act). Apart from 4 parlour-type houses with 4 bedrooms, all the houses on the Honeybun Estate have 3 bedrooms, and are made up of 14 bungalows, 14 doubledecker bungalows, 32 non-parlour and 138 parlour-type houses. The Eastcote Lane Estate houses are all non-parlour type, and consist of 72 two-bedroom and 183 three-bedroom houses. Of the 485 houses built by the Wealdstone Council, 260 are in Weald Village, and consist of 222 three-bedroom parlour type, and 38 three-bedroom non-parlour type. The Elmgrove Estate of 169 houses includes 96 three-bedroom parlour type, and 73 non-parlour type, of which 22 are three-bedroom and 51 twobedroom houses. At Meadow Way there are 10 houses of threebedroom-parlour type; a further 39 three-bedroom non-parlour type at Montrose Road, and seven bungalows at Canning, Byron, and Palmerston Roads. 337 of the 835 houses erected by the Hendon Rural District Council were built under the 1919 Act. Of these 88 parlour and 24 non-parlour type were built at Chandos Estate, Little Stanmore, 55 parlour and 28 non-parlour at Woodlands Drive, Harrow Weald; 45 parlour and 6 non-parlour at Canterbury Road, North Harrow; 42 parlour and 14 non-parlour at Pinner Hill Road, and The Close, Pinner; and 12 parlour and 20 non-parlour at Wolverton Road, Great Stanmore. Under the 1924 scheme 463 non-parlour houses were erected, being 88 at Chandos Estate, 40 at Bransgrove Road, Little Stanmore, 65 at Glebe Estate, Little Stanmore, 22 at Kenton Lane, Harrow Weald, 42 at Church Lane, Harrow Weald, and 206 at the Pinner Hill Estate Pinner. In addition the Council possessed 35 non-subsidy houses, namely, 20 at the Greenway, Pinner, 14 at Harrow Weald City, and Tithe Farm Cottage, Cannons Lane. SCHOOLS. Some of the Public Elementary Schools are of the old type of building and are not altogether satisfactory. Overcrowding occurs in some schools owing to the rapid increase in population. School attendance, however, has played comparatively little part in the dissemination of infection. No school has been closed or disinfected during the year on account of infectious disease. The following is a list of the schools with their divisions into departments, and the number of children on roll at the end of the year. 29 Name of School. Department. No. on Roll. 30.11.34 Greenhill Council School, St. Ann's Road S.M. 232 Harrow J.M. and I. 346 Vaughan Road Council School, Harrow Mixed 610 Infants 398 Roxeth Council School, Harrow J.M. 167 Infants 145 Welldon Park Council School, Harrow J.M. and I. 521 Eastcote Lane Council School, Harrow S.B. 345 S.G. 345 J.M. 557 Infants 514 St. Anselm's R.C. School, Harrow M. and I. 214 Bridge Council School, Wealdstone S.B. 319 S.G. 329 J.M. and I. 506 Glebe Avenue Council School, Wealdstone J.M. 448 Infants 319 High Street, Council School, Wealdstone J.M. 497 Infants 308 Whitefriars Council School, Wealdstone S.M. 591 J.M. and I. 440 Priestmead Council School, Harrow Weald J.M. and I. 831 Harrow Weald Council School, Uxbridge Road, Harrow Weald Mixed 339 Harrow Weald Council School, High Road, Harrow Weald Infants 265 Camrose Council School, Little Stanmore S.M. 674 J.M. and I. 746 Stanmore C.E. School, Stanmore Mixed 161 Infants 55 Headstone Council School, Pinner M. and I. 542 Pinner Park Council School, Headstone Lane, Harrow J.M. and I. 587 Pinner Council School, Marsh Road, Pinner J.M. and I. 204 Cannon Lane Council School, Pinner J.M. and I. 263 12,818 30 Sanitary Inspection of the District. Report of the Sanitary Inspectors. (a) Nature and Number of Inspections of:— Houses 4,289 Bakehouses 189 Slaughterhouses 592 Milk Shops and Dairies 405 Cowsheds 168 Foodshops 2,077 Infectious diseases enquiries 744 Rooms disinfected 897 Visits to fostermothers' premises 6 Smoke observations 23 No. of nuisances investigated 946 Outworkers' premises 40 Ice-Cream premises 9 Other visits 299 (b) Notices served. Complied with. Statutory 24 23 Informal 2,090 2,004 Smoke Abatement. There is comparatively little nuisance from smoke in this district. In the few instances where nuisances were apparent or where advice had been sought the trouble was usually rectified following advice being given to the stoker of the furnace. 23 observations were carried out, the summary of the results being that during 620 minutes there were only 11½ minutes of dense smoke and 81 minutes of moderate smoke. Offensive Trades. Fried Fish Shops. There are 25 fried fish shops in the district, to which a total of 287 visits were paid during the year. Most of these businesses are carried on in up-to-date premises and few complaints are received. One application for the establishment of a fried fish shop was received during the year, which was acceded to. Shops Acts, 1912-1934. The duties of the Inspectors under the Shops Acts are carried out by the Sanitary Inspectors. During the year 627 shops were registered and 173 infringements of the laws relating to the closing hours and other contraventions of the Acts were detected. 31 Rats and Mice (Destruction) Act, 1919. The duties under this Act are carried out by the staff of the Middlesex County Council. During the year 156 complaints were received regarding the presence of rats. On receipt of complaints inspections are made by the Sanitary Inspectors, and where no sanitary defects are found existing the complaint is forwarded to the County Inspector. Administration of the Factory and Workshop Act, 1901. In this district there are 190 factories, 183 workshops and 8 workplaces, to which the following numbers of visits were paid during the year: factories 238, workshops 218, and workplaces 65. Of the total of 53 Public Health Acts nuisances detected, 29 were due to want of cleanliness and one due to deficient ventilation. There were 17 instances of unsatisfactory sanitary accommodation, this being unsuitable or defective in 15 instances, insufficient in one, and no separate provision made for the sexes in one. No outwork was done in unwholesome premises. 32 HOUSING HOUSING STATISTICS FOR THE YEAR, 1934. Number of New Houses erected during the Year:— Total 4,331 (1) By the Local Authority - (2) By other Local Authorities (3) By other bodies and persons 4,331 1. Inspection of Dwelling-Houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,881 (b) Number of inspections made for the purpose 4,289 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 637 (b) Number of inspections made for the purpose 1,347 (3) Number of dwelling-houses found to be in a state so dangerous on injurious to health as to be unfit for human habitation 17 (4) Number of dwelling-houses (excluding those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 838 2. Remedy of Defects during the Year without Service of formal Notices Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 802 3. Action under Statutory Powers during the Year A. Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 11 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 13 (b) By local authority in default of owners — B. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 13 33 (2) Number of dwelling-houses in which defects were remedied after service of formal notices (a) By owners 12 (b) By local authority in default of owners — C. Proceedings under Sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 7 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 7 D. Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or ground rooms in respect of which Closing Orders were made — (2) Number of separate tenements or ground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — Demolition of Houses under the Housing Act, 1930. In 1933 the Ministry of Health called for a return of the properties it was anticipated would be considered for demolition under the Housing Act, 1930, under the various heads of Clearance Areas, Improvement Areas or as individual houses to be dealt with under Section 19. Clearance Areas: In the Wealdstone and the Hendon Rural Districts there were no properties scheduled under this heading. In the Harrow-on-the-Hill area a number of properties were tentatively scheduled, namely, 12 houses in Wellington Terrace, 9 in Waldron Road, 5 in West Street, and 9 in Waldrons Yard. At the end of 1934 the position with regard to these groups of properties was that the houses in Waldron Road had been reconditioned. Negotiations were proceeding with a view to the properties in Wellington Terrace being demolished and a smaller number of houses being erected on the site. Proceedings with regard to the properties in West Street were held up owing to a change in ownership, and the future of the properties in Waldrons Yard was the subject of negotiation with the owners of the houses. Improvement Areas: In none of the three districts was any property scheduled to be dealt with as an Improvement Area. Houses to be dealt with in Section 19: There were 21 houses in the Hendon Rural District which it was proposed should be dealt with under Section 19. It was not anticipated that all these properties would necessarily require demolition, the owners in 34 some cases preterring to incur the cost of reconditioning. By the end of the year three of these houses had been demolished and one reconditioned. Some are groups of insanitary houses and as such should be made the subject of Clearance Orders. In Wealdstone there was only a single cottage to be dealt with in this manner. The first step to effect this demolition was taken in November. In the Harrow-on-the-Hill district there were some 37 houses to be considered for action under Section 19, the programme being one for 1933, 12 for 1934, and nine, five, five and five in the next four years. A number of these are individual houses, though some are in small groups. By the end of the year three had been demolished and two reconditioned. Overcrowding. During the year 21 cases of overcrowding were reported. Of these 19 were abated, in many cases the occupants being rehoused in Council houses. 35 INSPECTION & SUPERVISION OF FOOD. (a) Milk Supply. Producers. Owing to building operations the number of cow keepers in the district is declining, there being now only 17, at the following addresses Pinner Wood Farm; Blythwood, Uxbridge Road; Woodhall Farm, Woodhall Gate; Mill Farm, Pinner Hill Road; Grange Farm, South Harrow; Pinner Park Farm; Grove Farm, Stanmore; Grim's Dyke Farm, Harrow Weald; Copse Farm, Harrow Weald; Brooks Hill Farm, Harrow Weald; Hill Farm, Elstree; Oxhey Lane Farm; College Hill Road; Brockley Hill Farm; Dennis Lane Farm; Warren House Farm, Wood Lane; Kenton Lane Farm. A few of these cowsheds are old and are likely to be demolished shortly. Those most used, however, are of modern construction, and the conditions of milk production are good. Retailers. There are 84 retailers at work in the district, including six company distributing centres. The following is a classification of the milks retailed:— Licensing. There are two premises licensed for the bottling of Grade "A" (Tuberculin Tested) milk, and three licensed for the pasteurizing of milk. Milk Sampling. During the year 83 samples of milk were taken for analysis. Of the 38 samples of certified milk, six gave unsatisfactory counts. Of the nine samples of Grade "A" T.T. milk, three were not satisfactory, as was one of the nine samples of Grade "A" Pasteurized milk. One of the eleven samples of Pasteurized milk gave a count exceeding the prescribed number of organisms, and six of the eleven samples of ordinary milk were not up to standard. Two samples of certified milk were also biologically examined for the presence of the tubercle bacillus, with negative results. 36 (b) Meat and other Foods. Meat Inspection. The following are the addresses of the nine licensed slaughter houses in the district: 7, Northolt Road, Harrow; rear of 25, High Street, Wealdstone; rear of 94, High Street, Wealdstone; rear of High Street, Pinner; Green Man, Honeypot Lane, Stanmore; Stanmore Hill, Stanmore; Stanmore Hall Farm, Dennis Lane, Stanmore; rear of 63, High Street, Edgware; Warren House Farm, Wood Lane, Stanmore. All these premises have been used for the purpose for a number of years. They are kept clean and any contraventions of the bye-laws noted have been immediately remedied. Comparatively little killing is now done in the district. All three constituent Councils of the present district adopted the clause of the Slaughter of Animals Act by which sheep are included in the list of animals to be slaughtered by the humane killer. 592 visits were paid by the Inspectors to these premises during the year, the number of carcases examined being 2,910. Of the 168 beasts slaughtered, 33 were unsound in some respect. Parasitic disease of the liver was found 25 times. The only other common disease present was tuberculosis, being found in the head of 6, tongue of 5, lungs of 9, liver of 5, stomach of 2, and fat of 2 (more than one organ of the same animal being frequently affected). In addition to these diseased organs, 40-lbs. of beef were condemned on account of bruising. 61 of the 2,068 pigs slaughtered were diseased, cirrhosis of the liver occurring in 16, pericarditis in 21, pleurisy in 9, and pneumonia in one. Tuberculosis was found in the head of 12, the lungs of 13, the liver of 13, the stomach of 12, and the fat of 19. 626 sheep were slaughtered, of which only 4 were found unsound in any respect, in each case the lesion being parasitic disease of the liver. In addition 20-lbs. of mutton were surrendered. No part of the 48 calves slaughtered was found unsound. All the diseased meat was surrendered, none having to be seized. Bakehouses. There are 28 factory and 7 retail bakehouses in the district, to which a total of 189 visits were paid in the course of the year. Food Shops. 681 visits were paid to butchers' shops, 305 to fish shops, 55 to provision shops, 405 to dairies and milk shops, and 65 to greengrocers' shops. 37 The following amounts of foodstuffs were condemned: fish 14 stone, chickens 53, potatoes 35 cwt., bananas 180, oranges 24, apples 10 lbs. and tomatoes 2 lbs. (c) Adulteration, etc. The Food and Drugs (Adulteration) Act is administered by the Public Control Department of the Middlesex County Council. During the year 141 samples were analysed. Of these 128 were of milk, of which 3 were adulterated. None of the samples of the other commodities examined, which included spirits, meat, and sausages, proved to be adulterated. (d) Chemical and Bacteriological Examination of Food. These examinations are conducted at the Laboratories of the Clinical Research Association, Ltd., Watergate House, Adelphi, London, W.C.2. 38 ISOLATION HOSPITALS. The Harrow-on-the-Hill Council maintained an isolation hospital at Rayners Lane, South Harrow and the Hendon Rural District Council one at Honeypot Lane, Stanmore. Wealdstone cases not suitable for home treatment were admitted to one of these two institutions if accommodation were available, failing which patients were admitted to one of the London County Council Hospitals. Latterly, Honeypot Lane Hospital has been used only for the admission of scarlet fever patients, cases of diphtheria being sent to the Harrow Hospital. The following are some particulars of these two institutions, as outlined in the report submitted in October. Rayners Lane Hospital. Date of erection—1896. Site—1½ acres. Capable of extension by taking land from the adjoining sewage farm. Water supply—Colne Valley Water Company. Sewage disposal—Water carriage to sewage farm. Heating—central heating to the scarlet fever wards, the remainder being heated by coal fires. Artificial lighting—gas. Construction of buildings—all buildings are of brick, except the diphtheria block which is of hollow brick, timber frame and cement rendered. Number of blocks—three. Number of wards—two for each of the two scarlet fever blocks; two diphtheria wards, and two single-bed side wards leading off. Number of beds on the basis of 144 square feet per patient— twenty-five. Accommodation for staff—Administrative block houses the Matron, four nurses and four maids. (Four nurses sleep elsewhere.) Porter in porter's cottage. Laundry—hand. Disinfecting apparatus—Thresh's Steam Disinfector. Ambulance—Morris Ambulance for the conveyance of patients and of bedding. Medical attendants—the medical practitioners attend their own patients if they so desire; if not, arrangements are made for another practitioner to attend. 39 Honeypot Lane Hospital. Date of erection—1902. Site—3.2 acres. Adjoining land not yet built on. Water supply—Colne Valley Water Company. Sewage disposal—water carriage to sewage farm. Heating—slow combustion stoves. Electric fires available. Artificial lighting—electric light. Construction of building—brick with slate roofs. Number of blocks—two. Number of wards—five. Number of beds on the basis of 144 square feet per patient—17. Accommodation for staff—matron, four nurses, two maids and the cook in the house. Porter and laundress in porter's lodge (one nurse sleeps in the discharge ward). Laundry—electric power. Disinfecting apparatus—Washington Lyon Steam Disinfector. Ambulance—an Austin ambulance; and Morris van for conveyance of bedding. Medical attendants—Medical Superintendent, the late Dr. Leslie Romer. The present arrangements are unsatisfactory for a number of reasons, the chief being that the accommodation is insufficient. Arrangements have been made with other local authorities for the admission to their institutions of cases for whom accommodation is not available. To minimise existing disadvantages and improve conditions for as long as these two buildings continue to be used, a number of changes have been or are to be made:— (1) Both institutions are to be run as one unit, acute cases being admitted to the Rayners Lane Hospital, from which convalescent scarlet fever cases will be transferred to the Honeypot Lane Hospital. (2) All laundry work to be done at the Stanmore Hospital, where there is electric power, obviating the hand laundering which was done at the Harrow Hospital. To cope with the additional work, changes have been made at the Stanmore laundry to reduce hand labour and a water-softener installed. (3) The conversion of the laundry block at the Harrow Hospital into cubicles to house a number of nursing and domestic staff, obviating the previous practice by which some members of the staff had to sleep out. 40 (4) One ambulance only will be used as such, the vehicle at the Harrow Hospital being used only as a van for the removal of bedding. (5) Medical attendance on patients will be carried out by the full time members of the Council's staff, replacing the part time service of the general practitioners. Charges to Patients. The Harrow-on-the Hill Council made a charge in respect of all patients over the age of 21 years, the Hendon Rural Council charged all patients, and the Wealdstone Council none. In May the Council agreed to make no charge for the maintenance of patients in the Isolation Hospitals, and in October resolved "that in future no charge be made for medical attendance or for surgeon's fees in respect of patients admitted to the Harrow Isolation Hospitals." In a report submitted to the Committee in October it was pointed out that 100 isolation beds were needed for the district, that number to be probably 130 by the time any extensions would be ready for use, and that land should be available, with the whole lay-out of the hospital designed to allow of a further addition of possibly 50 beds. The following recommendation by the Public Health Committee was adopted by the Council at their meeting on November 6th—" that an entirely new and modern Isolation Hospital be erected on land belonging to the Council at Rayners Lane, Harrow, to provide for 150 beds and suitable administrative blocks, the same to be of such design and construction as to permit of future additions." By Section 63 of the Local Government Act, 1929, the County Council was required to make a survey of the hospital accommodation for the treatment of infectious diseases in the county, and then to prepare in consultation with the county district councils, a scheme for the provision of adequate accommodation, for submission to the Minister of Health. A draft scheme was circulated amongst the local authorities for their observations in which the proposal was that the county should be divided into four geographical groups, for each of which a Joint Hospital Board should be formed, such Board to exercise control over all the isolation hospitals in its area, and decide what place each should occupy in the provision of isolation accommodation for that area. The particular area of interest is the North Circular Area, which comprised at that time the Urban Districts of Harrow, Hendon, Kingsbury, Wealdstone, Wembley, Willesden and the Rural District of Hendon. So far as this group was concerned, the proposals apparently were not favourably received. Both Hendon and Willesden Councils were opposed to the formation of any joint board which would affect their districts; but Hendon was prepared 41 to provide for Harrow, Hendon Rural and Wealdstone by agreement only, while Willesden would similarly provide for Kingsbury and Wembley. The latter two authorities, however, preferred that they should continue the existing arrangement by which they are provided for by Acton by agreement. Wealdstone were satisfied with the existing arrangements under which they were provided for by Harrow by agreement only. The scheme formulated by the County Council and submitted to the Minister in August, 1933, followed the lines of the draft scheme which had such an unfavourable reception by the constituent local authorities. So far as affects this area, the main items of the scheme were that for the area consisting of Harrowon-the-Hill Urban District, Hendon Rural District, Hendon Borough, Kingsbury Urban District, Wealdstone Urban District, Wembley Urban District, and Willesden Urban District 462 beds should be provided (a figure based on one per 1,000 of the total population of the areas). "Any additional accommodation rendered necessary by the provisions of the scheme shall be provided by the Councils of the county districts, for which purpose they shall as soon as may be initiate action and carry through any proceedings that may be necessary on their part for forming united districts, or altering the constitution of existing united districts, as may be required pursuant to the provisions of Section 279 and 297 of the Public Health Act, 1875, or for combining under Section 131 of the Act, one such united district or combination being formed for the area." "The hospitals maintained by each of the authorities shall be available for the reception of persons suffering from infectious diseases other than smallpox who are inhabitants of the other county districts of the area; and the hospital shall, in the event of a Joint Hospital Board being constituted for the area, be transferred to and become the property of such Board, or, in the event of a Joint Committee being formed, be held, maintained and used on such terms and conditions as may be agreed between the councils of the districts." The Minister suggested that Harrow Urban District and Hendon Borough form one area for the purpose of hospital accommodation for infectious disease, Hendon being the local authority to provide the accommodation, and to receive into their hospital patients from Harrow Urban District by agreement. The minimum number of beds suggested for the combined districts was 199. Section 63 (4) of the Local Government Act, 1929, reads "no scheme submitted to the Minister under this section shall be of any effect unless and until it is approved by the Minister, and the Minister, after considering any representation with respect to the scheme which may be submitted to him by any Council affected, may approve the scheme with or without modification." As the new Harrow Council had not had an opportunity of 42 submitting its views, and as the Scheme had not formally been approved, at the Council meeting on January 1st, 1935, the recommendation of the Public Health Committee was adopted, requesting the Minister to receive a deputation to place before the Minister the views of the local authority in regard to the proposed scheme for the provision of hospital accommodation for infectious diseases cases. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. NOTIFIABLE DISEASES (other than Tuberculosis) Disease. Under 1 year 1/4 5/9 10/14 15/19 20/24 25/34 35/44 45/54 55/64 65 & over Total Scarlet Fever 1 132 307 78 23 23 35 15 3 3 1 621 Diphtheria - 17 33 9 2 2 8 7 1 0 1 80 Pneumonia - 10 17 9 5 6 20 27 10 9 9 122 Erysipelas - 2 1 1 1 3 9 8 4 3 32 Puerperal Fever - - - - - 3 1 1 _ - - 5 Puerperal Pyrexia - - - - - 1 12 3 - - - 16 Enteric Fever - 1 - - 2 3 - - - - 1 1 Ophthalmia Neonatorum 5 - - - - - - - - - - 5 Cerebro-spinal Fever - - - 1 - - - - - - - 1 Dysentery - - - - - - - 1 - - - 1 Disease. Cases Notified Admitted to Harrow Isolation Hospital Admitted to Stanmore Isolation Hospital Admitted to other Isolation Hospitals Admitted to other Hospitals Deaths Registered Diphtheria 80 69 - 11 - 8 Scarlet Fever 621 194 207 94 — 9 Puerperal Fever 5 — — 4 — 5 Puerperal Pyrexia 16 - - 8 — Pneumonia 122 — — — - — Erysipelas 32 — - 1 10 — Enteric Fever 7 - - 2 5 1 Dysentery 1 — — — 1 1 Cerebro-spinal Fever 1 — — — 1 1 Ophthalmia Neonatorum 5 — — — 2 — 43 Diphtheria. There were only eighty cases of diphtheria notified during the year, being a rate per thousand population of 0.60 compared with the figure of 1.70 for the country as a whole. The weekly incidence throughout the year was low, rising somewhat in the last three months of the year. For the previous five years a similar low incidence has prevailed throughout the constituent districts. In view of this low incidence, coupled with the rapid importation of a population probably of abnormal age distribution, with a relative excess of child population, the herd immunity of the district to diphtheria must be low. Most cases were removed to the Rayners Lane Isolation Hospital, though a number, owing to absence of accommodation locally, had to be admitted to the hospitals of other authorities. A large number of the cases were secondary infections. Two missed cases each gave rise to two cases, one case gave rise to four secondary cases, and six cases gave rise to one each. Apart from these, a nasal case gave rise to four, making a total of eighteen secondary infections arising from ten primary cases. Two return cases followed on the discharge home of a patient admitted to hospital for diphtheria, and one of a patient sent in with scarlet fever. There were four cases of double infection, the other disease in three instances being scarlet fever, and in the remaining one, chicken pox. One case followed a few days after the removal of adenoids, and another, which proved fatal, after removal of tonsils and adenoids. One case of epidermal diphtheria was notified, the lesion occurring on the skin starting at the edge of a lung sinus. Eight deaths, seven male and one female, were certified as being due to diphtheria, being a case mortality of 10 per cent. In one, however, the patient, suffering from nasal diphtheria, developed appendicitis and peritonitis, which proved fatal. In another, a female of 69, the death certificate dated November 8th, read 1 (a) bronchitis, (b) pericarditis, (c) diphtheria, the onset of the attack of diphtheria being June 4th. Bacteriological Examinations. 987 diphtheria swabs were examined during the year at the Laboratories of the Clinical Research Association. Schools and Diphtheria. Schools appeared to play a very small part in the spread of the infection. In one department, three cases were notified in the same week, two of the affected children being in the same class. Apart from this instance, there was no association between the incidence of diphtheria and school attendance. No schools were closed during the year on account of diphtheria, and no school or school rooms fumigated. 44 Immunization. No immunization against diphtheria was carried out during the year, but on January 1st, 1935, the Council adopted the recommendation of the Public Health Committee passed at their December meeting:— That a sum not exceeding £200 be allocated for the period ending March 31st, 1935, to provide facilities for residents in the district whose annual income does not exceed £250 to receive immunization treatment against diphtheria, this sum to provide for payment of a fee of 10s. in each case to medical practitioners carrying out the treatment, and to cover the cost of the necessary propaganda, and that the Medical Officer of Health be authorized to take all necessary steps for circularizing practitioners, informing the public, and generally bringing the scheme into operation as soon as possible. Scarlet Fever. 621 cases of scarlet fever were notified during the year. This is an incidence rate of 4.70 per thousand population, compared with a figure of 3.76 for the country as a whole. This was a sharp rise on the figure of 402 for the year 1933, which was the highest up to then recorded as a total for the three districts. The notifications for the first three quarters of the year averaged between eight and nine a week—but, starting at the latter end of September, the average was about twenty per week for the rest of the year. The accommodation at the Isolation Hospitals proved insufficient even during the periods of lighter incidence, and cases were sent to the institutions of other authorities. This position was accentuated in the latter part of the year when large numbers of cases had to be sent to other hospitals. Those patients in whom the attack was mild in character and whose surroundings were suitable for home treatment, were encouraged to remain at home. The extent to which this practice can be carried out, however, is very limited, more particularly because of the necessary restrictions imposed on the rest of the household in such circumstances. Whilst suitable cases do quite well properly looked after at home, it is only when one is assured that the supervision will be satisfactory that one is happy about the retention at home of such cases, as even with due care even mild cases develop their complications—in the absence of care complications are invited. Secondary infections due to the retention of a patient at home were infrequent, partly of course because those treated at home were cases who could be suitably isolated and this usually denoted an absence of a great number of other children in the home. Home treated cases are visited by the fever nurse frequently in the early days, and at more widely spread intervals in the later stages. She now carries out no form of treatment, but instructs the mother in the steps necessary to avoid spread of infection, and advises her on the elements of sick nursing. 45 There were 24 missed cases of infection which were subsequently diagnosed, mostly by the desquamation in the later stages, one by the onset of nephritis, and a few by their having infected others in the same family. Infection of other members of the same family was very common, both by secondary infections and by return cases. Patients in whom the disease was missed at the onset gave rise each to a single case in seven instances, in three of these the onset of illness in the secondary case being within one week of the onset of the primary, and in four in the third week from the onset in the primary case. One missed case gave rise to a secondary case, and within ten days of the onset of illness in this patient a further three members of the family succumbed. In one family three members were found desquamating, the onset having been unrecognised in all cases. In 33 instances a patient gave rise to a secondary case, the infected patient in four of these being the mother. In two-thirds of these cases the onset of the illness of the secondary case was within four days of the onset in the primary infecting patient, the remainder occurring in the second week. In each of three families, two other members of a household succumbed after the primary case. In a further six instances, a secondary case occurred in a household in which the patient was being treated at home. In three of these the onset of illness of the secondary patient was within four days of that of the primary, in the other three cases the interval being ten days. One of the six secondarily infected patients was the mother. One member of a family who fell ill on November 24th, was removed to hospital on the 26th. On December 3rd another member of the family succumbed. This, however, was not a secondary case as the second patient had not been in contact with the first, who had been an in-patient in a general hospital at the time he fell ill, and had not been visited by the second case. There were 32 return cases. Of these 28 were single infections following on the return home of a patient discharged from the hospital within the month. On two occasions more than one member of the household succumbed to infection on the return home of the patient, and in two households three subsequently suffered from the illness. In such cases the second case occurring in the household may have been infected either by the returning patient or by the first of the return cases. In one instance two suffered with a simultaneous onset and were therefore presumably infected at the same time by the returning patient. All except one of the return cases succumbed within three weeks of the homecoming of the original patient, 10 out of 20 succumbing in the first week, 6 in the second and 3 in the third. In rather more than half, the infecting patients, although apparently fit on their return 46 home, developed a head cold, which gave rise to a nasal discharge. In most of those who gave rise to infection in the first week after their return home, no abnormality was detected, but most of those giving rise to infection in the second week, and to a less extent those in the third, gave a history of the development of a nasal discharge. One return case was apparently caused by an ear discharge, which started four days after the return home of the patient. In one case, where three of the family succumbed on the return home of the primary patient, two sickened on the fifth day after the return, and a third in another two days. In the other house where three succumbed, the intervals were seven, two and four days. In the two instances where two members developed infection the intervals in one household were 11 days between the return home and the onset of the first case and 17 days between the onset of the first and second, and in the other 4 and 12 days. There were two instances in which a return case followed on the return from hospital of one who had himself been a return case. One patient, who was at home 18 days as a missed case before removal to hospital, on his return home gave rise to a case. There were other instances of removal to hospital not having been effected for some days from the onset of illness where, although the patient had given rise to no secondary infections in the acute stage of his illness, on his return home apparently infected members of the household. One child discharged from hospital after being treated for diphtheria was readmitted the next day with scarlet fever, and another patient discharged after being treated with scarlet fever was readmitted four days later with a relapse. Not all cases of infection occurring in a home should necessarily be attributed to infection by the return patient. The following dates refer to three separate groups of patients : Primary case— Onset 26/9, removal 28/9, discharged from hospital 13/11, onset of illness in the other patient at home 8/11 ; onset 30/9, removal 4/10, discharged 30/10, onset in other patient 26/10; onset 26/10, removal 27/10, discharged 25/11, onset in other patient 16/11. In each of these three cases the times separating the onsets of illness of the first and the second cases were well over the usual incubation period of the disease, and had the onsets of the illness in each of the three secondary patients occurred after the return home from hospital of the primary patient it would not unnaturally have been assumed that that person was the infecting agent. Such cases as these show that it is erroneous invariably to incriminate the returning patient as being the source of infection in all return cases. Most of the patients who were treated at home progressed satisfactorily, any complications in most being limited to adenitis or otitis media. One patient whose onset was apparently mild was removed to hospital on the 18th day of illness on account of her 47 clinical condition and later died. One patient developed a mastoid involvement and was admitted for operation. Another on developing nasal diphtheria was removed to hospital. The only other case who commenced home treatment but was subsequently admitted was removed on account of difficulty of nursing owing to the mother having contracted the infection. There were a number of cases of double infection, chicken-pox occurring simultaneously in five patients, diphtheria in one and nasal diphtheria in another two, mumps in one, and measles in two. In six cases scarlet fever followed removal of tonsils and adenoids. In three cases the onset of illness was the third day after the operation, in two cases the second, and in one case the fourth. There were nine deaths from scarlet fever during the year, eight males and one female. In one, however, the death occurred some months after the illness from " heart failure following scarlatinal nephritis." A girl of seven died from endo- and pericarditis. Three deaths were due to extension of ear infection, a male of eighteen dying of cerebral abscess, one of six and one of seven from meningitis. Two patients whose illnesses were complicated by measles suffered from empyema, and one from pneumonia, and death occurred in a boy of six from septicaemia and acute endocarditis. No children were Dick tested during the year. The few cases of infection appeared to be associated with school attendance, mostly in schools of the older type of building. In one infants' department, following the occurrence of a few cases the school was visited and two children excluded, one suffering from rhinorrhœa and the other whose hands were desquamating. A group of cases in another school was apparently due to the return to school of a missed case who was absent during the acute stage. No schools were closed on account of the disease, and no schools or rooms fumigated. Enteric Fever. Seven cases of enteric fever were notified during the year. In each of the last three weeks of July a case of paratyphoid B was notified, the cases occurring in widely separated parts of the district, and apparently having no connection in origin. In August a case of typhoid was notified, the onset being the latter part of July ; and in the second week of August two nurses of the local general hospital fell ill, and were later notified as suffering from enteric fever. In September a boy of sixteen suffered from typhoid and later died from intestinal haemorrhage. Except for this last case, the patients made an uninterrupted recovery. Two were treated at isolation hospitals, the remainder in general hospitals. 48 Erysipelas. Thirty-two cases of erysipelas were notified, the months during which most cases occurred being April and November, the incidence during the summer months being very light. The age groups most commonly affected were 35 to 54, females being affected slightly more than males. About half the cases were treated at home. Of the hospital cases, three were admitted to isolation hospitals, the remainder to general hospitals. Small-pox. No cases of small-pox were notified during the year, though a number of contacts were reported to have moved into the district, mostly from ships. As the vaccination officer's districts do not coincide with the areas of the local sanitary authorities, it would be very difficult to obtain exact particulars of the position with regard to vaccination in the district. The following figures, however, which relate to the Harrow district and portions of adjoining areas, are a guide :— 1. Number successfully vaccinated 1,155 2. Number insusceptible 27 3. Conscientious objectors 1,124 4. Number who died before vaccination 98 5. Vaccination postponed by medical ficate 38 6. Infants removed 185 . 7. Number unaccounted for at present 123 The total number of certificates of successful primary vaccination of children under 14 received during the year was 1,344, and the number of statutory declarations of conscientious objection received was 1,349. No vaccinations were performed during the year by the Medical Officer of Health under the Public Health (Small-pox Prevention) Regulations, 1917. Other Infections. Cerebro-spinal Meningitis. In July a case of cerebro-spinal fever occurring in a girl of twelve was notified and proved fatal. Encephalitis Lethargica. Three cases of encephalitis lethargica proved fatal during the year, in none of which had the onset occurred in this year. 49 Measles. Measles was prevalent in the district in the earlier part of the year, and caused, mostly in the months of March and April, twelve deaths, of which most were of children under five. Whooping Cough. Whooping cough became prevalent in the latter part of the year, appearing at a number of schools in the district but not heavily affecting any one school. Three deaths, all of infants under one year of age, occurred from this disease. Chicken-pox. Chicken-pox was very prevalent in the last two months of the year, appearing in most schools and heavily affecting some. Mumps. Mumps also appeared in November and by the next month had invaded, though not to a serious extent, many schools. Influenza. Influenza caused a number of deaths in the earlier months of the year, amongst males more than females, and affecting most heavily, though not exclusively, the elderly. 50 Tuberculosis. (Notifications) New Cases. Deaths. Primary Notification. Brought to notice other than by Form A. Pulmonary NonPulmonary Pulmonary NonPulmonary Pulmonary NonPulmonary M F M F M F M F M F M F Under 1 - - - - - - - - - - 1 - 1— 1 - 1 2 - - 1 - - - 1 2 5— 2 2 1 2 - - - - - 2 1 - 10— 2 2 4 - - - 1 1 7 7 - 1 15— 2 5 - 3 - - - — 20— 10 7 - - 1 6 - 1 25— 28 18 3 1 4 7 - - 8 10 2 4 35— 14 9 - 1 1 - - - 7 5 - - 45— 6 5 - - - 1 - - 1 5 1 1 55— 4 3 - - - - - - 4 2 1 - 65 & upwards 1 - - - - - - - 3 1 - - 70 51 9 9 6 14 2 2 30 32 7 8 (Register) Pulmonary. Non-Pulmonary. Male. Female. Male. Female. No. on register Jan. 1st, 1934 218 186 41 51 New Notifications in 1934 70 51 9 9 Deaths in 1934 24 26 4 4 No. on register Dec. 31st, 1934 245 205 42 55 51 The total number of pulmonary cases on the Registers throughout the country on December 31st, 1933, was 227,775, of whom 122,398 were males and 105,377 females. The corresponding figures for non-pulmonary cases were 100,014, 51,347 and 48,667. Per 100,000 population of the country as a whole, the number of pulmonary cases on the registers were 306 for males and 263 for females, the local corresponding figures being 245 and 205. The corresponding national figures for non-pulmonary tuberculosis were for males 128 and females 122, the local figures being 42 and 55. During the year there were notified 121 cases of pulmonary tuberculosis and 18 of non-pulmonary disease. In addition there were brought to notice other than by primary notification 20 pulmonary and 4 non-pulmonary cases, these being mostly of persons who had transferred to the district suffering from the disease. In 1933 the rates per thousand population in England and Wales of formal notifications were 1.10 for pulmonary cases and 0.35 for non-pulmonary cases. The local rates for last year on the basis of a population of 132,049 were 0'91 and 013. 62 persons died from pulmonary tuberculosis during the year, of whom 30 were male and 32 female. One half of the males were at death between 15 and 34, and 19 of the females between the ages of 14 and 31. Of the 15 deaths from nonpulmonary tubercular causes, seven occurred in males and eight in females. More than half these deaths were due to meningitis, mostly in infants under three years of age. The death rate per 100,000 population for males from pulmonary tuberculosis was 22.6 and for females 24.2, compared with figures of 39.6 and 30.0 for the country as a whole in 1933. The corresponding local figures for non-pulmonary tuberculosis were 5.3 and 6.0, compared with figures of 7.2 and 6.3 for England and Wales in 1933. 119 samples of sputum were submitted for analysis during the year at the Laboratories of the Clinical Research Association. No action was taken during the year under Section 62 of the Public Health Act, 1925, for the compulsory removal to hospital of any infectious tubercular person. Prevention of Blindness. No special action was taken under Section 66 of the Public Health Act, 1925, for the prevention of blindness or for the treatment of persons suffering from any disease or injury to the eyes. 52 MATERNITY AND CHILD WELFARE. The story of the development of the Child Welfare Services in the district starts in 1913, when a weekly voluntary dental clinic was opened at the Bridge Schools, Wealdstone, but closed shortly after the outbreak of the war. On September 18th, 1915, Wealdstone Babies' House at Homewood, High Road, Wealdstone, was opened by Dr. Barbara Tchaykovsky as Organiser and Dr. Margaret Brady as Medical Officer. The scope of the work included a weekly consultative clinic and treatment of minor ailments of expectant mothers, nursing mothers and children under five. There was a day nursery accommodating twenty children and some limited residential accommodation for convalescent children. Dental treatment for the under-fives was started in June, 1916, but in 1917 this clinic was transferred to St. Ann's Road, where school children as well were treated. In June, 1917, the Infant Welfare Clinic was transferred to the Wesleyan School, Locket Road, Wealdstone, to return in May, 1919, to Homewood. The Harrow Maternity and Infant Welfare Clinic started in March, 1916, at the Harrow Cottage Hospital. Dr. Barbara Tchaykovsky was the Organiser and first Medical Officer, her duties in this latter capacity being later undertaken by Dr. Margaret Brady. The scope of the work included infant welfare and antenatal consultations. The clinic was later transferred to the Bessborough Road Sunday School. Dental treatment for those who attended and also for school children was carried out at St. Ann's Road School, and massage and remedial drill at Bessborough Road. A merging of these voluntary activities took place with the formation of the Council of Child Welfare whose object was " to co-ordinate and unify all local efforts on behalf of maternal and child welfare." Premises at 8, College Road, Harrow, were opened in July, 1919, at which many services were provided for the mothers and children of Harrow and Wealdstone. The Council of Child Welfare maintained a dental clinic, massage clinic, ear, nose and throat department, eye clinic, classes for mothers, a weekly ante-natal session and a fortnightly minor ailments clinic. In addition there was an observation ward of six cots. At the same premises the Harrow Urban District Council provided biweekly infant welfare sessions. At this time a weekly infant welfare centre was being held at Homewood for the Wealdstone mothers. This work was in April, 1920, taken over by the Wealdstone District Council, who maintained an infant welfare clinic at the Y.M.C.A. Hut in High Street, Wealdstone. About the same time the Harrow District Council opened an additional infant welfare centre at Wesley Hall, Roxeth, the voluntary creche then being closed. 53 The Council of Child Welfare which, from the geographical situation of their clinic, naturally dealt mostly with residents of Harrow and Wealdstone, did not close their doors to others needing treatment, even from Pinner, Harrow Weald and Stanmore. Offering the only facilities for treatment, they were recognised by the Harrow and Wealdstone Councils who were the local maternity and child welfare authorities, and received an annual grant. In respect of the dental work carried out on the school children, the Middlesex County Council made a grant for inhabitants of Harrow and Wealdstone and districts, but not in respect of any of the other treatment services provided for the school children. In 1919 the facilities offered at 8, College Road were the following clinics : infant welfare, ante-natal, dental, massage, eye, ear, nose and throat, in addition to which certain minor operations were performed, and there was a small ward for ailing babies. 8, College Road was, in effect, carrying out work of an out-patient department of a general hospital in respect of mothers and children. In March, 1925, a massage clinic was started for the treatment of adults, and in the autumn of 1926 further developments took place by the provision of an artificial sunlight clinic, though at the same time the ward for the ailing babies was closed. Artificial sunlight treatment was later made available to adults, but in 1931 all facilities to adults had to be withdrawn owing to the heavy cost of maintaining them when no financial contributions were forthcoming, but they were then taken over by the Harrow Hospital. Owing to the termination of the lease of the premises at 8, College Road in March, 1932, the clinic was transferred and restarted in October, 1932, at " Tyneholme," Headstone Drive, Wealdstone. At the new clinic the same services were provided, except that the ear, nose and throat clinic was closed, the work being transferred to the Harrow Hospital, while Borosini Treatment became available for the first time. The most recently established service is the Child Guidance Clinic. The Middlesex County Council in their proposals for the review of the county areas under Section 46 of the Local Government Act, 1929, urged that the County Council should be the local authority for maternity and child welfare purposes in the new Urban District of Harrow. The enquiry into the proposals of the County Council for the review of the county was held in February, 1933, but it was decided that the question of the maternity and child welfare services should be the subject of an enquiry under Section 60 of the 1929 Act. In November, 1933, the County Council passed the resolution that representation be made to the Minister under Section 60 as to the desirability of his giving effect to the proposals submitted by the County Council with regard to the maternity and child welfare services in the new Harrow Urban District. On February 9th, 1934, an enquiry was held at the Middlesex Guildhall into this application for the transfer to the 54 County Council of the services. The decision of the Minister, given on February 22nd, was in the following terms :— " The Minister has had some difficulty in arriving at a decision upon these representations. He is fully in accord with the principle that in general it is desirable that the maternity and child welfare services should be administered by the authority responsible for the school medical service. But in the present case he finds that the two districts will include populous urban districts in which the maternity and child welfare service has always been provided by the district councils, and so far as he is aware the County Council have not previously at any time proposed that the services in those districts should be transferred to them. Moreover, he is impressed by the fact that the population of the new district will be in the neighbourhood of 96,000 and will thus far exceed the population of any of the present urban districts the councils of which have been permitted to provide the maternity and child welfare service since its inception. " The Minister has therefore come to the conclusion that he would not be justified in refusing to allow the District Council at the outset to act as the maternity and child welfare authority for their district, and effect will be given to this decision in the Order which is about to be made under Section 46 of the Local Government Act, 1929. " The Minister is glad to learn of the desire of the County Council to work in co-operation with the district council. It is clear that there will be need for close co-operation if the health of mothers and children is to be adequately safeguarded, and he does not doubt that the County Council will do all that lies in their power to attain this result." Notification and Registration of Births. 1,793 notifications of live births were received during the year. 1,048 notifications of births (including stillbirths) were received from medical practitioners and parents, and 681 from midwives. The total number of births registered during the year was 2,167, 1,101 male and 1,066 female. Of these 58 were illegitimate, being a percentage of total births of 2.7. Stillbirths. 41 male and 30 female stillbirths were registered, being a rate per thousand population of 0.54, compared with the figure of 0.62 for the country as a whole. Infant Mortality. 102 infants under one year of age died during the year, giving an infant mortality rate of 47.5 compared with that of 59 for the country as a whole, 63 for the Great Towns and 67 for London. 55 The rate amongst legitimate children was 43.6, while for illegitimate children it was 172. Neonatal Deaths : There were 58 (37 male and 21 female) deaths of infants under one month of age, this being a neonatal rate of 26.9, and constituting 57 per cent. of the total infant mortality rate. Of these deaths, 27 (18 male and 9 female) occurred within twenty-four hours of birth, of which seven (six male and one female) were due to birth injuries, eight (five male and three female) to developmental abnormalities (congenital heart, spina bifida, etc.), and nine (five male and four female) to prematurity. A further nineteen (14 male and 5 female) deaths occurred within the first week. Of these, nine (seven male and two female) were due to congenital abnormalities, six (three male and three female) to prematurity, and one male to difficult labour. Of the remaining twelve cases which proved fatal within the month, three were due to congenital abnormalities, six to prematurity, and two to infections. There were fifteen deaths of infants aged between one and three months, eleven male and four female. Prematurity accounted for the deaths of two males, congenital pyloric stenosis another two, malnutrition one, bronchitis or pneumonia three, and accidents two. Gastro-enteritis caused the deaths of one male and two females, the cause of death in the other female being marasmus. Of the sixteen (ten male and six female) deaths of infants between three and six months of age, developmental causes by this time were less prominent, the death of one male being due to debility from birth and two females died from developmental abnormalities, namely spina bifida and congenital heart. Gastroenteritis in the warmer months of the year accounted for four deaths, and respiratory infections another four. The infections figured more prominently as the cause of death amongst the thirteen (eight male and five female) who died between the ages of six and twelve months, whooping cough being responsible for three, and respiratory infections for another four. One died from congenital syphilis and one from tuberculous meningitis, another from gastro-enteritis and three from idiopathic disease. Deaths of Older Children. Nine children died in their second year. Of these pneumonia accounted for four, measles for two, and tuberculous meningitis one. More deaths occurred amongst those in their third year, mostly due to infections including measles, diphtheria, and chest affections. A smaller number of deaths of those of three years of age was recorded, and a still smaller number of those aged four. Altogether 24 died between the ages of one year and five years, of which 20 were male and only four female, most of these deaths being due to infections. 56 Ophthalmia Neonatorum. Notified Treated at home Treated in hospital Vision Unimpaired Vision Impaired Total blindness Deaths 5 3 2 5 — — — Five cases of ophthalmia neonatorum were notified, of which two were removed for treatment to St. Margaret's Hospital, and one received treatment at home under the Council's scheme. All cases are investigated by the Health Visitors on receipt of notification and are visited regularly until the eyes are clear. Maternal Mortality. There were 13 deaths registered as due to or associated with pregnancy, of which five were due to sepsis, giving a maternal mortality rate from this cause of 2.30 and for other accidents and diseases of pregnancy and parturition a rate of 3.69, being a total rate of 5.99 per thousand live births. The corresponding rates for England and Wales were 2.03, 2.57 and 4.60. In addition there were five other deaths to which pregnancy was a contributory factor. One was that of a woman who died of valvular disease of the heart and auricular fibrillation, being eight months pregnant. Two cases of abortion, one at least being selfinduced, ended fatally from septicaemia. A patient confined in January died in April from septicaemia following a mammary abscess. The remaining case was one of a patient in whom labour was surgically induced and who died ten days later from miliary tuberculosis. Of the five fatal cases of sepsis, one patient was confined in hospital and another in a nursing home. The remainder had their confinements at home, but were later removed to hospital for treatment. All five were apparently normal confinements at full term. The death certificates in the various cases read :—“ Streptococcal septicaemia (hæmolytic streptococcus), normal labour," " General peritonitis, puerperal infection following full term normal delivery," " Septicaemia following uterine sepsis, following full term normal delivery," " General peritonitis following full term normal delivery," " Coronary embolism, puerperal septicaemia." One of the eight deaths not due to sepsis was from eclampsia. There was a history of albuminuria during pregnancy, which cleared up two weeks before labour which was itself normal, but shortly afterwards eclamptic convulsions set in and proved fatal. The blood pressure had apparently not been raised. The second case was one in which death was due to uraemia. Acute puerperal toxæmia followed on a difficult delivery for which the patient was admitted to hospital. Thirty-six hours after confinement the patient began to show signs of liver changes, passing into coma and 57 dying on the fourth day. Post-mortem examination revealed multiple areas of degeneration in the liver. Two deaths were due to post-partum haemorrhage due to adherent placenta, both of patients confined in hospital. The death certificate in one case read—1 (a) Exhaustion, (b) prolonged labour, (c) premature rupture of membranes ; 2 Primary uterine inertia ; 3 Rigid cervix. The patient had a perineal and cervical repair performed in 1933. She was a booked hospital case, but sought admission five days after the rupture of the membranes. Another hospital case, who had also had full ante-natal supervision, showed signs of sepsis some few days after a normal confinement and died on the eleventh day from pulmonary embolism. The sepsis was apparently due to infection of a retained cotyledon of the placenta. A patient confined at a hospital died under an anaesthetic shortly after forceps delivery under anaesthetic, performed on account of prolongation of labour. Post-mortem examination revealed myocardial degeneration. The remaining fatal case was due to (1) (a) myocardial failure, (b) puerperal mania. Enquiries into maternal deaths were previously undertaken in all three districts by members of the staff of the Middlesex County Council, but are now carried out by the Medical Officer of Health. Puerperal Fever and Pyrexia. Twenty-one notifications of puerperal fever were received during the year, 16 being of puerperal pyrexia and five of puerperal fever. Per thousand total births (i.e. live and stillbirths), the rates for these conditions were 7.1 and 2.2, the corresponding figures for the country as a whole being 9.6 and 4.0. One of the cases of puerperal fever proved fatal, the patient developing general peritonitis after a full-term normal delivery at home. Two of the 21 confinements took place in hospitals, and five in nursing homes. Twelve cases were removed to hospital for treatment. Work of the Health Visitors. Routine visits are paid to infants as soon as possible after the tenth day, and special visits are paid to cases of ophthalmia neonatorum, puerperal infection, stillbirths, infants' deaths, etc. Each Health Visitor is now appointed Infant Protection Visitor for her own area. The Health Visitors also attend the various clinics, the officer in charge of the session being, as far as possible, the visitor for the section from which the mothers attend. The following table shows the number of visits paid by the Health Visitors during the year :— (a) To expectant mothers First visits 141 Total visits 229 (b) To children under one year of age First visits 1,585 Total visits 3,590 (c) To children between the ages of one and five years Total visits 2,018 58 Infant Welfare Centres. At the end of the year there were fourteen weekly sessions held at eight separate premises in the district, namely two sessions each at two places at which clinics had previously been held by the Harrow-on-the-Hill Council, a similar number previously maintained by the Wealdstone Council, and six sessions held at four premises conducted by the Middlesex County Council. At each clinic two Health Visitors are in attendance and a number of voluntary workers kindly assist. The following table shows the work done at the Infant Welfare Centres during the year :— Total attendances at all Centres :— (1) By children under one year of age 19,290 (2) By children between the ages of one and five years 12,494 Total number of children who attended at the clinics for the first time during the year, and who, on the date of their first attendance, were :— (1) Under one year of age 1,276 (2) Between the ages of one and five years 394 Total number of children who attended at the Centres during the year and who, at the end of the year, were :— (1) Under one year of age 1,180 (2) Between the ages of one and five years 3,404 Percentage of notified live births represented by the number of children under one year of age who attended for the first time, 72.6. Treatment. The only treament services are those carried out by the Council of Child Welfare at " Tyneholme," these including ultra-violet therapy, massage, dental treatment, and the correction of visual defects. The Council made a grant in respect of those treated at " Tyneholme " who fell within the scope of the maternity and child welfare services. There is no scheme for the treatment and supervision of orthopaedic cases, and up to the end of the year no arrangements made for the treatment of tonsils and adenoids for necessitous cases. 250 children under 5 years of age made 580 attendances at " Tyneholme " for dental treatment during the period April 1st, 1934, to March 31st, 1935. 85 nursing mothers made 197 attendances for treatment, excluding 14 denture cases, who attended 44 times. At the Eye Clinic at " Tyneholme " 16 children under 5 years of age attended for the first time, 21 children making 42 attendances. Seven nursing mothers made eight attendances. 35 new cases amongst children under five attended the Massage Clinic, at which 36 cases made 466 attendances. At the Sunlight Clinic 92 children, including 70 new cases, made a total of 1,662 attendances. 59 The number of persons on the register who were receiving children for reward at the end of the year was fifty-four, and the number of foster children 134. Most foster mothers undertake the care of one child only, a small number being registered for the care of two, and still smaller numbers for more than two. The large difference between the number of children and the number of foster mothers is accounted for by there being in the district a number of nursery homes for the reception of small children, one being registered for 18 and another for 22. Each Health Visitor is appointed Infant Protection Visitor of her area. MATERNITY SERVICES. Ante-Natal Supervision. Most of the ante-natal work in the district, apart from that carried out by the medical practitioners on their own patients, is carried out by the Council of Child Welfare at " Tyneholme," to whom, in respect of these services, the Council makes a grant. Starting with a weekly session the work so increased as to warrant sessions twice weekly. At the Elmwood and the Broadway Clinics in Wealdstone monthly sessions were held, but towards the end of the year these were held weekly. The Middlesex County Council also held a monthly clinic at St. George's Hall, Headstone, and expectant mothers were seen at the Infant Welfare Clinics. The following table shows the work carried out at the Clinics during the year. Total number of attendances by expectant mothers at all clinics 1,354 Total number of expectant mothers who attended clinics 465 Percentage of total notified births (live and still) represented by the number of expectant mothers who attended the clinics 25 The Council at their meeting on January 1st, 1935, approved the recommendation of the Maternity and Child Welfare Committee approving of a scheme by which ante-natal supervision of uninsured women be carried out by the patient's own medical attendant, the Council paying the fees for such ante-natal and one post-natal examination. To remove the objection sometimes raised that a midwife might lose her fee if a patient she refers to the clinic is sent on medical grounds to hospital for confinement, provision is now made for the payment of compensation to a midwife for a case lost to her in this manner. 60 Arrangements for Confinement. At Home. To encourage confinements at home, arrangements have been made for the following forms of assistance to be available to necessitous persons :— (a) Payment of a midwife's fees. This payment ordinarily is conditional on the patient having received satisfactory ante-natal supervision. (b) Payment of the fees of a home help. (c) Provision of maternity sets. In an Institution. Up to 1931 there was at 10, College Road, Harrow, the Harrow, Wealdstone and District War Memorial Maternity Hostel of eight beds. By reason of an annual grant made to this Hostel, both the Harrow-on-the-Hill and the Wealdstone Councils were entitled to nominate a certain number of cases for admission at reduced fees. When, owing to the running out of the lease of this building in March, 1932, the Hostel closed down, the Harrow-on-the-Hill Council assisted in payment of patients' fees for admission to one or two local private maternity homes. As these arrangements, in view of the charges made, would prove costly, the new Harrow Council entered into agreement with a number of London maternity institutions for the reception of necessitous cases, an agreement of a temporary nature to bridge the gap until more suitable provisions could be made. Actually last year only 16 patients were admitted to hospitals for their confinements under the Council's scheme. Apart from the fact that many mothers will not accept these facilities although they may be cases for whom institutional accommodation is desirable, great difficulty is being experienced in getting beds for the patients. Additional maternity beds are needed to provide for the rapidly growing population in the neighbourhood. At a conference of the neighbouring authorities held in 1933, proposals were submitted for the reception of cases from this and other areas into an institution of a nearby authority. The suggestion was, however, apparently not acceptable to the various councils. The present policy of the Ministry of Health is to discourage the provision of small maternity homes as separate units, favouring the securing of maternity beds for complicated cases and for patients with unsuitable home conditions in small units associated with general hospitals. The only institutions in this locality in association with which such provision could be made are the Harrow and Wealdstone General Hospital and the Redhill County Hospital. It is understood that there is no likelihood of a maternity unit being established at the former of these two institutions. At Redhill there is a maternity department of some twenty-five beds which is to be extended to sixty beds. In the meantime, not one of the three districts which feed this hospital is as yet providing 61 additional beds for maternity cases. Each of these three districts is rapidly growing, and the total population is bordering on 400,000, a figure no doubt to be exceeded by the time additional beds are available. Owing to the limited accommodation, admissions were limited to complicated cases or primiparae, but recently even the latter group have had to be refused. With the growth of the population in the neighbourhood it does not appear that the additional beds to be provided at Redhill will go far to ease the situation, and the provision of further beds is an urgent necessity. With this object in view neighbouring authorities have been approached on the question of the erection of a joint institution to serve the needs of this and other districts. Consultant Services. Arrangements are in force by which a consultant is available to assist general practitioners in necessitous cases in the event of difficulty occurring during labour. Puerperal Infections. Cases are removed either to the London County Council North-Western Hospital or to the Isolation Block of Queen Charlotte's Hospital. During the year twelve patients were treated. Arrangements are in operation by which local medical practitioners can obtain the services of a consultant in cases of puerperal infection. Supervision of Midwives. Supervision of the midwives in the area is carried out by the staff of the Middlesex County Council as Local Supervising Authority. Following their July meeting, the Council made application to the Minister of Health for an Order constituting the District Council the Local Supervising Authority under the Midwives Acts, 1902-26, but as yet the request has not been acceded to. Maternity Homes. There are 18 Nursing and Maternity Homes in the district, possessing a total of 143 beds. Of these institutions, 14 are devoted either wholly or partly to the reception of maternity cases. The supervision of these Homes is carried out by the staff of the Middlesex County Council. At their meeting in July, 1934, the Maternity and Child Welfare Committee resolved that application be made to the Middlesex County Council for delegation to the District Council of the powers and duties of the County Council in the District under the Nursing Homes Registration Act, 1927. The application, however, was not complied with on the grounds that the County Council is the Local Supervising Authority under the Midwives Acts. CAUSE OF DEATH Under 1 year Over 1 and under 2 Over 2 and under 5 Over 5 and under 15 Over 15 and under 25 Over 25 and under 35 Over 35 and under 45 Over 45 and under 55 Over 55 and under 65 Over 65 and under 75 Over 75 Total RegistrarGeneral's Allocations M F M F M F M F M F M F M F M F M F M F M F M F M F 1. Typhoid fever - - - - - - - - 1 - - - - - - - - - _ - - - 1 - 1 - 2. Measles - - 1 1 4 1 2 3 - - - - - - - - - - - - - - 7 5 7 5 3. Scarlet fever - - - - 2 - 5 1 1 - - - - - - - - - - - - - 8 1 8 1 4. Whooping cough 1 2 - - - - - - - - - - - - - - - - - - - - 1 2 1 2 5. Diphtheria - - - - 4 - 2 - - - 1 - - - - - - - - 1 - - 7 1 7 1 6. Influenza - - - - - - 1 - - - 4 1 1 1 - 1 1 - 1 1 1 2 9 6 9 7 7. Encephalitis lethargica - - - - - - 1 - - - - - - - - - - - - 1 1 - 2 1 1 2 8. Cerebro-spinal fever - - - - - - - - - - - - - - - - - - - - - - - 1 - 1 9. Respiratory tuberculosis - - - - - - - 2 7 7 8 10 7 5 1 5 4 2 2 - 1 1 30 32 30 32 10. Other tuberculosis 1 - - 1 1 1 1 - - 1 2 4 - - 1 1 1 - - - - - 7 8 7 8 11.Syphilis 2 - - - - - - - - - - - - - - - - - - - - - 5 - 5 - 12. General paralysis of the Insane - - - - - - - - - - 1 1 - - 1 - - - - - - - 2 1 2 1 13. Cancer - - - - - - - 2 1 - - 3 6 9 9 16 17 21 22 19 15 15 70 85 70 86 14. Diabetes - - - - - - - - - - - 1 1 - - - - 2 3 2 - 1 4 6 4 6 15. Cerebral haemorrhage - - - - - - - - - - - - - - 1 2 6 5 10 16 7 17 25 40 21 36 16. Heart disease - - - - - - 1 - - - 7 2 5 3 10 9 15 16 30 39 21 41 89 110 88 114 17. Aneurysm - - - - - - - - - - - - - - - 1 1 - 2 - 1 - 4 1 4 1 18. Other circulatory diseases - - - - - - - - - - 1 - - 1 5 1 1 4 7 6 3 12 17 24 20 28 19. Bronchitis 1 - - - - - - - - - 1 1 - 1 1 1 - 1 3 6 9 2 15 12 13 12 20. Pneumonia 7 2 1 2 3 1 2 1 - - 2 2 8 1 6 4 5 2 6 4 3 5 43 24 43 21 21. Other respiratory diseases - - - - - - - - 1 - - 1 - 2 1 - 4 - 1 1 - - 7 4 7 2 22. Peptic ulcer 1 - - - - - - - - - - - 2 - 2 2 4 2 5 - 1 1 15 5 12 6 23. Diarrhœa (under 2 year) 4 1 - - - - - - - - - - - - - - - - - - - - 4 1 10 2 24. Appendicitis - - - - 2 - 2 - 1 1 2 - 1 1 - - 1 1 - - - - 9 3 8 2 25. Cirrhosis of liver - - - - - - - - - - - - - - 1 - - - - - - - 1 - 1 - 26. Other diseases of liver - - - - - - - - - - - - - - 1 - - 1 - 1 - 1 1 3 1 3 27. Other digestive diseases 3 1 1 - - - - - - - 2 - - 1 1 1 - 2 1 4 2 2 10 11 19 12 28. Nephritis - - - - - - - 1 - - 1 1 - 3 1 - 4 3 4 5 4 6 14 19 16 18 29. Puerperal sepsis - - - - - - - - - 1 - 2 - 2 - - - - - - - - - 5 - 5 30. Other puerperal causes - - - - - - - - 1 - 4 - 3 - - - - - - - - - 8 - 8 31. Congenital debility 40 28 - - - - - - - - - - - - - - - - - - - - 40 28 39 25 32. Senility - - - - - - - - - - - - - - - - - 1 2 6 12 25 14 32 14 24 33. Suicide - - - - - - - - 1 - 1 3 3 1 6 - 6 - - 1 1 - 18 5 18 5 34. Other violence 2 1 - - 2 - 3 1 2 3 3 - - 2 2 1 2 2 2 1 1 6 19 17 17 18 35. other defined diseases 4 1 2 _ 2 1 4 1 2 3 3 3 3 6 5 3 5 8 6 6 7 2 43 34 36 40 36. Causes ill-defined - - - - - - - - - - - - - 1 - - - 1 - - 1 - 1 2 1 2 Total 66 36 5 4 20 4 24 13 17 17 42 39 38 43 55 48 77 74 107 120 91 139 542 537 540 536 KING & HUTCHINGS, LTD. PRINTERS UXBRIDGE