WAN 11 SANITARY DEPARTMENT. REPORT on the SANITARY CONDITION of the several parishes comprised in toe WANDSWORTH DISTRICT, For 1859. BY THE MEDICAL OFFICERS OF HEALTH. London: PRINTED BY JOHN SMITH & CO., LONG ACRE. 1860. REPORT. To the Board of Works for the Wandsworth District. Gentlemen, We have the honour to present the following Report on the sanitary state of the Wandsworth District during the year 1859. It is arranged in accordance with your instructions, upon the plan heretofore adopted as the means best calculated for bringing to your knowledge the various local conditions affecting the public health which require to be specially dealt with, as well as for affording that information which is necessary for your guidance in the prosecution of measures of general application. It contains, therefore, as usual, separate communications from your Medical Officers of Health, having reference to their respective sub-districts, which are prefaced by a review of the principal facts relating to the health of the entire district. For the illustration of both of these, tables of the Statistics of mortality and sickness, epidemic disease, meteorology, &c., are appended to the end of the Report, together with a summary of the sanitary operations which have been earned out during the year. We are sorry to have to record that the health of the district was not in so satisfactory a condition during the past as during the three preceding years, and that this result was due to the greater prevalence of those epidemic diseases chiefly effecting the young, which it is the especial object of sanitation to diminish and prevent. It is trusted that this result will not be accepted as favouring that misty prejudice—engendered by ignorance and fostered by ancient tradition, which is now happily becoming fast dissipated by the light of modern knowledge, but which, half-admitted, still occasionally exists—in favour of the opinion that these diseases are the natural heritage of childhood, and as such will prevail in spite of all the endeavours of the sanitarian to the contrary. For it is matter of fact that they take up their permanent abode only where hospitality is afforded them, and, like parasites, drop away when their sustenance is withdrawn; and your Medical Officers, firm in the belief of the truths of science, which has long since established the preventibility of these diseases, and knowing that the benefits derivable from sanitarian agency can only be realized by slow degrees and in the course of time; seeing, moreover, very appreciable evidence of the good effects which have already been derived from the operations of your Board, they look upon the foregoing result (which was not exceptional, but common to the whole metropolis), as evidence only of the necessity for renewed and persevering exertions. We have the honour to remain, Gentlemen, Your very obedient Servants, THE MEDICAL OFFICERS OF HEALTH of the wandsworth district. 4 HEALTH OF THE ENTIRE DISTRICT. The health of the entire district during the year 1859 declined very considerably from the improved status which it had acquired during the three preceding years. The total deaths registered were 1322. This number (as is seen in Table 1 in the Appendix) is less by 14 than the average of the ten preceding years corrected for increase of population. But such average is unduly increased by the two cholera years 1849 and 1854. To obtain a just result, therefore, these years should be excluded in order to make comparison with an average derived from years of ordinary mortality. Assuming that the population has increased since the year 1851 in the same ratio as during the ten preceding years, it will have numbered in 1859, 59,873. Looking to the great influx into the district by immigration, which has been and is continually taking place, this estimate is probably below the true number, and if so, would proportionately lower the death-rate; but as it is applied to the following calculations alike, it does not vitiate comparison, which is the object sought. The mortality during the past year, deduced from the foregoing estimate, and the total number of deaths registered, was at the rate of 22 per 1000 living, and closely coincides with that for all London during the same period. Excluding those years in which Cholera prevailed epidemically, the average death-rate of the past lOyears was 19per 1000; but if these years be included it was 22.3 per 1000; so that the death-rate of 1859 was almost identical with the average which was extraordinarily raised by two very severe epidemics, and 3 per 1000 greater than that which may be considered as the ordinary average. The increase in the death-rate ot the past year arose from the occurrence of a greater fatality from epidemic diseases. These formed upwards of 21.4 per cent. of the whole mortality. Nearly one-half of the deaths resulting from these causes was due to Scarlet Fever; and on this essentially depends the heightened death-rate, and the great excess of infant mortality which is recorded in the several tables contained in the local summaries. The intensity ot disease, as estimated from the sickness and its resulting deaths amongst the poor, was greater than the average bv nearly a fourth part, or more correctly, in the proportion by figures of 40 to 32, the deaths having formed 4 per cent. of all cases of sickness, while the average of the past three years was 3.2 per cent. The birth-rate was 34.4 per 1000; the natural rate of increase 12.4 per 1000. LOCAL SUMMARIES. 7 WANDSWORTH. The following Report contains a summary of all the principal facts which are essential for the determination of the sanitary state of this parish during the year 1859. They are derived from an analysis of the Registrar General's Returns and the Parochial Records of Sickness and Mortality, and are for the most part tabulated for the purpose of affording facility for comparison with those of former years, and for illustrating the conclusions and inferences which are capable of being elicited from those sources of information. Mortality—Death-rate—Birth-rate—Natural Increase. The total number of deaths registered during the past year was 311; 178 were of males and 133 of females. The average number during the past ten years was 295. But an annual comparison of the deaths registered furnishes a very imperfect means of determining the status of the health of this parish unless certain conditions, which unduly increase or diminish the mortality, be taken into consideration. Thus, of the total deaths registered last year, 106 occurred in the following institutions, viz., in the House of Correction 6, in Saint Peters' Hospital 4, and in the Surrey County Lunatic Asylum 96. The inmates of these institutions are, with a fractional exception, derived from without the parish, and undergo no natural increase; in the second named are all aged people; and in the third, as in all such asylums, are subject to a very high mortality. In this way the natural death-rate of the parish, which can be alone employed in forming an estimate of its sanitary state, is unduly increased; on the other hand, it is diminished in consequence of the deaths of the aged and infirm or destitute poor of this parish who enter the workhouse being registered in Battersea, the workhouse being situated in that parish. In determining the natural death-rate, therefore, it is necessary, in order to ensure a just result, to withdraw from the calculation the population and mortality of the three first-named institutions, and to add to it the deaths of Wandsworth parishioners which have occurred in the workhouse. The death-rate for the past year deduced from the present estimated population,* and the deaths proper to this parish in accordancc with the foregoing considerations, was 18.7 per 1000 living. For 1858 it was 17.05; for 1857, 15.4; and for 1856, 21.3; during the previous 10 years it averaged 21.79 per 1000. 356 births—186 males and 170 females—were registered during the past year. The average number for the past 10 years was 321. The birth-rate was 31.3 per 1000; the natural rate of increase 12 per 1000. *This estimate is based upon the assumption that the population has increase since 1851, in the same ratio as during the preceding ten years. 8 Causes of Death. The following table contains a summary of all the causes of death, arranged in accordance with the classification of the Registrar General, and showing the sex, social position, and age at death at 8 periods. WANDSWORTH. SEX AGE SOCIAL POSITION Population in 1851, 9,611. Area in Acres, . . 2,478 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 under 40 years of age At 40, and under 60 years of age At 60, and under 80years of age 80 years and upwards Nobility and Gentry Professional Class, Merchants, Bankers, &c. Middleand Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes Disease* and other Causes of Death Diseases Classified. Classes:— I. Zymotic Small-pox 2 .. 2 .. .. .. .. 2 .. .. .. .. .. 2 Measles 4 3 7 1 5 1 7 .. .. .. .. .. .. .. 7 Scarlatina 18 26 43 2 23 12 41 1 1 .. .. .. .. 3 40 Diphtheria. 1 2 3 .. .. .. 1 1 1 .. .. .. .. 1 2 Hooping Cough .. 2 2 2 .. .. 2 .. .. .. .. .. .. 1 1 Diarrhœa 2 1 3 2 .. .. 2 .. .. 1 .. .. .. .. 3 Total 27 33 60 7 28 13 53 2 4 1 .. .. .. 5 55 2. Tubercular 21 22 43 7 6 .. 17 20 4 2 .. 1 .. 5 37 3. Of Brain, Nerves, &c 55 19 74 5 3 2 11 14 35 14 .. 1 .. 10 63 4. Of Heart, &c 6 3 9 .. .. 1 1 .. 4 3 1 1 .. 4 4 5. Of Respiratory Organs 20 21 41 6 11 1 19 3 8 8 3 .. .. 7 34 6. Of Digestive Organs 8 4 12 2 2 1 4 3 2 3 .. 1 .. .. 11 7. Of Kidneys 1 .. .. .. 1 .. 5 1 .. 1 .. 3.. 3 8. Of Uncertain Seat 9 8 17 2 2 1 6 2 5 1 .. 1 .. .. 16 9. Premature Birth, Low Vitality, Malforrnation, &c 6 5 11 11 .. .. 11 .. .. .. .. .. .. 1 10 10. Age 4 11 15 .. .. .. .. .. .. 7 8 1 5 .. 9 11. Violence 10 3 13 1 3 .. 5 2 4 2 .. .. 1 1 11 12. Not specified 6 3 9 1 2 1 4 1 3 1 .. .. .. 1 8 Total 178 133 311 42 57 20 133 47 74 46 12 7 6 37 261 As might be expected, from the circumstance that the County Lunatic Asylum furnished considerably more than ⅓ of the total registered mortality, the largest number of deaths are seen to have resulted from diseases of the brain and nervous system. But somewhat less than 1/5 part only of these belonged to Wandsworth, forming less than 5 per cent. of all deaths—an amount which is below the average. The remaining 4/5 and upwards are due to the Asylum, and lor the reasons previously assigned, are excluded from the estimate of the causes of mortaliy proper to this parish. The most prominent but least satisfactory feature in the table is the great mortality from diseases of the Zymotic class which formed 19.2 per cent, or nearly 1/5 of the whole. The Tubercular class, which includes Consumption, formed 13.8 per cent., and Diseases of the Respiratory Organs 13.1 per cent. of all deaths. Both are below the average. The unusual number of 13 deaths resulted from violence; 5 were of suicides, the remainder from accidental causes. In 9 instances the cause of death was not specified, and in 12 was not certified by medical opinion. Inquests were held in 28 cases, and in 6 the cause of death was not determined after such inquiry. In 18 instances, then, no medical testimony of the cause of death was adduced, and therefore so many in which death may have resulted from other than natural causes. It. is thought not out of place 9 in this Report to mention this fact, to show that in the present state of the law the possibility of the perpetration of secret crime remaining undetected is not precluded as far as it might be, by the intervention of medical investigation in all cases of death, the cause of which has not been certified by a registered medical practitioner. Of single diseases Scarlet Fever was the most fatal, causing 13.8 per cent. of all deaths; the next fatal was Consumption, which caused 9 per cent.; this amount is remarkably low, and it would appear from the Registrar General's Returns, that fatality from this disease, although actually great, is relatively low in this, compared with that of most of the other metropolitan districts. The remaining causes of death were of about the average number. Upwards of 42 per cent. of all deaths occurred under the age of 20, and nearly 32 per cent. did not cxceed the age of 5 years. This amount of infant mortality is greatly in excess of the average, as might be expected from the greater prevalence of diseases peculiarly obnoxious to children. More than 4/5 of the total mortality occurred amongst the labouring classes. Of the 60 deaths resulting from epidemic diseases, 55, and of the 46 deaths from Scarlet Fever, 42, took place amongst them. Epidemic Diseases—Prevalence and Fatality of. The following table shows the deaths which have resulted from epidemic diseases during the past and three preceding years. Years Small-pox Measles Scarlet Fever Diphtheria Hoopingcough Diarrhoea Fever, Typhus & Typhoid 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 1859 2 7 43 3 2 3 0 60 It is seen that the total amount in last year exceeded the average of the three preceding years by nearly one-half, and that the excess was due to Scarlet Fever. This disease prevailed very extensively during the first three quarters of the year; Measles to a considerable extent during May and the five following months; Diarrhoea during the entire year; but its amount was trifling, and much less than usual in the summer quarter; Hoopiny-cough during the first six months and in December; Small-pox was present to a slight extent in the spring quarter and in December: the only two deaths which occurred from this disease were of men both upwards of 40 years of age, and unvaccinated. The winter quarter, notwithstanding its great and sudden changes of climate, was remarkably healthy, and comparatively free from epidemic disease. There was a singular absence of death from Typhus or Typhoid Fever. 10 General Sickness—Amount and Intensity of. The death-rate of any locality is usually assumed as the criterion of its sanitary state; and calculated on an average of several years furnishes the best information in this respect. But it docs not tell everything—it takes into account the fatal results of disease, but it does not show the relation which has existed between such results and the amount of sickness which has produced them—or in other words the intensity of disease—and therefore fails to represent the lesser fluctuations of health, of which it is most desirable the sanitarian should have cognizance. It is not at present possible to obtain a record of the total sickness, with its results, which has prevailed; but a portion of it— that which has occurred amongst the poor—is accurately known, and is contained in Table 5 of the Appendix. By assuming the proportion of deaths to cases of sickness among the poor as the measure of the proportion of deaths to cases of sickness which occurred in the entire parish, a sufficiently correct estimate can be formed of the amount and intensity of the total sickness, as well as of the extent of epidemic diseases which prevailed. Thus, the total cases of sickness amongst the poor during the past year were 1211; the deaths 39, or 3.2 per cent.; the number of deaths proper to the parish 219; so that no fewer than 6800 cases of sickness, according to this calculation, must have occurred in the entire parish. But as the mortality is greatest amongst the poor, this computation is necessarily below the true number, in proportion to the difference between the mortality amongst them, and that amongst the remainder of the inhabitants; and although not accurate in this respect, it can be wrong only on the side farthest from exaggeration, and if taken from year to year forms a trustworthy basis for comparison.* If the same fatality from disease had taken place during the past year as during the 4 preceding years, the 219 deaths which occurred in the former would represent 7406 cases of sickness; but it is seen that they resulted from 6800 only, so that the intensity of disease last year was in excess of the average taken, as represented by the difference between these two numbers, or about 8 per cent. And so with reference to any diseases whioh have prevailed epidemically. The cases of epidemic disease amongst the poor were 367—the deaths 15, or a little over 4 per cent. of attacks. The deaths which occurred in the whole parish from Scarlatina were 46 (including 3 of Diphtheria); and as each death represents at least 25 attacks, it can be at once seen how very extensively this disease prevailed. Sanitary Operations. Table 6 in the Appendix contains a summary of the sanitary operations which had been carried out during the year, under the guidance of your able Surveyor. It is satisfactory to see that they have all been conducted, as in the year 1858, without the necessity for magisterial interference. In addition to these, all the butcher's slaughter-houses were examined in the month of September, and found to be in a satisfactory condition. The premises of Mr. Wallis, horse-slaughterer, Dunse Hill, became the subject of a special Report in October in consequence of a complaint that offensive effluvia arose from the *Should the Census of 1861 contain the social position of every person registered' this inaccuracy could be corrected. 11 processes of his trade. These, and the whole of his premises were carefully examined, and such alterations made at my suggestion, as diminished the evil as far as was practicable. Amongst the recommendations which were made relative to special circumstances affecting the public health, were the two following, which on account of their importance I beg to repeat here. The first referred to the propagation of contagious diseases by the retention of the dead within the dwelling-rooms of the poor. On the occurrence of death in the family of the labouring man, want of space often inflicts upon him or some of his family the necessity of dwelling and even sleeping in the presence of the dead. It needs but the mind to picture the room of death, as the one subservient to all the purposes of domestic life, to realize the painful incongruity of the circumstances. But there is stronger cause for reflection. The presence of death from contagious disease under such circumstances becomes, there is every reason to believe, a fruitful source for the propagation of contagion. The most that the Medical Officer of Health can at present do to obviate this evil is, to endeavour to persuade the relatives of the dead to procure as early an interment as possible. But such advice is seldom acted upon, for the mind of every one naturally revolts against any undue haste; moreover the coffin has to be made, and the convenience of the undertaker and of others consulted. The remedy consists in the setting apart some small building, in a convenient position, and as remote as possible from dwellings, for the reception of those who have died under the circumstances described, during the period intervening death and interment. The other recommendation, which was made at the beginning of the year, related to a means of more efficiently carrying out the humane intentions of the "Vaccination Act," and also to a means of diminishing the chances which exist for the propagation of contagious diseases at the National and other public schools, in consequence of children being allowed to return to school during convalescence from those diseases. Its purport was, that of inducing the committees of management of such schools to adopt the following resolutions in relation to these two subjects; viz.— 1. That no child should have admission to the school except upon the production of a certificate of having been successfully vaccinated. This requires but little comment. It would secure the vaccination of the great majority of children, and would inflict no hardship, inasmuch as it would be in accordance with the law. 2. That no child, absent from school on account of sickness, should be allowed to return to school except upon the production of a certificate from the medical attendant, that it might do so with safely to itself and others. This has been carried out for a considerable time in two or three instances, but its adoption should be general. The other recommendations have not been carried out. Conclusion. The foregoing statistical information furnishes data for the following conclusions:— 1. The health of this parish during the year 1859 was not in so satisfactory a condition as during the two preceding years, as represented by an increase 12 of the death-rate of nearly 1 per 1000, and by a greater amount and intensity of disease. 2. It was nevertheless above the average of the ten preceding years, as represented by a death-rate less by 3 per 1000 (exclusive of cholera years). 3. This deterioration of health was due to the prevalence of an extensive, and fatal epidemic of Scarlet Fever, which accounts for the great excess of infant mortality. In order to give practical value to these results for indicating the directions which sanitary operations should assume, it is desirable to know the particular localities in which those diseases which increased the death-rate, prevailed. I have therefore prepared a table showing the parts of the parish in which the deaths from epidemic diseases have occurred since the commencement of the operations of your Board. The deaths so recorded are found to be associated more or less with conditions prejudical to health. This table, I may remark, would be of great practical value if the houses throughout the parish were all properly numbered; every house in which a death occurred could then be accurately known by a reference to the register of deaths. I have handed the table (which is excluded here from want of space) to your Surveyor for his guidance. GEORGE EDWARD NICHOLAS, Medical Officer of Health for Wandsworth. 13 CLAPHAM. In the years 1856, 1857, and 1858, the numbers of registered deaths in this sub-district were respectively 286, 321, and 344, giving an average of 317. As the deaths in 1859 amounted to 328, it follows that an excess of 11 was registered over the average of those years; but as the deaths in the past year (1859) occurred in an increased population, they should be compared with the average raised proportionally to such increase. By this comparison the mortality of 1859 is found to be almost identical with that average. CLAPHAM. Population in 1851, l6,290 Are* in statute Acres, 1,233 DISEASES And other causes of death. SEX AGE SOCIAL POSITION 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 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 1. Small Pox 2. Measles 3. Scarlatina, and lignant Sore Throat 4. Hooping Cough 5. Diarrhoea & Dysentery . 6. Cholera 7. Fever 8. Erysipelas 9. Puerperal Fever 10. Lung Diseases, cept Phthisis 11. Phthisis 12. Hydrocephalus, Atrophy, Scrofula, and Convulsions of Children 13. Other Diseases 14. Violence, Privation, and Premature Birth Total 2 2 14 2 4 .. 7 2 .. 28 27 27 37 14 160 7 .. 12 4 7 .. 5 .. 1 29 18 13 51 15 162 9 2 26 6 11 .. 12 2 1 57 45 40 58 29 328 2 1 2 2 5 .. 1 2 .. 8 8 34 1 19 75 3 1 15 4 1 .. 4 7 12 4 3 54 1 .. 5 .. .. .. .. .. .. 1 .. 4 1 .. 12 7 2 24 6 6 .. 6 2 .. 17 8 40 8 23 149 1 .. 1 .. .. .. 1 .. .. 3 13 .. 9 1 20 1 .. 1 .. .. .. 12 13 .. 23 1 54 .. .. .. 4 .. 3 .. .. 14 4 .. 38 3 66 .. .. .. .. 1 .. .. .. .. 10 .. .. 10 22 .. .. .. 1 .. .. 2 2 2 .. 8 .. 15 .. .. 2 .. .. .. .. 1 5 4 3 10 1 26 1 1 6 1 3 .. 2 1 .. 14 7 11 31 2 80 8 1 18 4 8 .. 8 1 36 32 26 39 26 207 The annexed table exhibits the number of deaths from all causes in 1859, classified, as usual, under sex, age, and social position, from which it will appear that epidemic or zymotic diseases, in six of their principal forms, carried off one-fifth of the whole number of persons who died in this parish, or no less than 66. This table further shows, that 75 infants under one year, 54 from one to five years, and 12 from five to ten years, died during the year. It cannot be denied that a total of 141 deaths is a large infantile mortality, though it is gratifying to bo able to state that the death-rate under one year is considerably below that of 1858, as is also that between 5 and 10 years, making a total difference in favour of the past year of 20 lives, between the period of birth and the age of 10. 14 By making a further examination of the totals under the three first columns relating to age, &c., and by comparing them with those of a similar table given in my report for 1858, it will be seen that the number of deaths under one year, compared with that from 1 to 10 years, is slightly more favourable in 1859 than in the preceding year; but that, standing as the number does in the ratio of nearly seven to six, it indicates pretty clearly that the mothers' neglect of their offspring during the earlier periods of infancy is still most lamentably frequent: for the majority of these infant deaths, it is well known, are not caused by disease per se, but are either directly or indirectly the result of a low moral intelligence in respect to the proper management of young children on the part of the parents as their natural protectors. Above the age of 10 years the rate of mortality exhibits a decided improvement in 1859, as compared with 1858. Sickness and Mortality amongst the Out-door Poor. The cases of sickness amongst the out-door poor (vide Table V., Appendix) shows a decrease equal to 18 per cent. below that of 1858, the rate of mortality, when calculated upon the number of cases that have come under treatment remaining about the same, notwithstanding there were, during the past year, some alarming outbreaks of Small-pox and fever. The deaths, however, from these two maladies have been, I may safely say, more than compensated by the smaller number that have died amongst this class from other diseases during the" year under notice. Inspection of Houses. I can congratulate the ratepayers of this extensive sub-district upon the very visible improvement in the sanitary aspects of the parish as exhibited in Table VI., Appendix, wherein it will be seen that whilst the number of examinations of houses have been nearly the same as in 1858, the necessities for executing sanitary works have diminished by more than one-half, thus evidencing the value of the strict supervision hitherto pursued under the auspices of the Board of Works. Slaughter Houses, Cow Houses, and Dung Yards. The whole of the slaughter houses in the parish, 23 in number, as well as 36 dung yards, have been repeatedly inspected, and 18 cow-houses have been cleansed and limewhited during the year. I am of opinion that the whole of these places ought to continue under the strictest supervision in order to maintain them in a proper sanitary condition. Removal of Nuisances As many as 273 complaints and sanitary defects were entered in the Complaint Book, but altogether 297 were made in various ways, and examined into by myself and the Surveyor. Of these 297 complaints, it is gratifying to state, it was requisite to seek magisterial interference in three cases only. Various other cases of nuisance were brought to my knowledge during the year, but many of these were removed through friendly representations to 15 the offending parties, without the interference of the Board. As the density of the population of this parish is every year becoming greater, I respectfully urge that unremitting attention be paid to the removal of all known and acknowledged causes of disease, before the setting in of sultry weather. Offensive Ponds. It is also a matter upon which I may congratulate the inhabitants, that most of the offensive ponds (especially one very much complained of in former years, viz., the Building Pond) have undergone considerable improvement. There remains, however, the Harford and the Cock Ponds, of which I still feel it to be my duty to complain. I have had occasion to bring the condition of these ponds continually before the notice of the Board, and I now earnestly repeat my recommendations that something be done, and that speedily, to rid the locality of the dangers which lurk in the fetid accumulations of these two little better than extended cesspools. I have also again to direct attention to a pond on the estate of a private gentleman situated near the Green Lane, as being, if possible, a more serious nuisance than even those before named. As a receptacle for nightsoil, and all kinds of putrifying animal and vegetable refuse, this pond still continues its baneful influence in the production of disease, and to contaminate the atmosphere a considerable distance around it, to the great detriment of the health of the wealthy and other ratepayers, who have residences in its immediate vicinity. Nuisances existing upon private property, in various parts of the district, have been frequently dealt with by the Board through magisterial interference, and I would respectfully suggest that similar steps be forthwith taken to abate what I consider to be one of the grestest nuisances existing in the parish. In this opinion I am confirmed by several of my colleagues in office, whom I have consulted, as well as by many of the aggrieved parties, who are unceasingly calling my attention to the matter. Drainage and Water Supply. With regard to these two most important sanitary requisites, I can add nothing to the remarks I made in my last report, but which I will here, notwithstanding, take the liberty of emphasizing by joining in the earnest hope expressed by one of my colleagues in a former annual report:—"That as drainage is the summum bonurn of all efforts of sanitary legislation, the far reaching views of those members of your Board, whose profession it is to devise means to overcome engineering difficulties, will shortly be brought to bear upon the realization of this great sanitary desideratum,"—a desideratum, let me add, which continues to be especially recognized in this densely crowded sub-district. JOHN MACDONOGH, Medical Officer of Health for Clapham. 16 BATTERSEA. The instructions of your Board requiring an annual summary from each of the Medical Officers of Health, the following facts and figures are respectfully submitted as indicating the present condition of the public health of this sub-district, and the measures that have been adopted during 1859, to insure as many as possible of those sanitary inprovements suggested in former Reports. Statistics of Mortality. The number of deaths registered in the sub-district in the year 1859 was 394 (194 males and 200 females,))which is 14 in excess of the previous year; but as the deaths recorded in the present Report occurred in a population which has of course undergone some increase since my first Annual Return, they should be compared with a number corrected in proportion to such increase. By such a comparison it will be found that the proportion of deaths in 1859 was 35 more than the corrected average of the three preceding years. This excess is, I apprehend, in a great measure due to three causes—the continuance of the epidemic Scarlet Fever that occurred in November, 1858, the increased prevalence of Hooping-cough and Diarrhoea, and the unusual coldness of portions of the past year, which is attested by an increased mortality resulting from diseases of the respiratory organs. The subjoined table gives the number of deaths that has occurred from all causes and amongst all classes, ages, &c. :— BATTERSEA. Population in 1851, 10,560 Area in Statute Acres, 2,343 SEX AGE SOCIAL POSITION Males Females Total Under 1 year From 1 to 5 years From 0 to 10 years Under 20years, including all under 10 years At 20, and under 40years 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, Mechants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring! Classes DISEASES And other causes of death. 1. Small Pox 1 1 2 .. 1 .. 1 1 .. .. .. .. .. 2 .. 2. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3. Scarlatina,Malignant Sore Throat, and Diphtheria 26 17 43 10 16 10 39 2 2 .. .. .. 1 10 32 4. Hooping Cough 7 5 12 5 6 1 12 .. .. .. .. .. .. 1 11 5. Diarrhœa & Dysentery 10 13 23 19 2 .. 21 .. .. 2 .. .. 1 2 20 6. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7. Fever 4 7 11 .. 2 2 6 3 1 1 .. .. .. 1 10 8. Erysipelas 3 5 8 1 .. .. 1 1 1 4 1 .. .. 1 7 9. Puerperal Fever .. 1 1 .. .. .. 1 .. .. .. .. .. .. 1 .. 10. Lung Diseases, except Phthisis. 13 24 67 20 10 1 35 .. 14 16 2 .. 1 7 59 11. Phthisis 17 12 29 1 .. .. 4 15 9 1 .. .. .. 6 23 12. Hydrocephalus, Atrophy, Scrofula, and Convulsions of Children 11 12 23 14 5 2 21 1 1 .. .. .. .. 7 16 13. Other Diseases 55 92 147 17 6 .. 25 19 19 58 26 1 3 27 116 14. Violence, Privation, & Premature Birth 17 11 28 10 3 2 18 3 4 3 .. .. .. 4 24 Total 194 200 394 97 51 18 174 45 51 85 29 1 6 69 318 17 Prevalence of, and Mortality from, Zymotic Diseases. Diseases of the Zymotic class have, upon the whole, manifested themselves in a somewhat less virulent form during the past year than they did in the preceding one, since the six principal maladies of this class resulted in death in a less number of instances than during 1858, the numbers being respectively 88 and 103. Small-pox proved fatal in two cases in 1859, whereas in the year preceding there were no deaths from this disease recorded. Scarlatina, Malignant Sore Throat, and Diphtheria (of the latter 8 cases), grouped together in the mortality table, resulted in 50 deaths in 1858; but in 1859 there succumbed to the same diseases 43 persons. Of the 8 cases of death from Diphtheria registered, not one occurred amongst the union poor. Only one case, which I am happy to state resulted in recovery, came under treatment in my own practice. Of the 394 deaths registered, 105 occurred in the Union Workhouse, 23 of which were found by coroner's inquisition, viz., 13 from violence and 19 sudden, from natural causes. Of the deaths in the workhouse, 26 occurred between the ages of 70 and 80, 17 between 80 and 90, and 3 between 90 and 100, the oldest being 96. Mortality of Childhood—Proportion of Births to Deaths. The mortality amongst children between birth and 10 years of age has, I am pleased to state, rather diminished during the past year, 166 being the number registered against 174 in 1858; still, however, the number in 1859 is very large, and indicates the persistent operation of the much to be deplored cause alluded to in my last Annual Report. The births during the year have been 685, 366 males and 319 females; consequently, as the deaths number 394, there is an excess of births over deaths of 291. Sickness and Mortality amongst the Out-door Union Poor. Table V. Appendix, exhibits the nature and amount of sickness amongst the pauper population, as well as the deaths from each class of disease and other causes. Of 800 cases of sickness which came under treatment amongst this class, 35 terminated fatally, which is rather a larger proportion relatively to the number of cases treated than occurred in 1858, the mortality having then been 27 in 918 cases treated. Lung diseases, as I before observed, were unusually prevalent amongst all classes of the population during the past year; but amongst the union poor, of 174 cases treated, 10 only proved fat;-' In this calculation I do not include Phthisis, to which disease alone 29 de are attributed, but of these deaths one only occurred amongst the families of the out-door union poor. The per centage of deaths, in the number of cases of all diseases, accidents, &c., treated, may be said to be small, indicating that the pauper class are being greatly benefited by sanitary improvements, furnishing additional proof of the value of the measures that have been, and still continue to be, carried out by the authorities. Table VI. Appendix, furnishes one most gratifying fact, that every means B 18 are being employed, not only to rid the sub-district of all nuisances known or suspected of engendering or aggravating disease, but to gradually introduce such sanitary reforms as cannot fail to greatly benefit the parish, if not to place it ultimately (abounding, though it does, in manufactories of every kind) amongst the healthiest of the metropolitan suburbs similarly circumstanced. WILLIAM CONNOR, Medical Officer of Health for Battersea. 1.9 STREATHAM, INCLUDING TOOTING AND BALHAM. Streatham, Tooting, and Balham, constituting as they do a sub-district of Wandsworth, with a population at the last census little short of 10,000, shows a statistical return of 169 deaths for the year ending 31st December, 1859, being an excess of 69 over 100 in 1857— a year of low mortality—and 35 deaths more than were registered in 1858. In last year's Report, the then excess of mortality over the two preceding years was to be accounted for by the greater number of the aged dying, the deaths occurring at 60 and under 80 being unusually numerous—viz., 42. In the year 1859 the deaths amongst those of corresponding ages were 48. The following table will at a glance show these figures in an admirable manner, and also several other noteworthy facts of interest—1st, that Scarlet Fever has been committing ravages in carrying off 25 individuals, the disease having prevailed greatly and severely in the neighbourhood of Wells Lane, Streatham, a part very much in need of better drainage and sewerage, as pointed out after careful inspections made at the time of the prevalence of the epidemic;—2nd, that Phthisis has been the cause of death to 21 persons, a most exceptional number for the locality, as only 8 died from such cause in 1857, and 11 in 1858. The trying peculiarity of the weather and seasons, may in a measure account for a part of the great excess indicated. STEEATHAM, INCLUDING" TOOTING & BALHAM Population in 1851, 9,023 Area in Statute Acres, 3,465 SEX AGE SOCIAL POSITION Males Females Total Under 1 year From I 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. 1.Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 2. Measles .. 1 1 .. 1 .. 1 .. .. .. .. .. .. 1 .. 3. Scarlatina and Malingnant Sore Throat, and Diphtheria 12 13 25 .. 17 4 23 2 .. .. .. .. .. 3 22 4. Hooping Cough 3 .. 3 1 2 .. 3 .. .. .. .. 1 1 1 .. 5. Diarrhœa and Dysentery 3 .. 3 3 .. .. 3 .. .. .. .. 1 .. .. 2 6. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 7. Fever 2 1 3 .. 1 1 3 .. .. .. .. .. 1 1 1 8. Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 9. Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10. Lung Diseases, except Phthisis 16 10 26 5 5 .. 10 1 3 10 2 2 1 4 19 11. Phthisis 10 11 21 1 1 .. 9 8 3 1 .. .. 1 4 16 12. Hydrocephalus, Atrophy, Scrofula, and Convulsions of Children 6 5 11 8 3 •• 11 .. .. .. .. .. 1 2 8 13. Other Diseases 32 34 66 1 3 4 9 5 12 37 3 6 10 16 34 14. Violence, Privation, and Premature Birth 6 4 10 9 .. .. 9 .. .. .. 1 1 .. 1 8 TOTAL 90 79 169 28 33 9 81 16 18 48 6 11 15 33 110 20 I am happy again in being able to call attention to the fact of there having been no fatality attending Small-pox, and that but very few cases came under treatment in the sub-district, although, as is well known, it has been very prevalent and fatal in other metropolitan and suburban localities during the past year. The mortality of the young under 10 years of age has been great, and of those under 5 it has been unusually large, viz., 61 in 1859, against 41 in 1858, and 40 in 1857. The births in the year, as stated in Table II, Appendix, numbered 238. The deaths, as I before mentioned, were 169 ; the excess of births over deaths in the year 1859 is accordingly 69. Table IV, Appendix, exhibits the number of cases treated by the Union Medical Officers of this sub-district, and the number of deaths amongst the out-door poor, which is very instructive and satisfactory, as showing a very low rate of mortality (19) in the number of cases of sickness, &c., (299) that came under treatment. In all three localities comprised in this sub-district a number of sanitary improvements in the way" of drainage, water supply, removal of nuisances, &c., (vide Table V. Appendix) have been carried out, as I believe to the great advantage of the inhabitants and to the vast improvement of the individual parishes. In conclusion, I would repeat the earnest hope I expressed in my last Report, that a continuation of efforts in the same direction may confer still further sanitary benefits upon this important sub-district. D. C. NOEL, Medical Officer of Health for Streatham, Tooting, and Balham. i 21 PUTNEY AND ROEHAMPTON. In this report I propose to confine myself chiefly to a brief narration of facts and statistics bearing upon the condition of the public health of this sub-district during 1859. The attention these facts may deserve, and the measures they may suggest, I leave to the consideration of the authorities, fully assured that every reasonable project tending to benefit the health, and to improve the sanitary status of the parish, will be, in due time, carried out in a way to ensure the largest amount of good at the least possible expense. Statistics of Mortality. In the year 1859, the deaths registered in the sub-district were 119 (59 males and 60 females), which is, notwithstanding the increase of population in the interval, only one more than occurred in 1858, but would be rather under the death-rate of that year, if the ordinary corrections were made for such increase. A most accurate calculation in the above respect, may be made next year upon the completion of the approaching census, but at present only an approximate estimate can be arrived at in respect to the death-rate of any particular period, relatively to the exact number of persons living in the sub-district at that period. Extending the basis of a calculation of the kind referred to, which however is not done without some risk of either under or over estimating the present population, we may arrive at a rather more satisfactory conclusion as to whether we are progressing, or otherwise, in a sanitary sense, if we compare the mortality of the past year with that of the corrected average of the ten preceding ones. This done, and dug allowance being made for the difference between the natural deathrate from disease alone, and the registered death-rate from all causes, as well as for cholera years, which have unduly increased the rate of mortality, and the number of deaths that have occurred to non-parishioners in the recently established Royal Hospital for Incurables, it will be found that a steady ratio of somewhat under 18 in 1,000 of the present assumed population is being maintained, which being nearly the zero of the death-scale of the Registrar General, places Putney in a position of healthfulness very little inferior to the most favoured of rural districts. If there be any error in such a calculation, it is unquestionably one on the side farthest removed from exaggeration, since there are abundant proofs existing that the population of the parish has of late years increased by immigration and otherwise to an extent far beyond that which would be indicated by the usual correction adopted by the Registrar General, as the approaching census will, doubtless, clearly demonstrate. The following table gives the deaths from each class of disease and other causes, together with the sex, age, and social positions of the deceased 22 persons, for the year 1859, from January 1st to December 31st, both inclusive:— PUTNEY AND ROEHAMPTON SEX AGE SOCIAL POSITION Males Females Total Under 1 vear 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 uuder 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 Clares Population in 1851, 5,280 Area in Acres 2,176 DISEASES And other causes of death. 1. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. •• .. .. 2. Measles 4 5 9 1 6 2 9 .. .. .. .. .. •• 1 8 3. Scarlatina and Malingnant Diseases of the Throat .. 2 2 .. .. 1 2 .. .. .. .. .. 1 .. 1 4. Hooping Cough 1 3 4 1 3 .. 4 .. .. .. .. .. •• 3 1 5. Diarrhoea and Dysentery 2 3 5 5 .. .. .. .. .. .. .. .. •• .. 5 6. Cholera .. .. .. .. .. .. .. .. .. .. .. .. •• .. .. 7. Fever 5 1 6 .. 2 3 5 .. .. 1 .. 1 •• 1 4 8. Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. •• .. .. Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10. Lung Diseases, except Phthisis 6 9 15 1 2 1 4 1 2 6 2 1 •• 8 6 11. Phthisis 5 5 10 .. .. .. 2 5 2 1 .. .. .. 5 5. 12. Hydrocephalus, Atrophy, Scrofula, & Convulsions of Children 16 13 29 17 9 2 29 .. .. .. .. .. 1 6 22 13. Other Diseases 16 18 34 4 1 .. 7 3 3 16 5 4 5 11 14 14. Violence, Privation, and Premature Birth 4 1 5 4 .. .. 4 .. 1 .. .. 1 .. 4 Total 59 60 119 33 23 9 71 9 8 24 7 6 8 35 70 Of the 1,19 deaths recorded iu this table, 2G were the result of the six principal Zymotic diseases, which is a somewhat larger proportion than was exhibited in 1858, the number being in the last named year, 21. In 1858, however, not one fatal case of measles was registered, and but two of fever, but in the past year there took place as many as 9 deaths from the one and 6 from the other. Of fatal cases of lung disease, inclusive of 10 deaths from Phthisis, there occurred 25, which it is pleasing to observe is 6 less than appeared in a similar table in my last annual report. Infant Mortality, There is no very marked difference between the records of the two years of 1858 and 1859, in respect to the fatality attending the group of noncontagious diseases peculiar to childhood (No. 12 in the table), 29 being the number registered in the past year against 25 in the preceding one. If there be added to this the number of children who succumbed between the period of birth and 10 years of age, to epidemic and other diseases not included in the group just referred to, it gives the large number of 56, or about one-half of the total number dying of disease at all ages ! from which it may be inferred that the mothers of a rapidly increasing industrial population still continue to be regardless, in a great number of instances, of the deplorable consequences resulting from the neglect of home duties and 23 family responsibilities, whilst intent upon making the very most of their labour away from their offspring. It is a little singular, however, but no less gratifying, to find that the preponderance of deaths of children under the age of 10 years has been, during the past year, most decidedly on the side of the classes more or less removed from pauperism, the proportion being as great as 43 to 22, that is to say, of 65 deaths that took place amongst all classes of children at the ages above stated, 22 only occurred in the families of the union poor. Formerly, and before drainage and other sanitary improvements were introduced into and about the dwelling-places of the poor, the preponderance was as clearly on the side of the pauper. From this fact we may very reasonably conclude that the indigent as a class are being extensively benefited by the Act under which the improvements referred to have been carried out, and that more care than formerly is being bestowed by those who are mothers amongst the very poor, upon their offspring at the earlier periods of life. Birth-rate of the Sub-district. If we lose, in common with every other sub-district, a large number of children by deaths from disease and other causes, their places are quickly supplied, for during the past year the births of 189 (97 males and 92 females) were registered in the parish, giving an excess of births over deaths of 80, which is 15 more than the excess of the preceding year. The excess of births over the deaths of infants under 5 years is as great as 133. Sickness and Mortality amongst the Union Poor. Table V. Appendix, possesses some considerable interest as affording the means of judging of the general character of the prevailing diseases in the several parishes in the district, and indeed is the only reliable basis upon which such judgment can be formed, since unfortunately the cases of sickness occurring in private practice, unless they result in death, find no record. During the past year the cases of sickness amongst the union poor residing in this parish were rather more numerous than in 1858, but the proportion of deaths to the number of cases treated is small, viz., 29 to 675, or a fraction over 4 per cent. It is also gratifying to report that nearly one-fourth of the diseases resulting in death amongst this class in 1859, were of a chronic character, and not what are usually termed " preventible", and that they occurred to adults, three of whom were at the time of death bordering on 80, aid one above that age. Another most gratifying and note-worthy fact is, that of the total of 119 deaths registered in the sub-district, only 29 took piace in the families of the out-door Union poor. Prevalence and Fatality of Epidemic Diseases. Since one of the most important duties of a Medical Officer of Health is (as defined by the Act of Parliament) " to point out the most efficacious modes of checking or preventing the spread of contagious or epidemic diseases, and the local causes which are likely to originate and maintain such diseases," but little apology is necessary for here introducing the following 24 table, which exhibits the comparative mortality resulting from epidemic diseases during 1859, in oppositely conditioned localities of the parish. The localities indicated in this table have been especially noted for the information and guidance of the Surveyor. Localities Small Pox Measles Scarlet Fever Hooping Cough Diarrhœa Fever, Typhus, and Typhoid Totals Well drained, and in a fair sanitary condition ... 3 1 1 1 1 7 Badly drained, or without Sewers, and admitting of further sanitary improvements ... 6 1 3 4 5 19 Totals ... 9 2 4 5 6 26 It will be observed that no deaths from Small Pox are recorded in this table. Within my own knowledge no case of the disease, (if we except one of a mild character, known to have been imported by the gipsies,*) came under treatment either in public or private practice in 1859. Happily, this entire freedom from the disease has been noted in this parish for several years past; but I regret to state that within the last two months two or three cases have come under my notice in adults, who were, it was found, unprotected by vaccination. But it is not entirely for the purpose of showing the immunity enjoyed by this parish from Small Pox, that this table is inserted—read in conjunction with Table VI. in the Appendix, it clearly exhibits the fact, that although much has been, and continues to be, done in the way of sanitary improvement by drainage, water supply, abolition of cesspools, and remoral of nuisances in the crowded localities, there yet remains something to ???ccom- * The following paragraph is from the Lancet of June 2nd, 1860, and is here inserted to show that the proposal which emanated from this parish, to obtain legal powers to remove gipsies and others encamping on the commons and open spaces within the metropolitan area, is exciting some attention in influential quarters. " Small Pox propagated by Gipsies.—A memorial has been presented to the Metropolitan Board of Works by inhabitants of Putney, stating that the commons have for some time past been infested by swarms of gipsies, tramps, and hawkers, who live in tents and caravans. There is no existing law, say the memorialists, whih brings such persons not occupying ordinary places of abode, under the sanitary regulations of the Metropolis Local Management Act and the Nuisances Removal Act, and hence epidemic diseases are liable to be fostered and spread by these vagrant and lawless people. It is alleged that Small Pox has recently been so introduced in the parish of Putney, and that the most earnest solicitations of the Medical Officer of Health have been of little avail in inducing these tramps to allow their children to be vaccinated. It is obvious that to obtain the most complete security against Small Pox no portion of the community should be suffered to withdraw itself from the operation of those hygienic laws which are instituted for the common welfare. The source of infection pointed out by the inhabitants of Putney is certainly one that demands a remedy." 25 plish before the entire sub-district ean be pronounced so thoroughly satisfactory as it is believed to be in the power of the authorities to render it.* A further extension of the sewerage in the direction of the Charlwood and Upper Richmond Roads, being now wisely resolved upon, it is earnestly hoped the insertion of the above table will not only serve to justify an unqualified approval of the scheme, but also help to remove one of the greatest drawbacks to sanitary progress, viz., the extraordinary notion said to prevail in some quarters, that the drainage and other improvements of portions of a district can alone benefit those who reside in the immediate vicinity of such improvements, and that, therefore, certain ratepayers are justified in claiming exemption from assessments for such purposes made upon the inhabitants of a town generally ! It may seem almost superfluous to attempt to combat seriously such a notion, but that well-known fable which speaks of the unhappy differences that " once upon a time" sprang up between the trunk and limbs of a human subject and which was productive of such disastrous results to both, may here be referred to with advantage, as exhibiting the untenable nature of such an argument as I have adverted to. The moral of this excellent fable is, that if a part of a body suffers, all the other parts must, sooner or later, suffer with it, or if one portion is benefited, all the other portions must, in due time, receive a corresponding advantage, and that therefore it became a most suicidical policy for each organ to repudiate the good offices of the others, and to refuse to work together for the common benefit of all.† If the sewerage of the entire sub-district must, sooner or later, be rendered complete, it is surely the wiser policy—without reference to whether the advantages to ourselves individually will be direct or indirect, immediate or remote—to endeavour to arrive at such completeness in the most inexpensive and deliberate manner, than to be driven to accomplish it hastily and therefore badly, at a time when the parisli may possibly be in anything but a favourable condition for * In addition to the sanitary works indicated by Table VI., Appendix, as having been accomplished in the sub-district during the year 1859, it should be mentioned that all the buildings used for slaughtering purposes were carefully inspected and reported on by me previous to the time appointed for renewal of licences. I am pleased to state that all these places were found to be both clean and free from nuisances, and iu possession of all the sanitary requisites insisted upon by the authorities. Another exceedingly beneficial work in the way of sanitary improvement, accomplished by private subscription, and therefore not mentioned in the table, may be here alluded to, viz., the erection of a drinking fountain in one of the main thoroughfares of the town. It is a structure worthy both of the town and the subscribers, particularly so of the gentleman who, as the originator and largest contributor, has throughout superintended its erection. This fountain may be justly said to be as ornamental as it is unquestionably useful. † It is much to be regretted that so many difficulties should stand in the way of the present effectual drainage of Roehampton. A by no means difficult or expensive scheme was recently propounded for this purpose, which although approved by the District Board, Local Committee, and the Surveyor, was, I am told, set aside by the Metropolitan Board on the plea of its being not altogether compatible with the scheme of main drainage. If this be so, it surely affords an additional reason why an extension of, at least, so much of the drainage as may be really compatible with the general scheme, should be carried out in such portions of the parish as most need it, and where it has been long and urgently petitioned for, since if the whole be left for accomplishment until the central authority moves in the matter, there can be but very little doubt that much heavier expenses will have to be incurred to meet the then peremptory requirements of such authority than will now be the case. 26 the experiment. The recent improvements in respect to drainage, water supply, &c., in the vicinity of the Infant and National Schools (in which locality is included Cocks' Buildings and neighbourhood), may be adduced in proof of the advantages of such works of general benefit; for here severe diseases are now much less frequent and infinitely less fatal than they were when cesspools reigned supreme, and good water was in consequence an unobtainable luxury. If then, by good drainage, &c., success has attended the efforts made to improve the health and lessen the rate of mortality of an hitherto notoriously unhealthy locality, (where cholera and other severe epidemics had always found the greatest number of victims,) and to blot out one more plague-spot from the catalogue of places, whence were formerly derived the majority of our parochially supported widows and orphans, it is difficult to arrive at a conclusion other than that the entire sub-district must have been benefited by the improvements indicated. Further, if it can be shown that by the proposed extension of sewerage the drainage of what may be termed the suburban portions of the parish, such as Roehampton and the Heath, will, with greater certainty and facility, be hereafter secured, surely there can be but few—however much disposed some may be to shut their eyes to the necessity for such works on account of their cost—who will seriously deny the general benefits that must ultimately accrue from them. It should be recollected that although good sewerage is somewhat costly in its first formation, the constant expenses attendant upon widowhood and orphanage, and loss of labour through sickness, is infinitely more so. Upon the basis upon which life insurances are now calculated, it is a settled point with all experienced actuaries that the mean money-value of a healthy and effective labourer is as much as £226! Is it not, then, something to be able to save even one life per year amongst the labouring classes by measures of precaution such as arc now about to be taken in this sub-district ? Should but ten valuable lives be saved by such means in as many years, it is clear that the sum borrowed, and to be expended in the construction of the projected sewerage, will be more than returned to the commnnity, both principal and interest, in the equivalent of productive labour. Taking a retrospect of the improvements effected in this and the other parishes comprised in the Wandsworth District, within the last few years, we cannot fail to observe how gradually but surely have all the most important benefits we enjoy been secured to us. It is pleasing to review, as my colleagues and myself have attempted to do in this report, the progress we are making in sanitation—it must be even more so for such of the inhabitants who really desire the sanitary welfare of their several sub-districts, to aid and assist in this progress; but it will amount to an offence, it might almost be said, a crime, against the good government of communities, to be apathetic when so much yet remains to be accomplished, or to offer opposition when there is so much need of resolute and combined exertion in support of the greatest, and unquestionably the most important, movement of the age. R. HARLAND WHITEMAN, Medical Officer of Health for Putney, and Chairman of the Astociated Health Officer of the Wandsworth District. APPENDIX OF STATISTICAL TABLES. TABLE I. Showing the average mortality of the ten years previous to 1859, in the entire Wandsworth District, and the decrease in the number of deaths in favour of the past year. Deaths registered in the ten years, viz. : 1849 1850 1851 1852 1853 1854 1855 1856 1857 1858 1526 963 1016 1114 1148 1733 1144 1144 1097 1264 Average of the above ten years 1215 Above average, corrected for increase of Population 1336 Deaths registered in 1859 1322 Decrease of Deaths in favour of 1859 14 TABLE II. Births during the year ending 31st December, 1859. Sub-districts Males Females Total Clapham 290 304 594 Wandsworth 186 170 356 Battersea • 366 319 685 Putney and Roehampton 97 92 189 Streatham, including Tooting and Balham 117 121 238 Total 1056 1006 2062 ***The excess of Births over Deaths in the entire district is 740. 28 TABLE III. Meteorological Means for 1859.* Jan., Feb., and March April, May, and June July, Aug., and September Oct., Nov., and December The Year Temperature of the Air 43°9 52°6 6106 43°0 50°3 Evaporation 42°6 49°2 57°5 41°2 47°6 Dew Point 41°2 46°1 54°7 39°0 45°3 Weight of Vapour in a cubic foot of Air 3.24 grs. 3.78 grs. 4.97 grs. 3. 00 grs. 3.7 grs. Degree of Humidity (Satn 100) 91°9 79°9 79°1 86°5 84°3 Reading of Barometer 30.038 in. 29 .872 in. 29.976 in. 29.822 in. 29.927 in. Weight of a cubic foot of Air 550.1 grs. 535.9 grs. 527.4 grs. 543.3 grs. 539.2 grs. Rain (amount of) 3.731 in. 9.24 in. 7.43 in. 7.76in. 28.16 in. * These will be found to differ somewhat from those of the Registrar General, the former being derived from observations taken in the centre of this district, the latter from observations taken at Greenwich. TABLE IV. Showing the total Deaths from the principal Epidemic Diseases in each Sub-district and in the entire District, and the relation which they bore to the total Mortality during the years 1855-9. Deaths from Epidemics in each Sub-district Entire District Years Clapham Battersea Wandsworth Putney Streatham Total Deaths from Epidemics Total Deaths Registered Per centage of Deaths from Epidemics to Total Deaths 1855 41 39 50 4 16 150 1144 13.1 1856 39 45 44 13 15 156 1144 13.6 1857 55 46 28 7 14 150 1097 13.6 1858 85 100 22 20 15 241 1264 19.0 1859 63 96 60 26 38 283 1322 21.4 *** The Diseases included in the above Table are six in number, and constitute, as in the Registrar General's Returns, the principal maladies of the Zymotic class, viz., Small-pox, Measles, Scarlatina (including Diphtheria), Hooping Cough, Diarrhoea and Dysentery, and Fever. 29 TABLE V. Cases of Sickness amongst the Out-door Poor under the Treatment of the Union Medical Officers, with the Deaths from each Class of Disease, durnin the year that ended 31st December, 1859, compiled from the District Medical Relief Books. Sub-districts Total Cases of Sickncss treated in each Sub-district 1. Small Fox 2. Measles 3. Scarlatina and Malignant Sore Throat 4. Hooping Cough 5. Diarrhoea & Dysentery 6. Cholera 7. Fever 8. Erysipelas 9. Puerperal Fever 10. Lung Diseases, except Phthisis 11. Phthisis 12. Hydrocephalus, Atrophy, Scrofnla, aud Convulsions of Children 13. Other Diseases 14. - Violence, Privation, and Premature Birth Total Deaths in each Subdistrict Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Death Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Clapham 1245 77 5 6 .. 38 4 12 1 126 4 .. .. 320 1 8 1 2 1 127 9 20 7 18 2 408 13 83 1 49 Wandsworth 1211 16 2 53 3 120 9 18 1 134 .. .. .. 16 .. 10 .. .. .. 157 6 12 3 4 2 671 13 .. .. 39 Battersea 800 10 2 .. .. 47 5 29 4 89 3 .. .. 8 1 10 .. .. .. 174 10 6 1 4 1 392 7 31 1 35 Putney and Roehampton 675 .. .. 1 44 4 4 1 18 .. 54 2 .. .. 13 4 4 .. 1 .. 31 2 1 1 19 8 345 7 41 .. 29 Streatham, eluding Tooting and Balham 299 1 .. .. .. 20 8 1 .. 24 1 .. .. 3 1 3 .. .. .. 40 2 9 2 2 .. 179 7 17 .. 19 Totals 4230 104 9 203 7 229 25 78 6 427 10 .. .. 360 7 35 1 3 1 529 29 48 14 47 13 1995 47 172 2 171 30 TABLE VI. Summary of the Sanitary Operations in the entire District during the year 1859. Clapham Battersea Wandsworth Putney and Roehampton Streatham, including Tooting & Balham Totals Number of Houses and Premises inspected 860 200 274 97 208 1639 1st Notices served 129 28 15 10 37 246 2nd Notices served 20 2 5 ... ... Cesspools emptied and cleansed ... 50 45 11 149 255 Cesspools abolished 3 ... 6 3 19 31 Water-closets constructed 43 36 1 4 51 135 Houses supplied with Water 43 36 15 19 40 153 Drains constructed or connected with Sewer 16 25 7 8 51 107 Drains repaired or trapped, or obstructions removed 36 20 49 52 143 200 Open Ditches, Ponds, &c., cleansed 19 10 ... 9 ... 38 Dust-bins provided 43 50 ... ... 25 118 Pig Nuisances removed 15 4 3 ... 19 41 Accumulations of Offal, Manure, &c., removed 32 10 10 5 21 78 Unwholesomeand dilapidated Houses cleansed, or repaired 14 5 2 4 7 32 Cases investigated by Magistrates 3 1 ... ... ... 4 Compulsory Orders obtained 3 1 ... ... ... 4 Compulsory Works executed 3 1 ... ... ... 4 Works remaining in abeyance from various causes ... ... ... 2 ... 2