WAN 26 SANITARY DEPARTMENT. REPORT ON THE SANITARY CONDITION OF THE SEVERAL PARISHES COMPRISED IN THE WANDSWORTH DISTRICT During the Year 1874. by the MEDICAL OFFICERS OF HEALTH. REPORT, 1874. To the Board of Works for the Wandsworth District. Gentlemen, The first Sanitary Report from this District was rendered by the Medical Officers of Health in reference to the year 1856, consequently the termination of a second decade is near at hand, and one more Report only beyond the present will have to be made to furnish a twenty years' test of the efficiency of the sanitary measures carried out under the auspices of your Board. The present Report has been constructed on precisely the same plan as those of former years, and although some few suggestions have lately been made by several Health Officers to considerably enlarge and extend the statistical tables generally employed, we deem it inexpedient to make, at present, any material alterations in our own mode of proceeding ; but design to carefully consider the question at some future time, as for instance at the commencement of a fresh decennial period, when a change in the forms of tables would be less likely to interfere with the facilities for comparison now enjoyed by a continued use of those in force. 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 DISTRICT. General Remarks. Fifty-two weeks constitute the Registrar General's official year of 1874, which he has made to terminate, for obvious reasons, on Saturday, the 2nd January, 1875. During this time the population of the entire district was increased by the births of 5,221 Children, (2,697 Males, and 2,524 Females,) and was decreased by the deaths of 2,796 persons of all ages. That which is termed the natural increase of the population was therefore 2,425. The amount of the immigrational increase is a point not so easily determined, and it is feared cannot be so with any very near approach to accuracy, except through a much more frequent census, which is not at present, however desirable, very likely to be obtained. After the lapse of some three or four years from an ordinary decennial census the Health Officers, of populous and manufacturing localities especially, begin to experience considerable difficulty in fixing on a basis upon which a reliable calculation in respect to the number of inhabitants at any given period can be made, and are consequently compelled to fall back upon the uniform system adopted by the official statist in estimating the death-rates for all the great cities and most important towns of this and other countries. (See the Registrar General's Annual Summaries.) It is to be presumed that the eminent statist of the Registrar General's Department is quite unable to devise any better mode of calculation than the one he has employed for so many years, or he would have adopted it long since. It has been said with much truth that once indulge in mere speculations in a matter of this kind, and it becomes more than probable that some error of greater or less moment, will creep into any attempted calculations based upon so unstable a foundation. For these and 6 other reasons it is thought best to pursue the same course as was done in the last Report, and whilst deducing the Death-rate for the entire district by Dr. Farr's method, to leave it to each Health Officer to offer his own explanations of any exceptional circumstances which may appear to him to warrant a different principle of computation being applied to his own particular locality. Taking, then, the enumerated population at the last census (1871), and adding to such population 3¼ times the annual rate of increase which prevailed between the last and preceding census, it will at once bring the figures to apply to the middle of the year under review, and will give a population to this extensive District at that time of 142,799. The deaths in the year having amounted to 2,796, it follows that a mortuary rate for the entire district of 19.5 per thousand living is deducible. This death-rate, it should be observed, is two per thousand higher than that of the previous year, but seeing that that year was an exceptional one in respect to the fatality attending many of the Zymotic class of diseases, and seeing also that the death-rate for the whole of London, calculated in precisely the same way, was 22.5 per thousand, it is submitted that the statistical result referred to is anything but unsatisfactory. The ratio of deaths to estimated population in each of the Sub-districts, together with the comparative mortality of the two years 1873-4, will be best shown by the following table :— SUB-DISTRICTS. Estimated Population in the middle of Deaths. Ratio of Deaths to Population. Excluding Non- Parishioners who have Died in Public Institutions. 1873. 1874. 1873. 1874. 1873. 1874. 1874 Battersea 61,758 65,161 1,307 433 1,429 1 in 47 1 in 45 1 in 52 Wandsworth 21,284 21,893 458 1 in 40 1 in 48 1 in 61 Clapham 28,799 29,444 475 528 1 in 61 1 in 55 No . appreci- able dif- ference Streatliam, Tooting, ft; Balham 15,456 15,905 240 230 1 in 64 1 in 69 Putney & Roehampton 10,101 10,396 125 153 1 in 81 1 in 67 7 It has been remarked in previous Reports that there are disturbing circumstances which unduly exalt the death-rates of some of the Sub-districts, by reason of their containing a number of Public Institutions which, for the most part, derive their inmates from without the parishes in which they happen to be situated. The difference in the ratio of deaths to population when the deaths in these Institutions are excluded will be seen in the above table. The disturbances of the death-rates referred to occur almost entirely in the Wandsworth and Battersea Subdistricts, and it is found that during the past year no fewer than 266 deaths occurred in six of the principal Public Establishments in these two townships, and in that of Clapham, over and above the number that, so to speak, is 'proper to those parishes.* Zymotic Diseases.—The Table of Mortality (No. I., Appendix) gives, it will be seen, no less than 528 deaths as occurring during the year in the entire district from Zymotic diseases alone. In the previous year (1873) there were but 411 fatal cases due to epidemic maladies, or 117 less than in the past year, showing that 1874 was a period of exceptional severity in the propagation of zymotic influences. The numerical preponderance of deaths due to the seven principal epidemics over those * The Public Institutions here referred to are all comprised in a list furnished by the Registrar General, and includes the Workhouse and Infirmary of the Wandsworth and Clapham Union, the Westminster Union Industrial Schools (both situated at Battersea), the County Prison, the Royal Hospital for Incurables, the Surrey County Lunatic Asylum (which three are located in Wandsworth), and the British Home for Incurables in Clapham. If to the deaths in these officially recognized Public Institutions of the District are added those which have occurred at Wandsworth in St. Peters Hospital (2), the Royal Patriotic School (10), and the Reformatory for Boys (2), together with the deaths of 9 inmates of a large Lunatic Asylum (private) at Roehampton, it will give a total of no less than 289 fatal cases amongst persons, the great majority of whom had no claim, in the proper acceptation of the term, to residential occupation within the District. 8 from all causes was great during the year (see Table IV., Appendix), but still very much under the 10 years' average, the per-centage of the one to the other being 15.7 against 13.6 in the previous year, but against much higher numbers in the several years between 1864 and 1872. In one of these years (1871) the per-centage was as high as 28.8. The tables in the Appendix, as well as those in the several Local Summaries, will, if consulted, sufficiently indicate the zymotic maladies that were the most prevalent and the most fatal during the year; but it may be remarked that Scarlatina, Measles, Diphtheria, Croup, Whooping Cough, Erysipelas, Metria, and Diarrhoea exhibit in the table a marked increase of deaths over the numbers that were recorded in the pervious year. Fevers (typhus, typhoid, and continued) and Small-pox were the only diseases which exhibited a decrease in the number of fatal cases. From Fever there took place 48 deaths against 65 in the previous year, and the mortality from Small-pox happily fell from 9 to 5, the latter figure representing, with one exception, the smallest number of deaths due to this disease in 10 years, from 1863 to 1872. The exception named was in the year 1868, when, singular to say, the deaths from Small-pox were only 2, whilst the average of the 10 years is found to have been 55, the greatest fatality occurring in 1871, when the number of persons who succumbed to this dreaded malady in the entire District amounted to no less than 317! It is exceedingly satisfactory to mark the decrease from this very large number to 5 only in the past year, since it promises well for the ultimate success of the efforts that are being made towards what is termed "stamping out" the disease by a persevering enforcement of the vaccination laws upon every class and condition of the people, It is also most gratifying to find that at the time of penning these introductory remarks, the Registrar- 9 General did not report in his weekly return a single death from Small-pox in the whole of London, and, at the most, two in several previous weeks. Before concluding these remarks upon the fatality of Zymotic diseases, attention may be called to the remarkably high mortality from Puerperal maladies (Metria), recorded in the present table as having occurred in Battersea. The Medical Officer of Health of East Battersea, in his local summary, makes mention of a very painful circumstance of no less than 14 women in the prime of life, most of them mothers of large families, being sacrificed to a nurse's ignorance ; and in the summary for the division of West Battersea the Medical Officer of Health alludes to 11 other deaths having been registered from the same malady. As many, therefore, as 25 deaths in the entire Sub-district of Battersea took place from Puerperal Fever. The relation of this sad event will be read with melancholy interest, and it is to be hoped will lead to greater care being exercised by every one in the choice of what is called " a midwife." In some of the cases referred to in East Battersea, there appears to be evidence enough to show that the woman who dignified herself by the name of "a qualified Midwife" was not only careless, but wanting in common prudence as regards the cleanliness of her person and dress. Ordinary (Non-Zymotic) Diseases, &c.—The fatality attending ordinary diseases, including Violence, Accidents, &c., furnished to the Begister records of 2,270 deaths. A considerable increase over the numbers in the table of the previous years will be observed in the present one, under nearly all the headings, and will be found to have exceeded in the aggregate the ten years' average by 118. The Tubercular class of maladies (including a number of deaths from Phthisis), diseases of the Brain and Nerves, of the Heart, and of the Digestive Organs, all proved fatal in increased numbers over those of the previous year, as 10 did also the deaths under the heading "Premature Birth, Low Vitality, Malformation, &c." Under "Diseases of the Respiratory Organs" there was a slight decrease, as also was the case under "Urinary Organs," "Old Age," and " Diseases of Uncertain and Variable Seat." Ages at Death.—The deaths of infants and young children from birth to 10 years of age, amounted to no fewer than 1,336, which it is, with great regret, found to be above the 10 years' average by as many as 225. Scarlatina, Measles, Whooping Cough, and Diarrhœa were so fatal to children in some localities as to constitute a very serious amount of mortality relatively to that from all causes, and at all ages. At the other extreme of age, i.e., from 60 to 90 and upwards, there died 30 more persons than in the previous year, whilst of young and middle-aged adults (from 20 to 60 years of age), there succumbed 288 beyond the number last tabulated. The oldest person who died in the District within the past year had arrived at the advanced age of 98. The death of this person was registered at the Union Infirmary in Battersea. There were several others registered in different parts of the District at 91 and 92, and very many between 80 and 90. Social Position of the Deceased Persons.—Mortality amongst the Union Poor.—It will be unnecessary to dwell at any length upon those parts of the tables which have reference to "social position," since the relative numbers of deaths amongst the different classes of the community are fully referred to in the several local summaries ; it will suffice, therefore, to remark that there succumbed 1,993 of the industrial and poorer classes against 803 of the three classes above them collectively. The disparity of numbers then is found to be rather greater than in the previous year against the poorer classes. The fresh cases of disease, &c., falling under the treatment of the Union Medical Officers in the several 11 sub-districts were (see Table V., Appendix) 3,591, and the resulting deaths 193. This gives a per-centage of deaths to cases treated of 5.3. In the two previous years the ratio was 5.0 per cent. Inquests.—Violent, Accidental, and Sudden Deaths.— Unattested Deaths.—Inquiries as to the cause of death by Coroners were, throughout the District, necessitated in 125 instances. These will be seen, by a reference to the Local Summaries, to have been of the usual character, and to have been carried out with touch the usual results— satisfactory enough in some few cases, but the very reverse in others, and, it is to be much regretted, with very little apparent regard to the real objects of such investigations, viz., the detection of crime, and the furnishing of reliable vital statistics. The Lancet of a recent date has a short article upon this subject which is very much to the point, and is here given in extenso, in order to direct attention to the necessity which appears to exist for a thorough reform in the Coroners' courts throughout the kingdom :— VERDICTS AT CORONERS' INQUESTS. "The primary object of holding an inquest is undoubtedly to ascertain the cause of a death, whether it resulted from natural causes or from violence. Before the value of vital statistics was either understood or appreciated, such verdicts as ' Death by visitation of God,' or ' Death from natural causes,' or ' Accidentally killed,' &c., &c., answered all the purposes whieh inquests were then intended to serve. Now, however, that mortality statistics are turned to increasingly useful account by the expenditure of much time and money—both public and private—such verdicts as these not only cease to be satisfactory, but are decidedly objectionable. Coroners appear too often to lose sight of the fact that the verdict at inquests is entered on the Death Register as the cause of death, and that such verdicts as those wc have mentioned arc valueless for purposes of classification. About a week since an inmate of Millbank Prison died while undergoing a sentence of seven years' penal servitude. According to custom, although the cause of death was patent to the Medical Officer of the prison, an inquest was held before Mr. Bedford, one of the Middlesex 12 Coroners. Dr. Munro, the Medical Officer, gave evidence that deceased, when admitted, was suffering from tubercular disease of the lungs, and was on this account at once ordered into the prison infirmary, where he died. A post-mortem examination supported this evidence by showing that both lungs were extensively diseased and covered with tubercles. The jury returned a verdict of ' Death from natural causes,' and the cause of this death will be so entered in the Death Register. Here is an undoubted death from phthisis, and, had no inquest been held, the cause of the death would have been so certified by the Medical Officer; in consequence, however, of this open verdict, the cause of death is in reality 'not stated' in the Register. As inquests are held in about six per cent. of the deaths in England and Wales, well-defined verdicts are essential to the value of mortality statistics." The opinions of the Medical Officers of Health, it hardly need be stated, are quite in accord with this view of the matter. Unattested Deaths must be looked upon in quite as objectionable a light as the vague and ill considered verdicts of Coroners' Juries, and to be even more mischievous. The cases of this kind during the past year, numbered, in the entire District, 75, viz., 55 in Battersea, 13 in Wandsworth, 5 in Clapham, 1 in Streatham, and 1 in Putney. It is to be apprehended that the recent Act relating to Registration will effect but little good in altering the present practice, so long as any discretionary power is given to Local Registrars of receiving testimony as to the causes of death other than that obtainable from legally qualified and duly registered Medical Practitioners. Sanitation.—A much larger amount of Sanitary work appears to have been projected and acomplished throughout the District in the past than in the previous year, (Vide Table VI., Appendix). Taking, for example, the Tables of Sanitary work executed during the 19 years in which the Metropolis Local Management Act has been in force, and adding together the length of new sewers constructed in each year, it is found that no fewer than 626,316 feet 13 have been completed, the instalment for the past year being 18,707 feet. This is altogether equivalent to, in round numbers, 118 miles, and must necessarily have conferred upon the District great advantages in contributing to the means of warding off Zymotic diseases and of depriving such diseases of much of the fatality which might otherwise have attended them. It is a source of some considerable satisfaction to find that four of the Sub-districts, viz. Clapham, Wandsworth, Strcatham, and Putney, had no necessity whatever to refer any cases of nuisance or other sanitary matter to magisterial investigation. Battersea, however, has recorded in the table referred to no fewer than 40 such appeals. Pig nuisances, with which Battersea seems fated to be troubled (with at present very little prospect of permanent relief,) appears to have constituted the majority of these appeals, and it is hardly necessary to say that until, the Home Secretary can introduce into one of the many projected sanitary measures a clause that shall insist on all piggeries being licensed in the same way as are the slaughter-houses and cow-sheds throughout the Metropolis, very little good will result from these frequent contentions in Police Courts. Water Supply.—It affords some satisfaction to find that the water supplied by the Companies to this District has been of late of rather better quality than formerly, but still occasional complaints are heard of its incomplete filtration. Whilst this Report was being prepared for press, Dr. Frankland made the following Official Report:— " Taking the amount of organic impurity contained in a given quantity of the Kent Company's water as ninety, the proportional amount in an equal quantity of water supplied by each of the other 14 Metropolitan Companies was:—New River 1.3, Chelsea 2.2, West Middlesex 2.4, Grand Junction 2.5, Lambeth 2.9, East London 2.9, and Southwark 3.1. The river waters supplied to London have now fully assumed their summer quality, and contain scarcely half as much organic impurity as they did during the winter. Their efficient filtration has also become much easier to accomplish, nevertheless the Southwark and Grand Junction Companies delivered slightly turbid water, containing numerous moving organisms, to their customers. The remaining samples were clear when drawn from the Companies' mains." The greater part of this District, it is known, is supplied with water by the Southwark Company, and this water is shown by Dr. Frankland's last published tables to contain a larger amount of solid impurity than, with one exception, any others submitted to analysis. The Medical Officers of Health refer with considerable regret to the still incomplete arrangements to meet the requirements of the Act which was passed some time since to afford the entire Metropolis a supply of water on the constant service principle. What causes the delay it is somewhat difficult to discover. Perhaps there never was an Act of Parliament so completely ignored in many districts as the one in question. The Local Summaries will be found to contain remarks upon questions of more or less local and general interest, but to which it will be unnecessary to allude at much greater length in this place than will suffice to recommend the suggestions they embody to that consideration of the Board which their importance deserves. Amongst the observations made in these Summaries are some few from both the Health Officers of Battersea upon the catastrophe (previously referred to), of a number 15 of women having succumbed to Puerperal Fever whilst under the care of certain midwives. The most regretable circumstance connected with these deaths is that a woman in East Battersea did not earlier heed the warnings she received, to the effect that she was wanting in the requisite knowledge of the treatment of such serious cases, and of the necessity there existed for employing the most scrupulous cleanliness, particularly as regarded her own person. The results would have been deplorable enough had this woman discontinued her functions after the occurrence of the first two or three fatal cases, but to have persisted after so many had fallen victims to her ignorance and carelessness, was, to say the least of it, most reprehensible. The Health Officer of the Western Division of Battersea in reference to this matter very justly remarks —and in this he fully bears out the observations of his colleague :— "It is the duty of every person, whether midwife or surgeon, to cease attending lying-in women when he or she is unfortunate enough to have cases of this description;" and he refers to the opinions of Dr. Churchill upon the matter, and mentions the fact of medical men having changed every article of clothing, shaving off even the hair of their heads and whiskers, and, after abstaining from attendance upon such cases for weeks, returning to this kind of practice with the painful result of seeing their very first case prove fatal. After this it is not going too far to say that nurses and midwives ought to be placed under some kind of control in respect to such cases. In the Wandsworth Local Summary, the Health Officer of that Sub-District offers some remarks upon the excess of zeal of School Board Officials in sometimes enforcing upon parents a too early return of their sick and convalescent children to school without insisting on Medical certificates, and before all danger of conveying to others infectious or contagious diseases had ceased to be apprehended. The remarks here referred to, it is submitted, 16 well support those which the Health Officer of Putney has ventured to make on the importance of all children in schools being systematically instructed in elementary physiology, and the laws which govern their own organizations in both health and disease. Upon this subject it may be further remarked that even School Board Officials would be rendered none the worse agents of such Boards if they understood a little more than some of them appear to do at present concerning the laws of health, and of the delicate organizations of those they are, by virtue of their offices, so often called upon to deal with.* There are also, in all the contributions to this Report, remarks and suggestions which it is hoped may sufficiently attract the attention of everyone residing in, or having any interest in the sanitary welfare of the locality, as to lead to a general acquiescence in all sound and desirable measures that may be projected with the view to improve the neighbourhood, to lower the death-rates of the several parishes which comprise the District, and to sustain the efficiency of those works already carried out. Attention likewise may here be invited to the suggestions to be found in the Summary of West Battersea as to the establishment of a mortuary in that locality, and of a disinfecting station for the accommodation of the entire District. In the Summaries of Wandsworth, Clapham, Streatham, and Putney, there are also scattered remarks upon several of the same questions as those already noticed in the Battersea Reports, and, like them, they contain many allusions to the reforms which appear to be necessitated in Coroners' Courts, the evils of suffering the registration of deaths without medical certificates or other inquiry, the defective water supply, the success, as well as the failure, of endeavours to remove or abate certain * See Wandsworth Local Summary. 17 alleged nuisances, and several other kindred subjects, the whole of which, it is submitted, have no inconsiderable claims upon the consideration of the Board. In conclusion, and on presenting their respective He ports for 1874, the Medical Officers of Health submit there has been much in the past, in reference to the sanitation carried out under the auspices of the Board, to give the authorities, the public, and themselves, a considerable amount of satisfaction, and much also to cause them to look forward with increased confidence and renewed hopefulness to the results of future efforts. LOCAL SUMMARIES. c 2 20 WANDSWORTH. The following statistics, derived from an analysis of the Registrar General's Returns and of the Parochial Records of Sickness and Mortality, furnish evidence of the very favourable state of the health of this Sub-district during the year 1874. Statistics of Mortality, &c. The deaths which were registered as having occurred in this Sub-district during the past year numbered 453— 233 were of males, and 220 of females. Of this number 142 took place in the following Public Institutions, viz.:— In the Surrey County Lunatic Asylum, 107; in the Hospital for Incurables, 13; in St. Peter's Hospital, 2; in the House of Correction, 8 ; in the Royal Patriotic School for girls, 10 ; and in the Reformatory for boys, 2 ; 15 deaths of Wandsworth parishioners occurred in the Infirmary of the Union, and which, in consequence of that Institution being situated in Battersea, do not appear on the Wandsworth Death Register, Deatli-rate.—The rate of mortality during the past year, calculated from the total deaths registered, and a mean estimated population, was 20.69 per 1000 persons living ; the estimate being based on the assumption that the population has increased since the period of the last 21 census in the same proportion as it had done during the preceding ten years. But a rate derived from the deaths registered is inclusive of the mortality of the Surrey County Lunatic Asylum, St. Peter's Hospital and the Hospital for Incurables, and cannot be received as the natural one, inasmuch as the inmates of these Institutions are, with a fractional exception, derived from without the parish, undergo no natural increase, and are subject to a very high mortality, which formed last year nearly 27 per cent. of all deaths. Under disturbing influences of such extent, a calculation of the death-rate made in this manner would be worthless, for not only would it be unduly raised absolutely, but relatively its fluctuations would be represented by those of the mortality of the Institutions named. The natural death-rate, after due correction for these Institutions in the manner explained in previous reports, is found to have been 16.50 only per 1000 persons living on an average during the year, is less than that which obtains in the rural districts (17 per 1000), and is 2.49 per 1000 less than the average rate of this Sub-district during the preceding ten years. Birth-rate.—The births registered numbered 665— 338 of males, and 327 of females. The birth-rate, determined according to the foregoing calculations, was 31.73, and the rate of natural increase 15.23 per 1000 persons living of all ages. Causes of Death. The following table contains a summary of all the causes of death, arranged in accordance with the classification of the Registrar General, showing the sex, social position, and age at death at different periods, and particularizing the several diseases of the Zymotic class:— 22 STATISTICS OF MORTALITY. WANDSWORTH. Total Deaths from each Class of Disease, &e., in the Sub-District Sex Age Social Position Population in l871—19,783. Estimated population in middle of 1874. Area in Acres—2,478. Males Females Under 1 year From 1 to 5 years From 5 to 10 years Under 20 years, including all under 10 years At 20, and under 40 years of age At 40, and under 60 years of age At 60, and under 80 years of age 80 years and upwards Nobility and Gentry Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. I Industrial and Labouring Classes DISEASES, And other causes of Death. Diseases Classified. Classes:— Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 14 5 9 4 7 2 13 ... 1 ... ... ... 2 2 10 Scarlatina 2 1 1 ... 2 ... 2 ... ... ... ... ... ... ... 2 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 4 3 1 1 3 ... 4 ... ... ... ... ... ... 2 2 Whooping Cough 19 7 12 9 8 2 19 ... ... ... ... ... 1 3 15 1. Zymotic Typhus & fantile fever 5 3 2 ... 2 2 5 ... ... ... ... ... ... 1 4 Erysipelas 6 3 3 3 ... ... 3 3 ... ... ... ... ... 2 4 Metria, Childbirth 2 ... 2 ... ... ... ... 2 ... ... ... ... ... ... 2 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea & Dysentery 12 6 6 8 2 ... 10 ... ... 2 ... ... ... 3 9 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 64 28 36 25 24 6 56 5 1 2 ... ... 3 14 47 2. Tubercular 54 28 26 11 4 ... 25 13 12 4 ... ... 2 9 43 3. Of Brain, Nerves, &c. 99 54 45 11 6 2 20 17 37 ?4 1 2 9 11 77 4. Of the Heart, &c. 32 20 12 ... 1 ... 2 6 12 12 ... 3 3 6 20 5. Of Respiratory Organs 34 56 28 16 6 ... 22 12 21 22 7 6 5 15 58 6. Digestive Organs 21 8 13 5 ... 3 9 3 5 4 ... ... 1 6 14 7. Urinary Organs 2 2 ... ... ... ... 1 ... ... 1 ... ... 1 ... 1 8. Of Organs of Generation 5 ... 5 ... ... ... ... ... 3 2 ... 1 ... ... 4 9. Of Joints Bones, &c 4 3 1 ... ... ... 1 1 2 ... ... ... ... 2 2 10. Of Skin 2 2 ... 2 ... ... 2 ... ... ... ... ... ... ... 2 11. Premature Birth, Low Vitality, Malformation, &c. ) 29 16 13 29 ... 29 ... ... ... ... 1 ... 6 22 12. Of Uncertain Sea 20 6 14 ... 1 ... 1 4 9 6 ... 3 2 3 12 13. Age 23 6 17 ... ... ... ... ... ... 12 11 1 ... 6 16 14. Violence 12 3 9 2 ... 1 5 8 1 1 2 ... 3 2 7 15. Not Specified 2 1 1 2 ... ... 2 ... ... ... ... ... ... 1 1 Totals 453 233 220 103 42 12 175 64 103 90 21 17 29 81 326 23 For the same reasons as those already given in reference to the circumstances affecting the determination of the death-rate, it becomes necessary, in estimating the relative share in the causation of mortality held by the several classes of disease contained in the foregoing Table, to exclude Class 3 (Diseases of the Brain and Nervous System) from consideration, in consequence of the undue augmentation which it receives by the whole mortality of the Surrey County Lunatic Asylum. The first in order of fatality, exclusive of Class 3, was Class 5, comprising Diseases of the Respiratory Organs, which, as in the year previous, were unusually numerous, and at the beginning and end of the year of such severe type, and often so rapidly fatal, as to create a vague suspicion of some Zymotic origin; they formed upwards of 18 per cent. of all deaths, and took the place of priority usually occupied by diseases of the Zymotic-Epidemic-Contagious class (Class 1), the latter forming 14 per cent. only. As in the year preceding, also, the most fatal single disease was Bronchitis, filling the position usually held by Pulmonary Consumption. Next in order, No. 2, the Tubercular Class, which includes Consumption, formed 12 per cent. (nearly), and was somewhat higher than the average. Diseases of the Heart (Class 4) were unusually numerous, forming over 7 per cent., or about double the average. Class 11 was also unusually large, forming over 6 per cent. Although a heightened mortality from diseases of the Respiratory Organs holds a prominent position in the Table, an equally noteworthy, and more satisfactory fact is observable in the great diminution of epidemic or contagious diseases. Age at Death.—Upwards of 22 per cent. of all deaths occurred to infants under 1 year of age; 32 per cent. to children under 5 years of age; and upwards of 38 per cent. under 20 years of age. These figures are, with the exception of those relating to the first year of life, which are of average amount, considerably below the average. Although 23 deaths only are recorded as having resulted from age unassociated with any special disease, 68 deaths 24 took place above the age of 70, as follows, viz.; from 70 to 75, thirty-one; from 75 to 80, sixteen ; from 80 to 85, twelve; from 85 to 90, seven ; and. two attained 91 years of age. Social Position.—Upwards of 71 per cent. of the deaths from general disease, and upwards of 73 per cent. of the deaths from Zymotic diseases, took place amongst the labouring classes. These amounts are considerably below the average, especially those relating to deaths from Zymotic disease. Inquests, Violent and Uncertified Deaths.— 32 inquests were held during the year. 12 deaths resulted from violence, 9 of which were accidental and 3 suicidal. No less than 13 deaths were registered as not certified by medical testimony, and in two instances the cause of death was not specified—in all of which, therefore, death may have resulted from other than natural causes. A similar registration of uncertified deaths will be found recorded in every one of my annual reports since the year 1859; and as an amendment of the law on this important subject is still much needed, I venture to reproduce the substance of some of the observations made in my previous reports. As the essential function of the Coroner's Court is the determination of the cause of death, the necessity for the employment of medical testimony cannot be too strongly insisted on. In the absence of such testimony, the cause of death must be frequently assumed on mere conjecture; hence it becomes apparent to what an extent the Registrar General's Returns, upon which are based the Tables of Life Insurance, &c., are vitiated, as well as, and more importantly, to what extent the means of protecting society against secret crime, are defective. In every interest of society the cause of death should be a fact as far as human knowledge can make it so. 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. The presence or absence of suspicion, however, ought not to be accepted as the 25 exponent of the necessity for inquiry 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 such cases, it should be observed (and here it is that the law requires amendment), 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 great loss of time, and convenienceof iuries, and useless expense to the rate-payers. Epidemic Diseases.—Their Prevalence and Fatality.— The following table shews the deaths which have resulted from the 7 principal Epidemic diseases during the past and ten preceding years, and the relation which they bore to the deaths from all causes. YEARS Small Pox Measles Scarlet Fever Diphtheria WhoopingCougli Cholera Diarrhoea Fever—Typhus and Typhoid Total Deaths From Epidemics Total Deaths from all causes Percentage of deaths from Epidemics to deaths from all causes 1864 4 ... 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 6 73 351 20.7 1867 3 1 7 1 6 1 7 7 33 332 9.9 1868 ... 8 5 2 20 ... 22 7 64 394 16.2 1869 ... 23 36 7 ... 23 5 94 429 21.9 1870 ... 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 1873 ... 4 ... 3 8 ... 22 7 44 433 10.1 1874 ... 14 2 ... 19 ... 12 5 52 453 11.5 26 From an examination of the foregoing Table it is gratifying to find that the mortality which resulted from these diseases was 22 per cent. less than the average of the past 10 years, and that the proportion which it bore to the deaths from all causes was 33 per cent. less than such average. Of these diseases Diarrhoea was the most generally prevalent, having been present, as usual, during the whole year, but it was attended with less fatality to the extent of more than one third of the average of the preceding ten years. Whooping Cough prevailed epidemically during the first six months, and Measles during the first three months of the year. Both these diseases, considered in relation to their limited extent and duration, were very fatal. Both greatly exceeded the average, the former by nearly one half. Fever was present during the first six months also, and Scarlatina to a slight extent in the summer months, but neither can be said to have prevailed epidemically. It is very satisfactory to find that, as in the previous year, no death resulted from Small Pox, one isolated case only of that disease having come under treatment amongst the parochial poor during the year. Inasmuch as the fluctuation of the death-rate is found to depend essentially on the greater or less prevalence of diseases of this class (conclusive evidence of which is to be found in the annual reports), any circumstances having a tendency to admit of the fostering of these diseases, upon which science has so long stamped the word "preventible" deserve the serious consideration of all sanitary authorities. As is well known to every Medical Officer of Health, the propagation of infectious diseases is frequently promoted by a too early return to school of children recovering from such diseases. This very mischievous proceeding has increased under the zealous supervision of the School Board Officials, to an extent which has become observable also in reference to diseases of a general nature, inducing relapses and often risk to life. But as regards infection, there can be no doubt as to the impropriety of allowing compulsory 27 ance at school to become the means of propagating diseases which are attended with such great fatality, or, when not fatal, otherwise tend by their morbific consequences to lower the vital forces of the people. Looking to its great importance I venture, therefore, to again draw the attention of the Board to this subject by repeating a recommendation made in my report for 1859, and in several subsequent reports; viz.:— "That no children absent from school "on account of sickness should be allowed to return to "school except upon the production of a certificate from "their Medical Attendant that they might do so with safety "to themselves and others." A printed certificate to this effect, requiring the signature only of the medical attendant, is all that is needed to prevent an evil, the extent of which is far greater than is generally supposed. Sickness and Mortality amongst the Parochial Poor.— The amount, nature, and fatality of disease which prevailed amongst the parochial poor during the year is contained in Table V., Appendix. The total amount which prevailed was 23 per cent. less, and the resulting mortality 12 per cent. less, than the average of the preceding ten years. The amount of Epidemic disease was no less than 43 per cent. and its attendant fatality 40 per cent. below the average. Amount of General Sickness.—The total amount of sickness which has prevailed generally throughout the Sub-district can be estimated only by assuming the proportion which the deaths bear to the cases of sickness that came under treatment amongst the parochial poor (and which is accurately known) as the proportion borne by the deaths to the cases of sickness amongst all classes. Such an estimate, although approximate only, becomes valuable as a means of comparison with a similar estimate of previous years. By such a calculation it appears that the total amount of sickness which prevailed generally, could not have been less than 59 per cent. of the population; 28 the average of the preceding ten years by a similar calculation having been upwards of 72 per cent. Sanitary Proceedings, Removal of Nuisances, &c.— A summary of the general sanitary operations which have been carried out during the year, is, as usual, contained in Table VI., Appendix; and it is satisfactory to find that they were ail conducted without the necessity of any appeal to the law for their fulfilment. In addition to which, all the Slaughter-houses and Cow-houses of the Sub-district were examined and reported on prior to the renewal of their owners' licenses. The premises of the Royal Victoria Patriotic Schools were examined on two occasions in October last year, and formed the subject of a Special Report made conjointly with the Medical Officers of Health for Battersea. These examinations were made, under instructions of the Board, in consequence of a sudden outbreak of a very fatal form of enteric disease, but which fortunately ceased on the prompt removal of the cause. This was traced to the use of impure rain water, supplied from a tank to which sewer gases had access, and which a certain portion of the School had been inadvertently allowed to use. In anticipation of the forthcoming closure of the Burial Ground in Garratt Lane in January next, attempts have been made to secure a site within the parish for the formation of a new cemetery. Should the necessity arise for such an acquisition, it is to be hoped that due regard will be had to the sanitary aspect of the question, and that the selection of the site, in common with those for the establishing of noxious businesses, will be based upon some definite relation between the area and the population of the Sub-district. (See Report for 1872, page 27). The examination now made of the foregoing statistics affords ample confirmation of the opening statement in 29 this report of the high standard of health attained by this Sub-district during the past year. It also shews that this satisfactory condition, as represented by a low death-rate, a high birth-rate, and by a great diminution of infant mortality as well as of general sickness, was essentially dependent on a less prevalence of those diseases which it is the especial object of sanitation to diminish and prevent. And it also shews, concurrently with a less prevalence of these diseases, a diminution in the amount of mortality borne by the labouring classes in proportion to the other classes of the inhabitants, a result which must be gratifying in itself, as well as affording an indication of the direction in which future measures of sanitation can be successfully projected. GEORGE EDWARD NICHOLAS, M.D., Medical Officer of Health for Wandsicorth, 30 BATTERSEA EAST. The following detailed statements of the sanitary condition of the rapidly expanding population of this division of the Sub-district possess more than the usual interest on the present occasion, as for the first time the births registered as having taken place in this division have been separated from those registered in the Western division of the Parish, so that a much more accurate resume can be rendered than before. This arises from the wise and judicious course adopted by the Board, who, when the Registrar General, in the latter part of the month of April, discontinued supplying the Medical Officers of Health with copies of the Death Register, and other information previously given, decided, upon the advice of the Battersea Local Committee, to pay the Local Registrars for the same, an example which has been followed by nearly the whole of the District Boards and Vestries in the Metropolis. Population.—It is evident that no calculation as to the sanitary condition of this division of the Sub-district can be of much value unless the real population can be ascertained, and that has always been a matter of considerable difficulty in this parish, as its rapidly-increasing population defies ordinary calculations. In order to be well within correct limits, it should be stated that in 1873 the mean population, according to the mode sanctioned by the Registrar-General, was 31,344, and in 1874 it would be 33,085, a difference of 1741. This is the official increase of population, the erroneous 31 character of which is shown by the fact that in the Shaftesbury Park Estate alone 2,804 additional inhabitants found a home in 1874, besides which numerous houses and apartments which were formerly untenanted were occupied during the past year—indeed, there is scarcely an empty house in the Sub-district, a great improvement upon the state of matters in 1871, when one-sixth of the whole number of houses in the parish were empty. Evidently the official mean population is only sufficient to account for the ordinary increase of population, and to arrive at a correct conclusion as to the real deathrate, the inhabitants of the Shaftesbury Park Estate must be taken into account, which would together give a mean population for 1874 of 35,889, which I have reason to believe is rather under than over the actual number, the birth-rate showing a mean population of 37,023, as is hereafter explained. Mortality.—The deaths registered in the Eastern division of Battersea during 1874 were 701. The number registered in 1873 was 578, showing an increase of 123, fully accounted for by the largely-increased population. Of these, 380 were males and 321 females. The real population, which as I show elsewhere, from a consideration of the birth-rate and other data, may be assumed to be 37,023, would give a death-rate for the year 1874 of 18.9 per thousand per annum, or 3.7 per thousand lower than the metropolis generally. The official population of 33,085 gives a death-rate of 21.1 per thousand, which is 1.5 lower than that of London at large, which was, for the year 1874, 22.6 per thousand. The accompanying statistical table gives in detail the cause of death, age, social position, and other particulars, of the whole of the deaths registered as occurring in East Battersea during the year 1874. 32 STATISTICS OF MORTALITY. BATTERSEA EAST. Total Deaths from each Class of Disease, Arc., 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 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. Population June, 1873— 31,344. Estimated mean population, 1874—33,085. Area in Acres 1235. Classes:— Small Pox. 3 1 2 1 1 ... ... 2 1 ... ... ... ... ... 1 2 Measles 12 6 6 3 8 1 ... 12 ... ... ... ... ... ... ... 12 Scarlatina 50 30 20 4 28 16 2 50 ... ... ... ... ... ... 13 37 Diphtheria. 3 1 2 ... 1 ... 1 2 ... 1 ... ... ... 1 1 1 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 9 6 3 2 5 2 ... 9 ... ... ... ... ... ... 1 8 Whooping Cough 23 7 16 13 10 ... ... 23 ... ... ... ... ... ... 7 16 1. Zymotic Typhus, &c. 17 8 9 5 l 2 8 5 3 ... ... ... ... 2 15 Erysipelas. 3 2 1 2 ... ... ... 2 ... ... l ... ... 1 1 2 Metria, Childbirth 14 ... 14 ... ... ... ... ... 13 1 ... ... ... l 4 9 Carbuncle. 1 1 .. ... ... ... ... ... ... ... 1 ... 1 ... ... ... Influenza Diarrhoea & ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera 37 28 14 25 7 1 ... 33 1 2 l ... i 2 4 30 Totals of Zymotic Class 172 85 86 49 65 21 5 140 20 7 4 ... 2 4 34 131 2. Tubercular 172 101 71 82 24 4 11 121 29 20 2 ... 4 8 32 123 3. Of Brain, Nerves, &c. 100 58 42 40 29 1 ... 70 5 6 16 3 3 2 22 73 4. Of the Heart, &c. 25 15 10 2 ... 2 5 9 6 5 4 1 ... ... 11 14 5. Of Respiratory Organs 156 75 81 51 43 5 2 101 11 24 16 4 4 2 31 119 6. Of Digestive Organs 13 11 2 3 1 ... ... 4 1 5 3 ... ... ... 5 8 7. Of Urinary Organs. 4 4 ... ... ... ... ... ... 2 2 ... ... ... 1 ... 3 8. Of Organs of Generation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Of Joints, Bones, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Of Skin 2 1 1 2 ... ... ... 2 ... ... ... ... ... ... ... 2 11. Premature Birth, Low Vitality, Malformation, &c 23 16 7 23 ... ... ... 23 ... ... ... ... 1 1 10 11 12. Of Uncertain Seat 9 1 8 2 1 ... ... 3 ... 3 1 2 ... ... 4 5 13. Age 10 1 9 ... ... ... ... ... ... ... 4 6 1 ... 4 5 14. Violence 10 8 2 2 1 2 1 6 3 1 ... ... ... ... 1 9 15. Not Specified 5 4 1 1 2 ... ... 3 ... 2 ... ... ... ... ... 5 Totals 701 380 321 258 166 35 21 483 77 75 50 16 15 18 154 514 33 Under one year of age 258 deaths were registered, or 37 per cent. of the gross mortality, which is precisely the same as last year; from one to five years, 166; altogether under five years 424 deaths occurred, or GO per cent. of the total number; the preceding year (1873) gave 59 per cent. of the whole number of deaths as occurring within the same age-limits. Above 80 years of age 16 persons died, their respective ages being—Males, 81, 82, 84, 87 ; and Females, 80, 80, 80, 82, 82, 84, 87, 88, 88, 89, 89, 91. Social Position.—The social changes taking place in this division of the Sub-district are clearly pointed out by the relative positions in life of the persons whose deaths were registered in 1874:— Nobility and Gentry 15 Professional Class 18 Middle and Trading Class 154 Industrial and Labouring Class 514 Total - 701 In 1873 the Labouring Classes contributed 450 out of 578 deaths, or 77.8 per cent. of the total number. In 1874, 514 deaths occurred among that class, or 73.3 per cent. of the total number of deaths—701, showing an improvement in the social position of the inhabitants. This occurred almost exclusively among the Middle or Trading Class. D 34 Zymotic or Epidemic Diseases.—From these diseases 171 deaths occurred in 1873 and 1874, as below given:— The numbers for 1873 are given for the sake of comparison. 1874 1873 Scarlatina 50 3 Diarrhoea and Cholera 37 31 Whooping Cough 23 15 Typhus and other fevers 17 18 Diseases of Childbirth 14 14 Measles 12 23 Croup 9 4 Erysipelas 3 3 Diphtheria 3 1 Small Pox 2 8 Carbuncle 1 0 Total 171 120 Nearly one-fourth, or 25 per cent., of the total number of deaths arose from diseases of the Zymotic class, and this can be readily understood, as the year under consideration is memorable, in a sanitary point of view, for the occurrence of Scarlatina of a malignant type over the whole country. The large number of 50 deaths were attributed to this disease, or two-sevenths of the total epidemic mortality. Nearly the whole increase in the deaths from Zymotic disease was caused by Scarlatina—50 deaths being registered in 1874 against 3 in 1873. In the Report for 1873 for this division of the parish, an account was given of the manner in which a careless and uncleanly nurse communicated Small Pox to above twenty persons, eight of whom died. During the present year there occurred a melancholy illustration of the manner in which the most fatal diseases may be distributed broadcast by the ignorance and carelessness of women following the nurse's calling. In the 35 autumn of the year my attention was aroused by the fact that numerous deaths from Puerperal, or Childbed Fever, were registered, and, upon inquiry, I found that they all originated in the practice of one midwife, with whom I at once communicated; she acknowledged the existence of the cases, and seemed quite astonished when I informed her that she was the medium through which the disease was disseminated. She promised to abstain from "practice," which promise she kept for a month ; but it is melancholy to relate that fourteen women in the prime of life, most of them mothers of large families, were sacrificed to this woman's ignorance. Midwives usually attend what is ironically termed "the practice" of a lying-in hospital for about two months, the first half of which period is generally passed in performing the menial offices of the institution, and the latter in attendance on two or three natural cases of labour, which are superintended by the matron, after which they are free to "practice" as midwives, the examination they undergo being a perfect farce. Thirty-seven deaths were registered as occurring from Diarrhoea and Cholera, of these 25 were under 1 year of age, or 5-6ths of the whole number, and 7 between 1 and 5—altogether 32 under the first quinquennium. The deaths from these diseases exceeded those in 1873 by 6. From Whooping Cough 23 deaths in 1874 against 15 in the preceding year gave an increase of nearly 50 per cent. It is, however, probable that the next annual return may shew a diminished mortality from this cause, as the disease at the latter part of the year was of a type more amenable to treatment than before. From Typhus, Typhoid, and other forms of Fever, 17 deaths, or 1 less than in 1873, were registered, a fact on which the inhabitants may congratulate themselves, as in the other districts of London Fever was generally prevalent duRing the year 1874. D 2 36 The number of deaths from Measles diminished from 23 in 1873 to 12 in 1874, and in every case some complication, generally Pneumonia, was the real cause of death. This disease has for many years past been of a very mild type, so much so that, whatever may be the case at the antipodes, death from an attack of uncomplicated Measles is a rare event in this country in the present day. The other diseases of the Zymotic group do not call for much mention, except that the deaths from Croup increased in number from 4 in 1873 to 9 in 1874. The deaths from Small Pox were 3 in number against 8 last year; one of these cases occurred to a "navvy'' in whom vaccination was uncertain, and who contracted the disease elsewhere than in this parish ; the two others were returned as follows:—"Chicken Pox 14 days, Asthenia, Female, aged 10 months.''— "Chicken Pox 7 days, Convulsions 30 minutes, Female, aged 1 year and 5 months." Both were "not stated" as to vaccination, and were undoubtedly cases of some disease allied to Small Pox. Other diseases.—Tubercular diseases, which include Consumption, Water on the Brain, and Infantile Wasting, caused death in 172 instances, 46 more than in 1873. Diseases of the Respiratory Organs were the next great cause of death, as 156 cases were recorded, exceeding by 22 the preceding year. Diseases of the Brain and Nerves have much increased in number, 100 deaths having occurred from these causes, or an increase of 29. Heart Disease killed in 25 cases, Premature Birth 24, diseases of the Digestive Organs 13, against 25 in 1873; Old Age 10, Violence 10, which figured for 13 and 15 respectively in the last Report. 37 Taken altogether, the increased population is sufficient to account for the above numbers. Births.—For the first time, thanks to the wise liberality of the Board, an accurate record of the births registered in the Eastern Division of Battersea, has been furnished by the Registrar, and this is especially valuable on the present occasion, as a reliable test of the real population. It is evident that, in a given number of people of all ages, a certain number of births will occur in each year, and scarcely vary from one year to another, if the population be to a great extent identical, and of the same class. It has been shewn in former reports that the birth-rate of Battersea remains at 42 per thousand with remarkable steadiness, and as the births of 824 males, and 732 females, in all 1556, during 1874 in East Battersea in an officially estimated population of 33,085, gives a birth-rate of 47 per thousand, one of two things is evident, either that the population is much larger, or 5 additional births per thousand living persons have occurred in the year, a proposition which cannot be for a moment entertained. If the normal birth-rate of 42 per thousand be adopted, there results a mean population for 1874 in East Battersea, of 37,023, which is probably very nearly the true number. Vaccination.—The Register of the Public Yaccinator gives the following cases successfully operated upon during the year 1874. Primary Vaccinations 915 Re-Vaccinations7 922 38 Inquests.— Twenty-four cases were the subject of inquiry before the Coroner in this Sub-district during the year, and may be thus classified according to the verdicts given: Drowned (1 Suicide, 1 Wilful Murder) 9 Killed by Locomotives 4 Suffocated in bed, (Infants) 2 Scald 1, Poisoned by Carbolic Acid 1 2 Natural Causes 4 Hanging 1, Cut Throat 1, (Suicides) 2 Excessive drinking 24 Uncertified Deaths.—There were 23 persons consigned to the grave during the year from East Battersea, in whom the cause of death was not certified by a registered medical practitioner. Comment is superfluous. Sanitary Operations. — During the . past year a systematic house-to-house inspection has been made of nearly every inhabited dwelling in the Sub-district by the Inspector of Nuisances, under the supervision of myself and the Surveyor, Mr. Pilditch, to which latter gentleman I have to express my thanks for his prompt assistance on many occasions. Several nuisances of a character injurious to health were discovered by this means, which is the only practicable method of bringing sanitary measures to bear on the habitations of the lower section of the working classes, as they, from indifference or want of knowledge, are with their families those who, at all events in the first instance, pay the tribute of disease and death to imperfect hygienic conditions. It must not, however, be forgotten that when Zymotic disease is once engendered, it invariably spreads by infection to the classes above. 39 The principal sanitary defects observed were defects in house drains, and absence of, or insufficient dust-bins. Of defective drainage nothing can be written too strongly. There is far more danger in imperfectly-trapped and badly-ventilated drains than in their entire absence; and it is to be feared that from the want of proper traps to house drains communicating with the main sewers, the continued presence of Zymotic diseases amongst us is due. This defect is almost universal from the fact that neither the Board nor its officers on the one hand, nor the District Surveyors on the other, have power to insist on this most necessary precaution of effectually trapping every house drain, so that a heavy rainfall or a slight disturbance of atmospheric pressure may not convert our dwelling-houses into ventilators of the sewers, as is now but too frequently the case. An efficient system of ventilation of the main sewers is a desideratum of great moment, and cannot be much longer delayed. In every case where these defects have been discovered, notices were at once served upon the owners to remedy the same, and subsequent steps taken to ascertain that the necessary works had been executed. It is my pleasing duty to report that in no case was it necessary to resort to legal measures of compulsion. My attention was directed to the dilapidated condition of houses situated in Sleaford Street, and upon inspection I found they were unfit for human habitation, by reason of age and want of proper foundations. I reported to this effect to the Board, and suggested that the attention of the District Surveyor should be called to these ruinous structures. This gentleman at once condemned them, and they were pulled down. A nuisance of a specially dangerous and revolting 40 nature was brought by me under the notice of the Local Committee and the Board:— On a small plot of ground in Brougham Street, a depot for lint, tow and other debris from the hospital wards of the metropolis was discovered. These materials were saturated with human blood, pus, and other animal discharges of an offensive character, smelling most abominably, and dangerous to health from the character of the deposit. It was found that the lint was washed, prepared, and sold again, and, still more horrible, the tow was washed and made into ordinary twine in a contiguous railway arch. Considerable difficulty was found in suppressing this disgusting trade, which was at last only effected by putting strong pressure on the officials of the several hospitals to induce them to destroy these matters on their own premises by means of fire. They are now consumed in the furnaces of the respective hospitals instead of being mixed with ashes and other refuse as formerly. Of nuisances of a larger type, such as those reported upon formerly as proceeding from factories, there is, on the present occasion, nothing to record, the measures taken by the Board in former years having apparently produced a salutary effect. No complaint has been made of the mode of conducting any of the cow or slaughter houses during 1874, and the owners have, on every occasion, shown the greatest alacrity in complying with any instructions given to them by the Board's officers. W. H. KEMPSTER, Medical Officer of Health for Eastern Battersea. 41 BATTERSEA WEST. I am pleased at being able to present a very favorable report as to the deathi-rate and sanitary condition of this populous division of Battersea during the past year, 1874. Though the principal part of the population is composed of working people, who, owing to their occupation, cannot bestow upon themselves that care against changes of temperature and climate which is necessary, and which, therefore, tends to swell the mortality tables, still, the death-rate is low, and contrasts most favorably, not only with that of London generally, but many of the suburbs, as the following pages will show. By a recent order of the Board, the Medical Officers of Health are now supplied with the returns of births and deaths direct from the Registrar of the District every Saturday, in the place of their being forwarded by the Registrar General himself several days later. This is a great improvement on the old system, for by this means the Health Officers are made acquainted with any deaths from Zymotic Disease considerably earlier than they otherwise would be, so that means for the disinfection of houses and clothes can be at once taken, the value of which arrangement cannot be 42 over-rated. It also enables me to give the births for this division of the district, which I have never before been able to do, also the births relative to the population and the natural increase ; i.e., excess of births over deaths. The bodies found in the river will be taken into account in the death-rates of the localities in which they were picked up, though, probably many of them may be found not to have belonged to either division of Battersea. Zymotic Diseases.—West Battersea has not been quite so free from Zymotic disease during the past year as during the preceding one. Those showing an Epidemic character were Diarrhoea, Whooping Cough, Croup, Typhoid Fever, and Fever following Childbirth. Though the cases may have been in excess, the deaths are not numerous, and it is by their fatality we can alone judge of their severity. Not a single death from Small Pox has been registered during the year; this is the first year, since the Epidemic of 1871, of such an occurrence. Scarlet Fever, although it raged with some severity in the adjoining division only yielded 5 deaths in West Battersea. It is singular, also, that Small Pox prevailed in this division (the western), for six months before a single case occurred in the eastern division of the Parish. Diarrhcea was very prevalent during the summer months and gave the largest number of Zymotic deaths to the Register. It would have been considerably larger, but for the action taken by the Board in gratuitously supplying Medicine and Attendance to the poor. Too much stress cannot be laid on the necessity of early checking Diarrhoea, as the forerunner of Cholera. During the earlier months of the year, February and March, an Epidemic of Child-bed Fever prevailed, 11 deaths being registered from such disease. This is a terrible disease, bringing dreadful misery at a time usually so full of joy; it is also very contagious and taken readily by women during 48 and after confinement. It is the duty therefore of every person whether Midwife or Surgeon to cease attending lying-in women, whenever he or she shall be unfortunate enough to have cases of this description, as no known precautionary measures have ever been successful in removing the power of infection when once contracted. Medical men indeed, have relinquished practice for many weeks, destroyed all their clothes, and even shaved the hair from their heads and whiskers, and yet on returning to their duties, the first case attended has proved fatal. Mortality.—The total number of deaths registered during the past year was 68G, 3G0 males and 326 females, the males exceeding the females by 36. 136 of these deaths took place in Public Institutions, viz., 133 in the Infirmary of the Workhouse, 2 at the Freemasons' School, and 1 in the Westminster Union School. Deducting, then, the 133 Infirmary deaths, which, as the inmates are derived from the whole Union, it is only fair to do, it will leave 553 as the correct number proper to the out-door population of this division of the parish.* Of the 133 Infirmary deaths, 46 belonged to Battersea, and as the cases were derived from both divisions of the Parish, they will be taken into account in the summary table in the Appendix. Death-rate.—The death-rate for this, the Western division of the Parish, for the past year is 17*2 per 1000 persons living, or 1 in every 58, in an estimated population at the middle of the year 1874 of 32,135 souls, calculated on the method pursued by the Registrar-General. Looking * Out-door with reference to Infirmary, the Infirmary population being deducted. 44 at the fact that very few empty houses * now exist in the locality, and that a great amount of immigration must have taken place, I believe that the next census will show that the inhabitants have increased, in a much greater ratio than is yielded by the above calculations. The number of deaths registered in the previous year (1873) was 674, so that in the past year there is an increase of deaths by 12, a number by no means large.+ Ages at Death.—As many as 310 deaths took place of children under 5 years of age, 205 being under 1 year. Taking all ages up to 20, the number is 338 ; from 20 to 00, no fewer than 207 ; from 60 to 80 and upwards, 141 ; the three eldest being females of the respective ages 90, 95, and 98. These three persons were inmates of the Infirmary at the time of death. I have already called attention to the deplorable state of things as regards infant life, and to the fact that 205 infants perished under 1 year of age. This is an increase on the previous year of 15, and is no doubt due to the circumstance that many infants who had only breathed a few hours being now registered, whereas they were previously treated as stillborns, and buried without certificates or inquiry of any kind. No less than 28 infants were registered under " Premature Birth" or " Low Vitality." * The number of houses in this division of the Sub-district has been ascertained to be 15,782, and the rateable value £130,588. f It may be as well to state that, looking at the estimated population of the whole parish of JBattersea, and the total deaths registered, inclusive of all who died in the Infirmary and oilier Public Institutions of both divisions of the Sub-district, a death-rate of 21'9 per 1,000 per annum is deducible. 45 STATISTICS OF MORTALITY. BATTERSEA WEST. Population June, 1873— 30,814, Estimated mean population June, 1874— (52 weeks) 32,135. Area 1108 acres. Total Deaths from each Class of Disease, &c., in the Sub-District Sex Age Social Position Males F emales 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. Classes:— 1 Zymotic Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 8 2 6 2 6 ... ... 8 ... ... ... ... ... ... ... 8 Scarlatina 5 2 3 ... 2 2 ... 4 i ... ... ... ... ... 1 4 Diphtheria 2 ... 2 ... 2 ... ... 2 ... ... ... ... ... 1 3 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 16 9 7 3 12 1 ... 16 ... ... ... ... ... ... 2 14 Whooping Cough 30 18 12 13 17 ... ... 30 ... ... ... ... ... ... 6 24 Typhus & other Fevers 15 10 5 ... 4 1 3 8 ... 4 3 ... ... ... 4 11 Erysipelas 4 3 1 ... ... ... 1 1 1 1 1 ... ... i ... 3 Mctria, Childbirth 11 ... 11 ... ... ... ... ... 8 3 ... ... ... 2 4 5 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea Choleraic Disease 43 25 18 31 3 ... ... 34 o 3 4 ... ... ... 6 37 Totals of Zymotic Class 134 69 65 49 46 4 4 103 12 11 8 ... ... 3 24 107 2. Tubercular 113 67 46 37 12 1 2 52 41 17 3 ... 2 3 21 87 3. Of Brain, Nerves, &c. 111 53 58 31 20 ... 3 57 6 22 22 4 2 14 25 70 4. Of the Heart, &c 35 16 19 2 ... 2 1 5 5 11 11 2 1 2 6 26 5. Of Respiratory Organs 151 80 71 39 20 1 1 61 14 30 37 9 3 4 14 130 Digestive Organs 23 10 13 5 1 2 8 1 9 ... ... ... ... 3 20 7. Urinary Organs 6 5 1 ... ... ... ... ... 1 4 1 ... 3 ... 1 4 8. Of Organs of Generation 3 1 2 ... ... ... ... ... ... 2 1 ... ... ... ... 3 Of Cancer, &c 10 7 3 ... ... ... ... ... ... 4 6 ... ... 1 1 8 Syphilis 6 2 4 4 ... ... ... 4 3 1 ... ... ... 2 4 11. Premature Birth, Low Vitality, Malformation, &c 26 16 10 26 ... ... ... 26 ... ... ... ... ... ... ... 26 Of Uncertain Seat 27 11 16 6 2 1 2 11 2 5 8 1 ... 2 6 19 13. Age 22 9 13 ... ... ... ... ... ... ... 12 10 2 3 4 13 Violence 15 12 3 3 4 1 1 9 2 3 3 ... ... ... ... 15 15. Joints and Bones 4 2 2 ... 1 2 2 ... ... ... ... ... 2 2 Total 686 360 326 205 10 12 16 338 87 120 115 26 11 32 109 534 This table includes all deaths in the Infirmary of the Union, 46 Zymotic Diseases.—These diseases collectively give an increase of 19 deaths over the previous year. There is a decrease in Small Pox (none being registered). Measles, Diphtheria, Typhus, Typhoid, and Infantile Fevers, but an increase in Croup, Whooping Cough, Fever following Childbirth, and in Diarrhoea. Of the 134 persons who succumbed to this class of disease, 103 were under 20 years of age, 95 of whom were under 5 years, leaving but 31 at 20 years and upwards. The principal fatal diseases were Diarrhoea, Whooping Cough, Croup and Metria. One death was registered as Cholera. The preceding table will show the fatality of each disease, the respective ages at which death took place, and the social position of the deceased persons. The following table contrasts all deaths in West Battersea from Zymotic Disease for the past 3 years. 1872. 1873. 1874. Small Pox 4 1 0 Measles 24 11 8 Scarlatina 3 3 5 Diphtheria 15 3 5 Quinsy 0 0 0 Croup 7 6 16 Whooping Cough 31 24 30 Typhus, &c 13 22 15 Erysipelas 5 4 4 Metria, Childbirth 2 4 11 Carbuncle 1 0 0 Influenza 0 0 0 Diarrhoea and Cholera 32 37 43 Totals 137 115 137 Other causes of death.—Diseases of the Respiratory Organs, excluding Phthisis, takes the first place with 152 deaths, viz., Bronchitis 83, Pneumonia 46, Laryngitis 3, Asthma 4, and other Lung diseases 15. The Tubercular . class resulted in 113 deaths, by Phthisis 67, Tabes Mesenteric and Atrophy 41, Scrofula 4, and Hydrocephalus 1. Diseases of Brain and Nerves proved fatal in 111 cases, Heart 35, Uncertain Seat 27, Premature 47 Birth 26, Digestive Organs 23, Old Age 22, Violence 15, Cancer 10, Syphilis 6, Diseases of Kidneys 6, Joints and Bones 4, Uterus 2, and Generative Organs 1, making in all 552. There is a decrease on the previous year of 5 under Respiratory Diseases, and an increase of 7 and 13 under Tubercular maladies, and Diseases of the Brain and Nerves respectively. In these latter forms of disease Infant Mortality takes a conspicuous place, nearly half the total deaths having been children under 5 years of age. Disease of the Respiratory Organs were most fatal up to 5 years, and then from 20 to 80 and upwards. Phthisis was fatal in 41 cases between 20 and 40 years, and in 16 from 40 to 60, just the same periods at which it was most fatal in 1873. Of the 111 deaths from Diseases of the Nervous System, 54 occurred to children under 5 years of age, being principally from Convulsions, and 54 were of persons from 20 years and upwards, Paralysis being the chief cause registered. From pure Old Age 23 deaths were recorded, being 29 less than those in the previous year. The following table contrasts oil deaths from NonZvmotic causes in the past 3 vears :— 1872 1873 1874 Tubercular 106 106 113 Of Brain, Nerves, &c 76 100 115 Of the Heart, &c 24 34 31 Of Respiratory Organs 105 156 151 Of Digestive Organs 18 11 23 Of Urinary Organs 4 4 6 Of Organs of Generation 2 6 3 Of Joints, Bones, &c 0 0 4 Of Cancer 15 14 10 Premature Birth, Low Vitality, Malformation, &c 22 23 26 Of Uncertain Scat 61 50 27 Age 46 51 22 Violence 28 4 15 Syphilis 0 0 6 Totals 507 559 552 48 Total Deaths from all causes, including all deaths in the Infirmary ••— 1872 1873 1874 644 674 686 The Death-rates per 1000, excluding Infirmary deaths and its population: — 1872 1873 1874 17-0 17-6 17-2 Inquests, &c.—During the year 26 Coroner's inquests were held, which is 11 in excess of last year. The verdicts returned were as under:— From natural causes 9 Accidental causes 11 buicide 3 Found dead 3 Total 26 Of the suicides one was by shooting, another by poison, and the third by the deceased throwing himself out of a window. The 3 found dead were all infants newly born, one found in the river and two on Clapham Common. Social Position. — The per-centage of deaths in relation to social position was as follows :— Nobility and Gentry 1.6 Professional 4.66 Middle and Trading 15.89 Labouring 77.85 100.00 49 Deaths not Certified.—Of the 68G deaths, 32 were registered as not certified—that is, the deceased had no qualified medical attendance—and were registered and buried without any medical certificate of the cause of death. The Board, it will be remembered, petitioned Parliament in favour of supporting Dr. Lyon Playfair's amendment in the Registration of Deaths Bill, that every death should be iegally certified, and that where no certificate of death was forthcoming an inquest should be held, and a post-mortem examination made, if considered necessary, but unfortunately no law touching the matter was made. I say unfortunately, for as the law stands it offers a ready mode of hiding crimes, of getting rid of single girls' shame, and of encouraging the continuance of a great social evil. There is nothing to do but to say the child had had a fit, Bronchitis, Diarrhoea, or any other disease, when the dea,th is at once registered, 110 inquiry is held, and the undertaker's certificate for burial is given as a matter of course. 20 of these deaths were of children under 1 year old, which is an age when these little ones are entirely powerless to protect themselves, and therefore require the protection of the law. Why Dr. Playfair's amendment, which fully dealt with the matter, and would have answered every purpose, was not carried, I am at a loss to conceive. "Until legislation shall be brought to bear upon this question, and the power removed from the registrars of registering deaths without medical certificates or coroner's inquiries, we cannot hope that uncertified deaths will cease to be recorded in these reports. Mortuary.—The want of a Mortuary has been much felt during the year, persons dying suddenly, and bodies found in the Eiver or elsewhere, being taken to the only available place, viz., the small room, about 9 feet by 6, at the rear of the Clock-House Tavern, which, I understand, is used for cleaning pots and for other purposes of a like nature. I have had occasion to make post-mortem E 50 inations in this place, and dreadfully inconvenient it is. There is no light except through the door which opens into the yard which the customers are free to use. There is scarcely room indeed to get round the body, and one is dependent on the kindness of the Landloi'd for any necessaries required during the performance of these examinations. I must here hear testimony to the civility and obliging disposition of the proprietor of this Tavern. 1 trust that the negociations pending between the Board and the Ecclesiastical Authorities will soon be favorably completed, for all are agreed there could not possibly be a more suitable place for a Mortuary than the church yard at the back of the Parish Church. The Islington Mortuary, I may observe, is so placed. In the case of Eattersea, looking at the close proximity of the church yard to the river, where bodies are continually being picked up and brought ashore at the draw dock, it is thought a better position could not possibly be found. The painful scenes of bodies so found, being carried or carted through the streets to the said Clock-house Inn would then be avoided, as would also, in the cases of the poor, the making of postmortem examinations in rooms where people are born, sleep, live and die, the oidy operating table being the turned up coffin, or its lid. It would also be very desirable if a chamber for the disinfection of clothes and bedding, &c., could at the same time be brought into operation, for there is no doubt that the purification of such articles by heat, forms an effectual means of preventing the spread of epidemic diseases, no other means of disinfection being efficient. Births.—The births registered during the year were 1,311, G7G being of males, and 635 of females ; the birthrate is therefore 40·8 per 1000 persons living, and gives a natural increase to the population by births over deaths, of 625. Vaccination.—The number of Infants vaccinated at the station in West Battersea during the year was 609, no persons having presented themselves for re-vaccination 51 As I mentioned last year, Small Pox absent, no fear prevailing, and re-vaccination forgotten, the indifference of persons in this matter is to be regretted ; for perfect immunity from death from Small Pox is all but guaranteed by efficient vaccination and re-vaccination. Where four good cicatrices are left, experience at all hospitals proves that not a single death has taken place! The wisdom of appointing a Vaccination Officer is shown by the fact that every infant is knowD either to be vaccinated, to have died, or to have been pronounced by medical certificate unfitted by disease to undergo the operation. Disease and Mortality amongst the Union Poor.— The number of cases which came under treatment was 445, 180 being males and 265 females. 42 were sent into the Infirmary, 12 to Lunatic Asylums, and 2 to Hospitals. On reference to Table V., Appendix, will be found the nature of the diseases. It will be seen that not a single case of Scarlet Fever occurred during the year, and only one of Small Pox. There were 25 cases of Diarrhoea, Cholera 1, Measles 11, Erysipelas 10, and Fever 0—by no means large numbers, especially when wo consider the liability of the poor to these classes of disease, owing to their conditions of living, &c. The number of deaths which took place was 20, viz., males 16, Females 10, being at the rate of 5'9 per cent.—a very small death-rate when it is remembered the large numbers of aged and infirm persons which fall to the care of the District Medical Officers. Sanitary Inspections and Proceedings.—Many important sanitary matters have been efficiently dealt with during the year, and have been the subjects of much labour and repeated lengthened reports. Several applications for magisterial interference have had to be made, but the great majority of orders served for the removal of nuisances were complied with. Houses in which cases of Fever had occurred were fumigated and cleansed by means of burning sulphur, the clothes and bedding hung on lines across the room, and thus brought under the full action of the e 2 52 sulphurous fumes. Disinfectants such as carbolate of lime, Condy's fluid, and carbolic aoid have boon plentifully supplied to all applicants. The Board having appointed an Inspector of Nuisances for each division of the parish, we are enabled to give immediate attention to these matters. It -would be well, however, if the poor generally knew that these agents could be obtained by application at the Stone Yard. In all cases in which the patients or friends consented, infectious cases were removed to Hospitals, but it is in many cases a most difficult matter to obtain that consent; in such cases the infected persons are kept at home, where isolation is impossible, and hence often become a nucleus for the spread of the disease under which they may be labouring. I think if there was a ward set apart at the Infirmary for such cases, the distance for removal would not be great, and many would more readily consent to be removed than at present. The most important sanitary inspections on which reports have been submitted to the Board related to :— 1. The Battersea Cemetery. 2. The Alum and Ammonia Works. 3. Mr. Wliiffin's Quinine and Strychnine Works. 4. Gut-cleaning in Field Place. 5. Putrid fish-burial in Currie Road. 6. Pigs in Lachmere Grove, Lachmcre Lane, High Street, John Street, Usk Road, Mendip Wharf, and York Road. 7. Trade refuse deposit in Lachmere Grove. 8. Dog nuisance in Auckland Road. 9. Diseases amongst Pigs. 10. The irrigation, and sanitary condition of the Royal Patriotic Schools, Wandsworth Common. 11. Lombard Sewer. 12. Protective Masks for men working in sewers. 53 Battersea Cemetery.—Owing to fears being entertained of the law with reference to interments not being properly carried out in this cemetery, I was requested to report on the matter. I ascertained that deep graves were dug in the common ground, and were allowed to remain open till sufficient bodies were forthcoming to fill up the said graves. To within a certain distance of the surface, as many as 2G had been placed in one grave, and frequent complaints were made to me by the Clergy who officiated at funerals, of the very disagreeable smells proceeding from these open graves, which I verified myself on inspection. A considerable quantity of water was found in these deep graves, in fact they were far below the drainage of the cemetery which is 8 feet, and not connected in any way, consequently they formed large receptacles for the water to settle in. The number of bodies placed in these deep open graves, the amount of earth left between each coffin, and the distance of the uppermost coffin from the surface, formed the chief subjects of inquiry before the Government Inspector of Burial Grounds, which took place at the cemetery on August 4. and at which several Members of the Board of Works, the Surveyor, Mr. Estlin, and other gentlemen wei'e present. After a long enquiry, the Inspector said that the case for the Board was fully proved, viz.; that the official regulations had not been carried out. Since this, matters have mended, and I am informed that burials are now being conducted strictly in accordance with the law. This is most desirable ; for burial grounds in close proximity to houses, may become serious nuisances and most injurious to the health of tlie neighbourhood. It is only by conforming to rules carefully considered, that mischief can be avoided. With respect to this Cemetery, considering the large number of interments (over 1000 annually), and the small space of ground remaining unused, it must, it is surmised, soon cease as a general burial ground. Disposal of the Dead.—The rapid occupation of our 54 cemetery brings to my mind the discussions which have taken place upon the question of the disposal of human remains. There are only two methods at present advocated, 1st, burial in cemeteries (the "Sleeping place" of the Greeks, the " House of the living'' of the Jews, the " God's field " of the Germans) ; 2nd, cremation or burning. My opinion of these modes of disposition of human remains is solely from a sanitary point of view. With regard to the first mode, Mr. Seymour Had en says, " If we must have coffins, let them be of such construction as will not prevent their resolution. No coffin at all would be best, or a coffin of the thinnest substance Avhich would not long resist the action of the earth, or a coffin such as wicker or lattice work, open at the top, and filled in with any fragrant herbaceous matters that happened to be most readily obtainable. A layer of ferns or mosses for a bed, a bundle of sweet herbs for a pillow, and as much as it would still contain after the body had been laid in it, of any aromatic or flowering plant for a coverlet." The object of such a coffin and coverlet as the above, is that the earth may be as near as possible to the body, and so assist in its " resolution''; for there cannot be a doubt, that stout airtight coffins do prevent for years the decomposition of the body within them. I paid a visit to Brompton cemetery with the special object of noticing the condition of coffins which had been interred the 14 years required by the Act of Parliament, before the grave is re-opened. By the courtesy of the Superintendent, I was shown the coffins, and they appeared as sound as when they were first placed there. This was in the common ground, so that the Act which has provided for the re-opening of graves after a certain number of years, where the contents are expected to be a few dry bones, so as to allow the ground to be used in perpetuity is clearly a mistake. But whether decomposition is rapid or slow, its products must find their way into the earth, the water, and the atmosphere, so that there is not much advantage iu adopting one kind of enclosing 55 materia], wood, or the other, open wicker work. It is obvious that the real utility of one or other of these modes of enclosure, depends entirely upon the nature of the soil and the situation of the cemetery. With regard to the latter mode of disposition (cremation), there are advantages in its adoption, 1st, rapid decomposition, and therefore the less noxious method; 2nd, none or but remote injury to the living. It would be well to keep in mind, in order to an unprejudiced view of the subject, what actually occurs in the decomposition of dead bodies. After the death of animals, just as after that of plants, their component parts are reduced to the primary forms from which they were derived, so that they may begin again at the foot of the ascending scale of life. Very soon after life is extinct, the atmospheric oxygen begins to induce a change in some of the nitrogenous constituents, and this change is soon communicated to all parts of the body, which undergo a putrefaction, of which the ultimate results are the conversion of the carbon into carbonic acid, the hydrogen into water, the nitrogen into ammonia, nitrous aud nitric acids, and the sulphur into sulphuretted hydrogen. Before this ultimate result is attained, intermediate products arc obtained, which are highly complex in their composition and highly offensive in their character. The mineral constituents of the animal frame mingle with the surrounding soil, and are ready to take part in the nourishment of vegetation, which construct the organic components of their frames from the carbonic acid and ammonia furnished by the putrefaction of the animal, and these serve in their turn as sustenance for animals whose respiration supplies the air with carbonic acid, and takes in exchange the oxygen eliminated by the plant. Of course this disposition is not the immediate result of the evolution of the accompaniments of the putrefaction of the dead body, but the ultimate result may be thus stated, and it is evident that' the injury to public health is in those cases, and they arc by far the most numerous, where the noxious products of putrefaction come into contact with human beings, who are not the natural 56 correctives of these matters, but as before stated, the vegetable world, naturally is. Now we know that the operation of cooking animal food delays for a time the putrefactive powers, and where it does commence its character is very materially altered, because the changes are less complex. This diminished complexity of change, or in other words this simplicity of change, is induced by the rapid process of burning, or cremation, the great and white heat of which process reduces at once the complex matters of the body to very simple ones, and ultimately to carbonic acid, a product of ordinary combustion, water and sulphuric acid. And the mineral constituents would remain as an ash, which probably would be handed over to the representatives of the deceased to be preserved—never, however, to assist in poisoning the blood, or otherwise, of the living. Mr. P. EL Holland's objections, quoted from his letter in the Standard, are to the following effect :—" So might those employed to burn bodies be occasionally oversparing of fuel, and when they were so the danger and annoyance from imperfect burning would be far worse even than imperfect burial." This, however, has but little force, since a most unusually great degree of neglect must arise to cause the imperfection he fears. No doubt the balance of feeling is in favour of burying our dead, therefore the wise and proper course to pursue is to bury them far away from human habitations, and a sufficient distance beneath the earth's surface, so that the products of decomposition may be as far as possible got rid of. Drain the buryingground sufficiently deep, and carry the fluid matters into channels where they cannot by any chance mingle with water used for drinking purposes, and this mode of disposing of the dead must be considered as entirely unobjectionable, whatever description of envelope may be chosen for the body upon depositing it in the earth. 57 Chemical Works.—The Chemical Works of Messrs. Wliiffin. and the Alum and Ammonia Company's processes have been the subjects of many inspections and reports, not only by myself but by the aid of my colleague, of Dr. Carpenter and Mr. Keates, who were called in. They also have fully and exhaustively reported on the manufactures carried on. Neither of these gentlemen have decidedly said that they are injurious to health, but they recommend improvements to neutralise and to prevent the escape of disagreeable odours given off in the processes of manufacture. It is certain that since these inspections the nuisances have not been nearly so great, but have so subsided as to be bearable. It will be remembered that the stoppage of the Lombard Road sewer was traced to the refuse from one of these works, and the difficulty the men had of working in the sewer owing to the overpowering smells, several of the men being quite overcome by them, led me to devise an apparatus for the men to wear, which enabled them to work with perfect impunity. It appears to be a matter of difficulty to know what to do with the refuse of trades. A quantity was deposited in Lachmere Grove, which on analysis was found to contain strychnine,—a most dangerous poison. It is true, as Dr. Muter remarked, " it is not volatile;'' but any animal or a child eating it would be seriously affected. Again, nothing is so obnoxious to the sense of smell as putrid fish, yet quantities were buried on a plot of ground between two houses, and so objectionable did it become that serious complaints were made, and by order of the Board this piscatory burial-ground was closed. Refuse capable of undergoing decomposition should be taken far away from habitations, and buried deep, and not in places where in a short time houses would probably be built. Pigs and their Diseases.—Our friends the pigs have, as usual, giveii a great deal of trouble during the year; many inspections have been made, reports forwarded, and eight 58 summonses taken out; Police Courts have also been attended on several occasions, and the Board and pig proprietors were alike represented by counsel. On the first hearing arrangements were made by counsel that the pig keepers should have time to make such alterations in the construction of their styes, so as to prevent any nuisance. At the second hearing it was suggested by Mr. Douglas Straight that Mr. Ingham, the Magistrate, should visit Lachmere Grove Piggeries. He did so at once, and, as some of the owners had commenced the suggested improvements in the styes, and others complaining they had not had sufficient time, a further adjournment was made till March, and so the matter at present remains. I must thank those gentlemeu, Members of the Board, who undertook the unpleasant duty of inspecting these piggeries, and for presenting themselves at the Court for examination—not in any tyrannous spirit I believe against the proprietors, but as independent witnesses of the actual state of affairs. The subject of diseases among pigs having been so recently before the Board, it will be unnecessary for me to dwell upon it here, so I shall simply repeat the opinion given in my special report, viz. :— " Knowing that all diseases must affect the flesh, and that we are dependent on the purity of that flesh for the nourishment of our bodies, I cannot bring myself to the belief that the flesh of animals dyiug from inflammatory diseases is not hurtful to health. I further believe the animals on which myself and the Cattle Inspector of the Metropolitan Board of Works made postmortem examinations, and found had died of Tuberculosis, would be positively injurious as food. One would 1'eel some satisfaction if all meat was first sent to market; but I fear much questionable meat is disposed of without appearing there." The cow and slaughter-houses in this district, numbering over sixty, were duly inspected for the purpose of renewing the licenses. All were renewed with one exception, and the reason of this one being withheld was 59 that frequent complaints were made of it, and that houses were built within three feet of the slaughter-house door. The case was heard by the Justices, when, after taking my evidence, they decided to view the premises, after which, I believe, the license was granted. The Police Court was also attended in reference to gutcleaning, at 10, Field Place, and the Magistrate made an order for its discontinuance. JOSEPH OAKMAN, Medical Officer of Health for West Battersea. 60 CLAPHAM. In order to maintain the existing facilities for yearly and other comparisons, it will be seen that I continue to employ the same tables as I have done for many years past; and I think, with my colleagues, that the information it is necessary to impart to the readers of these reports cannot be conveyed in a more concise and complete manner than in forms that have been adopted from almost the very first year of the official exertions of the Medical Officers. An extra introductory tabic employed by me is the following, and I here repeat it as a means of saving much descriptive matter, and more particularly as a ground-work for the observations it will be necessary for me to make upon the sanitary events of the past year. Table showing the Births, Deaths, and Marriages that took place in the Sub-district of Clapham during 1874, compared with the number of these events in the ten previous years, 1864-73 :— Yeaus 18G4 18G5 1866 1867 1868 1869 1870 1871 1872 1873 1874 Marriages 227 221 310 244 272 234 158 249 236 257 284 Births 640 707 711 777 801 838 867 864 858 929 937* Deaths 408 393 425 451 450 508 480 604 482 475 528 Excess of Births over Deaths ... 202 314 286 326 351 330 387 260 376 454 409 *Of this number I successfully vaccinated in 263 cases. — J. M. 61 Referring more particularly to the principal events shown in the above table, it may be remarked that the marriages greatly exceeded those of any previous year named, except that of 1860, when they amounted to 310, thus evidencing a good sanitary and social position of this locality in that year, as it does in the present year compared with many previous ones. The births also will be seen to have been in excess of any year since 1864, though the excess of births over deaths falls short of that of the previous year by as many as 45 ; the natural increase of the population was, therefore, comparatively small. The next table I have to refer to is the one showing the numbers of deaths due to the seven principal epidemics, or Zymotic diseases, during 1874, and in the preceding ten years, 1864-73:— Years. 1864 1865 1866 1867 1868 1869 1870 1871 1872 1873 1874 Small-pox. 3 7 10 7 0 10 6 94 14 0 0 Measles 12 7 18 3 9 2 14 2 30 11 20 Scarlatina. 11 11 C 5 14 29 45 20 6 2 33 Diphtheria 2 4 5 3 7 0 2 3 3 3 4 Whoopingcough 10 15 14 7 25 29 9 18 25 14 15 Typhus 14 11 16 10 20 17 12 10 11 10 6 Diarrhœa & Cholera 20 17 21 28 30 31 31 39 25 27 Totals ... 03 75 86 5G 109 117 119 178 128 65 105 The principal point in this table deserving comment is the fact that no deaths occurred from Small Pox, either in the past or previous year. This is very satisfactory, and it is sincerely hoped it is a state of things that will continue. Of the other principal Zymotic diseases, Measles and Scarlatina both appear iu considerable excess as to their 62 fatality over 1873, though to the former malady not so many by ten succumbed as in 1872. There was a very slight excess of deaths due to Diphtheria, Whooping-cough, and Diarrhœa, but to Fever (Typhus, Typhoid, and Continued), the deaths were four less than in 1873. The total deaths from the seven principal epidemics was, for the past year, 105, which is in excess of the previous year's return of 40, but, with this exception, is under the number recorded since 1868. Scarlatina, it will be observed, was in great excess in 1870, but gradually declined in 1871, 72, and 73. In the past year the mortality from this disease again rose to 33, but, looking at the fact of the general prevalence and fatality of this disease throughout the kingdom in 1874, it should not be viewed as any decided indication of a decline in the favourable condition of the public health of this Sub-district that has been known to exist for some years past. I now refer to the principal table of this report, relating to the general mortality of the Sub-district. A fund of useful information will, as usual, be found in this table, giving, as it does, in a condensed form, not only the causes of the fatal diseases, but the ages, sex, and social positions of the deceased parties. It also furnishes other valuable statistical data by which to show the progress we are making in sanitation, and in lessening the rates of mortality. 63 STATISTICS OF MORTALITY. CLAPHAM. Total Deaths from each Class of Disease, &c., in the Sub-District. Sex Age Social Position Population in 1871—27,347. Estimated Population in middle of year 1874— 29,444. Area in Acres—1,233. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. Under 20 year, including all under l0 years. At 20, and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class. Merchants, Bankers, &c. Middle & Trading Class, Shopmen, Clerks, &c. Industrial and Laboring Classes. DISEASES And other Causes of Death Classes:— Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 20 9 11 7 11 2 20 ... ... ... ... ... ... 3 17 Scarlatina 33 22 11 2 20 8 33 ... ... ... ... ... 3 7 23 Diphtheria 4 ... 4 ... 2 2 4 ... ... ... ... ... ... 2 2 Quinsy 2 1 1 1 ... ... 1 1 ... ... ... ... ... ... 2 Croup 7 6 1 2 5 ... 7 ... ... ... ... ... ... ... ... Whooping Cough 15 7 8 6 9 ... 15 ... ... ... ... ... ... 3 ... 1. Zymotic Typhus, &c. 6 3 ... ... 1 2 5 ... 1 ... ... ... ... 1 5 Erysipelas 5 8 2 1 ... 1 2 ... ... 2 1 ... ... ... 5 Metria, Clildbirth 6 ... 6 ... ... ... ... 3 3 ... ... ... 1 1 4 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa, etc. 25 18 7 20 3 ... 23 1 ... 1 ... ... 1 6 18 Cholera 2 1 1 1 ... ... 1 1 ... ... ... ... ... ... 2 Totals of Zymotic Class 125 70 55 40 51 15 111 6 4 3 1 ... 5 23 97 2. Tubercular* 71 29 42 4 6 8 17 27 94 3 ... ... 7 22 40 3. Of Brain, Nerves, &c. 35 18 22 1 8 2 8 4 7 16 ... ... 8 12 15 4. Of the Heart, &c. 29 14 15 1 ... 1 3 7 6 13 ... ... 3 12 14 5. Of Respiratory Organs 73 32 41 17 6 3 28 5 18 22 ... ... 9 23 41 6. Of Digestive Organs 26 13 13 1 ... ... 1 4 11 9 1 ... 3 13 10 7. Of Urinary Organs 6 4 2 ... ... ... ... ... 2 1 3 ... 4 ... 2 8. Of Organs of Generation 7 ... 7 ... ... ... ... ... 6 1 ... ... ... 2 5 9. Of Joints, Bones, &c. 5 3 2 1 ... ... 3 ... 2 ... ... ... ... ... 5 10. Of Skin 5 2 8 2 1 1 5 ... ... ... ... ... 1 1 3 11. Premature Birth, Low Vitality, Malformation, &c. 71 44 27 60 6 5 71 ... ... ... ... ... 4 13 54 12. Of Uncertain Seat . 11 5 6 ... ... 1 2 3 2 4 ... ... 1 2 8 13. Age 37 10 27 ... ... ... ... ... ... 9 28 ... 8 12 17 14. Violence 1° 6 6 4 2 ... 6 1 2 2 1 ... ... 2 10 15. Not Specified 15 6 9 ... 1 1 2 3 5 5 ... 1 3 7 4 Totals 528 251 277 131 76 32 257 60 89 88 34 1 56 144 327 * Of the 71 deaths from Tubercular disease 49 were due to Phthisis. 64 One thing which will doubtless strike the reader of this table as being somewhat deplorable, is the circumstance of more than one-half the deaths in this Sub-district during the past year occurred to infants and young children from birth to 10 years of age. It is a sad reflection, in this boasted age of improved education, that we cannot succeed in educating parents to a better domestic care of their offspring than that which suffers them to die off in such large numbers from many of the acknowledged preventible diseases. Of elderly and other persons who succumbed to disease, &c., during the past year, from 60 to 90 years and upwards, amounted to 132, the five oldest of this number having reached the ages of 90, 91, and 92. Two at the latter age constitute the oldest persons dying in this parish during 1874. The united ages of these five persons being 455, it of course gives an average of 91 years to each. A very noteworthy fact in the table is also the disparity in the numbers of those dying amongst the industrial and poorer classes, and those succumbing amongst the well-to-do and higher classes of society. The deaths recorded in the first three columns relating to social position, it will be seen, are out of all proportion few, compared with the number recorded in the fourth column; and this was much the same in the last report. Comparison of Numbers of Zymotic and Non-Zymotic Diseases resulting in Death.—The Zymotic mortality, may be pronounced to have been excessive during the past year, viz., 105 against 65 of the preceding year. The total deaths from all causes being 528, and the mortality from the seven principal epidemics 105, it follows that the per-centage of the latter to the former is 19.8—a much larger proportion than in the previous year. Of the deaths due to the Zymotic class of diseases, from 78 to 105 is a large increase, but the fatal cases of non-Zymotic disease 65 was by no means out of proportion, having increased to the amount of one only, i.e., from 402 in 1873 to 403 in the past year. Increase of Population, Deatli-rate, &c.—The last Census, taken in 1871, gave to this Sub-district a population of 27,347. This was at a time when Small Pox raged throughout the kingdom, and caused as many as 94 deaths in this Parish, The consequence Was as many as 604 deaths were registered in that year, which made the rate per 1000 as high as 22.0. In the following year the estimated population was 28,154, and the death-rate 17.1 per 1000 persons living. This estimate, though it is made on the basis of all the death-rate calculations of the Registrar General, I regard as being too low; but this cannot be actually proved until another Census. In the year 1873, the population was calculated by the same method to be 28,799, and a death-rate of 16.4 per 1000 inferred—an estimate which, I am still of opinion, will be found much too low; but still it is one we are bound to adopt for the sake of uniformity and to avoid exaggeration. In the year under notice (1874), the same calculation being adopted, will bring the mean population of this Subdistrict up to 29,444, and will consequently give a deathrate of 17"9 per 1000, though, according to my own estimate as above stated, it must be something less. Be this as it may, when we see that the Registrar General's estimated rate for the whole of London is 22.5, we must not call even 18 per 1000, for such a populous district as Clapham, a very formidable one. Disease and Mortality amongst the Union Poor.— Table V. Appendix gives the proportion of deaths to the number of cases falling under treatment during the year amongst the Parish poor. It appears that there were as F. GG many as 829 cases of sickness, &c., recorded in the Medical Relief Book of this Parish, of which 60 ended fatally (13.8 per cent.) This is by no means a large per cent age, seeing what an inclement and sickly season has been passed through. The principal diseases treated amongst this class during the year were Measles, Scarlatina, "Whooping-cough, Diarrhoea, Fever, Diseases of the Lungs, and a rather unusual number of cases of Phthisis, as well as of maladies peculiar to young children, which are noted in the table under the heading of "Hydrocephalus, Atrophy, Scrofula, and Convulsions." Inquests.— Violent, Sudden, and Uncertified Deaths. —Of the 16 inquests held in this Parish during the past year, one was a case of child-murder, two of suicide, and five of accidental death. The remaining inquiries were held on persons whose deaths were obscure from their suddenness, but chiefly supposed to have been caused by natural disease, such as heart disease, &c, The evidence, in the case of one infant found dead, appears to have been of the usual meagre description, so as to leave the actual cause of death very doubtful. There were five cases of uncertified deaths, or of death and burial taking place without the cause being attested by medical certificate. One of these deaths was that of a man said to have died from lung disease, but of which there was no actual proof; and there were four infants, at and under one year of age, who had not been medically treated by any qualified practitioner, and the cause of whose deaths could have been only surmised. Sanitation of the Year.—The amount of sanitary work accomplished during the year will be best understood by a perusal of table VI. in the Appendix. In the column of this table devoted to Clap ham, it will be found that 1000 houses and premises were thoroughly inspected by the Surveyor and myself, and that, owing to 67 verance, and to occasional quiet remonstrance, in no case was it necessary to use compulsory means to enforce compliance with the orders of the Board. As many as 253 new drains have been constructed, or connected with the sewers, and the large number of 4600 feet of new sewers were completed. The new regulations that are to apply in future to the slaughter-houses and cow-houses of the District are a great improvement upon old arrangements, and will, it is thought, greatly benefit both tbe owners of these places and the public. As far as my powers have extended, I have as carefully inspected these places during the past year as in all former years, and shall continue to watch the effect of the new arrangements in future. Water Supply.—I have only to add to what I have already said upon this important matter in former years, that a great evil is being persisted in of maintaining closets in connexion with the cisterns that supply the resident families with drinking water. In the strongest terms I denounce this arrangement as likely to lead to most serious results, and as it may be remedied by the exercise of a little engineering skill, I hope to see the matter immediately attended to. JOHN MAC DONOGH, Medical Officer of Health for Clapham . 68 STREATHAM INCLUDING TOOTING AND BALHAM. The public health of the Sub-district, which includes the Parishes above-named, has been, during 1874, in a very favourable condition. Less deaths by 10, notwithstanding the increase of population, were registered during the year, and the death-rate was calculated to be 14.5 per 1000 persons living, instead of 15.5, which it had attained in the previous year. According to the method of calculation of the Registrar General, the population increased between the middle of the year 1873 and the same period of 1874, from 15,456 to 15,905, the deaths having numbered 230, and the births 465. The excess of births over deaths Avas, therefore, 235, constituting the natural increase of the population. The births, it seems, fell short of the number registered in the previous year by 23, a circumstance which may appear somewhat strange, seeing how large must have been the influx of new residents during the year; but it can be shown that this is not peculiar to this Sub-district, 69 The statistical facts referred to in this Report being fully set forth in the table which follows, it will be alone necessary to briefly allude to a few of the more important points of such table, viz.: 1. That the deaths from the epidemic class of diseases numbered two less than in 1873. 2. That the mortality due to the non-Zymotic forms of disease increased in some (viz,, Diseases of Brain and Nerves and Digestive Organs), and decreased in others (Premature Birth, Low Vitality, Whooping-cough, Fever, Diarrhoea, and Diseases of Uncertain Seat). 3. That infants and children between birth and ten years of age succumbed iu fewer numbers in the past than in the preceding year, the difference being 23 in favour of the past year. 4. That the columns relating to "Social Position" have been augmented in some, and diminished in others, but that the deaths amongst the industrial and poorer classes were fewer by 37 than in the previous year, and, relatively to the other three classes above them, presented a much less difference than usual—indeed, collectively, the three higher classes died in greater numbers than did the industrial class by as many as 59. In the previous year there were 122 deaths amongst the latter class to 118 amongst the former, but in the past year the difference was 85 to 145. I must now refer to the mortality table itself, and make a few comments on its several points of interest. 70 STATISTICS OF MORTALITY. STREATHAM, including TOOTING & BALHAM. Population in 1871—14,475. Estimated Population middle of 1874—15,905 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 2 2 ... ... ... ... 1 1 ... ... ... ... 1 1 ... Measles 9 4 2 ... 6 ... 9 ... ... ... ... ... 1 4 4 Scarlatina 3 1 2 ... 2 ... 12 1 ... ... ... ... 1 ... 2 Diphtheria 1 1 ... ... 1 ... 1 ... ... ... ... ... ... ... 1 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 4 2 2 1 3 ... 4 ... ... ... ... ... ... 1 3 Whooping Cough 3 2 1 2 1 ... 3 ... ... ... ... ... 1 1 1 1. Zymotic Typhus and other Fevers 2 ... 2 ... ... ... ... ... 1 1 ... ... ... 1 1 Erysipelas 2 1 1 ... ... ... ... 1 ... 1 ... ... ... 1 1 Metria, Childbirth 1 ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea & Choleraic Disease 6 2 4 3 ... ... 3 3 ... ... ... ... ... 1 5 Totals of Zymotic Class 33 15 18 6 13 ... 23 7 1 2 ... ... 4 12 17 2. Tubercular* 35 18 17 7 2 3 13 15 4 2 1 ... 2 19 14 3. Of Brain, Nerves, &c. 42 27 15 13 3 ... 19 3 5 13 2 2 6 19 15 4. Of the Heart, &c— 17 10 7 ... ... ... 2 2 9 4 ... ... 2 17 8 5. Of Respiratory Organs 47 19 28 6 5 1 12 5 9 17 4 1 5 26 15 6. Of Digestive Organs 17 7 10 2 2 1 6 4 4 3 ... ... 3 12 2 7. Of Urinary Organs 5 3 2 ... ... ... ... 2 2 1 ... ... 2 3 ... 8. Of Organs of Gene ration 2 ... 2 ... ... ... ... ... 2 ... ... ... ... 2 ... 9. Of Joints, Bones, &c. 1 ... 1 ... ... ... ... 1 ... ... ... ... 1 ... ... 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Malformation, &c. 12 9 3 10 2 ... 12 ... ... ... ... ... ... 5 7 12. Of Uncertain Seat 4 ... 4 ... 1 ... 1 ... 3 ... ... ... ... 1 2 13. Age 8 3 5 ... ... ... ... ... ... 5 3 ... ... 6 2 14. Voilence 6 2 4 1 ... ... 1 3 1 1 ... 2 ... 1 3 15. Not Specified 1 1 ... ... ... ... ... ... 1 ... ... ... ... 1 ... Totals 230 111 116 43 26 4 80 42 41 48 10 5 26 114 85 * Of the Tubercular class of Diseases, 18 deaths appear to have resulted from Phthisis. 71 Speaking more particularly of the Zymotic class of diseases, which are the first to claim attention in the table, it may be observed that two deaths from Small Pox were registered during the year, both cases having occurred to persons between 10 and 40 years of age. Measles and Diarrhœa appear to have resulted in death in 9 and 6 instances respectively, Croup in 4, Whoopingcough and Scarlatina each in 3 deaths, Fevers and Erysipelas respectively in 2 each, Diphtheria in 1, and Metria in 1. Of the seven principal epidemic diseases, as generally noted by the Registrar General, the deaths of 29 persons took place in 1873, but in the past year the same seven Zymotic diseases gave rise to 26 fatal cases. This decrease of 3 deaths is certainly not large, but must nevertheless be accepted as an indication of the improving health of the Sub-district. It should be observed also that neither of the deaths from Small Pox took place amongst the Union poor, although 3 cases of that disease came under the treatment of the District Union Medical Officers. The mortality of the seven principal epidemics to deaths from all causes was 11.3 per cent. To show the relative increase and decrease of deaths from the seven principal epidemics, the reader is referred to the following table:— DISEASES. 1873 1874 Increase 1874 Decrease 1874 Seven principal Epidemics. Small Pox ... 2 2 ... Measles 3 9 6 ... Scarlatina 1 3 2 ... Diphtheria ... 1 1 ... Whooping Cough 8 3 ... 5 Typhus, &c. 7 2 ... 5 Diarrhœa and Choleraic Disease 10 6 ... 4 Totals:— 29 31 11 14 72 Sickness and Mortality exclusively amongst the Union Poor.—There is no better measure of general sickness and fatality than that which is known, and accurately recorded, as taking place amongst the very poor. In the past year the sickness amongst this class appears to have been at a minimum, viz., 79 cases only, of which 10 proved fatal. Although this gives a somewhat larger percentage of deaths to cases treated than in most of the other Subdistricts, it must not be considered as particularly high, seeing that the inclemency of the autumn and winter months led to fatal results from Lung Diseases and from Phthisis in 6 of the 10 deaths recorded in the Medical Relief Books; and these, it should be remembered, were diseases that proved singularly fatal throughout the District—indeed it may be said throughout the kingdom. Ages at Death.—The mortality of infants and children from birth to 10 years of age has been already commented upon. The deaths of persons from 20 to 40 years of age were 42 against 22 in the previous year; those between 40 and 60 numbered 41 against 31, and those between 60 and 80 were 48 against 55, as enumerated in the last Report. The deaths of aged persons, i.e., at 80 and upwards, decreased in the two years from 17 to 10. The oldest person who died within the past year was an alms-woman, aged 92. There were several others who died between 80 and 90. Sudden, Accidental, and other Deaths, Inquests, &c. —The accidental, sudden, and other deaths upon which it was necessary to hold inquests, were 14 in number. These several inquiries resulted in the following verdicts:— 73 Natural Death.— Diseases of heart 5 Diarrhœa 1, Apoplexy 1 = i 7 Accidental Death.—Asphyxia in bed (overlaid), 1; „ Concussion of brain from „ falling down stairs, 1; Run „ over by locomotive, 1 3 Prematurely Born.— (Low vitality) 1 Found Dead.—(Infant, newly born, no marks of „ violence) 1 Hydrophobia.—(A female, aged 56) 1 Suicide.—(By inhaling carbonic acid gas) 1 Total - 14 It need scarcely be observed that some of the verdicts of " Natural Death " were arrived at without adequate Medical evidence confirmatory of the suspected causes. One death took place during the year, and was registered without Medical certificate, the cause of death being set down as "Marasmus from teething." This may or may not have been the true cause of death, but being doubtful, it would have been much more satisfactory had an inquiry of some kind been instituted. Recent legislation will, it is said, render these faulty registrations much less frequent; but this, according to many, may well be doubted. Sanitary Work of the Year.—Seeing how fully the several sanitary operations within the Sub-district have been tabulated (vide Table VI. Appendix), there appears little need to enlarge upon this part of the Report, beyond expressing satisfaction at finding that all the work performed was accomplished without a resort to magisterial interference in any one instance. It is suggested that this speaks exceedingly well for the vigilance and discretion exercised by the Surveyor, who, by proper advice 74 and quiet remonstrance, succeeded in very many cases in inducing offending and thoughtless parties to avoid litigation. I need scarcely add that I go very fully with my colleagues in the view they take of the beneficial results likely to accrue from recent sanitary legislation, as well as from that which is still under the consideration of Parliament. D. C. NOEL, Medical Officer of Health for Streatham, Tooting and Balham. 75 PUTNEY AND ROEHAMPTON. Putney, including the hamlet of Roehampton, contained, in 1874 (the year it is here proposed to review), a population of 10,396, as estimated for the middle of that year. This calculation is, as usual, based upon the Registrar General's time-honoured method; but there is reason to believe this mode of computing the yearly increase, although the best, and indeed the only one, that can be employed in the absence of an annual enumeration of the people, has the merit of being only approximately correct, by reason of its uncertain estimate of the immigrational element; but it is nevertheless considered by most statists to be sufficiently reliable for all practical purposes, and that, when employed annually and undeviatingly from one decade to another, it does not so greatly fail in giving the correct figures as it is popularly imagined it must do; at all events it has not been found so in the past as regards this Sub-district. In the past year there were registered in the 52 weeks 156 deaths, those who died having been nearly equally divided as to sex, viz., 80 males and 76 females. This, it need scarcely be said, gives a death-rate of 15.0 per 1000 persons living or 1 death to every 67 of the inhabitants. The excess of deaths over that of 1873 was 31. The death-rate of the past year was, therefore, 2.7 per 1000, higher than it was in the preceding one. This excess appears to have been due to an increased fatality of Tubercular diseases, including Phthisis, of affections of the Brain and Nerves, and of those of the 76 Respiratory Organs. The deaths from Phthisis alone were two in excess of those of the preceding year, 17 cases having occurred against 15 recorded in the last Report, During the year there were bom in the Sub-district, 290 children—148 males and 142 females. The excess of births over deaths was, therefore, 134, the birth-rate 27.8, and the rate of natural increase 12.8 per 1000. It is not often that a decline in the number of births has to be reported. The number has varied very considerably during the past ten years; but, contrasting the first with the last of these ten years, it must be admitted it is no inconsiderable leap from 191 to 290 of these events. On the vires acquirit eundo principle, and looking at the great yearly influx of new residents, it is but reasonable to look forward to a great increase of these events every year ; but it is a fact that a less number of births by 30 took place in the past year than in the previous one. With then more deaths and fewer births, it can excite no surprise that the past year should yield a rather less favourable Report than did the year 1873. Zymotic Diseases—their Prevalence and Fatality.— The first and most important point to consider, with reference to the annexed tables, is the fatality during the year of the Zymotic class of diseases. The number of deaths from the principal epidemics was 10 only; but it should be remarked that 4 of these were really not of a strictly epidemic character, being isolated cases of infantile diarrhoea incident to difficult dentition. The following table will show the percentage of deaths from the seven principal epidemics to deaths from all causes in comparison with the same statistics tabulated during the ten preceding years:— 77 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. 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 1873 125 6 4.8 1874 156 10 6.4 The next table (the mortality table) will afford all the necessary information as to the number of deaths that were registered as due to both the zymotic and non-zymotic forms of disease, giving the sex, age, and social positions of the diseased persons, and distinguishing those who died between birth and ten years of age. It is not a little gratifying to be able to record the same absence of all mention of fatal small-pox within the Sub-district, as has been done in several consecutive reports. It is equally satisfactory to speak of a very small mortality indeed due to the other epidemic maladies included in the table. Under the headings of Scarlatina, Quinsy, Croup, Whooping Cough, Fevers, Erysipelas, Metria or Childbirth, Carbuncle and Influenza, no deaths whatever are recorded. Of all the diseases, therefore, classed under the heading Zymotic, there were only 3 deaths from Measles, 2 from actual epidemic Diarrhoea, and 1 from Diphtheria, Nothing, it is submitted, can more clearly show than the above statistics, the good effects of the sanitary measures 78 that have been carried on in this Sub-district with so much earnestness during the existence of the District Board. It was some time since no uncommon circumstance to find recorded from 20 to 30 deaths due to the 7 principal Zymotic maladies, so that a reduction of these deaths from the above number to about 6 in each of the two past years, is a condition of the Register upon which the inhabitants of this favoured locality may be very fairly congratulated. Even the most economically disposed must concede that many of the results referred to in this and former Reports fully justify the expenditure incurred in the construction of an efficient system of sewerage, and the accomplishment of other necessary sanitary undertakings that have been rendered imperative by the acts of the legislature. Costly though some of these sanitary measures have proved, it should never be lost sight of, that it is not alone the saving of life effected by these undertakings upon which we have to congratulate ourselves, but the saving of a large amount of pain and suffering as well. It has been remarked by the Registrar General that " the last three years show a marked reduction in the mortality of London, and imply an improvement of the health of the drained city. The annual mortality of all London (including this District) for the ten years 1840-49, was 25.2 ; for the thirty-five years 1840-74, it was 24.2 ; for the last three years 1872-74, it was 22.2. Upon the population of 1874, this reduction of the mortality of 3 in 1000 implies a diminution of 10,200 deaths a year, and of the constant sufferings of double that number, on an average of sick people.'' 79 STATISTICS OF MORTALITY. PUTNEY AND ROE HAMPTON. Total Deaths from each Class of Disease, &c., in the Sub-Disrrict. Sex. Age. Social Position. Population (Census) 1871— 9,439. Estimated population in middle of the year 1S74— 10.396. Area in Statute Acres--'2,l76. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 1® 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 3 2 1 ... 2 1 3 ... ... ... ... ... ... ... 3 Scarlatina ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1. Zymotic Typhus and other Fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Metria, Childbirth ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Choleraic Disease. 6 5 1 5 1 ... 6 ... ... ... ... ... ... 4 2 Totals of Zymotic Class 10 8 2 5 3 1 9 1 ... ... ... ... ... 4 6 *2. Tubercular 9,4 8 l6 3 4 1 9 10 5 ... ... 2 3 10 9 3. Of Brain, Nerves, &c. 39 21 18 12 3 1 l6 5 7 3 3 6 7 13 13 4. Of the Heart, &c 8 6 2 1 ... ... 2 2 1 3 ... 2 1 1 4 5. Of Respiratory Organs 30 18 12 9 6 ... 15 2 4 8 1 2 1 9 18 6. Digestive Organs 11 3 8 ... ... ... 2 3 4 2 ... ... 4 5 2 7. Urinary Organs 3 3 ... ... ... ... ... ... 1 l 1 1 ... 2 ... 8. Of Organs of Generation ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Of Joints, Bones, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Malformation, &c. 7 2 5 7 ... ... 7 ... ... ... ... ... ... 3 4 12. Of Uncertain Seat 6 2 4 ... ... ... ... ... ... 5 ... 2 2 2 ... 13. Age 6 3 3 ... ... ... ... ... ... 4 2 ... 2 1 3 14. Violence 6 6 ... ... 1 ... 2 3 1 ... ... ... ... 3 3 15. Not Specified 2 ... 2 ... ... ... ... ... 2 ... ... ... ... 2 ... Totals 156 80 76 37 17 3 62 27 29 31 7 17 21 56 62 * Of the Tubercular class of diseases there were 17 deaths registered as being due to Pulmonary hthisis. 80 Mortality of Infants and young Children.—The mortality of Infants under one year amounted to 37, which is greater than in 1873 by 18. In children from 1 to 5 years 18 deaths took place, which is one less than in the previous year, whilst of those from 5 to 10 years, there were but 3 deaths recorded. With the one exception of a fatal case of Diphtheria which befel an adult, the deaths from Zymotic maladies enumerated in the Table, all fell upon children. The non-zymotic or ordinary diseases proved fatal to infants and children between birth and ten years of age in 49 instances, whilst 7 at the same ages died from "premature birth, low vitality, and malformation," The number of deaths of children under one year of age from all causes is 11 above the average of the preceding ten years, but this is certainly a most exceptional proportion, due perhaps to an unusually inclement autumn and winter, and to a somewhat large excess of deaths from Lung Diseases, and a st ill larger one from diseases of the Brain and Nerves, indeed, the latter maladies proved fatal in just double the number of instances than were recorded in the table of the previous year. A somewhat greater number of deaths took place of persons from 20 to 40 years of age than in 1873, whilst of those from 60 to 80, and from 80 and upwards, there is observable also a small increase. The very aged persons who died during the year, viz:—those between 80 and 90, and 90 and upwards, amounted to 7, the oldest having reached the advanced age of 91 years. Social Position of the Deceased.—The four columns of the mortality table devoted to "social position" furnish a study of some interest. The deaths amongst the industrial and poorer classes appeared, during the year, in proportions considerably greater than did those recorded in the last report, (62 against 38), but still this was very little higher than the average of the preceding ten years, that average being a fraction over 60. The disparity of numbers some years ago was very great between the 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, 1874. Compiled from the District Medical Belief Books. SUB-DISTRICTS. Total Cases of Sickness treated in each Sub-district. 1—Small Pox. 2—Measles. 3—Scarlatina and Malignant Sore Throat. 4—Whooping Cough. 5—Diarrhoea and Dysentery. 6—Cholera. 7—Fever. 8—Erysipelas. 9—Puerperal Fever. 10—Lung Diseases except Phthisis. 11—Phthisis. 12—Hydrocephalus, Atrophy, Scrofula, and Convulsions of Children. 13—Other Diseases. 14—Violence, Privation. and Premature Birth. Total Deaths in each Sub-District Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths Clapham 829 ... ... 33 7 9 ... 9 1 33 1 ... ... 157 ... 3 ... ... ... 138 12 33 9 43 8 316 21 55 ... 60 Wandsworth 1212 1 ... 53 1 3 37 5 65 1 ... ... 15 ... 13 ... ... ... 243 3 13 3 1 706 25 62 1 44 Battersea East 807 ... ... 5 1 33 3 7 ... 21 ... ... ... 12 ... 9 ... 8 1 133 8 69 12 19 4 496 9 ... ... 39 West 445 1 ... 11 ... ... 1 ... 25 1 1 1 6 1 10 1 1 1 101 11 4 1 4 2 270 1 10 ... 26 Putney and Roehampton. 219 ... ... 1 ... 8 ... ... ... 16 ... ... ... 3 ... 2 ... ... ... 31 3 6 3 1 1 142 7 9 ... 14 Streatham, including 79 3 ... 1 ... 2 ... ... ... 4 ... ... ... 1 ... 3 ... ... ... 18 4 2 2 ... ... 40 4 5 ... 10 Tooting and Balham Totals 3591 5 ... 104 9 55 3 54 6 164 3 1 1 194 2 40 2 4 2 164 41 127 30 68 15 1970 73 141 1 193 ***The ratio of deaths to cases treated is 5.3 per cent.