HORNC 29 Hornchurch Urban District Council ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1961 Public Health Department, James Gorman, Council Offices, M.B., Ch.B., D.P.H., F.R.S.H. Billet Lane, Medical Officer of Health HORNCHURCH, Essex. Telephone: Hornchurch 52555 Hornchurch Urban District Council ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1961 Public Health Department, James Gorman, Council Offices, M.B., Ch.B., D.P.H., F.R.S.H. Billet Lane, Medical Officer of Health HORNCHURCH, Essex. Telephone: Hornchurch 52555 2 TABLE OF CONTENTS Page Members of the Council (as at 31.12.61) 3 SECTION A - Statistics and Social Conditions of the Area 7 SECTION B - General Provision of Health Services for the Area 11 SECTION C - Sanitary Circumstances of the Area 14 SECTION D - Housing 26 SECTION E - Inspection and Supervision of Food and Food Premises 29 SECTION F - Prevalence of, and control over ,Infectious and other Notifiable Diseases 40 SECTION G - Factories Acts, 1937 to 1959 47 Index 49 3 MEMBERS OF THE COUNCIL (as at 31.12.61.) Councillor Mrs. E. H. Dean, J. P., Chairman. (1) Councillor A. C. Good, Vice-Chairman. (1) and (2) Councillor Mrs. W. M. Illingworth. " Mrs. J. L. C. Moore. (1) E. W. Bull. (1) L. W. CarroU, J. P. (1) F. W. H. Embleton. (1) A. J. Hall. " D. L. Hammerton. " G. F. Hancock. K. T. Hay. W. Hegarty. (1) E. A. HHlman, J. P. H. Holock. A. T. James. (1) S. A. Legg. " M. P. V. Leigh. " A. A. Livingstone. " J. S. Macy. " N. J. Miles. (1) " H. F. Moss. " J. F. Moultrie, J. P. " L.J. NichoHs. (1) " F. J. Powell. (1) and (3) " N. E. Richards. " A. C. Salinger, J. P. " S. B. Sanders. " B. K. Snooks. " A. J. Twigger. " C. A. Welch. (1) Member of Public Health Committee. (2) Chairman of Public Health Committee. (3) Vice-Chairman of Public Health Committee. 4 OFFICERS OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health: James Gorman, M.B.,Ch.B.,D.P.H.,F.R.S.H. Deputy Medical Officer of Health: (Part time) P. X. O'Dwyer, M.B., B.Ch., B.A.O., D.P.H. Chief Public Health Inspector: M. F. G. Randall, M.A. P.H.I. (1) and (2) Deputy Chief Public Health Inspector: E. Oliver, M.A.P.H.I. (1), (2) and (3). (Appointed 1.1. 61.) Public Health Inspectors: E. J. Day, M.A.P.H.I., (1), (2) and (3). W. R. M. Gray, (1), (2) and (3). (Commenced 30.1. 61). A. V. J. Hutchings, M.A.P.H.I. (1) and (2). R. E. Ingleby, M.A.P.H.I. (1), (2) and (3) (Commenced 1.3.61). M. A. Jackson, M.A.P.H.I. (1) and (2). F. W. Reeve, M.A.P.H.I. (1) and (2). G. H. Smith, M.A.P.H.I. (1), (2) and (3). S. Whitfield, M.A.P.H.I. (1) and (2). Chief Clerk: J. E. Blay. Clerical Staff: Miss E. Thompson. Miss W. A. Hepburn. P. R. Cheese. Rodent Operative and General Assistant: W. T. Blanchard. Public Analysts: J. Hubert Hamence, M.Sc., Ph.D., F.R.I.C. P. S. Hall, B.Sc., F.R.I.C. (1) Public Health Inspectors' Certificate of the Royal Society of Health and Public Health Inspectors' Joint Board. (2) Certificate of the Royal Society of Health as Inspector of Meat and and other Foods. (3) Certificate of the Royal Society of Health as Smoke Inspector. 5 Public Health Department, Council Offices, Billet Lane, HORNCHURCH, Essex. 20th May, 1962. Telephone: Hornchurch 52555. To The Chairman and Members of the Hornchurch Urban District Council. Madam Chairman, Ladies and Gentlemen, I beg to present my Report on the health of the district for the year 1961. It is with real regret that I note the death during the year of Dr. Alfred Ball, Medical Officer of Health of Romford Urban and Rural District Councils from 1921, part-time Medical Officer of Health Hornchurch 1926 and the first full-time Medical Officer of Health of this district from 1934 until his retirement at the end of 1945. I am indebted to Dr. O'Dwyer for the following appreciation:- "Dr. Alfred Ball's association with Public Health work In this part of Essex covered a span of 26 years. He served the area In the early formative years of Local Government in Essex, becoming your first full-time Medical Officer of Health in 1934 when the district was enlarged. He was of retiring disposition, but his personal charm and many kindly actions won him the respect and affection of all with whom he was associated. He retired in December 1945 because of failing health, having earned the highest regard of the people of the district whose interests he had served so faithfully." Population; and Vital Statistics. The population showed a material increase - mid-year figure 131,070. The birth and death rates each showed a slight drop, whilst the Infant Mortality figure rose somewhat. Clean Air. Continued progress is being made In our objective of a smoke-free Hornchurch. Food and Drugs. The year's work was largely routine; always interesting, never glamorous. This section of our Department plays an invaluable part in safeguarding the quality of our food supplies. Sewerage. The Regional Scheme has not yet achieved the strictly practical stage, although a certain amount of progress to that end appears to have been made. 6 Infectious Disease. The year whilst showing some change of pattern did not present any features of disquiet. Roval Commission on Local Government in Greater London. No firm decisions have yet been made at Central Government level. Acknowledgments. My best thanks are due to my fellow Council officials in other Departments, and especially to Dr. O'Dwyer, Mr. Randall and Mr. Blay in my own Department. I am, Your obedient servant, James Gorman, M.B., Ch.B., D.P.H., F.R.S.H. Medical Officer of Health. 7 SECTION A STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area in acres (including hall of tidal basin) 20, 308 Registrar-General's estimate of Home Population (mid-year 1961) 131,070 Number of inhabited houses according to rate books (December 1961) 40,208 Rateable Value (December 1961) £1,874, 107 Sum represented by a penny Rate (December 1961) £7, 675 Extracts from Vital Statistics for the Year. Live Births: Number 2,399 (1, 226 males,1, 173 females) Rate per 1,000 population 17.01 Illegitimate Live Births (percent of total live births) 2.3 Stillbirths: Number 41 (22 males, 19 females) Rate per 1,000 total live and stillbirths 16.8 Total Live and Stillbirths 2,440 Infant Deaths (deaths under 1 year) 54 (30 males, 24 females) Infant Mortality Rates: Total infant deaths per 1, 000 total live births 22.92 Legitimate infant deaths per 1,000 legitimate live births 21.75 Illegitimate infant deaths per 1,000 illegitimate live births 54.54 Neo-Natal Mortality Rate (deaths under 4 weeks per 1,000 total live births) 16.25 Early Neo-natal Mortality Rate (deaths under 1 week per 1,000 total live births) 15.42 Perinatal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and still births) 31.96 Maternal Mortality (including abortion): Number of deaths 1 Rate per 1,000 total live and still births 41 Deaths: Number 1,134 (581 males, 553 females) Rate per 1,000 population 10.52 8 DEATH RATE - COMPARISON WITH PREVIOUS YEARS 1946 9.0 1954 12.1 1947 8.3 1955 11.6 1948 8.2 1956 10.5 1949 10.6 + 1957 10.4 1950 10.4 1958 10.2 1951 10.3 1959 10.9 1952 10.4 1960 11.0 1953 13.1 1961 10.5 +Area Comparability Factor returned The Area Comparability Factor for deaths this year altered from 1.23 to 1.25 and for births from 0. 94 to 0.93. BIRTH RATE - COMPARISON WITH PREVIOUS YEARS. 1946 21.3 1954 14.7 1947 20.7 1955 15.4 1948 17.2 1956 16.7 1949 16.0 1957 17.1 1950 13.6+ 1958 18.5 1951 14.1 1959 18.1 1952 13.8 1960 18.3 1953 14.8 1961 17.0 +Area Comparability Factor returned The Area Comparability Factor might very generally be translated as one which being applied to certain local figures makes them suitable for general comparisons. 9 GENERAL MORTALITY - MAIN CAUSES 1951 - 1901 Causes of Death 1051 1052 1053 1054 1055 1056 1057 1058 1050 1060 1061 Tuberculosis (all forms) 25 17 21 11 4 5 3 9 5 10 4 Cancer 183 184 211 234 210 253 248 236 247 235 206 Infectious diseases 4 1 3 1 2 0 2 0 2 0 1 Cardio-vascular disease 418 425 602 500 501 682 670 502 560 548 565 Influenza 10 2 14 1 2 7 8 6 12 0 5 Pneumonia 30 40 52 41 40 53 65 58 57 30 56 Bronchitis 60 52 85 54 65 05 70 76 61 65 76 Other respiratory diseases 7 9 10 8 10 7 9 13 14 8 10 Gastro intestinal diseases 16 12 28 13 10 14 10 15 13 13 13 Motor vehicle accidents 14 9 11 10 12 8 10 15 9 10 22 All other accidents 12 4 10 18 18 20 18 15 8 18 13 Suicide 11 10 7 11 11 9 14 8 12 9 10 Cancer caused 29 fewer deaths and Tuberculosis 6 fewer than In the previous year as against which Cardio-vascular disease and Pneumonia each Increased by 15, whilst Bronchitis was responsible for 11 more deaths. 10 REGISTRAR - GENERAL'S ABBREVIATED LIST OF CAUSES OF DEATH IN CERTAIN AGE GROUPS (Corrected for Inward and Outward Transfers) CAUSES OF DEATH ALL AGES Age Groups Under 1 1 - 4 5 -14 15-24 25-44 45-64 65-74 75 and upwards Total Male Female M F. M. F. M. F. M. F. M. F. M F. M. F. M. F. 1. Tuberculosis, respiratory 3 2 1 - - - - - - - - - - 1 1 1 - - - 2. Tuberculosis, other 1 1 0 - - - - - - - - - - 1 - - - - - 3. Syphilitic disease 2 0 2 - - - - - - - - - - - - - - - 2 4. Diphtheria 0 0 0 - - - - - - - - - - - - - - - - 5. Whooping Cough 0 0 0 - - - - - - - - - - - - - - - - 6. Meningococcal infections 1 0 1 - - - - - - - - - - - 1 - - - - 7. Acute Poliomyelitis 0 0 0 - - - - - - - - - - - - - - - - 8. Measles 0 0 0 - - - - - - - - - - - - - - - - 9. Other infective and parasitic diseases 1 1 0 - - - - - - - - - - - - 1 - - - 10. Malignant neoplasm, stomach 23 12 11 - - - - - - - - 1 - 5 4 3 3 3 4 11. Malignant neoplasm, lung, bronchus 46 37 9 - - - - - - - - - - 23 4 10 3 4 2 12. Malignant neoplasm, breast 21 0 21 - - - - - - - - - 1 - 10 - 3 - 7 13. Malignant neoplasm, uterus 4 0 4 - - - - - - - - - - - 2 - 1 - 1 14. Other malignant and lymphatic neoplasms 114 59 55 - - 1 - - 1 - - 7 8 26 16 11 13 14 17 15. Leukaemia, aleukaemia 11 6 5 - - - - - - - - 2 - 2 - 1 4 1 1 16. Diabetes 8 2 6 1 - - - - - - - - - - 2 - - 1 4 17. Vascular lesions of nervous system 155 48 107 - - - - - - - - - 1 9 15 13 20 26 71 18. Coronary disease, angina 187 123 64 - - - - - - - - 2 - 62 14 34 22 25 28 19. Hypertension with heart disease 28 10 18 - - - - - - - - - - 2 1 3 1 5 16 20. Other heart disease 143 49 94 - - - - - - - - 3 4 6 11 6 16 34 63 21. Other circulatory disease 52 36 16 - - - - - - - - 1 1 10 6 10 5 15 4 22. Influenza 5 4 1 - - - - - - - 1 - - - - 3 - 1 - 23. Pneumonia 56 31 25 4 5 1 - - - - - 2 - 4 2 8 5 12 13 24. Bronchitis 76 58 18 - 3 - - - - - - 1 - 7 1 25 1 25 13 25. Other diseases of respiratory system 10 7 3 - - - - - - - - 1 - 1 3 2 - 3 - 26. Ulcer of stomach and duodenum 9 4 5 - - - - - - - - - 1 2 1 1 1 1 3 27. Gastritis, enteritis and diarrhoea 4 1 3 - - - - - - - - - - - - - 1 1 2 28. Nephritis and nephrosis 6 4 2 - - - - - - - - - 1 1 - 2 - 1 1 29. Hyperplasia of prostate 3 3 0 - - - - - - - - - - - - - - 3 - 30. Pregnancy, childbirth, abortion 1 0 1 - - - - - - - - - 1 - - - - - - 31. Congenital malformations 12 6 6 4 6 - - 1 - - - 1 - - - - - - - 32. Other defined and ill-defined diseases 107 47 60 20 10 2 1 2 2 - - 3 1 8 6 4 17 8 23 33. Motor vehicle accidents 22 16 6 - - - - 1 - 5 2 3 - 1 2 3 - 3 2 34. All other accidents 13 7 6 1 - - - - - - - 4 - 1 - - - 1 6 35. Suicide 10 7 3 - - - - - - 1 - 2 - 3 3 1 - - - 36. Homicide and operations of war 0 0 0 - - - - - - - - - - - - - - - - TOTAL 11.34 581 553 30 24 4 1 4 3 6 3 33 18 175 105 142 116 187 283 11 SECTION B GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Staffing, At the beginning of the year the newly created post of Deputy Chief Public Health Inspector was filled by the promotion of Mr. E. Oliver, one of our District Public Health Inspectors. The vacancy thus created and the increase in the establishment noted last year were filled by the appointment of Mr. W. R. M. Gray and Mr. R. E. Ingleby. It is gratifying to record that Mr. E. J. Day obtained the Smoke Inspectors' Certificate of the Royal Society of Health. Medical Examinations - Staff. Staff arrangements remain as last year. During the year arrangements were made for the examination of 248 (258) employees or prospective employees - 68 (84) permanent and 180 (174) temporary. The 1960 figures are given in parentheses. Public Relations. The Council now has on its staff a full-time Public Relations OfficerMr. Glyn Richards, J. P. - and it must be said that leaving the onus of dealing with public relations entirely to him has been a source of satisfaction. Whilst affording us due consultation on public health matters and full co-operation, he has nevertheless the time, experience and skill to present acceptably to the press and public, items of interest to them and of importance to us. He is, therefore, of very material value to this Department. It was decided to participate in the Hobbies and Handicrafts Exhibition organised by the Hornchurch Rotary Club. The theme of a modest endeavour of this kind is usually Clean Air and/or Clean Food. The Exhibition attracted considerable public support and attention and although it is demanding from the point of view of time it nevertheless affords an opportunity of placing our work before the public. In this instance it could be deemed successful. Laboratory Facilities. Under the County Council arrangements certain work hitherto carried out at the Counties Public Health Laboratories will in future be dealt with at the Public Health Laboratory, Chelmsford. Dr. E. A. Atkinson, Oldchurch Hospital, Romford, kindly deals with a variety of other bacteriological and occasionally pathological material, whilst the laboratories at both Rush Green and Harold Wood Hospitals respond willingly to any calls made upon them. Ambulance Service, The arrangements remain the same as last year. 12 Maternity and Child Welfare. The Essex County Council maintained clinics at the following centres throughout the year:- (i) Abbs Cross Lane, Hornchurch. (ii) Athelstan Road, Harold Wood. (iii) Front Lane, Cranham. (iv) Hornchurch Road, Hornchurch. (v) Nelmes Road, Hornchurch. (vi) St. Mary's Lane, Upminster. (vii) South End Road, Hornchurch. (viii) Suttons Hostel, Hornchurch. (ix) Upminster Road, Rainham. (x) Westland Avenue, Hornchurch. Nursing and Maternity Homes. The two registered Nursing and Maternity Homes in the district are supervised by the County Council. Midwives and Home Nurses. There are 12 midwives and 3 home nurse/midwives in the district who were appointed by the Essex County Council and are available to act in the capacity of midwife and of maternity nurse under the supervision of a registered medical practitioner. In addition to the home nurse/midwives there are eight home nurses working in the district. Day Nursery. A Day Nursery is established within the district at Diban Avenue, Elm Park. It provides accommodation for 50 children up to five years of age. Domestic Help Service, A domestic help service is in operation and is administered for the Essex County Health Services by the Area Medical Officer, 34, Cresthill Avenue, Grays. Domestic Helps can be supplied for a period of two weeks in the case of a home confinement, but as there is a great demand for this service, it is essential to apply as early as possible. Where there is illness approval may be given, upon receipt of a medical certificate, for a Help to attend. Domestic Helps are paid by the County Council, but the person assisted is required to contribute towards the cost according to his, or her, means. An assessment form must therefore be completed if it is desired to claim reduction in the charge, otherwise the full standard charge, which is at present 3s. 6d. an hour, will be payable. 13 My first application under Section 47 of the National Assistance Act, 1948, was made in respect of an elderly lady living under unfortunate circumstances. The Court duly ordered her removal to St. George's Hospital, Hornchurch. A number of border line instances were brought to my notice but, as previously, the combination of various factors enabled a solution to be found which obviated statutory action. Although Section 47 - already noted - does not embrace exclusively the aged, it clearly concerns them in large measure and action under it is one for the local Medical Officer of Health. The part which the environmental hygienist, i. e. the Medical Officer of Health and staff of a Sanitary Authority can and does play in safeguarding the welfare of the aged is, I believe, generaUy and seriously overlooked. It certainly receives no emphasis in many of the articles dealing with the subject. I do not, therefore, apologise for stating once again that the Public Health-Inspector is a real and important member of the team dealing with the problem of the aged and by no means the least successful member of that team. In any situation calling for team work (as does geriatrics) it is unjustifiable and unprofitable to analyse the contribution made by each member but equally it is remiss if the contribution of each member is not recognised. Home Safety. As from 1st January, 1962, matters of Home Safety will be dealt with through the Sub-Committee of the Public Health Committee. Full use will be made of the voluntary endeavour which was present on the original Home Safety Committee. Laundry Service for the Incontinent - Section 84. Public Health Act. 1936. Advantage is taken of the above Section legally to provide this type of service. Increasing use is made of it (a fuller note was made last year) and it is invaluable to the relatively few but deserving families who benefit by its operation. Since the service was commenced the number of cases partaking was 32. The number of garments treated during the year was 4, 499. The cost of the service during the year was approximately £288. 14 SECTION C SANITARY CIRCUMSTANCES OF THE AREA. Water Supplies- Main: 12 samples were taken by my Department during the year from the main supply. 6 were submitted for chemical and bacteriological examination and 6 for bacteriological examination only. In each case a satisfactory report was received. Well: Few now remain in this district. The South Essex Waterworks Company have kindly supplied the following particulars concerning the main supply for the District:- "The water supply of the whole of your area has been satisfactory in quality and quantity. Bacteriological and chemical examinations are made of the raw water, of the water in its various stages of treatment and of the water going into supply. A total of over 4,120 chemical, bacteriological and biological examinations have been made and all water going into supply was wholesome. In addition, samples were examined for radioactivity. Analyses have also been made of samples obtained from consumers' taps in the various parts of the Company's district, including that of your Council, and all proved to be satisfactory. The water is not plumbo-solvent. No action has been necessary in respect to any form of contamination. The number of dwelling houses supplied as at the 31st December last was 41,340 and the population as at the 30th June, 1961, as obtained from the Registrar General was 131,070. We are unable to state the number of houses supplied by standpipes, but the total is quite insignificant." The Engineer & Surveyor has kindly informed me of the rainfall figures for the year and which relate to "Langtons". The 1960 figures are given in parentheses. 15 The total rainfall for the year 19. 56 Inches was materially down on the previous year's figure of 26.76, while in 1961,134 days produced rainfall as against a relative 185 for the previous year. Amount of rainfall in inches. Number of days in which rain fell. January 0.46 (1.49) 15 (18) February 0.65 (1.42) 14 (15) March 0.09 (0. 84) 4 (12) April 1.96 (0.31) 16 (10) May 1.36 (1.93) 6 (8) June 1.41 (1.66) 5 (10) July 1.40 (2.48) 7 (20) August 2.37 (2.82) 12 (18) September 2.37 (3.92) 15 (11) October 2.91 (4.88) 16 (23) November 2.04 (12.93) 12 (22) December 2.54 (2.08) 12 (18) 19.56 (26.76) 134 (185) 16 Clean Air. It will be seen that our programme is progressing satisfactorily. The various factors governing progress were largely outlined last year and do not require repetition. Certain factors such as the number of persons applying for grant and the matter of objections are outwith local control, as, of course is the approval to and date of commencement of any Area. May I again emphasise that the ordinary household chimney is a major cause of pollution and that if the householders will do their best with their chimneys, we will do ours with any other than household sources of smoke. Smoke Control Areas. As you know the No. 1 Area in Cranham came into force on 30th. September 1959; the second in South Hornchurch came into operation on 1st November 1960; the third Area will come into operation on 1st July 1962; No. 4 Area will come into operation on 5th November 1962, whilst provisional plans have been made for Area No. 5. The following general details apply to the Areas noted No. l Area: Privately owned houses 11 Houses - Council 224 Houses - Essex County Council 4 The area is bounded by Front Lane, Brunswick Avenue and Roseberry Gardens. The acreage is 34. 8. Privately owned houses 888 Houses - Council 518 Houses - East Ham C. B. C. 306 E.C.C. Police Houses 8 R. A. F. Station Houses 67 Church and Church building 1 Schools and School House 3 Shops 19 The area is bounded by Ford Lane, Wood Lane, South End Road and Rainham Road. The acreage is 220. No. 3 Area: Privately owned houses 2,873 Houses - Council 717 Houses - Essex County Council 4 Houses - Dagenham B. C 4 Houses - British Transport Commission 1 Houses - Romford and Hornchurch Joint Sewerage Committee 13 Shops 64 R.A. F. Aerodrome 1 Public Houses 3 17 No. 3 Area (contd.): Schools 2 Garages 9 Factories 40 Gravel Pits 2 Coal Yards 2 Car Sales Sites 2 Warehouses 1 Waterworks Pumping Station 1 Churches 4 Nurseries (horticulture) 2 Health Services Clinic 1 Sewage Works 2 Social Clubs 1 Community Centres 1 British Transport Commission (Keeper's Cabin) 1 Offices 6 Milk Depots 2 Scrap Yards 2 Breakers' Yards 3 The Area is bounded by: (a) River Beam on its western side from River Thames up to the District Railway in vicinity of northern boundary of Bretons Sewage Works; (b) Rainham Road, Elm Park, from railway to junction with Ford Lane; (c) South side of Ford Lane to junction with South End Road, South Hornchurch; (d) East side of South End Road, South Hornchurch, from junction of Ford Lane to junction of Wood Lane; (e) Northern boundary of R. A. F. aerodrome to River Ingrebourne and then (f) River Ingrebourne to Rainham Creek and to the River Thames. The acreage is 2,050 (including 180 acres R. A. F. aerodrome). No. 4 Area: Privately owned houses 3,579 Houses - Council 1,208 Houses-R. A. F 62 Churches 5 Factories 8 Public Houses 1 Hospital, including Old People's Home and Hostel 1 Offices 11 Garages 2 Community Centre 1 British Legion Hall 1 Schools 6 Workshops 3 Shops 78 18 The Area is bounded by: The District Railway Line from the Beam River to the Ingrebourne River and thence by the Ingrebourne River to the northern boundary of the R. A. F. Aerodrome, Hornchurch and extending along that boundary to Wood Lane and via Rainham Road to the District Railway Line where it crosses the Beam River. The acreage is approximately 690. Specific Complaints; St. George's Hospital Chimney: New stoking arrangements should now solve this problem and appear to be in fact doing so. Special Processes: Liaison with the Alkali Inspector - Mr. G. Tiplady, M. Sc., F. R. I.C., - is excellent and of course common problems do from time to time arise. Neighbouring Authority Liaison: Contact is still maintained with Romford and Dagenham on General smoke control considerations. Atmospheric Pollution Investigation: As from 1st April, 1961, our lead peroxide candles and deposit gauges were discontinued. It appears to have been established that a Volumetric SO2 apparatus incorporating a smoke filter is likely to be the most useful form of apparatus. It is, of course, possible to use only a smoke filter which greatly minimises the amount of work required by avoiding the necessity for daily analysis. Our present programme comprises smoke filters at:- 1) Public Health Department; 2) Scar gill County Primary School, Mungo Park Road, Rainham; 3) Ayloffs County Primary School, Southend Road, Elm Park; 4) Whybridge County Primary School, Blacksmiths Lane, Rainham, and a Volumetric SO2 apparatus at the Public Health Department and Whybridge County Primary School. Clean Air Act. 1956. Section 21: This Section allows exemption from certain Sections of the Act for the purpose of investigation and research relevant to the problem of air pollution to be carried out without rendering applicants liable to proceedings under the Act. A trial period of three months was allowed for a special apparatus dealing with the burning of sawdust waste. Clean Air Act. 1956. Section 3: This Section requires that any furnace installed in accordance with plans and specifications submitted to, and approved for the purpose of this Section by the Local Authority, shall be deemed so far as practicable, smokeless or requires notice to the Local Authority of proposal to instal furnaces of a certain maximum heating capacity. 11 Notices of installation and/or plans of new furnaces were submitted to the Council during the year, A total of 29 have now been registered. 19 Clean Air Act. 1956. Section 12: This Section empowers a Local Authority to serve a Notice requiring adaptations to fireplaces on the owner or occupier of houses within a Smoke Control Area. 1 such Notice was served during the year on an owner. General Information: Meetings of the National Society for Clean Air and its South East Division, the Conference of Co-operating Bodies and the London and Home Counties Clean Air Advisory Council are attended as a routine. Sewerage and Sewage Disposal. Regional Scheme: This has been noted earlier and its proposals were detailed In last year's report. I must say that the residents, especially in the immediate neighbourhood of the Bretons Farm Works suffer, on occasion, a most serious degree of inconvenience from the smell of the Works activities. This situation no one would view with anything but concern. It is emphatically not the fault of this Council that the Regional Scheme has not progressed much more speedily. The Bretons Works are controlled by a joint Board with representatives of Hornchurch and Romford Councils and were the Works less ably managed cause for complaint might well be greater. This Council is I know doing everything which it can to hasten the progress of the Regional Scheme and lessen the load upon Bretons. This scheme alone can finally obviate the smell troubles which from time to time beset the neighbourhood. I am indebted to the Surveyor for the following information:- Soil Sewers: Work has been completed on approximately 1 mile of new sewers at:- Upminster Road, Rainham, relief soil sewer (12" diameter) which connects to an existing soil sewer at Dovers Corner, pending implementation of the Regional Scheme. Hall Lane/Warley Road, extension of soil sewer (9" diameter) dispensing with the need for a dozen cesspools and pall closets. Work has commenced on:- The Roneo Corner soil sewer improvement. Upminster Road, Hornchurch, soil (and surface water) improvement (relaying). Surface Water Sewers; The following works have been completed:- Marlborough Gardens relief (9" diameter). Spenser Crescent relief (9" diameter). 20 Surface Water Sewers (Contd.) Winchester Avenue relief (18" diameter). Cranston Park Avenue - new outfall (15" diameter). Surface water sewer in part of Wingletye Lane, near Ash Lane (21" diameter) Rain ham Road (21" diameter). Severn Drive relief (Isis Drive) (12" diameter). Norfolk Road relief (12" diameter). North Street - new surface water sewer C.D. Centre to the "Chequers" (9" diameter). Kinfauns Avenue - short extension (9" diameter). Farm Road outfall for part of Parsonage Farm Estate (18" diameter). Ditchworks - Nelmes Way to Wingletye Lane. A total length of approximately 1 1/5 miles. The following works are under construction:- Sycamore Avenue relief. Upmlnster Road, Hornchurch, improvement. Constructional works at Eastern Outfall Sewage Disposal Works will be substantially completed and be in operation by April 1962, but the provision of certain minor items, e.g. electric motors to drive the rotating distributor and mechanical screening equipment will not come into operation until later in the year due to delays in delivery of the equipment. Rivers. Ingrebourne: If the two could be related probably more words than water have flowed over this stream. Its position is relevant to our neighbour at Brentwood and to Nags Head Disposal Works. My duty is not to debate the pros and cons of the Regional Scheme or the improvement of that Works, but merely to insist that the content of the river should be much more satisfactory than has hitherto been the case. I have to thank Mr. Fish of the Essex River Board for providing me with copies of their sampling results. That Board is, of course, keenly interested in securing a clean river water, but I am not yet certain as to whether it has yet finalised its attitude as to how best this objective may be achieved. Ditches. Inevitably a certain amount of junk is deposited in the ditches of the district and cannot be removed without cost. It may be that much of it comes from outside the district. It is in any event to be deplored. Swimming Pool. 12 samples were taken and have been uniformly satisfactory. 21 Paddling Pools. Four samples were taken from each of the four Paddling Pools, i. e., in May, June, July and August. All the samples were satisfactory. Streets Made Up and Taken Over. The Engineer and Surveyor has supplied the following list of streets made up and taken over during the year ended 31st December, 1961:- Private Streets. Nelmes Way 807 yards. Inskip Drive 108 " Staverton Road 184 " Fanshaw Crescent (part) 52 " Saunton Road (part) 291" Frederick Road 774" Total Length 2,216 " Estate Roads Brights Avenue (part) 134 yards. New Hall Drive (part) 101 " Beverly Close 113 " Avenue Close 115 " Parkway 72 " Hedingham Road 327 " Ashby Close 66 " Carisbrooke Close 71 " Caernarvon Close 64 " Falkirk Close 72 " Holme Road (part) 34 " Judith Ann Court 76 " Westbury Terrace 364 " Birch Crescent (part) 63 " Tadworth Parade 111 " Essex Gardens 322 " Suffolk Way 750 " Cornwall Close 89 " Berkshire Way 209 " The Glen 350 " Oxford Avenue 207 " Hampshire Drive 126 " Surrey Drive 205 " South Hall Drive (part) 62 " Vincent Close 62 " Canberra Close 137 " Hunter Drive (part) 85 " Total Length 4, 387 " Disinfestation and Disinfection: No change in our arrangements has taken place within the last year. 22 Rodent Control. During the year the Rodent Operative paid some 402 visits to deal with infestations. 1,783 routine or re-visits were paid. The premises visited comprised 342 dwellings and 60 business premises or factories. Attendance at meetings of No. 3 Essex Workable Area Committee is normally made by the Chief Public Health Inspector so that a wider picture of County progress and procedure is available. Farm Work: 114 visits were made to farms by the Public Health Inspectors or Rodent Operative. 6 infestations were found and cleared. Establishments for Massage or Special Treatment. The Essex County Council granted licences to 11 persons during the year authorising them to carry on establishments for massage or special treatment. 27 visits were made to these premises. Heating Appliances (Fireguards) Act 1952 and Regulations 1953. During the year 4 visits were paid in this connection. 6 appliances were tested (involving 12 tests) and all were found to be satisfactory. Old Metal Dealers (Hornchurch) Order. 1956. At the end of the year 15 persons had registered as Dealers in Old Metal. Noise Abatement Act, 1960. 3 notices were served during the year in this connection. The Council was informed by the Ministry of Health that a Committee had been set up to investigate the nature, source and effects of the noise problem and to consider further measures of mitigation. Pet Animals Act. 1951. Fifty-two visits were paid to the eleven Pet Shops in the District. 4 notices were served during the year relevant to the display of the name and address of person having key of shop, the repair of broken windows, re-decoration, provision of thermometers, provision of dustbins, removal of refuse, cleansing and tidying of yard, improvemepts to cutting table. 23 Rag FlocK and Other Filling Materials Act, 1951. 2 addresses in the Urban District are registered pursuant to the provisions of Section 2 of this Act. 2 samples were taken during the year and satisfactory reports were received. Riding' Establishments Act. 1939. Mr. R. L. Wylie, M. R. C. V. S. and Mr. R. H. M. Coulton, M. R. C. V. S. are the officially appointed Veterinary Surgeons for the purposes of this Act. Quarterly reports are given on the 3 Riding Establishments in the District. Diseases of Animals (Waste Food) Order. 1957. All the licences, including those formerly issued by the Ministry of Agriculture, Fisheries and Food, are now issued by this Council. Routine supervision is maintained over the processes and premises involved. One licence was revoked during the year following the closing down of the piggery concerned. A total of 17 licences were in force at the end of the year. Agriculture (Safety. Health and Welfare Provisions) Act. 1956. 20 visits were made to farms in connection with the provision, maintenance and cleanliness of sanitary conveniences. No formal action was required. Public Health Inspection of the District. SUMMARY OF PUBLIC HEALTH INSPECTORS' WORK DURING 1961. Inspection of Food and Premises (visits paid). Bakehouses 121 Butchers' Shops 215 Cafes 198 Confectioners 213 Dairies 23 Fish Shops 90 Food Complaints 108 Greengrocers' Shops 199 Grocers' Shop3 674 Ice Cream vendors' and manufacturers' premises 142 Mobile Shops (hawkers) 106 Public Houses 53 Sampling 534 24 School Canteens 117 Slaughterhouses 1,043 Staff Canteens 45 Miscellaneous visits 205 Housing (visits paid). Overcrowding, etc. enquiries 131 Improvement grants 79 Sanitation 31 Structural defects 309 Water supply and pipes 80 Miscellaneous housing visits 241 Re-inspections 1,512 General Sanitary Circumstances (visits paid). Atmospheric pollution 644 Camping and fairgrounds, vans, etc. 222 Conveniences 22 Drainage and sewerage 1,297 Dustbins 77 Farms 20 Stables, piggeries, animals, birds, etc 81 Nuisances 379 Paddling pool samples 14 Refuse Tips 218 Pest Control 237 Swimming Pool samples 12 Water samples (main supply) 17 Rivers, streams, ponds, etc 57 Miscellaneous visits 332 Re-inspections 713 Factories and Outworkers. Number of visits paid 732 Shops Act. Number of inspections 817 Smoke Control Areas. Number of visits paid: 2,052 Miscellaneous (visits paid). Diseases of Animals (Waste Food) Order: 81 Heating Appliances (Fireguards) Act 4 Pet Animals Act 52 Rag Flock and Other Filling Materials Act 2 Old Metal Dealers 7 Massage establishments 27 Infectious Disease. Number of visits paid (including contacts) 896 25 Number of Notices served. Informal 646 Statutory 114 The main headings under which work was done may be noted as follows: Smoke Control Areas 2,052 General Sanitation 5, 342 Inspection of Food and Premises 4, 086 Housing 2,383 Infectious Diseases 896 Shops Act Inspections 817 Factories and Outworkers 732 Public Health Inspectors' Work. Although the number of Smoke Control visits was radically reduced (as the programme was awaiting decision on No. 3 Area) equivalent time was available for other routine tasks. The year's work, therefore, was fully up to standard. Shops Act.1950. The number of shops on the register at the end of the year was 1,192. 79 notices were served during the year regarding contraventions of the Act. 9 contraventions were reported to the Committee during the year and 6 others were referred to the Clerk for further action. No legal proceedings were Instituted during the year in connection with this Act. 26 SECTION D HOUSING. Number of New Houses erected during the year. (i) By the Local Authority 113 (62) (ii) By other Local Authorities Nil. (16) (iii) By other bodies or persons 554 (675) The previous year's figures are given in brackets. Number of Houses voluntarily demolished 2 19, Brookdale Avenue. 1, Oliver Cottage, Ford Lane. Number of Houses voluntarily closed 3 24, 174 and 176 High Street. Number of Demolition Orders made 1 41, St. Mary's Lane. Number of Houses demolished during 1961 following representations 7 1 and 2, Walnut Tree Cottages, Ockendon Road. 3, 4, 5, and 6, Cabbage Corner, „ „ . 41, St. Mary's Lane. Number of Areas represented 1 136, 138, 140, and 142,Ardleigh Green Road. (4 houses) (The Hornchurch (Ardleigh Green Road) Clearance Order, 1961). Certificate of Disrepair. The following is a summary of Returns under the Rent Act, 1957, made to the Ministry of Housing and Local Government covering the period 1st January to 31st December, 1961:- Part I - Applications for Certificates of Disrepair: (1) Number of applications for certificates 9 (17) (2) Number of decisions not to issue certificates 0(0) (3) Number of decisions to issue certificates: (a) in respect of some but not all defects 6(13) (b) in respect of all defects 3(4) (4) Number of undertakings given by landlords under paragraph 5 of the First Schedule 2 (12) (5) Number of undertakings refused 0(0) (6) Number of certificates issued 7(5) Part II-Applications for Cancellation of Certificates: (7) Applications by landlords for cancellation of certificates 4(7) (8) Objections by tenants to cancellation of certificates 1(1) (9) Decisions to cancel in spite of tenants objections 0(0) (10) Certificates cancelled by Local Authority 3(5) 27 As will be seen from the figures in parentheses the work has shown some decrease during the year. Improvement Grants My advice has been submitted to the Council in 55 instances during the year. Re-Housing - Medical Aspects. My advice was sought during the year on some 98 housing applications respecting which medical recommendations for priority had been submitted by hospitals or private practitioners. The re-housing of the aged is a problem involving medical factors often Indefinite in their implications. Each case, as always, is treated on its merits but necessarily any priority must be related also to the claim of others rather than absolute in the right of any individual. No general post-war survey has been carried out so that our information is limited. Action was taken in respect of 11, Brookway, Rainham, under Sections 36 and 90 of the 1957 Act. This at any rate dealt comprehensively with overcrowding dictating as it did the permitted occupancy of individual rooms. Even under conditions of general housing difficulty it is imperative that a watchful eye be kept on overcrowding especially when caused by lodger or multiple occupation. Failure to do so is certain to aggravate the overall position and accentuate the difficulty of a final solution. Caravans. There appears to be an increase in the number of caravans securing temporary lodging in this district whilst what has become almost a 'permanent' site at Lake Avenue, Rainham, remains with us. Whatever planning implications are involved in this caravan question, it appears to me that our public health obligations are in no way minimised. Whether a caravan is in Hornchurch or elsewhere it clearly ought to have proper sanitary accommodation, water supply, refuse disposal facilities and the like. It is, therefore, placing no undue hardship on the occupants to ensure that caravans in our district do provide these hygienic safeguards. In the present circumstances of housing shortage caravans provide for a diverse variety of individuals and circumstances. Caravans are not generally welcome in the district, at least not in the part in which one lives, and although conditions may be excellent relatively, they may more often be sub-standard. The sporadic urban caravanner tends under existing circumstances to be untidy and from the point of view of environmental health supervision of caravans represents a measure of prudence rather than oppression. 28 Everyone should be given the opportunity to enjoy adequate housing accommodation and surely were this possible the country's urban caravan problem would materially dissolve. It is certainly not on grounds of economy or convenience that many people choose caravans as a permanent habitat. Land Charges Enquiries. During the year 3,749 land charges enquiries were referred to the Department regarding the question of outstanding sanitary notices and/ or certificates of disrepair. This is one of the routine unpublicised but time-consuming occupations of the Department. There are no registered common lodging houses in the district. 29 SECTION E INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES. Food and Drugs Administration. In the following statistics the figures for the previous year are given In brackets. 322(308) samples were taken during the year of which 314 (300) were found to be genuine (List A) and 8 (8) to be sub-standard (List B). 17(21) food complaints were referred to the Public Analysts (T .1st C) and 17(22) food complaints were dealt with Informally (List D). The accompanying lists (A and B) Indicate the wide variety of food and drugs actually sampled. I would express my indebtedness to the Public Analysts, Dr. J. Hubert Hamence, M. Sc., Ph. D., F. R. I. C. and Mr. Philip Sydney Hall, B. Sc., F. R.I. C., for their helpful and ready advice in the many difficulties which necessarily crop up in this highly specialised branch of our work. 30 LIST A SAMPLES SUBMITTED TO PUBLIC ANALYSTS AND FOUND TO BE GENUINE. Article No. Article No. Anchovies, Fillets of 1 Cranberry Sauce 1 Apple, Prune Custard Strained 1 Cream 2 Cream, imitation 1 Apricot Dumpling 1 Cream, pure 1 Arrowroot, ground 1 Creamy mints 1 Bakewell Tart 1 Custard Powder 2 Beans,with Pork Sausages Baked 1 Dates 2 Dripping 1 Beef Curry 1 Essence, Rum Flavour 1 Beef,Hash Corned 1 Frosting Mix 1 Beef Steak & Four Vegetables with Gravy 1 Glace Cherries 1 Gelatine 1 Beef and Kidney Pie 1 Ginger, ground 1 Beef Suct 1 Ham, Devilled 1 Biscuits,Chocolate Fingers 1 Herrings in tomato sauce 1 Blackcurrant Juice Syrup 1 Honey 1 Blackcurrant Vitamin C Drink 2 Horseradish Relish 1 Ice Cream 37 Bread 1 Ice Lollies 24 Browning 1 Ice Lolly Syrup 1 Butter 2 Instant Whip 1 Buttered Cheese Spread 1 Irish Stew 1 Cara Wheat 1 Jam 3 Cayenne 1 Jellinorange 1 Cereal,High Protein 1 Jelly 3 Cheese Crisps 1 Jelly Creams 1 Cheese Spread 2 Lancashire Rarebit 1 Cherries, Cocktail 1 Lard 2 Chicken, Boned 1 Lemon and Orange Peel 1 Chicken and Ham Luncheon Meat 1 Lemonade Powder 1 Lemon Wafers 1 Chicken and Mushrooms, Curried 1 Lucozade 1 Mackerel Fillets 1 Chicken Supreme 1 Margarine 3 Chocolate 1 Marzipan 2 Chocolate Brown Colour 1 Meat Pudding 1 Chocolate Home Wheat Biscuits 1 Meringue 1 Milk 51 Chocolate Ice 1 Milk, Evaporated 2 Christmas Pudding 1 Milk Chocolate, Rum Flavour 1 Cloves, Whole 1 Mincemeat 1 Coconut, desiccated 1 Mint in Vinegar 1 Coffee 1 Mixed Dried Fruit 1 Cod, Skinless 1 Onion Sauce 1 Condiment, non brewed 1 Orange Crush 1 Cooking Oil 1 Orange Drink 1 Crab Spread 1 Paste 1 31 Article No. Article No. Peanut Poppets 1 Gin 2 Peanut Spread 1 Rum 1 Pork, chopped with Beef and Ham 1 Whisky 3 Altoids 1 Pork and Kidney Braised 1 Anadin Tablets 1 Pork Pie 1 Angettes 1 Potatoes, mashed 1 Bee-Cee Drops 1 Potatoes, new 1 Bicarbonate of Soda 1 Prawns in brine 1 Bone and Nerve Tonic 1 Pudding, Creamed Rice Milk 1 Catarrh and Bronchial Syrup 1 Chilblain Ointment 1 Puff Candy 1 Clearasil 1 Quick-Jel 1 Cold and Influenza Mixture 1 Rice 1 Compound Syrup of Glycerine and Honey 1 Rice, Ground 1 Robinade (Pineapple flavour) 1 Compound Syrup of Hyperphosphites 1 Sago 1 Salad Cream 1 Cough Linctus, Childrens 1 Salmon 1 Cough Pastilles 1 Salmon, Potted 2 Cough Syrup 1 Sauce 1 Eye Lotion 1 Sauce Tartare 1 Formula 44 Cough Linctus 1 Sausages, Beef 3 Glycerine Lemon and Honey 1 Sausages, Pork 9 Glycerine and Thymol Pastilles 1 Scone Mix 1 Shortcake 1 Indigestion Tablets 1 Shrimps (peeled) 2 Influenza Mixture 2 Sild 1 Olive Oil 1 Spaghetti Milanese 1 Opas Tablets 1 Soups 4 Paxedin Tablets 1 Starkles 1 Pectoral Balsam 1 Strawberries 1 Sucrets 1 Suet Pudding Mixture 1 Sulphur Ointment 1 Sugar, Soft Brown 1 Sulphur and Yeast Tablets 1 Sweets 3 Tramil 1 Tapioca 1 Vegetable Laxative Tablets 1 Tea 3 Vykmin 1 Toffees, Egg and Milk Flavour 1 Witch Hazel 1 Yeast Vite 1 Tuna Fillets 1 Zinc and Castor Oil 1 Trice Quick Rice Pudding 1 TOTAL 314 Vegetables and Beef 1 Vinegar 3 Walnut Halves 1 32 LIST B SAMPLES SUBMITTED TO PUBLIC ANALYSTS AND FOUND TO BE ADULTERATED OR UNDER STANDARD etc. Sample No. ARTICLE (General description) Nature of Adulteration or Irregularity Action Taken INF.2238 Cherries in Strawberry Jelly Poor in respect of its content of cherries. No reference to strawberry juice or fruit in list of ingredients. Description on labels being amended. INF. 2276 Irish Coffee Milk Chocolate, etc. Insufficient whiskey to justify the label. Description on label amended. INF. 2265 Chicken Noodle Soup. Meat content on the poor side. Distributors agreed to discuss matter with foreign Manufacturers and alter contents or amend label. INF.2278 Lemon Spread. In accord with Order but label "Full fruit standard" misleading. When present stocks exhausted new amended labels to be issued. INF.2354 Ice Lolly. Stated on the label to contain ice cream but no ice cream was found to be present. Formal sample sought but not obtainable. INF. 2361 Fillets of Mackerel in tomato and edible oil. Contained 300 parts per million of sulphur dioxide. No provision is made in the Public Health (Preservatives etc., in Food) Regs. for the preservation of fillets of Mackerel. Formal sample sought, but not obtainable in tomato. Formal sample in edible oil satisfactory. INF. 2447 Hi-Protein Bread. Protein content was below the recommended standard for "High Protein Bread" No contravention of existing regulations. INF. 2462 Casserole Steak. Meat content poor. Standards for meat content of canned meat under review by Food Standards Committee. Facts reported to them. It will be seen that the degree to which the samples were substandard was generally small. Informal approach does, however, often secure a measure of satisfaction in this instance which would be impossible to obtain through statutory action. 33 LIST C FOOD COMPLAINTS REFERRED TO PUBLIC ANALYSTS Sample No. ARTICLE (General description) Nature of Adulteration or Irregularity Action Taken CPT. 2211 1 Pint TT/Pasteurised Milk. Foreign matter adhering to inside of bottle. Examination showed foreign matter was flaw in the glass bottle. CPT.2223 Milk Bottle. Contained a fragment of Cement. Warning letter to Dairy. CPT.2243 Slices of white Bread. Bread alleged to have caused headaches and unconsciousness. No evidence on examination to substantiate allegation. CPT.2269 Steak and Kidney Pie. Contained mould growth. Legal proceedings instituted. Vendor fined £5. CPT.2304 Luncheon Meat. Contained two small blue streaks-caused by a synthetic colour. Matter taken up with Importers. CPT.2332 Irish New Potatoes. Alleged to discolour on boiling. Found to be free from contamination and discolouration inherent in variety of potato. CPT.2333 Chocolate Confection. Contained fragments of Glass. Legal proceedings instituted. Vender fined £20. CPT.2363 Large White Wrapped Farmhouse Loaf (Sliced) Showed the presence of mould growth onmost of the slices. Warning letter to Bakery. CPT.2364 Sausages containing dark material. Contained foreign matter in the form of pieces of sausage meat contaminated with iron oxide etc. Warning letter to Manufacturer. CPT.2365 Portion of Sausage Roll. Contained a fragment of a wasp. Warning letter to Vendor. CPT.2370 Chicken and Veal Pie. Contained mould growth on one piece of meat. Coding of pies taken up with Manufacturers. CPT.2388 Large White Sliced Wrapped Farmhouse Loaf. In a mouldy condition. Legal proceedings instituted. Vendor fined £5 plus costs. CPT.2416 Full Bottle of Milk. Contained a deposit of sand and cement. Warning letter to Vendor. CPT.2443 Creme Ginger Chocolate Bar. Contained Mould Growth. Matter pursued with Importers. 34 LIST C (Continued) Sample No. ARTICLE (General description) Nature of Adulteration or Irregularity Action Taken CPT.2458 Piece of Cake Contained a Nail. Warning letter to Manufacturer. CPT.2469 Castor Sugar Contained a mass of aggregated sugar including a calyx of banana Report given to complainant. No further action required. CPT.2474 Shelled Almonds Showed evidence of insect attack. Warning letter to Wholesaler. The "Action Taken" column effectively establishes that each case is really decided on its merits. In the case, particularly of food complaints, it is very often exceedingly difficult to obtain a clear picture of when the offending article was manufactured, when it arrived at the vendors and when it was finally sold by the vendor. This information may, on occasion, be completed, it may be incomplete and it may differ as between the recollection or record of the manufacturer and the vendor. Your Committee considered this matter in some detail and was most anxious to secure that any member of the public buying an article should have some visible indication of when that article was in fact manufactured. The subject was pursued with a number of persons and manufacturers and it was finally decided with regret that no one practicable effort of securing the objects of the Committee was in fact feasible. 35 LIST D. FOOD COMPLAINTS WHERE ANALYSIS WAS NOT REQUIRED Complaints Action Taken Pasteurised milk alleged to be sour and bitter. Shopkeeper prosecuted for not being registered as a Distributor of milk and for selling designated milk without a licence. Fined £1 on each charge. Metal can opener in bread pudding. Investigation at works canteen proved inconclusive. Firm warned. Pasteurised school milk containing red and blue foreign bodies. Dairy informed - no further action required. Cream vanilla slice with suspected mould. Discolouration not due to mould growth but to contact with metal of baking tin. No further action. Part of milk loaf with numerous small mould growths. Matter taken up with bakery concerned. Steak and kidney pie with mould growth underneath. Legal proceedings instituted Vendor fined £5. Stone in fruit cake. Warning letter to Baker concerned. Jam roll alleged to have an unpleasant taste and smell. Matter taken up with Vendor concerned - food not unfit. Chicken and veal pies containing mould growth and decomposing. Legal proceedings instituted Grocer fined £10 on each of two charges. White loaf containing screw. Legal proceedings instituted Baker fined £5. Pork pie containing mould growth. Legal proceedings instituted Case dismissed when Vendor pleaded warranty. Skinless beef sausages with mould growth. Legal proceedings instituted Grocer fined £5. Sponge cake alleged to have an unusual taste and odour. Matter taken up with bakery concerned. Bakery in question had recently been repainted. Chocolate cakes alleged to be dirty. Matter taken up with Manufacturers. Sausages alleged to have caused food poisoning. Sausages submitted to Oldchurch laboratory for bacteriological investigation with negative results. Bottle of milk containing foreign material. Matter taken up with firm concerned. Bottle of school milk containing glass. Matter taken up with firm concerned. This list comprises complaints in which the facts were clearly apparent and did not demand scientific corroboration. It is impracticable In this report to detail the circumstances of each complaint but were this possible it would go far to explain any apparent lack of logic in any of the decisions taken. 36 Food Premises. The number of food premises in the district may be classified as follows (where more than one trade is carried on at any premises then an entry is made in respect of each trade). The varying types remain remarkably constant as the figures (last year in brackets) show:- Bakehouses 17(14) Butchers 76(77) Cafes 53(53) Confectioners,(bread, cakes etc.) 41(40) Confectioners,(sweets, etc.) 126(126) Fish Shops 27(27) Grocers 179(179) Greengrocers 102(103) Ice Cream Dealers 309(306) Ice Cream Manufacturers 3(3) Food Hygiene Regulations 1955. Some 186 notices were served as against 123 last year. Essex County Council Act. 1952 - Section 105. Notification under Section 105 of the Essex County Council Act, 1952 still assists us to give prior advice to intending traders. Unsound Food. During the year the following foods were voluntarily surrendered to the Public Health Inspectors as being unfit for human consumption:- Tons Cwts Lbs. Ozs. Poultry - - 31 0 Meat - 3 58 5 Fish - 1 65 9 Vegetables - 5 40 0 Tinned Meat - 15 1 10 Tinned Fish - - 50 10 Tinned Milk - 2 52 5 Tinned Food 1 4 2 7 Miscellaneous Groceries - 5 103 5 Total 2 18 69 3 Meat Inspection. A new slaughterhouse opened in the District on the 17th March, 1961, and for the rest of the year provided a considerable volume of meat inspection work. Meat inspection is an onerous job, not particularly appealing in character, demanding physically and mentally, and last but not least, entails work at unattractive hours including week-ends. It is not, however, alone in justifying this description. If some practicable method could be achieved of limiting slaughtering to regular and reasonable hours then a great advance would be made from the point of 37 view of public health staff. It must, however, be conceded that the term 'reasonable' as applied to the staff might not be regarded as reasonable by the meat supplier who has a variety of his own problems and needs to consider. The subject is, however, quite patently one which does merit early consideration if our staffs are to be reasonably and economically utilised. Cysticercus Bovis. It was arranged during the year that specimens involving Cysticercus Bovis should be sent to the Veterinary Investigation Centre of the Ministry of Agriculture, Fisheries and Food, at Cambridge. The following tabular statement regarding the post-mortem inspection of animals at the two slaughterhouses is drawn up in accordance with the Appendix to Ministry of Health Circular 17/55:- Carcases Inspected and Condemned. Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Goats Number killed 4338 455 1664 8856 9500 11 Number Inspected 4338 455 1664 8856 9500 11 All diseases except Tuberculosis and Cysticercosis- Whole carcases condemned 1 4 7 12 1 0 Carcases of which some part or organ was condemned 701 161 23 971 1611 0 Percentage of number Inspected affected with disease other than tuberculosis, etc. 16.2 36.0 1. 1 11.0 17.0 0 Tuberculosis only- Whole carcases condemned - - - - - - Carcases of which some part or organ was condemned 13 4 0 0 262 0 Percentage of number inspected affected with tuberculosis 0.3. 0.8 0 0 2.8 0 Cysticercosis only- Carcases of which some part or organ was condemned 40 3 0 0 0 0 Carcases submitted to treatment by refrigeration 34 3 0 0 0 0 Generalised and totally condemned 0 0 0 0 0 0 Slalighter of Animaiq Act,1958 5 Slaughterman's licences were issued during the year. 38 Ice Cream. During the year 15 applications for registration as vendors and 13 applications for registration of premises for the storage and sale of ice cream were granted. At the end of the year 3 persons and premises were registered for manufacture and 309 for the storage and/or sale of ice cream. 83 samples were taken during the year. 80 proved satisfactory. In addition, 62 samples were taken under the Food and Drugs Act for examination by the Public Analyst. The quality of the ice cream sold locally remains in general of a highly satisfactory order. One notice was served during the year under the Ice Cream (Heat Treatment) Regulations. A successful prosecution was carried out during the year in respect of an ice cream vehicle which was not up to standard. Preserved Food Manufacturers. Section 90 of the Hornchurch Urban District Council Act, 1936, requires registration of preserved food manufacturers and premises. At the end of the year 71 persons and 93 premises were registered for the manufacture, preparation or storage of preserved meat, an increase of one person and 4 premises. Regular supervision is maintained over them. Essex County Council Act. 1952, Section 103. This section which deals with the registration of hawkers of food and their premises came into force on 1st April, 1953, and at the end of the year under review 74 persons and 16 premises had been registered. Milk Distributors. There are 8 milk distributors with 12 registered premises in the District. There are also 13 firms registered as milk distributors in Hornchurch whose premises are registered in other districts. In addition, 57 shopkeepers are registered for the sale of bottled milk only. One prosecution was taken during the year against a shopkeeper who failed to register as a Distributor of Milk. The Milk (Special Designation) Regulations. 1960. These Regulations consolidate and re-enact with amendments the Milk (Special Designation) (Raw Milk) Regulations, 1949-1954, and the Milk (Special Designation)(Pasteurised and Sterilised Milk)Regulations, 1949-1953, and came into operation on 1st January, 1961, insofar as they relate to Dealers'licences. The principal changes are:- (i)A dealers' (pre-packed milk) licence is introduced to permit the sale of all three kinds of specially designated milk (i.e. Pasteurised, Sterilised and Tuberculin Tested) where the milk is obtained by the dealer in the container inwhich it is to be supplied to the consumer. 39 (ii) The period for which a dealers' licence will be granted is extended from one to five years. (ill) Dealers' licences will permit sales outside as well as inside the area of the licensing authority and supplementary licences are therefore discontinued. The number of licences issued by the Council during the year was as follows Dealer's Pasteurised 47 " Sterilised 55 " Tuberculin Tested 34 One shopkeeper was prosecuted during the year for selling designated milk without a licence. Milk Sampling. The 64 samples of milk taken from the dairies and in the streets during the course of delivery to customers throughout the year were submitted to the Laboraties for testing. In each case a satisfactory report was received. In addition, 51 samples were submitted to the Public Analysts. Liaison With other Authorities. Our excellent liaison with the London Comity Council in respect of the Hornchurch Children's Homes and the Brentwood Group Hospital Management Committee in respect of Harold Wood Hospital regarding the testing of their milk supplies (noted in last year's report)continues. Shellfish. Samples of shrimps, winkles, cockles and jellied eels were sent for examination during the year with satisfactory results. School Canteens. A basis for successful co-operation with the Local Education Authority and their Divisional Executive Committee having been established, good reasons exist for hoping that future supervision will relate merely to current happenings - the backlog of unfinished minor work having been completed and largely a fresh start permitted. 40 SECTION F. PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER NOTIFIABLE DISEASES. Infectious and Other Notifiable Diseases. 1961. Disease Total cases notified. No. of cases hospitalised. Dysentery 14 1 Encephalitis (post infectious) 2 2 Erysipelas 10 1 Food Poisoning 26 2 Infective Hepatitis 91 31 Malaria (contracted abroad) 1 1 Measles 3,119 25 Ophthalmia Neonatorum 1 0 Paratyphoid Fever 1 1 Pneumonia 13 6 Poliomyelitis (paralytic) 1 1 Puerperal Pyrexia 2 1 Scarlet Fever 15 4 Whooping Cough 37 2 Measles had an epidemic year. Fortunately the mortality from this disease is now, in the light of modern progress, becoming relatively negligible. Dysentery showed a markedly decreased incidence. Food Poisoning cases rose from 13 to 26. Infective Hepatitis (Catarrhal Jaundice) incidence figures increased from 33 to 91. One case of Poliomyelitis occured in 1961. Food Poisoning. Although some 26 cases were notified they arose largely sporadically and no substantial outbreak occurred. In the cases for which a cause could be ascertained Salmonella typhi-murium was the organism recovered. International Certificates of Vaccination or Inoculation. 570 certificates were stamped during the year. Immunisation and Vaccination Statistics. I am indebted to Dr. R. D. Pearce, Area Medical Officer, for the following information concerning immunisation and vaccination statistics applicable to the Urban District for the year 1961- Diphtheria Immunisation: Completed primary immunisations 1,903 Boost injections 2,119 Whooping Cough Immunisation: Completed primary immunisations 1,488 Boost injections 140 41 Combined Diphtheria/Pertussis Immunisation: Completed primary immunisations 881 Boost injections 392 Poliomyelitis Vaccination: Completed 2 primary injections 7,862 Boost injections 7,916 Fourth injections 7,842 Smallpox Vaccination: Primary vaccinations 2, 061 Re-vaccinations 293 B. C. G. Vaccinations (School Children of 13 years) Number vaccinated 1,085 Infective Hepatitis: It will be noted that 1961 provided a large increase in cases of this illness. It is on record that a school outbreak in Cranham in 1954 (and fully reported in the report for that year) involved some 88 cases and a cursory analysis of the incidence in the two succeeding years was made. A comparison is made below for the years from 1955 to 1961, together with some additional information for the last year:- Age Groupings 1955 1956 1957 1958 1959 1960 1961 M. F. M. F. M. F. M. F. M. F. M. F. M. F. 0-4 - 3 - - - - - - - - 1 - 2 3 5 - 10 1 2 4 11 9 4 - 1 - - 8 5 21 14 11 - 20 1 - 5 3 3 4 - 1 - - 4 4 16 13 21 - 30 2 3 - 1 4 - - 3 - 2 1 3 2 5 31 - 40 - 2 2 2 3 3 - - 4 1 2 2 3 3 41 - 50 1 - 2 1 - 2 1 - 2 1 1 - 2 1 51 - 60 4 3 - 1 - - - - 1 - - - 3 2 Over 60 - 2 - 1 - 1 2 - - - 2 - - 1 Particular analysis was made of the cases arising in 1961 in Suttons Hostel which consists of hutted accommodation divided into rooms but with communal toilet, cooking and washing facilities for each hut and used as temporary housing accommodation under the control of the Essex County Council. The first case arose on 3rd September 1961, and the last on 16th November 1961, comprising in all 19 cases. Individual huts were affected as follows:- Hut 1 4 " 2 2 " 3 4 " 4 6 " 5 2 " 8 1 19 Cases occurred in chronological order among the Huts in the following order, 3, 3, 1, 3, 3, 5, 5, 4, 1, 3, 4, 4, 8, 4, 2, 5, 1, 2, 4. 42 General features of the 1961 figures are shown in the tables hereunder:- Month of Onset Number in affected house+ Case incidence in Wards Occupants Cases January 6 2 3 Hacton 35 February 10 3 9 Rainham 15 March 21 4 36 South Hornchurch 12 April 5 5 13 Hylands 8 May 9 6 14 St. Andrews 7 June 3 7 5 Elm Park 4 July 1 8 1 Harold Wood 2 August - 9 - Upminster 2 September 8 10 3 Emerson Park 1 October 9 Cranham 2 November 12 December 4 The total number analysed is less than the total number of cases because it proved impracticable in certain instances to secure information. Tuberculosis. The number of new notifications concerned in respiratory and nonrespiratory remained largely as last year. Respiratory: The number of new notifications increased from 43 to 45. Non-Respiratory: The notifications remained at 4. The site of infection and age of the non-respiratory cases were as under:- Endometrium Female 23 Cervical Glands " 21 Spine (Lumbar) 2-3 Male 59 Mastoid (Right) " 18 Inward Transfers: These totalled 32 as against 43 last year. Deaths: There were 4 this year as compared with 10 last year. Cases on Register: The number of cases of tuberculosis on the register at the end of the year was as follows:- Respiratory: Males 534 Females 444 Non-Respiratory: Males 45 Females 27 Romford Chest Clinic. Noted below are some notes from Dr. S. Thompson, the Consultant Chest Physician:- "During the year 1961 the Romford Chest Clinic has continued to serve the needs of the combined populations of Romford and Hornchurch. 43 The Hospital Management Committee (Romford Group 13), of which the Chest Clinic forms a part, decided to renovate the interior of the clinic and this was carried out satisfactorily and has improved the amenities of the clinic very markedly. In the X-ray Department various additions to the technical apparatus have been provided and improvements added for the protection of the staff and the general public against scattered radiation. The general trend of tuberculosis continues to be satisfactory, though, owing to transfers into the area of notified cases and a decreased death rate, the total number of notified cases on the register has increased slightly from 1, 522 to 1, 536. It is gratifying to note that the incidence in tuberculosis in children is very small and continues to fall. This is partly due to the great reduction in sputum-positive cases throughout the country which is brought about by early diagnosis and effective chemotherapy, which is often continued on a domiciliary basis for periods up to 2 years. The examination of contacts is considerably facilitated by the provision of the Miniature X-ray Unit in the Chest Clinic, and this is also used to follow up cases referred from the various Mass Radiography Units serving the Metropolitan Area. B. C. G. vaccination is carried out in all cases of children who are at risk as contacts to notified cases of tuberculosis. I should also like to mention the services of the Romford and Hornchurch Tuberculosis Care Association who have done invaluable work as a voluntary body for many years. Notified cases of tuberculosis can be registered as Disabled Persons and thereby become entitled to an extra allowance from the National Assistance Board if they are rendered incapable of work by the disease. They are also entitled to the National Insurance, but these two sources of help, generous though they usually are, do not cover all cases of need that arise in a family where a case of tuberculosis exists, and in these cases the Care Association are able, through their voluntary helpers, to render further most valuable aid". 44 Mans Radiography Unit. The clinical evaluation of Mass Radiography Unit 6B's visit during the previous year is given below. The Unit detected 7 cases of active pulmonary tuberculosis and 2 cases of carcinoma of the bronchus as against 6 and 5 last time. Males Females Total Tuberculous lesions. Calcified primary 27 18 45 Inactive tuberculosis 30 22 52 Active tuberculosis 5 2 7 Other abnormalities revealed. Abnormalities of the bony thorax and soft tissuescongenital 7 9 16 Abnormalities of the bony thorax and soft tissuesacquired 43 22 65 Congenital malformations of the lungs - 1 1 Bacterial and virus infections of the lungs 1 4 5 Bronchiectasis - 1 1 Emphysema 2 - 2 Pulmonary fibrosis - non-tuberculous 11 6 17 Pneumoconiosis 2 - 2 Carcinoma of the lung and mediastinum 1 1 2 Sarcoidosis and collagenous diseases - 1 1 Pleural thickening or calcification - non- tuberculous 66 26 92 Abnormalities of the diaphragm and oesophaguscongenital and acquired 3 1 4 Congenital abnormalities of heart and vessels - 4 4 Acquired abnormalities of heart and vessels 20 9 29 Miscellaneous 7 4 11 TOTALS 225 131 356 45 CASES OF AND DEATHS FROM TUBERCULOSIS, 1901. Age Groups New Cases Inward Transfers Total No. of Cases Added to Register Deaths Total Deaths Respiratory NonRespiratory Respiratory NonRespiratory Respiratory NonRespiratory M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Under 5 years 2 1 - - - - - - 2 1 - - - - - - 5-14 years 1 2 - - - 1 - - 1 3 - - - - - - 15-24 " 4 4 1 2 - 4 1 - 6 10 - - - - - - 25-44 " 6 4 - - 13 8 - - 19 12 - - - - - - 45-64 " 11 4 1 - 2 - 1 - 15 14 1 1 1 - 2 1 65 and over 3 3 - - 2 - - - 5 3 1 - - - 1 - TOTALS 27 18 2 2 17 13 2 - 48 33 2 1 1 - 3 1 46 INTERVAL BETWEEN NOTIFICATION AND DEATH OF FATAL CASES OF TUBERCULOSIS, 1951-1961 Within one month From 1-3 months From 3-6 months From 6-12 months From 1-2 years From 2-3 years From 3-4 years From 4 years & upwards Not Notified TOTAL 1951 3 - - 1 2 - 2 5 12 25 1952 - 1 - - 2 - 2 7 5 17 1953 2 - 1 1 1 2 2 8 4 21 1954 - - - 1 2 - - 5 3 11 1955 1 - - - - - 1 1 1 4 1956 1 - - - - - - 3 1 5 1957 - - - 1 - - - 1 1 3 1958 1 1 - - 1 - - i 5 9 1959 - - - - 1 1 - 2 1 5 1960 2 - - - - - - 5 3 10 1961 - - - 1 - 1 - 1 1 4 47 SECTION G. FACTORIES ACTS 1937 to 1959. Prescribed particulars on the administration of the Factories Act, 1937. PART I OF THE ACT. 1. Inspections for purposes of Provisions as to Health. Premises No. on Register No. of Inspections No. of written notices No. of occupiers prosecuted. (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by L.A's. 35 24 6 - (ii) Factories not included in (i) in which Sec. 7 is enforced by the L.A. 326 562 40 - (iii) Other premises in which Sec. 7 is enforced by the L. A. 48 103 8 - TOTAL 409 689 54 - 2. Cases in which Defects were found. Particulars Found Remedied Referred Prosecutions To H.M. Inspector By H.M. Inspector Want of cleanliness (Sec. 1). 1 1 - - - Overcrowding (Section 2) - - - - - Unreasonable Temperature (Section 3) - - - - - Inadequate Ventilation (Section 4) - - - - - Ineffective drainage of floors (Section 6) - - - - - Sanitary Conveniences (Section 7) (a) Insufficient 9 4 1 - - (b) Unsuitable or defective 42 32 - 5 - (c) Not separate for sexes 2 - - - - Other offences against the Act. - - 13 - - TOTAL 54 37 14 5 - 48 PART VIII OF THE ACT. OUTWORK - Sections 110 and 111. Nature of Work. No. of Outworkers in August list Wearing Apparel-Making, etc. 117 No instances of work in unwholesome premises. 49 INDEX Page Acknowledgments 6 Acreage 7 Adoption of Private Streets 21 Alkali Inspector 18 Aged, Care of 13 Agriculture (Safety, Health & Welfare Provisions) Act 1956. 23 Ambulance Service 11 Atmospheric Pollution 18 Births 7 Birth Rates 7 - Area Comparability Factor 8 - Comparative 8 - Illegitimate 7 Bretons Farm Sewage Works 19 Bury Farm Sewage Works 20 Canteens, School 39 Caravans 24 Care of the Aged 13 Certificates of Disrepair 26 Cesspools 19 Child Welfare 12 Clean Air Act, 1956 5, 16 Clinics, Child Welfare 12 Contents, Table of 2 Day Nursery 12 Deaths 7, 9, 10 - Age Groups 10 - Causes of 10 - Infantile 7 - Main Causes 9 - Maternal 7 Death Pates 7, 8 - Area Comparability Factor 8 - Comparative 8 - Early Neonatal 7 - Infant 7 - Neonatal 7 - Perinatal 7 Diphtheria Immunisation 40 Diseases of Animals (Waste Food) Order, 1957 23 Disinfection 21 Disinfestation 21 Ditches 20 Domestic Help Service 12 Drainage and Sewerage 5, 19 Dysentery 40 Essex County Council Act, 1952 - Section 103 38 - Section 105 36 Establishments for Massage or Special Treatment 22 50 Page Extension or Improvements to Sewage Works 20 Factories Acts, 1937 to 1959 24, 47, 48 - Defects 47 - Inspections 24, 47 - Outwork 24, 48 - Prescribed Particulars 47 Fireguards 22 Farms 23 Food Poisoning 40 Food- Complaints 33, 34, 35 Hawkers 38 Inspection of 23 Meat Inspection 36 Premises 23, 36 Preserved 38 Unsound 36 Food and Drugs Act, 1955 5, 29 - Administration 29 - Food Hygiene Regulations, 1955 36 - Public Analysts 4,29 - Sampling 23, 29, 30 General Mortality- Main Causes 9 General Sanitary Circumstances 14, 24 Heating Appliances (Fireguards) Act, 1952 and Regulations, 1953 22 Home Nurses and Midwives 12 Home Safety 13 Hornchurch Urban District Council Act, 1936, Section 90. 38 Houses- Inspection of 24 Number erected 26 Number inhabited 7 Housing 24,26,27,28 - Caravans 27 - Certificates of Disrepair 26 - Closure and Demolition 26 - Common Lodging Houses 28 - Improvement Grants 27 - Overcrowding 27 - Rehousing (medical aspects) 27 - Sub-standard Accommodation 26 - Visits paid 24 Ice Cream 38 - Registration 38 - Sampling 38 Immunisation and Vaccination Statistics 40, 41 Improvement Grants 27 Infectious and Other Notifiable Diseases 6, 40 - Hospitalisation 40 - Notifications 40 - Visits paid 24 51 Page Informal Notices Served 25 International Certificates of Inoculation/Vaccination 40 Laboratory Facilities 11 Land Charges Enquiries 28 Laundry Service 13 Maternity and Child Welfare 12 Maternity Homes 12 Measles 40 Meat Inspection 36 - Carcases Inspected and Condemned 37 Medical Examinations 11 Members of the Council 3 Members of the Public Health Committee 3 Metal Dealers 22 Midwives and Home Nurses 12 Milk- Distributors 38 Sampling 39 Special Designations 38 National Assistance Act, 1948, Section 47 13 New Streets 21 Noise Abatement Act, 1960 22 Notices Served 25 Nursing and Maternity Homes 12 Officers of the Public Health Department 4 Old Metal Dealers 22 Outworkers 24, 48 Paddling Pools 21 Penny Rate Product 7 Pet Animals Act, 1951 22 Poliomyelitis 40 - Vaccination 41 Population 5, 7 Preface 5 Public Analysts 4, 29 Public Health- Inspection 23, 24, 25 Inspectors 4, 11, 25 Public Relations 11 Radioactivity 15 Rag Flock and Other Filling Materials Act, 1951 23 Rainfall 14, 15 Rateable Value 7 Regional Sewerage Scheme 5, 19 Rent Act, 1957- Certificates of Disrepair 26 Riding Establishments Act, 1939 23 Rivers 20 Rodent Control 22 - Farm Work 22 52 Page Royal Commission on Local Government in Greater London 6 Scarlet Fever 40 School Canteens 39 Sewage Works 19 Sewerage and Sewage Disposal 5, 1 Shellfish 39 Shops Act, 1950 24, 2 Slaughter of Animals Act, 1958 37 Slaughterhouses 36, 37 Smoke Control Areas 16, 24 Soil Sewers 19 Staff 4, 11 - Medical Examinations 11 Staffing 11 Statutory Notices Served 25 Stillbirths 7 - Rates 7 Streets Made Up and Taken Over 21 Summary of Public Health Inspectors' Work 23, 24 Surface Water Sewers 19 Swimming Pool 20 Table of Contents 2 Tuberculosis 42 - Incidence and Mortality 42 - Mass Radiography 44 - Notification/Mortality Interval 46 - Chest Clinic 42 Vaccination Statistics 40, 41 Vital Statistics 5, 7 Water- Sampling 14 Supplies 14 Well 14 Whooping Cough Immunisation 40