WAN 31 The Board of Works for the Wandsworth District SANITARY DEPARTMENT. REPORT ON THE SANITARY CONDITION OF THE SEVERAL PARISHES COMPRISED IN THE WANDSWORTH DISTRICT, DURING THE YEAR 1879. BY THE MEDICAL OFFICERS OF HEALTH. London: G. MORRISH, PRINTER, 114, CAMBERWELL ROAD. 1880. REPORT, 1879. To the Board of Works for the Wandsworth District. Gentlemen, We have the honour to present the twenty-fourth Annual Report of the health and sanitary condition of the Wandsworth District. Though we cannot point to a decreased death-rate for the year 1879, we have the satisfaction of recording a low fatality in some of those diseases which usually contribute more largely to our annual, mortality; and to congratulate you generally upon the fact, that the extreme severity of the cold, and long continuance of the wet weather during the year, were not fruitful of a much higher death-rate than we have to report. In some of the sub-districts a specially low death-rate was found to prevail. The sanitary labours of your Officers increase year by year as the population becomes denser, and the need for sanitary precautions grows more urgent. Evidence is not wanting in the succeeding pages that the advancing necessities of the District are being noted and successfully met by those to whom you have entrusted the care of the public health. 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 near approach of the census of 1881 renders the Report, comprised in the succeeding pages, unsatisfactory from a statistical point of view, owing to the great uncertainty in estimating the population of this district. It is very obvious that the rate of increase prevailing before the last census (1871) was considerably lower than that of the succeeding years, and that the official estimate founded upon the former can give us no satisfactory datum upon which to calculate the birth and death-rates of the latter. We therefore present our figures with no great confidence as to their accuracy, but with the firm belief that they will prove, in every instance, to be an under rather than an over estimate of the rates they represent. The population in the middle of 1879, according to the official estimate, is 171,900. The year 1879 was distinguished for its unusually low temperature, and its continued and heavy rainfall. These two characteristics produced their effect upon the mortality of the year. Epidemic diseases, on the whole, were not in excess of previous years and in particular cases (e.g. Diarrhoea) unprecedently low; but the loss of life from diseases of the Respiratory Organs was, as might be expected, heavy, and largely contributed to the increase in the death-rate of the district, which we shall have occasion to observe below. 6 Births and Birth-rate.—During the year 1879 the births of 6,833 children were registered;—3,497 boys, and 3,336 girls. In the last few reports it has been remarked that the births of any district bears a much more reliable proportion to the population than the deaths. Being less liable to fluctuation, it has been proposed to make use of the births in estimating the population. The birth-rate of 1879 is 39.7 per 1,000, which may be seen is part of a steady increase in the birth-rate of the years succeeding the last census. See annexed table. Year 1871 1872 1873 1874 1875 1876 1877 1878 1879 Births 4380 4540 5053 5221 5529 5999 6159 6508 6833 Birth-rate per 1000 34.5 34.4 36.4 36.5 37.3 39.5 38.6 3.4 39.7 Deaths 2867 2421 2580 2796 3096 3154 2991 3275 3526 Death-rate per 1000 22.6 18.3 18.7 19.5 20.87 20.0 18.7 19.8 20.5 In all probability, the census of 1881 will place the birth-rate at about 34 or 35 per 1,000, at which rate the births of this district have been found, when the population has been estimated upon the basis of an actual enumeration. It is evident, therefore, that our population will be found greatly to exceed the modest limits of the official estimate when that enumeration takes place. The above number of births shews an increase of 325 upon those of last year, almost the same rate of increase as prevailed in the previous year. The birth-rate of London was 36.5 per 1,000. Deaths and Death-rate.—During the year 1879, 3,526 deaths were registered, 1,742 of males, and 1,784 of females. The death-rate, according to the official population, is 20.5 per 1,000. This shews an increase of 251 deaths over 7 those of 1878, and a difference of 07 per 1,000 in the death-rate. (See table ) The death-rate for 1879 is exactly the average death-rate since 1871; but for reasons already explained, it would be less by 2.0 per 1,000 if we could arrive at our actual population and calculate from it. The death-rate for London was 23.3 per 1,000, nearly the same as that in the previous year. In 23 large towns of the United Kingdom the average rate was 23.4—from 351 in Dublin, to 16.7 in Portsmouth. Of other 50 towns the average was 21.3—from 29.1 in Preston to 16.5 in Cheltenham and Middleborough. Considering density of population, and greater risk of epidemic disease than in the provincial districts, our death-rate may be looked upon as below the average. The average rate for the South Metropolitan Districts, of which the Wandsworth District is one, was 23.3. The table below gives the official population, deaths and death-rate of each of the five sub-divisons of the Wandsworth District. The figures ot the previous year are also given for the purpose of comparison. SUB-DISTRICTS. Officially estimated Population in the middle of Deaths. Death rate. Excluding NonPririshioners ho have Died in Public Institutions. 1878 1879 1878 1879 1878 1879 1879 Battersea 79,068 82,500 1,803 1,980 1 in 43 1 in 42 per 1000 23.9 per 1000 21.4 Wandsworth 24,449 26,000 422 516 1 in 57 1 in 50 19.0 16.1 Clapham 32,031 33,000 580 561 1 in 55 1 in 59 17.5 No apprecible difference. Streatham, Tooting, and Balham 17,667 18,500 284 290 1 in 62 1 in 64 15.6 Putney & Roehampton 11,597 11,900 186 179 1 in 62 1 in 66 15.0 The excess of births over deaths was 3,307, or nearly 20'0 per 1,000. This represents the natural increase of the population. 8 Causes of Death.—The statistics of mortality for the year 1879 will be found in Table I. of the Appendix. The first five columns contain the total deaths of each sub district, and the remaining columns shew the sex, age, and social standing of the deceased. The table now presented is intended to give a retrospect of the total deaths during the eleven vears. 1869-79. In comparing the figures it is necessary to bear in mind, increase of population. DISEASES. And other causes of Death 1869 1870 1871 1872 1873 1874 1875 1876 1877 1878 1879 Classes:— 1. Zymotic Small Pox 21 15 377 26 9 5 3 26 57 19 4 Measles *52 46 52 86 55 66 27 88 64 84 125 Scarlatina 133 352 126 26 2 94 134 86 58 39 134 Diphtheria 14 12 6 26 11 12 28 15 7 19 17 Quinsy ... 4 1 2 1 2 ... ... ... 1 ... Croup 22 25 13 18 21 40 26 27 20 39 40 Whooping Cough 96 51 52 108 74 89 107 126 73 149 148 Typhus and other Fevers 61 68 54 52 65 48 39 47 64 39 62 Erysipelas 8 13 22 13 12 20 24 13 13 5 13 Metria, Childbirth 23 16 13 15 28 34 15 26 20 7 28 Carbuncle 2 ... 2 1 ... 1 ... ... ... ... ... Influenza ... 1 ... ... ... ... ... ... 1 ... ... Diarrhoea & Choleraic Disease 139 148 140 140 126 117 134 159 114 182 94 Totals of Zymotic Class 571 751 858 513 411 528 537 613 419 583 665 2. Tubercular 326 374 423 419 426 469 565 555 514 501 513 3. Of Brain, Nerves, &c. 353 365 371 341 370 426 455 416 450 503 474 4. Of the Heart, &c. 119 132 152 127 139 146 176 170 204 212 203 5. Of Respiratory Organs 396 411 431 400 543 541 630 561 519 694 891 6. Digestive Organs 93 104 118 87 96 111 136 126 155 150 117 7. Urinary Organs 40 39 20 27 34 26 55 62 63 42 74 8. Of Organs of Generation 13 8 16 9 17 21 13 23 29 19 25 9. Of Joints, Bones, &c. 6 4 5 7 10 14 11 14 13 15 8 10. Of Skin 6 3 2 3 4 9 4 5 6 1 3 11. Premature Birth, Low Vitality, Maiformation, &c. 176 191 145 143 143 168 177 226 212 177 170 12. Uncertain Seat 62 154 69 118 126 77 105 97 101 106 91 13. Age 114 133 125 105 144 106 130 150 126 141 141 14. Violence 64 50 56 8 V 70 75 68 90 82 75 83 54 40 76 35 47 79 34 46 26 56 68 Totals 2393 2659 2867 2421 2580 2796 3096 3154 2991 327S 3526 9 Zymotic Diseases.—Class I.—An increase of 82 deaths from Zymotic diseases has occurred, in 1879 over those of 1878. The average for the series is 586, so that considering increase of population, and the fact that the RegistrarGeneral has taken 53 weeks in this year, our Zymotic mortality for 1879 is not by any means excessive. If we examine in detail the special diseases of the group, we find reason for satisfaction in some particulars. Excepting one year (1875) the mortality from Small Pox is the lowest in the series.* Only 4 deaths took place in the district from this cause; 3 in Battersea, and 1 in Wandsworth. It is right, however, to state that 48 cases occurred amongst the union poor (see Table V. Appendix), and probably a number among the private population, of which most were removed to Hospitals, and contributed, no doubt, to the mortality in these institutions. Of those cases we can obtain no record, though such a record ought, in the interests of Public Health, to be furnished to the Medical Officers of Health of the Metropolis. A remarkable decrease in the fatality from Diarrhoea has occurred during the year under review. The deaths from this cause are 20 fewer than those of 1877, which was the next lowest in the series. No doubt the low temperature of the year accounts for this falling off in a disease which usually contributes largely to the epidemic mortality. Except a trifling decrease upon those of 1878, in the deaths from Diphtheria and Whooping Cough, the other important Zymotic diseases shew an increase in fatality. Whooping Cough, however, was very prevalent. Measles and Scarlatina were the chief epidemics of the year. The former caused 37 more deaths than in 1876, when the disease attained its maximum for this district. The latter shews *It is a matter of congratulation that the Bill proposed by Mr. Dodson in the present year (1880) for the amendment of the Vaccination Act by an inconsistent and incomprehensible abandonment of its compulsory character, is withdrawn. The overwhelming and determined opposition it met with, even before it was formally presented, ought to prove that it was the demand only of a very small but noisy section of the community. 10 an increase upon the previous 3 years, and is exceeded by only one year (1870) in the series. Croup, Metria and Fevers were also somewhat above the average. The relative amount of Zymotic disease in each of the sub-districts, is given in the table below. 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 4.3 17.9 Clapham 2.4 14.4 Wandsworth 3.5 17.7 Streatham 1.9 12.4 Putney 1.8 11.1 Non-Zymotic Diseases.—The fatality from diseases of the respiratory organs is the great feature of the annual mortality. No less than 891 deaths were ascribed to lung diseases, not including Phthisis, which is placed among Tubercular diseases, and which must constitute nearly two-thirds of the deaths under that sub-class. Probably, at least 1,200 deaths, or more than a third of the entire mortality of the district, is due to diseases of the Lung. This heavy loss of life was, no doubt, due to the intense cold of the winter, both at the beginning and end of the year ; and to the amount of rain which prevailed during the entire year. Diseases of the Tubercular class did not exceed the average, and it is probable that deaths from Phthisis were not in excess. The mortality was due to what might be called the accidental forms of lung disease, Bronchitis—Congestion—Pneumonia, &c. There is nothing specially noteworthy regarding any other sub-class. Mortality According to Age.—As we had to remark last year, the increase of late years has been confined to the extremes of life; especially amongst children from 1 11 to 5, and elderly persons between 60 and 80. The number of deaths of children under 1 year has decreased since last year, a fact we are only too glad to chronicle. The following table will shew, at a glance, the deaths at various ages since 1869. YEARS AGE Under 1 year From 1 to 5 years From 5 to 10 years All under 20 years From 20 to 40 years From 40 to 60 years From 60 to 80 years ars &c upward 1869 692 489 57 1369 290 290 361 83 1870 713 540 157 1554 266 328 407 104 1871 753 538 142 1517 380 411 441 118 1872 705 452 61 1297 282 324 354 94 1873 636 387 75 1285 326 394 448 127 1874 777 452 107 1438 361 462 419 116 1875 886 467 132 1660 329 422 502 113 1876 910 524 99 1638 398 468 540 110 1877 840 466 109 1517 387 458 525 104 1878 983 600 100 1780 363 483 532 142 1879 947 682 102 1878 368 487 658 135 The percentage of deaths under 1 year, is 21.1 per 1,000; under 5, 46.2 per 1,000 The deaths over 60 are very numerous, constituting 22'5 per cent of the total mortality. The Social Position of the Deceased.—The proportion of deaths among the various classes is as follows: for the three years, 1877-79. 1877. 1878. 1879. Nobility and Gentry 2.5 1.62 8.3 per cent. Professional Class 6.2 5.08 5.9 „ Middle Class 18.2 18.10 17.4 Industrial Class 78.1 75.20 78.4 „ 100.0 100.0 100.0 12 The proportion of deaths among the better classes has again increased from the low rates of last year. Sickness and Mortality among the Union Poor.—The fifth table in the Appendix contains all necessary information as to the sickness and mortality among the Union Poor. The rate of mortality is 4.0 per cent, being slightly less than last year. The total number of cases has increased by 450, so that the decrease in mortality is very gratifying. Inquests and Uncertified Deaths.—During 1879, 130 inquests were held, in the following proportions:—59 in Battersea; 25 in Wandsworth; 18 in Clapham; 18 in Streatham, and 10 in Putney. The verdicts are as follow:— I. Accident 55 II. Natural 45 III. Suicide 21 IV. Found Dead, &c. 8 V. Execution 1 This constitutes 3.7 per cent of the total deaths, as compared with 4.2 and 5.0 per cent in 1878 and 1877 respectively. We confess we do not find much satisfaction in this reduction of inquests, when we find that no less than 89 persons died and were buried without attendance, certificate, or inquest. The number of deaths so summarily disposed of increases year by year, while the number of inquests steadily diminishes. No doubt a saving of time is effected to the Coroner, and some expense avoided, by this economical arrangement; but is life rendered more secure, and crime made more difficult? The majority of those deaths are of children, and a large proportion of them are not even submitted to the Coroner. Of these, 69 occurred in Battersea; 9 in Clapham; 6 in Wandsworth, and 5 in Putney. 13 Sanitation.— Table VI. in the Appendix contains the items of Sanitary Work during 1879. Columns of figures give a very inadequate idea of the amount of labour through which your Sanitary Inspectors, aided, when necessary, by the Medical Officers, have passed. The number of houses, &c., inspected, exceed the total of last year by 568. This increase is confined to the parishes of Battersea and Streatham. The other parishes shew a slight decrease. At the same time fewer notices required to be served, a fact indicating an improved sanitary condition of the inspected premises. Second notices this year were more numerous however, and more cases had to be brought before the magistrates, giving evidence of a greater disposition to resist the requirements of the Sanitary Acts. This was especially true of Clapham, and as regards the compulsory proceedings, of Battersea. The other items hardly call for remark in this report. It is again necessary to call attention specially to the subject of sewer overflow. The year 1879, from its heavy rainfall, brought the total inadequacy of the sewers to carry off storm and surface waters, into strong relief. The matter urgently demands attention, as the health of the population, will, sooner or later, seriously suffer. This subject is specially referred to in the summary for Putney. Cow and Slaughter-Houses and Piggeries.—It is a matter of satisfaction that the very necessary regulations, introduced during the year, for the control of cow-houses, have produced excellent results in this district. The improvements in the dairies and cowsheds has been in some cases radical, necessitating rebuilding of the entire premises. We are certain that the regulations tend to improve the quality and purity of the milk by increasing the health of the animals, and to restore the confidence of the public in the use of one of the most valuable of our food supplies. A suggestion as to the inspection of the health of the cows by Veterinary Inspectors, is thrown out in the 14 Putney summary. The slaughter-houses were also found satisfactory. A number of piggeries were got rid of during the year. We trust the day is not far distant when the odour of a piggery will be unknown in our district. The Water Supply.—It is unnecessary any longer to reiterate the complaints and arguments which have found a place in many previous Reports, regarding our water supply. We feel sure the public and the Government, both Local and Imperial, have awakened to the necessity for taking the supply of our daily want from the hands of the Companies who have grown wealthy upon the public - -badly served and treated though it has been—and for putting it under proper and efficient control. We trust the ratepayers, when they do possess the power, will demand water from a purer source than the Thames; which even after elaborate filtration, still yields a water "unfit for dietetic use." LOCAL SUMMARIES. 17 BATTERSEA The difficulties which arise in attempting to assume the average number of inhabitants living in the parish in the year 1879, are alluded to in the reports for the several sub-districts. It is, however, possible from the proportions between the births and deaths to estimate the birth and death rates with a considerable approach to accuracy. The total number of children born in the whole parish during 1879 was 4,001; of these 2069 were males, and 1932 females. The deaths of 1980 persons were also registered, 1001 being males, and 979 females, and the real death-rate founded upon the usual calculations does probably not exceed 19 0 per thousand during the year. The official mean population of the Registrar-General has by the lapse of time become inaccurate, very much under-estimating the population, which is, by the official method, assumed to be 82,509 for the year 1879, and would yield a death-rate of 23.9 per thousand persons living, which is without doubt much in excess of the real death-rate; of whom 204 persons died in the Union Infirmary and 4 in other public institutions, together amounting to 208, of whom only 105 belong to Battersea, and many of these are only credited to it as inhabitants from length of residence in the Infirmary itself, which happens to be just within the borders of the parish. B 18 If the non-parishioners who died in the Infirmary (103) be deducted, and the estimated mean population be employed in the calculation, a death-rate, as before stated, of 19 per thousand per annum results, being the same as for the year 1878, and 233 being the death-rate for the metropolis at large during the year under report, a lower mortality of 4 3 per thousand would appear to the credit of the parish. There are, however, many persons admitted into the hospitals and asylums of the metropolis from Battersea, the mortality amongst whom there is no means of ascertaining, and which would, without doubt, somewhat increase our smaller apparent death-rate. Other statistical considerations are deferred until the next year, when the operations of the census will supply indisputable numbers upon which to found the usual and necessary calculations. 19 BATTERSEA EAST. The approaching advent of the decennial census in 1881 renders it undesirable to attempt any dogmatic estimation of the real population of the sub-district, as the actual numbers supplied by the enumerator might possibly shew a wide divergence from those assumed. The methods hitherto adopted by the RegistrarGeneral would assign to Eastern Battersea an official mean population of 41,790, but the rapid increase of population renders this incorrect in the direction of under-estimation; as the births recorded during the year 1879 were 2,344 and the official population would give a birth-rate of 56 per thousand; the result of the two last census-returns shewing 42 per thousand to be the normal birth-rate of the sub-district. It is, therefore, necessary, as on previous occasions, to form an estimate of the population, and this is most safely derived from a definitely ascertained quantity—the number of births registered during the year. The natural increase of population consists of the excess of births over deaths, and as the births were 2,344, and the deaths but 978, an increased population to the extent of 1,366 resulted during 1879. It will be proper to state that the Registrar-General has included in the year 1879, 53 weeks. This occurs about every five years, and adds two per cent. to the apparent mortality of the particular year. The annexed Table gives the usual statement of the cause of death during the year, with the age and social position of the deceased, and the totals in each class. 20 STATISTICS OF MORTALITY. (53 Weeks.) BATTERSEA EAST. Total Deaths from each Class of Disease, Ac., in the Sub-District. Sex. Age. Social Position. Population, June 1878— 40,049 Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. From 10 to 20 years. All under 20 years. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers. &c. Middle & Trading Class, Shopmen, Clerks, &c. Industrial and Laboring Classes. Official mean population, June, 1879— 41,790 Area in Acres 1235. Classes:—, 1. Zymotic Small Pox 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 Measles 47 26 21 4 40 3 ... 47 ... ... ... ... ... ... 5 42 Scarlatina 44 25 19 3 29 8 2 42 2 ... ... ... ... ... 3 41 Diphtheria 6 3 3 ... 4 2 ... 6 ... ... ... ... ... ... 1 5 Croup 9 5 4 ... 7 2 ... 9 39 ... ... ... ... ... ... ... 9 Whooping Cough 39 14 25 16 23 ... ... ... ... ... ... ... ... 8 31 Typhus, &c. 13 4 9 1 5 1 ... 7 4 2 ... ... ... 1 2 10 Erysipelas 4 3 1 2 ... ... ... 2 ... 1 1 ... ... ... 1 3 Metria, Childbirth 12 ... 12 ... ... ... ... ... 11 1 ... ... ... 1 2 9 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea & Cholera 43 26 17 26 13 ... 1 40 ... 1 2 ... ... 1 6 36 Totals of Zymotic Class 218 107 111 52 121 16 3 192 18 5 3 ... ... 3 28 187 2. Tubercular 167 93 74 64 2R 6 11 109 27 25 6 ... l 3 11 152 3. Of Brain, Nerves, &c. 97 56 41 36 22 2 3 63 6 14 14 ... ... 2 16 79 4. Of the Heart, &c. 38 23 15 2 2 ... 4 8 9 9 11 1 1 2 8 27 5. Of Respiratory Organs 271 142 129 93 90 4 2 189 12 32 35 3 1 9 24 237 6. Of Digestive Organs 32 16 16 12 2 ... 2 16 3 7 5 1 1 1 4 26 7. Of Urinary Organs 11 3 8 ... ... ... 1 1 2 5 3 ... 1 ... 1 9 8. Of Organs of Generation 2 ... 2 ... ... ... ... ... ... 1 1 ... ... ... ... 2 9. Of Joints, Bones,&c. 3 2 1 ... ... ... 2 2 1 ... ... ... ... ... 1 2 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Malformation, &c. 55 27 28 55 ... ... ... 55 ... ... ... ... ... 2 9 44 12. Of Uncertain Seat. 21 6 15 3 1 ... 1 5 2 8 4 2 ... 2 3 16 13. Age 20 6 14 8 ... ... ... ... ... ... ... 13 7 ... 1 7 12 14. Violence 26 18 8 3 ... 1 13 5 6 2 ... ... 3 1 22 15. Not Specified 17 9 8 4 1 ... ... 5 2 10 ... ... ... ... ... 17 Totals 978 508 470 329 270 29 30 658 87 122 97 14 5 28 113 832 21 Mortality.—It will be better to defer any very exhaustive analysis of the ordinary rates of mortality in the sub-districts to the next report, before the publication of which, the newly enumerated and actual population will have been accurately determined. The deaths registered in the sub-district of Eastern Battersea during the year 1879 were, of males 508, and of females 470, the total number being 978. This, upon an estimated mean population based upon the births registered during the year, shew the death-rate for the sub-district for that year to have been 17.5 per thousand. The deathrate (calculated in a similar manner) for 1878 gave a death-rate of 17.8 per thousand. It will, therefore, be evident that the mortality of the sub-district has rather decreased during the year under report, especially as an additional, or 53rd week, has been included. The Registrar-General's official mean population would however, give the death-rate for 1879 as rather more than 23 per thousand. This is believed to be much above the real death-rate. In the next report the official and the estimated mean populations will be identical, and the discrepancy between the two methods of calculation will no longer exist. Ages at death.—The deaths under 1 year of age during 1879 were 329, about 32 per cent. of the total deaths. Between 1 and 5 years 270, or 27 per cent. The total deaths under five years were 599, and about 61 per cent. of the 978 deaths registered. This indicates a lessened infantile mortality, especially under 1 year, as the proportion last year of deaths at that age was 40 per cent. of the whole number. Above 80 years of age 14 persons died. The majority were females, as is usually the case, the oldest of whom attained 91 years. 22 Zymotic or Epidemic Diseases.—The total number of deaths recorded from diseases of this class in the subdistrict during the year was 218. The subjoined Table gives the necessary information. Comparative Tables for 1877 and 1878 are also appended. 1879 1878 1877 Measles 47 6 47 Scarlatina 44 19 18 Diarrhœa 43 71 47 Whooping Cough 39 63 26 Fevers 13 12 17 Metria 12 2 8 Croup 9 12 10 Diphtheria 6 4 1 Erysipelas 4 0 4 Small Pox 1 5 28 Total 218 194 206 Zymotic death-rate per 1,000 per annum 3.9 3.7 4.3 The mortality from Measles and its complications heads the list of fatal terminations of diseases of the epidemic class, and includes 47 deaths. In 1878 the number was but 6, while in 1877 the mortality was 47, identical with that of the year under report. This disease is one over which preventive medicine possesses at present but very slight control, the generally favourable termination of non-complicated cases rendering parents as a rule somewhat unapprehensive of its occurrence in families. The fatality of the disease is undoubtedly greatest during cold and wet years, as pneumonia, the most grave complication, will then most frequently supervene. Scarlatina was unusually prevalent and correspondingly fatal, 44 deaths having been registered from this disease and its sequelœ. Damp and ungenial weather would 23 predispose to the latter, to which, indeed, the fatal issue was, in the majority of instances ascribed. Kidney disease, convulsions from that affection, malignant sore throat, or dropsy being given as the real cause of death. The deaths were more numerous from this disease than during any previous year, which may arise from the larger population resident in the sub-district, and the therefore greatly increased chances of communicating it. The epidemic seems to have been diffused over the whole metropolis. Diarrhœa was fatal in 43 cases, against 71 in 1878 and 47 in 1877. The diminished mortality from this disease was probably the result of the cold and wet summer, and in some respects compensates for the increased fatality from the two diseases above mentioned. From Whooping Cough again a diminished mortality was returned, the numbers for the three years being 39, 63 and 26 respectively. The various diseases included under the denomination of Fever were returned as Typhoid or Enteric Fever in 10 instances, Typhus 2, and simple continued Fever one case. These numbers contrast very favourably with the mortality from these diseases in the Metropolis at large, and indicate the existence of effective supervision over the house drainage and other sanitary arrangements of the dwelling houses in the sub-district. The other diseases of the Zymotic class were assigned as the cause of death in but a small number of cases. These observations would be incomplete without reference to the one death from Small Pox here recorded. In 1878 5 deaths were registered, and in the preceding year, 1877, 24 28 deaths occurred from this disease alone, a preventible waste of human life. The thanks of the community are due to the Guardians and their Vaccination Officer, Mr. Payne, for the effective manner in which the Vaccination Acts are carried out. Other Diseases.—The diseases which arise from Tubercle are Phthisis, Hydrocephalus, or Tabes Mesenterica, which simply refers the tubercular deposit and the consequent local affection to the head, chest, or abdomen respectively. These diseases caused 167 deaths in 1879, contrasting with 166 in 1878, 193 in 1877, and 205 in 1876; shewing a diminished mortality from these diseases in an increased population. From diseases of the Respiratory Organs the severe winters of the last two or three years have produced a great and abmormal mortality. During the year under report, 271 deaths were registered from Bronchitis, Pneumonia, and the other diseases of this class. Diseases of the Brain and Nerves occasioned 97 deaths. It is interesting to observe that between 5 and 10 years but 2 deaths arose from this cause, and from 10 to 20 years 3 deaths only. Thus from 5 to 20 years but 5 deaths occurred from brain affection in a population of probably 50,000 persons, an absolute proof that the more perfect education of the young does not work mischief in this direction; indeed, we should expect to find this result, as it is a physiological axiom that an organ which is constantly and regularly called upon to fulfil its functions is less liable to disease than one which is allowed to remain dormant and unexercised. Diseases of the digestive system caused death in 32 25 cases, against 33, 32, and 35 for the three preceding years. Premature Birth was the registered cause of mortality in 55 instances. In former years many of these cases would have been buried as stillborn, having survived but a few minutes or hours ; hence the apparent increase in numbers. Violence caused death in 26 instances, all of which cases were subjected to investigation by the Coronor. The other causes of death do not call for detailed comment. Social Position.—The usual Table illustrating the social position of the deceased is here appended— =per cent. Nobility and Gentry 5 .5 Professional Class 28 3.0 Middle and Trading Class 113 11.5 Industrial and Labouring Class 832 85.0 Total number of deaths, 1879 978 100.0 The middle and trading class increases year by year. Vaccination.—The Register of Public Vaccination records the operations of this nature performed by the Public Vaccinator, which are as follows:— Successful Primary Vaccinations 1292 „ Re-Vaccinations 15 1307 Inquests.—These investigations into the cause of death, held before the Coroner, numbered 36 during the past year. The conclusions arrived at were as follows:— 26 Natural causes (found dead 2) 10 Accidental causes— Asphyxia (Children overlaid) 8 Drowned 6 Killed on Railway 5 Scald 2 Concussion, &c. 2 Shot 1—24 Homicidal— Poison (Suicides) 2 36 None of the above cases call for especial remark. Uncertified deaths.—The total number of persons buried during the year without a medical certificate of the cause of death or an investigation by the Coroner, was 40, and of these 29 were under 5 years of age. It is evident that no person should be interred without some inquiry by the proper officials into the circumstances attending the death. In cases where notice of the death together with the facts attendant thereon, have been submitted to the Coroner, and he has decided that enquiry is unnecessary, the Registrar has agreed in future to notify the fact in the weekly returns of registered deaths. Disease and mortality amongst the Union Poor.—An unusually large number of cases, 1231, has come under the care of the District Medical Officer during the past year, the result of an increased population and severe weather during the winter months, which deprived the working classes of their means of subsistence, and rendered them more liable to disease. The mortality, sixteen, is very small, but the more severe cases of acute disease were removed to the Infirmary or Special Hospitals, where proper food, nursing, and other necessary comforts would 27 be available, affording the sick poor a much better chance of recovery than in their own squalid and often miserable homes. Under the circumstances detailed above it might be anticipated that lung diseases would head the list of cases attended, 252, of which 5 died. Other diseases included maladies of almost every known variety, but they were principally the result of debility or exposure to the inclemency of the weather, such as Rheumatism, and these cases numbered 753 with 7 deaths. From Phthisis alone 46 cases were attended with 1 death. Diseases of the Zymotic or Epidemic class frequently demand treatment. Thus Small Pox occurred in 14 cases, Measles 25 cases, Scarlatina 25 cases, (all these without a single death in the sub-district), Whooping Cough 32 cases with one death, Diarrhœa 25 cases with one death, Fever 11 cases, and Erysipelas 12 cases, without a death in either disease. Some, however, of these cases were removed to Hospitals where a fatal termination may have occurred, but there is no means of ascertaining the number. Sanitation in the Sub-district during 1879.—The following abstract from the books of the Inspector of N uisances gives in detail the Sanitary operations during the period under report, and speaks for itself. Abstract of Sanitary Works carried out in East Battersea, During the Year ending December 31st, 1879. No. of houses inspected 1689 No. of 1st Notices served 179 No. of 2nd Notices served 24 Houses disinfected and where necessary cleansed after Small Pox 19 Houses disinfected and where necessary cleansed after various kinds of Fever 62 Defective drains cleansed and repaired 70 Cesspools abolished 17 Accumulations of Manure removed 10 28 Dust Bins provided 55 Defective apparatus to water closets repaired 67 Water supply added to houses 7 Pig nuisances removed 4 Covers to cisterns provided 27 Obstructions on roads and foothpaths removed 10 Dilapidated closets repaired 9 Dilapidated houses repaired 8 Summons 5 Order of the Board obtained 12 In conclusion, the health-condition of the Sub-district has been shewn in the preceding pages to be such as to reflect credit upon the sanitary authority. W. H. KEMPSTER, Medical Officer of Health for Eastern Battersea. 29 BATTERSEA WEST. The year under report has been productive of the greatest number of deaths ever registered in this district, having reached the large number of 1,002. This number includes all those which took place in the Infirmary, which are also in excess of any previous year, being 204. There is also another cause by which the deaths are swollen, viz., by taking in the calculations, in accord with the RegistrarGeneral, 53 weeks, the extra week being at the end of the year; and in which no less than 33 deaths were returned, being nearly double that of the usual average. Notwithstanding this excess in the deaths over the previous year, we have a death-rate of 20 per 1,000, being considerably less than that of the metropolis. This is satisfactory, for the addition which is and has been taking place in the population must be patent to all. With increased population there must of necessity be more houses, more impurities and prevention to the free circulation of air; and it generally follows that the greater the density of persons, so the amount of sickness is also increased. It is difficult to give with accuracy, in a district like this, a correct death-rate; and judging from the birth-rate I should say the estimated rate given above is at least two 30 per 1,000 in excess of that which actually exists. Next year, however, is the census year, which will exactly reveal the increase this district has undergone in reference to the population during the past ten years; and enable one to give statistics, with an accuracy (at all events for that year) which should at all times if possible characterise them. The prevailing epidemic diseases during the year, were Scarlet Fever, Measles, and Fevers generally, whilst Diarrhœa and Whooping Cough do not shew half their usual fatality. The whole of the district has been visited by the two former diseases, and if there was one part more than another so affected, it was the neighbourhood of Winstanley Road. The former disease, Scarlet Fever, is one of the most dangerous diseases of the Zpnotic class, and is always looked upon with dread when it makes its appearance. Not only from its power of disseminating itself, but from the terrible consequences it generally leaves behind. That the type of the disease with which we have had to contend during the past year was most severe, is shewn by the number of fatal cases. In the Non-epidemic classes, diseases of the Respiratory Organs and Tubercular disease shew a large excess. How much these and other diseases were caused or influenced by the constant flooding of the basements of houses with land and sewage water it is impossible to say; but certain it is that an immense amount of sickness prevailed in those houses, and no doubt the effects of the floodings in 1878 were very much felt in 1879. Mortality.—The total number of deaths registered as having taken place in the district, was 1,002; 493 being 31 males and 509 females, the latter being 16 in excess of the former. In 1878, 908 deaths were returned, there is therefore an increase on that year of 94. Of the total number, 1,002, 204 occurred in the Union Infirmary, 105 of which belonged to Battersea as a whole; leaving 99 to be divided amongst the other parishes of the Union. These 204 deaths are 14 in excess of the previous year, when 190 were returned. Deducting these 204 Infirmary deaths; 798 will be the correct number for this out-door* district; the 105 above referred to as belonging to Battersea will be taken into calculation in estimating the death-rate for the entire parish. Death-rate.—Calculating the death-rate in the same manner as in the previous year, after deducting all deaths in the Infirmary, the rate is 20 per 1,000. This is an increase of 1*5 per 1,000 on the year 1878. Birth-rate.—The number of births returned was 1,657; 879 being males and 778 females. And the rate calculated in the same manner as the deaths was 42.4 per 1,000, being an increase on the previous year of 2.4. This is a very high birth-rate, and points to the fact that our population is much higher than that estimated. This should not be lost sight of when reading the death-rate. Natural Increase.—The above number of births give an increase over the deaths of 859. The following table shews the causes of all deaths, classified at different ages, sex, and social position which have taken place in the sub-district during the year. * Out-door with reference to Infirmary. 32 STATISTICS OF MORTALITY. (53 Weeks.) BATTERSEA WEST. Population, June, 1878— 39,019 Total Deaths from each Class of Disease, Ac., 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, Ac. Industrial and Labouring Classes. Official mean population, June, 1879— 40,740 Area 1108 acres. Classes:— 1. Zymotic Small Pox 2 1 1 1 1 ... ... 2 ... ... ... ... ... ... ... 2 Measles 43 17 26 6 31 6 ... 43 ... ... ... ... ... ... 4 39 Scarlatina 55 20 35 6 34 14 3 35 ... ... ... ... ... ... 12 43 Diphtheria 7 5 2 6 1 ... 7 ... ... ... ... ... ... 1 6 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 8 5 3 2 ... ... ... 8 ... ... ... ... ... ... 3 5 Whooping Cough 11 3 8 5 6 ... ... 11 ... ... ... ... ... ... 2 9 Typhus & other Fevers 27 14 13 ... 7 4 2 13 7 2 4 1 ... ... 6 21 Erysipelas 2 1 1 ... 1 ... ... 1 ... ... 1 ... ... ... ... 2 Metria, Childbirth 2 ... 2 ... ... ... ... 0 2 ... ... ... ... ... ... 2 Carbuncle ... ... ... ... ... ... ... 0 ... ... ... ... ... ... ... 0 Influenza ... ... ... ... ... ... ... 0 ... ... ... ... ... ... ... 0 Diarrhœa & Choleraic Disease 17 10 7 12 3 ... ... 15 ... ... 2 ... 1 ... 2 14 Totals of Zymotic Class 174 76 98 32 93 25 5 155 9 2 7 1 1 ... 30 143 2. Tubercular 165 84 81 54 18 2 16 90 35 34 6 ... 1 ... 15 149 3. Of Brain, Nerves, &c. 136 87 49 39 17 2 7 65 8 20 38 5 3 ... 17 116 4. Of the Heart, &c. 56 33 23 5 ... 3 1 9 8 16 23 ... 3 1 8 44 Of Respiratory Organs 260 121 139 64 53 1 5 123 27 42 57 11 3 2 39 216 6. Digestive Organs 27 9 18 6 2 1 1 10 1 5 10 1 1 ... 6 20 7. Urinary Organs 20 8 12 1 2 1 3 7 3 5 5 ... 2 ... 2 16 8. Of Organs of Generation 9 2 7 ... ... ... ... 0 2 5 2 ... ... 1 1 7 9. Of Cancer, &c 14 5 9 1 ... ... ... 1 3 6 4 ... 1 ... 2 11 10. Syphilis 16 6 10 9 4 ... ... 13 3 ... ... ... ... ... ... 16 11. Premature Birth, Low Vitality, Malformation, &c. 36 18 18 36 ... ... ... 36 ... ... ... ... ... ... 5 31 12. Of Uncertain Seat 17 2 15 2 ... ... ... 2 ... 5 10 ... ... ... 4 13 13. Age 57 20 37 ... ... ... ... 0 ... ... 34 23 4 2 51 14. Violence 13 11 2 4 1 ... ... 5 2 3 3 ... ... ... 2 11 15. Joints and Bones 2 1 1 ... ... ... ... 0 ... 1 1 ... ... ... 1 1 Total 1002 483 519 253 190 35 38 516 101 144 200 41 19 4 134 845 * This table includes all deaths in the Infirmary at the Union. 33 Zymotic Mortality.—The deaths from this class of disease are 17 in excess of the previous year; the increase being in Measles, Scarlet Fever, and Fevers generally. Whilst the most marked decrease is in Diarrhoea, 17 being registered, a less number than for years past: owing no doubt to the low temperature prevailing during the summer months. There is also a decrease in Small Pox, 2 being returned as against 8. In Whooping Cough also there is a decrease, 9 being returned against 30. The total number of deaths were 174—76 being males, and 98 females; 125 were under 5 years of age, 155 inclusive were under 20, and 19 from 20 to 80 years and upwards. The number of fatal cases under 5 years of age is large, but then it is seen that 98 of the total number were registered as Scarlet Fever and Measles, diseases particularly applicable to children. The deaths from Fevers were classified as follows:— Typhoid, 14; Enteric, 5; Continued, 2; Rheumatic, 2; Typhus, Relapsing, Slow, and Intermittent, 1 each. In the class Typhoid several were registered, as for instance Pneumonia Typhoid; the Medical attendant expressed his surprise that the Registrar-General should record them as Typhoid Fever, as they were nothing of the kind. No less that 7 such deaths are included in the above number. The death-rate from this class of disease was 4 2 per 1,000. The following table contrasts all deaths from Zymotic causes during the past 8 years c 34  1872 1873 1874 1875 1876 1877 1878 1879 Small Pox 4 1 0 0 3 13 9 2 Measles 24 11 8 17 35 8 34 43 Scarlatina 3 3 5 48 20 8 4 55 Diphtheria 15 3 5 7 6 2 3 7 Quinsy 0 0 0 0 0 0 0 0 Croup 7 6 16 5 6 5 10 8 Whooping Cough 31 24 30 20 39 18 36 11 Typhus, &c. 13 22 15 14 19 25 15 27 Erysipelas 5 4 4 9 0 3 4 2 Metria, Childbirth 2 4 11 6 5 3 1 2 Carbuncle 1 0 0 0 0 0 0 0 Influenza 0 0 0 0 0 0 0 0 Diarrhœa & Cholera 32 37 43 35 43 22 41 17 Totals 137 115 137 155 168 107 157 174 Other Causes of Death.—These diseases collectively give an increase on the previous year of 77; 828 were returned—407 being males and 421 females. Diseases of Respiratory Organs, excluding Phthisis, gives 260 deaths, viz., 142 Bronchitis; 75 Pneumonia, and 43 from other Lung diseases. 121 were males, 139 females. The Tubercular class resulted in 97 deaths from Phthisis; being an increase of 19 on 1878. Atrophy, 59; Scrofula, 5; and Hydrocephalus, 4. The whole number being 165, of which Consumption and Atrophy are the chief factors. 84 were males, and 81 females. Diseases of Brain and Nerves were 136 ; Heart, 56; Digestive Organs, 27; Urinary, 29; Organs of Generation, 9; Cancer, 14; Syphilis, 16; Premature Birth, 36; and Old Age, 42. Of the 828 deaths from these classes of disease, 221 were under 1 year; 97 between 1 and 5; 361 under 20, inclusive; 20 to 40, 93; 40 to 60, 142; 60 to 80, 193; and above 80, 91. 35 The following Table contrasts all deaths from nonZymotic causes causes during the past eight years:— 1872 1873 1874 1875 1876 1877 1878 1879 Tubercular, including Phthisis 106 106 113 148 149 172 143 165 Of Brain, Nerves, &c 76 100 115 130 119 148 137 136 Of the Heart, &c 24 34 31 37 49 55 53 56 Of the Respiratory Organs, excluding Phthisis 105 156 151 197 160 124 204 260 Of Digestive Organs 18 11 23 27 19 37 27 27 Of Urinary Organs 4 4 6 10 13 14 10 20 Of Organs of Generation 2 6 3 7 8 8 3 9 Of Joints, Bones, &c 0 0 4 8 4 1 2 2 Of Cancer 15 14 10 2 23 22 23 14 Premature Birth, Low Vitality, Malformation, &c. 22 23 26 37 30 30 31 36 Of Uncertain Seat 61 50 27 39 37 25 29 17 Age 46 51 22 39 53 47 58 57 Violence 28 4 15 15 18 23 20 13 Syphilis 0 0 6 9 4 7 11 16 Totals 507 559 552 702 684 714 751 828 Total deaths from all causes, including all deaths in the Infirmary, in the respective years were— 1872 1873 1874 1875 1876 1877 1878 1879 644 674 686 857 852 820 908 1002 The deaths in the Infirmary were 204. The death-rates per 1000, excluding Infirmary deaths and its population were— 1872 1873 1874 1875 1876 1877 1878 1879 17.0 17.6 17.2 20.2 19.5 17.1 18.5 20.0 36 Ages at Death.—As in previous years the mortality in children was very large. Under 5 years, 443 were registered (of these 23 lived 2 hours; 35, 4 days and under); from 5 years to 20, 73 were returned; from 20 to 40, 101, the majority being from Phthisis; 40 to 60, 144; and above 60, 241—the eldest being a male, 91. Inquests.—During the year 23 Inquests were held on the bodies of 18 males and 5 females, being a decrease on the previous year of 15. Six other cases of sudden death were sumbitted to the Coronor, who did not deem an inquiry necessary. The verdicts on those held were as follows:— From Natural Causes 10 „ Accidental Causes 6 Found Dead 2 Suicide 5 Of the accidental causes, 4 were on infants suffocated under the bed-clothes, and 1 fell into a tub of pigs' wash and was so suffocated. Of the found dead, one was in the river, and one in a garden. The suicides were respectively:— Male, by Hanging. „ „ Shooting himself in the mouth. ,, „ Cutting his throat. „ „ Throwing himself from a window. ,, ,, Placing himself on a railway. Each of these latter cases were of unsound mind. The suicides are three in excess of last year. Whilst those of infants suffocated in bed with their parents, but 4 as compared with 9. 37 Uncertified Deaths.—Although the Inquests are fewer in number than the previous year there were no less than 29 persons who died without any legal Medical attendance, and with the exception of the 6 mentioned above, submitted to the Coronor, 23 were buried without any inquiry being made except by the Registrar into the cause of death. As most of these uncertitied deaths are those of infants, it is most unsatisfactory they should be consigned to the grave simply on statements of interested parties made to the Registrar. An easier mode of hiding crime cannot well be imagined. Social Position.—The per-centage of deaths to social position was as follows:— in relation Nobility and Gentry 1.9 Professional .4 Middle and Trading 13.4 Labouring 84.3 100.0 Disease and Mortality amongst the Union Poor.— The number of cases which came under treatment were 281—107 being males and 174 females. On reference to Table V. Appendix will be found the nature of the various diseases. Small Pox shews a decrease, as also Diarrhoea. Lung diseases were 68; Violence 9; and other diseases 154, consisting chiefly of Debility, Catarrh, Rheumatism, &c. All the Small Pox cases were removed to the special Hospitals; and each one took place in adults with the exception of a child 5 years of age, not vaccinated. It will indeed be deplorable if persons can purchase immunity from having their children vaccinated by the payment of a nominal line, as appears to be the intention of the present legislative body. I say deplorable, for nothing can be more positive than the saving effects of vaccination against this most loathsome of all diseases. 38 Of the 281 cases there were 20 deaths, which gives a death-rate of 7 per cent. This rate does not include those who were sent to Hospital, some of whom no doubt died. Vaccination and Re- Vaccination. — The number of Vaccine operations performed at the Public Station were— Primary Vaccinations 826 Re-Vaccinations 14 Total 840 Sanitary Matters.—A large amount of Sanitary Work has been carried out during the year; as will be seen on reference to the abstract from the Inspector of Nuisances report book at the end of this report. The Epidemics of Scarlet Fever and Measles, have caused a number of houses to be disinfected more than usual; and the success which follows the means we employ is most marked, for it is very rare that a second case makes its appearance after its use. The clothes are hung up on a line and thus fully exposed to the fumes of the Sulphurous Acid. Where the bedding is so soiled, from the discharges of the patient, as to be deemed dangerous and difficult to disinfect it is burned; a fair allowance being made by the Board to induce the owner to allow it to be so destroyed. Yet, notwithstanding the success we attain by burning Sulphur, I must express my opinion that our mode of disinfection will not be complete or certain until a proper chamber is obtained in which articles of soft materials can be submitted to the necessary heat, by which the germs of disease are more effectually destroyed. Constant inspections are being made to keep as far as possible the houses of the people in a good sanitary 39 condition. Whenever fever occurs, the house is frequently visited, disinfectants supplied, instructions given, and when ready, fumigated. In several instances complaints have been made of bad smells in the basement of houses, a board has been removed and the floor found covered with Fœcal matter, owing to defect in drain; in such a case the whole has been removed and covered with disinfectant. The same course was pursued in many of the houses which were flooded with sewage water. The Police Court Avas attended in several cases, both to obtain and enforce orders; the most important being houses in Lothair Street, totally unfit for occupation, and in a wretched condition as regards sanitary appliances. Orders were obtained to compel the owner to put his houses in order, which was done. The Pigs in Latchmere Grove have all been removed in accordance with the Magistrate's order, he seeing the fact that large numbers of these animals, with all the necessaries appertaining to their keeping in increasing neighbourhoods, cannot be kept without emitting noxious organic vapours, which if not actually injurious to health are an intolerable nuisance. The Bramlands piggery was also the subject of inquiry, when orders for removal were obtained and against keeping in the future. A matter of the greatest importance in the keeping of health, and preventing disease, is the supply of pure water. If the water we drink is rendered unfit for dietic purposes, from its pollution with organic matter, as is unfortunately too often the case (see reports of Dr. Frankland), we know not to what extent it may be a factor of disease. It may be efficiently filtered before leaving the Water Works, still it is reported as unfit for use; shewing clearly that the source of supply must be at fault, and 40 that the filtration used is quite unable to remove that which is the source of all danger. To avoid this danger all water before use, should be boiled, and filtered through charcoal. To shew with what (at times) utter thoughtlessness is used in the construction of dwellings with regard to the health of the inmates, the following case will prove. In New Road, Clapham Junction, a case of Diphtheria occurred. On searching for the water cistern, it was found to be placed immediately under the closet-pan. Sawdust was placed on the cover to soak up the drippings from the closet, which was saturated. As might be expected all in the house had the disease, two of whom died; it would be advisable to look to these matters before taking houses. However much your Officers may do, it is almost impossible, in a district such as this is, to have every house and its surroundings under efficient observation. We must look in some measure to the people themselves to assist us in keeping their Sanitary arrangements in such a state, as must be conducive to their health, comfort, and happiness. That a knowledge of this necessity is increasing I am convinced from the frequent improvements made by the people; and it is only by a general diffusion of this knowledge, that we can hope to lessen a very fruitful cause of disease. The following is a summary of the Sanitary Work carried out in the district, supplied by Mr. Richards, the very efficient Inspector of Nuisances:— Abstract of Sanitary Works carried out in West Battersea during the year ending December 31st, 1879:— No. of houses inspected 2376 No. of 1st notices served 357 41 No. of 2nd Notices served 35 Houses disinfected, and where necessary cleansed after Small-Pox Houses disinfected, and where necessary cleansed after various kinds of Fever 27 86 Defective drains cleansed and repaired 109 Cesspools abolished 14 Accumulations of manure removed 16 Dust bins provided 80 Defective apparatus to water closets repaired 106 Water supply added to closets 9 Water supply added to houses 11 Pig nuisances removed 36 Covers to cisterns provided 83 Cisterns provided 4 Sweeping trade refuse into the street discontinued 6 Obstructions on roads and footpaths removed 27 No. of houses where separate drainage has been enforced 12 Dilapidated closets repaired 4 Summonses 49 Order of the Board obtained 19 JOSEPH OAKMAN, Medical Officer of Health, West Battersea. 42 CLAPHAM. The year 1879 is the 24th year of the Medical Officers' Report. The Registrar-General has included the first few days of 1880 in his Annual Summary, so as to reckon 53 weeks in the past year. The following statistical table is presented as usual to give a comparative view of the marriages, births and deaths for the present year and the previous 10 years. Years 1869 1870 1871 1872 1873 1874 1875 1876 1877 1878 1879 Marriages 234 158 249 236 257 284 243 13 319 282 303 Births 838 867 864 858 929 937 965 1029 1019 1095 1125* Deaths 508 480 604 482 475 528 548 545 467 580 561 Excess of Births over Deaths 330 387 260 376 454 409 417 484 552 515 564 * Of this number I successfully vaccinated in 368 cases.—J. M. D. Referring to the above table, I may remark that the marriages in 1879 exceeded those of the previous year by 21, although they are fewer than the two previous years. The births are in excess of any previous year, while the deaths 43 shew a decrease from last year, both satisfactory facts to record. The excess of births over deaths were also greater than any previous year, and constitutes the natural increase of our population. The next Table I have to refer to, is one shewing the number of deaths, during the year 1879, due to the seven principal epidemic or Zymotic diseases. These diseases, the opprobrium of Medical Science, have at all times engaged the special attention of the Sanitarian, with the view of alleviating, removing, or stamping them out, and he hopes some day to achieve this great result, even though at present it appears impossible, for he knows that to perseverance in this direction much is possible. Years. 1869 1870 1871 1872 1873 1874 1875 1876 1877 1878 1879 Small-pox 10 6 94 14 0 0 2 14 12 3 0 Measles 2 14 2 30 11 20 3 13 5 23 17 Scarlatina 29 45 20 6 2 33 22 13 4 12 12 Diphtheria 0 2 3 3 3 4 6 0 3 1 cough 29 9 18 25 14 15 17 17 12 29 25 Typhus 17 12 10 11 10 6 2 5 4 5 9 Diarrhœa & Cholera 30 31 31 39 25 27 22 24 18 26 2 17 Totals 117 119 178 428 65 105 74 86 55 103 81 It is gratifying to note the absence of deaths from Small Pox in the above Table. In the entire sub-district there were in all about 8 cases of Small Pox, of which 5 occurred amongst the parish poor and 3 amongst other classes; but fortunately no death from this most loathsome disease took place in the past year in Clapham. Of the other principal Zymotic diseases, Measles was less in the past year than in 1878, but much in excess of 44 all former years; Scarlatina is equal to the past but is less than the average of former years; Whooping Cough is less than the past but greater than any of the previous 5 years; Diarrhœa is less than any year in the Table; but Fever including Typhus, Typhoid, and Continued, has a greater fatality than the last 5 years. The total deaths from the seven principal epidemics Avere 81 for the year 1879, being 22 less than the previous (1878), and below the average. In the preceding years they vary very much, and will, let us hope, decline in the course of years, owing to the various sanitary works that have been and will be carried out. On the eve of the census of 1881, it would be impossible to estimate our population as we have done on former occasions with anything like accuracy, but by adopting the method followed by the Registrar-General, I place the population of this Sub-district, in round numbers at 33,000 persons. During the year 1879 there were 1125 births registered—males 560, females 565. They yield a birthrate equal to 34.1 births per 1000 or 3.41 per cent, per annum. During the same period there were 561 deaths— males 266, females 295, registered in this Parish, which yield a death-rate equal to 17.0 deaths in every 1000 of our population, or l.70 per cent. In density we count at the rate of 27 persons to the statute acre. In all London 42 persons are counted to the acre. Density of population is an important item in many sanitary calculations. As usual I introduce the following Table, the principal one in this report, relating to the general Mortality of the Sub-district, and containing in a concise and comprehensive form all the Mortality Statistics of the year. 45 STATISTICS OF MORTALITY. CLAPHAM. Population in 1871—27,847. Official population in middle of year 1879— 33,000. Area in Acres—1,233. Total Deaths from each Class of Disease, &c., in the Sub-District. Sex Age Social Position Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. Under 20 years, including all under 10 years. At '20, and under 40 years of age. At 40, and under 60 years of age. At 60, and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, Ac. Middle A Trading Class. Shopmen, Clerks, Ac. Industrial and Laboring Classes. DISEASES And other Causes of Death Classes:— 1. Zymotic Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 17 9 8 7 8 1 16 1 ... ... ... 1 2 3 11 Scarlatina 12 5 7 1 7 4 12 ... ... ... ... ... 2 4 6 Diphtheria 1 1 ... ... ... 1 1 ... ... ... ... ... ... ... l Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 11 6 5 4 5 2 11 ... ... ... ... ... 1 4 6 Whooping Cough 25 8 17 10 15 ... 25 ... ... ... ... ... 2 8 15 Typhus, &c. 9 6 3 ... 1 1 6 3 ... ... ... 7 2 ... 6 Erysipelas. 2 ... 2 ... ... ... ... 1 ... 1 ... ... ... ... 2 Metria, Childbirth 8 ... 8 ... ... ... ... 8 ... ... ... ... 1 1 6 Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa, etc. 17 11 6 9 3 ... 12 ... 4 ... 1 2 ... 3 12 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 102 46 56 31 39 9 83 13 4 1 1 4 10 23 65 2. Tubercular 64 32 32 8 6 ... 21 25 14 4 ... 2 10 20 32 3. Of Brain, Nerves, &e. 70 34 36 23 13 ... 38 7 8 14 3 6 12 17 35 4. Of the Heart, &c. 42 19 23 ... ... 1 1 3 16 21 1 6 8 6 22 5. Of Respiratory Organs 129 61 68 37 22 ... 61 2 3 56 7 4 16 24 85 6. Of Digestive Organs 19 6 6 2 2 ... 4 ... 5 3 ... 1 3 2 6 7. Of Urinary Organs 19 15 4 1 ... ... 1 7 6 4 1 3 8 3 5 8. Of Organs of Generation 2 ... 2 ... ... ... ... ... ... 2 ... 1 ... 1 ... 9. Of Joints, Bones, &c. 3 1 2 ... ... ... ... 1 2 ... ... ... ... 1 2 10. Of Skin ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Premature Birth, Low Vitality, Malformation, &c. 34 18 16 33 1 ... 34 ... ... ... ... 2 3 7 22 12. Of Uncertain Seat ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13. Age 21 5 16 ... ... ... ... ... ... 10 11 3 6 5 7 14. Violence 13 8 5 1 1 1 3 4 4 2 ... 1 2 3 7 15. Not Specified 50 21 29 20 1 3 25 1 5 18 1 8 14 16 12 Totals 561 266 295 156 87 14 271 63 67 135 25 41 92 128 300 46 The two extremes of life, youth and old age, demand a few passing remarks. One of the most melancholy features of the above Table is the death of so many young children under 10 years of age who succumbed to the various diseases and accidental circumstances that make their lives so uncertain. In all they number 267, a very large mortality, out of the total 561 deaths at all ages. At the opposite extreme I find the large number of 159 died at the advanced ages of 60 to 80 and upwards; the oldest died at the ripe old age of 91 years. Amongst the parochial poor there were 807 new cases of illness For many years past they ranged between 800 and 900. The deaths were 43. A great deal of Fever and other epidemics was prevalent, yet amongst this class the mortality was very light. Of the other diseases, the mortality was high, particularly from diseases of lungs, owing to the long, cold, and wet winter we passed through. (See Table V. in the Appendix.) During the year 18 inquests were held; the causes of death, as far as could be ascertained, were— Nine accidental injuries sustained in various ways. Five suicides whilst probably in a state of unsound mind. Three from natural causes, supposed to be heart disease, and some other undefined causes. One from neglect, an infant, unknown. In the past year (and also in the preceding), there were 9 deaths of persons who had not medical attendance, and the causes of whose deaths were not certified in the usual way, thus stultifying the "Registration of Deaths' Act," and facilitating the commission of crime. 47 The sanitary works attended to during the past years will be found in Table VI. in the Appendix. Owing to the large number of houses duly inspected by the Surveyor, the Inspector of Nuisances, and myself, a great deal of useful sanitary work has been accomplished. There was also the annual inspection by the Surveyor, the Inspector of Nuisances, and myself of all the Slaughterhouses and Cow-houses in this parish. In several cases I had to make repeated inspections and suggestions as to improvements which some of the owners were slow to adopt. With reference to our water supply I have nothing more favourable to state this year than I have had for many years past. So long as the water is taken from the Thames it is hopeless to expect a pure water supply. Here is the "Fons et origo mali" of the water difficulty. Dr. Frankland says that the water supplied by the Southwark and Vauxhall Water Company in May last year was much polluted by soluble organic matter. Col. Bolton, government water examiner, says it is impossible to make it fit for drinking purposes. The Water Companies have done everything they could, and at great expense, but fail to supply suitable water for dietetic purposes, and it must be so as long as the source is polluted with sewage. I have long suggested obtaining the water from other sources. It seems to me it may be obtained from the chalk hills of Kent, at no great distance, and requiring neither filtering beds nor storage room. It is hard but good, and of equable temperature. No second service would be required, and there would be no chance of suffering from water famine, as we have occasionally been in danger of doing. JOHN MAC DONOGH. Medical Officer of Health for Clapham. 48 WANDSWORTH. An examination of the following statistics, derived from the Registrar-General's returns, and the parochial records of sickness and mortality, discloses the occurrence in this sub-district, during the year 1879, of higher rates of sickness and death than have obtained for several years. Nevertheless, in consequence of the remarkably low death-rates which have prevailed of late years, that of the past year will be found to have been still below the average. The heightened mortality of the past year was mainly due to the great prevalence of and severity of diseases of the respiratory organs during a winter of unusually low temperature; but it was also in great measure due to the epidemic diseases, Measles, Scarlatina, and Whooping Cough, the latter of which was attended with unusual fatality. VITAL STATISTICS. Population.—According to the method of calculation adopted by the Registrar-General, which is based upon the assumption that the rate of increase of the population has maintained the same proportion since the period of the last census, as that which obtained during the ten preceding years, the mean number of persons living during the year 1879 was 25,093. But this estimate, although sufficiently trustworthy for determining the population of the whole country, is inapplicable to a metropolitan suburb irregularly and disproportionately increasing by 49 tion. A more trustworthy method under the circumstances consists (as was explained in the Annual Report for 1875, pages 6 to 8), in the employment of the ratio borne by the mean annual number of births to the mean annual population during a considerable time as a measure of the ratio borne by the births to the population during the year under review, the proportion of births to population being almost uniformly constant, and capable of accurate verification; by this method of calculation the mean population of the past year was not less than 26,000. Mortality.—The total number of deaths registered during the year was 516, 248 of males, and 268 of females. 104 took place in the following public institutions, viz., in the Surrey County Lunatic Asylum, 85; in the Hospital for Incurables, 11; in St. Peter's Hospital, 3; in the House of Correction, 4; and in the Royal Patriotic Asylum for Girls, 1. 24 deaths of Wandsworth parishioners occurred in the Infirmary of the Union, which were registered in Battersea, in which parish that institution is situated. Death-rate.—The death-rate calculated from the deaths registered and a population estimated by the official method was 20.56 per thousand persons living on an average during the year. But, as has been explained in previous reports, a rate so derived cannot be accepted as the natural death-rate of this sub-district, in consequence of the disturbing influence of several public institutions which requires to be taken into consideration; these are the Surrey County Lunatic Asylum, the Hospital for Incurables, and St. Peter's Hospital, the inmates of which are derived from without the parish, undergo no natural increase, and are subject to a high mortality; the latter formed last year no less than a fifth part of all deaths registered, so that the above calculation must be entirely valueless. To arrive at the natural death-rate, therefore, it becomes necessary to eliminate from this calculation the D 50 population and mortality of the above-named institutions, the deaths of Wandsworth parishioners which occurred in the Union Infirmary being added to the mortality proper to the parish. Thus corrected in the manner indicated, the rate of the past year was 18.04 per thousand. Although this rate is considerably higher than that which has prevailed for several years, it is nevertheless somewhat below the average of the past ten years. The same calculation made with a population estimated from the registered births in the manner previously described, yields a deathrate of 17.39 per thousand, and is no doubt nearer the correct one than the former. Birth-rate.—The number of births registered was 744, 384 of males, and 360 of females. The birth-rate, calculated by the official estimate of the population, was 37.97 per thousand, and the rate of natural increase 19.93 per thousand persons of all ages. These unusually high rates point, as has been already indicated, to the lowness of the estimate of the population as determined by the official method of calculation ; and, inasmuch as they cannot be satisfactorily accounted for by a correspondingly large and sudden increase in the fecundity of the population, they must be necessarily attributable to an augmentation of the population by immigration, a supposition fully confirmed by the large number of houses Avhich have been erected and inhabited during the past two years. Calculated from the estimate of the population based on the pre-determined rates which the births bear to the population in a given time, the birth-rate of the past year was a little under 29 per thousand, and the rate of natural increase 12.39 per thousand. 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. 51 STATISTICS OF MORTALITY. WANDSWORTH. Population in 1871—19,783. Official population in middle of 1879—25,093. 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, Mer chants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labonuring Classes. DISEASES, And other causes of Death. Diseases Classified. Classes:— 1. Zymotic Small Fox 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 Measles 16 10 6 2 11 3 16 ... ... ... ... ... ... ... 16 Scarlatina 15 7 8 1 6 5 14 ... ... ... ... ... 2 13 Diphtheria 1 1 ... ... 1 ... 1 ... ... ... ... ... ... ... 1 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 8 6 2 2 4 2 8 ... ... ... ... ... ... 4 4 Whooping Cough 44 22 22 16 28 ... 44 ... ... ... ... ... 2 11 31 Fever 8 2 6 1 1 5 3 1 1 2 4 Erysipelas 4 4 ... 1 ... ... 1 1 1 1 ... ... ... ... 4 Metria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhœa &c Dysentery 7 6 1 1 1 ... 2 ... 2 3 ... ... ... 1 6 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals of Zymotic Class 104 59 45 24 52 10 91 6 3 4 ... 1 3 20 80 2. Tubercular 62 33 29 19 5 ... 32 18 11 1 ... 2 2 13 45 3. Of Brain, Nerves, &c. 96 40 56 13 5 2 23 18 28 26 1 6 3 20 67 4. Of the Heart, &c. 20 13 7 ... 1 ... 2 4 4 9 1 1 4 4 11 5. Of Respiratory Organs 125 54 71 22 26 ... 50 3 27 42 3 3 4 22 96 6. Digestive Organs 21 8 13 3 ... 1 6 2 4 8 1 3 2 7 9 7. Urinary Organs 10 6 4 ... ... ... 1 1 4 2 2 2 ... 5 3 8. Of Organs of Generation 10 ... 10 ... ... ... ... 7 3 ... ... 1 ... 2 7 9. Of Joints, Bones, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Of Skin 11. Premature Birth, Low Vitality, formation, &c. 18 11 7 18 ... ... 18 ... ... ... ... ... 1 3 14 12. Of Uncertain Seat 12 8 4 1 ... ... 1 3 2 5 1 ... 2 2 8 13. Age 26 9 17 ... ... ... ... ... ... 8 18 2 ... 7 17 14. Violence 11 6 5 1 2 1 4 2 4 1 ... ... ... 1 10 15. Not Specified 1 1 ... 1 ... .. 1 ... ... ... ... ... ... ... 1 Totals 516 248 268 102 91 14 229 64 90 106 27 21 21 106 368 52 For reasons similar to those referred to in the determination of the death-rate, it is obviously necessary to exclude Class 3 (Diseases of the Brain and Nervous System) from consideration in estimating the relative proportions borne by the several classes of disease in the causation of the mortality of this parish. The first in order of fatality, irrespective of Class 3, was Class 5 (Diseases of the Respiratory Organs), forming no less than 23 per cent. of all deaths; 78 of the deaths in this Class were attributed to Bronchitis, which was the most fatal single disease, thus assuming the place usually occupied by Consumption The next most fatal was Class 1 (Zymotic —Contagious—Epidemic), which usually takes precedence of the others, forming 20 per cent, of all deaths. Next, Class 2 (Tubercular) formed 12 per cent. The other Classes do not present any noteworthy deviation from their respective averages. The prominent points for observation in the Table are the great preponderance of the deaths from diseases of the Respiratory Organs and of those from epidemic diseases. Ages at death.—Infant mortality. The mortality of children during the past year was unusually high, in consequence of the greater prevalence of the Zymotic diseases incidental to children. 37 per cent. of all deaths occurred to children under 5 years of age, 20 per cent, occurred to infants in the first year of life, and 43 per cent. occurred to persons of 20 years of age and under. Senile mortality.—26 deaths were registered as having resulted from age, unassociated with disease; but 62, 24 males and 38 females (the females as usual having the advantage in longevity over the males), took place above the age of 70; viz., from 70 to 75, twenty-seven; 75 to 80, thirteen; 80 to 85, eleven; 85 to 90, six; 90 to 95, three and 2 females attained the extreme age of 97 years, one of whom was born at Summerstown, and her age was verified by the register of All Saints Church. 53 Social position of the deceased.—71 per cent. of all deaths and 77 per cent. of the deaths from epidemic diseases took place amongst the labouring population; These figures do not greatly exceed the average, so that notwithstanding the extensive prevalence and fatality of epidemic diseases, and the occurrence of a high death-rate, during the past year, the working classes did not suffer, as might be expected, a disproportionately large mortality, a result which indicates sanitary progress in the most desirable direction. Epidemic diseases—their prevalence and fatality.— The following Table shows the deaths which have resulted faom the seven principal Epidemic Diseases during the past and ten preceding years, and the relation which they bore to the deaths from all causes:— YEARS Small Pox Measles Scarlet Fever Diphtheria Whooping Cough Cholera Diarrhœa Fever—Typhus and Typhoid Total Deaths from Epidemics Total Deaths from all causes Per rentage of deaths from Epidemics to deaths from all causes 1869 •• 23 36 •• 7 •• 23 5 94 429 21.9 1870 •• 2 48 4 16 •• 33 10 113 450 25.1 1871 14 31 23 •• 11 •• 21 3 103 453 22.7 1872 1 5 1 3 13 •• 20 4 47 365 12.8 1873 •• 4 •• 3 8 •• 22 7 44 433 10.1 1874 •• 14 2 •• 19 •• 12 5 52 453 11.5 1875 1 2 5 2 14 •• 17 5 46 420 10.9 1876 1 17 12 1 10 •• 16 12 71 461 15.4 1877 •• •• 21 •• 11 •• 16 9 57 384 14.8 1878 •• 4 2 4 6 •• 19 3 38 422 9.0 1879 1 16 15 1 44 •• 7 8 92 516 17.8 54 It will be seen from the above Table that the number of deaths from these diseases exceeded the average of the past ten years by no less than 39 per cent. This excess was due to Scarlatina, Measles, and Whooping Cough, which prevailed extensively during the spring, summer, and winter quarters of the year, the last-named disease having been attended with unusually great fatality during the months of February, March, April, and May, the result, probably, of the low temperature which prevailed during that period. Indeed, the temperature of the whole year was unusually low, and may have some relation to the remarkably small amount of Diarrhoea which prevailed. The months in which the deaths from these diseases occurred and the mean temperature of each quarter are shewn in the following Table. 11 cases of Small-Pox and 5 of Fever were sent to Hospital for treatment, and therefore do not appear in the Table, 3 of the Small Pox cases terminating fatally. DISEASE. January- February March April May June July August September October November December Mean Temp. 37°.1 Mean Temp. 49°.5 Mean Temp. 58°.1 Mean Temp. 39°.9 Small Pox .. .. .. .. .. 1 .. .. .. ... .. .. Measles 3 .. .. .. .. .. .. .. .. .. 6 7 Scarlatina 2 .. .. 3 4 2 .. 2 1 .. .. .. Diphtheria .. .. .. .. .. .. .. .. .. .. 1 .. Whooping Cough .. 7 16 10 6 1 1 .. .. .. 1 3 Diarrhoea .. 1 .. .. 1 1 .. .. 2 2 .. .. Fever 2 .. .. .. 1 1 .. .. .. 1 2 1 Totals 7 8 16 13 12 6 1 2 3 3 10 11 Sickness and mortality amongst the parochial poor.—The nature, amount, and fatality of the sickness which came under treatment amongst the parochial poor during the year is exhibited in Table 5, Appendix. The amount of general sickness was greater than the average by about 12 55 per cent., but the resulting deaths were one-third greater than the average, forming nearly 6 per cent. of all cases of sickness, The amount of epidemic disease was about 9 per cent. above the average, but its resulting fatality was two-thirds greater than the average. The number of epidemic diseases formed 13 per cent. of all cases of disease which came under treatment; and the number of deaths from epidemic diseases formed 32 per cent. of the total deaths which occurred amongst the poor. Violent deaths.—Inquests.— Uncertified deaths.—During the year there were 25 Inquests held, with the following results, viz. :— Deaths from natural causes, 14. Deaths from violence Accident, 7 Suicide, 2 Execution, 1 Cause unknown, 1 In 6 instances the cause of death was not certified by medical testimony, in reference to which it is almost unnecessary to repeat what has been so frequently urged in these reports, that for security of life, and other interests of society, the intervention of a medical enquiry is an absolute necessity in every case of death the cause of which has not been duly attested by a registered medical practitioner. Sanitary proceedings.—A summary of the principal sanitary proceedings which were carried out during the year will be found as usual embodied in Table 6, Appendix. With two excetpions they were all conducted without the necessity of an appeal to the law. In addition to these all the cow-houses and slaughter-houses were examined and reported on, their greatly improved condition, and the excellent regulations put into practice by the Metropolitan Board of Works obviating the necessity of any opposition to the reneAval of their oAvners' licenses. The purification of infected houses was systematically employed when required, and often Avith marked success; and it is satisfactory to see 56 that there has been no relaxation in the ordinary work of sanitation. A large amount of work is recorded in the Table, but, it should be added, very imperfectly represented by figures which shew results but fail to shew the means by which those results were obtained, as when, for instance, the removal of a single nuisance necessitates several examinations and reports, attendances at the Police Court, &c. For remarks on the water supply to the district, (which, according to Dr. Frankland, continues to be the most polluted of all those furnished to the metropolis), and other matters possessing a general as well as local interest, the reader is referred to the introductory part of the Report. GEORGE EDWARD NICHOLAS, M.D. Medical Officer of Health for Wandsworth. 57 STREATHAM INCLUDING BALHAM AND TOOTING. The health of this sub-district during the year 1879, was remarkably good, the death-rate was low; even when calculated upon what I believe to be a considerable underestimate of the population. Zymotic or Epidemic diseases (excepting Whooping Cough) were not prevalent, and the deaths from the more preventable diseases of this class were below the average. Doubtless the low temperature and continuous rainfall contributed to this favourable result; whilst on the other hand these unusual climatic conditions tended toAvards a greater prevalence of and increased the mortality arising from diseases of the Respiratory Organs. Thus fully a third of the whole mortality Avas referable to diseases of the Lungs, either as the sole cause of death, or as a fatal complication of other diseases; evidence in support of these remarks, and other particulars, will be found in the following statistics derived chiefly from an analysis of the Registrar-General's Returns. Vital Statistics. Population.—It is extremely difficult to estimate the population of an increasing district like this Avith anything like accuracy; that it has been under-estimated of late 58 years there is little reason to doubt. In support of this view I may mention that over 3,000 houses are now rated in Streatham alone. 1,000 new houses have become occupied during the last four years, and 200 were let in the autumn of the year under review. The method we adopt in estimating the population does not fairly take into account the rapid influx of new comers. Happily, next year the census will be taken, and when the people are correctly numbered the death-rate and other calculations can be accurately determined and will consequently have a greatly increased value. Meanwhile, calculated in the usual way, there would be about 18,500 people living on an average during the year in Streatham and Tooting. Birth-rate.—The number of births registered were 636—310 were of males, arid 326 of females. Calculated on the foregoing estimate of the population, the birth-rate of the past year was 34.3 per 1,000 persons living of all ages. The excess of births over deaths was 346, the rate of natural increase being 18.7 per 1.000. Deaths and e ath-rate.—There were 290 deaths registered during the year—or only an increase of 6 on the number recorded in 1878 —147 were of males, and 143 of females. The death-rate deduced from the whole of the deaths registered, and the estimated population was 15.6 per 1,000 persons living on an average during the year; this rate compares favourably with the healthiest districts; but in view of the probable underestimate of the population it is 2 per 1,000 above the actual death-rate. The following table shews clearly the cause of death, sex, age, and social position of all persons whose deaths were registered during the year. 59 STATISTICS OF MORTALITY. STREATHAM, including TOOTING & BALHAM. Population in 1871—14,475. Official Population middle of 1879—18500. Area in Statute Acres—3,465. Total Deaths from each Class of Disease, Ac., 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, Ac. Middle A Trading Class, Shopmen, Clerks, &c. Industrial and Laboring Classes. DISEASES And other Causes of Death Classes:— 1. Zymotic Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 2 ... 2 ... 2 ... 2 ... ... ... ... ... 1 ... 1 Scarlatina 5 2 3 ... 4 1 5 ... ... ... ... 1 1 2 1 Diphtheria 2 ... 2 ... 2 ... 2 ... ... ... ... ... ... 1 1 Quinsy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Croup 3 2 1 1 2 ... 3 ... ... ... ... ... ... 1 2 Whooping Cough 21 10 11 11 10 ... 21 ... ... ... ... ... 1 4 16 Typhus and other Fevers 3 1 2 ... ... ... 1 ... 1 1 ... ... 2 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Metria, Childbirth 2 ... 2 ... ... ... 1 1 ... ... ... ... 2 ... ... Carbuncle ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dianhœa& Choleraic Disease 3 1 2 2 ... ... 2 ... 1 ... ... ... ... 1 2 Totals of Zymotic Class 41 16 25 14 20 1 37 1 2 1 ... 1 5 11 24 2. Tubercular* 32 19 13 3 2 1 14 13 4 ... ... 1 4 11 16 3. Of Brain, Nerves, &c. 41 22 19 9 6 ... 16 2 3 20 ... 6 5 13 17 4. Of the Heart, &c. 34 16 18 1 1 ... 3 1 11 19 ... 6 5 12 11 5. Of Respiratory Organs 64 31 33 12 12 1 26 3 13 19 3 5 4 15 40 6. Of Digestive Organs 16 11 5 2 1 ... 3 2 5 4 2 4 4 3 5 7. Of Organs of Generation 10 7 3 ... ... ... ... 1 1 5 3 2 4 3 1 9. Of Joints, Bones, &c. 1 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 10. Of Skin 1 1 ... 1 ... ... 1 ... ... ... ... ... ... 1 ... 11. Premature Birth, Low Vitality, Malformation, &c. 19 12 7 19 ... ... 19 ... ... ... ... 1 2 5 11 12. Of Uncertain Seat 6 2 4 ... ... ... ... 1 1 4 ... 1 1 2 2 13. Age 12 3 9 ... ... ... ... ... ... 6 6 2 2 3 5 14. Violence 13 7 6 2 1 1 5 3 3 1 1 ... 1 4 8 15. Not Specified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 290 148 142 63 20 3 124 28 43 80 15 29 37 83 141 * Of the Tubercular class of Diseases, 25 deaths appear to have resulted from Phthisis. 60 Zymotic Diseases —The various diseases in Class I. of the preceding table caused 41 deaths or a seventh of the whole. Over half these deaths were due to Whooping Cough, and this was the only infectious disease which could be called prevalent during the year; it was more especially fatal in the first and last quarter from Lung complications, 16 of the 21 deaths from this disease occurred among the industrial classes. There was no fatal case of Small Pox, nor was any person sent into hospital with the disease, indeed it was hardly, if at all, present in the district. A state of things not likely to continue if the proposed alteration in respect of compulsory vaccination is carried into effect. The remaining five diseases in this class, viz., Measles, Scarlatina, Diphtheria, Fevers, and Diarrhoea, caused altogether 15 deaths as against 31 in the previous year. So that, if we exclude Whooping Cough, the mortality from the principal epidemic diseases was barely half that of the previous year, and below the average of the six preceding years. The mortality from Zymotic diseases yields a percentage of 141 upon the number of deaths from all causes during the year. The following table contrasts all the deaths which resulted from the seven principal epidemic diseases during the past and six preceding years:— 61 DISEASES. 1873 1874 1875 1876 1877 1878 1879 Seven principal Epidemics. Small Pox .. 2 .. .. 4 1 ... Measles 3 9 2 2 2 11 2 Scarlatina 1 3 4 4 1 2 5 Diphtheria .. 1 3 7 3 3 2 Whooping Cough 8 3 5 7 6 11 21 Typhus, &c. 7 2 2 5 5 1 3 Diarrhœa and Choleraic 10 6 9 6 4 13 3 Totals:— 29 31 25 13 25 42 36 Other Diseases.—Tubercular diseases, Class 2, resulted in 32 deaths, not over the average in point of number; but 25 of these deaths were assigned to consumption as against 17 in the year before, and 14 in 1877, shewing an increased mortality from this class of Lung diseases. As might be expected from the cold wet spring, and early and severe winter, other diseases of the Respiratory Organs, Class 5, as Bronchitis, Pueumonia, &c., were in excess—thus 64 deaths were caused by the several diseases in this class. Violence (class 14) has a record of 13 deaths, the number of violent deaths, suicidal and accidental was remarkable; and excepting the year 1876 was double the amount of any one of the six preceding years. The other classes differ little from their averages, and call for no special remark. The following table contrasts all deaths from NonZymotic diseases during the past seven years. 62 Year 1873 1874 1875 1876 1877 1878 1879 Tubercular 35 35 34 31 23 23 32 Of Brain, Nerves, &c. 28 42 41 39 33 57 41 Of the Heart, &c. 23 17 20 18 33 31 34 Of Respiratory Organs 49 19 34 52 36 44 64 Of Digestive Organs 12 17 21 22 25 29 16 Of Urinary Organs 6 3 6 6 7 7 10 Of Organs of Generation 3 2 .. 6 11 2 1 Of Joints, Bones, &c. .. 1 1 2 7 2 .. Of Skin 1 . 1 .. 2 .. 1 Premature Birth, Low Vitality, Malformation, &c. 16 12 14 14 15 17 19 Of Uncertain Seat 6 4 8 2 4 3 6 Age 17 8 20 23 14 17 12 Violence 5 6 6 9 5 3 13 Not Specified 4 1 2 1 •• •• .. Totals 205 167 208 225 215 242 249 Age at Death.—The mortality of young children was below the average. Thus 86 children died under ten years of age, as against 113 in the previous year; 21 per cent. of all deaths occurred during the first year of life; upwards of 6 per cent. to children under 5 years of age, and upwards of 42 per cent. to persons under 20 years of age. At the other extreme of life the mortality was large, though only 12 deaths were registered as having resulted from old age alone; but 57 deaths were recorded as having occurred to persons over 70 years of age:—viz., from 70 to 80, 44; 80 to 90, 12, and one at 92; 25 of these were males and 32 females. Sickness and Mortality among the Union Poor.— Table V. in the Appendix shews the number of persons who were under treatment as well as the deaths which took place among the out-door Union Poor of the district, 99 cases were treated; these figures include only 9 cases of Zymotic disease, 5 of Whooping Cough, 3 of Diarrhœa and 1 of Erysipelas; there was 1 fatal case of Whooping 63 Cough, 1 of Diarrhœa, and 3 deaths arose from diseases of the Lungs. Social Position.—The following table gives the percentage of deaths in the various classes during the year. Nobility and Gentry 29 10.0 Per Cent. Professional Class 37 12.8 „ Middle and Trading Class 83 28.6 „ Industrial and Labouring Class 141 48.6 ,, Total number of deaths, 1879 290 100.0 Inquests, Violent Deaths &c.—18 Inquests were held with the following results.— I. Natural (1) Heart Disease 3 „ (2) Excessive Drinking of Ardent Spirits 1 ,, (3) Sudden Diarrhœa 1 „ (4) Rupture of a Blood-vessel 1 „ (5) Inanition 1—7 II. Accidental (1) Burns and Scalds 2 „ (2) Fracture of Skull, Thigh, &c. 1 „ (3) Fracture from fall in Bedroom 1 „ (4) Overlaid 1 „ (5) Poison 1—6 III. Suicidal (1) Drowning 1 „ (2) Hanging 1 „ (3) Cut-throat 2 „ (4) Decapitated by Railway Train 1—5 18 Sanitary Proceedings.—Table VI. in the Appendix contains a summary of the Sanitary operations, it shews that there was a large amount of work done; 557 new buildings were provided with water-closets, water supply 64 and dust bins; 17,861 feet of new sewers and branch drains were constructed; 527 houses and premises were inspected, and 50 notices served; 72 houses were cleansed and repaired; cesspools were abolished, pig and other nuisances were removed, and ponds and ditches cleansed; these and other particulars are fully set forth in the table. It is satisfactory to find that in no case was an appeal to the law required. The Cow-sheds and Slaughter-houses were inspected, the latter were found in a satisfactory condition. The Cow-sheds were repeatedly visited in order to see that the new regulations of the Metropolitan Board of Works were effectually carried out before the owners of the premises had their licenses renewed. The renewal of the licenses was postponed from time to time pending the alterations in, or reconstruction of, the buildings in accordance with the requirements of the Dairies, Cow-sheds and Milkshops order of 1879. FIELD FLOWERS SUTTON, M.D., Medical Officer of Heal'h for Streatham, including Balham and Tooting. 65 PUTNEY AND ROEHAMPTON. The near approach of the census of 1881 renders it impossible to present statistics of an accurate kind as regards the sanitary condition of this sub-district, as even a hypothetical estimate of the population of a rapidly increasing suburb is a matter of great difficulty and uncertainty. Still, the fact that 7 fewer deaths were registered in 1879 than in the preceding year is evidence, which requires no elaborate statistics to prove, of an advance in the direction towards which all sanitary effort is aimed—a substantial reduction in the death-rate. Population.—If we estimate the population according to the rate of increase prevailing between the last two census (1861-71), this sub-district in the middle of the year 1879 contained about 11,900 persons. This we are bound to accept as the official estimate, and to found our statistics upon, though we have good reason for believing it an under-estimate. Births and birth-rate.—The number of births registered during 1879 was 327. This is a decrease of 11 upon the births of last year, and of 24 upon those of 1877. Of these, 174 were of males, and 153 of females. The birthrate was 27.4 per thousand, or 1 birth in every 36 persons. Deaths and death rate.—The deaths registered during 1879 numbered 179, 89 of males and 90 of females. The death rate, according to the official estimate of population, is 15.0 per thousand. The deaths registered during 1878 were 186, and the death-rate 16.0 per thousand. This contrast is all the more gratifying when it is recollected that the Registrar-General has included another week in the year E 66 YEARS. Births. Birth-rate. Number of Deaths from all Causes. Death-rate. Rate of Natural Increase. 1869 248 26.6 133 14.9 12.8 1870 271 29.5 145 15.7 13.7 1871 275 28.9 151 15.8 13.0 1872 279 28.4 144 14.6 14.0 1873 320 30.6 125 13.3 18.3 1874 290 27.8 156 15.0 12.8 1875 292 27.3 167 15.7 11.6 1876 300 27.3 143 13.0 14.3 1877 351 31.1 170 15.0 16.0 1878 338 29.1 186 16.0 13.1 1879 327 27.4 179 15.0 12.2 1879 beyond the usual number, to compensate for the shorter years preceding. The Table here presented compares the year under review with the 10 preceding years. It will be seen that the difference between the births and deaths was 146, which represents the natural increase of population for the year. The rate of this increase is 12.2 per thousand. The death-rate of the year 1879 is probably, with the exception of 1876, the lowest on the Table since the discrepancy between the official population upon which the death-rate has been calculated, and the real, was greater during the former year than any other year of the series. The Table which follows is, in an abridged form, the same as that employed by the Registrar-General, and also arranged according to the classification of diseases drawn up by the College of Physicians of London, for use in certifying the causes of death. Some sub-classes which appeared to me unnecessary, have been omitted, and others which I deemed useful in classifying the causes of death, adopted. 67 STATISTICS OF MORTALITY. PUTNEY and ROEHAMPTON. Population (Census) 1871— 9,439. Official Population in middle of the year 1879— 11,900. Area in Statute Acres—2,170. Total Deaths from each Class of Disease, Ac., in the Sub-District. Sex age Social Position Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. At 10 and under 20 years of age. 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 A Trading Class, Shopmen, Clerks, &c. Industrial & Labouring Classes. DISEASES, And other Causes of Death. Classes:— I. Zymotic Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlatina 3 2 1 .. 2 1 .. .. .. .. .. .. 1 .. 2 Diphtheria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Typhus and Typhoid Fever 2 2 .. .. 1 .. .. 1 .. .. .. .. .. 1 1 Remittent and other Fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Diseases 4 .. 4 .. .. .. .. 4 .. .. .. .. 1 1 2 Croup 1 .. 1 .. 1 .. .. .. .. .. .. .. .. .. 1 Whooping Cough 8 1 7 2 6 .. .. .. .. .. .. .. .. 1 7 Erysipelas 1 .. 1 .. .. .. .. .. .. 1 .. .. 1 .. .. Diarrhoea, Dysentery, & Cholera 7 2 5 5 1 .. .. .. .. .. 1 .. .. 4 3 Other Zymotic Diseases 1 1 .. .. .. .. .. .. 1 .. .. .. 1 .. .. Totals of Zymotic Class 27 8 19 7 11 1 .. 5 1 1 1 .. 4 7 10 II. tutional Gout, and Rheumatism 1 .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. Cancer & other Tumours 3 1 2 .. .. .. .. .. 1 2 .. 1 1 .. 1 Tubercular 23 13 10 3 4 1 2 10 2 1 .. .. 3 7 13 III. Local Nervous 34 20 14 10 1 1 .. 4 6 10 2 1 8 9 16 Circulatory 13 6 7 .. .. .. .. 2 4 5 2 .. 1 4 8 Respiratory 42 19 23 11 5 4 2 1 3 11 5 .. 3 15 24 Digestive 9 7 2 4 1 .. .. .. .. 4 .. .. 2 2 5 Urinary 4 2 2 .. .. .. .. 1 .. 3 .. .. 2 1 1 Generative 1 .. 1 .. .. .. .. .. 1 .. .. .. .. 1 .. Locomotory .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Integumentary 2 l 1 1 1 .. .. .. .. .. .. .. .. 1 1 IV. Developmental Premature Birth, Atrophy, &c. 8 5 3 7 1 .. .. .. .. .. .. .. 3 1 4 Old Age 5 1 4 .. .. .. .. .. .. 2 3 1 3 1 V. Violence 7 6 1 1 .. .. .. 2 3 1 .. .. 1 .. 6 Totals 179 89 90 44 24 7 5 25 21 40 13 3 28 51 97 68 Zymotic diseases.—It is very satisfactory to notice that the reduction in the number of deaths during the year 1879 is entirely in the infectious or zymotic group of diseases. The total deaths in this sub-division was 27, as compared with 36 in 1878. The Table below gives a comparative view of the mortality from the seven chief epidemic diseases during the past decade. Y ears. 1869 1870 1871 1872 1873 1874 1875 1876 1877 1878 1879 Small-pox. ... ... 1 ... ... ... ... 1 ... 1 ... Measles 5 4 1 ... 2 3 ... 1 2 7 ... Scarlatina 6 3 21 7 ... ... ... 3 6 ... 3 Diphtheria 2 1 1 1 ... 1 4 ... 1 1 ... Whooping- cough.6 3 1 6 1 ... 9 7 ... 4 8 Typhus, &c. 5 ... 1 ... 2 ... ... ... 4 3 2 Diarrhcea & Cholera 7 8 6 5 1 6 7 5 710 7 Totals 31 19 32 19 6 10 20 19 20 26 20 Percentage of Deaths from Epidemics to deaths from all causes. 22.3 12.4 21.4 13.1 4.8 6.4 11.9 13.2 13.0 13.8 11.2 It will be seen that with the exception of 1873-4, the past year has a lower relative mortality as regards these diseases than any other year in the series, viz., 11.2 per cent. No Small-pox, Measles, or Diphtheria in a fatal form occurred during the year. Whooping Cough was almost epidemic at the beginning of the year, and Scarlet Fever prevailed during the latter part. Diarrhoea was of an average fatality, and, as usual, chiefly occurred during the autumn season. One case of Small-Pox occurred amongst the pauper class (see Table 5, Appendix), and was removed 69 to hospital and there died. The epidemic disease is arranged chronologically in the table below. The mean temperature DISEASE. 1879. First Quarter. Second Quarter. Third Quarter. Fourth Quarter. Mean Temperature 37°.l 49°.5 58°.l 39°.9 Small Pox ... ... ... ... Measles ... ... ... ... Scarlatina ... ... 2 1 Diphtheria ... ... ... ... Whooping Cough 3 3 ... 2 Diarrhœa 2 ... 4 1 Fever 1 1 ... ... Total 6 4 6 4 for each quarter is also shewn, from which it may be seen that the year was unusually low in temperature throughout. The mean for the year was 46°.2, 2.4 below the average of 108 years (see Table III, Appendix.) This may account for the diminished epidemic diseases, for cold is not favourable to most forms of epidemic disease. The year was, however, unhappily very humid, the rainfall amounting to 31.3 inches, being 6.0 inches above the average of 64 years. In 1878 the mean temperature was 49°.6, 1.0 above the average, and the rainfall 29.2, 3.8 above the average. Thus we had cold and moisture in 1879, and heat and moisture in 1878, an epidemic mortality being increased in the latter (especially from Diarrhoea), and diminished in the former. Although, happily, our infectious disease was very slight, we found not infrequent use for the disinfecting oven, and in all probability owe some part of our good fortune to the efficient manner in which it disinfects clothing bedding, and even furniture. Infection has been known to linger, in an active condition, in articles of wearing apparel &c., for months, and even years, and perfect disinfection of many articles is hardly possible without such 70 an apparatus, even if the public would take the trouble required to disinfect in any other way. II. Constitutional diseases.—Rheumatism was fatal in 1 case, and Cancer in 3. Tubercular diseases were less frequent as a total than they have been for the past 6 years, but the section of them known as Phthisis, is larger in proportion than the average, viz., 17 deaths. This is not surprising, from the atmospheric phenomena already commented upon. Years. 1869 1870 1871 1872 1873 1874 1875 1876 1877 1878 1879 C Gout and Rheumatism.. .. .. .. .. .. .. .. .. 3 1 Cancer and Tumours.. .. .. .. .. .. .. .. .. 7 3 Tubercular 20 18 22 24 19 24 26 26 26 32 23 L Nervous 17 18 19 20 26 39 23 26 29 28 34 Circulatory 6 9 9 14 13 8 13 6 8 12 13 Respiratory 15 31 29 26 21 30 36 23 29 37 42 Digestive 11 17 8 7 12 11 7 5 12 10 9 Urinary .. 5 1 5 4 3 8 7 11 2 4 Generative 1 .. 1 .. 2 .. 1 1 2 .. 1 Locomatory.. 1 .. 1 1 .. 1 1 2 .. .. Integumentary .. .. .. .. .. .. .. .. 1 .. 2 P Premature Birth, Atrophy, &c. 11 8 11 6 7 7 16 10 8 7 8 Old Age 4 8 7 3 3 6 11 8 8 7 5 V—Violence 8 4 4 6 5 6 4 7 9 5 7 Totals 99 125 118 124 116 146 147 121 148 150 152 III. Local diseases.—The striking preponderance of fatal cases from respiratory diseases is also in accordance with the above-mentioned atmospheric conditions. The number of deaths from this cause (42) exceeds any year in the series. In all probability the somewhat large mortality from nervous diseases was also contributed to by the cold and moisture, inducing those disturbances of the physical equilibrium which lead, at the extremes of life, to serious nervous derangements. The fatal cases under the subclass of Integumentary were both certified as due to "Eczema," a rare cause of death. 71 IV. Developmental.—It is satisfactory to observe no decided increase in deaths from premature birth, &c. Under that sub-class deaths are often put which, with care and judicious feeding ought not to have occurred. A small number of deaths from old age were registered. V. Violence.—The deaths registered under this class are about the average. Ages of the deceased.—The per-centage of deaths among children under 1 year to the total deaths in 1879 was 24'5 per cent.; in 1878 it was 27.9. Under 5 years 68 deaths occurred, as compared with 87 in 1878, and 70 in 1877; the per-centage is 37.9 of the total. Whooping Cough, Diarrhœa, Convulsions, Bronchitis, and Premature Birth were the chief causes of death among the young. Above 80, 13 deaths were registered, about 7 per cent. of the total. Of these 9 were of females, and 4 of males: the oldest was 91, a female, and the next 88, a male. 53 deaths occurred at 60 and upwards, or nearly 30 per cent. of the total. Diseases of the lungs, heart, and brain were the chief causes of death among the aged. 48 upwards of 60 died in 1878, so that although there are fewer very old, there were more persons died in 1879 of advanced age. Social position.—The proportion of the several classes is as follows:— Nobility and Gentry 1.7 Professional Class 15.7 Middle Class 28.5 Industrial, &c. 54.1 A larger proportion than usuual of the better classes suffered from epidemic diseases. Considering exposure to infection, &c., the industrial classes ought to be greater sufferers than they seem to be. No doubt this 72 fact is due to defective sanitary arrangements in betterclass houses. Inquests and uncertified deaths.—During the year 1879 10 inquests were held. This number is 4 in advance of last year. The verdicts given may be grouped into— I. Accident—drowning, 2; fall, 1. II. Natural—congestion of lung, 1; inflammation of lung, 1; heart disease, 1. III. Suicide—Hanging, 1; cut throat, 1. IV. Found dead, V. Debility from want of food or improper feeding, The last-mentioned case is a striking instance of the danger to which infant life is exposed. The death occurred at an "Orphanage" in College Street, and was clearly due to neglect of the commonest rules of infant management, combined with want of cleanliness. The child, which was healthy at birth, in six weeks died emaciated to a degree inconsistent even with ignorance in dietetic management, and gravely pointing to deficiency in the amount of nourishment afforded. Besides, want of sufficient heat and proper cleanliness contributed to the taking away of the little life. At the inquest the heartless woman who had charge of the child escaped a charge of manslaughter only on account of the impossibility of distinguishing between improper and insufficient feeding of infants. She was proceeded against however under the Infant Life Protection Act for not having her house registered and sentenced to three months imprisonment. In connection with this matter I may however remark, that the Act referred to is far from being efficient, limiting as it does the age of children coming under its protection in Institutions, to two years, and giving no power to enforce necessary improvements even in houses registered under its provisions. Many houses profess to be 73 ported by "charity" and managed by a "Committee," which thus escape registration and inspection under the Act and which have no claim to such exception. Five persons died without medical attendance and without an inquest. It is of course "understood" that there is no suspicion of foul play in any of these cases, but on examining the certificates we find that these died at the ages of seven hours, two days, and two months respectively, and, by a strange coincidence, all of one disease —"Convulsions." It is merely stultifying the register to put the cause of death at all, especially such an unlikely one at the above ages, when dentition had not commenced. Far better register the cause of death as "unknown" than have our statistics swelled up with fanciful diseases. Sanitary Proceedings.—In Table VI. in the Appendix will be found an epitome of the Sanitary operations of the year, for which I am indebted to our active and able Surveyor, Mr. Radford. During the year 819 inspections of houses, &c., were made; in 103 cases it was necessary to give notice of required improvements, and 14 of them required a second application. In four cases it was necessary to obtain an order from the Magistrate, to compel for the public good, the carrying out of improvements. We have 21 cesspools fewer in the sub-district, and one piggery, during the year. Some parts of this Sub-district were subjected during the year to the great fault of our modern sewage system— overflow of the Sewers. This was due to the heavy rainfall frequently exceeding the carrying powers of the sewer, which is well adapted for the conveyance of the ordinary sewage of the district, but can never receive the waterfall of the large area which falls within the limits of this parish There are certain watercourses, especially the Beverly Brook, which should be made to carry off the surface drainage, and so relieve the sewer of that task. 74 Our Surveyor has made every effort to forward this scheme, but as yet without effect. No doubt the overflow of sewage matter into the houses must have seriously affected the health of many families, and therefore demands an immediate remedy. Cow-houses, &c.—It is a matter of satisfaction that the very necessary regulations introduced during the year for the control of the Cowhouses have produced excellent results in this subdistrict. The improvements have been carried out cheerfully and efficiently by the proprietors, though in some cases requiring great alteration, even (in one) re-building of the entire premises. I am certain that the regulations will improve the quality and purity of the milk by increasing the health of the animals, and restore public confidence in the use of one of the most valuable of our food supplies. The regulations admirably meet the wants of the milk trade, except in one particular, viz., the diseased condition of the cows. It is a fact of great importance that tubercular diseases are capable of being transmitted by cow's milk, and some sort of inspection of the condition of the animals should be instituted by qualified veterinary experts. Perhaps cows should be only allowed to be used until a certain age for dairy purposes, being then drafted to the slaughter-house. The slaughterhouses were inspected as usual, and found satisfactory. The Water Supply.—The water supply is now receiving some of the attention the vast importance of the subject demands. ALEXANDER WALKER, M.D. Medical Officer of Health for Putney and Roehampton. 75 APPENDIX OF STATISTICAL TABLES. TABLE I. Summary of Deaths and their Causes, registered in the entire District during 1879, classified according to Sex, Age, and Social Position, and showing also the relative Numbers in each Sub-Distriet. POPULATION of ENTIRE DISTRICT, As corrected by the Registrar General. Census 1871—125,060. Official Population for middle of year, 1879,— 171,900. Area in Statute Acres, 11,695. Total Deaths from each Class of Disease,&c., in the entire District. sub-districts. Sex. Age. Social Position. Clapham—Population in 1871, 27,347, area in acres, 1,233. Wandsworth—Population in 1871. 19,783, area in acres, 2,478. Battersea—Population in 1871, 54,016, area in acres, 2,348. Putney—Population in 1871, 9,439, area in acres, 2,176. Streatham, Tooting. and Balham—Population 1871, 14,475, area in acres, 3,465. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. Under 20 years, including all under 10 years. At 20, and under 40 years of age. At 40, and under 60 years of age. At 60, and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks. &c. Industrial and Labouring Classes. DISEASES, And other Causes of Death. Classes:— 1 .Zymotic Small Pox 4 .. 1 3 .. .. 3 1 1 1 .. 2 2 .. .. .. .. .. .. 4 Measles 125 17 16 90 .. 2 62 63 19 92 13 124 1 .. .. .. 1 3 12 109 Scarlatina 134 12 15 99 3 5 61 73 11 80 33 131 3 .. .. .. 1 4 23 106 Diphtheria 17 1 1 13 .. 2 12 7 .. 13 4 17 .. .. .. .. .. .. 3 14 Quinsy .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Croup 40 11 8 17 1 3 24 16 9 25 6 40 .. .. .. .. .. 1 12 27 Whooping Cough 148 25 44 50 8 21 58 90 60 88 .. 148 .. .. .. .. .. 5 34 109 Typhus & other Fevers 62 9 8 40 2 3 29 33 2 15 6 34 17 5 5 1 2 4 13 43 Erysipelas 13 2 4 6 1 .. 8 5 3 1 .. 5 2 2 4 .. .. 1 1 11 Metria, Childbirth 28 8 .. 14 4 2 .. 28 .. .. .. 1 26 1 .. .. .. 5 4 19 Carbuncle .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa & Choleraic Disease 94 17 7 60 7 3 56 38 55 21 .. 77 .. 8 7 2 3 1 17 73 Totals of Zymotic Class 665 102 104 392 26 41 311 354 180 335 62 577 52 16 17 3 7 24 119 515 2. Tubercular 513 64 62 332 23 32 274 239 151 61 10 276 128 90 19 .. 7 22 77 407 3. Of Brain and Nerves 474 70 96 233 34 41 259 215 130 64 7 217 45 79 122 11 22 30 92 310 4. Of the Heart 203 42 20 94 13 34 110 93 8 4 4 23 27 60 88 5 17 21 42 123 5. Of Respiratory Or gans 891 129 125 531 42 64 428 463 239 208 10 471 48 120 220 32 16 38 139 698 6. Of Digestive Organs 117 12 21 59 9 16 57 60 29 8 2 44 8 26 34 5 10 12 24 71 7. Of Urinary Organs 74 19 10 31 4 10 41 33 2 2 1 10 15 21 22 6 10 14 15 25 8. Of Organs of Generation 25 2 10 11 1 1 3 22 .. .. .. .. 9 11 5 .. 2 1 5 17 9. Of Joints, Bones, &c. 8 3 .. 5 .. .. 4 4 .. .. .. 2 2 3 1 .. .. .. 3 5 10. Of Skin 3 .. .. .. 2 1 2 1 2 1 .. 3 .. .. .. .. .. .. 2 1 11. Premature Birth, Low Vitality, Malformation, &c. 170 34 18 91 8 19 91 79 168 2 .. 170 .. .. .. .. 3 11 30 126 12. Of Uncertain Seat 91 .. 12 68 5 6 31 60 16 5 .. 23 12 24 29 3 3 7 13 68 13. Age 141 21 26 77 5 12 34 107 .. .. .. .. .. .. 73 68 12 9 27 93 14. Violence 83 13 11 39 7 13 56 27 17 8 4 31 18 23 10 1 1 7 11 64 15. Not Specified 68 50 1 17 .. .. 31 37 25 2 3 31 3 15 18 1 8 14 16 30 Totals 3526 561 516 1980 179 290 1742 1784 947 682 102 1878 368 487 658 135 118 210 615 2583 76 TABLE II. Births registered during the year 1879. SUB-DISTRICTS. Males. Females. Total. Clapham 560 565 1,125 Wandsworth 384 360 744 Battersea East—Males, 1190; Females, 1154 2,069 1,932 4,001 West—Males, 879; Females, 778 Putney and Roeliampton 174 153 327 Streatham, including Tooting and Balham 310 326 636 Total 3,497 3,336 6,833 * * The excess of Births over Deaths in the entire district is 3,307. * TABLE III. METEROLOGICAL TABLE FOR LONDON, 1879. (Deduced, from Observations at Greenwich under the Superintendence of the Astronomer Royal, and compiled from Quarterly Tables, furnished to the Registrar General by James Glashier, 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. Residing of Thermometer on Grass. Air. Evaporation. Dew Point. Air— Daily Range. Number of Nights it was Lowest Reading at Night. Highest Heading at Night. Mean. Diff. from Average of 108 Years. Diff. from Average of 38 Years. Mean. Diff. from Average of 38 Years. Mean. Diff. from Average of 38 Years. Mean. Diff. from Average of 38 Years. Mean. Diff. from Average of 38 Years. Mean. Diff. from Average of 38 Years. Mean (Sat°=100). Diff. from Average of 38 Years. Mean. Diff. from Average of 38 Years. Mean. Diff, from Average of 38 Years. Amount. Diff. from Average of 64 Years. At or below 30°. Between 30° and 40°. Above 40°. 1879. o o o o o o o o o in. in. grs. gr. in. in. grs. grs. in. in. Sums. o o YEAR 46.2 —2.4 —3.3 43.9 —2.6 41.2 —24 13.6 —2.3 3.274 —0.022 3.1 —0.2 83 +2 29.770 —0.002 545 +4 31.3 +6.0 109 108 148 13.7 58.5 First Quarter 37.1 —1.7 —2.8 35.2 —2.8 32.3 —3.2 9.9 —2.0 0.184 —0.024 2.1 —0.3 82 +2 29.674 —0.091 554 +2 7.0 +2.0 48 38 4 18.7 44.9 Second do 49.5 —2.8 —3.5 46.4 —2.7 43.1 —2.4 17.3 —2.7 0.284 —0.024 3.2 —0.3 79 +3 29.665 —0.120 540 +1 10.3 +4.5 16 37 38 24.0 56.6 Third do 58.1 —1.6 —2.2 55.6 —0.7 53.3 +0.4 16.1 —3.3 0.408 +0.004 4.6 —0.0 84 +7 29.701 —0.098 530 +1 11.7 +4.4 0 3 89 36.0 58.5 Fourth do 39.9 —3.7 —4.6 38.4 —4.2 36.3 —4.4 11.1 —0.8 0.221 —0.039 2.6 —0.4 87 0 30.042 +0.300 557 +11 2.3 +4.9 45 30 17 13.7 50.0 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. 77 78 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 1869—79. Years. Deaths from the seven principal Epidemics in each Sub-District. Entire District. 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. 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 2796 15.7 1875 74 307 46 20 25 472 3096 15.2 1876 86 340 71 19 31 547 3154 17.4 1877 55 280 57 22 25 439 2991 14.2 1878 103 322 38 26 42 531 3275 16.9 1879 81 355 93 20 36 584 3526 16.5 * * The Diseases included in the above Table constitute, as in the RegistrarGeneral's Returns, the principal maladies only of the Zymotic class—viz.: Small Pox, Measles, Scarlatina, Diphtheria, Whooping-cough, Diarrhoea and Cholera, and Fever. 79 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, 1879. Compiled from the District Medical Relief Books. SUB-DISTRICTS. Total Cases of Sickness treated in each Sub-District. 1—Small Pox. 2—Measles. 3—Scarlatina and Diphtheria. 4—Whooping Cough. 6—Diarrhoea and Dysentery. 6—Cholera. 7—Fever. 8—Erysipelas. 9—Puerperal Fever. 10—Lung Diseases except Phthisis. 11—Phtliisis. 12—Hydrocephalus, Atrophy, Scrofula, and Convulsions of Children. 13—Other Diseases. 14—Violence, Privation, and Premature Birth. Total Deaths in each Sub-District. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Clapham 807 5 ... 6 1 9 ... 6 1 17 ... ... ... 81 1 1 ... ... ... 97 6 16 3 ... ... 508 23 61 8 43 Wandsworth 785 9 ... 7 2 13 6 54 7 18 ... ... ... 3 ... 1 ... ... ... 269 12 6 2 2 2 360 15 43 ... 47 Battersea East 1231 14 ... 25 ... 25 ... 32 1 25 1 ... ... 11 ... 12 ... ... ... 252 5 46 1 2 1 753 7 20 ... 16 West 281 19 ... 3 ... 3 1 ... ... 9 1 ... ... 8 ... 2 ... ... ... 68 8 5 4 1 1 154 5 9 ... 20 Putney and Roehampton 201 1 ... ... ... 1 ... ... ... 11 2 ... ... ... ... ... ... ... ... 43 2 2 ... 1 1 144 l 7 1 7 Streatham, including Tooting and Balham 99 ... ... ... ... ... ... 5 1 3 1 ... ... ... ... 1 ... ... ... 20 3 3 ... ... ... 63 ... 4 ... 5 Totals 3413 48 ... 41 3 51 7 97 10 83 5 ... ... 103 1 17 ... ... ... 749 36 78 10 6 5 1982 51 144 9 138 * * The ratio of deaths to cases treated is 4.04 per cent. 80 TABLE VI. Summary of the Sanitary Operations in the entire District during the year 1879. Clapham. Battersea. Wandsworth. Putney and Roehampton. Streatham, including Tooting and Balham. Totals. Number of Houses and Premises inspected 2000 4,065 377 819 527 7,788 1st Notices served 380 536 82 103 47 1,148 2nd Notices served 125 59 .. 14 3 201 Cesspools emptied and cleansed .. .. .. .. 1 1 Cesspools abolished 1 31 2 12 6 52 Waterclosets constructed or repaired .. 195 6 12 567 785 Houses supplied with water 2 18 6 3 13 42 Drains constructed or connected with Sewer 55 1,062 160 67 204 1,548 No. of feet of New Sewers and Branch Drains 1476 45,774 12,179 1,599 17,861 78,907 Drains repaired or trapped, or obstructions removed 80 179 32 23 97 411 Open Ditches, Ponds, &c., cleansed .. .. 4 .. 1,500 ft. 4 & 1500 ft. Dust-bins provided 170 135 4 13 6 328 Pig Nuisances removed 4 40 6 1 14 65 Accumulations of Offal, Manure, &c., removed 21 26 6 17 14 84 Unwholesome and dilapidated Houses cleansed or repaired 7 206 26 7 72 318 Cases investigated by Magistrates 2 54 2 4 .. 62 Compulstry Orders obtained 2 53 2 4 .. 61 Compulsory works executed 2 53 2 4 .. 61 Works remaining in abeyance from various causes .. .. .. .. .. ..