HARRO 5 1 8 9 7 . HARROW- ON - THE - HILL Urban District Council. ANNUAL REPORT OF JOHN FLETCHER LITTLE, M.B. Cantab, M.R.C.P. Lond., Medical Officer of Health for Harrow. Harrow: Printed by F. W. Provost, High Street. 1898. HARROW-ON-THE-HILL URBAN DISTRICT COUNCIL. Population, 1897, 8,777. Area, 2,197 Statute Acres. Population, 1891 (Census) 5,725, Area 1,000 Statute Acres. ANNUAL REPORT, 1897. 32, Harley Street, Cavendish Square, W. The Chairman, Harrow Urban District Council. Sir, I have the honour to present to you my Annual Report for the year ending December 31st, 1897. The estimated population to the middle of the year was 8,777. During the year the births of 100 Boys and 96 Girls were registered, total 196, showing a birth-rate of 22.3 per 1,000. There were 72 deaths registered, 39 males and 33 females, or one more than in 1896. The death-rate being 8.03 per 1,000. This is lower than the previous year, which was 8.5, and much below the average for the preceding 10 years, which was 11.5 per 1,000. Of these deaths 22 occurred in the March quarter, 18 in the June quarter, 11 in the September quarter, and 21 in the December quarter. The following is the distribution of deaths according to age: Under 1 year 14 Over 1 year and under 5 2 under 5 years 16 „ 5 years „ 15 3 ,, 15 „ „ 25 3 „ 25 „ „ 65 19 „ 65 ,, „ – 31 over 5 years 56 2 Comparing the 14 deaths of infants under 12 months old and the 196 births, it appears that there were 71 such deaths to each 1,000 births, or, in other words, of every 14 children born one died without seeing the anniversary of its birth. This shows a remarkable decrease on the figures for 1896 which were 113 per 1,000, and on the average for the previous 10 years, which was also 113 per 1,000. However, there is still room for improvement, since the deaths of some of these infants might have been prevented. The admissions of Harrow Paupers to the Hendon Workhouse in 1897 were 47, and the deaths 2. There were 2 deaths from Zymotic diseases, viz., Scarlet Fever 1, Typhoid Fever 1, or at the rate or .22 per 1,000. There were 3 deaths from Diarrhoea, and 7 deaths from Phthisis. There were certified during the 12 months 21 cases of Scarlet Fever, 7 cases of Diphtheria, 6 cases of Typhoid Fever, and 2 cases of Erysipelas. The malignant character of the fatal case of Scarlet Fever may be attributed to the insanitary condition of the house where it occurred. The existence of such a place constitutes a general danger to the Public Health. The fatal case of Typhoid Fever occurred in Hodsdon's Cottages. Here there was no skilled nursing, which in this disease is all-important. DECLINE OF DEATH-RATE. Once again I am able to report a diminished death-rate. This arises in two ways—a lessened infantile mortality, and a small number of deaths from zymotic diseases. The infantile death-rate is still needlessly high, and measures should be taken to diminish it. In 1896, in the Hampton Wick District, there were 52 births without a death under 1 year of age. Is there any reason why Harrow should not have a like record ! As cases of Measles are not notifiable in the district, I am unaware of their existence until deaths are registered. In Friern Barnet, after a trial of notification for Measles during two years, it has been continued. This disease is so 3 deadly to the children of the poor that I would again ask the Council to place it on the list of notifiable diseases, and thus afford the opportunity of lessening its ravages. In 1896, in Harrow, the number of deaths from Measles was five times greater than from all the other Zymotic diseases taken together. LONGEVITY. In Harrow when the dangers of infancy are safely passed long life may be anticipated. There were 31 deaths registered of persons over 65 years of age, being 43 per cent. of the total deaths. Of these 3 died between 65 and 70, 14 between 70 and 80, 12 between 80 and 90, and 2 between 90 and 100, 1 of whom reached the great age of 96. HOW TO REDUCE THE DEATH-RATE. If Harrow is to maintain its position in the race of health much remains to be done. House-to-house inspection is absolutely essential. The insanitary conditions reported as existing in various dwellings on the outbreak of Infectious Diseases show how important this is. These are evidently samples of the bulk. The present policy of deferring such inspection until disease breaks out is simply lamentable. I would once more urge that the Council should give instructions for house-to-house inspection. THE INFANT INCUBATOR. The great use of this apparatus in saving, not only children prematurely born, but also many suffering from chest affections and other diseases, causes me again to recommend that one should be provided. The lack of this in Harrow permits children to perish, whilst across the Channel they are preserved in large numbers. Now that the Cottage Hospital has been so liberally endowed, it appears unreasonable that what is so requisite should not be provided. 4 PREVENTION OF PHTHISIS AND TUBERCULOSIS. It is sad to have to record the deaths of seven people from Phthisis. This is now regarded as an infectious, and therefore preventable disease. The infection is usually spread through the inhalation of the dried expectoration, or by drinking the milk of tuberculous cows. Damp, ill-ventilated houses lower the vitality, and render the dwellers in them less able to resist the contagion. All such houses should be reported, and all rooms used by phthisical patients should be disinfected under the supervision of Mr. Charles, the Sanitary Inspector. A patient suffering from this disease should sleep alone. He should not expectorate on the floors, and all his sputa should be burned. Several cases of Tuberculosis have occurred in children. This should induce all parents to make careful enquiry concerning the sanitary condition of the sources of the milk they purchase for their children, and the Council should appoint a Veterinary Surgeon to test all the dairy cattle for Tuberculosis. DISTRICT NURSES. The circumstances of the death from Typhoid at Greenhill afford strong proof of the need in the district for such Nurses. In such cases skilled nursing is as essential as medical skill, yet but for the occasional attendance of a kind lady, the only nurse of the unfortunate patient was his wife, who was a cripple with the care of six children, all of tender age. Unless the philanthropy of the inhabitants provide District Nurses we must be prepared to expect similar tragedies. BACTERIOLOGICAL TESTS. That infectious diseases should be diagnosed early is essential to their prompt isolation. Tests by which they can be diagnosed at the outset are now available for Typhoid Fever, Diphtheria, &c. These tests have been provided for the medical men of the district at Brighton and other places. I recommend the Council to do so for Harrow. 5 ISOLATION HOSPITAL. During the year there were 18 cases of Scarlet Fever treated in the Hospital with one death. In 1896 31 cases of this disease were admitted. The need has been manifest for a room in which doubtful cases could be observed until a diagnosis is made. An Observation Ward is exceedingly desirable. At times the Administration Block has had to be used, owing to there being only two wards available. As the Hospital continues to grow in usefulness, it will be necessary to carry out the original plan, and build an additional ward. The prompt removal of all cases of Infectious Diseases to an Isolation Hospital is one of the surest means of getting rid of these plagues. The disappearance of Leprosy when dealt with in this way should be an object lesson. In this country Leper Houses are no longer needed, and in our old churches the Leper windows only serve to remind us of the wisdom of our forefathers. STEAM DISINFECTOR. The Council has decided to provide a Steam Disinfector. It will be a valuable adjunct to the hospital, and will supply a long felt need in the defensive arrangements against the spread of infection. WEST STREET POND. The filling up of this filthy pond by the order of the Council will remove another blot on our sanitation. The use of the site for healthy enjoyment must tend to the general good. THE RECREATION GROUND AT ROXETH. This much needed playground will soon be added to the attractions of Harrow. It should tend to improve the physique of the young people, and as well, give a moral tone, which will be an adequate return for the investment of the Council. WATER SUPPLY. The complaints that have reached me as to the quality of the water supplied by the Colne Valley Company lead me to advise 6 the Council to make arrangements for its chemical and bacteriological examination from time to time. Its colour has not been satisfactory and matter in suspension has been found in it. This suspended matter will clog the water filters and render them useless. The terrible experiences of Maidstone and other places render it needful that the inhabitants should be guarded against the introduction of water-borne diseases. The County Council at present takes no action and it will be necessary that each district should provide for itself. WATER CLOSETS WITHOUT WATER. There still remain a number of water closets without water, and their existence is an ever present menace to the health of the town. I would again invite the Council to place them in the same category as the obsolete bell-traps, and so that they may be dealt with by the Sanitary Inspector. TWO GALLON FLUSH TANKS. By exhaustive experiments the Sanitary Institute has demonstrated that flush tanks of two gallons are insufficient, and that tanks of three gallons are necessary to clear the drains. Three gallon tanks should therefore be introduced everywhere, but the Colne Valley Water Company stands on its strict legal rights and refuses to allow their introduction. The householder can secure himself by seeing that his two gallon tank is emptied twice on each occasion, and if the expenditure of the extra gallons becomes general, the Water Company will soon perceive an advantage to itself in permitting flush tanks of three gallons. That a town like Harrow should be compelled by a private Water Company to go on using a sanitary appliance of proved insufficiency is a strong argument in favour of the water supply being placed in the hands of the County Council, which would accept scientific facts and be amenable to public opinion. NEW BUILDINGS. There have been 56 new dwelling-houses erected, 23 additions and alterations made to those already existing, and 9 buildings, not dwelling-houses, completed during the year. Eight drainage plans were carried out. 7 DAIRY FARMS. The Dairy Farmers are carrying out (with more or less alacrity) the requirements of the Council. When they have all done so these places will be worthy of the confidence of the inhabitants. Your officials do all they can by periodical and unexpected visits to insure that the standard of sanitation is maintained. At the same time I ask the aid of the consumers of milk in our work. By their visiting the Cowsheds and Dairies from whence they receive their milk supply, they will encourage those who are keeping them in order, and exert a beneficial influence on those who are not. A milking cow should be kept as clean as a wellgroomed horse. When this is not done the milk is contaminated, and frequently there is even found a black sediment at the bottom of the vessels in which the milk is allowed to stand. The hands of the milkers should be scrupulously clean, and abundant provision should be made for washing them. The milk cans should be boiled in a copper each time before they are used. The yards, cowsheds, dairies, &c., should be kept scrupulously clean. When all these requirements have been complied with, it will still be advisable that all milk should be scalded—that is raised to temperature of boiling point, or 212° Fahrenheit in order to destroy all microbes. MILK FROM OUTSIDE THE DISTRICT. A large portion of the milk consumed in Harrow is brought from outside. The communication recently sent by the Council to the neighbouring Authorities will doubtless lead to a stricter supervision being exercised over the Dairy Farms of the County. There is, however, a considerable part of the supply, which comes through contractors who receive it from distant places, some as far off as Derbyshire and the Continent. When such milk is offered for sale in the town, it should be guaranteed by a certificate from the Medical Officer for the district from whence it is derived. The absence of this precaution may lead to outbreaks of infectious 8 diseases like those at Clifton and other places. These supplies of milk are not only liable to contamination at their source, but also in transit, as the Railway Companies will not allow the vessels to be sealed. In the refreshment room at Baker Street Station there is a printed notice on the counter stating that the purity of the milk sold there is not guaranteed. BAKERIES. The Bakeries have been kept in good order, and as by degrees new ones are being built with modern appliances the health of the workmen will improve, and bakers will no longer be a short lived class. SLAUGHTER HOUSES. These places are now kept in a fairly satisfactory state. The time, however, must come when private Slaughter Houses will be abolished, and public Slaughter Houses take their place. Perfect inspection of the meat cannot be carried out in the existing circumstances, and this is considered as of the first importance by all sanitarians. The extraordinary reduction of the mortality from Typhoid in the City of Munich is partly attributed to the abolition of 600 Slaughter Houses in that capital. The death-rate of England and Wales is more than four times greater than that of Munich. COMMON LODGING HOUSES. The Common Lodging House under my care is in good order, and I presume that the Licensing Magistrates are satisfied with the other Lodging House. METEOROLOGICAL REPORT. The total rainfall for the year was 26.01 inches. The wettest month was June (413 inches), and the dryest month, July (0.42 inches). January was the coldest month (Fah. 30.4 lowest mean), and July the hottest (Fah. 75.3° highest mean). The rainfall for the previous five years was 1892, 20.55; 1893, 21.04; 1894, 29.48; 1895,25.21; 1896,26.88. 9 I wish once more to place on record my indebtedness to Mr. Charles for his zealous and able help. A large amount of additional work has devolved upon him owing to the preparations being made for bringing up the Dairy Farms to the standard of modern sanitation. The rapid manner in which he has removed infectious cases to the Isolation Hospital and carried out the process of disinfection of the patients' houses afterwards is worthy of the highest commendation. I remain, Sir, Your obedient Servant, JOHN FLETCHER LITTLE, M.B. Cantab., M.R.C.P. Lond., Medical Officer of Health for Harrow. (A) TABLE OF DEATHS DURING THE YEAR 1897, Classified according to DISEASES, AGES, AND LOCALITIES. Estimated Popualtion, 8,777. Names of Localities adopted for the purpose of these Statistics; public institutions being shown as separate localities. Mortality from all causes, at subjoined ages. Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. At all ages. Under 1 year. and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Scarlatina. Enteric or Typhoid Fever. Diarrhoea & Dysentery Phthisis. Bronchitis, Pneumonia. & Pleurisy. Heart Disease. Influenza. Injuries. All other Diseases. Total. Harrow 72 14 2 3 3 19 31 Under 5 3 2 1 9 15 5 upwds. i 7 6 7 25 46 Cottage Hospital Under 5 1 1 2 5 upwds. 3 5 8 Isolation Hospital 5 upwds. 1 1 Totals 72 14 2 3 3 19 31 Under 5 3 2 1 1 10 17 5 upwds. 1 1 7 9 7 30 55 (B) TABLE OF POPULATION, BIRTHS, and of NEW CASES OF INFECTIOUS SICKNESS, Classified according to DISEASES, AGES, and LOCALITIES. Names of Localities adopted for the purpose of these Statistics; public institutions being shown as separate localities. Population at all Ages. Aged under 5 or over 5. New Cases of Sickness in each Locality. Number of such Cases Removed from their Homes in the several Localities for Treatment. Census 1891. Census 1896. Scarlatina. Diphtheria. Enteric or Typhoid Fever. Erysipelas. Isolation Hospital. Cottage Hospital. Scarlatina. Diphtheria. Enteric or Typhoid Fever. Urban Sanitary District of Harrow 5725 8373 Under 5 1 1 1 5 upwds. 20 5 6 2 17 1 1 Totals Under 5 1 1 1 5 upwds. 20 6 6 2 17 1 1 11 METEOROLOGICAL OBSERVATIONS TAKEN AT HARROW DURING THE YEAR ENDING DECEMBER 31st, 1897. BY T. CHARLES, SURVEYOR TO THE COUNCIL. Month. Hygrometer. Temperature. Rainfall. Wind. Dry Bulb. Wet Bulb. Max. Min. Earth. Total Depth Greatest Fall in 24 hours. No. of days 011 which .01 or more fell. Prevailing Wind. Depth Date. 1ft. 4ft. January. Means 34.09 34.2 39.2 30.4 31.6 44.5 2.06 .. .. .. N.E. Highest 44 43 46 42 43 45 .. 0.62 8th 19 .. Lowest 23 22 30 22 36 43 .. .. .. .. .. February. Means 42.07 40.07 47.3 37.6 40.5 42.9 2.82 .. .. .. S.W. Highest 49 47 58 48 45 44 .. 0.64 4 th 14 .. Lowest 32 31 37 28 36 42 .. .. .. .. .. March. Means 44 42.1 51.3 38.1 43.3 44.1 3.84 .. .. .. S.W. Highest 54 57 61 49 47 45 .. 0.63 17th 21 .. Lowest 35 34 43 27 40 44 .. .. .. .. .. April. Means 47.1 43.6 49.5 38.7 451 45.9 1.92 .. .. .. N.E. Highest 54 51 68 46 49 46 .. 0.24 30th 19 .. Lowest 34 33 42 28 42 45 .. .. .. .. .. May. Means 51.83 47.74 60.38 42.09 50.77 48.96 1.56 .. .. .. N.W. Highest 63 57 71 53 55 50 .. 0.38 31st 10 .. Lowest 43 37 47 33 48 46 .. .. .. .. .. June Means 6106 601 36.6 51.2 57.8 52.3 4.13 .. .. .. W. Highest 75 68 84 61 61 54 .. 2.24 24th 13 .. Lowest 52 47 55 43 56 50 .. .. .. .. .. July. Means 64.2 61.4 75.3 52.9 63.06 56.2 0.42 .. .. .. N.E. &W. Highest 76 67 81 59 63 58 .. 0.17 19th 5 .. Lowest 49 48 64 42 60 54 .. .. .. .. .. August. Means 62.1 58.5 65.2 52.6 62.4 58.8 3.13 .. .. .. S.W. Highest 75 67 87 60 64 60 .. 0.82 25th 16 .. Lowest 58 54 64 46 60 58 .. .. .. .. .. 12 Meteorological Observations (continued). Month. Hygrometer. Temperature. Rainfall. Wind. Dry Bulb. Wet Bulb. Max. Min. Earth. Total Depth Greatest Fall in 24 hours. No. of days on which .01 or more fell. Prevailing Wind. Depth Date. 1ft. 4th. September. Means 54.26 51 .83 62.36 48.03 56.73 57.43 1.94 .. .. .. N.W. Highest 60 58 68 58 60 59 .. 0.39 1st 13 .. Lowest 45 43 53 38 55 56 .. .. .. .. .. October. Means 49.32 47.09 57.61 43.41 52.54 55.32 0.76 .. .. .. N.E. Highest 59 56 67 56 57 56 .. 0.14 2nd 13 .. Lowest 39 37 52 29 50 54 .. .. .. .. .. November. Means 43.66 42.53 50.33 38.23 48.13 52.13 1.12 .. .. .. N.E. Highest 56 54 58 51 50 54 .. 0.37 27th 12 .. Lowest 29 29 43 27 45 51 .. .. .. .. .. December. Means 38.58 37.58 45.93 33.45 42.38 48.48 2.31 .. .. .. S.W. Highest 53 52 55 47 45 51 .. 0.65 7th 18 .. Lowest 24 24 41 17 39 47 .. .. .. .. ..