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50
inhabitants of certain important rays from the sun, while at the same
time adding contamination which irritates the lungs. Favourable
geographical siting alone, though, is not sufficient to ensure a low rate or
the district would not have suffered the high rates of 50.0 and 55.6 in
1940 and 1941. As a second factor can be put Harrow's fortunate
financial position. Most of the district is of recent development, which
means there are no large insanitary blots, while the general level of living
is not low. Many, of course, to-day are living in very distressing and
even unhygienic surroundings, but they are not accepting that as a
normal state. They react to it, and are only too anxious to better their
lot. Even the surroundings, then, of these smaller numbers have not
the same significance as when these are accepted by populations as a
normal above which there is to be no rising. Probably the harmful
effects of unsatisfactory surroundings are not so much direct as indirect.
Sanitation is low in such surroundings at ordinary times, not because of
the surroundings themselves as because of the attitude of mind and the
standard of living of those in them. It is the commonest experience to
see widely different standards of cleanliness and tidiness amongst neighbours
whose houses structurally are the same. Perhaps, then, the slight
effect of any adverse environmental conditions is due to the generally
high standards of domestic hygiene in those who ordinarily have been
fortunate enough to be living in houses in which such standards have
been easily maintained.
The high rates of the early part of the century, though, were not
limited to the black areas of the country. It would be exceptional for
even the most blessed and favourably placed districts at that time to
have reached as low as the national rate of to-day. An explanation for
this difference is education, not merely the knowledge imparted by the
health visitor to the mother, nor the knowledge acquired by the mother
as the result of compulsory school attendance for some decades, but
probably more important, all that went to the demand for compulsory
education and which, in its turn, makes the mother receptive to tuition.
The health visitor is perhaps the most important official in the public
health service. Partly as the result of the efforts of the sanitary inspector,
his work has become that much less important. Environmental hygiene
gave way to the personal services. It is to the health visitor that we
must look for the next improvements.
At the Annual Conference of the Royal Sanitary Institute, the subject
of infant mortality was discussed. The causes of the deaths were
analysed, and it was pointed out that in some districts lives were lost
because the homes of the babies born in hospital were not fit for them
to come to. The remedy suggested was the provision of a hostel to
which the mother and her baby could be admitted for a while till the
baby's hold on life was strengthened, so that it would survive the move to
its adverse home surroundings. Possibly in some districts such steps
are necessary. It would be most unfortunate, though, if such a policy
was to be generally pursued. The correct solution to that problem,
surely, is concentrating on the home so that its standard might be raised,
and the mother educated and helped to enable the child to return in
safety to a safer home. Such work is the responsibility of the health
visitor. The National Health Service Act has recognised her importance