WAN 34 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 1883. by the MEDICAL OFFICERS OF HEALTH. Lonbon: ashfield, steam printer, bridge road west, battersea. 1884. * - To the Board of Works of the Wandsworth District, Gentlemen, We have the honour to present the twonty-eighth Annual Report on the health and sanitary condition of the Wandsworth District, being for the year 1883. The same arrangement in its construction has been adopted as that hitherto employed, of separate reports of our respective sub-districts, prefaced by a general report on the condition of the entiie district, and illustrated by a series of statistical tables. By these comprehensive means which have been found best adapted for comparing existing conditions with those of former years as well as for furnishing the greatest amount of information of local as well as general interest, we have the agreeable duty of bringing to your notice the favourable state of health that prevailed during the past year. It would appear opportune at the present time to draw your attention also to the great diminution in the mortality that has taken place during the 28 years comprising your official existence. No clearer demonstration of the successful result of your sanitary supervision of this extensive and populous district is required than that afforded by the figures on page 8 of this report, wherein the gradual but great reduction of the 4 rate, amounting to upwards of 3 per 1,000 annually, is so prominently presented. The result there recorded must doubtless be a source of much gratification to your Board, as it is to ourselves, and calculated to ensure a continuance of those exertions which have been so fruitful of beneficial results. We have the honour to remain, Gentlemen, Y our obedient Servants, The Associated Medical Officers of Health of the Wandsworth District. June 19th, 1884. 5 REPORT, 1883. HEALTH AND SANITARY CONDITION OF THE ENTIRE DISTRICT. The health of this district daring the year 1883 will be found, on examination of the statistical and other information presented in the following pages, to have been in a very satisfactory condition; for although it did not maintain the exceptionally low rate of mortality that prevailed during the years 1881 and 1882, it was nevertheless favoured by a death-rate very considerably below the average, and bore advantageous comparison with that of the years referred to by the possession of a greater immunity from zymotic disease. VITAL STATISTICS. Population:—The mean number of persons living in this district during the year 1883, estimated from the rate of increase that prevailed during the ten preceding years, according to the method employed by the Registrar-General, amounted to 229,566. The number of inhabitants in the several sub-districts, of which this total population is made up, is shewn in the table on page 8. 6 Determined by the rate of increase in the number of births (after the manner described in the Report of 1875, page 7), the mean population during the past year was 229,906. The latter number is probably more correct than the former, which however in order to avoid any error of exaggeration has been employed in the calculation of the several rates and deductions which will be subsequently submitted. Births—Birth-rate—Rate of Natural Increase.—The total births registered during the year numbered 8,079, 4,110 of males and 3969 of females. The average annual number during the preceding ten years was 6,381. The numbers that occurred in the several sub-districts will be found compared in Table 1, Appendix. The birth-rate, calculated from the total births registered and the foregoing estimated population, was 35.14 per 1,000 persons of all ages. The rate of natural increase, represented by the excess of births over deaths, was 17.39 per 1,000; the annual average rate of the preceding ten years having been 18.24 per 1,000. Deaths, Death-rate:—The total number of deaths registered was 4,083, 2,023 of males and 2,060 of females. The death-rate, determined from the total registered deaths and the estimated population was 17.79 per 1,000 persons living on an average during the year. The deaths of inhabitants that occurred in Institutions without the district have been for the first time obtained from the office of the Registrar-General. The total number of such deaths amounted to 186, which would raise the foregoing death rate to 18*60 per 1,000. The birth-rates, death-rates, and rates of natural increase of the past and ten preceding years are exhibited in the following table:— 7 Birth-rates, Death-rates, and rates of Naiurat-tncreas in the entire district during the ten gears 1873—82, compared with those of the year 1883. Years. Births. Birth-rate per 1000. Deaths. Death-rate per 1000. Natural Increase. Rate of Notural Increase per 1000. 1873 5053 36.40 2580 18.70 2473 18.00 1874 5221 36.50 2796 19.50 2426 16.90 1875 5529 37.30 3096 20.87 2433 16.40 1876 5999 39.04 3154 20.00 2845 18.51 1877 6159 38.60 2991 18.70 3168 20.00 1878 6508 39.40 3275 19.80 3233 19.80 1879 6833 39.70 3526 20.50 3307 19.23 1880 7038 34.20 3593 17.50 3445 16.80 1881 7582 35.68 3647 17.16 3935 18.51 1882 7889 35.69 3851 17.42 4038 18.26 Mean of Ten Years 1873—82 ) 6381 37.25 3250 19.01 3130 18.24 1883 8079 35.14 4083 17.79 3996 17.39 Excluding the deaths in institutions as a necessity for just comparison with former years, the death-rate of the past year will he found to have been 1.22 per 1,000 less than the decennial average; 1.61 per 1,000 less than the rate of the other South Districts combined; and 2'G1 per 1,000 less than that for all London, the latter having been 20.4 per 1,000 and the lowest ever recorded in the annals of registration. The following death-rates recorded in a period extending from the years 1851—1833, furnish a reliable 8 exposition of the great improvement that has been effected in the sanitary condition of this district during the existence of the Board's jurisdiction. Death-rates in District per 1,000 of the Population. During 10 years, 1851—60 20,40 „ „ 1861—70 19,34 „ „ 1871—80 18,06 During the year 1881 17,16 „ 1882 17,42 „ „ 1883 17,49 The foregoing notable diminution in the death-rate occurring as it has done in a population which has, for the most part, changed its rural to those of urban conditions, and in which therefore, as the result of such change, an increase in the death-rate might have been fairly anticipated, speaks volumes in confirmation of the improvement above cited. The following Table shews the death-rates of the several sub-districts in relation to the amount and density of population and the proportional number of the industrial classes which each sub-district possesses:— * This correction is necessary in consequence of the undue exaltation of the deathrates of Baftersea and Wandsworth by the mortality of the Union Infirmary in the former, and of the Surrey County Lunatic Asylum, St. Petor's Hospital, and the Hospital f ir Incurablcs, in tlxc latter sub-district. SUBDISTKICTS Population in the middle of 1883. Per-centag-e of Total Population Deaths Death-rate per 1000 Death-rate per 1000 corrected for deaths in Public Institutions. Density of Population—No. of Persons to Acre. Relative Number percent, of Industrial and Other Clauses, Census, 1881. Industrial Classes Other Classes Battersea 119,197 51.93 2,344 19.66 18.23 50.8 84.0 16.0 Clapham 38,406 16.73 580 15.10 No. appreciable differ ence 31.1 49.2 50.8 Putney 14,068 6.12 241 17.13 6.4 47.3 52.7 Streatham. 528,042 12.22 419 14.94 8.0 48.5 51.5 Wandsworth 29,853 13.00 499 18.85 16.17 12.0 73.9 26.1 9 The death-rates of the seVei'al sub-districts, Uncorrected for institutions, were all somewhat higher than those of the year preceding. But apart from the disparity which they are invariably found to exhibit as the result of difference of social position and density of population, the relative difference observable between them has not been for a considerable period so great as theretofore; and it is worthy of remark that, on the occurrence of an increase in the death-rate of the district, as in that of last year compared with the two years preceding, the death-rates of the densely peopled sub-districts have not been raised to the same relative extent as in those sparsely populated; from which circumstance it may be reasonably inferred that the effects of sanitation have become manifest in those parts of the district where the greatest necessity has existed for sanitary administration, and where such a result was least likely to be realized. Mortality and its Causes.—The statistics contained in Tables 2 and 3 in the Appendix afford ample means for reviewing the incidence of disease and the causation of mortality throughout the district during the past year. The number and nature of the diseases and other causes of death (arranged in accordance with the classification of the Registrar-General) with the sex, age, and social position of the deceased and the relative numbers that occurred from each class of disease in the several sub-districts are set forth in Table 2; and in Table 3 the classified causes of death are enumerated and compared with those of the preceding ten years. On comparing the relative amount of fatality that resulted from the several classes of disease, the Zymotic class is seen, as usual, to have formed the largest proportion, amounting to 17.1 per cent, of all deaths, and 18 3.04 per 1,000 of the population. The greatest part of this amount was attributable to the seven principal diseases of the epidemic kind. Epidemic Diseases.—These diseases require more than a passing notice not only in consequence of their amenity to sanitary control, but also because, as the death-rate is invariably found to fluctuate with their greater or less prevalence, they furnish a means of indicating to a great extent the sanitary state of a locality. During the past year the deaths from those diseases underwent a considerable diminution compared with those of the two preceding years, and were less than the preceding decennial average by more than 4 per cent. They formed 14.7 per cent, of all deaths, with a death-rate of 2.63 per 1,000 of the estimated population. During the preceding year they formed 15.9 per cent, of all deaths, with a death-rate of 2.79 per 1,000 of the population. A comparison of these death-rates is more conveniently made in the following tabular form which shews the reduction that has taken place during the past six years:— Death-rales of the seven principal epidemic diseases per 1,000 of the population 1878—82, compared with those oj 1883. Years. Rate per 1000. 1878 3.22 1879 3.39 1880 3 .20 1881 2.72 1882 2.79 1883 2.63 Of the above-named diseases, Diarrhœa was the most fatal; the deaths from it however were 10 per cent. 11 less than the average number. The deaths from Measles and Whooping-Cough were of equal amount; the former were 23 per cent, above and the latter 8 per cent, below the average. The deaths from Diphtheria were upwards of one and a half times more numerous than the average. The fatal cases of Scarlatina were considerably less than half the average amount, and those of Fever were less by about a seventh part. 10 isolated cases of Small-pox occurred in different parts of the district, and were removed to hospital, but were unattended with fatality. The incidencc of these diseases in relation to population varied very considerably as usual in the several sub-districts; thus, the deaths from Measles were in excess in Battersea and more so in Clapham, but of relatively small amount in the other sub-districts. Those from Scarlatina were high in Battersea and Putney, low m Wandsworth, and very low in Streatham. As in the preceding year the mortality from Diphtheria in most part fell on Putney, but it was in excess in Wandsworth and more so in Streatham, while it was proportionally low in Clapham and very low in Battersea; the fatality from Whooping-Cough was high in Battersea and very low in the other parishes. The fatal cases of Fever were slightly in excess in Streatham and more so in Wandsworth, while they were low in Putney, very low in Clapham, and of due amount in Battersea. From Diarrhœa the deaths were few in Clapham, and considerably less than half their proportional amount in the other sub-districts, except Battersea, which sustained the bulk of the mortality from that disease. The death-rates from these diseases in the several sub-districts in relation to population as well as to the total mortality are compared with those of the five preceding years in the following table:— 12 No. of deaths from the seven Katio of deaths from the seven principal epidemic diseases principal epidemic diseases to per 1000 of the population. every 100 of the total deaths. Years. Battersea Clapham Putney Streatham Wandsworth Battersea Clapham Putney Streatham Wandsworth 1878 4 .02 3.21 2.24 2'93 1-55 17.8 17.70 13.8 14.70 9.00 1879 4.30 2.40 1.60 1'90 3-50 17-9 14.40 11.10 12.40 17.70 1880 3.60 3.30 1.90 2.50 3.30 18.7 21 .90 14.10 19.50 19.00 1881 3.50 1.93 1.65 1.43 2.44 17.63 14.22 13.70 11.82 13.60 1882 3.09 1.90 4.60 1.10 3.20 15.90 13.60 30.28 9.09 17.27 1883 3.09 2.26 2.98 1.78 1.90 15.74 10.01 17.42 11.93 11.42 The figures in the foregoing table fully corroborate the remarks already made with reference to the disproportionately greater reduction of the rates of mortality in the more densely populated localities. Vaccination.—Although Small-pox was almost absent from the district during the year, Vaccination was as steadily pursued as in previous years. It will be seen on reference to the following Return that of 7877 children, 6647 were successfully vaccinated, and that the remainder were accounted for by death, insusceptibility, or postponement in consequence of illness, with the exception of 434, or 5^ per cent., who had removed to places not known, or Avhose residence could not be discovered. The efficient manner in which vaccination is carried out in this district cannot but become in the course of time a strong barrier against the occurrence of Smallpox ; and if Re-vaccination in the adult were as exhaustively pursued, not by spasmodic efforts in the presence of an epidemic, but by steady and continuous action in the absence of the disease, the event of an epidemic of Small-pox would be impossible. 73 Return made February 7th, 1884, by the Vaccination Officers, respecting the Vaccination of children whose births were registered in the entire district from 1st January to December 31st, 1882 inclusive ;— SUB-DISTRTCTS. Number of Birtlis Returned from 1st January to 31st December, 1882. Successfully Vaccinated. Insusceptible of Vaccination. Had Small Pox. Dead, Unvaccinated. Postponed by Medical Certificate. Removed to Dis| tricts, Vaccination 1 Officer of which has 1 been duly apprised. Removed to places unknown, or which cannot he reached; and cases not having' been found. Battersea 4572 3815 11 .. 394 56 .. 296 Clapliam 1085 926 6 .. 74 26 •• 53 Putney 362 331 .. .. 19 7 3 2 Streatham 891 722 3 • • 72 17 29 48 Wandsworth 967 853 3 • • 69 7 .. 35 7877 6647 23 •• 628 113 32 434 Non-zymotic Diseases.—Diseases of the Organs of Respiration (Class 5) were as usual by far the most fatal of all the causes of death. The deaths from the several diseases of this class were slightly above the decennial average, and were heightened probably by the ulterior effects of Whooping-Cough and Measles. From Diseases of the Tubercular class (Class 2, which includes Scrofula and Consumption), the deaths showed a diminution to the extent of 12 per cent, of the average. The deaths from Diseases of the Brain and Nerves (Class 3), were slightly below the average. Diseases of the Heart (Class 4), were more fatal than the average by 5 per cent. Diseases of the Digestive Organs (Class 6), showed an increase in the number of deaths to the extent of 29 per cent., and 14 Diseases of the Urinary Organs (Class 7), an increase of 37 per cent. The deaths from Premature Birth, Low Vitality, Malformation, &c. (Class 11), decreased 3.6 per cent. Dropsy, Cancer, and others of uncertain seat (Class 12), shewed a decrease in the number of deaths of 1.4 per cent.; and Violence (Class 14), a decrease of 1.2 per cent. The deaths from Age (Class 13), increased 10 per cent, The increase or decrease in the number of deaths that occurred in each class of disease in relation to its decennial average corrected for increase of population is compared in the following table;— CLASSES OF DISEASE, &c. Number of deaths in 1883. Average Annual number of deaths in the ten years 1873-82. {Same averages corrected for Increaso of population. Number of deaths 1883 above corrected average. Number of deaths 1883 below corrected average. 1. Zymotic, viz:— Seven principal Epidemic Diseases. Small-Pox .. 16 20 .. 20 Measles 133 81 102 31 .. Scarlatina 65 94 118 .. 53 Diphtheria 63 19 24 39 .. Whooping Cough 133 115 144 .. 11 Fever 52 49 61 .. 9 Diarrhoea 158 140 176 .. 18 Other Zymotic Diseases 95 66 83 12 • • 2. Tubercular 654 595 744 .. 90 3. Brain and Nerves 574 463 579 .. 5 4. Heart, &c 255 194 242 13 .. 5. Respiratory Organs 829 658 822 7 .. 6. Digestive Organs 234 144 181 53 .. 7. Urinary Organs 99 58 72 27 .. 8. Generative Organs 30 23 29 1 .. 9. Joints, Bones, &c. 25 15 18 7 .. 10. Skin, &c 10 5 6 4 .. 11. Premature Birth, LowVitality, Malformation, &c 241 200 250 • • 9 1'2. Dropsy, Cancer, & Uncertain Seat 114 107 134 .. 20 13. Age 185 134 168 17 .. 14. Violence 94 85 107 .. 13 I5. Not Specified 40 51 64 .. 24 15 Death at different ages.—Infantile Mortality Calculated from the total births registered, the deathrate of infants under 1 year of age was 14.71 per cent, or very slightly below the average which was 14.79 per cent. The deaths of children however under 10 years of age, i.e.—during the period most obnoxious to infectious diseases—amounted to 49.4 per cent, of all deaths, the average of the preceding ten years having been 50.5 per cent. Senile Mortality.—The number of deaths at the extreme of life was somewhat greater than that of the preceding year as well as of the preceding decennial average. The deaths that occurred at 60 years of age and upwards amounted to 21 per cent, of all deaths, the rate of the preceding year having been 20.2, and that of tlio average 20.9 per cent, of the total mortality. All the deaths in the past and ten preceding years are classified according to age for comparison with each other in the following table:— YEARS. AGE. Under 1 yeur | From 1 to 5 years From i) to 10 years All under 20 years From 20 to 40 years | From 40 to GO years j F rom 60 to 80 years 80 years & upwards 1873 636 387 75 1825 326 394 448 127 1874 777 452 107 1438 361 462 419 116 1875 886 467 132 1660 399 422 502 113 1876 910 524 99 1638 398 468 540 110 1877 840 466 109 1517 387 458 525 104 1878 983 600 100 1780 338 483 532 142 1879 947 682 102 1878 368 487 658 135 1880 1,136 600 140 2021 374 500 560 138 1881 1,043 627 132 1938 410 548 599 152 1882 1,082 752 143 2,087 428 557 634 145 1883 1,189 696 134 2,145 484 593 670 191 16 Social position of the deceased.—The relative proportion per cent, of the mortality borne by the several classes of the inhabitants during the five years 1878—82 is compared with that of the past year in the following table:— Social Status. 1878 1879 1880 1881 1882 1883 Nobility and Gentry 1.62 3.30 3.40 2.71 3.43 2.48 Professional Class 5.08 5.90 5.50 5.12 4.44 5.66 Middle Class 18.10 17.40 16.90 19.00 20.85 19.59 Industrial Class 75.20 73.40 74.20 73.17 71.28 72.27 100.0 100.0 100.0 100.00 10000 100.00 The proportion of the mortality borne by the industrial and labouring classes in relation to that of the collective number of the other classes was somewhat higher during the past than in the preceding year; it nevertheless shews a very considerable reduction on that of the average of the preceding five years. The relative proportion per cent, is seen in the table to have been 72.3 per cent, in the past year, the average of the preceding five years having been 73.5 per cent. The diminution in the relative amount of mortality amongst the industrial population which has been often notified in these Reports, indicates such marked improvement in their condition as cannot but be reasonably entertained as the result of the well-sustained sanitary operations of the Board. 17 Inquests—Deaths ly Violence.— Uncertified deaths.—The inquests held during the year were 106 in number, or less by 2 than in the previous year, and formed 4 per cent, of the total deaths. The whole of the deaths which formed the subjects of inquiry in the district as well as in the several sub-districts, with the verdicts, are enumerated in the following table:— VERDICTS. SUB-DISTRICTS. Battersea. Clapliam. Putney. Streatham. Wandsworth. . East. West. Deaths from Natural causes :— 17 14 13 5 4 22 75 Deaths from Violence:— Accidental:— Fall from Van .. .. .. 1 .. .. 1 Fall from Window .. . . .. 1 .. .. 1 Drowning 9 2 1 5 2 5 24 Run over by Train . 2 2 .. .. 1 3 8 Suffocation 8 2 2 .. 1 1 14 Burning 2 1 .. .. .. 2 5 Fracture .. .. .. .. .. 2 2 Fall .. 2 .. .. .. .. 2 Concussion 3 .. .. .. .. .. 3 Run over by Vehicle 2 .. .. .. .. .. 2 Wound of Head •• •• 1 .. .. .. 1 Suicidal:- Hanging .. 1 .. 2 .. 1 4 Shooting .. .. 1 1 .. .. 2 Drowning .. 1 .. 1 .. .. 2 Poison .. .. .. .. .. 1 1 Cut-throat .. 2 .. •• .. .. 2 Homicidal:— Murder .. 1 .. .. 1 1 3 Execution .. .. .. .. .. 1 1 Want of attention at Birth .. .. 3 .. .. .. 3 Found Dead .. .. 2 2 1 .. 5 Found Drowned .. 3 .. 1 .. .. 4 Not Specified •• •• 1 • •• 1 43 31 24 19 10 39 166 74 18 On reference to the table it is seen that of the total number 78 were caused by violence; of these 63 resulted from accident, 11 from suicide, 3 from murder, and 1 from execution. In G instances the cause of death remained undetermined after inquest. Uncertified deaths.—The reduction that has taken place in the number of uncertified deaths during the past few years was remarkably great in that of last year. In the latter the number amounted to 48, or exactly one half only of that of the year preceding. Distributed, there were 18 in East Battersea, 7 in West Battersea, 0 in Clapham, in Putney 5, in Streatham 10, and 2 in Wandsworth. This great diminution in the number of unattested deaths is so far satisfactory; it is nevertheless obvious that until a course of procedure is adopted by which it will be rendered impossible for even one person only to be buried the cause of whose death has not been certified by medical testimony, there cannot be that security to life which the community has a right to expect at the hands of the legislature. (See Annual Reports with reference to this subject, passim.) Sickness and Mortality amongst the Parochial Poor.— Table 5 (Appendix) exhibits the nature, amount, and fatality of the sickness that occurred amongst the parochial poor in the several Sub-districts during the past year, and forms a valuable index of that which occurred in the District generally. The total cases of sickness numbered 2736, the average of the preceding five years having been 2778. The proportion of deaths to cases under treatment was 4-4 per cent., and slightly below the average. Estimated from the proportion which the deaths bore to the cases of sickness, the total amount of sickness that prevailed throughout the District formed 39 per cent, of the population, that of the year preceding by a similar calculation having been 42 per cent. 19 Meteorology.—The climate of the past year, as seen on reference to Table VII. in the Appendix, was like that of the year previous, for the most part temperate. The mean temperature was 49.48 (Farenheit), and coincided with the average of the past 42 years; but it was more equable, the first and last quarters of the year having been warmer, and the second and third cooler than usual. To the cooler temperature of the summer periods the diminution in the amount of fatality from Diarrhœa previously recorded was probably in great measure attributable. The amount of rainfall was 21-9 inches, and OG9 inches less than the average; the largest quantity fell in the first and third quarters, and the least in the second quarter. Water supply.—The water supply of this District, both as regards quality and quantity is still unsatisfactory. According to the report of Dr. Frankland on the waters supplied to the Metropolis during the past year it appears that although all the waters derived from the Thames underwent great improvement as regards filtration, those of the Southwark and Lambeth Companies equally contained on an average the largest amount of organic impurity of all the waters supplied to the Metropolis with the exception of that of the West Middlesex Company; while that of the Southwark Company, by which this District is chiefly supplied, contained relatively the largest amount of impurity, and was in the worst condition as regards turbidity and the presence of living organisms. It is unsatisfactory to find also, in a population which has increased at an annual rate of 6.8 per cent, and is probably still increasing at a higher ratio, that the quantity of water supplied by the Southwark Company during the past year was 16.8 per cent, less, and the quantity supplied by the Lambeth Company, 18 per cent, less than the quantities supplied by those Companies respectively during the year 1881. 20 Source of supply.—The report referred to also contains the following most important information:—“That “several of the Water Companies are now impressed “ with the necessity of ultimately abandoning the rivers “Thames and Lee as sources of water-supply; and some “ of them have already completed works for utilizing “ subterranean waters which have undergone natural “ filtration through great thicknesses of gravel and sand, “ whilst others are sinking deep wells into the chalk." Your Medical Officers sincerely hope that the latter source of supply, for the adoption of which they have So long contended, may be universally and speedily secured. Sanitation.— General remarks.—The sanitary work of the past year was of far greater amount and importance in the maintenance of the health of the District than has been hitherto accomplished. The increase, chiefly consisting of inspections of houses with the remedying their defects, and of the general removal of nuisances, arose out of the special precautions that were adopted against the anticipated advent of Cholera in this country. For the purpose indicated additional Inspectors of Nuisances were appointed who carried out, under the supervision of your Medical Officers of Health, a systematic house-to-house inspection by which a vast mass of sanitary defects was brought to light and remedied which could not otherwise have been discovered. As a result of the labours of those officials it will be seen on reference to Table VI., Appendix, (in which the principal sanitary operations for the year are enumerated), that the number of house-inspections amounted to 32,473; and the number of notices issued for the abatement of nuisances to 3,342. The corresponding numbers of the year preceding were 10,241 inspections, and 1,14.6 notices. 21 The same measures directed to the prevention of the spread of infective diseases were employed as heretofore, but to a greater extent. Every case of such disease brought to the notice of the Medical Officer of Health was immediately removed to Hospital that could possibly be so dealt with; failing which, disinfectants were supplied, and as soon as the recovery of the patient permitted, the house was disinfected by sulphur-fumigation. On the occurrence of a death from infective disease, the house in which such death took place, irrespective of the social position of its occupants, was visited by the Inspector and measures adopted for its disinfection. The houses requiring such procedure were fortunately not so numerous as in the preceding year, and out of 342 that underwent the process, in 4 instances only was a repetition found necessary. This well marked result speaks for itself in favour of the mode of procedure adopted, which it may be observed, constitutes the every day routine pursued at the present time. It is much to be regretted however, that the most important part of its administration viz:—“isolation" of the sick by removal to Hospital, admits of partial application only, inasmuch as Measles, Whooping-Cough and Diphtheria are as yet unprovided for in the Asylum District Board Hospitals. Before the suppression of these preventible diseases can be attempted with success, it will be necessary for hospital accommodation to be extended to the reception of all diseases of the epidemic class. For this purpose Local Hospitals would be required, and notwithstanding some obvious difficulties, smaller hospitals in smaller areas would be more satisfactorily employed for many reasons, of which facility of access with consequently greater safety in the removal of patients is not the least important. 22 There is one other very fertile source of the propagation of infective diseases which needs prevention; it is that presented by the congregation of large masses of children in Board Schools without the intervention of proper medical supervision, under which, we submit, all such schools should be placed. The various proceedings enumerated in the Table are exclusive of many that cannot be so represented, as for instance, the inspection of the Cow-houses and Slaughterhouses of the District, (70 of the former and 52 of the latter), 122 in number, which were all examined and reported on prior to a renewal of their owner's licenses: the attendances at the Police Court; and the numerous nuisances of local interest in the several sub-districts, and several important matters of general interest, which formed the subjects of special reports—many the result of protracted investigation. Collectively the sanitary operations of the past year shew that the supervision of your Board is keeping pace with the progressive sanitary requirements of the District. Amongst the latter however is one which has not received such attention as its great importance demands. We refer to the general administration of Scavenging, which in consequence of the perfunctory manner in which it has been carried out has much detracted from the otherwise efficient system of sanitation pursued in this District. It is in our experience, as it is no doubt in that of most householders, that the removal of house refuse is too infrequent and irregular and very often effected only under pressure of great inconvenience or greater nuisance. It is very desirable therefore that Scavenging should constitute one of the regular daily acts of sanitary procedure; that by its agency the surface of the streets and of the general surroundings of the 23 dwellings of the people should be kept clean, and the pavements washed after the manner in use in some cities, (as in Oxford for instance), with such a prompt removal of animal and vegetable garbage and other house-refuse as to preclude the injurious effects that necessarily result from their prolonged retention in dust-bins which as at present employed create a greater nuisance than that which they are intended to prevent. Efficiently performed in the manner indicated such proceedings would be the means of maintaining a cleanly condition of the District, and one therefore less assailable to sudden and violent attacks of epidemic disease. Further detailed information on matters of local interest is presented in the following Summaries by which each member of the Board may become acquainted with the conditions and requirements of the sub-district which he represents. LOCAL SUMMARIES. 27 BATTERSEA. During the year 1883, the revised census returns for 1881 were issued from the office of the Registrar-General and showed that by a clerical error the population of Eastern Battersea had been over stated to the extent of 2,479 persons, This number has been deducted from its enumerated population and credited to Western Battersea, within which subdistrict such persons resided. The official mean population for the year 1883 of the two sub-districts of the parish according to such revision of the census are as follows:— Eastern Battersea 60,758 Western „ 58,439 Total for whole parish ,, 119,197 The total number of births in the whole parish during the year were 4,711, and the birth-rate 39'52 per thousand per annum. The deaths numbered 2,344 which with the above stated population shews a death-rate for the year of 19-66 including deaths in the workhouse of persons belonging to other parishes. 28 BATTERSEA EAST. The revision of the census, with the usual allowance for an increased number of inhabitants, shews an official mean population for the sub-district during the year 1883 of 60,758, with a density equal to 64 persons per acre in the 947 acres included in its boundaries. It may be mentioned that the Metropolitan density of population is 52*5 persons per acre. As however, large open spaces, such as Battersea Park, the Southwark and Vauxhall Water Company's premises, Latchmere, many acres of building l?.nd as yet uncovered, the premises of the various railway and other public companies, together with those of numerous private manufacturers and others, occupy a very large proportion of the area ot the sub-district; the density of population in those parts which are built upon and occupied must be much greater than that stated above, probably at least twice as great. \ These considerations are of much importance, more especially with reference to the health condition and the mortality rates of the sub-district. No axiom in sanitary science is more abundantly demonstrated than that which asserts that the death-rate increases in direct proportion to the density of a given population. The sickness of a given locality is also increased in like proportion, so that a stationary, or better still, a diminished death-rate, where population is largely increasing in numbers and consequently density, is evidence of good sanitary administration; without which all previous experience demonstrates an increase both in the sickness and mortality of every place so circumstanced. 2 9 STATISTICS OF MORTALITY. BATTERSEA EAST. Total Deaths from each class of Disease, Ac., in the Sub-district. Sex. Age. Social Position. Population (Census) 1881 54,675 Official Population in middle of 1883. 60,758 Area in acres, 947. Diseases and other Causes of Death. 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 and Trading Class, Shopmen, Clerks, &c. Industrial and Laboring Classes. Classes:— SmallPox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 25 12 13 6 16 3 .. 25 .. .. .. .. .. .. 3 22 Scarlatina. 17 11 6 4 11 2 .. 17 .. .. .. .. .. 2 1 14 Diphtheria 6 5 1 1 3 1 1 6 .. .. .. .. .. .. .. 6 Croup 15 6 9 3 12 .. .. 15 .. .. .. .. .. .. .. 15 Whooping Cough 53 28 25 22 30 1 .. 53 .. .. .. .. .. 1 4 48 Zymotic Fevers .... 14 6 8 .. 1 2 1 4 7 3 .. .. .. 1 4 9 Erysipelas 1 .. 1 1 .. .. .. 1 .. .. .. .. .. .. .. 1 Metria, Childbirth 3 .. 3 .. .. .. .. .. 3 .. .. .. .. .. .. 3 Carbuncle .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhoea & Cholera.. 51 21 30 34 8 2 .. 44 •• 2 5 .. .. 5 8 38 Totals of Zymotic Class 185 89 96 71 81 11 2 165 10 5 5 .. .. 9 20 156 2.Tubercular 175 80 95 79 28 4 13 124 97 ?3 1 .. 1 4 20 150 3.Of Brain, Nerves, &c 119 55 64 32 30 9 3 74 10 14 18 3 .. 1 15 103 4. Of the Heart, &c. 44 19 25 1 1 1 2 5 10 19 8 2 ] 2 8 33 5.Of Respiratory Organs 248 144 104 85 84 5 2 170 10 33 27 2 .. 5 20 223 6. Of Digestive Organs 42 20 22 10 2 2 2 16 6 8 12 .. .. 3 8 31 7.Of Urinary Organs 16 9 7 2 .. .. 1 3 4 6 3 .. 1 1 .. 14 8. Of Organs of Greneration 9 .. 9 .. .. .. .. .. 5 4 .. .. .. .. 2 7 9. Of Joints, Bones, &c .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10. Of Skin .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11 Premature Birth, Low Vitality, Malformation, &c. 74 41 33 74 .. .. .. 74 .. .. .. .. .. 2 11 61 12 Of Uncertain Seat 22 10 12 l .. .. .. 1 3 14 4 .. .. .. 8 14 13.Age 21 7 14 .. .. .. .. .. .. .. 6 15 1 1 7 12 14. Violence 24 l6 8 0 9 2 9 15 3 3 3 .. .. .. .. 24 15.Not Specified 24 13 11 19 3 .. •• 22 1 .. 1 .. .. .. 1 23 Totals 1003 503 500 383 231 34 27 675 89 129 88 22 4 28 120 851 30 Births.-The births of 1,217 males and 1,166 females have been registered in the sub-district during the year 1883. The total number of births was 2,383, and the birth-rate, based upon these numbers and the official mean population of 60,758 is equal to 39.22 per thousand per annum. This varies but very little from that of the year 1882, when the rate was 39T3 per thousand. As a fact the birth-rate in this subdistrict has for many years been about 39 per thousand and constitutes a reliable factor in estimating the population at any period between the census years, and determining thereby the mortality rates. Mortality.—The deaths recorded during 1883 as having occurred in Eastern Battersea as shewn in the preceding table, comprehended those of 503 males and 500 females, the consequent total being 1,003. These in a population of 60,758 shew a death-rate of 16-5 per thousand for the whole year. The death-rate for the sub-district for the three preceding years when the population could be determined by the census with an accuracy not possible in former years was as follows:— Death-rate per 1,000. 1880 18.9 1881 16.8 1882 16.4 1883 16.5 This death-rate is equal to that of the most favored rural district, but, as will be demonstrated in the next paragraph the rate of mortality amongst all persons residing in the subdistrict, many of whom die elsewhere, is somewhat higher. Deaths in outlying Institutions. It has been frequently observed, and with a great amount of truth, that while we were able to give the death-rate of people dying within the parish, large numbers of persons go into Hospitals and Infirmaries who reside in this sub-district, there dying of their respective diseases or accidents, and that such deaths if accurately ascertained would materially increase the deathrate and have a tendency to shew that the mortality of the sub-district was equal to that of London generally. 31 By an arrangement between the Board and the RegistrarGeneral an officer attached to the General Register Office now supplies the Medical Office rs of Health with the particulars of parishioners dying in such outlying institutions, and from the sub-district of East Battersea 110 persons were during 1883 driven by sickness poverty or both combined, to seek an admission to Hospital, Infirmary, or Lunatic Asylum. This number of deaths in the population of 60,758 is equal to a death rate of 1*8 per thousand per annum. On the other hand, many persons from the Country attending the Cancer, Consumption or other Hospitals of the Metropolis, for convenience reside temporarily in this sub-district, and while living here succumb to the particular malady affecting them. These cases, although to my own knowledge numerous, as is proved by the many certificates of death given by the Medical Officers of institutions, cannot be isolated, and therefore tend to unduly exalt our death-rate. If to the mortality rate of persons dying in the sub-district, 16'5 per thousand, the death-rate of persons from East Battersea dying in outlying institutions, 1.8 per thousand, be added, a gross death-rate of 18.3 per thousand will result, and as the death-rate for the Metropolis generally was20.4 per thousand for the year under report, a difference of 2.1 per thousand in favor of the sub-district is clearly shewn to exist. Of the deaths in outlying institutions 26 took place in the Wandsworth and Clapham Infirmary; 5 in the County Lunatic Asylum; and 80 in the other Hospitals and public Institutions of the Metropolis. Ages at death.—The ages at death of the fatal cases are to the practical sanitarian of the utmost importance, as the greatest waste of human life takes place during the earlier years. Improved sanitation and the humane care taken of those temporarily disabled by accident or sickness, and of the aged and infirm, have so lengthened the duration of life, that but little more, comparatively speaking, remains to be done in the direction of greater longevity in the case of adults. Under one year of age 383 deaths occurred, or 38.2 per cent. of the deaths at all ages. Of these however 74 died from 32 premature birth, low vitality or congenital malformation; being beyond the reach of life-saving measures. The other 309 cases it is but reasonable to assume include many in which proper food, clothing, and care would have averted the excessive mortality amongst the very young, which it is the aim of sanitarians to reduce. Altogether under 5 years of age 605 deaths occurred or 60.3 per cent of the number at all ages. This is rather below the average but is vastly in excess of what should be the rate. Above 80 years of age 22 persons died during the year, exactly twice the number of the preceding year. Zymotic diseases.—It is in the direction of diseases of this class that careful sanitary administration is expected to indicate progressive improvement by a persistent diminution in the various diseases grouped under this heading. The subjoined table shows this most distinctly; a markedly diminished number of deaths having been recorded year by year, and that in a rapidly increasing population, containing a large proportion of young children, as is indicated by the high birth rate, and amongst whom a great proclivity to these diseases is always to be found. 1883 1882 1881 1880 1879 1878 Whooping Cough 53 56 37 43 39 63 Diarrhœa and Dysentery 51 37 45 78 43 71 Measles 25 33 60 22 47 6 Scarlatina 17 36 20 63 44 19 Croup 15 3 4 4 9 12 Fever Enteric 13 Typhus 1 14 14 17 15 13 12 Diphtheria 6 7 3 2 6 4 Metria (Child-birth) 3 4 8 5 12 2 Erysipelas 136440 Small Pox 0 0 17 1 1 5 Carbuncle 0 1 0 0 0 0 Total 185 194 217 237 218 194 Zymotic death rate per 3.0 3.2 3.7 4.3 3.9 3.7 1,000 per annum. 33 Whooping Cough has for the last two years been the most fatal of the epidemic diseases. It is a disease of early childhood, and except by isolation from those suffering from the disease, is but very slightly under the control of sanitation, the germs or morbific matter communicating it being evidently conveyed by means of the atmosphere from the lungs of one already suffering from the disease to those of the recipient. It has been observed that some complication such as pneumonia or bronchitis is usually the proximate cause of death, and although it is quite possible that the influence of the "materies morbi" of the disease may by affecting the nerve supply of the lungs by the medium of the spinal cord be directly the cause of death in some few instances, still it is to be feared that to injudicious exposure to inclement weather, especially during the earlier spring months, when the majority of deaths from this disease occurs, must be attributed much of the mortality caused by such complications. From Diarrhoea, Dysentery, and allied bowel disorders 51 deaths were registered. This is above the number of the previous year, which was however the lowest recorded, and is less than the average. The fatality of this disease seems to depend upon the temperature of the summer season—hot and dry years producing great mortality amongst young infants—• cold and wet summers arresting the disease. This may be explained on two hypotheses, the first being that great heat is directly productive of bowel affections by inducing decomposition of their contents, and by the effect of high temperatures upon the liver and the other eliminatories of the body ; and this is the generally accepted view. The other explanation is that a cold and wet summer keeps the sewers well flushed and checks decomposition generally, thus preventing the products of such decomposition setting up irritation of the digestive tract. Scarlatina caused but 17 deaths during 1883, the lowest 34 number for some years past. This is the most justly dreaded of all zymotic diseases, not only for its prolonged and uncertain period of infectiveness, but for its numerous and often fatal sequela. To Croup a larger number of deaths has been ascribed than for some years past. This probably arises from the fact that inflammatory affections of the larynx, which would formerly have been certified as laryngitis, are now included in the term " Croup" by many practitioners. The various forms of Fever caused 14 deaths during the year—of these 13 were registered as from Enteric Fever and 1 from Typhus. This is identical with the number recorded last year, and is in accord with the usual average. The other zymotic deaths were but few in number and do not present features calling for special remark. Some cases of Small Pox in Beaufoy Road, necessitated special inspections and reports which were made by me on April 17th, and May 4th, and measures of precaution were taken with the result of arresting the disease in that locality. Of course many cases of zymotic disease were removed to the special hospitals of the Metropolitan Asylums Board during the year. This body, which is far from popular, owing less to any faults in its administration, than to the very natural dislike which every locality feels at being selected as the site for a Small Pox or Fever Hospital for the reception of persons other than its own inhabitants, is gradually educing an efficient system of removal and treatment at its special hospitals, and subsequent isolation at its sanitoria for a sufficiently long period to render almost impossible any danger of infection from the patients discharged by it, to those with whom they consequently come in contact. The system pursued is now tolerably perfect, as the ambulances belonging to this authority now convcy the patients from their dwellings 35 to the special hospitals, whence on recovery they are removed to the convalescent hospitals and thence re-conveyed home. There is thus no danger of infection by conveying persons suffering from infectious diseases by means of cabs, &c., such as formerly existed. During the year there died in Hospitals out of the subdistrict four cases of Enteric Fever; two at Stockwell Fever Hospital, one at Middlesex Hospital, and one at St. George's Hospital. One case of Dropsy after Scarlet Fever died at St. Thomas's Hospital. These include all deaths from zymotic diseases in outlying institutions. No deaths from Small Pox or other than those mentioned above having occurred during the year. Other diseases.—From diseases of the respiratory organs 248 deaths arose, ten less than last year. As usual the very young were the chief victims. From diseases of Tubercular origin, Consumption, Atrophy, and Water on the Brain, 175 deaths were recorded. This is again a diminution of numbers compared with the year 1882, when 192 such deaths occurred, and as the population increases yearly the improvement is greater than it appears to be at the first view. Disease of the Brain, &c. caused 119 deaths—of the Heart -11; of the Digestive Organs 42; and Premature Birth, Low Vitality, and Congenital Malformation, added 74 to the year's mortality. The numbers here given are in accord with the average. Deaths not certified.—These cases, of which 67 were reported by me in 1882, have during 1883 amounted to but 18 in number. Of these 14 were submitted to the Coroner who held that no inquest was necessary. Iu the other four cases 36 no investigation whatever seems to have been made. They are recorded as follows :— " Convulsions " 1 day Attended by Midwife. „ 23 hours „ „ " Exhaustion" 20 minutes „ „ " Decay of nature " 20 years No remark. Only the latter case can fairly be said to be altogether without verification of the cause of death; and the scandal which existed a few years ago of numbers of person s being every year interred without any medical certificate or enquiry into the real cause of death by competent authority will, it is to be hoped, not recur. Inquests.—The Coroner held inquests in 43 cases of death, in addition to investigating the circumstances attending 14 deaths mentioned above, with the following results :— From Natural causes 17 From Accidental causes— Drowned9 Asphyxia (children overlaid 6) 8 Concussion, &c. 3 Killed on Railway 2 Scald or Burn 2 Run over 2 — 26 Total 43 Social position.—The social position ot persons deceased in the sub-district during 1883 was as follows :— No. percent Nobility and Gentry 4 = -4 Professional Class 28 = 2.7 Middle and Trading Class 120 = 11.9 Industrial and Labouring Class 851 = 850 Totals 1003 100. 0 37 Vaccination.—The successful operations performed at the public station during 1883 were— Primary Vaccinations 1,288 Ke-vaccinations 73 Total 1,361 Abstract of Sanitary Work carried out in Eastern Battersea, During the year ending December 31 st, 1883. No. of houses inspected 7571 „ 1st Notices served 896 „ 2nd Notices served 112 ,, houses disinfected and where necessary cleansed after small pox 4 „ houses disinfected and where necessary cleansed after various kinds of Fever 66 Drains unstopped and cleansed 152 ,, trapped and repaired 399 No. of houses where separate drainage has been enforced 11 Dilapidated closets repaired 57 Fold and offensive closets cleansed 145 Now cisterns provided or cisterns repaired 73 Covers to cisterns provided 172 Dirty cisterns cleansed 603 Water supply added to houses 13 Dirty and dilapidated houses cleansed and repaired 77 Overcrowding abated 7 Orders of the Board obtained 22 Summonses 3 Dust-bins provided 276 Accumulations of manure removed 16 Pig nuisance removed 3 (Articles destroyed—1 peck of strawberries, 1J peck of white cherries, 1 peck of red cherries, 16-lbs. of black currants, A bushel of gooseberries, small quantity of plums, and 2 tins of preserved lobster). 38 Mr. Richards, the Inspector of Nuisances, by whose assistance this abstract was compiled, reports an increased willingness year by year on the part of owners of houses to carry out necessary works for the comfort, health, and well-being of their tenants. The most hopeful feature is that the latter, instead of the sullen apathy or unconcealed dislike formerly evinced to sanitary domiciliary inspections, are now generally eager to direct the Inspector's attention to defects. The total removal of pigs and other nuisances has much improved the general condition of the sub-district, although of course some defects will always be found to exist, more especially in some of the few very old houses which are dilapidated and decayed by reason of their excessive age. With these exceptions each re-inspection finds fewer and fewer defects to be amended. Some very old tenements have been the subject of special inspection and report. They were situated in Sleaford Street, Foot's Place, Savona Street, Burrow's Buildings, Ann's Place, and Seymour Place, in addition to premises also out of repair in Ponton Street. The necessary orders were made and the works have in the majority of cases been carried out. In others there is a difficulty in getting the owners or agents to carry out the Board's requirements. A chemical factory was established in February near Old Battersea Bridge, which would have been very injurious to the locality by reason of the noxious fumes given off. Notice was served to abate the nuisance, and the fact of the Board having proceeded vigorously and successfully in a somewhat similar case in the New Road some years since mentioned to the parties, with the result of the objectionable manufacture being at once stopped. Bakclmises.—Recent legislation having once more relegated to the local authorities the task of supervising and regulating the bakehouses through their Medical Officers of Health, it 39 was found upon the resumption of those duties that the bakehouses generally were in a more defective condition than was the case before central supervision was imposed by the legislature some years since. A form of Register has now been authorised and adopted by the Board upon the advice of the Sanitary Committee, and regulations have been made and copies thereof sent to every bakehouse with instructions to affix them in some conspicuous position in the same. Nearly the whole of the defects found in the bakehouses for the sub-district have been remedied with the exception of the removal of water-closets having direct communication with bakehouses in one or two instances. Remonstrance with the owners has however resulted in promises to remove them forthwith, which is at the time of writing being carried out. In conclusion I may direct attention to the continued low death-rate which it has been again my pleasant duty to report; and to thank the Members of the Board and its Committees for the ready support I have received upon all occasions from them, without which it would have been impossible to carry out the duties of my office with usefulness to the public or satisfaction to myself. I have further to acknowledge the assistance always freely accorded me by all the officers of the Board. To Mr. Pilditch the Surveyor ot this parish, whose earnestness and zeal in every useful work are well known, I owe many thanks for much useful help. The Inspector of Nuisances, Mr. Richards has performed his difficult and often disagreeable and dangerous duties with efficiency and great tact, ably assisted by the Assistant Inspector for this sub-district, Mr. Barnes, a painstaking and useful officer. W. H. KEMPSTER, M.D. Medical Officer of Health for Eastern Batter sea. 40 WEST BATTERSEA. Taking a review of the past year we may look back with some amount of satisfaction on the condition of health enjoyed by the inhabitants of this Sub-district as will be seen by reference to the mortality tables and the nature of the causes of death—it is true the Zymotic total is slightly larger than that of the previous year but when we see that more than two-thirds of the deaths occurred in young children from infantile Diarrhœa Whooping Cough, &c., it is not so serious as it at first glance appears; while as to the adult part of the population over 20 years of age there were but 7 cases of Typhoid and other Fevers, a wonderfully small number in such a large crowded and poor population as exists in this Sub-district. Indeed, when we think of a population of 00,000 persons principally of the working classes, with two or more families in most of the houses, the enormous amount of sewers in connection with them it is simply wonderful and speaks volumes for the way in which the Board and its Officers carry out those Sanitary duties which tend so much to the welfare, happiness and health of the community. The year under report owing to the alarm caused by the expected visitation of Cholera has been marked by a very large amount of increased work. Special Inspectors were engaged to make house to house visitation throughout this Sub-district—duties which were carried out in as perfect a manner as possible—and discovered some thousands of defects: comprising defective drains, dirty closets, rooms, cisterns, &c., all of which were speedily remedied under notice, and it is gratifying to observe that in only 8 instances had the magistrate to be appealed to to compel compliance. One cannot speak too highly of the importance of this house to house work, bringing to light as it does many sanitary 41 fects of which without it we should know nothing. And well as the work has hitherto been done, now that a regular Inspector has been appointed to this Sub-district more frequent inspections will be made than it was possible before to do, and such a register will be kept that at a glance we shall know the condition of every house and street—and whether Cholera or any other disease may come amongst us we shall be in the best possible condition to resist it. And now that other sections of the Sanitary Act have come into operation and special regulations issued by the Local Government Board for adoption there will be scarcely any matter with which we shall not be able to deal. This is the first year for which the deaths of persons belonging to the Parish but dying in Institutions outside it, have been received and consequently taken into the calculations—the numbers were but 47 and make as will be seen further on, but a slight difference in the death-rate. It is satisfactory to observe that there were only two cases of Scarlet Fever all the others being chronic cases of illness or the result of accidents or operations in the general Hospitals, and I believe that this number is more than counterbalanced by persons from other districts who come to reside in the parish for the purpose of attending the various hospitals in the Metropolis of whom we have no record. Population.—In June the parish was divided into two registration districts by the Registrar-General and the exact number of persons residing in this Sub-district at the time of the census was given, viz: 52,587, this being 2,479 more than was originally stated by the local census officer. This will explain the alteration made in the population paragraph at the head of the mortality table. Taking this as the basis on which to calculate our present numbers in the usual way pursued by the Registrar-General 58,439 will be the official population for the district. At the same time, even with this increased number, the fact must not be lost sight of that the 42 birth-rate is again 3- per 1,000 more than that which prevailed during the census year, and if taken as a basis for calculation, over 60,000 persons must now be residing in the Sub-district. Mortality.—The total number of deaths returned by the Registrar as having taken place in this sub-district was 1341 —685 of males and 656 of females. In 1882 1,222 were returned, there is therefore an increase of 119 on those of that year. In addition to the above, 47 took place in Institutions not in the district, such as London Hospitals, &c., making a combined total of 1,388 persons who died connected with this sub-district. Of the 1,341—298 occurred in the Public Institutions, viz: 284 in the Union Infirmary, 14 in the Bolingbroke Hospital. These are 39 above those of the previous year—the increase being in the Infirmary, 126 belonged to Battersea as a whole, leaving 158 to be distributed among the other parishes forming the Union. The 126 belonging to Battersea as a whole have been taken into account when calculating the death-rate of the Parish. Deducting the 298 deaths in Public Institutions 1,043 will be the correct number for this out-door district.* The number of deaths registered in each quarter of the year was as follows — First Second Third Fourth Quarter. Quarter. Quarter. Quarter. 331 364 347 299 The deaths of 58 illegitimate children were registered during the year, some being a few hours, others a few days, and only 7 had reached the age of one year and upwards. Death-rate.—The death-rate, calculated on the population in June, 1883, according to the Registrar-General's method * Out-door with reference to Infirmary, &c. 43 was 17-86 per 1,000, and including those that took place outside the district, 18-68. It will thus be seen that the rate only increased by .6 per 1,000 on that of the previous year when they were not rendered, Total deaths from all causes including all deaths in the Infirmary in the respective years were:— 1874 1875 1876 1877 1878 1879 1880 1881 1882 1883 689 856 854 820 908 1002 1010 1195 1222 1341 ♦ The deaths in the Infirmary were 284. The death-rates per 1,000, excluding Infirmary deaths and including out-lying Institutions :— 1874 1875 1876 1877 1878 1879 1880 1881 1882 1883 17.2 20.2 19.5 17.1 18.5 20.0 16. 8 19.0 18.0 18.6 Birth-rate.—The number of births registered were 2,328, of which 1,163 were males and 1,165 females only a difference of two in the sexes. The rate is 39-83 per 1,000, being again 3- per 1,000 more than that of the census year. They are in excess of the previous year by 96. The return for each quarter was as follows :— First Second Third Fourth Quarter. Quarter. Quarter. Quarter. 576 577 609 566 Natural Increase—The above number of births are 940 in excess of the deaths and constitute the year's natural increase. The following table shows the causes of all deaths, classified according to age, sex, and social position, which have taken place in this Sub-district during the year :— 44 STATISTICS OF MORTALITY. BATTERSEA WEST. Population (Census) 1881 52,587 Official population in middle of 58,439 Area in acres 1,396 Total Deaths from each Class of Disease, &c., in the Sub-district. Sex. Aoe. Social Position. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. From 1ft to 20 yeanrs. All under 20 yours. At 20, and under 40 years. At 40, and under 60 years. At 60, and under 80 years. 80 yean and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. .Middle and Trading Class, Shopmen, Clerks, &e. Industrial and Labouring Classes. DISEASES And other causes of death. Classes:— Small Pox •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Measles 52 31 21 19 32 1 •• 52 .• •• •• •• •• •• 5 47 Scarlatina 26 12 14 1 17 3 2 26 • • • • • • .. • • • • 7 19 Diphtheria 2 1 1 •• 1 •• .. 1 •• 1 •• •• •• 1 •• 1 Croup 8 3 5 1 6 1 •• 8 •• • • •• •• •• •• 2 6 Whooping Cough 46 24 22 23 22 1 .. 46 •• •• •• •• •• •• 6 40 Typhus and 1. Zymotic other Fever 13 11 2 •• •• 3 3 6 2 3 2 •• 1 •• 3 9 Erysipelas Metria. 5 3 2 1 •• .. .. 1 .. 1 1 2 ... .. 1 4 Childbirth 2 .. 2 •• •• •• •• •• 2 •• •• •• .. .. .. 2 Carbuncle .. •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Influenza •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Diarrhœa & Choleraic Disease 64 33 31 52 4 •• •• 56 2 l 5 •• •• 1 12 51 Totals of Zymotic Class 218 118 100 100 82 9 5 196 6 6 8 2 1 2 36 179 2.Tubercular 255 134 121 94 20 1 19 131 75 41 5 .. .. .. 17 208 3 Of Brain. Nerres.&c. 168 99 69 52 25 5 3 85 10 18 40 10 1 1 20 140 4. Of the Heart, &c 85 41 44 9 1 1 4 l5 13 22 28 7 2 1 16 66 5. Of Respiratory gans 318 157 161 91 67 6 1 171 26 39 67 15 3 .. 45 270 6. Digestive Organs 68 37 31 15 2 1 2 20 1 17 25 2 3 .. 16 49 7. Urinaiy Organs 32 13 19 .. 1 .. 1 2 6 9 11 1 1 .. 11 20 8. Of Organs of Generation 11 1 10 .. .. .. .. .. 5 5 1 .. 1 .. 3 7 9. Joints and Bones 19 9 10 2 4 1 .. 7 2 2 7 1 .. .. 4 15 10. Skin 7 6 1 6 .. •• •• 6 •• •• 1 .. •• •• .. 11. Premature Birtli, Low Vitality, Malformation, &c. 30 16 14 30 .. .. .. .. .. .. .. .. .. .. 5 25 12. Dropsy,Cancer, and of Uncertain Sent 46 17 29 2 .. 1 .. 3 7 14 20 2 1 •• 20 19 13. Age 64 23 41 .. •• •• •• •• •• •• 22 42 6 2 5 18 14. \ iolencc 20 11 6 4 1 ••- 1 8 3 6 3 •• •• •• •• •• 15. Not Specified .. • • •• •• •• •• •• •• •• •• •• •• • • •• •• Total 1311 685 650 4ll 203 27 30 077 157 179 210 82 19 0 242 1074 * This table iududes 284 deaths, in the Infirmary of the Union, and 13 in other publie Institutions, in all 297. 45 Zymotic Alor/ulity.—The deaths from this class of disease were 218—118 of males and 100 of females—and are 24 in excess of those of the previous year. The greatest fatality was from Diarrhœa, Measles and Whooping-Cough, and contributed 157 of the total. The reason of the increase of this over last was due entirely to Diarrhœa, 64 being returned as against 39. Fevers other than Scarlet and Measles were 13, and classified as follows:—Typhoid, 12; Typhus, 1. This small number speaks well for the way in which our drainage matters are looked after. Of the total number 100 were under 1 and 82 from 1 to 5 years of age, thus more than two-thirds occurred in children under 5 years—the most susceptible period of life to Zymotic poison. Zymotic Diseases.—The following table contrasts all death from Zymotic causes during the past 10 years. 1874 1875 870 1877 1 878 1879 1880 1881 1882 1883 Small Pox 0 o! 3 13 9 2 0 4 1 0 Measles 8 11 35 8 31 43 8 50 30 52 Scarlatina 5 48 20 8 4 55 30 25 35 26 Diphtheria 5 7 5 2 3 7 3 9 4 2 Quinsy 0 0 0 0 0 0 0 o 0 0 Croup 16 5 6 5 10 8 1 3 12 8 Whooping Cough 30 20 32 18 36 11 23 31 47 46 Typhus, &c 15 14 19 25 15 27 10 10 14 13 Erysipelas 4 9 0 3 4 2 3 7 9 5 Metria 11 0 5 3 1 2 7 6 3 2 Carbuncle 0 0 0 0 0 0 0 0 0 0 Influenza 0 0 0 0 0 0 0 0 0 0 Diarrhœa and Cholera 43 35 43 22 41 17 61 53 39 64 Totals 137 155 108 107 157 174 146 198 191 218 The death-rate from this class of diseases was 3.6 per 1,000 of the population, exactly the same as that of last year. 46 Other causes of death, Non-Zymotic.—These diseases collectively show an increase on those of the previous year of 95. In all 1,123 were returned—the principal of which were: Disease of the Respiratory Organs, 318; Bronchitis, 176; Pneumonia, 98; and other diseases 34; Brain and Nerves, 168; Heart, 85; Digestive Organs, 68; Age, 64; Violence 20; Premature Birth, 30; Cancer, 33; Syphilis, 7 ; &c. Diseases of the Respiratory Organs, Digestive Organs, and Old Age, show an increase, whilst those of Brain and Nerves, Premature Birth, Low Vitality and Violence are not so numerous. From the Tubercular Class 255 were returned, viz:—from Phthsis, 149 ; Atrophy, 93 ; Scrofula, 11; and Hydrocephalus, 2. Of the Phthisical cases 75 were between 20 and 40 and 21 between 40 and 60 years of age. Of the 1,123 deaths 567 were males and 556 females—132 were under 5,538 inclusive under 20, and the remainder from 20 upwards. The deaths from pure Old Age have nearly doubled, being 64 against 37 of last year, the eldest as usual being females, in fact five were above 90, 1 being 102 years who died in Latchmere Grove. Reverting to the opposite extreme we find the duration of life was reckoned by five minutes in one instance, 14 by hours, and 45 by days. The following table contrasts all deaths from Non-Zymotic causes during the past 10 years. 47  1874 1875 1876 1877 1878 1879 1880 1881 1882 1880 Tubercular, including Phtlisis Of Brain,Nerves, 113 148 149 172 143 165 196 210 198 255 &c 115 130 119 148 137 136 117 147 173 168. Of tho Heart, &c. 31 37 49 55 53 56 72 94 83 85 Of tho Eespiratory Organs, including Phthsis 151 197 100 124 204 2G0 215 266 272 318 Of Digestive Organs 23 27 19 37 27 27 47 59 52 68 Of Urinary Organs 6 10 13 14 10 20 15 26 21 32 Of Organs of Generation 7 7 8 8 3 9 9 14 14 11 Of Joints, Bones, &c 4 8 4 1 2 2 3 15 12 19 Of Cancer 10 2 23 22 23 14 22 21 25 33 Premature Birtli, Low Vitality, Malformation, &c 20 37 30 30 31 36 70 37 78 30 Of Uncertain Seat 27 39 37 25 29 17 36 97 97 13 Age 22 39 53 47 58 57 35 31 37 64 Violence 15 15 18 23 20 13 23 40 30 20 Syphilis 0 6 4 7 11 16 4 10 6 7 Totals 552 702 686 713 751 828 864 997 1028 1123 Inquests.—These enquiries again show a decrease on those of the previous year, 31 being held against 39. Of the 31, 21 were on the bodies of males and 10 females. The verdicts were as follows :— From Natural Causes ,, ,, 14 ,, Accidental Causes 9 Suicides 4 Found Drowned 3 Wilful Murder 31 Of the accidental causes 2 were killed on the railway, 2 by 48 falls, 2 whilst bathing, 1 burnt, and 2 suffocated in bed with their parents—the latter are 8 less than those of the previous year. The suicides were respectively— 2 Cut-Throats 1 By Hanging, 1 By Drowning. The case of wilful murder was that of an infant one day old found in a pond on Wandsworth Common. In addition to the cases on which inquests were held 21 cases of sudden death were submitted to the Coroner, who after due enquiry did not deem an inquest necessary. They were mostly persons the subject (of some chronic disease or very young children who died in convulsions. Deaths not Certified.—It is satisfactory to again note the small number of persons registered without the usual medical certificate—in only one case, that of a child 14 months old was an unqualified person in attendance. The others being infants who died of convulsions—or who were born prematurely and of very low vitality—the ages being— 1 3 days. 2 2 „ 1 1 „ 3 1 hour. The mothers of these infants were all attended by midwives. Social Position.—The per-centage of deaths in relation to social position was as follows :— Nobility and Gentry 1 .41 Professional .44 Middle and Trading 18.05 Labouring 80.10 100.00 49 Disease and Mortality amongst the Union Poor.—The number of cases which came under treatment was 408—191 being males and 217 females. There are 107 above those of the previous year—the increase being in general diseases. On reference to Table VI. will be found the nature of the various diseases. Of the above cases 28 died, giving a death-rate of 6.9 per cent. Sanitary Matters.—Reference to the Abstract at the end of this Report, will show the enormous amount of work which has been carried out during the year. No less than 8197 houses have been inspected, bringing to light numerous defects. This number could not have been inspected with our usual staif, and it will be in the recollection of the Board how it was considerably augmented, and by so doing nearly the whole parish was placed under supervision. Consequently in reading the Abstract much larger numbers will be found than has before appeared in any previous report. There is one matter which is a subject for congratulation and that is the decrease in the number of summonses—only 8 being issued as against 24. This is owing to the entire removal oi pigs from the District—there not being now a single person who keeps pigs for the purpose of dealing—thus after many years' efforts we may say we are entirely free. Dead Ends of Water Service Pipes.—Complaints were made by persons living in Hope Street of the dirty and unwholesome condition of the water supply. Repeated inspections were made—cisterns cleaned, still the same state continued. The matter was represented to the Board who ordered the Medical Officers, Surveyor and Inspector to have an interview with the Officials of the Company. This was done—an appointment made to visit the spot. The stump end of the service was opened, when water of a most filthy description for some minutes issued from it—a sample of which was 50 shown to the Committee. The end had not been opened for some time and hence the accumulation and cause of complaint. A suggestion was made to do away with the dead end and carry the communication along Emma Street join that in George Street and so complete a circle. This has since been done and no further complaint has been made in the neighbourhood. It is most desirable that where these dead ends exists they should be frequently cleansed. Chemical Works, &c.—Hot e ffluent passing into Sewers.—This is amatter which, owing to the nuisance caused by hot water, &c., passing into the sewers and carrying off with the steam offensive gases contained therein, has occupied the serious attention of the Board. The manufacturers no doubt seeing the injury and annoyance which must ensue from such nuisance have shewn every desire to abate it, and have not only cooled the matters and in some instances have diverted their course into the river. Bakehouses.—Thesepremises are now registered, inspections made, and regulations framed for their construction and sanitary keeping. Defects were found which have been rectified and at the present time there is no fault to be found with any bakehouse in the Sub-district. Cow and Slaughter Houses were duly visited before the licenses were granted. There was no opposition. Abstract of Sanitary Work carried out in Western Battersea during the year ending December 31st, 1883. Number of houses inspected 8197 „ first notices served 1034 „ second notices served 128 ,, houses disinfected and -where necessary cleansed after Small-Pox 3 51 Number of houses disinfected and where necessary cleansed after various kinds of Fever 103 Drains unstopped and cleansed 121 „ trapped and repaired 456 Combined Drainage 14 Dilapidated closets repaired 61 Foul and offensive closets cleansed 210 Defective apparatus to water closets repaired and water laid on 429 New cisterns provided or cisterns repaired 85 Covers to cisterns provided 207 Dirty cisterns cleansed 634 Water supply added to houses 35 Dilapidated and dirty houses cleansed and repaired 127 Overcrowding abated 8 Urinals cleansed 2 Orders of the Board obtained 29 Summonses 8 Cesspools abolished 5 Dust.bins provided 330 Accumulation of manure removed 16 Pig nuisances removed 44 Sweeping trade refuse in street (abated) 3 In conclusion I have again to express my appreciation of Mr. Richards the Inspector of Nuisances, to whose untiring energy, the business.like way in which the Assistant Inspectors were supervised, and the excellent manner in which the inspections were recorded, were due. The small number of cases in which appeals to the Magistrate was necessary speaks well for the tact displayed in carrying out what must always be a disagreeable duty. JOSEPH OAKMAN, Medical Officer of Health, for West Battersea. 52 CLAPHAM. The following introductory table requires no comments from me to show the comprehensive nature of the information which it possesses, for all those who are interested in the social and sanitary progress of this rapidly increasing suburb. It shows at a glance the main features of the vital statistics of the year 1883 compared with those of the ten preceding years. Marriages, Births and Deaths during the eleven years 1873—83. Years. 1873 1874 1875 1876 1877 1878 1879 1880 1881 1882 1883 Marriages 207 284 243 313 319 282 303 329 349 339 318 Births 929 937 965 1029 1019 1095 1125 1082 1059 1081 1085 Deaths 475 528 548 545 467 580 561 544 499 544 580 Excess of Births over Deaths 454 409 417 484 552 515 564 538 560 537 505 53 The steadily increasing number of new houses recently inhabited, the high number of marriages and births, and the low mortality recorded in this table are ample proofs of the prosperity, as well as the satisfactory condition of the health and progress of this sub.district. The number of marriages though large shews a considerable decrease on that of the last three years; it was nevertheless higher than the average of the preceding ten years. Births—Birth.rate.—In the past year there were 1085 births or four more only than in the year preceding. They consisted of 577 males and 508 females. In almost all my former reports the female births ranged higher than the male, but in the past year the male births are seen to have been 69 higher than the female. The cause of this difference is not apparent. The birth.rate was 28.25 per 1,000 of the estimated population. Deaths—Death.rate.—580 persons—246 males and 334 females—died during the past year. Calculated from the population, estimated according to the official method to have been 38,406 at the middle of the past year, the death.rate was 15.10 in every 1,000 persons living. In addition to the deaths registered during the past year, as many as 81 deaths, 42 of males and 39 of females, took place in the several Hospitals and Institutions of the Metropolis. A few only of these deaths properly belonged to the sub.district of Clapham. Inclusive of those deaths in out.lying institutions the death.rate was 17.21 per 1,000. The following table—a lucid annual report within itself— shows the total number of deaths, and their causes, registered during the year 1883, with the relative numbers of each class of disease, and the sex, age, and social position of the deceased. 54 STATISTICS OF MORTALITY. CLAPHAM. Total Deaths from each Class of Disease, &c., in the Sub.District, Sex. Age. Social Position. Population (Census) 1881 36,380 Official Population in middle of 1883 38,406 Area in Acres, 1,233 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, &e. Middle & Trading Class, Shopmen, Clerks, &e. Industrial and Labouring Classes. DISEASES And other Causes of Death, Classes:— 1. Zymotic Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 33 13 20 10 17 3 3 33 .. .. .. .. .. .. 4 23 Scarlatina 8 3 5 2 5 1 .. 8 .. .. .. .. .. 2 2 4 Diphtheria 7 3 4 .. 3 2 .. 5 2 .. .. .. .. .. 3 4 Croup 17 8 9 4 10 3 .. 17 .. .. .. .. .. .. 4 13 Whooping Cough 16 6 10 3 9 1 3 16 .. .. .. .. .. 3 3 10 Typhus, &c. 3 1 2 .. .. .. .. 1 .. 2 .. .. .. .. 2 1 Erysipelas 2 .. 2 2 .. .. .. 2 .. .. .. .. .. .. .. 2 Metria, Childbirth 7 .. 7 .. .. .. .. .. 6 1 .. .. .. .. 3 4 Carbuncle .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa 19 9 10 12 3 .. .. 15 .. .. 4 .. .. 3 4 12 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 112 43 69 33 47 10 6 97 8 3 4 .. •• 14 25 73 2. Tubercular 76 30 46 9 10 3 6 28 26 20 2 .. .. 14 20 42 3. Of Brain, Nerves, &c. 66 30 36 25 11 1 1 38 .. 10 16 2 1 9 16 40 4 Of the Heart. &c. 39 19 20 .. .. 1 3 4 5 15 13 2 .. 9 10 20 5. Of Respiratory Organs 113 50 63 31 34 5 3 73 5 10 21 4 .. 8 20 85 6. Of Digestive Organs 26 13 13 3 1 .. 1 5 6 10 4 1 .. 4 9 13 7. Of Urinary Organs 21 9 12 1 .. .. 1 2 3 7 8 1 1 2 7 11 8. Of Organs of Generation .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 9. Of Joints, Bones, &c. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10. Of Skin 3 1 2 2 .. .. .. 2 .. .. 1 .. .. .. .. 3 11. Premature Birth, Low Vitality, Malformation, &c. 60 25 35 54 6 .. .. 60 .. .. .. .. .. .. 20 40 12. Dropsy, Cancer, and of Uncertain Seat 24 10 14 .. .. .. .. .. 2 14 6 2 .. 3 11 10 13. Age 25 10 l5 .. .. .. .. .. .. .. 13 12 1 1 13 10 14. Violence 7 3 4 2 .. .. .. 2 3 1 1 .. .. 1 4 2 15. Not Specified 8 3 5 .. .. .. .. 2 4 1 1 .. .. 1 3 4 Totals 580 246 334 160 109 20 21 313 62 91 90 24 3 66 158 353 55 Epidemic Death.rate.—The following table shows the deaths from the seven principal epidemic diseases. They are so placed in order that they may be compared with the corresponding numbers of the ten preceding years. The deaths from these diseases numbered 86 in the past year, and were 12 more than in the year preceding; they were however still below the average of the preceding ten years, allowing for increase of population. Years. 1873 1874 1875 1876 1877 1878 1879 1880 1881 1882 1883 SmallPox 2 14 12 3 .. 2 7 1 .. Measles 11 20 3 13 5 23 17 19 10 15 33 Scarlatina 2 33 22 13 4 12 12 21 15 26 8 Diphtheria 3 4 6.... 3 1 3 3 4 7 Whooping. Cough .. 14 15 17 17 12 29 25 25 13 17 16 Fever, &c... 10 6254594373 Diarrlhœaa & 25 27 22 24 18 26 17 36 20 4 19 Cholera .. 2 .. 2 .. Totals 65 105 74 86 55 103 81 ,112 , 71 74 86 Ages of Deceased Persons.—In many of my former reports I commented on the mortality as it occurs at the two extremes of life, with the view of showing the many advantages we possess of prolonging life by means of the sanitary measures we employ. Our infantile mortality during the past year which was unusually high is represented by the following figures, viz:—under one year 160 infants succumbed, from one to five years 109, and from five to ten years 20, making a total of 289 children under 10 years of age, or 49 per cent. of the total deaths. 56 At the other extreme of life our mortality was not so large as in the preceding years; in the past year it amounted to 127, in the previous year to 133: these figures refer to all deaths registered at 60 years and upwards. The oldest person registered was at the ripe age of 91 years. The Social Position of the Deceased.—When classified according to the social position of the deceased the deaths give the following per centage to each class in proportion to their numbers registered, as shewn in the table; and it will be observed that the industrial and labouring class outnumbers the other classes combined by as many as 120, viz :— SOCIAL POSITION. Deaths. Rate per cent. Nobility and Gentry 3 0.5 Professional Class 66 11.4 Middle and Trading Class 158 27.2 Industrial and Labouring Class 0.33 60.9 580 100.0 Inquests and Uncertified Deaths.—Twenty.four inquests were held during the year, the verdicts of which are subjoined, viz:— Natural causes .. 13 Drowning 1 Suffocation 2 Wound of head 1 Suicide 1 Want of attention at birth, 3 Found dead 2 Cause unknown 1 24 57 It is unsatisfactory to see that in 3 instances the cause of death was not determined after due investigation, and more unsatisfactory as well as remarkable, that in three other instances death resulted from "want of attention at birth." Six other deaths were also recorded of which the cause was not certified by medical testimony. Disease and Mortality amongst the Parochial Poor.—On reference to table V. in the Appendix it will be seen that 525 new cases of illness amongst the out.door parochial poor came under treatment during the past year, and that the deaths therefrom were 20, or a little over 5 per cent., which is a very low mortality, when we consider the many disadvantages under which such treatment has to be conducted. It is satisfactory to observe that there were no deaths from Small Pox, Scarlatina, or Diphtheria, amongst them. Sanitation during the Year.—In table VI. in the Appendix may be seen the large amount of sanitary labour expended by our Surveyor and his able Assistants during the year. As many as 5,896 houses and premises were carefully inspected, about 200 of which were also examined by myself. Thirty. nine houses were disinfected after the ocurrence of contagious diseases and it is very satisfactory to find that in one house only did such disease recur after disinfection. In ten houses the bedding was taken away and burnt and new bedding supplied. Two cesspools were abolished; it need scarcely be remarked that all cesspools should be done away with. 6,726 feet of new sewers and branch drains were constructed as well as many more salutary works carried out calculated to be of lasting benefit in the maintenance of the health of the sub. district. Cow and Slaughter Houses.—Accompanied by the Inspector I made a diligent inspection of all the cow.houses and 58 slaughter houses in this sub-district, as in former years, to ascertain if their sanitary conditions were in accordance with the prescribed regulations. As regards the cow.houses, in nearly all cases I found the cows clean, the sheds well ventilated, with a good water supply, and the drains and paving satisfactory. In like manner the slaughter houses with the necessary appliances used in the trade were found to be in excellent condition. In both cases cleanliness and order prevailed. JOHN MAC DONOGH, Medical Officer of Health for Clapham. 59 PUTNEY AND ROEHAMPTON. Population.—If we regard the rate of increase in the population of this rapidly growing Sub.district, as the same as that which prevailed previous to the census of 1881 the inhabitants numbered at 14,068 in the middle of the year 1883. From an intimate knowledge of the neighbourhood I am convinced that this is an under estimate of the population, and that a sudden and very large increase took place during the past year and a half. This was dependent to a certain extent upon the influx of labourers and mechanics with their families engaged in the construction of the new bridge, and the improvements it has necessitated. Probably fifteen thousand is an appropriate figure at which to represent our population. The recent increase also has been largely amongst the lowest class of labourers, receiving low wages and consequently living on poor diet. Amongst these and their families the mortality must necessarily be greater. Births and birth.rate.—A decrease has occurred in the birth.rate during 1883. The number of births registered was 349 as against 361 in 1882 and 340 in 1881. Of these 186 were of males, and 163 of females, the males as usual in this sub.district preponderating. The birth.rate was 24.7. This low birth.rate is in accordance with the lowness of the birthrate of London generally (33.6). Deaths and death.rate.—During the year 1883, 241 deaths were registered in the sub.district, of which 122 were of males 60 and 119 of females. This gives a death.rate of 17.1 per 1000 of the population estimated according to the official method explained in the first paragraph of this report, but if we calculate the unusual increase there mentioned we reduce the death.rate to 16.3 per 1,000, a rate not much in excess of our average mortality. The death.rate for London was 20.4, the lowest ever recorded, and that of 28 great towns 21.57, so that the mortality of the sub.district cannot be considered excessive. YEARS. Births. Birth.rate. Number of deaths from all classes. Death.rate. Rate of Natural Increase. 1873 320 30.0 125 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 1880 347 27.3 177 13.6 13.2 1881 340 25.5 167 12.5 12.9 1882 361 26.3 208 15.1 11.1 1883 349 24.7 241 17.1 7.6 The excess of births over deaths, constituting the natural increase in the population, was 108 give a rate of 7.6 per 1,000. The table which follows is, in an abridged form, the same as that employed by the Registrar-General, and also arranged accordingly 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. 61 PUTNEY and ROEHAMPTON. Total Deaths from each Class of Disease, &c., in the Sub-District. Sex. Age. Social Position. Population (Census) 1881 13,235. Official Population in middle of the year 1883 14,068. Area in Statute Acres.2,176 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 00 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, Shopman, Clerks, &c. Industrial & Labouring Classes. DISEASES, And other Causes of Death Classes:- Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 2 2 .. 1 1 .. .. .. .. .. .. .. .. 1 1 Scarlatina 7 2 5 .. 3 3 1 .. .. .. .. 1 9 .. 4 Diphtheria 24 11 13 .. 10 12 2 .. .. .. .. .. 4 6 14 Typhoid & Typhus Fever 2 1 1 .. 1 .. .. .. .. 1 .. .. .. 1 1 Remittent and other Fevers .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. I. Zymotic Puerperal Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough 2 1 1 1 1 .. .. .. .. .. .. .. .. .. 2 Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa, Dysentery, & Cholera 5 5 .. 2 1 1 .. .. 1 .. .. .. .. .. 5 Other tic diseases 2 1 1 1 1 .. .. .. .. .. .. .. .. .. 2 Totals of Zymotic Class. 44 23 21 5 18 16 3 .. 1 1 .. 1 6 8 29 II. Constitutional r G.out, and Rheumatism 5 1 4 .. .. .. 1 1 1 1 1 1 2 1 1 Cancer & other Tumours 8 .. 8 .. .. .. .. .. 6 1 1 1 1 3 3 Tubercular 28 14 14 4 3 3 1 11 6 .. .. .. 1 2 25 Nervous 44 25 19 11 4 1 1 .. 10 9 1 2 9 7 26 Circulatory 14 7 7 .. .. 1 1 .. .. 10 2 1 4 6 3 Respiratory 30 15 15 5 5 3 .. 2 5 7 3 1 5 4 20 Digestive 16 7 9 1 .. .. .. 2 .. 8 1 2 4 5 5 III. Local Urinary 6 4 2 .. .. .. 4 1 2 1 2 .. 2 2 2 Generative 4 .. 4 .. .. .. .. 3 .. 1 .. .. 2 2 .. Locomotory .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Integumentary .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. IV.Developmental Premature Birth, Atrophy, &c. 17 10 7 17 .. .. .. .. .. .. .. .. 3 8 6 Old Age 10 4 6 .. .. .. .. .. .. 5 5 2 2 1 5 V. Violence 15 12 3 .. .. .. 1 4 7 2 1 .. .. 4 11 Totals 241 122 119 43 30 24 12 31 38 46 17 11 41 53 136 62 I. Zymotic Diseases.—The following table gives a retrospect of the fatality from the chief Zymotic diseases during the ten years preceding the year under review. It will be seen that these diseases are represented, with one exception, by small numbers. Measles, Whooping-cough, Typhoid-fever and Diarrhoea may be reckoned below the average in intensity, and from personal knowledge I may also say in extent. Scarlet-fever was slightly in excess of the average, but not to such an extent as to render it noteworthy. The disease was however rather prevalent in a mild form. Diphtheria, the disease most nearly allied to Scarlet. fever, was unusually fatal during the past year. It is according to the usual experience to find these two types of disease prevailing at one time. Years. 1873 1874 1875 1876 1877 1878 1879 1880 1881 1882 1883 Small Pox .. .. 1 .. l .. .. Measles .. 2 3 .. 1 2 7.. .. 6 13 2 Scarlatina .. .. ..3 6 .. 3 1 8 4 7 Diphtheria .. 1 4 .. 1 1 1 29 24 Whooping. cough ..1 .. 9 7 .. 4 89 3 8 2 Typhoid &c 2 4 3 2 4 1 4 2 Diarrhœa & Cholera 1 6 7 5 7 10 7 10 3 5 5 Totals 6 10 20 17 20 26 20 24 22 63 42 Percentage of Deaths from Epidemics 4.8 6.4 11.9 18.2 13.0 13.8 11.2 13.6 13.17 30.1 17.4 to deaths from all causes. 63 The twenty-four deaths due to Diphtheria were however not fairly representative of the number of cases, which probably occurred in the district, for there is reason to believe a high rate of mortality prevailed among the persons affected. From careful investigation I found that the number of cases very largely decreased from an early period in the year, and in point of numbers the disease was very much less extensive than it was during the latter end of 1882. Indeed after the end of April Diphtheria could in no sense be called epidemic in the district, and I can only account for the large number of deaths which occurred by the fact that the disease was of an unusually severe type. Another noteworthy fact in relation to this outbreak is, that it occurred in distinct groups, separated not only by intervals of time, but by distinctions of locality and by the ages and social status ot the victims. This points to a separate set of causes leading to these outbreaks. The year 1882 had ended with a heavy mortality from Diphtheria. This was continued in January 1883, by five deaths, then the fatal cases declined to two in February and one in March. After an interval of six weeks (towards the end of April) six cases suddenly occurred, five of them within a week. Another month elapsed and one case appeared, and next month another, showing a subsidence of the disease. With the exception of two cases in August the disease seemed to disappear till the end of the year, when six more deaths occurred during the last three months. The isolation of the outbreak in April was very marked, six weeks preceding and four succeeding the group of cases among which the deaths occurred. Besides an entirely different locality was affected from that ot the previous and the subsequent outbreaks, and also older persons and those of a superior class were attacked. These facts attracted my special attention and led to a patient investigation, but it only resulted, as is so frequently the case in tracing out the etiology of disease, in failure to demonstrate the connection of the outbreak with 64 what appeared to be its obvious and immediate cause. In fact we deal with a matter incapable of demonstration—the virus or germ of disease. The subject is purely a medical one and one of which the profession alone is able to judge. The enquiry however resulted in serious defects being exposed and put right, so that it had its reward in increasing the public safety. The table below gives the distribution of the epidemic disease prevailing in the district during the four quarters of the year. It is worthy of remark that the third quarter with the highest temperature of the year, has the fewest number of fatal cases of diseases of this class. This was mainly due to the fact that Diphtheria had almost disappeared during that time, there being no fatal cases during that quarter. It is also due to the fact that Diarrhoea was less fatal than usual, dependent chiefly on the equable temperature prevailing during the year. 1883. DISEASE. First Second Third Fourth Quarter. Quarter. Quarter. Quarter. Mean Temperature 40*0 53.0 59.5 44.9 Small Pox .. .. .. Measles .. 1 1 Scarlatina 2 1 1 3 Diphtheria 9 9 .. 6 Whooping Cough 1 1 Diarrhœa 1 1 3 Fever 1 .. .. 1 Total 14 13 5 10 II. Constitutional and Local Diseases. An examination of the figures presented in the following table will lead to the conclusion that the greater mortality 65 Of the past year was not dependent so much upon the fatality from Zymotic disease as to an increase in the deaths from diseases less liable to fluctuation. Year. 1873 1874 1875 1876 1877 1878 1879 1880 1881 1882 1883 Gout & Rheumatism .. .. .. .. 3 1 4 4 4 5 C Cancer and Tumours .. .. .. .. .. 7 3 6 1 6 8 Tubercular 19 24 2G 26 26 32 23 18 17 12 28 Nervous 26 39 23 26 29 28 34 33 21 33 44 Circulatory 13 8 13 6 8 12 13 13 14 12 14 Respiratory 21 30 36 23 29 37 42 27 24 29 30 Digestive 12 11 7 5 12 10 9 13 17 15 15 Urinary 4 3 8 7 11 2 4 6 2 6 6 Generative 2 .. 1 1 2 .. 1 .. 2 2 4 Loeomotory 1 .. 1 1 2 .. .. .. Integumentary .. 1 .. 2 1 1 1 Premature Birth, Atrophy, &c 7 7 16 10 8 7 8 16 18 7 17 Old Age 3 6 11 8 8 7 5 9 6 5 10 V—Violence 56479576 13 7 15 (Other diseases) 3 12 1 1 3 .. .. .. .. Totals 116 146 147 121 148 150 152 152 140 139 196 In all the sub.classes of these groups an increase has taken place in the number of fatal cases, though with two exceptions none of them can be considered much above the average. These exceptions are in diseases of the nervous system and in deaths due to violence. The former was swelled 66 by the large number of deaths from infantile convulsions, the latter by the usual dangers of a riverside locality, viz:— drowning. Cancer was fatal in eight cases and appears to be increasing, a fact which has been noticed in other districts. The number of diseases classified under the name Premature birth, &c., was rather in excess during the past year as likewise those placed under the other sub-class of the same group, viz :—Old age. Ages of the Deceased. During 1883, 43 children under one year died yielding a per centag-e of 17.8 of the total deaths; this shows a still further decline on the rates of the past three years which were 19.2, 28.7 and 30.0, respectively. This is the more remarkable when we consider the large number of deaths from premature birth and infantile convulsions previously referred to and is due to the very slight fatality from Zymotic diseases amongst children under that age. The deaths of young persons from 5 to 20 were unusually numerous, and a slight increase took place amongst those from 20 to 60. The mortality of persons upwards of 60 was very heavy. No less than 53 deaths occurred above that age, of which twenty were between 70 and 80, fourteen between 80 and 90, and three upwards of 90. The oldest was that of a man within a year of being a centenarian. As regards sex those aged persons are more equally divided than we usually find. Of those above 70, 17 were of males and 20 of females. This mortality among the aged was hardly to be expected during a year in which extremes of temperature were conspicuously absent. Social Position. The proportion of the different classes of the community is represented in the following table. Nobility and Gentry 4.5 Professional and Merchant Classes 17.0 Middle, Tradesman, Clerks, &c. 22.0 Industrial 56.5 100.0 67 The professional classhad a much larger share of the mortality than usual in 1883. In the mortality table already introduced it will be observed that the Zymotic diseases as usual fell most heavily on the industrial class, although diphtheria was more than usually fatal among the other classes. Tubercular, nervous and respiratory diseases and violence were most fatal amongst the inferior classes, whilst from the other diseases the better classes suffered most severely. Inquests, &c.—Nineteen inquests were held during 1883, a very large number for this sub-district. The following were the verdicts given by the several juries. I. Natural.—Apoplexy, 1; Convulsions, 1; Hysteria, 1; Paralysis, 1; Peritonitis, 1. II. Accident.—Drowning, 5; Falls, 2. III. Suicide.—By Drowning, 1; Hanging, 2; Shooting, 1. IV. Found dead in river, 1; Found drowned, 1; Found dead, 1. The large number of deaths from drowning—eight in number—ought to stimulate the police, both of the river and shore to greater vigilance in preventing reckless boating on the Thames. Special caution is required during the bridge alterations which has temporarily increased the dangers of passing up and down the river to a very great extent. Not only is the passage room much decreased but the current is rendered dangerously swift for small craft. Six deaths were referred to the coroner and certified as follows:—Convulsions, 2; Concussion of Brain, Diphtheria, Pulmonary Disease, and Paralysis, 1 each. In these cases of course no inquest was held. Five deaths were registered from information received an unqualified practioner, the following were stated to be the causes of death:—Marasmus, 2; Convulsions, Meningitis and Albuminuria, 1 each. 68 Sanitary Proceedings, &c.—In table IV. appendix will be found a statement of the sanitary operations carried out in this sub.district. One of the most important subjects which engaged our attention during the prevalence of Diphtheria was the ventilation of the sewers. The presence of noxious gases in the sewers, especially after a period of drought is the great danger of our present system of sewage disposal. When a heavy rainfall occurs this gas must be displaced from the sewer, and unless that be provided with the means of egress the foul air must find its way through the drains and traps into the houses connected with it. The present system of street ventilators is intended to obviate this difficulty, but I doubt not the time will come when this will be looked upon as a rude and somewhat dangerous method. In the meantime of two evilswe have chosen the lesser, and we are not likely to get a better system of ventilation until the British taxpayer is willing to pay a very large price for his immunity from sewer gas poisoning. The removal of dust, &c. is a matter of great Sanitary importance. It is to be regretted that we have not yet adopted the method practised in many cities and towns, viz; The daily removal of refuse from the street doors. This would get rid of the dangers and annoyance of the hideous dust-bins. An equally important subject is the sanitary arrangement of private dwelling.houses. In many cases abundant cause is to be found for epidemic disease in some innocent looking apparatus for convenience or cleanliness with its fatal connection with the drain. The communication of stack pipes with the drain is frequently overlooked, regardless of the fact that they act as ventilators, and may convey the sewer gas into a window. A disused water.closet is often turned into a cloak.room or lumber.room, and the water in the trap dried up by evaporation. Insufficiently trapped or altogether 69 untrapped sink wastes are still the most frequent source of danger, especially among the poor. Deaths in Public Institutions:—By arrangement with the Registrar-General we now receive information about the fatal cases among persons received in the various public Institutions from the several parishes in the Wandsworth District. The following table gives the fatal cases from this sub-district, classified according to disease, sex, age, social status as well as Institution in which they died. DISEASE. Total. Sex. Age. Class. Institutions. Male. Female. Under 1 1 to 60. 60 and upw'ds. Middle Industrial Union Infirmary. Infectious Hospitals. General Hospitals. Diphtheria 1 1 .. .. 1 .. 1 .. .. .. 1 Enteric Fever 1 .. 1 .. 1 .. .. 1 .. 1 .. Diarrhœa 2 1 1 2 .. . .. 2 1 .. 1 Lung 6 1 5 .. 4 2 .. 6 3 .. 3 Circulatory 5 2 3 .. 3 2 1 4 3 .. 2 Nervous 2 2 .. .. 1 1 .. 2 1 .. 1 Other Diseases 5 3 2 .. 1 4 1 4 4 .. 1 Violence 1 1 •• .. 1 •• •• 1 •• .. 1 23 11 12 2 12 9 3 20 12 1 10 When these 23 deaths are added to the number of deaths actually occurring within the parish, they increase that number from 241 to 264, and add 2.0 per 1,000 to the death. rate. As however many of these cases had been long resident in the Institution in which they died, it is hardly practicable to include them in the general rate of the sub-district. ALEXANDER WALKER, M.D. Medical Officer of Health for Putney & Roehampton. 70 STREATHAM, INCLUDING BALHAM AND TOOTING. The following statistics derived for the most part from an analysis of the Registrar-General's Returns, show the state of the public health in this sub-district during the year, 1883. The death-rate includes this year for the first time, the deaths of those Streatham parishioners who died in the Metropolitan Asylum District Hospitals, Outlying Institutions, and Union Infirmary, thus adding about 1 per 1,000 to the death. rate ; even with this addition, the rate is by no means a high one, and it is doubtful if ever again from increasing density of population so low a death-rate will be recorded as obtained in 1881 and in 1882. Though the total deaths from Zymotic diseases exceed the average, several of the diseases in this class shew a marked decline in intensity: r.otably, three of the 7 principal Epidemic diseases, viz:—Small Pox, Scarlet Fever, and Whooping. Cough. Vital Statistics. Population.—The population of Streatham and Tooting in the middle of the year 1883, was 28,042, assuming that it has increased in the same ratio as obtained in the ten years previous to the census in 1881. This the official method of calculation accounts for little more than the natural increase of the population; whereas I have reason to believe that the number of inhabitants is in excess of this estimate and should rather be put at 30,000, and 71 as the official estimate forms the basis from which are calculated the birth and death-rate it is necessary to note this probable under-estimate of population. Birth.rate.—The number of births registered during the year was 1027—509 of males, and 518 of females, a difference of nine on the female side—a somewhat unusual circumstance. The birth-rate calculated from the total number of births and the foregoing estimate of the population was 36.9 per 1,000 persons living in the year. The births exceed those of the previous year by 136. The number registered in each quarter was as follows:— First quarter, 266; second quarter, 256; third quarter, 251; fourth quarter, 254. Natural increase.—The excess of births over deaths was 606—21.5 being the rate of natural increase. Death.rate.—The number of deaths registered during the year was 419—204 of males and 215 of females. The death. rate deduced from all the deaths registered and the official estimate of the population was 14.94 per 1,000 persons living during the year. This is slightly over the average death. rate of this sub-district, and though it exceeds the extremely low death-rate of the two previous years, will yet be found to compare favourably with the most healthy districts. If we add to the 419 registered deaths the 36 deaths that took place in Outlying Institutions, the death-rate would then be 16.2 per 1,000 of the population. The number of deaths in each quarter was as follows:— First quarter, 118; second quarter, 107; third quarter, 989 fourth quarter, 96. The following table shows clearly the cause of death, the sex, age, and social position of all persons whose deaths were registered during the year. 72 STATISTICS OF MORTALITY. STREATHAM, including Total Deaths from each Class of Disease, &c , in the Sub-District. Sex. Age. Social Position. TOOTING & BALHAM. Population Official population in middle of 1883. 25,553 28,042 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 to and under 00 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 Class. DISEASES, And other Causes of Death Classes:— Small Fox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 7 3 4 2 4 1 7 .. .. .. .. .. .. 2 5 Scarlatina 2 1 1 .. 2 .. 2 .. .. .. .. .. 1 .. 1 Dipjtheria 13 6 7 1 8 3 12 1 .. .. .. .. 2 2 9 Croup 7 7 .. .. 4 3 7 .. .. .. .. .. .. 4 3 Whooping Cough 11 10 1 4 6 .. 11 .. .. .. .. .. .. 5 6 Typhus and other Fevers 8 6 2 .. 3 .. 5 2 1 .. .. .. .. 3 5 1. Zymotic Tryipelas Metria 1 1 .. .. .. .. .. .. .. 1 .. .. .. .. 1 Childbirth 7 .. 7 .. .. .. .. 6 1 .. .. .. 1 3 3 Carbuncle .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa Choleraic Disease 9 4 5 7 1 .. 8 .. .. 1 .. 1 1 1 6 Totals of Zymotic Class 65 38 27 14 28 7 52 9 2 2 •• 1 5 20 39 2. Tubercular 56 29 27 11 9 2 31 21 4 .. .. 4 3 18 31 3. Of Brain, Nerves, &c. 59 27 32 17 11 1 29 4 10 14 2 6 9 10 34 4. Of the Heart, &c. 47 23 24 .. 1 .. 5 7 16 19 .. 7 10 13 17 5. Of Respiratory gans 50 21 29 9 8 .. 17 6 6 16 5 10 8 9 23 6. Of Digestive Organs 41 15 29 5 .. .. 5 6 14 19 .. 6 6 12 20 7. Of Urinary Organs 11 7 4 .. 1 . . 1 5 2 3 .. 2 3 1 5 8. Of Organs of Generation 5 .. 5 .. .. .. .. .. 2 3 .. 2 1 1 1 9. Of Joints,Bones, &c. 5 5 .. .. .. .. .. 1 3 1 .. .. .. 1 4 10. Of Skin .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11. Pinurture Birth, Low Vitality, Malformation, &c 37 24 13 37 .. .. 37 .. .. .. .. .. 5 8 24 12. Of Uncertain Seat 2 1 1 .. .. .. .. .. .. 2 .. 1 .. 1 .. 13. Age 32 10 22 .. .. .. .. .. .. 14 18 6 8 9 9 14. Violence 6 4 2 2 .. .. 4 1 1 .. .. .. 1 2 3 15. Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 419 204 215 95 58 10 181 60 60 93 25 45 59 105 210 73 Zymotic Diseases—their prevalence and fatality. The total deaths in this class were 65—38 of males and 27 of females. They yield a percentage of 13.1 upon the number of deaths from all causes during the year, as against 12.0 in the previous year, and a rate of 2.32 per 1,000 of the population. The following table contrasts all the deaths which resulted from the seven principal epidemic diseases during the past ten years. DISEASE. 1874 1875 1876 1877 1878 1879 1880 1881 1882 1883 Seven principal Epidemics Small Pox 2 .. .. 4 1 .. .. .. .. .. Measles 9 2 2 2 11 2 1 3 5 7 Searlatina 3 4 4 1 9 5 34 13 9 2 Whooping cough 1 3 7 3 3 2 7 1 4 13 Whooping Cough .. 3 5 7 G 11 21 8 0 0 11 Typhus, &c 2 2 5 5 1 3 5 2 1 8 Diarrliœa and Choleraic Disease 6 9 6 4 13 3 6 9 3 9 Totals 26 25 31 25 42 36 61 37 31 50 This table shows that 50 deaths resulted from the seven principal Zymotic Diseases, and though this number is above the average of the nine previous years, it is far below that of the year 1880, and only 8 above the year 1878, when the population was considerably less; moreover it will be seen that the deaths from four of the diseases in this class were below the average of the previous nine years. Examined in detail we find there was no death from Small Pox. Two cases were sent into Hospital in December, one of these occurred in a crowded mews, they both recovered, and I believe a formidable out-break of the disease was averted by the prompt removal of these cases, together with the measures taken to prevent the spread of infection. 74 The deaths from Scarlet Fever declined from 34 in 1880, 13 in 1881, and 9 in 1882, to 2 in 1883. Only in two years of the series do we find so low a record of deaths from this disease. It is therefore very clear that the prevalence of, and fatality from these two diseases was exceedingly small affording thus further proof of the value of our sanitary measures. Measles contributed 7, and Whooping Cough 11 deaths. Diphtheria caused 13 deaths, Fevers 8, and Diarrhoea 9; these were above the average. Altogether the seven principal diseases in this class form 11.9 per cent of deaths from all causes during the year and give a rate of 1.78 per 1,000 of the population. Other diseases.—The table given below contrasts all deaths from these diseases. Taken altogether the number exceeds the average of the last nine years; and only in class 5, diseases of the respiratory organs was there any marked diminution ot the mortality. In class 2, Tubercular diseases, there were 56 deaths, 15 ot males and 20 of females; 21 of these died between the ages of 20 and 40,—9 were under 20 and 5 over 40. The Tubercular class formed 13.6 per cent of all deaths. The diseases in the classes 3, 4, 5, 6, 11, and 13, caused respectively and in order 14.3, 11.4, 14.8, 10.7, 9.0, 7.8 per cent. of all deaths, as against 14.9, 9.3, 17.3, 12.3, 7.6, 8.2 in the previous year. Thus in classes 4, 5, 6, and 13 the percentage of deaths was below that of the previous year. The following Table contrasts all deaths from non-Zymotic diseases during the past eight years:- 75 Years 1876 1877 1878 1879 1880 1881 1882 1883 Tubercular 31 23 30 32 38 38 34 56 Of Brain, Nerves, &c 39 33 57 41 54 41 49 59 Of the Heart, &c 18 33 31 34 17 26 32 47 Of Respiratory Organs 52 36 44 64 52 48 59 50 Of Digestive Organs 22 25 29 16 25 33 42 44 Of Urinary Organs 6 7 7 10 3 10 6 11 Of Organs of Generation 6 11 2 1 5 8 7 5 Of Joints, Bones, &c. 2 7 2 .. 3 2 1 5 Of Skin .. 2 .. 1 .. 1 .. .. Premature Birth, Low Vitality, Malformation, &c. 14 15 17 19 37 29 26 37 Of Uncertain Seat 2 4 3 6 9 2 7 2 Age 23 14 17 12 25 20 29 32 Violence 9 5 3 13 11 9 8 6 Not Specified 1 .. •• •• .. •• •• •• Totals. 225 215 242 249 281 267 300 354 Age at death.—Infant mortality.—The total mortality in early life was above the average of the previous eight years, though it was not so high as in 1880 without correction for an increased population; 23.1 per cent of all deaths were of infants in the first year of life; 37.3 per cent of children under five years of age, and 44.8 percent of persons under 20 years of age, as against 23.4, 40.4, and 45.3 percent at similar ages in 1882. Senile mortality.—The mortality at the other extreme of life was large; thirty-two deaths were ascribed to old age alone; but no less than 118 persons died at 60 and upwards; of these 4.2 were upwards of seventy, 20 were over 80, and four were aged respectively 91, 92, 94, and 96. Of the persons who died at 70 and upwards 17 were males and 49 females. Sickness and mortality amongst the out-door poor of the parish.—Table V in the Appendix gives the number of persons who were under treatment, the nature and extent of the sickness that prevailed, as well the deaths that took place 76 among the out-door parish poor; 200 new cases were treated during the year; this does not include attendance given to permanent paupers. In the Zymotic class there were 17 cases as against 30 in 1881 and 10 in 1882. They include 2 cases of Small Pox, 4 of Scarlet Fever, 1 of Typhoid Fever, 1 of Measles, 2 of Whooping Cough, 6 of Diarrhoea, and 1 of Croup. With 3 deaths—1 from Croup, 1 from Diarrhoea, and 1 from Whooping Cough. In the other classes there were four deaths. The ratio of deaths to cases treated was 3.j per cent. Social Position.—The following table gives the per centage of deaths in the various classes during the year:— Nobility and Gentry 45 = 10.74 Per Cent. Professional Class 59 = 14.08 „ Middle and Trading Class 105 = 25.06 ,, Industrial and Labouring Class 210 = 50.12 ,, Total deaths in 1883 419 100.00 The per centage of deaths in the various classes differed but little from their usual averages. Inquests, Violent Deaths, &c.—Ten Inquests were held with the following results:— I. Natural Convulsions 2 Ruptured Aneurism 1 Apoplexy 1—4 II. Accidental Mortal injury to head and legs by locomotive in transit 1 Suffocated in bed 1 Drowned in a bath 1 Drowned—bathing 1 Want of attention at birth, found dead 1—5 III. Homicidal Murdered with iron chisel 1—1 10 77 Uncertified Deaths.—Ten deaths were uncertified, they were all submitted to the Coroner before being registered as having probably died from the following causes :— Hœmatemesis 1 Apoplexy 2 Heart Disease 3 Pneumonia 1 Syncope 2 Bronchitis 1 10 Sanitary Proceedings.—Table VI. in the Appendix contains a summary of the sanitary works that have been carried out during the past year; from this it will be seen that 6,364 houses and premises were inspected, these figures represent a very large amount of work done in the sanitary supervision of dwelling houses. During four months of the year three additional inspectors were appointed to carry out this work, owing to a possible advent of Cholera, and though it did not attack us, there can be no doubt an immense amount of benefit accrued from action taken on this account. Twenty.nine houses were disinfected, fumigated and cleansed after the occurrence of infectious disease; 18 houses were so treated after Scarlet Fever, 2 after Small Pox, 5 after Diphtheria, and four after Typhoid Fever. In no case was there a recurrence of the disease after the use of these sanitary measures. I must refer the reader to the table for the figures in respect of new sewers and branch drains constructed during the year; and also for those relating to the abatement, removal or abolition of nuisances, and for other sanitary works set forth therein. The Cowsheds and Slaughterhouses underwent the usual annual inspection. They were all found in a satisfactory condition, and the owners obtained a renewal of their licenses. F. F. SUTTON, M.D. Medical Officer of Health for Streatham and Tooting. 78 WANDSWORTH. The health of this Sub.district during the year 1883, considered whether in relation to the nature, prevalence and fatality of disease, or other exponents of its condition, was eminently satisfactory. The death.rate was unusually low; there was no special epidemic; the amount and fatality of zymotic disease were much less than the average, and infant mortality correspondingly diminished; while there was a greater prolongation of life as represented by a higher rate of senile mortality. Illustration of the existence of this high status of health will be found in the following statistics derived, as usual, from an analysis of the Registrar.General's Returns and the parochial Records of sickness and mortality. VITAL STATISTICS. Population.—The mean number of persons living in this Sub.district during the year 1883, estimated according to the method employed by the Registrar.General, amounted to 29,853. In this estimate it is assumed 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 years preceding it. 79 Mortality.—The total number of deaths registered was 499; 263 of males and 236 of females. The average annual number of the preceding ten years was 462. But as the deaths of the past year occurred in a greatly increased population, it is necessary for a correct comparison to raise the decennial average in proportion to that increase. Such procedure shews that the deaths of the past year were no less than 58 below the decennial average corrected for growth of population in the manner indicated. 116 of the deaths occurred in the following public institutions situated within the parish, viz:—in the Surrey County Lunatic Asylum, 93; in the Hospital for Incurables, 11; in St. Peter's Hospital, 2; and in the Prison, 10. 68 deaths also of Wandsworth parishioners took place in the following institutions without the parish, viz:—in the Infirmary of the Union, 52; and in various London Hospitals, 16. The latter, hitherto unobtainable, are for the first time included in these statistics. Death.rate.—Determined by the total number of deaths registered and the estimated population, the death.rate was 16.71 per 1,000 persons living at the middle of the past year. Inclusive of the deaths of "Wandsworth parishioners that occurred in institutions situated without the parish, the rate was 18.85 per 1,000. Both of these calculations however fail to represent the natural death.rate of the sub.district, inasmuch as they include the mortality of the Surrey County Lunatic Asylum, St. Peter's Hospital, and the Hospital for Incurables, the inmates of which institutions are, with a fractional exception, derived from without the parish, undergo no natural increase and are subject to the highest rate of mortality; the latter also, which during the past year constituted upwards of 21 per cent. of all deaths, is so great 80 as to render a deduction of the death.rate solely from the death.register, without taking into consideration the foregoing circumstances, entirely valueless. In order to arrive at the natural death.rate therefore, it becomes necessary to eliminate from the calculation the population and mortality of the above named institutions and to add to it the deaths of Wandsworth parishioners that occurred in institutions located without the parish. The death.rate calculated in accordance with these corrections was 16.17 per 1,000 of the population, or 0.83 per 1,000 less than that of the healthiest rural districts. Births. Birth.rate.—The number of births registered during the year was 907—458 of males and 449 of females, and was less by 62 than that of the year preceding. This diminution, which attracts notice from the circumstance that with but very few and slight variations the births have always shewn a continuous annual increase, was common to the whole metropolis, and does not admit of a ready explanation of its cause. The birth.rate calculated from the foregoing estimate of the population corrected for institutions was 32.07 per 1,000 persons of all ages. The Natural rate of increase, represented by the excess of births over deaths, was 15.90 per 1,000. The following table contains, as usual, a summary of all the causes of death arranged in accordance with the classification of the Registrar.General; showing the sex, social position and age at death at different periods, and particularizing the several diseases of the zymotic class. 81 STATISTICS OF MORTALITY. WANDSWORTH. Total Deaths from each class of Disease &c., in the Sub-District. Sex. Age. Social Position. Population (Census) 1881,— 28,004. Official Population in middle of 1883,— 29,853. Area in Acres—2,478. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. Under 20 years, including all under 10 years. At 20 and under 40 years of age. At 40 and under 60 years of age. At 50 and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class. Mercharts, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. DISEASES, And other causes of Death. Classes:— 1. Zymotic. Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 14 9 5 3 9 1 14 .. .. .. .. .. .. 1 13 Scarlatina 5 2 3 1 1 3 5 .. .. .. .. .. 2 1 2 Diphtheria 11 7 4 .. 6 5 11 .. .. .. .. .. 1 5 5 Whooping Cough 5 3 2 2 3 .. 5 .. .. .. .. .. .. .. 5 Typhus and other Fevers 12 6 6 .. 2 .. 5 5 .. 2 .. 1 1 4 6 Diarrhœa & Dysentery 10 2 8 7 3 .. 10 .. .. .. .. .. .. 1 9 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 1 .. 1 .. .. .. .. .. 1 .. .. .. .. 1 .. Motrin, Childbirth 6 .. 6 .. .. .. .. 5 1 .. .. .. .. 3 3 Carbuncle .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Croup 13 10 3 3 9 1 13 .. .. .. .. .. .. 5 8 Other tic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals of Zymotic Class 77 39 38 16 33 10 63 10 2 2 • • 1 4 21 51 2. Tubercular 64 27 37 14 5 1 21 27 12 4 .. 1 7 18 38 3. Of Brain and Nerves 118 74 44 19 9 4 33 22 33 26 4 3 6 22 87 4. Of the Heart, &c. 25 10 15 1 .. .. 2 3 8 11 1 2 4 7 12 5. Of Respiratory Organs 69 40 29 11 11 1 23 4 22 19 1 6 2 13 48 6. Of Digestive Organs 35 19 16 10 1 .. 13 7 7 8 .. 1 1 11 22 7. Of Urinary Organs 13 7 6 .. .. .. .. 3 4 6 .. 2 2 6 3 8. Of Organs of action .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 9. Of Joints, Bones, &c .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10. Of Skin .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 11. Premature Birth Low Vitality, Malformation, &c. 23 17 6 23 .. .. 23 .. .. .. .. .. 2 10 11 12. Dropsy, Cancer, and others of tain Seat 20 8 12 1 .. .. 2 2 7 9 .. 2 .. 6 12 13. Age 33 10 23 .. .. .. .. .. .. 18 15 1 3 7 22 14. Violence 22 12 10 2 1 2 7 8 3 4 .. .. .. 1 21 15. Not Specified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 499c 263 236 97 60 18 187 86 98 107 21 19 31 122 327 82 On examination of the foregoing Table, diseases of the Brain and Nervous System, (Class 3,) are seen to have formed by far the greatest proportion of the causes of death, amounting to upwards of 23 per cent. of the whole. But, as might be anticipated from the remarks already made concerning the determination of the death.rate, this class is unduly augmented by the mortality of the Surrey County Lunatic Asylum, which alone, during the past year contributed 80 per cent. of the total deaths from these diseases. The proportion borne by this class therefore can have no relative value in estimating the causation of the mortality proper to this Sub.district. Excepting this Class for the foregoing reasons, Zymotic diseases, (Class 1), stands foremost as usual in the order of fatality. They numbered 77, forming 15.4 per cent. of all deaths, and were below the decennial average corrected for increase of population. The next most fatal were diseases of the Respiratory Organs, (Class 5), of which Bronchitis alone constituted nearly two.thirds; they formed 13.8 per cent. of all deaths, and were 14 below the corrected decennial average. The next in order were the Tubercular, (Class 2, which includes Scrofula and Consumption); contributing 12.8 per cent. of all deaths and were 9.6 below the average. The largest factor in this class was Consumption, forming 10 per cent., and was, as usual the most fatal single disease. Diseases of the Digestive Organs, (Class 6), caused 7 per cent. of all deaths, and were 7.3 above the corrected average. Age, (Class 13), formed upwards of 6 per cent., and were 7.7 above the corrected average number. Heart Diseases, (Class 4), formed 5 per cent. and were 5 less than the average. The deaths from Premature Births, Low Vitality, &c., (Class 11), were 7 below the average, forming 4 per cent of all deaths. Violence, (Class 14), formed 4 per cent., and were 8 above the average number. The classes that exceeded the average were—diseases of the Digestive and Urinary Organs, Violence and Age; the 83 latter of course favorably so. All the other classes were below the average, especially Class 5, Diseases of the Respiratory Organs, and most importantly Class 1, which includes all the diseases of the epidemic or contagious kind. Epidemic Diseases, their prevalence and fatality. The following table exhibits the total number of deaths that occurred from the seven principal Epidemic diseases during the past and ten preceding years, and the relative proportion 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 Epidemic. Total Deaths from all causes. Per centage of deaths from Epidemics to deaths from all causes. 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 2 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 1880 .. 9 24 4 15 .. 20 6 78 484 16.1 1881 9 5 19 1 12 .. 19 4 69 507 13.6 1882 .. 18 9 3 26 .. 29 9 94 544 17.2 1883 •• 14 5 11 5 .. 10 12 57 499 11.4 The total number of deaths that resulted from these diseases during the past year exhibits a diminution to the extent of over one-eighth part of the corrected average of the preceding ten years. Three of the number however,—Measles, Fever and Diphtheria, were more fatal than usual. Measles was one. third above the average; Fever also exceeded the average 84 to the same extent, and Diphtheria was five times greater than the average. The cases of the latter disease were few but they were very fatal. On the other hand Scarlatina was more than three-fifths below the average; Diarrhœa was one-half, and Whooping-Cough no less than three-fourths below the average amount. The proportion which the total deaths from these diseases bore to the deaths from all causes was considerably more than one-third below the average. The following table shews the months in which the deaths from Epidemic diseases occurred, with the mean temperature of each quarter of the year. DISEASE. January February J March April May June July August September October November December Mean Temp. 40.0 Mean Temp. 53.0 Mean Temp. 59.5 Mean Temp. 44.9 Small Pox .. .. .. .. .. .. .. .. .. .. .. .. Measles .. 1 3 .. 1 3 2 4 .. .. .. .. Scarlatina 1 2 .. .. .. 1 .. .. .. 1 .. .. Diphtheria .. .. 1 2 3 2 .. .. .. .. 1 2 Whooping Cough .. .. .. 1 .. .. 1 .. 2 .. 1 .. Diarrhœa .. .. .. .. 1 1 3 4 .. 1 .. .. Fever .. 2 1 1 •• 1 1 2 1 3 .. .. Totals 1 5 5 4 5 8 7 10 3 5 2 2 i ' 11 1 1 17 20 9 The mean temperature corresponded exactly with the average of previous 42 years (see table 7 Appendix). It was also higher than the average in the first and fourth quarters and lower in the second and third, so that it was generally more equable—the winter warmer, and the summer cooler. To this circumstance the diminution recorded in the amount of fatality from diseases of the Respiratory Organs in the winter quarter, and in that of Diarrhœa in the summer quarter are probably attributable. 85 Deaths in relation to Social position.—The proportion per cent. of the total deaths, and of the deaths from Zymotic diseases in relation to the social position of the deceased are shewn in the following table. Social Position. Total Deaths. Deaths from Zymotic Diseases. 1883. Decennial Average. 1883. Decennial Average. Nobility and Gentry 3.81 3.57 1.30 0.12 Professional Class, Merchants, Bankers, &c. 6.21 5.29 51.9 5.36 Middle and Trading Classes, Clerks, &c. 24.45 18.88 27.27 17.81 Industrial and Labouring Classes 65.53 72.26 66.24 76. 71 100.00 100.00 100.00 100.00 The diminution in the rate of mortality which has been noted in these reports as gradually taking place amongst the industrial classes in comparison with the rate occurring amongst the other classes collectively, was very considerable during the past year. On reference to the above table it is seen that of the total number of deaths 65 per cent. occurred amongst the labouring classes, instead of 72 per cent. during the preceding ten years; and that of the total deaths from Zymotic diseases 66 per cent. occurred amongst them in the place of 76 per cent. during the preceding decade. This decrease in the mortality of the working classes is doubtless in great measure attributable to the lesser prevalence during the year of those Zymotic diseases which are always found to afflict them with relatively greater severity, and is deserving of especial notice as furnishing a trustworthy indication of sanitary improvement effected in the dwellings of that class of the community in which such improvement is most required, and with most difficulty attained. Ages at death.—The mortality of infants during the year was much diminished, while that of persons in advanced life 86 was increased. The deaths of infants under 1 year of age formed 19.4 per cent. of the total deaths; the average of the preceding ten years having been 22.7 per cent.; of children under 5 years of age the deaths were 31.4 per cent., the decennial average having been 35.3 percent.; and the deaths of all persons under 20 years of age formed 37.4 per cent., the average having been 42.2 per cent. The death-rate of infants calculated from the proportion which the deaths of infants under 1 year bear to the number of births was 10.6 per cent. the decennial average being 14 per cent. The deaths of persons at and above 70 years of age formed 13 per cent of all deaths, the average having been 12 per cent. Although 33 deaths only were recorded as having resulted from age unassociated with any disease, no less than 65—22 of males and 43 of females—were registered at 70 years and upwards; the deaths at high ages having been as usual, mostly attained by females. Thus there were from 70—75 sixteen of males and twelve of females; from 75—80 three of males and sixteen of females; from 80—85 three of males and twelve of females; at 8J two females; and one female reached the great age of 94. Sickness and Mortality amongst the parochial poor.—Table 5. Appendix exhibits the nature, amount and fatality of the sickness that came under treatment amongst the parochial poor during the year. The figures therein contained will be found to confirm the evidence afforded by the table of mortality, as well as the other indications of the favourable state of the health of the Sub.district that has been previously recorded. The total amount of sickness was considerably less than the average, and the amount of epidemic disease was upwards of one.third less than the average. The most prevalent diseases of the epidemic class were Measles and Whooping.Cough. Two isolated cases of Small Pox occurred, one of which was 37 imported into the town in the month of December; they were both removed to Hospital where they recovered. Inquests.—Violent deaths.—Uncertified deaths.—The number of inquests held during the year were 39; these, with the resulting verdicts are set forth in the subjoined table:— Deaths from natural causes 22 Deaths from Violence, viz:— Accidental Burning 2 13 Drowning 5 Fracture 2 Run-over by Train 3 Suffocation 1 Suicidal Hanging 1 2 Poison l Homicidal Murder 1 2 Execution l Total 39 The Inquests were more numerous by 7, but the deaths from Violence were 1 less than in the year preceding. There were two instances only in which the cause of death was not properly attested—a great and satisfactory redaction compared with former years; until, however, a Medical investigation is employed in every case in which the cause of death has not been certified by a Registered Medical Practitioner, there cannot be that complete security against the perpetration of secret crime to which Society is indefeasibly entitled at the hands of the law. (See Reports for 1835 et seq. on the subject). Sanitary proceedings.—A brief epitome of the nature and number of the principal sanitary proceedings that were carried out during the year are as usual contained in table 6, Appendix. It will be seen on reference to the table that a much greater activity prevailed in the inspection of houses, and the removal of nuisances than here to fore. The inspections of houses 88 and premises were three times as numerous as in the year preceding. The number of houses disinfected in consequence or the presence of infective diseases amounted to one-half only of th at of the previous year, the necessity for such procedure having been fortunately diminished to that extent. As evidence of the beneficial results of the process of sulphurous fumigation adopted in such cases, it should be noted that in two instances only out of 84 did a second attack of infective disease occur in the same house after the operation. A large number of Pig.nuisances was dealt with, 13 of which were investigated by the sitting magistrate, and in 10 instances compulsory orders were obtained for their removal. The extensive and serious nuisance created by large piggeries still continues, and requires a corresponding comprehensive law, which shall be applicable to all cases for their repression. It is impossible for large Piggeries (some of those referred to, contained 400 pigs), to exist in the heart of a populous town without creating a serious nuisance prejudicial to the health of the inhabitants; and for this reason, that however excellent the provisions may be for maintaining them in a state of cleanliness, the very procedure of cleansing becomes in itself a nuisance of the gravest character. I need scarcely repeat that the provisions of the Act of 57 George III., cap. 29, sec. 08, which prohibit the keeping of swine within 40 yards of any street or public place would most effectually meet the evil; and if the Act be, as is said to be, in point of law inapplicable to the suburbs of the Metropolis at the present time, it might be specially re.enacted. All the Slaughterhouses and Cow.houses were as usual examined and reported on. They were all found in possession of the sanitary requirements nccessary for a renewal of their owners licences. Many other nuisances formed the subjects of special reports too numerous to reproduce here, and which do not admit of tabulation. Tinned Meats and other provisions.—Many complaint 89 (reasonable foundations for which have been within my own knowledge), have reached me of serious illness having resulted from the use of "tinned provisions." Inasmuch as the quality of the food of the people is of great sanitary—indeed vital importance, it becomes my duty to draw attention to this subject by pointing out the probable cause of the ill effects complained of. Such cause doubtless arises from the decomposition which some of such provisions undergo from lapse of time. It seems to have been assumed (by the vendors as well as the purchasers), that these viands having been hermetically sealed after the exclusion of air, undergo no change lor an indefinite length of time. It should be borne in mind however that the exhaustion of the air, contemplated by the process employed in the manufacture, is not, and indeed cannot be complete, and that the decomposition however much delayed must gradually and surely take place. As it is impossible for the purchaser of these viands to determine how long they have been prepared, it would seem extremely desirable that some guarantee of the age of such provisions should be afforded, by the stamping of the tins with the date of manufacture, either through the agency of the Board of Trade, or by some other governmental procedure. The statistical and other information presented in the foregoing pages furnishes satisfactory evidence of the high standard of health attained by this sub-district during the past year; and the great general progress shewn to have taken place in all the operations of sanitation, may be fairly accepted as having conduced to so desirable a result. GEORGE EDWARD NICHOLAS, M.D. Medical Officer of Health for Wandsworth. May 29th, 1884. . APPENDIX OF STATISTICAL TABLES. 92 TABLE I. Births and Deaths registered during the year 1883. BIRTHS. SUB-DISTRICTS. Males. Females. Total. Battersea East—Males, 1217; Females, 1106 2,380 2,331 4,711 WEST—Males, 1163; Females, 1165 Clapham 577 508 1,085 Putney and Roehampton 186 163 349 Streatham, including Tooting and Balham 509 518 1,027 Wandsworth 458 449 907 Total 4,110 3,969 8,079 DEATHS. SUB-DISTRICTS. Males. Females Total. Battersea East—Males, 503; Females, 500 1,188 1,156 2,344 West—Males, 685; Females, 656 Clapham 246 334 580 Putney and Roehampton 122 119 241 Streatham, including Tooting and Balham 204 215 419 Wandsworth 263 236 499 Total 2,023 2,060 4,083 ...The excess of Births over Deaths in the entire District is 3,993. TABLE II. Summary of Deaths and their Causes, registered in the entire District during 1883, classified according to Sex, Age, and Social Position, and showing also the relative Numbers in each Sub-District. POPULATION OF ENTIRE DISTRICT, As corrected by the Registrar-General. Census 1881—210,434. Official Population for middle of year, 1883, 229,566, Area in Statute Acres, 11695. Total Deaths from each class of Disease, &c, in the entire District. Sub-Districts Sex. Age. Social Position Battersea—Population 119,197, area in acres, 2.343, Clapham—Population 38,400 area in acres,1,233, Putney—Population, 14,068, area in acres, 2,170, Streatham, Tooting and Balharn—Population, 28.042, area in acres, 3,405, Wandsworth—Population, 29,853, area in acres, 2,478. Males. Females. Under 1 year. From 1 to 5 years. From 5 to 10 years. Under 20 years, including all under 10 years. At 20 and under 40 years of age. At 40 and under 60 years of age. At 60 and under 80 years of age. 80 years and upwards. Nobility and Gentry. Professional Class, Merchants, Bankers, &c. Middle and Trading Class, Shopmen, Clerks, &c. Industrial and Labouring Classes. DISEASES, And other Causes of Death. Classes:— Small Pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 133 77 33 2 7 14 70 63 43 78 9 133 .. .. .. .. 6 16 111 Scarlatina 65 43 8 7 2 5 31 34 11 39 12 65 .. .. .. .. 1 9 11 44 Diphtheria 63 8 7 24 13 11 33 30 2 34 23 59 3 1 .. .. .. 8 16 39 Whooping. Cough 133 99 16 2 11 5 72 61 .. 74 3 133 .. .. .. .. .. 4 18 111 Typhus & other Fevers 52 27 3 2 8 12 31 21 .. 6 6 22 16 9 5 .. 2 2 17 31 Diarrhœa 158 115 19 5 9 10 74 84 114 20 3 137 2 4 15 .. 1 10 26 121 1. Zumotic Dysentery Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 10 6 2 .. 1 1 4 6 3 .. .. 4 .. 2 2 2 .. .. 2 8 Metria, Childbirth 25 5 7 .. 7 6 .. 25 .. .. .. .. 22 3 .. .. .. 1 9 15 Carbuncle .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Influenza .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Croup 60 23 17 .. 7 13 34 26 11 41 8 60 .. .. .. .. .. .. 15 45 Other Zymotic Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Total of Zymotic Class 699 403 112 42 65 77 349 350 239 292 64 613 43 19 22 2 4 40 130 525 2. Tubercular 654 430 76 28 56 64 314 340 211 75 14 349 187 106 12 .. 6 29 125 494 3. Of Brain and Nerves 574 287 66 44 59 118 310 264 156 90 21 276 53 95 128 22 13 35 96 430 4. Of the Heart 255 129 39 15 47 25 119 136 11 3 3 34 38 80 89 14 13 31 60 151 5. Of Respiratory gans 829 566 113 31 50 69 427 402 238 209 20 4 73 53 116 157 30 20 28 112 669 6. Of Digestive Organs 234 110 26 19 44 35 111 123 44 6 3 64 31 59 76 4 12 19 61 142 7. Of Urinary Organs 99 48 21 6 11 13 49 50 3 2 .. 8 22 30 35 4 7 10 27 55 8. Of Organs of ration 30 20 .. 5 5 .. 1 29 .. .. .. .. 13 12 5 .. 3 3 8 16 9. Of Joints, Bones, &c. 25 19 .. 1 5 .. 15 10 2 4 2 10 2 3 8 2 1 .. 5 19 10. Of Skin 10 7 3 .. .. .. 7 3 8 .. .. 8 .. .. 2 .. .. .. .. 10 11. Birth, Vitality, Malformance &c. 241 104 66 17 37 23 133 108 235 6 .. 241 .. .. .. .. .. 12 62 167 12. Dropsy, Cancer, and others of uncertain seat 114 68 24 .. 2 20 46 68 4 .. 1 6 14 49 41 4 4 3 52 55 13. Age 185 85 25 10 32 33 64 121 .. .. .. .. .. .. 78 107 17 17 42 109 14. Violence 94 44 7 15 6 22 61 33 19 4 6 37 22 21 13 1 .. 2 13 79 15. Not Specified. 40 24 8 8 .. •• 17 23 19 5 .. 26 6 3 4 1 1 2 7 30 Totals 4083 2344 580 241 419 499 2023 2060 1189 696 134 2145 484 593 670 191 101 231 800 2951 94 TABLE III, Showing the total number of deaths and their causes registered in the entire District, during the eleven years 1873-83, with the relative numbers of each class of disease, DISEASES, And other causes of Death 1873 1874 1875 1876 1877 1878 1879 1880 1881 1882 1883 Classes:— 1. Zymotic Small Pox 9 5 3 26 57 19 4 3 37 1 .. Measle 55 66 27 88 64 84 125 59 134 115 133 Scarlatina 9 94 134 86 58 39 134 173 100 119 65 Diphtheria 11 12 28 15 7 19 17 19 18 51 63 Whooping Cough 74 89 107 126 73 149 148 123 105 163 133 Typhus and otherfevers 65 48 39 47 64 39 62 44 37 49 52 Diarrhœa & Choleric Disease 126 117 134 159 114 182 94 213 149 117 158 Erysipelas 12 20 24 13 13 5 13 10 15 18 10 Metria, Childbirth 28 34 15 26 20 7 28 23 29 19 25 Carbuncle .. 1 .. .. .. .. .. .. .. 3 .. Influenza .. .. .. .. 1 .. .. .. .. .. .. Quinsy 1 2 .. .. .. 1 .. 1 .. 1 .. Croup 21 40 26 27 20 39 40 19 18 31 60 Totals of Zymotic Class 411 528 537 613 491 583 665 687 642 687 699 2. Tubercular 426 469 565 555 514 501 513 625 557 521 654 3. Of Brain, Nerves, &c. 370 426 455 416 450 503 474 464 540 539 574 4. Of the Heart, &c. 139 146 176 170 204 212 203 193 245 251 255 5. Of Respiratory Organs 543 541 630 561 519 694 891 657 695 850 829 6. Digestive Organs 96 111 136 126 155 150 117 155 208 195 234 7. Urinary Organs 34 26 55 62 63 42 74 66 70 89 99 8. Of Organs of Gene- ration 17 21 13 23 29 19 25 20 35 32 30 9. Of Joints, Bones, &c. 10 14 11 14 13 15 8 15 25 25 25 10. Of Skin 4 9 4 5 6 1 3 8 3 9 10 11. Premature Birth, Low Vitality, Malformation, &c. 143 168 177 226 212 177 170 266 232 234 241 12. Dropsy, Cancer, and others of Uncertain Seat 126 77 105 97 101 106 91 110 118 144 114 13. Age 144 106 130 150 126 141 141 136 120 153 185 14. Violence 70 75 68 90 82 75 83 96 113 104 94 15. Not Specified 47 79 34 46 26 56 68 95 44 18 40 Totals 2580 2796 3096 3154 2991 3275 3526 3593 3647 3851 4083 95 TABLE IV. Showing the total Deaths from the seven principal Epidemic Diseases registered in each Sub-District, and in tho entire District, with the relation which they bore to the total Mortality in the several years 1873-1883. Deaths from the seven principal Epidemics in each Sub-District. Entire District. Years. Battersea. Clapham. Putney. Streatham. Wandsworth. Total Deaths from the Seven Epidemics. Total Deaths Registered from all causes. Per centage of Deaths from the Seven Epidemics to Total Deaths. 1873 205 65 6 32 43 351 2580 13.6 1874 238 114 10 26 52 440 2796 15.7 1875 307 74 20 25 46 472 3096 15.2 1876 340 86 10 31 71 547 3154 17.4 1877 280 55 22 25 57 430 2991 14.2 1878 322 103 26 42 38 531 3275 16.9 1870 355 81 20 36 92 584 3526 16.9 1880 383 112 25 61 78 659 3593 18.3 1881 381 71 22 37 69 580 3647 15.8 1882 353 74 63 31 94 615 3851 15.9 1883 369 87 42 50 57 604 4083 14.7 ...The Diseases included in the above Table constitute, as in the RegistrarGeneral's Returns, the seven principal maladies only of the Zymotic class—viz. Small-Pox, Measles, Scarlatina, Diphtheria, Whooping-Cough, Diarrhœa and Cholera, and Fever. 9G 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, 1883. Compiled from the District Medical Belief Books. SUB-DISTRICTS. Total Cases of Sickness treated in each Sub-District. 1—Small Pox. 2—Measles. 3—Scarlatina. and Diphtheria. 4—Whooping Cough. 5—Diarrhœa and Dysentery. 6—Cholera. 7—Fever. 8—Erysipelas. 9—Puerperal Fever. 10—Lung Diseases, except Phthisis. 11—Phthisis. 12—Hydrocephalus, Atrophy, Scrofula, and Convulsions of Children. 13—Other Diseases. 14—Violence, Privation, and Premature Birth. Total Deaths in each Sub-District. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Cases. Deaths. Battersea East 7 62 2 .. 12 2 .. .. 7 .. 13 3 .. .. 13 .. .. .. .. .. 122 3 14 2 .. .. 579 4 .. .. 14 West 408 1 .. 13 .. 16 1 10 2 12 1 .. .. 5 .. 1 .. .. .. 110 8 7 7 2 2 220 7 1 1 .. 28 Clapham 525 3 .. 10 2 13 .. 11 2 24 7 .. .. 57 .. 5 .. .. .. 83 2 5 4 15 6 284 6 15 .. 29 Putney and Roehampton 161 .. .. .. .. 2 .. .. .. 10 .. .. .. 2 1 1 1 .. .. 39 1 5 4 .. .. 90 3 12 1 11 Streatham, including Tooting and Balham) 200 2 .. 1 .. 4 .. 3 1 6 1 .. .. 1 .. .. .. .. .. 20 .. 2 .. 1 1 160 4 .. .. 7 Wandsworth 680 2 •• 16 2 7 2 10 2 31 •• •• .. 4 •• 1 •• •• •• 179 12 11 1 2 1 393 14 25 •• 34 Totals 2736 10 •• 51 6 42 3 41 7 96 12 .. .. 82 1 8 1 •• •• 553 26 44 18 20 10 1726 38 63 1 123 ...The ratio of deaths to cases treated is 4.4 per cent. 97 TABLE VI. Summary of the Sanitary Operations in the entire District during the year 1883. Battersea. C'lapham Putney and Roehampton. Streatham, including Tooting & Balham. Wandsworth. Totals. Number of Houses & Premises inspected 15,768 5,896 1,606 6,364 2,839 32,473 1st Notices served 1,930 787 175 136 314 3,342 2nd Notices served 240 121 23 2 2 388 Number of Houses disinfected after contagious diseases 166 39 24 29 84 342 Number of Houses in which contagious disease occurred after disinfection 1 1 .. .. 2 4 Number of Houses from which bedding, &c., was burnt 2 10 .. 3 2 17 Overcrowding abated 13 1 .. .. 2 18 Disinfecting apparatus at Putney number of times used. .. .. 24 .. .. 24 Cesspools emptied and cleansed .. 2 .. .. .. 2 Cesspools abolished 5 .. 1 6 .. 12 Waterclosets constructed or repaired 473 197 34 14 23 741 Houses supplied with water 48 6 4 1 6 65 Drains constructed or connected with Sewer 391 130 29 296 122 968 No. of feet of New Sewers and Branch Drains 13,958 6,726 1,248 17,846 7,505 47,283 Drains repaired or trapped, or obstructions removed 1,128 336 27 63 21 1,575 Open Ditches, Ponds, &c., cleansed .. .. .. .. .. .. Dust-bins provided 606 165 64 55 58 948 Pig Nuisances removed 47 14 .. 11 57 129 Accumulation of Offal, Manure, &c., removed 32 20 7 23 14 96 Unwholesome and dilapidated Houses cleansed or repaired 204 9 9 29 7 258 Cases investigated by Magistrates 11 2 7 .. 13 33 Compulsory Orders obtained 11 1 7 .. 10 29 Compulsory works executed 11 1 7 .. 10 29 Works remaining in abeyance from various causes •• •• •• •• • • •• TABLE VII. METEOROLOGICAL TABLE FOR LONDON, 1883. (Deduced from Observations, at Greenwich, under the Superintendence of the Astronomer Royal, and compiled from Quarterly Tables, furnished to the Registrar General by James Glaisher, Esq., F.R.S. Winter Jan., Feb., March, Spring April, May, June, Summer July, Aug., Sept. Autumn Oct., Nov., Dec. Temperature of Flastic Force of Vapour. Weight of Vapour in a Cubic Foot of Air. Degree of Humidity. Reading of Barometer. Weight of a Cubic Fool of Air. Rain. Reading of Thermometer on Grass. Air. Evaporation. Dew Point. Air— Daily Range. Number of Nights it was Lowest Reading at Night. Highest Reading at Night. Mean. Diff. from Average of 112 Years. Diff. from Average of 42 years. Mean. Diff. from Average of 42 years. Mean. Diff. from Average of 42 Years. Mean. Diff. from Average of 42 Years. Mean. Diff. from Average of 42 Years. Mean. Diff. from Average of 42 Years. Mean. (Sato=100) Diff. from Average of 42 Years. Mean. Diff. from Average of 42 Years. Mean. Diff. from Average of 42 Years. Mean. Diff. from Average of 42 Years. At or below 30º. Between 30° & 40º. Above 40º. 1883. º º º º º º º º º in. in. grs. gr. in. in. grs. grs sum in. in. Sums. º º YEAR. 40.5 +0.8 0.0 10.5 0.0 13.6 0.0 15.6 — 0.2 .295 +0.001 3.4 0.0 82 0 29.784 +0.023 512 0 21.90 — 0.69 78 164 123 14.3 56.9 First Quarter 40.0 + 1.2 + 0.1 37.9 — 0.1 35.2 —0.2 11.7 — 0.1 .207 0.001 2.4 0.0 83 + 1 29.796 +0.033 552 0 5.36 + 0.35 48 40 2 14.3 19.5 Second do. 53.0 + 0.7 + 0.1 49.1 0.0 45.3 0.0 20.8 + 0.8 .310 + 0.003 3.5 0.0 77 0 29.801 + 0.019 538 — 1 4.75 — 1.08 18 39 34 18.6 56.3 Third do. 59.5 + 0.2 —0.7 56.1 — 0.3 53.2 + 0.1 19.1 — 0.6 .405 0.000 4.5 — 0.1 80 + 2 29.726 —0.029 529 0 0.53 — 0.12 0 18 74 32.3 56.9 Fourth do. 44.9 + 1.3 + 0.4 43.0 + 0.4 40.8 + 0.1 10.8 —1.0 .257 — 0.001 3.0 — 0.1 86 — 2 29.814 + 0.068 517 + 1 5.26 — 1.93 12 67 13 23.7 50.1 In this Table, + and — respectively signify that the numbers in the preceding column are above or below the average to the extent of the quintities to which these signs are prefixed.