WAN 14 SANITARY DEPARTMENT. REPORT ON THE SANITARY CONDITION of the several parishes comprised in the WANDSWORTH DISTRICT, For 1862. By the Medical Officers of Health. LONDON: m'coequodale & co., union hall, borough, s.e. WORKS, NEWTON. 1863. CONTENTS. s page 1. Introduction 3 2. Health and Sanitary Condition of the Entire District 4 3. Report on the Sub-District of Wandsworth, by Dr. G. E. Nicholas 7 4. „ on the Sub-District of Clapham, by Mr. J. MacDonogh 17 5. „ on the Sub-District of Battersea, by Dr. W. Connor 24 6. „ on the Sub-District of Streatham, by Dr. D. C. Noel 28 7. „ on the Sub-District of Putney, by Dr. R. H. Whiteman 34 8. Appendix of Statistical Tables, &c. 45 REPORT. To the Board of Works for the Wandsworth District. Gentlemen, We have the honour of submitting to your notice our respective contributions to the Annual Report for 1862 (the seventh year of our exertions under the Metropolis Local Management Act), together with the usual summary of the Health of the entire District, during J the same period. The Tables, both in the Local Summaries and in the Appendix, being constructed on forms that admit of ready comparison with those employed in previous years, it is unnecessary to say more in this place, than that the statistics embodied in these Tables have furnished us with materials for a Report, the reverse of discouraging. We have the honour to remain, Gentlemen, Your very obedient Servants, THE MEDICAL OFFICERS OF HEALTH of the wandsworth district. 4 HEALTH AND SANITARY CONDITION of the entire district. The deaths registered in the entire district during 1862, were 50 less than during 1861, the numbers being respectively 1,343 and 1,393. Building operations are rapidly progressing throughout the district, and the number of new houses erected since the census of 1861 must have been very considerable. The increase of population, therefore, by immigration alone, may be assumed to have been correspondingly large. If, however, the population has increased only in the same proportion as it was found to have done in the interval of 1851-61, which was 38.64 per 1,000 annually, it would, in the middle of the year 1862, (the year under consideration) amount to 72,832, or to an increase, since the last census, of 2,451 persons. mortality. The death-rate for the past year calculated upon the above basis, is 18.43 per 1,000 living; the birthrate, 30.89 per 1,000; and the rate of natural increase, 1246 per 1,000. Comparing the death-rate for the past year with that of the average of the 10 preceding years, (which was 19.57 per 1,000 living) it is found that there was, in round numbers, less mortality by one in every 1,000, in favour of 1862. In February, 1863, in an Annual Report of that date, the Registrar General writes:—"The south districts have achieved for themselves a marked improvement." This 5 is valuable testimony; and since the Wandsworth District is of the number of those referred to, it cannot be otherwise than gratifying to find, that whilst the mean annual rate of mortality of the southern districts collectively is 22.5 in every 1,000 living, that of this district individually, is, as above stated, only 18.43 in the same number. A comparison of the mortality tables accompanying the present local summaries with those for 1861, show, with one exception, a considerable decrease in the deathrate from the principal Zymotic diseases, and a very notable one, throughout the entire district, as regards the number of fatal cases amongst infants and children under 10 years of age. SICKNESS. By assuming the proportion which the deaths bear to the cases of sickness amongst the poor, as a measure of the proportion which the total deaths bear to the total cases of sickness amongst all classes, it is estimated that the amount of sickness under treatment, throughout the district, during the past year, was 58 per cent. on the population, and that one in every thirty attacks of sickness terminated fatally. sanitation. As may be seen by referring to Table VI. in the Appendix, a large amount of sanitary work has, as usual, been accomplished during the past year, the good effects of which it is hardly necessary to point out have been most apparent in those parishes in which the greatest extent of drainage, water supply, scavengering, paving, and other desirable sanitary measures have been made to reach the abodes of 6 the poor. It is hoped therefore the Special Reports about to be submitted by each of the local surveyors touching the application of a certain section of the Amended Metropolis Local Management Act to the bye-ways, courts and alleys of the several sub-districts, will lead to such an improvement in them all as to obviate the necessity of a reference to their general unhealthy condition in future reports. In order to facilitate the carrying out of these and other sanitary improvements, and to enable the Medical Officers of Health to accurately assign or bring home the local effects of disease to their local causes, it is extremely desirable that every part of the district should be permanently named, and every house numbered. Such a proceeding is strongly indicated by considerations of mere convenience, but to ensure a complete fulfilment of the requirements of sanitation it becomes a necessity. The prevalence of small-pox throughout the Metropolis has lately called for the adoption of stringent measures in reference to vaccination. The associated Medical Officers of Health of the Wandsworth District, have, in almost every one of their annual reports, ventured to offer some suggestions in reference to this important subject, and amongst the number, that of requiring the production of medical certificates of successful vaccination, by all parents seeking to obtain for their children admission into the public schools, has been specially dwelt upon. They offer no apology therefore for again calling the attention of the Board to this most necessary precaution, and they would beg to express an earnest hope that the authorities will assist in insuring its more general adoption. LOCAL SUMMARIES. WANDSWORTH. An examination of the Public Mortuary Returns and the Parochial Record of Sickness and Mortality, discloses a somewhat less satisfactory condition of the health of this sub-district during the year 1862 than has prevailed on an average since the existence of the Board of Works. The mortality was higher than usual; and the excess was, unhappily, due to a greater fatality from those diseases which it is the especial province of sanitation to prevent. death-rate. The total deaths which were registered as having occurred during the past year numbered 273; 136 were of males and 137 of females. The average number during the preceding 10 years, corrected for increase of population, was, exclusive of the cholera year (1854), 318; inclusive of that year, 328. From the foregoing figures, the mortality of the past year would appear to have been much below the average ; but, as has been explained in previous Reports, the death-register taken alone cannot be accepted as a trustworthy exponent of the health of this parish, in consequence of being unduly augmented by the mortality of the Surrey County Lunatic Asylum, whose inmates are derived from the whole county of 8 Surrey, and are sufficiently numerous to cause, by the fluctuations in their mortality, a notable disturbance of the death-register. Thus the mortality of the Asylum may be high, and the death-register consequently high, although the actual mortality proper to this parish may be low. The converse of this obtained last year. The mortality of the Asylum, as in the previous year, formed, in consequence of correspondingly fewer admissions, about one-sixth part of all deaths, in the place of about onethird which it averaged before that period; and it is this circumstance which causes the apparent lowness of the mortality of last year. The register also fails to show the deaths of Wandsworth parishioners who die in the workhouse; which, on account of the workhouse being situated in Battersea, are registered in that parish. In consequence of the foregoing conditions, the plan which has been adopted in determining the natural death-rate of this parish has been to exclude from the calculation the population and mortality of the Asylum, except such as is due to Wandsworth, and to add to it the deaths of Wandsworth parishioners which have occurred in the Workhouse. The death-rate for the past year, calculated in the manner just explained, was 18.61 per 1,000 persons living, or 1 per 1000 (nearly) higher than the average of the previous ten years. Birth-Rate—Rate of Natural Increase. The total births registered during the past year numbered 393, consisting of 197 males, and 196 females. The average of the preceding 10 years was 383. The birth-rate was 31 per 1,000, and the rate of natural increase, 12.67 per 1,000 of the entire population. 9 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 1861—13,346. Area in Acres—2,478. Total Deaths from each Class of Disease, &c. in the Sub-District Sex. Age. Social Position. Males 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. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle & Trading Class, Shopmen, Clerks, &c. Industrial & Labouring Classes. DISEASES, And other Causes of Death- Diseases Classified. Classes Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 28 15 13 6 19 3 28 ... ... ... ... ... ... ... 27 Scarlatina 2 1 1 ... 1 1 2 ... ... ... ... ... ... ... 2 Diphtheria 6 2 3 2 3 ... 5 ... ... ... ... ... ... 1 4 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 4 7 6 5 ... 11 ... ... ... ... ... ... 2 9 Zymotic Fever 11 8 3 ... 1 2 5 3 3 ... ... ... ... 1 10 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Metria, Childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea & Dysentery 5 2 3 2 2 ... 4 ... 1 ... ... ... ... ... 6 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 62 32 30 16 31 6 65 3 4 ... ... ... ... 5 57 2. Tubercular 46 21 25 8 6 1 18 16 11 1 ... 2 2 5 37 3. Of Brain, Nerves, &c. 46 26 19 5 5 1 12 8 15 10 ... 1 2 9 33 4. Of the Heart, &c 17 8 9 ... 1 1 2 2 5 8 ... ... 1 4 12 5. Of Respiratory Organs 30 20 10 9 7 ... 16 ... 8 6 ... ... 1 1 28 6. Of Digestive Organs 18 6 12 4 1 ... 6 2 6 3 ... l 1 6 10 7. Of the Kidneys, &c. 3 1 2 ... ... ... ... ... ... 3 ... ... 1 1 1 8. Of the Uterus, &c 5 ... 5 ... ... ... ... 1 2 2 ... ... 1 ... 4 9. Of Joints, Bones, &c ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality. Malformation. &c. 9 4 5 9 ... ... 9 ... ... ... ... 1 1 ... 7 12. Of Uncertain Seat 13 4 9 2 1 ... 3 1 2 7 ... 3 ... 3 7 13. Age 14 7 7 ... ... ... ... 4 10 ... ... 3 11 14. Violence 11 7 4 1 1 3 7 2 1 1 ... ... ... ... 11 15. Not Specified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 273 136 137 54 53 12 128 35 54 45 11 8 10 37 218 10 The prevalence of a severe epidemic of Measles, and the occurrence of a larger amount of Whooping-cough and Fever than usual, cause the Zymotic class of diseases (epidemic, endemic, contagious,) to stand foremost in the causation of the mortality of the past year, constituting upwards of 22½ per cent. of all deaths. Next in order of fatality was the Tubercular class, which includes Consumption and Scrofula, forming 16.8 per cent.; this class exceeded by one death only diseases of the Brain and Nervous system. Diseases of the respiratory organs (exclusive of consumption) formed about the same as last year, 10 per cent., which is considerably below the average. Diseases of the heart formed 6 per cent.; Consumption was the most fatal of any individual disease, and caused 11 per cent., or upwards of 1/8th of all deaths; next to it was Measles. The unusual number of 11 deaths were the result of violence; 7 of these accidental, 3 suicidal, and 1 homicidal. Twenty inquests were held during the year. In 11 instances the cause of death was not certified by medical testimony; in reference to which it may be well to reiterate the observation made in my last and previous reports, to the effect that, as in any of these cases death may have resulted from other than natural causes, the employment of medical investigation in all cases where the cause of death has not been certified by a registered medical practitioner would be extremely desirable, in order to prevent the possibility of secret crime escaping detection, and consequently be the means of deterring evil doers from its perpetration. 11 AGE AT DEATH. Upwards of 46 per cent. of all deaths occurred under 20 years of age; 39 per cent. under 5 years of age ; and nearly 20 per cent. died during the first year of life. SOCIAL POSITION. Nearly four-fifths of all deaths occurred amongst the labouring and industrial classes; and of the 62 deaths from epidemic diseases, 57 took place amongst them. On looking in the foregoing Table for an explanation of the higher death-rate of the past year, it is at once seen that such was due to a greater fatality from Zymotic diseases; hence it will be desirable to examine them more in detail, to ascertain the relation which they bore to each other as well as to the total deaths. EPIDEMIC DISEASES—PREVALENCE AND FATALITY OF. The following Table exhibits the deaths which resulted from the principal epidemic diseases during the past and six 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. entage of deaths from Epidemies 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 I 4 4 4 22 308 7.1 1861 1 1 12 1 4 8 3 30 246 12.1 1862 0 28 2 5 11 5 11 62 273 22.7 12 From this table it is seen that the proportion of deaths from Zymotic diseases to the deaths from all causes was nearly double the average of the preceding six years. It is unsatisfactory to find so large an increase in the mortality from these diseases, inasmuch as it is against the occurrence and extension of them that the preventive measures of the Sanitarian are most confidently projected. The excess is seen to have been produced principally by Measles, and partly by a greater fatality than usual from Fever and Whooping cough. Measles prevailed as a virulent epidemic during the latter six months of the year, and was attended with great fatality in the months of October and November. Whooping cough, Fever, and Diarrhoea, prevailed during the whole year— The first of these diseases was attended with fatality in February, March, April, May, November and December: the second in each of the first five months, July and August: and the third in February, August, September and October. Scarlatina prevailed during the first six months and the last, and was fatal in March and December. Diphtheria occurred to a slight extent in the first five months and the tenth, and was attended with fatality in March, April and October. No death resulted from Small-pox during the year. In the present year Smallpox has prevailed epidemically, and in common with the rest of the Metropolis this sub-district has not escaped its effects. As a very general alarm has existed in consequence of the prevalence of this pest, a tabular statement is here subjoined, showing the extent to which it has occurred during the past seven years. Table showing the total deaths which have taken place from Small-pox, in the sub-district of Wandsworth, during the seven years 1856—62; also the number of attacks 13 from that disease, with the resulting deaths which have occurred amongst the parochial poor during the same period:— SUB-DISTRICT OP WANDSWORTH- Area in Acres, 2,478. Population in 1861, 13,346. Years. Number of deaths from Small-Pox amongst all classes. Amongst the Parochial Poor. Attacks. Deaths. 1856 9 61 2 1857 0 0 0 1858 0 1 0 1859 2 16 2 1860 0 26 0 1861 1 23 1 1862 0 0 During the present year up to this date (May 30th, 1863,) there have occurred two deaths; and seven cases, two of which were modified by vaccination. The deaths were of persons unvaccinated. From the foregoing statement it is seen that Wandsworth has enjoyed comparative immunity from the disease. It should be added that vaccination is being extensively adopted, and that among the poor there is an increasing desire to avail themselves of its protective influence. SICKNESS AND MORTALITY AMONGST THE PAROCHIAL POOR. GENERAL SICKNESS—AMOUNT AND INTENSITY OF. Table V., in the Appendix, exhibits the total cases of sickness which came under treatment amongst the poor during the past year, the number of deaths which occurred, and the classes of disease which produced them. The information afforded by this record fully confirms 14 that which is conveyed by the death-register. The mortality amongst the poor was greater, the excess being due to a greater fatality from epidemic diseases. The total number of cases of sickness was 1410, and closely corresponded with the average of the preceding seven years. The deaths numbered 56, or 4 per cent. nearly (3.99) and exceeded the average by one third. Epidemic diseases numbered 419, or upwards of 29 per cent. of all the cases of sickness, the average being 358; and the deaths from these diseases 20, or about double the average. From the figures in this table, also, the amount and intensity of disease which has prevailed generally may be approximately estimated, by assuming the proportion of deaths to the cases of sickness amongst the poor as a measure of the proportion which the deaths bore to the cases of sickness amongst the inhabitants generally. From which calculation it appears that the cases of sickness (under treatment) must have been not less than 5891 during the past year, and that one death resulted from every 25 attacks: by a similar estimate, the average proportion of deaths to cases of sickness during the preceding six years, was 1 death in 34 attacks. SANITARY PROCEEDINGS. A summary of the sanitary proceedings which have been carried on during the year is contained in Table VI. of the Appendix. In addition to which a considerable amount of work, consisting in the removal of nuisances, has been done through the Surveyor, without the intervention of the Board. All the slaughter-houses and cowhouses were examined and reported on, previously to the procuring of licenses by their owners. These measures 15 have been carried on in the same way as heretofore, and, with one exception, without the aid of the law. The following proceeding was successfully adopted last year: Whenever infectious diseases were present, and particularly when death had resulted from them, the rooms of the houses in which such occurred were lime-whited, and when needing it, otherwise cleansed. Much benefit must result from this measure being thoroughly enforced; and the carrying out of it would be materially assisted if the landlords of small house property would adopt the more cleanly plan of distempering the walls of rooms in the place of papering them. Observation has afforded me ground for suspicion that the size and paste employed in papering rooms, when the walls are liable to dampness from without, or from within from the condensed exhalations arising from too many inmates, undergo decomposition, and become the means of sustaining the activity of any contagion which may have been present. In order that sanitary measures should be as efficient as possible in their ultimate application, it is desirable that they should be carried out in single detail. The circumstances and sanitary conditions associated with the occurrence of every death from infectious disease, and as far as possible with every attack of such like disease, require to be ascertained, and, if noxious, remedied. Hence it is necessary to know not only the locality, but the house and the room in which infection has presented itself. For the full attainment of the objects indicated it is imperatively necessary that every locality should have a fixed name, and that every house should be numbered; so that then a reference to the death register will exactly shew the house in which a death from infectious disease has occurred, and furnish the first trustworthy step in 16 ceeding, from a knowledge of the local effects, to a clear investigation of the local causes of disease. The higher death-rate of the past year, resulting as has been shewn from an excess of contagious disease, strongly urges the necessity for a renewed and persevering application of measures adapted for the removal of those many and various conditions which are found by all experience to extend and intensify disease of that nature, and which consist principally of those causes which prejudicially affect the healthfulness of dwellings. The fact that nearly four-fifths of all deaths—and, out of the 62 deaths from epidemic diseases, 57 occurred amongst the labouring classes—sufficiently marks out where these proceedings are most radically needed; while the very considerable improvement which has taken place in the health of this sub-district since the existence of the Board of Works, furnishes sufficient evidence for the conviction that such measures, if efficiently and perseveringly conducted, must be eventually attended with success. GEORGE EDWARD NICHOLAS, M.D., Medical Officer of Health for Wandsworth. CLAPHAM. The Table of Marriages, Births, and Deaths, with which I commenced my last annual report, and which I consider of much statistical import, I here reproduce, adding to it the figures relating to the year 1862. MARRIAGES, BIRTHS, AND DEATHS. Years. 1856 1857 1858 1859 1860 1861 1862 Marriages 154 151 150 156 183 182 175 Births 527 550 533 594 608 624 622 Deaths 286 321 344 328 429 390 343 Excess of Births over Deaths 241 229 189 266 179 234 279 By this Table it will be seen that the excess of births over deaths has been much greater in the past year than in any year since 1856, notwithstanding the marriages were fewer in number than in the two preceding years. To account for this last circumstance is somewhat difficult, but possibly the unhappy differences that have sprung up between employers and the employed may have had some influence in reducing the number of marriages, as it is everywhere found that such a result follows want of employment and diminished wages. B 18 STATISTICS OF MORTALITY, ETC. The excess of births over deaths will, of course, give the natural increase of population; and if the increase by immigration could be as correctly determined, a very just estimate might be formed of the present number of inhabitants, and a very accurate death-rate be at once deduced. The difficulty, however, of determining the increase which has taken place by immigration in such a fluctuating population as that of Clapham, necessarily obliges us to assume a good deal in calculating such death-rate. The population of this sub-district, at the census of 1861, was 20,890. The addition alone of the numbers representing the natural increase for the year, viz.—279, will bring the population up to 21,170. The deaths, then, being 343, it follows that the death-rate per 1000, without making any allowance for increase by immigration, will be under 17. With the lowest possible estimate for increase by immigration, the actual death-rate for the year cannot greatly exceed 16 per 1000. The deaths in 1861 were 390, or 47 more than in the past year, which is all the more satisfactory seeing that a very considerable proportion of this decrease in favour of the past year is due to a less fatality attendant upon zymotic diseases. The mortality table which follows shews that 63 deaths only took place as the result of epidemic maladies during 1862, whilst in the previous year the deaths from the same class of diseases amounted to as many as 86. Constructed as this Table is, with a view to shew the causes of death as well as the sex, ages, and social position of the deceased persons, it cannot fail of proving 19 tive beyond any verbal description of the same facts I might attempt to give in this place, and I therefore submit it with confidence as the best indication it is in my power to afford of the improving condition of this subdistrict. CLAPHAM. Population in 1861—20,890. Area in Acres—1,233. Total Deaths from each Class of Disease, &c. in the entire District Sex. Age. Social Position. Males 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 under40 years of age. At 40, and under 60 years of Age. At 60, and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, Ac. Middle & Trading Class, Shopmen, Clerks, Ac. Industrial A Labouring Classes. DISEASES, And other Causes of Death. Classes:— Small Pox 1 ... 1 ... ... 1 1 ... ... ... ... ... ... 1 ... Measles 6 3 3 4 2 ... 6 ... ... ... ... ... ... ... 6 Scarlatina 13 6 7 2 5 3 11 2 ... ... ... ... ... 2 11 Diphtheria. 3 ... 3 ... 3 ... 3 ... ... ... ... ... ... 2 1 Quinsy ... ... 2 1 1 ... 2 ... ... ... ... ... 1 ... 1 Croup 5 4 1 ... 4 1 5 ... ... ... ... ... ... 1 4 Whooping Cough 14 8 6 6 6 1 14 ... ... ... ... ... 2 ... 12 1. Zymotic Typhus and Infantile Fever 8 5 3 ... 5 ... 6 1 ... 1 ... ... ... 5 3 Erysipelas 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 Metria, Childbirth. 2 ... 2 ... ... ... ... 1 1 ... ... ... ... ... 2 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 Diarrhœa & Dysentery 7 2 5 3 1 ... 4 1 2 ... ... ... ... 1 6 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 63 31 32 16 27 6 52 5 4 2 ... ... 3 12 48 2. Tubercular 54 27 27 5 3 ... 13 25 13 3 ... ... 5 11 38 3. Of Brain and Nerves 31 14 17 5 4 3 15 2 6 8 ... ... 1 13 17 4. Of Heart 16 5 11 1 ... ... 1 3 7 5 ... ... 1 4 11 5. Of Respiratory Organs 38 20 18 14 4 1 20 1 3 12 2 ... 3 9 26 6. Of Digestive Organs 32 15 17 10 3 1 14 3 9 6 ... ... 5 11 16 7. Of Urinary Organs 6 4 2 ... ... ... 1 1 3 1 ... ... 1 3 2 8. Of Organs of Generation 2 1 1 ... ... ... ... ... 1 1 ... ... 1 1 ... 9. Of Joints, Bones, Ac. 3 ... 3 ... 1 1 3 ... ... ... ... ... ... 2 1 10. Of Skin 3 1 2 ... 1 1 2 ... 1 ... ... ... 1 1 1 11. Premature Birth, Low Vitality. Malformation, &c. 22 11 11 22 ... ... 22 ... ... ... ... ... 1 3 18 12. Of Uncertain Seat 4 1 3 1 ... ... 1 1 1 1 ... ... 1 1 2 13. Age 33 12 21 ... ... ... ... ... 7 12 14 ... 5 12 16 14. Violence 6 5 1 ... 1 1 3 1 1 ... ... ... 1 2 3 15. Not Specified 30 18 12 12 ... 1 13 6 8 3 ... ... 4 10 16 Totals 343 165 178 86 44 15 160 48 65 54 16 ... 33 95 215 20 ZYMOTIC DISEASES—THEIR PREVALENCE AND INTENSITY. By a reference to the above Table it will be seen that fever of a low type proved fatal in 8 cases, shewing that it must have prevailed extensively during the year; but happily the mortality—as was the case likewise with measles, scarlatina, diphtheria, whooping-cough, and diarrhoea—was comparatively light, taking into consideration the number of cases treated. From each of the above-named diseases, constituting the Registrar General's seven principal zymotic maladies, the resulting mortality was much less in the past than in any of the four preceding years; and this I consider a very encouraging circumstance, seeing how large has been the amount of epidemic disease noted during the year throughout the kingdom. SMALL POX AND VACCINATION. During the year 1862 I successfully vaccinated 206 individuals. The total number of births registered was 622; but I have good grounds for believing that scarcely the same number vaccinated by myself as the public vaccinator of the sub-district, could have been protected by the other medical practitioners in the neighbourhood. If, therefore, I am correct in my estimate, about a third of the children born during the year must have remained, at the termination of it, unprotected. Of course, some allowance is to be made for those infants who died within the three months, at or before the expiration of which the law enjoins the performance of the operation; but as these amounted to 37 only in the entire year, it will not very greatly affect the calculation. 21 In the years 1859 and 1861, the sub-district was severely visited by small-pox, and in the present year (1863) it is again unhappily the prevailing epidemic; promising to visit us still more severely, and to attack alike all classes and conditions of life, as well as all ages. The oldest patient under my care, a lady in affluent circumstances, was 57 years. A female of 50, a male of 32, and several between those ages, have also been assigned to my care, suffering more or less severely from this loathsome malady. I continue to supply most of my medical brethren in the neighbourhood with vaccine lymph, by which means I am kept tolerably well informed of the progress of the disease, and of vaccination in the parish. Most of my medical friends agree with me in the opinion that re-vaccination has become an absolute necessity. The neglect of vaccination in infant life I still have to deplore as a most serious evil, and when I mention the fact of having lately, by dint of great persuasion, brought under vaccination several adults, and sometimes as many as two, three, and four grown-up children in a family, who were previously unprotected, I cannot do otherwise than approve of the recommendation which emanated a short time ago from one of my colleagues (Dr. Whiteman), to the effect that your honourable Board and the Board of Guardians should unite in issuing cautionary notices as to vaccination. The manner in which this has been done by both Boards I have good grounds for stating has already resulted in giving a considerable check to the progress of small-pox in this populous locality. 22 ACCIDENTAL, VIOLENT, AND SUDDEN DEATHS. In the past year twelve inquests were held in this parish, and verdicts returned of three cases of "accidental or violent death," two of "sudden death," and seven of "natural or natural and sudden death;" but, as usual, medical testimony, (the chief element in enquiries of this kind) was dispensed with in the majority of instances, thereby setting at naught one of the statute laws of the land—the Registration Act, which enacts that the true cause of death should be ascertained in every case. It is strange that a desire on the part of the county magistrates to save a few medical fees to the county, (and instances have been known of their having disallowed such fees to coroners, even after they had been actually advanced by them to medical witnesses), should place our law administrators so justly under the imputation of being law breakers in every sense of the term ! SANITARY WORKS ACCOMPLISHED DURING THE YEARCONCLUSION. During the past year, as may be seen by a reference to Table VI. Appendix, a somewhat large amount of sanitary work has been designed and executed, and it will be acknowledged that your able surveyor has been more than usually energetic in the removal of nuisances, and in the accomplishment of that sanitation which we may reasonably hope is fast laying the foundation, so to speak, of a high sanitary status for this rapidly increasing subdistrict. Apart from the number of houses and premises inspected by your surveyor and myself, there has taken 23 place the usual sanitary supervision of all the slaughterhouses within the parish; and this year, for the first time, of all the cow-houses of those proprietors who have desired to hold licenses under the amended Metropolis Local Management Act. The length of new sewers executed, and the extent of open ditches, &c., cleansed, has been during the past year something considerable; and this, taken with the fact of preparations having been made to extend the high level main sewer through certain parts of the sub-district, which have long stood in need of this great work, cannot fail to reassure those of the inhabitants who were beginning to despair of the realization of this grand sanitary measure, that the authorities under whose direction the sewer is to be constructed, are now really in earnest in carrying out the important undertaking referred to. The progress of a work so greatly calculated to benefit this parish will, no doubt, be watched with deep interest by many a local sanitarian; but by no one with deeper interest than myself. JOHN MacDONOGH, Medical Officer of Health for Clapham. BATTERSEA. The total number of deaths from disease and other causes registered in this sub-district during the year 1862, numbered 491; 250 males and 241 females—being 14 less than in the previous year. Of the 491 deaths enumerated in the appended table, 109 occurred in the workhouse situated in this sub-district, the infirmary of which continues to be the recipient of a large number both of acute and chronic cases befalling the poor in the seven parishes comprising the Wandsworth and Clapham Union. A large proportion of the cases admitted are of persons in an exhausted and hopeless condition. Of the 109 deaths registered as having taken place in the workhouse, 80 were of individuals in no way connected with the parish of Battersea. Deducting, then, these deaths from the gross number it would reduce the number proper to the parish to 411, which, in comparison with that of former years, will not be found to be a very large per centage in a population, estimated as being now considerably over 20,000. By what is called the natural increase, as shown by the excess of births over deaths, the population of Battersea would amount to 20,146. What the increase by immigration may have been during the year it would be difficult to determine with accuracy; but assuming it to have been one-half less than the natural increase, it would, when also added to the population of the census of 1861, bring the number of inhabitants up to 20,292, 25 or in round numbers 20,300. The deaths proper to the parish having numbered 411, it would place the rate of mortality for the year at about 20 in every thousand living. The following table gives the number of deaths that have been registered during the year 1862 from all causes, and amongst all classes, specifying the sex, age, and social position of the deceased:— BATTERSEA. Population in 1861—19,852. Area in Statute Acres—2,343. Total Deaths from each Class of Disease, &c. in the Sub-District Sex. Age. Social Position. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. Under20years including all under 10 years At 20, and under40 years of age. At 40, and under 60 years of Age. At 60, and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants. Bankers. &c. Middle & Trading Class, Shopmen, Clerks, Ac. Industrial & Labouring Classes. DISEASES, And other Causes of Death. Classes:— Small Pox 2 1 1 ... ... ... ... 2 ... ... ... ... ... ... 2 Measles 16 6 10 3 11 1 16 ... ... ... ... ... 2 4 10 Scarlatina 15 8 7 2 8 4 15 ... ... ... ... ... 2 6 8 Diphtheria 8 6 2 2 3 ... 6 ... 1 1 ... ... 1 3 4 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 25 8 17 7 18 ... 25 ... ... ... ... ... ... 8 17 1. Zymotic Typhus and) Infantile Fever 17 8 9 ... 5 5 12 1 1 2 1 ... 1 2 14 Erysipelas 7 2 6 1 ... ... 2 3 ... 1 1 ... ... ... 7 Metria, Childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 22 12 10 11 5 ... 16 ... 2 4 ... ... 4 4 14 Cholera 1 ... 1 ... ... ... ... ... 1 ... ... ... ... 1 ... Totals of Zymotic Class 113 51 62 26 50 10 92 6 5 8 2 ... 8 27 78 2. Tubercular 58 31 27 5 3 1 15 25 16 2 ... 3 4 9 42 3. Of Brain and Nerves 81 42 39 25 13 ... 38 10 8 22 3 ... 4 15 62 4. Of Heart 10 8 2 ... ... ... 1 2 2 5 ... ... 2 2 6 5. Of Respiratory Organs 83 42 41 20 26 ... 46 8 12 14 3 1 1 20 61 6. Of Digestive Organs 29 19 10 9 4 1 14 4 4 7 ... 1 1 6 21 7. Of Urinary Organs 2 2 ... ... ... ... ... ... ... 1 1 ... ... 1 1 8. Of Organs of Generation 3 ... 3 ... ... ... ... ... 2 1 ... ... ... ... 3 9. Of Joints, Bones, &c 2 1 1 ... ... ... ... ... 2 ... ... ... ... 1 1 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, 42 23 19 39 2 ... 41 1 ... ... ... ... 2 4 36 12. Of Uncertain Seat ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13. Age 33 11 22 ... ... ... ... ... ... 16 17 1 1 2 29 14. Violence 12 10 2 2 ... 1 4 2 3 3 ... ... ... 1 11 15. Not Specified 23 10 13 7 1 ... 9 1 9 4 ... l 2 3 17 Totals 491 250 241 133 99 13 260 59 63 83 26 7 25 91 368 26 PREVALENCE AND FATALITY OF ZYMOTIC DISEASES. Diseases of this class have been somewhat less fatal during the past year than during 1861, the numbers being respectively 113 and 116. Scarlatina, diarrhoea, and fever have been less fatal. The deaths from measles and whooping cough have slightly increased; but two deaths from small pox were registered during the year. MORTALITY IN THE WORKHOUSE. Of the 491 registered deaths in the sub-district, 109 as before stated died in the workhouse: 21 between the ages of 70 and 80, 12 between 80 and 90, and 2 between 90 and 100, the oldest having reached the age of 93. INFANT MORTALITY—PROPORTION OF BIRTHS TO DEATHS. The mortality of children between birth and 10 years of age has considerably decreased, 150 being the number registered in the past year, against 269 in the preceding one; and this I take to be a good indication of advancing and well-directed sanitation. There have been 785 births during the year—384 males and 400 females, presenting an excess of 293 births over deaths; which excess gives, of course, the natural increase of the population. The excess noted is much larger than the average of three years 1859—61, which is only 188. This large natural increase also favours the view taken of the sanitation carried out in this sub-district, having exercised a very great influence in promoting the health and comfort of the inhabitants. SICKNESS AND MORTALITY AMONGST THE OUT-DOOR POOR. The Table No. V. in the Appendix, exhibits the nature 27 and amount of sickness amongst the pauper population of the sub-district, (exclusive of that treated in the workhouse), as well as the deaths that have resulted from disease and other causes. Of the 747 cases of sickness, accidents, &c., treated, and being registered in the medical relief book during the past year, 10 only are noted as having terminated fatally; being a rate of mortality very considerably less than has appeared in corresponding tables for many years past, a circumstance which strengthens the remark made in my last Report, that this particular class (the out-door poor) must have benefited considerably by the sanitary improvements that have been effected within the last few years. PREVENTIVE MEASURES ADOPTED DURING THE YEAR— AMOUNT OF SANITARY WORKS PERFORMED. The amount and kind of sanitary work executed within the sub-district during the year, may be gathered from a perusal of Table VI., Appendix. It will be manifest by a reference to the column of this table applying to this parish, that there has been no abatement of the energy with which sanitary improvements have been carried out in former years; indeed it must be conceded to this subdistrict that, seeing the many drawbacks which every large manufacturing population always presents to the attainment of a high sanitary status, it has, during the seven years of the operation of the Metropolis Local Management Act, made great advances towards that which legislation has sought to accomplish. WILLIAM CONNOR, Medical Officer of Health for the Sub-district of Battersea. STREATHAM, including TOOTING AND BALHAM. Notwithstanding the increase of population of this subdistrict since the last annual report, the mortality was one less in the past year than it was in 1861. The natural increase of the population, as shewn by the excess of births over deaths in the year 1862, is 137. If then, we add to this only about a third of that number as the increase by new residents since the census of 1861, it may be safely assumed that the inhabitants now number 10,250, at the very least. The registered deaths of the past year having amounted to 129, it follows that the death-rate for the year, under review, must have been only a fraction above 12 in every 1,000 living. This is all the more satisfactory, seeing that amongst the labouring classes the deaths have, for some years past, been gradually diminishing, thus confirming the inference that the sanitation carried out under the direction of your Board—especially the sewerage—must have been of no small benefit to those who always suffer the most from preventible diseases. In the past year, 10 less of the labouring class have succumbed to disease, accident, &c., than in 1861, and 14 less than in 1860. The appended Table of mortality embodies, as usual, a large amount of information in a concise form; and as it exhibits the classified causes of death, as well as the sex, age, and social position of the deceased persons, it 29 may be studied with great advantage, in connection with the Tables in former annual reports, by such as desire to mark the progress which this sub-district is making towards the realization of the best hopes of sanitarians, from the operation of the Metropolis Local Management Act. STREATHAM, including TOOTING and BALHAM. Population in 1861—10,052. Area in Statute Acres—3,465. 1 Total Deaths from each Class of | Disease, &c. in the Sub-District. Sex. Age. Social Position. Males. Females. Under 1 year. | From 1 to 5 years. | From 5 to 10 yeara. Under20 years including all under 10 years. At 20, and under40 years of age. At 40, and under 60 years of Age. At 60, and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle & Trading Class, Shopmen, Clerks, &c. Industrial & Labouring Classes. DISEASES, And other Causes of Death. Classes:— 1. Zymotic Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlatina 6 4 2 ... 5 ... 6 ... ... ... ... ... ... ... 6 Diphtheria 2 ... 2 ... 1 ... 2 ... ... ... ... ... 2 ... ... Quinsy 1 1 ... ... 1 ... 1 ... ... ... ... ... ... ... 1 Croup 2 1 1 1 1 ... 2 ... ... ... ... ... ... 1 1 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus and Infantile Fever 5 2 3 ... 1 1 2 2 1 ... ... ... 2 1 2 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Metria, Childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea & Dysentery 3 ... 3 ... 1 ... 2 1 ... ... ... ... ... 1 2 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 19 8 11 2 10 1 15 3 1 ... ... ... 4 3 12 2. Tubercular 14 6 8 1 2 ... 5 4 2 3 ... ... 2 7 5 3. Of Brain and Nerves 16 5 11 3 2 ... 5 3 1 6 1 ... 6 6 4 4. Of Heart 19 10 9 2 ... ... 3 2 2 12 ... ... 6 7 6 5. Of Respiratory Organs 14 6 8 4 3 ... 7 ... 2 6 ... ... 2 4 8 6. Of Digestive Organs 12 5 7 1 ... ... 1 3 4 3 1 2 2 2 6 7. Of Urinary Organs 6 4 2 ... ... ... ... ... 3 3 ... ... ... 3 3 8. Of Organs of Generation 3 ... 3 ... ... ... ... ... ... 3 ... ... 1 ... 2 9. Of Joints, Bones, &c 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... 10. Of Skin ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Malformation, &c. 6 4 2 6 ... ... 6 ... ... ... ... ... ... 1 5 12. Of Uncertain Seat 2 2 ... ... ... ... ... ... 1 1 ... ... ... 2 ... 13. Age 12 4 8 ... ... ... ... ... ... 3 9 1 1 6 4 14. Violence 2 1 1 ... ... ... ... 1 ... l ... ... ... ... 1 15. Not Specified 3 2 1 ... ... ... ... ... 1 2 ... ... 1 1 1 Totals 129 58 71 19 17 2 42 16 18 42 11 4 25 42 58 30 ZYMOTIC DISEASES. If we except scarlatina and diphtheria, to which diseases 8 persons have succumbed during the past year, it will not be found that the sub-district has suffered very greatly from the epidemic class of maladies; indeed, the above Table exhibits one death less, under this head, than in 1861, the numbers being respectively 19 and 20. Although small-pox has, since the termination of 1862, become very rife throughout the metropolis and suburbs, not a death from this disease was registered in the past year in the several parishes constituting this sub-district; and it is with no small regret that it is now found to be spreading somewhat alarmingly amongst all classes. The neglect of vaccination is, I believe, the main cause of this; and it is a question whether re-vaccination ought not to be generally practised, seeing how many exceptions there are to the general rule of vaccination in infancy protecting the individual throughout life. The isolation of patients, especially those of the poorer classes, suffering from small-pox, is another point in every way deserving the consideration of the authorities. Until the Compulsory Vaccination Act is properly carried out, and local infirmaries established in every union, it is feared this highly infectious disease will spread, in spite of every other care and precaution. INFANT MORTALITY.—MORTALITY AMONGST THE AGED. It is most gratifying to be able to refer to the diminished number of fatal cases of sickness amongst infants and 31 young persons, from birth to 10 years of age. During 18G2, 19 infants under 1 year succumbed, against 25 in the year preceding. From 1 to 5 years, the decrease is in the proportion of 17 to 21 in favour of the past year, whilst the deaths between 5 and 10 are the same in both years, viz., 2. In the aggregate, i.e., from birth to 10 years of age, there is a saving of life to the extent of 8 in favour of 1862. A somewhat large number of aged persons have succumbed during the year. The number registered as being between 80 and 100 years was 11, and between 60 and 80 as many as 42. The oldest (a female) had reached the advanced age of 95. There are two others registered at 87, and one at 88. The average age of the 11 persons dying above 80 years is 84 and a fraction, and their united ages amounts to no less than 928 years. The subdistrict has long been noted for the longevity of its inhabitants, and affords, I think, another proof of its salubrity and high sanitary status. SICKNESS AND MORTALITY AMONGST THE UNION POOR. Table V., Appendix, exhibits as usual, the number of cases and the general character of the sickness amongst the out-door poor of this sub-district, compiled from the relief books of the Union Medical Officers. Compared with the numbers in the Table appended to the Report of 1861, there is shewn a very considerable decrease in the number of cases, and a slight one in the number of deaths. In the cases treated, there is a decrease of 75—the numbers being respectively 194 and 269. In the deaths, there is a decrease of 1—the numbers being 9 in 1862, against 32 10 in the preceding year. In 1860, the deaths amongst the union poor were 20 in 247 cases treated, so that there can be but little doubt that sanitation, amongst the poor more particularly, is exercising some good influences in this sub-district. SANITARY OPERATIONS DURING THE YEAR. By a reference to Table VI., Appendix, it will be noticed that great exertions are being continued to sus- tain in all their efficiency the sanitary improvements already executed under the authority of your Board. The addition made during the year to the sewerage of the sub-district has been to the extent of 1,106 feet. In the year preceding the one under review, 2,590 feet of new sewers were completed. Whilst the drains constructed and connected with the main sewers have been numerous, very many houses have been supplied with water, a large number of nuisances abolished, and many improvements of a most beneficial character secured to the neighbourhood. In addition to the usual inspection of, and report on, the slaughter houses—the cow houses within the subdistrict have, during the past year, received attention, and under the Amended Metropolis Local Management Act, have all been regulated, in accordance with the requirements of the law. I have much pleasure in stating that all these places are now in a good sanitary condition, and that it will, under the Act, be the duty of the proprietors to keep them so, in order to maintain their licences from year to year. 33 I can only add, that I shall continue to use my best exertions to maintain the good sanitary status which this sub-district has acquired; and I venture to predict a still more favourable condition of the public health of the locality than even appears in this report, when other contemplated reforms shall have been matured and successfully carried out. D. C. NOEL, Medical Officer of Health for Streatham, Tooting, and Batham. c PUTNEY & ROEHAMPTON. It is with much satisfaction that I present the following favourable report of the sanitary condition of this subdistrict for the year 1862. Not only does the appended table of mortality exhibit a manifest decrease in the number of deaths from all causes, but it furnishes additional evidence of a fact frequently referred to in former reports,—that zymotic diseases, which it is the more immediate object of sanitation to control, are now attended with much less suffering, and as a consequence, with much less fatality than was formerly the case, before any really systematic efforts were made to oppose their invasion or to deprive them of their virulence. Another, and a no less important feature of the table referred to, is the record of much less mortality amongst the infant and youthful portion of the population than has been presented in former tables for several years past. MORTALITY AND CAUSES OF DEATH. The present table is constructed, as usual, with the view to shew, not only the causes of death, but the sex, age, and social position of the deceased persons, and is here referred to with much satisfaction as evidencing a most manifest improvement in the public health of the locality, 35 so far as the mortality test can be brought to bear upon the question. PUTNEY and ROEHAMPTON. Population in 1861—6,481. Area in Statute Acres—2,176. Total Deaths from each Class of Disease, &c. in the Sub-District Six. Age. Social Position Males Females. 1 Under 1 year. From 1 to 5 years. From 5 to 10 years. Under 20 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 Gentry. Professional Class, Merchants, Bankers, &c. 1 Middle & Trading Class, Shopmen, Clerks, &c. Industrial & Labouring Classes. DISEASES, And other Causes of Death. Classes Small Pox Measles ... Scarlatoma 1 2 Diphtheria 1 9 2 1 3 1 1 1 Quinsy Croup 3 1 1 3 3 2 1 Whooping Cough 1 ... 1 1 ... 1 ... 1 L Zymotic Typhus and Infantile Fever 2 1 1 ... 1 1 ... 1 ... 1 ... Erysipelas ... ... ... ... ... ... Metria, Childbirth ... ... ... ... Carbuncle Influenza Diarrhœa & Dysentery 5 1 4 3 ... 3 1 1 ... ... 2 3 Cholera ... ... Totals of Zymotic Class 16 4 12 5 6 1 12 1 2 1 ... 2 3 3 8 2. Tubercular 13 6 7 1 2 ... 5 7 1 ... ... 2 ... 3 8 3. Of Brain and Nerves 10 5 5 ... ... 1 1 1 1 6 1 2 2 3 3 4. Of Heart 7 4 3 ... ... ... ... 3 2 2 ... ... ... 3 4 5. Of Respiratory Oragans 16 8 8 3 1 ... 4 2 2 7 1 4 1 6 5 6. Of Digestive Organs 11 3 8 2 ... 1 3 1 4 3 ... ... 2 2 7 7. Of Urinary Organs 4 1 3 ... ... ... ... 1 1 2 ... ... 1 3 ... 8. Of Organs of Generation 1 ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 1 9. Of Joints, Bones, &c 3 ... 3 ... ... ... ... ... ... 2 1 ... 1 ... 2 10. Of Skin 2 1 1 1 ... ... 1 1 ... ... ... ... ... ... 2 11. Premature Birth, Low Vitality, Malforma- tion, &c 4 1 3 4 ... ... 4 ... ... ... ... ... ... 1 3 12. Of Uncertain Seat 6 ... 6 ... ... ... ... ... 4 7 ... 1 ... 4 1 13. Age 7 4 3 ... ... ... ... ... ... 4 3 ... ... 2 5 14. Violence 4 3 1 ... 1 ... 3 1 ... ... ... ... ... 2 2 15. Not Specified 3 1 2 1 ... ... 1 ... 1 1 ... 1 ... ... 2 Totals 107 41 66 17 11 3 35 18 18 30 6 12 10 32 53 As the above table has been constructed in such a manner as to admit of ready comparison with those of previous years, and as most of the points upon which 36 such statistics specially bear have been very fully discussed in former reports, it is unnecessary to do more than very briefly refer in this place to the leading results of the comparison that has been made of the present table with that of 1861. These are:—1. That less deaths by 17 occurred in the sub-district in 1862 than in the previous year. 2. That the deaths resulting from the seven principal zymotic diseases, viz., small pox, scarlatina, measles, diphtheria, whooping cough, fever, and diarrhoea, were less in the past than in the previous year in the proportion of 13 to 21. 3. That the deaths of infants and young persons between birth and 10 years of age have diminished more than one half—67 having succumbed in 1861, and only 31 in the year under review. The deaths registered in the past year from infirmity of age, were seven; from violence, four; and from premature birth, low vitality, and malformation, four. Deducting then the 15 deaths under the above three heads as the result of causes considered to fall more strictly under the denomination of accidental, the mortality from disease alone in the year under consideration will be reduced to 92, or 13 below that which was noted in 1861, after a similar deduction had been made. In the Royal Hospital for Incurables there were 12 deaths in the past year against seven in the previous one. As the mortality in this public institution, receiving as it does incurable cases from all parts of the kingdom, has to be duly considered in estimating the rate of mortality proper to the locality, these last named deaths may, as in former years, be fairly placed as a set-off against those of inhabitants taking place out of the parish, viz., in the Union Infirmary, and in the London and other Hospitals. 37 There is every reason, however, to believe that the deaths in the above-named institution, during 1862, somewhat exceeded those of the inhabitants away from the parish; still, if the same calculation be made from year to year, the average will, it is believed, give a very close approximation to a fair balance in the particular referred to. RATE OF MORTALITY. The population of this locality as a suburban parish is fast increasing, especially by immigration, so that to ascertain accurately its rate of increase, or the exact number of its inhabitants at a given period, would be next to impossible, unless a local census were periodically and systematically taken. It appears that 42 new houses have been completed within the past year, and that several others are in the course of erection. Scarcely any of these dwellings, however, have been designed for the poorer classes, and overcrowding amongst them must, as a consequence, be greatly on the increase. These circumstances considered, the difficulty of estimating by how much the population has increased, and is still increasing, by the influx alone of new residents, must be apparent. Making the calculation upon an assumed population of 6,559 only, or 78 above what it was estimated in 1861, (which is the natural increase of the year, as shewn by the excess of births over deaths), the rate of mortality is found to be 16.4 per 1,000 living. If due correction be made for increase by immigration as well as for natural increase, the death-rate would, of course, be considerably under the above figures. So long, however, as a town or metropolitan locality keeps 38 its rate of mortality below 17 per 1,000, so long may it feel justly proud of its relative sanitary position; inasmuch as but few rural parishes can boast of a much lower rate than that above-named. PROGRESS OF MORTALITY. The Table which follows exhibits the mortality within the registration district of Putney during the four quarters of 1862, viewed in connexion with four of the principal meteorological readings of those periods, thus affording the means of judging how far temperature, humidity, amount of rain, &c.,may have influenced the fatality that has attended the different classes of disease at different seasons of the past year. / REGISTERED CAUSES OF DEATH. NUMBER OF DEATHS. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. The Year. Zymotic Diseases (epidemic, endemic, and contagious) 2 0 6 8 16 Diseases of the Respiratory organs, including Phthisis 9 8 7 4 28 Other Diseases 17 7 14 9 47 Accidental and violent deaths, and deaths from malformation, premature birth, &c 4 4 1 0 9 Old Age [natural decay] 4 2 1 0 7 Totals 36 21 29 21 107 Meteorological Readings. Mean temperature of air 4101 53°3 58°7 45°0 49°5 „ Degree of Humidity 85° 80° 81° 89° 84° „ Readings of Barometer 29.770 29.902 29.729 29.792 29.798 Amount of Rain 4.5 in. 4.5 in. 4.3 in. 7.4 in. 20.7 in This Table will also point out the relative number of deaths in each quarter from each classified cause. 39 PREVALENCE AND FATALITY OF ZYMOTIC DISEASES. With reference to zymotic diseases, it is satisfactory to note a considerable decrease in the number of deaths, (from 24 to 16), in favour of 1862, compared with 1861. Whilst scarlatina numbered 15 victims in 1861, there were but 2 deaths registered from this cause in the past year. From neither small-pox nor measles were there registered any deaths whatever, though the latter disease prevailed extensively at the decline of the year. Small-pox began to shew itself in December, in the year under review, and resulted in death in one instance at the Small-Pox Hospital, where the case was, of course, registered, and hence is not noted in the mortality table appended to this Report. Since this period, the disease has unfortunately spread to some extent amongst all classes of inhabitants; but less amongst the parish poor than any other class. Only one fatal case has happily been registered in the present year, and down to the time of presenting this Report. It is also satisfactory to be able to state, that in no case within my own knowledge has the disease proved fatal, or caused disfigurement in those who had been previously and successfully vaccinated. In both the fatal cases it should be noted, the sufferers were wholly without this protection. In a series of local reports on small-pox emanating from the Metropolitan Medical Officers of Health, and recently published in the Medical Times and Gazette, the practice of re-vaccination is very generally advocated. I have myself a strong opinion that vaccination performed even simultaneously with the first appearance of the small-pox eruption will, in the majority of persons, not only greatly modify the disease, but arrest its fatal 40 tendency; and I am confirmed in such opinion by the cases noted in the following extract from my own contribution (June 13th, 1863,) to the series of papers above referred to— " Until December of last year, small-pox had for a long series of years been absent from this parish and adjoining hamlet. The first of about a dozen cases noted between the latter part of 1862 and the present time, occurred to an unvaccinated labouring man, who had just before removed into the parish. This case proved fatal in the Small-Pox Hospital, to which insti ution the patient was removed shortly after the appearance of the disease, and the death was, of course, registered there. The remains of the poor man, however, were brought from the Hospital to be buried in this neighbourhood. A brother of the deceased living in Putney attended the funeral, and contracted the disease; but having accidentally heard that this man was also unvaccinated, I persuaded him, although symptoms of the malady were then plainly visible, to submit himself at once to the operation, and a more decided proof ot its protective power I could not have received. The two diseases—the vaccine and the varioloid—went through their course together, and presented all the characteristic phenomena of each, but the one so modified the other that the patient recovered without a bad symptom. " The only other fatal case of which I am cognizant occurred to an unvaccinated nurse-child, nine months old, who it appears was not born in the parish, and whose unprotected condition was therefore unknown and unsusper ted until too late to remedy the evil. Two other persons residing in the same house in which this infant died, viz., a boy of 12 and a girl of 16, shortly afterwards took the disease. Whilst attending the infant, I noticed this boy and girl looking very ill, and, suspecting the cause, I urged the performance of vaccination on thern both. The boy submitted, being then unprotected, and he had the varioloid disease very slightly, and made a good and speedy recovery. Not so, however, the girl; who, relying on the efficiency of her vaccination in infancy (though I had great doubts whether the operation had ever been performed), was much opposed to its performance, and the consequence has been she has experienced a prolonged and painful convalescence; and will, doubtless, carry about with her to her latest hour the most unmistakeable facial indications of the virulence of the malady from which she has suffered. " I could cite many cases of a like kind from the records of a practice of nearly thirty years, during the greater part of which time I have performed the functions of a public vaccinator; but the above are referred to as having recently afforded to my own mind strong evidence that vaccination, submitted to even at the eleventh hour, does largely protect against the virulence and fatality of smallpox, if it accomplishes nothing more. My own experience is that, when properly performed, carefully inspected on the eighth day, and pronounced by a skilled 41 operator to have put on all the characteristic appearances of the true vaccine vesicle, as described by Jenner, it may be relied on as a perfect protection through life, in a large majority of cases, but since there are so many exceptions, and as it is an undoubted fact that many persons do take small-pox, though the most efficient vaccination has been accomplished in infancy, the question of re-vaccination becomes one of serious import to medical men, to whom the public are just now looking tor advice and direction upon so debateable a point. " The absolute infallibility of primary vaccination few practical men of the present day will be found to maintain, any more than they will the uniform action of the best established remedial agents. Persons of particular habits or idiosyncrasies there always will be in whom the most careful administration of well-known drugs will be followed by the most extraordinary and unlooked-for results, and it is not likely that cow-pock inoculation will be found uniformly exempt from all departures from its ordinary issues. " Whenever appealed to by the sceptical or the hesitating as to the desirability of re-vaccination, my reply is, that as the occasional introduction of genuine and well-selected vaccine lymph into the arms of young persons and adults is, with very few exceptions, attended by no other inconvenience than a slight and bearable irritation, and the most trifling constitutional disturbance, most medical men are disposed to look upon it as a very simple, but at the same time very valuable test of the efficiency, or otherwise, of previous vaccinations ; for should such re-vaccination fail to produce a perfect vesicle, what, I usually ask, can be more satisfactory than to feel assured that the protection afforded by the operation in infancy remains, in all probability, unimpaired? On the contrary, should it result in the production of the perfect vesicle, is it not something to feel more secure than before against the virulence of the disease, and the fatality so frequently attending it when occurring in the unprotected ? This kind of reasoning I generally find suffices to remove the scruples of those of my patients who are really capable of being reasoned with on such a subject. I am pleased to add that the authorities of this district are fully alive to the necessity of adopting measures for the isolation of the poor suffering from small pox, and that suitable conveyances have been placed at the disposal of the public to secure the easy and speedy removal of all desiring such isolation." SICKNESS AND MORTALITY AMONGST THE UNION POOR. Table IV., Appendix, concisely exhibits both the nature and amount of sickness which prevailed during the past year amongst the out-door poor of this parish, as well as its resulting mortality. Of 450 cases of sickness, accident, &c., that came under treatment, 16 deaths only appear to have resulted, which is a fraction over 42 per cent. This not only represents a less amount of sickness than appeared in the table of last year, but a less mortality by 8 ; the numbers being in 1861—cases, 599, and deaths, 24. It is most gratifying to note so manifest and persistent a result of sanitation. The steadily progressive improvement observable in the health of the Union poor of this sub-district, since sanitary regulations have found their way into and about their dwelling places, inspires a confident belief that well sustained efforts in the same direction will still further reduce the rate of mortality amongst them. SANITATION OF THE PAST YEAR—ITS AMOUNT AND EFFICIENCY. A reference to Table VI, in the Appendix, will show that much was accomplished during the year, in the way of the most beneficial sanitation, and that a large number of nuisances of various kinds were abated or removed. The Table also indicates that there were as many as 2,340 feet of new sewers constructed during the year, and many necessary repairs accomplished and improvements introduced into existing drains, water-courses, and the like; the combined effect* of which, it is believed, cannot prove otherwise than most beneficial to the neighbourhood. It should be stated that the construction of new sewers in this parish, during the past year, has been principally for the purpose of effecting the surface drainage of new roads on the Eoehampton Park Estate, and that the drains, gullies, &c., have been there laid down, at the cost of the owners of that property. A portion of the old sewer in High-street, Eoehampton, having been found in a defective condition, was taken up and reinstated by a twelve-inch pipe drain. A new sewer in Roehampton Lane, is about to be commenced by the Conservative Land Society, and in addition to which a sewer of 200 feet in length, as sanctioned by your Board, is to be reconstructed there at the expense of the parish. To effect the back drainage of certain new houses on the north side of the Upper Richmond-road, 43 200 feet of pipe sewer have been laid down at the expense of the owners, and numerous private drains throughout the parish have been connected with the main sewer. On the whole, then, a somewhat large amount of the most effective drainage will have been accomplished in this parish, before the issue of the next Annual Report. Apart from what has been set forth in the table above referred to, it may be mentioned that all the slaughter houses within the sub-district were, as usual, carefully supervised and reported on to the Board, and that the cow houses likewise, under the Amended Metropolis Local Management Act, were similarly inspected, prior to their proprietors receiving for the first time licenses for their continuance. Improvements of various kinds were suggested in several of these places with the view of rendering them better adapted for the purposes for which they were erected, and it is satisfactory to state that in every instance these suggestions were fully acted upon, and the improvements adopted. Lastly, it is gratifying to be able to say that all the sanitation noted in the table referred to, was this year brought about without the necessity of a single appeal to magisterial interference—indeed many improvements were accomplished without even an appeal to the District Board—private recommendations, in numerous instances, having sufficed to effect all that was required. Before leaving this subject I ought to refer to two other important measures that have been carried out during the year, but not noted in the table, viz.: the completion by the Board of the permanent pavement of the High-street, and the erection by the Parish authorities, on the site of the old pest houses on the Lower Common, of a number of model cottages for respectable labourers. Both these measures (frequently urged in these reports) may be said to supply requirements long considered necessary by the inhabitants, the one giving to the principal thoroughfare of the town an aspect of cleanliness and comfort, which before it did not nor could not possess, and the other affording some relief to overcrowded 44 neighbourhoods, by offering to a few of the more industrious and provident families the means of isolating themselves from the pauperizing influences which unfortunately abound in most localities occupied by the very poor. The cottages referred to, are, in point of domestic arrangements and sanitary appliances, all that can be desired, and it is hoped efforts will be made to supply more of them. It may be hardly necessary to remark, it is by such efforts as these to encourage cleanliness and provident habits amongst the industrious classes, that the benefits derivable from sanitation are greatly enhanced, and the moral and social well-being of a community the more effectually secured. R. HARLAND WHITEMAN, Medical Officer of Health for Putney and Roehampton. 45 APPENDIX OF STATISTICAL TABLES. TABLE I. Summary of Deaths and their Causes, registered in the Entire District during 1862, 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 Acrea, 11,695. Total Death from each class of Disease, &c., in the Entire District sub-districts. sex. age. social position Capham—Population in 1801, 20 890; area in acres. 1,233. Wandsworth Population in 1861, 13\346 ; area in acres, 2.478 Batterea - Population in 1861, 19,582 ; area in acres. 2,343. Putney and Roehampton—Population in 1861, 6.,481; area in acres 2.,76 Strearham. Tooring, & Balhum- Population 1861. 10,082 : area in acres. 3,465 | Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. Under 20 years, including all under 10 year-. 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. Profestional Class, Merchant, Bankers, & c Middle and Trading Class, Shopmen, Clerk*, &c Industrial and Labouring Classes. DISEASES. And other Causes of Death. Classes : — Small Pox 3 1 .. 2 .. .. 1 2 .. .. 1 1 2 .. .. .. .. .. 1 2 Measles 50 6 28 16 .. .. 24 26 13 32 4 50 .. .. .. .. .. 2 5 43 Scarlarina 38 13 2 15 2 6 19 19 5 21 9 36 2 .. .. .. .. 3 7 28 Diphtheria 21 3 5 8 3 2 9 12 4 12 1 19 .. 1 1 .. 1 4 6 10 Quinsy 3 .. .. .. .. 1 3 .. 1 2 .. 3 .. .. .. .. .. 1 .. 2 Croup 10 5 .. .. 3 2 6 4 1 8 .. 10 .. .. .. .. .. .. 4 6 Whooping Cough 51 14 11 25 1 .. 20 31 20 29 1 51 .. .. .. .. .. 2 10 39 I. Zymotic Typhus and Infantile Fever 43 8 11 17 2 5 24 19 .. 12 8 25 8 6 3 1 1 3 10 29 Erysipelas 8 1 .. 7 .. .. 3 5 1 .. .. 2 3 1 1 1 .. .. .. 8 Matrix, Childbirth 2 2 .. .. .. .. .. 2 .. .. .. .. 1 1 .. .. .. .. .. 2 Carbuncle .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza 1 1 .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. 1 Diarrhœa & Dysentery 4 7 5 22 5 3 17 25 19 9 .. 29 2 6 5 .. .. 6 6 30 Cholera 1 .. .. 1 .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. 1 .. Totals of Zymotic Class 273 63 62 113 16 19 126 147 65 124 24 226 18 17 10 2 2 18 50 203 2 Tubercular 185 54 46 58 13 14 91 94 20 16 2 56 77 43 9 .. 7 13 35 130 3. Of Brain and Nerves 183 31 45 81 10 16 92 91 38 24 5 71 24 31 52 5 3 15 46 119 4. Of Heart 69 16 17 10 7 19 35 34 3 1 2 7 12 18 32 .. .. 10 20 39 5. Respiratory Organs 181 38 30 83 16 14 96 85 50 41 1 93 11 27 44 6 5 8 40 108 6. Of Digestive Organs 10 32 18 29 11 12 48 54 26 8 3 38 13 27 22 2 4 11 27 60 7. Of Urnary Organ 21 6 3 2 4 6 12 9 .. .. .. 1 2 7 10 1 .. 3 11 7 8. Of Organs of Generation 14 2 5 3 1 3 1 13 .. 1 .. 1 1 5 7 .. .. 3 1 10 9. Of Joints, Bones &c. 9 3 .. 2 3 1 2 7 .. 1 1 3 .. 3 2 1 1 1 3 4 10. Of skin 5 3 .. .. 2 .. 2 3 1 1 1 3 1 1 .. .. .. 1 1 3 11. Premature Birth. Low Vitality, Mai- formation. &c 83 22 9 42 4 6 44 39 80 2 .. 82 1 .. .. .. 1 4 9 69 12. Of Uncertain Seat 25 4 13 .. 6 2 7 18 3 1 .. 4 2 8 11 .. 4 1 10 10 13. Age 99 33 14 33 7 12 42 57 .. .. .. .. .. 7 39 53 2 7 25 65 14. Violence 35 6 11 l2 4 2 26 9 3 3 5 17 7 6 5 .. .. 1 5 29 15. Not Specified 59 30 .. 23 3 3 31 28 20 1 1 23 7 19 10 .. 2 7 14 36 Totals 1343 343 273 491 107 129 655 658 309 224 45 625 76 219 253 70 31 103 297 912 46 TABLE II. Births registered during the year ending 31st December, 1862. sub-districts. Males. Females. Total. Clapham 308 314 622 Wandsworth 197 196 393 Battersea 384 400 784 Putney and Roehampton 84 101 185 Streatham, including Tooting & Balham 139 127 266 Total 1112 1138 2250 ** The excess of Births over Deaths in the entire district is 907. TABLE III. Meteorological Means for 1862, 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 41.1 53.3 58.7 45.0 49.5 Evaporation 39.2 50.4 55.6 43.7 47.2 Dew Point 36.9 47.5 52.8 42.1 44.8 Weight of Vapour in a cubic foot of Air 2.5 grs. 3.7 grs. 4.5 grs. 3.1 grs. 3.4 grs. Degree of Humidity (Satn 100) 85 80 81 89 84 Reading of Barometer 29.703 29.763 29 802 29.795 29.766 Weight of a cubic foot of Air 549 grs. 537 grs. 532 grs. 547 grs. 541 grs. Rain (amount of) 6.1 in. 7.4 in. 6.3 in. 6.6 in. 26.24 in. 47 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 1855-62. Years. Deaths from Epidemics in each Sub-District. Entire District. Clapham. Battersea. Wandsworth. Putney. Streatham. Total Deaths from Epidemics. Total Deaths Registered. Per centage of Deaths from Epidemics to Total Deaths. 1855 41 39 50 4 16 150 1144 13.1 1856 39 45 44 13 15 156 1144 13.6 1857 55 46 28 7 14 150 1097 13.6 1858 85 100 22 20 15 241 1264 19.0 1859 63 96 60 26 38 283 1322 21.4 1860 90 62 22 2 11 187 1374 13.6 1861 76 112 30 21 18 257 1393 18.4 1862 52 106 62 13 16 233 1343 17.3 * * The Diseases included in the above Table are seven in number, and constitute, as in the Registrar-General's Return, the principal maladies of the Zymotic class, viz.: Small Pox, Measles, Scarlatina, Diphtheria, Whooping Cough, Diarrhœa, and Fever. 48 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, 1862.— Compiled from the District Medical Relief Books. Deaths in each Sub-District. 41 56 10 16 9 132 14—Violence, Privation, and Premature Birth. Deaths. 2 2 ... ... ... 4 Cases. 74 72 10 30 14 200 13—Other Diseases. Deaths. 15 17 1 9 6 48 Cases. 489 719 597 264 137 2206 12—Hydrocephalus, Atrophy, Scrofula, and Convulsions of Children. Deaths. ... 4 ... 3 ... 7 Cases. 15 16 ... 10 ... 41 11—Phthisis. Deaths. 7 4 2 13 Cases. 30 14 ... 2i 5 51 10—Lung Diseases, except Phthisis. Deaths. 7 2 4 1 23 Cases. 185 170 46 64 24 489 9—Puerperal Fever. Deaths. ... ... Cases. 4 ... ... 1 ... 5 8—Erysipelas. Deaths. 1 ... ... 1 Cases. 8 13 7 4 ... 32 7—Fever. Deaths. 2 3 1 ... ... 6 Cases. 203 180 32 27 6 448j 6—Cholera. Deaths. ... ... Cases. ... ... ... 5 —Diarrhœa & Dysentery. Deaths. ... 1 ... 1 Ceses. 108 107 28 18 8 269 4—Whooping Cough. Deaths. 3 5 2 0 ... 10 Cases. 28 26 11 4 ... 69 i 3—Scarlatina & Malignant Sore Throat. Deaths. 3 2 1 ... 6 Cases. 37 15 7 7 ... 66 2—Measles. Deaths. 2 10 ... ... 12 Cases. 34 75 9 18 ... 136 1—Small Pox. Deaths. 1 18 1 Cases. 11 3 3 1 Total Cases of Sickness treated in each Sub-District. 1226 1410 750 450 194 4030 SUB-DISTRICTS. Clapliam Wandsworth Battersea Putney & Roehampton Streatham, including Tooting & Balham Totals 49 TABLE VI. Summary of the Sanitary Operations in the entire District during the year 1862. Clapham. Battersea. Wandsworth. Putney and Roehampton. Streatham, includingTooting & Balham Totals. Number of Houses and Premises inspected 850 600 530 192 110 1517 1st Notices served 28 23 73 19 40 211 2nd Notices served 12 3 8 5 ... Cesspools emptied and cleansed 26 50 24 25 177 302 Cesspools abolished 4 ... 2 25 4 35 Water-closets constructed 59 477 59 30 54 679 Houses supplied with Water 63 477 59 41 46 686 Drains constructed or connected with Sewer 13 36 10 39 44 142 No. of Feet of New Sewers, &c 1840 160 ... 2340 1106 5446 Drains repaired or trap- ped, or obstructions removed 17 2 11 20 56 106 Open Ditches, Ponds &c., cleansed 7180ft. 6 600ft. 2650ft. 57 ... Dust-bins provided 53 477 59 ... 47 636 Pig Nuisances removed 14 ... 3 5 2 24 Accumulations of Offal, Manure, &c., removed 27 10 7 6 8 58 Unwholesome and dilapidated Houses cleansed or repaired ... ... 34 3 ... 37 Cases investigated by Magistrates 2 ... 1 ... ... 3 Compulsory Orders obtained 1 ... 1 ... ... 2 Compulsory Works executed ... ... 1 ... ... 1 Works remaining in abeyance from various causes ... ... ... 1 3 4 D m'corquodale and co., union hall, borough (s.e.),works, newton.