WAN 16 SANITARY DEPARTMENT. REPORT ON THE SANITARY CONDITION OF THE SEVERAL PARISHES COMPRISED IN THE WANDSWORTH DISTRICT, DURING THE YEAR 1804. By the Medical Officer of Health. london: JOHN SMITH AND CO., LONG ACRE, W.C. 1865. 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. MacDonough 15 5. „ on the Sub-District of Battersea, by Dr. W. Connor 23 6. „ on the Sub-District of Streatham, by Dr. D. C. Noel 27 7. „ on the Sub-District of Putney, by Dr. R. H. Whiteman 32 8. Appendix of Statistical Tables, &c. 43 REPORT. 1864. To the Board of Works for the Wandsworth District. Gentlemen, The ninth year of the operation of the Metropolis Local Management Act having expired, it again necessitates, at our hands, the presentation of the usual annual report on the health and sanitary condition of the several parishes within the jurisdiction of your Board. In the last report we had the honour of submitting, we expressed our regret that the District had not then presented so healthy a condition as in some previous years, and referred to the fact of such result being evidently due to general rather than to local causes. It is found that similar general influences continued to operate in the production and propagation of disease in the District throughout the greater part of 1864. It is however satisfactory to note that it is not to zymotic maladies that the excess of mortality during the past year is to be attributed, but rather to the prevalence of that class of affections over which sanitation can exercise but little control, but which are mainly influenced, in respect to their fatality, by unfavourable atmospheric conditions— conditions, which we may reasonably hope will not be persistent. We have the honour to be, Gentlemen, Your very obedient Servants, THE MEDICAL OFFICERS OF HEALTH FOR THE WANDSWORTH DISTRICT. A 2 4 SANITARY STATE OF THE ENTIRE DISTRICT. birth rate—rate op natural increase. The Births registered in the entire Wandsworth District during the year 1864, numbered 2727; 1428 of boys, and 1299 of girls. The Deaths were 1688; 843 of males, and 845 of females. The excess of births over deaths was therefore 1039. Calculated upon the assumption that the population has increased during the past year, in the same ratio as it has done during the preceding ten years, the Birth-rate during the past year was 34.72 per 1000, and the Rate of Natural Increase 13.23 per 1000 persons living of the entire population. mortality-death rate. In presence of a high rate of natural increase, it is unsatisfactory to find a record during the past year of a mortality much higher than usual. The deaths exceeded the average of the past ten years, corrected for increase of population, by 219, or nearly 2 per 1000 ; the deathrate having been 21.49 per 1000 persons living. A similar excess of mortality, however, it should be observed, was suffered by the entire Metropolis, and to even a greater extent, the death-rate of which was greater by upwards of 2 per 1000 than the average of the past 25 years, inclusive of the two years of epidemic cholera. As in the Metropolis, also, the higher death-rate of this District is not found to be dependent on the prevalence of any special epidemic, or of a larger amount of epidemic diseases than usual; indeed, on reference to Table IV., in the Appendix, it will be seen that the ratio borne by deaths from epidemic diseases to the deaths from all causes, during the past year, was less by nearly 2 per cent. than the average of the past 9 years. There was a greater fatality than usual from Typhus, but not to an extent which would account for the high mortality recorded. Unusual fatality is also 5 seen to have attended several of the other classes of disease ; thus, the Tubercular class, including Consumption, Diseases of the Brain and Nervous System, and, principally, Diseases of the Organs of Bespiration (exclusive of Consumption) contributed, by their excessive fatality, mainly to the higher death-rate of the past year. sickness. The amount of sickness (or more correctly the number of cases of sickness coming under treatment) during the year, is calculated at about 55 per cent. of the population, and that one death resulted from every 26 attacks. This estimate, as explained in former reports, is made by assuming the proportion which the deaths bear to cases of sickness amongst the parochial poor as the proportion which the total deaths bear to the total cases of sickness, amongst all classes, and is the only present means by which the amount of sickness from which, the mortality of the District has resulted, can be even approximately arrived at. Looking to the circumstances that an excessive mortality during the past year was common to the whole Metropolis, and to very generally the same extent, and that the cause of such excess was not due to any unusual fatality from epidemic diseases, it may be fairly inferred that the higher mortality of this District was due to general causes (probably climatic) rather than to those local ones which come more immediately under the remedial control of sanitation. sanitation. A larger number of feet of new sewerage than even last year appears to have been constructed throughout the District, and in Table VI., in the Appendix will be found recorded numerous other sanitary measures of a beneficial character that have been completed since the issue of the previous Beport. Before any systematic attempts were made to improve the sanitary condition of this District, there can be no doubt Fever was both very frequent and very fatal. Subsequently 6 to the period when the proceedings of the Board of Works came into operation, that disease was found to greatly diminish. The increased fatality from Fever during the past year, however, would seem to point to the possibility of there being, in the immediate carrying out of most sanitary measures, especially with regard to the disposal of sewage, some danger, for a time at least, of increasing rather than of diminishing malarious influences. That such is the case, may be inferred from the fact of the prevalence of a larger amount of Typhus, during the past year, in those parts of the District in which the great Intercepting Sewer was in process of construction. There is the more reason, therefore, whilst this extensive undertaking is being completed—whilst innumerable cesspools are being emptied of their contents, and new ground as constantly opened in all directions, in the formation of tributary house drains—to exercise the greatest possible caution, to watch carefully for the earliest indications of the advent of zymotic disease, and to maintain a thoroughly well-cleansed condition of the entire District by an efficient and unremitting system of Scavengering. After the completion of the Main Drainage, it is confidently hoped that every house in the District will be found to possess its own proper drainage, a constant and liberal supply of water, and to be free from the many other sanitary defects which now so largely exist in the dwellings of the poor. And, finally, the great evil of overcrowding ought to be prevented to the utmost; inasmuch as it presents, even when all other sanitary defects may have been remedied, one of the most favourable conditions for the propagation and aggravation of infectious diseases. Any measures, therefore, which may be adopted for the purpose of affording to the labouring man a more capacious and healthful class of houses, will be the means of not only improving his moral and social welfare, but of indirectly conferring upon the public at large great and lasting benefits. LOCAL SUMMARIES. WANDSWORTH. An examination of the Mortuary Returns and of the Parochial Records of Sickness and Mortality furnishes evidence that the health of this sub-district during the past three years has gradually lapsed from the high status which it had previously acquired, and that during the past year it was still more unfavourable. The extent of this deterioration, however, is not alarming, inasmuch as the death-rate will be found to be still within the average rate of the entire District. The cause of this lowered vitality is not to be found in the prevalence of any special epidemic nor in the preponderance of epidemic diseases generally; for, contrary to the usual circumstance, which from its constancy has become to be accepted as a rule, of the death-rate fluctuating with the greater or less fatality from diseases of the epidemic class, the deaths from these diseases during the past year bore to the total deaths a proportion less than the average of the past eight years. And, as it has been shown by the Registrar General, that a less favourable condition of the public health has been common to the whole Metropolis during the past three years, it may be fairly assumed that the falling off of the health of this sub-district with that of others has been due to general rather than to local, and therefore more preventable causes. 8 mortality—death-rate. The total deaths which were registered as having occurred in this sub-district during the year 1864, numbered 311; 152 were of males and 159 of females; 87 occurred in the following Public institutions; viz.—72 in the Surrey County Lunatic Asylum; 11 in the House of Correction; 3 in St. Peter's Hospital and 1 in the Royal Patriotic School for girls; 30 Wandsworth parishioners also died in the Union Workhouse. The death-rate for the past year, calculated from the death register and an estimated population, with due correction for the Surrey County Lunatic Asylum and the Workhouse after the manner described in previous Reports, was 19.12 per 1000 persons living, or nearly 2 per 1000 higher than the average.* birth rate—rate of natural increase. The births registered during the year numbered 441, 242 males and 199 females. The birth-rate was 31.70 per 1000, and the rate of natural increase 12.58 per 1000 of the entire population. Although the births of males were in excess of the females during the past year, it is a somewhat singular circumstance, and contrary to the natural law which generally obtains in large communities, that the births of females exceed those of males in this sub-district; thus, during the past 14 years the births of 2598 females but of 2490 males only were registered. *The population is estimated upon the assumption that it has increased since the period of the last census in the same proportion as it had done during the preceding ten years. The inmates of the County Asylum are derived (with a fractional exception) 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 the calculation, and the deaths of Wandsworth parishioners which occur in the Workhouse are added to it. 9 causes of death. The following table will be found to contain 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 different periods, and particularizing the several diseases of the zymotic class. WANDSWORTH. Population in 1861—13,346. Area in Acres—2,478. DISEASES, And other Causes of Death. Diseases Classified. Total Deaths from each Class in 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, &c. Middle & Trading Class, Shopmen, Clerks, &c. Industrial & Labouring Classes. Classes:— 1. Zymotic Small Pox 4 1 3 .. 2 1 4 .. .. .. .. .. .. .. 4 Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlatina 3 .. 3 .. 1 .. 1 2 .. .. .. .. .. 2 1 Diphtheria 6 1 5 .. 3 2 6 .. .. .. .. .. 1 4 1 Quinsy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Croup 1 1 .. .. 1 .. 1 .. .. .. .. .. .. 1 .. Whooping Cough 9 3 6 6 3 .. 9 .. .. .. .. .. 1 1 7 Fever 13 8 5 .. 3 1 4 4 4 1 .. .. .. 3 10 Erysipelas 3 2 1 .. 2 .. 2 .. .. .. 1 .. .. .. 3 Metria, Childbirth .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Carbuncle .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa & Dysentery 8 4 4 6 1 .. 7 .. .. 1 .. .. .. 3 5 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 47 20 27 12 16 4 34 6 4 2 1 •• 2 14 31 2. Tubercular 60 31 29 13 11 3 30 17 12 .. 1 .. 3 8 49 3. Of Brain, Nerves, &c. 65 37 28 6 3 •• 10 18 23 12 2 •• 2 8 55 4. Of the Heart, &c. 9 4 5 .. .. .. .. 1 4 4 .. .. 1 3 5 5. Of Respiratory Organs 52 25 27 14 8 1 25 4 11 12 .. .. 1 6 45 6. Of Digestive Organs 16 4 12 1 3 2 7 3 2 3 1 1 2 3 10 7. Of the Kidneys 2 1 1 1 .. .. 1 1 .. .. .. .. .. 1 1 8. Of the Uterus 5 .. 5 .. .. .. 1 .. 4 .. .. .. .. 1 4 9. Of Joints, Bones, &c. 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. 1 10. Of Skin .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11. Premature Birth, Low Vitality, Malformation, &c. 15 8 7 14 •• •• 14 .. 1 .. .. .. 1 3 11 12. Of Uncertain Seat 13 6 7 •• 1 1 2 1 5 4 1 1 1 1 10 13. Age 16 8 8 .. .. .. .. .. .. 7 9 2 1 2 11 14. Violence 10 8 2 2 .. 1 5 2 1 1 1 1 .. 1 8 15. Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Total 311 152 159 63 42 12 129 54 67 45 16 5 14 51 241 10 Excluding diseases of the Brain and Nervous System from a consideration of the causation of mortality proper to this parish, in consequence of this class of diseases being unduly augmented by the mortality of the Surrey County Lunatic Asylum, the Tubercular class (which includes Scrofula and Consumption), caused the largest number of deaths, namely, 19 per cent. of the whole. Diseases of the organs of respiration (exclusive of Consumption), formed 16½ per cent. The zymotic class, which generally exceeds the two preceding classes, formed 15 per cent. Diseases of the digestive organs formed 5 per cent. The most fatal single disease was, as usual, Consumption, which caused 10 per cent. of all deaths, an amount which, although actually great, is relatively small in comparison with that of most of the other Metropolitan districts. Upwards of 20 per cent. of all deaths took place under 1 year of age, 33 per cent. under 5 years, and 41 per cent. under 20 years of age; 77 per cent. of all deaths, and nearly two thirds of the deaths from epidemic diseases occurred amongst the labouring and industrial classes. Twenty-nine inquests were held during the year. Ten deaths resulted from violence, 9 of which were accidental and 1 suicidal. Fifteen deaths were recorded of which the cause was not certified by any qualified Medical Practitioner; under such circumstances, which the law at present permits, society is not sufficiently secured against the possibility of any one of these deaths having been due to other than natural causes. epidemic diseases—prevalence and fatality of. The following Table exhibits the deaths which resulted from the principal epidemic diseases during the past and eight preceding years, and the relation which they bore to the deaths from all causes. 11 YEARS. Small Pox Measles. Scarlet Fever. Diphtheria. Whooping Cough. Diarrhœa. Fever— Typhus and Typhoid. Total Deaths from Epidemics. Total Deaths from all causes. Per cent. age 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 1864 4 0 3 6 9 8 13 43 311 13.8 It is seen from the foregoing Table that the mortality which resulted from epidemic diseases was but slightly greater than the average of the past 8 years, while the proportion which it bore to the mortality from all causes was somewhat less than the average. The greatest number of deaths from these diseases occurred during the second quarter of the year, when 22 were registered; 9 occurred in the first quarter, in the third 9, and in the fourth 3; the largest number occurred in April. Fever and Diarrhoea were, as usual, present during the whole year. The former was fatal in February, April, May, June, August, September and October, the latter in February and June, but, as usual, principally in August and September. Whooping Cough prevailed during the first six months, and in December, and was fatal in those months. Scarlet Fever prevailed and was attended with fatality, in April, August and November. The deaths from Diphtheria occurred in the summer quarter. Small-pox was present during the first six months, except in January, and November, and was fatal in February and April. There was an almost entire absence of Measles. There was no prevalence of any special epidemic during the past year, but Fever, which was greatly on the increase 12 throughout the Metropolis was the most fatal of these diseases. SICKNESS AND MORTALITY AMONGST THE PAROCHIAL POOR. Table V., in the Appendix, contains the amount, nature, and fatality of the sickness which occurred amongst the parochial poor during the past year. The total number of cases of sickness under treatment corresponds, within two, with the average of the past nine years, whilst the mortality therefrom (2.8 per cent.) was less than the average (3 per cent). Epidemic diseases were much fewer than usual, having numbered 1.95 only, the average number being 346. These diseases constitute on an average 26 per cent. of all sickness amongst the poor; last year they formed 14 per cent. only. GENERAL SICKNESS—ITS AMOUNT AND INTENSITY. There is no record of the total amount of sickness which has prevailed generally throughout the parish. It can therefore be only approximately estimated from that portion which is accurately known and recorded in the Table of Sickness and Mortality amongst the parochial poor above referred to. By assuming the ratio which the deaths bear to the cases of sickness amongst the poor, as the ratio borne by deaths to cases of sickness throughout the entire parish, it is estimated that the total cases of sickness which came under treatment amounted to 77 per cent. of the population, and that one death resulted from every 34 attacks of sickness. On an average of the past eight years, each death represented 32 attacks. The intensity of disease was therefore somewhat less than the average during the past year. SANITARY PROCEEDINGS. A summary of the principal sanitary proceedings which have been carried out during the year is, as usual, contained in Table VI. in the Appendix. With but two exceptions, 13 only, they were all effected without the intervention of the law. In addition to which, all the slaughter-houses, the cow-houses, and bake-houses, the latter for the first time, were examined, and specially reported on. Much benefit continues to be derived from the cleansing and limewhiting the rooms of the poorer classes in which contagious diseases have been present—a practice which cannot be too fully enforced for the public good. In my last annual report, and on several other occasions, attention has been directed to the great public nuisance to the town arising from the gipsey encampment, situated by the side of the Alma Road. Nothing has been yet done for the suppression of this great evil. As has been previously shown, these people import contagious diseases into the Town; and, contrary to the common impression, they suffer a high rate of sickness and mortality ; half the deaths which resulted from contagious diseases amongst the out-door poor during the past year, took place amongst them ; and, indeed, their mode of dwelling, alike so injurious to themselves and others, is such as ought not to be permitted in a civilized community. If the law be inoperative in the matter, it would seem a strange anomaly that it should permit a large number of human beings to herd together under conditions which would not be allowed to the same number of swine, or others of the lower animals. By a reference to the sanitary proceedings contained in the Table, it will be observed that they are of two kinds ; some being of a more or less permanent character, such as Drainage and Water-supply, while others are the reverse, requiring, in consequence of the transient nature of their effects, frequent renewal or repetition. These, although not equalling the former in individual magnitude or attractiveness, are equally important, and deserving a more careful culture than, on account of their apparently trivial nature, they usually receive; and, indeed, are such as in the aggregate would, by their complete fulfilment or otherwise, make all the difference between health and sickness—life and death—should an epidemic unfortunately 14 visit us. I would, therefore, again beg to urge upon your notice the necessity of a vigorous prosecution of all the minor sanitary proceedings, the chief of which are such as may be embraced by the general term Scavengering; and to point out, in conclusion, that such prosecution, to be efficient, must be systematic ; for it is not by the spasmodic efforts of a fitful zeal called into activity by present or impending pestilence, but only by endeavours well regulated and continuously sustained, that the full benefits of sanitary science can be expected to be realized. GEORGE EDWARD NICHOLAS, M.D., Medical Officer of Health for Wandsworth. CLAPHAM. The statistics of births, deaths, and marriages, are at all times of value to the sanitarian. Adopting the same table as used by me in most of my previous annual reports, and having precisely the same objects in view in referring to it, I need scarcely remark upon the importance of these statistics to all who are desirous of taking a comprehensive view of the progress of sanitation in this Parish. MARRIAGES, BIRTHS, AND DEATHS. Years. 1856 1857 1858 1859 1860 1861 1862 1863 1864 Marriages 154 151 150 156 183 182 175 181 227 Births 527 550 533 594 608 624 622 685 640 Deaths 286 321 344 328 429 390 343 355 408 Excess of Births over Deaths 241 229 189 266 179 234 279 330 232 Bearing in mind the limited area of this Sub-district, extending as it does, to only 1233 statute acres (by far the smallest extent of any sub-district under the jurisdiction of the Board of Works, although more densely populated) the variations, from year to year, in the number of births, deaths, and marriages, must strike every one as being most remarkable. For instance, although the marriages are represented by a larger number than in any year since 1856, the number of births are greatly out of proportion as compared with that of some other years, and the excess of births over deaths (232) is, in the past year, less by 9 than even the number recorded nine years ago, viz., in 1856, when it was 241. 16 Again in the years 1858 and 1860, the excess was much less than in 1856 and 1857, by a very large number, and what is more singular still, the past year's excess is ninetyeight less than in the year preceding, the numbers being respectively 232 in 1864, and 330 in 1863. There is, I believe, no way of account ing for these extraordinary fluctuations but by attributing them to the migratory tendencies of the industrial population. When work is plentiful and the food of the people abundant, then is the population found to largely increase—when otherwise, there is a corresponding falling off in the number of inhabitants observable. These fluctuations are well marked in the above table, and cannot prove otherwise than instructive. STATISTICS OF MORTALITY. The population of this sub-district continues largely to increase by births, as may be seen by the above Table. To what extent it may have increased by immigration since the last census, there are few or no data upon which we can rely ; unless therefore it is permitted us to assume a corresponding increase in the past year to that of former years, we cannot arrive at even an approximate estimate of the present population. In my last report I added half the natural increase of the population to that of the last census as the probable amount of increase by immigration. By adopting a similar calculation now, and adding to the estimate made for the year 1863, (which was 2l.780) both the natural increase of the past year and the assumed increase by immigration it is clear that even at this very low estimate, the inhabitants of this parish will have numbered 22.128 at the close of the year 1864. When the extraordinary number of new houses that have.lately sprung up in many parts of the parish, and now for the most part occupied, is considered, the above estimate cannot in any way be looked upon as an exaggerated one. Upon the above calculation then it is most satisfactory to find that the rate of mortality for the past year will be 17 something under 16 in every 1000 living; a most encouraging fact, and one which in my humble view repays us for all previous sanitary exertions. As usual, I here affix the much approved mortality table, which gives the number of deaths from each class of disease and the causes, as well as the age, sex, and social position of every person who died and whose death was registered in this parish, during the past year. CLAPHAM. Population in 1861—20,894. Area in Acres—1,233. DISEASES, And other Causes of Death. 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, Ac. Industrial & Labouring Classes. Classes:— 1. Zymotic Small pox 3 .. 3 2 .. .. 2 .. 1 .. .. .. .. 1 2 Measles 12 4 8 1 11 .. 12 .. .. .. .. .. .. 1 11 Scarlatina 11 5 6 3 5 2 10 1 .. .. .. .. 1 4 6 Diphtheria 2 .. 2 .. 1 .. 1 .. 1 .. .. .. .. .. 2 Quinsy 1 1 .. .. .. .. .. 1 .. .. .. .. .. 1 .. Croup 4 1 3 .. 3 1 4 .. .. .. .. .. 1 .. 3 Whooping Cough 10 4 6 3 7 .. 10 .. .. .. .. .. .. 2 8 Typhus, &c. 14 7 7 3 3 2 9 1 3 1 .. .. .. 2 12 Erysipelas 1 1 .. .. .. .. .. .. 1 .. .. .. .. 1 .. Metria, Childbirth 1 .. 1 .. .. .. .. 1 .. .. .. .. 1 .. .. Carbuncle 1 1 .. .. .. .. .. .. 1 .. .. .. 1 .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa & Dysentery 11 6 5 7 1 .. 8 .. 1 2 .. .. .. 4 7 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 71 30 41 19 31 5 56 4 8 3 •• •• 4 16 51 2. Tubercular 46 23 23 6 3 2 20 15 9 2 .. .. 4 17 25 3. Of Brain, Nerves, &c. 60 35 25 10 13 5 30 6 11 10 3 •• 8 22 30 4. Of the Heart, &c. 21 10 11 •• .. •• 2 •• 12 7 .. .. .. 6 15 5. Of Respiratory Organs 66 28 38 20 11 3 34 4 19 .. .. .. 1 19 46 6. Of Digestive Organs 33 14 19 12 8 1 21 1 3 7 1 .. 1 14 18 7. Of Urinary Organs 3 3 .. .. .. .. .. .. .. 3 .. .. .. 3 .. 8. Of Organs of Generation 2 1 1 .. .. .. .. 1 .. 1 .. • • 1 1 .. 9. Of Joints, Bones, &c. 9 5 4 .. .. .. 4 .. 2 3 .. .. .. 6 3 10. Of Skin 1 1 .. •• 1 •• 1 .. .. .. .. .. .. .. 1 11. Premature Birth, Low Vitality, Malformation, &c. 24 10 14 21 3 •• 24 .. .. .. .. .. 2 4 18 12. Of Uncertain Seat 2 1 1 .. 1 .. 1 .. 1 .. .. • • .. •• 2 13. Age 45 14 31 .. .. .. .. .. .. 12 33 • • 8 21 16 14. Violence 9 2 7 2 2 2 7 .. 1 .. 1 .. .. 3 6 15. Not Specified 16 3 13 6 1 1 8 l 3 4 •• •• 1 4 11 Totals 408 180 228 96 74 19 208 32 59 71 38 •• 30 136 242 b 18 Viewing this table first as regards the sex of the deceased persons, it is found that such excess is rather large on the side of females, the numbers being respectively, males 180, and females 228. The greater number of males than females who emigrate, leaves of course a larger field on the side of the latter for death to work upon, hence, perhaps, the disparity of numbers. As to age, I regret to say the mortality amongst infants and children has been greater during the past than during many previous years. As many as 96 infants under one year, 74 children from one to five years, and 19 from five to ten years, are registered as having died from all causes and amongst all classes, making a total of 189 deaths of children between birth and ten years of age, which is a much heavier mortality than has appeared during any of the eight preceding years. At the opposite extreme of age as many as 45 deaths were registered as entirely due to natural decay, and of these 12 were between 70 and 80. and 31 at or above 80. In addition to these deaths at an advanced age, three persons were registered as having succumbed to diseases of the brain and nervous system, one to disease of the digestive organs, and one to violence, all of whom were returned as being 80 years of age and upwards. Of all diseases and other causes there died during the past year 71 persons between 60 and 80, and 31 at 80 years and upwards, making a total of 109 persons of advanced life. The mortality amongst the labouring class (as I regret to say is generally found to be the case) is nearly double that of the other classes combined, a fact that points out, as it ever has done, in what direction sanitation should be continued, until more wholesome dwellings, a more abundant supply of pure water, and more efficient sewerage, has been secured to this class of the population. zymotic diseases. The following table concisely shews the comparative 19 number of deaths from each of the seven principal Zymotic Diseases, during the nine years in which the Metropolis Local Management Act has been in operation. It is gratifying to observe that the mortality from these diseases under each head (with three exceptions) was much lighter in the past year than in the preceding one. Years. 1856 1857 1858 1859 1860 1861 1862 1863 1864 Small-pox 1 0 1 9 6 6 1 11 3 Measles 14 2 14 2 20 0 6 24 12 Scarlatina 9 8 25 26 24 22 13 28 11 Diphtheria 0 0 0 0 9 13 3 1 2 Whooping-cough 4 13 13 6 21 14 14 9 10 Typhus 4 7 11 12 6 5 8 6 14 Diarrhœa 4 27 16 11 5 16 7 16 11 Totals 36 57 80 66 91 76 52 95 63 The Zymotic Diseases mentioned in the above table are mostly incidental to the young, and from their prevalence and fatality demand the most anxious consideration. The fluctuations observable in the number of deaths from these maladies from year to year are as remarkable as those in respect to the births and marriages. How soon science may be enabled to satisfactorily explain the causes of the invasion of these diseases it is impossible to say, but beyond calling them preventable, and shewing how they can be rendered less virulent and more amenable to treatment, science has, as yet, much to enlighten us upon. SMALL POX AND VACCINATION. In the past year there were registered 640 births (305 males and 335 females) of whom I successfully vaccinated 211 only. Of this number 25 were of young persons B 2 20 between 2 and 15 years of age, who bad not previously been protected. Although the parents of these children had had abundant opportunities of obtaining this protection at the hands of the public vaccinator, there is reason to believe they would not in many of the cases have permitted the operation, had it not been for the circumstance of Small Pox, in its most virulent form, attacking at the time one or more members of their families. This state of things is very unsatisfactory, and it is much to be deplored. It is true that vaccination fails to give the desired protection in all cases. In 1863 I had assigned to my care a young woman who had been successfully vaccinated in infancy. "When in her girlhood she had to nurse a child ill of Small Pox, and she took the disease, being then well marked by it; but notwithstanding this she contracted it a second time, and in the year above stated, died of the malady. This, however, is quite an exceptionable case. I believe that vaccination does afford, as a rule, the greatest possible protection, and I therefore think a law to become so inoperative as the Compulsory Vaccination Act has of late years done, must have in it many radical defects, defects that can only be remedied by an appeal to the legislature. At present so few appear to know the law, or have the least notion that the act is to extend vaccination and to make it compulsory on all, that medical men can scarcely wonder at meeting so much opposition to the performance of the operation, the less so when they bear in mind that a very strong disposition exists on the part of many, to foster the notion that the Act is alone intended to regulate the practice of vaccination amongst the very poor. This pauperizing association must therefore be removed, before the Act can satisfactorily be carried out for the general benefit. ACCIDENTAL, VIOLENT AND SUDDEN DEATHS. During the past year eighteen inquests were held on the bodies of deceased persons in this sub-district, in the majority of which medical evidence (although the inquiry is a purely medical one) was, strange to say, dispensed with 21 altogether, and such vague and loose verdicts returned as "natural," "sudden," "found dead," "probably disease of the heart," &c., &c., all of which opinions we are called upon to believe, were arrived at without medical evidence on the score of economy! the economy consisting in the saving of a few fees that would otherwise have found their way into the pockets of the medical profession. If this saving of fees be really the object, would it not be the best economy to save the county the expenses of Coroner's Inquests altogether ? Without medical testimony inquests can scarcely ever fulfil the purpose for which they are held, but must remain a reproach to the legislature as well as a fallacy to the public. sanitary works accomplished during the year. In Table VI, appendix, is seen that the sanitary work accomplished during the year in this parish has been very considerable, which, when added to what was carried out during the preceding year and duly noted in my report, must strike every reader as a great progress in the right direction. It is gratifying to be able to state that the high level sewer is now in full operation in many parts of this Sub-district, and it is to be sincerely hoped will ere long be so throughout its entire extent. As many as 950 houses and premises of various kinds were inspected by the Surveyor and myself, and although many nuisances, &c., were detected, coercive measures were wholly unnecessary to ensure their removal or abatement. The offending parties indeed had only to be reasoned with and shewn that their own best interests were being considered in the recommendations submitted to them, to cause them, in a great number of instances, to comply with such recommendations in the readiest possible manner. As usual, all the slaughterhouses, cowhouses and bakehouses in the parish underwent careful examination by me, and were subsequently reported on to the District Board. Although some considerable trouble and annoyance was 22 caused by a tardy compliance with the requirements of the Board in some few instances, all the proprietors were nevertheless prudent enough to accomplish the cleansing and other operations in time to obtain a renewal of their licenses, and in no one instance had I to oppose the grant of the same. Many, or I may say most, of the streets in this district have been named, but I regret to state the numbering of the houses has not been proceeded with with the same diligence. This is much to be regretted, as, in a district like Clapham, of limited area, the work would not be a difficult one. The advantages that would accrue to so densely populated a parish would, however, be incalculable. It may not be uninteresting to know that in this parish there are twenty-one public houses, and forty-two beer bouses. These last, in my opinion, require supervision in most instances ; and I am of opinion also, that those who license them would do well to examine both the interior and exterior arrangements of such places, with a view to remedy the very defective accommodation furnished by many of them. JOHN MAC DONOGH, Medical Officer of Health for Clapham. BATTERSEA. The health of the sub-district during the year 1864, was not so good as heretofore ; the deaths and general sickness have been very much in excess of previous years, which is attributable principally to the prevalence and fatality of Zymotic Diseases, and of Diseases of the Respiratory Organs. The deaths registered during the year, uumbered 669 (358 males and 311 females) being 147 in excess of the previous year. Of these 669 deaths, 116 occurred in the Workhouse, which is situated in this sub-district; 96 of these deaths not belonging to the sub-district, would, if deducted from the total, reduce the mortality to 573. Calculating from the natural increase, as shewn by the excess of births over deaths, and assuming the increase by immigration during the year to have been one half less than the natural increase (which is an exceedingly low estimate) it would, when added to the supposed population of last year (21,230) bring the number of inhabitants up to 22,086, which would place the rate of mortality for the year at about 25 in every thousand. The following table gives the number of deaths that have been registered during the year 1864, from all causes, and amongst all classes, specifying the sex, age and social position of the deceased. 24 BATTERSEA. Population in 1861—19,952. Area in Statute Acres—2,343 DISEASES, And other Causes of Death. 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, Arc. Middle & Trading Class, Shopmen, Clerks, Industrial & Labouring Classes. Classes:— 1. Zymotic Small Pox 225 15 10 6 10 2 18 6 1 .. .. .. .. 2 23 Measles 8 5 3 4 3 1 8 .. .. .. .. .. .. 2 6 Scarlatina 35 18 17 3 23 7 33 2 .. .. .. .. .. 8 27 Diphtheria 2 1 1 1 .. .. 1 1 .. .. .. .. .. .. 2 Quinsy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough 12 8 4 4 7 •• 11 1 .. .. .. .. .. 4 8 Typhus and Infantile Fever 21 10 11 •• •• 5 9 8 2 2 •• .. 2 5 14 Erysipelas 6 1 5 1 1 .. 3 .. 1 1 1 •• •• 3 3 Metria, Childbirth .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Carbuncle .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa & Dysentery 25 14 11 20 4 •• 24 1 .. .. .. .. .. 5 20 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 134 72 62 39 48 15 107 19 4 3 1 .. 2 29 103 2. Tubercular 80 37 43 20 7 4 38 28 12 2 .. .. 5 19 56 3. Of Brain, Nerves, &c. 107 53 64 32 22 3 58 6 18 25 .. 2 7 27 71 4. Of the Heart, &c. 45 21 24 2 3 •• 9 8 9 19 .. 3 1 19 22 5. Of Respiratory Organs 120 73 47 49 24 1 74 8 13 25 .. 2 2 29 87 6. Of Digestive Organs 13 9 4 3 .. 1 4 .. 5 4 .. 6 5 7. Of Urinary Organs .... 5 4 1 •• .. • • 2 •• 1 .. .. 1 4 8. Of Organs of Generation 6 .. 5 .. .. .. .. .. 2 3 •• 1 •• 1 3 9. Of Joints, Bones, &c. 1 .. 1 .. 1 .. 1 .. .. .. .. .. .. 1 •• 10. Of Skin .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11. Premature Birth, Low Vitality, Maltormation, &c. 55 35 20 55 .. .. 55 .. .. .. .. .. .. 12 45 12. Of Uncertain Seat .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 13. Age 41 14 27 .. .. .. .. .. .. 29 12 8 4 9 20 14. Violence 25 21 4 3 3 1 10 3 8 3 1 .. 1 4 20 15. Not Specified 38 19 19 4 1 1 8 8 10 9 3 .. 1 11 25 Totals 669 358 311 207 109 26 365 82 82 122 18 16 25 168 460 prevalence and fatality of zymotic diseases. Diseases of this class prevailed more extensively and were more fatal than in any previous year since the Metropolis Local Management Act came into operation, particularly Small-pox, Scarlatina and Fever, which three diseases terminated fatally respectively in 25, 35, and 21 instances. 8 persons died of Measles, 2 of Diphtheria, 12 of 25 Whooping Cough, 6 of Erysipelas, and 25 of Diarrhoea. This is a high mortality, since the total deaths from zymotic maladies are found to exceed those in the previous year by as many as 37. MORTALITY IN THE WORKHOUSE. Of the 669 registered deaths in the sub-district, 116, as before stated, occurred in the Workhouse, 20 between the ages of 70 and 80, and 11 between the ages of 80 and 90. INFANT MORTALITY, PROPORTION OF BIRTHS TO DEATHS. The mortality of children between birth and 10 years of age, has been, as usual, high, amounting to 342, and constituting therefore considerably more than one half of the total number of deaths from all causes. There have been 1140 Births, 616 males and 524 females, presenting the large excess of 571 Births over Deaths, which excess gives, of course, the natural increase of the population. This excess is 100 more than in 1863, and larger than any previous year within my recollection. SICKNESS AND MORTALITY AMONG THE OUT-DOOR POOR. Table V. in the appendix exhibits the nature and amount of sickness amongst the pauper population of the subdistrict, compiled from the Medical Relief Books of the Parochial Medical Officers, as well as the deaths that have resulted from diseases and other causes, and gives the proportion of 57 deaths in 842 cases treated. PREVENTIVE MEASURES ADOPTED DURING THE YEAR. AMOUNT OF SANITARY WORK PERFORMED. The amount and kind of work executed within the subdistrict, may be gathered from a perusal of Table VI., Appendix. 26 The improvements effected, particularly in the way of drainage, have been most important, as many as 3,222 feet of new sewers were completed in the year, and numerous drains were connected therewith. A somewhat larger number of cess-pools have been also abolished, and no fewer than 152 water closets constructed; thus affording every evidence that can be desired, of a determination on the part of the authorities to improve the sanitary condition of this densely inhabited locality, by all the means in their power. WILLIAM CONNOR, Medical Officer of Health for the Sub-District of Battersea. STREATHAM, INCLUDING TOOTING AND BALHAM. In respect to the united Parishes of Streatham, Tooting and Balham, a greatly augmented rate of mortality has, in common with most of the other sub-districts, to be recorded for the year 1864. This, however, does not appear, as in some places, to have been the result of an increased fatality attending the zymotic class of diseases, for there were registered less deaths by 10 from such diseases in the past year than in the year preceding. An examination of the accompanying Table of Mortality will show that the excess is really due to maladies of the Tubercular Class, and of the respiratory organs, the deaths from the former having increased from 17 in 1863 to 28 in the past year, and from the latter, 19 to 29. There has also been a slight increase in the mortality from diseases of the Brain and Nerves, and from Heart affections, and a somewhat large one, in the aggregate, from those maladies to which persons in advanced life most frequently succumb. In my last report, in the respective columns recording the ages of the deceased persons, there appeared under that of "60 to 80" a total of 39 deaths, and under that of "80 and upwards" 11 deaths. In my present report under the same columns the numbers are respectively 60 and 13; thus giving a total increase at those ages of 23 over the mortality of the preceding year. It is certainly gratifying to find so many reaching a ripe old age in this sub-district, since it seems to indicate the operation of some local influences peculiarly favourable to the attainment of such age. Of the 13 deaths at 80 and upwards, 2 appear to have reached their 94th year; two 28 others were upwards of 90; and the majority of the remaining nine were considerably above 80 at the time of death. A perusal of the Table which follows, will furnish many other particulars most interesting to the sanitarian, and will, moreover, by reason of its setting forth so clearly the relative number of all classes who have succumbed to disease, accident, &c., during the past year, afford, a no less important indication as to the direction which our future eflorts to save human life should be chiefly exerted. STREATHA.M, 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 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 aud Gentry. Professional Class, Merchants, Bankers, &c. Middle &c Trading Class, Shopmen, Clerks, &c. Industrial & Labouring Classes. Classes:- Smass Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 1 1 .. .. 1 .. 1 .. .. .. .. .. .. 1 .. Scarlatina .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 6 3 3 .. 4 .. 5 1 .. .. .. .. .. 1 5 Quinsy 1 1 .. .. 1 .. 1 .. .. .. .. .. .. .. 1 Croup 3 2 1 .. 3 .. 3 .. .. .. .. .. .. 2 1 Whooping Cough 4 4 .. 3 1 .. 4 .. .. .. .. .. .. 2 2 1. Zymotic Typhus and fantile Fever 5 1 4 .. 2 1 3 2 .. .. .. .. 1 .. 4 Erysipelas 1 .. 1 .. .. .. .. .. .. .. 1 .. .. 1 .. Metria, Childbirth .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Carbuncle .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa & Dysentery 6 5 1 4 .. .. 4 .. 1 .. 1 .. .. .. 6 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 27 17 10 7 11 1 21 3 1 .. 2 .. 1 7 19 2. Tubercalar 28 19 9 1 4 1 8 11 6 3 .. .. 1 10 17 3. Of Brain, Nerves, &c. 34 15 19 10 1 .. 12 1 3 16 2 .. 2 15 17 4. Of the Heart, &c. 14 6 8 .. .. 1 5 .. 2 7 .. .. .. 6 8 5. Of Respiratory Organs 29 19 10 6 5 .. 11 1 4 13 .. 1 3 13 12 6. Of Digestive Organs 5 3 2 .. l .. 1 .. 2 2 .. .. .. 4 1 7. Of Urinary Organs 8 5 3 .. .. .. .. 1 1 6 .. .. .. 5 3 8. Of Organs of Generation 2 .. 2 .. .. .. 1 .. 1 .. .. .. .. 1 l 9. Of Joints, Bones, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10. Of Skin .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11. Premature Birth, Low Vitality, tion, &c. 4 1 3 3 l .. 4 .. .. .. .. .. .. 1 3 12. Of Uncertain Seat 7 5 2 1 .. .. 1 .. 1 5 .. .. .. 4 3 13. Age 15 7 8 .. .. .. .. .. .. 6 9 .. 2 8 5 14. Violence 6 2 4 .. 1 .. 1 .. 3 2 .. .. .. 4 2 15. Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 179 99 80 28 24 3 65 17 24 60 13 1 9 78 91 29 The number of deaths from all causes registered in the sub-district, during the year ending 31st December, 1864, appears by the above Table to have been 179, (99 males and 80 females). This exceeds the number recorded in the preceding year by 14, and is the highest mortality reached since the Metropolis Local Management Act came into operation. At first view the excess noted may appear very large, but looking at the increase of the population, it is in reality small compared with that observable in many similarly positioned localities. The natural increase, as shewn by the excess of births over deaths (107), added to the increase by immigration, which, as last year, may be assumed to have been nearly double the natural increase, would, I calculate, bring up the number of inhabitants to about 10,900, In order, however, to avoid the possibility of overrating the increase, the latter source of such increase, may be put at a somewhat lower figure, and the population of the year 1864 taken, in round numbers, as being 10,800 only. Even at this low estimate, it would follow (the deaths being 179), that the mortuary rate would be maintained at under 17 in every 1000 living. ZYMOTIC DISEASES. The Table of Mortality gives, it will be seen, 27 as the number of deaths resulting from zymotic diseases during the year, which, as before observed, is 10 less than in 1863. The highest numbers appear opposite the headings Diphtheria and Diarrhoea, to each of which diseases 6 persons succumbed; Typhus and Typhoid Fever proved fatal in 5 cases. There were also recorded 4 deaths, the result of Whooping Cough, and 3 of Croup; whilst Measles, Erysipelas and Quinsy, respectively, contributed one death to the register of the year. Death from Small Pox, I am pleased to say, finds no record in the Table of the present report; but the subdistrict, in common with almost every parish within the 30 Metropolitan area, as well as most populated districts throughout the country, suffered from this disease to an extent, that still necessitates the greatest exertions being used to bring as many of the population as possible, regardless of class distinction, under the protective influence of vaccination. SICKNESS AND MORTALITY AMONGST THE PAUPER POPULATION. Of 174 cases of disease, accidents, &c., treated by the Union Medical Officers, 18 appear to have resulted in death. This number rather exceeds the per centage observable in former returns. In the Table of last year, corresponding to that marked No. 5, in the present appendix, there were noted 7 deaths only as occurring out of 246 cases treated; but it is apprehended, from what has been observed in other places, that the cases during the past year were altogether of a severer character than usual Phthisis and lung diseases, which in 1863, resulted in death amongst the class referred to in 3 instances only, proved fatal in the past year in as many as 8 cases. The mortality from Phthisis was in the past year excessive amongst all classes (23), and equally so was that from lung diseases, exclusive of Phthisis (29). This being the case, it could scarcely have excited surprise, had the Union poor being found to have contributed double the number of deaths from these causes to the register of so unfavourable a year as the one under review. SANITARY OPERATIONS, ETC. If it be found that not quite the same amount of sanitary work was accomplished during the past year, as during the preceding one, it may be safely taken that very considerable energy was put forth in maintaining those improvements which had been already effected. Table VI. Appendix, will, it is hoped, possess the usual interest, as shewing the extent to which improvements are still being carried out in the sub-district, that can in the 31 remotest degree coiiduce to the health of the inhabitants. One of the most gratifying features of the summary referred to is, perhaps, that of magisterial interference being in no one instance required to enforce any of the sanitary measures, the prosecution of which has occupied the attention of the authorities during the past year. It is equally satisfactory to find that little or no opposition on the part of the inhabitants has been offered to the complete fulfilment of every sanitary requirement enjoined by the the Metropolis Local Management Act. All the premises within the sub-district used for the slaughtering of cattle, sheep and pigs were inspected and reported on in September last, with the usual result of securing for each proprietor a renewal of the necessary license. The cowhouses in like manner were examined with a similar result, and the bakehouses continue to be duly supervised, in accordance with the recent Act, having reference to the better regulation of such places. In concluding my report I can only repeat the hope 1 have frequently before given expression to, viz., that the good sanitary status which this sub-district has acquired, may be maintained, as it only can be maintained, by future unrelaxing exertions towards the removal or abatement of every known source or aggravant of preventible disease. D. C. NOËL, Medical Officer of Health for Streatham, Tooting, and Balham. PUTNEY & ROEHAMPTON. A careful examination of the available records of the mortality and sickness that occurred in this sub-district during the year 1864, has yielded a result by no means unsatisfactory. Much sickness, it is true, prevailed throughout the year, especially in the winter months, and a few more deaths than were anticipated are to be found in the Mortuary Table accompanying this report; but it is a source of no small satisfaction to be able to state that much less sickness and consequently much fewer deaths from zymotic maladies, than for several years past, have found a place, during the past year, in the records above named. It is the one great object of sanitation to arrest, and, as far as possible, to remove, the causes that are known or suspected to operate either in the production or propagation of epidemic diseases. That something considerable has been accomplished in this direction, may be assumed from the fact that the mortality from the 7 principal maladies of this class, has been found to have fallen from 29 in the year 1863, to 11 in 1864, which is considerably below the average of the previous 9 years. Amongst the most severe and fatal of zymotic diseases, in the former of these two years, were Scarlatina, and its allied affection Diphtheria, but in the year under review 3 deaths only appear to have taken place, as the result of those affections. From Diarrhoea there occurred 6 deaths, chiefly of infants, which is 4 in excess of the previous year. The mortality from all other zymotic diseases has very materially diminished, and in but one year (that of 18G0) since the Metropolis Local Management Act came into operation has such mortality ever been lower than in 1864. Gratifying as it is to place before the authorities and the public, results such as the above, it is still mure so to be able to record the fact that the deaths from zymotic 33 diseases were one third less in the past year amongst the labouring classes than in the previous one, and that the number is gradually decreasing. The following table, constructed on the same basis as have been those employed in former reports, will give, at one view, the causes of death of all persons registered during 1864, as well as their ages, sex and social positions. STATISTICS OF MORTALITY, &c. PUTNEY and ROEHAMPTON. Population in 1861—6,481. Area in Statute Acres—2,176. DISEASES, And other Causes of Death. 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. Classes:- Small Pox 1 .. 1 .. .. .. .. 1 .. .. .. .. .. 1 .. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlatina 1 .. 1 .. 1 .. 1 .. .. .. .. .. .. .. 1 Diphtheria 2 2 .. .. 1 .. 1 1 .. .. .. .. .. 2 .. Quinsy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Croup 1 1 .. .. 1 .. 1 .. .. .. .. .. .. 1 .. Whooping Cough .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1. Zymotic Typhus and Infantile Fever 1 .. 1 .. .. .. .. .. .. .. 1 1 .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Metria, Childbirth 1 .. 1 .. .. .. .. 1 .. .. .. .. .. .. 1 Carbuncle .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa & Dysentery 6 3 3 5 .. .. 5 .. .. 1 .. .. .. 1 5 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 13 6 7 5 3 .. 8 3 .. 1 1 1 .. 5 7 2. Tubercular 27 15 12 5 5 1 12 9 4 2 .. .. 3 13 11 3. Of Brain, Nerves, &c. 17 8 9 5 2 .. 7 3 3 3 1 1 1 5 10 4. Of the Heart, &c. 7 4 3 .. .. .. 2 1 3 1 .. .. 1 2 4 5. Of Respiratory Organs 17 7 10 2 3 1 6 .. 3 8 .. .. 3 6 8 6. Of Digestive Organs 10 6 4 1 .. .. 1 .. 6 3 .. 2 2 3 3 7. Of Urinary Organs 1 1 .. .. .. .. .. .. .. 1 .. .. 1 .. .. 8. Of Organs of Generation .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 9. Of Joints, Bones, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10. Of Skin .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11. Premature Birth, Low Vitality, Malformation, &c 5 1 4 5 .. .. 5 .. .. .. .. .. .. .. 5 12. Of Uncertain Seat 4 3 1 .. .. .. .. .. 4 .. .. .. 1 .. 3 13. Age 15 1 14 .. .. .. .. .. .. 10 5 1 1 8 5 14. Violence 2 2 .. .. .. .. .. .. 2 .. .. .. .. .. 2 15. Not Specified 3 1 2 1 .. .. 1 .. 1 1 .. .. 1 2 .. Totals 121 55 66 24 13 2 42 16 26 30 7 5 14 44 58 34 The total deaths, according to this Table, is 121 (55 being of males and 66 of females), which is 8 less than in 1863. The population of this parish has lately increased to an extent that leaves little room for doubt, but that the estimate which puts the number of inhabitants for the year 1864, in round numbers, at 7,250, is as nearly correct as possible. This estimate, it may be as well to observe, is based upon a calculation embracing both the natural increase, as shewn by the excess of births over deaths, and the assumed increase by immigration, the former being 99, and the latter, at the very least, 150; and this is only assuming 5 persons to each newly erected house inhabited since the termination of the year 1863, at which period the population was estimated at about 7000. In order, however, to avoid exaggeration, we will let 100 only stand as the amount of the past year's increase by immigration. The deaths then being 121 and the population say 7,200, it follows that the rate of mortality for the past year cannot possibly have exceeded that which is usually termed the death zero of Dr. Farr, viz., 17 in every 1000 living. This calculation, favourable as it unquestionably is, will appear even more so when the unusual number of deaths during the year from old age, (15) is taken into consideration, and is deducted, together with the number registered as the result of violence and accident (2), from the total of the above Table. In this case the mortality resulting alone from actual disease will be 104, which in a population numbering as I have already assumed, 7,200 of all classes, and having rather above the usual proportion of labouring poor, attracted by the employment to be obtained in the market gardens of the locality, is as satisfactory a rate as can reasonably be looked for at the present time. Within the Bills of Mortality there are, in respect to deaths from zymotic diseases, but two parishes, viz., Dulwich and Eltham, that present a lower rate than does Putney. In Dulwich, with a population at the last census of 35 1,723, only 5 deaths were registered from the seven principal epidemics, and in Eltham, with a population of 3,009, but 3 were recorded from the same diseases. Putney, with its 6,481 inhabitants at the last census, furnishes but 11 deaths to the register of the past year, as the result of the seven maladies referred to; so that in relation to population, this sub-district can scarcely be said to hold an inferior position in the scale of healthfulness, as far as regards epidemic influences, to any locality within the Metropolitan area. The diseases included in the class "Tubercular," although exhibiting a lower mortality by 6 than the average of the three previous years, have, I regret to say, proved fatal in 3 more cases than in the year 1863, Phthisis alone having contributed 14 to the 27 deaths registered under this head. Next in the order of fatality appear to have been the Diseases of the Brain and Nerves, to which 17 deaths are attributed, whilst to Diseases of the Organs of Respiration (exclusive of Phthisis), a like number of persons died. Ten deaths took place as the result of affections having their seat in the Digestive Organs, which is rather above the average of the previous 7 years, whilst the mortality from all other diseases appears to be, on the whole, under the average of the same number of years. Ages at Death.—The unusual number of 15 deaths have been registered as entirely the result of "natural decay," a third of which is made up of persons over 80 years of age (the oldest 91). It is also gratifying to report that amongst infants and children between birth and ten years of age, disease has proved fatal in a less number of instances during the past year than has generally been recorded. In all my previous annual reports (with the one exception of 1862, when the deaths between the above ages were only 31), the mortality has, on an average, amounted to over 50. In the past year it only reached 39, a circumstance affording considerable satisfaction, inasmuch as it appears to indicate some advance of knowledge in respect to the application of sanitary principles to the saving of infant life. 36 Progress of Mortality—The table which follows points out, as usual, the fluctuations of fatal disease at the different periods of the year, as well as the rise and fall of the mortality from all causes in connection with the principal meteorological readings. 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 ... 2 0 9 2 13 Diseases of the Respiratory Organs 7 2 2 6 17 Pulmonary Consumption 7 3 2 3 15 Diseases of the Heart 2 4 0 2 8 Diseases of the Brain and Nerves 4 3 4 4 15 Diseases of the Digestive Organs 1 1 3 2 7 All other Diseases 10 4 8 3 25 Accidental and Violent Deaths 1 0 1 0 2 Premature Birth, Low Vitality, Malformation 0 1 2 1 3 Old Age (natural decay) 3 5 5 2 15 Totals 37 23 36 25 121 Meteorological Readings. Mean Temperature of air 37.9 53.1 59.4 43.7 48.5 „ Degree of humidity 83° 73° 71° 83° 78° „ Readings of Barometer 29.769 29.848 29.850 29.758 29.806 Amount of rain 4.4 in 3.5 in. 4.5 in. 4.3 in. 16.7in. This table is important also as showing the relative number of deaths from each classified cause in each of the four quarters of the year, and in the entire year. 37 Zymotic Diseases.— The 11 deaths from the seven principal zymotic diseases, contrasted with the 29 of the previous year, and with the average of the previous nine years, is satisfactory. Small pox was unusually rife during a portion of the past year, but resulted in death within the sub-district in one instance only. Two other cases of a very malignant type, removed to the Small Pox Hospital, proved fatal in that Institution, and were of course registered there. These fatal cases were all of adult persons in whom no marks of vaccination could be detected. The alarm amongst all classes was great during the time the disease prevailed in the parish, but it has happily led to a larger number than usual seeking the protection of vaccination since that event and down to a recent period; the good effects of this extended employment of the only protective against the horrors of such a malady as Small Pox have been most manifest in this sub-district, for there has not been a trace of that disease, even in its most modified form, for many months past.* * An erroneous notion prevails, and there is reason to believe the mischief resulting from it has a very extended operation throughout the kingdom, in deterring respectable persons from securing efficient vaccination for their children, that the provisions of the Vaccination Extension Act apply to paupers only; and further, that parents in good circumstances cannot, without rendering themselves recipients of relief in the manner of paupers, apply to a district public vaccinator for the gratuitous performance of even the surgical proceeding comprehended in the mere insertion of the vaccine prophylactic, and at the same time employ and pay the practitioner for any contingent medical advice or treatment that may be required or asked for at his hands and in his private capacity! In order to show what a mischievous error persons who hold such views fall into, the following most decisive opinions of the Poor Law Board on the subject are submitted. Extract from an Instructional Letter to Boards of Guardians—Official Circular, September 1840.—"The provision for vaccination is now therefore legally extended to the whole of the population; to all those who are independent as well as to those who are still dependent on relief, or who may 38 Sickness and Mortality amongst the Poor, and in Public Institutions.—The amount, as well as the nature of the sickuess and its resulting mortality amongst the become so." Again, in a general report of the Poor Law Board—Official Circular, January, 1851, the following passage occurs:—"The Board attach great importance to the provision which the legislature has made in reference to vaccination, aud they take every fitting opportunity of urging upon the Guardians the extension oj its benefits as widely as possible." Apart from these opinions, I have been favoured with one pronounced officially in one of the Metropolitan Unions. The point submitted by tho public vaccinator, a gentleman of high standing and repute in the profession, was inreference to the extension of vaccination to the families ofpersons in good circumstances, and the question asked was, "Ought I to place in the Register the names of those private patients from whom I have received a fee for vaccinating?" The reply was, "Not only are you bound to do so, but tho Guardians are bound by Section 6 of tho Act (16 and 17 Vict., cap. 100) to pay you for every person successfully vaccinated. The Guardians have nothing whatever to do with any additional fee which your private patients may choose to give you for the same operation." In communicating this opinion, reference was made to a very similar one expressed by the Poor Law Board, in reply to an inquiry by the Guardians of the Wem Union, who, it appears, like some other Boards, had taken an erroneous view of the provisions of the statute and the intentions of the Legislature. 24th August, 1819. "Clerk of Wem Union.—The medical officer of one of the districts having vaccinated the children of persons who are not paupers, but who are in good circumstances, and able to pay for their children being vaccinated, inquired if such practice is to be continued. The guardians think it was never intended that such persons should have their children vaccinated at the expense of the parish." Ans.—"The statute 3 and 4 Vict, c. 29, does not confine the contracts for vaccination to persons in receipt of relief from the poor rates, and the statute 4 and 5 Vict.,c. 32, expressly enacts that vaccination is not to be deemed relief, the object of the Legislature being to promote vaccination generally. As the contract, which the Guardians are required to make for vaccination, under the 3 and 4 Vict., c. 29, is for the vaccination "of all persons resident in tho union," it is certainly open to any persons therein, whether in the condition of paupers or otherwise, to apply to the public vaccinator." I have vontured to submit these opinions, not for my own personal advantage, but because it is evident the objects to be accomplished by the statutory law s relating to public vaccination are greatly misapprehended. It is evident also that inasmuch as the Public Vaccinator is the only person who is at all times in a position, by being abundantly supplied with fi'esh lymph, to elfectually perform the operation when it 39 pauper population of the parish, will be readily ascertained by a reference to the appended Table, No. Y. The number of cases of sickness, accident, &c., amongst this class treated during 1864, was 422, which is less by about 40 than during the preceding year. Of this number, 20 proved fatal, thus presenting about the same small per-centage as in the year 1863. It is with the same satisfaction expressed in previous reports, that I record the fact of the number of deaths registered as the result of zymotic diseases, only about one half, or 7 of the 13, occurred amongst the class to which I have just been referring. As to the mortality in public and other institutions during the past year, I am enabled to present a by no means unsatisfactory report. About the same number of deaths (11) took place in the Royal Hospital for Incurables as in the previous year, while in the Convent at RoeIt ampton, but one death is recorded—that of a Sister of the Religious Order there located. The difference in the number of deaths in these two institutions is great, but still not greater than might be reasonably expected, seeing that the one benevolently opens its doors to the hopelessly incurable, whilst the other affords an asylum to those who, from their isolation and strict hygienic discipline, are much less exposed to severe sickness than perhaps any other class in the kingdom.* is most required, and since private practitioners, as a rule, will not give the required certificates to insure the due registration of its success, aa enjoined by the Act, the Legislature intended it should be aa free for all persons to apply to that Public Officer for the gratuitous insertion of the vaccine lymph as it is for all to claim the gratuitous services of the Public Registrar of Births and Deaths. Both these Officers are paid out of the same public funds for that part of their respective duties defined by Acts of Parliament, and it is difficult to understand why a resort to the one should pauperize an applicant, and a resort to the other not do so. * The majority of the Patients formerly inmates of the Royal Hospital in Putney, have within the past year been removed to more suitable premises in the adjoining parish of Wandsworth. It is intended, ultimately, to remove the Institution entirely from this parish. When this is accomplished, it will materially decrease the rate of mortality of this Sub-District, and, of course, produce a corresponding increase in that of Wandsworth. 40 Sanitation.—In addition to the recorded sanitation of tlie year (vide Table VI. Appendix), all the slaughter and cow houses within the sub-district were, as usual, inspected and reported on by me. It is satisfactory to state that the proprietors of these places, with one exception, very promptly complied with all the regulations insisted upon by the authorities, and a renewal of their licenses was consequently secured. In the exceptional case above named, the licence for a cow house was ultimately granted upon the owner completing the required repair and cleansing of premises, until then much neglected. The Bakehouses, although open to inspection at all times, are not required to be licensed, but no difficulty has ever been experienced in this sub-district in inducing their proprietors to comply with the provisions of the Act having reference to the regulation of such places. The accomplished sanitation, in other respects, has not been inconsiderable during the year, and that in perspective, especially the contemplated extension of drainage, will possess an importance second to none of the measures of improvement that have been already earned out in this locality under the auspices of your Board. The progress of the Great Intercepting Sewer, that is to effect so much for the southern districts of London, will be watched with much interest, but to insure a thoroughly successful result, it is yet a question with many whether sufficient provision has been made for flushing purposes. The source of a sewer like the one in progress will unquestionably need some such provision as the above beyond all other points of its course, and it appears, in my humble view, to be a somewhat doubtful point whether, even though we succeed in effecting in the most perfect manner what is termed the scour of the sewer and its local tributaries, the river in the vicinity of this parish will be purified and improved to the extent desired, whilst all the sewage of all the townships and villages above Putney is still received into the tidal stream. To a certain extent then, and as far as this subdistrict is concerned, it is feared the Thames will have to 41 remain a sewer in every sense of the term, unless some system be adopted by which the soil, &c. at present flowing into it from populous places above the commencement of the great culvert at Putney can likewise be intercepted. To effect this, no better plan can perhaps be adopted than that suggested for another part of the kingdom by an able writer in the Dublin Medical Press, viz., that "barges should be placed under each outlet of a sewer, and provided with a filtering apparatus containing disinfecting materials, through which the sewage should be allowed to flow, the apparatus being so contrived as to retain the more solid part and the sediment of the sewage." The question of the utilization of sewage is becoming one of national importance. "It is neither fantastic nor ridiculous," writes Baron Liebig, "to believe that without purchasing foreign manure, and by a judicious utilization of the sewage of towns and villages, England would be able to dispense with the importation of food from abroad." If we are to attach any importance to the opinions of this great chemist, it is alone the manufacturers of artificial manures who are inimical to the utilization of sewage, and it is from that quarter the most strenuous opposition may still be expected. It would, however, it is believed, ensure the utter discomforture of the parties referred to, was the suggested experiment tried upon the sewage of the towns and villages bordering the river above Putney, and the result submitted to the impartial judgment of the public. It is hoped so excellent an opportunity of disposing of this vexed question will not be lost sight of. I cannot conclude this report without briefly referring, as I have done in former years, to the subject of overcrowding in the cottages of the poor. This evil, I regret to say, is increasing. Should the threatened epidemic of Cholera unfortunately reach us, this would prove assuredly one of the greatest possible drawbacks to efficient treatment, not only in this, but in every other Sub-district. In those localities where alone dwellings are to be found suitable to the limited means of the labouring man, 42 crowding lias always to be deplored as an evil difficult of removal. It is however through this condensation, if I may so speak, of the poor in particular neighbourhoods, that some of the highest triumphs of industry have been achieved ; and since it is clearly one of the concomitants of modern civilization, it is all the more obligatory upon those who profit by the toil of the industrial classes, to assist in removing from their midst every known or suspected cause of disease, by a cheerful acceptance of the cost of the application of sound sanitary measures. One of the chief of these measures remaining to be applied (I mean of course through private speculation), is the more extended house accommodation for the working classes of this parish. The efforts that have been made in this direction in various parts of the metropolis and suburbs, have generally proved great commercial successes, and it is said that pecuniary loss has resulted in scarcely one instance. Could, then, the wealthy and the speculative be induced to combine in order to effect this praiseworthy object, no inhabitant of this improving district need doubt the result, viz., that both the moral and social conditions of the artizan and the labourer would be immensely and permanently elevated. R. HARLAN D WHITEMAN, Medical Officer oj Health for Putney and Roehampton. APPENDIX OF STATISTICAL TABLES. TABLE I. Summary of Deaths and their Causes, registered in the Entire District during 1864, classified according to Sex, Age, and Social Position, and showing also the relative numbers in each Sub-District. POPULATION of ENTIRE DISTRICT. In 1861,-70,381. Area in Statute Acres, 11,695. DISEASES. And other Causes of Death. Total Deaths from each class of Disease, &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 1801, 13,340. area in acres, 2,478. Battersea—Population in 1861, 19,582, area in acres, 2,343. Putney—Population in 1861,6,481, area in acres, 2,176. Str. atham. Tooting, and Balham, 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 years. At 20, and under 40 years of age. At 40, and under 60 years of age. At 60 and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. Classes:- Small Pox 33 3 4 25 1 .. 16 17 8 13 3 25 6 2 .. .. .. .. 4 29 Measles 21 12 .. 8 .. 1 10 11 5 15 1 21 .. .. .. .. .. 1 14 6 Scarlatina 50 11 3 35 1 .. 23 27 6 30 9 45 5 .. .. .. .. 1 14 35 Diphtheria 18 2 6 2 2 6 7 11 1 9 2 14 3 1 .. .. .. 1 7 10 Quinsy 2 1 .. .. .. 1 1 1 .. 1 .. 1 1 .. .. .. .. .. 1 1 C rou p 9 4 1 .. 1 3 5 4 .. 8 1 9 .. .. .. .. .. 1 4 4 Whooping Cough 35 10 9 12 .. 4 19 16 16 18 .. 34 1 .. .. .. .. 1 9 25 1. Zymotic Typhus and Infantile 54 14 13 21 1 5 26 28 3 8 9 25 15 9 4 1 1 3 10 40 Feve Erysipelas Metria. 11 1 3 6 .. 1 4 7 1 3 .. 5 .. 2 1 3 .. .. 5 6 Childbirth 2 1 .. .. 1 .. .. 2 .. .. .. .. 2 .. .. .. .. 1 .. 1 Carbuncle 1 1 .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. 1 .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa, and Dysentery 56 11 8 25 6 6 32 24 42 6 .. 48 1 2 4 1 .. .. 13 43 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 292 71 47 134 13 27 144 148 82 111 25 227 34 17 9 5 1 10 81 200 2. Tubercular 241 46 60 80 27 28 125 116 45 30 11 108 80 43 9 1 .. 16 67 158 3. Of Brain and Nerves 283 60 65 107 17 34 148 135 63 41 8 117 34 58 66 8 3 20 77 183 4. Of Heart 96 21 9 45 7 14 45 51 2 3 1 18 10 30 38 .. 3 3 36 54 6. Of Respiratory Organs 284 60 52 120 17 29 152 132 91 51 6 150 17 40 77 .. 3 10 73 198 6. Of Digestive Organs 77 33 16 13 10 5 36 41 17 12 4 34 4 18 19 2 3 7 30 37 7. Of Urinary Organs 19 3 2 5 1 8 14 5 1 .. .. 2 4 2 10 1 .. 1 10 8 8. Of Organs of Generation 14 2 6 5 .. 2 1 13 .. .. .. 2 1 7 4 .. 1 1 4 8 9. Of Joints, Bones, &c. 11 9 1 1 .. .. 5 6 .. 1 .. 5 1 2 3 .. .. .. 7 4 10. Of Skin 1 1 .. .. .. .. 1 .. .. 1 .. 1 .. .. .. .. .. .. .. 1 11. Premature Birth, Low Vitality, formation, &c. 103 24 15 55 5 4 55 48 98 4 .. 102 .. 1 .. .. .. 3 20 80 12. Of Uncertain Seat 26 2 13 .. 4 7 15 11 1 2 1 4 1 11 9 1 1 2 5 18 13. Age 132 45 16 41 15 15 44 88 .. .. .. .. .. .. 64 68 11 16 48 57 14. Violence 52 9 10 25 2 6 35 17 7 6 4 23 5 15 6 3 1 1 12 38 15. Not Specified 57 16 .. 38 3 .. 23 34 11 2 2 17 9 14 14 3 .. 3 17 37 Totals 1688 108 31 1 669 121 179 843 845 418 264 62 810 200 258 328 92 27 93 187 1081 44 TABLE II. Births registered during the year ended 31st December, 1864. SUB-DISTRICT. Males. Females. Total. Clapham 305 335 640 Wandsworth 242 199 441 Battersea 616 524 1,140 Putney and Roehampton 106 114 220 Streatham, including Tooting and Batham 159 127 286 Total 1,428 1,299 2,727 ֶ The excess of Births over Deaths in the entire district is 1,039. TABLE III. Meteorological Means for 1864, 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 37.9 53.1 59.4 43.7 48.5 Evaporation 35.9 48.9 54.3 41.4 45.1 Dew Point 32.9 44.8 49.7 38.7 41.5 Weight of Vapour in a Cubic Foot of Air 2.2 grs. 3.4 grs. 4.0 grs. 2.7 grs. 3.1 grs. Degree of Humidity (Satn. 100) 83 73 71 83 78 Reading of Barometer 29.769 29.848 29.850 29.758 29.806 Weight of a Cubic Foot of Air 555 grs. 539 grs. 532 grs. 547 grs. 543 grs. Rain (amount of) 4.4 in. 3.5 in. 4.5 in. 4.3 in. 16.7 in. 45 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 1855-64. Years. Deaths prom Epidemics in each Sub-Distbict. 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 1864 63 12 9 43 11 22 268 1688 15.8 *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, Diarrhoea and Fever. 46 TABLE VI. Summary of the Sanitary Operations in the entire District during the year 1864. Clapham. Battersea. Wandsworth. Putney and Roehampton. Streatham, including Tooting and Balham. Totals. Number of Houses and Premises inspected 990 520 146 185 110 1951 1st Notices served 42 52 112 57 16 307 2nd Notices served 16 3 9 Cesspools emptied and Cleansed 66 60 43 16 178 363 Cesspools abolished 45 ... 32 ... 20 97 Water-closets constructed. 152 ... 22 33 106 313 Houses supplied with water 15 ... 18 45 106 184 Drains constructed or connected with Sewer 500 49 25 20 43 733 No. of feet of new Sewers, &c. 7712 3222 4640 15 9627 28216 Drainsrepairedortrapped, or obstructions removed 73 ... 24 29 40 166 Open Ditches, Ponds, &c. cleansed 14840 ft. ... 8 9370 ft. 7 miles ... Dust-bins provided 141 ... ... 33 98 272 Pig Nuisances removed 18 10 9 1 6 44 Accumulations of Offal Manure, &c. removed 14 12 6 6 16 54 Unwholesome and dilapidated Houses cleansed or repaired ... ... 25 5 2 32 Cases investigated by Magistrates 1 ... 2 ... ... 3 Compulsory Orders obtained 1 ... 1 ... ... 2 Compulsory Works executed 1 ... 1 ... ... 2 Works remaining in abeyance from various causes ... ... 1 ... ... 1 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, during the Tear ending December 31st 1861. Compiled from the District Medical Relief Books. SUB-DISTRICTS. Total Cases of Sickness treated in each Sub-District. 1—Small Pox. 2—Measles. 3—Scarlatina and Malignant Sore Throat. 4—Whooping-cough. 5—Diarrhoea and Dysentery. 6—Cholera. 7—Fever. 8—Erysipelas. 9—Puerperal Fever. 10—Lung Diseases, except Phthisis. 11—Phthisis. 12—Hydrocephalus, Atrophy, Scrofula, and Convulsions of Children. 13—Other Diseases. 14—Violence, Privation, and Premature Birth. Total Deaths in each Sub-District. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Clapham 1050 24 1 24 4 15 .. 3 1 67 1 ... ... 115 3 4 ... 4 ... 81 9 26 7 15 ... 616 13 56 2 40 Wandsworth 1352 19 1 1 ... 2 ... 16 1 115 2 ... ... 25 3 17 1 ... ... 167 11 8 4 8 9 896 4 78 ... 38 Battersea 842 57 5 2 ... 19 ... 7 ... 45 1 2 ... 36 2 3 ... 1 ... 116 6 17 3 ... ... 500 12 37 ... 29 Putney 422 20 ... ... ... 6 ... 1 ... 28 3 ... ... 20 ... 2 ... 3 1 55 2 1 1 8 6 242 10 36 ... 23 Streatham, including Tooting and Balham 174 2 ... ... ... 1 ... 4 ... 9 1 ... ... 3 1 4 ... ... ... 21 3 5 5 3 1 105 7 17 ... 18 Totals 3840 122 7 27 4 43 ... 31 2 264 8 2 ... 199 9 30 1 8 1 440 31 57 20 34 16 2359 46 224 2 148