WAN 12 SANITARY DEPARTMENT. REPORT on the SANITARY CONDITION of the several parishes comprised in the WANDSWORTH DISTRICT, For 1860. By the Medical Officers if Health. LONDON: PRINTED BY C. & F. BELL, KING'S ROAD, CHELSEA. 1861. REPORT. To the Board of Works of the Wandsworth District. Gentlemen, Proceeding on the same plan as in former years, and adopting the same forms for the tabulation of the statistics relating to the entire district, as well as to the sub-districts, we have the honour to present our Report for 1860, the fifth year since our appointment to office. We have much pleasure in bringing to your notice the facts contained in the following summary of the health of the entire district, which shew that your exertions in the prosecution of sanitary measures have been attended with very considerable success. 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. A VERY notable improvement in the health of the District, as evidenced by a considerable reduction in the death-rate, has taken place since the year 1856, the period of the commencement of the operations of the Board. This is shewn by a comparison of the average death-rate of the past ten years with the similar rate of the last five years. The mean annual death-rate of the District during the ten years 1851 —60, as deduced from the total deaths registered in those years, and the population at the recent census, was 2040 per 1000 living.* This is inclusive of the cholera year, 1854; exclusive of that year, it was 19.49 per 1000. In the ninth annual report of the Registrar-General the rate is stated to have been 19.74 per 1000 during the seven years 1838—44. The mean annual death-rate during the five years 1856—60 was 18.95, which is, therefore, less than the average of the past ten years, exolusive of the cholera year, by 00.54 per 1000; and is equal to an annual reduction of mortality, since the year 1856, of upwards of five deaths in every 10,000 of the population. The death-rate is found to vary considerably in the several subdistricts; thus, the mean annual death-rate per 1000 during the past ten years was in each sub.district as follows:- Battersea. Clapham Wandsworth. Putney. Streatham. †25.30 18.16 17.86 16.19 15.10 From an average of the past five years it is found that the ratio of deaths from epidemic diseases to the total deaths, is invariably higher *The death-rate of the district is unduly raised to the extent of about 1.50 per 1000 by the mortality of the Surrey County Lunatic Asylum, whose inmates are derived from the whole county of Surrey. † The high rate of Battersea is due to the mortality of the workhouse. 5 in the sub district of higher death-rate: or, in other words, the higher the death-rate, the greater is the proportion of deaths from epidemic diseases in relation to the total deaths. This is worthy of notice, inasmuch as it pointedly indicates the direction which sanitary operations should assume. The death-rate for the year 1860 was 19.64 per 1000, or about the average rate; the birth rate was 31.19 per 1000; and the rate of natural increase 11.55 per 1000. The population of the district has undergone a great increase since the period of the last census. In 1851 it numbered 50,764, and according to the recent census it numbered 70,381, so that in the interval of these periods it has increased at the rate of 38.64 per 1000 annually This progress has been due, in round numbers, in the proportion of one-third to natural increase, and the remaining twothirds to immigration. The female greatly exceeds in number the male portion of the population, the males numbering 31,585, and the females 38,796. There is an excess of females, therefore, of 7211, or upwards of 10 per cent. A greater or less excess is observable in each sub-district, but particularly in Clapham and Streatham; in the former it is rather more, and in the latter somewhat less than 15 per cent. The causes of this are not very apparent. LOCAL SUMMARIES. WANDSWORTH. In accordance with the plan pursued in previous years, the following Report will be found to contain a summary of the main facts which are necessary for determining and illustrating the sanitary state of this sub district during the year 1860, and which are tabulated, as far as is practicable, for the purpose of affording facility for general reference, and for comparison with those of former years. The recently-taken census of the population at length affords the opportunity of doing justice to this town, by assigning to it its proper sanitary status, which it is my gratifying duty to show is of a high grade, in controversion of the long existing belief in its alleged unhealthiness. Since the year 1665, when the population of this town was literally decimated by the plague, there is no reason derivable from the old Bills of mortality, or from the later reports of the Registrar General, for this belief. In whatever way it may have arisen, however, it has probably of late years been sustained by the mistaken acceptance of the relation which the total registered deaths bear to the population as the index of the natural death-rate, and at the same time by overlooking those extraneous conditions by which the mortality is the the one hand reduced, and on the other so greatly and unduly augmented. Thus the Surrey County Lunatic Asylum furnishes, on an average, considerably more than one-third of the total deaths registered ; its patients are derived from without the parish, with a fractional exception, and sometimes (as during the past year) without any exception, and are subject, as in all such institutions, to a high mortality. The registered mortality is also diminished to a certain extent, by the deaths of Wandsworth parishioners which take place in the workhouse being registered in Battersea. From these circumstances it will be readily understood that the assumption of the registered mortality as a datum for the determination of the natural death-rate must bo entirely fallacious In the following deductions in this Report, the population of the Asylum, with its mortality (except such as belongs to Wandsworth), is withdrawn from, and the deaths of Wandsworth parishioners in the workhouse are added to the calculation. Death-rate. The mean annual death-rate during the past ten years, deduced from the recent census and the mortality proper to this parish, was 17.86 per 1000 living. This closely corresponds with that obtained from the 10 tions in former reports, which, in the absence of any means of accurately ascertaining the true number of inhabitants, were based upon an estimated population, and gave for the past five years a mean annual death-rate of 17.70 per 1000. The rate of mortality in the various districts of England varies from 15 to 36 per 1000. According to the scale of health based upon this fact, as determined by Dr. Farr in the Registrar General's Reports, 17 per 1000 is assumed as the number, above which all deaths are in excess of what are natural. The foregoing death-rate of this parish, therefore, is less than 1 per 1000 above the zero of the health scale. It is inclusive also of the cholera year, 1854, exclusive of that year 17.07 per 1000 would be the rate. The deaths registered during the year 1860 numbered 308 ; 180 were of males, and 128 of females. 121 of these occurred in the County Lunatic Asylum. The deaths of Wandsworth ptrishioners in the workhouse were 13. According to these data, after due correction, the death-rate of the past year was 16.10 per 1000 persons living, or 1 per 1000 (nearly) less than the zero of the Registrar-General's health scale, or about 1 per 1000 only greater than that of the healthiest districts of England. Population—Rate of Increase—By Birth—By Immigration. The population in this parish in 1831 was 6,870; in 1841, 7614; in 1851, 9611; and at the recent census it numbered 13,346—6133 males, and 7213 females. During the ten years 1831—41 it increased, therefore, at the rate of rather more than 10 per 1000 yearly ; and during the similar period, 1841—51, at the rate of 26 per 1000 yearly. During the past ten years its progress has been at the rate of upwards of 38 per 1000 yearly, two-fifths of which were due to natural increase, and the other three fifths to immigration. The great increase which has taken place in both of these ways presents a most favourable indication of the sanitary, as well as of the social and industrial developments of the town. The excess of females over males in this parish, as shewn by the census, is somewhat remarkable. The total number of births registered during the past year was 391, 195 males and 196 females. The average number during the past ten years was 336, The birth rate for the past year was 31.41 per 1000; the rate of natural increase 15.31 per 1000. The number of inhabited houses in the parish in 1851 was 1522, and the number of persons to each house averaged rather more than 6. The number of inhabited houses is uow 1891, and the average number of persons to each house rather more than 7. So that with the advantages of a greatly increasing neighbourhood we are beginning to experience one of its disadvantages—crowding—which, in a sanitary point of view, is of the greatest importance, and indicates the necessity for carrying out, to their fullest extent, the provisions of the Metropolis Local Management Act for improving the sanitary condition of houses, in 11 order to obviate, as far as possible, the evils which over-crowding unavoidably promotes. 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, shewing the sex, social position, and age at death at 8 periods, and particularising the several diseases of the Zymotic class. WANDSWORTH. Population in 1S61, 13,346 Area in Acres, 2,478. Diseases and other Causes of Death. Diseases Classified. 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 Year* of age. 80 Years and upwards. Nobility and Gentry. Professional Class, Merchants. Bankers. &c. Middle and Training Class, Shopmen, Clerks, &c. Industrial and Labouring | Classes. Classes:- 1. Zymotic Measles 3 2 5 .. 5 .. 5 .. .. .. .. .. .. 1 4 Scarlatina 2 2 4 1 3 .. 4 .. .. .. .. .. .. .. 4 Diphtheria . 1 .. 1 1 .. .. 1 .. .. .. .. .. .. .. 1 Whooping Cough. 3 1 4 1 2 .. 4 .. .. .. .. 2 .. .. 2 Diarrhœa and Dysentery . 2 2 4 1 1 .. 2 1 1 .. .. .. .. .. 4 Croup 1 2 3 .. 3 .. 3 .. .. .. .. .. .. 1 2 Fever 1 3 4 .. .. .. 2 2 .. .. .. .. 1 .. 3 Erysipelas .. 1 1 .. .. .. .. 1 .. .. .. .. .. .. 1 Total 13 13 26 4 14 .. 21 4 1 .. .. 2 1 2 21 2. Tubercular 24 33 57 2 4 5 13 23 16 5 .. 1 1 7 48 3. Of Brain, Nerves,&c. 76 27 103 15 4 .. 20 23 35 24 1 2 1 6 94 4. Of the Heart, &c. 9 4 13 .. .. .. 1 1 3 7 1 1 1 .. 11 5. Of Respiratory Organs 27 23 50 18 8 1 28 3 7 12 .. 1 1 7 41 6. Of Digestive Organs 8 4 12 2 .. .. 2 .. 7 3 .. .. .. 4 8 7. Of the Kidneys, &c. 1 3 4 .. .. .. 1 1 2 .. .. .. .. 3 1 8. Of the Uterus, &c. .. 4 4 .. .. .. .. 1 3 .. .. .. .. .. 4 9. Of Uncertain Seat 2 3 S 1 .. .. 1 .. 2 2 .. .. 2 .. 3 10. Premature Birth, Low Vitality, Mal- formation, &c. 5 5 10 10 .. .. 10 .. .. .. .. 1 .. 1 8 11. Age 8 7 15 .. .. .. .. .. .. 7 8 3 .. 3 9 12. Violence 7 2 9 1 •• 1 3 3 3 .. .. .. .. 3 6 Total 180 128 308 53 30 7 100 59 79 60 10 11 7 36 254 12 As is seen in the table, rather more than 33 per cent of all deaths arose from diseases of the brain and nervous system ; but 7 per cent only are attributable to this parish, the remainder being due to the County Lunatic Asylum. The next class of diseases i. order of fatality was the tubercular (embracing consumption, scrofula, and hydrocephalus), which caused upwards of 18 pr. cent. of all deaths. The zymotic class,which usually takes precedence of the foregoing, shews a very great diminution in fatality, forming 8.4 per cent.; and particularly if compared with that of last year, when it formed upwards of 19 per cent of all deaths. Diseases of the respiratory organs caused 16 per cent., which is nearly one-fourth above the average, and is attributable to the unusual amount of wet and cold weather which prevailed. Of individual diseases, consumption was the most fatal, causing nearly one-sixth of all deaths, which is greatly in excess of the average, and doubtless due to the foregoing causes. 9 deaths resulted from violence, 7 of which were from accidental causes, and 2 from suicide. Inquests were held in 18 instances. In 11 cases the cause of death was not certified by medical testimony. As, in any of these, death may have resulted from other than natural causes, it is seen to what extent the possibility of secret crime remaining undetected still exists. The remedy is equally obvious, and, as mentioned in my last report, consists in the employment of medical enquiry in all cases of uncertified deaths. Aye at Death. 32 per cent. of all deaths occurred under the age of 20; nearly 27 per cent. did not exceed the age of 5 years; and 17 per cent. did not attain the age of 1 year. This death-rate of children under 5 years of age, compared with that of the metropolis, is relatively very low, and it is lower than the average of former years ; it is higher, however, than the mortality from epidemic diseases, by which it is mainly influenced, and which was unusually low last year, would presuppose. Deaths in Relation to Social Position. Upwards of 82 per cent. of all deaths occurred amongst the labouring classes, and of deaths from zymotic diseases 80 per cent. Of the 83 deaths which occurred to children under 5 years of age, 70 took place amongst the children of the labouring classes. 13 Epidemic Diseases—Prevalence and Fatality of. The following table exhibits the deaths which have resulted from the principal epidemic diseases during the past and four preceding years. YEARS. Smallpox, Measles. Scarlet Fever. Diphtheria. Whooping Cough. Diarrhœa. Fever, Typhus and Typhoid. Total. 1856 9 2 4 0 12 4 12 43 1857 0 1 2 0 1 14 11 29 1858 0 0 10 0 4 1 7 22 1859 2 7 43 3 2 3 0 60 1860 0 5 4 1 4 4 4 22 The mortality from this class of diseases shows a diminution to the extent of 16 deaths below the average of the four preceding years. Small-pox, scarlet-fever, whooping-cough, and typhus prevailed to a nearly equal, though not very great extent, during the spring and summer quarters ; the firstnamed disease was unattended with fatality. Measles and scarlet-fever prevailed to a considerable extent during the autumn and winter quarters. Typhus also prevailed to a slight extent during the same period. Diarrhœa occurred throughout the year, but it cannot be said to have, at any time, prevailed epidemically. The foregoing great diminution of fatality from epidemic diseases is one of the most satisfactory features of this Report, inasmuch as it in against this class of diseases that the efforts of the sanitarian are directed with the greatest probability of success. General Sickness—Amount and Intensity of. In the absence of any means of obtaining an accurate record of the total amount of sickness which has prevailed, that portion of the sickness with its results which has taken place amongst the poor furnishes the best evidence in corroboration of the facts indicated by the death-rate. By reference to table 5 in the Appendix it is seen that the total cases of sickness which occurred among the poor were 1241. This number is 6 per cent. less than the average of the past 5 years. The deaths (which were only slightly more 14 than 2½ per cent. of all cases of sickness) were one-fifth less than the average. The total cases of epidemic disease were 213, or about two-fifths less than the average, and formed 15½ per cent. of the total sickness; and the deaths from these diseases were considerably less than half the average. By assuming the proportion of deaths to cases of sickness amongst the poor as a measure of the proportion of deaths to cases of sickness which occurred in the entire sub-district, an approximate estimate can be formed of the extent and intensity of disease which has prevailed. From such a calculation it appears that while the extent of disease was rather greater, the intensity of disease during the past year was less than the average of the past 5 years, in the ratio by figures of 25 to 30; or, in other words, fewer deaths resulted from a given number of cases of sickness in that proportion. Sanitary Operations. A summary of the sanitary operations which have been carried out under the guidance of your able Surveyor during the year, is contained in table 6 of the Appendix. They were all conducted, with but one exception, without the necessity for the intervention of a magistrate. In addition to these, all the slaughter-houses were as usual examined and specially reported on during the month of September. The great improvement which has taken place in the health of the sub-district since the commencement of the operations of the Board, as indicated by a diminished death-rate, and a diminished fatality from epidemic disease, is satisfactory evidence of the benefits derived from the sanitary works which have been carried out. But the still large mortality from preventable disease demands a continued and persevering prosecution of them ; while the disproportionate mortality of the labouring classes, and particularly of their children, indicates the direction which these sanitary operations should assume. For this end a more searching examination of the sanitary condition of the houses of the poor is desirable, and would be best attained by a periodical house to house visitation, after the manner adopted by the Board during the first year of its existence. I would again urge upon your notice the necessity for an efficient and universal water-supply to this parish. "The mortality has indeed fallen notably since the improvement of the water-supply of London," writes the Registrar-General at the beginning of the year. This great fact must, if need be, enforce the importance of the subject. Conclusion. The preceding statistical information furnishes proof of these conclusions, viz.:— 1. That this sub-district has a high sanitary status, as evidenced by the possession of a low death-rate, a low infant death-rate, and a high rate of natural increase. 15 2. That during the past year it was remarkably healthy. The mortality from epidemic disease was greatly diminished, bearing to the total deaths a ratio less by nearly half than the average of the past five years ; the intensity of disease was considerably reduced ; and the death-rate was about 1 per 1000 only greater than that of the healthiest districts of England. GEORGE EDWARD NICHOLAS, Medical Officer of Health for Wandsworth. CLAPHAM. The disproportion between the population of Clapham at the beginning of the present century, and that disclosed by the recent census, being so extraordinary, I beg to submit the following table, showing the decennial increase from 1801 to 1861. Population. 1801. 1811. 1821. 1831. 1841. 1851. 1861. Males 1,675 2,150 3,124 4,412 5,214 6,970 8,857 Females 2,189 2,933 4,027 5,546 6,892 9,320 12,033 Total 3,864 5,083 7,151 9,958 12,106 16,290 20,890 By inspection of this table it will be seen that the rate of increase per cent. has varied considerably, having been for the first ten years 31.34, advancing in the second ten years to 40.6 (which was the greatest increase of the six periods), but slightly receding during the third decennial interval (1821—31) to 39.3. The smallest increase is observable in the fourth ten years, during which the cholera made its appearance, when it was only 21.57 per cent. During the fifth and six decades, the increase was respectively 34.56, and 28.23. The average increase of these six periods having been 32.63, it does not appear that in the last ten years the population has increased with undue rapidity. Many interesting speculations might be entered into, and important calculations made, based upon this table, did space permit. But one rather curious result of the last census may here be mentioned, namely, that the number of females exceeded the males by 3,106 on the 8th of April last, in this sub-district, as indeed it appears has always been the case, though to a much less extent, at the taking of every census since 1801. 18 Mortality. Since the passing of the Metropolis Local Management Act, the registered deaths in each year have been as follows :— Years 1856 1857 1858 1859 1860. Deaths 286 321 344 328 429. The past year having been one of unusual severity, it was to be expected that the mortality would be heavy. During the year 1859 there were, as stated in my last Annual Report, some alarming outbreaks of small-pox and fever; so also in the year 1860 the sub-district was similarly, and, I regret to say, somewhat more seriously visited; but it is rather remarkable, that with the exception of very early life, that is to say, infants under one year, children should have suffered most, whilst those advanced in life died in comparatively small numbers from diseases incident to a low atmospheric temperature. The population being assumed from the recent census to have been 20,735 for the year 1860, and the deaths having amounted to 429, it follows that the rate of mortality was 20.20 per 1000, being about 2 per 1000 less than the rate for all London, as ascertained in 1859. This is certainly too high a rate for such a suburb as Clapham to stand at permanently, and although we are perhaps justified in looking at the two last years as exceptional ones in regard to the mortality from zymotic diseases, it is hoped the circumstance of these maladies having proved so fatal of late will be taken as evidence of the necessity for renewed exertions to secure to the sub-district the benefits of perfect sewerage, and the complete abolition of the cesspool system, from which so many evils are known to arise. The following table, constructed, as usual, with a view to show the causes of death, and the ages, sex, and social positions of the deceased persons, will, I trust, further prove the necessity for the speedy adoption of the remedy suggested. 19 CLAPHAM. Population in 1861, 20,890. Area in 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. Under20 Years including all under 10 Years. 1 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 Oentry. Professional Class, Merchants, Bankers, &c. Middle & Trading Class, Shopmen. Clerks, &c. Industrial ana Labouring Classes. Classes:- 1. Zymotic Small Pox 5 1 6 1 2 .. 4 2 .. .. .. .. .. 2 4 Measles 8 12 20 4 14 1 20 .. .. .. .. .. .. 3 17 Scarlatina 11 13 24 3 11 7 24 .. .. .. .. .. .. 2 22 Diphtheria .. 9 9 1 5 .. 8 1 .. .. .. .. .. 4 5 Quinsey .. 1 1 .. 1 .. 1 .. .. .. .. .. 1 .. .. Croup 4 2 6 1 4 1 6 .. .. .. .. .. .. 2 4 Whooping Cough. 7 14 21 8 11 2 21 .. .. .. .. .. .. 4 17 Typhus& Infantile Fever 4 2 6 •• 1 5 6 .. .. .. .. .. .. 3 3 Erysipelas 2 3 5 1 3 •• 4 1 .. •• .. .. 1 .. 4 Metria, (Childbirth) •• 1 1 .. .. .. .. 1 .. .. .. .. .. .. 1 Carbuncle 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. 1 Influenza 2 1 3 .. 1 .. 1 1 1 .. .. .. .. 1 2 Diarrhœa 1 4 5 2 .. 1 3 .. .. 2 .. .. 1 1 3 Total 45 63 108 21 53 17 98 7 1 2 .. .. 3 22 83 2. Tubercular 27 26 53 4 7 1 15 17 20 1 .. .. 8 12 33 3. Of Brain and Nerves 27 21 48 7 11 2 23 1 12 10 2 .. 4 16 28 4. Of Heart 9 10 19 .. .. 3 3 1 7 7 2 .. 5 8 6 5. Of Respiratory Organs 26 35 61 14 12 1 29 3 9 19 1 .. 5 14 42 6. Of Digestive Organs 9 10 19 2 2 .. 5 5 5 4 .. .. 3 7 9 7. Of Urinary Organs 2 2 4 .. .. .. .. 1 1 2 .. .. 1 1 2 8. Of Organs of Generation .. 5 5 .. .. .. 1 2 .. 2 .. .. .. 1 4 9. Of Joints, Bones, &c. .. 4 4 1 .. .. 3 .. .. 1 .. .. .. 1 3 10. Of Skin 1 .. 1 .. 1 .. 1 .. .. .. .. .. .. .. 1 11. Premature Birth, Low Vitality, Malformation, &c. 15 14 29 28 1 •• 29 .. .. .. .. .. 2 5 22 12. Of Uncertain Seat 6 3 9 3 2 1 6 2 .. 1 .. .. 2 .. 7 13. Age 8 18 26 .. .. .. .. .. .. 11 15 .. 4 12 10 14. Violence 4 3 7 1 1 .. 4 1 2 .. .. .. .. 1 6 15. Not Specified 17 19 36 8 5 3 17 3 4 10 2 .. 6 10 20 Total 196 233 429 89 95 28 234 43 61 70 21 .. 43 110 276 20 The above table exhibits the by no means agreeable fact that the deaths from the zymotic class of diseases comprise about one-fourth of the total mortality of the year. As I have before observed, the younger portion of the population suffered most from the severe winter of the past year, and hence by comparing the mortality with the previous year, it is found that 89 infants under one year died in 1860 against 75 in the preceding year, 95 from 1 to 5 years against 54, and 28 from 5 to 10 years against 12, the total mortality between the period of birth and 10 years of age exhibiting an increase of 50 per cent. over the total at the same ages for 1859. Next to the zymotic class of diseases, those affecting the respiratory organs were the most fatal, resulting in death in 61 instances, whilst the tubercular class, which includes phthisis, carried off 53 persons, the majority being of the industrial or labouring portion of the population (which is indeed the case under all the forms of mortal disease), and continues to point very decidedly to the necessity of carrying our sanitary improvements into such places as will secure to the poor the full benefits to be derived from them. Some of my colleagues will have pointed out in their Reports the more noteworthy features of the local and general mortality tables, applicable alike to all the sub-districts, and therefore there is the less need for me to enlarge upon this portion of my own report. It is as well, however, to state that the number of deaths given iu the table of mortality inserted above, and transferred to the general table in the Appendix, differs in a slight degree from the number shewn in the annual summary of the Registrar-General, particularly as to the mortality from the seven principal forms of epidemic diseases. This arises from the circumstance of one or two deaths from that class of maladies having doubtless been tabulated in the office of the Registrar-General under the primary diseases given in the medical certificates, whereas, from the knowledge I have personally had of the actual causes of death in these cases being from diseases that had, long after the primary ones had subsided, supervened upon the original symptoms, I have adopted the latter in my own tabulation ; hence the slight difference of two in the totals of the epidemic table of this Report, and the Returns of the Registrar-General; and hence also will probably arise some slight difference in the numbers iu the two returns under the separate zymotic diseases. Birth-rate. The natural increase of the population by births has been large during the past year—larger than in 1859 by 14, the number in 1860 being 608, and in the previous year 594. The deaths for the past year being 429, it follows that the excess of births over deaths is 179. Inspection of Houses and Nuisances. The improvement in this respect is of the most gratifying character (vide table 6, Appendix), for whilst the houses and premises visited have been 21 greatly less in number than in 1859, the requisite notices to remove nuisances and to adopt sanitary measures for the prevention of disease have been served in a less number of instances by one-fifth than in the previous year. During the past year the complaints numbered little more than one-half of what they did in 1859, and many of the nuisances, &c., to which these complaints referred, were either abated or removed with but slight trouble, magisterial interference having been resorted to in but one instance only. Drainage. In those parts of the Wandsworth District, where the construction of sewers has been systematically proceeded with, it has been proved (and no doubt will be fully shown in other contributions to this Report) that very manifest improvement iu the health of the inhabitants has taken place—a result which would I believe equally follow similar sanitary operations in this sub-district. The high level main sewer having been brought so near to us as the Plough Inn, High-street, gives us the means of establishing very perfect drainage for those parts of the parish lying south and west of the locality named. This comprises the most important area of the sub-district; and looking at the continued high rate of mortality, it is earnestly hoped that such a necessary work of sanitation will, with as little loss of time as possible, be carried to its utmost limits. Offensive Ponds. The cleansing of one of the principal ponds in this sub-district (the Cock Pond) has been attended with the most beneficial results. When it is stated that upwards of nine hundred cart loads of refuse, in all stages of decomposition, were removed from this pond, it will be at once acknowledged that I was fully justified in saying all I did concerning it in my former reports. I regret to say that the Harford Pond, and the pond near the Green Lane, still remain intolerable nuisances. I need not reiterate my former representations with regard to these ponds, further than to express my opinion that the necessary cleansing operations much longer delayed may be attended with very serious consequences. JOHN MAC-DONOGH, Medical Officer of Health for Clapham. BATTERSEA. In submitting this contribution to the Sanitary Report for 1860, it may be as well that I premise a brief view of the state of the population of this sub-district as forming the basis upon which any estimate of its sanitary condition will have to be made. By the census of 1841 it appeared that the inhabitants of this parish numbered only 6,617: by that of 1851 it was found the number had reached 10,560, but by the one recently taken to as many as 19,582. In the twenty years' interval, therefore, it will be seen that an increase has taken place of 12,965, and that within the last decennial period alone there has been an augmentation of no less than 9,022. This fact at once shows not only the growing importance of the parish, but the necessity which exists for persevering exertions, in order to maintain so large a population under proper and efficient sanitary regulations. I should here state that the 19,582 inhabitants are made up of 9,502 males, and 10,080 females, thus giving a preponderance to the latter of 578. Statistics of Mortality. During 1860 there were registered in this parish 399 deaths from disease and other causes, of which number 205 were of males, and 194 of females, being five only in excess of the previous year, notwithstanding the increase of the population in the interval. The rate of mortality to population in 1860, I calculate, will have been somewhat under 21 in 1,000. The subjoined table gives the number of deaths from all causes, and amongst all classes, ages, &c., that have been registered during the year in this subdistrict. 24 BATTERSEA. Population in 1861, 19,852. Area in statute acres, 2,343. 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 & Trading Class. Shopmen. Clerks, &c. Industrial and Labouring Classes. Classes:- 1. Zymotic Small Pox 5 5 10 1 5 2 8 1 1 ... ... ... ... 1 9 Measles 4 9 13 5 5 2 13 ... ... ... ... ... ... 1 12 Scarlatina. 6 3 9 2 4 3 9 ... ... ... ... ... ... 2 7 Diphtheria 4 ... 4 ... 4 ... 4 ... ... ... ... ... ... 2 2 Whooping Cough 7 5 12 6 6 ... 12 ... ... ... ... ... ... 2 10 Typhus & Infantile Fever 2 4 6 ... ... 1 4 1 1 ... ... ... ... 1 5 Erysipelas 1 2 3 2 ... ... 2 ... 1 ... ... ... ... ... 3 Diarrhœa. 7 3 10 6 1 ... 7 1 1 1 ... ... 1 1 8 Cholera 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 Total 37 31 68 22 25 8 59 3 4 2 ... ... 1 10 57 2. Tubercular 8 8 16 12 4 ... 16 ... ... ... ... ... ... 2 14 3. Of Brain, Nerves, &c. 31 23 54 16 11 1 30 1 5 17 1 ... 2 13 39 4. Of Heart 10 14 24 4 ... 2 7 3 10 3 1 ... ... 7 17 5. Of Respiratory Organs 56 65 121 30 17 ... 53 24 27 17 ... ... ... 17 104 6. Digestive Organs 7 9 16 6 ... 1 7 3 2 4 ... ... 1 6 9 7. Of Urinary Organs 4 1 5 ... ... ... ... ... 3 2 ... ... ... 2 3 8. Of Organs of Generation ... 4 4 ... ... ... ... ... 4 ... ... ... ... ... 4 9. Of Joints, Bones, &c. 2 ... 2 ... ... ... 1 ... ... 1 ... ... ... 2 ... 10. Premature Birth, Low Vitality, Maiformation, &c. 8 9 17 17 ... ... 17 ... ... ... ... ... ... 3 14 11. Age 13 15 28 ... ... ... ... ... ... 15 13 ... 1 3 24 12. Violence 14 4 18 ... 1 1 3 7 6 1 1 ... 2 2 14 13. Not Specified. 15 11 26 5 2 1 9 4 4 9 ... ... ... 8 18 Total 205 194 399 112 60 14 202 45 65 71 16 ... 6 65 260 Prevalence of, and Mortality from, Zymotic Diseases. Diseases of the zymotic class have somewhat decreased, since the six principal maladies of this class resulted in death in a less number of instances than during 1859, the numbers being respectively 68 and 83. Small pox proved fatal in ten cases, the majority of the sufferers having been unvaccinated. Scarlet fever and diphtheria have also been less fatal; they resulted in 25 1858 and 1859 respectively in 50 and 43 deaths, but in 1860 there succumbed to the same diseases 13 persons. Measles have been much more fatal, no death having occurred in 1859, but in 1860, 13 persons (with one exception, children under 10 years of age) died of this disease. Lung diseases, including phthisis, have been unusually fatal, numbering 121. Mortality in the Workhouse. Of the 399 deaths registered, 84 cases occurred in the Union Workhouse, 17 between the ages of 70 and 80, 5 between 80 and 90, and 2 between 90 and 100, the oldest being 91. Mortality of Childhood—Proportion of Births to Deaths. The mortality of Children between birth and 10 years of age, has decreased, 131 being the number registered against 166 in 1859. There have been 680 births during the year (349 males and 331 females) consequently as the deaths number 399, there is an excess of 281 births over deaths. 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 the 739 cases of sickness which came under treatment amongst this class, 37 terminated fatally, which is within a fraction of 5 per cent. Lung diseases were very prevalent among all classes of the population during the past year, to which disease 80 succumbed, but amongst the Outdoor Union Poor, of 188 cases treated, 13 only proved fatal. In this calculation I do not include phthisis, to which disease alone 41 deaths are attributed, but of these deaths 4 only occurred among the families of the Out-door Poor, and 12 in the Union Workhouse. Thirty-three cases of sudden death from natural causes and from violence were found by coroner's inquisition, of which 5 occurred in the workhouse. Preventive Measures adopted—Amount of Sanitary Work performed in the Sub-District. Considering the amount and kind of population, and the number of families of the working classes which the manufactories in the neighbourhood compel to take up their permanent abode in this parish, and considering also that the workhouse, which is situated iu Battersea, and which is in fact the hospital for the union poor of the entire district, has contributed largely to the deaths of the year, the rate of mortality for 1860 can scarcely be looked upon, in comparison with the death-rate of all London, as excessive; but it certainly 26 points to the conclusion that the sanitary works executed since the Metropolis Local Management Act came into operation have not been without their benefits wherever they have been applied and properly sustained under the regulations of the Board of Works. Table VI., Appendix, will show at a glance the character of the efforts that have been made during the past year to improve the sanitary aspects of the sub-district, and when the whole of these works are taken into consideration, it can scarcely be disputed that very many salutary influences have been brought into operation, the good results of which, especially amongst the poor, are daily becoming more and more manifest. This being my opinion, I cordially join with my colleagues in recommending a continuation of efforts to the end of bringing the working classes to a still more profitable recognition of the laws of health, and consequently to a stricter obedience of those laws, as well in the performance of their social duties as of their physical labours. WILLIAM CONNOR, Medical Officer of Health for Battersea. STREATHAM, including TOOTING AND B ALII AM. In preparing the report for the year 1860, we have the advantage of being able to avail ourselves of the census just accomplished. The population of the whole of this sub-district numbers 10,082, the increase in the last ten years being 1,059; at the same time it must be remarked that there are fewer inhabitants in Tooting Graveney by 67, than at the census of 1851. The inhabitants of Streatham, including Balham, were 6,901 in 1851; now they number 8,027,—whilst the population of Tooting Graveney was 2,840 in 1841, 2,122 in 1851, and only 2,055 for 1860. The decrease in the Tooting district may be accounted for in a measure by the removal of several large schools out of the locality. The females outnumber the males by 1,496 for the whole sub-district,—the male population being 4,293, and the females numbering 5,789. The registered mortality during the year 1860 was 152 (80 males and 72 females) being 24 in excess of the average for the four years preceding, but less than for the year 1859, by 17. The large number of deaths of persons of 60 years of age and upwards, viz., 54, strikes one as being exceptional, and especially the fact of 15 of the number having been upwards of 80 years of age. I am happy in being able to state that the mortality of infants and children has been below the average, and much lower than during the year 1859, when 70 deaths were registered, whilst only 46 were recorded in 1860. The accompanying table will show the number of deaths from all causes, and amongst all classes and ages. It will be seen that only three deaths are placed against scarlatina and diphtheria—whilst 25 was the total for 1859. The deaths from diseases of the zymotic class in the seven principal forms, were 12 in number, two of the sufferers dying from small pox, two from measles, two from whooping cough, and three from diarrhoea. Phthisis carried off one less than last year, viz., 20 against 21, whilst in 1857 and 1858, 8 and 11 were the deaths registered under this head. 28 STREATHAM, Including TOOTING AND BALHAM. Population in 1861. 10,082. Area in statute acres. 3,465. 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 10, and under 60 years of aee. At 60, and under 80 year's of a ere. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen. Clerks. &c. Industrial and Labouring Classes. Classes:— Small Pox. 2 2 1 1 1 11 Measles 2 21 1 2 2 Scarlatina l 1 1 11 Diphtheria 1 l 2 1 211 Croup 2 2 2 2 2 Whooping .. 1 1 .. 1.. 1 .. .. .. .. .. .. .. 1 1.Zymotic Cough Typhus& Infantile 1 1 21 2 1 1 Fever Erysipelas. 1 .. 1 1 1.. Carbuncle .. 1 1.. .. .. .. .. 1 .. Diarrhaœ. 2 2 2.. .. 1.. 1 Total 9 7 16 5 4 11 2 1 2 1 5 10 2. Tubercular 12 8 20 .. .. 3 10 7 3 5 12 3. Brains and Nerves 15 11 26 7 5 1 14 1 4 6 1 5 9 12 4. Of Heart 7 7 14 6 8 2 7 5 5. Of Respiratory Organs 14 17 315 8 1 14 3 1 9 3 1 4 917 6. Of Digestive Organs. 3 1 7 2 1 1 3.. .. 1 3 3 7. Of Urinary Organs 2 1 3 1 1 1.. . .. 1 2.. 8. Of Organs of ration 9. Premature Birth, Low Vitality,Mai3 1 4 4 .. .. 4 4 formation, &e. .. 10. Of Uncertain Scat .. 3 7 10 .... 1 1 .. 0 3 1 .. 2 5 .3 11. Age 10 4 14 .. .. 6 8 4 3 4 3 12. Violence 1 2 3.. 1.. 1 .. .. 1 1.... 2 1 13. Not Specified 1 2 3 2 1.. 3.. 1 2 TOTAL 80 72 152 19 20 7 54 18 26 39 15 5 22 53 72 The births in the year, as stated in Table II., Appendix, numbered exactly the same as in 1859, viz., 238. The deaths as I before stated were 152 ; the excess of births over deaths in the year 1860, is accordingly 86. Table V., 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 as showing the rate of mortality (20) in the number of cases of sickness, &c., (247) that came under treatment. 29 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 to the very great benefit and comfort of the inhabitants, and to the vast improvement of the several parishes concerned. In taking leave of the subject, I earnestly hope, as I expressed in former reports, that a continuation of efforts in the same direction may confer still further sanitary benefits upon this increasingly important sub-district. D. C. NOEL, Mcdical Officer of Health for Slrealham, Tooting, and Balham. PUTNEY AND ROEHAMPTON. Until the Registrar General shall have had sufficient time to collate and arrange the vast amount of statistical information furnished by the recent census, and shall have published his usual summary of results, the bases upon which reliable calculations can be made, having reference to the sanitary condition of particular districts, must necessarily be somewhat limited. With, however, the aggregate amount of the population alone determined (and very little beyond this information has yet been given, even to the Medical Officers of Health), it is hoped the report which I have now the honour of submitting will not be without interest to both the authorities and ratepayers ; and further, that both will recognise some good grounds for the assertion I here most confidently make, that the condition of this parish, in a sanitary point of view, is steadily but surely advancing. Progress of Improvement—Sanitary Operations during the Year. Table VI., in the Appendix, well exhibits the amount and kind of sanitary seed sown during the year, from which it is confidently anticipated a still more satisfactory harvest of results than has already been gathered, will be reaped before the season again arrives to report progress. The extension of the main and branch sewerage, 3,980 feet in length,* to the Charlwood and Upper Richmond Roads, is the great sanitary event of the period, and I briefly allude to it in this place in order to reiterate my conviction, that with the view to secure to the sub-district the full benefits of the sanitary provisions of the Metropolis Local Management Act, no more desirable measure of improvement could have been determined upon. The same table shows that a somewhat large amount of other sanitary work has been carried out during the past year, and that many permanent improvements have been accomplished, which cannot fail, if properly sustained, to render the sub-district not only much less open than formerly to the invasion of disease, but a much more desirable and healthy suburb in every respect. In addition to the inspections, &c., indicated in the table referred to, it should be stated that all the slaughter houses in the sub-district were frequently visited by the Surveyor and myself, and having been found in the best possible condition to ensure to their proprietors a renewal of their licenses, at the usual period for granting the same, were so reported to the Board of Works. * The length of brick sewer recently constructed is 2,228 feet; that of pipe sewer, 1,752 feet. 32 There were during the year about the average number of complaints of nuisances, &c., made to the Inspector and myself, but many of these were removed without the interference of the Board or Local Committee, by friendly representations to the parties on whose premises they were known to exist. Magisterial interference was found necessary in three instances only ; I attended and gave evidence in two of these cases, when compulsory orders were obtained. Whether the sanitation carried out in this parish since 185G, has really had the good effects I am disposed to attribute to it, will perhaps be better judged of after a perusal of the statistical facts I shall now have the satisfaction of offering. Rale of Mortality—Causes of Death—Amount and Intensity of Disease— Increase of Population. Amongst the most reliable statistics, of which the Medical Officer of Health can avail himself, are those furnished by the weekly local, returns of the causes of death, from which the following table has been compiled :— PUTNEY AND ROEHAHPTON. Population in 1861, 6,481. Area in statute acres, 2,176. 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 year*, including all under 10 yeaTS. At 2o, anu under 40 yeais of ape. At 40. ana under 60 years of age. At 60. anu under 80 years of age. J 80 years and upwards. Nobility and Gentry. professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. Classes : — Croup .. 1 1 1 .. .. 1 .. .. .. .. .. 1 .. .. 1.Zymotic Diphtheria 1 .. 1 .. .. 1 1 .. .. 1 Typhus 1 .. 1 .. .. 1 1 .. .. .. .. .. .. .. 1 Total 1 1 3 1 .. 2 3 .. .. .. .. .. 2 .. 1 2.Tnbercular 5 10 15 1 1 .. 3 6 5 1 .. 2 2 4 7 3. Of Brain, Nerves, &c 9 6 15 1 1 1 3 1 2 8 1 .. 2 2 11 4. Of Heart 3 4 7 .. .. .. .. 2 5 .. .. 1 .. 1 5 5. Of Respiratory Organs 8 13 21 5 4 .. 10 4 .. 6 1 1 1 10 9 6. Of Digestive Organs .. 2 2 .. .. .. .. 1 1 .. .. .. .. .. 2 7. Of Kidneys, & c> 1 1 2 .. .. .. .. .. 1 1 .. 2 .. .. .. 8. Of Organs of Generation .. 2 2 .. .. .. .. .. 2 .. .. .. .. 2 .. 9. Of Uncertain Seat 2 5 7 1 1 .. 2 .. 2 2 1 .. 1 4 .. 10. Premature Birth, Low Vitality,Malformation, &c. 5 2 7 6 1 • • 7 .. .. .. .. .. 1 1 5 11. Age 1 .. 1 .. .. .. .. .. .. .. 1 .. .. .. 1 12. Violence 1 1 2 .. 1 .. 1 1 .. .. .. .. .. .. 2 13. Not Specified •• 2 2 .. .. .. .. 1 .. 1 •• .. 1 1 .. Total 37 49 86 15 9 3 29 16 18 19 4 6 10 25 45 33 In the absence of any complete and universal record of sickness, privately as well as publicly attended, but which it is impossible to obtain, it is hoped that this table, viewed in connexion with the one in the Appendix relating to pauper sickness and its results, will not be without its value as a measure of the progress we are making in sanitation. The total number of deaths registered in this parish during the year 1860, appears by this table to have been 86 only (37 males and 49 females), which is 33 less than the mortality from all causes in 1859. This fact to begin with is most satisfactory; supported as it will be by others equally reliable and equally indicative of sanitary progress, I may safely state I have not yet issued a report calculated to inspire more gratification for the present, or more hope for the future than the one I have now the pleasure of submitting. Calculating the ratio of deaths to population, even upon the census of 1851, it was found that the death-rate of the past year was but 1.7 per cent, or a fraction over 17 in 1000. The zero of the death-rate of that able statist, Dr. Farr, is just 17 in 1000 ; so that this enviable position may be said to have been nearly reached by this sub district in a population calculated at 1200 less than the ascertained number on the 8th April, 1861. The population according to the census just taken being 6,481, it is estimated that for the year 1860 it was 6,361, consequently, the deaths being 86, it gives 13.51 in 1000 only, which is nearly 4 in a 1000 less than the zero of Dr. Farr, and 5 and a fraction less in 1000 than the estimate made of a ten years' average mortality previous to the Metropolis Local Management Act coming into operation. So far it must be admitted that an advance, and by no means an inconsiderable one, has been made in the march of sanitation in this parish to have produced results such as I have here the gratification of recording. The last census also affords another interesting piece of information. The population of 1841 was 4,684 ; in 1851 it was 5,280. There was therefore an increase of 1.122 per cent, yearly, between the two periods. But the population in 1861 being 6,481, the increase in the last decennial interval is shown to have been rather over 2 per cent, yearly. The actual ten years' increase is 1,201. With the increase of population there has been a corresponding increase of houses. In 1851 the number of dwellings was estimated at 918. By the last census the number was ascertained to have reached 1,211, viz., 1,133 inhabited, 68 uninhabited, and 10 in progress of building. With the present population this gives, within a small fraction, 5f persons to each inhabited house, or something less than 5½ to the total number ; so that it finds the parish in a somewhat improved position in this respect to what it was in the first year of the operation of the Metropolis Local Management Act, when the ratio of population to houses was 5.75, or 5¾ to each available dwelling. The average annual value of houses in this sub-district continues high, being estimated at about £36. This last fact points to one rather important question,—Has the number of houses fitted to become the dwelling places of the poor, kept pace with the yearly increase of that class of tho population since the census of 1851? Until the Registrar General publishes his abstract of tho last census, it would 34 be difficult to determine with exactness the overcrowding or otherwise of the poorer localities generally. In one row of houses, however, 12 in number, in a part of the town where the poor most congregate, I have found, from personal observation, 8 1/3 to be the average proportion of inhabitants to each house—a proportion much too large, seeing that but two of the four small rooms in these houses are calculated to be used as sleeping apartments. The yearly increase of births amongst the labouring poor, apart from the increase by immigration, more than ever demands a remedy for the growing evils of overcrowding. One rather curious feature of the recent census was that the females in this sub-district were found to outnumber the males by as many as 881,—the former amounting to 3,681, and the latter to only 2,800. Births during 1860—Excess of Births over Deaths. The births during the year numbered 163—85 males and 75 females— which, singular to say, is less than in any year since 1856, when a calculation was first made for the purposes of a report, and less by 20 than in 1859. The excess of births over deaths in the past year is 77, which is less by 3 than the excess of the preceding year. Ages at Death—Social Position of the Deceased. In the mortality table inserted above it is shown that there died during the year 1860, 15 under 1 year of age, 9 from 1 to 5, and 3 from 5 to 10, which exhibits a decrease at these three periods of 18, 14, and 6 respectively, when compared with the death-rates at the same ages in 1859. The total deaths under 20, which includes all under 10, amounted in 1859 to as many as 71, but in the past year 29 only at the same ages were registered. From 20 to 40 and from 40 to 60 the deaths in 1860 were respectively 16 and 18, which gives an increase over 1859 of 7 and 9 at those two periods. From 60 to 80 and from 80 and upwards there was again a decrease upon the rates of the year preceding of 5 and 3, the deaths in the past year at the former ages being 19, and at the latter 4.* At all ages, therefore, with the exception of those from 20 to 40 and from 40 to 60, does the present table exhibit a considerable decrease in the number that died in 1860, compared with the number in 1859, and the total decrease being 33, it cannot be otherwise inferred but that some good influences have been in operation to produce so satisfactory a result, † • Of the 4 persons who died at 80 and upwards, the greatest age reached was 91, the deceased having been formerly a labourer in the market gardens. The other three were respectively 81, 82, and 83, at the time of death. † The deaths that have taken place (8 in number) in the Royal Hospital for Incurables, during the year, have to be duly considered in any estimate formed of the advance 35 Nor are the above statistical facts the only proofs to be adduced of the advance which this sub-district is making in the march of sanitary improvement. The following table will exhibit the yearly relative proportions of deaths amongst the labouring class to the deaths amongst all classes, during the past five years, and compared with what they were in the year 1844* :— Deaths in the Five Years, 1856 to 1860, compared with the number in 1814. 1856 1857 1858 1859 1860 1844, 16 years prior to the year under review. Amongst all Classes 92 88 118 119 86 89 Amongst the Labouring Classes exclusively - 56 55 69 70 45 66 It will be perceived that in this table a comparison in respect to the number of deaths is intended to be shown not only one year with an other during the five years in which the new act has been in operation, but with 1844, a period 16 years removed from the year I am now reviewing, when the population of the parish was estimated at nearly 2000 less than at present. By comparing the numbers under the two years, 1859-60, it will be seen that no less than 33 lives were saved in favour of the latter period, and what is equally satisfactory a less number of the labouring class died in 1860 than in the preceding year by 25. Further, it must not only be admitted that a total mortality of 89 in 1844 was a large one, relatively to the then population, but that the labouring class contributed in undue proportion to the register of that year, seeing that 21 more of that class are to be found upon such register than at a period 16 years later, -†- which the authorities are making in the removal of unhealthy influences. If we possessed no such hospital, it is clear, that although in the year under review there would have been a leas number of inhabitants upon which to have calculated the death-rate, on the other hand there would have been less deaths by 8—or 78 instead of 86—to record in this report. Four deaths which may be fairly attributed to old age, and two to violence, being withdrawn from the total, would still further reduce the rate of mortality from disease alone. * The year 1844 was chosen for this comparison for two reasons—that it was not only one in which the sub-district appeared to be comparatively free from those influences known to propagate diseases, particularly epidemics, but that it was a year the calculations in respect to whieh 1 had already at hand, having procured them for the purposes of a lecture on sanitary matters, delivered in Putney in 1848, the year previous to the first outbreak of cholera. † The increase observable in the number of deaths amongst the labouring population in the two years 1858 and 1859, is very satisfactorily accounted for by those years having been characterized by a most unusual prevalence of virulent diseases of the zymotic 36 This fact speaks very suggestively of the great and lasting benefits to be derived from increased exertions to carry sanitary improvements into and about the dwelling-places of the poor. Zymotic or Epidemic Diseases. Table IV., in the Appendix, relating to the mortality from seven principal forms of zymotic disease, furnishes the very gratifying fact that but two persons succumbed during the past year to these maladies. The reduction of the rate of mortality from zymotic diseases from 13 and 7 respectively in the two years 1856 and 1857, down to the minimum of 2 in 1860 (excluding the years 1858 and '59, for the reasons above stated), gives very fair evidence of progress, and affords, as well, no bad augury for the future sanitary prospects of this increasing sub-district. In the Registrar General's annual table of " Deaths from Seven Zymotic Diseases," the resulting mortality is recorded from returns received from 135 parishes, or sub-districts, within the bills of mortality, and yet, with tho exception of Dulwich, which parish does not appear to have had any deaths from epidemics in 1860, there is not one locality exhibiting so few deaths, viz., 2, from the seven diseases referred to, as that of Putney. The next lowest on the list is Eltham, in which parish with a population, in 1851, less by upwards of 5000 than Putney, there were registered in 1860 five deaths from these same diseases. This fact speaks well for the salubrity of this parish, and its comparative freedom from epidemic influences. Although several cases of small pox have occurred in the parish during the past year, not one death, I am happy to state, resulted. I continue to use my best exertions to bring as many as possible of the children of all clases under vaccination. During the past year, although the births in the sub-district numbered but 163, I successfully vaccinated 156 infants, and a small number of more advanced life. I regret to say that all my persuasions, added to the efforts of the clergy and district visitors, have been in vain with some few obstinate parents amongst the poor, whom no amount of reasoning could induce to submit their children to the protective power of this safe and simple process. In the absence of any provision in the Vaccination Act, securing to the public the advantages of a prosecutor of its penal clause, it is most important that every public school, at least, should insist upou properly certified vaccination before admitting a child upon its establishment. I most cordially join with my colleague, Mr. Nicholas, in the recommendation he so urgently made in respect to this important matter in his last annual contribution to the sanitary report.* class throughout the kingdom—indeed, throughout Europe ; but excluding these years that which renders the result of the comparison of the remaining three years with 184t most satisfactory, is the fact of the labouring class having gradually lessened the distance which fornjerly existed in the death scale between themselves and the classes above them. • It would be by no means an unreasonable provision to deprive all objecting public educational institutions of the benefits of any grant of money by Government, and in addition to insist upon the payment of all pool and other rates, from which they are now exempt. 37 Sickness and Mortality amongst the Out-door Union Poor—Infant Mortality. A most favourable rate of mortality amongst the pauper population of this parish is exhibited in Table V., Appendix. Not only was there a less amount of sickness in 1860 amongst this class than in any year since 1856, but an unusually small percentage of deaths in the number of cases treated. In comparison with the previous year the amount of pauper sickness was small, viz., 431 cases against 675. Of the 431 cases in the past year, 14 only resulted in death, or rather over 3.7 per cent. ; and what is a still more gratifying fact, but one death from zymotic disease was registered as having occurred amongst the union poor of this subdistrict, during the entire year ! This one death, the result of typhoid fever in a child, occurred in a vety confined and ill ventilated court (Pepper Alley) where with the utmost care it was found impossible to secure to the patient the needed amount of pure air. The diseases which have hitherto proved most fatal to the children of the poor (Croup No. 12, Table V., Appendix), ended fatally in but 4 instances in 1860 against 8 in 1859. The destruction of frail infant life amongst the poor is well known to be large in most localities where manufacturing or field labour is in much demand, and this arises from causes that are obvious enough when it is considered how many mothers are employed in such labour. In 1856, the first year in which a sanitary report was rendered, there died in this sub district 25 infants under 1 year, against 15 at the same age, recorded in the present table. The ratio of deaths of all classes under 10 years of age to the mortality at all ages, is in the present l-eturn, 27 in a total of 86 ; in that of 1856 (five years since) it was 45 in 92. This large difference—a difference very gradually arrived at—greatly favours the conclusion that the sanitary works executed in this parish since the Metropolis Local Management Act came into operation, especially those carried out in the poorer neighbourhoods, have tended, in no small degree, to the saving of life, as well as depriving disease of much of its former virulence. My daily experiences, in common with those of my colleagues, have long produced the conviction that to obtain the full benefits to be derived from sanitary legislation, " Pauperism," (to use the words of a & much admired living writer), " is the corner where we must begin—the levels all pointing thitherwards—the probabilities all clearly lying there." And the fact, that 72 per cent. 0] all paupers become such through 38 sickness, plainly shows the way in which our efforts should be directed, in order to work out that most important of social problems—how best to secure the successful intervention of the science of preventive medicine. R. HARLAND WHITEMAN, Medical Officer of Health for Putney, and Chairman of the Associated Health Officers of the Wandsworth District. APPENDIX OF STATISTICAL TABLES. APPENDIX OF STATISTICAL TABLES. TABLE I. Summary of Deaths and their Causes, registered in the Entire District during 1860, Classified according to Sex, Age, and Social Position, and showing also the relative Numbers in each Sub-District. POPULATION of ENTIRE DISTRICT, In 1861, 70,381. Area in Statute Acres, 11,695. DISEASES, And other Causes of Death. Total Deaths from each Class of Disease, 8cc. in the Entire District. Sub-Districts. Sex. • Age. Social Position. Clapham—Population in 1861, 20,890, | area in acres, 1,233. Wands worm—Population in 1861, 13,346, area in acres. 2.478. battersea— Population in 1861, 19,582, area in acres. 2 34.3. | Putney—Population in 1861, 6,481. area in acres. 2.176. Streatham, l ooting, & baiham—Population 1861. 10.082. area acre*. 3 465. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. Under 20 years, including an 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,  Classes Small Pox. 18 6 ... 10 ... 2 12 6 2 7 6 13 4 11 ... •• ... 4 14 Measles 40 20 5 13 ... 2 17 23 9 25 4 40 ... ... ... ... ... ... 5 35 Scarlatina 38 24 4 9 ... 1 19 19 6 19 10 38 ... ... ... ... ... ... 4 34 Diphtheria. 17 9 1 4 1 2 7 10 2 9 2 16 1 ... ... ... ... 1 7 9 Quinsy . 1 1 ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... 1 ... ... Croup . 12 6 3 ... 1 2 7 5 2 9 1 12 ... ... ... ... ... 1 3 8 Whooping 38 21 4 12 ... 1 17 21 15 20 2 38 ... ... ... ... 2 ... 6 30 Cough Typhus Infantile 19 6 4 6 1 2 9 10 •• 1 8 15 3 I ... ... ... 1 5 13 I. Zvmotic Fever Erysipelas . 10 5 1 3 ... 1 4 6 3 3 ... 6 3 1 ... ... ... 1 1 8 Metria, Child- birth 1 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 Carbuncle . 2 1 ... ... ... 1 1 1 ... ... ... ... 1 1 ... ... ... ... 1 1 o Influenza.. 3 3 ... ... ... ... 2 1 ... 1 ... 1 1 1 ... ... ... ... 1 2 Diarrhoea. and Dy- 21 5 4 10 ... 2 10 11 9 2 1 12 2 2 5 ... ... 3 2 16 sentery. * 1 Cholera 1 ... ... 1 ... • • ... 1 ... ... ... ... ... ... 1 _... ... ... ... 1 Totals of Zymotic Class 221 108 26 68 3 16 105 116 38 97 31 192 16 7 6 ... 2 8 39 172 2. Tubercular 161 53 57 16 15 20 76 85 20 15 8 50 56 48 7 ... 3 14 13 114 3. Of Brain and Nerves . 246 48 103 54 15 26 158 88 46 32 5 90 27 58 65 6 2 14 46 184 4.Of Heart 77 19 13 24 7 14 38 39 4 ... 5 11 7 31 25 3 2 8 23 44, 5. Of Respiratory Organs 284 61 50 121 21 31 131 153 72 49 3 134 37 44 63 6 3 11 57 213 6. Of Digestive Organs . 56 19 12 16 2 7 27 29 10 2 1 16 10 16 4 ... ... 5 20 31 7. Of Urinary Organs .. 18 4 4 5 2 3 10 8 ... ... ... 2 2 8 5 ... 2 2 8 6 8. Of Organs of Generation 16 5 4 4 2 1 ... 16 ... ... ... 1 3 9 3 ... •• •• 4 12 9, Of .Joints, Bones, &c. 6 4 ... 2 ... ... 2 4 1 ... ... 4 ... ... 2 ... ... ... 3 3 10. Of Skin 1 1 ... ... ... ... 1 ... ... 1 ... 1 ... ... ... ... ... ... ... 1 11.Premature Birth, . Low Vitality, Malformation, Sic. .. * 67 29 10 17 7 4 49 18 65 2 ... 67 ... ... ... ... 1 3 10 53 Of Uncertain Seat .. 31 9 5 ... 7 10 13 18 5 3 1 10 2 9 8 2 ... 7 9 15 3. Age 84 26 15 28 1 14 39 44 ... ... ... ... ... ... 39 45 7 3 22 47 14. Violence 39 7 9 18 2 3 27 12 2 4 2 12 12 11 2 2 ... 2 8 29 15. Not Specified 67 36 ... 26 2 3 33 34 15 7 4 29 8 8 19 3 ... 7 20 40 Totals 1374 129 308 399 86 152 709 G64 278 212 60 619 181 249 258 67 22 89 299 961 42 TABLE II. Births during the year ending 31st December, 1860. SUB-DISTRICTS. Males. Females. Total. Clapham 311 297 608 Wandsworth 195 196 391 Battersea 349 331 680 Putney and Roehampton 85 78 163 Streatham, including Tooting and Balham 126 112 238 Total 1066 1014 2080 • The excess of Births over Deaths in the entire district is 706. TABLE III Meteorological Means for 1860, from Observations taken at Greenwich. Jan., Feb., and March. April, May, and June. July, Aug., and September. Oct., Nov., and December. The Year. Temperature of the Air 38°8 50°5 56°0 42°6 47°0 Evaporation 36°7 47°4 53°9 41°4 44°9 Dew Point 33°9 44°2 51°7 40°0 42 °4 Weight of Vapour in a cubic foot of Air 2.3 grs. 3.3 grs. 4.3 grs. 2.9 grs. 3.2 grs Degree of Humidity (Satn 100) 82°0 79°0 85°0 91°0 84°0 Reading of Barometer 29.675 in. 29.718 in 22.721 in. 29.681 in 29.699 in. Weight of a cubic foot of Air 552 grs. 539 grs. 533 grs. 447 grs. 552 grs. Rain (amount of) 4.8 in. 10.7 in. 9.6 in. 6.9 in. 32.0 in. 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 1855-60. Years. Deaths from Epidemics in each Sub-District. Entire District. Clapham. Battersea. Wandsworth. Putney. Streatham. Total Deaths from Epidemics. Total Deaths Registed. 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 1860 90 62 22 2 11 187 1374 13.6 *•* The Diseases included in the above Table are seven in number, and constitute, as in the Registrar General's Returns, the principal maladies of the Zymotic class, viz., Small-pox, Measles, Scarlatina, Diphtheria, Hooping Cough, Diarrhcea, and Fever. 44 45 TABLE 7 Cases of Sickness, &c., with the Number of Deaths therefore amongst the Out door Poor Under Treatment of the Union Medical Officers, during the year that ended the 31st of December, 1860, compiled from District Medical Relief Books. SUB-DISTRICTS. Total Cases of Sickness treated in each Sub-District. 1—Small Pox. 2—Measles. 3—Scarlatina and Malignant Sore Throat. 4—"Whooping Cough. 5—Diarrhoea and Dysentery. 6—Cholera. 8. 7—Fever. 8—Erysipelas. 9—Puerperal Fever. 10—Lung Diseases, except Phthisis. 11—Phthisis. 12—Hydrocephalus, Atrophy, Scrofula and Convulsions ol Children. 13—Other Diseases, &c. 14—Violence, Privation and Premature Birth. Total Deaths in each Sub-District Cases. Deaths, Cases. Deaths Cases. Death? Cases. Death Cases. deaths. Cases. Death Oases, Deaths. Cases. Deaths. Cases. Deaths Cases. Deaths. Cases. Deaths Cases. Deaths Cases. Deaths. Cases. Deaths Ciapham 1301 72 5 113 4 45 6 28 ... 37 l ... ... 156 4 8 1 7 ... 202 10 13 7 21 4 535 15 64 2 59 Wandsworth 1241 26 ... 13 ... 32 2 4 ... 105 1 ... ... 13 1 20 ... ... ... 245 7 14 7 14 8 758 6 ... ... 32 Battersea 739 47 5 47 1 10 ... 19 3 28 2 ... ... 1 ... 5 ... ... ... 188 13 15 4 6 1 341 7 32 1 37 Putney and Roehampton 431 4 •• 8 ... 1 ... 2 ... 21 ... ... ... 12 1 3 ... 2 ... 19 3 5 1 11 4 311 5 32 ... 14 Streatham, including Toot-" ir.g and Balham 247 5 •• 2 ... 2 •• 13 •• 10 ... ... ... 7 ... 1 ... ... ... 48 5 4 5 1 ... 135 10 19 ... 20 Totals 3959 144 10 183 5 90 j 8 66 3 101 4 •• ... 189 6 37 1 9 ... 702 38 51 24 53 17 2080 43 147 3 162 TABLE VI. Summary of the Sanitary Operations in the entire District during the year 1860. - Clapham. Battersea. Wandsworth. Putney and Roehampton. Streatham, including Tooting& Balham Totals. Number of Houses and Premises inspected 870 500 283 176 150 1779 1st Notices served 23 27 40 13 20 137 2nd Notices served 8 2 3 1 ... Cesspools emptied and cleansed 9 32 54 10 123 208 Cesspools abolished ... 1 14 83 6 104 Water-closets constructed . 46 131 13 22 24 236 Houses supplied with Water 41 130 30 22 24 247 Drains constructed or connected with Sewer 12 26 13 54 36 141 No. of Feet of New Sewers, &c 288 ft. ... ... 3980 ft ... ... Drains repaired or trapped, or obstructions removed 32 33 32 16 95 208 Open Ditches, Ponds, &c. cleansed 2580 ft. 6 7 11 22 ... Dust bins provided 18 140 15 ... 25 198 Pig Nuisances removed 6 5 ... 1 3 15 Accumulation of Offal, Manure, &c., removed 17 4 22 8 13 64 Unwholesome and dilapidated Houses cleansed or repaired 2 ... 18 4 5 29 Cases investigated by Magistrates 1 ... 1 3 ... 5 Compulsory Orders obtained 1 • •• 1 2 ... 4 Compulsory Works exe-" cuted ... ... ... 1 ... 1 Works remaining in abey- " ance from various causes ... 1 ... 1 ... 2 46