WAN 17 SANITARY DEPARTMENT. REPORT on the SANITARY CONDITION of the several parishes comprised in the WANDSWORTH DISTRICT, DURING THE YEAR 1805. In the Medical Officer of Health. LONDON: JOHN SMITH AND CO., LONG ACRE, W.C. 1866. 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 9 4. „ on the Sub-District of Clapham, by Mr. J. MacDonogh 17 5. on the Sub-District of Battersea, by Dr. W. Connor 20 6. „ on the Sub-District of Streatham, by Dr. D. C. Noel 30 7. „ on the Sub-District of Putney, by Dr. R. II. Whiteman 35 8. Appendix of Statistical Tables, &c. 49 9. Supplemental Remarks on the Supply of Pure Water 54 REPORT, 1865. TO THE BOARD OF WORKS FOR THE WANDSWORTH DISTRICT. Gentelmen, We have the honor to submit our Annual Report for the tenth year since the Act for the Local Management of the Metropolis was put in operation in this District. The carefully collected statistics of this decennial period, and the adoption each year of the same forms of tables, can scarcely fail to afford a ready means both of comparing and of averaging results, and we have much pleasure in continuing them. We regret to have to bring under your notice the circumstance of the year 1865, presenting a death-rate for the entire district above the average, but it will be satisfactory to know that the causes of this have been in operation in portions only of the District, and that the majority of the parishes composing it are enabled to present favourable accounts of both sanitary progress and decreasing mortality. We have the honor to be, Gentlemen, Your very obedient Servants, The Medical Officers of Health of the Wandsworth District. 4 SANITARY STATE OF THE ENTIRE DISTRICT. The births registered in the entire Wandsworth District during the year 1865 numbered 2989—1573 of males and 1416 of females. The deaths were 1783; 910 of males and 873 of females. The excess of births over deaths was, consequently, 1206. Calculated from the death register and an estimated population, the death-rate for the past year was 21.94 per 1000 parsons living, or rather more than two per 1000 higher than the average. The birth-rate according to a similar calculation was 36.78 per 1000, and the rate of natural increase 14.84 per 1000 of the entire population. The increased death-rate over that of previous years may be attributed to the occurrence of an unusual amount of epidemic disease, the fatality attending which is found to have varied very considerably in the several sub-districts, as will be seen by a comparison of the local and general tables of mortality. The difference between the number of deaths resulting from the seven principal epidemic diseases in the past year, and in that immediately preceding it, was 75, the respective numbers having been 343 in 1865, and 268 in 1864. The average number for the past 10 years was 222. The ratio of deaths from these diseases to the total deaths from all causes was 19.2 per cent. for the past year, and 15.8 per cent. for the previous year. The average of the past 10 years was 17.5 per cent. This percentage, high as it is, does not, however, reach the exceptional one of 1863, which was 29.9. In 1859 it was 21.4, but in no year since 1856, excepting those named (1859 and 1863) did it attain 19.0. In three of the nine years preceding the one to which this report relates, it will not be found to have exceeded 13.6. While the deaths from Small Pox and Measles were in the past two years nearly equal, and from Diphtheria less by one half in the past than in the preceding year, there was a considerable increase in 1865 over 1864 in the 5 mortality from Scarlatina, Whooping Cough, Erysipelas, Fever, and especially Diarrhœa. The deaths from these diseases exceeded those of the previous year by no less than 91, and the increase is found to be within four of the excess of deaths from all causes in the past year, compared with the number registered in the previous one. That which claims particular attention in this Report is the great prevalence and fatality of Typhus and Diarrhoea during the past year; and the unusual fatality from the latter disease affords considerable cause for apprehension of the probable advent of Cholera in the ensuing season, and pointedly indicates the necessity for a vigorous prosecution of all sanitary proceedings. sanitation. The amount of sanitary work accomplished during the past year (vide Table VI. Appendix) has been considerably greater than that noted in former tables, particularly in the matter of sewerage, and is altogether of a character which, if well sustained, cannot fail to benefit most materially the general health of the District. It will not be necessary to offer any further remarks upon this Table, but there are several suggestions for sanitary improvements contained in the local summaries of this Report, to which it is desirable to direct the special attention of the Board. 1. As to a Constant Water Supply.—There can be no two opinions upon the necessity which exists for an arrangement of this kind, to secure the needed amount of water both for domestic purposes, and for house-drainage, the latter, indeed, having no chance of being rendered perfect without it. The Medical Officers of Health, therefore, unite in strongly supporting the present movement to secure this great desideratum. 2. As to an Improved System of Scavengering.— It is a question that strongly recommends itself to the consideration of the authorities, whether pauper labour might not be 6 economized and advantageously brought to bear upon the carrying out of this much-neglected but most important sanitary requirement. There are but few adult men, being inmates of Workhouse?, or amongst the out-door poor, even though disabled from undertaking labour of a move arduous kind, who are unable to handle a broom, or do such other light work as is required of the scavenger; and the employment of such persons, under proper supervision, would, it is thought, be far more profitable and satisfactory than any labour-test that could be devised. 3. As to the Establishment of a Sanitary Police.—It is hoped that this subject will receive the consideration due to it at this particular juncture; for it is evident that all the impromptu suggestions of Committees of Health, all house to house visitations, and such like necessarily fitful efforts to ensure respect for the law under the pressure of a severe epidemic, such as cholera, will fail of their purpose without the aid of a specially qualified Police, armed with sufficient power to act with promptness and decision in enforcing tho fulfilment of the several sanitary enactments. 4. As to the Naming of Streets and Numbering of Houses. —Nothing can be more obviously desirable than a measure of this kind for sanitary purposes, as well as for social convenience ; and it is hoped that every householder, and every proprietor or owner of houses, will co-operate with the authorities in carrying it out. 5. As to Over crowding in the Poorer Localities of the District.—The adoption of the suggestion for the establishment of a Sanitary Police would greatly assist to bring about a reform in this matter. It is feared, however, that without a better class of houses for labouring men, and a sufficient number of them to meet the exigencies of a constantly increasing population, no measure of relief of a permanent character is likely to be secured. This subject is worthy the best consideration of owners of small property and others interested in the welfare of the poor; for it is admittedly one of the greatest of our sanitary evils, and as such, has claims upon the attention of the authorities and the public equal, if not superior, to any other social question of the day. LOCAL SUMMARIES. WANDSWORTH. The following is a summary of the principal facts necessary for determining the sanitary condition of this sub-district during the year 18G5, and for forming a basis for further sanitary administration. Statistics of Mortality, &c.—The total deaths which were registered as having occurred during the past year, numbered 338. 173 were of males and 165 of females. 88 occurred in the following public institutions; viz.:—In the Surrey County Lunatic Asylum 64; in the House of Correction 7; in St. Peter's Hospital 4; in the Royal Patriotic Asylum for girls 3; in the Reformatory for boys 1; and in the Hospital for Incurables 9. 17 parishioners of Wandsworth died in the Union Workhouse, Battersea. The death rate for the past year, deduced from the register of deaths, and an estimated population, was 19.26 per 1000 persons living. The average rate of the past nine years has been 17.98 per 1000 The rate of last year is, however, very considerably below the average rate of the entire district. In making these calculations, correction is made for deaths in the public institutions after the manner described in the previous reports, and 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 preceding ten years. The births were 435 in number; 224 of males, and 211 of females. The birth rate was 30.15, and the rate of natural increase 11.03 in every 1000 of the entire population. Both were below the average. 10 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. Total Deaths from each Class of Disease, &c., in the Sub-District. Sex. Age. Social Position. Population in 1861—13,346. Area in Acres, 2,478. 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. trial & Labouring Classes. Diseases and other Causes of Death. Diseases Classified. Classes:– 1. Zymotic Small Pox 5 4 1 1 1 1 3 2 ... ... ... ... ... ... 5 Measles 2 1 1 ... 2 ... 2 ... ... ... ... ... ... ... 2 Scarlatina 3 1 2 ... 2 ... 2 1 ... ... ... ... ... ... 3 Diphtheria 1 ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 1 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 2 1 1 ... 2 ... 2 ... ... ... ... ... ... 1 1 Whooping Cough 6 3 3 2 4 ... 6 ... ... ... ... ... ... 1 5 Fever 18 8 10 ... 6 1 9 6 1 2 ... ... ... 1 17 Erysipelas 1 1 ... ... 1 ... 1 ... ... ... ... ... ... 1 ... Metria, Childbirth 3 ... 3 ... ... ... ... 3 ... ... ... 1 ... ... 2 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 19 12 7 12 2 ... 14 1 ... 3 1 1 1 3 14 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 60 31 29 15 21 2 40 13 1 5 1 2 1 7 50 63 27 36 16 5 1 29 20 11 3 ... 1 2 5 55 59 37 22 3 3 ... 8 11 17 18 5 4 1 9 45 4 Of the Heart, &c. 16 7 9 ... ... ... 1 2 6 6 1 3 1 3 9 5 Of Respiratory Organs 56 31 25 17 6 1 26 3 11 14 2 ... 3 6 47 6 Of Digestive Organs 25 12 13 9 2 1 12 3 6 4 ... 2 2 5 16 7 Of the Kidneys 7 4 3 ... ... ... ... 2 4 1 ... 1 ... 3 3 6 ... 6 ... ... ... ... 2 3 1 ... ... ... ... 6 9 Of Joints, Bones, &c. 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 10 Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Premature Birth, Vitality, Malformation, &c. 12 7 5 11 1 ... 12 ... ... ... ... ... ... 1 11 12 Of Uncertain Seat 4 3 1 ... 1 ... 1 ... 1 2 ... 1 ... ... 3 13 Age 20 6 14 ... ... ... ... ... ... 9 11 2 ... 4 14 14 Violence 9 8 1 2 ... 1 3 2 3 1 ... ... ... 3 6 15 Not Specified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 338 173 165 73 39 6 132 59 63 64 20 16 10 40 266 11 Diseases of the Tubercular class, which includes Consumption and Scrofula, stand first in order of fatality, constituting upwards of 18 per cent. of all deaths. These were nearly equalled by those of the Zymotic class which formed 17 per cent., and of the Respiratory organs which formed 16½ per cent. Diseases of the Digestive organs formed 7 per cent. As usual the most fatal single disease was Consumption, which caused 11 per cent. (nearly) of all deaths. Inflammation of the Lungs was unusually fatal, causing 7 per cent. Diseases of the Brain and Nerves cannot be entertained in a consideration of the causation of mortality of this parish, in consequence of the disturbing influence of the County Lunatic Asylum, whoso inmates are derived from the whole county of Surrey. That which must attract most notice in the table is the large proportion of deaths from Zymotic diseases, and from diseases of the Respiratory organs. Age at Death.— Upwards of 21 per cent. of all deaths took place under the age of one year, and 32 per cent. under the age of five years. This rate of infant mortality, although actually great, is relatively small compared with that of most populous localities. 39 per cent. occurred under 20 years of age. As favourable evidence of our general salubrity, the following instances of longevity deserve to be recorded—20 deaths are registered as having resulted from old age, the ages of 18 of which varied from 80 to 89, the average age having been 83. Social Position.— The labouring and industrial classes suffered 78 per cent. of all deaths, and 5-6ths of the deaths from Epidemic diseases. 7-8ths of the deaths from diseases of the Tubercular class, and, with but one exception, all the deaths from Consumption, took place amongst them. As the working classes constitute 9 out of 13 parts of the whole bulk of society, it is evident, that in addition to the circumstance of their having suffered an undue amount of general disease, they suffered also from the great bulk of those diseases which are found by experience to be associated with the defective sanitary conditions of houses and other causes of a vitiated atmosphere. Twenty-two inquests were held during the year. Nine 12 deaths resulted from violence, eight of which were accidental and one suicidal. Sixteen deaths occurred in which the cause was not certified by any qualified medical practitioner; so many instances, therefore, in which death may have resulted from other than natural causes. As the essential function of the Coroners' Court is the determination of the cause of death, the necessity for medical testimony at all such enquiries cannot be too strongly insisted on. The cause of death is on these occasions often assumed on conjecture, and to my own knowledge erroneously in two instances last year; and if they represent, as I believe they do, the manner in which Coroners' inquests are conducted generally throughout the country, it becomes apparent to what an extent the Registrar-General's Returns, upon which are based the Tables of Life Insurance, &c., are vitiated, as well as to what an extent the means of protecting society from secret crime are defective. In every interest of society the cause of death should be a fact, as far as human knowledge can make it so. The deaths which have resulted from the principal epidemic diseases during the past and nine preceding years, and the relation which they bore to the deaths from all causes, are shewn in the following table: — YEARS. Small Pox Measles. Scarlet Fever. Diphtheria. Whooping Cough. Diarrhœa. Fever— Typhus and Typhoid. Total Deaths from Epidemics. Total Deaths from all causes. Percentage of deaths from Epidemics to deaths from all cases. 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 1865 5 2 3 1 6 19 18 54 338 15.9 PREVALENCE AND FATALITY OF EPIDEMIC DISEASES. 13 The mortality from this class of diseases is seen to have been greater than the average during the past year by nearly a fourth part, and is sufficiently great to account for the excess in the entire death rate. The excess was due to a larger amount than usual of diarrhoea and fever, which diseases prevailed more or less during the whole year. The former disease was most prevalent and fatal as usual in the autumn, and the latter in the summer and at the end of the year. Small-pox prevailed during the summer and autumn, though not to any great extent, having been almost exclusively confined to the excavators employed on the sewer works. The largest number of deaths from this class of diseases—25 in number—occurred in the third quarter of the year; in the fourth quarter, 17; in the first, 8; and in the second, 4. The most unhealthy months were July and December; in the former, 14 deaths occurred, 9 of which resulted from diarrhœa; and in the latter 10 deaths, 8 of which were from fever. The most prominent fact revealed by this table is the unusual fatality of diarrhoea compared with former years. SICKNESS AND MORTALITY AMONGST THE POROCHIAL POOR. The amount, nature, and fatality of the sickness which prevailed amongst the parochial poor during the past year is contained in Table V in the Appendix. The amount of disease under treatment was considerably below the average, while the mortality (3.30 per cent.) was somewhat greater than the average (3 per cent.) of the past nine years. AMOUNT AND INTENSITY OF GENERAL SICKNESS. The amount of sickness which has prevailed generally throughout the parish is approximately estimated by assuming the proportion which the deaths bear to the cases of sickness amongst the poor, as the proportion borne by deaths to cases of sickness throughout the whole parish. By this calculation it is estimated that the total cases of sickness which came under treatment amounted to 58 per cent. of the population, and that one death resulted from every 30 14 attacks. On an average of the past nine years one death represented 33 attacks. The intensity of disease was therefore greater than the average during the past year. The facts disclosed by an analysis of the foregoing statistics of mortality and sickness furnish evidence that the health of the Sub-district during the past year was in a lower condition than has prevailed on an average of the past nine years. The higher death-rate was dependent upon the prevalence of an unusually large amount of epidemic diseases —those diseases which it is the especial province of sanitation to diminish and prevent. The special diseases from which this lowered vitality resulted were fever and diarrhœa, but essentially the latter disease, which was three times more fatal than the average since the cholera year 1854. This unusual fatality from Diarrhoea, compared with that of former years, indicates that the fears which have been entertained by sanitarians of the probable advent of Cholera arc not unfounded, and presents a caution, which, from its significance, ought not to be disregarded, against permitting the existence of conditions which arc known by experience to propagate and favour the development of this fatal disease. The most active of these, as conclusively proved by much experience, is the use of impure water. The question of a water supply to this Sub-district is fully discussed in my first annual report (185G), to which I beg to refer the reader. (Vide also Supplemental Remarks in the Appendix to this Report.) SANITARY PROCEEDINGS. In addition to the general sanitary proceedings, a summary of which is contained in Table VI in the Appendix, the slaughter-houses and cow-houses were examined and specially reported on.* The practice of lime-whiting and otherwise cleansing un- * In common with the rest of the Metropolis this Sub-district suffered from the effects of the Cattle Plague, which, between December, 1865, and March in the present year caused the destruction of 25 head of cattle. The disease was confined to three dairies, two of which were situated in the town and the third in Summerstowp. 15 wholesome houses in which contagious diseases have been present has been prosecuted as heretofore, and with marked benefit. All these proceedings have been carried out without any necessity for the intervention of the law. The great work of the year has been the construction of the main-sewer, from which this first great sanitary requirement of all populous localities the greatest benefits are to be anticipated. It nevertheless has an intrinsic defect inseparable from the conditions to which it is subservient, which ought not to pass unnoticed. I refer to the process of ventilation, which, as is generally known, is effected simply by openings at intervals communicating with the outer air. This ventilation of the sewers at the expense of aerial purity in our streets is admittedly a sanitary defect of very considerable magnitude, and from its extent throughout the whole Metropolitan drainage, requiring to bo comprehensively dealt with. Various measures have been tried with different degrees of success in the alleviation of the evil, amongst which the most satisfactory appears to have been the employment of coarsely powdered charcoal placed on perforated trays at the outlets of the ventilators. Your Surveyor. Mr. Dobson, has suggested, and with much apparent reason, the employment of fan-pumps at the main outfalls, after the manner in which mines are often ventilated. It is a proposition which certainly deserves entertainment, and worth the practical experiment of ascertaining over what an area of drainage such an apparatus would be capable, by its exhaustive power, of overcoming the slight resistance of gaseous transfusion. In the absence of any measure which is complete, and at the same time practical and simple, and, indeed, under any circumstances, the provision of an abundant and continuous flow of water is the best available means for the absorption of gases and the arrest of decomposition. The great nuisance to the town described in my last and previous reports, as arising from the encampment of gipsies by the side of the Alma Road, has not yet been dealt with. As a focus of contagion it urgently requires to be suppressed, and for all other reasons than sanitary ought not to be permitted to exist in any civilized community. The Water Supply is not yet such as it ought to be. It 16 is still partial and still intermittent. A constant supply to every house should be enforced according to law, and all cisterns, butts, and other objectionable receptacles entirely dispensed with. The general Scavengering of the town, including the removal of house refuse, &c., as at present conducted, is not such as is calculated to further the ends of sanitation to which it should bo subservient. House refuse, as a rule, is removed only under pressure of great inconvenience or intolerable nuisance, involving as great a nuisance in its removal. Such an arrangement, however suited to the convenience of the dust-contractor, is not by any means adapted for the fulfilment of what should be considered a prime necessity for the maintenance of the health of the public. A systematic house-to-house visitation of the Scavenger at certain regular intervals, without the necessity of any application to them by the householder, is what is required. Drainage.— To ensure the full benefits of the maindrainage to the general health of the town, the necessity for the completeness of the local drainage in every part, and therefore of every house, is sufficiently obvious; and as the local tributary sewers are in process of construction, it would seem a fit subject for consideration, whether a more general and consequently expeditious method than that of leaving each household to be dealt with separately, could not be satisfactorily and economically adopted. Amongst the measures of general application, the details of which are described in my first Annual Report (1856), and which I would now recommend the adoption of, the following especially require notice—viz., a constant water supply, an efficient system of scavengering, and the drainage of every house rigorously carried out. These are so self-asserting of their necessity, so susceptible of a general and uniform application, and so greatly beneficial in their results, as, in the face of the evidence in this report of a need for vigorous sanitary administration, to demand their early and complete fulfilment. GEORGE EDWARD NICHOLAS, M.D. Medical Officer of Health for Wandsworth. 17 CLAPHAM. Having usually commenced my annual report with the following table, I do so on the present occasion as a basis for the remarks I shall have to make upon the sanitary and social questions presenting themselves for discussion. MARRIAGES, BIRTHS, AND DEATHS. years 1856 1857 1858 1859 1860 1861 1862 1863 1864 1865 Marriages 154 151 150 156 183 182 175 181 227 221 Births 527 550 533 594 608 624 622 685 640 707 Deaths 286 321 344 328 429 390 343 355 408 393 Excess of Births over Deaths 241 229 189 266 179 234 279 330 232 314 In reference to this table I need not again comment at any length on the one great fact of its holding good with respect to man, as it does with the inferior animals, that the increase of the species always keeps pace with the greater or less abundance of food. Both food and employment have been most abundant during the past two years, hence a very marked increase in the number of marriages is observable in those years, and in the last year especially, the excess of births over deaths appears to have been unusually large. This also shows the increasing prosperity of the subdistrict in a very marked manner, and must be highly gratifying to all who take an interest in the social welfare of the different classes of inhabitants. STATISTICS OP MORTALITY, &C. For the year 1865, the deaths registered in the parish were 398, and these were nearly balanced as to sex, the B 18 males numbering 200, and the females 193. The births in the same period were 707 (males 379, females 328), which is within 79 of doubling the number of deaths. The number of deaths during the past year, it will be observed, was 15 less than in the year 1864, and this is most satisfactory, seeing that this diminution has occurred in a greatly increased population—increased to an extent which I calculate brings it now up, in round numbers, to 24,000. To the natural increase, that is to say the increase as shewn by the excess of births over deaths (314), must of course be added a rather large number for increase by immigration, because the number of newly erected houses, few of which remain unoccupied, has been, during the past year, unusually great. With, then, the population calculated at 24,000, and the deaths being 393, it follows that the mortuary rate of the past year could not have greatly exceeded 16 per thousand (the exact calculation is 16.37), and this, it may be observed, is based upon an exceedingly low estimate of the increase which has taken place alone from new residents. The table which follows will afford the usual detailed information as to the causes of death during the past year, as well as the sex, age, and social positions of the deceased. Though this table is a small one, its compilation each year proves a work of considerable labour, but it well repays the care and pains bestowed upon it, affording, as it does, a ready means of comparing the death rates of the year with those given in preceding reports. 19 CLAPHAM. Population in 1861—20,894. Area in Acres—1,233. 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 and Laboring Classes Classes:— l. Zymotic Small Pox. 7 6 1 2 2 ... 4 3 ... ... ... ... ... 1 6 Measles 7 4 3 ... 5 2 7 ... ... ... ... ... ... 1 6 Scarlatina 11 8 3 2 3 4 9 1 1 ... ... ... 1 4 6 Diphtheria 4 2 2 ... 2 1 3 1 2 2 Quinsy 1 ... 1 ... 1 ... 1 ... ... ... ... ... ... 1 ... Croup 9 6 3 ... 8 1 9 ... ... ... ... ... ... 2 7 Whooping Cough 15 7 8 9 5 1 15 ... ... ... ... ... ... 5 10 Typhus,&c. 11 6 5 ... 1 2 8 ... 3 ... ... ... 1 4 6 Erysipelas 7 1 6 3 ... ... 3 1 2 1 ... ... 3 ... 4 Metria, Childbirth 4 ... 4 ... ... ... ... 4 ... ... ... ... ... 1 3 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 20 12 8 17 ... ... 18 ... ... 2 ... ... 4 6 10 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 96 52 41 33 27 11 77 10 6 3 ... ... 9 27 60 2. Tubercular 32 14 18 ... 2 1 4 16 12 ... ... ... 2 7 23 3. Of Brain, Nerves, &c. 43 23 20 13 4 3 22 4 9 8 ... ... 4 6 33 .4. Of the Heart, &c. 21 12 9 1 ... ... 2 2 8 9 ... ... 4 7 10 5. Of Respiratory gans 54 28 26 15 9 ... 25 2 11 16 ... ... 5 8 41 6. Of Digestive Organs 23 14 9 11 3 ... 14 1 3 5 ... ... 3 4 16 7. Of Urinary Organs . 5 1 4 ... 1 ... 1 2 1 1 ... ... 1 1 3 8. Of Organs of ration 3 ... 3 ... ... ... ... 2 ... 1 ... ... ... ... 3 9. Of Joints, Bones, &c. 8 5 3 ... ... 1 2 1 3 2 ... ... 2 3 3 10. Of Skin 2 1 1 1 ... ... 2 ... ... ... ... ... 1 ... 1 11. Premature Birth, Low Vitality, Malformation, &c. 33 19 14 31 2 ... 33 ... ... ... ... ... ... 4 29 12. Of Uncertain Seat . 6 4 2 1 ... ... 2 1 3 ... ... ... ... 4 2 13. Age 34 12 22 ... ... ... ... ... ... 15 19 ... 3 15 16 14. Violence 12 8 4 5 1 ... 6 2 1 3 ... ... ... 2 10 15. Not Specified 21 7 14 3 ... ... 4 6 4 7 4 5 12 TOTALS 393 200 193 114 49 16 194 49 61 70 19 ... 38 93 262 20 It is somewhat remarkable that the tables of the present and past years should show so great a difference in the proportion of the sexes. In the year 1864 there were more deaths registered of females than of males, in the proportion of 108 of the latter to 228 of the former. During the past year the sexes have succumbed nearly in equal proportions, the males being in a small majority of seven. The difference referred to can only be accounted for by the greater activity of male emigration in the one year, and of female emigration in the other, and this I believe has really been the case. ages at death. I regret to say a very heavy infant mortality is shewn to have taken place in the past year. Of infants there died from all causes as many as 114 in the first year of their existence, 49 from 1 to 5, and 16 from 5 to 10 years of age, making a total, between birth and 10 years of age, of 179 deaths; but it is some consolation to find that even this large number was less by 10 than occurred in 1864 between the same ages. Of persons registered as having died of infirmity of age or natural decay, without mention of any other important cause, there were 34, viz., 15 between the ages of 70 and 80, and 19 at 80 years and upwards. If we add 52 other deaths, between 60 and 80, registered as being due to actual disease, it will give the rather large number of 86 persons in advanced life. This, however, is a less number by 23 than were registered as having died at the same ages in 1864. SOCIAL POSITIONS OF THE DECEASED. As is usually the case, the mortality amongst the industrial or labouring classes is much the heaviest. In the past year the number of this class dying of various diseases, accidents, &c., just doubled that of all the other classes combined. This is much to be deplored. 21 and, as I have observed in a former Report, can only be altered by persevering exertions in providing for workingmen and their families more wholesome dwellings, a mure abundant supply of pure water, and more efficient drainage. The last of these it is but reasonable to expect will be secured upon the completion through the District of the great sewer and its branches; and the other requisites named will, it is hoped, follow in due course. ZYMOTIC DISEASES. The following table exhibits the fatality of the seven principal diseases of the epidemic class during the past year, as well as during the nine previous years, and will furnish a means of comparison that will show in a very satisfactory way the extraordinary fluctuations in the total number of deaths from epidemics in the several years named:— Years. 1856 1857 1858 1859. 1860 1861 1862 1863 1864 1865 Small-pox. 1 0 1 9 6 6 1 11 3 7 Measles 14 2 14 2 20 0 6 24 12 7 Scarlatina. 9 8 25 26 24 22 13 28 11 11 Diphtheria 0 0 0 0 9 13 3 1 2 4 Whoopingcough 4 13 13 6 21 14 14 9 10 15 Typhus 4 7 11 12 6 5 8 6 14 11 Diarrhœa 4 27 16 11 5 11 7 16 11 20 Totals 36 57 80 66 91 76 52 95 63 75 22 In some families the mortality from epidemic maladies during the past year has been deplorable. Until, however, their exciting causes are better ascertained and understood, and until science is better able to demonstrate and explain their true origin, it is feared the advance towards the abolition of such diseases will be slow and by no means so satisfactory as could be wished. The twenty deaths from Diarrhoea alone are much to be deplored, since they augur somewhat badly for the results of any decided Choleraic invasion that may afflict this Sub-district; and of the approach of Cholera, it is almost needless to say we have of late had some very decided warnings. Whooping-cough, Scarlatina, and Diphtheria have also been very fatal during the year; indeed, the same may be said of nearly the whole of the seven epidemic diseases named in the above table. The total mortality from Zymotic diseases, though exceeding that of the previous year by as many as 12 deaths, did not, it will be observed, reach by a large number the total of either I860 or 1863, both of which are memorable years in respect to epidemics in this Sub-district. There is, therefere, some hope for the future that these diseases will gradually diminish, as the conditions under which they usually appear are modified by the sanitary improvements now in progress. small-pox and vaccination. During the year there were, as before stated, registered the births of 707 children; of this number 307 only were by me successfully vaccinated, 11 of them being re-vaccinations. There were also vaccinated 36 young persons at 2 years of age and upwards, upon whom the performance of the operation had been deferred by their parents until Smallpox had actually entered their own or their neighbour's houses. Even then, in the very presence of suffering and death, consent was given for vaccination in many cases with the utmost reluctance. As many as 7 deaths, and between 70 23 and 80 cases of illness from Small-pox, occurred during the year, every one of which might possibly have been prevented by timely vaccination. Two only of the seven deaths, it is satisfactory to find, occurred in the families of the parish poor, the remaining five falling upon the middle and more wealthy classes, a circumstance which seems to show that the very poor of this parish have not been the most prejudiced against vaccination. I still think a total misapprehension of the provisions of the existing Vaccination Extension Acts, by large numbers of the well-to-do classes, is at the bottom of much of the indifference displayed towards this valuable protection, when it is offered at the hands of the public vaccinators. The very word "Extension," used in the titles of the Acts, implies that it was the main object of the Legislature to confer the benefits of these measures, and to insure the due registration of the operation, beyond the mere pauper; and yet how few seem to view the existing Acts as having a general application. The first Act upon the subject of vaccination (3 & 4 Vic., c. 29,) was called, "An Act to extend the practice of vaccination the second Act (4 & 5 Vic., c. 32,) was termed," An Act to amend an Act to extend the practice of vaccination and the third and last Act (16 and 17 Vic., c. 100,) was, beyond all the others, passed with the object referred to, inasmuch as in the preamble we find the following words: "And whereas it is expedient that the practice of vaccination should be still further extended." In the face of all this it is extraordinary that any one should be found contending that public vaccination means only the vaccination of the pauper. That many do so contend is well known to every public vaccinator. An amended Act, and one less liable to be misunderstood and evaded, is the only remedy that suggests itself for this great evil. accidental, violent, and sudden deaths. As many as 23 inquests were held in this Sub-district during the year; of this number 9 were held to inquire 24 into the cause of death by violent means, and the remaining 14 were inquests on sudden deaths, the majority of which, it is to be presumed, involved a medical opinion. In but few instances, however, was this opinion sought for or obtained, a circumstance which, I contend, renders these inquiries farces in every sense of the term. One of two causes must operate to produce this extraordinary indifference to due investigation: either the jurors must consider themselves as competent as medical men to decide points of intricacy and difficulty in physiology and pathology, which is simply absurd; or they must dispense with medical evidence purely to save their time, which can hardly be said to be just either to the memory of the dead or, in many doubtful cases, to the character of the living. sanitation of the yeaR. Table VI. in the Appendix will show what has been accomplished during the year in the way of sanitation, the amount of which, it will be seen, far exceeds that of 1864. Without entering into minute details, which indeed the fulness of the table renders quite unnecessary, I may remark that the total length of sewers and drains constructed to the present date is 45,092 feet, and that 297 cesspools have been in consequence abolished, and 271 water-closets formed. Apart from this, 1050 houses and premises have been inspected by the Surveyor and myself. Scavengering on a somewhat large scale has been carried out, and the most strenuous exertions used (in many of the low-lying neighbourhoods especially) to render such scavengering continuously efficient. Until, however, the removal of dust and refuse is made compulsory on all occupants of houses, instead of being simply permissive, as it now is, it can scarcely be expected that the cleansing operations for so large a district can be so fully carried out as to fulfil the requirements we shall doubtless be soon 25 called upon to supply, in order to effectually oppose the ravages of cholera, should that disease unfortunately approach us. As usual, all the slaughtering places, cow-houses, and bake-houses were examined during the year. I cannot say this part of my duty was accomplished entirely without trouble and annoyance; for in a few instances I met with considerable opposition, and two owners of cow-houses, I regret to report, were found to have kept their premises in a condition so unsatisfactory as to necessitate a refusal of their licences by the Magistrates. In closing my report, I cannot avoid referring briefly to a great want in this Sub-district. I allude to the absence of any systematic attempts to number the houses in many of the streets, &c. Apart from the inconvenience of this in a postal point of view, it is to medical men, clergymen, and indeed to every one having duties to perform or business to transact in streets where duplicate numbers are frequently occurring, a most annoying task to go in search of an address. I strongly urge this matter upon the consideration of the authorities. JOHN MacDONOGH, Medical Officer of Health for Clapham. 26 BATTERSEA. It is unsatisfactory to state that the sickness and mortality of the past year has been in excess of the preceding, but the excess is not so great as that of 1864 over 1863. During the entire year Zymotic diseases prevailed extensively, and were more fatal, which must be expected as the poor population becomes more numerous. The deaths registered during the year numbered 785—412 males, and 373 females—being 116 in excess of the previous year. Of these 785 deaths, 127 occurred in the Workhouse, which is situate in this Sub-district; 114 of them not belonging to the parish of Battersea, would, if deducted from the total number, reduce the mortality to 671. The death rate for the past year, calculating from the registered deaths, natural increase, and estimated population, as described in previous reports, is, I regret to say, about 29 in 1000. The following table gives the number of deaths that have been registered during the year 1865, from all causes and amongst all classes, specifying the sex, age, and social position of the deceased. 27 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 and Tarding Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. DISEASES, And other Causes of Death. Classes– 1. Zymotic Small Pox 22 8 14 6 3 6 16 4 1 1 ... ... ... 5 17 Measles 15 10 5 5 9 1 15 ... ... ... ... ... ... 3 12 Scarlatina 39 19 20 3 29 7 39 ... ... ... ... 1 ... 4 34 Diphtheria 2 2 ... ... 1 1 2 ... ... ... ... ... .. 1 1 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 24 13 11 8 16 ... 24 ... ... ... ... ... ... 7 17 Typhus and Infantile Fever 28 16 12 ... 4 4 12 10 4 2 ... ... 4 7 17 Erysipelas 3 2 1 ... ... ... ... 1 1 1 ... ... ... 1 2 Metria, Childbirth 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 47 25 22 37 4 ... 42 3 1 1 ... ... 3 18 26 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 181 95 86 59 66 19 150 19 7 5 ... 1 7 40 127 2. Tubercular 135 69 66 40 14 4 67 38 27 3 ... ... 3 37 95 3. Of Brain, Nerves, &c. 115 64 51 42 26 2 70 8 16 17 4 2 7 32 74 4. Of the Heart, &c. 40 26 14 ... ... 4 9 5 15 11 ... 9 1 8 29 5. Of Respiratory Organs 118 50 68 38 37 ... 76 8 10 21 3 1 2 23 92 6. Of Digestive Organs 25 16 9 10 ... 1 12 2 6 4 1 1 2 6 16 7. Of Urinary Organs 6 4 1 ... ... ... ... 1 2 2 ... 1 ... ... 4 8. Of Organs of Generation 6 ... 6 ... ... ... ... 1 5 ... ... ... ... 3 3 9. Of Joints, Bones, &c 1 ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth Low Vitality, Mal formation, &c. 32 15 17 32 ... ... 32 ... ... ... ... ... 1 7 24 12. Of Uncertain Seat ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13. Age 42 17 25 ... ... ... ... ... ... 26 16 6 2 11 23 14. Violence 33 29 4 3 1 2 10 12 8 3 ... ... 1 7 25 15. Not Specified 52 27 25 19 2 1 22 6 9 15 ... 3 1 14 34 Totals 785 412 373 243 146 33 448 101 105 107 24 17 27 195 546 28 PREVALENCE AND FATALITY OF ZYMOTIC DISEASES. Diseases of this class have been very general and fatal: 181 deaths have been registered, being 47 in excess of the previous year. Fever prevailed more than in former years. By referring to the preceding table it will be seen that 22 persons died of Small Pox, 15 of Measles, 39 of Scarlet Fever, 24 of Whooping Cough, and 41 of Diarrhœa. MORTALITY IN THE WORKHOUSE. Of the 785 registered deaths in the sub-district, 127 occurred in the Workhouse, as before stated, 20 between the ages of 70 and 80, 13 between the ages of 80 and 90, and 3 between the ages of 90 and 100, the oldest reaching the great age of 97. INFANT MORTALITY. PROPORTION OF BIRTHS TO DEATHS- It is gratifying to observe that the mortality of children between birth and 10 years of age, has been more than one-half less than in the previous year, the numbers being respectively 342 and 144. There have been 1357 births, 710 males and 647 females, presenting the large excess of 573 births over deaths. This excess gives, of course, the natural increase of the population. 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 Sub-district, compiled from the Medical Relief Books of the Parochial Medical Officers, as well as the deaths that have resulted from disease and other causes, and gives the proportion of 23 deaths in 1002 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. 29 The improvements effected particularly in the way of drainage have been most important. As many as 53,751 feet of new sewers, and 413 drains connected with them, have been completed in the year, and 300 cesspools have been abolished. I need scarcely add that the slaughter and cow-houses, within the Sub-district, have received the usual attention. As the results of these inspections have been communicated to the Board in special reports, I need not allude to them here, further than to observe that advice was tendered where better regulations appeared to be desirable, and that such advice was generally well received and promised to be acted upon. WILLIAM CONNOR, Medical Officer of Health for the Sub-District of Batter ma. 30 STREATHAM, INCLUDING TOOTING AND BALHAM. The year 1865 has been marked in this Sub-district by events which, in a sanitary point of view, must be looked upon as very satisfactory. Not only has there been a less death-rate, by 27 below that of the preceding year, but the intensity of sickness, so far as the same can be judged of from what has been recorded as having occurred amongst the parish poor, presents a marked improvement over that of some former years. There has been rather a larger number of cases of sickness treated amongst this class during the past year (vide Table Y. Appendix) than during 1864, but the per-centage of deaths to cases treated is less, and the number of deaths due to Zymotic diseases has undergone no increase, one only of the out-door Union poor of the three parishes of which this Sub-district is composed having succumbed to this class of malady—viz., Scarlatina. It is also particularly gratifying to record the improvement in the rate of mortality amongst the labouring classes generally, viewed in relation to that amongst the classes of a higher social position. The following table shows there were less deaths from all causes amongst the inhabitants included under the heading "Industrial and Labouring Classes," by 24, than occurred in the preceding year, the respective numbers being 68 and 91; and that of the deaths from Zymotic diseases there occurred 11 only amongst this class to 18 amongst the three classes above them. This I am disposed to look upon as one of the good effects of the sanitation accomplished throughout the Sub-district, and particularly of the improved drainage secured to many of the poorer localities. 31 STATISTICS OF MORTALITY. STREATHAM, including Total Deaths from each Class of Disease, &c., in the Sub-District. Sex Age Social Position TOOTING & BALIIAM. Population in 1861—10,082. Area in Statute 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 30 and under 90 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle & Training Class, Shopmen, Clerks, &c. Industrial and Laboring Classes. DISEASES, And other Causes of Death Classes: — 1. Zymotic Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 1 1 ... ... 1 ... 1 ... ... ... ... ... ... ... 1 Scarlatina 13 7 ... 2 6 ... 12 ... ... ... ... ... 1 8 4 Diphtheria 2. 2 ... 1 ... ... 2 ... ... ... ... ... 1 1 ... Quinsy 1 1 ... ... 1 ... 1 ... ... ... ... ... ... 1 ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cough 2 2 2 2 ... ... 2 ... ... ... ... ... 1 1 ... Typhus and Infantile Fever 6 2 4 1 1 ... 3 ... 9 ... ... ... ... 3 3 Erysipelas 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 Metria, Childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carbuncle ... ... 1 ... ... ... . . . 1 ... ... ... ... ... ... 1 Influenza Diarrhoea & ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 2 1 1 ... 1 ... 1 1 ... ... ... ... ... 1 1 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 29 14 15 6 10 4 22 5 2 ... ... ... 3 15 11 2. Tubercular 13 4 9 1 ... ... 2 6 4 1 ... ... ... 4 9 3. Of Brain, Nerves, Ac. 17 11 6 5 4 ... 9 1 1 6 ... 1 1 5 10 4. Of the Heart, &c 13 7 6 ... ... ... ... 3 2 7 1 2 2 5 4 5. Of Respiratory Organs 20 9 11 4 1 ... 5 1 3 7 4 1 ... 8 11 G. Of Digestive Organs 12 6 6 1 ... ... 2 2 6 2 ... 9 1 5 4 7. Of Urinary Organs . 5 3 2 ... ... ... ... ... 9 3 ... 1 1 ?, 1 8. Of Organs of Gene ration 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 9i Of Joints, Bones, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Of Skin ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Mai formation, &c. 9 6 3 9 ... ... 9 ... ... ... ... ... ... 0 7 12. Of Uncertain Seat 5 2 3 1 ... ... 1 ... ... 3 1 1 2 2 13. Age 93 6 17 ... ... ... ... ... ... 10 13 a 0 12 ... 14. Violence 4 9 9 ... ... ... ... 9 2 ... ... ... ... 1 ... 15. Not Specified 1 1 ... 1 ... ... 1 ... ... ... ... ... ... ... 1 Totals 152 71 81 28 15 4 51 20 22 40 19 11 12 61 68 32 It may be observed in reference to this table that the largest number of deaths took place from Scarlatina, the mortality from the other forms of Zymotic disease presenting about the usual average. Notwithstanding the 13 deaths from Scarlatina, the number who succumbed to Zymotic diseases amounts to two more only than occurred in 1864. Two deaths, by the present table, is shown to have taken place from Diphtheria, which is four less than recorded in the table accompanying my last report, and the same may be said of the deaths in the two years from Diarrhoea and Dysentery, the numbers being two in the past year and six in the year preceding. One more death from Fever in the past year is also recorded than in 1864. Of the other sections of the table it may be remarked that under the heading " Small pox" no deaths are recorded. It is to be regretted, however, that there should still exist so much prejudice against public vaccination. I much fear that if, by fresh legislation on the matter, the Vaccination Extension Acts are not rendered more stringent in respect to their general application, and their provisions made to have an unmistakable bearing upon the vaccination of the entire population, we shall not always be in a position to report the absence of mortality from this dreaded disease in this Sub-district. Of the deaths recorded under the class "Tubercular," 12 of the 28 were registered from Phthisis—viz., 4 males and 8 females, varying in age from 8 months to 65 years. The ages at death from " Natural Decay," without any other cause being mentioned in the register, were high. Of 23 who succumbed to " old age" between 70 and 100 years, several were over 90 (the oldest 93), many more between 80 and 90, and more still bordering closely on 80. There were many more between 70 and 90 who were certified to as having died from disease, and the total number between the ages of 60 and 90 is 59. At the other end of the scale, 47 are shown to have died between birth and 10 years of age during the past year, which is 3 less than in the preceding one, whilst the infants dying 33 within the first year of their existence were, in the two last years, exactly equal—viz., 28. As regards the deaths from all causes amongst the outdoor parochial poor of this Sub-district, it is only necessary to observe that Table V. Appendix, gives a rate of mortality to the number of cases treated of 16 in 181. The rate of the preceding year was 18 in 174. The deaths from violence and accidents during the year were seven; of these, two (though sudden) were from "natural causes," one the result of "congestion of the brain from drinking ardent spirits," one from "accident on a railway," and one (an infant) "found dead, but whether born alive there was no evidence to show." Every one of these cases, I need hardly say, became the subject of a Coroner's inquisition. Deducting these seven deaths from violence, the total mortality, the result of disease alone, will be 142. This number of deaths in a population of only 11,000 (and there are grounds for believing so unusual an increase has taken place during the year from the influx of new residents as to warrant a much higher estimate) would place the rate of mortality as near as possible at 13 per 1000 living. This, I submit, is very satisfactory. The excess of births over deaths was 147, so that I am fully warranted in estimating the increase of population, including both the natural increase and that by emigration, at the figure I have put it. At all events this estimate cannot be looked upon as an exaggerated one, seeing that in my last year's Report the inhabitants of this Subdistrict were considered as numbering 10,800. THE SANITATION OF THE YEAR. At the commencement of my Report I spoke briefly of the benefits accruing from efficient sewerage. The construction within the year of 6,158 feet of new sewers and branch drains cannot have been accomplished without bringing with it the greatest advantages to the Sub- c 34 district. Looking also at the fact of there having been a large amount of other sanitary work accomplished in the way of abolishing cesspools, the supplying of water, and the removing of very many of the worst possible nuisances, there can, I think, be but few who will hesitate to acknowledge that the endeavours made during the past year to improve the sanitary condition of the Sub-district have been of a most satisfactory character. I should state that the nsual Special Reports were made to the Board, having reference to the condition of the slaughter and cow-houses in the Sub-district, and that these places, as well as the bakehouses, were, upon inspection, found to be clean and wholesome, and to have all the appliances insisted upon by the authorities. Lastly, I would press upon the Board the necessity of vigorously sustaining all accomplished improvements, as well as of designing and carrying out others that may have the effect of presenting a formidable, if not an impenetrable, barrier to Cholera and other epidemics that may either assail or threaten us. D. C. NOEL, Medical Officer of Health for Streatham, Tooting, and Balham. 35 PUTNEY AND ROEHAMPTON. The present is the Tenth Annual Beport for this Subdistrict that has been submitted since the Metropolis Local Management Act came into operation. It will, as heretofore, embrace an examination of the mortuary and other statistics, and present a brief summary of facts having: reference to local sanitation and its results during the year 1865. But few comments need be made upon the following table, showing as it does, in as concise a form as it is possible to render it, the causes of death, as well as the sex, age, and social positions of the inhabitants who have succumbed either to disease or accident during the twelve months to which the Beport relates. It may be as well to explain, with reference to the total deaths in this, and the Mortality Table in eachlocal summary, as well as in that in the Appendix, that such totals may differ, to a slight extent, from those given by the Begistrar General. For instance, it is intimated by the BegistrarGeneral, in a note appended to one of the tables in his last annual summary, that in some years his returns have been made to embrace 364 days, and in others 371 days, and that for this reason the figures must differ from those in such districts whose mortuary statistics are derived from returns for complete years, from the 1st January, to 31st December. c 2 36 STATISTICS OF MORTALITY, &C. PUTNEY and ROEHAMPTON. Population in 1861—6.481. Area in Statute Acres-2,176. Total Deaths from each Class of Disease, &c., in the Sub-District 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. 3Iiddle and Trading Class, Shopmen, Clerks, Ac. Industrial and Labouring Classes DISEASES, And other causes of Death. Classes:— • Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlatina . 2 ... 1 ... 2 ... 2 ... ... ... ... ... 1 1 ... Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 2 ... 2 ... 1 1 2 ... ... ... ... ... ... ... 2 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1. Zymotic Typhus & Infantile Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 4 4 ... ... 2 3 4 1 ... ... ... ... 4 4 Erysipelas. 2 2 ... 1 ... ... 1 ... ... ... 1 1 ... ... 1 Metria, Childbirth 1 ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea & Dysentery 1 ... 1 ... ... ... ... ... ... 1 ... ... ... 1 ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 16 7 9 1 3 3 8 5 1 1 1 1 1 7 7 2.Tubercular 98 14 14 4 9 1 7 17 4 ... ... 9 1 15 10 3. Of Brain, Nerves, &c. 13 9 4 3 4 ... 7 ... 3 3 ... 1 2 2 8 4. Of the Heart, &c. 6 1 5 ... ... ... ... 1 1 4 ... 2 1 3 5. Of Respiratory Organs 22 10 12 ... 9 ... 9 4 3 6 ... 3 ... 7 12 6. Digestive Organs 6 2 4 2 ... ... 2 ... 2 2 ... ... 1 2 3 7. Urinary Organs ... ... ... ... ... ... ... . . . ... ... ... ... ... ... ... 8. Of Organs of Generation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Of Joints, Bones, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Malformation, &c. 5 2 3 5 ... ... 5 ... ... ... ... ... ... 2 3 12. Of Uncertain Seat 6 8 ... ... ... ... 1 2 3 ... ... 3 3 13. age 8 4 4 ... ... ... ... ... ... 8 5 2 ... 3 3 14. Violence 4 4 ... 1 ... 1 2 ... 1 1 ... 1 ... 1 2 15. Not Specified 1 1 ... 1 ... ... 1 ... ... ... ... ... ... 1 ... Totals 115 54 61 17 18 5 41 28 17 23 6 12 5 44 54 37 From the above table and those of former reports has been constructed another, serving to show the annual death rate of the Sub-district for the past ten years, and the proportion of deaths from Zymotic diseases to deaths from all causes in each year. YEARS. Number of Deaths from all Causes. No. of Deaths from Seven of the principal Epidemic Diseases. Per centage of Deaths from seven principal Epidemics to Deaths from all Causes. 1856 92 13 14.1 1857 88 7 7.9 1858 118 20 16.8 1859 119 26 21.0 1860 86 3 3.4 1861 124 21 16.9 1862 107 13 12.1 1863 129 29 22.4 1864 121 11 9.0 1865 115 11 9.5 It will be seen by this table that the rate of mortality for the year under review, both in respect to total deaths from all causes, and the total from the seven principal diseases of the Zymotic class, is considerably below the average of the previous nine years. Assuming the population to have increased only in the same ratio as it has done in former decennial periods (and judging from the number of houses erected and inhabited during the past ten years, there is reason to believe the influx of new residents has been unusually great) the inhabitants must have numbered, for the year 1865, at the very least, 7,500. This assumption, it is almost needless to say, is based on a calculation embracing both the natural increase, as shown by the excess of births over deaths, and the supposed increase by immigration." The rate of mortality, * The deaths being 115, and the births 191, the excess of the latter over the former is consequently 76, which of course gives the natural increase of the population. There is reason to believe that the increase, by the influx of new residents, has been every much larger than the natural increase. 38 therefore, for 1865, the deaths having numbered 115, is something less than 16 per 1000 living, or 1 per 1000 less than is noted by the Registrar General as pertaining to the most healthy of rural districts. Zymotic Diseases and their resulting Deaths.—The 11 deaths from the seven principal epidemics that are enumerated in the Registrar General's weekly returns is, in an estimated population of 7500, a low rate of mortality compared with that of most of the suburban localities, and is, it is suggested, a very satisfactory indication of the operation within the Sub-district of some good sanitary influences. To improved sewerage more is perhaps due than to any other cause; for, without doubt, since good house drainage has become the rule, and the use of the disease-engendering cesspool the exception, the maladies comprehended in the term "epidemic," have not only exhibited themselves in a much less virulent form, but are wont now to prove fatal, almost exclusively, amongst the ill-fed and the scrofulous, instead of, as formerly, striking down the strong and the weak, the rich and the poor indiscriminately. Of the 16 cases of Zymotic disease that proved fatal in the past year, more than one-half were registered as having occurred to children of indigent parents, for the most part with a scrofulous taint to be detected in their families, and in localities where overcrowding, it is feared, will ever operate to unduly swell the mortuary returns of this parish. With the increase of population amongst the affluent and middle classes, the poor must necessarily, and in obedience to a natural law, increase in proportion ; but seeing that where there are annually erected scores of houses of a superior order, scarcely one is built of a kind that can be made available as a residence for the family of a labouring man, little else can be expected than that overcrowding will daily become more deplorable. It need hardly be observed, also, that when once a poor and overpeopled neighbourhood commences a downward course in respect to its sanitary arrangements, there is, if it be left 39 to itself, but little hope for the future of such locality, so far at least as concerns its ability to resist the spread of infectious diseases. Landlords and owners of small property, there is reason to believe, are much too frequently and undeservedly blamed for an indifference to sanitary arrangements when dirt and squalor reign supreme in and around such property; but in the majority of instances that have fallen under my own observation during a somewhat lengthened experience of the habits of the poor, the neglect and utter carelessness of the renters themselves could be shown to bo at the bottom of the evil referred to. Too often has it been the case that property of this description has been put into thorough repair, and every sanitary appliance provided, at an expense largely affecting the profits of the landlord, and yet, in a few months, or may be weeks, the best constructed drains and other conveniences have been again thrown into disorder from sheer neglect of the commonest precautions: conveniently-placed dust-bins that, properly used, would for years have met every conceivable requirement of the authorities, have, in like manner, been wantonly destroyed, and in their place every corner and open space has been converted into a receptacle for garble and refuse of the most offensive description. In short, every possible means will frequently appear to have been purposely resorted to to thwart the very best intentions of owners, whose manifest interest it is to keep such localities clean and wholesome. A remedy for this great evil, especially under the circumstances attending the dreaded approach of Cholera, would, it is submitted, be to place all such localities under the strictest surveillance of a sanitary police, of a police having special functions to detect and bring to justice all offenders against those laws which have been designed for the protection of the community at large. Great as have been the improvements in the dwellingplaces of the poor in this locality, through the introduction of good drainage, there is much to be accomplished in many neighbourhoods to render the houses therein thoroughly healthy habitations; and a good and unremitting water supply, together with an efficient and equally unremitting 40 system of scavengering, are unquestionably amongst the most important and necessary measures that will have yet to be carried out before the Sub-district can be pronounced in so thoroughly a protected state as all ratepayers must necessarily desire to see it. Upon the important subject of water supply the following remarks, published by the Metropolitan Association of Medical Officers of Health, in a pamphlet developing their proposal for "united action in the event of an epidemic of Cholera," are deserving of attention. As a member of the Association I need hardly say that I fully endorse these views; the more so, as they entirely bear out the remarks which my colleagues and myself have, from time to time ventured to make upon the question. (See "Supplemental Remarks"page 54, Appendix). "All experience shows that water is a most common and most dangerous vehicle of cholera, and that it may actually convey the discharges of the sick to the stomachs of the population. Should cholera be imported into any of those towns and villages which drain into the upper Thames, there can be no doubt that London would be in great danger. Hence it will be expedient, as regards the supply of water— "1. To communicate with the water companies, urging them to make sure that no water is delivered into their mains which has not undergone filtration; to take double care in delivering their water clear, for it has been shown that the organic sediment is the most dangerous part of foul water; and to have their filtering beds thoroughly washed and cleansed from organic matter. " So much for the quality of the water. Next as to quantity. "2. A daily supply should be given to the courts inhabited by the poor, guarded by a ' water-waste preventer.' "3. A supply on Sundays is absolutely necessary, for the greater washing and cooking on Sunday mornings, when working men are at their own homes. "4. As regards Storage or Water.—The public must be cautioned as to the condition of their water receptacles, which should be thoroughly cleansed. Drinking water ought not to be taken from butts or cisterns connected with water-closets. "5. All surface wells should be absolutely closed for drinking purposes." Again, as to removal of dust and general scavengering, the recommendations of the Association are given in the following terms:— "In anticipation of a cholera outbreak, contracts made with dustmen and scavengers should provide for the more frequent removal of house refuse, and for the more efficient cleansing of streets. All refuse, dust, 41 and dirt, ought to be looked upon as containing possible germs of disease, which may be lifted in vapour or blown about by the wind, and so be inhaled or swallowed. "It would be wise economy this summer to have the streets kept more cleanly.'' Of Zymotic diseases, Typhus Fever proved, in this Subdistrict, the most fatal during the year. Eight persons, five of whom were over 20 years of age, succumbed to this disease. Diarrhoea, which proved fatal in six cases in 1864, is registered as the cause of death in one only during the past year; and the Sub-district appears to have been singularly free from those Zymotic maladies which attack the young almost exclusively—viz., Scarlatina, Measles, and Whooping Cough. With the exception, then, of Typhus, there was little to cause alarm in respect to epidemics, and the undue prevalence of a type of fever, regarded by the profession as the product of a peculiar miasma, may be well accounted for by the opening of so much new ground during the construction of the great intercepting sewer, and by the consequent though unavoidable exposure of the contents of innumerable house drains and their noxious surroundings. The fact of Typhus having followed the course of the great culvert and invading in succession Battersea, Wandsworth, and Putney, during its construction through those localities, very greatly favours this theory. The good effects of efficient drainage are, however, becoming daily more and more manifest, and the decline of this type of fever as we approach the completion of the undertaking will contribute to reconcile us to the temporary evil referred to. No great fatality attended any of the affections of the epidemic class beyond those named, and Small Pox, I am pleased to report, resulted in death in no one instance. Of the vaccinations in the Sub-district during the past year, I regret to say, I cannot speak with the same satisfaction. To a strongly and very persistently encouraged prejudice against public vaccination, by a most indiscreet person who, like many others, had conceived the notion that the functions of public vaccinators had some very intimate association with the treatment of 42 paupers, must be attributed the great falling off in the number of children now submitted to the operation, compared with the number to be found duly certified to and recorded in the books of the Local Registrar before such notion came to be promulgated. From some statistics in my possession I gather that in an entire year just expired, 88 children only of 203 born in the parish were, within three months of their birth, vaccinated under the provisions of the statute, thus leaving the somewhat large number of 115, upon whom it would be very difficult indeed to say, without a general inspection, whether vaccination had been performed or not, since but few private certificates are given, or any systematic registration attempted of cases other than those which have come under the cognizance of the Public Vaccinator. That the Legislature in passing the several Vaccination Acts could have contemplated such a result as this, in a comparatively small community, none but the most prejudiced will believe. The terms of the Vaccination Extension Acts themselves, and the very strong and decisive opinions that have been from time to time published with regard to them by the Poor Law Board and other authorities, render it most difficult to understand upon what grounds it can possibly be contended that "public vaccination" can mean only the vaccination of the pauper! It is also a proposition almost too absurd for serious refutation that a Public Vaccinator, whilst strictly complying with the provisions of the Statute, and gratuitously inserting the vaccine lymph into the arms of " every person who shall apply to or be brought to him for that purpose," must afterwards render his private professional aid to all such persons in forma pauperis, and in no other way! Such a reading of the law can hardly be the one adopted by the Poor Law Board when we find that Board, in their instructional letters proffering such advice as the following : "A literal as well as a virtual compliance with a Statute is obviously preferable in all cases to a merely virtual compliance. In the present case, more especially, the duty of the Guardians is to give the whole of the residents the benefit of the measure." — Instructional Letter, September, 1840. 43 This opinion, then, most completely sets at rest the point that has been raised, and must convince even the most prejudiced of the original intentions of the Legislature.* *Having discovered, since the above was written, that the mischief produced by the promulgation of the false notions I have referred to was much wider spread than I at first thought possible, I have, in justice to my position as a Health Officer, been induced to submit the entire question to a competent referee, who, in reply to my inquiries, has obligingly pointed out a few passages bearing upon the subject in the publications of the Poor Law Board. After commenting upon a published table exhibiting the ratio of births to public vaccinations throughout the kingdom, and lamenting that there should be found a great disproportion of the former over the latter, in certain years, the Commissioners remark in one of their Reports to Her Majesty's Secretary of State:— "A few Boards still manifest great indifference on the subject. The Guardians of the parish of St. George the Martyr, Southwark, in July, 1844, passed a resolution that all cases for vaccination, in connexion with the parish, be performed at the workhouse, in Mint-street, on and after the 29th of September then next ensuing, and that the vaccinators in their respective districts appoint the particular day and hours of attendance for such purpose. On being made acquainted with that resolution we addressed a letter to the Board of Guardians objecting to the arrangement, and we stated that it would put an end to the general vaccination of the residents of the parish.'' There can be no doubt that such a proceeding as this was calculated, like the one I now complain of, to create anywhere the greatest possible prejudice against Vaccination amongst all classes. That it did so in the Parish of St. George the Martyr, clearly appears in the sequel; for after making some very pointed allusions to the almost certainty of those of the inhabitants who were not paupers "feeling unwilling to take their children to the workhouse, under the impression that by so doing they were placing themselves in the position of paupers," the Commissioners proceed to remark:— " In the year ended 29th September, 1844, at which date vaccination was first restricted to the workhouse, the number of persons vaccinated was 1,079, and in 1845 the number fell to 42, and in 1846 it was only 44." Such occurrences as the above (and the Commissioners allude to some others) are, it is submitted, quite sufficient to justify the remarks recently addressed to the Privy Council by one of our learned societies, through its distinguished President, Dr. W illiam Jenner, who writes:— "They (the society) have always protested, and feel bound still to protest, against this great branch of preventive medicine being associated with Poor Law relief." Again, in a recent authorized publication, exclusively devoted to the consideration of "The Vaccination Extension Acts, by Danby P. Fry, Esq., Barrister-at-Law, and of the Poor Law Board," the following are given as the expressed opinions of the Poor Law Board:— " Every person, of whatever grade and condition in life, may take his child to the Public Vaccinator to be vaccinated; for the provisions of the Vaccination Acts are not confined to the poor, but extend to all classes qf society." "It will be seen that, ancording to the form of contract prescribed by the Poor Law Board (see General Order), the Vaccinator undertakes to vaccinate ' every . person resident in the Union,' who shall apply to or be brought to him for that purpose; and that the Guardians undertake to pay him 'for every person so resident as aforesaid' who shall have been successfully vaccinated and duly entered in his register." That a Public vaccinator, then, has a right to place the names of every vaccinated 44 SICKNESS AND MORTALITY AMONGST THE POOR. Table V. in the Appendix proves a most valuable one as an index to the general sickness that has prevailed in the several Sub-districts. The column appropriated to the mortality statistics of this parish shows that the out-door poor have suffered during the past year but slightly from epidemic diseases (fever excepted), and that the deaths under the headings of both Zymotic and ordinary maladies have been below the average. Fourteen deaths in 400 cases of pauper sickness is a small per-centage, and pretty clearly indicates that sanitation carried into the dwelling-places of the poor can effect much good; and further, that such sanitation has already had considerable influence in modifying disease and rendering it less fatal amongst all classes of the community. AGES AT DEATH. Eight deaths have been registered as due entirely to advanced age or natural decay, five of which were of persons over 80 years—the eldest 90 years. The average age of these eight persons is 81 years. At the other extreme of the scale there will be noted little or no increase of the number dying under 10 years person in his register there can be no doubt whatever, notwithstanding any private fee that may be due to him for private medical treatment, or extra services rendered, either before or subsequently to the official act of inserting the vaccine lymph, which he is obligated by the Statute to perform on every one applying to him for the same. In the same publication as that above referred to, it is remarked that:— "If in fact he do so," (that is to say, place the names of the children of his private patients in his register, in order to ensure to every one the properly certificated registration, according to the provisions of the Statute,) " his right to be paid for the successful vaccination of such patients is established by the contract." It may seem at first sight hardly worth while to contend these points so seriously, but it never should be forgotten that if Health Officers will not take the trouble to expose, with a view to check such attempts to override the law, as those referred to, there is danger that their present impunity may give them a degree of authority hereafter, and it would not, I submit, be very desirable to set up such an authority in any district, seeing that in London alone something like 3,000 deaths have been lately recorded as resulting from Small-pox, in a single year. 45 of age, but of deaths under one year there will be found a decided decrease, 24 and 17 being the respective numbers in the years 1864 and 1865, making a difference of seven in favour of the latter. This is so far satisfactory as indicating some improvement in the habits of the poorer classes in respect to the care bestowed upon their helpless offspring at the earlier periods of life. PROGRESS OF MORTALITY. REGISTERED CAUSES OF DEATH. NUMBER OF DEATHS. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. THE YEAR. January, February, March. April, May, June. July, August, September. October, November, December Zymotic Diseases (epidemic, endemic, and contagious) 1 4 2 9 16 Diseases of the Respiratory Organs 8 4 2 5 19 Pulmonary Consumption 6 5 5 8 24 Diseases of the Heart 2 4 ... ... 6 Diseases of the Brain and Nerves. 5 3 3 3 14 Diseases of the Digestive Organs 4 1 1 3 9 All other Diseases 1 4 0 3 8 Accidental and Violent Deaths ... 1 2 1 4 Premature Birth, Low Vitality, Malformation ... 4 1 2 7 Old Age (natural decay) 5 2 1 8 Totals 32 32 17 34 115 Meteorological Readings. Mean Temperature of air 36.5 56.2 62.5 46.0 50.3 „ Degree of humidity 858 728 768 888 808 „ Readings of Barometer 29.616 29.917 20.860 29.739 29.783 Amount of Rain 61 in. 7 2 in. 65 in. 9.2 in. 29.0 in. Employing a similar table to that which has served in several of my past reports to illustrate what may be termed the progress of mortality, and to exhibit the fluctuation of fatal disease at different seasons of the year, it will be shown that the greatest number of deaths occurred in the winter quarter, and it will not be without regret to learn, by a comparison of the present with the table in my last year's report, that Pulmonary Consumption is decidedly 46 on the increase. This disease, so greatly dependent upon climatic influences, resulted in death in no less than 34 cases, thus yielding a larger number by seven than occurred from the same disease in 1864, and the largest of any under the different classes of disease recorded in the above table. It should not, however, be forgotten that some few of these deaths were of entire strangers, coming into the sub-district in order to avail themselves, temporally, of the benefits to be derived from a pure suburban atmosphere, which, in some portions of the parish, and particularly in those the farthest removed from the water, has the reputation of being most beneficial in prolonging the existence of sufferers from phthisical disease. Sanitation of the past year.—In addition to the usual inspections that have been made of the slaughterhouses and cowhouses, as well as of the bakehouses, in the Sub-district, (the whole of which places were duly reported upon to the Board and to the Local Committee at the time such inspections took place) Table VI. in the Appendix has been constructed to supply the usual summary of sanitary work accomplished during the year, and to this I must beg to refer the reader. It should be observed, however, that all the cowhouses and slaughterhouses in the parish received additional care in their inspection during the past year, by reason of the great prevalence of the cattle disease, and the danger of its rapid extension through the neglect of proper sanitary precautions. It affords me much pleasure to report that the proprietors, generally, of these places, recognized, to the fullest extent, the necessity of giving the strictest attention to disinfection and cleanliness, and that the consequence has been no case whatever of the Rinderpest, even in its mildest form, has been known to occur within the area of the Sub-district. The great intercepting culvert has now been finished, and with it the local contributory sewers and drains are fast being made to join. When this last portion of the great undertaking has been completed, one of the most important of the sanitary requirements of the day will 47 have been supplied to this parish. That the work has been costly, no one can deny : that it will afford the rate- payers an equivalent return for the outlay in the saving of ife, and in depriving disease of much of its former virulence, there can be scarcely two opinions. Let us hope, too, that the efficiency of this measure, will not be without its influence in arresting the approach of a disease much to be dreaded by all communities—I mean Cholera. For some time past there have been the most unmistakeable indications of the approach of this disease, but it is satisfactory to find both the medical profession, and the public entertaining such views of the nature of the threatened epidemic as are calculated to allay many of the worst fears, with which the advent of the malady was formerly regarded. Unquestionably, also, are we much better prepared than we were a few years since, to oppose the invasion of the district by Cholera and by many other diseases; but it cannot be disputed that, although our progress in sanitation has hitherto been satisfactory, there remains much to be accomplished, and that many well devised and vigorous measures, necessary to combat overcrowding, deficient water supply, and bad house-drainage, have yet to be carried out. Cholera, it is true, has not visited us severely since 1854, and it is possible may not again appear in this country under quite the same alarming conditions as it then did. As a public writer has well observed, "We are exposed, no doubt, to certain risks, but these risks are not, to all appearance alarming, whilst the measures recommended by actual experience may be easily distinguished from suggestions originating in causeless panic." Most medical and sanitary authorities agree in viewing the conditions under which the disease has lately made its appearance at some few of our ports, and in certain emigrant vessels, as bearing but little resemblance to those of former epidemics. Be this, however as it may, it would reflect but little credit upon us were we to neglect the usual reasonable precautions against the spread of this destructive malady, now that we have a willing Legislature to second our efforts, and Acts of Parliament to justify our measures; and it should never 48 be forgotten, let the disease assume ever so mild a form, or even pass over us altogether, that whatever is effective against Cholera will be qually so against fever, and all other epidemic diseases; so that under any circumstances (always bearing in mind that precautionary measures can be carried out with much less trouble, and much less expense, in the absence of the disease, than when it is present amongst us), whatever we may resolve upon to do will not be thrown away, or be adopted entirely in vain. E. HAKLAND 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 . 1861, classified according to .Sex, Age, and Social Position, and showing also the relative Numbers in each Sub-District. POPULATION of ENTIRE DISTRICT, In 1861, 70,381. Area in Statute Acres, 11,695. Total Deaths from each Class of Disease, &c., in the Entire District. Sub-Districts. Sex. Age. Social Position capnam—population in 1881, 20,890 area in acres, 1,233. Wandsworth—Population in 1861, 13,346, area in acres, 2,478. Battersea—Population in 1861, 19,582, area in acres, 2,343. Putney—Population in 1861, 6,481, area in acres, 2,176. Streatnam, Tooting, and Balham-popu lation 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. DISEASES, And other Causes of Death. Classes:— Small Pox 34 7 5 22 ... ... 18 16 9 6 7 93 9 1 1 ... ... ... 6 98 Measles 25 9 15 ... 1 16 9 5 17 3 25 ... ... ... ... ... ... 4 21 Scarlatina 68 11 3 39 2 13 36 32 ... 42 15 64 3 1 ... ... 1 8 17 47 Diphtheria 9 4 1 2 ... 2 6 3 ... 4 2 8 1 ... ... ... ... 1 4 4 Quinsy 2 1 ... ... ... 1 1 1 ... 2 2 ... ... ... ... ... 2 13 9 ... ... 2 ... 7 6 ... 11 2 13 ... ... ... ... ... ... 3 10 Whooping Cough 47 15 ... 24 ... 2 23 24 24 25 1 47 ... ... ... ... ... 1 14 32 1. Zymotic Typhus and Infantile ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fever 71 11 18 28 8 6 36 35 1 12 9 35 21 11 4 ... ... 5 19 47 Erysipelas 11 ... 1 3 2 1 6 8 4 1 ... 5 3 3 2 1 1 3 2 8 Metria, Childbirth 9 ... 3 1 1 ... ... 9 ... ... ... ... 9 ... ... ... ... 1 2 6 1 ... ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 Diarrhoea & Dysentery 89 20 19 47 1 2 50 39 66 7 75 5 1 6 2 1 8 29 51 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 382 96 60 181 16 29 199 183 117 127 39 297 52 17 13 3 3 22 102 255 2. Turbercular 271 32 63 135 28 13 128 143 61 93 7 109 97 58 7 ... 3 8 68 192 3. Of Brain and Nerve 247 43 59 115 13 17 144 103 66 41 5 116 24 46 52 9 8 15 54 170 4. Of Heart 96 21 10 40 6 13 53 43 1 ... 4 12 13 32 37 2 7 9 25 55 5. Of Respiratory Or gans 270 54 54 118 22 20 128 149 74 62 1 141 18 38 64 9 5 10 52 903 6. Of Digestive Or gans 91 23 25 2: 6 12 50 41 33 5 2 42 8 23 17 1 5 9 22 55 7. Of Urinary Organs 22 5 7 5 ... 5 12 10 ... 1 ... 1 5 9 7 3 2 6 11 8. Of Organs of Gene ration 16 3 6 6 ... 1 ... 16 ... ... ... ... 5 8 2 1 ... ... 3 13 9. Of Joints, Bones, &c 10 8 1 1 ... ... 5 5 ... ... 1 ... 3 2 2 ... ... 2 4 4 10. Of Skin 2 2 1 1 1 2 1 1 11. Premature Birth Low Vitality, Ma] formation, &c 91 33 12 32 6 9 49 42 88 3 ... 91 ... ... ... ... ... 1 16 74 12. Of Uncertain Seat 21 6 ... 6 5 9 12 2 1 ... 4 2 6 8 1 2 ... 9 10 13. Age 127 34 20 42 8 3 45 82 ... ... ... ... ... ... 63 64 13 7 45 62 14. Violence 62 12 9 33 4 4 51 11 11 2 4 21 18 15 8 ... 1 3 14 44 15. Not Specified 75 21 52 1 1 36 30 24 2 1 28 12 13 22 ... 3 5 20 47 Totals 1783 393 338 785 115 152 910 813 478 267 34 866 257 268 302 90 54 93 40 1196 50 TABLE II. Biths registered during the year ended 31st December, 1865. SUB DISTRICT. Males. Females. Total. Clapham 379 321 707 Wandsworth 224 211 435 Battersea 710 647 1,357 Putney and Roc-hampton 9G 95 191 Streatham, including Tooting and Balham 1C4 135 299 Total 1,573 1,416 2,989 The excess of Births over Deaths in the entire district ic 1,206. TABLE III. Meteorological Means for 1865, from Observations taken at Greenwich. Jan., Feb., and March. April, May, and June. Ju!y, Aug., and September. Oct., Nov., and December. The Year. Temperature of the Air 36.5 56.2 62.5 46.0 50.3 Evaporation 34.7 51.6 58.2 44.4 47.2 Dew Point 31.8 47.3 54.5 42.6 44.1 Weight of Vapour in a Cubic Foot of Air 2.1 grs. 3.7 grs. 4.7 grs. 3.1 grs. 3.4 grs. Degree of Humidity (Satn. 100) 85 72 76 88 80 Reading of Barometer 29.616 in. 29.917 in. 20.860 29.739 29.783 Weight of a Cubic Foot of Air 553 grs. 537 grs. 529 grs. 554 grs. 541 grs. Rain (amount of) 6.1 in. 7.2 in. 6.5 in. 9.2 in. 29.0 in. 51 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 1855-65. 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 1864 63 129 43 11 22 268 1688 15.8 1865 75 177 54 11 26 343 1783 19.2 *** 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 Dysentery, and Fever. D 2 TABLE Y. Cases of Sickness amongst the Poor under the treatment of tlie Union Medical Officers, with the Deaths from each class of Disease, &c., (luring the year ended 31st December, 1865. Compiled from the District Medical Belief 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 1056 37 2 10 1 11 ... 25 3 88 1 ... ... 122 2 5 ... 1 ... 89 10 18 5 10 ... 577 18 63 1 43 Wandsworth 1118 10 ... 14 1 7 1 5 1 65 ... ... ... 49 3 8 ... ... ... 149 6 14 8 6 3 791 14 ... ... 37 Battersea 1002 38 3 2 1 25 6 12 4 29 ... ... ... 36 1 8 ... 2 193 7 10 3 40 1 546 7 61 ... 33 Putney and Roehampton 400 1 ... ... ... 7 ... ... ... 18 ... ... ... 29 2 3 ... ... ... 45 4 ... ... 1 1 258 7 38 ... 14 Streathara, including Tooting and Balliam 183 1 ... ... ... 7 1 ... ... 4 ... ... ... 5 4 ... ... ... 35 3 7 2 2 ... 108 10 10 ... 16 Totals 3759 87 5 26 3 57 8 42 8 204 1 ... ... 241 8 28 ... 3 ... 511 30 49 18 59 5 2230 56 172 1 143 53 TABLE VI. Summary of the Sanitary Operations in the entire District daring the year 1865. Clapham. Battersea. Wandsworth. Putney and Roehampton. Streatham, including Tooting and Balham. Totals. Number of Houses and Premises inspected 1050 630 500 240 115 2,535 1st Notices served 68 45 54 11 401 250 2nd Notices served 10 6 16 ... ... Cesspools emptied and cleansed 64 130 18 6 135 353 Cesspools abolished 73 750 42 30 38 933 Waterclosets constructed 228 350 30 75 147 800 Houses supplied with water 146 469 25 75 147 862 Drains constructed or connected with Sewer 640 413 53 75 67 1,248 No. of feet of New Sewers, &c. 7,786 53,751 15,900 5,764 6,158 89,359 Drains repaired or trapped, or obstructions removed 49 45 52 34 60 240 Open Ditches, Ponds, &c., cleansed (in feet) 17,175 28,600 12,700 5,370 42,240 106,085 Dust-bins provided 270 480 48 31 109 938 Pig Nuisances removed 27 10 130 3 8 178 Accumulations of Offal, Manure, &c., removed 35 6 12 21 12 86 Unwholesome and di1 apidated Houses cleansed or repaired ... ... 15 ... ... 15 Cases investigated by Magistrates ... 8 ... ... ... 8 Compulsory Orders obtained ... 4 ... ... ... 4 Compulsory works executed ... 1 ... ... ... 1 Works remaining in abeyance from various causes 13 ... 4 ... ... 17 SUPPLEMENTAL REMARKS Oil the Supply of Pure Water during the prevalence of Cholera. The importance attached, at this particular juncture, to an abundant supply of pure water, and to the suggested closing of all surface and other wells found to contain organic matter, the result of percolation from cesspools and other sources of contamination, renders it desirable that all persons should have the means supplied them of forming correct views upon this momentous question. No apology, therefore, is necessary for here repeating the results of certain analyses and microscopical examinations of several of the well waters of this District made a few years since, more especially those in the large Sub-district of Wandsworth and the comparatively small one of Putney, as giving a fair sample of the condition of such waters throughout the District. Dr. Nicholas, Medical Officer of Health for Wandsworth, in 1856, appended the following table to his report for that year:— Table showing the Impurity and Hardness of samples of the several kinds of Water in general use in the Parish of Wandsworth. Source of Supply. Date. Solid Constituents in grains per Imperial Gallon. Hardness in degrees, each degree equal to one grain of chalk per gal. Remarks. Organic Matter. Inorganic Matter. Total Impurity. Temporary. Permanent. Total. Artesian boring at Young and Bainbridge's Brewery, High Street. Feb. 0.955 19.653 20.59 7°31 7°31 Sparkling, colorless, odourless. March 1.015 19.60 20.615 Artesian boring at Summerstown. Feb. 1.30 19.45 20 .75 7°04 7°06 14°1 Ditto. South wark and Vauxhall Co., from a Main in High St. March 1.35 16.73 18.08 6°35 6°40 12°75 Clear, colorless, odourless. River Wandle, after filtration, at Messrs. McMurray's Paper Mills. March 2.45 16.52 18.97 3°34 10°66 14°1 Ditto. Feb. 7.21 17.73 24.94 8°78 5°80 14°58 Turbid from the presence of much organic matter, visible to the naked eye; has an unpleasant smell. River Wandle, near the Bridge. March 3.90 17.54 21.44 .. .. April 6.45 16.95 23.40 .. .. .. Well, common to Nos. 3 & 4, Church Row. Pump at Dunse Hill- Jan. 7.70 103.0 110.70 15°21 33°15 48°36 Clear, straw colored; trace of ammonia; aboundsin nitric acid Ditto Feb. 9.55 111.95 121.50 16°15 30°25 46°4 Do. at Warple Row. April 11.375 110.05 121.425 13°86 58°64 72°5 Odourless, slightly opalascent, slight trace of nitric acid. Do, at Prince's Place April 13.50 59.80 73.30 5°5 26°0 31°5 Clear, colourless, odourless, contains nitric acid. Ditto. Do. at Point Pleasant April 13.82 37.20 51.02 7°2 18°8 26° Do. at Spencer's Court April *14.69 173.28 187.97 .. .. .. Clear, straw colored; contains much nitric acid. 14.90 172.66 187.56 19°45 47°20 66°65 Do. at Martin's Buildings, Frogmoor. April *15.40 187.10 202.50 .. ° .. Straw colored, clear when first pumped, but soon becoming more opalescent; trace of ammonia; contains much nitric acid. 15.31 186.65 201.96 16°37 44°75 61°12 The results contained in this table are the mean of not less than two analyses, several are of more than two. The hardness was determined by the soap-test process of Dr. Clark, the permanent hardness after boiling the water five minutes, the temporary hardness being the amount removable by the boiling. *These two analyses were made at the laboratory of St. Thomas' Hospital by Mr. Oersted, to whom, and to Dr. R. Dundas Thompson, I am much indebted for kind assistance and advice in these investigations. Dr. Nicholas, in reference to the above table, makes the following remarks :— "Surface Wells.—These furnish the principal supply to the parish. The samples were taken from different parts of the parish, as far apart as possible. They are seen to be, "without exception, excessively polluted. This is scarcely to be wondered at, when we consider the conditions affecting these falsely-named spring waters. "The great majority of these wells are simply holes in the ground, made for intercepting the surface water in its passage through the soil towards its complete filtration at a much lower level. If no other circumstances were in operation such water would simply be imperfectly filtered surface water; but when we reflect that the soil through which it percolates is of a loose gravelly nature, riddled all over with cesspools, and liable to every impregnation which can affect its surface derived unceasingly from town life; and that the nature of water is to absorb any soluble substance with which it comes in contact, we can realize some of the enormity of the pollution to which such water is subject. It would be as reasonable to expect to derive wholesome water from the filtering beds of one of the water companies between the strata of which was interposed a layer of town ordure, as from these wells. The conditions, differing only in degree, are parallel in both cases." Dr. Whiteman, Medical Officer of Health for Putney, has also given his attention to this subject. lie states in his report for 1856 "Although much of the well water in this sub-district is pure and wholesome, compared with that which several of my colleagues have given me to understand is obtainable by the inhabitants of some of the neighbouring parishes, there is a good deal that is most decidedly bad, and some that is quite unfit for drink or to be used for culinary purposes. In 1854 Dr. Hassall kindly examined with me many of the well and other waters of this parish, and the results of both the microscopical and chemical investigations then made have since been published in the general report on the cholera epidemic of 1854, laid before Parliament by the Board of Health. The following are a few extracts from Dr. HassaH's contribution to that Report. No. 6.—From Pump iu Cock's Buildings, Putney.—Collected 8th October, 1854, by Dr. Hassall and Dr. Whiteman. "This water, during the prevalence of cholera in Putney, was of a decided green colour, as was observed by the inhabitants of the many houses supplied by it; this appearance had gone off somewhat at the period when the specimen was obtained, at which time cholera was also on the decline, but still it was of a greenish hue, as was clearly seen when the water was poured out into a glass tumbler; scarcely any sediment was deposited, and there was discovered, in the little that was thrown down, four or five oxytriehsæ, one or two parainecia, masses and threads of the spiral vibrio, which exhibits a dotted appearance at each turn of the spire, and rather many monads. This water, from its appearance and from the account given of it, was evidently contaminated by percolation from a neighbouring cesspool, and the principal part of the organic matter present was in the fluid state, and in the form of nitrates. See Dr. Thomson's analysis." No. 7.—From Pump in Price's Folly, Putney.—Collected 8th October, 1854, by Dr. Hassall and Dr. Whiteman. "This water resembled the preceding in colour and appearance, but was still deeper; the source of contamination was also the same, namely, a neighbouring cesspool. Very little sediment wa3 deposited, enough only to be just visible to the naked eye, in a thin glass cell; it contained a considerable number of actinophrydes, some of the spiral vibriones before referred to, a few euglense, one or two small paramecia, a few small sporules and threads of fungus, and eight or ten frustules of different diatomaceae, including navicula and gomphonema; lastly, there were a few green circular sporules aggregated into little masses, and motionless. See Dr. Thomson's analysis." No. 8.—From Pump at 19, Stratford Grove, Putney.—Collected 8th October, 1854, by Dr. Hassall and Dr. Whiteman. "This water was coloured like the others, but the people of the house from which it was procured fancied that it was contaminated by leakage from a gas-pipe, which however is some distance away from it, nevertheless there is much reason to believe that the explanation given is correct, as there is no cesspool near, and as the water was always good until the gas-pipe was laid down. The sediment deposited was scarcely perceptible, and in it a few monads, vibriones, and sporules of fungus only were discovered." "The results obtainable from a chemical examination of these same waters, supplied by me in 1854, to Dr. R. D. Thompson, who kindly undertook the analyses, will be best understood by a table contrasting their Impurities with those of other waters of the metropolis examined in the same year. Table exhibiting the Degrees or Grains per Gallon of Impurity of certain Metropolitan Well Waters—Distilled water being taken as 0. Date. Situation of Wells. Total Impurity in Degrees or Total Residue Grains, Organic Matter, and Nitric Acid. January 18, 1854 Aldgate pump 49°10 13°94 February, 1854 Ditto 44.64 6.30 March, 1854 St. Thomas's pump 89.70 10.40 May 15, 1854 Camberwell 62.07 10.69 November 25, 1854. Ditto 48.72 7.26 July 20, 1854 Blackheath 28.00 92. 06 7.80 „ Buckingham Palace 59.00 8.08 „ Charing Cross Artesian well, supplied at Buckingham Palace 56.04 2.12 November, 1854 Putney, Cock's Buildings 180.40 16.00 „ Price's Folly 101.30 14.00 „ „ Stratford Grove 67.20 14.80 "By a mere glance at this table it will be readily conceded that I had no slight grounds for adhering to the opinion I formed several years ago, that the exceeding'y impure water of Cock's Buildings, Price's Folly, and other places, had much to do, if not with the production, certainly with the aggravation of many of the cases of cholera which fell under my notice at that period amongst the inhabitants of these cesspool-polluted neighbourhoods. "Several cases of cholera of the severest character occurred in both the above named localities, as well in 1848-9 as in 1854." It will be observed that the notorious Broad Street well yielded water in 1854 even more pure by several degrees than that pumped from Cock's Buildings and Price's Folly in Putney, and from Spencer's Court, Martin's Buildings, and other places in Wandsworth. It is true many of the surface wells in both Wandsworth and Putney have been closed since the above-named examinations took place, but they still exist in sufficient numbers throughout the District to cause much mischief. The Medical Officers of Health consider that they would fail in their duty did they not strongly urge the recommendation to close all surface wells, upon the consideration of the authorities and inhabitants generally, and they trust these supplemental remarks will not be considered out of place at a crisis like the present. August, 1866.