WAN 24 SANITARY DEPARTMENT. REPORT ON THE SANITARY CONDITION OF THE SEVERAL PARISHES COMPRISED IN THE WANDSWORTH DISTRICT During the Year 1872. BY THE MEDICAL OFFICERS OF HEALTH. London: JOHN SMITH & CO., 52, LONG ACRE, W.C. 1873. REPORT, 1872. To the Board of Works for the Wandsworth District. Gentlemen, We have the honor to submit the Seventeenth Annual Report on the Health and Sanitary Condition of the several parishes comprised in the Wandsworth District. The statistical information being tabulated on the same forms as heretofore, the Report, it is believed, will offer, by comparison, most decided indications of sanitary progress, upon which we think the ratepayers of the District may be very fairly congratulated. We have the honor to be, Gentlemen, Your very obedient Servants, The Medical Officers of Health of the Wandsworth District. B 2 HEALTH AND SANITARY CONDITION OF THE ENTIRE WANDSWORTH DISTRICT. General Remarks. In a sanitary point of view the past year (1872) has been characterised in this District by two rather gratifying circumstances—a greatly diminished intensity of disease generally, and, as a consequence, a lower death-rate than has been noted for some years past. The total number of deaths registered in the entire District during the year was 2,421, (1,203 of Males, and 1,218 of Females) which is less by the very large number of 446 than appeared on the record of the previous year. This is all the more satisfactory seeing how large has been the increase of population in the interval. The number of registered births was 4,540 (2,323 of Males, and 2,217 of Females), giving an excess of births over deaths of 2,119. Assuming then the population to have amounted, in the middle of the past year, to 131,891, the death-rate per 1,000 living will be found to be as low as 18.3! In the previous year the rate was 22.6 per 1,000, or 4.3 above the present calculation. The birth-rate, adopting the same mode of calculation, is found to be 34.4 per 1,000, and the rate of natural increase 16.1 per 1,000. Taking the Registrar General's corrected figures of the Census of 1871, as being for this District 125,060, the following Table will exhibit for the past year the number of inhabitants, the number of deaths, and the ratio of 6 deaths to population in each of the five Sub-districts, placed respectively in the order of their greatest mortality, and, to facilitate reference and comparison, side by side with the numbers as they stood in the table of the Report for 1871. SUB-DISTRICTS. Estimated Population in the middle of Deaths. Ratio of Deaths to Population. 1871. 1872. 1871. 1872. 1871. 1872. Battersea 54,016 58,260 1,472 1,202 1 in 37 1 in 48* Wandsworth 19,783 20,703 453 365 1 in 44 1 in 57* Clapham 27,347 28,154 604 482 1 in 45 1 in 58 Streatham, Tooting, & Balham 14,475 15,027 187 228 1 in 78 1 in 66 Putney & Roehampton 9,485 9,807 151 144 1 in 63 1 in 63 It may occasion some surprise to find that the locality of Streatham, which has hitherto occupied a very high position amongst the Sub-districts in respect to its deathrates, should now be the only one of the five to exhibit an increase in the number of deaths, and, as a consequence, a rate per 1,000 much higher than the average of the past ten years. A greater fatality of Zymotic diseases cannot be the cause of this increase, since the Streatham register records exactly the same number of deaths (31) due to the seven principal Epidemics, as in the table of the preceding year. It is, then, to the mortality from ordinary diseases we must look for an explanation of this exceptional and unexpected circumstance, and accordingly, upon turning *It should always be borne in mind that there are disturbing circumstances which unduly exalt the ratio of deaths to population in some of the Sub-Districts; in those of Battersea and Wandsworth in particular, including, as they do, within their respective areas the Workhouse and Infirmary in the one case, and the County Prison and County Lunatic Asylum in the other. This is more fully explained in the Local Summaries. 7 to the Local Mortality Table, it is seen that there has been a very marked increase of deaths in this Sub-district from the non-Zymotic class of maladies; but it must not be lost sight of, that this increase is most observable in the deaths that have taken place from diseases which are to a great extent uncontrolled by sanitary influences. So far this is satisfactory, but it is a little singular that if climatic and such like influences have operated to produce the state of things referred to, they should, all at once, have done so in such a partial manner, and that every one of the other Sub-districts should show in the past year results so opposite to those disclosed in the Streatham Report. The increase in the number of deaths over that of the previous year was in Streatham as many as 41, whilst in Battersea, Clapham, Wandsworth, and Putney, the numbers, respectively, were less by 270, 122, 88, and 7, than are to be found in the table of the last report! Zymotic Diseases.—Although a comparison of the Mortality Tables of the two past years discloses the gratifying fact of a great decrease of deaths due to Small Pox (from 377 to the very small number of 26) the disease is still found to linger in some of the poorer localities of the District to an extent much to be deplored. As many as 72 cases of this disease, it is found, were treated amongst the Union poor exclusively, and that 5 of these proved fatal during the year. The remaining 21 deaths from Small Pox occurred, it appears, amongst a class, more or less removed from the position of those receiving parochial relief. There is reason to believe that Vaccination has been prosecuted with a great deal more regularity than formerly, nor can it be doubted that this has had much to do with the great reduction of the number of fatal cases throughout the District. Measles, Scarlatina, Diphtheria, Fever, Diarrhoea, and some other of the Zymotic class of diseases, proved also much less fatal in the past year than in 1871, but 8 Whooping-Cough, it is found, resulted in death in rather more than double the number of instances recorded in the last report. In the aggregate, there were less deaths due to Zymotic diseases than in the previous year by 345, the relative numbers in the two years being 858 and 513, constituting 28.3 per cent of the deaths from all causes in 1871, and 18.4 per cent only in the past year. Other Diseases.— By comparing the Tables of this and the preceding report, it will be seen that under almost all the diseases named in the section relating to non-Zymotic maladies there is now recorded a less number of deaths than in 1871, by the large number of 101 in favour of the past year, the only increase being observable under the two headings of diseases of "Uncertain Seat," and of "Violence." In the first of these there has been an increase from 69 to 118, and in the last from 56 to 87. Ages at Death.—Perhaps the most gratifying portion of the present Table is that section of it which marks the ages at death between birth and 10 years. In the last report the total deaths of the three periods, "under 1 year,'' "from 1 to 5 years," and "from 5 to 10 years," was 1,433. In the present table the total number recorded at the same ages is 1,218, which is 215 less than in 1871. (For details see Local Summaries.) From old age or natural decay, there were registered, in 1871, as many as 125 deaths against 105 in the present table. Inclusive of those who died from pure old age, there succumbed, during the year, 448 persons between 60 and 80 years and upwards, the oldest (a lady who resided at Roehampton) having reached the great age of 97. There are in the other Sub-districts records of deaths at 95 (Wandsworth), 94 (Streatham), 92 (Battersea), and 91 (Clapham). Social Position of the Deceased Persons.—The statistics that have been tabulated bearing upon the above point are 9 tolerably satisfactory, inasmuch as a decided decrease of deaths is shown in the column relating to the "Industrial and Labouring Classes,'' the numbers being 1,860 in 1871, but for the past year 1,699. Amongst the "Middle and Trading Classes " there is also observable a decline in the number of deaths (from 791 to 518) and the same is found to be the case amongst the " Nobility and Gentry " (from 107 to 43) but amongst the "Professional and Merchant Class," it appears the deaths were more numerous than in 1871 by 52. There were 4,095 cases of sickness, &c., treated during the year by the Union Medical Officers, 206 of which, or 5 per cent., resulted in death. The per centage of deaths to cases treated in the previous year was 3.7. Uncertified Deaths, Inquests, &c.-The number of Inquests held in the year throughout the District was 122, many of them being exceedingly unsatisfactory as tests of the actual causes of death. The number of deaths registered unattested by medical certificates is found to be 47. In the previous year there were as many as 116 such entries in the returns which passed through the hands of the Medical Officers of Health. The Coroner of this division of the county, in a letter addressed to your Board, having taken upon himself to dispute the accuracy of the latter statement, it will not be out of place to remark here that your Medical Officers of Health are in a position to prove the correctness of their published statistics in every particular; and they, moreover, assert that to all the entries of unattested deaths in the returns of the local registrars to which they have referred, there can be seen attached, in the handwritings of such registrars, the words "not certified," so that there cannot exist the slightest doubt about the frequency with which uncertified deaths have found a place in the civil register books of this District. It was a remark made by your Medical Officers of Health, in their last report, that many 10 of the unattested deaths, to which they ventured to call attention, were found to relate to illegitimate children, shewing how defective is the law that permits so lax a system of death registration that can scarcely fail of having the very reverse of a deterring effect upon the commission of the crime of infanticide, now so much on the increase throughout the country. In the Coroner's letter there are other matters referred to, to which your Health Officers must take exception. For instance, it is contended by the Coroner, more particularly in cases of children "found dead," that it is both "futile" and "inexpedient'' to put the country "to the additional expense of £2 2s. by ordering post mortem examinations, unless there is evidence of positive identity," and unless also the fact of "an independent existence had been established." To this view of the matter the reply of your Health Officers may be included in two simple questions: Does the Coroner consider that positive identity can never be established after an Inquest had been held ? and does he think the fact of "independent existence," or the reverse, can be satisfactorily shown in any other way than through properly conducted post mortem examinations ? Mere negative evidence, founded upon such examinations, is rightly deemed by many Coroners of the utmost importance, by reason of the possibility of some subsequent accusation being made against a party who may not have been suspected until long after a jury had been dismissed; the term "futile," then, is surely quite inapplicable to such cases. Happily, all Coroners are not of the opinion of Mr. Carter. One of the Coroners for Middlesex, Dr. Lank ester, is reported to have remarked to the Bench of Magistrates of his district: "As well abolish the Coroners' Court altogether, as to abolish the practice of requiring post mortem examinations as a means of arriving at the actual causes of death." 11 With this opinion, it is almost needless to say, your Health Officers entirely agree.* Sanitation, &c.—From each of the Local Summaries, and from Table VI, Appendix, may be gathered all the information that can be supplied upon this subject without entering largely into the same details as will be found in such summaries, and in the Surveyors' reports of the * Many letters have lately appeared in the Medical Journals upon the subject of Coroners' Inquests, and upon the practice of dispensing with medical evidence and post mortem examinations. The following communication, taken from The Lancet of a recent date, affords an instance of a very general complaint amongst medical men. "To the Editor of The Lancet." « Sir, Now and again I read in your columns critiques on Coroners' Inquests. A case occurred)near this town recently, which I think illustrates the need of criticism. I was in Stewkley (Bucks) on Monday, about five miles from here, when, hearing that a man had just died suddenly, I at once drove to the house, examined the body externally, and left word with the relatives to convey information of my visit to the authorities, as 1 imagined that a post mortem examination would be required to elicit evidence wherewith to satisfy the jury. However, on visiting the place today, I learn that an inquest has been held without any medical evidence whatever, and that the jury arrived at the somewhat illogical verdict of 'died by the visitation ot God, through drink.' "Tours very truly, "Leighton Buzzard, (Beds.) I. A. Hedges." April 30tb, 1873." Another correspondent of The Lancet relates a case of a medical man being summoned to see a farm labourer, who was supposed to have fallen lrom a stack at a village in Derbyshire. The man died, but the surgeon was not asked to attend the inquest. The jury, however, arrived at the verdict of " died from Heart Disease !" " How in the world," writes this gentleman, " a dozen men, the majority farmers, could so soon find out the disease of the heart, is a wonder to meand he concludes his letter by hinting at a very different cause for the death than the one conjectured. There is even a third letter in the same number of this journal detailing the fact of two deaths taking place in Cumberland, under unusual circumstances, without an inquest in either case ! Seeing, then, the frequency with which the causes of death are thus conjectured by persons wholly incom; etent to form opinions upon such subjects, it cannot be wondered at that the Medical Profession should take the matter up rather warmly; at all events Dr. Farr, of the Registrar General's Department, was fully justified in the remark he made a few years since, that " the Coroner's Court is less effective than it might become in deterring evil doers from the commission of dreadful crimes." 12 year under review. Suffice it to say the Main Sewerage of the district has, since the last report was made, been largely supplemented, and that a great amount of other sanitary work has been accomplished, that cannot fail to produce good results in the future. Manifestly, too, the same good judgment, as hitherto observed, has been employed by the Surveyors and Inspectors in avoiding litigation, and it is gratifying to find that the number of summonses heard at the Police Court have declined from 17 to 8 in favour of the past year. The nuisances arising from the keeping of pigs are found to have been much fewer, but they are still sufficiently numerous to warrant the authorities in keeping in view the promise of the Minister, that he would endeavour, at no distant period, to give them increased legal powers of dealing with such nuisances through the system of licensing. Water Supply.—No furthur advance appears to have been made in securing to the inhabitants the full benefits of the system of constant supply. It is difficult to attribute to the absurdly expensive regulations as to the requirements of new fittings, &c., any other design on the part of the Companies than that of postponing, as long as possible, their responsibilities under the new Act. The fact that but one or two of the Water Companies have as yet taken any active steps in the matter, is beginning to tell upon the public patience, and there are not wanting those who think that the long-promised and long-looked-for boon of a constant service, stands but a poor chance of ever being fully realized. Be this as it may, it is some satisfaction to find that the last report of Dr. Frankland (25th April) speaks more favourably than usual of the condition of all the Metropolitan waters. "The water," he states, "drawn from the Thames during the month by the Chelsea, West Middlesex, Southwark and Vauxhall, Grand Junction, and Lambeth Companies, was of much 13 better quality than that distributed in March; for whilst the proportion of organic elements in this water was from 7½ to 9 times as great in March as that contained in the Kent Company's water, it was only from 3¼ to 3½ as great on the 10th instant."* The Gas Supply.—Very numerous have been the complaints of late against the impurity and deficient illuminating power of the gas supplied, not only in this District, but throughout the Metropolis. The consumption of gas is now so immensely large, that the companies, almost everywhere, find it difficult to keep up an adequate supply, and there are good grounds for believing that very few attempts are made to render it as pure as it might be, The views of a member of your Board, Mr. Thomas Adamson, of Putney,† are perhaps the soundest and the most practical of any that have been published upon this subject, and this gentleman is of opinion that gas, as at present manufactured, can be purified to a much greater extent than it now is, if sufficient time be given for such purification, or the gas be evolved at a much lower temperature than is usually the case. The removal of sulphur compounds, Mr. Adamson seems to think, may be both efficiently and economically accomplished by the proper application of lime, and he is of opinion that any direct failure of the process is to be attributed " more to the imperfect knowledge of the proper application of lime, than to any defect in the process itself." If, then, the interests of the consumers are to be properly studied, there can hardly be two opinions as to the responsibilities resting on all sanitary authorities to protect the ratepayers from being supplied with impure gas, for are not, it may be asked, impure gas, unwholesome gas, and gas of low illuminating power, identical? * The Registrar General's Weekly Return, April 26th, 1873. † Abstract of Report on Gas Impurities, read before the Committee of Delegates of the Vestries and District Boards of the Metropolis, bv Mr. T. H. Adamson, July 9th, 1872. 14 The paper read by Mr. Adamson is full 'of interest, and should be studied by all consumers of gas as a good resume of the whole question. The Adulteration of Food Act.—By all appearances the public stand a chance of being equally disappointed in the effectual carrying out of this Act, as they have been of that of the Water Supply Act. A few more such magisterial decisions as those recently made public will practically annul this measure of anticipated protection. It appears to be necessary, in order to ensure a conviction, that the prosecution should, in every case, prove a guilty knowledge on the part of the sellers of adulterated articles of food, and it is not difficult, therefore, to foresee what will be the fate of this much-lauded Act without further legislation on the subject. A clearer definition of what is to be considered adulteration appears to be the great desideratum. Metropolitan Slaughter Houses.—Some attempts having been recently made to prevent the abolition of private slaughter houses by a repeal of the 55th section of the 7th and 8th Victoria, c. 85, your Medical Officers of Health deem it right to state that they are unanimously of opinion that the establishment of public abattoirs, is, for many reasons, greatly preferable to the continuation of a system of slaughtering cattle under which so many known and acknowledged abuses are perpetrated. Those who have ever seen the mode of conducting a well-regulated abattoir on the continent, will be quite prepared to endorse the views of Dr.Littlejohn,the chief sanitary officer of Edinburgh, who states* "No private slaughter houses are now permitted in Edinburgh; but there is one public abattoir containing 43 booths and one piggery. To this building additions will be made immediately, providing 20 additional booths, the population of Edinburgh having regularly increased since the formation of the abattoir in 1851." Dr. Littlejohn *A letter addressed to the Medical Officer of Health of the Whitechapel District, by Dr. Littlejohn. 15 adds that "the abattoir is considered very advantageous to the trade and also to the general public; animals are slaughtered in it at a cheaper rate than in private slaughter houses, not to speak of the greater cleanliness of the process; the meat is decidedly cheaper in consequence of the unusual facilities afforded in the abattoir. The public, but especially the poor, are benefited, not only in the cheapening of the food, but also in the form of sound wholesome food. Without a public abattoir, in which all animals used for food must be brought for inspection and to be slaughtered, there cannot be a satisfactory inspection of butchers' meat. If private slaughter houses are allowed, the opportunities for deception are so great that no amount of inspection can prevent the sale of meat from unsound animals. In three years' time the rent of the Edinburgh abattoir will have discharged the cost of its erection; meanwhile the rents of the booths have been lowered to £8, and several butchers may combine to rent a booth, and the charge for each bullock is now l½d., for each sheep ¼d., and the entrails of the various animals, with the offal, feet, &c., are cleaned by a staff of women, free of expense." In view of this experience, as well as in the interests of humanity and public health, it is to be hoped that neither sanitary authorities nor the public will give their serious adhesion to any project calculated to set aside one of the most desirable sanitary enactments that has ever received the sanction of the Legislature, viz.:—the clause in a recent Act of Parliament which requires the abolition of all private slaughter houses in the Metropolis after 1874. The Disinfection of Bedding, Clothes, &c.—Constant enquiries are being made by Societies, Sanitary Authorities, and individuals known to take an interest in the above matter, s to the arrangements in force in this District in respect to disinfecting processes, and your Health Officers much regret that they have never been in a position to return very satisfactory replies; indeed all which seems to be in their power now to do is to refer their querists to their 16 Annual Reports, wherein this subject has been frequently mooted, and its consideration strongly urged upon your Board. It is sincerely hoped the subject will soon be revived, and well ventilated, in which case the Medical Officers will have but few misgivings as to the result of the Board's deliberations; for they cannot bring themselves to believe that any sanitary authority can long remain indifferent to what has, in many districts, been already effected, by the adoption of the process of disinfection by heat in properly arranged and suitably constructed buildings. Closely allied to this subject is that of the establishment of Baths and Wash-houses in the District. It is impossible to over-estimate the advantages which the poor in manufacturing localities such as Battersea and Wandsworth (as indeed in all the Sub-districts), would derive from properly regulated establishments of the description referred to. There is statistical information in abundance in possession of Medical Officers of Health, that might be here quoted, fully proving these advantages; and since sanitary authorities generally are supposed to be much interested in all schemes having for their object the diminution of the amount of disease, and the lessening of the rates of mortality, it is submitted that there can be no project more worthy of the consideration of Boards and Vestries, or to which they could give their countenance and support with a greater certainty of good results, than the one which is here recommended to notice. Scavengering.—Removal of House Refuse, &c.—The Medical Officers of Health are desirous of drawing attention to the general scavengering of the District, and the inefficient manner in which this very important sanitary business seems to be conducted in some localities. It must be evident to most householders that the removal of house refuse, and the cleansing operations embraced by the term scavengering, are too infrequent, irregular, and 17 incomplete, to be capable of affording the great practical benefits which would be undoubtedly secured by their complete fulfilment. The latter can be accomplished only by the adoption of a system of a thoroughly searching and unremitting nature, by which the refuse of every house shall be regularly and periodically removed without the necessity for any application by the householder to obtain its removal. These general remarks might be very greatly extended, but it is considered that enough has been said to ensure the attention of the readers of this report to the chief of those measures which all true sanitary reformers believe it to have been politic to put to the test of experience, as well as to a few of those in prospective, the advantages or disadvantages of which remain to be considered, and to receive the judgment of the public. The Medical Officers of Health must now refer their readers to the Local Summaries, and Statistical Tables which follow, believing there will be found therein more indications than usual of sanitary progress, and of good results. LOCAL SUMMARIES. c 2 20 WANDSWORTH. An examination of the following statistics, derived from an analysis of the public records of sickness and mortality, reveals the gratifying fact that the health of this Sub-district during the year 1872, considered both with regard to the amount of sickness which prevailed and its fatal results, was in a highly satisfactory condition; and it is matter for much congratulation that this heightened vitality has been due to the diminution of those diseases which it is the especial object of sanitation to mitigate and prevent. Statistics of Mortality, &c.—The total deaths which were registered as having occurred during the past year numbered 365:205 were of males and 160 of females. 105 of them took place in the following public Institutions; viz., in the Surrey County Lunatic Asylum, 85; in the House of Correction, 8; in the Hospital for Incurables, 7; in the Royal Patriotic Asylum for Girls, 4; and in St. Peter's Hospital, 1. 33 deaths of Wandsworth parishioners occurred in the Workhouse, which is situated in the parish of Battersea. Calculated from the total number of deaths which occurred, and 21 an estimated population, the death-rate for the past year was 17.73 per 1,000 persons living. The death-rate so determined cannot, however, be accepted as the natural one, in consequence of its being unduly exalted by the mortality of the Surrey County Lunatic Asylum, St. Peter's Hospital, and the Hospital for Incurables, the inmates of which institutions are derived, with a fractional exception, from without the parish, undergo no natural increase, and are subject to a very high mortality; and the deaths in which, during the past year, constituted, as is seen above, upwards of one fourth of the whole number registered. Correction having been made for these disturbing influences, after the manner described in previous reports, the natural death-rate, or that proper to the parish, is found to have been 15.52 per 1,000 persons living—the lowest rate ever attained since the existence of the Board, except in the year 1857, when the rate was a trifle less, viz., 15.40 per 1,000. In the foregoing calculations the population is assumed to have increased since the period of the last census in the same proportion as it had done during the preceding 10 years. Birth-rate.—The births registered during the past year numbered 622, 304 of males, and 318 of females. The birth-rate was 31.65, and the rate of natural increase 16.13 per 1,000 persons living. 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:— 22 STATISTICS OF MORTALITY. WANDSWORTH. Population in 1871—19,783. Estimated population in middle of year 1872- 20,703. Increase in 10 years—6,451. Area in Acres, 2,478. Total Deaths from each Class of Disease, &c., in the Sub-District Sex Age Social Position Males Females Under 1 year From 1 to 5 years From 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:— 1. Zymotic Small Pox 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... Measles 5 1 4 ... 5 ... 5 ... ... ... ... ... ... ... Scarlatina 1 ... 1 ... ... 1 1 ... ... ... ... ... 1 ... ... Diphtheria 3 ... 3 ... 2 1 3 ... ... ... ... ... l 2 ... Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 1 ... 1 ... ... 1 1 ... ... ... ... ... ... 1 ... Whooping Cough 13 6 7 7 6 ... 13 ... ... 1 ... ... l 1 1 Typhus & Infantile Fever 4 1 3 ... ... 2 2 1 ... 1 ... ... ... 2 Erysipelas 2 ... 2 2 ... ... 2 ... ... ... ... ... ... ... Metria, Childbirth 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 20 10 10 16 2 ... 18 ... 2 ... ... ... ... 2 1 Totals of Zymotic Class 51 19 32 25 15 5 46 2 2 1 ... ... 3 8 4 2. Tubercular 70 41 29 15 3 7 33 24 10 3 ... ... 3 10 5 3. Of Brain, Nerves, &c. 92 52 49 15 9 1 26 18 32 15 1 1 4 14 7 4. Of the Heart, &c. 19 13 6 1 ... 2 3 4 5 7 ... 1 1 5 1 5. Of Respiratory Organs 53 41 12 9 11 ... 20 3 19 9 2 2 ... 4 4 6. Digestive Organs 13 6 7 2 1 ... 3 ... 3 7 ... ... ... 2 1 7. Urinary Organs. 5 4 1 ... ... ... ... 2 2 1 ... ... ... 3 8. Of Organs of Generation 2 ... 2 ... ... ... ... ... 1 1 ... ... ... ... 9. Of Joints, Bones, &c. 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... 10. Of Skin 1 1 ... 1 ... ... 1 ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Malformation, &c. 20 7 13 20 ... ... 20 ... ... ... ... ... ... 2 1 12. Of Uncertain Seat 10 3 7 1 1 ... 2 1 3 3 1 ... ... 1 13. Age 12 5 7 ... ... ... ... ... ... 3 9 1 ... 2 14. Violence 14 11 3 1 4 ... 9 1 4 ... ... ... ... 2 1 15. Not Specified 2 1 1 1 ... ... 1 ... 1 ... ... ... ... ... Totals 365 205 160 91 44 15 164 56 82 50 13 5 11 53 29 23 Excluding diseases of the Brain and Nervous System from a consideration of the causation of mortality proper to this parish, in consequence of the undue exaltation of this class of diseases by the mortality of the Surrey County Lunatic Asylum, the Tubercular Class (which includes Consumption and Scrofula) constituted by far the greatest proportion of the causes of death, amounting to above 19 per cent. of the whole. Next in order of fatality were diseases of the Organs of Respiration, forming upwards of 14 per cent. The Zymotic Class (Epidemic, Endemic, Contagious,) which usually takes precedence of all the other classes, occupied, it is satisfactory to see, a much lower position last year, shewing a somewhat less per centage than the class preceding. Consumption was, as usual, the most fatal single disease, and formed over 13 per cent., or about one fourth higher amount than tho average. The other classes present but little deviation from the average amount. Age at Death.—Nearly one fourth of all deaths occurred to infants during their first year of age; nearly 37 per cent. to children under 5 years; and nearly 45 per cent. took place under 20 years of age. At the other extreme of life 12 deaths are recorded as having resulted from natural decay alone, but no less than 34 occurred above the age of 70 : viz,, from 70—75, fourteen; 75—80, eight; 80—85, seven; 85—90, four; and one at 95, Social Position.—Upwards of 81 per cent. of all deaths, and 78 per cent. of the deaths from Epidemic diseases, took place amongst the labouring classes. This proportion of mortality from Epidemic disease, although actually great, is relatively much less than the average. 24 Inquests.—Twenty-seven inquests were held during the year, 14 of which were on deaths from violence: of the latter, 12 were accidental, 1 suicidal, and 1 homicidal. 11 instances occurred in which the cause of death was not certified by medical testimony, and in which, therefore, death may have resulted from other than natural causes. In the present state of the law the employment of medical evidence in such cases rests with the discretion of the Coroner, who, as a rule, does not employ such evidence except where suspicion of crime has arisen. It is evident, however, that the presence or absence of suspicion ought not to be accepted as the exponents of the necessity for enquiry or otherwise, for there may be suspicion without crime, and, conversely, there may be crime without the least suspicion of its existence. In order to protect society to the utmost against the possibility of the perpetration of secret crime, it is most desirable that there should be a skilled investigation in every instance where the cause of death has not been certified by a registered medical practitioner; and, in all such cases, it should be observed, a preliminary medical enquiry, in the place of the unskilled enquiry of the Coroner's officer, would supersede the necessity for the great majority of the inquests which are now held, at the great loss of time and convenience of juries and useless expense to the rate-payers. 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. 25 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 all causes. 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 1870 0 2 48 4 16 ... 33 10 113 450 25.1 1871 14 31 23 ... 11 ... 21 3 103 453 22.7 1872 1 5 1 3 13 ... 20 4 47 365 12.8 It is very satisfactory to find from the foregoing Table that the mortality which resulted from these diseases during the past year has been upwards of one third less than the average of the preceding ten years, and to have borne the same diminished relation to the deaths from all causes. Diarrhœa was the most prevalent and the most fatal of this class of diseases; it was, however, considerably less so than it had been for several previous years. Whooping Cough, which with Diarrhoea was present during the whole year, was the next most fatal epidemic. Measles was somewhat prevalent in the summer quarter, but was attended with but little fatality, and Scarlet Fever, which during the preceding three years, and Small Pox during the year 1871, were so extensively prevalent and fatal, were almost absent, one death only having been recorded as resulting from each of these diseases. 20 Sickness and Mortality amongst the Parochial Poor.— The facts Indicating the greatly improved condition of the health of the Sub-district during the past year, as disclosed by an examination of the Table of General Mortality, are fully corroborated by Table V. Appendix, in which are contained the nature, amount and fatality of disease which prevailed amongst the parochial poor during the period. The total amount of sickness and its resulting mortality which occurred amongst them were about one fourth less than the average of the preceding three years, while the amount of epidemic disease was less by one half, and its attendant fatality less by three fourths, than a similar average. An approximate estimate of the amount of sickness which prevailed generally throughout the parish during the year, may be furnished by assuming the proportion which the deaths bear to the cases of sickness amongst the poor, as the proportion which the total deaths bear to the total cases of sickness which occurred. By such calculation it is found that the total cases of sickness will have corresponded with about 56 per cent of the population ; the average of the preceding ten years, by a similar calculation, having been about 67 per cent. Sanitary Proceedings.—A summary of the general sanitary proceedings which have been carried out during the past year is contained in Table VI. in the Appendix. It is satisfactory to see that they were all conducted without the necessity for any intervention of the law. The purification and disinfection of houses, in which the presence of contagious diseases had rendered such proceedings necessary, were employed in the usual manner. All the slaughter-houses and the cow-houses in the parish were, as usual, examined and specially reported on as possessing the necessary sanitary requirements, previous to a renewal of their owners' licences. Several nuisances 27 formed the subjects of special reports, one of which was connected with an offensive trade recently introduced into the parish. With reference to offensive trades generally, it should be remarked that the permission for their introduction into the District cannot be too jealously guarded, now that they are being expelled from the metropolis into its more healthy suburbs; and it becomes a matter for serious consideration whether there be not a requirement for the regulation of the local position of such trades by a law based upon the relative proportion existing between the area and the population of a district. Much other sanitary work was accomplished as usual, which is not contained in the table, the details of some of which are embraced in the general term Scavengering. The latter important sanitary proceeding is not performed in such a manner as is best calculated to ensure the fulfilment of its purpose ; it requires to be more frequent, regular and searching, especially in the close courts and alleys and the bye-ways round the dwellings of the poor, where it should be assisted by a free use of water. A more prompt and systematic plan of procedure is also needed, by which the refuse of every house shall be frequently removed by certain regular periodical visitations of the scavenger without the necessity for any special application of the householder for its removal, instead of the latter, as is too often the case, being effected only under the pressure of great inconvenience or of greater nuisance. The continuous daily renewal of the causes creating the necessity for these proceedings at once indicate what should be the scavenger's duty, and what the routine of its performance. In the presence of the very great improvement which has taken place in the health of the town during the past year, it is hoped that there will be no relaxation of these every-day details of sanitation, which, singly, are apt to be 28 disregarded on account of their apparently minor importance, but which, when thoroughly carried out, conduce in the aggregate so largely to the preservation of the general health on the advent of an epidemic. GEORGE EDWARD NICHOLAS, M.D., Medical Officer of Health for Wandsworth, 29 BATTERSEA. The Medical Officers of Health for Battersea have the pleasure of presenting a much more favourable report for the year 1872 than they were able to do in 1871, in which latter year epidemic disease added materially to the mortality. During 1872 the mortality was as follows, as will be seen by reference to the appended statistical tables:— In the Eastern Division of the Sub-district 540 In the Western Division (containing the Union Infirmary) 644* Bodies found in River which could not be apportioned to either Sub-district 18 Total mortality 1202 which, upon an assumed mean population of 58,285† will give a death-rate for the year of 20.6 per thousand per annum. If, however, 107 non-parishioners who died in the Union Infirmary be deducted, the legitimate death-rate will be found to be 18.9 per thousand. In 1871, with a mean population of 54,847, the deaths numbered 1,472, and consequently the rate of mortality was 26.8 per 1,000. In 1872 the proportion of deaths to persons living was 1 in 48, in 1871, 1 in 37, thus giving 11 years additional "probable duration" of life to every inhabitant. * It should be well understood that the Workhouse Infirmary being situated in the Western Division of Battersea, the deaths in that Institution, which were rather numerous in 1872, viz. 155, have to be taken into account in judging of the comparative mortality of the two divisions into which this large parish has recently been separated for Sanitary purposes. †These numbers are based upon those used by the Registrar General during 1872, the real mean population is probably somewhat larger, viz., 58,317. 30 STATISTICS OF MORTALITY. BATTERSEA. (Entire Sub-district) Population in 1871—54,016. Estimated Population in middle of year 1872 - 58,260. Area in Acres—2,343 Total Deaths from each Class of Disease, &c., in the Sub-District. Sex. Age. Social Position. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. Under 20 years, including all under 10 years. At 20, and under 40 years of age. At 40, and under 60 years of age. At 60 and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. DISEASES, And other Causes of Death. Classes— 1. Zymotic Small Pox 10 3 7 4 1 ... 6 4 ... ... ... ... ... ... 10 Measles 45 25 20 9 33 3 45 ... ... ... ... ... ... 7 38 Scarlatina 12 5 7 2 10 ... 12 ... ... ... ... 1 ... 3 8 Diphtheria 18 9 9 ... 14 3 18 ... ... ... ... ... 1 5 12 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 8 4 4 2 4 2 8 ... ... ... ... 1 ... 3 4 Whooping Cough 56 27 29 21 33 2 56 ... ... ... ... ... 1 3 52 Typhus, Infantile and other Fevrs 30 22 8 ... 10 3 18 3 5 4 ... ... 1 4 25 Erysipelas 5 3 2 2 1 ... 3 ... 1 1 ... ... ... ... 5 Metria, Childbirth 10 ... 10 ... ... ... 1 7 2 ... ... ... 1 1 8 Carbuncle 1 ... 1 ... ... ... ... ... 1 ... ... ... ... 1 ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 66 28 38 49 8 1 58 2 3 3 ... ... 5 13 48 Cholera 2 1 1 ... 2 ... 2 ... ... ... ... ... ... ... 2 Totals of Zymotic Class 263 127 136 89 116 14 227 16 12 8 ... 2 9 40 212 2. Tubercular 243 121 122 92 34 3 141 58 33 10 ... 1 14 34 194 3. Of Brain, Nerves, &c. 130 72 58 42 30 ... 75 7 21 22 5 ... 7 18 105 4. Of the Heart, &c. 56 24 32 2 1 1 6 9 22 14 5 1 2 3 50 5. Of Respiratory Organs 204 100 104 76 54 3 133 10 26 32 3 1 6 20 177 6. Of Digestive Organs 37 21 16 3 ... 2 6 4 16 11 ... 3 4 4 26 7. Of Urinary Organs 6 3 3 ... ... ... 2 1 1 2 ... 1 ... 1 4 8. Of Organs of ration 2 ... 2 ... ... ... ... ... 1 1 ... ... ... ... 2 9. Of Joints, Bones, &c. 2 1 1 ... ... ... ... 2 ... ... ... ... 1 ... 1 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Malformation, &c. 45 19 26 45 ... ... 45 ... ... ... ... ... 7 3 35 12. Of Uncertain Seat 94 35 59 24 2 1 30 16 33 12 4 ... ... 14 80 13. Age 56 20 36 ... ... ... ... ... ... 37 19 2 3 6 45 14. Violence 55 37 18 11 8 2 34 7 8 5 1 ... 1 1 53 15. Not Specified 9 2 7 3 2 ... ... 5 2 1 1 ... 1 ... 8 Totals 1202 582 620 384 250 26 699 135 175 155 38 11 55 144 992 31 But if the non-parishioners who died in the Infirmary be subtracted from the total mortality it will be found that one parishioner in 53 only died in 1872. The mortality for all London in 1872 was 21.4 per thousand, and that of Battersea at large 20.6, showing a difference in favour of this parish of 1.2 per thousand, and if the mortality amongst parishioners only, which as before shown was but 18.9 per thousand, be treated in a similar manner, it will be seen that the metropolitan mortality exceeds that of Battersea by 2.5 per thousand. Taking the least favourable view, by including the deaths of non-parishioners in the Union Infirmary, the year 1871 having had a death-rate of 28.6 per thousand, and the year 1872 one of 20.6 per thousand, a difference in favour of the latter year of 6.2 per thousand per annum results. This, as will be shown subsequently, is almost entirely owing to a diminution in the deaths from Zymotic, Epidemic, or preventable disease, and in that respect an evidence of the value of the extensive sanitary operations of all kinds carried out under the jurisdiction of the Board. The beneficial results of the perfected system of Main Drainage are now becoming evident, more especially in South London, and to quote the Registrar General's Annual Report for 1872, which says "That while the population "has gone on increasing, and has grown denser in the "parts formerly open, the mortality, as a whole, has not "increased; on the contrary, it has decreased; in "South London the mortality fell from 26.6 to 23.2 or 3.4 "in 20 years. This is decisive evidence of the salutary "effects of the drainage of South London, which was "formerly a marsh;" and the present report will probably be a convincing proof of the fact that Battersea has at least profited in an equal degree with its neighbours from the now completed system of sewers. 32 Births.—The births for the whole parish during 1872 were—Males 1,207, Females 1,142, total 2,349, being at the rate of 42 per thousand per annum, and exceeding the death rate of 20.6 per thousand by 21.4; the births being more than double the deaths in number. The natural rate of increase of population, 1,147, for the year arises similarly from the births exceeding the deaths by that number, the additional increase of population which is estimated being made up by immigration. Zymotic Diseases.—The following table of deaths from Zymotic diseases for the year 1871 and 1872, will at once make apparent the great difference between those years. 1872. 1871. Small Pox - 10 - 264 Measles - 44 - 17 Scarlatina - 12 - 55 Diphtheria - 16 1 Croup - 13 - 7 Whooping Cough - 60 - 19 Fevers - 26 - 34 Erysipelas - 5 - 12 Dis. of Childbirth - 10 - 2 Carbuncle - 1 - 1 Diarrhœa - 64 - 173 Cholera - 2 - 0 263 485 Thus giving a difference of 222 cases in favour of the year 1872, which number is more than made up by the almost total "stamping out" of Small Pox by vaccination and re-vaccination, 2.54 fewer deaths having taken place than in 1871. Measles and Whooping Cough alone exhibit any decided increase in numbers in 1872; Scarlatina and Diarrhœa show a very decided decrease; of the former disease 43, and of the latter 109, fewer died than in 1871. 33 Uncertified Deaths.—During the year under consideration 28 deaths were returned by the Registrar as "not certified," that is, no medical certificate of the cause of death was produced. These deaths may be conveniently arranged in the following manner with special reference to age :— Children {Under 1 year 21 (Above 1 year 5 Adults 2 Total 28 Attention should be drawn to the fact that all but two of the "uncertified" deaths were those of children, which plainly demonstrates the propriety of medical investigation in all such cases. Inquests.—In the following table the usual analysis of inquests, held during the year in this parish, will be found with the following verdicts :— Found dead Newly born 8 Adult 1 9 Found drowned 2 Natural deaths from disease, &c. 24 Accidental—Drowned 9, Asphyxiated 5 14 „ Injury to Brain & Spinal Cord 7,Fracture 2 9 „ Burns 1, Tetanus 1, Killed by loco- motive 2 4 „ Poison 2 Suicide—Drowning 1, Hanging 1, Fumes of Charcoal 1 3 Intemperance 1 68 Reference to sanitary matters equally affecting the whole District under the jurisdiction of the Board, such as the important question of the water supply, will be considered in the combined report of the associated Health Officers for the several Sub-districts. D 34 BATTERSEA EAST. In presenting a report upon the sanitary condition of the Eastern division of the parish of Battersea, for the first complete year during which it has been disassociated from the Western half of the parish, there are unfortunately no data by which a comparison of the public health in this large Sub-district, with that existing in former years, can be determined, and it will only be possible, upon the present occasion, to give the mortality from various causes, separating the Zymotic, Epidemic, or preventable diseases, from those which are less within the control of sanitary measures. It is at least extremely probable that a large proportion of the mortality, especially in relation to Zymotic disease, which has hitherto been credited to the parish at large, occurred amongst the very poor operatives and their families, who, during the last decade, have crowded into this Sub-district. Population.—The estimated mean population of this division of the Sub-district for the year 1872, based upon the census taken in April, 1871, is 29,592; a result arrived at by adding to the census numbers such an additional number as is proportional to the increase of population during the preceding decade 1861—1871, calculating the same to the middle day of the year 1872. 35 STATISTICS OF MORTALITY. BATTERSEA EAST. Population April, 1871— 27,416. Estimated increase— 2,176. Estimated mean population, 1872—29,592. Total Deaths from each Class of Disease, Ac., in the Sub-District. Sex. Age. Social Position. Males. Females. Under I year. From 1 to 5 years. From 5 to 10 years. From 10 to 20 years. All under 20 years. At 20 and under 40 years of age. At 40 and under CO 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. 6 2 4 4 1 ... ... 5 1 ... ... ... ... ... ... 6 Measles 20 11 9 3 16 1 ... 20 ... ... ... ... ... ... ... 20 Scarlatina 9 4 5 1 8 ... ... 9 ... ... ... ... 1 ... 2 6 Diphtheria. 1 ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... 1 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 6 3 3 1 4 1 ... 6 ... ... ... ... 1 ... ... 5 Whooping Cough 29 11 18 11 18 ... ... 29 ... ... ... ... ... 1 ... 28 Typhus, &c. 13 10 3 ... 5 ... 2 7 1 4 1 ... ... ... 2 11 Erysipelas. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Metria, Childbirth 8 ... 8 ... ... ... ... ... 6 2 ... ... ... 1 ... 7 Carbuncle. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 32 13 19 25 5 1 ... 31 ... ... 1 ... ... 4 3 25 Cholera 2 1 1 ... 2 ... ... 2 ... ... ... ... ... ... ... 2 Totals of Zymotic Class 126 55 71 45 59 3 3 110 8 6 2 ... 2 6 7 111 2. Tubercular 137 68 69 60 22 1 6 89 33 12 3 ... 1 12 16 108 3. Of Brain, Nerves, &c. 54 28 26 14 14 1 ... 29 5 11 9 ... ... 6 6 42 4. Of the Heart, &c. 32 15 17 2 ... ... 2 4 6 14 6 2 ... 1 2 29 5. Of Respiratory Organs 99 41 58 39 35 3 ... 77 1 11 10 ... 1 6 5 87 6. Of Digestive Organs 19 12 7 3 ... ... 1 4 4 9 2 ... 2 2 1 14 7. Of Urinary Organs. 2 1 1 ... ... ... 2 2 ... ... ... ... ... ... 1 1 8. Of Organs of Gene- ration ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Of Joints, Bones, &c. 2 1 1 ... ... ... ... ... 2 ... ... ... ... 1 ... 1 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Malformation. &c 19 7 12 19 ... ... ... 19 ... ... ... ... ... 2 1 16 12. Of Uncertain Seat 18 5 13 6 ... 1 ... 7 1 7 1 2 ... ... 1 17 13. Age 10 3 7 ... ... ... ... ... ... ... 7 3 1 3 2 4 14. Violence 13 8 5 3 3 1 2 9 1 1 1 1 ... 1 1 11 15. Not Specified 9 2 7 3 2 ... ... 5 2 1 1 ... ... 1 ... 8 Totals 540 246 294 194 135 10 16 355 63 72 42 8 7 41 43 449 d 2 36 Mortality.—The total number of deaths from all causes during the year 1872 was 540, giving a death rate of 18.2 per 1000 per annum, which compares favourably with that of the parish generally in former years, and is lower than that of the metropolis at large by 3.2 per 1000, the metropolitan mortality during 1872 having been 21.4 per 1000. Sex.—Of the total number of 540 deaths, as given above, 246 were males, and 294 females. Ages at death.—As usual, the very young have contributed largely to swell the mortality tables. Under one year of age 194 deaths took place, equal to 37 per cent of the total mortality, and between 1 and 5 years 135 deaths are recorded, being 25 per cent of the total number. If the total number of deaths under five years of age, viz., 339, be treated in the same manner, it will be found that 62 per cent were registered as so occurring. Forty-two persons died between 60 and 80 in this division of the Sub-district, and eight above the age of 80 years. None of these persons exceeded the age of 84 years. Social Position.—The position occupied by the deceased, or, in the case of women and children, by the husband or father of the persons whose deaths are under consideration, may be tabulated as follows— Nobility and Gentry 7 Professional Class, Merchants, Bankers, &c. 41 Middle and Trading Class, Shopmen, Clerks, &c. 43 Industrial and Labouring Class. 449 540 thus precisely five sixths of the mortality occurred in the ranks of the operative and labouring classes. 37 Zymotic, Epidemic, or preventable diseases.—The total number of deaths in this Sub-district during the year 1872 from these diseases is shewn in the following table, arranged in the order of their frequency— Diarrhoea 32 Whooping Cough 29 Measles 20 Fever (including Typhus, Typhoid, &c.) 13 Scarlatina 9 Diseases of Childbirth 8 Croup 6 Small Pox 6 Cholera (English) 2 Diphtheria 1 Total 126 This mortality from Zymotic diseases is at the rate of 4.2 per 1,000 persons living according to the estimated mean population for the year; and at the rate of 23.2 per cent of the total mortality from all causes. The fatal cases of Diarrhoea, with one exception, occurred to infants under one year of age. The two deaths returned as arising from Cholera were probably of the ordinary English type. Whooping Cough and Measles have been prevalent during the year. Small Pox is the only other disease of this class calling for special remark, and it is found that four of the six cases occurred under one year of age, one between one and five, and the other above 20 years of age. In only one of these cases is it stated that the deceased had been vaccinated, and in that instance the cause of death is given as "Suppressed Small Pox," leaving the real nature of the disease somewhat obscure. 38 Vaccination.—The total number of vaccinations in this division of the Sub-district, as shown by the Public Vaccinator's Register during 1872, was— Primary vaccinations 951 Re-vaccinations 30 981 In addition to the above there are those vaccinated by private practitioners, so that it is probable that very few cases escape vaccination; but at the same time it is, to say the least, unfortunate, that it has been found impossible to obtain information as to the actual number of births and vaccinations and their relation in point of numbers to each other. Other Diseases.—Tubercular maladies, in which are included Pulmonary, Phthisis, Tubercular disease of the Brain and other organs, and the wasting diseases of infancy, contributed 137 deaths to the total mortality. Diseases of the Respiratory Organs, other than Consumption; such as Bronchitis, Pneumonia,&c, were registered as the cause of death in 99 instances. Brain and Nerve diseases, yearly becomingmore prevalent, caused 54 deaths. Heart disease was registered as terminating life in 32 cases. Diseases of the Digestive Organs account for 19 other deaths, and Premature Birth for a like number. Diseases of uncertain seat, merely registered as occurring from "Cancer," "Dropsy," &c., 18 others. There were 18 deaths from violence during the year, all of them undergoing investigation by the Coroner. 39 Old Age was given as the cause of death in 10 instances, of whom the oldest were three females, respectively aged 84. There were 9 cases in which the cause of death was "not specified," and described as "unknown," &c,, and in these latter cases no medical certificate was given and no official inquiry appears to have taken place. Disease and Mortality amongst the Union Poor.—Table V. shews in a comprehensive manner the amount and kind of sickness which occurred amongst the Out-door Union Poor in the Eastern Sub-district of Battersea during the year 1872, The total number of fresh cases brought under care was 724. The total mortality when under treatment at home was 41, a death-rate of 5.6 per cent on the cases treated; this is exclusive of the deaths following removal to the Union Infirmary or to the Fever or Small Pox Hospitals or other special institutions. Of the new cases 176 were of Zymotic origin, and of these 12 only died under treatment at home, or less than 7 per cent. Lung disease played an important part in the sickness of the poor, 139 cases of Bronchitis, &c., 35 cases of Pht hisis, and allied to the latter, 19 other cases of Tubercular origin. To these diseases 20, or nearly one half of the deaths, are attributable. Thirty-five cases of accident were under treatment, without a single death. The other 320 cases, included under the head "Other Diseases," were generally of an asthenic type, the result of an insufficient diet. 40 Births.—The Registrar General having made no provision for keeping separate the births registered in either Sub-district of the parish, it is not possible to arrive at the correct numbers without access to the Birth Register, with a copy of which the Medical Officers of Health are not furnished, only the total number of births registered each week in the whole parish being supplied to them. Sanitary proceedings.—The Medical Officer of Health, the Surveyor, and the Inspector of Nuisances, have made many and frequent inspections of dwellings, factories, piggeries, slaughter houses, wharves and other premises where accumulations of refuse, insufficient drainage, or its entire absence, offensive and improperly conducted trades, or disease of Zymotic type existed; and in a very large majority of instances, by judicious advice to the owners or occupiers of such premises, obtained an abatement or total abolition of the existing evils, without the necessity arising of a special report to your Board, or an appeal to magisterial aid. A few of the more important inspections made during the year in the Eastern Sub-district were those made by direction of your Board at— 1. The Southwark and Vauxhall Water Company's premises at Nine Elms. 2. The Ozokerit Works of Messrs, C. J. Field in the Wellington Road. 3. The wharf occupied by Mr. Covington at the London, Brighton and South Coast Company's Goods Station and adjoining the Southwark and Vauxhall Water Company's premises. 1. In the case of the Southwark and Vauxhall Water Company's premises at Nine Elms, a communication was received alleging that the filtered water was exposed to contamination before delivery to the public. 41 An examination of the whole system of storage and filtration effectually disposed of this allegation; the open ponds being used, some for storage of unfiltered water, others for subsidence, and the remainder as filters, after passing through which latter, the water is delivered directly to the public by the mains, and is not subsequently exposed to the air or light. 2. Complaint was made early in the year of the escape of parrafin vapour from the ventilators and side drains connected with the Bridge Road sewer. The cause was known to be the effluent waste from the premises of Messrs. Field, the Ozokerit makers, and upon a previous occasion, by the advice of the Medical Officer and Surveyor, in conjunction with Dr. Letheby, a proper apparatus for reducing materially the nuisance complained of was devised and constructed. This apparatus was found to be still in good working order, the effluent water merely requiring to be reduced in temperature, and much diluted by the addition of cold water before running into the sewer, when no escape of gas of an offensive character would take place. 3. The dust and manure depot at the Brighton Company's Wharf has received much attention during the year, the Medical Officer having inspected it upon 24 occasions. The occupier was summoned at the Wandsworth Police Court, but a conviction was not obtained, the Magistrate deciding that the sorting, sifting, &c., of ashes was a necessary trade, and that there was no undue accumulation. A fence has been erected to protect, in some measure, the Water Company's ponds from pollution, but the law does not give the necessary powers to effect an entire removal of the offensive processes. 42 Cow and Slaughter Houses, &c.—Nine cow-houses and 12 slaughter-houses were inspected by the Medical Officer, and pending probable parliamentary action upon the subject, as promised a deputation from your Board by the President of the Local Government Board, no objections were taken to their being licensed. W. H. KEMPSTER, Medical Officer of Health, Battersea East. 43 BATTERSEA WEST. This is the first complete year that Battersea has been divided into two districts and a Medical Officer of Health appointed for each, for the purpose of sanitation and other matters, consequently it will be impossible in the present report to compare statistics and per centages in every case with those of previous years, but as far as possible it will be done. My colleague and myself have deemed it advisable to compile a separate report for each division, in which we hope to arrive at an accurate conclusion as to the death rate and other matters of interest in connection with each Sub-district. I must therefore refer the Board to the conjoint report of the whole Parish for the comparison of this year with previous ones with regard to health, &c. Death Rate.—For the purpose of unity I have still adhered to the method of calculation for increase of population pursued by the Registrar General, though at the same time, as evidenced by the increase during the past ten years, which was 17 per cent in Battersea, his mode of calculation has fallen very far short of giving to Battersea its actual increase. I have every reason to believe that the population in this district has increased during the past year at the same ratio, but taking the increase at 10 per cent only, which probably is as near correct as 44 possible for some other metropolitan districts, still does not apply to exceptional Battersea—for this reason, Battersea has ever been made to present a very conspicious death-rate, and to gain considerable opprobrium as an unhealthy parish, which it does not altogether deserve ; therefore, I trust this fact will not be lost sight of whilst perusing the following report which I have the pleasure to submit to the Board, and which shows such different results from those usually placed to the account of Battersea as a whole. The population of the Western District of Battersea in April, 1871, was 26,572. The increase for the whole parish in the previous ten years was 34,388. This then is the number (with a due allowance to East Battersea) on which to calculate the increase for the past year, in order to get the mean population of 1872, which will give to this District at that period, the month of June, 28,693 souls. Mortality.—The total number of Deaths registered were 644; 322 being Males, and 322 Females. Of these 644 deaths, 155 took place in the Workhouse Infirmary; deducting these, it will leave 489 as the correct number which occurred in the out-door* population of this District during the year,givingamortalityof 17 per 1000 persons living. Of the 155 persons who died in the Infirmary 48 belonged to the Parish of Battersea, and as these were removed from both Districts, they will be taken into account in the entire death-rate in the combined summary for the whole Parish. In looking at the different ages at which these deaths have occurred,† one cannot but be struck by the large number under five years of age, 300, being nearly half the total number of deaths. As we then ascend in years —from 5 to 10 and from 10 to 20—there seems to be * Out-door with reference to Workhouse and Infirmary, t For which see annexed Table, 45 almost an immunity from death, only 32 being registered. One hundred and ten persons had reached over 60, and 29 over 80 years, the three oldest being females, aged respectively 92, 89, and 88, making a total of 142 of the gross number of deaths: 644 who had attained the age of 60 years and upwards, 46 of whom were registered as having succumbed purely to old age. Thus we find the two extremes of life—i.e., below 5 and above 60—yielding two-thirds the entire number of deaths. This fact is extremely satisfactory as regards the aged, but is not so with reference to the infantile portion of the population; and this, I think may, in a great measure, be accounted for by the manner in which many of these infants are brought up—viz., by hand, spoon or bottle-feeding, the mothers going out to work and the children being placed with some person who, for a small remuneration, takes charge of them for the day, during which time they are fed on food, unsuitable both in quantity and quality, irritation of the bowels, diarrhoea, and convulsions following as almost a natural consequence; and it is thus these hand-reared infants gradually waste and die. These remarks apply with greater force to infants who are entirely placed out to nurse, and which are generally illegitimate. I trust the Infant Life Protection Act will be successful in extending its influence to these little ones, who are powerless to protect themselves. The following table gives information as to the diseases, &c., the ages, sex and social position of those who died in this Sub-district during the year, including all who succumbed in the Infirmary. 46 STATISTICS OF MORTALITY. BATTERSEA WEST. 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 From 10 to 20 years All under 20 years At 20, and under 40 years At 40, and under 60 years At 60, and under 80 years 80 years and upwards Nobility and Gentry Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. Population April, 1871— 26,572, Estimated mean population June, 1872— 28,693. Classes:- 1, Zymotic Small Pox 4 1 3 ... ... ... 1 1 3 ... ... ... ... ... ... 4 Measles 24 14 10 5 17 2 ... 24 ... ... ... ... ... ... 7 17 Scarlatina 3 1 2 1 2 ... ... 13 ... ... ... ... ... ... 1 2 Diphtheria 15 8 7 ... 12 3 ... 15 ... ... ... ... ... 1 5 9 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup V 3 4 1 5 1 ... 7 ... ... ... ... ... ... 3 4 Whooping Cough 31 18 13 10 19 2 31 ... ... ... ... ... ... 3 28 Typlius&InfantileFever 13 10 3 ... 1 3 3 7 2 1 3 ... ... 1 2 10 Erysipelas 5 3 2 2 1 ... ... 3 ... 1 1 ... ... ... ... 5 Metria, Childbirth 2 ... 2 ... ... ... 1 1 1 ... ... ... ... ... 1 1 Carbuncle 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea & Dysentery 32 14 18 22 3 ... ... 25 2 3 2 ... ... 1 10 21 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 137 72 65 41 60 11 5 117 8 6 6 ... ... 3 33 101 2. Tubercular 106 53 53 32 12 2 6 52 25 22 7 ... ... 2 18 86 3. Of Brain, Nerves, &c. 70 44 32 28 16 ... 2 46 2 10 13 5 ... 1 12 63 4. Of the Heart, &c. 24 9 15 ... 1 1 ... 2 3 8 8 3 1 1 1 21 5. Of Respiratory Or- 105 50 40 37 19 ... ... 56 9 15 22 3 ... ... 15 96 G. Digestive Organs 18 9 9 ... ... 2 ... 2 ... 7 9 ... 1 2 3 12 7. Urinary Organs 4 2 2 ... ... ... ... ... 1 1 2 ... l ... ... 3 8. Of Organs of ration 2 ... 2 ... ... ... ... ... 1 1 ... ... ... ... ... 2 9. Of Cancer, &c. 15 7 8 5 ... ... ... 5 8 4 3 ... ... ... 3 12 10. Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Malformation, &c. 22 12 10 22 ... ... ... 22 ... ... ... ... ... 5 2 15 12. Of Uncertain Seat 61 23 38 13 2 ... 3 18 12 21 8 2 ... ... 10 51 13. Age 46 17 29 ... ... ... ... ... ... ... 30 16 1 ... 4 41 14. Violence 28 15 13 8 4 1 1 14 3 7 4 ... ... ... ... 28 15. Not Specified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 644 322 322 186 114 17 17 334 66 102 113 29 4 14 101 525 47 Zymotic Disease.—During the past year no epidemic Disease has prevailed to any great extent in this district. The principal fatal diseases of this class being Diarrhoea, from which 32 deaths were registered, 25 of the sufferers being under 5 years of age; Whooping Cough, 31; Measles, 24; Diphtheria, 15; Typhus, Typhoid, and Infantile Fever, 13; Croup, 7; Erysipelas, 6; Small Pox, 4; Scarlet Fever, 3; Metria, 2; and Carbuncle, 1, being in all 137; a number which is small when compared with those of last year, as will be seen by reference to the table in the joint summary. Other Fatal Diseases.—Tubercular disease ranks first, with 106 deaths, of which 73 were from Phthisis. To affections of the respiratory organs were attributed 105 deaths, the principal of which were Bronchitis, 48; and Pneumonia, 35; Diseases of Brain and Nerves, 76; of Heart, 24; Premature Birth and Low Vitality, 22; not specified and of uncertain seat, 61. The deaths in relation to social position were, in the Industrial and Labouring class 81.52 per cent.; Middle and Trading 15.67; Professional 12.19; and Nobility and Gentry .62 Small Pox and Vaccination.—The epidemic of Small Pox which raged with such terrible results throughout the district in 1871, had almost ceased at the commencement of this year, so much indeed, that only 4 deaths are recorded. Now that the Vaccination Act has been made more stringent, and officers appointed to see that every infant is successfully vaccinated, and the renewal of vaccination is becoming general at the age of puberty, at which period the protective power of Vaccine Lymph appears to wane, I think it will be long ere we have another such visitation of Small Pox as took place in 1871. A word concerning its performance. The only places where it can be efficiently carried out are the stations appointed by the Local Government Board, and for this reason, that a considerable number of infants, and consequently a plentiful and choice 48 supply of fresh Lymph, is always at hand, which can be readily transferred from arm to arm. This is by far the best method, and none other should be resorted to under ordinary circumstances. It is the fact of infants having been inefficiently vaccinated, or stored Lymph having been used, which led to many deplorable results evidenced during the late epidemic, as the following extract from Dr. McCann's report on Small Pox will show. "When a considerable mortality occurring from Variola is seen amongst those reported in statistical tables as having been vaccinated, great allowance must be made for the correctness of any conclusions formed from them, for I feel convinced that not more than 20 per cent of all the cases admitted into the Hospital bore cicatrices undoubtedly genuine." It is really gratifying to have lost sight of the Antivaccination League, whose doctrines were calculated to do much harm amongst a credulous class of the community. The number of persons vaccinated at the station in this district during the year was as under:— Re-vaccinations Vaccinations Total 1872 13 501 514 1871 786 1083 1869 The year 1871, showing such large numbers, was the epidemic year of Small Pox, when 786 persons presented themselves for re-vaccination. In 1872, when fears were allayed, and the epidemic had subsided, only 13 were performed ! The above table only shows the number of vaccinations paid for by the Guardians, but no doubt as many more were vaccinated by private practitioners in the district. I should much like to give a table tracing out 49 every infant born in the district, but no means at present existing by which I can determine to which division of the parish each child belongs, I am unable to do so. Disease and Mortality amongst the Out-door Union Poor.—The number of cases attended during the year was 469, viz.:—Males 196, Females 273, being considerably less than in the previous year. This may be attributed to the absence of any epidemic, such as visited the district during 1871, when 245 cases of Small Pox occurred amongst the out-door poor exclusively, whilst this year there were only 11. The other diseases of an epidemic nature were Diarrhoea 26, Rubeola 16, Scarlet Fever 5, Whooping Cough 7, Fever 15 (comprising Typhus, Typhoid, and Continued), and Erysipelas 6 ; of the non-epidemic classes, disease of the Respiratory Organs stands first with 82 cases, Rheumatism and Gout next with 51. Of the 469 cases, 30 were removed to the Infirmary, 10 to the Small Pox Hospitals, 5 to the Fever Hospitals, 4 to Lunatic Asylums, and 420 were treated at their own homes. The number of deaths during the year was 26, viz.:-Males 15, Females 11, giving a mortality of 5.54 per cent, which would no doubt be slightly raised could we trace out the end of those who were removed to the Hospitals; but the number being so few (19), it would not be very materially affected, as would have been the case last year could that information have been obtained. This mortality is extremely low when we consider the unfavourable conditions which surrounded these poor people in the time of sickness, which must protract their ailments and somewhat retard their recovery. In the houses where Small Pox cases have occurred disinfection by means of fumigation by sulphur, free use of carbolic acid and Condy's fluid, has always been without delay carried out by Mr. Blackmore, the Inspector of Nuisances. In my opinion this is insufficient. Nothing short of great heat, in properly constructed chambers, will prove effectual in destroying the E 50 germs of disease in clothes and bedding.* Further information relating to the parochial out-door poor, in a classified form, will be found in the Appendix, Table V. Sanitary Inspections.—The customary annual inspection of Cow and Slaughter-Houses—to the number of 50, 26 being for cow keeping, and 24 for slaughtering Licences, has been carried out and the renewal of all, with three exceptions, recommended. The objections were on account of deficient sanitary arrangements, such as blood flowing directly into the sewer—insufficiency of receptacles, &c., which the law directs shall exist. Additions and improvements were ordered to be made, with which the owners readily complied, and the Licences were accordingly renewed. One new application for a Cow-House Licence was objected to and refused by the Magistrate on several grounds, the principal one was, its situation at the rear, and in close proximity to, Europa Place, a densely populated and very poor neighbourhood, where much sickness continually prevails. It is in such crowded neighbourhoods as these that the slaughtering of cattle does harm. Next year the provisions of the Building Act of 1844 will come into operation, and this Act imposes a penalty, on conviction, of £50 for the slaughtering of cattle in any building or vault, or in the open air at a less distance than 40 feet from a public way or than 50 feet from a domestic dwelling. I cannot help regretting that efforts are being put forth to repeal this provision and more especially in regard to London. I am decidedly of opinion that all classes will benefit, and for many reasons, by the use of public slaughtering houses, *This was well evidenced by the outbreak of Small Pox at St. George's Hospital, the bed clothes were at once removed and well boiled; on return from the laundry they were again placed on the beds and nearly every patient who slept in them took the disease; they were a second time removed and submitted to a very high dry heat and no other case of Small Pox showed itself in the Hospital. 51 and that the evils which are expected to result from this system will all vanish when once in proper working order. Other Inspections.—Various pig keepers' premises have been inspected, and also the Alum and Ammonia Companies Works in Lombard Road, improvements have been suggested, and carried out with a view to prevent the escape of disagreeable odours, and so conduce to the comfort and health of the inhabitants. JOSEPH OAKMAN, Medical Officer of Health far Batter sea West. 52 CLAPHAM. As I have remarked in former reports, the following form of table has an especial value in marking the social and sanitary advancement of this increasing township. It will, moreover, furnish a good groundwork for the observations I shall have to offer upon some other statistical tables relating to the past year (1872), a year which I am pleased to say contrasts most favourably with the preceding one. The year 1871 will be ever memorable for its epidemic of Small Pox, just as 1872 will be for its comparatively low rate of mortality; the same as after most cholera years, which in each instance has been followed by one of comparative mildness in respect to the fatality of Zymotic, and most other diseases. MARRIAGES, BIRTHS, AND DEATHS. Years 1862 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872 Marriages 175 181 227 221 310* 244 272 234 158 249 236 Births 622 685 640 707 711 777 801 838 867 864 858 Deaths 343 355 408 393 425 451 450 508 480 604 482 Excess of Births over Deaths 279 330 292 314 286 326 351 330 387 260 376 53 From the more detailed table which follows will be gleaned the usual particulars of the causes of death, as well as the ages, sex, and social positions of the deceased persons, and distinguishing the deaths that have resulted from Zymotic diseases from those that have been due to ordinary maladies. It may be remarked that this table furnishes almost a report in itself; for when carefully studied, and as carefully compared with corresponding tables in previous reports, a large amount of information may be obtained that cannot fail to interest those concerned in watching the advancement, or otherwise, of the locality in regard to its health and the prevalence or absence of particular diseases. It will be seen by this table that the number of deaths registered in the 52 weeks of the past year, was 482 (229 males, and 253 females), and by referring back to the first table it will be noted that this is Jess by 122 than the mortality of the year 1871, and within 2 of the number registered in 1870. Considering the great increase of population in the interval, this result may be looked upon as of a very satisfactory character. 54 STATISTICS OF MORTALITY. CLAPHAM. Population in 1871—27,347. Estimated Population in middle of year 1872— 28,154. 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, includingall under 10 yea rs. 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 ing classes DISEASES And other Causes of Death Classes:— Small Pox. 14 5 9 4 4 2 10 3 1 ... ... ... ... 5 9 Measles 30 17 13 10 19 1 30 ... ... ... ... ... ... 8 22 Scarlatina 6 1 5 ... 6 ... 6 ... ... ... ... ... ... 4 2 Diphtheria 3 1 2 1 ... 1 2 1 ... ... ... ... ... 3 ... Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup Whooping 7 4 3 ... 7 ... 7 ... ... ... ... ... 1 ... 6 Cough 25 9 16 9 16 ... 25 ... ... ... ... ... 1 10 14 1. Zymotic Typhus, &c. 11 4 7 ... 3 2 5 2 3 1 ... ... 1 2 8 Erysipelas Metria, 4 3 1 ... ... ... ... ... 2 2 ... ... 1 ... 3 Childbirth 3 ... 3 ... ... ... ... 3 ... ... ... ... ... ... 3 Carbuncle ... ... ... ... ... ... ... Influenza... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 38 17 21 25 8 ... 33 ... 2 2 1 7 13 18 Cholera 1 1 ... ... ... 1 1 ... ... ... ... ... ... ... 1 Totals of Zymotic Class 142 62 80 49 63 7 119 9 8 5 1 ... 11 45 86 2. Tubercular* 54 31 23 4 4 ... 10 17 23 4 ... ... 4 16 34 3. Of Brain, Nerves, &c. 57 26 31 11 13 ... 25 2 12 15 3 ... 13 14 36 4. Of the Heart, &c. 20 8 12 ... ... ... ... 4 6 10 ... ... 6 3 11 5. Of Respiratory Organs 75 37 38 19 21 1 43 3 11 13 5 ... 6 23 46 6. Of Digestive Organs 15 6 9 2 1 ... 3 3 6 3 ... ... 3 7 5 7. Of Urinary Organs 9 6 3 ... ... 1 1 4 3 1 ... ... 1 6 2 8. Of Organs of Generation 2 ... 2 ... ... ... ... ... 2 ... ... ... 2 ... ... 9. Of Joints, Bones, &c. 3 1 2 ... ... ... 1 ... 1 1 ... ... ... 2 1 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Malformation, &c. 58 34 24 51 7 ... 58 ... ... ... ... ... 7 20 31 12. Of Uncertain Seat 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... 1 13. Age 23 8 15 ... ... ... ... ... ... 6 17 ... 7 6 10 14. Violence 5 2 3 1 1 l 3 ... 1 ... 1 ... 2 1 2 15. Not Specified 18 8 10 1 1 ... 4 2 4 8 ... ... 7 3 8 Totals 482 229 253 138 111 10 267 45 77 66 27 ... 69 146 267 * Of the 54 deaths from Tubercular disease 37 were due to Phthisis. 55 There were also registered in the same year 858 births (453 males and 405 females), the excess of births over deaths being 376. In 1871, singular to say, this excess numbered 257 only. Death Rate.—Estimating the population after the method adopted by the Registrar General for the middle of the year 1872 as being 28,154, it follows that as the deaths were 482, the rate per 1000 living is exactly 17.1. In the previous year the rate was 22 per 1000. Zymotic Diseases.—Of this class of diseases there resulted in death a much less number than was registered in the previous year, in the proportion of 137 to 192. It is rather sad, however, to find that of these 137 deaths in the past year, a very large proportion were of infants and young children under 10 years of age, viz.:— 49 under one year, 63 from one to five years, and 7 from five to ten years, making a total of 119, and leaving only 23 to be distributed among the older persons dying from this class of diseases. The reason of this high mortality from Zymotic disease amongst children has so often been commented upon as to leave nothing new to be said upon the subject. It is some satisfaction, however, to find that in respect to the infant mortality from all causes, there is a slight decrease in the total number from that to be found in the table of my report for 1871. The following table is inserted to show the relative numbers of deaths from the seven principal diseases of the Zymotic class in the past year compared with those of the 10 preceding ones (1862 to 1871). 56 Years. 1862 1863 1864 1865 1866 1867 1868 1869 1870 1871 1872 Small-pox. 1 11 3 7 10 7 0 10 6 94 14 Measles 6 24 12 7 18 3 9 2 14 2 30 Scarlatina 13 28 11 11 6 5 14 29 45 20 6 Diphtheria 3 1 2 4 5 3 7 0 2 3 3 Whoopingcough 14 9 10 15 14 7 25 29 9 18 25 Typhus 8 6 14 11 16 10 26 17 12 10 11 Diarrhœa & Cholera 7 16 11 20 17 21 28 30 31 31 38 1 Totals 52 95 63 75 86 56 109 117 119 178 128 The 14 deaths from Small Pox in 1872 is much too large a number to afford any great amount of satisfaction, but it nevertheless shows the more than gradual decline of this dreaded malady when we compare this small number with the 94 fatal cases in 1871. Measles, it appears, is a disease that has always fluctuated very much as to its fatality, the number of deaths being higher in the past year than at any period since 1863, when it was even two less than is recorded in the present table. The deaths from Whooping Cough have slightly increased (6), and those from Diarrhoea and Choleraic Diarrhoea have also increased (5), over the numbers recorded in the preceding year. Diphtheria and Fever of various types were fatal in about the same number of cases in both years. 57 Ages at Death.—The deaths of 259 infants and young children between birth and ten years of age it appears occurred in this Sub-district during the year, and it is further shown in the mortality tables that 8 young persons from 10 to 20 succumbed in the same period, whilst the deaths of those from 20 to 40 numbered 45, from 40 to 60 77, and from 60 to 80, 66. The deaths of persons above 80 were 27, of which 11 were registered as having died from disease or accident, and the remaining 17 of pure old age, without the mention of any other cause or causes tending to shorten life. The oldest person dying in the last year had reached his 91 st year. Disease and Mortality amongst the Union Poor.—Table V., Appendix, sets forth the number of deaths amongst this class of persons to have been 61, and that these took place as the result of 972 cases of sickness, accident, &c., treated during the year by the District Union Medical Officer. Both the number of cases treated and the number which proved fatal, as will be seen, compare favourably with the record of 1871, which gives the deaths of Union patients from all causes as 76, and the cases treated 1489. Violent, Sudden and Uncertified Deaths, Inquests, &c.— During the past year there were held in this parish nine Coroner's Inquests, upon the remains of four infants and five adults, who had died under circumstances which appeared to necessitate inquiries as to the causes of death; of these latter cases, two persons, aged respectively 23 and 62 years, were decided to have died of Apoplexy; one, aged 55, of Disease of the Brain ; and one, aged 48, of the effects of an accident. In the cases of the four infants, whose ages ranged from birth to seventeen months, the verdicts returned were respectively: "still born," "found dead," "found drowned,'' and "accidently scalded." 58 There were 5 deaths registered during the year as not certified, that is to say, were inserted in the local registrar's returns without any certificates being obtained as to their causes from medical practitioners. These uncertified cases included the deaths of 4 infants whose ages ranged from 2 weeks to 7 months, and 1 adult female aged 74 years ; all these dying, it is presumed, without medical attendance. The public, I believe are, as a rule, very imperfectly informed upon the many defects of the existing Registration Acts. The law regulating the registration of both births and deaths needs great amendment to render it at all suitable to the present age. Sanitation of the Year.—As may be seen by consulting Table VI, in the Appendix, a somewhat large amount of sanitary work of various kinds was accomplished during the year, thus 1,200 houses and premises were inspected by the surveyor and myself, and 98 notices served for the removal of nuisances. There were also a number of houses supplied with water, and in many others drains were constructed and properly connected with the public sewers; but the most important sanitary achievement is the completion of the great intercepting sewer within this parish, as part of the general system of drainage for the metropolis, to which local sewer during the past year there has been made an addition of upwards of 9000 feet in main and branch drainage. There is now, it is ascertained, a length of main sewer within the Sub-district measuring 22¼ miles, and in full operation! To the credit of our able surveyor, this large amount of sewerage is being well maintained, and kept in a state of great efficiency, requiring only a better system of ventilation to render the undertaking in every respect perfect. That this will ultimately be accomplished few can doubt; in the mean time repeated and systematic flushing 59 must be resorted to as the only means of lessening the decomposition of stagnant sewage matter, and the generation of noxious gases. I need scarcely add that the usual careful supervision has been undertaken of all the slaughter and cow-houses within the parish, and licences were renewed at the proper period without opposition, except in one case, in which such licence was refused on account of a noncompliance with the regulations, and the consequent unsuitableness of the premises. I am pleased to report the fact that all the sanitation mentioned in the table referred to was accomplished without magisterial interference except in one solitary instance. Water Supply-—As this subject will be amply discussed in the introductory portion of this report, I need not offer any remarks beyond expressing my regret at seeing no advance made in the arrangements for a constant supply, without which complaints will never cease to be made of the unfitness of the water supplied through the medium of ill-constructed cisterns and other dirt-engendering receptacles. For my opinions on some other matters of general interest I must beg to refer my readers to the remarks applying to the entire district, in which, I need scarcely say, I fully concur. JOHN MAC DONOGH, Medical Officer of Health for Clapham. 60 STREATHAM, INCLUDING TOOTING AND BALHAM. The result of the tabulation of statistics applying to the year 1872, has been to show a less healthy condition of this Sub-district than usual. My calculations as to the deathrate in this locality in my last report, shewed the same to have been a fraction under 13 per 1000, living: in the past year it is estimated to have been as high as 15.1 per 1000, the deaths being 228, and the population in the middle of the year (1872) 15,027. In the preceding year (1871) it was found that 187 deaths had occurred in a population of 14,475. The difference in the death-rates of these two years is, then, quite 2 per 1000 in favour of 1871. This, it is thought, is quite an exceptional condition of things, and one which it is hoped and believed will not be persistent. The births during the year were, of males 223, and of females 209; total 432. The excess of births over deaths is 204. The usual mortality table, giving the causes of death, the sex, ages, and social positions of those who have died during the year, will now be referred to, and a few brief remarks made upon each division of such table. It may be remarked upon this table that the deaths registered within the 52 weeks of the past year, ending December 28th, are alone referred to, and the same numbers adopted as the Registrar General gives for this Sub-district in his last Annual Summary. 61 STATISTICS OF MORTALITY. STREATHAM, including TOOTING & BALHAM. Population in 1871—14,475, Estimated Population middle of 1872—15,027 Area in Statute Acres—3,465. Total Deaths from each Class of Disease, &c., in the Sub-District. Sex Age Social Position Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. Under 20 years, including all under 10 years. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle & Trading Class, Shopmen, Clerks, &c. Industrial and Laboring Classes. DISEASES, And other Causes of Death Classes:- Small Pox 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 Measles 6 2 4 1 4 1 6 ... ... ... ... ... ... 4 2 Scarlatina ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 1 ... 1 ... ... ... 1 ... ... ... ... ... ... 1 Quinsy 2 2 ... ... 2 ... 2 ... ... ... ... ... ... 1 1 Croup Whooping 2 1 1 1 1 ... 2 ... ... ... ... ... ... 2 ... 1. Zymotic Cough Typhus and other 8 4 4 4 4 ... 8 ... ... ... ... ... 1 3 4 Fevers 7 5 2 1 ... 3 5 2 ... ... ... ... ... 2 5 Erysipelas Metria, 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 Childbirth 1 ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 8 5 3 7 1 ... 8 ... ... ... ... ... 2 2 4 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 37 20 17 14 12 4 31 5 ... 1 ... ... 3 15 19 2. Tubercular* 38 15 13 4 2 ... 9 12 6 1 ... 2 ... 16 10 3. Of Brain, Nerves, &c. 36 19 17 6 8 14 1 7 14 2 22 12 4. Of the Heart, &c. 18 8 10 ... ... ... 1 ... 4 13 ... 1 2 11 4 5. Of Respiratory gans 42 19 23 10 7 ... 18 5 7 7 5 3 1 21 17 6. Of Digestive Organs 15 6 9 3 3 9. 4 2 0 8 3 7. Of Urinary Organs 2 2 ... ... ... ... ... ... 1 1 ... ... ... 2 ... 8. Of Organs of Generation 3 ... 3 ... ... ... ... ... 2 1 ... ... 1 1 1 9. Of Joints, Bones, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Of Skin 2 2 ... 1 ... ... 1 1 ... ... ... ... ... 1 1 11. Premature Birth, Low Vitality, Malformation, &c. 15 7 8 14 1 ... 15 ... ... ... ... 1 1 6 7 12. Of Uncertain Seat 8 3 5 ... ... ... ... ... 5 3 ... ... 1 4 3 13. Age 11 6 5 ... ... ... ... ... ... 4 7 1 ... 5 4 14. Violence 7 5 2 ... 1 ... 1 ... 3 2 1 ... 1 2 4 15. Not Specified 4 4 ... 2 ... ... 2 I 1 ... ... ... 1 ... 4 Totals 228 116 112 54 31 4 95 27 40 53 13 10 15 114 89 62 It will be observed that of the 228 deaths recorded in this table, 116 were of males, and 112 of females. Zymotic Diseases.—The seven principal Zymotic diseases, it appears, resulted in death in the past year (vide Table IV., Appendix,) in just the same number of instances as in 1871, viz.: 13; so that it must have been altogether the fatality attending on the prevalence of ordinary diseases (nonZymotic) that has so greatly increased the death-rate of the year under review. In a few of the epidemic class of diseases there is to be observed a slight increase in the numbers over those of 1871, and in one or two others as slight a decrease. Of non-Zymotic diseases the class "Tubercular" exhibits an increase of 6 deaths in 1872 over the previous year; Diseases of the "Brain and Nerves" 6; Maladies of the "Digestive Organs'' 3; "Heart Affections" 3; "Premature Birth, Low Vitality, and Malformation" 2; whilst diseases of the "Respiratory Organs" are found to be in excess of 18 over the deaths of 1871. The deaths from "Old Age'' and from "Violence" were both less than in 1871, in the respective proportions of 11 against 16, and of 7 against 11. In the aggregate the deaths during the past year, due to non-Zymotic diseases, were 191 against 152 in the previous year. Small Pox and Vaccination.—Small Pox has neither in the past nor in the year preceding claimed any very large number of victims, there having been 4 deaths in 1871 from this disease and one only in the past year. This I consider very satisfactory. Vaccination, I find, is being carried out with increased vigilance and efficiency, which is another matter for congratulation. Ages at Death.—The mortality of infants and children, from birth to 10 years of age, has greatly exceeded that of the previous year; then the number of deaths was only 69; it is now 89. 63 The deaths of persons from 20 to 40 years of age were 27 against 22 in the previous year, those between 40 and 60 numbered 40 as against 27, and those between 60 and 80 were 53 as against 45 enumerated in the last report. The deaths of very aged persons, at 80 and upwards, have decreased in the two years from 18 to 13. The oldest person who died within the past year was an inmate of the Almshouses in Garrat Lane, who had, at the time of death, attained her 94th year. Another death at 91 is found to be registered, and as many as 11 between 80 and 90 years of age. Social Position.—Of the nobility and gentry it appears that 10 have succumbed during the year; of the Professional classes, 15; of the Middle and Trading classes, 114; while amongst the Industrial and Labouring classes, with satisfaction be it stated, 89 only have died ! The ratio of deaths to cases treated exclusively amongst the Union Poor is somewhat high. The general table, No. V. in the Appendix, will shew there were 118 cases of recorded sickness and 13 deaths. In 1871 there were 172 cases and 9 deaths. Inquests, Violent, Sudden and Uncertified Deaths.— Ten inquests were held during the year, and verdicts returned as follows:—"Natural—Disease of the chest;" "Burns by her clothes taking fire accidentally," "Suicide by shooting himself when of unsound mind; "Natural— Exhaustion after drinking;" "Apoplexy through intemperance;" "Suicide by poison when of unsound mind;" "Mortal injuries by taking sulphuric acid in mistake for rum, accidentally;" "Mortal injuries from falling into a drain;" "Injuries from drinking hot water from a kettle;" "Natural—Disease of the heart." Two deaths were found to have been registered without being certified by any medical testimony as to their causes. 64 It may be hardly necessary to state, that I perfectly agree with my colleagues upon the necessity which exists for an amended Eegistration Act, by which information concerning the causes of death may be made more reliable. If this were the case, we surely should less often meet in the Local Registrar's returns such descriptions of the causes of death as "found dead," "died in a fit," and such like words of vague and undefined meaning. Sanitation.—A knowledge of the year's sanitation will be readily obtained by a mere glance at the column having reference to this Sub-district, in Table VI., Appendix. The principal work accomplished appears to be that of the construction of a very considerable length of new sewers and branch drains. As usual, the slaughter and cow-houses were examined and reported upon favourably to the Board, in consequence of which, no opposition to a renewal of licence, in any instance, was offered. I do not here venture to make any remarks upon water supply, the adulteration of food, and other vexed questions, since it is considered that these matters are best left to be discussed in the general observations, which will, as usual, precede this and the other Local Summaries. D. C. NOËL, Medical Officer of Health for Streatham, Tooting and Balham. 65 PUTNEY AND ROEHAMPTON. In submitting the present summary it is gratifying to be able to speak of the increasing healthiness and low deathrate of this Sub-district. The number of deaths registered in the past year was 144, (71 males, and 73 females), which, notwithstanding the increase of population in the interval, is 7 less than appeared on the record of the preceding year. The estimated population in the middle of the year 1872, calculated upon the basis adopted by the Registrar General, was very little short of 10,000 (9,807) and consequently a death rate of 14.6 per 1000 persons living, or as near as may be 1 death in 68 of the inhabitants, is indicated. Looking at the circumstance of 17 per 1000 persons living being considered by that eminent statist, Dr. Farr, as pointing to a very healthy population, a mortuary rate so low as that just stated may be viewed as exceedingly satisfactory. The births* registered during the year were 279, (136 males and 143 females) giving an excess of these events over those of deaths of 135, which of course indicates the natural increase of the population in contradistinction to the uncertain and unknown increase that yearly takes place from the influx of new residents. In a proverbially healthy locality such as Putney, the influx spoken of is much * The birth rate per 1000 living is, for the past year, 13.7. 66 encouraged by the constant erection of new and suitable dwellings for all except the working and poorer classes. For these classes, it must be stated with regret, that there continues such a deficiency of accommodation as to lead to much over-crowding, and to most of its attendant evils. The great majority of houses that have been recently erected appear to be for the accommodation of the rich and well-to-do classes; indeed, it is now frequently remarked by those who are well acquainted with the locality and its requirements, that building operations have been of late rather in excess of such requirements, and this is seemingly proved by the number of middle class houses remaining vacant at the present time. It is much to be feared that the absence of good approaches to rows of newly erected dwellings is the main cause of their failing to attract suitable tenants. To build houses, and to render them approachable only through mud and filth, is surely a mistaken policy, and it is submitted that local authorities should be vested with quite as sufficient legal powers of compelling owners of rateable house property to properly construct the first roads and footways, as they now have of compelling the formation of the first drains and water courses in connection with such property. The following detailed table of mortality, especially if it be read in connection with those in previous reports, will afford, inter alia, much information on a point of considerable importance, viz.:—the comparative frequency with which certain diseases have proved fatal in certain years; a kind of knowledge which will always give its possessor the means of forming a tolerably correct judgment as to whether, in a sanitary point of view, the locality is advancing or retrograding. 67 STATISTICS OF MORTALITY. <###>PUTNEY and ROEHAMPTON. Population in 1871—9,439. Estimated population in middle of the year 1872— 9.807. Area in Statute Acres--2,176. Total Deaths from each Class of Disease, &c., in the Sub-Disirict. 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. DISEASES, And other causes of Death. Classes:— Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlatina 7 5 2 ... 4 ... 7 ... ... ... ... ... ... ... 1 Diphtheria 1 1 ... ... ... 1 1 ... ... ... ... ... 1 ... ... Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 6 1 5 3 3 ... 6 ... ... ... ... ... 1 1 4 1. Zymotic Typhus & Infantile Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 1 ... 1 1 ... ... 1 ... ... ... ... ... ... ... 1 Childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 5 2 3 4 1 ... 5 ... ... ... ... ... 1 ... 4 Choleraic Diarrhœa. ... ... ... ... ... ... ... ... ... ... ...... ... ... ... ... Totals of Zymotic Class 20 9 11 8 8 3 20 ... ... ... ... ... 3 7 10 2. Tubercular 24 20 14 10 10 6 1 1 9 10 5 ... ... 1 2 9 12 3. Of Brain, Nerves, &c. 16 3 3 ... 7 2 6 11 ... 7 4 10 5 4. Of the Heart, &c 14 9 5 ... 1 ... 3 4 3 4 ... 2 1 5 6 5. Of Respiratory Organs 26 13 13 10 4 ... 16 3 ... 1 ... 2 ... 13 11 6. Digestive Organs 7 3 4 l ... 1 2 ... 1 4 ... 1 1 3 2 7. Urinary Organs 5 2 3 l ... ... 1 2 ... 2 ... 1 1 2 1 8. Of Organs of Generation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Of Joints, Bones, &c. 1 ... 1 ... 1 ... 1 ... ... ... ... ... ... 1 ... 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Mal- formation, &c. 5 4 1 4 l ... 5 ... ... ... ... ... ... 4 1 12. Of Uncertain Seat 5 1 4 ... ... ... ... 3 1 1 ... 1 ... 3 1 13. Age 3 1 9 ... ... ... ... ... ... 1 2 1 ... 1 1 14 Violence 6 4 9 ... ... l 2 1 3 ... ... ... 3 3 15. Not Specified 2 1 1 2 ... ... 2 ... ... ... ... ... ... ... ... Totals 144 71 73 35 19 6 68 25 19 30 2 16 12 61 55 F2 68 In reviewing the above table the Zymotic class of diseases are the first to claim attention. In the past year the deaths from these maladies amounted to 20. In the previous year 33 were registered, thus giving a less number by 13 in favour of 1872. It is satisfactory to note that in the present table there is a total absence of all record of deaths from Small Pox, Measles, Quinsy, Croup, Fever, Metria, Carbuncle and Influenza, the mortality being confined to five diseases of this class, viz.:—Scarlet Fever, 7, against 21 in the previous year; Diphtheria 1 (the same as in the previous year); Whooping Cough, 6 against 1; Erysipelas, 1 against none; and Diarrhœa, 5 against 6 in the former record. The absence from the present table of all record of deaths from Small Pox and Fever is a circumstance of a very gratifying character. It was long since predicted that the completion of the great intercepting sewer would have a most beneficial effect in reducing the number of cases of fever in every locality through which the same was made to pass, by reason of the large amount of branch drainage which it would necessitate, and in no Sub-district, it is believed, has this prediction been more fully realised than in Putney. Amongst the poor of this parish especially, it has been remarked, that of late years scarcely a single case of Typhoid Fever has proved fatal, and but very few indeed, and those of the mildest possible type, have presented themselves for treatment to the District Union Medical Officer. Before the Sub-district obtained the advantages referred to, fever cases were scarcely ever absent from the poorer parts of the town; and no wonder ! since the majority of these places were at one time completely riddled with cesspools, and the water from nearly all the wells in such neighbourhoods visibly contaminated with fœcal matter, and teeming with living organisms (see reports for 1865 and 1867.) 69 It may here be observed that in respect to Small Pox there can be but little doubt the practice of vaccination, under the new law, will be followed by excellent results in the future in warding off invasions of this terrible disease. But very few, if any, infants born in this parish are now found to escape the operation, and the exertions of the active Vaccination Officer, whose duty it is to see that the provisions of the Act are duly complied with in every case, cannot be too highly commended. It will be seen by the following table that the per centage of deaths due to the seven principal diseases of the Zymotic class to those occurring from all causes, is much below what it was in 1871, and below even the average of the preceding ten years. YEARS. Number of Deaths from all Causes. No. of Deaths from Seven of the principal Epidemic Diseases. Percentage of Deaths from seven principal Epidemics to Deaths from all causes. 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 1870 145 19 12.4 1871 151 32 21.4 1872 144 20 14.0 Concerning the deaths that have resulted from ordinary diseases (non-Zymotic) little need be said in this place, since the Mortality Table will show, at a glance, not only what diseases of this class have proved most fatal during the year, but the relative mortality amongst the different classes of inhabitants, their ages at death, social position, &c. 70 As usual, the deaths due to Tubercular diseases, diseases of the Brain and Nervous System, and of the Respiratory Organs, have respectively claimed the most victims. Of the 24 deaths due to the Tubercular class of maladies, as many as 20 were registered as the result of Phthisis. As to the ages at death, it is satisfactory to find that those who died during the past year between birth and 10 years of age, were fewer by 8 than were recorded in the last report, the principal diminution being found in children between 1 and 5 years of age. This is evidently owing to the great fatality of Scarlatina in 1871, when as many as 17 deaths of children occurred between the ages stated, whereas in the present table 4 only are recorded as having succumbed to this disease. The number of deaths of infants and children from birth to 10 years of age was 60, or 41.6 per cent of the deaths from all causes. The deaths of persons from 20 to 40 were 25, against 15 in the previous year; of those between 40 and 60, 19 against 13; of those from 60 to 80, 30 against 14; and of those over 80, 2 against 8. The age of the oldest person registered was 97. The social positions of the several deceased persons will be readily gathered from the Mortality Table. One of the most gratifying features of recent tables, is the record of such a comparatively small number of deaths amongst the working classes, and of the poor generally of this parish. Amongst the Union poor exclusively, the per centage of deaths to cases treated during the year was somewhat higher than usual (5.3). In the past year there were 282 cases of sickness, accident, &c., treated, and 15 resulting deaths. In the preceding year, (1871) the deaths were 12, and the cases treated 318, or 3.7 per cent. The Inquests held in this Sub-district upon the bodies of persons found dead, or who had died during the year from accident and other causes necessitating inquiry, were 8. 71 Of these deaths 4 were found by the Coroner's juries to have been "accidental," from drowning and being run over in the streets, &c. Two inquiries were also held on persons "found dead," but no decision whatever appears to have been arrived at as to the actual cause of death in either instance, One inquest was held on a person who was shown to have died from excessive drinking, and on another whose death was returned as being "natural, from a fit." It is submitted that a "fit" is one of the vaguest imaginable terms, even as a definition of a purely conjectural cause, since there may be a hundred unnatural ways of inducing convulsions or fits, whilst the actual causes of deaths, without properly conducted post mortem examinations, may, and frequently do, remain quite as great mysteries after inquests have been held, as before such inquiries had been determined upon. (See observations of the Medical Officers of Health in the introductory remarks of this and other Annual Reports.) Uncertified deaths, or deaths placed on the Register without their causes being first attested by medical certificates, were never very numerous in this Sub-district, and it is satisfactory to find that during the past year but one such occurrence has been noted. It is far from being contended that there was any suspicion of wrong in the case referred to, but it may be remarked the entire medical profession are agreed that a law which permits the registration of deaths by local registrars, upon mere conjectures as to their causes, is a bad law, and one greatly needing amendment. Sanitation.—A. summary of the sanitary proceedings in the past year, as carried out in this Sub-district, will, as usual, be found in Table VI., Appendix. Apart from what has been set forth in this table, it should be stated that all cow-houses, as well as all premises used for the slaughtering of cattle, &c., within the parish, have been carefully supervised throughout the year, and at the usual period for granting 72 licences to their proprietors were reported on favourably to the licensing Magistrates. It is also worthy of remark that all the sanitation of the year was accomplished with but one solitary appeal to magisterial authority. E. HAKLAND-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 1872. classified according to Sex, Age, and Social Position, and showing also the relative Numbers in each Sub-District. POPULATION ENTIRE DISTRICT, As corrected by the Registrar General. Census 1871—125,060. Assumed Population for middle of year, 1872,— 131,891. Area in Statute Acres, 11,695. Total Deaths from each Class of Disease, &c., in the entire District. Sub-Districts. Sex. Age. Social Position Clapham—Population in 1871, 27,347, area in acres, 1,233. Wandsworth—Population in 1871, 19,783, area in acres, 2,478. Battersea—Population in 1871, 54,016, area in acres, 2,348. Putney—Population in 1871, 9,439, area in acres, 2,176. Streatham, Tooting, and Balham—Population 1871, 14,475, area in acres, 3,465. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. Under 20 years, including all under 10 years. At 20, and under 40 years of age. At 40, and under 60 years of age. At 60, and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, & c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. DISEASES, And other Causes of Death. Classes:— Small Pox 26 14 1 10 ... 1 10 16 8 5 2 17 8 1 ... ... ... ... 5 21 Measles 86 30 5 45 ... 6 45 41 20 61 5 86 ... ... ... ... ... ... 19 67 Scarlatina 26 6 1 12 7 ... 11 15 2 20 3 26 ... ... ... ... 1 i 13 11 Diphtheria 26 3 3 18 1 1 11 15 1 16 6 24 2 ... ... ... ... 3 10 13 Quinsy 2 ... ... ... ... 2 2 ... ... 2 ... 2 ... ... ... ... ... ... 1 1 Croup 18 7 l 8 ... 2 9 9 3 12 3 18 ... ... ... ... 1 1 6 10 1. Zymotic Whooping Cough Typhus and Infantile 108 25 13 56 6 8 47 61 44 62 2 108 ... ... ... ... ... 5 18 85 Fever 52 11 4 30 ... 7 32 20 1 13 10 30 8 8 6 ... ... 2 10 40 Erysipelas Metria, 13 4 2 5 1 1 6 7 5 1 ... 6 ... 3 4 ... ... 1 ... 12 Childbirth 15 3 1 10 ... 1 ... 15 ... ... ... 1 12 2 ... ... ... 1 2 12 Carbuncle 1 ... 1 ... ... ... 1 ... ... ... ... 1 ... ... ... ... 1 ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 137 38 20 66 5 8 62 75 101 20 1 122 2 7 5 1 ... 15 30 92 Cholera or Choleraic Diarrhœa 3 1 2 ... ... 2 1 ... 2 1 3 ... ... ... ... ... ... ... 3 Totals of Zymotic Class 513 142 51 263 20 37 237 276 185 214 33 443 32 22 15 1 2 29 115 367 2. Tubercular 419 54 70 243 24 28 222 197 121 44 11 203 121 77 18 ... 4 23 85 307 3. Of Brain and Nerves 341 57 92 130 26 36 179 162 77 63 1 146 30 79 77 9 8 30 78 225 4. Of Heart 127 20 19 56 14 18 62 65 3 2 3 13 21 40 48 5 5 12 27 83 5. Of Respiratory Organs 400 75 53 204 26 42 210 190 124 97 4 229 24 63 68 16 8 13 81 298 6. Of Digestive Organs 87 16 13 37 7 15 42 45 11 1 3 17 9 30 31 ... 6 10 24 47 7. Of Urinary Organs . 27 9 5 6 5 2 17 10 1 ... 1 4 9 7 7 ... 2 2 14 9 8. Of Organs of Generation 9 2 2 2 ... 3 ... 9 ... ... ... 6 3 ... ... 3 1 5 9. Of Joints, Bones, &c. 7 3 1 2 1 ... 3 4 ... 1 2 3 1 1 ... ... 1 3 3 10. Of Skin 3 ... 1 ... ... 2 3 ... 2 1 3 ... ... ... ... ... ... 1 2 11. Premature Birth, Low Vitality, Malformation, &c. 143 58 20 45 5 15 71 72 134 9 143 ... ... ... ... 1 15 35 92 12. Of Uncertain Seat. 118 1 10 94 5 8 42 76 25 3 1 31 21 42 ... 5 2 ... 22 94 13. Age 105 23 5 12 56 3 11 40 65 ... ... ... 51 54 5 11 4 20 9 69 74 14. Violence 87 14 55 6 7 59 28 13 14 4 49 9 19 7 3 ... 15. Not Specified 35 18 2 9 2 4 16 19 9 3 14 3 8 9 1 ... 8 3 24 Total 2421 482 365 1202 144 228 1203 1218 705 452 61 1297 282 394 354 94 43 161 518 1699 74 TABLE II. Births registered during the year 1872. SUB.DISTRICTS. Males. Females. Total. Clapham 453 405 858 Wandsworth 304 318 g22 Battersea 1207 1142 2 349 Putney and Roehampton 136 143 279 Streatham, including Tooting and Balhatn 223 209 432 Total 2,323 2,217 4,540 V The excess of Births over Deaths in the entire district is 2,119. TABLE III. Meteoeoloqical Elements for 1872, 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 43.6° 52.8° 61.1° 45.3° 50.7° Evaporation 41.70 490° 57.1° 43.8° 47.9° Dew Point 39.5° 45.2° 54.0° 42.l° 45.2° Weight of Vapour in a Cubic Foot of Air 2.8 grs. 8.3 grs. 4.7 grs. 3.1 grs. 3.5 grs. Degree of Humidity (Satn. 100) 86° 76° 77° 89° 82° Reading of Barometer 29.578 in. 29.735 in. 29.747in. 29.48 in. 29.636 in Weight of a Cubic Foot of Air 544 grs. 537 grs. 528 grs. 541 grs. 538 grs. Rain (amount of) 6.5 in. 5.7 in. 6.5 in. 11.3 in. 30.0 in. 75 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 1862-72. Years. Deaths from the seven principal Epidemics in each Sub-District. Entire District. Clapham. Battersea. Wandsworth. Putney. Streatbam. Total Deaths from the Seven Epidemics. Total Deaths Registered from all causes Per centage of Deaths from the Seven Epidemics to Total Deaths. 1862 52 106 62 13 16 233 1343 173 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 1870 119 404 113 19 37 692 2659 26.0 1871 178 463 103 32 31 807 2867 28.8 1872 128 220 47 20 31 446 2421 18.4 *** 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 Poor under the treatment of the Union Medical Officers, with the Deaths from each class of Disease, during the year ended 31st December, 1872. Compiled from the District Medical Relief Books. SUB-DISTRICTS. Total Cases of Sickness treated in eacli Sub-district. 1—Small Pox. 2—Measles. 3—Scarlatina and Malignant Sore Throat. 4—Whooping Cough. 5— Diarrhoea and Dysentery. 6—Cholera. 7—Fever. 8—Erysipelas. 9—Puerperal Fever. 10—Lung Diseases except Phthisis. 11—Phthisis. 12—H y drocephal us. 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 982 35 2 47 2 3 1 37 3 67 ... ... ... 171 1 9 ... 3 3 106 7 17 17 34 15 383 9 70 1 61 Wandsworth 1520 4 32 2 ... ... 29 3 124 2 ... ... 11 1 10 ... ... ... 296 4 15 8 10 6 906 24 83 ... 50 Battersea East 724 19 2 42 6 9 ... 34 2 58 ... ... ... 6 2 8 ... ... ... 139 8 35 7 19 5 320 9 35 ... 41 West 469 11 1 16 ... 5 ... 7 ... 26 1 ... ... 15 3 6 ... ... ... 82 9 7 2 6 1 265 8 23 1 26 Putney and Roehampton. 282 1 ... 4 ... ... ... 32 4 14 1 ... ... 3 ... 1 ... ... ... 30 3 3 3 1 ... 170 3 23 1 15 Streatham, including Touting and Balkan 118 2 ... 14 1 1 ... 2 1 2 ... ... ... 1 ... 1 ... ... ... 10 3 2 2 ... ... 82 6 1 ... 13 Totals 4095 72 5 155 11 18 1 141 13 291 4 ... ... 207 7 35 ... 3 3 663 34 79 39 70 27 2126 59 235 3 206 *** The ratio of deaths to cases treated is 5 per cent. 77 TABLE VI. Summary of the Sanitary Operations in the entire District during the year 1872. Clapham. Battersea. Wandsworth. Putney and Roehampton. Streatham, including Tooting and Balham. Totals. Number of Houses and Premises inspected 120 1.990 358 153 210 2,331 1st Notices served 87 192 47 14 11 351 2nd Notices served 11 3 1 3 2 20 Cesspools emptied and cleansed ... 11 ... ... 22 33 Cesspools abolished 3 11 6 3 10 33 Waterclosets constructed ... 157 ... 59 213 429 Houses supplied with water 13 177 2 59 209 460 Drains constructed or connected with Sewer 94 122 29 38 86 369 No. of feet of New Sewers and Branch Drains 9,225 8,371 1,750 3,288 10,468 33,102 Drains repaired or trapped, or obstructions removed 37 82 6 14 35 174 Open Ditches, Ponds, &c. cleansed ... ... 1 ... 1,500 ft. ... Dust-bins provided 6 86 ... 59 139 290 Pig Nuisances removed 9 9 25 6 2 51 Accumulations of Offal, Manure, &c., removed 10 27 27 10 8 82 Unwholesome and dilapidated Houses cleansed or repaired ... 17 10 3 2 32 Cases investigated by Magistrates 1 6 ... 1 ... 8 Compulsory Orders obtained ... 5 ... ... ... 5 Compulsory works executed ... 5 ... ... ... 5 Works remaining in abeyance from various causes ... ... ... ... ... ... *** In the Sub-district of Battersea there has been destroyed during the year 4 cwt. of fish, and ½ cwt. of meat as unfit for human food.