THE ANNUAL REPORT OF HENRY BATESON, ESQ., M. D., LOND THE MEDICAL OFFICER, OF HEALTH FOR THE PARISH OF SAINT GEORGE THE MARTYR, SOUTHWARK, READ TO THE VESTRY OF THE PARISH AT THE MEETING HELD ON THE 10th DAY OF JUNE, 1873. Extracted, by order of the Sanitary Committee of the Vestry, from the Vestry's Seventeenth Annual Report. 1873 francis passmore, printer and stationer, 60, borough road, southwark.-s.e. Sou 18 THE ANNUAL REPORT OF HENRY BATESON, Esq., M. D„ Lond. THE MEDICAL OFFICER OF HEALTH FOR THE PARISH OF SAINT GEORGE THE MARTYR, SOUTHWARK, READ TO THE VESTRY OF THE PARISH AT THE MEETING HELD ON THE 10th DAY OF JUNE, 1873. Annual Report of the Medical Officer of Health—1872—3. 3 Parrish of Saint George the Martnr Southwark ANNUAL REPORT MADE TO THE VESTRY by the MEDICAL OFFICER OF HEALTH. FOR THE YEAR ENDING LADY-DAY, 1873. Mr. Chairman and Gentlemen, Four events have characterised the year now past, looked at simply from a sanitary point of view; and that is all which concerns us here. In it we have witnessed the passing away of an epidemic, which has been present between two and three years, killing, disfiguring, blinding, and otherwise maiming thousands upon thousands of the people of this country. In the year 1871 alone, it destroyed in England above 23,000 persons, 7,876 of which persons lived in London. The next event, is one of a negative kind, remarkable rather for its non-existence, and which is, that no other epidemic has yet appeared to take the place of the one that has disappeared. Experience has told us that, one epidemic treads hard upon the heels of another, and we have never long remained free. A change in this monotonous procedure may be at hand, and the land have rest. The third noticeable thing is the passing of the Public Health Bill. This Bill bears traces of the results of much labour and thought, and shows also that Government is no longer heedless about the health and comfort of the people. The neglect of which duty, has kept up our death rate, filled our homes with widows and orphans, crowded our Workhouses and the gates thereof with paupers ; a neglect which has eaten like a canker into the heart of our social system. The passing of this Bill, whilst on the one hand a source of satisfaction, had connected with its passage through the House of Commons much that tends to abate any great amount of enthusiasm. We should have reasonably expected that during the discussion of a measure so important, fraught in such a variety of ways with the weal or woe of the nation, that not a seat in the House would have been found vacant, except 4 Parish of Saint George the Martyr, Southwark. from absolute necessity: that all the suggestions and aids, which wisdom and experience could bring to bear would have been willingly and earnestly given, and would have been as willingly and earnestly received; and that there would have been manifested a most sincere and anxious endeavour, and a spirit of self-sacrifice in helping on the Bill. The reverse was almost the case; empty benches, lukewarm speeches, marked its weary course. No number of Public Health Bills will avail, unless the nation—and we look upon the House as its representative—will take some interest, and give itself some trouble in the matter. Sir J. D. Coleridge, Q.C., M.P., truly remarked, when speaking upon this subject at the last Social Science meeting, "that what was wanted was a complete and intelligent understanding of the immense importance of these questions, within the walls of the Legislature." And as long as it remains true, that the wealth and strength of a nation depends upon the health of its masses, the sooner this "complete and intelligent understanding" is gained, the better will it be for this country. The fourth and last event to which I will claim your attention is the Adulteration Act This Act was almost universally demanded, for adulteration had reached a most shameful extent, injuring alike the health of the purchaser, and the morals of the seller. I do not moan to assert that all adulterations are injurious to health, many are not so; but I do say that selling an article for that which it is not is a grievous wrong, and if we are to be stigmatised as a nation of shopkeepers, let us not give cause that we should be stigmatised as a nation of dishonest shopkeepers. If an article be mixed, let it be stated with what it is mixed. A Milkman in -a considerable way of business told us, that if we carried out rigidly this Act, there would not be quarter enough milk for London consumption. I have no doubt whatever, that this statement is correct as to the extent of the adulteration of this important article of diet. So, upon this one part of milk and three parts of water, the children of the Metropolis are fed. Well may such children be stunted in their growth, and have their lower limbs bent into a variety of shapes. Out of the phosphates which milk contains, should these soft bones become changed and formed into the "bones of strong men." Thousands of children have never tasted milk, other than this watery compound. From the beginning of life unto its close is man thus injured and destroyed. TABLE No. 1. Years 1863-4 1864-5 1865-6 1866-7 1867-8 1868-9 1869-70 1870-1 1871-2 1872-3 Deaths 1689 1646 1482 1502 1352 1501 1740 1410 1444 1119 Excess of Births 443 433 707 543 706 671 249 655 499 997 During the year 1872—3 that ended 29th March, 1873, there were born in this district 2116 children, 173 more than in the preceding year, 1050 of these were boys, and 1066 were girls. The number of deaths registered during the same period of time was 1,119, a decrease in the mortality to the extent of 325. Of these 561 were males, and 558 were females. The excess of births over deaths was 997. The death rate was near 20 per thousand, or one death in 51 persons living. In no year of the last ton, has there been so large an excess of births, and in no year of the same period have there been so few deaths. Annual Report of the Medical Officer of Health—1872—1873. 5 An examination of the first Table will clearly show this. The variation of the death rate from the highest to the lowest in these years was 363. TABLE No. 2. Week. Kent Road. Borough Road. London Road. Total. Mean Temperature. Week Kent Road. Borough Road. London Road. Total Mean Temperature. 14 8 10 6 24 44°.7 40 6 4 4 14 52°.4 15 10 7 10 27 51°.4 41 5 10 7 22 47°.3 16 6 6 14 26 46°.2 42 4 10 6 20 44°.4 17 4 10 7 21 50°.l 43 11 3 9 23 478.4 18 7 7 10 24 52°.6 44 7 4 12 23 49°.7 19 9 7 5 21 47°.2 45 1 6 3 10 50°.3 20 4 10 6 20 47°.5 46 4 5 11 20 87°.9 21 5 7 6 18 49°.8 47 10 7 7 24 43°.9 22 5 5 8 18 57°.7 48 3 4 7 14 48°.0 23 10 4 7 21 52°.6 49 4 7 7 18 41°.9 24 5 5 7 17 57°.9 50 9 4 8 21 38°.6 25 8 11 7 26 66°.5 51 6 4 7 17 41°.5 26 7 2 8 17 60°.3 52 5 5 2 12 48°.7 27 7 10 7 24 64°.5 1 7 3 3 13 45°.2 28 7 6 9 22 63°.1 2 8 4 8 20 47°.9 29 14 12 6 32 6l°.4 3 5 8 3 16 46°.l 30 6 3 15 24 71°.1 4 3 8 10 21 37°.4 31 9 9 9 27 61°.7 5 7 3 14 24 33°.3 32 5 4 12 21 59°.2 6 7 5 10 22 32°.9 33 7 16 6 29 60°.6 7 8 9 8 25 36°.0 34 10 5 10 25 61°.3 8 11 10 5 26 33°.4 35 5 11 7 23 60°.1 9 8 5 9 22 36°.0 36 6 5 8 19 64°.5 10 8 8 11 2 7 43°.3 37 8 8 7 23 62°.7 11 10 4 5 19 38°.6 38 4 3 9 16 54°.3 12 10 8 11 29 39°.1 39 5 10 10 25 49o.0 13 8 9 10 27 45°.3 The second Table gives the deaths for each week in each of the three Sub-districts, with the mean temperature for each week. In one week, the 45th, there were registered 10 deaths, in another, the 29th, there were registered 32 deaths. The temperature of the week does not point out the influence of the weather upon that week's death rate, inasmuch as a coll season would not increase the death rate until some time after, when perhaps the temperature might have risen. TABLE No. 3. SUB-DISTRICTS. POPULATION IN 1871. NUMBER OF DEATHS IN 1872-3. Kent Road 20430 356 Borough Road 16694 850 London Road 18959 413 6 Parish of Saint George the Martyr, Southwark. The deaths registered in the three Sub-districts may be seen by referring to Table 3. In the Kent Road sub-district there were 356, or one death in 57 persons living; in the Borough Road Sub-district there were 350, or one in 47 persons living; in the London Road there were 413, or one in 45 persons living. The Kent Road Sub-district was the most healthy, and the London Road Sub-district the most unhealthy. In the year 1871-2, London-road Sub-district was the most healthy, and the Borough-road Sub-district was the most unhealthy. TABLE No. 4. 1872—3 BIRTHS. DEATHS. Quarter ending June 532 280 Quarter ending September 477 310 Quarter ending December 537 238 Quarter ending March 570 291 The greatest number of deaths happened in the quarter ending September, when the deaths were 72 above the quarter ending December, which was the healthiest. The mortality in the different quarters is constantly varying. TABLE No. 5. 1868—9 1869—70 1870—1 1871—2 1872—3 First Quarter Second Quarter Third Quarter Fourth Quarter First Quarter Second Quarter Third Quarter Fourth Quarter First Quarter Second Quarter Third Quarter Fourth Quarter First Quarter Second Quarter Third Quarter Fourth Quarter First Quarter Second Quarter Third Quarter Fourth Quarter Small Pox 2 ... ... 2 3 7 3 1 1 1 2 49 79 22 11 8 10 7 1 ... Measles 11 3 16 5 14 13 13 6 3 1 3 10 8 15 20 15 6 ... ... 2 Scarlatina 8 11 29 3 6 59 61 26 14 27 17 7 7 8 9 5 3 2 5 1 Diphtheria 1 1 3 1 ... 1 2 ... 1 2 1 1 2 2 2 1 3 ... 1 1 WhoopingCough 19 16 5 3 20 11 22 21 8 5 5 8 8 11 22 41 19 9 7 10 Diarrhœa 11 68 0 3 7 63 3 2 10 47 8 1 3 63 6 6 4 60 5 1 Typhus 11 10 12 15 11 11 4 10 11 8 8 11 5 4 7 3 6 4 ... 10 There has been a remarkable diminution of deaths from the diseases included in the zymotic class. In the year 1871—2, the deaths from this class were 453, in the year now Annual Report of the Medical Officer of Health—1872—3. 7 ended they were 231, thus there was a decrease to the extent of 222. This is the class that is most amenable to sanitary measures. The destruction of houses which were utterly unfit for habitation, and the abolition of many courts, and alleys, and nooks where the people had made their homes, have been carried on to a considerable extent in our District. In this respect there remains much yet to be done: there is great need for a new Building Act, or, a more rigorous watchfulness over the old Act. Small-pox instead of destroying 120 as in the year 1871—2, destroyed but 18. These 18 deaths were voluntarily brought about either by the neglect, the ignorance, the prejudice of the sufferer, or others. The first Report issued by the Managers of the Metropolitan Asylum Districts, 1870-1-2, concerning this disease is one of great importance and interestOne thing is plain from reading it, that Vaccination in spite of legislation and all the means that have been put into operation, has been fearfully neglected, and what is as bad or almost worse, as it has led to a false security, is, that it has been most imperfectly perfnrmed The value of Vaccination, and the consequent safety of the patient, depends upon the manner in which it has been done. The percentage of deaths among the unvaccinated cases was 47½, whilst the percentage of those who had been carefully and thoroughly vaccinated was but 11. Nothing can more clearly show the benefit which accrues from this operation. In a total of 420 well vaccinated cases under 15 years of age, the death rate was 0.47, less than half a person in the 100. But let us consider what expense this dreadful disease caused, for that may tell with some, more than suffering and death. The Report tells us that there were 14,400 cases treated in the Hospital, and that of these 2,700 died, whilst 11,700 remained under treatment. The duration of the stay of these in the Hospital had they been efficiently vaccinated, would have been about 245,400 days, but the actual number of days they did spend there, was 378,700, or 133,300 days more than the efficiently vaccinated would have done. The average cost for each patient was 1s. 4¾. per day, consequently no less a sum than £9,300 was spent for their maintenance alone; as the salaries and the maintenance of the officers, nurses, and others were not included. Out of 2,528 cases treated at the Homerton Small Pox Hospital 1,006 had no vaccination marks, and 37 died in the 100. In another Hospital (provincial) out of 972 cases, 623 had been vaccinated more or less perfectly; whilst 266 had never been vaccinated at all; of the former 8 died in the 100, of the latter 31. Of those who had three or more good marks, none died. " They who can remember," says Dr. J. A. Symonds, " as I can, the time when the nation was just realising the benefit of Jenner's transcendent discovery in the new sense of security to life, and, I may add without any hyperbole, in the renaissance of the beauty of men and women; those who can remember that time, and the infinite labour expended in reasoning and preaching, and pleading, and persuading a doltish and prejudiced people to profit by the beneficent light which through a genius all but divine, had been flashed upon them; those who can remember the hard emergence of human life and human beauty from that period of desolation and disfigurement, are shocked by the pernicious levity with which doubts are now thrown upon the value of vaccination, the most precious boon that any one man ever conferred on his 8 Parish of Saint George the Martyr, Southwark. fellows." The very efficiency of the remedy has brought about its neglect. The remembrance of that disease so loathsome to sight and smell, and which presented such a mass of hideous corruption as "is not met with this side the grave," is obliterated from the minds of the present age, and forgotten. But let me for a moment bring before you small-pox as it rages and spreads where vaccination has never been performed. Captain Butler, in his interesting account of the "Great Lone Land" tells us that for some months previous to his journey (May, 1871), this disease had swept from the Missouri through the Black-feet Indians, and had ran the whole length of the North, passing from tribe to tribe, and "had left in its track depopulated wigwams and vacant council-lodges: thousands (and there are not many thousands all told) had perished on the great sandy plains that lie between Saskatchewan and the Missouri. Of all the fatal methods of destroying the Indians which his white brother has introduced into the "West, this plague of small-pox is the most deadly. The history of its annihilating progress is written in too legible characters on the desolate expanses of untenanted wilds, where the Indian graves are the sole traces of the red man's former domination. Beneath this awful scourge whole tribes have disappeared, the bravest and best have vanished, because their bravery forbade that they should flee from the terrible infection, and, like soldiers in some square plunged through and through and rent with shot, the survivors closed only the more despairingly together when the death-stroke fell heaviest amongst them. It had commenced in the trading camp, then it had travelled on, and everything had gone down before it—The chief and the brave, the medicine man, the squaw, the papoose. The camp moved away but the dread disease clung to it, and far over the plains the track was marked with the unburied bodies and bleaching bones of the wild warriors of the west." TABLE No. 6. 1863-4 1864-5 1865-6 1866-7 1867-8 1868-9 1869-70 1870-1 1871-2 1872-3 Small Pox 31 8 6 44 24 4 14 53 120 18 Measles 53 53 31 25 13 35 46 17 58 8 Scarlatina 92 79 28 34 42 51 152 65 29 11 Diphtheria 8 59 5 6 7 6 6 3 5 7 5 Whooping Cough 64 48 55 67 43 74 26 82 45 Diarrhœa 62 44 85 44 58 88 75 66 78 70 Fever 113 128 51 as 34 48 36 38 19 20 The most fatal disease of the zymotic class has been diarrhoea, although the deaths from tnis disease are 8 less than in the preceding year. The deaths from choleraic diarrhoea were two, the same as the year before. Whooping-cough follows next, to which were attributed 45 deaths; then fever which caused 20 deaths. But the deaths from fever of those who are removed to the hospital, are registered whore they die, and not in the district Annual Report of the Medical Officer of Health—1872 — 3. 9 from which they were taken, conseqently, 20 does not include all the deaths which have happened from fever In the year 1864-5 there died from this disease 128. I have had occasion to call your notice to cases where, this disease had been carried about by the milkman, others have since occurred which I will briefly relate. Towards the close of the year 1872, fever appeared in Leeds, in isolated places, and in places where the sanitary condition was unexceptionable. The cause of this for a while completely baffled discovery. At length however, it was found, that a milk dealer living in the centre of the town, supplied every house in which fever was present. But the milk-dealer got his milk from a Farm-house some distance away, and all within his own house were well. Upon visiting the Farm-house, six persons were found suffering from the disease, lying in a room adjoining that in which the milk-cans were kept; and what is more, nursed by the same woman who managed the dairy. The number attacked were 80, of whom 14 died. A dairyman in Glasgow, had fever in his house. He supplied 73 families living in five different streets. In these families 36 cases of fever occurred. In two families thus supplied, two alone used the milk, and both suffered. This evidence marks the " trail of the milkman " for evil. In like manner as I brought before you the destructive powers of small-pox when uninterfered with by vaccination, so I will place before you fever as it rages in localities where sanitary measures are neglected. In the beginning of the year 1871, fever was epidemic at Buenos Ayres, the effects of which were similar to those of the plague in London, only that the mortality was actually higher. It commenced in the low and thickly peopled districts. It spread rapidly and with ever increasing virulence. Through the hot months of February and March the death list grew longer and more sad, till early in April the climax was reached, for in one day there were 700 deaths, out of a population (reduced by flight and death from 200,000) of 70,000. By the middle of April, not more than 30,000 were left in the city: of this number it was calculated that 7,000 were ill of the fever, and there were still 300 deaths occurring daily. From this time they fell off to 100, and so decreased. "Shops were closed, and business suspended, in the market places and the exchange formerly filled with noise and bustle, now was nothing but silence and desolation. The streets but lately so full of busy life, were hushed and deserted, traversed only occasionally by a gloomy dead cart, by some poor family hastily flying at the last moment from the influence of the deadly foe, by a few forms pale and haggard, on whom the fever had spent its force, but failed in its work of death, by one or two bold and still unharmed men hurrying hither and thither to administer what aid they could to the suffering and the dying." This city of 200,000 souls was without a drain. Cesspools were dug in the courtyard of every house, through the soil until water appeared, the depth of which averaged about 26 feet. This filled, another was dug close by, and so the process went on. The dry nature of the soil and of the air keeping at bay disease. The water was drawn from wells nto which the cesspools drained (A. D. Carlisle, B.A). Means more fitted to bring about these terrible results could not have been adopted. The mere money loss from this epidemic, would have built a city of marble, and with such sanitary appliances, as the world must wait long centuries to see. Brain and nerve diseases, contrary to general opinion, have for several years been upon the decrease. The deaths were 20 less than in the former year. 10 Parish of Saint George the Martyr, Southwark. Always consumption has headed the death list, but this year bronchitis has gone beyond it; 128 deaths were attributed to the former, whilst to the latter were attributed 149. No other disease comes nigh these as cause of death. The mortality from diseases of the digestive organs varies very little. Indeed its regularity is remarkable. Out of the 11,119 deaths, 42 were registered from premature birth and debility. Twelve infants, their ages ranging from 11 days to 5 months, were suffocated, one of them from being too closely wrapped in a shawl. Two males and three females, aged respectively 2, 12, 22, 60, and 73 years died from injury to the brain. One of the females was killed from a blow from a stone, whence resulted a case of manslaughter. A male aged 48 years, poisoned himself with laudanum; and two women, aged 59 and 63 years, hung themselves. The deaths under 5 years of age, were 567, at 40 to 80 years 321, and 36 at 80 years and upwards. Two females reached 90, and 93, and one male 95 years. The regulations made by the Water Companies, and sanctioned by the Board of Trade, will prove so costly as to amount to a prohibition of obtaining a constant water supply, which was perhaps the end designed. The apparatus will it is said cost more than £10 for a cottage, and for a large west end house £60 and upwards. This cost to obtain one of the necessaries of life is far too great. But what is more, the efficiency and durability of the required apparatus, is considered doubtful. The outlay at first will be large, and to keep the machinery in order, continuous. Concerning the Water-waste Preventers now being placed in some parts of the district, I cannot say much at present; but I anticipate great benefit from their general use. One will be set up in the Vestry Hall, for the inspection of those who wish to learn their purpose and structure The Slaughter-houses, Cow-sheds, and Bakeries have been duly visited according to the requirements of the several Acts, and the necessary sanitary measures carried out There is gradual improvement; but no improvement could make some of them what we should desire, owing to structural difficulties. * The tons figured, are so many tons of impurity in 100,000 tons of water. TABLE No. 7 * NAME OF WATER COMPANY. TONS. NAME OF WATER COMPANY. TONS. 1872. 1872. Southwark Company—April 26 Lambeth Company -April 27 „ „ May 27 „ „ May 26 „ „ June 25 „ „ June 26 „ „ July 26 „ „ July 28 „ „ August 21 „ „ August 26 „ „ September 23 „ „ September 24 „ „ October 30 „ „ October 32 „ „ November 28 „ „ November 30 „ „ December 30 „ „ December 29 1873. 1873. „ „ January 28 „ „ January 29 „ „ February 32 „ „ February 32 „ „ March 30 „ „ March 30 11 Annual Report of the Medical Officer of Health—1872—3. TABLE No. 8. 1872—3. Small Pox Measles Scarlet Fever Diphtheria Whooping Cough Fever Diarrhœa 1872—3. Small Pox Measles Scarlet Fever Diphtheria Whooping Cough Fever Diarrhœa Ann's Place ... ... 1 ... ... ... ... London Road 1 ... ... ... 1 ... ... Adam's Place ... ... ... ... ... ... 2 Lant Place ... ... ... ... ... ... 1 Amelia Street ... ... ... ... ... ... 1 Market Street ... ... ... ... ... ... 1 Albert Terrace 1 ... ... ... ... ... ... Blackfriars Road ... ... ... ... ... ... 1 Martin Street ... ... ... ... 1 ... ... Mason Street ... ... ... ... 1 ... 1 Brough Road ... ... ... ... 1 ... ... Mina Road ... ... ... ... ... l ... Bangor Court ... ... ... ... 1 ... ... Brook Place ... ... ... ... 2 ... 1 Bath Street ... ... ... ... ... ... 1 New Kent Road ... ... ... ... 2 ... ... Northampton Row ... ... ... ... 1 ... ... Castle Street ... ... ... ... 1 ... 1 Northampton Street 1 ... ... ... ... ... ... Noel Street ... ... ... ... ... 1 1 Clarendon Street ... ... ... ... 1 ... 2 Clarence Place ... ... ... ... ... ... 1 Old Kent Road 1 1 ... 1 ... ... ... Cleghorn Cottages 1 ... ... ... ... ... ... Drapers' Alms Houses ... ... ... ... ... ... 1 Peabody Square ... ... ... ... 1 1 2 Potier Place ... 1 ... ... ... ... ... Drawin Street 1 ... ... ... ... ... ... Paragon ... ... 1 ... ... ... ... Duke Street ... ... ... ... ... 1 1 Disney Street ... ... ... ... ... ... 1 Queen Street ... ... ... ... 1 ... 1 Evelina Hospital ... ... 1 3 5 1 1 Red Cross Street ... ... ... ... 1 1 ... Elizabeth Cottages ... ... 1 ... ... ... ... Red Cross Square ... ... ... ... 1 1 ... Elliott's Row ... ... ... ... 1 1 1 East Street 1 ... ... ... 1 ... ... Southwark Bridge Road ... ... ... ... ... ... 1 Francis Place ... ... ... ... ... ... 3 St Stephen's Square ... ... 1 ... ... ... ... St. George's Road ... 1 ... 1 1 ... 1 Friar Street ... ... 3 ... 1 ... 1 Suffolk Street (Gt.) ... ... 1 ... ... ... ... Gibraltar Place ... ... ... ... ... ... 1 Staple Street ... ... ... ... ... ... 1 South Street ... 4 ... ... ... ... ... Stanford Place ... ... ... ... 1 ... ... Gladstone Street ... ... ... ... ... ... ... Swan Place 1 ... ... ... 2 ... l George Street ... ... ... ... ... ... 1 Green Street ... ... ... ... ... ... 3 Townsend Street ... ... ... ... ... 1 ... Gray Street 1 ... ... ... ... ... ... Herbert's Buildings ... ... ... ... ... ... 2 Temple Street ... ... ... ... ... ... 2 Tower Street ... ... ... ... 1 ... 3 Type Court 1 ... ... ... ... ... ... Harrow Street ... ... ... ... ... ... 1 Hunter Street 4 ... 2 ... 3 ... 8 Valentine Place ... ... ... ... ... ... 2 Henry Street ... 1 ... ... ... ... ... Hayle's Street ... ... ... ... ... 2 1 High Street ... ... ... ... ... ... 1 Valentine Row ... ... ... ... ... 1 ... Joiner Street ... ... ... ... 1 ... ... Westminster Bridge Road ... ... ... ... ... 3 ... Waterloo Road ... ... ... ... ... 1 1 James Street ... ... ... ... ... ... 1 Wellington Place ... ... ... ... ... ... 1 John Street ... ... ... ... 1 ... l Wickham Place ... ... ... ... 1 ... 1 King's Court ... ... ... ... ... ... 1 White Horse Yard ... ... ... ... ... ... 1 Warwick Street ... ... ... ... ... ... 1 Westcott Street ... ... ... ... 1 ... ... King's Place ... ... ... ... ... ... 1 Kent Street ... ... ... ... 2 ... 3 William Street ... ... ... ... 1 ... ... Kell Street ... ... ... ... 1 ... ... Webber Street ... ... ... ... ... 1 1 King Street ... ... ... ... ... ... 1 Webber Row 2 ... ... ... ... 1 2 West Square 1 Lansdowne Place ... ... ... ... ... 1 2 West place ... ... ... ... ... 1 ... Workhouse ... ... ... ... 1 ... 1 York Street 2 ... ... ... l ... ... Lancaster Street ... ... ... ... ... ... 1 Our courts, alleys, and poorer localities, do not give so large a mortality from zymotic diseases as formerly. Doubtless the sanitary measures that have been carried out, are telling for good upon the health of those who dwell therein. These places with reference to comfort, and cleanliness, present a striking and gratifying contrast, to what they 12 Parish of Saint George the Martyr, Southwark. did only a few years back. But sanitary measures as regards drainage, ventilation, house accommodation, and the like, do not by any means cover the whole ground of sanitary requirements. Sanitary reform, does not consist only in caring for that which is without the man, but also of caring for that which is within the man. Reformation is truly needed, but it is not easy to say where it is best to begin that reformation. Man is already hardened in his ways and habits, and is already suffering for the disobedience to the laws of health, which has marked his course onwards from childhood; and that which is crooked cannot be made straight. If we commence with the young our hopes of success seem brighter, and better established ; but, then, we find they are born, trailing after them the vices and the virtues, the diseases and the peculiarities of their ancestors. For more assured success in our endeavours, we seem compelled to go farther back still. It is matter of surprise in looking over the actions of our forefathers, to see what little attention has been paid to the physical welfare of man. Whether he should rise or fall in moral and intellectual power; whether his days should be few or many; whether those days should be spent in the joy and vigour of health, or dragged through in suffering and sadness, seemed to have claimed no special care or forethought. Present gain, and present gratification closed in the horizon of life. The situation of our towns; the land upon which the agriculturist has built his homestead ; the ground upon which has been roared the stately factory; the choice of dwelling by those who lived by the sweat of their brain, all have been selected with reference to commerce, to production of soil, and to where the works of art and literature were patronised. In not one of these selections was health ever considered. That health was wealth, and that sickness was poverty, remained an unheeded fact. Millions have suffered and perished, to bring this fact before our notice, and millions more must suffer and perish, before the lesson it teaches will be put into practice. Man is born into the world and passes through it, with multiform inherent tendencies, and according to the circumstances which surround his birth and life, will it happen, that these tendencies shall lie dormant, or be developed into full activity. The great and primitive design iu nature is towards health; through all her ways and works a beneficial tendency runs, which, thwarted and opposed, leads to the deterioration and degradation, of the race, until unfit for earth, it is swept away from the face thereof. On the other hand, when this tendency shall have full and froe scope for its natural and thorough developement, who may measure its limits, or fix its boundary line. The power by which are transmitted from father to child the same form, the same features, the same temperament, also transmits the same features and peculiarities to the hidden structures, namely, to the brain and nervous system, the heart, the lungs and other organs, from whence follow the diseases connected with these organs. This points out the care that should be exercised in our marriage regulations, for that truly is the foundation from whence commences physical, mental, and moral improvement. To this important matter no consideration whatever is given. Few, nay no marriages are promoted or forbidden upon such grounds. The mere gravely introducing such a consideration to those "about to marry," would be received with a burst of laughter, or a shout of derision. Now, " we have only to procure a marriage license, and we may without any kind of cen- Annual Report, of the Medical Officer of Health—1872—3. 13 sure bring any number of decrepid, imbecile, insane, scrofulous, and otherwise diseased children into the world." How often are we called upon to witness the sad results of the marriage of persons afflicted with the same mental and physical diseases, or tendencies thereto. The intensifying of disease, the early death of one or both parents, and the residue of a puny delicate offspring, are the sure and certain results from such ill-assorted marriages. The intermarriage of near relations has produced the most fatal results upon the progeny. It has proved one amongst other causes of the decline and fall of nations. "The degeneracy of the old Spanish nobility, through the result of a proud and arrogant exclusiveness in marriage is an instance in point at one end of the social ladder; and the degeneracy of some almost savage tribes in the wilds of Connemara point the same moral at the other end of it." By hereditary disease is not meant that disease is then and there actually present: there is simply the tendency of some part or parts of the body to take up a particular ailment, and which will most probably happen, unless measures be put in operation to prevent such result. And here is made manifest the benefit which may be derived from sanitary knowledge, by which we may be enabled to strengthen that which is weak for good, and crush down or stamp out that which is strong for evil. This may be done by the selection of suitable occupations, by the choice of healthy residences, by well selected marriages and by the strict observance of hygienic rules. I will select scrofula, a disease well known from its prevalence and fatality, to illustrate the consequences that follow from neglect of these duties. I must first tell you that scrofula and consumption are in all essentials one and the same disease, and that they betoken a serious deterioration and degradation of the system of those affected. Scrofula which proves fatal to child and adult, destroyed in this country in the year 1870, to the extant of 2,935 pet-sous: to tabes, a disease of childhood were attributed 4,762 deaths; to water in the head, another disease peculiar to children 7,483 and to consumption, which kills old and young alike 52,290. So that, from this one disease under different forms, 71,285 persons have died. We are greatly alarmed when we hear of cholera and its ravages, but in this case, we utter no exclamation of surprise or horror, but pursue calmly and apathetically the same fatal course, acting as heretofore did our ancestors with reference to plague and pestilence, of which Sydenham said, they were as regular as the return of swallows in spring. The swallows still return to announce the advent of that season, but where are the plagues and pestilences ? Not one death of this mighty host need have happened. Over their cause we have perfect control. We can augment, diminish or extinguish. Such a terrible punishment marks out the gravity of our disobedience. Think of the sufferings, the watchings, the heart-agony, the weary hours, involved in these thousands of untimely deaths. But do thinking can scale, no emotion repeat, no plummet sound their height, and depth, and extent. To prevent so monstrous an holocaust we should deem no labour too severe, no sacrifice too great; and yet neither labour nor sacrifice are needed, all that is needed is simple obedience to the laws of health and reason. Herbert Spsncer, the foremost Psychologist of the day, speaking of the ailing offspring of ailing parents, says, that their preservation instead of diminishing suffering eventually increased it, and that it favoured the multiplication of those worst fitted for existence. 14 Parish of Saint George the Martyr, Southwark. Besides, that it filled "the world with those to whom life will bring most pain, and tended to keep out of it those to whom life would bring most pleasure." The result being that, by their preservation positive misery was inflicted, and positive happiness prevented. However true this may be, our duty remains plain, and which is, to preserve and not destroy. Not only to save life in whatever degenerate and enfeebled form it may appear, but to try to elevate and strengthen it. For every child born into the world, there should be found plenty of water, of air, of light, and of food; these 'Nature has given to the wild beast of the forest." They are essential. Without them the blessing of life is turned into a curse. And with these should be combined open spaces, with natural rural objects in them, that instinct may find its realisation. For to every instinct there is a satisfaction somewhere. In our crowded towns, where every bit of ground is utilised and built upon, where shall these requisites be found ? It takes much to crush out our humanity, or London would but exist as a den of thieves, or as a vast desert. How children pass through childhood in localities we daily see, and retain their humanity is a marvel. That they should ever arrive at manhood or womanhood with any residue of health and strength, or that there should be found in them any moral feeling, shows what a resisting power to evil there exists in that humanity. Before concluding, I desire to draw your attention to the connexion that exists, between disease and crime, as cause and effect. Hitherto, this has not been generally considered, and yet it has an important bearing upon our social proceedings. The mind is connected with our organism, and if that organism should happen to be deficient in proportion, or defective in working, the mental faculty will also be deficient or defective in its operations. Dr. Wilks, before a gathering of the British Medical Association held at Birmingham, told them, that so close was this connexion, that he believed that vice and crime could never be eradicated whilst such was the condition of the organism. Hence, not only may disease be created or prevented, according as we take or do not take heed to man's physical condition, but so also may vice and crime. Thus, our power widens, and our responsibilities increase. Our laws punish the guilty only; but nature punishes the innocent with the guilty. Children and childrens' children suffer for the deeds of their ancestors. And when we learn that physical diseases will obliterate the distinctions of vice and virtue, of honesty and dishonesty, of kindness and cruelty, and in fact upset our whole moral nature, we may well stand aghast at the position we occupy. I will just refer to the effects of intemperance as bearing upon this point. As a rule, the children of drunkards are born with a defective vitality; stunted in growth, as regards both mind and body; unequal to the demands which the common duties of life make upon them; and possessing a craving for drink, often so imperious as to be irresistible. Farther, they are often born with a strong tendency towards insanity, whilst numbers are born idiotic. In an Asylum for Idiots, enquiries were purposely made concerning the parents of the inmates, when it was discovered that nearly half of them were habitual drunkards. In one family consisting of seven idiotic children, both parents were found to be irreclaimable drunkards.* The United Kingdom it is stated contains 50,000 idiots. Thousands who now fill our jails, and hulks, and penal settlements have been born with diseased organisations, the hereditary gift of many generations; and who have been born into the world amid circumstances the most propitious for their *Dr. W. B. carpenter in Contemporary Review. Annual Report of the Medical Officer of Health—1872—3. 15 developement. "My prattle" says one of these "was oaths, my play brutality, and my thoughts and learning crime." Many of our Judges it is said have been struck with the appearance of the criminals brought before them; for whilst showing traces of "craft and cunning" they were intellectually below the average. "In the convict prison of Millbank, the average of insane, weak-minded persons exceeds 20 per cent." "In Perth prison it is officially reported that one out of every nine is more or less insane, and one out of every 140 irresponsibly so. Of 664 tried for murder, 108 were legally pronounced insane." We have long enough tried what neglect and punishment will do. It is high time that we try what care, education, sympathy ,and sanitary arrangements will do. By judicious selection of what is best; by getting rid of what is bad and imperfect, almost any variety of plant, and almost any form of animal can be produced, and to quite an extraordinary extent improved. When man shall obtain the same equal care and consideration, as regards selection and education that is bestowed upon the animal and vegetable world, we shall receive our reward in like success. A man is of more value than many sparrows, said One who know what was in man, and we may venture to hope that ho is even of as much value as a horse or a bullock. "Each generation" says a modern writer, "has enormous power over the natural gifts of those that follow and" he maintains "that it is a duty we owe to humanity to investigate the range of that power, and to exercise it in a way that without being unwise to ourselves shall be most advantageous to future inhabitants of the earth. and such power is needed, for the stream of life is gushing on in an ever increasing volume and depth, that to resist will require greater endurance and strength. The raising the standard of our race but one degree would be followed by inconceivable changes. It seems most essential to the well-being of future generations that, the average standard of ability of the present time should be raised. Human denizens have been swept away during the last three centuries, less by the pressure of a stronger race, than through the influence of a civilisation they were incapable of supporting. And we too the foremost labourers are beginning to show ourselves incapable of keeping pace with our own work. We are in crying want for more brains and mental stamina in all stations of life. Our race is over weighted, and appears likely to be dragged into degeneracy by demands that exceed its powers. We want as much back-bone as we can get to bear the racket to which we are henceforth to be exposed, and as good brains as possible to combine machinery for modern life to work more smoothly than at present." To enlarge these "natural gifts," and to benefit the "future inhabitants of the earth,'' has employed the mind of this generation to an extent, never before shown or ever contemplated. By preventing disease; by lengthening life, and making the enjoyment of that life possible; by emancipating mind and body from the weary bondage bequeathed to us from the past, we shall raise, and exalt humanity to a degree, that we may now not even dare to hope. HENRY BATESON, M.D., Lond. Tuesday, June 10th, 1873. 16 Pariah of Saint George the Martyr, Southwark. TABLE No. 9.—DEATHS Registered in St. George the Martyr, Southwark, during the year ending March 29th, 1873. Deaths in the 1 Year 1871—72. causes of death. all ages. ages. M. F. T. Under 1— 1- 2.— 3.— 4.— All under 5 5.— 10.— 15.— All under 20 20- 40.— 60.— 80 and upwards. All Causes. 561 558 1119 364 102 57 25 19 567 40 23 12 642 120 188 133 36 453 I. Zymotic 120 111 231 93 39 27 10 13 182 14 8 .. 204 11 10 6 .. 40 II. Dropsy, &c. 112 12 24 2 .. .. .. 1 3 I .. .. 4 4 11 5 .. 240 III. Tubercular 104 101 205 54 18 9 4 1 86 11 4 6 107 51 37 10 .. 175 IV. Brain and Nerves 84 71 155 54 16 7 5 2 84 4 1 1 90 19 25 18 3 35 V. Heart, &c. 16 21 37 .. .. .. .. .. .. 4 2 1 7 9 17 4 .. 295 VI. Lungs, &c. 121 107 228 64 20 12 6 1 103 2 2 1 108 9 50 53 8 57 VII. Digestive Organs 30 33 63 18 7 .. .. .. 25 .. 3 1 29 6 15 11 2 7 VIII. Kidneys, &c. 8 10 18 .. .. .. .. .. .. 1 2 1 4 1 9 4 .. 5 IX. Childbirth, &c. .. 6 6 .. .. .. .. .. .. .. .. .. .. 4 2 .. .. 5 X. Joints, Bones, &c. 4 1 5 .. .. .. .. .. .. 3 .. .. 3 1 1 .. .. 1 XI.— Skin, &c. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 4 XII.- Malformation .. 2 2 2 .. .. .. .. 2 .. .. .. 2 .. .. .. .. 32 XIII.- Premature Birth and Debility 22 20 42 42 .. .. .. .. 42 .. .. .. 42 .. .. .. .. 21 XIV.— Atrophy 14 5 19 19 .. .. .. .. 19 .. .. .. 19 .. .. .. .. 43 XV.— Old Age 10 31 41 .. .. .. .. .. .. .. .. .. .. .. .. 18 .. 1 XVI.- Sudden 1 2 3 1 .. 1 .. .. 2 .. .. .. 2 1 .. .. .. 21 XVII.— Violence, Privation, &c. 12 19 31 14 2 1 .. .. 17 .. 1 1 19 2 7 3 .. 9 XVIII.— Not Specified 3 5 8 1 .. .. .. 1 2 .. .. .. 2 2 3 1 .. 120 I. Small Pox 13 5 13 8 11 3 7 l 14 1 .. .. 15 1 2 .. .. 58 Measles 5 3 8 .. 2 4 1 .. 7 1 .. .. 8 .. .. .. .. 29 Scarlatina 8 3 11 .. 1 1 2 2 6 4 1 .. 11 .. .. .. .. 52 Hooping Cough 22 23 45 19 14 7 1 3 44 1 .. .. 45 .. .. .. .. 24 Croup 13 11 24 2 7 6 1 3 19 4 1 .. 24 .. .. .. .. 1 Thrush 3 .. 3 3 .. .. .. .. 3 .. .. .. 3 .. .. .. .. 78 Diarrhœa 30 40 70 50 11 1 3 1 66 .. .. .. 66 1 1 2 .. .. Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Cholera 1 1 2 .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scurvy and Purpura .. 1 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. Ague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Remittent Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Infantile „ .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 19 Typhus „ 10 10 20 .. .. 3 .. 3 .. .. 3 .. 10 5 3 2 .. .. Metria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 6 Rheumatism 4 3 7 .. .. .. .. .. .. 1 2 .. 3 3 1 .. .. 5 Erysipelas 4 3 7 3 1 .. .. .. 4 .. .. .. 4 2 1 .. .. 2 Pyæmia 1 .. 1 .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. 20 Syphilis 4 5 9 7 2 .. .. .. 9 .. .. .. 9 .. .. .. .. .. Noma .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7 Diptheria 2 3 5 1 .. 2 1 .. 4 .. 1 .. 5 .. .. .. .. .. Hydrophobia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7 II. Hæemorrhage 4 1 5 2 .. .. .. 1 3 .. .. .. 3 1 1 .. .. 11 Dropsy 3 4 7 .. .. .. .. .. .. .. .. .. .. 2 3 2 .. 3 Abscess 1 .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 2 Ulcers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Fistula .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Mortification .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 12 Cancer 3 7 10 .. .. .. .. .. .. .. .. .. .. 1 6 3 .. 3 Gout 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. III .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 72 Tabes Mesenterica 24 30 54 34 10 4 3 .. 51 3 .. .. 51 .. .. .. .. 144 Phthisis 65 63 128 7 3 5 .. 1 16 4 4 6 30 51 37 10 .. 4 Spasmodic Croup 2 1 3 2 1 .. .. .. 3 .. .. .. 3 .. .. .. .. 20 Hydrocephalus 13 7 20 11 4 .. 1 .. 16 4 .. .. 20 .. .. .. .. 2 IV. Cephalitis 1 .. 1 .. 1 .. .. .. 1 .. .. .. 1 .. .. .. .. 30 Apoplexy 15 9 24 .. .. .. .. .. .. .. .. .. .. 3 14 6 1 9 Paralysis 8 6 11 .. .. .. 1 .. 1 .. .. .. 1 3 2 6 2 2 Delirium Termens .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chorea .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 8 Epilepsy 4 7 11 .. .. .. .. .. .. .. .. 1 1 5 4 1 .. 1 Tetanus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11 Insanity 5 6 11 .. .. .. .. .. .. .. .. .. .. 6 3 2 .. 80 Convulsions 43 34 77 50 13 7 3 1 74 2 .. .. 76 .. .. 1 .. 32 Disease of Brain, &c. 8 9 17 4 2 .. 1 I 8 2 1 .. 11 2 2 2 .. Annual Report of the Medical Officer of Health—1872—3. 17 Table No. 9 continued. Births M. 1050. F. 1066. Total 2116. Excess of Births over Deaths 997. Deaths M. 561. F. 558. Total 1119. Deaths in Year 1871—72. CAUSES OF DEATH. ALL AGES. AGES. M. F. T. Under 1 1.— 2.— 3.— 4- All under 5 5 — 10.— 15.— All under 20 20.- 40.— 60.— 80 and upwards 1 V. Pericarditis 1 5 6 .. .. .. .. .. .. 3 .. .. 3 2 1 .. .. .. Aneurism 2 .. 2 .. .. .. .. .. .. .. .. .. .. 1 1 .. .. 34 Disease of Heart, &c. .. .. 29 .. .. .. .. .. .. 1 2 1 4 6 15 4 .. 6 VI. Laryngitis 1 .. 1 .. .. .. 1 .. 1 .. .. .. 1 .. .. .. .. 192 Bronchitis 80 69 149 36 11 6 4 1 58 .. 1 .. 59 3 39 42 6 2 Pleurisy 3 2 5 .. .. .. .. .. .. .. .. .. .. 1 3 1 .. 76 Pneumonia 33 33 66 27 7 6 1 .. 41 2 1 1 45 5 7 8 1 8 Asthma 2 1 3 .. .. .. .. .. .. .. .. .. .. .. .. 2 .. 11 Disease of Lungs 2 2 4 1 2 .. .. .. 3 .. .. .. 3 .. 1 .. .. 26 VII. Teething 9 10 19 12 7 .. .. .. 19 .. .. .. 19 .. .. .. .. .. Quinsey .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Gastritis 1 1 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 .. 1 Enteritis .. 3 3 1 .. .. .. .. .. .. .. .. 1 .. 2 .. .. 5 Peritonitis 6 2 8 3 .. .. .. .. 3 .. 2 .. 5 2 .. 1 .. 2 Ascites 3 1 4 .. .. .. .. .. .. .. 1 .. 1 1 1 1 .. l Ulceration of Intestines .. 1 1 .. .. .. .. .. .. .. .. 1 1 .. .. .. .. .. Hernia .. 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. Ileus .. 1 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 2 Intussusception 2 .. 2 .. .. .. .. .. .. .. .. .. .. .. 1 1 .. 1 Stricture of Intestinal Canal .. 1 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. Fistula .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Diseases of Stomach, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Disease of Pancreas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Hepatitis .. 2 2 .. .. .. .. .. .. .. .. .. .. 1 1 .. .. 7 Jaundice 2 2 4 1 .. .. .. .. 1 .. .. .. 1 2 1 .. .. 10 Disease of Liver 7 8 15 l .. .. .. .. 1 .. .. .. 1 .. 7 6 1 Disease of Spleen .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 VIII. Nephritis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Nephria (Bright's Disease) 6 6 12 .. .. .. .. .. .. 1 2 1 4 1 5 2 .. .. Ischuria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diabetes .. 2 2 .. .. .. .. .. .. .. .. .. .. .. 2 .. .. Stone .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cystitis 1 1 2 .. .. .. .. .. .. .. .. .. .. .. 2 .. .. 1 Stricture of Urethra .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Disease of Kidneys, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. IX. Paramenia .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Ovarian Dropsy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. l Childbirth .. 5 5 .. .. .. .. .. .. .. .. .. .. 4 1 .. .. 1 Disease of Uterus, &c. .. 1 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. X. Arthritis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5 Disease of Joints, &c. 4 1 5 .. .. .. .. .. .. 3 .. .. 3 1 1 .. .. 1 XI. Carbuncle .. 1 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. Phlegmon .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diseases of Skin, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 XII. Cyanosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2 Spina Bifinda .. 1 1 1 .. .. .. .. 1 .. .. .. 1 .. .. .. .. 1 Other Malformation .. 1 1 1 .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. XIII. Intemperance .. 2 2 .. .. .. .. .. .. .. .. .. .. .. 2 .. .. .. Privation of Food .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Want of Breast Milk 1 1 2 2 .. .. .. .. 2 .. .. .. .. .. .. .. .. .. Neglect 1 .. 1 1 .. .. .. .. 1 .. .. .. 2 .. .. .. .. .. Cold .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Poison 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 Burns and Scalds l .. 1 .. .. .. .. .. 21 .. .. .. .. .. .. .. .. .. Hanging .. 2 2 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 13 Suffocation 4 8 12 10 .. .. .. .. 10 .. .. 1 .. .. 1 1 .. .. Drowning .. .. .. .. .. .. .. .. .. .. .. .. 11 .. .. .. .. 4 Fractures and Contusions 4 6 10 1 1 1 .. .. 3 .. 1 1 .. .. .. .. .. .. Wounds .. .. .. .. .. .. .. .. .. .. .. .. 4 .. .. .. .. .. Other Violance .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..