Ac 4388 WAND SWORTH WAN 21 SANITARY DEPARTMENT. REPORT ON THE SANITARY CONDITION OF THE SEVERAL PARISHES COMPRISED IN THE WANDSWORTH DISTRICT, DURING THE YEAR 1869. By the Medical Officers of Health. london: printed by john smith and co., 52, long acre, w.c. 1870. 5 HEALTH AND SANITARY CONDITION OF THE ENTIRE DISTRICT. The vital statistics contained in the general tables appended to this Report, relating to the entire District, will not be found to indicate any very alarming condition of the public health, though the past year has, in common with the whole of England, proved one of exceptional severity in respect to both the prevalence and fatality of epidemic diseases. That the population of this District has very greatly increased by excess of births over deaths, and greater still by immigration, in the interval of this and the previous year's Report, there are abundant proofs. By natural increase alone the number of inhabitants has been augmented to the extent of 1,711, the deaths having been 2,393, and the births in the same period 4,104. The increase by immigration can be conjectured only, but that it has been unusually great, may be inferred from the fact that building operations have at no period assumed such vast proportions as they have done in the past year, evidence of which is furnished by the reports of the several surveyors of the District. Until the taking of the next Census (which in all probability will be accomplished in April, 1871, and before the Report for 1870 is issued), it would serve no good purpose to attempt to deduce a death-rate from data which must of necessity be assumed, and from figures which there are at present no reliable means of verifying. Zymotic Diseases. — By reference to Table I, Appendix, which gives the number of deaths from all causes and particularizes the maladies of the Zymotic class, it will be seen, that in addition to a greatly heightened mortality from ordinary diseases, those of the Zymotic group have proved fatal in a larger number of cases by 110 than they did in 6 the preceding year, Measles, Scarlatina, Whooping Cough and Diarrhoea constituting the causes of death in the majority of instances throughout the District. Small-pox was fatal in 21 instances, the deaths occurring in about equal proportions in Battersea and Clapham only. In the Sub-districts of Wandsworth, Putney and Streatham, no fatal cases of this disease were registered in the past year. It may be here observed that the want of a public prosecutor to inforce the penal provisions of the Vaccination Act, as well as those of other legislative measures bearing upon the public health, is still felt; and some important amendments of the Acts relating to the adulteration of food, the regulation of labour in factories, and a few others, appear to be urgently required. The Royal Commission at present sitting in the metropolis, will possibly be able to effect some desirable alterations of the existing laws relating to the public health, and it is hoped the deliberations of this body will result in some really practicable and easily enforced measures of sanitary reform. Ages at Death.—There has unfortunately to be noted the same unsatisfactory feature of the Mortality Table as in the Report of the previous year, viz.:— a very high death-rate of infants and children in every Sub-district, and of almost every class of the community. By referring to the first three columns relating to "Age," in Table I. Appendix, it will be seen that 692 infants died under 1 year; that from 1 to 5 years, 489 succumbed; and that from 5 to 10 years, 57 deaths were registered, making a total between birth and 10 years of age, of 1,238, which is but 83 less than the total mortality at all ages. Of these 1,238 deaths, as many as 471 resulted from Zymotic diseases. The deaths registered as being exclusively due to natural decay, without the mention of any other cause, were 114, the oldest of these persons having attained the great age of 104! Amongst the persons of advanced life dying of disease or accident, there was one registered as being 103 at the time of death, several as being over 90 years, and still more between 60 and 80. Of the two 7 very old persons referred to as having died at the respective ages of 103 and 104, the former (a female) was an inhabitant of Battersea, the latter (also a female) resided in the Streatham Sub-district. Social Positions of the deceased Persons.—Little need be said respecting that portion of the Mortality Table devoted to the record of social position, since the last four columns of the form employed sufficiently indicate the relative proportions of deaths amongst the various classes of the community. It may be observed, however, that of the several sections mentioned, those comprehended in the fourth column, died during the past year in by far the greatest numbers; but it is satisfactory to find that the proportion of deaths amongst the indigent to the deaths amongst the other three classes collectively, was not so great on the side of the former as was the case years ago when systematic and well directed sanitation had scarcely been thought of as a means of controlling the sickness and of lessening the mortality of the inhabitants. Sickness and, Mortality amongst the Union Poor.— Table V. Appendix, possesses much interest, especially when viewed as a measure of the sickness and its resulting mortality, occurring generally amongst all classes. The number of cases treated by the Union Medical Officers was 5,674. The number of resulting deaths to cases treated is 237, or rather more than 4 per cent. This rate of mortality, considered in relation to the social position of the patients, is by no means high, but it is, however, considerably higher than that of previous years. SANITATION. Drainage.—In the last Report it was stated that a length of new sewers to the extent of 50,139 feet had, during the year 1868, been constructed within the area of this extensive District, and at that time the main culverts occupied a space that was equivalent in length to very little short of 100 miles. This great and enduring work, it will be seen (vide Table VI. Appendix), was 8 further supplemented during the past year by the completion of 42,886 feet of new sewerage. It is almost needless to add that these yearly additions to the main drainage of the District cannot fail to have eventually a most important bearing upon the public health of all the Sub-districts, and requires only the adoption of a more effective system of ventilation to render that which has been completed as perfect as it is possible to make it. The Medical Officers of Health, however, regret to find so little progress made in the investigation and settlement of that important question—How best to overcome the injurious effects of sewer emanations in the public thoroughfares? For the opinions of the Health Officers upon this subject, the reader is referred to several of their former Reports. Removal and Abatement of Nuisances.—In the removal or abatement of nuisances, the usual perseverance and energy has been displayed by the Surveyors and Inspectors throughout the District, and it is gratifying to find that comparatively few appeals to magisterial interference have been necessitated. Licensed Slaughter and Cow Houses.—The supervision and inspection of these places throughout the District was in the past year followed by very satisfactory results, since it was found that all the proprietors had evinced so great a regard for their own interests, as to give the Medical Officers of Health very little, if any grounds, for complaint. Every suggested improvement was well received and willingly carried out, hence all applications for the renewal of licenses, being unopposed, were granted by the magistrates. In the Local Summaries which follow these introductory remarks, as well as in Table VI. Appendix, will be found other important Sanitary proceedings, so fully referred to as to render further allusion to them unnecessary. Water Supply.—Although it must be admitted that the water supply by the Companies has undergone some improvement since the issue of the Royal Commissioners' Report, the constant system ought still to be insisted on. A strong argument in favour of this system is, that most of the existing receptacles, even those adopted 9 in many of the most respectable neighbourhoods, are wholly unfit for the storing away of potable water. This is especially the case in localities occupied by the labouring and artizan class. These receptacles, requiring, as they are known to do, such frequent and thorough cleansings, but which they rarely obtain, should be entirely abolished, and such an unremitting supply of water, directly from the mains substituted, as would render both butt and cistern (except perhaps in some cases for closet purposes), wholly unnecessary. Water waste-preventers are now in many places in extensive use, and with the best results, and it is hardly reconcilable with this circumstance, that the legislature should be so tardy in requiring their general adoption, in connection with the system of constant supply so long promised. Upon this subject, the Registrar-General, through Dr. Frankland, has recently remarked—" The intermittent system of distribution still prevails in London, although the Royal Commission on Water Supply have reported that the constant service system ought to be promptly introduced to the farthest extent possible, in the supply of the Metropolis. Out of 22 towns in Lancashire and Cheshire, the water supply of which was recently investigated by the Rivers Pollution Commission, it appears that there is only one which is not supplied on the constant system, and even this exceptional town has a constant supply for from 12 to 15 hours out of the 24. It is singular that a system of supply, which is elsewhere almost universal, and which all unite in regarding as an urgent sanitary necessity, should be found so difficult to introduce into the Metropolis." As to the quality of the water which the Companies continue to supply to this and other Districts south of the Thames, the same authority may be referred to, to show that there is still considerable room for improvement. Reasoning upon the opinion so generally entertained, and particularly by the Rivers Pollution Commission, "that there is no river in the United Kingdom long enough to effect the destruction of sewage by oxidation," the Medical Officers of Health fully concur in the belief that water, which is liable in ever so slight a degree to excremental 10 pollution may, and does, under certain conditions favourable to the development of living organisms, become dangerous for human consumption. Dr. Frankland in his last Report, furnished at the request of the Registrar-General, and published in the last annual summary of the Weekly Returns of Mortality, expresses a most decided opinion tha,t the water supplied to many parts of the Metropolis, especially that delivered to the South and South-West Districts, is still very imperfectly filtered, and he publishes tables which in every way makes good his assertion. On twelve occasions samples were, not long since, drawn from the Companies' Mains and submitted to careful examination, with the following results:— Thames. Number of occasions when clear and transparent Number of occasions when slightly turbid Number of occasions when turbid Number of occasions when very turbid Chelsea 7 3 2 0 Middlesex 12 0 0 0 Southwark 4 5 1 2 Grand Junction 8 3 1 0 Lambeth 5 3 1 3 Other Sources. New River 12 0 0 0 East London 6 3 2 1 Kent 12 0 0 0 11 It would appear then, that the Southwark and the Lambeth Companies' waters (which are those supplied to this District) were, more frequently than any others, found turbid in all the degrees mentioned, and were also less frequently than any others drawn from the mains in a perfectly clear and transparent condition. The public in all this, it is submitted, possess ample grounds for continuing their appeals to the Legislature until a thorough reform of the present system of supply is effected. The Medical Officers of Health trust they have urged enough in this Report to cause an increased interest in this important question; for not only have they long been convinced that much human suffering may be prevented, but a great pecuniary gain insured by a removal of some of those conditions in connexion with the water supply which experience has abundantly proved to be the cause of much preventible disease, and a large amount of mortality. LOCAL SUMMARIES. 14 WANDSWORTH. An examination of the public records of Sickness and Mortality shews that the health of this Sub-district during the year 1869, as in the year previous, suffered considerably from the effects of Epidemic disease, that the amount of general disease was great, and the mortality exceptionally high. A portion of this heightened mortality was due (as will be seen further on) to the occurrence of a greater number of deaths than usual in the public institutions, whose inmates, it should be remembered, are derived from without the Parish, and for the most part subject to a very high mortality; but the bulk of it resulted from the Epidemics which afflicted this locality in common with the rest of the Metropolis, and indeed the whole country, and the propagation of which cannot be regarded, therefore, as attributable to any specially local causes. The total deaths which were registered as having occurred in this Sub-district during the past year were 429 in number, which is greater by 47 than the corrected average of the previous ten years; 237 were of males and 192 of females. Ninety-eight occurred in the following public institutions, viz. :—In the Surrey County Lunatic Asylum, 66; in the House of Correction, 12; in St. Peter's Hospital, 3; in the Hospital for Incurables, 12; in the Patriotic Asylum for Boys, 1; in the Patriotic Asylum for Girls, 2; and in the Reformatory for Boys, 2. The average number in such institutions during the previous 15 10 years has been 86, shewing an excess of 12 deaths in last year. The number of births registered during the year were 583,—299 of males and 284 of females ; the excess of births over deaths, therefore, was 154, being 44 less than in the year preceding. A correct determination of the death-rate, which, it need scarcely be observed, is of extreme importance in a sanitary point of view, can be derived only from the true number of the population. The latter will be ensured by the Census of next year: but in this, the ninth year since the last Census, the absence of any means of accurately ascertaining the present number of the population, renders it undesirable to attempt a numerical estimate of the death-rate; the foregoing figures, however, sufficiently shew that the mortality of the past year was greatly in excess of what can be reasonably accounted for by any accession to the population by natural increase or by immigration. In this and the other Metropolitan Suburbs, and in any locality the inhabitants of which are known to be disproportionately increasing by immigration, a more frequent Census of the population is absolutely necessary, for in such localities, subject to such conditions, an interval of 10 years between each Census renders calculation of the population, upon which the calculation of all other vital statistics necessarily depend, more or less conjectural and untrustworthy. (See last year's Report, page 14.) 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. 16 STATISTICS OF MORTALITY. WANDSWORTH. Total Deaths from each Class of Disease, &c., in the Sub-District Sex Age Social Position Population in 1861—13,346. Area in Acres, 2,478. Males Females Under 1 year From 1 to 5 years From 5 to 10 years Under 20 years, including all under 10 years At 20, and under 40 years of age At 40, and under 60 years of age At 60, and under 80 years of age 80 years and upwards Nobility and Gentry Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes Diseases and other Causes of Death. Diseases Classified. Classes:— Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 23 11 12 5 17 ... 23 ... ... ... ... ... ... 1 22 Scarlatina 36 18 18 5 22 6 34 1 1 ... ... ... 1 8 27 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 7 4 3 2 5 ... 7 ... ... ... ... ... 2 ... 5 Whooping Cough 7 5 2 5 2 ... 7 ... ... ... ... ... ... 1 6 1. Zymotic Typhus & Infantile Fever 5 4 1 1 ... 1 3 2 ... ... ... ... 1 ... 4 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Metria, Childbirth 2 ... 2 ... ... ... ... 2 ... ... ... ... 1 ... 1 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea & Dysentery 23 11 12 15 5 ... 20 ... 1 1 1 ... ... 2 21 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 103 53 50 33 51 7 94 5 2 1 1 ... 5 12 86 2. Tubercular 55 28 27 8 6 1 22 21 11 1 ... 1 3 8 43 3. Of Brain, Nerves, &c. 98 58 40 15 15 ... 34 18 21 21 4 1 5 14 78 4. Of the Heart, &c. 17 10 7 ... ... ... 1 1 5 10 ... ... ... 4 13 5. Of Respiratory Organs 55 27 28 14 8 ... 23 5 14 13 ... 2 ... 6 47 6. Digestive Organs 18 13 6 4 2 ... 8 3 3 4 ... ... ... 5 13 7. Urinary Organs 11 7 4 ... ... ... ... 2 4 5 ... 2 2 2 5 8. Of Organs of Generation 2 ... 2 ... ... ... ... 2 ... ... ... ... ... 1 1 9. Of Joints, Bones, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Mal- formation, &c. 23 15 8 23 ... ... 23 ... ... ... ... ... 1 5 17 12. Of Uncertain Seat 17 9 8 5 ... ... 6 2 4 5 ... ... 1 4 12 13. Age 14 5 9 ... ... ... ... ... ... 10 4 ... ... 4 10 14.Violence 13 12 1 ... 8 1 5 5 2 1 ... ... 2 1 10 15. Not Specified 3 ... 3 3 ... ... 3 ... ... ... ... ... ... ... 3 Totals 429 237 192 105 85 9 219 64 66 71 9 6 19 66 338 17 That which must attract most notice in the Table is the great numerical preponderance of diseases of the Zymotic, Epidemic, or Contagious class, which caused 24 per cent of all deaths, and in conjunction with it, as might be anticipated, the very high amount of infant mortality, the number of deaths of children not exceeding five years of age constituting no less than 44 per cent of the total deaths. The Tubercular class, (Class 2,) which includes Consumption, and ((/lass 5) Diseases of the Respiratory Organs, exclusive of Consumption, were of equal amount, forming each upwards of 12 per cent of the whole mortality, which is somewhat higher than usual. The deaths due to Consumption alone, which is invariably the most fatal single disease, formed 10 per cent; and although this amount is actually large, it is relatively small in comparison with most other parts of the Metropolis; indeed the climate of this District appears, as it was formerly esteemed to be, generally favourable to chest diseases. Diseases of the Brain and Nervous System must, as heretofore, be excluded from an estimate of the causation of the mortality of this Sub-district in consequence of the disturbing influence of the Surrey County Lunatic Asylum. The other classes do not present any variation from the average requiring comment. Thirty inquests were held during the year; 13 resulted from violence, 5 of which were from accident; 3 were suicides and 1 homicide; while the deaths of seven persons were not accounted for. Eight deaths also were not certified by medical testimony. The fact of these deaths having been unaccounted for in one Sub-district alone, shews to what an extent throughout the country society remains unsecured against the possibility of the perpetration of secret crime. This is greatly to be deplored, inasmuch as an effectual remedy against this defect would be afforded by the employment of medical investigation in all cases of death the cause of which has not been certified by a duly registered medical practitioner. (See previous Reports.) Classed with reference to social position, the table shews that upwards of 78 per cent of all deaths, and upwards of B 18 83 per cent of the deaths from Epidemic diseases, occurred amongst the labouring classes. This amount of fatality from disease is very greatly in excess of what is attributable to their superiority of numbers. 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. Scarlet Fever. Diphtheria. Whooping Cough. Cholera. Diarrhœa. Fever— Typhus and Typhoid. Total Deaths from Epidemics. Total Deaths from all causes. Percentage of deaths from Epidemics to deaths from ail causes. 1859 2 7 43 3 2 ... 3 0 60 311 19.2 1860 0 5 4 1 4 ... 4 4 22 308 7.1 1861 1 1 12 1 4 ... 8 3 30 246 12.1 1862 0 28 2 5 11 ... 5 11 62 273 22.7 1863 8 2 23 1 9 ... 6 13 62 300 20.6 1864 4 0 3 6 9 ... 8 13 43 311 13.8 1865 5 2 3 1 6 ... 19 18 54 338 15.9 1866 3 23 10 2 5 7 18 5 73 351 20.7 1867 3 1 7 1 6 1 7 7 33 332 9.9 1868 0 8 5 2 20 ... 22 7 64 394 16.2 1869 0 23 36 0 7 ... 23 5 94 429 21.9 The mortality from these diseases is seen to be exceptionally great, amounting to no less than 94, the average of the preceding ten years having been 50. The excess was partly due to an Epidemic of Measles of severe type which occurred during the first three months, but principally to severe and very extensive Epidemics of Scarlatina and of Diarrhoea which prevailed during the latter seven months of the year. Small-pox, it is gratifying to observe, was almost entirely absent from the Sub-district. No death occurred from this disease, and but a single isolated case is recorded as having taken place amongst the parochial poor during the year. 19 The nature, amount and fatality of the sickness which came under treatment amongst the parochial poor during the year is shewn in Table V., Appendix. This record is valuable, inasmuch as it affords the only trustworthy means of estimating the nature and extent of disease which has prevailed generally throughout the Sub-district. The amount of sickness is seen to have been unusually great, the total number of cases amounting to 2130; the deaths were 62 in number, or 2.9 per cent. the average number of cases during the preceding ten years was 1362, and of deaths 41, or 3 per cent. The amount of Epidemic disease was also unusually great, the number of cases amounting to 470, being upwards of 22 per cent. of all sickness, and the deaths 24; the average number of cases during the preceding ten years was 309, and the deaths 11. A summary of the principal sanitary operations which have been carried out during the year is contained in table VI., Appendix. They were all conducted, with but one exception, without the necessity of any appeal to the law. In addition to these, the Slaughter-houses and Cow-houses of the Parish were all examined and specially reported on; and all the usual sanitary proceedings adopted by the Board for the prevention of the spread of infectious diseases in the houses of the poor were vigorously prosecuted with the greatest advantage. The benefits derivable from these proceedings would be greatly enhanced by the possession of a constant water supply, and by the erection of a public Mortuary in this parish. A constant water supply is needed not only for the purpose of ensuring increased quantity, but especially because the receptacles for the storage of water in the houses of the poor are, either from construction or position, for the most part dangerously unfit for the purpose. There is much need for a Mortuary (See Reports for 1859 and 1867) which, in addition to the ordinary usage of such a building, could be made available for the reception of persons dying from contagious diseases, during the period between death and interment, and for containing B 2 20 an appliance (Disinfecting Oven), for the disinfection of the clothing of those suffering from infectious diseases. These now universally acknowledged sanitary requirements affecting especially the houses of the poor, urgently need fulfilment, for as the great bulk of epidemic sickness, with its fatal results, as annually indicated in these reports, occurs in the houses of the labouring classes, it is there only that contagion can be attacked with any probability of success. And it is not foreign to the subject to add, that whatever measures are successfully projected against contagion in the places which form its stronghold will be successful not only in the diminution and alleviation of human suffering, but also in lessening the burden of the ratepayer, insomuch as is represented by the great expense attendant on pauperism, pauper sickness, and their inevitable results. GEORGE EDWARD NICHOLAS, M.D., Medical Officer of Health for Wandsworth. 21 CLAPHAM. The following form of table I again make use of, as in previous reports, for the purpose of bringing prominently under the notice of the reader, certain statistics having a rather important bearing upon the few comments I shall venture to make upon the health and sanitary condition of this Sub-district during the year 1869. This table, I need scarcely say, shows the number of births, deaths and marriages, as well as the excess of births over deaths in 1869, and in the 10 previous years. MARRIAGES, BIRTHS, AND DEATHS. Years 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868 1869 Marriages 156 183 182 175 181 227 221 310 244 272 234 Births 594 608 624 622 685 640 707 711 777 801 838 Deaths 328 429 390 343 355 408 393 425 451 450 508 Excess of Births ever Deaths 266 179 234 279 330 232 314 286 326 351 330 Statistics of Mortality, &c.—During the year 1869 there were registered in this Sub-district as many as 508 22 deaths—260 males, and 248 females. In the same period there were also registered 839 births, equally divided as to sex, namely 419 of each. The enlargement of the population by natural increase in the interval of this and the report of last year, is therefore 330, as shown by the excess of births over deaths. This excess is less by 21 than it was in 1868; but there are good grounds for believing the increase of the population by immigration was in 1869 very much larger than in the previous year. The Census, which will doubtless be taken in less than a year from this time, can alone determine the number of inhabitants from which the death-rate can be correctly estimated, and until then, it will be useless to speculate upon what such estimate is likely to be. The past year, it must be acknowledged, has been quite an exceptional one as regards the mortality from Zymotic diseases ; but if we take into consideration the constantly increasing population of this Sub-district, it is not thought that it can have fared, during the past year, worse than other localities within the Metropolitan area, the Health Officers of almost every one of which express their regret at being unable to furnish such favourable reports as they could have desired. The table which follows shows in the clearest manner the mortality of the past year, and, in addition to this, gives the ages at death at eight periods, as well as the sex and social positions of the deceased persons ; all this having been gleaned with very considerable labour from the elaborate manuscript returns kindly furnished to the Metropolitan Officers of Health by the Registrar-General. 23 STATISTICS OF MORTALITY. CLAPHAM. Population in 1861—20,894. Area in Acres—1,233. DISEASES And other Causes of Death Total Deaths from each Class of Disease, &c., in the Sub-District. Sex Age Social Position Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. Under 20 years, cludingall under 10 years. At 20, and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle & Trading Class, Shopmen, Clerks, &c. Industrial and Laboring Classes. Classes:- 1. Zymotic Small Pox 10 6 4 ... 7 ... 7 2 1 ... ... ... ... ... 10 Measles 2 2 ... ... 2 ... 2 ... ... ... ... ... 1 ... 1 Scarlatina 29 16 13 3 21 4 28 1 ... ... ... ... 2 7 20 Diphtheria. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 3 1 2 ... 3 ... 3 ... ... ... ... ... ... 2 1 Whooping Cough 29 18 11 13 16 ... 29 ... ... ... ... ... ... 5 24 Typhus, &c. 17 9 8 2 3 4 10 2 3 1 1 ... ... 4 13 Erysipelas. 1 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... Metria, Childbirth 4 ... 4 ... ... ... 1 3 ... ... ... ... ... 1 3 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 29 16 13 20 5 ... 25 ... 2 1 1 ... 2 11 16 Cholera 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 Totals of Zymotic Class 125 69 56 38 57 8 105 10 6 2 2 ... 5 31 89 2. Tubercular 50 22 28 2 1 ... 9 29 9 3 ... ... 3 16 31 3. Of Brain, Nerves, &c. 58 31 27 9 12 1 24 7 10 16 1 ... 9 12 37 4. Of the Heart, &c. 25 12 13 ... 2 1 6 5 8 6 ... ... 5 6 14 5. Of Respirator Organs 70 35 35 27 15 1 44 6 6 13 1 ... 1 23 46 6. Of Digestive Organs 13 5 8 1 4 ... 6 ... 4 3 ... ... 2 3 8 7. Of Urinary Organs 12 6 6 ... 1 ... 2 3 4 2 1 ... 3 6 3 8. Of Organs of Generation 3 ... 3 ... ... ... ... ... 2 1 ... ... ... 1 2 9. Of Joints, Bones, &c. 4 3 1 ... ... 1 3 ... 1 ... ... ... ... 2 2 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Malformation, &c. 66 40 26 63 3 ... 66 ... ... ... ... ... 2 19 45 12. Of Uncertain Seat 9 2 7 ... ... ... 1 ... 5 3 ... ... 1 2 6 13. Age 32 13 19 ... ... ... ... ... ... 14 18 ... 10 6 16 14. Violence 9 6 3 1 2 1 5 2 1 1 ... ... 1 2 6 15. Not Specified 32 16 16 5 4 ... 9 7 8 8 ... ... 4 11 17 Totals 508 260 248 146 101 13 280 69 64 72 23 ... 46 140 322 24 Ages at Death.—1 find, as in most of my former Reports, that at the two extremes of life the table yields very heavy results as to the mortality of the past year. Of infants and young children between birth and ten years of age there were registered as many as 260 as having succumbed to disease, accident, &c. ; which number exceeds by 12 one half of the total mortality at all ages, and is, I regret to say, 49 above the number registered at the same ages in 1868. Such a high rate of infant mortality is most unsatisfactory, but it may be in great part accounted for by the epidemic tendency having been everywhere excessive during the year we are now speaking of. Passing on to the columns which record the deaths of aged people, it will be seen that 95 succumbed at ages ranging from 60 to 90, of which number 72 were between 60 and 80, and 23 at 80 years and upwards. Zymotic Diseases.—Of this class of diseases 125 persons of all ages appear to have died in the year 1869, a number exceeding by one only the total of the previous year. It should be stated, however, that there occurred 14 more deaths from Zymotic diseases amongst children from birth to 10 years of age than the number recorded in the table of 1868; but at the same time it is satisfactory to be able to state that there were less deaths from this class of maladies by 10, in favour of the past year, of persons over 20 years of age, and up to the extreme end of the scale. To these 125 deaths in the past year, Scarlatina, it is found, contributed 29, and Whooping Cough and Diarrhoea respectively, the very same numbers, whilst Typhus claimed 17, and Small-pox as many as 10 victims within the year. The intensity of these five epidemics, I need scarcely say, was very great whilst they invaded the Sub-district, but the statistics of the Registrar General which apply to the entire Metropolis show, that throughout London these same diseases proved fatal in an unusual number of instances. 25 The following Table—the one I usually employ to show the fatality of the seven principal Epidemic diseases—will enable the inquirer to institute a comparison between the amount of mortality of the past year and of the ten preceding ones in respect to these maladies. Years. 1859 1860 1861 1862 1863 1864 1865 1866 1867 1868 1869 Small-pox 9 6 6 1 11 3 7 10 7 0 10 Measles 2 20 0 6 24 12 7 18 3 9 2 Scarlatina. 26 24 22 13 28 11 11 6 5 14 29 Diphtheria 0 9 13 3 1 2 4 5 3 7 0 Whoopingcough 6 21 14 14 9 10 15 14 7 25 29 Typhus 12 6 5 8 6 14 11 16 10 26 17 Diarrhœa & Cholera 11 5 16 7 16 11 20 17 21 28 30 Totals 66 91 76 52 95 63 75 86 56 109 117 Small-pox and Vaccination. —It will be seen that ten deaths from Small-pox occurred in the past year against none in the year previous. It causes me no little vexation to be obliged to announce this fact, because I had hoped for a far more diligent enforcement of the Vaccination Act of 1868, on the part of the authorities than has proved to be the case. Probably I should not have had to record the sacrifice of at least seven of these ten lives had the law been made to reach the parents of that number of young children, which the table shows succumbed to this loathsome malady between the ages of one and five. The Act referred to ought to be no longer called a compulsory one if the authorities continue to shut their eyes to the consequences of parental apathy. I cannot help expressing my regret that the comments of my colleagues and myself upon this important matter in previous Reports have been made to so little purpose. Disease and Mortality amongst the Union Poor.—In the Form No. V. Appendix, will be found tabulated the 26 various diseases treated and the deaths resulting therefrom, amongst the out-door union poor of this Sub-district. The number of cases treated of this class of persons was large (1095), but it is gratifying to be able to report that the resulting deaths were comparatively few (60), which yields a percentage of 18.2. Violent and sudden Deaths—Inquests.—I have to report the holding during the past year of 13 inquests, which inquiries resulted in verdicts indicating that one person committed suicide by hanging whilst in an unsound state of mind; that one new-born infant was suffocated by its mother, who, in the opinion of the jury had been guilty of wilful murder; that five persons were accidentally killed in various ways, and that the remaining six died suddenly, but naturally, of disease. There were also three deaths registered during the year not certified by any medical attendant. It is to be regretted that inquests are not held in all cases such as these, rather than registering them upon mere conjecture as to the cause of death. Sanitation of the Year.—Almost all the appliances of sanitation are now at the command of the authorities, and the complete system of sewerage, now in full operation throughout the parish, requires only the watchful care of the able and efficient Surveyor (and which the rate-payers may be fully assured it will obtain at his hands) to render it all that can be desired as a means of lessening the mortality and improving the sanitary condition of this Subdistrict. One thing, it is hoped, will receive the most careful consideration, and that is, some more certain and effective method than that now employed to render the sewer emanations less obnoxious and less likely to produce disease by their escape into the atmosphere through ventilating gratings placed in too close proximity to densely populated localities. The great advantage the Sub-district possesses in the employment of an active Inspector of Nuisances, whose 27 duty it is to enforce all the necessary requirements of sanitation, will become manifest by a perusal of the column relating to Clapham in Table VI., Appendix, in which it is shown that as many as 2000 houses and premises have undergone inspection during the past year, that very many unwholesome and dilapidated houses have been cleansed or repaired, pig nuisances abated, accumulations of offal, manure, &c., removed, and many other wholesome and necessary sanitary proceedings carried out. As usual, all the Cow and Slaughter-houses within the Sub-district were carefully inspected and supervised, and, after due investigation into their sanitary requirements, were all recommended for renewal of licenses. I am pleased to state I this year saw no grounds for objecting to any such license : and I am equally pleased to report that during the entire year nothing arose in the execution of the orders and recommendations of the District Board or of its committees, to require magisterial interference or investigation. If I venture to add anything to the recommendations contained in my previous Reports, it will be to urge particular attention being paid to the water supply of the Sub-district, which is still defective both in quantity and quality ; and which, in my humble opinion, requires reforming more than any other sanitary matter, with which the authorities are expected to deal; and here I must repeat my already expressed hopes, that as a basis for future legislation, the very excellent recommendations of the Royal Commissioners, to transfer the water supply from Joint Stock Companies into the hands of public bodies, will soon be brought into operation. JOHN MAC DONOGH, Medical Officer of Health for Clapham. 28 BATTERSEA. In presenting this, the 14th Annual Report, on the health and sanitary condition of this Sub-district, there will be much less need than last year to hazard a conjecture as to the possible increase of the population by immigration, since in a very short period a fresh Census will be taken, which will put the statist in possession of the most authentic information, and furnish a sound and reliable basis upon which to calculate the death-rate of every district in the kingdom. In so far, however, as the excess of births over deaths in the past year will permit of a calculation being made for this Sub-district in respect to what is termed the natural increase of the population, it may be stated that it exceeds that of 1868 by 46. During the past year (1869), there have been withdrawn from the population 1121 persons by death, and during the same period, the number of the inhabitants has 29 received an addition by births of 2,096 children. Without making any deduction for the number of deaths in the Workhouse, which is situated in this Sub-district, of persons not belonging to the parish, the excess of births over deaths will be little short of 1000, viz., 975. The deaths of non-parishioners in the Workhouse numbered 75, which reduces the number of deaths, so to speak, proper to the parish to 1,046, and this latter calculation gives an increase to the population of 1,050. There can be no doubt the increase by immigration was also very large, seeing that as many as 312 new houses have been erected during the past year. The estimated number of persons to each house is nine; assuming therefore, that only two-thirds of the 312 dwellings became inhabited by strangers during the year, the nine persons to each house would give an increase from this source alone of 2,106, and if this number be added to the correctly ascertained natural increase, it would bring the figures to 3,156. If this calculation be anything like correct, it cannot be said that 75 deaths in excess of the number registered in 1868, affords any very great indication of the Sub-district having become in reality less healthy than previously reported, especially when it is considered that the past year was quite an exceptional one, in respect to the fatality of Epidemic diseases throughout the country. The table which follows will afford the usual information as to the ages, sex and social positions of those who died in this Sub-district during the year we are considering. 30 STATISTICS OF MORTALITY. BATTERSEA. Population in 1861—19,852. Area in Statute Acres—2,343 DISEASES, And other Causes of Death. Total Deaths from each Class of Disease, &c., in the Sub-District. Sex. Age. Social Position. Males. Females. Under I year. From 1 to 5 years. From 5 to 10 years. Under 20 years, including all under 10 years. At 20, and under 40 years of age. At 40, and under 60 years of age. At 60 and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. Classes— 1. Zymotic Small Pox 11 4 7 5 2 2 10 1 ... ... ... ... ... ... 11 Measles 18 11 7 5 12 ... 18 ... ... ... ... ... 1 8 9 Scarlatina 52 23 29 4 35 9 52 ... ... ... ... ... ... 22 30 Diphtheria 7 3 4 1 3 3 7 ... ... ... ... ... ... 4 3 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 5 3 2 1 4 ... 5 ... ... ... ... ... ... 1 4 Whooping Cough 52 20 32 18 32 ... 52 ... ... ... ... 2 ... 20 30 Typhus and Infantile Fever 31 13 18 2 7 4 19 8 2 2 ... 1 ... 12 18 Erysipelas 7 5 2 2 ... ... 2 ... 4 1 ... ... ... 2 5 Metria, Childbirth 12 ... 12 ... ... ... 1 9 2 ... ... ... 1 6 5 Carbuncle 2 1 1 ... ... ... ... ... ... 2 ... ... 1 ... 1 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 65 25 40 50 12 ... 62 ... 1 2 ... ... ... 24 41 Cholera 11 7 4 5 6 ... 11 ... ... ... ... 1 ... 5 5 Totals of Zymotic Class 273 115 158 93 113 18 239 18 9 7 ... 4 3 104 162 2. Tubercular 183 91 92 54 24 2 101 51 29 2 ... 1 6 63 113 3. Of Brain, Nerves, &c. 155 85 70 41 40 5 91 12 16 31 5 3 8 59 85 4. Of the Heart, &c. 51 26 25 4 1 1 13 4 15 18 1 6 2 17 26 5. Of Respiratory Organs 216 116 100 81 55 4 142 13 24 36 1 3 5 70 138 6. Of Digestive Organs 36 16 20 11 2 ... 15 3 8 10 ... 4 1 11 20 7. Of Urinary Organs 9 6 3 ... ... ... 1 ... 2 6 ... ... ... 1 8 8. Of Organs of Generation 7 ... 7 ... ... ... ... 4 2 1 ... ... ... 6 1 9. Of Joints, Bones, &c. 2 1 1 ... ... ... 1 ... 1 ... ... ... ... 2 ... 10. Of Skin 4 3 1 1 ... ... 1 ... ... 3 ... ... ... 2 2 11. Premature Birth, Low Vitality, Malformation &c. 64 36 28 63 1 ... 64 ... ... ... ... ... 3 22 39 12. Of Uncertain Seat 27 13 14 9 1 ... 11 1 9 6 ... 3 ... 9 15 13. Age 54 14 35 ... ... ... ... ... ... 26 28 3 2 19 30 14. Violence 28 18 10 4 3 4 15 7 5 ... 1 ... ... 6 22 15. Not Specified 12 7 5 7 1 ... 8 ... 1 3 ... ... 1 2 9 Totals 1121 552 569 368 241 34 702 113 121 149 36 27 31 393 670 31 Zymotic Diseases.—Diseases of this class, it will be seen, have proved much more fatal during the past year than in 1868. Unfortunately 11 deaths occurred from Small-pox, against one only in the previous year. Almost all the other Zymotic maladies referred to in the table, show an increase in the number of resulting deaths over the record of 1868. The deaths from Measles in the two past years increased from 15 to 18, Scarlet Fever from 42 to 52, Croup from 5 to 13, Whooping-Cough from 28 to 52, Erysipelas from 5 to 7, and Diarrhoea and Cholera, from 67 to 76. The deaths from Fever (Typhus and Typhoid), and from diseases associated with childbirth, happily present little or no increase ; but altogether an excess of 44 deaths from Zymotic maladies above the number registered in the previous year, cannot be looked upon as very satisfactory. Other Diseases.—The fatal cases of Tubercular diseases have very considerably diminished. In the table of my Report for 1868, there are recorded 228 fatal cases under this head, but in the present table the deaths from the same class of diseases, which includes Phthisis, amount to 183, or 45 less than in the previous year. Phthisis itself, is shown to have proved fatal in 105 instances, against 76, so registered in 1868. Of affections of the Respiratory Organs, and of diseases of uncertain seat, the deaths were more numerous than in the previous year ; the same may be said of deaths from Old Age, which were in excess of 14 ; but under most of the other headings of this portion of the table, the numbers are found to be less than in 1868. Infant Mortality.—The deaths of children from birth to 10 years of age numbered 12 more than in the previous year. In the past year there were registered 643 such deaths, against 6'U in the preceding year. It is therefore anything but satisfactory to note that this mortality of the infant and youthful portion of the population is no less than 165 above one half of the deaths registered at all 32 ages. Of the 645 deaths of children, 224 were registered as having resulted from Epidemic diseases, and is 47 in excess of the number noted in 1868. Mortality amongst the Aged.—The number of persons registered in 1868 as having succumbed to old age was large, viz. 40. In the past year there were recorded 54 deaths due to natural decay, the oldest person at the time of death (a female), is registered as having reached the unusual age of 103. Of persons dying of old age, 28 appear to have reached 80 and upwards, and 26 as being between 60 and 80 years of age at the time of death. The total of aged persons dying both of disease and natural decay was 185, as many as 149 between 60 and 80, and 36 at 80 and upwards. The very aged person referred to above, as having died at 103, is registered as dying of an accident—(shock to the system from a fall)—so that it is impossible to say to what extent of years she might have reached, had she been spared the casualty which unfortunately befel her. Disease and Mortality amongst the Out-door Union Poor. — It appears by Table V. in the Appendix, that the Union Medical Officers treated, during the past year, 1,836 cases of disease, accident, &c., within the Sub-district, and that of these 82 resulted in death. The table itself will show the cause of death under 14 specified headings, and I need scarcely add that a per centage of deaths to total cases treated of 4.4 is a small one in comparison with that noted in some former Reports. It is to be regretted that so many as 31 cases of Small-pox were treated amongst the parochial poor, but at the same time it is gratifying to find that no deaths from this disease were recorded in the Medical Relief books of the year. The deaths then from this disease, 11 in number, recorded in the General Mortality Table, it is presumed, fell principally or wholly upon families of a class above that of the parochial poor, or rather upon those of the industrial class not in the receipt of union relief at the time of the invasion of their households by this terrible disease. 33 Accidental and Violent Deaths.—Inquests.—The accidental and violent deaths appear to have been one less than in the preceding year. The Coroner's Inquests during the past year were 38, and the verdicts may be thus particularized:— Found dead, newly born 5 Found dead in the water, no marks of violence 1 Accidentally drowned 7 Accidentally run over in the streets and on railways 5 Accidental deaths by burns and scalds 6 Suicides, cut throat, poisoning and drowning 4 Death by misadventure (swallowing vitriol) 1 Natural deaths from disease (sudden) 9 Total 38 Uncertified Deaths.—It is much to be regretted that there are so many deaths registered every year without being certified by any medical attendant. The number so registered in the past year was 20, and amongst them are to be found some few deaths of illegitimate children. In these cases the cause of death could only have been conjectured, or vaguely described in the Register upon information of interested relations or friends. The practice is fraught with evil, and certainly needs alteration. Sanitary proceedings of the Year.—Removal of Nuisances.—Seizure of unwholesome Food, &c.—Amongst the most important works connected with Sanitation that have been carried out during the year just past, is the construction of new sewers to the extent of 10,468 feet (See Table "VI., Appendix.) This is in addition to a large amount of house drainage connected with the sewers. The same Table also shows that a large number of nuisances have been abated, cesspools abolished, and unwholesome and dilapidated houses cleansed and repaired. Included in this last work, 9 infected dwellings were efficiently c 34 gated, and the bedding which patients had occupied destroyed. Considerable energy was displayed during the past year by the Inspector of Nuisances, and amongst the duties he was called upon to perform may be mentioned the seizure of 473 lbs. of fish, 1 cwt. of fruit, 29 lbs. of beef, and about 100 lbs. of potatoes, the whole of which food was subsequently condemned as unfit for human consumption. All the places within the Sub-district used for the keeping of cows, and the slaughtering of cattle, were inspected and reported upon, at the times appointed for the renewal of licenses by the Magistrates. In respect to the water supply of this crowded locality, I cannot bring myself to think, notwithstanding the improvement that appears to have taken place in the quality of the fluid supplied, that the Companies have yet accomplished all they have it in their power to do, to carry out the suggestions of the Royal Commissioners. In conclusion I must express some regret at the circumstance that so many magisterial investigations have been necessary to insure the proper carrying out of the orders and recommendations of the District Board of Works. WM. CONNOR, M.B., Medical Officer of Health for the Sub-district of Battersea. 35 STREATHAM, INCLUDING TOOTING AND BALHAM. The forthcoming general Census, which it is expected will be taken in April next, will convert the present doubt as to the increase of population which this Sub-district has lately undergone, into a certainty; and it is therefore considered much better to wait the result of such Census than to assume a death-rate based upon such insufficient data as we at present possess. The deaths registered in 1869, the year we are called upon to review, were 202, which is a number in excess of that of the previous year of 42. The births registered in the same period were 33.9, which is, singular to say, a less number by 3 than that recorded in 1868. Judging from the number of new dwellings (214) that have been erected since my last Report was furnished, there are good grounds for believing that whilst the above figures yield a natural increase somewhat under that of 1868, the increase by influx of new residents was very much larger in the past year than in the preceding one. The excess of births over deaths was, it will be seen, 137. As there is but very little doubt the increase by immigration nearly or quite trebled the above, it may be very fairly assumed that the actual rate of mortality did not very greatly exceed that of the previous year. That it should be, to some extent, in excess of that of 1868, can scarcely excite surprise, seeing how generally prevalent and fatal have been many of the diseases of the Zymotic class throughout the country. The following table, constructed as it always has been with a special view to a comparison with the collected statistics of previous years, will furnish the usual detailed information concerning the mortality of the past year. c 2 36 STATISTICS OF MORTALITY. STREATHAM, INCLUDING TOOTING & BALHAM. Population in 1861—10,082. Area in Statute Acres—3,465 DISEASES, And other Causes of Death Total Deaths from each Class of Disease, &c., in the Sub-District. Sex Age Social Position Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 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 90 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle & Trading Class, Shopmen, Clerks, &c. Industrial and Laboring Classes. Classes:- 1. Zymotic Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 4 3 1 1 2 1 4 ... ... ... ... ... 2 1 1 Scarlatina 10 7 3 1 6 1 10 ... ... ... ... ... ... 7 3 Diphtheria 5 3 2 ... 3 1 4 ... ... 1 ... 1 ... 3 1 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 6 5 1 1 5 ... 6 ... ... ... ... ... 1 3 2 Whooping Cough 2 1 1 1 1 ... 2 ... ... ... ... ... ... ... 2 Typhus and Infantile Fever 3 1 2 1 ... 1 2 ... 1 ... ... ... ... 2 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Metria, Childbirth 3 ... 3 ... ... ... ... 3 ... ... ... ... 1 2 ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysenterv 3 3 ... 2 1 ... 3 ... ... ... ... ... ... 1 2 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 36 23 13 7 18 4 31 3 1 1 ... 1 4 19 12 2. Tubercular 18 8 10 2 ... ... 5 8 3 2 ... 1 2 7 8 3. Of Brain, Nerves, &c. 25 14 11 7 7 ... 15 3 1 6 ... ... 4 8 13 4. Of the Heart, &c. 20 11 9 ... ... ... ... 5 4 10 1 ... 2 9 9 5. Of Respiratory Organs 40 25 15 10 9 ... 19 3 5 11 2 3 ... 9 28 6. Of Digestive Organs 15 6 9 3 ... ... 4 1 6 3 1 1 ... 7 7 7. Of Urinary Organs 8 5 3 ... ... ... ... 1 4 3 ... 1 1 4 2 8. Of Organs of Generation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Of Joints, Bones, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Of Skin 2 ... 2 ... 1 ... 1 ... 1 ... ... ... 1 1 ... 11. Premature Birth, Low Vitality, Malformation, &c. 12 6 6 12 ... ... 12 ... ... ... ... ... 2 2 8 12. Of Uncertain Seat 3 ... 3 ... ... ... 1 ... ... 2 ... 2 ... 1 ... 13. Age 10 4 6 ... ... ... ... ... ... 4 6 1 1 4 4 14. Violence 6 5 1 1 1 ... 3 1 ... 2 ... ... ... 2 4 15. Not Specified 7 2 5 2 ... ... 2 1 1 3 ... ... ... 1 6 Totals 202 109 93 44 36 4 93 26 26 47 10 10 17 74 101 37 Zymotic Diseases.—Six deaths only, due to Epidemic diseases above the number recorded in 1868, appear to have taken place in this Sub-district; during the past year Scarlatina and Croup seem to have been the most fatal maladies of the year. Diphtheria, Whooping Cough, and Diarrhoea resulted in death in fewer instances in the past year than in the preceding one, and Small Pox, to which one death was due in 1868, claimed no victims in the past year, neither were there any cases treated by the Union Medical Officers. Whether this satisfactory result is due to the increased vigilance exercised in carrying out the provisions of the new Vaccination Act, I can scarcely determine, but it would appear so, judging from what has been known of the prevalence and fatality of this disease in some former years. The working of the Act, I submit, is not quite so satisfactory as it might be made by further legislative interference. The appointment of a public prosecutor in connexion with this measure still appears the great desideratum in order to render the Act what it professes to be, a compulsory one. Other diseases and their resulting deaths. — The deaths due to diseases other than Zymotic, registered during the past year, were considerably in excess of the number recorded in the mortality table of the previous Report. This is particularly observable under the headings of Respiratory Organs, Digestive Organs, Violence, and Premature Birth, &c., but under those of Tubercular Diseases, Diseases of the Brain and Nerves, and Old Age, there is a record of fewer deaths in the aggregate than in the previous year. Of the deaths due to Tubercular diseases, it may be stated that Pulmonary Consumption or Phthisis, contributed to the register of the year as many as 15. Ages at death.—Exactly the same number of persons, viz.—10, has been recorded in the present table as in that of the preceding Report, as having died of old age or natural decay, the oldest (the widow of a carman) being 38 registered as having reached the very advanced age of 104 years! The total number of persons of advanced life dying between 60 and 80 was 47, and at 80 and upwards, 10 ; of these 57 persons 3 are registered as approaching 90 (83, 85, 89), and besides the one at 104, there is recorded the death of another female at 94. The total number of deceased persons under 20 years of age was 93, or 2 in excess of the number registered in the previous year. Of these as many as 44 died under one year, 36 between 1 and 5 years, and 4 between 5 and 10 years of age. The total between birth and 10 years of age, was therefore 84, or 41.5 per cent. of all deaths registered within the year. This excessive death-rate amongst children is greatly to be deplored. The remedy would appear to be chiefly in improved education of the poorer classes in all that relates to sanitation and domestic management, and to that end the efforts of philanthropists should be steadily directed. Social Position.—The relative numbers of those dying amongst the working classes, inclusive of the parochial poor, and of those dying amongst the three classes above them in 1868, was 64 of the former to 96 of the latter. In the past year the deaths were relatively the same, viz.:—101 of the former to exactly the same number of the latter. It is a fair inference to be drawn from this equality of numbers that both classes are being benefited by the sanitation carried out by the authorities in this Sub-district. Sickness and Mortality amongst the Union Poor.—The column of Table V., Appendix, which relates to the three Parishes comprising the Streatham Sub-district, records 118 cases of disease, accidents, &c., treated amongst the out-door parochial poor, and 7 resulting deaths, giving of deaths to cases treated a per centage of 5.9. The cases treated during the past year by the Union Medical Officers were, it appears by the table referred to, 128 less than in 1868, shewing a considerable diminution of the pauper element of the population of this improving locality. 39 Inquests,— Violent, Accidental, and Sudden Deaths.The inquests held during the past year were 7 in number, and upon the following cases:—Accidental Asphyxia, 1; Accidental Burns and Scalds, 2 ; Run over by locomotive on railway, 1; Suicides whilst mentally deranged, 2; Natural but sudden death from Heart Disease, 1. There is nothing in these inquiries calling for remark in this Report, further than that these accidental deaths are much to be regretted, displaying, as they do, an extraordinary amount of carelessness and indifference to life. Sanitary Proceedings of the Year.—By comparing Table VI. in the Appendix of this Report with that of the preceding year, it will be seen that a great number of feet of new sewers have been completed since the issue of the last Report. In 1868 as many as 14,672 feet of this great work were carried out. The number of feet completed in the past year is 19,430. For a detail of the other sanitary proceedings in this Sub-district, which have been quite as many and quite as important as any carried out in former years, the reader is referred to the table itself. I need scarcely remark that all the Cow and Slaughterhouses within the Sub-district were as usual inspected and reported on to the Board. It affords me much satisfaction to be able to state that no cases of nuisance were brought under the notice of the Police Magistrates, and that but slight difficulties have been experienced in carrying out the sanitary improvements that have been deemed necessary during the past year for the preservation of the public health. I make no allusion in this Report to the water supply of the Sub-district, because I consider the special Report which I joined my colleagues in rendering some months ago, contained all that could be urged upon the subject. I trust, however, the authorities and the public will not cease to agitate the question of a constant supply of this great necessary of life, until that much needed reform of the present system is fully accomplished. D. C. NOEL, Medical Officer of Health for Streatham, Tooting, and Balham. 40 PUTNEY AND ROEHAMPTON. Little need be added in the way of comment to the information afforded by the annexed tables. From them, in addition to the usual particulars, will be gathered the not very satisfactory fact that the year 1869 has proved one of exceptional severity in favouring the Zymotic activity of disease. In this respect, however, the Sub-district is found to stand by no means alone ; indeed, considering how prevalent and fatal these maladies have been throughout the country, and how greatly and rapidly this locality has increased in the number of its inhabitants in the interval of the present and previous years' Report, it is a matter for some congratulation, that but 15 more deaths from all causes have been registered above the number recorded in the Mortality Table of 1868. The excess of deaths in 1869 over the previous year, will be found to be more than accounted for by the increased number of deaths shown in that part of the table devoted to the record of fatal cases of Zymotic disease. Not only will the following condensed table show what great fluctuations have, for years past, taken place in the 41 force of epidemic influences, but how exceedingly wide has been the range of numbers in respect to deaths from this particular class of maladies in the 10 years preceding the one under review. 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. 1859 119 26 21.8 1860 86 3 3.4 1861 124 21 16.9 1862 107 13 12.1 1863 129 29 22.4 1864 121 11 9.0 1865 115 11 9.5 1866 121 16 13.2 1867 128 20 15.6 1868 118 14 11.8 1869 133 31 23.3 In the past year there were, it will be seen, 31 deaths registered as due to the seven principal Zymotic diseases, against only 14 recorded in the previous year, and instead of yielding a relative per centage to deaths from all causes of 11.8, as was the case in that year, now gives the much higher one of 23 3. In this respect the figures approach very closely those of 1859 and 1863, when the per centages were respectively 21.8 and 22.4, both these years being, like the past one, marked by the excessive fatality attending prevailing epidemics. The following table (the usual one employed in the several local summaries) gives more in detail the desired statistical information touching the mortality of the past year, and also particularises the several maladies of the Zymotic class which resulted in death. 42 STATISTICS OF MORTALITY. PUTNEY AND ROEHAMPTON. Population in 1861—6,481. Area in Statute Acres—2,176. DISEASES, And other causes of Death. Total Deaths from each Class of Disease, &c., in the Sub-District. Sex. Age. Social Position. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. Under 20 years, including all under 10 years. At 20, and under 40 years of age. At 40, and under 60 years of age. At 60, and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle & Trading Class, Shopmen, Clerks, &c. Industrial & Labouring Classes. Classes:- 1 Zymotic Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 5 2 3 1 4 ... 5 ... ... ... ... ... ... ... 5 Scarlatina 6 3 3 ... 3 1 6 ... ... ... ... ... 1 3 2 Diphtheria 2 2 ... ... ... 1 2 ... ... ... ... ... ... 2 ... Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 1 1 ... ... 1 ... 1 ... ... ... ... ... ... ... 1 Whooping Cough 6 3 3 2 4 ... 6 ... ... ... ... ... ... 3 3 Typhus & Infantile Fever 5 3 2 ... 1 ... 2 2 1 ... ... ... 1 3 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Metria, Childbirth 2 ... 2 ... ... ... ... 2 ... ... ... ... 1 1 ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 6 4 2 6 ... ... 6 ... ... ... ... ... ... 4 2 Choleraic Diarrhœa. 1 1 ... ... 1 ... 1 ... ... ... ... ... ... ... 1 Totals of Zymotic Class 34 19 15 9 14 2 29 4 1 ... ... ... 3 16 15 2 Tubercular 20 10 10 3 5 ... 8 6 6 ... ... 1 1 7 11 3 Of Brain, Nerves, &c. 17 4 13 2 ... ... 2 2 3 8 2 3 1 9 4 4 Of the Heart, &c. 6 4 2 ... ... 1 1 1 4 ... ... ... 2 4 ... 5 Of Respiratory Organs 15 7 8 3 5 ... 8 ... 3 4 ... 1 1 4 9 6 Digestive Organs 11 4 7 ... 2 ... 2 1 3 5 ... 2 1 6 2 7 Urinary Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 Of Organs of Generation 1 ... 1 ... ... ... ... ... ... 1 ... ... ... 1 ... 9 Of Joints, Bones, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11 Premature Birth, Low Vitality, Maiformation, &c. 11 4 7 11 ... ... 11 ... ... ... ... ... 3 6 2 12 Of Uncertain Seat 6 4 2 1 ... ... 1 2 2 1 ... ... ... 3 3 13 Age 4 2 2 ... ... ... ... ... ... 1 3 2 ... 1 1 14 Violence 8 6 2 1 ... ... 3 2 1 2 ... ... ... 3 5 15 Not Specified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 133 64 69 30 26 3 65 18 23 22 5 9 12 60 52 43 These statistics being each year tabulated on precisely the same forms, give likewise great facilities for a comparison of results from year to year, which, it is believed, could not be so well obtained through any other arrangement. It will be seen by this table that the total deaths from all causes was 133 (64 males and 69 females), and by Table II. Appendix, that the registered births were 248 (118 males and 130 females). The excess of births over deaths is therefore not so great as in the previous year. Then the excess was 145 ; it is now only 115, which last number, of course, correctly represents the natural increase of the population for the past year. We are (April, 1870) within a year of the usual period of taking the decennial Census, so that any mere conjectures as to the increase of population by immigration would be all but valueless, seeing how little reliance can now be placed upon the usual method of estimating the death-rate, and in view of the fact of there having been erected in the Sub-district during the past nine years, and since the taking of the last Census, a very large number of new dwellings, leading necessarily to an influx of new residents correspondingly great. All that can be said, then, upon this subject is, that it is confidently anticipated the next Census will fully bear out the belief that the figures indicating the relative proportion of deaths to population in this locality will be most favourable ones. Causes of Death.—The prevalence of those diseases (the Zymotic) first enumerated in the above table, has already been sufficiently remarked upon. It may be observed, however, that there were registered in the past year, from Measles, 5 deaths against 1 in 1868; from Scarlatina, 6 against 2; from Diphtheria, 2 against 1; from Whooping Cough, 6 against 0; from Fever, 5 against 2; and from Diarrhoea (ordinary and choleraic), 7 against 5; whilst there is little or no difference to-be found in the tables of the two years in the fatality attending the other epidemic maladies. 44 Happily in the past year, as in the previous one, no deaths were registered as being due to Small-pox, and what is equally satisfactory, in the Union Medical Relief Book no cases are recorded as having been treated amongst the poor. It is believed also that no cases were treated in private practice, since none were made known to me by my professional brethren. Be this, however, as it may, the local Registrar supplies a return which shows that of the 284 children born in the parish in 1869, there remained at the date of the return (27th April, 1870) 61 infants unprotected by vaccination. If this be so, it can scarcely be said that the Vaccination Act of 1868 has been of that benefit which was so confidently expected of it.* * The Return here referred to is as follows:— Number of Births from January 1st, 1869, to January 1st, 1870 1,52 weeks) = 248 Of this number there were vaccinated as under:— By the Public Vaccinator 93 By Resident Private Practitioners 58 By other Practitioners 18 169 Children that have not been vaccinated 1 Children that have died before Vaccination 18 Total 248 (Signed) ADAM WALKER, Registrar. It should not be lost sight of that a certain number of these unvaccinated infants were born in the latter months of the year 1869, so that at the date of the above return the parents of many of them may have deemed it prudent to defer applying to their medical attendants for vaccination on account of illness, the appearance of eruptive disease, or the occurrence of some other circumstance forbidding the operation at the prescribed period. It has been shown that Zymotic diseases were very prevalent and very fatal amongst children in the past year, and it may be stated as a fact that the Exanthematous maladies, particularly Measles, Scarlatina, and Chicken-pock, have afflicted infants to a somewhat large extent in the present year. Under these circumstances, and looking at the fears of most parents that vaccination might have the effect of rendering Epidemic diseases generally more virulent and dangerous, it can be scarcely wondered at that these postponements should be somewhat more numerous than usual. In my own practice, and for the reasons stated, I have lately thought it advisable in several cases to defer the insertion of the vaccine lymph to a more fitting opportunity, and this has doubtless been the case with other practitioners. It is hoped, then, that this list of 61 unvaccinated infants will, in the course of a very short time, be greatly reduced, if not made to entirely disappear. In the Vaccination Notice Paper which the Registrar of Births is required to hand to every parent or guardian, there is a form of Medical Certificate directed to be filled in and signed, in all cases of postponement of the operation. Parents generally would therefore do well to procure the signatures of their usual medical attendant to this document in the event of its becoming necessary to defer vaccination beyond the prescribed period of three months from the date of birth, as by so doing they will avoid the penalties attaching to a non-compliance with the provisions of the new Act. 45 Of the 99 deaths registered as being due to causes other than Epidemic or Zymotic, the Tubercular class of maladies will be found to occupy a prominent place in the tables, and to have contributed 20 deaths to the Register of the year, 17 of which being deaths from Phthisis alone. Diseases of the Brain and Nerves contributed the next largest number, viz., 17. Affections of the Respiratory Organs resulted in death in 16 cases; of the Heart, 6; of the Digestive Organs, 11; whilst from Violence, Accident, &c., 8 persons succumbed, and from all other causes, specified and not specified, 25. In the aggregate there were less deaths due to Non-epidemic maladies than were noted in 1868. Ages at Death.—The most unsatisfactory feature of almost all records of mortality, to whatever locality they may relate, is the preponderance of the deaths amongst the young. Comparing the present table with that of the previous year, it will be found that 59 deaths of infants and young children, from birth to 10 years of age, took place in this Sub-district in 1869, which is 23 above the number, at the same ages, registered in the previous year. This is accounted for by those diseases of the Zymotic class which proved fatal during the past year having fallen almost exclusively upon young children, the deaths of nine persons only, above 10 years of age, appearing in the table as having been due to this class of maladies. The total deaths of infants and children between birth and 10 years of age, to the total at all ages, is as high as 44.3 per cent. The deaths of persons of advanced life, that is to say from 60 to 80 years of age, and from 80 and upwards, were, it will be seen, on about the average scale. Of persons over 70 and under 80, there died 10 persons, whilst 5 succumbed who were registered as being over 80 years, the oldest at the time of death having reached the rather advanced age of 86. Of these deaths 4 were registered as due to natural decay, without the mention of any actual 46 disease operating as a cause of death. The remaining deaths of aged people were all of them certified as having resulted from either accident or some well ascertained disease. Social Positions of the Deceased Persons.—As some set-off to the excessive number of deaths of infants and young children, it may be referred to with satisfaction that the deaths amongst the artizan, labouring, and poorer classes, collectively, were fewer by 29 than the number recorded of the three classes above them collectively, the relative proportion being 81 of the latter to 52 of the former. In 1868 the proportion was 61 to 54. Sickness and Mortality amongst the Out-door Union Poor. —That portion of Table V. Appendix, relating to this Sub-district, exhibits, at one view, the number of cases treated, and the number of deaths from each class of disease amongst the parochial poor, exclusively. The number of cases of disease, accident, &c., treated during the year appears to have been 495, and the number of resulting deaths 20, giving a per centage of deaths to cases treated of 4.0. This is very satisfactory, and, it is submitted, fully demonstrates the efficiency of the means adopted to prevent the invasion of the poorer localities by disease of a severe and fatal character. The improved drainage carried out of late in these localities has been such as to convert some of the most notoriously unhealthy neighbourhoods into places in which fatal diseases amongst the indigent are now of rare occurrence. Accidental, Violent, and Sudden Deaths.—In the last Report it was observed as being somewhat singular that all the Coroner's inquiries in 1868 (six in number) were upon the remains of persons drowned, accidentally or otherwise, in the river Thames. In the past year there were nine of these investigations, resulting in the following verdicts:- 47 Drowned whilst bathing, and by the capsising of a boat 2 Crushed or run over by horses and vehicles in the public streets 3 Died suddenly, but from natural causes 2 Burned accidentally by falling into the fire* 1 Suffocated by mother, through pressure† 1 9 There were also registered three deaths, the causes of which were not certified by medical testimony. In these cases it would have been far more satisfactory had inquests been held, since no practice can be more open to objection, and for obvious reasons, than registration upon vague statements, such as are likely to be made by the relatives or friends of deceased persons who had received no medical attendance. Summary of Sanitary Proceedings.—Table VI. in the appendix presents a summary of all the principal operations carried out in the several Sub-districts. In the column of the table relating to this Parish, will be found a record of much accomplished sanitary work of a beneficial kind, that of new sewerage, being as usual, amongst the most important. In corresponding tables of former reports for several years past, very extensive operations in this direction have, with much satisfaction, been referred to. The many miles of main and branch sewers which have been constructed within the area of this Parish (including the hamlet of Roehampton) since the Metropolis Local Management Act was first put in force, were, it will * It is to be much regretted that the endowment of the Alms Houses situated in this parish, In which the case of death by burning occurred, does not permit of the employment of one or more resident females, qualified to undertake the general supervision of these aged people. The frequency of sudden and violent deaths in this institution renders such an arrangement most desirable. †The Coroner's Jury in this case returned a verdict indicative of an opinion that the death of the infant was wilfully caused, but the evidence before the Grand Jury did not appear to sustain so serious a charge, and the mother was consequently not put upon her trial. 48 be seen, farther supplemented during the past year, to the extent of 1,460 feet. Besides many other sanitary proceedings regarded as essential to the preservation or improvement of the public health, amongst which may be mentioned the supervision of the Slaughter and Cowhouses of the Sub-district (all of which were re-licensed without opposition,) a number of nuisances were either removed or abated, and it is satisfactory to report that, with one exception, all was accomplished without magisterial interference. The Acts having reference to the adulteration and sale of food, and to the regulation of the hours of labour in factories and workshops, still present many legal and other difficulties to their successful working. It is satisfactory, however, to find that no cases of non-compliance with the provisions of these Acts became known to the officers of the District Board, necessitating any interference on their part during the past year.* Water Supply.—After the thorough ventilation which this question underwent last year, it was expected that something would have resulted ere this, to place the supply, both in respect to the quality and quantity of the water furnished by the Companies, on a better footing. Complaints have been very general of late, that all has not been done that might have been to meet the recommendations of the Royal Commissioners, or the requirements of the public as regards the water supplied by the Southwark Company, so greatly complained of last year. It is satisfactory to find Dr. Frankland, in his more recent reports to the Registrar General, speaking somewhat more favourably of such supply. In his report for 1869 he writes thus, "This Company has since (i.e. subsequently to Mr. Radcliff's statement that the turbidity of the water arose from the communication *With reference to the adulteration of food and drugs, there is now some prospect of the question being seriously taken up by Government. In a recent debate upon the subject the Home Secretary candidly admitted that permissive legislation was useless. 49 of the Battersea reservoirs with the tidal portion of the river) improved and extended its filtering apparatus, and during the last four months of the year (1869) it stipplied perfectly clear and transparent water." In the same report, however, is to be found a table showing the number of samples out of a total of twelve, in which living organisms were found in the water supplied by the several Metropolitan Companies during the past year, and in this table the Southwark Company's water is not set down as being very conspicuous for its comparative purity. * The Rivers Pollution Commission say, and with much truth, "There is reason to believe that the excrementitious matters which exist in sewage mixed with water, even in the minutest portions, is likely by such properties, to spread particular diseases amongst populations which drink the water." So long, then, as there exists a possibility of infectious properties being possessed by water furnished to the inhabitants of a district, eo long ought those inhabitants to keep up that amount of agitation which is likely to secure them, by legislative interference, a better and purer supply. The agitation also of the question of a continuous supply of water for domestic and other purposes, in place of the irregular one, now and for years past so greatly complained of, commends itself to all sanitary authorities, as well as to all consumers of this indispensable necessary of life Commons and Open Spaces.—The sanitary history of this Sub-district, which I have attempted to embody in *The following is the Table referred to The samples examined were twelve in number. Names of Companies. Number of occasions when living Organisms were seen. Chelsea 3 West Middlesex 0 Southwark 8 Grand Junction 4 Lambeth 5 New River 0 East London 4 Kent 0 D 50 these Annual Reports during the past fourteen years, furnish, it is submitted, tolerably fair grounds for predicting a favourable future. The tendency of this history has always been to teach us to rely more upon preventive than any other procedures to sustain a satisfactory condition of the public health, and there is perhaps no hygienic question claiming the attention of the inhabitants more urgently at the present time than the preservation of our Commons and Heaths for the purposes of healthful recreation. This is essentially a sanitary question, and since it must be generally admitted that we have not too many of these breathing spaces around our ever-growing Metropolis, it is to be hoped any attempts to diminish the area of the few we have now left us, whilst giving back no equivalent advantages, will—the alleged rights of lords of manors notwithstanding—be successfully resisted. R. HARLAND-WHITEMAN, Medical Officer of Health for Putney and Roehampton. Chairman of the Associated Health Officers of the Wandsworth District. APPENDIX OF STATISTICAL TABLES. TABLE I. Summary of Deaths and their Causes, registered in the entire District during 1869, classified according to Sex, Age, and Social Position, and showing also the relative Numbers in each Sub-District. POPULATION of ENTIRE DISTRICT, In 1861, 70,381. Area in Statute Acres, 11,695. DISEASES, And other Causes of Death. Total Deaths from each Class of Disease, &c., in the entire District. Sub-Districts. Sex. Age. Social Position Clapham—Population in 1861, 20,890, area in acres 1,233. Wandsworth—Population in 1861,13,346, area in acres, 2,478. Battersea—Population in 1861, 19,582, area in acres, 2,343. Putney—Population in 1861, 6,481, area in acres, 2,176. Streatham, Tooting, and Balham—Population 1861, 10,082, area in acres, 3,465. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. Under 20 years, including all under 10 years. At 20, and under 40 years of age. At 40, and under 60 years of age. At 60, and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. Classes:- 1. Zymotic Small Pox 21 10 ... 11 ... ... 10 11 5 9 2 17 3 1 ... ... ... ... ... 21 Measles 52 2 23 18 5 4 29 23 12 37 1 52 ... ... ... ... ... 4 10 38 Scarlatina 133 29 36 52 6 10 67 66 13 87 21 130 2 1 ... ... ... 4 47 82 Diphtheria 14 ... ... 7 2 5 8 6 1 6 5 13 ... ... 1 ... 1 ... 9 4 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 22 3 7 5 1 6 14 8 4 18 ... 22 ... ... ... ... ... 3 6 13 Whooping Cough 96 29 7 52 6 2 47 49 38 55 ... 96 ... ... ... ... 2 ... 29 65 Typhus and Infantile Fever 61 17 5 31 5 3 30 31 6 11 10 36 14 7 3 1 1 2 21 37 Erysipelas 8 1 ... 7 ... ... 6 2 2 ... ... 2 1 4 1 ... ... ... 3 5 Metria, Childbirth 23 4 2 12 2 3 ... 23 ... ... ... 2 19 2 ... ... ... 4 10 9 Carbuncle 2 ... ... 2 ... ... 1 1 ... ... ... ... ... ... 2 ... ... 1 ... 1 Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 126 29 23 65 6 3 59 67 93 23 ... 116 ... 4 4 2 ... 2 42 82 Cholera or Choleraic Diarrhœa 13 1 ... 11 1 ... 8 5 5 7 ... 12 1 ... ... ... 1 ... 5 7 Totals of Zymotic Class 571 125 103 273 34 36 279 292 179 253 39 498 40 19 11 3 5 20 182 364 2. Tubercular 326 50 55 183 20 18 159 167 69 36 3 145 115 58 8 ... 4 15 101 206 3. Of Brain and Nerves 353 58 98 155 17 25 192 161 74 74 ... 176 42 41 82 12 7 27 102 217 4. Of Heart 119 25 17 51 6 20 63 56 4 3 3 21 16 36 44 2 6 11 40 62 5. Of Respiratory Organs 396 70 55 216 15 40 210 186 135 92 5 236 27 52 77 4 9 7 112 268 6. Of Digestive Organs 93 13 18 36 11 15 44 49 19 10 ... 35 8 24 25 1 7 4 32 50 7. Of Urinary Organs 40 12 11 9 ... 8 24 16 ... 1 ... 3 6 14 16 1 3 6 13 18 8. Of Organs of Generation 13 3 2 7 1 ... ... 13 ... ... ... ... 6 4 3 ... ... ... 9 4 9. Of Joints, Bones, &c. 6 4 ... 2 ... ... 4 2 ... ... 1 4 ... 2 ... ... ... ... 4 2 10. Of Skin 6 ... ... 4 ... 2 3 3 1 1 ... 2 ... 1 3 ... ... 1 3 2 11. Premature Birth, Low Vitality, Malformation, &c. 176 66 23 64 11 12 101 75 172 4 ... 176 ... ... ... ... ... 11 54 111 12. Of Uncertain Seat 62 9 17 27 6 3 28 34 15 1 ... 20 5 20 17 ... 5 2 19 36 13. Age 114 32 14 54 4 10 43 71 ... ... ... ... ... ... 55 59 6 13 34 61 14. Violence 64 9 13 98 8 6 47 17 7 9 6 31 17 9 6 1 ... 3 14 47 15. Not Specified 54 32 3 12 ... 7 25 29 17 5 ... 22 8 10 14 ... ... 5 14 35 Totals 2393 508 429 1121 133 202 1222 1171 692 489 57 1369 290 290 361 83 52 125 733 1483 52 TABLE IT. Births registered during the year 1869. SUB-DISTRICTS. Males. Females. Total. Clapham 419 419 838 Wandsworth 299 284 583 Battersea 1032 1064 2,096 Putney and Roehampton 118 130 248 Streatham, including Tooting and Balham 166 173 339 Total 2,034 2,070 4,104 * * The excess of Births over Deaths in the entire district is 1,711. TABLE III. Meteorological Elements for 1869, 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 41.3° 52.0° 61.4° 43.0° 49.5° Evaporation 39.4° 49.1° 57.0° 41.2° 46.7° Dew Point 36.9° 46.1° 53.3° 38.8° 43.8° Weight of Vapour in a Cubic Foot of Air 2.5 grs. 3.5 grs. 4.6 grs. 2.7 grs. 3.3 grs. Degree of Humidity (Satn. 100) 85° 81° 75° 84° 81° Reading of Barometer 29.767 in. 29.800 in. 29.846 in. 29.751 in. 29.791 in. Weight of a Cubic Foot of Air 551 grs. 539 grs. 529 grs. 548 grs. 542 grs. Rain (amount of) 6.6 in. 5.6 in. 4.9 in. 7.0 in. 24.1 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 1859-69. 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, 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 1869 117 247 94 31 27 516 2393 21.5 * * The 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, Diarrhoea and Cholera, and Fever. 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, 1869. 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 Dyseutery. 6—Cholera. 7—Fever. | 8—Erysipelas. 9—Puerperal Fever. 10—Lung Diseases except Phthisis. 11—Phthisis. 12—Hydrocephalus. Atrophy, Scrofula, and Convulsions, of Children. 13—Other Diseases. 14—Violence, Privation, and Premature Birth. Total Deaths in each Sub-District. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths Clapham 1095 17 4 12 ... 38 4 17 ... 63 3 ... ... 186 5 5 ... ... ... 190 11 22 10 48 7 434 22 63 ... 66 Wandsworth 2130 1 ... 140 8 63 6 25 1 170 9 ... ... 53 ... 20 ... ... ... 320 7 15 10 9 5 1213 5 101 1 62 Battersea 1836 31 ... 40 4 20 9 32 6 67 6 ... ... 89 9 7 ... 1 ... 317 12 58 7 21 3 1066 22 87 4 82 Putney and Roehampton 495 ... ... 50 ... 15 2 15 1 38 ... ... ... 17 1 2 ... ... ... 49 2 12 8 1 1 280 4 16 1 20 Streatham, including Tooting and Balham 118 ... ... ... ... 8 ... ... ... 3 ... ... ... ... ... ... ... ... ... 9 4 3 2 ... ... 95 1 ... ... 7 Totals 5674 49 4 242 12 144 21 89 8 341 18 ... ... 345 15 34 ... 1 ... 885 36 110 37 79 16 3088 64 267 6 237 55 TABLE VI. Summary of the Sanitary Operations in the entire District during the year 1869. Clapham. Battersea. Wandsworth. Putney and Roehampton. Streatham, including Tooting and Balham. Totals. Number of Houses and Premises inspected 2,000 3,753 48 57 250 6,108 1st Notices served 75 393 40 11 17 536 2nd Notices served 22 39 1 5 ... 67 Cesspools emptied and cleansed 36 19 ... ... 12 67 Cesspools abolished 42 19 3 2 22 88 Waterclosets constructed 42 305 ... 102 230 679 Houses supplied with water 126 305 ... 102 230 763 Drains constructed or connected with Sewer 166 257 65 67 285 840 No. of feet of New Sewers, &c. 5,100 10,468 6,428 1,460 19,430 42,886 Drains repaired or trapped, or obstructions removed 35 13 1 12 219 280 Open Ditches, Ponds, &c., cleansed (in feet) ... ... ... 1,850 2,000 3,850 Dust-bins provided 36 196 ... 67 214 513 Pig Nuisances removed 4 17 1 2 5 29 Accumulations of Offal, Manure, &c., removed 17 97 3 3 14 134 Unwholesome and dilapidated Houses cleansed or repaired 26 29 20 2 ... 67 Cases investigated by Magistrates ... 9 1 1 ... 11 Compulsory Orders obtained ... 8 1 1 ... 10 Compulsory works executed ... 8 ... 1 ... 9 Works remaining in abeyance from various causes ... ... ... ... ... ...