WAN 18 SANITARY DEPARTMENT. REPORT ON THE SANITARY CONDITION OF THE SEVERAL PARISHES COMPRISED IN THE WANDSWORTH DISTRICT, DURING THE YEAR 1866. By the Medical Officers of Health. LONDON: JOHN SMITH AND CO., LONG ACRE, W.C. 1867. 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 .. .. .. .. .. 11 4. „ on the Sub-District of Clapham, by Mr. J. MacDonogh .. .. .. .. .. 20 5. „ on the Sub-District of Battersea, by Dr. W. Connor .. .. .. .. . .. 29 6. ,, on the Sub District of Streatham, by Dr. D. C. Noël .. .. .. .. .. .. 35 7. „ on the Sub-District of Putney, by Dr. R. H. Whiteman .. .. .. .. .. 41 8. Appendix of Statistical Tables, &c. .. .. .. 53 REPORT, 1866. To the Board of Works for the Wandsworth District. Gentlemen, The eleventh year of our exertions under the Metropolis Local Management Act having expired, it again becomes our duty to furnish such statistical and other information which our individual experiences have put us in possession of, in order to determine the present sanitary condition of our respective Sub-districts, and of the entire District. Although a rate of mortality considerably above the average of the previous ten years has to be reported for 1866, it is satisfactory to find that the vigorous resistance which it was necessary to offer to the epidemic of that year, has led to an unusual amount of sanitation being effected throughout the District, and we are not without hope, that if such sanitation be well sustained, the exertions referred to will show results in the future of a very satisfactory character. We desire individually and collectively to thank the members of the District Board, and our respective Local Committees, for the aid and support afforded us in the performance of our duties during the prevalence of the epidemic. We have the honor to be, Gentlemen, Your very obedient Servants, The Medical Officers of Health of the Wandsworth District. 4 SANITARY CONDITION OF THE ENTIRE DISTRICT. A comparison of the local and general tables of mortality in the present with those in former reports, puts us in possession of the unsatisfactory circumstance of a large increase of mortality having befallen the District in 1866, due almost entirely to the prevalence and fatality of Zymotic diseases, especially of Cholera and Diarrhœa. The excess of deaths from the principal diseases of the Zymotic class over the number recorded in 1865, is 90, (see Table IV., Appendix,) and the ratio of deaths from these epidemics to the total deaths from all causes is 21.3 per cent., corresponding as nearly as possible with the per centage of 1859, but still being less than in 1863, when the ratio was 29.9 per cent. The population of the entire Wandsworth District for 1866 has been variously estimated, but that given by the Registrar General is 82,979. The death rate of the year (the deaths being 2,072) is therefore 24.97 per 1,000 persons living. It is satisfactory to note, that high as this rate appears to be, it is lower by 3 than the average of 13 of the largest towns in the United Kingdom. The birth rate per 1,000 is found to have been 37.12, and the rate of natural increase 10.54 per 1,000 of the entire population. REPORT ON THE SANITARY CONDITION OF THE SEVERAL PARISHES COMPRISED IN THE WANDSWORTH DISTRICT. 1866. Erratum at Page 4, Paragraph 3. Since the issue of the above Report, an error has been discovered in the calculation of the death-rate of the entire District which, it is considered, necessitates the following brief explanation:— The calculation referred to is that of the Registrar General, and was taken from a Table at page 18 of his last Annual Summary, and accepted, unquestioned, by the Medical Officers of Health. The error consists in 26.58 per 1,000 persons living being given as the death-rate of the entire District in the place of 24.97 per 1,000, the true result of the figures employed. Assuming, however, as a fair basis of calculation that the population of the entire District has increased in the same ratio since the period of the last census as it had done during the preceding ten years, the death-rate of 1866 was 249.97 per 10,000, or in round numbers 25 per 1,000 persons living. But it should be observed that as the population has so disproportionally increased by the influx of new residents since the period of the last census, the foregoing estimate must be accepted as greatly above that which the Medical Officers of Health, from their local knowledge of the extent of immigration in their respective Sub-Districts, believe to be correct. Septr. 13th, 1867. 5 The following Table will show the relative position held by the entire Wandsworth District among the South Districts, in respect to deaths from Cholera and Diarrhœa, as well as the rate of mortality per 10,000 from these diseases, compared with that of the several Districts referred to. SOUTH DISTRICTS. Estimated Population in 1866 DEATHS IN 1866. RATE OF MORTALITY per 10,000 in 1866. Cholera Diarrhœa Cholera and Diarrhœa Cholera Diarrhœa Cholera and Diarrhœa St. Saviour, Southwark 36,422 32 38 70 7.4 107 18.1 St. Olive, Southwark 18,914 20 19 39 8.5 10.0 18.5 St. George, Southwark 57,498 38 47 85 6.6 8.2 14.8 Rotherhithe 28,767 25 17 42 8.7 5.9 14.6 Bermondsey 64,310 34 82 116 5.3 12.8 18.1 Newington 92,680 26 53 79 2.8 5.7 8.5 Lambeth 174,904 114 180 294 6.5 10.3 16.8 Camberwell 81,818 46 68 114 5.6 8.3 13.9 Wandsworth 82,979 40 67 107 4.8 8.1 12.9 All London 337,991 5,577 3,184 8,761 18.4 10.5 29.9 It will be seen that the death rate from actual Cholera in the entire Wandsworth District was 4.8 per 10,000 in 1866. With the exception of Newington, which had a death-rate from Cholera of only 2.8 per 10,000, this District exhibited a rate much lower than any other of the South Districts. Compared with all London (18.4 per 10,000,) it will appear quite insignificant. Sanitation.—A vigorous prosecution of every suggested means of arresting the progress of the late epidemic marked the entire period of its invasion of this District, and a 6 reference to Table VI. in the Appendix will fully indicate the extent to which the cleansing and other sanitary operations were carried out in each of the Sub-districts. Seeing how great is the liability of a return of Cholera, the Medical Officers of Health consider they would ill perform their duty did they not strongly urge a continuance of efforts in the same direction.* Upon the first appearance of Cholera, and of its usual precursor, Diarrhœa, in this District, the Board of Works promptly assembled to consider the best means of meeting the emergency. The issue of an Order in Council, bearing date 21st July, 1866, having all the force of law within the Metropolitan area, threw a large amount of responsibility upon local authorities and their Medical Officers of Health, and accordingly proceedings were at once initiated in this District, of a character calculated to meet every requirement of that Order. Advantage was of course taken of the existing machinery of the Local Committees to organise, through them, an efficient system of local medical treatment, to cause a house to house visitation, by duly authorised Inspectors, to be made, and a thorough cleansing of the respective Subdistricts to be promptly undertaken. *Since this Report was prepared for the press, a Supplement to the "London Gazette,"(July 12th, 1867),has been published, containing various orders of the Privy Council, relative to the Acts for the prevention of Diseases. They continue in force for another six calendar months. "The Diseases Prevention Act, 1855," and the relative Act, 23rd and 24th Victoria, cap. 77; they also specify regulations for Boards and Vestries as to what shall be done when cholera is in a union, parish, or district, and renew for six mouths an order of January 10th, 1867, relative to vessels infected with dangerous or infectious diseases. The Authorities therefore, throughout the Metropolis, will be fully justified in continuing their precautionary measures, and in well sustaining those already carried into effect. 7 During the prevalence of the disease, disinfectants were liberally supplied, arrangements made for the destruction of infected clothing, bedding, &c., and every care taken to secure to the sick all requisite attendance, nursing, and medical comforts. The district authorities, and through them Her Majesty's Privy Council, were kept constantly informed by the Medical Officers of Health of the progress of the disease and of its fatality; placards, handbills, and admonitory notices, were freely distributed; the public were made duly acquainted with all special arrangements and regulations for the treatment of the sick, and the disposal of the dead; and, in short, without creating any undue alarm, every possible precaution was taken to prevent the spread of the infection. That these measures were productive of great good, there is no reason whatever to doubt, and looking at the small resulting fatality, compared with what it had been in some former years of Cholera, it is believed no better regulations than those here detailed, to avert the consequences of so great a calamity, could have been adopted, or carried out by the Committees and their executive officers with greater effect. The Medical Officers of Health have, however, still to deplore the defective arrangements for the due supply of water for domestic and other purposes. In the treatment of the late epidemic, it became manifest to every one concerned, that no measure of improvement was more needed than the supply of this necessary of life, upon what is called the constant service principle; and it is still believed that no other system of supply is calculated in so great a 8 degree to arrest the progress of any future epidemic, and to preserve the health of the people at large. The overcrowding of the dwellings of the poor, is also a subject the Health Officers consider should never cease to occupy the serious attention of all large communities. The erection of mansions, villas, and high class residences in such numbers as is now being done throughout the District, without a corresponding effort to supply suitable domiciles for the rapidly increasing poor, is a policy, it is thought, that cannot fail sooner or later, to tell most prejudicially upon every section of the population. It is therefore to this subject the Medical Officers of Health desire to invite the special attention of all capitalists and philanthropists resident in the District. For their individual opinions upon this, and other questions of equal importance to the sanitary welfare of the District, the Health Officers must refer their readers to the local summaries which follow. LOCAL SUMMARIES. WANDSWORTH. The health of this Sub-district, in common with the rest of the Metropolis, suffered during the past year from the effects of a severe epidemic of Diarrhœa, and its worst form, Cholera. It nevertheless enjoyed great immunity in comparison with most of the other metropolitan districts. As might be anticipated, therefore, an examination of the following statistics of mortality discloses a much higher death-rate than usual. Statistics of Mortality, &c.—The total deaths which were registered as having occurred in this Sub-district during the year 1866, numbered 351. 176 were of males, and 175 of females. 84 occurred in the following public institutions; viz., in the Surrey County Lunatic Asylum, 61; in the House of Correction, 7; in St. Peter's Hospital, 5; in the Royal Patriotic Asylums, 4; and in the Hospital for Incurables, 7. 18 deaths of Wandsworth Parishioners took place in the Union Workhouse, Battersea. The death-rate for the past year determined from the total deaths which occurred and an estimated population, (due correction having been made for deaths in public institutions, &c., after the manner described in previous reports,) was 19.80 per 1,000 persons living — an unusually high rate for this locality, the average rate of the preceding ten years having been under 18 per 1000. In order to avoid the employment of an exaggerated datum, these calculations are based upon the assumption that the population has increased since the period of the last census in the same proportion as it had done during the preceding ten years. There can be no doubt, however, that in consequence of the greatly disproportionate increase which the population has acquired by immigration, the death rate may be fairly assumed to be less than that determined in the manner described. Birth rate.—The births registered during the year numbered 476, 239 of males, and 237 of females. The birth rate was high, namely, 31.85 per 1000 persons living of all ages, and the rate of natural increase 12.05 per 1000. 12 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, Ac., 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:- Small Pox 3 1 2 1 1 ... 2 1 ... ... ... ... ... ... 3 Measles 23 10 13 5 16 2 23 ... ... ... ... 7 ... 5 17 Scarlatina 10 3 7 2 4 3 9 1 ... ... ... ... ... 1 9 Diphtheria 2 ... 2 ... ... 1 1 1 ... ... ... ... ... 1 1 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 3 2 1 1 2 ... 3 ... ... ... ... ... ... ... 3 Whooping Cough 5 5 ... 5 1 ... 5 ... ... ... ... ... 1 ... 4 Zymotic Fever 5 1 4 ... 2 ... 2 1 ... 2 ... ... ... 2 3 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Metria, Childbirth 2 ... 2 ... ... ... ... 2 ... ... ... ... ... ... 2 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 18 8 10 12 4 ... 17 ... ... 1 ... 1 ... 2 15 Cholera 7 1 6 ... 1 ... 3 3 ... 1 ... ... ... ... 7 Totals of Zymotic Class 78 31 47 26 31 6 65 9 ... 4 ... 2 1 11 64 2 Tubercular 55 32 23 7 8 ... 21 22 7 5 ... 2 2 8 43 3 Of Brain, Nerves, &c. 56 41 15 3 1 ... 6 21 19 10 ... 4 2 8 42 4 Of the Heart, &c. 19 9 10 2 ... ... 3 5 4 6 1 1 1 4 13 5 Of Respiratory Organs 57 29 28 20 9 1 30 7 10 9 1 1 3 2 51 6 Of Digestive Organs 20 5 15 5 ... ... 6 1 3 10 ... ... ... 2 18 7 Of the Kidneys 4 4 ... ... ... ... ... ... 2 2 ... ... ... 2 2 8 Of the Uterus 5 ... 5 ... ... ... ... 1 2 2 ... ... ... 1 4 9 Of Joints, Bones, &c. 3 ... 3 ... ... ... ... ... 1 2 ... 1 ... ... 2 10 Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Premature Birth, Low Vitality, formation, &c. 22 9 13 22 ... ... 22 ... ... ... ... ... ... 4 18 12 Of Uncertain Seat 12 2 10 ... ... ... ... 1 7 4 ... 1 ... 3 8 13 Age 11 6 5 ... ... ... ... ... ... 6 5 3 ... 3 5 14 Violence 9 8 1 2 2 ... 5 2 2 ... ... ... ... 1 8 15 Not Specified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 351 176 175 87 51 7 158 69 57 60 7 15 9 49 278 13 The most noticeable thing in this Table, especially by the Sanitarian, is the great numerical preponderance of diseases of the Zymotic class (Epidemic, Endemic, Contagious), which are seen to exceed all others in the causation of mortality, forming upwards of 22 per cent. of all deaths, and fully accounting for the excess of last year's death rate. Diseases of the Tubercular class, of the Brain and Nervous System, and of the Organs of Respiration, were of almost equal position, each causing about 16 per cent. Diseases of the Digestive Organs formed 5 per cent. Inflammation of the Lungs 8 per cent. The most fatal of any single disease, was, as usual, Phthisis, which caused upwards of 11 per cent. of all deaths. Age at death.—Upwards of 24 per cent. of all deaths took place under 1 year, and 39 per cent. under 5 years of age. This infant mortality is very considerably in excess of the average, resulting, as might be anticipated, from a greater prevalence of diseases which principally afflict children. These were Measles and Scarlet Fever, but especially the former, which prevailed epidemically, and to which the high per centage of mortality from inflammation of the lungs, is in a measure attributable, as one of its results. 45 per cent. of all deaths occurred under 20 years of age. Social position.—79 per cent. of the deaths from all causes, and 82 per cent. of the deaths from epidemic diseases, took place amongst the labouring classes. Inquests.—29 inquests were held during the year; 9 deaths resulted from accidental violence, 4 of which were from drowning and 1 from burning. In 12 instances the cause of death was not certified by medical testimony. These were so many instances, therefore, in which death may have resulted from other than natural causes, for which reason, as I have pointed out, in many previous reports, a medical investigation is imperatively needed in all cases of uncertified death. Prevalence and Fatality of Epidemic Diseases.—The deaths which have resulted from the principal Epidemic 14 diseases during the past and ten 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. Cholera. Diarrhœa. Fever— Typhus and Typhoid. Total Deaths from Epidemics. Total Deaths from all causes. entage of deaths from Epidemics to deaths from all causes. 1856 9 2 4 0 12 ... 4 12 43 314 13.6 1857 0 1 2 0 1 ... 14 11 29 248 11.2 1858 0 0 10 0 4 ... 1 7 22 289 7.6 1859 2 7 43 3 2 ... 3 0 60 311 19.2 1860 0 5 4 1 4 ... 4 4 22 308 7.1 1861 1 1 12 1 4 ... 8 3 30 246 12.1 1862 0 28 2 5 11 ... 5 11 62 273 22.7 1863 8 2 23 1 9 ... 6 13 62 300 20.6 1864 4 0 3 6 9 ... 8 13 43 311 13.8 1865 5 2 3 1 6 ... 19 18 54 338 15.9 1866 3 23 10 2 5 7 18 5 73 351 20.7 From this Table it is seen that the mortality from Epidemic diseases during the past year was 75 per cent. greater than the average, and its proportion to the deaths from all causes, nearly one-third greater than the average of the preceding 10 years. This excess was mainly due to Diarrhoea (including Cholera), which was 3½ times greater than a similar average, hut partly to a severe epidemic of Measles, which prevailed extensively throughout the year, and was almost as fatal as epidemic Diarrhœa. Scarlet Fever was also very prevalent and attended with considerable fatality. Sickness and Mortality amongst the Parochial Poor— Amount of General Sickness.—Table 5, Appendix, contains the amount, nature, and fatality of the sickness which came under treatment during the year. The rate of mortality was 3 per cent., which is the average of the past 10 year. No comparison of the amount with that of former years can be properly made, in consequence of the attendance on the sick poor during the Cholera epidemic, 15 having, by arrangement, been divided amongst four other Medical Practitioners; but an approximate estimate of the amount of sickness which prevailed generally throughout the parish, may be made by assuming the proportion which the deaths bear to the cases of sickness amongst the poor as the proportion which the deaths bear to the cases of sickness throughout the whole parish. This calculation (which can only err on the side farthest from exaggeration) places the total cases of sickness under treatment at 77 per cent. of the population. The similar estimate of the previous year was 58 per cent. Notwithstanding the very extensive prevalence of epidemic Diarrhœa of great severity, the fatality from actual Cholera is seen to have been comparatively slight. This result was doubtless in a great measure due to the prompt and energetic means adopted by the Local Committee of this Sub-district for preventing the spread of contagion, and for ensuring the earliest possible medical treatment to all persons suffering from the disease. Sanitary Proceedings.—A summary of the ordinary sanitary proceedings which were employed during the year, is contained in Table VI, in the Appendix. In addition to which, all the slaughter houses and cow houses were examined and specially reported on. In 9 instances nuisances of a special nature required magisterial interference for their removal. The advent of Cholera in the summer, also necessitated the adoption of many sanitary proceedings of a special and extraordinary character. These consisted of curative as well as preventive measures directed by Her Majesty's Privy Council, in an Order dated 21st July, to be employed for the suppression of the epidemic. They were carried out under the direction of the Local Committee of this Sub-district, who were empowered by the District Board to fulfil the instructions contained in the "Order in Council." Two additional Inspectors of Nuisances were also appointed by the Board. The following were the arrangements adopted; they 16 worked very satisfactorily and fully met every requirement. The Local Committee having invited the assistance and co-operation of all the qualified Medical Practitioners in the Sub-district appointed five of their number as "Medical Visitors." These undertook the treatment of all persons suffering from the epidemic who might apply to them at any time by night or by day, and were authorized to order nurses, clothing, nourishment, stimulants, disinfectants, or anything requisite for such treatment. The Inspectors of Nuisances made house to house visitation, effected the removal of any existing nuisance, and directed the attention of the Medical Visitors to any cases of the disease they met with. They also furnished me with samples of any waters which appeared to them objectionable, and in this way I ascertained that a large quantity of unwholesome well water was still extensively used. They supplied disinfectants from a depôt in the centre of the town to all applicants needing them. Placards containing the names and addresses of the Medical Visitors and of the Inspectors of Nuisances, were extensively posted, informing the public of the arrangements made, and how assistance was to be obtained. On the occurrence of a death from the epidemic, the corpse was placed in a coffin and surrounded with sawdust, and disinfectants, and removed to the Engine-house on the Plain (temporarily converted into a dead-house), from which interment was effected as speedily as possible. Linen and blankets were immediately placed in disinfecting fluids, and the bed and bedding, if soiled, burnt. (In such last named cases, compensation was made to the owner according to a pre-determined value.) The rooms were then purified by lime-whiting and disinfectants. The relatives of the dead readily acquiesced in or forwarded these arrangements, with but one exception, in which case it became necessary to apply to the sitting magistrate for a forthwith order for interment. Application was made to the Vicar for permission to build a dead house in the burial ground in South Street, but unfortunately met with a refusal. In reference to this subject, 17 the following extract, from my Report, for 1859 shews the same great necessity which now exists for a building of the kind. "On the occurrence of death in the family of the "labouring man, want of space often inflicts upon him or "some of his family the necessity of dwelling and even "sleeping in the presence of the dead. It needs but the mind "to picture the room of death, as the one subservient to all "the purposes of domestic life, to realize the painful "incongruity of the circumstances. But there is stronger "cause for reflection. The presence of death from con"tagious disease under such circumstances becomes, there "is every reason to believe, a fruitful source for the "propagation of contagion. The most that the Medical "Officer of Health can at present do to obviate this evil "is, to endeavour to persuade the relatives of the dead to "procure as early an interment as possible. But such "advice is seldom acted upon, for the mind of every one "naturally revolts against any undue haste: moreover, "the coffin has to be made, and the convenience of the "undertaker and of others consulted. The remedy con"sists in the setting apart some small building, in a "convenient position, and as remote as possible from "dwellings, for the reception of those who have died under "the circumstances described, during the period inter"vening death and interment." On reference to Table VI in the Appendix, it is seen that a large amount of new sewers, and drains was constructed during the past year—work of great and lasting benefit. But a great sanitary defect, as was pointed out in my last annual report, remains to mar the present otherwise excellent system of drainage. I refer to the ventilation of the sewers by means of openings into the streets, and often in close proximity to houses. It is doubtless a very difficult thing to obviate, but its great importance demands that no efforts should be spared to find a remedy for it. There can be no doubt that a continuous and sufficiently abundant flow of water would, by preventing decomposition and by absorbing gases, reduce the necessity for ventilation to a minimum ; but such a flow cannot be obtained under the present system of supply, which is still intermittent b 18 and very irregular. In the autumn of last year, the Metropolitan Board of Works issued a circular letter, inviting an expression of opinion upon the system of Water supply to the Metropolis. The following embodies the remarks I then made, and which, on account of the great importance of the subject, I venture to repeat here. "I "would most strongly urge upon your notice the great "sanitary and economic benefits which would result from "a constant supply, and the consequent removal of the "necessity which at present exists for the use of cisterns, "butts, and other objectionable receptacles. The following "conditions also require consideration. Water for domestic "use is required for two distinct and very different purposes: "the one for dietetic, and the other for general sanitary "purposes, including drainage. The first—as shewn by "abundant evidence of the evil influence of impure water "in the Cholera epidemic of 1854, and of the present "year—must of necessity be of the purest quality. The "requirements of the second would be fulfilled by ordinary "unfiltered river water, or by sea water, and could be "supplied in unlimited quantity for public baths, foun"tains, the cleansing of streets, drainage, and all other "sanitary purposes. Under the present system the great "bulk of the water which has been purified by filtration "for drinking use, and representing much money, is lost "in being used for all other purposes than that for which "the expensive process of filtration is employed. As it is "necessary for the Water Companies to economize such "expensive water to the utmost, the result is a necessity "for storage in itself an unnecessary and expensive evil "to the consumer—and a stint in the general supply, "even to an insufficiency, for the purpose of drainage. "Looking to these conditions, it becomes a matter for "consideration whether a sufficient supply of the purest "water for drinking use only, could not be obtained from "the chalk strata by Artesian borings, the general supply "for drainage, and all other sanitary purposes being fur"nished by ordinary river water, or by sea water. In "the employment of such a system of distribution, a "necessity would exist for a double system of pipes, but "the expense of these would be amply compensated for 19 “by the removal of the entire cost of filtration." This Sub-district could be easily and economically supplied in the manner here indicated. It is at length gratifying to be able to record the suppression of that great nuisance to the town, the Gipsey Encampment by the Alma Road. At the end of April of the present year, the owner of the property on which the encampment lay, evicted the whole of the people dwelling there, under pressure of an order made by the sitting magistrate for the abatement of the nuisance. GEORGE EDWARD NICHOLAS, M.D., Medical Officer of Health for Wandsworth. 20 CLAPHAM. Upon the table with which I have usually commenced my annual report, but few comments need be offered, but I would beg to draw attention for a moment to the unusual number of marriages appearing in the register during the year 1866. Although these marriages somewhat fluctuate in number for a few years between 1856 and 1859, the remainder of the table exhibits a very gradual increase from the year last named down to the present time, when it will be seen that the number rather more than doubles that of 1856, showing most incontestably the progressively prosperous condition of the locality, conducing by the abundance of food and no want of employment to the marriages referred to. MARRIAGES, BIRTHS, AND DEATHS. Years 1856 1857 1858 1859 1860 1861 1862 1863 1864 1865 1866 Marriages 154 151 150 156 183 182 175 181 227 221 310 Births 527 550 533 594 608 624 622 685 640 707 711 Deaths 286 321 344 328 429 390 343 355 408 393 425 Excess of Births over Deaths 241 229 189 266 179 234 279 330 232 314 286 In this table is shown that a continuous increase in the number of births has also taken place since 1856, and that it has been unusually large in both the past years, 1865 and 1866, thus affording another indication of the general prosperous condition of the inhabitants. Statistics of Mortality.—With so large an increase of population as must have taken place within the last few years, it is but reasonable to expect a corresponding annual increase in the number of deaths. The increase of the past year over the rate of the 21 ceding one (1865) is 32, a somewhat large excess it is true; but still, taking into consideration the recent epidemic, the very variable temperature of the summer months, and the excessive cold of a greater portion of the winter of 1866, it can hardly excite surprise that such an exceptional year should give rise to an exceptional mortality. The deaths registered in the sub-district during 1866, were 425—males 183, females 242—thus showing an excess, rather unusual, on the side of the female sex, of 59. In 1865 the excess was on the male side by 7 deaths. The births in the year were 711—males 343, females 368—the females thus exceeding the males by 25, but not by any means restoring the balance of the sexes, or the loss sustained by death on the female side, in the same year. The excess of births over deaths is 286, which of course gives the natural increase of the population of the year. What the average yearly increase by immigration may have been for the last six years, it is not possible to exactly determine, nor can it be accurately ascertained until after another census. Taking into account, however, the number of new houses that have been finished and occupied during even the last twelve months, it may, I think, be fairly assumed, without any fear of exaggeration, that the increase of the past year by new residents is quite,equal to the natural increase. Upon this calculation then, the inhabitants of this Subdistrict in 1866, I calculate, could not have fallen very far short of 24,500. The deaths during the year having been 425, it follows that the mortuary rate must have been as near as possible 18 per 1000 living; but this, considering the past year was marked by the prevalence of much choleraic disease, and by an unusual amount of sickness from pulmonary and tubercular maladies, is not so high as might have been reasonably anticipated. In the table which follows will be found a succinct record of the classified causes of all deaths that occurred within the parish in 1866, with the age, sex, and social position of the deceased persons:— 22 CLAPHAM. Population in 1861—20,894. Area in Acres—1,233. Total Deaths from each Class of Disease, &c., in the Sub-District. Sex Age Social Position Males Females Under 1 year 1 From 1 to 5 years From 5 to 10 years 1 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 DISEASES And other Causes of Death Classes:— Small Pox. 10 8 2 5 4 1 10 ... ... ... ... ... ... ... 10 Measles 18 7 11 4 11 1 17 1 ... ... ... ... ... 2 16 Scarlatina 6 2 4 ... 2 4 6 ... ... ... ... ... ... ... 6 Diphtheria. 5 3 2 ... 2 1 4 1 ... ... ... ... 1 2 2 Quinsy 1 1 ... 1 ... ... 1 ... ... ... ... ... ... ... 1 Croup Whooping 7 5 2 ... 7 ... 7 ... ... ... ... ... ... ... 1 Cough 14 10 4 4 9 ... 13 1 ... ... ... ... ... 4 10 1. Zymotic Typhus, &c. 16 7 9 1 4 ... 8 3 3 2 ... ... 3 4 9 Erysipelas. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Metria, Childbirth 2 ... 2 ... ... ... ... 2 ... ... ... ... ... 1 1 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza Diarrhœa & ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 13 5 8 9 2 1 12 ... ... 1 ... ... 1 4 8 Cholera 4 3 1 ... 2 1 3 ... 1 ... ... ... ... 1 3 Totals of Zymotic Class 96 51 45 24 43 9 81 8 4 3 ... ... 5 19 72 2. Tubercular 57 26 31 4 3 1 13 24 18 2 ... ... 2 22 33 3. Of Brain, Nerves, &c. 36 20 16 8 3 1 14 6 6 9 1 ... 3 12 21 4. Of the Heart, &c. 26 10 16 1 ... ... 2 1 7 16 ... ... ... 14 12 5. Of Respiratory Organs 73 25 48 23 14 1 38 4 12 19 ... ... 2 22 49 6. Of Digestive Organs 15 4 11 4 4 ... 8 1 3 3 ... ... 2 2 11 7. Of Urinary Organs 4 4 ... ... 1 ... 1 ... 2 1 ... ... ... 1 3 8. Of Organs of Generation 4 ... 4 ... ... ... ... ... 3 1 ... ... ... 1 3 9. Of Joints, Bones, &c. 4 1 3 1 1 1 2 2 2 10. Of Skin 3 1 2 2 1 ... ... ... ... ... 1 ... 2 11. Premature Birth, Low Vitality, Malformation, &c. 40 15 25 34 6 ... 40 ... ... ... ... ... 4 3 33 12. Of Uncertain Seat 3 1 2 1 ... ... 1 ... 2 ... ... ... 1 ... 2 13. Age 35 10 25 ... ... ... ... ... 1 18 16 ... 5 12 18 14. Violence 12 7 5 4 ... 2 7 1 ... 4 ... ... ... 3 9 15. Not Specified 17 8 9 3 2 1 6 2 6 3 ... ... 2 5 10 Totals 425 183 242 109 77 15 215 47 65 81 17 ... 27 118 280 23 Ages at Death—Social Position of the Deceased, &c.— The mortality amongst children, it will be seen, has exceeded that of 1865 by 22 deaths, the respective numbers of deaths between birth and 10 years of age having been in the two years 179 and 201. It will be seen, however, that most of the deaths due to Zymotic diseases were of very young children, amounting to the large number of 81 under 10 years of age. The table also exhibits a rather unusual circumstance, namely, that of the persons who succumbed to the late epidemic, whether of Cholera or Diarrhœa, only 2 adults, one between 40 and 60, and the other between 60 and 80 years of age, are to be found on the register of the year I am speaking of. At the opposite extreme of life, the number registered as having sunk from pure infirmity of age, without the mention of any other important cause tending to shorten existence, was 35, or one more than was recorded in 1865. Of those who died between 60 and 90 years, of some well marked disease, and whose deaths were so certified by their medical attendants, there are recorded as many as 63, thus making up in the aggregate a somewhat large mortality of persons in advanced life. A winter so severe and changeable as was that of 1866, has seldom been witnessed, and, as a consequence, many elderly persons succumbed to bronchial and lung affections, of an intensity which a milder season would not have rendered nearly so distressing, or so fatal. The social positions of the persons whose deaths are recorded in the register of 1866, are thus defined:—280 industrial or labouring class, 118 middle or trading class, 27 professional or merchant class, but not one of the nobility, by reason perhaps of their not being resident in this Sub-district in sufficient numbers to influence the death rate to any appreciable extent. Seeing how greatly the working classes outnumber the other sections of the community, and that they nearly double the other classes combined, it can hardly be expected that other than a very high death rate amongst them must always mark the mortuary records of this densely populated town. 24 It is not however very satisfactory to find that the deaths from Zymotic diseases, amongst the class I am speaking of, more than double those of the other classes combined, and this in the proportion of 72 to 24 in the register of the past year. The cause of this disparity of numbers must be obvious enough, but it is to be regretted notwithstanding, and should certainly urge us to increased exertions in the promotion of all those sanitary proceedings that are likely, in the slightest degree, to improve the moral and social status of the industrious poor. Zymotic Diseases, their prevalence and fatality.—The following table will show at a glance the epidemic maladies that have proved fatal in this parish during the year, as well as the relative numbers of deaths from each classified cause in eleven years, from 1856 to 1866. Years. 1856 1857 1858 1859 1860 1861 1862 1863 1864 1865 1866 Small-pox. 1 0 1 9 6 6 1 11 3 7 10 Measles 14 2 14 2 20 0 6 24 12 7 18 Scarlatina. 9 8 25 26 24 22 13 28 11 11 6 Diphtheria 0 0 0 0 9 13 3 1 2 4 5 Whoopingcough 4 13 13 6 21 14 14 9 10 15 14 Typhus 4 7 11 12 6 5 8 6 14 11 16 Diarrhœa 4 27 16 11 5 11 7 16 11 20 17* Totals 36 57 80 66 91 76 52 95 63 75 82 * The 17 deaths here recorded comprehend the 4 deaths from Cholera that took place during the year. It will be seen that Small-pox still holds a prominent place, in respect to numbers, in this table, and that 10 deaths are recorded as being due to this disease, which is three more than were recorded in the register of 1865. The deaths from Measles have also increased from 7 to 18, 25 Fever from 11 to 16; but it is somewhat remarkable that the deaths from Diarrhœa, notwithstanding the Cholera visitation of the past year, have diminished, the relative numbers in the two years being 20 in 1865, and only 13 in 1866, making a difference of 7 in favour of the cholera year. With regard to Small-pox, I can only repeat the observation made in my last report, to the effect, that the scepticism of thoughtless and unreflecting persons still proves as great a drawback as ever to the proper employment of vaccination. I may here mention, that although the births of 711 children were registered in the Sub-district in 1866, the parents of 274 only sought the performance of the operation at my hands, as the Public Vaccinator, in that year, and even of these 22 were re-vaccinations, and as many as 30 first vaccinations of persons varying in age from 2 to 16 years, many of the latter having been doubtless frightened into a compliance with the law by hearing of, or witnessing, the sufferings of their relatives, friends, or neighbours, ill of the disease. The deaths from Fever in 1866 have been more numerous than in any of the previous 10 years referred to in the table, and this may possibly be owing, as suggested by one of my colleagues, to the generation of some peculiar miasma by a combination of influences in active operation whilst new sewers and drains are being constructed on a large scale. This theory is rendered all the more probable by the fact that in Putney, on the completion of the town portion of the great intercepting sewer and its contributary drainage, the deaths from Fever fell from 8 in the year 1865 to one only in 1866, and further, that the number of cases of this malady treated amongst the union poor fell from 29 in 1866 to none in the year under review, which is a very remarkable circumstance. I look forward with strong hopes of being able, at no distant day, to report a similar result in my own Sub-district upon the completion of the remaining portion of the drainage, which the authorities have wisely resolved to carry out in connection with the great intercepting sewer. 26 I cannot conclude this part of my report without saying a few words upon the invasion of this Sub-district by Cholera and Diarrhœa during a portion of the past year. I have already referred to the fact that the deaths due to Diarrhœa (most of the cases of which were of a choleraic character) were less numerous than in 1865. Of actual Cholera, 4 persons are recorded as having died during the year in this parish, 3 of the deaths being of children under 10, and 1 of an adult between 40 and 60 years of age. The number of cases of both Cholera and Choleraic Diarrhoea treated, during the prevalence of the epidemic in this Sub-district, was not perhaps so large as in some of the previous cholera years; but there are recorded in the Medical Relief Book, amongst the poor alone, the treatment in 1866 of as many as 140 patients with Diarrhœa, and 31 with Cholera. I am pleased to report, however, that 5 only of this class of patients died of both forms of the epidemic, viz. 3 of Diarrhœa,, and 2 of Cholera. But for the prompt and efficient organization of a staff of Medical Visitors, the arrangements made for the treatment of bad cases, and the numerous precautions taken to prevent the spread of the infection, there is no reason to doubt but that the fears engendered by the presence of the disease would have been realized to a much greater extent than proved to be the case. I cannot suffer this opportunity to pass without expressing my satisfaction at the energy displayed by the able Surveyor of this Sub-district, as well as by the Sanitary Inspectors who were employed to assist in carrying out the Order in Council. There was indeed, an amount of co-operation among all the officials concerned that greatly added to the efficiency of the measures adopted, and my especial thanks are due alike to all who were concerned with me in carrying out these measures. The question now is, would it not be a wise policy to be fully and always prepared to do effective battle with such a foe? My own opinion is that a thorough and well sustained system of scavengering, and a good and constant water supply are, of all the means in the power of the 27 Authorities to adopt, the most important to be considered in anticipation of a further outbreak, of which it is said there have been already some few indications abroad, as well as in portions of our great and ever-extending Metropolis. Sickness and Mortality among the out-door Union Poor. —Table V. in the appendix sufficiently indicates all that need be said upon this portion of my report. The proportion of deaths to cases treated was last year (1865) 43 in 1056. In the present table the deaths are 60 in 1115 cases treated. In neither year is the per centage large, or by any means unusual. Accidental, Sudden, and Suspicious Deaths—Inquests.— To the comments I have offered upon this subject in former reports I have little to add, further than to state that 19 Coroner's Inquests were held in the parish during 1866, on the bodies of persons of various ages dying suddenly, by accident, or under circumstances of more or less suspicion, and that in many of these cases the inquiries were conducted and verdicts arrived at with the same indifference as formerly to medical evidence, or to that testimony which one would imagine could alone meet the requirements of the Registration Act, and, as a consequence, contribute to the prevention of crime. Sanitation during the Year.—The table No. VI. in the appendix requires perhaps less comment than any other, whether local or general, that has been inserted in this report. It is replete with such information that cannot fail to impress everyone who may consult it with the conviction that there has been no lack of energy on the part of the authorities in this or any other Sub-district, in endeavouring to accomplish as many of those reforms as possible, which the legal powers deputed to them will enable them to prosecute, and which modern science has shown us to be both practicable and necessary as a means of rendering ourselves more healthy. Besides the sanitation referred to in the Table, which has been unusually extensive during the past year, it is fit I should state that all the 28 Slaughterhouses and Cowhouses, as well as the Bakehouses within the parish, were duly inspected by the Surveyor and myself, and that being found to be in possession of every requirement insisted upon by the law, were so reported to the authorities, and, as a consequence, the proprietors of all such premises as required to be licensed by the magistrates, had such licenses renewed without opposition. JOHN MacDONOGH, Medical Officer of Health for Clapham. 29 BATTERSEA. The following is a brief summary of the sanitary events of 1866, together with the usual and necessary statistics by which to judge of the condition of the public health of the Sub-district in the year referred to. The year 1866 was marked by the prevalence in this locality of a large amount of disease, still, I am happy to say that the deathrate has been 4 in 1000 living, less than in the previous year. It must be recollected, that Battersea is very peculiarly circumstanced; first, in having become a very large manufacturing district, and, secondly, in having a labouring population daily and hourly enlarging, not only by natural increase, but by immigration, to an extent that would be hardly credited did not the parochial records fully bear out the assertion. The present population of the parish is variously estimated. By many, the number of inhabitants is considered to quite double that of the last census taken in 1861, and there are those who go even beyond this, and who, basing their calculations upon the number of houses erected within the last few years, and inhabited for the most part almost as soon as erected, assert that the number of inhabitants must largely exceed the above estimate. In the table that follows will be found as usual a record of the number of deaths under every classified cause, as well as the sex, ages, and social positions of the deceased persons. 30 STATISTICS OF MORTALITY. BATTERSEA. Population in 1961—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 Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. DISEASES, And other Causes of Death. Classes— Small Pox 20 15 5 19 4 1 18 1 1 ... ... ... ... 1 19 Measles 50 24 26 10 39 1 50 ... ... ... ... ... 1 7 42 Searlatina 26 10 16 1 17 8 26 ... ... ... ... ... 2 9 15 Diphtheria 14 6 8 2 6 3 12 2 ... ... ... ... ... 5 9 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 14 9 5 1 11 2 14 ... ... ... ... ... 1 1 12 Cough 51 22 29 13 34 4 51 ... ... ... ... ... 3 14 34 1. Zymotic Typhus and Infantile Fever 30 14 16 1 10 5 17 5 7 1 ... ... 3 3 24 Erysipelas 2 1 1 ... ... ... ... 1 ... 1 ... ... ... ... 2 Metria, Childbirth 8 ... 8 ... ... ... ... 7 1 ... ... ... ... 3 5 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 31 16 15 23 5 ... 28 ... ... 3 ... ... 1 5 25 Cholera 22 16 6 7 3 3 13 1 8 ... ... ... ... 5 17 Totals of Zymotic Class 268 133 135 70 129 27 229 17 17 5 ... ... 11 53 204 2. Tubercular 186 122 64 59 34 4 108 44 29 4 1 ... 3 65 118 3. Of Brain, Nerves, &c. 151 75 76 52 37 3 92 10 15 27 7 2 6 51 92 4. Of the Heart, &c. 45 28 17 ... ... 2 2 8 16 19 ... ... 4 15 26 5. Of Respiratory Organs 143 75 68 60 41 6 107 6 9 16 5 ... 9 39 95 6. Of Digestive Organs 27 11 16 6 3 ... 9 5 5 8 ... ... 5 10 12 7. Of Urinary Organs 8 6 2 ... 1 ... 2 3 3 ... ... ... 2 3 3 8. Of Organs of ration 13 1 12 2 ... ... 2 5 3 3 ... 1 1 2 9 9. Of Joints, Bones, &c. 7 4 3 1 2 1 5 ... 2 ... ... ... 1 1 5 10. Of Skin 11 8 3 6 ... ... 6 1 2 2 ... 1 ... 3 7 11. Premature Birth. Low Vitality, Malformation, &c. 47 24 23 47 ... ... 4 ... ... ... ... 1 4 14 28 12. Of Uncertain Seat 13 5 8 ... ... ... ... 4 5 4 ... ... 3 2 8 13. Age 43 13 30 ... ... ... ... ... 2 19 22 2 2 11 23 14. Violence 32 24 8 2 1 3 12 8 10 2 ... ... 1 6 25 15. Not Specified 8 2 6 1 ... ... 1 1 3 3 ... ... ... ... 8 Totals 1002 531 471 306 248 46 622 112 121 112 35 7 52 275 668 31 Number of Births and Deaths, Hate of Mortality &c.— The deaths registered in the past year, it will be seen, numbered 1,002. Males, 531; females, 471. As many as 137 of these deaths occurred in the Union Workhouse situated in this parish, but 93 of which were of persons not belonging to the parish. If these be deducted from the general total, it will, of course, reduce the mortality proper to the parish to 909. The births during the same period were 1,386; males, 757, females, 629. The excess of births over the deaths proper to the parish is therefore 476, which last number gives the natural increase of the population. In view of these statistics, and assuming the population to have doubled itself since 1861, it would place the death rate at a fraction over 25 per 1,000 living.* For an exceptional year, especially so as regards the fatality of many of the worst diseases that could befall a population such as that of Battersea, this is not, perhaps, a higher rate than might have been reasonably anticipated, but certainly far too high at which to express any great amount of satisfaction. Zymotic Diseases.—Diseases of this class, it will be observed, hold a very prominent position in the table as regards the number of deaths. Small pox, it is true, furnished in the past year less deaths by 2 to the mortuary register than it did to that of 1865, and Scarlet Fever 13 less; but under all the other principal maladies of this class, the mortality is shewn to have been much greater than the average, and to have exceeded to a very considerable extent that of the previous year. In the aggregate, the deaths from the seven principal Zymotic * This assumption of the increase of population, and the consequent death-rate, is founded on some valuable and reliable statistics furnished by the Board's able Surveyor for Bat'ersea, Mr. Buckham—He fin's that since 1859, and down to the present time, 3,302 houses have been erected in the Parish. This gives an average for the 8 years of about 412 new houses per year, which for the six years from 1861 to 1866, inclusive, (and in the former of these years the Census gave 19,852 as the population) would amount to 2,572 houses. If, then, an average of 7 persons be taken as the inmates of each house, it would give the large number of 18,004 additional inhabitants from this source alone. Add to this a portion only of the natural increase for the six years, as shown by the excess of births over deaths, and the statement that the population has quite doubled itself since 1861, is fully borne out. 32 diseases in 1S66, will have been in excess of those of 1865 by as many as 66—the difference being more particularly observable under Measles, Diphtheria, Whooping Cough, and Choleraic disease. Mortality from ordinary diseases (not Zymotic) and other causes.—The above table also shews, that under almost every form of ordinary disease there was an excess of deaths in 1866 over the numbers registered in 1865. In the aggregate it will be found that the deaths during the past year due to the non-epidemic class of diseases exceeded those of the previous one by 130. The number dying of Tubercular Disease was likewise very great. From Pulmonary Phthisis alone there were as many as 84 deaths. The excess of deaths from all causes of the past over the previous year is 229. The deaths from violence and from causes apart from actual disease, numbered also a great many. There were 37 Coroner's Inquests held in the Sub-district during the past year, in six of which only were the deaths found to have been “natural." At the remaining 31 inquests, 6 persons were found to have been struck down by locomotives on the railways that intersect this parish, 8 received mortal injuries from falls and other accidents, 5 were accidentally drowned, 2 appear to have committed suicide by immersion in the water, 6 were found dead in the water and elsewhere, under circumstances of greater or less suspicion, 2 deaths were due to burns and scalds, 1 to want and privation, and in one case a verdict of manslaughter against some person or persons unknown was returned. Ages at Death, &c.—The mortality of young persons under 10 years of age has, I regret to report, considerably increased. Of the 1,002 deaths, as many as 600, or greatly more than one half, were of children varying in age from a few hours after birth to 10 years, a large number (206) being of infants who had not reached the first year of their existence. This great mortality amongst infants and children is very characteristic of a large labouring population, amongst 33 which class indifference to the domestic requirements of infancy, improvident and dirty habits, and overcrowding are always to be greatly deplored, but for which, it is acknowledged by all, to be very difficult to find a remedy that shall be very speedy in its operation, or very lasting in its effects. Amongst those who have succumbed to old age or natural decay (43) without the registration of any other causes of death, 2 appear in the table as bordering on 60, 19 between 60 and 80, and 22 over 80, the oldest person amongst the latter having reached his 94th year. The deaths of this aged person took place in the Union Workhouse, in which institution three others succumbed during the year at ages over 90, and a large number between 80 and 90. Sickness and Mortality amongst the Union Poor.—To ascertain the prevailing diseases amongst the out-door Union poor, as well as their fatality during the past year, Table V., Appendix, need only to be consulted, and it will be seen that the ratio of deaths to the cases treated is very small, being only 35 in 1,286. It will be seen however that amongst the labouring or industrial class generally (which in the table includes the Union poor), the deaths just exactly double those of the three other classes enumerated in the columns referring to social position, and this very pointedly indicates to what parts of the Sub-district sanitary proceedings should be more particularly directed. Sanitation during the year.—Referring to Table VI. in the Appendix, it will be scarcely necessary to point to the fact of the amount of sanitary work having been very considerable during the year, and the description of work of the greatest possible importance, especially in the matter of sewerage. As many as 2,649 inspections of houses and premises were made, resulting, it will be seen, in the cleansing and repair of 203 unwholesome houses, to the construction, in connection with the main sewer, of 637 drains, to the abolition of 105 cesspools, and to the supply of water to 1,247 houses. c 34 In the poorer localities during the prevalence of the late epidemic, many houses were white-limed, fumigated, and otherwise disinfected by the most approved means, and in some dirty and impoverished habitations, where Cholera and Small-pox had existed, the beds, bedding, and furniture were destroyed, and clean and more wholesome articles of domestic comfort and necessity substituted. This proceeding (as indeed were all the other proceedings of the Local Authorities to meet the emergency and carry out the Order in Council) I have reason to believe, was attended with the best results in arresting the spread of the infection. A large quantity of diseased meat and of food unfit for human consumption was seized and destroyed, and in some instances, a fine was inflicted on the vendors by the magistrate. The slaughter and cow houses throughout the Sub-district, I need hardly say, received the usual attention, and a report of their condition at the time of the application for, and the renewal of licenses, was made to the Board. I have only to add my often repeated opinion, that to secure satisfactory and lasting results from the sanitary proceedings resolved upon, or already put in force in this parish, the water supply on the constant system, as well as the scavengering and general improvement of those localities inhabited by the labouring classes, should occupy the constant and unremitting attention of the authorities. WM. CONNOR, Medical Officer of Health for the Sub-district of Batter sea. 35 STREATHAM, INCLUDING TOOTING AND BALHAM. For the eleventh time since the Local Management Act came into operation, a brief summary of the sanitary proceedings of this Sub-district, and of its hygienic condition, is submitted. The Mortuary Table accompanying each contribution to the Health Officer's annual report is so constructed as to afford an amount of information that renders any very lengthened comments upon it wholly unnecessary. It is fit, however, I should remark, that 1866, to a detail of the principal sanitary events in which year this report will be confined, was marked by a less satisfactory condition of the public health than has been noted as its average state for the previous ten years, a higher rate of mortality and an increased amount of sickness having characterised the entire period. In my last report I had the satisfaction of noting a much lower death-rate, one indeed below that of the preceding year by as many as 27 deaths. In the present report the table of mortality exhibits an increased rate over that of 1865 by 18 deaths. It is, however, in the number of deaths due to Zymotic diseases that this increase is most marked. There were in 1865 but 29 deaths registered from epidemic maladies. In the present table they are found to amount to 38, and this is far higher, if we except the year 1859 (when the number was also 38) than has been observed in any year since 1856, the year in which the Medical Officers of Health of the Wandsworth District commenced their duties. c 2 36 It is satisfactory to find that whilst there has been a decided increase of deaths over those registered in 1865, in respect to Small Pox, Whooping Cough, Croup, Fever and Choleraic Disease, there has been a considerable decrease in the mortality from Measles, Scarlatina, and Diphtheria during the past year. The deaths due to diseases of the Respiratory Organs are, I regret to say, just double those registered in 1865, the tables of the two reports exhibiting an increase from 20 in 1865 to 40 in the past year. There is some increase also in the deaths from Tubercular Disease, for to Phthisis alone 16 persons succumbed during 1866. I have before remarked that this Sub-district has been long noted for the longevity of its inhabitants; we accordingly find that 13 persons died in the past year of old age alone, several of whom were bordering on 80 years, and about an equal number over that age, one female having reached the advanced period of life of 100 years. Of the deaths of children, I regret to say I cannot report so favourably as I was enabled to do in 1865; for it will be seen by a reference to the following table that as many as 65 between birth and 10 years of age died in 1866, which is 18 above the mortality registered in the previous year. I must now refer to the table itself to show that many other note-worthy facts and circumstances may be gathered from it having no slight bearing upon the present sanitary condition of the Sub-district. 37 STATISTICS OF MORTALITY. STREATHAM, including TOOTING & BALHAM. Population in 1861—10,082. Area in Statute Acres—3,465 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 & Training Class, Shopmen, Clerks, &c. Industrial and Laboring Classes. DISEASES, And other Causes of Death Classes:— Small Pox 1 ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 1 Measles 3 1 2 ... 3 ... 3 ... ... ... ... ... ... ... 3 Scarlatina 6 4 2 ... 4 1 5 ... ... ... ... ... 1 1 4 Diphtheria 1 1 ... ... 1 ... 1 ... ... ... ... ... ... ... 1 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 2 1 1 ... ?. ... 2 ... ... ... ... ... ... ... 2 Whooping Cough 7 3 4 4 3 ... 7 ... ... ... ... ... ... 2 5 1. Zymotic Typhus and Infantile Fever 9 2 7 ... 2 1 6 1 ... 2 ... ... 2 4 3 Erysipelas Metria, ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Childbirth 2 ... 2 ... ... ... ... 2 ... ... ... ... 1 1 ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 5 3 2 1 2 ... 3 ... ... 2 ... ... ... 3 2 Cholera 2 ... 2 ... 2 ... 2 ... ... ... ... ... ... ... ... Totals of Zymotic Class 38 15 23 5 20 2 30 4 ... 4 ... ... 4 11 23 2. Tubercular 19 8 11 ... 1 1 2 10 6 1 ... ... 3 7 9 3. Of Brain, Nerves, &c. 14 8 6 1 2 1 4 1 4 5 ... 1 5 4 4 4. Of the Heart, &c. 10 2 8 ... ... ... ... ... 5 5 ... ... ... 6 4 5. Of Respiratory Or- gans 40 25 15 7 9 ... 16 5 3 14 2 ... 3 12 25 G. Of Digestive Organs 4 2 2 ... ... ... ... 1 2 1 ... ... ... 4 ... 7. Of Urinary Organs . 4 4 ... ... ... ... ... 1 1 1 1 ... ... 3 1 8. Of Organs of ration 1 ... 1 ... ... ... ... ... 1 ... ... ... ... 1 ... 9. Of Joints, Bones, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Mal formation, &c. 11 9 2 10 1 ... 11 ... ... ... ... ... 1 5 5 12. Of Uncertain Seat 12 3 9 1 1 ... 2 1 3 6 ... ... 1 6 5 13. Age 13 8 5 ... ... ... ... ... ... 6 7 ... 2 7 4 14. Violence 4 2 2 1 ... ... 1 1 1 ... 1 ... ... ... 4 15. Not Specified 3 1 2 2 ... ... 2 ... 1 ... ... ... ... 1 2 Totals 173 87 86 27 34 4 68 24 27 43 11 1 19 67 86 38 Increase of Population, Death Rate, &c.—There are good grounds for believing that the increase of the population of the parishes comprising this Sub-district has been very considerable since my last annual report was submitted. The excess of births over deaths for the past year is 110, and I calculate if only the same number is added for increase by immigration in the same period, it would place the population at about 11,300 for 1866. The registered deaths then being 173, or 22 only over the number of the preceding year, it follows that a very small increase in the per centage of deaths to population has to be noted. In my last report the death-rate was estimated at 13 per 1,000 persons living. Even allowing my present estimate of the number of inhabitants to be somewhat too large, which I do not think is the case, I consider it would be giving the widest possible margin for any such overestimate to put the death rate for 1866 at 15 per 1,000 living, and as it cannot possibly exceed that, I cannot avoid saying I think it most satisfactory to be enabled to keep our mortuary rate below that of many a rural locality which, with a rate of even 17 per 1,000, is looked upon as holding a high place amongst the model parishes of England. It is with much satisfaction also that I refer to the fact, as evidenced by the social position columns of the table of mortality, of the deaths occurring amongst the industrious or labouring classes in 1866 being less than those amongst the three classes above them. In most localities, in consequence no doubt of the poor being found in much larger numbers than in this Sub-district, the preponderance of deaths is greatly on the side of the working population. The Streatham Sub-district, however, presents in this respect a very marked exception. Sickness and Mortality amongst the Union Poor.—Table V., Appendix, exhibits both the number of cases treated, and the number of deaths that occurred during the year amongst the parish poor. It also shows the character of the diseases most prevalent amongst this class of persons. 39 Looking at the small proportion of deaths to cases treated, the Union Medical Officers may be fairly congratulated upon the success of their administrations. There were, it appears, 21 deaths in 211 cases. It is true this is rather beyond the average of the previous ten years, but still is no less favourable than was the ratio of the preceding year, when the number of deaths to cases treated was 16 in 183. During the prevalence of the Cholera epidemic, the poor of this Sub-district appear to have suffered but very slightly, at all events, the Medical Relief Books do not tell of any victims, amongst the pauper population, of either Diarrhoea or Cholera. I may here remark that every precaution was taken in this locality to prevent the spread of the disease, and that all the assistance it was in the power of the authorities to render the profession in their treatment of the epidemic, was liberally and willingly afforded. The Special Meeting of the Wandsworth Board of Works, to consider the Order in Council, took place on August 1st. The Vestry, or Local Committee, to whom the Board delegated its powers to act in the emergency, was called together shortly afterwards, viz., on the 6th August, when every arrangement was made, not only to put in force the law in respect to the removal and abatement of nuisances, but for the adoption of all other measures that seemed advisable under the circumstances, with what effect the statistics I have already referred to will show. The appointment of an Assistant Sanitary Inspector, who was very energetic in his work, was attended by the best results. Sanitation of the year.—I need only refer the reader to Table VI. in the Appendix to show that the amount of accomplished sanitary work was greater during 1866 than during any year since operations were commenced under the Act for the Better Management of the Metropolis, and that this Sub-district has been behind none of the others in the promotion cf improvements conducing to the health of the inhabitants. 40 I need hardly say that all premises requiring to be licensed for the slaughtering of cattle, and the keeping of cows underwent the usual examination, and were favourably reported on to the Board, and by the Board to the Licensing Magistrates. I trust the same energy that has hitherto characterized the proceedings of all concerned in carrying out the behests of the Legislature in respect to sanitation will be continued (as I have no doubt it will be), and that to the manifest advantage of this fast increasing suburb. D. C. NOËL, Medical Officer of Health for Streatham, Tooting, and Balham. 41 PUTNEY AND ROEHAMPTON. In the absence of any really available and universal record of sickness in strictly private medical practice, it is of course impossible to measure the exact amount of disease that has occurred within a given period in any locality, but there can be no doubt the intensity of such maladies as may have prevailed in any particular year can be determined with tolerable accuracy by considering them in connexion with their fatality. If this be done with due regard to the age, sex, and social position of every person dying within the Sub-district, the annual record will become all the more valuable as a means of determining many a question of sanitary and social policy that might otherwise escape consideration. The accompanying table of mortality, the form being the same as that employed in these reports for a number of years past, is so arranged as to afford all the requisite details of every death that has been registered within the parish in the 52 weeks comprising the year 1866. Another important feature of this form of table is the facility it affords for comparing the statistics of one period with those of another, and for determining also the correct averages for any given series of years. The table in other respects is valuable, particularly in furnishing reliable data upon which to calculate periodically the local mortuary rates, as well as each year to assist in ascertaining the proportion which the deaths bear to population, and the ratio of the mortality from Zymotic diseases to that from all causes. 42 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. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes DISEASES, And other causes of Death. Classes:— 1. Zymotic Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 8 3 5 1 6 1 8 ... ... ... ... ... ... ... 8 Scarlatina 1 ... 1 ... ... 1 1 ... ... ... ... ... ... 1 ... Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 1 ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 1 Whooping Cough 1 ... 1 ... 1 ... 1 ... ... ... ... ... ... 1 ... Typhus & Infantile Fever 1 ... 1 ... ... ... ... ... 1 ... ... ... ... 1 ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Metria, Childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 4 2 2 1 1 ... 2 1 ... 1 ... ... ... ... 4 Cholera 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 Totals of Zymotic Class 17 5 12 2 9 2 13 1 1 2 ... ... ... 3 14 2. Tubercular 17 11 6 2 3 ... 5 6 6 ... ... 1 3 3 10 3. Of Brain, Nerves, &c. 20 10 10 ... 5 ... 6 ... 6 8 ... 2 2 8 8 4. Of the Heart, &c. 7 3 4 ... ... ... ... 1 1 4 1 3 1 1 2 5. Of Respiratory Organs 21 10 11 3 4 ... 8 3 6 4 ... 1 3 5 12 6. Digestive Organs 8 4 4 ... 1 ... 2 1 2 3 ... ... 1 3 4 7. Urinary Organs 1 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... 8. Of Organs of Generation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Of Joints, Bones, &c. 1 ... 1 ... ... ... 1 ... ... ... ... ... ... 1 ... 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Malformation, &c. 9 4 5 9 ... ... 9 ... ... ... ... ... 1 4 4 12. Of Uncertain Seat 5 1 4 1 1 ... 2 ... 1 1 1 ... ... 1 4 13. Age 4 1 3 ... ... ... ... ... ... 1 3 ... ... 2 2 14. Violence 9 6 3 ... ... ... 3 3 2 1 ... ... ... ... 9 15. Not Specified 2 1 1 ... ... ... ... 1 ... ... 1 1 ... ... l Totals 121 57 64 17 23 2 49 17 25 24 6 8 11 32 70 43 Assuming the population of this sub-district to have increased only at the ordinary rate of the 10 years between 1851 and 1861, the present table will, when compared with those of previous years, show that the deaths have not increased in the same ratio. In a year marked by the prevalence of such diseases as those of Cholera and Diarrhoea, an increase in the number of deaths was to be expected, but the 121 deaths registered in 1866, will be found to yield a rate by no means exceeding the average of any previous decennial period, if the usual correction be made for increase of population. The excess of births over deaths in the past year was 104, which furnishes an unusual addition to the population, being 28 beyond the number for the previous year, when the excess was but 76. The average yearly excess of the five years preceding 1866, was 71. Putting then the increase by immigration at only one half of that of the natural increase, the death rate of the past year would hardly reach the average point at which it has been shown to stand for some years past, viz. : about 16 per 1,000 living. The mean annual death-rate of the 10 years preceding the one in which the census was last taken, was 16.19 per 1,000 and since then there are good grounds for believing it has undergone some considerable diminution. Nothing therefore can be more satisfactory than these statistics as an indication of the persistently favourable condition of the public health of this parish. But few further comments need be made upon the mortuary table, but the points of interest which it discloses may be thus very briefly summarized:— 1. Of the 121 deaths, a slight excess appears on the side of the weaker sex, in the proportion of 64 females to 57 males. 2. Compared with the number in the report for 1865, the infants and children dying and being registered at the respective ages of "under one year," "from 1 to 5 years," and "from 5 to 10 years," are equal as to the first of these periods, in excess of 5 as to the second, and less by 3 44 as to the last. In the aggregate, that is to say, from birth to 10 years of age, the numbers that have succumbed are more by 2 in 1866 than in the previous year. 3. In respect to deaths from the Zymotic class of diseases, two only appear on the register of 1866, above the number recorded in the previous report. 4. Apart from the deaths registered as due to Choleraic Disease, (Cholera and Diarrhoea,) which were 5 in number, the six other principal epidemic maladies were much less fatal in 1866 than in the previous year, if we except Measles, to which 8 deaths are registered as being due, or rather to Pneumonia, which the severity of the season caused to follow the eruption in nearly all the cases that had a fatal termination. 5. A further comparison of the table of 1865 with that in the present report, exhibits the gratifying fact, that the deaths resulting from diseases of the Tubercular class, have very considerably diminished, and that whilst there is to be noticed a very slight increase in the mortality from Diseases of the Brain and Nervous System, the deaths from Affections of the Lungs (exclusive of Phthisis) have been less by one than in 1865, though rather over the average of the previous 10 years. Seeing what an inclement winter marked the year 1866, a much larger number of deaths might have been anticipated from diseases of the Respiratory Organs. The deaths due to Pulmonary Phthisis were, in 1865, as many as 24, but in the past year they fell to 13, which is a much less number than has been registered for some years past. During the previous 3 years, the deaths from Phthisis were respectively 17, 15, and 24. 6. Considering the many and active influences always at work in poor and crowde l neighbourhoods in intensifying all diseases, the deaths amongst the working classes, compared with the number recorded as having taken place among the three classes above them, are not by any means unusually disproportionate, 70 of the former to 51 of the latter being the figures appearing in that part of the 45 mortality table which marks the social position of the deceased persons. In my earlier reports the disproportion in this respect was shown to be very great, and almost always appeared very much more to the disadvantage of the labouring population than at present. In the year 1865, the incidence of the death-rate was even reversed, and the three classes above that comprehending those engaged in manual labour, showed by far the greatest number of deaths, in the proportion of 61 to 54. Zymotic Diseases.—The following table, a similar one to which has been employed in several annual reports, exhibits the proportion of deaths due to Zymotic diseases to deaths from all causes in the past and 10 previous years. YEARS. Number of Deaths from all Causes. No. of Deaths from Seven of the principal Epidemic Diseases. Percentage 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 1866 121 16 12.4 The excess of deaths from the seven principal epidemics over the number registered in 1865 is by no means great, and is only one and a fraction above the average of the previous 10 years. It is necessary to state that the 16 deaths in 1866, noted in the above table, includes the mortality from Cholera as well as from Diarrhœa. Small-pox, I am pleased to report, obtained no victims 46 in this Sub-district in 1866, but since the expiration of the year several cases are understood to have come under treatment, more especially in private practice, and it is believed, chiefly amongst the un-vaccinated. Of 225 children born in the Sub-district during the past year, the registration of 111 cases of successful public vaccination appears to have been accomplished in that year. How many of those born in the parish in 1866, (whose names in connexion with this important operation do not appear in the local register of the year,) may have had, or will have, the vaccine lymph inserted by other hands than those of the Public Vaccinator, it is impossible to say. The registration of all births and of all vaccinations should be made equally compulsory on parents and guardians, or every attempt at legislation on the subject must fail of its purpose.* *There is not perhaps a matter in the whole range of a Sanitary Officer's duties demanding more attention than the proper fulfilment of the provisions of the Vaccination Extension Acts. When the Registrar General's Returns for the Metropolitan area are found to record, sometimes in a single week, and week after week, between 30 and 40 deaths from Small-Pox, it becomes important that erroneous views regarding the description of persons who can legitimately claim gratuitous vaccination and registration at the hands of the Public Vaccinator, should be combatted, hence no apology is needed for again alluding to the mischievous promulgation (still persisted iu in this and other districts) of a notion that public vaccination can mean only the vaccination of the chi'dren of the Union Poor! Of cours3, it was never contemplated that persons in a superior condition of life should under the Vaccination Acts, claim anything of the Public Vaccinator gratuitously, beyond the insertion of the vaccine lymph, and the subsequent registration of the successful operation; but the followiug letter recently addressed to one of the Medical Journals, by a gentleman who authenticates his statement by his name and address, certainly bears out, in the fullest possible manner, the declaration of the Poor Law Board, made through one of their officers, that "Every person, of whatever grade and condition of 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 of society."— "About four years ago, Mr. Stevens, one of the Government Vaccination "Inspectors, visiting this district (Kidderminster) asserted that I was in error in "omitting to place my private patients on my account, explaining that the fee we were "paid was intended to include everyone, and considered as a registration fee more "than a fee for a surgical operation. I have ever since maintained my legal right to "this fee. placing all my private patients on the register with the others. Mr. Stt vens "remarked that unless we entered the whole of our cases, it was impossible for him "to arrive at any satisfactory conclusion on comparing the number of births with "the number of vaccinations. I am sure many Public Vaccinators will be glad to "know this opinion."—Correspondent in the Lancet, July 20th, 1867. The amended Vaccination Act, which has recently passed both Houses of Parliament, does not in any way vitiate this view of the question. The only material alteration that has been made is, that parents and guardians will themselves be required to register the successful operation through a certificate from their own private practitioner, or from the Public Vaccinator, at their option. Until now it rested with the Vaccinator to forward the certificate to the local Registrar, and no responsibility whatever was imposed upon the parent in respect to registration. 47 The deaths from Cholera and Diarrhoea during the year were remarkably few. From the weekly returns received from the Medical Practitioners of the Sub-district during the continuance of the epidemic (about 9 weeks) it appears that nearly 250 cases of Diarrhoea and 3 of Cholera came under treatment. Two of the cases of the last named disease were described in the returns as "English Cholera," but the third was indisputably of the most malignant character, and proved fatal in a few hours after the development of the more prominent symptoms which so well mark this most distressing malady. The deaths registered as due to the epidemic were 5 only, viz.: 4 from Diarrhoea, and the one from Cholera just referred to. The measures adopted, both medical and hygienic, to meet the requirements of the Order in Council, were prompt, and it is believed, judging from the slight mortality which resulted from the epidemic, effective. The house to house visitation, with the view to the removal of nuisances, and the detection of cases in their incipient, and therefore more curable stages, was energetically carried out, and the action of the local authorities in affording the Medical Officer of Health, the Surveyor, and the Inspector, every support and assistance in the discharge of their respective duties was satisfactory. Disinfectants were liberally furnished in all cases needing their employment; nearly all the well waters of the Sub-district were submitted to a qualitative analysisand microscopic examination; the Local Committee and the Board were kept duly informed of the progress of the epidemic; and it is believed there was nothing left untried that was in the remotest degree calculated to lessen the virulence of the disease, and to restore those who suffered from it to health. I have to thank the Local Committee for the approval they have been pleased to express, and to enter on their minutes, of my own individual endeavours to meet the exigencies of the occasion. Sickness and Mortality amongst the Union Poor.—It will be seen by consulting Table V. Appendix, that the deaths (18) during the past year amongst the union poor, have been few in number compared with the number of cases treated (418.) 48 Some inquiries having been recently made of the Poor Law Medical Officers of the Metropolis, having reference to the establishment of local infirmaries or hospitals for the special treatment of Small-pox and Fever amongst the indigent classes, in accordance with the provisions of the new Poor Law Act, information was asked of me relative to the number of cases of the above named diseases that would be, on an average, likely to require isolation and treatment away from the houses of the patients at any one time during any year. To enable me to assist the Union Medical Officer of this parish to make the required return, I drew up the following table, which I believe will supply, as far as this Sub-district is concerned, every fact of importance that may be needed to decide the question referred to. Table showing the number of deaths among all classes from Small Pox and Fever in the Sub-district of Putney and Iloehampton during 11 years, from 1856 to 1866 (both inclusive) ; also the number of cases treated and the number of deaths that have occurred from these diseases among the out-door Union poor exclusively, during the same periods:— SMALL POX. Years No. of Deaths amongst all classes Amongst the Union Poor No. of Cases Treated No. of Deaths 1856 ... ... ... 1857 ... ... ... 1858 ... ... ... 1859 ... ... ... 1860 ... 4 ... 1861 ... 1 ... 1862 ... 1 ... 1863 3 18 2 1864 1 20 ... 1865 ... 1 ... 1866 ... ... ... Totals 4 45 2 FEVER. Years No. of Deaths amongst all classes Amongst the Union Poor No. of Cases Treated No. of Deaths 1856 3 27 2 1857 5 21 ... 1858 2 23 ... 1859 6 13 4 1860 1 12 1 1861 2 40 1 1862 2 27 ... 1863 2 27 1 1864 1 20 ... 1865 8 29 2 1866 1 ... ... Totals 33 239 11 The first portion of the above Table shows that in 11 49 years there were only 4 deaths from Small-pox amongst all classes in this parish. Also that 45 cases in the same period were treated by the Union Medical Officer, of which two only proved fatal. There is reason to believe that many more than were removed of these 45 cases would have been sent into hospital, had there existed greater facilities for such removal, and had beds been always available in the only institution in the metropolis for the reception of poor patients labouring under this distressing malady. In like manner the second portion of the Table shows that in the same 11 years 33 deaths from Fever took place amongst all classes in this Sub-district, and that 239 poor patients were treated by the Union Medical Officer, with the result of only 11 deaths. In some of the larger parishes of this Union a much greater number of both cases and deaths occur yearly amongst the out-door poor; and there can scarcely be two opinions respecting the expediency of establishing local infirmaries or hospitals in sufficient numbers to meet a want long felt in many of the large and populous suburban districts. A very note-worthy fact in connection with the above Table may here be mentioned, viz., that a somewhat large number of fever cases are shown to have annually occurred before a system of efficient drainage in connection with the great intercepting sewer was projected and completed in the town portion of this parish, but since the accomplishment of this necessary undertaking, at the latter part of 1865, the malady referred to has claimed but a single victim, and further, that not a solitary case of this disease was treated, nor a death due to the same registered, amongst the parish poor, during the entire year of 1866 ! It is believed that nothing could better mark the benefits derivable from judicious sanitation than the circumstance here referred to, and costly though this measure of improvement has unquestionably been (and it never should be lost sight of that the execution of these extensive works is made compulsory on local authorities by an act of the legislature) the ratepayers may be very fairly congratulated upon the D 50 two great results of the experiment—the saving of life, and the diminution of suffering. Sanitation, &c.—Unusually great in amount, and of the utmost importance in all its bearings upon the public health of the Sub-district, has been the sanitary work accomplished during the past year, and detailed in Table IV. of the Appendix. The completion of 22,914 feet of new sewers is alone an event of such significance as to mark the year 1866 as one of great sanitary progress in this parish. The special appointment of a Sanitary Inspector during the prevalence of the epidemic, who was continued for some time after its departure, it will be likewise seen, led to the removal or abatement of a large number of nuisances of various kinds, as well as to a most thorough inspection of the parish. This Inspector, who performed his task with great care and energy, has left in my hands a valuable record of his labours in the shape of an abstract of his official reports, which cannot fail of being of considerable service to me in the future exercise of my functions. In the abstract referred to, the one great sanitary defect which appears to have manifested itself to this Officer, as it had done frequently to myself before bis inspections were commenced, was the indifferent water supply in many localities. "No water to closet," "Closet and pump in too close proximity," "Water from Well very bad," are expressions that more frequently occur than any others in the Inspector's notes and in my own reports, and it is certain that danger will ever attend this condition of things so long as the present system prevails, and the supply of this great necessity of life, on the principle of constant service, is withheld.* *Many of the well waters of this parish are known to be singularly impure, rendering a good supply from other sources a matter of great moment. The analyses of some of these waters male by the late Dr. Dundas Thompson in 1854, and published along w ith several others in one of the Government Reports, have been considered by several chemisls of note as exhibiting peculiarities demanding great caution in their use. Dr. Phipson, the professor of chemistry, thus writes to me on the subject. "In the analyses of Putney well waters quoted in the valuable report on the sanitary condition of the several parishes comprised in the Wandsw rth District (1865), which I have read with much interest, the organic matter strikes me by its high figure. This is a fact, however, but one w hich I cannot account for. It may 51 Captain Tyler, who was commissioned by the Board of Trade to enquire specially as to the quantity and quality of the water supplied to the East of London, has just made his report, from which the following is taken as evidencing, in the strongest possible manner, the necessity of similar inquiries being instituted in other districts. Many a parallel case to that quoted can, there is little doubt, be found in even the best conditioned districts. "At No. 85, Hare Street, 34 people had one butt belonging to the landlord, in w hich one of the staves was split, so that it would only hold 15 inches, or 20 gallons, instead of 40 to 43 gallons of water; one leaky barrel, which would only hold 18 instead of 36 gallons; and two smaller sound casks, which would hold, the one 18, the other 25 gallons. This double house belonged to a Member of the Metropolitan Board of Works. There was only one f inch pipe shared between it and No. 80, and yet the tenants were in want of storage more than of water. The split butt at No. 85 was the only one they could drink from. The same defects are apparent on inspection at every turn in the poorer districts. Pipes bent and broken; taps leaking, stuck fast, or missing; receptacles of every description, butter-firkins, tar-barrels, wine-butts, or cisterns, in all conditions of filthiness, leakiness, rottenness, or ill-repair; covers inefficient, or absent even where they have been supplied. The water runs sometimes over the side in place of into the butt, and too frequently runs to waste as long as it is turned on. In other cases, where there is a plurality of houses on one pipe—and there are in the East London District 500 cases in which four or more houses depend upon one servicepipe—the supply intended for each is unequally divided, according to the energies and opportunities of their inhabitants, among the whole. The purest water that can be delivered is hopelessly contaminated directly it leaves the service pipes by the dirty condition of the receptacles." It is, then, to the receptacles, quite as much as to the water that goes into them, that we have to look to secure ourselves against imbibing the germs of Cholera and other diseases. Who that has ever looked through a microscope at a small portion of the sediment of a glass of water drawn from an ill-conditioned cistern or water-butt (and I have on more than one occasion given the local authorities of this Sub-district ocular demonstration of what is occasionally to be met with in such water) but will instantly interest you to know that among the analyses in my books, I find one of water from a gentleman's house on Putney Heath which gave— Total impurities 56.0 grains per gallon. Organic matter 17.5 „ ,, The water was cloudy from presence of Sulphate of Lime in suspension. The amount of dry mineral matter, 24 5 grains, is not very much above what is tolirated, but the organic matter is about six times too high." D 2 52 become an advocate of the constant service system, and agree with Captain Tyler, that "second only to improved dwellings, a legislative enactment carrying out such a provision would be the greatest blessing that could be bestowed upon the working classes and the poor of London." It is scarcely necessary to state that all the cow houses in the Sub-district, as well as all the places used for the slaughtering of cattle, sheep, and pigs, received the usual attention, and were reported on so favourably as to secure the renewal of the licence in every instance. Once more referring to the subject of over-crowding amongst the poor, it may be remarked that there appears more necessity than ever for the adoption, throughout the entire District, of some means of lessening the many evils, moral and social, that are known to arise from the deficient house accommodation for the families of the labouring portion of the population. During the last five or six years a very large number of houses have been erected within the boundaries of this parish, but looking at the great outlay that must have been made in the construction and ornamentation of the majority of them, there is little hope of the builders of such bestowing much attention upon the supply of habitations for the necessitous poor. A class of house especially adapted to the wants and to the means of labouring men and their families, who are at present much too promiscuously crowded together, is the great desideratum, but it is one, it is submitted, that could be readily met by a combination of the more wealthy residents in forming a society for the accomplishment of this great and most pressing object. It is true, that as a speculation, that which is here suggested might not prove so immediately profitable as many other investments, but it should never be forgotten that it has over and over again been shown, as an eminent writer has very forcibly expressed it, "that nothing is so costly, in all ways, as disease, and that nothing is so remunerative as the outlay which augments health, and in doing so, augments the amount and value of the work done." R. HARLAND WI11TEMAN, Medical Officer of Health for Putney and Roehamjiton- APPENDIX OF STATISTICAL TABLES. TABLE I. Summary of Deaths and their Causes, registered in the Entire District during 1866, classified according to Sex, Age, and Social Position, and showing also the relative Numbers in each Sub-District. POPULATION of ENTIRE DISTRICT, In 1861, 70,381. Area in Statute Acres, 11,695. Total Deaths from each Class of Disease, &c., in the Entire District. Sub-Districts. Sex. Age. Social Position Clapham—Population in 1861, 20,890, area in acres. 1,233. Wandsworth—Population in 1861, 13,346, area in acres, 2,478. Battersea—Population in 1861, 19,582, area in acres, 2,343. Putney—Population in 1861, 6,481, area in acres, 2,176. Streatham, Tooting, and Balham—Population 1861, 10,082, area in acres, 3,465. Males. Females. After 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:— 1. Zymotic Small Pox 34 10 3 20 ... 1 24 10 18 10 2 31 2 1 ... ... ... ... 1 33 Measles 102 18 23 50 8 3 45 57 20 75 5 101 1 ... ... ... 1 1 14 86 Scarlatina 49 6 10 26 1 6 19 30 3 27 17 47 2 ... ... ... ... 3 12 34 Diphtheria 22 5 2 14 ... 1 10 12 2 9 5 18 4 ... ... ... ... 1 8 13 Quinsy 1 1 ... ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... ... ... 1 Croup 27 7 3 14 1 2 17 ... 2 23 2 27 ... ... ... ... ... 1 2 24 Whooping Cough 78 14 5 51 1 7 40 38 26 48 4 77 1 ... ... ... ... 4 21 53 Typhus and Infantile Fever 61 16 5 30 1 9 24 37 2 18 6 33 10 11 7 ... ... 9 12 40 Erysipelas 2 ... ... 2 ... ... 1 1 ... ... ... ... 1 ... 1 ... ... ... ... 2 Metria, Childbirth 14 2 2 8 ... 2 ... 14 ... ... ... ... 13 1 ... ... ... 1 5 8 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 71 13 18 31 4 5 34 37 46 14 1 62 1 ... 8 ... 1 2 14 54 Cholera 36 4 7 22 1 2 20 16 7 8 4 21 4 9 2 ... ... ... 6 30 Totals of Zymotic Class 497 96 78 268 17 38 235 262 127 232 46 418 39 22 18 ... 2 22 95 378 2. Turbercular 334 57 55 186 17 19 199 135 72 49 6 149 106 66 12 1 3 13 105 213 3. Of Brain and Nerves 277 36 56 151 20 14 154 123 64 48 5 122 38 50 59 8 9 18 83 167 4. Of Heart 107 26 19 45 7 10 52 55 3 ... 2 7 15 33 50 2 4 6 40 57 5. Of Respiratory Organs 334 73 57 143 21 40 164 170 103 77 8 199 25 40 62 8 2 20 80 232 6. Of Digestive Organs 74 15 20 27 8 4 26 48 15 8 ... 25 9 15 25 ... ... 8 21 45 7. Of Urinary Organs 21 4 4 8 1 4 19 2 ... 2 ... 3 5 8 4 1 ... 2 10 9 8. Of Organs of Generation 23 4 5 13 ... 1 1 22 2 ... ... 2 6 9 6 ... 1 1 5 16 9. Of Joints, Bones, &c. 15 4 3 7 1 ... 5 10 2 2 1 7 ... 4 4 ... 1 1 4 9 10. Of Skin 14 3 ... 11 ... ... 9 5 8 1 ... 9 1 2 2 ... 1 1 3 9 11. Premature Birth, Low Vitality, Malformation, &c. 129 40 22 47 9 11 61 68 121 7 ... 129 ... ... ... ... 1 10 30 88 12. Of Uncertain Seat 45 3 12 13 5 12 12 33 3 2 ... 5 6 18 15 1 1 5 12 27 13. Age 106 35 11 43 4 13 38 68 ... ... ... ... ... 3 50 53 5 9 35 57 14. Violence 66 12 9 32 9 4 47 19 9 3 5 28 15 15 7 1 ... 1 10 55 15. Not Specified 30 17 ... 8 2 3 12 18 6 2 1 9 4 10 6 1 1 2 6 2 Totals 2072 425 351 1002 121 173 1034 1038 535 433 74 1112 269 295 320 76 31 119 539 1383 54 TABLE II. Births registered during the year ended 31st December, 186. SUB DISTRICT. Males. Females. Total. Clapham 343 368 711 Wandsworth 239 237 476 Battersea 757 629 1,386 Putney and Roehampton 114 111 225 Streatham, including Tooting and Balham 140 143 283 Total 1,593 1,488 3,081 *** The excess of Births over Deaths in the entire district is 1,009. TABLE III. Meteorological Means for 1866, from Observations taken at Greenwich. Jan. Feb., and March. April, May, and June. July, Aug., and September. Oct., Nov., and December. The Year. Temperature of the Air 41.2° 53.0° 58.9° 46.2° 49.8° Evaporation 39.1° 49.1° 55.6° 44.4° 47.1° Dew Point 36.4° 45.3° 52.6° 42.4° 44.2° Weight of Vapour in a Cubic Foot of Air 2.5 grs. 3.5 grs. 4.5 grs. 3.1 grs 3.4 grs. Degree of Humidity (Satn. 100) 84° 76° 80° 87° 82° Reading of Barometer 29.586 in. 29.777 in. 29.663 in. 29.838 in. 29.716 in. Weight of a Cubic Foot of Air 547 grs. 538 grs. 529 grs. 546 grs. 540 grs. Rain (amount of) 9.3 in. 7.9 in. 7.9 in. 5.4 in. 30.5 in. 55 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 1856-66. Deaths from Epidemics in each Sub-District. Entire District. Years. Clapham. Battersea. Wandsworth. Putney. Streatham. Total Deaths from Epidemics. Total Deaths Registered. Percentage of Deaths from Epidemics to Total Deaths. 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 1866 86 244 73 16 34 453 2072 21.3 *** The Diseases included in the above Table constitute, as in the RegistrarGeneral's Returns, the principal maladies only of the Zymotie class—viz.: Small Pox, Measles, Scarlatina, Diphtheria, Whooping-cough, Diarrhoea and Cholera, and Fever. 56 TABLE V. Cases of Sickness, Accidents, &c., amongst the Poor under the treatment of the Union Medical Officers, with the Deaths from each class of Disease, &c., during the year ended 31st December, 1866. Compiled from the District Medical Relief Books. SUB-DISTRICTS. Total Cases of Sickness treated in each Sub-district. 1—Small Pox. 2—Measles. 3—Scarlatina and Malignant Sore Throat. 4—Whooping Cough. 5—Diarrhœa and Dysentery. 6—Cholera. 7—Fever. 8—Erysipelas 9—Puerperal Fever. 10—Lung Diseases except Phthisis. 11—Phthisis. 12—Hydrocephnlus 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. I Deaths. 1 Cases. 1 Deaths. I Cases. Deaths. | Cases. Deaths Clapham 1115 53 7 54 3 5 2 8 2 140 3 31 2 99 3 4 ... ... ... 143 13 15 1 8 2 494 20 61 2 60 Wandsworth 1281 12 ... 64 3 16 ... 14 ... 246 3 10 4 51 1 8 ... 2 ... 146 13 13 2 5 2 692 9 2 2 39 Battersea 1286 33 2 47 3 19 ... 20 1 78 3 8 3 87 2 18 ... ... ... 293 7 25 6 70 2 536 4 52 2 35 Putney and Roehampton 388 ... ... 19 5 4 ... 10 ... 53 2 4 1 ... ... 4 ... 1 ... 39 3 5 3 ... ... 215 5 34 ... 19 Streatham, including Tooting and Balham 211 3 ... 3 1 3 ... 6 1 6 ... ... ... 9 1 2 ... ... ... 44 6 3 3 2 ... 114 8 16 1 27 Totals 4281 101 9 187 15 47 2 58 4 523 11 53 10 246 7 36 ... 3 ... 665 42 61 15 85 6 2051 46 165 7 174 *** The ratio of deaths to cases treated is 4.8 per cent. for the entire district. 57 TABLE VI. Summary of the Sanitary Operations in the entire District during the year 1865. Clapham. Battersea. Wandsworth. Putney and Roehampton. Streatham, including Tooting and Balham. Totals. Number of Houses and Premises inspected 1,557 2,649 3,991 1,137 1,670 11,054 1st Notices served 292 305 379 98 138 1,117 2nd Notices served 32 47 26 Cesspools emptied and cleansed 14 32 68 22 220 356 Cesspools abolished 84 105 115 22 63 389 Waterclosets constructed 67 650 207 22 225 1,177 Houses supplied with water 215 1,247 239 22 225 1,948 Drains constructed or connected with Sewer 375 637 232 22 50 1,316 No. of feet of New Sewers, &c. 23,760 38,563 30,654 22,914 6,030 121,921 Drains repaired or trapped, or obstructions removed 214 325 136 27 185 886 Open Ditches, Ponds, &c., cleansed (in feet) 16,150 no return 2 miles 5,370 52,800 ...... Dust-bins provided 296 463 256 3 164 1,182 Pig Nuisances removed 32 47 10 28 45 162 Accumulations of Offal, Manure, &c., removed 26 54 32 3 51 166 Unwholesome and dilapidated Houses cleansed or repaired 136 203 129 3 22 493 Cases investigated by Magistrates 11 8 9 9 ... 37 Compulsory Orders obtained 10 8 8 9 ... 35 Compulsory works executed 10 8 8 9 ... 35 Works remaining in abeyance from various causes 38 15 ... 2 ... 55