WAN 28 SANITARY DEPARTMENT. REPORT ON THE SANITARY CONDITION OF THE SEVERAL PARISHES COMPRISED IN THE WANDSWORTH DISTRICT, DURING THE YEAR 1876. BY THE MEDICAL OFFICERS OF HEALTH. London: JOHN SMITH & CO., 52, LONG ACRE, W.C. 1877. REPORT, 1876. To the Board of Works for the Wandsworth District. Gentlemen, We have the honour to present the twenty-first Annual Report upon the health and sanitary condition of the Wandsworth District. We have considered it undesirable, even at the commencement of a third decade, to make any material alterations in the general plan, or the statistical tables, of previous reports; as the advantages of comparison with these would in great measure have to be sacrificed in favour of any important innovations. We trust the following pages will prove useful and interesting to all who take cognisance of the sanitary progress of our District; and be evidence to you that your officers are endeavouring, to their best ability, to fulfil the duties assigned to them. We have the honour to remain, Gentlemen, Your obedient Servants, The Medical Officers of Health for the Wandsworth District. 5 HEALTH AND SANITARY CONDITION OF THE ENTIRE DISTRICT. The year 1876 has been distinguished by no very remarkable outbreak of disease, and no relative increase in the deaths or death-rate. Yet we have the misfortune to report the occurrence of one disease at least in an epidemic form, and an increase in most of the diseases of the Zymotic class. But, leaving the consideration of these details for a future page, we will, as usual, introduce our report with the preliminary statistics. Population.—In giving an estimate of the population of a rapidly increasing District such as ours, it is necessary to say that we are compelled to adopt the official method of obtaining it; namely, by calculating the rate of increase since the census of 1871, as the same as that of the previous ten years. It is evident that such a method must result in very much underestimating our population, and so, in unduly increasing our death and birth-rate, especially in the later periods of a census decade, and must materially affect our position as compared with districts having a stationary or decreasing population. As will be shown subsequently, the discrepancy between the official and the (probably) actual population has become 6 very considerable. The population of the entire Wandsworth District at the middle of the year, 1876, according to the official method, was 153,648. Deaths and Death-rate.—During the past year 3154 deaths have been registered in the District, of which 1640 were of males, and 1514 of females. The death-rate, according to the above population, is 20.5 per 1000 persons living, or 1 in 48 persons. For reasons already stated, this death-rate is probably much too high; still it is 2 per 1000 less than that of the Metropolis, and more than 3 per 1000 less than that of 21 chief towns of the United Kingdom. The above death-rate is also subject to an important modification, from the fact that several public institutions—and those too contributing a higher rate of mortality than the surrounding District—are situated within our boundaries. The following Table will illustrate this remark, and also show the proportion each Subdistrict bears in the total death-rate:— SUB-DISTRICTS. Estimated Population in the middle of Deaths. Ratio of Deaths to Population. Excluding Non- Pariabioners. who have Died in Public Institutions. 1875 1876 1875 1876 1875 1876 1876 Battersea 68,648 70,144 1,724 1,745 1 in 40 1 in 40 1 in 44 Wandsworth 22,524 23,109 420 461 1 in 53 1 in 50 1 in 65 Clapham 30,088 30,734 548 545 1 in 55 1 in 56 able ference. Streatham, Tooting, & Balham 16,340 16,781 237 260 1 in 69 1 in 64 Putney & Roehampton 10,693 10,990 167 143 1 in 64 1 in 77 The number of deaths to be thus excluded from the total mortality of the District was 272. The total deaths 7 therefore, with the above exclusions, were 2882, and the death-rate 18.7 per 1000. Of course the deaths of parishioners of the Parishes in which these institutions are situated and who died in these institutions should not be excluded from the total; but for such details see the Local Summaries for Battersea and Wandsworth. It will be seen that, as regards the first two parishes, the deaths in public institutions have greatly modified the death-rate, especially in Wandsworth, where such deaths constituted nearly a third of the deaths in rest of the parish. A comparative Table of the death-rates for six years will be found in the next paragraph. Births and Birth-rate.—During the year 5999 births occurred in the district, 3121 of males and 2878 of females. The birth-rate, according to the official population, is 39.04 per 1000, or about 1 in 25. The following Table shows the birth and death statistics for six years ending 1876— Year 1871 1872 1873 1874 1875 1876 Births 4380 4540 5053 5221 5529 5999 Birth-rate per 1000 34.5 34.4 36.4 36.5 37.3 39.5 Deaths 2867 2421 2580 2796 3096 3154 Death-rate per 1000 22.6 18.3 18.7 19.5 20.87 20.0 In the introductory report of the year 1875 page 7, a method of calculation is explained for obtaining the population and death-rate with much more accuracy than by the official method. It is admitted that a given population, under similar conditions, in a given time, produces a fixed and constant ratio of increase. Upon this law of natural increase, therefore, we have a basis on which to found our calculations; so that, from a given number of births, we may find the population that may be fairly supposed 8 to have produced that increase, and then of course calculate the death-rate from the population. Thus, in 1851 or in 1871, the birth-rate was 34 per 1000 (in round numbers), or about 1 in 29. The mean birth-rate for the decade 1861-71 was 33*25 per 1000, or 1 in 30. In all London it was 1 in 28. It will be seen how nearly these figures correspond, even at long intervals of time, and how safe a guide they form as to the population. Additional proof of this theory will be found in the above Table; for, in the short space of six years, the birth-rate commences with 34*5 and ends with 39 per 1000, while the number of births does not increase in the same proportion, showing conclusively that the rates are calculated on lower estimates of the population than there should be. That is, that the official population is not keeping abreast of the actual population. Taking, therefore, 97,720 as the mean population, and 3384 as the mean number of births during the decade 1861-71, it follows that the present population, instead of 153,648, should be 173,233, and the death-rate 18*2 instead of 20"5, or 16*6 excluding the deaths in public institutions, and the birth-rate 34*6 instead of 39.* Causes of Death.—In Table I. in the Appendix the causes of death, and the sex, age, and social position of the deceased, may be found for the entire district. As the object of a report such as the present, is not only to collate and comment upon sanitary and other pertinent facts of the year under review, but also to compare or contrast these with those of previous years, the following new Table 'has been introduced for the first time, with the view and hope of assisting such comparison or contrast. Such a Table, moreover, may be useful in tracing out the effect of sanitary legislation and other efforts in checking or preventing the occurrence of some diseases, especially those of an epidemic character. By making use of both of the Tables referred to, the reader will be better able to follow our remarks. * The excess of births over deaths during the year 1876 was 2845, giving a rate of natural increase of 18*5. 9 DISEASES. And other causes of Death 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 1876 Classes:— 1. Zymotic, Small Pox 34 24 2 21 15 377 26 9 5 3 26 Measles 102 18 35 52 46 52 86 55 66 27 88 Scarlatina 49 32 66 133 352 126 26 2 94 134 86 Diphtheria 22 8 27 14 12 6 26 11 12 28 15 Quinsy 1 1 1 ... 4 1 2 1 2 Croup 27 26 20 22 25 13 18 21 40 26 27 Whooping Cough 78 41 77 96 51 52 108 74 89 107 126 Typhus and other Fevers 61 44 66 61 68 54 52 65 48 39 47 Erysipelas 2 4 12 8 13 22 13 12 20 24 13 Metria, Childbirth 14 10 21 23 16 13 15 28 34 15 26 Carbuncle ... ... ... 2 ... 2 1 ... 1 ... ... Influenza ... ... 1 ... 1 ... ... ... ... ... ... Choleraic Disease 107 74 133 139 148 140 140 126 117 134 159 Totals of Zymotic Class 497 282 461 571 751 858 513 411 528 537 613 2. Tubercular 334 338 382 326 374 423 419 426 469 565 555 3. Of Brain, Nerves, &c. 277 306 339 353 365 371 341 370 426 455 416 4. Of the Heart, &c. 107 101 124 119 132 152 127 139 146 176 170 5. Of Respiratory Organs 334 316 285 396 411 431 400 543 541 630 561 6. Digestive Organs 74 76 89 93 104 118 87 96 111 136 126 7. Urinary Organs 21 29 25 40 39 20 27 34 26 55 62 8. Of Organs of Generation 23 24 17 13 8 16 9 17 21 13 23 9. Of Joints, Bones. &c. 15 8 10 6 4 5 7 10 14 11 14 10. Of Skin 14 11 7 6 3 2, 3 4 9 4 5 11. Premature Birth, Low Vitality, formation, &c. 129 149 154 176 191 145 143 143 168 177 226 12. Uncertain Seat 45 64 64 62 154 69 118 126 77 105 97 13. Age 106 125 107 114 133 125 105 144 106 130 150 14. Violence 60 56 52 64 50 56 87 70 75 68 90 15. Not Specified 30 52 52 54 40 76 35 47 79 34 46 Totals 2072 1937 2168 2393 2659 2867 2421 2580 2796 3096 3154 10 Epidemic Diseases.—The fatality from Measles and Scarlatina is high, especially that from the former, which is exceeded by only one year in the above series. Whooping Cough might almost be called a severe epidemic, so high has its mortality mounted during the past year. It has been approached by no other year in the series. The same, unfortunately, can be said of the fatality from Diarrhoea. It contributes the largest share to the Zymotic mortality of the year. But in point of importance we must concede the first place in the present year to the re-appearance amongst us of a Small Pox epidemic. The number which represents on our tables the mortality from this disease seems quite a modest figure; but it must be remembered that it is no criterion of the number of cases which occurred, or even of those of them that proved fatal. This of course is due to the fact as the cases appeared they were-as many and as soon as possible-sent to the hospital. In fact, the mortality which did occur in the District, is evidence that the hospital accommodation for the epidemic was miserably deficient. This is corroborated by the local summary for Clapham—where the largest number of fatal cases occurred—in which a strong complaint is made regarding the lack of hospital accommodation. When this epidemic first made its appearance, though its approach was expected, and its severity anticipated, no preparations were made in an energetic manner, or on an adequate scale. No one would assume the responsibility of the situation, or accept the onus of providing the means of isolation. It was made painfully evident that both our powers and our zeal were sadly restricted in dealing with the malady. But we have reason to complain that this scourge is still so strong in our land, and to lay a very heavy load of guilt at the doors of those who, in spite of overwhelming evidence, evade or resist the Yaccination Act, and lead other ignorant and misguided persons to follow their evil example. To such persons we can give a reason but not an intellect, and against such invoke the only instrument fitted to overcome unreasoning obstinacy—the law of the land. By the evasion of the Vaccination Act, as well as the too limited 11 employment of revaccination in adults, a virgin soil, so to speak, still exists for this disease to spring up and thrive. Hence we must be prepared to meet the outbreaks of Small Pox which consequently will continue to occur. We need a scheme which will expand to an unlimited extent, when occasion requires, and yet be no burden when the necessity for it has passed. The ordinary Hospital, with its buildings, stores, staff, &c., will not, except at great expense and loss, meet the case. The difficulty of procuring a site, isolated and yet reachable, of maintenance during the latency of the disease, of transit from distances, &c., all militate against the ordinary hospital system. Perhaps the cottage hospital in scattered districts, by being procurable at short notice, by diminishing the risk of conveyance, by confining the disease to each parish, and probably by not mixing different types of the epidemic under one roof, presents great advantages, and should claim careful consideration, and improved development. A point of great importance has been brought out during the present epidemic; viz., the necessity for providing for non-pauper cases. It is naturally a repugnant idea to an independent person, to undergo the degradation of being pauperized before being taken to the hospital. Another point is worthy of attention; viz., the powers at present possessed under the Public Health Act in regard to the compulsory removal of infectious cases. At present only in cases of overcrowding can such force be exercised, and then only after a tedious application to a local Justice, during which the time for action is lost and the mischief done. It seems no infringement of the spirit of our liberal constitution, if the law should give the local authority power to remove a case of infectious disease, if the patient's life would not be greatly endangered by such removal, whenever the health of neighbouring families or even of the same family is obviously imperilled. The following Table illustrates the relative position of 12 the different sub-districts as regards epidemic disease during the year 1876. SUB-DISTRICTS No. of Deaths from Epidemics per 1000 of the Estimated population. Ratio of Deaths from Epidemics to every 100 of the total deaths. Battersea 4.8 19.5 Clapham 2.8 18.3 Wandsworth 3.06 15.4 Putney 1.7 13.2 Streatham 1.8 11.9 We also refer the reader to Table IV. in the. Appendix for a comparison of the intensity of epidemic disease during the last eleven years. Non-Zymotic Diseases.—Diseases of the Respiratory System were the most fatal of the group, though less so than in 1875 and rather under the average of the previous ten years. Tubercular diseases stand next in point of fatality, and diseases of the Nervous System occupy the third place. The diseases grouped under the title of Premature Birth, &c., form a numerous and important class, and naturally lead up to the next paragraph. Mortality according to Age.—The infantile mortality from a medico-legal, as well as a sanitary standpoint, is a very important subject. No less than 43.3 percent of the total mortality occurred amongst infants. A similar ratio for the whole of London was 42.5, nearly 1 per cent. less than in our district. If we glance at our causes of death, it will be seen that Diarrhoea and Premature Birth, &c., are 13 among the chief causes of this infantile mortality. As we know that improper and insufficient food and clothing, as well as exposure to climatic changes, are the chief causes of the former disease, we protest strongly against the inhuman custom of leaving infants to the care of children, or in the hands of unprincipled persons, that their mothers may undertake the duties of wet nurses or hands in factories, &c., while the father is alive and in full work. Then as regards the latter group of diseases, we are well aware that most of the mortality is due to stupidity, neglect, or wilful misconduct; and medical men, in giving certificates of death, often feel they are encouraging vice and offending their own consciences. And yet, there is no help for it, for disease and neglect are oftentimes so indistinguishable that it would be impossible to bring a charge home to the culprits. The mortality among the very aged (80 and upwards) is high. It constitutes 3.48 per cent. of the total mortality (that of the whole city is 3.45.) The oldest person who died last year was within a year of being a centenarian, another died at 97, and a third at 95. Social Position of the Deceased.—This portion of the mortality table takes its colouring from the most populous of the Sub-districts. Hence the poorer classes are found to be more dominant in this than in several of the tables in our Local Summaries. Still, certain causes of death, such as old age, brain disease, and diseases of the digestive system, show their usual partiality for the better classes (proportionally, of course). Epidemic diseases are relatively more numerous among the superior classes than we could expect, considering their better chances of avoiding infection, exposure, &c. Sickness and Mortality among the Parochial Poor.— Table V. in the Appendix gives all the necessary statistics. The deaths are only 137 to 3157 cases treated, or 4.3 per cent., nearly 1 per cent. below the average ratio. 14 Inquests, &c.—During the year 137 inquests were held. The verdicts may be tabulated as follow:— I. Accidental 67 II. Natural 51 III. Suicidal 13 IV. Found dead 5 V. Murder 1 Unattested Deaths.— No less than 25 deaths were registered as "uncertified." 16 in Battersea, 7 in Wandsworth, and 2 in Streatham. Surely no method could be devised more calculated to diminish the protective power of registration and valuable nature of the vital statistics it gives, than the method of taking the crude notions of friends or the questionable authority of unskilled persons, to avoid and often evade an inquest. But it appears a matter of serious import when we find a death registered as "unknown" without any inquest having been held upon it; and we are compelled to ask if such discretionary power is given to the Coroner as to allow such an entry to be made, and, if so, to question the wisdom of such latitude. It seems almost incredible that so many deaths should be uncertified in a community, where not even the question of expense need stand in the way of having proper medical attendance and a legal certificate. Sanitation.—In Table VI. in the Appendix the sanitary labours of the year are represented in a tabulated manner; but it is needless to say that these figures can convey no adequate idea of the work accomplished, A general improvement has been made in all the branches of sanitary work. More houses, &c., have been inspected during the past year than during the previous years. A much larger number of cesspools have been abolished, and better drainage arrangements presumably made. There is increased activity in the removal of piggeries, and of refuse accumulations, as well as in the cleansing and 15 repair of dilapidated and unwholesome houses. In several parishes recourse had to be taken to legal proceedings in carrying out necessary improvements. But it is satisfactory to note that such appeals to force are year by year decreasing in frequency; evidence, we hope, that the public are accepting sanitary truths with a better grace than heretofore, and lending a more willing hand in bringing about the improvements which they suggest. A point of some importance is urged in the Local Summaries for Battersea regarding the control of the Board and its Officers upon the internal drainage arrangements of houses. It is highly desirable that extended power should be procured in inspecting the appliances for household drainage, and in enforcing necessary alterations. In connection with this subject we would give a word of warning to the public against the folly of having washing and other apparatus in various parts of the house connected with the sewer by means of waste pipes, as no amount of trapping can ensure these from admitting, in certain conditions of the atmosphere, most dangerous and noxious gases into their apartments. For the same reason we would also protest against the custom of connecting the overflow pipe from cisterns with the sewer, especially when the cistern is covered and there is no free access of air to the surface of the water. The Water Supply — In several of the Sub-districts, particularly Battersea and Clapham, strong representations have been made regarding the water supply. Some of the complaints have been unnecessarily directed against the Water Company; for it must ever be remembered, that the source of our supply is the grand cause for dissatisfaction. So long as our water is obtained from the Thames, no company can supply water good enough for dietetic purposes. It should also be remembered that cisterns, and other receptacles for the daily supply, are attended with many evils; and want of proper cleanliness is the source of a very large number of the complaints raised against the condition of the water. So far back as 1866, when 16 opinions were invited by the Metropolitan Board of Works on the system of water supply to the Metropolis, pertinent remarks were made in reply in the local summary for Wandsworth in our annual report of that year. As they convey in substance our opinions on the subject, and as they have an important bearing on the question at the present juncture, we venture to reprint them here entire. "I would most strongly urge upon your notice the great "sanitary and economic benefits which would result from "a constant supply, and the consequent removal of the "necessity which at present exists for the use of cisterns, "butts, and other objectionable receptacles. The following "conditions also require consideration. Water for domestic "use is required for two distinctand very different purposes: "the one for dietetic, and the other for general sanitary "purposes, including drainage. The first—as shewn by "abundant evidence of the evil influence of impure water "in the Cholera epidemic of 1854, and of the present year— "(1866) must of necessity be of the purest quality. The "requirements of the second would be fulfilled by ordinary "unfiltered river water, or by sea water, and could be "supplied in unlimited quantity for public baths, foun"tains, the cleansing of streets, drainage, and all other "sanitary purposes. Under the present system the great "bulk of the water which has been purified by filtration "for drinking use, and representing much money, is lost "in being used for all other purposes than that for which "the expensive process of filtration is employed. As it is "necessary for the Water Companies to economise such "expensive water to the utmost, the result is a necessity "for storage—in itself an unnecessary and expensive evil "to the consumer—and a stint in the general supply, "even to an insufficiency, for the purpose of drainage. "Looking to these conditions, it becomes a matter for "consideration whether a sufficient supply of the purest "water for drinking use only, could not be obtained from "the chalk strata by Artesian borings, the general supply "for drainage, and all other sanitary purposes being fur"nished by ordinary river water, or by sea water. In 17 "the employment of such a system of distribution, a "necessity would exist for a double system of pipes, but "the expense of these would be amply compensated for "by the removal of the entire cost of filtration. This "District could be easily and economically supplied in the "manner here indicated." But, as regards the present supply, we have reason to complain that filtration has not been carried out as it ought. The filter beds have been improperly constructed, and the water has been taken constantly from the river, in whatever condition it happened to be, and poured on the filtering surfaces without any subsidence of the heavier particles. At certain seasons, according to the evidence of Col. Bolton, the Water Examiner to the Government, a vegetable fungus has grown rapidly on the surface of the bed, and formed an impervious coating, through which no water whatever has passed. In such extremities the Company has been tempted to pass into the mains water which has never been filtered at all. Then, no attempt has, as yet, been made by the Vauxhall Company to carry out the Act of Parliament by providing a constant service of water, and so taking away the necessity for the objectionable cistern system. All these are serious and just causes of complaint against the Company. In the meantime, we would strongly suggest the adoption, into the New Public Health Bill, of a clause providing for the proper inspection and control of cisterns by the Officer of the Board. We would also suggest the immediate amendment of the law regulating the power of the Government Water Examiner, by giving him authority to stipulate for quantity as well as quality of the Metropolitan water supply. This singular omission of the legislature has been noticed in the local summary for Battersea, and is a subject of the utmost importance, as several parishes have found to their cost. b 18 We would suggest the following indications to the Company, in the improvement of their water supply:— I. The proper management of efficiently constructed filter-beds. II. The construction of reservoirs capable of holding several days' supply, for the purpose— 1. Of allowing of the subsidence of the heavier portions of the mechanicallysuspended matter. 2. Of allowing of the intake being closed against the reception of water in a time of flood, when the water is in a particularly foul and unsuitable condition. III. The establishment of a constant service of water according to the Act providing for the same. For all matters of less general and more local interest, we refer the reader to the local summaries; and, in concluding our introductory remarks, we venture to express the hope that the success which has hitherto attended the operations of your Board may continue to reward its future efforts to secure the sanitary welfare of the Wandsworth District. LOCAL SUMMARIES. B 2 20 WANDSWORTH. The following Statistics, derived as usual from an analysis of the Registrar-General's Returns and the Public Records of sickness and mortality, will be found on examination to furnish satisfactory evidence that the health of this Sub-district during the year 1876, although it did not attain the exceptionally high position of the year preceding, was in a very favorable state. VITAL STATISTICS. Population.—The mean population living during the past year, estimated on the assumption that the same rate of increase had prevailed since the period of the last census as that which obtained during the preceding ten years, was 23,169. Mortality.—The total deaths registered during the year numbered 461; 247 were of males and 214 of females. 115 of the number took place in the following public institutions; viz., in the Surrey County Lunatic Asylum, 94; in St. Peter's Hospital, 4; in the House of Correction 4; in the Hospital for Incurables, 12; and 1 in the Royal Patriotic Asylum for Girls. In addition to the deaths recorded on the register 21 deaths of Wandsworth parishioners occurred in the Infirmary of the Union; these it is 21 necessary to take into account in the determination of the death-rate. Death-Rate.—Calculated from the number of deaths registered and the foregoing estimate of the population, the death-rate was 19.89 per 1000 persons living on an average during the year. But, as explained in previous reports, this rate so determined is inclusive of the mortality of the Surrey County Lunatic Asylum, St. Peter's Hospital and the Hospital for Incurables, the inmates of which institutions are derived, with a fractional exception, from without the parish, undergo no natural increase, and are subject to a high mortality; they moreover contribute such a large proportion of the deaths, amounting last year to nearly a fourth part, that a calculation so derived must be entirely worthless. It becomes necessary, therefore, in order to arrive at the natural death-rate of the Sub-district, to eliminate from the calculation the population and mortality of the above named institutions, and, for greater accuracy, to add to it the deaths of the Wandsworth parishioners who died in the Infirmary of the Union during the year. Thus determined, after correction made in the manner indicated, the death-rate of the past year was 16.73 per 1000 of the inhabitants. This rate, although upwards of 1 per 1000 higher than that of last year, is still somewhat below that of rural districts. Birth-Rate.—The births numbered 679; 373 of males and 306 of females, representing a rate, calculated on the foregoing estimate of the population, of 30.53 per 1000 persons living of all ages. The rate of natural increase was 13.80 per 1000. The following Table contains a summary of all the causes of death arranged in accordance with the classification of the Registrar-General, shewing the sex, social position and age at death at different periods, and particularizing the several diseases of the Zymotic class:— 22 STATISTICS OF MORTALITY. WANDSWORTH. Population in 1871—19,783. Estimated population in middle of 1876—23,169. Area in Acres—2,478. Total Deaths from each Class of Disease, &c., in the Sub-District Sex Age Social Position Males Females Under 1 year From 1 to 5 years From 5 to 10 years Under 20 years, including all under 10 years At 20, and under 40 years of age At 40, and under 60 years of age At 60, and under 80 years of age 80 years and upwards Nobility and Gentry Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes DISEASES, And other causes of Death. Diseases Classified. Classes :— 1. Zymotic Small Pox 1 ... 1 ... ... ... 1 ... ... ... ... ... ... 1 ... Measles 17 10 7 2 15 ... 17 ... ... ... ... 1 ... ... 17 Scarlatina 12 7 5 ... 6 5 11 1 ... ... ... ... ... ... 11 Diphtheria 1 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 3 1 2 ... 3 ... 3 ... ... ... ... ... ... ... 3 Whooping Cough 10 5 5 4 4 2 10 ... ... ... ... ... ... 1 9 Typhus & Infantile Fever 12 7 5 ... 4 1 7 4 ... ... ... ... ... 2 10 Erysipelas 2 1 1 1 ... ... 1 1 ... ... ... ... ... 1 1 Metria, Childbirth 4 ... 4 ... ... ... ... 4 ... ... ... ... 1 3 ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Dysentery 16 12 4 8 3 ... 11 ... 4 1 ... ... 4 3 9 Cholera 2 2 ... 1 1 ... 2 ... ... ... ... ... ... ... 2 Totals of Zymotic Class 80 46 34 16 36 8 64 10 5 1 ... 1 5 11 63 2. Tubercular 64 34 30 12 8 1 28 19 13 4 ... 2 3 8 51 3. Of Brain, Nerves, &c 125 72 53 13 6 2 28 21 41 35 ... 5 8 15 97 4. Of the Heart, &c. 26 9 17 ... ... ... 1 5 6 13 1 1 4 11 10 5. Of Respiratory gans 58 33 35 18 8 ... 26 2 12 17 1 3 1 8 46 6. Digestive Organs 29 10 19 8 1 1 11 3 9 5 1 1 4 6 18 7. Urinary Organs 6 5 1 ... ... ... ... 2 ... 4 ... ... 1 2 3 8. Of Organs of Gene ration 2 ... 2 ... ... ... ... 1 ... 1 ... ... 1 ... 1 9. Of Joints Bones, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Malformation,&c. 22 14 8 22 ... ... 22 ... ... ... ... ... ... 4 18 12. Of Uncertain Seat 18 6 12 1 ... ... 1 2 5 10 ... 2 2 4 10 13. Age 16 6 10 ... ... ... ... ... ... 9 7 3 1 4 8 14. Violence 14 11 3 1 4 3 9 3 2 ... ... ... ... 1 13 15. Not Specified 1 1 ... 1 ... ... 1 ... ... ... ... ... ... ... 1 Totals 461 247 214 92 63 15 191 68 93 99 10 18 30 74 339 23 On reference to the Table it is seen that Class 3, comprising Diseases of the Brain and Nervous System, presents by far the largest share in the causation of mortality, forming over 27 per cent of the whole. But, as might be anticipated from the remarks already made concerning the death-rate, this class is unduly augmented by the deaths in the Surrey County Lunatic Asylum, which during the past year contributed about three-fourths of its total amount. Of other Diseases, Class 1., the Zymotic (Epidemic-Endemic-Contagious) took precedence as usual, forming considerably upwards of 17 per cent, of all deaths. Next in order of fatality was Class 2, the Tubercular, which includes Scrofula and Consumption, contributing 14 per cent, (nearly). Diseases of the Organs of Respiration, Class 5, furnished 12g per cent., or upwards of half as much again as the average, Class 4 (Diseases of the Heart). Class 11, (Premature Birth, Low Vitality, &c.,) and Class 14,(Violence, &c.,) considerably exceeded the usual amount. Consumption was, as usual, the most fatal single disease, forming nearly 8½ per cent, of all deaths, but Bronchitis was attended with little short of the same fatality. The other classes present no variation from the average of sufficient importance to require notice. Age at Death.—Upwards of 22 per cent, of all deaths occurred to infants under the first year of age; more than 33½ per cent, were of children under 5 years of age; and upwards of 41 per cent, of persons under 20 years of age. These numbers are each somewhat higher than those of the preceding year. 16 deaths are recorded as the result of old age unconnected with disease, but no less than 58, or nearly one-eighth part of all deaths, occurred above the age of 70: viz., from 70-75, twenty-six; 75-80, twentytwo ; 80-85, five; three at 88 ; one at 89 ; and one at 95. Social Position. — 73½ per cent. of all deaths, and upwards of 78 per cent, of deaths from Zymotic diseases, took place amongst the labouring classes; the latter amount closely corresponding with the average. 24 Inquests, Violent Deaths, dc. - There were 25 inquests held during the year, with the following results: viz., Deaths from Natural Causes 11 Accident 11 Deaths from Violence Suicide 1 Cause Unknown 2 In 7 instances the cause of death was not certified by medical testimony, in each of which, it is scarcely necessary to observe, death may have resulted from other than natural causes. The intervention of a medical enquiry in every case of death, the cause of which has not been certified by medical testimony, is so obvious a necessity in the interests of society, that it ought to be invariably secured. (See last year's and previous Reports on the subject.) 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 Whooping'Cough Fever—Typhus and Typhoid Total Deaths From Epidemics Total Deaths from all causes Per centage of deaths from Epidemics to deaths from all causes Cholera Diarrhœa 1866 3 23 10 2 5 7 18 5 73 351 20.7 1867 3 1 7 1 6 1 7 7 33 332 9.9 1868 ... 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 62 453 11.5 1875 1 2 5 2 14 ... 17 5 46 420 10.9 1876 1 17 12 1 10 2 16 12 71 461 15.4 25 The total number of deaths which resulted from these diseases during the past year exceeded the average by a fourteenth part (nearly). This excess is seen on reference to the Table to have been due to the occurrence of a greater fatality from Fever, Scarlatina, and Measles, but chiefly from . the last named disease, the fatality from which exceeded the average of the preceding ten years by about one-third; and was the most fatal of the Diseases in the Table. The proportion, however, which this class of diseases bore to the deaths from all causes was somewhat lower (0.78 per cent.) than the average of the preceding ten years; although it was higher by about one-third than that of the year 1875, which, it will be remembered, was exceptionally free from Epidemics. Next to Measles Diarrhœa was the most fatal of these diseases. Fever (Typhus and Typhoid) and Scarlatina were of equal fatality; the latter having been slightly above, and the former more than double, the decennial average. former more than double, the decennial average. The following Table exhibits the months in which these diseases were attended with fatal results:— DISEASE. January February March April May June July August September October November December Small Pox ... ... ... ... ... ... ... ... ... ... ... 1 Measles ... ... ... ... ... 2 3 4 1 3 2 2 Scarlatina 2 ... 1 ... ... ... 3 1 ... 2 1 2 Diphtheria 1 ... ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... 1 4 2 2 ... 1 ... ... ... Diarrhœa 2 ... ... ... ... 1 5 7 2 ... ... 1 Fever 2 ... ... ... ... 2 1 2 2 2 1 ... Totals 7 ... 1 1 4 7 14 14 6 7 4 6 from which it is seen that by far the greater number of deaths occurred in the latter six months of the year, and 26 that the number in the autumn quarter was twice that in the winter quarter. Inasmuch as it is against Epidemic diseases—long since declared to be preventible—that the projection of sanitary measures are susceptible of greatest success, it becomes a matter of the deepest moment to ensure the employment of those means for the arrest of their propagation which are at once the most simple, the most effectual, and the most capable of the widest application. Such means are most completely presented by "Isolation" —the separation of the sick from the healthy. But as yet isolation is carried out to a very limited extent. It is of late years only that its application has been partially directed to Fever and Small Pox, very slightly to Scarlatina, and only when occurring in the adult, while no attempt has been made to bring Measles within its operation; yet, from an examination of the relative figures in the Table as regards fatality, it is obvious that the last named disease claims as much consideration at the hands of the sanitarian as any other of the eruptive fevers, unless it be unjustifiably held that the security of infantile life is of less importance to Society and the State than that of adult life. By sanitary proceedings of a general nature these diseases are doubtless much lessened in amount and mitigated in intensity; but if their periodic recurrence is to be successfully grappled with and prevented, it is evident that a more complete system of isolation must be employed than the very partial and limited one now in use. Such considerations forcibly indicate the want of arrangements for the treatment of all diseases of the epidemic class in the local hospitals. Sickness and Mortality amongst the Parochial Poor. —Table V., in the Appendix, exhibits, as usual, the amount, nature, and fatality, of the sickness which prevailed amongst the parochial poor during the year. The data furnished by the figures in the Table will be found to be in a marked manner confirmatory of the indications of 27 the health of the Sub-district derived from the statistics of the death register. The amount of sickness was greater than that of the year previous, but very considerably less than the average of the preceding ten years. The mortality was 4.46 per cent, of the cases treated, which is much higher than the average (3.32 per cent). The amount of Epidemic disease formed 16.7 per cent, of all cases of sickness, and although higher than that of the year previous, it was much less than the decennial average. Small Pox, which was very prevalent in some parts of the District, but very slightly affected this parish; as is seen in the Table, there were but 7 cases, and these were unattended with fatality. Amount of General Sickness.—In the absence of any records available for the purpose, the amount of sickness which has prevailed generally throughout the Sub-district cannot of course be absolutely determined; but it may be approximately arrived at with sufficient accuracy for the purpose of making comparison with a similar calculation of previous years. Thus, estimated on the assumption that the proportion borne by the number of deaths to the cases of sickness occurring amongst the parochial poor, represents the proportion borne by the deaths to the cases of sickness amongst all classes, the amount of sickness which prevailed generally could not have affected less than 44 per cent, of the population. Such amount will be found to be somewhat less than the average. Sanitary Proceedings.—In Table VI., Appendix, is contained a summary of the sanitary proceedings which were carried out during the year. A very much larger amount than usual of work of this kind will be found there recorded in comparison with that contained in the reports of previous years, especially as regards the inspection of and the cleansing and purification of unwholesome houses, and the removal of nuisances; and it is satisfactory to observe that all these operations were conducted without any necessity for the intervention of the law for their 28 enforcement. In addition to the proceedings so tabulated, all the Cow-houses and Slaughter-houses in the Sub-district were examined and reported on; and the conditions of the latter were such as to need no opposition to a renewal of their owners' licenses. Some sanitary defects formed the subjects of special reports, and several nuisances, which it is not necessary to particularise. The most important of the former related to the condition of the Waterside-houses. These were examined and reported on, it having been contemplated, in consequence of their dilapidated state, to deal with them under the provisions of the "Artisans' Dwellings Act." Eventually, however, such intention was not proceeded with. I have, as before, furnished your Surveyor with a tabulated list of the localities in which deaths from Epidemic diseases have occurred during the year, for guidance in the removal of any sanitary defects which may have been associated with the occurrence of those diseases. Tn conclusion, the inhabitants may be fairly congratulated on the health and sanitary condition of this Subdistrict during the past year. GEORGE EDWARD NICHOLAS, M.D., Medical Officer of Health for Wandsworth. June, 1877. 29 BATTERSEA. The total number of Births registered in the whole of this rapidly increasing Parish during the year 1876 was 3455. The official mean population of the Registrar General, which is admittedly too low, is 72,235; which would give an estimated annual birth rate of 48 per thousand. This is equally too high, and it is therefore evident that a larger population is being dealt with than can be assumed by the ordinary methods. If the normal birth-rate in Battersea which has been found to exist during the years in which the census has been taken, be accepted as the true birth-rate, we get an estimated mean population for the year 1876 of 82,434; a number which may be assumed to be nearly the correct one. In a like manner the official mean population gives a death-rate of 24 per thousand, which, it is unnecessary to observe, after the foregoing explanations, is far greater than is really the case in this parish. The estimated mean population, derived from the number of births, would give an estimated death-rate for the whole parish, including all deaths in 'public institutions, of 21 per thousand per annum. It will be observed that this is somewhat higher than the death-rates given in the reports relating to the Eastern and Western Sub-districts of the Parish, the difference being occasioned by the numerous persons dying in public institutions; the majority of whom had no previous residence in the Parish. Sanitary operations during the year 1876 in the Parish generally.—The Sanitary work of the past year has been of a very important and varied character, as will be seen on reference to Table VI., and the Medical Officers of Health for both the Sub-districts have been so frequently directed to inspect and report upon various alleged 30 ances and other matters conjointly, that this resume has been made to comprehend the operations of both Subdistricts. The number of houses in Table VI. recorded to have been inspected during the year was 3357. In many of these houses infectious disease had been present, and disinfection by means of fumigation, and antiseptic chemical agents, was effectively applied, and the recurrence of similar disease has not, as far as we have been informed, taken place in any instance. By these inspections many nuisances have been discovered, most of them having direct relation to defective drainage within the walls of dwellings. 359 1st notices were served and the majority attended to by the owners or occupiers of the premises. In 18 instances 2nd notices had to be served before the necessary repairs or alterations were executed. In reference to this subject numerous investigations have convincingly demonstrated the great necessity that exists for the extension of the control of the Board and its officers over the laying and construction of the drainage of houses within the walls as well as without. In nearly every complaint of nuisance the house drains have been the channel by which the offensive matter complained of gained admission; and the record of any great outbreak of Zymotic disease suggests that the disease has been frequently conveyed from house to house by the same means. It is imperatively necessary for the Public safety that all house drains should be well and efficiently trapped, that the joints should be effectively made with proper material, that a concrete foundation for the drains should be made through the basement, to prevent sinking and consequent leakage—which has many times in this parish been the cause of an immensity of illness a,nd many deaths—and last, but certainly not least in importance; the drain pipes should in all cases be continued, of the same calibre, to the roof of the house, or, still better, some two feet above it. These precautions, 31 which cannot now be enforced in the present state of the law, are necessary to make our present system of sewers not only efficient, but safe. It should not be forgotten that the lamentable outbreak on St. John's Hill, some two years ago, affecting as it did some hundreds of persons in a single night, and causing the loss of several valuable lives, would not and could not have occurred if the above measures had been adopted. The usual water seal in traps of house drains is liable to get out of order in many ways, the most frequent of which is back pressure of sewer gases when a heavy fall of rain occurs; in which circumstances, and under the present arrangements, a sudden flooding of the main sewers takes place and their gaseous contents are forced through the thin water seal of the ordinary water closets with the greatest facility. It is obvious that if the drain pipes were carried to the top of each house any back pressure of gas would not be able to find its way into that house. There is no doubt that legislation giving the Board control over the manner in which house drains are laid throughout their whole length would be of the greatest possible value, as numerous cases have occurred in this parish where the cause of death has been distinctly traced to the influx of sewer gases by these channels. This matter is one that should be brought to the front in any future legislation on the subject. Thanks in great measure to the members of the Anti-Vaccination League, and other foolish persons possessing a defective knowledge of the real effects of vaccination, and an ever ready belief in absurd and unreliable statements as to alleged subsequent outbreaks of disease, following and occasioned by this, the most beneficent discovery ever vouchsafed to the human race, another outbreak of Small Pox throughout the metropolis generally has to be reported. In this parish the deaths to the end of the year were 10, none of which were of unvaccinated children born in this parish; the two cases under 10 years of age which succumbed to the disease having been born elsewhere. 32 It will be seen upon reference to Table Y. that 84 cases of Small Pox carne under the care of the District Medical Officers; the majority within the last 3 months of the year. Every case where practicable was removed to one of the Small Pox Hospitals, at the earliest possible moment, the houses and apartments disinfected, and the rest of their inhabitants re vaccinated in those cases where they could be induced to consent thereto. When it is recorded by competent authorities that within the last few centuries the death-rate was about twice the present rate in the metropolis, and that one half of these deaths were caused by Small Pox, we are inevitably compelled to the conclusion that the mortality from Small Pox was then equal to the whole number of deaths from all causes at the present time. Nothing except vaccination and re-vaccination is known which is effectual as a preventitive to this disease; and its protective powers are shewn by the fact that during the present outbreak of the disease the majority of those who recovered had been vaccinated in early life; while those who died were either unvaccinated infants or adults in whom the protection afforded by primary vaccination, in many cases perhaps insufficient at the first in number of vesicles, had to a certain extent become exhausted by the changes which take place in the system during and after puberty, when in all cases re-vaccination should be performed—as is evidenced by the statements made by the Medical Superintendents in the Official Reports of the Small Pox Hospitals, that no case of Small Pox had been admitted into those institutions where undoubtedly successful re-vaccination has been performed,—and did we indeed need further proof of its efficiency, we have only to refer to the fact that ever since the establishment of special hospitals for the reception of patients suffering from this disease, a period of about 40 years, during which every official and servant has been re-vaccinated on joining the institution, in no instance, although in almost constant 33 contact with patients suffering from Small Pox in its worst forms, has any one of these persons taken the disease, with two significant exceptions, in which two nurses, who in the hurry consequent upon a sudden outbreak of the disease were allowed to enter upon their duties in the wards without this protective operation having been performed, and in each case a very severe attack of the disease occurred. The following Table shews the result of the Vaccination Officer's work in the parish during the year, and the small number left unaccounted for, viz., 5 out of a total of 3459, reflects the highest credit upon the manner iu which the duties devolving upon him have been carried out. MONTHS. Births registered during 1876 Successfully Vaccinated Insusceptible Had Small Pox Died Unvaccinated Postponed by Medical certificate Removed to places unknown Not accounted for January to June 1757 1484 9 ... 164 15 80 5 July to December 1702 1463 3 1 156 12 67 ... Totals 3459 2947 12 1 320 27 147 5 Water Supply.—The water supply has been the cause of many complaints, both as to the quantity and as to the quality of this absolutely necessary element. The parish is supplied by the Southwark and Yauxhall Water Company, and for many years past the public generally have complained of the defective and irregular nature of that supply. Other parishes have complained still more loudly than in our case,—notably the parish of Bermondsey some years since, when the so-called water famine occurred in that locality. By some strange inadvertence on the part of the legislature the water examiner has no control over the quantity, but merely over the quality, of the water supplied to the ratepayers. c 34 It is but just to say that, during the latter part of year under report, a much better supply of water was given than had ever been the case before, as far as quantity was concerned; but the quality, as evidenced by Dr. Frankland's reports to the Registrar General, was amongst the worst given by any of the Metropolitan Water Companies drawing their supply from the Thames, and was indeed in many respects almost identical with that from the river at the intake near Hampton, which is the source of supply. At the same time it was not sufficiently bad to have been taken from the Thames at Battersea—as was formerly proved to have occurred; that source of supply having been effectively cut off under Captain Tyler's directions some years since. The importance of a good supply of pure water cannot be overrated, as it is an undoubted fact that many diseases of a Zymotic nature can be and are readily conveyed by this medium. We cannot too strongly insist upon the duty of all concerned to provide water as free from organic impurities as possible, which, whilst the only available source of supply at present time is the Thames,— which receives above the intake of the Water Company the sewage of many towns, as well as the land water in time of flood, bringing with it decomposing organic matters,— is only to be obtained by preventing the drainage of the towns above the intake finding its way into the river; by impounding reservoirs having sufficient capacity for several weeks' supply, so as to obviate the necessity for the admission of the river water in times of flood; and further, by a careful and efficient method of filtration; as well as a more frequent cleansing of filters and of the filtering medium. During the year under report 149 houses and water closets were supplied with water for the first time as the result of house to house inspection. 35 During the year matters of serious moment in connection with the various factories in the parish have claimed our constant attention; the most notable of these being Messrs. Wallace's Chemical Works in the New Road; and the Alum and Ammonia Company's premises in the Lombard Road. As legal proceedings are still pending in connection with nuisances alleged to exist at both these works it would obviously be improper of us to offer any observations referring to them in this report. We therefore defer them to a future occasion. Further information relative to the sanitary condition of our respective Sub-districts will be found in the following pages. W. H, KEMPSTER, JOSEPH OAKMAN, Medical Officers of Health for East and West Battersea. C 2 36 BATTERSEA EAST. The greater the interval of time which has elapsed between the preceding census and the year under report, the greater becomes the difficulty of determining the real population of this important Sub-district, which increases in a probably accelerated ratio. The official mean population of Eastern Battersea for the year 1876 is 36,567, but, as has been shown in former reports, this is undoubtedly far below the real number; the birth-rate would be, if this estimate were accepted as correct, 53.8 per thousand per annum, a perfectly preposterous rate, the birth-rate for the metropolis being only 36.5 per thousand during the year. It is therefore necessary to use an estimated mean population, and as the birth rate in Eastern Battersea has, with remarkable uniformity, remained at 42 per thousand, an estimated mean population of 46,857 for the middle of the year 1876 has been deduced from the 1968 births registered, which is probably almost absolutely correct. The natural increase of population, arrived at by deducting the 893 deaths from the 1968 births registered 37 during the year, was 1075, which is by far the largest number recorded in the Sub-district, and by its increase on the number of the year 1875, viz., 842, shews that a large amount of immigration of persons of child-bearing age has taken place. There is no doubt that to immigration is chiefly due the estimated increase of population of 4799 during the year. Mortality.—The total number of deaths registered from all causes in the Eastern division of the parish of Battersea during the year 1876, was 893. Of these 463 were males and 430 females. The number registered in 1875 was 867; the increase in the number of deaths is only 26, while, as will be shown elsewhere, the births have increased 259. Taking the estimated mean population as the real population, the death-rate for the year would be 19 per thousand persons living. The death-rate for all London in 1876 was 22.3 per thousand. It is but proper to state that the official mean population, which should not be applied to rapidly-increasing communities like our own, would give 24.3 per thousand as the annual mortality, but its inapplicability will be evident from the foregoing considerations. The usual statistics of mortality are here appended in the usual form, presenting at a glance the sex, age, social position, and the total numbers of persons dying during the year under consideration, of the various diseases therein set forth. 38 STATISTICS OF MORTALITY. BATTERSEA EAST. Population, June, 1875— 34,826. Estimated mean population, 1876—36,567. Area in Acres 1235. Total Deaths from each Class of Disease, etc., 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 SO years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle & Trading Class, Shopmen, Clerks, &c. Industrial and Laboring ClnBsee. Classes:— 1. Zymotic Small Pox. 7 3 4 ... 1 1 ... 2 3 1 1 ... ... ... ... 7 Measles 20 11 9 6 11 3 ... 20 ... ... ... ... ... 2 1 17 Scarlatina. 34 20 14 3 22 7 2 34 ... ... ... ... ... ... 4 30 Diphtheria. 3 1 2 ... 3 ... ... 3 ... ... ... ... ... 1 ... 2 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 11 6 5 1 9 1 ... 11 ... ... ... ... ... ... ... 11 Whooping Cough 53 31 22 19 34 ... ... 53 ... ... ... ... ... 4 3 46 Typhus, &c. 6 2 4 2 ... 2 1 5 ... 1 ... ... ... 1 ... 5 Erysipelas. 2 2 ••• 2 ... ... ... 2 ... ... ... ... ... 1 1 ... Metria, Childbirth 10 ... 10 ... ... ... ... 7 3 ... ... ... ... 2 8 Carbuncle. ... ... ... ... ... ... ... ... ... ... ••• ... ... ... ... ... Influenza ... • •• ••• ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœ & Cholera 60 27 33 53 4 ... ... 57 ... 1 1 1 ... 3 8 49 Totals of Zymotic Class 206 103 103 86 84 14 3 187 10 6 2 1 ... 12 19 175 2. Tubercular 205 121 84 81 37 6 9 133 40 29 3 ... 3 10 14 178 3. Of Brain,Nerves, &c. 67 34 33 20 14 5 ... 39 4 10 12 2 2 2 8 55 4. Of the Heart, &c. 36 16 20 ... 3 1 2 6 7 11 11 1 ... 4 5 27 5. Of Respiratory Organs 189 86 103 61 65 8 2 126 13 24 25 1 2 6 17 164 6. Of Digestive Organs 35 20 15 6 1 ... ... 7 14 4 10 ... ... 2 8 25 7. Of Urinary Organs. 16 5 11 ... 2 1 2 5 2 4 5 ... 1 ... 2 13 8. Of Organs of Generation 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 9. Of Joints, Bones, &c. 4 3 1 ... 2 ... 1 3 ... ••• 1 ... ... ... ... 4 10. Of Skin ... ... ... ••• ... ••• ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Malformation, &c. 66 39 27 66 ... ... ... 66 ... ... ... ... ... 1 8 57 12. Of Uncertain Seat 14 7 7 4 ... ... ... 4 3 4 3 ... ... 1 ... 13 13. Age 13 2 11 ... ... ... ... ... ... ... 9 4 ... ... 1 12 14. Violence 32 25 7 7 3 1 8 19 6 4 3 ... ... 2 1 29 15. Not Specified 9 3 6 4 1 1 ... 6 1 1 1 ... ... ... 2 7 Totals 893 465 428 335 202 37 27 601 100 97 86 9 8 40 85 760 39 Ages at Death.—The deaths under 1 year of age were 335 out of a total of 893 deaths, or 37 per cent., being very much the same as for 3 years past, with the exception of last year, when it was 34 per cent. It must, however, be mentioned that the law has lately been made more stringent on the subject of death-certificates, and great numbers of newly-born children, which may have survived but a few hours, or even minutes, are now registered, which were formerly interred as still-born children, mainly with the object of saving the interment fees. In this way the number certified as having died from " Premature Birth, Low Vitality, &c.," increased from 32 in 1875 to 66 in 1876. Between 1 and 5 years 202 deaths were registered, being 25 less than the previous year. Altogether under 5 years of age 537 deaths were registered, or 54 per cent, of the total mortality, the percentage being 60 for the last two years, and this, despite the increased registration of deaths of newly-born infants; so that there seems to be some reason to hope that the appalling mortality amongst very young children, so frequently adverted to in former reports, is at last showing symptoms of diminution. Nine persons have died above 80 years of age in the Sub-district during the year. Social Position.—The rank or position in life of the deceased persons is given in this Table, together with the per centage each class bears to the others and the total. = per cent. Nobility and Gentry 8 .9 Professional Class 40 4.5 Middle and Trading Class 85 9.5 Industrial and Labouring Class 760 85.1 Total 893 100.0 which varies but slightly from the averages of former years. 40 Zymotic or Epidemic Diseases.—The mortality from these, the so-called preventible diseases, during the year was 206, as contrasted with 196 during 1875. The numbers for either year are given in the following table for the purpose of comparison. The increased population is more than equal to the increased numbers. 1876. 1875. Diarrhoea (and Cholera) 60 44 Whooping Cough 53 42 Scarlatina 34 55 Measles 20 9 Croup 11 13 Diseases of Childbirth 10 4 Small Pox 7 0 Fevers 6 16 Diphtheria 3 6 Erysipelas 2 7 Totals 206 196 Twenty-three per cent, (or precisely the same proportion as last year) of the total number of deaths in the sub-district were recorded by the Registrar as the result of this class of disease. Reviewing the diseases of this class as they occur in the table, it will be seen that Diarrhœa heads the list, 60 deaths being ascribed to this cause against 44 in 1875. The prolonged and excessive heat of the summer months was the direct cause of this increase, without doubt. Whooping Cough was again very prevalent, 53 deaths against 42 in the preceding year. Scarlatina, one of the most malignant and infectious of this class of diseases, was the cause of death in 34 instances against 55. This disease is peculiar in leaving a train of diseases behind it in those who escape death, and its diminished frequency is, 41 fore, matter for congratulation. Measles was very prevalent, and caused death in 20 instances. Croup was fatal in 11 cases. Diseases incidental to Childbirth caused the death of 10 women ; when it is, however, remembered that 1968 children were born, it will be apparent that the maternal mortality was only about one-half, or .5 per cent., a very low rate of puerperal mortality; at the same time much higher than during 1875, when but 4 deaths occurred from this cause. Small Pox again made its appearance in the Sub-district, and up to the last day of the year 10 deaths were registered. The number of deaths does not, however, by any means represent the number of persons afflicted by this, the most loathsome of all the Zymotic class of diseases Many persons were removed to the Small Pox Hospital, of whom several died. The District Medical Relief Book shows (vide Table V.) that 59 persons were attended amongst the parish poor alone suffering from this disease up to Dec. 31, of whom 1 died. The number of deaths from Fever diminish year by year in this Sub-district, and but 6 are recorded during 1876 against 16 in 1875. Diphtheria caused death in 3 cases and Erysipelas in 2, contrasted by 6 and 7 respectively in 1875. Other diseases.—Tubercular diseases, as Pulmonary Phthisis, Water on the Brain and Infantile wasting; invariably cause the majority of deaths, and during this year their fatality included 205 cases, contrasting with 197 in 1875. Diseases of the Respiratory Organs caused 189 deaths as against 196 last year. From diseases of the Brain and Nerves 67 deaths were recorded. 100 was the number during each of the two preceding years. 42 From Premature Birth 66 cases were registered against 32. Diseases of the Heart appear as the cause of 36 deaths and diseases of the Digestive Organs for 35. Thirty-two deaths were recorded as arising from Violence, particulars will be found under the head of Inquests. Births. —The births registered in the Sub-district during the year 1876 were males 1001, females 967; total 1968. The number during 1875, 1709 births registered, being an increase of 259 births. Vacchiation.—During the year the Register of Public Vaccination shews the following results:— Successful Primary Vaccinations 1133 J „ Re-Vaccinations 140 Total 1273 These are of course in addition to the operations performed by private medical practitioners. It may be said that very few children escape vaccination in this Sub-district, as the Vaccination Officer discharges his duties in an effective manner. No death from Small-Pox has occurred in any child born in this parish, all the fatal cases occurring in un-vaccinated children born elsewhere. Inquests.—The Coroner has held inquiry into the cause of death in 50 cases during the year. Of these 18 arose from natural causes, the other 32 were the results of violence. The findings of the Jury are tabulated below. Natural Deaths. (Heart Disease 5) 18 Accidental do.— Asphyxia (5 Infants overlaid) 8 Drowned (2 Suicide) 16 Killed on Railway 3 Scald 1, Fall 1, Poison 1 3 Suicide—Cut Throat 1, Hanging 1 2 50 43 Of the so-called natural deaths two arose from excessive drinking, Uncertified Deaths.—Sixteen cases of death, registered without medical certificate or inquest, occurred during the year. The majority are said to have died from Convulsions, 8; Natural Causes, such as Consumption or Diarrhoea, 7; and in one case the cause of death is said to be unknown. This condition of matters is very unsatisfactory indeed; the cause of every death should, in the best interests of Society, be investigated, and as far as possible, determined by some competent authority. W. H. KEMPSTER, Medical Officer of Health for East Battersea. 44 BATTERSEA WEST. The health of this Sub-district, so far as the actual number of deaths are concerned, compares favourably with the previous year, those returned in the year under consideration being five less than 1875; and when it is remembered that considerable increase in population, both naturally and by immigration, has taken place, as shown by the birth-rate—which is the only means excepting actual census taking; by which a population can be estimated—we have cause for congratulation, especially when we consider that the great majority of our population is made up of the working class, who, as a matter of necessity, are much exposed to climatic changes. With increase of population the mortality also usually increases, as it often implies over-crowding, poverty, impurity of air, deficiency of cleanliness, disease, &c.; but, as will be seen by reference to the Mortality Tables, this is not the case here. The efficient supervision in use by the Board for the removal of all those conditions which experience teaches us are the factors, if not of actual disease, certainly of injury to health, which render persons more susceptible, increase the severity of disease when it makes its appearance, and retards convalescence, conduces greatly to this result. Vapours, gases, and substances, are constantly passing into the atmosphere, all more or less injurious, directly or indirectly; it is with the gases from sewers we are chiefly concerned, seeing what a ready means they have of communicating with the whole District. In order to give a ready exit to these gases, special ventilators have been inserted at the stump-ends, but where ever these sewer gases are generated they must find their way amongst the people, either, if improperly trapped, into the houses by the drains, or by the ventilators into 45 the road; there to be diluted and disseminated by the winds. We may ventilate as much as we please, we may destroy, to all appearance, our sewer gases; but the only safe and effectual remedy consists in removing the animal and vegetable matter before decomposition sets in, and this can only be done by frequent and efficient flushings and cleansing. In seasons of wet weather, when there is much land-water, our sewers do not appear to be large enough to carry off the water, and, as a consequence, it finds its way backwards up the private drains into the basements of the houses. Many and serious complaints have been made, and very justly, as it is likely to be dangerous to the health, and certainly destroys the comfort of people. Complaints have been made of the unhealthiness of certain parts of the District; notably of the Clapham Junction Estate, and Gwynne Road. W ith respect to the former it is said, and on good authority, that more persons attend the Consumption Hospital from the neighbourhood of Clapham Junction than any other district. What then is the cause? Some ten years ago there was scarcely a house on the Estate, now there are over a thousand. It was then a swamp. Can this previous condition be the remote cause? It is well known that chest complaints are more prevalent in persons who reside in damp localities than in dry. The streets are well drained and all made up; and the houses should be built with the basements well off the ground, and so arranged as to admit a free passage of air. After carefully going over the deaths which have occurred from Lung diseases on this Estate—and this is the only means by which we can judge of the amount of sickness, no means for the registration of each case of disease existing—they are not more numerous than in any other equally populous portion of the District. 46 With respect to Gwynne Road and the abutting streets, cases of Diphtheria, Scarlet Fever, &c., were frequently occurring. An investigation took place, and the sewers were found to be unventilated; the stump-ends have been opened up in the usual way; and Gwynne Road itself has been made up under the orders of the Board. I trust the means taken will be efficient in checking the diseases which have hitherto visited this neighbourhood ; at the same time it must be understood if the people themselves neglect those precautions so necessary to health, the utmost a Sanitary Board can do must in a measure fail. The Mortuary is now complete, and open for the reception of bodies; it is situate at the rear of St. Mary's Church, in the churchyard, and consists of two rooms, one fitted up with four slate slabs, set on brick piers, and the other is used for the purposes of post-mortem examinations; it is light, well ventilated, and furnished with gas and water; the floor is of concrete. This building will prove of inestimable benefit to the public generally, and, being near the river, we shall be relieved of those sensational scenes which so often used to occur. The postmortem room is accessible to all the medical gentlemen in the parish, for the purpose of making those examinations which are often attended with much inconvenience to themselves and distress to the persons in whose houses they are generally made. I could wish it was complete with disinfecting chamber and inquest room. It also contains a shell made of galvanized iron, of sufficient size to admit of the largest coffin, the lid fits into a groove which contains water so as to prevent the escape of any gases, in the centre of the lid is a sheet of glass through which Jurymen may view the body on which any inquiry is being held. It is made after the model so kindly placed before the Local Committee by Mr. Tully. 47 Mortality.—The total number of deaths registered as having occurred in this District during the year was 852, 450 being males and 402 females (the males exceeding the females by 50), being a decrease on the previous year of 5. Of the total number 163 took place in the Infirmary, 76 of which were parishioners of Battersea, leaving 87 belonging to the other parishes of the Union ; these 163 deaths are a decrease on the previous year by 14, when 177 were returned. Deducting, then, the 163 Infirmary deaths, which, as the inmates are derived from the whole union, it is but just to do, it will leave 689 as the correct number of deaths for this out-door District. * Death-rate.—Calculating the death-rate on the assumption that the population has increased at the same rate as it did during the ten years ending 1871, we should have a population of 35,577 souls, and a death-rate of 19.5 per 1000. Birth-rate.—The births registered were 1487, the excess of males over females being 71—779 being males and 708 females; and the rate, calculated in the same manner as the deaths, was 41.7 per 1000, the natural increase to population being 635; after including all deaths in the Infirmary, this is 121 in excess of last year. The birth-rate forms a very reliable means of judging of the population, as it rarely exceeds 35 per 1000 per annum; if, then, our birth-rate is nearly 42, there must be a far greater number of persons in the district than our method of calculation allows; this fact should not be lost sight of when perusing the death-rate, which, if calculated by a population that would yield the recognised birth-rate must be considerably lower than 19 per 1000. The following Table shows the causes of all deaths classified at different ages, the sex, and social position, which have taken place in this Sub-district during the year 1876 :— * Out-door with reference to Infirmary. 48 STATISTICS OF MORTALITY, BATTERSEA WEST. Population June, 1875 — 33,856. Estimated mean population June, 1876— (52 weeks) 35,577, Area 1108 acres. Total Deaths from each Class of Disease, &c., in the Sub-District Sex Age Social Position Males Females Under 1 year From 1 to 5 years From 5 to 10 years From 10 to 20 years All under 20 years At 20, and under 40 years At 40, and under 60 years At 60, and under 80 years 80 years and upwards Nobility and Gentry Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. Classes;— 1. Zymotic Small Pox 3 1 2 2 ... ... 1 3 ... ... ... ... ... ... ... 3 Measles 35 22 13 11 22 2 ... 35 ... ... ... ... 1 1 4 29 Scarlatina 20 9 11 1 9 3 5 18 2 ... ... ... ... Diphtheria 5 ... 5 ... 1 3 1 5 ... ... ... ... ... ... 2 6 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 6 4 2 ... 5 1 ... 6 ... ... ... ... ... ... 1 5 Whooping Cough 32 13 19 14 10 2 ... 32 ... ... ... ... ... ... 8 24 Typhus & other Fevers 19 7 12 ... ... 2 3 5 1 10 3 ... 1 ... 2 16 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Metria, Childbirth 5 ... 5 ... ... ... ... ... 4 1 ... ... ... ... 2 3 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa Choleraic Disease 43 23 20 35 2 2 ... 39 ... 2 2 ... 1 ... 6 36 Totals of Zymotic Class 168 79 89 63 55 15 10 143 7 13 5 ... 3 1 29 135 2. Tubercular 149 79 70 41 10 4 11 (56 56 23 4 ... 3 23 123 3. Of Brain, Nerves, &c. 119 80 39 38 23 2 1 64 9 23 21 2 6 2 10 92 4. Of the Heart, &c 49 28 21 4 1 ... 1 6 b 13 21 3 ... 1 ... 42 5. Of Respiratory Or- 160 82 78 52 40 2 1 95 7 26 27 5 ... ... 30 130 G. Digestive Organs 19 7 12 4 ... ... ... 4 3 7 5 ... ... ... 5 14 7. Urinary Organs 13 8 5 ... ... ... 2 2 2 6 3 ... 2 ... 3 8 8. Of Organs of Gene- 8 1 7 ... ... ... ... ... 5 2 1 ... 1 ... 2 5 9. Of Cancer, &c 22 2 19 3 ... ... ... 3 1 8 9 1 ... 1 2 19 10. Syphilis 4 ... 4 2 1 ... ... 3 1 ... ... ... ... ... ... 4 11. Premature Birth, Low Vitality, Malformation, &c 30 21 9 29 1 ... ... 30 ... ... ... ... ... 2 ... 28 12. Of Uncertain Seat 37 23 14 3 4 3 ... 10 6 7 13 1 1 1 7 27 13. Age 53 25 28 ... ... ... ... ... ... ... 22 31 ... 2 5 46 14. Violence 18 13 5 6 4 1 ... 11 2 4 1 ... ... ... 1 17 15. Joints and Bones 4 2 2 2 ... ... 1 3 ... 1 ... ... ... ... 2 2 Total 852 450 402 247 139 27 27 440 105 132 132 43 17 10 133 692 * This table includes all deaths in the Infirmary of the Union. 49 Zymotic Mortality.—The deaths from this class of diseases collectively give an increase on the previous year of 13. Scarlet Fever, which was so prevalent during 1865, continued for some months to yield fatal results during the year now under consideration, still, but 20 were registered against 48. There is an increase in Measles by 24, Whooping Cough by 19, Fevers by 5, Small Pox by 3, and Diarrhoea by 8. The 3 deaths from Small Pox are the first that have been registered for the past three years. Of the 168 persons who succumbed, 79 were males and 89 were females, 118 were under 5 years of age, and 143, inclusive, were under 20, and 5 were 60 years and upwards; 2 of the deaths from Small Pox were under 1, and 1 was over 10 years of age, neither of them being stated whether vaccination had been performed or not. The following Table contrasts all deaths in West Battersea from Zymotic causes from the past five years. 1872. 1873. 1874. 1875. 1876. Small Pox 4 1 0 0 3 Measles 24 11 8 11 35 Scarlatina 3 3 5 48 20 Diphtheria 15 3 5 7 5 Quinsy 0 0 0 0 0 Croup 7 6 16 5 6 Whooping Cough 31 24 30 20 39 Typhus, &c 13 22 15 14 19 Erysipelas 5 4 4 9 0 Metria, Childbirth 2 4 11 6 5 Carbuncle 1 0 0 0 0 Influenza 0 0 0 0 0 Diarrhoea and Cholera 32 37 43 35 43 Totals 137 115 137 155 168 Other Causes of Death.—Diseases of the Respiratory Organs, excluding Phthisis, are again the highest in number of this class of diseases, 169 being registered; but D 50 although this is the case they are 37 below those of the previous year. From Bronchitis 87 were registered, Pneumonia 49, Asthma 2, and other Lung diseases 22. The Tubercular resulted in 149, of which 114 were from Phthisis, Atrophy 32, and Scrofula 3. Of the deaths from Consumption 79 occurred between the ages of 20 and 50, the ages at which I have noticed for years past this distressing disease has been most fatal. Conjointly this class of diseases are 1 in excess of the previous year, but there is an increase of 27 from Phthisis, and a decrease of 20 from Atrophy; this latter I am glad to report, as I trust it shows a better knowledge on the part of mothers in reference to feeding their infants. Diseases of the Brain and Nerves also show a decline on those of the previous year, 119 being registered against 130. Disease of Heart 49, Cancer 22, Digestive Organs 19, Urinary 13, Generation 8, Syphilis 4, Joints and Bones 4, Violence 18, Premature Birthand Low Vitality 30, of Uncertain Seat 37, and Old Age 53. Of the 684 deaths from the non-epidemic classes of disease 371 were males and 313 females. 184 were under 1 year of age, 84 between 1 and 5, 297 under 20, inclusive, from 20 to 40-98, 40 to 60-119, 60 to 80127, above 80-43. Of the total number of deaths from all causes the greatest period of freedom from any disease, except Phthisis, is from 10 to 40, in which period but 132 deaths were registered of the whole total 852, and 65 of these were from Phthisis; the most fatal period is the first year of life, no less than 247 being returned under that age. It is gratifying to observe the number of our parishioners who live to good old age; between 60 and 80, 132 were returned, and above 80, 43, two of the latter reaching the great age of 97 and 92 respectively, the eldest being, as usual, a female; it is also pleasing to remark that all but 5 of these aged persons died from diseases not of the acute nature which affects the younger portions of the population, most of the cases being of a chronic nature, 51 and we must hope that their sufferings were accordingly less severe. The following Table contrasts all deaths from nonZymotic causes during the past five years. 1872 1873 1874 1875 1876 Tubercular including Phthisis 106 106 113 148 149 Of Brain, Nerves, &c 76 100 115 130 119 Of the Heart, &c 24 34 31 37 49 Of the Respiratory Organs, excluding Phthisis 105 156 151 197 160 Of Digestive Organs 18 11 23 27 19 Of Urinary Organs 4 4 6 10 13 Of Organs of Generation 2 6 3 7 8 Of Joints, Bones, &c 0 0 4 8 4 Of Cancer 15 14 10 2 23 Premature Birth, Low Vitality, Malformation, &c. 22 23 26 37 30 Of Uncertain Seat 61 50 27 39 37 Age. 46 51 22 39 53 Violence 28 4 15 15 18 Syphilis 0 0 6 9 4 Totals 507 559 552 702 684 Total Deaths from all causes, including all deaths in the Infirmary, in the respective years were 1872 1873 1874 1875 1876 644 674 68 6 857 852 The Death-rates per 1000, excluding Infirmary deaths and its population, was— 1872 1873 1874 1875 1976 17-0 17-6 17-2 20-2 19-5 Inquests.—During the year 28 Coroner's Inquests were held, viz., on the bodies of 18 males and 10 females, D 2 52 this being a decrease on the previous year of 14; the verdicts returned were From Accidental Causes 17 Natural Causes 9 Suicide 1 Found Dead. No evidence of cause 1 Of the accidental causes 4 were by Asphyxia under bed clothes, 3 by burning, the clothes taking fire, 3 by injuries, 2 by drowning, and 1 by the impaction of bread in the throat causing suffocation. The suicide was that of a male aged 46 by drowning whilst mentally deranged; the natural causes were principally from fits and heart disease. The noticeable feature, as compared with last year, is the decrease of suicides, there being but 1 as against 7. Social Position.—The proportion of deaths in relation to Social Position was as follows;— Per cent. Nobility and Gentry 17 2. Professional 10 1.17 Middle and Trading 133 15.61 Industrial 692 81.22 852 100.00 Disease and Mortality amongst the Union Poor:— The number of cases which came under treatment were 384, 145 being males and 239 females. These numbers are 3 in excess of those of 1875, and small they are when we consider the nature and extent of our population; it shews clearly that there cannot be a large number of actual poor amongst us, or else in the time of health and prosperity they adopt the manly and independent course of making provision for the time of adversity, which sooner or later is sure to come. These applications for parochial medical relief are less than they were ten years ago when the population was not more than half of what it is at present, this shows that although the immigration into 53 the district has been so great, that the people are of the industrial classes; what the condition of things will be as age creeps upon them, is a matter for conjecture. Of these 384 cases, 22 were removed to Hospitals and 12 to Lunatic Asylums. There were 25 cases of SmallPox, 10 of Scarlet Fever, Diarrhoea 19, Fever 7, Measles 5, Erysipelas 3, Lung diseases 75, Phthisis 11, Violence 20, and 222 from other diseases, principally Rheumatism, Old Age and Disease of the Nervous system. On reference to Table 5, Appendix, the nature of the different diseases will be found, and also the deaths. In comparing the diseases with the previous year, there will be found a decrease in Measles, and an increase in Small Pox, so much so that an Epidemic was then feared, which fears have unfortunately been realised during the present year. Remarks on this disease will be found in the general summary for the whole parish. The number of deaths was 23 and the rate 7 per cent.; at the same time it must not be forgotten that several of those who were removed to Hospital succumbed and would under ordinary circumstances have been taken in the total death rate. J. OAKMAN, Medical Officer of Health, West Battersea. 54 CLAPHAM. In presenting for the twenty-first time my report as to the Sanitary condition of this Sub-district, I need make no apology for introducing, as usual, the following Table, believing that it will be found useful to those who are interested in the sanitary progress of this locality. Years 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 1876 Marriages 310 244 272 234 158 249 236 257 284 243 313 Births 711 777 801 838 867 864 858 929 937 965 1029* Deaths 425 451 450 508 480 G04 482 475 528 548 545 Excess of Births over Deaths 286 326 351 330 387 260 376 454 409 417 484 Of this number I successfully vaccinated in 338 cases. — J. M. D. It has been my habit to introduce into the above Table a return of the marriages solemnised in the district, as affording some indication of its material and social prosperity, and, it is satisfactory to notice, that the past year has been distinguished by a greater number of these events than any of the preceding nine years. Of these 313 marriages, no less than 382 were solemnized in the usual manner, and the remaining 16 were contracted before the Registrar. The marriage rate was 1.4 per 1000 of the population. 55 The number of births, almost necessarily, I might say, have also shown a larger increase than usual. In 1875 965 births were registered, and during the past year 1029 (530 males and 499 females), giving an increase of 55 births. The birth rate is 34.3 per 1000. While it is satisfactory to note an increase in the marriages and births, it is still more pleasant to record a decrease in the deaths. During the past year 545 deaths were registered, showing a decrease of 3 from those of 1875, and yielding a death rate of 17.7 per 1000. Such a deathrate is most creditable to our locality, and is evidence, I think, that its sanitary condition is improving notwithstanding its rapidly increasing population. The excess of births over deaths was 484, which, of course, represents the natural increase of the population. Zymotic Diseases.—The fatality from this class of diseases is shown in the following Table, drawn up with a view of comparing at a glance the past with the preceding ten years. Such a Table affords the means of judging to some extent of the success of scientific sanitation in the reduction of the number, or at least the intensity, of these maladies. Years. 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 1878 Small-pox. 10 7 0 10 6 94 14 0 0 2 14 Measles 18 3 9 2 14 2 30 11 20 3 13 Scarlatina. 6 5 14 29 45 20 6 2 33 22 13 Diphtheria 5 3 7 0 2 3 3 3 4 6 0 Whoopingcough 14 7 25 29 9 18 25 14 15 17 17 Typhus 16 10 26 17 12 10 11 10 6 2 5 Diarrhoea & Cholera 17 21 28 30 31 31 39 25 27 22 24 Totals 86 56 109 117 119 178 128 65 105 74 86 56 It will be seen that Small-pox was fatal in 14 cases. In 1875 only 2 cases were fatal, in the two preceding years none, while in 1872 there were 14, and in 1871 (the epidemic year) 94 deaths from Small-pox. Measles shows an increase upon the previous exceptionally favorable year (1875). Scarlatina was considerably less fatal during the past than the two preceding years. Diarrhoea had a lower fatality than any year since 1867 with the exception of 1875. Diphtheria was fatal in no case, while Whooping Cough maintained its average. During 1876, 98 cases of Small-pox occurred in this district, amongst the parochial poor alone. Fourteen cases were fatal in the district, and of those which were removed to various Hospitals, we can obtain no accurate account. The fact that many cases had to be removed to distant hospitals, because the authorities at Stockwell refused to utilize the empty wards of the adjacent Fever hospital for the reception of Small-pox cases, though entreated to do so, was most prejudicial to most of the cases and fatal to some. None of the cases I sent to hospital could afford to pay the hospital fees (£4. 4s.) but belonged to the poorer class, a class, moreover, which regards vaccination with dislike, and is most likely to suffer from the epidemic by evading preventive measures. No case of Small-pox occurred amongst those who had been successfully vaccinated recently. The following table, as of old, exhibits in a condensed form all the important facts to be noted regarding the mortality statistics of the district, and calls for no comment save by way of comparison with the statistics of the previous year. 57 STATISTICS OF MORTALITY. CLAPHAM. Population in 1871—27,347. Estimated Population in middle of year 1876— 30,734. Area in Acres—1,233. DISEASES And other Causes of Death Total Deaths from each Class of Disease, &c., in the Sub-District. Sex Age Social Position Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. Under 20 years, 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. Classes:— 1. Zymotic small Pox. 14 4 10 1 1 1 5 8 1 ... ... ... ... 2 12 Measles 13 6 7 8 5 ... 13 ... ... ... ... ... 4 9 Scarlatina. 13 10 3 4 6 3 13 ... ... ... ... ... 1 5 7 Diphtheria. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 5 3 2 ... 3 2 5 ... ... ... ... ... ... 3 2 Whooping Cough 17 7 10 7 10 ... 17 ... ... ... ... ... 1 5 11 Typhus, &c. 5 2 3 ... ... ... 1 2 1 1 ... ... ... 2 3 Erysipelas . 6 3 3 1 ... ... 1 ... l 3 1 ... 2 1 3 Metria, Childbirth 5 ... 5 ... ... ... 1 4 ... ... ... ... 1 2 2 Carbuncle . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa, etc. 24 17 7 17 ... ... 21 ... ... 3 ... ... 5 3 16 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class. 102 52 50 38 29 6 77 14 3 7 1 ... 10 27 65 2. Tubercular* 80 44 36 7 7 4 24 33 21 2 ... ... 5 23 52 3. Of Brain, Nerves, &c. 41 21 20 3 8 2 14 4 8 14 1 ... 3 20 18 4. Of the Heart, &c. 35 17 18 ... ... ... 3 7 14 11 ... ... 3 13 19 5. Of Respiratory Organs 79 38 41 21 15 2 39 3 14 22 1 ... 5 16 58 6. Of Digestive Organs 16 6 10 4 ... ... 5 2 2 7 ... ... 4 6 6 7. Of Urinary Organs . 14 6 8 2 ... ... 3 2 2 7 ... ... 1 6 7 8. Of Organs of Generation 5 2 3 ... ... ... 1 1 2 1 ... ... 1 1 3 9. Of Joints, Bones, &c. 3 2 1 ... ... ... ... ... 1 2 ... ... 1 1 2 10. Of Skin 1 1 ... ... ... 1 1 ... ... ... ... ... ... 1 ... 11. Premature Birth, Low Vitality, Malformation, &c. 84 42 42 70 14 ... 84 ... ... ... ... ... 4 29 51 12. Of Uncertain Seat 3 3 ... ... ... ... ... ... ... 2 1 ... ... 1 2 13. Age 37 16 21 ... ... ... ... ... ... 13 24 ... 12 7 18 14. Violence 10 7 3 1 ... ... 2 1 3 4 ... ... ... 3 7 15. Not Specified 35 14 21 3 l 1 5 4 8 17 1 ... 5 13 17 Totals 545 271 274 149 74 16 258 71 78 109 29 ... 53 167 325 * Of the 71 deaths from Tubercular disease 54 were due to Phthisis. 58 In the absence of an accurate estimation of the population, I have given, in round numbers, 30,000 as an approximate calculation of our population at the middle of 1876. I have already noticed the chief points regarding the Zymotic class of diseases in the table. Non-Zymotic Diseases.—During the past year diseases of this class are rather under the average, though their relative proportions remain very much the same as usual. Tubercular diseases are rather more numerous relatively than diseases of the Respiratory Organs. The number of Unspecified Diseases is decidedly above the average. But the notable point in the list is the high mortality from causes grouped under the title of Premature Births, &c. This leads me to notice prominently the Infant Mortality.—No less than 84 children under 5 years, of whom 7 0 were under 1 year, died from Premature Birth, Low Vitality, Malformation, &c., and 155 children, more than half of whom were under 1 year, from other causes. In all, 239 children, only 23 less than one-half of the total mortality of the district, died during the past year. This number is less by 30 than in 1875, and more by a like number than in 1874. I have in former reports expressed my regret at such a large infant mortality, and endeavoured to point out many of its preventable causes. Senile Mortality is also large, but, unlike the last, this is a matter of congratulation and encouragement. From Old Age 37 deaths occurred, 24 of which were of persons above 80, and 4 above 90, one of whom would next year have been a centenarian. From other causes 5 died upwards of 80, and 96 between 60 and 80. Sickness and Mortality among the Poor.-From Table V. in the Appendix it will be seen that a very large number of cases of sickness were attended during the past year, namely 1005. An important item in this total was the 98 cases of Small Pox already mentioned. The cases 59 of Fever 109 (96 of which were of the remittent type, and 13 infantile), also constitute a large and important item. The number of deaths resulting from these cases was 38, a small proportion, considering the amount of epidemic disease. There were no deaths from any epidemic disease except Small Pox, from which two deaths occurred. Inquests, &c.—In the course of the past year 15 inquests were held by the Coroner. The following is a list of the verdicts arrived at after a diligent and searching examination : 3 were suicidal—by poison, &c. 3 were accidental. 5 were natural from heart disease. 3 „ „ „ brain „ 1 was found dead (overlaid). The Sanitation of the Year.—From Table VI. in the Appendix it will be seen that a large amount of sanitary work was accomplished during the year. More than 2000 houses were specially examined by the Surveyor, the Inspector of Nuisances and myself; 5574 feet of new sewers and branch drains were constructed during the year. Few compulsory orders were required during the year, indicating a desire on the part of proprietors and others to execute necessary sanitary work without being compelled by legal processes. The slaughter houses and cow houses have been duly examined during the year, and the excellent enactments of the Legislature regarding these buildings, though at first complained of as unnecessary and expensive by the owners, have brought about a durable and permanent improvement in their condition which has given the greatest satisfaction to all parties. Still there is room for further improvements which time will suggest. The water supply is not complained of in the matter of quantity, but as to quality it is not only bad, but very 60 bad. According to Dr. Frankland's returns in the Registrar General's report, it seems positively unfit for domestic use, and worse than any other water supplied to the Metropolis. The great importance of pure water to the health of a community is an admitted fact, and we have, therefore, good cause to complain of the water supply of our district. If water could be procured from another and better source of supply than the Thames, as from deepwell borings, we might have a better quality supplied. Another point of great moment is the present frequent and close connection of the cistern and the water-closet. I have the Surveyor's authority for stating that one-half of the houses in this parish have the same cistern supplying water to the closet and for dietetic purposes. This state of matters could easily be remedied at a very trifling expense. Of course, in present circumstances, it is highly necessary to filter the water used for dietetic purposes in an efficient manner. Charcoal seems to be the best filtering medium. JOHN MAC DONOGH, Medical Officer of Health for Clapham. 61 STREATHAM, INCLUDING BALHAM AND TOOTING. The population of this Sub-district at the middle of the past year was estimated, according to the authorized method of calculation, at 16,781. Deaths and Death-Rate.—The number of deaths during 1876 in the district was 260, of which 139 were of males and 121 of females. The death-rate was accordingly 15-5 per 1000 persons living. This is an increase of 23 deaths upon the total mortality of 1875, and of 30 upon that of 1874, and is due, chiefly, to the excessive mortality from diseases of the Respiratory Organs. Births and Birth-Rate.—During the year 536 children were born, 280 males and 256 females. This is an increase of 17 over the number born last year. The birth-rate was, therefore, 32'06 per 1000 per annum. The excess of births over deaths was 276, giving a rate of natural increase of 16.4 per 1000 of the population. Zymotic Diseases —There is an increase this year in deaths from diseases of an epidemic character, as may be seen by referring to the following comparative table, showing the deaths from seven of the chief Zymotic maladies. This increase has occurred in the cases of Diphtheria, Whooping Cough, and Fevers. 62 DISEASES. 1875 1876 Seven principal Epidemics. Small Fox Measles 2 2 Scarlatina 4 4 Diphtheria 3 6 Whooping Cough 5 7 Typhus, &c 2 5 Diarrhœa and Choleraic Disease 9 7 Totals:— 25 31 Diarrhoea shows a slight decrease this year as compared with last. No death from Small Pox occurred. The above epidemic mortality yields a per-centage of 11.9 upon the number of deaths from all causes. Besides the seven epidemics in the above table, Croup was fatal in one case, Erysipelas in one, and Metria in two. This brings the Zymotic mortality to a total of 35 cases. The Table which follows indicates the cause of death, sex, age, and social standing of all persons whose deaths were registered during the year in this District. It is quite unnecessary to put into words what can be better understood by figures, and it is superfluous to make more than a few remarks by way of comparing the figures with those of former years. This has already been done with respect to the diseases grouped under the first heading. 63 STATISTICS OP MORTALITY. STREATHAM, including TOOTING & BALHAM. Population in 1871—14,475. Estimated Population middle of 1870—16,781 Area in Statute Acres—3,465. DISEASES, And other Causes of Death Total Deaths from each Class of Disease, &c., in the Sub-District. Sex Age Social Position Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. Under 20 years, including all under 10 years. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle & Trading Class, Shopmen, Clerks, &c. Industrial and Laboring Classes. Classes:— 1. Zymotic Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 2 2 ... 1 1 ... 2 ... ... ... ... ... ... 1 1 Scarlatina 4 3 1 ... 1 2 3 1 ... ... ... ... 2 ... 2 Diphtheria 6 2 4 1 2 1 5 ... 1 ... ... 1 3 1 1 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 1 1 ... ... 1 ... 1 ... ... ... ... ... 1 ... ... Whooping Cough 7 5 2 3 4 ... 7 ... ... ... ... ... 1 2 4 Typhus and other Fevers 5 5 ... ... ... 1 1 3 1 ... ... ... ... 2 3 Erysipelas 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 Metria, Childbirth 2 ... 2 ... ... ... ... 2 ... ... ... ... 1 1 ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea & Choleraic Disease 7 4 3 4 2 ... 6 ... ... 1 ... 2 1 1 8 Totals of Zymotic Class 35 23 12 9 11 4 25 6 3 1 ... 3 9 8 15 2. Tubercular* 31 19 12 8 4 1 16 8 4 3 ... 2 2 9 18 3. Of Brain, Nerves, &c. 39 19 20 8 4 ... 14 4 7 12 2 6 7 10 16 4. Of the Heart, &c. 18 9 9 ... ... ... 1 ... 5 10 1 4 4 2 8 5. Of Respiratory Organs 52 25 27 11 4 ... 15 6 11 18 2 2 8 13 29 6. Of Digestive Organs 22 12 10 3 ... ... 3 1 7 10 1 7 1 5 9 7. Of Urinary Organs 6 5 1 ... ... ... 1 1 3 1 ... ... 1 ... 5 8. Of Organs of Gene- ration 6 ... 6 ... ... ... ... ... 5 1 ... 1 2 1 2 9. Of Joints, Bones, &c. 2 1 1 ... ... ... 1 ... ... 1 ... 1 ... ... 1 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Malformation, &c. , 14 8 6 13 1 ... 14 ... ... ... ... ... 1 3 10 12. Of Uncertain Seat 2 1 1 ... ... ... ... ... ... 1 1 1 ... ... 1 13. Age 23 11 12 ... ... ... ... ... ... 16 7 7 3 3 10 14. Violence 9 6 3 ... 1 ... 1 2 4 2 ... ... 1 3 5 15. Not Specified 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 Totals 260 139 121 52 25 5 91 28 49 78 14 34 39 57 130 * Of the Tubercular class of Diseases, 21 deaths appear to have resulted from Phthisis. 64 Of the non-Zymotic diseases, it has been already remarked, the diseases of the Respiratory Organs occupy a prominent position. The number of deaths from these diseases this year is larger than it has ever before been in this district. Diseases of the Brain and Nervous System stand next in point of fatality, though they do not seem to be much above the average. Tubercular diseases show a slight decrease upon the fatality for the last few years. The other causes of death maintain very much their usual relative proportions. Sickness and Mortality among the Poor.—It will be seen from Table V. in the Appendix that 107 cases of sickness occurred among the pauper population, of these 12 died, that is, 11.2 per cent. There was exceedingly little epidemic disease, and no deaths from Zymotic maladies. The diseases of the Chest caused three-fourths of the above death-rate. Ages at Death.—The mortality among children during the past year was slightly in excess of the last two years. It compares favourably with other districts. Of the 82 fatal cases among children, 24 were of Zymotic origin, chiefly from Whooping Cough, Diarrhoea, and Diphtheria, 14 were grouped under the title of Premature Birth, Low Vitality and Malformation, and the remaining 44 were distributed amongst the Respiratory, Tubercular and Nervous groups. There were comparatively few deaths of persons between 10 and 60 years of age. One case of Scarlet Fever, one of Diphtheria, and four cases of other fevers occurred between these ages. The other cases were chiefly of Tubercular, Respiratory and Nervous diseases. The Senile mortality is most encouraging and speaks well for the salubrity of the district. More than a third of the total mortality was of persons above 60, namely 92 cases, of which 14 were above 80. The oldest was 90 years. Of course Old Age was the most frequent cause of death, followed by Respiratory, Nervous diseases and diseases of the Heart and Digestive organs. 65 Social Position.—About one eighth of the total deaths occurred amongst the nobility and gentry, a seventh from the ranks of professional men, merchants, &c., a fifth from the middle and trading class, and exactly one half from the industrial and labouring class. It is of importance to observe how few cases of Zymotic disease occurred among the first-mentioned class, while Old Age claims more than the average of deaths from that class, as also, diseases of the Digestive Organs, and of the Brain. Diseases of Tubercular origin, and of the Respiratory Organs, show a decided partiality for the lower ranks. Inquests, &c.,—Eleven inquests were held during the year. The verdicts may be thus grouped- I. Accident—(1) Spasm of Glottis, (2) Asphyxia, (3) and (4) Falls, (5) Drowning. II. Natural—(1) Heart Disease, (2) Old Age. (3) Painter's Colic. III. Suicide—(1) Shooting, (2) Poisoning. IV. Murder—(1) Poisoned by antimony. The last mentioned is too well known as "The Bravo Case " to need further remark. Two cases of death were registered as uncertified by any medical man. As one of these was described as " unknown," it seems strange that no inquest was held upon the case, and, whatever may be said of accepting the guesses of friends or the dictum of an unqualified man in registering the cause of death, surely a registration such as the above tends to stultify all vital statistics, and makes the protection the register ought to afford little short of a sham. Sanitary Work of the Year.—It is hardly necessary to do more than refer the reader to Table VI. in the E 66 dix, where a summary of the work of the year is found in its appropriate column. It is satisfactory to note that no cases have been brought before the magistrates, showing the readiness of our population to carry out required improvements voluntarily. The cow and slaughter houses received diie inspection and were found in a satisfactory condition. D. C. NOEL, Medical Officer of Health for Streatham & Tooting. 67 PUTNEY AND ROEHAMPTON. Tn presenting, for the first time, my own contribution to the Annual Report of the Medical Officers of Health, it seems only a just tribute to the memory of my worthy and respected predecessor, to express my sense of the loss his fellow officers have sustained by his death, and my determination that honest effort and assiduous care shall not be wanting on my part in taking up the duties he has so faithfully performed for twenty years, and in cultivating to the best of my ability the qualities which distinguished him as a sanitary reformer as well as an officer. Population.—At such a late period of the census decade, the population of a growing Suburban District such as ours can be only approximately determined, since the ratio of increase is being annually accelerated. Taking, however, the recognised method of calculation, the population of the combined parishes of Putney and Roehampton may be estimated at 10,990. Deaths and Death-rate, &c.—It is my good fortune to have to record an exceedingly low death-rate during the past year. Only 143 deaths were registered in this Sub-district during the year, of which 78 were of males and 65 of females. This gives the exceedingly low death- E 2 68 rate of 13.01 per 1000 persons living, or 1 death in 77. These figures are almost unprecedented, even in similarly favoured districts; and a comparison with the death-rates of the towns and districts, as given in the RegistrarGeneral's Summary for the year 1876, will fail to discover their equals. The death-rate of the whole of London was 22.3; that of 23 of the principal towns of the United Kingdom was 23.7 ; and that of other 50 large towns 21.9 per 1000. In a Table given on page 71 will be found the death-rate in this District for the last eleven years, and it will be seen that the death-rate of the past year has never been attained before. I think the inhabitants of this Subdistrict may be fairly congratulated on this encouraging fact, and may justly consider this one of the very healthiest parishes in all the five groups of Metropohtan Districts. Births and Birth-rate.—During the year 1876 300 births were registered, of which 158 were of males and 142 of females. The birth-rate is 27.3 per 1000, or 1 in 36. The excess of births over deaths was 1.57, and the rate of natural increase 14-3 per 1000. Distribution of Births and Deaths.—The following Table gives the total births and deaths in each quarter of the year, distinguishing also the number of deaths from Zymotic Diseases:— Quarters of the Year. Births. Total Deaths. Zymotic Deaths 1 84 43 8 2 75 24 1 3 75 36 10 4 66 40 3 Both births and deaths were most numerous in the first 69 quarter. The Zymotic mortality was highest in the third quarter. Zymotic Diseases.—There were 22 deaths from this class of diseases. These were distributed over 7 of the sub-classes of the group, and so, are rather in excess of the average of the Zymotic mortality, but indicative rather of the variety than the intensity of the Zymotic diseases. A noticeable feature is the absence of Diphtheria from the list. The Table given below presents a comparative view of the mortality from the chief Zymotic diseases for 11 years ending 1876. Years. 1866 1867 1868 1869 1870 1871 1872 1873 1874 1875 1876 Small-pox. ... 1 ... ... ... 1 ... ... ... ... 1 Measles ... 8 ... 1 5 4 1 2 3 ... 1 Scarlatina. 1 1 2 6 3 21 7 ... ... ... 3 Diphtheria ... 2 1 2 1 1 1 ... 1 4 ... Whoopingcough ... 1 9 ... 6 3 1 6 1 9 7 TyphuB, &c. 1 3 2 5 ... 1 ... 2 ... ... ... Diarrhœa & Cholera 5 4 5 7 8 6 5 1 6 7 7 Totals 16 20 11 31 19 32 19 6 10 20 19 Whooping-cough, it will be seen, was severe ; though less so than last year, or the year 1867. Scarlatina has again appeared after omitting three years. It was severely epidemic in 1871. Diarrhoea is rather over the average, and is only exceeded in one year (1870). The following Table may be interesting, as showing the season of year at which the cases of Zymotic diseases occurred. Whoopingcough and Diarrhoea are conspicuous. It may be remembered that the autumn of last year was excessively hot, which accounts for the mortality from the latter cause. 70 DISEASE. Small Pox Measles Scarlatina Diphtheria Whooping Cough Diarrhœa Fever 1876. First Second Third Fourth Quarter. Quarter. Quarter. Quarter. 1 1 1 2 5 1 1 1 6 It is a matter of regret to observe, .for the first time since 1871, a fatal case of Small Pox in our District. Though only one case was fatal, it is proper to add that, not only does this solitary case, in common with fatal cases of other diseases, fail to give us any idea of the prevalence of the disease, but, unlike them, is no criterion even of its intensity. This is of course due to the fact that this disease, like Cholera, is beginning to be treated, as all serious epidemic diseases ought to be, by the common-sense method of isolation. I say, beginning to be treated, because, if any fact regarding this epidemic was made conspicuously evident, it was the very inadequate preparation for the hospital accommodation of the cases. In many instances patients had to be left in crowded districts to spread the deadly infection, and themselves to die for want of proper nursing. In the introduction will be found the suggestions I, along with my fellow officers, have to make on this subject, and it is unnecessary to enter upon it here. Seven cases of Small Pox were removed to the Hospital during the year from this Sub-district, of which one died; of those not removed, of which there were about the same number, one died. Both the fatal cases were of adults, said to be vaccinated, and were of the confluent type. The most of 71 the cases were mild in character. There was the greatest difficulty in some cases in getting their removal to Hospital accomplished, even when there was Hospital accommodation for them, on account of the scruples of the patient or friends to entering a pauper institution, and especially to being taken there in the parish ambulance. The following Table presents a variety of Statistics, arranged under the eleven years ending 1876, for the purposes of comparison. It should be remembered that the population has been steadily increasing during the decade from the estimated population of 1866—8,030, to that of 1876—10,990, a difference of nearly 3,000. The Table will explain itself. YEARS. Births. Birth-rate. Number of Deaths from all Causes. Death-rate. Rate of Natural Increase. No. of Deaths from Seven of the principal Epidemic Diseases. Percentage of Deaths from seven principal Epidemics to Deaths from all causes. 1866 225 28.0 121 151 12.9 16 13.2 1867 207 24.8 128 15.4 9.3 20 15.6 1868 263 30.5 118 13.6 16.8 11 9.3 1869 248 26.6 133 14.9 12.8 31 23.3 1870 271 29.5 145 15.7 13.7 19 12.4 1871 275 28.9 151 15.8 13.0 32 21.4 1872 279 28.4 144 14.6 14.0 19 13.1 1873 320 30.6 125 13.3 18.3 6 4.8 1874 290 27.8 156 15.0 12.8 10 6.4 1875 292 27.3 167 15.7 11.6 20 11.9 1876 300 27.3 143 13.0 14.3 19 13.2 The Mortality Statistics of this Sub-district are tabulated below, according to the cause of death, and the age, sex, and social status of the deceased. It needs little comment, save by way of comparison with the statistics of former years. 72 STATISTICS OF MORTALITY. PUTNEY AND ROEHAMPTON. Population (Census) 1871— 9,439. Estimated population in middle of the year 1876— 10.990. Area in Statute Acres—2,176. 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 GO 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 Classen. DISEASES, And other causes of Death. Classes:— Small Pox 1 1 ... ... ... ... ... ... 1 ... ... ... ... 1 ... Measles 1 ... 1 ... ... 1 1 ... ... ... ... ... ... 1 ... Searlatina 3 2 1 ... 3 ... 3 ... ... ... ... ... 1 ... 2 Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... croup 1 1 ... ... 1 ... 1 ... ... ... ... ... ... 1 ... Whooping couph 7 3 4 3 4 ... 7 ... ... ... ... ... 1 3 3 1. Zymotic Typhus and other Fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 2 2 ... ... ... ... ... ... 1 1 ... ... ... 1 1 Metria, Childbirth Childbirth; ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa & Choleraic Disease. 7 3 4 7 ... ... 7 ... ... ... ... ... ... 5 2 Totals of Zymotic Class 22 12 10 10 8 1 19 ... 2 l ... ... 2 12 8 *2. Tubercular 26 14 12 3 2 6 15 5 3 11 11 2ti 15 11 7 6 12 2 2 9 I 1 10 6 9 G 4 2 ... 1 1 4 1 1 1 3 '16 9 14 <> 4 in 3 4 fi 2 3 7 11 6. Digestive Organs ... 5 2 3 ... 1 1 1 3 o 9 1 7. Urinary Organs 7 5 2 ... ... 2 2 2 I 3 3 1 ration 1 ... 1 ... . . . 1 1 10 Of Skin 1 ... ... ... ... i ... ... 1 ... ... ... ... ... Low Vitality, Mai- I 10 6 4 10 ... 10 3 7 12. Of Uncertain Seat ... 1 1 1 1 8 3 5 6 2 3 2 3 V « 1 1 ... 2 1 4 1 4 2 ... ... ... ... ... ... ... Totals 113 78 65 37 20 1 60 25 18 36 4 4 29 52 58 Phthisis Tubercular class of diseases there were 18 deaths registered as being due to Pulmonary 73 Non-Zymotic Diseases.—Tubercular diseases and diseases of the Nervous System, it will be seen, were equally fatal, while those of the Respiratory System almost as much so. To assist us in comparing these figures with those of former years the following Table may be useful. Years. 18G6 J 867 1868 1899 1870 1871 1872 1873 1874 1875 1876 Tubercular 17 21 24 20 18 22 24 19 24 26 26 Of Brain, Nerves,&c. 20 19 16 17 18 19 20 26 39 23 26 Of the Heart, &c. 7 9 9 6 9 9 14 13 8 13 6 Of Kespiiatory OrKans 21 20 21 15 31 29 2G 21 30 36 23 Of Digestive Organs 8 9 8 11 17 8 7 12 11 7 5 Of Urinary Organs 1 2 2 5 1 5 4 3 8 7 Of Organs of Generation ... 2 2 1 ... 1 ... 2 ... 1 1 Of Joints, Bones,&c. 1 ... 2 ... 1 ... 1 1 ... 1 1 Of Skin ... 1 ... ... ... ... ... ... ... ... ... Premature Birth, Low Vitality, Mai formation, &c 9 13 9 11 8 11 5 7 7 16 10 Of Uncertain Seat 5 2 4 6 5 5 5 2 6 1 1 Age 4 5 1 4 8 7 3 3 6 11 8 Violence 9 4 6 8 4 4 0 5 6 4 7 Not Specified 2 1 .. ... 1 2 2 1 2 ... ... Totals 104 108 104 99 125 118 124 116 146 147 121 The alteration in the population, and therefore the relative proportion of the figures, must be remembered in this as in all comparative Tables. The fatality from Nervous Diseases was slightly above the average, and that from Respiratory Diseases and from Premature Birth, &c., decidedly under it. Other diseases were about the average. It will be seen that there is an alteration in the relative proportion of Respiratory to Tubercular diseases, the former being usually in excess of the latter. Ages of the Deceased.—The mortality among children shows a decrease of thirteen from that of 1875 and a 74 slight increase upon that of 1874. The deaths from Zymotic diseases from all causes, except Small Pox and Erysipelas, were of children. Respiratory and Nervous diseases were especially fatal to children. The mortality from Premature Birth, &c., is less severe than usual. The mortality at other ages was about the average excepting that among the very aged, which is remarkably low. Only four died above 80 in the past year, as compared with 11 in 1875, and 7 in 1874. The oldest was (as usual, a female) aged 84 years. Social Position.—It will be seen that the usual proportion between the classes is not preserved in the past year. The mortality amongst the Industrial class is far exceeded by that of the other classes. The Professional and Merchant class have more than their usual share, and the Nobility and Gentry rather less. Brain diseases were especially fatal amongst the Professional class, and Epidemic diseases in the middle class. The deaths from Premature Birth, &c., were most frequent amongst the lowest classes, which is not surprising. Sickness and Mortality amongst the Union Poor.— The sickness amongst the pauper population was very slight. Scarlatina and Whooping Cough were somewhat more prevalent than usual. No deaths occurred among the cases of Epidemic disease, and there was a mortality of only three in the whole number of cases treated, or only about 2 per cent. See Table V. in Appendix. Inquests.—Eight inquests were held during the year, exactly double the number of those in the previous year. The Verdicts were as follow : — I. Accidental, (1) drowning, (2) suffocation, (3) burning. II. Suicidal, (1) drowning, (2) cutthroat. III. Natural, from heart disease, (2) IV. Found drowned ; no marks of violence or proof of how he came into the water. 75 Sanitary Proceedings, &c.—Table VI. in the Appendix gives an epitome of the sanitary work of the year, and to it I refer the reader. An important improvement was the removal of nine cesspools from various parts of the District. The removal of one pig nuisance is another encouraging improvement, as well as the riddance of no less than 37 accumulations of offal, manure, &c. It was necessary in three cases to obtain legal assistance in getting improvements effected. In two of these cases compulsory orders were obtained, and, of course, complied with. The Cow and Slaughter-houses underwent their usual inspection. Most of them were in a highly creditable condition. The regulations imposed on the slaughterhouse keepers have effected great improvement, and it would be productive of good if somewhat similar rules were imposed on the dairy-keepers, though in this District restrictions are hardly necessary. Tlw Water Supply. — Complaints have frequently been made to me of the condition of the water supplied to the District. For remarks and suggestions on that subject see introductory report, pages 15-18. ALEXANDER WALKER, M.B., Medical Officer of Health for Putney and Roehampton. APPENDIX OF STATISTICAL TABLES. TABLE I. Summary of Deaths and their Causes, registered in the entire District during 1876, classified according to Sex, Age, and Social Position, and showing also the relative Numbers in each Sub-District. POPULATION of ENTIRE DISTRICT, As corrected by the Regis rar General. Census 1871—125,060. Estimated Population for middle of year, 1876,— 153,648. Area in Statute Acres, 11,695. Total Deaths from each Class of Disease, &c., in the entire District. Sub-Districts. Sex. Age. Social Position Clapnam—Population in 1871, 27,347, area in acres, 1,233. Wandsworth—Population in 1871,19,783, area in acres, 2,478. Battersea—Population in 1871, 54,016, area in acres, 2,348. Putney—Population in 1871, 9,439, area in acres, 2,176. Streathain, Tooting, and Balham—I'opu-| lation 1871, 14,475, area in acres, 3,465. ! Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. Under 20 years, including all under 10 years. At 20, and under 40 years of age. At 40, and under 60 years of age. At 60, and under 80 years of age. 80 years and upwards. J Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle and Trading Class, shopmen, Clerics, &c. 1 Industrial and Labouring Classes. DISEASES, And other Causes of Death. Classes:— Small Pox 26 14 1 10 1 ... 9 17 3 2 2 11 11 3 1 ... ... ... 4 22 Measles 88 13 17 55 1 2 51 37 28 54 6 88 ... ... ... ... 1 3 11 74 Scarlatina 86 13 12 54 3 4 51 35 8 47 20 82 4 ... ... ... 1 4 13 68 Diphtheria 15 ... 1 8 ... 6 4 11 1 6 2 14 ... 1 ... ... 1 4 3 1 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 27 5 3 17 1 1 16 11 1 22 4 26 ... ... ... ... ... 1 5 21 Whooping Cough 126 17 10 85 7 7 62 64 50 72 4 126 ... ... ... ... ... 7 22 97 1. Zymotic Typhus & other Fevers 47 5 12 25 ... 5 23 24 2 4 6 19 9 14 4 1 1 1 8 37 Erysipelas 13 6 2 2 2 1 9 4 4 ... .. 4 1 3 4 1 ... 3 4 6 Metria, Childbirth 26 5 4 15 ... 2 ... 26 ... ... ... 1 21 4 ... ... ... 3 10 13 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea & Choleraic Disease 159 24 18 103 7 7 88 71 123 16 2 143 ... 7 8 1 3 13 26 117 Totals of Zymotic Class. 613 102 80 374 22 35 313 300 220 223 46 515 46 32 17 3 7 39 106 461 2. Tubercular 555 80 64 354 26 31 311 244 159 68 16 973 171 95 16 ... 10 23 89 433 3. Of Brain and Nerves 41 6 41 125 185 26 39 940 176 89 60 10 170 44 92 109 8 20 31 78 287 4. Of Heart 170 35 26 85 6 18 83 87 4 4 1 17 28 50 70 5 7 17 37 109 5. Of Respiratory Organs 561 79 58 349 23 52 273 288 169 126 12 312 34 91 115 10 9 23 91 438 6. Of Digestive Organs 196 16 20 54 5 22 57 69 95 3 1 31 23 30 40 2 8 13 32 73 7. Of Urinary Organs 62 14 6 29 7 6 34 28 2 2 1 9 12 17 22 2 3 6 16 3 J 8. Of Organs of Generation _3 5 2 9 1 6 4 19 ... ... ... 1 7 9 6 ... 2 4 4 13 9.Of Joints, Bones, &c. 14 ft 8 1 ? 9 5 0 9 ... 7 ... 3 4 ... 1 ... 4 9 10. Of Skin 5 1 ... 4 ... ... 1 4 2 1 1 4 ... ... 1 ... ... ... 1 4 11. Premature Birth, Low Vitality, Malformation, &c. 296 84 22 96 10 14 130 96 910 16 ... 296 ... ... ... ... ... 8 47 171 12. Of Uncertain Seat . 9i 3 18 73 1 2 48 64 11 4 3 18 13 24 38 4 4 8 14 71 13. Age 150 37 16 66 8 23 63 87 ... ... ... ... ... ... 75 75 10 20 22 98 14. Violence 90 10 14 50 7 9 68 n 16 12 5 44 15 17 14 ... 1 3 13 73 15. Not Specified 46 35 1 9 1 20 26 8 2 2 12 5 9 19 1 ... 5 15 26 Totals 3154 545 461 1745 143 260 1640 1514 910 524 99 1638 398 468 540 110 82 201 568 2303 77 TABLE II. Birtits registered during the year 1876. SUB-DISTRICTS. Males. Females. Total. Clapham 530 499 1,029 Wandsworth 373 306 679 Battersea East—Males, 1,001; Females, 067 j- 1,780 1,675 3,455 [ West—Males, 779; Females, 708 Putney and Roehampton 158 142 300 Streathain, including Tooting and Balharn 280 256 536 Total 3,121 2,878 5,999 *** The excess of Births over Deaths in the entire district is 2,845. TABLE III. METEOROLOGICAL TABLE TOR LONDON, 1876. (Deduced from Observations, at Greenwich, under the Superintendence of the Astronomer Royal, and compiled from Quarterly Tables, furnished to the Registrar General by James Olashier, Esq., F.R.S.) Winter Jan., Feb., March. Spring April, May, June. Summer July, Aug., Sept. Autumn Oct., Nov., Dec. Temperature of Elastic Force of Vapour. Weight of Vapour in a Cubic Foot of Air. Degree of Humidity. Reading of Barometer. Weight of a Cubic Foot of Air. Rain. Reading of Thermometer on Grass. Air. Evaporation. Dew point. Air— Daily Range. Number of Nights it was Lowest Reading at Night. Highest Reading at Night. Mean. Diff. from Average of 105 Years. Diff. from Average of 35 Years. Mean. Diff. from Average of 85 Years. Mean. Diff. from Average of 35 Years. Mean. Diff. from Average of 35 Years. Mean. Diff. from Average of 35 Years. Mean. Diff. from Average of 35 Years. Mean (Sat" = 100). Diff. from Average of 35 Years. Mean. Diff. from Average of 35 Years. Mean. Diff. from Average of 35 Years. Amount. Diff. from Average of 61 Years. At or below 30°. Between 30° and 40e. Above 40°. 1876. o o o o o o o o o in. in. grs. gr. in. in. grs. grs. in. in. Sums. o o YEAR 50.1 +1.3 +0.6 46.9 +0.3 43.7 0 0 16.3 + 0.3 0295 —o.ooo 3.4 0.0 80 —2 29.719 —0.057 540 —2 24.2 — 1.1 75 130 161 14.0 59.7 First Quarter 39.8 +1.0 —0.1 37'7 —0.2 34.9 — 0.5 120 +0.2 0.203 — 0.004 2.4 — 0.1 83 —2 29.705 —0.058 552 0 4.9 00 44 38 9 14.0 44.8 Second do 51.7 + 1.3 —1.3 47.6 —1.6 43.5 — 20 21.0 + 09 0.287 — 0.022 . —0.2 74 —2 29.817 +0028 540 +1 3.5 — 2.3 17 40 34 •1 55.8 Third do. 61.8 +2.1 +1.5 57.1 +0.7 53.1 +0.1 21.8 + 2.0 0.406 + 0.002 45 + 0.1 74 —4 29.763 —0.038 528 —2 5.3 —2.2 0 11 81 34.1 59.7 Fourth do 47.0 — 3.3 +2.4 45.1 +2.4 43.1 +2.3 10.3 —1.7 0.282 + 0.022 3.2 + 02 87 —1 29.590 —0.161 541 —6 10.5 + 3.4 14 41 37 20.3 53.9 In this Table, + and respectively signify that the numbers in the preceding column are above or below the average to the extent of the quantities to which these signs are prefixed. 79 TABLE IV. Showing the total Deaths from the Principal Epidemic Diseases registered in each Sub-District, and in the entire District, and the relation which they bore to the total Mortality in the several years 1866—76. Deaths from the seven principal Epidemics in each Sub-District. Entire District. Years. Clapham. | Battersea. Wandsworth. Putney. Streatham. Total Deaths from the Seven Epidemics. Total Deaths Registered from all causes. Per centage of Deaths from the Seven Epidemics to Total Deaths. 1866 86 244 73 16 34 453 2072 21.3 1867 56 122 33 21 10 242 1937 12.4 1868 99 194 64 14 28 399 2168 18.4 1869 117 247 94 31 27 516 2393 21.5 1870 119 404 113 19 37 692 2659 26.0 1871 178 463 103 32 31 807 2867 28.8 1872 128 220 47 20 31 446 2421 18.4 1873 65 205 43 6 32 350 2570 13.6 1874 105 238 52 10 26 440 2 96 15.7 1875 74 307 46 20 25 472 3096 15.2 1876 86 340 71 19 31 547 3154 17.4 *** The Diseases included in the above Table constitute, as in the RegistrarGeneral's Returns, the principal maladies only of the Zymotic class—viz.: Small Pox, Measles. Scarlatina, Diphtheria, Whooping-cough, Diarrhoea and Cholera, and Fever. TABLE V. Cases of Sickness amongst the Poor under the treatment of the Union Medical Officers, with the Deaths from each class of Disease, during the year ended 31st December, 1870. 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. 13—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 1005 98 2 5 ... 28 ... 4 ... 31 ... ... ... 109 ... 1 1 3 ... 114 6 23 6 ... ... 478 12 111 11 38 Wandsworth 806 7 54 6 19 ... 10 2 37 ... ... ... 4 1 4 ... ... ... 162 6 3 ... ... 460 14 46 1 36 Battersea East 707 59 1 6 ... 11 3 17 4 18 ... ... ... 16 ... 9 ... ... ... 99 8 41 5 ... ... 431 7 ... ... 25 West 384 25 1 5 ... 10 ... 4 1 19 ... ... ... 7 ... 3 ... 1 ... 74 5 11 6 2 2 203 8 20 ... 23 Putney and Roehampton 148 ... ... 1 ... 7 ... 6 ... 9 ... ... ... 2 ... 2 ... ... ... 19 ... 6 ... 4 1 82 2 10 ... 3 Streatham, including Tooting and Balham 107 1 ... 1 ... ... ... 2 ... 3 ... ... ... 1 ... 1 ... ... ... 21 5 3 3 ... ... 74 4 5 ... 12 Totals 3157 190 4 72 6 75 3 43 7 117 ... ... ... 139 1 20 1 4 ... 489 30 87 23 6 3 1728 47 192 12 137 The ratio of deaths to cases treated is 4.3 per cent. 81 TABLE VI. Summary of the Sanitary Operations in the entire District during the year 1876. Clapham. Battersea. Wandsworth. Putney and Roehampton. Streatham, including Tooting and Balliam. Totals. Number of Houses and Premises inspected 2000 3,357 135 217 220 5,929 1st Notices served 267 359 64 59 25 774 2nd Notices served 59 18 3 80 Cesspools emptied and cleansed ... ... ... ... 8 8 Cesspools abolished 6 8 9 8 31 Waterclosets constructed 6 14 ... 5 140 165 Houses supplied with water 149 3 13 148 313 Prains constructed or connected with Sewer 156 187 2,286 61 83 2,773 No. of feet of New Sewers and Branch Drains 5,574 9,435 5,350 2,071 4,833 27,253 Drains repaired or trapped, or obstructions removed 160 146 13 29 30 378 Open Ditches,Ponds, &c., cleansed ... ... 3 ... 1,500 ft. ... Dust-bins provided 142 110 ... 7 140 399 Pig Nuisances removed 7 7 17 1 5 37 Accumulations of Offal, Manure, &c., removed 19 32 11 37 5 104 Unwholesome and dilapidated Houses cleansed or repaired 143 49 24 17 10 243 Cases investigated by Magistrates... 1 8 ... 3 ... 12 Compulsory Orders obtained 1 8 ... 2 ... 11 Compulsory works executed 1 8 ... ... ... 11 Works remaining in abeyance from various causes ... ... ... ... ... ...