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7
the responsibility of the Welfare Officer of the County Council; nor is
it the responsibility of the staff of the Health Department of the County
Council. In spite of its being a personal service, and in spite too of the
personal services becoming in 1948 the responsibility of the major
authorities, County and County Borough Councils, the care of the aged
is not the responsibility of the County Council. The person whose duties
bring her most closely into contact with the individual problems of
these people is the Co-ordinating Officer. If she is to have to do this
work, work which is being done by no one else, her duties will cover a
much wider field than merely acting as Co-ordinating Officer of the
services provided by others.
The twenty-seven years since Harrow was created by the amalgamation
of three smaller districts has seen many changes in the field of public
health. In 1934 when the population of the district was not much more
than half what it is today, there were 102 infant deaths with an infant
mortality rate of 47 0; thirteen maternal deaths with a maternal mortality
rate of 5-8; 621 notifications of scarlet fever with nine deaths; eighty
notifications of diphtheria with eight deaths; twelve deaths from measles,
three from whooping cough and seventy-seven from tuberculosis. The
war years saw an interruption in the improvements on these figures but
in spite of this set-back, the position has been reached that an infant
mortality rate as high as eighteen is a disappointment and when for each
of the last few years there has been not more than one death arising
from or associated with pregnancy. These improvements are the result
of a combination of factors. Those working in the maternity and child
welfare service must be given credit, as too must the general practitioners
and those in the hospital service. Full employment with the improved
nutrition and general standards of living too have played their part.
For what has happened in regard to scarlet fever local authorities cannot
really take credit. That the virulence should have diminished so markedly
with the result that the last fatal case of scarlet fever contracted in this
district was in 1937, is due to changes in the organism. The position
today is satisfactory; changes in the reverse direction might cause the
disease to assume a case mortality as high as the 16 per cent it had for
some years in this country in the last century and in South East Europe
as recently as just before the war. Another striking change and one which
reflects the extraordinary reduction in the virulence of the organism
with consequent mildness of the illness, is that whereas at the beginning
of this period it was customary for nearly all sufferers to be removed to
the infectious diseases hospital, today this is quite the exception. The
district has been free from diphtheria since 1950. This is probably due
largely to the extent to which those of susceptible ages have been protected
by active immunisation against the infection. This is not the whole story
though because from 1934, even when not many had been protected by
immunisation, the district was very much more lightly attacked than the
country as a whole. Any individual can be rendered safe only by active
immunisation, the responsibility of the child's parents. Measles, which
UP to recently had been such a menace to small children, has become less
virulent, though there has been no reduction in its capacity for spreading.