WAN 10 SANITARY DEPARTMENT. REPORT on the SANITARY CONDITION of the several parishes comprised in the WANDSWORTH DISTRICT, For 1858. BY THE MEDICAL OFFICERS OF HEALTH. Zondon: PRINTED BY JOHN SMITH & CO., LONG ACRE. 1859. REPORT. To the Board of Works for the Wandsworth District. Gentlemen, In conformity with a recent order of your Board, we have the honour to submit the customary statistics of disease and mortality relating to our respective sub-districts, together with brief local summaries of the principal sanitary events of the year 1858. Besides these summaries we present, as usual, an appendix of tables having reference to the entire district, so as to furnish both local and general information, upon which we trust the Board may be able not only to base future measures of improvement, but to form a correct judgment of the effects upon the public health of those already completed and in full operation. It may be here observed that the amount of fatal epidemic disease in the entire district, during the past year, was considerably in excess of that of the two preceding ones. This excess is found to be chiefly due to scarlet fever, the deaths from which epidemic give to the Begistrar General's Returns for 1858 a number six times greater than in 1857, and absorb 8 per cent. of the total mortality of the year. Adopting a necessary correction of the Registrar General, as to the total number of persons dying and being registered within the several subdistricts during the year (from 1st January to 31st December inclusive) it is found that the mortality from all causes, and amongst all classes in the entire district, amounted, in 1858, to 1264. It will be seen by reference to Table I., Appendix, that this is a much higher rate than that of either 1856 or 1857, which were years in which the district was unusually exempt from epidemic disease; but that, as compared with the corrected average of the preceding 10 years, there is exhibited a decrease in favour of 1858 of no less than 42 deaths. A 2 4 Much as we have cause to deplore, in common with almost every other district within the Metropolitan area, and indeed throughout the country, an excess of mortality from one or two severe diseases of the zymotic class in 1858, it is not a little gratifying to find from the table of Pauper Sickness, &c., inserted in the appendix, that of 318 deaths registered in the entire Wandsworth district, as the result of 6 of the principal epidemic maladies, viz., small-pox, measles, scarlet fever, hooping cough, diarrhoea, and fever, not more than 41 of the deceased persons could have belonged to the out-door pauper class of patients—a circumstance from which it may be very fairly inferred that some good influences have been at work, under the auspices of your Board, in improving the sanitary condition of many of those localities that were formerly known and very generally spoken of as the abiding places of all the more severe and fatal forms of disease. Although much sanitary work of a decided beneficial character has been accomplished during the past year (see Table V., Appendix), there are unquestionably still remaining to be carried out—in the poorer neighbourhoods especially—many and very important improvements; and it is hoped and believed that a just estimate of the statistics, furnished with this and former reports, will lead to a very general acquiescence in the opinion entertained by your Health Officers, viz.: that as the end and aim of all the sanitation with the execution of which local authorities have been recently charged by the legislature, is to eradicate diseases, or to deprive them of their fatality; to strengthen the healthy, and to assist the suffering, so must it be their unceasing endeavour to carry their greatest reforms into and about the dwelling-places of the indigent; for nothing can be less open to dispute than that, in proportion as sickness and its consequences can be diminished amongst the poor of this great nation, will prosperity accrue to it, the best interests of the community at large be promoted, civilization advanced, and the fullest harmony of corporeal existence amongst all classes secured. We have the honour to be, Gentlemen, Your very obedient Servants, THE MEDICAL OFFICERS OF HEALTH of the wandsworth district. 5 LOCAL SUMMARIES. WANDSWORTH. The following is a condensed statement of the main facts relating to the sanitary condition of this parish during the year 1858, derived from the Registrar General's Returns, the Parochial Records of Sickness and Mortality amongst the Poor, and other reliable sources; with such remarks as are deducible from these data. Many of the facts, which were capable of being so compiled, have been placed in a tabulated form, in order to secure facility for comparison and general reference. Mortality.—Death-rate—Birth-rate—Rate of Natural Increase. The number of deaths registered in this parish during the year 1858 was 289—157 were of males, and 132 of females (Table I.) The average number during the last ten years, corrected for increase of population, was 303, exclusive of cholera years ; inclusive of those years, 325 ; so that, during the past year, there were at least fewer deaths by 14 than would have occurred had the average rate of mortality then prevailed. The death-rate for the past year deduced from the total deaths proper to this parish, and from the present estimated population, was (due correction being made*) 17.05 per 1000. The death-rate for the previous ten years, exclusive of cholera years, was 21.7; for 1856 it was 21.3; and for 1857 it was represented by the unprecedentedly low number of 15.4 per 1000. The number of births registered during the past year was 353—154 males and 199 females. The average number for the last ten years was 318. The birth-rate, according to the present estimated population, was 31.7 per 1000. The natural rate of increase, therefore, or excess of the birth-rate over the death-rate was 14.7 per 1000. The following Table shews the number of births and deaths registered during the past year compared with the average of ten preceding years. * In making this estimate justly, the mortality and population of the County Lunatic Asylum, the House of Correction, and St. Peter's Hospital, whose inmates (with a fractional exception) are derived from-without the parish, and undergo no natural increase, are withdrawn from, aud the deaths of Wandsworth parishioners in the Union Workhouse are added to, the calculation.—Sec Report for 1856, page 2. 6 TABLE I. SEX 1858 Average of last lOyears Excess of Births in 1858 over average Births of Last 10 years Excess of Births over Deaths in 1858, greater than average excess of last l0years Births |Deaths Excess of Births over Deaths Births Deaths Excess of Births! over Deaths Males 154 157 Females 199 132 Total 353 289 64 318 294 23 35 41 Causes of Death. The greatest number of deaths resulted from diseases of the brain and nervous system, but 4/5ths of these occurred at the County Lunatic Asylum ; so that 1/5th only can justly enter into an estimate of the causation of deaths proper to this parish. The next in order of fatality was the tubercular class, which formed 14 per cent, of all causes of death; this class includes consumption, which disease alone caused as many deaths as the whole of the diseases of the respiratory organs collectively, viz., 12.8 per cent, of the whole, and was the most fatal of any single disease. The deaths resulting from diseases of the zymotic class (epidemiccontagious) formed 10.3 per cent, of the whole. These results are seen on an examination of Table II., which contains a summary of all the causes of death, in accordance with the classification of the Registrar General, with the ages at death at eight periods; and arranged according to sex, age, and social position. TABLE II. Summary of Deaths during the year ending December classified according to Age, Sex, and Social Posi 31st, 1858, tion. wandsworth. SEX AGE SOCIAL POSITION Population in 1851, 9,611. Area in Acres, . . 2,478 Mules 1 Females Total Under 1 year From 1 to 5 years From 5 to 10 years Under 20 years, including all under 10 years At20, aud under 40 years of age At 40, aud under 60 years of age At 60, and under 80 years of age 80 years and upwards Nobility and Gentry Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial ad Labouring Classes Classes of Disease, and other Causes of Death Zymotic 17 13 30 5 10 4 22 3 1 4 .. .. .. 8 22 Tubercular 20 21 41 3 2 1 14 17 9 1 .. 3 1 8 29 Of Brain, Nerves, &c 58 32 90 11 1 1 13 28 37 11 1 2 2 10 76 Of Heart, &c 6 10 16 .. 1 .. 1 1 7 7 .. .. .. 7 9 Of Respiratory Organs 18 19 37 10 6 .. 16 3 6 12 .. 1 .. 4 32 Of Digestive Organs 5 9 14 2 .. .. 3 3 2 6 .. .. 1 2 11 Diseases of uncertain seat, Malformation, Age, SuddeuDeath,&c 22 20 42 2 1 1 5 5 8 13 11 1 1 5 34 Atroplay 6 4 10 6 3 1 10 .. .. .. .. .. .. 2 8 Violence, Privation,and Premature Birth 5 4 9 3 1 .. 5 1 1 2 .. .. 1 1 8 Total 157 132 289 42 25 9 89 61 71 56 12 7 6 47 229 7 Age at Death.—Infant Mortality. That which must attract most attention in the Table, is the very great preponderance of infant mortality ; of the total deaths upwards of 23 per cent, took place under the age of 5 years, while upwards of 14½ per cent, occured under 1 year of age. Upwards of 30 per cent, died under 20 years; 11 reached the advanced age of 80 and upwards, one of whom attained to beyond the very rare age of 103 years. A certain excess of infant mortality over that of adult age is a natural one, and due to the greater susceptibility of the delicate organization of infants to external influences; but the greater proportion of this excess is most undoubtedly due to causes capable of control, and arising from the various sanitary defects which are found by experience to intensify and favour the propagation of those diseases to which the mortality of infants is mainly attributable. These are diseases of the epidemic and contagious class ; of the tubercular class, as scrofula, atrophy, phthisis, hydrocephalus, &c. ; and diseases of the organs of respiration. Of the 67 deaths which occurred under the age of 5 years, 54 were due to diseases of the above classes; of the total deaths from diseases of the respiratory organs upwards of one-fourth occurred to infants under the age of 1 year. In proof of the above statement, if we would find those conditions known from all experience to be most prejudicial to the tender frames of infants, we look to the houses of those where overcrowding and bad ventilation from within, and bad drainage, collections of filth and other numerous sources of aerial impurity from without, prevail to still further impair their vital energies by the pollution of their blood already impoverished by bad or improper food, and too frequently by the absence of that maternal care and attention then most needed—to the houses of the poor—and it is just there that we find the greatest excess of infant mortality. Of the 67 deaths which occurred to infants under 5 years of age, 58 took place amongst the labouring classes; 7 amongst the trading class; 2 amongst the professional and merchant class; and none amongst the nobility and gentry; so that the infant children of the labouring classes suffered nearly 6½| times as much mortality as those of the other classes collectively. Further reference to Table II. shows that the labouring classes suffered 4½ times as much mortality as the other classes together. Allowing, for the sake of a safe argument, that the labouring classes are 4½ times as numerous, as would be the case if we assumed that all classes suffered the same relative amount of mortality, even then the excess of infant mortality amongst the poor would be 55 per cent, greater than that of the other classes. Epidemic Diseases—Prevalence and Fatality of. The deaths resulting from this class of diseases were due to typhus, diarrhoea, hooping-cough and scarlet-fever; no death having resulted from small-pox or measles, although the latter disease prevailed to some extent during the months of July, August and September. Typhus 8 and diarrhœa were the most persistently prevalent, having been present during the whole year. Hooping-cough prevailed throughout the year, excepting its first quarter. Scarlet-fever, which was the most fatal of the class, was present during February, August, October, November and December. All the deaths from these diseases occurred in July, August, November and December; excepting one case of fever in April, and another in June. The following table shows the deaths which have occurred during the past three years. It is seen that they exhibit a great and continuous decrease since the commencement of the operations of the Board :— TABLE III. Showing the deaths from epidemic disease during the years 1856-57-58. Years Small-pox Measles Scarlet Fever Hoopingcough Diarrhœa Typhus Total 1856 9 2 4 12 4 12 43 1857 0 1 2 1 14 11 29 1858 0 0 10 4 1 7 22 General Sickness—Amount and Character of. Table IV. in the Appendix shows the amount of sickness and mortality occurring amongst the poor during the past year, and serves as a means of judging from a portion of the sickness which has occurred, and which can be accurately known, of the amount and general character of the whole, which it is at present impossible to ascertain. There was upwards of 3 per cent, less total sickness, and 11 per cent, less epidemic disease, than prevailed on an average of the last three years. The deaths were about the average number. The intensity of disease was, therefore, by inference greater than the average in direct ratio to the diminution of sickness, and would appear to have been due to acute diseases of the respiratory organs, the deaths from which were as numerous as during the last three years collectively. Sanitary Operations. A summary of the sanitary operations carried on in the parish during the past year, is contained in Table V. of the Appendix. It is to be remarked as a matter for congratulation, that they have been effected without the necessity for magisterial interference. There is another thing to be noted which is not so satisfactory, which is, that water has been laid on to one house only during the year. Having fully discussed the subject of water supply to this parish in my report for 1856, to which I would again beg to refer, I need not now dilate upon it; but 9 witnessing the revolting fact that great numbers of the poorer classes are still compelled to drink the water of the Thames and Wandle, which is but sewage more or less diluted, I again beg to urge it upon your consideration as a matter of the utmost importance to the health of this town, that every house should be furnished with a proper supply of wholesome water, at least as an article of food (and a most important one), if it cannot be at present employed for drainage, and other purposes of general cleanliness. Conclusion. A greatly diminished rate of mortality, which during the past year barely exceeded that of the healthiest of the rural districts—a high rate of natural increase—a rate of infant mortality which although actually great, was relatively low compared with that of London and most of the metropolitan districts,* together with a great and continuous decrease of deaths from epidemic disease during the past three years—are the prominent facts elicited by the foregoing statistical information. They indicate unequivocally that the health of this parish has undergone a very notable improvement since the commencement of the sanitary operations of the Board, and that during the two past years it was in a very satisfactory condition ; they moreover bear such a marked relation to each other, that the results indicated by them cannot be satisfactorily accounted for, except by a full entertainment of the effects of sanitory agency. G. E. NICHOLAS, Medical Officer of Health for Wandsworth. * The rate of infant mortality in towns bears so invariable a relation to the general mortality, that the one may be received as the exponent of the other, and consequently as a very fair criterion of the health of any locality. The death-rate of infants under 5 years is 41 per cent, of all deaths in London ; in Marylebone, 41; in Islington and Uewingtou 45, In this pariah during the past year it was 23 per cent. 10 CLAPHAM. In the year 1856, the first year of the Health Officers' labours, the deaths from all causes amounted to 286, shewing a favourable state of the health of this sub-district. In the year 1857, the mortality ranged higher, as it amounted to 321 deaths, making an increase of 35. In the year 1858 a large amount of epidemic disease prevailed, and the mortality was raised to 344, making an increase of 58 deaths over those of 1856, and of 23 deaths over those of 1857. By the annexed Table is shewn the number of deaths that occurred in this sub-district during the past year, classified according to sex, age, and social position, and by it it appears that 83 persons died from epidemic or preventible diseases; also that 87 infants under one year, 50 from one to five years, and 24 from five to ten years, died, making a total of 161 deaths, thus constituting a large infantile mortality, and one considerably above the average. CLAPHAM. Population in 1851, 16/290 Area in statute Acres, 1,233 SEX AGE SOCIAL POSITION Under 1 year From 1 to 5 years From 5 to 10 years Under 20years, including all under 10 years At 20, and under40 years of age At 40, and under 60 years age At 60, and under 80 years of age 80 y ears and upwards Nobility and Gentry rroiessionl Class, Merchants, Bankers, &c. | . M iddle and Trading Class, Shopmen, Clerks, &c. Industrial aud Labouring 1 Classes DISEASES And other causes of death. Males Females Total 1. Small Pox .. 1 1 1 .. .. 1 .. .. .. .. .. .. .. 1 2.Measles 7 7 14 3 8 2 13 1 .. .. .. .. .. 1 13 3. Scarlatina and Malignant Sore Throat 13 12 25 4 9 7 24 1 .. .. .. 2 4 4 15 4. Hooping Cough 5 8 13 9 4 .. 13 .. .. .. .. .. 1 1 11 5. Diarrhœa & Dysentery 6 10 16 11 I .. 12 1 .. 3 .. 1 2 2 11 6.Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7. Fever 3 8 11 1 1 2 9 1 .. 1 .. .. 3 5 3 8. Erysipelas 2 .. 2 1 .. .. 1 .. .. 1 .. .. .. .. 2 9. Puerperal Fever .. I 1 .. .. .. .. 1 .. .. .. .. .. 1 .. 10. Lung Diseases, cept Phthisis 28 33 61 16 5 1 22 5 9 18 7 3 4 7 47 11.Phthisis 13 25 38 1 2 1 7 18 11 2 .. 2 5 7 24 12. Hydrocephalus, Atrophy, Scrofula, and Convulsions of 20 16 36 17 12 6 36 .. .. .. .. .. 2 7 27 13. Other Diseases 42 66 108 10 6 5 23 10 26 36 13 10 24 13 61 14. Violence, Privation, & Premature Birth 14 4 18 13 2 .. 16 .. .. 2 .. .. 3 3 12 Total 153 191 344 87 50 24 177 38 46 63 20 I8 48 51 227 By reference to Table IV., Appendix, exhibiting the sickness and mortality among the pauper population of this sub-district, it will be seen that 1,492 cases of illness and 60 deaths are tabulated as having occurred during the past year, giving a rate of mortality to this class of persons of 4.02 per cent, upon the cases of illness. 11 Inspection of Houses. The number of inhabited houses in this sub-district amount to 3,000. By reference to Table V., Appendix, it will be seen that 870 examinations of houses were duly made by the Medical Officer, Inspector of Nuisances, and Surveyor, and that a large number of sanitary improvements were executed in the past year, which the table for brevity sake is meant to show. Some of these houses were examined several times. Offensive Trades, Slaughter-houses, &c. I am happy to state that from offensive trades we are almost free. On one occasion, I had to inspect a cat or sheep-gut manufactory, in which I was given to understand that sheep-gut was the substance prepared for the strings of harps and other musical instruments. The proprietor kindly promised to comply with my instructions, and remove promptly all offensive matter to a distance from his dwelling. Twenty-three slaughter-houses were duly licensed, and one was opposed, owing to a non-compliance on the part of the owner with the necessary requirements. 69 examinations were made of the above-named. No complaints were made to me in the past year with regard to the sausage manufactories; but they ought, I think, to undergo occasional inspection, in order that they be kept in a wholesome condition. Removal of Nuisances. During the past year, 222 complaints were entered in the Complaint Book, all of which were attended to and remedied through friendly applications, except in seven cases, in which the orders of your Board were not complied with. In these cases, applications were made to the Police Magistrates, who gave orders for the abatement of the nuisances complained of. In the course of the year I had a great many complaints made to me of pig nuisances, dung heaps, cow sheds, and non-removal of dust, also of overcharged cesspools ; but friendly interviews led to the removal of many of them, without bringing them to the knowledge of your Board. I beg most respectfully to suggest that the greatest vigilance should be continued in respect to all these matters. This appears to me to be of vital importance, considering the density of our population, 19,000, and our limited area of 1,233 statute acres. Offensive Ponds. Great exertions have been made, and considerable expense incurred, both by your Board and private persons, in remedying these nuisances; yet a great deal remains to be done. During the last summer, and those of 1856 and 1857, many complaints were made to me of the filthy condition of the cock pond, the building pond, and the Harford pond, Clapham Common; also of a pond on private property, in the vicinity of Mrs. Wyld's residence and of the Convent School. I have frequently examined these ponds, and reported on them to your Board, 12 stating the number of years since they were cleaned out, and the probable quantity of animal and vegetable matter which they contain in the form of deposit. These four ponds are most serious nuisances, and injurious, in their present state, to the health of the inhabitants. 'Drainage. Your Surveyor's former reports describe the drainage of the entire Wandsworth District as very defective; and that this is especially the case in this sub-district I have good reason to know, since, in many instances, necessary house improvements have been impossible, on account of the dilapidated and antiquated condition of the sewers, without system and without design, which is much to be deplored. They are frequently productive of nuisances of the very worst character, and most injurious to the health of the inhabitants. A complete system of tunnel sewerage, substantially built and sufficiently capacious, as also a system of tubular pipe drainage for house purposes, are great desiderata. Our elevated site gives us a good fall for surface and underground drainage on every side, so that such drainage is easy of execution, and if carried out, would render our parish one of the cleanest and healthiest in the Metropolis. Water Supply. This parish is mainly supplied with water by the Southwark and Yauxhall Water Company, taken from the Thames at Hampton, about twenty-one miles above London Bridge. In quality this water is as good as can be procured from such a source; it is turned on daily, except on Sundays. For domestic purposes it answers tolerably well, but for drinking purposes I cannot commend it. There were formerly some good wells available to the public, but at the present time nearly the whole of these are enclosed and claimed as private property. Generally the first class houses have pumps, and most of the second class houses are similarly accommodated. On the whole, our supply is better and more abundant than it was in the year 1856; and I am happy to be able to state, that the.poorer classes generally enjoy the comforts of a more liberal supply of good water, and also of other sanitary requirements heretofore unknown in and about their dwellings. JOHN McDONOGH, Medical Officer of Health fur Clapham. 13 BATTERSEA, I regret to state the health of the sub-district compared with that of the previous year is not so favourable. The amount of sickness that prevailed is less, but the rate of mortality greater; which last is attributable to a very severe and fatal epidemic of scarlet fever, that prevailed in the last two quarters, and which has been much increased by the unhealthy practice of pig-keeping—a very general custom in the parish, and to which I took occasion to direct the attention of your Board in November last. It is remarkable, but nothing more than could have been expected, that the mortality fell with great violence on pig-keeping districts—particularly on localities where it is most general and most crowded. Of the total number of cases of sickness from all causes (918) that occurred amongst the out-door poor receiving parochial relief, 27 resulted in death ; 15 of which were of the zymotic class, chiefly scarlet fever. Of this disease there were 162 cases, mostly occurring within the last two months of the year. Of the 9 cases of death from diphtheritis registered, not one occurred amongst the union poor, nor have I witnessed a case of this disease amongst them. Of the 380 deaths registered, 75 occurred in the workhouse, 26 were found by Coroner's Inquisition, 18 of them from violence, and 8 of them sudden, from natural causes. In the subjoined Table is exhibited the number of deaths, classified according to age, sex, and social position. BATTERSEA. Popul-itkn in 185!, 10,560 Area in Statute Acres, 2,3-^3 SEX AGE SOCIAL POSlTlOy Under 1 year From 1 to 5 years From 5 to 10 years 1 Under 20years, including all under 10 years At 20, and under40 years of age At 40, aud under60 years of age At GO, and under 80 years of age 80 years and upwards Nobility and Gentry Professional Class, Mer- hants, Bankers, &c. Middle and Trading Class, Shopmen, Cleks, &c. Industrial and Labouring Classes DISEASES And other causes of death. Males Females Total 1. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2.Measles 5 4 9 3 6 .. 9 .. .. .. .. .. .. 5 4 3. Scarlatina and Malignant Sure Throat 30 20 50 4 25 15 50 .. .. .. .. .. 2 6 42 4.Hooping Congh 2 3 5 2 3 .. 5 .. .. .. .. .. .. 1 4 5. Diarrhoea & Dysenter 11 19 30 20 4 .. 25 1 .. 2 2 .. 1 2 27 6.Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7. Fever 6 3 9 .. 1 2 6 1 1 1 .. .. .. 2 7 8.Erysipelas 4 .. 4 .. .... .. .. .. 2 2 .. .. 1 2 1 9. Puerperal Fever .. 1 1 .. .. .. .. 1 .. .. .. .. .. .. 1 10. Lung Diseases, ex. cept Phthisis 33 21 54 19 9 1 29 2 6 14 3 .. 1 7 46 11. Phthisis I8 17 35 1 1 .. 5 20 8 2 .. .. .. 7 28 12. Hydroce phalus, Atro- phy, Scrofula, and Convulsions of 19 16 35 21 10 .. 31 4 .. .. .. .. .. 3 32 13. Othi r Diseases 74 52 126 12 4 4 24 8 29 41 21 4 5 25 91 14. Violence, Privation, & Premature Birth 15 7 22 6 .. 1 9 6 3 2 2 .. 3 5 14 TOTAL 217 163 380 88 63 23 157 43 49 67 28 4 13 65 297 14 For Tables of births, sanitary operations, and cases of sickness among the out-door poor receiving parochial relief, see Appendix. The most striking features of the Table given above are the excessive mortality amongst children under 10 years of age, and the preponderance of deaths amongst the industrial classes over those that have occurred to persons in a superior condition of life. Deducting the total number of deaths from violence, privation, and premature birth (22) from the general total (280), the mortality amongst children under 10 years (174) will have amounted to nearly one-half of the whole. It would be even considerably more than one-half if the deaths from old age were also deducted from the general total, so as to leave the comparison to be made upon the mortality that has resulted during the past year from disease exclusively. This excess, it will be seen, is not peculiar to this sub-district, but appears to be everywhere the result of a crowded industrial population, engaged principally in factory and field labour. The employment of women in these occupations, the majority of whom are mothers, is an evil for which the present condition of society, it is believed, is quite incompetent to supply an effectual remedy. The preponderance of deaths amongst the working classes over those amongst the classes above them, points, as it ever has done in this subdistrict, to the necessity of vigorously opposing our improvements and reforms to the sanitary defects discoverable in the poorer localities of the parish. WILLIAM CONNOR, Medical Officer of Health for Batteesed. 15 STREATHAM, INCLUDING TOOTING AND BALHAM. Streatham, Tooting, and Balham, having been consolidated into one sub-district for sanitary purposes, in the March quarter of 1858, at which period I entered upon my duties as one of the medical officers of health, I can only speak (from my own abservations) of nine months of that year; but it has been my endeavour to collect and to put together with the greatest accuracy possible under the circumstances, the necessary statistics for the whole year, including the quarter preceding my accession to office. In a population, at the last census, of 9,023, but which may now be assumed to have reached over 10,000, the deaths from all causes during the past year in this sub-district, amounted to 134. In the year 1856, 112 deaths only were registered; and in 1857, the smaller number still of 100; so that the mortality of 1858 was greatly in excess of that of both the preceding years. This excess may in a great measure be accounted for by the fact of more persons than usual having died from old age, viz., 16. The deaths also, occurring at 60, and under 80, have been unusually numerous, the number being 42 in 1858, against much lower figures in the two previous years. STREATHAM, including TOOTING & BALHAM Population in 1851, 9,023 Area in Statute Acres, 3,465 SEX AGE SOCIAL POSITION Under 1 year From 1 to 5 years From 5 to 10 years Under 20 years, including all under 10 years At 20, and under 40 years of age At 40, and under 60 years of age At 60 and under 80 years of age 80 years and upwards Nobility and Gentry Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes DISEASES And other causes of death. Males Females Total 1. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2.Measles 2 1 3 1 2 .. 3 .. .. .. .. .. .. .. 3 3. Scarlatina and Malignant disease of the Throat, viz., Diphtheria 3 4 7 1 2 3 7 .. .. .. .. .. 1 1 3 4. Hooping Cough 1 1 2 1 1 .. 2 .. .. .. .. .. .. 1 1 5. Diarrhoea and Dysentery 1 1 2 2 .. .. 2 .. .. .. .. .. 1 1 .. 6.Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7.Fever .. 2 2 .. .. .. .. .. 2 .. .. .. .. .. 2 8.Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 9. Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10. Lung Diseases, except 9 13 22 4 2 .. 7 3 3 8 1 4 4 3 11 11.Phtbisis 3 8 11 .. .. .. 1 4 6 .. .. .. .. 2 9 12. Hydrocephalus, Atrophy, Scrofula, and Convulsions of Children 8 10 18 7 7 2 18 .. .. .. .. 3 1 5 9 13. Other Diseases 32 31 63 3 4 1 9 4 10 34 6 9 5 18 31 14. Violence, Privation, and Premature Birth 4 •• 4 4 .. .. 4 .. .. .. .. .. 1 .. 3 TOTAI 63 71 134 23 18 6 53 11 21 42 7 16 13 31 74 16 In" the preceding useful and practical table is shown the number of deaths from all causes that have occurred in the sub district, together with the ages at death, and the sex and social positions of the deceased persons. This Table has been necessarily made a local one, because the information it professes to impart is exclusively local, and could not well have been placed in a general table applying to the entire district. It will be noticed, that although there has been a great increase of small-pox in other parts of the country, as well as in the metropolitan districts, there has not occurred a single death from that loathsome malady in this sub-district during the year under notice. It is also worthy of remark, that the fatal cases of zymotic disease (16) compared with those resulting from non-epidemic maladies, are few, considering the amount of population. The infantile mortality, or the number of deaths of children under 10 years of age, is large ; but it is believed does not greatly exceed the average. The births in the year, as stated in Table II., Appendix, numbered 258. The deaths, as I before stated, were 134 ; the excess of births over deaths in the past year, is therefore 124. Table IV. Appendix, which exhibits the number of cases treated by the Union medical officers acting in this sub-district, and the number of resulting deaths amongst the out-door poor, is very instructive, and moreover highly satisfactory, as showing a very low rate of mortality (14), in the number of cases of sickness, &c. (249) that came under treatment. The last table in the Appendix, showing the number of houses and premises examined and reported on in 1858, and the number of sanitary works executed during the same period, is also of a very satisfactory character, as leading to the conclusion that considerable advance has been made in sanitation in the past year, the tendency of which has been very greatly to improve the three localities comprised in the important sub-district for which I have the honour of acting as the health officer. I respectfully urge upon the Board a continuance of efforts in the same direction. DAVID C. NOEL, Medical Officer of Health for Streatham, Tooting, and Balham. 17 PUTNEY AND ROEHAMPTON. The number of deaths registered from all causes, and amongst all classes, in this sub-district during 1858, is somewhat in excess of the number registered in 1856 and 1857 respectively. The corrected average of the 10 years preceding 1858 is a fraction under 100. The number of deaths in 1856, was 92; in 1857, 88; in 1858, 118. The excess in 1858 above the two previous years, is due to the operation of three especial causes—1. The unusual fatality of zymotic diseases during the pasts year; thus as many as 15 deaths occurred in 1858 from scarletfever, diphtheria, and hooping-cough; whilst in 1857 the registered mortality from the above mentioned maladies was one only. 2. The unusual mortality from diseases peculiar to infancy. In 1858, for example, the deaths of 24 children were registered from hydrocephalus, scrofula, tabes mesenterica, and convulsions, against- only 10 in 1857. 3. The large number of deaths from causes unconnected with disease in 1858; thus the unusual number of 11 infants died at or soon after birth, from low vitality, the majority of which were prematurely born ; 4 persons came by their deaths by drowning; and 2 died from old age, at 83 and 93. A circumstance tending in some degree to increase the registered rate of mortality of this sub-district, and to cause it to be higher in 1858 than in the two previous years, is the recent establishment in Putney of the Royal Hospital for Incurables, the deaths in which institution are all required to be registered in the parish, although the patients are admissible from every part of the country. Allowing then for this and other equally evident special causes of increase, the natural death rate from actual disease, and amongst the bond fide parishioners, in contradistinction to the registered death rate, from all causes, including non-parishioners, and inmates of public institutions, may be fairly set down as being considerably under the average of the preceding ten years. Of the 118 deaths recorded in the following table, it will be seen that 21 were the result of diseases of the zymotic class. Although this number of deaths is beyond the average, it cannot be looked upon as a large per centage in an estimated population of upwards of 6,000. It should be remarked, that 3 of the 12 deaths enumerated in this table, under the head "Scarlatina and Malignant Diseases of the Throat," were the result of diphtheria. B 18 PUTNEY AND ROEHAMPTON Population in 1851, 5,280 Area in Acres 2,176 SEX AGE SOCIAL POSITION DISEASES And other causes of death. Males Females Total Under 1 year From 1 to 5 years From 5 to 10 years Under 20 years including all under 10 years At 20, and under40 years of age At 40, and under 60 years of age At 60, and under 80 years of age 80 years and upwards Nobility and Gentry Professional Class, Merchants Bankers, &c. Middle and TradingClass, Shopmen, Clerks, &c. Industrial and Labouring Classes 1. Small Pox 2. Measles 3. Scarlatina and Malignant Diseases of the 5 7 12.. 5 411 1 1 2 9 Throat 4 Hooping Cough 3 3 33 1 2 5. Diarrhoea and Dysentery 1 2 3 1 11 1 1 3 6. Cholera 7. Fever 1 1 2 2 2 1 1 8. Erysipelas 1 1 1 1 9. Puerperal Fever 10. Lung Disease., except Phthisis 3 4 3 5 7 1 6 10 11. Phthisis 6 6 12 1 1 6 5 8 4 12. Hydrocephalus, Atrophy, Scrofula, & Con vnlsions of Children 10 1424 16 8 24 8 1 13. Other Diseases 16 16 32 2 3 1 6 3 10 10 3 2 1 14 15 14. Violence, Privation,and Premature Birth8 4 10 6 8 Total, 60 58 118 27 24 5 59 14 24 18 3 4 42 69 By a further examination of the above table, it will be seen that the greatest number of deaths during the year resulted from diseases of the respiratory organs. Inclusive of phthisis, the mortality from this class of maladies was as high as 31, or just ¼th of the whole, if the deaths from old age and accident are deducted from the general total. But the most striking, and at the same time the most melancholy feature of the table referred to (and it is unfortunately found to be the same in every parish of the district, and in every district of the metropolis) is the excessive number of deaths shown to have occurred amongst children under 10 years of age. This excess, I regret to say, is found to amount in this sub-district to very nearly half of the entire mortality, the deaths under 1 year being as many as 27, and at all other ages under 10, 29! In such a sub-district as Putney, where the great majority of mothers amongst the industrial classes are employed in the fields and market gardens, or as assistants in the laundries which abound in the parish, this great mortality amongst children may be mainly accounted for by the fact of numbers of them being either too early weaned, or most insufficiently supplied with their natural sustenance. Very many infants thus left to the care and nurture of indifferent persons, to allow the mothers themselves to make the very most of their labour, die prematurely from sheer neglect, and this I fear is an increasing evil, and one for which it will be most difficult to find a remedy.* * From what I have myself seen of the manner of conducting one of those truly excellent establishments called " La Crêche," in Paris, in which infants of the poor, 19 That portion of the above table which refers to the deaths in this subdistrict in relation to the social positions of the deceased persons, will, it is hoped, possess some interest for the local statist who may be desirous of testing the true value of sanitation as affecting the most helpless classes of the community. The preponderance of deaths amongst the labouring classes compared with the number that occurred amongst the trading classes, although considerable, is unquestionably becoming less every year. The mortality amongst the higher class is always and everywhere much lower than amongst the class at the other extremity of the social scale, not only because the former live in plenty, and the latter in comparative want, but also because the wealthy are more cleanly and temperate, are less excited by low passions, and by no means so subject to those depressing influences that are induced by sudden changes of their circumstances. Considering, however, the many drawbacks under which disease is combated amongst the working classes generally, it is not a little gratifying to find that sanitation is really exerting a very beneficial influence in protecting the very poor from invasions of the more fatal forms of disease. It would be unreasonable to imagine that severe diseases will ever cease to afflict the poor and their families; but it is manifest that the number of pauper deaths relatively to the number of pauper cases treated, is now very considerably less in this, as in every other parish within the district, than was observable a few years ago, before preventive medicine came to be cultivated as a science, and sanitary subjects to be discussed with so much advantage to the public. Table IV., Appendix, will show that of 665 cases of sickness, accident, &c., coming under treatment amongst the out-door poor of this subdistrict in 1858, the number proving fatal was 23. If, however, the deaths registered in the past year as the result of accident, old age, and premature birth, are excluded from the calculation, the pauper mortality of the sub-district will be found to have amounted to 20 only. This small per centage of deaths in the number of cases treated cannot be otherwise than gratifying, since it may be very fairly looked upon as indicating a greatly improved sanitary condition of most of the localities inhabited by the recipients of parochial relief, where epidemic diseases were formerly wont to show themselves in their most fatal forms. In connexion with the table just referred to, it may be further remarked that although 72 cases of scarlet fever, of more than ordinary severity, during the hours of their parents' labour, are received and cared for, I am inclined to believe that their general adoption in this country would be the means of annually Saving thousands of children from a premature grave. I am aware that this is a sanitary requirement which the Board of Works could not legitimately recognize or supply. I allude to it, however, that the attention of the philanthropic may be drawn to the fact of the measure referred to having been already tried extensively, both in this and other countries, and found eminently successful in diminishing the rate of mortality amongst infants. There can be no doubt that in this parish it would prove quite as beneficial a sanitary measure as that other great desideratum of the district, the cheap bath for the poorer classes. Both these measures, if carried out, would be inexpensive, and might ultimately be made self-supporting. The good they are calculated to effect can scarcely be over estimated. B 2 20 were treated during the year amongst the families of the Union poor of this parish, 3 deaths only resulted. These 3 deaths, however, it should be stated, occurred in localities in which open cesspools, uncovered ditches, and such like nuisances still exist, and in parts of the sub-district where there is a great and an acknowledged want of effective sewerage. The localities considered to be insufficiently drained, and to which the above remark will more particularly apply, are portions of the Upper Richmond Road, Spencer Road, Charlewood Road, parts of the Lower Richmond Road and Windsor Street, Marches Place, and above all the hamlet of Roehampton. The appended table will show how greatly needed is a measure of the kind indicated, for the relief of some of the insufficiently drained localities of this rapidly increasing suburb. Comparative Mortality from Six of the principal Diseases of the Zymotic Class, in the Well Drained and Insufficiently Drained localities of Putney, during 1858. Localities Small Pox Measles Scarlet Fever and Diphtheria Hooping Cough Diarrhœea and Dysentery Fever, Typhus, and Typhoid Totals Well Drained .. .. 3 .. .. .. 3 Insufficiently Drained .. .. 9 3 3 2 17 Totals .. .. 12 3 3 2 20 It will be seen that Small Pox has happily no place in the above table. I am pleased in being able to state that this disease has not made its appearance in this parish for several years past. Since January, 1856, the period at which I entered on my duties as the Health Officer of this sub-district, upwards of 500 children and others have received, at my hands alone, the protection of vaccination; and I have every reason to believe, judging from the occasional supplies of lymph that have been obtained of me by my professional brethren, that numbers have been similarly protected at the hands of the other resident medical practitioners. This being the case, there are good grounds for believing that but comparatively few persons remain unprotected in this parish, and that to this circumstance the exemption so long enjoyed by Putney and Roehampton from Small Pox is to be mainly attributed. Table V., Appendix, will show at a glance what has been undertaken during the year 1858 towards improving the sanitary condition of this sub-district, by the removal of very many of the causes and aggravants of disease. I rejoice to find that sanitation and improved social habits amongst the poor of this parish are making a parallel progress, and that numbers of that class are beginning to have no mean appreciation of the advantages which sanitary supervision is calculated to confer upon them. My best efforts are being continued in teaching the indigent how to use and not to abuse these advantages; and I trust I shall, in future reports, be able to demonstrate still more satisfactorily, that with improved 21 knowledge of the conditions essential to the promotion of the general welfare, the endeavours towards carrying out those conditions, and of maintaining them when executed, have in this sub-district in no way diminished ; but that they are still being directed with a view to improve the sanitary aspects of the parish, to diminish the fatality of disease, and to benefit alike every class of the inhabitants. R. HARLAND WHITEMAN, Medical Officer of Health for Putney and Roehampton. APPENDIX of STATISTICAL TABLES. TABLE I. Showing the relative number of Deaths in the entire Wandsworth District, in the two years of 1857 and 1858; also the average Mortality of the previous ten years, compared with that of 1858. Deaths Death rate of 1857, corrected for increase of Population Increase of Deaths in 1858 over 1857 1857 1858 1097 1264 1206 58 Deaths registered in the ten years, viz.: 1848 1849 1850 1851 1852 1853 1854 1855 1856 1857 999 1526 963 1016 1114 1148 1733 1144 1144 1097 Average of the above ten years 1188 Above average, corrected for increase of Population 1306 Deaths registered in 1858 1264 Decrease of Deaths in favour of 1858 42 24 TABLE II. Births during the year ending 31st December, 1858. Sub-districts Males Females Total Clapham 273 260 533 Wandsworth 154 199 353 Battersea 276 286 562 Putney 91 92 183 Streatham, including Tooting and Balham 137 121 258 Total 931 958 1889 *** The excess of Births over Deaths in the entire district is 625. TABLE III. Meteorological Means for 1858. Jan., Feb., and March April, May, and June July, Aug., and September Oct., Nov., and December The Year Temperature of the Ail 37°8 54°3 61°0 43°8 4º2 Evaporation 35°8 49°7 56°3 42°0 46°0 Dew Point 32°9 45°3 52°2 39°9 42°6 Weight of Vapour in a cubic foot of Air 2.2 grs. 3.5 grs. 4.4 grs. 2.9 grs. 3.3 grs. Degree of Humidity (Sat" 100) 83° 73° 73° 87° 79° Reading of Barometer 29 926 in. 29.801 in. 29.824 in. 29.785 in. 29.834 in. Weight of a cubic foot of Air 558 grs. 537 grs. 530 grs. 548 grs. 553 grs. Rain (amount of) 3.3 in. 5.4 in. 5.4 in. 3.1 in. 17.2 in. to TABLE IV. Cases of Sickness amongst the Out door Poor under the Treatment of the Union Medical Officers, with the Deaths from each Class of Disease, during the year ending 31st December, 1858, compiled from the District Medical Relief Books. scb-disteicts Total Cases of Sickness treated in each Sub district Cases Deaths Sma" Pox Cases 2 Deaths Mea,sles Cases 3. Scarlatina and Malignant Deaths | tore Throat Cases 4 Deaths Hooping Cough Cases5. Deaths Diarrhoea & Dysentery Cases 6 Death,Deaths Cases 7 1 Death, Fcver Cases 8 Deaths Erysipelas Cases 9 | Death, puerperal Fever Cases | 10. Lung Diseases, except Deaths Phthisis Cases 11 | Death, phthisis Cases 12 . Hydrocephalus, Arroph Death, scrofula and Convu,. sions of Children Cases 13 Deaths 0t,her Disecse, Cases 14. v lolence, prilvation, anr Deaths Premature Bir.th Total Death in each Subdistrict Clapham 1492 7 .. 52 5 46 3 12 .. 201 3 .. .. 98 .. 13 1 .. .. 289 12 28 7 10 4 659 23 77 2 60 Wandsworth 1318 1 .. 6 1 74 7 24 1 153 .. .. .. 38 .. 20 .. 1 .. 180 13 6 4 19 11 791 14 .. .. 41 Battersea 918 1 .. 18 •• 40 12 6 .. 62 2 .. •• 20 .. 6 .. .. .. 152 8 4 .. .. .. 580 1 .. .. 27 Putney 665 .. .. 6 .. 72 3 14 1 52 .. .. .. 23 .. 6 .. .. .. 99 4 1 1 14 5 357 9 21 1 23 Streatham, including Tooting and Balbam 249 .. .. 6 .. 1 .. 8 1 8 .. .. .. 14 1 1 .. 1 1 50 1 3 3 1 •• 132 7 4 •• 14 Totals 4642 9 .. 88 6 242 25 64 3 476 5 .. •• 193 2 46 1 2 1 776 38 42 15 44 20 2519 54 122 3 165 26 TABLE V. Summary of the Sanitary Operations in the entire District during the year 1858. Clapham Battersea Wandsworth Putney and Roehampton Streatham, including Tooting & Balham Totals Number of Houses and Premisesinspected 870 150 219 86 247 1572 1st Notices served 2nd Notices served 298 50 28 36 1o 23 8 24 477 Cesspools emptied and cleansed 23 29 97 46 130 325 Cesspools abolished 18 .. .. 26 57 101 Water-closets constructed 19 17 1 22 61 83 Do supplied with Water 29 1 24 22 76 Drains constructed or connected with Sewer 31 17 3 26 3 80 Drains repaired or trapped, or obstructions removed 712 30 26 14 149 931 Open Ditches, Ponds, &c., cleansed .. 13 4 7 .. 24 Dust-bins provided 12 120 2 2 10 146 Pig Nuisanced removed 23 21 3 2 18 67 Accumulations of Offal, Manure, &c. 25 21 14 5 16 81 Unwholesome and dilapidated Houses cleansed, or repaired 35 .. 4 .. 52 91 Cases investigated by Magistrates 7 2 .. 4 .. 13 Compulsory Orders obtained 7 2 .. 4 .. 13 Compulsory Works executed 7 2 .. 4 .. 13 Works remaining in abeyance from various causes .. 20 .. .. 20