WAN 20 SANITARY DEPARTMENT. REPORT SANITARY CONDITION OF THE SEVERAL PARISHES COMPRISED IN THE WANDSWORTH DISTRICT, DURING THE YEAR 1868. By the Medical Officers of Health. london: printed by john smith and co., 52, long acre, w.c. 1869. CONTENTS. PAGE. 1. Health and Sanitary Condition of the Entire District 5 2. Report on the Sub-District of Wandsworth, by Dr. Nicholas 13 3. „ on the Sub-District of Clapham, by Mr. MacDonogh 21 4. „ on the Sub-District of Battersea, by Dr. Connor 28 5. „ on the Sub-District of Streatham by Dr. Noel 34 6. „ on the Sub-District of Putney, by Dr. Whiteman 39 7. Appendix of Statistical Tables, &c 51 REPORT, 1868. The Board of Works for the Wandsworth District. Gentlemen, The Report which we have now the honor to submit has reference to the 13th year of our official exertions. It embodies all the usual statistics and other information necessary to determine the health and sanitary condition of the entire District as well as of each Sub-district, and is arranged precisely as in previous years, so as to afford every facility for a comparison of results. We have the honor to be, Gentlemen, Your very obedient Servants, The Medical Officers of Health of the Wandsworth District. 5 HEALTH AND SANITARY CONDITION OF THE ENTIRE DISTRICT. The year 1868 has been unfortunately marked by a very considerable deterioration of the health of this District, compared with the average of previous years, as indicated by the public records of sickness and mortality. This lowered vitality will be seen, by a reference to Tables 1 and 4 in the Appendix, to be associated with a much greater fatality than usual, not only from epidemic, but from general disease also. By an examination of Tables 1 and 2, Appendix, may be gathered two important facts, viz.:-that the population of the entire District during the past year was increased by the births of 4,008 children,and that it was diminished during the same period by the removal of 2,168 persons by death. The actual gain to the population by natural increase was therefore 1,840. But this calculation does not take into account the results of immigration, by which there are good grounds for believing the population has increased during the past year to a much greater extent than during any year since the Metropolis Local Management Act came into operation. This is inferred from the large amount of building operations, and the consequent influx of new residents, both of which have been beyond all precedent. The impossibility of estimating correctly the increase of population in the several Sub-districts, imposes upon the Medical Officers of Health one important consideration, viz. :—whether they ought, within three years of a fresh census, to hazard any statement with regard to the deathrate of the entire District that must be based for the most part upon mere conjecture? The principle which most statists at present adopt in determining the death-rate of any particular locality, is that of assuming the annual increase to have been going on at the same ratio since the last census as before such census was taken, or, what 6 amounts to nearly the same thing, adding every year an uniform one tenth to the previous estimate, as is done by the Registrar General. It is obvious, however, that neither of these methods, though they are the only ones that can be adopted, are capable of yielding a true death-rate for districts where the population has so rapidly and greatly increased by immigration as to leave almost everything to be assumed with regard to it. The Health Officers therefore can only state in the present report, with reference to the Mortality, that the total number of deaths from all causes in the past year exceeded the average of the previous 10 years by no less than 593, and that the total number from epidemic diseases exceeded a similar average by 118. Full consideration however being given to the probable effects of the immigration above mentioned, it is not unreasonable to suppose that the hightened mortality of the past year was, to a considerable extent at least, dependent upon a greatly augmented population. Referring to the general table of mortality in the Appendix, the first important point claiming attention, is the number of deaths noted as being due to zymotic diseases. These deaths (461) greatly exceed the number (232) registered in 1867, the increase being chiefly observable under the following diseases, which are here placed in the order of their greatest fatality—Diarrhœa, increased in the past two years from 69 deaths to the large number of 230; Whooping Cough, from 41 to 77; Scarlatina, from 32 to 66; Fever, from 44 to 66; Measles, from 18 to 35 ; and Diphtheria, from 8 to 27. The past year therefore must be viewed as having singularly favoured the spread of the principal epidemic maladies. It will be seen also that the number of deaths due to ordinary diseases (non-epidemic) exhibits some increase, though not to a corresponding amount. The difference in the number of deaths due to the nonepidemic class of diseases in the past compared with that of the previous year, is 52, and in the number resulting from zymotic diseases, as many as 179, in favour of 1867; that is to say, there occurred in the past year more deaths from all causes by 231 than were registered in the previous year. 7 The several columns of the appended table of mortality referring to the ages at death, disclose the same unsatisfactory feature as do most statistical returns of a similar kind published throughout the country, viz.:- a large death rate amongst infants and children of all classes. The table just referred to shows that in this District, during the past year, as many as 667 died before reaching the first year of their existence; further, that there succumbed to disease and accident 369 children between 1 and 5 years, and 75 between 5 and 10 years of age, making a total of no less than 1,111, which is considerably more than one half of the total mortality at all ages. In most of the Subdistricts a larger number than usual of deaths of aged people appear to have been registered. The deaths from all causes amongst persons of advanced life were 312 between 60 and 80 years, and 99 at 80 and upwards, two persons having reached the great age of 98. In the last report the deaths of persons at 80 and upwards were shown to have been 56 only, which is 43 less than the number recorded in the table of the present report. Under the four headings marking the social positions of the deceased persons, the relative numbers of deaths amongst the working classes, to those amongst the other three classes collectively, will be found to be 1,279 of the former to 889 of the latter. The proportion in the previous year was 1,184 to 753. There was therefore a much nearer approach to an equality of numbers in the past than in the previous year, a circumstance so far satisfactory as indicating an improved sanitary condition of the localities inhabited by the poor and by those engaged in industrial pursuits. SANITATION. Drainage.—It is satisfactory to notice the great progress which is being made in the construction of sewers throughout the entire District. A length of new sewers, amounting, within the past year alone to no less than 50,139 feet 8 (Vide Table VI. Appendix), appears to be a work the beneficial effects of which upon the health of the neighbourhood it would be impossible to over rate. In the corresponding table of the last report, a much larger amount (148,040 feet) of new sewerage was noted as having been constructed within the District. In 1806 also the amount was very large (121,921 feet), making up, in three years only, a total of main drainage considerably over 300,000 feet in extent. It is calculated, taking the collective returns of the several Surveyors in each year since the District Board of Works was first constituted, that a length of this enduring work has been completed within the area of this District, equivalent to very little short of 100 miles. Ventilation of Sewers.—The great defect in the main sewerage, arising from the necessity for ventilation, is at length occupying the attention of engineers and others. Recently, in some of our scientific societies, the matter has undergone much discussion, and several papers have been read by men of eminence upon this subject, as well as upon that of water supply, with which it is intimately connected. But in the absence of any thorough scheme to meet the many evils arising from sewer emanations, no remedy presents itself of equal efficacy and facility of application as that of sufficient and continuous flow of w ater, by which means the sewage would be more rapidly removed, the decomposition through the accumulation of gases prevented, the absorption of gases when formed secured, and the necessity for ventilation thereby reduced to a minimum. As a necessity for the efficiency of the present main drainage, the above plan has been constantly, and from the very first, contended for by the Medical Officers of Health of this District, and it is moreover the conclusion which the Engineer of the Metropolitan Board of Works appears to have more recently arrived at (Vide Mr. Bazalgette's Report on the Ventilation of Sewers, January, 1866). Water supply.—The Medical Officers of Health have fully entered into the consideration of this important subject in a special report recently made to the District Board of Works, by request. Apart from the reports of 9 Professor Frankland on his analyses of the water supplied to the District by the Southwark Company, and to a small portion of the District by the Chelsea Company, which the Health Officers refer to in their special report, the recently published report of the Royal Commissioners appointed in 1866, to consider the water supply of the Metropolis, abundantly confirms them in the views they have ventured to express, and they rejoice greatly to find there is some prospect of an important alteration being effected both in the mode of delivery and in the quality of the supply, by the transfer of the interests of the present Companies to public control by municipal bodies. The Commissioners express the following strong opinion upon the bad quality of some of the waters supplied to the Metropolis. " We are of opinion that perfect filtration is "highly essential to the good quality of the water; that "this process is at present, in many cases, very imperfectly "performed; and that more efficient means of enforcing "the provisions of the law are required."* Withregard to some recent legislative measures, including the Act for the regulation of the hours of labour of women and children in factories and workshops, and that referring to the adulteration and sale of food, it is agreed on all hands that these are most deficient in compulsory clauses, and require many amendments before they can be effectually put in force. The want of a public prosecutor is also felt to be a great drawback to the proper fulfilment of the duties and responsibilities thrown upon the authorities by both these measures, as well as by that relating to Vaccination ; indeed the last named Act, it is very generally believed, cannot possibly be made a compulsory one in the sense intended by the legislature without the employment of such an Officer in every large community. Although magisterial interference is always recommended and resorted to with extreme reluctance, and indeed never *Professor Frankland, in Lis last report to the Registrar General, (26th June, 1869,) still continues his strictures upon the turbid condition of the water supplied by the Southwark Company. He says "with the exception of the Southwark and Grand "Junction Companies samples, which were turbid, all the waters were perfectly clear " and transparent. The turbid waters contained numerous living organisms." 10 until all other efforts have failed, it is nevertheless satisfactory to observe, as evidencing the determination of the Board to enforce the removal or prohibition of all nuisances injurious to health, that there were, during the past year, as many as 20 investigations at the Police Court, in 17 of which compulsory orders were obtained. The table in the Appendix, referring more particularly to the sanitation of the past year, as well as the comments thereon in the several local summaries, may be consulted with advantage by those who may desire to possess further information upon the amount and description of sanitary work carried out in the District during the period to which this report relates, and to these local summaries the Health Officers must now beg to refer their readers. LOCAL SUMMARIES. 13 WANDSWORTH. An analysis of the Registrar-General's Returns, and of the parochial records of sickness and mortality, discloses the ungenial fact that a high rate of sickness and death prevailed in this Sub-district during the past year, and was mainly attributable to a great prevalence and fatality of epidemic disease. Mortality, &c — The total number of deaths which were registered as having occurred during the year 1868, were 194 of males, and 200 of females; total 394. 88 occurred in the following public institutions: viz., 58 in the Surrey County Lunatic Asylum; 7 in the House of Correction; 8 in St. Peter's Hospital; 3 in the Royal Patriotic Asylum for Girls; 9 in the Hospital for Incurables; and 3 in the Reformatory for Boys. 24 parishioners of Wandsworth died in the Union Workhouse, Battersea. The number of deaths is greater by 58 than the average of the past ten years, corrected for increase of population, the population being estimated upon the assumption that it has increased since the period of the last census in the same ratio that it had done during the preceding ten years. Looking, however, to the very sudden and great augmentation which has taken place in the birth-rate during the past two years coincidental with a great increase in the number of inhabited houses, there is strong reason for believing that the increase in the population has occurred in a far higher ratio by means of immigration. 14 If such conjecture, which cannot however be tested until the next census, be correct, the excess of deaths, as above determined, would be correspondingly lower.* Birth-rate. Rate of natural increase.— The births registered during the year numbered 627—327 of males, and 300 of females. The average number during the ten years 1857—66 was 401: the annual average increase for the same period was 12.5, with a total increase of 125 for the whole period; during the last two years it has been 75.5, or a total of 151; so that the increase in the number of births during the past two years has been one fifth greater than that of the ten preceding years collectively. This circumstance is not consistent with the laws of natural development, and furnishes strong presumptive evidence of the probably great accession to the number of inhabitants, by immigration above referred to. The birthrate, calculated upon the foregoing estimate of the population, was 39.23, and the rate of natural increase 17.77 per 1000 persons living of all ages. 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. * Looking at the great value which belongs to an accurate determination of vital statistics as the first trustworthy step in the projection of sanitary science to the prevention of disease, it seems proper to mention that in the metropolitan suburbs and in large towns known to be greatly increasing by immigration, a more frequent census of the population is imperatively needed. In such localities, under such conditions, an interval of ten years, it need scarcely be observed, renders calculation unsound, and more or less conjectural. A quinquennial or, better still, a biennial census, with an extended scope of enquiry, might be made the means of conveying most important information, alike valuable to the sanitarian and the political economist. 15 WANDSWORTH. Total Deaths from each Class of Disease, &c., in the Sub-Disirict. 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. Industrial & Labouring Classes. Diseases and other Causes of Death. Diseases Classified. Classes:— Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 8 3 5 ... 6 1 8 ... ... ... ... ... ... 1 7 Scarlatina 5 1 4 ... 3 1 5 ... ... ... ... ... ... ... 5 Diphtheria 2 1 1 1 1 ... 2 ... ... ... ... ... ... ... 2 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 3 2 1 ... 3 ... 3 ... ... ... ... ... ... ... 3 Whooping Cough 20 7 13 15 5 ... 20 ... ... ... ... ... ... 1 19 1 Zymotic Fever 7 4 3 ... ... ... 3 3 ... 1 ... 1 1 1 4 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Metria, Childbirth 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 22 8 14 20 2 ... 22 ... ... ... ... ... ... 2 20 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 68 26 42 36 20 2 63 4 ... 1 ... 1 1 5 61 2 Tubercular 62 33 29 16 8 1 30 20 8 4 ... 1 3 13 45 3 Of Brain, Nerves, &c. 93 53 40 26 10 2 42 15 19 16 1 ... 4 8 81 4 Of the Heart, &c 20 9 11 1 ... ... 4 6 2 7 1 1 2 4 13 5 Of Respiratory Organs 43 22 91 12 5 1 19 1 8 14 1 1 2 5 35 6 Of Digestive Organs 24 9 15 4 ... 1 5 2 12 5 ... 2 1 4 17 7 Of the Kidneys 9 3 6 ... ... ... ... 3 5 1 ... 1 ... 3 5 8 Of the Uterus 1 ... 1 ... ... ... ... ... 1 ... ... ... 1 ... ... 9 Of Joints, Bones, &c. 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 10 Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Premature Birth, Low Vitality, Malformation, &c. 23 16 7 23 ... ... 23 ... ... ... ... ... 2 2 19 12 Of Uncertain Seat 19 6 13 ... ... ... ... 4 ... 8 3 ... ... 6 13 13 Age 18 7 11 ... ... ... ... ... ... 9 9 1 ... 2 15 14 Violence 13 10 3 1 2 1 5 2 3 2 1 ... 1 2 10 15 Not Specified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 394 194 200 119 45 8 191 57 63 67 16 8 17 54 315 Excluding diseases of the Brain and Nervous System from the estimate of the causation of mortality of this Subdistrict, in consequence of the undue augmentation of that 16 class of diseases, by the Surrey County Lunatic Asylum, Diseases of the Zymotic class (Epidemic, Contagious) stand first in the order of fatality, forming upwards of 17 per cent. of all deaths : next follows the Tubercular class, (which includes Scrofula and Consumption) forming nearly 16 per cent., Consumption alone contributing nearly 9 per cent., and being, as usual, the most fatal single disease. Diseases of the Respiratory organs, exclusive of Consumption, formed 11 per cent. Diseases of the Digestive organs contributed upwards of 6 per cent., and Disease of the Heart, 5 per cent. of all deaths; none of these classes, nor those remaining in the table, exhibit any noteworthy variation from the average, except the Zymotic, which is in excess. Age at Death.—The most noticeable thing in the table is the very great preponderance of infant mortality, upwards of 30 per cent. of all deaths occurring during the first year of life. This amount is 13 per cent. above the average of the preceding ten years, and the excess is seen to have resulted from a greater amount of diseases of the Zymotic class. 41 per cent. occurred under the age of 5 years, and upwards of 48 per cent. under 20 years of age. Of those dying at the other extreme of life, there were 26 between 70 and 80, 11 between 80 and 90, and 4 attained the high ages of 92, 95, 97, and 98 years respectively. The last was a woman who was born in and always lived in this parish, and she retained the use of all her faculties to the last. Her age was verified by the church register, and her son is now living, aged 74. Social Position.—Upwards of 80 per cent. of all deaths, and 8.9 per cent. of the deaths from Epidemic diseases, occurred amongst the labouring classes. It is not possible to ascertain by present means the relative numerical proportion of the different classes of the population of this locality, but the relative proportion which the infant mortality of the labouring classes bears to that of the other classes may be approximately estimated. Let it be assumed for the sake of a safe argument, that all classes suffered the same relative amount of mortality; then as 17 4/5ths of the whole mortality occurred amongst the labouring classes, the latter would be four times as numerous as the other classes collectively; according to such calculation, which cannot err by exaggeration, the infants of the labouring classes will have suffered during the past year nearly twice as much mortality from general disease, and three and a half times as much mortality from Epidemic diseases as the other classes collectively. Inquests were held in 25 instances during the year. 13 deaths resulted from violence, 11 of which were accidental, 1 suicidal, and 1 homicidal. In 11 instances the cause of death was not certified by medical testimony; and as in any of these, death may have resulted from other than natural causes, it is evident that society is not sufficiently protected, as it might be, by the intervention of a medical investigation in every death, the cause of which has not been certified by a registered medical practitioner. (See previous reports on this subject.) Epidemic Diseases—Their prevalence and fatality.— The following table shows the deaths which have resulted from the 7 principal Epidemic diseases during the past and ten preceding years, and the relation which they bore to the deaths from all causes. YEARS. Small Pox Measles. 1 Scarlet Fever. Diphtheria. Whooping Cough. Cholera. Diarrhœa. Fever— Typhus and Typhoid. Total Deaths from Epidemics. Total Deaths from all causes. Per centage of deaths from Epidemics to deaths from all causes. 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 1861 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 1868 0 8 5 2 20 ... 22 7 64 394 16.2 b 18 The mortality from these diseases is seen to have been greater than the average of the preceding ten years by nearly a fourth part. The excess was principally due to a severe Epidemic of Whooping Cough and Diarrhoea, which prevailed during the whole year, but mostly in the autumn; two thirds of all deaths from Epidemic disease having been due to these two diseases, all the victims of which were under the age of 5 years, and most of them under 1 year of age. Fever in its several types was, as usual, present during the whole year, but was not attended by any unusual fatality. Measles prevailed to a considerable extent in November and December: and Scarlatina, although present from May to the end of the year, was neither very prevalent nor fatal; indeed this Sub-district enjoyed a great immunity from the Epidemic, which in the Metropolis generally and elsewhere, was so extensively prevalent and destructive of life. It is satisfactory to have to record the absence of any death from Small-pox, and the almost entire absence of this disease, three isolated cases only having come under treatment amongst the parochial poor during the year. Sickness and Mortality amongst the parochial poor.— Table 5 in the Appendix exhibits the nature, amount, and fatality of the sickness which came under treatment amongst the parochial poor during the year. This portion of the general sickness, which is accurately known and recorded, furnishes a means, and at present the only one, of judging of the amount and general character of the whole which has prevailed. The amount of sickness was in excess of the average of the preceding ten years by upwards of ¼th; its resulting mortality was also greater than the average by about a tenth part; but relatively to the number of cases of sickness it was less, having formed 2'G2 per cent., as compared with 3.10 per cent., the corresponding average. Epidemic diseases formed 19 per cent. of all cases of sickness, and the deaths from these diseases formed 29 per cent. of all deaths. The conclusion derivable from these data is, that the heightened mortality of the Sub-district during the past year resulted from disease 19 not of great intensity, but of exceptionally large amount, which, assuming the proportion of deaths borne to cases of sickness amongst the poor as a measure of the same proportion amongst all classes, would appear to have considerably exceeded 90 per cent. of the population. Sanitary Proceedings.—Table 6 in the Appendix contains a summary of the principal sanitary proceedings carried out during the year. These were all conducted, (with one exception, in which a magisterial order was obtained, to prohibit the recurrence of a nuisance injurious to health), without the necessity of an appeal to the law. In addition to which the slaughter-houses and cow-houses, 33 in number, were examined and certified as possessing the necessary sanitary requirements previous to the renewal of their owners' licenses. The bake-houses, 22 in number, were also examined and specially reported on. The proceeding adopted by the Board, of causing the rooms of houses to be limewhited and otherwise purified, when so needing it on account of uncleanliness associated with the presence of contagious disease, was promptly carried out, with due regard to the convalescence of the patients. The arrest of contagion was very noticeable in several instances, and in all, the employment of this simple and inexpensive measure was doubtless attended with much sanitary benefit. The Scavengering of the town has been better conducted than hitherto; but it is as yet neither sufficiently systematic, nor frequent, nor sufficiently directed— where moat needed—to the courts and alleys, and the poorer localities. Water Supply.—The quantity of water supplied by the Vauxhall and the Lambeth Companies has been somewhat more abundant during the past year, compared with that of 1867 ; but it is as yet totally insufficient for the purpose of efficient drainage, as well as domestic use, for the prevention of that great sanitary defect in the main drainage, the necessity for the escape, through openings made for the purpose, of the noxious gases generated by the decomposition of the sewage in its passage through the sewers' b 2 20 A supply of water which would keep the sewers practically full would admit of very little necessity for ventilation. The quality of the water has been very impure for a length of time. In August last year I reported, " There is a very generally expressed complaint of the bad quality of the water furnished by the Southwark and Vauxhall Company. The water from the mains of this Company frequently contains much organic impurity, and is sometimes apparently unfiltered." The Company at the time denied the correctness of my statement, but the report of Dr. Frankland on the analysis of the waters supplied by the Metropolitan Water Companies during the year 1868, more than confirms all I said upon the subject, as will be seen on a reference to those reports, contained in the RegistrarGeneral's last annual summary of weekly returns. It will be also seen from Dr. Frankland's reports of 1869 that what I wrote in August, last year, might have been written with equal correctness and greater force every month this year. Remembering the now recognized influence exerted by the use of impure water in the propagation of disease, and looking to the exceptionally high mortality resulting from Diarrhoea during the past year, the present impure supply of water to this District presents itself as a subject of the greatest sanitary importance for consideration. GEORGE EDWARD NICHOLAS, M.D., Medical Officer of Health for Wandsworth. 21 CLAPHAM. The Registrar General has made his statistics of 1868, to embrace the mortality of 53 weeks, ended Saturday, January 2nd, 1869. The tables accompanying my present report are necessarily based on a similar calculation. The following is the usual table with which I have commenced my contributions to the annual report for some years past, and I again employ it, because I consider there can be no better introduction to the few comments it is my duty to offer upon the sanitary proceedings, &c., of the past year. This table, it maybe observed, exhibits, as usual, the number of births and deaths, the excess of births over deaths, and also the number of marriages in 1868 and the ten previous years. It is worthy of remark that of the 272 marriages that took place last year, 32 were what are termed "registrar's marriages," that is to say, the compacts were entered into before the Superintendent Registrar of the District, and were not solemnized by any minister of religion in either church or chapel. MARRIAGES, BIRTHS, AND DEATHS. Years 1858 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868 Marriages 150 156 183 182 175 181 227 221 310 244 272 Births 533 594 608 624 622 685 640 707 711 777 801 Deaths 344 328 429 390 343 355 408 393 425 451 450 Excess of Births over Deaths 189 266 179 234 279 330 232 314 286 326 351 Statistics of Mortality, &c.—In the past year the registered deaths were 450, equally divided as to the sex, viz., 225 of each, a rather unusual circumstance, seeing that in most of my former reports, the female mortality has been noted to exceed that of the male, sometimes to a very considerable extent. In the table of the report for 1867, 22 the deaths of females were 243, and of males 208, giving an excess of 35 on the side of the females. The registered births during 1868 were 801, the excess of births over deaths was therefore 551. The sexes in this case were also nearly equal, the female births slightly predominating, in the ratio of 410 of the latter sex to 391 of that of the male; hitherto the male births have generally predominated in this Sub-district. In the absence of any reliable datum beyond that furnished by a calculation of the excess of births over deaths, and called the "natural increase," it becomes very difficult to estimate the population with accuracy, and perhaps, under all circumstances, it is best not to attempt it until another census shall have given us more accurate information. This much I may say, that the increase of population by immigration has been such of late as to render the usual method of calculating the death-rate more a matter of conjecture than ever. Notwithstanding this there are some grounds for thinking such death-rate to be anything but generally excessive in this Sub-district compared with many towns having a similar mixed population. During the last year, it must be admitted, the deaths were considerably in excess of the average of the ten previous years, owing to the undue prevalence and fatality of Zymotic diseases. From the following table (the construction of which from the manuscript weekly returns furnished by the Registrar General to all the Metropolitan Medical Officers of Health, is a work of considerable nicety and labour) may be gathered the number, the sex, the ages, and the social positions of all who have died in the Sub-district within the year under review, and it will also be found to afford a considerable amount of other information interesting to the sanitarian. 23 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 l0 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, Hankers, &c. Middle & Trading class, Shopmen, Clerks, &c. Industrial and Laboring Classes DISEASES And other Causes of Death Classes:— 1. Zymotic Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 9 4 5 3 6 ... 9 ... ... ... ... ... 1 1 7 Scarlatina 14 7 7 1 10 3 14 ... ... ... ... ... 1 5 8 Diphtheria. 7 3 4 1 4 2 7 ... ... ... ... ... ... 1 6 Quinsy 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 Croup 3 2 1 ... 3 ... 3 ... ... ... ... ... 1 ... 2 Whooping Cough 25 12 13 8 13 4 25 ... ... ... ... ... 1 3 21 Typhus, &c. 26 14 12 1 3 1 10 6 5 4 1 ... 1 11 14 Erysipelas 6 2 4 1 ... ... 1 2 1 2 ... ... 1 2 3 Metria, Childbirth 4 ... 4 ... ... ... ... 3 1 ... ... ... 1 1 2 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza 1 ... 1 ... ... ... ... ... ... 1 ... ... 1 ... ... Diarrhœa & Dysentery 27 16 11 21 4 ... 25 ... ... 1 1 ... 3 6 18 Cholera 1 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... Totals of Zymotic Class 124 62 62 36 43 10 94 12 7 9 2 ... 11 31 82 2. Tubercular 48 24 24 2 2 1 11 19 14 4 ... ... ... 16 32 3. Of Brain, Nerves, &c. 45 22 23 4 6 5 15 4 10 16 ... ... 8 15 22 4. Of the Heart, &c. 30 15 15 1 1 1 5 3 9 12 1 ... 3 12 15 5. Of Respiratory Organs 52 28 24 18 8 1 28 ... 7 13 4 2 3 14 33 6. Of Digestive Organs 16 8 8 6 2 ... 8 1 3 4 ... ... 1 4 11 7. Of Urinary Organs 3 2 1 ... ... 1 1 1 ... 1 ... ... ... 1 2 8. Of Organs of Generation 4 3 1 ... ... ... ... ... 1 3 ... ... 1 1 2 9. Of Joints, Bones, &c. 3 3 ... ... 1 1 2 ... 1 ... ... ... ... ... 3 10. Of Skin 2 1 1 ... ... ... 1 1 ... ... ... ... ... 1 1 11. Premature Birth, Low Vitality, Malformation, &c. 53 33 20 40 6 1 53 ... ... ... ... ... 1 11 41 12. Of Uncertain Seat 2 1 1 ... ... ... ... ... 1 ... 1 ... ... ... 2 13. Age 38 8 30 ... ... ... ... ... ... 20 18 1 8 10 19 14. Violence 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 15. Not Specified 29 14 15 4 3 1 10 4 8 7 ... ... 4 12 13 Totals 450 225 225 117 72 22 228 45 62 89 26 3 40 128 279 24 Ages at Death.—At the two extremes of life, it will be gathered from the above table that a very high death-rate prevailed in the past year, compared with that of former years. Of infants and young children who succumbed to disease, accident, &c., there appears to have been a very large number, (211) varying in age from a few minutes after birth to 10 years. This mortality absorbs within 16, onehalf of the deaths that took place at all ages, and is, from that circumstance, one of the worst features of the table. The number of aged persons dying during the year was 115, varying in age from 60 to 90 years; 89 between 60 and 80, and 26 over 80, the oldest being 93. Zymotic Diseases.—There were registered during the past year of this class of diseases 124 deaths, which is, I regret to say, exactly double the number recorded in the mortality table of my last report. This increase is chiefly due to the fatality attending three very severe epidemics, viz., Diarrhœa and Choleraic disease, Fever, and Whoopingcough, which together resulted in death in no less than 79 instances, leaving but 45 persons to die of the other eight Zymotic maladies referred to in the table. Of the 124 deaths from epidemics, 82 were of persons belonging to the working class, the children of that class succumbing in unusual numbers. It is much to be lamented that of the 124 deaths due to the class of diseases I have been speaking of, so many as 39 children should have contributed to swell the register. I trust this state of things will not be long persistent. It will be remarked with some degree of satisfaction that although Scarlatina and Diphtheria combined found 21 victims entirely amongst children under 10 years of age, that three others under 5 years of age died of Croup, and that one infant under one year of age succumbed to Erysipelas, the most dreaded of all the Zymotic diseases, viz., Small-pox, resulted in death in no one instance during the past year. 25 I here append a table, showing, as I have before done, the exact number of deaths due to the seven principal epidemics occurring in the past and ten preceding years. Years. 1858 1859 1860 1861 1802 1863 1864 1865 1866 1867 1868 Small-pox 1 9 6 6 1 11 3 7 10 7 0 Measles 14 2 20 0 6 24 12 7 18 3 9 Scarlatina. 25 26 24 22 13 28 11 11 6 5 14 Diphtheria 0 0 9 13 3 1 2 4 5 3 7 Whoopingcough 13 6 21 14 14 9 10 15 14 7 25 Typhus 11 12 6 5 8 6 14 11 16 10 26 Diarrhœa 16 11 5 16 7 16 11 20 17* 21 28† Totals 80 66 91 76 52 95 63 75 86 56 109 Small-pox and Vaccination.—The new Vaccination Act which came into operation on the 1st January, 1868, has, I think, been productive of considerable good in this Subdistrict. There were born in the past year, as before stated, 801 children. The number of children and others vaccinated by myself in 1868 in my capacity of Public Vaccinator, was 360. Of this number I should state that 3 were re-vaccinations of persons exposed at the time to the contagion of Small-pox, and that 33 were first vaccinations of persons above the age at which the vaccine is appointed to be introduced, viz., between 2 and 34 years, the adults seeking the protection, as I believe, as much through fear of the penal clauses of the Vaccination Act as of Small-pox itself. Taking into consideration the number of children * The 17 deaths recorded in 1866, comprehend the 4 death8 from Cholera that took place during that year. † The 28 deaths in 1868, under Diarrhœa, includes one death from Cholera. 26 dying within three months of their birth, and before the protection could be afforded, as also the number I have myself vaccinated, and the number in all probability vaccinated by private practitioners, it is thought that but very few can remain unprotected of those that were born in the Sub-district in 1868. Disease and Mortality amongst the Union poor.—The table No. V., Appendix, in so far as it applies to this Sub-district, needs as little comment as did the one given in the last annual report. Of 1069 cases of sickness, accident, &c., treated amongst the Union poor, there resulted 80 deaths, a small percentage, though not quite so small as appears in the table of 1867, when 60 deaths only occurred of 1073 cases treated. The cause of this increased mortality in 1868 amongst the poor has been already explained. Violent and sudden Deaths, Inquests, &c.—I am pleased to report the holding of but eight inquests in this parish during the past year. In many previous years there has been recorded double this number. The verdicts of those inquiries conducted by the coroner in the past year, indicate that one death was accidental, that another was due to the excessive use of stimulants, (dipsomania), and that 6 were the result of disease, which latter, from being either sudden or unexpected, appeared to necessitate the inquiries that were subsequently held. Sanitation of the year.—The long-wished-for period has at length arrived, when the rate-payers can contemplate with satisfaction the near completion of a most efficient system of sewerage for this Sub-district. It is true it has been constructed at an enormous cost, but it may safely be predicted the inhabitants will find an equivalent for the outlay to which they have so largely contributed, in the greatly improved health of the town which cannot fail to follow. If this great undertaking be 27 well sustained, and its continued supervision placed in proper hands, such as those of the very able surveyor, there can be but little doubt it will prove of immense benefit to the neighbourhood. I rejoice to find that the complete system of sewerage, which I clearly saw could not be long delayed after the passing of the Metropolis Local Management Act, has been carried out with so much earnestness, and with such excellent prospects. Let us hope that the free use of disinfectants, and the repeated flushings which will no doubt be employed, especially in hot and dry conditions of the atmosphere, will render this great work all that can be desired. I need scarcely say that all the slaughter and cowhouses in the parish have received, during the year, the most careful supervision. Licences were granted to the owners of all these places without any opposition on my part, and I rejoice that this time I had slight cause to complain of the manner in which the regulations of the authorities had been generally carried out. For a detailed account of the large amount of other sanitary work completed and in progress, I must refer to Table V. in the Appendix. Lastly, I would warmly recommend the adoption of a more general and systematic scavengering, and a better supply of water as a means of improving the health, and of lowering the death-rate of this Sub-district. I quite concur in the opinion of my colleagues that the water supplied to the district is very impure. I also think some of the suggestions of the Royal Commissioners, who have just issued their report on water-supply, are, as a basis for future legislation, very excellent, particularly the transfer of the supply from joint stock companies into the hands of public bodies. JOHN MAC DONOGH, Medical Officer of Health for Clapham. 28 BATTERSEA. In this Sub-district the registered deaths in 1868 were 1046—553 males and 493 females. From this number, however, should be deducted 82 occurring in the Union Workhouse of persons not belonging to the parish, although dying within it. This will reduce the mortality proper to the Sub-district to 964. The registered births were, in the same period, 1975— 1007 males and 968 females. The excess of births over deaths was therefore (reckoning the entire mortality) 929, or, making the correction for the deaths of non-parishioners in the Workhouse, 1011. The addition to the population by natural increase was consequently large, but much larger it is calculated, must have been the increase by immigration. Without more reliable data than we possess at present, it is next to impossible to estimate with anything like exactness, the increase by influx of new residents, but the number of houses erected within the past year I have ascertained was 1530, so that (filled as a large number of these houses have been by strangers and their families within a few days or weeks of their completion) it may be fairly assumed that the increase by immigration in 1868 was quite as large as, if not larger than that of any year since 1861. Putting, however, the increase from all sources at the very lowest estimate, it is pretty clear that a seven years' interval must have added to the population to an unprecedented extent, giving a death-rate much lower than the mortality statistics would at first sight seem to warrant. There is embodied in the annexed Form (the usual one employed in the local summaries) much information relating to the mortality of this Sub-district during the past year, that cannot fail to put the reader in possession of many facts, it would be very difficult to furnish in a comprehensive manner, but through the medium of a carefully prepared statistical table—a table that shall give at one view, as this does, the sex, ages, and social positions of all who have died in the parish, and have been registered within the year under review. 29 STATISTICS OF MORTALITY. BATTERSEA. Population in 1861—19,852. Area in Statute Acres—2,343 Total Deaths from each Class of Disease, &c., in the Sub-District. Sex. Age. Social Position. Males. Females. Under I year. From 1 to 5 years. From 5 to 10 years. Under 20 years, including all under 10 years. At 20, and under 40 years of age. At 40, and under 60 years of age. At 60 and under 80 years of Age. 80 years and upwards. Nobility and Gentry Professional Class, Merchants, Bankers, Ac. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. DISEASES. And other Causes of Death. Classes— 1. Zymotic Small Pox 1 1 ... 1 ... ... 1 ... ... ... ... ... ... ... 1 Measles 15 9 6 4 9 2 15 ... ... ... ... ... ... 7 8 Scarlatina 42 22 20 10 23 8 41 1 ... ... ... 3 ... 18 21 Diphtheria 11 6 5 ... 7 3 10 ... 1 ... ... ... ... 5 6 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 13 7 6 1 12 ... 13 ... ... ... ... ... ... 6 7 Whooping Cough 28 10 18 9 18 1 98 ... ... ... ... ... ... 11 17 Typhus and Infantile Fever 30 13 17 2 4 5 18 6 6 ... ... ... 3 12 15 Erysipelas 5 3 2 1 ... ... 1 ... 3 1 ... ... 1 1 3 Metria, Childbirth 13 ... 13 ... ... ... ... 9 4 ... ... ... ... 6 7 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœea & Dysentery 65 31 34 44 11 ... 56 1 3 4 1 ... ... 29 36 Cholera 2 1 1 1 1 ... 2 ... ... ... ... ... ... 2 ... Totals of Zymotic Class 225 103 122 73 85 19 185 17 17 5 i 3 4 97 121 2. Tubercular 228 129 99 98 39 5 154 40 27 7 ... ... 8 105 118 3. Of Brain, Nerves, &c. 160 81 79 54 40 4 101 19 16 21 3 1 6 63 90 4. Of the Heart, &c. 46 25 21 3 2 2 11 7 16 10 2 1 1 21 23 5. Of Respiratory Organs 145 84 61 55 49 2 108 6 11 18 2 ... 3 71 71 6. Of Digestive Organs 37 24 13 9 1 ... 11 8 6 11 1 2 2 14 19 7. Of Urinary Organs 9 6 3 ... ... ... ... 2 5 2 ... ... ... 3 6 8. Of Organs of Generation 10 ... 10 ... ... ... ... 2 8 ... ... ... 1 1 8 9. Of Joints, Bones, &c. 4 3 1 ... ... 1 1 2 1 ... ... ... ... ... 4 10. Of Skin 5 3 2 3 ... ... 3 1 ... 1 ... ... ... 1 4 11. Premature Birth. Low Vitality, Malformation, &c. 61 42 19 61 ... ... 61 ... ... ... ... ... 6 25 30 12. Of Uncertain Seat 31 12 19 4 2 1 7 3 11 10 ... ... 4 17 10 13. Age 40 17 23 ... ... ... ... ... ... 10 30 3 2 13 22 14. Violence 28 18 10 2 5 2 13 7 3 5 ... ... 1 2 25 15. Not Specified 17 6 11 9 ... 1 10 2 2 3 ... ... ... 3 14 Totals 1046 553 493 371 223 37 665 116 123 103 39 10 38 433 565 30 Infant Mortality — In the few comments I shall venture to offer upon the above Table, I must refer more particularly to the infant mortality, or rather to the high death-rate exhibited by adding together the totals of the three columns comprehending the number of deaths that have taken place of children from birth to 10 years of age. These deaths amounted in the past year to the large number of 631, which very considerably exceeds half the number who died at all ages. In the preceding year (1867) the number was 512, which is 119 less than were registered in the past year. Mortality amongst the Aged.—Rather more persons in advanced life were registered in the past year than in 1867. As many as 40 aged people succumbed to what may be termed the weight of years alone, that is to say, their deaths were registered without the mention of any actual disease having afflicted them tending to shorten life. About the same number of persons appear to have died from disease or accident, whose ages varied from 70 to 80, and from 80 upwards. Of the total number of aged persons dying of diseases as well as of old age or natural decay, there were 4 who at the time of death exceeded 90 years of age, the oldest being 97. The united ages of these 4 persons amounted to 370 years, thus giving an average of nearly 93 years to each. Making the calculation to embrace the entire number of aged people, from 62 years of age (the age of the youngest of those said to have died of natural decay) to 97 (the age of the oldest recorded in the register of the past year) the average age at death would be 86 years. These statistics are perhaps more curious than important, but they show, notwithstanding the drawbacks that may be supposed to operate within the Sub-district against the attainment of long life amongst the labouring classes, that numbers of the inhabitants reach a ripe old age. Zymotic Diseases.—The diseases of this class were, I regret to report, fatal in a very large number of instances, 225 in the past year against 143 in the year preceding. The year 1868 was quite an exceptional one, in respect to the 31 fatality of Zymotic maladies, 8 of the 14 named in the Table, viz., Measles, Scarlatina, Diphtheria, Fever, Whooping Cough, Croup, Metria, aud Diarrhœa, contributing to the register no fewer than 217 deaths of the 225 recorded. Under all the diseases above mentioned there appears a considerable increase upon the number registered in the previous year. It will be seen, by comparing the tables of the two years, that Small Pox is the only disease exhibiting any diminution in the number of resulting deaths; there were 11 deaths due to this disease registered in 1867, but in the present table there will be found recorded one only. Whether the new Vaccination Act has contributed in any material degree to this gratifying result some persons perhaps will be disposed to doubt, but judging from the marked difference in the number of fatal cases recorded in the present table and in those of previous reports, I am disposed to believe the operation of this improved enactment has had some little to do with the reduction of the mortality from this disease observed in the past year. So great a decrease as that, from a five years' average of 19 deaths to one only in the past year is, I think, strongly confirmatory of this opinion. Other Diseases.—The mortality from Tubercular Diseases, including Phthisis, has, as usual, been very great, greater by 43 than it was in the preceding year. Of the 228 deaths under this heading, 76 were registered as the result of Phthisis alone, but this is a less number by 7 than was noted in my last report. The deaths that took place as the result of the diseases included under the several headings of 'Brain and Nerves,' 'Heart,' 'Digestive Organs,' and some few others, will also be found in the present table to stand at high figures, so that it would have excited little surprise had the augmentation of the death-rate of this Sub-district been much greater than the above statistics show it to be. Diseases and Deaths amongst the Out-door Union Poor.The column relating to this Sub-district in Table V, 32 Appendix, shows that of 2,224 cases of sickness, accidents, &c., treated by the Parochial Medical Officers in their official capacity, 66 only proved fatal in the past year. This will appear a strikingly small per centage of deaths to the number of cases treated amongst such a class as that of the Out-door Union Poor of this parish. Accidental and Violent Deaths.—Inquests.—Three more deaths from accident, violence, &c., than occurred in 1867 were made the subjects of Coroner's Inquests in the past year. In the past year there were 39 inquiries of the kind referred to, and verdicts returned in accordance with the evidence adduced. These deaths may be classified as follows:— Found dead, newly born, no marks of violence 6 Suicides by hanging whilst of unsound mind 5 Natural deaths from disease (sudden) 5 Accidentally drowned 4 Do. killed by falls, &c. 4 Run over in the streets and on railways 4 Burns and Scalds (accidental) 3 Found dead in the water, no marks of violence 2 Poisoning by misadventure 2 Asphyxia in bed 2 Lead poisoning (the deceased being a working plumber) 1 Excessive drinking of ardent spirits 1 Total Inquests 39 But one remark need be made on the above statistical statement, viz., that the six discovered attempts at concealment of birth, speaks rather badly for the morality of a certain section of the inhabitants of this Sub-district. How many undiscovered cases of this kind there may be every year, it is impossible even to surmise, but it is clear legislative interference is much needed everywhere to remedy this widely-spread social evil. 33 Sanitary operations during the Year.—Table VI. in the Appendix furnishes a summary of most of the sanitary proceedings applying to this as well as to the other four Subdistricts. The construction of new sewers and drains, the systematic inspection of houses, and the removal of various nuisances, are all sanitary matters that have been vigorously prosecuted during the year. There was seized and condemned during the year, a large quantity (6¾ cwt.) of Fish and about 15 lbs. of Plums as unfit for human consumption. All the slaughter and cow houses throughout the parish also received the usual supervision, and altogether it is believed there has not passed a year of more activity and determination on the part of those intrusted with the execution of sanitary measures than has that of 1868. I have not considered it necessary to allude in this place to the water supply of this Sub-district, since my views upon that subject are quite in accordance with those expressed by my colleagues. WM. CONNOR, M.B., Medical Officer of Health for the Sub-district of Battersea. 34 STREATHAM, including TOOTING AND BALHAM. I regret I am unable to present quite so satisfactory a Report for 1868 as I did for the previous year. There are recorded in the table of mortality of the present report 160 deaths, against 156 in that of 1867. Of these 160 deaths, 81 were of males, and 79 of females. The number of registered births was 342 (males 176, females 166). There was therefore an excess of births over deaths of 182, or 70 beyond the excess of the previous year. To this somewhat large natural increase of the population must be added a much larger one accruing from immigration. The occupation within the past year of a large number of newly erected houses fully justifies the belief that since 1867 to the present time, the number of inhabitants has been augmented to nearly double the extent of many previous years—indeed, when the next census shall have been taken (as it will doubtless be in about three years from this time) there are good grounds for thinking the increase of the ten years interval will considerably exceed the general anticipation, and will be such as to enable me to congratulate the inhabitants upon a small and highly satisfactory death-rate. Commencing this report with the usual table of mortality, which is so constructed as to afford every facility for comparison with the mortuary statistics of previous years, it may be remarked, that although the increase of deaths from all causes in 1868 over the number registered in the previous year amounts to 4 only, it is still a matter for very great regret that the mortality due to Zymotic diseases alone should in the past year have more than doubled that of the preceding one. 35 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 50 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 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 Measles 2 1 1 ... 2 ... 2 ... ... ... ... ... ... ... 2 Scarlatina 3 1 2 ... 1 1 2 1 ... ... ... ... ... 3 ... Diphtheria 6 2 4 ... ... 5 6 ... ... ... ... ... 1 1 4 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 1 ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 1 Whooping Cough 4 2 2 2 2 ... 4 ... ... ... ... ... 1 2 1 Typhus and Infantile Fever 1 ... 1 ... ... 1 1 ... ... ... ... ... ... ... 1 Erysipelas 1 ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 1 Metria, Childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 11 3 8 9 ... 1 10 ... ... 1 ... ... ... 5 6 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 30 9 21 11 7 8 27 2 ... 1 ... ... 2 11 17 2. Tubercular 20 12 8 2 4 1 7 10 3 ... ... 1 ... 12 7 3. Of Brain, Nerves, &c. 25 17 8 5 4 2 13 3 2 5 2 2 4 13 6 4. Of the Heart, &c. 19 11 8 1 ... ... 1 4 3 9 2 2 2 7 8 5. Of Respiratory Organs 24 10 14 4 3 2 9 ... 6 6 3 ... 1 9 14 6. Of Digestive Organs 4 3 1 ... ... 1 1 ... 1 2 ... 1 ... 1 2 7. Of Urinary Organs 2 1 1 ... ... ... ... ... ... 2 ... ... 1 1 ... 8. Of Organs of Generation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Of Joints, Bones, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Malformation, &c. 8 4 4 7 ... 1 8 ... ... ... ... 2 ... 3 3 12. Of Uncertain Seat 8 3 5 ... ... ... ... ... 4 3 1 ... 2 4 2 13. Age 10 6 4 ... ... ... ... ... ... 4 6 3 ... 6 1 14. Violence 4 1 3 ... 2 ... 2 1 ... 1 ... ... ... 3 1 15. Not Specified 6 4 2 4 ... ... 4 ... 1 1 ... ... ... 3 3 Totals 160 81 79 34 20 15 72 20 20 34 14 11 12 73 04 c 2 36 Zymotic Diseases.— Seeing how large has been the increase of population recently, it would have excited no very great surprise had the number of deaths from all causes been infinitely greater than it was in 1868. Relatively, however, to the estimated population of that year, the deaths due to the Zymotic class of diseases were greatly in excess. If that portion of the present table relating more particularly to this class of maladies be compared with that inserted in the last report, it will be seen that five of the seven principal disease named proved fatal in a much greater number of instances than in the previous year. The deaths resulting from Measles, for instance, were in excess of 2, Scarlatina 2, Diphtheria 6, Whooping Cough 4, and Diarrhœa 9, making a total of 23 deaths from these diseases above the number registered in 1867. Happily the deaths due to Small Pox and Fever slightly diminished in the past year, the former numbering 1, and the latter 5, less than in the preceding year. In the aggregate, the deaths due to Epidemic diseases in the past year were 16 in excess of the number registered in 1867, a circumstance by no means satisfactory, though almost all the principal diseases of the non-zymotic class named in the table, claimed a less number of victims in the past than in the preceding year, thus in some measure balancing the excessive fatality of epidemic maladies. Ages at Death—It is a very natural consequeuce of an increase in the number of deaths due to Zymotic diseases that there should be found a larger number of infants and young persons than usual amongst those who have succumbed to those diseases. Accordingly the table discloses the fact of there having been in the past year an excess of 22 deaths above the number registered in the preceding one of children between birth and 10 years of age. The number that succumbed under one year was of itself large, being 23. In the aggregate 72 persons under 20 years of age died during the year 1868, which is within 16 of onehalf the mortality at all ages. At the other end of the scale, the deaths from "old age" or "natural decay" have not been so numerous as in some former years. These 37 deaths were 10 in number, the deceased persons varying in age from 70 to 90 years. Besides these there were 25 persons of advanced life registered within the year as having yielded to disease or accident, the oldest of those dying within two years of an entire century of existence, viz., at 98. Another of these aged persons died at 92, and a third at 90. Social Positions of the Deceased.—It has seldom been the case in this Sub-district that the deaths amongst the working classes have so greatly exceeded those of the three other classes named in the table as to call for any particular remark. The relative numbers in the past year were 64 only amongst the working classes, against 96 amongst the three classes above them in the social scale. From this fact it may be fairly inferred that the industrial section of the inhabitants have reaped as large an amount of benefit from sanitation as those in a superior condition of life. Sickness and Mortality amongst the Union Poor.— Referring to Table V., Appendix, the percentage of deaths to cases treated, will be found to be small, viz., 13 to 246. This, however, is by no means so small as we may reasonably expect it to be when the full benefit and effects of the new sewerage works come to be felt in those localities specially occupied by the indigent. But two cases of Small Pox appear to have been treated amongst the Union poor during the entire year, neither of which resulted in death. The new Act relating to Vaccination, I have every reason to believe, has been of considerable benefit to this Sub-district, in bringing many more children under the desired protection than was the ease before such Act came into operation. The measure will, it is thought, require considerable amendment to render it perfectly satisfactory. A Compulsory Act should allow no child to escape Vaccination, and its penal clauses should be enforced alike on rich and poor. Violent Deaths, Deaths from Accident, Inquests.—There occurred 3 deaths from Burns or Scalds in the past year, upon two of which Coroner's inquiries were held, and 38 verdicts of accidental death returned. One other death necessitating an inquest, on the body of a person who committed suicide by hanging, was also registered; hut at none of the inquiries referred to did anything of a special character transpire calling for remark in this report. Sanitary Proceedings of the Year.—In addition to the usual inspections which preceded a renewal of licenses to all Cow and Slaughter-house keepers in the Sub-district, a somewhat large amount of sanitary work appears to have been accomplished, by no means the least important of which has been the construction of 14,672 feet of new Sewers, and as many as 562 drainage connections with such Sewers from private houses and other premises. Many nuisances were also removed, and many improvements effected (vide Table VI., Appendix) that can scarcely fail to have quite as beneficial a tendency as any of those carried out in former years. But one case of complaint, I am pleased to report, was litigated before the magistrates. In this a compulsory order was obtained and acted on with effect by the Local Authorities. With regard to the question of Water Supply, I quite agree with my colleagues as to the necessity for some considerable reforms. D. C. NOËL, Medical Officer of Health for Streatlham, Tooting, and Balham. 39 PUTNEY AND ROEHAMPTON. Had the population of this Sub-district undergone no increase whatever since the last annual report was rendered, the proportion of deaths to such population would have still indicated a very favourable condition of the public health. The natural increase of the population, as shown by the excess of births over deaths was, in 1868, greater than in the preceding year by 66, having reached 145. What the exact increase may have been through immigration, or the influx of new residents, it is most difficult to determine, and until the census of 1871 has been taken, the death rate of this rapidly increasing suburb could only be assumed on very imperfect and unreliable data. The Surveyor of the Sub-district has, however, furnished for this report a return of 149 as the number of houses erected during the past year. Assuming, then, that two-thirds of these new dwellings, or say 100, had become inhabited within the year, it will be evident that, allowing 5.75 inmates to each house, which was the estimate at the last census, the increase of the population by immigration will have been 40 much larger than usual, so large indeed as to fairly warrant the belief that the death-rate of the year was below that of any former period since the Metropolis Local Management Act came into operation. From the extreme difficulty of forming any estimate of the present population that could be relied upon, it is thought to be politic to wait the result of the forthcoming census before advancing any decided opinion upon the matter. It may be observed, however, that the total number of deaths from all causes was in the past year 118, whereas in the year preceding it was 128. As these 118 deaths took place in a greatly increased population, it follows that a death-rate considerably lower than that of the previous year, is fairly deducible. It is not advisable to hazard even a conjecture as to the last year's actual increase of population, since by so doing it may happen that the Sub-district will be made to occupy an apparent position of healthiness amongst the several Parishes comprising the Wandsworth District that it does not relatively hold. Be this, however, as it may, it is a fact that the total mortality of the past year was less than the average of the previous ten years, without any correction whatever being made (even the usual one adopted by the Registrar General) for increase of population in the interval of the last census and the present time. If such usual correction be admitted into the calculation, it would follow that the death-rate would be very considerably below the same average. The mortality table of the present report will, in many other respects, bear a very favourable comparison with that of 1867. It will be seen, for example, that not only has there been a rather large decrease in the number of deaths due to Zymotic diseases, but that the principal non-epidemic maladies (the tubercular excepted) resulted in fewer deaths than has been noted in the reports of several years past. 41 PUTNEY and ROEHAMPTON. Population in 1861—6.481. Area in Statute Acres—2,176. Total Deaths from each Class of Disease, &e., in the Sub-District Sex Age Social Position Males Females Under 1 year j 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, Hankers, &c. | Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes DISEASES, And other causes of Death. Classes:— Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 1 1 ... ... 1 ... 1 ... ... ... ... ... ... ... 1 Scarlatina 2 ... 2 ... 1 ... 2 ... ... ... ... ... 1 ... 1 Diphtheria 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... 1 Quinsy ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... ... ... 1 ... ... 1 ... ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... Metria, Childbirth 3 ... 3 ... ... ... ... 3 ... ... ... ... ... 2 1 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 5 4 1 5 ... ... 5 ... ... ... ... ... 1 2 2 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 14 5 9 5 2 ... 10 3 ... 1 ... ... 2 5 7 9. Tubercular 24 12 12 5 1 1 9 8 7 ... ... ... 3 12 9 3. Of Brain, Nerves, &c. 16 10 6 3 2 ... 8 2 3 2 1 1 1 7 7 4. Of the Heart, &c. 9 5 4 ... ... ... 1 5 2 1 ... 1 1 5 2 5. Of Respiratory Organs 21 12 9 3 3 ... 6 4 6 5 ... 2 3 4 12 6. Digestive Organs 8 5 3 2 ... ... 2 ... 1 4 1 1 ... 4 3 7. Urinary Organs 2 2 ... ... ... ... ... ... 1 1 ... ... ... 2 ... 8. Of Organs of Generation 2 ... 2 ... ... ... ... ... 1 1 ... ... ... 1 1 9. Of Joints, Bones, &c. 2 1 1 ... ... ... ... ... ... 1 1 ... ... 2 ... 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth. Low Vitality, Malformation, &c. 9 6 3 8 1 ... 9 ... ... ... ... ... 2 1 6 12. Of Uncertain Seat 4 2 2 ... ... .... ... ... ... 1 3 1 1 2 ... 13. Age 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 14 Violence 6 5 1 ... ... ... 2 3 ... 1 ... ... ... ... 6 15. Not Specified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 118 65 53 26 9 1 47 25 21 18 7 6 13 45 54 42 The salient points of this table, comparing it with that given in the report of the previous year, are:— 1. A diminished number of deaths resulting from Zymotic diseases generally, viz., from 20 in 1867 to 14 in the past year. 2. A slight increase in the number of deaths (from 21 to 24) due to the tubercular class of diseases, including Phthisis, the deaths (17) from the last named malady exceeding the number registered in 1867 by one only. 3. A decrease, more or less large, in the deaths due to the diseases tabulated under the respective headings of "Brain and Nerves," "Digestive organs," and "Premature Birth, Low Vitality, and Malformation but, on the other hand, a slight increase in the number of those which resulted from Diseases "Of the Heart," "Of the Respiratorv Organs," and one or two other classes of disease occupying a place in the table. 4. A very satisfactory diminution in the number of deaths of infants and young children between birth and ten years of age, viz., from 52 in 1867 to 36 in the past year. 5. An equally satisfactory falling off in the number of deaths amongst the poor and the working classes, the decrease being from 63 in 1867 to 54 in the past year. Zymotic Diseases. — The relative proportion and percentage of deaths due to Zymotic diseases to deaths from all causes that have occurred iu the past and ten previous years, will be better understood by a comparison of the figures embodied in the following table: 43 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.  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 24 1864 121 11 9.0 1865 115 11 9.5 1866 121 16 13.2 1867 128 20 15.6 1868 118 14 11.3 It is worthy of remark that of the 15 Zymotic diseases named in the table of mortality, 8 of them, viz., Whooping Cough, Croup, Quinsy, Erysipelas, Carbuncle, Influenza, Malignant Cholera, and Small Pox, did not contribute a single death to the Register of the past year. Of the last named disease (Small Pox) it is gratifying to report that the cases treated in both public and private practice were unusually few. It is also satisfactory to find that a resort to vaccination has become more general since the amended Act of Parliament has secured the registration of all certificates, whether given by private practitioners or public vaccinators. There is still, however, much prejudice to overcome, and much misunderstanding of the provisions of the new Act to be removed before all the good expected of the measure can be realized. Until the amended Act came into operation (Jan. 1st, 1868) it was not possible to ascertain correctly the number of children who had received the protection of vaccination, and the number upon whom the operation had never been performed. Now, however, these statistics can be collected and given with tolerable exactness. Of the 263 children born within the Sub-district in the past year, it has been ascertained that 108 had received the 44 required protection at the hands of the public vaccinator, and that 94 certificates of successful vaccination had also been received by the Registrar from private practitioners. Of the 61 infants remaining to be accounted for, 19 are known tohave died before vaccination could be accomplished; some few may be supposed to have been found too sickly or otherwise unfitted to undergo the operation at the proper period, whilst others may have left the neighbourhood. Eventually, it is hoped, all the children born and still residing in the parish will be brought under the influence of this valuable prophylactic. To accomplish this, the new Act must not be suffered to become, like the old one, a dead letter. The authorities in all places, however, rather than the public vaccinators, or private practitioners, both of whom might be suspected of having an undue interest in promoting vaccination, should be the parties to enforce the provisions of the Act. It is well known that a determined resistance on the part of the ill-informed and unreasonable has frequently followed private attempts to force or to frighten the public into a compliance with the measure. In any amendment of the Act the insertion of a clause insuring the appointment of a public prosecutor Avould be of manifest service. Private practitioners, as a rule, desire to ensure the protection of vaccination to the children of their own private patients, but few such practitioners will venture to become informers for the sake of securing the consent of objecting parents to the performance of the operation at the proper period. All misunderstanding and unpleasantness in this respect might be avoided by the proceeding suggested, and there can be conceived nothing more likely to ensure an universal compliance with the provisions of the Act than the appointment throughout the country of independent public officers to perform the duty indicated. By these means, together with an earnest effort on the part of medical practitioners generally to overcome the prejudices of the public, it is believed the 'stamping out,' as it is called, of Small Pox might, with almost a certainty, be accomplished in a very short period. 45 Whilst referring to the mortality due to Zymotic diseases, it may be remarked that both Typhus aud Typhoid Fevers still hold a very low death-rate in the Sub-district compared with what they used to do before their repeated invasions were met by the adoption of an efficient system of sewerage. There is no reason to believe otherwise than that these diseases, like Small Pox, might be got rid of, or at all events be rendered infinitely less fatal by persevering efforts to remove, by good drainage, and the proper employment of disinfectants, the specific poison engendering such maladies. To bring about so desirable a result, nothing suggests itself as likely to prove of more effect than some improved method of ventilating the culverts running through the public thoroughfares, or what would be better, the adoption of a continuous waterflow to carry off the sewage quickly, and thus prevent the escape into the atmosphere from the unadvoidably exposed ventilating gratings, of those gases which are more than suspected of containing the germs of fever, and of many other of the Zymotic class of maladies.* An authority on sanitary subjects thus writes upon the generation of fever. "The grand fact remains clear, that the occurrence of Typhoid fever points unequivocally to defective removal of excreta, and that it (Typhoid fever) is a disease altogether and easily preventable." * To encourage the employment of disinfectants, there has been recently introduced to public notice an invention as simple as it is inexpensive. The apparatus is called " The Patent Disinfecting Cup," and, as described by the patentees, "consists of a small portable cup or crucible (costing 6d. each), containing a Chloride internally, and coated externally with a composition of Sulphur. Its application is extremely simple, requiring only a lucifer match or light to ignite the external coating, in the burning of which is produced a quantity of sulphurous acid gas; the heat thus generated raises the temperature of the contents of the Cup, setting free chlorine gas. The two gases thus filling the apartment to be disinfected, attack severally the germs of disease, whether animal or vegetable, floating in the air, effectually destroying infectious particles, and thus preventing the spread of fever,—as Typhoid, Scarlatina, Measles, Small Pox, or any other infectious disease." I have recommended the use of these cups for disinfecting purposes, not only in rooms, but for the purification of clothing, bedding, &c., after sickness, and think very highly of them. The uses of this invention have been fully described in a pamphlet entitled "Infectious Diseases," by Dr. C. T. Pearce, and published by H. Bailliere, 219, Regeut Street. The cups themselves can be procured of any chemist and druggist at a very small cost, and wholesale of Messrs. Maw and Son, Aldersgate Street. Their efficiency has also been tested in places infected by sewer gas, which generates typhoid and other fevers, and they have been found invaluable. 46 Although but two deaths from fever were registered in the parish during the past year*, the Union Medical Eelief Book tells of a somewhat serious outbreak of this malady in the autumn quarter. Several cases both in public ;ind private practice occurred in localities peculiarly exposed to the emanations referred to, and it is therefore hoped that the statement of such a fact, borne out, as it must be, by the experience of all my colleagues, will be sufficient to justify a special enquiry into the matter. Disease and mortality amongst the Union Poor.—It is shown in Table V., Appendix, that there was about the average per centage of deaths to cases treated. The number of cases of disease and accident treated during the past year was 494, and the number of resulting deaths 19, which is 3.9 per cent. With the increase of population there must necessarily be looked for an increase in the number of applicants for medical relief, and it is therefore all the more satisfactory to find that the mortality amongst the very poor does not increase in the same ratio as the population enlarges. It is also satisfactory to be able to speak well of the sanitation carried out of late in the poorer neighbourhoods, and of its evident effect in controlling the virulency, and consequently in lessening the fatality of many of those diseases that were formerly looked upon as being almost the exclusive inheritance of the indigent. Inquest*—Accidental and Violent Deaths.—It is somewhat singular that all the Coroner's inquiries during 1868 (6 in number) were to investigate deaths caused by immersion in the river Thames. Of cases of accidental drowning whilst bathing, there were 2; of violent deaths by accidentally falling into the water 1; whilst open verdicts of " found dead in the water, without any evidence to show how the deceased became immersed,"were returned in 3 instances. Summary of Sanitary Proceedings.—In my last report, I ventured to make a few remarks upon the benefits likely to 47 accrue from the carrying out of the complete scheme of sewerage designed for, and it may be said, forced by Act of Parliament upon this and the other Sub-districts. I have little to add to those remarks further than to express my belief that, costly as the completion of this scheme has proved to be. such a system of drainage as that now in actual operation within the parish, cannot fail of rendering the town aud its suburbs as healthy and salubrious as any, either within the metropolitan area, or other part of the country. It was shown in the report for 1867, that rather more than 11¼ miles of new sewerage had then been completed in this Sub-district. To this has now to be added many thousands of feet of the same enduring work, thus securing the very best of drainage for the hamlet of Rioehampton and parts adjacent.* I had, a short time since, the satisfaction of accompanying the local authorities in their inspection of this extensive work, and I was much pleased with the manner in which it had been carried out. Throughout its whole extent, the work appeared to be thoroughly well executed, and to possess all the sanitary appliances looked for in such undertakings. A. further view of the Table No. VI., Appendix, will show that the persistent efforts made during the past year to improve the condition of the Sub-district, have resulted in the removal of a considerable number of nuisances. Much sanitary work of a beneficial character has likewise been perfected during the year, and no -pains appear1o have been spared to sustain that already completed. It is a noteworthy circumstance that magisterial interference, in the investigation of complaints, has been needed in one instance only. As in previous years, all the premises used for the keeping of cows, and for the slaughtering of cattle, &c., were several * The length of new sewers completed in the past year appears by the Table No. VI., Appendix, to have been 15,246 feet. This, however, is exclusive of drains, ific, from private houses, the length of which amounts to 2,007 feet. 48 times inspected, and duly reported on, prior to the usual applications being made for the renewal of licenses. There was, I am pleased to state, no opposition offered to such renewal in any case, since all the places visited were found to be clean and in good order, as well as in possession of all the sanitary requisites insisted on by the authorities. The Acts of Parliament having reference to the adulteration of food, &c., and to the regulation of the hours of labour of women and children in factories and workshops, received every attention it was found possible to give to them, but both these measures confer such doubtful legal powers upon the authorities as to render their active interference in prosecuting offenders everywhere a very questionable policy. In this Sub-district, happily, there are not likely to occur many cases calling for such interference in respect to the last-named Act. The other measure named has been found to be quite inoperative, and is now undergoing amendment at the hands of the legislature. It only remains for me to reiterate an often expressed opinion of the growing necessity there is for strenuous efforts being made to remove or to mitigate some of the many evils arising from the overcrowding of the dwellings of the poor, as well as to secure for the district an improved water supply. Speaking more particularly of the water supply, it is submitted that the question of its impurity is of far more consequence than that of its deficient and irregular delivery. Complaints were very general in this, as 1 believe they were in all the Sub-districts during 1868, of the frequent turbid condition of the water as it issued from the Company's mains, giving rise to the belief that the filtering process had often been entirely neglected. The results of the analyses by Dr. Frankland of the waters supplied by the Metropolitan Companies during 1868, have been published in the Registrar General's last 49 annual summary of weekly returns, and it is there stated that the mean amount of suspended impurity was found to be much greater in the water supplied by the Southwark and Yauxhall Company than in any other drawn from the Thames, and submitted to examination in that year. During the past year I several times, for my own satisfaction, and for that of complaining parties, submitted the water supplied to this Sub-district to microscopical examination, and can fully confirm the assertion of Dr. Frankland that its sedimental deposits have frequently been found to contain 'living organisms'; and this I have taken occasion to demonstrate to the Local Committee. More recently, viz., in May, 1869, I obtained and examined some water from a drinking fountain within the parish (one of the purest available sources), and found it scarcely, if at all, improved in either the quantity or character of its sedimentary deposit, though the abundance of 'living organisms in such deposit was perhaps less observable than at some former examinations. Since the publication (20th Feby., 1869) of the results of Dr. Frankland's analyses of 1868, the filtering arrangements of the Company may have been somewhat improved, but if we are to attach any importance to the statements which the analyst himself makes in every one of his monthly reports to the Registrar General, from January to May of the present year (1869), the impurity of the water supplied by the Southwark Company is still very great; and, it may be added, that its variable quality is, for obvious reasons, its very worst recommendation. This subject, from its great sanitary importance, commends itself to the serious consideration of the authorities. R. HAELAND-WHITEMAN, Medical Officer of Health for Putney and Roehampton. Chairman of the Associated Health Officers of the Wandsworth District. D APPENDIX OF STATISTICAL TABLES. TABLE I. Summary of Deaths and their Causes, registered in the Entire District during 1868. 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. Total Deaths from each Class of Disease, &c., in the Entire District. Sub-Districts. Sex. Age. Social Position Claphara—population in 1861,20,890, area in acres. 1,233. Wands worth—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, looting,ana isainam—i opulation 1861, 10,082, area in acres, 3,465. 1 Stales. 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.  Area in Statute Acres, 11,695. DISEASES, And other Causes of Death. Classes:— Small Pox.. 2 ... ... 1 ... 1 1 1 1 ... ... 1 1 ... ... ... ... ... ... 2 Measles 35 9 8 15 1 2 18 17 7 24 3 35 ... . . . ... ... ... 1 9 25 Scarlatina 66 4 5 42 2 3 31 35 11 38 5 64 2 ... ... ... 3 2 26 35 Diphtheria 27 7 2 11 1 6 12 15 2 12 10 26 ... 1 ... ... ... 1 7 19 Quinsy 1 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 Croup 20 3 3 13 ... 1 11 9 1 19 ... 20 ... ... ... ... ... 1 6 13 Whooping Cough 77 25 20 28 ... 4 31 46 34 38 5 77 ... ... ... ... ... 2 7 58 . Zymotic Typhus and Infantile Fever 66 26 7 30 2 1 31 35 3 7 7 33 15 11 6 1 1 5 25 35 Ery sipelas 12 6 5 5 ... 1 5 7 2 1 ... 3 2 4 3 ... ... 2 3 7 Metria, Child birt 21 4 1 13 3 ... ... 21 ... ... ... ... 16 5 ... ... ... 2 8 11 Carbuncle. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... Diarrhœa & Dysenter 130 27 22 65 5 11 62 68 99 17 1 118 1 3 6 2 ... 3 45 82 Cholera 3 1 ... ... ... 2 1 1 1 ... 2 ... ... 1 ... ... ... 3 ... Totals of Zymotic Class 461 124 68 225 14 30 205 256 161 157 31 379 38 24 17 3 4 20 149 288 2. Tubercular 382 48 62 228 24 20 210 172 123 54 9 211 97 59 15 ... 2 14 155 211 3. Of Brain and Nerve 339 45 93 160 16 25 183 156 92 62 13 179 43 50 60 7 4 23 106 206 4. Of Heart 124 30 20 46 9 19 65 59 6 3 3 22 25 32 39 6 5 9 49 61 5. Of Respiratory Or gans 285 52 43 145 21 24 156 129 92 68 6 170 11 38 56 10 5 12 103 165 6. Of Digestive Or gans 89 16 24 37 8 4 49 40 21 3 2 27 11 23 26 2 6 4 27 52 7. Of Urinary Organs 25 3 9 9 2 2 14 11 ... ... 1 1 6 11 7 ... 1 1 10 12 8. Of Organs of Gene ration 17 4 1 10 2 ... 3 14 ... ... ... ... 2 11 4 ... ... 3 3 11 9. Of Joints, Bones, &e 10 3 1 4 2 ... 7 3 ... 1 2 3 2 4 1 ... ... ... ... 10 10. Of Skin 7 2 ... 5 ... ... 4 3 3 ... ... 4 2 ... 1 ... ... ... 2 5 11. Premature Birth Low Vitality, Maformation, &c. 154 53 23 61 9 8 101 53 145 7 2 154 ... ... ... ... 2 11 42 99 12. Of Uncertain Seat 64 2 19 31 4 8 24 40 4 2 1 7 7 21 24 5 1 7 28 27 13. Age 107 38 18 40 1 10 38 69 ... ... ... ... ... ... 43 64 8 10 31 7 58 43 14. Violence 52 1 13 28 6 4 35 17 3 9 3 22 13 7 8 2 ... 2 15. Not Specified 52 29 ... 17 ... 6 24 28 17 3 2 24 6 11 11 ... ... 4 18 30 Totals 2168 450 394 1046 118 160 1118 1050 667 369 75 1203 263 291 312 99 38 120 731 1279 52 TABLE II. Births registered during the year 1868. SUB-DISTRICTS. Males. Females. Total.  Clapham 391 410 801 Wandsworth 327 300 627 Battersea 1007 968 1,975 Putney and Rœhamptou 132 131 263 Streatham, including Tooting and Balham 176 166 342 Total 2,033 1,975 4,008 *.* The excess of Births over Deaths in the entire district is 1,840. TABLE III. Meteorological Elements for 1868, 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 41.4 55.8° 63.9° 45.1° 51.6° Evaporation 39.l° 51.4o 58.4 43.5° 48.1° Dew Point 36.3° 47.1° 53.8° 41.7° 44.8° Weight of Vapour in a Cubic Foot of Air 2.5 grs. 3.7 grs. 4.6 grs. 3.0 grs. 3.5 grs. Degree of Humidity (Satn. 100) 82° 73° 70° 88° 79° Reading of Barometer 29.815 in. 29.869 in. 29.773 in. 29.669in. 29.789 in. Weight of a Cubic) Foot of Air 552 grs. 536 grs. 526 grs. 544 grs. 540 grs. Rain (amount of) 6.6 in. 4.3 in. 5.1 in. 9.2 in. 25.2 in. 53 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 1858-68. 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 Deaths from the Seven Epidemics to Total Deaths.  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 1868 99 194 64 14 28 399 2168 18.4 * Diseases included in the above Table constitute, as in the RegistrarGeneral s Returns, the principal maladies only of the Zymotic class—'viz.: Small Pox, Measles, scarlatina, Diphtheria, Whooping-cough, Diarrhœa and Cholera, and Fever. 54 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, 1868. Compiled from the District Medical Relief Books. SUB-DISTRICTS. Total Cases of Sickness treated in each Sub-district. 1—Small Pox. 2—Measles. 3—Scarlatina and Malignant Sore Throat. 4—Whooping Cough. 5—Diarrhoea and Dysentery. 0—Cholera. 7—Fever. 8—Erysipelas 9—Puerperal Fever. 10—Lung Diseases except Phthisis. 11—Phthisis. 12—Hydrocephalus Atrophy, Scrofula, and Convulsions of Children. 13—Other Diseases. 14—Violence, Privation, and Premature Birth. Total Deaths in each Sub-District  1 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 Clapliam 1069 4 ... 23 3 30 5 10 4 47 2 ... ... 177 7 6 1 ... ... 149 12 19 7 33 14 515 24 56 1 80 Wandsworth 1740 3 ... 14 2 46 1 46 4 220 3 ... ... 52 1 7 ... 1 1 306 8 9 5 5 4 940 15 91 ... 44 Battersea 2224 23 ... 50 1 37 3 26 1 136 3 ... ... 97 2 8 ... ... ... 370 9 71 9 28 7 1274 30 104 1 66 Putney and Roehampton 494 1 ... 30 1 8 1 ... ... 44 ... ... ... 19 1 3 ... 1 1 99 6 10 3 5 1 235 5 39 ... 19 Streatham, including ) Tooting and Balham / 246 2 ... 3 ... 15 ... ... ... 11 ... ... ... 4 1 4 ... ... ... 30 4 5 ... ... ... 155 8 17 ... 13 Totals 5773 33 ... 120 7 136 10 82 9 458 8 ... ... 349 12 28 1 2 2 954 39 114 24 71 26 3119 82 307 2 222 55 Wellcome Library for the History and Understanding of Medicine TABLE VI. summary of the Sanitary Operations in the entire District during the year 1868. Clapham. Battersea. Wandsworth. Putney and Roehampton. Streatham, including Tooting and Balham. Totals.  Number of Houses and Premises inspected 1,500 1,797 50 63 290 3,700 1st Notices served 40 379 76 7 49 551 2nd Notices served 20 67 3 2 3 95 Cesspools emptied and cleansed 60 22 ... ... 60 142 Cesspools abolished 70 48 5 26 83 169 Waterclosets constructed 70 479 ... 166 263 978 Houses supplied with water 20 635 ... 166 263 1,084 Drains constructed or connected with Sewer 60 374 13 140 562 1,149 No. of feet of New Sewers, &c. 200 13,620 6,401 15,246 14,672 50,139 Drains repaired or trapped, or obstructions removed 50 173 6 16 206 451 Open Ditches,Ponds, &c., cleansed (in feet) 850 ... ... 1,850 5,000 7,700 Dust-bins provided Pig Nuisances removed 58 457 ... 149 260 924 20 123 5 2 6 156 Accumulations of Offal, Manure, &c., removed 10 97 3 6 8 124 Unwholesome and dilapidated Houses cleansed or repaired 8 65 38 3 1 115 Cases investigated by Magistrates 2 15 1 1 1 20 Compulsory Orders obtained 2 13 1 ... 1 17 Compulsory works executed 2 12 ... ... 1 15 Works remaining in abeyance from various causes 10 ... ... ... ... 10