Fiftieth Annual

Report of the County

Medical Officer.

COUNTY COUNCIL OF THE

WEST RIDING OF YORKSHIRE
*

1938.
COUNTY COUNCIL OF THE WEST RIDING
OF YORKSHIRE.

FIFTIETH

ANNUAL REPORT
OF THR

County Medical Officer,

FOR THE YEAR. 1938.

Printed by Order of the Public Health and Housing

Committee, 19th June, 1939.
 Digitized by the Internet Archive
in 2018 with funding from
Wellcome Library

https://archive.org/details/b30263128
 1

WEST RIDING PUBLIC HEALTH AND HOUSING

COMMITTEE.

Chairman

County Alderman G. Probert.

Vice-Chairman

County Councillor J. Wilkinson.

County Aldermen

Bambridge, H. J. Quarmby, Sir John, K.B.

(Vice-Chairman of the County Council.)

Cartwright, W. B. Siddall, J.
(Chairman of the County Council.)

Dawson, Major J. M. Tomlinson, T.

Dean, W. Turner, Sir Ben, K.B., C.B.E.

Eddy, H., M.B.E. York, Col. E., D.L.

County Councillors

Allan, J. T. Jackson, F.

Atkinson, Mrs. E. M. E. Johns, W. J.

Bacon, B. Jones, W. E.

Bailey, A. R. Kilner, A.

Blackburn, A. Mellor, J. W.

Blewitt, W. T. Moorhouse, G.
Bradley, B. Palmer, G. E.

Crabtree, E. Radcliffe, R. J. P. J.

Dawson, H. M., M.B.E. Ramsden, Lady.

Drake, H. S. Richardson, J.

Fielding, T. G. Roberts, B.

Fletcher, A. Simpson, J. W.

Fouchard, A. Tack, A. W.

Goodall, N. Waddilove, V.

Heald, Mrs. M. Whittock, M.

Hibbert, W. Wood, A.

Hill, W. Wood, F. S.

Houldsworth, Mrs. H. F. Wragg, Mrs. E., M.B.E.

Inglis, E. P.
 2

TO THE CHAIRMAN AND MEMBERS OF THE PUBLIC HEALTH AND

HOUSING COMMITTEE OF THE COUNTY COUNCIL OF THE
WEST RIDING OF YORKSHIRE.

Mr. Chairman, Ladies and Gentlemen,

I have the honour to present the Annual Report on the health conditions in the
County during the year 1938.

Presentation of The Report is being submitted to the County Council along with my Annual
Three Reports on
Health Matters. Report as School Medical Officer and a special report upon a survey of the diets of
people in the West Riding. Much of the subject matter of these three reports is com¬
plementary one to the other.

Urgent At the time of writing (May, 1939), a communication has been received from
Communication
from Government. the Government requesting Local Authorities and County Councils to set aside for a period
of three months all matters not of vital urgency and to concentrate their activities so
far as possible upon essential measures of national defence in order to accelerate the
preparation and completion of Air Raid Precautions and National Defence Schemes.

Consequent Having- regard therefore to this urgent request from the Government and to
Restriction of
Contents of this
the heavy pressure already put upon the department in connection with medical, nursing,
Report. hospital and allied matters for the protection of the civilian population, I have considered
it desirable to restrict the contents of this report as far as possible.

Outstanding I regard the three outstanding features of the vital statistics for the year as being
Statistical
Features. (1) a further reduction in the infantile mortality; (2) a further reduction in the maternal
mortality and (3) a small decrease in the death rate from cancer.

Record Low The infant mortality rate represents the number of deaths of infants per
Infantile Mortality
Rate. thousand live births. This rate for the Administrative County was 51 for the year 1938,
being two below the corresponding rate for England and Wales; it represents a decrease
of nine upon the rate for the Administrative County for the year 1937 ; and it is the lowest
annual rate ever recorded in the Administrative County.

Record Low As regards the maternal mortality rate (the number of deaths of women in con¬
Maternal Death
Rate.
finement per 1,000 births), the reduction was only slight compared with the rate for
1937, being 3-92 in 1937 and 3‘74 in 1938; but when compared with the rate for the
Administrative County for 1933, when the rate was 6-24, it will be observed that the
saving in life of mothers in confinement is considerable. It should be noted however
that the rate for the Administrative County is still appreciably higher than the rate for
England and Wales (3-08).

Prospect of I am of the opinion that there is no good reason to be found why the rate in the
Maternal Death
Rate falling to that West Riding should be any higher than that of the country as a whole. There is in fact
of England and nothing of a causative nature inherent to the West Riding which is not common to
Wales.
other parts of the country; and I feel sure that if pregnant women during the ante-natal
period would take greater advantage of the facilities offered them either through the
ante-natal clinics or through their private medical practitioners the proportion of deaths
of mothers in the Administrative County should be no higher than elsewhere, in the
course of a few years time.

Check in Cancer
As to the death rate from cancer, the reduction is very slight, namely, from T60
Death Rate.
in 1937, to T55 in 1938, compared with 1 66 for England and Wales for 1938. Slight as
this reduction may be however, it is satisfactory to report a check in the insidious in¬
crease in the number of deaths which has been taking place from cancer during recent
years. In a disease such as this it is impossible to prognosticate the upward or down¬
Analogy with ward trend in the incidence as can be done with certain other diseases. For example
Tuberculosis.
in tuberculosis we know the root cause (the tubercle bacillus) of the disease as well as
the contributory causes, such as poverty, bad feeding, bad housing, overstrain etc. It
 3

has been discovered that by removing these contributory causes to tuberculosis we have
made it possible to a very large extent to prevent the infecting organism, the tubercle
germ, from launching a successful attack on the human frame.

In cancer, however, whilst we know7 of a number of contributory causes, e.g., Primary Cause of

certain forms of chronic irritation to different tissues of the body, we have not discovered ^"covered ***
the primary or root cause, bacterial or otherwise; but it is possible that as a result of
a general improvement in the standard of living and consequent removal of a number of
contributory causes, the human organism may be rendered less vulnerable to attack.
Such a process may be an explanation of the slight check recorded for 1938 in the Possible

gradual rise in the number of deaths which has taken place in preceding years. Checkin °rise*of
Cancer Rate.

It is to be noted in this connection that the “general death rate” for the Admin- Fall in "General
istrative County fell from 12'7 in 1937 to 11‘6 in 1938 (the same figure as for England Death Rate-
and Wales) and as one death in every seven is due to cancer an appreciable portion
of the reduced number of deaths in 1938 were among the cancer group. There was a check in Death
slight check also in the gradually increasing death rate from heart and circulatory Rate from "Heart

diseases, a group of diseases which is responsible for an even greater proportion of

deaths than is due to cancer.

In my last annual report I referred to the provision of general hospital accom¬ "General”
Hospital”
modation in the Administrative County and mentioned the scheme agreed by the County Accommodation.
Council for the provision of two new general hospitals and extensions to the appropriated
hospitals-—-“Staincliffe” at Dewsbury, and “White Rose” at Wakefield. The plans Extensions to
Existing
for these extensions are now in hand; but as regards the proposed new general hospitals,
Hospitals.
progress has been slow owing to the difficulty of securing satisfactory sites. In
connection with the proposed North-Western General Hospital, negotiations for a site of
approximately 80 acres on the outskirts of the Borough of Keighley, are almost com¬
pleted; but in the case of the proposed South Yorkshire General Hospital, although
what appears to be a satisfactory site, also of 80 acres, has been found at Marr, five New "General”
Hospital—
miles north-west of Doncaster, questions of mining subsidence have arisen and until
Difficulty in
this serious problem has been disposed of further progress will be slow'. South Yorkshire.

Whilst dealing with hospital matters it is appropriate to mention that the County Infectious

Council’s scheme for the provision of adequate isolation hospital accommodation for 'scheme
cases of infectious disease and smallpox has now been agreed by the County Council
and awaits the approval of the Minister of Health. Details of this scheme will be found
on page 32 of this report.

Work in connection with Air Raid Precautions and National Defence has National Defence.
become so extensive recently that it has been necessary to second an Assistant Medical
Officer and an Ambulance Officer from their normal duties in order to permit them to
devote the whole of their time to National Defence matters. In particular the establish- jgew Casualty
ment of hospital schemes involving the provision of approximately 5,000 additional beds Hospital Beds.

for casualty purposes, the arrangement of Personnel, both medical and nursing, for hos¬
pitals, first-aid posts, first-aid parties etc., has necessitated almost daily meetings Nursing ‘personnel.
together with large masses of correspondence with hospital authorities and represent¬
atives of the medical and nursing professions. More recently, at the request of the County Emergency
Central Emergency Nursing Committee I have convened a County Emergency Nursing
Committee, whose duties will be mainly associated with the recruitment, training and
enrolment of nursing auxiliaries, of whom I estimate we will require approximately 2,000 Government’s
to serve in connection with the additional hospital accommodation. The Government’s Casualty Scheme
proposal in general terms is that upon the Outbreak of war the Ministry of Health, Emergency.
through one of its Regional Officers, will Communicate with the County Medical Officer,
asking him to put into operation the pre-arranged hospital and casualty scheme to
operate in the whole of the Administrative Countv.

I have pleasure in reporting that in September, 1938, with the approval of

the County C ouncil, Dr. P. L. Sutherland, County Pathologist, was appointed to the
Chair of Forensic Medicine at Leeds University.

I have the honour to be,

Your obedient servant,

County Hall, Wakefield. T. N. V. POTTS,

May, 1939. County Medical Officer.
 4

Staff.
(June, 1939).
County Medical Officer and School Medical Officer.
T. N. V. Potts, M.D., B.S., B.Hy., D.P.H.

Administrative Assistant Medical Officers of Health.

P. L. Sutherland, M.B., Ch.B.,
D.Sc. (Public Health).
J. A. Fraser, M.B., Ch.B., D.P.H.
R. Lawrence, M.D., Ch.B., D.P.H.
G. S. Johnston, M.D., Ch.B., D.P.H.
J. A. Burgess, M.D., Ch.B., D.P.H.
J. Wood Wilson, M.D., Ch.B., D.P.H.
L. A. Willmott, M.B., B.S., M.R.C.S.,
L.R.C.P. (Temporary).
County Bacteriologist and Pathologist.
Senior Administrative Assistant Medical Officer.
Chief Assistant School Medical Officer and Child
Welfare Medical Officer.
Chief Clinical Tuberculosis Officer.
Venereal Diseases Officer and Air Raid
Precautions.
Administrative Assistant County Medical Officer.
Assistant Bacteriologist.

Consultant Tuberculosis Officers.

H. E. Raeburn, M.D., B.S., D.P.H. (Is also Medical Superintendent, Middleton Sanatorium).
V. Ryan, M.D., Ch.B., B.A.O., D.P.H. ( ,, ,, ,, Scotton Banks Sanatorium.)
E. Ratner, M.D., Ch.B., D.P.H. ( ,, ,, ,, Crookhill Hall Receiving Home.)
H. A. Crowther, M.A., M.R.C.S., L.R.C.P.
S. R. Wilson, M.D., Ch.B., D.P.H.

Assistant Tuberculosis Officers.

G. A. Crowley, B.A., M.D., B.Ch., D.P.H. R. L. Osmaston, B.A., M.B., B.Ch., D.P.H.
E. J. C. Groves, M.B., Ch.B. A. D. Rankin, M.B., Ch.B., D.P.H.
A. Leitch, M.B., Ch.B., D.P.H. T. W. Ruttledge, M.B., Ch.B., D.P.H.
W. B. Lipschitz, M.D., L.R.C.P., R. J. Vince, B.A., M.R.C.S., L.R.C.P.
L.R.C.S., L.R.F.P.S. E. A. Wilson, M.D., M.R.C.S., L.R.C.P.
N. J. S. Nathan, M.R.C.S., L.R.C.P.

Sanatorium Medical Staff.

G. S. Johnston, M.D., Ch.B., D.P.H.
H. E. Raeburn, M.D., B.S., D.P.H.
J. N. Hill, M.B., Ch.B., D.P.H.
N. D. Gordon, M.D., C.M. (McGill),
L.R.C.P. & S. (Man.).
B. Haring, M.R.C.S., L.R.C.P., D.P.H.
V. Ryan, M.D., Ch.B., B.A.O., D.P.H.
S. P. Wilson, M.D., Ch.B., D.P.H.
Margaret Mulvein, M.B., Ch.B.
E. Ratner, M.D., Ch.B., D.P.H.
(Chief Clinical Tuberculosis Officer),
Medical Superintendent, Cardigan Sanatorium,
Medical Superintendent, Middleton Sanatorium.
Senior Assistant M.O., and Deputy Medical
Superintendent, Middleton Sanatorium.
Junior Assistant M.O., Middleton Sanatorium.
Junior Assistant M.O., Middleton Sanatorium.
Medical Superintendent, Scotton Banks
Sanatorium.
Senior Assistant M.O., and Deputy Medical
Superintendent, Scotton Banks Sanatorium.
Assistant Medical Officer, Scotton Banks
Sanatorium.
Medical Supt., Crookhill Hall Receiving Home.

Sanatorium Nursing Staff.

Middleton Sanatorium. Matron J. Pegg. Nursing Staff, 42.
Scotton Banks Sanatorium. ,, M. Heslop. J J
34.
Cardigan Sanatorium. ,, A. Major (temporary). y y
8.
Crookhill Hall Receiving Home. ,, M. A. Toogood. y y 6.

Venereal Diseases Officers.

There are 16 part-time Medical Officers of Venereal Diseases Treatment Centres; see page 36,
for list of Centres.

School Oculists.
C. S. Stoddart, M.B., Ch.B., (Whole-time).
H. W. Murphy, M.B., Ch.B., D.P.H. (Whole-time).
G. C. Kay Sharp, M.D., Ch.B. (Part-time).
School Aural Surgeon. (Part-time).
H. M. Petty, M.B., Ch.B.
School Medical Inspectors.
N. Allan, M.B., Ch.B. G. M. Mayhall, M.R.C.S., L.R.C.P.
J. M. Anderson, M.R.C.S., L.R.C.P. B. M. Newlands, M.B., Ch.B., D.P.H.
R. B. Becker, M.D., Ch.B., D.P.H. M. E. Peaker, M.R.C.S., L.R.C.P.
J. Coupland, M.B., B.S., D.P.H. A. Rennie, M.B., Ch.B.
G. P. Holderness, M.B., Ch.B., D.P.H. D. C. Rice, M.B., Ch.B.
J. V. Kirkwood, M.B., Ch.B., D.P.H. J. J. Smith, M.B., Ch.B., D.P.H.
S. Lindsay, M.B., Ch.B. j. E. M. White, M.R.C.S., L.R.C.P.
J. M. Macmillan, M.B., Ch.B., D.P.H. L. Symons, M.R.C.S., L.R.C.P.
j. M. Watt, M.D., D.P.H., D.C.H. (Temporary).
(Part-time).
School Dentists.
B. R. Townend, L.D.S., Senior Dental Officer.
S. Ackers, L.D.S. K. Batten, L.D.S.
 5

School Dentists—(continued)
G. H. Bulcock, L.D.S. P. S. Nash, L.D.S.
F. W. Buzza, L.D.S. D. M. Phillips, L.D.S.
R. K. Cole, L.D.S. J. G. Richardson, L.D.S.
W. H. Etheridge, L.D.S. W. Rodger, L.D.S.
M. M. Gibson, L.D.S. A. W. Russell, L.D.S.
M. Hattan, L.D.S. R. Sclare, L.D.S.
J. Jackson, L.D.S. M. W. Shaw, L.D.S.
H. F. Jones, L.D.S. B. Sleight, B.Ch.D.
W. P. Jones, L.D.S. M. M. Thom, L.D.S.
G. Kilvington, L.D.S. J. Todd, L.D.S.
O. A. Long, L.D.S. F. C. Shenton, L.D.S.
J. H. N. Macdonald, L.D.S. E. Thornton, L.D.S.
J. M. Macdonald, L.D.S. J. R. Wishart, L.D.S.
J. Mackay, L.D.S. G. O. Wood, L.D.S.

Blind Persons Act, 1920.

24 Part-time Ophthalmic Surgeons.

County Analyst.
F. W. Richardson, F.I.C., F.C.S. (part-time).

Bio-Chemist.
D. W. Auchinachie, M.A., B.Sc. (Hons.), Ph.D.

Consultant Obstetricians, Gynaecologists and Physicians (53).

The following is a list of consultant obstetricians, gynaecologists and physicians as approved
by the County Council:—
Telephone Number
Name. Address. and District
Barnsley.
G. R. Potter. 10, Victoria Street, Barnsley. 779.
Bradford.
Basil Hughes. 1, Mornington Villas, Manningham Lane, 1119.
Bradford.
W. Foster Rawson. 9, Park Drive, Bradford. 3786.
Doncaster.
W. Moir Shepherd. Arendal House, Thorne Road, Doncaster. 2742.
J. P. Semple. 65, Thorne Road, Doncaster. 2302.
L. D. Callander. Danum House, South Parade, Doncaster. 2342.
P. Milligan. 149, Thorne Road, Doncaster. 3539.
J. B. Hogarth. Rosslyn, Thorne Road, Doncaster. 2591.
Harrogate.
T. A. Best. 67, King’s Road, Harrogate. 2036.
C. D’Oyley Grange. 2, Lancaster Road, Harrogate. 4548.
T. V. Pearce. 2, Brunswick Drive, Harrogate. 2898.
E. G. Campbell. 2, Ripon Road, Harrogate. 4404.
W. O. Greenwood. 19, Ripon Road, Harrogate. 2712.
Gladys Kay. Norfolk Lodge, Norfolk Road, Harrogate. 6238.
C. R. Morison. 3, Beech Grove, Harrogate. 3123.
T. Robinson. Princes Villa, 37, York Place, Harrogate. 3688.
Huddersfield
W. D. Galloway. Sunnybank, Holmfirth. 74.
W. S. Dickson. Wentworth House, New North Road, 2335.
Huddersfield.
Keighley.
H. S. Brander. Farfield House, Keighley. 2083.
Leeds.
Mrs. R. H. B. Adamson. 24, Park Square, Leeds. 22848.
Prof. A. M. Claye. 26, Park Square, Leeds. 27625.
Alfred Gough. 42, Park Square, Leeds. 22723.
Prof. Wm. Gough. 31, Park Square, Leeds. 22161.
B. L. Jeaffreson. 32, Park Square, Leeds. 22733.
Prof. Carlton Oldfield. 25a, Park Square, Leeds. 22312.
Wm. McGregor Young. 14, Eldon Terrace, Leeds. 22026.
D. W. Currie. 24, Park Square, Leeds. 23590.
Wm. MacAdam. 40, Park Square, Leeds. 28441.
Manchester.
W. R. Addis. 2, St. John Street, Manchester. 0435 (Blackfriars)
Kenneth V. Bailey. 2, St. John Street, Manchester. 0786 (Blackfriars)
Chas. P. Brentnall. Riversdale, Mersey Road, West Didsbury. 3762 (Didsbury)
J. Webster Bride. 74, Palatine Road, Withington, Manchester. 8963 (Blackfriars)
A. Callam. 1, Ormerod Road, Burnley. 2867 (Burnley)
A. L. Potter. Carisbrooke, 3, Crosshill Road, Blackburn. 6448 (Blackburn)
Prof. Daniel Dougal. Southernhay, Mersey Road, West Didsbury. 1434 (Didsburv)
G. W. Fitzgerald. Albert Square, Manchester. 6458 (Blackfriars)
Wm. George. 2, Fenton Street, Lancaster. 86 (Lancaster)
Eric Gerrard. 4, Rowsley Avenue, West Didsbury. 2681 (Didsbury)
J. W. A. Hunter. 2, St. John Street, Manchester. 3287 (Blackfriars)
F. H. Lacey. 16, St. John Street, Manchester. 1500 (Blackfriars)
Prof. W. F. Shaw. 5, Park Crescent, Victoria Park, Manchester. 7727 (Blackfriars)
Robert Newton. 11, St. John Street, Manchester. 2198 (Blackfriars)
 6

List of approved Obstetricians.—Continued.

Sheffield.
John Chisholm. 430, Glossop Road, Sheffield 10. 61980 (Broomhill)'
G. A. Davies. 432', Glossop Road, Sheffield 10. 62726 (Broomhill)
N. L. Edwards 64, Friar Gate, Derby. 1551 (Derby)
H. J. Malkin. 10, The Ropewalk, Nottingham. 43635
(Nottingham)
F. J. Milward. 7, Abercrombie Street, Chesterfield. 2967 (Chesterfield)
Prof. M. H. Phillips. 420, Glossop Road, Sheffield 10. 62302 (Broomhill)
J. Eric Stacey. 2, Durham Road, Sheffield 10. 31621(Broomhill)
L. B. Patrick. Egerton House, 420, Glossop Road,
" Sheffield 10. 62302 (Broomhill)
T. E. Gumpert. 12, Palmerston Road, Sheffield 10. 60749 (Broomhill)
York.
A. R. Lister. 57, Bootham, York. 3106.
Gerald S. Hughes. 6, St. Leonards, York. 3155.

Child Welfare Centre and Ante-Natal Medical Officers.—Total Number 114, as follows: —
Whole-time Medical Officers of Health ••• ••• ... ... ••• 2
School Medical Inspectors ... ... ... ... ... ... ... 12
Part-time Medical Practitioners in general practice ... ... ... 58
Part-time Medical Women in general practice ... ... ... ... 18
Part-time Medical Women not in general practice ... ... ... ... 21
Part-time Medical Men not in general practice ... ... ... ... 3

School Nurses and Health Visitors, etc.

4 Inspectresses of Nurses and Midwives.
2 Non-Medical Supervisors of Midwives.
129 Child Welfare and School Nurses.
5 School Nurses.
4 Orthopaedic Nurses.
9 Dental Nurses.
21 Dental Attendants.
22 Tuberculosis Nurses.
62 Part-time Child Welfare and School Nurses.
7 Part-time School Nurses.
184 Salaried Midwives (directly employed by County Council and includes 14 Health-visitor
Midwives).
162 Part-time Midwives (District Nurses subsidised by County Council).

Listerdale Maternity Home.

Matron—Miss D. D. McLean.
Sister ... ... ... ... 1.
Staff Nurse Midwives ... ... 2.
Midwives ... ... ... ... 6.

Technical Staff. Chief County Sanitary Inspector :

A. Brook.
County Sanitary Inspectors :
L. Butterworth. H. Tayler.
R. D. Irving. F. C. Brookes.
2 Junior Assistants.
Laboratory Staff:
Chief Laboratory Assistant :
J. W. Gooderidge.
Senior Laboratory Assistants:
I. W. Harris. R. Hodgson.
A. Lonsdale.
4 Junior Assistants, 7 Attendants.
County Radiographer :
Miss A. M. Byass, B.Sc., M.S.R.
Assistant Radiographer :
D. C. Kerr, M.S.R.
Food and Drugs Sampling Officers:
(Also act as Inspectors of Weights and Measures)
1 Chief Inspector, 9 Sampling Officers.

Clerical Staff. Chief Clerk.

J. Colman.
Senior Clerk.
J. C. Bennett.
Sectional Senior Clerks :
R. L. Rea. Treatment of Tuberculosis. J. W. Beaumont. Statistics, General Public Health.
B. E. Allenby. Maternity and Child Welfare. H. V. Stott. Cashier, V.D., Propaganda.
W. A. Ryder. School Medical Services. J. W. Bray. General, Local Government Act.
J. H. Gloyne. Milk Supply, Food and Drugs. A. B. Harrison. Laboratory.
H. Moorhouse. Hospitals, etc.
56 Clerks, 29 Typists.

Medical Officers of Health.

There are 15 whole-time and 64 part-time Medical Officers of Health of County Districts.
(June, 1939).
 T

District Medical Officers (Public Assistance) and Public Vaccinators.

Name Qualifications. District Area Population

(acres) (approx.)
No. 1.—Ewecross Area.
J. T. Bleasdell. M.R.C.S., L.R.C.P. 1 Gisburn 30302 2974
( Slaidburn 51369 1975
T. G. S. Harkness L.R.C.P., L.R.C.S. Great Mitton 1727 181
H. Thistlethwaite M.B., Cli.B. Dent 20895 925
T. W. Rothwell ... M.B., Ch.B. Sedbergh, Garsdale 31779 2644
B. S. Hyslop M.B., Ch.B. Horton and Settle 35775 5045
G. J. Marks M.B., Ch.B. Ingleton 26548 2785
T. L. Dowell M.B., Ch.B. Bentham 7718 2553
G. T- Marks . M.B., Ch.B. Clapham 25345 1120
H. M. Clegg . M.R.C.S., L.R.C.P. Long Preston 16295 2070
H. Wales M.B., Ch.B. Kirkby Malham 22328 535
G. D. G. Cameron M.R.C.S., L.R.C.P. Arncliffe 17998 260

No. 2.—Staineliffe Area.

+ H. Sheard M.D., Ch.B., M.R.C.S., L.R.C.P. ...
*J. Renwick M.B., Ch.B. ! Kildwick 11327 6580
W. L. Crabtree L.S.A., L.M.S.S. A. Addingham 20785 2761
G. D. G. Cameron M.R.C.S., L.R.C.P. Grassington and
Kettlewell j 60502 3245
I. C. C. Morrison M.B., Ch.B. Skipton 21978 15471
A. M. Niven M.B., Ch.B. Thornton 10002 6667
J. W. Pickard M.B., Ch.B. Barnoldswick 6572 12131
M. Purcell M.B., Ch.B., B.A.O. Silsden 7101 4919
H. Wales ... M.B., Ch.B. Gargrave 20994 1941

No. 3.—Claro Area.

JC. A. Flintoff M.R.C.S., L.R.C.P. Pateley Bridge 49939 5264
E. (J. Campbell M.B., Ch.B., D.P.H. Birstwith 25132 1270
P. A. Steven M.B., Ch.B. Ripon 18394 10613
*S H*v M.R.C.S., L.R.C.P.
1 Sharow 7391 890
+R. VV. H. * Anning M.B., B.S., M.R.C.S., L.R.C.P. . J
R. G M. Harvey ... L.R.C.P.I. & L.M., L.R.C.S.l. Kirkby Malzeard ... 25817 2151
j Harrogate . 10795 38935
S. Foskett ... M.D., B.S.
| Killinghall ... 15624 3132
JD. F. Dobson M.B., B.S., D.P.H. Knaresbro’
j 12141 8626
t+W. J. Forbes . M.B., Ch.B., B.A.O. Knaresbro'
S. C. Wilkinson ... M.B., Ch.B., L.S.A. .. Starbeck 2688 4818
J. S. Dudgeon M.D., B.Ch., B.A.O., D.P.H Acomb 7633 1444
K. H. Martin M.B., Ch.B. Green Hammerton ... 16981 2553
1J. M. Benson M.B., Ch.B. ... Gt. Ouseburn 10201 1298
r. P. Rust ... M.B., B.S., L.R.C.P., L.R.C.S. Boro’bridge 9926 2401

No. 4.—Barkston Ash

Area.
+J. L. Wightman ... M.R.C.S., L.R.C.P.
*T. H. Barton M.B., B.S. j- Bishopthorpe 5438 2363
J. B. Young M.B., Ch.B. Aberford 17300 10095
JC. C. Hargreaves M.B., Ch.B., D.P.H. Kippax 10122 12468
Wm. Murphy M.B., Ch.B., M.R.C.S., L.R.C.P Sherburn
| 22009 5448
Ryther
E. R. Brown . L.M.S.S.A. Tadcaster 22902 6184
R. W. Lee . M.B., Ch.,B. Boston Spa 11100 4178
H. B .Cook . M.D., Ch.B. Harewood
Kirkby Overblow | 19233 3547
O. D. Beetham MB., Ch.B. Thorner 7058 2685
*R. L. Kitching. M.B., B.S. Tockwith
J+E. R. Hargreaves M.B., B.Ch., D.P.H. | 27247 6366
Wetherby

No. 5.—Skyrack Area.

D. W. E. Burridge MB., Ch.B. Horsfortn 5659 17011
JA J. I. Muschamp MB., Ch.B. Yeadon 3979 13682
M.D., Ch.B.
[ Baildon 4984 11691
*A. E. Penn B.Sc., M.B., Ch.B.
*T. Browne-Hearder M.B., C.M.
| Ilkley 11646 10226
+A. W. Gott . M.B., B.S., M.R.C.S., L.R.C.P. ...
*W. H. Galloway M.R.C.S., L.R.C.P.
| Otley 37068 22238
ttH. Wolfe . M.D., B.S., D.P.H.

No. 6.— Worth Valley

Area.
fH. C. Ling . M.R.C.S. L.R.C.P. & L.M., North Keighley
)
l 11663 44411
tW. Lambert M.R.C.S., L.R.C.P. South Keighley
•F. Villy . M.D. 1
f Bingley . 9522 16780
W. A. Lochhead . M.B., Ch.B.
\ Culiingworth 1215 1790
J. E. Baird M.B., Ch.B., B.A.O. Haworth 9991 10716
tH. Sheard M.D., Ch.B., M.R.C.S., L.R.C.P. ...
| Sutton 4414 5179
*J. Renwick M.B., Ch.B.
T. M. S. Findlater M.B., Ch.B. Wilsden 2638 3000

No. 7.—East Morley

Area.
E. T. Hyland . M.B., B.Ch., B.A.O. . Pudsey 2397 14762
H. D. Merrington M.B., Ch.B. Drighlington 1135 4115
A. L. Mitchell M.B., Ch.B. Hunsworth (part of) 1381 879
J. A. Hope . M.B., C.M. Hunsworth (part of) _ 439
*J. G. Craig M.D., B.Ch., B.A.O. .
30628
+ H. Gibson M.R.C.S., L.R.C.P. . l Shipley 2175
A. H. Stewart M.D., C.M. Denholme 2536 2547
N. A. A. Hughes ... M.R.C.S., L.R.C.P. Calverley 2106 4020
T. H. Elmer . M.B., Ch.B. Farsley 821 6568

* Public Vaccinator only.

t District Medical Officer only.
♦ Medical Officer of Health (part time)
Assistant District Medical Officer.
 8

District Medical Officers (Public Assistance) and Public Vaccinators—continued.

Name. Qualifications. District. Area Population

(acres. 1 (approx.)

No. 8.—Calder Area.

IJ. J. Murphy . M.B.. B.Ch., B.A.O. . Shelf . 1303 2883
JA. J. W. Stephen M.B., Ch.B., D.P.H. . Ripponden 13240 5292
tH. W. Morck . M.R.C.S., L.R.C.P. Sowerby and | 4140
V. C. Meyer Sowerby Bridge 15628
M.B., Ch.B.
C. S. Ogilvy L.R.C.P., L.R.C.S., L.R.F.P.S. ... Luddenden Foot 2948 4546
+ H. N. Middleton M B., B.Ch., B.A.O. Brighouse
+R. Lawson M.D., Ch.B. Hipperholme 9082 31616
C. M. Stallard . M.D., Ch.B. . Rastrick j
A. G. Gamble L.M.S.S.A. Elland 3431 15150
W. J. L. Francis ... M.B., F.R.C.S. . Stainland 2262 4097
G. C. Sharp M.B.. Ch.B. Queensbury 1492 5780
H. Thorp . M.B., Ch.B., D.P.H. Todmorden 12770 21210
IF. J. Dowdall M.B., B.Ch. B.A.O. . Hebden Bridge 20977 11007
S. T. Henderson ... M.B., Ch.B. Mytholmroyd 6608 4476

No. 9.—Spen Valley

Area.
*H. Keighley M.R.C.S., L.R.C.P. Batley 3026 29030
tj. Walker . M.B., Ch.B.
A. Dick . M.B., Ch.B., D.P.H. . Birstall 1435 11631
A. L. Mitchell M.B., Ch.B. Cleckheaton 1756 12500
H. D. Merrington M.B., Ch.B. Gildersome ... 992 3178
E. M. Whitehead M.B., Ch.B. Gomersal 2024 6586
H. W. Laing M.B., Ch.B.. Heckmondwike 696 8948
*R. M. Beatty ... ... M.B., Ch.B. Liversedge ... 2136 14692
tR. Dick. M.B., Ch.B., F.R.C.S.
J. E. H. West . M.B., Ch.B. Mirfield 3394 11770
*W. S. Sykes . M.B., B.Ch., D.P.H. . Morley 3385 22430
tW. T. McCutcheon M.B., Ch.B.
S. B. Stoker . F.R.C.S., L.R.C.P., L.R.C.S., Ossett 3333 14080
L.R.F.P.S.
No. 10.—Lower Agbrigg
Area. Kirkhamgate
IT. Stephens B.Sc. M.R.C.S., L.R.C.P. Ardsley, E. and W. 6471 12050
Thorpe .
K. S. Macdonald-Smith M.B., B.Ch., F.R.C.S. Crigglestone 6261 6079
J+D. Bell . M.B., Ch.B., D.P.H. Emley 8076 6974
C. H. Smith M.B., Ch.B. Flockton
J. N. U. Russell ... Horbury 1280 7825
M.B., B.Ch., B.A.O.
+ M. Melvin MB., Ch.B. Lofthouse 6239 19706
J. D. Bottotnley ... M.B., Ch.B. and Stanley
+ F. J. G. Tocher. M.B., Ch.B.
D. Downie Walton 2662 1773
M.B., Ch.B.
+ H. Scholefield . M.B., Ch.B. Altofts | 3066 19824
N. S. Twist M.B., Ch.B. Normanton
+J. G. Munro M.B., Ch.B. Sharlston and l 4612 6611
*T. E. Lister M.B., Ch.B. Crofton )
C. H. Seville . M.B., Ch.B. Oulton 1178 4219
*H. Stevenson MB., C.M. Rothwell 3500 9322
+E. G. Williams. M.R.C.S., L.R.C.P.

No. 11.—Osgoldcross
Area.
G. Burnett M.B., Ch.B., F.R.C.S. Pontefract ... 9939 21166
IJ. Kehelly . M.B. B.Ch., B.A.O. Knottingley 14411 9341
F. G. Creaser MB., Ch.B. Hensall 5678 885
B. H. Gillbanks ... MB., Ch.B. Ferry Fryston 12423 10715
*J. J. W. Campbell ... L.R.C.P., L.R.C.S., L.R.F.P.S. ...
+M. I. Prangnell M.B., Ch.B.. Castleford 3728 36632
+G. T. W. Sloan. M.B., B.Ch., B.A.O.
J*W. Steven . M.B., C.M. Featherstone 4431 14440
+J. Duncan M.B., Ch.B.
Methley 3493 4482
E. W. L. White . M.B., Ch.B.
t*M. B. Taylor . M.R.C.S., L.R.C.P. Hemsworth 4163 13070
T. C. A. Sweetnam M.D., B.Ch.
Ack worth 8036 6869
W. L. Gardner M.B., B.S.
Smeaton 6504 872
J. Malloch M.B., Ch.B.
+ F. W. P. Sullivan M.D., B.Ch., B.A.O.
Sth. Kirkby 7019 33935
*E. J. H. Sullivan M.D., M.Ch., L.M.
°H. J. Hacker ... M.R.C.S., L.R.C.P.
Ryhill . 4297 6259
S. Hodkinson M.B., Ch.B., D.T.M.
Brierley 8413 8260
IW. R. Gardner. M.B., Ch.B.
Houghton 2318 3295
IJ. W. Whitworth M B., Ch.B.

No. 12.—Goole and

Selby Area.
J*A. M. Erskine ... M.D., B.Ch., D.P.H. 21841
Goole 10123
+J. Crawford M.B., B.Ch., B.A.O.
Snaith 13553 4600
F. G. Creaser M.B., Ch.B. Carlton 11902 1999
*W. Enrdley . M.B., B.Ch.
M.B., Ch.B. Swinefleet 8942 2oa3
+ P Enrdley .
P. Eardley ... M.B., Ch.B. Adlingfleet . 6425 344
O. L. Scarborough M.R.C.S., L.R.C.P. . Selby and Cawood 26354 14176

No. 13.—Don Valley /

Area.
tj. M. Hain . M B., Ch.B.
+W. L. Walker. M.B., Ch.B. Doncaster West
7983 19597
*W. E. L. Lawson M.B., Ch.B. (Arksey, etc.) ...
*B. Lyons ... M.D., B.Ch., D.P.H.

* Public Vaccinator only.

+ District Medical Officer only.
J Medical Officer of Health (part-time).
* Assistant District Medical Offi cer.
 9

District Medical Officers (Public Assistance) and Public Vaccinators—continued.

Name Qualifications. District. Area. Population

(acres) (approx.)
No. 13.—Don Valley
Area—(contd.).
H. F. Kenton M.D., B.S., M.R.C.S. j Armthorpe 15190 12130
+B. Hart . L.M.S.S.A. .
J. Malloch M.B., Ch.B. Askern 18035 9834
*W. F. Ward L.R.C.P., M.R.C.S. )
tP. Mullins M.B., B.Ch. r Bawtry 7939 14650
*P. Kane ... M.B., B.Ch., B.A.O. J
+G. B. Kelly M.B., Ch.B., B.A.O.
M.B., Ch.B. } Bolton-on-Dearne 2325 13670
•J. K. T. Mills ... ...
F. J. Boyle M.B., B.Ch., B.A.O. Thurnscoe 1254 10740
W. J. Maclure M.B., Ch.B.
L.R.C.P.I., L.M., L.R.C.S.I. & L.M J- Conisbrough 13117 27592
*J. O’Donnell
J. Wylie . M.B., Ch.B. Hooton Pagnell 11915 1769
D. Malloch M.B., Ch.B.
M.B., Ch.B. ... . | Adwick-le-Street 3605 19650
"A. M. McArthur
|*J. J. Huey L. S.A., L.M.S.S.A.
f Mexborough 4511 17423
+S. P. Bhatia M. B., B.S., M.R.C.S., L.R.C.P,
)H. M. Brown M.B., B.S. Tickh ill 12768 3176
C. D. Walker ... M.B., Ch.B. Hatfield 16188 7624
R. M. L. Anderson M.B., Ch.B. Stainforth 8806 9303
*JJ. M. Taylor M.B., Ch.B., D.P.H.
| Thorne 13425 16456
tW. Henry M.B., Ch.B. *’

No. 14.—Staiticross
A tea.
J. Leishman M.D., Ch.B. Dod worth 6075 8197
JH. R. L. Allott ... L.M.S.S.A. Hoyland 1961 11860
P. Lewis M.R.C.S., L.R.C.P. Hoyland Common 2999 10695
*H. A. L. Banham L. R.C.P., L.R.C.S.
| Worsborough 3084 7610
tj. K. A. Beverley M. B., Ch.B.
fR. Millar M.B., Ch.B., D.P.H. Darton 3968 8783
IJ. C. Pickup MB., Ch.B., D.P.H. Wombwell 3567 18117
|H. B. Pare M.B., Ch.B. Royston 4027 6207
L.R.C.P.I. L.M., L.R.C.S.I., &
IT. F. Quigley | Cudworth 1746 9301
L.M.
tJ. W. Whitworth M.B., Ch.B. Darfield 2881 5411
J. Smail M.B., Ch.B. Grenoside 3537 6468 '
*H. Sands ... M.B., Ch.B. B.A.O.
j Ecclesfield 2800 8950
tH. N. Skelton M.R.C.S., L.R.C.P.
J. A. R. Thomoson M.D., Ch.B. D.P.H Westnall 10573 4328
N. MacPhail MB., Ch.B. Bradfield 21727 4578
T. A. H Smith M.B., Ch.B. Southey 700 600
A. E. Goldie M.B., Ch.B. Stocksbridge 6938 10235
IT. H. Easton M.D., Ch.B. Wortley 7839 2320
A. A. Masser M.B., Ch.B. Penistone 17182 6755
E. L. Mommen ... L.R.C.P., L.R.C.S., L.R.F.P.S. Clayton West 6927 4298
F. L. Whincup M B , Ch.B. Cawthsrne 8778 4815

No. 15.—Upper Agbrigg

Area.
T. A. Stephens M.R.C.S., L.R.C.P. Kirkburton 6964 8414
JD. Bell . ... M.B., Ch.B., D.P.H. Skelmanthorpe 4158 6685
M. M. Dey ... M.B., Ch.B.. Shepley 7936 7645
W. D. Galloway ... M.R.C.S., L.R.C.P. Holmfirth 8993 5246
*E. Trotter ... M.B., Ch.B.
| Holmfirth 4641 7084
t+T.S. Davy ... M.B., Ch.B.
W. H. Smailes ... M.D., Ch.B., D.P.H. Honley 1977 4745
P. MacGirr M.B., Ch.B. Meltham 5901 5624
R. N. Kirk M.B., Ch.B. ... Slaithwaite 5439 9252
S. Hall . M.B., Ch.B., B.A.O. Golcar 1980 9525
G. R. Aspinwall ... M.R.C.S., L.R.C.P. Marsden 8633 5407
*S. Prior . MB., C.M.
| Kirkheaton 1580 2331
tj. E. Taylor L.M.S.S.A. ..
\l
ItE. A. Ramsden M.R.C.S., L.R.C.P., D.P.H. The whole of the ' ’)
J. Loftus M.B., Ch.B. area covered by the
J. G. Oliver M.B., Ch.B. former Saddleworth 18485 17224
tP. B. Wood M.B., Ch.B. Union

No. 16.—Rather Valley r

Area.
H. M. Mills M.B., Ch.B. Wentworth 2328 1811
tC. X. Ruhen M.B., Ch.B. 1
r Swinton 1730 1361Q
*C. J. H. Aitken ... M.D., C.M. ...
*G. R. Bailey M.B., Ch.B.
[ Wath-upon-Dearne 4954 15143 ,,f
I+T. Crowley L.R.C.P., L.R.C.S.
D. P. K. Jockel ... M.B. Ch.B. Rawmarsh ... 2602 18939 1
G. H. Sedgwick ... M.R.C.S., L.R.C.P. Dalton 4351 10195 1
IW. L. Dibb M.B., Ch.B., D.P.H. Maltby 9259 170541 !
G. S. L. Kemp M.R.C.S., L.R.C.P. Thurcroft 8945 11040' l
+J. S. Shirlaw M.B., Ch.B. , i • fi
tT. B. Johnstone L. R.C.P., L.R.C.S. 16570 ..
Kiveton Park 20070
tK. Mackenzie M. B., Ch.B.
B. D. Rawlin M.R.C.S., L.R.C.P. ) • .;i
*R. G. Selby M.B., C.M. Brinsworth and
tG. R. Carruth ... M.B., B.Ch., B.A.O. [ 6904 8260: ..a
tj. K. Sen L.R.C.P., L.R.C.S., L.R.F.P.S. )

• Public Vaccinator only.

t District Medical Officer only.
J Medical Officer of Health (part time).
* Assistant District Medical Officer.
 10

List of Vaccination Officers Serving Administrative County Area.

Name of Officer. Area in Population.

District Served
Acres. (approx.)

Area No. 1—Ewecross.

H. Fielden Bovvland Rural 83398 5130
G. Kayley Garsdale 11068 410
W. Battv ... Dent and Sedbergh 41606 3159
W. Slinger Bentham 69611 6457
C. Parker Settle and Long Preston 92396 7910

Area No. 2—StaiticUffe.

G. J. Harker Grassington 27356 2555
S. H. Day Kettlewell 33147 690
G. D. Hunt Gargrave 17757 1819
D. Slater ... Addingham 20785 2761
D. Slater Kildwick 20379 12096
D. Slater ... Skipton 19112 14765
D. Slater ... Barnoldswick 20726 19035

Area No. 3.—Claro.

R. L. Watson Great Ouseburn 44741 7406
C. W. Fawcett ... Knaresborough 1883S 9655
Mrs. M. E. Bowes Harrogate 22410 45856
G. E. Wilkinson Pateley Bridge 76071 6534
F. S. Metcalfe Ripon 61602 13654

Area No. 4.—Barkston Ash.

W. Bortoft Tadcaster 44911 11585
W. Wormald Aberford 27422 22610
S. C. Mellor . Wetherby 64614 16776
R. A. Wilkinson Bishopthorpe 5438 2363

Area No. 5—Skyrach.

( Guiseley ... 8963 25373
G. C. Clarke
j Horsforth 6659 18218
H. Wood. Ilkley 48714 34704

Area No. 6.— Worth Valley.

J. A. Sharp Keighley 49024
15472
Miss A. Hartley ... Bingley 24054
12773
W. H. Ogden Haworth 7788
8560
Miss A. Hartley ... Wilsden 3000
2638

Area No. 7.—East Morley.

C. W. Calverley . Farsley 2927 10586
H. Darnborough Drighlington 1135 4115
Miss A. Hartley ... Denholme 2536 2547
A. Hotchin Pudsey 2397 15340
Miss D. Wildman . Shipley 2175 30628
F. Higginson Hunsworth 1381 1318

Area No. 8.—Colder.

f. H. Hindle . Todmorden 40355 36693
T. I. Hughes . Brighouse 11877 40279
C. E. E. Robinson Sowerby 26021 44532

Area No. 9.—Speti Valley.

W. H. Holt . Batley 6485 47249
Miss G. Wormald Gildersome 992 3178
H. Jackson . Heckmondwike 2833 23638
E. R. Brearley. Mirfield 3394 11770
Miss E. W. Haigh Morley . 3385 22430
J. Terry Smith . Ossett . 8333 14080
F. Higginson Cleckheaton . 1756 12500

Area No. 10.—Lower Agbrigg.

W. Town ... ... ... Horbury and Normanton 41345 92088
Area No. 11.—OsgoUcross.
Mrs. L. I. Dodsworth ... Hemsworth East 31329
34750
I. Scott . Hemsworth West 30231
W. Town . Pontefract . 64103 97660
Area No. 12.—Goole and Selby.
H. S. Miller . Goole 38043 28868
W. B. Weaver. Selby 38256 18175
Area No. 13.—Don Valley.
F. Grisedale . Bolton-on-Dearne 21587 28722
F. Grisedale . Mexborough 7906 35635
A. J. Thorsby . Tickhill . 42973 39396
J. Thurgood Adwick-le-Street 26176 46478
H. E. Newton ... Thorne 38419 32383
Area No. 14.—Staincross.
E. Hammerton ... Darton and Darfield 19997 C6873
W. Taylor . Worsborough 7046 16999
B. J. B. Marsden Stocksbridge 38238 19141
F. Bailey. Wortley . 8083 2729
H. Dowson Ecclesfield 7037 16018
H. Redfearn . Penistone 86109 17828
 11

List of Vaccination Officers Serving Administrative County Area—continued.

Area in
Name of Officer. District Served Population.
Acres
(approx.)

Area No. 15.—Upper Agbngg.

E. Firth . Colne and Holme 58202 71958
A. Smith ... Saddleworth 16930 12484
Miss J. Lees . . Springhead . 1555 4740

Area No. ld.—Rother Valley.

G. C. Hearn ... . Rotherham Rural 8880 14280
VV. J. Blyth . Rawmarsh 2602 189.39
G. C. Hearn Maltby 20579 32269
T. H. Harrison ... Wath-on-Dearne 9012 30564
C. F. Airey . Kiveton Park 20070 16570

County Public Assistance Institutions.

Medical and Nursing Staffs.

Number of
Name of Hospital Telephone Medical Officer No. of
Qualifications. Nursing
or Institution. No. (part-time) beds.
Staff.

Settle Settle B. S. Hyslop M.B., CH.B. 122 10

3115
Skipton Skipton VV. H. Robinson 9
364
M.B., CH.B. 95

Knaresborough Knaresborough H. Steinbach 16*

3135
M.R.C.S., L.R.C.P. 69

Ripon Ripon R. W. H. Anning

238
M.B., B. S., M.R.C.S., 46 6*
L.R.C.P.

Tadcaster Tadcaster R. N. Crossley

13 L.M.S.S.A. 61 6

Wetherby Wetherby
5 E. R. Hargreaves M.B., C.M. 78 3

Otley Otley
93 J. T. Rhodes M.B., CH.B. 78 7

T. L. Walker MB., CH.B.

( Consultants—part time. called by

241 43*
Keighley Keighley 1 M.O. as required :—
2869 ■<
H. C. Ling M.R.C.S., L.R.C.P.
J
1 W. H. G. M. Ling F.R.C.S., L.R.C.P.

Clayton, Bradf’d Queensbury

2120 J. B. Stewart L.R.C.P., L.R.C.S. 310 41*
Todmorden Todmorden
120 H. Thorp M.B., CH.B., D.P.H. 97 10*
Dewsbury J. J. O’Reilly
Batley 28
M.B., F.R.C.S., D.P.H. 125 14*
(Medical Supt. of adjoining
appropriated hospital)

Wakefield Wakefield J. B. Lyle M.D., CH.B., B A.O

2188 (Visiting Physician to adjoining
appropriated hospital) •

Hemsworth Hemsworth T. C. A. Sweetnam M.D., B.CH., B. A.O. 81 12

13
Pontefract Pontefract G. Burnett M.B., CH.B., F.R.C.S 243 29*
42
Goole Goole J. Crawford M.B., B.CH., 58 7
16
Selby Selby O. L. Scarborough M.R.C.S., L.R.C.P. 53 6
15
Penistone Penistone A. A. Masser MB., CH.B. 35 5
10
Grenoside Ecclesfield T. D. Norton L.M.S.S.A. 96 12
Deanhouse Holmfirth W. H. Smailes M.D., CH.B., D.P.H. 145 21*
10

Includes Male Attendants.

 12

PART I.

GENERAL PUBLIC HEALTH.

Summary of Vital Statistics—1938.

Area of Administrative County ... 1,613,570 acres on 31st March, 1938.
,, ,, ,, ,, ... ... 1,610,829 acres from 1st April, 1938.

Estimated Resident Population (Mid-Year 1938) ... 1,501,100

(Adjusted for changes in boundary which took
place on 1st April, 1938).

Enumerated Population at 1931 Census ... ... ... ... 1,530,405

Population at 1931 Census ... ... ... ... ... ... 1,504,057
(Adjusted for the changes in boundary which took place on 1st April, 1938).

County Districts, 115, namely:—11 Boroughs.

(See Table VI folded in at page 19). 80 Urban Districts (58 from 1st April, 1938).

24 Rural Districts (21 from 1st April, 1938).

Note.—Alterations in boundary. The above statistics relate to the year 1938. They are not
adjusted for the changes in boundary which took place on the 1st April, 1939, as a result of
the County of York, West Riding Review Order, 1939.

The Vital Statistics for the Administrative County for the decennia 1917-26
and 1927-36, and for the years 1937 and 1938 are summarised below:—
Averages for
10 years:—

1917-26 1927-36 1937 1938

Birth Rate 20-6 16-1 15-2 15-5
(Per 1,000 estimated population.)

Death Rates:—
(All per 1,000 estimated population).

All Causes 13 2 12 2 12-7 116

Smallpox 000 000 Nil. 0-00

Enteric Fever 003 0-01 o-oo 000

Scarlet Fever 002 003 0-01 001

Diphtheria 0-09 009 0-09 009

Measles 0-20 008 0-02 0-05

Whooping Cough ... 0T5 007 0-04 0-02

Zymotic Diseases (seven principal) 0-72 0-37 0-21 0-23

Phthisis 0-76 0-54 0-46 0-38

(Tuberculosis of Respiratory System.)
Other Forms of Tuberculosis ... 0-31 0-17 Oil 0 11

Respiratory Diseases 2-36 T50 1-23 0-99

Cancer 1T4 1-38 1-60 1 -55

Heart Disease 1-49 2-45 319 316

Infantile Mortality . 90 69 60 51
(i.e., Number of deaths under one year per 1,000 live births.)

Diarrhoea . 10-48 5-08 3-05 3-48

(Deaths in infants under 2 years of age per 1,000 live births).

Maternal Mortality:—
(Deaths of mothers ip childbirth per 1,000 live births).

Puerperal Sepsis ... ... ... ... 164 208 0-92 1-07
Other Causes 308 334 3-00 2-67
Total 4-72 5-42 3-92 3-74
 13

Area and Population.

As a result of the operation of the County of York, West Riding Review Order, 1938,
changes took place on the 1st April, 1938, in the boundaries of the Administrative County, two
West Riding County Boroughs, and a large number of County Districts.

These changes are summarised below: —

Population as at 1931
No. of Districts. Acreage.
Census.

Districts.
Before After Before After Before After
Change. Change. Change. Change. Change. Change.

10 10 County Boroughs ... 165,783 168.524 1,843,635 1,848,354

11 11 Non-County Boroughs 58,395 83,147 1
80 58 Urban Districts 318,373 295,836 f
24 21 Rural Districts 1,236,802 1,231,846 409,957 383,669
— — West Riding Administrative
County 1,613,570 1,610,829 1,508,776 1,504,057

The effect of the changes was to reduce the number of County Districts in the Administrative
County from 115 to 90, and the cumulative effect of the County of York, West Riding Review
Orders, 1937 and 1938, was to decrease the number of County Districts from 146 to 90.

Further changes were made on the 1st April, 1939, by the County of York, West Riding
Review Order, 1939, which brought the number of County Districts down to 89 as will be observed
from the figures shown below which are provisional and subject to amendment: —
Acreage.
10 County Boroughs ... ... ... ... 168,524
11 Non-County Boroughs ... ... ... ... ... 83,147
57 Urban Districts ... ... ... ... ... ... 297,189
21 Rural Districts ... ... ... ... ... ... 1,230,493
Administrative County ... ... ... ... ... 1,610,829

The name of the Todmorden Rural District was changed to the Hepton Rural District as from
the 1st April, 1939.

Live Births.

The number of live births registered in the Administrative County during the year 1938 was
23,246 (males 12,075, females 11,171). This was equal to a rate of 15-5 per 1,000 of the estimated
population and is 03 higher than the rate for 1937. The live birth rate for England and Wales
for the year under review was 15T per 1,000. The birth rate for the urban districts of the County
during 1938 was 151 per 1,000 and 16-6 for the rural districts. The folded-in table on page 19
shows the number of births and the birth rate for each sanitary district in the County, and the records
for previous years are given in the accompanying graph and in the tables on page 18.

During the year 1,060 still births were registered. Illegitimate births numbered 870—449
males and 421 females.

The following lists show the Countv Districts having the highest and lowest birth rates during
the vear 1938:'—

Districts with Highest Birth Rates.

Adwick-le-Street U. ... 19.0 Pontefract B. ... 19.2

Conisbrough U. ... 20.6 Rovston U. ... 21.4
Cudworth U. ... 19.8 Tickhill U. ... 20.9
Darton U. ... ... 21.9 Wombwell U. ... 19.6
Dearne U. ... ... 20.0 Doncaster R. 18.8
Dodworth U. . 20.6 Hemsworth R. ... 19.9
Hemsworth U. . 21.4 Rotherham R. ... 19.1
Knottinglev U. ... 19.5 Thorne R. ... ... 19.4
Maltby U. ... 22.1

Districts with Lowest Birth Rates.

Barnoldswick U. 9.8 Silsden U. ... ... 10.9

Earby U. ... 9.9 Todmorden B. ... 10.3
Hebden Royd U. . 8.9 Sedbergh R. 9.8
Midgley U. ... 10.7 Todmorden R. ... 10.3
 14

West Riding Administrative County.

Birth Rate for the 38 years 1901—1938.

Deaths.
The nett deaths registered as belonging to the Administrative County during the year 1938
were 17,430 (8,999 males and 8,431 females). This figure gives a crude death rate of 1T6 per
1,000 of the estimated population, and is IT per 1,000 lower than the rate for 1937, and identical
with the provisional death rate for England and Wales. The death rate for the aggregate urban
districts of the County was 12T per 1,000, and 10'3 for the rural districts.

The mortality figures are given for each sanitary district in the County in the table on page
19 and the returns have been analysed in detail in the statistical tables on pages 16 to 27.

The maternal mortality and infant mortality rates are discussed in another section of this
report.

During the year 1938, 4,588 deaths were allocated to the usual district of residence by the
County Medical Officer under the Registrar General’s scheme of quarterly distribution.

The districts registering the highest and lowest crude death rates are set out in the following
tables :•—
Districts with the Highest Crude Death Rates.

/ Ossett B. ... 15.4

Barnoldswick U. . 15.8
Harrogate B. . 15.1 Ripon City ... ... 14.5
Hebden Royd U. . 15.6 Ripponden U. ... 15.5
Heckmondwike U. . 15.0 Sowerby Bridge U. ... 14.8
Midgley U. ... . . 14.9
 15

Districts with Lowest Crude Death Rates

Adwick-le-Street U. 9.9 Stocksbridge U. 7.8

Bentley-with-Arksey U. . 9.9 Doncaster R. 8.0
Conisbrough U. 9.5 Hemsworth R. 9.5
Cudworth U. . 9.5 Kiveton Park R. ... 9.0
Dearne U. ... 9.1 Rotherham R. 9.2’
Garforth U. . 8.7 Thorne R. ... 8.1
Maltby U. . 7.5

ADJUSTED DEATH-RATES.

The age and sex constitution of the population is not the same in different districts, and
this affects the level of the crude death rate. For instance, of two areas or districts, that
containing the larger proportion of elderly people will almost certainly have the higher crude
death-rate, and this in spite of the fact that the general health conditions of its population may be
the better of the two. The adjusted death-rate takes into account the variation in the age and sex
constitution of the population, and is a more reliable index for a comparison of the death-rates of
different districts, and of those districts with that of England and Wales.

The adjusted death rate for 1938 for the whole of the Boroughs and Urban Districts of the
Administrative County is 12-9 and for the Rural Districts 1T3. In column 11 of table folded in
at page 19 is given the adjusted death rate for 1938 for each County District, and below are lists
showing those Districts with the highest and lowest rates: —
•

Districts with Highest Adjusted Death Rates.

Barnoldswick U. ... .. 16.3 Ossett B. ... 16.6

Castleford U. .. 15.5 Royston U. ... ... 14.5
Heckmondwike U. .. 15.0 Sowerby Bridge U. ... 14.7

Districts with Lowest Adjusted Death Rates.

Baildon U. ... .. 10.3 Sedbergh R. ... 10.4

Garforth U. 8.9 Selby R. ... 9.8
Kirkburton U. .. 10.2 Wortley R. ... ... 10.0
Stocksbridge U. 9.4

West Riding Administrative County.

Death Rate for the 38 years 1901—1938.

 16

Mortality at Different Ages from the Various Causes.

The following table shows the mortality, in age groups, from the various causes in the West
Riding Administrative County during 1938.

Table I.

AGB AT DEATH

CAUSES OH DEATH Under 1 and 2 and 5 and 15 and 25 and 35 and 45 ant 55 and'f»5 anc 75 and Total
1 under under under under under under under under! under up- Inefc
year 2 5 IS 25 35 45 55 i 65 wards death*)
1 75

1. Typhoid and paratyphoid fevers ... — 1 i i — 1 4

2. Measles 22 28 20 8 i 79
3. Scarlet fever — — 8 6 i — i _ — — 16
4. Whooping Cough 14 5" 7 1 — — — — — 27
6. Diphtheria 2 9 34 84 4 2 2 3 i 1 — 142
6. Influenza 3 3 3 3 6 8 10 22 22 31 21 132
7. Encephalitis Lethargica — — — 2 2 5 3 5 4 2 2 25
8. Cerebro-spinal fever 9 2 2 3 3 1 — i — — — 21
9. Poliomyelitis
10. Polio-encephalitis . 2 i 1 _ 1 _ _ _ _
—
i 6
11. Tuberculosis of respiratory system — — 3 7 121 136 100 98 76 26 6 573
12. Other Tuberculous diseases 9 15 17 21 38 21 4 16 9 8 1 159
13. Syphilis 8 -- — 1 2 1 3 9 1 3 29
1
14. General paralysis of the insane, tabes
dorsalis — — — — _ 3 7 15 16 10 1 52
16. Cancer, malignant disease — 3 1 2 15 35 146 349 660 748 366 2325
16. Diabetes ... . — — — 3 3 6 9 26 79 124 52 302
17. Cerebral haemorrhage, etc. — — — — 2 2 20 70 247 399 375 1115
18. Heart disease — 1 — 15 57 76 152 339 854 1635 1616 4745
19. Aneurysm . — — — 2 2 1 4 4 8 11 1 33
20. Other circulatory diseases — -- — — — 4 10 36 164 421 505 1140
21. Bronchitis . 36 6 4 5 6 6 15 36 69 133 167 483
22. Pneumonia (all forms) . 184 66 48 22 23 42 56 83 130 131 86 871
23. Other respiratory diseases 6 2 1 1 4 4 9 22 26 21 35 131
24. Peptic ulcer ... I — — — 1 4 14 39 47 27 9 142
25. Diarrhoea, etc. 70 11 6 1 4 7 6 6 8 8 14 141
26. Appendicitis ... — — 5 11 13 8 12 9 10 10 3 81
27. Cirrhosis of liver — — — 1 1 1 2 7 16 9 1 38
28. Other diseases of liver, etc. — — — 1 — 8 7 16 36 44 36 148
29. Other digestive diseases ... 14 7 9 4 8 16 23 42 69 52 45 289
30. Acute and chronic nephritis — — 1 3 14 15 36 64 150 165 87 535
31. Puerperal Sepsis . — — — — 6 11 8 — — — — 25
32. Other puerperal causes — — — — 10 31 21 — — — — 62
83. Congenital debility, premature birth,
malformations, etc. 725 4 5 5 3 2 — — — — — 744
34. Senility . — — — — — — — 4 67 458 529
35. Suicide . — — — — 8 31 26 43 54 19 5 186
36. Other violence 22 18 32 50 98 78 85 75 95 79 82 714
37. Other defined diseases 66 22 34 71 61 78 97 184 247 323 194 1377
38 Causes ill defined or unknown — — — — — — — — 2 4 3 9
1
ALL CAUSES ... 1191 204 241 334 516 645 889 1622 3104| 4511 4173 17430

AGB AND SEX DISTRIBUTION OP THB NET DEATHS

URBAN DISTRICTS:—
Males 508 81 94 139 204 245 367 650 1337 1829 1391 6845
Females 347 57 82 107 167 228 307 584 1121 1710 1809 6519
Persons 855 138 176 246 371 473 674 1234 2458 3539 3200 13364

RURAL DISTRICTS:—
Males 199 37 39 45 SO 95 1 10 202 349 545 453 2154
Females 137 29 26 43 65 77 105 186 297 427 520 1912
Persons 336 66 65 88 145 172 215 388 646 972 973 4066
WEST RIDING ADMINISTRATIVE
COUNTY:—
Males 707 118 133 184 284 340 477 852 1686 2374 1844 8999
Females 484 86 108 150 232 305 412 770 1418 2137 2329 8431
Persons 1191 204 241 334 516 645 889 1622 3104 4511 4173 17430

/
 The following table shows the proportion of deaths from each cause per thousand deaths from
all causes. The various causes are arranged in order of incidence in 1938, but the figures must
not be taken to indicate any more than which are the principal killing diseases.

Table II.

Number of Deaths. Proportion of Deaths

per 1,000 deaths from
Five years all causes.
Cause of Death.
1937 1938
Average 1932-36 1937 1938
Total.
)er year

Diseases of Heart and Circulatory System 20,576 5,315 5,948 5,918 288 309 340

Cancer, Malignant Disease ... 11,206 2,241 2,417 2,325 121 126 133

Bronchitis, Pneumonia, and other Diseases of

Respiratory System not including Tuberculosis 9,544 1,909 1,863 1,485 103 97 85

Cerebral Haemorrhage, etc. 5,895 1,179 1,266 1,115 64 66 64

Violent Deaths :— 4,476 895 877 900 49 46 52

Suicide 937 187 167 186 10 9 11

Other Violence 3,539 708 710 714 39 37 41

Diseases of Digestive System 4,734 947 844 839 51 44 48

Congenital Debility 4,075 815 813 744 44 42 43

Tuberculosis (All Forms):— 4,630 926 858 732 50 45 42

Respiratory Tuberculosis 3,625 725 695 573 39 36 33

Other Tuberculous Diseases 1,005 201 163 159 11 9 9

Acute and Chronic Nephritis 3,421 684 665 535 37 34 31

Diabetes 1,473 295 326 302 16 17 17

Diphtheria ... ... . 859 172 138 142 9 7 8

Influenza 2,156 431 785 132 23 41 8
Measles ... . 482 96 28 79 5 1 4

Whooping Cough 432 86 65 27 5 3 1

Scarlet Fever 193 39 17 16 2 1 1

Other Defined Diseases . 1 2,141 2,428 2,302 2,130 132 120 122

Causes ill defined or unknown 79 16 14 9 1 1 1

Totals ... 92,372 18,474 19,226 17,430 1,000 1,000 1,000

Urban and Rural Statistics for 1938.

These are set out below for the aggregate districts, and a comparison is
afforded with the figures for England and Wales: —

Table III.

Maternal Mortality
Annual Rates per 1000 of the Estimated (Deaths of Mothers in
Population Infant Childbirth per 1000
Mortality Live and Still-births) Diarrhoea
(Deaths (Deaths
under under 2
Other
Zy¬ Phthi¬ Tub.
Respira¬
Heart one year years o
Live tory age per
Death motic sis Dis¬ and Cir¬ per 1000 Puerperal Other
Birth¬ Diseases Cancer 1000 live
rate Death Death eases culator} Live Sepsis Causes
rate Death births)
rate* rate Death Diseases Births)
rate t
rate

(1) Urban Districts in the

West Riding 15-1 12-1 0-23 0-39 Oil 1-04 1 -61 4-20 51 0-97 2-35 3-30

(2) Rural Districts in the

West Riding 16-6 10-3 0-25 0-37 0-09 0-84 1-3S 3-21 51 117 306 3-96

(3) Wbst Riding

Administrative County 15-5 11-6 0-23 0-38 Oil 0-99 1 -55 3-94 51 1 03 2-55 3-48

(4) England & Wales 15-1 11-6 § 0-53 010 § 1-66 § 53 0-86 2-11 5-5

* Includes deaths from Diarrhoea, etc., under two years of age only.
+ Deaths from Pneumonia, Bronchitis and other Respiratory Diseases; does not include Tuberculosis
of the Respiratory System.
§ Figures not available at time of going to press.
 18

West Riding Birth and Death Rates for Ten Years.

The following table shows the County Birth and Death Rates for the past 10 years :—

Table IV.

1929 1930 1931 1932 1933 1934 1935 1936 1937 1938

Birth Rate . 16-7 16-9 161 15-8 150 15-2 15-0 151 15-2 15-5
Death-rate . 13-6 11-4 12-4 121 12-2 11-7 11-9 12-3 12-7 11-6
Infant Mortality*. 89 63 74 70 70 58 58 63 60 51
Zymotic Death-rate 0-54 0-33 0-38 0-39 0-30 0-41 0-28 0-29 0-21 0-23
Death rates from :—
Small pox . 000 0-00 Nil Nil. Nil Nil Nil Nil Nil. 000
Scarlet Fever . 0-05 0-03 002 001 002 0-05 003 0-02 001 001
Diphtheria . 0-08 009 0-10 0-08 008 0-17 0-14 0-10 009 0-09
Bnteric Fever . 0-02 0-02 0-01 0-02 0-01 000 0-00 0-00 000 0-00
Measles. 0-10 006 0-11 0-10 0-03 0-11 0-02 005 002 0-05
Whooping Cough 0-18 0-05 005 0-09 0-07 003 0 04 006 004 002
Diarrhoea, &c.f. 6-96 4-59 5-10 6-00 6-07 3-21 3-42 4-00 3-05 3-48
Respiratory Diseases 2-22 1-35 1-64 1-33 1 -36 1-16 113 1 -25 1-23 0-99
Phthisis! . 0-66 0-57 0-57 0-52 0-49 0-44 0-48 0-44 0-46 0-38
Other Tuberculous
Diseases . 0-21 020 0-16 0-17 0-14 0-12 0-10 0-12 Oil 0-11

* Deaths under one year per 1,000 births,

t Deaths under two years of age per 1,000 births.
1 Tuberculosis of the Respiratory System.

Average Birth and Death Rates from 1918 to 1937.

The following table gives the average rates for quinquennial periods (compared with the rates
for 1938) for the Urban and Rural Districts of the Administrative County and for the Adminis¬
trative County as a whole.

Table V.

Urban Districts Rural Districts Administrative County

Year Year Year

Quinquennial Periods 1938 Quinquennial Periods 1938 Quinquennial Periods 1938
for for for
com¬ com¬ com¬
1918- 1923- 1928- 1933- par¬ 1918- 1923- 1928- 1933- par¬ 1918- 1923- 1928- 1933- par¬
22 27 32 37 ison 22 27 32 37 ison 22 27 32 37 ison

Birth Rate. 20-6 18-7 15-7 14-6 15 1 23-8 22-3 19-2 16-5 16-6 21 -4 19-6 16 7 15-1 15-5
‘Infant Mortality ... 96 81 71 61 51 95 76 74 62 51 96 80 72 62 51
Death Rates:—
Ail Causes . 14-1 12-6 12-6 12-8 12-1 13-4 11-5 11-2 10-7 10-3 13-9 12-3 12-2 12 2 116
Zymotic Diseases 0-85 0-50 0-35 0-30 0-23 0-95 0-51 0-47 0-31 0-25 0-88 0-50 0-38 0-30 0-23
Smallpox . 000 0-00 0-00 Nil Nil 000 0-00 0-00 Nil 0-00 0-00 0-00 0-00 Nil 0-00
Scarlet Fever 002 0-02 0-03 003 0-01 0-03 0-03 0-02 0-02 0-00 0-02 0-03 0-03 0-02 0-01
Diphtheria . Oil 0-05 0-07 0-13 0-09 0 -1 1 0-04 0-10 0-09 0-10 0-11 0-05 0-08 0-12 0-09
Bnteric Fever ... 004 0-02 0-02 0 00 0-00 0 03 0-02 0-02 0-01 Nil 0-04 0-02 0-02 0-00 0-00
Measles . 0-26 0-13 0-07 0-05 0-05 0-26 0-13 0-10 0-05 0-07 0-26 0-13 0-08 0-05 0-05
Whooping Cough... 016 0-12 008 004 0-02 0-19 0-14 0-10 0-06 0-02 0-17 0-13 0-08 0-05 0-02
Respiratory
Diseases . 2-58 2-18 1-64 1-26 104 2-35 1 -95 1 - 50 1-14 0-84 2-52 2-12 1 -60 1 -23 0-99
Respiratory Tuber-
culosis. 0-84 0 71 0-62 0-48 0-39 0-67 0-59 0-52 0-42 0-37 0-80 0-68 0-59 0-46 0-38
Other Tuberculous
Diseases . 0-34 0-25 0-19 0-12 0-11 0-29 0-23 0-21 0-12 0-09 0-33 0-25 0-19 0-12 0-11
Cancer . 1-15 1-25 1-40 1-60 1 -61 0-97 Ml 1-17 1-23 1-38 1-10 1-22 1-34 1-49 1-55
Heart Disease 1-48 1-69 2-42 3-11 3-36 1-28 1 - 41 1-90 2-37 2-59 1 -43 1 -61 2-28 2-90 3-16
fDiarrhcea (Deaths
in children under
2 years of age) ... 11-96 7-98 5-20 3-46 3-30 13-34 6-73 6-52 4-99 3-96 12-36 7 - 61 5-63 3-95 3-48
(Maternal Mortality-
Puerperal Sepsis 1 -57 1-71 2-38 1-75 1 -02 1-82 1-72 1-94 1-83 1-22 1-64 1 -71 2-23 1-78 1-07
Other Causes 3-11 3-37 3-53 3-55 2-46 3-01 2-40 3-03 2-45 3-20 3-08 3-08 3-37 3-20 2-67
Total 4-68 5-08 5-91 5-30 3-48 4-83 4 12 4-97 4-28 4-42 4-72 4-79 5-60 4-98 3-74

* Deaths under one year per 1,000 live births,

t Deaths per 1,000 live births.
 Table VI

Births, Deaths, Annual Rates, etc., for the year 1938.

4-*
_f> <»r- 1 rS
Annual Rates per thousand of m ® -C CO (/) ct> (/> ■M 4/ Infant
B -5 Hstimated Resident Population S- tA s:
•M C -*H ;c>
a «J Mortalit
Z 20>trt 4».i;
23 5 a2'"3 w ^06 8 (Deaths MEDICAL
jHO U LV. L. .c

5 years IS
Average I
Mortality
0 1/5 0> >>V- *-•w under 1 OFFICER
SANITARY AREA 5|5:
C£ © ©j- I.IVH-
BIRTHS DEATHS
t OJ
•M ■o 4> •2S o ^ c3 O W
— 0-5 year pel OF HEALTH.
" n «U 3 205 1,000
DISTRICT. (Acres). <u .2.2 <u (Nett). (Nett),
•oi
A) Cl
•oOS e.OJ .20!
•C u
3“
l- X! s.s g ^ IN 1938.
aaa 3 c w. w£.C
73 V u T3 Live
inti-, n
B '5 '3 2 2.C 2.C
2 +• ** 1 O «.52 rt U 4,
> * > »-
Births)
9 nu I Cd £3 •Sq « at i: 1938.
IT 1/104™ 3 0 0
N 1
a gQ 'Q> llS
tua. 3 ■f Q H O
20 21
10 II 12 13 14 15 Irt 17 18 19
9
I
1
I. URBAN. 0-10 1 ■ 20 3-08 i 2-63 76 74 A. B. Dunne.
3805 19170' 19170 364 189 27 16 19-0 9-9 14-7 0-37 0-78 *¥ *¥ A. J. I. Muschamp.
Adwick-le-Street 1 * * * § ** Zo 42
*12-5 *0- 19 *0-43 *0-09
*Aireborough ... 8856 23220 I 23220 309 263 13 16 13-3 in-i — —
— 1 • 3-01 51
nAltofts a | _ 1 1148 18 12 — 1 15-7 10-5 11-6 0-87 . __ E. G. Firth.
10-3 0-10 1 I • Z6 tj 2 • 93 S47 39
Baildon ... 2831 9792 9792 129 101 5 5 13-2 10-3 — H. C. Alderton,
0-10 1 • oJ 8*35 60 39
102 164 4 7 9-8 15-8 16-3 — 0-58
Barnoldswick ... 2784 10360 10360 W. F. T. McMath.
13-4 0-25 0-03 J • LK) 4 • 15 i 1-72 52 40
Batley B. 4461 39800 39800 547 533 22 33 13 •? 14-3 0-30 __ A. B. Dunne.
— 0-11 U * Clf) 6-95 69 32
Bentley-w-Arksey 4956 17700 17700 313 175 10 15 17-7 9-9 13-7 0-85
i 3-32 54 42 O. T. Wade.
13-8 0-28 0-18 0-28 0 • 78 3-80
cBingley 11418 21710 21722 285 300 12 16 13-1 13-1 ♦* ** R. Sutherland.
0-17 1 • Zb 2 4-42 46
Brighouse B. ... 7873 30140 434 408 20 19 14-4 13-5 13-4 0-07 0-50
30140 1-44 65 61 W. Kemp.
0-54 0-19 1*10 3-34 1
cCastleford 4394 48090 37218 668 407 41 27 17-9 10'9 15-5 0-73 - —
-- - 56
5 — 1 4•6 4-8 —
aClayton West ... a 435 2 11 -5 *♦ 2 7-35
** 66 R. T. F. Naismith.
12-5 — 0-44 0-57
Colne Valley ... 16054 22930 22930 258 287 17 14 11-3 13-3 J. McArthur.
0 • 64 3-49 1 2-71 84 71
17100 352 162 25 17 20 • 6 9-5 12-4 0-47 0-12 0-18
Conisbrough 1593 17100 T. F. Quigley.
0-60 0-24 1 • 90 5 ■ 06 77 90
Cud worth 1746 8399 8399 166 80 15 9 19-8 9-5 12-8 0-24 J. W. Whitworth.
— 0 • 35 6-25 1 10-64 71 43
5698 92 60 4 2 16-1 10-5 12-2 0-35 0-70
Darfield 2018 5698 77 61 R. Millar.
0-30 0 • 07 1 • 0*4 6-02 3 9-80
cDarton 4725 13540 13458 295 137 18 11 21 -9 10-2 12-6 —
0 • 87 §5-19 3 5-98 $75 52 J. K. W. Morris.
24270 485 220 25 17 20-0 9- 1 12-7 0-58 0-45 0-12
Dearne ... 3888 24270 _ — 48 59
_ — — — Z * <rU
aDenby and Cumberworth a 838 17 11 i 20-3 13-1 13-4 ** *¥
0-67 1 10-20 42 D. Bell.
10185 10010 7504 95 76 4 3 12-7 10-1 10-8 — 0-13
bDenby Dale 48 29 D. W. N. Blackmon
— — — 0 • 40
Denholme 2536 2531 2531 34 32 1 2 13-4 12-6 10-9 _ _ G. Horne.
— 0-73 6-28 72 95
1857 4085 84 42 8 2 20-6 10-3 12-9 0-49 0-49
Dod worth 4085 _ _ 56 — A. Falconer.
— 12-2 — 0-63 — 1 • 26 6-92
Earby 3519 4753 4753 47 58 1 9-9 13-4 *¥ — **
1 -05 — 63 F. Clegg.
19060 238 274 15 14 12-5 14-4 14-1 0-05 0-16 0-16
Elland 5946 19060 _ — 333
oEmley ... a _ 368 3 6 1 1 8-2 16-3 17-9 — — — 43
1 • 02 2-17 — — 76 57 W. Steven.
4424 13690 227 151 13 6 16-6 11-0 13-3 0-29 0-66 0-15
Featherstone 13690 — — 200
— — — — 2-86 10-99 59
oFlockton a 350 5 4 1 14-3 11-4 14-2 —
1 -05 _ — — 93 36 C. C. Hargreaves.
1519 3806 3806 56 33 2 1 14-7 8-7 8-9 — 0-79 0-79
Garforth — — 40 A. M. Erskine.
0-46 0-20 0 • 66 2-30 06
Goole B. 1267 195601 19560 325 195 13 14 16-6 10-0 10-7 0-20
— — — 52-63 — — 56 —
a — 73 1 — — 13-7 — — —
oGunthwaite & Inbirchworth — — 54 49 /. Mair. s'
514 647 25 12-0 15-1 12-8 0-19 0-40 0-09 0 • 93 3-80
rHarrogate B. ... 8320 44170 42885 16
2-17 _ _ — 48 111
a Haworth a _ 1382 18 21 2 3 13-0 15-2 14-0 2-17 — —
0-10 1 -06 6-84 1 9-90 40 32 F. J. Dowdall.
Hebden Royd ... 7084 10420 10420 93 163 3 8 8-9 15 • 6 14-2 0-10 0-38
0-11 1 -26 11-88 1 8-13 64 50 G. H. Pearce.
1 Ieckmondwike 696 8758 8758 120 131 6 3 13-7 15-0 15-0 — 0-57
0-08 0-94 4-23 — — 71 66 M. B. Taylor.
Hemsworth 4163 12790 12790 274 136 18 14 21-4 10-6 12-9 0-31 0 • 94
— — — — — -- — — —
a Holme (l 78 1 12-8 10-4
0-18 0-90 3-34 _ — 56 54 T. S. Davy.
cHolmfirth 17648 18870 16580 205 221 11 6 12-4 13-3 13-6 0-12 0 • 24
0-89 0-89 0-89 3-39 — — 31 —
aHonley a _ 1121 18 25 — — 16-1 22 -3 22-7 —
— 0-13 0-52 3-33 -- — 75 62 H. L. Neil.
Horbury 1280 7653 7653 113 93 7 8 14-8 12-2 12-8 0-26
0-33 0-17 0-17 §1-20 1 5-68 42 30 H. Bailey.
Horsforth 2706 12080 12080 164 135 5 12 13-6 11-2 112 —
0-41 0-14 1*57 5-53 1 3-89 59 40 H. R. L. Allott.
cHoyland Nether 1872 14610 14618 248 149 10 9 17-0 10-2 11-8 0-27
— 180 2 3 1 — 111 16-7 17-3 — — — 5 ■ 56 _ — 122 500
aHoylandswaine it ** **
— 0 • 38 0-06 0-89 1 5-68 23 H. T. Bates.
llkley . 8610 15710 15710 174 225 4 2 11-1 14-3 12-6
0-39 0-12 1 -07 6-05 3 3-98 70 76 H. M. Holt.
rKeighley B. ... 2361 1 55680 51476 713 725 54 41 13-9 14-1 14-1 0-54
*0-83 15-00 — — 62 51 A. Tait.
*eKirkburton ... 13847 17300 13764 156 140 8 8 11-3 *11-7 110-2 — *0-42 *0-08
** _ — **
— — — — — — 200
nKirkheaton a 61 1 15 15 3 24-5 24-5 25-8
0-71 — 0-85 2-18 _ — 57 10 D. F. Dobson.
cKnaresborough 2494 7304 7020 96 100 1 6 13-7 14-2 11-5 —
* — — ** 50
111 13-9 0-44 0-22 0-1 1 2-07 J. Kehelly.
Knottingley 2835 9178 9178 179 9 9 19-5 12-1 ¥*
2-56 ** _ — 200
aLepton a — 780 10 13 2 — 12-8 16-7 17-2 1-28 — —
0-09 1 -59 5-25 <> 8-23 76 47 W. L. Dibb.
Maltby. 4788 10700 10700 236 80 11 7 22-1 7-5 11-1 0-47 0-47
61 0-20 0 • 40 — 0-61 3-52 1 14-49 40 30 R. Gellatly.
cMeltham 5906 5039 4950 67 2 2 13-5 12-3 12-0
182 16 0-23 0-34 0-06 1-01 6-85 2 6-62 50 55 J. J. Huey.
cM exborough ... 1452 18420 17750 290 12 16-3 10-3 12-4
25 — 0-60 — 0-60 9-71 — — 40 — C. S. Ogilvy.
Midgley 2183 1679 1679 18 2 10-7 14-9 14-3
146 161 6 — 0-08 0-08 0-84 §6-10 1 6-49 §50 41 J. A. Smith.
Mirfield 3394 11920 11920 8 12-2 13-5 13-6
482 35 0-23 0-36 0-13 1-22 4-24 2 3-08 47 57 F. G. E. Hill.
Morley B. 9493 39350 39350 613 36 15-6 12-2 13-0
— 2 — — 0-97 1 -94 4-26 — — 68 167
aNew Mill a 1030 12 17 2 11-7 16-5 18-8
0-61 0-11 1-11 4-66 — — 75 54 W. M. McKie.
cNormanton 3066 19110 17962 276 183 15 6 15-4 10-2 11-9 0-22
— — — — — — 4-03 — — 72 67
aOakworth a 935 15 8 1 16-0 8-6 8-4
219 221 6 15-4 16-6 0-28 0-28 0-07 1 * 62 6-10 2 8-77 55 27 J. S. Coad.
Ossett B. !W!>3 14360 14360 9 15-3
0-36 (>•27 0-45 §3-84 — — §58 22 W. E. Bennett.
Otley 2934 11060 11060 138 125 3 7 12-5 11-3 11-4 0-45
-. — — — — 1 -93 9-09 _ — 37 —
aOxenhope a 519 7 6 3 13-5 11-6 11-0
0-57 4-57 1 1 1 -36 28 57 A. G. Wilson.
ePenistone 5593 5884 5251 87 58 5 1 16-6 11-0 11-0 0-19 0-38 0-]9
** ¥¥ 49 W. T. Hessel.
4865 21340 409 222 20 14 19-2 10-4 11-4 0-33 0-33 0-09 1 -36 1 2-36
Pontefract B. ... 21340
0-75 2-90 — 55 45 W. ]. Frain.
Pudsey B. 5323 27880 27880 445 353 20 22 16-0 12-7 12-4 0-22 0-32 0-11
0-46 11-15 _ — 42 17 J. J. Murphy.
Queensbury and She 2795 8340 8640 121 122 2 8 14-0 14-1 13*3 — 0- 12 0 • 23
0-27 1-10 8-60 1 3-03 63 39 C. W. A. Lister.
Rawrtiarsh 2602 18210 | 18210 309 185 12 21 17-0 10-2 1 1 -9 0-49 Oil
— 0-35 — 1-42 5-89 1 6-99 53 57 C. H. Greenwood.
Ripon City 1812 8474 8474 140 123 8 3 16-5 14-5 12-2
2 0-19 0-19 — 1 -34 6-31 1 12-99 41 27 A. J. W. Stephen.
Ripponden 13289 5220 5220 75 81 2 14-4 15-5 14-4
19 o-os 0-49 0-20 0-74 3-89 — — 64 56 H. Stevenson.
Rothwell 10698 24440 24440 339 260 17 13-9 10-6 116
165 91 9 0-13 0-52 — 1-68 6-71 1 5-68 46 55 H. B. Pare.
Royston 1423 7724 7724 11 21 -4 118 14-5
209 11 0-12 0-17 0 • 29 1-33 6-84 — — 42 54 E. A. Ramsden.
Saddleworth 18485 17240 17240 205 10 11-9 12-1 12-1
155 121 6 12-3 0-10 0-70 0 • 20 1-40 3-55 3 18-75 50 39 IF. B. Hill.
Selby 3848 10030 10030 5 15-5 12- 1
— 7 4 — — 19-4 11-0 2-78 — — 2-78 23-26 — — 95 —
aShelley a 360 11-1
— 4 — — — 2-53 — — — — — 56 —
aShepley a 395 4 10-1 10- 10-0
0-03 0-84 §4-63 2 4-46 §66 42 E. D. Irvine.
Shipley ... 2183 31000 31000 428 377 IS 20 13-8 12-2 12-6 0-13 0-29
0-81 1 17-54 62 19 W. Scatterty.
Silsden ... 7101 4954 4954 54 71 1 3 10-9 14-3 14-2 0-20 0-20 0-20
— 16 9 — 1 11-9 — — — — 5-49 — — 92 —
aSkelmanthorpe a 861 18-6 10-5
** ¥¥ 30 IF. Scatterty.
Skipton ... 4211 12830 12830 168 152 5 5 13-1 11-8 12- 1 — 0-31 O-OS 1 -01 1 5-78
9 12 1 — — — — — _ _ — 86 111
aSouth Crosland a — 733 12-3 16-4 16-0
** _. — ** 51 A. O. Jollie.
Sowerby Bridge 4856 17690 17690 217 262 11 13 12-3 14-8 14-7 — 0-28 0-06 0-85
494 463 30 20 13-6 13-0 0-16 0-33 0-08 1 ■ 18 ** _ — ¥¥ 61 L. Pickering-Pick.
Spenborough 8251 36420 36420 12-7 ¥¥
** 4-15 70 T. Stephens.
Stanley ... 4866 15660 15660 230 172 16 11 14-7 11-0 12-5 0-13 0-32 0-06 1-15 1
76 8 — 0-21 — 1-03 §5-27 1 6-76 §61 58 W. M. Robertshaw.
Stocksbridge 4630 9748 9748 138 10 14-2 7-8 9-4
218 124 11 8 0-17 0-33 0-08 0-58 8-82 — — 55 50 S. O. Hatherley.
eSwinton 1718 11410 1 1982 18-2 10-3 11 -7
a — 595 12 4 1 — 20-2 6-7 6-7 — — — 1 - 68 6-54 — — 82 | 83
oThurlstone
*«Thurstonland and
Farnley Tyas a _ 938 6 4 1 — 6-4 *11-4 +3-8 — — *2-86 *2-86
. _
_
—
43 167
H. M. Brown.
5580 2302 2302 48 28 3 5 20-9 12 • 2 11-2 — — — 0-43 9-90 46 63
Tickhill
1-32 §3-35 1 4-39 §57 60 J. H. Kitson.
Todmorden B. 12789 21140 21140 218 274 13 10 10-3 13-0 12-3 0-14 0-24 0-05
154 0-96 2-34 2 7-75 70 28 T. Crowley.
cWath-upon-Dearne 2677 13520 13505 246 7 12 18-2 11-4 18-9 0-52 0-59 0-07
— 196 5 3 — — 25-5 15-3 17-1 — — — — — — — 51 —
aWhitley Upper a
— 25 24 2 1 1-13 1-70 — 2-83 5-77 _ — 91 80
aWhitwood a 1766 14-2 13-6 18-3
0-06 1-01 3-61 _ — 58 49 J. C. Pickup.
Womb well 3850 17780 17780 349 190 17 10 19-6 10-7 13-3 0-22 0-45
241 145 13 0-30 0-38 0-08 1-67 4-23 5 19-92 57 54 J. H. Ritchie.
cWorsborough ... 3408 13150 13160 10 18-3 11-0 13-4

Total for Urban Districts 378983 1113261 1106941 16686 13364 855 762 15-1 12-1 12-9 0-23 0-39 0-11 1 -04 5-05 5S 3-32 61 51

II. RURAL.
a 1336 27 12 1 3 20-2 9-0 10-3 0-75 1-50 59 37
aBarnsley .
83327 4921 4921 66 56 2 4 13-4 11-4 11-3 — 0-20 — 0-61 3-28 1 14-29 55 30 J. H. Fairweather.
Rowland
49630 49715 933 398 46 50 18-8 8-0 10-7 0-34 0-24 0-14 0-93 £5-67 9 9-16 §63 49 A. Penman.
cDoncaster . 75656
8691 149 97 13 2 17-1 11-2 10-8 0-12 0-35 0-23 0-46 8-16 1 6-62 47 87 IF. B. Hill.
Goole 36776 8691 **
2-28 ** — — 33
a — 1756 30 23 1 3 17- 1 13-1 12-6 0-57 — —
aGreat Ouseburn
48370 48375 963 458 55 49 19-9 9-5 12-3 0-35 0-48 0-14 1 -03 3-59 3 2-96 67 57 W. R. Gardner.
cHemsworth 29019
a 2508 37 33 2 1 14-8 13-2 12-9 0-40 — 0-40 4-91 — — 48 54
oKeighley
20070 16320 16320 264 147 11 10 16-2 9-0 10-8 0-37 0-49 — 0-74 3-88 — — 59 42 /. A{. Watt.
Kiveton Park ...
— 2582 33 35 3 2 12-8 13-6 12-1 0-39 — — 0-39 1-47 — — 34 91
aKnaresborough a
** ** fW. J. Forbes.
75009 11190 8393 136 112 7 4 16-2 13-3 11-3 — 0-12 — 0 • 36 2 14-29 51
fcNidderdale \J. M. Benson.
** *•
33954 7530 11218 199 136 7 4 17-7 12-1 11-5 0 - 53 0-71 0 ■ 09 1 -07 1 4-93 35 J. Kehelly.
cOsgoldcross
6548 6173 70 75 9 7 11-3 12-1 13-0 0-16 0-49 0-32 0-97 2-39 — — 40 129 T. H. Easton.
cPenistone 29003
124861 10980 10980 157 139 7 5 14-3 12-7 10-6 0-09 0-36 — 1 -09 10-35 — — . 49 45 C. A. Flintoff
Ripon and Pateley Bridge
28860 39830 39820 761 366 45 32 19- 1 9-2 11-4 0-18 0 • 33 0-10 0-93 2-64 2 2-52 75 59 ]. M. IFaft.
cRotherham .
3895 38 48 4 — 9-8 12-3 10-4 — — 0-26 0-51 — — — 39 105 IF. Scatterty.
Sedbergh . 52674 3895
** — — »*
32909 5703 5703 78 65 3 2 13-7 11-4 9-8 0-18 0 • 35 — 0-88 38 IF. B. Hill.
Selby
152087 13776 13780 186 183 5 12 13-5 13-3 12-1 0 • 22 0-36 0-07 0-58 1-92 1 5-05 38 27 IF. Scatterty.
cSettle. ** **
146071 22490 21334 237 298 10 11 11-1 14-0 13-0 0-28 0-19 0-05 0-61 1 4-03 42 IF. Scatterty.
cSkipton ** **
78334 31420 31840 481 343 22 24 15-1 10-8 11-2 0-09 0-41 (>•06 0-88 2 3-96 46 IF. B. Hill.
eTadcaster .
38419 30820 30820 598 251 37 28 19-4 8-1 10-8 0-52 0-42 0-10 0-49 4 *65 2 3-19 83 62 J. M. Tavlor.
Thorne .
Todmorden (Hepton) ... 20482 4378 4378 45 54 2 2 10-3 12-3 11-3 0-91 — 0-46 *53-65 — — §50 44 F. J. Dowdall.
•* *• 58
c Wakefield 21835 18690 18360 325 186 19 19 17-7 10-1 12-0 0-11 0-27 0- 16 1-14 1 2-91 T. Stephens.
64424 16840 16865 240 208 8 5 14-2 12-3 10-9 0-12 0 • 59 0-65 1 -72 1 4-08 48 33 J A Hargreaves.
cWetherby . •* ««
39378 5267 5267 65 56 2 3 12-3 10-6 11-3 0-19 1-52 0-19 — — 31 H. Wolfe.
Wharfedale
48698 30550 30552 442 287 15 16 14-5 *10-2 110-0 *0-18 *()• 18 *0-07 * 1 * 20 S3-06 2 4*37 §46 34 A. Anderson.
*cWortley .
- -

Total of Rural Districts ... 1231846 387839 395582 6560 4066 336 298 16-6 10-3 11-3 0 • 25 0-37 0 • 09 0-84| 4-09 29 4-23 62 51

Names in italics
are those of whole*
Grand Total for
1501100 1502523 23246 17430 1191 1060 15-5 11-6 — 0-23 0 • 38 0 ■ 991 4-75 87 3 • 58 62 51 time Medical Offic¬
1610829
ers of Health.

2 3 4 5 6 | 7 8 9 10 11 12 13 14 1 15 16 17 18 19 20 21

* The birth rate and crude death rates for this District are based on a population figure which has been adjusted for patients resident in the Mental
Hospital situate in the District.
+ For an explanation of this adjusted death rate see page 15.
♦ The adjusted death rates for Aireborough U.D., Kirkburton U.D., Thurstonland and Farnley Tyas U.D., and Wortley R.D., are based respectively on
the total estimated population including patients resident at the Mental Hospital situate in the respective Districts.
1! In consequence of the operation of the County of York, West Riding Review Order, 1938, the boundaries of the Administrative County and of a number
of the County Districts were altered, and some County Districts were abolished as from the 1st April, 1938. The acreage of the Administrative County
and for each County District, shown in column 2 of the above table is that of the area as constituted on the 1st April, 1938. Where a District has
been abolished this is denoted in column 2 by the letter a.
A number of changes in boundaries were made on the 1st April, 1939, as u result of the operation of the County of York, West Riding Review Order,
1939, but the figures for these are not shown.
§ Due to changes in boundary, this average rate is not strictly accurate but is sufficiently so for the purposes of comparison.
** Due to changes in boundary it is not possible to give the average rate in this case.
a This District was abolished as from the 1st April, 1938, as a result of the operation of the County of York, West Riding Review Order, 1938, and the
statistics for the year 1938 in the above table relate to that portion of the year prior to the date of abolition of the District; the population figure given
is not the figure of the actual population, but one for use in calculating the birth and death rates for the portion of the year 1938 that the District was
in existence.
b This District came into being on the 1st April, 1938, and the statistics refer only to the last nine months of the year 1938.
c A change in the boundary of this District was made on the 1st April, 1938, as a result of the operation of the County of York, West Riding Review
Order, 1938, and the statistics in the above table are composite figures comprising the records of the area for the portion of the year prior to the
date of the change and those of the altered area for the remainder of the year. The population figure in column 3 is the mid-year estimate of
population for the area as constituted on the 1st April, 1938, and that in column 4 is a modified estimate specially designed for use with the composite
records of births and deaths.
 Table VII

Causes of Death, 1938.

Deaths from Subjoined Causes.

Diarrhoea, etc. (under 2 years).

Congenital Debility, Premature

Causes ill-defined or unknown.

t

Other Diseases of Liver, etc.

!

Acute and Chronic Nephritis.

Diseases.

Other Respiratory Diseases.

Other Circulatory Diseases.
Malignant Disease.

Cerebral Htemorrhage, etc.

1 uberculosis ot Kespiratory
u

Other Digestive Diseases.

Birth. Malformations; pfr

Gen. Paralysis of Insane,
T 03 C/7
U £

Pneumonia (all forms).

*< 1 '/
.1

Cerebro-Spinal Fever.
So p
X CTJ
03

Other Tuberculous

Cirrhosis of Liver.
C O

Puerperal Sepsis.
5

Whooping Cough.
—j
SANITARY <v

Tabes Dorsalis.
5 L

Heart Disease.
J 07 -v
DISTRICT. aM U <v

Peptic Ulcer.
17 w Cl c

Appendicitis.
T3 > u
-J 07

Diphtheria.

Bronchitis.
a V P <v

Influenza.
. tu c3 in B Ph Q
(/)

syphilis.

Senility.
3 (/) CD

Cancer,
c

System.
<3 07 a U t-
!/> -uL>
4-
<v $ P 47
1 au ND
u
c
07 X JC
C
H < n S < 0

?
34 35 I 36 37

S£
1^

•r
'•£.

^
^
“
^
£5

£5
31

£§
3
£

^
“
(3

~
—
M
18
c/i

os

x>

°
—
1 2 3 i 15

3
8

I. URBAN.

Adwick-le-Street i i 4 3— 1 15 2 2 i 20 4 6 49 — 5 1 19 3 2 1 2 5 a 1 la — 10 13
Aireborough 2 — — 1 — — 9 2 — — 36 5 10 74 2 20 8 14 4 4 2 2 2 5 15 f 6 5 24
bAltofts . 1 — — — — — — —— — 1 1 — 3 — 1 — 2 — — — — 1 1 1
Baildon ... — — — —— — 1 —— — 23 — 2 19 — 11 2 9 1 — -- 1 2 5 2 4 5 2 9
Barnoldswick ... — 6 1 — 2 17 3 11 59 — 15 3 15 1 1 — —— 2 3 4 — 1 4 1 11
Batley B. i 2 i i 3 1 — 1 10 1 — 1 74 5 32 160 1 62 12 27 11 7 4 2— — 9 22 i If 11 15 38
Bentley-w-Arksey — .... — — — — — 15 2 — 3 15 5 16 44 1 6 2 12 1 3 — 2 1 1 5 4 — 7 1 14 13
aBingley . — —— 2 3 4 2 — 4 6— 1 34 3 22 124 1 11 7 9 1 1 1 2— 3 6 10 i 4 — 9 24
Brighouse B. i — i — — 3 3 — 15 5 1 1 51 9 18 121 — 43 11 23 4 3 — 1 2 5 6 13 — 2 14 10 11 29
aCastleford — 15 — 1 5 4— 1 20 7 1 — 51 6 26 106 — 16 12 24 5 5 6 2— 4 9 11 — I 19 12 17 19
hClayton West —
Colne Valley . — — —■ — — 3— — 10 — — — 45 6 23 73 — 22 2 11 — — — 2— 2 6 12 — 2 13 14 10 26
Conisbrough — 3 — — 1 1 — — 2 3 — — 20 3 10 40 1 11 4 7 — 2 4 1 1 — 4 2— I 14 1 10 14
Cudworth — —— 1 1 —— — 5 2 — — 7 — 1 20 — 2 1 14 1 — — 1 — — — —— — 6 1 11 6
Darfield. — 1 — — 1 1 — — 4 — — — 5 1 8 21 — 3 — 2 — — — — — 1 1 3— 1 3 — 2 1
aDarton . — —— — — 2 1 1 4 1 — — 24 2 9 30 — 3 10 3 1 2 — — — 1 3 3 1 2 12 1 8 12
Dearne ... — 2— 1 7 2— — 11 3 — — 28 1 11 35 1 18 3 16 2 1 4 — 1 1 5 7 1 2 16 3 18 17
bDenby and Cumber worth — —— — — 1 — — — — — — 3 — — 1 — 1 1 — 1 — — —— — — 1 —— 1 — 1
cDenby Dale ... — —— — — —— — 1 — — — 15 2 3 27 — 2 2 1 2 1 — 1 — — 1 1 — 1 4 5 3 4
Denholme — — — — — — — -- — — — — 7 — 1 9 1 2 1 — — — — — 1 1 — 1 —— I 1 6
Dodworth — —— 2 — 2— — 2 — — — 2 — 4 11 1 6 2 1 — — — —— — — ——— 5 — 1 3
Earby — —— — — —— — 3 — — 2 5 — 1 30 — 2 2 3 1 — — — — 1 — 1 —— — 1 1 5
Elland . — —— — 1 1 — — 3 3 — — 46 11 23 63 — 19 8 9 3 2 — 1 1 4 5 10 — — 12 10 9 28
bEmley ... — 2 1 1 1 1
Featherstone — 1 — 1 2 2 1 — 9 2 — — 19 1 5 38 2 11 4 10 — 2 — 1 — 1 3 1 —— 8 7 1 -! 4
bFlockton — —— — — —— — — — — — — — — 1 — — 1 — — — — — — — — ——— — — 2
Garforth — —— — — —— — 3 3 — — 1 1 2 8— — — 4 — — — —— — 2 1 — — 1 —. 2 5
Goole B. . — —— 1 — 3 1 — 9 4 — — 19 3 10 67 — 7 1 12 — 2 3 — 1 3 6 2—— 8 5 8 17
bGunthwaite & Ingbirchwort —
aHarrogate B. ... i 1 i — 3 6 1 1 17 4 1 1 100 10 58 176 2 50 15 20 5 5 2 2 2 10 14 23 — — 18 11 10 61
bHaworth — — — — 3 —— — — —— — 2 •_ — 8— 1 1 1 I — — — — — — —— 1 2
Hebden Royd ... — —— — 1 —— — 4 1 — — 30 4 15 54 — 13 6 4 1 2 — 1 — 2 3 3— 1 1 2 2 8
Heckmondwike — — — — — 2— — 5 1 — — 17 1 11 40 — 10 1 9 1 2 — 3 — — — 1 — 1 4 9 1 8
Hemsworth — —— — 2 2 1 — 12 I — 4 16 2 6 23 1 6 6 6 — — 2 — — 1 2 5— 10 10 11
b Hoi me ... — 1
aHolmfirth — —— 1 — 1 1 — 4 3 1 — 36 i 12 61 1 19 5 8 2 1 1 — 2 3 2 14 — 7 2 27
bHonley — —— — — 1 — — 1 1 — — 4 — 3 5— 1 1 — — 1 — — — — — 1 — — 2 3
Horburv — 1 — — 1 1 — — — 1 — — 17 2 5 31 — 7 2 1 1 — — — — 1 — 2 6 1 8
Horsforth — —— — — —— — 4 2 1 1 22 1 8 52 — 8 — 1 1 3 — 1 — 2 4 1 3 2 16
— 1 — — 3 1 — 1 6 2— — 21 O
A. 2 39 — 8 9 14 — 2 — 1 1 •— — 2 1 4 5
aHoyland Nether 15
bHoylandswaine — —— — — —— — — —— — — — — —— — 1 — — — — — — — — 1 — 1
llkley — —— — — 4 i — 6 i — 1 38 1 10 62 — 25 5 6 3 21— 2 2 4 10 1 4 6 19
aKeighley B. ... — 1 2 4 17 5— — 20 6 4 6 93 17 39 211 2 31 23 27 5 7 4 5 2 9 18 29 2 1 29 14 67
aKirkburton — — 5 1 — i 19 2 3 41 i 15 1 9 — — — i 1 — 4 6 13 9
bKirkheaton — — — 2 i 2 5— — — — — — — — — 1 — 3 — 1
aKnaresborough — —— — — 2 1 — 5 —— 2 16 — 13 33 — 3 1 5 — — — i 1 — 2 4 — 1 — 7
Knottingley . — —— — 3 —— 1 2 1 1 — 8 2 1 33 — 1 7 10 2 i 1 — 1 2 7 2 10 7
bLepton ... — —— 1 — —— — — —— — — — — 5— — 1 1 — i — i — — — — — 2
Maltby ... — —— — 2 —— — 4 1 — ... 9 — 3 17 — 3 3 13 1 — 3 — — 2 1 1 1 4 1 5
aMeltham — — I — —— — 2 —— — 5 3 6 17 — — 1 2 — 2 — — — 1 — 5 — 1 1 3 8
aMexborough ... — — 3 — — — 6 1 — — 19 3 16 48 — 7 9 7 2 3 1 i 1 1 3 7 2 9 11 17
Midgley ... — — — —— — 1 —— — 4 — 1 9— 2 — 1 — — — — 1 1 — — 3 2
Mirfield ... — — — 1 — — 1 1 — — 12 1 13 60 — 8 2 7 1 — — i 2 2 11 1 5 8 14
Morley B. — 1 4 1 4 1 2 14 5— 1 62 10 41 123 i 30 19 25 4 — 3 2 1 5 6 15 1 1 22 24 31
bNew Mill — — —— — — i — — 2 — 1 4 — — — 1 1 — — i — 2 1 — 3
aNormanton — 1 3 — — — 11 2— 1 23 3 12 39 — 13 8 11 1 2 — — 2 3 4 7 12 11
bOakworth — — — 1 — — 2— 1 — — — — — — — — — — — 3
Ossett B. — — 1 3 — — 1 4 1 — — 28 2 31 54 i 16 11 7 1 1 — — 3 7 14 2 3 4 13
Otley . — ! 4 1 — — 4 3 — — 16 2 4 51 — 14 — 4 1 2 — — -1 — 2 — 3 — 9
— -- — — — — —— — — 1 — 2— 1 1
bOxenhope 1
nPenistone — — — — 1 1 2 1 — — 9 1 5 12 i 3 1 2 — — 1 i 3 1 2 1 4 — 5
Pontefract B. ... ... — 3 — 4 3— — 7 2 1 — 25 6 10 68 — 9 17 11 1 1 — 2 1 7 2 1 11 4 10
Pudsey B. ... ... 1 1 2 — — — 9 3 1 36 6 31 115 i 21 7 11 3 3 2 2 1 4 8 12 12 18 33
— 2 — — 1 2 1 — 18 2 9 49 — 10 2 2 — 1 — 1 3 1 5 2.
Queensbury and Shelf 1 8
Rawmarsh 2 1 5 1 1 — 6 2— — 29 4 13 43 — 13 4 15 1 1 1 — — 2 2 1 5 5 22
Ripon City — — 2 — 3 —— — 15 2 2 35 — 11 4 7 1 1 — — — 1 5 8 1 5 7 8
Ripponden 1 —— — 1 —— — 12 2 6 24 — 5 — 7 — 1 — — — 1 1 — 1 3 — 9
Roth well 2 — 3— — 12 5— 1 25 7 20 61 i 18 6 10 2 2 — 1 — 2 5 6 12 18 26
Royston 1 — 1 — — 4 —— — 11 — 4 28 — 3 2 11 — 2 — — 3 1 2 1 5 1 8
Saddleworth — 3— 1 3 5— 28 3 14 52 — 16 14 7 2 — 2 1 2 6 8 4 6 17
Selby — —— — 7 2 1 — 22 4 10 24 — 5 7 6 1 1 1 — 1 6 3 1 2 3 2 8
bShelley — —— — — — — — — 1 — 1 — — — 1 — — — — — — — — — 1
bShepley — —— — 1 —— — — — — 1 — — — — — — — — 1 — — — — — 1
Shipley. i 1 3— 1 9 1 — 3 60 6 20 117 i 29 8 18 — 2 3 1 2 3 10 9 2 9 4 10 17 26
Silsden ... 1 — — 1 — 1 1 — — 4 1 7 31 — 3 2 2 — 2 — — — — 1 2 1 1 — 10
bSkelmanthorpe 3
Skipton . — — —— — 4 1 — — 23 — 8 34 i 25 8 4 1 1 — 1 1 — 3 4 1 5 3 17
— — 3 — 4 3
5South Crosland 1
Sowerby Bridge — — 1 — 2 5 1 — 2 43 7 19 79 — 23 3 10 2 1 — 2 1 4 1 11 7 1 24
Spenborough . 5 2 1 — 14 3— 2 63 8 37 121 2 30 17 19 7 4 1 1 3 2 8 13 20 28 29
Stanley ... 1 1 — — — — 5 1 3 1 25 2 19 50 — 9 5 13 — 2 — — — 1 3 1 10 3 10
Stocksbridge — — — — 2 —— — 13 2 6 14 1 5 4 5 1 — — —— — 3 2 1 6 1 5
aSwinton 1 — 1 1 4 1 — 1 24 3 6 29 — 4 3 4 — — 1 —— 2 1 4 9 3
— 13
bThurlstone — — — — —— — — — 1 1 — — 1 — — — — — — — — 1 —
b'fhurstonland and
Farnley Tyas — — — — — — 1 — — — — — 1 — — — 1 — 1 — —— — — —— _ _
Tickhill ... — — 2 — — — — 1 1 7 1 1 4 — 1 — 1 — — — 1 — 1 — 1 _ 3 _
— 3
Todmorden B. ... 1 2 5 — 5 1 1 — 26 10 31 55 1 23 22 5 1 1 — 2— 2 9 18 _ 1 9 8 11 19
oWath-upon-Dearne ... 3 — 4 — — 1 8 1 — — 23 3 3 42 — 13 4 9 — 2 — —— 2 2 2— 2 4 8 7 7
bWhitley Upper — — — — — —— — 1 — — 1 — — — — — — — —— — — ——— — 1
— — — — — 3 —— — 2 — — — — — — —— — —
bWhitwood 2 5 2 1 4 i __ 1 3
Wombwell ... ... — 3 1 2 1 — 8 1 — — 27 2 12 48 1 9 5 11 2 2 — 2 2 1 5 8__ 8 3 15
oWorsborough. 2 1 1 — 5 1 1 — 13 3 11 32 — 13 S 14 — 1 1 2 1 2 5 2 2 3 8 3 2

Total of Urban Districts ... 4 53 15 21 103 94 22 17 427 123 21 41 1781 229 879 3722 30 896 394 657 101 107 55 63 29 121 257 428 17 41 514 383 153 501 1057

II. RURAL.

bBarnsley — 1 1 — — — —— — 2 — _ 3— — — 2 _ _ _ __ 1 _ 1
Rowland — — — —— — 1 —— — 6 4 5 15 — 7 — 3 — 1 — —— _ 2 __ 1 2 2 4 3
aDoncaster — 5 1 6 5— — 12 7— — 45 7 16 80 1 17 14 30 o 4 5 1 2 5 16 12 2 7 29 5 29 29
Goole — — 1 — — 3 2— — 11 1 2 35 — 4 — 4 — 3 1 —— 1 3 2_ 1 8 5 3 7
bGreat Ouseburn — 1 — — — —— — 3 — 1 11 — — 1 3 1 1
9 — 1
«Hemsworth — 1 6 5 — — 23 7 2 — 51 10 17 93 — 21 11 36 3 3 1 1 — 3 14 17 t 2 34 24 22 34
bKeighley — — 1 1 — — — —— — 2 1 4 10 — 1 1 _ — 1 _ 2 1 1 6
Kivelon Park ... 4 2 —— — 8 —— — 19 5 10 34 — 8 3 7 2 — — 1 — 2 _ 6 8
— —— — 9 14
bKnaresborough — 1 — — 4 1 — 12 — 2 — 1 — — — 1 — _ 2 2
— — — — — 1 — 9
cNidderdale 1 22 2 3 45 — 7 — 2 1 1 — —_ 1 1 2 O 8 6
aOsgoldcross — 1 — 5 <> 9
— 8 1 1 2 12 9 43 — — 3 8 1 — — 2 2 JU 6_ 1 4 10 4 11
aPenistone — — — — 1 — 3 2— — 14 2 8 10 — 9 3 2 1 — 1 _ _ 1 1 7
— — — — — — — 3 6
Pontefract
Ripon and Pateley Bridge — — 2 4 — — 21 2 8 34 —
12 5 7 — _ _ 2 7
4 13 4 *14
aRotherham — 2 1 1 3 1 1 14 4 2 1 53 3 22 72 — 16 8 23 6 6 3 _ 1 4 ii 7 9 8 24 2/
Sedbergh — 1 — 1 — — 6 — 21 — 8 — 2 — — — 3 1 2 3
Selby — — — — 2 —— 13 1 7 13 — 1 2 1 1 — _ _ 2 2 7
2 *7 2 9
aSettle ... 1 i — 1 5 1 — 1 19 4 10 59 1 26 4 2 3 1 2 5 5 3 2
— •\ 6 15
aSkipton — 3 3 4 1 — 2 41 7 19 93 1 32 5 7 1 3 i _ 1 11 7 1 8 14 25
aTadcaster . 1 5 1 13 2— 1 40 6 35 81 — 17 7 20 1 6 2 3 2 8 1C — 2 15 17 20 26
Thorne ... 2 2 4 1 1 — 13 3 1 — 34 4 15 50 — 5 3 11 1 1 8 3 2 4 6 — 2 26 IS 19 13
Todmorden — — 1 — 4 — 1 10 — 6 10 — 5 1 — 1 _ _ 1 1 3 9
aWakefield ... ... — I — — 1 — — 1 6
2 5 3 1 35 1 6 48 8 2 15 4 2 1 1 1 4 1 14 4
nWetherby — 1 — — 1 — — 9 15
3 1 10 1 31 4 17 62 15 3 8 — 1 1 1 1 2 4 J 5 4
Wharfedale ... — — 1 — — — — — — 10 21
8 6 3 4 14 4 — 1 —
1 2 a — 2
oWortley 4 2
5 3 1 5 2 1 1 44 5 12 75 — 19 15 17 2 2 2 _ 2 ( 4 2 8 12 17 21

Total for Rural Districts ... - 26 i 6 39 38 3 4 146 36 8 11 544 73 236 1023 3 244 89 214 30 35 26 If 9 27 92 107 8 21 23C 146 213 *326 1
Grand Total for I 1
Administrative County 4 7 fl 16 27 142 132 25 21 573 159 29 52 2325 302 1115 4745 33 1140 483 871 131 141 j 81 |3f 1148 341 535 25 62 744 529 186 714 1383
1 81 t
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32—33
64 35 36 37
a A change in the boundary of this District was made on the 1st April, 1938, and the statistics in the above table are composite figures comnrisi a
records of the area for the portion of the year prior to the date of the change and those of the altered area for the remainder of the year. H 8 ^
b This District was abolished as from the 1st April, 1938, as a result of the operation of the County of York, West Riding Review Order 1938 ,8
statistics for the year 1938 in the above table relate to that portion of the year prior to the date of the abolition of the District. ’
c This District came into being on the 1st April, 1938, and the statistics refer only to the last nine months of the year 1938.
* Includes one death from smallpox.
 o£

- 1 .nil1 ; !. 'P. Cqr ’ !Jh<?G^W6q OL

OH”* b- n> )|*r»a«**

O — t x K — c C? - . i- rv» ^
IC=
• t- .“ ■ ■ .: V.

i-5 B!-!*r /jaTioLijjjn. i e-

(j": Dcpijp)/ b/-eujainitf
::K" r: i:j ■ -.j ?? OlP6t WiciltGi.9] '^sn>to*-
j. -n 'i f it r., [*■
- :' *■ .>• : . ' t- v : ' rv
V'-1 • • 1 • .p 'lie • . ; f r.-v
rc a- c? ; cl c. r .%j o<

W * pa ? -

r’t .;tos;a oj j i, l-
* ■ « i: »• to j »: w
PJ /bbtuqrciiyi’
3D | i f *r W»
* Disrupt**’ etc* (i uqu j Xnt.-.---
cv r- »— 09 1
il },»b(fc fjft I.’

t? o<V’;; >-;= D!*4**6*'

• • ' i A* .. k? tr .
pj V ' -- K
^ jJu6muour’» {»;; imuia)-
- -r. p* ('? ' '> :'~rc >■ ‘ . cCV
Cv>
. ’j . " .** -wo) - j£T • i . /0
1 i' I - 1 V- H U — *-T
■?: ov;; <"''cn|S!ot* f ■ • *'

J i I "
~fi - •■• <= - - ••••' • • i.»»! S'
3 hk3l* a is

X c6l6(,if,l jS^iubi.LpsRt-' 3
#
DP' r-.tt-

nrn I !' ,"P --Hr' « Jt*P«- D0*-**!!*' ,X

t*eu* J,:;i H|X.;<j oj ; »
lZ pXbprfp -S
u
fl i-
IT C)fPet Xr,P‘*lcnlon2 Df?6^?':,a'
« ” Vre'ir' j a 2j,tr'2 o^Stj-vj. -. aistsuf-
X«p i.cntoei? oi p t.w(OtX
-c |..
lOditt » nirnr ft
: Tttt' -• | ■»
ir jncti. r

* D!1 i. cjjcljw

■ jr.'obp. f

(•rv-
re 'yjr, a<, t>
J^.SpOiq U'l L^l-^libpoiq 1-6' L ■

as •N
a, &

V;
o’ <=
3 <•
: : a, v |.-/ a » - • : L._ A *2 U
? 7 F-F ' ’v' , C-S

- - - -: ; ^ .>
 21

Mortality from Heart Disease.

The table below gives the number of deaths and death rates from diseases of the heart in
the years 1928 to 1938 :—
Table VIII.

West Riding Administrative County England Proportion of deaths from

Death rate per 1,000 of and Heart Disease per 1,000
Total No. of Deaths.
Year. population. Wales total deaths from all causes
Death W. R. Admin. England
Urban Rural County Urban Rural County Rate. County and Wales

1928 2,231 669 2.900 204 1-56 1-90 1-95 165 167

1929 2,661 830 3,491 2-42 1 -94 2-28 2-44 168 181

1930 2,542 865 3,407 2 -32 198 2 • 22 2-26 195 198

1931 2,841 876 3,717 2-59 1-97 2-41 2-54 195 206

1932 3,007 915 3,922 2-76 205 2-55 2-56 212 212

Average
for 5 years | 2.656 831 3,487 2-42 1-90 2-28 2-35 187 193
1928-32

1933 3,032 925 3,957 2-79 206 2-58 2-68 211 218

1934 3,285 997 4,082 2-84 2-22 2-66 2-69 227 228

1935 3,348 1,065 4,413 3 09 2-36 2-87 2-82 242 240

1923 3,678 1,201 4,879 3-41 2-67 319 311 259 255

1937 3,722 1,092 4,814 3-43 2-57 3-19 314 250 253

Average
for 5 years
1933-37
j 3,373 1,056 4,429 3 11 2-37 2-90 2-89 238 239

1938 3,722 1,023 4,745 3-36 2-59 3-16 • 272 •

* Figures not available at time of going to press.

HEART DISEASE.
Mortality per 100,000 living at different ages in the West Riding Administrative County in the
years 1911-20, 1921-30, 1931-35, 1936, 1937, and 1938.
Table IX.

Urban Districts. Rural Districts. Administrative County.

Ages.
1911-20 1921-30 1931S5 1930 1937 1938 1911.20 1921-30 1931-36 1930 1937 1933 1911-20 1921-30 1931-85! 1936 1937 1938
1

MALES.
Under 15
years 13 9 9 11 5 3 11 8 9 10 5 4 12 8 9 11 5 4
15 and under
25 years ... 30 21 23 19 20 22 21 18 25 12 26 20 28 20 22 17 22 21
25 and under
45 years ... 56 44 41 42 43 49 46 38 28 30 36 45 53 42 37 39 41 48
45 and under
65 years ... 325 270 393 486 457 446 265 217 298 343 270 334 310 277 367 445 406 418
65 and
upwards ... 1,446 1,666 2,996 3,533 3,646 3840 1,201 1,585 2,644 3,191 3,184 3360 1,376 1,662 2,898 3,435 3,521 3722

All ages 152 166 281 340 337 345 127 144 214 259 242 261 146 165 261 315 309 323

FEMALES.
Under 15
years 15 11 9 10 6 8 8 10 10 15 2 13 11 9 10 9 6
9
15 and under
_o_

25 years ...
'0

26 24 32 22 17 28 30 27 25 14 39 15 27 23 19 23 24
25 and under
45 years ... 61 48 51 57 47 47 49 44 47 38 53 53 58 48 50 52 48 48
45 and under
65 years ... 309 265 295 345 338 265 265 233 255 322 274 318 299 264 285 339 323 277
65 and
upwards ... 1,406 1,669 2,725 3,304 3,513 3399 1,230 1,574 2,467 3,243 3,236 3,121 1,362 1,667 2,663 3,289 3,448 3340

All ages 157 183 282 342 349 324 132 162 216 276 272 267 151 182 264 324 328 310
 22

Cancer.
The table below gives the number of deaths and death rates from cancer during the years
1928—1938.

Table X.

West Riding Administrative County. England Proportion of deaths from

Death rate per 1,000 of and cancer per 1,000 total
Total No. of Deaths. deaths from all causes.
Year. population. Wales
Death W. R. Admin. England
Urban Rural County Urban Rural County Rate. County and Wales

1928 1,476 483 1,959 1 -35 113 1-29 1-43 112 122
1929 1,495 465 1,960 1-36 108 1-28 1 -44 95 107

1930 1,522 512 2,034 1-39 1-17 1 -33 1-45 116 127

1931 1,538 496 2,034 1-40 112 1-32 1-48 107 121
1932 1,658 587 2,245 1-52 1 -32 1 - 46 1-51 121 125

Average
for 5 years - 1,538 509 2,047 1-40 117 1-34 1-46 111 120
1928-32

1933 1,652 526 2,178 1 - 52 117 1 - 42 1-53 116 124

1934 1,689 518 2,207 1-56 115 1 -44 1-56 123 132

1935 1,733 540 2,273 1-60 1-20 1-48 1-59 124 135

1936 1,767 536 2,303 1 64 119 1-51 1-63 122 134

1937 1,812 605 2,417 1-67 1-42 1-60 1-63 126 131
Average
for 5 years - 1,731 545 2,276 1-60 1-23 1 - 49 1-59 122 131
1933-37 )

1938 1,781 544 2,325 1-61 1-38 1-55 1-66 133 *

* Figure not available at time of going to press.

CANCER.
Mortality per 100,000 living at different ages in the West Riding Administrative County in the
years 1911-20, 1921-30 1931-35, 1936, 1937 and 1938.

Table XI.

Urban Districts. Rural Districts. Administrative County.

1911.20 1921-30 1031.85 1938 1937 1938 1911-20 1921-30 1931-35 1938 1937 1938 1011.20 1921-30 1931-35 1938 1937 1938

MALES.
Under 15
years 2 2 3 2 2 1 2 4 2 7 5 2 2 3 3 4 3 1
15 and under
25 years ... 4 5 4 3 3 4 4 3 4 2 5 11 4 4 4 3 4 6
25 and under
45 years ... 27 24 26 29 29 29 22 22 20 22 29 36 26 23 24 27 29 31
45 and under
65 years ... 256 267 285 311 322 287 206 230 231 196 248 237 244 258 270 278 302 274
65 and
upwards .. 832 931 1,205 1,373 1,354 1313 712 891 1,059 1,235 1,330 1370 798 920 1,164 1,333 1,348 1327

All ages 95 115 143 163 163 152 80 100 110 117 133 133 91 110 133 149 154 147

FEMALES.
Under 15 f
years 2 2 2 3 2 3 2 3 — — 2 2 2 2 2 1 2
15 and under 2
25 years ... 8 4 3 1 3 6 2 5 3 3 3 6 3 5 3 2 3 6
25 and under
45 years ... 40 45 46 39 45 34 43 43 41 35 46 39 44 45 40 40 45
45 and under 42|
65 years ... 326 305 308 300 / 306 313 294 286 274 277 332 277 319 301 300 294 313 305
65 and
upwards ... 862 901 1,050 1,117 1,158 1063 716 867 1,048 857 1,203 1252 826 893 1,050 1,053 1,169 1103

All ages 117 138 160 165 .7. 167 98 122 131 122 152 147 112 134 152 153 166 162
 23

Mortality from Cancer.

About one in every seven deaths which occur in the Administrative County is due to cancer,
and therefore, it is noteworthy that in 1938 the death rate from this disease, per thousand of the
population, has receded from the rate of 160 for the previous year to 1-55, thus reflecting- the de¬
crease which has taken place in 1938 in the death rate from all causes. The year 1938 is the
only year since 1931 in which there has been no increase in the County death rate from cancer,
and the only year since 1919 for which a decrease has been recorded.

Table X on page 2'2 gives the death rates per thousand of the population for the West Riding
Administrative County and England and Wales, and Table XI on page 22 gives the rates by sex
and age for the Administrative County. It will be observed from the latter table, that between the
ages of 25 and 65 the mortality of females from cancer is in excess of that of males, due largely to
the number of deaths of females between the ages of approximately 25 and 55 from cancer of the
breast and uterus. On the other hand, mortality from cancer of the buccal cavity is about six
times as great among males as females, from cancer of the respiratory organs nearly four times
as great and from cancer of the digestive organs nearly twice as great.

The death rate from cancer in the Administrative County has increased more rapidly among
males than females as the following statistics show. On the other hand, the rate was in the first
place higher among females than males.
Period.
MALES.
Death rate per 100,000 male 1911-20 1921-30 1931-35 1936 1937 1938
population 91 110 133 149 154 147
Percentage increase on rate for
1911-20 . — 21 46 64 69 62

FEMALES.
Death rate per 100,000 female
population . 112 134 152 15.3 166 162
Percentage increase on death rate
for 1911-20 . _ 20 36 37 48 45

Mortality in Early Years of Life.

A decline in mortality among children from one to fifteen years of age has been taking place
for many years; and in particular it will be noted that the death rate among children from 1 to 2
years of age has fallen more rapidly recently than among those in the first year of life. This com¬
parison is set out in the mortality statistics for the past eight years given below: —
Death Rates from all Causes per 1,000 Children Living.

West Riding Administrative County and England and Wales.

Table XII.

Death Rate at Ages 1.

Period. Linder 1 year. 1 to 2 years. 2 to 5 years. 5 to 15 years.

W.R. E. & W. W.R. E. & W. W.R. E. & W. W.R. E. & W.

1931-1935 . 65.60 64.92 15.03 13.11 5.67 4.42 2.10 1.77

1936 . 63.14 61.80 10.86 10.72 5.61 3.77 1.57 1.57 ,
1937 . 59.54 60.56 10.49 9.72 4.01 3.54 1.47 1.50
1938 . 51.24 * 9.60 * 3.78 * 1.41 *
Rate for 1938
expressed as a
percentage of
the average rate 78.1 * 63.9 * 66.7 * 67.1 *
for 1931-35
* Figures not available.
The main causes of death in children from 1 to 15 years of age are enumerated below:'—
Table XIII.

Percentage of deaths to total deaths at

following ages in the eight years 1931—1938.
Cause of Death.
1 to 2 years. 2 to 5 years. 5 to 15 years.

Diphtheria 2.3 13.7 19.5

Measles 11.7 8.5 2.1
Whooping Cough . ... ... . 7.6 4.7 0.5
Pneumonia and Bronchitis 39.2 22.8 9.5
Tuberculosis 7.9 9.1 9.3
Violence ... . 5.0 9.8 12.2
Heart Disease . ... . 0.2 0.4 6.1
Digestive Diseases ... 7.1 6.8 8.2

The mortality from diphtheria is heaviest between the ages of 2 and 15 years, measles and
whooping cough between 1 and 5 years, pneumonia, and to a much less extent bronchitis,
between 1 and 5 years, and heart disease between 5 and 15 years. Among the digestive diseases
the main cause of death from 1 to 5 years is diarrhoea and enteritis, and appendicitis from 5 to
15 years. The deaths from tuberculosis are chiefly due to the non-respiratory form of the disease.
 24

The following table shows the death rates from the aforementioned causes for the West
Riding Administrative County and England and Wales: —

Death Rates in the West Riding Administrative County and England and Wales from
Certain Causes per 1,000 Children Living. Five Years 1931-35, and Years 193G, 1937 and
1938.
Table XIV .

Age.

Cause of death and period. 1 to 2 years. 2 to 5 years. 5 to 15 years.

W.R. E. & W. W.R. E. & W. W.R. E. & W.

Diphtheria.
1931—1935 . 0.28 0.29 0.72 0.53 0.39 0.25
1936 . 0.32 0.21 0.77 0.55 0.33 0.28
193 / ... ... ... ... 0.28 0.23 0.67 0.55 0.29 0.27
1938 . 0.42 * 0.53 * 0.35 *
Measles.
1931—1935 . 1.93 1.89 0.52 0.45 0.05 0.05
1936 . 0.97 1.83 0.45 0.45 0.03 0.05
1937 . 0.42 0.66 0.12 0.17 0.02 0.02
1938 . 1.32 * 0.31 * 0.03 *
Whooping Cough.
1931—1935 . 1.16 1.17 0.27 0.26 0.01 0.01
1936 ... ... . 1.07 1.02 0.25 0.21 0.00 0.01
1937 . 0.98 0.87 0.20 0.20 0.02 0.01
1938 . 0.24 * 0.11 * 0.00 *
Pneumonia and Bronchitis.
1931—1935 . 5.87 4.87 1.35 0.95 0.21 0.16
1936 . 4.36 3.64 0.86 0.70 0.13 0.13
1937 . 4.50 3.75 0.86 0.76 0.11 0.12
1938 . 3.39 * 0.82 * 0.11 *
Tuberculosis.
1931—1935 . 1.25 0.99 0.51 0.47 0.19 0.23
1936 . 0.97 0.78 0.38 0.36 0.16 0.18
1937 . 0.51 0.81 0.48 0.37 0.14 0.17
1938 . 0.71 * 0.31 * 0.12 *
Heart Disease.
1931—1935 . 0.03 0.01 0.02 0.02 0.13 0.11
1936 . — 0.01 0.03 0.03 0.14 0.10
1937 . — 0.02 0.03 0.03 0.09 0.09
1938 . 0.05 * — * 0.06 *
Diseases of the Digestive System.
1931—1935 . 1.01 1.00 0.36 0.35 0.18 0.16
1936 . 0.60 0.74 0.37 0.30 0.08 0.15
1937 . 1.02 0.79 0.30 0.29 0.13 0.14
1938 . 0.85 * 0.31 * 0.08 *
Violent Causes.
1931—1935 . 0.58 0.54 0.48 0.41 0.24 0.22
1936 . 0.79 0.58 0.51 0.39 0.20 0.20
1937 . 0.79 0.58 0.62 0.38 0.22 0.21
1938 . 0.85 * 0.50 * 0.21 *

* Figures not available.

The above statistics show that in the Administrative County there has been a steady decline
in mortality from diphtheria among children from 2 to 15 years of age, except for an increase in
the death rate for the year 1938 among children of 5 to 15 years.

Having regard to the decline in the death rates from whooping cough there would appear to
be a downward trend in mortality therefrom in the Administrative County but the child population
is subject to epidemics from this disease and the death rate may increase therefore in the future.

Pneumonia is the chief killing disease of the first five years of life; 35 per cent, of the deaths
of children in the second year of life are due to this cause, and 20 per cent, of those among children
of 2 to 5 years of age. It is gratifying therefore, to observe from the figures in the table above
the extent of the decline in mortality in the Administrative County from this disease and the allied
respiratory ailment of bronchitis in the short period covered by the past three years. From these
two causes, the average number of deaths per year for the five years 1931-1935 was 280, and 170
for the three years 1936-1938. In 1938 only, the deaths numbered 151. It is not possible to be
sure that the mortality will stay at the low level now reached, as a widespread epidemic of measles,
to which pneumonia is very frequently the sequela, may have the effect of increasing the death
rate. In that event, however, it is probable that the mortality will not reach the level of the
five years 1931-1935. The death rate from pneumonia and bronchitis is higher in the West Riding
Administrative County than in England and Wales, and no doubt this is due in some degree to
the northern situation and industrial character of the County.

The death rate from violent causes remains at all ages almost constantly at the same level.
Of the accidental violent deaths in the first five years of life about 40 per cent, are due to burns
and scalds, 40 per cent, to injury by falls or crushing including road accidents, and nearly 10 per
cent, to drowning. In the la-ter years of childhood about 65 per cent, are due to injury by falls
or crushing such as road accidents, nearly 15 percent, to drowning and 10 per cent, to burns and
scalds.
The violent deaths of boys are almost twice as numerous as those of girls.
 25

Infant Mortality.

In 1938, the deaths of infants under one year of age numbered 1,191, representing a rate of
51 per thousand live births, which is two below the corresponding rate for England and Wales.
This is the lowest annual rate ever recorded for the Administrative County, is a decrease of nine
on the rate for 1937, and just half the average rate for the ten years 1912-21. As will be observed
from Table XVI headed “Causes of Infant Mortality in the years 1912-1938” on page 26 the decline
took place in connection with all the principal causes of infant deaths except for small increases
in the case of measles, diarrhoea and certain respiratory diseases.

A perusal of the column headed “Measles” in the above-mentioned table will show that the
mortality from measles has always ebbed and flowed, but the levels reached in the “peak years”
of the last decade have not been so high as those in previous years.

Below is a table showing the quarterly incidence of infantile mortality in the Administrative
County: —
Quarter of year :—
Average rates for : — First. Second. Third. Fourth
Five years 1926-30 ... . 100 69 55 76
,, ,, 1931-35 . . 90 65 50 63

Rates for years :—

1936 . . 96 65 44 63
1937 . . 76 57 46 61
1938 . . 64 48 44 51

As might be expected, the mortality of infants is highest in the first and fourth quarters of the
year, when the coldest weather is experienced and, in consequence, bronchitis and pneumonia
are more prevalent. There wras a time, however, in the early years of the present century and
before, when infantile diarrhoea was prevalent and in the Administrative County infant death rates
as high as 190 per thousand births were reached during the third quarter of the year. Better
sanitation, including the considerable reduction in the number of privy closets and improvements
in the production and distribution of the milk supply, coupled with the better methods of feeding
of infants, has brought the infantile death rate from diarrhoea, or “summer diarrhoea” as it was
formerly so aptly termed, down to the low figure at which it stands to-day.

The infantile mortality rate from most of the principal causes of death has declined steadily
for a number of years, but in the case of the group of causes comprised of congenital debility,
malformation, premature birth, and injury at birth in difficult cases of confinement, the infant mor¬
tality rate has shown little decline, and for the past twenty-three years has remained at a level of
30 to 36 per thousand births as will be seen from the statistics below: —

Fifteen Five
years years 1936. 1937. 1938.
1916-30. 1931-35.
Congenital Debility, Malformation, Premature
Birth, etc.
Deaths per 1,000 births 33.87 34.51 33.41 34.77 31.19
Percentage increase ( + ) or decrease ( —) on
rate for 1916-30 ... +1.89 +1.36 +2.66 -7.91

Bronchitis, Pneumonia and other Respiratory

Diseases.
Deaths per 1,000 births 20.25 14.04 14.17 12.05 9.72
Percentage increase (+) or decrease (—) on
rate for 1916-30 ••• -30.67 -30.02 -40.49 -52.00

Diarrhcea.
Deaths per 1,000 births 7.79 4.09 3.61 2.53 3.01
Percentage increase ( + ) or decrease ( —) on
rate for 1916-30 ... ... -47.50 -53.66 -67.52 -61.37

Other Causes.
Deaths per 1,000 births 24.04 13.05 11.95 10.19 7.32
Percentage increase ( + ) or decrease ( —) on
rate for 1916-30 ... ... -45.72 -50.29 -57.61 -69.55

Nearly 61 per cent, of the deaths of infants in 1938 were from the group of causes which
includes congenital debility, premature birth and injury at birth, and of these deaths approximately
85 per cent, occurred in the first four weeks of life. Many of the conditions (for example congenital
debility and malformations) included in this group are definitely incompatible with life, and the in¬
fant unfortunately afflicted is in reality a physiological failure whose life no amount of care and
medical skill will save. If the present rate of decline in infantile mortality continues in the future
it is the deaths from these causes which will constitute at no very distant period the bulk of what
might be termed the inevitable infant deaths.

There are other causes of death included in this group, more especially injury at birth and
premature birth, the mortality from which can be reduced by ensuring through efficient ante-natal
care that so far as is possible every mother has a normal confinement. This is one objective of
the ante-natal clinics and of the midwifery scheme recently established.

Table XV on page 26 gives a comparison of the infant mortality rate lor the Administrative
County with that for England and Wales, and the chart on page 27 shows the decline in the rate.
 26

Table XV.
Infant Mortality Rate (Deaths of
ii West Riding Administrative County. infants under one year of age, per
1,000 live births).
PERIOD. Number of
West Riding England
Number of Deaths of Infants
Administrative and
Live Births. under one year
County. Wales.
of age.

Average No. per Average No. per Average Average

year year Ten-yearly rate Ten-yearly rate
1901-1910 40,449 5,443 136 128
1911-1920 34,326 3,735 109 100
1921-1930 29,491 2,352 80 72

Actual numbers Actual numbers Yearly rate Yearly rate

1931 24,900 1,835 74 66
1932 24,319 1,692 70 65
1933 23,084 1,615 70 64
1934 23,393 1,347 58 59
1935 23,077 1,330 58 67
1936 22,995 1,452 63 59
1937 22,978 1,368 60 58
1938 23,246 1,191 51 53

The table folded in at page 19 gives the infantile mortality rate for each Countv District,
and below are given lists of Districts with the highest and lowest rates for 1938: —
County Districts with an infant mortality rate of 65 or over.
Adwick-le-Street U.D ... 74 Hemsworth U.D. ... 66
Colne Valley U.D. . ... 66 Keighley B. ... ... 76
Conisbrough U.D. . 71
County Districts with an infant mortality rate of 45 or under.
Aireborough U.D. ... 42 Pudsey B. ... 45
Batley B. ... 40 Rawmarsh U.D. ... 39
Bentley-with-Arksev U.D. ... 32 Shipley U.D. ... ... 42
Bingley U.D. ... ... 42 Kiveton Park R.D. ... ... 42
Goole B. ... ... 40 Wortley R.D. ... 34

West Riding Administrative County.

Causes of Infant Mortality in the years 1912=38.

Table XVI.

Number of Deaths un der On e Year per 1000 live births

|

Debility and ;
Malformation

Other Causes
Tuberculosis

Tuberculous

(All Causes)
Respiratory

Respiratory
Pneumonia

U
Premature
Diphtheria

Bronchitis

Congenital
I nfluenza

Diarrhoea
Smallpox

Year
Diseases

Diseases
Measles
Enteric

Scarlet

Ot her

Other
Fever

Fever

Birth

Total

■h
j§

1912 nil. nil. 2-67 0 05 3-94 0-18 0-36 0-15 2-87 8-31 8-66 0-61 6-71 40-81 19-61 94-93
1913 nil. nil. 2-59 0- 11 2-35 0-16 0-19 0-19 3-42 10-30 12-94 0-40 20-12 45-41 21-42 119-60
1914 nil. nil. 2-87 005 5-48 0-24 0-24 0-21 301 9-36 11-41 0-53 18-19 41-86 20-48 113-93
1915 003 nil. 4-20 0-21 4-28 0-21 0-21 015 2-90 10-07 12-91 0-35 14-48 41-47 20-65 112-12
1916 nil. ml. 1 -35 0-09 2-68 009 0-25 0-31 2-34 9-64 11-05 0-77 10-96 34-45 21 -86 95-84
1917 nil. nil. 2-70 004 2-67 0-18 0-25 0-36 2-45 10- 17 12-24 0-71 8 11 34-72 23-73 98-33
1918 nil. nil. 5 05 nil. 7-50 007 5-01 0 ■ 36 1 -53 11-19 14-18 0-57 9-77 36-68 19-87 111-78
1919 nil. nil. 0-88 nil. 1-62 0 11 2-85 0-35 1 -80 12-25 12-39 0-63 8-55 39-14 19-46 100-03
1920 nil. nil. 2-48 0 05 1 -64 Oil 1-14 016 2-09 9-88 11-04 0-42 11-92 31-65 19-15 91 -73
1921 nil. nil. 017 003 4-53 003 110 0-31 1 - 76 7-82 13-40 0-37 14-22 36-94 16-52 97-20

Average
for 10
years
000 nil. 2-48 0 06 3-65 0-14 1 05 0-25 2-46 9-80 11-92 0-53 12-54 38-48 20-21 103-57
1912-21

1922 003 0 03 1-69 nil. 2-91 0- 10 0-51 016 1 -95 6-75 11-86 0-38 6-52 33 • 50 14-51 80-90
1923 nil nil. 1-81 0 06 216 0 06 0-55 0-36 1 • 55 6-71 11-00 0-48 7-10 33-52 15-91 81-27
1924 nil. nil. 1 09 nil. 2-67 nil. 1 - 48 006 1-35 6-14 15-47 0-61 6-72 33-10 13-96 82-65
1925 nil. nil. 1 -88 0-06 2-92 0-29 0-62 0-29 1 - 46 6-22 13-09 0-45 7-06 33-17 13-41 80-92
1926 nil. nil. 0-47 0 03 4-02 0-07 0-20 017 1 -23 5-35 10-97 0-43 6-45 30-87 13-16 73-42
1927 nil. 019 2-65 0 08 2-79 0 08 1 04 0-15 1 - 45 5-33 15-46 0-37 4-73 32-35 12-49 79-16
1928 nil. nil. 0-56 0 04 Ml 0-07 0-33 0-04 1 -67 2-59 9-31 0-30 4-71 30-14 11-49 62-36
1929 nil. 004 1-41 nil. 4-97 0-24 2-54 0-24 0-90 6-65 17-44 0-31 6 14 33 • 75 13-92 88-55
1930 0-04 nil. 0-89 ml. 1-89 0-23 0 08 0-08 1 -20 2-47 8-71 0-23 3-86 34-00 11-45 65-13
1931 nil. nil. 1 • 12 nil. 1-52 008 0-72 0-20 1-28 4-78 13-25 0-28 4-42 35-34 10-72 73-71
Average
for 10
years
0-01 002 1 -36 0 03 2-71 0-12 0-79 018 1-42 5-38 12-63 0-39 5-86 32-95 13-20 77-05
1922-31

1932 004 nil. 115 nil. 2-59 0-21 1 03 0-04 1 -23 4-28 10-20 0-16 4-93 34-26 9-46 69-58
1933 nil. nil. 017 nil. 1-82 009 1 -90 nil. 0-56 3-08 12-09 0-13 5-37 36 • 35 8-40 69-96
1934 nil. nil. 1 - 54 017 0-90 0-17 0-21 0-04 0-51 2-48 7-53 0-34 2-91 33-21 7-57 57-58
1935 nil. nil. 0-56 nil. 1-21 0-13 0-43 017 0-61 2-90 8-54 0-17 2-82 33-41 6-68 57-63
1936 nil. nil. 0-87 nil. 1-91 0-09 0-48 0-22 0-70 2-91 11-04 0-22 3-61 33-41 7-69 63-14
1937 nil. nil. 0-31 nil. 1 • 13 0-22 0-52 004 0-61 2-39 9-66 nil. 2-53 34 • 77 7-36 59-54
1938 nil. nil. 1 0-95 nil. 0-60 0-09 0-13 nil. 0-39 1 -55 7-91 0-26 3-01 31-19 5-16 51-24
 27

West Riding Administrative County.

Infantile Mortality Rate for the 38 years, 1901 to 1938.

EPIDEMIOLOGY.
Statistics as to incidence of the principal infectious diseases are given below. The combined
death-rate from these diseases was 0-23 per 1,000 of the estimated population, compared with
0 21 for the previous year, and the average rate of 0'37 for the ten years 1927-36.

The table headed “West Riding Birth and Death Rates for Ten Years’’ on page 18 shows the
mortality rates for each disease for each of the ten years 1929 to 1938, and table V on the same
page headed “Average Birth and Death Rates from 1918 to 1937” gives similar information for
the quinquennial periods comprised in those years.

Table XVII.

Ratio of Deaths.
No. of
No. of Cases (a) per 1,000 (b) per 1,000
Zymotic Disease. Deaths
1938. persons persons
1938.
attacked. living.

(1) Smallpox 3 1 333-33 0-00

(2) Scarlet Fever ... 3,475 16 46-04 0-01
(3) Diphtheria 2,560 142 55-47 0-09
(4) Enteric Fever 22 4 181-82 0 00
Measles * 79 ? 0-05
(5)
Whooping Cough * 27 P 0-02
(6)
(7) Diarrhoea, etc., under two years ... * 81 ? 0-05

Total of principal Zymotic Diseases ... ? 350 9 0-23

* The numbers of cases of measles, whooping cough and diarrhoea are not available, as cases of these diseases are
not compulsorily notifiable in every district in the Administrative County.

The following table gives the number of cases of infectious disease notified, and the rate per
thousand population, in the Administrative County during the six years 1933-1938.
 28

The number of cases notified in 1938 in each Sanitary District of the Administrative County
will be found in Table XX folded in at page 31 and paragraphs with regard to the incidence
of the principal infectious diseases will be found on this and the following pages.

Table XVIII.

II Number of Cases Cases Notified per 1,000

Notified population.
Diseases. 1 1 England
Average and
1933 1934 1935 1936 1 QQ’7
lyj/ for 5 yr» 1938 1933 1934 1935 1936 1937 for 5 yrs. 1938
II
| 1933-37 1933-37
1938

S'mall-pox ... ...I| 3 1 i 3 0 00 0 00 _ 0-00 0-00 0-00

Scarlet Fever. 6218 6645 6108 4978 3945 5579 3475 4 05 4-33 3-98 3-26 2-61 3-65 2-31 2 41
Diphtheria 1652 3062 3175 2261 2337 2497 2560 108 200 207 1-48 1-55 1-63 1-71 1-58
Enteric Fever ... 58 36 50 54 53 50 22 004 002 0 03 0-04 0-04 0-03 0-01 0-03
Puerperal Fever 60 63 77 69 *2-48 *2-56 *3-18 *2-87 14-42
[245 241 238 | *10-18 *9-93 *9-79
Puerperal Pyrexia 149 172 186 182 *615 *7 00 *7-68 *7-56
Cerebro-Spinal Fever 175 70 39 41 34 72 21 Oil 005 003 0-03 0-02 0.05 0-01 +
11 002 001 0-01 0-01 0.01 0-02 +
Acute Poliomyelitis ... ! 37 14 18 17 19 23 001 +
Acute Polio-Encephalitis 3 1 1 0 00 0 00 0-00 0.00 0-00 +
1 — — 1 — — +
+
Encephalitis Lethargica 9 13 6 15 2 9 9 001 001 000 0-01 0-00 0-01 0-00 +
Ophthalmia
Neonatorum ... 87 105 100 112 133 107 115 t3 • 77 14-49 14-33 14-87 15-79 14-65 14-95 +
+
Erysipelas . 670 808 662 631 577 670 649 0-44 0-53 0-43 0-41 0-38 0-44 0-43 0-40
Respiratory
Tuberculosis 1 1431 1225 1133 1088 1052 1186 1029 0-93 0 80 0-74 0-71 0-70 0-78 0-69 +
+
Other Forms of
Tuberculosis 548 559 528 510 456 520 506 0-36 0-36 0-34 0-33 0-30 0-34 0-34 +
+

* Cases notified per 1,000 Registered Total Births.

I yy 15 yy yy yy x->1 yy
\ Figures not available at time of going to press.

SMALL-POX.

On the 25th November the County Medical Officer received a communication from Dr. Flintoff,
Medical Officer of Health for the Ripon and Pateley Bridge Rural District, that he had received
notification of a case of suspected smallpox in a man aged 73; and later in the evening the County
Medical Officer visited the patient and found that it was a definite case of smallpox. On making
enquiries it was ascertained that the daughter of the patient had returned from Oporto on the
S.S. “Anselm,” which arrived at Liverpool on the 21st October. She became ill on the 30th
October and a rash was noticeable on thel 4th November. Her younger sister had suffered from
what appeared to be influenza on the 17th November, and on examination the typical marks of
healed smallpox lesions were found on both patients.

The case of smallpox was removed to the Tadcaster Smallpox Hospital at Sherburn-in-
Elmet, and placed under the care of Dr. W. B. Hill who reported that it was a case of variola
major and nearly confluent smallpox. The patient became very ill and died on the 21st December.

All Medical Officers of Health in the geographical County were immediately informed of the
occurrence of smallpox and lists of persons who had been in contact with these patients were
distributed to the Medical Officers of Health concerned. Over 100 persons in the immediate
neighbourhood were vaccinated before the 30th November and no further case of smallpox was
notified.

SCARLET FEVER.
There was a slight decrease in the prevalence of scarlet fever during 1938, when 3,475 cases
were notified as against 3,945 in the previous year.

The districts which experienced the highest attack rates, i.e. number of cases notified per
thousand of the estimated population, were :—

Horbury U.D. 5-49 Stanley U.D. 6-90

Morley B. 4-60 Nidderdale R.D. 4-29
Normanton U.D. 4-29 Osgoldcross R.D. 4-78
Ripponden U.D. 5-36

The number of cases notified during the last eight years is given below :—

Year 1931. 1932. 1933. 1934. 1935. 1936. 1937. 1938.

No. of cases 2,952 3,261 6,218 6,645 6,108 4,978 3,945 3,475

It will be observed that the epidemic prevalence of this disease reached its peak in 1934.
The disease continues to b.e mild in type.

DIPHTHERIA.
Diphtheria was still prevalent during the year, the number of cases notified being 2,560
compared with 2,337 during the year 1937.
 29

The districts with the highest attack rates, i.e. number of cases per thousand of the estimated
population were :—
Adwick-le-Street U.D. 9-49 Knottingley U.D. 5 45
Cudworth U.D. 5-24 Otley U.D. 606
Dearne U.D. 5-52 Wath-upon-Dearne U.D. 5-92
Keighley B. 5-26 Osgoldcross R.D. 6 24

The notifications received during the last five years were as follows :■—
Year .1934. 1935. 1936. 1937. 1938.
No. of cases .3,062 3,175 2,261 2,337 2,560

Diphtheria Immunisation.

Immunisation clinics have been continued throughout the year in all parts of the Adminis¬
trative County area and facilities for the protective treatment are offered in the following ways :—
(1) At clinics held in schools.
(2) By private medical practitioners.
(3) At Child Welfare Centres.

In addition to these three methods, special clinics have occasionally been held if the number
of acceptances for treatment has been so great as to interfere with the normal Child Welfare
sessions.

Immunisation against diphtheria is also offered to nurses joining the staffs of the two approp-
iated Hospitals and to the children resident in County Children’s Homes.

The number of children immunised since 1932 is as follows :■—

Year. 1932. 1933 1934. 1935. 1936. 1937. 1938.
Number of children immunised 2,232 4,063 16,525 54,435 14,218 9,923 15,252
or undergoing treatment.

It is satisfactory to note that 15,252 children received the protective treatment during the year
1938 under the County Council’s Scheme, which is a substantial increase on the figure 9,923 for
the previous year. Of this number 832 were pre-school children and 14,420 children of school
age. The number of children immunised by private practitioners was 2,190.

The treatment is provided free of cost to the parents, the County Health Department supply¬
ing the immunising material direct to the medical practitioner or medical officer in charge of the
clinic.

The prophylactic in most general use for the immunisation of pre-school and school children
and adults was T.A.F. given in three injections with a time interval of two weeks between the
injections.

Although the use of T.A.F. was almost general, no restriction was placed on Medical Officers
doing this work with regard to the prophylactic with which they may desire to be supplied, and
a small number of children have been immunised with T.A.M. (goat) and A.P.T.

A special campaign calling attention to the facilities offered by the County Council for diphth¬
eria immunisation was carried out at Child Welfare Centres during the year, which included lec¬
tures to parents and a display of the film “The Empty Bed.’’
The districts visited were :—
Adwick-le-Street Glusburn
Askern Queensbury
Carcroft Haworth
Cudworth Shelf
Dunscroft
Diphtheria Carriers.
No cases of diphtheria carriers presented themselves for treatment by local ultra-violet light
irradiation during the year.

ENTERIC FEVER.
There were 22 cases of typhoid or paratyphoid fever notified during 1938 as compared with
53 in the year 1937.

The districts affected were as follows:—

Boroughs and Urban Districts.
Adwick-le-Street ... 1 Ilkley . ... 1
Aireborough ... 1 Keighley ... ... 1
Bentley-w-Arksey ... 1 Mirfield ... 1
Conisbrough ... 1 Pontefract ... 1
Goole ... 1 Saddleworth ... 1
Hebden Royd ... 2 Shipley ... 1
Holmfirth ... ... 1 Stanley ... 1
Rural Districts.
Doncaster ... 4 Tadcaster ... 1
Hemsworth ... 1 Wortley ... 1
It will ae seen that the cases were spread over a large number of districts, the h
ases notified in any one district being four.
 30

ACUTE POLIOMYELITIS.
(Infantile Paralysis.)

23 cases of Acute Poliomyelitis were notified during the year as compared with 11 cases in
1937. The cases occurred in 19 separate sanitary districts, only 4 districts reporting more than
one case. There was no evidence of a common factor being associated with any of the cases.

1 case of Acute Encephalitis occurred in the Pontefract Municipal Borough, and 2 cases of
Encephalitis Lethargica were notified in the Swinton Urban and Settle Rural Districts respectively.

CEREBROSPINAL FEVER.
21 notifications of Cerebro-Spinal Fever were received during the/ year, the districts reporting
more than one case being as follows :—
No. of cases notified.
Adwick-le-Street U. ... ... ... ... 2
Hemsworth R. ... ... ... ... ... 5

There is a reduction in the number of sporadic cases notified in the Administrative Area com¬
pared with previous years, as indicated below :—
No. of cases notified.
1934 .. 70
1935 .. 39
193G .. 41
1937 .. 34
1938 .. 21

DYSENTERY.

There were 16 cases notified as against 2 in 1937. The districts affected were as follows:—
Batley B. ... 4 Thorne R. ... ... ... 2
Hemsworth U. 3 Wortley R. ... ... 5
Rotherham R. ... 2

ISOLATION HOSPITALS.
The following table gives particulars of the removal to hospital of cases of Smallpox, Scarlet
Fever, Diphtheria and Enteric Fever during 1938. Columns 24 to 27 of Table XX folded in at
this page show the removals for each district: —
Table XIX.

Total cases Cases removed to Hospital.

notified. Number. Percentage.

Smallpox 3 1 33-3
Scarlet Fever ... ... . . 3,475 3,037 87-4
Diphtheria 2,560 2,484 97-0
Enteric Fever. 22 20 90-9

Total for 1938 ... 6,060 5,542 91-5

 Table XX

Notified Cases of Infectious Diseases, 1938.

|| Cases removed
to Hospital of
Cases Notified or Otherwise Ascertained. undermentioned
diseases

Other forms of Tuberculosis

Respiratory Tuberculosis
E
3
u
to O
4-*
a
c3
■3 a)
C J=
J3 3 do
o o _ 8 3
O
Cfl

Enteric Fever
c V—•
£
,P* a.
w- 03
O 0>)
SANITARY - 3
N
cd H

Diphtheria
<u
.2 £ O to

Erysipelas
<D
DISTRICT Q. c U*
Uh
D O
G
O
3 1 C
V '5.
*5 £ .5 .fi X o <D
o T
£ c 3 ■S o .c
a
o
9* 5 a> xj o. IS o
C/) in hs e c
CU rt O U m

^ So
?
1 10 11 12 23 24

5
22 25

73

5
2 6 8 13 14

3
3 4 5 7 9

I. URBAN
co
Adwick-le-Street 76 182 1 50 9 2 2 31 29 3 74 182 1
tAireborough. ..V _ 1 2 1 23 3 25 16 1
Baildon . ...
28
16
16 16
_ 9
16 —

Barnoldswick. _ 5 29 _
12 _ ___ __ __ 7 14 5 1 29 —
Batley B. . _
83 28 —
52 8 _
1 _ _ _ _
4 18 31 11 74 26 —
Bentley-w-Arksey ... _ 62 32 1 18 4 _ _ _ _ _ —
6 17 5 62 32 1
feBingley . _ 65 41 —
38 3 _ _ _ _ _ _ _
12 1910 59 41 —
Brighouse B. ... _ 70 32 _
31 1 19 22 11 *346 52 31 —
rCastleford ... _ 77 69 _
27 4 1 _ _ _ _ _ _
10 44 13 75 68 —
Colne Valiev ... _
17 4 —
35 1 ___ _ _
14 14 8- 16 4 —
Conisborough ... _ 18 32 1 13 5 _ 18 32 1
Cudworth ... —
19 44 —
20 3 1 2 7 2 *73 7 44 —
Darfield _ 8 6 _
6 2 _ 1 4 10 4 7 6 —
cDarton _
35 6 —
11 5 1 _ _ _ _ —
7 9 8 16 6 —
Dearne ... ... ... —
30 134 —
25 12 1 _ — _ _ — —
18 24 13 30 134 —
aDenby Dale. —
2 1 —
4 — — _ — — — — —
4 — 1 1 1 —
Denholme ... _ 7 4 —
1 1 __ __ ___ 5 2 — 4 3 —
oDodworth _ 10 6 —
1 2 __ _ _ ___ 1 1 5 5 6 —
Earby ... _
5 9 —
5 __ __ _—— 2 2 1 —
3 —
Elland ... — 50 9 — 25 4 1 — — — — — — 10 12 11 - 5 2 —

feFeatherstone —
30 44 —
14 1 —
1 4 10 6- 319 29 44 —
Garforth . _ 3 7 1 4 2- 3 7 —
Goole B. —
36 20 1 21 3 6 9 7- 33 20 1
cHarrogate B. ... —
76 20 —
68 9 1 21 24 17 - '97 106 '10 70 20 —
Hebden Royd ... 2 2 3 — _ 7 - x 2 2
Heckmondwike
—

_
17
32 4 _
5 _
_ 1 __ ___ —
4 5
5 1 - x x x
14
31 4 —
Hemsworth —
22 25 —
30 _ _ 3 24 11 3 22 25 —
fcHolmfirth —
17 6 1 27 2 —
6 5 4- x 17 6 —

Horbury —
42 5 —
13 1 3 2 2- 41 5 —
Horsforth _ 21 5 _
5 _ 3 7 8- 20 5 —
bHoyland Nether _
43 32 —
17 1 1 ______ 10 14 3- 40 31 —
t+Ilkley —
22 5 1 10 2 _
1 _ _ — — —
20 5 —
fcKeighley B. ... —
133 293 1 39 10 1 16 30 17 - 120 286 1
o+Kirkburton. _ 8 6 _
11 7 15 10 7 1 —

cKnaresborough —
15 8 —
4 3 — 2 __ _—— 2 2 I - 15 8 —
Knottingley —
18 50 — 23 — 1 — ————— 4 5 3- 18 50 —
Maltby ... ... —
25 17 — 3 3 2 4 4- 24 17 —
cMeltham .. . _ 2 1 _ 3 _ _ _ _ __ _ _ — 3 — 2 1 —
cMexborough ... —
53 10 — 3 1 _ i 3 13 7- 49 10 —
Midgley ... — 1
Mirfield ... ... — 31 3 1 6 2 4 4 6- 30 3 1
Morley B. —
181 37 —
58 4 — _ _— — — —
17 29 19 - 156 36 —
hNormanton —
82 32 — 29 4 — i —— — — — 6 18 11 - 80 32 —
Ossett B. _ 72 11 —
4 3 _ _ __ _ _ _
7 13 — 66 11 —
Otley 1 12 -
frPenistone
_

_
9
4
67
2
—

_
40
1 ____ —

—
3 15
3 1 -
9
4
67 —
2 —
Pontefract B. ... ... _
34 68 1 42 6 i 1 _ _ _ _
16 21 10- '92 34 67 1
Pudsey B. _
58 20 _
11 4 _ _ _ _ _ _
17 10 13- 56 20 —
Queensbury and Shelf _
25 _ 4 _ _ __ _ _ _
5 1 -
...
85 80 25 —
Rawmarsh ... _
54 43 _ 67 7 15 11 4 - 52 43 —
Ripon City _ _ 6 . _ _ __ _
Ripponden . _
18
28 2 _ 3 __ _ __ _ _ 4 —
18
24 2
Roth well _ 26 _ 6 __ __ __ _
hRoyston
...

_
78
11 6 _
38
9 ___ _
_ __ _
16 18 17 - 59
7
19
6
Saddleworth _ 20 7 1 10 4 4 14 3- 7 3
Selby . _ 16 14 _ 8 1 _ i 1 8 5- 10 13
Shipley ... _ 100 45 1 18 8 7 36 4- 91 43
Silsden ... ... _ 19 i .
19
Skipton _ 14 _ 2 1 _ __ ___
Sowerby Bridge _
7
29 28 _ 3 __ _ _ ___
5
4
9
8
4 -
3-
6
29
14
28
Spenborough _ 117 44 _ 31 1 _ i 12 29 11 - *315 111 42
Stanley ... —
108 13 1 46 9 9 2- 98 13
Stocksbridge — 2 1 — 2 __ —— ——— 6 11 8- x 1
cSwinton _ 7 17 _
41
12 3 1 _
_ 1 ___ 5 11 1-
2
7 17
Tickhill . _ _ 11 _ _ ___ x
Todmorden B. ... —
45 22 —
13 1 — i —— ——— 8 10 10- x 39 21
cWath-upon-Dearne ... —
24 80 — 7 — 1 — — — — — — 4 6 1- 23 80
dWhitwood —
2 8 1 2 — 2 8
Wombwell — 67 46 — 48 2 14 11 6- 22 45
rWorsborough — 29 20 — 35 3 — 2 — — ——— 7 13 10 - 27 20

Total of Urban Districts ... — 2635 1945 15 1282 167 15 19 1 1 — — 7 87 497 785 373 - 2290 1894 13

II. RURAL

cBowland 11 3 1 1 X 6
cDoncaster — 191 99 4 51 20 — 1
—— ——— 6 17 43 31 — — — — -' _ 185 98 4
Goole — 4 4 — 8 — — — —— ——— i 2 5 ——— — — _ _ 3 4
cHemsworth — 127 87 1 83 15 5 — 2 39 38 29 — — — — _ 127 86 1
Kiveton Park. — 30 39 — 13 — — — — — — —— — 10 8 1 —— X X _ _ 27 39
eNidderdale — 48 4 — 12 — — — — — ——— — 4 5 3— — — — -1 _ 39 4
cOsgoldcross — 36 47 — 8 — — — — — —— — 5 8 4 33 46 _
6Penistone — 5 — — 1 i — — — -- — — — 1 1 — — — — — — — — 5 _ _
Ripon and Pateley Bridge ... 3 22 17 — 5 — — 1 —- — — — — — 3 6 2—— *10 — — 1 22 17 _
cRotherham . — 57 38 — 40 7 1 — —— —— 2 3 15 21 9 — — X X X — 51 38
Sedbergh . — 1 1 — 3 — —• — — — — — — — — 3 ——— — — — — 1 _
— 1 1 — 2 — — — —— ——— — 2 4 3 — — — — — —
Selby . 1 1 _
cSettle ... — 38 2 9 — 1 — 2 6 4—— — — — — 37 2
cSkipton — 20 47 4 3 — — — — ——— 1 3 ii — — — — — — — 18 46 _
cTadcaster — 65 22 1 19 — — 2 — — ——— 3 7 15 12 — — — — — — 51 22 1
Thorne . — 41 132 — 36 10 2 7 4 30 11 17 118
Todmorden (Hepton) ... — 5 — — 2 1
—— - — — — — 1 — 1 2—— — — — — 5 _
eWakefield — 38 16 — 27 2
— — —— — — — 1 14 8 12 — — — — — _ 27 17
cWetherby — 42 7 — 9 3 — — —— — — — 1 4 6 2—— — — — — 38 4
Wharfedale — 10 3 — 2 — —— — — — — — — 7 4 — — — — — _ 10 3
e+Wortley 48 46 1 33 9 5 1 19 19 3 45 44 1

Total of Rural Districts ... 3 840 615 7 367 71 6 4 — 1 — 9 28 152 244 133 — — — — 1 747 590 7

Administrative County ... 3 3475 2560 22 1649 238 21 23 1 2 — — 16 115 649 1029 506 — — — 1 3037 2484 20
_
1 2 3 4 5 6 7 20 21
8 9 10 11
22 23 24 25 26 12 13 14 15 16 17 18 19 27
A x in columns 21, 22 or 23 signifies that the disease was known to be prevalent during the year 1938.
‘ Compulsorily notifiable during a part or whole of the year 1938.
+ The figures for this District include 5 cases of diphtheria, 1 case of enteric fever, 1 case of puerperal pyrexia,
11 cases of pneumonia, 5 cases of erysipelas, 16 cases of respiratory tuberculosis, and 3 cases of other forms of
tuberculosis notified from the Mental Hospital situate in the District.
++ The figures for the District include one case of scarlet fever notified from the Mental Hospital situate in the
District.
+ The figures for this District include 7 cases of respiratory tuberculosis notified from the Mental Hospital situate
in the District.
+ The figures for this District include 1 case of enteric fever and 5 cases of dysentery notified from the Mental
Hospital situate in the District.
'* Includes typhoid and paratyphoid fever.
|| A number of cases of other diseases such as pneumonia, puerperal pyrexia, cerebro-spinal fever, erysipelas, etc.,
were also removed to Isolation Hospital.
a This District was created on the 1st April, 1938, as a result of the operation of the County of York, West Riding
Review Order, 1938, but the figures in the above table are for the whole of the year for the District as constituted
on the 1st April, 1938.
b The boundaries of this District were altered on the 1st April, 1938, as a result of the operation of the County of
York, West Riding Review Order, 1938, and the figures in the above table refer to the whole of the year for the
District as constituted on the 1st April, 1938.
c The boundaries of this District were altered on the 1st April, 1938, as a result of the operation of the County
of York, West Riding Review Order, 1938, and the figures in the above table are a composite record comprising
notifications for the former area for the portion of the year prior to the date of change and those of the altered
area for the remainder of the year.
d This District was abolished on the 1st April, 1938, as a result of the operation of the County of York, West Riding
Review Order, 1938, and the figures in the above table refer only to the first three months of 1938.
e This district was created on the 1st April, 1938 by the amalgamation of parts of the Great Ouseburn and Knares-
borough Rural Districts. The figures in the above table are a composite record comprising the notifications prior
to the 1st April, 1938, for the whole of the Great Ouseburn and Knaresborough Rural Districts and the noti¬
fications from and including 1st April, 1938, for the Nidderdale Rural District.
 IS

1 pofniic ' '.t.t

V

*-'•* ' . it "3 -: 11 ” : ■ $ RP U 4 * |

■ ;

/^jioofan.S cor jj

p yjestjtit

r-j CP:'r:u •

~ . (oouti.t(«nq tipirrjq;

2 yi’j|8ti» r i-•••■•!•*»:

1 - •* 1 - «>» j/ipetu.;* •

- . .- -i - '■: - *':

i ^ ( f IVi ' - ■. ■ . . - . i*n

~ :.cst.\
y: pd•' .*■ (,(a < uc.c|

i- _| 5 :pn.T J. t

1 • • r^uHk&iea

— »:
v ( . wpio ' ' T ’•
1 ru . ;•» .’J ■*■ 30 .-0

* q py ■' >

... , at* >.rc iAtit

>(ba.i» | ”ifa

■, . « c o-C* o t I- . A*
\r gctfi , v.GA6L

n ;aur jib©*

: . sc

.: : t
iC
^ « u
c .cr
c 1

/
 32

Isolation Hospital Accommodation.

Section 63 of the Local Government Act, 19 29, required every .County Council to make a
survey of the hospital accommodation available in the County for the treatment of infectious
diseases including smallpox, and to prepare in consultation with the Councils of all County Dis¬
tricts in the County or combinations of such Councils, and, if deemed desirable, with the Council
of any County Borough adjoining the County, and submit to the Minister of Health for his approval,
a scheme for the provision of adequate hospital accommodation for the treatment of persons suffer¬
ing from infectious disease within the County. Tentative proposals were formulated so far back
as 1929, and the County Council in March, 1930, approved of the preparation of a scheme by the
Public Health and Housing Committee on the lines of those proposals. Its preparation was held
in abeyance, however, by certain legal difficulties which arose in connection with the Isolation Hos¬
pital Committees formed under Orders of the County Council and by the knowledge that changes
in the boundaries of County Districts were to be brought about by the Review of County Districts.
The provisions of Section 63 of the Local Government Act, 1929, were embodied with necessary
modifications in Section 185 of the Public Health Act, 1936, and the Act, in addition, contained
provisions framed to obviate the legal difficulties mentioned above, also in June, 1938, the nature
of the last of the changes in boundary in connection with the Review of County Districts became
known. The preparation of a scheme for isolation hospital accommodation could thus be proceeded
with, for which purpose a Special Sub-Committee of the Public Health and Housing Committee
was appointed.

The County Districts of the West Riding are served by 35 hospitals for general infectious
diseases with accommodation for 1,456 beds. In three of these, with accommodation for 156 beds,
certain County Boroughs have an interest, along with certain County Districts. The smallpox
hospitals number 29, and have accommodation for 480 beds. In two of these smallpox hospitals
having accommodation for 50 beds certain County Boroughs have an interest, along with certain
County Districts.

The hospitals are classified below according to the extent of the patient-bed accommodation
each one provides:— Number of Hospitals.
General
Smallpox Infectious
Diseases.
70 beds or over ... — 8
40 beds but under 70 — 7
30 > > >5 >> 40 4 5
20 >> )> 5f 30 7 9
10 >> >> 20 11 4
Under 10 beds ... 7 2

The chief defects of the present arrangements are: —

(1) The multiplicity of hospitals of small size.
(2) The too localised control of accommodation.
(3) The existence of certain County Districts with no definite provision of isolation hospital
accommodation.

The multiplicity of small hospitals arose when motor transport was not developed and at a
time when the size of the area to be served w. as determined by the distance which a patient
could be conveyed by a horse-drawn vehicle. The best modern practice is not to regard isolation
hospitals as places of isolation only, but as institutions with the facilities for skilled nursing and
medical treatment which are expected to exist in a hospital to-day. These facilities the small
hospital cannot provide usually, and with adequate motor transport there is now no reason why
one well-equipped hospital should not serve a wider area than heretofore, and travelling facilities
should usually overcome any objection as to distance should the need arise for the presence of
parents or relatives in cass that are seriously ill. The localised control of hospitals which obtains
to-day due to the comparatively large number of hospital authorities means that in cases of
epidemics whilst one hospital may be overtaxed, neighbouring hospitals under different control
may be empty, or nearly so, with no facilities for bringing the vacant accommodation into
immediate use.

In January, 1939, the County Council adopted a scheme, which is now awaiting the approval
of the Ministry of Health, for the division of the County into a number of larger hospital areas
with a view to overcoming eventually the deficiencies set out above. The scheme groups the
County Districts into 11 areas for isolation hospital accommodation for general infectious diseases
and 6 for smallpox. Each area will be under the control of a Joint Hospital Authority, and pro¬
vision is made for the Hospital Authority of one area to draw upon the available accommodation
of another, in case of necessity, without undue delay. Existing arrangements whereby certain
County Districts, or parts of County Districts, have accommodation jointly with neighbouring
County Boroughs are left undisturbed.
 33

Hospital Accommodation for Cases of Infectious Diseases other than Smallpox.

Minimum
County Districts Approx. number of Existing Hospitals in Area. Patient-bed
comprised in Hospital Acres. population, beds for Accommo¬
Area. 1937. patients. dation.
Situation. Authority controlling.
(1> (2) (3) (4)
Beds.
Barnoldswick U. D. 2,764 10,520 Morton Banks, Keighley, Bingley and Shipley 102
Bingley U.D. 11,418 21,810 near Keighley Joint Hospital Board
Denholme U.D. 2,536 2,518 Shipley . Keighley, Bingley and Shipley 30
Earby U.D. 3,519 4,818 Joint Hospital Board
Keighley B. 23,611 55,830 Skipton . Skipton Joint Hospital 42
Shipley U.D. 2.183 30,930 Committee
Silsden U.D. 7.101 4,981 Austwick, Settle Settle Rural District Council 20
Skipton U.D. 4,211 12,840 Rural District
Bowland R.D. 83,327 5,026 Sedbergh. Sedbergh Isolation Hospital 6
Sedbergh R.D. 52,674 3,921 Committee*'*'
Settle R.D. 152,087 13,940 Barnoldswick Barnoldswick Urban District 6
Skipton R.D. 146,071 22,650 Council

491,502 189,784 130 Total accommodation 206

Aireborough U. D. 6,856 23,000 Menston

. Wharfedale Union Joint 88
Baildon U.D. 2,831 9,712 Isolation Hospital Committee
Harrogate B. 8,320 43,930 Knaresborough ... Harrogate, Knaresborough and 78
Horsforth U.D. 2,706 12,080 Wetherby Joint Isolation
Ilkley U.D. 8,610 15,840 Hospital Committee*
Knaresborough U. D. 2,495 7,320 Ripon . Ripon and Pateley Bridge, and 16
Otley U.D. 2.934 11,095 Wath Rural District Councils’
Ripon City ... 1,812 8,542 Joint Isolation Hospital
Nidderdale R.D. 75,008 11,401 Committee
Ripon and Pateley Bridge Garforth Cliffe ... Tadcaster Rural District 28
R.D. 124,861 11,080 Council
§Tadcaster R.D. ... 75,834 24,050
Wetherby R.D. 64,424 16,800
Wharfedale R.D. 39,378 5,180

416,069 200,030 134 Total accommodation 210

Goole B. 1,267 19,670 Hook, Goole Goole Joint Hospital Board 26

Knottingley U. D. 2,835 8,993
Pontefract B. 4,865 21,160 Pontefract Pontefract Joint Hospital Board 36
Selby U.D. 3,848 10,100
Goole R.D. 36.776 8,621 Selby Selby Joint Isolation Hospital 21
Osgoldcross R.D. . 33,954 8,075 Committeef
Selby R.D. ... 32,909 5,705
116.454 82,324 82 Total accommodation 83

Castleford U.D. . 4,394 42,580 Rothwell ... Rothwell Urban District Council
Darton U.D. 4,725 35
13.290
Featherstone U.D. 4,424 13,830 Aketon, Feather- Normanton and District Joint
§Garforth U.D. 4,019 11,000 stone Isolation Hospital Committee^ 60
Horbury U.D. 1,280 7,679
Normanton U.D. . 3.066 19,248 Carr Gate, Stanley Wakefield Rural, Stanley and 26
Ossett B. ... 3,333 14,320 Morley Councils’ Joint
Roth well U.D. 10,698 24,350 Committee
Stanley U.D. 4,866 15,470 Horburv ... Horburv Urban District Council 16
Wakefield R.D. . 21,835 18,880
62,641 180,647 182 Total accommodation 137

Cudworth U.D. 1,746 8,502 East Brferley Hemsworth and Wombwell 77SS
Darfield U.D. 2,018 5,701 Common, Hems- Joint Hospital Committee
Dodworth U.D. 1,857 4,060 worth
Hems worth U.D. 4,163 12,780
Royston U.D. 1,423 7,764
§Wombwell U.D. 3,838 17,710
Hemsworth R.D. 29,019 48,380
44,064 104,897 106 Total accommodation 77

Batley B. ... 3,457 35,700 Brighouse Brighouse Corporation 34

(Except Soothill Upper)
Brighouse B. 7,873 30,120 Birstall, Batley ... Oakwell Joint Hospital Board 76
Elland U.D. 5,946 19,150
Mirfield U.D. 3,394 11,870 Mirfield . Liversedge and Mirfield Joint 23
Morley B. ... 9.493 39,210 Hospital Board
Queensbury and Shelf
U.D. 2,795 8,641 Morley . Morley Corporation 20
Spenborough U.D.
(Except the Townships Queensbury Queensbury and Shelf Urban 12
of Cleckheaton and District Council
Huns worth) 5,051 22,200
38,009 '166,891 168
1
* Now the Harrogate, Knaresborough and Wetherby Joint Hospital Board.
Total accommodation ... 165

** Now dissolved and ownership of hospital transferred to the Sedbergh R. D. C.

+ Now the Selby Joint Hospital Board,
t Now the Castleford and District Joint Hospital Board.
§ As at 1st April, 1939.
§§At this hospital extensions are in course of erection or approved which will increase the accommodation from 48 to 77 beds.
 Minimum
County Districts Approx. number of Existing Hospitals in Area.
Patient-bed
comprised in Hospital Acres. population beds for
Accommo¬
Area. 1937. patients
dation.
Situation. Authority controlling.
(1) (2) (3) (4)
Beds.
Hebden Royd U D. 7,084 10,500 Todmorden Fielden Joint Hospital 51
Ripponden U.D. ... 13,289 5,248 Committee
§Sowerby Bridge U.L). ... 5,763 19,550
Todmorden B. 12,789 21,410
^Todmorden (Hepton)
R.D. 21,758 4,370

60,683 61,078 60 Total accommodation 51

Colne Valley U. D. 16,054 23,040 Meltham ... Colne and Holme Joint Isolation 54
Holmfirth U.D. 17,648 18,950 Hospital Committee*
Kirkburton U.D. 13,847 17,250 Kirkburton Kirkburton Urban District 24
Meltham U.D. 5,906 5,080 Council
Saddleworth U. D'. 18,485 17,300

71,940 81,620 54 Total accommodation 78

Denby Dale U.D. 10,165 10,019 Grenoside ... Wortley Rural District Council 26
Penistone U.D. 5,593 5,733 Hoylandswaine, Penistone District Isolation 17
Stocksbridge U. D. 4,630 9,537 Penistone Hospital Committee**
Penistone R.D. 29,003 6,600
Wortley R.D. 48,698 30,300

98,089 62,189 42 Total accommodation 43

Adwick-le-Street U. D'. ... 3,605 19,330 Conisbrough Doncaster and Mexborough 85

Bentley-w-Arksey U. D. 4,956 17,550 Joint Hospital Board.
Conisbrough U.D. 1.593 17,190
Mexborough U. D. 1,452 18,550
Tickhill U.D. 5,580 2,306
Doncaster R.D. 75,656 48,980
Thorne R.D. 38,419 30,760

131,261 154,666 156 Total accommodation 85

Dearne U.D. 3,888 24,360 Rawmarsh Rawmarsh Isolation Hospital 281

§Hoyland Nether U.D. ... 2,001 14.670 Committee
Maltby U.D. 4,788 10,740 Aston, Rotherham South Rotherham and Kiveton 42
Rawmarsh U.D. ... 2,602 18,230 Rural District Park District Isolation
Swinton U.D. 1,718 11,250 Hospital Committee!
Wath-upon-Dearne U.D. 2,677 13,580 Wath-upon-Dearne Wath, Swinton and District 73
§Worsborough U.D. 3,420 13,160 Joint Hospital Board
Kiveton Park R. D. 20,070 16,290
§Rotherham R.D. 28,731 39,420

69,895 161,700 162 Total accommodation 143

Hospital Accommodation for Cases of Smallpox.

Minimum
County Districts Approx. number of Existing Hospitals in Area.
Patient-bed
comprised in Hospital Acres. population, beds for
Accommo¬
Area. 1937. patients.
dation.
Situation. Authority Controlling.
(1) (2) (3) (4)
Beds.

Barnoldswick U. D. 2,764 10,520 Heaton Royds, Keighley, Binglev and Shipley 16

Bingley U.D. . 11,418 21,810 Shipley Joint Hospital Board
Denholme U.D. ... 2,536 2,518
Earby U.D. 3,519 4,818 Morton Banks, Keighley, Binglev and Shipley 32
Keighley B. . 23,611 55,830 Keighley Joint Hospital Board
Shipley U.D. . 2,183 30,930
Silsden U.D. 7,101 4,981 Stanbury, Keighley Keighley, Binglev and Shipley 13
Skipton U.D. . 4,211 12,840 Joint Hospital Board
Bowland R.D. 83,327 5,026
Sedbergh R.D. 52,674 3,921 Skipton Skipton Urban District Council 11
Settle R.D. . 152,087 13.940
Skipton R.D. 146,071 22,650

Total Accommodation 72
491,502 189,784 24 V

* Now the Colne and Holme Joint Hospital Board.

** Now the Penistone Joint Hospital Board.
t At this hospital there is in addition a temporary wooden pavilion with accommodation for 22 beds, which was
originally erected for cases of smallpox.
J Now the South Rotherham and Kiveton Park Joint Hospital Board.
§ As at 1st April, 1939.
 Minimum
County Districts Approx. number of Existing Hospitals in Area.
Patient-bed
comprised in Hospital Acres. population, beds for Accommo¬
Area. 1937. patients. dation.
Situation Authority controlling.
(1) (2) (3) (4)
Beds.
Aireborough U. D. 6,856 23,000 Sherburn, near Pontefract and Tadcaster 38
Baildon U.D. 2,831 9,712 Tadcaster Smallpox Joint Hospital
Castleford U.D. . 4,394 42,580 Committee
Cudworth U.D. 1,746 8.502 Cardigan, near Wakefield and District 20
Darfield U.D. 2,018 5,701 Wakefield Smallpox Isolation Hospital
Darton U.D. 4,725 13,290 Committee
Dodworth U.D. 1,857 4,060 Glasshoughton, Normanton and District Joint 26
Featherstone U. D 4,424 13,830 Castleford Isolation Hospital Committee*
gGarforth U.D. ... 4,019 11,000 Killinghall, Harrogate, Knaresborough and 10
Goole B. ... 1,267 19,670 Harrogate Wetherby Joint Isolation
Harrogate B. 8,320 43,930 Hospital Committee**
Hemsworth U.D. 4,163 12,780 Ripon Ripon and Pateley Bridge, and 6
Horbury U.D. 1,280 7,679 Wath Rural District Councils’
Horsforth U.D. 2,706 12.080 Joint Isolation Hospital
Ilkley U.D. 8,610 15,840 Committee
Knaresborough U. D' 2,495 7,320 Guiseley Wharfedale Union Joint 6
Knottinglev U. D. 2,835 8,993 Isolation Hospital Committee
Normanton U.D. ... 3,066 19,248 Hessav, near York Nidderdale Rural District 4
Ossett B. ... 3,333 14,320 Council
Otley U.D. 2,934 11,095 Gcole Goole Corporation 14
Pontefract B. 4,865 21,160 Ossett Ossett Corporation 12
Pudsey B. ... 5,323 27.350
Ripon Citv 1,812 8,542
Rothwell U.D. 10.698 24,350
Royston U.D. 1,423 7,764
Selby U.D. 3,848 10,100
Stanley U.D. 4,866 15,470
gWombwell U.D. 3,838 17.710
Goole R.D. 36,776 8.621
Hemsworth R.D. ... 29.019 48.380
Nidderdale R.D. ... 75,008 11,401
Osgoldcross R.D. 33,954 8.075
Ripon and Patelev Bridge 124,861 11,080
R.D.
Selbv Rural District 32,909 5,705
§Tadcaster R.D. ... 75,834 24,050
Wakefield R.D. 21,835 18,880
Wetherby R.D. 64.424 16,800
Wharfedale R.D. 39,378 5,180
644,550 595,248 74 Total Accommodation 136

Batley B. 3.457 35,700 Elland Elland and District Joint 16

(Except Soothill Upper) Hospital Board
Brighouse B. 7,873 30,120 Birstall, Batley ... Oakwell Joint Hospital Board 20
Colne Valley U. D. 16,054 23,040 Morlev Morley Corporation 30
Elland U.D. 5,946 19.150 Meltham Colne and Holme Joint 6
Hebden Koyd U. D. 7,084 10,500 Isolation Hospital Committee!
Holmfirth U.D. 17,648 18,950 Mirfield Liversedge and Mirfield Joint 18
Ivirkburton U. D. 13,847 17,250 Hospital Board
Meltham U.D. 5.906 5.080 Kirkburton Kirkburton Urban District 6
Mirfield U.D. 3,394 11,870 Council
Morley B. 9.493 39.210 Saddleworth Saddleworth Urban District 6
Oueensburv and Shelf 2,795 8,641 Council
U.D. Sourhall, Sourhall Joint Hospital 24
Ripponden U.D. ... 13,289 5,248 Todmorden Committee
Saddleworth U.D. 18.485 17,300
gSowerby Bridge U.D. ... 5.763 19,550
Spenborough U.D. 8.251 36,440
Todmorden B. 12,789 21,410
gTodmorden (Hepton) 21,758 4,370
R.D.
173,832 323,829 42 Total Accommodation 126

Denby Dale U.D. 10,165 10,019 Grenoside ... Wortley Rural District Council 11
Penistone U.D. 5,593 5,7.33 Stocksbridge Stocksbridge Urban District 11
Stocksbridge U.D. 4.630 9.5.37 Council
Penistone R.D. 29,003 6,600 Penistone ... Penistone District Isolation 6
Wortley R.D. 48,698 30,300 Hospital Committee}
98,089 62.189 8 Total Accommodation 28

Adwick-le-Street U.D. ... 3,605 19,3.30 Conisbrough Doncaster and Mexborough

Bentley-with-Arksey 4,956 17,550 Joint Hospital Board 28
U.D.
Conisbrough U.D. 1,593 17,190
Mexborough U.D. 1.452 18.550
Tickhill U.D. 5,580 2,306
Doncaster R.D. ... 75,656 48,980
Thorne R.D. . 38,419 30,760

131,261 154,666 20 Total accommodation 28

Dearne U.D. . 3,888 24.360 Brampton, South Rotherham and Kiveton 12

gHoyland Nether U.D. ... 2,001 14,670 Rotherham Park District Isolation
Maltby U.D. 4,788 10,740 Rural District Hospital Committee||
Rawmarsh U.D. ... 2,602 18,230 Rawmarsh Rawmarsh Isolation Hospital 26
Swinton U.D. 1.718 11,250 Committee
Wath-upon-Dearne U.D. 2,677 13,580 Hoober, Wath, Swinton and District 20
gWorsborough U.D. 3.420 13.160 Rotherham Joint Isolation Hospital
Kiveton Park R.D. 20,070 16,290 Rural District Board
gRotherham R.D. 28,731 39,420
69 895 161,700 20 Total Accommodation 60

* Now the Castleford and District Joint Hospital Board.

**Now the Harrogate, Knaresborough and Wetherby Joint Hospital Board.
1 Now' the Colne and Holme Joint Hospital Board,
t Now the Penistone Joint Hospital Board.
§ As at 1st April, 1939.
|| Now the South Rotherham and Kiveton Park Joint Hospital Board.
 Treatment of Venereal Diseases.
Table XXI.
List of the Venereal Diseases Treatment Centres with the days and hours of attendance: —

Days and Hours of Attendance.

Address of Centre.
Men. Women and Children.

Barnsley Clinic, Queen's Road Monday, 8 to 10 p.m. Thursday, 3 to 6 p.m.

Thursday, 6-30 to 9-30 p.m.
Bradford St. Luke’s Hospital Monday and Saturday, 9-30 a.m. Monday, 5 to 7 p.m.
Tuesday, 6 p.m. Friday, 10-0 a.m.

Burnley Victoria Hospital
Dewsbury and District Infirmary
Doncaster Royal Infirmary
Goole, Bartholomew Hospital
Royal Halifax Infirmary
Harrogate and District General
Hospital.
Huddersfield Municipal V.D.
Treatment Centre, York Place, Tuesday, 6 to 8-30 p.m.
New North Road
Keighley Victoria Hospital
General Infirmary at Leeds
Oldham Royal Infirmary
Rotherham T.B. Dispensary, 12
Frederick Street
Monday, 10 to 11 a.m. and 5-30 to
6-30 p.m.
Thursday, 5-30 to 6-30 p.m.
Monday, 3 to 6 p.m.
Thursday, 7 to 9 p.m.
Tuesday, 4 to 6 p.m.
Friday, 9 to 11 a.m. and 4 to 6 p.m.
Friday, 8-0 p.m.
Thursday, 6 to 8 p.m.
Tuesday, 5-30 to 7 p.m.
Monday, 6 to 8-30 p.m.
Thursday, 6 to 8-30 p.m.
Friday, 6 to 8-30 p.m.
Wednesday, 10 a.m. to 12 noon.
Thursday, 6 to 8 p.m.
Monday to Friday inclusive, 10 a.m.
to 12 noon and 2 to 7 p.m.
Saturday, 10 a.m. to 12 noon.
Tuesday, 7-30 p.m.
Wednesday, 7-30 p.m.
Tuesday, 11-30 a.m. to 12-30 p.m. and
6
to 8 p.m.
Wednesday, 6 to 8 p.m.
Friday, 11 a.m. to 12 noon.
5-30 to 6-30 p.m.
Monday, 3 to 5 p.m.
Thursday, 7 to 9 p.m.
Monday, 4 to 6 p.m.
Friday, 2 to 4 p.m.
Friday, 6-0 p.m.
Tuesday, 3-30 to 4-30 p.m. and
6 to 8 p.m.
Thursday, 5-30 to 7 p.m.
Monday, 6 to 8-30 p.m.
Tuesday, 6 to 8-30 p.m.
Thursday, 6 to 8-30 p.m.
Friday, 6 to 8-30 p.m.
Wednesday, 10 a.m. to 12 noon.
Tuesday, 6 to 8 p.m.
Monday, 1-30 to 3 p.m.
Thursday, 5-30 to 7 p.m.
Monday, 7-30 p.m.
Tuesday and Thursday, 2 to 4-30 p.m.
Friday 11-30 a.m. to 12-30 p.m., and
6 to 8 p.m.

Sheffield Jessop Hospital for Women Tuesday, 5 to 7-30 p.m.

Sheffield Royal Hospital
Sheffield Royal Infirmary
Wakefield Clayton Hospital
York County Hospital
Thursday, 7 to 9 p.m.
Saturday, 12-30 to 2-30 p.m.
Tuesday, 7 to 9 p.m.
Friday, 7 to 9 p.m.
Tuesday, 2 to 4 p.m.
Thursday, 2 to 4 p.m.
Wednesday, 6 to 8 p.m.
Friday, 5-30 to 7-30 p.m.
Wednesday, 6 to 8 p.m.
Friday, 10 a.m. to 12 noon.
Monday, 3 to 4 p.m.
Thursday, 6 to 7 p.m.
Friday, 7-30 to 8-30 p.m.
Thursday, 5 to 7-30 p.m.
Saturday, 11 a.m. to 1-30 p.m.
Thursday, 10 a.m. to 1 p.m.
Tuesday, 2 to 4 p.m.
Thursday, 2 to 4 p.m.
Monday, 4 to 6 p.m.
Friday, 3 to 5 p.m.
Wednesday, 3 to 4 p.m.
P'riday, 7 to 7-30 p.m.

Table showing the Venereal Diseases Treatment Centres and number of attendances, etc., during
1938, of West Riding Patients:—
Table XXII.
--
No. of new patients No. of No. of
In-patient Out-patient
Centre Soft Non- days attendances
Syphilis Chancre Gonorrhoea Venereal

Barnsley Clinic, Queen’s Road 19 55 34 — 7,676

Bradford St. Luke’s Hospital 32 — 45 36 201 3.124
Burnley Victoria Hospital 2 — 3 — 112
Dewsbury Infirmary 16 — 34 35 45 3,792
Doncaster Royal Infirmary 47 — 120 30 25G 12,616
Goole, Bartholomew Hospital 7 — 14 10 — 531
Halifax Royal Infirmary 30 — 35 24 229 2,912
Huddersfield V.D. Centre 18 -- 48 48 82 4,859
Keighley Victoria Hospital 15 2 37 — 3,686
Leeds General Infirmary 91 — 152 136 4 12,288
Oldham Royal Infirmary 4 — 5 — — 228
Rotherham T.B. Dispensary,
12, Frederick Street ... 18 _ 40 45 — 3,399
Sheffield Jessop Hospital 2 — 10 17 296 880
Sheffield Royal Hospital 6 — 13 6 36 242
Sheffield Royal Infirmary 8 — 8 7 63 1,097
Wakefield Clayton Hospital 29 24 32 5 8,983
York County Hospital ... 2 8 10 14 611

346 2 650 501 1,231 67,036

 37

Table XXIII.

Table giving an analysis ol the combined returns of treatment centres for the year 1938,
compared with previous years :—
No. of
Out-patient
Year. New Patients. In-patient
attendances.
days.

1933 1,484 3,644 57,868

1934 1,674 1,539 62,231
1935 1,555 1,079 61,646
1936 1,722 1,054 62,204
1937 1,659 1,002 67,089
1938 1,499 1,231 67,036

The returns for the year 1938 for the various treatment centres show that 160 fewer new
patients residing in the Administrative County attended the various clinics serving the area. This
reduction is almost entirely in the numbers of new cases of syphilis and non-venereal conditions,
since the number of new cases of gonorrhoea is onlv 16 less than in 1937.

It is gratifying to note that
suffering from complaints other
have attended treatment centres
disease, but who, after prolonged
not to be infected.
33 per cent, of the total number of new cases were found to be
than venereal disease. These cases are made up of persons who
for examination on their suspicion of having contracted venereal
clinical, bacteriological and serological examination were found

1 he ratio of total attendances to total new cases continues to grow and is now 45 to 1 compared
with 39 to 1 in 1933. It is of interest to record that although there has been a 10 per cent, reduction
in the total number of new cases Compared with 1937, there has been a reduction of less than 1 per
cent, in the number of out-patient attendances. This suggests that infected patients are attending
more regularly for examination and treatment and that there are fewer defaulters.

I he New Venereal Diseases Clinic at the Harrogate and District General Hospital has been
completed and was opened for the treatment of patients on the 1st October, 1938. The building
is well equipped for its purpose and should prove of great value in bringing infected persons in
the district under treatment.

The number of patients receiving treatment in the Hope Hospital was 17, the total number
of in-patient days being 1,327, and the number ol doses of arsenobenzene compounds given in
treatment was 30.

Genera] practitioners who are approved in accordance with the requirements of the Ministry
of Health to receive arsenobenzene compounds now number 101, an increase of 8 from the previous
year.

1 he usual programme consisting of a month's intensive campaign divided into two weeks in
the spring and two weeks in the autumn was again a complete success, and the lecturer from the
British Social Hygiene Council was received with great appreciation. The itinerary in the spring
comprised visits to Oxenhope, Haworth, Oakworth, Steeton, Keighley, Sutton-in-Craven, Cowling,
Denholme, Bingley and Morton. In the autumn visits were paid to Moorends, Thorne, Dunscroft,
Stainforth, Rawcliffe, Goole, Selby, Swinefleet, Cawood and Snaith, and 6,750 was the estimated
total of attendances.

Public Health Legislation, etc., during 1938.

I.—ORDERS, CIRCULARS AND MEMORANDA ISSUED BY THE MINISTRY OF

HEALTH, AND OTHER GOVERNMENT PUBLICATIONS.

General.
Cmd. 5628. Local Government and Public Health Consolidation Committee, 3rd Interim
Report, December, 1937.
Cmd. 5629. Local Government and Public Health Consolidation Committee. Draft
of a Food and Drugs Bill, prepared by the Committee.
Cmd. 5664. Report on a Public Inquiry into an Outbreak of Typhoid Fever at Croydon
in October and November, 1937.
The Milk Marketing Scheme, 1933, as amended to 3rd August, 1937.
Ministry of Agriculture and Fisheries.
Bulletin No. 52. Modern Milk Production, 2nd Edition, November, 1937. Ministry of
Agriculture and Fisheries.
Milk. Arrangements for Increasing the Demand for Milk within the Area
of the Milk Marketing Board by Publicity and Propaganda. 4th Scheme.
6th December, 1937. Ministry of Agriculture and Fisheries.
Cmd. 5772. Milk Acts, 1934 to 1937. Certain provisions of the Acts showing amendments
proposed to be made by the Milk (Extension and Amendment) Bill.
Order No. 217. Milk and Dairies Amendment Order. 15th March, 1938.
Order No. 218. Milk (Special Designations) Amendment Order. 15th March, 1938.
 38

Circular No. 1685. Agriculture Act, 1937. Part IV. Milk and Dairies Acts and Orders;
Tuberculosis Order, 1938. 22nd March, 1938.
Memo. No. 197. Sale of Milk under Special Designations. Addendum. The Milk (Special
Designations) Order, 1938, and Part IV of the Agriculture Act, 1937.
Milk and Dairies Acts and Orders: Short Guide to the Powers and Duties
of Local Authorities. Ministry of Agriculture and Fisheries.
Leaflet No. 167. Hand and Machine Milking. Revised April, 1938. Ministry of Agriculture
and Fisheries.
Report. Hospitals and other Public Buildings, Final Report of the Departmental
Committee on the cost of. February 2nd, 1938.
Circular No. 1702. On the Departmental Committee’s Final Report on the cost of Hospitals.
May 18th, 1938.
Report. Children with Defective Hearing. Report of Committee of Inquiry into
Problems relating to. Board of Education.
Report. Central Advisory Water Committee. First report on the Underground Water
Planning of Water Resources and Supplies. 28th March, 1938.
Circular No. 1681. The Blind Persons Bill, and Blindness due to Cataract. 14th March, 1938.
Memo. D.D.101. Dangerous Drugs Acts, 1920 to 1932. Duties of Doctors and Dentists.
4th Edition. May, 1938. Home Office.
Order No. 569. Registration of Births, Stillbirths and Deaths Regulations. 2nd June, 1938.
Order No. 775. National Health Insurance (Dental Benefit) Amendment Regulations, 27th
July, 1938.
Circular No. 1732'. Air Raid Precautions. Provision of Hospital Accommodation. 12th August,
1938.
Memo. 215/Med. Smallpox, Memorandum on. September, 1938.
Circular No. 1755. Food and Drugs Act, 1938. 5th December, 1938.

Housing.

House Production, Slum Clearance, etc. England and Wales. Position at

30th September, 1937.
Memo. 212. On the Housing (Financial Provisions) Act, 1938.
Housing (Financial Provisions) Act, 1938. Rural Housing Manual.
Circular Nos. 1696 On the Housing (Financial Provisions) Act, 1938. 23rd April, 1938.
and 1697.
Circular No. 1716. Housing (Rural Workers) Amendment Act, 1938. 1st July, 1938.
Order No. 216. The Housing Act, 1936 (Operation of Overcrowding Provisions) Order. 16th
March, 1938.
Report. Central Housing Advisory Committee. Report of the House Management
and Housing Associations Sub-Committee on the Management of Muni¬
cipal Housing Estates. 6th April, 1938.
Circular No. 1740. On the report on the Management of Municipal Housing Estates. 31st
October, 1938.

Maternity and Child Welfare.

Order No. 32. Public Health (Nursing Homes Registration Form) Regulations. 21st
January, 1938.
Circular No. 1674. Registration of Nursing Homes. 4th February, 1938.
Order No. 147. The Midwives (Certifying Hospitals and Institutions) Order. 25th February,
1938.
Circular No. 1678. The Midwives Act, 1936. 9th March, 1938.
Circular No. 1693. Midwifery Training. 12th April, 1938.
Circular No. 1694. Health Visitors Training. 12th April, 1938.
Memo. 211. Conditions upon which grants will be made by the Minister of Health in aid
of Midwifery Training. April, 1938.
Circular No. 1705. Maternal Mortality. Medical Practitioners called in by Midwives. 14th June,
1938.
Order No. 689. The Midwives (Certifying- Hospitals and Institutions) Order (No. 2). 20th
July, 1938.
Circular No. 1714. Midwives Act, 1936. 29th July, 1938.

Pharmacy and Poisons.

Order No. 1547. The Poisons List (Amendment) Order, dated 15th December, 1938.
Order No. 1548. The Poisons (Amendment) Rules, dated 15th December, 1938.

II— ACTS OF PARLIAMENT.

Blind Persons Act, 1938.
Population (Statistics) Act, 1938.
Housing (Financial Provisions) Act, 1938.
Housing (Rural Workers) Amendment Act, 1938.
Children and Young Persons Act, 1938.
Mental Deficiency Act, 1938.
Food and Drugs Act, 1938.
Milk (Extension and Amendment) Act, 1938.
Young Persons (Employment) Act, 1938.
 39

HOUSING AND GENERAL SANITARY MATTERS.

A. BROOK, Chief County Sanitary Inspector.

Housing.
Provision of New Houses.
The table below sets out the numbers of new houses provided in the area of the Adminis
trative County during 1938.
1 louses Provided by : —
Local Private
Totals.
Authorities. linterprise.*
In Municipal Boroughs 1,024 1,634 2,658
In Urban Districts . 3,541 2,667 6,208
In Rural Districts . 1,001 2,146 3,147

5,566 6,447 12,013

* Numbers relate to houses completed during the year ended September 30th, 1938, and exclude those with a rateable
value exceeding £78.

Houses Erected during the Years 1932—1937 inclusive.

1932 1933 1934 1935 1936 1937

6,265 7,065 9,207 10,499 10,238 10,249

During 1938 there was a decided increase in the number of new houses provided, amounting
to 1,684 over the average for the three preceding years. Private enterprise still continues to
be responsible for the greater portion of the new houses constructed, though not to the same
degree as during 1937.

As pointed out in the report for 1937, when considering the above figures, it must not be
assumed that during the year the total houses in the West Riding Administrative Area has been
increased by 12,013. This is bv no means the case, as many of the houses built by local authorities
were to provide accommodation for persons displaced from houses demolished under slum clearance
schemes, etc. In 1936, 2,100 houses, in 1937, 3,391 houses, and in 1938, 2,968 houses were
approved for the purpose of re-housing displaced persons, by the Minister of Health.

In connection with the number of houses provided by Local Authorities which is included in
the above figures, there is no information in the possession of this Department as to the number
of each type of house (i.escullery, parlour, and whether two, three or four bedrooms, houses for
aged persons, etc.).

A demand still appears to exist for houses, chiefly of the smaller type, capable of being let at a
low rental.
In regard to the progress made in the abatement of overcrowding, it is almost impossible to
give any trustworthy opinion; overcrowding still persists in parts of the Riding, but whether to
the same extent or not, is most difficult to say. Despite the above observations it must not be taken
that nothing is being done in this connection—that is far from the truth, as will be seen from the
figures contained in Table XXV, under “Overcrowding.”

Slum Clearance.
Housing Act, 1936.

Action during the Year 1938.

Table XXIV.

1
Action taken. Municipal i Urban Rural Total
Boroughs Districts Districts 1

Clearance Orders submitted.

No. of Orders 98 136 31 265

No. of houses to be demolished ... 937 860 107 1,904

No.-of persons to be displaced from above

houses 2,792 2,808 . 349 5,949

■[Clearance Orders confirmed.

No. of Orders ... ... ... ... ... 70 156 30 256

No. of houses to be demolished ... ... ... 904 1,027 105 2,036

No. of persons to be displaced from above

houses ... ... 2,691 3,307 315 6,313

No. of Clearance Orders where confirmation

was entirely refused. _ .

^Houses approved for re-housing persons dis-

placed 772 1,810 386 2,968

+ Includes Orders submitted in 1937, but not confirmed until 1938.

* Includes houses for re-housing persons displaced as result of demolition under Section 11. Separate figures of houses
approved to re-house persons displaced as a result of demolition in clearance areas are not available.
 40

Table XXV.

Housing Statistics.

Summary of housing work, showing action taken bv Local Authorities in the Administrative
County during 1938.

1.—Inspection of dwelling-houses during the year. Urban Rural Totals

District* Districts
(1) (a) Total number of dwelling houses inspected for housing defects
(under Public Health or Housing Acts) ... 20,385 5,617 26,002
(b) Number of inspections made for the purpose ... 48,433 11,589 60,022
(2) (a) Number of dwelling-houses (included under sub-head (1) above),
which were inspected and recorded under the Housing Consolidated
Regulations 7,758 2,297 10,055
(b) Number of inspections made for the purpose ... 16,969 5,313 22,282
(3) Number of dwelling-houses needing further action 11,679 2,576 14,255
(a) Number considered to be in a state so dangerous or injurious to
health as to be unfit for human habitation ... 3,186 978 4,164
(b) Number (excluding those in sub-head (3) (a) above) found not to be
in all respects reasonably fit for human habitation ... 8,493 1,598 10,091

Note:—Totals of (<?)•—(a) and (b) should equal the figure given

for (3).

2.—Remedy of defects during the year without service of

FORMAL NOTICES.

No. of defective dwelling-houses rendered fit in consequence of informal

action by the Local Authorities or their Officers ... ... . 8,698 1,222 9,920

3.—Action under Statutory Powers during the year.

A. Proceedings under Sections 9, 10 and 16, Housing Act, 1936.

(1) No. of dwelling-houses in respect of which notices were served
requiring repairs . . 787 550 1,337
(2) No. of dwelling-houses which were rendered fit after service of
formal notices . ... . ... . 553 442 995
(a) By owners ... . . 540 442 982
(6) By Local Authority in default of owners. 13 — 13
B Proceedings under Public Health Acts:—
(1) No. of dwelling-houses in respect of which notices were served
requiring defects to be remedied. 1,925 409 2,334
(2) No. of dwelling-houses in which defects were remedied after service
of formal notices ... . ... ... . 1,488 372 1,860
(a) By owners ... . . 1,440 366 1,806
(6) By Local Authority in default of owners. 48 o 54
C. Proceedings under Sections 11 and 13 of the Housing Act, 1936:—
(1) No. of representations, etc., made in respect of dwelling-houses unfit
for habitation . . . 1,440 522 1,962
(2) No. of dwelling-houses in respect of which Demolition Orders were
made . ... . . 870 177 1,047
(3) No. of dwelling-houses demolished in pursuance of Demolition Orders 834 317 1,151
D. Proceedings under Section 12 of the Housing Act, 1936 :—
(1) Number of separate tenements or underground rooms in respect of
which Closing Orders were made. 127 133
(2) Number of separate tenements or underground rooms, the Closing
Orders in respect of which were determined, the tenement or room
having been rendered fit. 12 6 18

4.—Housing Act, 1936—Part IV—Overcrowding.

(a) (1) Number of dwellings overcrowded at the end of the year ... 3,780 902 4,682
(2) Number of families dwelling therein 3,872 960 4,832
(3) Number of persons dwelling therein ... ... ... . 23,386 5,819 29,205
(b) Number of new cases of overcrowding reported during the year 393 112 505
(c) (1) Number of cases of overcrowding relieved during the year 1,811 729 2,540
(2) Number of persons concerned in such cases ... . 11,572 5,215 16,787

Totals 180,492 48,542 229,034

NOTE:—The above statement is compiled from Returns furnished by the Medical Officers of
Health of the Sanitary Authorities throughout the Administrative County.

Work of the County Inspectorial Staff.

This included: —
Clearance Areas.

(1) Inspections made and evidence given at Ministry of Health inquiries at: —
Holmfirth U.D.
Meltham U.D.
Oueensbury and Shelf U.D.

(2) Attendance at Ministry of Health inquiries at: —

Municipal Boroughs:—Batley, Brighouse, Goole (2), Keighley, Morley, Ossctt, Pudscy,

Ripon, Todmorden.

Urban Districts:—Aireborough, Colne Valley, Darton (2), Dearne, Denby Dale, Hebden
Royd, Knottinglcv, Rothwell, Saddle worth (4), Stocksbridge (2).

Rural Districts:—Doncaster, Hemsworth, Nidderdale, Pcnistone (2), Tadcaster.

 41

Housing Surveys were made as follows: —

Penistone U.D., Queensbury and Shelf U.D., Todmorden R.D. (Heptonstall).

A re-survey to ascertain progress was als< made in Todmorden R.D. (Heptonstall).

Other visits or inspections in regard to housing conditions were made in the following
districts: —
Urban Districts. Rural Districts.
Aireborough. Doncaster.
Dodworth. Goole.
Hebden Royd. Hemsworth.
Hoyland Nether. Nidderdale.
Rawmarsh. Tadcaster.
Swinton. Wetherby.
Wortley.
Housing (Rural Workers) Acts 1926 and 193
Housing (Rural Workers) Amendment Act, IS

From the commencement of the operation of the above-mentioned Acts up to December 31st,
1938, 145 applications have been received.

In 90 cases, covering 216 houses, the applications received favourable consideration, and at
the end of the year 158 houses had been reconditioned at a cost to the County Council of
£14,441 3s. 6d. Of this amount half is repayable to the County Council as loan charges under
the provisions of the Acts. In the case of the other houses the works of re-conditioning are in
hand.
Thirty-nine applications, affecting 114 houses have been refused, and 16 applications concerning
35 houses were withdrawn.

Periodical inspections of the reconstructed dwellings are undertaken by the County Sanitary
Inspectors to ascertain that the conditions under which the grants were made are being observed.

Smoke Abatement.
During the year the County Staff made a total of 214 observations, each of 30 minutes duration
in 13 urban and 3 rural districts. Particulars of these observations are set out in the tabular
statement which follows. In 28 of the 214 observations, excessive emission of black smoke
occurred, varying from a maximum of 23'5 minutes down to 3’5 minutes, the average over the
whole of the 28 being 8'77 minutes. In 37 other observations, emissions of black smoke of 3
minutes or under occurred and in the remaining 149, the emission of black smoke was absent
entirely. The average duration of black smoke per 30 minutes observation for the total obser¬
vations (214) was T418 minutes. The figures although an improvement on those for 1937 can be
regarded with but little satisfaction.

On the whole, in spite of what has been, and is being done bv various organisations, such
as the National Smoke Abatement Society, and in the face of statements by members of the
medical profession, of which the following is an example:—“There is no doubt whatsoever in the
“minds of those competent to judge, that the unclean atmosphere of this country is one of the most
“serious factors adversely affecting the health of the community.’’ The general public has not
vet been made “smoke conscious’’ and until this is so, the rate of progress will continue to be slow.

As regards the emission of smoke from domestic fires, with the existing generation of house¬
holders, little hope of any great change in their outlook appears to exist. The majority are firmly
wredded to the open coal fire, and it is believed that in this connection better results would accrue
from anti-smoke crusades conducted among the younger generation. It is also suggested that it
would be a step in the right direction if it could be arranged for simple talks on the evils resulting
from the pollution of the atmosphere by smoke, to be given occasionally in schools.

Smoke Observations taken by the County Inspectors during the year 1938.

Table XXVI.

No. of Observations showing an excessive emission Number of observations Average

observations of Black Smoke. showing : Amount
Sanitary District. taken in Black Smoke No of Black
each Number. Maximum Minimum Average. of 3 minutes Black Smoke per
District. Emission. Emission. or under. Smoke. observation.
Minutes. Minutes. Minutes. Minutes.
URBAN.
Castleford ... ... 30 2 15.5 5.0 10.3 9 26 0.8
Colne Valley ... 16 2 10.0 6.0 8.0 2 12 1 1
Darton ... 9 — — — — 1 8 0 2
Featherstone ... 2 _ _ — — __ 2 o 0
Holmfirth ... 18 —- — — — 2 16 0.2
Honley • •• 9 — — — — 1 8 0.2
Mirfield ... 16 — — — — 6 10 0 5
Morley M.B. ... 19 2 5.5 5.0 5.3 3 14 0.9
Pontefract M.B. ... 16 — — — — 2 14 0.3
Saddleworth . •• 3 — — — — 3 . 1 0
Selby ... 5 — — — — 2 3 0.5
Swinton ... 9 i 5.5 5.5 5.5 i 7 0.7
Wombwell ... ... 8 2 10.5 4.0 7.3 i 5 1.9

RURAL.
Doncaster ... ,, , ... 23 7 23.5 3.5 12.0 2 14 3.8
Thorne . * ... 1 — — — — i _ 2.0
Wakefield ... * * ... 30 12 15.0 4.0 7.9 8 10 3.8

214 28 — — 8.8 37 149 1.4

 Drainage, Sewerage and Sewage Disposal.
The above matters are continually receiving attention by the various local authorities in the
Riding. In some of the rural areas the provision of piped water supplies, with the consequent in¬
crease in the flow of sewage brings about, as a natural result, the introduction of sewerage systems
and sewage disposal works, where such did not exist, and following on the increase in the number
of houses fitted with baths and the continued growth of the water carriage system, enlargement of
or reconditioning of existing sewage disposal works is necessitated in other areas. As a conse¬
quence of building developments, extensions of sewers are also brought about in various areas,
and speaking generally, it may be stated that improvements are steadily being effected throughout
the County Area.

The contributions which the County Council agrees to pay towards the cost of sewerage and
sewage disposal works in certain cases have also encouraged improvement in regard to these matters,
as will be seen from a reference to the tabular statement following, which sets out the schemes in
regard to which, up to the end of the year 1938, the County Council has agreed to contribute
towards the cost.

Table XXVII.

Sewerage and Sewage Disposal.

Name of Authority to whom Townships or Districts for which Estimated cost Amount of grant
grant was made. works are to be carried out. of works. made by
County Council.
£
Rowland Rural Orindleton ... . 5,950 £37 annually for

CO
o
years.

<r
o
Doncaster Rural ... Braithwell 2,825 do.

Do. Norton 13,000 £127 10s. do.

Nidderdale Rural ... Upper and Nether f’oppleton ... 14,708 £192 do.

Do. Little Ouseburn ... 700 £7 10s. do.

Osgoldcross Rural Brotherton 11,890 £209 10s. do.

Rotherham Rural ... Aston-cum-Aughton and Ulley 5,970 £105 do.

Skipton Rural Linton 2,500 £9 do.

Do. Bradleys Both 4,250 £80 do.

Tadcaster Rural Sherburn-in-Elntet 0,275 £183 do.

Do. Appleton Roebuck ... - 2,700 £74 do.

Do. Askham Bryan ... 4,250 £34 do.

Wharfedale Rural ... Askwith 3,330 £41 do.

Joint Water and Sewage Scheme.

Nidderdale Rural ... Ferrensby 3,303 £72 do.

Attendances at Local Inquiries held by the Ministry of Health into application for sanction to
borrow money for schemes of sewerage and/or sewage disposal were as under: —

Nidderdale R.D. (Little Ouseburn). Tadcaster R.D. (Swillington).

Ripon and Pateley Bridge (Bewerley Thorne R.D. (Thorne),
and High and Low Bishopside).

Investigation or inquiry was made by the Department in regard to drainage, sewerage or

sewage disposal in the following districts: —
Urban.
Holmfirth, Horsforth, Ilkley, Knaresborough, Ripon City, Saddleworth.
Rural.
Doncaster (Sprotborough), Hemsworth (Walden Stubbs), Nidderdale (Knaresborough
Outer and Little Ouseburn), Osgoldcross (Brotherton), Ripon and Pateley Bridge (Clint),
Rotherham (Aughton and Ulley), Tadcaster (Barwick-in-Elmet), Wharfe'dale (Askwith).

Water Supplies.
The question of water supply still continues to exercise the minds of many local authorities.
With the increased numbers of houses provided with baths and water closets greater and greater
demands for water have to be faced, while in the areas where piped supplies are not available
the provision of such supplies is constantly in the minds of local authorities and their officers. In
respect of these areas where public water supplies are not yet available, having in view the likeli¬
hood of many of these localities being used for the purpose of accommodating evacuees in time of
war, it appears that a resuscitation of the scheme of grants from the Government in aid of the cost
of providing water supply would serve a very useful purpose. Otherwise it is very problematical
if the existing supplies in some of the areas dependent on spring and well supplies, with their
liability of failure in dry periods, would meet the increasing demand which would arise if ever the
evacuation schemes come into operation.
 The tabular statement which follows is self-explanatory.

XXVIII.
Table

RURAL WATER SUPPLIES ACT, 1934.

LOCAL GOVERNMENT ACT, 1929—SECTION 57.
PUBLIC HEALTH ACT, 1936—SECTION 307.
Schedule of Grants in Aid of Schemes for the Provision of Water Supplies
TO END OF 1938.

Amount of
Estimated
Name of Authority to whom Townships or Districts grant made by
cost of
grant is made to be supplied County
works
Council
£ £
Bowland Rural Gisburn Forest 450 75
Do . Rimington 1,200 150
Do. . Newton-in-Bowland 1,250 100
Goole Rural . Adlingfleet and Fockerby 1,602 250
Hemsworth Rural Wintersett 1,050 400
Do. . Skelbrooke 1,850 450
Do. . Walden Stubbs 925 son By annual
payments

Do. . Ackworth 24,187 5,000

Kirk Smeaton
Little Smeaton
North Elmsall
Thorpe Audlin and Upton
Kiveton Park Rural . Anston 6,000
25,157
Dinnington
Firbeck
Gildingwells
Harthill-with-Woodall
Letwell
St. John’s-with-Throapham
Thorpe Salvin
Todwick
Wales
Woodsetts
Nidderdale Rural. Roecliffe 1,088 75
Do. . Whixley, Cattail, Hunsingore, Great
Ribston-w-Walshford, Kirk
Hammerton and Nun Monkton 14,700 835
Do. . Ferrensby
Joint Water S ewage Scheme*
Osgoldcross Rural . Whitley
2,205
Do. ... . Womersley
2,117 250
Do. ... ...
. Burton Salmon, Hillam and
5,000 125
Monk Fryston
Do. . Cridling Stubbs
1,657 150
Penistone Rural . Greenmoor, Hunshelf 1,536 275
Do. . .
Sim Hill and Eastfield, Thurgoland 735 125
Rotherham Rural ... Aston, LUley and Thurcroft 2,547 600
Do. . Aston
317 75
Do. . Thurcroft
208 25
Do. .
Thrybergh and Hooton Roberts 1,565 325
Do. ...
. Wickersley
179 25
Do. . Whiston
453 100
Selby Rural ... . Newland 2,514 625
Do. . Long Drax 1,360 400
Skipton Rural . Hartlington 1,500 200
Tadcaster Rural. Grimston 6,376 1.000
Kirkby-cum-Milford
Ryther-cum-Ossendyke
Stutton-cum-Hazel wood
Towton
Ulleskelf
Do Appleton Roebuck, Colton anti 7,850 TOO annually for
Bolton Percy 30 years
Wetherby Rural . Wike
1,550 450
Do. . Kearby-with-Netherby 3,280 225
Do. . Angram
12,213 400
Bickerton
Bilton
Cowthorpe
Hutton Wandesley
Long Marston
Tockwith
Wharfedale Rural . Askwith
* See fable XXV11 on page 42. 1,400 250
 During the year Local Inquiries held by the Ministry of Health into applications for sanction
for loans in connection with works of water supply, were attended at:'—

Urban Districts. Rural Districts.

Maltby. Doncaster.
Penistone.

Investigations into questions regarding water supplies were carried out by officers of the
Department in 13 urban and 11 rural areas during the year.

Survey of Water Supplies.

The survey of water supplies begun in the latter part of 1937, was continued during the year.
As previously stated, the survey is designed to obtain information on the following points: —

Distribution of population, source of water supply, treatment (if any), storage, distribution,
yield and consumption. In addition, samples of water for chemical and bacteriological examin¬
ation are collected from each supply.

The survey has been completed in 2 Municipal Boroughs, 30 Urban Districts and 12' Rural
Districts as set out below:-—-

Municipal Boroughs.
Brighouse. Todmorden.

Urban Districts.

Ad wick-le-S treet. (1) Hoylandswaine.

Bentley-with-Arksey. Maltby.
Bingley. Mexborough.
Colne Valley. (2) New Mill.
Conisbrough. (.3) Penistone.
Cudworth. Rawmarsh.
Darfield. Ripponden.
Darton. Royston.
Dearne. Saddleworth.
Dodworth. Skipton.
Elland. Stocksbridge.
(1) Gunthwaite and Ingbirchworth. Swinton.
Hebden Royd. (5) Thurlstone.
Hemsworth. (6) Thurstonland and Farnley Tyas.
(2) Holme. Tickhill.
(3) Holmfirth. Wath-upon-Dearne.
(4) Honley. Wombwell.
Hovland Nether. Worsborough.
Note.—(1) Now in Penistone Rural District.
(2) Now part in Holmfirth II.D. and remainder in Penistone R.D.
(3) Since enlarged.
(4) Now in Holmfirth U.D.
(5) Now part in Penistone U.D. and remainder in Penistone R.D.
(6) Now part in Holmfirth U.D. and remainder in Kirkburton U.D.

Rural Districts.
Bowland. Sedbergh.
Doncaster. Settle.
Hemsworth. Skipton.
Kiveton Park. Thorne.
Penistone Todmorden.
Rotherham. Wortley.

The total number of supplies dealt with was 222, of which 92 served the 2 Municipal Boroughs
and 36 Urban Districts, and 130 served the 12 Rural Districts.

The sources of these supplies may be classified as follows: —

Table XXIX.

Urban. Rural.

Sources.
Public. Private. Total. Public. Private. Total.

1. Upland surface water . 6 — 6 4 3 7

2. Springs . 15 17 32 38 37 75
3. Rivers and Streams . — 1 1 4 6
4. Drifts or headings ... 7 3 10 — 1 1
5. Boreholes ... . 16 1 17 18 5 23
6. Purchased in bulk from County
Boroughs . 32 — 32 15 4 19

Totals. 76 22 98 77 54 131
 45

The totals do not agree with the figures given in the preceding paragraph because in the case
of some supplies there are two or more sources which fall into different groups in the table given
above. This table is merely intended to indicate approximately the type of source from which
water is derived. Indeed it is difficult to draw any hard and fast line between the first three
groups, the water from upland surface springs and moorland streams, which have been included
in groups (2) and (3) respectively, being actually almost identical with upland surface water,
group (1). On the other hand, there is a wide variation between individual sources of supply in¬
cluded in group 2 (springs) and to a lesser degree in the other groups.

Thirteen (all public supplies) out of 60 urban supplies and 24 (16 public and 8 private) out of
117 rural supplies receive treatment in the form of either filtration, chlorination, deacidification or
softening, or a combination of any of these. No inspections in regard to this matter were made
in the case of supplies purchased in bulk from a County Borough but it is understood that in most
cases the water is, in fact, treated.

In connection with the survey of water supplies, 165 samples of water for chemical analysis
and 217 samples for bacteriological examination have been collected, a summary of the results
being set out below:'—
Table XXX.

Results of Chemical Analysis. Results of Bacteriological Examination.

Sources.

Satisfactory. Unsatisfactory. Satisfactory. Doubtful. Unsatisfactory.

Urban Public Supplies. 39 1 (2-5%) 58 i (1.6%) 5 (7.8%)

Urban Private Supplies ... 18 2 (10.0%) 15 — — 6 (28.5%)

All Urban Supplies . 57 3 (5.0%) 73 i (1-2%) 11 (12.9%)

Rural Public Supplies. 56 2 (3.4%) 41 8 (10.0%) 31 (38.8%)

Rural Private Supplies ... 4G 1 (2-1%) 18 4 (7-7%) 30 (57.7%)

All Rural Supplies . 102 3 (2-9%) 59 12 (9-1%) 61 (46.2%)

Totals. 159 6 (3.6%) 132 13 (6.0%) 72 (33.2%)

It is only fair to point out that most of the above doubtful and unsatisfactory results have been
obtained from the smaller and chiefly untreated supplies. In this connection it should be said that
whilst 73 out of 132 rural supplies (i.e., 55.3%) were not satisfactory, the number of houses served
by these 73 supplies is only 15.8% of the total houses supplied in the rural districts surveyed.

The attention of the Local Authorities concerned (8 urban and 7 rural) was directed to those
supplies in the case of which doubtful or unsatisfactory results were obtained.

Unsatisfactory conditions were noted in regard to 15 supplies (9 private, 6 public) in 3 urban

districts, and in regard to 20 supplies (15 private, 5 public) in 6 rural districts. The attention of
the Local Authorities concerned was also directed to these matters.

The proportion of houses connected to the mains of the public and private supplies included in
the survey varies in the case of the 38 urban districts from 57 0% to 100%, the total over the
whole of the urban districts being 92'9%. In the rural districts, the proportion varies from 27'4%
to 99’5%, the total over the whole being 90'0%. The following table shows the number of districts
with proportions within the various limits set out. Included in the table also are particulars regarding
the 206 parishes comprised in the 12 rural districts.
Table XXXI.
80 to 90%

60 to 70%

50 to 60%

30 to 40%
40 to 50%

20 to 30%

10 to 20%
Total %

0 to 10%

o O
o
None
100%

CO
t*H

o o
Cl

Urban (38) ... 92.9 6 21 4 6 1 ...

Rural (12). 90.0 4 4 2 1 1

1
Rural Parishes (206) 64 32 16 9 7 6 8 2 5 1 38
18

The 38 parishes in which no public supply is provided are mostly very thinly populated with
houses widely separated. The average number of houses per parish is 54 and the total 2,055,
equivalent to 3’0% of the total number of houses in the rural districts surveyed.

Plumbo Solvency.
In accordance with the usual practice, samples wrere taken during the year of water supplies
known to have plumbo-solvent properties in order to ascertain whether effective measures were
being taken to counteract this characteristic. In all 92 samples of water were collected in accord¬
ance with the method described in the Annual Report for 1937.
 46

The results of the examinations showed that 10 samples from 7 different supplies contained
lead; 7 of these samples were of water which had stood overnight in the pipes, and the lead
found varied from 1 /50th to 2/5ths of a grain per gallon; the remaining 3 samples had stood for
thirty minutes and contained from 1 /80th to 1 /8th of a grain per gallon.

It is usually considered that the presence of 1 / 10th of a grain of lead per gallon in drinking
water is deleterious to health. A list of those supplies found to contain this amount or over is
set out below: —
Grains of lead per gallon after standing
Supply. lead service pipes.

(a) Overnight. (b) 30 minutes.

R. 2 / 5th 1 / 8th
B. ... 1 / 5th None
E. 1/10th 1/35th
S. B. ... 1/10th None
H.R. ... 1/10th None
S. 1/10th None
The local Medical Officers of Health were informed of the results of the examination and in
the case of the supply mentioned above under the reference letter “R” a treatment plant has
since been installed.

Collection and Disposal of Refuse.

It would appear that the amount of domestic refuse requiring to be collected and disposed of
by Local Authorities still continues to grow, at any rate so far as bulk is concerned, for the
quantity of paper, cardboard boxes and material of a similar nature shows little if any decrease
in spite of the exhortations to householders to burn such material and so help to reduce the rates.

There is no doubt that the work of Local Authorities in this connection would be materially
reduced if householders would so far as is practicable burn the combustible material that now-a-
days so easily finds its way into the dustbin. But with the continued increase in the use of gas
and electricity for heating and cooking, facilities for burning such material are not in every case
so readily as formerly.

On the whole in the administrative area of the West Riding, little real ground for complaint
in regard to the collection of refuse appears to exist, Local Authorities recognising the necessity for
this work being regularly and efficiently carried out. In fact, in only one area was investigation
necessitated by an officer of the Department in this regard.

In some areas the disposal of the refuse collected could be improved upon in respect to the
condition in which the refuse tips are maintained, and it is again suggested that with the im¬
proved method of transport facilities available, local authorities should seek to limit to a minimum
the number of places used as refuse dumps, and should also see that they are maintained in such
a condition that no cause for complaint as regards fire, smell, unsightliness, etc., arises therefrom.

During the year officers of the Department attended two inquiries held by the Ministry of
Health into applications by Local Authorities for sanction to borrow money for the purchase of land
for use as refuse tips, and also made inquiry regarding the condition of refuse tips in two urban
and three rural districts.

Sanitary Accommodation.
The statement below sets out the percentages of closets on the water carriage and conserv¬
ancy systems in the urban and rural districts which form the Administrative County, for each of
the years 1934 to 1938 inclusive:-—
Table XXXII.

Urban Areas. Rural Areas

1934 1935 1936 1937 1938 1934 1935 1936 1937 1938

Water-Carriage System 90-29 90-98 92-59 92-61 93-44 68 • 24 68-34 71-91 72-81 72-10*

Conservancy System ... 9-71 9-02 7-41 7-39 6-56 31-76 31 -66 28-09 27-19 27-90

* The decrease shown here is due to the transfer of populous parts of certain rural districts, containing a large
number of water closets, to urban districts.

The number of closets on the water carriage system still increases.

During 1938 the total of the privy closets replaced by water closets was 1,109 in urban, and
1,206 in rural districts, in addition 1,194 water closets were provided for existing properties to
supplement the existing closet accommodation. In connection with new properties 10,751 water
closets were provided.
Inquiries were made by the County Sanitary Inspectors relative to sanitary accommodation in
one urban and three rural districts during 1938.
 47

Milk Supplies.
MILK (SPECIAL DESIGNATIONS) ORDERS, 1936 and 1938.
The work devolving upon the County Sanitary Inspectors in connection with the above Orders
occupied a considerable amount of their time during the year, and the transfer of the County
Veterinary Staff to the Ministry of Agriculture has resulted in additional duties falling on them,
i.e., routine inspection of licensed premises, investigations in regard to unsatisfactory reports on
milk samples, etc.

During 1938 the numbers of applications received for licences under the above Orders were
as follows: —
For production of “Tuberculin Tested” Milk ... ... 12
Do. do. “Accredited’ Milk ... ... ... 199

The inspections and re-inspections of premises, etc., carried out by the officers of this Depart¬
ment tend to show that there is an undoubted desire on the part of the large majority of the milk
producers in the West Riding to provide the public with a good, clean milk supply. There axe of
course a few of the licensees who do not appear to appreciate entirely their responsibilities as
they should do. There is, however, one matter, the importance of which a number of licensees
do not appear to realise, viz. : the necessity for steam sterilisation of milking utensils, etc., before
each use.

From January 1st, 1937, the standards which both “Tuberculin Tested” and “Accredited”
milks must reach have been as follows:—“The milk when tested in accordance with the prescribed
methods must not decolourise methylene blue within 4-|- hours if the sample is taken at any time
from 1st May to 31st October, or within 5-| hours if the sample is taken at any time from the 1st
November to the 30th April, and at all dates it must contain no coliform bacillus in 1/100
millilitre.”
Now, with a further year’s experience of the methylene blue reduction test, one feels better
able to comment on it. From the results obtained here, it would rather appear that to a greater
extent than was perhaps generally realised, the result of the test is affected by atmospheric temper¬
ature. An examination of the results of 1,028 samples of “Tuberculin Tested” and “Accredited”
milk subjected to the test during the period May 1st to October 31st showed 23'7 per cent, of failures
as compared with 108 per cent, of failures out of 1,026 samples, examined during January,
February, March, April, November and December. On examining the failures it was seen that
7’5 per cent, occurred during the last hour of the test. It is of course known that hay-making
and harvesting occur during the May to October period, and it may be that in some instances all
of the care usually taken in milk production may not obtain during these times, but even with this
in mind, it is thought that the allowance of one hour in the test during the above period (as com¬
pared with November-April period) is not sufficient to compensate for the increased temperature
which usually obtains and it is suggested that the allowance be increased to 2 hours, i.e., length
of test during May to October should be 3^ hours.
“Tuberculin Tested” Milk.
On 1st January, 1938, there were 50 licences for the production of “Tuberculin Tested” milk
operating in the administrative area of the County Council, 37 of these licensees also holding
licences for bottling such milk at the place of production. During the year 12 new licences were
issued; one was revoked, another reverted from the production of “Tuberculin Tested” milk to
“Accredited,” and in another case the licence was allowed to lapse at the end of the year, so that
on 1st January, 1939, there were 59 licensees for production of “Tuberculin Tested” Milk operating
and of these 40 were also licensed for bottling of the milk at place of production. During the year
193 samples of “Tuberculin Tested” milk were collected by the County Staff of which 32 or 166
per cent, failed to reach the required standard on examination. This is an improvement on the
previous year when the failures reached 22" 4 per cent., but room for betterment still exists.
Thirty-seven of the licence holders had an absolutely clean record so far as milk samples were
concerned during 1938. A disquieting feature was revealed when 145 of the above samples on
being examined for the presence of B. tuberculosis showed positive results in 3 cases, equal to
2 0 per cent, of the samples examined.
“Accredited” Milk.
There were on the 1st January, 1938, producers of “Accredited” milk to the number of 539
in the County area of whom 110 also held licences for bottling of such milk at the place of pro¬
duction. On the 1st January, 1939, there were 627 licensed producers of “Accredited” milk in the
Administrative County Area, 131 of whom also held licences for bottling of such milk at the place
of production.

In the course of the year, the licence of one producer was revoked following unsatisfactory
reports on the milk, and in other instances the producers were called before the appropriate Com¬
mittee of the County Council in consequence of contraventions of the Orders and/or samples of
milk not reaching the necessary standard on examination.

During the year 1,861 samples of “Accredited” milk collected by the County Staff were sub¬
mitted to the methylene blue reduction test, and of these 323, equal to 17'4 per cent., failed such
test. These results show a decided improvement on those of 1937.

SUPPLY OF MILK TO SCHOOL CHILDREN.

Milk for school children is supplied in bottles each containing one-third of a pint. This
general rule does not apply in the cases of a few rather isolated schools, where, owing to the
small amount of milk required, difficulty is experienced in finding milk producers willing to supply
milk in bottles, and in these cases a bulk supply is permitted.
 48

The tabular statement which follows gives for the last four years the total bottles of milk
supplied each year together with the average daily supply: —

1935 1936 1937 1938

Total bottles supplied ... ... ... ... 23,152,999 22,596,766 21,827,298 25,957,168
Average number of bottles per day ... ... 105,241 103,793 101,051 110,756

It will be observed that during 1938 there has been a decided increase in the amount of milk
supplied to schools and it is to be hoped that this upward trend will continue.

In a report made to the County Supplies Committee (18/4/39) the following statement appeared
“In the West Riding there are 32 schools who are receiving dried milk and 82 schools who are not
receiving any milk because they prefer to do without rather than have the substitute.” The report
continues to say “Contractors evidently do not consider it worth their while to convey milk in some
parts of the Riding and this is no doubt due to the fact that the distribution allowance of 6Jd. per
gallon made by the Milk Marketing Board is not sufficient to cover the overhead expenses incurred in
the conveying of milk to small schools in certain rural areas.”

The Joint Sub-Committee which went into the whole of the circumstances of the difficulty
experienced in obtaining the supply of milk to certain schools, expressed the opinion that both
from the standpoint of obtaining greater competition for the supply of milk to schools and in order
to ensure a supply to all schools, the Milk Marketing Board should be pressed to agree to the
payment of an increased amount per gallon for distribution. In regard to this the Milk Marketing
Board intimated that it was hoped to increase the 6|d. allowance to 7d., but funds would not
permit the Board to go further.

At the end of 1938, there were 102 contractors supplying milk to schools under the scheme,
of these 21 supplied pasteurised and 81 raw milk, and during the year 17,797,272 bottles of
pasteurised and 8,159,896 bottles of raw milk were supplied.

In addition to the inspection by the County Sanitary Inspectors of the premises of milk producers
and pasteurising plants from which milk is supplied to schools, systematic examination of the milk
supplies is carried out. The statement which follows shows the results of the examination of
samples of school milk during the year. These results are not considered satisfactory, as both in
the case of pasteurised and raw milk approximately one sample in every four failed to reach the
specified standards.*
Table XXXIII.

Samples of School Milk Examined.

Numbers and Percentages.

Class of Milk. Total-

Satisfactory. Unsatisfactory.
.
Pasteurised 87 (75-65%) 28 (24-35%) 115

Raw . 239 (75-39%) 78 (24-61%) 317

Totals 326 (75-46%) 106 (24-54%) 432

*The standards adopted for school milk are set out below: —

1. Tuberculin Tested Milk.

Must not decolourise methylene blue within 4^ hours if the sample is taken at any time
from the 1st May to the 31st October; or within 5£ hours if the sample is taken at any time
from the 1st November to the 30th April. The milk must not contain coliform bacillus
in 1/100 millilitre.
2. Tuberculin Tested Milk (Pasteurised).

Not to contain more than 30,000 bacteria per millilitre.

3. Accredited Milk.

Must not decolourise methylene blue within 4^ hours if the sample is taken at any time
from the 1st May to the 31st October; or within 5J hours if the sample is taken at any
time from the 1st November to the 30th April. The milk must not contain coliform bacillus
in 1/100th millilitre.*

4. Pasteurised Milk.
Not to contain more than 100,000 bacteria per millilitre.

5. Ordinary Milk.

Must not decolourise methylene blue within 4^ hours if the sample is taken at any time
from the 1st May to the 31st October; or within 5-| hours if the sample is taken at any
time from the 1st November to the 30th April.
* Most of the samples are submitted only to the Methylene Blue test, the Coliform test being reserved for
occasional use.
 49

The results of the examinations of the pasteurised milk samples is somewhat difficult to
account for. The fault may lie either in the plant or in its operation—one would rather suspect
the latter in most cases. Be that as it may, it is somewhat perturbing- to find that of the milk
supplied to school children, the percentage of samples of pasteurised milk failing the test pre¬
scribed reached 24-35% of the whole.

It cannot be too strongly emphasised that no matter how efficient the plant is, the personal
element has to be considered, and in connection with such an important food as milk it would appear
desirable for legislation to be enacted making it compulsory for persons supervising or operating
pasteurising plants to possess a certificate, which should only be granted after they had attended
a thorough course of training and have shown by examination that they are competent to operate
and supervise such plants.

Further, it should be made obligatory for all persons handling milk or other food stuffs to
undergo medical examination at regular intervals so as to ensure that such persons are not
suffering from any disease likely to be communicable through such food supply.

The licensing authority in connection with the pasteurisation of milk is the Council of the
district in which the plant is situate. It is suggested that greater uniformity as regards con¬
ditions which must be observed, and more efficient supervision would result if the licensing of
such premises devolved upon County Councils.

This suggestion is not meant to imply in any way either neglect or inefficiency on the part
of the officers of the Local Authorities, but it must be apparent that with one licensing authority
for a large area, a greater experience of the different types of apparatus, methods, etc. would be
gained by the officer responsible for this work, which will naturally, as stated above, result in
greater uniformity and more efficient supervision.

MILK AND DAIRIES (CONSOLIDATION) ACT, 1915.

Under the above Act a Medical Officer of Health of any Local Authority who has reason to
suspect that tuberculosis is caused or likely to be caused by the consumption of milk which is being
sold within the area of the Local Authority, shall endeavour to ascertain the source of supply and
on ascertaining the facts, at once notify the County Medical Officer. On receipt of such notifi¬
cation, information is forwarded to the Divisional Inspector of the Ministry of Agriculture who
arranges an early examination of all milk producing animals on the farm. Samples of milk are
collected from cows showing suspicious signs and group samples are taken from the remainder
of the herd for examination in the County Laboratory. Where tubercle bacilli are discovered,
arrangements are made for the immediate slaughter of the affected animals.

Notifications were received from the Medical Officers of Health of the following Authorities
during the year ended 31st December, 1938:—Bradford 11; Doncaster 2; Halifax 1; Huddersfield
5; Leeds 4; Manchester 4; Rotherham 8; Salford 4; and Sheffield 13.

Food and Drugs (Adulteration) Act, 1928.

Table XXXIV.
Quarterly Report of Samples taken during 1938.

Samples taken during 1938.

District. Sampling Officer.
First Second Third Fourth
Quarter. Quarter. Quarter. Quarter. Total.

Harrogate W. B. Greenwood 103 97 80 86 366

Mexborough K. Hutchison 119 85 83 115 402
Mirfield F. Ward 125 129 127 137 518
Pontefract D. Bennett 85 45 77 115 322
Rothwell T. A. Bramley 89 93 81 68 331
Shipley T. Naylor 108 104 69 76 357
Skipton T. S. Roberts 105 100 97 99 401
Sowerby J. W. Bramley 92 90 84 88 354
Wombwell A. Nobbs 73 103 81 142 399

Total samples taken by Sampling Officers ... 899 846 779 3 450
926
Local Authorities ... 244 206 193 233 876

Total Samples . 1,143 1,052 972 1,159 4,326

The above total includes 61 “appeal to cow’’ samples (i.e., samples direct from the farm at
the time of milking), which frequently entail early morning visits. Of the 61 samples, 48 were
obtained bv our Sampling Officers and 13 by Local Authorities.

Excluding the “cow’’ samples, 2,322 samples of milk were collected by our officers, and 787
by local Sanitary Inspectors, making a total of 3,109, and of this total 249 or 8'0 per cent, were
adulterated.
 50

Table XXXV.
Record of Samples for Five Years, 1929-1933 and for Five Years, 1934=1938.
Total samples submitted by
Total Total Percentage
Year. County examined.
Local adulterated. adulterated.
Council. Authorities.

1929 2807 706 3513 207 5.8

1930 3153 702 3855 187 4.8
1931 3241 741 3982 201 5.0
1932 3308 858 4166 232 5.5
1933 3305 876 4181 263 6.2

Average for
5 years, 3162 776 3939 218 5-5
1929-33

1934 3233 858 4091 224 5.4

1935 3495 878 4373 210 4.8
1936 3276 868 4144 180 4.3
1937 3433 975 4408 258 5.8
1938 3402 863 4265 275 6-4

Average for
5 years, 3368 888 4256 229 5*3
1934-38

It will be noted that in 1938, 275 (or 6’4 per cent.) samples were adulterated, and these con¬
sisted of 249 of milk and 26 other, namely:— Bismuthated Magnesia Tablets, 1; Black Beer, 1;
Camphorated Glycerine, 1; Castorettes, 1 ; Chocolate Laxatives, 1 ; Dripping, 1 ; Glauber Salts, 2 ;
Jam, 2; Lard, 1; MacLeans Stomach Powder, 1; Olive Oil, 1; Orange Juice, 2; Peroxide of
Hydrogen, 1; Potted Meat, 4; Sweets, 2; Tea, 1; Thyme, 1; Tinned Cream, 2.

The extent of adulteration necessitated proceedings in regard to 28 samples of Milk, and one
of Peroxide of Hydrogen. As regards the other adulterated samples, cautions were issued where
deemed necessary.

Table XXXVI.
Particulars of Milk Samples obtained by County Sampling Officers during the past Five Years.

Percentage
Year. Genuine. Adulterated. Total.
Adulterated.

1934 2141 138 2279 6.0

1935 2180 131 2311 5.6
1936 2145 144 2289 6.3
1937 2222 160 2382 6.7
1938 2145 177 2322 7-6

Special Milk Sampling. Sampling Officers made surprise visits in 24 districts and obtained
110 samples of milk from Sunday morning supplies, and 14 (or 12 7 per cent.) samples were
reported against by the County Analyst.

Three samples were seriously adulterated and proceedings were instituted in each case. As
regards the remainder, cautions were issued where action was deemed necessary.

Milk Samples taken by Local Authorities.

The following local authorities are authorised under the Food and Drugs (Adulteration) Act,
1928, to take samples for analysis, and with the exception of Harrogate the milk samples shown in
the table below are obtained under a scheme whereby the County Council defrays the cost of
analysis, and conducts any subsequent proceedings :■—
Barnoldswick ... ... 8 Harrogate ... 190 Stanley ... ... 20
Batley ... 118 Hemsworth ... 12 Todmorden ... 8
Bentley ... ... 29 Horsforth ... 12 Wath-upon-Dearne ... 8
Brighouse ... 72 Hoyland Nether ... 29 Worsborough ... 4
Castleford ... 19 Ilkley . ... 6 Kiveton Park R. ... 26
Cudworth ... 20 Maltbv ... ... 16 Nidderdale R. ... ... 16
Dearne ... ... 14 Normanton ... 10 Ripon and
Elland ... 59 Pudsey ... ... 20 Pateley Bridge R. 5
Goole ... 31 Rothwell ... 35 ,-
787

Of the 597 samples of milk submitted under the scheme, 52 (or 8-7 per cent.) were reported
against, and in respect of 5 samples prosecutions ensued. The remainder were not sufficiently
serious to necessitate proceedings and cautions were issued where deemed advisable.

Atmospheric Pollution.
The Department of Scientific and Industrial Research have for some years been making an
investigation into the nature of atmospheric pollution and the best ways of measuring it, in which
Local Authorities and other Bodies have been invited to co-operate, chiefly by the setting up and
maintenance of deposit gauges, which are of a standard pattern, and arranging for the contents
thereof to be analysed at monthly intervals.
 51

Very few West Riding County District Councils were co-operating in the scheme, and as an en¬
couragement the County Council agreed to bear the cost of the analyses of the contents of a
number of deposit gauges to be placed in selected situations in the Administrative County, pro¬
vided that each County District Council concerned would pay for the cost of the gauge, and
permit their Sanitary Inspector to give it the necessary attention. Five gauges have been so pro¬
vided, and the results of the analysis of the contents of four are summarised below. The remaining
gauge has only been set up a few months.
Table XXXVII.
-_-
Mean monthly deposits recorded
(in tons per square mile).
Rainfall
Situation of Deposit Gauge. Year.
(inches). Total
Insoluble Soluble
matter. matter. solids.

Keighley B. (Morton Cemetery) 1936 3.58 3.77 14.02 17.79

1937 2.48 3.84 8.51 12.35
1938 2.83 4.06 8.50 12.56

Colne Valley U.D. (Marsden Park). 1936 5.33 7.48 11.72 19.20
1937 3.35 7.61 7.98 15.59
1938 3.86 6.74 8.53 15.27

Otley U.D. (Nursery Gardens, Westgate) 1936 2.56 3.37 9.17 12.54
1937 2.48 5.82 7.96 13.78
1938 2.76 9.17 8.69 17.86

Skipton U.D (rear of Town Hall) 1936 3.07 5.09 10.27 15.36
1937 2.44 4.60 7.46 12.06
1938 3.23 4.84 10.37 15.21

As might be expected the figures show that the higher the rainfall, the heavier the deposit.

The amount of deposit varies with the time of the year, and an examination of the monthly
records shows that the figures for the above-mentioned gauges compare favourably with those
for gauges, in situations with similar conditions, in other parts of the country.

The sites of the four gauges are as described below:—-

Keighley B. ... ... In an open space in the cemetery at Morton, two miles from the centre of
the town in an easterly direction. The surrounding district is residential.

Marsden In Marsden Park in a residential and manufacturing- area, seven miles south
of Huddersfield. There are eight major factory chimneys within one mile
of the gauge.
Otley ... In nursery gardens, 600 yards south-west of the centre of the town. The
district is a manufacturing one.
Skipton U.D. At the rear of the Skipton Town Hall in a residential and manufacturing
district.

Swimming Baths and Bathing Pools.

The necessity for maintaining the water in swimming baths and pools at a proper standard of
purity is now generally recognised and in connection with those situate in the Administrative
County which are open to the public on payment, the action outlined in the Annual Report for 1937
was continued during 1938 by the County Health Department, including arrangements for the
examination in the County Laboratory from time to time of samples of water from each bath or
pool; particulars of these examinations are given on page 69. Considerable numbers of West
Riding school children attend at these baths for instruction in swimming under the auspices of the
West Riding Education Committee, and where the purity of the water in a bath was unsatisfactory
due to defects in equipment, or lack of a proper purification plant, the use of such bath for in¬
struction was discontinued, but has been resumed where the equipment has been improved or a
purification plant installed. In some baths having a proper purification plant the water was un¬
satisfactory due to the inefficient operation of the plant, but as to the majority of these cases it is
pleasing to be able to record that on being made aware of the conditions, the local authorities or
owners of the baths brought about an improvement which has since been maintained.

Efficient continuous filtration, combined with continuous and accurately controlled chlorination,
are authoritatively considered to be the best means of maintaining the water in swimming baths
and pools at the requisite degree of purity, and since the action taken by the County Health Depart¬
ment, four baths which were without filtration and chlorination plants have been equipped with
modern plants whilst another with means of filtration only has been equipped with a chlorination
plant.

The object of continuous chlorination should be to maintain a strength of free chlorine in the
water of the pool itself of not less than 0'2 parts and not more than 0-5 parts per million parts of water
during the whole of the time that the bath is in use. The maintenance of such an amount, together
with efficient filtration and aeration of the water, will ensure the water having a degree of purity
from a bacteriological point of view equal to that of most drinking waters.
 A bath may be equipped with an up-to-date filtration and chlorination plant, but it is im¬
possible to be sure that the plant is being- efficiently operated unless appropriate and frequent
examinations of the water are made, and in this connection the examinations of samples
of bath water which are carried out in the County Laboratory are of assistance. These examin¬
ations are, however, more in the nature of control tests. The dosage of chlorine and other
chemicals necessary to keep the free chlorine content and alkalinity of the water within the limits
considered requisite varies with the “bathing load” but tests are available which the baths super¬
intendent, or a member of his staff, is usually quite capable of carrying out, and the results enable
the dosage to be properly adjusted to current requirements. The provision of the simple and in¬
expensive apparatus required for these tests has been encouraged and practical demonstrations
of its use have been given where necessary.

In the West Riding Administrative County, there are now approximately 41 swimming baths
and bathing pools open to the public on payment, and of these 30 are equipped with satisfactory
filtration and chlorination plants, 3 with filtration plants of an unsatisfactory design and 8 have
no purification plant; two baths which have no purification plant are closed and it is probable that
they will not be opened until plants have been installed; twenty-seven of the baths belong to
County District Councils, 2 to Miners’ Welfare organisations and 12 to private owners.

The Final Report of the Departmental Committee on the Cost of Hospitals and other Public
Buildings which was appointed by the Minister of Health was issued in 1938. This report con¬
tains concise information on the design of swimming baths and pools which will be of considerable
assistance to those contemplating the provision of new swimming baths or pools, or the improve¬
ment of existing ones.

National Health Campaign.

In the autumn of 1937, the Central Council for Health Education in co-operation with the
Ministry of Health and the Board of Education launched a scheme for a nation-wide campaign
to encourage the wider use of the health services. County Councils and other Local Authorities
were invited to take part in this campaign which was carried out in accordance with a monthly
programme in the last quarter of 1937 and the first quarter of 1938.

The campaign was inaugurated by the Prime Minister on the 30th September, 1937, who in
the course of his speech said, “Health counts for far more than wealth; disease or physical
weakness lowers the spirits and undermines the temper. The greatest blessing we can confer upon
the community is to save them from the disabilities that bear down the man or woman whose body
is a constant source of suffering or discomfort.”

The keynote of the campaign was that the health services provided for the public were not
being used to the extent that they should be and that sound and sustained publicity would make a
marked change in this state of affairs.

The first month was devoted to publicity of a preliminary character the objective being to
create interest in the campaign itself, but during the months which followed a particular aspect of
the public health services was dealt with each month.

The County Council through the West Riding Public Health and Housing and Education
Committees co-operated in the campaign by the issue and display of copies of the varied posters,
folders and other literature which constituted a substantial part of the campaign. This publicity
material, the cost of which was borne mainly by the Government, was attractively designed and
printed in colours. Where appropriate, there were spaces on the folders and leaflets for the printing
of material of local value and in connection with those distributed by the County Council, parti¬
cularly the folders, these spaces were utilised for information, set out according to the district of
distribution, as to the location of the health services dealt with in the folder. The amount of
material issued or displayed through the arrangements of the County Council was as under:-—-

Description. Number.
Posters .... ... ... ... ... 8,400
Traffic Notices ... ... ... ... 2,500
Bookmarks ... ... ... ... ... 560,100
Folders ... ... ... ... ... 454,500
Display Cards ... ... ... ... 625

In March, 1938, a National Fitness Campaign was held and was devoted to the facilities
existing for physical training and recreation. In connection with this, a further 300 posters,
140,000 bookmarks and 207,000 folders were issued.

The size of the Administrative County is approximately 2,000 square miles, and the ordering
of suitable material and its packing, and distribution through the various channels, required some
time and organisation, and could not have been done so smoothly without the ready co-operation
with the County Health Department of the officials in other branches, particularly those of the
schools organisation.

Disinfection of Library Books.

During the year 1938, 182 books belonging to the County Public Library, which had been
in contact with infectious disease, were either disinfected or destroyed.
 53

Pharmacy and Poisons Act, 1933.

There were 1,581 Listed Sellers in the Administrative County at the end of 1938.

Included in the list are 73 sets of premises from which are sold preparations containing
poisons included in the First Schedule to the Poisons Rules, such as arsenic, mercury and nicotine,
the sale of which is subject to special restrictions.

There are also 41 premises which are either partly or almost wholly concerned with the sale
of various preparations for the treatment of human ailments, and it requires the exercise of
vigilance in these cases to ensure that no preparations are sold containing poisons which it is
unlawful to sell from such premises.

From the majority of the remaining premises on the County Council’s list preparations con¬
taining such poisons as ammonia, phenols (in carbolic disinfectants), caustic soda, caustic potash
and salts of lemon (potassium quadroxalate) are sold, and the questions which arise in connection
with the sale of these poisons mostly involve the regulations as to labelling and form of containers.

Many infractions are due to misunderstandings of the requirements of the Act and Rules, and
it has sometimes been found expedient to interview or write to the wholesaler or manufacturer in
connection with such matters as packages of preparations observed in the course of inspections
which might contain poisons which a Listed Seller is not entitled to sell, or as to irregularities in
labelling or form of containers of such substances as prepacked ammonia or carbolic disinfectant
supplied by him to the Listed Seller for resale. In such cases ready co-operation has generally
been met with, and now that manufacturers and wholesalers are more familiar with the requirements
of the Act and Rules, the irregularities in connection with labelling and containers which were
observed for some time after the Act came into force have almost disappeared so far as prepacked
articles supplied by the larger firms and wholesalers are concerned.

In most cases of non-compliance with the legal provisions, verbal admonishment, confirmed
by letter where considered necessary, has sufficed to check any laxity observed during inspections.
During the year 416 inspections were made.

General Hospital Accommodation.

Details of Accommodation Provided. The following table gives particulars of the medical and
nursing staffs, the number and classification of the beds available and the number of admissions
and discharges during the year under review: —

Staincliffe County Hospital, Dewsbury. (Telephone No. Dewsbury 1614).

Medical Superintendent. J. J. O’Reilly, M.D., F.R.C.S. (Ed.), D.P.H..

Deputy Medical Superintendent. D. B. McVittie, M.B., Ch.B.

Classification of Beds. Males. Females. Children. Total.

Medical ]
Surgical >... 130 165 12 307
Chronic j
Tuberculosis 12 10 — 22
Isolation 5 5 — 10
Maternity — 10 10
349

Admissions 1,893
((a) living 1,517
Discharges
|(b) deaths 416

White Rose County Hospital, Wakefield. (Telephone No. Wakefield 3454).

Visiting Physician. J. B. Lyle, M.D.
Visiting Surgeon. 1). H. Russell, F.R.C.S. (Ed.).

Classification of Beds. Males Females. Children. Total.

Medical 1
Surgical > ... 76 60 26 162
Chronic J

Tuberculosis 4 2 — 6

Maternity ... ... — 2 — 2

170

Admissions 842
I (a) living 630
Discharges
((b) death: 241
 54

User Agreements. The County Council have agreements with the County Boroughs of
Dewsbury (in regard to Staincliffe) and Wakefield (in regard to White Rose) for the accommodation
of the sick poor from those two County Boroughs. This arrangement is working satisfactorily and
the following table shows the number of User Agreement patients admitted and discharged during
the year.

Staincliffe County Hospital.

Admissions 328
Discharges 345

White Rose County Hospital.

Admissions 337
Discharges 338

White Rose County Hospital, Wakefield. Dr. J. B. Lyle, Visiting Physician, reports: —
During the year 842 patients were admitted and 030 patients were discharged after receiving
treatment. There were 19 confinements in the Maternity Ward of which 15 were normal births and
4 stillbirths. Fifty-one surgical operations under general anaesthetic were performed in the Hospital
Operating Theatre. Owing to a case of scarlet fever occurring in the Children’s Ward in June,
1938, visiting in that ward was suspended for a short period.

During the winter months, the accommodation has been taxed to its utmost on both male and
.female wards, as shown by the following figures, i.e.:

Accommo¬
Patients. Date
dation.

Males-—

F. Ward 40 36
G. Ward . 40 42

Totals 80 78 21:2:38

F EMALES-

D. Ward . 40 56
E. Ward .. 24 21

Totals 64 77 12:3:38

The internal decorations of the hospital, i.e., the painting of the ceilings and some walls, were
•commenced in December, 1938.

fhe full complement of probationer nurses has been maintained with some difficulty, but it
has not been possible to obtain the number of staff nurses required. The accommodation for nursing
staff is still bad owing to overcrowding but an effort is being made to alleviate the problem by
renting a house in Peterson Road, Wakefield which when furnished, will provide accommodation
for eleven nurses. It is hoped by this means to lessen the pressure on the accommodation until
such time as the proposed extensions are completed.

Staincliffe County Hospital, Dewsbury. Dr. J. J. O’Reilly, Medical Superintendent, reports : —

The year 1938, the first complete year following the appropriation of the sick wards of the
County Institution, Batley, as a Public Health Hospital under the Public Health Acts, has been
full of interesting developments. The abolition of the admission of patients by Relieving Officer’s
order, with the exception of residents from the County Borough of Dewsbury, and the substitution
of the method of admission by the recommendation of the general practitioner, resulted in a very
decided increase in the number of in-patients, particularly of the more acute type of case. With
the exception of the maternity cases recommended from the Dewsbury Public Health Depart¬
ment, the types of case admitted from this County Borough are invariably of an elderly chronic
nature and are sent in on the order of the Borough Relieving Officers.

The number of patients admitted in the year 1938 was 1,897 as compared with 1,317 in
1937, the latter part of which represents six months under appropriation.

The tuition of junior probationer nurses for the compulsory education test has meant the
institution of a course of tutorial instruction in English language, literature, general knowledge and
arithmetic. This course is held in the hospital in the evenings and conducted by secondary school
teachers from Batley and was started in the month of July. Text books covering the syllabus have
been provided free and at intervals examination tests are held. The introduction by the General
Nursing Council of the compulsory educational test examination has raised an additional barrier
to the entrance of candidates for the nursing profession, and has resulted in the rejection of several
girls who, so far as could be judged, were likely to become worthy members of the nursing
profession.

The number of nursing probationers from this hospital who sat for the educational test exam¬
ination since it came into force was 20, and the number rejected at the first sitting was 9. It will
be evident that the normal wastage in nurses accepted for training, already high, is consequently
going to be very materially increased.
 As a result of the increase in the number of in-patients, it was found necessary to recommend
an addition to the normal established complement of the nursing staff, and approval was obtained
for the recruitment of twelve assistant nurses. As it was found impossible to get these within
reasonable time, an attempt was made to get probationer nurses in lieu thereof and the number
now in training is 52.

There has been unusual difficulty in filling the staff nurse vacancies, and this combined with
a rather high incidence of non-serious but incapacitating illness amongst the staff during the latter
half of the year necessitated the employment of locums for rather long periods on end. Only 8 cases
of infectious disease occurred amongst the nursing'staff, viz. :—one of pulmonary tuberculosis,
one of scarlet fever and six of diphtheria.

To accommodate the increased nursing staff and to alleviate the existent overcrowding in the
nurses’ home, a large private and recently decorated house situated within easy reach of the hos¬
pital was leased, suitably renovated and furnished, and now provides sleeping room for the entire
night staff and two maids. This has certainly relieved the strain on the home accommodation, and
is in accordance with the accepted principle that night nurses should reside in a separate block.

Since April, 1938, the position of Sister-Tutor has been vacant and though arrangements have
been made to carry on her work by lectures and tuition courses arranged and given by senior
members of the staff, yet I must confess that this work has been carried on under difficulty.

In October, Sister Roberts, who had been granted three months’ leave of absence to take a
course of studies in house-keeping, returned and was temporarily allocated to the duties of Assistant
Home Sister as it appeared that the present Assistant Matron and Home Sister found it impossible
to do justice to the duties of her composite appointment.

A visiting physician (Dr. J. H. Towers) was appointed in September, and he holds a monthly
session of two to three hours. The appointment of a visiting staff of consulting specialists appears
to be very desirable and would go far to raising the status of the hospital in the eyes of the local
medical men.

A temporary night porter was appointed in September, and has supplied a long felt need.
He exercises general supervision in the hospital and around the grounds at night, visits “Uplands”
(Nurses’ Hostel) where he attends to the slow-combustion stove, and assists generally in the routine
manual work such as transport of patients to the wards and theatre, and in the removal of dead
bodies to the mortuary.

Without doubt one of the biggest improvements during the year was the installation of a
modern internal telephone system with switch-board, which connects all the wards, Nurses’
Home and the Administrative Block, and to any of these, incoming calls on the two exchange lines
can be passed.

A telephonist and shorthand typist took up duty in October, as the existing clerical staff were
unable to get through the amount of work within reasonable hours.

The two large rooms on the top floor of the Administrative Block have been altered and
equipped to serve the purpose of lecture, demonstration and study rooms for the nursing staff.
Sufficient desks and chairs have been provided to suit individual nurses, and all the equipment
from the old lecture-room (which is really a small hospital ward and will now revert to its former
use) was transferred. The epidiascope which has been supplied to complete the equipment should
prove extremely helpful and beneficial in the demonstration of lantern slides on anatomy and
pathology and kindred subjects.

Owing to the difficulty in providing electric light and furnishing equipment for the six wooden
shelters, which were obtained on loan from the Tuberculosis Department, it was not found prac¬
ticable to put them into use for the nursing of certain types of pulmonary and non-pulmonary
tuberculosis, but it is hoped to put them into use next spring.

Following the crisis of last September, all the windows in the hospital, with the exception of
those in the operating theatre, were fitted with brass and wooden curtain rails for blinds. With
reference to the roof light and side windows of the theatre, I would suggest that owing to their
size and peculiar conformity, it might be found possible, in the event of another contingency, to fit
a waterproof and opaque blind to the exterior which could be fixed to the roof above the upper
edge of the glass, and when unfolded would unroll down over the window and obscure all internal
lighting to the exterior.

It is intended to have several courses of A.R.P. lectures for the hospital staff, and as these
are open to members of the nursing profession living locally as well as to officers of the institution,
it is proposed to hold them in the large board-room of the County Institution, Batley.

Major operations performed . 341

Cases confined . 210
X-Ray photographs ... ... 1,506
Cases attending as out-patients . 750
Treatment given ... ... . . 4,000
Attendances ap the ante-natal clinic . 858

All these figures are very much higher than the preceding years, and indicate the increasing
extent to which the services provided are being utilised.

Several new trucks have been put into use for the transport of laundry and dry stores.

Two new-born children developed pemphigus neonatorum on the 23rd December and owing to
the prevalence of this disease in the surrounding district, it was considered imperative to cancel
all maternity bookings and close down the maternity ward to further admissions except from areas
which were clear of this disease.
 56

The three rooms in the basement have been thoroughly cleaned, ventilated, lime-washed,
lighted and converted into stores for drugs, dressings and general hospital equipment, and were
.found very convenient for the storage of the increased amount of stock requisitioned at the time
.of the crisis.

In the Administration Block, the large room on the right of the main entrance has for some
time past been used for the meetings of the Visiting Hospital Committee. It was also used for
inquests of which 16 were held during the past year.

1 ho new system of central heating of the entire Hospital and Home was completed at the end
of the year and so far as can be judged is likely to prove satisfactory. The system of steam¬
heating in the theatre has also been improved bv the fixation of the radiators and the fitting of
controls to regulate the temperature. As the large stoves in the hospital wards are now redundant,
it is recommended that they should now be removed and replaced bv surgical wash-basins.

Table XXXVIII.

Classification of In=patients Discharged from or Died in the Staincliffe and White Rose County
Hospitals during the period 1st January, 1938 to 31st December, 1938.

STAINCLIFFE. WHITE ROSE.

Disease Groups.
Children Children
(under 16 years I Men and Women (under 16 years Men and Women
of age) of age)

Dis¬ Dis¬ Dis¬ Dis¬

Died Died Died Died
charged charged charged charged
A. Acute infectious disease 39 1 9 2 9 1 6 —

'B. Influenza 1 — 2 — — — I —

<C. Tuberculosis—
Pulmonary ... 4 21 18 — — 8 7
1
Non-pul mon ary 6 3 7 2 — 1 3

D. Malignant disease 34 40 — — 15 35

.E. Rheumatism—
(1) Acute rheumatism (rheumatic
fever) together with sub-acute
4 — 11 — 10 0- 9 —
rheumatism and chorea ...
(2) Non-articular manifestations of
so-called “rheumatism” (mus¬
cular rheumatism, fibrositis,
lumbago and sciatica) 2 — 7 — 2 — 12 —
(3) Chronic arthritis ... — — 29 2 — — 7 1

"F. Venereal disease 4 18 — _ — 7 —

tG. Puerperal pyrexia, including cases classi-

fied (in London) as puerperal fever
(a) Women confined in the hospital — — 3 — — — 1 —
(b) Other cases ... — — 1 — — — 4 —

H. Other diseases and accidents connected

with pregnancy and childbirth ... — 12 80 6 — 1 13 1

T. Mental Diseases—
(a) Senile dementia — — — — — — 3 —

(b) Other — — — — 7 — 15 —

J. Senile decay ... — — — 6 — — 45 48

K. Accidental injury and violence 11 52 19 21 4

2 i —

IN RESPECT OF CASKS NOT INCLUDED ABOVE:

| •>
L. Disease of the nervous system and sense 1
organs 28 9 174 100 8 1 58 34

M. Disease of the respiratory system ... 33 4 97 38 27 3 50 15

N. Disease of the circulatory ... 1 1 102 104 2 2 58 63

O. Disease of the digestive 45 9 119 9 6 3 17 3

P. Disease of the genito-urinary 11 62 24 2 1 16 11

Q. Disease of the skin ... 27 34 1 20 — 10 —

R. Other diseases 13 1 25 2 10 2 96 2

S. Mothers and infants discharged from

maternity wards and not included in
above figures—
Mothers — — 202 — — — 15 —

Infants 198 — — — 12 — — —

T. Any persons not falling under any of the

above headings 5 — — 19 4 —
 Prevention of Blindness.
The work in connection with this scheme is increasing-, and considerable help is being- given
to all classes of people in the County.

Provision was again made in the financial estimates for the year 1938, that an amount of £250
be included to cover the expenditure under this heading.

In accordance with this scheme, during the year under review the enumerated particulars given
below convey some idea how this phase of the work has developed.
(a) Applications received ... ... ... ... ... ... ... 514
(b) Examinations by County occulists . ... ... ... ... ... 294
(c) Recommendations for provision of glasses ..., ... ... ... ... ... 246
(d) Patients who provided glasses at own expense ... ... ... ... ... 87
(e) Patients who have had glasses provided at the County Council’s expense ... 159
(f) Patients on waiting list at 31/12/1938 ... ... ... ... ... ... 153
(g) Failed to attend or refused examination ... ... ... ... ... ... 67

In cases where the spectacles are provided at the cost of the County Council the financial cir¬
cumstances are verified and everything considered before they are supplied.

The financial circumstances of all applicants are investigated with the exception of those
cases where the full cost of the spectacles is paid for voluntarily.

So far, practically all the applicants have been examined by the County Oculists but on
account of the large number of requests and the increasing number of school cases for examination,
considerable delay has taken place in many instances, which unfortunately was unavoidable.

It is, therefore, intended to bring about in the early part of next year a panel of ophthalmolo¬
gists, whereby these examinations can be carried out more expeditiously.

Each year an optical company is given the contract for the provision of these spectacles, and
the cost according to the present contract is as follows:1—

Nickel Shellite 3s. 3d.

Gold-filled Shellite 6s. 9d.

Treatment of Patients by Radium.

The County Council approved of the continuation of this scheme and a sum of £5,000 was in¬
cluded in the estimates for the service. The three centres at present approved by the Radium
Commission are Leeds, Bradford and Sheffield.

The financial terms to the Leeds and Bradford centres are at the rate of 12s. 6d. per day per
patient, this amount including the cost of maintenance as well as specialist treatment. For
out-patient treatment the charge is at the rate of 5s. Od. per patient per treatment.

In - connection with the Sheffield Radium Centre, however, to meet the local conditions,
arrangements have been made for payment on a different basis, namely:1—

(a) Treatment. A per caput payment of £5 11s. Od. per patient is made; this amount covers
the whole of the treatment of the patient, irrespective of the duration of such treatment.

(b) Maintenance. Payment at the rate of 9s. Od. per day is made to the Sheffield hospital
in which the patient is accommodated during the course of treatment at the Radiation
Centre.

The following table shows the number of patients who have received treatment (in-patient
and out-patient) during 1938, together with the average duration of stay and the approximate
cost:—
Table XXXIX.

No. of Cases. Average duration

Name of Centre. of stay Estimated Cost.
In-patient Out-patient or Treatment.
£ s. d.

Leeds 178 52 17 days 2,000 0 0

Bradford 11 — 17 days 160 0 0

Sheffield 70 29 16 days 1,050 0 0

Number of new cases ... ... ... .... ... ... 259
Do. of re-admissions ... ... ... ... ... ... 74
 In each case, enquiries are made before financial responsibilty is accepted to ensure: —
(a) that the patient is a resident in the West Riding- Administrative County Area;
(b) that the clinical condition is one of cancer;
(c) that the patient is actually receiving radiation treatment;
(d) that the hospital gives the County Council the benefit of a reduction in the daily main¬
tenance charge in those instances where the patient is a direct or indirect contributor to
the hospital funds.

Travelling expenses are also paid to enable patients to attend the cancer clinics as and when
required.

Public Assistance Medical Services.

A list of District Medical Officers will be found on pages 7 to 9 of this report. Many of
these officers were transferred from the former Poor Law Authorities under the Local Government
Act, 1929, on the 30th April, 1930, but all appointments made subsequently by the County
Council are in the nature of temporary appointments from year to year.

Each District Medical Officer is required by the regulations of the Ministry of Health to make
a fortnightly return of work done in connection with medical out-relief and the following tabular
statement gives a summary of the services rendered during the year. The returns show that
165,617 home visits and consultations were recorded during 1938. This figure is an increase of
7,743 over that of 157,874 for the preceding year. In certain parts of the County there was
a diminution in the number of requests for medical out-relief, and this was most marked in the
Ewecross, Lower Agbrigg, and Goole and Selby districts.

On the other hand an increased number of services was recorded in the following districts: —
Skyrack, East Morley, Osgoldcross and Don Valley.

Table XL.

Work oi the Public Assistance District Medical Officers, 1938.

No. of attendances on
No. of
assisted persons.
Guardians Committee District
Acreage. Population.
Area. Medical
At At Total
Officers.
home. surgery. Visits.
fa i

1. Ewecross 288,079 23,066 10 514 165 679

2. Staincliffe 159,261 53,721 8 4,200 1,589 5,789
3. Claro 212,662 83,395 13 2,668 1,881 4,549
4. Barkston Ash ... 142,409 53,334 9 4,073 1,762 5,835
5. Skyrack 63,336 74,848 5 2,190 985 3,175
6. Worth Valley ... 39,443 83,876 6 2,085 1,640 3,725
7. East Morley ... 12,551 63,956 8 1,068 745 1,813
8. Calder ... 78,253 121,685 14 2,575 2,307 4,882
9. Spen Valley 22,177 134,845 10 4,065 2,788 6,853
10. Lower Agbrigg 41,345 92,383 14 9,064 7,651 16,715
11. Osgoldcross 88,853 159,220 16 17,060 19,380 36,440
12. Goole and Selby . 76,229 45,043 4 2,362 1,214 3,576
13. Don Valley 137,061 182,614 20 15,690 21,587 37,277
14. Staincross 115,309 139,588 19 7,961 5,889 13,850
15. Upper Agbrigg 76,687 89,182 15 2,089 929 3,018
10. Rother Valley 61,143 112,622 13 6,481 10,960 17,441

Totals 1,614,798 1,513,378 184 84,145 81,472 165,617

The following tabular statements set out briefly the accommodation available and the work
undertaken in the sick and infirm wards of the County Public Assistance Institutions. In regard
to the available accommodation it should be noted that the Deanhouse County Institution was closed
temporarily during the year for repairs to the heating apparatus, and the patients were transferred
to other Institutions.

The Keighley County Institution was closed on the 31st March, 1938 and the Ministry of
Health has now approved the continued closing of the casual wards at Wakefield without limitation
as to time.

With regard to the Settle County Institution which was closed for the reception of Public
Assistance patients during 1937, these premises are now being used for the accommodation of
mental defectives for whom the West Riding Mental Deficiency Acts Committee is responsible. The
accommodation provided with the approval of the Board of Control in this connection in the
County Institutions is as follows: —

County Institution, Settle 100 patients.

County Institution, Tadcaster 24 patients.
County Institution, Grenoside 36 patients.
County Institution, Deanhouse 35 patients.
 59

Table XLI.

Available Accommodation and Beds Occupied in the 18 County Institutions and the Keighley.
County Hospital.

Healthy
Receiving
Able- Tub- Children
Infirm. Sick Mater- Mental and isola-
bodied ercu-
nity tion wards
losis Under Over
3 years 3 years
M. F- M. F. M. F. C. M. F. M. F.

Available
accom¬ 693 379 517 382 587 694 86 45 242 267 76 79 67 104 169
modation

Beds
occup ied 386 202 415 309 482 485 60 8 192 173 13 24 20 47 147
31. 12. 38.

Table XLII.

Brief Analysis of Cases Maintained during the Year (excluding Able-bodied and Casuals)

Name of Institution.
Knaresborough

Hems worth
Todmorden

Type of Case.

Deanhouse
Pontefract
Tadcaster

Staincliffe

Wakefield

Grenoside
Wetherby

Penistone
Keighley

Total
Skipton

Clayton

Batley
Ripon
Settle

Goole
Otley

Selby
Sick (Acute and
Chronic) 4 240 95 49 30 39 236 323 371 78 78 599 235 209 117 30 67 203 3003
Infirm . — 120 147 34 35 35 70 130 307 133 251 116 113 55 74 64 64 23 16 1787
Mental . 105 17 2 10 28 22 2 146 71 12 90 — 42 10 — 13 2 37 42 651
Maternity — 5 11 1 2 — 5 245 21 — — — 14 9 — 28 i 4 — 346
Other Cases 5 2 31 5 13 20 57 6 7 39 58 25 8 18 i 11 13 319

Totals 109 387 257 125 100 109 333 901 776 230 458 116 826 334 291 240 98 142 274 6106

Number of Deaths.

Sick (Acute and

Chronic) 2 46 73 18 10 12 78 70 58 41 28 — 128 37 26 21 13 14 50 725
Infirm . — 27 — 5 2 — — 33 44 — — — — 26 5 6 — 9 6 163
Mental . — — 2 2 — — — 17 3 — 10 — _ _ _
2 _ _ 3 39
Maternity 15
Other Cases 3 2 3 1 3 9 4 — — 1 1 — 27

Totals 2 73 77 28 12 12 80 132 106 44 38 — 137 67 31 33 14 24 59 969

Subscriptions to District Nursing Associations.

Section 178 of the Public Health Act, 1936, empowers County Councils to contribute by way
of an annual subscription towards the support and maintenance of Nursing Associations.

In respect of the year 1938, subscriptions amounting to £1,077 were made to District Nursing
Associations for their services in connection with the nursing of the aged sick, old-age pensioners,,
etc., in the West Riding Administrative Area.
 60

Table XU 11.

Vaccination of Children whose Births were registered from 1st January to 31st December, 1937, inclusive.

Number of these Births duly entered by Number of these Births which on 31st .dumber of these Births
Number of 31st January, 1939. in Columns I. 11, IV, and V of the January. 1039, remained unentered in the emaining on 31st Jan., Number of Statutory
Births Vaccination Register” (Birth List Sheets)»viz “ Vaccination Register " on account (as 1939, neither duly Declarations of Number of Total number
returned in shown by “ Report Book ”) of entered in the Total number of Children
Conscientious Objection vaccinated of
the “Birth Column IV “Vaccination Certificates of actually received hy the Certificates of
Name of List Sheets” Column 11 Removal to Removal to Register" (columns 3, Successful Primary Vaccination Officer after Successful
Vaccination Vaccination District as registered Column 1 Number in res- Column V places
Districts, the unknown, irrespective of the declaration of \ accusation
Officer from 1st pect of whom Postponement Vaccination or Return) nor tern- dates of birth of the Conscientious for year 1938
which cannot jorarily Children under 14 Objection
January to Successfully Statutory by Officers of accounted for received during the children to which they
31st December Vaccinated Insusceptible Declarations of je reached; and had been Vaccination
Had Died Medical which have Cases not n the “Report Book” Calendar Year 1938 relate, during the
1937 Smallpox Conscientious Unvaccinated Certificate been duly (columns 8, 9 and 10 Calendar Year, 1938. made. Officers.
Vaccination having been
Objection have apprised found of this Return)
been received
j

H. Fielden. Bowland Rural ... 45 14 30 1 17 33 _ 2

G. Kayley . Garsdale (Sedbergh) ... 6 1 — — 5 — — — — — 1 6 _

W. Batty. Sedbergh ... 34 16 _ — 18 — — — — — 3 21 1

W. Slinger. Bentham (Settle) . 78 16 — — 50 4 — 2 2 4 31 55 9
C. Parker ... Settle and Long Preston 93 34 1 — 55 3 — — — — 49 34 3
G. J. Harker . Grassington (Skipton) 24 10 — _ 12 —
1 — —
1 11 9 1 2
S. H. Day. Kettlewell (Skipton) ... 6 4 — _ 2 — — — — — 3 1 — —
G. D. Hunt Gargrave (Skipton) 17 11 — — 6 — — — — — 8 12 — —
D. Slater. Barnoldswick, etc.
(Skipton) 398 38 1 293 19 5 6 7 29 24 311 _ „_

R. L. Watson . Gt. Ouseburn 203 83 — _ 78 13 — 17 — 12 153 112 1 6

C. W. Fawcett . Ivnaresborough ... ... 115 51 — — 56 3 — — 2 3 45 65 _
6
Mrs. M. E. Bowe* Harrogate ... ... 590 181 — — 351 26 10 5 17 — 213 318 -
10
G. E. Wilkinson. Pateley Bridge • •• ... 80 35 — — 41 — — — — 4 21 34 2
F. S. Metcalfe Ripon • •• ... 208 89 — — 103 8 2 4 2 — 96 102 _ 5
W. Bortoft . Tadcaster ... ... 127 95 — — 28 3 — — 1 — 112 35 . 14
Aberford ... • •• ... 252 65 — -- 134 15 — 1 4 33 73 155 _ _
13
W. Wormald
S. C. Mellor Wetherby ... • •• ... 171 107 1 _ 51 5 4 1 2 — 145 54 _ 33
R. A. Wilkinson. Bishoptborpe ... ... 19 9 — — 10 — — — — — 9 5 —

G. G, Clarke ... ... Horsforth ... ... 366 87 — _ 218 14 4 17 8 18 135 196 28
H. Wood ... Ilkley and Otley ... 291 93 1 — 140 12 5 4 19 17 116 151 ,_
6
G. C. Clarke Yeadon ... ... 257 38 — — 190 4 4 6 5 10 37 215 ■ 4
J. A. Sharp . Keighley ... ... ... 649 12 1 _ 595 27 5 8 1 — 26 676 1
Miss A. Hartley. Bingley ... ... 196 17 — — 168 8
—
1 —

—
1
—
1 24
—
136 . 8
W. H. Ogden . Haworth ... ... ... 73 6 — — 63 4 _ 5 _

1 31 — — 3 2 32
Miss A. Hartley. Wilsden ... ... 35 — — — _ _ —

131 46 — — 78 3 — 4 — —
71 100 _ 15
C. W. Calverley ... Farsley ... ...
52 6 — —
37 — — — 7 — 5 34 ___ —
H. Darnbrough ... — Drighlington ... ...
155 53 — — 88 5 1 3 5 — 44 80 - 11
A. Hotchin . Pudsey ... ...
556 54 — — 474 27 — — 1 — 54 418 - —
Miss D. Wildman Shipley ... ...
129 7 — — 114 3 — — 4 1 9 114 —
Cleckheaton ... ...
F. Higginson
T. I. Hughes Sowerby ... ... 406 60 — — 321 12 — — — 13 78 315 _ 21
37 —
224 6 — — 6 62 214 1 30
do. ... ... 273 — —
C. E. E. Robinson —
243 15 — — — 26 227
Todmorden ... ... 285 27 — — 4
J. H. Hindle 1 464 38 — — 72 85 474 2
Batlev and Gomersal ... 658 83 — — ■ -
W. H. Holt . 22 1 — — — 10 24 4
Gildersome ... ... 32 9 — — — _
Miss G. Wormald 1 16 — — 54 246 7
Li versed ge ... ... 306 44 — 237 5 3
H. Jackson — 5 2 ■- — 27 68
... ... 104 30 — 66 1 . 4
E. R. Brearley Mirfield —
... 301 39 1 —
246 10 i 3 1 49 339 _ 4
Miss E. W. Haigh Morley ...
... 201 26 —
— 141 7 —
— 27 20 135 — 6
J. T. Smith . Ossett ...
W. Town Horbury and Normanton,
256 1 —
760 28 ii 1 16 16 289 825 1 46
etc. ... ... 1.089
187 — — 400 23 ii 4 15 — 164 399 9
Mrs. L. I. Dodsworth ... Hemsworth East 640 —

216 — — 306 26 5 — 34 — 202 303 ■ 11

I. Scott . Do. West
406 1 — 1,165 85 11 8 30 18 469 1,243 1 30
W. Town Pontefract 1.724
79 — —
331 23 — — 8 -- 72 331 — —
H. S. Miller . Goole ... ... ••• 441 —
82 — 107 6 2 — 4 88 139 — 5
W. B. Weaver Selby . 201 35
277 2 —
913 74 2 42 12 297 963 1 21
F. Grisedale . Bolton-upon-Dearne 1,357
550 146 — 378 21 5 — — 76 261 1 10
A. J. Thorsby Bawtry and Tickhill
128 i 474 32 -- 3 36 125 452 — 7
J. Thurgood . Adwick-le-Street ... 24
87 o•j 376 29 8 — 20 90 344 1 1
H. E. Newton Thorne ... ... 546 50
226 i 822 53 3 4 1 227 864 _ 17
E. Hammerton Darfield and Darton ... 1.160
64 — 273 16 •- 3 3 78 217 , 7
VV. Taylor Worsborough . 359
216 58 — 143 8 3 --- 4 77 141 — 6
B. J. B. Marsden ... Stocksbridge — 2
44 12 28 2 12 27
F. Bailey Wortley 5
192 47 2 126 6 1 1 4 56 138 _ 17
H. Dowson Ecclesfield 4
39 117 6 ■- 11 29 168
H. Redfearn Penistone 177 — — — —

456 31 1 1 2 4 133 439

E. Firth ... . Colne and Holme Valley 607 112 — — 7
A. Smith Saddleworth . 102 16 — _ 73 3 — — i 9 16 81 — 6
Miss J. Lee» Springhead . 55 3 — - 50 1 ■- —
i — 6 36 — 2
246 62 — _ 170 8 1 — — 5 12 39 1 —
G. C. Hearn Rotherham Rural
294 26 — _ 234 13 7 4 — 10 20 228 _ 2
W. J. Blyth . Rawmarsh
566 101 — — 396 31 2 2 6 28 134 528 - 2
G. C. Hearn Maltby .
470 30 — —
336 19 1 3 4 77 32 313 —
T. H. Harrison Wath-upon-Dearne
218 32 i — 163 8 1 5 8 40 288 — 4
C. F. Airey Anston .

20,435 4,326 19 — 14,080 869 119 164 336 522 4,602 14,333 9 471

1
I
1
1
|
 00

i: ; j noN tL • l 1 • .)fff mr.JiiD id nabia ov-V

*»—-=S±=r_
-riJi : .
111 1!
VI liciiaaissa ' *.! i’ll ■ ,
m '*1
/I air"' -Ji> rfiiitl sd i
11 nrr laO 'V>09r.- 1 -.1 ;
bo-, ii;. n. ) •1 noi.. ft .jEncjaiiV
Ifi i mi ■ vwMO •
'
ill" s .is '■ .ill.
:ilfcG;.u.V 19 1119 1»<1 3* it • j
K" ,'tMm -■ a J-. aan /
V»«l
sv .d (I I.. ; <’

Of. ... > noil bi i /.-oH . 090191H -H

0 .. (rtjpsti;. ( ... ... xstyfi'A O
Ell tK .i,;.;i :!••• .yiisH .W
. (3?) ■<£) HI.. ‘ Hi*: { .In; ; niI2 .7/
?c. 80 BO» l1! gnaJ bllE 3lJl!K
or «S (noiqijlfc; rtoJjjniazniO . li'iilBli .1. .0
0 («o)iji.*2) i;9-»9lJb«>J ... ..\ Q .H .2
it (nojqii!2) 3V»iyi' I> ... ... Iniilf .0 .0
.. ,4v> rdai weblom •i . . 19laid .Cl
c«s: ee PtO'
6T '_ 88 808, .. ... niudbauO ,jti . no;. (.•/•/ .1
13 oil .xJ^UOirvd nfiiUl .. -

[ifl 06o" . alfijgOTjjiH •9Wofl a .1/ .aiM

ft of. Of .«)b;i9 -. - -r'i .qoerctiliiW .3 .3
— e« 808 ... , ... 'A ... slbsDJr'Ill .d .'■!
a. V8I ... •«* Jlqnotl .'ff
r.o SflS ••• •• /. t'■ WnmmW .'//
iS . a nr .. UtiT'rfl '<• ..; ioifoi.. .o .2
01 c 81 3(j ' "('Ul .j! ... .. noeniiilivV A *1
BIS 008 ... ... ).f! • . 9)h6l0 .D .O
■fct ee res ysI'O bus , i. . . boaff ,H
Odl BK (t ... .. sjIiijO .3 .O
»C8 I tl C.M-0 . . n - . . .. qv; i.d ,/ ^
sai EH! I . / ■■ inifl ... y.'llif' 11 ./. ■•■'HA
Cel 3 AT .rfftovrr.H ... r b„0 .V/
IF. r 38 . n»b? ... yr>i ibH .A 8».'ir
3b IF! ... y9[i9vK,3 .V/ .3
TF, 8 8<r .. noipiiiidgJiQ ... tijjlK.dr 01 .H
. vb-.i'i.'I ... nidjioil .A
J-3 06?, . •i!-.1liH . ■ rtsmbliV/ .Ci :|
Jkll — V ! ... nolKSri; *13 iKMiii-ji/g!’ i. .3
00 ... -,<ii9WC"‘ ... asrfrjuH .1 .T
TF fTC ... rioenidoJl .3 .3 .')
KU*
’ M- 4
688, ... slbniil .11 .1
Innsrm i f". ^?l- 8
« 88 M*rmoV7 .! ’iiiM
! ...
Of 10 r i ... .. I'tt'i'1 / . yt- n; ifl .M .3
1 8fl mr .. ri^isH . AT .3 *.i 1/
10 8 ...
nw.>T .V/
-lift” I Genii .iJ:*
OM T2X 010 u»3 tin Aipwitiyfl .1 .1 .tilA
0(8 .. . >i : .1
oOM E ... . . . ii t/oT W
GV rr . isllil.l .8 .H
or ... is' .a .w
mu TT8
iltl ::: :?
mt ... te'Mta.sJ* i-ji / h/\ fcrosiudi .1.
i'TF ... smc.ifT
001* • Ooi-.t.G * L: lir, noliarmneH ,H
IS 2 no 0c.;. ... .■ < . lolysT .7/
nsbna... ,fl .I .3
SI . (slnoW ... ysIisH .3
»ei it SGI ... b(9f)« an
tii 90''Jain'.'i msolbrsM ,H
?it TOO ... rini3 .3
u 801 dnowsllbta ... diinid .A
0(i ... baoftgniiqd .1 eail/
So or;- ’fiufl ff id ^rlio." mn9H .3 .it
MS" rilyia l .V/
for 006 ... . ydJlaM 01B9H .3 .0
w OVb (im»(l ni'i;u dl«W noehiaH .H .T
«ji 818 nolinA ysiiA .3 .3

t BO,*I nuB.n 68*-, 02

 61

PUBLIC VACCINATION.
A summary of the yearly returns supplied by Vaccination Officers for the past five years gives-
the following information :—
Table XLIV.

No. of Births No. of No. of Statutory

No. of
in the Certificates Declarations of
Year. Certificates of Others.
Administrative of successful Conscientious
insusceptibility.
County Area. vaccination. Objection.

1933 21,522 5,283 (24-54%) 53 14,051 (65-24%) 2,135

1934 21,660 5,251 (24-24%) 34 14,329 (66-15%) 2,046
1935 21,220 4,936 (23-26%) 28 13,992 (65-94%) 2,264
1936 20,988 4,759 (22-67%) 30 13,965 (66-54%) 2,234
1937 20,435 4,326 (21-17%) 19 14,080 (68-90%) 2,010

There are 157 Public Vaccinators under contract to perform vaccinations and re-vaccinations
in the 170 vaccination districts, and at the 15 County Institutions.
There are also 59 Vaccination Officers, 15 of whom are paid by salary and 44 by fees. Two
hold appointments with neighbouring County Boroughs and 54 are Registrars of Births and
Deaths, or have appointments under the Public Assistance Committee.
Remuneration of Vaccination Officers.

The areas and terms of service of Vaccination Officers will be reviewed in connection with
the re-arrangement of County District boundaries.
The tables set out below indicate the work done under the Vaccination Acts in the Admini¬
strative County Area during the year ended 30th September, 1938.
Table XLV.

No. of successful primary

No. of
vaccinations of persons.
successful
Under 1 re-vaccin-
1 year and
year of Total. ations.
upwards.
age.

Performed by Public Vaccinator* 3,554 223 3,777 94

Performed by Medical Officers of County Institutions 5 5 10 —

3,559 228 3,787 94

Detailed figures relating to the vaccinations and re-vaccinations performed by each Public
Vaccinator and Medical Officer of a County Institution are given below: —
Table XLVL
Vaccinations Performed in County Institutions, Year Ended 30th September, 1938.

Primary Vaccinations
Name of County Name of Medical Re-vaccina-
Institution. Officer. 1 year tions.
Under
and Totals.
1 year.
upwards.

Grenoside T. D. Norton _ _ — _
Hemsworth T. C. A. Sweetnam — — — —
Keighley T. L. Walker — — — —
Knaresborough C. H. Steinbach ... 2 1 3 —
Otley J. T. Rhodes — — — —
Penistone A. A. Masser ... . — — — —
Pontefract G. Burnett . — — — —
Settle B. S. Hyslop — — — —
Skipton . W. H. Robinson — — — —
Tadcaster ... . R. N. Crossley ... — — — —
Todmorden H. Thorp . — 4 4 —
Wetherby E. R. Hargreaves — — — —
Goole J. Crawford — — — —
Ripon . . R. W. H. Anning . i — 1 —
Selby . . O. L. Scarborough 2 — 2 —

5 5 10 —
 62

Table XLVII.
Vaccinations Performed in Vaccination Districts, Year ended 30th September, 1938.

Primary Vaccinations.
Name of Vaccination Re-vacci-
District. Public Vaccinator. 1 year nations.
Under 1 and Totals.
year. upwards.

Area No. 1.—Ewecross.

Sedbergh T. W. Rothwell ... 2
Dent C. A. Allan 1 — 1 —
Slaidburn [. T. Bleasdell ... 8 — 8 3
Gisburn ... J. T. Bleasdell — — — —
Mitton ... T. G. S. Harkness — — — —
Long Preston ... H. M. Clegg . 8 2 10 —
Austwick T. Lovett ... 4 — 4 —
Atncliffe G. D. G. Cameron 9 3 12 —
Bentham T. L. Dowell 9 2 11 —
Malham H. Wales ... 3 — 3 —
Ingleton G. J. Marks 8 — 8 —
Settle B. S. Hyslop 24 — 24 3

Area No. 2.—Staincliffe.

Skipton ... I. C. C. Morrison — — — —
Addingham W. L. Crabtree ... 3 — 3 —
Barnoldswick ... J. Pickard — 3 3 1
Cowling j. Renwick 1 — 1 —
Gargrave H. Wales ... 11 — 11 1
Grassington G. D. G. Cameron 4 — 4 -
Silsden ... M. Purcell . 2 — 2
Earby A. McKay Niven 3 — 3

Area No. 3.-—Claro.

Green Hammerton K. H. Martin 24 1 25 2
Boroughbridge F. P. Rust . 29 — 29 2
Acomb ... J. S. Dudgeon 2 — 2 —
Great Ouseburn J. M. Benson 3 — 3 —
Sharow ... S. Hey . 4 — 4 —
Ripon P. A. Steven 36 3 39 —
Kirkby Malzeard R. G. M. Harvey 9 — 9 —
K naresborough D. F. Dobson 34 1 35 —
Harrogate (part) S. Foskett 53 5 58 —
do. (Starbeck) ... S. C. Wilkinson ... 11 — 11 i
Ripley S. Foskett 7 — 7
Bishopside C. A. Flintoff 16 — 16 i
Birstwith E. G. Campbell ... 8 — 8 —

Area No. 4.—Barkston Ash.

Bishopthorpe T. H. Barton 3 — 3 —

Sherburn Wm. Murphy 43 — 43 —

Kippax ... C. C. Hargreaves — — —

Aberford J. B. Young 55 — 55 i
Padcaster E. R. Brown 37 _ 37 i
Boston Spa R. W. Lee . 44 29 73 5
Harewood, Sicklinghall H. B. Cook . 21 1 22 _
I'horner O. D. Beetham ... 27 2 29 1
Wetherby E. R. Hargreaves 34 1 35

Area No. !>.—Skvrack.

Baildon ... A E. Penn 2
1 3
Ilklcy T. B. Hearder 8 3 11
A eadon ... A. J. I. Muschamp 26 2 28
Horsforth D. W. E. Burridge 5 _ 5
Otley W. FI. Galloway 48 2 50 1

Area No. 6.— Worth Valley.

Keighley F. Villy
Bingley (part). W. A. Lochhead
Cullingworth ... W. A. Lochhead
Haworth J. E. Baird
Steeton ... J. Renwick
Wilsden T. M. S. Findlater

Area No. 7.~ -East Morlev.

Hunsworth J. A. Hope
Drighlington H. D. Merrington 6
Calverley 6
N. A. A. Hughes 13
Farsley ... 13
T. H. Elmer 28
Shipley ... 28
J. G. Craig 42
Denholme 43
A. H. Stewart 1
Pudsey ... 1
E. T. Hyland 36 37
Area No. 8.—C alder.
Sowerby Rridge V. C. Meyer 16
F.llnnd .
17
A. G. Gamble 16 16
Stainland W. J. L. Francis 11
Brighouse 12
C. M. Stallard ... 36
Shelf ... 36
I. J. Murphy
Oueensbury G'.'C. Sharp 10
Midgley. 10
C. S. Ogilvy 1
Barkisland 1
A. J. W. Stephen 11
Todmorden H. Thorp ...
12
8 10
Hebden Bridge F. J. Dowdall 3 3
"My tholmroyd ... S. T. Henderson 4 5
 63

Table XLVII—continued).

Primary Vaccin
Name of Vaccination Re-vacci¬
Public Vaccinator.
District. 1 year nations.
Under 1 and Totals.
year. upwards.

Area No. 9.—Spen Valley.

Liversedge ... . R. M. Beatty 25 4 29
Birstall. A. Dick . 9 3 12
Gildersome ... . H. D. Merrington — —
Batley . H. Keighley ... . 32 1 33
Heckmondwike . H. W. Laing 10 2 12
Mirfield. J. E. H. West 26 — 26
Morley ... W. S. Sykes 37 — 37
Birkenshaw . E. M. Whitehead 7 — 7
Ossett . S. B. Stoker 23 4 27
Cleckheaton A. L. Mitchell ... . 3 — 3
Area No. 10.—Lower
Agbrigg.
Horbury ... . J. N. U. Russell 14 4 18
Normanton N. S. Twist 53 4 57
Crigglestone K. S. Macdonaid-Smith 33 4 37
Walton ... I). Downie 11 — 11
Stanley ... . J. D. Bottomley ... 61 3 64
Emley ... ... . C. H. Smith 5 — 5
Crofton ... 1 . E. Lister 20 1 21
Ardsley ... . T. Stephens 17 1 18
Roth well H. Stevenson 30 — 30
Oulton ... C. H. Seville . 18 1 19

Area No. 11.—Usgoldcross.

Heck . F. G. Creaser 14 1 15
Knottingley . J. Kehelly . 78 — 78
Pontefract ... . G. Burnett 60 3 63
Methley ... . E. W. L. White 17 — 17
Featherstone Win. Steven 51 1 52
Castleford . J. J. W. Campbell 90 — 90
Brotherton ... . B. H. Citibanks 64 — 64
Kirksmeaton J. Malloch 7 — 7
E. J. H. Sullivan 119 2 121
South Elmsall ...
Ryhill . S. Hodkinson 47 3 50
Brierley W. Ross Gardner 42 44
Great Houghton J. W. Whitworth . — —
Hemsworth T. C. A. Sweetnam 46 1 47
Kinsley ... M. B. Taylor . 40 — 40
Ackworth W. L. Gardner ...

Area No. 12.—Goole and

Selby.
Drax 16 16
F. G. Creaser
45 4 49
Selby O L. Scarborough
35 — 35
Snaith ... ... . F. G. Creaser
2
Swinefleet W. Eardley —
Goole A. M. Erskine 15 1 16
I’. Eardley . i 1
Eastoft ... —

Area No. 13.—Don Valley.

Bolton-on-Dearne J. K. T. Mills . 58 fi 64
Mexborough J. J. Huey . 25 4 29
Tickhill ... H. M. Brown 8 — 8
Bentley-with-Arksey ... B. Lyons ... 35 1 36
Conisbrough W. J. Maclure ... 178 25 203
Askern ... J. Malloch 47 3 50
Adwick-le-S treet D. Malloch 46 — 46
'l'hurnscoe F. J. Boyle 63 9 72
Brodsworth J. Wylie. 9 — 9
Armthorpe H. F. Renton 35 — 35
Bawtry ... W. F. Ward . 25 — 25
C. D. Walker . 38 *- 38
Hatfield
J. M. Taylor 28 3 31
Thorne ...
R. M. L. Anderson 20 — 20
Stainforth
Area No. 14.—Staincross.
Hoyland H. R. L. Allott. 40 6 46
Worsborough ... H. A. L. Banham 33 — 33
Cudworth 1. F. Quigley 51 — 51
Darfield J. W. Whitworth 9 — 9
Dodworth J. Leishman 17 — 17
Darton ... R. Millar. 33 3 36
Wombwell J. C. Pickup 29 — 29
Hoyland P. Lewis ... 29 4 33
Royston H. B. Pare 34 2 36
Bradfield J. A. R. Thompson 22 — 22
Stannington N. MacPhail 16 — 16
Loxley ... T. A. H. Smith. — —
Chapeltown H. Sands ... 33 — 33
Grenoside J. Smail 23 i 24
Stocksbridge A. E. Gofdie 33 5 38
Tankersley P. Lewis ... — —
Wortley T. H. Easton 1 — 1
Silkstone F. L. Whincup ... 8 1 9
Clayton West ... E. L. Mommen ... 4 — 4
Thurgoland T. H. Easton ... . 5 1 5
I’enistone A. A. Masser 18 1 19
 (> 4

Table XLVII—continued).

Primary Vaccinations
Name of Vaccination Re-vacci-
Public Vaccinator Under 1 1 year and
District nations
Totals
year upwards

Area No. 15.—Upper Agbrigg.

Kirkburton J. A. Stephens 13 1 14 1
Skelmanthorpe D. Bell . 7 1 8 —
Shepley ... ... . M. M. Dey 7 — 7 - •
Holmfirth W. D. Galloway ... 10 1 11 —
Scholes. E. Trotter . 17 — 17 —
Honley ... W. H. Smailes ... 6 — 6 —
Meltham P. MacGirr 17 — 17 —
10 5 15 —
Slaithwaite R. N. Kirk .
— 14
Golcar ... S. Hall . 14 —
Marsden G. R. Aspinwall 14 2 16 —
Kirkhfeaton S. Prior 4 — 4 —
Springhead J. G. Oliver ... . 2 — 2 —
Saddleworth J. Loftus ... 3 2 5 —

Area No. ICt.—Rother Valley.

Brinsworth R. G. Selby 33 2 35 —
Thurcroft G. S. L. Kemp ... 25 2 27 —
Wentworth Id. M. Mills . 4 — 4 2
Wath-on-Dearne G. R. Bailey 4 1 5 —
Rawmarsh D. P. K. Jockel. 24 3 27 —
Maltby ... W. L. Dibb . 39 1 40 1
Swinton C. J. H. Aitken .. 15 2 17 2
Thryberg G. H. Sedgwick ... 29 29 —
Harthill, Anston B. D. Rawlin 36 2 38

3,554 223 3,777 94

MEDICAL EXAMINATIONS OE THE STAFF OF THE COUNTY COUNCIL.

In view of the large number of officers and servants employed by the County Council there
is necessarily a considerable volume of medical examinations to be carried out. In the West
Riding all of these are not made by the medical staff of the County Council as certificates are
accepted from the candidates own medical practitioners. The form of the report on all medical
examinations is one laid down by the County Medical Officer and each report and certificate are
submitted to him for final approval.

The following table shows the number of medical examinations made during the last three
years :—
1936. 1937. 1938
Examinations by County Medical Officer’s
staff ... 185 280 438
Examinations approved by County Medical
Officer but made by general practitioners. 411 396 172
Special examinations bv County Medical
Officer’s staff 7 12 26'

603 688 636

The special examinations are usually made at the request of the “Sickness” Sub-Committee
on employees whom it is thought may have become incapable of discharging the duties of their
office owing to ill health. Such examinations are made by two or more medical officers.
 PART II.
THE WORK OF THE COUNTY LABORATORY.
Dr. P. L. Sutherland—Bacteriologist and Pathologist.

The total number of specimens examined in the County Laboratory during the year 1938,
was 103,535.

This number includes 20,629 specimens received from the County Boroughs of Barnsley, Dews¬
bury, Doncaster, Halifax, Middlesborough and Wakefield, from the Dewsbury and Heckmondwike
Joint Waterworks Board, and from the Ministry of Agriculture and Fisheries.

The following table shows the number of specimens of different kinds examined during each
month of the year.

Table XLVIII.

Serum
Reaction for Sputum for Suspected Venereal Miscel¬
Month.
Enteric Tubercle Diphtheria Disease laneous Total
Fever Bacilli

January . 59 582 4,648 3,087 2,457 10,833

February 32 527 4,206 2,992 2,427 10,184
March 76 662 3,598 3,111 2,544 9,991
April . 89 566 2JL33 2,478 1,946 7,212
May . . 116 675 2,810 2,714 2,705 9,020
June ... 76 538 1,685 2,481 2,877 7,657
July. 94 620 1,935 2,944 2,266 7,859
August 88 499 1,378 2,964 1,750 6,679
September ... 65 595 1,827 3,099 2,374 7,960
October 64 617 2.421 3,355 2,221 8,678
November ... 115 675 3.181 3,330 2,285 9,586
December ... 46 501 2,798 2,379 2,152 7,876
. ..

Total 920 7,057 32,620 34,934 , 28,004 103,535

The next table gives the figures for 1938, in comparison with those for the previous
six years :—

Table XLIX.

Serum
Sputum for
Reaction for Suspected Venereal Miscel¬
Year. Tubercle
Enteric Diphtheria Disease laneous Total
Bacilli
Fever

1932 1,545 5,983 14,750 4,132 11,128 37,538

1933 846 6,423 15,383 4,532 10,145 37,329
1934 522 6,399 25,136 4,964 11,472 48,493
1935 510 6,165 29,494 6,459 13,341 55,969
1936 676 6,216 24,383 9,715 17,359 58,349
1937 755 6,394 28,245 28,643 23,959 87,996

1938 920 7,057 32,620 34,934 28.004 103,535

A more classified list of the specimens received during the whole year, showing results where
possible, is given in the following table.

Table L.

Type of Specimen. Positive. Negative. Total.

Enteric Fever.

Widal reaction (blood).

B. Typhosus 14 220 234
B. Paratyphosus A . — 234 234
B. Paratyphosus B . . 16 218 234
B. Paratyphosus C 1 — 1

Urines.
B. Typhosus — 165 165
B. Paratyphosus A — 165 165
B. Paratyphosus B ... ... ... . 1 164 165

Fceces.
B. Typhosus — 322 322
B. Paratyphosus A — 322 322
B. Paratyphosus B 17 305 322
B. Paratyphosus C 2 — 2
 6t>

Table L—(continued).

Type of Specimen. Positive Negative Total

Undulant Fevkr ... ... . 9 208 217

Food Poisonino 6 15 21

Dysentery ... 13 175 188

Human Tuberculosis.
Sputa.
First examinations 1,579 4,487 6,066
Second examinations ... 16 640 656
Third examinations 11 324 335
Urines 10 154 164
Urines ... ... . — — 1,476

Bovine Tuberculosis.
C.V.O. milks from single cows ... 10 78 88
C.V.O. group samples 4 63 67
Ministry of Agriculture milks from single cows ... 65 456 521
Ministry Agriculture group samples ... 34 3d6 390
Ministry of Agriculture control samples 14 72 86
Mixed milks from various sources 145 3,802 3,947
Milks from single cows received from
County Boroughs 1 8 9

Milks for Bacterial Content ... ... . — — 4,468

Waters for Bacteriological Examination. — — 1,886

Diphtheria.
Swabs for diagnosis 1,260 5,280 6,540
Swabs from convalescents 2,647 17,274 19,921
Swabs from “contacts” ... 209 5,950 6,159

Cbrebro-Spinal Fever. ... 11 224 235

Anthrax.
Human 4 12 16
Bovine —
Wools . 2 40 42

Bio-Chemical Examinations — — 3,079

Zondek Aschheim Tests ... 140 146 286

Ringworm. . 44 66 110

Ophthalmia Neonatorum 8 37 45

Cytological Specimens ... ... ... ... . — — G60

Histological Specimens (Clinical) ... . — — 315

Vaccines — — 29

Post-Mortem Examinations — — 92

Medico-Legal Histology Examinations . — — 373

Examinations for the Police ... — — 26

Venereal Disease.

Syphilis.

Wassermann reaction 987 6,961 7,948

Pallida reaction 967 6,367 7,334
Meinicke reaction M.K.R. 11 1,548 6,277 7,825
Ballungs reaction 1,433 6,685 8,118
Mastic reaction 37 61 98
Lange gold sol test ... 11 115 126
Slides for Spirochaetes — — —
Gonorrhoea.
Gonococcal complement fixation test 185 897 1,082
Ballungs gonococcal test 125 791 916
Slides for gonococci ... 241 1,246 1,487

Silicosis ... ... ... ... . — — 22

Other Specimens ... — _ —

EXAMINATIONS MADE FOR OTHER AUTHORITIES.
The following table gives the number of examinations made for other Authorities, exclusive
of Venereal Diseases examinations, which are given in detail in Table LIV on page 70.

Table LI.

Authority No. of Specimens Cost to Authority

£ s. d.

Barnsley C.B. 1,859 331 lli 0

Dewsbury C.B. 310 96 18 0
Doncaster C.B. 47 11 12 6
Halifax C.B. ... 39 8 2 6
Wakefield C.B. 2,345 383 4 6
Middlesborough C.B. 52 13 14 0
Dewsbury and Heckmondwike
Joint Waterworks Board 101 50 10 0
Ministry of Agriculture and
Fisheries 939 468 10 0

5,692 1.364 7 6

ENTERIC FEVER.
Examination for Widal reaction.— During the year, 703 specimens of blood were tested for
the Widal reaction for the diagnosis of typhoid fever and paratyphoid fever. In the majority of
cases the blood was tested against B. typhosus, B. paratyphosus A, and B. paratyphosus B.
14 specimens gave a positive agglutination with B tvphosus, 16 with B. paratyphosus B. and 1 with
B. paratyphosus C.

It has been mentioned in recent reports that the improvement in the quantity of blood sent
to the Laboratory for this examination permitted of the macroscopic test being carried out in the
majority of cases. This improvement has again been maintained during 1938 so that the additional
test for B. Abortus has been carried out on the majority of specimens received primarily for exam¬
ination for enteric fever.

Examination for B. typhosus and B. paratyphosus A. and B.—The number of specimens exam¬
ined for organisms of the typhoid group was 1,163. These consisted chiefly of samples of urine
and faeces from convalescent cases and from suspected “carriers.” Of these 17 specimens of
faeces and 1 of urine contained B. paratyphosus B and 2 specimens of faeces contained B. paraty¬
phosus C.

A considerable number of specimens of blood for widal reaction and of urine and faeces for
examination for B. typhosus and B. paratyphosus A. and B. have been received from Medical Offi¬
cers of Health from workmen employed on waterwork schemes. These specimens have been sent
in accordance with the recommendation contained in the Ministry of Health’s Memorandum No. 221
(Memorandum on the safeguard to be adopted in day to day administration of Water Under¬
takings).

UNDULANT FEVER.
217 specimens of blood were examined for undulant fever, and 9 specimens proved positive.

DYSENTERY.
122 specimens of faeces, 21 of urine, 10 of blood, 23 of water and 12 of milk were examined
during the year for B. Dysenteriae and 10 specimens of faeces and 3 of urine proved positive. The
organism in each case was B. Sonne.

FOOD POISONING.
21 specimens were received during the year for examination for food poisoning organisms.
These comprised 16 specimens of faeces, 2 specimens of blood, an empty peach tin, salmon and
pasteurised milk. Six specimens of faeces proved positive; 4 showing the presence of B. Gaertner
and 2 B. Aertrycke.

HUMAN TUBERCULOSIS.
Sputum.—The specimens examined microscopically for the tubercle bacillus numbered 6.066
and in 1,579 or 26-0 per cent, the bacillus was found.

656 specimens which had been previously examined twice microscopically with negative result
were re-examined by the sedimentation method, and 16 or 2 4 per cent, were found to be positive.

335 specimens which had been previously examined three times microscopically and once by
sedimentation with negative result, were again re-examined by the sedimentation method, and
by culture. Of these, 11, or 3 2 per cent., were found by one or other but chiefly by the cultural
method, to be positive.

By the sedimentation and cultural methods, 2-7 per cent, of specimens were found to be
positive, after two or three microscopic examinations had failed to show the presence of the
tubercle bacillus.
 68

Urine.—Of the 1,476 specimens of urine which were received for examination, for various
reasons, 164 were examined for tubercle bacilli to exclude the presence of tuberculosis of the
bladder or kidney. Of these,10 were found to contain B. tuberculosis.

Other specimens.—The remaining 125 specimens of human origin examined lor the tubercle
bacillus were pus 43, pleural fluids 35, fteces 21, cerebro-spinal fluids 20, and fluids from knee 6. In
5 specimens of pus, 1 of pleural fluid, 1 of fmces, 4 of cerebro-spinal fluid, and 1 of fluid from knee,
tubercle bacilli were found.

BOVINE TUBERCULOSIS.
Milk.—Veterinary Samples.—During the first quarter of the year 155 samples of milk were
examined for the Chief Veterinary Officer of the West Riding and during the remainder of the year
997 were examined for the Ministry of Agriculture and Fisheries, a total of 1,152. These milks
were examined by the inoculation test. They comprised 609 milks from individual cows, 457 group
samples and 86 control samples (i.e., mixed samples from a herd). Of these 75 from individual
cows or 12‘3 per cent., 38 group samples or 8%3 per cent., and 14 control samples or 162 per cent,
proved positive.

In addition, 569 of the above samples of milk from individual cows, were examined culturally
for tubercle bacilli, and 44 or 7 7 per cent., proved positive. Thirty-one of these cultural positive
results were confirmed by the biological test. In 11 cases, where the cultural result was negative,
the biological test proved positive.

Mixed Milks.—During the year, samples of milk of all grades were examined by the inocula¬
tion test for tubercle bacilli.

The specimens included samples of school milk and graded milk submitted by the central
staff, samples from local sanitary inspectors, and a few sent by the sanitary inspectors of
other authorities, viz., Barnsley, Dewsbury and Wakefield County Boroughs.

The following table gives the result of the examination of these milks :—
Table LI I.

Mixed Milks examined for B. Tuberculosis.

West Riding Administrative Area.

From County Total.
Milk supplied to Milk collected by Other Mixed Borough
Schools. County Central Staff. Milks.
Class of
% Positive.

% Positive.
Positive.

% Positive.

% Positive.
Examined.
Examined.

Examined.

Examined.

Examined.
Positive.

Positive.

Positive.

Positive.

Positive.

Milk.
No.

No.
No.

No.

No.
%

Tuberculin
Tested 145 3 20 7 15 167 3 1 -8

Accredited ... — — — 1410 57 40 11 — — 70 2 2-8 1491 59 3-9

Pasteurised 121 2 1-6 — — — 200 5 2•5 62 1 1 -6 383 8 20

Ordinary 262 9 3-4 129 2 1 -5 1335 58 4-3 180 6 3-3 1906 75 3-9

3S3 11 2-8 1684 62 3-6 1553 63 4-0 327 9 2-7 3947 145 3-6

Nine samples of milk, taken from single cows, were received from various County Boroughs
and examined with positive result in one case.

884 samples of milk, received for the Methylene Blue Reduction test, were not in addition
examined by animal inoculation to exclude tubercle bacilli owing to the fact that in some cases a
sample of milk from the same producer was at the time undergoing the test or, in other cases, to
lack of room in the animal house.

The total number of milks examined was 3,947, of which 145 or 3-6 per cent., were found to
be tuberculous. It will again be observed that a designated milk is not necessarily free from tubercle
bacilli.

Of the 11 positive school milks, 6 also failed to fulfil the standard set up as regards cleanliness.

Following the practice carried out in previous years, the result of each positive milk was
immediately notified by telephone to the Chief Veterinary Officer of the West Riding during the
first three months of the year and to the Ministry of Agriculture and Fisheries during the remainder
of the year, who at once instituted investigations for the detection and destruction of the tuberculous
animal.
 69

As a result of these investigations 70 cows were found and slaughtered from 57 herds. In
5 of these cases the cow was found during routine inspection between the time of the sample being
taken and the result being known. In addition it was ascertained that one farmer had sent a cow
for slaughter voluntarily immediately following the sample of milk being taken. In 72 cases the
offending animal could not be found.

In addition, 3 positive cases were referred to the Barnsley Medical Officer of Health, 4 to
Leeds, 4 to Wakefield and 4 to the County Medical Officer of the East Riding of Yorkshire.

EXAMINATION OF MILK FOR BACTERIAL CONTENT.

4,468 specimens of milk were examined for bacterial content, in the case of Tuberculin Tested,
Accredited and Ordinary milks by the methylene blue reduction test and Pasteurised milks by the
plate count test. Of these, 1,145, or 25-6 per cent., were unsatisfactory.

These samples include the milk supplied to schools, designated milk, and the milk of applicants
for licences, collected by the County Central Staff, and milk sent by other Authorities.

The following table gives the details of examinations made :—

Table LIII.

Mixed Milks examined lor Bacterial Content.

West Riding Administrative Area. From

county Durougns Total
Supplied to Milks collected by
Schools County Central Staff Other
Design ation. Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory Unsatisfactory
O

Percentage

Percentage
Percentage

Percentage

Total
Total

Total

Total

Total

XM
Number

Number

Number
Number
Number

c
u
O
u
V
Qh

Tuberculin — — — 193 32 16-5 12 2 16-6 24 3 12-5 229 37 161

Tested

Accredited ... — — — 1861 323 17-3 20 2 100 72 21 29 ■ 1 1953 346 17-7

Pasteurised 115 28 24-3 — — — 197 52 26-4 67 22 32-8 379 102 26-9

Ordinary 317 78 24-6 167 45 26-9 1338 511 38-2 85 26 30-5 1907 660 34-6

432 106 24-5 2221 400 18-0 1567 567 36'1 248 72 29 0 4468 1145 25-6

WATER.
1,886 samples of water were examined of which 1,013 drinking waters were pure, 620 polluted
and 106 of doubtful purity. The remaining 147 were samples of swumming baths waters.

There has been a marked increase in the number of drinking waters examined compared with
1937 and a considerable improvement in the percentage of satisfactory drinking waters. The
standard adopted is still the same, i.e., as laid down by the Ministry of Health in their memorandum
No. 71 “The Bacteriological Examination of Water Supplies.’’

In the investigation of water supplies a careful topographical examination should be made

in every case and use should be made of both chemical and bacteriological methods of examination.
There is a tendency to neglect chemical in favour of bacteriological examination and to omit topo¬
graphical examination. Water supplies should only be judged after a careful consideration of
the results obtained by all three methods.

DIPHTHERIA.
During the year; 32,620 swabs were examined for the diphtheria bacillus.

Swabs for Diagnosis.—The number of swabs submitted by practitioners for diagnosis was
6,540, of which 1,260 or 19-2 per cent, were positive.

Swabs from convalescents.—The number of swabs examined in order to determine if conval¬

escents were free from infection and ready for discharge from isolation, was 19,921, and of these
2,647 or 3 2 per cent, were found to be positive. The swabs were received chiefly from the
medical superintendents of isolation hospitals.

Swabs from “ contacts.”—The number of swabs from “contacts” was 6,159, of which 209, or
3-3 per cent, were positive. The swabs were collected from persons, mostly children, known to
have been in contact with cases of diphtheria, from suspected “ carriers,” and from children attend¬
ing schools where diphtheria was prevalent. These specimens were sent by local medical officers
of health, or collected by members of the central staff.
 70

VENEREAL DISEASES.
The number of pathological examinations performed under the Public Health (Venereal
Diseases) Regulations, 1916, was 34,934. Of these, 14,937 were made on behalf of the County
Boroughs of Barnsley, Dewsbury, Doncaster, Halifax and Wakefield.

Table LIV.

Nature of Test.

Specimens examined for

SYPHILIS gonorrhoea
Cost to
District Gonococ¬ Ballungs Total
Wasser- Pallida Meinickc Ballungs Mastic Lange Slides for cal Gono¬ Slides for Authority
mann Reaction Reaction Reaction Reaction Gold Sol Spiro- Comple¬ coccal Gono¬
Reaction M K.R II. Test chaetes ment cocci
Test
Test
£ s. d.
West Riding ... 4561 4200 44S7 4857 60 68 — 633 534 597 19997

Barnsley C.B. ... 594 538 590 503 6 36 — 28 23 1 2319 164 18 6

Dewsbury C.B. 350 324 345 324 8 1 — 17 14 159 1542 140 14 6

Doncaster C.B. 651 608 639 824 — — — 325 277 700 4024 402 1 0

Halifax C.B. ... 1371 1263 1351 1223 20 3 — 35 34 4 5304 424 2 0

Wakefield C.B. 421 401 413 387 4 18 — 44 34 26 1748 171 0 0

7948 7334 7825 8118 98 126 — 1082 916 1487 34934 1302 16 0

CEREBROSPINAL FEVER.
215 specimens of cerebro-spinal fluid were examined for the presence of meningococci. In 5
specimens of fluid the meningococcus was found, which confirmed the diagnosis of cerebro-spinal
fever and 2 showed the presence of pneumococci (pneumococcal meningitis.)

Twenty fluids which were negative as regards meningococci were examined culturally to exclude
tubercle bacilli and in 4 the tubercle bacillus was found. In 204 specimens the result was negative.

HUMAN ANTHRAX.
Sixteen specimens were received during the year for examination for B. Anthracis. In 4 cases
the result was positive, particulars of which are as follows:—•

Male, age 56; Dewsbury.

Male, age 34; Dewsbury. Pustule on right arm.
Female, age 31 ; Dewsbury. Pustule.
Male, age 27; Keighley. Pustule on neck.

The Keighley case subsequently proved fatal and a post-mortem was performed by the County
Pathologist (Post-Mortem No. 64).

EXAMINATION OF WOOL, etc., FOR ANTHRAX.

42 samples of wool were examined for the presence of B. Anthracis, with positive result in 2
cases. The material in which B. Anthracis was found was as follows:1—

Unwashed medium Turkey mohair.

Dust from cyclone.

The first specimen was received in connection with the case at Keighley (mentioned in the
preceding paragraph) and the second in connection with] a case at Earlsheaton.

RINGWORM.
The number of specimens of hairs and scales examined was 110, and 44 or 40 0 per cent,
gave a positive result.

OPHTHALMIA NEONATORUM.
45 specimens of pus from the eyes of infants suffering from ophthalmia, suspected to be of
gonorrhoeal origin, were examined, 8 of which proved positive.

CYTOLOGICAL EXAMINATIONS.
660 examinations were made, including examinations of blood films and determination of the
number of white cells, red cells and haemoglobin.
 71

BIOCHEMICAL EXAMINATIONS.
During the year, 3,079 bio-chemical examinations were made. The chief items amongst
these examinations comprised blood sugar and blood urea estimations, the examination of samples
of pasteurised milk for pasteurisation efficiency (phosphatase test), and the examinations of blood
and urine in connection with a special ante-natal investigation for the Ministry of Health.

VACCINES.
29 autogenous vaccines were prepared during the year, from the following material:—
pus from boils etc. 15, pleural fluid 2, sputa 7, swabs 2, faeces 1, hairs from beard 1 and ear
discharge 1.

ZONDEK ASCHHEIM TESTS.

286 specimens of urine were received for the Zondek Aschheim test; 140 of these proved
positive.

POST-MORTEM EXAMINATIONS AND INQUESTS.

During the year, 92 examinations were made by Dr. Sutherland, at the request of West
Riding Coroners, and evidence was given at 80 inquests. Evidence was also given at Leeds
(5 cases), and York Assizes, and at the Doncaster, Huddersfield, Otley, Pontefract, Pudsey,
Skipton, Tadcaster and York West Riding Magistrates’ Courts.

Details of the cases examined were as follows:—

Table LV.
No. Age. Sex. No. Age. Sex.
1 50 M. Hodgkin’s disease. 47 17/12 M. Asphyxia, cause not shown.
2 14/12 M. Asphyxia, cause not shown. 48 60 F. Silicosis and carcinoma of lung.
3 24/365 M. Asphyxia, cause not shown. 49 7/52 F. Bronchitis.
4 67 M. Carcinoma of stomach and liver. 50 61 F. Coal gas poisinig.
5 42 M. Impaction of denture in larynx. 51 12/365 M. Icterus neonatorum.
6 47 M. Silicosis and pulmonary tuberculosis. 52 60 M. Dementia Paralytica.
7 27 F. Uraemia. •53 59 M. Anthraco-silicosis.
8 51 M. Pulmonary tuberculosis. 54 58 M. Pericarditis and silicosis.
9 34 M. Pulmonary tuberculosis 55 59 M. Haemorrhage and shock following fracture
10 3/12 M. Asphyxia, cause not shown. of pelvis and right femur.
11 24 F. Septic endometritis and peritonitis following •56 52 M. Cancer of liver.
abortion. 57 45 M. General peritonitis resulting from rupture
12 62 M. Massive silicosis and pneumonia. at small intestine.
13 3/365 M. Pneumonia. 58 51 M. Silicosis and tuberculosis.
14 74 M. Fracture of nose and upper jaw. 59 38 M. Pulmonary tuberculosis.
Manslaughter. 60 New born F. Atelectasis.
15 New born F. Asphyxia, cause not shown. 61 37 F. Septic peritonitis from salpingitis.
16 4/365 M. Asphyxia, cause not shown. 62 40 I-. Exhaustion and haemorrhage following
17 New born F. Congenital heart defect. abortion.
18 32 F. Pulmonary embolism. 63 12 F. Diphtheria.
19 1/12 M. Asphyxia, cause not shown. 64 27 M. Anthrax.
20 34 M. Rupture of spleen. Alleged assault. 65 24 F. Septicaemia following abortion.
21 42 M. Cerebellar haemorrhage. 66 4/365 F. Asphyxia; cause not shown.
22 37 F. Wounds on scalp. Fractures of skull and 67 5 M. Enteritis; probably dysentery.
lacerations of brain. Murder. 68 50 M. Pulmonary tuberculosis.
23 63 M. Septicaemia, cause not known. 69 7/12 M. Gastro-enteritis.
24 57 M. Pulmonary tuberculosis. 70 64 F. Coronary atheroma and myocardial
25 10/52 F. Asphyxia, cause not shown. degeneration.
26 34 M. Pulmonary tuberculosis. 71 25 F. Death from anaesthetic.
27 38 F. Septicaemia following abortion. 72 44 M. Myocarditis.
28 9J months F. Congenital heart disease. 73 26 F. Septicaemia following abortion.
29 50 M. Silicosis and tuberculosis. 74 44 M. Pulmonary tuberculosis.
30 69 M. Haemorrhage from tuberculous cavity and 75 70 M. Silicosis and tuberculosis.
silicosis. 76 47 M. Tuberculosis.
31 30 F. Septic abortion. 77 56 M. Atheroma of the coronary arteries.
32 3/12 F. Atelectasis of lungs. 78 20/12 M. Acute pericarditis.
33 32 M. Pulmonary tuberculosis. 79 43 M. Cancer of lung.
34 63 M. Myomalacia cordis. Marked coronary 80 58 M. Silicosis and tuberculosis.
atheroma. 81 47 M. Fibroid phthisis and pneumonia.
35 58 M. Chronic bronchitis. Emphysema. Coronary 82 47 M. Cerebral haemorrhage.
artery sclerosis. 83 3/12 M. Capillary bronchitis.
36 33 F. Malignant endocarditis. 84 62 M. Cardiac failure from atheroma of aorta and
37 45 M. D'ementia paralyticia. cardiac valve accelerated by carcinoma of
38 New born M. Still born. base of right lung.
39 19 F. Sepsis following abortion. 85 48 M. Aneurysm of aorta : rupture into left bronchus
40 62 M. Silicosis and tuberculosis. 86 63 M. Sclerosis of coronary arteries.
41 33 F. Septicaemia following abortion. 87 6/12 M. Gastro-enteritis.
42 45 M. Pulmonary tuberculosis and silicosis. 88 60 M. Tuberculosis and silicosis.
43 52 M. Pulmonary tuberculosis. 89 61 M. Silicosis and tuberculosis.
44 67 M. Myeloid leukaemia. 90 39 hours M. Atelectasis and jaundice.
45 6/12 M. Capillary bronchitis. 91 29 M. Toxic jaundice.
46 6/52 M. Bronchitis. 92 8/12 M. Haemorrhage into pleura.

EXAMINATIONS MADE FOR THE POLICE.

26 examinations were made for the Police (24 for the West Riding, 1 for Wakefield City
and 1 for Dewsbury Borough).

As usual the majority of the examinations were of clothing for spermatozoa in connection with
cases of alleged criminal assault and indecency. Other cases comprised the examination of a
white powder in connection with alleged poisoning, a brown fluid and drinking glasses connected
with cases of drinking out of hours, and clothing and other material in cases of alleged criminal
abortion.
 72

BIOLOGICAL EXAMINATIONS.
During- the year, 5,603 specimens were examined biologically, involving the use of 12,034 animals
(10,604 guinea-pigs and 1,430 mice) for diagnostic purposes. The tests on guinea pigs were simple
subcutaneous inoculations for the detection of tubercle bacilli chiefly on samples of milk, for the
determination of the virulence of B. diphtheriae and for the detection of anthrax bacilli.

The mice were used for the Zondek-Ascheim reaction for the diagnosis of pregnancy.

Since February of 1937, the biological test for the tubercle bacillus has been replaced bv cultural
examination in the case of sputa, pus, cerebro-spinal fluids and other routine samples unless a
biological examination is specially requested by the sender.

The cultural method has proved superior to biological examination in these cases and has
resulted in a considerable saving of guinea-pigs. An attempt is made, however, to confirm the
diagnosis by animal inoculation in the case of every positive culture.

These tests were made not only for the West Riding County Council, but also on behalf of the
County Boroughs of Barnsley, Dewsbury, Doncaster, Halifax, Wakefield, the Government Wool
Disinfecting Station at Liverpool, and the Ministry of Agriculture and Fisheries.

Table LVI.

List of Sanitary Districts in the West Riding showing the Number of Specimens received from
each during 1938.
Urban Districts. Urban Districts. Rural Districts.
Adwick-le-Street ... 641 Malt by . 94 Bowland 25
Aireborough 85 Meltham ... ... ... 64 Doncaster ... 578
Baildon 48 Mexborough ... ... 143 Goole ... . 39
Barnoldsvvick 392 Midgley . 3 Hemsworth 335
Batley B. ... 961 Mirfield ... ... ... 141 Kiveton Park . 65
Bentley-with-Arksey 214 Morley B. 1,942 Nidderdale ... 76
Bingley 411 Normanton 188 Osgoldcross 72
Brighouse B. 702 Ossett B. ... ... ... 170 Penistone 23
Castleford ... 533 Otley . 375 Ripon and Pateley Bridge 39
Colne Valley 110 Penistone ... ... ... 34 Rotherham 227
Conisborough 61 Pontefract B. . 365 Sedbergh 37
Cudworth ... 20 Pudsey B. 173 Selby 28
Darfield 14 Queensbury and Shelf ... 198 Settle . 87
Darton 48 Rawmarsh ... ... ... 31 Skipton . 182
Dearne 323 Ripon C. ... ... ... 48 Tadcaster ... . 228
Denby and Cumberworth 78 Ripponden ... ... ... 23 Thorne 63
Denholme ... 24 Rothwell . 138 Todmorden ... 7
Dodworth ... 15 Royston ... ... ... 21 Wakefield ... 147
Earby 95 Saddleworth ... ... 80 Wetherby 405
Elland 93 Selby . 108 Wharfedale 74
Featherstone 145 Shipley . 913 Wortley 159
Garforth 24 Silsden ... ... ... 14
Goole B. 281 Skipton . 199 County Boroughs : —
Harrogate B. 688 Sowerby . 365 Barnsley 1,859
Hebden Royd 62 Spenborough ... ... 152 Dewsbury ... 310
Heckmondwike 60 Stanley ... ... ... 94 Doncaster. 47
Hemsworth 165 Stocksbridge ... ... 44 Halifax 39
Holmfirth ... 150 Swinton . 103 Wakefield ... 2,345
Horbury 46 Tickhill ... ... ... 20
Horsforth ... 217 Todmorden B. 369 Hospitals, etc. 29,975
Hoyland Nether 208 Wath-upon-Dearne ... 116 School Medical Inspection
Ilkley 93 Wombvvell ... ... ... 134 and Child Welfare Staff 526
Keighley B. 2,672 VVorsborough ... ... 31 County Central Staff 6,269
Kirkburton )••• 53 Tuberculosis Staff 4,995
Knaresborough 11 Venereal Specimens 34,934
Knottingley 59 Specimens from Chief
Veterinary Officer
and the Ministry of
Agriculture and Fisheries 2,269
Government Wool Disin¬
fecting Station, Liverpool 42
Staff Appointments 329
Total No. of Specimens
examined bacteriologic-
ally ... . 103,535
 73

PART III.

MATERNITY AND CHILD WELFARE.

Dr. R. Lawrence.—Chief Assistant Medical Officer for Child Welfare and School Medical
Inspection.

Dr. J. Wood Wilson—Assistant County Medical Officer.

Statistics, 1938.
County Council’s
Whole of Maternity and
Administrative Child Welfare
County. Area.

Estimated Population, 1938 1,501,100 940,402

No. of Live Births (registered) ... 23,246 14,989
No. of Illegitimate Births ... 870 560
No. of Stillbirths 1,060 682
Birth Rate 15-5 15-7
Deaths under one year 1,191 761
Infantile Mortality Rate 51 51

^Infantile Mortality Rate, average for 10 years, 1928-37 67 67

Notified cases of Ophthalmia Neonatorum 115 i 76

Notified cases of Puerperal Pyrexia 238 148

Maternal deaths from Sepsis 25 19

Maternal deaths from Other Causes 62 47

Maternal Mortality Rate (Per 1,000 Live and Still births) 3-58 4-21

,, ,, ,, (Per 1,000 Live births) 3-74 4-40

*Maternal Mortality Rate, average for 10 years, 1928-37 5-30 5-43

* Per 1,000 live births.

Midwives Acts, 1902 to 1936.

The County Council is the Local Supervising Authority under the Midvvives Acts for the
whole of the Administrative County.

The present position of the midwifery service is as follows: —

During the year 1938, 622 midwives notified their intention to practise, and out of the total
number of births, including still-births, i.e., 24,306, they reported their attendance upon 17,519 cases
in the capacity of midwives and 3,079 in the capacity of maternity nurses—a total of 20,598 cases
or an average of approximately 33 cases each. Of this number of midwives 532 are residing in
the County Council’s administrative area, and the remaining 90 reside in County Borough and other
County Council areas, but take occasional cases in the County Council’s area.

These 622 midwives are classified as follows .—

Employed by County Council . 179

District Nurse-midwives . 183

Employed in Institutions . 108
Independent Midwives . 152

The supervision is carried out by the County Medical Officer, his Assistants, two non-medical
Supervisors and four Inspectresses. During the year, 1,316 visits of inspection were made. Twelve
midwives were cautioned by the County Medical Officer for minor infringements of the Rules; and
two midwives were reported to the Committee for unsatisfactory practice. One midwife died and
from the 1st August 1936, to the end of the year 64 midwives had surrendered their C.M.B. certi¬
ficates under Section 5 of the Midwives Act, 1936.

One of the two midwives reported to the Committee was reported to the Central Midwives
Board. The Board decided to postpone sentence and required the midwife to undergo a six months
residential course of post-certificate midwifery training, after which sentence will be pronounced.
 74

Number of Births attended by Certified Midwives.

Midwives attended 17,519 births and 3,079 cases of confinement as Maternity Nurses, out of
a total of 24,306 live and still births registered, or 84-7 per cent.

The following table shews the number of births attended by mid wives, and the percentage to
the total births registered, compared with previous years: —
Table LVII.

Year. Births attended by Total Births registered Percentage attended

midwives. in County Area. by midwives.

Live Still Total

1932 17,198 24,319 1,239 25,558 67.2
1933 17,284 23,084 1,143 24,227 71.3
1934 17,836 23,393 1,183 24,576 72.5
1935 18,409 23,077 1,136 24,213 76.0
1936 19,007 22,995 1,071 24,066 79.0
1937 18,994 22,978 1,081 24,059 78.9
1938 20,598 23,246 1,060 24,306 84.7

The following table shews the number of cases attended by individual midwives during the
years 1933-38 :—

Table LVIII.

No. of Cases attended by

No. of Cases attended by No. of Cases attended by
No. of Cases attended by Salaried Midwives (including
Midwives employed in Midwives employed by
Independent Midwives Cases when in independent
Institutions Nursing Associations
practice)
Year
toe 80 Under 100 50 Under 100 60 Under
Nil
100 50 Under
Nil
Nil Nil to 200 to 100 50
to 200 to 100 50 to 200 to 100 50 to 200 to 100 50

1933 21 77 213 29 — 5 57 6 — 5 164 17 — — — —

1934 24 74 232 15 — 10 71 3 — 9 160 1 — — — —

1935 16 89 206 25 — 4 77 15 — 6 158 6 — — — —

1936 31 86 223 25 — 5 79 14 — 9 152 1 — — — —

1937 2 21 121 28 — 24 44 5 — 14 163 2 16 70 95 —

1938 2 18 83 21 — 18 59 4 — 10 167 1 12 107 66 —

Medical Aid Records.

The following table summarises the records received from midwives during the year 1938 and
compares them with similar records for previous years : —
Table LIX.

1933 1934 1935 1936 1937 1938

Records of sending for Medical aid. 5,953 6,385 6,398 6,596 7,731 8,893
Deaths of (a) Mother 17 14 15 5 17 19
(b) Child . 123 126 122 105 157 175
Still-births. 322 327 216 294 332 261
Laying out the dead . 27 35 47 31 51 73
Liability to be a source of infection ... 107 157 155 185 190 282
Substitution of artificial feeding for
breast-feeding 174 189 193 232 361 431

Ihe number of copy medical aid records received from midwives during the year was 8 893
or 50.7 per cent, of the cases attended as midwives.

The following table shows the nature of the cases in which medical aid was sought classi¬
fied according to the Rules of the Central Midwives Board: —
Table LX.

Rule E 12(1).
Nil.

Rule E.12(2)—Pregnancy.
Various abscesses ... ... 9 Post Maturity ... 23 Toxaemia . ... 47
Ante-Partum Haemorrhage... 330 Oedema ... Ill Hydramnios ... ... 9
Abortion or Miscarriage ... 345 Ante-natal Examination ... 62 Hyperemesis ... ... 107
Threatened Abortion ... 148 Purulent Discharge ... ... 49 Contracted Pelvis ... ... 23
Eclampsia ... ... ... 9 Varicose Veins ... 72 Hysteria . ... 6
Albuminuria.343 Haemorrhoids ... 12 Sugar in Urine ... 9
High Blood Pressure ... 72 Anaemia ... 82 Nephritis . ... 26
Heart Condition ... 22 Pyelitis ... 53 Abdominal pain ... 68
Disproportion . 39 General Conditions ... ... 102 Epileptic fits. ... 5
No foetal movements ... 6 Rheumatism and chorea ... 13 Pyrexia . ... 10
Rash .14 Chest conditions ... 75 Pyorrhea and Dental ... 7
Prolapse . 1 Molar pregnancy ... 2 Abnormal or malpresen-
tation
 75

Table LX (continued).
Rule E.12(3)—Labour.
Adherent Placenta ... ... 48 Rigid Cervix or Perineum. . 51 Prolapse . i
Retained Placenta or Collapse . . 24 Albuminuria ... ... 10
Membrane ... ... 107 Breech Presentation . 158 Foetal Distress . 47
Placenta Praevia ... 51 Undefined do. . 34 Debility ... ... ... 37
Ruptured Perineum ... 1,990 Transverse do. . 6 Anaesthetic . 17
Prolonged Labour ... ... 895 Funis do. . 32 Deformity of Mother ... 9
Obstructed Labour ... ... 110 Face do. . 26 Heart Trouble . 20
Precipitate Labour ... ... 71 Hand do. . 12 Hysteria and Distress ... 27
Uterine Inertia ... 220 Foot do. . 18 Disproportion . 27
Premature Labour ... ... 80 Occipi to-Posterior Surgical Induction. 8
Hydramnios. ... 5 Presentation . 123 Pyrexia ... ... ... 9
Chest conditions ... 10 Eclampsia . 11 Unsuitable home conditions... 6
Contracted Pelvis ... 25 Fits .. 3

Rule E.12(4)—Lying-in.
Post-Partum Haemorrhage... 151 Pulmonary embolism l Albuminuria. 2
Secondary p.p.h. 4 Eclampsia 8 Sub-involution of Uterus ... 38
Oedema 2 Varicosity 4 Collapse .13
Prolapse of Uterus ... 7 Post-natal Examination 5 Pyelitis . 13
Thrombosis 11 Rigor ... . 5 Weak Heart.16
Anaemia 66 Hysteria and melancholia 3 Puerperal Insanity. 3
Purulent Discharge ... ... 7 Chest Conditions 46 Rash .14
Influenza 18 Erysipelas 2 Strangulated hernia. 1
General conditions ... 36 Pyrexia 211 Contact with scarlet fever ... 2
Phlebitis . 41 Mastitis 97
Rule E. 12(5)—The Child
Injuries at Birth 7 Unsatisfactory umbilicus .. 27 Inflammation of Eyes ... 309
Twins. 78 Icterus Neonatorum 40 Prematurity.96
Other Malformations 42 Hare Lip and Cleft Palate.. 14 Phimosis . ... 72
Pemphigus 38 Spina Bifida . 30 Rash .42
Convulsions . 29 Still-birth . 43 Haemorrhage from mouth ... 4
Dangerous Feebleness 193 Melasna 10 Asphyxia ... ... ... 80
Talipes 28 General conditions ... 58 Deaths of Infants . 3
Imperforate anus 2 Hernia 2 Macerated Foetus . 16
Imperforate urethra 1 Injury due to mother Apparently dying . 2
Chest conditions 37 falling 1 Abscesses 13
Vomiting, etc. ... 12 Tongue Tied 24

StilLBirths notified by Midwives.

The number of still-births notified by midwives was 261 or T26 per cent, of the total births
attended by them.

The following table gives the number of still-births attended by midwives, and the percentage
to total births attended by them, compared with previous years: —
Table LXI.

Number of Births Number of Still-births Percentage of Still-births

Year
attended by Midwives notified. to Births attended

1933 17,284 322 1.86

1934 17,836 337 1.89
1935 18,409 316 1.72
1936 19,007 294 1.55
1937 18,994 332 1.75
1938 20,598 261 1.26

Liability to be a Source of Infection.

The number of notifications of liability to be a source of infection received from midwives was
282 compared with 190 for the previous year.

The following table shows the cases of infection with which midwives came into contact: —
Puerperal Pyrexia 179
Scarlet Fever . 25
Diphtheria 10
Pemphigus Neonatorum 30
Erysipelas 3
Tonsillitis 9
Pneumonia . 10
Other cases of infection ... 16

282

During the year 2 midwives were suspended from midwifery practice for a period exceeding
24 hours owing to contact with cases of infectious disease.

Provision of Midwives.
At the present time the County Council is not training midwives, but in accordance with
circular 559, dated 27th February, 1925, of the Ministry of Health, a sum of £30 is paid to the
West Riding Nursing Association in respect of each newly trained midwife placed in districts in
the West Riding Administrative Area.

During 1938 a sum of £30 was paid to the West Riding Nursing Association for the provision
of 1 newly trained midwife to serve the areas of Steeton and Eastburn (Skipton R.).
 76

Payment of Doctors called to the Assistance of a Midwife.

This is a statutory obligation under the Midwives Act, 1918, and during 1938, midwives
practising in the West Riding issued 8,893 medical aid notices, and a sum of £11,421 was paid to
medical practitioners called by midwives in emergency.

Compensation of a midwife when suspended from practice on account of infection, not being her¬
self in default.
This is a statutory obligation under the Midwives Acts, and during 1938 one midwife was
paid the sum of 18/-

The following table shows the position of the midwifery service in the administrative county
area on 31st March, 1939 :—
Table LXII.

County Council’s
Scheme. Independent.

G t/>
w wi WJ 4_, W — G c“* o
•o $ <-> 0) £ <v o <v g T3 O o z<
.a > > <D ■ rj
i: u -r ^ G cW >«
«'£ 5 3 & & (A 3 > o z 4-> Remarks.
03 'O •- eirH
H
is s G G
W ~ «§•§

NomCounty Boroughs.

Batley 4 — 2 — 5 11 1
Brighouse ... 4 * 2 — — 6* 2
. Goole . 3 i i — 3 8 —
Harrogate 3 3 4 3 2 15 9
Keighley 4 3 3 — 5 15 i
Morley 6 — — — 3 9 2
Ossett . 2 — 1 — — 3 i
Pontefract ... 3 — 1 — 3 7 2
Pudsev . 3 1 1 — 2 7 2
Ripon — 3 — — 2 5 —
Todmorden 1 1 2 4 10 3
2

Urban Districts.

Adwick-le-Street ... 3 3 _ _ 6 1
Aireborough 1 4 1 • — 3 9 —
Baildon 1 — 3 — — 4 —
Barnoldswick 2 — — — — 2 —
Bentley-w-Arksey 4 — — — — 4 —
Bingley 2 1 1 — 1 5 —
Castleford ... 9 — 1 — 6 16 — 1 Emergency Midwife.
Colne Valley 2 2 — — — 4 —
Conisbrough 4 — — 2 — 6 1
Cudworth ... 2 — — — — 2 —
Darfield i — — — — i 1
Darton 3 — 1 — — 4 1
Dearne 6 — 1 — — 7 2
Denby Dale — 5 1 — — 6 —
Denholme. — 1 — — — 1 —
Dodworth . 2 — 2 — — 4 2 1 Emergency Midwife.
Earby . — — — — — — —
Elland O 2 i — — 5 —
Featherstone 2 — — — — 2 2
Garforth ... ... — 1 — — — i —
Hebden Royd ... — 1 — 2 1 4 —
Heckmondwike ... — 2 — — 2 4 i
Hemsworth 3 — i — i 5 i
Holmfirth ... — 3 i — 4 8 —
Horbury ... ... 1 — — — — 1 i
Horsforth . — 2 i — — 3 —
Hoyland Nether ... 2 — 2 — — 4 —
Ilkley . — 4 2 — 3 9 —
Kirkburton 1 2 ! i — 5 —
Knaresborough — 2 — — i 3 —
Knottingley 2 — 1 — — 3 —
Maltbv 1 3 1 — — 5 —
Meltham . — 2 1 — — 3 —
Mexborough 2 — — — 6 8 i
Midgley . — 1 — — — 1 —
Mirfield — 3 — — — 3 i
Normanton 2 2 1 — — 5 4
Otley — 3 2 — 1 6 —
Penistone . — — — — — — — See Penistone R.
Queensbury and Shelf 1 — i — — 2 2
Rawmarsh 1 2 i 2 — 6 —
Ripponden. 1 — — — i —
Rothwell 4 1 i — — 6 —
2 — i — — 3 5
Royston .
Saddleworth i 3 2 — — 6 2
o — i — 2
Selby . 5 —
Shipley 3 — 3 — 7 13 —
Silsden — 1 — i — 2 —
Skipton . 2 — — — 6 8 —
Sowerby Bridge ... . ./ 1 3 1 5
Spenborough 5 i 1 — — 2 1 Emergency Midwife.
Stanley 3 — — — — 3 i
Stocksbridge i — — — 3 —
Swinton . 2 — — 6 i 1 Emergency Midwife.
— i — — — 1 —
Tickhill
Wath-upon-Dearne 3 — — — '- 3 i
Wombwell . 4 — 1 ’—' — 5 i
Worsborough 2 — — — — 2 i

1
 77

Table LXII—(continued).

County Council’s
Scheme. Independent.

,
Institutions !
Employed in

Midwives Act,
under Sect. 5,
Resignations
Midwives.
Midwives.

Midwives
Midwives
Salaried

District
District
Nurse

Nurse

Total.

1936.
Remarks.

Rural Districts.

Bowland ... . _ 3 — — — 3 —

Doncaster. 9 3 2 — — 14 — 1 Emergency Midwife.

Goole 1 2 — — — 3 1
Hems worth . 5 6 5 1 3 20 4
Kiveton Park . 3 — 1 — — 4 1
Nidderdale. 1 8 — — — 9 —
Osgoldcross . 1 2 — — — 3 —
Penistone . — 3 1 — — 4 1
Ripon & Pateley Bridge ... 1 5 1 — — 7 3
Rotherham . 6 5 7 — 7 25 1
Sedbergh . — 2 1 — — 3 —
Selby •. 2 1 — — — 3 —
Settle ... . 3 4 1 — 2 10 1
Skipton . 2 6 4 2 — 14 —
Tadcaster. 3 10 3 — — 16 —
Thorne 7 1 I / - — 9 3
Todmorden . — — — — — — — See Hebden Royd U.
Wakefield. 3 5 — — — 8 2
Wetherby . — 9 3 — 1 13 —
Wharfedale . 1 1 — 2 — 4 —
Wortley . 3 4 3 — 1 11 —

W.R. County Nursing

Assocn. (Relief Nurses) — 6 — — — 6 —
County Boroughs. i 1 — — — 2 7 Emergency Midwife.

TOTALS ... 183 162 93 18 87 543 75

The following tables give a monthly summary of the cases attended by midwives directly and
indirectly employed by the County Council under the Midwives Act, 1936.

Table LXIII.

(a) Whole=time Midwives.

Patients Patients attended in

Patients
No. of Patients referred to confinement Patients
attending
Month midwives awaiting Doctor for removed to
ante-natal
employed confinement ante-natal As maternity Hospital
clinic As midwife
supervision nurse

1938.

January 182 3,143 1,524 341 784 59 88

February . 181 3,258 1,511 337 800 82 82

March. 183 3,198 1,421 393 887 72 90

April . 183 3,135 1,575 355 963 82 99

May . 182 3,160 1,649 393 858 73 84

June . 182 3,120 1,713 370 704 70 83

July . 182 3,075 1,698 366 928 71 92

August ... 181 3,058 1,660 352 672 54 79

September . 177 3,099 1,643 389 738 63 81

October . 177 3,067 1,624 364 938 86 86

November 176 3,147 1,717 418 670 74 67

December . 177 2,917 1,568 372 883 77 100

Total ... — — — — 9,825 863 1,031

 Table LXIV.

(b) ParTtime District Nurse*Midwives.

Patients Patients attended in

Patients
No. of Patients referred to confinement Patients
attending
Month Nurse awaiting Doctor for removed to
ante-natal
midwives confinement ante-natal As maternity Hospital
clinic As midwife
supervision nurse

1938.

January 158 1,185 325 102 220 60 23

February 158 1,174 331 88 235 69 12

March ... ... ... 158 1,167 347 91 238 80 22

April . 157 1,138 332 93 321 93 35

May ... ... .». 157 1,106 337 104 274 76 24

June . 157 1,025 298 103 238 69 37

July . 158 1,031 293 119 285 116 25

August ... 158 997 297 110 202 85 19

September . 158 1.044 314 85 198 67 26

October 158 1,075 354 109 222 96 36

November 158 1,116 383 107 197 78 25

December 158 1,017 352 100 270 67 39

Total ... — — — 2,900 956 323

During the year the midwives reported 84,617 visits to patients during the ante-natal period,
and 217,686 visits to patients during labour and the puerperium.

These visits are summarised as follows :—

Whole-time District
midwives Nurse-midwives
Ante-natal patients 58,509 26,108
Labour and the puerperium 153,014 64,672

Necessitous Cases.
During the year 2,320 applications were received towards the payment of a midwife’s fee and
36 in respect of a maternity nurse’s fee.

The financial circumstances of these applicants were investigated and in 389 cases the net
family income exceeded the scale of payment and no financial assistance was given.

These applications are summarised as follows :—

Whole-time service. Part-time service.

Cases attended as— Cases attended as— Totals.
Midwives, j Mat. Nurses Midwives. | Mat. Nurses

Applications approved 1,616 18 319 14 1,967

Applications refused 347 3 38 1 389

1,963 21 357 15 2,356

Amount of fees paid or

remitted ... £1,713 10 0 £12 £330 £7 10 0 £2,063

Compensation of Midwives for loss of cases sent to a Maternity Hospital.

This scheme is carried out by the County Council and the sum of 15/- is paid for each patient
booked by the midwife and sent to hospital by the medical officer to an ante-natal clinic or a
medical practitioner, on account of some abnormality.

During 1938, 219 cases were referred to a maternity hospital, and a sum of £164 5s. Od. was
paid in compensation to independent midwives and District Nursing Associations. As from the
1st July, 1937, compensation under this heading is not paid to midwives employed by the County
Council under the Midwives Act, 1936.
 79

Marriage of Midwives.
The Minister of Health in Circular 1569 dated the 18th September, 1936, regarding the employ¬
ment of married midwives states :•—

“The Minister trusts that any Authority whose rules would prevent their employ-
“ment will so revise the rules so as to enable the Authority, when first selecting
“midwives for salaried posts, to have regard only to their efficiency.’’

This suggestion of the Minister was adhered to by the County Council, but in consequence
of several midwives reporting their marriage after appointment, the following resolution was
approved:—

“Child Welfare Sub-Committee—12th January, 1938 (1077). That midwives be

“required to resign their appointment on marriage subsequent to appointment,
“subject to this condition being waived in any case where the County Medical
“Officer reports that a midwife’s retention is desirable in the interests of the ser-
“vice, and that in any such case, the position be reviewed annually.”

Since the commencement of the scheme under this Act, six whole-time midwives have notified
their marriages, and after consideration the Committee decided to retain each midwife on the
staff.

Two midwives reported that they were pregnant and the following resolution was approved:
“That, in future, cases of pregnancy of midwives in the service of the County
“Council, the midwife be required to cease duty at the fifth month of pregnancy
“until a period of three months after confinement has elapsed, and that no
“salary be paid during this period.”

Post'Certificate Courses of Instruction for Midwives.

The rules of the Central Midwives Board on post-certificate courses of instruction for practising
midwives came into operation on the 1st January, 1939, and it has been arranged by the Central
Midwives Board that all midwives from the County Council’s area shall attend for such instruction
at the Municipal Hospital (St. Luke’s) Bradford.

The rules are divided into two parts; Part I relating to midwives who notify their intention to
practise; and Part II relating to midwives who do not notify their intention to practise but who
are employed by Local Supervising Authorities as supervisors or assistant supervisors of midwives.

Briefly the rules under Part I provide that a midwife who notifies her intention to practise
on and after the 1st January, 1939 is required, as determined by the Local Supervising Authority,
to undertake a four weeks residential course of training in an approved institution before the 1st
January, 1946, unless: —

(a) She has, within seven years immediately preceding each year she notifies her intention
to practise, either completed a like course to the satisfaction of the Central Midwives
Board or passed the examinations of the Central Midwives Board for admission to the
Roll of Midwives, and provided thatr—

(b) If she has not practised, either as a midwife or maternity nurse, during the two years
immediately preceding each year she notifies her intention to practise she may be required
by the Central Midwives Board (notwithstanding that she would otherwise be exempted
under (a) above) to complete to its satisfaction a course of instruction of such nature
and duration as it may think proper before resuming or entering practice as a midwife.

The rules under Part II provide that a supervisor shall undertake a course of training at
intervals of not less than five years, which shall consist of not less than one weeks training con¬
sisting of lectures and practical demonstrations on the various phases of midwifery work, and Part
II shall consist of a visit or visits to a local Supervising Authority other than that in whose area
she is employed, for the purpose of studying the methods adopted bv the officers of such author¬
ity in the supervision of midwives in the area.

The two parts of the course need not be taken consecutively.

Each local Supervising Authority is required in January of each year to notify the Central
Midwives Board of the names of the supervisors working in its area who have attended a course
of instruction during the preceding year in accordance with Part II of these rules.

Resignations of Midwives.
In accordance with Section 5 of the Midwives Act, 1936, under certain conditions a midwife
may voluntarily surrender her Central Midwives Board Certificate and receive compensation to
the value of three times the net average income derived from her practice during the previous
3 years, and a midwife may be directed to surrender her Central Midwives Board certificate when
she is incapable, by reason of age or infirmity of mind or body, of efficiently performing her duties
as a midwife. In such cases a midwife is entitled to payment of compensation amounting to five
times the average net income calculated as above.

The Minister of Health makes a grant of 50% of this expenditure.

 80

At the time of writing (April, 1939) 74 applications from midwives were approved for the pay¬
ment of compensation in respect of the surrender of their C.M.B. certificates. Of this number,
55 voluntarily surrendered their certificates, and 19 were compulsorily surrendered.

The amount of compensation paid to the 74 mid wives from the commencement of this Act
is made up as follows: —

Proportion payable by Proportion payable by

| Amount of Compensation
other Authorities to C.C. C.C. to other Authorities
paid
(included in Col. 2) (included in Col. 2)
(1) (2) (3) (4)
£ s. d. £ S. d. £ s. d.

55 Voluntary surrend - 10.562 8 2 123 5 7 115 11 0

19 Compulsory surren 3,976 9 8 70 11 8 5 3 2

Supervisors of Midwives.
The two non-medical Supervisors of Midwives who took up duty on the 7th September, 1937,
have completed a full year under the Midwives Act Scheme of the County Council.

The number of visits made during the year are as given below: —

Routine visits to midwives ... ... ... ... 250

Visits to patients—ante-natal . ... ... ... 51
labour ... ... ... ... 21
lying-in ... ... ... ... 839

Enquiries into cases of—puerperal pyrexia ... ... ... 88

pemphigus neonatorum ... ... 15
and deaths of mothers ... ... 18

The two Supervisors have endeavoured to carry out the recommendation of the Minister of
Health—that is to be a friend and advisor of the midwives, to be helpful and encouraging rather
than a severe critic causing depression and antagonism during and after the visit. As a result
of this method it has been found that the midwives on occasions of re-visits have been found
willing to co-operate with the Supervisors and to realise that any criticism of their methods is
given in a helpful manner.

The number of times in which the Supervisors have been present to see a midwife at a
delivery is disappointingly small and is to some extent explained by the extent of the Administrative
County, the large proportion of district nurse-midwives each with relatively few cases, and the
number of confinements occurring during the night, when it is often impracticable to notify a
Supervisor living many miles distant.

The Supervisors have, however, obtained much useful information on the capabilities of the
midwives by attending with them at lying-in and ante-natal visits. As a result of their obser¬
vations the midwives found to be below the average are noted for early attendance at a Refresher
Course.

Notification of Puerperal Pyrexia.

Beds are not specially reserved for the treatment of puerperal sepsis, but cases are transferred
to any of the following hospitals with which the County Council has an arrangement.
Isolation Hospitals.
Colne and Holme Joint Hospital, Meltham. Skipton Joint Hospital, Skipton.
Leeds City Fever Hospital, Seacroft. Keighley and Bingley Joint Hospital,
Wharfedale Joint Hospital, Menston. Morton Banks.
Goole Joint Hospital.

Voluntary General Hospitals.

Jessop Hospital for Women, Sheffield. Leeds Maternity Hospital.

Huddersfield Royal Infirmary. York County Hospital.
Harrogate and District General Hospital.
Municipal Hospitals.

Staincliffe County Hospital, Dewsbury. Halifax General Hospital (St. Luke’s).

White Rose County Hospital, Wakefield.
Private Nursing Homes.

St. George’s Nursing Home (attached to the Edenfield Maternity Home at

Doncaster) is set aside chiefly for the treatment of cases of puerperal
sepsis.
 81

Isolation Wards connected with Maternity Units.

An observation ward with one bed is used for obscure cases of pyrexia at the Skipton and
District Hospital. At the County Maternity Home, Montagu Hospital, Mexborough, two isol¬
ation wards containing one bed each are available. At the Listerdale Maternity Home a
separate unit containing two observation beds is provided.

The following table gives details of the special services provided by the County Council in
connection with cases of Puerperal Pyrexia, together with the cost of such services to the County
Council, during the year 1938.

Cases Amount
£ s. d.
Hospital Treatment ... 144 1,788 7 10
^Consultant Obstetrician (14 cases) 6 73 10 0
Domiciliary Nurse ... 1 6 18 0
151 £1,868 15 10

*The services of the Consultant Obstetricians were requested in 14 cases 8 of which were
removed to hospital, and are included in the list of hospital cases.

The Public Health (Ophthalmia Neonatorum) Regulations, 1926-1937.

On the 21st January, 1937, The Public Health (Ophthalmia Neonatorum) Amendment Regu¬
lations, 1937, were made by the Minister of Health.

The effect of these Amendment Regulations is that the Authority for maternity and child
welfare is the Authority for the administration of the Regulations.

The following table shows the number of cases of ophthalmia neonatorum reported in the
whole of the Administrative County during the last five years :—

1934 1935 1936 1937 1938

105 100 112 133 115

The details of the cases reported upon in the County Maternity and Child Welfare Area, are
shown in the following table, in accordance with the instructions issued by the Ministry of Health
(Circular 648, p. 12, dated December, 1925).

Cases.

Vision Vision Total Still under

Treated. Removed
Died. treatment at
Notified. Unimpaired. Impaired. Blindness. from Area.
end of year
At Home. In Hospital.

90 58 32 84 1 — 1 2 2

Registration of Nursing Homes.

Public Health Act, 1936, Sections 187—195.

The Nursing Homes Registration Act, 1927, which came into force on the 1st July, 1928,
repealed Part II. of the Midwives Act, 1926. It is now incorporated in the Public Health Act, 1936.

Under this Act, certain types of Nursing Homes are required to be registered by the Local
Supervising Authority. There is a penalty not exceeding £50 on summary conviction for non-com¬
pliance with this requirement.

The following shows the work undertaken during 1938 :—

Number o f patients provided for :—

Number of
Homes. Maternity Others Totals

Homes first registered during

the year 11 21 35 56

Homes on the register at the

end of the year 54 115 170 285
 82

Action taken during 1938 :—

Number of applications for registration refused.

(i) under proviso (a) to Section 187 (3) ... ... ... ... ... nil
(ii) under proviso (b) to Section 187 ... ... ... ... ... ... 3
(iii) under proviso (c) to Section 187 ... ... ... ... ... ... nil
(iv) under proviso (d) to Section 187 ... ... ... ... ... ... nil
Number of registrations cancelled under Section 188 ... ... ... ... 1
Number of appeals by aggrieved persons to a Court of Summary Jurisdiction
under Section 189 (3) ... ... ... ... ... ... ... nil
Number of cases in which fines were imposed ... ... ... ... ... nil
Number of inspections ... ... ... ... ... ... ... ... 134
Number of registered homes not inspected ... ... ... ... ... nil

Home Helps.
The County Council adopted a scheme for the provision of “home helps,” which was brought
into operation in the West Riding Maternity and Child Welfare area on the 1st April 1938, and
during the remaining nine months of the year 87 patients were attended.

The services of home helps are primarily intended for assisting in the work of the household
where a maternity patient is nursed at home or in hospital. They also are available for any case
of illness directly attributable to recent or approaching confinement.

Suitable women have been recommended by the health visitors and midwives, and 270
have signified their acceptance of the conditions of employment and their names have been placed
on the register of home helps available for work in connection with this scheme, but owing to the
intermittent character of the work difficulty has been experienced in obtaining the services of Home
Helps in certain areas where female labour is employed in regular occupations.

Applications for the services of a home help are made through the County health visitors or
midwives. A form is supplied for completion by the head of the household and although a stamped
undertaking to repay the whole cost is obtained in every case, on completion of the verification of
the family circumstances the amount recoverable from the applicant is assessed in accordance with
the following scale of payment, on the average weekly income for the six weeks prior to the
confinement.

There has been a gradual growth in the number of applications received for the services of Home
Helps and it is anticipated that there will be a still larger increase in the number of cases attended
as the facilities available become more widely known.

SCALE OF PAYMENT-

Where the total family income, after deducting

Amount Payable by
the actual rent and rates paid and 5/- for each
Applicant
child under 14 years of age and not working

Does not exceed 34/- per week Nil.

Is between 34/- and 44/- per week 1/- per day
Exceeds 44/- per week 6/- per day

Each applicant is informed whether the request for a home help has been approved or other¬
wise and the home help is also notified at the same time.

With each approval a copy of the following rules is forwarded to the patient.

Rules for the Guidance of Home Helps.

1. (a) A Home Help must NOT attend cases of confinement, UNLESS A MIDWIFE IS IN
ATTENDANCE.

(b) >> y y ASSIST at the confinement, but should be at hand to bring hot
water, etc., to the doctor or midwife in attendance.

(c) >> yy interfere in any way with the instructions of the doctor or mid¬
wife, and she must recognise that she is NOT a nurse, but
simply a domestic help.

(d) y y y y wash the patient nor make her bed.

(e) y y y y attend upon her relatives at the expense of the County Council.
(f) y y y y make any charge to the patient.

(g) y y yy accept bus fares and/or present from the patient.

(h) y y yy give her services unless authorised by the County Medical

Officer, otherwise the County Council will not be responsible
for the payment of wages.
 83

2. She must attend at the home to which she is sent from 8.0 a.m. to 6.0 p.m. (Sundays and
Bank Holidays excepted, unless the patient’s husband has Sunday duties, in which circum¬
stances the Home Help will attend). The period for which she will be required for each case
will not usually exceed fourteen days.

3. She must attend when required in the home during the confinement, even when this occurs
between the hours of 6.0 p.m. and 8.0 a.m. At no other time shall she be in the home
after 6.0 p.m.

4. She must:—
(a) Keep the house clean and tidy.
(b) Cook and prepare meals for the family.
(c) Care for any children there may be and see that those attending school do so punctually
and are clean and tidy.
(d) She will undertake two weeks’ family washing for not more than two adults and six
children and also wash daily for the infant, and mother if necessary. Arrears of family
washing should not be undertaken.

5. Cleanliness of person is essential and overalls and aprons must be worn whilst on duty.

6. She must supply and cook her own food, and not use the food provided by the family for
whom she works.

7. Where a case of infectious disease occurs in the House of a Home Help, or in the family of
a patient, or should the Home Help in any way come into contact with infection, she must
report at once to the County Medical Officer for instructions.

8. Where the County Council has agreed to provide the services of a Home Help, a written
order will be sent to her stating the name and address of the person requiring her services.

WITHOUT SUCH WRITTEN ORDER NO PAYMENT WILL BE MADE.

9. Any conduct on the part of the Home Help which is contrary to the interests of the house¬
hold where she is employed, if brought to the notice of the Department, will lead to her name
being removed from the list.

10. Home Helps are specially warned that THEY ML1ST NOT GOSSIP under any circum¬
stances about the affairs of the families to which they have been sent.

11. Home Helps are at liberty to obtain private employment when not engaged on County
Council duties.

12. Fees. Home Helps will be paid at the rate of 6/- per day, which includes the cost of food
to be provided by her, and will be payable on completion of her services to the patient.

A report is received from the Health Visitor or Midwife on the services of each Home Help
which is also in the nature of an account form and the fees of the Home Help are paid through
the West Riding Treasurer on the completion of her attendance on the patient.

Ante-Natal Services.
Domiciliary Ante-natal Service.
Prior to 1936 the domiciliary ante-natal scheme in the West Riding was divided into two main
parts : —

(a) In urban and populous rural areas ante-natal clinics were established at convenient
centres where expectant mothers could receive ante-natal supervision.

(b) In remote rural areas arrangements were made for a local medical practitioner, on receipt
of a request from the certified midwife booked by a patient, to carry out two examinations
prior to the confinement, for which a fee of 5/- per examination plus motor car mileage
allowance was paid to the doctor.

By these and other arrangements it was estimated that of the 15,500 live and still births
which took place each year in the County Council Child Welfare Area, two-thirds were examined
by a doctor during the ante-natal period, leaving a total of 5,100 births per annum which did not
come within the scope of the ante-natal scheme.

During the year 1936 the County Council approved of an extension of the scheme mentioned
in (£>) above, whereby in addition to the remote rural areas these arrangements were extended
to the whole of the urban and populous rural districts in the County Council Child Welfare area
and the new arrangement commenced on the 1st April, 1937. During 1938, 2,080 expectant
mothers were examined ante-natally under arrangements made by the County Council with private
medical practitioners at a total cost to the County Council of approximately £900.

Under all schemes, the percentage of expectant mothers examined by a doctor in the ante¬
natal period was 81T.
 84

Services of Consultants.
The Minister of Health is urging Local Authorities to take all possible steps to reduce the
amount of illness and number of deaths among women following upon childbirth, and with this
object in view the West Riding Public Health Committee has approved a scheme under which
consultant obstetricians may be called in by medical practitioners in cases of abnormality occurring
during pregnancy, labour or lying-in in the homes of patients. Under this scheme the County
Council defrays the whole of the cost of the consultant’s fee, and there is no financial liability
upon the patient.

Hitherto there has been a wide gap between the hospital and domiciliary consultant services,
and it is considered that this gap has been reduced considerably and the services much improved
by the introduction of the domiciliary consultant scheme.

The fees approved are as follows:—•

(a) For consultation—£3 3s. Od. up to 10 miles.

£4 4s. Od. 10 to 15 miles.
£5 5s. Od. 15 to 20 miles.
£6 6s. Od. 20 miles or over.
plus operative fee when such is necessary.

This scheme applies only to those areas where the County Council is the Authority under the
Maternity and Child Welfare Act, thus the following districts, which are autonomous for maternity
and child welfare services, are excluded :—the Boroughs of Batley, Brighouse, Goole, Harrogate,
Keighley, Morley, Ossett, Pontefract, Pudsey and Todmorden; the Urban Districts of Bingley,
Castleford, Heckmondwike, Ilkley, Rothwell, Shipley, Spenborough and Wombwell, and the Rural
District of Hemsworth.

The number of domiciliary consultations undertaken during 1938 was 152.

Ante=Natal Clinics.

Steady progress is being made in this branch of the service and the number of these special
clinics was increased to 103.

Ante-natal clinics were established during the year, in conjunction with existing Child Welfare
Centres at Birdwell, Elland, Snaith and S.tocksbridge.

Additional sessions were also arranged at the ante-natal clinics at Airedale, Armthorpe, Bentley,
Darfield, Fitzwilliam, Maltby, Rossington, Royston, Selby, Stainforth, Stanley, Thurcroft and
Upper Conisbrough.

Owing to the small number of expectant mothers seeking advice at the Luddendenfoot Clinic,
it was decided to close this clinic and put into operation the domiciliary ante-natal scheme in the
whole of the district.

The following table gives particulars of the ante-natal clinics established by the County
Council, shewing their location, days and times of sessions, name of Medical Officer and qualifi¬
cations, nursing staff in attendance and the average attendance of expectant mothers at each
clinic.
 85

. c
•o o nS
t/J -M
Is O rj
Ou^
s«

aj V
c rt
o —■ id x
> 2 <Z
CM !N -h <N <N

v. g
_g O CN O 00 <N CD CO id n* id CD n* *-« ^
oEo'j r- CN X »—• OA ca <N D4 ^ <n
H 3 ”
c cn

■*X-• XJrt 05
CD <N
CO 05
CO
c rt
J5 P$ 1 (X c
£ o i

— c; CO ^ ID — ^ cs lO CN O o 00 CN »- CD
a <v <N 05 00 — CO CN *— — CD O ID ID CO N’ 05
c PI CN — M
o|l
H= < c

39
05 Ofl
Post¬

55

27
05 (N N*
69

27

25

CD X CD ID CD X
natal

29 1 1 1 CD 1
■3 3
C3 L
H C5 1)
h.E ^ ■’+■ 05 CD (N O 05 CD cc ID O -r CM
<u cs 05 CD 05 -r <N 05 X (N X
3 P ID ' CD co CD 00 CD C l -r O 05 (N CD CD ID X C^J X
4-> 4-> c « 05 <N CN CD CD N* CN CD ID ID N* X
O CTj C c
H

•- -a ~Z
£Sj£ > X ~ ^ CO

*■ Area transferred to Autonomous Authority, figures given to 31/3/38 only,

v> -x* >
o z, ?
• V*
_C ru
'Z
«|2 <N — <M <N r- ~ t~
8 x>
U.Z.W

”3 CD cc M
CQ
C/3 CQ CO JC CQ
if. CO
« JC
CQ
d Jt Jt CO V—1 CQ q CQ
c/3
CJ o S q CQ fj u P Ki O j= S
z CQ E - S o cc
I
C «J CQ d CQ JS . - s oi
CO CO
5 § J= E d CQ
2
CJ tt j*
o s u *—> u“ S w—1 CO tT CO
S <5
*3 , S T3
II o <d * t’S 3 C C « t
cO JO C3 « ■ *; *-r* -a* ^ «-p<
CQ o
cC qp
C3 -JZ c
0) o
c fcCQ 05 J
O S «
u w- . C hU
.
•- -• o
-
4—. O (-U

CQ

t Ante-natal Clinic opened in December, 1938.

E S &
CO 05 V boa, "V ® Co U taoa
in §
CO
E o •gc I
z a C • 05 E
E 0; r,
E
3 • Q. CO C •otyo a. »- a
> aO* CL
« (/)
c Oh JS
o
o
2 1i
s CL
CO
JZ
to r
• CO r) !q.:
D .2 _**■
JC
> u • w ^ CQ CQ Sea a co CQ -s CSS CO
p -a c U > Oh
U : CO J- ^Z■ c
CQ. co u
w « .5 -c 05 CJ #05 .2 j= 05 .
c d •*- , •Sfi
w ■£ u £ u dJ c £ ^ 75 J—
-5«>U 05 £?rE-f U
CO U
to
►J O 3 & <-5 o
CO
t- O « c CO o OJ o
ca U Q ^ < CC i Q CQ cc § co X CO Q co o C
<
T3
H 2 E. ^ c E >, o
E a
E E 3 E 3 C
■3 M CL *3 CO 3
p cL d 75 Cl Cl "375 Cl *3
75 C Q. ex •3
75
3
*3
ID
d >0 “5 S E f ID
3
JO
05
c
O
05 C l-
3 *3
H d. O CO C
o 2 o o
rn y ro “ 2 O' H *3
05 _ 75
| S'*
O
•C
H
o

j:
3 « 6 CT N
£
"5 >• o
° ri c ^ S' ^ __ (N
CO
3
r -3 "3 cp >-»
<N
E p E’S
CO *3 . *3 3
I TD >, a « ~ b4_
75 o c ° -1 h I CO
'•'J 3 "3
• O
C- [i, C-“JC
c
• ^
CO T3 T3 CO 05 - I *3
“ >, *3
T3 _ U
75 75
E •a CO >, C £ fcE| . *3 _: 75 3 75
ID
C " 75 P h P *3 •O CO *3 3 C.*" 2 05 Z U •oiotioE
05 3
— Cl *n .*2 C
CL,-g E C 3 C
*3
e „ c ™
2rt.S 3 , -C
dr^
"H
^ c c
3 ^
*3
C ^ 03 ID —
05 J
C 9 r“
o Oh
-C « S « Kb *3
C ID
Uh . *3 - 88 Ul 3
t-1 o c H

a >>« >,
, T3 CO
O
T3
C
"docco’Eoco
% ^ X, z Cw u CO i co ^ c 5 * 2
l— ^.-j !-• O 05 ^ <2 o O If O 05 1 75 75 d■l^
UN U (N ON HID u3 A
( 05 N U
05 2
>
05
> IE ^
t
2 °? in
<L O
g
.%
o
05 > .h 05 .3 05 —
3 OW
c § N .b «
u w H (/i h W t/3 W Jit E (D Ci. CD < W U- cr CD

C
a
c
c d
o
. p S°.
:2 j-. : T3 : « • u
:Q :
: c . P :d w
^ : -c
3D • o
Q
o ^ CD ' E g<
_ Jd D
» 5 t
K § S
Q
-|q 3 b£’-x
05 3"
.Sod
; 75 o 2 « D
CX 3 O 05
• 3 O C
o-u U = 1-
:Q 3
JP JC
oi : ^ ~ 3 :
• o
3

r/ . o £-0.^ ^ CJ 3
c 3 j^
« inu 1 „
tj Tt *“■' J= oP « JP 4-. 75
Sx *•
Ew S
= ci‘5 u •- o 3 d 3
JZ 05 qP| PC
o QJ ^ jd CD <0- PCX b >,C2
"-M
U
«0 05
u SCI
75 Q CD 3 <oU
C ' 13 ^
U ^5
^ .2 ‘c 3

3
q
_
a
:H 75 05
0Cc>5 . n
w-1
=
O ~
05 O cO
Jr
a
• 3 H
C 3 C, r 3 u • 05 _ : o

u -2 ^ E Pd «u2 E ”8
o D '
o
Q- ^
Q) <5 >-'Q .2^ O g-J -a a;
3 K*- r* C
& <ii • 3 r- 5- l_ A
Qn a
O 0)
3 •*-* flj *3 . w j: . 3

J *- 3 H 3 fe C C .P Q.)-^ 75 v. „•■ O S •2^1 C O cu

> £y= C • CD
05 JS C tS -S to
« c
CO l-
p ca oj v) 75 ^ a;
S
' _J m >
-£Q
d ^P i)
^M
•E s n
05 ^ U
8u o 1 «WQ £ co co
111 1/5 "3 •5O ^05 K
js u x: P 05 C ” .
75 ^ r~. c " -b!
75 C *-•
■ _m j£ m C X E 8 S Q
k- ►
0^.2
cn c 0£ OJO C — < •
Q „ & •Sp'' •5 -3 2 05 C S
OoiC
3W 3 c S 05-. .Q ,
i 2," U
C ° t 3
-- l/l 75 — O j- O o Js O C H
u_ . ~ •ole E >,S | 75 33 _
a. c
« >> o •£ 5 it:
• - "O
2 _g 05 r-
•5 05 ^ t: Jd C
^ H.2 O w; *“ C-P O) P P P ? JJ CO S
3 05 C o T'E2 o.

.2 ot »“5
£ E-o
Oj 3 c 05
05 CJ 05 O *05 C Q
*3 c
tfln: 5 ■ c £
o -C O-V- .2 3.2 3 I | cS ^ O
liS ?P Ji CQ j- cq c >; §CQ SO
o
.Bf> o PI *3 Oh CO ^ 3
•o *
<
75 3
C2
05 —
CQ CQ
^E^3 •4- Uh o
I Q^ CT!
u u O O u
L- U
u p a c a
< =1 < <

o (N
<N <N
 86

_ C'J 1 CM 1 | CM 1 CD CM 1 1 1 CM 1 | | CM r-t
o c< 1 1 1 1 1 1 1 1 1 1
0-2

U 4) o tM 1% CO O CM -r CD I> CD X o o X X X
> C c as CO CM
< a <Z

o CM CM CM CD o O -*r CM CM CM CM X
"S £ o tj ID CM CM CM CM CM TT
H 3 g
C C/D

o c u CO •n- CD CD —■ 1 03 ID 03 1 Tt* 1 CM X | X X CM X
u * g w -w CO CM 1 ID ^ 1 1 CM 1 CM
O 0$
i c« * 0.2
P O Cfl
3f C
C £ fc-
o CD 03 — ID CO CO 00 ID ID 00 Tj* 03 CM X X X ID X
ID CD CM CM T CD CO o O — CO ID CO CD X X r>. CM X
c os
gfs <Z

Area transferred to Autonomous Authority, figures given to 31/3/38 only.

u w> CD O CD GO T 1 CM ID — CM 1 1 CM X | O X X X
c.£
+J os
tfl tu (N CM »—< 1 ID (N 1 1 CM 1 r—> y—* CM X
OS u o os CD
•3 3 Q-Z
c*o u
« O Ctf
<u
0S.£c >>
00 O ^ O o 03 CO -H ID 03 CD CM ID X X ^ X ID X
T— ID r—< GO CD CO CD 'T CD CO CM CO X T-X ^ CM X X
c os ID CO CM CO CM CM CM X
o OS <Z
H
xx ^
" C/3 w tj tofll
”3c at
OS - — ~
fc* -w 5.> <N CO CM CM CM CM CM CM X CM CM CM
LXV.—Ante=Natal Clinics.—(continued)

- - - - - - - -
^ C/D~ *
z *
s
3 S.Eit:
z 15.t: « CM CM CM r* CM
- - - - - - -- - - - - - - -

CQ EC
a CD r CQ CQ _
45 45
C.M
M.B

M.B.

CQ
Ch.B
M.B., Ch.B.

45 45 u
Ch.B
u . C/5
a/
E75 V □ q U
B.,

CQ .'CQ
c m 45 u ca CD CQ
W Q 45 d® BQ „ E CQ
M.B., C

s CQ u CQ CQ G s' 6
25-43 03 m IS s s
J* s c CQ
II u
M 5 O S - 43 . s S tT o
7) ► . CQ q
73*
CQ o S 73 73 — .to u 0> • oT tT
tGcc O 6 u u O G c 43 CL S S o
03 O § |q 45 c 03 U o *E c .E^S c o
two s c 03 o E 03 CL
W §
* *cs C-I 45
73 E ?P® 7) c
E c
03
03
Kirk

1) oCa G 3 > 03 oT E 45 H
03 A 0)’ O) .
^oss,

•7 45 U ^ G
3.H.

4d
o G
03
cJd O G |oi 703
3
CD
H E Q es 35 G
H o c/d C/5 . : •—■) C3 0) CD r 43
■ 2t3 <Eu
'r <3
u > to ca .s . c to CQ G S3 CQ • . .
u ■ >- cn. c03
73 C
jJ'*5 ® w
4/ cJ >’q’S 45 G ra 45
m ra JZ o
.a. co OJ
E .c xi -c ^ .a"
c c -e O TCQ 3 nj
2-cS^ c s J -S On
uw NW oin C -eu go c G cQ
eg CB o o c c O 13 <3 03 c
s ca = « | S s s Q G W < G fcd CQ E ^
73 73
E 6 c E
Table

e
CL
E E 03
73
03 P >»
. 03 CL ci
>-*
03
E cL
CL Q. 03 75 03 75 03
cL 73 73 CL 75 T3 CL
75 *o O
73 Q. G 73 Tf(
O CO U.
O
3 03 c ^ 2 ID C
G
o O
T}H

o o 2 3 G 3 *3 lO o
2 « 45 G 03 O E’ 45 o
CM •C 2 ^
wC 2 ^ fH o >> H
>> CM « H £ U
>*
03
.2 n 03
E(M ;C; 3 CM 6 CO C^l T3
75 3 75 03 T3
G t3 03
75
73 O _ m O u
. CD O T3 T3 i-
e'? 7)
•H Q. . 3
ST1 ^ ^ . >%
03 JO 03 , G -n c G 45 >> >. O 03 c
73
E3 03

C S
c 4-* 75 ’u C I
75 H ^ T3 d H s H o JS • T3 03 ^ 73
. «3 c
03 03
c
C 03 T3
73
G Q- C
CO JO T3
CL 3 *o C C
d"S T3
CL
°--ri CL C
• ^ C

>><
03
3
-o
c
d
E• 03s ^ J5 C ^
o o o .Tjt 3 ^ o
O

03
CD ^ C ^ rji |^G CL c 03 h
H 03
O * O
03 o
S-go c ^ ^ r-«
o ^ o a o'1
Q ,5-^ iJ c ^ *P
71 (M c 00 U

> '-I
3
o .is
7)
C^l
73 3 .
O ^ 9,
. O
“^£2 8S
S3
r-< UN J-
M | « | 03
>
fcu G (x. U. G H U. C/1 L. G ^ G c/5 G G i G G G

• 03 O
o
E
JZ G 03 03
03 CL * 0)
: c5 ^ 03 :G t •E
o ‘ 03 ^ G
W * _
TD
w *a

G _
45
U U “
q E 03
7)
r*^ ii ^
o.tJ «
c
3 T5
03 . • D G : CL, IE g CD
-4§4, EP Q :
4)
CL
73
:D
:v< u. _
Q
:Q
•
: o
3 X
q 8® C
03
tx 5 ^
03CL
c >»
D E D c —" >>-S DS-g c
o oo iq=K O 03 03
G (U o c «
03 ^ 5
O 45
G G (/).
£os « O tib L
.Sq •o o
I u
4-1
«
r*
■3 - i § S 03 c
o
• 03 fcuo . j= j= a:
Hi u'
^ |
O os d ci tn * G G G 2
3 03 . ■*-- C
I VI
o 2 « 03 03 .
g | ® 4 O JC in CL
:u O
rc > C/D C 03
O ^
c c>
J Q o 03 *0 C
> C U c 03 03 - O ^>Ci 2
= s«
w :o o -D 1= * E £
**5 3°
- G 51 5 c 4= D
o u
. 3 Q t 2 *G
ojiE
w So 03
.:dP-S
0)
»•Sdu
=
;G
E 8
03 s C C
r> Eq
03 -
03
C 03 c c
T • « *2 73
tx* 1u°- = 12 < .4
l
C5 *ri
ox r
c
03 73
G
’D
& 03 o O 4_»
D
JO S
0/D CO C
DQ
D cS^
*5 c o § T3 >. 03 5
O
3
03 3M ^ gW £ ’-5 £ 45
Q *c D *03 o u-p . Sd o c
■K
0/5 03 O *n d*G
g £r*o ^
>, ec 4_,^ m5
7) y JD 73 D5
>» 03 >
= L 0)
2 O 45
73 G
73 7)
5 ,(/3 — *->
03
5
3
d
OP
r- ^ Jq
c ^2 ^ ^03 03 C ut r\ -C **■* C3 *J 7) 45 03 45 03 £
c^ > N u- £> 03 rj 03 u t-
<d § *-
03
w
O OI
Oi w x) S z 7«L 03 ^ 03 03 7h CD V- w u "3 U ’ .^S o o vi o
G Q Q GG Id oo o o O X E E E E
co ID co r* GO 03 O <N CO
CO CO
ID
CO
CD
CO
00 03
CN (N M CS DJ CO CO CO CO
 87

1 ^ CM —< CM X CM
o as
0-Z

u o O Gi CO
<L> O
c as CM cM
> C
<J cs «<Z

00 CM CO CO CM X 00 ' ^ CM CM CM CO CO CM «-< CM CM CM CM O lO
o £ o w CO CM — CM ' —« O . P-* T?« *-< -*7* -< ^ — — to CM
r~ 5 W
c w

° 5* u CO CO ”7* O ^ < x — oo in
Tf *-* cm CO CO
,.-2 2 O os
00

=» Q-Z
co#
cfl
uo CM Oi CO 00 05 to CM 00 05 lO X CO O X
« co CO CO CO X ^ X CO CO CO CO to — to to 05
c os cm CM
<Z

o o co CM CO X 00 ~ ~ CM 05 ID
c.h •«• X —' CM CO 05 ^ XX
ct u O os ^ cm
■o a Q<Z
CT3 u

a.t ‘
^ co X X Tf« cm —« CM CM X o 05 X x o CM X ^ CM -*■
C 05
CO o X X X 05 O X X X X O X X XX
05 ~ CO cm 05 — x ~ ^ CO
o OS <z
H

.5*4 g
(/) W--
u S £ CM *-• —< CM CM
Table LXV.—Ante^Natal Clinics.—(continued)

3 C/D-S'*
z *
e -C *
z *5*2 *— *—' CM CM -n *-h ^ ^
rr--55

m
CO ir. 03 CQ ^ .
03 03 03
. o
co J3 j: cd JO j:
<U
03 J3 U J3 PQ U CQ 33 j- CO
CO
j=U u PQ U
r-c
cc O
ji
U U
£ c U .
ei •c
CO o . a V) J= CO
C3 o U
CQ CQ s PQ U 2 >ai r 0^3
S 03 CO U 03
r03 ® CQ
S r 2 :C3 2UQ
II O s CQ
s c
o
C/2
s . PQ 2 . 03. 2 03 s a s' 00 3
cc aj ^_; >.CC2
CO -J3
S _
c S
<15 ^
c .
O-
•Is c 2 w i
2 2'^
^5
5) 3 <u C3 Gh E
o -Q c c &
C 2 J► v GJ
. w .2
x I >
o
<v
E u
c EQ rG
> u g 2
73 o 05 ^
8-g 3
<D ^ H
03 S3 c 2^1 = 0^®
o u c ® ^ - « o
“T3 .o oOe
Q r
c • 'a 03 a) Hi •— u
: - o E^Uti
c «
•- fed
73 C
•2 rj u >, 75 cc -CQ C
<D . CC
: CQ .E m •c qj n . 03 PU
V CO fc." ^ u £ so 3 . OK — DC ^ w
rC
s . o ' pC O <u . tx
s <u < JT
C3
CC
-a
03 J3 £ £ J

■eu gu
M

e “
«
iur
i 03
ClJ

c ^ ~ <u
p ® C
5gi
cffld
a)
0)
•r j u
c/J
E-o
O ^
O 03
J S Q CQ 5 <E E 2 o Q 3

. X
E 03
E
E E O E E g E
E
= d 73 a. E d d C C
d (/) d d £ ^2 d d o 73
tt)
CO ^
Tfl
g x 7 X
P
05 d
Tjl 3
*> o o o > .
u W o ^ o H
o o u
.2
~ 2c °
x cO o o
o
o-4
o o
^
03
3 O w o OM ~ •£ rG E O o 73
® >> M ^ p>
o CM CM U pCC ■*-• X
O 2 CM °? H u d4-1 I
CM 3 >»CM CM
^ CM a 73 73 p jJ- 3 CM CM
X 73 CO
>. - o : 73
03 >. 03 3 ^
-2 ^ - o ^
Cj_, “
■gg
03 03 03 2 c 3 E x -S X CO 73 73 E E ^ £ o W
73 03 73 03
73 <fi X 73 ^ . t. E
C T3 C 73 C “ o^H d c u X U oj £ -o 0 ^3 73 ^ 03 c h
O C o a 3 C o T-l 0 3 aj Si C Cl. C Ecm?
73 C - ^ d
pC O 3
_3 . E3 £ E 2 03
S.2 ^ 'r-i §
g Tf
os _ 03
«wSr
r-1 E h 03 r—I tO w—i £ dH
^ Tf
OS d' H £H ^ 03 H 73 X 03
c o
Q ■Ss-g <->•*“' L. S? . d
F 73^
.h o
-5^ C
O 05
>.
-S
X I aE
o .h C/J CD ..-■ X X
u
CO
> .35 > O CM J3 > .h N 2 N £ .h - ° .h ^
r* U 73 CM u a 73
<15 .h ^ >
W tJ- W
15 r.
W £ < £ £
ri
H w
15
c/) U- iZ u.

Op
03 l—l CO
° p-: O-
CC 03 05 G
cd ^ X
. -C • ,C 3 o
__• '-5 “ :' c
. 03 ^ 05 :o X T3 ^ 05
o-
Q
73
C
q - XT' 00
^pE 'O
13
U o
u
3 p-f Q
D cn £
73 CO 73
>
<
o n £’u 05 3 73
- >-» G O ' G
. D . G > pG tuo >>
>~> G 7 . pG CO
. a) CQ
; .2 CO Q :£ : 05 ■
O 73
O c
Q • >. : r y pis5 > •
c J5 c D< >%.2
.E >* CO > w d 2 X
o X
U -*-<
-H (7)
V
►
-
05 -^3
P
"E E ^ •£ CUD
05
v-. X
05 *rr
o
w, *05 o
2/
c cn S q 73 ^ n
CQ ^ 15 > U 05 <G . 05 n. O 'l| PQ o
Lsi «a c 4-1 0) d
o
^ o . Q S° o :>•§ £ - £ ; lax) c X ' ^ 73 — ^
X5 05
pG C Dh p
► c U 15 o c S H ^ * CUD Oj 0)
05 Op r
05 ^iJh
o
00 o J- c0 ^ E 52, o ry G c O-
E
>» 05 4_, •
pj a^
.a . ra
30r 3
Q •—I U CO “Q
15 3
3 05 Q 03
_E -0 J3 , SrT;
o
D
§
o x: G ‘Z
Q_K -isi 3 ( FU cu CO X
OJ ^ o : dq QH
0) ft
“ >,£-3 HQ dQ
pG
ox r'c G
0.2 c 3|
^ 73
C
^ i-
7T ° ® 15
&■ ■*-> >
-S'c
W , *
S
‘C vD
2 « S E co
E 73 o d 05 X 3 ^ £ *
*E 2 15 X5£> -—i 05 ^ 2 -E -o 73 *f? C > X5
73 03 E -c c o 03 q3 a u ^ c E LG ^5 o O c d O CO »
C S Jy-So
05 a C o 73 05 C >> o 05 To 15 E 2
c2 2 p§£
O TJ CO O o ? «
X x —
u O X 1 s
’Z o 05
- - <D J3
5 73 X *J E3 ^^'EpG CG S 8 •5 2 E >> £pC •g£
P c c
a * Q£
o .h
7~
<
- r?p O
c " c
« in cu < *3 C“1 13 03 H .2 >20 •b 5 O 3 ^ 3 "-I « .&■
E fed fed fed 2 z; O Ch a

X o — CM X X X X O CM X X X x 03
rf X X X X X X X X X X X X X X XX
 88

1 ° 4 15
J
rf cs cs X
0 w
1 1 1 1 1 1 1
£ Ki dz
osx "

" u

U ft; 4/ OS
4) O
c to
O 03 cs T}* X X 03 X cs X X
cs
"'T X X X 03 cs X X

< a <Z

in 0 X cs cs cs cs cs cs ■*r X X cs C^J cs 03 X
o E oi cs X cs C^l cs cs X cs
h 3 2
c in

O C u __
O 0 0 X X 1 X X 1 X X 1 0 X 03 1 X 1 X
« « (/. w X X 1 1 1 1 X 1
o>
>,
O cO
n CO £<Z
P O ’Ofi
3 -g.S

= 3 03 X 0 X cs TT X CS X 0 TJ*
«s-° 03 cs X 0 0 TT
X x r—> X 0 ■—< rr r— r-> cs X X X »— 0 cs cs IN X »—«
grs <z
s

O x X X X 1 1 X 0 1 0 X X 1 0 Tf 1 X
o Cl X X 1 cs 1 cs 1 cs cs 1 X 1
-3 3
CT3 U
0.55

— O Tt< X* 0 r- CS X ~r C'J X X X X X cs X X 0 X
G *—t r> X 03 X O X X *—• IN X X cs 0 »—< X X 0
-M c a X cs
X cs bi cs X
o a < Z

tic ^
.E it: b K
Clinics.—(continued).

ells cs X X Tf cs X cs cs cs cs X cs cs
- - - - - - -

£.S&:

- cs - cs - - - - cs - - cs cs - - - cs - - " cs
.2.3m
X>

CQ CQ
m o

Cfl CO
J3 CQ
U
•C
CQ
cr.
CQ 33
cs CQ
a.
u
a •c
BJ u
J 3 CQ U CQ in
33
U u
33 E

s o a>
o DC CQ
DC U u CQ a. CQ u
E g
< u (33 2 CQ
2 CQ
H
w O 2 2
E S
Z'J
2 2 2 « ■ *5
LXV.—Ante=Natal

CQ CQ CQ a>
I 1,5 “snr
D3 V _j 2 CQ H CQ
xt
J o
secc
c J •
o 1 s' 2 S
u
n
j »•
2 cs W33 W
§ td
o £ o o a> 33 -U g
c Q
- :X
■ 33 < c £»(
c MO. >, E
cX ■ 3 | r E
to 3 .IS
n • w
5 * a; a> O
u cs ;UCD CS
tn E
p Z« |
rC
W r
DC *3 CQ JvQ2 3
■sa u co *2 u CQ^ <=CL 2 CQ
CQ
« .5 to
M 0) g CQ 1: ■ 2« «2:
.2-a u u g d 2
73 c |cq£cq a> . >,CQ .
<D
4 3
J C gn
xs
„ • • ‘u &
•“ -C co — <d . *r
u g« '§*
2« c
2 -Q >^cC c 33
CQ ^ ^
•5 r'O
^
Jl'C'Si
r >.CQ'
*u __v
a •2.T;
s
c gU’C^^J c £flj= ■S J £ U c s £U
su =
1 o
0
u
-S
x
c
<
J3
a,
55 3
o m
nl
a DC
0 nU to
DC « U
G >—J QJ

2 X a s <
bD*
Q
33
Dh
g

s :
cs
Table

c o
E co E
E CO
E E >> E
>* d- E d d cq a)
d CtJ CO rj<
d
d
c
*G 3 O
d.
o X 3 Tf< d o
CO
X
’C
G O
Tfl
13
„ o
co X
c o o. u- o
o cc r? X w ^x
o o tL« G £
u W *C c* o
3 2 s
o
^ c M 2
X G ,

■5
(M O o
►G
1 a. c s ^
G
O o 2 c .
3
£-3 ' cs w 03
3
w
XJ
>,
03
(M
C 3 xj .co"
>-> 3
X
1 O t « "
3 C0 u O
P-.
; ^0
X 3 (M
X
CO
XJ .d
^
G . ^
CX)
C3 o
- c CC<N
X
co
G T?CQ
C 4-*
C « a
T3 1 5 c CO 3
g

2
J-g ^
G
- f—I G
1 • CL)
CO C3 w
X
X
c ^
x
E
- — <M ^
•
:H ^ X
co
G
u
3
X
CO
^X
c
c ^ o G C ^
x _ a. c X <0 o
3 u
3 G ,
!« S XJc3 M
G O C G X -C
a< o -H •> Cl) X ~ a>
3 03 ^ *- 00 x X 3
^
.
>>
G
rt ! CO-w Q.&L, > C tP ^
H X 03 G X £^
co - H
x
J
H
u ^ £■§ G
Q
I ^ CO 3 h
, +J* cig 2 cgx
o ^ U
CO
C
• CO
£ f>
•
x w G O
O ■*“* co
.
cej
C G +-»
op (O
c
o
O X

H 3 O 1—
, XJ u o ^ ' ■ <v ' JZ u au
f_ ^ ^ cn ;
a>N£2
o H u
(D :— 0
o
)
t- »o
U- m H £ £ < H » C/3 C/3 Dh r-c in ^ in £

■ G •
G G
C o
& >>
cs
o

.a 3
<u
■ w
J2 G
c
G : >»
. G
>.
is
: ^
■
•• : o ; Z
: £x o
. 3 • .
tuo
O)
l_
X :3 -s X ■*-*
d d "?
^ G *Z3
• o *

3 G
0.
r*
v*_i Q. § 44
<l> ^ O G tc u Q
G
/33 ,q
Ui
c
:Q- :
Q.—
D 75 t •
*-
G
dgg d Q .
£ . £ & 0 C .
■ O
3
c
o
O C
oQ
•mU g o < 3=^“ : I G
N CD G
a)
:£
o
'& 3
JZ
G .K
•s X
a js
- U a1
du“
• u 5 d d 3
’2

’p
G
.2
m
3
■2.2 o G
> 45
CD
co .
« Ec 3 45
CS
u N
•
•
I
*-*
r*z3 d
3
| .
^ ^*'a)
S : cs •a
. o 11 ® ^0)
?> w
U 0
^ - uO
c ►X CD CO 45
G o : o
G co
o
_2 Q x ^ — >>•£
.DC
_ _ - p
s„-.& Q 85 3 cd

q
q g 3 .3 0)
^
s 7 3 <u bP x 73 5 *o
G c Q O d5
2 SN
o
3po X X

: Q wD = ■ ^ 3 o
— ^
X *T1
v- co .id
S)

^•sr-sb-go- ; 0) a>
- 7 sbuO :Q
o is C —.
G S
t 3 o
JJ £
a> 2
Si JJ 0)
o
•a « 'mm _ w ^ bX)-^ ffi
G G
^ a> 0) D
G
<D 2 O
C *-? 0) G
^ 3 143 . O jfbm
« of 3^3 -5 >-.D _ G 45 2 g aJ
X a
x
0 IS r/t £*~» G
0*33 ^ u o O u G CD = •

+2 ' 45 -1 45 2 45
XO ) C O ^0)0 = c o~ is ^ tUDCr2
^ J QD o s ^ ! c
c
o
0--G
£
2 G
’co G
O O
O O
t £ 0
a) o
m) >> JE ► li-s
GO
Sf G ■£
S O X ^ CD'S
C ) G jg 0 o C _- C+H
^b i O

.s-u
co x
O ^ 45
2 cq
G
G 0 0 CD
u U g in gU
CD
O* ioiffi ’5 K '&
5 c£ in m in in m in in in in in in m cn X in w

O *- cs x X X r> x 03 0 — cs X X CD X a o
IN X x X X Oi
 89

CN - - - - - CM
1 1 - ~
1 X 1
0.2
ft) uft)
PS o.
O X CM X X CM X X 1
c os CM CM CM 1
<a <Z

—ps xi5^.2c r»
X X — X ID X f—i X -r ID X
o £ o'S T CO CM CM CM i—1 CM CM *-* *—1 X
H 3C (4, cm"

oCU -4-»OB 05*-> <N

^H
o ID I 1 'V
y—
X
*—>
CO 05 o
ftj PS X CM CM X '•I* 1 1 C4 CM
1-^4) oa
JOft) -M« ^ ^ 0.2

III
-HCc
rS ft)G tj=
ID
*D -*r X
CD
~r
X
05
O X
»—• CM
X
CM
05
X
X X X
X
c-a
C 5 rti ca *-* •—
X
»— 1 05
<Z rC

00
ft) C£ •*? (N •*r LD 1 1 ■*r X X 05 o
rr rj- r—> *—«
C.S
as o as
X D1 CM X 1 1 CM X
X
T3 3 0.2 cm"
ca t
£ oS
«.S * CO 05 CO O X CM X X ID X CM X o
o ID -r X CM r—« X X 05 X

*’ Area transferred to Autonomous Authority, figures given to 31/3/38 only.

C 05 CO cs X X CM CM
C2 X
CM

Ofl
.Hits-A
MU +JPS •"5— CN CM X CM 1 X CM CM
1
LXV.—Ante=Natal Clinics.—(continued)

- - - - -
3C/3S
Z

£
3
z eS.tJ w - - - - - CM CM - 1 CM CM - CM
1
2.£5d
£>
co m 03 K 03 03 03
U -c
to q CQ j: jd jd jd jd jd U
A) £ .2 u U U CJ U U
a g U Ojn. rn s
CQ
H
0
*0 o . CQ
H
£.i
<- 4-» (3 m CO m 03 CQ m
« fw'S
. ‘I o u s s
c
t£ cg IS ho g®
C3 '_G £ C c03 oco
w •*- Cl,
r« • .2*
rn rt £ C
■gm’• a)EQ
C/J CC3
3
a a 12 o o X c
-a ^d a, CL O 3
CJ r CL
03
CL
03 Cl, CO CO
“•O gu [/) - a W X 'V Pi P4
TJ C U S W f^PQ
4) CS
fc* CO 03 -C CO ^ G .1 < ^

-S j CQ 2
03w. L03W3 £u
c5 i. o O 03 3
03 bX)^ w >rH 1 o
w < ca Q Q O S »< w Q
CO ID ID (M
Table

E O) c rH
03 03 >> d . (M c O O
T3 T3 <3 -a0) E d O
T3 to d 33 (M tP
£ fc d^ C3
2 <u o r? -aC.\) C
O c/Tc/T o
a00
3 W X ^
■S o‘C 3 o
5 CL z. 03 03
° §
J-» T3 3 H CM w
*33u T3 T3 03
T3CO
O . T3 <3
| ”-2 I
p.m.
Tue

C ^ G■ .2 • >% 3 03 <D
■gg X £* CO "3
•oC h-5 •o -t-> oj^
2 X
H 12 C
rt 4-» ^ d-g a _ *- • ^
o. n 03 G *3 T3 ID «
’C 33<3
w ^ C3 «-c <3 H
rt►.<
C3 3 3 . C3
3 3 c c ^ CC3 . 03
•O qTJ
2 gu c
p.m,

c 2 c c _g ^ do
Item

Q 2 03 o >, >< ac. go T3 O

oo CM O
o OCJ £ 00 03 CO
<3 (1)
<M uCO .(M CD> <D
H u.
.2 ^ « -D _i- G CO 2 CL °
CO CO iZ u CO Oh CO £ d < < CO
• - w
X q
,c
#D bo
. . *ca
* V. •
. . ’a 3 .x o
• a) : :ffi O :
c
G
L
L
o
2 °
X-C. <3 03 2^
/-~x
Q U ^
<3
X
(A o .
Q Q :Q 8 ; «i ra Q
c : DC £ • -c j u 3
; o cn
o pi . o> q q cz
^ CO
° ^ > 3 ^ 1P
-*-* Q 3 E tD Jr. a)
J3 J3
cs «3 . r*~> k bo o
o : ^ ■■' JC <3 d; ^ CD T? X >? <3 C d M :
o CL c CL 2 4_J <3
a a.n'a-
*“ , , y. c
*U. C3 03 C3 C3
C
J <u j| C5 u
J3 03
C3 u a x. c Q ^
C W c X, 03 M 3 Q <v w
w co “ o
Q <3 O o U *' 3 ^•u|«D -C ' G a) ^-i
H UQ CJ QJX r~ <U
bo a X)X)>
c^ > O C^C-o 3 < 3 ^ r.
<3
03
H.O) »*H
4J <3 C3
>% O §"£
5:•o 0-0
x C3 . C3 o ou O hc/2<K
- X ^
0) C <3 CJ ^0) ft) 3 O) s o ^r %XXo CJ-eg
.»-
<U 9- £
C t CJ ,-S je ^ *W ft) to ^ Q co . C .C3 O- £
8J L U '- I 11-5 3 •wCO >
« T3r- > fG
*3 ’O O
O r~ 3: p IS wQ (Up1 <3^>
% <3
O hJ u n C3 L-
^ <3 “ 03
H H H : ^ ^ ^ r s° ^ £
C3 1/5 CD 00 05 O
O O
C'l
o
cc
o
05 05 05 05 05 05 05
 90

Table LXVI.
Ante-natal Clinics.

The following- table shews the distribution of Ante-natal Clinics in days and weeks.

Week of Friday.
Monday. Tuesday. Wednesday. Thursday.
month.

First Birdwell Denby Dale tBlacker Hill Crofton Birdwell

Darton Ferrybridge Brampton Ecclesfield Crigglestone
Golcar Hemsworth Bierlow Edlington Penistone
Horsforth tMicklefield *Conisbrough tGrassington Queensbury
Kirk Sandall Otley (Denaby Main) Horbury *Stainforth
Linthwaite Royston Fitzwilliam Meltham Stocksbridge
Mytholmroyd Sowerby Bridge tGuiseley Middlestown Swinton
Ripponden High Green Swillington Wath-upon-
Skipton *Rossington Thurcroft Dearne
Shelf Wetherby

Second Carcroft *Armthorpe tGreetland Bolton-on- Barnoldswick

Springhead Featherstone *Moorends Dearne Darfield
Knottingley Outwood Dalton Hebden Bridge
Royston West Melton Kiveton Park Sprotborough
Settle Stanley Swinton
Swallownest (Birth Control)
Tadcaster
Thorne
Wrenthorpe

Third Darton Ferrybridge Brampton Allerton Bywater Garforth

Elland Mirfield Bierlow Edlington Sharlston
Marsden ^Conisbrough Horbury South Milford
Skipton (Denaby Main) Lepton *Stainforth
Doncaster (Birth Thurcroft Swinton
Control) Wath-upon-
Fitzwilliam Dearne
*Rossington
tYeadon

Fourth Carcroft *Armthorpe Holmfirth Bolton-on- D'arfield

Gawber Featherstone fMoorends Dearne Earby
Golcar Knottingley West Melton Kiveton Park Hebden Bridge
Royston Outwood Saddleworth Sprotborough
Stanley Swinton
(Birth Control)
Tadcaster
Thorne

Last Dalton Chapeltown

Alternate Catcliffe Maltbv Ripon

Selby Worsborough Snaith
Dale
Worsborough
Bridge

Weekly f Conisbrough *Adwick-le- Dunscroft Askern Bentley

Upper Street + Leeds (Birth tNormanton Cudworth
Hoyland Mexborough Control) Rawmarsh Dinnington
Hoyland Leeds Consultant
Common Clinic
Knaresborough Thurnscoe
Listerdale

+ Sessions held in morning. * Sessions held in morning and afternoon. All other sessions held in afternoon only.

Consultant Ante=Natal Clinics.

In furtherance of the scheme to combat the high rate of maternal mortality in the Riding,
progress has been made by the establishment of consultant ante-natal clinics in connection with
the County Maternity Home at Montagu Hospital, Mexborough, and the Listerdale Maternity
Home at Wickersley, in addition to those at Leeds, Sheffield and Doncaster.

These clinics serve all the child welfare centres and ante-natal clinics in the Riding, and
consultations are held once a month or more often if required. A suitable date is fixed for expect¬
ant mothers to attend the consultant clinics, and patients, nurses and midwives are notified of the
times and dates of the consultations A report of the examination is supplied to each medical
officer. In urgent cases where the confinement is imminent and any abnormality is suspected, the
patient is sent into the maternity hospital for immediate examination. If the patient is unable
to travel by ordinary means of transport, arrangements are made to remove her to hospital by
ambulance or taxi and in necessitous cases the cost is defrayed by the County Council.
 91

During 1938, 386 patients were referred to consultant clinics, in addition to 152 domiciliary
consultations.

Doncaster. This clinic serves the County Area around Doncaster to which exceptional
maternity cases from centres, ante-natal clinics, etc., are referred.

During 1938, 102 patients were examined at this clinic.

Leeds. By arrangement with the Leeds Maternity Hospital Consultant Clinics are now held
daily at this Hospital by the honorary obstetric surgeons.

During the year 1938, 106 patients were referred to this clinic.

Sheffield. In October, 1935, a consultant clinic was established in Sheffield to serve at least
18 ante-natal clinics within a reasonable distance of Sheffield, to which cases are referred by the
ante-natal officers for consultant opinion. It has been arranged that such patients should not be
seen at the Jessop Hospital (where the work of these consultants is “honorary”) but at their con¬
sulting rooms by appointment. In Sheffield there are four consultants who have been appointed by
the County Council for this service and a rota operates for a period of three months each.

During 1938, 60 patients were referred to the several consultants in Sheffield.

The Consultant Clinics established at Mexborough and Listerdale are in charge of Mr. L. B.
Patrick, F.R.C.S., one of the consultants attached to the Jessop Hospital for Women at Sheffield.
The number of patients examined during 1938 was as follows :—

Mexborough 93. Listerdale 25.

Birth Control.
In March and July, 1931, the Minister of Health issued memoranda on the question of Birth
Control and after consideration the County Council decided to take action in this matter on
the lines indicated by the Ministry’s memoranda. In the memoranda it is pointed out that Local
Authorities have no power to establish rate-aided birth control clinics and that their activities are
restricted to the giving of advice through their medical officers at Child Welfare and Ante-Natal
Clinics, and to the provision of appliances in those cases where it is considered undesirable on the
grounds of health that certain married women should give birth to children. Having regard to the
acute division of public opinion on the subject of birth control, the Ministry decided that no
Departmental sanction which may be necessary to the establishment of such Clinics shall be given
except on condition that contraceptive advice will be limited strictly to cases where further preg¬
nancy would, be detrimental to health.

The following table gives particulars of clinics where West Riding patients receive advice and
instruction in birth control methods. These clinics serve a large number of child welfare centres
and ante-natal clinics from which women are referred for advice.

In necessitous cases, appliances and materials are supplied free of cost, and travelling expenses
are paid.

Table LXVII.

Number of:—
Medical Staff.
Day and hours of
Location. Names and Health
Attendance. Nursing
Qualifications. Visiting
Staff.
Staff.

Doncaster, Edenfield Maternity Home, Third Wednesday in Agnes G. Bruce, M.B., — 1

Thorne Road ... . Month at 2 p.m. Ch.B.

•Halifax Womens W'elfare Clinic, Second and fourth D. W. Heynemann, — 1

19 Saville Road, Halifax Wednesday at 6-30 p.m. M.B., Ch.B.

Leeds. Maternity Hospital, Any Wednesday at Consultant on duty. — 1

Hyde Terrace ... . 11 a.m.

•Sheffield. Attercliffe Vestry Hall ... First and third Tuesday Margaret M. Owen, — 1

at 2-30 p.m. M.B. Ch.B.

Swinton. Rock House ... . Second and fourth Friday Margaret M. Owen, 2 —
in month at 2 p.m. M.B., Ch.B.

•Manchester. 70, Upper Brook Street, Each Thursday, 3-0 p.m. Committee of Honorary — 3
Chorlton-on-Medlock ... and 7-30 p.m. Medical Officers.

*Patients are seen by arrangement at these Clinics, which are Affiliated Branches of the National
Birth Control Association.
 92

During 1938, 411 married women received advice at the above clinics, a decrease of 81 on
the previous year, and these were distributed between them as under.
Doncaster . 132
Leeds . 76
Sheffield. . 4
Swinton ... . 199

Total 411

Maternity Homes.
The County Council sends patients to 31 maternity hospitals and homes belonging to the County
Council, or to other Municipal, voluntary or private bodies. The total number of patients admitted
to these hospitals during 1938 was 3,659. This figure shows a decrease of 18 compared with the
year 1937.

Listerdale Maternity Home, Wickersley, near Rotherham.

The Listerdale Maternity Home was officially opened on the 12th March, 1938, by County
Alderman W. B. Cartwright, then Vice Chairman of the West Riding County Council and Chairman
of the West Riding Finance Committee. Full details of the building, furniture, equipment, staffing,,
etc., appeared in my annual report for 1937. The Home is provided with 20 beds and an observation
unit of 2 beds.
During the period 12th March to the end of the year 161 maternity cases were admitted.
The average duration of stay was 14-9 days. Of this number 136 were delivered by midwives and
6 by doctors. In 42 cases assistance was sought by midwives in emergency.

One case of puerperal pyrexia and one case of ophthalmia neonatorum occurred during the year
and the result of treatment in each case was satisfactory.

It is pleasing to report there were no maternal deaths in the Home during the year.

Number of Infant Deaths.

(i) Stillborn ... ... ... 7
(ii) Within 10 days of birth ... 5

The deaths of infants were ascribed to:—

Prematurity ... ... ... ... 4
Anencephalic ... ... ... 1

Private practitioners are summoned in cases of emergency arising in the maternity home in¬
accordance with the rules of the Central Midwives Board.

The Home is also available for private patients who have engaged their own doctors to attend
them at confinement.

Fees.
The fees at the Listerdale Maternity Home for patients resident in the West Riding Maternity
and Child Welfare area are at the rate of £3 3s. Od. per patient per week, but for those patients
entering the home from districts outside the County Maternity and Child Welfare area the charges
are at the rate of £4 4s. Od. per patient per week.

Final Accounts.
The final accounts in respect of erection, furniture and equipment of the Listerdale Maternity
Home shew the total cost to be £19,255.

County Maternity Home, Montagu Hospital, Mexborough.

The work undertaken during the year at the County Maternity Home is given below _
Twenty maternity beds are provided by the County Council and during 1938, 345 patients
were admitted and 301 cases delivered.
The average duration of stay was 17-3 days.
The midwives employed in the wards delivered 264 patients and the doctors 37 patients.
Medical assistance was sought in 92 cases, an increase of 37 compared with the year 1937.
Five cases of puerperal pyrexia were notified during the year.
One case of ophthalmia neonatorum was notified and was discharged cured.
Five maternal deaths occurred during the year, one more than the previous year.

The causes of death in these five cases were :■—

Placenta Praevia with P.P.H. ... 2

Post Eclampsia ... ... ... 1
Albuminuria—Placenta Praevia ... 1
Pernicious anaemia, Hyperemesis
and Albuminuria ... ... ... 1
 The number of infant deaths were :—

(i) *27 stillborn, an increase of 15 over the previous year.

(ii) 9 within ten days of birth, an increase of 5 over the previous year.

These latter were ascribed to :•—

Congenital Malformation of the Heart ... 1

Ruptured liver ... ... ... ... 1
Delayed labour ... ... ... ... 1
Asphyxia Pallida ... ... ... ... 1
Prematurity ... ... ... ... ... 5

Mr. L. B. Patrick, F.R C.S., the House Surgeons, the Matron, Sister and nurses are to be
congratulated on the excellent results which continue to be obtained at the Home.

Wortiey Maternity Home, Chapeltown, Near Sheffield.

The erection of the maternity home at Chapeltown comprising 20 beds and an observation
unit of 2 beds, is proceeding rapidly. The layout is on similar lines to the one erected at Wick-
ersley (Listerdale Maternity Home).

The tenders for erection amount to £24,130 18s. Od. and in addition the cost of furniture and
equipment is £3,500.

In the building contract there is a time limit clause of 15 months and the Home should be ready
for occupation sometime during 1940.

Harrogate and District General Hospital.

The new maternity wards erected at the above Hospital were opened by Her Royal Highness
the Princess Royal on the 24th September, 1938.

The wards contain 14 beds (including 2 isolation beds) and the total cost was approximately
£12,600, of which amount contributions were made as under :—
£
The National Council of Women ... 5,100
Harrogate Corporation ... ... ... 1,100
The West Riding County Council ... 4,500
Harrogate and District General Hospital 1,900

Of the 12 maternity beds available, the County Council has reserved three and the Harrogate
Corporation three, although both Authorities occupy additional beds as required.

Doncaster Area.
Negotiations are proceeding with the Doncaster Corporation and the Governors of the Doncaster
Royal Infirmary for the erection of a maternity unit of 80 to 100 beds on a site adjoining the Don¬
caster Royal Infirmary, on terms to be agreed.

The principle of the erection of maternity home accommodation jointly with the Doncaster
Corporation has been agreed to and the special Sub-Committee already appointed to deal with
the matter has been empowered to negotiate with the Doncaster Corporation as to terms, plans etc.

Survey of Maternity Home Accommodation.

In connection with the survey of maternity home accommodation in the County, special Sub¬
committees have been appointed to meet representatives of the Pontefract Corporation, Pontefract
General Hospital, Goole Borough Council, the Holme Valley Memorial Hospital Committee and
the Selbv War Memorial Hospital Committee to discuss the question of the provision or extension
of maternity home accommodation in these areas.

Other Maternity Homes.

During the year the County Council made arrangements for the admission of patients, and
revised terms or consulted with Local Authorities regarding maternity institutional treatment as
follows :—
St. Helen’s Hospital, Barnsley.
Arrangements were made with the Barnsley Corporation for the treatment of West Riding
maternity patients in this hospital at a cost of £2 0s. lid. per patient per week.

Keighley Area.
A special Sub-Committee conferred with representatives of the Keighley Corporation and the
Keighley Victoria Hospital Committee with regard to the provision of maternity institutional
accommodation for Keighley Borough patients and patients from the surrounding County maternity
and child welfare area. The Corporation representatives came to the conclusion that it would be
preferable for maternity cases from the Borough to be admitted to the maternity section of the
proposed new North-Western General Hospital, rather than to have an additional small unit at
the Keighley Victoria Hospital.

Edenfield Maternity Home, Doncaster.

The maintenance charges for West Riding patients at this Home were increased from £3
7s. 6d. to £3 10s. Od. per patient per week as from the 1st January, 1938.
 94

Leeds Maternity Hospital.

A fee at the rate of £3 19s. lid. per patient per week was approved in respect of West Riding;
maternity patients admitted to this hospital for a period of one year from the 1st April, 1938.

Bradford Royal Infirmary.

A fee at the rate of £3 14s. lid. per patient per week was approved in respect of the treatment
of West Riding maternity cases sent to this Infirmary for the year commencing the 1st April, 1938.

Goole Municipal Maternity Home.

The fee payable to Goole Corporation for the treatment of West Riding patients admitted to
their Municipal Maternity Home was increased from £3 3s. Od. to £4 4s. Od. per patient per week
as from the 1st February, 1939.

Royal Halifax Infirmary.

The County Council made a grant of £350 to the Royal Halifax Infirmary in respect of the
treatment of West Riding maternity patients during the year ending the 31st March, 1939.

The Child Welfare Sub-Committee also agreed that no cost of treatment be recovered from
patients undergoing treatment at the Royal Halifax Infirmary.

Castleford Municipal Maternity Home.

In view of the amalgamation of surrounding districts, with an estimated population of 23,188,
with the Castleford Urban District in accordance with the provisions of the County of York, West
Riding Review Order, 1938, it was no longer desirable to reserve the use of two beds in the Castle¬
ford Maternity Home for West Riding patients and notice was given to the Castleford Urban Dis¬
trict Council terminating the arrangement.

MATERNITY PATIENTS ADMITTED TO HOSPITALS AND MATERNITY HOMES.

The total admissions of West Riding patients to maternity homes in the County and in the
neighbouring County of Lancashire numbered 3,659 against 3,677 in 1937, a decrease of 18 patients.

The following table gives particulars regarding the admission of patients to Maternity Homes
during 1938 :—
Table LXVIII.

No. of
patients
admitted Deaths
No. of Feet
Name of Municipal Authority from of
Maternity C.C.'s Deaths Still- of
or Hospital Committee. of Infants Home
Beds in M. &C.W, Births
Mothers within per
Institu¬ area
tion 10 days week
during of birth
1938
1 2 3 4 5 6 7

£ s. d.
1. Barnsley Corporation, Municipal Maternity Home 7 38 1 3 3 0
2. Barnsley Corporation, St. Helen Hospital ... 10 15 — 2 1 2 0 11
3. Batley Corporation 10 1 — — — 3 0 0
4. Blackburn Corporation 20 — — — — 3 13 6
6. Bradford Royal Infirmary — 8 — — — 3 14 11
6. Burnley Corporation 36 2 i — 1 4 4 0
7. Castleford U.D.C. 13 85 — — 3 4 4 0
8. Colne Corporation 14 67 — — 7 4 4 0
9. County Maternity Home, Montagu Hospital,
Mexborough 20 344 5 9 27 3 7 6
10. Doncaster, Edenfield (Private) 54 603 5 14 35 3 10 0
11. Goole Corporation 4 18 — — — 4 4 0
12. Royal Halifax Infirmary 26 118 1 — 6 350 p a.
13. Halifax General Hospital 60 270 — 6 12 2 12 6
14. Harrogate and District General Hospital ... 14 61 1 1 4 3 3 0
15. Heckmondwike Nursing Association 5 — — — — 2 7 0
16. Holmfirth, Holme Valley Memorial Hospital 5 100 — 3 2 3 3 0
17. Huddersfield Corporation, Municipal Maternity
Home 32 216 8 5 4 0 0
18. Huddersfield Corporation, St. Luke’s Hospital . 8 43 — 1 1 2 2 0
19. Huddersfield Royal Infirmary ... 15 68 1 4 10 3 3 0
20. Keighley, St. John’s Hospital (W.R.C.C.) 14 27 — — 2 12 6
21. Leeds Maternity Hospital 100 506 1 19 33 3 19 11
22. Listerdale Maternity Home (W.R.C.C.) ... 10 161 — 5 7 3 3 0*
23. Oldham Corporation Municipal Maternity Home 14 23 — i — 3 3 0
24. Oldham Corporation General Hospital ; 3 — — — 3 3 0
25. Ripon Nursing Institution 7 47 — 2 3 4 4 0
26. Rotherham Corporation 40 106 3 4 5 3 17 6
27. Sheffield, Jessop Hospital for Women 51 : 81 f 3 13 41 3 3 0
28. Skipton and District Hospital 6 173 — 3 8 3 7 6
29 South Elmsall, etc. ... . 5 1 — — 3 3 0
30. Wakefield, Corporation ... . 33 174 1 3 14 3 3 0
31. York Corporation 28 50 3 3 7 6

671 3659 25 98 229

Patients residing outside the administrative area of the West Riding County Council are required to undertake
repayment of maintenance fees at the rate of £4 4s. Od. per week and all medical and consultant fees incurred.
+ Includes West Riding patients admitted under the Hotpital’s ld.-in-the-£ scheme.
Note.—(a) The Bradford and Huddersfield Royal Infirmaries and St. Helen’s Hospital, Barnsley, only admit
complicated cases.
(b) Castleford Urban District Council and the Huddersfield Corporation only accept normal cases.
With the exception of Bradford Royal Infirmary, Harrogate General Hospital, Halifax General Hospital, Huddersfield'
Royal Infirmary, Leeds, Sheffield and York, where the fees are inclusive, a surgeon’s fee is chargeable for
special cases. In the case of the Royal Halifax Infirmary an annual grant is made.
 95

Deaths in Maternity Homes.

Although the majority of admissions into maternity homes are of an abnormal character it is
gratifying to report that at 19 of these homes there were no deaths. At the remaining 12 there
were 25 deaths of women in childbirth, a decrease of 11 compared with the previous year.

MATERNITY PATIENTS ADMITTED TO PUBLIC ASSISTANCE INSTITUTIONS.

Under the Local Government Act, 1929, Part I, 22 institutions and one separate hospital
(Keighley) were transferred to the County Council on the 1st April, 1930. In 13 of these institu¬
tions, 46 beds are available for maternity cases and during 1938, 304 patients were admitted.

The following table gives particulars of these institutions shewing the beds available, cases
admitted, and number of maternal and foetal deaths :—

Table LXIX.

was soughtbyamid-
No. of cases in which
No. of cases

medical assistance

wife in emergency
fined during 1938. No. of cases No. of Foetal
No. of cases con¬
No. of maternity

No. of Maternal
delivered by notified as deaths

Neonatorum.
Neonatorum.

deaths.

days of birth.
Ophthalmia
beds.

Pemphigus

within ten
Midwives.

Still-born.
Puerperal
Name of County

Doctors.

Pyrexia.
Institution.

i. Clayton 6 14 12 2 9 — i
2. Goole ... . 4 1 i — — — — — — — —
3. G renoside 1 3 3 — — — — — — i —

4. Hemsworth ... 2 6 6 — — — — — — — i
5. Keighley . 14 226 197 29 — —- — — — 14 8
6. Knaresborough 4 12 12 — — — — — — 1 1
7. Otley ... 2 3 3 — i — — — — — 1
8. Pontefract 4 11 11 — * i — i — — —
9. Ripon 3 1 1 — — — — —
— —
10. Selby ... 3 20 12 8 — — — — i 2 2
11. Skipton 1 5 5 — 3 i i — — — —
12. Tadcaster 1 2 1 1 2 — — — — — —
13. Todmorden ... 1

46 304 264 40 12 2 i i i 19 13

COLLECTION OF MATERNITY HOME FEES.

The County Council have fixed the maximum fee to be paid by patients received into Mater¬
nity Homes by arrangement with the County Council, at £3 3s. Od. per week, and in cases where
the fee charged exceeds £3 3s. Od. per week the County Council pay the balance of such fee.

The County Council also pay the doctor’s and specialist’s fees.

In October, 1937, the County Council amended the scale of payment, as under, and in necessitous
cases, the whole or part of the fees are paid by them.

Scale of Payment.

Where the total family income, after deducting the

actual rent and Rates paid and 5/- for each child Amount payable by Patient.
under 14 years of age, and not working

Does not exceed 24/- per week ... . Nil

Is between 24/- and 34/- per week . Amount of Maternity Benefit received
Is between 34/- and 44/- per week Half Fees.
Exceeds 44/- per week ... Whole Fees.

In ascertaining the weekly income of the family, the average earnings for the six weeks
preceding the birth are taken, and in addition special deductions in appropriate cases are allowed
as follows :—
Workmen’s Compensation ... First 7/6 weekly to be deducted from gross income.
National Health Insurance ... First 7/6 weekly to be deducted from gross income.
Sick Club benefits ... First 5/0 weekly to be deducted from gross income.
Army Disability Pension ... First £1 weekly to be deducted from gross income.

Income from lodgers or family in

respect of board Only 4/0 in each £1 is to be reckoned as income.

If any part of a house is let furnished, only one half the rent therefrom is to be reckoned
as income.

The Public Health Department ascertains the fee to be paid in each case, and is responsible
for rendering accounts.
 96

The collection of fees is undertaken by 18 area collectors attached to the West Riding Treasurers
Department.

To facilitate the collection of fees the following changes in procedure were approved and adop¬
ted by the Child Welfare Sub-Committee early in the year, viz :—

(1) That arrangements be made for all maternity homes to notify the C.M.O. immediately
a patient is admitted to the Home and to render accounts to the County Council weekly in respect
of all patients discharged.

(2) On receipt of the above notification of admission—

(a) The case be referred for the verification of the family circumstances.

(b) The C.M.O. to render immediately on receipt of the account from the hospital an
account equal to the amount of maternity benefit to each contributor who, according
to the unverified particulars of family circumstances, is prima facie a paying case,
together with a circular letter indicating that the amount charged will, if necessary
be modified and the exact assessment forwarded after verification of the contributors’
circumstances, and also showing the County Council’s scale.

(3) On receipt of report from the verification staff a final account to be rendered to the con¬
tributor by the County Medical Officer.

The number of claims dealt with is as follows :—

1934 1935 1936 1937 1938

Whole fees .280 315 349 1,000 1,158

Half fees .250 320 264 550 843
Maternity benefit .681 426 288 425 181

1,211 1,061 881 1,975 2,182*

* In addition to these claims, 1,427 provisional assessments each for the amount of £2 Os. Od.
were forwarded in accordance with the amended scheme for recovery of fees approved by the Child
Welfare Sub-Committee on 12th January, 1938.

The following statement is for the period 1st October, 1937 to 30th September, 1938.
£ s. d. £ s. d.
Amount outstanding 1st October, 1937 4,540 9 4
Less amounts written off 1,060 5 10 3,480 3 6

Accounts rendered ... 11,075 18 9

14,556 2 3
Less fees collected by West Riding Treasurer 6,229 6 3

Amount outstanding 30th September, 1938 ... 8,326 16 0

Section 184 (1) Public Health Act, 1936.

The effect of this Section of the Public Health Act 1936 provides that a Local Authority shall
recover from a patient maintained in an institution, or from any person legally liable to maintain
him or from the patients estate if he has died, any expenses incurred. Previously the words
“legally liable to maintain” have not been extended beyond the liability of a parent to provide for
his or her children or a husband to provide for his wife.

After consideration of the matter the Child Welfare Sub-Committee decided not to make any
alteration in the present procedure for the recovery of institutional fees under the maternity and
child welfare scheme.

Convalescent Home for Delicate Women and Children.

Some years ago the Child Welfare Sub-Committee considered this matter and hinted that a
suitable place for the erection of a convalescent home might be on the shores of Morecambe Bay.
Subsequently, Netherside Hall, near Grassington, was offered bv Sir Geoffrey Ellis, M.P., but this
scheme was not proceeded with owing to the cost entailed.

A Sub-Committee has been appointed to prepare a scheme and to find a suitable site within
the Administrative County, preferably in the Wetherby, Ilkley, Harrogate or Wharfedale areas.

The proposed home would be required to accommodate 50 patients. There is a suitable site
of approximately 11 acres lying just to the west of Linton Village, which is about 1| miles from
Wetherby, and negotiations are at the present time being entered into for the purchase of this site
for the purpose of a convalescent home for delicate women and children.
 97

Grants to Nursing Associations.

Local Government Act, 1929. Section 101.

Under the County Council’s scheme for the establishment of a domiciliary midwifery service,
which came into operation on the 1st July, 1937, the grants to nursing- associations under
Section 101 of the Local Government Act, 1929, were cancelled with the exception of a sum of
£8 per annum paid to the Denaby Main Nursing- Association. In an amending scheme under
Section 131(2) of the Local Government Act, 1929, providing for the omission from the scheme
made by the County Council under Section 101 of the Act, of the annual contributions to the
voluntary associations now taking part under the scheme of the Midwives Act, 1936, the following
scheme was approved by the Minister of Health and secures the payment of the following annual
■contributions up to the 31st March, 1942:-—
£ s. d.
West Riding County Nursing Association . 38 11 9
Denaby Main and Conisbrough Nursing Association ... ... 8 0 0
Bentham Infant Welfare Centre . ... 5 4 7
Heckmondwike District Nursing Association ... . 214 4 11
St. Agnes Babies’ Home, Harrogate ... ... ... ... ... 206 6 5

.£472 7 8

Local Government Act, 1929.—Review of County Districts.

Maternity and Child Welfare Services.
(a) Nursing Associations.
In accordance with the provisions of the County of York, West Riding Review Order, 1938,
which took effect on the 1st April, 1938, the areas set out in column 2 of the following schedule
were amalgamated with the districts shown in column 3 thereof, and the grants specified in column
5 of the schedule were paid to the nursing associations as stipulated in column 1 as from the 1st
April, 1938, in substitution for the grants set out in column 4 in respect of health visiting and
school nursing work undertaken by such nursing associations on behalf of the County Council.

Grant as
Transferred Previous
Nursing Association. Areas. from
to Grant.
1 :4 :38.
(1) (3) (3) (4) (5)
£ £

Spofforth ... . Follifoot P. (part) . 30 25

Killinghall ... Killinghall P. (part). |. Harrogate 24 16
Kirkby Overblow ... Kirkby Overblow P. (part) ... B. 40 38
Rigton P. (part)
Bingley U.D.C. Morton East and West Keighley B. 80 80

2. The necessary notice was given to terminate the grants hitherto paid to the undermentioned
nursing associations bv the County Council in respect of the health visiting and school nursing
■duties undertaken by them, as from the 1st April, 1938.

Amount of
Nursing Association. Areas. Transferred to—
Grant.

(1) (2) (3) (4)

£ s. d.

Pannal Pannal P. (part) Harrogate B. 32 0 0

Oakworth ... Oakworth U.D. Keighley B. 44 0 0
Netherton and South Crosland ... South Crosland U.D. ... Huddersfield C.B. 49 12 0

(b) Medical Officers of Centres.

The appointments of the following part-time medical officers of centres in districts transferred
to areas autonomous for the maternity and child welfare services, were terminated on the 1st
April, 1938:—

Airedale Dr. Christina M. Hawick.

Glass Houghton ... Dr. Emily E. Johnson.
Haworth Dr. Doris M. Ringrose.
Whitwood ... Dr. Marjorie Steven.

(c) Child Welfare Nurses.

Three child welfare nurses were concerned in areas affected by the provisions of the Order but
■only one of the nurses desired to transfer her services and accordingly arrangements were made
for two of them to be retained on the staff.
 98

(d) Castleford Urban District.

The Castleford Urban District Council asked the County Council to continue to carry out the
maternity and child welfare work in Airedale, Glasshoughton and Whitwood, which districts were
added to the Castleford Urban District under the provisions of the County of York, West Riding
Review Order, 1938, on the 1st April, 1938, pending the preparation of a scheme by the Urban
Council to cover the enlarged urban district. The County Council continued to carry out these
duties on behalf of the urban council for a period of six months from the 1st April to the 30th
September, 1938.

Notification of Births.
Public Health Act, 1936.—Part VII.
During the year, 14,989 live births (14,429 legitimate, 560 illegitimate) and 682 still births
(658 legitimate, 24 illegitimate) were registered in the County Notification of Births Area, and
12,927 (12,530 live births, and 397 still births) were notified. Of the 12,927 births, 11,704 were
notified by midwives, and 1,223 by doctors and parents.

At the end of 1938 there were 10 Boroughs, 8 Urban Districts and 1 Rural District exercising
powers under the above Act, namely:—The Boroughs of Batley, Brighouse, Goole, Harrogate,
Keighley, Morley, Ossett, Pontefract, Pudsey and Todmorden, the Urban Districts of Bingley,
Castleford, Heckmondwike, Ilkley, Rothwell, Shipley, Spenborough and Wombwell, and the Rural
District of Hemsworth.

The estimated mid-year population in 1938 of the Administrative County was 1,501,100 and
deducting the 19 autonomous areas enumerated above, having a total population of 560,698, the
population of the County Notification of Births Area totalled 940,402.

Arrangements made by the County Council in the interests of economy and to avoid over¬
lapping are as follows :—

Authorities performing school nursing for the County Council on agreed terms : Bingley,
Heckmondwike and Wombwell Urban Districts.

Districts where the County Council employ whole-time school nurses on account of large size
of area : Goole Borough, Castleford, Ilkley and Rothwell Urban Districts and Hemsworth Rural
District.

At Heckmondwike and Wombwell, the County Council’s school clinics combine with the mater¬
nity and child welfare centres belonging to the Local Authority.

Home Visits.
Visits made by Health Visitors during the year were as follows (for detailed analysis see table
LXXII folded in at page 101).
Expectant Mothers ... ... ... ... ... ... 16,528
Infants under one—first visits ... ... ... ... 14,375
Infants under one—Total ... ... ... ... ... 99,698
Children 1/5 ... ... ... ... ... ... ... 116,840
Special Visits (ophthalmia neonatorum, teething, marasmus,
feeding, circumcision, etc.) ... ... ... ... 3,166
Measles cases ... ... ... ... ... ... 1,791

Measles.
During 1938 the Health Visitors made 1,791 visits to measles cases distributed over 40 sanitary
districts, being an increase of 674 over the previous year (see table folded in at page 101).

Nursing Staff.
The number of nursing staff employed in connection with the maternity and child welfare work
at the end of 1938 is as follows: —
4 inspectresses of nurses and midwives.
1 emergency nurse.
120 child welfare nurses, undertaking combined duties of health visiting and school nursing.
14 health visitor-midwives employed under the salaried midwifery scheme.
62 part-time nurses, employed by nursing associations to undertake on behalf of the County
Council the health visiting and school nursing work.

Recently the establishment of health visitors and school nurses has been increased to 150, but
owing to the lack of suitable applicants, difficulty has been experienced in bringing the number
up to the authorised establishment.

Miss Anne Carey of Eltham, London, was appointed as Assistant Inspector of Nurses and
Mid wives.
 99

The following permanent appointments as Health Visitors were made during the year: —
F. Allison. E. M. Senior.
N. Bruce. M. F. Senior.
B. P. Butler. H. Walker.
E. P. Jones. N. Wingfield.
E. E. Ryall.

Nurses C. M. Sheldon and H. B. Stockwell, previously employed as temporary nurses, were

transferred to the permanent staff.

The following nurses were employed in a temporary capacity during the year:—
G. H. A. J. Hall.
C. W. Little.
E. W. Wells.

The following health visitors resigned their posts during the year:'—
Name. Reason for resignation.
G. H. A. J. Hall (temporary) To take up training for the Health Visitor’s
Certificate.
M. Mindham ... Appointed Chief Superintendent Health Visitor
under the Preston Corporation.
D. J. Lawlor ... Returned to her home in Ireland.
L. B. Taylor ... Marriage.
D. L. Wildman Marriage.

Training of Nurses.
For many years difficulty has been experienced, not only in the West Riding of Yorkshire,
but in other parts of the country, in obtaining an adequate number of recruits for the nursing
service. The West Riding Education Committee award bursarships to girls in attendance at
secondary schools, who have reached the age of 16 years and wish to become nurses, and for the
school year 1938-39 decided to offer 25 awards. Previously only 10 awards have been made in
each year. The bursarships provide the whole or some portion of the tuition fees, games subscrip¬
tions, charges for the use of books and necessary travelling expenses if living more than two miles
from the school. Maintenance allowances are also granted in accordance with the scale approved
by the Committee for county continuation scholars. The awards are made for a period of two
years so as to enable bursars to remain at school until they reach the age to train as nurses. On
attaining the standard of general education which exempts her from the test educational exam¬
ination of the General Nursing Council, the successful candidate is required to give an undertaking
that at the age of about 18 years she will enter a hospital which receives probationers at that age
to take the course of training to qualify as a general trained nurse.

The former requirement that on completion of her general training a bursar should obtain the
Central Midwives Board Certificate with a view to qualifying for employment as a health visitor
is at present under consideration and in view of the Authority’s desire to encourage a larger
number of good candidates to enter training as general nurses, this specific requirement to train
as a health visitor may possibly be abolished.

It is necessary for candidates to satisfy the Committee of their suitability for the career of a
nurse and each candidate who is accepted as suitable on grounds of personality is required to
undergo a medical examination before the award is made.

The following tables give particulars of the results of awards up to the 31st December, 1938,
together with a list of hospitals where trainees have been placed.

Nursing Bursarships.
Schedule of Results of Awards up to 31st December, 1938.

Table LXX.

Bursars in Bursarships cancelled,

Bursarships awarded. Bursars Bursars
training for etc. Bursars
actually actually in
New Health still at
in General Midwifery Before After
Visitors school.
Year. No. Training. Training. training training
Certificate.
commenced. commenced.

1931-32 . 9 2 5 1 — 1 —

1932-33 . 9 5 1 — — 3 —

1933-34 . 8 6 1 _ 1 —

1934-35 . 6 6 — — —

1935-36 . 9 7 — 1 — 1

1936-37 . 7 5 — 1 — 1

1937-38 . 9 — 1 — 8
_

1938-39 . 14 — — — — 14

Totals ... 71 31 7 1 3 5 24
 Trainees Trainees
Name of Hospital.
(General). (Midwifery).

Battersea 1
Beckett Hospital (Barnsley) 1
Bradford Royal Infirmary 3
Clayton Hospital, Wakefield 1
Derby Royal . 1
Jessop Hospital (Sheffield) 1
Leeds General Infirmary ... 11
Leeds Maternity Hospital 2
Nottingham 1
Paddington Infirmary 2
Preston Royal Infirmary ... 1
Royal Halifax Infimary ... 1
Royal Manchester Children’s Hospital 1
Scunthorpe War Memorial Hospital . 1
Sheffield General Hospital 1 2
Sheffield Royal 4
Whitechapel 2
York Maternity Home 1

31 7

Inspectresses of Nurses and Midwives.

Table LXXI.

•
Miss A. M Miss M. Miss R. Miss A.
TOTAL
Clarke Davenport O’Brien Carey

Visits to Whole-time Health Visitors 200 150 115 85 550

,, ,, Part-time ,, ,, 33 4 75 93 205

,, ,, Child Welfare Centres and

Ante-natal Clinics . 150 149 92 104 495

,, ,, Toddler’s Clinics 2 8 6 12 28

,, ,, Ultra-Violet Ray Clinics 2 6 4 15 27

,, ,, Midwives 300 368 304 264 1,236

,, ,, Children nursed for reward 3 2 — 6 11

,, ,, Maternity Homes 3 17 12 3 35

Premises inspected as to their suitability

for Child Welfare Centres ... 36 24 14 13 87

Special visits (ophthalmia neonatorum,

puerperal pyrexia, uncertified practice,
concealment of birth, abortifacients,
pemphigus and deaths of children) 6 93 6 8 113

Attendance at meetings of local Child

Welfare Committees and with nursing
associations and interviews with med¬
ical practitioners and various people
relative to Maternity and Child
Welfare Scheme 158 147 81 27 413

Visits re compensation claims under

Midwives Act, 1936, Section 5 20 8 18 13 59

Visits to sick staff — 7 — — 7

913 983 727 643 3,266

In addition, during the year the Inspectresses carried out the following duties:'—
(a) Attended official openings and also gave addresses at Child Welfare Centres.
(b) Met and instructed local voluntary social workers in their duties.
(c) Assisted with the ante-natal investigations in connection with the nutrition of expectant
mothers. /

They also instructed new nurses in their duties; assisted with the preparation of schedules of
furniture and equipment for maternity homes, child welfare and ante-natal clinics.
 Table LXXII.
Record of Visits by the Health Visitors during the year 1938 in districts for which the County Council is the Authority
under the Public Health Act, 1936 (Section 200).
No. of Attendances at No. of visits
No. of First No. of No of Pre-Natal No. of (a) Ante Natal (b) Child Welfare to children
No of Visits. Clinic Centres_ nursed for
Visits. Re-Visits. Special No. of No. of reward
Total Births Measles
Jve and Notified** Still- Deaths Cases
Sanitary District. (Ophthal¬ Births under Infants Children Public
Still (including mia Visited. Exp. Health Act
Births. Still- Under Between Under Between Notified. one year. under between 1936
First Other Neonato¬ Mothers. one. 1—5 years
Births), 1 1 and 5 1 1 and 5 rum, etc.) Section 206.

13 14 IS Id 17
1 2 3 4 5 6 7 8 9 10 11 12

I
1 1
1. URBAN. 1
27 26 1268 3892 3228
Adwick-le-Street . 380 336 363 50 2254 2866 87 179 143 10 52
13 19 468 2619 3013
Aireborough ... 325 275 277 21 803 1298 37 32 17 5
373 60
JAltofts. 19 15 26 106 127 1 -- 1
. — 5 — — 946 438
Baildon 134 62 79 6 194 189 13 8
2 4 3 81 1000 706
Barnoldswick 109 49 109 8 331 693 55 43 122
— 22 — — —
Batley Boro’* . 580 _ _ -. — —
Bentley-with-Arksey 5 10 8 669 2273 1894
328 223 295 46 1496 2304 41 40 17
§Bingley* 301 — — — _ — — — —• 12 —
Brighouse Boro’* . — _. — -- _ __ — — — 20 — 11 "
453
SCastleford* . — -- _. _ — — — 41 — - ’
695
+Clayton West . 6 _ — 1 — — ' ”
3 3 43 51 1 11 1
Colne Valley. 272 42 5 17 3 611 4569 5754
124 268 29 1716 3003 149 184
Conisbrough. 369 43 11 25 — 573 5079 2888
324 353 16 1114 1059 100 53
15 19 564 2312 1442 5
Cudworth . 175 153 200 80 491 931 73 37 44 4
4 I 172 727 1206 5
Darfield . 94 74 91 8 829 901 48 51 33 3
§Darton . 5 18 1 398 4527 3248
306 284 231 8 1971 2149 57 233
Dearne 27 8 25 1285 6380 2733
502 409 508 19 982 2596 79 26
1 -- 29 151 238 —
+Denby and Cumberworth ... 17 10 2 9 79 66 11 28
||Denby Dale. 1 4 29 89 452 713
98 71 72 50 755 770 36 177 31
Denhohne — — 1 — 142 193
36 24 32 2 276 490 19 28
§Dodworth 9 25 2 8 110 — 2156 2081
86 72 80 246 1074 43 26
Earby ... 1 — 84 670 762
48 29 32 3 244 508 9 27 l
Elland ... 24 6 15 — 72 1966 3878
252 111 246 14 3252 1510 37 21
•Emley ... 4 5 5 5 15 — 1 1 — — —
31 61 8 9
§Featherstone ... 92 11 4 13 49 370 1163 3753
233 228 199 62 750 1049 47
JTlockton 1 O
5 4 5 78 51 2 ‘r
Garforth 2 — 171 747 1473 32
57 35 30 1 269 169 42 42 12
Goole* ... _ -- _ _. — -. 13 — — — —
339
JGunthwaite & Ingbirchworth _ _ _ _ _ — — — — — —
1
§ Harrogate Boro'* _. _ — _ _ — 25 - • — — —
530
•.Haworth . __ _ — 2 — — 151 303
21 16 20 361 246 1 2
Hebden Royd 101 106 20 14 56 5 3 — 244 1614 1941
76 1692 1829
Heckmondwike* _ . . _ _ — 6 — — — —
123
Hemsworth 288 229 39 65 1 12 18 — 360 2672 2007
265 1333 1035 78 — —
•Holme ... _ _ __ _ _ — — — ' -
§Holmfirth . 211 191 2 48 32 6 11 1 124 827 727
203 1062 1533 35
•Honley ... -. — — — — —
18 12 18 120 156 4 12 2
Horbury ... ... 121 73 121 24 36 19 5 7 — 175 1613 1714
256 861 24 i
Horsforth 176 274 166 9 40 5 9 5 — 65 2768 1779
314 395 31
§Hoyland Nether 257 232 247 19 90 17 6 10 I 1347 5157 2932
819 1054 97 — —
JHoylandswaine 2 3 3 _ 13 _ _ — 1 — —
26 —
llkley* . 176 _ — _ _ — — 4 — — —
^Keighley Boro’* 754 _. -- _ . _ _ _ — 54 — — — —
§Kirkburton 164 3 8 — 138 768 2092 25
118 159 10 1489 1557 68 66 4
•Kirkheaton 15 — — — 3 — — — — 3
7 15 91 66 4
§Knaresborough 102 94 — 4 1 — 315 1057 1867 26
98 213 496 9 3
Knottingley 188 221 7 9 — 452 2330 2160
178 21 1372 1182 37 15 10
JLepton . 10 8 — — — — 2 — 46 107 502
6 20 6
Maltby 243 212 249 14 1240 724 69 78 10 5 ii — 285 2257 1286
§Meltham 69 -- -. 2 2 — 102 1266 1717 ''
39 71 418 541 33 34
§Mexborough ... 302 320 940 28 16 — 1932 2515 985 9
541 643 245 4 20
Midgley . 20 33 — — — — — — — — ‘
12 23 250 348 —
Mirfield . 154 95 127 3 1825 2255 38 2 6 — 179 2006 865
10
Morley Boro’* 649 — — -- _ — — — 35 — — — — —
iNew Mill — — — 2 — — — —
14 5 14 11 155 202
§Normanton 282 211 258 28 71 30 6 15 — 470 3797 1529 11
1040 1662 64
•Oakworth 15 — — — 1 — — — —
6 4 114 88 7 16
Ossett Boro’* _ — — _ _ _ — 6 — — — — —
228
Otley ... 145 88 155 15 3 2 3 3 — 181 1936 2052 —
1377 1320 41
•Oxenhope 10 7 -- — — — — — — —
5 1 75 160 3 4
JsPenistone 88 81 95 12 416 36 — 1 5 24 138 1333 1282 1
488 22
Pontefract Boro’* 423 __ _ _ _ _ _ — 20 — — — — —
Pudsey Boro’* 467 — _ — _ _ _ — — — 19 — — — — —
Queensbury and Shelf 129 73 153 32 867 113 192 — 2 3 190 1662 1529 2
1791 55
Rawmarsh 330 274 246 66 2635 303 281 13 12 397 462 3946 707 —
2721 430
Ripon City 143 127 7 8 — 384 1165 2007 18
186 5 522 818 16 50 1
Ripponden 77 40 78 6 457 497 50 22 3 2 — 114 702 643 —
13 — —
Rothwell* . 356 — — — _ _ — — 19 — — —
§Royston ... ... ... 176 154 159 — 493 24 — 8 9 — 371 3241 1937 6
358 20
Saddleworth ... 215 134 148 1 875 18 140 2 11 — 322 3269 3876 —
842 22
Selbv 160 162 148 1 454 7 55 3 6 4 290 695 1254 4
896 6
•Shelley . 7 — — — 1 — — — — — --
5 9 51 69 1
IShepley . 4 3 4 -. 46 _ — — — — — — — — —
52
Shipley* 448 — — — — _ _ — — — 17 — — — — —
Silsden 57 2 1 — — 380 420 —
34 50 20 323 388 54 195 8
•Skelmanthorpe 17 12 11 — 77 79 15 16 1 — — — — — —
Skipton 173 219 110 2 674 741 67 43 10 5 — 264 1960 1366 4
42
•South Crosland 9 7 5 2 110 49 — — 1 — — — — —
90 10
Sowerby Bridge 230 106 158 60 2434 2196 75 6 4 11 — 328 2870 3334 2
30
Spenborough* 514 — — — — — — — — 30 — — — — —
Stanley 241 174 229 40 1444 1885 97 24 6 16 47 396 2627 3683 2
62
Stocksbridge ... 148 121 146 1 2181 2435 9 111 8 39 37 1488 1078 —
3
§Swinton 226 213 271 4 773 1593 35 — 8 11 — 345 3276 3150 —
39
•Thurlstone 13 7 10 — 38 78 2 — — 1 — —
2 1
•Thurstonland and Farnley
Tyas . 6 1 3 —- 23 44 1 — 1 — — — — —
1 —

52 40 232 3 — — — — —
Tickhill . 39 — 215 5 1 1
Todmorden Boro’* ... 228 — — — — — — — 13 — — — — —
§Wath-upon-Dearne ... 258 197 210 9 441 1129 21 20 4 7 — 650 3073 3809 —
28
•Whitley Upper . 5 2 3 — 29 25 — — — — — — — — —
•Whitwood 26 19 26 — 208 162 12 _ — 2 — 43 296 583 —
2
Wombwell* 359 — — — — — — — — 17 — — — — —
§Worsborough ... 251 215 266 52 1607 1723 95 8 13 14 298 5426 5329 4
79 Ill

Total of Urban Districts ... 17,448 8,173 9,084 1,942 50,320 63,080 4,377 3.267 1,841 271 853 807 17,860 108,928 103,184 229

II. RURAL.

30 17 27 5 198 241 3 39 -- 2 1 — — — — -
•Barnsley .
70 45 54 10 381 601 1 — — 1 2 — — — — —
§Bowland
^Doncaster . 983 861 813 33 3351 4031 356 353 196 24 46 175 1560 8403 7015 17
151 123 42 15 922 1687 98 295 4 2 13 — 112 954 1539 —
33 22 15 4 446 596 22 122 11 I 1 2 — — — —
JGreat Ouseburn
1012 — — — — — — — — — 55 — — — — —
^Hemsworth* ...
38 24 41 — 232 281 4 5 4 — 2 2 — — — —
tKeighley .
Kiveton Park 274 231 262 17 1969 1389 146 2 5 5 ii 18 700 3092 1347 1
35 17 7 4 205 475 22 127 5 1 3 1 — — — —
•Knaresborough
140 107 115 34 1530 2464 86 601 9 2 7 — — 124 302 9
||Nidderdale
{jHOsgoldcross ... 203 175 201 35 1945 2868 84 454 25 — 7 19 320 437 876 14
77 64 74 13 403 974 14 17 27 1 9 27 — — — —
fJPenistone
Ripon and Pateley Bridge 162 1 15 43 24 341 1091 30 220 25 2 7 9 — — — —
^Rotherham . 793 797 878 147 5176 7335 233 331 38 27 45 93 1697 7810 5152 34
38 31 18 2 308 420 10 53 — 2 4 — — — — —
Sedbergh
Selby . 80 59 142 87 856 1521 58 441 75 1 3 424 — — — —
§ Settle. 198 150 199 138 1674 2337 92 533 67 7 5 2 37 1175 672 6
^Skipton 248 193 421 314 2686 4326 146 351 10 7 10 40 36 593 824 4
SJTadcaster 505 333 344 97 2159 2063 294 678 272 8 22 43 573 3611 3943 53
Thorne 626 554 699 75 2842 3052 341 188 6 19 37 4 1657 8171 3018 2
Todmorden 47 26 39 7 300 893 16 50 8 2 — — — — 1
^Wakefield . 344 262 244 129 2123 3320 171 682 14 7 19 117 530 4221 3527 —

^Wetherby . 245 156 127 46 1472 2360 109 772 9 — 8 4 26 1297 2194 16
68 46 42 9 367 568 15 57 1 2 2 — — 1
Wharfedale —

gWortley . 458 346 444 14 3117 5666 75 87 514 7 15 2 399 5415 8070

Total of Rural Districts ... 6,858 4,754 5,291 1,259 35,003 50,559 2,426 6,458 1,325 126 336 984 7,647 45,303 38,659 158

Grand Total for the

Administrative County ... 24,306 12,927 14,375 3,201 85,323 113,639 6,803 9,725 3,1 (S(S 397 1,189 1,791 25,601 157697 140614 387

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17

* The County Council is not the Welfare Authority in these districts.

|| This District was created as a result of the operation of the County of York, West Riding Review Order, 1938, and the figures refer only to the last nine
months of the year 1938.
t Under the County of York, West Riding Review Order, 1938, this area was abolished as from 1st April, 1938 and the figures given refer only to the
quarter ended 31/3/38.
**F.xcluding transferred notifications.
§ A change in the boundary of this District was made on the 1st April, 1938, as a result of the operation of the County of York, West Riding Review Order,
1938, and the statistics in the above table are composite figures comprising the records of the area for the portion of the year prior to the date of the
change and those of the altered area for the remainder of the year.
 102

Revision Course for Health Visitors.

The Child Welfare Sub-Committee has approved arrangements for the holding of a revision
course of instruction for health visitors, to be held at the County Council’s Training College for
Teachers at Bingley, from the 30th March to the 5th April, 1939. The estimated cost of the course
is approximately £360, the whole of which it is contemplated will be recovered by means of fees.
The following is a summary of the lectures arranged in connection with this course.

1. Inaugural Address. T. N. V. Potts, m.d., b.s., B.Hy., d.p.h., County

Medical Officer, West Riding of Yorkshire.

2. Child Psychology. Dr. Grace Calver, Physician, Children’s Dept.,

Tavistock Clinic, London.

3. Skin Diseases. J. T. Ingram, m.d., f.r.c.p., Physician in Charge,

Dermatological Dept., Leeds General
Infirmary.

4. Growth and Behaviour in Children. }H. A. Harris, m.d., b.s., d.sc.(lond.), m.r.c.p.,
Professor of Anatomy, University of
5. Diet in the Working-class Home. Cambridge.

6. Modern Treatment of Pulmonary P. W. Edwards, m.b., ch.b., Medical Supt.,

Tuberculosis. Cheshire Joint Sanatorium and Wrenbury Hall
Colony, Nantwich.

7. Prevention of Common Infections. H. Stanley Banks, m.a., m.d., d.p.h., Medical

Supt., Park Hospital, London County Council.

8. The Protection of the Household in K. H. Beverley, m.r.c.s., l.r.c.p., Medical In¬

case of Air Raid. structor, Air Raid Precautions, Home Office.

9. The Diagnosis and Treatment of Mr. B. Whitchurch Howell, Senior Surgeon to

Orthopaedic Disabilities in Children, the Queen’s Hospital for Children, London,
with special reference to Acute Orthopaedic Surgeon to the Essex County
Anterio-Poliomyelitis. Council.

10. Ante-natal and Post-natal Exercises. Demonstration and Lecture by Miss Margaret
Morris, of the International Institute of
Margaret Morris Movement.

Child Welfare Centres.

Attendances at Child Welfare Centres.
The total attendances at the Child Welfare Centres show an increase of 2,521 children com¬
pared with the previous year. To some extent this increase is due to to the establishment of
additional child welfare centres (5), but this is offset by the transfer to districts autonomous for
maternity and child welfare services under the County Review Order, 1938, the child welfare
centres at Airedale, Glasshoughton, Haworth and Whitwood.

The number of children attending a child welfare centre for the first time was 14,060, a
decrease of 65 as compared with first attendances in 1937 (see table LXXIII).

The total attendances at the 130 County Council Child Welfare Centres (see Table LXXIII on
pages 106-112) were 301,156, the average number per session being 49.

Establishment of Child Welfare Centres.

During the year, child welfare centres were established at Blacker Hill (Worsborough U.),
Church Fenton (Tadcaster R.), Denholme U., Loxley (Wortley R.), and Whixlev (Nidderdale R.)

Provision of Multiple Clinics and Child Welfare Centres—Building Programme.

A report on a survey of centres where more convenient accommodation is required was app¬
roved in June 1938, and a five-year building programme is to be embarked upon.

This programme is to some extent in conjunction with the school building programme of the
Education Committee, and wherever possible clinics will be erected on sites adjacent to school
buildings. The districts to receive consideration in connection with these proposals are: —

(a) Multiple Clinics.

1938- 39. Featherstone, Goldthorpe (Dearne U.), Hemsworth, and Rossington (Doncaster R.).
1939- 40. Armthorpe (Doncaster R.), Dinnington (Kiveton Park R.), Normanton and
Worsborough.
1940- 41. Maltby, Skipton, Thrybergh (Rotherham R.), Yeadon (Aireborough U.).
1941- 42. Darfield, Garforth, Settle (Settle R.), Thurcroft (Rotherham R.).
1942- 43. Barnoldswick, Kippax (Tadcaster R.), Knottingley, Penistone.
 103

(b) Child Welfare Centres.

1938- 39. Catcliffe (Rotherham R.), Hatfield (Thorne R.), Wickersley (Rotherham R.).
1939- 40. Horbury, Outwood (Stanley U.), Queensbury.
1940- 41. Crofton (Wakefield R.), Barugh (Darton U.), Elland.
1941- 42. Earby, Hebden Bridge (Hebden Rovd U.).
1942- 43. Glusburn (Skipton R.), Snaith (Goole R.).

In addition to the above list the erection of Clinics were previously approved at Conisbrough,
Hoyland and Rawmarsh.

Progress is being' made with the building programme and the following is a list of multiple
and other clinics erected, in course of erection, approved or to be approved by the County Council.

District, Situaton.
Erected.
Rawmarsh Barber’s Avenue

In Course of Erection.
Conisbrough Church Road

Plan stage.
Hatfield Adjoining Broadway on the main Doncaster—
Hatfield Road.
Hemsworth Regent Street
Hoyland West Street
Rossington Grange Lane

Site obtained.
Goldthorpe Goldthorpe Green

Site inspected.
Catcliffe Negotiations are to be entered into for the purchase
of a plot of land.

Improvements at Existing Child Welfare Centres.

Crigglestone (Wakefield R.) A doorway has been provided at the Village Institute to
allow of more easy access to the kitchen.

Darton (Old Infants’ School). A Gas radiator was installed and repairs carried out.

Denholme. A child welfare centre was established at the Wesleyan Sunday School, and was
opened on the 20th July, 1938. The sessions are held on alternate Wednesday afternoons. The
County Council also provided a fixed partition for the more convenient working of the Clinic.

Edlington (Doncaster R.). The Edlington Parish Council asked to be supplied with infor¬
mation as to area of land required for the erection of a centre in order that they might make
suitable provision on land belonging to the Parish Council.

Golcar. This Centre is held at “Woodville”, Golcar, and part of the premises were until
recently occupied by the former Golcar Urban District Council. After consultation with the Colne
Valley Urban Council, the County Council are to take over the whole of the premises and to pay
to the Urban Council the principal and interest of the debt still outstanding in respect of the
premises.

Goldthorpe (Dearne U/). In connection with the building programme, a type A. C. D.

(Child Welfare, Dental and Tuberculosis) Multiple Clinic is to be erected on land adjoining the
Bolton-on-Dearne Senior School site. The site belongs to the Education Committee and the val¬
uation amounts to £725 and in addition a sum of £110 is to be expended in fencing, including
removal of hedge and adjustment of the surface.
 104

Hatfield (Thorne R.). In connection with the building programme, the Education Committee
have been asked to place sufficient land at the disposal of the Child Welfare Sub-Committee for
the erection of a child welfare centre and school clinic. A junior infants’ school is also to be
erected on the site, which contains five acres and is adjoining Broadway on the main Doncaster
■—Hatfield Road.
This centre will serve part of Dunscroft, the whole of Dunsville, Hatfield Village and Eden-
thorpe. The total population to be served is 7,600 with approximately 150 births per annum, and
562 school children in the area.

Hovland. Plans and estimates have been prepared and submitted for the erection of a child
welfare centre in West Street, Hoyland, and the centre will provide child welfare, ante-natal, U. V.
ray, school, dental and aural clinics, at an estimated capital cost of £5,550.

Honley. The Child Welfare Sub-Committee has approved the establishment of a child welfare
centre at the Southgate Methodist Church, Honley, to be held on one half day weekly. This centre
was officially opened by the Vice-Chairman of the Child Welfare Sub-Committee, County Councillor
H. S. Drake, on the 14th April, 1939.

Kikkburton. It was found that the accommodation provided by the Ivirkburton Urban Dist¬
rict Council in rooms in the Council Offices was inadequate for the purposes of a child welfare
centre and arrangements were made to transfer the centre to the Dogley Congregational Chapel,
Kirkburton.

Lepton. A legacy of £100 was left by the late Miss Emma Jagger for the provision of a
summer outing for mothers attending the Lepton centre. The income arising from this legacy is
paid to the Honorary Treasurer of the Voluntary Committee attached to the Lepton centre after
a report of the summer outing has been given, provided the total amount of the income from
such legacy has been expended.

Loxley. A child welfare centre has been provided for the residents of the Loxlev area in
rooms in the Congregational Chapel, Loxley. The centre is held on one half day each fortnight.

Pateley Bridge. A child welfare centre has been provided for the residents of Pateley Bridge
at the Methodist Church Lower School Room, Pateley Bridge. Sessions are held on one half day
per calendar month and alternate with the sessions held at Summerbridge.

Rawmarsh. A multiple clinic has been erected in Barber’s Avenue, Rawmarsh, and was
opened on the 12th December, 1938, by Lady Mabel Smith. The accommodation consists of a large
waiting hall, dental operating room, dental recovery room, kitchenette, food store, toddlers’ room
which is also used by the oculist and aural surgeon, U.V. ray treatment room, nurses’ and un¬
dressing room, doctor’s consulting room and weighing room.

Rossington. There is a proposal to erect a child welfare centre to be attached to the prop¬
osed infants’ school in Grange Lane, Rossington. The plans have been prepared by a private
architect engaged by the Education Committee. This centre is to include a dental unit in addition
to the child welfare, ante-natal, U. V. rav, aural, eye and school clinics.

Summerbridge. A child welfare centre has been establised in the Methodist Church School
rooms and the sessions are held on one half day per calendar month.

Wetherby. The Highways Committee have purchased the former Rural Council Offices in
Crossley Street, Wetherby, and have placed the ground floor of the premises at the disposal of the
Child Welfare Sub-Committee for use as a child welfare centre. Renovations and adaptations
have been carried out by the Highways Committee at a cost of approximately £460. It is hoped
the premises will be ready for occupation about June, 1939.

Wickersley. There is a likelihood of the Wickersley Parish Council erecting a Parish Hall
and so adapting the premises as to be in every way suitable for child welfare purposes.

Internal decorations were carried out during the year at the Holmfirth, Mexborough, Sowerby
Bridge, Stocksbridge and Tadcaster Centres.

Alterations, including the provision of additional heating and more amenities for the storage
of perambulators werej carried out at the following centres :•—

Crigglestone, Guiseley, Knaresborough, Knottingley, Normanton, Saddleworth, South Milford,

Sprotbrough, Stannington, Thurnscoe and Wrenthorpe.
 105

Medical Officers of Centres.

The following new appointments were made daring the year :—

Name of Centre. Medical Officer. Name of Centre. Medical Officer.

Armthorpe ... Dr. Mary Allen. Kiveton Park . Dr. B. D. Rawlings.

Baildon . Dr. Elizabeth Cairncross Listerdale Maternity Home Dr. Barbara Demaine.
(Ante-natal Clinic.)
Birdwell (Ante-natal Clinic) ... Dr. Jean H. Ritchie. Otley Dr. R. T. Rushton.

Blacker Hill . Dr. J. H. Fairclough Pateley Bridge Dr. Dorothy Potter.

Blacker Hill (Ante-natal Cline) Dr. Jean V. Kirkwood. Stocksbridge (Ante-natal Clinic) Dr. Joan Dunbar.

Carcroft (Ante-natal Clinic) Dr. Mary Allen. Summerbridge Dr. Dorothy Potter.

Chapeltown (Ante-natal Clinic) Dr. Rachel Powell. Swinton Child Welfare and
Ante-natal Clinic Dr. Ursula Gray.
Church Fenton . Dr. W. Murphy.

Darfield (Ante-natal Clinic) ... Dr. Gwyneth Cotterell Thorne (Ante-natal Clinic) Dr. Helen Lindsay.

Denholme ... Dr. Doris M. Ringrose. Whixley . Dr. L. Allison Thomas-

The following resigned their appointments :•—

Name of Centre. Medical Officer.

Airedale Dr. C. M. Hawick.

Baildon Dr. E. G. Firth (Died)

Glass Houghton ... Dr. Emily E. Johnson

Kiveton Park Dr. J. N. Clark (Died)

Otley Dr. H. Wolfe

Thorne (Ante-natal Clinic) Dr. Margaret Creaser

Whitwood ... ... ... ... ... ... Dr. Marjorie Steven

The following transfers of medical officers of centres were also effected during the year:—

Dr. B. M. Newlands was relieved of the Carcroft ante-natal clinic to enable her to take an
additional toddlers’ session at the Denaby Main Centre.
Dr. Helen Lindsay was relieved of the Darfield ante-natal clinic to enable her to act as medical
officer to the Thorne ante-natal clinic.
Dr. Dorothy Summers was transferred from the Middlestown child welfare centre to the
Linthwaite child welfare centre.

/
 106

one and five

o>

the ages of
c £ o

Between
a) G •G

years
oc 3* >c cc

242
u, ct3 r- cm CD O CM 03 CD
C? QJ o x CO ic 3* 3* UO O CM 1C CM ic
T3 b3
rz c -a-5 I CM CM
Jb p C^, J.
O £j “ O u
V4-N CC 05 *T-1
c a>c ?£
h
D (U U 05 05

u-f. a c tuo
0 CCS
id J -r |
r^. cm CD 05
O
cc CD CM cc
o
cd
s d n
05u O CM CO CM cc X X CC
<D c o CM
u, sz 33 J-
c 03
is U «

a
<4-1 usjp[iq3 O 0 ■*r os '3' X r- CM 03 Tf* X -r 0 O X X
10 -r CD CD X O X 03 X t>* X X 0 X X 03 —1
CD CD CO 1^ O «D X ^ O CM X CM xr ir. T X CM X X
1B1°X Tf “rf i—■ cm CM CM CM CM CM X
"" “

sjua^
9Al| pUU 0UO ■3* r^» O X X X X Tf X X 03 CM X X O X 03
-C “S8 O 31 X -r — -r X 0 03 ID X X O C^J CM 0 X X
b 05 u00M;0q CO 'rr c^. CM 03 X ■'f X X X X tJ* -3* 03 CM X
U CM
U0JPIIHO
•a
c
cd O 3 CD 0 03 X X 0 X CM X »D X X X -r X 0 X
0uo J0pun -31 CM CD -t> 0 —-1 CM CM
• 03 03 — X -f O CM X t'x T 0
O usjpimo
00 CM lO *- 03 03 O CM X X X X X O 03 X '3 CM
Vi CM CM t-. CM CM
a>
a — g
4- 2 c
<D
4-> O 0)
HO sjaipoj^ X 35 CC
cd CC cc
s 3UBJ30dx3
Medical Officer

C
1676

1218

I486
286

1058

407

916

862
340

1793

260

60S

1350

803

89
655

1234

686
D
No. of Cases

0
C U3JPI!H0
seen by

X
U

CM '3* X

54
sjatpop^ X X X
1 1 1 1 * 1 I I 1 1 1 1
jm?jo0dx3
i/)
<D
a P[0l{ SUOISS0CJ 03 Cl r> O — I> O X
■3*
C^l 0 X 0 X 0 X X
<u rp X X X ^ X X X -r ID ID X X CM X X
(J 1° °N ffi50X
>>
u
03 X E
<n 4-* Vi
n
05 a y c
a 4J 0.2
0) ^
b o c E =5.2
05 -= E B so ^ c c
c > 05 b£ C
Qj
E *5 *
• r; O
05 *
0>
E (i E
CCS 05
E
^ n c E
05
i)^ c —
05 u C c •— U
<V ' dn ra l- S* B -g
03 C O o|« d ji'a o C .G D _
■3 • E — “ • E
"5 —
U jz: G c
G *4-
45 P-I O *j* #o «Q O QY.HQ
*_> (j
C o b o o i K -3 g i ffi | o o
cC 2 ’5 g ^ g T3 u "a
O 4I ~ ^ c t ^ 2 "2 o t ^ E 6 3 ■5 J-
rC “ (1) b 05 X rfr • - o
cfl . ®u
*r ' j
<4-1 X 03 V cO « >r±J o
<u £ §£ Oh ^CU £ 0-. § IT. .“•s'5
In 0 ^
« O w £ GO
0Aq pUB 0UO
vw X ^ X JO S0j§B 0ip
0
136

35
23

22

28

I> CM 03 X
44

23

X X X X X X
64

33 Gb 1
"3 cd m
<
QJ T—1 U00M}0q CM X CM

£ C
05 C U9JPHMD
■§H ij s-i
cd CC P
0uo japun X X 3* X X O in cm 3 3- 03 X X X X CM 3* X
0^ X y—> X 3 0 X X X X X 3* CM 03 3 X X X X 3*
CM
a Jb 05
u3jpimo
c & E
J3 a u. *Xj
o flJ
u U c » sj9qiop\[
.? ^ jui?539dx3
^ d)
c X
a
o *0Ay pue 0UO
+ C.W.C. transferred 1/4/38 to Autonomous Authority, figures given to 31/3/38 only.

05
O c
O JO S00B 0LJJ
28

28
60

38

37

X X CM X
37

c 0 X 03 3* 03 X X X 03
U00M^0q X —
<u J3
Pp Vi
nC C 4) U0jpiiq3
05 CD
*-> v-
>N < 15 •0UO
XI CL
0 03 CM 03 CM •— O O X X 3* CM CM X 3* X X X O
40pu ll •3" CM •3* *-* CM CM 3' CM X X 3" X CM CM 3*
>
< U3JPI1HO
<L>
X
CO

3
cd
4-»
CO
5 ° c
OJ *-»
>, c d>
b£i
id.11
s
U T3 “
n 1 ji 21 in
.
. . .
1.1w nil X 33
H
£ £
<D CC3 C 05 c c •a c "c *a E
c -s
3 33 . ^ S o p
X o §3 05 O «5 05 J3
x
p
p 0)* * •o rc
H -° X O 5
s H s Sh ££ ^ ^ s H H co
p ^ CM
CO Hr 03 rH ^ r—(
<v H IN
u
4-1
c Vi
<D C ^ , >>
U #o 2 — *L n • E5
^ QJ ”aj ri "E w o o o o o o o o o . 'OiD -—' o o o o 1 C£l—*-
^ 05 ■5j5
« g y> .S .ho « Q Q Q Q Q OQ a a O Q Q Q a be c 05
o
t/5 & "E 0 *>
3: X X

cd
33
C q ^ Q _
o
03 Q
2 ° . CO o o
■ •£ -5 :«oQ :
CO 05 H J'd .
tn 05
• Q 2
CO ^S.D X
q • : • 3 05
1 • Q : qj oj Q J £ o * o
bjo
03 J3
O CO DC .3 ' a a 5C* -G QJ IS) ■
v) l/) b CO
;Q . J= £ trt V- 3 o-OC 3=‘ oS 2 OC — p
c o; 33 iP ~a
MU o (/} CS w % 03 4-1 3^ a
03
K *2
o 03 05 in 05 ~j ^ ^ «
>«r,
n. C5 |E &•§ :n es
& O -t-J W 4_J Q3 v- n) ^
'% • QJ c a
o 33
Q- 3. U ’ .2 u be c« 1- to x _c 05
I I ■ 3 -G G £1 £ o
33 o 33 n 33 05 -*-1 ,—.
< 4-T CC3
05 X <0 § 11“
c b* 0! o C
Lb - kP C3 w CO
C X X
G
O
fc.2 P
c W
33 05 (J C
o
a QJ
03 *5 J 03 c3 ^ O *-> 05 QJ • ’> cf ” o
: 4 .2 os ■*-' 4-J _ 05
c
X
S .s c x 05 73 •n o >
1) c3 ^5! 03 PUS a
~ QC > S U
03
S
< fcK'5
C ^ C W3 X g
05 'X UO -
X co 05 is qj CL buo-^
05 05 -Q 0) U -ru O- tfj H
o- C s- C/1 05c (fl : ^ J3 P CO
H e T o . C 'T H ^ »-
O Qj c *J v-. o. ^-3
-o C3 5->.S- > £ S'.3 o £
03 X X
5y°C ! 33 x C £ 0-5 Jd c 1L4_ c tJD 05 a;
*— 05 X
^ 4? fc u
"Q 5 O V. P 05 C u X X
.2 QJ o £ 3 05 -b • - 05 03 &■ O , us •— s
o n O G ^ C • bd O u. 0
u c05 G ^ P ^ — <c
|S X£& ;« H X CQ X iS u o * U«^2^0J5S-U C CQ
33 < = < <
03
X
X
X X
Jb ^ nC O ^
< < X X m CQ 0 u u u u

CO X CD H cd 03 0
H r-4 r-i CM
 Table LXXIII.'—Child Welfare Centres—(continued).

Av. Attendance Number who attended for No. of Cases Total No. of children
Total No. of attendances at
per Session the first time during 1938. seen by who were in attendance
Centres during 1938.
Medical Officer at the Centre and who
Present
Day and at the end of the
arrangements
time of year were:—
for medical
Meeting
supervision Between

*3UO
JO -ON pnox
Under one the ages of

aapun
PJ31J SUOISS3S
S4B0X
lBl°L

U99A\}9q
sjaqtoj^
U39M]9q

U9JPl!llO
u9JPl!40
sjanjopj
SJ9H10W

U9JPUM0
uajpimo
U99A\}0q

U9JPI lM3

u8JPimO
uajpimo

UWPUMD
year of age one and five

auo jopun

tuetoadxg
juejoadxg
juejoadxg
3UOjapun

jo sdSn 9iji
9Ay puc 0UO

jo sdBe aqj
9Ay pue auo

*9Ay pue 3uo

years

04
—

04
©
•ef
Mon. 2—4 111 Part-time 1433 2851 1299 4150 28 73
Medical woman.

04
cd

©
ID
Wed. 2—4 8 73 Part-time 8 213 19 1176 1141 2317 63 151
Medical man.

©
*—>
Tt*
Mon. 2—4 57 Do. 1311 947 662 1609 40 116

04
•—
to
—
id
Wed. 2—4 108 138 Part-time 108 1009 346 2312 1442 3754 128 108
Medical woman.

04
©
Q
©

© *-•
©
©
Tues. 2—4 14 104 Part-time 14 848 14 1541 364 1905 146 97
Medical man.

04
©
Q
04
x*

©
©
Wed. 2—4 83 Do. 627 727 1206 1933 64 97

t-
04
d
04
(N
■'T

©
©
Thurs. 2—4 16 58 Do. 16 515 1452 1343 2795 45 127
107

cc
Wed. 2—4 14 142 Do. 14 133 14 1843 892 2735 96 137

-x
Tues. 2—4 55 Do. 65 652 1232 1013 2245 41 152

CQQ

04 04 CO
GO G 6
(DC4C4'U,W-04«N«
—'04—

MC (N
m lO If)
Wed 2—4 105 School M I. 981 603 951 1554 85 120
Part-time

~
Wed. 2—4 14 27 Medical woman. 46 147 46 142 193 335 20 57

»—1 04
CO CO
Q Q
© co
o©

CO ©
Tues. 2—4 150 134 Do. 162 787 550 2165 620 2785 158 72

CO
CO
Q
^
~

©
go
"tf
Tues. 2—4 29 87 Part time 116 1047 149 2156 2081 4237 71 199
Medical man.

CO
Q
—
04

^
»-•
ooeO"rcor^^r^oo©©c^co^''f
cp
oooooo—«r^t^r^
Tf
Tues. 2—4 31 139 Part-time 72 745 182 1956 • 654 2610 103 134
Toddlers, Medical man.
Alt. Fri.
Wed. 2—4 8 38 Do. 2 175 39 670 762 1432 34 56

ff
TO q

wa
©^

CO CO
© ©
—* 04
—• ’'T
© oo

’'TO
©©

Mon. 2—4 6 73 Whole time 6 793 6 931 2041 2972 64 142

V-
M.O.H.

±->
r-
—

w
04
id
©
'»T

CO
©
oo

Tues. 2—4 121 Do. 1190 1238 716 1954 93 113

Part-time

V uO'^2 a
3
~-
04

&V a c S c
•a ^"=-3 .
O^Eq“D,
is o Si a
04
CO
©

s
©
©
©

CO
^
Wed. 2—4 42 77 Medical man. 47 1004 293 1450 1750 3200 77 103

©
—
o
04
—

cc
©
Tues. 2—4 4 26 Part-time 15 119 15 82 131 213 10 37
Medical man.

©
©
©
Tf*
oo

o
Wed. 2—4 33 110 Part-time 33 702 143 812 3168 3980 no 112
Toddlers, Medical man.
2nd & 4th
Thursday
 108
«h-. €3
o o c
c -G £ £* z I^> •4T 0 CO -r X X ~r I 0 03 X CM O CO X 03 X
£ C^J CO rj -r X — X X 1 -r X <CJ 0 X X X X
•OTJ r; $
Z
ttf c
od (d
* cs — DJ —■ — CM — ” —
7G C *G P 1
.C *> C , 1
rn 03 03
O £ <d 03 34 £ c
«4_t <d ) T3 w 0
£
£ C
G *> *
° * U 0) D 03
c M
z isu .c «
<V Q 'f to [ r- — X 0 1 -T 03 O 10 _ r— 0 0 O -r
n & " —4 cn 10 1 CO X ^—1 10 M X X X 03 X X X X X X CM
o o - « r—
~0 u
(-, j= « c cd
5 «
3 g.

CO CN 0 CO CO r^» -T X X to CM X rp X -r CM
C^l 03 <m ~r CO X -r r- X X 03 X X X CM -r •—• O
00 CN CD X X <o X X 03 03 X 0 X X •o X -r r--
1E>°1 «N <N CM CM C4 r-* X ’t* X CM

G 00
cj CO sjebX
*o ^3 TT to CO 03 03 to X X O X X 03 X O 03 03 X
c rH to 10 I"'* CN «o r- CD 374 0 X 0 CM X O CM —' —• •—> -r
U99M49q Tt* X ■*f 'T X X X ~r X 0 03 X O 03 X
~ ttf (M 2 CM
«.E
uajpnqo
3
° -a _
03 rf CD CD X 0 X r> X Tf* X X CO X
O c/3 9uo jspun CO •—1 CM —■ X IO O X
CD O TT X 0 03 X
DJ 0 <n X O O'! iO 10 X 03 X ''T X X X X X
usjpuqo CM X

sj^qjoj^ x
X r~>
ID —•
CO
x
CO
00
cm
cm
03 03
to
ao
CD
juejDddxg CM CO

T-l r> X X CM 03 CM X X X X X 03 O CM •— 03 «o
IA « X x r—• X r>» X X x CO 03 CM
X X X X
4>
J2 > *E
uajpilMD CM X CM CM ■*r
CO
X '*r X X CM CM X X r4 CM X CM CD CO O

cj -° O
o §3
o o ^ o CO x CO
6 SJ9L{40p\[ cm to -H CD CO
CM 00
o
2
4UB4D9dX3

-c
<v o CM o ao o
ppq suoissa^; x
CD
CM
00
•'f X '■* to
jo *OjS[ U5*0£

o
CJ

c G
CA „g«o cd cd
QJ
£ E --3 3 G 6 e c
Sj « V > rj o « O
03 tUD G U
t- C c 43 a, E £ <U 0) ^ 43 QJ « E
.§ 73.1 ■« d
QJ 0. S U a.
O u O G .§•3 O O o .§ 73 o ~a o .§«
U, '♦-. </i
.S3 Q Q 'S So a o V .S3 V .Si D Q Q V .S3 a V .S3 C
<d £ ^
o “ -a tl xi t; •o t! ■o
JG CO ,
u. cd. cd ^ o a «J « cd ^ a "
P5
e+-»
(X , Oh S CD CL, S Ch 5S CL, CL, *S CL, ^ Oh ,

9Ay pue 9U0

o
u-. 00
CO o CJ CD CO to —' •
JO S9x?B 9qj CO CM ’
_ 03 C^l CO CM
£ *0
43
r-i U99A\40q
T5
"O C C U9JPI!M3
t C.W.C. transferred 1/4/38 to Autonomous Authority, figures given to 31/3/38 only.

St
65
158

O
29

cd X C^ CO
76

X X
53

9UO J9pun
67

X X X X X
TP x— -*r X X r- X 03
2 g uajpim3
&!
JG C/> ^
1
30

X
34

X
36
06
60

sjaqjo^j to X X
11

X E cH
G
1 1 1 1 1 1 1
X juejDadxg

*9Ay pue auo

^ ^P X
42
34

X
20

03 X
29

46

20

03 X
29

CQ O JO sqSb 8l[t X
X X
X X
CM CM ^ X »—<
< <d 0 U99AV49q
*2
G 55
to uaapiiqo
QJ 43
ti CD
< u *9110 rH X X X X CM _ X X X X O x x -* 0
japun CM 1-H • CM X X r"* —• X
>• o-
< uajpimo
-r '-r -r ^p rp ^P 1 -r -p •f - C/) 1 T -r - m t 1
Mon. 2—

Wed. 2—

Mon. 2—
Mon. 2—

Tues. 2—

Thurs. 2-

Thurs. 2-

Mon. 2—

Tues. 2—

Tues. 2—

Thurs. 2-
Mon. 2—

Wed. 2—
Toddlers
2nd Tuei
Tues. 2—

Thurs, 2-
Wed. 2—

Tues. 2—

Tues. 2—

Tues. 2—

Wed. 2—

Toddlers
2nd Thur
Day and

Meeting
time of

4>
G
H
>* >>
*->
G
>* JG _>> Jc ,c
JX GxJ G3J
issioi

fort-
ghtl
held
eekl

OX) d
etc.

6 u 6 6 V 6 6 6 6 6 6 6 6 6 6 6
Q V aa 4-J
Lh
k) _£ CJ Q Q a a a a a QQ a c Q
£ c O u
CD 0 o
tl, Uh CJL.

*a -*-*
q 3 cd.««
. o 4-
T3 O
O . o
cd q U
cd
ry a. O JG •—• o p
p :gg :O :q Q^ cd . ry» CJ O
o
\1 r
—« • (8 u . • •
: ’■a CQ • ^ c/: : d "5 : cd
03 P JG •a qj .td
>. ;
33 cQ 0^ ‘ g >, 4_r o E G JG 4-J
_ _ o <
Q-^
d 'gl •£ 5 c 3 cd G
2 m ^ g
K-, •a Cd
^ s
cd <U C E "
M =
& 0> & : G O :3 ;“! ■ 13 rj
. -o .S-a :• ,2 —E
CD OJO
:q
U-5 _
q oi_o a
G
-o ’» -aG ir ■ X O
h_. QJ
b CP c 1 c•
— O CL C3 ' 3 c 5^ Cfl a. T3
TG c •- "h U 1 g>e
s 3
cd
G ; o
< m to C a 5! _ ® *5 a> - O 7G 03
u o cd « I E O aj
rb t/>’ cd b •—; PG
a) uG H-cd
c Oh S-S 8 C/j 3 _
0) CD
T3
Cy cu O <u Uh H&o o
C
O t£o . 2 ^ o UJ : -c 2 4
: £G :s
w J=i O 3 x
cd
4/
o 53, c t/5 tibt/5
tUDjSf) « 3 ' '—'GO o ^|J- <U . :^-g S.« . £j^ UO J ' <L
t- n — m°S u r ^ Tl G
E 2
L* 32 >, p" o -' £
u CL 32 ”3 tl r0 oW P o /C O" O T3 S -O fe E C S
<d ^J3 ’3) u M Q £3 c !■§ >. eye H-. c c •' fa C3 .G y- G CU C r- CL O
c >. 4) O » CJ
G V- b
<u 9- S= j= •SR s l
C/3 «
<U jd __
/h
O v- u-* G "S - S o C/3 hC O <U
JS^; E
c u CJ
u
w u
C.' ^ G
brra:
r* GO-oU to o U S' z •GCQ CD ■O X" £ U .BPS o O CD 0 «* S'Z U w~
a O O E E K ac : E £
co ^ ao 03 o CD l> 03 o
58 to ID tO *0 to CD
 109
<D _ v-, aj
r- D O c o >
S C X £(V' 4)co<^ M CO o 03 03 03 r>» CO CO CO 1—< Tf 00 04 03 CO o 03 CD cc
w d ^ -73 v-
00 Ol o CO LC io 00 -* ’’T 00 — 03 CO IO 03 CD 03 CO X 03
-a -a ^ tJD C 04 04 04 04
r: ct3 w TO TO O
x c a; a)
U tj R o X C
w I’-o *-* O
c b c
-a) ea> (ua,
£Ox C tUD
£ <D CO t> I> Tf* CO 04 CO CO CO 03 -f lO O — o o 04 03
t> CO lO CO o CO r—i 04 cd »n 1C 04 04 -T CO '»T CD 03 04
-
- TO
o oX
G
D

CO CO X •*r X CD r» X X x -t* X o o T-1 — X o X X

uaJPI!M3 CO 03 X 04 03 X >n O io X o X 1—1 03 04 1—( X X
o 04 t^. 03 IO Tt< X *—* X X 03 03 X X X X X o 03 X
IB»°X 04 04 04 04 04 y—i ^ XX 04 X y~i 04 04 X
0)o .
sjbsA
C 00 X X 04 o X 03 X X X 03 X o Xo X X 04 X
03 CO 9Ay puB duo X X ■'T X o O 03 o XXX •—« X On X X »—i X X X
-a 03 X X *—i X X X o 03 04 04 X 03 X X XX 03 X o 1—
U99A\)dq
4)c
4-
,_H
ti/D "
04 1- — 04 04
*—I _. U3JPH40 ”
to .5
^ u.
°5 9UO J9pun X X X X 1% X o O On X X X X X X O' X X 04
o XT 04 'rr X 03 04 X -n* 04 X X X *—1 X X O X O X On
O* w X o 04 X X 04 X 04 X 03 O X t~N X 03 X
55 U3JPI!lI3 04 »- 04 04 04 04

sJ9qjoj\[ X o X 1 X 1 X XXX 1 o 1 l> — 1 On X o

X 04 04 1 Tl- 03 1 XXo 1 X 1 X l X X
JUBJOsdxg

X o X O- 04 03 X X XXX 04 03 X X X X o X X
X o o X M* X o r—l X r» x X —« X 04 -r 04 04 04 1—1 03
uaJPI!M3 03 X X X 04 X o X O X X 03 *—< X— X o On 03
cs 04
O^O
o 4>c0> *-•
TOCD
sj9qjoj^ X o X X X X 1 X ox — 1 o 1 11 <0 1 On 1 X
6 w^ X X — — X 04 X
Welfare Centres—(continued).

1 1 I 1 1
z " jUBjoadxg

q suoiss9§ r> X o- On o Tt* [N IN O On X X X XX o o 04 o

04 X Tf tT rt- X 'fTf x 03 04 xr -r X o• X X
JO -O^ IBJOX

a
0)0.“
S Hfl G03 C
03
So v <d O : ^• d) cC
id Cyjp , B 0) ^ o> <u E «=Q 4) 6
>- c c E—
Oh to v-
uu, «*-.
O : 73 o .§ 73 .§73 9, .§ 73 o .1 03 O o 6 .5 TO o• .1 73 E75 o
\HQ Y“V.2o G vi ol!^ G Q o Q V.H Q o V.H Q
03 : v. o tj 'G o t; ■?,
ns _ I’S
a “ tfl “ o 03 •— s|l^l
-C
o
u ’S
TO « G <D
TO CD ns «J
CL 2 cl, 2 cl, 2 to Oh S Oh S C/)0hS in Oh *9 Oh <9 CL 2
9Ay PUK 9UO
o 00 o. On X NT XX o 04 X o* OX X
33

26

8
33

43

25
Table LXXIII.—Child

<D, X jo sqSe 9yj 1 X 03 — X 04 X

NTH ° U99M59q 04
*G tUD uajpi;q3
a) .G j
9uo jopun | 04 o X X X X X X 04 — Xo X X On X X O- o O 'rr X
•O 'TT X X o X 'rf — -r x X X •o 04 X 03 04 -r 03 O X
I—. —
J 2 U3JPIIM3
& B
u
03 X X X o 03 X X X 04 X
20

37

sj9qjoj^ 1 1 — 04 — 1 1 1 1 * 1
G^ juejoadxjj
^ a)
tG
*9Ay pue 9U0
X 04 O' 04 03 X X O X ooX O' o 04 X X X X 03 -r
jo so8b atjj X X X 04 04 04 04 04 'rf X — 04 — — — — x 04
ttendai
Sessioi

U99AU9q
U9JPHH3

■< U *9UO X o 04 04 X O' o XX— O' X O' — On -r t'N O'

CD jopun 04 04 04 — ”1* X 04 04 04 X 04 X
> o-
< uajpimo
NT Nf TT
'rr TD 'rr tT 'TT 'rT | '«r tT ^r
bfl ! 1 C/3 u >>T 1 1 1 l ci, “ ^7 I 041T1 1 1 co'c 1
1 1 04 1 i X =3 041 1 04
04 04 04 04 04 a T3 04 04 04 04 . 04 C3 . v U 04 04 • 04 04 S ° G
* v'Z C/3 . CO . CO —< X . . u, ce = 2
urs

c « CO CO T3 Vh C/3 • "O =>5 C/3 W3 CO — u CO C/3 — T3 CO i3 to T3 C/3 3 ^ b

TO c CD G CD c T3 G
2 ^
^ CD CD CD g G ID CD G 7G g> CD y iv ^ ^ a T T3
Q “2 G G JG G (D3 G G 3^-c G G x: o G U G X
H H s H H hSh hhhh X Uh ^^H x H

>N _>>
_>» 4H >» X
G . >N -C £ GD X
.2 23i“U GO to
13 6 4D 6 6 c 6 u 6 d 6 6 CD
CD
6 6 6 6 6 6
03 Q G
4-1 CD Q c Q Q c «QQ QC CQ Q a q Q
S_ u u
CA ? e £ o o O
Cl u« CL.

o G
G - o §*G Q T3
Q 4=
. u _G .. . C Q
_ O
^o .: ai :-J2
X : cn GC3 :j3 Q ; O <
Ug G : <D>> : d * ** 1c : .2 K
Go cx CD ^ OC ^ s 3 Q *>
5 >> X
O <D
v-
03
G qf- 2 oj
03 c n
w ; o
X CD
03 ^ 0;1

7D ~ os <d b r.^ 03
</> G -O
C
G
O ’ CD
: >
«uh .2 73 -o c o o
: TD
0) DG
^ ;&
TD 2 -a M- s Z ^ ,Q‘
o /, v- C U
«>n
>%15 ■*£ tuj
(1) 0)
U 9"
03 -^ O f*c v- -* ^
Cl ^D
i— •- c
i o
< C/3
E 0,73 cn O^o 03
03 E
JG ^
^o
-Q dg
G
03 - ^ £
CD c O
^ CL
3Q o 3 6| 73u • o.O CD
T3
G TO3o cn | » J „ce W) ori- u! U - (i, c o 03 ^ CD
CQ^r £
H rG <S) ^
CD, O
o T3 u 43
03 uoK
g t [/] c —• 5 o sw c
o U - [-. >,V-H ,
03 5 g a TJ . *, „
2 „-£<« 03 g ^ “ c- tuo +-. "O
70 o ale 5, U - G CO t r— <si P L. . >,2 u - 'C J7
CD c S C JD o ’G03 d)u , c<v to c CG ~
E ° ^ <S1 2 TD "c CD C • , -TO c
ti/3 dj V- T3
CD u v- c O TO C X
9 4j<0 tJ03 ‘ZC Q-
- „
E ^f) 03 ‘5> CO CD ^ tuD C s ^ a. £ H
03 a S^ Co: w 03 G (D
O jQ I 8 &* C 0) rr n't r/i •q ud 03 3-3 £ » OQ r 5 c CO
£ ° x 5 X 2£ Uc5 "S o
O. J c U gu T3
O ^3 > 5 ^5 <4= g >tG CD rr . 5 G
G r £^
.b < c u gu G
£ CQ f.70.b § >,G cr. O ^u ^U
5 S M M J j 2 <9 ^ s o
CO
o H (M 03
l> *>
^ to CO
*>
o M
CO 00
 110

- O >
c r%
43
45
<l> 1 *0
>
c/>,
u 05 05 X © 00 d X —« © CO 05 00
u,
■a -o
Cfl £ 43
*5 ^ C S3 X Cl ~r © co co GO — CO lO CO CO X 05
w C? cj D GO — «—I d
~ c
jd u
O 4)

etc
— c 4,
45 45
O C
—
2 £ u U-. 03 X IO o X X X X X x r> •o O lO
"t 3 X »o -r -r Cl 03 T —< -r X X X ■n* -r -r Cl
o o *3 u Cl
H-f C 03
45
P

IO 03 X d co -r X lO 03 X _ d o X to X X X
U3JPI!M3 X f—l X LO -r X "T -r d —< Cl © Cl X X X d
X X X o — C* 03 d d -t* X X —« r> IO X
lK5°X Cl Cl -r X d IO X Cl X Cl -r
<Jj
4) 00
O CO SJU9A
C 05
03 rH 9Ay pUB 9110 o
o
Cl
X
o
-r o
r>*
o
X
-r X
r>
X
—1
X
-r 03
lO —<
-r
03
03
X
o
d
X
X
o
©
'03 X X
*o r- «—<
c oo U99A\J9q Cl Cl 03 o X IO 03 o d — © IO -r X © —t ©
oj c Cl d Cl d
p *c uajpimj
03 D
^ -c
O
9U0 j-9pun X 03 X IO d -f IO [■'N X © © IO r^. © ©
U3 X X Cl X o •—> -r X 03 O X X X X CD IO
6 £ USJPPMO
IO X 03
X p
r^- IO d X X X *”' X X 03 X X d
d
c
— <v
2 u
o
sjdqjo^
jucwdxg
Officer

696

530

1386
170

293

1073

2199

829

1668

2328
1055

102

1213

1157

405

567
3034

X
Cases

-r
uajpimo X ©
i by

0 is 5
d © X X
69

sJ9qjoj\r so Cl © | | -
O “d ~r 1 1 1 1 1 <D 1 1
1
Table LXXII1.—Child Welfare Centres—(continued).

X; *> JUBJ99dX3

X © LO X X o 03 X r- ■*r © X X
-r Oi IO ~r -r -*r •o LO ^ d ■~P -r d lO lO IO Cl ©
jo -OM [B)OJ

CO
o
W 0) O
c 2 £ 03C 3
5 E *5
" «'VC > 03 £o c
45 —.’
c
2
c
c
45 to
u c c
u
o 4, 6 45 ^ E^ 45 - 45 ^

Oh 03 5 l- *
.§•«. £ 03 .§« o .5 C3 .2 03 3 o Eo E- O o o
v .2 O a *r to v c a JS o v v ,y C Q O Q
£2 t T3
O £2 £^ o o
.2
£ ~3 £ "O c o
jg jd JD jz
03 *> JD
c3 ^ «* 2 03 2 03 *> c3 ,
0* '‘ cO CU C/5 0- ,
9Ay pue 9U0
o 00 X -r © © Cl io © io © io
19
60

24
34
20

jo S9.Sc 9qj
7

C(_ CO © d Cl
— 05
U09AVj0q X
45 r-t

T3 t5i0
c c U9JPl!MD
45 U
*-»
•-

03 T>3 . 9uo j-spun o © •O J) X

X X x ci X

£ s U9JPl!M3
& .§
fc 4_,
JD c/3
sj^qjoj^
05
X
juujoadxg
z S

45(J •0 AIJ pUB 9 0 U

C C
JO S 9 ^B 91 {J !>■ -r 05 X X 'O X Cl o Cl Cl
03 O U99A\J9q
Cl —< Cl CO d Cl Cl Cl Cl

■?
C
45 45
W
(/; U 9 JPIIIJ 3
t! C /5
< u •9U0
4 )
J9pun
X © ©
r>»
X
Cl
io X -r
X
X
X
-t* X
— d
-~r
d
X IO X
X
X
d
d LO X
d
d

U9JPI!43

I C/J °?
I u II V- O L
-t
CO
^ *-• -r
I I
'f
I
- u Tf
I TT Cl
T I
"3 T
n ° .5 d <N Cl JD ^ <N w Cl Cl _4J T3 Cl 1 ! Ill 1 I ci

L
il=ilSg •o2« • s «
03 C c u
45
<#; r*
453 ^ u
o o "S • 3 Y 3
-3
3 3
3 3 *u JZ 3 £ 3 E- x:
C; ‘
s H ^ ^ ^ H k co !> b-H H S H H H H

c >, *n

.2 245 245
W
3 o o o o 3 o
o
o o o o *S)2 O
•C *T>
W .BP qS
$^ V- tbfl 45 Q Q a Q q a a
Q Cl Q Q ^
-- 45
C 45 a O C>
° > ’t. rs
X > c U-

03 45 45 ~

"3 C w 4)0
Q
45
45 .2 io i J >> CO
03
•a
. 03C 3
BQi »c ^ ex >>
. a 3 C . ^ on C3 ® •
3
O
: o .2
45 : d; “3 : 2 u >»c
•
‘ C* 05>C bfi
3 c
"T co :Q
§•
03 •5 Sj « s EEC
Q
-
3 we 3 0^ •jicin o c
u' JD3 < o c 03c 2 03
ex S >ts >
«
„ g
03 _u cj
P s E o
CO
03o y c : J= 45
_
CO
45 1 Q
: xj o<
• u

"O
3 03 O 22 £
00 Q cz <g r^-jD
_
O
G
• C
03 ^ C *C t-J
03
> 03 d 45 H
g S.^ C T] ?
T
<
u
3 P c O ° a, 2 3 3
O M
* o
° r[ cd '—'•| .*
c mz S o
P *2 lo 2-3 P jd jd_£3 *Z § rj *2 t 45 03 ^
159^ ■' 4;
CO
■o 03 (/> OS .
: ^ CO C 2
co
4) -a S-S^l « co2
c
03 (X w . Q ex C°
*45 „,>in .(SO oj o
45
co ^ >>
c c S ^ 45
„r co
—
*-*
w
45 c ?! ^ o <
»S
J E
45 45
■O
^03
4C'3O JD3 45 »503 3
W *-*O) ^
o ^*3
0 453
ti
E X3 **-
j D
Q
JD
T -
03 3s _cj c. ■ <C CO „
« «
"O —-'
05 O 'D! >»
03 03 TD O /) C O o

II «ivh m 5 ^ o ^ J
C u a .Y o o
2: # CO 45" 45S js 3
c/5 C EG W
+j m T U r - D r
^ ca -c 45 .
U

c D.^= C/3 •—v 3 !-• *_< Pi,_" CL 3 •-A CJ •

£ 5 C 2 2 e^ ^ C/I ^ P £ 2 P •- in *E P ex ’« ^ 3
3 P
c! cs .2* au o u o ^ J8 ^ 45 45 JD JD C O « I
3 0 <
jv; 5 C6 C/3 e/i c/: c/3 e^ (75 Tfi (X CX CX

X 00 03 o’ ci X Tfi io x N X © o ci
X X X X © © © © © © © © © © o o
 11
05 c >
0
c O JD C
c 05
03 ij 01 -o V-
CO o X cD — CM
T3 TD c & to c 03 c Cl 02 X
'— C T3 M CO CO
-C 05 C Mm 05 05
O cO O cc -C c "
05
*4M CO 05 1-. *- 0
1m T3 05
0 C
c
— c « (D 0)
<L) 4) <U
C bfl
o ca
£ u ^ X a: X — CD
ID
O
X
O
»-*
o CM CD X O'.
CM
~
X
o o — -o
CD CM — 03 X
h -C ~ c
u

O O X X r>* X CM r^- X X X X 0 'T CM 0 X 03 X

uajpUMO O X X X X X X ID CM 0 CM ID X ID X CM r>* X Cl
T C3 CM X X ID 03 CM -r X rj* -r- 03 CM X ID X X X 'T
1B)°1 X CM X CM CM X CM X X X
in
<u "
c oo
SJB9A
•0 2 X — X CM X X H X O O X 03 X CM t" O 03 X 03 X CM
9Ay pue auo a> X r- -*? X T— CM X 03 CM X CM O O T— 03 X 0
c ^
ID X X O r' X rf CM X X X CM X X
2 K U99MJ9q X CM
co .E uajp[ii|3
Im
°-o
»D 03 CM rr X 03 r^. X X X X t^- CM X -f
O in 9Uojapun O 03 X X X 0 C4 CM X CM CM X *— X X 03 CM
X X
CD X 0 -r CM 03 X CM X CM 1"* X X 03 X CM X -f CM —
5s £ U8jpimo CM X

du
rf* I I 1 G. 03 X O 1 03 O I 03 1 O X I 03 0 CM
sjsqjoj^ X 1 1 1 CM CM X 1 X MM 1 1 ID M- 1 -r CM •— MM
tuBjoadxg

X CM T X X X X r- 0 X 03 X CM X O r^» O ^M X cm -r
X 03 O -Tf 0 MM X X 0 -»r 03 X X O X 0 O ~r -r X X
u®JPl!MD 0 X X 03 03 03 CM 1— X X MM X X 03 CM 03 X CM -*• X X
>*e
u o
c —
<d ca
0) o
sjaqjo^ 0
X
I
1
I
1
I
1
03
CM CM
X
X
c 1
1 X
03 I
1
1
1
03 I
1 -r
I
1
1
1
X X 0
*-■ T~‘
}uuj09dx;q

pj9q SUOISS9S X — X
05 ID CM
JO *0>J JRIOJ
Welfare Centres —(continued).

C ca £
w at cj .£
S E ^ ■-
5a) « j >
he C >-
CC

V- r- u 03 a; u at a> E a> ^ a> ^

E- 3_ 3 3 _ • o o
C3 £■ ca .3 C3 .3 ca .3 02 O o o o o
Cm CC U G- o o
I- G 3 •“ .= cc c O
u Mh
ca
Vi V ^ *V o cj **p o *c
' T .Si *t V .H "V .H C Q a Q Q Q a Q a *r .y O Q
ca ca 2 ca 2 ca 2 ~ 03 0)^0 0) 03 . C3 2
C-< ^ Cm D-. «< S. Cm C- Cm C- *>. Cu
9Ay pUB 9UO
o 00
6

CM -*r
63

76

X X 03 03 X
94

4- CO JO S9^B 9qj X X — C' - — X CM X O

X X CM —■ X
_. 05
TJ rH U99AAJ9q CM
0)
-a x>©
c c U9JPUM3
OJ •-
03 , 3
ret _
9uo jopun r> CJ 03 03 0 X O X CM X 03 CM O X CM X 03 X
XJ X 03 X rr 03 r* X T M- 03 X CM O O i"* X X — r~~
CM
Table LXXlll.—Child

J= £
Areas transferred to Autonomous Authorities 1/4/38, figures given to 31/3/38 only.
uajPim3
£2
u ^
03 4_,
33 1/5
-*r
09

X 03 0 I X X CM O 'T*
sjgq^oj^j
1 1 1 1 1 ® 1 1 1 ;
’7I*
05
r-« r-
}UB)09dx3 1

*9Ay pUB 9U0

03
o
16

X
17

16

X
32

X X
32

X X 03 CM 03 X
11

JO S9^B 0qj
c c X CM CM X 'tr CM 1 d
03 O U99M}9q
r *
C C/3
a) 05 u9jpnH3
ts CO
*9110 „
< X X X CM X CM O X r>» X — 03 X X X O 0 ■*r
a> X CM CM X X X X CM CM X CM 'f CM 11 ^
> J9pun
< U9jpiiq3

rf
T ^
-r rf 'T ■*r -r -r -f -t* ■** 73 X 'rf rf -T I T 1
1 1 1
"5 to
« °.E T c«CTcl CM
1
CM
1
CM
1
CM
1
CM
1 CM ? 1
ca CM CM
I
CM
1
CM
1
CM
1 2 1 1
^ CM CM CM CM
1 CM CM 1 «
CA-,
cl
.
am
Thurs

05 *-»
Thurs

Thurs

^3 CO
Wed.

CM
Mon.
Tues.
Wed.
Tues.
Wed.

C «
Mon.

Mon.

Mon.
Mon.

Mon.

Mon.

T3 CO *d V CO
CIS c 05 C ^ C5 c W
5 33 <15 0 3
3
1st

2 -C 3 3
H
^Hh £ H H

-*-» 4~>
c >, , >>
O -O -o «L T3 -C .
U4 SZ 2 -C
X 15 « £ -C 2 u o o o o o c o o o ^ to o 05 O o o o o c 4^ co^J ^ ex
jc 05 2 to a> 05 Q Q Q Q Q a a O Q n'cO 05 a Q Q Q a Q Jr c t
O u;> C u E
X) c5 c tL >(JU

C3
Q D
q «so - 05

D ■ ^ ;D
'T' C/3
D :& ,C .
d Q : § :QcQ ; 1c C :
i: 0) ,
'J= •-
' E : °^d d ‘D ■ d
'_ CD, QJ
«
5 to
03 x ^ 03 ^ K oj
O ® ■*J O u d D3
05
C/J
C< 05 J2 QJ . Q E 3 15 a) 2
£
l_ > JD ^ O
u & • 0> 05 Jr
k'a •—« t-* . u
3
)r 05 j.
05 ^ : CJ ~ a
3
• 03 -o' a ►> “
I
• 05 • _ J ■*-* JD
a) U o -h
T3 03 ajO. 01l T3 * *5 *3 *5
4M < 05
•o c • ~
u
a. «
n g *£ (/, — D- u w C * Dm *05 2
T2 r o o j; ° W t cl3-
co -f
< c C 05 g- V-
i
05e ^
•o D
s cQs C0/O 03 -g 05 C 5 w
•C 05 _ c JD *0
05
'
^ *£ C 05
D ;
ID V5 O — o c/ c HU 00^: %ji •. • co
E 0) o UQ 2 <■> * cu^-o U> >
:
^ X3
^
05
tuo
C
*-« 05 1 4JM OB 8 0 c^ffi > 05
^
CO * c -2 C C tiiD “ H-
4. K
c_ 4M
05 £ c c ^ ■ .^ 2
«2 ■-5 3 V)
05 &■§ o : CO N O nj^u d o « u1 0)7^2^ >A O CO 05 •M* — CC .
05
03 —' XJ w —
E j 2 O o ! ^ - *05 fp-e!g/i'P *r ^ E
s i-s XJfl c ^ “ a ' 2 c ’K 2 ""' X'o . 03 **-j fr-o &“ c o
03 >»a. a g u <c 7n «"! '7r, ® g
/. Ofi ^
C 05 iXJ o ’Z. U
2 £ i> « •£•0 2 3
c _ cr C »St5“c';«S c ^ •c C OT 05 _
> 05
> 05
•S O o v J > C = 3 c £ c l-S-E 8 || I 05 ^ 05 *c
2 W > *£ ;> -J -C .. .

U<~>
a. c. 3^ TO U cca ^U n Q
o /-s cc rr
U ■■"tt
^ •°W5 §W2 ®f-JiS J u CO sts Q a. C-- o J> -D
s LO in in m v) cn X. ID H H H H H IS IS
■4-

0X rji
O
X
0 X
0 0 c»
0 03
O
0 CM X Tf X
rH
X
rH rH
00
rH
03
rH
O
CM
rH
CM S3
CD ■*?
CM CM
^4 H •—< *—1 rH rH rH rH rH rH rH rH rH rH rH rH rH rH rH rH
 112

Q - o >
St*C C«w JZ a)V t*
© -o (AC
TD T3 £ 45 o X o
ZZ C ■o5 |
£ G « o X o o
jz £
S w « £ CM CM 05
•n
w w43«oO o> c
o
Jr; «-* o
c ficS
tc V >
45 05 u 41 05
u -c «j C (UO
o w
- °
73 £ X m o 05 -r X o
o o' OJ CD m -r X — •—I X
*0 u.
L-, JZ G CO X
' Z •—\ 05
>>

X O
uajPI!H0 in in X
CO to CO
IB30X CM X
<T)
(A
6 CM
o .
c03 $ SJesA
CO

1583
969
2920

1523

212
CM

140614
9Ay pUB 9UO
•gs U99AU9q X

uajpimo
CM 05 -r X X r*
9UO J9pun Cl X X o 1-4 05
O (f) -r »n X o 1—1 CM X
Z a>
^ u
udJPl!HD •—1 i— r-
m
73 c
w a>
f2° sjoqiojv ai
-r
JUBJOadxg *r
m

m CM ai o
Udjpnqo m x ai X X
CD o CM CO
in
O O o
•3 <1)0
S«
6 sjaqjo^i 05
X
Z *> JUB)D9dY3 c/: m
S cm
U3
Welfare Centres—-(continued).

p:
pjaq suoissag X 05
'f Z X
fo -om JBIOX 05
in
uu
u

c c OJ d
c 03 03
c p c E r c g
*1
5 03 o 03 o
tL £ >
05 .> E 05 ^ a. E 45 ^
5- i- CZ c 73 E-s 6-3 .i 73 X E —
3 o u 1 .45 v.% — o v .y
V «
03 •3 u •? t. y U "3
03 03 X
r\ IS CuS D- CL a, S
I

CHILD
|

9,\y pue 3uo

o 00
42
30

jo soSe aqj
35

3984
9

Wi X
_ 05
ua9M}8q
LXXI1I.—Child

■g ?P u^PllMD
4) .5
C3 . P
90

10076

9UO 49pun
55

113

28
18

T3
51

ARY

£ S U9JPUH3
*J
r« -- - -
ZD
<D 4-
c/3
| ' 50 | ^ N
1546

sjaqjoj^
*7*I*
0) iuejoadxg X
^ 9= c
Table

*9Ay pue 9U0 >

jo S99e 3qj r> CM 05 X X 05
X X — CM —
U99AA J9q
1
' 05 U9Jpnqo 1
»c/5
'9UO x x cm m 05
J9pun ~r x *-• cm
1
U9jpiiqo

1 C/5- "^3• ^| -*r

1
3? >*h bfl CM1 U 2 1 CM 1 1
CM
|
C'l
5 ° c . 05 *T CM CM
3rd W
Toddl

Thurs
Thurs

45 ?
Tues.

T hurs
Tues.
Mon.

n .£ ^
Q

C >n .
x:
S 75 iu d ~ <D O o
E -c oj v2 ^ 45 a Q
> o
C/5 £ c LL

tuo o
3 o
o 45 JCo _i
c^ <
-S-gQ a- Q H
"O 3C _ • o
x; oo P Q 03 O
H
?P x q|
J cud
■o « o o sai
*a 03 ca os 45 ^
< Q-w o£ “ W)< in T5 o
T3 ^ C
x •S 73
C JC 3 3 <v X
03 w>2-“ 4) cn 52-m
41 = oC CL ip
o O J2 JC ^ x: '— <u
I c 0 2 ° a
L e c h|
ctf ^ V)
z ■so -1 JZ
J3 O
° 2£ w JZ3 o ^ to
■O »-
3
u • u "S o
ceOJ c_ v-03 ~
H
o hD cn o u “ s ^
> £ CQ ca
x
1M
 11.'

Children under School Age.

In May, 1936, the Minister of Health issued Circular 1550 with regard to children under
school age. In this circular it was pointed out that in many areas insufficient attention was being
given to the health of young children between the ages of 18 months and 5 years. The Minister
also stated that more than 16% of the children entering school were found to require treatment
for some disease or defect and it was clear that many of these conditions could have been prevented
from developing or could have been quickly cured if adequate supervision of the health of the
children had been exercised throughout the pre-school years.
In December, 1937, the Child Welfare Sub-Committee considered a report of the County-
Medical Officer and were of opinion that further provision should be made for the supervision
of the health of children between the ages of 18 months and 5 years, including the provision of
nursery classes, special clinics for the treatment of eye, ear, nose, throat and teeth conditions
and toddlers’ clinics and the appointment of orthopaedic nurses and additional child welfare nurses.

(a) Nursery Schools and Classes.

The West Riding Education Committee has been asked to consider the erection of nursery
.schools or the provision of nursery ('lasses in the following areas :—
Urban Districts:—
Darton. Otley.
Elland. Royston.
Holmfirth. Saddleworth
Horbury. Selby.
Horsforth. Stanley (Outwood).
Knottinglev. Stocksbridge.
Mexborough. Wath.
Mirfield. Worsborough.

Rural Districts :■—

Doncaster R. Rossington, Armthorpe.
Rotherham R. Swallownest, Thurcroft.
Thorne R. ... I'horne, Dunscroft.
Wakefield R. Crigglestone.
Wortley R. Chapeltown, Ecclesfield, High Green.

Nursery cl: isses have been provided bv th Education Committee at the undermentioned
schools:—

No. of children
Division under five years
Name ot School.
No. of age on
Register.

1 Bentham, High Council 19

2 Skipton, Broughton Street Council 36
Skipton, Ings Council ... 20
Barnoldswick, Gisburn Road Council 28
Earby, New Road Council 29
4 Otley, Newall Council 39
Aireborough, Yeadon South View Council ... 81
5 Knaresborough, Castle Council 34
6 Bingley, Cottingley Council ... 12
Bingley, Mornington Road Council ... 46
Silsden, Aire View Council 54
8 Garforth Council 27
10 Hebden Royd, Central Street Council 30
Sowerby Bridge, Fuel Lane ... 28
12 Havercroft Council 30
13 Rothwell Council 34
Rothwell, Stourton Council ... 35
Rothwell, Robin Hood Council 25)
Sharlston Council 52
Stanley, VVrenlhorpe Council 29
14 Grimethorpe Council 98
Hemsworth, South Road Council ... 36
Hemsworth, Kinsley Council ... 51
South Elmsall, Broad Lane Council ... 55
South Kirkby, Moorthorpe Council ... 70
South Kirkby, Common Road ... 61
North Elmsall, Harewood Lane Council 91
15 Casteford, Temple Street Council ... 43
Castleford, Wheldon Lane Council ... 31
Whitwood Mere, Hightown C. E. ... 36
Normanton, Common Council (2) 67
Xormanton, Woodhouse Council 51
Normanton, C. E. 36
Kerr) Frvston, Airedale Council 81
Kerry Frvston, New Frvston Council 36
16 Askern, Moss Road Council ... 28
Featherstone Council 82
17 Colne Valley, Marsden Council 25
Saddleworth, Springhead Council 19
Lepton Council 13
1!) Penistone, Spring Vale Council 24
21 Mirfield, Shroggs Road Council 45
 No. of children
Division under five years
No. Name of School.
of age on
Register.

92 Conisbrough, Balbv Street Council 51

Denaby Main, Rossington Street Council ... 89
Dearne, Highgate Council 41
Dearne, Thurnscoe Council 53
Dearne, Thurnscoe, The Hill Council 145
23 Edlington, Hill Top Council ... 82
Edlington, Victoria Council 68
Bentley, Cooke Street Council . . 24
Bentley, New Village Council ... 59
Armthorpe, Council 95
Adwick, Highfield Council 63
Sprotbrough, Richmond Hill Council ... 10
24 Goole, Old Goole Council 78
Goole, Pasture Road Council ... 126
Thorne, Moorends Council 62
Thorne, Moorends West Road Council 87
Stainforth, Junction Road Council 70
25 Hoyland, Market Street Council 23
Hoyland, King Street Council 28
Dinnington Council 80
26 Swinton, Kilnhurst Council ... 31
Brampton Bierlow, Cortonwood Council 24
Wombwell, Park Street Council ... .. ... 52
Wombwell, Barnsley Road Council 50
Wombwell, Jump Council 38
27 Treeton Council ... 27
Brinsworth Council 52
Rawmarsh, Rotherham Road Council 63
Rawmarsh, Rycroft Council ... 61
Thrybergh Council 84
Maltbv, Crags Council ... 46

A recent survey undertaken by the Education Officer, shews that the number of children
under five years of age in attendance at Elementary Schools in the West Riding- is 10,158.

(b) Special Clinics.

Many special clinics are already provided for the treatment of eye, ear, nose, throat and teeth
conditions and these are to he made available to the fullest extent for children between the ages of
one and five years.

(c) Toddlers’ Clinics.

In connection with the scheme it is proposed to establish gradually toddlers’ clinics at the
following child welfare centres: —

Urban Districts :—

Adwick-le-Street (Woodlands). Normanton.

Aireborough (Yeadon). Royston.
Bentley. Saddleworth.
Darton. Selby.
Dearne (Goldthorpe and Thurnscoe). Skipton.
Elland. Sowerby Bridge.
Hemsworth (Fitzwilliam). Stanley (Outwood).
Holmfirth. Stocksbridge.
Hoyland Nether (Hoyland and Swinton.
Hovland Common). Wath-upon-Dcarnc (Wath and West
Maltby. Melton).
Mirfield. Worsborough.

Rural Districts :—

Doncaster R. Armthorpe, Edlington, Rossington.

Kiveton Park R. Dinnington.
Rotherham R. Cortonwood, Dalton, Swallownest, Thurcroft.
Tadcaster R. Allerton Bywater, Micklefield, Swillington.
Thorne R. Moorends, Stainforth, Thorne.
Wort lev R. Chapeltown, Ecclesfield, High Green anti
Stannington.

The establishment of Toddlers’ clinics in the County Maternity and Child Welfare Area is
proceeding steadily and the following table gives particulars of the child welfare centres where
these are provided, together with information as to the day and time of sessions and total attend¬
ances during 1938.
 115

Table LXXIV.
Attendances at Special Toddlers’ Clinics during 1938.

Total
Average
Day and times of No. of No. of attendance
Address of Clinic. children j No. of
sessions. Sessions. per
who attendances, session.
attended.

1. Conisbrough, Balby Street Second Friday, 9-30—

Council School, Denaby Main 11-30 a.m. 26 27 9

2. Cudworth, Wesley Hall Weekly, Wednesday,

10-30—12 noon. 39 72 36

3. Dunscroft (Thorne R.), Weekly, Friday,

Church Hall 2—4 p.m. 140 265 43 7

4. Featherstone, Gospel Hall Second and fourth

Thursday, 2—4 p.m. 69 105 11 10

5. Hemsworth, West End Second Thursday,

Council School ... 2—4 p.m. 26 61 10

6. Horsforth, St. Margaret’s Hall Second Tuesday,

2—4 p.m. 39 113 19

7. Knottingley, Secondary School, First and third Thursday,

Chapel Street .1 2 p.m. 45 54 7

8. Mexborough, Clinic Hut, ! First and third Wednes-

Bank Street .: day, 2—4 p.m. 66 287 26 11

9. Otley, Primitive Methodist { Third Monday, 2—4 p.m. 24 68 4 17

Chapel, Station Road ...

10. Oueensbury, Cricket Pavilion Weekly, Friday. 35 569 48 12

11. Rawmarsh, Barbers Avenue Weekly, Wednesday,

10-30—12 noon. 671 1,169 45 26

13. Worsborough Dale, Third Wednesday,

Wesleyan Sunday School, 3—4 p.m. 31 55 18
Edmonds Road ...

Totals ... 1,211 2,845 205

Maternal Mortality.
Below are tables giving comparative statistics as to maternal mortality. Comments on the
Maternal Death Rate will be found in the foreword to this report on page 2.

Table LXXV.

Deaths of mothers per 1,000 live births

Infant Mortality
Other Puerperal Total Puerperal Rate
Puerperal Sepsis
Causes Mortality
Year
England England England England
Admin. Admin. Admin. Admin.
and and and and
County County County County
Wales Wales Wales Wales
1928 1-79 2-11 2-63 3-34 4-42 5-45 65 62
1929 1-80 2-27 2-53 2-97 4-33 5-24 74 89
1930 1-92 2-43 2-48 3-82 4 40 6 • 25 60 65
1931 1-66 2-29 2-45 3-53 4 11 5-82 66 74
1932 1 61 205 2-60 317 4-21 5-22 65 70
1933 1-83 2-08 2-68 4-16 4 51 6-24 64 70
1934 2 03 2-31 2 • 57 3-50 4-60 5-81 59 58
1935 1 -68 1 -86 2-42 2-69 4-10 4 • 55 57 58
1936 1 -40 1 -70 2-41 2-65 3-81 4-35 59 63
1937 0-97 0-92 2-26 300 3 • 23 3-92 58 60
Average ]
for 10
years
l 1-67 2-01 2-51 3-29 4- 18 5-30 63 67
1928-37 )
1938 0-89 1 07 2- 19 2-67 3-08 3-74 53 51

As from the year 1931, there has been a revision in the classification of deaths, and this has
affected the figures relating to Maternal Mortality. As a result, the figures for 1931 and
following years are not strictly comparable with those for the previous years which are shown in the
above table; however, the discrepancy is so slight as barely to affect either the figures or rates,
and for all practical purposes comparisons can be made.
 116
Table LXXVI.

Deaths of mothers per 1,000 live and still births.

Year. Puerperal Sepsis. Other Puerperal Causes. Total Puerperal Mortality.

England and Administrative England and Administrative England and Administrative
Wales. County. Wales. County. Wales. County.

1929 1-73 216 2-43 2-83 4-16 4-99

1930 1-84 2-32 2-38 3 64 4-22 5-96
1931 1-59 219 2-35 3-37 3-94 5-56
1932 1-55 1-96 2-49 301 4 04 4-97
1933 1-71 1-98 2-52 3-96 4-23 5-94
1934 1-95 2-20 2-46 3-33 4-41 5-53
1935 1 -61 1-78 2-32 2-56 3-93 4-34
1936 1-34 1-62 2-31 2-54 3-65 416
1937 0-94 0-87 2-17 2-87 311 3-74
1938 0-86 1-03 2-11 2-55 297 3-58

Columns 16-18 of Table VI, headed “Births, Deaths, Annual Rates, etc., 1938,’’ folded in
at page 19 contain the maternal mortality rates for the year 1938 and the average rates for
the five years 1933-37 for each county district. It should be mentioned, however, that the
majority of the districts in the Administrative C ounty have too small a number of births for satis¬
factory comparisons to be made of their maternal mortality rates, for example, in a district with
250 births, one maternal death gives a rate of 4 0 per thousand births which is a comparatively
favourable rate. Should there be two maternal deaths the rate will be 8-0 which compares
unfavourably with those for England and Wales and the Administrative County.
 117

Maternal Deaths.
The following is a summary and report by Dr. Rhoda Adamson in respect of her analysis
of the 88 deaths of women which were associated with pregnancy and reported in the County
Council’s Maternity and Child Welfare area during 19,‘18.

71 C7 ID X X cr.
uz

11 •JUSIJBd JO
>
03 UOUBJado-OO -
1 1 1 ] 1 l 1
t 1 juoSiijojuj
■C ■'

•JBridSOlJ UI
C ra
_ ai juauijBSj} - - -
1 1 1 i 1
■£3 jsijBjosds
c3 0
11 >

Vh *Xj9Aipp
11 C 1& ssuijpuj
7 u - - -
7U 11 1 1 l 1
11 ouj^sqo
'
J9W9H

•9JB9
p4«u-93ue - - | 1 !
J9WU ' ' '

o 03 _ i
73
c t£73 b O .
C £ c C 73 cT
4-J *-
O 5 § CC
c c
£ •5 .22 a? ^
o
£ 3 C3 g Q.
ou g
-O
C 03 ^ .
C - c u >’
C
o 2 §5 ■0L-
C <
_ B ~ ^ 73<->
aj a U-
T3 ^ pQ
_ c 11 4_ — O **“ 03
73 o• c C *“
7 a - 3 O
•S 73 a, o .1 ^ “ -a n CL n
c c ^* ».§ ™
-- c: c 7 C J S c 11 — X 03:C*~ c
o ° * ~ o o
Z Z CC Z

3UIOJ-J
UA\Q

£
03
3iuoH N
<11
73

JE}ldsOj-J
Table LXXVII.

T3
« 8 c/) «
*-> 00 a; t:

-C si 03 <u v-
S cr c JC o e«
as
11
•gs>, 01
73 U C
U 03
L KH (3
J-
73 2 cc 02 D
*c Q 73 JC E ^
t£ !r C -7
0 . ^ 03 .b S j»
0 0 £ X) ^ ^ 73
03 73 — £ a;
>- c <u
c x: 73 E •- 03v- c: -r
£
3 0 cu -Q«4H £
V- rn
<u E 0 0) O^H
”2£ • 11 9 0/)
a « ^ ^ .E
o .22
73 c -P T3 o(A. <»
03 ai ^ *5 u O 9- o c
0 3 73 15
C C O *3 u 03 -r
11 >. 03 S C
jO 0
T3 0 ^
1

5 E
O =5
-Q *£ 2 a.
03 QJ £ ^
eu ,
~ CL
.—. u 5 S 5. .j •
cc a) < .2 2 w 3
tj 2 ¥ O
E g.
U ^ . j; .= a.
03
O ««- ra '•£ c '3 ,2 £
C c P a>
w
a.
L.
OJ
.t~! *3 c/i
35 J 1.2 • u- O
Z Sio .
11 y (/i p o h
ITi 6 -G t> w o r ^
o L ? u
c3 22
<u c —
w S-t?, <5^
c ^ <D E E 11
«■£■&! a: o 73 « ^
o
•H ST
cLC £ «3ls:i
C- _C r-H c/: Q. 53
a; o
CT CC cr.
Comfortal

CO
Good
Poor

Poor

Poor
do.

V-
C*. CV.
0

E
0
u
u

11
H-i

Ou 6 d d d d d d d
3 -e y 73 *0 73 73
O
E

01
Ofi 10 (N X
CO X -t* CN <N X X <N
<

11
CD O
X lO X t^ CO 03

u
 118

S5
uz

•juaijed jo
Cd
UOI}B49do-OQ

f I jusSiipjuj

'i-o
•[BJldsoq UI
^ 03 JUSUIJB3J}
42 13
w .4
cd O }SI[Bp9dg
>
"O cd
v- _
•XjSAlpp
<1) C
JZ 03 }B S9I1IJI0BJ

ou;9}sqo
49U9Q

•9JB0
[B}BU-9JUB
J9;jag

o o o <v
!— u ' i- c/3 c _c
C C O , cj 44 C CD
£ I 6
(j o ^ If 3 42 OJ £j5 42 •-g^S
° §
o
3
03
o o
u C3 « C
a
"3^2
’U _ M- n
<v ^ o 12 £ o £.
*c3
O 03

i
4_,
cd o
03
4_i 13 <L>
G »—<
u
I c 03 O 03
Jj in
c 2P £
QJ 03
cd
—
£
o C 13
03 •° S3 c 03 CO o ^ CO 4-> S- ^ C 03 .U 03
12 42 W
03
% 12 ^ (fl
C L,
O)
rr* ^
D
.K C »-! O 03 C ^ 4J ° £
•" CO 03
i 03 O r—l c t— ‘ " dj ^ U EC E 03 T •z w >A
03 12 C
E H
03 o 03 to .2 *2 CL
c .£
C
o no C 3 03
C^^42
U
d c £
12
cd
OJ - 03
42 £ 73 —« T2 C V-
L. fe g
£
u ^
03 E 42 o . cd cd s 12 ^ C cd
03 03 03 r- g«2 cd O .tJ 03 3 CL ^2
42 CL cd w 3 . c
12
03
12
s s E
2
12
>
u
03
12
03
12
CL ^
V) ,t2
CL
!5 • 12
03
12
*73 J_ 03 12
V- 03
HJ
03
Oj
^ ^ s 12 u ’cd tj 4-1
03 O L-
*0 •— 03 u CL c
•r oj
12
03
12
U
03 c

CJ
w o
v- ■*-
03
C
c o
03
c 3
CL
3
C 12 C/3
C O
42 . •S 2 o ■r o > cd
•§■8 ^ 42
C o
c C > 73 o
03 -42 r03 K c ^
12
C
<13 CJ
13 o
O J2
n ° fc 5
cd u D.
0)
C/3 Cd 42
O •4- Cd C/3 §-12 C/i 4_> cd cd X 2 o in 03 42 Cd cd 4-1 c ^

< &c < < in < < < p

DUJOI^
UMQ

3UIOH *K
rt
03
12
LXXVII—(continued).

|u;idsoj-j

SO) w ,i3
X 3 b/)
o 3 03
04 43 J c? c • c
•d 23 03 £ •s fe u »£» .£
13 *— 8>
s t
03 «
"cd
*£ Oh O £ 12 E's

c ■£
o c .2
C 12
2 C
2
03 7:3
«
5-
°
W
03 *55 . c 2 23 C
CL CD
03 < 42
5-°«
% Cd
Cd •—<
C
E
03
E
O £ cL^rt 12 o• ■S*
0) CO ^4-
O cj 'C 03 3 42
03 -5 Dh 73 03 O
u L) ^ K (/)
£
Table

03 c o ^
i ® 03
O •
£
CL
W .2
ra:3^ o ^
£ -o § 13 o c u O
C O) H a; 13 O) #cd ^ o
a. u 1 73 42 42
03
U >
03 fe 03 Q_
O
CL
*73 1— H Q- C
0) 5
03 42 §4 g-g-a
£ 42 03 -a e
c
to Q cd
o •3 4Q
< CL, w

0)
c o p
25
03 .2 ,03 5 C 03
23^ 42 o >
o C ^ CJ 42
S 2 ^ c
0) .- £ O)
w CL ^ 03
^ <-*- 3 12
tic 2 h4 O tUD >,1 O)
C
03
c
.£ fej CL "£- ««
cT °-
*S fc 4
W 03
CJ
<+H 0) C O 03 C3 12
3- j3 C O
cc Pl
^ 13 03
03
.2 i c ^ £ 12
c ^
03 g
03
03
03
C c
£— C “ i2 03 5— C
42 *4
W CJ c Cii5 « X
s c ^ #c O C3 £ r cj ftj 42
*Z3 c 03 03
C 4-
CL 33 EH CL 03 cC
03 03
C/3 in in

42 42
03 03
o o
o o O
12
O
-c
Dh CL
£ c £
o o
O
O O

c
.2
03
CL o O O O O O O O
3 3
12 12 12 12 12 12 12 12
O
X

V
Ofl U3 03 1/2 O CO <M 1/2
CO <N CS C^2 C'J CO
<

u-
 119

Case
No.
O CM CO rf 1/3 CD O

28

29
CM CM CM CM CM CM CM CM CO

CD •juapad jo
uopajado-oD - - 1
CO 1 1 1 1 1 1 1
juaSjipjuj
f 1
*G
bpS •[Bjidsoq u;
C r3 juauuBsaj - - -
1 1 1 1 1 1 1
jstiBToadg
CO ’0
CO ■XjSAiiap
^ _ JB SOIJJIPBJ
CD C
r- QJ - - -
’tj <D oujajsqo 1 1 1 1 1 1
03 X! '
jspag
r>
*9JED
JUJBU-94UB 1 ’-H 1 1 1 1
jgjjag

c K*~l
} o .2 rj ^ > CO
<D w .00 CD CO
C /G W CO T5 C
5 c ^ w a 33 a c g 0
J T3 0> ° ^ *fe O a) o co o 'a i-g 3 • r*
C c/)
0) T3 (D G •G c -a *5
s g
<D G 0) G^ .2 tuo 2 3 _ KM <D
C/3 3
CO -O 3 > CO
C <D CO O G CD G a.
C£^ K <u O " C • 81 C *C £ 1/5
G E Q-
O
<D c D< o O 05 tao.2 Ofe 1 tUD o .a S
c -a im <D 4-» O C-
3
CD p
s g c o >,3 ,> w
03 C
u ° g ^ £ G
P-> a) -2 « O CD JD O -O C 0) M-H
>, o •a • c -1 -c c X! CD Q- CO
T? S tlfl TJ ^ CO -d KM T3 <D .G *G
3 a)
G ’ £ .Hoc C a; c 3 CD __ c <D 3 03 w
*G tJO 5
03 *g
3 T3 — o T3 S3 55 ^
< G 2 £ " c G ^ G « c 25 ■g-g C O
I CD <D CO * >> 5 C? g . <d .c > QJ L* oPg
0 JP2
X!•§ -Q £ ■*-> co ■*-• CO ’G c/3 G CD

3LUOJ-J
UMQ

3UI0H ‘N
cO
<D
*3
Table LXXVII—(continued).

jE^ldSOJ-I

tic
V)
CZ
c 3
CD • O c 2
O JZ ‘55
o,
X3 .2 £
~ 3
,, £ r\
L-J
— 3 CD 03 c^*
03 D-i o
CD
s B JH L
MH 2.2
CO Z
.2 ^
TD 3 u . CD
0 *5 ^
2 ^
CO V
6 .a
c/3 4-.
£ *
CO _ E
in
»
C
c'&
0
3 2 . X w
"> .<2 c
3: Q- 0 c 3S O .2 ^ 0
o CD CO
o
X) i-
. O G , 0 feO 0 • - c
.Q W) G JD c o ^
-G 3

E-o
CO id E o
CD
E c ■3^ . C (D
KM ID u § ^ 03 _ • G
" c CO
C OJ co

2^ V)
^ 03
c c/) O4 cO

<D CO 03
C £ co CL-C CO G . TJ
.G c r ^2 o C C W c CO .2^ ^T3
O o ^ o CD ^ G
•3 E ^ | CO o CD CS
c «
O & S 2 fc co DC X! •—
< JS 3
gu< g 3u ^ Cfl CA tJiD
3
04 CL, 04 o

3 •43o -
co
cO 8j i-
C -G
O 2 <13
JD G
.2-
3 ^ CO *0
o^: 2 bo
-g G
CO ••-*
KM o w c
G 3- 8j o
_ <4-.
-G o '£ f;
tJC "
>2 -o "E
OJ c II
o a
.2 ra "p
2 C B-a-c o c.!
ftj Q. u ^ o
& *
CD G
•- 2 ’■H o O
CL O c
CD
IT)

-Q
CO CO

o
o o o O
o
’■a -c TJ T3
04
2
o O
2 O O
o
U •G

c
.2 O
CL 0)
co 0) 2^G o-
Q. C/) o o
•o
o
TT
o
T3
O
*d
o
TJ
O
T3 CD ^
3 3 •o
J- ^
o O O CO
Z
EC u

V
KM 03 00 o o CO o CO
CO CO CO CO
< CSI CO

O o CN CO CC 00
CM
03
CM
o
CO
cs CN CM CM
Z
 120

in CD r>. 00 03
co CD co CO CO
u-

•jugpBd jo
uojjBjgdo-oo
}ua3i[ja}ui

.’Ssja' •[Bjidsoq ui
CD
juguijBajj
’S r2 }si[Epads
03 "o
V
T3 03
>
•Xj3Ai[ap
(D c
U r- }B S9UIJI3BJ
r- <V
tS CD oujajsqo
CD Q
.3 jgjjgg
■ajBO
IBJBU-gjUB
-MWg
O
u. G OX) , U £
J <D 3 O
> O --
| <2
<D E
•C «
>A u U->
2
Q
o
£1
>3 gl Cfl c 5 cd
3 * c/f c* o
2 , , o O •r cd -c CD 2 ^ o TJ . T3
r <d O— tl *3 CD •-<
w *j D c/3
Set;0 feCD w^ ^ 03 03 . C .3 g £
■s gG
5 « -(D <D
■ ° O CD CD C C ° £ 03
3 G : jz 3 k o Ei E i §*-§ n 3
O o O T3
C/3 O (Si
_ o i e8.e >>CO
1 a? *4-* £ ^ .2 .c £ ^
I c °a) 03
4-J ®£ E « •73 rf) 03 03 •73 ^
c uo 3 3 03 (Si 8 * <d 3
< O 3 C <D K 3
•j r-t “
•a E 13 "a T-l H
.2 ^
’qj b/}1 o <D & E %% o .£ c o J t
c
CD o •
D2 C3 3
vr 3 c
03 .« O C
3 o '2- 03
H g: Eii E C o o £ <3
< CD CQ £ £

3UI0J-J
UA\Q

3UI°H "M
LXXVII—(continued).

[Bjidsoj-i

O 3
K tUD O
. £. 03 «D
H *£ 03
•3 0£.' a. >
.2
03 Cx a> .t; >» 03 3 £ 6 UW !3 ^
05 a,— t> . SP >-D 0/D ^ 2 ^
03 E 2
0 ) <d -a 03 >-* E 0) , ,
05
C if) ’C 2 do a>
TJ
e S'-,03 E
32• .sd *"3 « <D O
g DC 8 ^ -E’S ^
^ *0)
3
-Q
' o <D U
3
“■§
-= c O a fco 3 S' o ■ u
Q CD u
£
O S2- c
3 c W . cr;-S 5*
cc«S
. c/) o •G o3 ? 5)
‘C h 3 o K
c E •s
£■3,
.2 EE O o
3 £2
a
> <u ^ <D £ c CD
- >A
CA rQ °-S :§| g
-a < m
S Mo’® CO CD E -a-
U (D
05 p c •- CD - <D CD C o «
C
HJ
4)
0.
Table

Qh .3 ^ .£ G CD Cfl 0 CD
3 £ CD .3 c CD *5 TD .2 8.2'‘ID cd D. ^ o-
03
t 26 t
O 3 ,t2 c *-* 03
«+H O
3 q .,2 « g..S
3 o > 03 T3 3 03 u
a.
C £ O
03 o W <D
3 <D 03 £ JZ 03
£•3 0 a E J2
a <D m E g-8 « tc T’ c^ n. u 03 C «; « J!
E ttS E
u c £ C £ o «J
<d a 3 CD £ u t- . 3
' <D £ £ D= £ CL PC
CO
’O 3 ^
i- (fi r < 03 O
£. 03 D2I £ 3
Ov 3- .32 w ”o
CD u CD D W

3 a
03
U «•-
•S 'E2>
E

fc d

a i ^
« d g
a g
■sgc
•2

s|S?
•— *—
v-
D-
<D
Cd CD

G>
03

c o o o O
o o o o 03 -a
CD CD CD
6 £ £
o c
U CJ U
o

c
.2
£
CD
<D
C/) o O o O O CD
C/J o
3 T3 -a 'D "O 3 *T3
3
O H O
ffi ffi

OJ 03
CuO m co o CO CD CO
CO CO CO CO
<

C4 CO Tf m CD 00 03
CO CO CO CO CO CO CO CO
 121
04 C7 00
O'

*)U9pBd £0
03
UOUB40C1O-OO
t43 ^I }U9xhq9}UI

G •jBqdsoq ui
u d
rC &
+3 d }U9UJ}e9.l}
P *n }siiet09dg
<D
* Xj9AI|9p
43 0) }B S9pI[I0HJ
OU49;sqo
J3»9a

•9JBD
IB}BU-9}UB

J3»3a

#o
^C
u P c
.5 S c GJ d tl£)
5 •o^ T3 03 0) & S £ a
1 c
O c s^d
JG d
4. <L>
QJ ■*-»
03
a o' >. "3 -§ •r S'o
O CO 3 133 . 03 03 > .13 4—>
03 t3

C3 > OJ J5 ‘S” £ * C 4_> C/l 03 oj

11 "s t. 1- > - tn 03 43 ’a) C C 3^
7 G cd C ja ttfi u Q. > . <
p >2
o <D G £ d "G 3 • o c
a) ► 3
D- l- o . < 43 o U .2
qj
a) bjO >
S o-S « 00 p •*-> o V
QJ QJ
m 3 G i .a >,OVl c p c-° £
C “ 2 O "C u o 4PE O w3 03 c . 3 V-
a. « 73 3 •
G 4^ 03
CC c/3
„ w c O
-i O o-
i—i ^
E ^ •a
>,.G
•n ^"a
3
SM—i w *q
• rrj
y j 03 d
QJ
-
QJ
-C CO 3 A
QJ , <D ^ ^ s o
G 03 oj 2 O C (j i C
< d «D 0> •° <2 a d ' ; sn d E X a 5 •d 7
g G QJ ”
d °
v- V
oj qj 0) a/ g S
,c IMu ? 2 o G ._|! GJ
U c i-i a> <D P o O c/)
O O a) c
0) c
u
o3.^
a
gj os
03 C Sc* .5 tuQ-fj > o Cu ^ cs C
o L- 03 Cu O 03 23 o -O 43 3D 03 C/3 T3

£ c* < 2:

3LUOjq

UMQ

03 3UI0H *N
0)
d
LXXVII—(continued).

|B^|dso|q

flj —' o
o' o Vr-t U O 03
5 -*-* 43 43 a
IrC 03 ^ 03 in o in os o
C •-• d 03
tin «J § -S „• c ■ 5
o u
u 3
If)
(u a P d
<d d
GJ su *3
Ch O s«5 O .2 3 CL,
h 03 GJ
43 m —■ £ d ^ m vp
«4-t 43 O)
O XC . j- s
7^ 03 d <D 0.5
03 43 o u
4J 3 (D 03 C o a. <V o
c « 43^ O d
P u-'
r? o> •-.
C 3 G <«
G Vh
Table

<D <s> > 43 a>

^ d 03 43 JO ^
33 0)
3 _ ^ p o </) <D _, —
c .J2
o d o -*-> C 0) d E
03 s_
.. t7 d G3 U O 03 3 G > .So
d o) >, U 7 ^
£■«
<D 3 § g 43 <£ d 7 *n gd
03 > p 03 7 03 43*CN > 04 m G
0) 43 d 3 ^ w cd ^ 2 «
d U O in U
O
43
Oh
3 O
03
o
03 <D
O
c
c 0)
c 03
O u
tn •
c c
^r° .i3 O
O 5 to
43 4_< OJ ^
< c I g
in 4=
G Qj o3 £ a
>
d d ^ vi d
• — 03
c ^ .13 C
os a) <5 C *3
CO'S > o E
.3 g w < QJ
a, E OH°d E b
in

43 43 43 43
os CO 03 03
o o u o o
o o o o O o o
d d
a, «4-H Oh Ch
a, p
6 C
O o o O
u O U O
o

c a)
.2 7n
in 4±; c
Oj OJ tin
Q-
QJ
if) o o o o o o is c
d d d d d d 3
3 3
O ‘2 ‘w O
X >

aj C7 r> 04 C7 04 00 03
&0 •M 04 C7 04 04 C7 04
<
t)
So 04 CO
OZ
 122
V •
V) o cm CO in CO x o
a 7 m m m LO m in CO

> •JU9l}Bd JO
cO
uopnjodo-oo
f I ^U95iU9;UJ
JdiT
£ T3 •jBjidsoq ui
45 -S 3U9UJ}e94}
CO
5Si{eio9dg

*y{j9ATJ9p
JE S9t5l[IOBJ
O) 43
43 ou}9}sqo
J9}}9g

*9JE0
JB^BU-9 }UB

J9Wq

iS *3
G <d
a. aj ^ CO _
(D u jj -g > .G 03
U U. 4J
CO
0-44 *45 C 45 o .M « « o. tj O C3
(/) o C C E 43 CO V-, r-
2 jZi
-3 O °^D
£ B r?
G
g.2 S'-5 *3 3 4-*
CD V
< .2 •§ S-Es-"
CO • C g 3
0) 43 3
**-> —
O 'S » ; » « 3 c co £ o its cn e
CO G .G c _c C O -3 CO S ^ W
.3 45 w . ^ ^
a) §*f .8 £ o^!3.
„1S3) c
« .G -a o
.£ <D «■§ ° O £
EcZ
§ E* £ S gN£i?
3h
T3 CM G^
£ •a6 38 £§ J 2c "° .5 - § CO
CD

^ o " u
c -3 £
*d u
x> •-h O) _
3 tin T3 G O ;£ cO T3 _ 3 TJ ■£ 43
d -c t; m
•
O CO 3 (D CO 43 32 C 03 3 ~ tm
< C rr i_ L- (D •2
C
-ZS e O M
r- U
* 43
a
' ' .3
G 03 M J+5 J3J <D ^ cO u
£ £ *4 43 +-1
O u ^ G — - o <u c c
CO ^ 3 £ JH CO CO CJ 43 <■
8 ^ & O o gc-S 3
< CQ C3 £ cc

91UOJ-J

U A\Q

31UOH ‘N
03
03
T3

03
45
JBJldsOjq

5 4*
> CJ
b
45 CO
O O G
0) •S 3 T3 O
G E^
u)
3 CO co
CL,
S g o G
G
C W M
CO *—
4) 3
G
C
CO
.2 3 CO M t CL, g° 1 tin c
G tm
c to 3“
o (D
4C G .2 G tin
o E .2 G to O CO
o £ B CO o X5
rc CO . *5 t
cai O CO CO
u '- EO **H , ’ . •Q
_g K
•2 x
o u a, u
CD
.GJ C/3
Q- TJ
§> <D • CTGh ^ 2
B 2 s u< O .>
oO
o c
'OC co 3
<8 *G 3 TI 2 *a3 •
> T3
*c c *5 ^ 2
_ co
o a) is tm
CA) C
X CO O- a; a. C/3 CO o CO -r;
■an a) o <1> g CC CO O-
tn ^
X c E c o
w _ co o CO
co <u
5
•- c w 43
J 03
il
C u ° o 2^ g O s_,
.43
4 X CO 3 a-
o [L, rr
0) 3 *> >ou C Q- - D rG 43 3
w CL, CLh & w
m
<
H

cO
U S'®
• c
.2 o 05
•G V> c
»—* G Q
3 O oo
G4 g
0) CO CD
o Cu
„ T3
O <D
— O •
3; a _
03 T3
°*.g c
- o
.2^ g
C/3 O)
CL CD
03
cn

8 *’ 43 43
CO cC
O o o o
g |
o o o o
"D
o
CL a, a* cu
3 s s
o o o
u o U
u

C
o
4-1
co 0) •H I
« g "
C I -a
" 8 .2
If
03
a.
g tin
<D C
o o o <u S UO
E > G o £■!; 11
3 •a -o •v °«8
3 O u
s« o ^ ^ c
3
o Q g O
K
E E

0) CO in CD m CD
00 CM co CO CO CM

03 .
to O CM eo m oo a> o
CO >7 m m in m in CD
 123
U .
“ o cm 03 «D CD 00 03
CO CD CD CD CD CD CD CD
oz

•juapud jo

uopBJ0do-oo
4U0SJII04UI

be >.
E^
•jB^idsoq ui
T3 }U0Ul}e9J}
43 O)
- rs 5SijuiD0ds
<D O

•XjGAipp

}B S9pIJI0BJ
DI4}9}SqO

•0JBO

IUJBU-9}UB
J9^0g

o >>
>■> <D ft> *= C V 43 £
<0 CM 43 £ C g
T3 CC S **§ C S
P • —
03 O E £0 S CD
43 .2 g
43 o
p
CO G2 03
03 33 43 .S£ G D Clr
CD o •*-> Si .
•n.S «
JtJ "O c CO cd 33
K “ o
0)^4)
pp
3 £ *g
CC3 C 0) o —<

S’0
D (D .
O 42 2
*4-< C
~
O
c
O
« 2
-5 3 e
g’S'i
F ~ o
p (D CD C ■g.s
z; P <d o5 c3 -a
c 43 p cd
w a 43 c/j
CO o </) 03 o G — J 03
. Sr ti a; J- •—
CD C« c > V-
-c i- ^ G
C cd
| C : ^ £
CJ *-» P
<2 ^
> 2
CD p*
S
-h *o
ft? .P <D T3 Cu
<D P <D CD - c
CC3 •~ C3 - C 1- OO -4
|s c C 9 O
43 £ 43
o3 G
£ £ 03 T3 C ^ CL CM CQ o O g Q cd o
CL Z £ Z

3UJO |-J
UMQ

31110 H 'N
—(continued).

jBjidsoH

X3
<D ODD CD
O C cd
c
ttf §
^ •4“'
"5 . cr o
u C o (A
CO fl) CD r
CL
co 2 >-»
CO a> o cd eg co •*->
2 «
LXXVII

'-t— TD
J-.CC
cl *- 2c cd Q u ^ cd
£ u c
(A C u 03 c
03 xth «D -*-' O 03
O 03 o
43 41 B >> • 30
8 J_ 03 </> •
O 33 C 43
03 , -a C c/3 . CL G
CD
V-
O
CO .P tXD ^ 5 §S
> CD 43 O CD
G §D ^ « 8L
Ph
g $?£" 03 O CD
eLz £r
Table

8 i- ’C3
03 CL <D
°-s CO 03 qj 43
03 u 03 C
03 g P= £ •p O
O CO i_, O-
G
5 03 c 33 g 03 w
G p J2l
C E 3 O <D C o o J2 CL o
„ tSL
D flj Z1 & 5 § s CD S
CJ Cd cd r a3 £ o E*g o <u n
C3 u ?' c Ch 1- £ CJ “fc
g “ CD ^ c °-
H
U U Ch <

u
c
he
c

03 JO (/)
o
G
CL « .
CD o
CA CD -c pr
i cd
G
H ; m C
O
o
CJ
X c Z
3 CD c ^ 8
03 CL C o
• CL
.2 oj
X£ £
0^0.
in H O
Comfortable
Comfortable

destitute
to
Poor

Poor
Poor

do.

Poor

o. cv.

C o CD
.2 v-t

c5 1
CL
3
CD 6
T3
6
T3
o
-3
6
T3
6
TJ
cv. CD 6
T3
3 P
O O
X

CD
PC oc /
O 03 O
'T O 00 -r
< CO CO C*3 03 03 CM 03

CM O'} -t* ID CD X 03
CD CD CD CD CD CD CD CD CD
a-
 124

Case
No,
CO

Uuaijed jo
> uoqejado-oo
JU93lI[9}UI
t J.
[Bjxdsoi, U!
S t3 4U3UJJE9J;
r; 4Si,Bio9dc;
3 C
0) >
-a c3 •/Cj9AI]9p
G ^ ;B S9I}l[I0BJ
CD C
♦j CJ ou;9)sqo
J9U9Q
>
•9JB0
IB4BU-9JUB
JS«8H
c *c
4->
O r-
qj tr
O
2 8
O ~ <+h c c 03 O- 03
0) O 03 T5 o ^ u ^ w O)
^ T3
C TJ
^
X 03 >. >
' T3 - ‘tt .3 °-
> W c o 03 rT (S3
>>.§ *3
C 03
£ H tii C o
CD .tJ
ti/D o 2 CO 2
§ I 3 S
M—4 ■*—' O
O 03 CD
£>-, •P tlfl Si
C 0)
* a
2£
o^ o
C CJ -o
OJ
" s?
° CG 33 X G c * 2.2
CD *~
2 o 03
g w)
. §
S 2 £ .5 Q T3 05 .5
c Q “"•oE
CJ C g Im -u ^ oj -o *33
c O.S os .j2 ^ 3 0) ^ H 03
< • G tuD£ : o "o o o) —
<U 03 CJ <G cj cj C o
•o > -o I5 G 3 c c CJ h C c G
C 4-i 03
> § & CD (Si o o c — O
D 2; 2; £

suiojq
umO

os 3UioH -N
<v
T3
Table LXXVII—(continued).

[T34ldS0J-I
£

c g G m
T3 CJ o £
*“ O G
G O co c/5
C _, 03 i'3 —< T3 T3 0) C/3
>.
o E o Cm 03 <u
w 3 •- «H X G nd C
G ~Q)
O 33 u O <o O.0) a) (D 0) S' CO O
.G w t{ r!
C 2 G
c/3 C .2 £ c « o ® S
O £ «J *co ° 42 " <u
r*0£ c >
G *ZJ 2- G w 2 j c/: ,—,
-Q (D "3 o-S 03 H •■“ 3 •r D
O > 03 03 E i2 g u *■* 4= *0iD • Jz g
O Oh
a"3 ■S
J3 CG c OJ T3 °
03 £ O . 4-4
O CJ o
c o «f> «0 <D ^ ■§ S 8| S2;
G
> 42 C - c c: •g
3 Eg.
& -2 w .t: 3 ^ 3 CJ 03 . E -2 c J2 , «3 ^
(S'. o ° P . c 0) 3 O c3 -5 " «.2t
<D *33 3 D tO >• £ "e c c ID
(4-4 £
a. 55 4J 03 -*-*
x: G
a.,2 03 ■2§ ^ G G •-
0) <D *0 4-, 4-4 C
C ■§2.2
C 03 3 •£ £ *co
2 c P g: 03 G 0)
c3 — .a c 2 C3 O i—> 4-4 <d -a
o | <-G § O m CJ — ti/D G is 2 cu ■_ 2
o «£ CD c O
|| QJ
S M H rr
2t3 •O *_» *3 1 s «o G P O' 3 £ *
a « H
o *S *5 > 03 03 3 OO
-Q
3
8i a>
S a- 3
?,o g 03 03
■§ s o o'0-0
Oh Ch -J U
£
3
<3
O

*3
C
03

C
o
G 03
3 *C
CD C

O- o
G *4-<
x a.
n cu

<D
X) Xi
03 03 03
o G o G o o
o O
<4-H o o
G o o
04 CL, 04 Oh
E
o
2
o
so
O U CJ
O

G
.2 O
<3
4-1 £ 3/D ^ tl/D •G
03 <D o o O o O
Q- (S) C T3 ■a T3 -3 £ g Z.S
3 3 3 in
O O
X O
E

O o ID o
GO io CN CO 03
CO
CO CO IN CO CO CO CO
<

Cl GO 03
o CD
c3 -T. r~>
oz
 125
V .
52 .7
° © CO X X
re GO X X X X

•juapcd jo
uojiejodo-oo
JU9^IJJ9^U J

to.n*

* jBjidsoij UI
}U9imB9J}

}SllBl09d§

*Xj9AT jop
JU S0pI[I9BJ
ou;9;sqo
J9«9g

*0JBD

ltt}BU-9}UE

J3}}3£J

TJ to O
o> oj
c c C 3
u tf) o C
S >«~ o
o -a a ts c w ° o
<b u T3 C
O ■ ca "ca
4->1—
. £ c
*3 ifl « DT3 o ca c _c
o < .2 ca .ti c ca o ca *2 ca
ca : ^ C/) ca -c c
— > cl £ ca O <u
< CA ca
o 0) O A §
txo
— CD --o v- ^
<D r*
cQ-
.5 ca ^ •C-c fc
ca c
c
*5 ca 73
o ca
c <d CD *C c ° — £ . c T3 u n "3
ca 73 C (D 5 *3 0) o u ca
4_> CQ CD ca V C -c
CD 2 S *3 a
l/) CD
If) A rj w E § •S-g c c
> c O « o o
2 § £ CD cd 5
-t-> ca •o ^ •*-> TD +J
CD

9LU0J-I

UMQ

3 9lUOH ‘N
CD
•3

jB^idsopi
LXXVII—(continued).

. lx
to
c
t_; ’S rC
•£
.2 S *C V- Cl *s §• .5 o
U •— . ca 2
o V
3 to u > f*
C *3 C .2 £ ^ cd £a •-
o
n §- •o Oj
*c 2 *- CL ' ca ca o
c 3 ca *3
^ „ <u <D CD ca 2 E e
73 £ M" 3 £ 2
= 1
«*;§ o j2 -c £.2 C o O *?
, (D 3 -Q o-t: is
3
of .S txi o ca
<D £ ° oT CD — E u S.S-«
73 i O n « |£u d) CD
3
ca co o C/.)
-X c 2 E T3 o
ca 2 >> C-
■S|s ca
c ’T i c u>
ca
Table

-D u 3 TO o l. c
£ T3 ^
0; .5 ■»
U ca u c c o
U to ca c^ +j o '^S MS
.2 c E.2 o p ^ r- • C <U £ >.
C3
— to c J5 A c ° r 5 c
c ca
<D 2 aj *—1 ca UQ >,U o *3 S.fc 2C
-3 O U 3^
n CU

tio h
3 i! o
ca
*_ 3
U
° «
•o
c £ o
G s
ca « o CD •-
J- lx
to
j: ca
O
(/) ca cj
o . jd c^ ^ ca *
*3 CA; c ca ca ca
c *n
a. *2 ca c S 3 to
to « re o_ (D
CJ CD
3 •S
Q-'q.
a. a. cd
<L J3 S-< ®
cn m

o
-Q •o
ca
o o o
o
o o
*3
o
cu a. a
E
c
o o
U U

c
.2
C3 CD
CL o O o O O O o
V)
*3 rer *3 *3 ■3 *3 *3
3 3
O O.
X

V
to O
<N CO
Oi
Ol
CN
CO
X
X
CO CN
X
<

u .
s o o CN CO ic X r> X
C3 X 00 X X X x X
Uz
 126

During the year 1938 there were 88 fatal cases in women who were pregnant or who had
recently been pregnant.

At first sight this number compares unfavourably with the number of deaths in 1937 which
was 81.

Of the total 88 cases, 12 women died of intercurrent disease when they happened to be preg¬
nant or recently delivered, the fatal results in no way being dependent upon their pregnancies.

These cases were as follows: —

No. 4. Lobar pneumonia and debility after childbirth.

No. 7. Multiple cerebral haemorrhages, necrosis of liver. Terminal premature labour of
macerated twins.
No. 13. Septic endocarditis. Infarction of spleen. Recent delivery.
No. 37. Acute appendicitis. Operation followed by uraemia. Terminal abortion at 26 weeks.
No. 47. Subacute endocarditis (streptococcus viridans). Terminal abortion at 26 weeks.
No. 64. Cerebral haemorrhage. 16 weeks pregnant.
No. 68. Salpingitis. Pelvic abscess. Operation when 5 weeks pregnant.
No. 70. Acute intestinal obstruction by old band to diverticulum of colon. Previous
Caesarian section without observation of this band.
No. 72. Pulmonary tuberculosis. Condition discovered when admitted to hospital for self-
induced threatened abortion which settled down.
co

No. Lobar pneumonia of fulminating type. Terminal abortion in patient not known to
be pregnant.
No. 77. Coronary embolism. Myocardial degeneration. Normal puerperium.
No. 86. Operation for perineal repair 9 months after childbirth. P.M. findings.'—Imperfectly
developed lungs and narrowed aorta.

In addition to these cases there was one death from haemorrhage due to a ruptured ectopic
gestation where the patient was unaware of her pregnancy (No. 59) and one death from delayed
chloroform poisoning confirmed by post-mortem examination in which the amount of chloroform
administered during labour was only 4 drachms (No. 81).

There were 7 cases of abortion which were directly responsible for the condition causing death
and of these 3 were known to be the result of criminal interference though no conviction was ob¬
tained in any prosecution.

One of the cases which died of sepsis following an accidental abortion occurred in a woman
who suffered from a large ulcerated uterine procidentia which should not have been left without
surgical treatment before pregnancy started.

If these 21 cases of death are deducted from the total 88 cases, there remain 67 cases where
death resulted from some defect connected with pregnancy, labour or the puerperium.

Of these 67 cases there were 14 deaths from sepsis, following normal delivery in 10 instances,,
forceps delivery after long labour in 3 cases and classical Caesarian section after long labour with
ruptured membranes in one case.

There were 13 cases of death from pulmonary embolism in patients who were doing well
up to the time of their sudden death. Three of these deaths followed Caesarian section operations
and one of these died on the evening of her return home from hospital. These 13 deaths appeared
to be entirely unavoidable and resulted from the inevitable risk of childbirth.

There were 6 deaths from ante-partum haemorrhage. One of these was an accidental variety
and the remaining 5 were due to placenta praevia.

One case of placenta praevia had made no preparation for her delivery because she was ashamed
of being pregnant at 45 years. There was delay in transference to hospital and in consequence
she was moribund on arrival. This death would definitely rank as avoidable.

There were 4 deaths from post-partum bleeding

There were 7 cases of obstetric shock.

One patient died of shock following an abortion at the end of an attack of acute infective
gastro enteritis.

Two patients died at the end of a normal labour.

One patient was known to be suffering from Graves disease for which she had been treated
before labour.

A patient suffering from Graves disease is always a poor obstetric risk.

 127

One patient had suffered a long labour with failed forceps, a 24 hours wait, podalic version
and craniotomy of the after coming head.

One patient died after manual removal of a retained placenta.

There were 3 cases of ante-partum eclampsia and 3 cases of post-partum eclampsia in addition
to 2' patients who died of severe toxaemia of pregnancy without fits.

Eight patients suffered from severe heart disease and in 6 of these the pregnancy or labour
definitely aggravated the condition. Of these cases one was not recognised at the ante-natal clinic
and the patient was left to be delivered in a cottage house by a single handed midwife and an¬
other refused to go back to the clinic when she was advised to enter hospital for her delivery.

There was one extraordinary case of a well to do patient who had suffered several attacks of
heart failure apart from child bearing. This patient neither engaged her family doctor nor a nurse
and the doctor was only called in to a heart attack and told she was pregnant when he reached
the house and found her in labour. If he had known of her pregnancy he would have arranged
for her delivery in hospital or a nursing home as he was perfectly aware of her serious cardiac
condition.

One patient suffered from severe anaemia of pregnancy for which she was admitted to hos¬
pital. It was proposed to give her a blood transfusion and blood was obtained from her sister
who was of the same group. Transfusion was stopped almost at once as she had a severe rigor
and death took place 5 hours later, presumably from anaphylaxis.

While in most cases death appeared to be unavoidable, it is very noticeable how little use was
made of the specialist services which have been placed at the disposal of all obstetric patients what¬
ever their financial resources.

The casual attitude towards childbirth adopted by some patients and their husbands is almost
beyond belief. Where one finds that a husband went to bed at home leaving a comatose eclamptic
wife to travel 7 miles alone in an ambulance to hospital one wonders whether such behaviour results
from stupidity, or callousness.

R. H. B. Adamson.

Ultra-Violet Light Treatment.

The following table shews the arrangements made by the County Council for Ultra Violet
light treatment. The cases dealt with are mainly school children, but infants suffering from mal¬
nutrition, debility and rickets receive this treatment from time to time at the hospitals and clinics
provided.
Table LXXVIII.

Day and hours Medical Staff. Health

Location. of Names and Visiting
Attendance. Qualifications. Staff.

Bingley, Baths . Monday, Wednesday, O. T. Wade, 1

Friday. All day. M.R.C.S., L.R.C.P.
Brighouse, Huddersfield Road. Monday and Friday, R. Sutherland, M.D., 1
4 to 5 p.m. D.P.H.
Conisbrough, Miners’ Welfare Institute Thursday, 2 p.m. D. C. Rice, M.B., Ch.B. 3
Dewsbury, General Infirmary ... Daily 9 a.m. — —

Doncaster, Thorne Road . Any day, 5 to 6 p.m. G. W. Wigg, M.R.C.S., —

L.R.C.P.
Do. Balby Road Any day, 9 to 10 a.m., G. W. Wigg, M.R.C.S., —
6-30 to 7-30 p.m. L.R.C.P.
Hemsworth, Army Hut, West End Council
School ... Wednesday, 1-30 p.m. D. C. Rice, M.B., Ch.B. 1
Holmfirth, Town Hall ... Monday and Thursday, Muriel V. Wilby, 1
10 to 12 noon. M.R.C.S., L.R.C.P.
Ilkley, St. Margaret’s Hall, Regent Road ... Tuesday, 10 a.m. and L. A. Williams, M.D., 1
Friday, 2 p.m. D.P.H.
Leeds, General Infirmary Any day. __
Rawmarsh, Barber’s Avenue. Monday, 10 a.m. ; R. B. Becker, M.D., 3
Wednesday, 2 p.m. ; Ch.B., D.P.H.
Friday, 10 a.m.
Rothwell, Central Clinic Wednesday and Friday, H. Stevenson, M.B., 2
2 p.m. C.M.
Sowerby Bridge, Allan House ... /. Tuesday and Thursday, Janet M. Macmillan, 2
10 a.m. M.B., Ch.B., D.P.H.
Wakefield, Clayton Hospital Any day.
Wombwell, Free Library. Monday and Thursday, J. C. Pickup, M.B.,
2 p.m. D.P.H. 1
 128

The clinics at Conisbrough, Hemsworth, Holmfirth, Rawmarsh and Sowerby Bridge are pro¬
vided by the County Council, and those at Bingley, Brighouse, Dewsbury, Ilkley, Rothwell and
Wombwell belong to the local Council and accept cases by arrangement with the County Council
at an agreed fee. The last remark also applies to the facilities available at the Clayton
Hospital, Wakefield, and the Leeds General Infirmary. The clinics at Doncaster are provided
by private arrangement with Dr. G. W. Wigg.

All treatment is given free of charge and fares are paid in necessitous cases.

Verification of Family Circumstances.

A scheme for the verification of family circumstances in connection with all forms of relief
granted by the County Council is now in operation throughout the whole of the Administrative
Area.

The results achieved during the year can be seen from the following: —

(1) Maternity Home Treatment.

A total of 3,171 cases has been investigated by the County Public Assistance Officer during
the year and accounts have been rendered to patients as follows:—

Whole fee cases ... ... ... 1,158

Half fee cases ... ... ... ... 843
Maternity benefit cases ... ... 181

Total number of accounts rendered 2,182

These accounts represent approximately £9,900, which has been claimed from patients, where¬
as before verification was commenced, the figure amounted only to approximately £4,500 each
year. The number of admissions to maternity homes has not substantially changed.

(2) Midwives' Fees in Necessitous Cases.

A total of 2,356 cases has been investigated and to 389 of these it has been necessary to
refuse assistance.

(3) Supply of Milk and Foods.

13,411 cases have been investigated during the year and of these, 806 cases have been refused
further issues because of inaccurate statements and in 1,2'22 cases it has been necessary to charge
half price for subsequent issues.

(4) Dental Treatment.

An application for assistance towards the cost of dental treatment is not approved if the
declared income of the applicant exceeds the maximum prescribed by the scale of assistance, and
yet of 632 cases investigated after completion of the treatment approved, in 121 cases it has been
found necessary to recharge the full cost to the patient.

Assessment and Collection of Contributions.

In order that more uniformity could be obtained in the application of assessment of contri¬
butions towards the cost of treatment and the provision of milk and foods under the Maternity
and Child Welfare scheme, the County Council adopted the following scales to be applied in the
assessment and collection of contributions.

Income Included for Assessment. i

Amount to be brought into

Description of Income.
account.

Wages, salary, pension and/or value of Full amount.

emoluments
House property (in which patient does not reside) Net income derived.
Payments by lodgers (including relatives) for
full or part board ... Estimated reasonable profits at 4/- in the £.
Proceeds of sub-letting—
(a) Unfurnished rooms Net proceeds.
(b) Furnished rooms One-half.
All other income or means ... Full amount.
 129

Special Income to be Disregarded.

Particulars. Amount.

Wounds or disability pensions First £1 per week.

Workmen’s compensation weekly payment First 7/6.
National Health Insurance Benefit First 7/6 per week.
Friendly Society sick benefit and trade union
sick pay First 5/- per week.

(a) Provision of Dried Milk and Other Foods.

Where the total family income, after deducting the

actual rent and rates paid and 5/- for each child under 14 Amount payable by Amount payable by
years of age and not working, applicant. County Council.

Does not exceed 24/- per week Nil. Whole.

Is between 24/- and 34/- per week Half. Half.
Exceeds 34/- per week Whole. Nil.

(b) Hospital, Orthopedic, Convalescent and Dental Treatment, and Cases arising under
the Distress Fund.

Where the total family income, after deducting the

actual rent and rates paid and 5/- for each child under 14 Amount payable by Amount payable by
years of age and not working, applicant. County Council.

Does not exceed 24/- per week Nil. Whole fees.

Is between 24/- and 44/- per week Half fees. Half fees.
Exceeds 44/- per week Whole fees. Nil.

(c) Maternity Home Treatment.

Where the total family income, after deducting the

actual rent and rates paid and 5/- for each child under 14 Amount payable by patient.
years of age and not working,

Does not exceed 24/- per week ... Nil.

Between 24/- and 34/- per week ... Amount of Maternity Benefit
received.
Between 34/- and 44/- per week ... Half fees.
Exceeds 44/- per week Whole fees.

(d) Payment of Midwives' Fees in Necessitous Cases.

Where the total family income, after deducting the

actual rent and rates paid and 5/- for each child under 14 Amount payable by Amount payable by
years of age and not working, applicant. County Council.

Does not exceed 24/- per week ... 10/-. 20/-

Exceeds 24/- per week Whole fee. Nil.

(e) Employment of Midwives as Maternity Nurses.

Where the total family income, after deducting the

actual rent and rates paid and 5/- for each child under 14 Amount payable by Amount payable by
years of age and not working, applicant. County Council.

Does not exceed 24/- per week ... 10/-. 10/-.

Exceeds 24/- per week Whole fee. Nil.

(£) Provision of Mid-day Meals for Expectant Mothers.

Only cases where the total family income, after deducting the actual rent and rates paid and
5/- for each child under 14 years of age and not working, does not exceed 34/- per week, are
considered.

(g) Provision of Home Helps.

Where the total family income, after deducting the

actual rent and rates paid and 5/- for each child under 14 Amount payable by applicant.
years of age and not working,

/
Does not exceed 34/- per week. ... Nil.
Is between 34/- and 44/- per week 1/- per day.
Exceeds 44/- per week 6/- per day.
 130

Homes and Hospitals for Children under Five Years of Age.

The following- table shews that during the year 162 children under five years of age were
treated in hospitals. The cases dealt with were mainly those of premature babies, improper
feeding, or ophthalmia neonatorum.

Table LXXIX.
No. of
patients
Name of Home or Hospital treated by Inclusive fees of Home
County per week
Council
during 1838
£ s. d.
i. Edenfield Private Maternity Home, Doncaster 68 1 1 0
2. Bradford Eye and Ear Hospital — 1 1 0
3. Halifax (General Hospital) 2 1 1 0
4. Harrogate Municipal Babies’ Hospital 16 1 10 0
5. Harrogate and District General Hospital 1 3 3 0
6. Huddersfield Maternity Home 8 1 1 0
7. Huddersfield Royal Infirmary 1 1 1 0
8. Leeds General Infirmary 3 1 10 0
9. Leeds Maternity Hospital 23 1 1 0
10. Marguerite Home, Thorparch (Orthopaedic) 6 1 15 0
11. Scarborough Children’s Convalescent Home 19 1 1 0
12. Skipton and District Hospital 5 1 1 0
13. York Municipal Maternity Hospital — 1 1 0
14. Yorkshire Children’s Orthopaedic Hospital, Kirbymoorside 3 1 18 6
15. n
Other Institutions —

Total ... 162

Dental Treatment of Expectant and Nursing Mothers.

Dental treatment is provided by the County Council for expectant and nursing mothers
attending Child Welfare Centres and Ante-natal Clinics, who are not eligible for dental treatment
from any other service, provided that such treatment is certified by the Medical Officer of the
Child Welfare Centre or Ante-natal Clinic to be necessary. Treatment is similarly provided in
special cases when recommended by the patient’s private medical attendant.

Arrangements are made for treatment, including provision of dentures, with dentists approved
by the County Medical Officer. The patient is allowed the choice of dentist in the district where
she resides, and the treatment is carried out and paid for by the County Council in accordance
with the scale approved by the Dental Benefit regulations made by the Minister of Health and
the National Health Insurance Joint Committee for the use of Approved Societies under the National
Health Insurance Acts.

Dental clinics have now been established at Wath-on-Dearne, Rawmarsh and Wakefield, and
serve the surrounding districts. While giving the patients choice of dentists, Medical Officers of
Ante-natal Clinics are urging them to utilise the services of the County Dentist. It is anticipated
that there will thus be a saving to the County Council of at least one third of the total cost charged
by private dentists. The cost to the patient for treatment carried out under this scheme is assessed
on the same scale as in cases where treatment has been completed by a private dentist.

At the meeting of the County Council in March, 1939, a report was approved upon a proposal
to provide dental treatment and dentures for Maternity and Child Welfare, Public Assistance and
Blind Persons Act patients and to increase the staff of school dentists and dental attendants to
enable this to be done. The scheme also entails the establishment of a dental laboratory at No. 2,
Bond Terrace, Wakefield, and the appointment of a dental mechanic and laboratory assistant.
Suitable clinic accommodation is essential for this work and the scheme will therefore be inaugurated
gradually as permanent dental clinics in various parts of the County are established and the dental
staff will be appointed as and when required.

The cost of treatment is recovered from the patients, but in necessitous cases the cost is paid by
the County Council, according to the following scale :—

SCALE OF PAYMENT.

Where the total family income,

after deducting the actual rent and Amount payable by Amount payable by
rates paid and 5/- for each child under patient County Council
14 years of age and not working.

Does not exceed 24/- per week Nil Whole Fees

Is between 24/- and 44/- per week Half Fees Half Fees

Exceeds 44/- per week Whole Fees Nil

 131

All cases are reported to the Committee for consideration before any part of the cost of
treatment is claimed from the patient.

During 1938, 558 expectant and nursing mothers received treatment under this scheme at a
total cost to the County Council of £3,505.

Supply of Milk and other Foods to Expectant and Nursing Mothers and
Children under Five Years of Age.
The County Council’s scheme for the sale and distribution of milk at Child Welfare Centres
was extended as from the 1st April, 1937, to include the following special foods:—
Sunrose No. 1. ... Full cream dried milk powder ... ... ... ...\
Sunrose No. 2 ... Full cream dried milk powder with added iron and | 1/5 per
calciferol . ... ... ... ... ... I lb. carton.
Sunrose No. 3 ... Humanised milk, half cream ... ... ... ... )
Cow & Gate ... ... Full cream. l/8d. per lb. carton.
Fresh milk ... ... This is only supplied where dried milks have been tried and found to be
unsuitable.
Virol l/4d. per lb. carton.
Glucose D. ... 4d. per 4-oz. packet,
Malt and Cod Liver fid. per 1-lb. container.
Oil.
Pure Cod Liver Oil 6d. per 8-oz. bottle. (This is necessary for the proper observance of anti¬
rachitic precautions if any dried milk not containing sufficient vitamin D.
is recommended.)
Cod Liver Oil
Emulsion ... 6d. per 8-oz. bottle.
Olive Oil 9d. per 10-oz. bottle.
Lactagol 1 /4d. per 4-oz. tin.
Parrish’s Chemical
Food 5d. per 8-oz. bottle.

Other foods such as Ostermilk may be obtained when specially recommended, it it is con
sidered that Sunrose milk would be unsuitable.

In addition to the above, ferrous sulphate tablets, adexolin tablets, Blaud’s pills and calcium
lactate tablets are supplied on the requisition ol Medical Officers of Centres for distribution in
necessitous cases only.

Dried milk only is distributed because of its convenience in handling, its concentration and
the greater ease of recovery of payments. It is supplied free or at less than cost price for:'—

(a) Children up to three years of age and exceptionally to children between three and five
years.
(b) Nursing mothers.
(c) Expectant mothers at any stage of pregnancy.

Ordinarily a 1-lb. carton per week (equivalent to five and a half pints of fresh milk) is
supplied, but where considered necessary, three cartons may be supplied per fortnight. It is
supplied free or at a reduced price in necessitous cases.

Issues are made on the recommendation of the Medical Officer of a Child Welfare Centre, or
in districts where there is no Centre on the recommendation of the local Medical Officer of
Health, or the private medical attendant of the patient. If the supply is recommended by the local
Medical Officer of Health or the medical attendant, he may sign the necessary certificate and the
mother may then arrange for it to be presented at a Child Welfare Centre by any member of the
family.

The scale of family income adopted by the Committee as a guide to the supply of foods free
or at less than cost price is now as follows: —

Where the net weekly income of the family, after deducting the actual rent and rates paid and
5/- for each child under 14 years of age and not working does not exceed 24/- per week, the
County Council provide dried milk free.

Where the net weekly income of the family, calculated as above, exceeds 24/- per week but
does not exceed 34/- per week, the County Council provide dried milk at half the cost price.

Where the net weekly income of the family, calculated as above, exceeds 34/- per week, the
applicant must pay the full cost price for dried milk.

In ascertaining the weekly income of the family, the average earnings for the six weeks prior
to the application are taken. All applicants in necessitous cases are required to fill in aform showing
the income of the family from all sources, number of children under 14 years of age, name and
address of employer and the signature of the father is required to this statement.
 132

The scheme for the verification of family circumstances is now operating in the whole of the
County Council’s area, and the statements of circumstances mentioned above are investigated by
the Public Assistance Officer. During 1938, 13,411 cases were verified and in 806 cases it was
found necessary to charge full cost price in respect of future issues and in 1,222 cases to charge
half the cost price.

The certificate of the Medical Officer that milk is needed on the grounds of health is valid
for four weeks and may then be renewed on application. Each applicant signs a receipt in the
space provided on the form for all foods which are issued.

During 1938, the following issues were made at Child Welfare Centres: —

Free. Half Price. Full Price.

Packages. Packages. Packages.
Dried Milk . 122,289 7,760 127,225
Other Foods ... . 19,033 506 69,201

Provision of Meals for Expectant Mothers.

One of the findings of the Special Committee set up by the Minister of Health to investigate
the subject of maternal mortality was that malnutrition of mothers was a possible contributory
factor to the high maternal death rate.

It was estimated from enquiries made in the County that approximately 5% of expectant
mothers who attended child welfare centres were suffering from malnutrition. In certain cases
it was found, especially where the husband was unemployed, that the mother was unable to provide
the necessary food. It was for this class of patient that a scheme to provide extra nourishment,
in addition to the supplying of milk, was formulated.

1. The meal, i.e., mid-day dinner, is provided on weekdays only and is in addition to milk.

2. During the year 1938, 139 expectant mothers received 1,738 meals, a slight reduction com¬
pared with the previous year when 176 expectant mothers received 2,233 meals. .

3. The diet is prescribed by the ante-natal officer and this varies according to the needs of the
individual patient, but is usually vegetable soup, meat or fish, potato and other vegetable, milk
puddings and stewed fruit.

The meals cover a period not exceeding four weeks and if it is desired to continue with these
the ante-natal officer, after further examination of the patient, completes another certificate.
The cost averages l/5d. per meal per patient.

The meals are usually provided at some nearby cafe or restaurant and not at the patient’s
home. This arrangement ensures that the meals are consumed by the mother herself.

4. Meals are only supplied to expectant mothers. Usually the average period of pregnancy
when an expectant mother first attends the ante-natal clinic is 4^ months, and she continues
to attend up to about 8£ months; if necessary, meals are supplied during the whole of this
period.

5. The ante-natal officer decides whether the mother is in need of the meals, or not.

6. Mid-day meals are only supplied in necessitous cases, i.e., where the total family income, after
deducting the actual rent and rates paid and 5/- for each child under fourteen years of age
and not working, does not exceed 34/- per week.

Child Life Protection.

Public Health Act, 1936, Sections 206—220.

Visits are made periodically and in cases where the Child Protection Officer is not satisfied
with the condition of a child or the home, and where any irregularity occurs, the circumstances
are reported immediately and investigations made by the Assistant County Medical Officers or one
of the Inspectresses.

The following return relates to the administration of the above Sections of the Public Health
Act, 1936, during the year 1938.
1. Notification:—
(i) Number of foster parents on the Register at the end of the year 107
(ii) Number of children on the Register
(a) at the end of the year . ... ... ... • 119
(b) who died during the year .
(c) on whom inquests were held during the year ... ... ... 1
 133

2. Visiting :•—•
(i) Number of Officers holding appointments under Section 2 (2)
at the end of the year:-—

(a) Health Visitors ... . . 120

(b) Female, other than Health Visitors . 4

(c) Male ... ... ... . . 3

(ii) Number of persons or societies authorised to visit under the

proviso to Section 2(2). none

3. No proceedings were taken during the year under the various Sections of the Act.

4. No sanctions were given under Section 3 (a) (b) and (c) during the year.

5. No orders were obtained during the year under Section 5 (1) from a Justice or from the
Local Authority.

During the year 1938 the Child Protection Officers made 387 visits to children notified as
being nursed for reward.

During the year an application was received from the National Incorporated Association of
Dr. Barnardo’s Homes for exemption under Section 291(3) of the Public Health Act, 1936, in
respect of the “Ever-open-Door,” West Mount, Ripon. The Committee agreed to exempt this
home from Sections 206—220 of the Public Health Act, 1936.

Widows5, Orphans’ and Old Age Contributory Pensions Act, 1925.

The County Council is the Local Authority under the above Act for certain administrative
purposes.

The duties to be performed by the Local Authority necessitate enquiry as to the conduct of
widows in relation to the desertion, abandonment or non-support of children.

The County Council decided that, having regard to the nature of the enquiries, it was
desirable that they should be undertaken by women, and accordingly any investigations are carried
out by the inspectresses. In every case the report of the Health Visitor in the area is also con¬
sidered. No investigations were made during 1938.

/
 134

PART IV.

TUBERCULOSIS SCHEME.
Dr. G. S. Johnston.—Chief Clinical Tuberculosis Officer.

Table LXXX.

Mortality from Tuberculosis of the Respiratory System.

(Pulmonary Tuberculosis).

West Riding Administrative County England

Year & Wales
Total No. of Deaths Death-rate per 1,000 of population Death-
rate
County Urban Rural County Urban Rural

1928 926 706 220 0.61 0.64 0.51 0.76

1929 1011 747 264 0.66 0.68 0.62 0.79
1930 876 673 203 0.57 0.62 0.46 0.74
1931 882 632 250 0.57 0.58 0.56 0.74
1932 806 617 189 0.52 0.57 0.42 0.69
1933 745 545 200 0.49 0.50 0.45 0.09
1934 671 513 158 0.44 0.47 0.35 0.64
1935 734 529 205 0.48 0.49 0.45 0.61
1936 669 486 183 0.44 0.45 0.41 0.58
1937 695 516 179 0.46 0.48 0.42 0.58

Average
for 10 801 596 205 0.52 0.55 0.47 0.68
years,
1928-37
1938 573 427 146 0.38 0.39 0.37 0.53

Table LXXXI.

Mortality from Other Forms of Tuberculosis.

West Riding Administrative County England

Year <S Wales
Total No. of Deaths Death-rate per 1,000 of population Death-
rate
County Urban Rural County Urban Rural

1928 342 246 96 0.22 0.22 0.22 0.17

1929 321 223 98 0.21 0.20 0.23 0.17
1930 309 213 96 0.20 0.20 0.22 0.16
1931 253 164 89 0.16 0.15 0.20 0.15
1932 264 182 82 0.17 0.17 0.18 0.15
1933 218 157 61 0.14 0.14 0.14 0.13
1934 181 131 50 0.12 0.12 0.11 0.13
1935 157 109 48 0.10 0.10 0.11 0.11
1936 185 130 55 0.12 0.12 0.12 0.11
1937 163 118 45 0.11 0.11 0.11 0.11

Average
for 10 239 167 72 0.16 0.15 0.16 0.14
years,
1928-37
1938 159 123 36 0.11 0.11 0.09 0.10

Table LXXXI I.

Tuberculosis Deaths in 1938 at different periods of Life.

•
Age Groups.
A
Cfl 1 and 2 and 5 and 15 and 25 and 35 and 45 and 55 and 65 and 75 and All
Under under under under under under under under under under up¬ Ages
1 year 2 5 15 25 35 45 55 65 75 wards
Respiratory
Tuberculosis j M. _ _ 2 3 36 50 45 50 51 10 4 251
Urban Districts ... 1 F. — — 4 50 54 27 18 13 9 1 176

Rural Districts ... J M. _ _ 1 _ 10 21 19 25 10 4 — 90

1 F. — — — — 25 11 9 5 2 3 1 56

Administrative County — — 3 7 121 136 100 98 76 26 6 573

Other Tuberculous
Diseases—
M 3 g 7 11 14 6 2 6 4 2 1 62
Urban Districts ... j 4 4 — 61
F. 2 7 5 6 16 12 5

M 2 2 9 1 3 2 2 2 1 2 _ 19
Rural Districts ... | 3 — — 17
F. 2 3 3 5 1

Administrative County 9 15 17 21 38 21 4 16 9 8 1 159

 135

Table LXXXIII.

Tuberculosis of Respiratory System.

Mortality per 100,000 living at different ages in the West Riding Administrative County in the
years 1911-20, 1921-30, 1931-35, 1936, 1937 and 1938.

Urban Districts. Rural Districts. Administrative County.

Agbs.
1911-20 1921-30 1931-35 1936 1937 1938 1911-20 1921-30 1931-35 1936 1937 1938 1911-20 1921-30 1931-35 1936 1937 1938

MALES.

Under 15
years 27 14 7 5 4 4 21 12 8 3 2 2 25 14 7 4 3 4
15 and under
25 years ... 106 77 54 53 57 40 79 60 50 37 31 28 99 72 53 48 49 37
25 and under
45 years ... 150 107 78 54 72 56 124 90 60 40 65 65 143 102 73 50 70 58
45 and under
65 years ... 175 127 101 108 101 82 127 89 86 108 83 85 163 117 97 108 96 83
65 and
upwards ... 82 65 61 55 65 45 53 48 64 40 9 39 73 60 62 50 50 44

All ages 104 79 61 55 60 47 78 59 49 44 44 46 97 73 57 52 55 47

FEMALES.

Under 15
years 37 19 7 8 7 3 25 21 7 9 6 34 19 7 8 6 2
15 and under
25 years ... 111 106 86 68 61 55 100 99 80 57 53 75 108 104 84 65 59 60
25 and under
45 years ... 109 83 61 42 49 44 109 76 61 54 75 35 109 81 61 46 56 42
45 and under
65 years ... 73 51 33 37 33 22 65 51 33 32 31 17 71 51 33 36 32 21
65 and
upwards ... 48 37 29 20 20 25 39 28 17 38 17 37 46 35 26 25 19 27

All ages 79 62 44 36 36 30 69 55 41 37 41 29 77 60 43 36 37 30

Table LXXXIV.

Other Forms of Tuberculosis.

Mortality per 100,000 living at different ages in the West Riding Administrative County in the
years 1911-20, 1921-30, 1931-35, 1936, 1937 and 1938.

Urban Districts. Rural Districts. Administrative County.

Ages.
1911-20 1921-30 1931-35 1936 1937 1938 1911-20 1921-30 1931-35 1936 1937 1938 1911-20 1921-30 1931-35 1936 1937 1938

MALES.

Under 15
years 96 62 33 30 33 22 73 50 30 27 9 14 89 58 32 29 25 20
15 and under
25 years ... 25 22 15 16 9 16 20 15 12 12 10 8 24 20 14 15 9 14
25 and under
45 years ... 19 12 11 8 9 5 15 11 8 7 6 6 18 12 10 8 8 5
45 and under
65 years ... 18 14 6 8 8 8 18 13 9 2 7 7 18 14 7 6 7 8
65 and
upwards ... 20 15 9 10 7 10 11 8 12 24 26 20 17 13 9 14 12 12

All ages 45 28 16 14 14 12 36 24 15 13 9 10 43 27 16 14 12 11

FEMALES.

Under 15
years 80 47 25 22 16 17 61 52 29 10 21 17 74 48 26 18 18 17
15 and under
25 years ... 26 22 15 22 9 18 20 21 13 11 11 15 24 22 14 19 10 17
25 and under
45 years ... 14 11 6 6 6 14 10 8 15 10 2 14 11 7 7 7 5
45 and under /4
65 years ... 14 12 5 1 4 6 11 9 5 9 7 7 14 12 5 3 5 7
65 and
upwards ... 14 12 7 3 5 10 19 11 16 8 17 — 15 12 9 4 8 8

All ages 35 22 12 10 8 11 30 2 14 11 12 9 34 22 12 10 9 10
Chart shewing Mortality from Tuberculosis during the Years 1921-38 in the West Riding Administrative County
and England and Wales,
136
 137

Table LXXXV.

Tuberculosis Mortality—Comparison of Dispensary Areas.

Death Rates per 1,000

Deaths in 1938.
Estimated Population.

Estimated
Dispensary Area and
Population Pulmonary. Non-Pulmonary.
Centre.
(mid. 1938). Non-
Pulmonary.
Pulmonary.
Male. Female. Male. Female.

No. 1. (Skipton) 140,137 33 22 5 9 0-39 010

No. 2. (Harrogate) ... 151,800 38 27 7 4 0-43 0-07
No. 3. (Doncaster) ... 386,698 110 72 25 25 0-47 013
No. 4. (Barnsley) 474,897 99 71 24 21 0-36 0.09
No. 5. (Sowerby
Bridge) ... 347,568 61 40 20 19 0-27 0.11

County Totals ...j 1,501,100 341 232 81 78 0-38 0.11

|

NOTIFICATION OF TUBERCULOSIS.
Table LXXXVI.

Notifications received during the period 1922=1938 under the Public Health (Tuberculosis)
Regulations.

Pulmonary Non-Pulmonary
Year. Cases. Cases. Total.
M. F. M. F.

Average 5 years, 1922-1926 1,321 1,120 377 354 3,172

,, ,, 1927-1931 . 1,142 886 429 360 2,817
,, ,, 1932-1936 . 651 528 273 248 1,700
1936 . 539 446 261 243 1,489
1937 . 590 415 228 236 1,469
1938 . 565 414 254 246 1,479

Table LXXXVII.

Public Health (Tuberculosis) Regulations 1930.

Summary of Notifications during- the period from the 1st January, 1938, to the 31st December,.
1938, in the area of the West Riding- Administrative County.

Formal Notifications. (/)

G
O
Number of Primary Notifications of new cases of Tuberculosis.
Age Periods. *-■ u
Total O tc
0— 1— 5— 10— 15— 20— 25— 35— 45— 55— 65— (all H -n
ages) z

Pulmonary Males ... 9 28 21 54 74 109 100 77 70 23 565 597

,, Females — 9 15 22 68 74 117 48 33 21 7 414 432
Non-pulm. Males 4 35 64 43 23 21 26 17 10 6 5 254 264
,, Females 3 32 43 39 36 21 40 17 9 3 3 246 254

Part II.—Supplemental Return.

New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during
the above-mentioned period, otherwise than by formal notification.

Age period. 0— 1— 5— 10— 15— 20— 25— 35— 45— 55— 65— Total

Pulmonary Males ... 4 3 5 13 10 16 10 13 3 77

,, Females — — — 2 6 14 18 11 5 2 2 60
Non-pulm. Males 2 7 9 10 2 3 3 3 3 3 1 46
,, Females 3 5 3 2 3 1 1 2 3 2 2 27

The source or sources from which information as to the above-mentioned cases was obtained
are given below :—

No. of Cases.
Source of Information. Non-
Pulm.
Pulm.

Death Returns jfrom >°cal Registrars . 28 29

(transferable deaths from Registrar General ... . . 7 6
Posthumous notifications ... 10 13
‘Transfers” from other areas (other than transferable deaths). 91 25
Other sources 1
 138

Table LXXXVII—(continued).

Part III.—Notification Register.

Pulmonary Non-pulmonary Total

m. f. Total m. f. Total
cases

Number of cases of Tuberculosis remaining at the

31st December, 1938 on the Registers of Notifica¬
tions kept by District Medical Officers of Health
in the County. 4488 3366 7854 2206 1942 4148 12002

Number of cases removed from the Registers during

the year by reason inter alia of:—

1. Withdrawal of Notification 21 23 44 13 8 21 65
2. Recovery from the disease 201 119 320 140 163 303 623
3. Death (all causes). 324 202 526 53 37 90 616
4. Otherwise 368 257 625 141 113 254 879

Table LXXXVIII.

Notified Cases in the West Riding in December, 1937 and 1938.

Pulmonary. Non-Pulmonary.

Totals.
Males. Females. Males. Females.

No. of cases on registers of local Medical Officers

of Health at end of 1937 . 4,855 3,604 2,266 2,129 12,854
New Cases notified in 1938 ... 642 474 300 273 1,689
Cases removed from registers during 1938 1,009 712 360 460 2,541
No. of cases on registers of local Medical Officers
of Health at end of 1938 ... 4,488 3,366 2,206 1,942 12,002

Under the Tuberculosis Regulations notifications were received during the year of 979 new
cases of pulmonary tuberculosis, a reduction of 26 cases compared with the previous year. 912
(or 93%) of these cases were referred to the dispensaries for examination by the dispensary staffs.

Notifications were also received in respect of 500 cases of non-pulmonary tuberculosis, an in¬
crease of 36 over the number recorded for the previous year. 429 (or 86%) of these cases were
referred to the dispensaries for examination.

Enquiries have been made into the 138 cases who did not take advantage of the services pro¬
vided by the County Council for the treatment of tuberculosis. The details are summarised below
and it will be observed that 32 (or 48%) of the pulmonary and 29 (or 41%) of the non-pulmonary
cases died before any action could be taken. In all cases the county service is placed at the
disposal of the notifying practitioner or medical officer.

Table LXXXIX.

Notified cases not accepting Public Treatment.

Pulmonary. Non-Pulmonary.
Reason for non-acceptance.
Total.
Male. Female. Male. Female.

Died 17 15 12 17 61

Declined, or did not require, public treatment ... 14 13 8 27 62

Removed from, or not living in, West Riding ... 4 1 2 1 8

Unable to trace 1 1 1 2 5
Notified in error 1 — — i 2

37 30 23 48 138

A feature of interest is the reduction which has occurred within the past five years in the
after-death notifications. It was not until after the issue of the Public Health (Tuberculosis)
Regulations 1930 that these were recorded in detail, and in 1933, 265 notifications of this character
were received. During the past year 93 notifications were received, a reduction of 65%.
 139

Dispensary Scheme.
For the Administrative County of the West Riding during 1938, the death rate from pulmonary
tuberculosis of 0’38 per 1,000 population is the lowest on record. The total number of deaths
from respiratory tuberculosis in the West Riding during 1938 was 573 as compared with 695 for
1937. The number of deaths from pulmonary tuberculosis during the past six years were as
follows: —

1933 . 745 1936 . 669

1934 . 671 1937 . 695
1935 . 734 1938 . 573

With regard to non-pulmonary tuberculosis, the total deaths (159) represent a death rate of
0T1 per 1,000 population and, except for 1935 (which was 0T0), is the lowest on record for the
County.

It will be observed from Table LXXX1V on page 135 that during the past 10 years a remarkable
drop has taken place in the death rate from surgical tuberculosis in children under 15.

The number of definite cases on the dispensary registers at the end of 1938 was 7,476. This
represents a reduction of 727 cases during the preceding 12 months. Pulmonary cases numbered
5,022, 1,652 of which are known to have a positive sputum. During 1938, 753 cases were
marked off the register “recovered,” 636 were reported to have died, and 889 had left the district,
were lost sight of, or were found to have no further need of assistance under the County scheme.

863 definite cases of pulmonary tuberculosis attended the dispensaries for the first time during
1938, and 445 (or 52%) of this number were eventually found to have a positive sputum. 130 (or
29%) of the positive cases died before the end of the year.

That the open case of pulmonary tuberculosis is still a problem will be observed from the
following figures :—

Of the 1,652 infectious pulmonary cases attending the dispensaries there were 44 patients from
houses where more than one family resided, 503 instances where they slept two in a bed, and 7
where worse conditions prevailed.

During the year 416 positive and infectious cases of pulmonary tuberculosis were discharged
from sanatorium or hospital, 161 of them returning to homes where there were children or young
adults.

To limit the possibility of home infection, open air shelters are provided. There has been
however a steady decline in the number of applications received for the loan of open-air sleeping
shelters during the year, due largely to patients obtaining better housing accommodation. During
1938, one shelter was sold, and three were condemned owing to their dilapidated condition, and
were destroyed by the local Sanitary Inspectors concerned. The local Sanitary Inspectors are
always willing to undertake this work, and to assist in other ways, such as disinfecting shelters and
equipment, and inspecting sites. The shelters are kept under the supervision of the dispensary
staff and health visitors, and periodical reports upon their condition are regularly furnished to the
central department. There were 85 shelters available for loan at the end of the year.

Dispensary attendances of old and new cases (including contacts) during the years 1934-1938
(inclusive) :—

New cases examined: —

1934 1935 1936 1937 1938

(a) Contacts 1,282 1,425 1,659 1,433 1,326

(b) Others 3,210 4,274 3,658 3,559 3,592

(c) Attendances 32,990 30,992 30,318 29,026 29,403

(all cases)

Of the applications for treatment during the year :—

1 1,356 were recommended Sanatorium Treatment.

’ 121 ,, ,, Hospital ,,
86 ,, ,, Dispensary ,,
1,388 ,, ,, Dispensary Supervision
319/ ,, referred to their own Doctor.

During the year the high standard of work of the dispensaries has been maintained, and co¬
operation with the general practitioners, which is an essential part of the scheme, has been excellent.
 140

The value of the dispensary as a centre for diagnosis and education is revealed in the number
of patients referred to the Consultant Tuberculosis Officers during the year by the general practi¬
tioners, and the number of ex-sanatorium patients attending for treatment. 91% of the cases noti¬
fied during 1938 werq referred to the Consultant Tuberculosis Officer for diagnosis or treatment.

That so many should delay seeking advice until there is definite evidence of the disease is
unfortunate. The cause in the majority of cases seems to be an inherent dread on the part of the
patient to attend the dispensary lest he be found tuberculous. Cases are known where other
remedies have been tried before the more serious signs and symptoms have compelled the patient
to seek medical advice.

That the results of treatment are definitely more hopeful in the early stages of the disease
is shown on Table CVII. Thus, of the cases discharged from sanatorium 59% were discharged
quiescent and 2% died in the early stages as compared with 2% quiescent and 42%deaths in stage
III. In the campaign against this disease, therefore, it should be the aim of the Tuberculosis
Authority to encourage patients to seek advice early and to point out the facilties that exist at the
dispensaries for diagnosis. Every means of publicity should be used to educate the public.

There has been an efficient liaison between the Dispensary and the School Medical and Child
Welfare Services. Children with suspicious symptoms have been referred to the dispensary for
diagnosis, and many incipient cases have been saved bv prompt diagnosis and treatment.

Patients’ Travelling Expenses.

Hitherto the payment of travelling expenses incurred by patients in attending dispensaries,
clinics, sanatoria and hospitals for treatment, etc. under the tuberculosis scheme has been governed
by the application of a prescribed income scale.

Attention has been drawn to the adverse effects of the application of income scales under this
scheme, particularly in the case of patients who are attending various centres for U. V. Light
treatment where prolonged treatment and daily attendance are often required. The attendance of
the head of the household may result in loss of wages for broken time, and where the mother or
child is affected, alternative arrangements are necessary for the care of the household or for escorts.
These factors entail in many instances a strain on financial resources which are already slender
and have led to poor attendances and subsequent relapse in the condition of the patient. Inter¬
mittent treatment, especially in the case of lupus, is unsatisfactory to the specialist and adds mater¬
ially to the ultimate length of time required for a cure.

The County Council have now approved of a recommendation whereby the income scale is
ignored in connection with the payment of travelling fares for patients granted any kind of treat¬
ment under the Tuberculosis Scheme.

Staff.
During the year three vacancies occurred in the establishment of Assistant Tuberculosis Officers.
Dr. S. P. Wilson was appointed as Senior Assistant Medical Officer and Deputy Medical Super¬
intendent at the Scotton Banks Sanatorium, and Dr. D. S. Hayes left the County service. It is
with regret that I have also to report the resignation of Dr. J. E. Gething owing to protracted and
permanent ill-health. Dr. Gething was appointed to the West Riding Tuberculosis Medical Service
in August 1917, as Assistant Medical Officer at Middleton Sanatorium, and has acted as District
Tuberculosis Officer in the Huddersfield area since January 1920. Dr. Gething was a valuable mem¬
ber of the Dispensary Staff, and his experience will be greatly missed.

The above vacancies were
B.A., M.B., Ch.B., D.P.H.,
M.R.C.S., L.R.C.P., to the
Dr. W. B. Lipschitz, M.D.,
area.
filled by the appointment, in November 1938, of Dr. R. L. Osmaston,
to the Wakefield Dispensary area and Dr. R. J. Vince, B.A.,
Barnsley and Doncaster Dispensary areas; and, in December, 1938,
L.R.C.P., L.R.C.S., L.R.F.P.S., to the Huddersfield Dispensary

During the year facilities were given to Dr. H. E. Raeburn and Dr. V. Ryan, Consultant
Tuberculosis Officers and Medical Superintendents respectively of the Middleton and Scotton Banks
Sanatoria, to attend a post-graduate course in chest surgery at the Brompton Hospital.

Dispensary Premises.
In accordance with recommendations approved in the previous year, central heating was in¬
stalled, early in 1938, in the Barnsley, Doncaster, Pontefract and Sowerby Bridge Dispensaries.

A Special Visiting Sub-Committee was appointed in April 1938 and visits were subsequently
made to the Dispensaries at Goldthorpe, Pontefract, Thorne and Wakefield. Approval was given
to the Committee’s recommendations, which included the installation of electric lighting at the
Goldthorpe and Wakefield Dispensaries.
 141

Table XC.

Table shewing the work of the Dispensaries during 1938

Pulmonary. Non-Pulmonary. Total.

Total
Grand
Diagnosis. Adults. Children. Adults. Children. Adults. Children.

M. F. M. F. M. F. M. F. M. M. F.
R

A—New Cases examined

during the year (ex¬
cluding contacts):—
(a) Definitely tuber¬
culous ... 389 287 30 23 88 87 96 79 477 374 126 102 1079
(6) Diagnosis not
completed _ _ _ — — — — — 147 161 59 58 425
(c) Non-tuberculous ... — — — — — — 802 639 353 294 2088

B.—Contacts examined
during the year:—
(a) Definitely tuber¬
culous ... 22 26 23 7 2 5 10 9 25 30 33 16 104
(b) Diagnosis not
completed _ _ — — — — — 19 16 25 19 79
(c) Non-tuberculous ... — 203 314 337 289 1143

C.—Cases written off the

Dispensary Register
as:—
(a) Recovered ... 201 134 65 52 32 44 121 104 233 178 185 157 753
(b) Non-tuberculous
(including any such
cases previously diag¬
nosed and entered
on the Dispensary
Register as tuber¬
culous) . 1078 1019 i 732 647 3476

D.—Number of Cases on
Dispensary Register
on December 31st:—
(a) Definitely tuber¬
culous ... 2546 1611 478 387 454 478 S43 679 3000 2089 1321 1066 7476
(6) Diagnosis not
completed — — 172 99 586
— — — — — — 203
|*“
1. Number of cases on Dispensary Register 2. Number of cases transferred from other
on January 1st 8700 areas and cases returned after discharge 198
under Head 3 in previous years

3. Number of cases transferred to other areas, 4. Cases written off during the year as Dead
cases not desiring further assistance (all causes) 636
under the scheme, and cases “lost sight
of” . ... 889

5. Number of attendances at the Dispensary 6. Number of Insured Persons under Domi¬

(including Contacts) . 29403 ciliary Treatment on the 31st December 343

7. Number of consultations with medical 8. Number of visits by Tuberculosis Officers

practitioners :— to homes (including personal consul¬
(a) Personal ... 1486 tations) ... . 3197
(b) Other 6654

9. Number of visits by Nurses or Health 10. Number of :—

Visitors to homes for Dispensary (a) Specimens of sputum, etc., exam¬
purposes 40097 ined 2948
(b) X-ray examinations made ... 5487
in connection with Dispensary work

11. Number of “Recovered” cases restored 12. Number of “T.B. plus” cases on Dispen¬
to Dispensary Register, and included sary Register on December 31st 1652
in A(a) and A(b) above. 19

/
 142

Table XC1.

TABLE SHOWING ENVIRONMENTAL AND SOCIAL CONDITION OF PATIENTS,

DECEMBER, 1938.

Non-infectious
Infectious Pulmonary Non-Pulmonary
Pulmonary
Total
15 and 15 and 15 and
Under 15 Under 15 Under 15
Over Over Over

No. of cases from houses where

more than one family reside _ 44 10 100 37 46 243

No. of cases where patient sleeps

in separate room 11 874 192 879 374 498 2,828

No. of cases where patient sleeps

in separate bed but not sep¬ 4 227 202 308 409 254 1,464
arate room

No. of cases where patient sleeps

“two in a bed” 2 501 153 1,583 332 570 3,141

No. of cases where patient sleeps

“more than two in a bed” ... — 7 7 45 29 12 100

SPECIAL TREATMENT AT DISPENSARIES.

Artificial Pneumothorax.
During the year an artificial pneumothorax was induced in one dispensary patient, whose
condition improved. Refills were also given to 7 patients following inductions at sanatoria during
the year and to a further 43 patients in continuation of treatment commenced prior to 1938. A
total of 604 refills were given and the following table summarises the results of the treatment or
indicates the condition of the patients at the end of the year:—

Table XCII.
Sex and Classification of Patients

Results of treatment or Men. Women.

Total
Condition on 31-12-38.
T.B. T.B. T.B. T.B. T.B. T.B. \ T.B. T.B.
Minus 114 1114 Minus 1+ 114 1114
' +

Disease Arrested ... __ — 1 1 _ 2

Disease Quiescent — 5 — 1 5 13

Condition improved or
maintained — 11 3 2 I 5 1 23

Condition worse or treat-

ment discontinued — 1 3 1 I 3 1 10

Re-admitted to Sanatorium ■ _ 1 — 1 2
— —

Left the District ... — — — — 1 i

Died . — — — — —

Total ... — 1 20 4 3 Ft 16 2 51

Gold Salts.
Five Dispensary patients received gold treatment during the year. One attended the Mex-
borough dispensary and did very well. The remaining four cases all attended dispensaries in the
Skipton area and were given Solganol B. Oleosum. The dosages ranged from T20 to 4T grammes
during the year and improvements were recorded in, every case although one patient relapsed later.
In each case, however, tubercle bacilli persisted in the sputum and were present either at the end
of the vear or at the termination of the course of treatment.
 143

Tuberculin.
Tuberculin was administered to 8 pulmonary and 76 non-pulmonary patients during- the year.
One patient was improving under treatment but left the district before the course was completed.
The following table indicates the various lesions treated and the results recorded or the condition
of the patient at the end of the year:■—

Treatment with Tuberculin,

Table XC1II.

Arrested Quiescent Improving In Statu Quo Active Total

Pulmonary:—
T.B. Minus ... 6 — 1 — 1 8
Non-Pulmonary:—
Bones and Joints ... 1 — 1 — 1 3
Abdomen — 1 1 — — 2

Eyes ... . — — 2 — — 2
Lupus — 1 — — — 1
Genito-urinary 2 1 3 1 1 8
Glands . 18 7 25 — 10 60

Total 27 10 33 1 13 84

Consultant Surgeons.
In continuance of the arrangements made for certain cases of pulmonary and non-pulmonary
tuberculosis to be referred to surgeon specialists, consultations have been held from time to time
at the various sanatoria and dispensaries, and operations performed at Middleton Sanatorium,
Scotton Banks Sanatorium, Leeds General Infirmary, Sheffield Royal Infirmary, and the St. James’s
Hospital at Leeds as below :—

Chest Surgeons.

49 cases in consultation as follows :—

Scotton Banks Sanatorium. 24
Cardigan Sanatorium ... ... 13
Oakwood Hall Sanatorium ... 2
Crookhill Hall Receiving Home ... 5
Doncaster Dispensary Area ... 1
Sowerby Bridge Dispensary Area 4

39 operations were performed by the surgeons.

Ortliopcedic Surgeon.

21 cases.
Cardigan Sanatorium ... ... 2
Middleton Sanatorium ... ... 16
Scotton Banks Sanatorium ... 3

30 operations were performed by the surgeon.

Lary ngolo gists.

113 cases.
Middleton Sanatorium ... ... 12
Cardigan Sanatorium ... ... 39
Scotton Banks Sanatorium ... 62

3 operations were performed by the surgeons.

Dermatologist.

The skin specialist saw 8 cases at Middleton Sanatorium.

/
 144

ti.ss ^ c oj X
re o
c/3 o r -fJ I ^ CO I CM Ol — CM — 05 r> In re- 05 IX X X X X CM X 1 CM -t* X X rN 05 X X
■- c o a; 1 1 CD — CM 05 CM CM X 1 CM CM r—1 CM
-c.‘2r-
V) -
Q c CU a
C Z
, , -r
CO i-« CD »X 05 CM O O 05 ix IX CM pn x x 05 0 05 X »— 05 X 0 CM CM CM O X CM CM 05 X 05 X X
c —: CO CM CC l> cd -r — t"s 05 ■’T' IX X X CD 03 O X -r X Tf rr T— M- X X CM X X X X r—• Pn ^ -r X
w >» B o 3
CM r—
c re y ZCL CM
fl> w) a>

ss°
C3 C.4J CO CO 05 O CM O CONCOh -T CO ' X O IX O X 05 05 X t^- x x X X PN X 05 ■'f P^ Cl 05 Cl
CL t/; c/3 05 05 CO -t* CO CD CM CO cc ^ 0 IX 05 IN X -t X O Tf 0 00 D1 X X In 0 X »— -f —t* CM X X Cl
CO CM X r— 0
Q CO X

3
05 05 p> Cl X X pN

3
CM O CM CO 05 ID (D O h P K 0 10 0 X X X X X X X X X X
SPSS'S I
1 CO '-r •—> X CD CM CM X Cl X
S-Ste* X
o £ oQ

»X IX I CO IX IX tx CD I X CD ^ CO ’t 05 03 O ix -f* M* 05 X X X O O 1 pN -r X 0 X X X 05
1 1 IX ~f ix -t1 —• CM X X — CM T—' -Tf CN 1 CM X
c i> X
O O' re ~ re -J tjo '
>.
C/3 i-
—
re re
t/3 •a i
ft> • U 1/3 CM CO Tf •—< 0 CO 10 IX 't —< X 03 O iO h X 0 CM — X X Pn X X CM 05 X -*r O X 0 X X
> c c/3 taj c y 3 «X —r 0 CM CD IX CO IX 1—< O X 05 05 X O X X -T X X X X X p' X Cl X X Cl X 05 X CM X
O u •r i- c x> o X — *—1 CM »—i r-< CM CM -r
E a Q X5Z 3 n X
2.2 ^ f-. *■*
oca
wHm 5
6
7

3
4

cd CM CO ^ CM X In. D1 O X X X X X X ~ir 0 X 1^ — O CM Cl 05 0 X 05 M* X X
y -m re o
C/3 4_i
>_” — co ^ X X X X »- X IX —< CM D1 X Cl X
«’ES= ° “
U > o u
IN

* X

T3
4 4)
O )
u
„
2

00 IX —• CM — ix X X CM X 0 P^ X X X
1
* c ** S w CO CM I CD CM CO —' IX X X X
* c a/ 4> C -C -W 1 CM *— r-> 05
: o x: c/3 c/3
-e re 03
S**-1 O (U U o3 ■ OI So
CJ
1938.

1 L
•
c (U
-5
C/3
o
«x
T—1
I
1
05 O IX
— CO
-r 05 -r — co
CD CM CM CM
0 X 05 X O Pn X CM
t^> IX ^ 1^ X CM X
X Pn X x -r
■*T — X CM r—1
1
1
X CM X X -t* X
— 05 X
O
X
X X 05 CM
CM X CM
X
-r
OX) .2
2 3 3
Registers,

H y

I CM — 1 1 IX X -- CM - ’t In CM I ^ 1 1 W 1 I 1 1 X X X 05
11^1
1 1 1 1 1 1 1 1 1 1 1 1 1 1
Table XCIV.
Dispensary

, >, i, w — (N I M* CD 1 1 CM X X — O l>* — X 1 1 CM Cl 1 I CM 1 M* 1 M-
1 II I 1 'C
'S^xO 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0

Q.-3 3
w ch y

-t* IX I —< IX CO P'- CO CO 1 CM Tt* -r -r ix x -r 0 X X 05 X Pn X —1 0 O CM O Cl X CM 05 X X

ix '-** 1 CM CD 05 CM r—1 CO — -f- CM X CM - X In X CM X X X CM P- Cl Cl 1—1 X X -r X X X »—< X
ox x 0
2 Cl
of

3 3
H o
Revision

IX r-1 I CM CM 1 CO ^ X -t X X O X X 0 X X X X X 1— Cl ■*r I -r 0 X 0 X X CM X X
1 1 ix — T— -r — X X •— 1 Cl Cl r—c Cl CM
-r

rN 0 X X X CM X X Pn 0 05 Cl
, ir w.1/5 CD OO CM 1^ CM Tf CD CO '•t T— X 05 X X IX Pn '-r 05 p* X Cl X 0 05
(C D 03 5
4) 4_i O'1 O
<N CM CO — »X CM — X CM >—1 1 Tf X (M CM X -T CM X CM — CM CM r—■ X X -* •-f PN
0

<U
9

05
6

CO CD CM CD CM — CO I CD X *-1 X 'Tf 0 Pn X X X 1 X X CM 1 X X CM Cl Cl X 1
D « *- . 1 00 »—1 ■—< r—<
—< - Ol X N X X 1 «—1 1
re c/3 o -
1 Cl 1 05
'-f
sic£
o
y

-T 05 X X X [-N X P^ IN.
O C
CM CM
— Oi
CM CM r —1 • X 05 r—'
CD m
00
CO' -
— O 05 X X 05 X
x 0 IX IN IN 0 h O
0 X X
Dl X X X X —t’ »—• X 0 X X M* X
X 05 0 X 0 0 X
CM Cl X X CM
*—< • — CM — CM CM •—1 X
“ ^3
c *< c CM
y S2 re
Z c *-3
»
ti y
— X PN t—' 05 05 05
CO CD O X 05 IX »— CM 05 CM CM IX CM 05 X X O X 0 X Cl 'T X X X
O 0 p^ PN c 05 CM x — X X 0 Pn —« X X -r 0 X X
O 05 r* O -t* CD CM -t- ^
T—<
05 05 CM CO CO 1— IX —
X CM — -h CM IX — CM -'T ■— 1— '— X —- •— 1 •—1 T—1
X

cn
J
<
H
O
H

:::::::::: to :
>-, •u
JD
!
_C •£
*5 bo
Jsf
a> *n

»- 3 o *-
*_, g 4) C C .Jfffl c

o o re rf
2 be ° <u 2 t).
XI —

o 03 t ^ re t 10 Si £ ££ ® 2 >-,£ E
X. v 2 1-
C 33 5 >.5 S/3 g-o £ ^© —5?sr|!I'll rim!
Jz. c 0)TJ p •— „ ’£- o ^3 -1- s.
11 v- ® o u
* ^

55 1- re a.£ T
re 2 *o
0 0^3
c * C 3 o Jie«4-.Cb*^uc^3*-'w/^rere
Z c rt ■- .2 ® o u 3°°2^^
.SP o.|
(D r- n Q-
re —• . o o
.5* ffi u: 5tnH _ §OOKSa,mH _ re
re ^paQjS’z&.D-KPic/)!^^ w £h w
re 5 re jr
« x SB
a> Q «ea

■< «< •c
 145

LIST OF TUBERCULOSIS DISPENSARIES, SHEWING DISPENSARY ADDRESSES

AND TIMES OF SESSIONS (Revised April, 1939).
County Medical Officer: T. N. V. Potts, M.D., B.S., B.Hy., D.P.H., County Hall, Wakefield.
Chief Tuberculosis Officer: G. S. Johnston, M.D., Ch.B., D.P.H., County Hall Wakefield.

Situation of Chief Dispensary or

Day and Time of Session; County Districts included in Area. Medical Staff.
Branch.

AREA No. 1
54, Keighley Road, Skipton (Tel. 31). Mondays, 10 a.m. jSilsden U., Skipton U., Skipton R. Consultant Tuberculosis
Fridays, 10 a.m. (part). Officer:
Whiteley Croft, Station Road, Otley, Thursdays, 10 a.m. Illkley U., Otley U., Wharfedale R. H.E. Raeburn, M.D.,
(Telephone 218). B.S., D.P.H.

95, Town Street, Horsforth. Thursdays, 2 p.m. Aireborough U., Horsforth U. Assistant Tuberculosis
Officer:
2, Manchester Road, Barnoldswick. Tuesdays, 10 a.m. and |Barnoldswick U., Earby U., Bowland E. A. Wilson,
2 p.m. R. (part). M.D., M.R.C.S.,
L.R.C.P.
Bowland Chambers, Clitheroe. Last Wednesday in (Bowland R. (part).
month, 11-30 a.m.
St. John Ambulance Rooms, Settle. First Wednesday in Sedbergh R., Settle R
month, 11 a.m.
AREA No. 2. Consultant Tuberculosis
10, North Park Road, Harrogate Tuesdays & Thursdays Harrogate B., Knaresborough U.,; Officer.
(Telephone 5339) 2 p.m. ; I Nidderdale R., Wetherby R., Pateley V. Ryan, M.D., M.B.,
Bridge and Ripon R. (part). B.Ch., B.A.O., D.P.H

44, Ousegate, Selby. Mondays, 10 a.m. (Selby U., Selby R. Assistant Tuberculosis
Child Welfare Centre, Westgate, First Wednesday in Tadcaster R. (part). Officer:
Tadcaster. (Telephone 151). month, at 10-30 a.m. G. A. Crowley,
4, College Road, Ripon. First and Third Thurs¬ Ripon C., Pateley Bridge and Ripon R. B.A., M.D., B.Ch.,
day in month, 10 a.m. (part). D.P.H
14, Hilderthorpe Terrace, Garforth. Friday, 10-30 a.m. Garforth U., Tadcaster R. (part),
AREA No. 3. Lock Lane in Castleford U.
Merton House, 20, Christchurch Road, Mondays, 2 and 6-30 p.m. Adwick-le-Street U., Bentley U., Tick- Consultant Tuberculosis
Doncaster (Telephone 3552). hill U., Doncaster R. Officer:
37, Hook Road, Goole Mondays, 10-30 a.m. (Goole U., Goole R. E. Ratner, M.D., M.B.,
Thorne Hall, Thorne Fridays, 10 a.m. Thorne R. B.Ch., D.P.H.
The Lindens, Linden Terrace, Tanshelf, Tuesdays, 2 & 6-30 p.m. Pontefract B., Castleford U., (less Assistant Tuberculosis
Pontefract (Telephone 88). Lock Lane), Featherstone U., Officers:
| Knottingley U., Osgoldcross R.
Exchange Buildings, Market Street, Mondays, 10-30 a.m. Conisborough U., Mexborough U., A. Leitch,
Mexborough Wednesdays, 10-30 a.m. Swinton U., Wath U. M.B., Ch.B., D.P.H
T. W. Ruttledge,
8. Goldthorpe Road, Goldthorpe Thursdays, 10 a.m. Dearne U. M B.. Ch.B.. D.P.H
Plimsoll Street, Hemsworth Thursdays, 10 a.m. Hemsworth U. Hemsworth R. (part) R. J. Vince, B.A.,
The Green, South Kirkby Fridays, 10-30 a.m. Hemsworth R. (part) M.R.C.S., L.R.C.P.
AREA No. 4.
46, Church Street, Barnsley Weds., 10 a.m. & 2 p.m. Cudworth U., Darfield U., Darton U., Consultant Tuberculosis
(Telephone 2802). Fridays, 10 a.m. Dodworth U., Hoyland Nether U., Officer:
Royston U., Wombwell U., Wors- H. A. Crowther,
borough U., Wakefield R. (part). M.A., M.R.C.S.,
Wesleyan Sunday School, Penistone 1st and 3rd Thursdays, L. R.C.P.
Penistone U., Penistone R. (part).
in month, 2 p.m.
5, Almshouse Lane, Wakefield. Tuesdays and Fridays,
Horburv U., Stanley U., Wakefield R., Assistant Tuberculosis
2 p.m.
(part), Ossett B. (part). Officers:
The Park Pavilion, Normanton Tuesdays, 10 a.m.
Normanton U. E. J. C. Groves,
Isolation Hospital, Rothwell Mondays, 10 a.m. M. B., Ch.B.
Rothwell U.
Branch House Chambers, Bradford Rd., Thursdays, 2 p.m.
Batley B., Ossett B. (part). N. J. S. Nathan,
Batley. (Telephone 73). Second Thursday in
M.R.C.S., L.R.C.P.
month at 6 p.m.
R. L. Osmaston, B.A.,
Wellington House, High Street Thursdays, 10 a.m.
Morley B. M.B., B.Ch., D.P.H.
Morley (Telephone 22).
Old Town Hall, Knowler Hill, Liver- Fridays, 10 a.m. Spenborough U., Heckmondwike U.
sedge
45, Richardshaw Lane, Pudsey. Tuesdays, 2 p.m. Pudsey B.
Carnson House, Moorgate Road, Fridays, 10 a.m. and Maltby U., Rawmarsh U.,
Rotherham (Telephone 59). 2 p.m. Rotherham R.
162, Lorden’s Hill, Dinnington Tuesdays, 10 a.m. Kiveton Park R.
Urban District Council Offices, Stocks- Mondays, 2 p.m. Stocksbridge U., Wortley R. (part)
bridge
102, Parson Cross Rd., Wadsley Bridge. Thursdays, 10-30 a.m. Wortley R. (part)
AREA No. 5. Consultant Tuberculosis
Greenups Terrace, Sotverbv Bridge Tuesdays, 10 a.m. Elland U., Midgley U., Oueensbury and Officer:
(Telephone 81221). Thursdays 2 p.m. to 7 Shelf U., Ripponden U., Sowerby
S. R. Wilson,
p.m. Bridge U.
M.D., M.B., Ch B ,
Masonic Hall, Todmorden. Fridays, 2 p.m. Todmorden B., Hebden Royd U., D.P.H.
Hepton R.
143, Skipton Road, Keighley. Mondays, 2 p.m., and Keighley B., Denholme L\, Skipton R. Assistant Tuberculosis
(Telephone 3625). Wednesdays, 1 p.m. (part). Officers:
1, Peel Street, Huddersfield Tuesdays, 2 p.m. Colne Valley U., Denbv Dale U., Kirk- A. D. Rankin, M B..
(Telephone 3641—Extension 8). Fridays, 2 p.m. burton U., Holmfirth U., Meltham U., Ch.B., D.P.H.
Mirfield U., Penistone R. (part). W. B. Lipschitz, M.D.,
Court Street, Uppermill 1st/and 3rd Thursdays Saddle worth U. L.R.C.P., L.R.C.S.,
in month, 10 a.m. L.R.F.P.S.
Mill House, Bradford Road, Brighouse Fridays, 10 a.m. .Brighouse B.
Farr Royd, Otley Road, Shipley Mondays, 10 a.m. and Baildon U., Bingley U., Shipley U.
(Telephone 1897). first Wednesday in
month at 5-30 p.m.
 146

Table XC'V.

Applications for Treatment, 1938.

Kind of Treatment Granted. Cases

referred
to own Totals.
Sanator¬ Dispensary Dispensary Medical
Hospital. Attendant.
ium. Treatment. Supervision.

New Cases ... 970 66 45 454 119 1,654

Old Cases reconsidered ... 386 55 41 934 200 1,616

Totals 1,356 121 86 1,388 319 3,270

Table XCVI.
Summary of Dispensary Work , 1938.
Visits paid by
Domiciliary visits
Number of Consultant and Attendances
paid by Dispensary
Consultations Assistant Tuber¬ made by
Dispensary Area. Nurses and Health
with culosis Officers to old and new
Visitors to old and
Practitioners. patients at their patients.
new cases.
homes.

Area No. 1 . 861 4,840 469 3,373

Area No. 2 . 530 3,207 269 2,815

Area No. 3 . 2,667 12,446 643 7,771

Area No. 4 . 2,450 13,637 780 8,323

Area No. 5 . 1,632 5,967 1,036 7,121

Totals .
8,140 40,097 3,197 29,403

Table XCVII.
Home Visitation by Dispensary Staff.

Visits by Visits by Dispensary Visits by Health

Year
Tuberculosis Officers. Nurses. Visitors.

1934 3,686 30,742 5,199

1935 3,818 30,511 5,694
1936 3,627 35,121 6,060
1937 3,440 35,788 4,265
1938 3,197 36,405 3,692

Tuberculosis Cases in Public Assistance and other Institutions.

During the year, 309 cases in County Institutions and local infirmaries and hospitals were
seen by the Tuberculosis Officers. The following table shews the action taken under the Tuber¬
culosis Scheme.

Table XCVIII.

No. of Cases seen by Action taken under County Council Scheme.

Tuberculosis Officers.
Dispensary Area
Dispensary Referred to
Institutional Treatment or
Own Medical Remarks.
Pul. Non.-Pul. Treatment Supervision Attendant

No. 1 (Skipton). 21 20 18 4 3 16 non-tuberculous.

10 non-tuberculous.
No. 2 (Harrogate) 20 12 14 6 1
1 not a W. R. case

o 1 1 non-tubercu!uus
No. 3 (Doncaster) 19 22 33 3
) 2 died

No. 4 (Barnsley) 101 47 52 82 9 l 11 non-tuberculous

) 1 died.

No. 5 (Sowerby Bridge) 12 35 32 14 — 1 declined treatment.

Total 173 136 149 109 8

 147

Dispensary X=Ray Scheme.

X-Ray plants are now working at seven centres in the West Riding. When the original six
units were installed in 1932, the number of examinations recorded was 2,942. During the past year
the number examined was 6,328. As a result of the increased work it has been necessary to appoint
an additional radiographer with a knowledge of electrical engineering.

The seven X-Ray units require constant attention and the services of a skilled technician will
minimise the wastage which may be incurred owing to breakdowns normally requiring the interven¬
tion of the manufacturers’ representative.

There are still certain areas of the County where no convenient County X-Ray Centre is
available, and arrangements are made for cases in these districts to visit private clinics, or for the
X-Ray examination to be carried out at a local hospital or infirmary, as shown :■—

Oldham Royal Infirmary. For Saddleworth and Springhead

patients.

Skipton and District General Hospital. Patients from Barnoldswick, Clith-

eroe, Settle, Keighley, Skipton and
Otley Dispensaries.

Dr. J. A. Thomson, Harrogate. Patients from Harrogate, Ripon and

Tadcaster Dispensaries.

Dispensary patients in No. 1 area, (see schedule page 145) within reasonable distance of the
Middleton Sanatorium, attend at Middleton for X-Ray. This is found to be a convenient arrange¬
ment for the Consultant Tuberculosis Officer, who is also Medical Superintendent. During 1938,
a total of 238 dispensary patients attended for X-Ray examination at the Sanatorium. Similar
arrangements are being made for the attendance of suitable patients from the No. 2 dispensary
area at the Scotton Banks Sanatorium.

In all, during the year, a total of 6,328 examinations are recorded from the dispensary X-Ray
Centres, as follows :—

Barnsley 469 Rotherham 498

Batley ... 1,341 Sowerby Bridge 519

Doncaster ... 1,292 Shipley 517

Pontefract ... 1,692

4,968 of the above examinations were of patients referred from the dispensaries, and 1,299
of patients undergoing institutional treatment, etc., i.e.: —

Cardigan Sanatorium ... ... 366 Crookhill Hall Receiving Home 120

Eldwick Sanatorium ... ... 67 Staineliffe County Hospital ... 746

The remaining 61 cases comprised 49 pregnant women patients and 12 patients who were exam¬
ined at the request of the Silicosis Board.

The following table gives details of 5,487 dispensary patients examined during the year.
These figures include 239 cases referred to Middleton and Scotton Banks Sanatoria, and 280 re¬
ferred to private .clinics and institutions:—

Table XCIX.

For Treatment
For Diagnosis
and Progress

Dispensary Area. Pulmonary Non-Pulmonary Total

Non-
Pul¬
Pul¬
monary
Pos. Neg. Pos. Neg. monary

Area No. 1 (Skipton) 65 270 4 14 81 2 436

Area No. 2 (Harrogate) 32 91 3 4 11 2 143

Area No. 3 (Doncaster) 259 1124 26 61 841 43 2354

Area No. 4 (Barnsley) 180 887 17 76 334 96 1590

/
Area No. 5 (Sowerbv
Bridge) 193 397 10 15 298 51 964

729 2769 (SO 170 1565 194 5487

 148

Provision of Clothing.
During the year 329 orders were issued under the Council’s scheme for the provision of
clothing, in respect of applications for assistance in necessitous cases, where the a pplicant was
receiving sanatorium treatment as follows: —

Middleton Sanatorium ... 201 Crookhill Hall Receiving Home .. 28

Scotton Banks Sanatorium 31 Cardigan Sanatorium 35
Eldwick Sanatorium 4 Other Institutions 30

West Riding Distress Fund.

Cases have been reported, from time to time, of persons suffering from tuberculosis, who,
through financial stress, have not been able to purchase extra bedding, and have therefore been
compelled to sleep with other members of the family. To enable these infectious patients to occupy
separate beds, the following articles have been purchased through the “West Riding Distress
Fund,” and supplied on loan during the year:—4 blankets, 1 pillow, 1 mackintosh bed sheet) 6
sheets and 1 quilt.

From the Fund travelling expenses were paid in three necessitous cases, to enable parents to
visit patients who were seriously ill in Sanatoria.

Also from the Fund was paid the statutory fee to enable one patient to present a claim for
compensation to the Silicosis Board.

WAR PENSIONERS FOR TUBERCULOSIS.

Three new War Pensioners for tuberculosis were added to the list of tuberculous ex-servicemen
during 1938. The following is a classification of the cases remaining on the Dispensary Registers
at the end of the year:—

Table C.

Institutional
General Dispensary
Dispensary. Domiciliary. (includes San., Hosp.,
Supervision
and Training).
Class Class Class Class
7) c/)
T.B. Minus

T.B. Minus

T.B. Plus T.B. Plus T B. Plus T.B. Plus -1

3 s'
AREA <
cr. C * 5 ro
Class

Class

Cl cn M y5 3 V. ■— * « *3 cn ~3 H
K S a A c: ■£ Cl a. O
a a a 3. O. c. a a a a a a H
3 c 3 3 C 3 3 c
5a O
u
3
O
u
3
O
Im
o O
V.
O 0
u
3
0
b
3
0
u
3
0
u
O
3
0
u
O
u
O 0
£ z Z z
o o O O 0 0 0 0 O

No. 1 (Skipton) . 1 _ — — _ 34 — 6 1 — 4 — 4 — 1 _ — — — — 51
,, 2 (Harrogate) . 8 — 3 1 1 1 1 3 4 1 23
,, 3 (Doncaster) . 3 — — i 1 59 1 6 3 — 62 4 4 8 6 — — 1 — — 159
,, 4 (Barnsley) . 3 — — — 1 S5 l 6 1 3 93 1 8 2 1 205
,, 5 (Sowerby Bridge) 11 — — — 3 28 — 2 4 3 9 — 2 4 1 67

Totals . 18 — — i 5|214 2 23 10 i
7 169 6 21 18 10 - — 1 — - 505

COMBINED TREATMENT AND TRAINING.

The following table shows the admissions and discharges of all classes of patients to courses
of combined treatment and training, with or without a view to ultimate settlement. At the end
of the year the County had 26 colonists; 9 at Preston Hall, near Maidstone, Kent, 14 at Papworth
Hall, near Cambridge, and 3 at East Lancashire Tuberculosis Colony, Barrowmore Hall, Great
Barrow, Chester.

Table Cl.

No. No. remain¬

No. under No. admitted
discharged ing under
Colony. training on during
during training on
1.1.38. 1938.
1938. 31.12.38.

Papworth Village Settlement, 1 1 For training only.

near Cambridge
British Legion Village, Preston
Hall, near Maidstone, Kent ...
East Lancs. Tuberculosis Colony,
Gt. Barrow, Chester ...
Burrow Hill San. Colony,
Frimley, Surrey
Derwen Cripples’ Training
College, Oswestry . 6
Stanmore Cripples’ Training
College, Stanmore, Middlesex
10 5 8 7 Qualifying for Village
_ 2 1 1
Settlement.
Do.
1 1 1 1 Do.
4 1 2 3 For training only.
2 2 6 Do.
1 1 — 2 Do.

Of the 14 cases shown under the heading “discharged” 2 completed a course of training, 5
did not complete courses, having been prematurely discharged for various reasons, 4 were dis¬
charged at own request, one having obtained employment as a domestic servant, 1 was transferred
to the special nursing staff at Papworth Hall, and 2 died.
 149

Three ex-trainees were placed in employment during the year. One, who had undertaken a
course of painting and signwriting at the Derwen Cripples’ Training College Settlement, was found
similar work in the services of the local District Council; a second, after a course of instruction
in surgical appliance making at the Derwen Cripples’ College, was found employment with a firm
of artificial limb makers at Leeds; and a third, after a course of horticultural training at the
Burrow Hill Sanatorium Colony, is now employed as a temporary Assistant Porter-Gardener at the
Cardigan Sanatorium.

The Yorkshire Association for the Care of Cripples have also volunteered their co-operation
m the endeavour to secure suitable employment for tuberculous cripples.

ARTIFICIAL SUNLIGHT TREATMENT.

Dispensary patients in need of artificial sunlight treatment have been sent to the following
private and voluntary clinics and during the year 149 patients were referred by the dispensaries
for this treatment.

Clayton Hospital, Wakefield. Dr. J. Grieve, Burnley.

Huddersfield Royal Infirmary. Middleton Sanatorium.
Leeds General Infirmary. Manchester and Salford Hosptal for
Sheffield Royal Infirmary. Skin diseases.
Pontefract General Infirmary Dr. G. W. Wigg, Doncaster.

The following table indicates the work done in respect of different dispensary areas and the
results noted at the end of the year.

Table Cl I.

• oo
° ^ Result of treatment
Z (\j
No.
Dispensary Area Type of Case.
Treated Quiescent Much
o 05 and Impro¬ No
apparent¬ impro¬
£ £ ved change
ly well. ved

No. 1 (Skipton) Adenitis (Cervical and Inguinal) 2 55 _ 2 _ _

Lupus 6 321 — 4 2 —
Other Conditions 4 131 i 2 — 1

No. 2 (Harrogate) Adenitis (Cervical and Inguinal) — — — — — —

Lupus 14 1426 5 6 2 1
Other Conditions 1 31 1

No. 3 (Doncaster) Adenitis (Cervical and Inguinal) 24 2313 11 12 —

1
Lupus . 28 3706 3 14 8 3
Other Conditions . 9 1235 1 5 2 1

No. 4 (Barnsley) Adenitis (Cervical and Inguinal) 19 912 6 5 7 1

Lupus . 21 2334 9 6 4 2
Other Conditions . 2 110 — — 1 1

No. 5 (Sowerbv Adenitis (Cervical and Inguinal) 12 596 10 — 2 —

Bridge) Lupus 3 314 — 2 i —
Other Conditions 4 156 1 2 i —

DENTAL TREATMENT.
Approval was given for the provision of dental treatment in 164 necessitous cases during the
year, at an estimated cost of £322 13s. 4d. Approved Societies and parents contributed £59 19s.
9d. towards the cost of treatment, and the balance, £262 13s. 7d., was paid by the County Council.
Particulars of the treatment approved are shewn below :—

Table CIII.
Extractions

Repairs etc.
Part Lower
Part Upper
Full Upper

m
Sealines

Dentures

tr
Denture

Denture
Denture

V
Denture
Lower

Upper

Lower

J*
Institution or Dispensary °s c %
and

. t/5
Area. O £
zo
-

Z V
X
1

Middleton Sanatorium ... 43 332 18 2 10 i i 3 2 _ _

Scotton Banks Sanatorium . 49 309 7 — 9 4 2 — i 3 i
Cardigan Sanatorium 17 83 5 3 1 1 — — — 1 —
Crookhill Hall Receiving Home 9 65 — — 4 2 i — —' — 2
Eldwick Sanatorium 35 50 10 3 — — — — — — —
British Legion Village ... 1 32 — — 1 — — — — *- —
Derwen Cripples’ Training College ... 1 — — — — i — — — — —
Papworth Village Settlement ... / ... 5 55 6 1 2 — — — — — —

Shropshire Orthopaedic Hospital 2 — — — 2 — — — — — —

Westmorland Sanatorium 2 1 i 1

Totals ... 164 926 46 9 29 9 4 4 4 4 4

 150

ORTHOPAEDIC AFTER=CARE.
In connection with the after care of non-pulmonary cases discharged from orthoptedic hospitals
valuable assistance has been rendered in the wav of re-application of splints, surgical appliances,
etc. as follows :•—

Patients who have received treatment at the Shropshire Orthopaedic Hospital are re-admitted
to that hospital for the re-adjustment of surgical appliances supplied to patients on their initial
discharge from the institution. At the same time the opportunity is taken of bringing the case*
before the orthopaedic surgeon for re-examination etc.

By arrangement with the Sheffield County Borough, patients from the southern parts of the
county area are referred to a special clinic at Sheffield for examination by Dr. C. Lee Pattison,
Surgical Tuberculosis Officer and Medical Superintendent of the King Edward VII Hospital,
Sheffield. A nominal charge is made for such examinations and the County Council pay the cost
of X-Ray examinations, splints, appliances, etc., considered necessary.

Similar arrangements have been considered necessary for other parts of the county and a clinic
is now held at monthly intervals at the Staincliffe County Hospital, Dewsbury, where patients are
seen by Dr. H. L. Crockatt, Surgical Superintendent of the Yorkshire Children’s Orthopaedic
Hospital, Kirbymoorside.

SURGICAL APPLIANCES.
The following Surgical Appliances were supplied to patients receiving dispensary or domi¬
ciliary treatment during the year, namely :—

Thoracoplasty Support ... ... ... ... ... ... ... 1

Surgical Boots ... ... ... ... ... ... ... ... 9
Spinal and Abdominal Supports ... ... ... ... ... 2
Split Crutches ... ... ... ... ... ... ... ... 2
Air Ring ... ... ... ... ... ... ... ... ... 1
Blocked Leather Spica ... ... ... ... ... ... ... 2
Blocked Leather Thigh Support ... ... ... ... ... 1
Artificial Limbs ... ... ... ... ... ... ... ... 1
Artificial Nose ... ... ... ... ... ... ... ... 1
Alterations, Repairs and Renewal Parts ... ... ... ... 9
Stump Socks for Artificial Leg ... ... ... ... ... ... 1
Foot Splint ... ... ... ... ... ... ... ... ... 1

The cost of these appliances was £91 3s. 8d of which a sum of £9 15s. 9d. was subscribed
by or on behalf of three patients.

In addition to those enumerated, some 31 surgical appliances of various types representing

a total cost to the County Council of £129 18s. fid. were supplied during the period of the report
to patients actually undergoing residential institutional treatment for surgical tuberculosis.

Contributions towards the cost of surgical appliances are required where patients are not
receiving institutional treatment and where the circumstances of the family, as determined by
the. approved scale of income, permit of this. In the case of patients undergoing Hospital or under
residential treatment for surgical tuberculosis, appliances are prescribed by and fitted under the
supervision of the Medical Superintendent, and the full cost of these is borne by the County Council.

EXTRA NOURISHMENT.
1 he County Council continues to provide suitable necessitous tuberculous patients with grants
of extra nourishment. I his system, recognised as an integral part of the tuberculosis scheme on
its inception in 1912, increases the patients bodily resistance, a vital factor in the treatment of the
disease. I he absence of some such provision would necessitate increased institutional treatment
and would nullify the benefits oi treatment derived from the dispensary and sanatorium organ¬
isations.

During 1938, <96 patients undergoing dispensary or domiciliary treatment received grants
from the County Council in the form of eggs and milk at a total cost of £3,728 13s. fid.

It is known that a high proportion of adult patients suffering from pulmonary tuberculosis are
in receipt of Public Assistance, and many tuberculous children are members of families whose
income is derived or supplemented from that source. Conferences have taken place between mem¬
bers of the Public Assistance and Public Health Departments with the object of avoiding duplication
of assistance and ensuring that patients or their families are granted the maximum benefits per¬
missible. . It has been agreed that in all cases recommended for extra nourishment, where the
family is in receipt of relief from the Public Assistance Committee, the matter should be reported
to the County Public Assistance Officer for consideration by his Committee. During the past year
67 cases have been referred in this manner and it is pleasing to report that in all cases an increase
in relief, sufficient to provide the additional nourishment recommended, has been granted.
 The arrangements for co-operation with the Unemployment Assistance Board continue. Area
Officers of the Board refer any alleged, suspected, or confirmed cases of tuberculosis in the family
of an applicant for Unemployment Assistance allowances to the Public Health Department. In
this manner duplication of grants by the two authorities is avoided.

TUBERCULOSIS CARE COMMITTEES.

The 6 local Voluntary Committees have continued to carry out further valuable work during
1938. Reports received from areas where Committees are formed indicate that over 200 tuberculous
persons have received assistance. Grants have been made for extra food, clothing, dental treat¬
ment, travelling fares to relatives to enable visits to be made to patients under treatment in sana¬
toria, holidays, and boarding-out of children of infected households. The Committees have also
secured the co-operation of the local Borough Councils in the provision of better housing accom¬
modation.

Encouraging reports are made regarding the success of boarding-out children. At Goole, 25
children were sent to a Convalescent Home for periods of from 2 to 8 weeks, and in all cases
great improvement has been shown in the general physical condition.

At Castleford, 5 children have been boarded-out with various people in a neighbouring village.
The homes to which these children are sent are selected only after exhaustive enquiries, and
gratifying reports are to hand of the improvement in the health of the children concerned.

The work of all these Committees is carried out in close co-operation with the Consultant Tuber¬
culosis Officer of the area, and is to be highly commended and encouraged. The County Council
continue to supplement the local efforts to raise funds for this work, and the following table shows
the grants made to the several Committees during 1938 :>—

Table CIV.

Number of cases in which

Total
grants have been made Grants made
Expenditure
Care Committee by County
incurred in
Food and Boarding-out or Council.
Other 1938.
Clothing. Convalescent Home

£ s. d. £ 5. d.
Barnsley 15 — 3 19 12 0 10 0 0

Castleford ... 70 5 5 254 10 8 130 0 0

Doncaster. 10 — 3 12 10 0 7 0 0

Huddersfield 2 — — 10 4 9 6 0 0

Aberford 10 — — 6 14 5 4 0 0

Osgoldcross . . 83 28 3 264 14 1 143 0 0

190 33 14 568 5 11 300 0 0

INSTITUTIONAL TREATMENT.
The object of sanatorium treatment to-day is to cut short the advance of the disease by
increasing the patient’s resistance by active or passive means by (a) surgical intervention, or (b)
ordinary routine sanatorium methods, i.e. fresh air, diet and graduated rest and exercise.

In both instances the object is the same, namely to bring about a healing process in the lung
and to cause a diminution in the amount of sputum with (if possible) a final disappearance of the
tubercle bacillus (sputum conversion).

In (b) ordinary sanatorium routine methods of rest and fresh air may be all that are necess¬
ary to effect an improvement, the patient’s natural resistance being gradually built up.

With surgical intervention (a) the object is to bring about, by mechanical means and by com¬
pletely immobilising the lung, a healing process. The methods usually adopted are such as
artificial pneumothorax, phrenic evulsion, extra pleural pneumothorax, thoracoplasty etc.

It will be noted from the various Sanatoria reports that the number of sputum conversion
cases following surgical treatment in one form or another appears to justify the treatment. For
example, at Middleton during 1938, 50 patients received surgical treatment, and of these the
sputum became negative in 26 (or 52%) of the cases. Without surgical treatment it may be as¬
sumed few would have become negative.

It is interesting to note that for the year 1930 the number of artificial pneumothorax induc¬
tions carried out at the various sanatoria was 56 and refills 253, as compared with 80 inductions
and 1,634 refills for 1938.
/
The immediate results of treatment of patients discharged from sanatoria during the year are
given in Table CVII. It will be observed that as far as early cases of pulmonary tuberculosis
are concerned, the results are satisfactory, but the more advanced the disease the less favourable
do they become.
 152

The average waiting period prior to admission to institutions during 1938 was as follows :—
(a) Sanatoria ... ... ... ... Males 4 weeks.
Females 6 ,,
Children 6 ,,
(b) Orthopaedic Hospitals ... ... Adults 5 ,,
Children 6 ,,

During the year 608 beds were available for the treatment of pulmonary tuberculosis and 194
for other forms of the disease, compared with 626 pulmonary and 181 non-pulmonary beds available
in the previous year.

579 (or 95%) of the pulmonary and 50 (or 26%) of the non-pulmonary beds are provided
in County Council Sanatoria.

250 beds at Middleton Sanatorium and 200 at Scotton Banks Sanatorium are reserved for the
treatment of pulmonary tuberculosis. As these institutions are each equipped with modern oper¬
ating theatre and X-Ray unit, treatment by artificial pneumothorax and chest surgery is available
as well as the ordinary sanatorium routine, i.e., fresh air and graduated rest and exercise. Suit¬
able observation cases are also admitted for diagnosis.

At Middleton Sanatorium 50 beds are also reserved for the treatment of tuberculosis ortho¬
paedic conditions occurring in men and boys.

Consulting surgeons and physicians are available at all tuberculosis institutions under the
West Riding Tuberculosis Scheme for the following :—
Chest Surgery.
Orthopaedic Surgery.
Ear, Nose and Throat conditions.
Skin Diseases.
Diseases of the Eye.

The results of treatment are included in the Sanatoria reports.

During the year visits of inspection by members of the Tuberculosis Sub-Committee were made
as follows :—
March ... Papworth Village Settlement, Cambridge.
April Shropshire Orthopaedic Hospital, Oswestry.
Derwen Cripples’ Training College, Oswestry.
May Royal National Orthopaedic Hospital, Stanmore.
St. Vincent’s Orthopaedic Hospital, Pinner.
June . Westmorland Sanatorium, Meathop.
Wensleydale Sanatorium, Aysgarth.
October East Anglian Sanatorium, Nayland.
Papworth Village Settlement, Cambridge.

Table CV.
Institutional Accommodation Available for West Riding Cases—December, 1938.
N o. of Beds available
For Pulmonary Cases For Non Pulmonary Cases

Men Women Children Men Women Children

Controlled bv County Council (Public Health

Committee).
Middleton-in-Wharfedale Sanatorium, near Ilkley 250 — — 25 _ 25
Scotton Banks Sanatorium, Knaresborough — 100 100 — — —

Cardigan Sanatorium, near Wakefield — 50 — — — —

Crookhill Hall Receiving Home, Conisborough ... 40 — — — —

Eldwick Sanatorium, near Bingley . 39

Not Controlled by the County Council.

Oakwood Hall Sanatorium, Rotherham ... 1 11 _ _ _ 13
Wensleydale Sanatorium, Aysgarth 5 — 1 3 5
Westmorland Sanatorium, Meathop 2 4 _ _ _
King Edward VII Hospital, Sheffield. _ _ _ _ 39
Leasowe Hospital, Cheshire ... ... . _ _ _ _ 6 4
Marguerite Home, Thorparch . . _ _ _ _ 31
Royal National Orthoptedic Hospital, Stanmore, _ _ _ 3
Middlesex
Shropshire Orthopaedic Hospital, Oswestry _ _ _ 9 11 _
Yorkshire Children’s Orthopaedic Hospital, Kirby-
moorside _ 6
Miscellaneous Institutions 4 2 1 7 5

297 172 139 36 27 131

 Table CVI.

Institutional Treatment during 1938.

U U
CJ if4 c c
.si Admissions 1938 ~ C Discharges 1938 ■- C 00
E o E
*- u ^ -3 “ 4-1 U '•
C CM

Children

Children
C C '■

Women

Women
Institution n *“ c 0.^2 c c jr <u <u ~
T3 JJ — o •- ;tj • •
ft 7)
■

Men
Men
4 * 55 co
CL vu o S CL w
(2 « H

Pulmonary Institutions.

Middleton-in-Wharfedale Sanatorium ... 111 509 — 25 534 509 — 20 529 282

Scotton Banks Sanatorium 174 — 226 124 350 — 192 148 340 184
Cardigan Sanatorium 50 — 135 2 137 — 135 4 139 48
Crookhill Hall Receiving Home 59 81 — — 81 80 — — 80 40
Eldwick Sanatorium 31 — — 82 82 — — 93 93 20
Oakwood Hall Sanatorium 28 — 20 30 50 — 28 25 53 25
Wensleydale Sanatorium ... 8 — 14 3 17 — 6 5 11 14
Westmorland Sanatorium 6 2 6 — 8 2 6 — 8 6
Barrowmore Hall ... 1 2 — — 2 2 — — 2 1
East Anglian Sanatorium 8 — 6 — 6 — 5 8 13 1
Papworth Sanatorium 3 — — — -- 1 1 — 2 1
Preston Hall Sanatorium 4 — — — — 2 — — 2 2
Stannington Sanatorium 1 — — — — — — 1 —
1

Non-Pulmonary Institutions.

King Edward VII Hospital 35 — — 24 24 — — 20 20 39

Leasowe Hospital ... 9 — 8 — 8 — 5 2 7 10
Marguerite Home ... 31 — — 13 13 — — 13 13 31
Royal National Orthopaedic Hospital ... 4 — — — — — — 1 1 3
Shropshire Orthopaedic Hospital 26 19 25 — 44 22 28 — 50 20
Yorkshire Children’s Orthopaedic Hospital ... 7 — — 4 4 — — 5 5 6
Alton Hospital 1 — — — — — — — — 1
Harlow Wood Orthopaedic Hospital. — — 4 — 4 — 1 — 1 3
Heswall Hospital ... 1 — — — — — — — — 1
Margate Royal Sea Bathing Hospital — — 1 — 1 — — — — 1
Marple Children’s Orthopaedic Hospital — — — 1 1 — — — — 1
Melton Lodge Hospital ... 1 — — — — — — 1 1 —
St. Vincent's Hospital 1 — — — — — — — — 1
Bradford Royal Infirmary — 1 2 1 4 1 2 1 4 —
Doncaster Royal Infirmary — 2 2 1 5 2 2 1 5 —
Harrogate and District General Infirmary ... 1 2 2 3 7 2 2 4 8 —

Huddersfield Royal Infirmary ... — 7 5 7 19 7 4 7 18 1

Lancaster Royal Infirmary — — 1 — 1 — 1 — 1 —
Leeds General Infirmary ... 2 31 44 30 105 31 43 29 103 4
Leeds Maternity Hospital — — 1 — 1 — 1 — 1 —

Leeds, St. James’s Hospital ... — 1 2 — 3 1 2 — 3 —

Manchester Royal Infirmary — — 3 — 3 — 3 — 3 —

Manchester and Salford Hospital 1 1 1 — 2 2 1 — 3 —

Sheffield Royal Infirmary — — 6 1 7 — 5 1 6 1

York County Hospital — 1 — — 1 1 — — 1 —

750 659 514 35) 1524 665 473 3S9 1527 747
 154

Table CVII.
Immediate Results of Treatment of Patients Discharged from Residential
Institutions during the year 1938.
(a) Pulmonary Cases.

Duration of Treatment in the Institution.

Classifi¬

Total.
Condition at time Under 3 3—6 6—12 More than
cation on
of Discharge. months months months 12 months
admission*

M. W. Ch. M W. Ch. M. W. Ch. W. Ch.

Class Quiescent 15 9 9 22 18 20 15 10 28 4 _ 10 160

T.B. Not Quiescent 36 8 4 21 4 4 8 2 6 3 — 4 100
Minus. Died in Institution 3 1 1 1 1 7

Class Ouiescent 2 5 3 4 2 1 17
T.B. -f Not Quiescent 3 7 — 4 2 1
— —
1 — — — 18
Group Died in Institution ~“-
I.

Class Quiescent 2 4 3 7 1 12 1 6 36
T.B. + 12
Not Quiescent 28 — 45 19 — 40 17 I 27 6 1 196
Group 1 2 1 2 2
Died in Institution 8
II.
~

Class
T.B. + Quiescent 3 2 1 6
Group Not Quiescent 17 27 — 11 26 — 14 25 1 10 9 1 141
III. Died in Institution 33 17 — 19 7 1 10 2 11 1 — 107
6
Totals ... 137 81 13 136 86 25 93 79 40 \ 63 26 17 796

(b) Non-Pulmonary Cases.

Duration of Treatment in the Institution.

Classifi¬
Condition at time Under 3 3—6 S—12 More than 03
cation on O
of discharge. months month s months 12months
admission* H

M. w. Ch. M. W. Ch M. w. Ch. M. W. Ch.

Quiescent 5 9 2 4 5 2 5 6 7 14 5 26 90
Bones and
Not Quiescent 3 3 10 2 3 4 i — 3 — 2 31
Joints.
Died in Institution 2 i 1 4

Quiescent 1 3 6 2 16 i 21 1 2 53
Abdominal. Not Quiescent | 1 1 2 I 3 — — — — 1 — 2 11
Died in Institution i 2 1 1 4

Quiescent 2 1 1 1 2 1 2 10
Other
Not Quiescent 1 5 i — — 2 — — 2 1 1 — — 12
Died in Institution i 1

Peripheral Quiescent 1 2 1 1 3 2 19 6 35
Glands. Not Quiescent ... i 5 2 1 1 3 13
Died in Institution

Totals ... 18 23 27 10 17 23 13 12 50 22 6 43 264

Patients whose stay in residential institutions has not exceeded 28 days

are not included in these tables.
* Classification according to Memo. 37/T.

(c) Observation Cases.

For Pulmonary For Non-Pulmonary
Tuberculosis. Tuberculosis.
Totals.
Diagnosis on discharge Stay under Stay over Stay under Stay over
from observation. 4 weeks. 4 weeks. 4 weeks. 4 weeks.

M. w. Ch. M. 1 w. Ch. M. j W. Ch. M. w. Ch. M. W. Ch.

Tuberculous 8 9 5 15 3 21 1 2 2 1 7 26 15 33
Non-tuberculous . 8 5 3 36 21 53
3 — —
2 20 47 28 76
Doubtful 2 2 3
1 1 — 2 3 3

Totals . 18 16 13 51 24 74 I 4 1 2 — 2 4 27 75 46 112
 155

INSTITUTIONAL TREATMENT—IMMEDIATE RESULTS.

It is pleasing to record a decrease in the number of patients suffering from pulmonary tuber¬
culosis who were discharged, or took their own discharge, from institutional treatment after a period
of residence not exceeding 28 days. 119, such cases occurred during 1938 as compared with 160
in the previous year. A slight increase from 109 to 115 is shown in similar non-pulmonary cases,
but this is due to an increased number of patients being re-admitted to hospital for re-examination
and repair or re-adjustment of surgical appliances. The total of these early or premature dis¬
charges represents 15% of the cases discharged from institutional treatment during the year, a
reduction of 2’5% on the previous year. The results of treatment in these cases are not included
in the details given below. 27 of the pulmonary and 3 of the non-pulmonary cases died within
this period.

A more precise determination of the presence of the tubercle bacillus is reflected in the con¬
tinued increase in the proportion of positive sputum cases admitted to institutional treatment.
The proportion admitted during the year under review was 69% as compared with 62-5% in the
previous year.

(a) Pulmonary Cases. Adults.

701 adult patients (429 male and 272 female) suffering from pulmonary tuberculosis were
discharged from institutional treatment during the year. Of these 182 were of the T. B. Minus
group and 519 were patients with positive sputum. An analysis of the immediate results of treat¬
ment is given on page 154, but further details are given below to indicate the proportion of cases
discharged quiescent or otherwise.

Table CVIII.

Discharged Discharged Died in

Total cases quiescent not quiescent Institution
treated
(adults)
No. % No. % No. %
Males
(T.B. —) 129 56 434 68 52-7 5 3-9

Females
(T.B. —) 53 37 69-8 14 26-4 2 3-8

Males
(T.B.+) 300 14 4-7 208 69-3 78 26-0

Females
(T.B. + ) 219 43 19-6 142 64-9 34 15-5

Of 701 cases dealt with, 440 (or 62'8%) were discharged, or took their own discharge after
a period of treatment of less than six months. 139 (or 3T6%) of these were of the T. B. Minus
group, and 301 (or 68'4%) were cases with a positive sputum.

Of the deaths which occurred in the institutions 112 (or 94T%) were cases with positive
sputum.

(b) Pulmonary Cases.—Children.

The number of children suffering from pulmonary disease and discharged from institutional
treatment was 95 and 10 of these (or 10'5%) were positive cases.

(c) Non=Pulmonary Cases.

264 cases of the non-pulmonary form of tuberculosis were discharged from in-patient treatment
during the year; 121 adults and 143 children.

The immediate results of treatment show a quiescent condition on discharge in the case of
62% of the adults and 79% of the children.

MIDDLETONHN-WHARFEDALE SANATORIUM, ILKLEY.

Dr. H. E. Raeburn, Medical Superintendent, reports :—

Buildings and Equipment.

A temporary hut, formerly used for Orderlies was moved to a site near the Nurses’ Hostel to
accommodate additional Nurses.

A swimming pool for th^ Domestic Staff was opened on the 2nd of September, and has been
very popular.

Staff.
Eleven Nurses passed the final examination of Tuberculosis Association.
 156

Statistics.
The number of cases admitted during the year was 513, compared with 483 the previous
year. They were classified as follows:—

Pulmonary.
T.B. Negative 173
T.B. Positive—Group I 20
Group II 118
Group III

Total Pulmonary .366

The percentage of sputum positive cases was 52 73 as compared with 53 2 in 1937 and 47-7
in 1936.

Non-Pulmonary.
Bones 39
Abdomen 21
Glands 4
Skin 3

Total non-pulmonary ... ... ... ... ... ... 67

Observation . 80

Of the 80 observation cases, 26 were diagnosed as suffering from tuberculosis, and 21 of

these were retained for treatment.

The percentage of bed patients was 6912 as compared with 66’58 in 1937 and 67-37 in 1936.

Immediate Results of Treatment.

The following table shows the immediate results of treatment of patients discharged with
tuberculosis in 1938. In 42 cases the period of residence was less than 29 days; the results of
treatment in these are not included in the table.
Table CIX.

Duration of Residence.
Classification Condition at
on admission to time of Totals
Under 3 3 to 6 6 to 12 Over 12
the Institution Discharge
months months months months
M. B. M. B. M. B. M. B.
Pulmonary.
Class Quiescent . 7 — 17 — 12 — 4 — 40
T.B. Not Quiescent 32 — 20 — 7 — 3 — 62
Minus Died. 2 — — — — — 1 — 3

Class Quiescent ... 5 5

T.B. + Not Quiescent 3 — 7 — 4 — 2 — 16
Group Died. — — —
I. ~

Class Quiescent . 1 _ 1 _ _ _ 1 3
T.B. + Not Quiescent 23 — 40 — 35 — 25 — 123
Group Died ... — — 2 — 1 — 2 — 5
II.

Class Quiescent . _ _ _ _ _ _ 1 i
T.B. + Not Quiescent 11 — 8 — 11 - | 4 — 34
Group Died ... 24 — 16 — 9 — 10 — 59
III.
Non-Pulmonary.
Bones Quiescent ... 3 — 2 1 3 2 10 2 23
and Not Quiescent 1 — 1 — 4 — 2 1 9
Joints Died.

Quiescent . 1 _ _ 2 _ 2 1 6
Abdomen Not Quiescent 1 1 1 — — — 1 — 4
Died ... 2 — — 2
~ “

Quiescent . 1 — — 2 3
Other
Not Quiescent 5 1 1 7
Organs
Died. — 1 1

Quiescent ... 2 — 2
Peripheral
Not Quiescent 2 — 1 3
Glands
Died. — — —

Total 116 2 122 3 88 5 70 5 411

 157

Treatment of Pulmonary Cases.

The treatment of the pulmonary cases consisted of the usual sanatorium routine of rest and
graduated exercise, assisted where necessary by the various forms of collapse therapy, and by
injections of gold and calcium salts.

Thoracoplasty.
Three patients had a partial or complete thoracoplasty. One patient developed pneumonia and
died. One was discharged as not quiescent, but the sputum changed from positive to negative.
One patient is still in the sanatorium. His condition is considerably improved, and the sputum has
changed from positive to negative. Four patients were discharged who had had a thoracoplasty
previous to 1938. All were improved, and in two cases, the sputum changed to negative.

Phrenic Paralysis.
“Phrenic evulsion’’ was performed in two cases, and “phrenic crush” in five cases. In two
of the cases the sputum changed to negative.

Artificial Pneumothorax.
Artificial pneumothorax was induced in 32 cases. It was attempted in seven others but failed
owing to pleural adhesions. At the end of 1938, 21 cases were having artificial pneumothorax
treatment. Of these, 17 were induced in 1938, 2 continued from 1937 and 2 continued from 1936.
27 cases were discharged who had this treatment, the results being.
Quiescent 1
I mproved 16
Stationary 4
Died 6

In 8 cases the sputum changed from positive to negative.

773 refills were given, and 48 aspirations and air-replacements were done. In addition, 60
refills were given to out-patients at Middleton.

Thoracoscopy and Adhesiotomy,

Thoracoscopy was performed 11 times on 7 cases, and adhesions were cut in 6 cases. Although
the collapse of the lung improved, in only three cases has the sputum become negative up to the
time of this report. One of the cases developed a pyopneumothorax.

Extra^Pleural Pneumothorax.
Extra-pleural pneumothorax was tried in three cases. The first was most successful, and the
patient was discharged with a good collapse of the upper part of the lung. The sputum became
negative.

In the second case the pneumothorax obliterated in the course of a few weeks, but the patient
showed some improvement. The sputum became temporarily negative.

It was impossible to establish a pneumothorax in the third case owing to adhesions.

Gold.
21 patients received gold treatment during 1938. Of these, 6 commenced in 1938, and 1&
continued from 1937. 2 patients were continuing gold treatment at the end of 1938. Of those
discharged, the results were as follows :—

Quiescent 0
Improved 17
Stationary 5
Died ... 9

24

In 7 cases the sputum changed from positivi to negative.

374 injections were given during the year.

Calcium.
13 cases received calcium treatment during 1938. Of these, 8 copimenced in 1938, and 5
continued from 1937. 1 patient was continuing calcium treatment at the end of 1938. Of those
discharged, the results were as follows :—

Quiescent 1
Improved 6
Stationary 9
Died 2

18

In 3 cases the sputum changed from positive to negative. The patient discharged as quies¬
cent had no sputum.

163 injections were given during the year.

Treatment of Non=Pulmonary Cases.
The treatment of the non-pulmonary cases varied with the site of the disease. Rest and sun¬
light (artificial and natural) formed the basis of the treatment, assisted by splints and plasters in
the orthopaedic cases, and in the renal cases, by injections of tuberculin.

Mr. R. Broomhead, the Consulting Orthopaedic Surgeon visited the sanatorium 15 times during
the year. He had 16 consultations, and performed 31 operations.

Massage.
The masseur commenced duty on the 24th January. He treated 72 patients, and gave 2,496
“treatments.” From the beginning of the year until that time, the temporary masseuse had con¬
tinued her work. She had given 77 “treatments.”

Splints.
All the orthopaedic cases, whether receiving operative treatment or not, required some form
of splint, and the following were made on the premises by the splintmaker.

Spinal and hip frames ... ... 30

Spinal carriages ... ... ... 2
Spinal braces ... ... ... 10
Splints and crutches (various) ... 94
Repairs and alterations to splints 164

Tuberculin.
Tuberculin was given to 12 patients in 1938. Nine of these commenced in 1938 and 3 in 1937.
Of those discharged, the results were:'—

Quiescent ... ... ... 3

Improved ... . . ... 4
Stationary ... ... .. 1

95 injections were given during the year :—

Surgery.

The following operations were performed during the year:—

Thoracoplasty (3 cases) ... ... 9 Appendicectomy 1

Phrenic paralysis—evulsion ... ... 2 Cauterization of larynx 14
Phrenic paralysis—crush ... ... 5 Biopsy papilloma larynx 1
Thoracoscopy and adhesiotomy ... 9 Empyema drainage 4
Thoracoscopy ... ... ... ... 2 Cystoscopy 3
Bronchoscopy ... ... ... ... 9 Intercostal drainage ... 1
Hibbs spinal fusion ... ... ... 4 Excision of glands of axilla ... 1
Extra-pleural pneumothorax ... ... 3 Removal of tonsils and adenoids ... 3
Arthrodesis of hip ... ... ... 1 Turbinectomy ... 1
Arthrodesis of knee ... ... ... 6 Removal of nasal polypi 1
Sacro-iliac fusion ... ... ... 1 Sub-mucous resection ... 1
Amputations—leg ... ... ... 5 Rectal examination and catheterization 1
Amputations—arm ... ... ... 2 Intrathecal injections of alcohol 4
Pre-sacral neurectomy ... ... 1 Opening abscess and sinuses of chest
Removal of stone in common bile duct wall 1
and drainage ... ... ... 1 Opening abscesses 6
Closing supra-pubic wound ... ... 1 Incisions of septic fingers 10

The orthopaedic surgery was done by Mr. Broomhead; the ear, nose and throat operations
by Mr. Donald Watson ; and the general and thoracic surgery by the Medical Superintendent. One
patient was transferred to the Bradford Eye and Ear Hospital for an operation on his eye.

Radiography. The number of films taken during the year was:—

In-patients ... ... 1,720

Out-patients ... ... 388
Staff . 176
Scotton Banks ... ... 92

2,376

These include 4 Barium Meals and 13 Lipiodol examinations.

Ultra=Violet Light. Light treatment was given in the following cases :—

Out-patients. In-patients.
Bones ... ... ... ... ... — 2
Glands ... ... ... ... ... 4 4
Abdomen ... ... ... I 1
Skin ... ... ... ... ... •— 23
Other organs ... ... ... ... -'5
Sinuses ... ... .. ... —

8 32

All but one patient improved.

Consultations.
Eyes. Dr. C. G. Kay Sharp, the eye specialist visited the sanatorium once during the year,
and had three consultations.

Skin. Dr. J. Ingram, the Consultant Dermatologist also visited the sanatorium and saw 8
patients.

Ear, Nose and Throat. Mr. Donald Watson,, the Ear, Nose and Throat Specialist visited the
sanatorium four times during the year. He had nine consultations, and performed six operations.

Dental Treatment. The Dentist, Mr. Thornton visited the sanatorium 31 times, and gave
treatment to 77 patients during the year.

Pathological Laboratory.
All the routine work was carried out by Mr. Goodacre, the Laboratory Technician.

The total number of specimens examined in the Laboratory was 5,187, showing an increase
of 634 over the previous year’s total of 4,553

Bacteriology. Examinations of the following were made: —

Sputa ... 3,830

Swabs from eyes, ears, nose
or throat for B. Diphtherise
or other bacteria ... 191 (one contained B. diphtheria;.)

Swabs, various for B. Tuber¬

culosis or other bacteria ... 21
Urines (Bacteriology and
microscopy) 175
Blood for culture 5
Pleural effusions 46
Faeces ... 90
Pus from various sources ... 18
O
Blood for Widal Reaction ... •j
Cerebo-spinal fluid 9
Miscellaneous 78

265 speciments of sputum, negative on ordinary examination, were cultured on Lowenstein-

Jensen medium for the presence of B. Tuberculosis, which was found in 43 cases. Of these, 19
had always been negative previously.

The efficacy of treatment of swimming-pool water with ammonia and chlorine was again pro¬
ved. Specimens taken at regular intervals from both the Nurses and the Maids swimming-pools
were examined, and at no time was any dangerous contamination found.

Several disinfectants were tested during the year for their respective efficiency as to the des¬
truction of B. Tuberculosis and Haemolytic Streptococci.

All media used were prepared in the laboratory.

Htematology. Specimens of blood were taken for:—

Enumeration of Red and White

Corpuscles ... . 212
Estimation of Haemoglobin . . 192
Von Bondsdorf Count . 169
Sedimentation Rate of Red Blood
Corpuscles . 185
Calculation of Houghton’s Index 169

1 hese investigations are carried out in all cases before attempting collapse therapy.
 160

Bio=Chemistry.
Estimation of Blood Urea ... ... 12
Estimation of Blood Sugar ... ... 51
Estimation of Blood Calcium ... 11
Estimation of Urinary Urea ... 12
Fractional Test Meals ... ... 6
Van Den Berg reactions ... .. 3
Estimation of cells, protein, chlor¬
ides, sugar and globulin in
cerebro-spinal fluid ... ... 9
Examination of Faeces for Occult
Blood ... ... ... ... 54

All urine specimens are examined for albumen, sugar and reactions, as a routine procedure.

Pathology. Sections were cut from 91 specimens taken at operations or post-mortem exam¬
inations, and interesting specimens preserved.

On several occasions, as in the previous year, nurses weie given a talk on a few of the
routine laboratory methods, and were instructed in the use of simple apparatus; for example,
the blood counting chamber, determination of the sedimentation rate of Red Blood Corpuscles and
the staining and cultivation of the Tubercle Bacillus.

Postmortems. During the year, 29 post-mortem examinations were undertaken. 16 were at

the request of the Coroner as the patient had worked in stone. In 2 cases silicosis was found.

Air Raid Precautions. During the year, two courses of lectures on Air Raid Precautions were
given to the staff. The first, which commenced in February, was given by Mr. Tayler (County
Council A.R.P. Lecturer) to all members of the sanatorium staff. At the end of the course, ail
took the short examination required.

The second course, which commenced in June was given by Dr. Beverley, the Home Office
Instructor. This was given to doctors and nurses, who attended both from the sanatorium and
the district. The number of staff attending was 52. Following the course, three examinations
were held at Middleton for the St. John Ambulance Instructor’s Certificate, and the results were
as follows :—

Passed Grade I Instructor’s Certificate ... 13

Passed General Public A.R.P. Certificate ... 13

At the time of the crisis in September, provision was made for darkening and gas proofing
the wards and staff rooms.

Gas masks were fitted to all patients and staff.

Occupational Therapy. The average number of patients attending daily for instruction in 1938
was 17. In addition, patients wTere visited on the wards.

The work consists of carpentry, rug and raffia work, weaving, fancy leather work, pewter
work, book-binding and cobbling. 204 fancy leather purses were made.

During the year, 400 pairs of boots were repaired, 161 for necessitous cases; and 239 pairs
were paid for by staff and patients.

Library. I here are 3,891 books in the library, and during the vear, 2,84(5 books were loaned
to the patients.

Entertainments. 1 alking pictures were shown once a week during the winter, and once a fort¬
night during the summer. Concerts were given fortnightly during the winter. During the
summer, three motor-coach excursions were arranged, and patients spent the afternoon awav from
the sanatorium.

Chapel. Services wrere held in the Chapel regularly, and Clergv also visited the sanatorium
during the week. I he average attendance of patients for services held in the Chapel was 16.

Sanatorium Farm. A herd of tuberculin-tested cows is kept at the sanatorium farm, and during
the year 18,116 gallons of milk were supplied to the sanatorium. Other supplies to the sana¬
torium were 1,222 fowls, 235 stone of pork, and 102,431 eggs. The cash sales during the vear
realised £412 17s. 2d., and to other Institutions £7 10s. Od.
 161

SCOTTON BANKS SANATORIUM, KNARESBOROUGH.

Dr. V. RYAN, Medical Superintendent, reports:—

Buildings and Equipment.

During the year 1938 a central covered corridor was erected connecting the pavilions with the
patients’ dining hall and the medical centre, and mechanical stokers of the Riley Underfeed type were
provided on the Lancashire Boilers. The covered corridor is a great boon and is much appreciated
by the patients and staff, while the mechanical stokers have eliminated the question of smoke from
the chimney. Other alterations were, a new floor in the operating theatre, the adaptation of a
room in the medical centre to form a minor operating theatre, where such methods as thoracoscopy
and bronchoscopy can be carried out. The alternating current supply became available for the
X-Ray and other medical apparatus in July. The laying out of the grounds continued during the
year and extra trees and shrubs were planted, while new flower beds gave a good display of blooms
during the summer. The work of cutting out paths for the patients’ walks continues. Waiting
rooms for patients’ visitors were sanctioned during the year and building is to start soon. The
need for a recreation room for patients is a pressing and urgent one.

Staff.
Medical The post of Senior Assistant Medical Officer remained vacant until the 1st October
1938, when the duties were taken up by Dr. S. P. Wilson, Assistant Tuberculosis Officer in the
Barnsley area. During the preceding nine months the work was carried on with the assistance
of a series of locum tenens, seven in all, and with some help from members of the Tuberculosis
Dispensary Service.

Nursing. No difficulty was experienced in securing Probationer Nurses, and six additional
temporary Probationers were appointed during the year. The appointment of an X-Ray and
Theatre Sister was sanctioned during the year, but there were no applicants for the post and there
was some difficulty in obtaining trained Nurses. A system of lectures and training was instituted
to enable Nurses to qualify for the Tuberculosis Association’s Certificate. Four Nurses sat for
Part 1 of the examination and all four were successful. The tuition was given by the Assistant
Matron, who acts also as Sister Tutor, and to whom great credit is due. The lectures on Anatomy
and Physiology were given by the Medical Superintendent.

Domestic. The full quota was maintained during the year and the chief change was the
appointment of a new cook.

Other Staff. After the resignation of the late assistant engineer and chauffeur, a re-allocation
of duties was made. A porter was promoted to be chauffeur, continuing to act as porter when
not engaged on driving, and a full time assistant engineer was appointed. One temporary porter
was placed on a permanent basis, thus involving an increase of one on the staff. Two temporary
gardeners were engaged for a period during the year, but the number was later reduced to one.

Statistics. The number of patients admitted during the year was 326, comprising 214 Women
and 112 Children. They were classified as follows:—

Pulmonary.
T.B. Negative 77
T.B. Positive—Group I 6
Group II 26
Group III 92

Total Pulmonary 201

The percentage of sputum positive cases was 62, as compared with 55T in 1937.
Non=Pulmonary.
Bones ... ... ... ... ... ... ... ... ... 4
Abdomen ... ... ... ... .., ... ... ... 23
Glands ... ... ... ... ... ... ... ... 17
Skin . 2
Other organs ... ... ... ... ... ... ... 5

Total Non-Pulmonary ... ... ... ... ... ... 51

Observation ... ... ... ... ... ... ... ... ... 74
Of the Observation cases, 24 were diagnosed as suffering from Tuberculosis and were retained
for treatment.
 162

Immediate Results of Treatment.

The following table shows the immediate results of treatment of patients discharged with
tuberculosis in 1938. In 23 cases the period of residence was less than 29 days; the results
of treatment in these are not included in the table.

Tablf. CX.

Classification on Duration of Residence.

Condition at time of
admission to the Totals.
Discharge. Under 3 3 to 6 6 to 12 Over 12
Institution.
months. months. months. months.
W. Ch. W. Ch. W. Ch. W. Ch.

Pulmonary.
Class Quiescent 5 6 11 7 7 20 — 3 59
T.B. Not Ouiescent 2 1 1 — — — — 4
Minus Died ... . 1 — 1 — — — — — 2
Class
T.B. + Quiescent 1 3 4 1 1 10
Group Not Quiescent — — 1 — — — — 1 2
I. Died ... — — — — — — — — —
Class
T.B. + Ouiescent 2 3 5 5 15
Group Not Quiescent — — 3 — 4 — 3 — 10
II. Died ... 1 — — — — — — — 1
Class
T.B. + Quiescent _ 2 1 _ 3
Group Not Quiescent 5 — 18 — 14 — 3 1 41
III. Died . 10 —
5 — 4 2 — — 21
Non-Pulmonary. 4
Bones Quiescent 1 — 1 — — 1 — 1 1
and Not Quiescent — — 1 — — — — —
Joints. Died — — — — — — — —

Quiescent . 2 4 1 4 1 17 — 1 30
Abdomen.
Not Quiescent
Died ... — — — — — — — — —

Other Ouiescent 1 1 1 3
Organs. Not Quiescent — — I — 1 — — 2
Died ... — — — — — — — — —

Peripheral Quiescent 1 _ _ 2 _ 12 _ 1 16
Glands. Not Quiescent — — — — — — — —
Died ... — — — — — — — — —

Totals ... 32 11 50 13 43 54 13 8 224

Treatment.
Environmental. The customary sanatorium routine is observed, the patients at all times being
in an atmosphere of fresh and moving air. A generous and varied diet is supplied and the routine
is directed towards keeping the patients occupied and interested. As before, a system of carefully
controlled rest and exercise is applied.

The proportion of adults to children was higher during the year.

There was one outbreak of infectious disease (diphtheria) amongst the children in May. A
child with a chronic nasal discharge was found to be the source. She infected three other child¬
ren. All four were removed to the local Isolation Hospital and made satisfactory recoveries.

Artificial Pneumothorax. Artifical Pneumothorax was tried in 22 cases, and succeeded in

14. In 2 of these patients the pneumothorax was bilateral. In 2 cases the treatment was soon
abandoned, because selective collapse could not be obtained. 396 refills were given during the
year.

Thoracoscopy and Adhesiotomy. Thoracoscopy was carried out on 7 pneumothorax patients.

In 3 of these, large areas of lung were adherent to the chest wall and nothing further could be
done, but in the case of the other 4 there were adhesions, capable of being cauterised. One of
these patients had two cavities held open by adhesions. After the first cauterisation the remaining
cavity gradually disappeared. The second patient also showed closure of one of her cavities, but
a pleural effusion supervening obscured the X-Ray picture of the collapsed lung. The third pa¬
tient who had adhesions cut was a case of bilateral pneumothorax. The cauterisation had no
appreciable effect on the cavity. The fourth case had a good result, the cavity closing after
adhesiotomy.

Phrenic Evulsion. A phrenic evulsion was performed in 13 cases. The operation was done in
7 cases because of the failure to induce an artificial pneumothorax. In 4 instances it was done
to enhance the collapse produced by the artificial pneumothorax, and in 2 cases the indication for
the operation was a lesion at the base of the lung.
 Thoracoplasty. There was only 1 case submitted for thoracoplasty. The operation was done
in the Leeds General Infirmary and the patient developed an acute exacerbation of her disease
and died some months later.

Other operations. Other operations were comprised as follows :•—

Glands ... ... ... ... ... ... 1

Cystoscopy ... ... ... ... ... 1
Cauterisation of Urethra ... .. ... 1

The major operations were performed by Mr. Moir.

Tuberculin Treatment. Tuberculin treatment was given to 2 patients suffering from renal
tuberculosis.

Gold Treatment....Gold was administered to 20 patients, either separately or in conjunction

with other treatment.

Consultations. Mr. P. J. Moir, F.R.C.S. (Eng.) the Consulting Thoracic Surgeon, saw patients
in consultation as regards their suitability for operations on the chest. These have already been
referred to. On an average he visited the Sanatorium twice a month.

Mr. R. Broomhead, F.R.C.S. (Eng.) visited the Sanatorium once and advised on three
orthopaedic cases.

The services of one of the West Riding School Oculists were available when required, and
Dr. Murphy attended on three occasions.

Mr. Webster, L.D.S., R.C.S. (Edin.) of Harrogate visits even Wednesday to give dental treat-
ment.

Ear, Nose and Throat Clinic. Mr. A. B. Pavey-Sniith, F.R.C.S. (Eng.) of Harrogate, was
appointed Visiting Ear, Nose and Throat Surgeon during the year and has attended monthly since
July. All cases where there is a suspicion of laryngeal involvement are referred to him. He
performed one minor operation, namely, the removal of nasal polypi.

X=Ray Department. The Sanatorium X-Ray apparatus became available for use on the 1st
July. 304 examinations were carried out on it during the six months to the end of the year.
Prior to that time patients were X-Rayed at the Middleton Sanatorium and at Dr. Thomson’s
Surgery, Harrogate. The number of examinations during the first six months were 92 at Middle-
ton and 95 at Dr. Thomson’s Surgerv.

Ultra=Violet Ray. 28 patients were treated during the year, as fallows :•—

Lupus ... ... ... ... ... ... 2

Abdomen ... .. ... ... ... 7
Cervical Glands ... ... ... ... 8
Kidney ... ... ... ... ... ... 2
Bones and Joints ... ... . . ... 2
Eye ... ... ... ... ... ... 1
General Debilitv ... ... . ... (>

28

Religion.
Church of England—Service on alternate Sundays.
P'ree Church'—Service on alternate Sundays.
Roman Catholic Church—Services as required.

Air Raid Precautions. During the September crisis measures were taken for dealing with an
actual emergency. A trench was dug and a room in the basement made gasproof and bombproof
while all the windows were fitted with blinds to provide against the showing of lights.

Entertainments. Entertainments are given, on an average, once a month.

CARDIGAN SANATORIUM, Near Wakefield.

The Medical Superintendent reports: —
Buildings and Equipment. /
Alterations were made to an annexe near the mortuary for the sterilization of sputum cups
and flasks.

Repairs were made to the main road leading to the sanatorium.

 164

Statistics.
The number of cases admitted during the year was 135, including two children, as compared
with 137 in the previous year. They were classified as follows:—

Pulmonary—T.B. Negative ... ... 54

T.B. Positive—Group I
—Group II ... ... ... 40
—Group III ... ... ... ... 26

Total Pulmonary ... ... ... ■■■ 120

The percentage of sputum positive cases was 55.

Non=Pulmonary ... . ... ... ... 6

Observation . . . . . ... ... ... ... 9

Of the seven patients who were discharged from observation one was found to have pulmonary
tuberculosis and one was found to have pulmonary tuberculosis and tuberculous peritonitis. These
two patients were retained for treatment. Three were discharged as non-tuberculous, one took her
own discharge before investigations were completed and one died.

There were 557 sputum examinations made during the year. In 13 cases the sputum which was
positive on or before admission became negative before discharge.

There were 14 deaths in the sanatorium during the year. This includes 1 case which was
admitted for observation and died 5 days later from broncho-pneumonia, also 2 cases with pul¬
monary tuberculosis who developed a tuberculous spine and a tuberculous hip respectively.

Immediate Results of Treatment.

The following table shows the immediate results of treatment of patients discharged with
tuberculosis in 1938. In 14 cases the period of residence was less than 29 days; the results of
treatment in these are not included in the table.

Table CXI.

Period of Residence
Classification Condition at
on time Total
Under 3 3/6 6/12 Over 12
Admission of discharge.
months months months months
W. Ch. W. Ch. W. Ch. W. Ch.
Pulmonary:—
Class Quiescent . 3 5 1 1 — — 10
T.B. Not quiescent 3 — 1 - l — 5
Died ... .
Minus
~ j
Class Quiescent . 1 — — — _ _ _ 1
T.B. + Not quiescent — — — — — —
Group Died — — — — — —
I.
Class Quiescent 1 3 5 1
— — — —
10
T.B. + Not quiescent . 9 10 — 8 — 3 1 31
Group Died — — —
— —
11.
Class Quiescent — _ 1 _ _ ..
1
T.B. + Not quiescent 20 8 — 7 1 5 — 41
Group Died . 7 2 — 2 — 1 — 12
III.
Non-Pulmonary:— Quiescent . — — — — — _
Bones Not quiescent 1 — — — — — 1
and Died ... . — — — — — — —
Joints.
Quiescent 1 — 1 — — — — — 2
Abdomen. Not quiescent 1 2 :- — — — — 3
Died . — — — — — —
Quiescent . 1 — — — — — 1
Peripheral
Not quiescent — — — — — — — —
Glands.
Died — — — — — —
1
Totals ... ... 46 — 34 l 25 1 10 1 118

Abdominal Tuberculosis. Of 5 patients discharged with abdominal tuberculosis 3 were quiescent,

1 showed no improvement and 1 was transferred to Leeds General Infirmary. This patient
developed a pericardial effusion and a pericardiotomy was performed.

Insulin. 1 case of diabetes complicating the pulmonary condition was successfully controlled
with a suitable diet and Insulin.
 Artificial Pneumothorax Treatment. During the year artificial pneumothorax was induced
and maintained in 24 cases. This includes 1 bilateral pneumothorax. In 2 cases the pneumo¬
thorax was supplemented with Gold Salts and in 1 case with phrenic evulsion and Cadmium. In
all, 465 pneumothorax refills were given. Out-patients attended fortnightly for their refills.
In 17 cases discharged during the year the condition at time of discharge was, quiescent 3, im¬
proved 8 and no improvement 6.

Surgical Treatment. During the year 11 patients were seen by Mr. P. J. Moir, M.B., Ch.B.,
F.R.C.S., in consultation and 9 cases were transferred to the General Infirmary, Leeds. In 6 cases
the phrenic nerve was evulsed and in 3 cases the nerve was crushed. 6 cases were improved, 2
became worse and 1 died. The 2 remaining cases were admitted to St. James’s Hospital for
thoracoscopy. Mr. Fawcett, F.R.C.S., saw 3 cases in consultation and these were transferred to
Sheffield Royal Infirmary. 1 case had a “two stage’’ thoracoplasty, 1 case had an extra pleural
pneumothorax and 1 case had division of adhesions. These patients were improved.

Gold Salts. Sanocrysin, Solganol B Oleosum and Myocrysin were the preparations given.
18 patients were given a course of one or the other of these preparations. 272 injections were
given. 2 cases became quiescent, 8 cases improved and 8 cases showed no improvement.

Cadmium. A further trial was made with this new preparation which is an olive oil suspension
of cadmium sulphide. 10 cases received a complete course totalling 150 injections in all. In only
1 case was improvement noted.

Orthopaedic Treatment. 1 tuberculous spine and 1 tuberculous hip were complicated by pul¬
monary disease. The first case was transferred to Oakwood Hall Sanatorium and the second case
died. 1 case with tuberculous spine was transferred to Leeds General Infirmary under the care
of Mr. Broomhead, F.R.C.S.

Laryngology. Mr. Donald Watson, F.R.C.S., attended 4 sessions during the year. Twenty-
eight patients were examined and of these 8 were found to be suffering from tuberculous laryngitis.
Under special treatment improvement occurred in 5 patients.

Radiography. 366 X-Ray examinations were made during the year, the patients being sent
either to Staincliffe County Hospital or to Pontefract Dispensary. All films were taken by the
County Radiographer, including 3 lipiodol examinations of the chest and 1 Barium Meal.

Occupational Therapy. Mrs. Crowe, the Instructress, attends for two sessions (4 hours)
each week. Leatherwork, embroidery, table mat making and raffiawork are being taught. The
Medical Officers indicate those patients who are fit for this work before it is undertaken.

Dental Treatment. 21 patients saw Mr. F. G. W. Bruce, the Dental Surgeon, during the
year for extractions.

Provision of Clothing. 36 patients were provided with clothing under the County Council
Scheme.

Air Raid Precautions. At the time of the National Emergency in September, arrangements
were being made for all patients who were sufficiently well to be discharged to their homes and
for the Sanatorium to be reserved for the reception of acute cases of tuberculosis occurring in
women. This measure was essential because of the proposal to evacuate the Scotton Banks
Sanatorium which was to serve as a Base Hospital.

For the reception of ambulant patients and staff a large shelter trench was constructed in
the Sanatorium grounds. This was prepared in accordance with the existing Home Office spec¬
ifications, the floor being drained and covered with clinker and the trench lined with timber; the
whole surmounted by corrugated iron sheeting, earth, and a layer of turf. Entrance was by means
of a ramp.

Curtain rails and black curtains were provided for all the windows in the Sanatorium, to en¬
sure the effective elimination of light in the event of an air raid.

CROOKHILL HALL RECEIVING HOME, CONISBROUGH.

Dr. E. RATNER, the Medical Superintendent, reports: —

Buildings and Equipment.

Crookhill Hall is a mansion 300 years old. On the ground floor is one 8-bedded ward and on
the first floor are four wards each with 4 beds. 16 patients are housed in eight 2-bedded chalets.
There are no balconies or verandahs.

Staff.
Medical. Dr. Hayes terminated his services on receiving an appointment in Manchester, and
was succeeded by Dr. Vince, who commenced duties in December, 1938.
 166

Nursing and Domestic. There has been a great difficulty in securing nursing staff. This
necessitated some alteration in the staffing, and it was decided to abolish the Probationer Nurse and
employ “Assistant Nurses,’’ and increase the number of Wardmaids. It remains to be seen
whether the experiment will be successful.

Statistics. . The number of cases admitted during the year was 80 as compared with 73 in
the previous year. They were classified as follows :•—

Pulmonary.
T.B. Negative ... ... ... ... ... ... ... 27
T.B. Positive—Group I ... ... ... ... ... ... —
Group II ... ... ... ... ... ... 22
Group III ... ... ... ... ... ... 26

Total Pulmonary ... ... ... ... 75

The percentage of sputum positive cases was 64.

Observation . . 5

In 3 cases the period of observation was completed. A diagnosis of pulmonary tuberculosis

was established in 2 of these, 1 being retained for a period of treatment, and the third was dis¬
charged as non-tuberculous.

Immediate Results of Treatment.

The following table shows the immediate results of treatment of patients discharged with
tuberculosis in 1938. In seven cases the period of residence was less than 29 days; the results
of treatment in these are not included in the table.

Table CXII.

Period of Residence.
Classification on
Condition at time
admission to the Total.
of discharge.
Institution. Under 3 3-6 6-12 Over 12
months months months months

Pulmonary.
Class Quiescent 8 5 3 — 16
T.B. Not quiescent . 3 1 1 — 5
Minus Died . 1 1 — — 2

Class Quiescent . _ 2 1 ,
3
T.B. + Not quiescent ... 5 4 3 1 13
Group Died . — — — — —
II.

Class Quiescent _ _ _ 1 1
T.B. -f Not quiescent . 5 2 3 6 16
Group Died . 9 3 1 1 14
III.

Totals 31 18 12 9 70

During the year 79 patients were discharged or died. 20 patients died, of whom 5 died within
29 days of admission. Thus there was a death rate of 25-3%

Complications. The following complications were observed :>—

Silicosis and Tuberculosis ... 1 Rectal prolapse 2

Cancer of caecum ... ... ... 1 Tuberculous ulcer of the tongue 1
Pleurisy with effusion ... ... 2 Carcinoma Bronchus 1
Tuberculous Laryngitis ... ... 6 Spondylitis (non-tuberculous) 1
Tuberculosis Enteritis ... ... 2 Senile Decay 1
Syphilis ... ... ... ... 2 Mental Symptoms ... 2
Cerebral Haemorrhage 1

Occupations. The occupations of the patients discharged were as follows:—

Coal Miners 48
Labourers 9
Non-Manual Workers 5
Farm Workers 2
Textile Workers 2
Soldiers 2
Other Workers 11
 167

Artificial Pneumothorax. Artificial pneumothorax was attempted in two cases. One was suc¬
cessful but the patient refused to have it continued.

Phrenic Evulsion. A phrenic evulsion was successfully performed on two cases.

Gold. Gold treatment was carried out in one case, with indifferent success.

Dental Treatment. Mrs. Keates, the dental surgeon, visited the sanatorium and carried out
the necessary dental treatment.

X=Ray Examinations. All the X-Ray examinations were carried out at the Doncaster Dispensary.

Air Raid Precautions. During the summer of 1938 the staff attended a course of lectures at
the Conisbrough Isolation Hospital. In September certain alterations were made to ensure com¬
plete darkness in case of black-out. Preparations were also made to receive extra patients from
other sanatoria.

ELDWICK SANATORIUM, Bingley.

During the year a Special Sub-Committee was appointed to consider the future of the Eldwick
Sanatorium, and it was ultimately decided that the retention of this institution was uneconomic,
the beds being surplus to the requirements of the County Council.

The Sanatorium was closed on the 7th January 1939 and, therefore, the statistical matter
contained in this report refers also to those patients removed during the first week in 1939.

Statistics. The number of cases admitted during the year was 64, classified as follows:'—

Pulmonary.
T.B. Negative ... . 15

Non=PuImonary.
Bones and Joints . 1
Abdomen . 10
Glands ... . 7

Observation. ... . 31

Total 64

Immediate Results of Treatment.

The following table shows the immediate results of treatment of patients discharged with
tuberculosis in 1938. In 2 cases the period of residence was less than 29 days and the results of
treatment are not included in the table.

Table CXIII.

Period of Residence.
Classification on Condition at
admission to the time Total
Institution. of discharge. Under 3 3-6 6-12 Over 12
months months months months

Pulmonary:—
Class Quiescent 1 12 9 i 23
T.B. Not Quiescent 6 8 5 3 22
Minus Died ... ... ... — — —

T.B. + Quiescent . 1 1
Group Not Quiescent . — — — _ —

I. Died — — — — —
Non-Pulmonary:—
Bones Quiescent
and Joints Not Quiescent . 1 _ _ 1
Died . — — — —

Quiescent ... ... ] 14 1 1 17

Abdomen Not Quiescent . 1 _ _ —
1
Died ... ... ... — — —

Peripheral Quiescent ... ... 8 2 10

Glands Not Quiescent — 1 1 1 3
Died .../ ... ... — — — —

Totals ... 10 35 25 8 78
 168

Dr. Margaret Sharp, Medical Superintendent, reports:—

Twenty children were in residence on the 31st December 1938, of whom twelve were trans¬
ferred to Scotton Banks Sanatorium to complete treatment, and eight went home.

For the sake of completeness, these have been included in the returns for 1938, but the result
is to send up unduly the number of cases tabulated as discharged non-quiescent. An analysis of
such cases shows :—

Transferred to Scotton Banks ... 11

Refused such transfer 5
Transferred to Orthopaedic Hospital
(knee case) 1
Irregular discharges (removed by parents
before completion of treatment) 7
Discharged in the ordinary course as
non-quiescent 5

29

Observation Cases. Forty children were admitted for periods of observation and diagnosis; of
these, twenty-five were notified as tuberculous and retained for treatment. Of those not con¬
sidered tuberculous, the most interesting cases were:—

1. A boy found to be suffering from eyestrain. His whole condition altered rapidly after
glasses had been obtained for him, and all symptoms disappeared.

2. A boy who had been in hospital with a severe febrile attack, accompanied by abdominal
symptoms. These symptoms did not appear at all during his stay in the sanatorium, but he had
some pain and marked loss of power in one leg. This recovered completely, though slowly.

These two cases illustrate the desirability of keeping doubtful cases long enough to observe
the effect of treatment on their symptoms.

Mantoux Test. This was made in every case with 1 in 1,000 and 1 in 100 dilutions of human
tuberculin and bovine tuberculin successively, in order to ascertain whether any reaction indicating
tuberculous infection would take place.

29 cases were found to be negative to all four tests. Of these 13 were observation cases not
finally considered tuberculous. The remainder, though notified before admission as tuberculous,
were regarded as doubtful.

48 cases were positive to Human Tuberculin and 8 cases were positive to Bovine Tuberculin
only. Of the latter, one was a case of abdominal tuberculosis and one tuberculous glands. The
other 6 were cases of pulmonary tuberculosis, of which one was a boy of 12 years who had had
an acute attack of pleurisy before admission, and had another on the same side after he had been
in the Sanatorium a few weeks. This seems to emphasise the importance of using the Bovine
Tuberculin for the test in all cases negative to Human Tuberculin.

X=Ray Examinations. 81 children had skiagrams taken before admission. Of these, 25 were
so examined once again after admission, and 12 were examined 2, 3, or 4 times. The help so
obtained in observing the progress of lung cures has been considerable, but in no instance did a
skiagram of the abdomen throw any light upon a case; calcified glands, if present, bearing no
relation to symptoms and palpable masses of glands not always appearing on the film.

Tonsils and Adenoids. Tonsils and adenoids were removed for 17 children; throat conditions
were improved in all, and 3 cases showed marked improvement in chest conditions and general
health.

Dental Treatment. The dentist attended for two consecutive visits every three months, inspected
all the children, and gave all treatment required.

Ultra-Violet Light Treatment.

Carbon Arc Lamp. Treatment was commenced at 3 feet from the lamp, 3 minutes exposure
being given back and front, increasing by 3 minutes at each sitting up to 30 minutes each way. It
is found that most children do not easily stand exposures of longer than one half hour at a time,
so that where a stronger dose was needed, it was obtained by gradually bringing the child nearer
to the lamp, up to 2^ feet, which is as near as the heat will allow.
 169

Mercury Vapour Lamp. Exposures were applied as for carbon arc, but were only carried up
to 15 minutes each back and front. This lamp was also used for local treatment in some cases
of glands, being “pushed’* until a strong erythema was induced, and then omitted for a time.

Results Carbon Arc Mercury

Lamp Vapour
Lamp
Good result (not necessarily due to lamp). 25 5
Fair result 2 —

Definite benefit ... . 11 7

Treatment not complete . 8 3

46 15

As a rule, the most marked benefit was shown in cases complicated by asthma, nervous sym¬
ptoms or anaemia, but there were some cases where the response was immediate though we had
no special reason to expect it.

Infectious Diseases. One case of diphtheria arose, and was unaccounted for, but there were no
further cases. No epidemic of any kind arose during the year.

Air Raid Precautions.

General.
Towards the end of 1937 the Air Raid Precautions Act became law, and this Act required
inter alia a county council to prepare Air Raid Precautions schemes for securing the protection of
the civil population throughout the whole county. From the public health standpoint the chief
effect was to require the County Medical Officer to become the Executive Officer for securing :>—

(a) the co-ordination and expansion of the necessary ambulance services;

(b) the maintenance of close liaison with the medical aspect of the various schemes prepared
in the 16 A.R.P. divisions into which the County has been divided;
(c) assistance in the preparation of schemes for emergency hospital services and in acting
as Hospital Liaison Officer;
(d) the making of suitable arrangements for anti-gas training of the personnel of County
Hospitals ;
(e) approval of arrangements for the training of the personnel of first-aid posts and first-aid
points;
(f) the establishment of a Civil Nursing Reserve and the organisation of a scheme for
securing applicants for enrolment as nursing auxiliaries, the interviewing of candidates,
training' of approved applicants in first-aid and home nursing and their subsequent practical
training in hospitals.

It will be noted that generally speaking local A.R.P. Committees in the 16 divisions into which
the County has been divided have been left to deal with the local problems such as anti-gas
training, establishment of first-aid posts and points, ambulance units and decontamination centres.
The following table shows the areas included in the 16 A.R.P. divisions, the name and address of
the organiser, telephone number, number of first-aid posts and number of mobile units.

Table CXIV.

No. of No. of
A.R.P. Name and Address of Telephone
Districts. F.A. Mobile Total.
Division. Organiser. No.
Posts. Units.

Ewecross. Sedbergh R. Major J. Clark, O.B.E., Settle _

Settle R. Martins Bank Chambers, 3170. 1 1 2
Bowland R. Duke Street, Settle. — — —

Skipton. Barnoldswick U. Inspector J. G. Rochester, Skipton 1 _ 1

Earby U. Martins Bank Chambers, 658. 1 — 1
Skipton U. High Street, Skipton. 1 1 2
Silsden U. — 1 1
Skipton R. — — —

Claro. Harrogate B. G. A. McDowall, Harrogate 3 — 3

Ripon C. /la,Wells House, 5220. 1 1 2
Ivnaresborough U. Cold Bath Road, Harrogate. 1 1 2
Nidderdale R. — — —
Ripon and Pateley — — •—
Bridge R.
 170

No. of No. of
A.R.P. Name and Address of Telephone
Districts. F.A. Mobile Total.
Division. Organiser. No.
Posts. Units.

Keighley. Keighley B. S. N. Jenkinson, M.B.E., 3 1 4

Bingley U. 66, North Street, Keighley. Keighley 1 — 1
Denholme U. 2495. — --
Shipley U. 1 1 2

Skyrack. Pudsey B. Captain J. Pullan, Guiseley 3 — 3

Aireborough U. Town Hall, Guiseley, 567. 1 1 2
Baildon U. Near Leeds. 1 — 1
Ilkley U. 2 — 2
Horsforth U. i — i
Otley U. i — i
Wharfedale R. — 1 i

Barkston Ash. Garforth U. Major M. H. Birch-Reynardson, Tadcaster i 1 2

Tadcaster R. Kirkgate, Tadcaster. 211. i l i 3
Wetherby R. i J
Calder Valley. Brighouse B. Captain T. Campbell, Sowerby 2 — 2
Todmorden B. 21, Town Hall Street, Bridge i 1 2
Elland U. Sowerby Bridge. 81558. i — 1
Hebden Royd U. i 1 2
Ripponden U. i — i
Sowerby Bridge U. i — i
Queensbury and — 1 i
Shelf U.

Spen Valley. Batley B. Captain D. Griffiths, Heckmond- i 1 2

Heckmondwike U. 1, Church Street, wike i — i
Mirfield U. Heckmondwike. 295. i — i
i 2 3
Spenborough U.

Morley and Morley B. Captain J. R. Atkinson, Morley 3 i 4

District. Ossett B. Town Hall Buildings, 779. 1 — 1
Horbury U. Morley. 1 — 1
Normanton U. 1 i 2
Rothwell L . 1 l i 3
Stanley U. 1 j
Wakefield R. — i 1

Pontefract 2 — 2
Pontefract and Pontefract B. Inspector T. Downhill,
District. Castleford U. Beastfair, 532. 3 i 4
Featherstone U. Pontefract. 1 — i
Hems worth U. 1 — i
Knottingley U. 1 — i
Hemsworth R. 4 1 5

Goole. Goole B. Major T. A. B. Elliott, Goole i 2 3

Selby U. National Provincial Bank 439. i — 1
Goole R. Chambers, — — —
1 X '
Osgoldcross R. Boothferry Road, — 1 1
Selby R. Goole. 1 1

2 2
Upper Agbrigg. Colne Valley U. Captain F. Roper-Lowe. Honley
Denby Dale U. Council Offices, 303. i — i
Holmfirth U. Honley. i 2
1
Kirkburton U. i i
Meltham U. — 1 i
i 1 2
Saddleworth U.

Penistone. Penistone U. VV. T. Kimberlin, i i

Stocksbridge U. Edward Street, i — i
Penistone R. Stocksbridge. — — —
Wortley R. i 2 3

Staincross. Cudworth U. Captain H. A. P. Symons, M.C., Barnslev i — 1

Darton U. 73, Church Street, 3067. i i 2
Darfield U. Barnsley. i — i
Dodworth U. — i i
Hoyland Nether U. i — i
Royston U. — i i
Wombwell U. i — 1
Worsborough U. i i 2

Rother Valley. Maltby U. Captain T. E. Peart, M.C., Rotherham i — i

Rawmarsh U. 44, Moorgate, 1566. i i 2
Swinton U. Rotherham. i — i
Wath-upon- i — i
Dearne U.
Kiveton Park R. i i 2
Rotherham R. 2 i 3

Don Valley. Adwick-le-Street J. A. Harrison, Doncaster 2 — 2

U. Nether Hall, 3427.
Bentley-w-Arksey Doncaster. 1 — i
U.
Conisbrough U. 1 i 2
Dearne U. 1 i
2 — 2
Mexborough U.
Tickhill U. — — —
Doncaster R. 5 — 5
Thorne R. 3 3
 171

Establishment of County Ambulance Services.

In accordance with the suggestions contained in the Ministry of Health Circular 1764 dated
10th January, 1939, arrangements have been made for one of the County Sanitary In¬
spectors (Mr. R. D. Irving) to be seconded as County Ambulance Officer. His work has been
directed chiefly to the co-ordination of the local schemes for the provision of ambulance services
and the earmarking of vehicles suitable for conversion into ambulances in the event of an emergency.
As one of the preliminary steps in this work the local medical officers of health have been asked to
appoint district ambulance officers who will assist the County Ambulance Officer with the work
in each individual district.

FirsUAid Posts, Mobile Units and Points.

As a result of conferences with the local authorities convened in March, 1939, definite proposals
for the establishment of first-aid posts and mobile units in the different districts were submitted to
the Ministry of Health. The Ministry eventually agreed to the establishment of 96 first-aid posts
and 39 mobile units in the various County Districts, but following subsequent correspondence the
number of mobile units was increased to 41. Details of the number of first-aid posts and mobile
units are shown in Table CXIV on pages 169 and 170.

Training of Personnel.
The personnel required for the staffing of first-aid posts and mobile units is 5,678. Many
of these have already been trained in first-aid and anti-gas measures through the efforts of the
local St. John Ambulance Brigades and the district medical officers of health.

The appointment of medical practitioners to the first-aid posts is being undertaken by the
local Emergency Committees of the British Medical Association and at the present time a number
of doctors have already been provisionally appointed. Arrangements are now being made for the
collective training of first-aid post personnel which will be undertaken under the direction of the
medical officer in charge.

Storage of Equipment.
Arrangements have been made for the storage of equipment for first-aid posts and mobile
units in the County Central Stores at Wakefield, and these are kept ready for immediate trans¬
mission to the appropriate first-aid posts if needed. The equipment for the first-aid points is
being distributed to the stores already provided in the 16 A.R.P. divisions.

AntbGas Lectures.
During the year, courses of instruction in anti-gas technique were arranged, at which many
medical practitioners, school medical inspectors, school dental surgeons, health visitors and midwives
attended. In addition, the necessary steps were taken for courses of lectures to be given to the
nursing and other staffs of the County Hospitals and Sanatoria.

Hospitals.
The officials of the Ministry of Health have completed their survey of all the hospital accom¬
modation available in the Administrative County of the West Riding of Yorkshire. As a result
of this survey it is stated that the present capacity of the hospitals in the Administrative County
is 6,800 beds and it is proposed that this number should be increased by 4,600 beds (making a
total of 11,400) by the crowding of beds in certain wards, the use of rooms in hospitals not at
present used as wards and the erection of temporary hutments on hospital sites. This expansion
of hospital beds will necessitate a large reserve of nurses to staff the additional accommodation
and the steps now being taken are referred to below.

Equipment for Hospitals.

In the meantime certain equipment, e.g., mattresses, mattress covers, pillow cases, dressings,
drugs, etc., has been received and is being stored in the various County Hospitals and Sanatoria.
Consideration is also being given to the establishment of first-aid posts at two of the County
Hospitals situated in populous areas.

The necessary steps have been taken to make arrangements for the darkening of all windows
and other parts of the hospitals, where necessary. Questions relating to the provision of additional
operating theatre accommodation, X-Ray apparatus, kitchen and stores accommodation are now
being considered.

Civil Nursing Reserve.

It will be noted from the paragraph under “Hospital Accommodation” that approximately
2,000 nursing auxiliaries will be required for the County Administrative Area to assist in the
staffing of the “upgraded” hospitals. The necessary steps are being taken to establish local
committees in the various “Hospital Areas” to interview candidates and to make the necessary
arrangements for training in first-^id and home nursing. Subsequently it is proposed that the
County Medical Officer will assist'in securing the training of these nursing auxiliaries in practical
hospital work, and a County card index register of such nursing auxiliaries will be maintained. In
the meantime the necessary steps are being taken to secure information relating to those nursing
auxiliaries who would be willing to serve in any part of the County or who wish to restrict their
services to hospitals in the vicinity of their homes.
 172

In addition, efforts are being made to obtain a complete list of all trained nurses who have
either retired or have recently married or are otherwise not engaged in actual nursing work.
These trained nurses are being asked if they will be prepared to volunteer for service in the event
of an emergency.

Conclusion.
In accordance with the general A.R.P. scheme for the Administrative County, the County
Medical Officer has been appointed as a Deputy Controller and executive officer in charge of the
first-aid and ambulance services in the County as well as the officer responsible for hospital liaison
and hospital emergency services.
 173

INDEX.
Page
Air Raid Precautions and National Defence 3, 169-172
Ante-Natal Supervision ... 2, 83-91
Area and Population of Administrative County ... 12, 13
,, ,, ,, County Districts 19 (Table VI)
Atmospheric Pollution (See also Smoke Abatement, page 41) 50-51
Bacteriological Laboratory ... 65-72
Births and Birth Rates ... 12, 13, 14, 17 (Table III), 18 (Tables IV and 19 (Table VI)
Births, Notification of 98
Birth Control ... .., 91
Blindness, Prevention of 57
Cancer, Mortality from
2, 3, 16 (Table 1), 17 (Tables II and III), 18 (Table V), 20 (Table VII), 22, 23
,, Treatment of Patients by Radium 57-58
Cardigan Sanatorium ... 163-165
Cerebro-Spinal Fever, Incidence of, etc. 28 (Table XVIII), 3C 31 (Table XX, Col. 8)
Child Life Protection 132
Child Welfare Centres ... 102-112
Children Under School Age, Homes and Hospitals for ... 96,130
Clinics, Multiple, Provision of 102
Consultant Obstetricians and Gynaecologists ... 5-6, 84
Convalescent Home for Delicate Women and Children 96
Crookhill Hall Receiving Home ... 165-167
Deaths and Death Rates ... 3, 12, 14-27
Dental Treatment of Expectant and Nursing Mothers 130
Diphtheria ... ... ... 227 (Table XVII), 28 (Table XVIII), 28, 29 31 (Table XX, Col. 4)
District Medical Officers (Public Assistance), List of 7-9
,, ,, ,, ,, ,, W ork of 58
Drainage and Sewage Disposal 42
Dysentery, Incidence of, etc. 30, 31 (Table XX, Col. 14)
Early Years of Life, Mortality in ... 23-24
Eldwick Sanatorium 167-169
Enteric Fever, Incidence of, etc. 27 (Table XVII), 8 (Table XVIII), 29 31 (Table XX, Col. 5)
Epidemiology 27-31
Family Circumstances, Verification of (Maternity 128-129
Food and Drugs (Adulteration) Act, 1928 49-50
Food Poisoning 67
Health Visitors, Revision Course for 102
,, ,, Staff 98
,, ,, Home Visits by ... 98
Heart and Circulatory System, Diseases of 3, 17 (Tables II and III)
,, Disease, Mortality from 12, 16 (Table I), 18 (Table V), 21
Home Helps (Maternity and Child Welfare) 82
Housing 39-41
Hospital Accommodation, General ... 3, 53-56
Hospital Treatment for Children under 5 years 130
Infant Mortality ... ... 2, 18 (Tables IV and \ 19 (Table VI, Cols. 7, 19, 20), 25-27, 73
Infantile Paralysis, Incidence of ... ... ... 28 (Table XVIII), 30, 31 (Table XX, Col. 9)
Infectious Disease, Incidence of ... 27-31
Inspectresses of Nurses and Midwives ... 100
Isolation Hospital Accommodation, County Scheme under Public Health Act, 1936,
Section 185 3, 32-35
Isolation Hospitals, Cases Removed to ... ... ... ... 30, 31 (Table XX, Cols. 24-27)
Laboratory, County Public Health 65-72
Legislation, etc., during 1938 37-38
Library Books, Disinfection of ' 52
Maternal Mortality ... ... ... ... 2 18 (Table V), 19 (Table VI, Cols. 16-18), 115-127
Maternity and Child Welfare Service ... ... ... ... ... ... ... ... 73-133
Maternity Homes and Hospitals, Accommodation, Admission of Patients, etc. 92-95
,, ,, ,, ,, Collection of Fees ... 95-96
Meals, Provision of, for Expectant Mothers 132
Measles, Visits to Cases by Health Visitors 98
Medical Examination of County Council Staff 64
Medical Officers of Health (County Districts) 6, 19 (Table VI, Col. 21)
Middleton-in-Wharfedale Sanatorium . 155-160
Midwifery Service ... ... ... 73-80
Milk, Bacteriological Examination of 66, 68, 69
Milk, Pasteurised (Phosphatase Test) 71
,, Samples taken under Food and Drugs (Adulteration) Act, 1928 50
,, (Special Designations) Orders, 1936 and 1938 ... 47
,, and Dairies (Consolidation) Act, 1915 49
,, Supply of, to School Children 47-49
,, Supply of, to Mothers, and Children under 5 years of age ... 131
Ministry of Health, Circulars and Orders 37-38
 174

INDEX—continued.
Page
National Defence (see under Air Raid Precautions).
National Health Campaign ... 52
Notification of Births (Maternity and Child Welfare) 98
Nursery Schools and Classes 113
Nurses, Training- of ... 99
Nursing Associations 97
Nursing Homes, Registration of ... 81
Nursing Staff (Maternity and Child Welfare) 98
Obstetricians and Gynaecologists, Consultant 5-6, 84
Ophthalmia Neonatorum, Treatment of, etc. 28 (Table XVIII), 31 (Table XX, Col. 15), 81
Pharmacy and Poisons Act, 1933 ... . 53
Polio-Encephalitis .28 (Table XVIII), 30
Poliomyelitis, Acute ... 28 (Tab! XVII1), 30, 31 (Table XX, Col. 9)
Population 13, 19 (Table VI, Col. 3)
Public Assistance Institutions, Medical and Nursing Stall’s . 11
,, ,, ,, Available Accommodation and Beds Occupied ... ... 58, 59
,, ,, ,, Admission of Maternity cases ... ... ... ... 95
,, ,, ,, Tuberculosis Cases in ... ... ... ... ... ... 146
,, ,, ,, Work Undertaken in Sick and Infirm Wards 59 (Tables XLI & XLII)
,, ,, Medical Services ... ... ... ... ... ... ... ... 58
Puerperal Fever and Pyrexia, Arrangements for Hospital Treatment of ... ... ... 80
,, ,, ,, Statistics relating to notification of cases
28 (Table XVIII), 31 (Table XX, Col. 7)
Radium, Treatment of Patients by ... ... ... ... ... ... ... ... 57-58
Refuse Collection and Disposal ... ... ... ... ... ... ... ... ... 46
Sanitary Accommodation ... ... ... ... ... ... ... ... ... ... 46
Scarlet Fever, Incidence of, etc. 27 (Table XVII), 28 (Table XVIII), 28, 31 (Table XX, Col. 3)
Scavenging (See “Collection and Disposal of Refuse,” page 46).
Scotton Banks Sanatorium ... ... ... ... ... ... ... ... ... ... 161-163
Sewerage and Sewage Disposal ... ... ... ... ... ... ... ... ... 42
Smallpox Hospital Accommodation, Countv Scheme under Public Health Act, 1936
Section 185 ... ... ... ... ... ... ... ... ... ... ... 32-35
Smallpox, Incidence of, etc. 27 (Table XVII), 28 (Table XVIII), 28, 31 (Table XX, Col. 2)
Smoke Abatement (See also Atmospheric Pollution, pages 50 to 51) ... ... ... 41
Staincliffe County Hospital, Dewsbury ... ... ... ... ... ... ... ... 53-56
Staff, List of . 4-11
Staff of County Council, Medical Examination of . 64
Still Births .'. . 19 (Table VI, Col. 8)
Swimming Baths and Bathing Pools . 51-52
“Toddlers,” Clinics for .114, 115
Tuberculosis, Incidence and Mortality 19 (Table VI, Cols. 13 and 14), 134-137, 139
,, Notifications of 28 (Table XVIII), 31 (Table XX, Cols. 17 and 18), 137-138
Tuberculosis, Treatment of:—
Applications for Treatment . 146 (Table XCV)
Care Committees 150 (Orthopaedic After-Care), 151
Cases on Register ... 138, 144
Clothing, Provision of, in necessitous case 148
Consultant Surgeons T43
Dental Treatment 149
Dispensary Areas and Staff ... ... 140,145
Dispensary Attendances 139
Dispensary Premises ... 140
Dispensary Treatment ... 139-147
Distress Fund 148
Environmental Condition of Patients 142 (Table XCI)
Extra Nourishment Grants, etc. 150
Home Visitation of Patients ... 146 (Table XCVII)
Institutional Treatment ... 151-169
Instructional or Occupational Therapy and Tramin 148, 160, 165
Orthopaedic After-Care 150
Public Assistance Institutions, Cases in 146
Results of Treatment ... 142, 49. 4-155, 156, 162, 164, 166, 167
Sanatorium Accommodation 152
,, Treatment (see under “Institutional rent me nt
Surgical Appliances, Supply of, to Patients 150
Vocational Training, Occupational Therapy, etc. 148, 160, 165
War Pensioners, Treatment of 148
X-Ray Examination, Arrangements for 147
Typhoid Fever, Incidence of, etc. (See under “Enteric Fever”),
Ultra-Violet Ray and Light Treatment of School Child ren and Infants 127
Vaccination, Public ... 7-11, 60-64
Venereal Diseases, Treatment of 36-37
Vital Statistics, Summary of 12
Water Supplies 42-46
White Rose County Hospital, Wakefield 53, 54, 56
Widows’, Orphans’ and Old Age Contributory Pensions Act, 1925 133
Zvmotic Disease 19 (Table VI, Col. 12), 27-31
 -