WAN 13 SANITARY DEPARTMENT. REPORT on the SANITARY CONDITION of the several parishes comprised in the WANDSWORTH DISTRICT, For 1861. By the Medical Officers of Health. LONDON: Printed by C. and F. Bell, 133, King's Road, Chelsea. 1862. REPORT. To the Board of Works for the Wandsworth District. Gentlemen, THE Report now submitted for the year 1861, has been arranged in accordance with your instructions, on precisely the same plan as heretofore. It is hoped, therefore, that little or no difficulty will be experienced in comparing the statistics of the present with those of former reports, either as relating to the entire district or to the respective sub-districts. We refer with no less confidence than we did last year to the summary of the health of the entire district, and to the Tables in the Appendix, for evidence of the success that has attended the numerous works carried out under the control of your Board during 1861, which year, it may be observed, completed the sixth of our exertions in furtherance of sanitary measures under the Metropolis Local Management Act. Looking forward to such a continuation of efforts as shall still further demonstrate the utility of sanitary regulations, and their effective bearing on social advancement, We have the honor to be, Gentlemen, Your very obedient Servants, THE MEDICAL OFFICERS OF HEALTH for the wandsworth district. 4 HEALTH OF THE ENTIRE DISTRICT. ADOPTING the method employed by the Registrar-General in calculating the annual death-rate of the whole of London, it is found that the population of the entire Wandsworth District was 70,871 in the middle of the year 1861, or 490 more than at the taking of the last census. Upon this basis it is calculated that the death-rate of this district for the past year was 19.65 per 1,000; the birth-rate, 31.24 per 1,000; and the rate of natural increase, 11.59 per 1,000. Although there were 19 deaths registered in the entire district in 1861 in excess of the number recorded in 1860, the usual comparison of the year's mortality with that of the average of the previous ten years, is but very slightly affected by such excess. Taking, then, the population as 70,871, the excess referred to will not be found to amount to more than one death in 10,000, or, in fractional figures, not to exceed 0.16 in every 1,000, the average rate of the 10 previous years being 19.49, and the actual death-rate of the year under review, as above stated, 19.65 in every 1,000 living. The slight excess here noted was undoubtedly due to the unusual prevalence and fatality of zymotic diseases, since it is found (vide Table I., Appendix) that 56 more deaths were registered as the result of maladies of this class in the past year than in the one immediately preceding, the numbers being respectively 287 and 221. In the same table it will be seen that scarlet fever and diphtheria alone resulted in death in 107 cases, whilst in 1860 the same diseases contributed to the register 55 deaths only, or less by nearly onehalf. The fatality of these two closely allied diseases was, however, by no means confined to this district, but was common to the entire metropolis, so that the 19 deaths in excess of the previous year in 5 the Wandsworth District, which embraces, with one exception, (Lewisham) a much larger area than any other district under the Metropolis Local Management Act, cannot be considered as any indication of an actual or persistent decline of the favourable condition of the public health noted in former reports. A reference to Table IV. in the Appendix will shew that the per centage of deaths in 1861 from the seven principal forms of zymotic disease to the total deaths was 18.4, whilst the average of the six preceding years was 15.7, thus giving an excess to the past year of 2.7 only, notwithstanding the unusual prevalence and fatality of this class of maladies in almost every one of the sub-districts. It was remarked in the last year's summary of the health of the entire district that " the higher the death-rate in a sub-district, the greater was the proportion of deaths from epidemic diseases in relation to the total deaths." This fact cannot, it is considered, be put too frequently or too prominently forward, since it indicates, in the clearest manner possible, the necessity for persevering exertions in order to place all the sub-districts in an equally good sanitary condition, so that no one locality may be suffered to lose caste by comparison with others in which more attention may have been paid to sanitation, and to the carrying out of such improvements as are calculated to restrain the upward tendency of the death-scale. The same melancholy feature which attaches to almost all tables of mortality, from whatever large community they may emanate, is, unfortunately, not absent from the one appended to this report (Table I.), viz., the great proportion of deaths of infants and young children between birth and ten years of age to the total number at all ages. Of the 1,393 deaths which occurred in the district during the past year, as many as 666 infants and children were registered before reaching the age of ten years, viz.:—375 under one year, 214 between one and five years, and 77 between five and ten years. As by far the greater number of these deaths occurred in the families of the labouring poor, it still further indicates the direction 6 which sanitation should take to henceforth ensure the most satisfactory results. As some set-off to this by no means encouraging circumstance, it may be mentioned that, of 4,471 cases of sickness, accident, &c., treated by the District Medical Officers of the Union (vide Table V., Appendix) only 159 deaths, or 3.55 per cent. of the number attended, were registered during the past year, which is saying much for the good results of the sanitation already carried out in some of the poorest localities. LOCAL SUMMARIES. WANDSWORTH. THE following Report will be found to contain, with the usual statistics of mortality and sickness, a brief summary of the principal things which have to be considered in reviewing the sanitary condition of this sub-district during the past year. death-rate. The total deaths registered in this parish during the year 1861 numbered 246—125 males and 121 females—the lowest number recorded for the last 13 years. The average number during the past 10 years, corrected for increase of population, was, exclusive of the cholera year, 319; inclusive of that year, 328. From the unusual lowness of the number of births registered a corresponding lowness of the death-rate might at first sight be inferred; hut the latter, although, as will be subsequently seen, remarkably low, is not so low as these figures appear to indicate. It has been 8 already explained in previous reports that the registered mortality cannot be accepted as a trustworthy datum for the determination of the death-rate proper to this parish, in consequence of the disturbing influences of the Surrey County Lunatic Asylum and the Union Workhouse.* The inmates in the former institution are derived (with a fractional exception) from without the parish, undergo no natural increase, are subject, as in all such institutions, to a high mortality, and furnish on an average upwards of one-third of all deaths registered; while the deaths of Wandsworth parishioners which take place in the workhouse unduly diminish, to a certain extent, the mortuary register. To estimate the death-rate justly, therefore, it has been necessary to exclude the population of the Asylum with its mortality from the calculation, and to add to it the deaths of the Wandsworth parishioners occurring in the workhouse. The deaths occurring in the Asylum, which have averaged annually 107, or, as has been stated, upwards of one-third of all deaths registered, numbered last year, in consequence of correspondingly fewer admissions, 57 only. It is this circumstance which accounts for the unusual lowness of the mortality registered, and furnishes another very cogent reason for excluding the mortuary statistics of that institution from the means used in determining the natural death-rate of this parish. The deaths of Wandsworth parishioners which took place during the year in the workhouse numbered 20. The death-rate of this parish during the past year, deduced from the death register, after due correction has been made in accordance with the foregoing considerations, was 1683 per 1,000, or about 1 in every 58 persons living. This rate is below the average of the preceding ten years by 1 per 1,000. BIRTH-RATE—RATE OF NATURAL INCREASE. The total number of births registered during the past year was 400—191 males and 209 females. The average number during the preceding ten years was 336. The birth-rate for the past year was 32.21 per 1,000 of the population. There was one birth among about every 18 females of all ages. The rate of natural increase was 15.38 per 1,000, the average of the past years, 1856-60, having been 14.35 per 1,000. • The Workhouse is situated in Battersea, consequently the deaths of Wandsworth inhabitants occurring there, are registered in the parish of Battersea. 9 CAUSES OF DEATH. The following Table contains a summary of all the causes of death, arranged in accordance with the classification of the RegistrarGeneral, shewing the sex, social position, and age at death at eight periods, and particularising the several diseases of the zymotic class. WANDSWORTH. Sex. Age. Social Position . Population in 1861, 13,346. 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 80 Years of age. 80 Years and upwards. Nobility and Gentry. Professional Class, Mer- chants, Bankers, &c. Middle and Training Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. Diseases and other Causes of Death. Diseases Classified. Classes:— Small-Pox ... 1 1 ... 1 ... 1 ... ... ... ... ... ... ... 1 Measles ... 1 1 ... 1 ... 1 ... ... ... ... ... ... ... ... Scarlatina 5 7 12 ... 6 3 10 1 1 ... ... ... ... 1 11 Diphtheria 1 ... 1 ... ... 1 1 ... ... ... ... ... ... ... 1 1.Zymotic Whooping Cough 2 2 4 4 ... ... 4 ... ... ... ... ... ... ... 4 Diarrhœa & Dysentery 9 6 15 6 5 1 12 ... 1 2 ... ... ... 2 13 Croup 1 2 3 1 2 ... 3 ... ... ... ... 1 ... 1 1 Fever 2 1 3 ... 1 ... 2 1 ... ... ... ... ... ... 3 Erysipelas 1 ... 1 1 ... ... 1 ... ... ... ... ... ... ... 1 Total 21 20 41 12 16 5 35 2 2 2 ... 1 ... 4 36 2. Tubercular 29 24 53 8 5 ... 20 16 12 5 ... 2 1 3 47 3. Of Brain, Nerves, &c. 32 20 52 10 3 1 14 13 13 11 1 1 2 5 44 4. Of the Heart, &c. 2 3 5 ... ... ... ... ... 5 ... ... 1 ... ... 4 5. Of Respiratory Organs 14 13 27 4 5 ... 9 6 4 8 ... 1 ... 4 22 6. Of Digestive Organs 8 8 16 3 ... 2 5 3 5 2 1 2 ... 4 10 7. Of the Kidneys, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8. Of the Uterus ... 3 3 ... ... ... ... 2 1 ... ... ... ... ... 3 9. Of Uncertain Seat 2 15 17 2 ... 1 3 ... 6 7 1 3 1 1 12 Low Vitality, Malformation, &c. 9 5 14 14 ... ... 14 ... ... ... ... ... ... 2 12 11. Age 6 10 16 ... ... ... ... ... ... 7 9 3 ... 3 10 12. Violence 2 ... 2 ... ... ... ... 1 1 ... ... ... ... ... 2 Total 126 121 246 53 29 9 100 41 43 41 12 13 4 26 203 In consequence of the great diminution in the number of deaths in the Asylum last year from the cause above mentioned, diseases of the brain and nervous system do not, as usual, take the highest place in the causation of mortality. The tubercular class (which includes consumption, scrofula, and hydrocephalus) exceeds them by one death. These classes formed each about 21 per cent. of all deaths. Of the former, one-half only, or ten per cent. of all 10 deaths, belonged to the parish proper. Next in order of fatality the zymotic class (epidemic, endemic, contagious) formed exactly one-sixth of the whole, or about double the per centage of last year. Diseases of the organs of respiration (excluding consumption) formed upwards of 10 per cent; this is considerably below the average; during the previous year they formed 16 per cent. Diseases of the heart were more than one-half less than the average. The other classes of disease exhibit nothing of moment. Consumption (as is usual when not exceeded by some epidemic) was the most fatal of any single disease, forming 15 per cent., or upwards of one-seventh of the whole mortality. Two deaths only resulted from violence, and those were from accidental causes. Twelve inquests were held in the year; 18 in the year preceding. In 11 instances the cause of death was not certified by medical testimony. It should be here observed, as has been pointed out in previous reports, that as in any of these cases death may have resulted from other than natural causes, the possibility of secret crime escaping detection is not precluded, as far as might be, by the intervention of medical investigation in all cases where the cause of death has not been certified by a registered medical practitioner. The following quotation from the RegistrarGeneral's Annual Report for 1854 has a strong bearing upon this subject:—"The Coroner's Court is less effective than it might become in deterring evil doers from the commission of dreadful crimes." age at death. Of the total deaths, upwards of 40 per cent. died under 20 years of age; 33 per cent. did not exceed 5 years; and upwards of 21 per cent. did not attain the age of 1 year. The mean age at death of those who died during the past year was 32 years. There is a great and remarkable difference in the mean age at death presented by the two sexes—having been 36 years among females, while among males it was only 27 years. SOCIAL POSITION. 82.5 per cent. of all deaths occurred amongst the industrial and labouring classes; and of deaths from epidemic diseases, 87.8 per cent. The average per centage amongst them during the past 5 years, both of total deaths and of deaths from epidemic diseases, was 80 per cent. Of the 82 deaths under 5 years of age, 72 took place amongst them. 11 EPIDEMIC DISEASES—PREVALENCE AND FATALITY OF. The following Table exhibits the deaths which resulted from the principal epidemic diseases during the past and 5 preceding years, and the relation which they bore to the deaths from all causes. YEARS. Small Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Diarrhœa. Fever. Typhus and Typhoid. Total Deaths from Epidemics. Total Deaths from all causes. Per centage of deaths fromEpidemics to deaths from all causes  1856 9 2 4 0 12 4 12 43 314 13.6 1857 0 1 2 0 1 14 11 29 248 11.2 1858 0 0 10 0 4 1 7 22 289 7.6 1859 2 7 43 3 2 3 0 60 311 19.2 1860 0 5 4 1 4 4 4 22 308 7.1 1861 1 1 12 1 4 8 3 30 246 12.1 The mortality from the principal epidemic diseases, as shewn in the above table, exhibits a considerable increase over that of last year. This increase was due to scarlet fever and diarrhoea, both of which were persistently prevalent during the whole year. Fever also, principally in the form of typhus, was very prevalent during the whole year, but was attended with slight fatality. Small-pox occurred to a slight extent during the first six months; measles in January, May, and August; and whooping-cough, to a considerable extent during the latter nine months of the year. It is satisfactory to find that the mortality from the above diseases although much greater than that of the previous year, was less by a seventh part than the average of the past five years; the more so, inasmuch as it is just this class of diseases that comes most immediately under the control of sanitary operations. GENERAL SICKNESS—AMOUNT AND INTENSITY OF. The indications of the health of the parish furnished by the death-register are fully corroborated by the conclusions derivable from the record of sickness and mortality amongst the poor contained in Table V. of the Appendix. In it are shewn the total cases of sickness which came under treatment amongst the poor, the number of deaths, and the classes of disease which produced them. 12 This record is valuable, inasmuch as it affords the only available means of viewing the mortality in relation to sickness, and of so becoming acquainted with the lesser fluctuations of health not indicated by the death register. By the latter we are informed of how many persons die in a given number of the population, but we do not by such means become aware of how much or how little sickness those deaths resulted from—of, in other words, the intensity of disease. It need scarcely be observed that there is no means of ascertaining the total amount of disease which has prevailed throughout the parish; but an approximate estimate both of its intensity and amount can be formed from that portion, with its resulting mortality, which has occurred amongst the poor, and which is accurately known. By a reference to the table it is seen that the number of cases of sickness were 1,371, the corrected average for the previous six years being 1,439. The deaths numbered 35, or about 2½ (2.55) per cent. the average of the previous six years being 3 per cent., nearly 2.93. There were 394 cases of epidemic disease, forming 28.7 per cent. of all cases of sickness; the deaths from these diseases, which were somewhat less than the average, numbered 10, a mortality not greater than that resulting from all diseases collectively. From these figures it is gathered that the intensity of disease amongst the poor was less than the average in the proportion by figures of about 25 to 29, and that while the amount of epidemic disease exceeded the average in the proportion of 28 to 25, the mortality from them was a little less than the average. The total amount of sickness can be estimated 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 have occurred in the entire parish. From such a calculation it is found that the amount of sickness was 72 per cent. of the population. By a similar calculation on the average of the past six years, it was about 80 per cent. Although such estimate must be inaccurate, inasmuch as the sickness and mortality are much greater amongst the poor than the rest of the community, it nevertheless furnishes, if taken from year to year, a good, and, indeed, until we are in possession of the information contained in the recent census, the only basis for comparison. SANITARY OPERATIONS. Table VI. in the Appendix contains a summary of the sanitary operations which have been carried out during the year. It is 13 satisfactory to find that they have been effected without the necessity for any appeal to the law. In addition to these, the slaughterhouses were examined and specially reported on as usual previously to the renewal of their owners' licenses; and it should be stated that much sanitary work, such as the cleansing and emptying of cesspools, the removal of filth, and other nuisances, has been effected through the representation of your Surveyor and myself, without the necessity for reporting to the Board, and which is therefore not recorded in the table. The many sanitary improvements which have been carried out by the Board since its first formation have been attended with very beneficial results, as evidenced by a lessened death-rate and by a considerable reduction in the mortality from epidemic diseases; but what has been done in this respect is but the commencement of what will have to be done before we can expect to find any permanent reduction in the mortality from preventable causes. Among the many requirements for attaining this desirable result, those which are most immediately needed are a perfect water supply and a thoroughly efficient system of scavengering—searching and frequent—particularly in the close courts and alleys (all of which, as I have before pointed out, require to be paved), in the byeways and around the dwellings of the poor. These are practical matters which can be dealt with by the Board completely and, without doubt, successfully. The foregoing information, derived from an analysis of the mortuary returns and of the parochial records of sickness and mortality amongst the poor, furnishes satisfactory evidence of the favourable state of the health of this sub-district during the past year. The death-rate which, as has been shewn, was less by about 1 per 1,000 than the average of the past 10 years, was somewhat lower than the average natural death-rate (17 per 1,000) of the rural districts. This and the relation which has been shewn to have existed between sickness and mortality amongst the poor, warrant the conclusion that the amount and intensity of disease which prevailed generally was less than the average. These results afford much encouragement for an extended and persevering application of the measures which have been shown to have been hitherto successfully adopted. GEORGE EDWARD NICHOLAS, Medical Officer of Health for the Sub-district of Wandsworth. CLAPHAM. IN my last Annual Report, I made use of a statistical table of some value, as giving the condition of the population from the commencement of the present century down to the last census of 1861. In the present report I insert a table of a similar description, but applying to the marriages, births, and deaths, in this sub-district from 1856 to 1861—a table which, I venture to think, will furnish as solid a basis for future calculations in reference to this parish as the former one. MARRIAGES, BIRTHS, AND DEATHS. YEARS. 1856 1857 1858 1859 1860 1861  Marriages 154 151 150 156 183 182 Births 527 550 533 594 608 624 Deaths 286 321 344 328 429 390 Excess of Births over Deaths 241 229 189 266 179 234 In this table is shewn that the excess of births over deaths has varied considerably in the several years, and that when in one year the excess has been small, a very considerable increase has been observable in the year following; thus in 1858 the excess was small, but in 1859 it exceeded even the past year (1861) by 32 births. In like manner, 1860 was remarkable for a small excess, whilst 1861 was as remarkable for a large one. It appears also by this table that the number of births in 1861 exceeded that of 1860 by 16, and that of 1859 by 30. 15 The following table gives the number of deaths registered during 1861 from all causes, and amongst all classes, together with the sex, and ages at death at eight different periods. CLAPHAM. Sex. Age. Social Position.  Population in 1861, 20,890. Area in Acres, 1,233. 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. Proiessional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. DISEASES. And other causes of Death Classes:— Small-Pox 4 2 6 1 2 2 5 ... 1 ... ... ... 2 1 3 Searlatina 9 13 22 5 11 4 22 ... ... ... ... ... 1 4 17 Diphtheria 8 5 13 2 5 6 13 ... ... ... ... ... ... 8 5 Quinsey 1 ... 1 1 ... ... 1 ... ... ... ... ... ... ... 1 Croup 2 ... 2 ... 2 ... 2 ... ... ... ... ... ... ... 2 Whooping Cough 7 7 14 7 7 ... 14 ... ... ... ... ... ... 2 12 1. Zymotic Typhus and Infantile Fever 2 3 5 ... 1 1 3 1 1 ... ... ... 1 1 3 Erysipelas Metria 2 1 3 1 ... ... 3 ... ... ... ... ... ... 1 2 Childbirth ... 1 1 ... ... ... ... 1 1 1 ... ... ... ... 1 Influenza ... 3 3 ... ... ... ... ... 1 1 1 ... ... 1 2 Diarrhœa 12 4 16 15 ... ... 15 1 ... ... ... ... 1 3 12 Total 47 39 86 32 28 13 78 3 3 1 1 ... 5 21 60 2. Tubercular 26 30 56 13 3 2 27 16 12 1 ... ... 4 16 36 3. Of Brain and Nerves 17 21 38 10 5 6 21 2 5 8 2 ... 2 12 24 4. Of Heart 8 10 18 1 1 ... 5 3 6 4 ... ... 3 8 7 5. Of Respiratory Organs 26 29 55 15 4 2 24 6 9 16 ... ... 2 19 34 6. Of Digestive Organs 14 12 26 10 3 2 17 1 2 6 ... ... 2 7 17 7. Of Urinary Organs 5 6 11 1 ... ... 3 1 2 5 ... ... ... 6 5 8. Of Organs of Generation ... 3 3 ... ... ... ... ... 3 ... ... ... ... ... 3 9.Of Joints, Bones, &c. 2 3 5 ... ... ... 1 2 1 1 ... ... 1 2 2 10. Of Skin 1 ... 1 1 ... ... 1 ... ... ... ... ... ... 1 ... 11. Premature Birth,Low Vitality, Malformation, &c. 20 14 34 30 3 1 34 ... ... ... ... ... ... 9 25 12. Of Uncertain Seat 6 6 12 3 ... ... 3 1 1 6 1 ... ... 4 8 18. Age 12 16 28 ... ... ... ... ... 1 8 19 ... 2 12 14 14. Violence 2 4 6 1 ... 1 2 ... 1 3 ... ... ... 1 5 15. Not specified 2 9 11 1 ... ... 1 2 7 1 ... ... 2 3 6 Total 188 202 390 118 47 27 217 37 53 60 23 ... 23 121 246 PREVALENCE AND FATALITY OF ZYMOTIC DISEASES. In the past year a large amount of zymotic disease was noted as prevailing in Clapham, but the above table shows that but comparatively few of the cases treated proved fatal—indeed the 16 deaths resulting from this class of diseases were 20 per cent. less than in 1860, a circumstance that may be very fairly accounted for by the attention which has been paid of late years to sanitary improvements, and the perseverance that has been manifested in sustaining such improvements, so as to render them permanently effective. What greater decrease in the fatality of these diseases may be brought about time alone can show; but it may be pretty safely predicted that such decrease will ever be in proportion to the consistent execution of all required sanitary works. The decrease in the total number of deaths from all causes, as compared with that of 1860, is about 7.25 per cent. The rate of mortality from diseases of the zymotic class, exhibited in the above table, places Clapham, for the past year at least, below the metropolitan average, the proportion being 22 per cent. of all deaths in this sub-district, against 24 in the entire metropolis. As observed in former reports, preventive measures, particularly when applied to the poorer localities, are always found to be far more effective in keeping down the death-rate from epidemic diseases than those of any other class. MORTALITY OF CHILDREN AND INFANTS. Although the mortality amongst children under 10 years of age is 10 per cent. less than the rate of 1860, that of infants under one year is found to be a third more in the past year than in the year preceding. This feature of the mortality table is always, and in every district, a melancholy one to comment on, as no remedy but the moral improvement of the labouring poor can be suggested for an evil that mainly arises from maternal neglect. DISEASE AND MORTALITY AMONGST THE UNION POOR. The amount of sickness amongst the union poor of this parish (see Table V., Appendix) has during the year undergone a very satisfactory reduction, and so likewise has the rate of mortality ; for it will be seen that, of 1,262 cases coming under treatment, 57 persons only succumbed to those diseases, &c., for which they received medical and surgical aid. Small pox, I regret to say, forms a considerable item in the abovenamed table, as it has done in almost all former ones ; but it is seen that only one death from this malady has occurred amongst the Union poor in the last year, against six in 1860, which is a matter for considerable congratulation. It is much to be regretted, however, that the number of births in the year should have so largely exceeded the number of vaccinations. As the public vaccinator of this sub-district, I have 17 formed the operation on 205 children only during the past year, which is less than one-third of the number born in the same period; and it has been ascertained that by no means another third have been protected by the other practitioners residing in the subdistrict; so that, even after due allowance is made for the number of infants dying before the time that vaccination is usually resorted to, it may be safely assumed that fully one-third of the children living under one year of age remain unprotected, and possibly very many adults. Measles was scarcely observed amongst the poor in this parish in the past year, and scarlatina decreased one-half from the year preceding. Diarrhoea and dysentery increased as regards the number of cases treated over that of the previous year, in the proportion of three to one, without any very manifest increase of mortality. Diseases of the respiratory organs decreased from the previous year at least one third, though they still furnish a somewhat formidable portion of the deaths exhibited in the mortality table inserted above. SUDDEN AND VIOLENT DEATHS—INQUESTS. There were but fourteen inquests held in this parish during the year, of which three only were returned to the local registrar as having been cases of 'violent death'; but as medical evidence does not appear to have been made, as it unquestionably ought to be, a feature of the majority of these inquiries, it is feared that increased vigilance in either the prevention or detection of crime has not been the result of the recent alterations introduced as to the payment of Coroners and other arrangements. INSPECTIONS MADE, AND SANITARY WORK ACCOMPLISHED DURING THE YEAR. The inspection of houses and premises, as well as the complaints of nuisances investigated by the Surveyor and myself, have been rather less numerous in the past year than in 1860. A large amount of other sanitary work (see Table VI., Appendix) in the way of cleansing and improving drains, open ditches, &c., &c., has also been accomplished, and the water closets constructed, cesspools emptied, and drains connected with sewers, have been decidedly more numerous than in 1860. A most satisfactory feature of this table, as it applies to this parish, is the absence of any mention of magisterial interference during the year to enforce compliance with the orders of your Board. 18 It affords me much pleasure to speak favourably of the improvements effected in the Lyham Road, at one time so greatly and, I may add, so justly complained of. In its former condition it was a source of not only much inconvenience to the inhabitants generally, but of positive danger to those who resided in its vicinity. My poor-law medical duties in this locality, before the present re-construction of the road, were onerous in the extreme; for scarcely a day passed that I did not have occasion to make repeated visits—not unfrequently at night—to patients seriously ill from preventible causes connected with this road, but since the improvement referred to, my visits have not averaged more than two in the week. The improved moral character of the neighbourhood is also amongst the most satisfactory results of this great and long required work of sanitation. DRAINAGE AND SEWERAGE. I have dealt so frequently with this subject in former reports that it would be needlessly occupying my limited space by again referring to it, further than to congratulate those most concerned upon the prospect there now is of shortly witnessing the completion of the high level sewer, a work second to none in importance in its connection with this sub-district. OFFENSIVE PONDS. No metropolitan district, I believe, contained so many ponds as did Clapham at the commencement of the operations of your Board. From long neglect most of these had become so foul, so offensive, and so dangerous to health, as to compel me to notice them in all my former reports. I am pleased to find that the trouble taken and the money expended have not been thrown away, but that a visible improvement has resulted from what has been already accomplished in respect to them, during the past year especially. There are, however, two or three remaining to be dealt with, and I must express a hope that they may be attended to before the increased temperature of midsummer renders it, as it cannot fail to do, equally as dangerous to attempt to cleanse them as it will be to suffer them to remain in their present condition. JOHN MAC-DONOGH, Medical Officer of Health for Clapham. BATTEESEA. DURING the year 1861 there were registered in this parish 505 deaths from diseases and other causes, of which number 265 were males and 240 females, being 33 in excess of the previous year. This increase is attributable to the fatality of scarlet fever, whooping cough, diarrhoea, and fever. Diseases of the brain, heart, digestive, and respiratory organs, were also unusually fatal during the year under review. Of the 505 deaths enumerated in the appended table, 112 occurred in the workhouse, the infirmary attached to which, it should ever be borne in mind, is the hospital for the entire union, receiving many of the acute and no inconsiderable number of the chronic cases of disease befalling the poor in the surrounding subdistricts. Of the 112 deaths registered as having taken place in the workhouse, 92 were of individuals in no way connected with the parish of Battersea. Deducting these deaths therefore from the gross number it will reduce the mortality proper to the subdistrict to 413, which even then, regard being had to increase of population, is somewhat largely in excess of the previous year. The subjoined table gives the number of deaths from all causes that have been registered during the year in the sub-district, and since the sex, age, and social position of all the deceased persons is, as correctly as possible, set forth in such table, it is presumed that no one really interested in the sanitary welfare of the parish can fail to derive from it much valuable information—information which pages of mere description would fail to convey in so clear a manner, or to afford such facilities for comparison with similar statistics in previous reports. 20 BATTERSEA Sex. Age. Social Position. Population in 1861, 19,852. Area in statute acres, 2,343. Males. Females. Total. Under 1 Year. From 1 to 5 Years. From 5 to 10 Years. Under 20 Years, including all under 20 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 Class. DISEASES, And other Causes of Death. Classes Small Pox ... 1 1 1 ... ... 1 ... ... ... ... ... ... ... 1 Measles 2 1 3 2 ... 1 3 ... ... ... ... ... ... ... 3 Scarlatina 17 15 32 2 18 12 32 ... ... ... ... 1 ... 9 22 Diphtheria 3 5 8 2 1 2 7 ... 1 ... ... ... 2 3 3 1. Zymotic Whooping Cough Typhus and Infantile Fever 7 14 21 8 13 ... 21 ... ... ... ... ... 1 2 18 8 11 19 ... 7 3 19 ... ... ... ... ... ... 10 9 Erysipelas 3 1 4 2 ... ... 2 ... ... 2 ... ... ... 1 3 Diarrhœa 15 11 26 22 3 ... 25 1 ... ... ... ... 2 7 17 Cholera 2 ... 2 ... 1 ... 2 ... ... ... ... ... ... 1 1 Total 57 59 116 39 43 18 102 1 1 2 ... 1 5 33 77 2. Tubercular 13 15 28 16 8 1 28 ... ... ... ... ... 2 2 24 3. Of Brain, Nerves, &c. 26 30 56 23 6 4 35 3 7 8 3 2 3 7 44 4. Of Heart 16 9 25 ... 1 2 5 ... 13 6 1 ... 4 4 17 5. Of Respiratory Organs 73 62 135 28 29 1 65 29 28 13 ... 2 3 23 107 6. Digestive Organs 21 15 36 14 2 ... 17 1 11 6 1 ... 1 9 26 7. Of Urinary Organs 6 2 8 ... ... 1 1 ... 4 3 ... ... ... 3 5 8. Of Organs of Generation ... 6 6 ... ... ... 1 3 2 ... ... ... 1 1 4 9. Of Joints, Bones, &c. 1 1 2 ... ... ... 1 1 ... ... ... ... ... 1 1 10. Premature Birth, Low Vitality, Malformation, &c. 13 11 24 22 ... ... 24 ... ... ... ... ... 2 7 15 11. Age 16 11 30 ... ... ... ... ... ... 20 10 ... 2 4 21 12. violence 10 5 15 1 4 2 7 5 1 1 1 ... 1 4 10 13. Not Specified 13 11 24 3 ... 1 5 2 9 8 ... ... 1 4 19 Total 265 240 505 146 93 30 301 45 76 67 16 5 25 102 373 PREVALENCE OF AND MORTALITY FROM ZYMOTIC DISEASES. Diseases of this class have been unusually prevalent during the past year, and have likewise proved unusually fatal, since of nine epidemic diseases enumerated in the table, as many as 116 resulted in death, whilst in the previous year there were registered only 68 deaths from the same class of diseases. This instance of excessive mortality from zymotic disease deserves to be recorded and remembered as a warning, and will, it is hoped, lead to the adoption of increased precautionary arrangements. Measles and small pox have been much less fatal during the past year than during 1860, 3 deaths only having occurred from the 21 former disease against 13, and 1 from the latter against 10 in the previous year. Speaking of small pox, there is much reason to fear that vaccination, as is the case almost everywhere, is neglected in this parish to a deplorable extent. The indifference of parents, amongst the poorer classes especially, to submit their offspring to this valuable prophylactic appears to be increasing in all directions, and to call loudly for the interference of the legislature. It is indeed almost incredible that such an immense loss of life as occasionally occurs in some of the poorer districts of the metropolis and elsewhere should be incurred from the neglect of a preventive of the most simple and efficacious kind. MORTALITY IN THE WORKHOUSE. Of the 505 registered deaths in this sub-district, 112, as before stated, died in the workhouse, but what is particularly worthy of being noted is the circumstance of 12 persons dying in that house during the past year at various ages between 80 and 90, and as many as 27 between 70 and 80. The oldest person who succumbed had reached the advanced age of 89. INFANT MORTALITY—PROPORTION OP BIRTHS TO DEATHS. The mortality of children between birth and 10 years of age has been much greater than in 1860, the numbers being 269 against 131, or more than double that of the previous year. Convulsions, premature birth, and low vitality, have contributed largely to this excess. Precisely the same causes as were commented upon in previous reports, viz., the neglect of infants by mothers, employed in large numbers in the manufactories which abound in this neighbourhood, appear to be in as active operation as ever in producing the lamentable condition of things above referred to, and it is much to be feared that with the increased demand for female labour, and the consequent increase of the population by immigration, a corresponding increase of the evil is inevitable. SICKNESS AND MORTALITY AMONGST THE OUT DOOR POOR. Table V., Appendix, exhibits the nature and amount of sickness amongst the pauper population of the sub-district (exclusive of those treated in the infirmary of the workhouse), as well as the deaths that have resulted from disease and other causes. Of 970 cases of sickness, accidents, &c., which came under treatment and which were registered in the Medical Relief Books during the 22 year 1861, 33 only terminated fatally, being a rate of mortality considerably less than was noted in the corresponding table appended to the report of the previous year. This fact is very remarkable, and not a little encouraging, since it shows, that notwithstanding the increased mortality amongst all classes, this particular class must have benefited to a considerable extent by the sanitary improvements that have been effected within the last few years. The excess of infant mortality alluded to above, it is clear must have been dependent upon fatal disease, &c., occurring amongst the families of a class in the receipt of fair wages, and therefore out of the pale of pauperism; and it is just this class of persons who are found most neglectful of home duties and responsibilities. PREVENTIVE MEASURES ADOPTED DURING THE YEAR._AMOUNT OP SANITARY WORK PERFORMED._CONCLUSION. It was remarked in my last report that very many salutary influences had been brought into operation within the sub-district under the auspices and efforts of your Board, the good results of which, especially amongst the poor, were every day becoming more and more manifest. I have great pleasure in stating that these efforts are being continued with as much energy as those of previous years. Table VI., Appendix, will show that some 800 inspections of houses and premises have been made; that 44 notices have been served, calling upon parties to remove existing nuisances, &c.; that 650 feet of new sewerage have been laid down; that six miles of open sewers, ditches, &c., have been effectually cleansed; and that between six and seven hundred other sanitary operations have been performed during the year, all of which, it may be fairly assumed, must have had a very important influence in staying the ravages of disease, and in promoting the health and comfort of the inhabitants. It only remains for me to express a belief I know to be shared in by all my colleagues, that the great bulk of the industrious poor are still placed in circumstances unfavourable to that condition of health it is most desirable to see them possess—circumstances which but too frequently forbid the preservation of the ordinary decencies and moralities of life, and that it is only by well sustained efforts in that particular direction, and by an earnest diffusion of the principles of sanitary science, we can hope to stay the havoc which death annually makes amongst the working class. WILLIAM CONNOR, Medical Officer of Health for the Sub-district qf Batteries, STREATHAM, INCLUDING TOOTING AND BALHAM. IN accordance with instructions from your Board, necessitating the production of an Annual Report and summary of the year's sanitary operations in this sub-district, the following remarks and tables are with deference submitted, as indicating the progress which sanitation is making in this locality. STATISTICS OF MORTALITY. The deaths registered during the year 1861 numbered 128— 69 males and 59 females—which is exactly the average of the four preceding years, but less than for the year 1860 by 24, and for 1859 by 41. The returns show a very decided improvement for the past year in comparison with the three previous years. The number of persons dying between the ages of 60 and 80 and upwards has undergone a diminution from 54 in the year 1860 to 40 in the year under review. The number who reached 80 years and upwards has also decreased from 15 to 8. Nearly the same number of young persons under 20 succumbed during the past year as during 1860. Of these, the children who died under 5 years greatly predominated, the number registered being 46, whilst in 1860, only 39 were recorded. This death-rate of infants between birth and 5 years of age, compared with that of the entire district, is relatively low, doubtless in consequence of there being fewer poor in the parishes comprising this sub-district, and therefore fewer of those causes in operation that tend to foster disease in the very young, than are to be found in more crowded localities. Seeing, however, it is to what are usually termed preventible diseases that a large number of infants fall victims, the high death-rate above referred to ought to stimulate us to increasing endeavours to remove every possible cause having a tendency to augment the result we have so frequently to deplore. The mean annual death-rate of this sub-district for the past ten years is a fraction over 15 per 1,000 living, a number according to the Registrar General's statistics, comparable with that of the healthiest places in all England. 24 ZYMOTIC DISEASES. The sub-district has, during the past year, been very free from diseases of this class, if we except whooping cough, which appears to have resulted in death in six instances to children under 5 years of age. The total number who succumbed to the seven forms of zymotic disease enumerated in the table appended was 20, which is slightly in excess of the number recorded as the result of 10 diseases of the same class in a similar table attached to my report for 1860, where the total will be found to be but 16. The following table accurately shows the number of deaths from all causes and amongst all classes, ages, &c., that have been registered during the past year, and will be fonnd to exhibit a very satisfactory result in respect to the total deaths, when compared with that given in my former report, the numbers being 128 in the past year against 152 in that immediately preceding. I am justified therefore in assuming that the sanitary operations of the year have contributed greatly to the health of this sub-district. STREATHAM, Including TOOTING & BALHAM. Population in 1861,10,082. Area in statute Acres, 3,4 65. Sex. Age. Social Position. DISEASES, And other causes of Death. Males. Females. Total. Under 1 Year. From 1 to 5 Years. From 5 to 10 Years. Under 20 Years, including all under 10 Years At 20, and under 40 Years of age. At 40, and under 60 Years of age. At 6o, 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:- 1. Zymotic Measles 1 1 2 — — — 1 1 — - - - - 2 — Scarlatina 31 4 — 2 2 4 — — — — — 2 1 1 Whooping cough 4 2 6 1 5 - 6 - - - - - 2 1 3 Typhus and Infantile 1 1 2 - 2 - 2 — - - - - - — 2 Fever Metria (Childbirth) — 2 2 — - - - 2 - - - - - 1 1 Diarrhœa 2 2 4 3 1 - 4 - - - - - - 1 2 Total 11 9 20 4 10 2 17 3 - - - - 6 4 10 2. Tubercular 10 11 21 2 3 — 7 9 5 — — — 1 4 16 3. Brain and Nerves 2 5 14 4 3 — 7 - 3 4 - - - 4 10 4. Of Heart 7 1 3 — — — 2 1 1 4 - - 2 4 2 5 Of Respiratory Organs 9 10 19 5 6 — 10 — 2 7 — - 4 4 11 6. Of Digestive Organs 54 9 1 — - 1 1 2 5 — — 1 4 4 7. Of Urinary Organs 7 — 7 - - - - - 4 3 - - 4 1 2 8. Of Organs of Generation — 1 1 - - - - - - -1- - - 1 - 9. Premature Birth, Low Vitality, Mal4 5 9 9 — — 9 —- - - -1 1 7 formation, &c. 10. Of Uncertain Seat — 3 3 — — — — 1 2 — - - 1 - 2 11 Age 5 9 14 - - - - - - 6 8 - - 12 2 12. Violence 1 - 1 - - - - - - 1 - - - 1 - 13. Not Specified 1 1 2 — — - — - 1 1 - - - - 2 Total 69 59 128 25 21 2 53 15 20 32 8 - 20 40 68 25 PROPORTION OF BIRTHS TO DEATHS. The births registered in the year under notice (vide Table II., Appendix) number 271—137 males and 134 females—which is 33 more than in either of the years 1859 or 1860. The deaths being, as before stated, 128, it follows that the excess of births over deaths is as great as 143. If such a rate of natural increase were continued it would in ten years add to the population, apart from the increase by immigration, 1,430 souls. SICKNESS AND MORTALITY AMONGST THE UNION POOR. Table V., Appendix, exhibits the number of cases and character of the sickness treated by the Union Medical Officers of this subdistrict. A most favourable rate of mortality is exhibited in this table, inasmuch as only 10 deaths resulted in 269 cases of sickness, accident, &c., recorded in the medical relief books, which is 10 less than occurred in 247 cases that came under medical treatment in 1860. SLAUGHTER HOUSES. The whole of the slaughter houses were carefully inspected during the year, and found to be kept in a very creditable state as to cleanliness and the possession of all those requirements insisted upon in the regulations issued by your Board. SANITARY OPERATIONS, &c. In all the three divisions of this sub-district a number of very necessary, and in many cases indispensable, sanitary improvements, tabulated under the heads of drainage, water supply, removal of nuisances, &c., have been carried out (vide Table VI., Appendix) to the undoubted great advantage as well as to the increased comfort and health of the inhabitants. Although the good accomplished, as evidenced by the very favourable report I am enabled to furnish, should be a source of considerable congratulation, still I am bound to recommend that similar improvements and sanitary works should be carried forward in coming years, if it be wished to maintain the reputation for healthiness which this sub-district, by attention to these matters, has already gained. D. C. NOEL, Medical Officer of Health for Streatham, Tooting, and Balham. PUTNEY AND ROEHAMPTON. SO much having been accomplished in this sub-district during the year 1860, in the way of main and branch drainage, and other equally desirable improvements, it can scarcely be expected that quite so large an amount of completed sanitary work, as was exhibited in the summary of that year will, be found recorded in Table VI. appended to the present report. Nevertheless, it is believed the present table will show that there has been throughout the past year not only considerable activity displayed in carrying out works of acknowledged utility, but that all previously effected improvements have been well and efficiently sustained. The principal sanitary work, and one for which there arose the greatest necessity, was carried out at Roehampton. The following is an extract from one of my returns furnished in the autumn of last year, and is here inserted to show the condition of the hamlet which had led me so repeatedly to refer to its want of efficient drainage:— "Scarlatina of a malignant type, I regret to say, continues to prevail at Roehampton. I desire, therefore, to call particular attention to the very defective drainage of this locality, which I believe has lately, and during the prevalence of former epidemics, proved a source of great danger to the inhabitants. At every outbreak of zymotic disease in the hamlet the cases that have presented themselves have been, generally speaking, of an unusually malignant character, and not only has there been more fatality than could be reasonably expected in such an otherwise healthy neighbourhood; but convalescence in the recovered cases has been infinitely more protracted than amongst patients who have suffered from the same disease in the better drained portions of the subdistrict. I would therefore warmly urge a consideration of this important matter, with a view to the adoption of some means 01 improving the existing drainage, if it be beyond the power of the Board at present to entirely alter it." 27 With a promptness that was scarcely to be expected, after the rejection by the Metropolitan Board of more than one well-devised scheme on the plea of not being in strict conformity with the great "intercepting project," your Board, upon receiving the above report, ordered an immediate inspection of the existing sewer, and a thorough repair of the same wherever required. The inspection by the local surveyor disclosed a condition of things but little suspected. Along the entire frontage of a row of cottages exclusively occupied by working men and their families, and where scarlet fever was then raging, and had proved fatal to several of the inmates, there was found a small ill-constructed brick drain, very much out of repair, and with its inner side, throughout a portion of its course, actually formed by the foundations of such dwellings! The consequence of this faulty construction had been, in one house in particular where two children had died of the fever, that the liquid soil had, by capillary absorption, so impregnated the external wall as to be distinctly visible within the cottage, and what was worse, as plainly to be detected by another sense by persons entering the dwelling from the fresh air. The wonder is, then, not that the fever should have invaded such a place, but that it should have done so little mischief among the swarms of poor children inhabiting this and the tenements immediately adjoining. A reconstruction of this defective sewer by the application of drain pipes, an increased fall, and other improvements, not only effectually relieved the neighbourhood of a great and disgusting nuisance, but appeared at once to stay the ravages of disease; for, happily, not a single fresh case of sickness of any description has since, and down to the time of publishing this report, come under treatment amongst the poor children of this locality, and but one (the result of age) amongst adults. I should add that private benevolence secured the adoption of several additional sanitary measures beyond those so promptly and judiciously executed by the order of your Board, the combined effect of which upon the health and comfort of the poorer inhabitants of the hamlet has been of an exceedingly gratifying character. Table VI., Appendix, will be found to record the completion in the sub-district of numerous other sanitary works of importance. In the carrying out of these improvements there unfortunately arose three cases for magisterial interference, but in each compulsory orders were obtained, and the works afterwards satisfactorily completed. The several places used as slaughtering houses were also duly inspected, and found to be furnished with all the requisites insisted upon in the published regulations of your Board. 28 RATE OF MORTALITY—CAUSES OF DISEASE AND DEATH—PREVALENCE AND FATALITY OF ZYMOTIC DISEASES—INFANT MORTALITY, &c. The subjoined table gives the number of deaths registered during 1861 from all causes and amongst all classes, with the sex and ages at death, as in former reports—an arrangement than which, it is believed, no better could be adopted to afford facilities for comparison with similar statistics of previous years:— PUTNEY and ROEHAMPTON. Population In 186l, 6,481. Area in statute acres, 2,170. 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. Profeessional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. DISEASES, And other Causes of Death. Classes, &c:- 1. Zymotic Measles - 1 1 - 1 - 1 - - - - - - 1 - Scarlatina 8 6 15 - 10 4 15 - - - - - - 3 12 Croup 1 1 2 - 2 - 2 - - - - - - - 2 Whooping Cough - 1 1 1 - - 1 - - - - - - - 1 Typhus and Infantile Fever - 2 2 - 1 - 1 - - 1 - - - 1 1 Metria, — 1 1 - — — - 1 - - - - - - 1 Diarrhœa 1 1 2 1 - - 2 - - - - - - 1 1 Total 11 13 24 2 14 4 22 1 — 1 — — - 6 18 2. Tubercular 11 7 18 4 4 1 2 2 7 - - - 1 5 12 3. Of Brain and Nerves 15 11 20 3 3 3 11 5 1 7 2 2 5 8 11 4. Of Heart 1 3 4 - - - - 1 - 3 - - - 3 1 5. Of Respiratory Organ 7 6 13 4 3 — 7 — 4 2 - 1 1 3 8 0. Of Digestive Organs 1 2 3 — — — — 1 - 2 - - 1 1 1 7. Of Urinary Organs 4 1 5 - - - 1 1 1 2 - 1 - 3 1 8. Of Organs of Generation - 2 2 - - - - - 1 1 - - 1 1 - 8. Of Joints, Bones, &c 1 1 2 - - - - - 2 - - - 1 1 - 10. Premature Birth, Low Vitality, Malformation, &c. 5 6 11 11 - - 11 - - - - 1 1 3 6 11. Of Uncertain Seat 2 6 8 1 — 1 3 1 I 3 - - - 3 5 12. Age - 2 2 - - - - - - 1 1 1 - - 1 13. Violence 2 3 5 1 — — 2 — 2 1 - - 2 1 2 U. Not Specified 1 — 1 1 — — 1 - - - - - - - 1 Total 61 63 124 20 24 9 67 12 19 23 3 6 13 38 67 The total number of deaths, as exhibited in the above table, is 124, nearly equally divided as to sex, but presenting a most 29 decided increase on the rate of mortality of the previous year, especially in its relation to children under 10 years of age, the large number of 59 having died before reaching that period of life, against only 27 in the year 1860. This increase of mortality amongst children was chiefly due to the fatality of scarlet fever, croup, and other zymotic diseases, the first of which prevailed with unusual severity in almost every district of the metropolis. To properly estimate the mortality of the year we have to take into consideration the number of deaths (18) that have resulted from age, premature birth, and violence, none of which, it should be borne in mind, come strictly within the category of morbific causes. If, then, these deaths are deducted from the general total in the above table, the actual mortality from disease alone will be 107. The reception of strangers from all parts of the kingdom into the Royal Hospital for Incurables—of such, indeed, as enter the parish only to linger awhile and die—also tends to unduly swell the mortality returns of the local registrar; but there is reason to believe that the deaths which took place in this institution during 1861, and which were seven in number, are as nearly as possible balanced by the deaths of inhabitants registered during the same period out of the sub-district, viz., in the Union Workhouse and in the London hospitals. If, however, the whole 124 deaths are admitted into the calculation, there is the satisfaction of knowing that the average mortality of the past ten years is still somewhat under what is termed the "zero" of that eminent statist, Dr. Farr, viz., 17 in every 1,000 living. Last year the estimated 10 years' average was 16.19 per 1000 only. The death-rate of this parish for the year under review is 1904 per 1,000 living, which is 2.85 in excess of an average calculated last year upon the numbers of the ten previous years, but the average will be found to be still under 17 per 1,000 if the calculation bo made to include the year 1860, since that year was remarkable for its low rate of mortality. The birth-rate of the past year was 25.95 per 1000, and the natural rate of increase 6.91 per 1,000. In reviewing the mortality from zymotic diseases exclusively, it may be remarked, that much as we have to deplore the unusual number of deaths from scarlet fever, we have the gratifying fact to place in the opposite scale, that but one case of that loathsome disease, small pox—and that happily not a fatal one—was treated in the parish during the entire year. This case, it should be stated, was an unvaccinated one, and the patient a very young man belonging to the labouring class—a circumstance that points to the necessity of some more efficient measure being adopted than has 30 yet been devised to ensure to all children the protection of this safe and simple operation. The number of children successfully vaccinated by myself in 1861 was 105, and doubtless several received protection during the same period at the hands of the other resident practitioners; but there is still some reason to fear a goodly number of children of both the poor and well-to-do classes are growing up without this protection being afforded them, or even thought of by their parents. The increase of the population, as exhibited by the excess of births over deaths in the year under review is 45, the births having numbered 169, and the deaths 124; but there has been, it is estimated, a much greater increase by immigration since the taking of the last census. The question therefore to be asked is the same as that asked by the Registrar-General in respect to all London, "Is the town equal to the task of providing by new and improved arrangements for the constant accumulation of human beings within its limits?" "The growth of a population," continues this authority, "is not a strength to be trusted, but a weakness to be feared, if improvements in its physical and moral condition is not commensurate with the growing urgency of its wants; for when a family increases in its narrow dwelling in circumstances of dirt and squallor, that increase which should be its blessing becomes its bane." There can be no doubt that in this parish the poor increase much faster than do the other classes of inhabitants, and yet it is a fact that scarcely a single fresh dwelling was erected during the past year for the accommodation of that class. Nothing else, it is feared, can follow the inadequate supply of houses to the increase of the labouring population, but overcrowding and all its attendant evils. Quite as many of the same bad influences as ever appear to be at work in causing a large infant mortality. Ignorance and neglect of physiological laws are still the great producers, in the young especially, of moral and physical degradation; mothers engaged in field and other labour still continue to neglect their offspring at a time when the supply of their natural wants is most imperative; and indifferent and scanty food, and the impure atmosphere of the one living and sleeping room, which so many of this class are compelled to breathe, still operate with the same force and certainty in causing scrofula and other prostrating diseases. If we add to this catalogue of causes those of wilful neglect and criminality, the contemplation becomes a painful one indeed.* *The following is from the "Times" of a recent date, and relates to one of the greatest social evils of the age—to one which cannot engago too much of the attention of both sanitarians and philanthropists "Infancy in London has to 31 It seems to me, then, very desirable that some systematic efforts should be made in this district to improve the dwellings of the labouring classes, or to erect, on the plan of the "model lodging houses" and the "healthy homes," which have elsewhere proved such great successes, buildings which would secure to the poor the means of bringing up their children in greater comfort and decency than it seems possible for them now to do under the existing system of sub-letting, which in numerous instances secures but single apartments for whole families in which to pass a most miserable and immoral existence. In this age of improvement and philanthropy it is difficult to account for any buildings, charitable or otherwise, being erected after designs which seek to keep at their very minimum, rather than increase and extend the comforts of the poor inhabitants in the direction in which the linger of science is now so continualy pointing. "When, however," as an eminent physiologist has observed, "people shall be deeply convinced that the eternal laws of nature have connected pain and decrepitude with one mode of life, and health and vigour with another, they will surely avoid the former and adhere to the latter." My sincere hope is the day is not far distant when this improved understanding of the sanitary requirements of the poor and helpless creep into life in the midst of foes. Wo hear often of the impoverished or poisoned air of close alloys and rooms unfit for habitation, and now the coroners have just told us in their official returns that 67 infants under two years of age were murdered last year in the metropolis. 150 more were 'found dead,' a large proportion of them left exposed in the streets; how many of these were 'persuaded not to live' must remain a secret till the disclosure of all secrets. Of above 50 others we learn that they either lost their lives through the misconduct of those who should have tended them, or that their deaths are attributable, wholly or in part, to neglect, want, cold, or exposure; the mother of one was only 13½ years old. More than 250 infants were suffocated, very generally in bed, and in upwards of half these cases there was no evidence how the suffocation was caused, or the juries did not state in their verdict that it was accidental. 1,104 deaths of infants in London in 1861 under two years old were such as to demand a coroner's inquest upon them. The age is the same as in the massacre which Christendom annually remembers, but the size of this great metropolis causes it to out-Herod Herod." In this sub-district (Putney) three deaths appear to have been registered during the year without medical certificates, the deceased persons not having been professionally attended, but the information as to the cause of death received by the local registrar from friends or relatives. Although this is permitted by the RegistrarGeneral, it can scarcely be considered to afford that amount of protection against crime which it is desirable society should possess. Six inquests took place during the year; in all those at which medical evidence was received the verdicts of tho juries were satisfactory enough, but in one or two, in which such evidence was dispensed with, especially in cases of infants found dead, the returns are so vague as to render the inquiries apparently worthless as a means of ascertaining the "cause of death," which is, of course, the sole object sought by the holding of inquests. Surely it were better to incur the expense of hundreds of pounds than that one murderous deed should escape detection. A medical inquiry without, as in many instances, a single medical element in it, appears to be an anomaly standing greatly in need of correction. 32 classes, which must have the effect of rendering them better members of society, more healthy, more useful, and more moral, will bo fully and completely realised.* GENERAL, REMARKS—CONCLUSION. One of the most striking, and at the same time most satisfactory results of the sanitation effected of late years in this sub-district, has been the gradual lessening of the distance, so to speak, which formerly existed in the death-scale applying to the labouring class and that applying to the other three social divisions employed in the mortality tables. In the past year the deaths amongst the labouring classes exceeded by only 10 the number registered as having occurred amongst the three other classes collectively, the former furnishing 67, and the latter 57. Before sanitary regulations came to be regarded as equally essential to the promotion and preservation of the health of the poor as of the more wealthy, the difference was as great as is indicated by the difference between 66 and 23, that being the ratio as ascertained in 1844. Another, and a no less gratifying result of the same sanitation, is the small percentage of deaths in the number of cases treated amongst the out-door Union poor of this parish (vide Table V. Appendix). Of 599 cases of disease and accident recorded in the Medical Relief Book there were registered 24 deaths, which is but 4 per cent of the cases treated. Not many years since, when the Union poor were much fewer, less crowded together, but under no kind of sanitary regulations, the per centage was infinitely higher, since more died then of preventible diseases. A very fair inference deducible from the two facts here referred to, notwithstanding an occasional epidemic visitation suffered (as in * The Registrar-General, speaking of the invasion of the faulty dwellings of the poor by disease, calls such disease "a health inspector that speaks a language which nobody can misunderstand; "and further he says— athe oversights, the errors of persons who in responsible offices have charge of the health and lives of men, are proclaimed aloud by this inexorable voice." A very natural desire then to avoid any such "proclamation" of neglected responsibilities on my part, induces me, in reference to the project of building new almshouses in this parish, to avail myself of the present opportunity of placing on record the opinion which was solicited of and given by me as a public sanitary officer—an opinion happily in accord with that entertained by all the most eminent sanitarians, by every one of my colleagues, and by the entire medical profession of the sub-district—that to furnish, as is proposed, only one room worthy of being called such to each recipient of the charity, is to perpetuate an evil of the greatest magnitude; and further, that it is (to use the words employed by Dr. Letheby, in a letter recently addressed to me on the subject) "to commit an act which nothing but absolute necessity, as limited means or space, could possibly justify, since it is contrary to the first principles of sanitary science." 33 the past year) in common with almost every district of the metropolis, is that Putney and Roehampton have still strong claims to be considered as amongst the most healthy of suburban localities. R. HARLAND WHITEMAN, Medical Officer of Health for Putney and Roehampton, and Chairman of the Associated Health Officers ' of the Wandsworth District. . APPENDIX OF STATISTICAL TABLES. TABLE I. Summary of Deaths and their Causes, registered in the Entire District during 1861, 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. Total Deaths from each class of Disease, &c., in the Entire District. Sub-Districts. Sex. Age. Social Position. Clapham—Population in 1861, 20,890, area in acres, 1,233. Wandsworth—Population in 1861, 13,346, area in acres, 2,478. Battersea—Population in 1861, 19,582, area in acres, 2,343. Putney—Population in 1861, 6,481, area in acres, 2,176. Streatham, Tooting, &Balham—Population 1861, 10,082, area acres, 3,465.' Males. J Females. 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. 60 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. Classes:— Small Pox 8 6 1 1 ... ... 4 4 2 3 2 7 ... 1 ... ... ... 2 1 5 Measles 7 ... 1 3 1 2 3 4 2 2 1 6 1 ... ... ... ... 2 1 4 Scarlatina 85 22 12 32 15 4 43 42 7 47 25 83 1 1 ... ... 1 3 18 63 Diphtheria . 22 13 1 8 ... ... 12 10 4 6 9 21 ... 1 ... ... ... 2 11 9 Quiney 1 1 ... ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... ... ... 1 Croup 7 2 3 ... 2 ... 4 3 1 6 ... 7 ... ... ... ... ... ... ... 7 Whooping Cough.. 46 14 4 21 1 6 20 26 21 25 ... 46 ... ... ... ... ... 3 5 38 1. Zymotic Typhus & Infantile Fever 31 5 3 19 2 2 13 18 •• 12 4 27 2 1 1 ... ... 1 12 18 Erysepelas 8 3 1 4 ... ... 6 2 4 ... 6 ... 2 ... ... ... 2 6 Metria, Childbirth 4 1 ... ... 1 2 ... 4 ... ... ... ... 4 ... ... ... ... ... 1 3 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza 3 3 ... ... ... ... ... 3 ... ... ... ... ... 1 1 1 ... ... 1 2 Diarrhœa and Dy- sentery. 63 16 15 26 2 4 39 24 47 9 1 58 2 1 2 ... ... 3 14 46 Cholera 3 ... ... 2 ... ... 2 ... ... 1 ... 2 ... ... ... ... ... ... 1 1 Totals of Zymotic Class 287 86 41 116 24 20 147 140 89 111 42 264 10 6 6 1 1 16 67 203 2. Tubercular 176 56 53 28 18 21 89 87 43 23 4 91 43 36 6 ... 2 9 30 135 3. Of Brain and Nerves 186 38 52 56 26 14 99 87 50 20 14 88 23 29 38 8 5 12 36 133 4. Of Heart 60 18 5 25 4 8 34 26 1 2 2 12 5 25 17 1 1 9 19 31 5. Of Respiratory Organs 249 55 27 135 13 19 129 120 56 46 3 115 41 47 46 ... 4 10 53 182 6. Of Digestive Organs 90 26 10 36 3 9 49 41 28 5 4 40 7 20 21 2 3 4 25 58 7. Of Urinary Organs 31 11 ... 8 5 7 22 9 1 ... 1 5 2 11 13 ... 1 4 13 13 8. Of Organs of ration 15 3 3 6 2 1 ... 15 ... ... ... 1 5 7 2 ... ... 2 3 10 9. Of Joints, Bones, &c. 9 5 ... 2 ... 4 5 ... ... ... 2 3 3 1 ... ... 2 4 3 10. Of Skin 1 1 ... .. ... ... 1 ... 1 ... ... 1 ... ... ... ... ... ... 1 ... 11. Premature Birth, Low Vitality, Malformation, &c. 92 34 14 24 11 9 51 41 86 3 1 92 ... ... ... ... 1 4 22 65 12. Of Uncertain Seat 40 12 17 ... 8 3 10 30 6 ... 2 9 3 10 l6 2 3 2 8 27 13. Ages 90 28 16 30 2 14 39 51 ... ... ... ... ... 1 42 47 4 4 31 51 14. Violence 29 6 2 15 5 1 17 12 3 4 3 11 6 5 6 1 ... 3 7 19 15. Not Specified 38 11 ... 24 1 2 17 21 5 ... 1 7 4 17 10 ... ... 3 7 28 Totals 1393 390 246 505 124 128 708 685 375 214 77 738 152 217 224 62 25 84 326 958 36 TABLE II. Births during the year ending 31st December, 1861. SUB-DISTRICT. Males. Females. Total. Clapham 313 311 524 Wandsworth 191 209 400 Battersea 364 386 750 Putney and Roehampton 78 91 169 Streatham, including Tooting & Balham 137 134 271 Total 1083 1131 2214 *** The excess of Births over Deaths in the entire district is 921. TABLE III. Meteorological Means for 1861, 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 39°9 51°8 60°4 45°5 49°4 Evaporation 38°7 48°7 56°6 43°9 47°0 Dew Point 36°9 45°6 53°2 41°9 44°4 Weight of Vapour in a Cubic Foot of Air 2.5 grs. 3.6 grs. 4.5 grs. 3.1 grs. 3.4 grs. Degree of Humidity (Satn 100) 89° 80° 78° 87° 84° Reading of Barometer 29.770 29.902 29.729 22.792 29.798 Weight of a Cubic Foot of Air 552 grs. 541 grs. 529 grs. 546 grs. 542 grs. Rain (amount of) 4.5 in. 4.5 in. 4.3 in. 7.4 in. 207 in. 37 TABLE IV. Showing the total Deaths from the principal Epidemic Diseases registered in each Sub-District, and in the entire District, and the relation which they bore to the total Mortality in the several years 1855-61. Deaths from Epidemics in each Sub-District. Entire District. Years. Clapham. Battersea. Wandsworth. Putney. Streatham. Total Deaths from Epidemics. Total Deaths Registered. Percentage 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 1861 76 112 30 21 18 257 1393 18.4 *** The Diseases included in the above Table are seven in number, and estimate,as in the Registrar-General's Returns, the principal maladies of the Zymotic class, viz., Small Pox, Measles, Scarlatina. Diphtheria, Hooping Cough, Diarrhœa, and Fever. TABLE V. Cases of Sickness amongst the Out-door Poor under the treatment of the Union Medical Officers, and the Deaths from each class of Disease, &c., during the Year that ended 31st December, 1861. Compiled from the 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. 7—Fever. 8—Erysipelas. 9—Puerperal Fever. 10—Lung Diseases, except Phthisis. 11—Phthisis. 12—Hydrocephalus, Atrophy, Scrofula, and Convulsions of Children. 13—Other Diseases. 14—Violence, Privation, and Premature Birth: Total Deaths in each Sub-District.  Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Clapham 1262 55 1 2 •• 21 3 23 1 123 2 •• •• 155 6 4 •• 1 1 133 6 27 13 12 1 639 23 64 •• 57 Wandsworth 1371 23 1 7 .. 30 5 16 1 210 2 .. .. 66 1 12 .. .. .. 166 10 12 4 9 3 790 8 .. .. 35 Battersea 970 4 1 23 •• 127 13 14 •• 128 .. .. .. 23 3 2 .. .. .. 191 5 6 3 •• •• 443 8 9 •• 33 Putney and Roehampton 599 1 •• 6 1 46 6 9 1 43 1 •• •• 40 1 3 3 •• 44 5 5 2 10 3 347 5 42 • • 24 Streatham, including Tooting and Balham 269 •• .. 2 •• 1 .. .. .. 20 1 •• •• 8 •• 2 .. .. .. 41 3 8 2 1 •• 173 4 13 • • 10 Totals 171 83 3 40 1 228 27 62 3 554 6 .. .. 292 11 23 .. 4. 1 575 29 58 24 33 7 2392 48 128 .. 159 39 TABLE VI. Summary of the Sanitary Operations in the entire District during the year 1861. Clapham. Battersea. Wandsworth Putney and Roehampton. Streatham, includingTooting& Balham Totals. Number of Houses and Premises inspected 800 800 352 153 128 2233 1st Notices served 29 40 20 32 30 159 2nd Notices served ... 4 2 ... 2 Cesspools emptied and cleansed 23 150 32 7 120 332 Cesspools abolished • •• • •• 12 34 4 50 Water-closets constructed 55 200 56 34 24 369 Houses supplied with Water 40 200 59 34 24 370 Drains constructed or connected with Sewer 22 33 56 34 37 182 No, of Feet of New Sewers, &c. 300 650 4000 ... 2590 7540 Drains repaired or trapped, or obstructions removed 3406 ft. 50 52 16 61 ... Open Ditches, Ponds, &c., cleansed 3850ft. 6 miles 5400ft. 5 31 ... Dust-bins provided 35 200 45 17 24 321 Pig Nuisances removed 10 10 ... 2 5 27 Accumulations of Offal, Manure, &c., removed 10 7 10 6 13 46 Unwholesome and dilapidated Houses cleansed or repaired 8 15 1 9 ... 33 Cases investigated by Magistrates ... ... ... 3 ... 3 Compulsory Orders obtained ... ... ... 3 • •• 3 Compulsory Works executed ... • • • ... 3 • •• 3 Works remaining in abeyance from various causes 3 1 • • • ... ... 4