WAN 15 SANITARY DEPARTMENT. REPORT ON THE SANITARY CONDITION OF THE SEVERAL PARISHES COMPRISED IN THE WANDSWORTH DISTRICT, DURING THE YEAR 1863. By the Medical Offices of Health. london: JOHN SMITH AND CO., LONG ACRE, W.C. 1864. CONTENTS. 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 25 6. „ on the Sub-District of Streatham, by Dr. D. C. Nöel 29 7. „ on the Sub-District of Putney, by Dr. R. H. Whiteman 8. Appendix of Statistical Tables, &c. 35 REPORT. To the Board of Works for the Wandsworth District. Gentlemen, In conformity with the order of your Board, and section 43 of the Metropolis Local Management Amendment Act, we have the honour to submit our report for 1863. We regret to have to record a less healthy condition of the District than in our report of last year, though at the same time some consolation is to be found in the knowledge that this result is due to general, rather than to local causes. It should be borne in mind that zymotic diseases, to which the high rate of mortality can alone be attributed, were very prevalent and very fatal, as well throughout the kingdom as in the Metropolis during the year under review, and that the unusual amount of sickness has given rise, almost everywhere, to the same regrets as those we here express. We trust, however, to be able to exchange these regrets for congratulations, upon the operation of far more favourable influences in our next Report. We have the honour to be, Gentlemen, Your very obedient Servants, THE MEDICAL OFFICERS OF HEALTH for the wandsworth district. A 2 4 HEALTH AND SANITARY CONDITION of the entire district. The year 1863 was characterised by the prevalence of a large amount of epidemic disease; and, in common with the rest of the Metropolis, this District did not escape its fatal effects. A comparison of the contents of the several tables of mortality appended to the Annual Reports for some years past, will show that the deaths due to diseases of the epidemic class were disproportionally great during the past year. During the period of eight years, (1855 to 1862,) the highest percentage of deaths from the seven principal epidemics to the total deaths from all causes (vide Table IV, Appendix,) was attained in 1859, when it was 21.4; but in the past year it will be found to have reached 29.9 per cent., which is considerably more than three-fourths greater than the eight years average. In addition to a larger amount than usual of Scarlatina, Measles, and Fever, Small-pox prevailed epidemically. It is to the first named disease that the excess of mortality of the year has been essentially due; and not, as might first appear, to Small-pox, the fatality of which malady, although it was extensively prevalent, contrasts favourably with most of the other districts of the Metropolis. This is a matter for much congratulation, seeing the obstacles which stand in the way of efficient vaccination, arising from the negligence of the people, and the inefficient powers of the Compulsory Vaccination Act. 5 mortality. Assuming the population of the entire District to have increased in the same ratio since the last census as it did during the preceding ten years, the rate of mortality for the past year would be 20.17 per 1000 persons living, or one per 1000 greater than the average. Calculated upon the same basis, the birth-rate was 34.78 per 1000 of all ages, and the rate of natural increase 14.61 per 1000. Of the five groups of districts into which London is divided by the Registrar-General, the West, South, and North exhibit for the past year the lowest death rates per 1000, viz., 2324 in the first group, 23.37 in the second, and in the last 23.81. The death-rate of the entire Wandsworth District being 20.17, it is a matter for considerable congratulation that this district individually presents a difference of more than two per 1000 under the rate of any one of these groups collectively, including the group (the South) of which it forms a part. The East and Central districts show a death-rate respectively of 26.55 and 26.64 per 1000, so that comparing the rate of the entire Wandsworth District with that of either the last-named groups, it will give no fewer than 6 per 1000 as the favourable difference. sickness. It is calculated that the cases of sickness under treatment amongst all classes throughout the District was not less, during the past year, than 60 per cent. of the population; and that one in every 27 attacks of sickness proved fatal. This calculation (which is approximate only) is arrived at by taking the proportion which the deaths bear to the 6 cases of sickness amongst the Union poor as a measure of the proportion which the total deaths bear to the total cases of sickness amongst all classes, and is the only method by which the amount of general sickness can be estimated. sanitation. It will be seen by reference to the appended table, No. VI., that in no year since the Metropolis Local Management Act came into operation, has so large an amount of effective sewerage (25,411 feet) been carried out in the District, and in no year has more energy and activity been displayed in the completion of other measures of real and lasting improvement than during 1863. The complaints that have been most frequently urged upon the Board of Works and its Local Committees by ratepayers and others, appear to have been inefficient roadwatering and scavengering—requirements which, it is almost needless to say, to be effective and satisfactory to all, must be liberally met, and as liberally carried out throughout the entire District. Amongst the suggestions offered in the present report may be specially mentioned that of the establishment of baths and washbouses in the more populated localities—a sanitary measure than which not one that has ever been advocated by the Medical Officers of Health could possibly recommend itself more strongly, as a private speculation, to the notice of the inhabitants. LOCAL SUMMARIES. WANDSWORTH. The health of this Sub-district during the year 1863, as evidenced by the Mortuary Returns, and the Parochial Records of Sickness and Mortality amongst the Poor, was not in so satisfactory a condition as heretofore. As in the entire District, and indeed in the Metropolis generally, the mortality was higher than the average, such excess having been principally due to diseases of the zymotic class. Nevertheless, the increase of mortality is small compared with that of most of the other Metropolitan Districts. mortality—death-rate. birth rate—rate of natural increase. The total deaths which were registered as having occurred during the past year numbered 300; 149 were of males and 151 of Females; 82 occurred in the following public institutions; viz.—In the Surrey County Lunatic Asylum 58; in the House of Correction 11; in St. Peter's Hospital 9; and in the Royal Patriotic School for Boys 4. 8 The Death-rate for the past year, calculated from the Registrar-General's Returns of Mortality, and an estimated population, with due correction for the Surrey County Lunatic Asylum and the Union Workhouse, after the manner described in previous Reports was 18.74 per 1000 persons living; closely approximating, therefore, to that of the preceding year, which was about one in a thousand higher than the average. The population is estimated upon the assumption that it has increased since the period of the last census in the same ratio as it had done during the decenniad 1851—61. The inmates of the Asylum are, with a fractional exception, derived from without the parish; and the deaths of Wandsworth parishioners in the Workhouse are registered in Battersea, in consequence of such building being situated in that parish. For these reasons, in estimating the death-rate, the population and mortality of the Asylum are withdrawn from, and the deaths of Wandsworth parishioners in the Workhouse are added to, the calculation. The total births registered during the past year numbered 444; 198 of males and 246 of females. The Birthrate was 33 per 1000 of the entire population. The Rate of Natural Increase was 13.69 per thousand, being one in a thousand higher than the year previous. 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 eight periods, and particularising the several diseases of the zymotic class. WANDSWORTH. Total Deaths from each Class of Disease, Ac., in the Sub-District. Sex. Age. Social Position. Population in 1861—13,316. Area in Acres—2,748. 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 year of age. At 40, and under 60 years of a«e. 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:— 1. Zymotic Small Pox 8 2 6 1 1 4 6 1 .. 1 .. .. .. .. 8 Measles 2 1 1 .. 2 .. 2 .. .. .. .. .. 1 .. 1 Scarlatina 23 15 8 4 12 6 22 1 .. .. .. .. .. 2 21 Diphtheria 1 1 .. .. .. 1 1 .. .. .. .. .. .. .. 1 Quinsy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Croup 4 3 1 .. 3 .. 4 .. .. .. .. .. .. 2 2 Whooping Cough 9 2 7 6 4 .. 9 .. .. .. .. .. 2 .. 7 Fever 13 5 8 1 6 2 10 2 .. 1 .. .. .. 3 10 Erysipelas 3 .. 3 1 1 .. 2 .. 1 .. .. .. .. .. 3 Metria, Childbirth .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Carbuncle .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa Dysentery 6 3 3 5 .. .. 5 1 .. .. .. .. .. 6 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 69 32 37 17 28 13 61 5 1 2 .. •• 3 7 69 2. Tubercular 45 27 18 7 6 2 17 14 11 3 .. .. .. 7 38 3. Of the Brain, Nerves, &c. 70 46 24 11 4 1 18 10 23 17 2 3 4 8 55 4. Of the Heart, &c. 12 3 9 .. .. .. .. .. 1 10 1 1 1 2 8 5. Of Respiratory Organs 30 12 18 3 6 1 11 1 7 10 1 .. .. 6 24 6. Of Digestive Organ 22 6 16 8 5 1 14 2 2 4 .. .. .. 2 20 7. Of the Kidneys, &c. 3 3 .. .. 1 .. 1 .. 1 1 .. 1 .. 2 .. 8. Of the Uterus, &c. 3 .. 3 .. .. .. .. .. 2 1 .. .. .. .. 3 9. Of Joints, Bones, &c. 1 1 .. .. .. .. .. 1 .. .. .. .. .. .. 1 10. Of Skin .. .. .. .. .. .. .. .. .. .. .. .. .. • • • • 11. Premature Birth, Low Vitality, Malformation, &c. 13 7 6 13 .. .. 13 .. .. .. .. .. .. 1 12 12. Of Uncertain Seat 14 4 10 1 .. • • 2 • • 4 8 .. 2 2 1 9 13. Age 12 3 9 .. .. .. .. .. .. 3 7 .. .. 4 8 14. Violence 3 5 1 .. 1 .. 2 1 3 .. .. .. .. .. 6 15. Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 300 119 151 60 51 18 139 31 55 61 11 7 10 40 243 10 Diseases of the Brain and Nervous system are seen in the Table to have caused the largest number of deaths. But this class of disease is unduly raised by the mortality of the Surrey County Lunatic Asylum, (whose inmates are almost entirely derived from without the parish), and must, therefore, be excluded from a consideration of the causes of death proper to this parish. About a sixth part only of this class belongs to this parish. The zymotic class of diseases (Epidemic—Endemic—Contagious), stands foremost in the causation of mortality, having formed 23 per cent. of all deaths. Next in order of fatality, and no less associated than the preceding class with bad ventilation, over-crowding, and other sanitary defects of houses, is the Tubercular class, (which includes Scrofula, Consumption, &c.,) forming 15 per cent. Diseases of the respiratory organs formed 10 per cent. as in the preceding two years, an amount considerably below the average. Diseases of the digestive organs formed 7 per cent. The most fatal of any single disease was Consumption, which caused 10 per cent of all deaths, and next to it Scarlatina, which caused nearly 8 per cent. Twenty-five inquests were held during the year. Six deaths resulted from violence, two of which were accidental and four suicidal. In eleven instances the cause of death was not certified by any Medical Practitioner, so many instances, therefore, in which death may have resulted from other than natural causes. Assuming that uncertified deaths are registered throughout the Kingdom in a similar manner (and from the Registrar-General's Reports, such would appear to be the case) it becomes alarmingly apparent how large is the portal through which evidence of secret crime may be permitted, in the present state of the law, to pass undetected to the grave. As has been submitted in previous reports, the remedy consists simply in the employment 11 of medical investigation in all cases where the cause of death has not been certified by a Registered Medical Practitioner. Age at Death.—A fifth part of all deaths occurred during the first year of life; 37 per cent. did not exceed 5 years of age; and 46 per cent. took place under the age of 20. Social Position.—Upwards of four-fifths of all deaths occurred amongst the labouring and industrial classes. Of the 69 deaths from epidemic diseases, 59 took place amongst them. epidemic diseases—prevalence and fatality of. The following Table exhibits the deaths which resulted from the principal epidemic diseases during the past and seven preceding years, and the relation which they bore to the deaths from all causes. YEARS. Small Pox Measles. Scarlet Fever. Diphtheria. Whooping Cough. Diarrhoea. Fever— Typhus and Typhoid. Total Deaths from Epidemics. Total Deaths from all cause. Per centage of deaths from Epidemics 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 1862 0 28 2 5 11 5 11 62 273 22.7 1863 8 2 23 1 9 6 13 62 300 20.6 From which it is seen that the total number of deaths from these diseases was the same in the last as in the preceding year; and that the proportion which they bore to deaths from all causes was about one third greater than the average. This excess was due principally to a severe epidemic of Scarlet-fever which prevailed during the latter six months of the year. This 12 disease was very fatal in the Autumn months, particularly in August. Small-Pox prevailed epidemically during the latter nine months of the year, and, as elsewhere, this sub-district did not escape its fatal effects, which were, however, very slight compared with those of most of the other metropolitan districts. On account of the important place which this disease holds in the subject of preventive medicine, and the naturally great alarm which its occurrence creates in the public mind, the following Table is subjoined to show accurately its fatality during the past eight years. Notwithstanding the great safeguard to life offered by vaccination, and the facilities which exist for obtaining that security, it is seen that 8 deaths resulted from this disease. They were all of persons unvaccinated—a circumstance which, though furnishing negative evidence only, still admits much to be inferred in favour of vaccination. Table showing the total deaths which have taken place from Small-pox, in the sub-district of Wandsworth, during the eight years 1856-63; also the number of attacks from that disease, with the resulting deaths which have occurred amongst the parochial poor during the same period:— SUB-DISTRICT OF 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 3 0 1863 8 34 3 13 Whooping-cough prevailed during the latter nine months of the year, and was fatal in April, July, October, and November. Diarrhoea and Fever were present, as usual, in every month of the year; the former was attended with fatality in March, August, and September, and the latter in January, June, August, November, and December. By far the largest number of deaths from epidemic diseases took place in the month of August. sickness and mortality amongst the parochial poor. general sickness—its amount and intensity. The total amount of sickness, with its resulting mortality, which occurred amongst the parochial poor during the past year is recorded in Table V. of the Appendix. Although somewhat greater than the average of the past eight years, it contrasts favourably with that of the year previous. The rate of mortality, relatively to cases of sickness, was below the average, the deaths having been considerably less than 3 per cent. (2.83) of all cases of sickness, the average being 3.01 per cent.; the proportion in the preceding ) ear was 4 per cent. The proportion which epidemic diseases bore to total diseases was also more favourable during the past year. These diseases formed a fifth part of all cases of sickness, the average proportion for the past eight years having been a fourth part. In estimating as comprehensively as possible the general health of the locality, the Table referred to forms a valuable supplement to the information conveyed by the deathregister, inasmuch as the details are capable of exact comparison with those of former years; and not only are the deaths shown, but the nature and amount of sickness which produced them; so that from this portion of the 14 entire sickness and its results, which is accurately known, the total amount of sickness which has prevailed generally throughout the parish (and of which there is, of course, no record) may be approximately estimated. By assuming the ratio of deaths to the cases of sickness amongst the poor as the ratio for the entire sub-district, it would appear that the total cases of sickness which came under treatment during the year must have amounted to not less than 66 per cent. of the population, and that one death occurred in every 31 attacks of sickness; in the preceding year each death represented 25 attacks. During the past 7 years the proportion was one death in 33 attacks. So that although somewhat greater than the average, the intensity of disease was less during the past than during the preceding year in the proportion represented by the figures 31 and 25. sanitary proceedings. In Table VI. of the Appendix is contained a summary of the sanitary proceedings which have been carried out during the year under the superintendence of your surveyor. They have all, it is satisfactory to observe, been conducted without the intervention of the law. In addition to these, all the Slaughter-houses and Cow-houses of the sub-district were examined and reported on as usual before the renewal of their owners' licences. The great nuisance to the town arising from the mode of dwelling adopted by the gipsies who encamp in large numbers by the side of the York Road, was investigated, and specially reported on. In December, at the period of my report, there were 14 vans and 33 tents, the former containing 63, and the latter 154 persons —in all 217 persons of all ages. Their mode of existence was found to be so void of the usages of civilized life, 15 as to be equally detrimental to their own health and that of those living in the neighbourhood — at once a means of importation into the town of contagious diseases, and a prolific source of their propagation. On the advent of the epidemic of Small-pox in 1856, the first case which came under my notice, and the first death from that disease occurred, amongst them; and to the best of my belief, after full enquiry, this disease was imported into the town by them in that year. It has appeared to me desirable to reproduce here briefly the main circumstances contained in that report, in order to show that the evil is of sufficient magnitude to require measures to be adopted for its suppression. The plan of causing to be cleansed and limewhited all rooms amongst the houses of the poor requiring such measure, in which contagious disease had been present, was carried out last year much more fully than heretofore, (as seen on comparing the Table with those of former reports), and has been attended with much benefit; the extension of contagious diseases having often been promptly arrested by these simple but important proceedings, where, without them, its further development would have been as certainly anticipated. The process of naming streets and numbering the houses has been applied to several parts of the town. Of the greatest assistance in the efficient prosecution of sanitary works, and in the investigation of the local causes of disease, this otherwise great public convenience will, it is hoped, be universally adopted throughout the parish. The general scavengering of the town has been performed better than heretofore, but it is still very short of what is needed. It requires to be more systematic, more searching, and more frequent; particularly in the bye-ways, in the 16 courts and alleys, and around the dwellings of the poor, the ensuring of cleanliness outside of which, will in time, lead to the adoption of general habits of cleanliness inside them. It is much to be regretted, both on economic and sanitary grounds, that there are no Public Baths and Washhouses in this town. Those who are aware of the great obstacles to cleanliness which want of space inflicts on the families of the poor, will feel that every possible facility for the adoption of habits of cleanliness should be afforded to the household of the labouring man. The cleanliness of the individual is the cleanliness of the community. In conclusion, it is hoped that all the minor details of sanitation will be vigorously and continuously prosecuted; for it is these apparently trivial and humble, but in reality most important, efforts, which in the aggregate essentially form the means of saving life, improving health, and adding to the social comfort of the community. GEORGE EDWARD NICHOLAS, M.D. Medical Officer of Health for Wandsworth. CLAPHAM. The fluctuations in the number of births and deaths in a community, have, of course, a very important bearing upon all sanitary enquiries; but the variations in the number of marriages from year to year, is of no less significance as a means of measuring human happiness and social progress. I therefore, as in former years, commence my report with a table, having for its object the shewing of these fluctuations in a concise form, and for a series of years, dating from 1856, the period at which the Local Management Act came into operation. MARRIAGES, BIRTHS, AND DEATHS. Years. 1856 1857 1858 1859 1860 1861 1862 1863 Marriages 154 151 150 156 183 182 175 181 Births 527 550 533 594 608 624 622 685 Deaths 286 321 344 328 429 390 343 355 Excess of Births over Deaths 241 229 189 266 179 234 279 330 By the above Table it is seen that the marriages in this sub-district during eight years have by no means kept B 18 pace with the increase of population, the number solemnized in 1863 being even less than in 1860; though it is somewhat singular that the excess of births over deaths has been much greater during the year under review than it has been in any year since the commencement of the Health Officer's Duties. statistics of mortality. The natural increase of the population, as shown by the excess of births over deaths, since the census of 1861, would alone be very considerable. What the increase by immigration may have amounted to in the same interval, it is scarcely possible to estimate with accuracy; but assuming it to have been only one half as great as the natural increase, it would now bring up the number of inhabitants to about 21,780, and would consequently (the deaths having been 355) give a rate mortality of, as near as may be, 16 in every 1000 living; an estimate, if it errs at all, certainly does not err on the side of exaggeration. Although the deaths in the past year were 12 more than in 1862, they were 35 less than in 1861, and 94 less than in 1860. The following approved and perspicuous Table will at once shew the number of deaths under each class of disease, and will furnish other reliable and valuable information touching the sex, age, and social position of the deceased persons. 19 CLAPHAM. Total Deaths from each Class of Disease, Ac., 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, Ac. Middle A Trading Class, Shopmen, Clerks, &c. Industrial & Labouring Classes. Population in 1861—20,890. Area in Acres—1,233. DISEASES, And other Causes of Death. Classes:- 1. Zymotic Small Pox 11 6 5 3 4 .. 10 .. 1 .. .. .. •• 1 10 Measles 24 12 12 10 12 2 24 .. .. .. .. .. .. 7 17 Scarlatina 28 10 18 2 10 10 25 2 1 .. .. .. 5 5 18 Diphtheria 1 .. 1 .. .. .. 1 .. .. .. .. .. .. 1 .. Quinsy 2 2 .. .. 2 .. 2 .. .. .. .. .. .. .. 2 Croup 1 .. 1 .. 1 .. 1 .. .. .. .. .. .. .. 1 Whooping Cough 9 6 3 4 4 .. 8 .. 1 .. .. .. 1 1 7 Typhus, &c. 6 2 4 1 2 1 5 .. .. .. 1 .. •• 2 4 Erysipelas 1 1 .. 1 .. .. 1 .. .. .. .. .. .. .. 1 Metria 1 .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. Childbirth Carbuncle .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza 1 1 .. 1 .. .. 1 .. .. .. .. .. .. 1 •• Diarrhœa & 16 10 6 11 4 .. 15 .. 1 .. •• .. 1 1 14 Dysentery Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 101 50 51 33 39 13 93 3 4 .. 1 1 7 19 74 2. Tubercular 47 23 24 4 1 1 9 24 14 .. .. .. 3 10 34 3. Of Brain, Nerves, &c. 36 21 12 11 7 3 24 I 8 3 .. .. 4 10 22 4. Of the Heart, &c. 23 11 12 1 .. 1 2 5 8 8 .. 2 2 6 13 5. Of Respiratory Organs 39 19 20 8 10 .. 19 1 12 8 .. 1 1 It) 27 6. Of Digestive Organs 27 10 17 7 5 1 13 1 9 4 .. .. 2 8 17 7. Of Urinary Organs 4 3 1 .. .. .. .. .. 4 .. .. .. 2 2 .. 8. Of Organs of Generation 6 .. 6 .. .. .. .. 1 5 .. .. .. 2 I 3 9. Of Joints, Bones, &c. 2 1 1 1 .. .. 1 1 .. .. .. 1 .. .. 1 10. Of Skin 2 .. 2 2 .. .. 2 .. .. .. .. .. .. 1 1 11. Premature Birth, Low Vitality, tion, &c. 14 5 9 13 1 .. 14 .. .. .. .. 1 2 3 8 12. Of Uncertain Seat 6 3 3 1 .. .. 1 1 1 3 .. .. .. .. b 13. Age 29 12 17 .. .. .. .. .. .. 13 16 1 7 10 11 14. Violence 7 4 3 2 1 .. 3 1 2 .. 1 .. 1 3 3 15. Not Specified 12 9 3 3 1 1 5 3 2 2 .. .. 2 3 7 Totals 855 174 181 86 65 20 85 42 69 41 18 7 35 86 227 As to sex, the deaths of females are seen, as usual, to predominate, though to no greater extent this year than 7, the numbers being respectively, males 174, females 181. With regard to age, an unusually heavy mortality appears against infants and young children, 86 having succumbed under one year; 65 between the ages of one B 2 20 and five years, and 20 between five and ten years, making a total of 170 under 10 years, or within 15 of one half of the deaths registered during the year. At the other extreme of the scale, namely, of old age or natural decay, there died 29 persons, 13 between the ages of sixty and eighty, and as many as 18 above 80 years. Taking, then, the mortality under twenty years of age, and adding the number that succumbed to old age, it will be seen that nearly two-thirds of the deaths registered in the past year befel the very young and very old, thus confirming my often-repeated assertion, that whenever a higher rate of mortality than usual has manifested itself in this populous sub-district, the local registrar has always recorded the fact referred to. Under the head of social position, it will be found that a great preponderance of deaths took place amongst the labouring classes, much greater than amongst the three other classes combined. This circumstance plainly points out the direction which sanitation ought still to take, to secure for it the greatest advantages to the community at large. diseases of the zymotic class—their prevalence and fatality. In order to exhibit the large amount of zymotic disease this sub-district was subject to, in common with every other parish in the District, during the past year, the following table had been prepared. This will also show the great fluctuations that have attended the mortality from zymotic diseases for the past eight years, and demonstrate the fact of the year 1863 being quite an exceptional one both in regard to the prevalence and the fatality of the seven principal epidemic maladies. It will, likewise, show 21 that with the two or three exceptions (Diarrhœa especially, which disease proved fatal in no less than 27 cases in 1857) most of the other principal zymotic maladies, (Small-pox, Measles and Scarlatina), included in the table, were fatal in a much larger number of cases in 1863 than in any year since 1856. Years. 1856 1857 1858 1859 1860 1861 1862 1863 Small-pox 1 0 1 9 6 6 1 11 Measles 14 2 14 2 20 0 6 24 Scarlatina 9 8 25 26 24 22 13 28 Diphtheria 0 0 0 0 9 13 3 1 Whooping-cough 4 13 13 6 21 14 14 9 Typhus 4 7 11 12 6 5 8 6 Diarrhœa 4 27 16 11 6 16 7 16 Totals 36 57 80 66 91 76 52 95 SMALL POX AND VACCINATION. In the past year I successfully vaccinated in 336 cases, which is the largest number recorded in any year of the eight referred to in the above table. I also re-vaccinated in 132 cases. It is not too much to say, therefore, seeing how exposed this large number of persons must have been to the contagion of small-pox, during its prevalence in this, and surrounding parishes, that the probabilities are very many lives were saved through the timely employment of this valuable protective measure. At the same time I am bound to note the fact of 8 of the re-vaccinated persons, and as many as 20 of the primarily vaccinated subsequently took the disease, but all these, it is satisfactory to remark, 22 suffered so slightly as to escape being laid up, upon an average, beyond two or three days; and I am delighted to add, not one of them were marked in the slightest degree from the effects of the disease. The total number of deaths from Small-pox was 11, which is by no means a heavy mortality, seeing that the disease attacked alike all classes and conditions of the population. During an experience of thirty years in this parish, I have never known this disease to spread more rapidly, nor assume a more severe form amongst the unvaccinated than it did during the past year; and this, I find corresponds with the experience of most of my medical brethren practising in the locality. By reference to Table V., Appendix, it will be seen that 88 cases of Small-pox were treated amongst the out-door union poor of this parish, and that 4 of these cases proved fatal. At the same ratio, the 11 deaths from this malady, would give amongst all classes 242 cases treated during the year, which I imagine is about the number that actually occurred in both public and private practice within the sub-district. If this calculation is correct, as I believe it to be, it will give during the year a large amount of disease that might possibly have been entirely prevented by a more strict enforcement of the provisions of the Compulsory Vaccination Act. accidental, violent, and sudden deaths. As many as 14 inquests were held during the year, and I regret to say, in but a very small proportion of them was medical evidence received, or even thought of; and why, it may *be asked, under such circumstances, should the time of the tradesmen, who generally compose coroners' 23 juries, be so often wasted if nothing more is permitted to result from these enquiries than the record of such verdicts as "found dead,'' "died from a fit," and others expressed in equally vague and unmeaning terms? It must, I think, be conceded that the Registration Act, which ought to enable us to render our mortality tables the most complete and perfect records of the causes of death, is, when ignored in the way described, all but useless for the purposes for which it was designed by the legislature. sanitary works accomplished during the year— conclusion. It appears by Table VI., Appendix, that as many as 800 houses and premises were inspected by the Surveyor and myself, with very satisfactory results; inasmuch as by a system of private recommendations and explanations of the evils and consequences resulting from a neglect of sanitary measures and defiances of the law, very many improvements were brought about, and nuisances removed, without recourse to magisterial interference in a single instance. Besides these inspections, as many as 23 slaughterhouses and 26 cow-houses in the sub-district were reported upon after due examination, prior to the renewal of licenses; and since then 30 bake-houses have been visited with results equally satisfactory. With regard to the great desideratum, drainage, we seem to be in a fair way of having our best anticipations realized. During the past year there have been no fewer than 14,135 feet of new sewerage completed; and, since the High Level Sewer is fast approaching completion, there are good grounds for congratulating the inhabitants on 24 the prospect before them, through this and other equally important improvements, of shortly seeing this rapidly increasing parish assuming a sanitary position of the very highest order. JOHN MacDONOGH, Medical Officer of Health for Clapliam. BATTERSEA. The general mortality of this sub-district was higher than that of 1862, but the deaths arising from zymotic, or preventible disease, I am happy to say, have much decreased, which I hope may be attributed to the improved sanitation. The total number of deaths from diseases and other causes registered during the year 1863 numbered 522: 269 males and 253 females, being 31 in excess of the previous year. Of the 522 deaths enumerated in the appended Table, 98 occurred in the Workhouse situate in this sub-district, the infirmary of which continues to be the recipient of a large number of both 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 98 deaths registered as having taken place in the Workhouse, 77 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 445. By what is called the natural increase, as shown by the excess of births over deaths, the population of Battersea would amount to 20,641. What the increase by immigration may have been during the year, I cannot say; but assuming it to have been one half less than the natural increase, it would, when added to the supposed population of last year, bring the number of inhabitants up to 21,230. 26 The deaths proper to the parish having numbered 445, it would place the rate of mortality for the year at about 20 in every 1000 living. The following table gives the number of deaths that have been registered during the year 1863 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. 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. Classes:- 1. Zymotic Small Pox 11 4 7 1 5 1 7 3 .. 1 .. .. 1 1 9 Measles 13 7 6 4 8 1 13 .. .. .. .. .. .. .. 13 Scarlatina 26 9 17 .. 18 5 26 .. .. .. .. .. 4 3 19 Diphtheria 7 2 5 3 2 2 7 .. .. .. .. .. .. 1 6 Quinsy 1 .. 1 .. 1 .. 1 .. .. .. .. .. .. .. 1 Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough 5 3 2 1 4 .. 5 .. .. .. .. .. .. .. 5 Typhus and Infantile Fever 8 5 3 .. 1 1 3 3 .. 2 .. .. 1 .. 7 Erysipelas 2 .. 2 2 .. .. 2 .. .. .. .. .. 1 .. 1 Metria, Childbirth 7 .. 7 .. .. .. .. 3 4 .. .. .. 1 1 5 Carbuncle .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa & Dysentery 16 7 9 15 1 .. 16 .. .. .. .. .. 2 1 13 Cholera 1 .. 1 1 .. .. .. .. .. .. .. .. .. 1 .. Totals of Zymotic Class 97 37 60 27 40 10 81 9 4 3 .. .. 10 8 79 2. Tubercular 84 48 36 18 16 1 39 20 19 6 .. .. 2 17 65 3. Of Brain, Nerves, &c. 77 42 35 25 17 1 45 5 10 13 4 1 3 10 16 4. Of the Heart, &c. 43 21 22 2 1 .. 5 6 15 13 4 1 1 6 35 5. Of Respiratory Organs 75 42 33 25 17 1 50 4 .. 20 1 1 1 19 54 6. Of Digestive Organs 34 22 12 14 .. .. 20 4 .. 10 .. .. 4 12 18 7. Of Urinary Organs 7 5 2 .. .. .. .. 1 1 5 .. 1 .. .. 6 8. Of Organs of Generation 3 1 2 2 .. .. .. .. 1 .. .. .. 1 2 9. Of Joints, Bones, &c. 1 .. 1 .. .. 1 1 .. .. .. .. .. .. 1 .. 10. Of Skin .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11. Premature Birth. Low Vitality, Malformation, &c 28 10 18 25 .. 1 28 .. .. .. .. .. 1 4 23 12. Of Uncertain Seat 14 5 9 6 2 .. 10 .. .. 4 .. .. .. 4 10 13. Age 23 6 7 .. .. .. .. .. .. 14 9 .. 1 4 18 14. Violence 26 23 3 2 .. 1 6 7 6 7 .. .. .. 3 23 15. Not Specified 10 7 3 4 1 1 6 l .. 3 .. .. .. 4 Totals 522 269 253 160 94 17 93 57 55 99 18 4 23 93 402 27 prevalence and fatality of zymotic diseases. Diseases of this class prevailed more, but were less fatal during the past year than during 1862; the numbers being respectively 97 and 113. Small-pox prevailed most extensively, terminating fatally in 11 cases. Scarlet-fever, Diphtheria, and Measles terminated fatally in 26, 7, and 13 cases respectively. mortality in the workhouse. Of the 522 registered deaths in the sub-district, 98, as before stated, died in the Workhouse; 21 between the ages of seventy and eighty, and 7 between the ages of eighty and ninety, the oldest having reached the age of eighty-nine. infant mortality—proportion of births to deaths. The mortality of children between birth and ten years of age has been higher than in 1862; 171 being the number registered in the past year against 150 in the preceding one, but considerably less than in the year 1861. There have been 1042 births during the year; 528 males, and 514 females, presenting the large excess of 520 births over deaths ; which excess gives, of course, the natural increase of the population. This excess is much larger than has been before noted, which speaks much for 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 and amount of sickness amongst the pauper population of 28 the sub-district compiled from the Medical Relief Books of the Parochial Medical Officer, as well as the deaths that have resulted from disease and other causes, and gives the small proportion of 46 deaths in 930 cases treated. preventive measures adopted during the year— amount of sanitary work 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 sanitary improvements have been carried out with the same unabated energy as in previous years. WILLIAM CONNOR, Medical Officer of Health for the Sub-District of Battersea. STREATHAM, INCLUDING TOOTING AND BALHAM. It is not without regret that with regard to the death-rate of this sub-district for the year 1863, I am compelled to speak somewhat more unfavourably than upon the last occasion I had the honour of submitting similar statistics. The following Table will clearly exhibit the causes of death, and to what the increase of mortality has been due. It will also shew that under almost every group of diseases, particularly the zymotic, there have unhappily been registered more deaths than for several years past, if we except the year 1859, when the fatal cases amounted to within four of the number recorded during the past year. A note-worthy fact gathered from this Table is that diseases having their seat in the brain and nerves, have resulted in death in the large number of 29 instances. The next largest number of deaths in the year appear to have been due to diseases of the respiratory organs, exclusive of Phthisis. To Phthisis alone, 13 deaths were due. 30 STREATHAM, INCLUDING TOOTING AND BALHAM. Population in 1861—10,082. Area in Statute Acres—3,465. DISEASES, And other Causes of Death. Total Deaths from each Class of I Disease, Ac., in the Sub-District. Sex. Age. Social Position Males. Females. Under 1 year. From I to 5 years. From 5 to 10 years. Under 20 years, including all under 10 years. At 20, and under 40 years of age. At 40, and under 60 years of age At 60, and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle A Trading Class, Shopmen. Clerks, &c. Industrial & Labouring Classes. Classes:— Small Pox 1 .. 1 .. .. .. .. 1 .. .. .. .. .. 1 .. Measles 8 5 3 4 4 .. 8 .. .. .. .. .. .. 1 7 Scarlatina 5 3 2 .. 2 1 3 1 1 .. .. .. 2 2 1 Diphtheria 2 2 .. .. .. 1 1 .. 1 .. .. .. .. 1 1 Quinsy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping 3 .. 3 .. 3 .. .. .. .. .. .. ..3 Cough I. Zymotic Typhus and Infantil Fever 8 6 2 .. 3 14 2 2 .. .. .. 1 1 6 Erysipelas 1 .. 1 1 .. .. 1 .. .. .. .. .. .. ..1 Metria Childbirth2 ..2 .. .. .. .. 2 .. .. .. ..1 .. 1 Carbuncle .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa &..) 6 2 4 5 .. .. 5 .. .. 1 .. .. 1 1 4 Dysentery Cholera 1 1 .. 1 .. .. 1 .. .. .. .. .. .. 1 .. Totals of Zymotic Class 37 19 18 11 12 3 26 6 4 1 .. .. 5 8 24 2. Tubercular 17 11 6 1 3 .. 5 6 6 .. .. .. 3 5 9 3. Of Brain, Nerves, &c 29 15 14 8 2 2 13 5 .. 11 .. 3 4 11 11 4. Of the Heart, &c 12 8 4 1 .. .. 1 1 .. 8 2 2 1 4 5 5. Of Respiratory Organs 19 9 10 9 3 .. 12 2 .. 5 .. 1 .. 8 10 6. Of Digestive Organs 9 3 6 1 1 .. 2 1 2 1 3 6 7. Of Urinary Organs 4 1 3 .. .. .. .. 2 1 1 .. .. 1 2 8. Of Organs of Generation 1 .. 1 .. .. .. .. .. 1 .. .. .. .. .. 1 9. Of Joints, Bones, &c. 1 .. 1 .. .. .. .. 1 .. .. .. .. 1 .. 10. Of Skin 1 .. 1 .. .. .. .. .. .. 1 .. .. 1 .. 11. Premature Birth, Low Vitality, Malforma tion, &c 8 3 5 7 .. .. 8 .. .. .. .. .. .. 1 7 12. Of Uncertain Seat 6 3 3 .. .. .. .. .. 2 3 1 .. .. 3 3 13. Age 13 6 7 .. .. .. .. .. .. 6 7 .. 3 8 2 14. Violence 7 5 2 .. 1 .. 2 1 3 1 .. .. 1 .. 6 15. Not Specified 1 1 ..1 1 .. .. 1 .. .. .. .. .. .. .. 1 Totals 165 84 81 39 22 5 70 23 22 39 11 7 17 54 87 The number of deaths from all causes and amongst all classes appears by this table to have been 165 (84 males, and 81 females) which is 36 in excess of the number registered in 1862. But it must be borne in mind that this number of deaths took place in a greatly increased population. The population at the census of 1861, was 10,082. The natural increase since that period would alone raise it 31 to 10,256, and if we assume the increase by immigration to have been only double the natural increase, (which seeing the number of new houses that have sprung up in the three parishes since the census, is a very low estimate), not far short of 10,600 would be tbe representative number upon which to calculate the death rate of the year I am now reviewing. Upon the above data, therefore, the sub-district, notwithstanding the unfavourable influences that have been in operation, both causing and aggravating disease throughout the country, will present a death-rate very slightly over 16 in every 1,000 of the inhabitants. zymotic diseases. As already intimated, zymotic diseases have proved during the year unusually fatal. Only 19 deaths were registered from this class of maladies in 1862, but as many as 36 (nearly double the number), appear in the present Table. Measles, and Fever of a low type, have together caused 16 deaths, or 11 over the number recorded in 1862, whilst Small-pox, Scarlatina, Diphtheria, Whooping Cough, and Diarrhoea, have proved fatal in 18 cases, or 7 over the rate of the preceding year. Death, as usual, has been, in respect to this group of diseases busy amongst infants and very young children, 23 of the 36 who succumbed to them having been under 5 years of age. With reference to Small-pox, it may be stated that, although but one death was registered during the year, the cases treated in the three parishes of Streatham, Tooting, and Balham, were far more numerous than they ought to have been, looking at the facilities for efficient 32 vaccination. It is a matter for regret in this, as in most communities, that so many persons, particularly amongst the poor, fail, until too late, to avail themselves of the protective influence of vaccination, when, with so little trouble, and without any expense to themselves, parents may secure for their families comparative immunity from one of the most loathsome diseases that can befall humanity. Hopes, however, may still be entertained that the legislature will not leave the so-called " Compulsory Vaccination Act" much longer in the unsatisfactory state in which it is found at present. mortality amongst children and aged persons. The infant mortality has necessarily been much greater during the past year than during 1862, by reason of the unusual prevalence of zymotic diseases, the greatest number of which are well known to attack children almost exclusively. No fewer than 66 children under 10 years of age appear by the Table of Mortality to have succumbed to disease, accidents, &c., during the past year, against 16 in the previous one, which is by no means a satisfactory occurrence to place on record, and would be more lamentable were it not for the fact of every parish in the district having, in common with the whole country, suffered unusually from zymotic maladies. The deaths amongst the aged numbered one more than in 1862, viz., 13, seven of which were of persons over 80 years, and six verging closely upon that age. sickness and mortality amongst the union poor. A reference to Table V., Appendix, will show a much more satisfactory condition of the public health of this sub- 33 district, so far as the very poor are concerned, than has usually been exhibited in this statistical record. In the year 1862 there were 9 deaths in 194 cases treated amongst this class. In the past year the proportion is 7 deaths in 246 cases, or less than 3 per cent. This result speaks volumes for the sanitation which has been effected in the poorer localities of the sub-district under the directions of the Board of Works. A further analysis of this table yields a result equally satisfactory, viz., that not a single death took place amongst the Union poor from five of the principal zymotic diseases — Small-pox, Whooping-cough, Measles, Diarrhoea, and Fever, whilst from Scarlatina and its allied malady, Diphtheria, there succumbed 3 only. sanitary operations, &c. There has, I may confidently state, been no relaxation of efforts during the past year in effecting all that was practicable in sanitation throughout the three parishes of which this sub-district is composed. Table VI. in the Appendix exhibits an amount of accomplished work in this direction quite as satisfactory as that noted in my last report. Not only has new sewerage been provided to the extent of 4,066 feet; but many improvements in the way of house drainage, removal of acknowledged nuisances, water supply, and the like, have been carried out with excellent effect, and I believe much to the satisfaction of the ratepayers. In addition to the above, all the slaughter and cow houses were inspected and reported on at the time appointed for a renewal of licences to their proprietors; and for the first time the bake houses have lately undergone a similar examination with a view to a report concerning them being presented to the Board. c 34 It is most satisfactory, then, to state that nothing appears to have been left undone in the way of sanitation that could by any possibility contribute to the health and physical welfare of the inhabitants; and I cannot avoid expressing my high appreciation of such efforts, and to urge their continuance, feeling well convinced they are calculated to give to this locality a sanitary status second to none within the metropolitan area. D. C. NOEL, Medical Officer of Health for Streatham, Tooting and Balham. PUTNEY AND ROEHAMPTON. Throughout the greater portion of the year 1863, this sub-district largely shared in the epidemic sickness so unusually prevalent both in the Metropolis and Provinces. The rate of mortality has consequently somewhat exceeded the average of the seven years during which the Local Management Act has been in operation. The table which follows will clearly shew to what fatal diseases this excess has been due; and when it is borne in mind that as the result of three zymotic maladies only, viz., Smallpox, Scarlatina, and Diphtheria, no less than 14 deaths took place above the number registered in the previous year, and nearly the same number above the average of the past seven years, the year under review must be regarded, in respect to the operation within the parish of epidemic influences, as altogether an exceptional one. Whilst then it is a matter for some regret that not quite so favourable a report as last year can be submitted, it is so far satisfactory to find that this parish has simply participated in the general sickness, and that it does not per se present any remarkable death-rate for the year distinguishing it from surrounding parishes. It need scarcely be observed that the table of mortality which follows, is constructed on the same principle as those in previous reports, to afford the usual facilities of comparison, and to obviate the necessity of too lengthened comments. c 2 36 STATISTICS OF MORTALITY, &C. PUTNEY and ROEHAMPTON. Population in 1801—6,481. Area in Statute Acres—2,176. Total Deaths from each Class of Disease, Ac., 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 year 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 A Trading Class, Shopmen, C'erks, &c. Industrial & Labouring Classes. DISEASES, And other Causes of Death. Classes:— 1. Zymotics Small Pox 3 3 .. 1 .. 1 2 1 .. .. .. .. .. .. 3 Measles 3 1 2 l 2 .. 3 .. .. .. .. .. .. .. 3 Scarlatina 10 6 4 .. 7 3 10 .. .. .. .. .. .. 4 6 Diphtheria 6 3 3 .. 4 2 6 .. .. .. .. .. 1 1 4 Quinsy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough 3 2 1 1 2 .. 3 .. .. .. .. .. 1 1 1 Typhus and Infantile Fever 2 .. 2 .. .. .. .. 2 .. .. .. .. .. 1 1 Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Metria, Childbirth 2 .. 2 .. .. .. .. 2 .. .. .. .. .. .. 2 Carbuncle 1 1 .. .. .. .. .. .. .. .. 1 .. .. 1 .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa & Dysentery 2 2 .. .. 1 .. 2 .. .. .. .. .. .. 1 1 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 32 18 14 3 16 6 26 5 .. .. 1 .. 2 9 21 2. Tubercular 24 5 19 4 1 1 9 10 4 1 .. 1 2 5 16 3. Of Brain, Nerves, &c. 13 3 10 .. 4 .. 4 .. 3 6 .. 2 1 4 6 4. Of the Heart, &c 6 2 4 .. .. .. 2 3 .. 1 .. 1 .. .. 5 5. Of Respiratory Organs.. 18 6 12 3 6 .. 9 .. 1 8 .. 2 2 4 10 6. Of Digestive Organs 3 .. 3 .. .. .. .. 1 .. 2 .. 1 .. .. 2 7. Of Urinary Organs .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 8. Of Organs of Generation 3 .. 3 .. .. .. .. 1 .. 2 .. .. 2 1 .. 9. Of Joints, Bones, &c. 1 .. 1 .. .. .. .. .. 1 .. .. .. .. .. 1 10. Of Skin .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11. Premature Birth, Low Vitality, Malformation, &c 4 3 1 4 .. .. 4 .. .. .. .. .. .. 2 2 12. Of Uncertain Seat 13 7 6 .. .. .. 2 2 5 4 .. 1 2 6 4 13. Age 4 1 3 .. .. .. .. .. .. 3 1 .. .. 1 3 11. Violence 6 5 1 2 .. .. 2 2 1 1 .. .. .. 2 4 15. Not Specified 2 .. 2 .. .. .. .. .. 1 1 .. .. .. 2 .. Totals 129 50 79 16 27 7 58 24 16 29 2 8 11 36 74 The total deaths registered in the year appears by the above table to have been 129, of which number 50 were of males and 79 of females. The average of the preceding seven years, the usual correction being made for increase of population, is 115, con- 37 sequently upon this calculation the 14 deaths in excess of' that average exactly corresponds with the excess observable as the result of the three diseases of the zymotic group referred to above. But there is reason to believe the increase of population, by immigration especially, has been within the last few years such as to warrant a totally different correction of the average to that usually adopted, and one that would give to this sub-district a by no means unsatisfactory sanitary position amongst surrounding parishes. Upon an estimate founded upon both the natural inmcrease of population, as shewn by the excess of births over deaths, and the assumed increase by immigration, as shown by the number of new houses erected and inhabited since the census of 1861, the number of inhabitants cannot now amount to less than 7,000. The number of births since the census of 1861 being 373, and the deaths 256, it follows that the natural increase of the population is 137. The number of new houses erected in the same period is 108. Calculating, therefore, only 5 persons to each house, and that but 80 of these houses are as yet inhabited, it may be fairly taken that the influx of new residents has been, at the very least, 400. These two sources of increase give a somewhat larger number than is required to bring the population of 1861, which was 6,481, up to 7,000 in 1863. The deaths being 129, it follows that the rate of mortality is 18.42 per 1,000 living, or little more than one per 1,000 above the favourable standard of the Registrar-General distinguishing the most healthy of the rural districts. progress of mortality. Introducing a similar table to that employed in my last 38 report, which pointed out the relative number of deaths in each quarter from each classified cause, I am enabled to shew what may be appropriately termed the progress of mortality, and its rise and fall in connection with temperature, humidity, and the readings of the barometer. REGISTERED CAUSES OF DEATH. NUMBER OF DEATHS. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. January, February, March. April, May, June. July, August, September. October, November, December The Year. Zymotic Diseases, (epidemic, endemic, and contagious 5 7 15 5 32 Diseases of the Respiratory Organs 5 4 2 7 18 Pulmonary Consumption 3 4 6 4 17 Diseases of the Heart 2 2 2 0 6 Diseases of the Brain and Nerves 4 1 4 4 13 Diseases of the Digestive Organs 2 0 1 0 3 All other Diseases 9 1 6 10 26 Accidental and Violent Deaths 3 2 1 0 6 Premature Birth, Low Vitality, Malformation 2 0 1 1 4 Old Age (natural decay) 1 2 1 0 4 Totals 36 23 39 31 129 Meteorological Readidge. Mean Temperature of air 42.6 53.0 58.8 46.8 50.3 „ Degree of humidity 83° 77° 74° 86° 80° ,, Readingsof Barometer 29.825 29.799 29.799 29.817 29.810 Amount of rain 3.9 in 5.6 in. 5.9 in. 4.6 in. 20.0 in. 39 mortality from zymotic diseases. In the year under review, 32 persons of all classes succumbed to zymotic diseases, which is exactly double the number registered from the same class of maladies in the preceding year. Small-pox, Scarlatina, and Diphtheria contributed 19 deaths to the register of the past year, against only five in 1862, whilst Measles, Whooping-cough, Fever, and Diarrhoea, were likewise in excess of 10 against 8. The three deaths from Small-pox—a disease which had for a long series of years been absent from this locality—is not satisfactory, and is less so, seeing that to a most stubborn resistance of vaccination on the part of some, and to an utter indifference to its prophylactic power on the part of others, must be attributed much of the suffering, and I believe, the whole of the mortality registered in the parish, as the result of this pestilence. The amount of ignorance prevailing on the subject of vaccination, and on the advisability of adopting a perfect system of isolation in Small-pox cases, is something extraordinary, and more than ever indicates the necessity of further legislation for the protection of the community generally against the indiscretion and indifference of the few whom the law is at present unable to reach. In the absence of this legislation, much, however, might be accomplished by district visitors and others in making the poor feel ther individual responsibility in relation to this disease. The committees of public schools, the employers of labour in workshops and factories, indeed, all persons having the control of children and of servants might do immense service to the cause of sanitation, by judiciously insisting 40 upon the performance of vaccination upon every unprotected person about to enter their respective establishments. In short, every householder might, in this respect, become a sanitary inspector with excellent effect, and but comparatively few of the population, it is believed, would then escape vaccination. The practice of re-vaccination is one that also deserves more serious attention than it appears to receive. But few of the medical profession of any experience will be found at the present day to dispute the fact, that the longer persons have been vaccinated, the more liable they are to take Small-pox in after life; and it is surely a wise precaution to submit to a slight temporary inconvenience, even a dozen times, than once risk the contraction of so loathsome and destructive a disease by a neglect of the only possible test of the efficacy of vaccination performed in infancy. The most perfect isolation of persons suffering from Small-pox is another, and a no less important consideration in any attempts we may make to prevent the spread of the disease ; and more essential is it that this isolation should be promptly accomplished when the sufferers belong to the class of the very poor. The comfortless abodes of the majority of this class will not admit of such desirable arrangements being made as to effect the proper separation of the sick from the healthy, either by night or by day; and when the feelings of the patients happen (as they too frequently are) to be against removal to the special hospitals or infirmaries, the results are deplorable in the extreme, and certainly necessitates the greatest caution being used by all who take upon themselves the office of advisers of the poor, especially on the subject of the domestic management of the sick, in relation to which the labouring classes of this country, as a rule, display the most lamentable ignorance and apathy. 41 It has been well observed by an authority on these matters,* that "Small-pox might be entirely arrested, and for ever banished from the earth, if people would only act intelligently upon the known laws of it existence and spread." But this intelligence, I fear, we shall look for in vain amongst those upon whom Small-pox inflicts the greatest suffering and the heaviest mortality; and nothing, therefore, is more to be regretted than the absence of those really compulsory regulations which, in most continental states, have been long put in operation with the best and most satisfactory results. The same observations in reference to isolation will apply to Scarlatina and Diphtheria, which two diseases resulted in death during the year in 16 instances, viz., 10 from the former, and 6 from the latter; and this, it may be remarked, is a much higher rate of mortality than has yet been recorded as occurring from those maladies since the Metropolis Local Management Act came into operation. The resulting mortality from the other principal diseases of the zymotic group has been, I am pleased to say, below the average of the past seven years. From Measles, Whooping-cough, Fever, and Diarrhoea combined, the deaths were 10 only. It is satisfactory, also, to note that, considering the increased number of registered deaths from zymotic diseases during the past year, there was no proportionate increase in the number of children under 10 years of age, who succumbed to those diseases. sickness and mortality amongst the union poor. Table IV., Appendix, exhibits both the nature and amount * Dr. Lankester, Medical Officer of Health for St. James's, Westminster, and one of the Coroners for Middlesex. 42 of sickness amongst the out-door Union poor of this parish, as well as the resulting mortality during the year 1863. Of 463 cases treated, which rather exceeds the number in the preceding year, 21 only succumbed to disease, accident, &c., thus giving about the same small per centage as noted on the average of the past seven years. The most fatal diseases afflicting the Union poor, as indeed all other classes in the sub-district, were those of the pulmonary organs, including Phthisis, due, no doubt, to the ever-changing atmospheric conditions which marked the entire year. It is most gratifying to note that, of the 32 deaths which occurred amongst all classes from zymotic diseases, the insignificant number of four only took place amongst the pauper class; a result all the more pleasing, seeing that before the dwelling-places of the poor were cared for by judicious sanitation, applied under the Local Management Act, the picture was reversed, and the majority of deaths from epidemics was always found on the side of the indigent portion of the population. sanitation of the past year. In Table VI., Appendix, will be found a summary of the sanitary operations carried out in this parish during the past year. They have been both numerous and important, and have been, it appears, as last year, all effected without magisterial interference. Amongst the most important of these operations, may be named the completion of 3,555 feet of new sewerage, the hamlet of Roehampton participating largely in the benefits of the same. In addition to the usual inspections of the Slaughterhouses and Cow-houses in the sub-district, the Bakehouses 43 throughout the parish have this year been examined and reported on. It is my pleasing duty to state that, with the exception of a few alterations and improvements in ventilation, necessitated by the Act of Parliament, there was nothing to complain of in any of these places, all being found to be clean and wholesome, in substantial repair, and regulated, in every respect, in accordance with the requirements of the law. There can be no doubt the construction of efficient sewerage, the abolition of cesspools, the removal of innumerable nuisances, and the adoption of stringent sanitary regulations under the directions of the Local Board, have done much during the past seven years towards depriving disease of its virulence, and in removing many of those causes or agencies which engender, as well as promote, the diffusion of fever. Dr. Milroy, in speaking of the origin and spread of fever, has said that "Wherever there is little fever, there the mortality from many other diseases—all those, for example, of the scrofulous or tuberculous family; not to mention also Dysentery, Erysipelas, &c., is almost invariably at a low average upon the whole. The frequency of fever thus becomes a pretty sure test of the general salubrity of a place, and at the same time may be fairly taken as a standard to judge of the efficacy of all sanitary propositions and reforms." That these observations apply, in their fullest force, to this sub-district, I believe myself to be in a position to speak with some confidence. Cases of fever of a low, typhoid character were, a few years ago, not only very frequent for so small a population, but very fatal, particularly amongst the poor. Now they are seldom met with, and when they are, they prove, generally speaking, of much 44 shorter duration, and much more amenable to treatment than formerly. My belief is, fevers of this type would be even less frequent could means be adopted to insure a less over-crowded condition of the dwellings of the poor. The point, then, in which the sanitary condition of this parish is susceptable of the greatest improvement, is in reference to a more adequate supply of suitable houses for the working-classes. In the year 1862 there were erected 42 new houses, and in the past year as many as 66, making, in two years, since the taking of the last census, 108 dwellings of all classes. But very few of these new houses are, however, available as dwellings for the very poor, and it needs, therefore, but little reflection to become convinced of the more than probable consequences of such a state of things a few years hence. Increased taxation is, I am aware, at no time a very palatable recommendation, but I submit a self-imposed tax upon the time and energies of the wealthier classes of the community by combining to effect the suggested improvement, is infinitely to be preferred, both socially and economically, to one in the shape of widowhood and orphanage, and increased poor-rates. To such, then, as desire the future welfare and social advancement of their poorer neighbours, a timely effort in the direction indicated is most earnestly recommended. R. HARLAND WHITEMAN, Medical Officer of Health for Putney and Roehampton. APPENDIX OF STATISTICAL TABLES. TABLE I. Summary of Deaths and their Causes, registered in the Entire District during 1863, 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. Baltersea — Population in 1861, 19,582, area in acres, 2,343. Putney—Population in 1861,6,481, area in acres, 2.176. Striatham, Tooting, and Balham, Population. 1361, 10,082. area 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 years. At 20, and under 40 years of age. At 40, and under 60 years of age. At 60 and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks. Ac. Industrial and Labouring Classes. DISEASES. And other Causes of Death. Classes I. Zymotic Small Pox 34 11 8 11 3 1 15 19 6 10 6 25 6 1 2 .. .. 1 3 30 Measles 50 24 2 13 3 8 26 24 19 28 3 50 .. .. .. .. .. 1 8 41 Scarlatina 92 28 23 26 10 5 43 49 6 39 25 86 4 2 .. .. .. 11 16 65. Diphtherta 17 1 1 7 6 2 8 9 3 6 6 16 .. 1 .. .. .. 1 4 12 Quinsy 3 2 .. 1 .. .. 2 1 .. 3 .. 3 .. .. .. .. .. .. .. .. Croup 5 1 4 .. .. .. 3 2 .. 4 .. 5 .. .. .. .. .. .. .. .. Whooping Cough 29 9 9 5 3 3 13 16 11 17 .. 28 .. 1 .. .. .. 4 2 23 Typhus and Infantile Fever 37 6 13 8 2 8 18 19 2 11 5 22 9 2 3 1 .. 2 7 28 Erysipelas 7 1 3 2 .. 1 1 6 5 1 .. 6 .. 1 .. .. .. 1 .. 6 Metria, Childbirth 12 1 .. 7 2 2 .. 12 .. .. .. .. 8 4 .. .. 1 2 1 8 Carbuncle 1 .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. 1 .. .. 1 .. lnfluenza 1 1 .. .. .. .. 1 .. 1 .. .. 1 .. .. .. .. .. .. 1 .. Diarrhœa, and Dyentery 40 16 6 16 2 6 24 22 36 6 .. 43 1 1 1 .. .. 4 4 38 Cholera 2 .. .. 1 .. 1 1 1 1 .. .. 2 .. .. .. .. .. .. 2 .. Totals of Zymotic Class 336 101 69 97 32 37 156 180 90 125 45 287 28 13 6 2 1 27 51 25 2. Tubercular 217 47 45 84 24 17 114 103 34 27 5 79 74 54 10 .. 1 10 44 162 3. Of Brain and Nerves 225 36 70 77 13 29 130 95 55 34 7 164 21 41 50 6 9 16 43 157 4. Of Heart 96 23 12 43 6 12 45 51 4 1 1 10 15 24 40 7 7 5 18 66 5. Of Respiratory Organs 181 39 30 75 18 19 83 93 48 42 2 100 8 20 51 2 5 4 47 125 6. Of Digestive Organs 95 27 22 31 3 9 41 54 30 11 2 49 8 15 22 1 1 6 25 63 7. Of Urinary Organs 18 4 3 7 .. 4 12 6 .. 1 .. 1 3 7 7 .. 3 2 5 8 8. Of Organs of Generation 16 6 3 3 3 1 1 15 2 .. .. 2 2 8 4 .. .. 4 3 9 9. Of Joints, Bones, &c. 6 2 1 1 1 1 2 4 1 .. 1 2 2 1 1 .. 1 .. 2 3 10. Of Skin 3 2 .. .. .. 1 .. 3 2 .. .. 2 .. .. 1 .. .. .. 2 1 11. Premature Birth, Low Vitality, Malformation, &c 67 14 13 28 4 8 28 39 62 1 1 67 .. .. .. .. 1 3 11 52 12. Of Uncertain Seat 53 6 14 14 13 6 22 31 8 2 .. 15 3 12 22 1 3 4 14 32 13. Age 81 29 12 23 4 13 28 53 .. .. .. .. .. .. 41 40 1 11 27 42 14. Violence 52 7 6 20 6 7 42 10 6 3 l 15 12 15 9 1 2 8 42 15. Not Specified 25 12 10 2 1 17 8 8 2 2 12 4 3 6 .. .. 2 9 14 Totals 1471 355 3 522 129 165 726 745 350 249 67 745 180 216 270 60 33 96 309 1033 46 TABLE II. Births during the year ended 31st December, 1863. SUB-DISTRICT. Males. Females. Total. Clapham 346 339 685 Wandsworth 198 246 444 Battersea 528 514 1,042 Putney and Roehampton 98 90 188 Streatham, including Tooting and Balham. 141 133 274 Total 1,311 1,322 2,633 *** The excess of Births over Deaths in the entire district is 1,162. TABLE III. Meteorological Means for 1863, 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 42.6 35.0 58.8 46.8 50.3 Evaporation 40.3 49.5 54.5 45.0 47.3 Dew Point 37.7 46.0 50.7 42.9 44.3 Weight of Vapour in a Cubic Foot of Air 2.6 grs. 3.5 grs. 4.1 grs. 3.2 grs. 3.4 grs. Degree of Humidity (Sato. 100) 83 77 74 86 80 Reading of Barometer 29.825 29.799 29.799 29.817 29.810 Weight of a Cubic) Foot of Air 550 grs. 538 grs. 531 grs. 545 grs. 541 grs. Rain (amount of) 3.9 in. 5.6 in. 5.9 in. 4.6 in. 20.0 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 1855-63. 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 1863 95 86 62 29 32 304 1471 29.9 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. 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 Tear that ended 31st December, 1863. 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—Diarrhœa 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. j Cases. Deaths. Cases. Deaths. Cases. Deaths. Ca-es. j Deaths. Cases Deaths.. Cases. | Deaths. Cases. Deaths. Cases. Deaths. Clapham 1101 88 4 58 7 26 4 6 1 42 2 ... ... 189 3 7 ... ... ... 116 7 16 4 7 ... 490 4 56 3 39 Wandsworth 1520 34 3 17 ... 23 4 12 1 102 3 ... ... 125 3 17 ... ... ... 198 7 12 5 8 8 909 8 63 1 43 Baltersea 930 37 6 16 2 21 4 4 ... 53 ... ... ... 35 1 6 1 1 ... 142 17 4 2 19 7 550 7 42 ... 47 Putney and Roehampton 463 18 2 40 ... 11 ... 4 ... 18 1 ... ... 27 1 ... ... ... ... 36 4 1 1 10 2 276 7 22 3 21 Streatham, including Tooting & Balham 246 8 ... 4 ... 3 3 ... ... 10 ... ... ... 4 ... 3 ... ... ... 19 2 9 1 ... ... 172 1 14 ... 7 Totals 4260 185 15 135 9 84 15 26 2 225 6 ... ... 380 8 33 1 1 ... 511 37 42 13 44 17 2397 27 197 7 157 49 TABLE VI. Summary of the Sanitary Operations in the entire District during the year 1863. Clapham. Battersea. Wandsworth. Putney and Roehampton. Streatham, including Tooting and Balliam. Totals. Number of Houses and Premises inspected 1000 1000 208 122 143 2473 1st Notices served 527 33 117 16 22 738 2nd Notices served 4 13 3 3 Cesspools emptied and cleansed ... 100 50 20 204 374 Cesspools abolished 48 ... 5 20 28 101 Water-closets constructed 108 507 87 20 106 848 Houses supplied with water 108 507 96 29 108 848 Drains constructed or connected with Sewer 254 38 93 16 41 442 No. of feet of New Sewers, &c 14,136 505 3149 3555 4066 25,411 Drains repaired or trapped, or obstructions removed 23 4 37 18 47 129 Open Ditches, Ponds, &c., cleansed 12,410 ft. 1 2 miles 9370 ft. 10 miles ... Dust-bins provided 107 507 88 8 78 788 Pig Nuisances removed ... 3 16 2 5 26 Accumulations of Offal, Manure, &c., removed 16 3 16 6 9 50 Unwholesome & dilapidated Houses cleansed or repaired ... ... 60 19 2 81 Cases investigated by Magistrates ... ... ... ... ... ... Compulsory Orders obtained ... ... ... ... ... ... Compulsory Works executed ... ... ... ... ... ... Works remaining in abeyance from various causes ... ... ... ... 2 2