WAN 19 SANITARY DEPARTMENT. REPORT ON THE SANITARY CONDITION OF THE SEVERAL PARISHES COMPRISED IN THE WANDSWORTH DISTRICT, DURING THE YEAR 1867. In the Medical Officer of Health. london: printed by john smith and co., 52, long acre, w.c. 1868. CONTENTS. PAGE 1. Health and Sanitary Condition of the Entire District 3 2. Report on the Sub-District of Wandsworth, by Dr. Nicholas 13 3. „ on the Sub-District of Clapham, by Mr. MacDonogh 20 4. „ on the Sub-District of Battersea, by Dr. Connor 27 5. „ on the Sub-District of Streatham, by Dr. Noel 32 6. ,, on the Sub-District of Putney, by Dr. Whiteman 37 7. Appendix of Statistical Tables, &c. 48 REPORT, 1867. To the Board of Works for the Wandsworth District. Gentlemen, We have the honor to present for your consideration our 12th annual report. The past year was happily not marked by any of those exceptional circumstances which characterized the previous one, but notwithstanding there was less necessity for the adoption of such extraordinary measures of precaution as were taken on the appearance of cholera in 1866, the ordinary sanitary requirements of the several sub-districts received, it is shewn, during 1867, more than their usual attention, and the consequence, we are pleased to report, has been a considerable fall in the death-rate, and an improved condition of the public health of the entire District. We have the honor to be, Gentlemen, Your very obedient Servants, The Medical Officers of Health of the Wandsworth District. 4 HEALTH AND SANITARY CONDITION OF THE ENTIRE DISTRICT. A greatly improved condition in the health of this District, as indicated by a much reduced death-rate, a high birth-rate, and by a general diminution of all the principal diseases of the epidemic class, characterized the year 1867. This will be fully shewn by an examination of the tables embodied in the local summaries, and of those annexed by way of Appendix to this report, in which will be found recorded all the statistical information necessary for illustrating the condition of each sub-district, as well as that of the entire District. The total number of deaths in the District during the past year was 1,937—944 of males, and 993 of females. The total number of births was 3,614—1,858 of males and 1,756 of females. The rate of mortality during the same period was 22.34 per 1000 persons living. That of the year 1866 was 24.97 per 1000. This calculation is based on the assumption that the population increased during the past year in the same ratio as it is found to have done between the census of 1851 and that of 1861. According to a similar calculation the birth-rate was 41.68 per 1000, and the rate of natural increase 19.34 per 1000 of the entire population. 5 The other most noteworthy facts disclosed by the table of mortality (No. 1 Appendix) are— 1. That the deaths of infants under 1 year amounted to 571, which is within 49 of one half of the entire mortality at all ages. 2. That the aggregate mortality of infants under 1 year, of children from 1 to 10 years, and of young persons from 10 to 20 years, was 981, which is 25 above one half of the total number of deaths registered in the year. 3. That, of old age, without the registration of any specific disease as the cause of death, there died during the year 125 persons; that 302 other persons between 60 and 80, and 25 between 80 and 100 years, also died from duly certified disease; that in the aggregate as many as 452 died within the District at advanced periods of fife, i.e., between 60 and 100 years of age; and that three or four of the oldest persons registered had at the time of death reached the great age of 95 years. 4. That of the deaths enumerated in the table under the four headings of social position, there occurred amongst the labouring classes 1,184 and amongst the three classes above them in the social scale, 753, thus giving a majority to the former over the latter of 431 deaths. 5. That the number of deaths (36) of the nobility and gentry, compared with the number that occurred of the three other classes collectively, (1,901) is strikingly small, and clearly indicates to what portions of the District the efforts of the sanitarian should be principally directed. 6 Zymotic Diseases.—In 1866 the numerical preponderance of deaths due to Zymotic diseases was the worst feature of both the local and general tables of mortality. The deaths resulting from seven of the principal maladies of this class amounted, in that year, to no less than 453. In the past year, however, only 242 deaths due to the same diseases were registered in the entire District, which is very considerably less than one half the number registered in the previous year, and instead of forming 21.3 per cent of the total deaths, did not exceed 12.4 per cent. It is also gratifying to be able to record the fact, that with the one exception of Erysipelas, which contributes 4 deaths to the register of 1867, there is not a single disease of the Zymotic class having a place in the mortality table, but exhibits a lower death-rate in the past year than in that of the previous one, and in some instances to a very considerable amount. For example, the deaths from Smallpox fell in the two years from 34 to 24; Measles from 102 to 18: Scarlatina from 49 to 32; Diphtheria from 22 to 8; Whooping cough from 78 to 41; and Fever from 61 to 41. It is a little singular, however, that the deaths from Diarrhæa in the past year were within 2 of the number registered in the previous year— the cholera year of 1866—the figures in the two tables shewing respectively 69 and 71 deaths. From actual Cholera and Choleraic Diarrhœa, there is, as might be expected, a considerable fall in the mortality in favour of the past year, the numbers being respectively 36 in 1866. against 5 in 1867. Sanitation of the Year.—From the singular persistency and fatality of Diarrhœa in some of the more populous 7 parts of the District, it may be fairly assumed that the more virulent form of this epidemic may again, at any time, invade us, if a breach could be found or made by the enemy in any of our sanitary defences. To strengthen these defences by every possible means should be our constant aim, and it is with much satisfaction, therefore, that we refer to those portions of this report which speak encouragingly of the exertions that have been made during the past year to improve and to perfect the main sewerage of the entire District. Efficient sewerage is very properly held to be the basis of all wise sanitation, and it is therefore with no small degree of satisfaction that we are enabled to point to the fact of so large an amount as 148,042 feet of this necessary work having been completed during the past year, and to 3,383 connexions, within the same period, being effected with the main culverts. This of itself is a large amount of work to accomplish in a single year, but when the entire length of main drainage that has been constructed in this District during the 12 years of the operation of the Metropolis Local Management Act is taken into consideration, few, it is thought, will be found to contend that the carrying out of this great and enduring work is one that can possibly fail, when fully completed, to present a barrier against the inroads of much disease, especially that of the Zymotic class. Connected with this subject is one which it appears exceedingly desirable should receive immediate attention. We refer to the evil which has been pointed out in the last and preceding reports, as arising from the escape of the gases from the ventilating gratings of the main sewers, 8 to the danger of every one living near, and, in certain conditions of the sewer, of those having occasion to pass by or over them. There is a generally expressed complaint that cess-pools have been abolished by the authorities in situations where there could arise little or no nuisance from their continuance, and are now placed in another and a worse form in the public thoroughfares, and in close proximity to dwellings, where there is no escaping their baneful influences. There can be no doubt that the efficiency of the main drainage is greatly marred by this intrinsic defect. It is earnestly hoped, therefore, that the subject will meet with the consideration which its great importance demands. Referring to other portions of the Table of Sanitary Operations (No. VI. Appendix,) it is a source of considerable satisfaction to note the large number of nuisances, of various kinds, that have been got rid of in the several subdistricts. The number of houses and premises inspected has also been large. Very little short of 1,000 notices appear to have been served to remove or abate nuisances, as many as 48,790 feet of open ditches, ponds, &c., have been cleansed, and some 4,000 operations of a sanitary character have been carried into practical effect during the year. That magisterial interference has been necessitated in 10 cases only, is also satisfactory, the more so as, by a comparison of Table VI. in the Appendix of the present report with that of the previous year, it is shewn that a less number of cases by 27 were litigated in 1867 than were so dealt with in the preceding year. Sanitary Legislation.—Attention may be advantageously 9 directed to some recently projected sanitary legislation, having a very important bearing upon the public health. The important Bill of Mr. Tite, having reference to the better management of metropolitan buildings, &c., is by no means so perfect a measure as could be desired. Its main object appears to be to protect the rights of property, but while it does this, it leaves quite untouched many of those ill-considered and badly working provisions of existing Acts, which all sanitarians and local authorities are agreed stand much in need of amendment. Another important measure, and one worthy of every consideration is that of Mr. Torrens, the object of which is to enable local authorities to purchase or pull down unhealthy dwellings, and to erect others fit for habitation. This Bill has recently passed the House of Commons, and has since been referred to a Committee of the House of Lords.* There has also been recently printed a Bill to give increased powers to local authorities to deal with the adulterations of food, &c., a measure of the highest importance, proposing as it does great amendments of the existing Acts upon the subject. The Act to amend the laws relating to Vaccination, and the Workshops and Factories Regulation Act, limiting the hours of labour of women and children, are both in operation, but as yet so indifferently carried out in many localities as to render them all but useless for the purposes for * Since this Report was written, the measure of Mr. Torrens has become law. Mr. Torrens, speaking of the new Act, says "a competent surveyor is to be required to say whether the dwelling is capable of being made wholesome by any and by what repairs or whether it must be pulled down and rebuilt. In either case the owner of the property is to have the option of doing the necessary work. If he declines, the vestry in the metropolis (or the corporation elsewhere) is empowered and directed to have the repairing or re-building properly done; and, in case of neglect or delay, appeal may be made by the ratepayers to the Secretary of State." There are other provisions of the highest importance in a sanitary point of view, which renders the Act of great value. Great responsibilities are also thrown upon Medical Officers of Health by this measure. 10 which they were designed. The first of these Acts needs the vigorous interference of the authorities in respect to its penal clauses, to render it of the least use as a corrective of the growing indifference to vaccination, especially amongst the poor. We cannot conclude this portion of our report without once more calling attention to the overcrowding of the dwellings of the poor, and to the necessity which is daily becoming more obvious, of providing against this increasing evil. The great sanitary problem of the day is—How are cheap and wholesome dwellings for the labouring population to be supplied in sufficient numbers to meet the demand? Towards the solution of this question it is submitted, that public opinion should be, in some way, influenced to obtain a repeal of the oppressive law of settlement, or to extend the area of its operation. The cottage market will then be as freely open to the influence of the commercial law of supply and demand as any other, and proper house accommodation for the poor and industrious classes, it is believed, would be thus very readily secured throughout the country. It may here be remarked that the water supply of the district remains in a most unsatisfactory state. The constant service arrangement, so long promised and looked for, appears to be as far off as ever, and it is predicted that so long as this system is withheld from the public, so long will many of the epidemic class of diseases set the science and the skill of the sanitarian at defiance. For the individual opinions of the medical officers ot health on other topics of interest bearing upon the public health, the reader is referred to the local summaries which follow. LOCAL SUMMARIES. WANDSWORTH. The following vital statistics, derived from an analysis of the Register of deaths and of the parochial records of sickness and mortality, reveal the gratifying fact that the health of this Sub-district during the past year underwent a very marked improvement. Death-rate, &c.—The total deaths which were registered as having occurred in this parish during the year 1867, numbered 332. 154 were of males, and 178 of females. 74 occurred in the following public institutions; viz., 46 in the Surrey County Lunatic Asylum; l7 in the Hospital for Incurables; 2 in the House of Correction; 2 in St. Peter's Hospital; 3 in the Royal Patriotic Asylum for Girls; 2 in the Royal Patriotic Asylum for Boys; and 2 in the Boys Reformatory. 19 deaths of Wandsworth Parishioners took place in the Union Workhouse, Battersea. The deaths in these institutions are recorded separately in order to show the amount of disturbing influence which some of them exert upon the determination of the death- 14 rate, in consequence of their inmates (as of the Surrey County Lunatic Asylum, the Hospital for Incurables, and St. Peter's Hospital) being derived from without the Subdistrict, undergoing no natural increase, and being subject to a high mortality. The 19 deaths which occurred in the Workhouse also do not appear upon the Wandsworth Register of deaths. For these reasons the death register taken alone cannot be adopted as a trustworthy datum for the calculation of the natural death-rate of this Subdistrict; which, therefore is, as hitherto, deduced from the total deaths which have occurred and an estimated population, due correction having been made for deaths in public institutions after the manner described in previous reports, and the population being estimated upon the assumption that it has increased since the period of the last census, in the same ratio as it had done during the preceding ten years. Thus calculated, the death-rate for the past year was 18.49 per 1000 persons living, which is nearly 2 per 1000 less than the average of the past ten years corrected for increase of population. Birth-rate. Rate of natural increase.—The births registered during the year were 588 in number—276 of males, and 312 of females. Calculated upon the abovementioned estimate of the population, the birth-rate and the rate of natural increase were unusually high, the former having been 38 and the latter 19.5 per 1000 persons living of all ages. This great and sudden augmentation in the birth-rate would appear to indicate a great accession to the population by immigration ; and such inference is supported by the fact that not less than 330 houses were built during the year. Causes of Death.—The following table contains a summary of all the causes of death arranged in accordance with the classification of the Registrar-General, showing the sex, social position, and age at death at different periods, and particularizing the several diseases of the Zymotic class. 15 WANDSWORTH. Population in 1861—13,346. Area in Acres, 2,478. Total Deaths from each Class of Disease, & c., in the Sub-District. Sex. Age. Social Position. Males. Females. Under 1 year. From 1 to 5 years. From 6 to 10 years. Under20 years, including all under10 years. At 20, and under 40 years of age. At 40, and under 60 years of age. At 60, and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle A Trading Class, Shopmen, Clerks, &c. Industrial & Labouring Classes. Diseases and other Causes of Death. Diseases Classified. Classes:- 1 Zymotic Small Pox 3 2 1 ... 1 ... 1 2 … … … … … … 3 Measles 1 … 1 … 1 … 1 ... ... … … … … … 1 Scarlatina 7 5 2 … 6 1 7 … … … … … … 2 5 Diphtheria 1 ... 1 … 1 … 1 … … … … … 1 … … Quinsy ... … … … … … … ... … … … … … … … Croup 9 4 5 2 7 … 9 … … … … … … 2 7 Whooping Cough 6 4 2 3 3 … 6 … … … … ... … … 6 Fever 7 3 4 1 ... 1 3 1 3 … ... … … … 7 Erysipelas 1 ... 1 … ... … ... … 1 … … … … 1 … Metria, Childbirth 1 … 1 … ... ... ... 1 … … … … … 1 ... Carbuncle … … … ... … … … … … … … … … ... … Influenza ... … ... ... ... … ... … … ... … ... … … ... Diarrhœa & Dysentery 7 2 5 2 1 … 3 1 1 2 ... 1 ... … 6 Cholera 1 … 1 1 … … 1 … … ... ... … … … 1 Totals of Zymotic Class 44 20 24 11 20 2 34 5 5 2 … 1 1 5 39 2 Tubercular 50 27 23 9 7 5 28 9 12 1 … … 1 9 40 3 Of Brain, Nerves, &c. 57 30 27 6 4 … 11 8 21 16 1 3 4 9 41 4 Of the Heart, &c 21 6 15 1 … 1 3 4 4 10 … 1 … 4 16 5 Of Respiratory Organs 46 23 23 16 7 1 24 4 8 9 1 … 1 7 38 6 Of Digestive Organs 23 4 19 5 1 … 7 5 5 6 … 1 3 6 13 7 Of the Kidneys 3 2 1 … ... … … 1 … 2 … … 1 2 … 8 Of the Uterus 4 … 4 … … … … 2 1 1 … 1 … 2 1 9 Of Joints, Bones, &c. 2 1 1 … … … … … 1 1 … … … … 2 10 Of Skin 2 2 … ... … ... 2 … … … … … … … 2 11 Premature Birth, Low Vitality, Malformation, &c 21 13 8 21 … … 21 … … … … ... 2 1 18 12 Of Uncertain Seat 14 7 7 … 2 … 2 1 1 10 … … 1 3 10 13 Age 32 9 23 … … … … … … 19 13 1 2 9 20 14 Violence 13 10 3 3 ... ... 4 5 4 … … 1 … 1 11 15 Not Specified ... … … … … ... … ... … … … … … … ... Total 332 154 178 72 41 9 134 44 62 77 15 9 16 58 249 15 A reference to the foregoing table shows that diseases of the Tubercular class (which includes Scrofula and Consumption) assumed the highest position in the causation of mortality of the past year, forming 15 per cent, of all deaths. Next in rank and of equal fatality were diseases of the Organs of Respiration and diseases of the Zymotic class (Epidemic, Contagious), forming nearly 14 per cent., the latter class being much below the average. Consumption was, as usual, the most fatal single disease, causing upwards of 8 per cent, of all deaths. The unusually large amount of upwards of 9 per cent, of the whole mortality is recorded as having resulted from old age. The other classes do not present any variation from the average requiring comment. Age at Death.—Upwards of 21 per cent, of all deaths took place under I year, 34 per cent, under 5 years, and 40 per cent, under 20 years of age. An unusually large number of deaths took place at the other extreme of life, 92 having occurred above 60 years, and 37 above 75 years of age. The ages of these latter were as follows;—three exceeded 76, eight 77, four 78, seven 79, one 80, one 81, three 82, four 84, two 86, one 87, one 89, one 91, and one exceeded 95 years. Those who attained the age of 80 and upwards were, with two exceptions, females. Social position.—75 per cent, of all deaths, and 84 per cent, of deaths from Epidemic diseases, occurred amongst the labouring classes. Inquests, &c.—16 inquests were held during the year. There were 13 deaths from violence, 12 of which were accidental and 1 suicidal. The cause of death was not certified by medical testimony in 9 instances. The necessity which exists for an investigation in all cases of uncertified death cannot, as has been often reiterated in these reports, be too strongly insisted on. (See observations in report for 1865). Prevalence and Fatality of Epidemic Diseases.—The following table exhibits the deaths which have resulted from the principal Epidemic diseases during the past and 17 10 preceding years, and the relation which they bore to the deaths from all causes. YEARS. Small Pox Measles. Scarlet Fever. Diphtheria. Whooping Cough. Cholera. Diarrhœa. FeverTyphus and Typhoid. Total Deaths from Epidemics. Total Deaths from all causes. Percentage of deaths from Epidemics to deaths from all causes. 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 1867 3 1 7 1 6 1 7 7 33 332 9.9 It is important in this respect especially, that so closely do the variations in the general death-rate correspond with the fluctuations in the mortality from Epidemic disease, that the latter may be generally accepted as the exponent of the former. A reference to the table shows that the mortality from Epidemic diseases during the past year was upwards of one-third less than the average of the preceding ten years. Small-pox prevailed during the first six months, and Scarlatina during the latter six months in the year; both, however, to a slight extent. Whooping Cough was also slightly prevalent, chiefly iff the first and third quarters of the year. Diarrhoea and Fever were present, as usual, more or less during the whole year; and the former was the most prevalent of any of these diseases. Sickness and Mortality amongst the Parochial Poor.— The nature and amount of sickness, with its fatal results, which came under treatment amongst the parochial poor during the vear, is shown in Table 5, in the Appendix. B 18 The amount and fatality of general sickness was slightly higher than the average, but the amount of Epidemic diseases was much less, while the fatality from them was upwards of one-third less than the average; these diseases during the past year having numbered 247 with 5 deaths, while the average of the past 10 years was represented by 309 cases and 10 deaths. Sanitary Proceedings.—A summary of the principal sanitary proceedings carried out during the year, is contained in Table 6, in the Appendix. In addition to these, all the slaughter-houses and cow-houses in the parish, 33 in number, were as usual examined and specially reported on, previous to the renewal of their owners' licenses. The bake-houses also, 22 in number, were examined and reported on as possessing the sanitary conditions required oy the Act of Parliament. Attention was directed in June last, to the circumstances of a grave nuisance, with resulting injury to health, arising from the non-interment of a corpse lying at a house in Malva street, and which forcibly illustrated the great necessity which exists, as I have repeatedly pointed out in these reports, and of which the late Cholera Epidemic presented ample confirmation, for a public Mortuary in this parish. (See Annual Report for, 1859.) Repeated complaints have been made, and very justly so, by inhabitants of the town, of the very serious nuisance arising from the sewer gases which escape from the ventilating gratings of the main sewers. As I have pointed out in my last and preceding Annual Reports, a sufficient and continuous flow of water is what is most needed for the prevention of the evil, and which would reduce the necessity for ventilation to a minimum, not only by a more rapid removal of the sewage, but by the absorption of gases and the prevention of decomposition. For it is evident that water, being the vehicle which has taken the place of the horse and cart of the old system, forms the most important element in the present system of sewerage, and, to be efficient in the performance of the work assigned to it, must be of a sufficient quantity for the purpose. 19 That the present supply of water is insufficient, is shewn by the fact that the nuisance complained of is greatest at night, that is, just when the least amount of water is entering the sewers. Moreover, the necessity for ventilation of the sewers and the difficulty of effecting such without nuisance, being admitted, there can be no reason, in a town like this, why the position of these gratings should not have been so placed as to avoid the very close proximity to houses which many of them now possess. Altogether this is a subject requiring the most earnest consideration of the Board, and indeed of the other Metropolitan Boards, for unless some remedy be soon forthcoming, the occurrence of some epidemic cannot but be apprehended. The continued pollution of the River Wandle in various ways, is also a subject requiring attention. GEORGE EDWARD NICHOLAS, M.D., Medical Officer of Health for Wandsworth. 20 CLAPHAM. The following is the usual table with which, for a number of years past, I have commenced my annual report. It exhibits, besides the number of births and deaths, the excess of the one over the other, as well as the number of marriages that have been solemnized during each year, from 1856 to 1867 inclusive. MARRIAGES, BIRTHS, AND DEATHS. years 1856 1857 1858 1859 1860 1861 1862 1863 1864 1865 1866 1867 Marriages 154 151 150 156 183 182 175 181 227 221 310 244 Births 527 550 533 594 608 624 622 685 640 707 711 777 Deaths 286 321 344 328 429 390 343 355 408 393 425 451 Excess of Births over Deaths 241 229 189 266 179 234 279 330 232 314 286 326 The principal facts to be noted in this table, are the gradually progressive increase of births during the past 12 years, and the unusual excess of births over deaths in the 21 year under review. In 1856 the number of births was 527, but in the past year it was 777, or more by 250 than it stood at twelve years ago, and nearly 160 above the average of the previous eleven years. It is somewhat singular, however, that the marriages were fewer by 66 in the past than in the previous year, and can be accounted for only by the year 1866 being altogether an exceptional one in this particular. In respect to the deaths, the gradual increase observable in the numbers from year to year, is of course due to the corresponding increase of the population. Statistics of Mortality.—The number of deaths registered in the past year was 451, (males 208, females 243) the females greatly preponderating, as was the case in the preceding year. Of the births, the preponderance is found to be on the side of the males by as many as 19—the male births numbering 398, and the female 379. Taking into account both the natural increase and that from immigration, the present population of the Sub-district may, I think, be very fairly estimated at, in round numbers, 25,500. Believing this to be as nearly correct an estimate as it is possible to arrive at, I calculate the death rate as slightly over 17 per 1000 living. The amount of mortality amongst infants and children, as well as the sex, age and social position of all the persons whose deaths have been registered in the Sub-district within the year 1867, will be readily ascertained by the usual table which follows.— 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 From 1 to 5 years From 5 to 10 years Under 20 years, including all under 10 years At 20, and under 40 years of age At 40 and under 60 years of age At 60 and under 80 years of age 80 years and upwards Nobility and Gentry Professional Class, Merchants, Bankers, &c. Middle & Trading Class, Shopmen, Clerks, &c. Industrial and Laboring Classes DISEASES And other Causes of Death Classes:— 1. Zymotic Small Pox. 7 2 5 4 1 ... 5 1 1 … … … … 1 6 Measles 3 1 2 1 1 1 3 ... ... ... … … ... ... 3 Scarlatina 5 3 2 2 2 1 5 ... ... … … … 1 2 2 Diphtheria 3 2 1 ... … 1 1 ... … 2 … … … 1 2 Quinsy … ... … ... … … … … … … … … … … … Croup 5 3 2 ... 5 ... 5 ... ... ... … … ... 1 4 Whooping Cough 7 3 4 5 2 … 7 … … … … … … 2 5 Typhus, &c. 10 4 6 ... 2 1 7 ... 2 1 … … 1 2 7 Erysipelas ... ... … … … … … ... … … … … … … … Metria, Childbirth 1 … 1 … … … … … 1 … … … … … 1 Carbuncle … ... ... ... ... ... … ... … … … … ... ... ... Influenza ... ... ... ... ... ... … ... ... ... … ... ... ... ... Diarrhœa & Dysentery 21 7 14 15 1 … 17 1 1 2 … … 1 8 12 Cholera … ... ... ... … ... … … ... ... … … … … … Totals of Zymotic Class. 62 25 37 27 14 4 50 2 5 5 ... … 3 17 42 2. Tubercular 59 26 33 3 6 3 19 19 21 … … … 2 21 36 3. Of Brain, Nerves, &c. 63 29 34 18 9 3 30 6 8 18 1 … 5 25 33 4. Of the Heart, &c. 33 17 16 1 ... ... 3 3 14 12 1 … 3 14 16 5. Of Respiratory Organs 66 36 30 18 5 1 25 4 15 20 2 … 3 22 41 6. Of Digestive Organs 21 12 9 8 ... 1 9 2 6 4 … … 2 7 12 7. Of Urinary Organs 7 5 2 … ... … ... 2 1 4 … … … 4 3 8. Of Organs of Generation 3 … 3 … … … … 1 … 2 … … … 1 2 9. Of Joints, Bones, &c. 4 2 2 ... … ... ... 1 2 1 … … 1 2 1 10. Of Skin 1 1 … ... ... … ... ... 1 … … … … … 1 11. Premature Birth, Low Vitality, Malformation, &c. 42 27 15 42 … … 42 … … … … … 1 9 33 12. Of Uncertain Seat 8 1 7 2 1 ... 3 … 2 2 1 … 1 1 6 13. Age 44 12 32 ... ... ... ... … … 21 23 … 5 9 30 14. Violence 7 6 1 2 ... ... 3 2 2 … … … … 2 5 15. Not Specified 31 9 22 27 7 ... 8 2 11 10 … … 4 13 14 Totals 451 208 243 128 35 12 192 44 88 99 28 ... 29 147 275 23 The number of deaths of infants and children from birth to 10 years of age, it will be seen, was 175, which is a favorable rate compared with that of the preceding year, when it was 201. The deaths due to Zymotic diseases at all ages, and amongst all classes, were 62, which is a less number by 34 than in the preceding year. It is satisfactory also to find so many persons living beyond the natural age of man, the table showing that as many as 83, ranging from 70 to 90 years and upwards, succumbed to the infirmities and maladies inseparable from old age. These facts, it is submitted, show incontestibly the high value of sanitation, and should reconcile us somewhat to the heavy expenses incurred in the attainment of so gratifying a status amongst the parishes included in the Wandsworth district as that now held by Clapham. Zymotic Diseases.—The comprehensive table which follows exhibits the comparative number of deaths from the seven principal Zymotic diseases in 12 years, from 1856 to 1867, inclusive. years. 1856 1857 1858 1859 1860 1861 1862 1863 1864 1865 1867 Small-pox. 1 0 1 9 6 6 1 11 3 7 10 7 Measles 14 2 14 2 20 0 6 24 12 7 18 3 Scarlatina. 9 8 25 26 24 22 13 28 11 11 6 5 Diphtheria 0 0 0 0 9 13 3 1 2 4 5 3 Whoopingcough 4 13 13 6 21 14 14 9 10 15 14 7 Typhus 4 7 11 12 6 5 8 6 14 11 16 10 Diarrhœa 4 27 16 11 5 16 7 16 11 20 17* 21 Totals 36 57 80 66 91 76 52 95 63 75 86 56 * The 17 deaths recorded in 1866, comprehend the 4 deaths from Cholera that took place during that year. 24 With reference to the first disease named in the table, it may be remarked that the deaths due to that malady were three less than in 1866, though at the same time it cannot be contended, that with all the facilities afforded to the public for vaccination, a mortality of 7 from Small-pox is a slight one, or one which at all justifies us in relaxing in our endeavours to still further reduce such mortality. Of the 777 infants born in the parish in 1867, the parents of 272 only had recourse to public vaccination for the protection of their children. It is true as many as 302 persons of all ages were vaccinated by me as the public vaccinator, but of these 30 were re-vaccinations. It is a noteworthy fact, also, that 35 of the number above stated were primary vaccinations of members of families whose ages ranged from 2 to 40 years, and who, for the most part, appeared to have been frightened into a submission to the operation by the circumstance of having at the time relatives or friends in close proximity, either dead or dying of small pox. While such a state of things exists, it is little wonder that this fearful disease should so repeatedly invade our densely populated locality. Year after year I have spoken strongly on this subject, yet the thoughtless and unreflecting are, I find, as averse as ever they were to take timely advantage of the means of averting or of rendering the disease less fatal, which is to be found in carefully performed vaccination at a proper age. With regard to the mortality due to the other principal diseases of the Zymotic class, a glance at the table will show how very favoured has been this sub-district during the past year. The low mortality from fever is also a most gratifying result of judicious sanitation. Disease and Mortality amongst the Union Poor.—The table No. 5, Appendix, needs no comment. It shows that 60 deaths took place amongst this class. Of 1,073 cases treated during the year, this is not an unusual death-rate, 26 though it is certainly somewhat greater in proportion to the number treated in the preceding year. Violent and sudden Deaths.—Deaths from Doubtful causes.—Coroner's Inquests.—It appears that 13 Coroner's Inquests took place in 1867. The verdicts returned were, deaths from accident, 3; from suicide, 3; from natural causes, 5; found dead (cause of death unknown), 1. The same irregularities as I have referred to in many of my previous reports, and as it appears to me in utter defiance of the provisions of the Registration Act, have been practiced during the year; and I cannot help thinking there is no judicial proceeding in this country that needs reforming so much as that of the Coroner's Inquisition. Sanitation of the Year.—Upon this subject I beg to reproduce a passage from my first contribution to the Annual Report of the Medical Officers of Health; and I do this because it has been most satisfactory to me to find that nearly every improvement suggested by me more than 12 years ago has either been already realized, or in a fair way of becoming so. "A more complete system of tunnel sewerage, more substantially built, and far more capacious than at present, appears to be much needed, as is also a system of tubular pipe drainage for house purposes. " Owing to the elevated site of this parish, drainage becomes an easy matter. On almost every side there is a good fall for surface and underground drainage, and I believe, if these were sufficiently carried out, Clapham might be rendered one of the most healthy districts of the Metropolis, as, by such means, we should get rid of that most revolting abomination, the cesspool system." The completion, since the above was written, of about 15 miles of new sewers, at a cost of over £60,000, can have left, it is hoped, but few cesspools to be dealt with; and it is with no small amount of satisfaction that I perceive a prospect of their speedy and total abolition. The table, No. 6, Appendix, further shows, that an 26 ampled amount of other sanitary work has been accomplished during the year. In addition to what appears in the table, all the slaughterhouses, cowhouses, and bakehouses in the parish have, as in previous years, undergone the most careful inspection. It may be stated that some of the proprietors of premises used for the above named purposes, and requiring to be licensed, gave a large amount of trouble before complying with the law; but such obstinacy clearly points to the necessity of a constant supervision of these places. JOHN MAC DONOGH, Medical Officer of Health for Clapham. 27 BATTERSEA. In the fifty-two weeks constituting the year 1867, there were registered in the Sub-district 870 deaths (439 males, and 431 females). The births in the same period were 1,734 (913 males and 821 females). The excess of births over deaths is therefore 864, which is greater by 388 than it was in the preceding year. It is satisfactory also to find that the deaths were fewer by 132 than in 1866. In my last report I assumed upon good authority, that the population had nearly or quite doubled itself since the census of 1861, and that it amounted in the year 1866 to (in round numbers) 39,700. Adding now the natural increase or the excess of births over deaths for the year 1867, and allowing only an equal number for increase by immigration, the number of inhabitants must considerably exceed 41,000. If this be so the mortuary rate must have been brought down from 25 to something under 21 per 1,000 living. The following carefully compiled table will furnish, as usual, the necessary particulars concerning the deaths that have been registered within the year, and will further show the social position of the deceased, as well as their lex and ages at eight periods of life. 28 STATISTICS OF MORTALITY. BATTERSEA. Population in 1861—19,852. Area in Statute Acres—2,343 DISEASES, And other Causes of Death. Total Deaths from each Class of Disease, &c., in the Sub-District. Sex. Age. Social Position. Males. Females. Under I year. From 1 to 6 years. From 5 to 10 years. Under 20 years, including all under 10 years. At 20, and under 40 years of age. At 40, and under 60 years of age. At 60 and under 80 years of Age. 80 years and upwards. Nobility and Gentry Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. Classes— 1. Zymotic Small Pox 11 8 3 4 4 2 10 ... 1 ... ... ... ... 3 8 Measles 14 9 5 3 10 1 14 ... ... ... ... ... ... 6 8 Scarlatina 18 9 9 1 12 4 18 ... ... ... ... ... 1 6 11 Diphtheria 2 1 1 1 1 ... 2 ... ... ... ... ... ... 2 ... Quinsy 1 ... 1 ... ... 1 1 ... ... ... ... ... ... ... 1 Croup 10 5 5 3 7 ... 10 ... ... ... ... ... ... 7 3 Whooping Cough 19 6 13 9 9 1 19 ... ... ... ... ... 1 9 9 Typhus and Infantile Fever 19 8 11 ... 4 7 14 3 ... 1 1 ... 1 8 10 Erysipelas Metria, 3 2 1 1 ... ... 1 1 1 ... ... ... ... ... 3 Childbirth 7 ... 7 ... ... ... 1 4 2 ... ... ... ... 2 5 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza Diarrhoea & Dysentery 35 21 14 20 9 1 30 ... ... 3 2 ... 2 10 23 Cholera 4 2 2 2 2 ... 4 ... ... ... ... ... ... 2 2 Totals of Zymotic Class 143 71 72 44 58 17 124 8 4 4 3 ... 5 55 83 2. Tubercular 185 90 95 68 36 5 115 42 22 6 ... ... 8 66 111 3. Of Brain, Nerves, &c. 142 72 70 50 43 2 97 8 10 25 2 ... 1 53 88 4. Of the Heart, &c. 26 12 14 1 1 ... 4 5 7 10 ... ... ... 14 12, 5. Of Respiratory Organs 159 84 75 43 47 2 94 3 22 35 5 1 4 63 91 6. Of Digestive Organs 16 11 5 4 ... ... 4 1 6 5 ... ... 1 7 8 7. Of Urinary Organs 8 8 ... ... ... ... ... 1 5 2 ... ... ... 2 6 8. Of Organs of Generation 11 ... 11 ... ... ... 1 5 2 3 ... ... ... 3 8 9. Of Joints, Bones, &c. 2 1 1 ... ... ... 2 ... ... ... ... ... ... ... 2 10. Of Skin 8 2 4 4 ... 1 5 ... 1 ... ... ... ... 1 5 11. Premature Birth, Low Vitality, Malformation, &c. 66 31 35 66 ... ... 66 ... ... ... ... ... 2 17 47 12. 0f Uncertain Seat 86 19 17 1 1 1 8 7 10 10 1 1 3 10 22 13. Age 32 17 15 ... ... ... ... ... ... 18 14 1 1 15 15 14. Violence 22 16 6 2 3 2 11 4 4 3 ... ... ... 8 14 15. Not Specified 16 5 11 9 1 ... 10 1 2 3 ... ... ... 7 9 Totals 870 439 431 292 190 30 541 85 95 124 25 3 25 321 521 29 Infant Mortality.—Although it may be very gratifying to refer to the evidently decreasing mortality of the Subdistrict, it is the very reverse of being so to find that nearly two-thirds of the deaths registered in 1867 have been of infants and young persons, varying in age from birth to 20 years. This it must be confessed, is a most melancholy feature of the table, since it discloses the fact that of the 870 deaths, as many as 292 were of infants under 1 year, 190 of children from 1 to 5 years, 30 from 5 to 10 years, and 29 of young persons from 10 to 20 years of age. This mortality of youth, large as it appears in the table, is, perhaps, no greater than is found in many manufacturing localities. Uncertified Deaths.—Another equally sad circumstance connected with this part of my report is, that as many as 24 deaths were registered during the year as having occurred (chiefly among the children of the labouringpoor), the causes of which were not certified—that is to say, were registered on the vague information afforded by unprofessional persons, no medical advice having been sought for or obtained during the closing hours of existence. Without the coroner's inquisition, or post mortem examination, who could say how many of these uncertified deaths were due or not to other than natural causes 1 Zymotic Diseases.—A somewhat large amount of mortality from this class of diseases occurred during the year, but I am pleased to state the fact of the deaths due to the seven principal epidemics having been less by 122 than the number recorded in the preceding year, when they amounted to 244. As many as 20 deaths were registered in 1866 as having been due to Small-pox, but in the past year 11 only were recorded. The deaths due to Measles in the two years will be found to have fallen from 50 to 14 ; Scarlet Fever from 26 to 18 ; Whooping-cough from 51 to 19 ; and Fever from 30 to 19. There is also a considerable reduction in the mortality from Diphtheria and Choleraic disease. Other Diseases.—The mortality due to the Tubercular class of diseases has always been large in this Sub-district, 30 and necessarily so in a manufacturing suburb like Battersea, where the neglect of children by parents engaged in labour is most deplorable. Under the above heading in the mortality table there is noted 185 deaths, which is one less than occurred in the preceding year. Of these 185 deaths no less than 83 were due to Pulmonary Phthisis. There is likewise a considerable decrease from the preceding year's mortality in the number of those who succumbed to Diseases of the Brain and Nerves, to Heart affections, to maladies connected with the Digestive Organs, and to Violence ; but the deaths resultingfrom Premature Birth, Low Vitality, and Malformation, are more by 29 than the number recorded under that heading in 1866. The total deaths from all causes compared with that of 1866, shows, as I have already observed, a considerable decrease, amounting to as many as 132 in favour of the past year. Ages at Death. — I have already remarked upon the excessive infant mortality. Amongst persons of advanced life the numbers of deaths under various ages do not exhibit any remarkable disparity, but the number dying of old age is less by 11 than that recorded in the table of my last report. Of those who at the time of death were labouring under some form of disease, often associated with old age, there were two who had reached their 95th year. There are also to be found on the year's register 26 between 70 and 80 years of age, 6 between 80 and 90, and 3 (inclusive of the two at 95) between 90 and luO. Mortality in the Workhouse and among the Out-door Union Poor.—Of the total number of deaths (870), 125, or about a seventh of the whole, were inmates of the workhouse at the time of their decease, 51 only however belonged to the parish of Battersea. The remainder of these workhouse deaths (74) being deducted from the total will, of course, reduce the mortality proper to the parish to 796, and consequently make a corresponding difference in the death-rate per 1000, referred to at the commencement of my report. I may here observe that 35 persons died in the infirmary of the Union at advanced ages, that is to say, between 70 and 95 years. The amount of sickness among the out-door Union poor 31 during the year, as well as the number of resulting deaths, will be easily ascertained by a reference to Table V. in the Appendix. The per centage of deaths to the cases treated will be found to be by no means large, the proportion they bear to each other being 57 deaths to 2,547 cases. Violent Deaths—Inquests.—The deaths due to violence and to other causes than actual disease, were greatly less than they were in 1866. There were 36 inquests held during the year, and verdicts were returned as follows :— Excessive drinking 2 ; accidents from falls, or being crushed or run over by engines, street carriages, &c., 7 accidentally drowned 5 ; burns and scalds 3 ; suicides 2 ; manslaughter 1 ; sudden, though natural deaths from disease 11 ; and, found dead, no evidence of cause of death 5. Sanitation during the Year.—The Table VI. in the Appendix, indicates much accomplished sanitary work— work which it is believed will show results, both now and in the future, highly satisfactory to the inhabitants generally. The employment of an extra inspector during the year has been of essential service in effecting the removal of a great number of nuisances, but, perhaps, the most satisfactory item in the table is that which refers to the construction of 26,068 feet of new sewerage. Among ihe important duties of the inspector of nuisances, one has been most satisfactorily fulfilled by the seizure of a quantity of fish (159 lbs.), proved to be unfit for human consumption, besides preventing the sale of other unwholesome food. It was hardly to be expected that the large amount of sanitation referred to in the table should be accomplished without some few appeals being made to magisterial authority; accordingly, we find that 7 cases of complaint were investigated at the District Police Court, and that 5 compulsory orders were there obtained. It is satisfactory, however, to state that, apart from producing the requisite evidence to secure these orders, it was not necessary to resort to any very unpleasant means of enforcing the qqtyip WM. CONNOR, Medical Officer of Health of the Sub-district, of Battersea. 32 STREATHAM, including TOOTING AND BALHAM. In reviewing the sanitary proceedings of the past year, (1867) as they relate to this Sub-district, the first point that offers itself for congratulatory notice is the difference in the amount of mortality when compared with that of the preceding year. The annexed table will show that the deaths from all causes, and amongst all classes, were considerably fewer during the past year than during 1866. Another fact, and perhaps one of equal importance, is, that the decrease referred to is almost entirely confined to the deaths registered as having resulted from the Zymotic class of diseases—from those diseases which it is the especial object of sanitation to deal with, and as far as it is possible, to lessen the fatality of. In the table which accompanied my report for 1866, there will be found recorded as many as 38 deaths registered as being due to Zymotic maladies, but it is satisfactory to note that in the present table there appears but 13, which is 25 less than the number dying of these diseases in the preceding year. The total deaths registered within the 52 weeks of 1867 being 156, and the total births .308, it follows that the excess of the latter over the former (152) will correctly represent the year's natural increase of population ; but what the increase by the influx of new residents may have been in the same period, it is not so easy to determine. From the building operations incessantly going on in the Sub-district, there are however good grounds for believing there is a two-fold greater increase, within a given period, from immigration than from that derived from the excess of births over deaths. Under any circumstances the increase has been such during the past year, and since my last report was rendered, as to quite justify the assumption that the death rate does not, nor cannot, greatly exceed, if it even reaches, 14 per 1000 living at the present time. 33 STATISTICS OF MORTALITY. STREATHAM, INCLUDING TOOTING & BALHAM. Population in 1861—10,082. Area in Statute Acres—3,465 DISEASES, And other Causes of Death Total Deaths from each Class of Disease, &c., in the Sub-District. Sex Age Social Position Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 year 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 50 and under 90 years of age. 80 years and upwards. | Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle & Training Class, Shopmen, Clerks, &c. Industrial and Laboring Classes. Classes:- 1. Zymotic, Small Pox 2 ... 2 • •• 2 ... 2 ... ... ... ... ... ... ... 2 Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlatina 1 ... 1 ... ... 1 1 ... ... ... ... ... ... ... ... Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 2 1 1 1 1 ... 2 ... ... ... ... ... ... 1 1 Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus and Infantile Fever 5 3 2 ... 1 ... 1 3 1 ... ... ... ... 1 4 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Metria, Childbirth 1 i ... ... ... 1 Carbuncle ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... Diarrhoea & Dysentery ... 2 ... 2 ... ... 2 ... ... ... ... ... ... ... 2 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 13 6 7 3 4 1 8 3 2 ... ... ... ... 2 11 2. Tubercular 23 12 11 4 2 ... 8 9 4 2 ... ... 3 11 9 3. Of Brain, Nerves, &c. 25 13 12 7 5 ... 12 ... 2 10 1 2 4 8 11 4. Of the heart, &c. 12 7 5 ... 1 1 2. ... 4 6 ... 1 1 5 5 5. Of Respiratory Organs 25 12 13 5 2 ... 7 3 ... 13 2 l 1 10 13 6. Of Digestive Organs 7 5 2 1 ... ... 1 1 1 4 ... 3 1 1 2 7. Of Urinary Organs 9 5 4 ... ... ... 1 2 5 1 ... 1 2 5 1 8. Of Organs of ration 4 ... 4 ... ... ... ... 1 3 ... ... ... 1 ... 3 9. Of Joints, Bones, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Of Skin 1 ... 1 1 ... ... 1 ... ... ... ... ... ... 1 ... 11. Premature Birth, Low Vitality, Malformation, &c. 7 4 3 7 ... ... 7 ... ... ... ... ... 2 1 4 12. Of Uncertain Seat. 4 2 2 ... ... ... ... ... 2 2 ... 1 1 1 1 13. Age 12 5 7 ... ... ... ... ... ... 3 9 7 ... 2 3 14. Violence 10 8 2 ... ... ... 1 2 4 3 ... ... ... 2 8 15. Not Specified 4 2 2 3 ... ... 3 ... 1 ... ... ... ... 1 3 Totals 156 81 75 31 14 2 51 21 28 44 12 16 16 50 74 c 34 Comparative Mortality from Zymotic and other Diseases.—With the exception of the deaths registered as having been due to diseases of the respiratory organs (which were less by 15 than in 1866), there is nothing particular in that portion of the table relating to the mortality from diseases not Zymotic, requiring to be commented upon. Under some of the headings, when compared with those in the table of 1866, there is found a slight increase of deaths ; but again, under others, the numbers are slightly less than in the preceding year, so that the balance is pretty well preserved in respect to the total number. Precisely the same number of persons succumbed during the past year to Pulmonary Phthisis as in the preceding one, viz., 16. Of the deaths due to the seven principal Zymotic diseases, the greatest decrease is observable under the heading Whooping Cough, the mortality from which, from 7 cases in 1866, fell to none in the past year's record. The deaths from Small-pox were 2 in the past, against only 1 in the preceding, year. To Fever, Measles, and Diarrhoea, fewer persons have succumbed than in 1866, and no deaths in the past year were registered from Diphtheria. This is altogether very satisfactory. Violent deaths.—The deaths from violence, including those from accident, negligence, and from suicide, were 11, upon all of which Coroner's Inquests were of course held. The accidental burning of four adult male persons, from the taking fire of a house at Tooting, was an appalling circumstance, and scarcely less distressing were the suicides of two persons, the one by hanging, and the other by drowning, while in an unsound state of mind. Besides these, two male persons were accidentally crushed to death by carriages on the railway, and another by a large quantity of hay falling on the person, and causing suffocation. A lad aged 12 also died from hanging by misadventure. There were likewise four inquests held on the remains of persons dying suddenly, though evidence was subsequently adduced showing that the cause of death in each instance was perfectly natural. 35 Ages at death. — There appears to have been about the average number of deaths of aged people, viz. 44 from 60 to 80, and 12 from 80 years and upwards, the oldest being 90. In the last year's table the numbers under these ages were respectively 43 and 11, and the oldest person dying had reached her 100th year. Of the number of aged people dying during the past year, 12 are certified as having succumbed to natural decay without the intervention of any specific disease. Concerning the mortality which befell the infantine and youthful portion of the population in 1867, it is most satisfactory to be able to report that the deaths between birth and 10 years of age were 18 less than in the preceding year, or in the proportion of 47 to 65. Sickness and Mortality amongst the Union Poor.—The Union Medical Officers appear to have had under treatment during the year, as ascertained from the Medical Relief Books, 263 cases of sickness, accident, &c., with the result of only 19 deaths. This is a small percentage, and speaks well for the salubrity of the Sub-district, so far as the poor are concerned. The worst feature of the table (No. V., Appendix,) is, that as many as 19 cases of Small-pox were treated in this Sub-district, amongst the Union poor, and resulted in two deaths. The new enactment relating to vaccination will, it is hoped, render the recurrence of so many cases of small pox all but impossible. Social Position of the Deceased Persons.—Of the four classes of persons noted in the mortality table, that of the labouring population has contributed to the register, as usual, by far the greatest number of deaths, compared singly, with any of the other three classes. But it is satisfactory to find that 74 only of the industrial poor succumbed in the last year, against 86 in the previous year : and it is equally satisfactory to be able to state, that there were less deaths by 2 amongst the labouring class (including the union poor), than took place, amongst the three classes above them, collectively. c 2 36 Sanitation during the Year.—Another source of gratification is derived from the proofs that are daily manifesting themselves of the value of good sewerage. It will be seen, by a reference to the column relating to the sanitary works completed in this Sub-district (Table VI., Appendix) that 54,037 feet of new sewers have been constructed, ensuring to localities previously but ill supplied with drainage, the means of getting rid of much that was formerly permitted to stagnate in cesspools and open ditches, to the great detriment of the public health. Besides the various inspection and the removal of a great many complained of nuisances, (the number and description of which are specified in the Table,) the usual report, with a view to a renewal of licenses, was made on the condition of all the cow-houses and slaughter-houses within the Sub-district, and I am pleased to state that but little complaint could be urged against the manner in which the provisions of the Acts of Parliament regulating these places had been complied with. Finally, I can assert with confidence that every effort is still being made by the local executive officers to sustain, and to add to, the important sanitary operations that have been carried out under the authority of the District Board of Works in this improving locality. D. C. NOEL, Medical Officer of Health for Streatham, Tooting, and Balhain. 37 PUTNEY AND ROEHAMPTON. Of the several duties attached to the position of a Medical Officer of Health, that of periodically reporting on the hygienic resources, &c., of his locality, is one of the most important; and it may be remarked that the investigation necessary for the due fulfilment of this duty, will generally acquire an additional interest, when in the results disclosed there is found — as it is hoped is the case in this report—some evidence of real and unmistakable progress. The year 1867, unlike that of the preceding one, happily passed over without the occurrence of any serious epidemic, and, moreover, did not necessitate the adoption of any special or extraordinary measures of precaution. It will be quite unnecessary, therefore, to occupy so much space as ha some former reports, in commenting upon the sanitary experiences and events of the period. The statistics embodied in the appended tables may indeed, to a greater extent than usual, be suffered to speak for themselves, and if duly compared with those in previous reports, will, it is believed, alone afford no slight evidence of the steady advancement that is being made in this Sub-district in everything that is calculated to promote both the social interests and the sanitary welfare of its inhabitants. Increase of Population—Death-rate—Birth-rate. — The increase of population, calculated upon a due consideration of the excess of births over deaths, and especially of that addition which may be fairly attributed to immigration, is found to be much greater in 1867 than during any similar period within the past 12 years. 38 Although the estimate that was made in 1866 has not been very materially enlarged by the natural increase of the past year (the excess of births over deaths being 79 only), there are good grounds for believing that in the interval the increase by immigration has been unusually great, so that it is scarcely possible to arrive at any other conclusion than that a death-rate considerably under 17 per 1000, is still being maintained in this improving parish. It should be stated that the above is given as an approximate estimate only, since it is out of the power of any one, until the results of another census are known, to make any really accurate calculation upon this point, or one that would not be open to considerable objection on the score of unreliable information. Looking, however, at the large number of new dwellings that have been very recently erected, and to the circumstance of the majority of them being taken possession of by strangers almost as soon as completed, it is believed, if there be any error hi the above estimate, it is certainly not one on the side of exaggeration.* Statistics of Mortality.—The following table is the usual one employed in these reports by which to show the number of deaths that have occurred in the Sub-district during the year, as well as the diseases and other causes to which such deaths were certified as being due. From this table may also be gathered the sex, ages, and social positions of the deceased persons, and an amount of other information it would be scarcely possible to supply in any other form, keeping in view the great object of these tabulated statistics, viz.—the affording of facilities for a yearly comparison of results. * The surveyor, in a recent return, communicates the fact of there having been, during the year just ended 125 notices received for new dwelling-houses, '• the greater portion of which," he adds, " have been erected, and some few are still in progress." Giving to each newly erected house, the average number of inmates, (5*75), it follows that the population must have been somewhat largely increased by the influx of new residents during the past year. 39 PUTNEY and ROEHAMPTON. Population in 1861—6.481. Vrea in Statute Acres—2,176. DISEASES, And other causes of Death. Total Deaths from each class of Disease, &c., in the Sub-District Sex Age Social Position Males Females Under 1 year From 1 to 5 years From 5 to 10 years Under 20 years, including all under 10 years At 20, and under 40 years of age At 40, and under 60 years of age At 60, and under 80 years of age 80 years and upwards Nobility and Gentry Professional Class, Merchants, Bankers, &c. Middle and Trading Class,1 Shopmen, Clerks, &c. i Industrial and Labouring Classes Classes :— 1. Zymotic Small Pox 1 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlatina 1 1 ... ... 1 ... 1 ... ... ... ... ... ... ... 1 Diphtheria 2 1 1 ... 1 1 2 ... ... ... ... ... ... 1 1 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 9 5 4 1 8 ... 9 ... ... ... ... ... 1 4 4 Typhus & Infantile Fever 3 ... 3 ... ... ... 1 2 ... ... ... ... ... 2 1 Erysipelas.. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Metria, Childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza Diarrhœa & ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 4 2 2 3 1 ... 4 ... ... ... ... ... ... 1 3 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 20 10 10 4 11 1 17 3 ... ... ... ... 1 9 10 2. Tubercular 21 9 12 2 1 ... 7 12 2 ... ... 2 2 7 10 3. Of Brain, Nerves, &c. 19 8 11 4 3 1 8 1 3 6 1 1 2 5 11 4. Of the Heart, &c. 9 3 6 ... ... 1 4 1 ... 4 ... 3 2 2 2 5. Of Respiratory Or gans 20 10 10 6 2 ... 8 3 4 5 ... 1 1 6 12 6. Digestive Organs 9 3 6 ... ... ... 1 1 3 3 1 1 2 4 2 7. Urinary Organs 2 1 1 ... 1 ... 1 ... ... 1 ... ... ... 1 1 8. Of Organs of Generation 2 ... 2 ... ... ... ... 2 ... ... ... ... ... ... 2 9. Of Joints, Boues, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Of. Skin 1 ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... 11. Premature Birth. Low Vitality, Malformation, &c. 13 10 3 12 ... ... 13 ... ... ... ... ... 2 4 7 12. Of Uncertain Seat 2 1 1 ... ... ... ... ... ... 2 ... ... ... 2 ... 13. Age 5 2 3 ... ... ... ... ... ... 1 4 ... 1 ... 4 14. Violence 4 4 ... ... 2 ... 3 1 ... ... ... ... 1 ... 3 15. Not Specified 1 1 ... 1 ... ... 1 ... ... ... ... ... ... ... 1 Totals 128 62 66 29 20 3 63 25 12 22 6 8 14 41 65 40 Apart from a consideration of the mortality from zymotic diseases, which will form the subject of another section of this report, the most noteworthy points in the above table are:— 1. A slight increase in the total number of deaths from all causes (128), compared with that of the preceding year (121) —a by no means disproportionate one, however, seeing how great has been the increase of population since the last report was submitted. 2. A very small excess in the number of deaths of females over those of males, the proportion being 66 of the former to 62 of the latter. 3. An increase of 4 in the mortality due to Tubercular Disease, to which Pulmonary Phthisis contributes no fewer than 16 deaths of the 21 registered during the past year under that heading. 4. A somewhat considerable increase in the number of deaths under the heading, " Premature Birth, Low Vitality, and Malformation," but a decrease almost as considerable under that of " Violence." * The number of coroner's inquests in this Sub-district during the year was 4. Of these 2 were accidental; 1 suicide, and 1 natural, though sudden, from " Pulmonary Apoplexy." 5. A very satisfactory decrease of mortality amongst the labouring classes compared with that registered of the 41 three classes above them. The proportion in 1806 was 70 deaths of the labouring classes to 51 of three classes above them, but in the past year the numbers were nearly equal, viz., 65 of the former to 63 of the latter. 6. A large increase (comparing the numbers in the tables of the past and previous years, which are respectively 63 and 49) in the mortality of infants, and of children and young persons dying between the ages of 1 and 20 years. 7. A number exactly equal in the two years, (6), of persons dying at advanced ages, that is to say, at 80 years and upwards, (the oldest 95), an increase of 8 between 20 and 40, and a decrease of 12 and 2 respectively, in the number dying between 40 and 60, and between 60 and 80 years. Prevalence and Fatality of Zymotic Diseases.—The following table exhibits the relative proportion and per centage of deaths due to the seven principal epidemics 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. 1857 88 7 7.9 1858 118 20 16.9 1859 119 26 21.8 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 13.2 1867 128 20 15.6 Although 4 more deaths, it will be seen, took place from Zymotic diseases in 1867 than in 1866, a reference to the general table of mortality will show that this increase is more than accounted for by an unusual number of children 42 dying during the year of Whooping-cough. The Registrar General remarks in his annual report that, " Whoopingcough carried off many children all over London.'' In the entire Wandsworth district this disease appears to have been fatal during the past year in 43 cases, 9 of which were registered in this sub-district. The cause of this unusual fatality was doubtless the variable temperature which marked many of the months of 1867, during which the disease prevailed, and which was known to have led, in numerous instances, to the supervention of Pneumonia and other lung affections of a dangerous and fatal character. It may be remarked that but one death due to Whooping-cough took place in the Sub district in 1866. The average number of deaths from this disease for 12 years is 2 only, so that the 9 deaths in the past year is a strikingly disproportionate number. Small Pox and Vaccination.—Of 207 infants born in the parish in 1867, the public vaccination of 115 appears to have been accomplished and duly registered in that year. Hitherto it has not been possible to determine the number of vaccinations performed by the private practitioners of the Sub-district, since scarcely one of them have ever furnished the required certificates ensuring the due registration of their successful cases. The new Vacchiation Act, which came into operation on the 1st January of the present year (1868), will doubtless furnish, before its close, same accurate information upon which to judge of the necessity or otherwise of a still further amendment of the laws relating to this most important question. It cannot be said that the new measure has any claims to be considered a perfect one, nor is it one likely to ensure results that shall be entirely satisfactory to either the medical profession or the public. It is a step, however, in the right direction, inasmuch as it must have the effect of causing a more general resort to vaccination than has hitherto been the practice. The registration of every successful case of vaccination is, by the provisions of the new Act, supposed to be thoroughly secured ; for whether the operation has been performed by a private practitioner 43 or a public vaccinator, it is enacted that a certificate shall be given and that such certificate shall be forwarded to the registrar of the district in which the child's birth had been previously registered. If the vaccination has been performed by a public vaccinator, the Act enjoins that that public officer shall himself forward his certificate to the registrar; on the other hand, if performed by a private practitioner, such as the parents' or guardians' usual medical attendant, the responsibility is made to rest on such parent or guardian to execute that duty. As, however, the certificate can legally be sent to the registrar by post, unpaid, no difficulty need arise upon this point, indeed it . is tolerably certain that none will arise if the penal clauses of the measure are more rigidly enforced than have been those of former Acts. If they are not enforced it is almost needless to say the new Act will not only be entirely useless, but positively mischievous. Fever, its gradual decline, and diminishing fatality.— It is most satisfactory to find that the Sub-district continues free from epidemic fever. Nothing, it is believed, admits of clearer demonstration than that sanitation, particularly the carrying out of an improved system of sewerage, has done much to fortify the parish against invasion by a malady formerly much too prevalent and fatal. There have been years in which as many as 40 cases of Fever of a decided typhoid character have been treated by the District Medical Officer of the Union, with the residt of from 6 to 8 deaths, but during the past two years, and since the town portion of the main drainage has been in full operation in connexion with the great intercepting sewer, scarcely a case of this disease amongst the poor has even required treatment. One death due to Fever, it is true, is recorded as having taken place amongst the Union poor in the past year; but this case could be scarcely viewed as being other than a puerperal fever, supervening, as it did, upon difficult and dangerous parturition. It is submitted that such persons as persistently declare, and 44 refuse to be convinced of the contrary, that drainage has effected nothing for the real good of the parish, must be hopelessly prejudiced against all sanitation in this direction, if they can shut their eyes to such a fact as I have here ventured to refer to, and am able fully to substantiate by statistics in my possession.* Sickness and Mortality amongst the Union Poor.—The column in the table (No. V., Appendix) relating to the * That great improvement in the public health has everywhere followed the adoption of judicious and well matured sanitation, is a fact that is daily becoming more patent. By the sceptical on this point, the following may be read with advantage. " Sanitary Facts.—Some results of the works of drainage, sewerage, water supply, and cleansing, which, within the last few years have been accomplished in various towns in England, may be stated in figures that cannot be too well known. In Cardiff the monstrous mortality of 33 2 per 1000 per annum has been brought down to 22.6, and in Newport the ratio of 318 per 1,000 has given place to 21.6— reductions of 32 per cent., or allowing for cholera and dysentery, 23 per cent. In Salisbury, Croydon, Macclesfield, and Merthyr, the mortality has been reduced by a fifth. In Ely, the reduction—the saving of life—has amounted to 14 per cent, per annum; in Banbury to nearly as much. Dover has only saved 7 per cent., but its death rate was previously moderate for an unreformed town. In Leicester, the total reduction is but 4£ per cent., but the fatality of typhoid fever is little more than half what it was. So also the reduction of the general rate of mortality is not strikingly great at Cheltenham, but its former rate, 19.4 per 1,000 was not high ; and its death rate by typhoid fever, only 8 per 10,000 before, has been reduced below 5 per 10,000. In Bristol the full completion of the works has been too recent for an estimate of their results, but typhoid fever has lost about a third of its fatality, and in so large a town important savings of life result from even small per-cental reductions of mortality. The death rate by typhoid fever has fallen in Salisbury to a fourth of what it was; in Croydon and Stratford-on-Avon, to about a third ; in Banbury, Warwick, Ely, Penrith, Macclesfield, Ashby-de-laZouch, about half. The improvement in the cholera rate at each successive epidemic in the towns reported by Dr. Buchanan, from whose report to the medical officer of the Privy Council these statements are compiled, is equally striking. It is also shown that the drying of the soil, which has in most cases accompanied the laying of main sewers in the improved towns, appears to have led to the diminution of the mortality from consumption—a diminution approaching 50 per cent, in Salisbury and Ely; exceeding 40 per cent, in Rugby and Banbury ; amounting to about a third in Worthing, Leicester, Newport and Macclesfield, a fourth in Cheltenham, a fifth at Dover and Warwick, a sixth at Bristol. Cardiff and Croydon, a tenth at Merthyr. Only one-fifth of the towns here reported on have appointed a medical officer of health, and Bristol, with apparent timidity, only recognizes him as a " medical inspector; " but in various towns the medical practitioners have given their fellow-townsmen valuable unpaid services in the work of stopping the waste of life. Mr. Simon, in presenting in his report these and similar statements relating to 25 English towns, with an aggregate population exceeding 600,000, observes that medical science could not from the first regard these great popular experiments in the managemeut of the public health as of doubtful promise, but to the popular mind they had to be judged by their actual fruits. The splendid results which have already been secured may serve not only to confute persons who have despaired of any great preventability of disease, but also to justify in the public eye, and to encou rage in their noble labour, those who for years have been spending their powers in this good work." 45 Union poor of this Sub-district, needs only to be glanced at to obtain strong evidence of the fact that has just been alluded to, viz., that sanitation is still doing much to lessen the death-rate amongst the labouring classes. During the year 1866 the Medical Relief Book of this District of the Union contained a record of 1.0 deaths of 388 cases treated. During the past year, it appears by the same record that 14 deaths only of 421 cases treated, occurred amongst the out-door poor belonging to this parish. It hardly admits of a doubt, then, that we are beginning to reap no slight advantages from efficient sewerage, and other sanitary measures carried out and sustained in neighbourhoods inhabited by the indigent classes. Could overcrowding in such localities be more effectually prevented than it is at present, there is much reason to believe that even this low death-rate might, in a short time, be still further reduced. Summary of Sanitary proceedings during the year.— Although it may seem scarcely necessary to offer a single comment on that portion of the general table, (No. VI., Appendix,) which exhibits so perspicuously the amount and character of the sanitary work accomplished in this Sub-district during 1867, it may not be out of place to make a passing remark upon the almost incredible extent of main and branch drainage that has been constructed within the past 8 or 9 years, with such great advantage to the parish. Putting together the figures annually furnished by the Surveyor, from no further back than 1860, it appears that no less than 59,422 feet of new sewers and drains of various dimensions are in full operation within the parish at the present time. There were, it is believed, a considerable number of feet of new drainage executed before the year 1860, but since then it is calculated that an amount of this necessary and valuable work has been completed equal in extent to rather more than 11¼ miles ! Nothing, it is believed, could be more satisfactory than the manner in which the extensive works referred to, have been throughout executed by the several contractors engaged. Down to the present time the utmost diligence, compatible with good workmanship and stability of 46 struction, has been used to bring the whole system of sewerage in this Sub-district into practical operation. The only drawback, and it is confessedly a very serious one, to the thorough efficiency of this great undertaking, is the difficulty, (not however confined to this district, but appearing to be very generally deplored wherever works of this kind have been carried out) of obtaining the ventilation of the sewers without the necessity of placing the gratings, &c., for the escape of the generated gases, in the most frequented and exposed parts of the public thoroughfares and streets. Though difficult of remedy, it is hoped that science and engineering skill will not be long in devising something towards the abatement at least of this acknowledged evil. With regard to the recent Act for regulating the hours of labour of women and children in factories and workshops, which is just now exciting considerable notice, it is to be greatly apprehended that the condition of those whom the measure was intended to benefit will be but very slightly improved, unless some more effective machinery than that now employed for working its provisions, can be adopted. " In the regulation of their hours of labour," remarks a public writer upon this subject, " they (the labouring classes), see only the limitation of their wages, and of course in their poverty and necessity such a limit is eminently distasteful to them. The police cannot enforce the law in the places where it is most necessary, therefore no change is made in the old disastrous state of affairs." Happily in this Sub-district there exists scarcely an establishment to which the Act referred to will apply, and I have reason to believe there have been no attempts to evade any of its provisions on the part of employers in this locality. Besides the usual report submitted to the local authorities upon the condition of the slaughter and cowhouses in the Sub-district, the sale of adulterated food and of provisions unfit for human consumption, has been a matter not overlooked, though it is one which the present 47 feet state of the law, and the want of a public prosecutor, necessitates the greatest circumspection in dealing with. I am pleased to report that during the past year no sales or frauds of the kind referred to were detected or brought under the notice of the authorities in this parish. In concluding this report, I must once more venture to urge upon the attention of the authorities the still unsatisfactory arrangements for the supply of water in some few localities within the Sub-district. The intermitting system of the companies, as well as the supplies drawn from surface wells, and from wells in the vicinity of cesspools or drains, where there is danger from the percolation of fœecal matter, are still to be deprecated and deplored throughout the entire Wandsworth District—the one as affording an inadequate amount for closet-flushing and other domestic purposes, and the other, a most unwholesome, not to say in many instances, poisonous supply of one of the greatest necessaries of life. I have heard it frequently expressed as appearing somewhat extraordinary, that the decision in the well-known case of " The Wandsworth District Board of Works v. Tinkler," has not yet led to ar^y effectual amendment of the Metropolis Local Management Act, upon the closet question, since very many houses inhabited by the labouring poor throughout the District (I can point to some few such in this parish) are still found to be entirely without water for the purposes indicated—a long-existing evil, for which there is no excuse, but which past legislation appears to have entirely failed to remedy. B. HA11LAND WHITEMAN, Medical Officer of Health for Putney and Roehampton. APPENDIX OF STATISTICAL TABLES. TABLE I. Summary of Deaths and their Causes, registered in the Entire District during 1867, classified according to Sex, Age, and Social Position, and showing also the relative Numbers in each Sub-District. POPULATION OF ENTIRE DISTRICT, In 1861, 70,381. Area in Statute Acres, 11,695. DISEASES, And other Causes of Death. Total Deaths from each Class of Disease, &c., in the Entire District. Sub-Districts. Sex. Age. Social Positios 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. 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. Prolessional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and labouring Classes. Classes:— 1. Zymotic 'Small Pox 24 7 3 11 1 2 13 11 8 8 2 18 4 2 ... ... ... ... 5 19 Measles 18 3 1 14 ... ... 10 8 4 12 2 18 ... ... ... .... ... ... 6 12 Scarlatina. 32 5 7 18 1 1 18 14 3 21 7 32 ... ... ... ... ... 2 10 20 Diphtheria 8 3 1 2 2 ... 4 4 1 3 2 6 ... ... ... 2 ... 1 4 3 Quinsy 1 ... ... 1 ... ... ... 1 ... ... 1 1 ... ... ... ... ... ... ... 1 Croup 26 5 9 10 ... 2 13 13 6 20 ... 26 ... ... ... ... ... ... 11 15 Whooping Cough 41 7 6 19 9 ... 18 23 18 22 1 41 ... ... ... ... ... 2 15 24 Typhus and Infantile Fever 44 10 7 19 3 5 18 26 1 7 9 26 9 6 2 1 ... 9 13 29 Erysipelas Metria, 4 ... 1 3 ... ... 2 2 1 ... ... 1 1 2 ... ... ... ... 1 3 Childbirth 10 1 1 7 ... 1 ... 10 ... ... ... 1 4 5 ... ... ... ... 2 8 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Infuenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 69 21 7 35 4 9 34 35 43 11 1 56 2 2 7 2 1 3 19 46 Cholera 5 ... 1 4 ... ... 2 3 3 2 ... 5 ... ... ... ... ... ... 2 3 Totals of Zymotic Class. 282 62 44 143 20 13 132 150 88 106 25 231 20 17 9 5 1 10 88 183 2. Tubercular 388 59 50 185 21 23 164 174 86 52 13 177 91 61 9 ... 2 16 114 206 3. Of Brain and Nerves 306 63 57 142 19 25 152 154 85 64 6 158 93 44 75 6 6 16 100 184 4. Of Heart 101 33 21 26 9 1 9 45 56 3 2 3 16 11 29 42 1 5 6 39 51 5. Of Respiratory Organs 316 66 46 159 20 25 165 151 88 63 4 158 17 49 82 10 3 10 108 195 6. Of Digestive Organs 76 21 23 16 9 7 35 41 18 1 1 22 10 21 22 1 5 9 25 37 7. Of Urinary Organs . 29 7 3 8 2 9 21 8 ... 1 ... 2 6 11 10 ... 1 3 14 11 8. Of Organs of ration 24 3 4 11 9 4 ... 24 ... ... ... 1 11 6 6 ... 1 1 6 16 9. Of Joints, Bones, &c. 8 4 2 2 ... ... 4 4 ... ... ... 2 1 3 2 ... ... 1 2 5 10. Of Skin 11 1 2 6 1 1 5 6 5 ... 1 8 1 2 ... ... ... ... 3 8 11. Prematura Birth, Low Vitality, Malformation, &c. 149 42 21 66 13 7 85 64 148 ... ... 149 ... ... ... ... ... 8 32 109 12. Of Uncertain Seat . 64 8 14 36 2 4 30 34 3 4 1 13 8 15 26 2 2 6 17 39 13. Age 125 44 32 32 5 19 45 80 ... ... ... ... ... ... 62 63 9 9 35 72 14. Violence 56 7 13 22 4 10 44 1? 7 5 2 22 1 4 14 6 ... 1 1 13 41 15. Not Specified 52 31 ... 16 1 4 17 35 40 8 ... 22 3 14 13 ... ... 4 21 27 Totals 1937 451 332 870 128 156 944 993 571 306 56 981 218 286 364 88 36 100 617 1184 49 TABLE II. Births registered during the year ended 31st December, 1867. SUB DISTRICT. Males. Females. Total. Clapham 398 379 777 Wandsworth 276 312 588 Battersea 913 821 1,734 Putney and Roehampton 111 96 207 Streatham, including Tooting and Balham... 160 148 308 Total 1,858 1,756 3,614 *.* The excess of Births over Deaths in the entire district is 1,677. TABLE III. Meteorological Elements for 1867, from Observations taken at Greenwich. MEANS. Jan., Feb., and March. April, May, and June. July, Aug., and September. Oct., Nov., and December. The Year. Temperature of the Air 38.9° 53.5° 59' 7° 42.5° 48.6° Evaporation 36.9° 49.8° 56.1° 41.0» 45.9° Dew Point 34.1° 46.1° 52.9° 39.0° 43.0° Weight of Vapour in a Cubic Foot of Air 2.3 grs. 3.5 grs. 4.5 grs. 2.8 grs. 3.3 grs. Degree of Humidity (Sat". 100) 83° 76° 79° 88° 82° Reading of Barometer 29.678 in. 29.767in. 29.825in. 29.910in. 29.796in. Weight of a Cubic Foot of Air 552 grs. 537 grs. 531 grs. 552 grs. 543 grs. Rain (amount of) 6.3 in. 6.3 in. 11.3 in. 4.5 in. 28.4 in. D 50 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 1857-67. Deaths from the seven principal Epidemics in each Sub-District. Entire District. Years. Clapham. Battersea. Wandsworth. Putney. Streatham. Total Deaths from the Seven Epidemics. Total Deaths Registered from all causes Per centage of Deatbs from the Seven Epidemics to Total Deaths. 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 1867 56 122 33 21 10 242 1937 12.4 ** r^^le Diseases included in the above Table constitute, as in the Registrar* Generals Returns, the principal maladies only of the Zymotic class—viz.: Small PoxMeasles, Scarlatina, Diphtheria, Whooping-cough, Diarrhoea and Cholera, and Fever. 51 TABLE V. Cases of Sickness amongst the out-door Poor under the treatment of the Union Medical Officers, with the Deaths from each class of Disease, during the year ended 31st December, 1867. Compiled from the District Medical Belief Books. SUB- DISTRICTS. Total Cases of Sickness treated in each Sub-district. 1—Small Pox. 2—Measles. 3—Scarlatina and Malignant Sore Throat. 4—Whooping Cough. 5—Diarrhoea and Dysentery. 6—Cholera. 7—Fever. 8—Erysipelas 9—Puerperal Fever. 10—Lung Diseases except Phthisis. 11—Phthisis. 12—H ydrocephalus Atrophy, Scrofula, and Convulsions of Children. 13—Other Diseases. 14—Violence, Privtion, and Prema ture Birth. Total Deaths in each Sub-District Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths Clapham 1078 20 2 7 1 10 ... 6 1 53 1 ... ... 145 4 6 ... 8 ... 162 12 29 10 20 5 540 23 67 1 60 Wandsworth 1385 26 1 7 ... 15 2 19 1 120 ... ... ... 47 1 13 ... ... 277 12 9 4 8 4 774 24 70 1 50 Battersea 2547 491 1 17 1 25 1 42 1 80 1 1 ... 120 4 8 ... ... ... 391 16 107 10 6 2 1141 20 119 2 58 Putney and Roehampton 421 3 ... ... ... 5 ... 17 1 36 ... ... ... 3 1 6 ... ... ... 89 5 2 ... 7 1 224 6 29 ... 14 Streatham, including Tooting and Balham 265 19 2 15 ... 7 1 ... ... 8 ... ... ... 6 1 3 ... ... ... 52 6 1 1 4 ... 128 8 20 ... 19 Totals 5691 559 6 46 2 62 4 84 4 297 2 1 ... 321 11 36 ... 8 ... 971 43 148 25 45 12 2807 71 305 4 201 *** ratio of deaths to cases treated was 3*5 per cent ; during the preceding year it was 4.8 per cent. 52 TABLE VI. Summaby of the Sanitary Operations in the entire District during the year 1867. Clapham. Battersea. Wandsworth. Putney and Roehampton. Streatham, including Tooting and Balham. Totals. Number of Houses and Premises inspected 2,020 1,684 345 123 120 4,297 1st Notices served 420 377 31 27 7 862 2nd Notices served 56 47 7 4 ... 114 Cesspools emptied and cleansed 2 18 ... ... 110 130 Cesspools abolished 101 18 20 17 304 460 Waterclosets constructed 126 122 15 18 158 439 Houses supplied with water 78 1,032 4 128 158 1,400 Drains constructed or connected with Sewer 181 822 12 1,562 806 3,383 No. of feet of New Sewers, &c. 36,960 26,068 22,068 8,909 54,037 148,042 Drains repaired or trapped, or obstructions removed 535 12 6 28 265 846 Open Ditches, Ponds, &c., cleansed (in feet) 750 ... 2,300 3,500 42,240 48,790 Dust-bins provided 257 129 ... 125 160 670 Pig Nuisances removed 13 57 2 2 3 77 Accumulations of Offal, Manure, &c., removed 12 79 5 12 6 114 Unwholesome and dilapidated Houses cleansed or repaired 110 37 ... 2 1 150 Cases investigated by Magistrates. 3 7 ... ... ... 10 Compulsory Orders obtained 3 5 ... ... ... 8 Compulsory works executed 3 ... ... ... ... 3 Works remaining in abeyance from various causes 57 ... 2 ... ... 59